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Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. 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.)

We aimed to evaluate the impact of a multicomponent healthcare intervention, primarily designed to improve glycemic control, on blood pressure and lipids in individuals with poorly controlled type 2 diabetes mellitus (T2DM) in the Catalonian primary care setting A cluster, non-randomized, controlled pragmatic trial was conducted across 11 primary care centers. The intervention group (N=225) received a comprehensive, patient-centered approach, including a dedicated monographic consultation to address therapeutic inertia. The control group (N=181) mirrored the intervention group but lacked the monographic consultation. Secondary endpoints included lipid and blood pressure control assessed at baseline and after a 12-month follow-up. 245 participants completed the study over 12 months. We found no differences in the reduction of lipid laboratory parameters between the groups at the final visit. However, no significant differences were found between the groups for other lipids or the proportion of participants achieving lipid target values. Likewise, no differences were noted between the groups for blood pressure, its target control, and treatment at the final visit. Various clinical factors such as age, sex, diabetes duration, HbA1c levels, BMI, and macrovascular complications among the participants were associated with achieving lipid and blood pressure targets at the final visit. The pragmatic multicomponent intervention proposed in the INTEGRA study, showed that including a component designed to reduce clinical inertia in the management of glycemia did not demonstrate benefits in improving lipids and blood pressure in patients with poorly controlled T2DM. • Numerous patient- and healthcare system-related barriers contribute to this suboptimal control. • Intervention had no effect on lipid profile target control • Intervention had no effect on blood pressure or blood pressure target control • Age, sex, T2DM duration, HbA1c, BMI, and T2DM complications were associated with targets of lipid and blood pressure [ABSTRACT FROM AUTHOR]

Substituting dietary meat and fish for mycoprotein, a fungal-derived food source rich in protein and fibre, decreases circulating cholesterol concentrations in laboratory-controlled studies. However, whether these findings can be translated to a home-based setting, and to decrease cholesterol concentrations in overweight and hypercholesterolemic individuals, remains to be established. We investigated whether a remotely-delivered, home-based dietary intervention of mycoprotein-containing food products would affect various circulating cholesterol moieties and other markers of cardio-metabolic health in overweight (BMI >27.5 kg⋅m−2) and hypercholesterolaemic (>5.0 mmol⋅L−1) adults. Seventy-two participants were randomized into a controlled, parallel-group trial conducted in a free-living setting, in which they received home deliveries of either meat/fish control products (CON; n = 39; BMI 33 ± 1 kg⋅m−2; 13 males, 26 females) or mycoprotein-containing food products (MYC; n = 33; BMI 32 ± 1 kg⋅m−2; 13 males, 20 females) for 4 weeks. Fingertip blood samples were collected and sent via postal service before and after the dietary intervention period and analysed for concentrations of serum lipids, blood glucose and c-peptide. Serum total cholesterol concentrations were unchanged throughout the intervention in CON, but decreased by 5 ± 2 % in MYC (from 5.4 ± 0.2 to 5.1 ± 0.2 mmol⋅L−1; P < 0.05). Serum low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol concentrations were also unchanged in CON, but decreased in MYC by 10 ± 3 % and 6 ± 2 % (both by 0.3 ± 0.1 mmol⋅L−1; P < 0.05). Serum high-density lipoprotein cholesterol and free triglyceride concentrations were unaffected in CON or MYC. Post-intervention, MYC displayed lower mean blood glucose (3.7 ± 0.2 versus 4.3 ± 0.2 mmol⋅L−1) and c-peptide (779 ± 76 vs. 1064 ± 86 pmol⋅L−1) concentrations (P < 0.05) vs. CON. We show that a home-based dietary intervention of mycoprotein-containing food products effectively lowers circulating cholesterol concentrations in overweight, hypercholesterolemic adults. This demonstrates that mycoprotein consumption is a feasible and ecologically valid dietary strategy to improve markers of cardio-metabolic health in an at-risk population under free living conditions. NCT04773483 (https://classic.clinicaltrials.gov/ct2/show/NCT04773483). [ABSTRACT FROM AUTHOR]

In this article we describe two cases that presented with persistent fever and a hyperinflammatory state in association with severe acute respiratory syndrome-coronavirus-2 infection with various negative reverse transcription-polymerase chain reaction results. These cases subsequently developed myocarditis with cardiogenic shock that required vasoactive drugs and had a good response to corticosteroid treatment. All cases met criteria for a definitive case of multisystemic inflammatory syndrome in adults, a recently described entity associated with coronavirus disease 2019, which has a good response to immunomodulators and a good prognosis in most cases. < Learning objective: Multisystemic inflammatory syndrome in adults is a severe disease with predominantly cardiac involvement, associated with severe acute respiratory syndrome-coronavirus-2 infection. The presentation of these two cases shows the importance of early recognition, especially in this coronavirus 2019 pandemic scenario in which almost anyone is susceptible to have had contact with the virus. It usually has a good therapeutic response to corticosteroids and invasive diagnostic tests, such as endomyocardial biopsy, could be avoided.> [ABSTRACT FROM AUTHOR]

Surgical site infection is one of the most common complications of gynecologic cancer surgery. Current guidelines recommend the administration of cefazolin preoperatively to reduce surgical site infection rates for patients undergoing clean-contaminated surgeries such as hysterectomy. To evaluate the impact of a quality improvement project adding metronidazole to cefazolin for antibiotic prophylaxis on surgical site infection rate for women undergoing gynecologic surgery at a comprehensive cancer center. This retrospective, single-center cohort study included patients who underwent surgery in the gynecologic oncology department from May 2017 to June 2023. Patients with penicillin allergies and those undergoing concomitant bowel resections and/or joint cases were excluded. The preintervention group patients had surgery from May 2017 to April 2022, and the postintervention group patients had surgery from April 2022 to June 2023. The primary outcome was a 30-day surgical site infection rate. Sensitivity analyses were performed to compare surgical site infection rates on the basis of actual antibiotics received and for those who had a hysterectomy. Factors independently associated with surgical site infection were identified using a multivariable logistic regression model adjusting for confounding variables. Of 3343 patients, 2572 (76.9%) and 771 (23.1%) were in the pre-post intervention groups, respectively. Most patients (74.7%) had a hysterectomy performed. Thirty-four percent of cases were for nononcologic (benign) indications. Preintervention patients were more likely to receive appropriate preoperative antibiotics (95.6% vs 90.7%; P <.001). The overall surgical site infection rate before the intervention was 4.7% compared with 2.6% after (P =.010). The surgical site infection rate for all patients who underwent hysterectomy was 4.9% (preintervention) vs 2.8% (postintervention) (P =.036); a similar trend was seen for benign cases (4.4% vs 2.4%; P =.159). On multivariable analysis, the odds ratio for surgical site infection was 0.49 (95% confidence interval, 0.38–0.63) for the postintervention compared with the preintervention group (P <.001). In a sensitivity analysis (n=3087), the surgical site infection rate was 4.5% for those who received cefazolin alone compared with 2.3% for those who received cefazolin plus metronidazole, with significantly decreased odds of surgical site infection for the cefazolin plus metronidazole group (adjusted odds ratio, 0.40 [95% confidence interval, 0.30–0.53]; P <.001). Among only those who had a hysterectomy performed, the odds of surgical site infection were significantly reduced for those in the postintervention group (adjusted odds ratio, 0.63 [95% confidence interval, 0.47–0.86]; P =.003). The addition of metronidazole to cefazolin before gynecologic surgery decreased the surgical site infection rate by half, even after accounting for other known predictors of surgical site infection and differences in practice patterns over time. Providers should consider this combination regimen in women undergoing gynecologic surgery, especially for cases involving hysterectomy. [ABSTRACT FROM AUTHOR]

Research reporting plasma micronutrient status and its impact on clinical outcomes in paediatric cancer is scarce. Therefore, we investigated the prevalence of plasma micronutrient abnormalities and their impact on clinical outcomes and treatment complications. A multicentre prospective-cohort study of children aged <18 years diagnosed with cancer was performed between Aug 2010-Jan 2014. Clinical and nutritional data were collected at diagnosis, 3, 6, 9, 12 and 18 months. Micronutrient status was established using in-house laboratory references (vitamin B12, vitamin A and Vitamin E/Ch) and aged adjusted Z -scores (Mg, Se, Zn and Cu) generated from a cohort of healthy Scottish children. Clinical outcomes were classified as "event free survival (EFS)" or "event" (relapse, death, new metastasis or becoming palliative) and treatment complications. Descriptive statistics, logistic regression and multilevel analysis were performed. Eighty-two patients [median (IQR) 3.9 (1.9–8.8) years, 56% males] were recruited. Of these, 72 (88%) samples were available, 74% (53/72) patients had micronutrient abnormalities at baseline; deficiencies (25%, 18/72), excesses (19%, 14/72) and a combination of both (29%, 21/72), which continued for 18 months. Vitamin A deficiency (15%, 3/20) and excess (50%, 10/20) were most prevalent at 18 months, whilst vitamin E/Cholesterol and vitamin B12 were mostly within the normal range. Prevalence of Zn deficiency at diagnosis was 36% (16/44 adjusted for CRP), which remained at these levels throughout the study. Reduction in each selenium concentration unit increased the odds of an event by 2% (OR 0.02) and lower Se predicted higher complications at diagnosis [ β (−1.2); t (−2.1); 95% CI (−2.9 – (−0.04)); p = 0.04], 3 months [ β (−3.9); t (−4.2); 95% CI (−5.57 – (−2.02)); p < 0.001] and 12 months [ β (−2.3); t (−2.4); 95% CI (−4.10 – (−0.34)); p = 0.02]. Given the prevalence of micronutrient abnormalities and the negative impact of low selenium on clinical outcome, micronutrient status should be assessed and monitored in paediatric cancer patients. Larger multicentre population based studies and clinical trials are now warranted. [ABSTRACT FROM AUTHOR]

The analysis of thermoacoustic engines and the equations that describe the internal physical phenomena are far from simple. Previous studies on energetic characterisation of thermoacoustic engines are based only on the determination of the active acoustic power flow distribution. In this paper, another variable, known as the reactive acoustic power, is additionally estimated and studied. This article proposes a simple method which is based on the combination of both active and reactive acoustic power flow for the evaluation and optimisation of thermoacoustic Stirling engines. In addition the paper illustrates the method using a thermoacoustic Stirling engine demonstrator design which is able to fit three different feedback branches. The results show that the amount of reactive acoustic power supplied towards the core branch differs depending on the specifications of the selected feedback branch. Besides, the amount of reactive acoustic power distributed towards the core branch is a good indicator of the grade of traveling-wave phasing. An improvement of 16.4% in the active acoustic power towards the extraction branch is achieved and besides, the amplification of the active acoustic power through the core branch has increased by 12%. The method can serve as an effective tool to study and optimise thermoacoustic devices. [ABSTRACT FROM AUTHOR]

Clavicle non-union is a challenging problem. Open reduction with internal fixation and autologous bone grafting is usually the first line treatment. In case of failure, the medial femoral condyle corticoperiosteal flap in association with a non-vascularized bone graft is one of the therapeutic options, which is well adapted to the clavicle anatomical characteristics. We performed a retrospective study of all patients treated with this technique in our department. Between 2014 and 2017, five patients with recalcitrant post traumatic clavicle non-unions received this surgical treatment. The average nonunion time period was 50.2 month (range 10 to 108 months), and the mean defect length was 3.4 cm (between 2 and 5 cm), defects were all located in the medial third of the clavicle Three patients achieved full consolidation with an average time of consolidation of 8,7 months (range 6 to12 months). Patients with radiological consolidation had better functional improvement and pain reduction with an average DASH score improved from 53,6 before surgery to 19,6 after consolidation (at the last follow up visit). There was one donor site complications (hematoma). The medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft is a good option for the management of recalcitrant clavicle non-union, especially when the bone defect is small. [ABSTRACT FROM AUTHOR]

There are few prospective studies in the gynecologic surgical literature that compared patient-reported outcomes between open and minimally invasive hysterectomies within enhanced recovery after surgery pathways. This study aimed to compare prospectively collected perioperative patient-reported symptom burden and interference measures in open compared with minimally invasive hysterectomy cohorts within enhanced recovery after surgery pathways. We compared patient-reported symptom burden and functional interference in 646 patients who underwent a hysterectomy (254 underwent open surgery and 392 underwent minimally invasive surgery) for benign and malignant indications under enhanced recovery after surgery protocols. Outcomes were prospectively measured using the validated MD Anderson Symptom Inventory, which was administered perioperatively up to 8 weeks after surgery. Cohorts were compared using Fisher exact and chi-squared tests, adjusted longitudinal generalized linear mixed modeling, and Kaplan Meier curves to model return to no or mild symptoms. The open cohort had significantly worse preoperative physical functional interference (P =.001). At the time of hospital discharge postoperatively, the open cohort reported significantly higher mean symptom severity scores and more moderate or severe scores for overall (P <.001) and abdominal pain (P <.001), fatigue (P =.001), lack of appetite (P <.001), bloating (P =.041), and constipation (P <.001) when compared with the minimally invasive cohort. The open cohort also had significantly higher interference in physical functioning (score 5.0 vs 2.7; P <.001) than the minimally invasive cohort at the time of discharge with no differences in affective interference between the 2 groups. In mixed modeling analysis of the first 7 postoperative days, both cohorts reported improved symptom burden and functional interference over time with generally slower recovery in the open cohort. From 1 to 8 postoperative weeks, the open cohort had worse mean scores for all evaluated symptoms and interference measures except for pain with urination, although scores indicated mild symptomatic burden and interference in both cohorts. The time to return to no or mild symptoms was significantly longer in the open cohort for overall pain (14 vs 4 days; P <.001), fatigue (8 vs 4 days; P <.001), disturbed sleep (2 vs 2 days; P <.001), and appetite (1.5 vs 1 days; P <.001) but was significantly longer in the minimally invasive cohort for abdominal pain (42 vs 28 days; P <.001) and bloating (42 vs 8 days; P <.001). The median time to return to no or mild functional interference was longer in the open than in the minimally invasive hysterectomy cohort for physical functioning (36 vs 32 days; P <.001) with no difference in compositive affective functioning (5 vs 5 days; P =.07) between the groups. Open hysterectomy was associated with increased symptom burden in the immediate postoperative period and longer time to return to no or mild symptom burden and interference with physical functioning. However, all patient-reported measures improved within days to weeks of both open and minimally invasive surgery and differences were not always clinically significant. [ABSTRACT FROM AUTHOR]

Highlights • New Electronic Screening Cognitive Impairment in Multiple Sclerosis (SCI-MS) test. • SCI-MS showed good psychometric properties. • Time of pictogram completion had an acceptable diagnostic accuracy of CI. • Time of pictogram completion tool is an easy and quick score for early identify CI. Abstract Objective Although cognitive impairment (CI) is common in multiple sclerosis (MS), it is difficult to suspect in patients with low disability and there is a lack of brief and effective CI screening tools with a define cut-off point to be used during routine clinic visits. This study aims to validate the Electronic Screening Cognitive Impairment in Multiple Sclerosis (SCI-MS) test for CI among MS patients. Methods Cross-sectional, observational study that included adult patients, diagnosed with MS, Expanded Disability Status Scale (EDSS) score ≤6.5, without relapses within the last 2 months and no depression symptoms. The SCI-MS test consists of two modules: questionnaire (SCI-MS-Q) and pictogram matching tool (SCI-MS-P) measured for score and time. At inclusion, patients completed the Beck Depression Inventory (BDI-II test), the Brief Repeatable Battery of Neuropsychological Test (BRB-N) and the SCI-MS. The SCI-MS feasibility, test-retest reliability and predictive validity were assessed. Results A total of 194 patients (59.3% female) were included: mean (SD) age of 42 (9) years, mean time since diagnosis of 10 (7) years, 89.7% relapsing-remitting MS, and median (Q1-Q3) EDSS of 2.0 (1.0–3.5). According to BRB-N, 26.8% of patients had CI. Internal consistency was high (Cronbach alpha: 0.97). The intra-class correlation coefficient was 0.88 for the SCI-MS-Q, 0.09 for the SCI-MS-P score and 0.48 for the SCI-MS-P time, corresponding to AUC of the ROC curves of 0.571, 0.574 and 0.714, respectively. For a clinically significant cut-off point of ≥60 seconds, the reached CI sensitivity of SCI-MS-P time was 0.75 and the specificity 0.51. Conclusion SCI-MS showed good psychometric properties. SCI-MS-P time of pictogram completion had an acceptable diagnostic accuracy of CI in MS patients with low disability. SCI-MS-P time of pictogram completion tool is an easy and quick score that can help neurologists to early identify CI in MS patients that should be further assessed to confirm CI diagnosis and to describe its characteristics and mainly affected domains. [ABSTRACT FROM AUTHOR]

In recent years, autonomous electric vehicles (A-EVs) have attracted the attention of academia and industry. In urban mobility, this topology requires consensus to control behaviours under swarm robotics. Although several model-based solutions have successfully enhanced accuracy and overcome some limitations, specific technological, methodological, and security issues remain. In this study, we systematically reviewed existing research related to swarm intelligence and multi-agent systems in urban mobility. Based on the obtained results, we propose a new directed acyclic graph-based multilayer architecture model. Furthermore, we propose a long short-term memory recurrent neural network model to make predictions. To validate the model, available data based on real traffic in Madrid (Spain) were considered. [ABSTRACT FROM AUTHOR]

Objective To assess the prevalence and causes of hepatobiliary involvement (HBI) in systemic sclerosis (SSc), to investigate the clinical characteristics and prognosis of SSc patients with HBI (SSc-HBI) and without HBI (SSc-non-HBI), and to compare both groups according to the cutaneous SSc subsets. Methods In all, 1572 SSc patients were collected in the RESCLE registry up to January 2015, and all hepatobiliary disturbances were recorded. We investigated the HBI-related characteristics and survival from the entire SSc cohort and according to the following cutaneous subsets: diffuse cutaneous SSc (dcSSc), limited cutaneous SSc (lcSSc), and SSc sine scleroderma (ssSSc). Results Out of 1572, 118 (7.5%) patients had HBI. Primary biliary cholangitis (PBC) was largely the main cause ( n = 67, 4.3%), followed by autoimmune hepatitis ( n = 19, 1.2%), and anti-mitochondrial negative PBC ( n = 6, 0.4%). Other causes of HBI were as follows: secondary liver diseases ( n = 11, 0.7%), SSc-related HBI ( n = 7, 0.4%), nodular regenerative hyperplasia ( n = 3, 0.2%), liver cirrhosis ( n = 3, 0.2%), and HBI of unknown origin ( n = 2, 0.1%). In multivariate analysis, HBI was independently associated to lesser risk of dcSSc (5.1% vs. 24.4%), and higher frequency of calcinosis (26% vs. 18%), left ventricular diastolic dysfunction (46% vs. 27%), sicca syndrome (51% vs. 29%), and anti-centromere antibodies (ACA, 73% vs. 44%). According to the cutaneous subsets, HBI was associated (1) in lcSSc, to longer time from SSc onset to diagnosis (10.8 ± 12.5 vs. 7.2 ± 9.3 years), sicca syndrome (54% vs. 33%), and ACA (80% vs. 56%); (2) in ssSSc, to sicca syndrome (44% vs. 19%), and (3) in dcSSc, no associations were found. HBI was the cause of death in 2.3% patients but the cumulative survival according to the presence or absence of HBI showed no differences. Conclusions HBI prevalence in SSc is 7.5% and dcSSc is the least involved subset. PBC is the main cause of HBI. Patients with SSc-HBI exhibited specific clinical and immunologic profile. Survival is similar for SSc patients with HBI. [ABSTRACT FROM AUTHOR]

The ecosystem service (ES) concept is becoming mainstream in policy and planning, but operational influence on practice is seldom reported. Here, we report the practitioners’ perspectives on the practical implementation of the ES concept in 27 case studies. A standardised anonymous survey ( n  = 246), was used, focusing on the science-practice interaction process, perceived impact and expected use of the case study assessments. Operationalisation of the concept was shown to achieve a gradual change in practices: 13% of the case studies reported a change in action (e.g. management or policy change), and a further 40% anticipated that a change would result from the work. To a large extent the impact was attributed to a well conducted science-practice interaction process (>70%). The main reported advantages of the concept included: increased concept awareness and communication; enhanced participation and collaboration; production of comprehensive science-based knowledge; and production of spatially referenced knowledge for input to planning (91% indicated they had acquired new knowledge). The limitations were mostly case-specific and centred on methodology, data, and challenges with result implementation. The survey highlighted the crucial role of communication, participation and collaboration across different stakeholders, to implement the ES concept and enhance the democratisation of nature and landscape planning. [ABSTRACT FROM AUTHOR]

Venous thromboembolism is a life-threatening complication of surgery. An Enhanced Recovery After Surgery program is a multimodal care pathway that facilitates faster recovery from surgery. The rate of venous thromboembolism after gynecologic surgery on an Enhanced Recovery After Surgery program is unknown. This study aimed to evaluate the rate of venous thromboembolism within 30 days of gynecologic surgery on an Enhanced Recovery After Surgery pathway performed at a cancer center. Data were collected prospectively on Enhanced Recovery After Surgery pathway gynecologic patients undergoing open surgery (November 3, 2014, to March 31, 2021) and minimally invasive surgery (February 1, 2017, to March 31, 2021). Care was delivered at a tertiary cancer care center located in a large urban area. Patients undergoing emergency surgery or multispecialty surgeries were excluded. Patients undergoing open surgery were to receive heparin prophylaxis before surgery, sequential compression devices during surgery and admission, and low-molecular-weight heparin prophylaxis during admission. If diagnosed with malignancy, patients were to receive extended venous thromboembolism prophylaxis for 28 days after surgery. For minimally invasive surgery, patients received only sequential compression devices during surgery and no heparin prophylaxis before or after surgery. Venous thromboembolism events were included if detected on imaging obtained for symptoms or other indications. Descriptive statistics and bivariate statistical analyses were performed. Of 3329 patients, 1519 (45.6%) underwent laparotomy, 1452 (43.6%) underwent laparoscopy, and 358 (10.8%) underwent robotic surgery. The incidence rates of venous thromboembolism were 0.6% (n=21; 95% confidence interval, 0.4%–0.9%) overall, 1.1% (n=16, 95% confidence interval, 0.6%–1.7%) in the open approach, and 0.3% (n=5; 95% confidence interval, 0.3%–0.6%) in the minimally invasive approach (P =.02). The incidence rates of venous thromboembolism among the 1999 patients with malignancy were 0.9% (n=18; 95% confidence interval, 0.5%–1.4%) overall, 1.4% (n=15; 95% confidence interval, 0.7%–2.2%) in the open approach, and 0.3% (n=3; 95% confidence interval, 0.1%–0.9%) in the minimally invasive approach. The incidence rates of venous thromboembolism among the 1165 patients with benign disease were 0.3% (n=3; 95% confidence interval, 0.1%–0.7%) overall, 0.3% (n=1; 95% confidence interval, 0.0%–1.7%) in the open approach, and 0.2% (n=2; 95% confidence interval, 0.0%–0.9%) in the minimally invasive approach. The rate of venous thromboembolism among patients undergoing laparotomy and minimally invasive surgery on an Enhanced Recovery After Surgery pathway was ≤1%. This study established a benchmark for the rate of venous thromboembolism after gynecologic surgery on an Enhanced Recovery After Surgery pathway performed at a cancer center. [ABSTRACT FROM AUTHOR]

Thinning is recommended in overstocked thickets to improve forest structure and reduce high-intensity stand replacing fires. Many studies have outlined the benefits of thinning for forest growth and reproduction but effectiveness in fire intensity needs more attention. Moreover, the effect that slash generated by thinning may have on fire behavior has been seldom explored. Here we simulated fire behavior on unthinned and thinned Aleppo pine ( Pinus halepensis ) thickets in Catalonia (Northeast Spain) where woody residues were left in situ . Furthermore, we simulated fire behavior one year later considering the reduction in the dead fuel load, using decomposition rates empirically determined under high and low rainfall. We could also assess the accuracy of our simulations by measuring fire severity on trees in the same study area after a real wildfire. Simulations predicted that thinning prevents the occurrence of active crown fires and reduces mean flame length (from 6.2 ± 0.8 to 1.5 ± 0.2 m), the rate of fire spread (from 5.4 ± 0.9 to 0.9 ± 0.1 m min −1 ) and the fireline intensity (from 3631 ± 686 to 446 ± 70 kW m −1 ) compared to unthinned thickets. In the thinned stands these parameters further decrease one year later owing to the decomposition of woody residues. Decomposition of woody residues was observed to be faster under a high rainfall scenario leading to a reduction in simulated flame length and fire intensity twice as fast as under low rainfall. In accordance with the lack of active crown fires and the lower flame length predicted for thinned thickets, fire severity observed after a real wildfire in the study area was lower in thinned than in unthinned stands (respectively, 2.02 ± 0.13 vs. 2.93 ± 0.15 in a scale of 0–4). The agreement between simulations that predicted a reduction in fire intensity in thinned thickets and the lower fire damage (fire severity) observed confirms the benefits of thinning young P. halepensis thickets to reduce fire effects. Moreover, our results indicate that leaving woody residues in situ after the thinning of these young thickets does not increase fire intensity. Yet, the influence of precipitation on the decomposition of woody residues highlights the uncertainties that an increase in drought in Mediterranean-type climates may have in the behavior of future fire events. [ABSTRACT FROM AUTHOR]

An increasing number of studies demonstrate the need of applying a social-ecological system approach for landscape planning. However, there is a lack of empirical research that operationalizes the concept of social-ecological system for landscape planning through the characterization of social-ecological interactions. In this study, we develop a methodological framework to delineate the boundaries of social-ecological systems and to characterize their main social-ecological units in a spatially explicit way. Social-ecological units represent the interactions between the biophysical and socio-economic sub-systems at local scale. The methodology is structured in four phases: (1) ecological regionalization, i.e. identification and mapping of consistent ecological units based on biophysical variables; (2) socio-economic regionalization, i.e. identification and mapping of homogeneous groups of municipalities based on socio-economic variables; (3) identification of social-ecological systems boundaries and characterization of social-ecological units; and (4) validation of the social-ecological systems boundaries with key informants through participatory mapping. By applying the proposed methodological framework to three different Mediterranean cultural landscapes, we define the boundaries of social-ecological systems and illustrate how social and ecological sub-systems interact at local scale. We conclude that the proposed methodological framework is useful to operationalize the concept of social-ecological systems in landscape planning. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the leading cause of death from gynecologic malignancy and the fifth cause of cancer death in women in the United States. The most common and lethal histologic subtype of epithelial ovarian cancer is high-grade serous carcinoma (HGSC), which generally presents at an advanced stage. HGSC may be associated with BRCA1 and BRCA2 mutations. Historically, HGSC was believed to originate from the ovarian epithelial cells. However, more recent evidence supports the idea that most ovarian cancers originate in the fallopian tube epithelium in both high-risk women and in the general population. Serous tubal intraepithelial carcinomas may ultimately evolve into ovarian or peritoneal cancer. As a result, prophylactic salpingectomy with conservation of the ovaries has become an increasingly more common practice for premenopausal women undergoing risk-reducing surgery. Because the fallopian tube is now recognized as the most common potential site of origin of ovarian carcinoma, there is ongoing research to explore molecular and genetic factors that may be critical in the development of this disease. Further research is needed to identify novel opportunities for early detection and screening of ovarian cancer with the ultimate goal of increasing overall survival. [ABSTRACT FROM AUTHOR]

Objective Digital ulcers (DU) are the most common vascular complication of systemic sclerosis (SSc). We compared the characteristics between patients with prior or current DU with those never affected and evaluated whether a history of DU may be a predictor of vascular, organ involvement, and/or death in patients with SSc. Methods Data from SSc patients with or without prior or current DU were collected by 19 referral centers in an ongoing registry of Spanish SSc patients, named Registro de ESCLErodermia (RESCLE). Demographics, organ involvement, autoimmunity features, nailfold capillary pattern, survival time, and causes of death were analyzed to identify DU related characteristics and survival of the entire series and according to the following cutaneous subsets—diffuse cutaneous SSc (dcSSc), limited cutaneous SSc (lcSSc), and SSc sine scleroderma (ssSSc). Results Out of 1326, 552 patients enrolled in the RESCLE registry had prior or current DU, 88% were women, the mean age was 50 ± 16 years, and the mean disease duration from first SSc symptom was 7.6 ± 9.6 years. Many significant differences were observed in the univariate analysis between patients with and without prior/current DU. Multivariate analysis identified that history of prior/current DU in patients with SSc was independently associated to younger age at SSc diagnosis, diffuse cutaneous SSc, peripheral vascular manifestations such Raynaud’s phenomenon, telangiectasia, and acro-osteolysis but no other vascular features such as pulmonary arterial hypertension or scleroderma renal crisis. DU was also associated to calcinosis cutis, interstitial lung disease, as well as worse survival. Multivariate analysis performed in the cutaneous subsets showed that prior/current DU were independently associated: (1) in dcSSc, to younger age at SSc diagnosis, presence of telangiectasia and calcinosis and rarely a non-SSc pattern on nailfold capillaroscopy; (2) in lcSSc, to younger age at SSc diagnosis, presence of Raynaud’s phenomenon as well as calcinosis cutis, interstitial lung disease, and higher incidence of death from all causes; and (3) in ssSSc, to younger age at first SSc symptom and greater incidence of death from all causes. Conclusions Digital ulcers develop in patients with SSc younger at diagnosis, mainly in patients with dcSSc and lcSSc, and they are associated to other peripheral vascular manifestations such as Raynaud’s phenomenon, telangiectasia, and acro-osteolysis but also to calcinosis, and interstitial lung disease. History of DU in SSc leads to worse survival, also noticeable for lcSSc and ssSSc subsets but not for dcSSc patients. [ABSTRACT FROM AUTHOR]

Summary Background and aims Vitamin D inadequacy is now an internationally recognized health problem and pediatric cancer patients may be at even higher risk than healthy children. We aimed to evaluate primary research to establish the prevalence of vitamin D inadequacy and to explore its possible causes in pediatric cancer patients. Methods Electronic databases were searched (no restriction-Aug 2013) with no language restrictions and keywords related to cancer and vitamin D. We included studies of patients aged <18 years, diagnosed with and treated for cancer and reporting plasma vitamin D status. Evidence was critically appraised employing the CASP tool. Meta-analysis was performed when appropriate. Results We included 19 studies, which were mainly of moderate-quality and heterogeneous in the definitions of vitamin D deficiency and insufficiency. The median (range) prevalence of vitamin D deficiency was 14% (0–61.5%) and insufficiency 23% (0–83%). Finally, a significant effect of younger age with vitamin D inadequacy was shown (effect size: −0.132; 95%CI −0.203, −0.060). Conclusion There is a possibility of a high prevalence of vitamin D inadequacy in pediatric cancer patients, especially older children, urging the need for high-quality population-based longitudinal studies using standard definitions. [ABSTRACT FROM AUTHOR]

• Treatment with natalizumab during pregnancy requires careful management. • The NAP-30 protocol is designed to maintain natalizumab efficacy and safety during pregnancy. • The NAP-30 protocol allows for adjusting and maintaining natalizumab every 6 weeks up to week 30. • The NAP-30 protocol implementation is based on scheduled delivery at week 40. • Application of the NAP-30 protocol in 6 pregnant women was effective and safe. Pregnancy planning in women with highly active multiple sclerosis (HAMS) who need a high-efficacy disease-modifying therapy (heDMT) currently requires a careful risk-benefit evaluation. This includes minimizing fetal drug toxicity and preventing MS reactivation. We describe our experience with natalizumab in women with HAMS and unplanned pregnancy by implementing a clinical practice protocol (NAP-30) designed to maintain the effectiveness of natalizumab during pregnancy, reduce fetal exposure and prevent complications. This was an observational retrospective study including women with HAMS on active treatment with natalizumab who became unexpectedly pregnant in the period 2018–2021 and continued this treatment during pregnancy according to the NAP-30 protocol. MS clinical and radiological variables were analyzed before and during pregnancy and in the postpartum period, along with maternal and fetal toxicity during pregnancy and safety findings in newborns. We also describe the NAP-30 protocol, which includes the use of a bridging dose to adjust and maintain natalizumab infusions every 6 weeks during pregnancy up to week 30 and scheduled delivery at week 40. Six women (one in her first gestation) with a median age of 31.5 years at the onset of pregnancy (min-max: 24–37 years) were included. All were negative for anti-John Cunningham virus (JCV) antibodies and were on treatment with intravenous natalizumab 300 mg every 4 weeks. At the time of conception, three patients had received 12, 17 and 53 infusions of natalizumab, respectively, while for the remaining three patients natalizumab was their first DMT (two patients had received 6 infusions and one patient had received 3 infusions of natalizumab). All six patients received 6 doses of natalizumab during pregnancy according to the NAP-30 protocol. After delivery, all six patients restarted natalizumab every 4 weeks (median: 3 days; range: 2–4 days). No patients had relapses during pregnancy or at 6 months postpartum, nor did they develop any general health or laboratory abnormalities. The MRI scan performed at 4–6 months postpartum showed no new T2 lesions or gadolinium-enhancing lesions. No miscarriages or threatened miscarriages were reported. One of the patients underwent elective preterm delivery at week 35 after mild-to-moderate anemia was detected by fetal Doppler scan. The newborn had low birth weight (2080 g) and mild anemia, which resolved within two months with oral iron supplementation. The other infants were born with normal birth weight and showed no blood count abnormalities. After a median follow-up of 10 months, all six babies showed normal development with no complications detected. Based on our experience, the implementation of the NAP-30 protocol in women with HAMS and unplanned pregnancy undergoing treatment with natalizumab allows the continuation of natalizumab during pregnancy, with a very favorable clinical and radiological effectiveness and maternal-fetal safety profile during pregnancy and postpartum. Both in pregnancy with HAMS and in general, and particularly for successful implementation of the NAP-30 protocol, obstetric support and monitoring is essential for adequate pregnancy management. [ABSTRACT FROM AUTHOR]

The Strategic Plan for Biodiversity 2011–2020 recognizes the increasing importance of scientific knowledge to support conservation policies and decision making. In this study, we assessed the tendency of such knowledge in the first decade of the 21st century. We carried out a systematic review of publications in biodiversity conservation, considering the following aspects: type of research, main topic of study, object of study (i.e. biodiversity organizational level, taxonomic groups and ecosystems), pressures and drivers of change, as well as geographical distribution. In total, 966 publications were analyzed within the three journals with higher academic reach in the field under study: Biodiversity & Conservation, Biological Conservation, and Conservation Biology. Our results show that there are several biases in scientific knowledge associated with the object of study, and analyzed drivers of changes, as well as geographical distribution. However, research trends are not uniform along the first decade of 21st century, as there are some differences between 2000 and 2011 regarding the main topic of the study, the spatial scale and geographical region, and the analyzed ecosystems. We finally discuss the implications of current knowledge trends in biodiversity conservation for achieving the targets delineated by the Strategic Plan for Biodiversity 2011–2020. [ABSTRACT FROM AUTHOR]

Desert sand samples were thermally analyzed and their suitability for use as sensible heat thermal energy storage (TES) media is evaluated. Mass loss during heating was monitored with a thermal gravimetric analyzer (TGA) linked to a Fourier transform infrared spectrometer (FTIR). This technique showed that the relative mass loss rate of all the samples is comparable and that carbon dioxide is produced during their degradation. The calcite content of each sample is estimated assuming full calcination during the process. Additionally, larger fractions of the samples were heated in a high temperature electric furnace. This experiment showed that some samples tend to agglomerate at high temperatures, thus rendering their use as heat transfer fluid media questionable. Furthermore, color change from lighter tones to whiter tones is observed. This effect may impact the radiative properties of the samples, especially their solar absorptivity values. Finally, the average heat capacity in the 150-1100 °C temperature range was measured with a differential scanning calorimeter. The average heat capacity for all the samples was 926.1 J kg -1 K -1 . [ABSTRACT FROM AUTHOR]

An energy and exergy analysis of a novel solid particle solar receiver is presented based on experimental data and well-known correlations found in the literature. A sand sample from the deserts of the United Arab Emirates has been chosen as the solar absorber and heat carrier material. The intent of the receiver is to be used as a part of a sensible thermal energy storage system for concentrated solar power plants based upon the concept of storing solar heat in sand particles for a later discharge through a specific sand-steam heat exchanger. The results of the analysis indicate low efficiency figures that can be caused by imperfections on the experimental setup and on the original design. Several paths of improvement are discussed in conclusion. [ABSTRACT FROM AUTHOR]

An innovative gravity-fed combined solar receiver/storage system for thermal energy storage (TES) is presented for concentrated solar power (CSP) plants with beam down tower configuration. Sand particles are employed as heat collector, heat transfer and thermal energy storage media in contrast to conventionally used materials such as molten salts or synthetic oils. Relevant properties of two sand samples from the United Arab Emirates (UAE) deserts are examined. A prototype of the receiver was manufactured and its elements were characterized. Preliminary tests on the prototype were performed under the concentrated flux of a 2 kW solar furnace and associated results are presented. [ABSTRACT FROM AUTHOR]

Aim To determine the prevalence of the use of CAM and spiritual practices in the paediatric oncology population of SE Scotland and to establish both the reasons for their use and the perceived benefits. Methods A retrospective survey was performed using previously piloted questionnaires. These were distributed to families whose children were <18 years and diagnosed with cancer. Demographic and clinical data were collected, descriptive statistics were used to establish frequencies and univariate associations were established by χ 2 test. Results Of 169 families approached, 74 (44%) returned completed questionnaires. 41 (55%) families used CAM and 42 (57%) sought spiritual remedies whilst receiving conventional treatment. Higher socioeconomic status was the only factor associated with CAM usage and the most popular therapies were vitamins and minerals ( n = 22; 53%), followed by massage ( n = 12; 29%) and fish oils ( n = 12; 29%). Most families used CAM to reduce stress and, overall, CAM was perceived to be beneficial. Conclusion The high prevalence of CAM usage in this population highlights the need for physicians to enquire routinely about CAM use and warrants high-quality interventional studies to assess safety and efficacy. Summary The use of Complementary and Alternative Medicine (CAM) among paediatric patients during cancer treatment is popular worldwide, yet data from the UK are scarce. This study showed that more than half of this Scottish cohort used CAM and that there was an overall positive perception of the effect that these therapies had on the patients. Also, socio-economically advantaged families might be more likely to use CAM in Scotland. [ABSTRACT FROM AUTHOR]

Abstract: Some of the main research questions in the assessment ecosystem services include how to integrate ecological and social information into the analysis and how to make it spatially explicit. We mapped six ecosystem services delivered by forests in the Sierra Nevada Mountains (south-east Spain) from the supply- to the demand-sides, taking into account the influence of protected areas on the capacity of supply services. Semi-structured interviews and geographical information system sources were used to map the supply-side, whereas 205 face-to-face questionnaires were distributed to assess and map the demand-side. Our results show the existence of consistent ecosystem service bundles in terms of both the supply- and demand-sides, particularly between erosion control–recreational hunting and between mushroom harvesting–nature tourism. We found a spatial scale mismatch for the erosion control, with its supply at the local scale and its demand at the regional–national scales, with implications at the institutional scale at which it should be managed. Consequently, mapping both the supply- and demand-sides is essential for environmental decision making because it can indicate where management interventions should be focused, either by defining high-priority areas for protection or defining the institutional scale at which these services should be managed. [Copyright &y& Elsevier]

Abstract: The present study analyzes the relationship between landscape multi-functionality and social preferences toward Mediterranean landscapes in terms of monetary and non-monetary techniques. Twenty landscape views were selected as representative of the landscape units characterizing Nacimiento and Adra semi-arid watersheds (southeastern Spain). Face-to-face questionnaires were used to assess social factors that influence willingness to pay for aesthetic landscape enjoyment (use value) and landscape conservation (non-use value). Meanwhile, an expert focus group analyzed the capacity of the selected semi-arid ecosystems for supplying services to society. The favorite landscape views mainly contained steeper reliefs, water flows, and traditional human activities. Our results suggest a strong positive effect between respondents’ place attachment and the level of support for landscape conservation. Respondents were more willing to pay for the conservation of semi-arid rural landscapes when their sense of belonging was greater. We also found that multi-functional landscapes, which provide higher numbers of regulating and cultural services, were also preferred in terms of their visual quality (use value). Additionally, they had more social support for their conservation (non-use value). The conversion of multi-functional landscapes to mono-functional ones disturbs the stability of rural areas, their capacity to provide other ecosystem services, and the social support toward their preservation. To reverse this tendency, two major ideas should be emphasized. The first is the necessity of considering the ecological components and processes behind landscapes, and the second is the role of the local population on rural landscape conservation. [Copyright &y& Elsevier]

• We studied retinal neuromodulators expression in normoglycemic Irs2-deficient mice. • Expression of P450 Aromatase in the retinal layers was significantly increased. • Müller cells showed decreased immunocytochemical expression for GS. • A reduced immunopositive reaction for TH was observed in the amacrine cells. • Aromatase could promote local neuroprotective mediators for repairing retina damage. Insulin receptor substrate (Irs) belongs to a family of proteins that mediate the intracellular signaling of insulin and IGF-1. Insulin receptor substrate 2 (Irs2) is necessary for retinal function, since its failure in Irs2-deficient mice in hyperglycemic situation promotes photoreceptor degeneration and visual dysfunction, like in diabetic retinopathy. The expression of P450 aromatase, which catalyzes androgen aromatization to form 17ß-estradiol, increases in some neurodegenerative diseases thus promoting the local synthesis of neuroestrogens that exert relevant neuroprotective functions. Aromatase is also expressed in neurons and glial cells of the central nervous system (CNS), including the retina. To further understand the role of Irs2 at the retinal level, we performed an immunocytochemical study in adult normoglycemic Irs2-deficient mice. For this aim, the retinal immunoexpression of neuromodulators, such as aromatase, glutamine synthetase (GS), and tyrosine hydroxylase (TH) was analyzed, joint to a morphometric and planimetric study of the retinal layers. Comparing with wild-type (WT) control mice, the Irs2-knockout (Irs2-KO) animals showed a significant increase in the immunopositivity to aromatase in almost all of the retinal layers. Besides, Irs2-KO mice exhibited a decreased immunopositive reaction for GS and TH, in Müller and amacrine cells, respectively; morphological variations were also found in these retinal cell types. Furthermore, the retina of Irs2-KO mice displayed alterations in the structural organization, and a generalized decrease in the retinal thickness was observed in each of the layers, except for the inner nuclear layer. Our findings suggest that the absence of Irs2 induces retinal neurodegenerative changes in Müller and amacrine cells that are unrelated to hyperglycemia. Accordingly, in the Irs2-KO mice, the increased retinal immunocytochemical reactivity of aromatase could be associated with an attempt to repair such neural retina injuries by promoting local neuroprotective mediators. [ABSTRACT FROM AUTHOR]

• Pluripotent stem cells (hiPSCs) were generated from healthy individuals and patients with RRMS and PPMS. • All the generated hiPSC lines displayed the pluripotency features similar to hESCs. • Both healthy and patient specific iPSC lines were successfully differentiated to neural stem/progenitor cells (NPCs) i.e., building blocks of CNS. • PPMS and RRMS diseased NPCs displayed compromised stemness and elevated cellular senescence. The advent of cellular reprogramming technology converting somatic cells into induced pluripotent stem cells (iPSCs) has revolutionized our understandings of neurodegenerative diseases that are otherwise hard to access and model. Multiple Sclerosis (MS) is a chronic demyelinating, inflammatory disease of central nervous system eventually causing neuronal death and accompanied disabilities. Here, we report the generation of several relapsing-remitting MS (RRMS) and primary progressive MS (PPMS) iPSC lines from MS patients along with their age matched healthy controls from peripheral blood mononuclear cells (PBMC). These patient specific iPSC lines displayed characteristic embryonic stem cell (ESC) morphology and exhibited pluripotency marker expression. Moreover, these MS iPSC lines were successfully differentiated into neural progenitor cells (NPC) after subjecting to neural induction. Furthermore, we identified the elevated expression of cellular senescence hallmarks in RRMS and PPMS neural progenitors unveiling a novel drug target avenue of MS pathophysiology. Thus, our study altogether offers both RRMS and PPMS iPSC cellular models as a good tool for better understanding of MS pathologies and drug testing. [ABSTRACT FROM AUTHOR]

Background: Value in healthcare is reflected by patient-centered outcomes of care per health dollar expended. Although liposomal bupivacaine is more expensive, it has been shown to provide prolonged analgesia (up to 72 hours).Objective: This study aimed to evaluate whether the addition of liposomal bupivacaine to standard bupivacaine could decrease opioid intake and improve pain control after laparotomy for gynecologic surgery compared with standard bupivacaine alone in an enhanced recovery after surgery pathway.Study Design: A prospective randomized controlled single-blinded trial of wound infiltration with liposomal bupivacaine plus 0.25% bupivacaine (study arm) vs 0.25% bupivacaine (control arm) was performed at a National Cancer Institute-designated tertiary referral cancer center. Participants were patients aged ≥18 years undergoing exploratory laparotomy for a gynecologic indication. All patients were treated on an enhanced recovery pathway including local wound infiltration before closure. In this study, 266 mg of liposomal bupivacaine (free base; equal to 300 mg bupivacaine HCL)+150 mg of bupivacaine mixed in the same syringe was used in the study arm, and 150 mg of bupivacaine was used in the control arm. The primary outcome was the proportion of patients who were opioid-free within 48 hours after surgery. Secondary outcomes included number of opioid-free days from postoperative day 0 to postoperative day 3, days to first opioid administration, morphine equivalent daily dose, and patient-reported outcomes collected with the MD Anderson Symptom Inventory. The MD Anderson Symptom Inventory was administered as a preoperative baseline, daily while hospitalized, and at least weekly for 8 weeks after discharge. All outcomes were prespecified before data collection.Results: In this study, 102 patients were evaluated. Among them, 16.7% of patients in the study arm received no opioids up to 48 hours compared with 14.8% in the control arm (P=.99). There were no significant differences in the amount of intraoperative opioids administered or days to first opioid use. There was no significant difference between the 2 arms in median cumulative morphine equivalent daily dose (21.3 [study arm] vs 33.8 [control arm]; P=.36) or between the groups in morphine equivalent daily dose per individual day. There were no significant differences in patient-reported pain or interference with walking between the 2 arms or other patient-reported outcomes.Conclusion: Within an enhanced recovery after surgery pathway, adding liposomal bupivacaine to 0.25% bupivacaine wound infiltration did not decrease the proportion of patients who were opioid-free within 48 hours after surgery, did not decrease opioid intake, or did not improve patient's self-reported pain and functional recovery compared with standard bupivacaine. [ABSTRACT FROM AUTHOR]

Abstract: INTRODUCTION: The development of empyema as a result of an intra-abdominal pathology is a rare condition. PRESENTATION OF CASE: We present a 31-year-old woman at 28 weeks’ gestation who was referred to our hospital with diagnosis of pneumonia with pleural effusion. She presented with signs of septicemia and fetal distress. A thoracic-abdominal-pelvic CT-scan showed a right pleural effusion with a retroperitoneal collection in contact with the pleural space. Due to her critical condition, immediate surgical exploration and pregnancy interruption was decided. The fetus was delivered by cesarean with satisfactory vitality. After abdominal exploration, a retrocecal appendicular abscess was evidenced and appendectomy was performed. Subsequently, the right chest was accessed through a posterolateral thoracotomy. An empyema with lung abscess and purulent fluid accessing from the retroperitoneum at the posterior pleural space was found. Due to parenchymal compromise, a right inferior lobectomy was performed. The patient had an uneventful recovery and was discharged at postoperative day 10. DISCUSSION: A septic condition in a pregnant patient with significant thoraco-abdominal infection requires an aggressive approach, with interruption of pregnancy and urgent exploration of the chest and abdomen. CONCLUSION: When an empyema is developed in absence of lung disease or other intrathoracic cause, intra-abdominal origin should be considered. [Copyright &y& Elsevier]

• The rebound phenomenon, a period of increased disease activity, following natalizumab discontinuation is recognised but its incidence has not been well documented. • Using two different treatment schedules of intravenous methylprednisolone, we observed disease activity following natalizumab discontinuation. • The incidence of rebound was 10%, lower than previously observed. • Rebound, in our study population, occurred in younger patients. • Treatment with intravenous methylprednisolone may reduce the incidence and severity of the rebound phenomenon. Natalizumab (NTZ) is a disease-modifying treatment (DMT) in multiple sclerosis (MS) whose discontinuation can produce a "rebound effect", consisting of severe clinical deterioration and/or evidence of disease reactivation on magnetic resonance imaging (MRI). To analyze the efficacy of two treatment schedules with intravenous methylprednisolone (IVMP) administered during the washout period of natalizumab (i.e., before starting another DMT) in preventing the rebound phenomenon. Five-year retrospective study of NTZ withdrawals after at least 24 uninterrupted doses. Two IVMP schedules were tested. In schedule 1 (3-month washout), 1, 2, and 3 g of IVMP were administered on the first, second, and third month respectively. In schedule 2 (2-month washout), 1 and 2 g of IVMP were administered on the first and second month respectively. A new DMT was started 10 days after the end of each schedule. Rebound was defined as at least one clinical relapse plus rebound activity on MRI (>5 gadolinium-enhanced lesions and a number of new/T2-enhanced and/or gadolinium-enhanced lesions greater than before initiation of NTZ) during washout or at 6 months after new DMT initiation (6M-DMT). Clinical and MRI evaluations were performed at 3, 6, 12, and 24 months after initiation of the new DMT. Fifty patients (68% women) were included, with a mean (SD) age of 37.76 (10.88) years and pre-NTZ annualized relapse rate (ARR) of 1.78 (1.04). During NTZ therapy, mean Expanded Disability Status Scale (EDSS) score was 3.7 (1.73) and ARR was 0.23 (0.39). The ARR (mean of both schedules) was 0.1 (0.71) during washout and 0.32 (0.84) at 6M-DMT. Rebound was observed in 10% of cases (n = 5), with no significant clinical or radiological differences (p >0.05) between the two IVMP schedules. Rebound was observed in younger patients and was associated with new MRI lesions and higher ARR at 3M-DMT and 6M-DMT respectively, with no difference in EDSS after 2 years of follow-up. Neither the ARR before NTZ initiation nor the choice of new DMT after NTZ discontinuation was associated with development of rebound effect. Both IVMP schedules were well tolerated during NTZ washout and rebound was observed in only 10% of cases. In our experience, administration of IVMP during NTZ washout could reduce the possibility of a rebound effect. [ABSTRACT FROM AUTHOR]

Relatives of individuals with Crohn's disease (CD) carry CD-associated genetic variants and are often exposed to environmental factors that increase their risk for this disease. We aimed to estimate the utility of genotype, smoking status, family history, and biomarkers can calculate risk in asymptomatic first-degree relatives of patients with CD. We recruited 480 healthy first-degree relatives (full siblings, offspring or parents) of patients with CD through the Guy's and St Thomas' NHS Foundation Trust and from members of Crohn's and Colitis, United Kingdom. DNA samples were genotyped using the Immunochip. We calculated a risk score for 454 participants, based on 72 genetic variants associated with CD, family history, and smoking history. Participants were assigned to highest and lowest risk score quartiles. We assessed pre-symptomatic inflammation by capsule endoscopy and measured 22 markers of inflammation in stool and serum samples (reference standard). Two machine-learning classifiers (elastic net and random forest) were used to assess the ability of the risk factors and biomarkers to identify participants with small intestinal inflammation in the same dataset. The machine-learning classifiers identified participants with pre-symptomatic intestinal inflammation: elastic net (area under the curve, 0.80; 95% CI, 0.62–0.98) and random forest (area under the curve, 0.87; 95% CI, 0.75–1.00). The elastic net method identified 3 variables that can be used to calculate odds for intestinal inflammation: combined family history of CD (odds ratio, 1.31), genetic risk score (odds ratio, 1.14), and fecal calprotectin (odds ratio, 1.04). These same 3 variables were among the 5 factors associated with intestinal inflammation in the random forest model. Using machine learning classifiers, we found that genetic variants associated with CD, family history, and fecal calprotectin together identify individuals with pre-symptomatic intestinal inflammation who are therefore at risk for CD. A tool for detecting people at risk for CD before they develop symptoms would help identify the individuals most likely to benefit from early intervention. [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery programs have been associated with improved outcomes after gynecologic surgery. There are limited data on the effect of enhanced recovery programs on healthcare costs or healthcare service use.Objective: The purpose of this study was to evaluate differences in hospital charges for women who undergo surgery for a suspected gynecologic cancer that is managed in an enhanced recovery program as compared with conventional perioperative care.Study Design: We performed a retrospective cohort study of women who underwent open abdominal surgery for a suspected gynecologic cancer before and after the implementation of an enhanced recovery after surgery program. Consecutive patients from May to October 2014 and from November 2014 to November 2015 comprised the conventional perioperative care (before enhanced recovery after surgery) and enhanced recovery after surgery cohorts, respectively. Patients were excluded if they underwent surgery with a multidisciplinary surgical team or minimally invasive surgery. All technical and professional charges were ascertained for all healthcare services from the day of surgery until postoperative day 30. Charges for adjuvant treatment were excluded. Charges were classified according to the type of clinical service provided. The primary outcome was the difference in total hospital charges between the pre-enhanced recovery after surgery and the enhanced recovery after surgery groups. Secondary outcomes were between group differences in hospital charges within clinical service categories.Results: A total of 271 patients were included in the analysis (58 patients in the pre-enhanced recovery after surgery and 213 patients in the enhanced recovery after surgery cohort). A total of 70,177 technical charges and 6775 professional charges were identified and classified. The median hospital charge for a patient decreased 15.6% in the enhanced recovery after surgery group compared with the pre-enhanced recovery after surgery group (95% confidence interval, 5-24.5%; P=.008). Patients in the enhanced recovery after surgery group also had lower charges for laboratory services (20% lower; 95% confidence interval, 0--39%; P=.04), pharmacy services (30% lower; 95% confidence interval, 14--41%; P<.001), room and board (25% lower; 95% confidence interval, 20--47%; P=.005), and material goods (64% lower; 95% confidence interval, 44--81%; P<.001). No differences in charges were observed for perioperative services, diagnostic procedures, emergency department care, transfusion-related services, interventional radiology procedures, physical/occupational therapy, outpatient care, or other services.Conclusion: Hospital charges and healthcare service use were lower for enhanced recovery patients compared with patients who received conventional perioperative care after open surgery for a suspected gynecologic cancer. Enhanced recovery programs may be considered to be high value in healthcare because they provide improved outcomes while lowering resource use. [ABSTRACT FROM AUTHOR]

Telestroke services can improve access to stroke thrombolysis. To address challenges of night time coverage we explored the feasibility of an international telestroke service between Scotland and New Zealand taking advantage of international time zone differences. After addressing medico-legal, governance, and technical issues we tested this international service model and here we present the first 5 cases. Based on our initial experience this new model of care appears feasible and has the potential to improve patient care through reduced doctor fatigue and improved access to expert care in regions where stroke specialist input is limited. [ABSTRACT FROM AUTHOR]