Resumen es: Introduccion A los episodios de inestabilidad anginosa precipitados por causas secundarias que, no infrecuentemente, no pueden discernirse de razones pri...
Substance use disorders (SUDs) are increasingly recognised as neuroprogressive conditions characterised by cumulative and dynamic alterations across multiple levels of brain organisation. This integrative narrative review synthesises current evidence on the molecular, cellular, circuit-level, and biomarker mechanisms underlying neuroprogression in SUDs and proposes a multilevel translational framework. Evidence from preclinical and clinical studies indicates that chronic exposure to psychoactive substances induces persistent neuroinflammation, oxidative stress, mitochondrial dysfunction, and epigenetic dysregulation, which collectively disrupt synaptic plasticity and promote ferroptotic processes. These alterations progressively translate into large-scale dysfunction of frontolimbic and frontostriatal circuits, contributing to impaired inhibitory control, maladaptive decision making, and increased vulnerability to relapse. Neuroimaging findings further support this model by demonstrating structural, functional, and metabolic changes associated with chronic substance use. In parallel, neurofilament light chain has emerged as a promising but non-specific research fluid biomarker of cumulative neuroaxonal damage, with potential value for linking biological alterations and clinical expression in future longitudinal and multimodal studies. From a translational perspective, this framework may inform early intervention, clinical staging, and the development of more integrated and scalable models of care. Overall, neuroprogression provides a coherent model for understanding SUDs and may contribute to guiding more precise, biologically informed approaches in addiction psychiatry.
Introducción: Las enfermedades cardiovasculares son la principal causa de muerte, siendo la hipertensión arterial (HA) su principal factor de riesgo. En nuestro país, 1 de cada 3 hipertensos desconoce su condición, con un menor conocimiento entre los jóvenes menores de 40 años. Además, hábitos no saludables, como el tabaquismo, la obesidad y el consumo excesivo de sal, se arraigan desde edades tempranas. La educación escolar sobre hábitos saludables podría impactar no solo en los niños, sino también en sus hogares. Este estudio tuvo como objetivo describir factores de riesgo, hábitos de vida y el nivel de conocimiento en alumnos de 5to grado. Métodos: Se realizó un estudio descriptivo de corte transversal en 133 alumnos de una escuela pública de La Plata. Se aplicaron encuestas sobre factores de riesgo y hábitos, seguidas de talleres interactivos dirigidos por estudiantes avanzados de Medicina y Biología. La PA fue medida con técnicas estandarizadas y se entregaron materiales educativos para su difusión en los hogares. Resultados: Ningún alumno conocía su valor de PA, y más del 60% creía que debía medirse a partir de los 14 años. Solo el 5% consumen frutas y verduras regularmente. El 40% de los alumnos reconoció que alguno de sus padres tiene HA, pero el 88% refirió que en sus hogares agregan sal al plato. El 74% no cree que la principal causa de muerte sea la cardiovascular. Conclusión: El bajo nivel de conocimiento sobre HA y hábitos saludables en preadolescentes evidencia una necesidad crítica de educación sanitaria desde edades tempranas. La intervención escolar podría ser una herramienta costo-eficaz para la prevención de ECV, impactando tanto en los niños como en sus familias.
Importance:The primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown. Objective:To determine the impact of semaglutide on total hospital admissions and duration of hospital stay. Design, Setting, and Participants:The SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025. Interventions:Once-weekly subcutaneous semaglutide, 2.4 mg, or placebo. Main Outcomes and Measures:The total number of hospital admissions and days in hospital between the semaglutide and placebo groups. Results:A total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex. Conclusions and Relevance:In this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction. Trial Registration:ClinicalTrials.gov Identifier: NCT03574597.
The session rating of perceived exertion (s-RPE) is a validated tool for monitoring subjective training intensity across various sports. We aimed to assess the association between s-RPE recorded within 30 min post-training and a single retrospective weekly RPE (wRPE) reported at the end of the week. We tracked the training loads (TLs) of eight professional tennis players over one season and analyzed the association among three parameters: the weekly average of session-specific RPE (mRPE) vs. wRPE; weekly TL (s-RPE × duration) derived from both mRPE and wRPE; and week-to-week percentage changes in TL. We employed a nested model and a Bland–Altman analysis to evaluate association, bias, and limits of agreement. Our analysis revealed very large associations between mRPE and wRPE (r = 0.804) and between week-to-week TL progressions (r = 0.885). The association between TL measures themselves was nearly perfect (r = 0.974). Bland–Altman plots demonstrated superior agreement at lower loads, whereas higher loads were associated with greater variability. We conclude that a single self-reported measure at the end of the week was strongly associated with session-derived RPE, TL, and weekly TL progression in professional tennis players. Nevertheless, these two approaches are not interchangeable, and consistency in the chosen method is key for reliable TL monitoring in professional tennis players.
