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This study analyzed the factors identified by inclusive faculty members that hinder or facilitate the inclusion of students with disabilities and their recommendations for universities to achieve f...

Accurate assessment of disease extent is required to select the best primary treatment for advanced epithelial ovarian cancer patients. Estimation of tumour burden is challenging and it is usually performed by means of a surgical procedure. Imaging techniques and tumour markers can help to estimate tumour burden non-invasively. 2-[18F]FDG PET/CT allows the evaluation of the whole-body disease. This study aimed to correlate HE4 and CA125 serum concentrations with tumour burden evaluated by volumetric 2-[18F]FDG PET/CT parameters in advanced high-grade epithelial ovarian cancer. We included 66 patients who underwent 2-[18F]FDG PET/CT and serum tumour markers determination before primary treatment. Volumes of interest were delimited in every pathological uptake. Whole-body metabolic tumour volume (wb_MTV) and total lesion glycolysis (wb_TLG) were calculated summing up every VOI’s MTV value. SUVmax thresholds were set at 40% (MTV40 and TLG40) and 50% (MTV50 and TLG50). In addition, four VOI subgroups were defined: peritoneal carcinomatosis, retroperitoneal nodes, supradiaphragmatic nodes, and distant metastases. MTV and TLG were calculated for each group by adding up the corresponding MTV values. TLG was calculated likewise. wb_MTV and wb_TLG were found to be significantly correlated with serum CA125 and HE4 concentrations. The strongest correlation was observed between HE4 and wb_MTV40 (r = 0.62, p

Resumen Contexto El desarrollo de protocolos ERAS (Enhanced Recovery After Surgery) en pacientes sometidos a cirugia mayor ha aportado beneficios perioperatorios en diversas disciplinas. En urologia, su principal aplicacion se centra en pacientes sometidos a cistectomia radical. Objetivo Revision sistematica de la literatura disponible de protocolos ERAS aplicados a pacientes intervenidos de cistectomia radical, tanto a nivel de resultados perioperatorios como en el analisis de su implementacion. Adquisicion de la evidencia Se realizo busqueda bibliografica en base de datos electronicas Pubmed, Embase, Cochrane y Scopus, utilizando los terminos «Cystectomy», «Enhanced Recovery After Surgery» y «Fast-Track». Se seleccionaron estudios aleatorizados y no aleatorizados que comparasen la implementacion de un protocolo ERAS en pacientes sometidos a cistectomia radical frente a un protocolo tradicional. Sintesis de la evidencia Se identificaron 869 articulos; 25 fueron seleccionados para el analisis final: 22 estudios no aleatorizados y 3 aleatorizados. No se detectaron diferencias en cuanto a caracteristicas demograficas entre los distintos estudios. Se identificaron diferencias estadisticamente significativas a favor del protocolo ERAS en tiempo de estancia hospitalaria, tasa de complicaciones mayores, tiempo a primera deambulacion y recuperacion intestinal. En el analisis de protocolos se detecto una alta variabilidad, tanto en numero de items como en metodo de implementacion. Conclusiones El caracter multidisciplinar y el numero de items de los protocolos ERAS conlleva una alta heterogeneidad en su implementacion. Se requieren mas estudios aleatorizados, estandarizacion a la hora de reportar y analizar resultados, asi como un analisis sistematico de la adherencia posterior para aumentar la comparabilidad entre grupos.

Context The development of ERAS (Enhanced Recovery After Surgery) protocols in patients undergoing major surgery has brought perioperative benefits in several disciplines. Its main application in urology is focused on patients undergoing radical cystectomy. Objective Systematic review of the available literature on ERAS protocols applied to patients undergoing radical cystectomy in terms of perioperative outcomes as well in the analysis of their implementation. Evidence acquisition A bibliographic search was conducted in the electronic databases PubMed, Embase, Cochrane and Scopus, using the terms ≪Cystectomy>>, ≪Enhanced Recovery After Surgery>> and ≪Fast-Track>>. Randomized and non-randomized studies that compared the implementation of an ERAS protocol versus a traditional protocol in patients undergoing radical cystectomy were selected. Evidence synthesis 869 articles were identified; 25 were selected for final analysis: 22 non-randomized and 3 randomized studies. No differences were observed in terms of demographic characteristics between studies. Statistically significant differences were identified in favor of the ERAS protocol: length of hospital stay, major complication rate, time to first ambulation and return of bowel function. In the analysis of protocols, a high variability was detected in the number of items and in the implementation method. Conclusions The multidisciplinary nature and the number of items of the ERAS protocols imply a high heterogeneity in their implementation. Further randomized studies, standardized reporting and analyzing results, as well as a systematic analysis of subsequent adherence are required to increase comparability between groups.

Background: The postpartum period may be a vulnerable life stage for a woman's cardiometabolic health. We examined associations of exposure to common endocrine-disrupting chemicals (EDCs) during pregnancy with weight from delivery through 1 year postpartum among 199 women in Mexico City. Materials and Methods: During each trimester of pregnancy, we collected a urine sample to assay bisphenol A (BPA), mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP), monobenzyl phthalate (MBzP), mono-3-carboxypropyl phthalate (MCPP), mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), mono-2-ethylhexyl phthalate (MEHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP), and monoethyl phthalate (MEP). We calculated summary scores for di-2-ethylhexyl phthalate metabolites (ΣDEHP) and dibutyl phthalate metabolites (ΣDBP). We calculated the geometric mean of each EDC across pregnancy for use in the analysis. At delivery and three additional times during the first year postpartum, we measured the women's weight. We used mixed-effects linear regression models to estimate associations of each EDC with weight at delivery (kg) and weight change (kg/year) from delivery through 1 year postpartum. Covariates included urinary specific gravity, maternal age, parity, height, first trimester body mass index, and gestational age at enrollment. Results: Mean ± standard deviation weight change during the first postpartum year was −0.49 ± 4.04 kg. The EDCs were inversely associated with weight at delivery, but positively associated with weight change through 1 year postpartum. For example, each interquartile range of urinary ΣDEHP corresponded with 1.38 (95% confidence interval: 0.44–2.33) kg lower weight at delivery and 1.01 (0.41––1.61) kg/year slower rate of weight loss. We observed similar associations for other EDCs. Conclusions: Prenatal exposure to EDCs is associated with lower weight at delivery, but slower rate of weight loss through the first postpartum year.

INTRODUCTION: Endometriosis is a chronic inflammatory gynecologic disease affecting 5–10% of women of reproductive age of all ethnicities. Symptoms of this painful condition impact the physical, mental health, and quality of life of patients. Stigma is a social determinant of health documented to negatively impact people living with chronic conditions and have been associated with social exclusion, high levels of stress, and interference with medical care. The purpose of this study was to document stigma experiences among Latina women living with endometriosis. METHODS: A qualitative design using focus groups was implemented. Thematic analysis was conducted for data interpretation. A total of 50 women participated in five focus groups. RESULTS: The main theme “changuería” emerged as a label applied across multiple contexts and interactions in the lives of participants, suggesting that stigmatization is an ever-present barrier among women living with endometriosis. Participants reported that relatives, partners and health professionals perceive pain during menstruation as something women should be able to manage, producing a sense of inability to disclose the extent of suffering. CONCLUSION: These results highlight the importance of addressing stigma as a way to foster healthcare seeking and minimize its impact on physical, mental health, and wellbeing.

Objective To assess the diagnostic capability of PET/CT with [18F]F-Fluoromethylcholine in prostate cancer (PC) with biochemical recurrence and its therapeutic impact. Material and methods We included 108 patients, diagnosed with PC with biochemical criteria for recurrence. A PET/CT choline scan was performed by dynamic pelvic and whole body study at 60 min post-tracer injection. The relationship between the positive studies and the PSA value was analysed by classifying patients into three groups ( 2 ng/ml), and the diagnostic capacity was assessed with respect to pelvic MRI and the impact on the therapeutic decision. Results The location of recurrence was identified in 85 of 108 patients (78.7%): 34 local, 47 pelvic lymph nodes and 58 distant lesions, including retroperitoneal, mediastinal lymph nodes and distant organ lesions (bone and lung). Second tumors were diagnosed in 4 patients. No significant differences were found in the percentage of positive studies depending on primary treatment. Patients with PSA > 2 ng/ml showed a higher percentage of disease detection than patients with a lower PSA level, with significant differences (p Conclusions PET/CT with [18F]F-Fluoromethylcholine is a useful tool in the detection of locoregional and disseminated disease of PC treated with suspicion of recurrence, providing a change in therapeutic management in 62% of patients.

Breast implants are associated with well-known common complications that have been widely studied, such as rupture and capsular contraction. However, the increasingly growing number of patients with breast implants has led to the increased likelihood of coming across less common complications; these include seromas or late infection; adenopathies in the internal mammary chain; granulomas in the capsule of the implant, which in some cases can extend beyond the fibrous capsule; desmoid tumors associated with the implants; and breast implant-associated large cell anaplastic lymphoma. This article aims to review the main uncommon complications associated with breast implants and to describe and illustrate their findings in different imaging techniques. Proper management of these complications is important; this is especially true of late seroma and the diagnosis of breast implant-associated large cell anaplastic lymphoma for their repercussions.

ObjectiveThis study investigated the sex difference in prevalence of depression at 90 days after first-ever stroke.MethodsPatients with first-ever stroke (n = 786) were identified from the population-based Brain Attack Surveillance in Corpus Christi project (2011–2016). Poststroke depressive symptoms were assessed by the 8-item Patient Health Questionnaire, and prestroke depression status (history and medication use) was self-reported. Logistic regression was used to examine the association between sex and depression after stroke, and effect modification by prestroke depression status, accounting for missing data.ResultsWomen were more likely to have a history of and be on medication for depression at the time of stroke than men (p< 0.001). Prevalence of depression at 90 days was 28.2% for men (95% confidence interval [CI], 23.7%–32.8%) and 32.7% for women (95% CI, 27.8%–37.5%). The age-adjusted odds ratio (OR) of depression after stroke comparing women and men was 1.34 (95% CI, 0.97–1.85), and fully attenuated after adjustment for sociodemographic, stroke, and prestroke characteristics. Effect modification by prestroke depression status was present (p= 0.038). Among participants on medication for depression at the time of stroke, women were significantly less likely to have depression at 90 days compared with men (OR, 0.39; 95% CI, 0.16–0.96), whereas significant sex differences were not noted among those with and without a depression history.ConclusionThe sex difference in prevalence of depression at 90 days after first-ever stroke was not significant overall, but varied by prestroke depression status. Interventions to address and prevent poststroke depression are needed, particularly among those with prestroke depression but not undergoing treatment for depression at stroke onset.

BackgroundClimate change and urbanization are rapidly increasing human exposure to extreme ambient temperatures, yet few studies have examined the impact of temperature on mortality across Latin America, where 80% of residents live in urban areas.MethodsWe used distributed lag nonlinear conditional Poisson models to estimate city-specific associations between daily temperatures above (“heat”) and below (“cold”) each city-specific minimum mortality temperature and all-cause mortality, overall and stratified by age and cause of death. We estimated the percentage of total deaths attributable to heat or cold (excess death fraction [EDF]) and the difference in mortality per 1°C higher daily mean temperature above the 95th percentile of observed daily temperature.ResultsWe analyzed data from 326 cities in nine Latin American countries between 2002-2015, representing 15,431,532 deaths from 249 million residents. The EDF of total deaths from heat was 0.67% (95% confidence interval [CI] 0.58%, 0.74%), and from cold was 5.09% (95% CI 4.64%, 5.47%). EDFs from heat and cold were particularly high among individuals aged 65+ years (0.81% [95% CI 0.75%, 0.86%] and 6.82% [95% CI 6.41%, 7.18%], respectively). The relative risk of death per 1°C increase above the city-specific 95th percentile daily temperature was 1.057 (95% CI 1.046, 1.067).ConclusionsIn Latin American cities, a substantial proportion of deaths are attributable to non-optimal ambient temperatures. Older populations are particularly vulnerable. Marginal increases in observed hot temperatures are associated with steep increases in mortality risk. Projected increases in temperature from climate change may have a substantial impact on mortality.SIGNIFICANCE STATEMENTLatin America has a large population at risk of urban heat exposure, yet little is known about the linkages between ambient temperature and health in the region. We analyzed over 15 million deaths in 326 Latin American cities to characterize the relationship between ambient temperature and mortality, overall and by age and cause of death. We found that 5.75% of all deaths are associated with non-optimal temperatures, older individuals are particularly vulnerable, and cardiorespiratory deaths are especially affected. A single degree increase (1°C) in daily temperature was associated with a 5.7% higher mortality among hot days, suggesting that projected increases in temperature from climate change may have a substantial impact on mortality.

Pancreatic cancer leads the most common lethal tumor in America. This lethality is related to limited treatment options. Conventional treatments involve a non-specific use of chemotherapeutical agents like 5-FU, capecitabine, gemcitabine, cisplatine, oxaliplatine, or irinotecan, that produce several side effects. This review we focus on the use of targeted nanoparticles as an alternative to the standard treatment for the pancreatic cancer. The principal objective of the use of nanoparticles is the reduction in side effects that conventional treatments produce, mostly because of their nonspecificity. Currently, several molecular markets of pancreatic cancer cells have been studied to target nanoparticles and improve the actual treatment. Therefore, properly functionalizated nanoparticles with specific aptamers or antibodies can be used to recognize pancreatic cancer cells and once cancer is recognized, these nanoparticles can attack the tumor by drug delivery, hyperthermia, or gene therapy.

We explored associations between residential preferences and sociodemographic characteristics, the concordance between current neighborhood characteristics and residential preferences, and heterogeneity in concordance by income and race/ethnicity. Data came from a cross-sectional phone and mail survey of 3668 residents of New York City, Baltimore, Chicago, Los Angeles, St. Paul, and Winston Salem in 2011-12. Scales characterized residential preferences and neighborhood characteristics. Stronger preferences were associated with being older, female, non-White/non-Hispanic, and lower education. There was significant positive but weak concordance between current neighborhood characteristics and residential preferences (after controlling sociodemographic characteristics). Concordance was stronger for persons with higher income and for Whites, suggesting that residential self-selection effects are strongest for populations that are more advantaged.

Introduction/purpose Limited studies have examined the association of physical activity with reproductive hormones, DNA methylation, and pubertal status among adolescents. Methods Among 248 boys and 271 girls, we estimated daily physical activity levels based on 7 d of wrist-worn accelerometer data. We used an isotemporal substitution paradigm and sex-stratified regression models to examine the association of physical activity levels with 1) testosterone, cortisol, progesterone, and androstenedione concentrations; 2) DNA methylation of long interspersed nucleotide (LINE-1) repeats and the genes H19, hydroxysteroid (11-Beta) dehydrogenase 2 (HSD11B2), and peroxisome proliferator-activated receptor alpha (PPARA) from blood leukocytes; and 3) Tanner stages, adjusted for age, BMI, and socioeconomic status. Results In boys, substituting 30 min of moderate physical activity for 30 min of sedentary behavior per day was associated with 29% (-49%, 0%) of lower testosterone and 29% (4%, 61%) of higher progesterone. Substituting 30 min of light physical activity for sedentary behavior was associated with 13% (-22%, -2%) of lower progesterone. Among girls, 30 min of additional sedentary behavior was associated with 8% (-15%, 0%) of lower testosterone and 24% (8%, 42%) of higher progesterone concentrations. Substituting 30 min of moderate physical activity for sedentary behavior was associated with 15% (0%, 31%) of higher cortisol, whereas substituting the same amount of light physical activity for sedentary behavior was associated with 22% (-39%, 0%) of lower progesterone. Substituting 30 min of vigorous physical activity for sedentary behavior per day was associated with almost six times higher levels (5.83, 95% confidence interval = 1.79-9.86) of HSD11B2 methylation in boys. Conclusions Accelerometer-measured daily physical activity was associated with reproductive hormones and HSD11B2 DNA methylation, differed by sex and activity intensity levels.

Context Several cross-sectional studies have assessed the association of lead exposure with type 2 diabetes and cardiometabolic risk factors in adults; however, studies of such associations in childhood are rare. Objective We assessed the prospective associations of prenatal exposure to lead with type 2 diabetes and cardiometabolic risk factors in children. Design The Early Life Exposure in Mexico to Environmental Toxicants is a birth cohort study of pregnant women and their offspring. Setting Public hospitals in Mexico City. Patients or Other Participants Women were recruited during pregnancy; their offspring were recruited for a follow-up visit at age 10 to 18 years (n = 369). Main Outcome Measures We measured fasting serum markers of type 2 diabetes and cardiometabolic risk factors in children, including fasting glucose, insulin, and lipids. The index of insulin resistance was calculated. Results The geometric mean of maternal blood lead levels (BLLs) during pregnancy was 4.3 µg/dL (95% confidence interval [CI]): 4.0-4.6 µg/dL) in the entire sample. In boys, those with maternal BLLs ≥ 5 µg/dL (compared with those with BLLs < 5 µg/dL) had significantly lower z scores for total cholesterol (β = -0.41, 95% CI: -0.71, -0.12), high-density lipoprotein cholesterol (β = -0.32, 95% CI: -0.59, -0.05), and low-density lipoprotein cholesterol (β = -0.52, 95% CI: -0.81, -0.22), adjusting for covariates. No associations were detected in girls. Conclusions In our study, we found that higher prenatal exposure to lead was associated with lower levels of cholesterol in children following a sex-specific pattern. Further studies with a larger sample size that examine whether sex is a potential modifier are needed to confirm our findings.

Resumen La neuroimagen funcional de la PET con 18F-FDG y la SPECT de perfusion son exploraciones cada vez mas imprescindibles para la localizacion prequirurgica del foco epileptogeno. Presentamos el caso de un paciente varon de 18 anos con crisis epilepticas refractarias a tratamiento antiepileptico. La RM mostro displasia en cortex insular posterior derecho. El SISCOM detecto un aumento focal de captacion en cingulo frontoparietal izquierdo y en la PET-FDG se visualizaba una distribucion normal del radiotrazador. Se realizo reseccion insular posterior derecha, cuyo resultado anatomopatologico fue ganglioglioma grado I de la clasificacion de la OMS. El paciente mostro una evolucion posquirurgica favorable, encontrandose libre de crisis desde hace 5 anos (Engel I). Un analisis retrospectivo de este caso con 2 nuevos metodos de procesamiento de imagenes: PET-Analysis y PISCOM, permitio localizar correctamente el foco epileptogeno en cortex insular posterior derecho.

Prepulse inhibition (PPI) is a sensorimotor gating mechanism that reduces interfering influences to the neural processing of incoming stimuli, and is associated with several neurodevelopmental disorders. To date, research on PPI and neurodevelopmental disorders has primarily been in cross-sectional, clinical settings. In this prospective, epidemiologic study, we used a data-driven prediction model to identify socio-demographic predictors of PPI in children and adolescents from Mexico City to inform future etiologic studies evaluating PPI. We conducted variable selection and validation using a modified version of the multiple imputation random lasso (MIRL) variable selection algorithm. MIRL identified six predictors of PPI at a stimulus onset asynchrony of 120 ms or 240 ms. Of those six predictors, maternal education, birthweight, and total breastfeeding months were highlighted as previously unstudied variables associated with enhanced PPI. Our findings highlight the potential value of PPI as an adjunct screening tool for identifying children at risk for neurodevelopmental disorders and underscore the relevance for validation research on this topic.

Objective To examine the association between sleep-disordered breathing and stroke outcomes, and determine the contribution of sleep-disordered breathing to outcome disparities in Mexican Americans. Methods Ischemic stroke patients (n = 995), identified from the population-based Brain Attack Surveillance in Corpus Christi Project (2010-2015), were offered participation in a sleep-disordered breathing study including a home sleep apnea test (ApneaLink Plus). Sleep-disordered breathing (respiratory event index ≥10) was determined soon after stroke. Neurologic, functional, cognitive, and quality of life outcomes were assessed at 90 days poststroke. Regression models were used to assess associations between sleep-disordered breathing and outcomes, adjusted for sociodemographics, prestroke function and cognition, health-risk behaviors, stroke severity, and vascular risk factors. Results Median age was 67 years (interquartile range [IQR] = 59-78); 62.1% were Mexican American. Median respiratory event index was 14 (IQR = 6-25); 62.8% had sleep-disordered breathing. Sleep-disordered breathing was associated with worse functional outcome (mean difference in activities of daily living/instrumental activities of daily living score = 0.15, 95% confidence interval [CI] = 0.01-0.28) and cognitive outcome (mean difference in modified Mini-Mental State Examination = -2.66, 95% CI = -4.85 to -0.47) but not neurologic or quality of life outcomes. Sleep-disordered breathing accounted for 9 to 10% of ethnic differences in functional and cognitive outcome and was associated with cognitive outcome more strongly for Mexican Americans (β = -3.97, 95% CI = -6.63 to -1.31) than non-Hispanic whites (β = -0.40, 95% CI = -4.18 to 3.39, p-interaction = 0.15). Interpretation Sleep-disordered breathing is associated with worse functional and cognitive function at 90 days poststroke. These outcomes are reasonable endpoints for future trials of sleep-disordered breathing treatment in stroke. If effective, sleep-disordered breathing treatment may somewhat lessen ethnic stroke outcome disparities. ANN NEUROL 2019;86:241-250.

Objective This study aimed to describe characteristics of cervicovaginal cytokines obtained during pregnancy from women who subsequently delivered at term. Study Design We used repeated measures of 20 cervicovaginal cytokines, collected on average on a monthly basis, from the second to the ninth month of gestation among 181 term pregnancies in the Mexico City Pregnancy Research on Inflammation, Nutrition, & City Environment: Systematic Analyses cohort (2009–2014). Cytokines were quantified using multiplex assay. Results Cytokine distributions differed more between than within cytokines. Across trimesters, cytokines interleukin (IL)-1Ra, IL-1α, and IL-8 consistently had high concentrations compared with other measured cytokines. Cytokine intraclass correlation coefficients ranged from 0.41 to 0.82. Spearman's correlation coefficients among cytokine pairs varied but correlation directions were stable; 95.3% of the 190 correlation pairs remained either negative or positive across trimesters. Mean longitudinal patterns of log-transformed cytokines from Tobit regression varied across but less within cytokines. Conclusion Although mean concentrations of cervicovaginal cytokines among term pregnancies were high, they were largely stable over time. The high cytokine concentrations corroborate that pregnancy is associated with an active inflammatory state. These characterizations may serve as a baseline for comparison to other obstetric outcomes, which may be helpful in understanding deviations from normal gestational inflammation.

Background: Previous studies have examined the association between blood lead levels and pubertal timing in adolescent girls; however, the evidence is lacking on the role of lead exposure during sensitive developmental periods on sexual maturation. Objectives: To examine the association of prenatal and early childhood lead exposure with pubertal stages among 264 boys and 283 girls aged 9.8–18.0 years in Mexico City. Methods: We measured maternal bone lead (a proxy for cumulative fetal exposure to lead from maternal bone stores mobilized during pregnancy) at 1 month postpartum. Blood lead was measured annually from 1 to 4 years. Pubertal stage was assessed by a pediatrician. We examined the association between lead and pubertal stages of breast, pubic hair and genitalia using ordinal regression. Age at menarche was evaluated using Cox proportional-hazard models. Results: Multivariate models showed that maternal patella lead and early childhood blood lead were inversely associated with breast growth (patella OR = 0.72, 95% CI: 0.51–1.00; blood OR = 0.70, 95% CI: 0.53–0.93) in girls. Girls with maternal patella lead in the 3rd tertile and child blood lead in the 2nd tertile had a later age at menarche compared with girls in the 1st tertile (patella HR = 0.60, 95% CI: 0.41–0.88; blood HR = 0.65, 95% CI 0.46–0.91). Additionally, early childhood blood lead was negatively associated with pubic hair growth (OR = 0.68, 95% CI: 0.51–0.90) in girls. No associations were found in boys. Conclusions: These data suggest that higher prenatal and early childhood exposure to lead may be associated with delayed pubertal development in girls but not boys. Our findings are consistent with previous analyses and reinforce the reproductive effects of lead for girls. Keywords: Bone lead, Blood lead, Pregnancy, Early childhood, Puberty, Age at menarche

Introduction UI after RP is a factor that has a major impact on patients’ quality of life and the associated healthcare costs. The definition of UI is very variable in the literature. Similarly, a great many predictors have been studied that affect recovery of continence after surgery, the most important of which are intraoperative. Material and methods A retrospective and observational study performed between September 2008 and March 2015. We studied intraoperative factors through visualisation using a video editor of 148 patients who underwent robot-assisted radical prostatectomy, together with other perioperative factors associated with continence, and described in the literature. We assessed continence through ICQ questionnaires, urinary loss calculated by pad count, and clinical interview in the first, third, sixth month and at one year after surgery. We defined continence as not having to use a pad or using a pad for protection socially, or an ICQ ≤ 7. We used binary and lineal logistic regression analysis to study the relationship between the intraoperative and perioperative variables on urinary continence measured at the first, third, sixth month and one year after the operation, and on continence stability. Results In our study, 72.9% of the patients were continent at one year after surgery with a mean continence stabilisation time at 4.3 months. In our lineal logistic regression analyses we found no significant relationship with the continence variable analysed during the first year. In the lineal logistic regression analysis we found that tension-free sutures had a direct positive effect (p ≤ 0.05) on the stability time of continence, as well as the urinary losses measured in the first month after surgery. Conclusion In conclusion, we found in our study that the tension-free sutures were able to help towards early stability of continence. We found no other intraoperative predictors that influenced urinary continence. The urinary losses measured in the first month related to early recovery of continence.

Resumen Introduccion La IU tras PR es uno de los factores con mayor impacto en la calidad de vida de los pacientes y en el gasto sanitario asociado. La definicion de IU es muy variable en la literatura. De igual modo, son multiples los factores predictores estudiados que influyen en la recuperacion de la continencia posquirurgica, siendo los mas importantes los factores intraoperatorios. Material y metodos Estudio retrospectivo y observacional, desde septiembre del 2008 hasta marzo del 2015. Se realiza el analisis de factores intraoperatorios mediante la visualizacion, con un editor de videos, de 148 pacientes tratados mediante prostatectomia radical asistida por robot, junto con otros factores perioperatorios asociados a la continencia y descritos en la literatura. Valoramos la continencia mediante cuestionarios ICQ, perdidas urinarias contabilizadas con absorbentes y entrevista clinica en el primer, el tercer y el sexto mes, y al ano de la cirugia. Definimos continencia como el no uso de absorbente o uno como proteccion social o ICQ ≤ 7. Analizamos mediante regresion logistica binaria y lineal que relacion tienen las variables intraoperatorias y perioperatorias sobre la continencia urinaria medidas el primer, el tercer y el sexto mes, y al ano de la cirugia, y sobre la estabilidad de la continencia. Resultados En nuestro estudio el 72,9% de los pacientes conseguian estar continentes al ano de la cirugia, con un tiempo medio de estabilizacion de la misma a los 4,3 meses. En nuestro analisis de regresion logistica binaria de las variables intraoperatorias, no hemos encontrado una relacion significativa con la variable continencia, analizadas durante el primer ano. En el analisis de regresion logistica lineal hemos encontrado que las suturas libres de tension tienen un efecto directo positivo (p ≤ 0,05) sobre el tiempo de estabilidad de la continencia, al igual que las perdidas urinarias medidas en el primer mes de la cirugia. Conclusion En conclusion, en nuestro estudio encontramos que aquellas suturas libre de tension pueden ayudar a la estabilidad precoz de la continencia. No hemos encontrado otros predictores intraoperatorios que influyan en la continencia urinaria. Las perdidas urinarias medidas en el primer mes se relacionan con la recuperacion precoz de la continencia.

Background Obesity prevalence remains high among children of Pacific Islander (PI) origin, Filipino (FI), and American Indian/Alaska Native (AIAN) origins in the United States. While school nutrition policies may help prevent and reduce childhood obesity, their influences specifically among PI, FI, and AIAN children remain understudied. We evaluated the association of the California (CA) state school nutrition policies for competitive food and beverages and the federal policy for school meals (Healthy, Hunger-Free Kids Act of 2010 (HHFKA 2010)) with overweight/obesity among PI, FI, and AIAN students. Methods and findings We used an interrupted time series (ITS) design with FitnessGram data from 2002 to 2016 for PI (78,841), FI (328,667), AIAN (97,129), and White (3,309,982) students in fifth and seventh grades who attended CA public schools. Multilevel logistic regression models estimated the associations of the CA school nutrition policies (in effect beginning in academic year 2004 to 2005) and HHFKA 2010 (from academic year 2012 to 2013) with overweight/obesity prevalence (above the 85 percentile of the age- and sex-specific body mass index (BMI) distribution). The models were constructed separately for each grade and sex combination and adjusted for school district-, school-, and student-level characteristics such as percentage of students eligible for free and reduced price meals, neighborhood income and education levels, and age. Across the study period, the crude prevalence of overweight/obesity was higher among PI (39.5% to 52.5%), FI (32.9% to 36.7%), and AIAN (37.7% to 45.6%) children, compared to White (26.8% to 30.2%) students. The results generally showed favorable association of the CA nutrition policies with overweight/obesity prevalence trends, although the magnitudes of associations and strengths of evidence varied among racial/ethnic subgroups. Before the CA policies went into effect (2002 to 2004), overweight/obesity prevalence increased for White, PI, and AIAN students in both grades and sex groups as well as FI girls in seventh grade. After the CA policies took place (2005 to 2012), the overweight/obesity rates decreased for almost all subgroups who experienced increasing trends before the policies, with the largest decrease seen among PI girls in fifth grade (before: log odds ratio = 0.149 (95% CI 0.108 to 0.189; p < 0.001); after: 0.010 (−0.005 to 0.025; 0.178)). When both the CA nutrition policies and HHFKA 2010 were in effect (2013 to 2016), declines in the overweight/obesity prevalence were seen among White girls and FI boys in fifth grade. Despite the evidence of the favorable association of the school nutrition policies with overweight/obesity prevalence trends, disparities between PI and AIAN students and their White peers remained large after the policies took place. As these policies went into effect for all public schools in CA, without a clear comparison group, we cannot conclude that the changes in prevalence trends were solely attributable to these policies. Conclusions The current study found evidence of favorable associations of the state and federal school nutrition policies with overweight/obesity prevalence trends. However, the prevalence of overweight/obesity continued to be high among PI and AIAN students and FI boys. There remain wide racial/ethnic disparities between these racial/ethnic minority subgroups and their White peers. Additional strategies are needed to reduce childhood obesity and related disparities among these understudied racial/ethnic populations., Dr. Mika Matsuzaki and co-authors found evidence of favorable associations between state and federal school nutrition policies with overweight/obesity prevalence trends among children of Pacific Islander origin, Filipino, and American Indian/Alaska Native origins in the United States., Author summary Why was this study done? Governmental school nutrition policies can potentially have a wide-reaching impact on children’s dietary behaviors and health. It is currently unclear whether state and national school nutrition policies are equally effective among children of different racial/ethnic backgrounds. Children of Pacific Islander (PI), Filipino (FI), and American Indian/Alaska Native (AIAN) origins are some of the most understudied subgroups experiencing high prevalence of overweight/obesity. What did the researchers do and find? We used an interrupted time series (ITS) design to examine whether state and national school policies in the United States were associated with favorable changes in overweight/obesity prevalence among PI, FI, and AIAN children. During the baseline period without any policies, the overweight/obesity prevalence increased among nearly all subgroups, with steeper increases for PI and AIAN students. After the California (CA) competitive foods and beverages (CF&B) policy took place, the rates of change in overweight/obesity prevalence decreased for most subgroups. There was weaker evidence for favorable changes in overweight/obesity prevalence after the addition of the national policy. Decreasing trends in overweight/obesity prevalence following the school nutrition policies were seen for some of the White and FI students but not for PI or AIAN students. What do these findings mean? The study found some evidence of favorable changes in overweight/obesity prevalence following the state and national school nutrition policies. Regulation on CF&B may be an especially effective strategy to reduce overweight/obesity among schoolchildren. There remain large disparities between PI and AIAN children and FI boys and their White peers. There is a need to further strengthen policies to improve food environments for children from racial/ethnic minority populations with high obesity prevalence.

Vitiligo is a multifactorial disease characterized by the loss of skin pigment, which results in achromic macules and patches. There are currently several medical treatments available, which aim to arrest progression and induce skin repigmentation. These treatments alone or combined have exhibited varying degrees of pigmentation, and the majority are safe and effective. All therapies for vitiligo are limited, and no known treatment can consistently produce repigmentation in all patients. Individualized treatment is appropriate according to the location, clinical presentation and the presence of disease activity. The present review summarizes the medical treatments available for vitiligo: Systemic and topic pharmacological therapies, physical and depigmentation treatments. Several treatments are still underway and have not yet been approved. However, due to the promising preliminary results, these are also mentioned in the present review.

Preterm birth (PTB), defined as birth before 37 completed weeks of gestation, is a major cause of infant morbidity and mortality. Inflammation is an important component in the physiopathologic pathway leading to PTB but results from cross-sectional studies on associations between inflammation, as measured by cytokines, and PTB are inconsistent. Timing of cytokine measurement during pregnancy varies between studies and may contribute to inconsistent findings. We investigated the effects of timing on associations between 16 cervico-vaginal cytokines (Eotaxin, IL-10, IL-12p40, IL-17, IL-1RA, sIL-2rα, IL-1a, IL-1β, IL-2, IL-6, IP-10, MCP-1, MIP-1α, MIP-1β, TNFα, and VEGF) and PTB among 90 women throughout pregnancy. We used logistic regression to compare associations between concentrations of cervico-vaginal cytokines from periods in pregnancy and PTB. Trimester 1 cytokines had the strongest positive associations with PTB; for example, OR = 1.76 (95% confidence interval: 1.28, 2.42) for IL-6. Second and third trimester associations were weaker but largely positive. IL-1α was the only cytokine with a negative association (trimesters 2, 3 and overall pregnancy). Strong first trimester associations between cytokines and PTB suggest that measuring cytokines early in pregnancy may hold promise for early identification of PTB risk. Variations in cytokine measurement during pregnancy may contribute to inconsistencies among studies.

Background: Evidence suggests exposure to endocrine-disrupting chemicals (EDCs) can influence Metabolic Syndrome (MetS) risk in adults, but it is unclear if EDCs impact women during midlife. We examined if EDCs measured in adult women were predictive of MetS and its components 9 years later.Methods: We measured urinary phthalate metabolites, phenols, and parabens collected in 2008 among 73 females from the ELEMENT study. MetS and its components (Abdominal Obesity, Hypertriglyceridemia, Cholesterolemia, Hypertension, and Hyperglycemia) were assessed in 2017. We regressed log-transformed EDC concentrations on MetS and MetS components using logistic regression, adjusting for age and physical activity.Results: At follow-up, the mean (SD) age was 46.6 (6.3) years; the prevalence of MetS was 34.3%. Sum of dibutyl phthalate metabolites (ΣDBP), monobenzyl phthalate (MBzP), and monoethyl phthalate (MEP) were associated with an increased odds of hypertriglyceridemia. 2,5-dichlorophenol (2,5 DCP) and 2,4-dichlorophenol (2,4 DCP) were associated with increased odds of hypertriglyceridemia. The odds of hypertension were 4.18 (95% CI: 0.98, 17.7, p < 0.10) and 3.77 (95% CI: 0.76, 18.62, p < 0.10) times higher for every IQR increase in MCOP and propyl paraben, respectively. The odds of hyperglycemia were 0.46 (95% CI: 0.18, 1.17 p < 0.10) times lower for every IQR increase in the sum of di-2-ethylhexyl phthalate metabolites (ΣDEHP), and the odds of abdominal obesity were 0.70 (95% CI: 0.40, 1.21, p < 0.10) lower for every IQR increase in the concentration of triclosan.Conclusion: We found EDCs measured in 2008 were marginally predictive of hypertriglyceridemia and hypertension 9 years later. Results suggest that lower exposure to certain toxicants was related to lower markers of metabolic risk among midlife women.

Objective We aimed to evaluate the accuracy of sentinel lymph node (SLN) mapping with transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) to detect lymph node (LN) metastases, in patients with intermediate and high-risk endometrial cancer (EC), focusing on its performance to detect paraaortic involvement. Methods Prospective study including women with preoperative intermediate or high-risk EC, according to ESMO-ESGO-ESTRO consensus, who underwent SLN mapping using the TUMIR approach. SLNs were preoperatively localized by planar and single photon emission computed tomography/computed tomography images, and intraoperatively by gamma-probe. Immediately after SLN excision, all women underwent systematic pelvic and paraaortic lymphadenectomy by laparoscopy. Results The study included 102 patients. The intraoperative SLN detection rate was 79.4% (81/102). Pelvic and paraaortic drainage was observed in 92.6% (75/81) and 45.7% (37/81) women, respectively, being exclusively paraaortic in 7.4% (6/81). After systematic lymphadenectomy, LN metastases were identified in 19.6% (20/102) patients, with 45.0% (9/20) showing paraaortic involvement, which was exclusive in 15.0% (3/20). The overall sensitivity and negative predictive value (NPV) of SLNs by the TUMIR approach to detect lymphatic involvement were 87.5% and 97.0%, respectively; and 83.3% and 96.9%, for paraaortic metastases. After applying the MSKCC SLN mapping algorithm, the sensitivity and NPV were 93.8% and 98.5%, respectively. Conclusion The TUMIR method provides valuable information of endometrial drainage in patients at higher risk of paraaortic LN involvement. The TUMIR approach showed a detection rate of paraaortic SLNs greater than 45% and a high sensitivity and NPV for paraaortic metastases in women with intermediate and high-risk EC.

Background Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19. Methods This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments. Results One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant. Conclusions Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality. Sin financiación 1.553 JCR (2020) Q4, 125/136 Microbiology 0.430 SJR (2020) Q3, 1417/2447 Medicine (miscellaneous) No data IDR 2020 UEM

BackgroundEndocrine disrupting chemicals (EDCs) such as metals have been reported to alter circulating reproductive hormone concentrations and pubertal development in animals. However, the relationship has rarely been investigated among humans, with the exception of heavy metals, such as Pb and Cd. Our aim was to investigate measures of in utero and peripubertal metal exposure in relation to reproductive hormone concentrations and sexual maturation and progression among boys from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohorts.MethodsOur analysis included 118 pregnant women and their male children from the ELEMENT study. Essential and non-essential metals were measured in urine collected from the mothers during the third trimester of pregnancy and their male children at 8–14 years. Reproductive hormone concentrations [serum testosterone, estradiol, dehydroepiandrosterone sulfate (DHEA-S), inhibin B, and sex hormone-binding globulin (SHBG)] were measured in blood samples from the children at 8–14 years. We also assessed Tanner stages for sexual maturation (genital, pubic hair development, and testicular volume), at two time points (8–14, 10–18 years). We used linear regression to independently examine urinary metal concentrations in relation to each peripubertal reproductive hormones adjusting for child age and BMI. Generalized estimation equations (GEEs) were used to evaluate the association of in utero and peripubertal metal exposures with sexual maturation and progression during follow-up based on Tanner staging and testicular volume.ResultsIn utero and prepubertal concentrations of some urinary metals were associated with increased concentrations of peripubertal reproductive hormones, especially non-essential metal(loid)s As and Cd (in utero), and Ba (peripubertal) as well as essential metal Mo (in utero) in association with testosterone. More advanced pubic hair developmental stage and higher testicular volume at the early teen visit was observed for boys with higher non-essential metal concentrations, including in utero Al and peripubertal Ba, and essential metal Zn concentration (peripubertal). These metals were also associated with slower pubertal progression between the two visits.ConclusionThese findings suggest that male reproductive development may be associated with both essential and non-essential metal exposure during in utero and peripubertal windows.

Aim The aim of this study was to evaluate if integrating whole-body PET/CT with CT colonography (PET/CTC) improves the preoperative diagnosis of obstructive colorectal cancer (CRC). Methods We prospectively included 47 consecutive patients (18 women and 29 men; mean age, 71 ± 14 years) suspected of having CRC by optical colonoscopy, which was not completed due to obstructive masses. To perform PET/CTC, a small caliber Foley catheter was inserted to distend the colon with CO2 insufflations. Polyps measuring 10 mm or larger were considered as high risk of malignancy. All findings were histologically confirmed. Results Colorectal cancer was localized in the sigmoid (n = 21), rectum (n = 7), rectosigmoid junction (n = 5), ascending (n = 7), descending (n = 5), and transverse (n = 2) colon. All tumors showed FDG uptake (mean ± SD SUVmax, 20.02 ± 9.9) including one synchronic tumor (SUVmax, 10.46). Forty-seven polyps were histologically confirmed as smaller than 10 mm (n = 35) and 10 mm or larger (n = 12). All 12 polyps 10 mm or larger showed FDG uptake (SUVmax range, 3.08-19.5), but only one smaller than 10 mm could be identified by PET. Pathological lymph nodes were diagnosed in 17/47 cases after surgical removal with a sensitivity and specificity for CTC and PET/CTC of 71% and 97% and 59% and 100%, respectively. Liver metastases were confirmed in 9 patients and in 4/9 along with lung metastases (n = 2) or implants (n = 2), showing a sensitivity and specificity for CTC of 89% and 100% and both 100% for PET/CTC. Conclusions PET/CTC is a reliable technique for staging CRC and diagnosing synchronous tumors. In this series, PET/CTC was not able to identify small polyps but showed potential use for ruling out 10 mm or larger polyps at high risk of malignancy.

Global Navigation Satellite Systems (GNSS), such as the Global Position System (GPS), are currently used to replace the traditional pastoralism and to remotely control the movements and location of the herds. Besides, the use of this remote monitoring can benefit the understanding of grazing resource use and livestock management. In this work we investigated the herd behaviour in a Spanish organic farm of free pastoralist sheep with a joint use of different geodata sources. The area of study comprised approximately 900 hectares with a variety of land covers dedicated to pasture.A herd of 300 head was monitored during 2009 and 2010. GPS data were acquired every 5 minutes. In addition, a comprehensive map of land uses/land covers (LU/LC) was retrieved through a supervised classification of a mosaic of orthophotographs (visible and near infrared bands, VNIR). Then, the digital elevation model (DEM) and the digital surface model (DSM) were obtained from a 2010 LiDAR (light detection and ranging) campaign, which allowed the retrieval of terrain attributes and vegetation parameters. The positioning and behaviour of the GPS-tracked sheep were analysed in terms of the retrieved topographic characteristics and land uses. The study of the most influential variables indicated that the slope and aspect were the topographic attributes that most exerted impact on the grazing activity, being the north direction the most preferable, as well as a gentle slope. Regarding the LU/LC, grassland areas were selected by the sheep, specifically in areas of short vegetation (i.e., outside shrublands and trees beyond 0.5 m high).

[EN] The project "VerSus+ / Heritage for PEOPLE", founded by the European Commission as part of the Creative Europe Culture Programme (Ref. 607593-CREA-1-2019-1-ES-CULT-COOP1) during the period 2019-2023, focuses on the transmission of knowledge to all branches of society and the general public. Its aim is to raise awareness on what constitutes the basis for the conservation of the tangible and intangible heritage as well as for a more sustainable contemporary architecture. This in-depth transmission of the lessons from vernacular heritage to future society is to be carried out in specific defined contexts, such as islands and archipelagos (geographically limited territories that are accessible to collaborators and administrative, technical and social agents), where vernacular heritage is under pressure, subjected to the transformations of contemporary life, particularly mass tourism. These pilot experiences should serve as a real testing ground for the implementation of actions for social participation, dissemination, education, communication, and promotion in different contexts and through different media. This project aims to reach out to society in order to showcase the sustainable qualities of the examples identified, through the establishment of an operative approach that can be adjusted to different contexts. The experiences on each island are expected to have repercussions throughout the region and, in turn, throughout the country in question, improving the perspectives and opportunities starting from best practices, and promoting the development of local skills. In addition, promotion and support from partners and associate partners will allow these experiences to be applied in other similar European and international contexts., The "VerSus+ / Heritage for PEOPLE" project was co-funded by the European Commission as part of the Creative Europe Culture Programme (Ref. 607593-CREA-1-2019-1-ES-CULTCOOP1) for the period 2019-2023.

The chief resident plays a strategic role in terms of leadership and cohesion among residents.To characterize the activities developed by chief residents and identify their achievements and difficulties.A survey about demographic outcome measures, activities performed, most and least gratifying situations, and training needs was completed.In total, 88 % of chief residents completed the survey; 46 % were females. Activities were related to health care (26 %), academic management (25 %), teaching (24 %), administration (16 %), and research (10 %). The most gratifying situation was playing a teaching role, and the least gratifying one were difficulties in the management of interpersonal relations. A lack of training was recognized by 57 %, whereas 95 % would recommend becoming a chief resident.The most gratifying situation was playing a teaching role, and the least gratifying one were difficulties in the management of interpersonal relations.Introducción. El jefe de residentes es una figura estratégica en el liderazgo y cohesión entre los residentes. Objetivo. Caracterizar actividades desarrolladas por jefes de residentes e identificar logros y dificultades. Métodos. Se realizó una encuesta; sobre variables demográficas, actividades desarrolladas, situaciones más y menos gratificantes, necesidad de capacitación. Resultados. Contestaron el 88 % de los jefes de residentes; el 46 % fueron mujeres. Las actividades fueron asistenciales (el 26 %), gestión académica (el 25 %), docentes (el 24 %), administrativas (el 16 %) e investigación (el 10 %). La situación más gratificante fue el desarrollo del rol docente, y la menos gratificante, las dificultades en el manejo de relaciones interpersonales. El 57 % reconoció la falta de capacitación, y el 95 % recomendaría realizar la jefatura de residentes. Conclusión. La situación más gratificante fue el desarrollo del rol docente, y la menos gratificante, las dificultades en el manejo de relaciones interpersonales.

Background: Mexico is an upper-middle income country, as other developing regions, there is an accelerated aging of the population that will double the absolute number of new breast cancer (BC) cases by 2035. Unfortunately, the incidence of stage III and IV in women older than 65 years old represented 45% of new cases (higher than high-income regions); also, 21% had diabetes, 41.1% hypertension and 71% overweight/obese. These factors make our older adults patients with BC a high-risk population of recurrence and dead from disease. Objective: Describe the characteristics of older women with BC that received palliative care in a multidisciplinary setting. Patients and Methods:A cross-sectional, retrospective, descriptive of 178 patients with advanced breast cancer, older than 65 years from our data based, that were referred to palliative service during 2010-2016 at National Cancer Institute, Mexico. Statistical analysis was done with STATA V12.0. We described clinical, pathological and sociodemographic characteristics of this older women with advanced BC and analyzed the risk factors that influence dead. Approval from IRB was obtained. Results:The median age was 75 years old (range 69-82), 71(41%) was widows, 51(29%) had none education, 93(52%) had elementary school. Highlights that 93 (52%) of the patients evaluated had any income source. Diabetes was present in 43(24%), hypertension in 81 (46%) and cardiopathy in 17(10%) of cases. ECOG-2 were 58 (33%) patients, ECOG-3 was in 47 (26%)patients and ECOG-4 was reported in 19 (11%). None patient had geriatric assessment. Affected metastasis sites were bone 90 (51%), lung 66 (37%), central nervous system 31 (17%), liver 27 (15%). 69 (62%) patients had hormonal receptor positive, 17 (15%) triple negative, 12 (11%) HER2positive and 13(12%) of the cases were triple positive, 41 (74%) patients had Ki-67 higher than 50%. Polypharmacy was identified in 77 (43%) of the patients. The median survival after the admission in the palliative service was 2 months (IQR 0-10). After a logistic regression univariate Ki-67>20% (OR 10.25), triple negative (OR 1.5), HER2 positive (OR 2.3), influence negative survival. Conclusions: Management of BC in the elderly is complex. Our data show that we have highly vulnerable population. Additionally, we found an unfortunate late reference to palliative care services that limited the impact of the multidisciplinary approach. We need to identify the barriers that influence this delay. Health care provides have a challenge in early reference of older women with advanced breast cancer patients to the palliative care and need to think in integrate to the multidisciplinary team a geriatrician with oncology perspective. Citation Format: Cabrera-Galeana P, Sánchez N, Verastegui E, Rodriguez C, Bargallo E, Monreal E, Allende S. Palliative care and older women with advanced breast cancer in Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-11-04.

Dialysis patients are a risk group for SARS-CoV2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-Cov2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID19 (almost 1000 patients in 100,000 h). In the form of a diary, we present the actions undertaken, the incidence of COVID19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit.We started with 90 patients on HD: 37 (41.1%) had COVID19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4%

Resumen: Los pacientes en diálisis son un grupo de riesgo de sufrir la infección por el SARS-CoV-2 y posiblemente de tener más complicaciones, pero la información con la que contamos es escasa. El objetivo de este trabajo es describir la experiencia del primer mes de pandemia por SARS-CoV-2 en una unidad hospitalaria de hemodiálisis (HD) que atiende al 2.o distrito madrileño con más en incidencia de COVID-19 (casi 1.000 pacientes en 100.000 habitantes). Se presenta mediante un diario las acciones llevadas a cabo, la incidencia de COVID-19 en pacientes y en el personal sanitario, algunas características clínicas y el resultado de un cribado entre todos los pacientes de la unidad.Al inicio, teníamos 90 pacientes en HD: 37(41,1%) han tenido COVID-19, de los que 17 (45,9%) fueron diagnosticados por síntomas detectados en el triaje o durante la sesión y 15 (40,5%) en un cribado realizado a posteriori en los que no se había hecho test diagnóstico por PCR-SARS-CoV-2 hasta ese momento. El síntoma más frecuente fue la fiebre, el 50% presentó linfopenia y el 18,4% saturación de O2

This article analyses James Gray’s We Own the Night (2007) as a cinematic retelling of Shakespeare’s Henriad that presents Hal’s story not as the chivalric redemption of a national hero but as a tragic fall from happiness. Through close comparative reading of these texts, I explore how We Own the Night rewrites Hal’s story as a (post)modern tragedy which addresses the concerns of the so-called Generation X. Hal’s liminal position—caught between opposing social worlds of crime and law—presents the narrative’s major conflict, which itself echoes Jan Kott’s tragic vision of Shakespeare’s play.

In epidemiological studies, telomere shortening has been associated with age-related diseases and mortality. We assessed whether a genetic risk score (GRS) combining seven telomere length (TL)-associated genetic variants identified in a European-American genome-wide association study (GWAS) predicts TL and change in TL over 10 years in a multi-ethnic sample. Research Hypotheses: 1. In cross-sectional analysis, the GRS will be inversely associated with TL. 2. In longitudinal analysis, the GRS will be associated with change in TL over a 10-year period. Methods: TL was assessed on a sample of 1198 white, African-American and Hispanic participants, who attended both, MESA Exam 1 and 5, 10 years apart. Participants were 45-84 years at Exam 1. We used MESA measured or imputed genotype data to create the TL GRS and constructed the GRS using weighted estimates from the prior GWAS. Our main exposure was TL GRS. For hypothesis 1, we used linear mixed-effects model (LMEM) including all valid observations from both exams and adjusted for an exam indicator, age, sex and specific genetic principal components (PC). For hypothesis 2, we used LMEM with time-varying covariates and adjusted for follow-up time since Exam 1, age, sex and PC. We stratified our analysis by race/ethnic group and used the top three race/ethnic-specific genetic PC to account for population stratification. Results: In cross-sectional analysis, we observed a significant inverse association between GRS and TL (estimates= -0.18 (S.E.=0.08), P =0.02 for white; -0.18 (0.07), P P =0.01 for Hispanic) after full adjustment. In the longitudinal analysis, only among Hispanics, higher TL GRS predicted a reduction in TL over a 10-year period (-0.22 (0.06, P Conclusion: In the cross-sectional analysis, higher TL GRS was associated with shorter TL in the three race/ethnic groups studied. TL GRS did not predict telomere attrition in any of the race/ethnic groups.

Background and importance Medication overdose headache (MOH) is a secondary headache disorder occurring on 15 or more days per month developing as a consequence of regular overdose of headache medication for more than 3 months. The prevalence of MOH is approximately 1–2% and is higher in women than in men. Many medications used to treat headaches have the potential for causing MOH. Currently, MOH secondary to triptans is increasing and leads to MOH sooner than with other medications. Anxiety and depression may be risk factors for the evolution of migraine into MOH. Aim and objectives To determine the prevalence of patients treated with triptans at risk of MOH (regular intake for ≥10 days/month for >3 months) and the profile in our health area; to identify and communicate to the prescribers those patients with overuse of triptans; and to inform all clinicians about MOH: aetiology, clinical features, diagnosis and treatment. Material and methods We analysed the dispensation records of all patients treated with triptans over 3 months (June 2019–September 2019). Data collected were sex, age, monthly intake frequency and co-medication. We alerted prescribers by email, including management and de-prescription recommendations for MOH. We posted content about MOH in our blog. Results The prevalence of patients treated with triptans was 0.50%; 47 of 538 patients taking triptans (8.7%) were at risk of MOH. Their median age was 55 years and most were women (79%). Median monthly intake was 16 doses (10–48). Thirty patients (64%) had prescriptions for anxiety and/or depression and 13 patients (28%) had preventive therapy prescriptions for headache. Twenty-nine prescribers were notified by email. Dispensation record history, co-medication, MOH management guide and patient education leaflets were attached. Conclusion and relevance MOH is a common problem in clinical practice that needs to be properly managed to increase the likelihood of successful chronic daily headache treatment. The results obtained in our population were similar to published studies, both in prevalence and in patient profile. However, the MOH rate was still lacking as it needs a clinician diagnosis. In 6 months we will collect information about the evolution of these patients, and we expect that our intervention will lead to treatment optimisation, better use of triptans and headache relief. References and/or acknowledgements No conflict of interest.

Background: General Health Perception and Quality of Life of Puerto Ricans with Cardiovascular Diseases Cardiovascular diseases (CD) are among the leading causes of mortality in Puerto Rico. In the United States, Latinos report a higher prevalence of risk factors related to CD. Objective: to evaluate the relationship between the general health perception (GHP) and health related quality of life (HRQoL) in Puerto Ricans who suffer from CD. Method: We used the "Puerto Rico Behavioral Risk Factor Surveillance System" survey (2015) to compute the relationship between GHP and HRQoL in people who reported suffering from CD (n = 588). Results: The bivariate analysis show an association between HRQoL (mental and physical), GHP and CD. CD-adjusted models show a greater probability of adults reporting a poor HRQoL. The findings indicate a higher probability that adults with coronary heart disease report having poor mental (OR=2.36; p

Background: Epidemiologic and animal-based studies have raised concern over the potential impact of fluoride exposure on neurobehavioral development as manifested by lower IQ and deficits in attention. To date, no prospective epidemiologic studies have examined the effects of prenatal fluoride exposure on behavioral outcomes using fluoride biomarkers and sensitive measures of attention. Objective: We aimed to examine the association between prenatal fluoride exposure and symptoms associated with attention-deficit/hyperactivity disorder (ADHD). Method: 213 Mexican mother-children pairs of the Early Life Exposures to Environmental Toxicants (ELEMENT) birth cohort study had available maternal urinary samples during pregnancy and child assessments of ADHD-like behaviors at age 6–12. We measured urinary fluoride levels adjusted for creatinine (MUFcr) in spot urine samples collected during pregnancy. The Conners' Rating Scales-Revised (CRS-R) was completed by mothers, and the Conners' Continuous Performance Test (CPT-II) was administered to the children. Results: Mean MUFcr was 0.85 mg/L (SD = 0.33) and the Interquartile Range (IQR) was 0.46 mg/L. In multivariable adjusted models using gamma regression, a 0.5 mg/L higher MUFcr (approximately one IQR higher) corresponded with significantly higher scores on the CRS-R for DSM-IV Inattention (2.84 points, 95% CI: 0.84, 4.84) and DSM-IV ADHD Total Index (2.38 points, 95% CI: 0.42, 4.34), as well as the following symptom scales: Cognitive Problems and Inattention (2.54 points, 95% CI: 0.44, 4.63) and ADHD Index (2.47 points; 95% CI: 0.43, 4.50). The shape of the associations suggested a possible celling effect of the exposure. No significant associations were found with outcomes on the CPT-II or on symptom scales assessing hyperactivity. Conclusion: Higher levels of fluoride exposure during pregnancy were associated with global measures of ADHD and more symptoms of inattention as measured by the CRS-R in the offspring. Keywords: Fluoride, Pregnancy, Neurobehavioral, ADHD

PurposeWe present a modified version of the SISCOM procedure that uses interictal PET instead of interictal SPECT for seizure onset zone localization. We called this new nuclear imaging processing technique PISCOM (PET interictal subtracted ictal SPECT coregistered with MRI).MethodsWe retrospectively studied 23 patients (age range 4-61years) with medically refractory epilepsy who had undergone MRI, ictal SPECT, interictal SPECT and interictal FDG PET and who had been seizure-free for at least 2years after surgical treatment. FDG PET images were reprocessed (rFDG PET) to assimilate SPECT features for image subtraction. Interictal SPECT and rFDG PET were compared using statistical parametric mapping (SPM). PISCOM and SISCOM images were evaluated visually and using an automated volume of interest-based analysis. The results of the two studies were compared with each other and with the known surgical resection site.ResultsSPM showed no significant differences in cortical activity between SPECT and rFDG PET images. PISCOM and SISCOM showed equivalent results in 17 of 23 patients (74%). The seizure onset zone was successfully identified in 19 patients (83%) by PISCOM and in 17 (74%) by SISCOM: in 15 patients (65%) the two techniques showed concordant successful results. The volume of interest-based analysis showed no significant differences between PISCOM and SISCOM in identifying the extension of the seizure onset zone. However, PISCOM showed a lower amount of indeterminate activity due to propagation, background or artefacts.ConclusionPreliminary findings of this initial proof-of-concept study suggest that perfusion and glucose metabolism in the cerebral cortex can be correlated and that PISCOM may be a valid technique for identification of the seizure onset zone. However, further studies are needed to validate these results., This work was supported by AGAUR (Agencia de Gestio d'Ajuts Universitaris I de Recerca) 2014 SGR 279 grants.

BACKGROUND Bisphenol A (BPA) and phthalates metabolites are linked to a variety of adverse health consequences but studies have not explored their association with growth trajectories. OBJECTIVE Explore body mass index (BMI) trajectories for tertile exposures to BPA and phthalates metabolites in the third trimester of pregnancy. METHODS We constructed BMI (kg/m2 ) trajectories from birth to 14 years in a birth cohort of 249 children from Mexico City using tertiles of third trimester maternal urinary concentrations of BPA and phthalates metabolites. Fractional age polynomials and mixed effects models were fit separately by sex. Predicted models were plotted for each metabolite tertile with the covariates mother's education and BMI centered at average values. RESULTS Highest predicted BMI trajectories for female children were observed for third tertile exposure to the phthalate metabolite mono(2-ethyl-5-carboxypentyl) phthalate. In male children, first tertile exposure to mono-isobutyl phthalate and monobenzyl phthalate and second tertile exposure to mono(2-ethylhexyl) phthalate and mono(2-ethyl-5-hydroxyhexyl) phthalate predicted the highest BMI trajectory by adolescence. There was no relationshsip between BPA and child growth trajectory. CONCLUSIONS These results suggest sex-specific differences in BMI trajectories by levels of metabolite exposure. Additional studies are needed to consider growth through adolescence in assessing the association of pregnancy exposures on child's BMI.

Obesity is a complex, chronic, and multifactorial disease that has become a major, and worldwide, public health problem contributing to an increased number of pathologies, including type 2 diabetes, cardiovascular disease, hyperlipidemia, and metabolic syndrome, thus suggesting a commolon origin. A diet high in sugar and fats coupled with a sedentary lifestyle has a major role in the development of obesity. However, the genetic background has also been associated with body fat accumulation. The aim of this study was to assess the effect ofACE-rs4646994, APOA5-rs662799, and MTP-rs1800591 gene polymorphisms on clinical and biochemical parameters and to evaluate the association with body phenotypes in children and adolescent population of Saltillo, Coahuila, Mexico.Anthropometric, clinical, biochemical parameters and BMI were obtained from 405 children and adolescents. The BMI was used to determine the body phenotype. The rs4646994 gene polymorphism was determined by PCR, whereas rs662799 and rs1800591 were determined by PCR-RFLP. The obtained results were analyzed to determine their association of these single nucleotide polymorphisms with body phenotype and biochemical parameters.TT genotype for APOA5-rs662799 was associated with increased levels of HDL-C in the analyzed population (p0.05). The ACErs4646994gene polymorphism is associated with high Insulin levels, HOMAIR index, and triglyceride levels, mainly when presenting a I/I genotype (p0.05).The polymorphic allele of the ACE gene is capable of modulating triglyceride levels, insulin levels and HOMA-IR index in the evaluated population; it must be highlighted that this has not been reported in other studied populations elsewhere.

Pancreatic cancer is the most common lethal tumor in America. This lethality is related to limited treatment options. Conventional treatments involve the non-specific use of chemotherapeutical agents such as 5-FU, capecitabine, gemcitabine, paclitaxel, cisplatin, oxaliplatin, or irinotecan, which produce several side effects. This review focuses on the use of targeted nanoparticles, such as metallic nanoparticles, polymeric nanoparticles, liposomes, micelles, and carbon nanotubes as an alternative to standard treatment for pancreatic cancer. The principal objective of nanoparticles is reduction of the side effects that conventional treatments produce, mostly because of their non-specificity. Several molecular markers of pancreatic cancer cells have been studied to target nanoparticles and improve current treatment. Therefore, properly functionalized nanoparticles with specific aptamers or antibodies can be used to recognize pancreatic cancer cells. Once cancer is recognized, these nanoparticles can attack the tumor by drug delivery, gene therapy, or hyperthermia.

Objectives: This study aims to describe salivary beta-2 microglobulin (sB2M) levels in our setting and to assess the performance of sB2M for the diagnosis of Sjogren's syndrome (SS). Patients and methods: This cross-sectional, comparative study included 192 SS patients (2 males, 190 females; mean age 53.1 years; range 23 to 84 years) and 64 healthy controls (1 male, 63 females; mean age 46.9 years; range 21 to 82 years). Patients were divided into three groups as those with primary SS, secondary SS, and sicca non-Sjogren's syndrome (snSS). sB2M was measured by enzyme-linked immunosorbent assay in whole unstimulated saliva (ng/mL). Differences in sB2M were evaluated using the Kruskal-Wallis test. Receiver operating curves were generated to determine the performance of sB2M for distinguishing between SS and non-autoimmune snSS groups, and between SS group and healthy controls. Results: The primary SS and secondary SS groups had a significantly higher concentration of sB2M than the other two groups. There was no significant difference in the concentration of sB2M between primary SS and secondary SS groups, and neither between snSS group and healthy controls. The receiver operating curve analysis for distinguishing SS and snSS showed an area under the curve of 0.661 (95% confidence interval 0.590-0.728, p=0.0001) with an optimal cutoff value of 0.582 ng/mL. Sensitivity, specificity, positive predictive value, and negative predictive value were 68.7%, 59.3%, 20.2%, and 92.7%, respectively. The reported prevalence of SS in Mexico was considered when calculating the last two values. Conclusion: In our setting, sB2M effectively distinguished between SS patients and non-autoimmune sicca symptoms. Including sB2M in our conventional diagnostic arsenal may assist in the evaluation of patients in whom SS is suspected; however, further studies are needed to clarify this hypothesis. Keywords: Beta-2 microglobulin; diagnosis; saliva; Sjogren’s syndrome.