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This study analyzes cases in which electronic brachytherapy (eBT) led to acceptable treatment plans in cervical cancer. Findings were compared with dosimetry values obtained inWe retrospectively analyzed 48 patients with cervical cancer from two centers. The patients were treated withStatistically significant differences were found between the eBT andeBT provides appropriate dosimetry for treatment of cervical cancer in selected cases.

In large-scale industry, the WGS reaction is the most widely used method for the purification of hydrogen obtained from natural gas. This is a process that hinges on factors such as temperature, pressure, type of catalyst, etc. In this work, copper-based solids were obtained from hydrotalcites, which were characterized through various techniques and evaluated within the WGS reaction at different temperatures. Hydrotalcite-type precursors displayed thermal behaviors that depend on their composition, whereby higher temperatures become necessary for the collapse of the HTLc structure in the solids with higher zinc and aluminum content. The calcination of precursors led to the formation of CuO particles in all the materials, which were more resistant to the reduction processes as the aluminum content augmented. The catalysts were active in the reaction under study with C0.50Z0.25A0.25 being the most active material due to the higher content of metallic copper on the surface. The most effective material in terms of metallic copper content present on the surface was C0.33Z0.33A0.33, in which the occurrence of CuO was not evinced after its use, in addition to displaying the smallest particle size of Cu0 as well as, possibly, the existence of Cu–Zn interactions on the surface.

Resumen: Introducción: Clásicamente se ha considerado el estreñimiento como un factor de riesgo de la enuresis, aunque cada vez hay más publicaciones que reportan una prevalencia de estreñimiento similar en enuréticos y no enuréticos. Objetivo: Determinar la influencia del estreñimiento en la enuresis monosintomática y la no monosintomática y conocer la prevalencia de las 3 entidades así como de disfunciones del trato urinario inferior y disfunción vesicointestinal en la población. Material y método: Estudio observacional transversal de prevalencia sobre una muestra representativa de la población gallega de niños y niñas escolarizados de 5 a 9 años. Se realizó una encuesta en los colegios sobre hábitos miccionales e intestinales que incluía las preguntas del cuestionario Paediatric Lower Urinary Tract Scoring System (PLUTSS) de diagnóstico y graduación de las disfunciones del tracto urinario inferior. Se consideró la enuresis según los criterios de la Sociedad Internacional para la Continencia en Niños (ICSS), y si además asociaba sintomatología diurna, se clasificó como enuresis no monosintomática. El estreñimiento se valoró de acuerdo con los criterios Roma III y la escala de heces de Bristol adaptados. Resultados: Se incluyeron 772 encuestas en el estudio. La prevalencia de estreñimiento fue del 20%, la de enuresis del 9,1% (enuresis monosintomática 62,9% y no monosintomática 37,1%) y la de disfunción vesicointestinal del 5,2%. Observamos que el estreñimiento no influye en la presencia de enuresis monosintomática, pero sí en la enuresis no monosintomática y las disfunciones del trato urinario inferior, donde constituye un importante factor de riesgo. Conclusiones: Es fundamental el diagnóstico diferencial entre enuresis monosintomática y no monosintomática en la valoración inicial de un paciente enurético, ya que el manejo terapéutico y las características de ambas entidades son diferentes, constituyendo el estreñimiento un factor de riesgo solamente en el caso de las enuresis no monosintomáticas. Abstract: Introduction: Constipation has classically been considered as a risk factor of enuresis, although there are increasingly more publications that report a similar prevalence of constipation in both enuretics and non-enuretics. Objective: To determine the influence of constipation in monosymptomatic and non-monosymptomatic enuresis, and to find out the prevalence of the three disorders, as well the lower urinary tract dysfunction and bladder-bowel dysfunction in the population. Material and method: A cross-sectional observational prevalence study on a representative population sample of 5 to 9 year-old school boys and girls of Galicia, Spain. A questionnaire was completed in the schools on urinary and bowel habits, which included questions from the Paediatric Lower Urinary Tract Scoring System (PLUTSS) diagnostic questionnaire and grading of the lower urinary tract dysfunctions. The enuresis was diagnosed using the International Children's Continence Society (ICSS), and if it was also associated with diurnal symptoms, it was also classified as non-monosymptomatic enuresis. The constipation was evaluated using the Rome III criteria and the adapted Bristol stool scale. Results: A total of 772 questionnaires were included in the study. The prevalence of constipation was 20% and that of enuresis was 9.1% (62.9% monosymptomatic enuresis and 37.1% non-monosymptomatic), with the prevalence of bladder-bowel dysfunction being 5.2%. It was observed that constipation had no influence on the presence of monosymptomatic enuresis, but it did have an influence on non-monosymptomatic enuresis and lower urinary tract dysfunctions, where it was a significant risk factor. Conclusions: The differential diagnosis between monosymptomatic and non-monosymptomatic enuresis is essential in the initial evaluation of the patient with enuresis, since the therapeutic management and the characteristics of both disorders are different, with constipation only being a risk factor in cases of non-monosymptomatic enuresis.

To describe the way patients die in a Spanish ICU, and how the modes of death have changed in the last 10 years.Retrospective observational study evaluating all patients who died in a Spanish tertiary ICU over a 10-year period. Modes of death were classified as death despite maximal support (D-MS), brain death (BD), and death following life-sustaining treatment limitation (D-LSTL).Amongst 9264 ICU admissions, 1553 (16.8%) deaths were recorded. The ICU mortality rate declined (1.7%/year, 95% CI 1.4-2.0; p = 0.021) while ICU admissions increased (3.5%/year, 95% CI 3.3-3.7; p0.001). More than half of the patients (888, 57.2%) died D-MS, 389 (25.0%) died after a shared decision of D-LSTL and 276 (17.8%) died due to BD. Modes of death have changed significantly over the past decade. D-LSTL increased by 15.1%/year (95% CI 14.4-15.8; p0.001) and D-MS at the end-of-life decreased by 7.1%/year (95% CI 6.6-7.6; p0.001). The proportion of patients diagnosed with BD remained stable over time.End-of-life practices and modes of death in our ICU have steadily changed. The proportion of patients who died in ICU following limitation of life-prolonging therapies substantially increased, whereas death after maximal support occurred significantly less frequently.

Background Transcatheter mitral valve repair (TMVR) utilization has increased significantly in the United States over the last years. Yet, a risk-prediction tool for adverse events has not been developed. We aimed to generate a machine-learning-based algorithm to predict in-hospital mortality after TMVR. Methods Patients who underwent TMVR from 2012 through 2015 were identified using the National Inpatient Sample database. The study population was randomly divided into a training set (n = 636) and a testing set (n = 213). Prediction models for in-hospital mortality were obtained using five supervised machine-learning classifiers. Results A total of 849 TMVRs were analyzed in our study. The overall in-hospital mortality was 3.1%. A naive Bayes (NB) model had the best discrimination for fifteen variables, with an area under the receiver-operating curve (AUC) of 0.83 (95% CI, 0.80–0.87), compared to 0.77 for logistic regression (95% CI, 0.58–0.95), 0.73 for an artificial neural network (95% CI, 0.55–0.91), and 0.67 for both a random forest and a support-vector machine (95% CI, 0.47–0.87). History of coronary artery disease, of chronic kidney disease, and smoking were the three most significant predictors of in-hospital mortality. Conclusions We developed a robust machine-learning-derived model to predict in-hospital mortality in patients undergoing TMVR. This model is promising for decision-making and deserves further clinical validation.

Resumen Introduccion y objetivos La asistencia de los testigos es decisiva para mejorar los resultados de la parada cardiaca extrahospitalaria. Pese al numero creciente de metodos de formacion en soporte vital basico (SVB), la formula mas efectiva no esta definida. Esta revision sistematica pretende describir los posibles metodos de entrenamiento en SVB para poblacion general adulta y analizar su eficacia aspirando a identificar un patron de referencia. Metodos Se reviso la base de datos MEDLINE (de enero de 2006 a julio de 2018) empleando criterios de inclusion y exclusion predefinidos y considerando todos los estudios que evaluaron metodos practicos de formacion en SVB. Dos revisores extrajeron los datos de manera independiente y evaluaron la calidad de los estudios mediante la escala MERSQI (Medical Education Research Study Quality Instrument). Resultados Se incluyeron 27 de los 1.263 estudios identificados. Los ensayos aleatorizados y controlados eran minoria, con una calidad media de 13 sobre 18 y un considerable acuerdo interobservadores. La heterogeneidad de los contenidos y los instrumentos de formacion y evaluacion limitan la comparabilidad. Los metodos guiados por instructor, incluyendo practica y apoyados por dispositivos de retroalimentacion, parecen haber obtenido los mejores resultados y el reentrenamiento facilito la retencion. La formacion mejoro ademas aspectos actitudinales. Conclusiones Aunque los datos no son lo bastante coincidentes para establecer el metodo optimo, hubo una aparente ventaja de los guiados por instructor, con practica y apoyados por retroalimentacion, asi como del reentrenamiento. Futuros estudios deberian perseguir criterios de calidad estandarizados e instrumentos de evaluacion validados para garantizar la coherencia y la comparabilidad.

Introduction and objectives Bystander assistance is decisive to enhance the outcomes of out-of-hospital cardiac arrest. Despite an increasing number of basic life support (BLS) training methods, the most effective formula remains undefined. To identify a gold standard, we performed a systematic review describing reported BLS training methods for laypeople and analyzed their effectiveness. Methods We reviewed the MEDLINE database from January 2006 to July 2018 using predefined inclusion and exclusion criteria, considering all studies training adult laypeople in BLS and performing practical skill assessment. Two reviewers independently extracted data and evaluated the quality of the studies using the MERSQI (Medical Education Research Study Quality Instrument) scale. Results Of the 1263 studies identified, 27 were included. Most of them were nonrandomized controlled trials and the mean quality score was 13 out of 18, with substantial agreement between reviewers. The wide heterogeneity of contents, methods and assessment tools precluded pooling of data. Nevertheless, there was an apparent advantage of instructor-led methods, with feedback-supported hands-on practice, and retraining seemed to enhance retention. Training also improved attitudinal aspects. Conclusions While there were insufficiently consistent data to establish a gold standard, instructor-led formulas, hands-on training with feedback devices and frequent retraining seemed to yield better results. Further research on adult BLS training may need to seek standardized quality criteria and validated evaluation instruments to ensure consistency.

Traumatic tracheobronchial injuries occur in 1% of patients with thoracic trauma, most of them dying at the site of the trauma. In this case report, we present a 26-year-old female patient admitted to the ICU due to a blunt chest trauma causing life threatening hypoxaemia and acidosis; deciding to implant percutaneous venovenous extracorporeal membrane oxygenation. The use of percutaneous venovenous extracorporeal membrane oxygenation, implemented with a lower anticoagulation target, allowed the diagnosis and treatment of a bronchopleural fistula under conditions of respiratory and hemodynamic stability without haemorrhagic complications, obtaining a fast and adequate assistance achieving the survival of the patient.

Resumen Las lesiones traqueobronquiales traumaticas ocurren en el 1% de los pacientes con traumatismo toracico, y la mayoria de ellos fallecen en el lugar del trauma. En este caso clinico presentamos a una paciente de 26 anos de edad, ingresada en UCI debido a un traumatismo toracico cerrado causando hipoxemia y acidosis grave, decidiendose implantar la membrana de oxigenacion extracorporea percutanea venovenosa. El uso de membrana de oxigenacion extracorporea percutanea venovenosa, iniciado con un objetivo de anticoagulacion mas bajo, permitio el diagnostico y tratamiento de una fistula broncopleural en condiciones de estabilidad respiratoria y hemodinamica sin complicaciones hemorragicas, obteniendo una asistencia rapida y adecuada para la supervivencia de la paciente.

Objective: To compare the quality of chest compressions performed according to the classical technique (MT) versus a new technique (NM) (compression with 2 thumbs with closed fists) in an infant manikin. Design: A controlled, randomized cross-over study was carried out in professionals assisting pediatric patients. Setting: A University Hospital with a Pediatric ICU in the north of Spain. Participants: Residents and nurses in Pediatrics who had completed a basic and an advanced pediatric cardiopulmonary resuscitation course. Interventions: Quantitative analysis of the variables referred to chest compression quality in a 2-minute cardiopulmonary resuscitation scenario in infants. Laerdal's SimPad® with SkillReporter™ system was used. Main variables of interest: Mean rate and percentage of compressions in the recommended rate range, mean depth and percentage of compressions within the depth range of recommendations, percentage of compressions with adequate decompression, and percentage of compressions performed with the fingers in the center of the chest. Results: Global quality of the compressions (NM: 84.2 ± 23.7% vs. MT: 80.1 ± 25.4% [p = 0.25; p = ns]), percentage of compressions with correct depth (NM: 59.9 ± 35.8% vs. MT: 59.5 ± 35.7% [p = 0.76; p = ns]), mean depth reached (NM: 37.3 ± 3.8 mm vs. MT: 36 ± 5.3 mm [p = 0.06; p = ns]), percentage of complete re-expansion of the chest (NM: 94.4 ± 9.3% vs. MT: 92.4 ± 18.3% [p = 0.58; p = ns]), and percentage of compressions with the recommended rate (NM: 62.2 ± 34.6% vs. MT: 51 ± 37.2% [p = 0.13; p = ns]) proved similar with both methods. Conclusions: The quality of chest compressions with the new method (thumbs with closed fists) is similar to that afforded by the traditional method.

The interest of food industry to merchandise natural astaxanthin is growing up. However, it confronts scientific and technological challenges mainly related to its poor water solubility and chemical instability. Here, we present a new quick and efficient green process to simultaneously extract, encapsulate and stabilize astaxanthin from Haematococcus pluvialis. The process is based on the hitherto unexplored combination of supramolecular solvents (SUPRAS), nanostructured liquids generated from amphiphiles through sequential self-assembly and coacervation, and nanostructured lipid carriers (NLCs). These novel nanosystems were characterized by means of dynamic light scattering, AFM and cryoSEM, revealing spherical particles of ∼100 nm. Their antioxidant activity was measured by ORAC (20.6 ± 3.9 μM TE) and α-TEAC (2.92 ± 0.58 µM α-TE) assays and their in vitro capacity to inhibit ROS by DHE probe. Results showed that the SUPRAS-NLCs proposed yield high extraction and encapsulation efficiencies (71 ± 4%) in combination with a remarkable time stability (180 d, 4 °C).

In the present paper, we study how the morphological features related to developmental physiology of other participants influence the decision to cooperate in a social dilemma. To that end, we let a large sample of men play a prisoner's dilemma game, both anonymously and against a series of counterparts whose photographs were shown. We focus on three characteristics already linked to cooperative behavior and with described effects on the adult facial shape: facial fluctuating asymmetry, a frequently employed but debated proxy for developmental instability; the degree of facial dimorphism, related to levels of testosterone during puberty; and the second to fourth digit ratio, related to relative prenatal testosterone exposure. We find significantly higher cooperation rates in anonymous interactions than in the non-anonymous round. We also find that individuals are more likely to cooperate with more asymmetric counterparts, and that more asymmetric participants were less likely to believe that their counterpart would cooperate. Variables related to exposure to testosterone during development do not display any effect. We conclude by discussing how out-of-the-game rewards can explain our results.

Radiotherapy has been used for more than a hundred years as a local tumor treatment. The occurrence of systemic antitumor effects manifesting as regression of tumors outside of the irradiated field (abscopal effect) was occasionally observed but deemed too rare and unpredictable to be a therapeutic goal. This has changed with the advent of immunotherapy. Remarkable systemic effects have been observed in patients receiving radiotherapy to control tumors that were progressing during immune checkpoint blockade, stimulating interest in using radiation to overcome primary and acquired cancer resistance to immunotherapy. Here, we review the immunological mechanisms that are responsible for the ability of focal radiation to promote antitumor T cell responses that mediate tumor rejection and, in some cases, result in systemic effects.

Background Combination immunotherapy has the potential to achieve additive or synergistic effects. Combined local injections of dsRNA analogues (mimicking viral RNA) and repeated vaccinations with tumor-lysate loaded dendritic cells shows efficacy against colon cancer mouse models. In the context of immunotherapy, radiotherapy can exert beneficial abscopal effects. Patients and methods In this two-cohort pilot phase I study, 15 advanced cancer patients received two 4-week cycles of four intradermal daily doses of monocyte-derived dendritic cells preloaded with autologous tumor lysate and matured for 24h with poly-ICLC (Hiltonol), TNF-α and IFN-α. On days+8 and+10 of each cycle, patients received intratumoral image-guided 0.25mg injections of the dsRNA-analogue Hiltonol. Cyclophosphamide 600mg/m2 was administered 1 week before. Six patients received stereotactic ablative radiotherapy (SABR) on selected tumor lesions, including those injected with Hiltonol. Expression of 25 immune-relevant genes was sequentially monitored by RT-PCR on circulating peripheral blood mononuclear cell (PBMCs) and serum concentrations of a cytokine panel were sequentially determined before and during treatment. Pre- and post-treatment PBMC from patients achieving durable stable disease (SD) were studied by IFNγ ELISPOT-assays responding to tumor-lysate loaded DC and by TCRβ sequencing. Results Combined treatment was, safe and well tolerated. One heavily pretreated castration-resistant prostate cancer patient experienced a remarkable mixed abscopal response to SABR+ immunotherapy. No objective responses were observed, while nine patients presented SD (five of them in the six-patient radiotherapy cohort). Intratumoral Hiltonol increased IFN-β and IFN-α mRNA in circulating PBMC. DC vaccination increased serum IL-12 and IL-1β concentrations, especially in patients presenting SD. IFNγ-ELISPOT reactivity to tumor lysates was observed in two patients experiencing durable SD. Conclusions This radio-immunotherapy combination strategy, aimed at resembling viral infection in tumor tissue in combination with a dendritic-cell vaccine and SABR, is safe and shows immune-associated activity and signs of preliminary clinical efficacy.

Thyroid hormones and their metabolites constitute a vast class of related iodothyronine compounds that contribute to the regulation of metabolic activity and cell differentiation. They are in turn transported, transformed and recognized as signaling molecules through binding to a variety of proteins from a wide range of evolutionary unrelated protein families, which renders these proteins and their iodothyronine binding sites an example for extensive convergent evolution. In this review, we will briefly summarize what is known about iodothyronine binding sites in proteins, the modes of protein/iodothyronine interaction, and the ligand conformations. We will then discuss physiological and synthetic compounds, including popular drugs and food components, that can interfere with iodothyronine binding and recognition by these proteins. The discussion also includes compounds persisting in the environment and acting as endocrine disrupting chemicals.