Exotic Magnetism in Perovskite KOsO_{3}.

A new perovskite KOsO_{3} has been stabilized under high-pressure and high-temperature conditions. It is cubic at 500 K (Pm-3m) and undergoes subsequent phase transitions to tetragonal at 320 K (P4/mmm) and rhombohedral (R-3m) at 230 K as shown from refining synchrotron x-ray powder diffraction (SXRD) data. The larger orbital overlap integral and the extended wave function of 5d electrons in the perovskite KOsO_{3} allow to explore physics from the regime where Mott and Hund's rule couplings dominate to the state where the multiple interactions are on equal footing. We demonstrate an exotic magnetic ordering phase found by neutron powder diffraction along with physical properties via a suite of measurements including magnetic and transport properties, differential scanning calorimetry, and specific heat, which provide comprehensive information for a system at the crossover from localized to itinerant electronic behavior.

Assessing the role of visual dysfunctions in the association between visual symptomatology and the use of digital devices.

PURPOSE: To evaluate the association between visual symptoms and use of digital devices considering the presence of visual dysfunctions. METHODS: An optometric examination was conducted in a clinical sample of 346 patients to diagnose any type of visual anomaly. Visual symptoms were collected using the validated SQVD questionnaire. A threshold of 6 hours per day was used to quantify the effects of digital device usage and patients were divided into two groups: under and above of 35 years old. A multivariate logistic regression was employed to investigate the association between digital device use and symptoms, with visual dysfunctions considered as a confounding variable. Crude and the adjusted odds ratio (OR) were calculated for each variable. RESULTS: 57.02 % of the subjects reported visual symptoms, and 65.02% exhibited some form of visual dysfunction. For patients under 35 years old, an association was found between having visual symptoms and digital device use (OR = 2.10, p = 0.01). However, after adjusting for visual dysfunctions, this association disappeared (OR = 1.44, p = 0.27) and the association was instead between symptoms and refractive dysfunction (OR = 6.52, p < 0.001), accommodative (OR = 10.47, p < 0.001), binocular (OR = 6.68, p < 0.001) and accommodative plus binocular dysfunctions (OR = 46.84, p < 0.001). Among patients over 35 years old, no association was found between symptoms and the use of digital devices (OR = 1.27, p = 0.49) but there was an association between symptoms and refractive dysfunction (OR = 3.54, p = 0.001). CONCLUSIONS: Visual symptoms are not dependent on the duration of digital device use but rather on the presence of any type of visual dysfunction: refractive, accommodative and/or binocular one, which should be diagnosed.

Seroprevalence and coprological prevalence of liver fluke Fasciola hepatica in cattle and sheep from Santander department, Colombia.

Fasciola hepatica is a parasite with a worldwide distribution that affects several mammals, including humans, and is considered a public health problem. Therefore, the aim of this study was to determine the prevalence of Fasciola hepatica in humans, cattle and sheep, as well as to evaluate factors associated with the prevalence. A total of 185 serum samples from sheep, 290 from cattle, and 114 from humans were collected and processed using an in-house developed ELISA to detect IgG antibodies against F. hepatica. Additionally, 185 stool samples from sheep and 290 from cattle were examined using a Dennis sedimentation technique. Risk factors were analyzed using epidemiological surveys. The overall seroprevalence was 46.5% (86/185) in sheep, 32.5% (94/289) in cattle, and no humans tested positive for the infection. The coprological prevalence was 47.7% (86/180) in sheep and 33.7% (98/290) in cattle. Female gender and cattle living with alternate grazing management showed 2.5 and 6.5 times higher probability of infection, respectively. Bovines coexisting with sheep exhibited a higher risk of infection (odds ratio [OR]=4.3) compared to those without sheep. We concluded that F. hepatica in cattle and sheep has an endemic behavior, and therefore represents a problem of public health for rural communities.

Genotypic Comparison of Pasteurella multocida from Healthy Animals at Entry to the Feedlots with That and from Bovine Respiratory Disease-Affected Animals during the Fattening Period.

The aim of this study was to investigate the possible genotypic differences between commensal Pasteurella multocida isolates from apparently healthy animals (AHA) at the time of entry to feedlots and those from BRD-affected animals (BRD-AA). A total of 20 batches of beef calves in seven feedlots were followed-up during the fattening period. P. multocida was isolated from 28.1% of AHA and 22.9% of BRD-AA. All isolates belonged to the A: L3 genotype. Most isolates from clinical cases (81.0%) grouped into a PFGE cluster were significantly associated with BRD cases (OR, 24.9; 95% CI, 6.4-96.2). The whole genomes of 14 isolates representative of the pulsotypes most frequently detected in BRD-AA and AHA were sequenced and compared with 53 bovine genomes belonging to the identified ST13, ST79, and ST80 genotypes for a global comparison. No differences were found in the virulence-associated gene content between sequence types (STs) globally or between BRD-AA and AHA isolates in this study. Significantly, ST79 isolates harbored ARGs, conferring resistance to different antimicrobials, including macrolides and tetracyclines, which are commonly used for the treatment of BRD. Two Spanish ST79 isolates carried an ICE highly similar to ICE Tn7407, which was recently detected in Germany, suggesting that ST79 P. multocida isolates in Europe and North America may be associated with different ICEs.

Full endoscopic minimally invasive extraperitoneal modified Sugarbaker approach for para-colostomy hernia repair: Technical aspects and 2-year follow-up results of a prospective cohort.

AIM: This study aimed to assess technical aspects and clinical results of a new minimally invasive technique in parastomal hernia (PSH) repair, full endoscopic retromuscular access, after 2 years of follow-up. METHODS: Data from consecutive patients requiring minimally invasive ventral PSH repair were collected from 2019 to 2022. The inclusion criteria were patients aged between 18 and 80 years old with symptomatic PSH. Demographics and perioperative and postoperative data were collected. Postoperative pain and functional recovery were compared with preoperative data. RESULTS: Twelve patients with symptomatic PSH were included. The mean PSH defect area was 16.2 cm2 and the mean midline defect was 8.7 cm2 . No intra-operative complications or conversion to open surgery were detected. One patient (8%) required postoperative readmission due to partial bowel obstruction symptoms that required catheterization of the stoma. Pain significantly worsened after the first postoperative day compared to preoperative data but improved after the first postoperative month compared to the first postoperative week and after the 90th postoperative day compared to the first postoperative month, with significant differences. Significant restriction improvement was identified when 30 days after surgery data were compared to preoperative data and when the 180th postoperative day results were compared to 30 days after surgery. The average follow-up was 29 months. During the follow-up no clinical or radiological recurrence was observed. CONCLUSION: This paper shows low rate of intra- and postoperative complications with significant improvement in terms of pain activities restriction compared to preoperatory. After 29 months follow-up, no recurrence was identified, confirming that this approach offers good mid-term results.

Efficacy of optometric phototherapy: a systematic review.

PURPOSE: To analyse the scientific evidence about the efficacy of Syntonic phototherapy for producing changes in visual function. MATERIAL AND METHODS: A systematic review was performed to obtain studies on the effects of Syntonic phototherapy on vision. A search in health science databases (Medline, Scopus, Web of Science and PsycINFO) for studies published between 1980 and 2022 was conducted in accordance with the principles of Cochrane approach. The search identified 197 articles. Only clinical studies which used the Syntonic phototherapy as a vision therapy for any visual condition were included. Clinical cases and case series were excluded. Following the inclusion criteria, 8 clinical studies met inclusion, 5 of them being pseudo-experimental studies with an equivalent control group and 3 pre-post pseudo-experimental studies. GRADE tool was used to assess the certainty of the evidence of the studies. The GRADE evidence profile for the studies through the Soft table was made to analyse data. RESULTS: The studies analysed seven outcomes: visual symptoms, functional visual fields, visual acuity, contrast sensitivity, deviation (phoria/tropia), stereopsis and reading abilities. Finding table about results (Soft Table) showed that for all outcomes reviewed, all studies yielded very low certainty of evidence. Results revealed a lack of scientific evidence of the efficacy of Syntonic optometric phototherapy to produce changes in the visual function. CONCLUSION: This systematic review found no consistent evidence for the efficacy of Syntonic phototherapy to cause changes in visual function. There is no scientific evidence to support its clinical use for treating any type of visual anomalies.

Fattening Iberian Pigs Indoors vs. Outdoors: Production Performance and Market Value.

The current Quality Standard regulating the Iberian pig provides for various differentiated farming systems subject to the type of management implemented and the breed of the pigs. This study attempts to analyse the differences between two of these production systems, i.e., the outdoor and the indoor rearing systems by comparing the main technical and economic factors of six farms, three operating under each system, in order to ascertain the most profitable production system. This analysis is based on the information provided by the farm owners. It also evaluates the impact that the COVID-19 pandemic outbreak had on profitability. The results show that both systems spend the same resources on animal feed, which represents nearly 60% of the expense, with the price of purchase of piglets representing 30-32% of the total; however, there are differences in the cost of labour, which is higher in the outdoor variant. In economic terms, outdoor farms obtained a higher gross margin than indoor farms did. Although their production costs are higher, these are offset with larger incomes due to the higher market price of the pigs at the time of slaughter. Lastly, all the farms under study reveal large financial losses on account of COVID-19, given that there was a general decrease in the revenues due to the decrease in the selling price of the pigs, which seems to be the most determinant factor for the economic profits made by these kinds of farms.

Salud mental y COVID-19 en estudiantes de enfermería / Mental Health and COVID-19 in Nursing Students

Introducción: La salud mental de los estudiantes de enfermería en tiempos de COVID-19 ha tenido diversas afectaciones, lo que implica un desafío para la formación. Por ser un tema emergente, es necesario integrar en una perspectiva unitaria los estudios más relevantes, para vislumbrar los impactos inmediatos de la pandemia y las acciones que se han emprendido. Objetivo: Analizar la evidencia científica disponible sobre la salud mental de estudiantes de enfermería en el contexto de la pandemia por COVID-19. Métodos: Revisión integrativa realizada durante febrero y marzo de 2021, en las bases de datos Scopus, ScienceDirect, Lilacs, PubMed, CINHAL, Web of Science, SciELO y PsycINFO. La ecuación de búsqueda incluyó los términos Medical Subject Headings (MeSH): "Mental Health", "COVID-19" y "Students, Nursing", combinados con el operador booleano AND. Se evaluaron estudios primarios y secundarios con diferentes enfoques o metodologías en idioma español, inglés o portugués, con disponibilidad de texto completo, publicados hasta la fecha de revisión. Se excluyeron artículos de opinión y cartas al editor. De un total de 535 artículos, se incluyeron 25. Se realizó análisis de contenido cualitativo. Conclusiones: Se identificaron impactos inmediatos en las emociones, estados de ánimo y trastornos emocionales como ansiedad, estrés y depresión; todos ellos mediados por determinantes sociales, biológicos y psicológicos. Las acciones emprendidas están relacionadas con estrategias de afrontamiento y respuestas institucionales(AU)

Introduction: The mental health of nursing students in times of COVID-19 has had diverse issues, which implies a challenge for training. Being an emerging matter, it is necessary to integrate in a unitary perspective the most relevant studies, to glimpse the immediate impacts of the pandemic and the actions that have been undertaken. Objective: To analyze the available scientific evidence on the mental health of nursing students in the context of the COVID-19 pandemic. Methods: Integrative review conducted during February and March 2021 in the databases Scopus, ScienceDirect, Lilacs, PubMed, CINHAL, Web of Science, SciELO and PsycINFO. The search equation included the terms Medical Subject Headings (MeSH): "Mental Health", "COVID-19" and "Students, Nursing", combined with the Boolean operator AND. We evaluated primary and secondary studies with different approaches or methodologies in Spanish, English or Portuguese, with full text availability, published up to the review date. Opinion articles and letters to the editor were excluded. From a total of 535 articles, 25 were included. Qualitative content analysis was performed. Conclusions: Immediate impacts on emotions, mood states and emotional disorders such as anxiety, stress and depression were identified; all mediated by social, biological and psychological determinants. Actions taken are related to coping strategies and institutional responses(AU)

Validation of the Symptom Questionnaire for Visual Dysfunctions (SQVD): A Questionnaire to Evaluate Symptoms of any Type of Visual Dysfunctions.

PURPOSE: To assess psychometric properties of the Symptom Questionnaire for Visual Dysfunctions (SQVD) questionnaire, including accuracy, validity, and reliability, in a clinical sample of patients having any type of visual dysfunction. METHODS: A clinical sample of 306 patients self-administered the SQVD. Rasch analysis was performed to analyze the functionality of the response categories, fit statistics, differential item functioning (DIF), person and item reliability, targeting, local dependency, unidimensionality, and transformation table. Accuracy was assessed by means of receiver operating characteristic (ROC) curves, using symptoms reported in each patient's clinical record as the gold standard for classifying patients with and without symptoms. The concurrent validity, known group validity, and test-retest reliability (repeatability, using the intraclass correlation coefficient [ICC]) were also examined. RESULTS: SQVD showed orderly category responses. The 14 items fit the Rasch model without significant DIF for gender, presbyopia, and dysfunctions. Person and item reliabilities were 0.81 and 0.85, respectively. Targeting was -1.49 logits. Yen's Q3 statistic showed no local dependency. SQVD was unidimensional (first contrast of the residual = 1.852 eigenvalue with a variance explained by measures of 52.23%). The area under the ROC curve was 0.836 (95% confidence interval [CI], 0.792-0.879) with a cutoff of ≥6 showing good accuracy (sensitivity = 0.759; specificity = 0.783). SQVD showed good concurrent and known group validity and high repeatability (ICC, 0.857; 95% CI, 0.710-0.933) when administered twice 1 week apart. CONCLUSIONS: SQVD has shown good psychometric properties. It can be considered an accurate, valid, and reliable questionnaire to detect visual symptoms related to any type of refractive, accommodative, and binocular dysfunction. TRANSLATIONAL RELEVANCE: SQVD may be used for diagnostic purposes, as it can accurately detect symptoms related to any sort of visual dysfunction. It may also be useful to monitor the treatment outcomes of these conditions.

Not the same, but is it the same? Cycling of biologic agents in rheumatoid arthritis. Experience in the Instituto Mexicano del Seguro Social.

INTRODUCTION: Available data for biocomparable drugs are not enough to make clear decisions with respect to the potential consequences of a change for non-medical reasons in efficacy, security and inmunogenicity in patients. In the near future, options on biological treatments, biocomparable drugs, non biocomparable drugs and new chemical synthesis options will grow. Therefore, it is important to know how patients behave in persistence of treatment after a change for non- medical reasons, which already happens on a regular basis in social security institutions in Mexico. This information will help us to better understand the standard of treatment for patients with chronic immunomediated conditions. OBJECTIVE: The primary objective was to measure the impact of change for non-medical reasons in patients with rheumatoid arthritis (RA) treated with an innovative biological on persistence of treatment after changing to a biocomparable drug or a non-biocomparable drug, compared with those patients staying with the innovative biological. STUDY DESIGN: This is an observational study (non-interventionist) of paired cohorts, where an historic cohort obtained by review of clinical records of stable patients in which no modifications to treatment were made for at least six months is compared with two cohorts of patients whose treatments were switched to another treatment with the same therapeutic mechanism for-non-medical reasons (cycling). RESULTS: We included 264 RA patients (ACR/EULAR, 2010); 132 were switched for non-medical reasons, and 132 were not switched. Two-hundred and thirty (87.1%) were female. Average age was 53.9 years, ranging from 16 to 84 years. Two-hundred and sixty-three patients were Latino (99.6%); one was Caucasian. Persistence of treatment 12 months after the change was 84.8% (85.8% in Enbrel/Infinitam, 78.9% for Remicade/Remsima). No statistical difference was found with respect to RA clinical activity measured by DAS28 12 months after the switch (P > .05). In the 134 switched patients, 20 discontinued the new treatment due to lack of efficacy of the new drug and were changed to a different drug with a different biologic target. Although no differences were found in the cohorts of switched patients with respect to DAS 28 after 12 months of use, we did find differences in the frequency of adverse events. Forty-two patients had an adverse event in the drug switch cohorts: 33 in the Enbrel-Infinitam group and 9 in the Remicade-Remsima group. CONCLUSIONS: The persistence of treatment after switching from an innovative drug to a biocomparable or a non- biocomparable in RA patients did not show statistically significative differences in our cohorts, but we did find a higher number of adverse events when comparing those who were changed with those who continued on an innovative drug. Twenty patients in the switch groups had to receive a new drug with a different biological target due to lack of efficacy of the switched drug.

Antibacterial efficacy of a pH-neutral electrolyzed super-oxidized solution for nonsurgical periodontal treatment.

Objective: Mouthwash is effective in maintaining oral hygiene in patients; however, there is concern that it may adversely affect human oral mucosa. We evaluated a pH-neutral electrolyzed super-oxidized solution (ESS, tradename OxOral®) combined with dental scaling in periodontitis patients. This longitudinal study was conducted with 34 patients divided into three groups. The control group treated with scaling plus saline, the second with scaling plus ESS mouthwash, and another with scaling plus ESS mouthwash and gel. The plaque index (PI), gingival index (GI), and probing depth (PD) were determined before and after periodontal treatment. Results: The final PI and GI decreased compared with the initial measurements in the three treatment groups (p < 0.05). Scaling plus ESS mouthwash and gel significantly reduced the final PI, GI, and DP compared to the control group (p < 0.05). Conclusion: Our study shows the antiseptic properties of ESS with mouthwash and gel. Further studies are needed to verify the results.

Use of Noncanonical Tyrosine Analogues to Probe Control of Radical Intermediates during Endoperoxide Installation by Verruculogen Synthase (FtmOx1).

Important bioactive natural products, including prostaglandin H2 and artemisinin, contain reactive endoperoxides. Known enzymatic pathways for endoperoxide installation require multiple hydrogen-atom transfers (HATs). For example, iron(II)- and 2-oxoglutarate-dependent verruculogen synthase (FtmOx1; EC 1.14.11.38) mediates HAT from aliphatic C21 of fumitremorgin B, capture of O2 by the C21 radical (C21•), addition of the peroxyl radical (C21-O-O•) to olefinic C27, and HAT to the resultant C26•. Recent studies proposed conflicting roles for FtmOx1 tyrosine residues, Tyr224 and Tyr68, in the HATs from C21 and to C26•. Here, analysis of variant proteins bearing a ring-halogenated tyrosine or (amino)phenylalanine in place of either residue establishes that Tyr68 is the hydrogen donor to C26•, while Tyr224 has no essential role. The radicals that accumulate rapidly in FtmOx1 variants bearing a HAT-competent tyrosine analog at position 68 exhibit hypsochromically shifted absorption and, in cases of fluorine substitution, 19F-coupled electron-paramagnetic-resonance (EPR) spectra. By contrast, functional Tyr224-substituted variants generate radicals with unaltered light-absorption and EPR signatures as they produce verruculogen. The alternative major product of the Tyr68Phe variant, which forms competitively with verruculogen also in wild-type FtmOx1 in 2H2O and in the variant with the less readily oxidized 2,3-F2Tyr at position 68, is identified by mass spectrometry and isotopic labeling as the 26-hydroxy-21,27-endoperoxide compound formed after capture of another equivalent of O2 by the longer lived C26•. The results highlight the considerable chemical challenges the enzyme must navigate in averting both oxygen rebound and a second O2 coupling to obtain verruculogen selectively over other possible products.

Ruminant-associated Listeria monocytogenes isolates belong preferentially to dairy-associated hypervirulent clones: a longitudinal study in 19 farms.

Studies have shown that ruminants constitute reservoirs of Listeria monocytogenes, but little is known about the epidemiology and genetic diversity of this pathogen within farms. Here we conducted a large-scale longitudinal study to monitor Listeria spp. in 19 dairy farms during three consecutive seasons (N = 3251 samples). L. innocua was the most prevalent species, followed by L. monocytogenes. Listeria monocytogenes was detected in 52.6% of farms and more frequently in cattle (4.1%) and sheep (4.5%) than in goat farms (0.2%). Lineage I accounted for 69% of L. monocytogenes isolates. Among animal samples, the most prevalent sublineages (SL) and clonal complexes (CC) were SL1/CC1, SL219/CC4, SL26/CC26 and SL87/CC87, whereas SL666/CC666 was most prevalent in environmental samples. Sixty-one different L. monocytogenes cgMLST types were found, 28% common to different animals and/or surfaces within the same farm and 21% previously reported elsewhere in the context of food and human surveillance. Listeria monocytogenes prevalence was not affected by farm hygiene but by season: higher prevalence was observed during winter in cattle, and during winter and spring in sheep farms. Cows in their second lactation had a higher probability of L. monocytogenes faecal shedding. This study highlights dairy farms as a reservoir for hypervirulent L. monocytogenes.

Rasch analysis for development and reduction of Symptom Questionnaire for Visual Dysfunctions (SQVD).

To develop the Symptom Questionnaire for Visual Dysfunctions (SQVD) and to perform a psychometric analysis using Rasch method to obtain an instrument which allows to detect the presence and frequency of visual symptoms related to any visual dysfunction. A pilot version of 33 items was carried out on a sample of 125 patients from an optometric clinic. Rasch model (using Andrich Rating Scale Model) was applied to investigate the category probability curves and Andrich thresholds, infit and outfit mean square, local dependency using Yen's Q3 statistic, Differential item functioning (DIF) for gender and presbyopia, person and item reliability, unidimensionality, targeting and ordinal to interval conversion table. Category probability curves suggested to collapse a response category. Rasch analysis reduced the questionnaire from 33 to 14 items. The final SQVD showed that 14 items fit to the model without local dependency and no significant DIF for gender and presbyopia. Person reliability was satisfactory (0.81). The first contrast of the residual was 1.908 eigenvalue, showing unidimensionality and targeting was - 1.59 logits. In general, the SQVD is a well-structured tool which shows that data adequately fit the Rasch model, with adequate psychometric properties, making it a reliable and valid instrument to measure visual symptoms.

Importance and Antimicrobial Resistance of Mycoplasma bovis in Clinical Respiratory Disease in Feedlot Calves.

Bovine respiratory disease (BRD) is an important viral and/or bacterial disease that mainly affects feedlot calves. The involvement of Mycoplasma bovis in BRD can lead to chronic pneumonia poorly responsive to antimicrobial treatment. Caseonecrotic bronchopneumonia is a pulmonary lesion typically associated with M. bovis. In Spain, M. bovis is widely distributed in the feedlots and circulating isolates are resistant to most antimicrobials in vitro. However, the role of this species in clinical respiratory disease of feedlot calves remains unknown. Furthermore, available data are relative to a fixed panel of antimicrobials commonly used to treat BRD, but not to the specific set of antimicrobials that have been used for treating each animal. This study examined 23 feedlot calves raised in southeast Spain (2016-2019) with clinical signs of respiratory disease unresponsive to treatment. The presence of M. bovis was investigated through bacteriology (culture and subsequent PCR), histopathology and immunohistochemistry. The pathogen was found in 86.9% (20/23) of the calves, mainly in the lungs (78.26%; 18/23). Immunohistochemistry revealed M. bovis antigens in 73.9% (17/23) of the calves in which caseonecrotic bronchopneumonia was the most frequent lesion (16/17). Minimum inhibitory concentration assays confirmed the resistance of a selection of 12 isolates to most of the antimicrobials specifically used for treating the animals in vivo. These results stress the importance of M. bovis in the BRD affecting feedlot calves in Spain.

Clip migration after cholecystectomy.

We present the case of a 43-year-old female who underwent cholecystectomy with choledochotomy and laparoscopic lithoextraction for choledocholithiasis, who came to the emergency room due to abdominal pain of 3 days' evolution. An abdominal CT scan showed a possible cholangitis with a liver abscess at the level of segment VI, with metal density material near to the lesion. The inflammatory process extended to the right iliac psoas.

Endovascular treatment of coronary subclavian steal syndrome: a case series highlighting the diagnostic usefulness of a multimodality imaging approach.

BACKGROUND: Coronary subclavian steal syndrome (CSSS) is an uncommon complication observed in patients after coronary artery bypass surgery with left internal mammary artery (LIMA) grafts. It is defined as coronary ischaemia due to reversal flow from the LIMA to the left subclavian artery (SA) when a proximal left SA stenosis is present. In practice, the entire clinical spectrum of ischaemic heart disease, ranging from asymptomatic patients to acute myocardial infarction, may be encountered. CASE SUMMARY: Three cases of CSSS recently detected at our hospital are being described. Two patients presented with an acute coronary syndrome, so diagnosis was suspected based on coronary angiography findings, as retrograde blood flow from LIMA to the distal SA was present. Myocardial ischaemia was documented by myocardial perfusion scintigraphy in one case. The third patient was asymptomatic and CSSS was suspected during physical examination and confirmed by computed tomography (CT). Endovascular intervention with balloon-expandable stent implantation of the stenotic SA was performed by vascular surgeons in all patients. No periprocedural complications occurred, and complete resolution of symptoms was achieved. DISCUSSION: In CSSS, subclavian angiography is the standard diagnostic test. However, other diagnostic techniques may be valuable to better clarify this challenging diagnosis. In the herein small series, the usefulness of a multimodality imaging approach including Doppler ultrasound, myocardial perfusion scintigraphy, and CT is well demonstrated. Furthermore, this study endorses the safety and utility of endovascular treatment in different clinical scenarios, including asymptomatic patients.

Not the same, but ¿is it the same? Cycling of biologic agents in rheumatoid arthritis. Experience in the Instituto Mexicano del Seguro Social. / No es el mismo pero ¿es igual? Cycling de agentes biológicos en artritis reumatoide. Experiencia en el Instituto Mexicano del Seguro Social.

INTRODUCTION: Available data for biocomparable drugs are not enough to make clear decisions with respect to the potential consequences of a change for non-medical reasons in efficacy, security and inmunogenicity in patients. In the near future, options on biological treatments, biocomparable drugs, non biocomparable drugs and new chemical synthesis options will grow. Therefore, it is important to know how patients behave in persistence of treatment after a change for non-medical reasons, which already happens on a regular basis in social security institutions in Mexico. This information will help us to better understand the standard of treatment for patients with chronic immunomediated conditions. OBJECTIVE: The primary objective was to measure the impact of change for non-medical reasons in patients with rheumatoid arthritis (RA) treated with an innovative biological on persistence of treatment after changing to a biocomparable drug or a non-biocomparable drug, compared with those patients staying with the innovative biological. STUDY DESIGN: This is an observational study (non-interventionist) of paired cohorts, where an historic cohort obtained by review of clinical records of stable patients in which no modifications to treatment were made for at least six months is compared with two cohorts of patients whose treatments were switched to another treatment with the same therapeutic mechanism for-non-medical reasons (cycling). RESULTS: We included 264 RA patients (ACR/EULAR, 2010); 132 were switched for non-medical reasons, and 132 were not switched. Two-hundred and thirty (87.1%) were female. Average age was 53.9years, ranging from 16 to 84years. Two-hundred and sixty-three patients were Latino (99.6%); one was Caucasian. Persistence of treatment 12months after the change was 84.8% (85.8% in Enbrel/Infinitam, 78.9% for Remicade/Remsima). No statistical difference was found with respect to RA clinical activity measured by DAS28 12months after the switch (P>.05). In the 134 switched patients, 20 discontinued the new treatment due to lack of efficacy of the new drug and were changed to a different drug with a different biologic target. Although no differences were found in the cohorts of switched patients with respect to DAS28 after 12months of use, we did find differences in the frequency of adverse events. Forty-two patients had an adverse event in the drug switch cohorts: 33 in the Enbrel-Infinitam group and 9 in the Remicade-Remsima group. CONCLUSIONS: The persistence of treatment after switching from an innovative drug to a biocomparable or a non-biocomparable in RA patients did not show statistically significative differences in our cohorts, but we did find a higher number of adverse events when comparing those who were changed with those who continued on an innovative drug. Twenty patients in the switch groups had to receive a new drug with a different biological target due to lack of efficacy of the switched drug.

Evolution from sinusoidal to collinear A-type antiferromagnetic spin-ordered magnetic phase transition in Tb1-xPrxMnO3solid solution.

The present study reports on the structural and magnetic phase transitions in Pr-doped polycrystalline Tb0.6Pr0.4MnO3, using high-resolution neutron powder diffraction (NPD) collected at SINQ spallation source, to emphasize the suppression of the sinusoidal magnetic structure of pure TbMnO3and the evolution to a collinear A-type antiferromagnetic ordering. The phase purity, Jahn-Teller distortion, and one-electron bandwidth for egorbital of Mn3+cation have been calculated for polycrystalline Tb0.6Pr0.4MnO3,in comparison to the parent materials TbMnO3and PrMnO3, through the Rietveld refinement study from x-ray diffraction data at room temperature, which reveals the GdFeO3type orthorhombic structure of Tb0.6Pr0.4MnO3havingPnmaspace group symmetry. The temperature-dependent zero field-cooled and field-cooled dc magnetization study at low temperature down to 5 K reveals a variation in the magnetic phase transition due to the effect of Pr3+substitution at the Tb3+site, which gives the signature of the antiferromagnetic nature of the sample, with a weak ferromagnetic component at low temperature-induced by an external magnetic field. The field-dependent magnetization study at low temperatures gives the weak coercivity having the order of 2 kOe, which is expected due to the canted-spin arrangement or ferromagnetic nature of Terbium ordering. The NPD data for Tb0.6Pr0.4MnO3confirms that the nuclear structure of the synthesized sample maintains its orthorhombic symmetry down to 1.5 K. Also, the magnetic structures have been solved at 50 K, 25 K, and 1.5 K through the NPD study, which shows an A-type antiferromagnetic spin arrangement having the magnetic space groupPn'ma'.