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BackgroundChagas cardiomyopathy (CHCM) is the most important clinical manifestation of Chagas disease. The analysis of cardiac miRNAs may contribute to predicting the progression to CHCM in Chagas indeterminate phase and/or to the differential diagnosis for cardiomyopathy.MethodsWe carried out a case-control study to identify circulating miRNAs associated with CHCM. We assigned 104 participants to four groups: healthy controls (HC), Chagas non-cardiomyopathy controls, CHCM cases, and ischemic cardiomyopathy controls. We performed a clinical, echocardiographic, and laboratory evaluation and profiled circulating miRNA in the serum samples.ResultsDifferences between groups were observed in clinical variables and in the analysis of miRNAs. Compared to HC, CHCM participants had 4 over-expressed and 6 under-expressed miRNAs; miR-95-3p and miR-130b-3p were upregulated in CHCM compared with controls, Chagas non-cardiomyopathy and ischemic cardiomyopathy participants, suggesting that might be a hallmark of CHCM. Analysis of gene targets associated with cardiac injury yielded results of genes involved in arrhythmia generation, cardiomegaly, and hypertrophy.ConclusionsOur data suggest that the expression of circulating miRNAs identified by deep sequencing in CHCM could be associated with different cardiac phenotypes in CHCM subjects, compared with Chagas non-CHCM, ischemic cardiomyopathy controls, and healthy controls.

Objective: To analyze the excipients and impurities contained in the various docetaxel products available on the market and find out whether they may be responsible for any of the different adverse events associated with the use of docetaxel in patients with breast cancer receiving adjuvant or neoadjuvant treatment. Method: This is a prospective, multicenter, longitudinal observational, study carried in 26 hospitals in Madrid, Catalonia, Andalusia, and the Valencia Region. The different docetaxel formulations were characterized in terms of their pH, amount of The active ingredient and impurities. The cumulative incidence of adverse events of any grade was evaluated. Adverse events were stratified by drug type and differences were analyzed by means of a chi-square test. Results: Statistically significant differences were found between the different docetaxel formulations in the cumulative per-cycle incidence of: dosage change, anemia, hypersensitivity reactions and anaphylaxis, neuropathy, palmoplantar and dermal toxicity, ungual toxicity and facial edema. The formulation with the lowest content of impurities showed better results in terms of change of dosage, visits to the emergency room and incidence of anemia and facial edema. However, it was associated with poorer results regarding hospitalization, febrile neutropenia, motor neuropathy and palmoplantar toxicity. Conclusions: The results of the study showed differences In the incidence of adverse events of the different docetaxel products available in Spain. Such differences were statistically significant for some of the variables analyzed. The study was not able to determine which of the products offered the best toxicity profile. Nor was it possible to establish a correlation with respect to the composition of excipients or the content of impurities.

Resumen: La implantación de prótesis valvulares aórticas transcatéter (TAVI) ha representado una verdadera revolución en el tratamiento de la estenosis aórtica grave y sintomática. Varios avances han propiciado un aumento significativo en el número de implantes, así como una disminución gradual de las complicaciones asociadas. Un factor clave para el éxito de la TAVI ha sido el papel desempeñado por las técnicas de imagen cardiaca no invasivas en la planificación previa al procedimiento y en la selección de candidatos. Estas técnicas permiten determinar el tipo y tamaño de la prótesis a implantar, prever los riesgos, evaluar la idoneidad del acceso vascular, supervisar el procedimiento y realizar un seguimiento después del implante. En esta revisión se analiza el papel de las técnicas de imagen no invasivas antes, durante y después de la implantación de una prótesis aórtica transcatéter. Abstract: Transcatheter aortic valve implantation (TAVI) has been a true revolution in the treatment of severe symptomatic aortic stenosis. Various advances have led to an exponential growth in the number of implants and a progressive reduction in their complication rate. One key factor in the success of TAVI has been the role of non-invasive cardiac imaging techniques in pre-procedural planning and candidate selection. These techniques enable the determination of the type and size of the prosthetic valve to be implanted, prediction of risks, assessment of the suitability of vascular access, procedure monitoring, and post-implant follow-up. This review addresses the role of non-invasive imaging techniques before, during, and after transcatheter aortic valve implantation.

Abstract Background Malnutrition and sarcopenia are highly prevalent in patients with head neck cancer (HNC). An accurate early diagnosis is necessary for starting nutritional support, as both are clearly associated with clinical outcomes and mortality. We aimed to evaluate the applicability and accuracy of body composition analysis using electrical bioimpedance vectorial analysis (BIVA) for diagnosing malnutrition and sarcopenia in patients with HNC cancer undergoing systemic treatment with chemotherapy or radiotherapy. Methods Cross‐sectional, observational study that included 509 HNC patients. A comprehensive nutritional evaluation that included BIVA was performed. Results The prevalence of malnutrition was higher in patients that received treatment with chemotherapy (59.2% vs. 40.8%, P

Background: Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time. Methods: We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021. POAF was defined as new, clinically important atrial fibrillation occurring within 30 days after surgery. We assessed the use of rhythm-control and anticoagulation treatment in response to POAF, at hospital discharge and at 30 days after surgery. We assessed for temporal trends using multivariable logistic regression. Results: Of the 27,896 patients included, 545 (1.9%) developed clinically important POAF. Patients received rhythm-control treatment in 48.6% of cases. The level of use of rhythm-control treatment increased over the course of the trials (POISE-1 vs POISE-2 vs POISE-3; 40.9% vs 49.5% vs 59.1%). A later randomization date was associated independently with use of rhythm-control treatment (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.09). Anticoagulation treatment was prescribed in 21% of POAF cases. The level of anticoagulation treatement use was higher in POISE-3, compared to that in the 2 previous trials (POISE-1 vs POISE-2 vs POISE-3—16.4% vs 16.5% vs 33.6%). A later randomization date was associated independently with use of anticoagulation treatment (odds ratio, 1.06 per year; 95% confidence interval, 1.02-1.11). Conclusions: Despite the absence of randomized controlled trials, the level of use of rhythm-control and anticoagulation treatment for POAF is rising. High-quality trials are needed urgently to determine whether these interventions are safe and effective in this population. Résumé: Contexte: En chirurgie non cardiaque, la fibrillation auriculaire postopératoire (FAPO) d’importance clinique est une complication cardiaque fréquente. La prise en charge ponctuelle des patients présentant une FAPO est mal connue et on ne sait pas précisément si les pratiques ont évolué au fil du temps. Méthodologie: Nous avons mené une sous-étude d’observation auprès de patients ayant présenté une FAPO et dont le risque cardiovasculaire était élevé, et qui avaient participé aux études 1, 2 ou 3 du programme d’essais cliniques POISE (PeriOperative Ischemic Evaluation) entre 2002 et 2021. La FAPO était définie comme un nouvel épisode de fibrillation auriculaire (FA) d’importance clinique au cours des 30 jours suivant une intervention chirurgicale. Nous avons évalué l’utilisation d’un traitement visant à régulariser le rythme cardiaque et de l’anticoagulothérapie dans la prise en charge d’une FAPO, au moment du congé de l’hôpital, puis 30 jours après l’intervention chirurgicale. Nous avons procédé à l’évaluation des tendances temporelles par régression logistique multivariée. Résultats: Sur les 27 896 patients inclus dans l’analyse, 545 (1,9 %) ont présenté une FAPO d’importance clinique. Dans 48,6 % des cas, les patients ont reçu un traitement visant à régulariser le rythme cardiaque. Le taux d’utilisation d’un traitement visant à régulariser le rythme cardiaque a augmenté d’une étude à l’autre (étude POISE-1 vs étude POISE-2 vs étude POISE-3; 40,9 % vs 49,5 % vs 59,1 %, respectivement). Une date plus tardive de la répartition aléatoire était un facteur indépendant de l’utilisation d’un traitement visant à régulariser le rythme cardiaque (rapport de cotes = 1,05 par an; intervalle de confiance [IC] à 95 % : 1,01-1,09). Une anticoagulothérapie a été prescrite à 21 % des patients ayant présenté une FAPO. Le taux d’utilisation d’une anticoagulothérapie était plus élevé dans l’étude POISE-3, comparativement aux deux essais précédents (étude POISE-1 vs étude POISE-2 vs étude POISE-3; – 16,4 % vs 16,5 % vs 33,6 %, respectivement). Une date plus tardive de la répartition aléatoire était un facteur indépendant d’utilisation d’une anticoagulothérapie (rapport de cotes = 1,06 par an; IC à 95 % : 1,02-1,11). Conclusions: Malgré l’absence d’essais comparatifs avec répartition aléatoire, le taux d’utilisation d’un traitement visant à régulariser le rythme cardiaque ou d’une anticoagulothérapie chez les patients présentant une FAPO est en augmentation. Il existe un besoin urgent de réaliser des études cliniques de grande qualité afin de déterminer si ces interventions sont sûres et efficaces dans cette population de patients.

IntroductionBefore implementing a new health care strategy, it is important to assess effectiveness but also to perform an economic evaluation. The goal of the present study was to perform a comparative economic evaluation of a new strategy aimed at using proposed implementation of the Plateletworks guidance (measurement of platelet function) with usual practice (delayed time to surgery) in patients on chronic antiplatelet treatment and scheduled for surgery with neuraxial anaesthesia due to proximal femur fracture.MethodsThis is an economic evaluation carried out alongside a randomised controlled clinical trial at four centres in Spain. Patients were randomised to undergo either early platelet function-guided surgery (experimental group) or delayed surgery (control group). As AFFEcT trial results demonstrated significative difference between groups in the primary efficacy endpoint, the median time to surgery, a cost-effectiveness analysis was performed. Direct costs associated with hospitalisation until one-month post-discharge were considered and measured from a hospital perspective. All costs were reported in euros. Analyses were performed on a per protocol basis. Effectiveness outcome measures were the incremental cost and incremental cost per reduction in days to surgery. A deterministic sensitivity analysis was implemented to quantify uncertainty.ResultsA total of 156 patients were randomized to the two groups (n = 78 per group). A total of 143 patients were included in the per protocol population (75 and 68 patients in the experimental and control groups, respectively). The median time to surgery was 2.30 days (IQR: 1.53–3.73) in the experimental group and 4.87 days (4.36–5.60) in the control group (a reduction of 2.40 days). Total costs during the 1-month study perioperative period were higher in the delayed surgery group (€18,495.19) than for the early surgery group (€16,497.59). The incremental cost was negative (€1,997.60), a statistically significant difference (P

La poesía confesional traza una línea delgada entre voz poética y autor. Como género, puede utilizarse como vehículo de introspección, para el auto reconocimiento, y como un ejercicio catártico-terapéutico. La obra intensamente autobiográfica de Sylvia Plath se encuentra en este espacio liminal donde sus versos concisos permiten vislumbrar la experiencia de la autora misma. “Lady Lazarus” y “Daddy” presentan instancias específicas de violencia donde el yo poético pretende dar sentido al trauma personal mediante metáforas bíblicas y del Holocausto. En ambos poemas, el cuerpo es un elemento desmembrado, catalogado en partes y escindido dolorosamente para recalcar disconformidad durante la búsqueda de identidad. El trato brutalizado del cuerpo evoca procesos de disociación, según la teoría del “cuerpo fragmentado” de Jacques Lacan, semejante a cómo Primo Levi lidia con el trauma de la deshumanización en relatos memorísticos de los campos de concentración. Por lo tanto, el uso de una tragedia histórica ajena en estos poemas actúa como recurso de generalización para la expresión personal de Plath. El yo poético lleva a cabo una “cosificación” propia mediante el préstamo de la experiencia grupal histórica más próxima, como el Holocausto, para capturar las preocupaciones íntimas de la autora (como la ansiedad hacia la guerra nuclear y su difícil relación con la masculinidad represiva). En “Lady Lazarus” y “Daddy”, el entramado del dolor psíquico con el corporal es un hilo conductor que brinda coherencia a la sensibilidad dislocada de Plath, tanto como potenciador del trauma o como medio contemplativo y liberador. Con esta aproximación, este artículo analiza, en ambos poemas, el uso de imágenes con asociaciones históricas ajenas a la autora y, por lo tanto, “problemáticas” para la expresión del cuerpo; así mismo, este texto busca poner a prueba los posibles límites del recurso semiautobiográfico en la obra confesional de Sylvia Plath.

ObjectiveIdiopathic central precocious puberty (CPP) precipitates epiphyseal fusion of growth plates in long bones, leading to reduced adult stature. Gonadotropin-releasing hormone analogues (GnRHa) are the treatment of choice for idiopathic CPP, but their benefit on height gain is unclear. We aimed to elucidate the effects of GnRHa treatment on adult height in girls with idiopathic CPP.DesignThis prospective observational descriptive study analyzed data of girls with idiopathic CPP diagnosed at 55 centers in Spain between January 1, 1998 and December 31, 2012 included in the Spanish Society for Pediatric Endocrinology’s national registry.MethodsWe included girls with idiopathic CPP (thelarche < 8 years, positive LHRH stimulation test, bone age > 1 year older than chronological age, and normal brain imaging) treated with triptorelin (3.75 mg monthly, adjusted according to LHRH test results and clinical findings). We assessed weight, height, BMI, and secondary sexual characteristics every 6 months and bone age every 12 months until adult height (AH) was attained. The primary outcome was the difference between AH and target height (TH).ResultsA total of 465 girls (18.90% adopted) were included; we analyzed data recorded at treatment end in 358 girls and at AH in 216. Mean difference between AH and TH was -1.5 (95%CI: -2.56− -0.45) cm and between AH and PAH 2,57 (95%CI:-3.56− -1.58) cm.ConclusionsGnRHa treatment helps preserve genetic growth potential in girls with idiopathic CPP.

Background Lung ultrasound (LUS) has emerged as a useful tool in the acute phase of patients admitted for ST‐segment–elevation myocardial infarction. However, its long‐term significance remains uncertain, and risk scores do not include LUS findings as a predictor. This study aims to assess the 1‐year prognostic value of LUS and its ability to enhance existing risk scores. Methods and Results This is a multicenter prospective cohort study involving 373 patients with ST‐segment–elevation myocardial infarction. LUS was performed during the first 24 hours after angiography. LUS results were assessed both as a categorical (wet/dry lung) and continuous variable (LUS score). The primary end point comprised the following major adverse cardiovascular events: all‐cause mortality or hospitalization for heart failure, acute coronary syndrome, or stroke within 1 year. We also evaluated whether LUS could enhance the predictive value of the GRACE (Global Registry of Acute Coronary Events) score. Major adverse cardiovascular events occurred in 51 (13.7%) patients over a median follow‐up of 368 days. After multivariate analysis, the LUS score was an independent predictor (hazard ratio [HR], 1.06 [95% CI, 1.01–1.10]; P=0.009] for each additional B‐line), whereas the categorical classification was an independent predictor in patients with ST‐segment–elevation myocardial infarction Killip I (HR, 3.12 [95% CI, 1.34–7.31]; P=0.009). Incorporating LUS into GRACE resulted in a net reclassification index of 31.6% and a significant increase in the area under the curve; GRACE alone scored 0.705 compared with GRACE+LUS 0.791 (P=0.002). Conclusions Detecting B‐lines on LUS at the acute phase predicts major adverse cardiovascular events at 1 year in patients with ST‐segment–elevation myocardial infarction and enhances the predictive value of the GRACE score. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04526535.

Macrophomina phaseolina (Tassi) Goid. (Mp) is the causal agent of charcoal rot in soybean, an economically serious and potentially destructive disease. Chemical control sometimes has limited effects on disease severity and may pose a threat to the environment, so the use of Trichoderma as a biological product could be a feasible alternative for charcoal rot management. The objective of this research was to isolate and characterize native Trichoderma spp. from northwestern Argentina and study their antagonistic effect against Mp in soybean. Isolations were performed from soil samples followed by cultural and microbiological characterization of the Trichoderma spp. isolates collected. Then, the antagonist effect against Mp was studied in vitro, under greenhouse conditions, and finally under field conditions with pathogen artificial inoculations during two soybean crop seasons (2020 and 2021). The results demonstrated that isolate Tr009 had a biocontrol effect against Mp in soybean. This control was evidenced in vitro and under controlled and field conditions with high emergency of plants compared to the Mp inoculated control. Under field conditions, treatments that included Trichoderma presented lower disease severity, colony-forming unit index and disease severity index values than the pathogen inoculated control. Moreover, Tr009 improved weight and length of soybean plants under greenhouse conditions. Isolate Tr009 was identified as Trichoderma koningiopsis by molecular methods. These results indicate that this biological tool can be used against Mp and thus favor a sustainable management of soybean charcoal rot.

Spatial assessment of the risks faced by marine habitats provides essential information for adaptation to the impacts of multiple anthropogenic stressors. Climate change is one of the main stressors affecting the persistence and resilience of healthy marine ecosystems. However, protection against other stressors such as marine habitat loss and direct exploitation of natural marine resources is needed to ensure that conservation efforts are not threatened by cumulative combined effects. We used habitat risk assessment to explore the cumulative impacts of multiple stressors, including aquaculture activities, fishing vessel pressure, and climate change, on marine habitats of giant kelp forests. The assessment was applied in Chilean Patagonia, focusing on three protected areas: Magdalena Island National Park, Guaitecas National Reserve, and Kawésqar National Reserve. Our findings reveal that sea surface temperature increases, salmon farming, and the aquaculture-associated ship fleet are the stressors contributing most significantly to risk. High-risk areas are concentrated in northern Patagonia, specifically in the fjords of Guaitecas National Reserve and Magdalena Island National Park, with some risk hotspots found in the fjords of Kawésqar National Reserve. The highest risk levels are observed in scenarios that include both climate change and industrial salmon farming. Identifying the areas most at-risk is crucial for marine spatial planning because it allows for the design of targeted conservation actions to mitigate stressors and prevent risks from reaching levels that could compromise the integrity of marine habitats. The spatial approach used is key for informing future planning processes in Chilean Patagonia, where conflicts between intensive salmon farming, small-scale fishing, traditional Indigenous sea uses, and nature conservation are escalating. Despite some limitations in the data, our study provides valuable insights that can guide future conservation planning and policy-making, helping to balance economic activities with the need to protect and maintain the health of marine habitats in Chilean Patagonia.

Plants are a valuable source of specialized metabolites that provide a plethora of therapeutic applications. They are natural defenses that plants use to adapt and respond to their changing environment. Decoding their biosynthetic pathways and understanding how specialized plant metabolites (SPMs) respond to biotic or abiotic stress will provide vital knowledge for plant biology research and its application for the future sustainable production of many SPMs of interest. Here, we focus on the proteomic approaches and strategies that help with the study of plant-specialized metabolism, including the: (i) discovery of key enzymes and the clarification of their biosynthetic pathways; (ii) study of the interconnection of both primary (providers of carbon and energy for SPM production) and specialized (secondary) metabolism; (iii) study of plant responses to biotic and abiotic stress; (iv) study of the regulatory mechanisms that direct their biosynthetic pathways. Proteomics, as exemplified in this review by the many studies performed to date, is a powerful tool that forms part of omics-driven research. The proteomes analysis provides an additional unique level of information, which is absent from any other omics studies. Thus, an integrative analysis, considered versus a single omics analysis, moves us more closely toward a closer interpretation of real cellular processes. Finally, this work highlights advanced proteomic technologies with immediate applications in the field.

This article aims to explore the conceptions of forgiveness and resilience, and the relationship that may exist between them, from the perspective of victims of the Colombian armed conflict in the municipality of San Juan Nepomuceno in Montes de María. We followed an exploratory qualitative methodology with a descriptive and interpretative focus. The data was analyzed based on grounded theory, and a non-probabilistic snowball sampling approach was employed. Six semi-structured interviews were conducted including questions about forgiveness and resilience, whether victims believed forgiveness was possible, how they perceived resilience in their community, and their opinions on expressions of remorse by former members of armed groups. Within the framework of these two study categories, victims’ perspectives provided definitions of forgiveness and resilience. Forgiveness was described as a personal decision influenced by individual thinking, serving as a means to heal wounds and free oneself from negative emotions while not erasing the memory of past events. Resilience, on the other hand, was perceived as the individuals’ ability to navigate through challenges and traumatic situations, to explore alternative possibilities regardless of their available resources, and to empower themselves in order to enhance their own quality of life. Individual and collective coping strategies also came to light, encompassing practices such as art, dialogue, and communal memory processes.

En este artículo se vinculan dos temáticas relevantes para la calidad educativa, a saber, la participación familiar y la convivencia escolar. En concreto, los objetivos planteados parten del conocimiento del clima de convivencia en unos centros de educación primaria, exploran el sentimiento de pertenencia y la implicación en el hogar de las familias, y tratan de establecer relaciones entre el clima de convivencia y la participación de las familias en la educación escolar. Estamos ante un estudio cuantitativo, no experimental, exploratorio y evaluativo. Los participantes han sido 1326 familias y 844 estudiantes, que pertenecen a un contexto agrícola, en un municipio de la Región de Murcia, España, en el que la población migrante está sobre el 30 %. La recogida de información se llevó a cabo con dos instrumentos: un cuestionario ad hoc dirigido a las familias y el cuestionario CRAE-P de Bueno et al. (2017) a los estudiantes. Los resultados nos indican que las familias manifiestan un adecuado sentimiento de pertenencia hacia los centros y la implicación que muestran en la educación de sus hijos e hijas en el hogar es alta. Por la parte de los estudiantes, en su mayoría manifiestan un estado de bienestar positivo.

Bladder duplication (BD) is a rare malformation that is often associated to other anomalies. We report a newborn diagnosed with BD in the sagittal plane, associated to persistent urogenital sinus (UGS), given the opening of the vagina immediately below the bladder neck. It is the fourth time this association is reported. Surgical repair was made: both bladders were joined, the common channel was left as urethra and the vagina was descended with a vaginoplasty with an intestinal segment. She also presented an anterior anus, that required posterior mobilization. The patient is currently 3 years old with good sphincter control.

Anti-dsDNA, anti-Sm, and anti-ribosomal-P autoantibodies are hallmarks of systemic lupus erythematosus (SLE), being anti-dsDNA and anti-Sm included in 2019-ACR/EULAR SLE-Classification Criteria. Enzyme-linked (ELISA) and chemiluminescence assays (CIA) are widely established in immunology laboratories, but new technologies, such as particle-based multi-analyte technology (PMAT), are nowadays available. The present study aimed to compare the presence of anti-dsDNA and anti-Sm autoantibodies measured by CIA and PMAT and analyze diagnostic and clinical SLE activity performance. Anti-ribosomal-P autoantibodies by PMAT were also included. Consequently, anti-dsDNA and anti-Sm detected by CIA showed substantial agreement with PMAT (Cohen's kappa = 0.662 and 0.671, respectively). Anti-dsDNA autoantibodies measured by PMAT showed a positive correlation with clinical SLEDAI-2K (p

Abstract This study aimed to establish factors associated with delayed surgery in patients with proximal femoral fracture and to assess patients’ health-related quality of life (HRQoL) after surgery including all-cause 6-months mortality. This was a single-center, observational, prospective cohort study that included patients with a proximal femur fracture. We described patients’ HRQoL measured by EuroQoL (EQ-5D-5L and EQ-VAS) questionnaire and perioperative complications (including mortality) 6 months after surgery. We included 163 patients with a mean age of 80.5 years, the majority were women and 76.1% reported falling from their own height. The mean time between hospital admission and surgery was 8.3 days (SD 4.9 days) and the mean hospital stay was 13.5 days (SD 10.4 days). After adjustment, the principal factor associated with delayed surgery was adjournment in surgery authorization (3.7 days). EQ-5D-5L index values and the VAS score at 1 month after surgery were 0.489 and 61.1, at 3 months were 0.613 and 65.8, and at 6 months 0.662 and 66.7 respectively. Mortality at 6 months of follow-up was 11% (18 patients). In conclusion, administrative authorization was the strongest associated factor with delayed time from hospital admission to surgery. HRQoL of patients with a proximal femoral fracture improved 6 months after surgery. Trial registration: NCT04217642.

IntroductionBioelectrical impedance analysis (BIA) serves as a method to estimate body composition. Parameters such as phase angle (PA), standardized phase angle (SPA), body mass cell (BCM), BCM index (BCMI), and fat-free mass (FFM) might significantly impact the prognosis of head and neck cancer (HNC) patients. The present study aimed to investigate whether bioelectrical parameters can be used to predict survival in the HNC population and establish the optimal cutoff points for predictive accuracy.MethodsA multicenter observational study was performed across 12 tertiary hospitals in Andalusia (a region from the south of Spain). A total of 494 patients diagnosed with HNC between 2020 and 2022 at different stages were included in this study, with a minimum follow-up period of 12 months. The BIA assessment was carried out during the first 2 weeks of radical radiotherapy treatment with chemotherapy or other systemic treatments. A multivariate logistic regression analysis of overall survival, complications, hospital admission, and palliative care and its relationship with BIA nutritional assessment was performed.ResultsSignificant prognostic factors identified in the multivariable analysis encompassed phase angle (PA), standardized phase angle (SPA), body cell mass (BCM), and BCM index (BCMI). Lower PA and BCM values were significantly associated with adverse clinical outcomes. A BCM threshold above 17 kg/m2 was the most significant predictor for predicting survival within the overall HNC population. The PA values of

RESUMEN introducción: El uso exclusivo de clavo suprapatelar para la osteosíntesis de las fracturas de tercio proximal de tibia se ha perdido con el tiempo, ampliándose su indicación para las fracturas de tibia en todos sus niveles. El objetivo de este trabajo es mostrar nuestra experiencia en instrumentación de la tibia por esta vía para todas las fracturas de tibia que cumplan con indicación de clavo endomedular, en un periodo de 3 años del equipo de cirujano especialista en pierna y pie. Material y Método: se operaron 40 pacientes de los cuales luego de aplicar criterios de inclusión y exclusión se eliminaron 14, siendo el total evaluado 26 pacientes, bajo normas abaladas por el comité de ética de la institucion. Se utilizó los scores Olerud & Molander (0-100); Lower Extremity Functional Scale (LEFS): 80/80 100% Se analizó dolor de rodilla, haciendo una subdivisión en 6 cuadrantes, para valorar situación anatómica del dolor. Resultados: Olerud & Molander promedio fue de 76,92. LEFS promedio fue de 72,33. 5 pacientes presentaron dolor en región de la rodilla cuadrante 3, reproduciéndose este a la flexión máxima de la rodilla y 1 en el cuadrante 5, sitio del bloqueo proximal, que resolvió con retiro del mismo. Ninguno presentó dolor en sitio ingreso del clavo ni dolor femoropatelar. Conclusión: La instrumentación suprapatelar de las fracturas de tibia se ha vuelto el gold standard en el tratamiento de estas fracturas en el equipo CEPP debido a sus ventajas técnicas y evolución favorable posoperatoria Estudio retrospectivo. nivel de evidencia IV Autores declaran no tener conflictos de interés.