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Obstructive Sleep Apnea Syndrome (OSAS) or Apnea-Hypoapnea Syndrome (SAHS) is one of the most prevalent sleep disorders in the general population. It is associated with an increase in the prevalence of difficult orotracheal intubation and postoperative complications. The application of validated early detection tests, such the STOPbang test in English (STBC), is recommended; a test of high methodological quality, sensitivity and specificity in the early detection of SAHS in both surgical and general populations.The validation, translation, cross-cultural adaptation of the STBC to the Spanish population.The transcultural adaptation of the STBC to Spanish was carried out and a subsequent validation study with 77 consecutive patients was carried out. The statistical analysis evaluated the reliability, validity and feasibility of the translated and culturally adapted version.44% of women and 56% of men were included, with a mean age of 53.58 ± 12.88 years. The reliability results were: a Cronbach's Alpha Coefficient of 0.767, a Pearson correlation r = 0.777 (P.001) and a Sperman correlation rho = 0.455 (P = .044). The feasibility of the study was 100%. Criterion validity was evaluated using the Kappa coefficient, which was 0.444. For a score3 of the questionnaire adapted to Spanish, the results of sensitivity, specificity according to the different cut-off levels of the apnea hypopnea index (AHI)5,15,30) were: Sensitivity 87%, 91% and 100% respectively and Specificity of 50%, 31% and 22%.The STBC questionnaire translated, adapted and validated into Spanish, evaluated in the present study, is reliable and valid with respect to the original design of the questionnaire. It is a useful tool that is easy to understand and implement, which can be used rigorously to stratify surgical risk and carry out adequate perioperative planning of those patients at risk of SAHS.

Drug addiction is a worldwide phenomenon that specifically besets the global society a great deal such that the government waged war against it. While eradicating illicit drugs entirely is quite challenging, this study aims to look at it eruditely from the lens of psychology by investigating the associated "needs" that push people towards drug addiction. The study performed a series of focused-group discussions with 22 stakeholders of Mega Drug Abuse Treatment and Rehabilitation Center, one of the biggest in the country, consisting of ten Persons Who Use Drugs (PWUDs) and two of their close relatives, three reformed users, one psychologist, two psychometricians, two nurses, and two social workers. Data were analyzed using Interpretative Phenomenological Analysis (IPA). Trustworthiness was secured through triangulation methods ("member checking," "peer debriefing," "audit trailing," and literature review). Results yielded 35 various themes grouped accordingly to 16 subordinate themes and finally, three superordinate themes. Overall, the data showed that drug addiction might be best viewed in terms of psychologically-oriented needs themed into three dynamics: intrapersonal – those factors that originated from within the PWUDs, interpersonal – those factors that relate to the PWUDs' interaction (or lack thereof) with others, and milieu-related – those factors that refer to the PWUDs' macro-level socio-economic situations that affect their efforts against, predisposes them to, and perpetuate the illicit drug use. In conclusion, the nature of drug addiction, even from the psychological viewpoint, considerably has multi-layered and -faceted underpinnings. Pertinent recommendations as to how these data can be used for further practice were elucidated.

Funding Acknowledgements Type of funding sources: None. Background Remote monitoring of implantable cardiac devices (CIEDs) has proven to be reliable, more efficient and even safer than conventional in-office follow-ups However, its implementation has not been as desired. The COVID 19 pandemic and the need to keep patients away from hospitals may have been the final boost for this form of monitoring. Purpose We sought to evaluate the pre and post-pandemic trends in CIEDs remote monitoring activations from a large nationwide database in order to determine the global effect of the COVID-19 pandemic on CIEDs implants in Spain. Methods The Covid-19 Remote Monitoring Spain Registry (Covid-19 RM-Spain) is a survey supported by the Heart Rhythm Association of the Spanish Society of Cardiology to request the whole national data, regarding the number of CIED´s implants and remote monitoring activations from the five main manufacturers classified according to each autonomous community (not by institutions).All data were aggregated and anonymized to analyse the total sample. Appropriate permissions were granted to use the data and a confidentiality agreement was signed in order to avoid any transmission of sensitive information. Results The percentage of devices for which remote monitoring was activated was 24.5%; 28.4%, 42% and 49% in 2018, 2019 ,2020 and 2021, which implies that remote monitoring is now activated on more than twice as many devices in Spain as in 2018. The table shows the differences in the percentages of remote monitoring activation between three different periods for each type of device. (Period 1 /pre-lockdown January 2018-February 2021; Period 2/ lockdown: March-June 2020 and Period 3/ lockdown: July 2020-December 2021. Footnotes: Period A vs. B p Abbreviations : CRT-D: Cardiac resynchronization Therapy -Desfibrillator; CRT-P: Cardiac resynchronization Therapy -pacemaker; ICD: Implantable cardiac defibrillators; ILR: Implantable Loop recorders; LLPM: Leadles Pacemakers; PM: Pacemakers; S-ICD: Subcutaneous Implantable cardiac defibrillator.

Funding Acknowledgements Type of funding sources: None. Background The Covid-19 pandemic has meant a very significant reduction in all urgent and non-urgent activity, including the implants of Cardiac Implantable electronic devices (CIEDs) throughout 2020. From the end of 2020 and throughout the year 2021, hospital activity has normalised, but it is uncertain whether the devices that were not implanted within 2020 have been delayed in time or actually lost. Purpose We sought to evaluate the pre and post-pandemic trends in CIEDs implantations from a large nationwide database in order to determine the global effect of the COVID-19 pandemic on CIEDs implants in Spain. Methods The Covid-19 Remote Monitoring Spain Registry (Covid-19 RM-Spain) is a survey supported by the Heart Rhythm Association of the Spanish Society of Cardiology to request the whole national data regarding the number of CIED´s implants and remote monitoring activations from the five main manufacturers classified according to each autonomous community (not by institutions).All data were aggregated and anonymized to analyse the total sample. Appropriate permissions were granted to use the data and a confidentiality agreement was signed in order to avoid any transmission of sensitive information. Results No institution objected to the use of their data, so the total number of devices implanted in Spain were obtained, which were 50258, 52994, 47330 and 54490 in 2018, 2019, 2020 and 2021 respectively. When we try to balance the drop in implants during 2020 and the subsequent increase experienced during 2021 against the average of 2018 and 2019, we have observed that approximately 2600 pacemakers (7%) and about 150 defibrillators (3.1%) have been "lost". With regard to the rest of the devices, adding up the differences between 2020 and 2021 and comparing them with the average for 2018-19, an increase of 419 Cardiac Resynchronization defibrillators (18%), 130 Cardiac Resynchronization Pacemakers (9.4%) and 1189 Implantable Loop recorders ( 26%) have been observed. Conclusion(s) In 2020 there was a large reduction in all CIEDs implants. In the most numerous devices (pacemakers), unlike the rest, the increment has not compensated for the reduction in implants that occurred in 2020 by the end of 2021. The marked increase in the number of cardiac resynchronization implants may suggest that the indication for single or dual-chamber defibrillator implantation may have finally evolved in a significant number of patients into an indication for cardiac resynchronization. Abbreviations: CRT-D: Cardiac resynchronization Therapy -Desfibrillator; CRT-P: Cardiac resynchronization Therapy -pacemaker; ICD: Implantable cardiac defibrillators; ILR: Implantable Loop recorders; LLPM: Leadles Pacemakers; PM: Pacemakers; S-ICD: Subcutaneous Implantable cardiac defibrillator.

Analysis of the dipicolinic acid (DPA) released from Clostridium botulinum spores during thermal processing is crucial to obtaining a mechanistic understanding of the factors involved in spore heat resistance and related food safety applications. Here, we developed a novel mixed-mode liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for detection of the DPA released from C. botulinum type A, nonproteolytic types B and F strains, and nonpathogenic surrogate Clostridium sporogenes PA3679 spores. DPA was retained on a mixed-mode C18/anion exchange column and was detected using electrospray ionization (ESI) positive mode within a 4-min analysis time. The intraday and interday precision (%CV) was 1.94-3.46% and 4.04-8.28%, respectively. Matrix effects were minimal across proteolytic type A Giorgio-A, nonproteolytic types QC-B and 202-F, and C. sporogenes PA3679 spore suspensions (90.1-114% of spiked DPA concentrations). DPA recovery in carrot juice and beef broth ranged from 105 to 118%, indicating limited matrix effects of these food products. Experiments that assessed the DPA released from Giorgio-A spores over the course of a 5-min thermal treatment at 108 °C found a significant correlation (R = 0.907; P 0.05) between the log reduction of spores and amount of DPA released. This mixed-mode LC-MS/MS method provides a means for rapid detection of DPA released from C. botulinum spores during thermal processing and has the potential to be used for experiments in the field of food safety that assess the thermal resistance characteristics of various C. botulinum spore types.

Retrospective impact evaluation of frailty as measured by the Memorial Sloan Kettering Frailty Index (MSK-FI) on outcomes in older women surgically treated for advanced epithelial ovarian cancer (EOC). Women ≥ 60 years with stage IIIC/IV EOC who underwent primary debulking surgery (PDS) or interval debulking surgery (IDS) were included. Medical records were reviewed for patients’ characteristics and outcomes. We retrospectively applied the MSK-FI which included 10 comorbidities and functional assessment that were extracted from medical records. The MSK-FI ranges from 0 to 11; a score of ≥ 3 was considered frail. Associations were assessed using logistic regression and Cox proportional hazards regression. We identified 79 patients treated with PDS (n = 36, 45.5%) or IDS (n = 43, 54.4%) with complete data. The prevalence of frailty based on MSK-FI was 25%. Almost half of the frail patients (47.3%) were admitted to the ICU compared to 16% of non-frail patients (p = 0.006). In univariable analysis, the MSK-FI was associated with postoperative complications [OR 1.57 (95% CI 1.04–2.37), p = 0.03] and ICU admission [OR 2.05 (95% CI 1.30–3.23), p = 0.002], but not with readmission rate [OR 1.29 (95% CI 0.65–2.59), p = 0.5], postoperative mortality [OR 1.02 (95% CI 0.51–2.00), p = 0.9], and hospital stay [β 0.60 (95% CI − 1.19–2.41)]. In multivariable analysis, the frailty index was independently associated with postoperative complications [OR 1.54 (95% CI 1.02–2.34), p = 0.04] and ICU admissions [OR 1.97 (95% CI 1.23–3.16), p = 0.004]. Frailty, based on the Memorial Sloan Kettering Frailty Index, is associated with adverse postoperative outcomes in older women with advanced ovarian cancer, suggesting that MSK-FI can improve the predictive ability of current surgical assessment tools.

Resumen: Introducción y objetivo: El estándar de tratamiento para la enfermedad de la vesícula biliar es la colecistectomía laparoscópica. Una disección del triángulo hepatocístico complicada con sangrado puede resultar en conversión a cirugía abierta durante el procedimiento, la cual se asocia a una mayor morbilidad. La identificación de factores de riesgo por la conversión en el contexto de colecistitis aguda permitirá individualizar el cuidado del paciente y mejorar los resultados. Materiales y métodos: Estudio retrospectivo de casos y controles que incluyó a todos los pacientes admitidos en un centro académico de tercer nivel desde enero de 1991 hasta enero de 2012 con diagnóstico de colecistitis aguda según las guías de Tokio 2018. Analizamos las variables utilizando regresión logística para identificar los factores de riesgo para conversión. Las variables que se identificaron como predictores de conversión significativos en el análisis univariado fueron incluidas en un modelo multivariado. Finalmente realizamos un análisis exploratorio para identificar la sumatoria de factores con mayor sensibilidad para conversión. Resultados: El estudio incluyó a 321 pacientes con colecistitis aguda. La edad promedio fue de 49 años (DE: ± 16.8). El 65% fueron del sexo femenino y el 35% del sexo masculino. Treinta y nueve casos (12.14%) se convirtieron a cirugía abierta. En el análisis univariado, la mayor edad, el sexo masculino, el grosor de pared vesicular y el líquido pericolecístico se asociaron con un mayor riesgo de conversión. En el análisis multivariado, todas las variables con excepción del líquido pericolecístico mantuvieron asociación con conversión. Nuestro modelo de predicción de riesgo demostró una sensibilidad del 84%. Conclusiones: Es posible utilizar datos clínicos preoperatorios para identificar a pacientes que tienen un mayor riesgo de conversión a cirugía abierta. Conocer dichos factores puede mejorar la planeación del plan quirúrgico y estar preparados para casos desafiantes. Abstract: Introduction and aims: The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes. Materials and methods: A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion. Results: The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%. Conclusions: Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.

Excessive use of insecticides has led to resistance of some pathogenic organisms (nematodes, bacteria and fungi), environmental contamination, and the presence of hazardous residues. Therefore, the aim of the present study was to evaluate synthetic metabolites derived from previous studies with edible mushrooms against the soybean weevil Rhyssomatus nigerrimus Fahraeus (Curculonidae) because of the relevance of pest control in an economically important crop. Furthermore, this is one of the first studies where edible fungal molecules are evaluated for the control of these insects. Initially, two in vitro tests (toxic effect and immersion) were evaluated against R. nigerrimus. In these tests, sensitivity and viability were determined in the 2% Tween control in water. For these two tests, the synthetic metabolites pentadecanoic acid (PNA), palmitic acid (PMA), stearic acid (STA), linoleic acid (LNA), β-sitosterol (βT) were evaluated individually as well as in combinations, “the fraction of standards (E1)”. Based on the results obtained, the dip test was selected to evaluate the mixtures of two standards (1. PMA + βT, 2. PMA + PNA, 3. PMA + LNA, 4. PMA + STA, 5. STA + βT, 6. STA + PNA, 7. STA + LNA, 8. PNA + βT, 9. PNA + LNA, 10. LNA + βT), three (1. PNA + βT + LNA, 2. PNA + βT + STA, 3. STA + LNA + PNA and 4. STA + LNA + βT) and four (PNA, βT, LNA and STA). The results showed that the mixture of three standards caused a higher percentage of mortality relative to the control group: l. PNA + βT + LNA and 2. PNA + βT + STA with 54.44 and 48% mortality of R. nigerrimus insects exposed for 15 days. These results show the importance of evaluating mixtures of molecules against R. nigerrimus. Resumo O uso excessivo de inseticidas levou à resistência de alguns organismos patogênicos (nematódeos, bactérias e fungos), à contaminação ambiental e à presença de resíduos perigosos. Portanto, o objetivo do presente estudo foi avaliar a mortalidade de metabólitos sintéticos derivados de estudos anteriores com cogumelos comestíveis contra o gorgulho-da-soja Rhyssomatus nigerrimus Fahraeus (Curculonidae) por causa da relevância do controle de pragas em uma cultura economicamente importante. Além disso, este é um dos primeiros estudos em que as moléculas fúngicas comestíveis são avaliadas para o controle desses insetos. Inicialmente, dois testes in vitro (efeito tóxico e imersão) foram avaliados contra R. nigerrimus. Nesses testes, a sensibilidade e a viabilidade foram determinadas no controle de 2% de Tween na água. Para esses dois testes, os metabólitos sintéticos – ácido pentadecanoico (PNA), ácido palmítico (PMA), ácido esteárico (STA), ácido linoleico (LNA) e β-sitosterol (βT) – foram avaliados individualmente, bem como a combinação dos 5, “a fração de padrões (E1)”. Com base nos resultados obtidos, o teste de imersão foi selecionado para avaliar as misturas de dois padrões (1. PMA + βT, 2. PMA + PNA, 3. PMA + LNA, 4. PMA + STA, 5. STA + βT, 6. STA + PNA, 7. STA + LNA, 8. PNA + βT, 9. PNA + LNA, 10. LNA + βT), três (1. PNA + βT + LNA, 2. PNA + βT + STA, 3. STA + LNA + PNA e 4. STA + LNA + βT) e quatro (PNA, βT, LNA e STA). Os resultados mostraram que a mistura de três padrões foi a com maior porcentagem de mortalidade em relação ao grupo controle, quais sejam, l. PNA + βT + LNA e 2. PNA + βT + STA, com 54,44% e 48% de mortalidade, respectivamente, em uma exposição de 15 dias contra R. nigerrimus. Estes resultados mostram a importância de avaliar as misturas entre moléculas contra R. nigerrimus.

The shape memory (SM) capabilities of nanocomposites based on two photocurable acrylated/methacrylated resins, doped with carbon nanotubes (CNTs), and manufactured by digital light processing 3D printing were investigated. The mechanical properties and glass transition temperature (Tg) can be tailored in a broad range by varying the weight ratio of the two resins (Tg ranging from 15 to 190 °C; Young’s modulus from 1.5 to 2500 MPa). Shape fixity (SF) and recovery (SR) ratios are strongly influenced by the temperature being significantly higher at temperatures close to the Tg. The results confirm that the SF strongly depends on the stiffness of chain segments between cross-linking points, whereas the SR mainly depends on the cross-link density of the network. CNT addition barely affects the SF and SR in the conventional oven, whereas the recovery speed using IR heating is significantly increased for the doped nanocomposites due to their higher IR absorbance.

Background: In Mexican traditional medicine, Cecropia obtusifolia is extensively used, from central to southeast regions, to treat diabetes and some inflammation-related disorders, including renal illness and obesity. Objective: To evaluate the effect of the hydroalcoholic and methanolic extracts, standardized in chlorogenic acid, on some metabolic syndrome-related signs induced by hypercaloric diet in mice. Methods: C57BL/6 mice were administered the hydroalcoholic or the methanolic extract for 8 weeks. The data were analyzed with a one-way ANOVA followed by Tukey post hoc test. Results: Methanolic extract was able to reduce insulin resistance, clotting time, adipose tissue content, food consumption, weight gain, and hypertension. It also decreased renal inflammation, as assessed by the quantification of TNF-α, IL-6, and IL-10. On the other hand, the hydroalcoholic extract, vs negative control, decreased IL-6 (-60.4%) and TNF-α (-82.1%) and increased IL-10 (39.1%). Conclusion: Overall, the methanolic extract had higher efficacy, since it reduced insulin resistance and visceral fat and showed a tendency to reduce clotting time, which may be related to improve liver function. Peer Review History: Received: 11 July 2022; Revised: 15 August; Accepted: 8 September, Available online: 15 September 2022 Academic Editor: Dr. Amany Mohamed Alboghdadly, Princess Nourah bint abdulrahman university, Riyadh, amalbgadley@pnu.edu.sa UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. Nazim Hussain, North East Frontier Technical University, Arunachal pradesh, India, nhussain116@gmail.com Prof. Dr. Ali Gamal Ahmed Al-kaf, Sana'a university, Yemen, alialkaf21@gmail.com Dr. Sangeetha Arullappan, Universiti Tunku Abdul Rahman, Malaysia, sangeetha@utar.edu.my Similar Articles: EVALUATION OF METABOLIC SYNDROME IN HEALTHY YEMENI POPULATIONS

SUMMARYThe circadian clock is a time-tracking endogenous system which anticipates and coordinates adaptation to daily environmental fluctuations. Circadian misalignment leads to obesity, which is accompanied by reduced levels of the clock-controlled metabolite NAD+. Concomitantly, increasing NAD+ levels is emerging as a therapy for diet-induced obesity and type 2 diabetes; however, the impact of daily fluctuations of NAD+ on these therapies remains unknown. Here, we demonstrate that time-of-day determines the efficacy of NAD+ as a therapy for diet-induced metabolic disease in mice. Restoring regular NAD+ oscillations at the onset of the active phase ameliorates metabolic markers of disease such as body weight and glucose and insulin tolerance, and restores hepatic gene expression related to inflammatory response and lipid metabolism. However, the same treatment designed to increase NAD+ at the onset of the rest phase severely compromises these beneficial responses. Notably, hepatic nutrient-sensing mTOR, AMPK or AKT signaling, became rhythmic specifically in obese mice treated just before the active phase. Remarkably, NAD+ at the onset of the rest phase was accompanied by uncoupled oscillations between the SCN and the hepatic clock, which were phase inverted in the liver, while keeping behavioral rhythms largely intact. These findings demonstrate that the time of day determines the beneficial effects of NAD+-based therapies and pave the way for the basic strategy of a chronobiology-based therapeutic approach.

Exposome factors that lead to stressed skin can be defined as any disturbance to homeostasis from environmental (meteorological factors, solar radiation, pollution or tobacco smoke) and/or internal exposure (unhealthy diet, hormonal variations, lack of sleep, psychosocial stress). The clinical and biological impact of chronic exposome effects on skin functions has been extensively reviewed, whereas there is a paucity of information on the impact of short-term acute exposure. Acute stress, which would typically last minutes to hours (and generally no more than a week), provokes a transient but robust neuroendocrine-immune and tissue remodeling response in the skin and can alter the skin barrier. Firstly, we provide an overview of the biological effects of various acute stressors on six key skin functions, namely the skin physical barrier, pigmentation, defenses (antioxidant, immune cell-mediated, microbial, and microbiome maintenance), structure (extracellular matrix and appendages), neuroendocrine, and thermoregulation functions. Secondly, we describe the biological and clinical effects on adult skin from individual exposome factors that elicit an acute stress response and their consequences in skin health maintenance. Clinical manifestations of acutely stressed skin may include dry skin that might accentuate fine lines, oily skin, sensitive skin, pruritus, erythema, pale skin, sweating, edema, as well as flares of inflammatory skin conditions such as acne, rosacea, atopic dermatitis, pigmentation disorders, and skin superinfection such as viral reactivation. Acute stresses can also induce scalp sensitivity, telogen effluvium, and worsen alopecia.

Purpose Lumbar discogenic diffuse pain is still not understood. Authors describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor studies are rare and controversial. Therefore, the aim was to revisit the origin, course and distribution in a body-donor study. Methods Six lumbar blocks (3 female, 3 male) aged between 59 and 94 years were dissected. After removal of the back muscles, lamina, dura mater and cauda equina, the anterior vertebral venous plexus, spinal artery and SVN were exposed and evaluated. Results 43 nerves out of 48 levels could be evaluated. The origin of the SVN was constituted by two roots: a somatic and a sympathetic branch arising from the rami communicantes. In 4/48 intervertebral canals studied (8.3%), we found two SVN at the same level. In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The SVN had a recurrent course below the inferior vertebral notch; in the vertebral canal it showed different patterns: ascending branch (31/43, 72.1%), common branch diverging into two branches (10/43, 23.3%), double ascending branch (1/43, 2.3%) finalizing two levels above and a descending branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral connections with another SVN. The distribution ended in the middle of the vertebral body supplying adjacent structures. Conclusion A thorough understanding of the anatomy of the SVN might lead to significant benefits in therapy of discogenic low back pain. We suggest blocking the SVN at the level of the inferior vertebral notch of two adjacent segments. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding

Although there is growing recognition that extreme weather events pose significant challenges to Central American agriculture, little is known about what factors influence farmers’ implementation of adaptation practices. Such information is critical for the formulation of climate change policies. To fill this knowledge gap, we surveyed 446 maize and bean farmers in Guatemala and Honduras in order to (1) describe their perceptions toward exposure and sensitivity to droughts, hurricanes, floods, and torrential rains; (2) identify factors related to the use of adaptation measures following these events; and (3) describe the perceived effectiveness of the adaptations in reducing farmers’ vulnerability to extreme weather events. Only 19.3% of farmers had implemented adaptation measures in response to extreme weather events and, of these, 22% perceived that the adaptations were not effective at reducing their vulnerability. Factors that were positively related to the implementation of adaptation measures included perceptions of repeated exposure and increased frequency of extreme weather events, land ownership, access to training, aid received, and additional incomes (e.g., coffee production). Farmers need site-specific knowledge about which agricultural practices are effective at reducing their vulnerability to extreme weather events, as well as access to training, technical support, and aid after such events happen.

The geriatric population has increased considerably in the last decades. Such increases come along with new challenges for surgical practitioners, who now face a risen number of frail patients in need of major operations. The value of frailty indexes in this setting has been discussed recently. This study assessed the modified Rockwood frailty index (mRFI) as a predictive tool for postoperative complications in older adults subjected to major abdominal operations and correlated it with other scores widely utilized for this purpose.We performed a prospective study utilizing the mRFI including all patients older than 65 years subjected to major abdominal surgery between May 2017 and May 2019 in a third-level academic center. A comparison between frail (mRFI0.25) and non-frail patients (mRFI0.25) was performed. We performed logistic regression to identify predictors of postoperative complications and 30-day mortality. We analyzed the correlation between mRFI and ACS-NSQIP, P-POSSUM, PMP, and Charlson score risk calculators.One hundred forty patients were included in our study, of whom 49 (35%) were identified as frail. Frail patients demonstrated significantly prolonged hospital stay (p.0001), ICU admission rates (p=0.004), hospital readmissions (p=0.007), and higher mortality rates (p=0.02). Our univariate analysis associated frailty (mRFI0.25), ASAIII, increased age, and BMI with postoperative complications. In our multivariate analysis, frailty remained an independent predictor for postoperative complications (OR 6.38, 95% CI [2.45-16.58], p0.001). Frailty was also associated with length of stay (LOS) regardless of the type of surgery (OR 3.35, 95% CI [0.37-6.33], p= 0.03). mRFI0.25 demonstrated a sensitivity (Se) of 70% and specificity (Sp) 67% with area under the curve (AUC) 0.75 for perioperative complications, Se 69% and Sp 70% with AUC 0.74 for ICU admissions, and Se 83% and Sp 68% with AUC 0.83 for mortality.Frail patients demonstrated significantly prolonged hospital stay, ICU admission rates, hospital readmissions, and higher mortality rates. mRFI is an independent predictor for perioperative complications with a Se of 70% and Sp 67% and AUC 0.75.

The microbial safety concern associated with thermally processed extended shelf life (ESL) refrigerated foods is based on adequate elimination of spore-forming pathogens such as nonproteolytic Clostridium botulinum types B, E, and F. These pathogens are traditionally regarded as targets for validation of thermally processed ESL foods. However, their use for research is restricted due to their designation as select agents. In this study, the thermal resistances of spores of 10 nonproteolytic C. botulinum types B and F and seven psychrotrophic Bacillus cereus strains were evaluated in ACES (N-(2-acetamido)-2-aminoethanesulfonic acid) buffer (0.05 M, pH 7.00) and compared to determine whether any of the B. cereus strains could serve as a nonselect agent for establishing thermal processes for ESL refrigerated foods. Thermal decimal reduction times (DT-values) of both nonproteolytic C. botulinum types B and F and psychrotrophic B. cereus strains decreased as process temperature increased from 80 to 91°C, and the highest values were obtained at 80°C. All psychrotrophic B. cereus strains tested were more thermally resistant than nonproteolytic C. botulinum types B and F. DT-values of nonproteolytic C. botulinum types B and F decreased to

Funding Acknowledgements Type of funding sources: None. Introduction There is little evidence regarding if the electrocardiographic pattern following CRT has impact on morbidity and mortality. In a previous study, a specific group of patterns in three leads of the ECG (Rs in V1, Qr in aVL or rS in I) was associated with lower incidence of the composite endpoint of death from any cause and heart failure hospitalization at 1 year. Purpose In this historical cohort study we analyzed if the specific pattern (Rs in V1, Qr in aVL or rS in I) was associated with outcomes at 2 years follow up. Methods Patients with CRT devices were consecutively included from January 2012 to April 2019. The primary endpoint was a composite of death from any cause and heart failure hospitalization at 2 years. Secondary endpoints included the individual components of the primary endpoint at 2 years. Survival analysis was performed using Kaplan-Meier test, comparing survival graphics through Log-Rank test. For multivariate analysis, Cox regression was performed. Results We included 111 patients. Baseline characteristics are reported in Table 1. Presence of any of the three patterns was not significantly associated with the primary endpoint (p=0.182). Patients who presented any of these patterns had not a significantly lower incidence of death from any cause (p=0.303), but had a significantly lower incidence of HF hospitalization (4.7% vs. 17.6%, hazard ratio 0.207, 95% confidence interval 0.046-0.93, p=0.04). Previous atrial fibrillation was independently associated with a higher incidence of primary and secondary endpoints. QRS duration postimplantation was independently associated with incidence of the primary endpoint. Conclusion The presence of the patterns Rs in V1, Qr in aVL or rS in I is an independent predictor of reduced HF hospitalizations at 2 years in patients with CRT. Previous atrial fibrillation and QRS duration were also associated with outcomes.

Bumble bees are key pollinators with some species reared in captivity at a commercial scale, but with significant evidence of population declines and with alarming predictions of substantial impacts under climate change scenarios. While studies on the thermal biology of temperate bumble bees are still limited, they are entirely absent from the tropics where the effects of climate change are expected to be greater. Herein, we test whether bees' thermal tolerance decreases with elevation and whether the stable optimal conditions used in laboratory-reared colonies reduces their thermal tolerance. We assessed changes in the lower (CT

The purpose of this cross-sectional study was to determine the prevalence of intimate partner violence (IPV) among university students, investigate the potential predictors of IPV in this population, and study the link between IPV and depression. The survey included sociodemographic, relationship quality, and depression-related questions. From 498 respondents, the prevalence of IPV was 4.8%, depression was 30.9%, and suicidal ideation was 20.3%. After adjusting for covariates and confounders, relationship satisfaction (odds ratio [OR], 0.201; 95% confidence interval [CI], 0.101-0.401; p < 0.001) and jealousy (OR, 0.270; 95% CI, 0.094-0.776; p = 0.015) were significant predictors of IPV. Relationship satisfaction predicted depressive disorders (OR, 0.504; 95% CI, 0.365-0.698; p < 0.001). IPV trended toward predicting the presence of a depressive disorder (OR, 0.436; 95% CI, 0.170-1.113; p = 0.083). Relationship satisfaction and jealousy predicted IPV. Although IPV did not predict depression, poor relationship satisfaction increased the odds of depression, implicating the influence of relationship satisfaction on both IPV and depression.

Women who have bilateral oophorectomies prior to the age of natural menopause are at increased risk of developing mild cognitive decline, dementia, anxiety, and depressive type disorders. Clinical and animal studies indicate angiotensin type 1 receptor (AT1R) blockers (ARBs) have blood pressure (BP)-independent neuroprotective effects. To investigate the potential use of ARBs in normotensive women at increased risk of developing neurocognitive problems, we studied a rat model of bilateral oophorectomy. Long Evans rats were sham-operated (Sham) or ovariectomized (Ovx) at 3 months of age and immediately treated continuously with vehicle (Veh) or the ARB losartan (Los) for the duration of the experiment. In contrast to many hypertensive rat models, ovariectomy did not increase mean arterial pressure (MAP) in these normotensive rats. Ovariectomized rats spent less time in the open arms of the elevated plus maze (EPM) [(% total time): Veh, 34.1 ± 5.1 vs. Ovx, 18.7 ± 4.4; p

To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity. We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate. Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p

The following work is an approach to the theoretical framework that builds the concept of territorial Bioethics, as part of the paradigm of urban development and the policy of attention to the spatial needs of society; It is part of the project of consolidation of the research line on indicators for urban sustainability and identifies within the process of social resilience, the relations between the territory, the anthropic environment and the attitudes of the social organization as well as models of reconstitution of environments degraded Emphasizes the active attitude of society to promote effective and dignified intervention with participation instruments; that it manages to restore attributions of adaptation and resilience to the environmental emergency; In addition, reference is made to a group vulnerable to such an emergency: the elderly.