Genetic Variants Associated with Biological Treatment Response in Inflammatory Bowel Disease: A Systematic Review.

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the digestive tract usually characterized by diarrhea, rectal bleeding, and abdominal pain. IBD includes Crohn's disease and ulcerative colitis as the main entities. IBD is a debilitating condition that can lead to life-threatening complications, involving possible malignancy and surgery. The available therapies aim to achieve long-term remission and prevent disease progression. Biologics are bioengineered therapeutic drugs that mainly target proteins. Although they have revolutionized the treatment of IBD, their potential therapeutic benefits are limited due to large interindividual variability in clinical response in terms of efficacy and toxicity, resulting in high rates of long-term therapeutic failure. It is therefore important to find biomarkers that provide tailor-made treatment strategies that allow for patient stratification to maximize treatment benefits and minimize adverse events. Pharmacogenetics has the potential to optimize biologics selection in IBD by identifying genetic variants, specifically single nucleotide polymorphisms (SNPs), which are the underlying factors associated with an individual's drug response. This review analyzes the current knowledge of genetic variants associated with biological agent response (infliximab, adalimumab, ustekinumab, and vedolizumab) in IBD. An online literature search in various databases was conducted. After applying the inclusion and exclusion criteria, 28 reports from the 1685 results were employed for the review. The most significant SNPs potentially useful as predictive biomarkers of treatment response are linked to immunity, cytokine production, and immunorecognition.

Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England.

INTRODUCTION: The clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database. METHODS: CPRD data were linked to National Health Service Hospital Episode Statistics data. Patients with a diagnosis of clavicle fracture between 2010-2018 were selected in CPRD (date of fracture = index date). Of those, patients with surgical intervention within 180 days from index fracture were identified. Rates of post-surgical complications (i.e., infection, non-union, and mal-union), reoperations (for device removal or for postoperative complications), post-operative costs and median time to reoperations were evaluated up to 2 years after surgery. RESULTS: 21,340 patients with clavicle fractures were identified (mean age 35.0 years(standard deviation (SD): 26.5), 66.7% male). Surgery was performed on 672 patients (3.2% of total cohort) at an average 17.1 (SD: 25.2) days post-fracture. Complications (i.e., infection, non-union, or malunion) affected 8.1% of surgically treated clavicle fracture patients; the rate of infection was 3.5% (95% CI, 1.7%- 5.2%), non-union 4.4% (95% CI, 2.4%-6.5%), and mal-union 0.3% (95% CI, 0%-0.7%). Adjusting for age, gender, comorbidities and time to surgery, the all-cause reoperation rate was 20.2% (13.2%-30.0%) and the adjusted rate of reoperation for implant removal was 17.0% (10.7%-25.9%)-84% of all-cause reoperations were thus performed for implant removal. Median time to implant removal was 254 days. The mean cost of reoperations for all causes was £5,000. The most expensive reoperations were for cases that involved infection (mean £6,156). CONCLUSIONS: Complication rates following surgical clavicle fracture care averaged 8.1%. However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. Technologies to alleviate secondary device removal surgeries would address a significant clinical unmet need.

Influence of Mediterranean climate and lunar calendar on milk production in Lacaune breed ewes.

Environmental factors affect daily milk production in dairy animals. The aim of this study was to quantify the effects of environmental factors, specifically mean temperature (°C), relative humidity (%), temperature-humidity index (THI), solar radiation (°), pluvial precipitation (mm) and lunar calendar (full moon, waxing quarter, waning quarter, new moon), on milk production (kg/d). The analysis was based on 96,195 morning and evening milking records documented on 109 consecutive days, from 869 Lacaune ewes. Ewes were housed in groups of 174 individuals. The analysis was performed in two independent procedures, a Pearson correlation analysis and a multivariate analysis of the ewe's interrelationships, which was based on the total variance estimate and a Varimax-rotated factorial analysis. Milk yield (kg/d) was significantly (p < 0.05) negatively correlated with mean temperature (-0.24), relative humidity (-0.16), THI (-0.24), and radiation (-0.18), which suggests that the higher these environmental factors, the lower the milk yield. Lunar calendar had a significant (p < 0.01) effect on milk production yield; specifically, yields were higher on the full moon and new moon (2.25 ± 0.05 kg/day) than they were on the crescent or waning moon (2.17 ± 0.05 kg/day). In conclusion, ewes that had been exposed to higher mean temperature, relative humidity, THI and solar radiation had the lowest milk yield, and milk yields are highest on full and new moons. The results of this work may be helpful in making predictions for milk production in Lacaune ewes in the Mediterranean region throughout the year.

Substance use, mental health and dual disorders on pregnancy: Results of prevalence and treatment rates in a developed country. / Salud mental, abuso de sustancias y trastornos duales en el embarazo: Tasas de prevalencia y tratamiento en un país desarrollado.

Smoking and substance use during pregnancy are major preventable causes of mortality and morbidity, having a bidirectional and deleterious relationship with the mental health of the mother and child. As part of the WOMAP (Woman Mental Health and Addictions on Pregnancy) initiative, our study aimed to describe the prevalence of co-occurring mental illness and substance use problems, diagnoses and severity of those considered at risk and rates of treatment.A screening of 2,014 pregnant women was done using the AC-OK scale and they were asked about their smoking habits and services use for mental health/substance abuse. Of these, 170 women were considered at risk of co-occurring mental illness and substance use problems (≥ 2 positive responses to the AC-OK-Mental Health subscale, ≥ 1 positive response to the AC-OK-Substance Abuse subscale and/or smoking more than once a month and no use of specialized services) and were assessed with a more extensive battery of measures (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Posttraumatic stress disorder [PTSD] Checklist for DSM-5 [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] and Fagerström).In the last year, 614 women (30.5%) smoked tobacco (42.5% daily) and 9.8% were positive for both substance use and mental illness per the AC-OK. Only 11.1% of them received specific treatment in the previous three months while another 13.6% were scheduled to attend services in the following month. From the subsample assessed in depth, 62(36.5%) endorsed at least moderate depression, 35(20.6%) endorsed at least moderate anxiety, 32(18.8%) endorsed PTSD on the PCL, and 37 out of 88 alcohol users scored above the threshold in AUDIT (≥ 3). In conclusion, high prevalence and low treatment rates suggest that effective detection mechanisms should be integrated into usual care, allowing for early interventions.

El tabaquismo y el consumo de sustancias durante el embarazo son importantes causas prevenibles de morbimortalidad, teniendo una relación bidireccional y deletérea con la salud mental de la madre y el niño. Como parte de la iniciativa WOMAP (Woman Mental Health and Addictions on Pregnancy), se estudiaron 2.014 embarazadas buscando describir la prevalencia de trastornos mentales y por uso de sustancias concurrentes, las tasas de tratamiento y los diagnósticos y la gravedad. Las participantes fueron evaluadas con la escala AC-OK y se les preguntó sobre sus hábitos tabáquicos y uso de servicios de salud mental/sustancias. De las participantes, 170 mujeres resultaron positivas para un trastorno mental y por uso de sustancias concurrentes (≥ 2 positivos a la subescala AC-OK-Salud Mental, ≥ 1 positivos a la subescala AC-OK-Sustancias y/o fumar más de una vez al mes y no estar en tratamiento) y fueron evaluadas en profundidad mediante una batería de escalas (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Post-traumatic stress disorder Checklist [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] y Fagerström).En el último año, 614 mujeres (30,5%) fumaron tabaco (42,5% diariamente) y el 9,8% fueron positivas para problemas por uso de sustancias y salud mental según la AC-OK. Solo el 11,1% había recibido tratamiento en los tres meses previos y solo un 13,6% tenía una cita en el siguiente mes. De las 170 pacientes evaluadas secundariamente, 62(36,5%) presentaron al menos depresión moderada, 35(20,6%) al menos ansiedad moderada, 32(18,8%) fueron positivas a la PCL-5, y 37 de las 88 que reconocieron uso de alcohol puntuaron por encima del umbral en AUDIT (≥ 3). En conclusión, la combinación de una prevalencia significativa junto con bajas tasas de tratamiento, remarcan la necesidad de mecanismos de detección efectivos en la atención habitual, permitiendo una intervención temprana.

The Role of Three-Dimensional Endoanal Ultrasound on Diagnosis and Classification of Sphincter Defects After Childbirth.

BACKGROUND: Diagnostic tests for fecal incontinence have been improved over time. This study aims to evaluate the role of Three-dimensional endoanal ultrasound (3D-EUS) and the Starck's score in the assessment and treatment of obstetric sphincter injuries. METHODS: A prospective observational study was performed including primiparous women who were evaluated at 20 wk of pregnancy and 3 mo after childbirth. Sphincter defects were classified according to the Starck's and Obstetrical Anal Sphincter Injuries classifications. Patients also completed the Fecal Incontinence Quality of Life and the Wexner questionnaires before and after childbirth. RESULTS: Sphincter defects were detected in 45% of the 56 women included, although 85% had an uneventful delivery. Most defects were found isolated to the external anal sphincter except for two cases, classified by a Starck's score >8. Fecal Incontinence Quality of Life and Wexner questionnaires showed a rate of symptomatic patients of around 46%. We observed that 30% of patients with sphincter injuries remained asymptomatic. CONCLUSIONS: The 3D-EUS is a useful test in assessing sphincter defects after childbirth. This method makes it possible to detect small sphincter defects that otherwise would have gone unnoticed, as 30% of patients with sphincter injuries were asymptomatic. In addition, both the 3D-EUS and the Starck's score were valuable in establishing an algorithm for the treatment of obstetric sphincter injuries.

Quality of life and 3D-EUS assessment for anal incontinence after childbirth.

BACKGROUND: the incidence of obstetric sphincter tears has risen to 15-30% and the prevalence of anal incontinence (AI) symptoms after childbirth may be as high as 40%. The present study evaluates the correlation between obstetric injuries detected by endoanal ultrasound (3D-EUS) and AI symptoms, as well as their impact on the quality of life (QOL) of women after childbirth. METHODS: a prospective observational study was performed of pregnant women evaluated before (baseline) and three months after childbirth to ensure the integrity of the anal sphincters and to evaluate possible injuries. The Fecal Incontinence Quality of Life (FIQL) questionnaire and the Cleveland Clinic Score of Incontinence (Wexner) were completed before and after childbirth. The questionnaire results were correlated with an assessment of sphincter defects performed by 3D-EUS. RESULTS: a total of 56 females were included in the study. Overall, 48% developed symptoms of AI after childbirth, with a significant decrease in their FIQL compared to the initial evaluation, 3.9 (0.05) vs 3.4 (0.8), respectively (p = 0.000). In addition, 42% of the cohort presented with some kind of obstetric sphincter defect on the 3D-EUS. Instrumental assisted delivery and the sphincter defects were the only two significant factors identified via multivariate analysis that were associated with a decrease in QOL (0.4, 95% CI, 0.07-0.8). CONCLUSIONS: AI after childbirth was associated with a huge impact on QOL, especially in patients with sphincter injuries. A complete clinical evaluation, including 3D-EUS, is recommended to prevent, manage or treat AI in primiparous females.

Carcass traits and meat quality assessment of two slow-growing chicks strains fed Acheta domesticus larval meal.

Presently, there has been a noticeable rise in the consumption of poultry meat within the general population, particularly focusing on poultry sourced from alternative rearing systems as opposed to intensive ones. This study evaluated the impact of incorporating house cricket (Acheta domesticus,AD) larvae meal into the diet of 2 slow-growing chicken strains on their carcass traits and meat quality. A total of 256 one-day-old male chicks were utilized, with 128 belonging to the Red (R) strain and 128 to the Naked Neck (NN) strain. Chicks from each strain were randomly assigned to 16 replicates of 8 chicks each. Eight replicates were allocated to 2 distinct treatments (n=64 chicks/treatment) based on the diet employed: the control treatments for the Red (R-C) and Naked Neck (NN-C) strains were fed soybean meal, while the other 2 treatments were fed AD meal (R-AD and NN-AD). Three different rations were used throughout the growth cycle of the animals, tailored to meet the nutritional needs of the birds. All chickens were slaughtered at 95 d of age, and eight chickens per treatment were randomly chosen to assess carcass traits and meat quality. Near-infrared reflectance spectroscopy (NIRS) was employed to classify meat based on the feed and the chick strain, achieving a correct discrimination of 100% of the samples. The carcass traits exhibited significant alterations due to the inclusion of insect larval meal in the diet, resulting in reduced values across all parameters for chickens consuming AD meal, irrespective of genotype. The pH and cooking losses were generally higher for chicks fed cricket meal, as occurred with moisture. However, protein content was lower in the meat of chicks consuming cricket meal. Fat content showed lower values for NN chickens. There were minimal differences in the fatty acid profile, with lower C18:3n-3 values for chickens fed cricket meal. Therefore, including Acheta domesticus meal in the diets of slow-growing chick strains is a viable alternative to replace soybean meal. It provides meat quality characteristics comparable to those obtained in conventional systems.

Analyzing the spatiotemporal habitat colonization dynamics of the common vole (Microtus arvalis Pallas) in Castilla y León, northwest Spain, using a hotspot-based approach†.

BACKGROUND: The common vole is an agricultural pest and population outbreaks have caused significant crop damage in the agricultural areas of the west-central part of the Iberian Peninsula (Spain) during the last few decades. Thus, monitoring is imperative to gain a comprehensive insight on its spatiotemporal habitat colonization dynamics. This work was performed on a long-term database with the primary objective of establishing an operational framework for understanding the spatial and temporal distribution of the common vole, all of it based on the Getis-Ord statistics. RESULTS: The temporal evolution of the vole abundance index (VAI) was consistent for the three studied habitats, that is, crops, reservoirs and paths. Furthermore, the majority of common vole abundance peaks coincide with summer periods, especially in annual herbaceous crops. The spatial distribution of vole abundance exhibited a non-random pattern, characterized by spatial clustering. Particularly, the areas with higher significance of this clustering were located at the so-called 'Tierra de Campos' county, covering northern Valladolid, southern Palencia and north-eastern Zamora provinces. Periods of major incidence and concentration were 2013-2014, 2016-2017 and 2019. Common vole temporal occupancy patterns demonstrate that colonization occurred simultaneously in alfalfa reservoirs and dispersion paths, both preceding settlement in annual herbaceous crop plots. CONCLUSION: The geographic information system (GIS)-hotspots-based methodology proposed here can be valuable for stakeholders involved in integrated management of the common vole, serving as a detector of pest-prone areas in both space and time. These hotspots are useful for predicting future surveillance areas that accurately reflect pest colonization patterns. It was found that common vole abundance along dispersal paths acts as a source of dissemination, preceding the risk of colonization in annual herbaceous crop plots. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Nail fixation of unstable trochanteric fractures with or without cement augmentation: A cost-utility analysis in the United States: Cost-utility of cement augmentation.

OBJECTIVES: Recent clinical studies have shown favorable outcomes for cement augmentation for fixation of trochanteric fracture. We assessed the cost-utility of cement augmentation for fixation of closed unstable trochanteric fractures from the US payer's perspective. METHODS: The cost-utility model comprised a decision tree to simulate clinical events over 1 year after the index fixation surgery, and a Markov model to extrapolate clinical events over patients' lifetime, using a cohort of 1,000 patients with demographic and clinical characteristics similar to that of a published randomized controlled trial (age ≥75 years, 83 % female). Model outputs were discounted costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) over a lifetime. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainty on results. RESULTS: Fixation with augmentation reduced per-patient costs by $754.8 and had similar per-patient QALYs, compared to fixation without augmentation, resulting in an ICER of -$130,765/QALY. The ICER was most sensitive to the utility of revision surgery, mortality risk ratio after the second revision surgery, mortality risk ratio after successful index surgery, and mortality rate in the decision tree model. The probability that fixation with augmentation was cost-effective compared with no augmentation was 63.4 %, 58.2 %, and 56.4 %, given a maximum acceptable ceiling ratio of $50,000, $100,000, and $150,000 per QALY gained, respectively. CONCLUSION: Fixation with cement augmentation was the dominant strategy, driven mainly by reduced costs. These results may support surgeons in evidence-based clinical decision making and may be informative for policy makers regarding coverage and reimbursement.

Exploring the influence of density-dependence and weather on the spatial and temporal variation in common vole (Microtus arvalis) abundance in Castilla y León, NW Spain.

BACKGROUND: The common vole has invaded the agroecosystems of northwestern Spain, where outbreaks cause important crop damage and management costs. Little is yet known about the factors causing or modulating vole fluctuations. Here, we used 11 years of vole abundance monitoring data in 40 sites to study density-dependence and weather influence on vole dynamics. Our objective was to identify the population dynamics structure and determine whether there is direct or delayed density-dependence. An evaluation of climatic variables followed, to determine whether they influenced vole population peaks. RESULTS: First- and second-order outbreak dynamics were detected at 7 and 33 study sites, respectively, together with second-order variability in periodicity (2-3 to 4-5-year cycles). Vole population growth was explained by previous year abundance (mainly numbers in summer and spring) at 21 of the sites (52.5%), by weather variables at 11 sites (27.5%; precipitation or temperature in six and five sites, respectively), and by a combination of previous abundance and weather variables in eight sites (20%). CONCLUSIONS: We detected variability in vole spatiotemporal abundance dynamics, which differs in cyclicity and period. We also found regional variation in the relative importance of previous abundances and weather as factors modulating vole fluctuations. Most vole populations were cyclical, with variable periodicity across the region. Our study is a first step towards the development of predictive modeling, by disclosing relevant factors that might trigger vole outbreaks. It improves decision-making processes within integrated management dealing with mitigation of the agricultural impacts caused by voles. © 2023 Society of Chemical Industry.

The Characterization of Dry Fermented Sausages under the "Chorizo Zamorano" Quality Label: The Application of an Alternative Statistical Approach.

The characterization of quality brand meat products, such as "Chorizo Zamorano" dry fermented sausages, involves a wide range of data which makes it necessary to use alternative statistical methodologies. In this study, the feasibility of the Categorical Principal Components Analysis as a multivariate non-linear technique for the characterization of "Chorizo Zamorano" was assessed. The data analyzed were those of eight commercial brands covered by the quality mark over an eight-year period (2013-2020) and included parameters of the physicochemical composition and organoleptic properties of the product. The results showed that "Chorizo Zamorano" has an average moisture content (28.28%), high protein (38.38%) and fat (51.05%) contents, and a very low carbohydrate concentration (1.52%). Results showed that the fat and protein content and the sensory parameters related to external and internal odor appeared to be the studied variables with the greatest influence on the classification of the products according to their quality.

Use of Acheta domesticus meal as a full soybean substitute in the feeding of slow-growing chicks.

Sustainable poultry meat production involves the use of slow-growing chick strains and the utilization of new protein sources as an alternative to the current monopoly of soybean meal. In this scenario, a study was conducted to assess the effect of replacing soybean meal with domestic cricket (Acheta domesticus) meal on the developing cycle of slow-growing chicks. To this end, a total of 128 one-day-old male chicks (Colorield) were randomly assigned into 16 experimental units, each consisting of 8 chicks, which in turn were grouped into 2 groups fed isoproteic and isoenergetic diets in which the protein source differed: the control group (C) fed soybean meal and the Acheta group (AD) fed Acheta domesticus insect meal as the main protein source. Chicks were slaughtered at 95 d of age. Three different diets (F1, F2 and F3) were used for each experimental group according to the nutritional needs of the birds during their growth. The F1 diet (1-29 d) resulted in higher feed and water intake and higher body weight gain for group C, but a lower feed conversion rate. On the contrary, during F2 (29-60 d) no differences in productive performances were observed between the 2 groups, except for a higher water intake for group C. Finally, during the period corresponding to diet F3 (60-95 d) there were only differences in feed intake, which was higher for the AD group. In conclusion, the substitution of soybean meal for Acheta domesticus meal caused a decrease in feed intake during the first month and consequently a lower body weight. During the first 4 weeks of life of the chicks, a partial replacement of soybean meal may be recommended, since high inclusions of A. domesticus meal in this period seem to be detrimental in young chicks. Given the absence of relevant differences in productive performances between both groups, it could be concluded that the use of A. domesticus cricket meal can be a potential protein alternative to soybean meal.

Efficiency of Artificial Insemination at Natural Estrus in Organic Churra Ewes.

Hormonal treatments used in the artificial insemination (AI) of sheep can cause several physiological problems that can affect negatively fertility and animal health; however, AI protocols based on the detection of natural estrus offer a more sustainable option and can achieve high fertility. In this study, an AI protocol at natural estrus in organic Churra sheep was performed. In the first phase (AI protocol development), 125 ewes were exocervically inseminated, and their fertility was assessed based on the following factors: number of AI, physiological state, body condition, estrus detection-AI interval, and vaginal fluids in cervix. That protocol was repeated for six consecutive years. In all individuals, fertilities based on the timing of insemination after estrus detection were very high. Lactating ewes produced better results than did dry ewes, which was probably because of the better feeding of the former. In addition, double insemination increased the fertility of ewes whose estrus was detected within 16 h of onset. Body condition and amount of vaginal fluid were correlated with fertility. Exocervical inseminations at natural estrus can produce acceptable fertility and prolificity in Churra ewes.

Classification of airborne multispectral imagery to quantify common vole impacts on an agricultural field.

BACKGROUND: The common vole (Microtus arvalis) is a very destructive agricultural pest. Particularly in Europe, its monitoring is essential not only for adequate management and outbreak forecasting, but also for accurately determining the vole's impact on affected fields. In this study, several alternatives for estimating the damage to alfalfa fields by voles through unmanned vehicle systems (UASs) and multispectral cameras are presented. Currently, both the farmers and agencies involved in the integrated pest management (IPM) programs of voles do not have sufficiently precise methods for accurate assessments of the real impact to crops. RESULTS: Overall, the four multispectral classification methods presented showed similar performances. However, the normalized difference vegetation index (NDVI)-based segmentation exhibited the most accurate and reliable appraisal of the affected areas. Nevertheless, it must be noted that the simplest method, which was based on an automatic classification, provided results similar to those obtained by more complex methods. In addition, a significant direct relationship was found between the number of active burrows and damage to the alfalfa canopy. CONCLUSION: Unmanned vehicle systems, combined with multispectral imagery classification, are an effective and easily transferable methodology for the assessment and monitoring of common vole damage to agricultural plots. This combination of methods facilitates decision-making processes for IPM control strategies against this pest. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Performance of Slow-Growing Chickens Fed with Tenebrio molitor Larval Meal as a Full Replacement for Soybean Meal.

Insect larval meal is an increasingly common protein source in poultry systems. In this study, the effect of replacing soybean meal with Tenebrio molitor larval meal on the performance of slow-growing chickens was assessed. A total of 128 one-day-old chickens (Colorield) were randomly divided into a control group (C) (n = 64), fed with soybean meal, and an experimental group (TM) (n = 64), fed with T. molitor larvae meal. The chicks were slaughtered after 95 days. Three different isoenergetic and isoproteic diets (F1, F2 and F3) were used for each group. The F1 diet resulted in higher body weight gain and higher feed and water intakes in group C, but a lower feed conversion ratio. Contrarily, diets F2 and F3 did not produce differences in the studied parameters between the two groups, except for body weight gain in the case of diet F2, which was highest in group C. Therefore, weight gain and feed and water intakes were significantly higher in group C, but there were no differences in feed conversion ratio or live weight. In conclusion, the total replacement of soybean meal with T. molitor larvae meal resulted in a reduction in feed intake and a consequent reduction in weight. During this period, partial rather than total substitution may be recommended.

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures.

BACKGROUND: A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determine whether this reduced risk may result in long-term cost savings, the present study assessed the cost-effectiveness of TRAUMACEM V+ cement augmentation versus no augmentation for the fixation of unstable trochanteric fractures from the German health-care payer's perspective. METHODS: The cost-effectiveness model comprised 2 stages: a decision tree simulating clinical events, costs, and utilities during the first year after the index procedure and a Markov model extrapolating clinical events, costs, and utilities over the patient's lifetime. Sources of model parameters included the previous RCT, current literature, and administrative claims data. Outcome measures were incremental costs (in 2020 Euros), incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model uncertainty was assessed with deterministic and probabilistic sensitivity analyses. RESULTS: The base-case analysis showed that fixation with cement augmentation was the dominant strategy as it was associated with cost savings (€50.3/patient) and QALY gains (0.01 QALY/patient). Major influential parameters for the ICER were the utility of revision, rates of revision surgery within the first year after fixation surgery, and the costs of augmentation and revision surgery. Probabilistic sensitivity analyses demonstrated that estimates of cost savings were more robust than those of increased QALYs (66.4% versus 52.7% of the simulations). For a range of willingness-to-pay thresholds from €0 to €50,000, the probability of fixation with cement augmentation being cost-effective versus no augmentation remained above 50%. CONCLUSIONS: Fixation with use of cement augmentation dominated fixation with no augmentation for unstable trochanteric fractures, resulting in cost savings and QALY gains. Given the input parameter uncertainties, future analyses are warranted when long-term costs and effectiveness data for cement augmentation are available. LEVEL OF EVIDENCE: Economic and Decision Analysis Level II . See Instructions for Authors for a complete description of levels of evidence.

Healthcare resource use and costs related to surgical infections of tibial fractures in a Spanish cohort.

Surgical site infection constitutes a serious complication in the healing process of bone fractures and has been associated with increases in medical resource use and healthcare costs. This study evaluates the economic impact of surgical site infection in tibial fractures in a Spanish cohort. It is a retrospective, single-centre, comparative cohort study of patients with tibial fractures with longitudinal follow-up for up to 18 months post-surgery. Included patients (n = 325) were adults, with tibial fracture, either isolated or polyfracture, or polytrauma with an Injury Severity Score >15. Patients had been surgically treated within 30 days of the tibial fracture by external or internal fixation, or external followed by internal fixation. Most patients (84.9%) had an American Society of Anaesthesiology score of 1-2. 20% of the patients had one open tibial fracture, 12.3% had polytrauma, and 20% had multiple fractures. Most patients were treated with a nail (41.8%) or a plate (33.8%). 56 patients (17.2%) developed surgical site infection. Patients with infection had significantly higher hospital length of stay (34.9 vs 12.0 days; p<0.001; +191%), readmissions (1.21 vs 0.25; p<0.001; +380%) and mean operating theatre time (499 vs 219 min; p<0.001; +128%) than patients without infection. Mean length of stay in intensive care did not significantly increase with infection (2.8 vs 1.7 days; p = 0.25). Total in-hospital costs for patients with infection increased from €7,607 to €17,538 (p<0.001; +131%). Overall, infections were associated with significantly increased healthcare resource use and costs. Preventive strategies to avoid infections could lead to substantial cost savings.

Spanish Asthma Management Guidelines (GEMA) VERSION 5.1. Highlights and Controversies. / Guía española para el manejo del asma (GEMA) versión 5.1. Aspectos destacados y controversias.

In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.

[Translated article] Spanish Asthma Management Guidelines (GEMA) v.5.1. Highlights and Controversies.

In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.

The Effect of Grazing Level and Ageing Time on the Physicochemical and Sensory Characteristics of Beef Meat in Organic and Conventional Production.

This study investigated the influence of the production system (conventional vs. organic), the grass consumption level and the ageing period (7 and 14 days) on beef quality. Three groups of samples from Limousin × Avileña calves were analysed: F100, formed by animals fed 100% on forage; F74, formed by animals fed on an average amount of forage of 74%; and F35, formed by animals fed on straw fodder (35%) and concentrate (65%). The results showed that the higher the grass content, the lower the fat oxidation and the higher the n-3 content, but also the higher the SFA level, the initial Warner-Bratzler shear force (WBSF), and the more residue it leaves on chewing. As for the effect of production system, organic samples showed higher intramuscular fat content and lower moisture and MUFA content. These samples were darker and showed lower values for flavour quality. Among the organic samples, F100 had higher n-3 and CLA content and higher values for colour, hardness, odour and flavour quality. Increased ageing time may improve the sensory characteristics of the meat, especially in the case of the F100 samples. The results pointed out that F100 samples aged at least 14 days showed the best physico-chemical, nutritional and sensory characteristics.