Dpto. Medicina, Dermatología y Toxicología

Impact of Body Composition on Intraperitoneal Pressure and Ultrafiltration in Peritoneal Dialysis

2026-01-01T00:00:00Z

Introduction: An increase in body mass index (BMI) raises intraperitoneal pressure (IPP), which in turn counteracts ultrafiltration (UF). However, BMI is not directly associated with UF, contrary to what might be expected. We examined these relationships in greater depth by breaking down BMI into fat tissue index (FTI), lean tissue index (LTI), and overhydration (OHI), assessed by bioimpedance spectroscopy (BIS). Methods: Two peritoneal equilibration tests (PETs) using 4.25%/3.86% dextrose (2 L and 1 L fill volumes) were performed in 76 unselected patients. IPP was measured repeatedly and BIS was conducted to calculate LTI, FTI, OHI and phase angle at 50 kHz (PhA). Results: IPP increased with intraperitoneal volume (empty: 7.8 cmH₂O; 1 L: 10.3 cmH₂O; 2 L: 12.2 cmH₂O) and correlated negatively with UF. BMI correlated positively with IPP but not with UF. FTI correlated positively with BMI and IPP and negatively with UF. LTI did not correlate with BMI or IPP but correlated positively with UF. These relationships were mirrored in aquaporinmediated free water transport (FWT). PhA mirrored LTI. Conclusions: The effects of BMI on IPP and of IPP on UF appear to be mediated by FTI, whereas LTI independently enhances UF. Aquaporin-mediated FWT shows similar associations. Routine assessment of IPP and body composition may help identify patients at higher risk for IPP-related UF impairment.

Estudio de la adherencia al tratamiento con presión continua positiva en la vía aérea en pacientes con síndrome de apnea obstructiva del sueño en el confinamiento impuesto durante la pandemia de COVID-19

2020-01-01T00:00:00Z

El estudio evalúa el impacto del confinamiento impuesto durante la pandemia de COVID-19 sobre la adherencia al tratamiento con presión positiva continua en la vía aérea (CPAP) en pacientes con síndrome de apnea obstructiva del sueño, mediante datos de telemonitorización domiciliaria. En una amplia cohorte de pacientes, se observa un incremento significativo del uso y del cumplimiento terapéutico durante el confinamiento, con mejora de los parámetros de eficacia del tratamiento, independientemente del sexo, la edad o la gravedad de la enfermedad. Los resultados ponen de manifiesto la utilidad de la telemedicina para garantizar la continuidad asistencial en situaciones de restricción del acceso sanitario.

usefulness of artificial neural networks in the diagnosis and treatment of sleep apnea-hypopnea syndrome

2017-01-01T00:00:00Z

Sleep apnea-hypopnea syndrome (SAHS) is a chronic and highly prevalent disease considered a major health problem in industrialized countries. The gold standard diagnostic methodology is in-laboratory nocturnal polysomnography (PSG), which is complex, costly, and time consuming. In order to overcome these limitations, novel and simplified diagnostic alternatives are demanded. Sleep scientists carried out an exhaustive research during the last decades focused on the design of automated expert systems derived from artificial intelligence able to help sleep specialists in their daily practice. Among automated pattern recognition techniques, artificial neural networks (ANNs) have demonstrated to be efficient and accurate algorithms in order to implement computer-aided diagnosis systems aimed at assisting physicians in the management of SAHS. In this regard, several applications of ANNs have been developed, such as classification of patients suspected of suffering from SAHS, apnea-hypopnea index (AHI) prediction, detection and quantification of respiratory events, apneic events classification, automated sleep staging and arousal detection, alertness monitoring systems, and airflow pressure optimization in positive airway pressure (PAP) devices to fit patients’ needs. In the present research, current applications of ANNs in the framework of SAHS management are thoroughly reviewed.

Comparative evaluation of dynamic risk stratification according to ATA 2015 and ATA 2025 in low-risk differentiated thyroid cancer without radioiodine ablation

2026-01-01T00:00:00Z

Purpuse. To compare dynamic risk stratification (DRS) according to the 2015 American Thyroid Association-Momesso et al. 2016 extension (ATA2015-M) and the 2025 ATA update in low-risk differentiated thyroid cancer (DTC) managed without radioactive iodine (I-131), and to explore the role of an intermediate thyroglobulin (Tg) cutoff of 1 ng/mL. Methods. We conducted a retrospective analysis of a prospectively collected cohort of 74 low-risk DTC patients treated with total thyroidectomy (n = 55) or hemithyroidectomy (n = 19) between 2020 and 2024. Clinical, histopathological, and biochemical data were collected. DRS was assessed at the first follow-up visit (6 months after surgery) and at the last visit (median follow-up 27 months [IQR 16–41]) using ATA2015-M and ATA2025 criteria. An exploratory analysis applying a Tg cutoff of 1 ng/mL was performed. Results. According to ATA2015-M, excellent response (ER) rates in total thyroidectomy patients increased from 49.2% at baseline to 52.8% at final follow-up. In contrast, ATA2025 classified 89.1% as ER at baseline and 98.2% at final follow-up (p < 0.001). Using the intermediate cutoff of 1 ng/mL, ER rates were 80.0% and 89.1%, respectively. Reclassification to ER under ATA2025 was primarily driven by anti-thyroglobulin antibody (TgAb) negativization, as Tg values remained stable and below the new 2.5 ng/mL threshold. No structural incomplete responses were observed. Conclusion. ATA2025 criteria substantially increase ER classification in low-risk DTC patients managed without I-131 compared with ATA2015-M. A 1 ng/mL Tg cutoff may provide a more realistic representation of clinical practice. The dynamic trend of TgAb, rather than their presence alone, is a key determinant for reclassification during follow-up.

Arsenic exposure, diabetes-related genes and diabetes prevalence in a general population from Spain

2018-01-01T00:00:00Z

norganic arsenic exposure may be associated with diabetes, but the evidence at low-moderate levels is not sufficient. Polymorphisms in diabetes-related genes have been involved in diabetes risk. We evaluated the association of inorganic arsenic exposure on diabetes in the Hortega Study, a representative sample of a general population from Valladolid, Spain. Total urine arsenic was measured in 1451 adults. Urine arsenic speciation was available in 295 randomly selected participants. To account for the confounding introduced by non-toxic seafood arsenicals, we designed a multiple imputation model to predict the missing arsenobetaine levels. The prevalence of diabetes was 8.3%. The geometric mean of total arsenic was 66.0 μg/g. The adjusted odds ratios (95% confidence interval) for diabetes comparing the highest with the lowest tertile of total arsenic were 1.76 (1.01, 3.09) and 2.14 (1.47, 3.11) before and after arsenobetaine adjustment, respectively. Polymorphisms in several genes including IL8RA, TXN, NR3C2, COX5A and GCLC showed suggestive differential associations of urine total arsenic with diabetes. The findings support the role of arsenic on diabetes and the importance of controlling for seafood arsenicals in populations with high seafood intake. Suggestive arsenic-gene interactions require confirmation in larger studies.

Estrogen receptor genes polymorphisms determine serum lipid profile in healthy postmenopausal women treated with calcium, vitamin D, and genistein

2019-08-01T00:00:00Z

Cardiovascular risk increases in women after menopause. Unfavorable lipid-lipoprotein changes due to a lack of estrogens may have an important role in this context. Estrogen actions are mainly mediated by their binding to two estrogen receptors (ERs) whose signaling may be conditioned by different factors. Calcium, vitamin D, and genistein, among others, cause a beneficial effect on serum lipid profile by its modulation. Some genetic factors can also determine this signal. We determined the possible additive effect of genistein on calcium and vitamin D supplementation regarding serum lipid profile changes and whether ER polymorphisms may mediate in this effect. We performed a prospective, double blind study in which women were randomized in two groups: one group received calcium and vitamin D and the other group received calcium, vitamin D and genistein. Subsequently, we studied rs9340799, rs928554, and rs4986938 ER polymorphisms in both groups. Our results showed that being a carrier of the variant allele G of rs928554 polymorphism was associated with a greater decrease in triglyceride levels and that the homozygous AA genotype of rs9340799 polymorphism was associated with a greater decrease in total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels after calcium, vitamin D, and genistein supplementation. This is the first report showing an association between polymorphisms in ER genes and an improvement of the serum lipid profile after taking calcium, vitamin D, and genistein supplementation in postmenopausal women. It reinforces the hypothesis that genetic factors are crucial in ER signalling.

Trabecular bone score in patients with normocalcemic hyperparathyroidism

2016-01-01T00:00:00Z

Objective: The effects of normocalcemic hyperparathyroidism (NHPT) on bone remain unclear. The objective of this study was to evaluate differences in the trabecular bone score (TBS) of NHPT patients and asymptomatic hypercalcemic hyperparathyroidism (HHPT) patients. Methods: We performed a prospective study that enrolled consecutive patients with asymptomatic hyperparathyroidism (NHPT and HHPT) with a follow-up ≥1 year at the University Hospital of Valladolid, Spain. Metabolic phosphocalcium plasma and urine parameters were evaluated in ≥2 determinations during follow-up to classify patients as NHPT patients or asymptomatic HHPT patients. A control group was enrolled during the same period. TBS and bone mineral density (BMD) were evaluated. Results: Thirty-nine patients with asymptomatic HPT (24 with NHPT and 15 with HHPT) and 24 controls were recruited. NHPT patients and HHPT patients had a similar mean age, vitamin D level, TBS, and areal BMD (all sites). Compared to controls, symptomatic HPT patients had significantly higher parathyroid hormone (PTH) and calcium levels and significantly lower TBS and areal BMD at all sites (all P<.05). A significant negative relationship between TBS and PTH was found in asymptomatic HPT patients (r = -0.320, P = .043), which remained significant after adjustment for age, sex, and body mass index. Conclusion: There was no difference in the TBS between NHPT and HHPT patients. However, there was a reduction in the TBS of patients with asymptomatic HPT that was related to PTH levels but had no repercussion on bone mass. Higher levels of PTH seem to be responsible for this alteration in microarchitecture texture.

Genomic and metabolomic profile associated to clustering of cardio-metabolic risk factors

2016-01-01T00:00:00Z

Background: To identify metabolomic and genomic markers associated with the presence of clustering of cardiometabolic risk factors (CMRFs) from a general population. Methods and findings: One thousand five hundred and two subjects, Caucasian, > 18 years, representative of the general population, were included. Blood pressure measurement, anthropometric parameters and metabolic markers were measured. Subjects were grouped according the number of CMRFs (Group 1: <2; Group 2: 2; Group 3: 3 or more CMRFs). Using SNPlex, 1251 SNPs potentially associated to clustering of three or more CMRFs were analyzed. Serum metabolomic profile was assessed by 1H NMR spectra using a Brucker Advance DRX 600 spectrometer. From the total population, 1217 (mean age 54±19, 50.6% men) with high genotyping call rate were analysed. A differential metabolomic profile, which included products from mitochondrial metabolism, extra mitochondrial metabolism, branched amino acids and fatty acid signals were observed among the three groups. The comparison of metabolomic patterns between subjects of Groups 1 to 3 for each of the genotypes associated to those subjects with three or more CMRFs revealed two SNPs, the rs174577_AA of FADS2 gene and the rs3803_TT of GATA2 transcription factor gene, with minimal or no statistically significant differences. Subjects with and without three or more CMRFs who shared the same genotype and metabolomic profile differed in the pattern of CMRFS cluster. Subjects of Group 3 and the AA genotype of the rs174577 had a lower prevalence of hypertension compared to the CC and CT genotype. In contrast, subjects of Group 3 and the TT genotype of the rs3803 polymorphism had a lower prevalence of T2DM, although they were predominantly males and had higher values of plasma creatinine. Conclusions: The results of the present study add information to the metabolomics profile and to the potential impact of genetic factors on the variants of clustering of cardiometabolic risk factors.

Exon array analysis reveals genetic heterogeneity in atypical femoral fractures. A pilot study

2015-01-01T00:00:00Z

Atraumatic subtrochanteric and diaphyseal (atypical) femoral fractures are a rare, but important adverse event in patients treated with potent anti-resortive agents. The mechanisms involved are unknown and particularly the association with genetic variants has not been explored. The aim of the study was to identify rare genetic variants that could be associated with the occurrence of these fractures. We performed a genome-wide analysis of up to 300,000 variants, mainly distributed in gene coding regions, in 13 patients with atypical femoral fractures and 268 control women, either healthy or with osteoporosis. Twenty one loci were more frequent in the fracture group, with a nominal p value between 1 × 10(-6) and 2.5 × 10(-3). Most patients accumulated two or more allelic variants, and consequently the number of risk variants was markedly different between patients and controls (p = 2.6 × 10(-22)). The results of this pilot study suggest that these fractures are polygenic and are associated with the accumulation of changes in the coding regions of several genes.

Genomic and metabolomic profile associated to microalbuminuria

2014-01-01T00:00:00Z

To identify factors related with the risk to develop microalbuminuria using combined genomic and metabolomic values from a general population study. One thousand five hundred and two subjects, Caucasian, more than 18 years, representative of the general population, were included. Blood pressure measurement and albumin/creatinine ratio were measured in a urine sample. Using SNPlex, 1251 SNPs potentially associated to urinary albumin excretion (UAE) were analyzed. Serum metabolomic profile was assessed by 1H NMR spectra using a Brucker Advance DRX 600 spectrometer. From the total population, 1217 (mean age 54 ± 19, 50.6% men, ACR>30 mg/g in 81 subjects) with high genotyping call rate were analysed. A characteristic metabolomic profile, which included products from mitochondrial and extra mitochondrial metabolism as well as branched amino acids and their derivative signals, were observed in microalbuminuric as compare to normoalbuminuric subjects. The comparison of the metabolomic profile between subjects with different UAE status for each of the genotypes associated to microalbuminuria revealed two SNPs, the rs10492025_TT of RPH3A gene and the rs4359_CC of ACE gene, with minimal or no statistically significant differences. Subjects with and without microalbuminuria, who shared the same genotype and metabolomic profile, differed in age. Microalbuminurics with the CC genotype of the rs4359 polymorphism and with the TT genotype of the rs10492025 polymorphism were seven years older and seventeen years younger, respectively as compared to the whole microalbuminuric subjects. With the same metabolomic environment, characteristic of subjects with microalbuminuria, the TT genotype of the rs10492025 polymorphism seems to increase and the CC genotype of the rs4359 polymorphism seems to reduce risk to develop microalbuminuria.

Evaluation of Muscle Mass and Quality With an AI‐Based Muscle Ultrasound Imaging System in Patients at Risk of Malnutrition

2025-01-01T00:00:00Z

Este estudio observacional transversal evaluó la utilidad de un sistema de ecografía muscular asistido por inteligencia artificial para valorar masa y calidad muscular en 647 pacientes con riesgo de desnutrición. La sarcopenia, definida por criterios EWGSOP2, estuvo presente en el 25,8%. Los pacientes sarcopénicos mostraron menor grosor y área del recto femoral, menor ángulo de penneación y peor calidad muscular por análisis de ecogenicidad. Los parámetros ecográficos se correlacionaron con la fuerza prensil y el ángulo de fase. El análisis multivariante identificó el grosor muscular y la ecogenicidad baja como factores protectores frente a sarcopenia y dinapenia, respectivamente.

Effect of a new plant-based high-energy oral nutritional supplement in adult malnourished patients: an open-label, randomized clinical trial

2025-01-01T00:00:00Z

Este ensayo clínico aleatorizado, abierto y multicéntrico evaluó la eficacia de un suplemento nutricional oral hipercalórico de origen vegetal frente a uno convencional de origen animal en 129 pacientes adultos con desnutrición según criterios GLIM. Tras 12 semanas, ambos grupos mostraron aumentos significativos y comparables de peso corporal, mejora del estado nutricional, fuerza prensil y circunferencia de la pantorrilla, sin diferencias significativas entre intervenciones. El suplemento vegetal demostró no inferioridad respecto al convencional, con buena tolerancia gastrointestinal, alta adherencia y elevada satisfacción de los pacientes. Los resultados respaldan su uso como alternativa eficaz en la práctica clínica.

Effect of Calcium Hydroxy-Methyl-Butyrate-Enriched Diabetes-Specific Oral Nutritional Supplementation on Patients with Heterogeneous Diabetes Mellitus Population with Disease Related Malnutrition Assessed with AI-Assisted Ultrasound Imaging

2025-01-01T00:00:00Z

Este estudio prospectivo observacional evaluó el efecto de una fórmula oral específica para diabetes enriquecida con calcio β-hidroxi-β-metilbutirato (CaHMB) en 95 pacientes con diabetes mellitus y riesgo de desnutrición. Tras tres meses, ambos grupos aumentaron la ingesta energética y proteica, pero solo el grupo con CaHMB mostró incrementos significativos en la masa muscular del recto femoral, medidos por ecografía asistida por inteligencia artificial. El consumo de CaHMB se asoció de forma independiente con mayor probabilidad de mejora en el grosor y el área muscular, sin empeorar el control glucémico, apoyando su utilidad en la prevención de sarcopenia.

Artificial intelligence–assisted rectus femoris ultrasound vs. L3 computed tomography for sarcopenia assessment in oncology patients: establishing diagnostic cut-offs for muscle mass and quality

2025-01-01T00:00:00Z

Este estudio transversal comparó la ecografía del recto femoral asistida por inteligencia artificial con la tomografía computarizada a nivel L3 para la evaluación de la sarcopenia en 337 pacientes oncológicos. La ecografía mostró correlaciones moderadas con los parámetros de masa muscular derivados de la TC y correlaciones significativas, aunque más débiles, con los indicadores de calidad muscular. Se establecieron puntos de corte ecográficos específicos por sexo para masa y calidad muscular, con buen valor predictivo negativo para baja masa muscular y alto valor predictivo positivo para miosteatosis. La ecografía con IA se confirma como una herramienta factible, no invasiva y útil en la práctica clínica.

Association between muscle mass assessed by an artificial intelligence–based ultrasound imaging system and quality of life in patients with cancer-related malnutrition

2025-01-01T00:00:00Z

Este estudio evaluó la asociación entre la masa muscular, medida mediante un sistema de ecografía muscular asistida por inteligencia artificial, y la calidad de vida relacionada con la salud en 158 pacientes ambulatorios con cáncer y desnutrición. La calidad de vida se valoró con el cuestionario EuroQol-5D. Los parámetros musculares del recto femoral (área transversal, grosor muscular y ángulo de penneación) se correlacionaron positivamente con el índice EuroQol-5D, la escala visual y la fuerza muscular, y negativamente con marcadores inflamatorios. En el análisis multivariante, el área muscular y la fuerza fueron determinantes independientes de la calidad de vida.

Soluble Oncoimmunome Signatures Predict Muscle Mass Response to Enriched Immunonutrition in Cancer Patients: Subanalysis of a Multicenter Randomized Clinical Trial

2025-01-01T00:00:00Z

Este subanálisis de un ensayo clínico aleatorizado multicéntrico evaluó el impacto de una suplementación nutricional oral enriquecida sobre la masa muscular y el perfil inmunológico en 28 pacientes oncológicos con desnutrición relacionada con la enfermedad. Tras ocho semanas, solo el grupo con suplemento enriquecido mostró un aumento significativo de peso y masa muscular. El análisis proteómico identificó una reducción de marcadores inflamatorios (TRAIL, LAMP3) y un aumento de galectina-1, asociada a diferenciación miogénica. Además, determinados biomarcadores basales permitieron predecir la respuesta anabólica, apoyando estrategias de inmunonutrición personalizada.