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In this paper, I want to focus on a specific set of numismatic images of Alexander the Great, which has received less attention than comparable ones: the depictions on the Late Roman medallions known ascontorniates. First, in two introductory sections, I connect the tradition of Alexander's numismatic imagery with thecontorniatesand present the general characteristics of these medallions. Next, I offer a detailed analysis of the different depictions of Alexander oncontorniates. Thirdly, I briefly summarise the discussion of the functions of thecontorniatesand, on this basis, question the interpretations of them as pagan symbols and amulets proposed by Alföldi and Mittag. Finally, based on the critique of these interpretations, I argue that the Alexandercontorniatesreflect an interest in the historical figure of the great conqueror and the quasi-fictional hero of theAlexander Romance. If this Alexander was a symbol, it was of Greco-Roman patriotism and the empire's ability to prevail over its barbarian enemies.

Leukocoria is the result of an alteration in the normal red reflex of the ocular fundus, secondary to an obstruction of the normal passage of light to the fundus of the eye that produces a white light reflex. There are many ocular pathologies that can present as leukocoria, among which retinoblastoma is the most frequent. Other causes include cataracts, Coats disease, persistent fetal vasculature, coloboma, retinopathy of prematurity, vitreous hemorrhage, astrocytic hamartoma, and ocular toxocariasis. Although in many situations the diagnosis of these pathologies is clinical or possible with the use of ocular sonography, in certain circumstances, CT or MR imaging may play a very important role in the differential diagnosis. In this review article, we propose that findings such as ocular size, the presence of calcifications, intravenous contrast enhancement, MR imaging signal intensity, CT density, and other pathology-specific findings, along with some clinical data, will guide us to the cause of leukocoria. Knowledge of the most prevalent ages of presentation of these pathologies assists with establishing the final diagnosis.Learning Objectives: To understand why leukocoria occurs, to list the major causes of leukocoria in children, and to recognize the imaging findings of the most frequent causes of leukocoria and apply them in the differential diagnosis

Background Transarterial radioembolization with yttrium-90 (Y-90 TARE) microspheres therapy has demonstrated positive clinical benefits for the treatment of liver metastases from colorectal cancer (lmCRC). This study aims to conduct a systematic review of the available economic evaluations of Y-90 TARE for lmCRC. Methods English and Spanish publications were identified from PubMed, Embase, Cochrane, MEDES health technology assessment agencies, and scientific congress databases published up to May 2021. The inclusion criteria considered only economic evaluations; thus, other types of studies were excluded. Purchasing-power-parity exchange rates for the year 2020 ($US PPP) were applied for cost harmonisation. Results From 423 records screened, seven economic evaluations (2 cost-analyses [CA] and 5 cost-utility-analyses [CUA]) were included (6 European and 1 USA). All included studies (n = 7) were evaluated from a payer and the social perspective (n = 1). Included studies evaluated patients with unresectable liver-predominant metastases of CRC, refractory to chemotherapy (n = 6), or chemotherapy-naïve (n = 1). Y-90 TARE was compared to best supportive care (BSC) (n = 4), an association of folinic acid, fluorouracil and oxaliplatin (FOLFOX) (n = 1), and hepatic artery infusion (HAI) (n = 2). Y-90 TARE increased life-years gained (LYG) versus BSC (1.12 and 1.35 LYG) and versus HAI (0.37 LYG). Y-90 TARE increased the quality-adjusted-life-year (QALY) versus BSC (0.81 and 0.83 QALY) and versus HAI (0.35 QALY). When considering a lifetime horizon, Y-90 TARE reported incremental cost compared to BSC (range 19,225 to 25,320 $US PPP) and versus HAI (14,307 $US PPP). Y-90 TARE reported incremental cost-utility ratios (ICURs) between 23,875 $US PPP/QALY to 31,185 $US PPP/QALY. The probability of Y-90 TARE being cost-effective at £ 30,000/QALY threshold was between 56% and 57%. Conclusions Our review highlights that Y-90 TARE could be a cost-effective therapy either as a monotherapy or when combined with systemic therapy for treating ImCRC. However, despite the current clinical evidence on Y-90 TARE in the treatment of ImCRC, the global economic evaluation reported for Y-90 TARE in ImCRC is limited (n = 7), therefore, we recommend future economic evaluations on Y-90 TARE versus alternative options in treating ImCRC from the societal perspective.

Objective: We investigated the association between the density of internal human migration, in the urban neighborhood, on frailty in the older adult population in Colombia.Methods: The data used in this study are from four Colombian population surveys. We analyzed 633 census tracts with a sample of 2,194 adults 60 years and over for frailty (measured using the Fried criteria). We considered the proportion of inhabitants in a census tract with a history of internal migration as the exposure variable considering three temporalities. For contextual forced migration, we identified two types: 5-year, and 1-year. Poisson multivariable regression models with two hierarchical levels (individual and census tracts) were estimated.Results: The prevalence of pre-fragile/frailty was 80.63% [CI 95%: 77.67, 83.28]. The prevalence ratio were significantly higher for the older adults who live in neighborhoods where a higher proportion of internal migrants reside.Conclusion: We conclude that older adults who lived in neighborhoods with a high proportion of internal migrants experience more frailty. Potential explanations are that neighborhoods with high internal migration could experience social (l increase in cultural heterogeneity, in the perception of insecurity, violence and physical conditions (pressure on local economies and services, leading elderly residents to compete for neighborhood resources), translated into social stress.

Climate change and urbanization are rapidly increasing human exposure to extreme ambient temperatures, yet few studies have examined temperature and mortality in Latin America. We conducted a nonlinear, distributed-lag, longitudinal analysis of daily ambient temperatures and mortality among 326 Latin American cities between 2002 and 2015. We observed 15,431,532 deaths among ≈2.9 billion person-years of risk. The excess death fraction of total deaths was 0.67% (95% confidence interval (CI) 0.58–0.74%) for heat-related deaths and 5.09% (95% CI 4.64–5.47%) for cold-related deaths. The relative risk of death was 1.057 (95% CI 1.046–1.067%) per 1 °C higher temperature during extreme heat and 1.034 (95% CI 1.028–1.040%) per 1 °C lower temperature during extreme cold. In Latin American cities, a substantial proportion of deaths is attributable to nonoptimal ambient temperatures. Marginal increases in observed hot temperatures are associated with steep increases in mortality risk. These risks were strongest among older adults and for cardiovascular and respiratory deaths.

OBJECTIVE: Recent studies have observed that racial or ethnic adult health disparities revealed in national data dissipate in racially integrated communities, supporting the theory that “place, not race” shapes the nature and magnitude of racial/ethnic health disparities. We test this theory among children. METHODS: In 2020, we estimated racial/ethnic childhood obesity disparities within integrated schools and between segregated schools, using statewide cross-sectional data collected in 2019 on 5th, 7th, and 9th grade students from California public schools. RESULTS: School segregation accounted for a large part of the obesity disparities between White children and children of color (Latinos, Blacks and Filipinos). In racially integrated schools, obesity disparities were much smaller than those in state-wide data, whereas racial or ethnic childhood obesity disparities were larger when comparing children in majority White schools to those attending schools with majority enrollment of children of color, except for Asians, who generally had lower obesity rates than their White peers. CONCLUSIONS: School-level racial segregation is a salient contributor to racial/ethnic childhood obesity disparities. Reducing obesity disparities may be particularly effective if place-level interventions target socioeconomically disadvantaged integrated schools and segregated schools attended primarily by children of color.

ObjectivesOne of the issues that has increasingly become relevant to medical practice is the ability to communicate well with patients. Better communication results in better care for the patient, as well as greater satisfaction for the physician. For this reason, the aim of this study was to assess the efficacy of a communication skills training program for medical residents (MR).MethodEighty-six MR underwent a 6-month training program in three phases: a 12-h theory and practice workshop, a period of real practice, and a 4-h workshop in which the most challenging scenarios were role played with an actress. In each phase (T0, T1, and T2), participants’ beliefs about their competence in caring for patients’ psychosocial aspects and their self-confidence in communication skills were assessed.ResultsNo differences were found between T0 and T1 in participants’ beliefs of self-competence in psychosocial care. However, this competence significantly improved after completion of the entire program. Only 7 of the 12 areas explored in communication skills significantly improved between T0 and T1. However, after T2 completion, significant improvements were observed in all 12 areas.Significance of resultsThe research results highlight the usefulness and importance of training young doctors to foster their psychosocial approach to patient care and improve their confidence in their own communication skills. The results also show the appropriateness of the structure of the training: the key features of the programme were the follow-up of the participants in three phases over 6 months, and a focus on the needs of the residents and the resolution of difficult clinical cases, with the support of an actress. Therefore, the training presented in this study may become a guide for other trainings in other contexts with similar objectives.

The increasingly early diagnosis of breast disease and the more widespread use of primary systemic therapy leads to an increasing number of surgeries for non-palpable breast lesions (NPL) in clinical practice. Breast-conserving surgery often requires the use of an image-guided preoperative localization procedure, in which a device is placed within the lesion to be removed to guide the surgeon during surgery. These are patients with small, non-palpable tumors detected in the population screening mammogram, cases with significant reduction of the lesion after neoadjuvant chemotherapy and sometimes it is even necessary to mark axillary lymphadenopathies prior to systemic treatment. For decades, wire localization has been the standard for preoperative marking in breast cancer. Due to the external component of this device, extreme care must be taken not to alter its position before surgery, which is why it is placed hours before surgery and entails complex and limited flexibility in surgical programming. Intraoperative ultrasound improves this drawback but has the limitation that it can only be performed in those NPLs that have ultrasound translation. The Radioguided Occult Lesion Localization (ROLL) technique, although it is another alternative adopted by many institutions, is not without complications, among which the possibility of diffusion of the radiotracer into healthy tissue stands out. To overcome these problems, more recently

The wastes generated by the shrimp industry are approximately between 50 and 60% of the catch volume. These residues such as head, viscera, and shell are potential pollutants if they are not treated for proper disposal. One way to solve this problem is to use the residues as functional food ingredients. In this regard, shrimp residues are rich in chitin, the second most abundant biopolymer on the planet after cellulose. Chitin is composed of N-acetyl glucosamine, a molecule used as a sweetener in the food industry and as an aid in the treatment of coronary diseases and gonarthrosis. N-acetyl glucosamine can be obtained by the hydrolysis of colloidal chitin using chemical or enzymatic methods; however, chemical methods are associated with pollution. In this study, we determined the hydrolysis conditions of shrimp colloidal chitin for obtaining N-acetyl glucosamine, using the extracellular enzymes produced by a marine bacterium isolated in the coastal zone of Progreso, Yucatan, Mexico. The best N-acetyl glucosamine yield obtained was 2.65%, using 10 mg/mL colloidal chitin, at 60°C, and pH 8.9 with 3.5% NaCl.

Posidonia oceanica meadows are ecosystem engineers which, despite their ecological relevance, are experiencing habitat fragmentation and area decrease. Cartography and information on the ecological status of these habitats is key to an effective maritime spatial planning and management for habitat conservation. In this work we apply an acoustic methodology to map benthic habitats (substrate and vegetation) in an archipelago of the Natura 2000 Network close to the coast of Murcia (SE Spain) where dense and sparse areas of P. oceanica, and patches of Cymodocea nodosa appear over a sandy and had bottom. The methodology uses dual frequency information (200 kHz and 38 kHz) acquired with a single-beam echosounder to develop a bathymetry, and performs sea bottom and vegetation supervised classifications, using video and scuba diver observations as groundtruthing data. Sea bottom was classified from acoustic features of the first and second 200 kHz echoes into 5 substrate classes using a random forest classifier: sand, fine sand, coarse sand, hard bottoms and hard bottoms with sandy patches. The vegetation was classified from features extracted from the “above-bottom” part of the echo (height and backscattering intensity) in both frequencies, resulting also in a 5 class classification: C. nodosa meadows, dense P. oceanica meadows, dispersed P. oceanica meadows, dense P. oceanica with sand patches, and no-vegetation; according to the random-forest Gini index, 38 kHz features were the most informational variables for this classification. The validation accuracies of both classifications were 85% (substrates) and 70% (vegetation), close to accuracies reported in the literature when using a similar number of classes. The results of this article (including bathymetric, and substrate and vegetation thematic maps), together with the acoustic methodology described and used, are contributions that can improve the continuous monitoring of Mediterranean seagrasses., The authors would like to thank the Instituto de Investigación para la Gestión Integrada de Zonas Costeras of the Polytechnic University of Valencia for their loan of the acoustic equipment used for data acquisition. They would like to thank Virginia Sandoval and Jose Antonio Rodríguez Navarro for support with fieldwork. This study was funded by D.G. Nature, Autonomous Community of the Region of Murcia, under contract N-143-2020. They also acknowledge the funding of open access charges by Universidade de Vigo/CISUG.

A major challenge in studies relating built environment features to health is measurement error in exposure due to geocoding errors. Faulty geocodes in built environment data introduce errors to exposure assessments that may induce bias in the corresponding health effect estimates. In this study, we examine the distribution of the measurement error in measures constructed from point-referenced exposures, quantify the extent of bias in exposure effect estimates due to geocode coarsening, and extend the simulation extrapolation (SIMEX) method to correct the bias. The motivating example focuses on the association between children’s body mass index and exposure to the junk food environment, represented by the number of junk food outlets within a buffer area near their schools. We show, algebraically and through simulation studies, that coarsening of food outlet coordinates results in exposure measurement errors that have heterogeneous variance and non-zero mean, and that the resulting bias in the health effect can be away from the null. The proposed SC-SIMEX procedure accommodates the non-standard measurement error distribution, without requiring external data, and provides the best bias correction compared to other SIMEX approaches.

This study analyzed the factors identified by inclusive faculty members that hinder or facilitate the inclusion of students with disabilities and their recommendations for universities to achieve f...

Accurate assessment of disease extent is required to select the best primary treatment for advanced epithelial ovarian cancer patients. Estimation of tumour burden is challenging and it is usually performed by means of a surgical procedure. Imaging techniques and tumour markers can help to estimate tumour burden non-invasively. 2-[18F]FDG PET/CT allows the evaluation of the whole-body disease. This study aimed to correlate HE4 and CA125 serum concentrations with tumour burden evaluated by volumetric 2-[18F]FDG PET/CT parameters in advanced high-grade epithelial ovarian cancer. We included 66 patients who underwent 2-[18F]FDG PET/CT and serum tumour markers determination before primary treatment. Volumes of interest were delimited in every pathological uptake. Whole-body metabolic tumour volume (wb_MTV) and total lesion glycolysis (wb_TLG) were calculated summing up every VOI’s MTV value. SUVmax thresholds were set at 40% (MTV40 and TLG40) and 50% (MTV50 and TLG50). In addition, four VOI subgroups were defined: peritoneal carcinomatosis, retroperitoneal nodes, supradiaphragmatic nodes, and distant metastases. MTV and TLG were calculated for each group by adding up the corresponding MTV values. TLG was calculated likewise. wb_MTV and wb_TLG were found to be significantly correlated with serum CA125 and HE4 concentrations. The strongest correlation was observed between HE4 and wb_MTV40 (r = 0.62, p

Bruises threaten the welfare of cattle because they cause pain, suffering, and stress during the pre-slaughter stage. Thus, we used meta-analyses to estimate the prevalence of carcass bruising in cattle from the American continent, determined the characteristics of the bruises, and calculated the odds ratio (OR) of risk factor categories associated with bruising. We searched electronic databases to retrieve primary studies conducted in the American continent, which reported cattle carcass bruising, analyzed the size, location, shape, and age of the bruises, and assessed risk factors for bruising. We included 46 studies from nine countries comprising 928 447 cattle carcasses with an overall prevalence of 59.5 % (95 % CI: 51.9 – 66-9) and 2.9 (range 3.4 – 7.4) bruises per carcass in average. The prevalence doubled from 30.7 % during 1991 – 2000 to 64.2 % during 2011 – 2020. Fresh, small-sized bruises of the lowest severity and located mainly in the hindquarter were highly prevalent (37.5 – 66.4 %). The removed meat due to bruising ranged 0.11 – 1.12 kg/carcass with an accumulated weight of condemned meat between 15.6 – 647 kg. Among intrinsic factors, older cattle, dairy cattle, and female cattle had greater odds of bruising (OR=1.57 – 1.98). For extrinsic factors, the odds for bruising increased 1.4 – 2.2 in cattle sourced from auction markets and exposed to poor handling, suboptimal transportation conditions, and deficient facilities. In cattle from America, bruises are a concern because their prevalence is growing and 60 % of cattle assessed in the studies suffered a bruise. Improving facilities and transportation conditions together with proper training of the personnel during the handling and transportation of the cattle will reduce bruising incidence.

The efficiency of a thermoelectric generator model under maximum conditions is presented for two optimization criteria proposed under the context of finite-time thermodynamics, namely, the efficient power criterion and the Omega function, where this last function represents a trade-off between useful and lost energy. The results are compared with the performance of the device at maximum power output. A macroscopic thermoelectric generator (TEG) model with three possible sources of irreversibilities is considered: (i) the electric resistance R for the Joule heating, (ii) the thermal conductances Kh and Kc of the heat exchangers between the thermal baths and the TEG, and (iii) the internal thermal conductance K for heat leakage. In particular, two configurations of the macroscopic TEG are studied: the so-called exoreversible case and the endoreversible limit. It shows that for both TEG configurations, the efficiency at maximum Omega function is always greater than that obtained in conditions of maximum efficient power, and this in turn is greater than that of the maximum power regime.

Background Data comparing the populations’ mental health from before, during and after the pandemic is needed. We aim to assess the risk factors for the first-onset and persistence of major depressive disorder (MDD) and suicidal thoughts and behaviours (STB) during the first year of the pandemic among the Spanish general population. Methods Cohort study through two online surveys from before the pandemic (N = 2,005, October/November 2019) and 12-months later (N = 1,357) on an adult Spanish, nationally representative, population-based sample. Multiple logistic regression models were used to assess the association between socio-demographic, COVID-19 related variables and healthcare received during the pandemic with the onset and persistence of MDD and STB. Results Women have more than 3-fold risk for the onset (OR 3.18; CI95% 1.40 -7.22) and persistence (OR 8.62; CI95% 1.74-42.48) of MDD. Studying and working at the same time (OR 10.13; CI95% 2.17-47.35) and having close relatives/friends with COVID-19 infection (OR 14.84; CI95% 1.91-115.18) or death (OR 5.26; CI95% 1.56-17.73) due to COVID-19 are risk factors for MDD onset. Sick-leave (OR 17.19; CI95% 2.65-112.56) and unemployment (OR 7.01; CI95% 1.85-26.43) increased the risk for MDD persistence. Death of friends/colleagues due to COVID-19 (OR 8.40; CI95% 1.47-48.07) increased the risk for STB onset, and being on sick-leave (OR 7.91; CI95% 1.80-34.66) for STB persistence. Conclusions During the COVID-19 pandemic, women were consistently more at risk of having worse mental health than men. Direct and indirect consequences caused or aggravated by the pandemic are common risk factors for the increased risk for the onset and persistence of both MDD and STB. Identification of high-risk subgroups and risk factors for MDD and STB among the Spanish general population will allow the developing and implementing of evidence-driven strategies for reducing the long-term impact of the pandemic in populations’ mental health. Key messages • The pandemic consequences, whether due to having had COVID-19, having close people affected or who have died from the infection and the social consequences increase the risk for worse mental health. • Evidence-driven strategies for reducing the long-term impact of the pandemic in populations’ mental health should be a public health priority.

It is currently unknown whether the relationship between affluence of school neighbourhoods and prevalence of youth overweight/obesity is uniform across demographic subgroups and areal context in the United States.We examined association between school-neighbourhood income tertiles and school-level overweight/obesity (OVOB) prevalence, using data on body mass index of fifth, seventh, and nineth graders who attended public schools in California in 2001 and 2010 (n = 1 584 768), using multiple logistic regression models.Overall, OVOB prevalence was higher in lower-income school neighbourhoods, with a steeper income-OVOB gradient for girls. Among boys, the gradient became steeper in 2010 than 2000. Among Asian and White girls, the negative gradients were steepest in rural areas. For African-American students in all areas and Latino boys in rural areas, there was less clear evidence of inverse income-OVOB gradients. Addition of fast-food restaurant availability to the models did not change the observed inverse school-neighbourhood income-obesity gradients.The findings suggest the needs to investigate reasons for this variability with consideration to combinations of sociodemographic, economic, and environmental risk factors that may contribute to disparities in childhood obesity.

Resumen Contexto El desarrollo de protocolos ERAS (Enhanced Recovery After Surgery) en pacientes sometidos a cirugia mayor ha aportado beneficios perioperatorios en diversas disciplinas. En urologia, su principal aplicacion se centra en pacientes sometidos a cistectomia radical. Objetivo Revision sistematica de la literatura disponible de protocolos ERAS aplicados a pacientes intervenidos de cistectomia radical, tanto a nivel de resultados perioperatorios como en el analisis de su implementacion. Adquisicion de la evidencia Se realizo busqueda bibliografica en base de datos electronicas Pubmed, Embase, Cochrane y Scopus, utilizando los terminos «Cystectomy», «Enhanced Recovery After Surgery» y «Fast-Track». Se seleccionaron estudios aleatorizados y no aleatorizados que comparasen la implementacion de un protocolo ERAS en pacientes sometidos a cistectomia radical frente a un protocolo tradicional. Sintesis de la evidencia Se identificaron 869 articulos; 25 fueron seleccionados para el analisis final: 22 estudios no aleatorizados y 3 aleatorizados. No se detectaron diferencias en cuanto a caracteristicas demograficas entre los distintos estudios. Se identificaron diferencias estadisticamente significativas a favor del protocolo ERAS en tiempo de estancia hospitalaria, tasa de complicaciones mayores, tiempo a primera deambulacion y recuperacion intestinal. En el analisis de protocolos se detecto una alta variabilidad, tanto en numero de items como en metodo de implementacion. Conclusiones El caracter multidisciplinar y el numero de items de los protocolos ERAS conlleva una alta heterogeneidad en su implementacion. Se requieren mas estudios aleatorizados, estandarizacion a la hora de reportar y analizar resultados, asi como un analisis sistematico de la adherencia posterior para aumentar la comparabilidad entre grupos.

Context The development of ERAS (Enhanced Recovery After Surgery) protocols in patients undergoing major surgery has brought perioperative benefits in several disciplines. Its main application in urology is focused on patients undergoing radical cystectomy. Objective Systematic review of the available literature on ERAS protocols applied to patients undergoing radical cystectomy in terms of perioperative outcomes as well in the analysis of their implementation. Evidence acquisition A bibliographic search was conducted in the electronic databases PubMed, Embase, Cochrane and Scopus, using the terms ≪Cystectomy>>, ≪Enhanced Recovery After Surgery>> and ≪Fast-Track>>. Randomized and non-randomized studies that compared the implementation of an ERAS protocol versus a traditional protocol in patients undergoing radical cystectomy were selected. Evidence synthesis 869 articles were identified; 25 were selected for final analysis: 22 non-randomized and 3 randomized studies. No differences were observed in terms of demographic characteristics between studies. Statistically significant differences were identified in favor of the ERAS protocol: length of hospital stay, major complication rate, time to first ambulation and return of bowel function. In the analysis of protocols, a high variability was detected in the number of items and in the implementation method. Conclusions The multidisciplinary nature and the number of items of the ERAS protocols imply a high heterogeneity in their implementation. Further randomized studies, standardized reporting and analyzing results, as well as a systematic analysis of subsequent adherence are required to increase comparability between groups.

Background Transarterial radioembolization (TARE) with yttrium-90 microspheres is a clinically effective therapy for hepatocellular carcinoma (HCC) treatment. This study aimed to perform a systematic review of the available economic evaluations of TARE for the treatment of HCC. Methods The Preferred Reported Items for Systematic reviews and Meta-Analyses guidelines was followed by applying a search strategy across six databases. All studies identified as economic evaluations with TARE for HCC treatment in English or Spanish language were considered. Costs were adjusted using the 2020 US dollars based on purchasing-power-parity ($US PPP). Results Among 423 records screened, 20 studies (6 cost-analyses, 3 budget-impact-analyses, 2 cost-effectiveness-analyses, 8 cost-utility-analyses, and 1 cost-minimization analysis) met the pre-defined criteria for inclusion. Thirteen studies were published from the European perspective, six from the United States, and one from the Canadian perspectives. The assessed populations included early- (n = 4), and intermediate-advanced-stages patients (n = 15). Included studies were evaluated from a payer perspective (n = 20) and included both payer and social perspective (n = 2). TARE was compared with transarterial chemoembolization (TACE) in nine studies or sorafenib (n = 11). The life-years gained (LYG) differed by comparator: TARE versus TACE (range: 1.3 to 3.1), and TARE versus sorafenib (range: 1.1 to 2.53). Of the 20 studies, TARE was associated with lower treatment costs in ten studies. The cost of TARE treatment varied widely according to Barcelona Clinic Liver Cancer (BCLC) staging system and ranged from 1311 $US PPP/month (BCLC-A) to 71,890 $US PPP/5-years time horizon (BCLC-C). The incremental cost-utility ratio for TARE versus TACE resulted in a 17,397 $US PPP/Quality-adjusted-Life-Years (QALY), and for TARE versus sorafenib ranged from dominant (more effectiveness and lower cost) to 3363 $US PPP/QALY. Conclusions Economic evaluations of TARE for HCC treatment are heterogeneous. Overall, TARE is a cost-effective short- and long-term therapy for the treatment of intermediate-advanced HCC.

Neuromyelitis optica spectrum disorder (NMOSD) is characterised by recurrent attacks of optic neuritis and transverse myelitis. The purpose of this work was to identify the incidence and prevalence of NMOSD and its clinical characteristics in the population treated for demyelinating diseases in Western Mexico.A descriptive, retrospective study was carried out in the Department of Neurology, at the Sub-specialty Medical Unit, Specialties Hospital (known by its Spanish abbreviation UMAE-HE), of the National Western Medical Center (CMNO), Mexican Institute of Social Security (IMSS). A review of the electronic files for all patients with a diagnosis of NMOSD in 2019, was carried out in the State of Jalisco, Mexico.Fifty-eight patients with NMOSD were included in the study. The incidence was 0.71/100 000 (CI 0.60-0.85) and the prevalence was 1.09/100 000 (CI 0.84-1.42). There were 79.3% women, and 20.6% were men (P = .01). All (100%) patients presented with anti-aquaporin-4 immunoglobulin G, and 89.6% showed seropositivity for anti-aquaporin-4 (CI 82.6-94.9). Magnetic resonance imaging was performed on 100% of patients, where 34.4% were normal, and 65.5% (38) abnormal, presenting with non-specific subcortical lesions (P = 0.04). The initial clinical presentation was optic neuritis (ON) in 58.6%; where 31.0% was bilateral ON, 20.7% was left ON, and 6.9% were right ON; transverse myelitis in 26.0%, area postrema syndrome (APS) in 10.3%, among others.The incidence of NMOSD exceeds 0.71/100 000, the prevalence is low at 1.09/100 000, and NMOSD is predominantly found in women.

Background Transport walking has drawn growing interest due to its potential to increase levels of physical activities and reduce reliance on vehicles. While existing studies have compared built environment-health associations between Euclidean buffers and network buffers, no studies have systematically quantified the extent of bias in health effect estimates when exposures are measured in different buffers. Further, prior studies have done the comparisons focusing on only one or two geographic regions, limiting generalizability and restricting ability to test whether direction or magnitude of bias are different by context. This study aimed to quantify the degree of bias in associations between built environment exposures and transport walking when exposures were operationalized using Euclidean buffers rather than network buffers in diverse contexts. Methods We performed a simulations study to systematically evaluate the degree of bias in associations between built environment exposures in Euclidean buffers and network buffers and transport walking, assuming network buffers more accurately captured true exposures. Additionally, we used empirical data from a multi-ethnic, multi-site cohort to compare associations between built environment amenities and walking for transport where built environment exposures were derived using Euclidean buffers versus network buffers. Results Simulation results found that the bias induced by using Euclidean buffer models was consistently negative across the six study sites (ranging from -80% to -20%), suggesting built environment exposures measured using Euclidean buffers underestimate health effects on transport walking. Percent bias was uniformly smaller for the larger 5 km scale than the 1 km and 0.25 km spatial scales, independent of site or built environment categories. Empirical findings aligned with the simulation results: built environment-health associations were stronger for built environment exposures operationalized using network buffers than using Euclidean buffers. Conclusion This study is the first to quantify the extent of bias in the magnitude of the associations between built environment exposures and transport walking when the former are measured in Euclidean buffers vs. network buffers, informing future research to carefully conceptualize appropriate distance-based buffer metrics in order to better approximate real geographic contexts. It also helps contextualize existing research in the field that used Euclidean buffers when that were the only option. Further, this study provides an example of the uncertain geographic context problem.

The original strategy applied by Langevin to Brownian movement problem is used to solve the case of a free particle under a harmonic potential. Such straightforward strategy consists in separating the noise termin the Langevin equation in order to solve a deterministic equation associated with the Mean Square Displacement (MSD). In this work, to achieve our goal we first calculate the variance for the stochastic harmonic oscillator and then the MSD appears immediately. We study the problem in the damped and lightly damped cases and show that, for times greater than the relaxation time, Langevin's original strategy is quite consistent with the exact theoretical solutions reported by Chandrasekhar and Lemons, these latter obtained using the statistical properties of a Gaussian white noise. Our results for the MSDs are compared with the exact theoretical solutions as well as with the numerical simulation.

Background: The postpartum period may be a vulnerable life stage for a woman's cardiometabolic health. We examined associations of exposure to common endocrine-disrupting chemicals (EDCs) during pregnancy with weight from delivery through 1 year postpartum among 199 women in Mexico City. Materials and Methods: During each trimester of pregnancy, we collected a urine sample to assay bisphenol A (BPA), mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP), monobenzyl phthalate (MBzP), mono-3-carboxypropyl phthalate (MCPP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono-2-ethylhexyl phthalate (MEHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP), and monoethyl phthalate (MEP). We calculated summary scores for di-2-ethylhexyl phthalate metabolites (ΣDEHP) and dibutyl phthalate metabolites (ΣDBP). We calculated the geometric mean of each EDC across pregnancy for use in the analysis. At delivery and three additional times during the first year postpartum, we measured the women's weight. We used mixed-effects linear regression models to estimate associations of each EDC with weight at delivery (kg) and weight change (kg/year) from delivery through 1 year postpartum. Covariates included urinary specific gravity, maternal age, parity, height, first trimester body mass index, and gestational age at enrollment. Results: Mean ± standard deviation weight change during the first postpartum year was −0.49 ± 4.04 kg. The EDCs were inversely associated with weight at delivery, but positively associated with weight change through 1 year postpartum. For example, each interquartile range of urinary ΣDEHP corresponded with 1.38 (95% confidence interval: 0.44–2.33) kg lower weight at delivery and 1.01 (0.41––1.61) kg/year slower rate of weight loss. We observed similar associations for other EDCs. Conclusions: Prenatal exposure to EDCs is associated with lower weight at delivery, but slower rate of weight loss through the first postpartum year.

INTRODUCTION: Endometriosis is a chronic inflammatory gynecologic disease affecting 5–10% of women of reproductive age of all ethnicities. Symptoms of this painful condition impact the physical, mental health, and quality of life of patients. Stigma is a social determinant of health documented to negatively impact people living with chronic conditions and have been associated with social exclusion, high levels of stress, and interference with medical care. The purpose of this study was to document stigma experiences among Latina women living with endometriosis. METHODS: A qualitative design using focus groups was implemented. Thematic analysis was conducted for data interpretation. A total of 50 women participated in five focus groups. RESULTS: The main theme “changuería” emerged as a label applied across multiple contexts and interactions in the lives of participants, suggesting that stigmatization is an ever-present barrier among women living with endometriosis. Participants reported that relatives, partners and health professionals perceive pain during menstruation as something women should be able to manage, producing a sense of inability to disclose the extent of suffering. CONCLUSION: These results highlight the importance of addressing stigma as a way to foster healthcare seeking and minimize its impact on physical, mental health, and wellbeing.

Objective To assess the diagnostic capability of PET/CT with [18F]F-Fluoromethylcholine in prostate cancer (PC) with biochemical recurrence and its therapeutic impact. Material and methods We included 108 patients, diagnosed with PC with biochemical criteria for recurrence. A PET/CT choline scan was performed by dynamic pelvic and whole body study at 60 min post-tracer injection. The relationship between the positive studies and the PSA value was analysed by classifying patients into three groups ( 2 ng/ml), and the diagnostic capacity was assessed with respect to pelvic MRI and the impact on the therapeutic decision. Results The location of recurrence was identified in 85 of 108 patients (78.7%): 34 local, 47 pelvic lymph nodes and 58 distant lesions, including retroperitoneal, mediastinal lymph nodes and distant organ lesions (bone and lung). Second tumors were diagnosed in 4 patients. No significant differences were found in the percentage of positive studies depending on primary treatment. Patients with PSA > 2 ng/ml showed a higher percentage of disease detection than patients with a lower PSA level, with significant differences (p Conclusions PET/CT with [18F]F-Fluoromethylcholine is a useful tool in the detection of locoregional and disseminated disease of PC treated with suspicion of recurrence, providing a change in therapeutic management in 62% of patients.

Resumen Objetivo Describir las medidas adoptadas dentro del plan de contingencia del COVID-19 respecto a la biopsia selectiva de ganglio centinela (BSGC) y analizar su impacto sobre la actividad asistencial. Metodologia Estudio cualitativo, descriptivo y retrospectivo de BSGC realizadas durante el periodo del 14/03 al 11/05 de 2020. Analisis de las medidas tomadas para minimizar las probabilidades de contagio y resultados de PCR de pacientes y personal. Comparativa de casos con los realizados en el mismo periodo de 2019. Actividad diaria de linfogammagrafia y de cirugia radioguiada (CRG) por indicacion medica. Calculo numerico y porcentual de CRG por hospital y recursos humanos diarios de medicina nuclear requeridos. Resultados Se realizaron 42 intervenciones con BSGC, un 31,1% menos que en 2019. La indicacion medica de cancer de mama experimento el mayor descenso de actividad (n = 18, 41,9%). Del total de CRG, Hospital Clinic realizo el 45,2%, Hospital Maternitat el 31,0%, Hospital Plato el 16,7% y Hospital Sant Joan de Deu el 7,1% restante. En relacion con los recursos humanos, la planificacion inicial se cumplio en un 77% de los dias. El total de los controles PCR a pacientes (n = 42) y personal de CRG (n = 9) dio resultado negativo. Conclusiones El COVID-19 influyo negativamente en la actividad asistencial de la BSGC del Hospital Clinic, pero fue compensado por una planificacion acertada, basada en el analisis previo de los procesos del procedimiento, que permitio adaptar los recursos de material y personal a las circunstancias cambiantes, otorgandole una flexibilidad que posibilito el cumplimiento de la programacion establecida.

Background Alopecia areata is an autoimmune disease that produces non-scarring hair loss around the body. Gene variants of the cytotoxic T-lymphocyte antigen 4 (CTLA4) gene, a negative regulator of T-cell response, have been associated with a predisposition to autoimmune diseases in different populations; however, the involvement of these genetic variants in the development of AA is controversial. Objective The present study evaluated the potential association of two CTLA4 gene variants with alopecia areata in a Mexican population. Methods We genotyped +49AG (rs231775) and CT60 (rs3087243) variants in 50 AA patients and 100 healthy control participants through PCR-RFLP. Results No statistical difference was observed for either of the gene variants regarding allele or genotype frequencies between AA patients and the controls when the parameters of family/personal history of autoimmune diseases or gender were considered (p > 0.05). Study limitations: Small sample size of patients and the data were obtained from Northeast Mexico population. Conclusion The genetic variants rs231775 and rs3087243 of the CTLA4 gene are not a risk factor for the development of alopecia areata in the analyzed Mexican population.

Resumen Los implantes mamarios se asocian a complicaciones frecuentes ampliamente conocidas y estudiadas como la rotura y la contractura capsular. Sin embargo, debido al numero cada vez mayor de pacientes portadoras de implantes mamarios, podemos encontrarnos con patologia mas infrecuente como la presencia de seroma o infeccion tardia, adenopatias en la cadena mamaria interna, granulomas en la capsula del implante –que en algunos casos pueden extenderse mas alla de la capsula fibrosa–, tumores desmoides asociados a los implantes y el linfoma anaplasico de celulas grandes asociado a implantes mamarios. El objetivo de este articulo es revisar las principales complicaciones infrecuentes asociadas a los implantes mamarios y sus hallazgos radiologicos en las diferentes tecnicas. Es importante un correcto manejo de esta patologia, principalmente del seroma tardio, para diagnosticar precozmente el linfoma anaplasico de celulas grandes por su mayor transcendencia.

Breast implants are associated with well-known common complications that have been widely studied, such as rupture and capsular contraction. However, the increasingly growing number of patients with breast implants has led to the increased likelihood of coming across less common complications; these include seromas or late infection; adenopathies in the internal mammary chain; granulomas in the capsule of the implant, which in some cases can extend beyond the fibrous capsule; desmoid tumors associated with the implants; and breast implant-associated large cell anaplastic lymphoma. This article aims to review the main uncommon complications associated with breast implants and to describe and illustrate their findings in different imaging techniques. Proper management of these complications is important; this is especially true of late seroma and the diagnosis of breast implant-associated large cell anaplastic lymphoma for their repercussions.

ObjectiveThis study investigated the sex difference in prevalence of depression at 90 days after first-ever stroke.MethodsPatients with first-ever stroke (n = 786) were identified from the population-based Brain Attack Surveillance in Corpus Christi project (2011–2016). Poststroke depressive symptoms were assessed by the 8-item Patient Health Questionnaire, and prestroke depression status (history and medication use) was self-reported. Logistic regression was used to examine the association between sex and depression after stroke, and effect modification by prestroke depression status, accounting for missing data.ResultsWomen were more likely to have a history of and be on medication for depression at the time of stroke than men (p< 0.001). Prevalence of depression at 90 days was 28.2% for men (95% confidence interval [CI], 23.7%–32.8%) and 32.7% for women (95% CI, 27.8%–37.5%). The age-adjusted odds ratio (OR) of depression after stroke comparing women and men was 1.34 (95% CI, 0.97–1.85), and fully attenuated after adjustment for sociodemographic, stroke, and prestroke characteristics. Effect modification by prestroke depression status was present (p= 0.038). Among participants on medication for depression at the time of stroke, women were significantly less likely to have depression at 90 days compared with men (OR, 0.39; 95% CI, 0.16–0.96), whereas significant sex differences were not noted among those with and without a depression history.ConclusionThe sex difference in prevalence of depression at 90 days after first-ever stroke was not significant overall, but varied by prestroke depression status. Interventions to address and prevent poststroke depression are needed, particularly among those with prestroke depression but not undergoing treatment for depression at stroke onset.

Transarterial radioembolization (TARE) with yttrium-90 microspheres is a clinically effective therapy for hepatocellular carcinoma (HCC) treatment. This study aimed to perform a systematic review of the available economic evaluations of TARE for the treatment of HCC.The Preferred Reported Items for Systematic reviews and Meta-Analyses guidelines was followed by applying a search strategy across six databases. All studies identified as economic evaluations with TARE for HCC treatment in English or Spanish language were considered. Costs were adjusted using the 2020 US dollars based on purchasing-power-parity ($US PPP).Among 423 records screened, 20 studies (6 cost-analyses, 3 budget-impact-analyses, 2 cost-effectiveness-analyses, 8 cost-utility-analyses, and 1 cost-minimization analysis) met the pre-defined criteria for inclusion. Thirteen studies were published from the European perspective, six from the United States, and one from the Canadian perspectives. The assessed populations included early- (n = 4), and intermediate-advanced-stages patients (n = 15). Included studies were evaluated from a payer perspective (n = 20) and included both payer and social perspective (n = 2). TARE was compared with transarterial chemoembolization (TACE) in nine studies or sorafenib (n = 11). The life-years gained (LYG) differed by comparator: TARE versus TACE (range: 1.3 to 3.1), and TARE versus sorafenib (range: 1.1 to 2.53). Of the 20 studies, TARE was associated with lower treatment costs in ten studies. The cost of TARE treatment varied widely according to Barcelona Clinic Liver Cancer (BCLC) staging system and ranged from 1311 $US PPP/month (BCLC-A) to 71,890 $US PPP/5-years time horizon (BCLC-C). The incremental cost-utility ratio for TARE versus TACE resulted in a 17,397 $US PPP/Quality-adjusted-Life-Years (QALY), and for TARE versus sorafenib ranged from dominant (more effectiveness and lower cost) to 3363 $US PPP/QALY.Economic evaluations of TARE for HCC treatment are heterogeneous. Overall, TARE is a cost-effective short- and long-term therapy for the treatment of intermediate-advanced HCC.

Insects are currently of interest due to their high nutritional value, in particular for the high concentration of quality protein. Moreover, it can also be used as an extender or binder in meat products. The objective was to evaluate grasshopper flour (GF) as a partial or total replacement for potato starch to increase the protein content of sausages and achieve good acceptability by consumers. GF has 48% moisture, 6.7% fat and 45% total protein. Sausages were analyzed by NIR and formulations with GF in all concentrations (10, 7, 5 and 3%) combined with starch (3, 5 and 7%) increased protein content. Results obtained for the sausages formulations with grasshoppers showed an increase in hardness, springiness, gumminess and chewiness through a Texture-Profile-Analysis. Moreover, a* and b* are similar to the control, but L* decreased. The check-all-that-apply test showed the attributes highlighted for sausages with GF possessed herbal flavor, brown color, and granular texture. The liking-product-landscape map showed that the incorporation of 7 and 10% of GF had an overall liking of 3.2 and 3.3, respectively, considered as "do not like much". GF can be used as a binder in meat products up to 10% substitution. However, it is important to improve the overall liking of the sausage.

With the recent growth in food-delivery applications, creating new recommendation systems tailored to this platform is essential. State-of-the-art restaurant recommendation systems are based on users’ ratings or reviews, with data that are obtained from questionnaires or online platforms such as TripAdvisor, Zomato, Foursquare, or Yield. However, not all users give ratings or reviews after their purchase. This document proposes a recommendation system whose input is the number of orders stored by a real food-delivery application. These data are always available for all food-delivery applications and are stored all the time. Our proposal is based on the nearest-neighbor technique that calculates the client’s preferred restaurants and analyzes other clients with similar buying patterns. In addition, we propose a performance metric that can be used for this specific recommendation system that is based on real restaurant sales. We use a real dataset (available online) to validate our proposal. Based on our experiments, the recommendation system successfully gives only an average of 7.7 options from 187 that are available. We compared our proposal with other state-of-the-art recommendation techniques and obtained a better performance. Our results indicate that it is possible to generate recommendations based on the number of orders, making the use of a restaurant-recommendation system feasible in a real food-delivery application.