Abstracts of 1st PhD Research Symposium in Health Sciences and Biomedicine Part 2

e00050
Control of the professional exposure to sevoflurane waste in
sedation of pediatric patients for magnetic resonance.

Alonso Prieto M1*, Alonso Calderón JL2, Sanabria Carretero P3.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00050

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Alonso Prieto M, Alonso Calderón J, Sanabria Carretero P. Control of the professional exposure to sevoflurane waste in
sedation of pediatric patients for magnetic resonance. IBJ Plus 2018 (S2):e00050 doi: 10.24217/2531-0151.18v1s2.00050.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Volatile anesthetics must be used in compliance with the recommended set of control strategies,
institutional policies and laws in order to keep the occupational exposure in safe limits. Operating theatres are provided
with the mandatory gas scavenging and ventilation systems, which have demonstrated to be effective reducing the
volatile anesthetic environmental pollution. Unfortunately, these measures are often unavailable outside the operating
room. There are also ecological concerns about the possible ecological impact of volatile anesthetics. Research in these
matters is very scarce.

Material and methods: We developed a prospective observational study to compare air concentration of sevoflurane
during sessions of sedation in pediatric patients in the magnetic resonance room in three different conditions: basal
group: without any intervention to reduce gas pollution; second group, using a gas scavenger connected to the breathing
circuit; third group: using the scavenging system and a supplementary ventilation of the room.

Results: The preliminary analysis shows a statistically significant reduction in air waste sevoflurane concentration between
basal group and the second group: mean reduction 22,89 (CI 95%: 12,74-33,03) parts per million (ppm) (p˂0,001) and
also between the basal and the third group: mean reduction 28,57 (CI 95%: 19,51-37,63) ppm (p˂0,001). We didn´t find
differences between second and third group.
Regarding the legal limits of professional exposure, expressed as “Valor límite ambiental-exposición diaria” (VLA-ED®),
which represents the mean concentration considered as safe for a standard 8 hours a day and 40 hours working week,
the study shows that only in the third group, the limit stays under the limit considered as safe (2 ppm).

Conclusions: Using sedation with sevoflurane of pediatric patients in the magnetic resonance room might result in
professional overexposure to volatile anesthetic waste if the proper conditions of gas scavenging and ventilation are
not provided. These conditions that guarantee occupational safety can be achieved easily with simple and inexpensive
strategies.

e00051
Late-onset cardiotoxicity in Anthracyclinebased chemotherapy
for breast cancer patients.

R Mata Caballero1, J M Serrano Antolin2, IA Gonzalez Garcia2, J Muniz Garcia3, A Curcio Ruigomez2, JJ Alonso Martín4.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00051

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: R Mata Caballero, J M Serrano Antolin, IA Gonzalez Garcia, J Muniz Garcia, A Curcio Ruigomez, JJ Alonso Martín. Lateonset cardiotoxicity in Anthracyclinebased chemotherapy for breast cancer patients. IBJ Plus 2018 (S2):e00051 doi: 10.24217/2531- 0151.18v1s2.00051.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Background: Anthracycline cardiotoxicity (AC) represents a mayor limitation for the treatment of breast cancer patients (pts) and it may manifest years after treatment (lateonset cardiotoxicity). The aim of the study is to establish incidence and predictors of lateonset cardiotoxicity in a cohort of these type of pts.

Methods: 100 consecutive pts receiving Anthracyclinebased chemotherapy (CHT) were included in this prospective study. All pts underwent evaluation at baseline, at the end of CHT, 3 months after the end of CHT and 1 and 4 years after the beginning of CHT. Clinical data, systolic and diastolic echo parameters and cardiac biomarkers including highsensitivity Troponin T (TnT), NTproBNP and Hearttype fatty acid binding protein (HFABP) were assessed.

Results: Mean doxorubicin dose was 243 mg/m2. Mean followup was 51.8±8.2 months. At one year incidence of AC was 4% and at the end of followup was 18% (15 pts asymptomatic left ventricular systolic dysfunction, 1 pt heart failure and 2 pts a sudden cardiac death). Forty nine pts developed diastolic dysfunction (DD) during first year. In the univariate analysis DD during first year was the only parameter associated with AC (Table). In the logistic regression model DD was independently related with the development of AC, with an odds ratio value of 7.5 (95% CI 1.5935.3).

Conclusions: Incidence of lateonset
cardiotoxicity is high but mostly subclinical. Diastolic dysfunction early after
chemotherapy is a strong predictor of anthraciclyne cardiotoxicity.

e00052
Predictive factors of 1-year mortality after a hip fracture. A
literature review.

Rocío Menéndez-Colino1,2, Alicia Gutiérrez Misis2,3, Juan I. González-Montalvo1,2,3.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00052

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Rocío Menéndez-Colino, Alicia Gutiérrez Misis, Juan I. González-Montalvo. Predictive factors of 1-year mortality after a hip
fracture. A literature review. IBJ Plus 2018 (S2):e00052 doi: 10.24217/2531-0151.18v1s2.00052.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Fragility hip fracture is a frecquent event in elderly people associated with high mortality. For reasons not
yet fully understood, 1-year mortality after a hip fracture varies between 12.1% and 35%, which signifies an excess of
mortality of 8% to 18% per year compared to the population of the same age without hip fracture. This study aimed to
review the factors most frequently described to predict 1-year mortality after a hip fracture

Methods: Studies published in Pubmed were reviewed by dividing them into systematic reviews and meta-analysis,
studies performed in orthogeriatric co-managed units, studies performed in Orthopaedic Services and studies that used
prognostic risk scores.

Results: Seven systematic reviews and meta-analysis including 741,247 patients, 11 co-managed studies including 5,829
patients, 5 studies that used risk scores including 12,820 patients and 34 studies performed in Orthopaedic Services
including 452,842 patients were included. The most frequently described factors associated with one year mortality
were age and male sex (34 studies); prior functional status, such as impaired mobility and dependence for basic or
instrumental activities of daily living (16 studies); mental problems, such as the presence of cognitive impairment or
dementia (16 studies); clinical factors, such as the number of comorbidities (14 studies); malnutrition (14 studies); healthcare
related factors, such as delayed surgery (14 studies) ; high ASA grade (13 studies); the presence of postoperative
complications (7 studies) and social factors, such as living in residential care (12).

Conclusions: Many studies including big samples of patients have been published about this topic. Described factors are
from very different nature; there are demographic, functional, cognitive, clinical, severity of illness and social factors.
Unfortunately only a few of them are modifiable factors.

e00053
A Standard AV Fistula in Animal Model.

Cristian Arriagada1, Sandra Osorio2.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00053

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Cristian Arriagada, Sandra Osorio. A Standard AV Fistula in Animal Model. IBJ Plus 2018 (S2):e00053 doi: 10.24217/2531- 0151.18v1s2.00053.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction:
The number of patients with chronic kidney disease in renal replacement therapy is steadily increasing. Among the different
substitution therapies, hemodialysis is the most used. The Arteriovenous Fistulae (AVF) is the Gold Standard.
Complications are the main disadvantage of AVF. Overall (primary and secondary) patency of AVF at one year is 55% and 62%
respectively, which in the long term is of crucial importance for the morbidity and mortality of these patients. Understand
biology and complications requires as a first step to create AV fistulas in biological (animal) models, previous to any intervention.
There are few experiences with animal models of AV fistula and no standard model.

Objectives:
1. Create a standard animal AV fistula model.
2. Maintain an AV fistula

Material and Methods:
We performed 4 AV fistulas in pigs (Specimen Suido), of 2 months old, 20 kg weight at implant, gender female.
Step 1: No oral intake the night before after midnight. Pre-anesthesia: Ketamine 10 mg/kg IM.
Anesthesia Induction: 5% sevoflurane in oxygen through face mask. Prophylactic antibiotic: Cefazolin 1 g/iv.
Step 2: The surgical procedure:

a. Groin shave.
b. Ultrasound identification of femoral vessels.
c. Sterile draping preparation and material technique.
d. Inguinal longitudinal incision 5 cm below groin, to localize common femoral vein, and femoral artery.
e. Control of proximal and distal arteries with clamps bulldog atraumatic.
f. Anticoagulant intraop (2.000 heparin units).
g. Anastomosis with latero-lateral venotomy-arteriotomy (7 mm). Poplypropilene 7-0 continuous suture.
h. Fascial and skin closure, silk suture separated.

Step 3: Controls:

i. Ultrasound control after AV creation and bi-weekly.
j. Aspirin 300 mg daily.
k. Use of antibiotic: amoxicil/clavulanic in case of local infection.

Results:
1. Duration of controls: 8 weeks.
2. Maturation of AV fistula occurred at 4 weeks.
3. Infections occurred in 25%. Heal after antibiotic treatment: 100%.
4. Spontaneous thrombosis was avoided using antiplatelet prophylactic, without complications.
5. Caliber fistula increased the first 4 weeks, with patency of 100%.
6. Caliber reduction was after 4 weeks, complete occlusion at 8 weeks.
7. Doppler Turbulence flow interpretation: good patency.
8. Doppler laminar flow interpretation: pre-stenotic.

In conclusion, we created a feasible AVF animal model, with a key close ultrasound observation for period of 8 weeks, with
optimal prevention of early thrombosis and optimal management of early infection. Patency after 4 weeks was 100%. With this
model, we can proceed with minimally invasive interventions to increase the patency of AVF fistulas before the total occlusion
period (8 weeks).

e00054
Posterior Components Separation with double mesh for
abdominal’s wall incisional hernia: surgical technique and results.

Jiménez Cubedo Elena1, García Ureña Miguel Ángel1, López Monclús Javier2, Sánchez Turrión Víctor2

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00054

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Jiménez Cubedo Elena, García Ureña Miguel Ángel, López Monclús Javier, Sánchez Turrión Víctor. Posterior Components
Separation with double mesh for abdominal’s wall incisional hernia: surgical technique and results. IBJ Plus 2018 (S2):e00054 doi:
10.24217/2531-0151.18v1s2.00054.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

INTRODUCTION: The complex incisional hernia of the abdominal wall is a challenge for wall surgeons. For years, posterior
component separation surgery has been used as a safe and reliable technique for the treatment of most incisional hernias,
including midline, subcostal and lateral. In addition, the use of two meshes is proposed, which increase the benefits of
this technique. The aim of this study is to present the results of the posterior components separation technique with two
meshes, for the repair of complex abdominal wall hernias, including lateral and midline.

MATERIAL AND METHODS: A prospective and descriptive multicentre study was carried out that including patients from
Spanish and foreign centers, who underwent repair of incisional hernias of the abdominal wall, medial and lateral, using
the technique of Posterior Components Separation (with or whithout transversus abdominis release) placing a double
mesh (reabsorbable and non-absorbable) in extraperitoneal position, from May 2010 to December 2016. Data related
to patient, surgical technique, as well as complications and long-term follow-up, were collected in a specific database.

RESULTS: 169 patients were included, 99 men (58.6%) and 70 women (41.4%), mean age 60.9 years (range 32-86 years).
47.3% had midline hernias, of which 49% were type M1-M5, while 35% had lateral hernias, being the most frequent L3
type of the European Hernia Society (EHS). According to the classification of the Ventral Hernia Working Group (VHWG),
50% had grade II hernias. The mean of the maximum size of the defect was 12.7 cm (range 4-40 cm). Regarding the
surgical technique, 3 patients underwent posterior components separation over transversus abdominis muscle or
Carbonell technique (2%), while 166 patients underwent posterior components separation with transversus abdominis
muscle release (SPC -TAR) (98%), with a mean duration of surgical procedure of 219 min (range 65-490 min). As local
complications there were 33 subcutaneous seromas (19.5%), 23 deep haematoma (13.6%) and 21 surgical site infections
(12.4%). After a mean follow-up of 21,4 months (range 12-54 months), we only found 2 hernia recurrence (1,2%) and 3
symptomatic bulging (1,7%). The timing of recurrence was between 10 and 21 months.

CONCLUSIONS: The posterior components separation with double mesh placement improves the results in the repair of
the complex incisional hernias of the abdominal wall, midline and lateral or subcostal, with an acceptable incidence of
local and systemic complications, and a low recurrence rate.

e00055
Study of genetic basis of Idiopathic Central Precocious Puberty.

Ortiz-Cabrera NV1,2, Riveiro R1, López-Martínez M1, Pérez-Segura P3, Aragón I3, Ayuso C1, Trujillo-Tiebas MJ1, Soriano-Guillén L3*.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00055

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Ortiz-Cabrera NV, Riveiro R, López-Martínez M, Pérez-Segura P, Aragón I, Ayuso C, Trujillo-Tiebas MJ, Soriano-Guillén L. Study
of genetic basis of Idiopathic Central Precocious Puberty. IBJ Plus 2018 (S2):e00055 doi: 10.24217/2531-0151.18v1s2.00055.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Idiopathic central precocious puberty (ICPP) is the premature activation of the hypothalamic-pituitary-gonadal axis in the
absence of organic disease. Up to now, loss-of-function variants of the maternally imprinted gene MKRN3 (MIM:616346) are
most common genetic cause of ICPP, in 3 patients gain-of-function mutations of KISS1/KISS1R have been described. Recently,
DLK1, another maternally imprinted gene have been implicated in the origin of ICPP, Methods: The sample group: 28 patients
with ICPP, we gathered blood samples from them, their parents and affected relatives. Control group: 46 female European
adults with known menarche age. We studied the clinical exome of 20 patients from the sample group using the Illumina
platform. Variants were filtered using a list of 7 genes related to the gonadotropin-releasing hormone pathway: GNRHR,
LIN28B, KISS1, KISSR1, MKRN3, TAC3, TACR3. Variants were validated using sanger sequencing, in both the family and control
group. Study of chromosome 14 haplotypes using STRs around DLK1 in the 28 families. Results: In the primary analysis we
found 1 likely pathogenic variants in 1 patients, 2 variants of unknown significance (VOUS) in 2 patients listed in table 1, we also
found polymorphisms (not shown) in the genes listed. We found none Uniparental Disomy in the sample group.

Conclusion: variants in MKRN3 are the most frequent genetic cause of familial ICPP, so it is wise to screen for MKRN3
mutations in all patients with ICPP. The burden of DLK1 in the pathogeny of ICPP is yet to be assessed. Besides, because
multiple studies, including this one, failed to demonstrate the presence of pathogenic variants in the coding regions of
the genes related to this disease, we assume that it must be caused by alterations of epigenetic or regulatory factors.
Further studies are needed to probe this hypothesis.

e00056
Comparison of pharmacological treatment alone versus treatment combined with implantable cardioverter-defibrillator therapy inpatients over 75 years.

Julia Anna Palfy MD1, Marcelino Cortés MD-PhD2, Marta Lopez MD2, Juan Martinez MD2, Ana Lucia Rivero MD2, Ana Devesa MD2, Juan Antonio
Franco MD-PhD2, Sem Briongos MD3, Mikel Taibo MD2, Juan Benezet MD2, Jose Manuel Rubio MD0-PhD2, Jose Tuñon MD-PhD2

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00056

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Julia Anna Palfy, Marcelino Cortés, Marta Lopez, Juan Martinez, Ana Lucia Rivero, Ana Devesa, Juan Antonio Franco, Sem Briongos, Mikel Taibo, Juan Benezet, Jose Manuel Rubio, Jose Tuñon. Comparison of pharmacological treatment alone versus treatment combined with implantable cardioverter-defibrillator therapy in patients over 75 years. IBJ Plus 2018 (S2):e00056 doi:
10.24217/2531-0151.18v1s2.00056.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

BACKGROUND: The implantable cardioverter defibrillator (ICD) reduces mortality in selected patients. The role of ICD in patients over 75 years is not well established.

MATERIAL AND METHODS: Between January 2008 and July 2014, we assessed patients aged ≥75 years with left ventricular
ejection fraction ≤35%. We identified 385 patients with a class I or IIa recommendation for an ICD implantation. Based
on the patients or attending cardiologists’ decisions, 92 patients received an ICD. In order to avoid potential confounding
factors, we performed a propensity-score matched analysis.

RESULTS: Finally, 126 patients were included (63 with ICD). The mean age was 79.1±3.1 years (86.5% males). As
compared with the medical therapy group, the ICD patients had a lower percentage of chronic obstructive pulmonary
disease (19.0% vs 38.1%, p<0.05), with higher use of beta-blockers (BB) (85.7 vs 70.0%, p<0.05). Other treatments were
otherwise similar in both groups. There were not differences in relation with age, etiology or other comorbidities. During
follow-up (39.2±22.4 months), total mortality was 46.0% and cardiovascular events (death or hospitalization) occurred in
66.7% of the patients. After a multivariate analysis, only BB therapy was shown to be an independent protective variable
with respect to mortality [HR 0.4 (0.2-0.7)]. ICD therapy did not reduce overall mortality or cardiovascular event rate.

Conclusion: According to our results, the use of ICD did not demonstrate any benefit as compared with medical
therapy. Well-designed randomized controlled studies in patients over 75 years are needed to ascertain the value of ICD
therapy.

e00057
Check Mate of ADHD-II: A pilot study.

Rodrigo-Yanguas María1*, Blasco-Fontecilla Hilario1,2,3,4

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00057

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Rodrigo-Yanguas María, Blasco-Fontecilla Hilario. Check Mate of ADHD-II: A pilot study. IBJ Plus 2018 (S2):e00057 doi:
10.24217/2531-0151.18v1s2.00057.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Attention deficit hyperactivity disorder (ADHD) is a major public health issue. ADHD is the most prevalent
psychiatric disorder diagnosed in youth people, affecting between 4% and 8% of youth people worldwide. The multimodal
treatment -drugs, psychological treatment, and psychoeducation- is the most effective treatment. Pharmacological
intervention is the most frequent and convenient treatment for ADHD in developed countries. Unfortunately, many
parents are reticent to putting their child on drugs. Furthermore, psychotherapy is usually expensive. On the other hand,
there are preliminary reports suggesting that chess, a traditional, simple board game that requires the use of complex
cognitive strategies could be used in different mental disorders, including ADHD. In this context, testing the putative
therapeutic effect of chess training is worthwhile. The objective of the present study is to test if chess is useful in children
with ADHD within the context of the “Check mate of ADHD” Project (www.jaquemate-tdah.com).

Material y Methods: The HUPH Institutional Review Board committee approved the study (n12, 16, July 11th 2016).
After a complete description of the study, all children and their parents signed the written consent.
Thirty-two children aged 7 to 14 years with ADHD were included between July 1st 2016 and December 31st 2017. All
children were randomized to either the experimental group (CG) -received chess classes during one month- or the
control group -treatment as usual, TAU-. The following scales were used for psychological testing: The Spanish Version
of the Swanson, Nolan and Pelham Scale for parents (SNAP-IV), the Abbreviated Conner’s Rating Scales for parents
(CPRS-HI), The Behavior Rating Inventory of Executive Function (BRIEF), The Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR) and The Conner’s’ Continuous Performance Test II. Mann-Whitney correlation analyses were
used to ascertain differences between both groups. Statistical significance was set as p<.05.

Results: There weren´t significant relationship between children played chess against those who didn´t play (p<.05). We
found a slight improvement in the CG group as compared with the TAU group in the CPT-II that reached no statistical
significance.

Conclusions: One month of chess training is not useful for the treatment of ADHD. This is not surprising, given that
cognitive rehabilitation –cognitive-behavioral therapy; neurofeedback- usually requires a minimum of three months to
find some improvements. This pilot project highlights the importance of carrying out larger studies and during a longer
period using a case-control randomized design.

e00058
Levels of fecal calprotectin in healthy children (0 to 18 years). The importance of age.

Marta Velasco Rodríguez-Belvís1*, Carmen Plata Fernández1, Javier Francisco Viada Bris1, Alberto García Salido1, Julia Asensio Antón1, Rosa Ana
Muñoz Codoceo1.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00058

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Marta Velasco Rodríguez-Belvís, Carmen Plata Fernández, Javier Francisco Viada Bris, Alberto García Salido, Julia Asensio Antón, Rosa Ana Muñoz Codoceo. Levels of fecal calprotectin in healthy children (0 to 18 years). The importance of age. IBJ Plus 2018
(S2):e00058 doi: 10.24217/2531-0151.18v1s2.00058.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Calprotectin is a calcium binding protein of neutrophil granulocytes that correlates strongly with neutrophil infiltration of the intestinal mucosa when measured in faeces. However, fecal calprotectin (FC) is a non-specific inflammation marker and can
be potentially influenced by factors like diet and age. In fact, previous studies report that children tend to have higher FC levels than
adults. However, only a few trials have been specifically designed to establish the normal FC levels in healthy children, and in each
case analyzed small and/or heterogeneous samples. Our primary aims in this study were to (i) establish normal levels of FC in healthy
children living in a modern Spanish urban environment; and (ii) analyze their correlation with age.

Material and methods: A multicenter, cross-sectional and observational study was conducted between January 2015 and December
2016. We enrolled healthy voluntary donors from 0 to 18 years of age who attended one of the four participating primary health
centers for routine growth monitoring or vaccination. The exclusion criteria were: (i) immunodeficiency; (ii) gastrointestinal or
autoimmune disease; (iii) intake of drugs or gastrointestinal symptoms in the previous 15 or 30 days respectively; or (iv) positive
finding in the accompanying microbiological study. We determined the FC levels using the Quantum Blue® Calprotectin test, and we
perfomed stool cultures, including parasites, rotavirus and adenovirus detection. All data was analysed using SPSS® version 20.

Results: We included 395 subjects from 3 days to 16.9 years old (mean 4.2 years, SD 4.7 years), distributed in 8 age groups. Among them, 204 were boys (51.6%) and 191 were girls (48.4%). The FC levels in each age group are shown table 1. The FC values did not show a normal distribution, with higher figures in children under six months old. The correlation between age (days) and FC (μg/g) was analyzed using the Spearman correlation coefficient, with a bilateral significance of 0.00.

Conclusions: normal FC values in healthy children were higher than those considered as pathological in adults. This was particularly the case in children under four years old, and especially in those under 12 months. A negative correlation with age was observed. Based on this, it seems necessary to reconsider the levels of FC considered pathological in pediatric patients by age group.

e00059
Satisfaction, quality of life and perception of patients regarding burdens and benefits of vitamin K antagonists compared with direct oral anticoagulants in patients with nonvalvular atrial
fibrillation. ALADIN Study.

María del Mar Contreras Muruaga1, Carmen Suárez Fernández1.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00059

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: María del Mar Contreras Muruaga, Carmen Suárez Fernández. Satisfaction, quality of life and perception of patients regarding
burdens and benefits of vitamin K antagonists compared with direct oral anticoagulants in patients with nonvalvular atrial fibrillation.
ALADIN Study. IBJ Plus 2018 (S2):e00059 doi: 10.24217/2531-0151.18v1s2.00059.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Atrial fibrillation (AF) is associated with a fivefold excess risk of stroke. Except when contraindicated, chronic oral
anticoagulants,
with vitamin K antagonist (VKAs) or direct oral anticoagulants (DOACs), are the therapy of choice for reducing
the risk of thromboembolic complications. Few data are available on the impact of anticoagulation
therapy on satisfaction
and quality of life in patients with AF. ALADIN was designed to validate the Anti-Clot Treatment Scale (ACTS) questionnaire in
outpatients with AF treated with oral anticoagulants, attended in internal medicine and neurology departments in Spain. The
objectives of the present study were to analyze the impact of treatment with oral anticoagulants
on quality of life, satisfaction
and patients’ perception of the burdens and benefits of anticoagulation therapy and to identify the factors associated with
these variables.

Material and Methods: ALADIN was an observational cross-sectional study carried out in neurology and internal medicine
departments in Spain. The study population comprised patients with non valvular AF (NVAF), treated with oral anticoagulants
who had been seen in those departments in Spain, from September 2014 to March 2015. The patients completed
the ACTS, SAT-Q (Satisfaction Questionnaire) and EQ-5D-3L (EuroQol 5 dimensions questionnaire, 3 level version)
questionnaires. The statistical analysis was performed using SPSS for Windows.

Results: The study population comprised 1337 patients, of whom 587 were taking DOACs and 750 VKAs. Compared
with VKAs, DOACs were more commonly prescribed in patients with a history of stroke and in patients with a higher
thromboembolic risk. The ACTS Burdens score (54.83±6.11 vs 49.50±9.15, p<0.001) and ACTS Benefits score (12.36±2.34
vs 11.48±2.46, p<0.001) were higher with DOACs than with VKAs. The logistic regression analysis performed with data
from the SAT-Q is shown in the table.

Conclusions: NVAF patients treated with oral anticoagulants had many comorbidities and a high thromboembolic risk.
Satisfaction and quality of life with oral anticoagulants were high, although they were both better with DOACs than with
VKAs.

e00060
Curcumin treatment decreases acute kidney injury associated with rhabdomyolysis.

Melania Guerrero-Hue1, Cristina García-Caballero1, Alejandra Palomino-Antolín2, Gina Marcela Córdoba1, Cristina Vázquez-Carballo1, Carmen Herencia1, Víctor Farré-Alins2, Alfonso Rubio-Navarro1, Javier Egea2, Jesús Egido1, Juan Antonio Moreno1*

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00060

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Melania Guerrero-Hue, Cristina García-Caballero, Alejandra Palomino-Antolín, Gina Marcela Córdoba, Cristina Vázquez-Carballo,
Carmen Herencia, Víctor Farré-Alins, Alfonso Rubio-Navarro, Javier Egea, Jesús Egido, Juan Antonio Moreno. Curcumin treatment
decreases acute kidney injury associated with rhabdomyolysis. IBJ Plus 2018 (S2):e00060 doi: 10.24217/2531-0151.18v1s2.00060.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

The release of myoglobin into the bloodstream due to a muscle damage (rhabdomyolysis) can induce acute kidney injury (AKI).
Myoglobin causes tubular cell death, oxidative stress and nitric oxide decrease, promoting vasoconstriction and endothelial
damage in the kidney. Curcumin, a compound from the Curcuma longa, has different antioxidant effects because it is an inductor
of Nrf2 (Nuclear factor (erythroid-derived 2) -like 2). In this study we analyzed the possible beneficial effect of curcumin in the
prevention of AKI associated with rhabdomyolysis.

We performed an experimental model of AKI associated with rhabdomyolysis by a single intramuscular injection of 50%
glycerol (10ml/kg body weight) in each thigh caudal muscle in male C57BL/6 mice at 12 weeks of age. Curcumin was injected
intraperitoneally (1mg/kg) the day before and the same day of the injection of glycerol. Animals were sacrificed 24 hours post
glycerol injection. Blood and kidney samples were collected to perform gene expression studies by Real Time-PCR and protein
expression by western blot and immunohistochemistry. In addition, we performed in vitro studies with murine tubular cell
(MCT) to study the molecular mechanisms involved in the protection of curcumin against the adverse effects of myoglobin.

Mice with rhabdomyolysis had increased serum levels of urea and creatinine, as well as increased histological damage
(tubular death, tubular dilatation, loss of brose border and oedema). In line with these results, we observed an increase in
gene expression of tubular damage (NGAL and KIM-1) and endothelial activation markers (ICAM-1 and endothelin), as well
as increased expression of proinflammatory cytokines (CCL2 and TNF-α), oxidative stress (production of MDA and decreased
GSH content), induction of catabolism of the heme group (HO-1 and ferritin), and cell death (TUNEL). All these effects were
partially reversed with curcumin treatment. In tubular cells, the administration of curcumin induced the activation of Nrf2 and
HO-1. In line with our in vivo data, administration of curcumin to the MCTs decreased cell death and oxidative stress induced
by myoglobin.

Our results suggest that renal damage associated with rhabdomyolysis decreases with curcumin treatment, so this compound
could be a possible therapeutic approach in patients with this pathology.

e00061
Non-celiac gluten sensitivity and chronic low back pain.
Retrospective study of response to gluten-free diet in non-celiac
patients with spondyloarthritis features.

Alexandre Stadnitsky1, Carlos Isasi2, Ana Royuela3

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00061

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Alexandre Stadnitsky, Carlos Isasi, Ana Royuela. Non-celiac gluten sensitivity and chronic low back pain. Retrospective study of response to gluten-free diet in non-celiac patients with spondyloarthritis features. IBJ Plus 2018 (S2):e00061 doi: 10.24217/2531- 0151.18v1s2.00061.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Objective: To study non-celiac gluten sensitivity in patients with chronic low back pain and spondyloarthritis features.

Methods: This is a retrospective study with 110 non-celiac patients with refractory low back pain and spondyloarthritis
features, who underwent a gluten-free diet.
Demanding improvement was defined as reaching at least one of the following objectives: Be asymptomatic, remission
of chronic low back pain, normal life recovery, return to work, change from being limited in bed or wheelchair to be able
to walk, recovery of independence for personal care, withdrawal of opioids.

Results: The average age at onset of low back pain was 30 years. The average duration was 15 years. 62% of the patients
achieved a demanding improvement. The average duration of gluten-free diet in patients with demanding improvement
was 60 months. 96% of the patients with demanding improvement who ingested gluten had clinical worsening. . Oral
aphthae and having a celiac relative were associated with a good response to a gluten-free diet. Out of 28 patients
with axial spondyloarthritis, 23 had demanding improvement. Out of 16 patients with uveitis, 13 had demanding
improvement.

Conclusions: Gluten-free diet may be beneficial in non-celiac patients with chronic low back pain and spondyloarthritis
features, and in patients with axial spondyloarthritis. Information about clinical variables to consider in predictive models
of response to a gluten-free diet is provided.

e00062
Conceptualization and use of Physical Restranit in ICU from the
experience of Physicians and Nursing Assistant: looking for an
interdisciplinary reading.

Acevedo-Nuevo M1,2*, González-Gil MT2.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00062

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: González-Gil MT, Acevedo-Nuevo M. Conceptualization and use of Physical Restranit in ICU from the experience of Physicians
and Nursing Assistant: looking for an interdisciplinary reading. IBJ Plus 2018 (S2):e00062 doi: 10.24217/2531-0151.18v1s2.00062

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: In spite of all current international evidence, Critical Care Units (ICU) are one of the clinical settings were
physical restraint are used excessively. Theoretical frameworks developed in other caring contexts indicate that nurses
are the main actors in physical restraint management. However, other members of ICU staff such as physicians and
nursing assistants can wisely contribute in nursing decision making about physical restraint use.
The aim of this study was to explore physicians and nursing assistant experience on ICU physical restraint management
and to identify the way this experience can influence nurses’ decision making.

Material and methods: A multicenter phenomenological research was carried out in 17 ICUs in Madrid (Spain). The ICUs
were stratified according to physical restraint “common use” versus “lacking use”. Three focus groups were developed.
The first one was composed by nursing assistants from “common use” ICUs, the second one by nursing assistants from
“lacking use” ICUs and the last by physicians of both types of ICUs. Sampling method: purposeful. Data analysis: thematic
content analysis. Data saturation was achieved.

Results: Four main themes emerge from data analysis: 1) safety and risk meanings (patient safety versus staff safety),
2) restraint types, 3) professional responsibilities (prescription and professional roles) and 4) “zero restraint” paradigm.
Conceptualization about the use of physical restraint shows differences in some themes depending the type of ICU
policies about physical restraint use and management (common use versus lacking use).

Conclusions: A real reduction of physical restraint use in ICUs should have a key starting point: the acceptance of
the complexity of the phenomenon. The differences in the use of physical restraints among UCIs are influenced by
individual, collective and organizational factors. These factors determine the understanding of safety and risk, the focus
of caring (patient or clinician based care), the concept of restrain, professional responsibilities and interventions, and
team interactions and leadership.

e00063
Conceptualization and use of Physical Restranit in ICU from the
experience of Physicians and Nursing Assistant: looking for an
interdisciplinary reading.

Patricio Alfredo Vallejo Valdivieso1, Graciela Hernestina Zambrano Pincay1, Patricio Yosue Vallejo Pilligua1.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00063

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Patricio Alfredo Vallejo Valdivieso, Graciela Hernestina Zambrano Pincay, Patricio Yosue Vallejo Pilligua. The malnutrition
screening aimed at excess diabetes mellitus, hypertension and chronic kidney disease in a sample population from the city of
Portoviejo, Manabí in 2017. IBJ Plus 2018 (S2):e00063 doi: 10.24217/2531-0151.18v1s2.00063.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

The screening carried out between November 1st and on December 15th, 2017, a field, exploratory, descriptive
and correlation investigation was carried out, based on an opportunistic and selective strategy with a sample of 398
adults malnourished by excess a total of 190 overweight and 208 obese from the parish Andrés de Vera, in the city of
Portoviejo, the province Manabí; possible through capillary glucometry evidencing 106 cases of prediabetes and 61 of
diabetes mellitus; 99 in pre-hypertensive stage and 199 with arterial hypertension. Although no case of chronic kidney
disease was identified, with the application of the albumin urine test in 24-hour, 7 patients with different degrees of
albuminuria were identified. Given the effectiveness and simplicity of the procedure used and its low cost, we propose
its generalization in the province and the country.

e00064
Quality of life of patients with chronic pain and frailty criteria in a primary care center.

Otones Reyes Pedro1*, Pedraz Marcos Azucena2, García Perea Eva2, Ferrari Piquero Carmen3, Alcalde Román Mercedes1, Alberquilla Menéndez-Asenjo Ángel4.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00064

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Otones Reyes Pedro, Pedraz Marcos Azucena, García Perea Eva, Ferrari Piquero Carmen, Alcalde Román Mercedes, Alberquilla
Menéndez-Asenjo Ángel. Quality of life of patients with chronic pain and frailty criteria in a primary care center. IBJ Plus 2018
(S2):e00064 doi: 10.24217/2531-0151.18v1s2.00064.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Frailty is a clinical state in which there is an increase in an individual’s vulnerability for developing increased dependency
or mortality when exposed to a stressor. It is a common state in older adults and it has consequences in physical activity
limitation, depression and poor quality of life. Chronic pain is also a frequent condition in older adults. Its consequences
are similar to the consequences of frailty. Frailty can be prevented and managed by physical activity encouragement; our
aim is to examine the effectiveness of a physical exercise program to manage chronic pain and frailty.

Objectives: This investigation is divided into two phases: the first phase of the investigation is a cross-sectional study
whose objective is to analyze a population of older adults with chronic pain to determine their frailty statement, physical
activity, pain characteristics and quality of life. The second phase of the investigation consists on a randomized controlled
trial whose objective is to study the effectiveness of a physical exercise program for patients identified as pre-frail older
adults in the phase 1 of the investigation.

Methods: Participants in the first phase of the investigation will be recruited by the consultation of the electronic
registers of the Madrid Health Service. Patients older than 65 years with chronic pain will be searched and their frailty
status will be assessed and related to pain characteristics, quality of life and physical activity. Pre-frail patients will
be identified and they will be randomized into a control group and an intervention group. Control group will receive
ordinary recommendations for physical activity, and intervention group participants will be included in a physical
exercise program for 8 weeks. The physical exercise program consists on warm-up exercises, muscle strengthening
and stretching, balancing and self-administered massage After the intervention, and after 6 months follow-up, frailty
statement, physical activity, quality of life, depression and intensity and location of pain will be assessed in both groups.

e00065
Evaluation of a computerized system for the monitoring of
procedures performed in a general surgery service.

L.F. Toranzo Ramos1, A. Martín Vega2, A. Zarazaga Monzón1, J.A. Rodríguez Montes1..

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00065

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: L.F. Toranzo Ramos, A. Martín Vega, A. Zarazaga Monzón, J.A. Rodríguez Montes. Evaluation of a computerized system for the
monitoring of procedures performed in a general surgery service. IBJ Plus 2018 (S2):e00065 doi: 10.24217/2531-0151.18v1s2.00065.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Background: Surgical research is faced with difficulties not encountered in clinical research. The variety of surgical
interventions, their undefined nature, the patient´s previous physiopathological status, the surgeon´s expertise, and
the variety of adverse events, their severity, and occurrence in time – all of which makes some of them go unnoticed
– cause surgical research to be considered as highly complex. Structured hospital databases are not producing the
evidence decision makers arguably need in surgical departments, as those databases gather administrative information
and exclude information related to surgical care. Therefore we must develop an easily manageable database integrating
all the clinical and surgical data (Real World Data) aimed at monitoring and assessing surgical results from a third-level
Hospital´s General Surgery Department.

Methods: A prospective observational study, was carried out from 2011-2013, based on RWD of a 4,572 surgical
interventions record cohort from 4,248 patients. This RWD was developed by refining and structuring all the information
contained in the following, but not exclusive, list of hospital databases: BMDS, HP-HCIS, HP-DOCTOR. Furthermore,
we have incorporated information that is not readily available in hospital databases: adverse events severity ranking,
patient comorbidity, surgical complexity level etc. To demonstrate this system´s versatility, twelve surgical scenarios
were developed in two anatomical areas (colon and rectal) owing not only to the type of cases per se but also to the
diversity and complexity of adverse events.

Results: Mortality in colon surgery was not recognized by existing databases as surgery-related in 50% of the cases, with
the number going up to 83.33% in rectal surgery. The analysis reveals that 3.2% of those patients requiring re-intervention
following right hemicolectomy surgery went unnoticed by the hospital databases on their first admission. Through the
analysis of the same cohort over a five-year span, it was found that 18.58% additional patients were not included in
hospital databases. The number of patients undergoing low anterior resection surgery requiring re-interventions in the
first admission and going unnoticed to hospital databases was 6.38% and 31.91% over a 5-year period.

Conclusion: The information extracted from current hospital databases does not necessarily allow the surgeon to take
the best decision based on prior surgical evidence. It is mandatory that the surgeon define all the clinical and surgical
data. All the data must be structured in order to build and develop a surgical RWD thereby transforming this data into
information instrumental in the decision making process.

e00066
Adequacy of antithrombotic treatment, characteristics and inhospital
mortality of elderly patients with non-valvular atrial
fibrillation: results of the NONAVASC registry.

Alejandra Gullón1, Francesc Formiga2, Jose María Mostaza3, Carmen Suárez1, on behalf of the NONAVASC study group. Vascular Risk Group of the
Spanish Society of Internal Medicine.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00066

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Alejandra Gullón, Francesc Formiga, Jose María Mostaza, Carmen Suárez, on behalf of the NONAVASC study group. Vascular
Risk Group of the Spanish Society of Internal Medicine. Adequacy of antithrombotic treatment, characteristics and in-hospital
mortality of elderly patients with non-valvular atrial fibrillation: results of the NONAVASC registry. IBJ Plus 2018 (S2):e00066 doi:
10.24217/2531-0151.18v1s2.00066.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Background and objectives: The prevalence of non-valvular atrial fibrillation (NVAF) increases with age and is associated
with high morbi-mortality rates. The main goals of this study were to describe the characteristics of elderly patients
hospitalised with NVAF, to evaluate the adequacy of the antithrombotic strategies used and to identify the predictors of
in-hospital mortality.

Patients and methods: Observational, prospective, multicentre study carried out on patients with NVAF over the age of
75, who had been admitted for any medical condition to Internal Medicine departments in Spain.

Results: We evaluated 804 patients with a mean age of 85±5.1 years, of which 53.9% were females. The prevalence of
risk factors and cardiovascular disease was high: hypertension (87.6%), heart failure (65.4%), ischemic cardiomyopathy
(24.4%), cerebrovascular disease (22.4%) and chronic kidney disease (45%). Antithrombotic treatment was prescribed
in 86.2% of patients at the admission: anticoagulants (59.7%), antiplatelet (AP) medication (17.8%) and double therapy
(8.7%). Older age, AF diagnosed within <1 year, higher HAS-BLED scores and severe cognitive impairment were associated
with the use of antiplatelet therapy. Permanent AF favoured the use of anticoagulants. During the hospitalization 10.1%
(n=81) of the patients died. The strongest determinants of in-hospital mortality were the baseline functional status
(Barthel Index) (OR for total dependency 4.73, 95% CI 2.32-9.63), and admissions for stroke (OR 3.55, 95% CI 1.41-8.90)
and acute renal failure (OR 1.93, 95% CI 1.12-3.32).

Conclusions: elderly patients hospitalized with NVAF showed numerous comorbidities and their in-hospital mortality
was high. The anticoagulation rates were low and 18% received only AP drugs. The patient’s age and the severity of the
cognitive impairment were determinant for the choice of the antithrombotic strategy. The baseline functional status was
the strongest predictor for in-hospital mortality, ahead of comorbidities and pharmacological therapies. These results
enhance the importance of incorporating a global geriatric assessment in order to guide and adjust our therapeutic
efforts during the management of these complex patients.

e00067
Surgical treatment of type A acute aortic dissection with “Frozen
Elephant Trunk” technique.

Luis Fernando López Almodóvar1*, Irene Narváez Mayorga2, Beatriz Castaño Moreira3, Blanca Mateos Pañero3, Marcelino Sánchez Casado4, Jose
Antonio Blázquez González5.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00067

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Luis Fernando López Almodóvar, Irene Narváez Mayorga, Beatriz Castaño Moreira, Blanca Mateos Pañero, Marcelino Sánchez
Casado, Jose Antonio Blázquez González. Manuscript´s full Title. IBJ Plus 2018 (S2):e00067 doi: 10.24217/2531-0151.18v1s2.00067.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Background: Acute type A aortic dissection (AAAD) is a surgical emergency. In patients with arch and descending aorta
involvement (DeBakey type I), a total aortic arch replacement with frozen elephant trunk (FET) could favour false lumen
thrombosis and improve long-term results. We hereby present our experience with this technique in a low-volume centre,
to assess if the technique is feasible to treat such disease.

Methods: From January 2011 to December 2016, 43 patients with acute type A aortic dissection were operated on in
our Institution, which carries out 300-350 annual procedures. Among these, 12 patients with an intimal tear in the aortic
arch and/or proximal descending aorta received a FET procedure (10 males, age 57 years). Concomitants procedures
were aortic valve replacement (42%), Bentall (25%) and aortic valve repair (17%).

Results: Cardiopulmonary bypass, cross-clamp and circulatory arrest times were 235±43 min, 171±33 min and 75±20
min, respectively. The operative mortality was 16,7% (n=2). Stroke and rethoracotomy for bleeding occurred in 8% (n=1)
and 8% (n=1), respectively. There was not spinal cord injury. Follow up was 36,1 months. During follow-up, no patients
died or required a reoperation on the downstream aorta.

Conclusion: Although all patients have been operated on in a low-volume centre, our results with FET in AAAD are acceptable.
Even though this technique demands high technical skills, the learning curve has not had impact on mortality
or morbidity.

e00068
The response to a high fat diet in a mouse model of Alzheimer’s
disease is sexually dimorphic.

Alejandra Freire-Regatillo1,2,3, Sonia Díaz-Pacheco4, Clara González4, María L. Ceballos4, Luis Miguel García-Segura4,5, Jesús Argente1,2,3,6*, Julie A.
Chowen2,3,6.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00068

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Alejandra Freire-Regatillo, Sonia Díaz-Pacheco, Clara González, María L. Ceballos, Luis Miguel García-Segura, Jesús Argente,
Julie A. Chowen. The response to a high fat diet in a mouse model of Alzheimer’s disease is sexually dimorphic. IBJ Plus 2018
(S2):e00068 doi: 10.24217/2531-0151.18v1s2.00068.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

High fat diet (HFD)-induced metabolic alterations, including neuroinflammation and gliosis, are risk factors for Alzheimer’s
Disease (AD), with males and females possibly responding differently. Transgenic amyloid protein mice (TgAPP) are used
as a model of AD and HFD-induced metabolic alterations are a risk factor for AD. We analyzed the response of male and
female TgAPP and wild type (WT) mice to a HFD.

Male and female (7-8 months old) WT C57BL/6 mice (controls) and TgAPP mice were put on either a HFD or a low-fat diet
(LFD) for four months before sacrifice. Circulating metabolic parameters were measured. The mRNA expression levels
of orexigenic neuropeptides Agouti-Related Protein (AgRP) and neuropeptide Y (NPY), the anorexigenic neuropeptide
pro-opiomelanocortin (POMC) and interleukins (IL) 1-beta and -6 were analyzed in the hypothalamus and leptin receptor
(LepR) and cytokines in visceral and subcutaneous adipose tissues by RT-PCR. Intracellular signaling pathways were
analyzed by Western-blotting.

All females significantly increased their body weight (p<0.0001) on the HFD, while males did not. Triglycerides were
elevated in all APP mice compared to their controls (p<0.03). Circulating insulin levels were lower in WT female mice
than in WT males. There was a tendency to increase circulating insulin with HFD, but it was only significant in APP mice of
both sexes (p<0.02). Circulating levels of monocyte chemoattractant protein (MCP) -1 were higher in LFD male mice than
in LFD females and HFD decreased MCP-1 levels in males, but not in females. Circulating levels of plasminogen activator
inhibitor (PAI) -1 were higher in males than in females. In males, HFD lowered the mRNA levels of AgRP (p<0.005) and
NPY (p<0.005), regardless of genotype, and phosphorylated protein kinase B (pAkt) levels only in hypothalami of APP
mice (p<0.05). In females, HFD increased POMC mRNA levels (p<0.05) in both genotypes. WT males had higher POMC
mRNA levels than APP males regardless of diet (p<0.01) and tended to have higher hypothalamic IL1beta expression s.
LepR expression in visceral adipose tissue was higher in APP males than in WT males (p<0.04). However, APP females
had lower LepR expression than WT females (p<0.03), which was significant in those on a HFD (p<0.05). Also, WT males
had lower LepR expression than WT females (p<0.003).

In conclusion, mice from this AD model exhibit different metabolic and hypothalamic responses to HFD compared to WT
mice, with these responses also depending on sex. Thus, these data further support the concept that dietary intake and
the sex of an individual are factors that should be taken into consideration in the study and treatment of Alzheimer’s
Disease.

e00069
Initial evaluation of a real-time Prostatic Fusion Biopsy system:
starting the programme.

Martinez-Ballesteros Claudio1, Martinez-Salamanca Juan Ignacio1, Carballido Rodriguez Joaquin Alberto1.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00069

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Martinez-Ballesteros Claudio, Martinez-Salamanca Juan Ignacio, Carballido Rodriguez Joaquin Alberto. Initial evaluation of a
real-time Prostatic Fusion Biopsy system: starting the programme. IBJ Plus 2018 (S2):e00069 doi: 10.24217/2531-0151.18v1s2.00069.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Development of Multiparametric Magnetic Resonance Imaging (mpMRI) of the prostate has allow for the use of a variety
of ultrasound-MRI fusion systems, drawing the prostatic biopsy in last two years. We present here our initial results of a
series of transperineal prostatic biopsies using an image fusion system.

Between november-2015 and december-2016, we selected 85 out of 121 evaluated subjects candidates to prostate
biopsy. We used a fusion image software (Biopsee® and the stepper EX3 with estabilizer Micro-Touch®(Civco®). All cases
were submitted to a prior prostatic mpMRI in wich was described, at least one suspicious lesion. The procedure was
performed under general anaesthesia and the patients were discharged the same day. The aim of this study is to estimate
the diagnostic powerful of this test and to correlate images and pathologic finds.

We performed 85 transperineal fusion biopsies (112 targets). Mean age 67.5 y, median prostate volume 72.97cc. 69 p
were submitted to a prior transrectal ultrasound prostate biopsy (TRUSB) (which is consider as the standart so far) and
55 of them had a negative result.
Median number of cores token per patient was 18 (target + randomized). 63 /85 biopsied cases had an elevated suspicious
lesion in their MRI, resulting in final diagnostic of Prostate Cancer (PCa) 66.6% (table1). If the MRI describes an elevated
suspicious lesion, 55% of patients have a clinically significant PCa.

We conclude that implementation of a real-time Prostatic Fusion Biopsy system in clinical practice has shown as an
effective tool to improve detection rates of PCa in our institution. Diagnostic output of this procedure is superior to TRUSB
detection rates published so far. We observed good correlation between MRI and presence of a clinically significant PCa.
An adequate selection of candidates for this procedure is required, taking into account radiological report.

e00070
Facial bradykinesia in Parkinson´s disease and its correlation with
motor and non-motor symptoms.

T Maycas-Cepeda1, C E Feliz-Feliz2, R Arroyo1, P J García-Ruiz2

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00070

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: T Maycas-Cepeda, C E Feliz-Feliz, R Arroyo, P J García-Ruiz. Facial bradykinesia in Parkinson´s disease and its correlation with
motor and non-motor symptoms. IBJ Plus 2018 (S2):e00070 doi: 10.24217/2531-0151.18v1s2.00070.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Reduced facial expression or amimia is one of the most typical features of Parkinson´s disease (PD). Despite
being described in classic texts, its significance, physiopathology and correlation with motor and non-motor symptoms,
including depression and cognitive impairment, is largely unknown.

Material and Methods: We studied facial bradykinesia in a group of 60 PD patients.
Clinical assessment was performed with the (on) Unified Parkinson´s Disease Rating Scale (UPDRS) and Hohen-Yahr scale
(on). Cognitive study was assessed by Parkinson Disease cognitive Rating scale (PD- CRS). Depression by the 16-Item
Quick Inventory of Depressive Symptomatology (QIDS-SR16) and Facial bradykinesia was rated according to item 19 of
UPDRS III.

Results: Facial bradykinesia statistically correlated with motor UPDRS (r: 0.54 Spearman), Hoehn-Yahr scale (r: 0.3865)
and also with cognitive status (r: 0.35).
Conclusion: Our study suggests that facial bradykinesia correlates with motor and cognitive situation in PD.

e00071
Functional outcomes of the renal transplants obtained from
controlled donation following cardiopulmonary death (DCD)
with compartmental normothermic extracorporeal membrane
oxygenation support (NECMO).

P. Ramírez Rodríguez-Bermejo1, J. Carballido Rodríguez1,G. Rodríguez Reina1, D. Vázquez Alba1

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00071

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: P. Ramírez Rodríguez-Bermejo, J. Carballido Rodríguez, G. Rodríguez Reina, D. Vázquez Alba. Functional outcomes of the
renal transplants obtained from controlled donation following cardiopulmonary death (DCD) with compartmental normothermic
extracorporeal membrane oxygenation support (NECMO). IBJ Plus 2018 (S2):e00071 doi: 10.24217/2531-0151.18v1s2.00071.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Since the implementation of the DCD protocol at our institution in 2012, some modifications have taken
place in order to improve the organ viability. As for this, the NECMO has proven to be an effective method and to help
reduce the isquemic organ damages.

Objetives: To analyse the functional outcomes of the transplanted kidneys (TK) obtained from DCD using NECMO.
Methods: We have reviewed the results from 15 kidney transplants (KT), whose organs where obtained from 9 DCD
using NECMO as the preservation method, from 2015 to 2017 at our institution.
Currently, in our protocol, arterial and venous femoral canulae and the aortic occlusion balloon catheter are placed in
the operating room, on a premortem and setup.
We have assessed the donors and recipient characteristics and also the TK outcomes, using a descriptive method from
all our data available.

Results: From the 9 DCD, we have obtained 15 valid kidney grafts, who were transplanted at our institution, just one was
not suitable due to anatomic alterations. The other 2 allografts were offered to other Hospitals.
Donor age averaged 52 years and allografts recipients averaged 48 years.
Four patients (26%) underwent previous kidney transplant, with an overall kidney allograft survival of 13.4 years.
Prior to KT, 13% were on a pre-dyalisis basis and the remaining 86% were on renal replacement therapy for an average
of 14 months.
Cardiopulmonary death occurred within an average of 12.2 minutes following withdrawal of life support.
From the 15 KT, 13 (83%) continue to function, 1 had arterial thrombosis which led to transplantectomy and the other
suffered acute rejection.
The 6 month average Cr was 1.6mg/dL.
Delayed graft function, defined as at least one postoperative episode of dialysis, occurred in 40% of kidneys (6/15).

Conclusions:
1- The organ quality from DCD is comparable to brain death donors.
2- ECMO supported DCD is feasible and easily implemented if necessary resources are available
3- Helps optimizing the donation-renal transplant process as the medical team responsible is involved.

e00072
Exosomes as predictive biomarkers in acute ischemic stroke
patients: A translational research approach.

Alonso López Elisa1, Laso García Fernando1, Gómez de Frutos Mari Carmen1, Otero Ortega Laura1, Martínez Arroyo Arturo1, Díez Tejedor Exuperio1,
Fuentes Gimeno Blanca1, Gutiérrez Fernández María1

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00072

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Alonso López Elisa, Laso García Fernando, Gómez de Frutos Mari Carmen, Otero Ortega Laura, Martínez Arroyo Arturo, Díez
Tejedor Exuperio, Fuentes Gimeno Blanca, Gutiérrez Fernández María. Exosomes as predictive biomarkers in acute ischemic stroke
patients: A translational research approach. IBJ Plus 2018 (S2):e00072 doi: 10.24217/2531-0151.18v1s2.00072.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Main objective: to study the prognostic predictor potential of exosomes as biomarkers in acute ischemic stroke patients.
Specific objectives:
-To determine whether exosome serum levels are specific or not to cerebral ischemic injury.
-To correlate exosomes serum levels with functional outcome as well as brain repair markers detected in serum in patients and
in an experimental animal model. In addition, in the animal model we aim to correlate the above variables with damage/repair
markers in brain histological sections.
-To identify an exosome level cut-off associated with functional outcome that could be of utility as a predictor of prognosis.
-To evaluate the composition of exosomes released into serum in relation to functional outcome and to investigate possible
differences in the composition in terms of various diseases in patients and the animal model.

Methodology:
-Clinical, observational study on 200 subjects (N=50 in each group) distributed as follows: Healthy; Non-lacunar acute ischemic
stroke (middle cerebral artery); Lacunar acute ischemic stroke; Acute myocardial infarct
-Animal model study on 70 rats (N=10 in each group) distributed as follows: Healthy; Cerebral infarct (middle cerebral artery);
subcortical cerebral infarct; Acute myocardial infarct and 3 Sham groups for each animal group.
Study variables: functional outcome by various scales; neuroimaging (Magnetic Resonance Imaging); exosome levels
(ExoQuickELISA); exosome composition assessment by the proteomic technique (Orbitrap); Brain repair markers in serum by
ELISA in subjects and animals. In the animal model, repair markers in brain tissue will also be analyzed using immunofluorescence
and Western blot techniques. Exosomes will be isolated from serum. They will be measured in subjects at 24/72hours and at
3months and in the animals at 24hours and 14days.

Preliminary data: Study is open for recruitment since March 2017.125patients have been included(62.5% of total).Age
range 32-90years:50healthy volunteers(21men,29 women;mean age: 62.6), 35patients with non-lacunar acute ischemic
stroke(15men,20women; mean age: 71);17patients with lacunar acute ischemic stroke(11men,6women; mean age 66) and
23patients with acute myocardial infarct (9women,14men; mean age:52.5).At this rate, recruitment could be finished in ten
months.In the animal model 61 rats (87%)have been included: 10healthy rats(5males,5females),10rats in the group subcortical
cerebral infarct(5males,5females) and their 10 shams rats(5males,5females),8rats in the group cerebral infarct(middle cerebral
artery)(3males,5females)and their 10shams rats(5males,5females)and 8rats in the group myocardial infarct(5males,3females)
and their shams rats (5males).

e00073
Adaptation of the dimensional anhedonia rating scale (DARS).

Alonso López Elisa1, Laso García Fernando1, Gómez de Frutos Mari Carmen1, Otero Ortega Laura1, Martínez Arroyo Arturo1, Díez Tejedor Exuperio1,
Fuentes Gimeno Blanca1, Gutiérrez Fernández María1

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00073

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Arrua-Duarte E, Migoya-Borja M, Barrigón ML, Barahona I, Delgado- Gómez D, Courtet P, Aroca F, Sakina J. Rizvi, Sidney H.
Kennedy, Lena C. Quilty, Baca-Garcia. E. Adaptation of the dimensional anhedonia rating scale (DARS). IBJ Plus 2018 (S2):e00073 doi:
10.24217/2531-0151.18v1s2.00073.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Anhedonia is described as “pleasure desensitization”. Only two of the nine available scales for measuring
anhedonia have been adapted to be used in a Spanish population. The Dimensional Anhedonia Rating Scale (DARS) is
a 17-item self-report scale that has demonstrated reliability and validity in the measurement of anhedonia. The aim of
this work was to translate the DARS into Spanish and to determine its reliability and validity in a group of patients with
different psychiatric diagnoses.

Methods: The original DARS scale (English version) was translated and back-translated from Spanish to English and
subsequently validated 134 psychiatric outpatients older than 18 years recruited from Psychiatry Department of the
Fundación Jiménez Díaz University Hospital, Madrid, Spain, with a range of psychiatric diagnoses. The Spanish version of
the Snaith Hamilton Pleasure Scale (SHAPS) was also administered to obtain the convergent validity of the DARS scale.
Sociodemographic characteristics and diagnosis were also collected in all patients. Statistical analysis was performed by
using a factor analysis. Internal reliability was assessed by calculating the Cronbach’s alpha index and the convergent
validity was obtained by means of the Pearson’s correlation among total DARS and its subscales and SHAPS score.

Results: Our results show that the Spanish version of the DARS maintains the psychometric characteristics of the original
English questionnaire. A strong internal consistency was observed (Cronbach alpha=0.92 for total scale score and 0.91-
092 for subscale scores). In addition, a strong significant correlation was found between the total scores of the DARS and
the SHAPS (r=0.51, p<.01).

Conclusions: The results show that the Spanish DARS maintains the psychometric characteristics of the original
questionnaire, with a strong internal consistency and adequate validity. Particularly, the addition of items reflecting
motivation, interest and effort brings potential advantages to the current measure over other anhedonia scales. Its
structure seems to be suitable to differentiate anhedonia state of anhedonia trait in different diagnoses; which leaves
open the possibility to future studies addressing this issue. Additionally, a future line of research to be consider is the
transdiagnostic study of anhedonia, comparing DARS in patients with different psychiatric diagnoses.

e00074
Predicting response to standard first line treatment in high grade
serous ovarian cancer by angiogenesis-related genes.

Patricia Cruz Castellanos1, Marta Mendiola2, Andrés Redondo3.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00074

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Patricia Cruz Castellanos, Marta Mendiola, Andrés Redondo. Predicting response to standard first line treatment in high grade
serous ovarian cancer by angiogenesis-related genes. IBJ Plus 2018 (S2):e00074 doi: 10.24217/2531-0151.18v1s2.00074.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Predicting response to treatment in High Grade Serous Ovarian Carcinoma (HGSOC) still remains a scientific
challenge. The standard of care for first line treatment, based on a combination of carboplatin and paclitaxel, achieves
high response rate, but the development of drug-resistance is one of the major limitations of efficacy. Therefore, the
identification of biomarkers able to stratify patients is a critical step for prognosis and treatment of disease. Emerging
and consolidated evidences suggest that angiogenesis is an important process in the development of ovarian carcinoma
and chemoresistance phenomena.

Material and Methods: The aim of this study is to identify selected genes or a combination of them related to this process
as biomarkers for response in HGSOC. We include thirty-nine patients diagnosed with HGSOC, with formalin-fixed and
paraffin-embedded (FFPE) biopsy tissue and clinical data available and we examined the baseline tumor expression of
82 angiogenesis-related genes.

Results: Univariate analysis identified 5 statistically significant genes (ANGPT1, ARNT, CD34, EGF and MMP3) associated
to response to treatment. Also, a multivariate analysis by Lasso-penalized Cox regression generated a model of 7 genes
combined expression (AGT, CD34, EGF, EPOR, IL8, MMP3 y MMP7). Area under the curve (AUC) and Cross-validated
Kaplan-Meier were generated to estimate the predictive accuracy of these predictors, that need of further validation in
order to confirm these results. Our data support the important role of angiogenesis in ovarian carcinoma.

Conclusion: In conclusion, we have identified a reduced marker profile that could have a role in the prediction to standard
chemotherapy response in HGSOC, but further investigation for validating it is needed.

e00075
Levels of molecular biomarkers of angiogenesis and growth
(Intraplatelet) in patients with systemic sclerosis with pulmonary
involvement.

Bryan Josué Flores Robles1,2*, José Luis Andréu Sánchez2, María Alejandra Sánchez3, José Luis Bueno Gil4, Natalia Martos Gisbert5, Hildegarda Godoy
Tundidor2, Juan Mulero Mendoza2.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00075

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Bryan Josué Flores Robles, José Luis Andréu Sánchez, María Alejandra Sánchez, José Luis Bueno Gil, Natalia Martos Gisbert,
Hildegarda Godoy Tundidor, Juan Mulero Mendoza. Levels of molecular biomarkers of angiogenesis and growth (Intraplatelet) in
patients with systemic sclerosis with pulmonary involvement. IBJ Plus 2018 (S2):e00075 doi: 10.24217/2531-0151.18v1s2.00075.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Systemic sclerosis is a serious disease of the connective tissue, characterized mainly by dysfunction of the
microcirculation, dysregulation of the immune system and fibrosis in various organs. Angiogenesis is a complex process
regulated by both angiogenic and angiostatic factors. Normally the functions of these factors are under an adequate
balance, however, under certain conditions these factors can be induced, initiating disorganized angiogenic phenomena.
Among the angiogenic factors with high levels it is VEGF-α, PDGF BB, HGF, TFG-β1, FGF2, G-CSF, Ang-2, leptin, IL 8, IL 6,
IL1. However, these levels have been done in serum and never intraplatelet as in this work.

Methods: We have consecutively included 24 patients who met criteria for systemic sclerosis proposed by ACR / EULAR
2013 and who had been assessed in the different services, during the follow-up, at least one videocapillaroscopic study
was carried out, respiratory function tests, echocardiogram and high resolution tomography. Additionally, patient records
were accessed to obtain all clinical, serological and demographic parameters. The patient was referred to the Unit of
Non-Transfusion Hemotherapy to collect platelet-poor plasma and platelet-rich plasma using an apheresis procedure
and thus obtained the platelet concentrate sample (PCS) and the plasma sample (PS) in which the desired angiogenic
factors will be measured (Currently samples are frozen at -80 c, pending financial support from two relevant entities to
purchase the kits).
Sixteen healthy individuals (controls) were recruited. The platelet samples will be lysed through the freeze-thaw system
and subsequently the growth factors (GF) will be measured in said sample, together with the plasma GF levels will be
measured (VEGF-α, PDGF BB, HGF, TFG-β1, FGF2, G-CSF, IGF-1, IL 8, IL 6, IL1).

Results and Conclusions: A descriptive summary has been made of the data collected from the patients without finding
statistically significant associations (multivariable study), however, this is not the objective of the study, since the main
objective is to assess intraplatelet factor levels. We hope that the day of the symposium we will have the preliminary
results since in recent days we have received the money for the purchase of the kit of growth factors that we will to
measure.

e00076
How does self-efficacy influence pain perception, postural stability
and range of motion in individuals with chronic low back pain?

La Touche, Roy1,4, Grande-Alonso Mónica1,2, Arnés-Prieto Paloma1, Paris-Alemany Alba1,4.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00076

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: La Touche, Roy, Grande-Alonso Mónica, Arnés-Prieto Paloma, Paris-Alemany Alba. How does self-efficacy influence
pain perception, postural stability and range of motion in individuals with chronic low back pain? IBJ Plus 2018 (S2):e00076 doi:
10.24217/2531-0151.18v1s2.00076.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Low back pain (LBP) is the most prevalent musculoskeletal problem among adults, its a great socioeconomic
impact and one of the most frequent cause of work absenteeism and disability. Subjects with chronic LBP (CLBP) can
present an alteration in psychological factors and a lack of self-efficacy of pain. This study aimed to compare the process
of summation induced by the repetition of pain related to activity, as well as the lumbar range of motion and postural
stability in patients with non-specific DLC (NSLBP) based on the level of self-efficacy.

Material and Methods: Sixty patients with NSCLBP were classified into two groups based on a median split of
score on the Chronic Pain Self-Efficacy Scale; High self-efficacy group (n=30) with a mean age of 38.17 ±12.24
and low self-efficacy group with a mean age of 36.53±13.83. After consenting to participate, all the recruited
participants received a sociodemographic questionnaire, a set of self-report measures and completed the Temporal
Summation Lifting Task, Lumbar Range of Motion and Multi-Directional Functional Reach Test (MDFRT).

Results: Our results indicated that low self-efficacy group presented less lumbar range of motion and postural stability,
in addition to more pain intensity in temporal summation lifting task compared to patients in high self-efficacy group.
The strongest correlations were found in the analysis for the high self-efficacy group where it was found that there was
a positive relation between the fear of movement and temporal summation lifting task (r = .711 p < .01) and MDFRT
forward (r = .738 p < .01).

Conclusions: In conclusion, high of self-efficacy group has less intensity of pain in the temporal summation lifting task,
more range of movement and a greater functional range, in addition to a less influence of psychological factors.

e00077
Mortality associated factors of patients admitted with flu during 2015-2016 and 2016-2017.

Alberto Mangas Moro1, Carlos Javier Carpio Segura1, Ester Zamarrón de Lucas1, Concepción Prados Sánchez1, José Ramón Arribas López2, Beatriz
Díaz Pollán2, Rodolfo Álvarez-Sala Walther1, Multidisciplinary Flu Team.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00077

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Alberto Mangas Moro, Carlos Javier Carpio Segura, Ester Zamarrón de Lucas, Concepción Prados Sánchez, José Ramón Arribas
López, Beatriz Díaz Pollán, Rodolfo Álvarez-Sala Walther, Multidisciplinary Flu Team. Mortality associated factors of patients admitted
with flu during 2015-2016 and 2016-2017. IBJ Plus 2018 (S2):e00077 doi: 10.24217/2531-0151.18v1s2.00077.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

OBJECTIVES: The aim of this study is to analyze demographic and clinic factors related to mortality of patients admitted
due to flu during 2015-2016 and 2016-2017 periods, at La Paz University Hospital of the Community of Madrid, Spain.

MATERIAL AND METHODS: This is an unicentric, transversal and retrospective study of patients admitted due to infection
by influenza virus at La Paz University Hospital, during 2015-2016 and 2016-2017 periods. Demographic, clinical,
microbiological, therapeutic and comorbidities characteristics were collected for this group of patients. Univariate and
multivariate analysis were performed in order to evaluate the objective of the study. Ethic guidelines were followed.

RESULTS: 33 out of 429 patients included in the study died (2015-2016 period: 4 patients; 2016-2017: 29 patients).
Mortality risk factors observed: development of secondary bacterial pneumonia (OR 3.3 [1.6-7.1]), acute respiratory
distress syndrome (ARDS) (OR 7.1 [2.8-18.1]), multiorgan failure (MOF) (OR 16.4 [7.1-38.1]). On the other hand,
oseltamivir antiviral treatment proved to be a protective factor (OR 0.4 [0.1-0.8]). In the multivariate analysis, age (OR
1.067 [1.02-1.11]) and multiorgan failure (MOF) (OR 43.2 [13.1-142.8]) were independently associated to the mortality
of the analyzed patients; while antiviral treatment was a protective factor itself (OR 0.3 [0.1-0.7]).

CONCLUSION: Mortality associated to patients admitted with flu would be related to old age and to multiple organ
failure. Moreover, the oseltamivir treatment is a protective factor towards mortality.

e00078
Inhibitor of differentiation-1 (ID1) expression correlates with
epithelial-mesenchymal-transition (EMT)-related proteins in
epithelial ovarian cancer (EOC) and constitutes a novel prognostic
factor.

Alberto Berjón1,2, Victoria Heredia2,3, Andrés Redondo4,5,7, Laura Yébenes1,2, Alberto Peláez-García2, Marta Mendiola2,3,6, David Hardisson1,2,6,7.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00078

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Alberto Berjón, Victoria Heredia, Andrés Redondo, Laura Yébenes, Alberto Peláez-García, Marta Mendiola, David Hardisson.
Inhibitor of differentiation-1 (ID1) expression correlates with epithelial-mesenchymal-transition (EMT)-related proteins in epithelial
ovarian cancer (EOC) and constitutes a novel prognostic factor. IBJ Plus 2018 (S2):e00078 doi: 10.24217/2531-0151.18v1s2.00078.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Ovarian cancer is the most lethal gynecological cancer, and most patients present with advanced stage
disease. To date, outcome prediction after multimodal therapy remains one of the most important challenges for
patient’s stratification according to effective treatments.
Epithelial to mesenchymal transition (EMT) is now recognized as a potential mechanism for tumor progression. One of
the main hallmarks of this process is the loss of E-cadherin (ECAD) by the activation of transcriptional repressors such
as Snail and Slug.

Objectives: To investigate the expression of inhibitors of differentiation (ID) proteins in Advanced Epithelial Ovarian
Cancer (AEOC) and their relation with EMT-related markers. To analyze IDs expression in relation with clinical and
pathological features in order to establish their role as prognostic factors.
Material and Methods: 69 patients with AEOC (stages III-IV) were included in this study. All patients underwent surgical
cytoreduction and received a combined chemotherapy with carboplatin and paclitaxel. Immunohistochemistry (IHC)
with specific antibodies for ID1, ID2, ID3 and ID4 was performed on tissue microarray sections, as well as for some EMT
regulators, including ECAD, ZEB1, ZEB2, SNAIL, SLUG, LOX, and LOXL2.
Expression levels were scored for intensity (range 0-3) multiplied by the percentage of positive cells (H-score). Survival
curves were calculated using the Kaplan–Meier method, and hazard ratios were estimated using the Cox proportional
hazards model. IDs expression was correlated with appropriate clinical and pathological variables.

Results: ID2 and ID3 proteins were uniformly expressed in our series of EOC. ID1 and ID4 were overexpressed in
different proportions (41% and 88% of cases, respectively). No correlation between increased ID proteins expression and
histological subtype, tumor grading, debulking surgery status or treatment response was detected. ID1 overexpression
correlated with prognosis, specifically with Time to Treatment Failure (TTF) in both, uni- and multivariate analysis
adjusted to clinical factors (HR: 1.06; 95% CI: 1.02 – 1.09), and with Overall Survival (OS) [HR: 1.03 (95% CI: 1.00 – 1.05)]
in the univariate analysis. This finding was confirmed in the group of high-grade serous carcinomas. ID1 is known to be
associated with more invasive features of cancer, and with EMT. In our cohort, ID1 expression was correlated with some
EMT-regulators, such as ECAD and SLUG (p< 0.05).

Conclusions: ID proteins expression is frequently deregulated in EOC patients and it seems to influence clinical prognosis,
particularly, ID1. Their usefulness as prognostic biomarkers should be further investigated in larger series.

e00079
Radio as an instrument of rehabilitation and recovery in patients
diagnosed with severe and chronic mental disorders in community
settings.

Carlos Manuel Leal Leal1, José María Poveda de Agustín1, Manuel Angel Fernández Sande2.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00079

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Carlos Manuel Leal Leal, José María Poveda de Agustín, Manuel Angel Fernández Sande. Radio as an instrument of rehabilitation
and recovery in patients diagnosed with severe and chronic mental disorders in community settings. IBJ Plus 2018 (S2):e00079 doi:
10.24217/2531-0151.18v1s2.00079.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: The purpose of this research is to study how the performance of a radio workshop affects the rehabilitation
(psychiatric and psychosocial) and recovery of patients diagnosed with severe and chronic mental disorder in three
Centers for Psychosocial Rehabilitation (CRPS) of the Community of Madrid that carry out radio programs on community
radio stations.

Method: It is an exploratory, applied, transversal, descriptive, explanatory and comprehensive study. We have used
a comprehensive multi-method model based on the integral theory that has combined methodological pluralism,
where three investigative moments have been established, a first analytical empirical moment, a second hermeneutical
phenomenological moment and a third investigative moment where participant observation has been used. The sample
is constituted by 23 users of the CRPS of Los Cármenes, Villaverde and Getafe who have participated in the radio programs
Ábrete Camino, Mejor Imposible, and Frecuencia favorable; seven coordinators-therapists of the radio workshops; three
directors of the CRPS of Los Cármenes, Villaverde and Getafe; and three directors of the community radio stations Radio
Onda Merlín Comunitaria, Radio Getafe and Radio Ágora Sol.

Results: Radio, as a mass media, is an excellent instrument that enables recovery and psychosocial rehabilitation, since
it allows the radio workshop participants to establish new interpersonal relationships, increase motivation, enhance
their autonomy, strengthen decision-making and responsibility, commitment to the activity and colleagues, facilitate
free expression, creativity and spontaneity, encourage and increase the critical spirit, promote involvement throughout
the recovery process, work awareness of the population on the reality of the person with mental disorder, and develop
positive attitudes towards group work. On the other hand, the scores in the Brief Psychiatric Rating Scale, BPRS, at the
time of the start of radio activity and at the present time (time to do the research), show that psychiatric symptoms
improve with radio activity, except in the case of hallucinations and delusional thinking, which got worse.

Conclusions: The participation in a radio workshop in a community setting by patients with a diagnosis of severe and
chronic mental disorder allows to promote autonomy, stimulate social relationships, the development of new roles,
support the overcoming and remission of symptoms, and favoring the community integration.

e00080
Characteristics of cystic fibrosis (CF) patients with troubled
evolution after suffering an atelectasis.

María Martínez-Redondo1; Concepción Prados Sánchez1; Francisco García-Rio1; Carlos Carpio Segura1; Esther Quintana Gallego2; Silvia Castillo
Escorullón3; Antonio Salcedo Posadas1; Rosa Girón Moreno1; Maite Martínez Martínez1; Marta García Clemente 4; Luis Máiz Carro1; Marina Blanco
Aparicio 5;David Iturbe Fernández 6; Jochen G Mainz7; Rodolfo Álvarez-Sala Walther1.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00080

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: María Martínez-Redondo, Concepción Prados Sánchez, Francisco García-Rio, Carlos Carpio Segura, Esther Quintana Gallego,
Silvia Castillo Escorullón, Antonio Salcedo Posadas, Rosa Girón Moreno, Maite Martínez Martínez, Marta García Clemente, Luis Máiz
Carro, Marina Blanco Aparicio, David Iturbe Fernández, Jochen G Mainz, Rodolfo Álvarez-Sala Walther. Characteristics of cystic fibrosis
(CF) patients with troubled evolution after suffering an atelectasis. IBJ Plus 2018 (S2):e00080 doi: 10.24217/2531-0151.18v1s2.00080.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: The objective of this study was to analyze atelectasis as a factor of poor prognosis in CF.

Material and methods: A retrospective study was conducted in CF units nationwide. Up to December 2017, 46 CF cases that had
suffered atelectasis have been included. We have studied: demographic data, respiratory infections, pulmonary complications
and comorbidities, lung function and exacerbations, diagnosis through imaging tests, medical and bronchoscopic treatment,
clinical and radiological improvement and final evolution. They were collected in different follow-up periods, following the
ethical regulations of each center.

Results: in our series, atelectasis accounted for 4% of the CF population studied. 11/46 cases (23.9%) had a torpid evolution,
of which six were women (54.5%)
• Microbiology: At the time of atelectasis, Pseudomonas aeruginosa was found in 8/11 patients (72.7%), followed by
Staphylococcus aureus methicillin-sensitive in six of them (54.5%).
• Mutations: six patients were heterozygous, two were homozygous, and two had an unknown allele for the Phe.508
mutation. One patient had a different mutation.
• Location: five patients presented it in RUL (of which, one of them had an episode of bilobar atelectasis together with the
lingula), three patients in LUL and one in LLL, one segmental patient in the left lung and finally, one patient suffered two
episodes of atelectasis that affected the LUL, lingula and ML.
• Pulmonary complications /comorbidities: one patient presented ABPA and another had a pneumothorax. Three patients
suffered an hemoptysis, of which two required embolization. Of the total of eleven patients, only two of them did not
present pancreatic insufficiency.
• 4 patients died (36.4%): 1 patient died in the transplant, another included in the list and the last two, without having
even entered the list, at the ages of 26, 31, 33 and 39 years, respectively, between 1 and 9 years after the diagnosis of
atelectasis.
• 7 live patients (63.6%): 5 patients received a lung transplant, 1 patient was in the transplant waiting list, 1 patient
required the realization of a right pneumonectomy.

Conclusions:
Risk factors could be established for the appearance of atelectasis with torpid evolution: carrier of the Phe.508del mutation, recurrent hemoptysis, localization in upper lung lobes, pancreatic insufficiency and polymicrobial chronic bronchial infection (P. aeruginosa and SAMS)
A fall in FEV1 is observed after atelectasis, causing death, entry into the transplant list or finally the transplant, and motivating, in the current study, to know if in our cohort, this decline is due to the evolution of the underlying disease or the appearance of pulmonary complication

e00081
T cell exhaustion profile (CD4+/CD28- CD8+/CD28-) in stem cell
transplantation (SCT) and respiratory viral infection (RVI). Clinicoepidemiological
findings.

Miguel Villanueva1, Angela Figuera1, Yaiza Perez2, Clara Cuellar1, Jose María Galván3, Cecilia Muñoz2.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00081

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Miguel Villanueva, Angela Figuera, Yaiza Perez, Clara Cuellar, Jose María Galván, Cecilia Muñoz. T cell exhaustion profile
(CD4+/CD28- CD8+/CD28-) in stem cell transplantation (SCT) and respiratory viral infection (RVI). Clinico-epidemiological findings. IBJ
Plus 2018 (S2):e00081 doi: 10.24217/2531-0151.18v1s2.00081.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Background: Recipients of allogeneic stem cells grafts have clonally expanded CD8+/CD28- and CD4+/CD28- T
lymphocytes during the early period after SCT, this cellular dynamic is probably associated with the acquisition of a toxic
phenotype who overproduce granzime and perforin. This scenario predisposes to continuous inflammation, increase
Tcell cytotoxic, NK activity (NKPer+Gran+) and favor the appearance of senescent lymphocytes. The direct consequences
of respiratory viral infection (RVI),could also initiate a cascade of immunologic events (T cell exhaustion, inflammation)

Methods: In a prospective study, peripheral blood samples were obtained previous SCT and at day +100 post SCT from 34
patients (11 autologous, 23 allogeneic).To evaluate the expression of CD4+/CD28-Per+/Gran+, CD8+/CD28-Per+/Gran+,
flow cytometry analysis was performed:100μL of PB was labeled, with a panel of 8 monoclonal antibodies: PERFORIN
FITC, GRANZIME PE, CD4 PerCP, CD28 APC, CD8 APCH7, CD16/56 V450 and CD45 V500.The molecular detection of RV
were tested with the CLART® Pneumovir assay based on the principle of multiplex PCR and DNA microarray.Statistical
analysis: IBM SPSS v24

Results: 34 patients were evaluated from November 16 to December 17 at the HULP.The median percentages of baseline
CD8+/CD28- cell line was 9,09% (range, 4,1-14,7) and the median percentages of CD8+/CD28-cell line at +100d were
29,2% (range, 13,3 -38,9). Likewise, significant differences were found (p=0.001). We compared between the group of
patients who had a RVI and the group without RVI: We found differences between patients with VRI and those who did
not have VRI in the CD8+/CD28- +100d cell line, the median percentages of the RVI patients were 58.43% (range, 42.72-
68.43) and the median percentages in the uninfected were 29.26% (range, 13.26-38.94) (p=0.002).

Conclusion: This is the first data publication of this project, we show a dynamic change in the exhausted phenotype of T
cell lymphocytes CD8+/CD28- throughout the SCT. There is a statistically significant difference when analyzing patients
infected with RV vs non infected patients (baseline vs + 100d). In agreement with previous reports, there was a marked
increased od CD8+/CD28- cell fraction early after SCT. Exposure to certain VR in the first 100d after STC may contribute
the appearance of populations of exhausted T lymphocytes CD8+/CD28- favoring a sustained inflammatory environment
and probably works as a trigger in certain immune-dysregulation

e00082
Relevance of nocturnal hypoxemia and alterations of REM sleep
in carbohydrate metabolism disorders.

Ester Zamarrón de Lucas1,2,3, Elisabeth Martínez Cerón1,2,3, Raquel Casitas Mateo1,2,3, Raúl Galera Martínez1,2,3, Isabel Fernández Navarro1,2,3,
Francisco García Río1,2,3

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00082

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Ester Zamarrón de Lucas, Elisabeth Martínez Cerón, Raquel Casitas Mateo, Raúl Galera Martínez, Isabel Fernández Navarro,
Francisco García Río. Relevance of nocturnal hypoxemia and alterations of REM sleep in carbohydrate metabolism disorders. IBJ Plus
2018 (S2):e00082 doi: 10.24217/2531-0151.18v1s2.00082

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction. Several evidences suggest a possible relationship between respiratory sleep disorders and the development
of insulin resistance (IR) and later, diabetes.

Objective: To compare sleep characteristics among people without IR, with IR or with established diabetes.
Material and methods. We selected 96 consecutive subjects referred to a multidisciplinary unit of sleep breathing
disorders for suspected obstructive sleep apnea. The anthropometric and clinical characteristics were collected, including
comorbidities and usual treatment. A supervised video-polysomnography was performed, according to guidelines, and
the next morning, an extraction of venous blood was carried out to determine the HOMA and QUICKI indexes. IR was
considered when HOMA> 2 or QUICKI <0.339.

Results: 30 subjects had a normal carbohydrate metabolism, so they were considered as a control group, while 48 had
IR and 18 had diabetes. There was no significant difference in the anthropometric characteristics or in the association
with other metabolic or cardiovascular comorbidities when the three groups were compared. A progressive increase
in nocturnal hypoxemia was noted between the control group, with IR and diabetes, based either on the desaturation
index (18.5 ± 12.8 vs. 27.8 ± 18.2 vs. 41.1 ± 13.3 h-1, p = 0.045) or in the nighttime with SatO2 < 90% (12.5 ± 12.5 vs. 21.9
± 17.0 vs. 35.8 ± 18.1%, p = 0.042). Likewise, control groups, with IR and with diabetes showed a progressive increase in
the hypopnea index (18.6 ± 14.0 vs. 21.6 ± 22.5 vs. 33.6 ± 23.8 h-1, p = 0.033) and in the RDI (25.4 ± 12.7 vs. 27.4 ± 18.8
vs. 45.2 ± 19.8 h-1, p = 0.048). Strikingly, differences between the study groups were only evident in the REM sleep, both
for the hypopnea index (15.2 ± 14.2 vs. 17.5 ± 20.0 vs. 32.0 ± 28, 7 h-1, p = 0.021) as for the RDI (11.4 ± 18.8 vs. 24.5 ±
16.3 ± 37.1 ± 17.5 h-1, p = 0.036).

Conclusion: There is a progression in nocturnal hypoxemia and in the presence of respiratory events among patients
suffering from IR and diabetes. It is likely that the contribution of these alterations to the dysregulation of carbohydrate
metabolism has a particular relevance during the REM sleep.

e00083
Correlation between metacarpal cortical bone mineral density
measured by dual x-ray densitometry and radiogrammetry on
early arthritis patients.

I. Llorente1*, L. Merino3, A. M. Ortiz1, S. González3, E. Escolano2, J. A. García Vadillo1, E. F. Vicente1, R. García Vicuña1, I. González1, S. Castañeda1.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00083

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: I. Llorente, L. Merino, A. M. Ortiz, S. González, E. Escolano, J. A. García Vadillo, E. F. Vicente, R. García Vicuña, I. González, S.
Castañeda. Correlation between metacarpal cortical bone mineral density measured by dual x-ray densitometry and radiogrammetry
on early arthritis patients. IBJ Plus 2018 (S2):e00083 doi: 10.24217/2531-0151.18v1s2.00083.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Low bone mass at metacarpal (MC) diaphysis measured by radiogrammetry (DXR) has been described as
a poor prognostic factor in rheumatoid arthritis (RA). This technique is not available in our environment. Our group has
previously described the measurement of bone mineral density (BMD) at metacarpophalangeal joints (MCP) by dual
X-ray absorptiometry (DXA). This measurement showed an acceptable correlation with the DXR at MC bones. DXR at MC
mainly assesses cortical bone, whereas DXA at MCP mainly analyzes trabecular bone. We have developed a procedure
to evaluate MC’s (2nd to 4th) bone mass of the nondominant hand through DXA.

Objectives: To study the correlation between BMD at 2nd to 4th MC of the nondominant hand measured by DXA with
data obtained by DXR.

Methods: 171 patients belonging to the Princesa Early Arthritis Reginster Longitudinal (PEARL) (84% women, 55.4 years
at symptoms onset; 56.7% fulfilled RA 2010 criteria; 52% RF+ and 43.5% ACPA+). Demographic, clinical and laboratory
data were collected per protocol. Hand X-rays were performed at baseline and after one year of follow-up, as well as
nondominant hand BMD assessment by DXA (Hologic © QDR4500, Elite). The standard Hologic© software allows to
design regions of interest (ROI) similar to that in DXR. The BMD by DXA was the average of 3 successive measurements.
The BMD by DXR was measured with standardized software Sectra (Linköping, Sweden) on hand digital X-ray (GE © DX
Definium 8000).
Statistical analysis was performed using Stata 12 for Windows, including linear correlations according to the Spearman
test between the BMD values of MC by DXA and DXR and BMD by DXA at global hand and MCP joints. A multivariate
analysis was performed to determine which variables account for the differences between MC bone mass measured by
DXR and DXA.

Results: 248 BMD measurements (154 at baseline and 94 at second visit) of the 3 regions described whose values BMD
0.529±0.074 g/cm2 (MC-DXR); 0.427±0.060 g/cm2 (MC-DXA), 0.327±0.041 g/cm2 (Total Hand DXA), 0.265±0.040 g/
cm2 (MCP DXA). Difference with MC-DXR: 0.104±0.074 (MC-DXA; p<0.0001), 0.206±0.060 (Total Hand DXA; p<0.0001),
0.268±0.053 (MCP DXA; p<0.0001). Correlation with MC-DXR: 0.865 (MC-DXA; p<0.0001), 0.824 (Total Hand DXA;
p<0.0001), 0.717 (MCP DXA; p<0.0001).

Conclusions: MC bone mass measured by DXA shows the lowest absolute difference and the best correlation with MC
bone mass by DXR. Female gender (beta coefficient = 0.013; p = 0.039), patients older than 65 year old (beta coefficient
= 0.014; p = 0.019) and patients with higher body mass index (beta coefficient = 0.002 by kg/m2; p = 0.019) were
significantly associated with lower differences between the values of MC by DXA and DXR.

e00084
Is HCV-RNA in Chronic Hepatitis C Recipients of Kidney
Transplantation detected by Ultracentrifugation or in Peripheral
Blood Mononuclear Cells, after antiviral treatment and Sustained
Viral Response?

Teresa Olea1, Carlos Jiménez1, Inmaculada Castillo2, María José Santana1, Rafael Selgas1, Vicente Carreño2.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00084

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Teresa Olea, Carlos Jiménez, Inmaculada Castillo, María José Santana, Rafael Selgas, Vicente Carreño. Is HCV-RNA in Chronic
Hepatitis C Recipients of Kidney Transplantation detected by Ultracentrifugation or in Peripheral Blood Mononuclear Cells, after
antiviral treatment and Sustained Viral Response? IBJ Plus 2018 (S2):e00084 doi: 10.24217/2531-0151.18v1s2.00084.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Background and aim: Presence of HCV- RNA after ultracentrifugation of serum samples during the follow-up of chronic
hepatitis C patients with a sustained virological response (SVR) has previously described to predict reactivation of
hepatitis C virus (HCV) infection, in patients treated with conventional antivirals. The aim of this study is to analyse
if HCV- RNA is detected after serum ultracentrifugation or by peripheral blood mononuclear cells (PBMC) in chronic
hepatitis C recipients of kidney transplantation (KT) with a SVR (defined as serum HCV-RNA negativity by conventional
assays 6 months after the end of therapy) to antiviral therapy.
Patients and methods: We tested 13 adults recipients of KT, whose HCV infection had been treated with antiviral therapy.
HCV –RNA was tested by real-time RT- PCR in PBMC and in 2 ml of plasma after ultracentrifugation.

Results: Only in one male, genotype 1b, previously treated with interferon, HCV- RNA was detected in plasma by
ultracentrifugation. HCV- RNA was no detected in any case by RT- PCR in PBMC. We included 9 males, (69.2%), whose
etiology of renal insufficiency was mostly a glomerular disease (38.5%) followed by hereditary (23,1%), or systemic
(15.4%). All the patients had previously received dialysis, (hemodialysis in 58.3%, peritoneal dialysis in 16.7%, and both
in 20%). 7 patients (53.7%), had their first KT, and in the others were the second one. The predominant HCV genotype
was 1b (53.8%), followed by 3a (46.2%). 6 patients had been treated with DAA. 3 of them had been previously treated
with interferon, and had a reactivation of HCV infection, then treated with direct-acting antiviral (DAA). HCV- RNA was
no detected in PBMC or in plasma after ultracentrifugation in any case in those patients, treated with DAA.

Conclusions: Only in one male, genotype 1b, previously treated with interferon in monotherapy, HCV- RNA was detected
in plasma by ultracentrifugation. HCV- RNA was no detected in any case by RT- PCR in PBMC and either in the 6 recipients
of KT treated with DAA by RT- PCR in PBMC and in plasma after ultracentrifugation. Although more patients and longer
follow up, are need, to make definitive conclusions, it seems that DAA are more effective, than conventional antivirals.

e00085
Role of HIF2α oxygen sensing pathway in bronchial epithelium
biology.

M. Torres-Capelli1, G. Marsboom2, Q. O. Yang Li1, D. Tello1, F. Melendez Rodriguez1, T. Alonso3, G. Peces Barba4, F. Garcia-Rio5, J. Ancochea3, J. Aragonés1

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00085

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: M. Torres-Capelli, G. Marsboom, Q. O. Yang Li, D. Tello, F. Melendez Rodriguez, T. Alonso, G. Peces Barba, F. Garcia-Rio,
J. Ancochea, J. Aragonés. Role of HIF2α oxygen sensing pathway in bronchial epithelium biology. IBJ Plus 2018 (S2):e00085 doi:
10.24217/2531-0151.18v1s2.00085.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Pulmonary epithelium is the first contact line with oxygen but the role of hypoxia-inducible factors (HIFs) in the
airway’s primary response to oxygen fluctuations as well as cigarette smoke remains largely unknown. The lung exhibits the
highest levels of HIF2α, which is the main regulator of renal erythropoietin (Epo) in response to hypoxia.

Objectives: Here, we first explored whether HIF2α isoform could also induce Epo in the lung as a compensatory response to
hypoxia and second, whether the HIF-dependent program could also be induced in other scenarios different from hypoxia such
as cigarette smoke exposure.

Methods: We used mouse models of loss and gain of function of HIF2α pathway as well as mice exposure to atmospheric hypoxia
and cigarette smoke. Lung tissues from these mice were subjected to protein and RNA analysis as well as immunohistochemistry
analysis.

Results: Our novel data shows that lung induces Epo expression in response to hypoxia as well as upon constitutive activation
of the HIF pathway. Importantly, this extra-renal source of erythropoietin is completely dependent on the HIF2α isoform
and mainly confined in the bronchial epithelium. Regarding the relevance of HIF2α in bronchial epithelium, we previously
showed that HIF2a-dependent genes such as Resistin-like molecular-alpha (RELMα) are induced in Club cells in response to
hypoxia. Significantly our latest data also shows that RELMα and other HIF-dependent genes are also remarkably induced in
cigarette smoke-exposed mice.

Conclusions: Our findings have unveiled that bronchial epithelium acts as an extra-renal source of Epo and suggests the role of
airway HIF expression in response to cigarette smoke exposure.

e00089
Noradrenaline innervation in the primate thalamus: similarities and differences in macaques and humans.

I. Pérez-Santos1, C. Cavada1.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00089

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: I. Pérez-Santos, C. Cavada. Noradrenaline innervation in the primate thalamus: similarities and differences in macaques and
humans. IBJ Plus 2018 (S2):e00089 doi: 10.24217/2531-0151.18v1s2.00089.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Noradrenaline (NA) in the thalamus is interesting because of its role in modulating the transmission of
information, and because of the abnormalities described in some conditions. For instance, NA is depleted in many
thalamic nuclei of Parkinson’s disease patients. Also, noradrenergic drugs are used for diverse purposes, including
anesthesia, posttraumatic stress disorder or attention deficit hyperactivity disorder. Despite this interest, the distribution
of NA axons has not been fully explored in the healthy primate thalamus.

Materials & Methods: We performed immunohistochemistry against dopamine-β-hydroxylase (monkey) and the NA
transporter (monkey and human) on coronal sections containing the thalamus. Afterwards, we built high-resolution
maps of immunoreactive (-ir) axons based on 20x magnification pictures using Neurolucida® software.

Results: In the human and monkey thalamus, the distribution patterns of the NA innervation are overall similar: NAir
axons are present in all thalamic nuclei, albeit with notable density differences. Midline and intralaminar nuclei
(central medial, paraventricular, paracentral) receive the densest NA innervation. Most of the remaining nuclei receive
a moderate innervation. The lateral geniculate nucleus holds the lowest innervation. The reticular nucleus is sparsely
innervated by NA-ir axons.
Differences between the macaque and human thalamus are also present. In macaques, the medial sector of the
mediodorsal nucleus (MD) is densely innervated, whereas in humans MD receives a moderate innervation, only denser in
the most ventral-medial region. The NA innervation in the centromedian-parafascicular (CnMd-Pf) intralaminar complex
is also different in monkeys and humans: In the macaque thalamus, Pf is heavily innervated by NA axons and CnMd holds
an average density; whereas in human thalamus, CnMd, in particular at caudal levels of the CnMd-Pf complex, is notably
innervated while Pf holds a weaker density of NA axons. Also, in the human thalamus, the ventral posteromedial (VPM)
and ventral posterolateral (VPL) nuclei appear more densely innervated by NA than in the monkey.

Conclusions: In primates, NA may play a prominent role in thalamo-striatal circuits acting through the intralaminar
and midline nuclei. Because NA axons are located as well in nuclei supporting cortico-thalamo-cortical and subcorticothalamo-
cortical transmission, NA likely modulates transmission also in those pathways. The role of NA in somatosensory
transmission through the thalamus might be more relevant in humans than in macaques, since the relative innervation
of the first order nuclei in this system (VPM and VPL) is denser in the human than in the macaque thalamus.

e00090
Medial prefrontal cortex modulation of thalamic whisker responses in urethane-anesthetized rats.

Guillermo Escudero Pérez1, Ángel Núñez Molina1.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00090

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Guillermo Escudero Pérez, Ángel Núñez Molina. Medial prefrontal cortex modulation of thalamic whisker responses in urethane-anesthetized rats. IBJ Plus 2018 (S2):e00090 doi: 10.24217/2531-0151.18v1s2.00090.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: The medial prefrontal cortex (mPFC) has been implicated in novelty detection and attentional processes
so it could modulate sensory responses in the cortex and/or in the thalamus. The effect of mPFC stimulation on whisker
responses recorded in the ventroposterior medial thalamic nucleus (VPM) or the posterior thalamic nucleus (POm) has
been studied in urethane-anesthetized rats.

Material and Methods: Local field potentials and unit recordings were performed in the VPM or POm nuclei and in the
Zona Incerta (ZI). Somatosensory evoked potentials were elicited by whisker deflections. Current pulses were delivered
by bipolar stimulating electrodes aimed at the prelimbic (PL) and infralimbic (IL) areas of mPFC or lateral Superior
Colliculus (lSC).

Results: Current train stimulation (50 Hz, 500 ms) on PL induced a long-lasting facilitation of whisker responses
in the VPM nucleus, but only a short-lasting inhibition in the POm nucleus. Similar train stimulation on IL induced a
short-lasting facilitation of whisker responses in both VPM and POm nuclei. This facilitatory effect was underlied by
corticofugal projections since it was reduced after S1BC cortical inactivation with lidocaine, and by activation of the
NMDA glutamatergic receptors which were blocked by D-APV (50 μM). Paired stimulation of the mPFC and whisker
deflections revealed an inhibitory effect at short intervals (50 – 100 ms), which may be due to TRN and ZI activation.
Likewise, PL-lSC paired stimulation provided a facilitatory effect on the majority of recorded incertal neurons even at
long intervals (50 – 300 ms) while inhibition could be seen on the 29% of these neurons only up to 100 ms. IL-lSC
paired stimulation showed a facilitatory effect on the 25% of the incertal neurons in a very short interval (50 ms) and a
inhibitory effect on the 33% of these neurons which remained up to 100 ms.

Conclusion: Multi-synaptic prefrontal modulation of somatosensory drives in the thalamus may require the recruitment
of different GABAergic populations as those found in the TRN and ZI nuclei.

e00091
Gait evaluation of patients with mild cognitive decline and mild
alzheimer´s disease.

Martín-Gonzalo JA1,2, Wang Y1, Wang T1, Gomez-Andrés D1,4, Pulido-Valdeolivas I1,5, Torrecillas-Narváez D3, Chiclana-Actis G3, Algarra-Lucas C3,
Miralles-Martínez A3, Rausell E1*.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00091

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as:Martín-Gonzalo JA, Wang Y, Wang T, Gomez-Andrés D, Pulido-Valdeolivas I, Torrecillas-Narváez D, Chiclana-Actis G, Algarra-
Lucas C, Miralles-Martínez A, Rausell E. Gait Evaluation of patients with Mild Cognitive Decline and Mild Alzheimer´s Disease. IBJ Plus
2018 (S2):e00091 doi: 10.24217/2531-0151.18v1s2.00091.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Mild Cognitive Decline (MCD) is a clinical stage characterized by a memory and/or cognitive function loss which does not
interfere with daily routines. That condition is part of a process that in a noticeable percentage of patients progresses
towards Mild Alzheimer´s Disease (MAD), which is characterized by a cognitive loss that affects the patient´s daily life
activities. Early detection of which MCD patients will convert into MAD remains a challenge that would represent a
key to design appropriate therapeutic approaches. Patients with MCD and MAD suffer gait alterations that deteriorate
progressively and can be described observationally within a wide spectrum of impairment even preceding the cognitive
alterations. We reckoned that Instrumental Gait Analysis (IGA) should allow us to describe accurately the gait kinematic
changes that coexist with abnormal cognitive function, with the hypothesis that we should find a gait biomarker to
differentiate both conditions.

We recruited 25 patients with MCD (56%women; median age 71yrs, IQR 9.0yrs; median MMSE score 25pts, IQR 6pts)
and 26 patients with MAD (53%women; median age 69yrs, IQR 7.3yrs; median MMSE 20pts, IQR 5.3pts) diagnosed
in a specialized unit at the H.U. Infanta Sofía. 79 voluntary subjects were also recruited as a control group (CG, 56%
women; median age 68yrs, IQR 10yrs; median MMSE 30pts, IQR 1pt). 43 gait left and right lower limb spatiotemporal
and kinematic parameters were extracted in a single session from 4-5 cycles from each subject. Those had been acquired
by a 3D-optoelectronic system (CODAmotion) and processed with homemade software for validation. We assessed
differences CG vs. MCD, CG vs. MAD and MCD vs. MAD by means of Cohen’s d (an effect size statistic that is calculated
as the difference of groups means normalized by a pooled standard deviation) and their confidence intervals (95%CI).
Walking speed and cadence are similar in MCD and MAD patients but lower than CG being the variability higher in
patients. Double support time is significantly increased in patients. Compare to CG, there is a trend by which the range
of hip flexion, knee flexion, ankle flexion and foot progression angle is decreased in MCD patients and this is statistically
significance for MAD patients. However, there are no significant differences between MCD and MAD except in the ranges
of ankle dorsiflexion in swing and stance.

These results suggest that conversion MCD-MAD occurs within a spectrum of changes in the lower limb joint control by
which gait is progressively slower, more variable at expense of lower push off. This conditions a shorter advance of the
oscillating leg and therefore lower cadence and lower walking speed and longer support time

e00092
Dopamine innervation of the mediodorsal and reticular thalamic nuclei in MPTP parkinsonian monkeys.

M.H.G. Monje1,2, J.Blesa2, M.A. García-Cabezas1,3, M.A. Sánchez-González1, J.A. Obeso2,4, C. Cavada1*.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00092

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: M.H.G. Monje, J.Blesa, M.A. García-Cabezas, M.A. Sánchez-González, J.A. Obeso, C. Cavada. Dopamine innervation of
the mediodorsal and reticular thalamic nuclei in MPTP parkinsonian monkeys. IBJ Plus 2018 (S2):e00092 doi: 10.24217/2531-
0151.18v1s2.00092.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Dopamine loss in parkinsonism affects most intensely the mesostriatal system. Understanding how
dopamine loss affects brain structures beyond the striatum is, nonetheless, important to understand barely explained
pathogenic mechanisms and clinical manifestations. Because the primate thalamus is densely innervated by dopaminergic
axons, we hypothesised that a dopamine deficit might be present in the thalamus of the parkinsonian brain. Also, given
the heterogeneity of the thalamus, differences might be present among the different nuclei. We have explored the
mediodorsal and reticular nuclei because of their relevant role in attention, cognition and brain synchronization.

Materials and Methods: We used immunohistochemistry against the dopamine transporter (DAT) in brain sections of
control and parkinsonian monkeys. The toxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was administered
to adult macaque monkeys via a slow intoxication protocol. The intoxicated monkeys were distributed in four groups
by motor tests: asymptomatic, recovered, mild parkinsonian and severe parkinsonian. After immunoreaction (ir) of the
brain sections, we estimated the total length of DAT-ir axons in the mediodorsal and reticular thalamic nuclei using a 3D
fractionator. We also generated maps of the distribution of the DAT-ir axons.

Results: Compared to control animals, parkinsonian monkeys exhibited less DAT-ir axonal length in the MD nucleus.
The dopamine denervation was already present in monkeys that were asymptomatic at the time of sacrifice and
showed moderate substantia nigra cell loss (40-60%). The dopamine denervation was most pronounced in the severe
parkinsonian animals. By contrast, parkinsonian monkeys had an increase of DAT-ir axonal length in the reticular nucleus
relative to control monkeys. The maps of DAT-ir axons support the quantitative findings.

Conclusions: The above results show a heterogeneous reaction of thalamic dopamine to MPTP intoxication. Changes
in the dopaminergic innervation of the thalamus may result in dysfunction of thalamocortical and intrathalamic
transmission and may contribute to motor and non-motor manifestations of PD, especially attention defects and sleep
disturbances.

e00093
Myelination-promoting drugs acting on oligodendrocyte
precursor cells generated by direct lineage conversion from adult
rat mesenchymal cells.

Jorge Pascual-Guerra1, Lara Vellosillo1, Gonzalo Gómez-Hernández1, Mª Paz Muñoz1, Carlos Luis Paíno1*.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00093

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: Jorge Pascual-Guerra, Lara Vellosillo, Gonzalo Gómez-Hernández, Mª Paz Muñoz, Carlos Luis Paíno. Myelination-promoting
drugs acting on oligodendrocyte precursor cells generated by direct lineage conversion from adult rat mesenchymal cells. IBJ Plus
2018 (S2):e00093 doi: 10.24217/2531-0151.18v1s2.00093.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Dopamine loss in parkinsonism affects most intensely the mesostriatal system. Understanding how
dopamine loss affects brain structures beyond the striatum is, nonetheless, important to understand barely explained
pathogenic mechanisms and clinical manifestations. Because the primate thalamus is densely innervated by dopaminergic
axons, we hypothesised that a dopamine deficit might be present in the thalamus of the parkinsonian brain. Also, given
the heterogeneity of the thalamus, differences might be present among the different nuclei. We have explored the
mediodorsal and reticular nuclei because of their relevant role in attention, cognition and brain synchronization.

Materials and Methods: We used immunohistochemistry against the dopamine transporter (DAT) in brain sections of
control and parkinsonian monkeys. The toxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) was administered
to adult macaque monkeys via a slow intoxication protocol. The intoxicated monkeys were distributed in four groups
by motor tests: asymptomatic, recovered, mild parkinsonian and severe parkinsonian. After immunoreaction (ir) of the
brain sections, we estimated the total length of DAT-ir axons in the mediodorsal and reticular thalamic nuclei using a 3D
fractionator. We also generated maps of the distribution of the DAT-ir axons.

Results: Compared to control animals, parkinsonian monkeys exhibited less DAT-ir axonal length in the MD nucleus.
The dopamine denervation was already present in monkeys that were asymptomatic at the time of sacrifice and
showed moderate substantia nigra cell loss (40-60%). The dopamine denervation was most pronounced in the severe
parkinsonian animals. By contrast, parkinsonian monkeys had an increase of DAT-ir axonal length in the reticular nucleus
relative to control monkeys. The maps of DAT-ir axons support the quantitative findings.

Conclusions: The above results show a heterogeneous reaction of thalamic dopamine to MPTP intoxication. Changes
in the dopaminergic innervation of the thalamus may result in dysfunction of thalamocortical and intrathalamic
transmission and may contribute to motor and non-motor manifestations of PD, especially attention defects and sleep
disturbances.

e00094
Endocannabinoid mediated NMDAR independent ltd of glutamatergic synaptic transmission at layer v pyramidal neurons of rat infralimbic cortex.

JA. Noriega-Prieto1, LE. Maglio1,2, D. Fernandez de Sevilla1*.

Published May 18, 2018.

DOI: 10.24217/2531-0151.18v1s2.00094

Copyright: © 2018 Author. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite as: JA. Noriega-Prieto, LE. Maglio, D. Fernandez de Sevilla. Endocannabinoid mediated NMDAR independent ltd of glutamatergic
synaptic transmission at layer v pyramidal neurons of rat infralimbic cortex. IBJ Plus 2018 (S2):e00094 doi: 10.24217/2531-
0151.18v1s2.00094.

Edited: Madrid, España.

Editor: Alberto M. Borobia Pérez.

Abstract

Introduction: Some forms of spike timing-dependent LTD at cortical glutamatergic synapses require the coactivation of
presynaptic NMDA and CB1 receptors, being crucial the release of endocannabinoids by postsynaptic calcium spikes.

Methods:
•Electrophysiology: In vitro. Patch-Clamp recordings at layer V pyramidal neurons in whole-cell voltage-clamp and
current-clamp configurations.
•Calcium Imaging. Cytosolic calcium elevations analysis with Fluo-4 indicator.

Results: Here we have analyzed the role of calcium spikes on the induction of LTD at glutamatergic synapses of layer V
pyramidal neurons of rat infralimnic cortex. After recording the control postsynaptic currents (PSCs) evoked by electrical
stimulation in the basal dendrites, we increased the stimulation intensity to generate a postsynaptic potential (PSP)
followed by an action potential (AP) and a calcium spike (PSP-AP-Ca2+ spike responses). Repeating the stimulation 60
times at a frequency of 0.2 Hz induced a robust long-term depression (> 40 minutes) on the PSC peak amplitude (48.9 ±
4.15% compared to control). The LTD was blocked under Nifedipine (20μM) plus D-AP5 (50 μM) when APs were blocked
by intracelullar QX-314 (5mM). However LTD was unaffected by intracelullar QX-314 (5mM) or Nifedipine (20μM) plus
D-AP5 (50 μM) applied alone. A similar LTD was obtained when EPSCs were isolated under PiTX (50 microM). This LTD
was mediated presynaptically because the decrease in the amplitude of the EPSCs was associated with a change in the
coefficient of variation, being unaffected the postsynaptic currents evoked by local puff application of glutamate. The
LTD of the PSCs was prevented by intracellular BAPTA or by AM251 bath superfussion. In addition, AM251 was not able
to prevent the LTD of the EPSCs recorded under PiTX.

Conclusion: Taken together our results suggest that the cytosolic calcium increase mediated by the PSP-AP-Ca2+ spike
responses release endocannabinoids from layer V pyramidal neuron that reduce the GABAAR mediated inhibition
allowing the induction of a NMDAR independent presynaptic LTD of the EPSCs.