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Endoscopy featured water-aided colonoscopy (WAC) as novel in the Innovation Forum in 2011. Gastrointestinal Endoscopy published a modified Delphi consensus review (MDCR) that supports WAC for clinical practice in 2021. We tested the hypothesis that experience was an important predictor of WAC use, either as water immersion (WI), water exchange (WE), or a combination of WI and WE.A questionnaire was sent by email to the MDCR authors with an in-depth knowledge of WAC. They responded and also invited colleagues and trainees without in-depth knowledge to respond. Logistic regression analysis was used with the reasons for WAC use treated as the primary outcome. Reports related to WAC post MDCR were identified.Of 100 respondents, 80% indicated willingness to adopt and modify practice to accommodate WAC. Higher adenoma detection rate (ADR) incentivized WE use. Procedure time slots ≤ 30 and 30 min significantly predicted WI and WE use, respectively. Co-authors of the MDCR were significantly more likely to perform WAC (odds ratio [OR] = 7.5, P = 0.037). Unfamiliarity with (OR = 0.11, P = 0.02) and absence of good experience (OR = 0.019, P = 0.002) were associated with colonoscopists less likely to perform WAC. Reports related to WAC post MDCR revealed overall and right colon WE outcomes continued to improve. Network meta-analyses showed that WE was superior to Cap and Endocuff. On-demand sedation with WE shortened nursing recovery time.An important predictor of WAC use was experience. Superior outcomes continued to be reported with WE.

Risk-reducing operations are an important part of the management of hereditary predisposition to cancer. In selected cases, they can considerably reduce the morbidity and mortality associated with cancer in this population.The Brazilian Society of Surgical Oncology (BSSO) developed this guideline to establish national benchmarks for cancer risk-reducing operations.The guideline was prepared from May to December 2021 by a multidisciplinary team of experts to discuss the surgical management of cancer predisposition syndromes. Eleven questions were defined and assigned to expert groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments, classified the level of evidence, and voted on the recommendations.For all questions including risk-reducing colectomy, gastrectomy, and thyroidectomy, a major agreement was achieved by the participants, always using accessible alternatives.This and its accompanying article represent the first guideline in cancer risk reduction surgery developed by the BSSO and it should serve as an important reference for the management of families with cancer predisposition.

The interest to characterize texture-modified foods (TMFs) intended for people with oropharyngeal dysphagia (OD) has grown significantly since 2011. Several instrumental and sensory techniques have been applied in the analysis of these foods. The objective of the present systematic review was to identify the most appropriate techniques, especially for the food industry and clinical setting. The search was carried out in three online databases according to the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA). Across the multiple trials reviewed, Texture Profile Analysis and the Uniaxial Compression Test were most used as the instrumental technique for solid foods, and the Back Extrusion Test for fluid and semisolid foods. All trials used descriptive analysis as the sensory technique. However, the experimental conditions of the trials lacked standardization. Consequently, the results of the trials were not comparable. To properly characterize the texture of TMFs intended for OD by each technique, an international consensus is needed to establish standardized experimental conditions. Methods based on these techniques should also be validated by collaborative studies to verify repeatability, replicability, and reproducibility. Open access funding provided by Universidad Pública de Navarra.

KEY POINTS: High-altitude (HA) hypoxia has the potential to alter the structural-functional integrity of the neurovascular unit (NVU) in humans. For the first time, we examined to what extent chronic and lifelong hypoxia impacts multimodal biomarkers reflecting NVU structure-function in lowlanders and native Andean highlanders. Despite lowlanders presenting with a reduction in systemic oxidative-nitrosative stress and maintained cerebral bioenergetic and cerebrovascular function during chronic hypoxia, there was evidence for increased axonal injury and cognitive impairment. Compared to lowlanders at sea-level, highlanders exhibited elevated vascular NO bioavailability, improved dynamic regulatory capacity and cerebrovascular reactivity, comparable cerebral substrate delivery, neurovascular coupling and maintained cognition. Unlike lowlanders following chronic-HA, highlanders presented with lower concentrations of S100B, neurofilament-light chain and total-tau. These findings highlight novel integrated adaptations towards the regulation of the NVU in highlanders that may represent a neuroprotective phenotype underpinning successful adaptation to the lifelong stress of HA hypoxia.ABSTRACT: High-altitude (HA) hypoxia may alter the structural-functional integrity of the neurovascular unit (NVU). Herein, we compared male lowlanders (n = 9) at sea-level (SL) and after 14-days acclimatization to 4,300 m (chronic HA) in Cerro de Pasco (CdP), Peru (HA), against sex, age and body mass index-matched healthy highlanders (n = 9) native to CdP (lifelong-HA). Serum proteins were examined to reflect NVU integrity and venous blood assayed for free radicals and nitric oxide (NO). Regional cerebral blood flow (CBF) was examined in conjunction with cerebral substrate delivery, dynamic cerebral autoregulation (dCA), cerebrovascular reactivity to carbon dioxide (CVRCO2 ) and neurovascular coupling (NVC). Psychomotor tests were employed to examine cognitive function. Compared to lowlanders at SL, highlanders exhibited elevated plasma and red blood cell NO bioavailability (P = 0.005, d = 1.549 and P = 0.003, d = 1.681), improved anterior and posterior dCA (low frequency Gain: P = 0.029, d = -1.292 and P = 0.017, d = -1.255 respectively), elevated anterior CVRCO2 (P = 0.113, d = -0.852) and preserved cerebral substrate delivery and NVC (all P = >0.100). In highlanders, S100B, neurofilament light-chain and T-tau were consistently lower (P = 0.018, d = -1.244, P = 0.037, d = -1.075 and P = 0.100) to lowlanders following chronic-HA. These findings highlight novel integrated adaptations towards regulation of the NVU in highlanders that may represent a neuroprotective phenotype underpinning successful adaptation to the lifelong stress of HA hypoxia. Abstract figure legend We determined how the hypoxia of high-altitude across the temporal continuum of chronic through to lifelong exposure impacts the neurovascular unit (NVU) phenotype and to what extent this is subject to altered redox homeostasis. Basal multimodal biomarkers reflecting NVU structure-function were determined in lowlanders at sea-level (lifelong normoxia) and after 2 weeks acclimatization to 4,300 m (chronic hypoxia) in Cerro de Pasco, Peru (CdP) and compared to age/sex-matched highlanders native to CdP (lifelong hypoxia). Compared to acclimatized lowlanders, highlanders were characterized by elevated systemic nitric oxide (NO) bioavailability, improved dynamic cerebral autoregulation (dCA) and cerebrovascular reactivity to carbon dioxide (CVRCO2 ) and lower concentrations of S100B, neurofilament-light chain (NF-L) and total tau (T-Tau) in the face of preserved cerebral bioenergetics and cognition. Collectively, our novel findings tentatively suggest that these integrated adaptations may collectively reflect a neuroprotective phenotype to cope with the lifelong stress of high-altitude hypoxia. MCA, middle cerebral artery; PCA, posterior cerebral artery; ICA, internal carotid artery; VA, vertebral artery.

Dentin hypersensitivity (DH) is characterized by pain caused by an external stimulus on exposed dentin. Different therapeutic approaches have been proposed to mitigate this problem; however, none of them provide permanent pain relief. In this study, we synthesized and characterized experimental bioactive glasses containing 3.07 mol% SrO or 3.36 mol% K2 O (both equivalent to 5 wt% in the glass), and evaluated their effect on dentin permeability to verify their potential to treat DH. The experimental materials were characterized by field-emission scanning electron microscopy, Fourier transform infrared spectroscopy, micro-Raman spectroscopy, and X-ray diffraction to confirm the respective structures and chemical compositions. The reduction in the hydraulic conductance of dentin was evaluated at the three stages: minimum permeability; maximum permeability (24% ethylenediaminetetraacetic acid [EDTA] treatment); and final dentin permeability after treatment with the bioactive glasses. They all promoted a reduction in dentin permeability, with a significant difference for each sample and posttreatment group. Also, a significant reduction in dentin permeability was observed even after a simulated toothbrushing test, demonstrating effective action of these materials against DH. Besides, incorporating 3.07 mol% SrO was a positive factor. Therefore, strontium's desensitizing and re-mineralizing properties can be further exploited in bioactive glasses to promote a synergistic effect to treat DH.

Key points Humans suffering from polycythaemia undergo multiple circulatory adaptations including changes in blood rheology and structural and functional vascular adaptations to maintain normal blood pressure and vascular shear stresses, despite high blood viscosity. During exercise, several circulatory adaptations are observed, especially involving adrenergic and non-adrenergic mechanisms within non-active and active skeletal muscle to maintain exercise capacity, which is not observed in animal models. Despite profound circulatory stress, i.e., polycythaemia, several adaptations can occur to maintain exercise capacity, therefore making early identification of the disease difficult without overt symptomology. Pharmacological treatment of the background heightened sympathetic activity may impair the adaptive sympathetic response needed to match local oxygen delivery to active skeletal muscle oxygen demand and therefore inadvertently impair exercise capacity. Abstract Excessive haematocrit and blood viscosity can increase blood pressure, cardiac work and reduce aerobic capacity. However, past clinical investigations have demonstrated that certain human high-altitude populations suffering from excessive erythrocytosis, Andeans with chronic mountain sickness, appear to have phenotypically adapted to life with polycythaemia, as their exercise capacity is comparable to healthy Andeans and even with sea level inhabitants residing at high altitude. By studying this unique population, which has adapted thru natural selection, this study aimed to describe how humans can adapt to life with polycythaemia. Experimental studies included Andeans with (n = 19) and without (n = 17) chronic mountain sickness, documenting exercise capacity, and characterizing the transport of oxygen thru blood rheology, including haemoglobin mass, blood and plasma volume & blood viscosity, cardiac output, blood pressure and changes in total and local vascular resistances thru pharmacological dissected of α-adrenergic signalling pathways within non-active and active skeletal muscle. At rest, Andeans with chronic mountain sickness had a substantial plasma volume contraction, which alongside a higher red blood cell volume, caused an increase in blood viscosity yet similar total blood volume. Moreover, both morphological and functional alterations in the periphery normalized vascular shear stress and blood pressure despite high sympathetic nerve activity. During exercise, blood pressure, cardiac work and global oxygen delivery increased similar to healthy Andeans but were sustained by modifications in both non-active and active skeletal muscle vascular function. These findings highlight widespread physiological adaptations that can occur in response to polycythaemia, which allow the maintenance of exercise capacity. This article is protected by copyright. All rights reserved.

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) first emerged in December 2019 and spread quickly causing the coronavirus disease 2019 (COVID‐19) pandemic. Recent single cell RNA‐Seq analyses have shown the presence of SARS‐CoV‐2 entry factors in the human corneal, limbal, and conjunctival superficial epithelium, leading to suggestions that the human ocular surface may serve as an additional entry gateway and infection hub for SARS‐CoV‐2. In this article, we review the ocular clinical presentations of COVID‐19 and the features of the ocular surface that may underline the overall low ocular SARS‐CoV‐2 infection. We critically evaluate the studies performed in nonhuman primates, ex vivo organ culture ocular models, stem cell derived eye organoids and the differences in infection efficiency observed in different parts of human ocular surface epithelium. Finally, we highlight the additional work that needs to be carried out to understand the immune response of the ocular surface to SARS‐CoV‐2 infection, which can be translated into prophylactic treatments that may be applied to other organ systems., Schematic showing potential SARS‐CoV‐2 entry into the eye via infection of ocular surface epithelium (left hand side panel) or the systemic routes (right hand side panel).

NEW FINDINGS: What is the central question of this study? Does chronic mountain sickness (CMS) alter sympathetic neural control and arterial baroreflex regulation of blood pressure in Andean (Quechua) highlanders? What is the main finding and its importance? Compared to healthy Andean highlanders, basal sympathetic vasomotor outflow is lower, baroreflex control of muscle sympathetic nerve activity is similar, supine heart rate is lower and cardiovagal baroreflex gain is greater in mild CMS. Taken together, these findings reflect flexibility in integrative regulation of blood pressure that may be important when blood viscosity and blood volume are elevated in CMS. ABSTRACT: The high-altitude maladaptation syndrome chronic mountain sickness (CMS) is characterized by excessive erythrocytosis and frequently accompanied by accentuated arterial hypoxaemia. Whether altered autonomic cardiovascular regulation is apparent in CMS is unclear. Therefore, during the 2018 Global REACH expedition to Cerro de Pasco, Peru (4383 m), we assessed integrative control of blood pressure (BP) and determined basal sympathetic vasomotor outflow and arterial baroreflex function in eight Andean natives with CMS ([Hb] 22.6 ± 0.9 g·dL(-1) ) and seven healthy highlanders ([Hb] 19.3 ± 0.8 g·dL(-1) ). R-R interval (RRI, electrocardiogram), beat-by-beat BP (photoplethysmography) and muscle sympathetic nerve activity (MSNA; microneurography) were recorded at rest and during pharmacologically induced changes in BP (modified Oxford test). Although [Hb] and blood viscosity (7.8 ± 0.7 vs. 6.6 ± 0.7 cP; d = 1.7, P = 0.01) were elevated in CMS compared to healthy highlanders, cardiac output, total peripheral resistance and mean BP were similar between groups. The vascular sympathetic baroreflex MSNA set-point (i.e. MSNA burst incidence) and reflex gain (i.e. responsiveness) were also similar between groups (MSNA set-point, d = 0.75, P = 0.16; gain, d = 0.2, P = 0.69). In contrast, in CMS the cardiovagal baroreflex operated around a longer RRI (960 ± 159 vs. 817 ± 50 ms; d = 1.4, P = 0.04) with a greater reflex gain (17.2 ± 6.8 vs. 8.8 ± 2.6 ms·mmHg(-1) ; d = 1.8, P = 0.01) versus healthy highlanders. Basal sympathetic vasomotor activity was also lower compared to healthy highlanders (33 ± 11 vs. 45 ± 13 bursts·min(-1) ; d = 1.0, P = 0.08). In conclusion, our findings indicate adaptive differences in basal sympathetic vasomotor activity and heart rate compensate for the haemodynamic consequences of excessive erythrocyte volume and contribute to integrative blood pressure regulation in Andean highlanders with mild CMS.

NEW FINDINGS: What is the central question of this study? Herein, a methodological overview of our research team's (Global REACH) latest high altitude research expedition to Peru is provided. What is the main finding and its importance? The experimental objectives, expedition organization, measurements and key cohort data are discussed. The select data presented in this manuscript demonstrate the haematological differences between lowlanders and Andeans with and without excessive erythrocytosis. The data also demonstrate that exercise capacity was similar between study groups at high altitude. The forthcoming findings from our research expedition will contribute to our understanding of lowlander and indigenous highlander high altitude adaptation. ABSTRACT: In 2016, the international research team Global Research Expedition on Altitude Related Chronic Health (Global REACH) was established and executed a high altitude research expedition to Nepal. The team consists of ∼45 students, principal investigators and physicians with the common objective of conducting experiments focused on high altitude adaptation in lowlanders and in highlanders with lifelong exposure to high altitude. In 2018, Global REACH travelled to Peru, where we performed a series of experiments in the Andean highlanders. The experimental objectives, organization and characteristics, and key cohort data from Global REACH's latest research expedition are outlined herein. Fifteen major studies are described that aimed to elucidate the physiological differences in high altitude acclimatization between lowlanders (n = 30) and Andean-born highlanders with (n = 22) and without (n = 45) excessive erythrocytosis. After baseline testing in Kelowna, BC, Canada (344 m), Global REACH travelled to Lima, Peru (∼80 m) and then ascended by automobile to Cerro de Pasco, Peru (∼4300 m), where experiments were conducted over 25 days. The core studies focused on elucidating the mechanism(s) governing cerebral and peripheral vascular function, cardiopulmonary regulation, exercise performance and autonomic control. Despite encountering serious logistical challenges, each of the proposed studies was completed at both sea level and high altitude, amounting to ∼780 study sessions and >3000 h of experimental testing. Participant demographics and data relating to acid-base balance and exercise capacity are presented. The collective findings will contribute to our understanding of how lowlanders and Andean highlanders have adapted under high altitude stress.

This is the pre-peer reviewed version of the following article: M. Assis, F. C. Groppo Filho, D. S. Pimentel, T. Robeldo, A. F. Gouveia, T. F. D. Castro, H. C. S. Fukushima, C. C. de Foggi, J. P. C. da Costa, R. C. Borra, J. Andrés, E. Longo. Ag Nanoparticles/AgX (X=Cl, Br and I) Composites with Enhanced Photocatalytic Activity and Low Toxicological Effects, which has been published in final form at https://doi.org/10.1002/slct.202000502. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Periodic structures induced by electron irradiation are a unique phenomenon when electron beams irradiate on the surface of some materials. These periodic structures have potential for technological applications. However, the fuzzy nature of the electron‐induced structuring hinders its further exploration in such applications. In this paper, novel Ag nanoparticle/AgX (X=Cl, Br and I) composites, with enhanced photocatalytic activity and low toxicological effects, were prepared, for the first time, using electron beam irradiation. The remarkable advantage of this approach is that the Ag nanoparticles/AgX composites can be easily prepared in one‐step without the need for high‐pressure conditions, surfactants, ionic liquids, or reducing agents. Furthermore, our method does not involve any toxic substances, which makes the as‐synthesized samples highly applicable for technological applications. The structure, morphology and physicochemical properties of the Ag nanoparticles/AgX composites were studied using various characterization techniques. Using first‐principles calculations based on density functional theory and the quantum theory of atoms in molecules, we reveal how the concentration of excess electrons in the AgX materials induces the formation of the Ag nanoparticles under electron beam irradiation. These results extend the fundamental understanding of the atomic process underlying the mechanism of Ag−X bond rupture observed during the transformation induced via electron irradiation of the AgX crystals by increasing the total number of electrons in the bulk structure. Thus, our findings provide viable guidance for the realization of new materials for the degradation of contaminated wastewater with low toxicity.

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. In the posttransplant period, the induced immunosuppression leads to an increased risk of developing infectious diseases, a leading cause of death after kidney transplantation. Human pegivirus-1 (HPgV-1) is considered a nonpathogenic human virus and is highly frequent in individuals parenterally exposed, however, its impact on kidney transplantation outcome is poorly understood. Given the scarcity of epidemiological data for this infection on organ recipients in Brazil, we conducted a study in a single center for kidney transplantation in Rio de Janeiro, aiming to determine HPgV-1 prevalence and genotypic distribution. Serum samples from 61 renal recipients, followed up for the first year after transplantation, were evaluated for viral RNA and genotypes were determined by sequencing of the 5'-untranslated region. HPgV-1 RNA was detected in 36.1% (22/61) of patients. Genotype 2 was the most commonly found (80.9%), followed by genotypes 3 (9.5%), 1, and 5, in 4.8% each. Statistical comparisons did not reveal any significant impact of HPgV-1 in patient outcome. Further epidemiologic studies are needed to understand if immunosuppression may interfere in HPgV-1 persistence rates and if viremia might impact graft dysfunction rates in kidney recipients.

RATIONALE, AIMS AND OBJECTIVES Literature have showed inconclusive or contradictory results regarding medication review services effectiveness in optimizing process indicators. Thus, this study aimed to evaluate the process indicators of a medication review service between pharmacists and physicians. METHOD This quasi-experimental study was conducted between March 2013 and February 2014 with patients who were receiving care in a medication review service in a teaching hospital in northeastern Brazil. The main process indicators were number of pharmaceutical consultations; identification and resolution of drug-related problems (DRP) and pharmaceutical interventions that were classified according to type and degree of acceptance. Descriptive statistics were used to report data. The statistical significance of the association between variables was evaluated using the Mantel-Haenszel chi-square test. The 95% confidence interval was considered, and differences were deemed statistically significant if P ≤ .05. RESULTS A total of 146 patients attended the medication review service. The number of consultations per patient ranged from one to five (2.1 ± 1.1). The service identified 366 DRP, most of which were indication (67.5%). Patients who had four to five pharmaceutical consultations were 1.14 times more likely to have their DRP identified (χ2 = 33.83, P

Zeolite crystals can be used as seeds or aluminosilicate sources in syntheses to control polymorphs and/or reduce the quantity of organics used as structure-directing agents. A frequently invoked hypothesis for interzeolite transformations is that zeolites share some underlying similarity in structure, most notably in cases pertaining to organic-free syntheses. Herein, we show for the first time that ZSM-5 (MFI) can be directly obtained from USY (FAU) through an interzeolite transformation between parent-daughter structures lacking common building units in the absence of a structure-directing agent and seeds. We show that interzeolite transformation leads to a crystalline product with fewer defects. Our findings also reveal that ZSM-5 is a metastable intermediate that undergoes further transformation to mordenite (MOR) and quartz. The MFI-to-MOR transition is counter to reported trends for which transformations lead to structures with reduced molar volume. Herein, we propose mechanistic arguments that suggest the driving force for interzeolite transformation is more complex than guidelines posited in the literature.

EGLN1 encodes the hypoxia-inducible factor (HIF) pathway prolyl hydroxylase 2 (PHD2) that serves as an oxygen-sensitive regulator of HIF activity. The EGLN1 locus exhibits a signature of positive selection in Tibetan and Andean populations and is associated with hemoglobin concentration in Tibetans. Recent reports provide evidence for functional roles of protein-coding variants within the first exon of EGLN1 (rs186996510, rs12097901) that are linked to an adaptive signal in Tibetans, yet whether these same variants are present and contribute to adaptation in Andean highlanders is unknown. We determined the frequencies of these adaptive Tibetan alleles in Quechua Andeans resident at high altitude (4,350m) in addition to individuals of Nepali ancestry resident at sea level. The rs186996510 C (minor) allele previously found at high frequency in Tibetans is absent in Andean (G: 100%) and rare among Nepali (C: 11.8%, G: 88.2%) cohorts. The minor G allele of rs12097901 is found at similarly low frequencies in Andeans (G: 12.7%, C: 87.3%) and Nepalis (G: 23.5%, C: 76.5%) compared to Tibetans. These results suggest that adaptation involving EGLN1 in Andeans involves different mechanisms than those described in Tibetans. The precise Andean adaptive variants remain to be determined.

New findings What is the central question of this study? Are coagulation and fibrinolytic factors disrupted in Andean highlanders with excessive excessive erythrocytosis. What is the main finding and its importance? Excessive erythrocytosis is not associated with prothombotic disruptions in coagulation or the fibrinolytic system in Andean highlanders. Impairments in coagulation and fibrinolysis may not contribute to the increased vascular risk associated with excessive erythrocytosis. Abstract Increased coagulation and reduced fibrinolysis are central factors underlying thrombotic risk and events. High altitude-induced excessive erythrocytosis (EE) is prevalent in Andean highlanders, contributing to increased cardiovascular risk. Disruption in the coagulation-fibrinolytic axis resulting in uncontrolled fibrin deposition may underlie the increased thrombotic risk associated with high altitude EE. The experimental aim of this study was to determine whether EE is associated with a prothrombotic blood coagulation and fibrinolytic profile in Andean highlanders. Plasma coagulation (von Willebrand factor {vWf}, factor VII, VIII, and X) and fibrinolytic (tissue-type plasminogen activator {t-PA} and plasminogen activator inhibitor-1 {PAI-1}) factors as well as D-dimer levels were determined in 26 male residents of Cerro de Pasco, Peru (4,340 m): 12 without EE (age: 40 ± 13 yr; Hb: 17.4 ± 1.9 g/dL) and 14 with EE (43 ± 15 yr; 24.4 ± 1.6 g/dL). There were no significant differences in vWf (40.5 ± 24.8 vs 45.5 ± 22.4 %), factor VII (77.0 ± 14.5 vs 72.5 ± 8.9 %), factor VIII (55.6 ± 19.8 vs 60.7 ± 26.8 %) and factor X (73.9 ± 8.3 vs 67.3 ± 10.9 %) between the Andean highlanders without or with EE. t-PA antigen (8.5 ± 3.6 vs 9.6 ± 5.4 ng/mL), t-PA activity (5.5 ± 2.4 vs 5.8 ± 1.6 IU/mL), PAI antigen (45.0 ± 33.8 vs 40.5 ± 15.8 ng/mL), PAI-1 activity (0.24 ± 0.09 vs 0.25 ± 0.11 IU/mL) and the molar concentration ratio of active t-PA to active PAI-1 (1:0.051 ± 0.034 vs 1:0.046 ± 0.021 mmol/L) were also similar between the groups as were D-dimer levels (235.0 ± 126.4 ng/mL vs 268.4 ± 173.7 ng/mL). Collectively, the results of present study indicate that EE is not associated with a hypercoagulable, hypofibrinolytic state in Andean highlanders. This article is protected by copyright. All rights reserved.