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Although fear in early childhood is an emotion that permits survival of danger, fear of water can block and limit children's adaptive development towards this very fear. Aquatic competence is an important milestone in the improvement of general health in childhood, but there are no scales that measure how fear of water can hinder a child's development in the aquatic environment. This study aimed to design and analyze the validity of a Scale to Measure Fear of the Aquatic Environment (SFAE) to evaluate the perceived fear of the aquatic environment in three- to six-year-old children. Construct validity was also evaluated by verifying its relation to aquatic competence. The exploratory and confirmatory factor analyses support the use of five dimensions of influence on the perception of fear of the aquatic environment: social context, equipment/installations, attitude, experiences, and competence. The correlation pattern also supports construct validity showing negative and significant relations between fear and aquatic competence. The SFAE shows a promising initial validity for its use in the aquatic environment during early childhood., Motricidade, Vol. 16 No. 4 (2020): Motricidade

Pedagogical strategies following both the ABI model and the interest pedagogy were implemented in order to vegetal physiology lesson students to promote their motivation, basic competences and research abilities, and to develop in a holistic way the conceptualization of plants as open, complex and cybernetic systems. So, higher levels of motivation and researching abilities were achieved, as expressed by better resolutions of biological questions, along with empowering of the experimental design and the statistical method, in addition to a high expository capacity of both written and verbal results during the public defens of talks in national congresses.RESUMENCon el propósito de promover la motivación, las competencias básicas (interpretativa, argumentativa y propositiva) y las habilidades investigativas, en los estudiantes del curso de fisiología vegetal del programa de biología de la Universidad de Pamplona, se implementaron estrategias pedagógicas siguiendo el modelo ABI y la pedagogía de los intereses, para la comprensión integral del concepto de planta como sistema abierto, complejo y cibernético. Desde el punto de vista conceptual, se logró construir, participativamente, una visión holística de la planta; desde lo pedagógico, se alcanzaron mayores niveles de motivación y de capacidad investigativa, expresada en una mejor resolución de las preguntas biológicas, con empoderamiento del diseño experimental y del método estadístico, alta capacidad expositiva de los resultados tanto escritos como verbales, junto con la defensa pública en ponencias a nivel de semilleros de estudiantes y congresos nacionales.

Background Besides promising results of metal-on-metal (MOM) hip arthroplasty (HA), frequent failures have been reported even in the short term. Many host, surgical, design, metallurgical, and processing factors have been evoked in the base of these events. We have tried to characterize and to evaluate metallurgical and processing features present in this type of implants. Methods The acetabular and femoral components of 20 MOM HAs collected from a multicenter retrieval program were examined. All the specimens were inspected with naked eye, with confocal microscopy and vertical scanning interferometry, scanning electron microscopy, back-scattered electron imaging, and energy-dispersive X-ray spectroscopy, in 25 zones of each articular component. Results Gas pores, shrinkage voids and holes of detached carbides, carbides on surface, embedded particles, scratches and marks of wear, surface discoloration, surface deposits, and tribochemical reaction layers were widely dispersed through a substantial percentage of the total bearing surface in all the implanted components. Surface cup and head voids, and cup scratches showed significant correlation with the clearance of pair. A higher surface damage of the cup and head was observed mainly in the low clearance prostheses. There was no other significant correlation or difference in the incidence and importance of any of these defects between resurfacing hip arthroplasties and total hip arthroplasties, or according to the pair diameter. Conclusion Some metallurgical features and surface damage were significantly present in the retrieved implants of MoM HAs. It would be desirable to improve the structure and metallurgical characteristics of these implants to avoid those effects and optimize their performance.

Highlights • A novel surgical technique for reconstructing pelvic defects in hip revision surgery is described. • The Stoppa approach allows for pelvic damage control and reconstruction of bone defect. • The bone reconstruction is made by combining an intrapelvic plating with augmented socket reconstruction., Introduction Failed hip arthroplasty with intrapelvic acetabular migration can be challenging due to the potential damage of intrapelvic structures. Presentation of the case We present a case of a 75 year-old lady with failed hip arthroplasty with loosening of implants and intra-pelvic migration of the cup, antiprotrusio cage mesh, screws and plate. A modified Stoppa approach was performed, a part of the migrated elements were safely removed, the intrapelvic structures were controlled, and the bone defect was reconstructed through the Stoppa approach combined with the lateral window of ilioinguinal approach by means of bone struts and metallic plates, which is a novel technique. Then an extended posterolateral hip approach was done and the acetabulum was reconstructed using porous tantalum augments and morselized allograft. A cemented constrained socket was implanted. After one-year follow-up the patient is able to walk with one crutch without pain. Discussion Due to intrapelvic migration, the implants used in hip arthroplasty may become entrapped between the anatomical structures lodged in the pelvis and cause damage to them. A careful preoperative assessment and planning are mandatory. A migrated socket can be inaccessible through a conventional hip approach and removal could be very difficult and dangerous. Conclusion The Stoppa approach in hip revision surgery can be a complement to traditional approaches to control the intrapelvic structures, remove migrated implants of previous surgery and reconstruct the pelvic defect.

**Background:** Anti-thrombotic prophylaxis is routinely used in patients undergoing elective total hip or knee replacement (THR or TKR) to reduce the risk of venous thromboembolism (VTE). In Spain, pharmacological prophylaxis is performed with low-molecular-weight heparin, enoxaparin being the most commonly used. Rivaroxaban is an oral antithrombotic drug that has shown superior efficacy and similar safety profile compared to enoxaparin regimens in randomized clinical trials. The aim of the study was to estimate the budget impact of increasing the use of rivaroxaban with respect to enoxaparin in the prophylaxis of VTE in patients undergoing elective THR or TKR. **Methods:** A budget impact analysis was conducted in order to estimate the economic cost from an increase of rivaroxaban use versus enoxaparin by 10%, 20%, and 30% over the 3 years of the time horizon (2015, 2016, and 2017) for the THR and TKR populations. Data related to rate of thromboembolic events, major bleeding events and use of resources (local or general anesthesia and nurse care after surgery) were obtained from the Xarelto® for VTE Prophylaxis After Hip or Knee Arthroplasty (XAMOS) study, an international, non-interventional, observational, open-label study in unselected patients undergoing THR or TKR surgery in routine practice. The study included a total of 17 701 patients from 252 centers in 37 countries, including Spain, Italy, France and United Kingdom, among others. Two cohorts where considered (patients undergoing THR or TKR) with two arms (patients treated with rivaroxaban or enoxaparin). The Spanish patients enrolled in the XAMOS study were 262 with THR and 538 with TKR. Thromboembolic events, major bleeding rates and health care resources were considered from both the international and the Spanish population. Health care resources including pharmacologic prophylaxis, anesthesia and nurse care costs (Euros 2014) were estimated from the Spanish National Healthcare System (NHS) perspective. The annual cost associated with each cohort was estimated based on the mean cost per patient and the estimated distribution of use of rivaroxaban or enoxaparin in the base case scenario and alternative scenario (increase of rivaroxaban use) over the 3 years. A one-way sensitivity analysis was conducted to evaluate the effect that the uncertainty of the input parameters may have on the results of the impact budget. **Results:** The difference in cost per patient undergoing THR or TKR with rivaroxaban versus enoxaparin was -€140.69 including event rates and resource use from the Spanish XAMOS population, and -€110.54 when considering event rates and resource use from the multinational XAMOS population (including but not limited to European [Spain, France, Italy, United Kingdom, Portugal, etc.], American [Canada, Mexico, Colombia, Venezuela, etc.], Asian [China, etc.] and Australian countries). In the analysis per cohort (THR or TKR), the impact of increasing the use of rivaroxaban in the THR cohort, was -€1106, -€2875, and -€5607 for 2015, 2016, and 2017, considering the data from the Spanish XAMOS population, and -€869, -€2259, and -€4405 considering the data from the multinational population. Considering the TKR cohort, the impact was -€2271, -€5904, and -€11 513, and -€1784, €4639, and -€9046, respectively. **Conclusions:** The present analysis shows that, according to effectiveness data from the XAMOS study (Spanish and multinational cohorts), an increase in the usage of rivaroxaban in VTE prophylaxis would lead to significant direct cost reduction in elective THR and TKR patients.

Although the cement in cement technique is a simple method for exchanging cemented stems, it may be technical demanding. The different geometry of different-offset Exeter long stems can be a problem with this technique. We describe a case revision hip surgery as a consequence of neglected bipolar hemiarthroplasty dislocation in which a 44 mm offset long stem was exchanged by a shorter and smaller size 37.5 mm offset stem. The implications of the procedure and the surgical pitfalls are discussed.

Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup.We asked whether a tibial component fixed by a porous tantalum system might achieve (1) better clinical outcome as reflected by the Knee Society Score (KSS) and WOMAC Osteoarthritis Index, (2) fewer complications and reoperations, and (3) improved radiographic results with respect to aseptic loosening compared with a conventional cemented implant.We randomized 145 patients into two groups, either a porous tantalum cementless tibial component group (Group 1) or cemented conventional tibial component in posterior cruciate retaining TKA group (Group 2). Patients were evaluated preoperatively and 15 days, 6 months, and 5 years after surgery, using the KSS and the WOMAC index. Complications, reoperations, and radiographic failures were tallied.At 5-year followup the KSS mean was 90.4 (range, 68-100; 95% CI, ± 1.6) for Group 1, and 86.5 (range, 56-99; 95% CI, ± 2.4) for Group 2. The effect size, at 95% CI for the difference between means, was 3.88 ± 2.87. The WOMAC mean was 15.1 (range, 0-51; 95% CI, ± 2.6) for the Group 1, and 19.1 (range, 4-61; 95% CI, ± 2.9) for Group 2. The effect size for WOMAC was -4.0 ± 3.9. There were no differences in the frequency of complications or in aseptic loosening between the two groups.Our data suggest there are small differences between the uncemented porous tantalum tibial component and the conventional cemented tibial component. It currently is undetermined whether the differences outweigh the cost of the implant and the results of their long-term performance.

The economic burden of periprosthetic infections is enormous, but the number of economic studies dealing with this issue is very scarce. This review tries to know the economic literature existing, assess the value of current data, and recognize the less costly and more effective procedures for prevention, diagnosis and treatment of periprosthetic infections.Forty five studies meeting the inclusion criteria and adhering to the quality criteria used were carefully analyzed to extract the economic data of relevance in evaluating the magnitude of problem and the more cost-effective solutions. However, because the heterogeneity and the low-quality of most of these studies meta-analytical technique has not been possible. Instead, the studies have been reviewed descriptively.Optimizing the antibiotic use in the prevention and treatment of periprosthetic infection, combined with systemic and behavioral changes in the operating room; detecting and treating the high-risk groups; a quick, simple, reliable, safe, and cost-effective diagnosis, and the rationale management of the instituted infection, specifically using the different procedures according to each particular case, could allow to improve outcomes and produce the highest quality of life for patients and the lowest economic impact. Nevertheless, the cost effectiveness of different interventions to prevent and to treat the periprosthetic infection remains unclear.

AimThe effective results shown in the porous systems of tantalum employed for the use of osseointegrates has been demonstrated by means of animal experimentation. However, there is a total lack of any research studies on the osseointegration of tantalum implants from retrieval of the same after a period of time whereby the material had been implanted within the human body.Materials and MethodsFor this study, five rod implants used for the treatment of avascular necrosis of the femoral head were retrieved following collapse of the femoral head and conversion to total hip arthroplasty. The time of implantation ranged between six weeks and twenty months.ResultsObservation during this study has confirmed the effectiveness of osseointegration within this period of time. New bone was observed around and within the porous system of the on rod devices at retrieval date. The bone ingrowth, however, proved to be slower and less intense than that resulting within animal species during the first few months after implantation.ConclusionsThe results obtained in the quantitative assessment of this process proved to be similar to those results achieved by other authors in previous experimental work studies.

The instability in hip arthroplasty, or joint dislocation in its most dramatic form, is a complication that changes the outcome of this procedure, causing a decrease in the quality of life of the patients, and a loss of confidence in their relationship with the surgeon. If we discount failures due to infection, dislocation is the most frequent cause of a short to medium term revision, and the number of cases that require several operations to provide stability to the joint is not insignificant. Despite the frequency and severity of this complication there are few studies with a high level of scientific evidence on this subject. We have attempted to review the published literature and its level of evidence on the pathogenic origin, prophylaxis and treatment of this eventuality. As well as recording and summarizing the findings of each study in this review, we have added the evidence level of the corresponding literature reference.

Resumen La inestabilidad en las artroplastias de cadera o la luxacion en su forma mas dramatica, es una complicacion que altera la evolucion de este procedimiento introduciendo una perdida de bienestar en el paciente y una perdida de confianza en su relacion con el cirujano. Si no consideramos los fracasos por infeccion, la luxacion supone la causa mas frecuente de cirugia de revision a corto y medio plazo y no es desdenable el numero de casos que precisan varias intervenciones para aportar estabilidad a la articulacion. A pesar de la frecuencia y gravedad de esta complicacion no son frecuentes estudios con alta evidencia cientifica en este tema. Hemos pretendido recoger la literatura publicada con su grado de evidencia acerca de la etiopatogenia, profilaxis y tratamiento de esta eventualidad. Para ello ademas de anotar y resumir los hallazgos de cada trabajo, hemos anadido el nivel de evidencia tras la cita bibliografica correspondiente.

Background Identifying the aetiological agent of atypical pneumonia in human can sometimes be a tedious process, especially in cases where Mycoplasma pneumoniae, Legionella species and Chlamydia pneumoniae are ruled out. In such cases, a correct anamnesis of the patient is basic to clarify which pathogens might have produced the infection. For this reason, health professionals including veterinarians and laboratory personnel working with zoonotic pathogens should keep their doctors informed. Case presentation A human case of atypical pneumonia linked to Chlamydia abortus is reported. A 47-year-old male, a veterinarian researcher into chlamydiae, developed respiratory symptoms, breathing problems and high fever. Serological analyses ruled out the involvement of several respiratory pathogens, such as M. pneumoniae, Legionella pneumophila, Rickettsia conorii and C. pneumoniae, and Chlamydia abortus was identified as the possible aetiological agent of the infection. The isolation of C. abortus from the patient’s sputum and subsequent molecular analysis confirmed the presence of this microorganism. Conclusion As far as we know, although C. abortus has not been previously described as capable of causing pneumonia in humans, this is the first reported case of atypical pneumonia in which C. abortus is thought to have played an aetiological role.

Conversion of hip arthrodesis to a THA reportedly provides a reasonable solution, improving function, reducing back and knee pain, and slowing degeneration of neighboring joints associated with a hip fusion. Patients generally are satisfied with conversion despite the fact that range of mobility, muscle strength, leg-length discrepancy (LLD), persistence of limp, and need for assistive walking aids generally are worse than those for conventional primary THA.We compared THA after hip arthrodesis and primary THA to determine whether these procedures would be associated with similar functional scores, maintenance of scores with time, complications and failures, survivorship of the arthroplasty, and patient satisfaction.We retrospectively matched 48 patients undergoing conversion of a fused hip to a THA between January 1980 and January 2000, with 50 patients receiving a primary THA during the same period. We prospectively followed all patients between January 2000 and January 2010. The changes in function and pain after THA were compared between the two cohorts using the Harris hip score (HHS) and the Rosser Index Matrix (RIM). The Oxford hip score (OHS) and the SF-36 also were used to assess quality of life (QOL) during followup. Complications were collected and survivorship of the THA was evaluated. Patient satisfaction was assessed using the Robertsson and Dunbar questionnaire. The minimum followup was 10 years (mean, 17 years; range, 10-29 years).At last followup, hip function and health-related QOL were similar for patients having conversion of hip arthrodesis to THA and for patients having a routine THA. Scores diminished overall in the two groups between 2000 and 2010, but without a difference for the HHS, RIM QOL, and OHS in the study cohort. The rate of complications, THA survival, and patient satisfaction were similar in both groups.Conversion of hip arthrodesis to a THA provides substantial improvement of hip function and health-related QOL, with an acceptable rate of complications, good expectancy of survival for the arthroplasty, and high level of patient satisfaction comparable to those of primary THA.Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Our working hypothesis was that minimally invasive surgery was superior to conventional surgery for total hip arthroplasty procedure. We compared THR results in the minimally invasive posterior approach with THR results in the conventional posterior approach.Prospective, randomised trial. Fifty patients were selected and then divided into two groups based on treatment (minimally invasive posterior approach or conventional posterior approach).Perioperative bleeding, postoperative pain, time of recovery, component orientation, complications and functional results. One year follow-up.No differences were found in blood loss, surgical time, component orientation, rate of complications or functional result. The minimally invasive lateral approach produced less postoperative pain and a faster recovery, with a shorter hospital stay and earlier walking-start, and a positive economic impact with 5% of the total process cost saved.Minimally invasive surgery permits less postoperative pain, faster recovery and a positive economic saving, without differences in the rest of the items studied.

Porous tantalum is reportedly a good substitute for structural bone graft in several applications. So far, its use has not been reported in tibial tuberosity anteriorization (TTA) for treatment of isolated degenerative chondral lesions of the patellofemoral joint.We asked whether the use of this material would produce similar standardized functional scores, pain (VAS), fusion rates, complications, and patient satisfaction to those for bone graft.We performed a randomized, controlled trial in 101 patients (108 knees) scheduled for TTA comparing a porous tantalum implant (57 knees) with an autologous local tibial bone graft (51 knees). The minimum followup was 5 years (mean, 6.2 years; range, 5-8 years).At the last followup, clinical scores, fusion rates, and maintenance of the anteriorization either were better or similar for the TTA using the tantalum implant depending on the respective parameter. The operative technique was easier and shorter with the tantalum device. Complication and failure rates were greater using bone graft. Patient satisfaction was greater using the tantalum implant.Porous tantalum provided a reasonable alternative to bone graft in TTA.Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Efficacy of osteointegration of tantalum porous systems has been demonstrated through animal experimentation. However, there is a lack of studies that evaluate osteointegration of implants retrieved after a period of implantation in humans. For this study, eight rod implants used for the treatment of avascular necrosis of the femoral head were retrieved following collapse of the femoral head and conversion to total hip arthroplasty. The time of implantation ranged between six weeks and twenty three months. Observation during this study has confirmed effectiveness of osseointegration within this period of time. New bone was observed around and within the porous system of the on rod devices at retrieval date. Bone in growth however, proved to be of a slower and less intense degree than that resulting within animal species during first months after implantation. Nevertheless, the results obtained in the quantitative evaluation of this process proved to be similar to those results achieved by other authors in previous experimental studies.

Different bearing surfaces, including alumina-on-alumina, have been used to avoid osteolysis. We prospectively followed 288 patients (319 hips) in which an alumina-on-alumina cup was used with a hydroxyapatite stem. The patients' mean age was 52.7 (range, 14-70 years), and the minimum followup was 3 years (mean, 4.7 years; range, 3-8 years). At final followup, five cups (including one with an alumina liner fracture) and two stems underwent revision. The cumulative probability of not having a revision of one or both components for any cause was 97% (95% confidence interval, 94.7%-99.1%). No patient spontaneously reported any noises from the hip and none reported noises when specifically questioned. All patients who had not undergone revision had good clinical results, but five of these patients had radiographic cup loosening at last followup. These data suggest alumina-on-alumina prostheses had reasonable outcomes after 5 years. One acetabular component fractured from trauma. We observed no linear femoral head penetration. Continued followup will be required to determine if reduction in wear between the alumina-on-alumina bearings results in less osteolysis and loosening.Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Los Planes Generales Municipales de Ordenación Urbanística como instrumento de planeamiento general “tradicional”, son rígidos, costosos, poco participativos, con programación / estudios económicos virtuales y con periodos de elaboración / tramitación muy dilatados en el tiempo. En la presente Tesis Doctoral, se ha desarrollado una figura de planeamiento “estratégico”, que subsana las patologías que se originan durante la redacción y ejecución de las determinaciones de los Planes. A esta figura de Planeamiento estratégico, se le ha denominado “Plan Estratégico Municipal de planeamiento y gestión urbanística” (PEMpgu), y está compuesta básicamente por tres documentos: (A)‐ Análisis y diagnóstico. (D)‐ Directrices estratégicas. (N)‐ Normas Complementarias. Las previsiones del PEMpgu se programan para seis años, y se pueden estimar los importes económicos de inversión a partir de la técnica del predimensionado de costes de “construcción de la ciudad”. Para el desarrollo del documento técnico del PEMpgu, se prevé un plazo óptimo de seis/ocho meses y máximo de un año, incluyendo las exposiciones e informaciones públicas. El PEMpgu desarrollado, contiene los siguientes atributos: 1‐ Planeamiento eficiente y focalizado. 2‐ Estrategias orientadas hacia la demanda urbana. 3‐ Predominio del proceso sobre el producto. 4‐ Límites del ámbito de análisis más amplio que el área de actuación. 5‐ Planificación flexible. 6‐ Sencillez documental e instrumental. 7‐ Agilidad temporal de redacción y ejecución. 8‐ Programación y propuestas con efectiva participación ciudadana. 9‐ Redacción, gestión y ejecución estratégica. 10‐ Estimación económica objetiva de inversiones. Por último, añadir que se proyectan cinco niveles de salud urbanística sobre el área de actuación, con sus correspondientes cinco grados de intervención estratégica. En la aplicación práctica del Plan Estratégico Municipal de planeamiento y gestión urbanística al caso concreto de la ciudad de Murcia, el diagnóstico de salud urbanística considerado es el de “obsoleto”, correspondiéndole según la metodología desarrollada el grado cuatro, es decir, nivel “alto” de intervención estratégica, a implementar mediante la ejecución de los seis proyectos estratégicos “críticos” resultantes del proceso de elaboración del PEMpgu. Ingeniería, Industria y Construcción

Alemtuzumab; Eficacia; Práctica clínica habitual Alemtuzumab; Effectiveness; Daily clinical practice Alemtuzumab; Eficàcia; Pràctica clínica habitual Introduction Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. Objective A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. Development A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. Conclusion The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice. Introducción Alemtuzumab es un fármaco de alta eficacia aprobado por la Agencia Europea de Medicamentos como tratamiento modificador de la enfermedad en pacientes con esclerosis múltiple remitente recurrente. Objetivo Elaborar un documento de consenso sobre el manejo de alemtuzumab en la práctica clínica habitual, que sea de aplicación en el ámbito español. Desarrollo Un grupo de expertos en esclerosis múltiple revisó las publicaciones disponibles hasta diciembre de 2017, de tratamiento con alemtuzumab y esclerosis múltiple. Se incluyeron trabajos sobre eficacia, efectividad y seguridad, despistaje de infecciones y vacunación, administración y monitorización. La propuesta inicial de recomendaciones fue desarrollada por un grupo coordinador con base en la evidencia disponible y en su experiencia clínica. El proceso de consenso se llevó a cabo en 2 etapas; se estableció como porcentaje inicial de acuerdo grupal el 80%. El documento final con todas las recomendaciones acordadas por el grupo de trabajo se sometió a revisión externa y los comentarios recibidos fueron considerados por el grupo coordinador. Conclusiones El documento aportado pretende ser una herramienta útil para facilitar el manejo del fármaco en condiciones de práctica clínica habitual. Sanofi-Genzyme provided financial support to this project.

Objective: Our aim was to provide practical recommendations on the management of patients with metastatic castration-resistant prostate cancer (mCRPC) who have progressed after docetaxel plus androgen-deprivation therapy (ADT) or abiraterone plus ADT. Methods: Systematic literature review (SLR), nominal group meeting, and Delphi process. A panel of 12 experts was established who defined the scope, users, and sections of the document. We performed an SLR in order to assess the efficacy and safety of available drugs in patients with mCRPC. Abstracts from the American Society of Oncology and European Society for Medical Oncology meetings were also examined. The results were discussed during an expert meeting in which 14 recommendations were generated. The level of agreement with the recommendations was also tested by 13 additional experts following the Delphi process. Recommendations were voted by means of scores ranging from 0 (total disagreement) to 10 (total agreement). We defined agreement when at least 70% of the experts voted ⩾7. Next, we assigned a level of evidence and grade to the recommendation using the Oxford Centre for Evidence-based Medicine Levels of Evidence, following which the final document was drafted. Results: The literature search did not find any articles meeting the inclusion criteria. Finally, 13 out of 14 recommendations were accepted after two Delphi rounds (two were modified after the first round). They pertain to general and individual case-based treatment recommendations. Conclusions: In mCRPC patients who have progressed after docetaxel or abiraterone plus ADT in the metastatic hormone-sensitive prostate cancer setting, these recommendations may support treatment decision-making, due to the lack of evidence or other globally accepted sequencing algorithms.

This animal study evaluated the osseointegration level of a new nanotextured titanium surface produced by anodization. Ti-cp micro-implants (1.5 mm diameter by 2.5 mm in length) divided into two groups: titanium nanotextured surface treatment (Test Group) and acid etched surface treatment (Control Group). Surface characterization included morphology analysis using scanning electron microscopy and wettability by measuring contact angle. Sixteen Wistar rats were submitted to two micro implants surgical placement procedures. In each rat, one type of micro implant placed in each tibia. The animals sacrificed after two (T1) and six weeks (T2) post-implantation. After the euthanasia, tibias processed for histomorphometric analysis, which allowed the evaluation of bone to implant contact (BIC) and the bone area fraction occupancy between the threads (BAFO). Our surface analysis data showed that the Control Group exhibited an irregular and non-homogenous topography while the Test Group showed a nanotextured surface. The Test Group showed higher wettability (contact angle = 5.1 &plusmn, 0.7&deg, ) than the Control Group (contact angle = 75.5 &plusmn, 4.6&deg, ). Concerning the histomorphometric analysis results for T1, Control and Test groups showed BIC percentages of 41.3 &plusmn, 15.2% and 63.1 &plusmn, 8.7% (p &lt, 0.05), respectively, and for BAFO, 28.7 &plusmn, 13.7% and 54.8 &plusmn, 7.5%, respectively (p &lt, 0.05). For T2, the histomorphometric analysis for Control and Test groups showed BIC percentages of 51.2 &plusmn, 11.4% and 64.8 &plusmn, 7.4% (p &lt, 0.05), respectively and for BAFO, 36.4 &plusmn, 10.3% and 57.9 &plusmn, 9.3% (p &lt, 0.05), respectively. The findings of the current study confirmed that the novel nanotextured surface exhibited superior wettability, improved peri-implant bone formation, and expedited osseointegration.

SummaryBackground and Purpose Chronic kidney disease (CKD) has been related to poor anticoagulation control and an increased risk of bleeding. This study aims to evaluate the association between impaired renal function (eGFR

Background: Disseminated germ cell cancers are at high risk of developing thromboembolic complications. We evaluated the prognostic value of venous thromboembolic events (VTE) in disseminated germ cell cancer. Methods: Patients with germ cell cancer receiving upfront platinum-containing chemotherapy between 2004 and 2014 were pooled from the Spanish Germ Cell Cancer Group (SGCCG) registry and reviewed for the presence of VTE. Results were validated in an independent international group of patients. We used a penalized Cox proportional hazards model including VTE as a time-varying covariate to identify and validate prognostic factors. All statistical tests were two-sided. Results: The SGCCG registry identified 416 patients from 14 referral institutions. With a median follow-up of 49 months, VTEs were observed in 9% of patients (n = 38). Events occurred at diagnosis, during chemotherapy, and after chemotherapy in 2.6%, 5.0%, and 1.4% of patients, respectively. VTE was associated with shorter progression-free survival (PFS; hazard ratio [HR] = 2.29, 95% confidence interval [CI] = 1.18 to 4.47, P = .02) and overall survival (OS; HR = 5.14, 95% CI = 2.22 to 11.88, P < .001). In multivariable analysis, the effect was consistent in the intermediate-risk group, both for PFS (HR = 9.52 95% CI = 2.48 to 36.58, P < .001) and OS (HR = 12.84, 95% CI = 2.01 to 82.02, P = .007). VTE at diagnosis is also an adverse prognostic variable for progression-free survival (HR = 4.64, 95% CI = 2.04 to 10.54, P < .001) and for overall survival (HR = 6.28, 95% CI = 1.68 to 17.10, P = .01). These results were validated in an independent international cohort that included 241 patients from four hospitals. Conclusions: VTE is an independent adverse prognostic factor in disseminated germ cell cancers, in particular for the intermediate prognostic group of the International Germ Cell Cancer Collaborative Group classification. The presence of VTE at diagnosis has also prognostic significance and should be further explored in future prognostic classifications.

Introduction: Although subcutaneous treatments for multiple sclerosis (MS) have been shown to be effective, adverse reactions and pain may adversely affect treatment satisfaction and adherence. This study presents an adapted and validated Spanish version of the Multiple Sclerosis Treatment Concerns Questionnaire (c) (MSTCQ), which evaluates satisfaction with the injection device (ID) across 4 domains: injection system (A), side effects (B) (flu-like symptoms, reactions, and satisfaction), experience with treatment (C) and benefits (D). Methods: Two study phases: 1) Cultural adaptation process with input from experts (n = 6) and patients (n = 30). 2) Validation obtained by means of an observational, cross-sectional, multi centre study evaluating 143 adult MS patients using an ID. Tools employed: MSTCQ, Patient Reported Indices for Multiple Sclerosis (PRIMUS), and Treatment Satisfaction Questionnaire for Medication (TSQM (c)). Psychometric properties: Feasibility (percentage of valid cases and floor/ceiling effects); Reliability (Cronbach alpha) and test-retest correlation (n =41, intractass correlation coefficient, ICC); and construct validity (factor analysis of domains A and B) and convergent validity (Spearman rank-order correlation for MSTCQ (c) vs TSQM (c)). Results: Mean age (SD) was 41.94 (10.47) years, 63% of the group were women, and 88.11% presented relapsing-remitting MS. Mean (SD) EDSS score was 2.68 (1.82) points. MSTCQ (c) completion was high (0%-2.80% missing data). Internal consistency was high at alpha = 0.89 for the total score (A+ B) and alpha = 0.76, 0.89, and 0.92 for domains A, B, and C, respectively. The version demonstrated excellent test-retest reliability for the total (ICC = 0.98) and for domains A, B, and C: ICC =0.82, 0.97, and 0.89, respectively. Factor analysis corroborated the internal structure of the original questionnaire. The association between total and domain scores on both the MSTCQ (c) and the TSQM (c) was moderately strong (Rho = 0.42-0.74) and significant (P

The XVI Post-ECTRIMS meeting was held in Seville on 20 and 21 October 2023, where expert neurologists in multiple sclerosis (MS) summarised the main new developments presented at the ECTRIMS 2023 congress, which took place in Milan from 11 to 13 October. The aim of this article is to summarise the content presented at the Post-ECTRIMS Meeting, in an article in two parts. This second part covers the health of women and elderly MS patients, new trends in the treatment of cognitive impairment, focusing particularly on meditation, neuroeducation and cognitive rehabilitation, and introduces the concept of fatigability, which has been used to a limited extent in MS. The key role of digitalization and artificial intelligence in the theoretically near future is subject to debate, along with the potential these technologies can offer. The most recent research on the various treatment algorithms and their efficacy and safety in the management of the disease is reviewed. Finally, the most relevant data for cladribine and evobrutinib are presented, as well as future therapeutic strategies currently being investigated.