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Background: Cannabis plants and their seed have been used in many cultures as a source of medicine and feeding during history. Today, there is an increasing demand for cannabis seeds for medical use. Moreover, a seed sales market with no legal regulations has also grown. This may pose some issues if a quality control is not set in place. Identification of cannabis strains is important for quality control purposes in a nonregulated growing market and in cases of illegal traffic and medical use. Owing to the high price as a pharmacological drug, commercial products of cannabis plants and seeds for medical users are often subjected to adulterations, either when packing or distributing certified seeds in the market. Materials and Methods: Cannabis commercial seeds and cannabis seeds for medical use were analyzed with high-resolution melting (HRM) analysis using barcoding markers. Humulus lupulus L. plants from a local market were used as outgroup control. DNA barcoding uses specific regions of the genome to identify differences in the genetic sequence of conserved regions such as internal transcribed spacer (ITS) and rbcL. DNA barcoding data can be generated with real-time polymerase chain reaction combined with HRM analysis to distinguish specific conserved DNA regions of closely related species. HRM analysis is the method of choice for rapid analysis of sequence variation. Results: The melting temperature (Tm) of homogeneous packages was consistent with single genotypes. However, packages containing contaminating seeds showed Tm differences of 0.2°C on average. Conclusions: An effective, rapid, and low-cost method based on ITS nuclear DNA and on chloroplast rbcL regions for screening and detection of contamination in commercial cannabis seeds was developed and applied for the analysis of different samples. This approach can be used as a quality control tool for cannabis seeds or other plant material.

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

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

Resumen Introduccion y objetivos El lactato y su evolucion se asocian con el pronostico de los pacientes en shock, si bien es escasa la evidencia en aquellos asistidos con oxigenador extracorporeo de membrana venoarterial (ECMO-VA). Nuestro objetivo es evaluar su valor pronostico en shock cardiogenico asistido con ECMO-VA. Metodos Estudio de pacientes tratados con ECMO-VA por shock cardiogenico de indicacion medica entre julio de 2013 y abril de 2021. Se calculo el aclaramiento de lactato: (lactato inicial − lactato 6 h) / lactato inicial × tiempo exacto entre ambas determinaciones. Resultados De 121 pacientes, 44 (36,4%) tenian infarto agudo de miocardio; 42 (34,7%), implante intraparada; 14 (11,6%), tromboembolia pulmonar, 14 (11,6%), tormenta arritmica y 6 (5,0%), miocarditis fulminante. A los 30 dias habian fallecido 60 pacientes (49,6%); la mortalidad fue mayor con el implante intraparada que con el implante en circulacion espontanea (30 [71,4%] de 42 frente a 30 [38,0%] de 79; p = 0,030). Se asociaron de manera independiente con la mortalidad a 30 dias la alanina aminotransferasa (ALT) antes del implante y el lactato (tanto basal como a las 6 h y el aclaramiento). Los modelos de regresion que incluian el lactato presentaron mejor capacidad predictiva de la supervivencia que las puntuaciones ENCOURAGE y ECMO-ACCEPTS, con mayor area bajo la curva ROC en el modelo con lactato a las 6 h. Conclusiones El lactato (basal y a las 6 h y el aclaramiento) es un predictor independiente para el pronostico de los pacientes en shock cardiogenico asistidos con ECMO-VA que facilita una mejor estratificacion del riesgo y tiene una capacidad predictiva superior.

With the aim at developing a landscape dynamics framework for environmental planning and management and testing the effectiveness of protected areas in achieving the 2030 Agenda of the United Nations sustainability goals, we characterized the historical transformation trajectories of forest area changes from 1936 to 2010 in the Metropolitan City of Rome Capital (Italy). Remote sensing-based products coupled with landscape pattern metrics and fragmentation analysis have been implemented, comparing different historical forest maps. The results show a remarkable forest area gain – from 17.6% to 25.5% – thanks to 68,299 ha of recently established forest. Statistical descriptors showed that the highest relative gain occurred in mountain zones, confirming a wide European forest recovery pattern in marginal areas from past deforestation and overexploitation. Deforestation mainly occurred in the flat and hilly areas where almost 26,000 ha of forests were lost since 1936. In summary, two main forest landscape dynamics were reconstructed: (I) the increase of forest cover fragmentation in the lowland areas; and (II) the rise in the forest area in the interior sectors of the mountain landscape, mainly within protected areas. Restoring the forest ecosystem's bioecological integrity has been highlighted as an urgent action for biodiversity conservation and carbon mitigation. In lowland areas, the study revealed the urgent need to establish new protected areas and rewilding spaces as landscape metrics are relatively below the sustainability targets for healthy forest ecosystems. The proposed framework can be used for testing the effectiveness of environmental planning and management in other forest landscapes to achieve the Agenda 2030 goals.

BACKGROUND: Augmentative and Alternative Communication (AAC) systems are used by people with motor disabilities, such as those with cerebral palsy (CP). The assessment of physical functional skills is crucial for appropriately choosing the computer access tool. OBJECTIVE: This study aimed to do a systematic literature review addressing the importance of the analysis of physical functional performance for the construction of specific tools to support communication. METHODS: The review followed PRISMA guidelines. We searched articles from 2009 to 2021 using three databases (PubMed, Lilacs in Portuguese, and SciELO). Three reviewers extracted the data. Registration was made to PROSPERO. The risk of bias was assessed using the Cochrane Collaboration tool. RESULTS: We found 132 articles in the databases. First, we excluded 31 articles because they did not provide evidence for the use of alternative communication in people with CP and did not use high technology resources. We also excluded 57 duplicated articles. At the end of this first step, 44 articles were left, 38 of them were excluded because they are not clinical trials. We selected 6 articles for the final analysis. CONCLUSIONS: The systematic review had a positive impact on the precise dissemination of knowledge ensuring comparisons of interventions and articles such as assistive technology programs.

Cellular therapy based on chondrocytes implantation is the most widely used procedure for inducing cartilage regeneration. However, the dedifferentiation process that these cells suffer and their limited capacity of proliferation, when they are cultured in vitro, restrict their use in cellular therapy protocols. To investigate the capacity of mesenchymal stromal cells (MSCs) to promote chondrogenesis from chondrocytes or chondrons in 2D and 3D coculture systems. Murine chondrocytes and chondrons were cocultured with MSCs at different cell ratios (100/0, 50/50, 70/30, 0/100) in two-dimensional (2D) and three-dimensional (3D) culture systems. High proliferation of cells with chondrocyte morphology, enhanced GAG production and expression of cartilage genes (aggrecan, type II collagen, and SOX-9) were observed in chondrocytes/MSCs cocultures. In contrast, fibroblastoid cells, down-regulation of cartilage gene expression and reduction of GAG production were observed in chondrons/MSCs cocultures. Chondrocytes within cartilage lacunae and surrounded by extracellular matrix were observed in chondrocytes/MSC pellets. MSCs promote the proliferation of functional chondrocytes in 2D and 3D culture systems. Transplantation of chondrogenic construct based on MSCs and chondrocytes may constitute a potential treatment for inducing cartilage repair.

Background and aims: HCV is associated with an increased risk of cardiovascular events (CV). Whether HCV clearance by direct-acting antivirals (DAA) reduces incident CV disease is poorly understood. We investigate whether HCV eradication reduces CV events. Methods: In a prospective multicentre study, 2204 HCV patients (F0–F2:29.5%, F3–F4: 70.5%) were enrolled. Males were 48%, median age was 68 (59–74) years and BMI 25.9 (23.1–28); 24.7% were smokers, 18% had diabetes, 13.2% had cholesterol levels >200 mg/dl and 9.1% took statins, 44% had hypertension. During an overall median follow-up of 28 (24–39) months, incident CV events, such as ischemic heart disease (IHD) and ischemic cerebral stroke (ICS), were recorded. An overall of 2204 patients were evaluated as control group and 1668 patients after HCV elimination were followed as a case group. Factors associated with CV events were evaluated by uni- and multi-variate analyses. Results: Incident CV rates per 100 patient years in pre-treatment and untreated controls and treated cases were 1.12, 1.14 and 0.44 (p = 0.0001 vs. controls), respectively, and a decreased of relative risk (RR = 0.379; p = 0.0002) was observed. CV risk was 2.0–3.5 times lower then in controls (HR 3.671; 95%C.I.:1.871–7.201; p < 0.001). The calculated number of patients to be treated to get a benefit in a patient was 55.26. The annual incidence reduction of CV events was 0.68%. HCV clearance was independently associated with CV events reduction (OR, 4.716; 95% C.I.:1.832–12.138; p = 0.001). Conclusions: HCV clearance by DAA reduces CV events (IHD and ICS) with both clinical and socio-economic benefits.

Objective: To evaluate whether there is a relationship between occlusion and body posture evaluated using a stabilometric platform. Methods: Observational studies that analyzed the relationship between dental occlusion (changes in mandibular position and/or dental malocclusion) and body posture evaluated with a stabilometric platform in patients older than 13 years without orthodontic or orthopedic intervention and systemically healthy were considered eligible for inclusion. PubMed, EMBASE, Science Direct, LILACS, and Google Scholar databases were searched to obtain articles published from September 2019 up to March 2020. Results: Twelve articles met the inclusion criteria, of which 66.7% showed a relationship between dental occlusion and body posture, and 33.3% found no relationship. The marked heterogeneity between studies did not allow data to be combined for meta-analyses. Conclusion: For the mandibular positions, the postural changes were mainly in the mediolateral direction, while in the malocclusions, they were in the anteroposterior direction.

Background:Cervical pain is a problem with a high prevalence of ~13% of the population, and is more common in women (16.5%). The most affected age group is 65–74 years. Our aim was to assess the effectiveness of self-applied acupressure for decreasing benign-origin cervical pain, under the supervision of a health professional and in combination with usual treatment, as well as to examine its impact on the patient’s self-perceived health condition and their opinion of the technique.Methods:Pragmatic, multicenter, controlled clinical trial randomized by healthcare center. A total of 160 patients with benign-origin cervical pain between 18 and 65 years of age who attended primary care were included from 12 healthcare centers in the autonomous community of Madrid by consecutive sampling, and randomly assigned to a control or intervention group. The main outcome variable was pain intensity measured on a visual analogue scale (VAS) and secondary variables were self-perceived quality of life (EuroQol-5D utility index) and functional ability (neck disability index). An explanative model of generalized estimating equations was built taking into account the lack of independence among observations. The analysis was performed over 6 months.Results:In total, 150 patients completed the study. Mean age was 45 years (SD: 10.7), 86.7% were women, 86.2% were currently employed, and 57.9% did not perform any physical exercise. Average days experiencing pain was 32.9 (SD: 2.8) and 80% were undergoing previous pharmacological treatment. The quality of life utility index after 3 months was 1.6 points (95% CI: 0.54–2.71) higher in the intervention group. The pain score on the VAS was 0.16 points (95% CI: 0.80–0.48) lower in the intervention group. The health professional explained 10.4% of the reduction in pain observed on the VAS throughout the medical visits.Conclusion:Acupressure applied in addition to usual practice appeared to improve cervical pain in the long term. The effectiveness of this technique was partially explained by the health professional that trained the participants on technique application.Trial registration number::NCT01855893

Cranial radiotherapy (CRT) is used to treat a large variety of benign and malignant disorders. We present two cases of late neurological complications after CRT and briefly discuss its diagnosis and their shared pathophysiological aspects. The first case is a patient with cognitive impairment associated to mineralizing microangiopathy ten years after CRT for nasopharyngeal carcinoma and the second one is a woman with Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome two years after CRT for anaplastic meningioma. Nowadays, higher survival rates might cause an increase in appearance of late neurological complications after CTR. These reported cases show that late complications can mimic a wide variety of neurological conditions and the importance of magnetic resonance image (MRI) to get a diagnosis.

Background Face masks have been proven to be effective in protecting the public against airborne transmitted diseases when fitted appropriately. However, for homemade cloth masks and surgical masks, the fit is often poor, allowing viruses to escape through the gap. Objective This work aims to identify the correlation between the mask leakage, mask configurations, and individual’s facial features. Methods A novel locally morphing 3D face model, and a minimum-energy-based mask deployment model are used to systematically examine the mask fit for a large cohort of exemplars. Results The results show that the mask size and tuck-in ratio, along with selective facial features, especially nose height and chin length, are key factors determining the leakage location and extent. A polynomial regression model is presented for mask fitness based on localized facial features. Significance This study is a complete pipeline to test various masks on a wide range of faces with controlled modification of distinct regions of the face, which is difficult to achieve with human subjects, and provide knowledge on how the masks should be designed in the future. Impact statement The face mask “fit” affects the mask’s efficacy in preventing airborne transmission. To date, research on the face mask fit has been conducted mainly using experiments on limited subjects. The limited sample size in experimental studies makes it hard to reach a statistical correlation between mask fit and facial features in a population. Here, we employ a novel framework that utilizes a morphable face model and mask’s deployment simulation to test mask fit for many facial characteristics and mask designs. The proposed technique is an important step toward enabling personalized mask selection with maximum efficacy for society members.

This is a multicenter prospective observational study which included a large cohort (n = 397) of allogeneic (allo-HSCT) (n = 311) and autologous (ASCT) hematopoietic stem cell transplant (n = 86) recipients who were monitored for antibody detection within 3 to 6 weeks after complete SARS-CoV-2 vaccination from February 1st 2021 to July 20th 2021. Most patients (n = 387, 97.4%) received mRNA-based vaccines. Most of recipients (93%) were vaccinated more than 1 year after transplant. Detectable SARS-CoV-2-reactive antibodies were observed in 242 (78%) of allo-HSCT and in 73 (85%) of ASCT recipients. Multivariate analysis in allo-HSCT recipients identified lymphopenia

Resumen Antecedentes La cirugia bariatrica es un procedimiento quirurgico relativamente seguro y con alta tasa de exito. Sin embargo, reportes recientes indican una mayor prevalencia de abuso de alcohol u otras sustancias en este grupo de pacientes. El proposito del presente estudio fue revisar la evidencia que existe al respecto para que sea tomada en cuenta por el equipo multidisciplinario que atiende a este grupo de pacientes. Metodos Se realizaron busquedas en las bases de datos de PubMed y CENTRAL, y se extrajeron las razones de momio de los distintos articulos, comparando la prevalencia por abuso de alcohol o de otras sustancias en el periodo posquirurgico vs. los niveles prequirurgicos. Tambien se comparo la prevalencia de abuso de alcohol tras distintos tipos de cirugia bariatrica. Resultados Un total de 49.121 pacientes bariatricos (80,8% mujeres) fueron evaluados para abuso de alcohol. De manera general, se encontro que la cirugia bariatrica estaba asociada con un aumento en la prevalencia por abuso de alcohol (4,58 ± 5,3 vs. 1,58 ± 10,7% en el periodo prequirurgico). Tambien encontramos que la poblacion de pacientes que se sometieron a cirugia de tipo RYGB tenia mayor prevalencia de abuso de alcohol que aquellos que se sometieron a otro tipo de cirugia (OR: 1,83; IC 95%: 1,51-2,21). La prevalencia de abuso de sustancias distintas al alcohol tras este procedimiento esta menos estudiada, aunque parece existir un aumento en el riesgo por abuso a ciertas sustancias. Conclusiones La cirugia bariatrica es el mejor tratamiento para la obesidad y sus complicaciones. La evidencia revisada sugiere que se relaciona con un aumento modesto, pero consistente en la prevalencia por abuso de alcohol y otras sustancias. El equipo medico a cargo del paciente bariatrico debera estar informado acerca de esta eventualidad para su oportuna prevencion, diagnostico y tratamiento.

Sepsis is a common cause of acute respiratory distress syndrome (ARDS) associated with a high mortality. A panel of biomarkers (BMs) to identify septic patients at risk for developing ARDS, or at high risk of death, would be of interest for selecting patients for therapeutic trials, which could improve ARDS diagnosis and treatment, and survival chances in sepsis and ARDS. We measured nine protein BMs by ELISA in serum from 232 adult septic patients at diagnosis (152 required invasive mechanical ventilation and 72 had ARDS). A panel including the BMs RAGE, CXCL16 and Ang-2, plus PaO2/FiO2, was good in predicting ARDS (area under the curve = 0.88 in total septic patients). Best performing panels for ICU death are related to the presence of ARDS, need for invasive mechanical ventilation, and pulmonary/extrapulmonary origin of sepsis. In all cases, the use of BMs improved the prediction by clinical markers. Our study confirms the relevance of RAGE, Ang-2, IL-1RA and SP-D, and is novel supporting the inclusion of CXCL16, in BMs panels for predicting ARDS diagnosis and ARDS and sepsis outcome.

OBJECTIVE To validate the performance of a natural language processing (NLP) model in characterizing the quality of feedback provided to surgical trainees. DESIGN Narrative surgical resident feedback transcripts were collected from a large academic institution and classified for quality by trained coders. 75% of classified transcripts were used to train a logistic regression NLP model and 25% were used for testing the model. The NLP model was trained by uploading classified transcripts and tested using unclassified transcripts. The model then classified those transcripts into dichotomized high- and low- quality ratings. Model performance was primarily assessed in terms of accuracy and secondary performance measures including sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). SETTING A surgical residency program based in a large academic medical center. PARTICIPANTS All surgical residents who received feedback via the Society for Improving Medical Professional Learning smartphone application (SIMPL, Boston, MA) in August 2019. RESULTS The model classified the quality (high vs. low) of 2,416 narrative feedback transcripts with an accuracy of 0.83 (95% confidence interval: 0.80, 0.86), sensitivity of 0.37 (0.33, 0.45), specificity of 0.97 (0.96, 0.98), and an area under the receiver operating characteristic curve of 0.86 (0.83, 0.87). CONCLUSIONS The NLP model classified the quality of operative performance feedback with high accuracy and specificity. NLP offers residency programs the opportunity to efficiently measure feedback quality. This information can be used for feedback improvement efforts and ultimately, the education of surgical trainees.

Los profesionales de la salud de las unidades de endoscopia tienen un posible riesgo de infección por SARS-CoV-2 por diferentes vías: inhalación de gotitas en el aire, aerosoles, contacto conjuntival y transmisión fecal-oral. Objetivo Describir la detección del SARS-CoV-2, en una serie de pacientes, programados para endoscopia digestiva en el Hospital Santa Caterina. Salt. (Girona). Métodos Estudio descriptivo de una serie de casos de pacientes programados para endoscopia durante el mes de mayo de 2020, en el reinicio de la actividad endoscópica después del pico pandémico, siguiendo las recomendaciones de SCD, SEED, AEG y ESGE. Examinamos muestras nasofaríngeas 48-72 horas antes de la cita, mediante RT-PCR a todos los pacientes. La extracción del ARN se hizo mediante kits: Qiagen®-adaptado, BiosSprint®96-DNA-Blood-Kit (384). Para amplificación-detección del SARS-CoV-2 se siguieron métodos recomendados por la OMS y el CDC. Resultados Se programaron 110 pacientes asintomáticos sin contacto estrecho con positivo los 14 días previos; 105 (96,4%) fueron negativos y 5 (4,5%) positivos. Dos pacientes desarrollaron clínica respiratoria después del diagnóstico (presintomáticos) y 3 continuaron asintomáticos. Los 5 pacientes eran casos autóctonos y sin antecedentes de viaje o residencia en otra ciudad o país asociado a alta prevalencia de infección. Cuatro casos fueron mujeres entre 60-81 años. El gen N fue detectado en todos los casos. Conclusiones Se detectó una alta prevalencia de infección por SARS-CoV-2 en pacientes programados por endoscopia digestiva. Dado el riesgo de transmisión a los profesionales, consideramos recomendable realizar RT-PCR del SARS-CoV-2 48-72 horas antes de la exploración en situaciones de alta incidencia poblacional.

El síndrome de Guillain-Barré (SGB) es una polirradiculoneuropatía inflamatoria aguda con presentaciones clínicas diversas clasificadas como variantes clínicas, sobre las cuales se tiene escasa infomación en nuestra región. Objetivo: Determinar las características epidemiológicas y variantes clínicas del SGB. Material y Métodos: Estudio descriptivo transversal retrospectivo. Se revisaron las historias clínicas de los casos sospechosos de SGB en tres hospitales de Piura, entre 2018-2019. Se incluyeron todos los casos sin límite de edad, excluyéndose únicamente aquellos con duda diagnóstica o historias incompletas. Los datos se analizaron mediante STATA vs 15.0. Resultados: De 123 casos, 61% fueron varones, con una edad promedio de 37 años. El 36,59% de los casos no presentaban antecedentes clínicos. La comorbilidad más frecuente fue Hipertensión Arterial (HTA). Sólo 40% de los casos fueron confirmados. El 78% se trató con inmunoglobulina. La variante más frecuente fue Poliradiculopatía Desmielinizante Inflamatoria Aguda (AIDP, sigla en inglés). Conclusiones: El SGB se presentó con mayor frecuencia en el sexo masculino y la forma clásica fue la variante más frecuente seguida de la regional. La mayoría de casos fueron clasificados como leves, con un grado promedio de discapacidad de 3. Se recomiendan estudios sobre la asociación entre cada variante clínica y las características clínicas de la enfermedad.

Background Moderate/severe cases of COVID-19 present a dysregulated immune system with T cell lymphopenia and a hyper-inflammatory state. This is a study protocol of an open-label, multi-center, double-arm, randomized, dose-finding phase I/II clinical trial to evaluate the safety, tolerability, alloreactivity, and efficacy of the administration of allogeneic memory T cells and natural killer (NK) cells in COVID-19 patients with lymphopenia and/or pneumonia. The aim of the study is to determine the safety and the efficacy of the recommended phase 2 dose (RP2D) of this treatment for patients with moderate/severe COVID-19. Methods In the phase I trial, 18 patients with COVID-19-related pneumonia and/or lymphopenia with no oxygen requirement or with an oxygen need of ≤ 2.5 liters per minute (lpm) in nasal cannula will be assigned to two arms, based on the biology of the donor and the patient. Treatment of arm A consists of the administration of escalating doses of memory T cells, plus standard of care (SoC). Treatment of arm B consists of the administration of escalating doses of NK cells, plus SoC. In the phase II trial, a total of 182 patients with COVID-19-related pneumonia and/or lymphopenia requiring or not oxygen supplementation but without mechanical ventilation will be allocated to arm A or B, considering HLA typing. Within each arm, they will be randomized in a 1:1 ratio. In arm A, patients will receive SoC or RP2D for memory T cells plus the SoC. In arm B, patients will receive SoC or RP2D for NK cells plus the SoC. Discussion We hypothesized that SARS-CoV-2-specific memory T-lymphocytes obtained from convalescent donors recovered from COVID-19 can be used as a passive cell immunotherapy to treat pneumonia and lymphopenia in moderate/severe patients. The lymphopenia induced by COVID-19 constitutes a therapeutic window that may facilitate donor engraftment and viral protection until recovery. Trial registration ClinicalTrials.govNCT04578210. First Posted : October 8, 2020

[Background and purpose]: Given the overlapping clinical manifestations and pathology, the differentiation between essential tremor (ET) and Parkinson's disease (PD) is difficult. Our aims were to examine the plasma metabolomics profiling and their association with motor and non-motor symptoms (NMS) in patients with PD, and to determine differences between de novo PD compared to moderate-advanced PD vs. controls and patients with ET., [Methods]: Plasma samples were collected from 137 subjects including 35 age matched controls, 29 NOVO-PD, 35 PD and 38 ET patients. PD severity, motor and NMS including cognitive function were assessed using the UPDRS, NMS and PD cognitive rating scales, respectively. Metabolomics analysis was performed by UPLC-ESI-QToF-MS followed by unsupervised multivariate statistics. The area under the curve of the biomarkers according to distribution of their concentrations and the diagnosis of PD (NOVO-PD, advanced PD) vs ET and healthy controls was used as a measurement of diagnostic ability., [Results]: Several acyl-carnitines, bilirubin, tyramine and tetrahydro-21-deoxycortisol (THS) presented good predictive accuracy (AUC higher than 0.8) for differentiating de novo PD and advanced PD from controls and ET, suggesting an alteration in the lipid oxidation pathway. In multivariate regression analysis, metabolite levels were not significantly associated with motor and NMS severity in PD., [Conclusions]: Diverse acyl-carnitines, bilirubin, tyramine and some adrenal gland derived metabolites are suggested as potential biomarkers able to distinguish between PD from controls and ET., This work was supported by Junta de Castilla y León (BIO/BU06/14).

Renal cell carcinoma (RCC) is one of the most lethal urological cancers, highly resistant to chemo and radiotherapy. Obesity and smoking are the best-known risk factors of RCC, both related to oxidative stress presence, suggesting a significant role in RCC development and maintenance. Surgical resection is the treatment of choice for localized RCC; however, this neoplasia is hardly diagnosable at its initial stages, occurring commonly in late phases and even when metastasis is already present. Systemic therapies are the option against RCC in these more advanced stages, such as cytokine therapy or a combination of tyrosine kinase inhibitors with immunotherapies; nevertheless, these strategies are still insufficient. A field poorly analyzed in this neoplasia is the status of cell signaling pathways sensible to the redox state, which have been associated with the development and maintenance of RCC. This review focuses on alterations reported in the following redox-sensitive molecules and signaling pathways in RCC: mitogen-activated protein kinases, protein kinase B (AKT)/tuberous sclerosis complex 2/mammalian target of rapamycin C1, AKT/glycogen synthase kinase 3/β-catenin, nuclear factor κB/inhibitor of κB/epidermal growth factor receptor, and protein kinase Cζ/cut-like homeodomain protein/factor inhibiting hypoxia-inducible factor (HIF)/HIF as potential targets for redox therapy.

The study examined the use of Pixton to support the teaching of English as a foreign language (EFL) writing to students at a private university in southern Ecuador. For this purpose, 52 EFL students (male and female, aged 19–24 years old) who were enrolled in a writing course participated in the study for a period of five months. At the start, most of these students had an A1+ proficiency level, according to the Common European Framework of Reference for Languages (CEFR). The study employed an action research design. A diagnostic test was applied at the beginning of the instruction period, and, at the end, a final exam and a perceptions questionnaire were administered. The findings indicate positive perceptions about Pixton, and students’ online writing skills improved due to the pedagogical use of this technological tool. Furthermore, Pixton increased students’ engagement, motivation and dynamic work to a remarkable extent. Finally, an improvement was observed in aspects of students’ writing, such as grammar, vocabulary, coherence and cohesion. https://doi.org/10.26803/ijlter.20.9.7

Introduction:Excited delirium, which has been defined as combativeness, agitation, and altered sensorium, requires immediate treatment in prehospital or emergency department (ED) settings for the safety of both patients and caregivers. Prehospital ketamine use is prevalent, although the evidence on safety and efficacy is limited. Many patients with excited delirium are intoxicated with illicit substances. This investigation explores whether patients treated with prehospital ketamine for excited delirium with concomitant substance intoxication have higher rates of subsequent intubation in the ED compared to those without confirmed substance usage.Methods:Over 28 months at two large community hospitals, all medical records were retrospectively searched for all patients age 18 years or greater with prehospital ketamine intramuscular (IM) administration for excited delirium and identified illicit and prescription substance co-ingestions. Trained abstractors collected demographic characteristics, history of present illness (HPI), urine drug screens (UDS), alcohol levels, and noted additional sedative administrations. Substance intoxication was determined by UDS and alcohol positivity or negativity, as well as physician HPI. Patients without toxicological testing or documentation of substance intoxication, or who may have tested positive due to ED sedation, were excluded from relevant analyses. Subsequent ED intubation was the primary pre-specified outcome. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare variables.Results:Among 86 patients given prehospital ketamine IM for excited delirium, baseline characteristics including age, ketamine dose, and body mass index were similar between those who did or did not undergo intubation. Men had higher intubation rates. Patients testing positive for alcohol, amphetamines, barbiturates, benzodiazepines, ecstasy, marijuana, opiates, and synthetic cathinones, both bath salts and flakka, had similar rates of intubation compared to those negative for these substances. Of 27 patients with excited delirium and concomitant cocaine intoxication, nine (33%) were intubated compared with four of 50 (8%) without cocaine intoxication, yielding a 5.75 OR (95%, CI 1.57 to 21.05; P = .009).Conclusion:Patients treated with ketamine IM for excited delirium with concomitant cocaine intoxication had a statistically significant 5.75-fold increased rate of subsequent intubation in the ED. Amongst other substances, no other trends with intubation were noted, but further study is warranted.

Introduction:The use of dasatinib in patients with CML has improved life expectancy and follow-up with transthoracic echocardiography (ECOTT) for early detection of PAH allows modifications to the treatment.Objective:To determine the echocardiographic parameters and echocardiographic probability for PAH in patients with CML treated with dasatinib.Methods:Correlation, cross-sectional, retrospective, single-center study; patients with CML treated with dasatinib were included. Spearman and Pearson correlation was used.Results:16 patients were analyzed, mean age 53.5 years; 62.5% men, 37.5% women. The dasatinib dose was 50 mg / day in 18.7%, and 100 mg / day in 81.2%, mean pulmonary arterial pressure (mPAP) 26.3 mmHg, mean maximum tricuspid regurgitation velocity (VmxRT) 2.9 m / s, mean pulmonary artery systolic pressure (PSAP) 41 mmHg. 56.2% had right ventricular diastolic dysfunction (RVDD). 43% were categorized as low probability for PAH, 18.7% intermediate, and 37.5% as high. Relationship between PAPm and VmxRT with p = 0.012. Relationship between mPAP and RV diastolic function, with p = 0.002. Relationship between probability for PAH and mPAP, with p = 0.008.Conclusion:The echocardiographic parameters PAPm, VmxRT, PSAP, DDVD and echocardiographic probability for PAH are useful and necessary for the diagnosis of PAH. The determination of all these parameters should be carried out early and as a follow-up, since a considerable positive relationship was found for each one with the presence of PAH, which is not dependent on the treatment time or the dose of dasatinib. Introducción:La leucemia mieloide crónica (LMC) es un desorden clonal de células madre hematopoyéticas, predomina en el género masculino entre 55 y 65 años. El ecocardiograma transtorácico (ECOTT) para detección temprana de hipertensión arterial pulmonar (HAP) permite hacer modificaciones al tratamiento con dasatinib.Objetivo:Determinar los parámetros ecocardiográficos y la probabilidad ecocardiográfica para HAP en pacientes con LMC tratados con dasatinib.Métodos:Estudio de correlación, transversal, retrospectivo, unicéntrico; se incluyeron pacientes con LMC tratados con dasatinib. Se utilizó correlación de Spearman y Pearson.Resultados:Se analizaron 16 pacientes, edad promedio 53,5 años; 62,5% hombres, 37,5% mujeres. La dosis de dasatinib fue 50 mg/día en 18,7%, y 100 mg/día en 81,2%, presión media de la arteria pulmonar (mPAP) 26,3 mmHg, velocidad máxima de regurgitación tricuspídea (VmxRT) media 2,9 m/s, presión sistólica de arteria pulmonar (PSAP) media 41 mmHg. El 56,2% presentó disfunción diastólica del ventrículo derecho (DDVD). Se categorizaron 43% en baja probabilidad para HAP, 18,7% intermedia y 37,5% en alta. Relación entre mPAP y VmxRT con p=0,012. Relación entre mPAP y función diastólica del ventrículo derecho (FDVD), con p=0,002. Relación entre probabilidad para HAP y mPAP, con p=0,008.Conclusión:Los parámetros ecocardiográficos mPAP, VmxRT, PSAP, DDVD son útilesy la probabilidad ecocardiográfica para HAP deben realizarse de forma temprana y como seguimiento, ya que se encontró relación positiva con la presencia de HAP, la cual no es dependiente del tiempo de tratamiento ni de la dosis de dasatinib.

The objective of this manuscript was to describe the clinical incidents that were sent to the voluntary reporting system during 2020 at the National Children's Hospital of Costa Rica, belonging to the Costa Rican Social Security Fund. A descriptive observational study of the consolidated data that was sent during the months of January to December of the year 2020 was carried out. During 2020, 1.6% of the patients treated in the hospital experienced some type of clinical incident. The total discharges decreased by 38.4% compared to the discharges of the year 2019, however, the reported clinical incidents increased in the year 2020 by 37.6%, especially from the month of August. Sentinel events were not reported this year. The services that made the highest number of reports were Intensive Care (14.3%), General Surgery (12%), Neonatology (9.8%) and Infectiology (9%). The day on which the most incidents were reported was Wednesday (27.8%), in the first hospital shift most of the cases were reported (48.1%) and these incidents occurred predominantly to male individuals (66%). Regarding the age of the patients, the majority were in the age range from 1 year to less than 5 years (36.1%), followed by the age range from over 29 days to under 1 year (24, 1%). Most of the cases were related to the care provided to the patient (63.9%). 41.4% of the incidents required clinical measures but the sequelae were transitory. 51.1% of the cases merited some type of additional medical care to their therapeutic scheme upon admission. 96% of clinical incidents were reported by nursing staff. Most of the clinical incidents (35.3%) in this period were errors related to notes in the digital file.

BackgroundDetermining potential predictors of clinical response would allow a more personalized rheumatoid arthritis (RA) treatment approach in heterogeneous populations such as Latin American (LA) patients.MethodsPost hoc analysis to identify baseline characteristics predictive of clinical remission in response to treatment with etanercept (ETN) plus methotrexate (MTX) in LA patients with moderate to severe MTX-resistant RA. We report data from the group of patients who received ETN 50 mg/week plus MTX (ETN + MTX,n = 281) in a clinical trial consisting of an initial 24-week open-label phase, followed by a 104-week extension. Remission was defined as 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR) score ResultsAt Week 24 and Week 128, 27% (66/241) and 42% (91/219) of patients in the ETN + MTX group achieved remission. On average, patients achieving remission were younger and had lower baseline ESR, lower Physician Global Assessment (PGA) scores, lower total Health Assessment Questionnaire (HAQ) scores, and lower visual analog scale (VAS) Pain scores compared with patients who did not achieve remission. The best subset of baseline variables predicting Week 24 remission in the stepwise regression model were age ≤ 49 years (odds ratio [OR] 2.93), body mass index (BMI) > 28.5 kg/m2(OR 3.24), disease duration > 3.7 years (OR 2.22), ESR ≤ 42 mm/h (OR 2.72), PGA ≤ 6 (OR 3.21), tender joint count ≤ 14 (OR 2.25), and total HAQ score ≤ 1.6 (OR 2.86). At Week 128, age ≤ 42 years (OR 2.21), SF-36 Mental Health Scale score > 39.6 (OR 2.16), White race (OR 4.07), > 18 swollen joints (OR 2.11), and VAS Pain ≤ 41 (OR 6.05) at baseline were the best subset of significant predictors of remission.ConclusionsIn LA patients with RA, younger age, higher BMI, longer disease duration, higher SF-36 Mental Health Scale score, higher swollen joint count, and overall lower disease activity predicted clinical response to ETN + MTX therapy.Trial registration: ClinicalTrials.gov Identifier: NCT00848354.

In this paper, we use the correlation between the average wind speed and the elevation above sea level to present a regression model for calculating the average wind speed and evaluating the wind potential in the southern region of Ecuador. After obtaining the regression model, an adjustment factor based on the topographic slope has been included, mainly since the wind speed could vary largely as it blows across the lower slope regions or intermediate hills of mountains. Once the wind speed was obtained, both at 10 m and 100 m, the wind power density was calculated, which includes the impact of wind speed and air density. Finally, the model accuracy was obtained by comparing other free access data sources including actual data from meteorological stations, using statistical parameters to quantify the error. According to the results obtained, we find that wind speed has a good correlation with the terrain elevation of the southern region of Ecuador. The simulated wind speed compared to the actual data has errors between 7.75% and 16.89%, which indicates that the model can predict with > 83% accuracy. In addition, both the root means square error and the standard deviations have around 1 m/s of error.

Different types of agile approaches and LEAN methodologies have guided the development of solutions based on a minimum viable product mainly from the product design and development body of the knowledge. However, these approaches offer generic practices for a wide variety of solutions. This study presents an original proposal that provides a vertical solution for the conception of a minimum viable multimedia system, with a practice expressed in the graphic notation language of Essence. The study presents a contribution through a case study related to the clarity about the flow of activities, techniques, and specific tools that the practitioners must use to define a minimum viable multimedia system. This work also contributes to the criteria unification of the teamwork to carry out the follow-up of the progress in realizing the activities necessary to complete the job needed for the conception of the minimum viable multimedia system, using an MS-value sub-alpha.

Heating, ventilation, and air conditioning (HVAC) systems provide the people working/living inside buildings with ‘conditioned air’ so that they will have a comfortable and safe environment. Thermal comfort is considered as an aspect of a sustainable building in almost all sustainable building evaluation methods and tools. In fact, in the building sector, HVAC systems represent between 40 and 60% of energy consumption. In this paper, two thermal comfort methods have been experimentally analysed (Predicted Mean Vote or the so-called Fanger’s method, and the Adaptive Comfort Method). The measurement campaign was divided into two stages. In an initial stage, HVAC electrical consumption, indoor temperature, carbon dioxide concentration, relative humidity, global horizontal irradiance, and outdoor temperature were measured through controlled conditions, performing a considerable number of tests in 112 days, covering all seasons. Later, in a second phase, with the experimental data, the two thermal comfort methods were calculated analytically. In both cases, the main conclusion is that – when the HVAC system was working with minimum energy consumption – more than 80% of the possible occupants would be satisfied with the indoor temperature, by more than 90% of the time.

CASE HISTORY Medical records of dogs (n = 5) that had been treated for patellar fracture with transarticular external skeletal fixation (TA-ESF) to augment internal fixation, at a single referral hospital in the United Kingdom between 2015 and 2017, were reviewed. CLINICAL FINDINGS AND TREATMENT At presentation, two dogs had polar patellar fractures, two had comminuted fractures and one dog had a transverse fracture. The median age at the time of the surgery was 21 (min 8, max 132) months and the median body weight was 19.0 (min 8.3, max 28.6) kg. In all cases, TA-ESF (Type IA lateral triangulated or modified Type II) was used in combination with internal fixation with pins and/or orthopaedic wire, supported by nylon leader line (patella-to-tibia mattress suture) and/or absorbable suture in a locking loop and/or circum-patellar pattern. All cases had short-term (6-12 weeks) post-operative radiographic follow-up, which showed evidence of fracture healing in 2/5 cases. All TA-ESF were removed 6 or 7 weeks post-operatively and four dogs had minor complications related to TA-ESF. More than 2 years post-operatively, the owners of all dogs were contacted and questioned using the Liverpool Osteoarthritis in Dogs questionnaire regarding the mobility of their pet. Four of the five cases were re-examined to evaluate their long-term outcomes. Based on the results of goniometric measurement of stifle range of motion, subjective gait assessment and objective gait analysis with a pressure-sensitive walkway, all dogs showed a satisfactory outcome at the final follow-up. CLINICAL RELEVANCE A combination of internal fixation and TA-ESF for stabilisation of traumatic patellar fractures is a valid treatment option. Further investigations with larger case numbers are necessary to evaluate success and complication rates.

A new permanent geophysical station was installed in the Seymour-Marambio Island, Antarctica, for monitoring electromagnetic, CO2, and CH4 gas signals. Those signals require specialized low noise instruments and the survey shall be carried out in places far away from cultural noise, such as populated human settlements. The most suitable place would be near the Earth's poles, where noise is the lowest possible. To measure these variables, the Geophysical Instrumentation Laboratory (Laboratorio de Instrumentación Geofísica - LIG) of the Universidad Nacional de Colombia, in a partnership with the Instituto Antártico Argentino (IAA) under the Argentinean National Antarctic Direction (Dirección Nacional del Antártico - DNA), deployed the COCOAonMEAT project, oriented to design, built and install a low-cost station with time synchronization via GPS and data transmission in almost real-time. Since January 2020, the project monitors continuously (24/7) seven variables: three magnetic components, two electric dipoles, methane (CH4), and carbon dioxide (CO2) gas. Due to operative facilities and its low electromagnetic noise, the place chosen for its installation was the Argentinean Marambio Scientific Base in the Antarctic Peninsula, with the Multidisciplinary Antarctic Laboratory's collaboration (Laboratorio Multidisciplinario Antártico en la Base Marambio - LAMBI). This station provides valuable information on electromagnetic signals and greenhouse gases related to regional tectonic activity and local perturbations associated with global climate change.

The design of new products is a matter of great importance that can directly affect profitability and competitiveness in modern companies. For this reason, the selection of a final product design needs to consider at least four factors of importance: anticipated market demand for the product design, preference heterogeneity among consumers, decision-maker preferences, and fuzzy preference information in the design criteria. This paper proposes a frequency-based preference choice model that considers all the above factors and can be used with algorithms that solve the optimal product design problem using the share of preference frequency criterion. The choice model introduced in this paper is based on the multicriteria outranking approach, and its predictive accuracy is optimized with genetic algorithms. The proposed genetic algorithm is compared with Interior Point OPTimizer, a software package for large-scale non-linear optimization. The experiment results demonstrate that the proposed method achieves near-optimal solutions in reasonable computational time and significantly outperforms the runtime compared algorithm.

Background Although gallbladder cancer (GBCA) is characterized by a dismal prognosis, there is a proportion of patients who are cured. The aim of this study was to analyze the profile of these patients. Methods A database was queried for patients who underwent curative resection with a follow-up of at least 5 years. Patients were prospectively treated and registered by the same surgical team. A multivariate regression analysis was used to identify factors associated with long-term survival. Results From 1988 to 2013, 461 patients were evaluated and 112 who underwent resection were analyzed. Among the patients, five year survival was 57% while lymph node and liver compromise were the only independent factors associated with survival. On the other hand, the elapsed time between the cholecystectomy and the resection, the differentiation grade and the level of wall invasion did not have an independent effect on the prognosis. Conclusion Despite its poor prognosis, a subset of patients can be cured of GBCA. R0 resection of patients without lymph and liver infiltration are key to GBCA survival.

Objectives: The objective of this study was to verify the effect of brushing on the mass, color and roughness of the acrylic resin artificial teeth of the RDP, using a dentifrice incorporated with 1% Brazilian Red Propolis (BRP) after 5 years of brushing. Methods: The specimens were distributed in 3 groups / 10 each: Distilled Water (DW), 1% BRP-based dentifrice (PD) and Positive Control dentifrice (CD), analyzed before and after 24, 36 and 60 months of brushing. Data were expressed as mean and standard deviation, submitted to the Kolmogorov-Smirnov normality test and compared by Friedman or Kruskal-Wallis tests followed by the Dunn post test (p Key words: Dental Prosthesis, Propolis, Toothbrushing, Natural Products, Dentistry.

In myelodysplastic syndromes (MDS), the 20q deletion [del(20q)] may cause deletion of the ASXL1 gene. We studied 153 patients with MDS and del(20q) to assess the incidence, prognostic value and impact on response to azacitidine (AZA) of ASXL1 chromosomal alterations and genetic mutations. Additionally, in vitro assay of the response to AZA in HAP1 (HAP1(WT)) and HAP1 ASXL1 knockout (HAP1(KN)) cells was performed. ASXL1 chromosomal alterations were detected in 44 patients (28 center dot 5%): 34 patients (22%) with a gene deletion (ASXL1(DEL)) and 10 patients (6 center dot 5%) with additional gene copies. ASXL1(DEL) was associated with a lower platelet count. The most frequently mutated genes were U2AF1 (16%), ASXL1 (14%), SF3B1 (11%), TP53 (7%) and SRSF2 (6%). ASXL1 alteration due to chromosomal deletion or genetic mutation (ASXL1(DEL)/ASXL1(MUT)) was linked by multivariable analysis with shorter overall survival [hazard ratio, (HR) 1 center dot 84; 95% confidence interval, (CI): 1 center dot 11-3 center dot 04; P = 0 center dot 018] and a higher rate for acute myeloid leukaemia progression (HR 2 center dot 47; 95% CI: 1 center dot 07-5 center dot 70, P = 0 center dot 034). ASXL1(DEL)/ASXL1(MUT) patients were correlated by univariable analysis with a worse response to AZA. HAP1(KN) cells showed more resistance to AZA compared to HAP1(WT) cells. In conclusion, ASXL1 alteration exerts a negative impact on MDS with del(20q) and could become useful for prognostic risk stratification and treatment decisions.

Background Little is known about how benign prostatic hyperplasia (BPH) develops and why patients respond differently to medical therapy designed to reduce lower urinary tract symptoms (LUTS). The Medical Therapy of Prostatic Symptoms (MTOPS) trial randomized men with symptoms of BPH and followed response to medical therapy for up to 6 years. Treatment with a 5α-reductase inhibitor (5ARI) or an alpha-adrenergic receptor antagonist (α-blocker) reduced the risk of clinical progression, while men treated with combination therapy showed a 66% decrease in risk of progressive disease. However, medical therapies for BPH/LUTS are not effective in many patients. The reasons for nonresponse or loss of therapeutic response in the remaining patients over time are unknown. A better understanding of why patients fail to respond to medical therapy may have a major impact on developing new approaches for the medical treatment of BPH/LUTS. Prostaglandins (PG) act on G-protein-coupled receptors (GPCRs), where PGE2 and PGF2 elicit smooth muscle contraction. Therefore, we measured PG levels in the prostate tissue of BPH/LUTS patients to assess the possibility that this signaling pathway might explain the failure of medical therapy in BPH/LUTS patients. Method Surgical BPH (S-BPH) was defined as benign prostatic tissue collected from the transition zone (TZ) of patients who failed medical therapy and underwent surgical intervention to relieve LUTS. Control tissue was termed Incidental BPH (I-BPH). I-BPH was TZ obtained from men undergoing radical prostatectomy for low-volume, low-grade prostatic adenocarcinoma (PCa, Gleason score ≤ 7) confined to the peripheral zone. All TZ tissue was confirmed to be cancer-free. S-BPH patients divided into four subgroups: patients on α-blockers alone, 5ARI alone, combination therapy (α-blockers plus 5ARI), or no medical therapy (none) before surgical resection. I-BPH tissue was subgrouped by prior therapy (either on α-blockers or without prior medical therapy before prostatectomy). We measured prostatic tissue levels of prostaglandins (PGF2α , PGI2 , PGE2 , PGD2 , and TxA2 ), quantitative polymerase chain reaction levels of mRNAs encoding enzymes within the PG synthesis pathway, cellular distribution of COX1 (PTGS1) and COX2 (PTGS2), and tested the ability of PGs to contract bladder smooth muscle in an in vitro assay. Results All PGs were significantly elevated in TZ tissues from S-BPH patients (n = 36) compared to I-BPH patients (n = 15), regardless of the treatment subgroups. In S-BPH versus I-BPH, mRNA for PG synthetic enzymes COX1 and COX2 were significantly elevated. In addition, mRNA for enzymes that convert the precursor PGH2 to metabolite PGs were variable: PTGIS (which generates PGI2 ) and PTGDS (PGD2 ) were significantly elevated; nonsignificant increases were observed for PTGES (PGE2 ), AKR1C3 (PGF2α ), and TBxAS1 (TxA2 ). Within the I-BPH group, men responding to α-blockers for symptoms of BPH but requiring prostatectomy for PCa did not show elevated levels of COX1, COX2, or PGs. By immunohistochemistry, COX1 was predominantly observed in the prostatic stroma while COX2 was present in scattered luminal cells of isolated prostatic glands in S-BPH. PGE2 and PGF2α induced contraction of bladder smooth muscle in an in vitro assay. Furthermore, using the smooth muscle assay, we demonstrated that α-blockers that inhibit alpha-adrenergic receptors do not appear to inhibit PG stimulation of GPCRs in bladder muscle. Only patients who required surgery to relieve BPH/LUTS symptoms showed significantly increased tissue levels of PGs and the PG synthetic enzymes. Conclusions Treatment of BPH/LUTS by inhibition of alpha-adrenergic receptors with pharmaceutical α-blockers or inhibiting androgenesis with 5ARI may fail because of elevated paracrine signaling by prostatic PGs that can cause smooth muscle contraction. In contrast to patients who fail medical therapy for BPH/LUTS, control I-BPH patients do not show the same evidence of elevated PG pathway signaling. Elevation of the PG pathway may explain, in part, why the risk of clinical progression in the MTOPS study was only reduced by 34% with α-blocker treatment.

Resumen La rinosinusitis cronica con polipos nasales (RSCcPN) es una enfermedad con gran impacto sobre la salud. La opcion quirurgica mediante cirugia endoscopica nasosinusal es la alternativa terapeutica cuando no se alcanza el control de la enfermedad con el tratamiento medico. Los abordajes endoscopicos extensos se estan postulando como posible mejor opcion de tratamiento quirurgico en ciertos fenotipos de RSCcPN. La mucoplastia endonasal asociada a estos abordajes ha demostrado ser una tecnica complementaria que mejora tanto la cicatrizacion como el edema mucoso a corto plazo en pacientes con RSCcPN. El objetivo de nuestro estudio ha consistido en analizar los resultados de las mucoplastia endonasal asociada a una etmoidoesfenoidotomia completa mas sinusotomia frontal de grado III en el tratamiento de RSCcPN a medio plazo. Para ello se realizo un estudio prospectivo de casos y controles (10/10) en pacientes con RSCcPN. En el grupo de casos se asocio a la cirugia una mucoplastia endonasal en la fosa nasal izquierda y en el grupo control no. La evaluacion de la calidad de vida al ano de la intervencion quirurgica, medida mediante la diferencia de medias de SNOT-22 (media [DE]), en el grupo de casos fue significativamente mejor que en el grupo control (45,9 [19,6]-26,6 [16,05]; p = 0,027). La mejoria endoscopica de la cicatrizacion y del edema mucoso, medida mediante la escala de Lund-Kennedy modificada, mostro mejorias relevantes al comparar ambas fosas, pero sin alcanzar la significacion (p = 0,29). La mucoplastia endonasal favorece la cicatrizacion a corto plazo, lo que mejora la calidad de vida a medio plazo (un ano) de los pacientes tratados con resecciones extensas endoscopicas de los senos.

Astrocytes play a formative role in memory consolidation during physiological conditions; when dysregulated, astrocytes release glial fibrillary acidic protein (GFAP), which has been linked with negative memory outcomes in animal studies. We examined the association between blood GFAP, memory, and white matter (WM) integrity, accounting for blood markers of AD pathology (i.e., Aβ42) and neurodegeneration (i.e., total tau; neurofilament light chain) in 114 older adults (asymptomatic, n = 69; MCI/AD dementia, n = 45). Higher levels of GFAP were associated with lower memory scores (p0.0001), such that for 1 SD increase in mean GFAP values, the memory composite score decreased on average by 0.49 (Standard error = 0.071). These results remained significant after controlling for diagnostic status and AD-related blood biomarkers. Higher GFAP was also related to lower WM integrity in regions vulnerable to AD pathology; however, WM integrity did not account for the association between GFAP and memory. Study findings suggest that higher blood levels of a marker of astrogliosis may reflect impoverished memory functions and white matter health, independent of markers of amyloid or neurodegeneration.

The present study is aimed at analyzing the impact of digital sto-rytelling on English as a Foreign Language (EFL) pre-service teachers’ writing skills. The participants were 101 students, who were enrolled in four distance courses of the English Major at a private university in Ecuador. Their ages ranged between 19 and 22 years old. They were divided into one control (49) and one experimental (52) group since this study used a quasi-experimental approach combined with a mixed-method design. The instruments included a pre-question-naire, a pre-test, a post-questionnaire, and a post-test. The main findings show that there was a significant improvement in students’ writing skills, particularly in aspects related to grammar and vocabulary. In addition, digital storytelling us-ing Storybird was perceived as a useful strategy to develop the participants’ EFL writing skills since they were more engaged in activities that allowed them to demonstrate their knowledge when designing narrative projects.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with great impact on health. The surgical option using endoscopic sinus surgery is the therapeutic alternative when control of the disease is not achieved with medical treatment. Extensive endoscopic approaches are being postulated as a possible best surgical treatment option in certain phenotypes of CRSwNP. Endonasal mucoplasty associated with these approaches has been shown to be a complementary technique that improves both healing and mucosal edema in patients with CRSwNP in the short term. The aim of our study was to analyse the results of endonasal mucoplasty associated with a complete ethmoid-sphenoidotomy plus grade III frontal sinusotomy in the treatment of CRSwNP in the medium term. For this purpose, a prospective case-control study (10/10) was carried out on patients with CRSwNP. In the case group, endonasal mucoplasty in the left nostril was associated with surgery, and the control group was not. The assessment of quality of life at one year after surgery, as measured by the mean difference in SNOT-22 (mean [SD]), was significantly better in the case group than in the control group (45.9 [19.6]-26.6 [16.05] P=0.027). The endoscopic improvement in healing and mucosal edema, measured by the Modified Lund-Kennedy scale, showed relevant improvements, when comparing both nostrils, but without reaching significance (P=0.29). Endonasal mucoplasty promotes short-term healing, improving the quality of life in the medium term (one year) of patients treated with extensive endoscopic mucosal resections.

The COVID-19 pandemic, caused by the rapid global spread of the novel coronavirus (SARS-CoV-2), has caused healthcare systems to collapse and led to hundreds of thousands of deaths. The clinical spectrum of COVID-19 is not only limited to local pneumonia but also represents multiple organ involvement, with potential for systemic complications. One year after the pandemic, pathophysiological knowledge has evolved, and many therapeutic advances have occurred, but mortality rates are still elevated in severe/critical COVID-19 cases. Mesenchymal stromal cells (MSCs) can exert immunomodulatory, antiviral, and pro-regenerative paracrine/endocrine actions and are therefore promising candidates for MSC-based therapies. In this review, we discuss the rationale for MSC-based therapies based on currently available preclinical and clinical evidence of safety, potential efficacy, and mechanisms of action. Finally, we present a critical analysis of the risks, limitations, challenges, and opportunities that place MSC-based products as a therapeutic strategy that may complement the current arsenal against COVID-19 and reduce the pandemic’s unmet medical needs.

Introduction The aim of this study was to explore the utility of measuring motivation to quit smoking as a predictor of abstinence maintenance among smokers who wanted to quit and who were included in a multicenter study conducted in daily clinical practice. Methods This observational, longitudinal (prospective cohort), multicenter study was conducted in smoking clinics in Spain and the Argentine Republic in daily clinical practice. Motivation was assessed using three quantitative motivation tests and a Visual Analogue Scale. Statistical analysis included descriptive, association measures and logistic regression models. Results Of a total of 404 subjects, 273 were ultimately included for analysis (147 women; 53.8%), mean age 51±11 years). In one year, 53.5% (36.13% by intention to treat) of subjects (146) were successful in quitting smoking [men: 45.2% (66) and women: 54.8% (80)], with no differences between sexes. None of the scales utilized was associated, in an unquestionable or direct way, with long-term abstinence, although three of them, in a very complex model, with additional variables and added interactions, were associated with the 'result' variable, when other variables intervened in certain circumstances. Conclusions None of the analyzed motivational scales alone demonstrated an association with success or failure in quitting smoking; thus, their use in isolation is of no value. Some of the scales analyzed might be related to the maintenance of abstinence but in complex models where other variables intervene, which makes interpretation considerably difficult. Therefore, the predictive capacity of the tests analyzed, based on the models, was low.

We conducted a multicenter interventional study to assess the efficacy of Therakos ECP to treat steroid-resistant graft-vs-host disease (SRes-GVHD) after allogeneic HSCT and to identify biomarkers of GVHD response. A total of 62 patients were treated for acute SRes-GVHD (n = 37) or chronic SRes-GVHD (n = 25). Median time to best response was 35 days (range, 28-85) and 90 days (range, 27-240) in acute and chronic SRes-GVHD, respectively. Overall, 27 patients (72.9%) with SRes-aGVHD responded to treatment (40.5% CR and 32.4% PR). The response rate was significantly higher in grade I-II than in grade III-IV aGVHD (100% vs 50.0%, respectively, P-value = .001). In chronic SRes-GVHD, 22 patients (88%) achieved a clinical response (24.0% CR and 64% PR). Response was higher in moderate than in severe SRes-cGVHD (100% vs 75%, P = .096). In both acute and chronic SRes-GVHD patients, the percentage of peripheral blood CD3+ CD4+ was higher and CD3+ CD8+ lower in responding than nonresponding patients. Acute SRes-GVHD responding patients presented a higher number of Treg cells (CD4+ CD25+ CD127low/- ) at day 0 (P = .028) than nonresponding patients, differences that were maintained over the observation period. Phenotypic analysis of T-cell maturation showed a trend toward reduction in TCD8 naive cells, along with an increased percentage of TCD8 Mem Efect T cells after starting ECP in responding patients. None of the studied serum cytokines displayed statistically significant changes in either acute or chronic SRes-GVHD. ECP is an effective treatment for patients with SRes-GVHD. Biomarkers could help guide decision-making on ECP treatment initiation and duration.

Dentro de la atención clínica, el profesional de la fonoaudiología cuenta con recursos evaluativos para describir la biomecánica secuencial de la ingesta; uno de los recursos utilizados es la Auscultación Cervical (AC). Teniendo en cuenta la descripción de la importancia de la intervención oportuna y efectiva de los procesos de alimentación en los niños con parálisis cerebral, se considera necesario resolver ¿cuál es el perfil espectrográfico que registra la fase faríngea de la deglución en el paciente pediátrico con parálisis cerebral? Su metodología contempla una Revisión sistemática bajo metodología PRISMA, estableciendo la búsqueda de artículos científicos en la utilización de la AC en la evaluación clínica de la deglución en sujetos pediátricos diagnosticados con Parálisis Cerebral. Como resultado se hallan 180 artículos en las bases de datos indagadas, tomando de acuerdo a los criterios de elegibilidad 6 artículos del total, estableciendo un 3,34% de inclusión. En ausencia de procesos instrumentales de evaluación deglutoria, la AC aporta como beneficio la accesibilidad del procedimiento, además de características de temporalidad en la secuencia de los sonidos deglutorio, sin ningún tipo de factor adverso para su realización. Es por ello que la auscultación es un recurso importante en la evaluación clínica, establece un primer paso en el análisis fisiológico de la deglución con los aspectos fisiológicos de la fase faríngea. Esto, pone a la auscultación en una posición privilegiada, pero que debe ser estandarizada por los estudiosos y teóricos del tema.

Debido a la complejidad de los sistemas eólicos, la necesidad de contar con aerogeneradores fiables es de suma importancia, por ello se han desarrollado metodologías para mejorar sus características y desempeño. El método de análisis de modos de falla, efectos y criticidad se ha utilizado para estudiar la confiabilidad de diferentes sistemas de generación de energía. En este documento se presenta la aplicación de dicha metodología a un aerogenerador de inducción doblemente alimentado, para realizar una evaluación cualitativa y cuantitativa de las características de falla en el mismo. Además, para tomar en cuenta consideraciones económicas en el análisis, se presenta el enfoque del método basado en el riesgo, con el fin de mitigar las limitaciones que presenta el método tradicional. Como resultado se determina que la prioridad de atención debe enfocarse en el generador, luego el sistema eléctrico y posteriormente en las palas.