Nitrogen and phosphorus budget in an intensive irrigation area and effects on littoral water and groundwater (Yaqui Valley, Northwestern Mexico).

The Yaqui River Irrigation District is a region in Mexico with intensive agricultural production; thus, large quantities of fertilizers are used, and excess fertilizer can affect the quality of water bodies. The aim of this work was to estimate the water budget and nitrogen (N) and phosphorous (P) mass budgets to evaluate possible contamination of a littoral water body (Tóbari Bay) and leachates into an aquifer (Yaqui Valley aquifer). Wheat and corn crops were studied, climate information was compiled, and soil and water samples were collected for analysis. The water budget showed excess irrigation occurred due to the need for soil washing to prevent salinization. A total of 24% of all irrigation water was used for crops, 60% was discharged into the bay through runoff of the drainage system, and 16% corresponded to effective infiltration (aquifer recharge). The N budget showed that of the 100% N input, the highest percentage was used by plants (63%), and only minimal loss occurred through runoff (11%) and leachate into the aquifer (7%). The remaining N stayed in the soil (18%) or was volatilized (1%). These results indicate that the drainage system prevented large amounts of N from entering the aquifer; thus, the N concentrations in the groundwater did not exceed the regulated maximum limit for drinking water (10 mg N-NO3/L). In terms of the water pollution level in the bay, the presence of NO3- was minimal (concentrations below the quasintifiable limit). Of the 100% of P that was applied, 55% was used by the plants, and 40% remained in the soil; therefore, the P that was transported by runoff or was leached was minimal (3 and 2%, respectively). However, this minimal amount of P ranged from 0.1 to 0.2 mg/L in the bay, and these values exceeded the suggested values for the protection of aquatic life (0.01 mg/L). The administrators of the irrigation district must pay special attention to phosphate fertilizer management and implement irrigation techniques that increase water use efficiency.

Diagnostic performance of transvaginal ultrasound and magnetic resonance imaging for preoperative evaluation of low-grade endometrioid endometrial carcinoma: prospective comparative study.

OBJECTIVE: To compare the diagnostic performance of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the prediction of deep myometrial invasion (DMI) and cervical stromal invasion (CSI) in patients with low-grade (Grade 1 or 2) endometrioid endometrial cancer (EEC). METHODS: This was a prospective study including all patients with low-grade EEC diagnosed between October 2013 and July 2018 at the Vall d'Hebron Hospital in Barcelona, Spain. Preoperative staging was performed using TVS and MRI, followed by surgical staging. Final histology was considered as the reference standard. Sensitivity, specificity, likelihood ratios and diagnostic accuracy were calculated for both imaging techniques in the prediction of DMI and CSI, and the agreement index was calculated for both techniques. The STARD 2015 guidelines were followed. RESULTS: A total of 131 patients with low-grade EEC were included consecutively. Sensitivity was higher for TVS than for MRI both for the prediction of DMI (69% (95% CI, 53-82%) vs 51% (95% CI, 36-66%), respectively) and CSI (43% (95% CI, 27-61%) vs 24% (95% CI, 12-41%), respectively). Specificity was similar for TVS and MRI in the prediction of DMI (87% (95% CI, 78-93%) vs 91% (95% CI, 82-96%)) and equal in the prediction of CSI (97% (95% CI, 91-99%) for both). The agreement index between TVS and MRI was 0.84 (95% CI, 0.76-0.90) for DMI and 0.92 (95% CI, 0.85-0.96) for CSI. CONCLUSIONS: The diagnostic performance of TVS is similar to that of MRI for the prediction of DMI and CSI in low-grade EEC, and TVS can play a role as a first-line imaging technique in the preoperative evaluation of low-grade EEC. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

An extremely high-altitude plume seen at Mars' morning terminator.

The Martian limb (that is, the observed 'edge' of the planet) represents a unique window into the complex atmospheric phenomena occurring there. Clouds of ice crystals (CO2 ice or H2O ice) have been observed numerous times by spacecraft and ground-based telescopes, showing that clouds are typically layered and always confined below an altitude of 100 kilometres; suspended dust has also been detected at altitudes up to 60 kilometres during major dust storms. Highly concentrated and localized patches of auroral emission controlled by magnetic field anomalies in the crust have been observed at an altitude of 130 kilometres. Here we report the occurrence in March and April 2012 of two bright, extremely high-altitude plumes at the Martian terminator (the day-night boundary) at 200 to 250 kilometres or more above the surface, and thus well into the ionosphere and the exosphere. They were spotted at a longitude of about 195° west, a latitude of about -45° (at Terra Cimmeria), extended about 500 to 1,000 kilometres in both the north-south and east-west directions, and lasted for about 10 days. The features exhibited day-to-day variability, and were seen at the morning terminator but not at the evening limb, which indicates rapid evolution in less than 10 hours and a cyclic behaviour. We used photometric measurements to explore two possible scenarios and investigate their nature. For particles reflecting solar radiation, clouds of CO2-ice or H2O-ice particles with an effective radius of 0.1 micrometres are favoured over dust. Alternatively, the plume could arise from auroral emission, of a brightness more than 1,000 times that of the Earth's aurora, over a region with a strong magnetic anomaly where aurorae have previously been detected. Importantly, both explanations defy our current understanding of Mars' upper atmosphere.

On the aqueous solvation of AsO(OH)3vs. As(OH)3. Born-Oppenheimer molecular dynamics density functional theory cluster studies.

While arsenous acid, As(OH)3, has been the subject of a plethora of studies due to its worldwide ubiquity and its toxicity, pentavalent As in the form of arsenic acid, AsO(OH)3, has recently been found in rivers in central Mexico as the most abundant naturally occurring arsenic species. To better understand the solvation patterns of both toxic acids at the molecular level, we report the results of Born-Oppenheimer molecular dynamics simulations on the aqueous solvation of the AsO(OH)3 and As(OH)3 molecules at room temperature using the cluster microsolvation approach including 30 water molecules at the B3LYP/6-31G** level of theory. We found that the average per-molecule water binding energy is ca. 1 kcal mol-1 larger for the As(v) species as compared to the As(iii) one. To account for the asymmetry of both molecules, the hydration patterns were studied separately for a "lower" hemisphere, defined by the initially protonated oxygens, and for the opposite "upper" hemisphere. Similar lower hydration patterns were found for both As(iii) and As(v), with the same coordination number CN = 7. The upper pattern for As(iii) was found to be of a hydrophobic type, whereas that for As(v) showed the fourth oxygen to be hydrogen-bonded to the water network, yielding CN = 3.7; moreover, a proton "hopped" from the lower to the upper side, through the Grotthuss mechanism. Theoretical EXAFS spectra were obtained that showed good agreement with experimental data for As(iii) and As(v) in liquid water, albeit with somewhat longer As-O distances due to the level of theory employed. Proton transfer processes were also addressed; we found that the singly deprotonated H2AsO3- species largely dominated (99% of the simulation) for the As(iii) case, and that the deprotonated H2AsO4- and HAsO42- species were almost equally present (45% and 55%, respectively) for the As(v) case, which is in line with the experimental data pKa1 = 2.24 and pKa2 = 6.96. Through vibrational analysis the features of the Eigen and Zundel ions were found in the spectra of the microsolvated As(iii) and As(v) species, in good agreement with experimental data in aqueous solutions.

Reference curves for CD4 T-cell count response to combination antiretroviral therapy in HIV-1-infected treatment-naïve patients.

OBJECTIVES: The aim of this work was to provide a reference for the CD4 T-cell count response in the early months after the initiation of combination antiretroviral therapy (cART) in HIV-1-infected patients. METHODS: All patients in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) cohort who were aged ≥ 18 years and started cART for the first time between 1 January 2005 and 1 January 2010 and who had at least one available measurement of CD4 count and a viral load ≤ 50 HIV-1 RNA copies/mL at 6 months (± 3 months) after cART initiation were included in the study. Unadjusted and adjusted references curves and predictions were obtained using quantile regressions. RESULTS: A total of 28 992 patients were included in the study. The median CD4 T-cell count at treatment initiation was 249 [interquartile range (IQR) 150, 336] cells/µL. The median observed CD4 counts at 6, 9 and 12 months were 382 (IQR 256, 515), 402 (IQR 274, 543) and 420 (IQR 293, 565) cells/µL. The two main factors explaining the variation of CD4 count at 6 months were AIDS stage and CD4 count at cART initiation. A CD4 count increase of ≥ 100 cells/mL is generally required in order that patients stay 'on track' (i.e. with a CD4 count at the same percentile as when they started), with slightly higher gains required for those starting with CD4 counts in the higher percentiles. Individual predictions adjusted for factors influencing CD4 count were more precise. CONCLUSIONS: Reference curves aid the evaluation of the immune response early after antiretroviral therapy initiation that leads to viral control.

Longitudinal changes in fetal biometry and cerebroplacental hemodynamics in fetuses with congenital heart disease.

OBJECTIVES: To determine the longitudinal behavior of fetal biometric measures and cerebroplacental hemodynamics throughout gestation in fetuses with congenital heart disease (CHD). METHODS: Fetal biometry and Doppler hemodynamics (uterine artery (UtA), umbilical artery (UA) and fetal middle cerebral artery (MCA)) were measured serially in a cohort of consecutive fetuses diagnosed with CHD. Evaluations were made at various time points, from diagnosis (20-25 weeks) to delivery, with at least two measurements per fetus that were at least 2 weeks apart. Fetuses were classified into three groups according to the pattern of blood supply to the brain (placental vs systemic) that would be expected on the basis of the type of CHD. All parameters were transformed into Z-scores. A linear mixed model to analyze repeated measurements was constructed for each parameter to assess its behavior throughout gestation. RESULTS: Four hundred and forty-four ultrasound examinations were performed in 119 CHD fetuses, with a median of two measurements per fetus. The fetuses presented a small head at diagnosis (biparietal diameter (BPD) Z-score, -1.32 ± 0.99; head circumference (HC) Z-score, -0.79 ± 1.02), which remained small throughout gestation. UtA and UA pulsatility indices (PI) showed a significant increase towards the end of pregnancy, whereas no significant changes were observed in MCA-PI or cerebroplacental ratio (CPR) with gestational age. Both MCA and CPR presented significant differences in longitudinal behavior between CHD groups, while BPD and HC did not. CONCLUSIONS: CHD fetuses have a relatively small head from the second trimester of pregnancy, regardless of the type of CHD anomaly, and increasing resistance in the UtA and UA as pregnancy progresses, suggestive of increasing degree of placental impairment. Our findings indicate the early onset of mechanisms that could lead to poorer neurodevelopment later in life. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Do knowledge of uterine artery resistance in the second trimester and targeted surveillance improve maternal and perinatal outcome? UTOPIA study: a randomized controlled trial.

OBJECTIVES: To ascertain whether screening for pre-eclampsia (PE) and intrauterine growth restriction (IUGR) by uterine artery (UtA) Doppler in the second trimester of pregnancy and targeted surveillance improve maternal and perinatal outcomes in an unselected population. METHODS: This was a multicenter randomized open-label controlled trial. At the routine second-trimester anomaly scan, women were assigned randomly to UtA Doppler or non-Doppler groups. Women with abnormal UtA Doppler were offered intensive surveillance at high-risk clinics of the participating centers with visits every 4 weeks that included measurement of maternal blood pressure, dipstick proteinuria, fetal growth and Doppler examination. The primary outcome was a composite score for perinatal complications, defined as the presence of any of the following: PE, IUGR, spontaneous labor < 37 weeks' gestation, placental abruption, stillbirth, gestational hypertension, admission to neonatal intensive care unit and neonatal complications. Secondary outcomes were a composite score for maternal complications (disseminated intravascular coagulation, maternal mortality, postpartum hemorrhage, pulmonary edema, pulmonary embolism, sepsis), and medical interventions (for example, corticosteroid administration and induction of labor) in patients developing placenta-related complications. RESULTS: In total, 11 667 women were included in the study. Overall, PE occurred in 348 (3.0%) cases, early-onset PE in 48 (0.4%), IUGR in 722 (6.2%), early-onset IUGR in 93 (0.8%) and early-onset PE with IUGR in 32 (0.3%). UtA mean pulsatility index > 90(th) percentile was able to detect 59% of early-onset PE and 60% of early-onset IUGR with a false-positive rate of 11.1%. When perinatal and maternal data according to assigned group (UtA Doppler vs non-Doppler) were compared, no differences were found in perinatal or maternal complications. However, screened patients had more medical interventions, such as corticosteroid administration (relative risk (RR), 1.79 (95% CI, 1.4-2.3)) and induction of labor for IUGR (RR, 1.36 (95% CI, 1.07-1.72)). In women developing PE or IUGR, there was a trend towards fewer maternal complications (RR, 0.46 (95% CI, 0.19-1.11)). CONCLUSIONS: Routine second-trimester UtA Doppler ultrasound in an unselected population identifies approximately 60% of women at risk for placental complications; however, application of this screening test failed to improve short-term maternal and neonatal morbidity and mortality. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Liver stiffness and aspartate aminotransferase levels predict the risk for liver fibrosis progression in hepatitis C virus/HIV-coinfected patients.

OBJECTIVES: The aim of the study was to investigate liver fibrosis outcome and the risk factors associated with liver fibrosis progression in hepatitis C virus (HCV)/HIV-coinfected patients. METHODS: We prospectively obtained liver stiffness measurements by transient elastography in a cohort of 154 HCV/HIV-coinfected patients, mostly Caucasian men on suppressive antiretroviral treatment, with the aim of determining the risk for liver stiffness measurement (LSM) increase and to identify the predictive factors for liver fibrosis progression. To evaluate LSM trends over time, a linear mixed regression model with LSM level as the outcome and duration of follow-up in years as the main covariate was fitted. RESULTS: After a median follow-up time of 40 months, the median increase in LSM was 1.05 kPa/year [95% confidence interval (CI) 0.72-1.38 kPa/year]. Fibrosis stage progression was seen in 47% of patients, and 17% progressed to cirrhosis. Aspartate aminotransferase (AST) levels and liver fibrosis stage at baseline were identified as independent predictors of LSM change. Patients with F3 (LSM 9.6-14.5 kPa) or AST levels ≥ 64 IU/L at baseline were at higher risk for accelerated LSM increase (ranging from 1.45 to 2.61 kPa/year), whereas LSM change was very slow among patients with both F0-F1 (LSM ≤ 7.5 kPa) and AST levels ≤ 64 IU/L at baseline (0.34 to 0.58 kPa/year). An intermediate risk for LSM increase (from 0.78 to 1.03 kPa/year) was seen in patients with F2 (LSM 7.6-9.5 kPa) and AST baseline levels ≤ 64 IU/L. CONCLUSIONS: AST levels and liver stiffness at baseline allow stratification of the risk for fibrosis progression and might be clinically useful to guide HCV treatment decisions in HIV-infected patients.

Dynamics of allograft fibrosis in pediatric liver transplantation.

Progressive liver allograft fibrosis (LAF) is well known to occur long term, as shown by its high prevalence in late posttransplant liver biopsies (LBs). To evaluate the influence of clinical variables and immunosuppression on LAF progression, LAF dynamic was assessed in 54 pediatric liver transplantation (LT) recipients at 6 months, 3 and 7 years post-LT, reviewing clinical, biochemical data and protocol LBs using METAVIR and the liver allograft fibrosis score, previously designed and validated specifically for LAF assessment. Scoring evaluations were correlated with fibrosis quantification by morphometric analysis. Progressive LAF was found in 74% of long-term patients, 70% of whom had unaltered liver enzymes. Deceased grafts showed more fibrosis than living-related grafts (p = 0.0001). Portal fibrosis was observed in correlation with prolonged ischemia time, deceased grafts and lymphoproliferative disease (p = 0.001, 0.006 and 0.012, respectively). Sinusoidal fibrosis was correlated with biliary complications (p = 0.01). Centrilobular fibrosis was associated with vascular complications (p = 0.044), positive autoantibodies (p = 0.017) and high gamma-globulins levels (p = 0.028). Steroid therapy was not associated with reduced fibrosis (p = 0.83). LAF could be viewed as a dynamic process with mostly progression along the time. Peri- and post-LT-associated factors may condition fibrosis development in a specific area of the liver parenchyma.

Depth of a strong jovian jet from a planetary-scale disturbance driven by storms.

The atmospheres of the gas giant planets (Jupiter and Saturn) contain jets that dominate the circulation at visible levels. The power source for these jets (solar radiation, internal heat, or both) and their vertical structure below the upper cloud are major open questions in the atmospheric circulation and meteorology of giant planets. Several observations and in situ measurements found intense winds at a depth of 24 bar, and have been interpreted as supporting an internal heat source. This issue remains controversial, in part because of effects from the local meteorology. Here we report observations and modelling of two plumes in Jupiter's atmosphere that erupted at the same latitude as the strongest jet (23 degrees N). The plumes reached a height of 30 km above the surrounding clouds, moved faster than any other feature (169 m s(-1)), and left in their wake a turbulent planetary-scale disturbance containing red aerosols. On the basis of dynamical modelling, we conclude that the data are consistent only with a wind that extends well below the level where solar radiation is deposited.

Hazy Blue Worlds: A Holistic Aerosol Model for Uranus and Neptune, Including Dark Spots.

We present a reanalysis (using the Minnaert limb-darkening approximation) of visible/near-infrared (0.3-2.5 µm) observations of Uranus and Neptune made by several instruments. We find a common model of the vertical aerosol distribution i.e., consistent with the observed reflectivity spectra of both planets, consisting of: (a) a deep aerosol layer with a base pressure >5-7 bar, assumed to be composed of a mixture of H2S ice and photochemical haze; (b) a layer of photochemical haze/ice, coincident with a layer of high static stability at the methane condensation level at 1-2 bar; and (c) an extended layer of photochemical haze, likely mostly of the same composition as the 1-2-bar layer, extending from this level up through to the stratosphere, where the photochemical haze particles are thought to be produced. For Neptune, we find that we also need to add a thin layer of micron-sized methane ice particles at ∼0.2 bar to explain the enhanced reflection at longer methane-absorbing wavelengths. We suggest that methane condensing onto the haze particles at the base of the 1-2-bar aerosol layer forms ice/haze particles that grow very quickly to large size and immediately "snow out" (as predicted by Carlson et al. (1988), https://doi.org/10.1175/1520-0469(1988)045<2066:CMOTGP>2.0.CO;2), re-evaporating at deeper levels to release their core haze particles to act as condensation nuclei for H2S ice formation. In addition, we find that the spectral characteristics of "dark spots", such as the Voyager-2/ISS Great Dark Spot and the HST/WFC3 NDS-2018, are well modelled by a darkening or possibly clearing of the deep aerosol layer only.

Stabilization of HIV incidence in women of reproductive age in southern Mozambique.

INTRODUCTION: The collection of incidence data on HIV infection is necessary to evaluate the status and dynamics of the epidemic and the effectiveness of intervention strategies. However, this is usually difficult in low-income countries. METHODS: Five yearly point HIV prevalence estimations (in 1999, 2003, 2004, 2005 and 2008) were obtained for women between 15 and 45 years of age participating in three studies carried out for other purposes at the Antenatal Clinic (ANC) in Manhiça, Mozambique. HIV incidence was estimated between prevalence points using a previously validated methodology. Two methods were used, one based on mortality rates for three HIV epidemic scenarios, and the other based on survival information after infection. The pattern over time was captured by fitting a log-regression model. RESULTS: The prevalence of HIV infection ranged from 12% in 1999 to 49% in 2008. The HIV incidence increased from approximately 3.5 cases per 100 person-years in 2001 to 14 per 100 person-years in 2004, with stabilization thereafter to levels of around 12 cases per 100 person-years. The incidence estimates were comparable for the two methods used. CONCLUSION: These findings indicate an increase in the prevalence and incidence of HIV infection among women of reproductive age over the 9 years of the analysis, with a plateau in the incidence of infection since 2005. However, the very high figures for both prevalence and incidence highlight the importance of the continuation of the prevention and treatment programmes that already exist, and suggest that implementation of preventive measures is needed in this area.

Sonographic cervical length measurement in pregnant women with a cervical pessary.

OBJECTIVES: The aims of this study were to describe and assess the feasibility of measuring cervical length by standard transvaginal sonography (TVS) and transperineal sonography (TPS) in women with a cervical pessary and compare these measurements with those obtained with a new transvaginal technique. METHODS: Measurement of cervical length by TPS was attempted immediately before measurement using TVS in 48 women with a cervical pessary at between 22 and 23 weeks' gestation. The TVS procedure consisted of two types of measurement: in the first, the probe was placed on the anterior fornix (standard technique) and in the second, the probe was inserted into the pessary to touch the anterior cervical lip (new technique). Two physicians consecutively performed these procedures and compared the measurements obtained. Intraclass correlation coefficients (ICCs) with 95% CI were used to evaluate interobserver reliability, and Bland-Altman analysis was used to assess interobserver agreement. RESULTS: In total, 258 measurements (obtained from 43 women) were analyzed. Interobserver ICCs of the measurements obtained were 0.58 (95% CI, 0.34-0.75) for TPS, 0.65 (95% CI, 0.44-0.79) for the standard TVS technique and 0.97 (95% CI, 0.95-0.98) for the new TVS technique. Bland-Altman analysis showed small mean differences between measurements obtained by two physicians for the three methods, but with narrower limits of agreements (LOA) for the new TVS technique: TPS mean difference - 0.99 mm (95% LOA, - 13.23 to 11.25 mm), standard TVS technique mean difference - 0.23 mm (95% LOA, - 10.90 to 10.44 mm) and new TVS technique mean difference - 0.01 mm (95% LOA, - 2.57 to 2.55 mm). It was apparent from the images obtained that the external os was not visible in 89% of cases when either the TPS or standard TVS technique was used. However, the external os was visible in all cases when the new TVS method was used. CONCLUSIONS: We propose a new technique for measuring and monitoring cervical length in women with a cervical pessary that provides improved visualization of the cervix and increased reliability in comparison to established techniques.

Kinetics and drainage index in function of pH, in the dewatering of arsenic iron sludge.

Water for human consumption containing arsenic from natural and anthropogenic sources is a public health problem worldwide. Therefore, different technologies must be used to remove it from the water (coagulation-filtration assisted with ferric chloride, adsorption, membranes, etc.). While these technologies produce water that is free from arsenic, they also produce toxic residuals with high arsenic concentrations, which must be treated in order to decrease their volume and thereby facilitate transport and final disposal. Thus, the main purpose of this investigation was to study the physical and chemical properties of arsenic iron sludge in thickening, chemical conditioning, and dewatering processes, as well as to propose new kinetic criteria for obtaining the drainage index (Eg) based on polymer dose, mesh permeability, specific resistance to filtration, and pH. We found a significant improvement in the physical and chemical properties when thickening the sludge, in particular, floc size increased and specific resistance to filtration and Z-potential decreased due to weakened repulsive forces, resulting in more sedimentation. The polymer AN913VHM (PF2) had the best behavior in the chemical conditioning and dewatering tests, with an optimal dose of 8 mg/L and a mesh permeability of 80-100 ft3/min ft2, which made it possible to retain more flocs (60% in 3.74 min). The pH affected the amount of total solids in the cake, with more solids obtained at a pH of 6 (25.93 g/L) and 6.5 (21.81 g/L), and with rapid drainage of surface water (69.28%). Furthermore, new kinetic criteria were obtained for a drainage time of 120 s in order to eliminate 60% of the total volume of the filtrate mass, with Eg of 3.05 at a pH of 6. This value is considered medium drainage for this type of sludge, which is difficult to treat.

[Effectiveness of tranexamic acid for decreased allogenic blood transfusion in total hip arthroplasty]. / Eficacia del ácido tranexámico para la disminución de la transfusión de sangre alogénica en la artroplastía total de cadera.

INTRODUCTION: ATC can cause considerable blood loss. To reduce the need for blood transfusion, various preoperative techniques such as administration of tranexamic acid (ATX) are used. OBJECTIVE: to demonstrate that the use of ATX decreases the need for allogeneic blood transfusion in patients operated on ATC. MATERIAL AND METHODS: Prospective, observational, descriptive study, used to observe the allogeneic blood transfusion rate in patients who underwent unilateral primary ATC from May 2016 to December 2017. ATX was applied preoperatively and after 24 hours a blood count was taken and the need for blood transfusion was assessed. RESULTS: A total of 70 patients were included in the study. The average postoperative Hb 11.7 mg/dl with a range of 9.2 to 14.9 mg/dl and an average Ht of 37.1% with a range of 30.2 to 44.2%. None of the patients required allogeneic blood transfusión. CONCLUSIONS: This study demonstrates how ATX is a transoperative strategy to reduce the need for allogeneic blood transfusion in patients undergoing primary ATC.

INTRODUCCIÓN: La artroplastía total de cadera (ATC) puede causar una pérdida considerable de sangre. Para reducir la necesidad de transfusión de sangre se utilizan diversas técnicas preoperatorias como la administración de ácido tranexámico (ATX). OBJETIVO: Demostrar que el uso de ATX disminuye la necesidad de transfusión de sangre alogénica en pacientes operados de ATC. MATERIAL Y MÉTODOS: estudio prospectivo, observacional, descriptivo, utilizado para observar la tasa de transfusión de sangre alogénica en pacientes a quienes se les practicó ATC primaria unilateral de Mayo de 2016 a Diciembre de 2017. A los pacientes incluidos en el estudio se les aplicó ATX preoperatoriamente, a las 24 horas se tomó una biometría hemática y se valoró la necesidad de transfusión sanguínea. RESULTADOS: Se incluyó un total de 70 pacientes en el estudio. La Hb promedio postquirúrgica 11.7 mg/dl con un rango de 9.2 a 14.9 mg/dl y un Hto promedio de 37.1% con un rango de 30.2 a 44.2%. Ninguno de los pacientes requirió de transfusión de sangre alogénica. CONCLUSIONES: En este estudio se demuestra cómo el ATX es una estrategia transoperatoria para reducir la necesidad de transfusión de sangre alogénica en pacientes a quienes se realiza una ATC primaria.

Oncologic impact of micrometastases or isolated tumor cells in sentinel lymph nodes of patients with endometrial cancer: a meta-analysis.

PURPOSE: There is a gap in knowledge regarding the impact of micrometastases (MIC) and isolated tumor cells (ITCs) found in the sentinel lymph nodes of patients with endometrial cancer. Here, we present a meta-analysis of the published literature on the rate of MIC and ITCs after lymphatic mapping and determine trends in postoperative management. METHODS: Literature search of Medline and PubMed was done using the terms: micrometastases, isolated tumor cells, endometrial cancer, and sentinel lymph node. Inclusion criteria were: English-language manuscripts, retrospectives, or prospective studies published between January 1999 and June 2019. We removed manuscripts on sentinel node mapping that did not specify information on micrometastases or isolated tumor cells, non-English-language articles, no data about oncologic outcomes, and articles limited to ten cases or less. RESULTS: A total of 45 manuscripts were reviewed, and 8 studies met inclusion criteria. We found that the total number of patients with MIC/ITCs was 286 (187 and 99, respectively). The 72% of patients detected with MIC/ITCs in sentinel nodes received adjuvant therapies. The MIC/ITCs group has a higher relative risk of recurrence of 1.34 (1.07, 1.67) than the negative group, even if the adjuvant therapy was given. CONCLUSION: We noted that there is an increased relative risk of recurrence in patients with low-volume metastases, even after receiving adjuvant therapy. Whether adjuvant therapy is indicated remains a topic of debate because there are other uterine factors implicated in the prognosis. Multi-institutional tumor registries may help shed light on this important question.

Multilayer hazes over Saturn's hexagon from Cassini ISS limb images.

In June 2015, Cassini high-resolution images of Saturn's limb southwards of the planet's hexagonal wave revealed a system of at least six stacked haze layers above the upper cloud deck. Here, we characterize those haze layers and discuss their nature. Vertical thickness of layers ranged from 7 to 18 km, and they extended in altitude ∼130 km, from pressure level 0.5 bar to 0.01 bar. Above them, a thin but extended aerosol layer reached altitude ∼340 km (0.4 mbar). Radiative transfer modeling of spectral reflectivity shows that haze properties are consistent with particles of diameter 0.07-1.4 µm and number density 100-500 cm-3. The nature of the hazes is compatible with their formation by condensation of hydrocarbon ices, including acetylene and benzene at higher altitudes. Their vertical distribution could be due to upward propagating gravity waves generated by dynamical forcing by the hexagon and its associated eastward jet.

[Use of tranexamic acid in primary total knee arthroplasty]. / Uso de ácido tranexámico en la artroplastía total primaria de rodilla.

BACKGROUND: Reducing blood loss and transfusions in patients operated on primary TKR is associated with a better clinical and functional outcome. The use of Tranexamic Acid (ATX) is one of the methods used to decrease that bleeding. MATERIAL AND METHODS: Results in Hb, Hto, rate of bleeding and transfusion, surgical time and pain between groups A (with ATX) and group B (without tranexamic acid) after TKR are compared. Results: Statistically significant differences were found during surgery and perisurgical bleeding, in the decrease of Hb at 24 hours, transfusion rate, surgical time and pain to wandering in favor of group A. DISCUSSION: There are no published studies in Mexico on the use of ATX in patients operated on TKR. We consider its use to be increasingly common, the optimal dose and route of administration remains a controversial topic. CONCLUSION: The use of ATX in the proposed scheme is safe and effective in reducing the rate of bleeding and transfusions in patients operated on ATR.

INTRODUCCIÓN: La reducción de la pérdida sanguínea y de las transfusiones en pacientes operados de artroplastía total de rodilla (ATR) primaria se asocia a un mejor resultado clínico y funcional. El uso de ácido tranexámico (ATX) es uno de los métodos utilizados para disminuir ese sangrado. MATERIAL Y MÉTODOS: Se compararon los resultados en hemoglobina (Hb), hematocrito (Hto), tasa de sangrado y de transfusión, tiempo quirúrgico y dolor entre los grupos A (con ATX) y grupo B (sin ATX) posterior a la ATR. RESULTADOS: Se encontraron diferencias estadísticamente significativas en la disminución del sangrado transquirúrgico y periquirúrgico global, en la disminución de la Hb a las 24 horas, en la tasa de transfusión, en el tiempo quirúrgico y en el dolor a la deambulación a favor del grupo A. DISCUSIÓN: En México no hay literatura publicada sobre el uso de ATX en pacientes operados de ATR. A pesar del uso cada vez más común del ATX, la mejor dosis y vía de administración sigue siendo un tema controversial. CONCLUSIÓN: El uso de ATX en el esquema propuesto es un método seguro y eficaz para disminuir la tasa de sangrado y de transfusiones en los pacientes operados de ATR.

SEOM clinical guideline for treatment of cancer pain (2017).

Pain is a highly prevalent symptom in patients with cancer. Despite therapeutic advances and well-accepted treatment guidelines, a percentage of patients with pain are under-treated. Currently, it has been recognized that several barriers in pain management still exist and, in addition, there are new challenges surrounding complex subtypes of pain, such as breakthrough and neuropathic pain, requiring further reviews and recommendations. This is an update of the guide our society previously published and represents the continued commitment of SEOM to move forward and improve supportive care of cancer patients.

Intensive care admission and hospital mortality in the elderly after non-cardiac surgery.

OBJECTIVE: To assess whether patient age is independently associated to Intensive Care Unit (ICU) admission after non-cardiac surgery. DESIGN: An observational cohort study of the Spanish subset of the European Surgical Outcome Study (EuSOS) was carried out. SETTING: Hospitals of the public National Health Care System and private hospitals in Spain. INTERVENTION: None. PATIENTS AND METHODS: All patients over 16 years of age undergoing inpatient non-cardiac surgery in the participating hospitals during a 7-day period in the month of April 2011 were consecutively included. MAIN VARIABLES OF INTEREST: ICU admission rate, factors associated with ICU admission and hospital mortality were assessed using logistic regression analysis and fractional polynomial regression. RESULTS: Out of 5412 patients, 677 (12.5%) were admitted to the ICU after surgery. The adjusted odds ratio (95% confidence interval [CI]) for ICU admission was 1.1 (0.8-1.4) for patients aged 65-74 years, 0.7 (0.5-1) for patients aged 75-85 years, and 0.4 (0.2-0.8) for patients over 85 years, respectively. Age, ASA score, grade of surgery (minor, intermediate, major), urgent surgery, surgical specialty, laparoscopic surgery and metastatic disease were independent factors for ICU admission. Global risk-adjusted mortality was 1.4 (95% CI 0.9-2.2). The ASA score, urgent surgery, surgical specialty and diabetes were predictors of hospital mortality. CONCLUSIONS: Elderly patients (over 80 years) appear less likely to be admitted to ICU after non-cardiac surgery in Spanish hospitals. There was no significant association between age and postoperative mortality in this cohort.