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Super-resolution optical imaging tools are crucial in microbiology to understand the complex structures and behavior of microorganisms such as bacteria, fungi, and viruses. However, the capabilities of these tools, particularly when it comes to imaging pathogens and infected tissues, remain limited. We developed µMagnify, a nanoscale multiplexed imaging method for pathogens and infected tissues that are derived from an expansion microscopy technique with a universal biomolecular anchor. We formulated an enzyme cocktail specifically designed for robust cell wall digestion and expansion of microbial cells without distortion while efficiently retaining biomolecules suitable for high-plex fluorescence imaging with nanoscale precision. Additionally, we developed an associated virtual reality tool to facilitate the visualization and navigation of complex three-dimensional images generated by this method in an immersive environment allowing collaborative exploration among researchers around the world. µMagnify is a valuable imaging platform for studying how microbes interact with their host systems and enables development of new diagnosis strategies against infectious diseases.

To report the clinicopathologic correlation of a case of bilateral serpiginous-like chorioretinitis (SLC) associated with unilateral ciliochoroidal melanoma.A 71-year-old white woman was diagnosed with progressive SLC in both eyes associated with ciliochoroidal melanoma in the right eye. Clinical findings and imaging before and after enucleation in the right eye were correlated to histologic and immunohistochemistry sections.Examination and imaging identified a peripheral bilobed amelanotic lesion with low reflectivity on B-scan ultrasound with an associated exudative detachment in the right eye. Additionally, multiple areas of new SLC lesions in the macula and peripapillary region in the right eye and along the inferior arcade in the left eye were observed. Oncologic evaluation confirmed a Class 2, ciliochoroidal melanoma, and the eye was enucleated. Autoimmune and infectious laboratory evaluations for the etiology of the SLC lesions were negative. Histopathology of the enucleated eye confirmed the diagnosis of uveal melanoma with lymphocytic inflammation at the edges of the tumor itself and in the areas of discrete SLC lesions. Immunohistochemistry identified similar predominantly CD3 and CD8 T cells and fewer CD20 B cells in both regions.Serpiginous-like chorioretinitis may present as a paraneoplastic, predominantly T-lymphocyte inflammation associated with intraocular tumor such as uveal melanoma.

The purpose of this study was to adapt and validate the Basic Psychological Needs in Exercise (BPNES) and the Psychological Need Thwarting Scale (PNTS) to merge both measures and create a specific scale for the coaching context. Two studies were conducted. In Study 1, three sports psychologist experts adapted two instruments to analyze the coaches’ psychological needs on a single and multidimensional scale. Also, the content validity and comprehension of the scale were evaluated by 37 coaches ( Mage = 33.03 ± 10.65; work experience = 8.79 ± 6.57 years). In Study 2, we tested other psychometric properties (i.e. confirmatory factor analysis, reliability, and concurrent validity) of the final version of the scale with 352 coaches ( Mage = 32.88 ± 11.14; work experience = 8.03 ± 8.18 years) from four collective sports (soccer = 227; basketball = 69; handball = 43; and volleyball = 13). We tested a first-order six-factor solution of CBPN-Q and an H-CFA by including two second-order latent factors of need satisfaction and need frustration. The first-order six-factor solution obtained a better fit to the model than the H-CFA solution. The standardized factor loadings were positively significant and higher than.47. An adequate internal consistency was also obtained, and the concurrent validity of the scale was calculated with the types of motivation. These findings provide a valid and reliable scale to measure need satisfaction and need frustration in the field of coaching.

A febrero de 2022 el mercado laboral mostró señales de recuperación, con un crecimiento sostenido en el empleo, observado tanto en las encuestas de hogares, como en los distintos registros administrativos. Las diferentes fuentes de información sugieren que el nivel de empleo se encuentra ligeramente por encima del registrado antes de la pandemia. El buen desempeño de la ocupación se observa en las ciudades y el área rural. Asimismo, la mayoría de los sectores económicos registraron aumentos en empleo. Los índices de vacantes, que reflejan la demanda de nuevos puestos de trabajo en el sector formal, reafirman el diagnóstico de un entorno favorable para el empleo. Los mayores crecimientos en las vacantes se presentan en ocupaciones de alto nivel de calificación, entre las cuales se destacan profesionales, científicos e intelectuales, y técnicos. Por el lado de la oferta laboral, también se observa una importante recuperación. Este comportamiento, junto con el mayor dinamismo en el empleo, se refleja en una reducción de la tasa de desempleo (TD) durante los últimos meses. Al desagregar las cifras de desempleo, se observa que la mayor reducción se ha registrado en el dominio urbano. Aunque todavía no se observan cambios importantes en los salarios, tanto los indicadores de holgura, como los de cuellos de botella y la curva de Beveridge muestran un mercado laboral que se va estrechando. Dadas las previsiones en materia de crecimiento económico del equipo técnico del Banco de la República para 2022, consignadas en el Informe de Política Monetaria de abril de 2022, los pronósticos ubican la TD nacional entre el 10 % y 11,9 % en promedio para dicho año. Por su parte, las estimaciones de la tasa de desempleo no inflacionaria (Nairu) sugieren una brecha de desempleo urbana cercanas a cero para 2022. Estas estimaciones indicarían que la menor holgura del mercado laboral ya no estaría generando presiones a la baja en la inflación. Este reporte se divide en dos secciones. En la primera se profundiza en los hechos coyunturales del mercado laboral anteriormente descritos. En la segunda se estudia la actualización de la Gran encuesta integrada de hogares (GEIH) realizada por el DANE, y los principales cambios que se generan en los indicadores del mercado laboral. Además de la actualización del marco geoestadístico y las proyecciones poblacionales construidas a partir del Censo nacional de población de 2018. La actualización de la encuesta sirvió para incorporar recomendaciones de organismos multilat erales, como la Organización Internacional del Trabajo (OIT) y la Organización para la Cooperación y el Desarrollo Económicos (OCDE), con el fin de mejorar la clasificación y caracterización de la población en edad de trabajar (PET), visibilizar estadísticamente a grupos poblacionales y llevar los indicadores del mercado laboral a nuevos estándares internacionales. Los principales cambios encontrados en los indicadores del mercado laboral obedecen a varios factores. En primer lugar, se actualizó el umbral de la PET, disminuyendo el nivel de la población fuera de la fuerza laboral (inactiva), al sustraer a cerca de 2,9 millones de menores entre 10 y 14 años. En segundo lugar, se modificó la forma de clasificar y caracterizar la población ocupada. No obstante, este cambio no parece tener impactos sustanciales en esta población. Así, lo más probable es que los cambios en el nivel de los ocupados que se observan obedezcan a la actualización del marco geoestadístico. Finalmente, la población desempleada es la que menos sufre cambios por la actualización de la encuesta. Adicionalmente, este reporte especial presenta una propuesta provisional de empalme y desestacionalización de los principales agregados del mercado laboral para el estudio de las dinámicas del mismo, que será empleada en este y en reportes futuros, hasta el momento en que el DANE publique series empalmadas y desestacionalizadas oficiales definitivas.

Oncolytic viruses (OVs) encoding a variety of transgenes have been evaluated as therapeutic tools to increase the efficacy of chimeric antigen receptor (CAR)–modified T cells in the solid tumor microenvironment (TME). Here, using systemically delivered OVs and CAR T cells in immunocompetent mouse models, we have defined a mechanism by which OVs can potentiate CAR T cell efficacy against solid tumor models of melanoma and glioma. We show that stimulation of the native T cell receptor (TCR) with viral or virally encoded epitopes gives rise to enhanced proliferation, CAR-directed antitumor function, and distinct memory phenotypes. In vivo expansion of dual-specific (DS) CAR T cells was leveraged by in vitro preloading with oncolytic vesicular stomatitis virus (VSV) or reovirus, allowing for a further in vivo expansion and reactivation of T cells by homologous boosting. This treatment led to prolonged survival of mice with subcutaneous melanoma and intracranial glioma tumors. Human CD19 CAR T cells could also be expanded in vitro with TCR reactivity against viral or virally encoded antigens and was associated with greater CAR-directed cytokine production. Our data highlight the utility of combining OV and CAR T cell therapy and show that stimulation of the native TCR can be exploited to enhance CAR T cell activity and efficacy in mice.

Clinical care pathways and new technologies have decreased the length of stay after many surgeries. However, doubt exists about the safety of shorter hospital stays. We sought to evaluate the feasibility of next-day discharge after minimally invasive partial nephrectomy in a national cohort of US patients and surgeons. Using the National Surgical Quality Improvement Program database, we analyzed patients who underwent minimally invasive partial nephrectomy from 2012 to 2016. Patients were grouped into discharge on post-operative day 1, or discharge on days 2 and 3. Propensity score matching was used to balance patient characteristics and univariable analysis was used to determine the effect of next-day discharge on readmission, post-discharge complications, and major post-discharge complications. A total of 8153 patients were included in the analysis and 4430 were matched. The matched cohort was balanced on all patient and peri-operative characteristics. On univariable analysis, no increase in odds were observed in the next-day discharge group for readmission (odds ratio 0.8; 95% confidence interval 0.6–1.4; p = 0.2), post-discharge complications (odds ratio 1.0; 95% confidence interval 0.7–1.4; p = 0.9), or post-discharge major complications (odds ratio 0.9; 95% confidence interval 0.5–1.4; p = 0.6). Next-day discharge in select patients after minimally invasive partial nephrectomy is effectively being utilized by a large, nationwide cohort of surgeons. This approach is feasible in certain patient populations though further research must determine selection criteria for safe next-day discharge.

Temperature and relative humidity have opposing effects on evaporative water loss, the likely mediator of the temperature-dependence of nephrolithiasis. However, prior studies considered only dry-bulb temperatures when estimating the temperature-dependence of nephrolithiasis. We used distributed lag non-linear models and repeated 10-fold cross-validation to determine the daily temperature metric and corresponding adjustment for relative humidity that most accurately predicted kidney stone presentations during hot and cold periods in South Carolina from 1997–2015. We examined three metrics for wet-bulb temperatures and heat index, both of which measure the combination of temperature and humidity, and for dry-bulb temperatures: (1) daytime mean temperature; (2) 24-hour mean temperature; and (3) most extreme 24-hour temperature. For models using dry-bulb temperatures, we considered four treatments of relative humidity. Among 188,531 patients who presented with kidney stones, 24-hour wet bulb temperature best predicted kidney stone presentation during summer. Mean cross-validated residuals were generally lower in summer for wet-bulb temperatures and heat index than the corresponding dry-bulb temperature metric, regardless of type of adjustment for relative humidity. Those dry-bulb models that additionally adjusted for relative humidity had higher mean residuals than other temperature metrics. The relative risk of kidney stone presentations at the 99(th) percentile of each temperature metric compared to the respective median temperature in summer months differed by temperature metric and relative humidity adjustment, and ranged from an excess risk of 8% to 14%. All metrics performed similarly in winter. The combination of temperature and relative humidity determine the risk of kidney stone presentations, particularly during periods of high heat and humidity. These results suggest that metrics that measure moist heat stress should be used to estimate the temperature-dependence of kidney stone presentations, but that the particular metric is relatively unimportant.

Objective To assess whether discharging patients early after radical cystectomy (RC) is associated with increased risk of readmissions and post-discharge complications. Materials and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried to identify patients who underwent an elective RC from 2012 to 2015. Patients were stratified into two groups: those with hospital length of stay (LOS) of 4-5 days (early-discharge) and those with LOS of 6-9 days (routine-discharge). We used multivariable logistic regressions to assess the impact of early-discharge on 30-day readmission and post-discharge complication rates. Sensitivity analyses and subgroup analyses were performed to validate the robustness of our primary analyses. Results A total of 3,311 patients were included. Unadjusted outcomes comparison showed no difference in readmission rate (21.6% vs. 23.0%) or post-discharge complication rate (17.7% vs. 19.6%) between early-discharge and routine-discharge groups. Multivariable logistic regression also showed early discharge was not associated with increased odds of readmission (OR=1.00, 95%CI=0.82-1.22, P=1.000) or post-discharge complication (OR=0.95, 95%CI=0.77-1.17, P=0.616). Two-step sensitivity analyses (excluding patients with LOS of 8-9 days followed by patients with any pre-discharge adverse event) validated the robustness of our primary analyses. Subgroup analyses also showed similar results in all subgroups except the subgroup of patients with age ≥ 85 years. Conclusions Early discharge after RC was not associated with readmissions or post-discharge complications. Future prospective studies, with defined perioperative care pathways, are needed to identify potential components that may enable hospitals to discharge patients early without compromising post-discharge outcomes. This article is protected by copyright. All rights reserved.

Robot-assisted radical prostatectomy (RARP) has become the preferred surgical treatment for localized prostate cancer in the United States. Little is reported about the association between predischarge outcomes and postdischarge outcomes following RARP. The objective of this study was to explore the predischarge predictors of readmissions and postdischarge complications in RARP.The National Surgery Quality Improvement Program (NSQIP) database was used to identify prostate cancer patients who underwent elective RARP from 2012 to 2014. Multivariable logistic regression was performed to assess potential predischarge predictors of readmissions and NSQIP-defined postdischarge complications within 30 days of RARP. To test the robustness of primary analysis, a secondary multivariable logistic regression was performed in the cohort of patients without any NSQIP-defined predischarge complications.A total of 9975 patients were included. The readmission rate in the cohort was 3.3% (n = 332), and 4.4% (n = 441) had at least one complication. Multivariable logistic regression showed that American Society of Anesthesiologists (ASA) score of 3-4 (odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.00-1.62, p = 0.050), increasing operative time (OT, per minute) (OR = 1.002, 95% CI = 1.000-1.003, p = 0.012), increasing length of hospital stay (LOS, per day) (OR = 1.36, 95% CI = 1.23-1.49, p 0.001), and predischarge complication (OR = 2.15, 95% CI = 1.27-3.65, p = 0.004) were associated with readmission. Increasing OT (OR = 1.002, 95% CI = 1.001-1.004, p = 0.002) and increasing LOS (OR = 1.16, 95% CI = 1.02-1.30, p = 0.020) were associated with postdischarge complications. Logistic regression in patients without predischarge complications (n = 9804) confirmed that ASA score of 3-4 (OR = 1.37, 95% CI = 1.07-1.75, p = 0.013), increasing OT (OR = 1.002, 95% CI = 1.000-1.003, p = 0.022), and increasing LOS (OR = 1.34, 95% CI = 1.21-1.49, p 0.001) were associated with readmissions. Secondary analyses also confirmed that increasing OT (OR = 1.002, 95% CI = 1.001-1.004, p = 0.002) and increasing LOS (OR = 1.18, 95% CI = 1.04-1.34, p = 0.011) were associated with postdischarge complications.Predischarge complications, OT, and LOS are associated with readmissions and postdischarge complications after RARP. It may be possible to identify patients at a higher risk of postdischarge adverse events to direct prevention interventions. Further prospective studies are needed to validate our findings.

Background and aim: Compared to female mammals, males have greater evaporative water loss and renal water reabsorption, which affects urine volume, a determinant of kidney stone formation. In this ...

PURPOSE To investigate the impact of hospital volume on short-term outcomes after cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC). METHODS We identified mRCC patients who underwent CN from 2006 to 2013 in the National Cancer Database. Annual hospital CN volume was categorized as high (top 20th percentile) and low. Multivariable logistic regressions were used to compare 30-day mortality, 90-day mortality, prolonged length of stay (PLOS, ≥7 days), and 30-day readmission rates. Sensitivity analyses were performed with hospital volume considered as a continuous variable. RESULTS A total of 9789 patients were included with high-volume (n = 1916) defined as ≥8 cases and low-volume (n = 7873) as 1-7 cases annually. Multivariable logistic regression showed that high-volume was associated with lower odds of 30-day mortality (OR = 0.69, P = 0.013), 90-day mortality (OR = 0.65, P

OBJECTIVE To evaluate the impact of hospital volume on outcomes of robot-assisted partial nephrectomy (RAPN). MATERIALS AND METHODS Patients with renal cell carcinoma who underwent RAPN between 2010 and 2013 were identified in the National Cancer Database. Hospital yearly RAPN volume was categorized into groups by sorting patients as closely as possible into five groups of equal size (quintiles): very low; low; medium; high; and very high volume. Outcomes included 30-day mortality, 90-day mortality, open conversion, prolonged length of hospital stay (PLOS; defined as >3 days), 30-day readmission rate, and positive surgical margin (PSM) rate. Unadjusted analyses and multivariable logistic regressions were used to compare outcomes. Sensitivity analyses with hospital volume considered as a continuous variable were also performed. RESULTS A total of 18 724 RAPN cases were included. Hospital volume quintiles were: very low volume, 1-7 cases (n = 3 693); low volume, 8-14 cases (n = 3 719); medium volume, 15-23 cases (n = 3 833); high volume, 24-43 cases (n = 3 649); and very high volume, ≥44 cases (n = 3 830). There was no significant difference in 30-day or 90-day mortality among the five groups. Multivariable logistic regression analysis (reference: very low volume) showed that higher hospital volume was associated with lower odds of conversion (low [odds ratio {OR}: 0.88; P = 0.377]; medium [OR: 0.60; P = 0.001]; high [OR: 0.57; P < 0.001]; very high [OR: 0.47; P < 0.001]), lower odds of PLOS (low [OR: 0.93; P = 0.197], medium [OR: 0.75; P < 0.001]; high [OR: 0.62; P < 0.001]; very high [OR: 0.45; P < 0.001]), and lower odds of PSMs (low [OR: 0.76; P < 0.001]; medium [OR: 0.76, P < 0.001]; high [OR: 0.59; P < 0.001]; very high [OR: 0.34; P < 0.001]). Sensitivity analyses confirmed increasing hospital volume (per 1-case increase) was associated with lower odds of conversion (OR: 0.986; P < 0.001), PLOS (OR: 0.989; P < 0.001) and PSMs (OR: 0.984; P < 0.001). A difference in 30-day readmission rate was found in unadjusted analysis but not in adjusted analyses. CONCLUSION Undergoing RAPN at higher-volume hospitals may have better peri-operative outcomes (conversion to open and LOS) and lower PSM rates. Future studies are needed to explore the detailed components that lead to the superior outcomes in higher-volume hospitals.

OBJECTIVE: We sought to determine the prevalence of initial computed tomography (CT) utilization and to identify regions in the United States where CT is highly used as the first imaging study for children with nephrolithiasis. METHODS: We performed a cross-sectional study in 9228 commercially insured children aged 1 to 17 years with nephrolithiasis who underwent diagnostic imaging in the United States between 2003 and 2011. Data were obtained from MarketScan, a commercial insurance claims database of 17 827 229 children in all 50 states. We determined the prevalence of initial CT use, defined as CT alone or CT performed before ultrasound in the emergency department, inpatient unit, or outpatient clinic, and identified regions of high CT utilization by using logistic regression. RESULTS: Sixty-three percent of children underwent initial CT study and 24% had ultrasound performed first. By state, the proportion of children who underwent initial CT ranged from 41% to 79%. Regional variations persisted after adjusting for age, gender, year of presentation, and insurance type. Relative to children living in West South Central states, the highest odds of initial CT utilization were observed for children living in the East South Central US Census division (odds ratio: 1.27; 95% confidence interval: 1.06–1.54). The lowest odds of initial CT were observed for children in the New England states (odds ratio: 0.48; 95% confidence interval: 0.38–0.62). CONCLUSIONS: Use of CT as the initial imaging study for children with nephrolithiasis is highly prevalent and shows extensive regional variability in the United States. Current imaging practices deviate substantially from recently published guidelines that recommend ultrasound as the initial imaging study.

Tamsulosin is associated with increased passage of ureteral stones in adults but its effectiveness in children is uncertain. We determined the association between tamsulosin and the spontaneous passage of ureteral stones in children.We performed a multi-institutional retrospective cohort study of patients 18 years or younger who presented between 2007 and 2012 with ureteral stones up to 10 mm and who were treated with tamsulosin or oral analgesics alone. The outcome was spontaneous stone passage, defined as radiographic clearance and/or patient report of passage. Subjects prescribed tamsulosin were matched with subjects prescribed analgesics alone, using nearest neighbor propensity score matching to adjust for treatment selection. Conditional logistic regression models were used to estimate the association between tamsulosin and spontaneous passage of ureteral stones, adjusting for stone size and location.Of 449 children with ureteral stones 334 were eligible for inclusion, and complete data were available for 274 patients from 4 institutions (99 receiving tamsulosin, 175 receiving analgesics alone). Following case matching, there were no differences in age, gender, weight, height, stone size or stone location between the 99 subjects prescribed tamsulosin and the 99 propensity score matched subjects prescribed analgesics alone. In the tamsulosin cohort 55% of ureteral stones passed, compared to 44% in the analgesics alone cohort (p=0.03). In multivariate analysis adjusting for stone size and location tamsulosin was associated with spontaneous passage of ureteral stones (OR 3.31, 95% CI 1.49-7.34).The odds of spontaneous passage of ureteral stones were greater in children prescribed tamsulosin vs analgesics alone.

The role of pre- and post-test counselling in new HIV testing strategies to reduce delayed diagnosis has been debated. Data on time devoted to counselling are scarce. One approach to this problem is to explore patients' views on the time devoted to counselling by venue of their last HIV test.We analysed data from 1568 people with a previous HIV test who attended a mobile HIV testing program in Madrid between May and December 2008.The majority (71%) were men (48% had had sex with other men), 51% were30 years, 40% were foreigners, 56% had a university degree, and 40% had the most recent HIV test within the last year. As regards pre-test counselling, 30% stated they were told only that they would receive the test; 26.3% reported10 min; 20.4% about 10 min; and 24.2%, 15 min or more. For post-test counselling: 40.2% stated they were told only that the test was negative; 24.9% reported 2-6 min; 16.4% about 10 min; and 18.5%, 15 min or more. The percentage of participants who reported no counselling time was higher among those tested in general health services: primary care, hospital settings and private laboratories (over 40% in pre-test, over 50% in post-test counselling). Women received less counselling time than men in almost all settings.Policies to expand HIV testing in general health services should take this current medical behaviour into account. Any mention of the need for counselling can be a barrier to expansion, because HIV is becoming less of a priority in developed countries. Oral consent should be the only requirement.

Under consideration of the conceptual model of cohesion (Carron & Eys, 2012), this study examined how perceptions of ambiguity and role conflict can predict group cohesion and how it could influence transactive memory and collective efficacy in female sport teams. The participants were 225 professional female soccer players (M = 22.20, SD = 4.61). Each individual belonged to one of 13 federate teams that participated in the First Division of the Spanish Women’s Soccer League. The structural equation model showed that members that perceived greater ambiguity and role conflict perceive less task cohesion with their teams. Additionally, individuals who feel more united with their team and are willing to work in a collaborative manner state that a greater transactive memory in regards to performing tasks and greater collective efficacy in realizing these tasks exist. The results suggest that the group leaders in female sports teams will have to make an effort to define the roles of each member of the team to improve the union and group work, because these factors are linked to the capacity of sharing knowledge among group members and the confidence in abilities when facing team work.

Purpose To evaluate the impact of surgical waiting time (SWT) on the survival outcome in patients with upper tract urothelial carcinoma (UTUC). Materials and methods We identified patients with nonmetastatic UTUC who underwent radical nephroureterectomy (RNU) between 2004 and 2013 in the National Cancer Database. The association between SWT and overall survival (OS) was evaluated using Cox proportional hazards regression. SWT was categorized into 6 groups: SWT ≤ 7 days, SWT 8 to 30 days, SWT 31 to 60 days, SWT 61 to 90 days, SWT 91 to 120 days, and SWT 121 to 180 days. Multivariable analyses were adjusted for patient, tumor, and facility-related factors. Results A total of 3,581 patients were included in the final overall cohort and 2,397 (66.9%) patients had the higher-risk disease (high-grade or ≥pT2). Multivariable Cox regressions showed that patients in the groups of SWT 31 to 60 days, SWT 61 to 90 days, and SWT 91 to 120 days had similar OS compared with patients who had SWT of 8 to 30 days in the overall cohort and higher-risk cohort. Patients with SWT 121 to 180 days had worse OS (HR = 1.61, 95% CI: 1.19–2.19, P = 0.002 in the overall cohort; HR = 1.56, 95% CI: 1.11–2.20, P = 0.010 in the higher-risk cohort). Conclusions Increased SWT from diagnosis to RNU appears to be not associated with worse OS within 120 days after the diagnosis of UTUC but SWT>120 days may be associated with worsened survival. These findings might have important implications for trial design in the evaluation of neoadjuvant chemotherapy for UTUC and future clinical practice.

In recent years, the immigrant population has substantially increased in Spain. However, there is a lack of information in the knowledge of alcohol abuse among Spanish immigrants. We describe the epidemiology of alcohol abuse among foreign-born immigrants versus Spanish natives. We carried out a cross-sectional study that uses data from the European Survey of Health on the General Population of Spain of 2009. A sample of 22,188 subjects was analyzed (of whom, 3,162 were foreign). Proxies of problematic alcohol consumption were the prevalence of excessive average consumption and the prevalence of excessive episodic consumption (binge drinking). Descriptive analysis of the population, determination of area of origin with major alcohol consumption and related factors for each kind of consumption, separating immigrant and native population, were performed. The immigrant profile was heterogeneous, though predominantly aged between 35 and 54, and were living with their family and working. 3.4% of immigrants and 3.2% of natives were considered excessive drinkers; 8.9% and 10%, respectively, reported binge drinking in the last year. Immigrants from Northern and Western Europe, and Latin America, Andean countries had significantly a higher report of frequent alcohol consumption and/or binge drinking compared to native. On the contrary, born in Africa was a protective factor. Unemployment was the most relevant related factor, being more important in the immigrant population. The excessive alcohol consumption in immigrants is dissimilar; the interventions must be adapted to their social situation, environments and areas of origin.A pesar del gran incremento de la población inmigrante en los últimos años, su uso de alcohol está poco estudiado. Se describe la epidemiología del consumo de riesgo de alcohol en la población inmigrante residente en España, frente a la nativa. Se emplearon datos de 22188 respondentes a la Encuesta Europea de Salud de 2009, de los que 3162 eran extranjeros. Como indicadores de consumo problemático se usó la prevalencia de consumo excesivo promedio y el consumo excesivo episódico. Se realizaron análisis descriptivo de la población, determinación de zonas de procedencia con mayor consumo de alcohol y factores relacionados para cada tipo de consumo separando población inmigrante de autóctona. El perfil sociodemográfico del inmigrante fue heterogéneo, aunque predominantemente de entre 35 y 54 años, que vive en familia y trabaja. Se consideraron bebedores excesivos promedio al 3,4% de los inmigrantes por el 3,2% de los nativos, y bebedores excesivos episódicos en el último año el 8,9% frente al 10%. Los inmigrantes procedentes de Europa del Norte y del Oeste, y América latina, países andinos, fueron aquellos que presentaron mayores razones de prevalencia de bebedores de riesgo que la población nativa. Por el contrario, proceder de África fue un factor protector. De los factores relacionados con un mayor consumo, destaca el desempleo, siendo más relevante en la población inmigrante. El consumo excesivo de alcohol en inmigrantes es muy heterogéneo, debiendo adecuarse las intervenciones sobre el mismo a su situación social, diferentes entornos y áreas de procedencia.

This paper presents a framework for segmentation of renal parenchymal area from ultrasound images based on a 2-step level set method. We used distance regularized level set evolution method to partition the kidney boundary, followed by region-scalable fitting energy minimization method to segment the kidney collecting system, and determined renal parenchymal area by subtracting the area of the collecting system from the gross kidney area. The proposed method demonstrated excellent validity and low inter-observer variability.

Ecthyma gangrenosum (EG) is a cutaneous infection most commonly associated with Pseudomonas aeruginosa sepsis. EG generally occurs in immunocompromised hosts, such as patients with severe neutropenia. EG presents as erythematous, hemorrhagic, or necrotic macules or plaques most commonly in the perineal or gluteal areas, but can occur elsewhere. EG is a dermatologic emergency in immunocompromised patients and should be included in the differential diagnosis when urologists are asked to evaluate perineal lesions. We describe the case of a highly immunocompromised infant with labial EG to highlight the importance of prompt clinical diagnosis and of multi-disciplinary medical and surgical management.

Background and objectives Approximately 20% of boys with posterior urethral valves develop ESRD; however, few factors associated with the risk of ESRD have been identified. The objective of this study was to determine if renal parenchymal area, defined as the area of the kidney minus the area of the pelvicaliceal system on first postnatal ultrasound, is associated with the risk of ESRD in infants with posterior urethral valves. Design, setting, participants, & measurements A retrospective cohort of boys who were diagnosed with posterior urethral valves at less than 6 months of age between 1988 and 2011 and followed for at least 1 year at a freestanding children’s hospital was assembled. Cox proportional hazard regression and Kaplan–Meier analysis were used to estimate the association between renal parenchymal area and time to ESRD. Cox models were adjusted for age at presentation, minimum creatinine 1 month after bladder decompression, and vesicoureteral reflux. Results Sixty patients were followed for 393 person-years. Eight patients developed ESRD. Median renal parenchymal area was 15.9 cm2 (interquartile range=13.0–21.6 cm2). Each 1-cm2 increase in renal parenchymal area was associated with a lower risk of ESRD (hazard ratio, 0.64; 95% confidence interval, 0.42 to 0.98). The rate of time to ESRD was 10 times higher in boys with renal parenchymal area,12.4 cm2 than boys with renal parenchymal area$12.4 cm2 (P,0.001). Renal parenchymal area could best discriminate children at risk for ESRD when the minimum creatinine in the first 1 month after bladder decompression was between 0.8 and 1.1 mg/dl. Conclusion In boys with posterior urethral valves presenting during the first 6 months of life, lower renal parenchymal area is associated with an increased risk of ESRD during childhood. The predictive ability of renal parenchymal area, which is available at time of diagnosis, should be validated in a larger, prospectively-enrolled cohort.

Background: High ambient temperatures are a risk factor for nephrolithiasis, but the precise relationship between temperature and kidney stone presentation is unknown. Objectives: Our objective was to estimate associations between mean daily temperature and kidney stone presentation according to lag time and temperatures. Methods: Using a time-series design and distributed lag nonlinear models, we estimated the relative risk (RR) of kidney stone presentation associated with mean daily temperatures, including cumulative RR for a 20-day period, and RR for individual daily lags through 20 days. Our analysis used data from the MarketScan Commercial Claims database for 60,433 patients who sought medical evaluation or treatment of kidney stones from 2005–2011 in the U.S. cities of Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Los Angeles, California; and Philadelphia, Pennsylvania. Results: Associations between mean daily temperature and kidney stone presentation were not monotonic, and there was variation in the exposure–response curve shapes and the strength of associations at different temperatures. However, in most cases RRs increased for temperatures above the reference value of 10°C. The cumulative RR for a daily mean temperature of 30°C versus 10°C was 1.38 in Atlanta (95% CI: 1.07, 1.79), 1.37 in Chicago (95% CI: 1.07, 1.76), 1.36 in Dallas (95% CI: 1.10, 1.69), 1.11 in Los Angeles (95% CI: 0.73, 1.68), and 1.47 in Philadelphia (95% CI: 1.00, 2.17). Kidney stone presentations also were positively associated with temperatures < 2°C in Atlanta, and < 10°C in Chicago and Philadelphia. In four cities, the strongest association between kidney stone presentation and a daily mean temperature of 30°C versus 10°C was estimated for lags of ≤ 3 days. Conclusions: In general, kidney stone presentations increased with higher daily mean temperatures, with the strongest associations estimated for lags of only a few days. These findings further support an adverse effect of high temperatures on nephrolithiasis. Citation: Tasian GE, Pulido JE, Gasparrini A, Saigal CS, Horton BP, Landis JR, Madison R, Keren R, for the Urologic Diseases in America Project. 2014. Daily mean temperature and clinical kidney stone presentation in five U.S. metropolitan areas: a time-series analysis. Environ Health Perspect 122:1081–1087; http://dx.doi.org/10.1289/ehp.1307703

La toma de decisiones de politica economica requiere estimaciones del comportamiento de la actividad economica en tiempo real. Sin embargo, la informacion utilizada solo esta disponible a nivel de indicadores de actividad y de encuestas de opinion, los cuales suelen tener distintas frecuencias y rezagos de publicacion, ademas de choques idiosincraticos. En este trabajo se adaptan para la economia colombiana los esquemas de pronostico de Camacho y Perez-Quiros (2009,2010) que producen estimaciones del crecimiento del PIB en tiempo real. El modelo de factores dinamicos adaptado involucra series de actividad de diferente frecuencia, disponibilidad y procedencia, empleadas con la informacion disponible en el momento de cada publicacion. La evaluacion de pronostico sugiere que el modelo presenta un mejor desempeno frente a otros esquemas de referencia, y que la precision de los pronosticos aumenta al incorporar el flujo de informacion en tiempo real de los indicadores de actividad.