Search

Resumen La presencia de manifestaciones extraglandulares del sindrome de Sjogren abre un amplio debate en el campo de la neurologia, en el cual la asociacion o similitud con la esclerosis multiple y el espectro de la neuromielitis optica plantea la necesidad de mejores marcadores, dentro de los cuales los anticuerpos contra la acuaporina 4 han ganado mayor relevancia. Asi mismo, la tecnica para la medicion de estos autoanticuerpos, con su realizacion en suero y en liquido cefalorraquideo, es de utilidad para el diagnostico y el pronostico. A continuacion se presenta el caso de un sindrome de Sjogren sin sicca que curso con neuritis optica unilateral.

Introduction Femoral neck fractures (FNF) are frequent injuries and not rarely complicated by non-union, implant failure, and avascular necrosis. Some of these fractures represent a dilemma for trauma surgeons. Which fracture should be fixed? Which replaced with a prosthesis? How? The aim of this narrative review is to investigate the literature in order to provide the most updated and evidence-based knowledge about FNF’ treatment. Materials and methods A literature research has been performed to find the essential key points to consider when dealing with FNF and their treatment. The most representative papers and the new meta-analysis were matched with authors’ experience to give a concise but comprehensive view of the problem. Timing, age, comorbidities, vascularization of the femoral head, displacement, instability, comminution of the fracture, bone quality, and surgeon experience seem to be the major topics to consider in the decision making. We then focus on the optimal fixation or replacement as suggested by the literature. Results Age is the main independent factor to consider. Timing seems essential in the elderly population to reduce mortality and important in the younger patients to reduce complications. Vascular supply should be always considered. Displacement, instability, and comminution of the fracture are negative prognostic factors for fixation as well as, theoretically, bone quality. In the elderly hip replacement is mostly indicated. A stable and solid fixation is mandatory to allow early mobilization. Sliding Hip Screws (SHS) seem preferable to cannulated screws for displaced/unstable (Pauwels II-III, posterior comminution) and basicervical fracture patterns or in smokers. There is a tendency toward Total Hip Arthroplasty (THA) also in the elderly if the patient is an indipendent ambulator without severe comorbidities. Dual mobility cups are gaining popularity in THA for FNF. Conclusions FNF are frequent injuries and represent, in some cases, a dilemma for the trauma surgeon. Age, timing, comorbidities, bone quality, femoral head vascularization, fracture displacement, intrinsic instability, and comminution as surgeon experience should be carefully evaluated before surgery. A case-to-case analysis of the patient-related factors helps the surgeon to make the right choice and reduce the well-known complications.

Resumen Introduccion La reconstruccion de base de craneo constituye uno de los mayores retos de la cirugia endoscopica endonasal expandida. Existen multitud de injertos y colgajos de origen endonasal que han demostrado su utilidad en el control de complicaciones como las fistulas de LCR, entre otras. Se hace necesaria la revision y el analisis de los recursos endonasales y su uso en cirugia endoscopica endonasal expandida. Objetivos Documento de consenso sobre el uso de los distintos injertos y colgajos de origen endonasal y su uso en cirugia endoscopica endonasal expandida. Material y metodos Revision bibliografica sobre los injertos libres y colgajos vascularizados de origen endonasal mas relevantes. Analisis mediante el metodo Delphi, sobre el uso de los distintos recursos endonasales para la reparacion endoscopica de defectos de base de craneo. Resultados Se obtuvieron dos resultados. 1) Una seleccion de los colgajos e injertos de origen endonasal mas representativos, describiendo origen, superficie e indicaciones, a partir de una revision bibliografica. 2) Un documento de consenso, utilizando la metodologia Delphi, con las consideraciones generales (2), recomendaciones (10) y limitaciones (6) sobre el uso de los distintos colgajos e injertos de origen endonasal. Conclusiones Presentamos el primer documento de consenso en el campo de la cirugia endoscopica endonasal utilizando el metodo Delphi como herramienta de trabajo. Se destaca la utilidad del colgajo nasoseptal junto con el resto de colgajos e injertos de origen endonasal para la cirugia reconstructiva de base de craneo.

Resumen Introduccion El objetivo fue adaptar y validar, de forma culturalmente sensible, la metodologia del Programa orientado a la comunidad para el control de enfermedades reumaticas (COPCORD) en la comunidad indigena misak de Colombia. Material y metodos Se realizo una validacion culturalmente sensible del cuestionario Copcord en espanol, que se tradujo al nam trik wam, lengua usada por el pueblo misak del resguardo de Guambia. El cuestionario se adecuo al contexto de esta poblacion y posteriormente se llevo a cabo una retrotraduccion al espanol. Por ultimo, se valido aplicando la encuesta con el apoyo de traductores bilingues. Los participantes con dolor, rigidez o hinchazon en cualquier articulacion en los siete dias previos, o en cualquier momento de la vida, fueron evaluados por medicos y fisioterapeutas. Al confirmarse el diagnostico de una enfermedad musculoesqueletica los participantes eran examinados por un reumatologo. Resultados De la poblacion estudiada (n = 106) el 58,5% fueron mujeres, con una edad promedio de 45,4 anos. En los ultimos siete dias, 51 sujetos (48,1%) informaron tener dolor musculoesqueletico y siete (44,3%) refirieron dolor en algun momento de su vida. Quienes recibieron tratamiento reportaron el uso de medicamentos tradicionales en un 53,1% de los casos, homeopaticos en el 34,4% y alopaticos en el 25%. El cuestionario COPCORD Misak demostro una adecuada capacidad para detectar los trastornos musculoesqueleticos, con una sensibilidad del 63,3%, una especificidad del 80,3%, una razon de verosimilitud positiva de 3,2 y un area bajo la curva de 0,71. Conclusion La metodologia COPCORD es una herramienta valida de cribado de enfermedades musculoesqueleticas en el pueblo misak.

Objective To describe 5-year postoperative outcomes of a small series of Fuchs’ endothelial dystrophy (FED) patients who underwent Descemet stripping only (DSO) with a scraping technique. Methods DSO technique and early clinical outcomes of 5 patients with mild central FED were previously reported. In the same cohort of patients, corrected distance visual acuity, central corneal ultrasound pachymetry, refractive spherical equivalent, endothelial cell count, slit-lamp photography, and corneal Scheimpflug tomography were obtained at baseline, 6 months, and 1 and 5 years postoperatively. No patient used topical Rho-kinase inhibitors at any point in time. Results One patient (20%) failed to clear the early postoperative edema and 1 patient (20%) developed corneal decompensation 1 year after DSO. Both patients underwent successful Descemet stripping automated endothelial keratoplasty. The remaining 3 patients had stable corrected distance visual acuity, progressive reduction of corneal ultrasound pachymetry, and mild myopic shift of the refractive spherical equivalent over the follow-up time. An improvement in posterior stromal opacities and irregular astigmatism was observed, whereas posterior elevation at Scheimpflug tomography remained unchanged. Conclusion At 5 years postoperatively, DSO with a scraping technique and without Rho-kinase inhibitors resulted in sustained clinical amelioration of 3 of 5 patients (60%) with mild FED.

Current edge computing systems are deployed in highly complex application scenarios with dynamically changing requirements. In order to provide the expected performance and energy efficiency values in these situations, the use of heterogeneous hardware/software platforms at the edge has become widespread. However, these computing platforms still suffer from the lack of unified software-driven programming models to efficiently deploy multi-purpose hardware-accelerated solutions. In parallel, edge computing systems also face another huge challenge: operating under multiple conditions that were not taken into account during any of the design stages. Moreover, these conditions may change over time, forcing self-adaptation mechanisms to become a must. This paper presents an integrated architecture to exploit hardware-accelerated data-parallel models and transparent hardware/software multithreading. In particular, the proposed architecture leverages the \ARTICo framework and ReconOS to allow developers to select the most suitable programming model to deploy their edge computing applications onto run-time reconfigurable hardware devices. An evolvable hardware system is used as an additional architectural component during validation, providing support for continuous lifelong learning in smart edge computing scenarios. In particular, the proposed setup exhibits online learning capabilities that include learning by imitation from software-based reference algorithms.

PURPOSE: SSFS is an underdiagnosed complication of craniectomized patients, which mainly presents with headache, motor weakness, and cognitive impairments. In these patients, cranioplasty improves these symptoms. Furthermore, patients without a classical SSFS have been shown to improve their neurological functions after reconstructive surgery. Amongst the many different pathophysiological theories proposed, the changes of CBP caused by the cranial defect might have a role in the neurological deficiencies. We have studied CBP in twelve cortical areas of both hemispheres, using 99mTc-HMPAO SPECT-CT before and after cranioplasty.METHODS: Twenty-eight craniectomized patients subject to reconstructive surgery were studied with 99mTc- HMPAO in three different times, before cranioplasty, a week after, and three months later. The images were processed with quantification software comparing CBP of 24 cortical areas with a reference area , and with a database of normal individuals. A mixed effects model was used to determine the signification of CBP changes in the cortex regions of both the damaged and undamaged brain hemispheres.RESULTS: CBP increased significantly in both hemispheres after cranioplasty both in ratio (β=0.019 p-value=0,030 first post-surgical SPECT-CT and β=0.021 p-value=0,015 in the second study, vs. pre-surgical) and Z-score (β=0.220 p-value=0,026 and β=0.279 p-value=0,005 respectively). Nine of twelve areas of the damaged side had a significant lower CBP ratio and Z-score than the undamaged. Posterior cingulate showed an increased CBP ratio (p-value=0,034) and Z-score(p-value0,028) in the first post-surgical SPECT-CT.CONCLUSION: CBP changes significantly in specific cortical areas after cranioplasty, which might explain the clinical improvements observed. Posterior cingulate changes might explain some improvements in attention impairments described. 99mTc-HMPAO SPECT-CT might be a valid tool to assess CBP changes in these patients and could have a role in the management of craniectomized individuals.CLINICAL TRIAL REGISTRATIONNot applicable

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.

Resumen Introduccion y objetivos HeartLogic es un algoritmo multiparametrico incorporado a desfibriladores automaticos implantables (DAI). La alerta asociada predice descompensaciones de insuficiencia cardiaca (IC). Nuestro objetivo es analizar la asociacion entre alertas y eventos clinicos bajo un protocolo de seguimiento comun en un registro multicentrico. Metodos Se evaluaron la fase 1 (investigadores ciegos al estado de la alerta) y las fases 2 y 3 (tras la activacion de HeartLogic, segun practica local y un protocolo comun respectivamente). Resultados Se incluyo a 288 pacientes en 15 centros. En fase 1, tras una media de observacion de 10 meses, hubo 73 alertas (0,72 alertas/paciente-ano), con 8 hospitalizaciones y 2 visitas a urgencias por IC (0,10 eventos/ano-paciente). No hubo hospitalizaciones fuera del periodo de alerta. Las fases activas tuvieron una media de seguimiento de 16 (IC95%, 15-22) meses, con 277 alertas (0,89 alertas/ano-paciente); 33 se asociaron con hospitalizaciones o muerte por IC, 46 con descompensaciones menores y 78 con otros eventos. La tasa de alertas inexplicables fue 0,39/ano-paciente. Fuera del estado de alerta solo hubo una hospitalizacion y una descompensacion menor. La mayoria de las alertas (el 82% en fase 2 y el 81% en fase 3; p = 0,861) se gestionaron a distancia. La mediana de NT-proBNP fue superior en estado de alerta que fuera de el (7.378 frente a 1.210 pg/ml; p Conclusiones El indice HeartLogic se asocio con descompensaciones de IC y otros eventos relevantes, con baja tasa de alertas inexplicables. Un protocolo estandarizado permitio detectar y actuar a distancia con seguridad sobre las alertas.

AimsThe aim of this study was to understand the impact of optical coherence tomography (OCT)-detected thin-cap fibroatheroma (TCFA) on clinical outcomes of diabetes mellitus (DM) patients with fractional flow reserve (FFR)-negative lesions.Methods and resultsCOMBINE OCT-FFR study was a prospective, double-blind, international, natural history study. After FFR assessment, and revascularization of FFR-positive lesions, patients with ≥1 FFR-negative lesions (target lesions) were classified in two groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint compared FFR-negative TCFA-positive patients with FFR-negative TCFA-negative patients for a composite of cardiac mortality, target vessel myocardial infarction, clinically driven target lesion revascularization or unstable angina requiring hospitalization at 18 months. Among 550 patients enrolled, 390 (81%) patients had ≥1 FFR-negative lesions. Among FFR-negative patients, 98 (25%) were TCFA positive and 292 (75%) were TCFA negative. The incidence of the primary endpoint was 13.3% and 3.1% in TCFA-positive vs. TCFA-negative groups, respectively (hazard ratio 4.65; 95% confidence interval, 1.99–10.89; P ConclusionsAmong DM patients with ≥1 FFR-negative lesions, TCFA-positive patients represented 25% of this population and were associated with a five-fold higher rate of MACE despite the absence of ischaemia. This discrepancy between the impact of vulnerable plaque and ischaemia on future adverse events may represent a paradigm shift for coronary artery disease risk stratification in DM patients.

Resumen Proposito A instancias de la Organizacion Medica Colegial, elaborar un nuevo nomenclator de actos y procedimientos medicos en Otorrinolaringologia basado en la Clasificacion Internacional de Enfermedades CIE-9-MC. Estipular los principios generales y definir criterios e indicadores cuantitativos y cualitativos que puedan determinar el baremo y facilitar el calculo de su retribucion en la asistencia medica privada. Metodos Se realizo la actualizacion del nomenclator vigente desde 2001 eliminandose procesos obsoletos y anadiendo nuevos. Se importaron actos medicos de otras especialidades que tambien pertenecen al area de la Otorrinolaringologia. Se modificaron descripciones y se trasladaron de grupo otros por razones de complejidad quirurgica. Ademas, se solicito a todas las Comisiones de la Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello (SEORL-CCC) que, para cada acto medico/quirurgico, asignaran cuatro criterios e indicadores cuantitativos y cualitativos de baremacion: el coste unitario por grupos (CU), la formacion profesional y complejidad (F), la responsabilidad profesional y complicaciones (R), asi como el valor salud (V). Se asigno una tarifa preliminar por acto medico (TP) resultado de la suma de CU + R + V, siendo la tarifa final la suma de TP + F, segun la experiencia del profesional que realiza el procedimiento. Resultados La nueva propuesta presenta un total de 395 actos medicos, frente a 150 del baremo previo, lo que supone un aumento del 163% de actividades en ORL-CCC desde la publicacion del primer baremo. Los procedimientos quirurgicos baremados en ORL-CCC aumentaron de 113 a 313 (177%). Por subespecialidades, la que mayor numero de actos ha incorporado es Laringologia, con un aumento del 213%, seguido de Rinologia (141%) y Otologia (82%). Se han eliminado 20 de los 150 actos presentes con anterioridad por estar desfasados o haberse actualizado. Se han conservado un 87%, siendo el 40% de los actos los que se mantienen igual y el 47% restante los que han sufrido modificaciones, pero conservando el codigo de la Organizacion Medica Colegial previo. Conclusiones El nuevo nomenclator de Otorrinolaringologia propuesto por la SEORL-CCC actualiza y mejora el baremo predecesor, adecuando los procedimientos a los procedimientos recogidos en la CIE-9-MC e incorporando las nuevas tecnicas desarrolladas y aquellas que no estaban recogidas en el baremo anterior. Adicionalmente, establece nuevos criterios de baremacion e indicadores cuantitativos y cualitativos que permiten optimizar la baremacion y, por ende, el calculo de la remuneracion de los actos medicos de nuestra especialidad.

One of the main advantages brought by the Internet of Things (IoT) is the possibility of having large amounts of data from several sources that allow us, once analyzed, to make decisions in various domains in real time. This implies the need to be able to process large volumes of data in more or less limited processing times depending on the application domain. In this sense, Complex Event Processing (CEP), used in conjunction with an Enterprise Service Bus (ESB), has proven to be very efficient in multiple domains. In search for greater efficiency, some CEP engines offer the option of using Flow-Based Programming (FBP) rather than their traditional programming using CEP together with an event bus. However, its use, while it may be more efficient, can lead to other limitations. In this paper, we analyze and describe the performance and limitations of using a CEP engine with an ESB versus a CEP engine with FBP. This will allow developers to decide which option is more convenient for their IoT system depending on the application domain and its specific needs.

Objectives To assess the efficacy and safety of hydroxychloroquine (HCQ) compared with no treatment in healthcare workers with mild SARS-CoV-2 infection. Methods Prospective, non-randomized study. All health professionals with confirmed COVID-19 between April 7 and May 6, 2020, non-requiring initial hospitalization were asked to participate. Patients who accepted treatment were given HCQ for five days (loading dose of 400 mg q12 h the first day followed by200 mg q12 h). Control group included patients with contraindications for HCQ or who rejected treatment. Study outcomes were negative conversion and viral dynamics of SARS-CoV-2, symptoms duration and disease progression. Result Overall, 142 patients were enrolled: 87 in treatment group and 55 in control group. The median age was 37 years and 75% were female, with few comorbidities. There were no significant differences in time to negative conversion of PCR between both groups. The only significant difference in the probability of negative conversion of PCR was observed at day 21 (18.7%, 95%CI 2.0–35.4). The decrease of SARS-CoV-2 viral load during follow-up was similar in both groups. A non significant reduction in duration of some symptoms in HCQ group was observed. Two patients with HCQ and 4 without treatment developed pneumonia. No patients required admission to the Intensive Care Unit or died. About 50% of patients presented mild side effects of HCQ, mainly diarrhea. Conclusions Our study failed to show a substantial benefit of HCQ in viral dynamics and in resolution of clinical symptoms in health care workers with mild COVID-19.

Purpose The menopausal transition (MT) is a period when there may be an increase in visceral fat mass and a worsening of cardiometabolic risk factors. Few studies have evaluated the efficacy of plant-based low-calorie diets on groups of women at different stages of MT. The purpose of this study is to compare the effectiveness of a high plant-to-animal protein ratio diet in women of similar age but with different fertility statuses. Design/methodology/approach Subjects were divided into three groups according to their fertility status at the baseline: “premenopausal” (n = 11), “perimenopause” (n = 14) and “postmenopause” (n = 18). Body composition (BC) was measured at the beginning and after eight months of treatment. Individualised lifestyle treatment included a strong component of plant-based foods. Findings Forty-three overweight or obese Caucasian women (age 52.3 ± 4.5 years, body mass index 30.6 ± 5.4 kg/m2, fat mass 33.1 ± 9.3 kg data presented as means ± SD) were included in the study. Mean physical activity was 8.4 ± 7.6 metabolic equivalent of tasks/week. Subjects had an improvement in BC (fat mass −5.6 ± 4.0 kg, p < 0.001 protein −0.3 ± 0.5 kg, p < 0.001), HDL-C and systolic blood pressure values. Waist circumference and hip circumference decreased by 4.1 ± 3.1 cm and −6.0 ± 4.3 cm, respectively. Weight loss resulted in a significant improvement in some blood lipid values, such as total and high-density lipoprotein cholesterol. Adherence to a high plant protein diet helps adult women with different fertility statuses to improve BC and reduce cardiovascular risk factors. Long-term studies with larger sample sizes are needed to confirm these findings. Originality/value In pre-peri- and post-menopausal adult women, a diet high in plant proteins improves body composition and reduces cardiovascular risk factors.

The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis. Venous ultrasound (VU) is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis. Various protocols have been proposed for its execution, such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area. The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe. Initially, the thrombus is hypoechogenic and adherent to the vessel; later, it tends to organize and recanalize. Usually, in the early stages, the risk of embolism is higher. The role of studying the iliac axis and calf veins is still uncertain. VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.

Background: INSURE (Intubation, Surfactant administration, and Extubation) therapy is controversial in managing respiratory distress syndrome (RDS) in late preterm newborns. This study aims to determine whether the use of the INSURE in late preterm infants with RDS is associated with improved outcomes compared to similar infants managed with CPAP alone. Methods: A retrospective cohort study compared two different neonatal care units with two different treatments of RDS in late preterm infants in Bucaramanga, Colombia. One cohort used selective bubble CPAP and rescue surfactant, the second cohort used selective bubble CPAP and INSURE within the first hour of life. We included all the newborns with gestational age between 33 - 366/7 weeks, born between 2012 to 2017, that developed early RDS and were treated with CPAP. Results: We recruited 208 patients (57 CPAP and rescue surfactant and 151 CPAP + INSURE). Early INSURE was reported in 117 patients (56.3 %). INSURE therapy was associated with a reduced risk of CPAP failure (RR = 0.50; 95 % CI 0.26 - 0.98); this effect was evident only when surfactant was administered within the first two hours of life (RR = 0.29; 95 % CI 0.12 - 0.69). Early INSURE was associated with a decreased risk of pneumothorax (RR = 0.07; 95 % CI 0.01 - 0.77) and pulmonary hypertension (RR = 0.34; 95 % CI 0.14 - 0.78). Conclusions: Early INSURE therapy was associated with a reduced incidence of CPAP failure, pneumothorax, and pulmonary hypertension in late preterm infants with moderate to severe RDS. Large, well-powered randomized controlled trials are needed to confirm these observations, but its use is supported by studies with similar results in more premature infants.

Intracranial extension of acquired cholesteatoma is a rare occurrence that can develop secondary to trauma, chronic otitis media or acquired aural cholesteatoma. The most commonly observed symptoms are headache and hearing loss. The authors report on a rare case of intracranial cholesteatoma presenting with atypic symptoms: swelling and temporomandibular joint disorders.

Dyskeratosis congenita is a rare disease caused by telomerase dysfunction classically characterised by the triad: skin pigmentation, nail dystrophy and mucosal leukoplakia. Few cases are described in literature regarding patients with head and neck squamous cell carcinoma affected by dyskeratosis congenita, and the therapeutic decisions are not yet well defined. A review of the literature of the last 20 years (2001–2021) was performed, and it was analysed the case of a 38-year-old male patient affected by dyskeratosis congenita diagnosed with a squamous cell carcinoma of the inferior alveolar ridge, treated with surgery. The absence of complications and the good postoperative recovery of the patient comfort in saying that resection and reconstructive surgery can be safely performed. The occurrence of disseminated disease 6 months after the treatment warns about the extreme aggressiveness of the pathology, its often systemic nature and the necessity of a multidisciplinary approach as well as further studies.

INTRODUCTION: Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating behaviors such as cognitive restraint, emotional eating and uncontrolled eating are related to self-reported sleep experiences. Specifically, we hypothesized that poor eating habits would be associated with (1) more insomnia symptoms, (2) overall worse sleep quality, (3) increased daytime sleepiness, and (4) shorter sleep duration. METHODS: Data were collected from N=100 adults (age 18–60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for “cognitive restraint,” “uncontrolled eating, “and “emotional eating.” Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included: age, sex, Body Mass Index (BMI), education and immigrant status. RESULTS: Overall TFEQ score (problematic eating) was positively associated with greater insomnia, poorer sleep quality, more sleepiness, and less weekend (but not weekday) sleep. Mean TFEQ score in the sample was 18.7 (range 0–51). In adjusted analyses, every point on the TFEQ was associated with 0.6 ISI points, 0.8 PSQI points, 0.5 ESS points, and 1.1 minutes of less weekend sleep duration. Regarding subscale scores, relationships were generally seen between sleep and emotional eating and unrestricted eating, and not cognitive restraint. CONCLUSIONS: Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.

Introduction: Kidney transplant recipients and patients on the waiting list for kidney transplant who acquire SARS-CoV-2 infection are at serious risk of developing severe COVID-19, with an increased risk of mortality for the their immunosuppressive state; other risk factors for mortality have been identified in some comorbidities such as obesity, diabetes, asthma and chronic lung disease. Materials and methods: The COVID-19 pandemic has led to a sharp reduction in kidney transplants in most countries, mainly due to the concern of patients on the waiting list for their potential increased susceptibility to acquire SARS-CoV-2 infection in healthcare facilities and for the difficulties of transplant centers to ensure full activity as hospitals have had to focus most of their attention on COVID-19 patients. Indeed, while the infection curve continued its exponential rise, there was a vertical decline in kidney donation/transplant activity. Conclusion: This review article focuses on the damage induced by SARS-CoV-2 infection on kidney and on the adverse effect of this pandemic on the entire kidney transplant sector.

BACKGROUND The role of circulating progenitor cells (CPC) in vascular repair following everolimus-eluting stent (EES) implantation is largely unknown. The aim of the study was to investigate the relationship between temporal variation in CPC levels following EES implantation and the degree of peri-procedural vascular damage, and stent healing, as measured by optical coherence tomography (OCT).Methods and Results:CPC populations (CD133+/KDR+/CD45low) included patients with stable coronary artery disease undergoing stent implantation, and were evaluated using a flow cytometry technique both at baseline and at 1 week. OCT evaluation was performed immediately post-implantation to quantify the stent-related injury and at a 9-month follow up to assess the mid-term vascular response. Twenty patients (mean age 66±9 years; 80% male) with EES-treated stenoses (n=24) were included in this study. Vascular injury score was associated with the 1-week increase of CD133+/KDR+/CD45low (β 0.28 [95% CI 0.15; 0.41]; P

Resumen La investigación tuvo como finalidad revelar los aspectos socioeconómicos, productivos y tecnológicos del Caribe colombiano tomando como referencia el cultivo de ahuyama en la región. Para ello, se diseñaron y aplicaron encuestas estructuradas y complementariamente se realizaron talleres para la determinación de patrones de costos e indicadores económicos del cultivo. La información se analizó utilizando métodos multivariados como la distancia de Gower y el agrupamiento jerárquico de Ward. Los resultados revelan un bajo nivel en la tecnología local de producción; asimismo el cultivo presenta una baja dependencia de agroinsumos y los costos de producción son compatibles con la realidad económica del pequeño productor. Abstract This research aimed at revealing socioeconomic, productive and technological aspects associated with squash crops located on production areas in the Caribbean región of Colombia. To accomplish this goal several surveys were structured and applied along with some workshops in order to determine costs patterns and economic indicators from squash cultivation. The resulting information was compiled and analyzed using multivaria-te statistical methods such as Gower's distance and Ward's hierarchical agglomerative cluster. The results indicate a low level in the local production technology, the squash crop managements suggest a low influence of agrochemicals, and production costs showed connection with the economic conditions from peasants who participated in this study. JEL: Q16

Positron emission tomography (PET) is a functional imaging technique introduced in 1970s. Over the years, PET was used alone but is in 2000 when the first hybrid PET/CT device was clinically introduced. Since then, PET has continuously been marked by technological developments, being the most recent one the introduction of silicon photomultipliers (SiPMs) as an alternative to standard photomultiplier tubes used in analog PET/CT systems. SiPMs, the basis for the so called digital PET/CT systems, are smaller than standard photomultiplier tubes (enabling higher spatial resolution) and provide up to 100% coverage of the crystal area, as well as high sensitivity, low noise, and fast timing resolution. SiPMs in combination with optimized acquisition and reconstruction parameters improve the localization of the annihilation events, provide high definition PET images, and offer higher sensitivity and higher diagnostic performance. This article summarizes the evidence about the superior performance of the state of the art digital PET and highlights its potential clinical implications. Digital PET opens new perspectives in the quantification and characterization of small lesions, which are mostly undetectable using analog PET systems, potentially changing patient management and improving outcomes in oncological and non-oncological diseases. Moreover, digital PET offers the possibility to reduce radiation dose and scan times which may facilitate the implementation of PET to address unmet clinical needs.

Background Cerebellar arteriovenous malformations (cAVMs) are rare and challenging lesions with an aggressive natural history. The mechanisms whereby a patient can worsen clinically after a supratentorial AVM resection include an acute alteration in cerebral hemodynamics, which is a known cause of postoperative hyperemia, edema and/or hemorrhage. These phenomena has not been described for cAVMS. Moreover, the underlying pathophysiology of edema and hemorrhage after AVM resection still remains controversial. Methods We report a patient that presented an abrupt neurological deterioration after cAVM surgical resection. Emergent external ventricular drainage to treat incipient hydrocephalus only partially reverted the patient's deterioration. Consecutive post-surgery CT images revealed fourth ventricle compression secondary to cerebellar swelling that concurred with a new neurological deterioration. Densitometric analysis was performed in these CT images to reveal the nature of these changes as well as their evolution over time. Results Importantly, we demonstrated a dynamic increase in the cerebellum mean density at the interval of Hounsfield values which correspond to hyperemia values. These changes were dynamic, and when hyperemia resolved and cerebellar density returned to basal levels, the fourth ventricle re-expanded and the patient neurologically recovered. Conclusions This study demonstrated the utility of quantitative CT image analysis in the context of hemodynamic alterations following cAVM resection. Densitometric CT analysis demonstrated that hyperemic changes, but not ischemic ones, were time-dependent and were responsible for swelling and hemorrhage that conditioned neurological status and patient's evolution.

Background Approximately 20,000 people died from influenza in the US in the 2019-2020 season. The best way to prevent influenza is to receive the influenza vaccine. Persons who are foreign-born experience disparities in access to, and utilization of, preventative healthcare, including vaccination. Methods National Health Interview Survey data were analyzed to assess differences in influenza vaccination coverage during the 2012-2013 through 2017-2018 influenza seasons among adults by nativity, citizenship status of foreign-born persons, race/ethnicity, and language of the interview. Results Influenza vaccination coverage increased significantly during the study period for US-born adults but did not change significantly among foreign-born racial/ethnic groups except for increases among foreign-born Hispanic adults. Coverage for foreign-born adults, those who completed an interview in a non-English language, and non-US citizens, had lower vaccination coverage during most influenza seasons studied, compared with US-born, English-interviewed, and US-citizen adults, respectively. Conclusions Strategies to improve influenza vaccination uptake must consider foreign-born adults as an underserved population in need of focused, culturally-tailored outreach. Achieving high influenza vaccination coverage among the foreign-born population will help reduce illness among the essential workforce, achieve national vaccination goals, and reduce racial and ethnic disparities in vaccination coverage in the US.

Resumen Antecedentes y objetivo Describir las caracteristicas clinicas de los pacientes tratados con evolocumab, las razones del inicio de la terapia y los efectos del tratamiento en la fase inicial de disponibilidad de evolocumab en las unidades de nefrologia de Espana. Material y metodos Estudio retrospectivo, observacional y multicentrico que incluye los pacientes que iniciaron tratamiento con evolocumab (desde febrero de 2016 a agosto de 2018) en 15 unidades de nefrologia en Espana. Se revisaron las caracteristicas demograficas y clinicas de los pacientes, el tratamiento hipolipemiante y la evolucion de los perfiles lipidicos entre 24 semanas antes y 12 ± 4 semanas despues del inicio de evolocumab. Resultados Se incluyeron 60 pacientes: 53,3% mujeres, edad media (DE) de 56,9 (12,8) anos, el 45,0% con hipercolesterolemia familiar (HF) (5,0% homocigota y 40,0% heterocigota) y el 65,0% con enfermedad cardiovascular aterosclerotica (ECVA) previa. El filtrado glomerular estimado (FGe) medio fue de 62,6 (30,0) ml/min/1,73 m2 (51,7% pacientes con FGe 2]), el 50,0% con proteinuria (> 300 mg/g) y el 10,0% con sindrome nefrotico. Otros factores de riesgo CV fueron: hipertension (75,0%), diabetes mellitus (25,0%) y habito tabaquico (21,7%). El 40,0% eran intolerantes a estatinas. Al inicio de evolocumab, el 41,7% tomaban estatinas de alta intensidad, el 18,3% estatinas de moderada intensidad y el 50,0% ezetimiba. Los niveles medios (DE) de c-LDL al inicio de evolocumab fueron de 179,7 (62,9) mg/dl (53,4% pacientes con c-LDL ≥ 160 mg/dl y 29,3% ≥ 190 mg/dl). Despues de 12 semanas del tratamiento con evolocumab se observo una reduccion de los niveles de c-LDL del 60,1%. A la semana 12, el 90,0% de los pacientes alcanzo niveles c-LDL Conclusiones En las unidades de nefrologia de Espana, evolocumab se ha prescrito principalmente en pacientes con HF, enfermedad renal cronica (ERC > 2) y prevencion secundaria, con niveles de c-LDL muy por encima de los recomendados por las guias. Evolocumab utilizado en practica clinica, redujo significativamente los niveles de c-LDL en todos los pacientes incluidos en el estudio.

Retrospective studies and meta-analyses suggest that upfront primary tumour resection (UPTR) confers a survival benefit in patients with asymptomatic unresectable metastatic colorectal cancer (mCRC) undergoing chemotherapy, however a consensus of its role in routine clinical practice in the current era of targeted therapies is lacking. This retrospective study aimed to analyse the survival benefit of UPTR in terms of tumour location and mutational status, in patients with synchronous mCRC receiving chemotherapy and targeted therapy.Survival was analysed in a pooled cohort of synchronous mCRC patients treated with a first-line anti-VEGF or anti-EGFR inhibitor in seven trials of the Spanish TTD group, according to UPTR, tumour-sidedness and mutational profiling.Of 1334 eligible patients, 642 (48%) had undergone UPTR. UPTR was associated with significantly longer overall survival (OS; 25.0 vs 20.3 months; HR 1.30, 95%CI 1.15-1.48; p 0.0001). UPTR was associated with significant OS benefit in both left-sided (HR 1.38, 95%CI 1.13-1.69; p = 0.002) and right-sided (HR 1.39, 95%CI 1.00-1.94; p = 0.049) tumours, RASwt (HR 1.29, 95%CI 1.05-1.60; p = 0.016) and BRAFwt (HR 1.49, 95%CI 1.21-1.84; p = 0.0002) tumours, and treatment with anti-EGFRs (HR 1.47, 95%CI 1.13-1.92; p = 0.004) and anti-VEGFs (HR 1.25, 95%CI 1.08-1.44; p = 0.003). Multivariate analysis identified number of metastatic sites, RAS status, primary tumour location and UPTR as independent prognostic factors for OS.Considering the selection bias inherent to this study, our results support UPTR before first-line anti-EGFR or anti-VEGF targeted therapy in right and left-sided asymptomatic unresectable synchronous mCRC patients. RAS/BRAF mutational status may also influence UPTR function.

Cushioning for the central and plantar zone of the forefoot, integrated into the body of the sock, could reduce excess pressures in that zone. The objective of this study was to verify the capacity of a sock with a cushioning element to reduce forefoot plantar pressures relative to the same sock model without that element. Dynamic plantar pressures were measured in a sample of 38 participants (25 women and 13 men) using the FootScan plate system following the two-step protocol. Measurements were made in three situations selected at random - barefoot, wearing control socks, and wearing the experimental cushioned socks. Maximum pressures were analysed in seven zones of the forefoot (hallux, lesser toes, and 1st to 5th metatarsal heads). The zone of greatest plantar pressure was in all situations located under the 3rd metatarsal head. The pressure was lower (p = 0.009) under the 2nd metatarsal head with the experimental sock (10.2 ± 3.1 N/cm

Resumen Introduccion y objetivos Una profundidad mas alta del implante percutaneo de una valvula aortica autoexpandible minimiza el dano en el sistema de conduccion y puede reducir las tasas de marcapasos permanente a 30 dias. El objetivo es determinar la seguridad y la eficacia de modificar la tecnica de implante clasica para el reemplazo percutaneo de la valvula aortica a una tecnica de proyeccion de superposicion de cuspides (PSC) para lograr una profundidad mas alta del implante y reducir la necesidad de marcapasos permanente. Metodos Desde marzo de 2017 se incluyo a 226 pacientes consecutivos: 113 tratados con tecnica de implante PSC frente a 113 casos consecutivos previos con implante clasico. La profundidad del implante se evaluo mediante 3 metodos en todos los pacientes (cuspide no coronaria a valvula cardiaca percutanea (VCP); media de cuspide no coronaria y cuspide coronaria izquierda a VCP y el borde mas profundo de cuspide coronaria izquierda y cuspide no coronaria a VCP). Resultados El grupo de PSC presento una profundidad del implante menor que el del grupo de implante clasico (4,8 ± 2,2 frente a 5,7 ± 3,1 mm; p = 0,011; 5,8 ± 3,1 frente a 6,5 ± 2,4 mm; p = 0,095; 7,1 ± 2,8 frente a 7,4 ± 3,2 mm; p = 0,392). A los 30 dias de seguimiento, 40 pacientes (17,7%) requirieron el implante de marcapasos permanente, menos en el grupo de PSC (el 12,4 frente al 23%; p = 0,036). La tecnica de implante PSC protegio contra el evento principal (OR = 0,45; IC95%, 0,21-0,97; p = 0,043), con parecidos exito del procedimiento y complicaciones. Conclusiones La tecnica de implante PSC es una simple modificacion en el protocolo que proporciona una profundidad del implante mas alta de la protesis valvular autoexpandible con menores alteraciones de la conduccion y tasas de marcapasos permanente.

BACKGROUND: The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve implantation (TAVI) by the transfemoral (TF) approach. Intravascular lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium and increases vessel compliance allowing TF TAVI in selected patients with peripheral artery disease (PAD). AIMS: The aim of this study was to report on the safety and efficacy of IVL-assisted TF TAVI in an all-comers population. METHODS: Clinical, imaging and procedural data on all consecutive patients treated by IVL-assisted TF TAVI in six high-volume European centres (2018-2020) were collected in this prospective, real-world, multicentre registry. RESULTS: IVL-assisted TF TAVI was performed in 108 patients, increasing from 2.4% to 6.5% of all TAVI from 2018 to 2020, respectively. The target lesion was most often localised at the common and/or external iliac artery (93.5% of cases; average TL-MLD 4.6±0.9 mm with 318 degrees of calcium arc). Transfemoral aortic valve delivery was successful in 100% of cases; final procedural success in 98.2% (two conversions to cardiac open surgery for annular rupture and valve migration). Complications of the IVL-treated segments consisted of 1 perforation and 3 major dissections requiring stent implantation (2 covered stents and 2 BMS). Access-site-related complications included 3 major bleedings. Three in-hospital deaths were recorded (2.8%, 1 failed surgical conversion after annular rupture, 1 cardiac arrest after initial valvuloplasty, 1 late hyperkalaemia in renal dysfunction). CONCLUSIONS: IVL-assisted TF TAVI proved to be a safe and effective approach, which helps to expand the indications for TF TAVI in patients with severe calcific PAD. However, these patients continue to have a higher-than-average incidence of periprocedural complications.

Objectives The aim of this study is to assess the feasibility, efficacy and safety of the “RotaTripsy” approach in severe calcified coronary artery lesions. Background Coronary lesions with a high calcium content represent a challenging scenario in interventional cardiology , requiring a proper lesion preparation. In this light, very little is known about the possibility to combine the benefits of rotational atherectomy and intravascular lithotripsy . Methods We retrospectively enrolled 34 patients from a real-word, multicenter, cohort of patients affected by severe calcified coronary artery lesions, which required the “RotaTripsy” to obtain a proper lesion preparation. In all the cases, rotational atherectomy and then intravascular lithotripsy were performed as a bail-out strategy following sub-optimal non-compliant balloon expansion. In 53% of the cases, the procedure was guided by intracoronary imaging findings. Results Procedural success was reported in all the cases, without any in-hospital major complication. Few major adverse clinical events were reported at mid-term follow-up. Conclusions “RotaTripsy” can represent a valid therapeutic option for undilatable heavily calcified coronary artery lesions. Our findings demonstrate the feasibility, safety and efficacy of this approach.

Introduction and objectives: Carbohydrate antigen 125 (CA125) has been shown to be useful for risk stratification in patients admitted with acute heart failure (AHF). We sought to determine a CA125 cutpoint for identifying patients at low risk of 1-month death or the composite of death/HF readmission following admission for AHF.Methods: The derivation cohort included 3231 consecutive patients with AHF. CA125 cutoff values with 90% negative predictive value (NPV) and sensitivity up to 85% were identified. The adequacy of these cutpoints and the risk of 1-month death/HF readmission was then tested using the Royston-Parmar method. The best cutpoint was selected and externally validated in a cohort of patients hospitalized from BIOSTAT-CHF (n = 1583).Result: In the derivation cohort, the median [IQR] CA125 was 57 [25.3-157] U/mL. The optimal cutoff value was < 23 U/mL (21.5% of patients), with NPVs of 99.3% and 94.1% for death and the composite endpoint, respectively. On multivariate survival analyses, CA125 < 23 U/mL was independently associated with a lower risk of death (HR, 0.20; 95%Cl, 0.08-0.50; P < .001), and the combined endpoint (HR, 0.63; 95%Cl, 950.45-0.90; P = .009). The ability of this cutpoint to discriminate patients at a low 1-month risk was confirmed in the validation cohort (NPVs of 98.6% and 96.6% for death and the composite endpoint). The predicted ability of this cutoff remained significant at 6 months of follow-up.Conclusion: In patients admitted with AHF, CA125 < 23 U/mL identified a subgroup at low risk of short-term adverse events, a population that may not require intense postdischarge monitoring. (C) 2021 Sociedad Espanola de Cardiologia. Published by Elsevier Espafia, S.L.U. All rights reserved.

Resumen Introduccion y objetivos El antigeno carbohidrato 125 (CA125) se ha mostrado util para la estratificacion del riesgo de los pacientes ingresados por insuficiencia cardiaca aguda (ICA). Se intenta determinar un punto de corte para identificar a los pacientes con bajo riesgo de muerte y muerte/reingreso por insuficiencia cardiaca 1 mes tras el ingreso por ICA. Metodos La cohorte de derivacion incluyo a 3.231 pacientes con ICA consecutivos. Se identificaron valores de corte de CA125 con un valor predictivo negativo (VPN) del 90% y una sensibilidad de hasta el 85%. La idoneidad de estos puntos de corte y el riesgo de muerte/reingreso al mes se evaluaron mediante el metodo de Royston-Parmar. Se selecciono el mejor punto de corte y se valido en una cohorte del BIOSTAT-CHF (n = 1.583). Resultados En la cohorte de derivacion, la mediana [intervalo intercuartilico] de CA125 fue 57 [25,3-157] U/ml. El punto de corte optimo fue Conclusiones En pacientes ingresados por ICA, el CA125

Diet plays a central role in aging and in the prevention of age-related diseases. Specifically, dietary lipids have influence on processes like oxidative stress or inflammation. This review summarizes and compares the effects of lifelong feeding on three different fat sources, namely virgin olive oil, sunflower oil or fish oil (which differ in fatty acid profile and minor components content) in the pancreas, liver, alveolar bone and femur of old rats. Also, effects on longevity and causes of death are summarized. Animals fed on virgin olive oil had a lower number of β cells and insulin content in the pancreas, less liver fibrosis, less loss of alveolar bone, and greater bone mass density in the femur. In general, the markers of oxidative damage at the liver, pancreatic, gingival and systemic levels were also lower in animals fed on virgin olive oil compared to those treated with sunflower or fish oil. Finally, although the animals died from similar causes regardless of the experimental group, virgin olive oil increased lifespan compared to sunflower oil. Therefore, it is evidenced the chance to modulate the effects of the physiological aging process by diet and, more specifically, by dietary fat.

Resumen Introduccion y objetivos La calcificacion grave esta presente en mas del 50% de las oclusiones coronarias cronicas totales (OCT) tratadas mediante intervencion percutanea. Nuestro objetivo fue describir el uso contemporaneo de los dispositivos de modificacion de placa (DMP) en este contexto. Metodos Los pacientes se incluyeron en el Registro Iberico de OCT de forma prospectiva y consecutiva (32 centros de Espana y Portugal), de 2015 a 2020. Se compararon en funcion del uso o no de DMP. Resultados Se incluyo a 2.235 pacientes, en 1.900 de los cuales se logro cruzar con exito la lesion con guia. Se utilizo al menos un DMP en un 7% (134 pacientes) y mas de uno en 24 pacientes (1%). Los DMP seleccionados fueron: aterectomia rotacional (35,1%), litotricia (5,2%), laser (11,2%), balones de corte (27,6%), balones OPN (2,9%) o combinaciones de mas de uno (18%). Se utilizaron DMP en pacientes mas ancianos, con mayor riesgo cardiovascular y puntuaciones Syntax y J-CTO mas elevados. Esta mayor complejidad se asocio con procedimientos mas prolongados, pero similar longitud total de stent (52 frente a 57 mm; p = 0,105). Cuando la guia cruzo con exito la oclusion, la tasa de exito final del procedimiento fue del 87,2%, pero se incremento al 96,3% cuando se utilizaron DMP (p = 0,001). Por el contrario, los DMP no se asociaron con mayor tasa de complicaciones en el procedimiento (3,7 frente a 3,2%; p = 0,615). Pese al peor perfil de riesgo basal, a los 2 anos de seguimiento no hubo diferencias en la tasa de supervivencia (94,3% DPM frente a no-DMP: 94,3% no-DPM, respectivamente, p = 0,967). Conclusiones Cuando la guia cruzo con exito una OCT, la tasa de uso de los DMP fue del 7% y se asocio a una tasa de exito final del procedimiento significativamente mayor. Los resultados a medio plazo fueron comparables cuando se precisaron DMP pese a su mayor riesgo basal, lo que sugiere que un mayor uso adecuado de estas tecnicas en este contexto podria conllevar tanto beneficios tecnicos como pronosticos.