Methylene Blue Instillation: A Cost-Effective Diagnostic Approach for Pleuroperitoneal Fistula in Resource-Limited Settings.

A pleuroperitoneal fistula, an uncommon complication of peritoneal dialysis, involves a connection between the peritoneal cavity and the pleural space. This case highlights a cost-effective diagnostic option for detecting these fistulas in primary care hospitals and emphasizes the importance of considering this condition in patients with a history of peritoneal dialysis and persistent pleural effusion. We present a case of a 55-year-old female patient undergoing peritoneal dialysis for end-stage renal disease who developed a pleuroperitoneal fistula, leading to persistent pleural effusion. This condition was successfully diagnosed using methylene blue instillation into the dialysis bags, demonstrating a potentially viable diagnostic technique that is effective, safe, and cost-efficient for primary and secondary care hospitals. The presented case underscores that pleural effusion, as a complication with high mortality, should be considered in any patient with end-stage renal disease presenting with dyspnea, desaturation, and pleuritic pain secondary to peritoneal dialysis sessions. Furthermore, the use of methylene blue is proposed as a cost-effective and accessible diagnostic alternative. This approach not only facilitates accurate diagnosis but also simplifies the diagnostic process without relying on advanced imaging technologies that might not be available.

Effects of video-guided active breaks with curricular content on mental health and classroom climate in chilean schoolchildren aged 6 to 10: study protocol for a multicentre randomized controlled trial.

Background: The incidence of mental health issues in children is increasing worldwide. In Chile, a recent surge in reports of deteriorating mental health among school populations and an increase in complaints related to poor school climate have been observed. Physical activity, specifically active breaks in the classroom, has shown positive effects on children's health. However, evidence regarding its impact on mental health and school climate in children is limited. Objective: This work outlines the design, measurements, intervention program, and potential efficacy of the "Active Classes + School Climate and Mental Health" project. This project will assess a 12-week program of active breaks through guided videos with curricular content in the school classroom, and its effects on mental health and school climate as its primary indicators. Additionally, it will measure physical activity, physical fitness, motor competence, and academic performance in students aged 6-10 years in the Biobío province, Chile, as secondary indicators. Methodology: A multicenter randomized controlled trial involving 823 students from 1st to 4th grade (6-10 years old), six schools (three intervention and three control) will be conducted in the Biobío region, Chile. Participants belonging to the intervention group will implement video-guided active breaks through the "Active Classes" web platform, featuring curricular content, lasting 5-10 min and of moderate to vigorous intensity physical activity, twice a day, Monday to Friday, over a span of 12 weeks. Expected Results/Discussion: To our knowledge, this will be the first study in Chile to evaluate the effects of incorporating video-guided active breaks with curricular content on mental health variables and school climate in schoolchildren. Thus, this study contributes to the scarce evidence on the effects of video-guided active breaks on mental health variables and school climate in schoolchildren worldwide. Additionally, it will provide crucial information about active teaching methodologies that have the potential to positively contribute to the wellbeing of students, thus addressing the problems of mental health and climate in Chilean schools. ClinicalTrials.gov ID NCT06423404.

Hospitalization Causes and Epidemiological Characteristics Among Patients With End-Stage Renal Disease: A Six-Year Retrospective Study.

BACKGROUND: Chronic kidney disease (CKD) leads to a high rate of complications requiring hospital admission for advanced management. Therefore, this study aims to analyze the main causes of hospitalization following the initiation of renal replacement therapy (RRT). MATERIALS AND METHODS: This observational and descriptive study utilized a non-probabilistic quota sampling method, reviewing a total of 423 medical records from General Regional Hospital 1 of the Mexican Social Security Institute in Querétaro. The study evaluated the frequency and causality of hospitalizations during a retrospective period from 2018 to 2023. RESULTS: There were 1,162 hospitalization events involving 423 patients; 71.63% of patients started RRT with peritoneal dialysis, while 26% began with hemodialysis. The leading cause of hospitalization was electrolyte imbalance (397; 34.17%), followed by peritonitis associated with peritoneal dialysis (351; 30.21%), change to hemodialysis (270; 23.24%), Tenckhoff catheter dysfunction (209; 17.99%), and fluid overload (205; 17.64%). The group with the highest number of events was renal-related complications, followed by infectious causes. CONCLUSIONS: Hospitalizations in end-stage CKD patients often arise from the complex renal pathophysiology and complications related to acute and decompensated renal function. This condition refers to the kidneys' failure to maintain essential physiological functions despite ongoing treatment, leading to issues such as electrolyte imbalances, fluid overload, and uremic syndrome. To reduce morbidity and mortality, measures such as enhanced training in ambulatory dialysis, improved catheter care, and early infection detection are crucial. A comprehensive approach that addresses both acute issues and preventive strategies is essential for improving clinical outcomes and quality of life for these patients.

Comparative Analysis of Surface Roughness and Plastic Deformation of Reciprocating Instruments after Clinical Use.

This study assessed the surface topography and plastic deformation (PD) of new and used contemporary reciprocating instruments. Twenty-six WaveOne Gold (WOG) and EdgeOne Fire (EO) instruments were photographed under magnification. The instruments were randomly assigned to a control group of new instruments preserved for surface roughness analysis (n = 6 each), or to an experimental group to shape the root canal system of a single molar (n = 20 each), making a total of four groups (WOGnew, EOnew, WOGused, EOused). Used instruments were also photographed after instrumentation. The presence of fractures was registered. Preoperative and postoperative images were randomly ordered for evaluation. Two blinded calibrated examiners evaluated the presence of PD. Inter-observer agreement was calculated with the Kappa coefficient (K = 0.89). 3D profilometry was also used for the surface roughness analysis of six randomly selected instruments from the WOGused and EOused groups. Chi-square and two-way ANOVA tests were used to, respectively, compare PD and changes in surface roughness among the groups. No instruments fractured; however, a significantly greater percentage of EO instruments suffered plastic deformation than WOG instruments (p < 0.001), (OR = 11.09 (CI 95% 2.6-56.3)). The overall surface roughness was higher for most parameters in the EO instruments (p < 0.05). Single uses of EO instruments produced significantly higher chances of PD and increased surface roughness values compared to WOG.

Wireless ear EEG to monitor drowsiness.

Neural wearables can enable life-saving drowsiness and health monitoring for pilots and drivers. While existing in-cabin sensors may provide alerts, wearables can enable monitoring across more environments. Current neural wearables are promising but most require wet-electrodes and bulky electronics. This work showcases in-ear, dry-electrode earpieces used to monitor drowsiness with compact hardware. The employed system integrates additive-manufacturing for dry, user-generic earpieces, existing wireless electronics, and offline classification algorithms. Thirty-five hours of electrophysiological data were recorded across nine subjects performing drowsiness-inducing tasks. Three classifier models were trained with user-specific, leave-one-trial-out, and leave-one-user-out splits. The support-vector-machine classifier achieved an accuracy of 93.2% while evaluating users it has seen before and 93.3% when evaluating a never-before-seen user. These results demonstrate wireless, dry, user-generic earpieces used to classify drowsiness with comparable accuracies to existing state-of-the-art, wet electrode in-ear and scalp systems. Further, this work illustrates the feasibility of population-trained classification in future electrophysiological applications.

Performance of obturation techniques in anatomical irregularities located at different thirds of the root canal system.

This study aimed to compare the quality of root canal obturation (ratio of area occupied by gutta-percha (G), sealer (S), and presence of voids (V)) in different anatomical irregularities (intercanal communications, lateral irregularities, and accessory canals) located at different thirds of the root canal system of mandibular molar replicas. Sixty-seven 3D printed replicas of an accessed mandibular molar were prepared using ProGlider and ProTaper Gold rotatory systems. Three specimens were randomly selected to be used as controls and did not receive further treatment. The rest were randomly distributed in 4 experimental groups to be obturated using either cold lateral compaction (LC), continuous wave of condensation (CW), and core-carrier obturation (ThermafilPlus (TH) or GuttaCore (GC)) (n=16 per group). AHPlus® sealer was used in all groups. The three controls and a specimen from each experimental group were scanned using micro-computed tomography. The rest of the replicas were sectioned at the sites of anatomical irregularities and examined at 30× magnification. The G, S, and V ratios were calculated dividing the area occupied with each element by the total root canal area and then compared among groups using the Kruskal-Wallis test. Voids were present in all obturation techniques with ratios from 0.01 to 0.15. CW obtained a significantly higher G ratio in the irregularity located in the coronal third (0.882) than LC (0.681), TH (0.773), and GC (0.801) (p<0.05). TH and GC achieved significantly higher G ratios in those located in the apical third (p<0.05). The worst quality of obturation was observed in the loop accessory canal with all obturation techniques. Whitin the limitations of this study, it can be concluded that CW and core-carrier obturation are respectively the most effective techniques for obturating anatomical irregularities located in the coronal and the apical third.

Environmental prospective of valorizing corn processing effluent to produce ferulic acid grafted chitosan polymer.

The food industry requires new production models that include more environmentally friendly waste management practices, considering that the environmental loads of solid waste and wastewater associated with this sector cause damage to the receiving ecosystems. The approach considered in this study focuses on the design and environmental assessment of an enzymatic process for the valorization of ferulic acid present in the effluent of a corn tortilla plant. The ferulic acid can be immobilized on chitosan so that the ferulic acid grafted chitosan can be used as a bioactive film with enhanced antioxidant properties with potential applications in the biotechnology sector. Its real projection approach requires the evaluation of its environmental and economic performance, trying to identify its benefits and potential in the value chain, using the Techno-Economic Analysis (TEA) as a phase for the conceptual design of the process and the Life Cycle Assessment (LCA) methodology for the environmental evaluation. It should be noted that the TEA indicators are promising, since the values of the financial indicators obtained are representative of the economic profitability, which makes the ferulic acid valorization a viable process. In terms of the environmental impact of the process, the buffer dose and the chitosan production process are identified as the main critical points. This double benefit in environmental and economic terms shows that the valorization of ferulic acid for chitosan functionalization is a promising alternative to improve the sustainability performance of corn processing.

Knowledge of undergraduate and postgraduate dental students about managing traumatic dental injuries based on the 2020 International Association of Dental Traumatology guidelines: A online survey of 10 dental schools from 10 countries.

BACKGROUND/AIM: The knowledge of dental students about managing traumatic dental injuries (TDIs) may not be uniform, depending on global location and dental education. The aim of this study was to evaluate the level of knowledge of undergraduate and postgraduate students specializing in endodontics and pediatric dentistry at 10 dental schools in 10 countries about the 2020 International Association of Dental Traumatology (IADT) guidelines regarding the management of TDIs. MATERIALS & METHODS: A previously published questionnaire was used in the current survey. It was an online survey with 12 questions regarding the management of TDIs and some additional questions regarding sociodemographic and professional profiles of the participants were added. The survey was distributed to final-year undergraduate students and postgraduate students in pediatric dentistry and endodontics from 10 dental schools. Simple frequency distributions and descriptive statistics were predominantly used to describe the data. Differences in the median percentage scores among the student categories were assessed using the Kruskal-Wallis test followed by Dwass-Steel-Critchlow-Fligner pairwise comparisons. RESULTS: A total of 347 undergraduates, 126 postgraduates in endodontics, and 72 postgraduates in pediatric dentistry from 10 dental schools participated in this survey. The postgraduates had a significantly higher percentage score for correct responses compared with the undergraduates. No significant difference was observed between the endodontic and pediatric dentistry postgraduates. CONCLUSION: The knowledge possessed by undergraduate and postgraduate students concerning the IADT-recommended management of TDIs varied across the globe and some aspects were found to be deficient. This study emphasizes the critical importance of reassessing the teaching and learning activities pertaining to the management of TDIs.

Multidrug-resistant bacterial infections after liver transplantation: Prevalence, impact, and risk factors.

BACKGROUND & AIMS: Infections by multidrug-resistant bacteria (MDRB) are an increasing healthcare problem worldwide. This study analyzes the incidence, burden, and risk factors associated with MDRB infections after liver transplant(ation) (LT). METHODS: This retrospective, multicenter cohort study included adult patients who underwent LT between January 2017 and January 2020. Risk factors related to pre-LT disease, surgical procedure, and postoperative stay were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of MDRB infections within the first 90 days after LT. RESULTS: We included 1,045 LT procedures (960 patients) performed at nine centers across Spain. The mean age of our cohort was 56.8 ± 9.3 years; 75.4% (n = 782) were male. Alcohol-related liver disease was the most prevalent underlying etiology (43.2.%, n = 451). Bacterial infections occurred in 432 patients (41.3%) who presented with a total of 679 episodes of infection (respiratory infections, 19.3%; urinary tract infections, 18.5%; bacteremia, 13.2% and cholangitis 11%, among others). MDRB were isolated in 227 LT cases (21.7%) (348 episodes). Enterococcus faecium (22.1%), Escherichia coli (18.4%), and Pseudomonas aeruginosa (15.2%) were the most frequently isolated microorganisms. In multivariate analysis, previous intensive care unit admission (0-3 months before LT), previous MDRB infections (0-3 months before LT), and an increasing number of packed red blood cell units transfused during surgery were identified as independent predictors of MDRB infections. Mortality at 30, 90, 180, and 365 days was significantly higher in patients with MDRB isolates. CONCLUSION: MDRB infections are highly prevalent after LT and have a significant impact on prognosis. Enterococcus faecium is the most frequently isolated multi-resistant microorganism. New pharmacological and surveillance strategies aimed at preventing MDRB infections after LT should be considered for patients with risk factors. IMPACT AND IMPLICATIONS: Multidrug-resistant bacterial infections have a deep impact on morbidity and mortality after liver transplantation. Strategies aimed at improving prophylaxis, early identification, and empirical treatment are paramount. Our study unveiled the prevalence and main risk factors associated with these infections, and demonstrated that gram-positive bacteria, particularly Enterococcus faecium, are frequent in this clinical scenario. These findings provide valuable insights for the development of prophylactic and empirical antibiotic treatment protocols after liver transplantation.

Long-term follow-up of patients with high-risk facial basal cell carcinoma treated with interferon.

BACKGROUND: Surgery is the treatment of choice for patients with basal cell carcinoma (BCC). When surgery is not a choice, only radiotherapy is recommended for patients with high-risk facial BCC. Interferon could be an acceptable therapeutic option for these patients. OBJECTIVE: To evaluate the long-term clinical response to interferon therapy in patients with high-risk facial BCC. METHODS: Patients with high-risk facial BCC were treated with perilesional injections of alpha-2b+ gamma interferons. Those with incomplete clinical response were reevaluated, their residual tumors excised, and declared cured. Patients treated with interferon and those treated with interferon plus surgery were followed for five years. Time to recurrence and the emergence of a new facial BCC were estimated by Kaplan-Meier survival analysis. Adverse events were documented. RESULTS: This study included 195 participants; 143 (73.3%) showed a complete response (95% CI 67.2‒80.1). Patients developed recurrence after a mean of 55 months (95% CI 53.8‒57.4). The estimated rate of recurrence was 12.3% (95% CI 7.4‒17.1). Patients developed a new BCC after a mean of 52.7 months (95% CI 50.4‒54.9). The estimated rate for development of a new BCC was 20.0% (95% CI 14.4‒25.9). Fifteen (7.7%) patients abandoned the study during follow-up. Adverse events were frequent but moderate or mild; fever and local pain were the most frequent. STUDY LIMITATIONS: Observational cohort design without a control group for comparison. CONCLUSIONS: Perilesional injections of alpha-2b+ gamma interferons in patients with facial high-risk BCC offer a satisfactory cure rate after five years of follow-up with an acceptable safety profile.

Influence of the incorporation of small-group practical seminars to a traditional lecture for the understanding of root canal morphology classification systems.

INTRODUCTION: This study aimed to assess if the incorporation of small-group practical seminars into a traditional lecture format improved the understanding and learning of the root canal classification systems in undergraduate students. MATERIALS AND METHODS: A small-group practical seminar was designed for 3rd year undergraduate students. The seminar consisted of the analysis of a guided summary of root canal morphology classifications, a participative discussion of several cases and drawing exercises of several internal anatomies based on the different classifications in templates presenting the external anatomy of different dental groups. Students were inquired about their perspectives on the different classifications and the learning strategies with an anonymous questionnaire. The knowledge acquired was assessed in an exam. The scores obtained were compared using the Mann-Whitney U-test with those obtained in the cohort of the previous year in which only the traditional lecture was delivered. RESULTS: Students' scores (mean = 7.7; SD = 2.5) were significantly higher (p = .006) than those from the previous cohort (mean = 6.9; SD = 2.3). Most students agreed that Ahmed's classification system was the most complete (98.8%) and intuitive (84%), but also the most difficult to understand (67%). All the students believed that the learning activity helped them understand the new classification system. CONCLUSION: The incorporation of small-group practical seminars into traditional lecture improved the understanding and learning of root canal configurations in undergraduate students. Students rated the classification system suggested by Ahmed et al. as the most complete and intuitive out of the three systems, but also the most difficult to learn.

Cross-Cultural Validation of the TeamSTEPPS Teamwork Perceptions Questionnaire-Spanish in Colombia.

BACKGROUND: Teamwork influences health care quality and patient safety. Yet, validated instruments for assessing teamwork in Colombia are lacking. PURPOSE: The purpose of this study was to validate the Spanish version of the TeamSTEPPS-Teamwork Perceptions Questionnaire (T-TPQ-S) for the Colombian health care context. METHODS: The T-TPQ-S underwent translation, cultural adaptation, and comprehensive psychometric testing, including reliability and confirmatory factor analyses and item difficulty and discrimination analyses. RESULTS: The T-TPQ-S demonstrated high internal consistency and excellent fit to the theoretical model. Item discrimination was within expected ranges, with response thresholds displaying an ascending order. The tool better differentiated subjects with low and high teamwork perceptions. CONCLUSIONS: The T-TPQ-S is an effective, reliable, and valid instrument for assessing teamwork perception among Colombian health care workers.

Long-term follow-up of patients with high-risk facial basal cell carcinoma treated with interferon

Abstract Background Surgery is the treatment of choice for patients with basal cell carcinoma (BCC). When surgery is not a choice, only radiotherapy is recommended for patients with high-risk facial BCC. Interferon could be an acceptable therapeutic option for these patients. Objective To evaluate the long-term clinical response to interferon therapy in patients with high-risk facial BCC. Methods Patients with high-risk facial BCC were treated with perilesional injections of alpha-2b+ gamma interferons. Those with incomplete clinical response were reevaluated, their residual tumors excised, and declared cured. Patients treated with interferon and those treated with interferon plus surgery were followed for five years. Time to recurrence and the emergence of a new facial BCC were estimated by Kaplan-Meier survival analysis. Adverse events were documented. Results This study included 195 participants; 143 (73.3%) showed a complete response (95% CI 67.2‒80.1). Patients developed recurrence after a mean of 55 months (95% CI 53.8‒57.4). The estimated rate of recurrence was 12.3% (95% CI 7.4‒17.1). Patients developed a new BCC after a mean of 52.7 months (95% CI 50.4‒54.9). The estimated rate for development of a new BCC was 20.0% (95% CI 14.4‒25.9). Fifteen (7.7%) patients abandoned the study during follow-up. Adverse events were frequent but moderate or mild; fever and local pain were the most frequent. Study limitations Observational cohort design without a control group for comparison. Conclusions Perilesional injections of alpha-2b+ gamma interferons in patients with facial high-risk BCC offer a satisfactory cure rate after five years of follow-up with an acceptable safety profile.

Performance of obturation techniques in anatomical irregularities located at different thirds of the root canal system

Abstract This study aimed to compare the quality of root canal obturation (ratio of area occupied by gutta-percha (G), sealer (S), and presence of voids (V)) in different anatomical irregularities (intercanal communications, lateral irregularities, and accessory canals) located at different thirds of the root canal system of mandibular molar replicas. Sixty-seven 3D printed replicas of an accessed mandibular molar were prepared using ProGlider and ProTaper Gold rotatory systems. Three specimens were randomly selected to be used as controls and did not receive further treatment. The rest were randomly distributed in 4 experimental groups to be obturated using either cold lateral compaction (LC), continuous wave of condensation (CW), and core-carrier obturation (ThermafilPlus (TH) or GuttaCore (GC)) (n=16 per group). AHPlus® sealer was used in all groups. The three controls and a specimen from each experimental group were scanned using micro-computed tomography. The rest of the replicas were sectioned at the sites of anatomical irregularities and examined at 30× magnification. The G, S, and V ratios were calculated dividing the area occupied with each element by the total root canal area and then compared among groups using the Kruskal-Wallis test. Voids were present in all obturation techniques with ratios from 0.01 to 0.15. CW obtained a significantly higher G ratio in the irregularity located in the coronal third (0.882) than LC (0.681), TH (0.773), and GC (0.801) (p<0.05). TH and GC achieved significantly higher G ratios in those located in the apical third (p<0.05). The worst quality of obturation was observed in the loop accessory canal with all obturation techniques. Whitin the limitations of this study, it can be concluded that CW and core-carrier obturation are respectively the most effective techniques for obturating anatomical irregularities located in the coronal and the apical third.

Process modeling, environmental and economic sustainability of the valorization of whey and eucalyptus residues for resveratrol biosynthesis.

Biomass is one of the renewable resources with the greatest potential, not only because of the possibility of energy recovery but also because of its content in components of interest. In this context, the regions of Galicia and Portugal have large areas of land dedicated to forestry, agriculture and livestock, and the large amount of waste generated represents a cost for the producer. The importance of these facts has aroused great interest in society to focus its interest on improving the current situation while seeking a benefit, both environmental and economic, from existing resources. That is why the integration of biotechnological processes and biorefinery for their valorization are considered key aspects in the way of producing bioproducts and bioenergy. This research article proposes a process for producing resveratrol from whey from the dairy industry and eucalyptus residues from forestry exploitation. In order to evaluate its suitability, a techno-economic analysis and an environmental assessment have been carried out using the Life Cycle Assessment (LCA) methodology. The results obtained show the potential of these scenarios both from the economic point of view, by obtaining a minimum sale price of resveratrol to ensure the viability of the process below the market average, and from the environmental point of view, being eucalyptus residues those that result in a lower contribution to the environment per unit of resveratrol produced. Future research should focus on increasing the throughput of the production process to increase its profitability and on reducing energy requirements throughout the process, as these have been the main critical points identified. In addition, following the sensitivity assessment, it has been concluded that opting for renewable energy is the most sustainable option.

Synthesis of Chalcones: An Improved High-Yield and Substituent-Independent Protocol for an Old Structure.

Chalcones are a type of molecule that can be considered as easily synthesizable through aldol condensation or that can be readily purchased from habitual commercial vendors. However, on reviewing the literature, one realizes that there are no standard procedures for such aldol condensations, that there exists a wide range of alternative methods for the aldol condensation (indicating that such a condensation is not always simple), and that, in many cases, low yields are obtained that involve purifications by recrystallization or column chromatography. To develop a robust standard protocol independent of the nature of the substituents present on the acetophenone or the benzaldehyde involved in the aldol condensation leading to the chalcone, we made a comparison between an aldol condensation in KOH/EtOH and a Wittig reaction between the corresponding ylide and benzaldehyde in water. We describe an improved procedure for the Wittig reaction and a protocol for the elimination of the Ph3P=O byproduct (and the excess of ylide used) by filtration of the crude reaction product through a silica gel plug. We thus demonstrate that such an improved procedure can be a general method for the synthesis of chalcones in high yield and excellent purity and is clearly an improvement on the classical aldol condensation.

Functional composites by programming entropy-driven nanosheet growth.

Nanomaterials must be systematically designed to be technologically viable1-5. Driven by optimizing intermolecular interactions, current designs are too rigid to plug in new chemical functionalities and cannot mitigate condition differences during integration6,7. Despite extensive optimization of building blocks and treatments, accessing nanostructures with the required feature sizes and chemistries is difficult. Programming their growth across the nano-to-macro hierarchy also remains challenging, if not impossible8-13. To address these limitations, we should shift to entropy-driven assemblies to gain design flexibility, as seen in high-entropy alloys, and program nanomaterial growth to kinetically match target feature sizes to the mobility of the system during processing14-17. Here, following a micro-then-nano growth sequence in ternary composite blends composed of block-copolymer-based supramolecules, small molecules and nanoparticles, we successfully fabricate high-performance barrier materials composed of more than 200 stacked nanosheets (125 nm sheet thickness) with a defect density less than 0.056 µm-2 and about 98% efficiency in controlling the defect type. Contrary to common perception, polymer-chain entanglements are advantageous to realize long-range order, accelerate the fabrication process (<30 min) and satisfy specific requirements to advance multilayered film technology3,4,18. This study showcases the feasibility, necessity and unlimited opportunities to transform laboratory nanoscience into nanotechnology through systems engineering of self-assembly.

Reassessment After Locoregional Treatment of Hepatocellular Carcinoma Previous Liver Transplantation: Is MRI Necessary for All Patients?

BACKGROUND: The tumor response of cirrhotic patients with hepatocellular carcinoma (HCC) undergoing locoregional treatment (TLR) before liver transplantation can be evaluated using different imaging tests. The aim of this study was to compare the correlation of radiological response evaluated by magnetic resonance imaging (MRI) vs computed tomography (CT) vs ultrasound with histopathological findings. METHODS: A retrospective single-center study was performed. Data of patients undergoing Liver transplantation due to HCC between January 2010 and December were collected, selecting patients who underwent TLR. RESULTS: Four hundred and four patients were transplanted, of whom 103 (25.5%) had HCC. Ninety-seven patients (93.2%) received TLR. Eighty-eight of these patients (90.7%) underwent a reevaluation imaging test: 8 (8.2%) underwent ultrasound, 68 (70.1%) underwent MRI, and 12 (12.4%) underwent CT. Of the 88 patients, 59% were classified as nonviable LR-TR (Liver Imaging Reporting and Data System Treatment Response), 32.5% as viable LR-TR, and the rest (8.5%) as equivocal LR-TR. Regarding the correlation of the degree of radiological response according to each imaging test, ultrasound categorized 62.5% as nonviable LR-TR vs 60.6% by MRI vs 44.4% by CT, with these differences not being significant (P = .779). Regarding the correlation of patients classified as nonviable LR-TR by each test and total tumor necrosis in histopathology, both MRI and ultrasound correctly classified 60% of complete necrosis as nonviable LR-TR, and in the case of CT, it was 50%, with these differences not being significant (P = 1). CONCLUSION: Ultrasound and CT have obtained similar results as reevaluation tests to MRI, which could replace it in case of unavailability of the latter.

Effect of cryotherapy duration on experimentally induced connective tissue inflammation in vivo.

Objectives: This study tested the hypothesis that cryotherapy duration influences lipopolysaccharide (LPS)-induced inflammation in a rat model. Materials and Methods: Six Wistar rats (Rattus norvegicus albinus) were used. Five sites were selected per animal and divided into 5 groups: a negative control group (NC), 2 positive control groups (PC1 and PC2), and 2 experimental groups (E1 and E2). Cryotherapy was applied for 1 minute (E1) or 5 minutes (E2). An acute inflammatory response was induced in the PC and E groups via subcutaneous administration of 0.5 mL/kg. In the PC2 group, a catheter was inserted without additional treatment. For the E1 and E2 groups, 2.5°C saline solution was administered through the implanted catheters for 1 and 5 minutes, respectively. The rats were sacrificed, and samples were obtained and processed for histological analysis, specifically examining the presence of polymorphonuclear neutrophils and hemorrhage. The χ2 test was used to compare the presence of acute inflammation across groups. Dependent variables were compared using the linear-by-linear association test. Results: Inflammation and hemorrhage varied significantly among the groups (p = 0.001). A significantly higher degree of acute inflammation was detected (p = 0.0002) in the PC and E1 samples than in the E2 group, in which cryotherapy was administered for 5 minutes. The PC and E1 groups also exhibited significantly greater numbers of neutrophils (p = 0.007), which were essentially absent in both the NC and E2 groups. Conclusions: Cryotherapy administration for 5 minutes reduced the acute inflammation associated with LPS and catheter implantation.

Transfusion-associated adverse events incidence and severity after the implementation of an active hemovigilance program with 24 h follow-up. A prospective cohort study.

BACKGROUND: Hemovigilance (HV) is usually based on voluntary reports (passive HV). Our aim is to ascertain credible incidence, severity, and mortality of transfusion-associated adverse events (TAAEs) using an active HV program. STUDY DESIGN AND METHODS: Prospective cohort study to estimate transfusion risk after 46,488 transfusions in 5830 patients, using an active HV program with follow-up within the first 24 h after transfusion. We compared these results to those with the previously established passive HV program during the same 30 months of the study. We explored factors associated with the occurrence of TAAEs using generalized estimating equations models. RESULTS: With the active HV program TAAEs incidence was 57.3 (95% CI, 50.5-64.2) and mortality 1.1 (95% CI, 0.13-2.01) per 10,000 transfusions. Incidence with the new surveillance model was 14.0 times higher than with the passive. Most events occurred when transfusions had already finished (60.2%); especially pulmonary events (80.4%). Three out of five deaths and 50.3% of severe TAAEs were pulmonary. In the multivariate analysis surgical patients had half TAAEs risk when compared to medical patients (OR, 0.53; 95% CI, 0.34-0.78) and women had nearly twice the risk of a pulmonary event compared to men (OR, 1.84; 95% CI, 1.03-3.32). Patient's age, blood component type, or blood component shelf-life were unrelated to TAAEs risk. DISCUSSION: Active hemovigilance programs provide additional data which may lead to better recognition and understanding of TAAEs and their frequency and severity.