Explore the vast range of titles available.

Functional dependence for the performance of basic activities of daily living (ADLs) is one of the main causes of institutionalization. This study analyzed the interrelationships between basic and instrumental activities of daily living, use of assistive mobility devices, socioeconomic factors, changes during COVID-19 pandemic confinement, and 3-year survival in the ADL-dependent people of the Orcasitas neighborhood of Madrid (Spain). A longitudinal descriptive study, carried out on the entire population of functional dependent patients (Barthel ≤ 60) in the Orcasitas neighborhood. We included 127 patients, 78.7% women and 21.3% men, with a mean age of 86 years. Pre-pandemic, post-confinement (June 2020) and June 2023 data were contrasted. Results: The use of crutches-cane was associated with a higher probability of being independent in performing ADLs, leaving home (OR 4.848; CI 1.428-16.458), improving functional capacity during confinement (OR 3.621; CI 1.409-9.308), and even ceasing to be functionally dependent (OR 0.394; CI 0.165-0.941). Using a wheelchair was associated with a higher level of dependency (OR 2.583; CI 1.167-5.714) and higher mortality (HR 1.913; CI 1.106-3.309). After COVID-19 pandemic confinement, having a financial income of less than 11,200 euros/year (OR 2.413; CI 1.159-5.023), or using a wheelchair (OR 2.464; CI 1.009-6.017), increased the risk of living homebound. Living homebound decreased the probability of survival, while maintaining the ability to leave home increased it (OR 3.880; CI 1.834-8.211). Economic capacity modulated the results. Lower economic capacity was associated with higher mortality (HR 2.47 (Exp(B) 0.405; CI 0.232-0.708). Living in confinement and having a low economic income were associated with higher mortality (OR 0.127; CI 0.029-0.562), mortality that was also higher with respect to those who could leave their home (OR 6.697; CI 2.084-21.525). Functional ADL-dependence affects multiple facets of the person. Confinement triggered changes in the baseline conditions of this cohort, which were influenced by the level of dependency, mobility capacity and economic income level. Economic capacity modulated the results, showing that social inequalities influence survival. The ability to leave home and the use of a wheelchair should be included in the assessment of the risk level of this population group.

IntroductionFunctional dependence for the performance of basic activities of daily living (ADLs) is one of the main causes of institutionalization. This study analyzed the interrelationships between basic and instrumental activities of daily living, use of assistive mobility devices, socioeconomic factors, changes during COVID-19 pandemic confinement, and 3-year survival in the ADL-dependent people of the Orcasitas neighborhood of Madrid (Spain).MethodsA longitudinal descriptive study, carried out on the entire population of functional dependent patients (Barthel ≤ 60) in the Orcasitas neighborhood. We included 127 patients, 78.7% women and 21.3% men, with a mean age of 86 years. Pre-pandemic, post-confinement (June 2020) and June 2023 data were contrasted.ResultsResults: The use of crutches-cane was associated with a higher probability of being independent in performing ADLs, leaving home (OR 4.848; CI 1.428-16.458), improving functional capacity during confinement (OR 3.621; CI 1.409-9.308), and even ceasing to be functionally dependent (OR 0.394; CI 0.165-0.941). Using a wheelchair was associated with a higher level of dependency (OR 2.583; CI 1.167-5.714) and higher mortality (HR 1.913; CI 1.106-3.309). After COVID-19 pandemic confinement, having a financial income of less than 11,200 euros/year (OR 2.413; CI 1.159-5.023), or using a wheelchair (OR 2.464; CI 1.009-6.017), increased the risk of living homebound. Living homebound decreased the probability of survival, while maintaining the ability to leave home increased it (OR 3.880; CI 1.834-8.211). Economic capacity modulated the results. Lower economic capacity was associated with higher mortality (HR 2.47 (Exp(B) 0.405; CI 0.232-0.708). Living in confinement and having a low economic income were associated with higher mortality (OR 0.127; CI 0.029-0.562), mortality that was also higher with respect to those who could leave their home (OR 6.697; CI 2.084-21.525).ConclusionsFunctional ADL-dependence affects multiple facets of the person. Confinement triggered changes in the baseline conditions of this cohort, which were influenced by the level of dependency, mobility capacity and economic income level. Economic capacity modulated the results, showing that social inequalities influence survival. The ability to leave home and the use of a wheelchair should be included in the assessment of the risk level of this population group.

MicroRNAs (miRNAs) have a crucial role in regulating immune response against infectious diseases, showing changes early in disease onset and before the detection of the pathogen. Thus, we aimed to analyze the plasma miRNA profile at COVID-19 onset to identify miRNAs as early prognostic biomarkers of severity and survival. Plasma miRNome of 96 COVID-19 patients that developed asymptomatic/mild, moderate and severe disease was sequenced together with a group of healthy controls. Plasma immune-related biomarkers were also assessed. COVID-19 patients showed 200 significant differentially expressed (SDE) miRNAs concerning healthy controls, with upregulated putative targets of SARS-CoV-2, and inflammatory miRNAs. Among COVID-19 patients, 75 SDE miRNAs were observed in asymptomatic/mild compared to symptomatic patients, which were involved in platelet aggregation and cytokine pathways, among others. Moreover, 137 SDE miRNAs were identified between severe and moderate patients, where miRNAs targeting the SARS CoV-2 genome were the most strongly disrupted. Finally, we constructed a mortality predictive risk score (miRNA-MRS) with ten miRNAs. Patients with higher values had a higher risk of 90-days mortality (hazard ratio = 4.60; p-value < 0.001). Besides, the discriminant power of miRNA-MRS was significantly higher than the observed for age and gender (AUROC = 0.970 vs. 0.881; p = 0.042). SARS-CoV-2 infection deeply disturbs the plasma miRNome from an early stage of COVID-19, making miRNAs highly valuable as early predictors of severity and mortality.

Background Diagnosing septic shock promptly is essential but challenging, especially due to its clinical similarity to non-septic shock. Extracellular vesicle-derived miRNAs may serve as biomarkers to distinguish septic shock from non-septic shock, providing a more accurate diagnostic tool for postsurgical patients. This study aims to identify extracellular vesicle-derived miRNA signatures that differentiate septic shock from non-septic shock in postsurgical patients, potentially improving diagnostic accuracy and clinical decision-making. Methods A multicentre, prospective study was conducted on miRNA profiles in shock patients. Two cohorts were recruited from the Intensive Care Units of two Spanish hospitals: a discovery cohort with 109 patients and a validation cohort with 52 patients. Plasma samples were collected within 24 h of shock diagnosis and subjected to miRNA sequencing. High-throughput sequencing data from the discovery cohort were analysed to identify differentially expressed miRNAs. These findings were validated via qPCR in the validation cohort. Results Thirty miRNAs were identified as significantly differentially expressed between septic and non-septic shock patients. Among these, six miRNAs—miR-100-5p, miR-484, miR-10a-5p, miR-148a-3p, miR-342-3p, and miR-451a—demonstrated strong diagnostic capabilities for septic shock. A combination of miR-100-5p, miR-148a-3p, and miR-451a achieved an area under the curve of 0.894, with qPCR validation in the validation cohort yielding an area under the curve of 0.960. Conclusions This study highlights extracellular vesicle-derived miRNAs as promising biomarkers for differentiating septic from non-septic shock. The identified three-miRNA signature has significant potential to enhance septic shock diagnosis, thereby aiding in timely and appropriate treatment for postsurgical patients.

Cities are complex systems requiring urban design models that balance order and disorder. Collective creativity initiatives engage citizens in these processes, empowering bottom-up approaches that prioritize people and social well-being within urban development. This paper investigates an ‘Urban Laboratory’ as a case study, examining the potential of collective creativity to address urban complexity. The successful and ongoing project ‘El Campo de Cebada’ in Madrid, Spain, demonstrates how a community transformed a vacant lot into a vibrant social hub. The phases of this study include case selection, data collection, data analysis, and presentation of the results. This study identifies key enabling factors, including agents, management, social dynamics, infrastructure, and actions. These insights offer a methodological framework for designing future collaborative, resilient, and inclusive urban spaces, addressing the complex needs of communities within our cities.

Coinfection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) alter lipid and glucose metabolism mediated by cytokines release. Our aim was to assess the evolution in metabolic plasmatic markers of people living with HIV (PLHIV) after HCV elimination either spontaneously or with direct active antivirals (DAAs). Multicenter prospective study of 116 HIV patients: i) HCV chronically infected patients (CHC) = 45; ii) Spontaneous clarifiers (SC) = 36; and iii) HIV control group = 35. HCV-exposed patients were all studied at baseline and 48 weeks after achieving sustained virological response (SVR). Plasma levels of 14 metabolic biomarkers were measured. Differences between groups were evaluated by statistical methods. At baseline, CHC patients showed higher levels of adiponectin, NGAL and sICAM-1, than the control group. After achieving SVR, the CHC group showed a significant decrease in the 3 cytokines that were increased at baseline: adiponectin, NGAL and sICAM. In contrast, there was an increase in cortisol. After the end of the follow-up CHC showed normalization of all measured markers that were increased at baseline. Any changes were observed in the same follow-up period for the SC group. Chronically coinfected HIV + /HCV + patients showed altered levels in lipid and glucose metabolism compared to HIV monoinfected subjects and spontaneous clearers. The elimination of chronic HCV infection by DAAs normalized the metabolism profile except for cortisol that remains increased after reaching RSV compared to levels observed in the HCV-/HIV + group. Spontaneous clarification of HCV did not modify metabolism biomarkers in these patients.

Background Around 10% of people with HIV (PWH) exhibit a low-level viremia (LLV) under antiretroviral therapy (ART). However, its origin and clinical significance are largely unknown, particularly at viremias between 50 and 200 copies/mL and under modern ART based on integrase strand transfer inhibitors (INSTIs). Our aim was to characterize their poor immune response against HIV in comparison to individuals with suppressed viremia (SV) and non-HIV controls (NHC). Methods Transversal observational study in 81 matched participants: 27 PWH with LLV, 27 PWH with SV, and 27 NHC. Activation (CD25, HLA-DR, and CD38) and senescence [CD57, PD1, and HAVCR2 (TIM3)] were characterized in peripheral T-cell subsets by spectral flow cytometry. 45 soluble biomarkers of systemic inflammation were evaluated by immunoassays. Differences in cell frequencies and plasma biomarkers among groups were evaluated by a generalized additive model for location, scale, and shape (GAMLSS) and generalized linear model (GLM) respectively, adjusted by age, sex at birth, and ART regimen. Results The median age was 53 years and 77.8% were male. Compared to NHC, PWH showed a lower CD4+/CD8+ ratio and increased activation, senescence, and inflammation, highlighting IL-13 in LLV. In addition, LLV showed a downtrend in the frequency of CD8+ naive and effector memory (EM) type 1 compared to SV, along with higher activation and senescence in CD4+ and CD8+ EM and terminally differentiated effector memory RA+ (TEMRA) subpopulations. No significant differences in systemic inflammation were observed between PWH groups. Conclusion LLV between 50 and 200 copies/mL leads to reduced cytotoxic activity and T-cell dysfunction that could affect cytokine production, being unable to control and eliminate infected cells. The increase in senescence markers suggests a progressive loss of immunological memory and a reduction in the proliferative capacity of immune cells. This accelerated immune aging could lead to an increased risk of developing future comorbidities. These findings strongly advocate for heightened surveillance of these PWH to promptly identify potential future complications.

Various immune checkpoint proteins have been linked to cirrhosis. This study aimed to explore the association between plasma levels of these proteins measured one year after successful HCV treatment and persistently liver stiffness (defined as liver stiffness measurement (LSM) ≥ 12.5 kPa) five years after HCV treatment in people with HIV (PWH). We conducted a retrospective study involving 39 patients with HIV/HCV-coinfection who had advanced fibrosis or cirrhosis and achieved sustained virologic response (SVR). Plasma samples were obtained one year after treatment, and levels of immune checkpoints along with inflammatory biomarkers were evaluated using a Luminex 200 TM analyzer. Statistical analyses were performed using Generalized Linear Models (GLMs) with a gamma distribution. Spearman correlation tests were used to analyze the correlation between significant immune checkpoints and inflammatory biomarkers. Although LSM values showed a decreasing trend over the years following successful HCV treatment, this trend was not statistically significant due to substantial variability among PWH. Persistently high liver stiffness was observed in 61.5% of patients five years after HCV treatment. Elevated plasma levels of soluble BTLA, PD-1, and TIM-3 one year after HCV treatment were associated with persistently liver stiffness five years later. These significant immune checkpoints were found to correlate with inflammatory biomarkers in PWH with persistently high liver stiffness. In conclusion, increased plasma concentrations of immune checkpoints one year after successful HCV therapy were linked to persistently high liver stiffness five years later, particularly BTLA, PD-1, and TIM-3. This suggests a potential immunopathological mechanism in ongoing liver stiffness post-HCV eradication.

Recent advances in visual programming tools for algorithmic modelling have significantly expanded the possibilities for designing industrial products. This study analyses the capacity and adaptability of Grasshopper, a graphical algorithm editor integrated with Rhinoceros 3D, as a parametric design tool in the development of product platforms. Three case studies were conducted to evaluate the impact of parameter configuration in product families: perfume bottles, outdoor furniture, and desk organisers. The analysis provided insight into the ability of Grasshopper to (1) automate the generation of product variants within platforms; (2) enable the flexible creation of scalable, customised design alternatives; and (3) improve efficiency in the platform design process in terms of time and technical resources. The results show that Grasshopper provides strong capabilities for customising geometric parameters compared to traditional modelling in Rhinoceros 3D. However, its adaptability is more limited when customisation involves interdependent parameters, such as those related to ergonomics or usability, due to the difficulty of translating these requirements into algorithmic structures. In addition, the initial definition of parameters and constraints may restrict modifications in later design phases. These findings underline the need for algorithm models that support iterative adjustments and flexible reconfiguration throughout all phases of the design process.