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Background: Successful catheter ablation of ventricular tachycardia (VT) in repaired tetralogy of Fallot (TOF) can be achieved by targeting 1 or more anatomical isthmuses. However, significant interindividual variability in the size and location of surgical patches means careful mapping is required to design ablation lines to block the isthmus. Intracardiac echocardiography (ICE) may assist ablation by accurate identification of individual TOF anatomy. Objectives: The authors hypothesized ICE-guided VT ablation improved isthmus recognition, ablation, and procedural outcomes. Methods: Retrospective study of adults with repaired TOF undergoing VT ablation between January 1, 2017 and December 31, 2022. ICE integration was compared to a strategy using electroanatomical mapping only to identify anatomic boundaries. All cases underwent ablation and had proven isthmus block as the procedural endpoint. Results: Twenty-three patients (age 47 ± 14 years; 61% male) underwent 27 VT ablations (ICE: 16/27 [59%]; no ICE: 11/27 [41%]). ICE improved the ability to localize and ablate the anatomical isthmus (ICE: 13/15 [87%] vs no ICE: 4/11 [36%]; P = 0.014); however, there was no difference in long-term freedom from VT (ICE: 9/12 [75%] vs no ICE: 8/11 [73%]; P = 0.901). ICE had no impact on procedural times (ICE: 173 ± 48 minutes vs no ICE: 157 ± 47 minutes; P = 0.399), fluoroscopy time (ICE: 30 ± 16 minutes vs no ICE: 29 ± 10 minutes; P = 0.864), or major complications (ICE: 1/16 [6%] vs no ICE 0/11; P = 1.000). Conclusions: ICE improves ablation of the anatomical isthmus for sustaining VT in patients with repaired TOF by demonstrating the individual anatomy but does not improve long-term outcomes.

IntroductionThe regimen with daratumumab, bortezomib, melphalan, and prednisone (D-VMP) is one of the recommended treatments for newly diagnosed multiple myeloma (NDMM) non-transplant eligible due to the results described in the ALCYONE trial. However, real-life outcomes with this regimen are limited. This study assesses the real-life effectiveness and safety of this regimen.MethodsWe retrospectively analyzed the data on efficacy, safety, and survival parameters of D-VMP regimen in 112 patients with NDMM not eligible for autologous stem-cell transplantation with attention to the effect of age, R2-ISS, high-risk cytogenetic abnormalities (CA), and depth of response.ResultsPatients aged ≥75 years constituted 70% of our cohort. Fifty-two percent had R2-ISS 3-4, and 60% had high-risk CA. Twenty-three percent of patients would have been excluded from the ALCYONE trial. After a median follow-up of 31.4 months, all patients had completed induction, with a median number of cycles of 9 (IQR 6-9). The overall response rate was 95%, and 72% achieved very good partial response (VGPR) or better. The median progression-free survival (PFS) was 41.5 (95% CI, 34.3 to NE), and the median overall survival (OS) was not reached. The most frequent adverse event (AE) was neuropathy (27%), followed by gastrointestinal symptoms (13%) and hematological AE (10%). Age did not negatively impact survival outcomes. Patients with ≥2 high-risk CA or those who achieved

Biodiversity monitoring is key for understanding the delivery of ecosystem functions and services. Mediterranean forests and woodlands harbor many characteristic species of the Mediterranean vascular flora, and hence, they are a good surrogate for detecting changes in biodiversity linked to global change. In this work, we present a database resulting from the study of vascular plant diversity in multi-scale plots of 0.1 ha, measured around the first decade of this century and located in Mediterranean forest environments. Diversity profiles are calculated from Hill numbers (0, 1 and 2) for local (α) and regional (ϒ) diversity, as well as a multiplicative calculation of differential diversity (β). The main Mediterranean forests sampled had a medium coverage of 51% and stand dominant height of 10.6 m, and they were monospecific in two-thirds of cases. Local diversity reaches its highest values (around 78 species per 0.1 ha) in Holm oak dehesas, with values below 50 species for the most productive forest stands dominated by species of the genus Pinus. As regards the contribution to regional diversity, broadleaf formations contribute the most, with stone pine forests and dehesas in an intermediate position, and pine forests contributing the lowest in species richness terms.

Desde finales del año 2018 hemos sido testigos del arribo de miles de personas de origen centroamericano, caribeñas, sudamericanas y extracontinentales que huyendo de sus países en “caravanas” por diferentes razones y circunstancias buscan llegar a los Estados Unidos, en cuyo tránsito padecen un sinfín de vicisitudes que se asocian a su condición de irregularidad, a la restricción de las políticas migratorias y la falta de capacidad en las políticas de protección. En dicho escenario, el sur de México se ha convertido en un espacio de espera forzada, a razón de que la legislación mexicana establece que quien solicita el reconocimiento de la condición de refugiado en el país, deberá permanecer en la entidad federativa en el que inició su procedimiento. Este artículo tiene a bien analizar, por un lado, las acciones tomadas por el gobierno mexicano en el sur de México a través de su política migratoria, y por el otro lado, contrastar cómo se vive la contención, espera, de la población solicitante de la condición de refugiado. Desde un abordaje etnográfico, nos interesa mostrar la vida cotidiana e imaginarios de esta población en los espacios locales, a nivel laboral y de construcción de redes sociales.

The aim of this study is to estimate the diagnostic accuracy of abdominal point of care ultrasound (POCUS) performed by family physicians () in primary care (PC), in comparison with the findings in the medical record (MR) at 12 months of follow-up. This study is conducted entirely in PC healthcare centers in Spain. Abdominal ultrasound scans performed by (selected on the basis of their ultrasound knowledge and experience) are compared with the findings, or not, in the patient's MR after a 12-month follow-up period. The study will involve 100 in Spain and an estimated sample size of 1334 patients who are to undergo abdominal POCUS at the indication of their physician. The results of the abdominal POCUS will be collected and compared with the findings of the MR. This comparison will be performed by another physician of the research team, different from their FP after one year of follow-up. The diagnostic accuracy of abdominal POCUS has been addressed in the hospital setting but not in PC. This lack of evidence can begin to be resolved with studies such as the one we present, designed for populations such as those treated in PC and taking the patient's MR as the gold standard, which will allow us to make comparisons with the patient's clinical course.

Desde hace casi una década México ha registrado un incremento exponencial en el número de solicitudes para el reconocimiento de la condición de refugiado, lo cual se ha traducido en un reto para la gestión y atención de estas poblaciones, no solo por la cantidad de personas que han arribado a nuestro país sino sobre todo por la aplicación de una política migratoria basada en la contención migratoria. La presente propuesta analiza la tensión existente entre la política migratoria y la política de protección del Estado mexicano, en cuyos hallazgos evidencia algunos desencuentros y contradicciones, mismos que, terminan por imposibilitar e incidir negativamente en su acceso al derecho a ser reconocidas como refugiadas.

Objectives: A quality improvement initiative was introduced to the adult congenital cardiac surgery program at Toronto General Hospital in January 2016. A dedicated Adult Congenital Anesthesia and intensive care unit team was introduced within the cardiac group. The use of factor concentrates was introduced. The study compares perioperative mortality, adverse events, and transfusion burden before and after this process change. Methods: We performed a retrospective analysis of all adult congenital cardiac surgeries from January 2004 to July 2019. Two groups were analyzed: patients undergoing operation before and after 2016. The primary outcome was in-hospital mortality. One-year mortality and prevalence of key morbidities were analyzed as secondary outcomes. A separate analysis looked at patients who had and had not attended an anesthesia-led preassessment clinic. Results: In-hospital mortality was significantly reduced in patients undergoing operation after 2016 (1.1% vs 4.3%, P = .003) despite a higher risk profile. One-year mortality (1.3% vs 5.8%, P = .003) and ventilation times (5.5 hours [3.4-13.0] vs 6.3 hours [4.2-16.2], P = .001) were also reduced. The incidence of stroke and renal failure was similar between groups. Blood product exposure was comparable, but the incidence of chest reopening decreased (1.8% vs 4.8%, P = .022), despite more patients with multiple previous chest wall incisions, on anticoagulation, and with more complex cardiac anatomy. There were no significant outcome differences between those who did or did not attend the preassessment clinic. Conclusions: Both in-hospital and 1-year mortality were significantly reduced after the introduction of a quality improvement program, despite a higher risk profile. Blood product exposure remained unchanged, but there were less chest reopenings.

Abstract This phase Ib, non‐randomized, open‐label study evaluates the safety and tolerability of ruxolitinib in combination with nilotinib and prednisone in patients with naïve or ruxolitinib‐resistant myelofibrosis (MF). A total of 15 patients with primary or secondary MF received the study treatment; 13 patients had received prior ruxolitinib treatment (86.7%). Eight patients completed seven cycles (53.3%) and six patients completed twelve cycles of treatment (40%). All the patients experienced at least one adverse event (AE) during the study (the most common AEs were hyperglycemia, asthenia, and thrombocytopenia), and 14 patients registered at least one treatment‐related AE (the most common treatment‐related AEs were hyperglycemia (22.2%; three grade 3 cases). Five treatment‐related serious AEs (SAEs) were reported in two patients (13.3%). No deaths were registered throughout the study. No dose‐limiting toxicity was observed. Four out of fifteen (27%) patients experienced a 100% spleen size reduction at Cycle 7, and two additional patients achieved a >50% spleen size reduction, representing an overall response rate of 40% at Cycle 7. In conclusion, the tolerability of this combination was acceptable, and hyperglycemia was the most frequent treatment‐related AE. Ruxolitinib in combination with nilotinib and prednisone showed relevant clinical activity in patients with MF. This trial was registered with EudraCT Number 2016‐005214‐21.

Abstract Poly(lactic acid)/poly(butylene succinate‐co‐adipate) (PLA/PBSA) blends are found promising for film packaging applications because of their flexibility, resistance, and compostability. Industrially extruded granules and films based on PLA and containing different amounts of PBSA are reprocessed through mini‐extrusion, to simulate recycling, and tested in terms of their melt flow rate as a function of PBSA content. Moreover, pure PLA commercial granules and the film produced extruding the PLA/PBSA 60/40 blend are reprocessed several times by injection molding and characterized in terms of melt flow rate, mechanical properties, thermal properties, and color as a function of injection molding cycles. The variation in melt fluidity and thermo‐mechanical properties is negligible up to 3 injection molding cycles for both pure PLA granules and PLA/PBSA blend. In the case of blend the change in color (yellowing and darkening) is more evident and slight local compositional change in injection molded items can be evidenced as well as a slight decrease in PBS crystallinity as a function of injection molding cycles. Nevertheless, in applications where these aspects are not critical, these materials can be recycled by extrusion or injection molding before being composted, thus prolonging their life cycle and storing carbon in them as longer as possible.

Immunoparesis (IP) in multiple myeloma (MM) patients can be measured by classic assessment of immunoglobulin (Ig) levels or by analysis of the uninvolved heavy/light chain pair of the same immunoglobulin (uHLC) by the Hevylite® assay. In this study we evaluate the prognostic value of recovery from IP measured by classic total Ig and uHLC assessment in newly diagnosed MM transplant-eligible (NDMM-TE) patients with intensive treatment and its association with minimal residual disease (MRD). Patients were enrolled and treated in the PETHEMA/GEM2012MENOS65 trial and continued in the PETHEMA /GEM2014MAIN trial. Total Ig (IgG, IgA and IgM) and uHLC were analyzed in a central laboratory at diagnosis, after consolidation treatment and after the first year of maintenance. MRD was analyzed by next-generation flow cytometry after consolidation (sensitivity level 2x10-6). We found no differences in progression-free survival (PFS) between patients who recovered and patients who didn’t recover from IP after consolidation when examining classic total Ig and uHLC. However, after the first year of maintenance, in contrast to patients with classic IP, patients with recovery from uHLC IP had longer PFS than patients without recovery, with hazard ratio of 0.42 (95% confidence interval [CI]: 0.21-0.81; P=0.008). Multivariate analysis with Cox proportional-hazards regression models confirmed recovery from uHLC IP after the first year of maintenance as an independent prognostic factor for PFS, with an increase in C-statistic of 0.05 (95% CI: -0.04 to 0.14; P

El maíz es el principal grano en la dieta mexicana y uno de los granos más importantes a nivel mundial. Sin embargo, debido a su alta demanda, se requieren de estrategias para obtener altos rendimientos en su cultivo. Para ayudar a resolver este problema, se evaluó el efecto de altas densidades de siembra del maíz híbrido AZ-60. Se empleó un diseño de bloques al azar en parcelas para comparar densidades de siembra de maíz en un sistema de riego por goteo y evaluar altura, diámetro de tallo, valores en el fruto y estimación del rendimiento. Se seleccionaron tres densidades de siembra para los tratamientos(T): T1) densidad de 150,000 semillas por hectárea; T2) densidad de 120,000 semillas por hectárea; T3) densidad de 90,000 semillas por hectárea. Durante el periodo de cosecha se determinó que variables como la altura de planta y diámetro de tallo no mostraron diferencias significativas. Sin embargo, en variables de la mazorca como número de hileras, granos por hilera y peso de grano, se observó que los mayores valores se presentaron en la densidad de siembra de 90,000 semillas por hectárea. Como resultado, al estimar el rendimiento de grano se observaron diferencias (p

Abstract Introduction Belantamab mafodotin (BM) is a new anti-BCMA antibody–drug conjugate, recently approved for triple-class relapsed and refractory multiple myeloma (RRMM). We assessed real-world outcomes with BM in patients under the Spanish Expanded Access Program (EAP). Methods We conducted an observational, retrospective, multicenter study including RRMM patients who received ≥ 1 dose of BM (Nov 2019 to Jun 2021). The primary endpoint was overall response rate (ORR). Secondary endpoints were progression-free survival (PFS), overall survival (OS), and incidence of treatment-emergent adverse events (TEAEs). Results Thirty-three patients were included with a median of 70 years of age (range, 46–79 years). Median time from diagnosis was 71 months (range, 10–858 months). Median prior lines was 5 (range, 3–8 lines); 90% of patients were triple-/quad-/penta-refractory; 48% showed high-risk cytogenetics. Median BM doses was 3 (range 1–16 doses), with a median follow-up of 11 months (6–15 months). ORR was 42.2% (≥ VGPR, 18.2%). Median PFS was 3 months (95% CI 0.92–5.08) in the overall population, and 11 months (HR 0.26; 95% CI 0.10–0.68) for patients who achieved ≥ PR. PFS was not significantly different according to age, cytogenetic risk, and prior therapy lines. OS was 424 days (95% CI 107–740). Non-hematological TEAEs (57.6% of patients; 30.3% ≥ G3) included keratopathy (51.5%; 21.2% ≥ G3) and patient-reported vision-related symptoms (45.5%). Keratopathy was resolved in 70.6% of patients. G3 hematological TEAEs was 18.2%, thrombocytopenia (21.2%). Dose reductions due to TEAEs: 30.3%; delays: 36.4%. Treatment discontinuation causes: progression (54.5%), toxicity (non-ocular; 6%/ocular; 6% /ocular + non-ocular toxicity; 3%), death (6%), and patient’s decision (3%). Conclusions BM showed relevant anti-myeloma activity in RRMM with a manageable safety profile. These results corroborate those observed in the BM pivotal trial.

Aim of study: An individual-tree growth system was developed for Aleppo pine (Pinus halepensis Mill.) plantations. Area of study: Aragón region (Northeast Spain). Material and methods: Two datasets were used: Second and Third Spanish National Forest Inventories (104 plots with 1,678 trees), and ad hoc permanent plots (58 plots with 1720 trees, including 36 dead trees). Individual tree growth system was based on nine models. Different combinations of yield classes, initial stocking rates, thinning parameters, rotation periods, and age at first thinning were evaluated through the three most representative scenarios: timber production; soil conservation and biodiversity enhancement. Main results: The nine models demonstrated a significant explanatory power for the data, with R2 values ranging from 0.71 to 0.99. These findings are consistent with previous research, indicating a strong goodness of fit. Additionally, yield tables were developed for the three prevalent silvicultural scenarios. To enhance usability, all models within the system were seamlessly integrated into a web-based application SIMANFOR. Research highlights: To date, Aleppo pine forest managers in Aragon could only simulate silvicultural scenarios in natural stands. This study provides a new tool for plantations.

This work focused on developing optical coatings for decorative applications that remain transparent in the radiofrequency range. To achieve this, a combination of dielectric material (silicon-aluminum nitride, SiAlNx) and low-electrical-conductivity semiconductor material (germanium) was utilized. Germanium plays a crucial role in providing absorption in the visible spectrum, facilitating the design of coatings with various aesthetic appearances, while allowing for control over their transmittance. The optical properties of thin germanium layers were thoroughly characterized and leveraged to create multilayer designs with diverse aesthetic features. Different multilayer structures were designed, fabricated, and optically characterized, resulting in coatings with metallic gray, black, or various colors in reflection, while retaining the ability to transmit visible light for illumination and signaling applications. Finally, the radiofrequency attenuation of the developed coatings was measured, revealing negligible attenuation; this is in stark contrast to the metallic coatings used for decorative purposes, which can attenuate by up to 30 dB.

Abstract The increase in the number of therapeutic alternatives for both newly diagnosed and relapsed/refractory multiple myeloma (RRMM) patients has widened the clinical scenario, leading to a level of complexity that no algorithm has been able to cover up to date. At present, this complexity increases due to the wide variety of clinical situations found in MM patients before they reach the status of relapsed/refractory disease. These different backgrounds may include primary refractoriness, early relapse after completion of first-line therapy with latest-generation agents, or very late relapse after chemotherapy or autologous transplantation. It is also important to bear in mind that many patient profiles are not fully represented in the main randomized clinical trials (RCT), and this further complicates treatment decision-making. In RRMM patients, the choice of previously unused drugs and the number and duration of previous therapeutic regimens until progression has a greater impact on treatment efficacy than the adverse biological characteristics of MM itself. In addition to proteasome inhibitors, immunomodulatory drugs, anti-CD38 antibodies and corticosteroids, a new generation of drugs such as XPO inhibitors, BCL-2 inhibitors, new alkylators and, above all, immunotherapy based on conjugated anti-BCMA antibodies and CAR-T cells, have been developed to fight RRMM. This comprehensive review addresses the fundamentals and controversies regarding RRMM, and discusses the main aspects of management and treatment. The basis for the clinical management of RRMM (complexity of clinical scenarios, key factors to consider before choosing an appropriate treatment, or when to treat), the arsenal of new drugs with no cross resistance with previously administered standard first line regimens (main phase 3 clinical trials), the future outlook including the usefulness of abandoned resources, together with the controversies surrounding the clinical management of RRMM patients will be reviewed in detail.

Aim of study: We introduce the software ModERFoRest (Modelling Environmental Requirements for Forest Restoration), which is a tool to estimate the environmental requirements and environmental performance of the main forest tree species growing in Spain. Area of study: Two of their modules have been developed to be applied mainly in Spain, but the main section can be used elsewhere as long as the user provides with presence data and environmental information. Material and methods: ModERFoRest has been programmed in C++, also using the Armadillo library for algebraic computation. The application can be downloaded from the INIA website (https://www.inia.es/serviciosyrecursos/recursosinformaticos/modernforest/Paginas/ModERFoRest.aspx) where there are also more accessible resources (currently only in Spanish language). Main results: ModERFoRest provides three basic utilities, firstly, to select the optimal species to be used for forest restoration, at local or regional scale, among the 22 most important taxa or formations in Spain, based on ecological criteria and physiographic, climatic and edaphic information. Secondly, to explore the potential distribution areas of the species using the ecological niche models and algorithms developed throughout different projects on the autecology of the species over the last 55 years. Finally, the application provides the option of comparing different areas of the species ecologically, in order to obtain the most suitable reproductive material for the forest site under study. Research highlights: Users can also run not only recent but also future climate scenarios in order to simulate the distribution of ecological species and use the results in reforestation programmes and planning.

Abstract Aims While heart failure (HF) is a leading cause of death in adults with congenital heart disease (ACHD), few studies report contemporary outcomes after the first HF hospitalization. We examined outcomes of ACHD patients newly admitted for HF compared with ACHD patients without HF and the general HF population without ACHD. Methods and results Using population databases from a single‐payer health system from 1994 to 2018, ACHD patients newly admitted for HF were matched 1:1 to ACHD patients without HF (n = 4030 matched pairs). Similarly, ACHD patients newly admitted for HF were matched 1:1 to HF patients without ACHD (n = 4336 matched pairs). Patients with ACHD and HF (median age 68 years, 45% women) experienced higher mortality in short‐term [30 day adjusted hazard ratio (HR) 4.68, 95% confidence interval (CI) 4.06, 5.43, P

Anti-CD38 monoclonal antibody (MoAB) therapy has significantly improved the prognosis of patients with multiple myeloma. However, not all patients sustain durable responses. We aimed to describe the natural history of patients relapsed or refractory (R/R) to CD38 MoAB therapy. We performed a single-center, retrospective analysis of the clinical characteristics and outcomes of 81 patients with multiple myeloma who progressed after treatment with daratumumab. Our cohort was heavily pretreated, with a median of two lines prior to daratumumab and only 17 patients received daratumumab as a first line. A total of 38.2% had received a previous autologous stem cell transplantation (ASCT), and 61.7% had received both an immunomodulatory drug (IMID) and a proteasome inhibitor (PI). The median overall survival (OS) was 21 months for the global cohort but it decreased to 14 months for triple-class refractory patients and 5 months for penta-refractory patients. Most of the patients (83.9%) received treatment after daratumumab progression, in many cases with second generation IMID or PI, but seven patients were treated with anti-BCMA therapy and three patients received CART therapy within a clinical trial. In conclusion, patients R/R to daratumumab represent an unmet clinical need with poor prognosis and in need of incorporation of new treatments.

Abstract The assessment of measurable residual disease (MRD) in bone marrow has proven of prognostic relevance in patients with multiple myeloma (MM). Nevertheless, and unlike other hematologic malignancies, the use of MRD results to make clinical decisions in MM has been underexplored to date. In this retrospective study, we present the results from a multinational and multicenter series of 400 patients with MRD monitoring during front-line therapy with the aim of exploring how clinical decisions made based on those MRD results affected outcomes. As expected, achievement of MRD negativity at any point was associated with improved PFS versus persistent MRD positivity (median PFS 104 vs. 45 months, p

Polymers are essential materials in our daily life. The synthesis of value-added polymers is mainly performed from fossil fuel-derived monomers. However, the adoption of the circular economy model based on the bioeconomy will reduce the dependence on fossil fuels. In this context, biorefineries have emerged to convert biomass into bioenergy and produce high value-added products, including molecules that can be further used as building blocks for the synthesis of biopolymers and bioplastics. The achievement of catalytic systems able to polymerize the natural monomer counterparts, such as terpenes or terpenoids, is still a challenge in the development of polymers with good mechanical, thermal, and chemical properties. This review describes the most common types of bioplastics and biopolymers and focuses specifically on the polymerization of terpenes and terpenoids, which represent a source of promising monomers to create bio-based polymers and copolymers.

Background: Implantable cardioverter defibrillators (ICDs) are effective in preventing arrhythmic sudden cardiac death in patients with tetralogy of Fallot (TOF). Although ICD therapies for malignant ventricular arrhythmias can be life-saving, shocks could have deleterious consequences. Substrate-based ablation therapy has become the standard of care to prevent recurrent ICD shocks in patients with ischemic cardiomyopathy. However, the efficacy and safety of this invasive therapy in the prevention of recurrent ICD shocks in patients with TOF has not been well evaluated. Methods: Records of a total of 47 consecutive TOF patients (mean age: 43.1 ± 13.2 years, male sex: n = 34 [72.3%]) who underwent ICD implantation for secondary prevention between 2000 and 2018 were reviewed. Results: Twenty (42.6%) patients underwent invasive therapy (radiofrequency catheter ablation, n = 8; surgical ablation with pulmonary valve replacement, n = 12) before ICD implantation. Twenty-seven patients (57.4%) were managed noninvasively. During follow-up (median 80.5 [interquartile range, 28.5-131.0] months), 2 (10.0%) patients in the invasive group and 10 (37.0%) patients in the noninvasive group received appropriate ICD shocks (P = 0.036). Logistic regression analysis showed that invasive therapy was associated with a decreased risk of ICD shocks by 81.1% (odds ratio, 0.189; 95% confidence interval, 0.036-0.990; P = 0.049). Furthermore, invasive therapy was associated with decreased risk of the composite outcomes of ICD shock, death, cardiac transplantation, and hospital admission (odds ratio, 0.090; 95% confidence interval, 0.025-0.365; P = 0.013) compared with noninvasive therapy. Conclusions: Invasive substrate modification therapy was associated with a lower likelihood of ICD shocks and improvement of long-term outcomes in TOF patients. Résumé: Contexte: Les défibrillateurs cardioverteurs implantables (DCI) sont efficaces pour prévenir la mort cardiaque subite provoquée par une arythmie chez les patients présentant une tétralogie de Fallot (TF). Bien que le traitement des arythmies ventriculaires malignes par DCI puisse sauver des vies, les chocs administrés peuvent avoir des conséquences délétères. L’ablation du substrat est devenue le traitement de référence pour prévenir l’administration à répétition de chocs par DCI chez les patients atteints d’une cardiomyopathie ischémique. L’efficacité et l’innocuité de ce traitement invasif pour prévenir l’administration de chocs répétés chez les patients présentant une TF n’ont toutefois pas été bien évaluées. Méthodologie: Nous avons examiné les cas consécutifs de 47 patients présentant une TF (âge moyen : 43,1 ± 13,2 ans; hommes : n = 34 [72,3 %]) ayant reçu un DCI en prévention secondaire entre 2000 et 2018. Résultats: Au total, 20 (42,6 %) patients ont subi un traitement invasif (ablation par cathéter par radiofréquence, n = 8; ablation chirurgicale et remplacement de la valve pulmonaire, n = 12) avant l’implantation d’un DCI. Vingt-sept patients (57,4 %) ont été pris en charge de façon non invasive. Au cours de la période de suivi (durée médiane de 80,5 [intervalle interquartile : 28,5 à 131,0] mois), 2 (10,0 %) patients du groupe ayant subi une intervention invasive et 10 (37,0 %) patients du groupe ayant subi une intervention non invasive ont reçu un choc approprié par DCI (p = 0,036). Les résultats de l’analyse par régression logistique montrent que le traitement invasif est associé à une réduction du risque de choc par DCI de 81,1 % (rapport des cotes : 0,189; intervalle de confiance à 95 % : de 0,036 à 0,990; p = 0,049). En outre, le traitement invasif est associé à une réduction du risque de survenue d’un des événements du paramètre d’évaluation composé, soit un choc administré par DCI, le décès, une transplantation cardiaque ou une hospitalisation (rapport des cotes : 0,090; intervalle de confiance à 95 % : de 0,025 à 0,365; p = 0,013) par rapport au traitement non invasif. Conclusions: La modification invasive du substrat a été associée à une probabilité plus faible de choc administré par DCI et à une amélioration des résultats à long terme chez les patients présentant une TF.

The height to crown base (hcb) is a critical measure used in many investigations as an input variable to investigate the vigour of the stands, the social position of the trees, and to evaluate the behaviour of forest fires, among other uses. Though measuring height-related variables in the field is always time-consuming, the foremost benefits offered by modelling hcb are that it permits to generalize and average a very uneven attribute and, furthermore, provides insights about which tree and stand variables have a significant impact on hcb. However, there are many species in which models of the crown base height have not been developed in Croatia. The objective of this research was to develop a height to base crown model for each of the main species present in the two-layered mixed stands of this study. According to previous investigations, logistic models provide the highest precision and require the lowest inventory cost owing to less frequent measurements. Tree- and plot-level variables with distance-independent competition indexes were studied in the fitting model. In this research, we obtained models for the main stand species: Acer campestre (root mean squared error (RMSE) = 2.28 m, R2 = 82.80%); Alnus glutinosa (RMSE = 1.78 m, R2 = 85.36%); Carpinus betulus (RMSE = 2.47 m, R2 = 67.55%); Fraxinus angustifolia (RMSE = 2.46 m, R2 = 82.45%); Quercus robur (RMSE = 2.60 m, R2 = 80.57%); Tilia sp. (RMSE = 2.01 m, R2 = 89.07%); and Ulmus laevis (RMSE = 1.71 m, R2 = 92.42%). The combination of the total height, tree, and plot-level variables with distance-independent competition indexes contributed to the prediction accuracy of proposed model significantly.

Aims: Sudden cardiac death (SCD) is a major cause of mortality in adults with congenital heart disease (ACHD). The role of implantable cardioverter-defibrillator (ICDs) in preventing SCD has been established, however, robust, clinical evidence-based guidelines are lacking in ACHD. The aim of this study was to evaluate the ICD guidelines in ACHD patients. Methods and Results: A total of 131 ACHD patients (male: n = 96 (73.3%), mean age: 42.8 ± 14.7 years, mean follow-up: 40.9 ± 28.3 months) undergoing ICDs implantation between 2010 and 2017 were reviewed. Sixty-nine patients (52.6%) received ICDs for a primary prevention indication. 122 (93.3%) patients had congenital heart disease of moderate to severe complexity. CRT-D (implantable cardiac resynchronization defibrillator) was implanted in 55 (42.0%) patients. During follow-up, 23 patients (17.6%) received appropriate ICD therapy. According to the current guideline (PACES/HRS 2014), 84 (64.1%), 8 (6.1%), and 39 (29.8%) could be classified as Class Ⅰ, Class Ⅱa, and Class Ⅱb indication, respectively. Compared to patients with Class Ⅱa and IIb indication, those with Class Ⅰ indication received more appropriate therapy (P = 0.030). Multivariate analysis showed that age (per 10-years decrease; P = 0.015, HR 1.254 CI; 1.045–1.505) and creatinine (per 100-μmol/L increase; P = 0.019, HR 1.555 CI; 1.076–2.247) were associated with appropriate therapy. Conclusion: Implantation of ICDs for preventing SCD based on current guidelines is reasonable. For patients with a borderline indication, younger age and renal dysfunction may aid in the selection of ICDs candidates.

En un contexto de inusitados cambios en las dinámicas migratorias en México, la frontera sur se ha convertido en un espacio de encuentros y desencuentros, de tensiones, pero también de muestras de solidaridad entre la población local y la extranjera proveniente de regiones como África, Asia, el Caribe, Sudamérica y, por supuesto, Centroamérica. A partir de contextualizar el origen del que huye la población desplazada, enfatizamos en las experiencias de vida que se desprenden de habitar temporalmente en una ciudad fronteriza como Tapachula, que históricamente ha tenido una dinámica de flujos laborales con la región centroamericana. Reflexionamos en torno a los impactos que ha tenido la pandemia en el control de la movilidad de las personas, generando una condición de inmovilidad que arrastra consigo una persistente vulnerabilidad, y con ello, el fortalecimiento de enfoques para la gestión migratoria altamente restrictivos, ahora justificados por motivos sanitarios.

Vilém Flusser é um pensador desenraizado. Judeu e praguense, tem a família assassinada pelos nazistas. Após um ano na Inglaterra, chega ao Brasil em 1940, onde viveria por pouco mais de três décadas. Filósofo multilíngue, faz da autotradução o seu pressuposto de pensamento, postulando que tantas são as realidades quantas forem as línguas articuláveis. Retorna à Europa em 1972 e, a partir de então, leva a vida entre palestras e conferências, sem se filiar formalmente a nenhuma instituição acadêmica. Apesar de sua biografia e filosofia desterradas, o conceito de engajamento não deixou de ser central em sua obra, sobretudo pelo tempo em que viveu no Brasil. É no Brasil que a veiculação afetiva e política a um lugar atravessa o pensamento deste filósofo apátrida, sentimento que o acompanha até o final da vida. A proposta deste artigo, a partir da leitura atenta da correspondência inédita com alguns de seus principais interlocutores, é discutir o engajamento brasileiro de Flusser. A premissa é que Flusser forjou um modelo imaginativo, ainda que sem a pretensão de formular uma “filosofia brasileira”, que pode servir de chave crítica para o entendimento do Brasil contemporâneo. As dúvidas sobre as formas de engajamento no Brasil, que atravessaram a vida de Flusser, especialmente nos anos 1970, estão colocadas à mesa novamente.

PURPOSE Trastuzumab has shown an overall survival (OS) benefit in patients with human epidermal growth factor receptor 2 (HER2)–positive breast cancer (BC), in both the adjuvant and the metastatic setting. We assessed the effectiveness of trastuzumab in patients treated in daily practice according to national treatment coverage protocols and compared our results with those reported by randomized clinical trials. These coverage protocols included patient selection criteria similar to those of those clinical trials and were developed by the Uruguayan National Resource Fund (FNR), the agency that has funded these prescriptions for more than a decade. PATIENTS AND METHODS We included all patients with HER2-positive BC treated with trastuzumab under FNR coverage approved between January 1, 2006, and December 31, 2016. The source of data was the FNR database, and primary outcome was OS, analyzed through Cox proportional hazards regression analysis. RESULTS A total of 1,944 women were included: 1,085 women (55.8%) were postmenopausal and 1,240 (63.7%) had HER2 and hormone receptor–positive BC. Trastuzumab was administered as adjuvant therapy to 1,233 patients (63.5%), of whom 154 also received it as a neoadjuvant treatment. Three hundred nineteen patients (16.4%) received trastuzumab for advanced disease. Five-year OS in the adjuvant setting was 86.4% (95% CI, 84.0% to 88.7%). The median survival of patients with advanced BC was 25.1 months (95% CI, 10.1 to 42.5 months). CONCLUSION Our survival results are not inferior to those reported in clinical trials, in both adjuvant and advanced settings. Importantly, these results support the relevance and the feasibility of treating patients in routine practice, following coverage protocols based on patient selection criteria and methods supported by positive clinical trials. In addition, these results favor quality and appropriate access to BC treatment in our country.

A 52-year-old man following surgery for Ebstein’s anomaly after repair developed acute hemodynamically significant left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve and severe mitral regurgitation. Fluid resuscitation and weaning of inotropes were unsuccessful. Left ventricular outflow tract obstruction and mitral regurgitation resolved by using esmolol. (Level of Difficulty: Intermediate.)

Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher’s exact tests and the OS by Kaplan–Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (≥60 years) (1.84) compared with younger (≤40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity.

Sensitive and specific genotyping of human papillomaviruses (HPVs) is critical for the surveillance and monitoring of the vaccine effectiveness. Here, HPV genotypes were identified in 137 cervical samples with different histology (79 ≤CIN1 and 58 CIN3+) using Nested-PCR followed by Next-Generation sequencing (NGS) and relative proportions for each genotype in multiple infections were computed. All samples had been previously genotyped by PCR-Reverse Blotting Hybridization (PCR-RBH) thus allowing for a concordance analysis between both techniques. Multiple infections were present in 85% of ≤CIN1 cases compared to only 41% in CIN3+ cases (p

Multiple myeloma (MM) remains an incurable plasma cell malignancy. While its origin is enigmatic, an association with infectious pathogens including hepatitis C virus (HCV) has been suggested. Here we report nine patients with monoclonal gammopathy of undetermined significance (MGUS) or MM with previous HCV infection, six of whom received antiviral treatment. We studied the evolution of the gammopathy disease, according to anti-HCV treatment and antigen specificity of purified monoclonal immunoglobulin, determined using the INNO-LIA™ HCV Score assay, dot-blot assays, and a multiplex infectious antigen microarray. The monoclonal immunoglobulin from 6/9 patients reacted against HCV. Four of these patients received antiviral treatment and had a better evolution than untreated patients. Following antiviral treatment, one patient with MM in third relapse achieved complete remission with minimal residual disease negativity. For two patients who did not receive antiviral treatment, disease progressed. For the two patients whose monoclonal immunoglobulin did not react against HCV, antiviral treatment was not effective for MGUS or MM disease. Our results suggest a causal relationship between HCV infection and MGUS and MM progression. When HCV was eliminated, chronic antigen-stimulation disappeared, allowing control of clonal plasma cells. This opens new possibilities of treatment for MGUS and myeloma.

The development of new resources for a more accurate diagnosis and response assessment in multiple myeloma has been a long process for decades, mainly since the middle of the 20th century. During this time, the succession of technical advances has run parallel to the better knowledge of disease biology and the availability of novel therapeutic strategies. The cornerstone of standardized criteria to uniformly evaluate the disease response in myeloma dates back to the 1990s when the key role of complete remission was established. Since then, different updates have been implemented according to available scientific evidences not always without certain controversies. The progressive improvements in survival results of myeloma patients and the growing quality of responses due to the novel therapies have led to the need of developing new tools for better monitoring of tumor burden. In this way, the concept of minimal residual disease and its key value based on the prognostic significance and the clinical relevance has been consolidated during the last years, overcoming the value of conventional response criteria or classical adverse prognosis markers. Nevertheless, its precise role in the clinical management of myeloma patients to detect early treatment failure and trigger early rescue strategies is still pending to be defined. In this review, we revisit the major milestones in the understanding of tumor reduction in multiple myeloma until the most recent imaging techniques or liquid biopsy approaches, including a critical view of conventional response criteria, whose backbone has remained unchanged during the last 20 years.

Despite a lack of evidence, a bone marrow aspirate differential of 500 cells is commonly used in the clinical setting. We aimed to test the performance of 200-cell counts for daily hematological workup. In total, 660 consecutive samples were analyzed recording differentials at 200 and 500 cells. Additionally, immunophenotype results and preanalytical issues were also evaluated. Clinical and statistical differences between both cutoffs and both methods were checked. An independent control group of 122 patients was included. All comparisons between both cutoffs and both methods for all relevant types of cells did not show statistically significant differences. No significant diagnostic discrepancies were demonstrated in the contingency table analysis. This is a real-life study, and some limitations may be pointed out, such as a different sample sizes according to the type of cell in the immunophenotype analysis, the lack of standardization of some preanalytical events, and the relatively small sample size of the control group. The comparisons of differentials by morphology on 200 and 500 cells, as well as by morphology (both cutoffs) and by immunophenotype, are equivalent from the clinical and statistical point of view. The preanalytical issues play a critical role in the assessment of bone marrow aspirate samples.

Lung ultrasound (LUS) allows for the detection of a series of manifestations of COVID-19, such as B-lines and consolidations. The objective of this work was to study the inter-rater reliability (IRR) when detecting signs associated with COVID-19 in the LUS, as well as the performance of the test in a longitudinal or transverse orientation. Thirty-three physicians with advanced experience in LUS independently evaluated ultrasound videos previously acquired using the ULTRACOV system on 20 patients with confirmed COVID-19. For each patient, 24 videos of 3 s were acquired (using 12 positions with the probe in longitudinal and transverse orientations). The physicians had no information about the patients or other previous evaluations. The score assigned to each acquisition followed the convention applied in previous studies. A substantial IRR was found in the cases of normal LUS (κ = 0.74), with only a fair IRR for the presence of individual B-lines (κ = 0.36) and for confluent B-lines occupying < 50% (κ = 0.26) and a moderate IRR in consolidations and B-lines > 50% (κ = 0.50). No statistically significant differences between the longitudinal and transverse scans were found. The IRR for LUS of COVID-19 patients may benefit from more standardized clinical protocols.

An adhesive based on a Fe3O4-nanoparticle (MNP)-doped epoxy resin was proposed for the development of detachable adhesive joints with GFRP substrates. The analysis of cryofractures showed that the increasing MNP content promotes a higher presence of larger aggregates and a lower sedimentation of nanoparticles due to the higher viscosity of the mixture. In this regard, the inclusion of expandable microspheres (MS) induces a more uniform dispersion of MNPs, reducing their sedimentation. The capability of the proposed adhesives for electromagnetic (EM) heating was also evaluated, with increases in temperature of around 100 °C at 750 A, enough to reach the Tg of the polymer required to facilitate the adhesive detachment, which is around 80 °C. Finally, the lap shear strength (LSS) of 14 and 20 wt.% MNP samples was evaluated in a single-lap shear joint with simultaneous EM heating. The LSS values were reduced by 60–80% at 750 A, thus promoting successful adhesive joint detachment under EM heating.

The pathological increase of clonal IgM in Waldenström macroglobulinemia can be associated with acquired von Willebrand syndrome and can be a major risk of bleeding symptoms in this subgroup of patients with Waldenström macroglobulinemia. The Bruton tyrosine kinase inhibitor ibrutinib is one of the approved treatments for symptomatic Waldenström macroglobulinemia. However, some controversy exists regarding the use of ibrutinib in these patients with high risk of bleeding because of its antiaggregant effect that could increase the risk of bleeding. Here, we present the case of a patient with Waldenström macroglobulinemia with associated acquired von Willebrand syndrome and progressively significant bleeding symptoms, who experienced a rapid increase in von Willebrand factor with ibrutinib treatment, despite only reaching a partial response in IgM levels similar to those reached with other previous treatments. We suggest that the control over the monoclonal protein is not the only mechanism that explains the good response, improvement in the bleeding symptoms and von Willebrand factor levels. This fact could be explained by the reduced glycoprotein Ib receptor expression induced by ibrutinib and the consequent von Willebrand factor increase in peripheral blood.

Background: Anomalous origin of a coronary artery from the pulmonary artery (PA) is a rare condition that usually presents in childhood. The aim of this study is to describe its characteristics in unrepaired adults. Methods: We conducted a retrospective study of 18 patients with left and right anomalous coronary artery from the PA (ALCAPA and ARCAPA) diagnosed in adulthood. Patients ≥18 years old at diagnosis and assessed at least once in our institution were included. Results: Median age at diagnosis was 29.5 years [IQR 24.0–48.8]. Presentation mode varied, with two patients (11%) diagnosed following aborted sudden cardiac death. Diagnosis was most frequently made by coronary angiography (44%) and cardiac computed tomography (28%). The mean left ventricle ejection fraction (LVEF) at presentation was 56 ±10% and moderate or severe mitral regurgitation was present in 5 patients. Surgical or interventional repair was performed in 14 patients (78%), 9 of whom (50%) underwent reimplantation. Median follow-up was 8.5 years [IQR 0.98–13.8]. One patient with severe pulmonary hypertension died during the follow-up. Most patients (79%) were in NYHA functional class 1 at last follow-up with a mean LVEF of 53±12%. Conclusions: Anomalous origin of a coronary artery from the PA can present in adulthood in various ways. Multimodality imaging allows the diagnosis and assessment of functional impact. Surgical correction of ALCAPA with establishment of a dual coronary pathway was the most frequent management strategy in our cohort. The majority of patients experienced favorable long-term outcomes.

The estimation of forest residual biomass is of interest to assess the availability of green energy resources. This study relates the Pinus halepensis Miller forest residual biomass (FRB), estimated in 192 field plots, to several independent variables extracted from Airborne Laser Scanner (ALS) data in Aragón region (Spain). Five selection approaches and four non-parametric regression methods were compared to estimate FRB. The sample was divided into training and validation sets, composed of 144 and 48 plots, respectively. The best-fitted model was obtained using the Support Vector Machine method with the radial kernel. The model included three ALS metrics: the 70th percentile, the variance of the return heights, and the percentage of first returns above mean height. The root-mean-square error (RMSE) after validation was 8.85 tons ha−1. The influence of point density, scan angle, canopy pulse penetration, terrain slope, and shrub presence in model performance was assessed using graphical and statistical approaches. Point densities higher than 1 point m−2, scan angles lower than 15°, canopy pulse penetration over 25%, and terrain slopes under 30% generated a smaller variability in mean predictive error (MPE) values, thus increasing model accuracy in 0.56, 1.94, 1.44, and 5.47 tons ha−1, respectively. Shrub vegetation caused greater variability in MPE values but slightly decreased model accuracy (0.10 tons ha−1). No statistically significant differences were found between the categories in the influencing variables, except for canopy pulse penetration. The mapping of Pinus halepensis Miller FRB using the best-fitted model summed up a total of 3,627,021.25 tons, which equals to 1,584.91 thousand tonnes of oil (ktoe).

Introduccción: en Uruguay, el cáncer de cuello uterino ocupó el tercer lugar con una incidencia promedio de 312 nuevos casos por año; fallecieron 134 mujeres promedio por año en el período 2010 - 2014. Objetivo: el objetivo de este trabajo fue analizar los primeros resultados de una experiencia piloto con la aplicación del test de HPV captura híbrida HC2 (QiagenR ) como test de tamizaje primario del cáncer de cuello uterino en una zona del departamento de Canelones. Método: se estudiaron 1.010 mujeres asintomáticas entre 30 y 64 años que concurrieron a realizarse el test de PAP a dos unidades de toma de muestras del Programa de prevención del cáncer de cuello uterino. Se realizó la extracción conjunta de la muestra para PAP, que fue derivada a uno de los laboratorios de citología de la Red de Atención Primaria de Salud y la muestra de HPV que fue procesada con la técnica de captura híbrida en el laboratorio de biología molecular del Centro Hospitalario Pereira Rossell. Las usuarias con resultados HPV + y PAP anormales (ASC-US+) fueron derivadas a colposcopia, con biopsia y posterior tratamiento cuando correspondió. Resultados: el test de HPV fue positivo en 126/1.010 mujeres (12,5%) y el PAP anormal en 167/1.010 (16,5%). El test de HPV fue positivo en todos los casos CIN2+ 13/13 (100%) mientras que el PAP fue anormal (ASCUS+) en 7/13 (54%) para CIN2+ por biopsia. Conclusión: el test de HPV resultó más eficaz y eficiente que el PAP para la detección de lesiones precancerosas de cuello uterino.

Introduction: In Uruguay, breast cancer has the highest incidence and mortality of all cancer in women. Knowledge of the distribution of risk factors related to disease development supports the implementation of prevention strategies in routine clinical practice. This study aimed to determine the epidemiological profile for breast cancer and the frequency of mammographic surveillance in the surveyed population. Materials and Methods: A survey was conducted among Uruguayan women diagnosed with breast cancer who were assisted in the mastology unit of the oncology service of the Hospital de Clínicas in Montevideo, Uruguay, from September 1, 2018, to March 1, 2020. Results: This study included 398 respondents, with a median (SD) age at diagnosis of 61 (34-86) years. A total of 310 respondents (78.0%) had 1 or more risk factors. Most women aged over 50 years (264 out of a total of 338 [78.1%]) underwent mammographic surveillance at least biennially. Conclusions: Consistent with international reports, most respondents had a risk factor. Among the group of respondents aged over 50 years, most underwent mammographic and clinical surveillance at least biennially. Although it is only possible to formulate conclusions about the surveyed women because of the study design, the obtained data further our understanding of the epidemiological profile of the Uruguayan population, which can contribute to prevention practices.

Adapted automated peritoneal dialysis (aAPD), comprising a sequence of dwells with different durations and fill volumes, has been shown to enhance both ultrafiltration and solute clearance compared to standard peritoneal dialysis with constant time and volume dwells. The aim of this non-interventional study was to describe the different prescription patterns used in aAPD in clinical practice and to observe outcomes characterizing volume status, dialysis efficiency, and residual renal function over 1 year. Prevalent and incident, adult aAPD patients were recruited during routine clinic visits, and aAPD prescription, volume status, residual renal function and laboratory data were documented at baseline and every quarter thereafter for 1 year. Treatments were prescribed according to the nephrologist’s medical judgement in accordance with each center’s clinical routine. Of 180 recruited patients, 160 were analyzed. 27 different aAPD prescription patterns were identified. 79 patients (49.4%) received 2 small, short dwells followed by 3 long, large dwells. During follow-up, volume status changed only marginally, with visit mean values ranging between 1.59 (95% confidence interval: 1.19; 1.99) and 1.97 (1.33; 2.61) L. Urine output and creatinine clearance decreased significantly, accompanied by reductions in ultrafiltration and Kt/V. 25 patients (15.6%) received a renal transplant and 15 (9.4%) were changed to hemodialysis. Options for individualization offered by aAPD are actually used in practice for optimized treatment. Changes observed in renal function and dialysis efficiency measures reflect the natural course of chronic kidney disease. No safety events were observed during the study period.

Understorey evaluation is essential in wildlife habitat management, biomass storage and wildfire suppression, among other areas. The lack of a standardised methodology in the field measurements, and in their subsequent analysis, forces researchers to look for procedures that effectively extract understorey data to make management decisions corresponding to actual stand conditions. In this sense, when analysing the understorey characteristics from LiDAR data, it is very usual to ask: “what value should we set the understorey height range to?” It is also usual to answer by setting a numeric value on the basis of previous research. Against that background, this research aims to identify the optimal height to canopy base (HCB) filter–LiDAR metric relationship for estimating understorey height (UH) and understorey cover (UC) using LiDAR data in the Pokupsko Basin lowland forest complex (Croatia). First, several HCB values per plot were obtained from field data (measured HCBi—HCBM-i, where i ϵ (minimum, maximum, mean, percentiles)), and then they were modelled based on LiDAR metrics (estimated HCBi—HCBE-i). These thresholds, measured and estimated HCBi per plot, were used as point cloud filters to estimate understorey parameters directly on the point cloud located under the canopy layer. In this way, it was possible to predict the UH with errors (RMSE) between 0.90 and 2.50 m and the UC with errors (RMSE) between 8.8 and 18.6 in cover percentage. Finally, the sensitivity analysis showed the HCB filter (the upper threshold to select the understorey LiDAR points) is the most important factor affecting the UH estimates, while this factor and the LiDAR metric are the most important factors affecting the UC estimates.

BackgroundStringent complete response (sCR) is used as a deeper response category than complete response (CR) in multiple myeloma (MM) but may be of limited value in the era of minimal residual disease (MRD) testing.MethodsHere, we used 4-colour multiparametric flow cytometry (MFC) or next-generation sequencing (NGS) of immunoglobulin genes to analyse and compare the prognostic impact of sCR and MRD monitoring. We included 193 treated patients in two institutions achieving CR, for which both bone marrow aspirates and biopsies were available.ResultsWe found that neither the serum free light chain ratio, clonality by immunohistochemistry (IHC) nor plasma cell bone marrow infiltration identified CR patients at distinct risk. Patients with sCR had slightly longer progression-free survival. Nevertheless, persistent clonal bone marrow disease was detectable using MFC or NGS and was associated with significantly inferior outcomes compared with MRD-negative cases.ConclusionOur results confirm that sCR does not predict a different outcome and indicate that more sensitive techniques are able to identify patients with differing prognoses. We suggest that MRD categories should be implemented over sCR for the future classification of MM responses.

A partir de la irrupción en México de las denominadas “caravanas migrantes” a finales de 2018 y principios de 2019, en este país se generaron muestras de solidaridad y rechazo hacia este movimiento masivo de ciudadanos centroamericanos. Haciendo uso de la etnografía como herramienta para el análisis de las prácticas sociales y sus significados, el artículo busca dar cuenta de algunas situaciones suscitadas en las fronteras norte y sur de México. Se ofrece un acercamiento a los discursos generados por la población local y la prensa en torno al flujo masivo de personas indocumentadas desde Centroamérica y en su paso por México. Los discursos recogen las complejidades del tránsito en caravana, así como las expresiones de xenofobia, racismo y solidaridad por parte de un segmento de la población local para con los migrantes. De esta forma, este artículo reflexiona sobre cómo en espacios fronterizos se ponen en juego imaginarios diversos, y a veces divergentes, en torno a la persona migrante.

Resumen: Este artículo es continuación de la revisión iniciada en el número anterior sobre la utilidad de la ecografía clínica abdominal en Atención Primaria (AP), y completa los escenarios de grandes vasos abdominales, bazo, nefrourológicos y ginecológicos. Abstract: This article is a continuation of the review initiated in the previous issue about the usefulness of point of care ultrasound in Primary Care, completing the scenarios of large abdominal vessels, spleen, nephrourological and gynecological ultrasound. Palabras clave: Ecografía clínica, Medicina familiar, Utilidad, Fiabilidad, Keywords: Point of care ultrasound, Family practice, Usefulness, Reliability

Resumen: La ecografía es una técnica segura y fiable que aumenta la capacidad diagnóstica, agiliza y mejora la toma de decisiones de los profesionales de la medicina en cualquier ámbito de ejercicio. El médico de familia (MF), que debe ser competente para abordar la práctica totalidad de los problemas de salud de las personas, es un especialista idóneo para incorporar esta herramienta a su actividad, dotándose con ella de una capacidad de manejo hasta ahora desconocida, al ser muy numerosas las situaciones clínicas de la práctica habitual en las cuales se puede beneficiar de ella de modo fiable, eficiente y eficaz. Al tratarse de una tecnología muy dependiente del explorador, se hace necesario asegurar la competencia de quienes la practican, definir los beneficios y los potenciales riesgos que su uso puede generar, así como sus escenarios de aplicación, en aras de evitar exploraciones innecesarias y minimizar el coste oportunidad que puede suponer incorporar esta actividad a una agenda de por sí desbordada. Este trabajo pretende resumir el estado actual de la ecografía clínica abdominal y su utilidad para el MF en aquellos escenarios en los que resulta fiable y eficaz. Abstract: Ultrasound is a safe and reliable way to increase diagnosis capabilities, as well as an improving and speed up method for taking decisions for healthcare professionals of every medical specialty. Family doctor, who must be ready to address all kind of health problems for his patients, is the key person to incorporate this tool to his daily activity, acquiring the best managing skill, unknown nowadays, being quite large the clinical situations in the day by day practice, in which he can obtain benefit in a reliable and effective way.Due to this practice is explorer dependent, it's needed to assure the best competence of the professional who practice it, and define the benefits and potential risks its use can create, as well as its application scenarios, in order to avoid unnecessary explorations and minimize opportunity costs that this activity can add to a currently saturated agenda. This work pretends to summarize the current state of abdominal point of care ultrasound, and its utility for the family doctor, in those scenarios that can be potentially reliable and effective. Palabras clave: Ecografía clínica, Medicina familiar, Utilidad, Fiabilidad, Keywords: Point of care ultrasound, Family practice, Usefulness, Reliability

Despite tremendous progress being made in recent years, multiple myeloma (MM) remains a challenging disease. The laboratory plays a critical role in the overall management of patients. The diagnosis, prognosis, clinical monitoring and evaluation of the response are key moments in the clinical care process. Conventional laboratory methods have been and continue to be the basis of laboratory testing in monoclonal gammopathies, along with the serum free light chain test. However, more accurate methods are needed to achieve new and more stringent clinical goals. The heavy/light chain assay is a relatively new test which can overcome some of the limitations of the conventional methods for the evaluation of intact immunoglobulin MM patients. Here, we report an update of the evidence accumulated in recent years on this method regarding its use in MM.