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Disease burden and treatment patterns in patients with hidradenitis suppurativa and concomitant arthritis: a multicenter case-control study
No full textBackground: The relationship between HS and arthritis is well-established; however, the impact of their combined disease burden and the associated treatment pattern have not been determined yet. The aim of this study was to assess disease burden and treatment approaches in HS patients with and without arthritis and estimate the prevalence and distribution of arthritis subtypes among HS patients. Methods: A multicenter, retrospective, case-control study of 272 adults (69 with HS and arthritis; 203 with HS only), matched by sex, age, and HS duration. Data was analyzed using non-parametric tests, linear mixed-effects models, and logistic regression. Results: Patients with HS and arthritis had higher rates of immune-mediated diseases, including inflammatory bowel disease (OR 9.44, p<0.0001) and psoriasis (OR 2.99, p=0.0038). They exhibited higher DLQI scores (6.30 vs. 4.03, p=0.031), more dermatology visits (7 vs. 5, p=0.0077), and increased biologic therapy use (72.1% vs.39.9%, p<0.0001). Arthritis prevalence in HS was 1.7% (0.4-4%) in a cohort of 3,644 patients. Spondyloarthritis was the most common subtype, accounting for 66.6% of cases.Conclusions: HS patients with arthritis have a greater disease burden and higher biologic therapy utilization, emphasizing the need for interdisciplinary care and optimizing resources
Cardiovascular risk assessment in women at high risk for pre-eclampsia in first half of pregnancy
No full textAltres ajuts: Juan Rodés contract (JR19/00047)Background: Women diagnosed with pre-eclampsia (PE), especially those with early-onset and severe forms, are at heightened risk of future cardiovascular disease (CVD). It is uncertain if women at high-risk for PE present cardiovascular impairment at the beginning of pregnancy. The aim of this study was to assess cardiovascular biomarkers and cardiac function in the first half of pregnancy in women at high-risk for PE. Methods: This was a prospective cohort study including women attending first trimester screening for PE. Risk of PE in the first trimester was calculated using a previously validated model, which includes maternal factors and biophysical markers. A cut-off of 1 in 250 was used to classify high-risk for developing PE. Maternal echocardiographic function and morphometry were evaluated, and peripheral blood samples were obtained to assess hematological and biochemical variables, including lipid profile and cardiovascular and angiogenic factors. Results: A total of 349 pregnant individuals were included; 257 at high-risk and 92 at low-risk for PE. Maternal echocardiography was performed at a mean ± SD gestational age of 14.9 ± 1.3 weeks and blood sampling at 16.3 ± 1.9 weeks. The high-risk PE group exhibited a significantly worse lipid profile (lower levels of high-density lipoproteins 69.7 ± 14.2 vs 74.0 ± 14.6 mg/dL, p=0.020), lower placental growth factor (0.89 ± 0.63 vs 1.15 ± 0.58 MoM, p<0.001), and significantly lower levels of N-terminal pro-brain natriuretic peptide (51.0 ± 2.1 vs 52.1 ± 2.0 ng/L, p=0.008). Echocardiographic evaluation indicated concentric remodeling, along with an altered diastolic pattern in the high-risk group. Conclusions: Women at high risk of developing PE exhibit differences in lipid profile, angiogenic factors, and echocardiographic parameters, indicative of cardiac maladaptation or impairment during the first half of pregnancy. These findings suggest a link between subclinical cardiovascular dysfunction, PE development and later CVD risk
Characteristics, treatment, and safety profile in patients with atopic dermatitis based on eligibility for randomized clinical trials: An analysis of the Spanish Atopic Dermatitis Registry (BIOBADATOP)
No full textArticle que forma part d'una tesi per compendi de publicacions. La data d'embargament que ara consta és provisional i es corregirà o s'eliminarà quan es publiqui la versió de l'editor.Background: Advanced systemic treatments for moderate to severe atopic dermatitis (AD) have appeared in recent years. The efficacy and safety of these treatments, however, is supported by data from randomized clinical trials (RCTs) involving a highly selected group of patients. This limits the generalizability of trial findings to the broader population of AD patients. Objective: To determine the proportion of patients receiving advanced systemic treatments for AD in routine clinical practice who are underrepresented in RCTs and to compare the safety and drug survival of these treatments between RCT-eligible and RCT-ineligible patients. Material and methods: Descriptive and comparative analysis of data from the Spanish atopic dermatitis registry BIOBADATOP. Patients were deemed RCT-ineligible if they met at least one of eight common exclusion factors: age ≥65 years; pregnancy desire, pregnancy, or lactation; uncontrolled hypertension, cardiovascular disease, or diabetes; chronic renal disease; current or past cancer diagnosis; liver disease; history of tuberculosis, human immunodeficiency virus or hepatitis B or C infection; and active or acute infection, including superinfection of AD lesions. Results: Of the 366 patients in BIOBADATOP on advanced systemic treatments for AD in March 2024, 18.3% would not be eligible to participate in an RCT. Ineligible patients were older and had more comorbidities than eligible patients. Inclusion of an Eczema Area and Severity Index (EASI) score <16 in the sensitivity analysis increased the proportion of ineligible patients to 22.1%. Janus kinase inhibitors were used less often as a first treatment in RCT-ineligible patients. Serious adverse events were significantly more common in ineligible patients, but this difference was lost after adjusting for age, sex, and comorbidities. Conclusions: Overall, 18.3% of real-world patients with AD-and 22.1% of those with EASI <16-are underrepresented in RCTs. Age and comorbidities influence safety outcomes and should be considered when taking treatment decisions and designing RCTs
Claves y retos en la lectura socializada del libro-cómic : un estudio de caso en un aula de 4º de Educación Primaria
No full textLa lectura socializada del libro-cómic, en el marco de la formación literaria en Primaria, constituye una oportunidad para profundizar en la interpretación multimodal, en la negociación de las diversas interpretaciones y en el aprendizaje metadiscursivo para aprender a hablar sobre el cómic. En este artículo se presenta un estudio de caso orientado a la documentación y análisis de un proyecto de lectura socializada del cómic "Explorando el cómic" en un aula de 4o curso de Educación Primaria (9-10 años). El objetivo del estudio de caso ha consistido en documentar y analizar el valor didáctico de la lectura socializada de cómic, con sus pros y sus dificultades, a través del estudio específico de un proyecto de aula co-diseñado entre maestra e investigadora. El proyecto se implementó en cuatro sesiones en 2022 y los datos se recogieron mediante cuestionarios al alumnado, entrevistas a la docente, grabaciones audiovisuales de las sesiones, fotografías del desarrollo del proyecto y el registro documental en un diario de campo. El análisis de los datos articula varios ejes. Por un lado, se examina el tipo de respuestas lectoras del alumnado durante la lectura socializada del libro-cómic y se identifican las estrategias que se pusieron juego en el contexto de esa lectura multimodal. Por el otro lado, se analizan los aprendizajes literarios que se abordaron, y los retos didácticos y prácticos que emergieron (relacionados con la lectura de la imagen y los recursos del aula). El análisis ha permitido, en última instancia, identificar las claves para la integración exitosa del cómic en esta dinámica de lectura, vinculadas al planteamiento didáctico, a los recursos y a los roles de los participantes.The practice of reading comic books collaboratively, framed in Elementary-level literary education, constitutes an opportunity to delve into the multimodal interpretation, in the negotiation of diverse interpretations and in the metadiscoursive learning on how to talk about comics. This article presents a case study aimed at documenting and analysing a socialised reading project with comics "Exploring comics" on a 4th year Elementary class(9-10-year-olds). The objective of the case study was to document and analyse the didactic value of reading comics collaboratively, with its advantages and difficulties, through the study of a classroom project which was co-designed between a teacher and a researcher. The project was implemented in four sessions in 2022, and the data was gathered through questionnaires to the students, interviews with the teacher, audiovisual recordings of the sessions, photographs of the project development and logs in a field journal. The analysis of the data articulates several core themes. On one side, it informs us of the predominant reading responses of the students during the collaborative reading of the comic book and it identifies the strategies that emerged in the context of the multimodal reading. On the other side, it also analyses the literary learnings which were addressed, and the didactic and practical challenges that have emerged (connected with reading images and the classroom resources). The analysis has allowed to identify the keys to successfully integrate comics in this reading dynamic, connected with the didactic plan, the resources and the roles of the participants
Insulin resistance 1 modulates gut microbiota and incretin response remodeling after bariatric surgery in severe obesity
No full textThis study aims to assess the impact of insulin resistance (IR) on gut microbiota (GM) composition, incretin responses, and metabolic outcomes following sleeve gastrectomy (SG) in people with severe obesity who do not have diabetes. Methods: A prospective single-center study encompassed patients with severe obesity and normal glucose tolerance who underwent SG. Participants were stratified into two cohorts based on the magnitude of their insulin resistance state, as determined by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index: high-IR (Hi-IR; HOMA-IR 95th percentile) and low-IR (Lo-IR; HOMA-IR < 25th percentile). Body composition measurements, biochemical analyses, and microbiota assessments were performed before and six months post-surgery. Additionally, the responses to a standardized meal tolerance test (MTT) of glucagon-like peptide-1 (GLP-1) and glucagon-like peptide-2 (GLP-2) were evaluated. Results: The study cohort consisted of 18 patients (9 with Hi-IR and 9 with Lo-IR), with a mean age of 48.8 ± 9.2 years and a mean body mass index (BMI) of 45.03 ± 4.82 kg/m². Six months post-surgery, the mean percentage of total weight loss (WL) was 26.5 ± 6%, with both groups exhibiting enhanced secretion of GLP-1 and GLP-2 following MTT. At baseline, participants exhibited distinct microbiota profiles; the Hi-IR group showed a higher relative abundance of Prevotella species, which are previously associated with adverse metabolic and inflammatory profiles. Post-surgery, both groups exhibited positive incretin responses and significant modifications in GM composition. Notably Hi-IR people experienced more 146 pronounced changes in microbial diversity, including increases in Akkermansia and Veillonella species and decreases in Prevotella species. Enhanced GLP-1 and GLP-2 responses were correlated with WL and metabòlic improvement, particularly in the Lo-IR population. Conclusions: These findings underscore the role of GM in metabolic changes and surgical outcomes after SG. Targeting gut microbiota may offer a promising avenue for improving obesity treatment strategies
Marco jurídico y ético para la aplicación de la inteligencia artificial en universidades
No full textLa responsabilidad civil en los delitos contra la libertad sexual : en concreto, por el daño moral
No full textLa mujer, y especialmente la mujer vulnerable o con discapacidad, se configura en el Derecho Penal como un sujeto pasivo necesitado de especial protección. El objeto de este trabajo es centrarse en la reparación del daño, esto es, desde el punto de vista de la responsabilidad civil derivada del delito, la cuantificación del daño moral
Propuesta de regulación del régimen de la responsabilidad civil derivada de accidentes ocasionados por vehículos autónomos en el ordenamiento español tras las últimas iniciativas legislativas de la Unión Europea
No full textSe camina a nivel mundial hacia la automatización total de los vehículos o vehículos sin conductor, escalando hacia niveles de autonomía cada vez mayores. Es en los niveles 4 y 5 de automatización, en los que se puede prescindir del conductor humano, en los que, las nuevas características de funcionamiento de esta nueva tecnología hacen muy difícil la aplicación de los sistemas tradicionales de responsabilidad civil. De ahí la importancia de articular un sistema de responsabilidad asequible y accesible para los perjudicados.Desde la UE se impulsa el desarrollo de los vehículos autónomos mediante diferentes iniciativas que por el momento no están incidiendo en el aspecto concreto de la responsabilidad civil derivada de accidente, habiéndose dejado por ahora en manos de las legislaciones internas de los Estados miembros la concreción de un régimen específico de responsabilidad en este ámbito. En España, en cumplimiento de los mandatos provenientes de la UE, el Ministerio del Interior ha iniciado un paso importante en la construcción de un marco regulatorio para los niveles 4 y 5 de automatización en los vehículos por medio de la publicación del borrador del Proyecto de Real Decreto por el que se modifican el Reglamento General de Circulación, aprobado por Real Decreto 1428/2003, de 21 de noviembre, y el Reglamento General de Vehículos aprobado por Real Decreto 2822/1998, de 23 de diciembre, en materia de conducción automatizada (RDCA), poniéndose así a la altura de Países como Reino Unido, Japón, China y Alemania.Este trabajo estará dedicado al análisis de los avances aportados por el reciente RDCA en el ámbito concreto de la responsabilidad civil, tras las últimas iniciativas legislativas europeas en la materia, así como a la elaboración de una propuesta de regulación de la responsabilidad civil para la conducción altamente automatizada o autónoma en el ordenamiento español, ante las lagunas e insuficiencias detectadas en el RDCA.The world is moving towards full automation of vehicles or driverless vehicles, scaling up to ever higher levels of autonomy. It is at levels 4 and 5 of automation, where the human driver can be dispensed with, that the new operating characteristics of this new technology make it very difficult to apply traditional civil liability systems. Hence the importance of articulating an affordable and accessible liability system for those affected. The EU is promoting the development of autonomous vehicles through various initiatives that for the moment are not affecting the specific aspect of civil liability arising from accidents, having left for now in the hands of the internal legislation of the Member States the specification of a specific liability regime in this area. In Spain, in compliance with the mandates from the EU, the Ministry of the Interior has begun an important step in the construction of a regulatory framework for levels 4 and 5 of automation in vehicles by publishing the draft of the Draft Royal Decree amending the General Traffic Regulations, approved by Royal Decree 1428/2003, of November 21, and the General Vehicle Regulations approved by Royal Decree 2822/1998, of December 23, in the field of automated driving (RDCA), thus putting itself on a par with countries such as the United Kingdom, Japan, China and Germany. This work will be dedicated to the analysis of the advances brought by the recent RDCA in the specific area of civil liability, following the latest European legislative initiatives in the matter, as well as to the elaboration of a proposal for the regulation of civil liability for highly automated or autonomous driving in the Spanish legal system, given the gaps and inadequacies detected in the RDCA
Veto del Tribunal de Justicia al pasaporte dorado maltés : hacia una nueva relación entre ciudadanía de la Unión y nacionalidad de los Estados miembros o ¿quo vadis, Micheletti?
No full textLa sentencia de 29 de abril de 2025 resuelve el recurso por incumplimiento interpuesto por la Comisión Europea contra Malta en relación con su programa de naturalización para inversores establecido en 2020. El Tribunal de Justicia declara que dicho régimen, que permite la naturalización a cambio de pagos o inversiones sin exigir un vínculo real con el Estado, vulnera el art. 20 TFUE y el principio de cooperación leal del art. 4.3.º TUE. El fallo representa un cambio cualitativo muy relevante tanto en relación con la configuración de la ciudadanía de la Unión como de sus relaciones con la nacionalidad estatal. Por un lado, refuerza la dimensión constitucional del estatuto de ciudadanía, al vincularla con valores y principios estructurales de la Unión como la solidaridad, la confianza mutua y la cooperación leal lealtad. Por otro lado, incide en el concepto mismo de nacionalidad al exigir una «relación especial de solidaridad y lealtad» entre el individuo y el Estado miembro, introduciendo límites sustantivos a la discrecionalidad de los Estados en materia de concesión de la nacionalidad y reequilibrando la relación entre la nacionalidad estatal y la ciudadanía de la Unión.The judgment of 29 April 2025 resolves the infringement action brought by the European Commission against Malta concerning its 2020 citizenship investment programme. The Court of Justice rules that such a scheme, which allows naturalization in exchange for payments or investments without requiring a genuine link with the Member State, infringes Article 20 TFEU and the principle of sincere cooperation enshrined in Article 4(3) TEU. The ruling represents a significant qualitative shift both in the configuration of Union citizenship and in its relationship with Member State nationality. On the one hand, it reinforces the constitutional dimension of the EU citizenship status by linking it to structural values and principles of the Union such as solidarity, mutual trust and sincere cooperation. On the other hand, it impacts the very notion of nationality by requiring a «special relationship of solidarity and good faith» between the individual and the Member State, introducing substantive limits to Member States' discretion in conferring nationality and rebalancing the relationship between national citizenship and Union citizenship
Recensión : «La simulación tributaria», de Luís Manuel Alonso González : Marcial Pons. 2024 (501 págs.)
No full textLa monografía titulada «La simulación tributaria», del Dr. Luís Manuel Alonso González, Catedrático de Derecho Financiero y Tributario de la Universidad de Barcelona, constituye una de las aportaciones científicas más relevantes de los últimos tiempos sobre la materia. Y argumentos no faltan como intentaremos remarcar presentando su objeto, estructura, perspectiva, y comentado sumariamente su contenido