Search

This study aimed to clinically evaluate the effectiveness of two different at-home whitening protocols and to determine which is more effective: applying the whitening gel (16% carbamide peroxide) every 24 hours (Group A) or every 48 hours (Group B) for 2 weeks. Group C received a placebo gel (glycerin) without peroxide, which was applied every 24 hours for 2 weeks. The differences in terms of tooth sensitivity were also analyzed. A sample of 60 patients was divided into three groups of 20 patients. To compare the groups, color measurements were made using a spectrophotometer, and Student t test was used for independent samples. The confidence level was set at 95% (P ≤ .05). No statistically significant differences were found between Groups A and B (P > .05). The study concluded that 16% carbamide peroxide was equally effective when applied with either protocol and obtained the same results, but the 48-hour application protocol produced less sensitivity than the 24-hour application protocol. [ABSTRACT FROM AUTHOR]

Background: Brachytherapy (BT) treatments involving temporary high‐dose rate (HDR) sources are extensively employed in clinical practice. Ensuring the consistency of all measurement equipment at the hospital level is crucial, requiring a robust redundancy and consistency program. This enables the institution to verify the stability of the dosimetry system over time. Purpose: To describe, justify, and analyze a component of the redundancy program of the calibration protocols followed by the Radiotherapy Department of the Hospital Universitari i Politècnic La Fe (València, Spain) during the last 10 years for the case of HDR BT as an additional component to ensure long term stability of the measurement equipment. Methods: At the time the HDR BT source is replaced, its Air Kerma Strength (SK) is measured. By comparing this value with the one obtained at the time of installation (corrected by decay), a clear determination of the stability of the measurement equipment can be performed. Results: Difference between SK,vendor and SK,hosp as a function of the measurement date is reported for a 10 years' period. All measurements are well within the ±3% tolerance level recommended in current international guidelines. Percentage differences of SK,hosp values at the time of replacement compared to SK,hosp ones at the time when the source was installed are within the ±0.5% range, reflecting oscillations around a null deviation. Conclusions: The method proposed allows any hospital to ensure a redundancy component of the long‐term stability of all equipment involved in BT measurements in a very simple and time efficient manner. Additionally, it enables the hospital to maintain a detailed log of historical differences, facilitating the identification and correction of potential systematic deviations over time. [ABSTRACT FROM AUTHOR]

Context Few data exist about the clinical course of acromegaly, surgical and medical outcomes in patients with GH- and prolactin cosecreting pituitary adenomas (GH&PRL-PAs). Nevertheless, some series described a more aggressive clinic-radiological behavior than in growth hormone–secreting pituitary adenomas (GH-PAs). Objective This work aims to evaluate differences in clinical presentation and in surgical outcomes between GH-PAs and GH&PRL-PAs. Methods A multicenter retrospective study was conducted of 604 patients with acromegaly who underwent pituitary surgery. Patients were classified into 2 groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal (ULN) and IHC for GH and PRL was positive or PRL levels were greater than 100 ng/dL and PRL IHC was not available (n = 130) and b) GH-PA patients who did not meet the previously mentioned criteria (n = 474). Results GH&PRL-PAs represented 21.5% (n = 130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P <.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs 77.4%; P =.001) and tended to be more invasive (33.6% vs 24.7%; P =.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (odds ratio 2.8; 95% CI, 1.83-4.38). Insulin-like growth factor ULN levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [interquartile range (IQR) 1.73-3.29] vs 2.7 [IQR 1.91-3.67]; P =.023). There were no differences in the immediate (41.1% vs 43.3%; P =.659) or long-term postsurgical acromegaly biochemical cure rate (53.5% vs 53.1%; P =.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs 2.4%; P =.011) in GH&PRL-PA patients. Conclusion GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger, and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently. [ABSTRACT FROM AUTHOR]

Pituitary apoplexy is a clinical syndrome that can cause vision loss and oculomotor (OM) deficits. Neurosurgical decompression is still considered the treatment of choice for those with visual impairment. We aim to explore the influence of timing of neurosurgical decompression on visual outcome. Multicentre retrospective study of patients presenting with pituitary adenoma and pituitary apoplexy who were operated in three Spanish tertiary hospitals between 2008 and 2022. We identified 49 patients with pituitary apoplexy with visual symptoms and were operated. Among the visual symptoms, 35 patients (73%) had visual acuity (VA) impairment and 33 (67%) had an OM nerve paresis. Twenty-three of the 35 patients improved their VA, and 24 of the 33 improved their OM nerve paresis after surgery. The median time between apoplexy to surgery was 10 days (range 0-164). Regarding visual acuity, 50% (3 out of 6) of those operated within 3 days of apoplexy showed improvement, compared to 69% (20 out of 29) of those operated beyond (p = 0.37).Regarding OM paresis, 62.5% (5 out of 8) of those operated within 3 days of apoplexy improved, compared to 76% (19 out of 25) of those operated beyond (p = 0.56).Mean apoplexy to surgery time was 18 ± 19 days in those whose VA improved (vs. 32 ± 51; p = 0.46); and mean apoplexy to surgery time for those whose OM symptoms improved was 21+/- 35 days (vs. 24 +/- 37; p = 0.86). Our results suggest that timing of neurosurgical decompression does not affect the visual outcome of patients with pituitary apoplexy. [ABSTRACT FROM AUTHOR]

There is evidence of the effect of probiotic intake on the immune system. However, the effect probiotics may have on the rate of aging is unknown. The aim of this study is to determine the effect of a probiotic blend on immunity, redox state, inflammation, and the rate of aging or biological age. A group of 10 men and 14 women took, daily for 2 months, a sachet with three probiotics (Bifidobacterium animalis subsp. lactis BSO1, Lactobacillus reuteri LRE02, Lactobacillus plantarum LP14) and vitamin D. Before starting the treatment and after 2 months, peripheral blood was collected. Immune functions were assessed in isolated immune cells, and cytokine concentrations were also measured both in mononuclear cell cultures and plasma. Redox state parameters were also analyzed in whole blood cells. Finally, the Immunity Clock was applied to determine the biological age. Results show that the intake of this probiotic blend in general, in both men and women, improves immunity and decreases the oxidative and inflammatory state. In addition, it rejuvenates the biological age by 10 years on average. It can be concluded that this probiotic blend could be proposed as a good strategy to slow down the aging process, and to achieve healthy aging. [ABSTRACT FROM AUTHOR]

Introduction: Historically, Multiple Endocrine Neoplasia type 1 (MEN1)-related pituitary adenomas (PAs) were considered more aggressive and treatmentresistant than sporadic PAs. However, recent studies suggest similarities in their behavior. This study aimed to evaluate the long-term outcomes of MEN1 PAs and identify predictive factors. Methods: Nationwide multicenter retrospective cohort study of MEN1-related PAs with a minimum 1-year follow-up, collecting patient demographics, germline MEN1 pathogenic variants (PV), PA size, secretory profile, radiological characteristics, treatments, and outcomes. Results: We analyzed 84 PAs, 69%in females and 31% in males (P<0.001), diagnosed at a mean age of 35.2±14.9 years, mostly through screening (60.7%). Median follow-up was 9 years (IQR:4-16). Prolactin-secreting PAs (PRLomas) (53.5%) and microadenomas (65.5%) were most common. Dopamine agonist treatment was first line for 16 macroPRLomas and 25 microPRLomas, 60.9% of them achieved PRL normalization. There was no significant association observed with tumor size, sex, treatment duration or MEN1 PV. The risk of progression from micro-PA to invasive macro-PA was 7.2% (4/55), after 8 years (IQR:4-13), all of them were microPRLomas. Kaplan-Meier estimation curve showed significantly higher progression probability in microPRLomas than in other microadenomas subtypes (P=0.017) or microNFPAs (P=0.032). No differences were found between sex, age, or germline MEN1 PV. Conclusion: MEN1-related micro-PAs have a low risk of progressing to invasive macro-PAs, regardless of sex, age at diagnosis, or MEN1 germline PV. The risk is higher for microPRLomas over the long term. Therefore, long-term surveillance with reduced frequency, rather than intensive short-term monitoring, may be appropriate for patients with MEN1-related PAs. [ABSTRACT FROM AUTHOR]

Background: Vitamin D, through the activation of its receptor (VDR), plays an immunomodulatory role in the gastrointestinal tract. Single-nucleotide polymorphisms (SNPs) in the VDR gene have been associated with Crohn's disease (CD) risk, and patients carrying the TaqI polymorphism in this gene run a higher risk of developing a penetrating behavior. Aims: We analyzed the association of BsmI, ApaI, TaqI, and FokI SNPs in the VDR gene with the clinical characteristics of CD. Methods: Four polymorphisms identified in the VDR gene (BsmI, FokI, ApaI, and TaqI) were genotyped in blood samples from CD patients (n = 115) by using PCR-RFLP. The disease's location and behavior and the presence of perianal fistulas were collected from each patient. Intestinal fibroblasts from ileal resections of CD patients (n = 10) were genotyped, and the expression of fibrotic and inflammatory markers was analyzed by RT-PCR. Results: The data reveal no association between any of the polymorphisms and CD risk. A strong linkage disequilibrium was detected between TaqI and both ApaI and BsmI, which in turn were strongly associated. Homozygosis or heterozygosis for the a allele of the ApaI SNP or b allele of the BsmI SNP was significantly associated with a lower risk of a penetrating behavior, while the aa genotype was associated with a lower risk of perianal fistulas. Fibroblasts carrying the aa genotype expressed lower levels of fibrotic and inflammatory markers. Conclusion: The aa genotype of the ApaI SNP in the VDR gene is associated with a lower risk of perianal fistulas in CD and a reduced expression of fibrotic and inflammatory markers in intestinal fibroblasts. [ABSTRACT FROM AUTHOR]

We present ground-based photometric observations of secondary eclipses of the hottest known planet KELT-9 b using MuSCAT2 and Sinistro. We detect secondary eclipse signals in i and |$z_{\rm s}$| with eclipse depths of |$373^{+74}_{-75}$| and |$638^{+199}_{-178}$| parts per million, respectively. We perform an atmospheric retrieval on the emission spectrum combined with the data from HST/WFC3, Spitzer, TESS, and CHEOPS to obtain the temperature profile and chemical abundances, including TiO and VO, which have been thought to produce temperature inversion structures in the dayside of ultra-hot Jupiters. While we confirm a strong temperature inversion structure, we find low abundances of TiO and VO with mixing ratios of |$\rm {log(TiO)}=-7.80^{+0.15}_{-0.30}$| and |$\rm {log(VO)}=-9.60^{+0.64}_{-0.57}$|⁠ , respectively. The low abundances of TiO and VO are consistent with theoretical predictions for such an ultra-hot atmosphere. In such low abundances, TiO and VO have little effect on the temperature structure of the atmosphere. The abundance of |${\rm e}^{-}$|⁠ , which serves as a proxy for |${\rm H}^{-}$| ions in this study, is found to be high, with |$\rm {log(e^-)}=-4.89\pm {0.06}$|⁠. These results indicate that the temperature inversion in KELT-9 b's dayside atmosphere is likely not caused by |${\rm TiO/VO}$|⁠ , but rather by the significant abundance of |${\rm H}^{-}$| ions. The best-fitting model cannot fully explain the observed spectrum, and chemical species not included in the retrieval may introduce modeling biases. Future observations with broader wavelength coverage and higher spectral resolution are expected to provide more accurate diagnostics on the presence and abundances of |${\rm TiO/VO}$|⁠. These advanced observations will overcome the limitations of current data from HST and photometric facilities, which are constrained by narrow wavelength coverage and instrumental systematics. [ABSTRACT FROM AUTHOR]

Background/Objectives: Implementing model-informed precision dosing (MIPD) strategies guided by population pharmacokinetic/pharmacodynamic (PK/PD) models could enhance the management of inflammatory diseases such as psoriasis. However, the extent of individual experimental data gathered during MIPD significantly influences the uncertainty in estimating individual PK/PD parameters, affecting clinical dose selection decisions. Methods: This study proposes a methodology to individualize ustekinumab (UTK) dosing strategies for 23 Spanish patients with moderate to severe chronic plaque psoriasis., considering the uncertainty of individual parameters within a population PK/PD model. Results: An indirect response model from previous research was used to describe the PK/PD relationship between UTK serum concentrations and the Psoriasis Area and Severity Index (PASI) score. A maximum inhibition drug effect (Imax) model was selected, and a first-order remission constant rate of psoriatic skin lesion (kout = 0.016 d−1) was estimated. Conclusions: The MIPD approach predicted that 35% and 26% of the patients would need an optimized and intensified dosage regimen, respectively, compared to the regimen typically used in clinical practice. This analysis demonstrated its utility as a tool for selecting personalized UTK dosing regimens in clinical practice in order to optimize the probability of achieving targeted clinical outcomes in patients with psoriasis. [ABSTRACT FROM AUTHOR]

Purpose: To identify clinical and radiological factors associated with a higher risk of developing a severe pituitary apoplexy (PA). Methods: Multicenter retrospective study of patients presenting with clinical PA in three Spanish tertiary hospitals of Madrid between 2008 and 2022. We classified PA as severe when presenting with an altered level of consciousness (Glasgow Coma Scale (GCS) < 15) or visual involvement. Results: A total of 71 PA cases were identified, of whom 80.28% (n = 57) were classified as severe PA. The median age was 60 (18 to 85 years old) and 67.6% (n = 48) were male. Most patients had macroadenomas, except for one patient with a microadenoma of 9 mm. Headache was the most common presenting symptom (90.1%) and anticoagulation was the most frequent predisposing risk factor, but it was not associated with a higher risk for severe PA (odds ratio [OR] 1.13 [0.21–5.90]). Severe cases were associated with male gender (OR 5.53 [1.59–19.27]), tumor size >20 mm (OR 17.67 [4.07–76.64]), and Knosp grade ≥2 (OR 9.6 [2.38–38.73]). In the multivariant analysis, the only variables associated with a higher risk for severe PA were tumor size and Knosp grade. Surgery was more common in severe PA than in non-severe (91.2% vs. 64.3%, P = 0.009). Conclusion: A tumor size >20 mm and cavernous sinus invasion are risk factors for developing a severe PA. These risk factors can stratify patients at a higher risk of a worse clinical picture, and subsequently, more need of decompressive surgery. [ABSTRACT FROM AUTHOR]

Introduction: The multiparametric nature of recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) still leads to uncertainty with its practical management. This study aims to characterize the main posttransplant recurrence patterns of HCC and to explore the therapeutic modalities targeting recurrence. Methods: Consecutive patients who underwent LT for HCC at a single tertiary center were analyzed. The time from first recurrence to death was investigated for each site of presentation. The impact of each recurrence-targeted treatment on survival was studied. Results: Of 660 patients with HCC, any recurrence occurred in 96 (15.4%) patients with a median time to recurrence of 20.0 months (95% CI: 15.6–23.8). Patients recurred across different patters including solitary distant locations (30.8%, n = 28), liver only (24.2%, n = 22), lung (18.7%, n = 17), multi-organ disease (17.6%, n = 16), and bone (8.8%, n = 8). Multi-organ and bone recurrences had the poorest survival, while solitary distant lesions and pulmonary recurrences had the best outcomes. Each treatment modality carried a distinctive survival. Conclusions: Patients recurred across 3 patterns with different prognostic implications. The benefit of each treatment option on distinct recurrence patterns appears to be influenced by the biological behavior inherent in the recurrence pattern itself. [ABSTRACT FROM AUTHOR]

Phelan–McDermid syndrome (PMS) is a neurodevelopmental disorder characterized by a developmental delay and autism spectrum disorder (ASD)-like behaviors. Emerging research suggests a link between gut microbiota and neuropsychiatric conditions, including PMS. This study aimed to investigate the fecal microbiota and immune profiles of children with PMS compared to healthy controls. Fecal samples were collected from children diagnosed with PMS and age-matched healthy controls. The bacterial composition was analyzed using 16S rRNA gene sequencing, while short-chain fatty acids (SCFAs) were quantified through gas chromatography. Immunological profiling was conducted using a multiplex cytokine assay. Significant differences were observed in the gut microbiota composition between PMS patients and controls, including a lower abundance of key bacterial genera such as Faecalibacterium and Agathobacter in PMS patients. SCFA levels were also reduced in PMS patients. Immunological analysis revealed higher levels of several pro-inflammatory cytokines in the PMS group, although these differences were not statistically significant. The findings indicate that children with PMS have distinct gut microbiota and SCFA profiles, which may contribute to the gastrointestinal and neurodevelopmental symptoms observed in this syndrome. These results suggest potential avenues for microbiota-targeted therapies in PMS. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of pituitary surgery on glucose metabolism and to identify predictors of remission of diabetes after pituitary surgery in patients with acromegaly. Methods: A national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria. Results: A total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range [IQR] 45–163). At the acromegaly diagnosis, 23.8% of the patients had diabetes mellitus (DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4–7.9) [51.9 mmol/mol (IQR 46.4–62.8)]. In the multivariate analysis, older age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), arthropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-I levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of DM. At the last follow-up visit after surgery, 21.1% of the DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of DM was more common in older patients (hazard ratio [HR] 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75). Conclusion: Glucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery. [ABSTRACT FROM AUTHOR]

Background Post-transplant anemia is a prevalent yet often overlooked condition that poses significant risks. Current guidelines consider the same treatment recommendations and goals for these patients as for chronic kidney disease patients not on dialysis. Previous reports demonstrated a lack of awareness and suboptimal management, indicating a pressing need for improvement. We therefore wanted to update the information on post-transplant anemia. We aimed to describe the present state of anemia management, goals and adherence to guidelines within a representative sample of the kidney transplant (KTx) population. Methods We designed a retrospective nationwide multicenter study including outpatients from eight KTx hospitals. Nephrologists gathered data from electronic medical records encompassing demographics, comorbidities, KTx characteristics and immunosuppressive therapy, and information pertaining to anemia management (laboratory values, previously prescribed treatments and subsequent adjustments). The European statement on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines was the reference for definitions, drug prescriptions and targets. Anemia occurring within the initial 6 months post-transplantation was classified as early onset. Results We included 297 patients with post-transplant anemia aged 62.8 years (standard deviation 13.6), 60% of whom were male. They had received a graft from cardiac death or brain death donors (61.6% and 31.1%, respectively) a median of 2.5 years (0.5–8.7) before. Among them 77% (n  = 228) were classified as having late post-transplant anemia, characterized by a higher prevalence of microcytic and iron deficiency anemia. A total of 158 patients were on erythropoietic-stimulating agents (ESAs) treatment, yet surprisingly 110 of them lacked iron supplementation. Notably, 44 patients had an indication for iron supplementation and among them, 30 exhibited absolute iron deficiency. Out of the 158 patients receiving ESAs, only 39 surpassed the limit for the ESA resistance index, indicating poor response. This resistance was more frequent among patients with early post-transplant anemia (26.1% vs 9.2%). We have identified iron profile, early post-transplant anemia and estimated glomerular filtration rate as factors associated with the highest risk of resistance Conclusion We found that hemoglobin targets are individualized upwards in post-transplant anemia. In this setting, iron therapy continues to be underutilized, especially intravenous, and iron deficiency and prior events (blood transfusion or hospital admission) explain most of the hyporesponsiveness to ESA. This highlights missed opportunities for precise prescription targeting and adherence to established guidelines, suggesting a need for improved management strategies in post-transplant anemia patients. [ABSTRACT FROM AUTHOR]

Background: The worldwide prevalence of diabetes is increasing, particularly among older adults. Understanding the association between muscle strength and mortality in this population is crucial for developing targeted exercise recommendations. Objectives: To assess the prospective association of muscle strength with mortality in older adults with diabetes. Methods: From the Survey of Health, Ageing and Retirement in Europe (SHARE) study, spanning 28 countries, we included 16 149 diabetic adults aged 50 years and older (mean age 68.2 [standard deviation, SD, 9.2] years). Participants fulfilled two criteria: (1) diabetes diagnosis (ever) and (2) current use of diabetes medication. Muscle strength was assessed using handgrip dynamometry (unit: kg). Using time‐varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with all‐cause and cause‐specific mortality, controlling for various confounders. Results: Over a mean follow‐up of 5.9 years (SD 3.8), 2754 participants died (17%). Using the median level of muscle strength as reference (30 kg), lower and higher levels were associated in a curvilinear fashion with higher and lower all‐cause mortality risk, respectively. The 10th percentile of muscle strength (17 kg) showed a hazard ratio (HR) of 1.65 (95% confidence interval (CI) 1.53–1.79). The 90th percentile (47 kg) of muscle strength showed a HR of 0.55 (95% CI 0.49–0.63). A somewhat similar pattern, with varying strength of associations, was seen for mortality due to cardiovascular disease (CVD), respiratory disease, severe infectious disease, digestive system disease and cancer. Conclusion: Muscle strength is gradually and inversely associated with all‐cause and cause‐specific mortality risk in older adults with diabetes. As muscle strength is highly adaptable to resistance training at all ages, the present findings highlight the importance of improving muscle strength in older adults with diabetes. [ABSTRACT FROM AUTHOR]

The TESS mission searches for transiting exoplanets by monitoring the brightness of hundreds of thousands of stars across the entire sky. M-type planet hosts are ideal targets for this mission due to their smaller size and cooler temperatures, which makes it easier to detect smaller planets near or within their habitable zones. Additionally, M dwarfs have a smaller contrast ratio between the planet and the star, making it easier to measure the planet's properties accurately. Here, we report the validation analysis of 13 TESS exoplanet candidates orbiting around M dwarfs. We studied the nature of these candidates through a multi-colour transit photometry transit analysis using several ground-based instruments (MuSCAT2, MuSCAT3, and LCO-SINISTRO), high-spatial resolution observations, and TESS light curves. We present the validation of five new planetary systems: TOI-1883b, TOI-2274b, TOI-2768b, TOI-4438b, and TOI-5319b, along with compelling evidence of a planetary nature for TOIs 2781b and 5486b. We also present an empirical definition for the Neptune desert boundaries. The remaining six systems could not be validated due to large true radius values overlapping with the brown dwarf regime or, alternatively, the presence of chromaticity in the MuSCAT2 light curves. [ABSTRACT FROM AUTHOR]

Thin films of silver-doped zinc oxide (SZO) were deposited at room temperature using a DC reactive magnetron co-sputtering technique using two independent Zn and Ag targets. The crystallographic structure, chemical composition and surface morphology of SZO films with different silver concentrations were correlated with the photocatalytic (PC) properties. The crystallization of the SZO films was made using millisecond range flash-lamp-annealing (FLA) treatments. FLA induces significant structural ordering of the wurtzite structure and an in-depth redistribution of silver, resulting in the formation of silver agglomerates. The wurtzite ZnO structure is observed for silver contents below 10 at.% where Ag is partially incorporated into the oxide matrix, inducing a decrease in the optical band-gap. Regardless of the silver content, all the as-grown SZO films do not exhibit any significant PC activity. The best PC response is achieved for samples with a relatively low Ag content (2–5 at.%) after FLA treatment. The enhanced PC activity of SZO upon FLA can be attributed to structural ordering and the effective band-gap narrowing through the combination of silver doping and the plasmonic effect caused by the formation of Ag clusters. [ABSTRACT FROM AUTHOR]

Nursing preceptors play a crucial role in supporting and educating clinical students. Understanding the perceptions and needs of nurse preceptors is essential to enhance their role as preceptors and to improve their teaching practices. This study aimed to explore preceptorship in diverse settings and specific contexts. Content analysis was performed to analyze open‐ended responses from a questionnaire based on nurses' perceptions of preceptorship with undergraduate nursing students. Data were collected from two university hospitals, with different healthcare provision levels. Of the 370 responses, 295 (96%) were those of women, and 34.5% were in the age group of 41‐50 years. Three main themes were identified: (1) the role of preceptorship as a key component in learning, (2) challenges in student preceptorship, and (3) personal recognition and compensation for teaching work. This study highlights the positive experiences and provides valuable insights into the challenges and opportunities faced by nurse preceptors in their teaching roles, and emphasizes the need for institutional support and educational programs to enhance their teaching responsibilities. Improving communication and collaboration among stakeholders is crucial for improving learning outcomes and satisfaction. [ABSTRACT FROM AUTHOR]

A range of novel BODIPY derivatives with a tripodal aromatic core was synthesized and characterized spectroscopically. These new fluorophores showed promising features as probes for in vitro assays in live cells and offer strategic routes for further functionalization towards hybrid nanomaterials. Incorporation of biotin tags facilitated proof‐of‐concept access to targeted bioconjugates as molecular probes. Computational explorations using DFT and TD‐DFT calculations identified the most stable tripodal linker conformations and predicted their absorption and emission behavior. The uptake and speciation of these molecules in living prostate cancer cells was imaged by single‐ and two‐photon excitation techniques coupled with two‐photon fluorescence lifetime imaging (2P FLIM). [ABSTRACT FROM AUTHOR]

Aim: To develop a conceptual framework for nurses' protocol‐based care decision‐making. Design: Miles & Huberman's bottom‐up approach to developing conceptual frameworks was followed, using data collected from a multiple embedded case study examining protocol‐based decision‐making by nurses in three hospital wards within a university hospital in northern Spain. Methods: The qualitative data from the case study, obtained through documentary analysis, observations, and interviews, underwent a secondary analysis consisting of four steps: data reduction, data display, comparison, and drawing conclusions. Results: The framework for protocol‐based care decision‐making comprises four components: (1) protocol‐based care, as a balance between standardisation and individualised care, (2) the process, (3) the context, and (4) the elements of protocol‐based care decision‐making. These components and their relationship as a context‐dependent, linear, variable and multifactorial process, directly influenced by the perception of risk, are described and illustrated. Conclusions: This study provides a rigorous bottom‐up framework for nurses' protocol‐based care decision‐making. The framework could be a valuable resource for managers, clinical nurses, educators, and researchers to guide and evaluate nurses' decision‐making, leading to improved care quality and reduced variability in clinical practice. Furthermore, the framework lays a foundation for further research and practical applications. Impact: This study addressed the problem of understanding nurses' protocol‐based care decision‐making and the need for a specific conceptual framework. The main findings of the study contribute to the development of a rigorous bottom‐up framework comprising four components of protocol‐based care decision‐making. The framework has the potential to improve care quality, reduce variability, enhance patient safety, and increase healthcare efficiency by guiding nurses' decision‐making in various healthcare settings. No Patient or Public Contribution: Patient or public contribution was not applicable since the study focused on nurses' decision making. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to evaluate the clinically beneficial effect of adding transvaginal monopolar non-ablative radiofrequency (RF) to pelvic floor muscle training (PFMT) on leakage severity, quality of life and urinary incontinence-related symptoms in women with stress urinary incontinence (SUI). Methods: A double-blind randomised controlled trial was conducted, with a 6-week intervention and a 6-month follow-up. Participants were randomly assigned to the experimental group (PFMT plus RF; n = 18) or the control group (PFMT plus placebo; n = 20). The primary outcome was the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Secondary outcomes included the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), self-efficacy, female sexual function, pelvic floor muscle dynamometry, 1-h pad test and number of SUI episodes per week. Inferential analyses of the data were performed using a two-factor analysis of variance. Results: Both groups achieved a statistically significant improvement in ICIQ-SF over time. However, the differences observed in the experimental group exceeded the minimal clinically important differences by 4 points (MD = −9.4, 95% CI = −12.6 to −6.3), which was not observed in the control group (MD = −3.9, 95% CI = −6.9 to −1.0). This was maintained at the 6-month follow-up with a significant time*group interaction (p < 0.001, ηp2 = 0.150). There was no time*group interaction in the other variables (p > 0.05). Additionally, a significant difference in favour of the experimental group was observed in the 1-h pad test and episodes of SUI per week (p < 0.05). Conclusions: This study highlights the beneficial effects of adding transvaginal RF to PFMT on the severity and amount of leakage, as well as on the quality of life and urinary incontinence-related symptoms in women with moderate SUI. Future trials are needed to assess the effects of this intervention in women with severe SUI. [ABSTRACT FROM AUTHOR]

Introduction: No previous studies have implemented a standard blood flow restriction (BFR) training session in people with severe haemophilia (PwH), where this type of training has been contraindicated. Aims: The purpose of this study was to evaluate the tolerability, adverse events, and neuromuscular and perceptual responses to an acute session of low load (LL) knee extensions with BFR in PwH under prophylaxis. Methods: Eight PwH performed one LL‐BFR session with 40% arterial occlusion pressure (AOP). Perceptual responses and adverse effects were assessed, together with high‐density surface electromyography of vastus medialis (VM) and lateralis (VL). Results: Significant normalized root mean square differences were found within each set, but not between sets. Spatial distribution (centroid displacement (p >.05), modified entropy (VM, set two, cycles three and five, p =.032) and coefficient of variation (VM, set two, cycles four and five lower than cycle three (p =.049; p =.036)) showed changes within each set. Median frequency showed a slight increase during cycle four of set four (p =.030). Rate of perceived exertion slightly increased with each set while tolerability slightly decreased in the last set and fear of training with BFR generally decreased after the session. Conclusions: In PwH, a LL‐BFR session at 40% AOP is safe and feasible. Our results suggest that potential muscle impairments may blunt neuromuscular adaptations induced by BFR. [ABSTRACT FROM AUTHOR]

We assessed whether multiplex real-time PCR plus conventional microbiological testing is safe and more effective than conventional microbiological testing alone for reducing antibiotic use in community-acquired pneumonia (CAP). In this randomised trial, we recruited adults hospitalised with CAP at four Spanish hospitals. Patients were randomly assigned (1:1) to undergo either multiplex real-time PCR in non-invasive respiratory samples plus conventional microbiological testing or conventional microbiological testing alone. The primary endpoint was antibiotic use measured by days of antibiotic therapy (DOT). Between February 20, 2020, and April 24, 2023, 242 patients were enrolled; 119 were randomly assigned to multiplex real-time PCR plus conventional microbiological testing and 123 to conventional microbiological testing alone. All but one of the patients allocated to multiplex real-time PCR plus conventional microbiological testing underwent PCR, which was performed in sputum samples in 77 patients (65.2%) and in nasopharyngeal swabs in 41 (34.7%). The median DOT was 10.04 (IQR 7.98, 12.94) in the multiplex PCR plus conventional microbiological testing group and 11.33 (IQR 8.15, 16.16) in the conventional microbiological testing alone group (difference −1.04; 95% CI, −2.42 to 0.17; p = 0.093). No differences were observed in adverse events and 30-day mortality. Our findings do not support the routine implementation of multiplex real-time PCR in the initial microbiological testing in hospitalised patients with CAP. Clinicaltrials.gov registration: NCT04158492. Here, the authors report the results of a randomised trial assessing whether adding multiplex real-time PCR to conventional testing reduces antibiotic use in community-acquired pneumonia and observe no significant reduction in days of antibiotic therapy or in 30-day mortality. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a common situation in the Spanish paediatric population. Malnourished children may benefit from different strategies, including dietary modifications or nutritional supplements (NS). It is important to know the different factors that can influence treatment tolerance and adherence, and their impact on nutrition monitoring. Objectives: To explore the perception of doctors who prescribe nutritional supplements (NS) in children and to investigate different factors involved in tolerance and adherence. Material and methods: A cross-sectional, descriptive observational study based on an ad hoc electronic survey designed to study doctors' perceptions of at least five of their children with NS and their families, subjected to outpatient follow up. Variables included were the socio-demographic variables of the doctors and children, nutritional status of the patients, amount and characteristics of NS (hyper-caloric oral with fibre (HOFF), oral peptide (OPF) and hyper-caloric infant (HIF)), route of administration, perceived benefits, satisfaction, palatability, adherence, and acceptance. Results: 815 patients aged 0–16 years (mean 10.6 years; SD 7.8) were included. A proportion of 64% received HOFF, 16% FOP, and 20% HIF. A proportion of 84% received exclusive oral NS. Total daily calorie intake prescribed with NS ranged from 30–75% in 48.2% of cases, though it was significantly higher in children under 6 months of age. Improvement in overall condition, nutritional status and quality of life was observed in 82%, 79.5%, and 80% of subjects. Improvement in tolerance and digestive symptoms was reported in 83.5% and 72% of subjects. The degree of satisfaction and acceptance of NS was very good in 80% of cases, with taste being the most influential factor (82.3%). Adherence was adequate in more than 60%, and smell was the most significant feature in lack of adherence (55%). The flavour of the best-accepted supplement was chocolate (44%). A total of 97% of prescribing doctors would recommend the same formula again. Conclusions: In our study, prescribing doctors and families perceived an excellent benefit from the use of the prescribed formulas, improved quality of life, high satisfaction, acceptance, and adherence. The positive factors for adequate adherence were sufficient information about the formulations and their benefits, and continuity of care during follow-up. Prescribing doctors would recommend supplement use again given the perceived benefits and satisfaction. [ABSTRACT FROM AUTHOR]

Copyright of Historia Agraria is the property of Historia Agraria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Historia Agraria is the property of Historia Agraria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article examines water management under the Spanish liberal state between 1833 and 1866, focusing on how the early liberal state addressed hydraulic issues and the evolution of water regulations before the establishment of a formal hydraulic policy. It highlights the legislative actions and the transition from old regime practices to new forms of water management, emphasizing the state's role in mediating conflicts and developing regulatory frameworks during this period.

The article examines the agronomic advancements and elite influence in Valencia, Spain, between 1840 and 1860, highlighting the diverse nature of agricultural transformations in Europe and the selective adoption of new techniques. It discusses how the diffusion of agricultural knowledge from northern Europe was limited in its impact on the southern regions and how local agrarian elites played a significant role in shaping agricultural practices and innovations.

The article explores the intersection of scientific and practical knowledge in Valencian agriculture during the 19th and early 20th centuries. It examines how scientific innovations, such as new fertilizers and agricultural techniques, were integrated with traditional farming practices. It emphasizes that while scientific advancements played a role, the persistence of local knowledge and practices significantly shaped agricultural development in the region in Spain.

Copyright of Historia Agraria is the property of Historia Agraria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article reviews a course held at the Universidad Internacional Menéndez Pelayo in Valencia, Spain, from September 21 to 24, 1992, titled "Las burguesías en el mundo contemporáneo" (The Bourgeoisies in the Contemporary World). It mentions that, directed by Jesús Millán y García-Varela and Pedro Ruiz Torres, the course explored the historical and theoretical aspects of the bourgeoisie, particularly in the context of 19th-century European and Spanish societal transformations.

The article explores the evolution of agrarian capitalism in the Valencian region in Spain from the 18th to the 19th centuries, emphasizing the tension between traditional feudal structures and modern agricultural practices. It delves into the historical and economic dynamics that shaped Valencia's agricultural landscape, including the impact of irrigation systems, land ownership changes, and economic transitions from feudalism to a more capitalist agrarian economy.

The article focuses on the impact of urban expansion on peri-urban agricultural lands, specifically examining the case of the Huerta of Valencia in Spain. It details how these fertile agricultural lands, once integral to urban areas, are being increasingly overtaken by urban and industrial development, leading to significant loss and degradation of agricultural spaces.

BACKGROUND AND PURPOSE: Rotator cuff tears are commonly addressed through arthroscopic surgical intervention and postoperative rehabilitation exercises. The addition of postoperative blood flow restriction therapy (BFRT) in patients with arthroscopic rotator cuff repair has not been described in the literature. The purpose of this case report was to describe the use of BFRT in the postoperative rehabilitation of a patient with arthroscopic rotator cuff repair. CASE PRESENTATION: A 54-year-old male with an arthroscopically treated full-thickness rotator cuff tear completed a 12-week postoperative rehabilitation that included low-intensity resistance exercises with BFRT. Assessment was performed at baseline, at 6 and 12 weeks of treatment, and at 6 months follow-up. At baseline, the patient presented with a reduction in shoulder muscle thickness, strength, and active range of motion and reported shoulder pain and limited physical function. OUTCOME AND FOLLOW-UP: At the 12th week of postoperative physical therapy discharge, the patient showed clinically significant improvements in biceps brachii muscle thickness, abduction and external rotation strength and range of motion of the shoulder, movement-evoked pain, and physical function. DISCUSSION: The addition of BFRT to postoperative rehabilitation exercises may be a valuable therapeutic strategy in arthroscopically treated rotator cuff tears. Randomized clinical trials are needed to evaluate the efficacy of BFRT in patients with arthroscopic rotator cuff repairs. JOSPT Cases 2024;4(3):104-111. Epub 2 July 2024. doi:10.2519/josptcases.2024.0052 [ABSTRACT FROM AUTHOR]

Background: The promotion of daily breakfast consumption and the importance of making appropriate breakfast choices have been underscored as significant public health messages. The aim of this study was to examine the relationship between breakfast frequency and life satisfaction in large and representative samples of school-going children and adolescents aged 10–17 years from 42 different countries. Methods: This study used information from the 2017/2018 Health Behavior in School-aged Children study, comprising nationally representative samples of children and adolescents aged 10–17 years who were attending school. The total number of participants from the 42 countries included in the study was 155,451 (51.3% girls). The evaluation of breakfast consumption in this study involved a specific question: "How often do you typically have breakfast (more than a glass of milk or fruit juice)?". To measure life satisfaction, a subjective assessment scale was used in the form of a ladder, visually spanning from 0 to 10. On this scale, the topmost point (10) denotes the highest conceivable quality of life, whereas the bottom point (0) represents the worst imaginable quality of life. Results: After adjusting for several covariates, the lowest estimated marginal mean of life satisfaction was identified in those participants who skipped breakfast (mean [M] = 5.6, 95% confidence interval [CI] 5.5 to 5.8). Conversely, the highest estimated marginal mean of life satisfaction was observed in those who had breakfast every day (M = 6.5, 95% CI 6.3 to 6.6). Overall, a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents was identified (p-for-trend < 0.001). In addition, the highest estimated marginal mean of life satisfaction score was identified in those participants from Portugal who had breakfast every day (M = 7.7; 95% CI 6.9 to 8.5 points). Conversely, the lowest estimated marginal mean of life satisfaction was observed in those participants from Romania who no breakfast (M = 3.5; 95% CI 2.6 to 4.4 points). Conclusions: There is a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents. Considering the potential health advantages associated with breakfast during this critical age phase, these findings imply the necessity for additional global efforts to promote increased breakfast consumption among children and adolescents. [ABSTRACT FROM AUTHOR]

Copyright of Tropelías: Revista de Teoría de la Literatura y Literatura Comparada is the property of Prensas Universitarias de Zaragoza and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Aula Abierta. Revista de Investigación, Formación e Innovación en Educación (RIFIE) is the property of Universidad de Oviedo, Servicio de Publicaciones and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and hypothesis: Self-efficacy for pelvic floor exercises, i.e. confidence in achieving pelvic floor contractions, may predict adherence to treatment. However, there is a paucity of literature investigating the clinical relevance of this outcome. The aim was to determine the relationship between self-efficacy for pelvic floor exercise and symptom severity, pelvic floor distress and impact on quality of life, as well as sociodemographic characteristics and pelvic floor muscle strength in women with stress urinary incontinence (SUI). Methods: A cross-sectional study was conducted in women with SUI. The Spanish version of the Broome Pelvic Muscle Self-Efficacy Scale was used to assess self-efficacy for pelvic floor exercise. The dependent variables were: urinary incontinence symptoms using the International Consultation on Incontinence Questionnaire, short form (ICIQ-SF), pelvic floor distress symptoms using the Urogenital Distress Inventory-6, impact on quality of life using the Incontinence Impact Questionnaire (IIQ-7), leakage using the 1-h pad test, number of SUI episodes per week and pelvic floor muscle strength. Results: A total of 56 women with a median age of 44.5 years were included. Self-efficacy for pelvic floor exercise correlated negatively and moderately with the ICIQ-SF (r = −0.529; p < 0.001), IIQ-7 (r = −0.442; p = 0.001), 1-h pad test (rs = −0.467; p < 0.001); and number of SUI episodes/week (rs = −0.489; p < 0.001). Correlation with the other outcomes was weak or non-existent. Linear regression with forward selection showed that the ICIQ-SF was the variable most related to self-efficacy (β: −3.01, 95% CI: −4.03 to −1.69). Conclusions: These findings highlight the importance of assessing self-efficacy for pelvic floor exercise in the treatment of women with SUI. Future prospective studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Introduction: Although resistance training is frequently prescribed for people with haemophilia (PWH), no previous meta‐analyses have quantified the effect of this intervention on muscle strength, nor the implications of the intervention's modality and duration. Aim: (1) To determine the effects of resistance training on muscle strength in adults with haemophilia; (2) To determine the most effective duration and modality among the exercise protocols. Methods: A systematic search from inception until 28 November 2023 was conducted in PubMed, Embase, Web of Science, CENTRAL and CINAHL databases. We included randomised controlled trials or before‐after studies that involved resistance training without other physiotherapy co‐interventions. Study selection, data extraction and risk of bias assessment were independently performed by two reviewers. Disagreements were resolved in consultation with a third author. The level of evidence was determined according to the GRADE methodology. Results: Seven studies were included. Measurements of knee extensor strength and elbow extensor strength were included in the meta‐analysis. Subgroup analysis showed significant effects for both elastic resistance protocols (SMD: 0.54; 95% CI: 0.02–1.07) and conventional training (isometric and weight‐based equipment) (SMD: 0.88; 95% CI: 0.50–1.25), demonstrating small and moderate effect sizes respectively. Additionally, both protocols of duration 5–7 weeks (SMD: 1.16, 95% CI: 0.63–1.69) as well as those of duration ≥8 weeks (SMD: 0.57, 95% CI: 0.20–0.94) showed a significant difference. Conclusion: Resistance training is effective in improving muscle strength of the knee and elbow extensors in PWH. Both elastic resistance and conventional training show benefits. [ABSTRACT FROM AUTHOR]

This document is a list of references to various scientific articles related to the treatment and management of acromegaly, a hormonal disorder characterized by excessive growth hormone production. The articles cover topics such as the effectiveness of different medications, predictors of treatment response, long-term safety, and diagnostic criteria for acromegaly. The references provide a comprehensive overview of the current research and clinical guidelines in the field, which can be valuable for library patrons conducting research on acromegaly. [Extracted from the article]

Objective The aim of this study is to compare the response to first-line medical treatment in treatment-naive acromegaly patients with pure growth hormone (GH)-secreting pituitary adenoma (GH-PA) and those with GH and prolactin cosecreting PA (GH&PRL-PA). Design This is a retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least 6 months of first-line medical treatment. Methods Baseline characteristics, first-line medical treatment strategies, and outcomes were analyzed. We employed a multiple logistic regression full model to estimate the impact of some baseline characteristics on disease control after each treatment modality. Results Of the 144 patients included, 72.9% had a GH-PA, and 27.1% had a GH&PRL-PA. Patients with GH&PRL-PA were younger (43.9 ± 15.0 vs 51.9 ± 12.7 years, P <.01) and harboring more frequently macroadenomas (89.7% vs 72.1%, P =.03). First-generation somatostatin receptor ligand (fgSRL) as monotherapy was given to 106 (73.6%) and a combination treatment with fgSRL and cabergoline in the remaining 38 (26.4%). Patients with GH&PRL-PA received more frequently a combination therapy (56.4% vs 15.2%, P <.01). After 6 months of treatment, in the group of patients under fgSRL as monotherapy, those patients with GH&PRL-PA had worse control compared to GH-PAs (29.4% vs 55.1%, P =.04). However, these differences in the rate of disease control between both groups disappeared when both received combination treatment with fgSRL and cabergoline. Conclusion In GH&PRL-PA, the biochemical control achieved with fgSRL as monotherapy is substantially worse than in patients harboring GH-PA, supporting the inclusion of cabergoline as first-line medical treatment in combination with fgSRLs in these subgroups of patients. [ABSTRACT FROM AUTHOR]