Biocompatibility analysis and chemical characterization of Mn-doped hydroxyapatite.

The present work studies the effect of Mn doping on the crystalline structure of the Hap synthesized by the hydrothermal method at 200 °C for 24 h, from Ca(OH)2 and (NH4)2HPO4, incorporating MnCl2 to 0.1, 0.5, 1.0, 1.5 and 2.0 %wt of Mn concentrations. Samples were characterized by the X-Ray Diffraction technique, which revealed the diffraction peaks that corresponded to the hexagonal and monoclinic phase of the Hap; it was observed that the average size of crystallite decreased from 23.67 to 22.69 nm as the concentration of Mn increased. TEM shows that in all samples, there are two distributions of particle sizes; one corresponds to nanorods with several tens of nanometers in length, and the other in which the diameter and length are very close. FTIR analysis revealed absorption bands corresponding to the PO4-3 and OH- groups characteristic of the Hap. It was possible to establish a substitution mechanism between the Mn and the ions of Ca+2 of the Hap. From the Alamar blue test, a cell viability of 86.88% ± 5 corresponding to the sample of Hap at 1.5 %wt Mn was obtained, considered non-cytotoxic according to ISO 10993-5. It also evaluated and demonstrated the good osteoinductive properties of the materials, which were verified by histology and immunofluorescence expression of osteogenic markers. Adhesion, viability, biocompatibility and osteoinductive properties, make these materials candidates for future applications in bone tissue engineering with likely uses in regenerative medicine.

Design of a compact off-axis four-mirror objective system for a thermal camera.

The optical design of a compact off-axis four-mirror objective system (OFOS) of a thermal camera for a syndromic surveillance system that captures bioclinical signals, like temperature, directly related to the physical symptoms of the COVID-19 disease through thermal images is presented. The OFOS design works on wavelengths of 7.5-14 µm, with an f-number of 4, and a field of view (FOV) of 24×4 deg.

Real-world effectiveness and safety of dapagliflozin therapy added to a GLP1 receptor agonist in patients with type 2 diabetes.

BACKGROUND AND AIM: To evaluate the effectiveness and safety of a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, dapagliflozin, in patients with type 2 diabetes mellitus (T2DM) and background glucagon-like peptide-1 receptor agonist (GLP1-RA) therapy. METHODS AND RESULTS: This is a 12-month, real-world observational study, which assessed the effectiveness and safety of dapagliflozin in patients with T2DM and background GLP1-RA therapy. The main outcome measures were changes in A1C and weight at 6 and 12 months from baseline. Secondary outcomes were differences in A1C and weight reduction between this cohort and another group of patients with T2DM treated with dapagliflozin but without background GLP1-RA therapy. In total, 109 patients with GLP1-RA and 104 patients without GLP1-RA were included. Baseline mean A1C and weight in the GLP1-RA and non-GLP1-RA groups were 7.4% vs. 7.3% and 96.2 kg vs. 95.1 kg, respectively. A significant reduction in A1C was seen with dapagliflozin in both cohorts at 6 and 12 months (GLP1-RA: -0.51% and -0.34%, non-GLP1-RA: -0.69% and -0.62%, respectively, p < 0.0001 in all analyses). Weight was significantly reduced in both groups at 6 and 12 months (GLP1-RA: -2.3 kg and -2.4 kg, non-GLP1-RA: -3.9 kg and -4.8 kg, respectively, p < 0.0001 in all analyses). A1C reduction and weight loss were significantly lower in patients with GLP1-RA than in patients without GLP1-RAs. Drug discontinuation rates were similar in both cohorts. CONCLUSIONS: Dapagliflozin, when added in real life to patients with T2DM treated with GLP1-RAs, induced a further significant, albeit modest improvement in A1C and a further weight loss.

Retrospective multicentre observational study on clinical management and treatment of different types of status epilepticus in clinical practice. / Estudio observacional multicéntrico retrospectivo sobre el manejo clínico y terapéutico de los diferentes tipos de estatus epiléptico en la práctica clínica.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency associated with significant mortality and morbidity. We analyse characteristics of this entity in our population. METHODS: Data from electronic medical records of adults diagnosed with SE were collected retrospectively from 5 hospitals over 4 years. RESULTS: Data reflected 84 episodes of SE in 77 patients with a mean age of 60.3 years. Of this sample, 52.4% had a previous history of epilepsy. Status classification: 47.6% tonic-clonic, 21.4% complex partial, 17.9% partial motor, 6% partial simple, 3.6% myoclonic, and 3.6% subtle SE. Based on the duration of the episode, SE was defined in this study as early stage (up to 30min) in 13.1%, established (30-120min) in 20.2%, refractory (more than 120min) in 41.7%, and super-refractory (episodes continuing or recurring after more than 24h of anaesthesia) in 13.1%. Ten patients (11.9%) died when treatment failed to control SE. The cumulative percentage of success achieved was 8.3% with the first treatment, 27.3% for the second, 48.7% for the third, 58.2% for the fourth, 70.1% for the fifth, 80.8% for the sixth, 83.2% for the seventh, and 84.4% for the eighth. CONCLUSIONS: In our study, we found that SE did not respond to treatment within 2h in approximately half the cases and 11.9% of the patients died without achieving seizure control, regardless of the type of status. Half the patients responded by the third treatment but some patients needed as many as 8 treatments to resolve seizures. Using large registers permitting analysis of the different types and stages of SE is warranted.

Central nervous system prophylaxis with intrathecal liposomal cytarabine in a subset of high-risk patients with diffuse large B-cell lymphoma receiving first line systemic therapy in a prospective trial.

The dissemination in the central nervous system (CNS) is an uncommon but fatal complication occurring in patients with diffuse large B-cell lymphoma (DLBCL). Standard prophylaxis has been demonstrated to reduce CNS relapse and improve survival rates. Intrathecal (IT) liposomal cytarabine allows maintaining elevated drug levels in the cerebrospinal fluid for an extended period of time. Data on the efficacy and safety of liposomal cytarabine as CNS prophylaxis in patients with DLBCL are still insufficient. The objective of the present study was to evaluate the effectiveness and safety of the prophylaxis with IT liposomal cytarabine in prevention of CNS relapse in high-risk patients with DLBCL who were included in a trial of first line systemic therapy with 6 cycles of dose-dense R-CHOP every 14 days. Twenty-four (18.6 %) out of 129 patients were identified to have risk factors for CNS involvement, defined as follows: >30 % bone marrow infiltration, testes infiltration, retroperitoneal mass ≥10 cm, Waldeyer ring, or bulky cervical nodes involvement. Liposomal cytarabine (50 mg) was administered by lumbar puncture the first day of the 1st, 2nd, and 6th cycle of R-CHOP14 scheme. Among 70 IT infusions, grade 3-4 adverse events reported were headache (one patient) and nausea/vomiting (one patient). With a median follow-up of 40.1 months, no CNS involvement by DLBCL was observed in any patient. In conclusion, IT liposomal cytarabine is safe, feasible, and effective for CNS prophylaxis, causing few associated risks and little discomfort to patients with DLBCL.

[Decorative elements in the medical imaging area improve patients' perception of pleasantness]. / Los elementos decorativos ambientales en el Área de Imagen Médica mejoran la percepción de agradabilidad del paciente.

OBJECTIVES: To evaluate the sensation of pleasantness perceived by patients attended in the radiology department in response to decorative elements hung on the walls in the waiting rooms and in the hallways of the imaging area. MATERIAL AND METHODS: The material resources comprised works of art in the form of "magic windows" representing scenes from nature installed on the ceilings and walls of the waiting area and hallways of the imaging area. Patients were given a brief questionnaire with general data and questions (sadness-cheerfulness, coldness-warmth, darkness-light, and pessimism-optimism) about their perception of the decorative elements. RESULTS: Of the 150 questionnaires collected, 142 were filled out correctly. The overall health of these patients was good in 84 (56%), not bad in 58 (39%), and poor in 8 (5%). The idea seemed very good to 70 patients (47%), good to 58 (39%), not bad to 8 (5%), indifferent to 11 (7%), bad to 1 (1%), and very bad to 2 (1%). As far a patients' mobility, 119 patients (79%) walked into the department, 18 (12%) were wheeled in on beds, and 13 (9%) needed wheelchairs. CONCLUSIONS: We found a high level of satisfaction with the decorative elements.

[Choice of Family and Community Medicine in the MIR 2002-2023: An objective approach shows that it is as highly valued as hospital specialties]. / Elección de Medicina Familiar y Comunitaria en el MIR 2002-2023: un enfoque objetivo muestra que es una especialidad tan valorada como las hospitalarias.

INTRODUCTION: Currently there is a shortage of general practitioners (GP), and this is expected to increase in the coming years. Despite this need, it is a specialty that is supposedly little demanded, leaving specialized training places unfilled in recent years. The purpose of this study is to present new parameters to more objectively measure the demand and the relationship between supply and demand. METHODS: A database was used with the results of the places assigned in the MIR calls from 2002 to 2023. The calculated parameters were quoting index (CI), quote order, the order of top demand and the order of total demand of the GP specialty. The software R version 4.3.02 was used for statistical analysis. RESULTS: The specialty quotation and top demand have remained constant during the study period, while there has been a slight and progressive worsening of the total demand. Nevertheless, the total demand for Family Medicine in the last call for MIR exam was higher than that for specialties such as urology, neurology, ENT, endocrinology, oncology, intensive care medicine or neurosurgery, among others. CONCLUSIONS: In contrast to the subjective perception of the worsening attractiveness Family Medicine in the last MIR calls, using objective parameters, we found that the attractiveness of the specialty, measured as quotation (supply/demand ratio) and demand, has remained stable (with a slight worsening of total demand).

Imaging dynamical chiral-symmetry breaking: pion wave function on the light front.

We project onto the light front the pion's Poincaré-covariant Bethe-Salpeter wave function obtained using two different approximations to the kernels of quantum chromodynamics' Dyson-Schwinger equations. At an hadronic scale, both computed results are concave and significantly broader than the asymptotic distribution amplitude, φ(π)(asy)(x)=6x(1-x); e.g., the integral of φ(π)(x)/φ(π)(asy)(x) is 1.8 using the simplest kernel and 1.5 with the more sophisticated kernel. Independent of the kernels, the emergent phenomenon of dynamical chiral-symmetry breaking is responsible for hardening the amplitude.

Phylogenetic signal, feeding behaviour and brain volume in Neotropical bats.

Comparative correlational studies of brain size and ecological traits (e.g. feeding habits and habitat complexity) have increased our knowledge about the selective pressures on brain evolution. Studies conducted in bats as a model system assume that shared evolutionary history has a maximum effect on the traits. However, this effect has not been quantified. In addition, the effect of levels of diet specialization on brain size remains unclear. We examined the role of diet on the evolution of brain size in Mormoopidae and Phyllostomidae using two comparative methods. Body mass explained 89% of the variance in brain volume. The effect of feeding behaviour (either characterized as feeding habits, as levels of specialization on a type of item or as handling behaviour) on brain volume was also significant albeit not consistent after controlling for body mass and the strength of the phylogenetic signal (λ). Although the strength of the phylogenetic signal of brain volume and body mass was high when tested individually, λ values in phylogenetic generalized least squares models were significantly different from 1. This suggests that phylogenetic independent contrasts models are not always the best approach for the study of ecological correlates of brain size in New World bats.

[Study of incidence of COVID-19 in Spain and its relationship to geographical province distribution]. / Estudio de la incidencia de COVID-19 en España y su relación geográfica provincial.

BACKGROUND: The aim of this study was to determine incidence of COVID-19 in relationship to geographical distribution among Spain. METHOD: Cluster analysis taking into consideration the incidence of COVID-19 in the provinces and autonomous cities of Spain in each of the first six waves of the pandemic. RESULTS: All the provinces of the Canary Islands, Catalonia and Andalusia form independent clusters. In Comunidad Valenciana, Galicia, País Vasco and Aragón two out of three provinces (three out of four in Galicia) were in the same cluster, with no other provinces. DISCUSSION: The incidence of COVID-19 in Spain in the first six waves forms clusters that reproduce the territorial division of Spain into autonomous communities. Although this could be explained by greater mobility within a community, it cannot be ruled out that this distribution is due to differences in screening, diagnosis, registration or reporting of COVID-19 cases.

Spoof four-wave mixing for all-optical wavelength conversion.

We present for the first time an all-optical wavelength conversion (AOWC) scheme supporting modulation format independency without requiring phase matching. The new scheme is named "spoof" four wave mixing (SFWM) and in contrast to the well-known FWM theory, where the induced dynamic refractive index grating modulates photons to create a wave at a new frequency, the SFWM is different in that the dynamic refractive index grating is generated in a nonlinear Bragg Grating (BG) to excite additional reflective peaks at either side of the original BG bandgap in reflection spectrum. This fundamental difference enable the SFWM to avoid the intrinsic shortcoming of stringent phase matching required in the conventional FWM, and allows AOWC with modulation format transparency and ultrabroad conversion range, which may have great potential applications for next generation of all-optical networks.

Are there differences between ceftolozane/tazobactam and ceftazidime/avibactam in treating patients with complicated abdominal infections? Evidence from clinical trials.

Ceftolozane/tazobactam (C/T) and ceftazidime/avibactam (CZA) are new possibilities of antimicrobial treatment that combined a ß-lactam with a ß-lactamase inhibitor. The United States (US) and European regulatory agencies approved their clinical use in adults with complicated intra-abdominal infections. This study aims to know if one of the two antibiotics obtain better efficacy in adults with complicated intra-abdominal infections and by specific pathogens such as P. aeruginosa or E. coli. A search of all trials in MEDLINE, Scopus, and Web of Science comparing a C/T or CZA based antimicrobial regimen with other treatments in patients with intraabdominal infections until August 2021 was performed. To make indirect comparisons, we used a frequentist approach using the R package netmeta.The effects have been expressed through the relative risk (RR) with its confidence interval. Considering the clinical cure and failure rates between the different trial populations (mMITT, CE, ME) and the mortality at the end of the study, we have not found significant differences between CZA and C/T. In the case of Pseudomonas, the RR of treatment failure between these two antibiotics is 1 (95% CI 0.55-1.18). In the case of E. Coli, although it seems that CZA would have a worse result than C/T, differences did not reach statistical significance (RR1.06; 95% CI 0.9-1.14). In conclusion, we have not found statistically significant differences between ceftolozane-tazobactam and ceftazidime-avibactam in treating cIAI. In regards to E. Coli, our results do not reach significance, but it would be possible that C/T and meropenem had better results than CZA. Perhaps new trials would allow a better profile of the role in different types of patients or infections caused by specific microorganisms in the future.

Urticaria due to antihistamines.

H1-antihistamines are probably the most frequently used drugs in allergic diseases, with widely established efficacy, tolerance, and safety. We report a patient with urticaria due to ingestion of ebastine and fexofenadine. Skin prick tests, patch tests, and basophil activation tests with the implicated drugs and antihistamines from other families were negative. The oral challenges with the implicated antihistamines and other antihistamines tested were positive, but the patient tolerated an oral challenge with cetirizine. We present a patient with urticaria induced by different antihistamines in whom the diagnosis was established by oral challenge. The mechanism of sensitization remains unclear.

Potential hypersensitivity due to the food or food additive content of medicinal products in Spain.

The Drug Allergy Committee of the Spanish Society of Allergology and Clinical Immunology reviewed the allergenic potential of several substances of food origin that are found in the composition of some drugs. Despite recent legislation on labeling, many labels do not clearly state whether the drug contains raw material (active ingredients, excipient, or other manufacturing intermediate) with an origin in any of the substances in the list of the 14 groups of food allergens that are subject to mandatory declaration. The objective of legislation is that the drug package, the Summary of Product Characteristics, and the patient information leaflet clearly state the food content in order to improve the safety of allergic patients. Therefore, any food or allergen derivative that must be declared should be clearly stated on the drug label. Of all the evaluated products, egg and milk derivatives are the most frequently discussed in literature reviews. The natural or synthetic origin of potentially allergenic substances such as lysozyme, casein, lactose, albumin, phosphatide, and aromatic essences should be clearly stated. Providing this information has 2 clear advantages. First, allergic reactions to drugs in patients with food allergy could be avoided (if the substances have a natural origin). Second, prescription would improve by not restricting drugs containing synthetic substances (which do not usually induce allergic reactions).

[Scientific and research activity and degree of satisfaction of residents of Orthopedic Surgery and Traumatology in different hospitals of the health network in Spain]. / Actividad científica e investigadora y grado de satisfacción de residentes de Cirugía Ortopédica y Traumatología en diferentes hospitales de la red sanitaria en España.

INTRODUCTION: Healthcare pressure has changed the acquisition of knowledge during residency training. The aim of this study was to analyze the clinical and research training, and level of satisfaction, during orthopedic and traumatology residency in different hospitals of the Spanish National Health Service. MATERIAL AND METHODS: An online survey was distributed between 06/25/2020 and 07/31/2020. Demographic, institution, clinical and research variables were analyzed. Satisfaction was graded in a scale from 0 to 5. RESULTS: 120 residents answered the survey, having a mean age of 27 years and being 58% male. Distribution of residents by year was 26 R5 (21.7%), 24 R4 (20.0%), 45 R3 (37.5%), 25 R2 (20.9%). Only 37.5% answered that they did not have any clinical activity the next day after medical guard, and 45% answered that they performed clinical activity outside of working hours. A total of 56.7% answered that their orthopedic training program did not include research training. No resident had specific time assigned to research activities. Mean satisfaction value was 2.4 points. CONCLUSIONS: Clinical activity shows aspects incompatible with current legislation. Orthopedic programs need improvements with regard to research training. A significant percentage of residents are unsatisfied with their training.

INTRODUCCIÓN: La presión asistencial ha provocado un desequilibrio hacia la vertiente clínica con respecto a la científica. El propósito del trabajo fue analizar la actividad asistencial e investigadora y el grado de satisfacción en los residentes de cirugía ortopédica y traumatología, en diferentes hospitales de la red sanitaria en España. MATERIAL Y MÉTODOS: Encuesta de ámbito estatal realizada en el período del 25/06/2020 al 31/07/2020. Se analizaron variables demográficas y del servicio, de labores asistencial e investigadora. Se determinó la satisfacción del residente en escala continua de cero a 5. RESULTADOS: 120 médicos haciendo residencia respondieron a la encuesta, rondando una edad media de 27 años y predominio de varones en 58%. La distribución por año de dichos residentes fue de 26 R5 (21.7%), 24 R4 (20.0%), 45 R3 (37.5%), 25 R2 (20.9%). Sólo 37.5% indicaron carecer de labor de tipo asistencial asignada el día siguiente de la guardia y 45% respondieron que realizaban algún papel asistencial fuera del horario laboral del hospital. De esos interrogados, 56.7% contestaron que su plan individual de formación no contemplaba la praxis científica ajustada a su año de residencia como un objetivo a cumplir. Ninguno de ellos tenía tiempo asignado con periodicidad semanal para acciones de investigación. El valor medio del nivel de satisfacción de estos médicos fue de 2.4 puntos. CONCLUSIONES: La actividad asistencial presenta aspectos incompatibles con la legislación actual. Los planes individuales de adiestramiento precisan mejoras con respecto a la ocupación investigadora. Un porcentaje no despreciable de estos estudiantes de posgrado no estaban satisfechos con su plan personal de especialización.

Towards automated extraction of 2D standard fetal head planes from 3D ultrasound acquisitions: A clinical evaluation and quality assessment comparison.

INTRODUCTION: Clinical evaluation of deep learning (DL) tools is essential to compliment technical accuracy metrics. This study assessed the image quality of standard fetal head planes automatically-extracted from three-dimensional (3D) ultrasound fetal head volumes using a customised DL-algorithm. METHODS: Two observers retrospectively reviewed standard fetal head planes against pre-defined image quality criteria. Forty-eight images (29 transventricular, 19 transcerebellar) were selected from 91 transabdominal fetal scans (mean gestational age = 26 completed weeks, range = 20+5-32+3 weeks). Each had two-dimensional (2D) manually-acquired (2D-MA), 3D operator-selected (3D-OS) and 3D-DL automatically-acquired (3D-DL) images. The proportion of adequate images from each plane and modality, and the number of inadequate images per plane was compared for each method. Inter and intra-observer agreement of overall image quality was calculated. RESULTS: Sixty-seven percent of 3D-OS and 3D-DL transventricular planes were adequate quality. Forty-five percent of 3D-OS and 55% of 3D-DL transcerebellar planes were adequate. Seventy-one percent of 3D-OS and 86% of 3D-DL transventricular planes failed with poor visualisation of intra-cranial structures. Eighty-six percent of 3D-OS and 80% of 3D-DL transcerebellar planes failed due to inadequate visualisation of cerebellar hemispheres. Image quality was significantly different between 2D and 3D, however, no significant difference between 3D-modalities was demonstrated (p < 0.005). Inter-observer agreement of transventricular plane adequacy was moderate for both 3D-modalities, and weak for transcerebellar planes. CONCLUSION: The 3D-DL algorithm can automatically extract standard fetal head planes from 3D-head volumes of comparable quality to operator-selected planes. Image quality in 3D is inferior to corresponding 2D planes, likely due to limitations with 3D-technology and acquisition technique. IMPLICATIONS FOR PRACTICE: Automated image extraction of standard planes from US-volumes could facilitate use of 3DUS in clinical practice, however image quality is dependent on the volume acquisition technique.

Class II DRB polymorphism and sequence diversity in two vesper bats in the genus Myotis.

Almost no studies have been done with respect to major histocompatibility complex (MHC) polymorphism and sequence diversity in bats, although they account for one in five living mammalian species. We analysed MHC Class II DRB polymorphism and sequence diversity in two Mexican verpertilionid bat species, the widespread continental species Myotis velifer and the narrowly distributed (and endangered) island endemic Myotis vivesi. We find extensive DRB polymorphism in the widespread M. velifer, similar to that commonly reported in other mammals. The geographically restricted M. vivesi by contrast shows only very limited polymorphism. We conclude that M. vivesi has undergone a dramatic loss of MHC polymorphism. The significance of this inference in light of other information on population structure and genetic diversity in this species is discussed.

Reaction strategies for the enzymatic synthesis of neopentyl glycol diheptanoate.

This work describes for the first time the green synthesis of neopentyl glycol diheptanoate in a solvent-free medium via an enzymatic pathway. The process has been carried out in an open-air reactor in order to ease water removal through evaporation and shift the chemical equilibrium towards product formation. The inhibiting effect of high concentrations of heptanoic acid has been put into evidence by a reduction of initial reaction rate when esterification was performed with stoichiometric amounts of substrates. Therefore, in this work different strategies for the stepwise addition of heptanoic acid are proposed, and best results were obtained when stoichiometric quantities of acid were divided in four equal amounts and added when previous batch was consumed. Biocatalyst Novozym® 435 concentration and temperature were optimised, giving yields of 90% in neopentyl glycol diheptanoate when 7.5% (w/w) and 70 °C were used. With a remaining 7% of heptanoic acid (probably caused by the alcohol evaporation) the addition of neopentyl glycol led to a conversion of 95%. Thus, product can be used in cosmetics without further purification and can be labelled as environmentally-friendly synthesized because of its enzymatic origin.