Treatment of depressed skull fractures with vacuum devices in the neonatal period: A case series.

PURPOSE: The management of depressed skull fractures in infants can be either conservative or surgical. This study aimed to examine the outcomes of management with a negative-pressure vacuum device on depressed skull fractures in newborns. METHODS: Twenty-eight patients (aged 1-6 days) with simple depressed skull fractures underwent skull elevation using negative-pressure vacuum devices. A protocol for nonsurgical management was adopted for infants with such fractures between 2010 and 2023. All patients were initially evaluated with neurological examination and complementary assessments-hematological and coagulation studies, transfontanel transcranial ultrasound, skull radiography, and computed tomography scanning with three-dimensional reconstruction-according to availability and clinical needs. Gentle (negative) extraction pressure was applied with one of several devices (according to institutional availability) for a maximum duration of 60 s; this was performed as soon as possible after diagnosis, preferably within 72 h. Follow-up data, available in the clinical records, were reported. RESULTS: All patients exhibited satisfactory elevation of the depressed bone without associated injuries, except one patient who presented with an associated cephalohematoma which prevented optimal device coupling to generate sufficient vacuum pressure for correction. Neither neurological deficits nor development of epilepsy was noted; normal neurological assessment and oral alimentation tolerance were confirmed within 24 h post procedure. CONCLUSIONS: According to our data, ping-pong skull fracture elevation using the vacuum method is a safe and satisfactory treatment in the neonatal period. Early treatment allows for quick resolution, and in our opinion is the strategy of choice for depressed skull fractures in newborns.

Identification of atlastin genetic modifiers in a model of hereditary spastic paraplegia in Drosophila.

Hereditary spastic paraplegias (HSPs) are a group of neurodegenerative disorders characterized by progressive dysfunction of corticospinal motor neurons. Mutations in Atlastin1/Spg3, a small GTPase required for membrane fusion in the endoplasmic reticulum, are responsible for 10% of HSPs. Patients with the same Atlastin1/Spg3 mutation present high variability in age at onset and severity, suggesting a fundamental role of the environment and genetic background. Here, we used a Drosophila model of HSPs to identify genetic modifiers of decreased locomotion associated with atlastin knockdown in motor neurons. First, we screened for genomic regions that modify the climbing performance or viability of flies expressing atl RNAi in motor neurons. We tested 364 deficiencies spanning chromosomes two and three and found 35 enhancer and four suppressor regions of the climbing phenotype. We found that candidate genomic regions can also rescue atlastin effects at synapse morphology, suggesting a role in developing or maintaining the neuromuscular junction. Motor neuron-specific knockdown of 84 genes spanning candidate regions of the second chromosome identified 48 genes required for climbing behavior in motor neurons and 7 for viability, mapping to 11 modifier regions. We found that atl interacts genetically with Su(z)2, a component of the Polycomb repressive complex 1, suggesting that epigenetic regulation plays a role in the variability of HSP-like phenotypes caused by atl alleles. Our results identify new candidate genes and epigenetic regulation as a mechanism modifying neuronal atl pathogenic phenotypes, providing new targets for clinical studies.

Trends in Cleft lip and/or Palate Prevalence at Birth in Mexico: A National (Ecological) Study Between 2003 and 2019.

OBJECTIVE: To describe trends in cases and prevalence at birth rates of cleft lip and/or palate (CL/P) in Mexico between 2003 and 2019. DESIGN: Ecological study. SETTING: Multiple data sources systematically collected into a national epidemiological surveillance data warehouse. PARTICIPANTS: National Live Birth Information System. MAIN OUTCOME MEASURE(S): Both cases and prevalence at birth rates of CL/P in Mexico within a 17-year period were used as dependent variables. RESULTS: At the national level there were 23 184 new cases of CL/P (average of 1364 per year) in the 32 states of Mexico, with an average prevalence at birth rate of 0.53 per 1000 live births. The states with the highest prevalence at birth rates of CL/P during the period were Hidalgo (1.59) and Jalisco (1.32), while the states with the lowest rates were Nayarit (0.22) and Durango (0.29). A slight decrease in both cases (z = -2.41, P = .016) and prevalence at birth rates (z = -2.58, P = .010) of CL/P was observed at the national level. States such as Durango, Puebla, Chiapas, Guerrero, Oaxaca, Mexico City, State of Mexico, Coahuila and Jalisco showed a clear downward trend (P < .05) in their prevalence at birth of CL/P between 2003 and 2019, while in Hidalgo its trend was upward (P = .05). Significant differences by sex and region were observed (P < .05). CONCLUSION: Some states consistently had the highest or lowest prevalence of CL/P. Decreasing trends in the overall prevalence at birth rates were observed. More detailed, epidemiological studies are necessary to adequately characterize CL/P in the Mexican population.

Hybrid Laparo-Endoscopic Resection of Submucosal Cardial Tumors Assisted by Flexible Articulated Instruments.

We report a new surgical method in 10 patients who underwent hybrid laparo-endoscopic resection (HLER) of submucosal tumors with the combination of flexible articulated laparoscopic instruments (FALI). We have assessed technical reproducibility, safety, and morbidity. Resection was completed in all cases. Mean surgical time was 60 min (30-85). Median tumor size was 16 mm (12-30). The more frequent location was the gastroesophageal junction. No complications were observed during the procedure. Length of stay was 1 day in all cases. We have found HLER to be a safe procedure allowing margin resection and organ preservation. The addition of FALI added ease of performance in hard-to-reach tumor locations.

Biomechanical Features of Reinforced Esophageal Hiatus Repair in a Porcine Model.

Recurrence rates in the laparoscopic repair of the hiatal hernia range from 12% to 59%. Limitation of reinforcement has been principally the risk of adverse events caused by synthetic materials. Biologic and resorbable synthetic materials are valid alternatives. This study compares the host response to all these materials after hiatal hernia repair. A total of 20 Landrace pigs, underwent laparoscopic primary hiatal hernia repair and reinforced with a polypropylene mesh (PROLENE: polypropylene [PP]), an absorbable synthetic scaffold (GOREBIO-A: polyglycolic acid [PGA]), a urinary bladder matrix scaffold, (Gentrix: urinary bladder matrix [UBM]), or without reinforcement, control group (C). Animals were survived for 3 months. Endpoints included gross morphology, biomechanical testing, and histology. Pigs in PP and PGA groups showed fibrosis at the repair site, with robust adhesions. In UBM and C groups, only mild adhesions were found. Load at failure (gr) and stiffness (gr/mm) of PP were higher than C group (PP:2103 ± 548.3 versus C:951.1 ± 372.7, P = 0.02; PP:643.3 ± 301 versus C:152.6 ± 142.7, P = 0.01). PGA and UBM values for both parameters were in between PP and C samples. However, stiffness in UBM was tended to be lower than PP group, and approached a significant difference (643.3 ± 301 versus 243 ± 122.1, P = 0.0536). In UBM group, the histology resembled native tissue. By contrast, PP and PGA groups showed mononuclear infiltrates, fibroencapsulation, necrosis, remnants of mesh, and disorganized tissue that was validated with a histologic score. In this setting, UBM scaffolds showed the most appropriate features for hiatal hernia repair, recovering the tissue properties that can help reduce the possibility of early failure and prevent complications associated with the implanted material.

Urinary Bladder Matrix Scaffolds Promote Pericardium Repair in a Porcine Model.

Pericardium closure after cardiac surgery is recommended to prevent postoperative adhesions to the sternum. Synthetic materials have been used as substitutes, with limited results because of impaired remodeling and fibrotic tissue formation. Urinary bladder matrix (UBM) scaffolds promote constructive remodeling that more closely resemble the native tissue. The aim of the study is to evaluate the host response to UBM scaffolds in a porcine model of partial pericardial resection. Twelve Landrace pigs were subjected to a median sternotomy. A 5 × 7 cm pericardial defect was created and then closed with a 5 × 7 cm multilayer UBM patch (UBM group) or left as an open defect (control group). Animals were survived for 8 wk. End points included gross morphology, biomechanical testing, histology with semiquantitative score, and cardiac function. The UBM group showed mild adhesions, whereas the control group showed fibrosis at the repair site, with robust adhesions and injury to the coronary bed. Load at failure (gr) and stiffness (gr/mm) were lower in the UBM group compared with the native pericardium (199.9 ± 59.2 versus 405.3 ± 99.89 g, P = 0.0536 and 44.23 ± 15.01 versus 146.5 ± 24.38 g/mm, P = 0.0025, respectively). In the UBM group, the histology resembled native pericardial tissue, with neovascularization, neofibroblasts, and little inflammatory signs. In contrast, control group showed fibrotic tissue with mononuclear infiltrates and a lack of organized collagen fibers validated with a histologic score. Both groups had normal ultrasonography results without cardiac motility disorders. In this setting, UBM scaffolds showed appropriate features for pericardial repair, restoring tissue properties that could help reduce postsurgical adhesions and prevent its associated complications.

Anesthesia for Nonobstetric Surgery in Pregnancy.

Nonobstetric surgery during pregnancy occurs in 1% to 2% of pregnant women. Physiologic changes during pregnancy may have an impact when anesthesia is needed. Anesthetic agents commonly used during pregnancy are not associated with teratogenic effects in clinical doses. Surgery-related risks of miscarriage and prematurity need to be elucidated with well-designed studies. Recommended practices include individualized use of intraoperative fetal monitoring and multidisciplinary planning to address the timing and type of surgery, anesthetic technique, pain management, and thromboprophylaxis. Emergency procedures should be performed immediately and elective surgery should be deferred during pregnancy.

OXIDATIVE STRESS, TELOMERE LENGTH, AND FRAILTY IN AN OLD AGE POPULATION.

Background: A global aging population requires focusing on the risk factors for unhealthy aging, preventive medicine, and chronic disease management. The identification of adverse health outcomes in older adults has been addressed by the characterization of frailty as a biological syndrome. In this field, oxidative stress and telomere length have been suggested as biomarkers of aging. Objective: The objective of the study was to study the association of oxidative stress, telomere length, and frailty in an old age population. Methods: We conducted a cross-sectional study based on 2015 data from 202 members of a cohort of older adults (n = 202; F/M gender ratio: 133/69; mean age: 69.89 ± 7.39 years). Reactive oxygen species were measured by dichlorofluorescein diacetate and lipid peroxidation by malondialdehyde. Telomere length was determined using quantitative polymerase chain reaction with SYBR Green Master Mix. Results: Statistical analysis showed an association between telomere length and frailty but no association between oxidative stress and telomere length or frailty. Conclusions: Telomere length could eventually be used as a marker to differentiate between healthy and unhealthy aging as expressed by frailty phenotype; oxidative stress seemed merely a biological process of aging.

Per oral endoscopic myotomy vs. laparoscopic Heller myotomy, does gastric extension length matter?

OBJECTIVE: To report our experience in POEM vs. LHM, with particular focus on myotomy extension. BACKGROUND: POEM has been adopted worldwide as a treatment for achalasia. While resolution of dysphagia is above 90%, postoperative reflux ranges from 10 to 57%. Myotomy length has been a controversial topic. METHODS: Thirty-five cases of POEM were prospectively analyzed and compared retrospectively to the last 35 patients that underwent LHM, from December 2010 to August 2016. Mean follow-up was 10 months (6/32) for POEM and 20 months (6/68) for LHM. All patients with LHM had a myotomy extension ≥3 cm on the gastric side. In POEM cases, extension was defined by direct vision (Hill type II) and never exceeded 2 cm. RESULTS: Follow-up was completed in 100% of patients. Efficacy (ES ≤ 3) was 33/35 (94.2%) for POEM and 32/35 (91.4%) for LHM in a short-term follow-up (p = 1.000) and 31/35 (88.6%) and 27/35 (77.1%), respectively, in a long-term follow-up (p = 1.000), with average ES drop from 9 to 1.2 (p = 0.0001) in POEM vs. 9.2 to 1.3 (p = 0.0001) in LHM. Major Postoperative complications occurred in 1 patient (leak) for LHM and 1 patient (massive capnothorax) in POEM. Hospital stay was shorter for POEM than for LHM (1.3 vs. 2.1, respectively) (p = 0.0001). Symptomatic reflux cases included 7/35 POEM (20%) vs. 6/35 LHM (17.1%) (p = 0.4620). Esophagitis signs in endoscopy appeared in 1/21 POEM (4.7%) vs. 1/22 LHM (4.5%) (p = 1.000). Patients requiring PPI included 8/35 POEM (22.8%) vs. 7/35 LHM (20%) (p = 0.6642). Further treatment (endoscopic dilation) was performed in 10/35 POEM (28.5%) vs. 8/35 LHM (22.8%). CONCLUSIONS: A shorter myotomy on the gastric side in POEM may contribute to an acceptable reflux rate with comparable relief of dysphagia. Although our follow-up for POEM is shorter than for LHM, the trends are promising and warrant future prospective studies to address this topic.

Training future anesthesiologists in obstetric care.

PURPOSE OF REVIEW: In order for the obstetric anesthesiologist to become a true perioperative / peripartum physician, a change in formative programs and certification process in anesthesia are needed. RECENT FINDINGS: Anesthesia training programs are migrating to competency based medical education (CBME) worldwide. The traditional model of attending lectures, grand rounds, reading textbooks and journal papers should be complemented by virtual modalities such as massive open online courses or online teaching tools. The gold standard for assessment of procedural skills in anesthesia consists of a combination of global rating scales and previously validated checklists. Behaviors in the perioperative environment not directly related to the use of drugs, equipment or medical expertise are known as anesthesiologist nontechnical skills and trainees must learn and practice these skills; nontechnical skills can determine 50-80% of adverse events in high-risk professions, including medicine. Regular certification programs are also an important component of the new approach in medical education, in some high-income countries, the specialist anesthesiologist is undertaking regular certification but the impact of these programs on overall outcomes is still unknown. SUMMARY: The obstetric population is becoming a higher risk population, requiring an obstetric anesthesiologist taking on the role of a perioperative / peripartum physician. It is essential that anesthesia training programs migrate to CBME through simulation-based curriculum that allow the achievement of nontechnical skills and team work competencies. It is also essential that regular certification for specialist anesthesiologists occur throughout their entire career.

Hyperuricemia on Admission Predicts Short-Term Mortality due to Myocardial Infarction in a Population with High Prevalence of Cardiovascular Risk Factors.

BACKGROUND: National health surveys have revealed an outstandingly high prevalence of obesity, hypertension, and diabetes in Mexico. OBJECTIVE: To assess whether serum uric acid levels on admission may predict short-term mortality in patients with ST-segment elevation myocardial infarction in a population with an unusually high prevalence of classic cardiovascular risks. METHODS: A total of 795 ST-segment elevation myocardial infarction patients undergoing primary reperfusion therapy were classified as having normouricemia or hyperuricemia according to serum uric acid levels at admission, and the occurrence of mortality and major adverse cardiovascular events during coronary care unit stay was assessed. RESULTS: Patients with hyperuricemia (n = 291; mean age 61.2 ± 11.9 years; 74.8% males) were older, obese, hypertensive, and had a higher Killip class at admission than those with normouricemia (n = 504; mean age 57.6 ± 11.3 years; 88.9% males). Mortality rates were 1.7 and 0.7 cases/100 patients per day of coronary care unit stay in hyperuricemic and normouricemic patients, respectively. Comparatively, no association was observed for the occurrence of major adverse cardiovascular events. After multivariate adjustments, independent predictors for short-term mortality were only Killip class ≥ 2 (HR: 13.15; 95% CI: 5.29-29.85; p < 0.0001) and elevated serum uric acid levels (HR: 1.99; 95% CI: 1.08-3.66; p = 0.026). CONCLUSIONS: Hyperuricemia on admission remains associated with short-term mortality in ST-segment elevation myocardial infarction patients from a population with an unusually high prevalence of cardiovascular risk factors.

Coffee Consumption Increases the Antioxidant Capacity of Plasma and Has No Effect on the Lipid Profile or Vascular Function in Healthy Adults in a Randomized Controlled Trial.

BACKGROUND: Coffee, a source of antioxidants, has controversial effects on cardiovascular health. OBJECTIVE: We evaluated the bioavailability of chlorogenic acids (CGAs) in 2 coffees and the effects of their consumption on the plasma antioxidant capacity (AC), the serum lipid profile, and the vascular function in healthy adults. METHODS: Thirty-eight men and 37 women with a mean ± SD age of 38.5 ± 9 y and body mass index of 24.1 ± 2.6 kg/m(2) were randomly assigned to 3 groups: a control group that did not consume coffee or a placebo and 2 groups that consumed 400 mL coffee/d for 8 wk containing a medium (MCCGA; 420 mg) or high (HCCGA; 780 mg) CGA content. Both were low in diterpenes (0.83 mg/d) and caffeine (193 mg/d). Plasma caffeic and ferulic acid concentrations were measured by GC, and the plasma AC was evaluated with use of the ferric-reducing antioxidant power method. The serum lipid profile, nitric oxide (NO) plasma metabolites, vascular endothelial function (flow-mediated dilation; FMD), and blood pressure (BP) were evaluated. RESULTS: After coffee consumption (1 h and 8 wk), caffeic and ferulic acid concentrations increased in the coffee-drinking groups, although the values of the 2 groups were significantly different (P < 0.001); caffeic and ferulic acid concentrations were undetectable in the control group. At 1 h after consumption, the plasma AC in the control group was significantly lower than the baseline value (-2%) and significantly increased in the MCCGA (6%) and HCCGA (5%) groups (P < 0.05). After 8 wk, no significant differences in the lipid, FMD, BP, or NO plasma metabolite values were observed between the groups. CONCLUSIONS: Both coffees, which contained CGAs and were low in diterpenes and caffeine, provided bioavailable CGAs and had a positive acute effect on the plasma AC in healthy adults and no effect on blood lipids or vascular function. The group that did not drink coffee showed no improvement in serum lipid profile, FMD, BP, or NO plasma metabolites. This trial was registered at registroclinico.sld.cu as RPCEC00000168.

Impact of socio-demographic, socioeconomic, and water variables on dental fluorosis in adolescents growing up during the implementation of a fluoridated domestic salt program.

The objective of this study is to determine the impact of socio-demographic, socioeconomic, and other risk indicators on dental fluorosis (DF) among Mexican adolescents. A cross-sectional study was carried out in 1,538 adolescents 12 and 15 years of age in semi-rural communities located at high altitude (>2,000 m) and with high concentration of fluoride in water (1.38-3.07 ppm) in Hidalgo, Mexico. DF was determined by means of Dean's Index and all teeth were examined. Remaining variables were collected using a questionnaire. The adjusted final model was performed using ordered logistic regression. After adjusting for sex, the variables associated with DF were (p < 0.05): being 12 years old (OR = 1.10) versus 15 years old; having lived the first 6 years of life in El Llano (3.07 F ppm) (OR = 3.19) or San Marcos (1.38 F ppm) (OR = 1.63) versus Tula (1.42 F ppm); having public (OR = 1.35) or private health insurance (OR = 1.36) versus those without insurance; belonging to the lower quartiles of socioeconomic position (SEP) [1st quartile (OR = 2.48), 2nd quartile (OR = 1.81), 3rd quartile (OR = 1.49)] versus the highest quartile; having drunk tap water (OR = 1.83) or from a well or spring (OR = 2.30) versus those who drank water purchased in large containers or bottles. Demographic and socioeconomic variables were associated with DF. While better SEP appeared to play an important role in DF, a pattern of water intake associated with water purchased in large containers or bottles (which have different connotations to the use of bottled water in industrialized Western countries) did reduce DF risk in these high fluoride content, high altitude communities.

[Oral hygiene customs in 6-12 year old schoolchildren]. / Uso de auxiliares para la higiene bucal y su distribucion por edad u sexo en escolares de seis a 12 anos de edad.

OBJECTIVE. To characterize utilization of oral hygiene devices and customs in schoolchildren. MATERIAL AND METHODS. We performed a cross-sectional study in 1,404 schoolchildren (6- 12 year olds) from 14 public schools in Pachuca, Hidalgo, México, using a questionnaire for sociodemographic variables and 1) Tooth brushing frequency (<1/d vs. at least 1/d), 2) Use of toothpaste (not always vs. always), 3) Flossing (never, does not know vs. at least 1/week), 4) Use of mouthwash (never, does not know vs. at least 1/week). Analyses were performed with nonparametric tests. RESULTS. Mean age was 8.97 ± 1.99 years; 50.1% were male. Prevalence of utilization of oral hygiene devices and associated customs were 85.5% tooth brushing, 90.9% toothpaste, 19.4% flossing, and 28.2% mouthwash. Only 11.8% of participants reported utilization in all 4 categories. We observed differences (p < 0.05) across sexes only in the use of toothpaste, as women used it more often. Differences across age were observed (p < 0.05) for tooth brushing (younger children brushed more often) and flossing (older children flossed more often). CONCLUSIONS. Tooth brushing was the oral hygiene practice more often performed in this sample, with other frequencies being relatively low. There were differences by age and sex across some variables.

[Multidisciplinary management of esophageal affections: Two challenging cases]. / Manejo multidisciplinario de la enfermedad esofágica: dos casos complejos.

Esophageal pathologies can exhibit extremely low incidence and prevalence rates. Therefore, it is essential to have multidisciplinary teams including surgeons specialized in esophageal pathology, with a high caseload, to ensure proper diagnosis and management. This manuscript presents a series of esophageal pathology cases with favorable outcomes and atypical resolution for non-specialized groups. However, failure to refer to specialists in a timely manner can result in missed diagnoses or poor quality of life for patients. These findings underscore the importance of having surgeons specialized in esophageal pathology and multidisciplinary teams to provide the best possible care for patients. Lusoria dysphagia (LD) is a condition caused by vascular compression of the esophagus, resulting from the most common embryological vascular abnormality of the aortic arch: the aberrant right subclavian artery (ARSA) or lusoria artery (LA). This variant occurs in 0.5 to 2.5% of individuals. Necrosis of the gastric tube following an esophagectomy is a rare complication with a high mortality rate. Esophageal replacement with coloplasty is the preferred technique for a second attempt at reconstruction. However, this remains a complex surgery with a high rate of complications.

Las enfermedades del esófago pueden presentar una incidencia y prevalencia extremadamente baja. Por lo tanto, es fundamental contar con equipos multidisciplinarios que incluyan cirujanos especializados en afecciones esofágicas, con un alto volumen de casos, para garantizar un diagnóstico y manejo adecuados. En este estudio, se analizan casos de enfermedad esofágica con resultados satisfactorios y una resolución atípica. La falta de derivación a especialistas a tiempo puede llevar a una ausencia de diagnóstico o una baja calidad de vida para los pacientes. Estos hallazgos subrayan la importancia de disponer de cirujanos especializados en esófago y equipos multidisciplinarios para asegurar la mejor atención posible para los pacientes.

The 2023 ACR/EULAR antiphospholipid syndrome classification criteria identify patients at high risk of complications.

OBJECTIVES: This study aims to evaluate the utility of the 2023 ACR/EULAR antiphospholipid syndrome (APS) classification criteria in identifying primary APS patients at high risk of complications. METHODS: In this single-center study, primary APS patients were classified according to both the revised Sapporo criteria and the 2023 ACR/EULAR criteria. The risk of complications was assessed using the adjusted Global Antiphospholipid Syndrome Score (aGAPSS). RESULTS: Forty-five patients (73% females, median age 49 years) were included. Thirty-six patients met the 2023 ACR/EULAR criteria, all of whom also fulfilled the revised Sapporo criteria. Additionally, four out of nine patients not meeting the 2023 ACR/EULAR criteria satisfied the revised Sapporo criteria. Agreement rate between the two classification criteria was 91%, with a Cohen's kappa index of 0.66. Patients meeting the 2023 ACR/EULAR criteria had significantly higher aGAPSS scores compared to those who did not (13, 8-13 vs. 3, 0-5; p = 0.005). Furthermore, 55% of patients meeting the 2023 ACR/EULAR criteria were categorized as high risk based on aGAPSS scores, while those not meeting the criteria were predominantly categorized as low risk (77%). Interestingly, patients not meeting the 2023 ACR/EULAR criteria but fulfilling the revised Sapporo criteria had significantly higher aGAPSS scores compared to those not meeting either set of criteria (7, 5-13 vs. 0, 0-1.5; p = 0.015). CONCLUSION: The 2023 ACR/EULAR criteria effectively identify primary APS patients at increased risk of complications, as indicated by the aGAPSS score. Key Points • Identifying primary APS patients at high risk of complications remains a significant challenge. • The 2023 ACR/EULAR criteria show a correlation with the aGAPSS score, exhibiting the highest correlation with laboratory domains and minimal correlation with clinical domains. • The 2023 ACR/EULAR classification criteria are effective in identifying primary APS patients at high risk of complications.

Physical Performance and Telomere Length in Older Adults.

BACKGROUND: The aging population prompts studying risk factors and markers to predict healthy aging. Telomere length is a promising candidate for assessing various age-related traits. AIM OF THE STUDY: To investigate the association between physical performance and telomere length. METHODS: We enrolled 323 older Mexican adults from the "Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults" affiliated with the Instituto Mexicano del Seguro Social and assessed their physical performance using the Short Physical Performance Battery, dividing participants into low (≤7) and high (>7) groups. Absolute telomere length was determined by qPCR, and individuals were classified into short (≤4.22 kb) and long (>4.22 kb) groups. We calculated the mean and adjusted mean, considering sex and age, among others, with 95% CI. We estimated the effect size between physical performance and telomere length using Cohen's d for unequal group sizes and calculated the odds ratio for physical performance based on telomere length. RESULTS: Participants with low physical performance had significantly shorter telomeres (mean 4.14.44.7 kb, adjusted mean 3.54.04.5 kb, p <0.001), while those with high physical performance exhibited longer telomeres (mean 5.55.75.9 kb, adjusted mean 4.75.35.8 kb, p <0.001), with a medium-to-high telomere length effect size (d = 0.762). The odds of low physical activity increased 2.13.66.1-fold per kb of telomere attrition (adjOR 1.73.36.3, p <0.001). CONCLUSION: Decreased physical function is associated with shorter telomere length. Absolute telomere length presents a promising biomarker for distinguishing between healthy and unhealthy aging, warranting further investigation.

Structural Equation Models to Infer Relationships between Energy-related Blood Metabolites and Milk Daily Energy Output in Holstein Cows.

During lactation, high-yielding cows experience metabolic disturbances due to milk production. Metabolic monitoring offers valuable insights into how cows manage these challenges throughout the lactation period, making it a topic of considerable interest to breeders. In this study, we used Bayesian networks to uncover potential dependencies among various energy-related blood metabolites, i.e. glucose, urea, Beta-hydroxybutyrate (BHB), non-esterified fatty acids (NEFA), cholesterol (CHOL), and daily milk energy output (dMEO) in 1,254 Holstein cows. The inferred causal structure was then incorporated into structural equation models (SEM) to estimate heritabilities and additive genetic correlations among these phenotypes using both pedigree and genotypes from a 100k chip. Dependencies among traits were determined using the Hill Climbing algorithm, implemented with the posterior distribution of the residuals obtained from standard multiple trait model (MTM). These identified relationships were then used to construct the SEM, considering both direct and indirect relationships. The relevant dependencies and path coefficients obtained, expressed in units of measurement variation of 1σ, were as follows: dMEO → CHOL (0.181), dMEO → BHB (-0.149), dMEO → urea (0.038), glucose → BHB (-0.55), glucose → urea (-0.194), CHOL → urea (0.175), BHB → urea (-0.049), and NEFA → urea (-0.097). Heritabilities for traits of concern obtained with SEM ranged from 0.09 to 0.2. Genetic correlations with a minimum 95 % probability (P) of the posterior mean being > 0 for positive means or < 0 for negative means include those between dMEO and glucose (-0.583, P = 100), dMEO and BHB (0.349, P = 99), glucose and CHOL (0.325, P = 100), glucose and NEFA (-0.388, P = 100), and NEFA and BHB (0.759, P = 100). The results of this analysis revealed the existence of recursive relationships among the energy-related blood metabolites and dMEO. Understanding these connections is paramount for establishing effective genetic selection strategies, enhancing production and animal welfare.

Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders.

BACKGROUND: Geographical variations in mood and psychotic disorders have been found in upper-income countries. We looked for geographic variation in these disorders in Colombia, a middle-income country. We analyzed electronic health records from the Clínica San Juan de Dios Manizales (CSJDM), which provides comprehensive mental healthcare for the one million inhabitants of Caldas. METHODS: We constructed a friction surface map of Caldas and used it to calculate the travel-time to the CSJDM for 16,295 patients who had received an initial diagnosis of mood or psychotic disorder. Using a zero-inflated negative binomial regression model, we determined the relationship between travel-time and incidence, stratified by disease severity. We employed spatial scan statistics to look for patient clusters. RESULTS: We show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20% (RR = 0.80, 95% confidence interval [0.71, 0.89], p = 5.67E-05). We find nine clusters/hotspots of inpatients. CONCLUSIONS: Our results reveal inequities in access to healthcare: many individuals requiring only outpatient treatment may live too far from the CSJDM to access healthcare. Targeting of resources to comprehensively identify severely ill individuals living in the observed hotspots could further address treatment inequities and enable investigations to determine factors generating these hotspots.

The frequencies of mental disorders vary by geographic region. Investigating such variations may lead to more equitable access to mental healthcare and to scientific discoveries that reveal specific localized factors that contribute to the causes of mental illness. This study examined the frequency of three disorders with a major impact on public health ­ schizophrenia, bipolar disorder, and major depressive disorder ­ by analyzing electronic health records from a hospital providing comprehensive mental health care for a large region in Colombia. We show that individuals receiving outpatient care mainly live relatively near the facility. Those receiving inpatient care live throughout the region, but cluster in a few scattered locations. Future research could lead to strategies for more equitable provision of mental healthcare in Colombia and identify environmental or genetic factors that affect the likelihood that someone will develop one of these disorders.