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Statement of problem The light source stability of digital cameras and smartphones is important in shade matching in restorative and prosthetic dentistry to communicate objectively with the dental laboratory. Techniques that standardize the light source of such devices are lacking, and this limitation can lead to color mismatches, difficulties in color communication, and treatment documentation. Purpose The purpose of this clinical study was to compare the magnitude of color difference (ΔE) among 3 shade selection methods during the fabrication of ceramic crowns: visual shade selection with a shade guide, digital shade selection with a digital camera and cross-polarizing filter, and digital shade selection with a smartphone and a light-correcting device. Material and methods Forty-five patients in need of ceramic crowns were enrolled, and shade selection was evaluated according to different protocols: visual shade selection (A-D shade guide and IPS Natural Die Material Shade Guide, sent to the dental laboratory technician via a laboratory prescription); digital shade selection with a digital camera (D7000; Nikon Corp) with an 85-mm lens and wireless close-up flash, with and without a cross-polarizing filter (Polar eyes); and digital shade selection with a smartphone and a light-correcting device (iPhone XS attached to Smile Lite MDP, with and without its cross-polarizing filter accessory). Information from the smartphone was imported to an app (IPS e.max Shade Navigation App; Ivoclar Vivadent AG) that converted the reading to a shade and level of translucency for the ceramic restoration. For all photographs, a gray reference card with known color values was positioned by the mandibular teeth and was used for white balancing of the digital photographs with a software program. All photographs were edited and sent to the dental laboratory: white-balanced with the shade guide; white-balanced with the substrate shade guide; black and white; saturated; and cross-polarized. Ceramic crowns were made with the same lithium disilicate material (IPS e.max CAD; Ivoclar Vivadent AG) and cemented with the same resin cement (RelyX Ultimate Clicker, A3 shade; 3M). The ΔE values between the crown and the adjacent tooth were determined. The data were analyzed by using a 1-way analysis of variance (ANOVA) and Tukey posthoc tests (α=.05). Results The mean ΔE between a cemented ceramic crown and the adjacent tooth in the visual shade selection group was 5.32, significantly different than both digital camera (ΔE=2.75; P=.002) and smartphone (ΔE=2.34; P=.001), which were not different from each other (P=.857). Conclusions The digital shade selection with photographs acquired with both a digital camera and a smartphone with a light-correcting device showed a threshold within the acceptable values (ΔE 3.7). The use of a gray reference card helped standardize the white balance from the digital images.

The development and subsequent adaptation of mass cytometry for the histological analysis of tissue sections has allowed the simultaneous spatial characterization of multiple components. This is useful to find the correlation between the genotypic and phenotypic profile of tumor cells and their environment in clinical-translational studies. In this revision, we provide an overview of the most relevant hallmarks in the development, implementation and application of multiplexed imaging in the study of cancer and other conditions. A special focus is placed on studies based on imaging mass cytometry (IMC) and multiplexed ion beam imaging (MIBI). The purpose of this review is to help our readers become familiar with the verification techniques employed on this tool and outline the multiple applications reported in the literature. This review will also provide guidance on the use of IMC or MIBI in any field of biomedical research.

In the last years, the number of connections in mobile telecommunication networks has increased rampantly, and in consequence, the number and type of relationships among entities. Should such interactions are to be profitable, entities will need to rely on each other. Hence, mobile telecommunication networks demand trust and reputation models that allow developing feasible communications in 5G and beyond networks, through which a group of entities can establish chains of services between cross-operators/domains, with security and trustworthiness. One of the key obstacles to achieving generalized connectivity beyond 5G networks is the lack of automatized, efficient, and scalable models for establishing security and trust. In this vein, this article proposes a pre-standardization approach for reputation-based trust models beyond 5G. To this end, we have realized a thorough review of the literature to match trust standardization approaches. An abstract set of requirements and key performance indicators has been extracted, and some pre-standardization recommendations proposed to fulfill essential conditions of future networks and to cover the lack of common trust and reputation models beyond 5G.

Background: The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear.Objective: This study aimed to determine the effectiveness of MT for functional outcomes in patients with thumb carpometacarpal OA. Design: Systematic review and meta-analysis of randomized clinical trials. Methods: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared MT versus other interventions in functional outcomes, such as thumb and/or hand function questionnaires, pinch and/or grip strength, thumb and/or hand range of motion, and pain intensity or pressure pain threshold in patients with thumb carpometacarpal OA. Results: Five clinical trials met the eligibility criteria; for the quantitative synthesis, four studies were included. The mean difference (MD) for grip strength was 0.87kg (95% CI = 0.29-1.44, p = .003), for pinch strength was 0.10kg (95% CI = -0.01-0.20, p = .06), and for the pressure pain threshold was 0.64kg/cm2 (95% CI = 0.07-1.20, p = .03). All differences were in favor of the MT group. Conclusions: In the short-term, there was moderate to high evidence, with statistically significant differences in the functional outcomes, in favor of MT versus sham interventions in patients with thumb carpometacarpal OA. However, these differences are not clinically important.

Supplemental Digital Content is available in the text., Background and Purpose: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. Methods: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis. Results: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55–1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61–1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19–1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20–1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53–1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82–1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89–1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30–0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49–1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71–0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (

We report a 51-year-old asymptomatic male, with type II diabetes, referred to our outpatient clinic due to ST and T alterations on the precordial leads on the electrocardiogram. The echocardiogram showed apical akinesia and left ventricular hypertrophy. There were no angiographic lesions in the coronary angiography. In the left ventriculography, a hyperdynamic left ventricle with suspected left ventricular hypertrophy and an apical aneurysm were found. The cardiac magnetic resonance confirmed those findings, without late gadolinium enhancement. According to the European Cardiology Society Risk Score, the patient had a low sudden death risk. However, this score does not consider the presence of an aneurysm as risk factor for sudden death, but it is considered in the 2017 ACC/AHA Heart Rhythm Society Guidelines, as a major risk factor. Therefore a defibrillator was implanted, and he was discharged on permanent oral anticoagulation.

Statement of problem During the selection of tooth color, subjective communication with the laboratory and an incorrect color registration technique can lead to a poor color match of a restoration to adjacent teeth and oral structures. Purpose The purpose of this cross-sectional study was to compare color registration and color matching in a young Chilean population with 3 different methods: visual with a shade guide, digital visual with a cross-polarized filter, and instrumental with a spectrophotometer. Material and methods A total of 60 young volunteers were selected for tooth color registration of the maxillary right central incisor by using 3 different methods. Tooth color registration was performed using the CIELab and ΔE coordinate system. Results Significant differences were detected between the coordinates recorded by the visual analog method in comparison with the other 2 methods. In contrast, no significant differences were found between the L∗ and b∗ coordinates of the spectrophotometer and the digital visual method with use of a cross-polarization filter. The ΔE obtained between the visual shade and spectrophotometer was 7.35, and the ΔE between the digital visual method with the use of a cross-polarization filter and the spectrophotometer was 6.12. Conclusions No statistically significant differences were observed in the digital image with the cross-polarization filter and the spectrophotometer in the L∗ and b∗ coordinate of the CIELab system. In contrast, the visual analog method led to large differences with the other methods under study. The ΔE of the digital visual method with the use of cross-polarization filters and the spectrophotometer was 6.2, considered as an acceptable color mismatch (

The Pierre Robin sequence (PRS) is characterized by the triad of micrognathia, glossoptosis, and airway obstruction. Conservative management in Pierre Robin sequence consists of nasogastric tube feeding and positioning of the neonate (prone or lateral position) that facilitates the anterior position of the tongue or the application of continuous positive nasal pressure. In case of failure of this treatment, emergency tracheostomy and/or mandibular distraction must be performed.Mandibular distraction is a standard technique used by craniofacial surgeons to achieve an anteroposterior horizontal lengthening of the mandibular body, correcting the posterior position of the base of the tongue and thus retropharyngeal enlargement of the airway.The authors present 2 clinical cases of hypertrophy of the sublingual salivary glands with the use of mandibular distractors in SPR patients with severe airway obstruction.

INTRODUCTION Digital workflow is currently available for different fields of dentistry. Additionally, to clinical use, digital technology is focused on the education and training of students. The objective of this study was to show the potential benefit of the use of digital CAD / CAM technology and assisted training software in the evaluation and improvement of student skills in preclinical and clinical environments. MATERIALS AND METHODS 30 models of dental preparations were digitalised and analysed by PrepCheck software, after that was used the PrepCheck Report tool, gathering the results of the analysis in an automatically created report and containing the following parameters: analysis of the conicity, distance between a preparation and the opposing jaw, analysis of the type of preparation, quality of the margin and total occlusal convergence. RESULTS The use of the PrepCheck Pro 2.1 software makes evident the errors made by the students during the biomechanical preparation, since they generally change the inclination, in order to have less difficulties to comply with the parameters established in the preparations. Regarding the evaluated parameters for anterior and posterior fixed prosthesis) such as: 'Conicity', 'Type of preparation' and 'Distance to the antagonist', the preparations, in their majority, were classified within the tolerance range with of 50-60%, 80-93% and 53-67%, respectively. CONCLUSION This pilot study demonstrated the benefits of using software and CAD/CAM technology in both preclinical and clinical environments for teaching and learning. Its use on preclinical environments allows the student observe qualitatively and quantitatively a preparation flaws when compared to a master's preparation. Lastly, the ease of visualising errors associated with magnification would allow students to improve their skills.

The aim of this study was to determine the effectiveness of early versus delayed motion on the functional outcomes in patients with distal radius fracture (DRF) treated with a volar locking plate. A systematic review and meta-analysis of randomized clinical trials was performed. An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria included randomized clinical trials that compared the effect of early versus delayed motion on wrist and/or upper limb function, pain, grip strength, and wrist range of motion in subjects older than 18 years with DRF treated with a volar locking plate. Five clinical trials were included that met the eligibility criteria for the quantitative synthesis. At 6 weeks, the PRWE questionnaire showed a mean difference (MD) of -10.6 points (p 0.001), the MD was -11.1 points for the DASH questionnaire (p 0.001), -0.56 cm for pain on VAS (p = 0.01), 5.0 kg for grip strength (p = 0.01), 12.5 degrees for wrist flexion (p = 0.07), and 12.8 degrees for wrist extension (p = 0.05). All differences favored the early motion treatment. At 3 months of follow-up, only the DASH, pain on VAS, and grip strength showed significant differences in favor of early motion. At 1 year of follow-up, none of the variables studied were different between groups. In the short term, there was moderate to high evidence of clinically and statistically significant differences in the functional outcomes in favor of early versus delayed motion in patients with DRF treated with a volar locking plate. But these differences were not observed at 1 year of follow-up. PROSPERO registration no.: CRD42020158706.

Extrapulmonary tuberculosis (TB) contributes to 15% of total cases, representing a great diagnostic and therapeutic challenge. Pericardial involvement is present in 1 to 2% of TB patients and is considered an unusual presentation form of TB. We report a 67-year-old male presenting with fever and progressive dyspnea. A chest CAT scan showed a bilateral pleural effusion and an extensive pericardial effusion. An echocardiogram showed signs of tamponade. Therefore, an emergency pericardiectomy was performed. The pathological report of pericardial tissue showed caseating necrosis and its Koch culture was positive. The patient was treated with anti-tuberculous drugs with a favorable evolution.

Adapting to new climate conditions will require an intricate mix of knowledge, planning, coordination, and foresight. There is increasing sectoral evidence on the implementation of successful adaptation actions. However, the success of these actions when we consider the interdependencies among sectors remains debatable. This paper aims to assess who benefits from implementing adaptation options in a multiuser river basin to both climate-induced and demographic stress on water use. Our analysis relies on a hydro-economic model that considers two sets of water users: agriculture and urban households. We innovate in our modelling approach by analyzing and explicitly integrating the household-level economic behavior through its water demand. We assess the cross-user consequences of autonomous and planned adaptation actions. We provide insights into the different trade-offs at the basin level, demonstrating the compatibilities and divergences between agriculture and household-level water demand. We found different consequences of implementing either autonomous or planned adaptation measures. For instance, a decentralized scheme would drive negative implications for the entire basin, although the less water-intensive sector will be better off. On the other hand, different policy interventions would drive positive consequences for the entire basin, with the most water-intensive sector benefiting the most. These results highlight the distributional consequences across users of different adaptation measures.

Patients with obstructive sleep apnea (OSA) and comorbid diabetes mellitus (DM) are reported to have an increased risk of cardiovascular (CV) outcomes; however, data on CV mortality are scant. This study aimed to evaluate if patients with comorbid OSA and DM have an increased risk of CV mortality that is higher than the two diseases in isolation. In this prospective cohort study, we included patients referred for a sleep study with and without DM at baseline. We developed four study groups as follows: group 1 (reference group), OSA (−) DM (−); group 2, OSA (−) DM (+); group 3, OSA (+) DM (−); group 4, OSA (+) DM (+). Intergroup differences were evaluated using the t test and χ2 test, and multivariate analysis was performed using logistic regression. The incidence rates of CV mortality were calculated using the Kaplan–Meier (log-rank) model, and adjusted HRs were calculated using the Cox regression model. A total of 1447 patients were included in the analysis—group 1: 441 participants; group 2: 141 participants; group 3: 736 participants; group 4: 151 participants. The mean follow-up was 5 years. The association between OSA + DM showed an independent risk of incident CV mortality (HR 2.37, CI 1.16–4.82, p = 0.02) and an increased prevalence of coronary heart disease (OR 3.44, CI 1.73–5.59, p < 0.01). In addition, T90% was also associated with CV mortality. The coexistence of OSA + DM was associated with an independent risk of CV mortality. In addition, T90% was also associated with CV mortality.

Background Vibrio species display variable and plastic fitness strategies to survive and interact with multiple hosts, including marine aquaculture species that are severely affected by pathogenic Vibrios. The culturable Vibrio sp. strain ArtGut-C1, the focus of this study, provides new evidence of such phenotypic plasticity as it accumulates polyhydroxybutyrate (PHB), a biodegradable polymer with anti-pathogen activity, particularly in the marine larviculture phase. The strain was isolated from the gut of laboratory-reared Artemia individuals, the live diet and PHB carrier used in larviculture. Its main phenotypic properties, taxonomic status and genomic properties are reported based on the whole-genome sequencing. Results Vibrio sp. ArtGut-C1 yielded 72.6% PHB of cells’ dry weight at 25°C. The genomic average nucleotide identity (ANI) shows it is closely related to V. diabolicus (ANI: 88.6%). Its genome contains 5,236,997-bp with 44.8% GC content, 3,710 protein-coding sequences, 96 RNA, 9 PHB genes functionally related to PHB metabolic pathways, and several genes linked to competing and colonizing abilities. Conclusions This culturable PHB-accumulating Vibrio strain shows high genomic and phenotypic variability. It may be used as a natural pathogen biocontrol in the marine hatchery and as a potential cell factory for PHB production. How to cite: Yevenes M, Quiroz M, Maruyama F, et al. Vibrio sp. ArtGut-C1, a polyhydroxybutyrate producer isolated from the gut of the aquaculture live diet Artemia (Crustacea). Electron J Biotechnol 2021;49. https://doi.org/10.1016/j.ejbt.2020.10.003

In the current network-based computing world, where the number of interconnected devices grows exponentially, their diversity, malfunctions, and cybersecurity threats are increasing at the same rate. To guarantee the correct functioning and performance of novel environments such as Smart Cities, Industry 4.0, or crowdsensing, it is crucial to identify the capabilities of their devices (e.g., sensors, actuators) and detect potential misbehavior that may arise due to cyberattacks, system faults, or misconfigurations. With this goal in mind, a promising research field emerged focusing on creating and managing fingerprints that model the behavior of both the device actions and its components. The article at hand studies the recent growth of the device behavior fingerprinting field in terms of application scenarios, behavioral sources, and processing and evaluation techniques. First, it performs a comprehensive review of the device types, behavioral data, and processing and evaluation techniques used by the most recent and representative research works dealing with two major scenarios: device identification and device misbehavior detection. After that, each work is deeply analyzed and compared, emphasizing its characteristics, advantages, and limitations. This article also provides researchers with a review of the most relevant characteristics of existing datasets as most of the novel processing techniques are based on machine learning and deep learning. Finally, it studies the evolution of these two scenarios in recent years, providing lessons learned, current trends, and future research challenges to guide new solutions in the area.

La Fibrosis Quística (FQ) es la enfermedad hereditaria de pronóstico reservado más frecuente en raza blanca. Desde el año 2003, Chile inicia un Programa Nacional de Fibrosis Quística, de carácter integral, dirigido por la Unidad de Salud Respiratoria del Ministerio de Salud. Hasta la fecha, los principales resultados del Programa registran una significativa mayor sobrevida (promedio 27 años) y una significativa reducción en la edad de diagnóstico de los pacientes ingresados desde 2006 en adelante. El acceso a la canasta GES (Garantías Explícitas en Salud), la implementación del tamizaje neonatal en algunas regiones del país, la organización y la constitución de equipos entrenados en FQ de diversas especialidades, ha contribuido a mejorar los resultados. Si bien las principales manifestaciones son del aparato respiratorio y digestivo, el carácter multisistémico de la FQ obliga a conocer los distintos aspectos involucrados en su manejo, a fin de optimizar los resultados del tratamiento y los recursos invertidos, tanto en el sector público como privado. Este documento es una revisión y actualización sobre los principales aspectos del diagnóstico, seguimiento y tratamiento de las manifestaciones respiratorias y no respiratorias de la FQ.

Significant human and material resources have been diverted to coronavirus disease 2019 (COVID-19). Healthcare workers are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We assess the impact of the COVID-19 pandemic on gastroenterology and hepatology departments and specialists in Spain.This study involves a nationwide survey addressing the impact of COVID-19 on resources, procedures, and physicians of gastroenterology and hepatology departments in 81 hospitals representative of the Spanish National Health Service.Overall, 41.8% of hospital beds and 40.7% of gastroenterology and hepatology beds were allocated to COVID-19 patient care, as well as 24.8% of gastroenterologists and 58.3% of residents. Outpatient visits, abdominal ultrasounds, and endoscopies were reduced by 81.8-91.9%. Nine large university hospitals had 75% and 89% reductions in therapeutic endoscopies and hepatocellular carcinoma surgery, respectively, with cancelation of elective liver transplant and transjugular intrahepatic portosystemic shunt. Prevalence of infected physicians was 10.6% and was dependent on regional population incidence (r = 0.74, P = 0.001), with 11% hospitalized and one physician dying. Up to 63.4% of physicians may have been infected before or shortly after Spain entered lockdown, 57% of them having recently performed endoscopies. Adequate protection was acknowledged in 80% hospitals, but only 2.9% performed regular SARS-CoV-2 testing.The impact of the COVID-19 pandemic on healthcare delivery has been massive. A wave of gastroenterology-related complications is expected because of resource diversion. Gastroenterologists have a high prevalence of infection, although they may have been infected during a first phase of lower awareness and protection. Regular SARS-CoV-2 screening, adequate protection, and quick reorganization of healthcare resources are still needed.

Old patients with hepatotoxicity have been scarcely studied in idiosyncratic drug-induced liver injury (DILI) cohorts. We sought for the distinctive characteristics of DILI in older patients across age groups. A total of 882 DILI patients included in the Spanish DILI Registry (33% ≥65 years) were categorized according to age: “young” (

We report the case of an older infant with no prior morbidity that approximately 3 weeks after receiving MMR vaccination (measles, mumps, rubella) was hospitalized for feverish symptoms, increased parotid volume and compromised consciousness. Aseptic meningitis was diagnosed, detecting pleocytosis in the CSF, predominantly mononuclear, and confirming by molecular biology, presence of parotid virus in CSF. A study was carried out by the Institute of Public Health of Chile, where serology (IgM and IgG) was positive. Saliva sample confirmed the etiology of parotid virus with genotype N. The evolution was favorable and at 6-month follow-up, there were no sequelae. Given this clinical situation, information regarding the association and causality of this clinical entity and the MMR vaccine, focused on different strains of the mumps virus, was reviewed.

Background: Upper limb (UL) function is compromised in university students due to prolonged academic activities and excessive use of electronic devices. However, it is unknown whether this relationship was affected by the COVID-19 pandemic situation. Aim: To determine the risk factors associated with reduced UL functionality in university students in a pandemic situation due to COVID-19. Material and Methods: Cross-sectional study that included 621 university students from the northern, central and southern areas of Chile. Physical variables, musculoskeletal, anthropometric and sociodemographic history were evaluated through self-reported questionnaires. Results: The factors with the higher association with a lower UL functionality were pain (Odds ratio (OR) = 17.6; 95% confidence intervals (CI) = 5.2-60; p < 0.01) and injury (OR = 10.4; 95% CI = 3.9-28.3; p < .001). Also, a low weight (OR = 10.5; 95% CI = 2.2-49.6; p < 0.01) and a quarantine lasting for five or more weeks (OR = 9.1; 95% CI = 1,1-77.2; p = 0.043) were considered risk factors. The lower probability was observed in male participants (OR = 0.2; 95% CI = 0.1-0.51; p < 0.01) and in those with a moderate/high muscular condition (OR = 0.3; 95% CI = 0.1-0.9; p = 0.031. Conclusions: The identification of these modifiable risk factors can help to implement preventive or rehabilitative actions at home or universities.

Kienböck's disease is a clinical-radiological condition that can permanently affect wrist functionality and the patient's quality of life. Proper, pertinent diagnosis and treatment are required to avoid salvage procedures. Arthroscopic techniques have emerged as an important tool for the treatment of certain stages of the disease.We present a review of the literature and propose a treatment algorithm according to the stage of the disease, including arthroscopic techniques. We detail the surgical technique of arthroscopic scaphocapitate arthrodesis, and the functional outcomes obtained by our group.

Background Dental bleaching in traditional concentrations generates greater sensitivity. In this respect, new systems of lower concentration of hydrogen peroxide for tooth bleaching appeared, with color stability unknown over time. The aim of this study was to compare the change and stability of color with low-concentration (6%) hydrogen peroxide gel in an in-office bleaching setting relative to conventional 37.5% gel, including their effects on psychosocial and esthetic self-perception, after 1 year. Methods Patients (n = 25) were assessed at 12 months post bleaching treatment (whitening with 6% chemo-activated alkaline formula gel versus 37.5% traditional concentration gel). Color changes were measured objectively using total variation in color (ΔE), and subjectively using Vita Classical and Vita Bleached scale (ΔSGU) by calibrated evaluators (Kappa = 0.85). The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and Oral Health Impact Profile (OHIP-14) aesthetic questionnaires were used to measure the self-perception and the psychosocial impact of the bleaching protocols. Results The effect (ΔE) of 37.5% HP (8.37 ± 2.73) was significantly better than that of 6% HP (5.27 ± 2.53) in terms of color rebound after 1 year of follow-up. There were significant differences in psychosocial impact and esthetic self-perception measurements prior to bleaching versus one-year post-whitening time points; positive effects were maintained. Conclusions Low concentration (6%) achieved effective bleaching with good stability after 1 year, accompanied by a positive psychosocial impact and enhanced self-perception at follow-up. Trial registration NCT03217994 (before enrollment of the first participant). Data register: July 14, 2017.

Background OSA is found commonly in the elderly population (≥65 years old), and CPAP improves sleepiness and health-related quality of life (HRQoL) in the middle-aged population; however, data about its efficacy in elderly patients are unclear. The purpose of this study was to evaluate the efficacy of CPAP for sleepiness, HRQoL, mood, and cognition in elderly patients with OSA. Research Question In elderly patients (≥65 years old) with OSA, is CPAP, compared with usual care or sham CPAP, effective at improving sleepiness, HRQoL, mood, and neurocognitive function? Study Design and Methods We conducted a systematic review and meta-analysis of randomized controlled trials that included trials performed in elderly patients with OSA. As an intervention, we compared CPAP vs a control group. Two independent reviewers explored several databases; risk of bias (RoB) was evaluated with the Cochrane tool. Changes in sleepiness (Epworth Sleepiness Scale), HRQoL (Quebec Sleep Questionnaire), mood (Hospital Anxiety-Depression Scale), and neurocognitive tests after treatment were the outcomes. The meta-analysis was conducted according to the DerSimonian-Laird method, and the quality of evidence was rated according to the GRADE guidelines. Results A total of 4 randomized controlled trials (680 participants) were included. RoB was high for performance and detection bias. CPAP was associated with a 2.62-point improvement in the Epworth Sleepiness Scale (1.93 to 3.30; I2 = 52%). All domains of the Quebec Sleep Questionnaire were improved: hypersomnolence, 0.67 points (0.31 to 1.03; I2 = 75%); diurnal symptoms, −0.71 points (−0.98 to −0.44; I2 = 58%); nocturnal symptoms, 1.09 points (0.9 to 1.27; I2 = 9%); emotions, 0.45 points (0.30 to 0.61; I2 = 11%); and social interaction, 0.55 points (0.1 to 0.99; I2 = 82%). CPAP also improved the Hospital Anxiety-Depression Scale depression domain, and there were reports of a slight improvement in neurocognitive tests. The quality of evidence was low and very low for all outcomes. Interpretation Although CPAP therapy reportedly results in important clinical differences in sleepiness, HRQoL, and mood and a slight improvement in neurocognitive tests, concerns regarding the RoB and quality of the evidence do not support the benefit in all patients. Trial Register PROSPERO ID CRD42019146947

Background The use of kinetic impact projectiles (KIPs) for crowd-control has increased worldwide. Despite having been created as non-lethal weapons, significant damage to several organs, including the eye, has been reported. In this study, we investigated cases of ocular trauma from KIPs during the civil unrest in Chile. To our knowledge, this is the largest case series recorded in international literature. Methods We included all patients who sought care or were referred to the Eye Trauma Unit, a national referral centre in Santiago, Chile, during the civil unrest from October 18 to November 30, 2019. We reviewed paper medical records and extracted data on suspected cause of trauma, type of trauma, visual acuity and sociodemographic data. Results We included 259 patients, out of which in 182 cases (70.5%) KIPs were the suspected cause. Cases by KIPs were predominantly male (86.6%), young (median age 26.3, interquartile range 22.0–31.4) and living in the Metropolitan Region. Eighty-nine patients (48.9%) had severe visual impairment or were blind at the first examination. The trauma was an open-globe injury in 20.3% of cases and 13 cases required evisceration of the ocular content. Compared to other causes of ocular trauma, KIPs were related to a more severe loss of visual acuity and a higher frequency of open-globe injuries. Conclusions The use of KIPs during a period of civil unrest in Chile resulted in severe ocular trauma, visual impairment and permanent disability. KIPs should be avoided as a method of crowd-control.

El articulo recoge el conjunto de medidas propuestas por la SEPD, la AEEH, GETECCU y la AEG que pretenden servir de ayuda a los servicios en su reincorporacion a la actividad habitual. Hemos confeccionado una serie de recomendaciones practicas respecto al manejo y a la reintroduccion progresiva de la actividad asistencial. Estas recomendaciones estan guiadas por la escasa y cambiante evidencia disponible y seran objeto de futuras actualizaciones, en base a las necesidades diarias y la disponibilidad del material fungible para adecuarse a las mismas; y se podran implementar en cada servicio en funcion de la incidencia acumulada de SARS-CoV-2 en cada region y de la carga que la epidemia ha ocasionado en cada uno de los hospitales. Los objetivos generales de estas recomendaciones son: • Proteger a nuestros pacientes de los riesgos de la infeccion por SARS-CoV-2 y prestarles una atencion de calidad. • Proteger a todos los profesionales sanitarios de los riesgos de la infeccion por SARS-CoV-2. • Recuperar el normal funcionamiento de nuestros servicios en un entorno de riesgo continuado de infeccion por SARS-CoV-2.

Study Design:Multicenter, prospective, randomized, and double-blinded study.Objectives:To compare tubular and endoscopic interlaminar approach.Methods:Patients with lumbar spinal stenosis and neurogenic claudication of were randomized to tubular or endoscopic technique. Enrollment period was 12 months. Clinical follow up at 1, 3, 6 months after surgery with visual analogue scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score. Radiologic evaluation with magnetic resonance pre- and postsurgery.Results:Twenty patients were enrolled: 10 in tubular approach (12 levels) and 10 in endoscopic approach (11 levels). The percentage of enlargement of the spinal canal was higher in endoscopic approach (202%) compared with tubular approach (189%) but was not statistically significant ( P = .777). The enlargement of the dural sac was higher in endoscopic group (209%) compared with tubular group (203%) but no difference was found between the 2 groups ( P = .628). A modest significant correlation was found between the percentage of spinal canal decompression and enlargement of the dural sac ( r = 0.5, P = .023). Both groups reported a significant clinical improvement postsurgery. However, no significant association was found between the percentage of enlargement of the spinal canal or the dural sac and clinical improvement as determined by scales scores. Endoscopic group had lower intrasurgical bleeding ( P < .001) and lower disability at 6 months of follow-up than tubular group (p=0.037).Conclusions:In the treatment of lumbar spinal stenosis, endoscopic technique allows similar decompression of the spinal canal and the dural sac, lower intrasurgical bleeding, similar symptoms improvement, and lower disability at 6 months of follow-up, as compared with the tubular technique.

Patients with moderate to severe obstructive sleep apnea (OSA) have an increased risk of cardiovascular comorbidities and mortality. Although different subtypes of OSA have been described, data about oximetric parameters and their suitability to identify a different phenotype are scant. In this study, we evaluate the association between moderate to severe OSA and oximetric parameters included in the home sleep apnea test (HSAT) and the risks of all-cause mortality, cardiovascular mortality, and cancer mortality. Adult patients with moderate to severe OSA from a clinical cohort in Chile were included (SantOSA study). We developed a latent class analysis (LCA) incorporating oximetric measures commonly reported on HSAT. Differences between the groups were evaluated using ANOVA and the chi-squared test. Survival curves were constructed using a Kaplan-Meier (log-rank) model, and adjusted hazard ratios of mortality were calculated using a Cox regression model following a confounder analysis of cardiovascular comorbidities. A total of 889 patients were included in the analysis. LCA identified three different clusters: Cluster 1, “nonhypoxemic” (n = 591); cluster 2, “moderately hypoxemic” (n = 297); and cluster 3, “severely hypoxemic” (n = 115). The mean follow-up was 4.7 years. The hypoxemic groups showed an increased risk of cardiometabolic comorbidities and an independent risk of all-cause mortality (adjusted HR 1.67 (CI 1.0–2.64) p value = 0.027). The moderately hypoxemic group had an adjusted HR of 2.92 (CI 1.00–8.58), p value = 0.05, while the severely hypoxemic group had an adjusted HR of 2.55 (CI 1.08–6.02), p value = 0.031. For cardiovascular mortality, we found an HR of 2.03 (CI 0.50–8.136), p value = 0.31, and for cancer mortality, we found an HR of 5.75 (CI 1.03–32.17), p value = 0.042. Oximetric parameters are useful for describing a different phenotype with a high risk of mortality among patients with moderate to severe OSA, beyond the apnea–hypopnea index.

The use of peripheral nerve blockade for hip surgeries has proved to be beneficial. The PEricapsular Nerve Group block is a new technique described for hip fracture and hip arthroplasty that has shown to provide better analgesia compared to other peripheral blocks commonly performed for this type of surgery. This technique blocks the obturator nerve and the articular branches of the femoral nerve and the accessory obturator nerve. There are few reports describing continuous analgesia using catheters inserted in the pericapsular nerve group area. We describe a case of continuous nerve block for preoperative analgesia that lasted up to 120hours in an adult patient with a fracture of the posterior column and wall of the acetabulum. We found that by increasing the infusion rate, analgesia reached the distal femoral area. Unlike the original technique, a high-frequency linear probe was used in this case.

Nowadays, digital culture affects all levels of society. However, differences exist between individuals, commonly named as the “digital divide,” which impedes the equal access to the benefits of new technologies. The Usability and Accessibility (UA) module is a core, first-semester module during the first year of the Multimedia Engineering degree at the University of Alicante. The UA module’s main objective is to provide students with the necessary concepts and tools to design and develop products with usability and accessibility features, thus achieving end products that are more usable and accessible, regardless of the end users’ status, ability or situation. This paper presents a new learning methodology aimed at making students become everyday users of their own digital products. Daily use of these products improves the UA learning process, since students can appreciate their accessibility and usability in everyday life conditions for a better understanding of how their own design decisions affect potential users. A non-equivalent control group design with pre- and post-test control groups was used to test the research hypothesis. The results of this study showed a significant improvement in their academic performance compared to the control group. This work was supported in part by the I3CE Network Program of research in university teaching at the Institute of Educational Sciences of the University of Alicante (ICE call 2018-19)., Ref. 4331.

Field-effect transistor (FET) sensors are attractive potentiometric (bio)chemical measurement devices because of their fast response, low output impedance, and potential for miniaturization in standard integrated circuit manufacturing technologies. Yet the wide adoption of these sensors for real-world applications is still limited, mainly due to temporal drift and cross-sensitivities that introduce considerable error in the measurements. In this paper, we demonstrate that such non-idealities can be corrected by joint use of an array of FET sensors – selective to target and major interfering ions – with machine learning (ML) methods in order to accurately predict ion concentrations continuously and in the field. We studied the predictive performance of linear regression (LR), support vector regression (SVR), and state-of-art deep neural networks (DNNs) when monitoring pH from combinatorial H+, Na+, and K+ion-sensitive FET (ISFET) sequences of readings collected over a period of 90 consecutive days in real water quality assessment conditions. The proposed ML algorithms were trained against reference online measurements obtained from a commercial pH sensor. Results show a greater capability of DNNs to provide precise pH monitoring for longer than a week, achieving a relative root-mean-square error reduction of 73% over standard two-point sensor calibration methods., The authors acknowledge funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 747848 and the SNSF-Sinergia WeCare project (No.CRSII5_177255).

Alcohol-related liver disease (ARLD) is the most prevalent cause of advanced liver disease and liver cirrhosis in Europe, including Spain. According to the World Health Organization the fraction of liver cirrhosis attributable to alcohol use in Spain is 73.8% among men and 56.3% among women. ARLD includes various stages such as steatohepatitis, cirrhosis and hepatocellular cancer. In addition, patients with underlying ARLD and heavy alcohol intake may develop alcoholic hepatitis, which is associated with high mortality. To date, the only effective treatment to treat ARLD is prolonged withdrawal. There are no specific treatments, and the only treatment that increases life expectancy in alcoholic hepatitis is prednisolone. For patients with alcoholic hepatitis who do not respond to treatment, some centres offer the possibility of an early transplant. These clinical practice guidelines aim to propose recommendations on ARLD taking into account their relevance as a cause of advanced chronic liver disease and liver cirrhosis in our setting. This paper aims to answer the key questions for the clinical practice of Gastroenterology, Hepatology, as well as Internal Medicine and Primary Health Centres, making the most up-to-date information regarding the management and treatment of ARLD available to health professionals. These guidelines provide evidence-based recommendations for the clinical management of this disease.

Helicobacter pylori (H. pylori) eradication using standard triple therapy (STT) with proton pump inhibitors (PPI), amoxicillin and clarithromycin (CLA) has been the standard in Latin America. However, CLA resistance is a rising problem affecting eradication rates. Genetic polymorphisms of CYP2C19, a PPI metabolizer may also affect eradication. The primary aims of this study were to evaluate the effect of clarithromycin resistance on H. pylori eradication in a population from Santiago, and to establish the pooled clarithromycin resistance in Santiago, Chile. Symptomatic adult patients attending a tertiary hospital in Santiago were recruited for this study. CLA resistance and the polymorphisms of CYP2C19 were determined on DNA extracted from gastric biopsies, using PCR. The STT was indicated for 14 days and eradication was determined by a urea breath test 4–6 weeks after therapy. A meta-analysis of CLA resistance studies among adult residents in Santiago was performed. Seventy-three out of 121 consecutive patients had positive rapid urease test (RUT) and received STT. Sixty-nine patients (95%) completed the study. The H. pylori eradication rate was 63% and the prevalence of CLA resistance was 26%. According to the CYP2C19 polymorphisms, 79.5% of the RUT-positive patients were extensive metabolizers. Multivariable analyses showed that only CLA resistance was significantly and inversely associated with failure of eradication (OR: 0.13; 95% confidence interval [95% CI], 0.04–0.49). A meta-analysis of two previous studies and our sample set (combined n = 194) yielded to a pooled prevalence of CLA resistance of 31.3% (95% CI 23.9–38.7). Our study shows that CLA resistance is associated with failure of H. pylori eradication. Given the high pooled prevalence of CLA resistance, consideration of CLA free therapies in Santiago is warranted. We could recommend bismuth quadruple therapy or high-dose dual therapy, according to bismuth availability. Further studies need to evaluate the best therapy.

Resumen Introducción. Trypanosoma cruzi se transmite principalmente por vía vectorial, sin embargo, las rutas oral y congénita han tomado relevancia. Objetivo. Evaluar la infección por T. cruzi en mujeres puérperas y sus neonatos en el Hospital Universitario Dr. Luis Razetti de Barcelona, estado Anzoátegui, Venezuela. Materiales y métodos. Se hizo un estudio prospectivo de corte transversal, de mayo de 2015 a agosto de 2016, en el que se evaluaron 1.200 mujeres para determinar la infección mediante las pruebas ELISA, MABA e IFI. Los neonatos de las madres seropositivas se evaluaron con la prueba de PCR y por serología a los nueve meses de edad. Se estimó la prevalencia de la infección por T. cruzi en mujeres puérperas y sus neonatos. Para establecer los factores de riesgo asociados a la infección, se usó la prueba de ji al cuadrado (c2) y la razón de probabilidad (OR). Resultados. En total, 78 (6,50 %) mujeres resultaron positivas (IC95% 5,10-7,89 %). En seis (9,09 %) recién nacidos de madres seropositivas, se detectó ADN parasitario. Tras nueve meses de nacidos, once lactantes evaluados resultaron serológicamente negativos. La infección estuvo asociada con la duración del embarazo (OR=0,36; IC95% 0,15-0,84), origen del domicilio actual (OR=0,34; IC95% 0,24-0,62) o previo (OR=2,50; IC95% 1,38-4,52) y el tener familiares con la enfermedad de Chagas (OR=1,75; IC95% 1,02-3,01). Conclusiones. La seroprevalencia para la infección por T. cruzi en mujeres puérperas del medio rural, fue elevada. La detección de ADN parasitario al momento del nacimiento no es indicativa de enfermedad de Chagas congénita. Abstract Introduction. Trypanosoma cruzi is mainly transmitted by vectors. Other pathways such as oral and congenital transmission have become increasingly relevant. Objective. To evaluate T. cruzi infections in post-partum women and their newborns who attended the Hospital Universitario Dr. Luis Razetti (Barcelona, Anzoátegui state, Venezuela). Materials and methods. A prospective cross-sectional study was undertaken from May, 2015, to August, 2016. ELISA, MABA and IFI assays were used to determine the infection in 1,200 post-partum women. The newborns of seropositive women were then examined for T. cruzi by PCR amplification and serological tests at nine months old. The prevalence of the parasitic infection in post-partum women and their newborns was then estimated. To establish the relationship between risk factors and infection, the chi-square test (c2) and the probability ratio (OR) was applied. Results. A total of 78 women were identified as seropositive (6.50 %) (CI 95%: 5.10-7.89%), and parasitic DNA was detected in six of their newborns (9.09%). Nine months after birth eleven infants were examined, and all were found to be serologically negative. Risk factors detected were pregnancy duration (OR: 0,36; CI95%: 0,15-0,84), where the patients lived at present (OR: 0,34; CI95%: 0,24-0,62) or previously (OR: 2,50; CI95%: 1,38-4,52) and having relatives with Chagas disease (OR: 1,75; CI95%: 1,02-3,01). Conclusions. Seroprevalence for T. cruzi infection in young post-partum women in rural areas was high. The detection of parasite DNA at birth was not indicative of congenital Chagas disease.

Neurological manifestations associated with SARS-CoV-2 infection as well as its pathogenesis are insufficiently explained. We present two cases of severe COVID-19 who required hospitalisation in the intensive care unit with persistently depressed mental status and severe leukoencephalopathy. We discuss the clinical and radiological findings and also propose the possible pathogenesis involved.

Introduction Between the indications for endomyocardial biopsy (EMB) is the study of patients with heart failure associated with restrictive or infiltrative cardiomyopathy, such as cardiac amyloidosis if another workup is inconclusive. Although a risk-procedure, EMB is recommended in clinical scenarios in which the unique prognostic and diagnostic value of the information gained is felt to outweigh the procedural risks. Purpose We want to know the diagnostic value of EMB in the scenario of suspected cardiac amyloidosis and the role of the place of EMB for diagnosis. Methods We prospectively collected patients from our center with infiltrative cardiomyopathy and suspected cardiac amyloidosis who were referred to perform EMB. We gathered data on diagnostic profitability considering two different groups: those with samples from the right ventricle (group 1) and those with samples from the left ventricle (group 2; 90.8% with transradial approach). We consider major complications myocardial perforation, pericardial tamponade, arrhythmias, or bleeding with hemodynamic instability and death. Results We collected data from 111 patients referred for EMB for infiltrative cardiomyopathy suspicion. We present the results in table 1. The most common diagnosis was cardiac amyloidosis for wild-type transthyretin (43.48% in group 1 and 58.46% in group 2). There were no complications in the patients with confirmed cardiac amyloidosis in group 2. Conclusions In our EMBs for infiltrative cardiomyopathy suspicion we found that patients undergoing left-sided EMB had a shorter time of X-ray exposure and less time of admission without any other risk associated. So, we conclude that EMBs performed in the left heart are secure and comfortable for patients and physicians. Funding Acknowledgement Type of funding sources: None.

We report the case of a newborn girl with jaundice due to increased indirect bilirubin with a positive direct antiglobulin test (DAT) and compensated hemolysis. The result of the newborn's DAT was discrepant with the negative result of the mother's indirect antiglobulin test. The multiparous mother had a previous history of fetal hydrops miscarriage, with no known cause, and no record of the cause was found at the hospital where she was treated. After referring samples from the mother and newborn to a reference laboratory, the rare alloanti-Sc2 was identified in the mother's plasma and in the newborn's eluate. HEA BeadChip genotyping of the newborn's DNA sample predicted the SC:1,2 phenotype.We report the case of a newborn girl with jaundice due to increased indirect bilirubin with a positive direct antiglobulin test (DAT) and compensated hemolysis. The result of the newborn’s DAT was discrepant with the negative result of the mother’s indirect antiglobulin test. The multiparous mother had a previous history of fetal hydrops miscarriage, with no known cause, and no record of the cause was found at the hospital where she was treated. After referring samples from the mother and newborn to a reference laboratory, the rare alloanti-Sc2 was identified in the mother’s plasma and in the newborn’s eluate. HEA BeadChip genotyping of the newborn’s DNA sample predicted the SC:1,2 phenotype.

OBJETIVO: Evaluar el resultado del cribado de hepatitis B y C en pacientes ingresados con COVID-19. PACIENTES Y MÉTODOS: Estudio transversal, prospectivo, realizado en dos hospitales españoles de tercer nivel. Se estudiaron marcadores de hepatitis B (HBsAg, anti-HBc) y C (anti-VHC, ARN VHC) a todos los pacientes hospitalizados con COVID-19 del 1 de marzo al 31 de diciembre de 2020. RESULTADOS: En este periodo ingresaron 4662 pacientes con COVID-19: 56,3% fueron varones, la edad mediana fue 76 (0-104) años. Se realizó serología de hepatitis B a 2915 (62,5%) pacientes; 253 (8,75%) presentaban anti-HBc+ y 11 (0,38%) HBsAg+. De los 11 pacientes, 4 desconocían el diagnóstico, 7 recibieron esteroides y uno recibió profilaxis. Hubo un caso de reactivación del VHB. Se determinaron anticuerpos anti-VHC a 2895 (62%) pacientes; 24 (0,83%) fueron positivos. De ellos, 13 pacientes estaban diagnosticados: 10 habían recibido tratamiento, uno se había curado espontáneamente y dos no habían sido tratados. De los 11 restantes, 10 tenían ARN VHC indetectable. En total, sólo 3 (0,10%) pacientes tenían carga viral detectable. Sin embargo, ninguno recibió tratamiento (2 > 90 años con comorbilidades, 1 falleció por COVID-19). CONCLUSIONES: El cribado de hepatitis C en pacientes ingresados por COVID-19 en nuestro medio ha mostrado menor utilidad de la esperada. La baja prevalencia de infección activa tras los tratamientos antivirales y la alta edad mediana de nuestra población limitan la detección de potenciales candidatos a tratamiento. El cribado de hepatitis B debería dirigirse a prevenir la reactivación en pacientes que precisen tratamientos inmunosupresores.

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© 2019 Elsevier Ltd. All rights reserved., Background: Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods: In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH, non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2-F3, or F1 with at least one accompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpoints for the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2-F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings: Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1-F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2-F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1-F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation: Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes.

Harmful algae blooms (HABs) monitoring has been implemented worldwide, and Chile, a country famous for its fisheries and aquaculture, has intensively used microscopic and toxin analyses for decades for this purpose. Molecular biological methods, such as high-throughput DNA sequencing and bacterial assemblage-based approaches, are just beginning to be introduced in Chilean HAB monitoring, and the procedures have not yet been standardized. Here, 16S rRNA and 18S rRNA metabarcoding analyses for monitoring Chilean HABs are introduced stepwise. According to a recent hypothesis, algal-bacterial mutualistic association plays a critical synergetic or antagonistic relationship accounting for bloom initiation, maintenance, and regression. Thus, monitoring HAB from algal-bacterial perspectives may provide a broader understanding of HAB mechanisms and the basis for early warning. Metabarcoding analysis is one of the best suited molecular-based tools for this purpose because it can detect massive algal-bacterial taxonomic information in a sample. The visual procedures of sampling to metabarcoding analysis herein provide specific instructions, aiming to reduce errors and collection of reliable data.

The development of diagnostic tools for measuring a wide spectrum of target analytes, from biomarkers to other biochemical parameters in biological fluids, has experienced a significant growth in the last decades, with a good number of such tools entering the market. Recently, a clear focus has been put on miniaturized wearable devices, which offer powerful capabilities for real-time and continuous analysis of biofluids, mainly sweat, and can be used in athletics, consumer wellness, military, and healthcare applications. Sweat is an attractive biofluid in which different biomarkers could be noninvasively measured to provide rapid information about the physical state of an individual. Wearable devices reported so far often provide discrete (single) measurements of the target analytes, most of them in the form of a yes/no qualitative response. However, quantitative biomarker analysis over certain periods of time is highly demanded for many applications such as the practice of sports or the precise control of the patient status in hospital settings. For this, a feasible combination of fluidic elements and sensor architectures has been sought. In this regard, this paper shows a concise overview of analytical tools based on the use of capillary-driven fluidics taking place on paper or fabric devices integrated with solid-state sensors fabricated by thick film technologies. The main advantages and limitations of the current technologies are pointed out together with the progress towards the development of functional devices. Those approaches reported in the last decade are examined in detail.

Obesity is one of the main worldwide public health concerns whose clinical management demands new therapeutic approaches. Bariatric surgery is the most efficient treatment when other therapies have previously failed. Due to the role of gut microbiota in obesity development, the knowledge of the link between bariatric surgery and gut microbiota could elucidate new mechanistic approaches. This study aims to evaluate the long-term effects of bariatric surgery in the faecal metagenome and metabolome of patients with severe obesity. Faecal and blood samples were collected before and four years after the intervention from patients with severe obesity. Biochemical, metagenomic and metabolomic analyses were performed and faecal short-chain fatty acids were measured. Bariatric surgery improved the obesity-related status of patients and significantly reshaped gut microbiota composition. Moreover, this procedure was associated with a specific metabolome profile characterized by a reduction in energetic and amino acid metabolism. Acetate, butyrate and propionate showed a significant reduction with bariatric surgery. Finally, correlation analysis suggested the existence of a long-term compositional and functional gut microbiota profile associated with the intervention. In conclusion, bariatric surgery triggered long-lasting effects on gut microbiota composition and faecal metabolome that could be associated with the remission of obesity.

Background: Timely eye fundus examinations are essential to prevent the consequences of retinopathy among patients with type 2 diabetes mellitus. Aim: To assess the coverage rate (CR) of eye fundus examination in the Chilean diabetic population, between 2011 and 2019. Material and Methods: Analysis of monthly statistical summaries of the Cardiovascular Health Program published online by the Chilean Ministry of Health. The number of patients aged 15 years or more with a diagnosis of Type 2 diabetes mellitus and the number of those who had an eye fundus examination within the same year, were obtained. Data was analyzed at a national and regional level. Results: The national eye fundus examination CR was 19.1% in 2011. In 2016, the figures became significantly higher, reaching 32.5%. In 2019, the highest value of 36.5% was recoded although not significantly different from 2016. The highest average annual CR was observed in Ñuble Health Service (49.5%), and the lowest in Central Metropolitan Service (15%). The highest CR positive absolute and relative variation between 2011 and 2019 was observed in Viña del Mar Quillota Health Service (38.9 and 489% respectively), and the lowest negative variation was observed in Araucania Norte Health Service (-8.42 and -24.21% respectively). Conclusions: There is a low eye fundus examination CR in Chile, with important differences between regional health services.

In tied-arch bridges, the way the arch and the deck are connected may become crucial. The deck is usually suspended from hangers made out of steel pinned cables capable of resisting axial forces only. However, a proper structural response, (both in-plane and out-of-plane) may be ensured by fixing and stiffening the hangers in order to resist, additionally, shear forces and bending moments. This paper studies the effect of different pinned and stiffened hanger arrangements on the structural behavior of the tied-arch footbridges, with the intention of providing designers with useful tools at the early steps of design. As a major conclusion, regarding the in-plane behavior, hangers composed of cables (either with vertical, Nielsen-Löhse or network arrangements) are recommended due to its low cost and ease of erection. Alternatively, longitudinally stiffened hangers, fixed at both ends, can be used. Regarding the out-of-plane behavior, and in addition to three-dimensional arrangements of cables, of limited effectiveness, transversally stiffened hangers fixed at both ends are the most efficient arrangement. A configuration almost as efficient can be achieved by locating a hinge at the end corresponding to the most flexible structural element (normally the arch). Its efficiency is further improved if the cross-section tapers from the fixed end to the pinned end.

To fully cope with the requirements of innovative 5G use cases, evolving business models and flexible networking scenarios spanning multiple administrative domains are envisioned. In this context, transparent and trusted frameworks that enable network service providers and infrastructure providers to advertise, negotiate and acquire, in real time, 5G resources and services, distributed over various geographical areas, are extremely valuable. To address this goal, emerging Distributed Ledger Technologies (DLTs) arise as well-suited solutions to ensure distributed security and trust, as well as effective and agile transaction management across the various parties involved in the 5G service chain implementation. Following this vision, this paper presents the design of a DLT-enabled Marketplace aimed to foster the secure trading of heterogeneous resources in dynamic 5G ecosystems. The performance of an initial implementation as proof-of-concept is also analyzed. The results of this proof-of-concept validate the feasibility of a decentralized marketplace implementation in the context of 5G resource trading.

Current trends in science education recommend the complementary use of virtual and hands-on methods of teaching. In neurobiology, for instance, there is a plethora of virtual laboratories and simulators that can be readily combined with traditional physical labs. Unfortunately, physical laboratories are almost unaffordable for many institutions due to the high cost of equipment. In this paper, we present a simple and low-cost in vivo method for demonstrating some of the basic biophysical properties of neural action potentials. The method involves the following steps: a) dissection of the ventral nerve cord of earthworm; b) electrical stimulation; c) amplification and visualization of the medial and lateral giant fibers’ action potentials; and d) recording. The system showed stability, expected amplification, high signal-to-noise ratio, and an estimated total cost of US$ 5.662. We provide guidelines for assembling the system and discus its utility as a teaching alternative for low budget institutions.

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a very common, yet undiagnosed, breathing disorder that has many more implications besides disrupted sleep. Its role as an independent risk factor for metabolic abnormalities such as insulin resistance (IR) and impaired glucose tolerance is becoming increasingly recognized. The main treatment for OSAHS is continuous positive airway pressure (CPAP), however the impact of CPAP on IR and glucose metabolism is still debated.Compile all available evidence regarding the effect of CPAP on IR in non-diabetic OSA patients.A literature search in Medline, Epistemonikos and the Cochrane Controlled Trial Register were searched through March 2018. We included Randomized Controlled Trials (RCTs) comparing CPAP treatment with sham CPAP, placebo or no treatment in non-diabetic adults with OSAHS. Risk of Bias was evaluated using Cochrane tool and a meta-analysis evaluating the efficacy of CPAP in both HOMA index and fasting glucose was done. Certain of evidence was rated using GRADE approach.Nine studies consisting of 443 participants were included. CPAP treatment significantly improved HOMA index (Mean difference = -0.39 Ui (CI, -0.69 to -0.08), p 0.05. I2 = 57% (GRADE = LOW). However, CPAP showed no significant changes in fasting glucose (GRADE = LOW).This systematic review and meta-analysis shows evidence that metabolic disturbances could be halted and regressed with CPAP treatment in patients with insulin resistance and OSAHS. In conclusion, treatment with CPAP could improve HOMA IR index.