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Background People’s life expectancy has increased significantly in the past few decades, which has been associated with an increased prevalence of chronic diseases. Chronic-complex patients (CCP), including those characterized as polypathological patients (PPP), are now the majority among chronic patients and are considered a priority group in healthcare settings. This study aimed to determine the health-related quality of life (QoL) of Spanish CCP and its association with sociodemographic, clinical and functional variables and cognitive status. Methods Patients identified as CCP or PPP from six hospitals in the Community of Madrid were included. The primary endpoint was to determine the QoL of CCP/PPP. To do so, patients were asked to complete the EuroQol questionnaire that included the visual analog scale (EQ-VAS), and the questionnaire with 5 dimensions and 5 levels (EQ-5D-5 L). Several socio-demographic/health-related variables were further evaluated and correlated with QoL. Results A total of 128 CCP/PPP were included. A median EQ-VAS score of 60.0 [45.0, 80.0, and 0.64 [0.40, 0.79] on the EQ-5D-5 L Index were observed. Moderate to severe pain, functional impairment, gait disorders, and malnutrition were independently associated with poorer QoL when using the EQ-5D-5 L scale, and with the last two variables (gait disorders and malnutrition) when using the EQ-VAS scale. Conclusion The present study highlights the need for better strategies to qualify and validate the QoL in this specific group of patients. Given the small sample of respondents, the present findings should be considered preliminary and only for hypothesis generation. Nevertheless, it further sheds some light on the different factors that should be considered, not only to stratify patients at varying levels of QoL but also to modulate the life quality of CCP/PPP in daily care setting. Trial registration Not applicable.

(1) Background: The inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. (2) Methods: Retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish SEMI-COVID-19 Registry. The three categories of low, intermediate, and high risk were determined by taking into consideration the terciles of the total lymphocyte count and the values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer taken at the time of admission. (3) Results: A total of 17,122 patients were included in the study. The high-risk group was older (57.9 vs. 64.2 vs. 70.4 years; p < 0.001) and predominantly male (37.5% vs. 46.9% vs. 60.1%; p < 0.001). They had a higher degree of dependence in daily tasks prior to admission (moderate-severe dependency in 10.8% vs. 14.1% vs. 17%; p < 0.001), arterial hypertension (36.9% vs. 45.2% vs. 52.8%; p < 0.001), dyslipidemia (28.4% vs. 37% vs. 40.6%; p < 0.001), diabetes mellitus (11.9% vs. 17.1% vs. 20.5%; p < 0.001), ischemic heart disease (3.7% vs. 6.5% vs. 8.4%; p < 0.001), heart failure (3.4% vs. 5.2% vs. 7.6%; p < 0.001), liver disease (1.1% vs. 3% vs. 3.9%; p = 0.002), chronic renal failure (2.3% vs. 3.6% vs. 6.7%; p < 0.001), cancer (6.5% vs. 7.2% vs. 11.1%; p < 0.001), and chronic obstructive pulmonary disease (5.7% vs. 5.4% vs. 7.1%; p < 0.001). They presented more frequently with fever, dyspnea, and vomiting. These patients more frequently required high flow nasal cannula (3.1% vs. 4.4% vs. 9.7%; p < 0.001), non-invasive mechanical ventilation (0.9% vs. 3% vs. 6.3%; p < 0.001), invasive mechanical ventilation (0.6% vs. 2.7% vs. 8.7%; p < 0.001), and ICU admission (0.9% vs. 3.6% vs. 10.6%; p < 0.001), and had a higher percentage of in-hospital mortality (2.3% vs. 6.2% vs. 23.9%; p < 0.001). The three risk categories proved to be an independent risk factor in multivariate analyses. (4) Conclusion: The present study identifies three risk categories for the requirement of high flow nasal cannula, mechanical ventilation, ICU admission, and in-hospital mortality based on lymphopenia and inflammatory parameters.

Background Corpora amylacea of human brain, recently renamed as wasteosomes, are granular structures that appear during aging and also accumulate in specific areas of the brain in neurodegenerative conditions. Acting as waste containers, wasteosomes are formed by polyglucosan aggregates that entrap and isolate toxic and waste substances of different origins. They are expelled from the brain to the cerebrospinal fluid (CSF), and can be phagocytosed by macrophages. In the present study, we analyze the phagocytosis of wasteosomes and the mechanisms involved in this process. Accordingly, we purified wasteosomes from post-mortem extracted human CSF and incubated them with THP-1 macrophages. Immunofluorescence staining and time-lapse recording techniques were performed to evaluate the phagocytosis. We also immunostained human hippocampal sections to study possible interactions between wasteosomes and macrophages at central nervous system interfaces. Results We observed that the wasteosomes obtained from post-mortem extracted CSF are opsonized by MBL and the C3b complement protein. Moreover, we observed that CD206 and CD35 receptors may be involved in the phagocytosis of these wasteosomes by THP-1 macrophages. Once phagocytosed, wasteosomes become degraded and some of the resulting fractions can be exposed on the surface of macrophages and interchanged between different macrophages. However, brain tissue studies show that, in physiological conditions, CD206 but not CD35 receptors may be involved in the phagocytosis of wasteosomes. Conclusions The present study indicates that macrophages have the machinery required to process and degrade wasteosomes, and that macrophages can interact in different ways with wasteosomes. In physiological conditions, the main mechanism involve CD206 receptors and M2 macrophages, which trigger the phagocytosis of wasteosomes without inducing inflammatory responses, thus avoiding tissue damage. However, altered wasteosomes like those obtained from post-mortem extracted CSF, which may exhibit waste elements, become opsonized by MBL and C3b, and so CD35 receptors constitute another possible mechanism of phagocytosis, leading in this case to inflammatory responses.

The role of 2-hydroxy-(4-methylseleno)butanoic acid (OH-SeMet), a form of organic selenium (Se), in selenoprotein synthesis and inflammatory response of THP1-derived macrophages stimulated with lipopolysaccharide (LPS) has been investigated. Glutathione peroxidase (GPX) activity, GPX1 gene expression, selenoprotein P (SELENOP) protein and gene expression, and reactive oxygen species (ROS) production were studied in Se-deprived conditions (6 and 24 h). Then, macrophages were supplemented with OH-SeMet for 72 h and GPX1 and SELENOP gene expression were determined. The protective effect of OH-SeMet against oxidative stress was studied in H2O2-stimulated macrophages, as well as the effect on GPX1 gene expression, oxidative stress, cytokine production (TNFα, IL-1β and IL-10), and phagocytic and killing capacities after LPS stimulation. Se deprivation induced a reduction in GPX activity, GPX1 gene expression, and SELENOP protein and gene expression at 24 h. OH-SeMet upregulated GPX1 and SELENOP gene expression and decreased ROS production after H2O2 treatment. In LPS-stimulated macrophages, OH-SeMet upregulated GPX1 gene expression, enhanced phagocytic and killing capacities, and reduced ROS and cytokine production. Therefore, OH-SeMet supplementation supports selenoprotein expression and controls oxidative burst and cytokine production while enhancing phagocytic and killing capacities, modulating the inflammatory response, and avoiding the potentially toxic insult produced by highly activated macrophages.

To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3–15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01–1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06–1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26–2.69), asthma (OR: 1.52; 95% CI: 1.04–2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86–0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76–0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00–1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.

Introducción. La actual ley educativa española propone un cambio de paradigma con la incorporación de métodos activos. En España este abordaje no resultaba habitual en Educación Física (EF). Objetivo. Este trabajo analiza la adquisición de competencias del bachillerato mediante el Aprendizaje Basado en Proyectos (ABP) y Aprendizaje-Servicio (ApS). Para ello se establecieron cuatro proyectos: sesión de prácticas motrices; programa de acondicionamiento físico; expresión corporal, y propuesta de organización de un evento relacionado con prácticas motrices. Este último se vinculó con las escuelas deportivas del centro, con otras materias (departamento de economía) y otras instituciones (Programa Xogade - Xunta de Galicia). Todo ello logró dinamizar la práctica motriz del centro bajo principios de “banco de tiempo”, sistema por el que los participantes debían colaborar en la organización de otras actividades, y el trabajo colaborativo. Metodología. Para la evaluación se utilizaron herramientas cuantitativas (cuestionario tipo Likert) y cualitativas (cuestionario con preguntas cerradas y abierta, y diario del profesor). Resultados. Los resultados mostraron que la propuesta permitió la adquisición de competencias tradicionalmente no asociadas a la EF. Así, las percibidas como más desarrolladas fueron: la competencia “social y ciudadana”, “autonomía e iniciativa personal”, “conocimiento e interacción con el mundo físico” y “aprender a aprender”. Además, la comparación de los resultados de los cuantitativos de las UDs centradas en ABP y ApS con las desarrolladas de forma tradicional permitieron apreciar una mayor percepción de adquisición de competencias en las primeras. Conclusión. La propuesta fue percibida por los estudiantes como más adecuada para desarrollar las competencias que los métodos tradicionales. Introduction. The current Spanish education law proposes a paradigm shift with the incorporation of active methods. In Spain, this approach was not common in Physical Education (PE). Objective. This study analyzes the acquisition of high school skills through Project-Based Learning (PBL) and Service-Learning (SLL). Four projects were established: a motor practice session; a physical conditioning program; body expression; and a proposal to organize an event related to motor practices. The latter was linked to the school's sports schools, other subjects (the Department of Economics), and other institutions (the Xogade Program - Xunta de Galicia). All of this managed to energize the school's motor practice using the principles of \"time banking,\" a system whereby participants were required to collaborate in the organization of other activities, and collaborative work. Methodology. Quantitative tools (Likert-type questionnaire) and qualitative tools (closed-ended and open-ended questionnaires, and teacher diary) were used for the evaluation. Results. The results showed that the proposal enabled the acquisition of competencies not traditionally associated with PE. Thus, those perceived as most developed were: \"social and civic\" competencies, \"personal autonomy and initiative,\" \"knowledge and interaction with the physical world,\" and \"learning to learn.\" Furthermore, comparing the quantitative results of the DUs focused on PBL and SL with those developed traditionally revealed a greater perception of competency acquisition in the former. Conclusion. The proposal was perceived by students as more appropriate for developing competencies than traditional methods. Introdução. A atual lei educativa espanhola propõe uma mudança de paradigma com a incorporação de métodos ativos. Em Espanha, esta abordagem não era comum na Educação Física (EF). Objetivo. Este artigo analisa a aquisição de competências no ensino secundário através da Aprendizagem Baseada em Projetos (ABP) e da Aprendizagem-Serviço (ASP). Foram estabelecidos quatro projetos: uma sessão de prática motora; um programa de condicionamento físico; expressão corporal; e uma proposta para organizar um evento relacionado com práticas motoras. Este último estava ligado às escolas desportivas da escola, a outras disciplinas (Departamento de Economia) e a outras instituições (Programa Xogade - Xunta de Galiza). Tudo isto foi bem-sucedido na otimização da prática motora da escola, utilizando os princípios do \"banco de tempo\", um sistema através do qual os participantes eram solicitados a colaborar na organização de outras atividades e no trabalho colaborativo. Metodologia. Para a avaliação foram utilizadas ferramentas quantitativas (questionário do tipo Likert) e qualitativas (questionários fechados e abertos e diário do professor). Resultados. Os resultados mostraram que a proposta possibilitou a aquisição de competências não tradicionalmente associadas à Educação Física. Assim, as percebidas como mais desenvolvidas foram: competências \"sociais e cívicas\", \"autonomia e iniciativa pessoal\", \"conhecimento e interação com o mundo físico\" e \"aprender a aprender\". Além disso, a comparação dos resultados quantitativos das UD focadas na ABP e na LS com as desenvolvidas tradicionalmente revelou uma maior perceção de aquisição de competências nas primeiras. Conclusão. A proposta foi percebida pelos alunos como mais adequada para o desenvolvimento de competências do que os métodos tradicionais.

(1) Background: Different clinical presentations in COVID-19 are described to date, from mild to severe cases. This study aims to identify different clinical phenotypes in COVID-19 pneumonia using cluster analysis and to assess the prognostic impact among identified clusters in such patients. (2) Methods: Cluster analysis including 11 phenotypic variables was performed in a large cohort of 12,066 COVID-19 patients, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish Society of Internal Medicine (SEMI)-COVID-19 Registry. (3) Results: Of the total of 12,066 patients included in the study, most were males (7052, 58.5%) and Caucasian (10,635, 89.5%), with a mean age at diagnosis of 67 years (standard deviation (SD) 16). The main pre-admission comorbidities were arterial hypertension (6030, 50%), hyperlipidemia (4741, 39.4%) and diabetes mellitus (2309, 19.2%). The average number of days from COVID-19 symptom onset to hospital admission was 6.7 (SD 7). The triad of fever, cough, and dyspnea was present almost uniformly in all 4 clinical phenotypes identified by clustering. Cluster C1 (8737 patients, 72.4%) was the largest, and comprised patients with the triad alone. Cluster C2 (1196 patients, 9.9%) also presented with ageusia and anosmia; cluster C3 (880 patients, 7.3%) also had arthromyalgia, headache, and sore throat; and cluster C4 (1253 patients, 10.4%) also manifested with diarrhea, vomiting, and abdominal pain. Compared to each other, cluster C1 presented the highest in-hospital mortality (24.1% vs. 4.3% vs. 14.7% vs. 18.6%; p < 0.001). The multivariate study identified age, gender (male), body mass index (BMI), arterial hypertension, chronic obstructive pulmonary disease (COPD), ischemic cardiopathy, chronic heart failure, chronic hepatopathy, Charlson’s index, heart rate and respiratory rate upon admission >20 bpm, lower PaO2/FiO2 at admission, higher levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH), and the phenotypic cluster as independent factors for in-hospital death. (4) Conclusions: The present study identified 4 phenotypic clusters in patients with COVID-19 pneumonia, which predicted the in-hospital prognosis of clinical outcomes.

Cyperus esculentus L. tubers (tiger nuts) contain different compounds with several intestinal health-promoting properties. Here, we studied the capacity of tiger nuts from Valencia, Spain, to prevent epithelial barrier function disruption induced by Salmonella enteritidis in Caco-2 cell cultures. Paracellular permeability was assessed by transepithelial electrical resistance (TER) and tight junction protein immunolocalization. Moreover, the effect of tiger nuts on S. enteritidis agglutination, oxidative stress, and Lactobacillus plantarum growth was tested. Compared to controls, tiger nuts partially restored TER in S. enteritidis-infected cultures, an effect confirmed by immunolocalization of tight junction proteins ZO-1 and occludin. The results also revealed that this protective effect may be associated with the capacity to agglutinate the pathogen, restore TER in TNFα-stimulated cultures, and reduce reactive oxygen species in H2O2-stimulated cultures. Moreover, they favor L. plantarum growth. In conclusion, this study demonstrates that the tiger nut protects epithelial barrier function by reducing bacterial invasion, along with counteracting TNFα and H2O2 effects, thus giving an additional value to this tuber as a potential functional food.

Corpora amylacea (CA) in the human brain are granular bodies formed by polyglucosan aggregates that amass waste products of different origins. They are generated by astrocytes, mainly during aging and neurodegenerative conditions, and are located predominantly in periventricular and subpial regions. This study shows that CA are released from these regions to the cerebrospinal fluid and are present in the cervical lymph nodes, into which cerebrospinal fluid drains through the meningeal lymphatic system. We also show that CA can be phagocytosed by macrophages. We conclude that CA can act as containers that remove waste products from the brain and may be involved in a mechanism that cleans the brain. Moreover, we postulate that CA may contribute in some autoimmune brain diseases, exporting brain substances that interact with the immune system, and hypothesize that CA may contain brain markers that may aid in the diagnosis of certain brain diseases.

Maternal diet influences offspring development, immune function, and intestinal health. This study investigates the effects of maternal supplementation with a key component of the Mediterranean Diet, extra virgin olive oil (EVOO), on the immune health of offspring at the end of lactation. Lewis rat dams received either refined olive oil (ROO), EVOO, or water (REF) during gestation and lactation. Plasma immunoglobulin G2c (IgG2c) concentration was elevated in pups born to EVOO-supplemented mothers, indicating enhanced immune development. Histological analysis of the small intestine revealed more goblet cells in the EVOO group, indicating a potential positive effect on the intestinal barrier function. In vitro assays showed that EVOO metabolites did not display cytotoxicity and had improved barrier integrity under a stress stimulus. These findings suggest that maternal EVOO supplementation may have beneficial effects on immune and intestinal development and health in offspring.