A Prospective, Observational Study of the Effect of a High-Calorie, High-Protein Oral Nutritional Supplement with HMB in an Old and Malnourished or at-Risk-of-Malnutrition Population with Hip Fractures: A FracNut Study.

BACKGROUND: Hip fractures are prevalent among older people, often leading to reduced mobility, muscle loss, and bone density decline. Malnutrition exacerbates the prognosis post surgery. This study aimed to evaluate the impact of a 12-week regimen of a high-calorie, high-protein oral supplement with ß-hydroxy-ß-methylbutyrate (HC-HP-HMB-ONS) on nutritional status, daily activities, and compliance in malnourished or at-risk older patients with hip fractures receiving standard care. SUBJECTS AND METHODS: A total of 270 subjects ≥75 years of age, residing at home or in nursing homes, malnourished or at risk of malnutrition, and post hip fracture surgery, received HC-HP-HMB-ONS for 12 weeks. Various scales and questionnaires assessed outcomes. RESULTS: During the 12 weeks of follow-up, 82.8% consumed ≥75% of HC-HP-HMB-ONS. By week 12, 62.4% gained or maintained weight (+0.3 kg), 29.2% achieved normal nutritional status (mean MNA score +2.8), and 46.8% improved nutritional status. Biochemical parameters improved significantly. Subjects reported good tolerability (mean score 8.5/10), with 87.1% of healthcare providers concurring. CONCLUSIONS: The administration of HC-HP-HMB-ONS markedly enhanced nutritional status and biochemical parameters in older hip-fracture patients, with high compliance and tolerability. Both patients and healthcare professionals expressed satisfaction with HC-HP-HMB-ONS.

[Impact on weight loss and body composition of a food education intervention associated with Liraglutide treatment to address obesity]. / Impacto en la pérdida de peso y la composición corporal de una intervención de educación alimentaria asociada al tratamiento con liraglutida para el abordaje de la obesidad.

Introduction: Introduction: clinical practice guidelines recommend considering pharmacological treatment of obesity only as a complement to lifestyle modification. Drugs alone are usually ineffective in the long term after discontinuation, so pharmacological weight loss strategies should always be accompanied by lifestyle modifications. Objective: to analyze the changes in weight, body mass index and body composition by means of electrical bioimpedance after a 32-week treatment with liraglutide in patients with obesity, associated or not with a food education program. Materials and methods: the study involved 68 patients who were randomly divided into 2 groups. One group received treatment with liraglutide 3.0 mg/day along with individual dietary education, and the other group was treated with liraglutide 3.0 mg/day and standard medical follow-up for 32 weeks. The data collected were weight (kg), height (m) (Seca® brand), body mass index (kg/m2) and body composition using multifrequency bioimpedance (SECA 112® brand). The variables were analyzed at the beginning and at the end of the treatment. Results: after 32 weeks of treatment, both study groups lost weight significantly. The group treated with liraglutide and individual dietary education had a reduction of 8.77 kg (9.08 %) (p < 0.001) and the group treated with liraglutide without education had a reduction of 3.55 kg (3.45 %) (p < 0.001). The BMI of the participants treated with liraglutide and education decreased by -4,04 kg/m2 (10.35 %) (p < 0.001) and in the group without education it decreased by -3.22 kg/m2 (8.30 %) (p = 0.003). In the educated group, fat mass decreased by -7.65 kg (15.89 %) (p < 0.001), although skeletal muscle mass also decreased by -1.62 kg (6.8 %) (p < 0.001). In those treated with liraglutide without education, a reduction in fat mass and skeletal muscle mass was also observed - fat mass by -4.72 kg (9.43 %) (p < 0.001) and skeletal muscle mass by -0.17 kg (0.70 %) (p < 0.001). Differences were also observed between groups, observing a greater reduction in weight, BMI, fat mass and skeletal muscle mass in the group with liraglutide and education compared to the group without education, although these differences were not statistically significant. Conclusions: dietary education associated with liraglutide treatment may contribute to increasing weight and fat mass losses. However, it was also associated with an unwanted loss of skeletal muscle mass, probably related to the greater intensity of weight loss, which will have to be reversed in future therapeutic approaches. Habit modification through multidisciplinary treatment, including nutritional education, combined strength and resistance exercise, and cognitive-behavioral therapy, could be an effective way to treat obesity and maintain weight, body composition, and adherence to a lifestyle.

Introducción: Introducción: las guías de práctica clínica recomiendan considerar el tratamiento farmacológico de la obesidad únicamente como complemento de la modificación del estilo de vida. Objetivo: analizar los cambios sobre el peso, el índice de masa corporal y la composición corporal mediante bioimpedancia eléctrica tras un tratamiento de 32 semanas con liraglutida en pacientes con obesidad, asociado o no a un programa de educación alimentaria. Materiales y métodos: participaron 68 pacientes que fueron divididos aleatoriamente en 2 grupos. Uno recibió tratamiento con liraglutida 3,0 mg/día junto con educación alimentaria individual y el otro fue tratado con liraglutida 3,0 mg/día y seguimiento médico estándar durante 32 semanas.Datos recogidos:l peso, talla, IMCl y composición corporal mediante bioimpedancia multifrecuencia. Se analizaron las variables al inicio y al final del tratamiento. Resultados: tras 32 semanas de tratamiento, los dos grupos de estudio redujeron el peso de manera significativa. El grupo tratado con liraglutida y educación alimentaria individual tuvo una reducción de 8,77 kg (9,08 %) (p < 0,001) y el grupo tratado con liraglutida sin educación tuvo una reducción de 3,55 kg (3,45 %) (p < 0,001). El IMC de los participantes tratados con liraglutida y educación disminuyó en -4,04 kg/m2 (10,35 %) (p < 0,001) y en el grupo sin educación se redujo en -3,22 kg/m2 (8,30 %) (p = 0,003). En el grupo con educación disminuyó la masa grasa en -7,65 kg (15,89 %) (p < 0,001), aunque también la masa muscular esquelética en -1,62 kg (6,8 %) (p < 0,001). En los tratados con liraglutida sin educación también se observó una reducción de la masa grasa y masa muscular esquelética: la masa grasa en -4,72 kg (9,43 %) (p < 0,001) y la masa muscular esquelética en -0,17 kg (0,70 %) (p < 0,001). También se observaron diferencias entre grupos, observándose mayor reducción del peso, del IMC, de lamasa grasa y de la masa muscular esquelética en el grupo con liraglutida y educación con respecto al grupo sin educación, aunque estas diferencias no llegaron a ser estadísticamente significativas. Conclusiones: la educación alimentaria asociada al tratamiento con liraglutida puede contribuir a incrementar la pérdida de peso y de la masa grasa. Sin embargo, llevó también asociada una pérdida no deseada de masa muscular esquelética, probablemente relacionada con la mayor intensidad de pérdida de peso, que habrá que revertir en futuras aproximaciones terapéuticas.

The Effect of Fasting on Body Composition Assessment in Hospitalized Cancer Patients.

Guidelines for bioelectrical impedance analysis (BIA) recommend fasting before measurements, but how it affects the outcomes is unclear. This descriptive, before-and-after study examines the effect of fasting on BIA results and its impact on the diagnosis of malnutrition in hospitalized cancer patients. Fifty-three oncology patients (admitted in January-March 2020) were consecutively enrolled regardless of their nutritional status. Patients were assessed by the same dietician 24-48 h after admission, following the usual clinical practice. The measurements were taken after 12-h fasting (fasting state) and 60-90 min after breakfast (non-fasting state). Bioimpedance parameters (resistance [R], reactance [Xc], phase angle [PA]) and body composition indices (free-fat mass index [FFMI] and appendicular skeletal muscle index [ASMI]) were calculated. On average, R values did not significantly differ between fasting and non-fasting states (mean difference: +1.82 Ω; p = 0.64). The non-fasting Xc and PA were reduced (mean differences: -1.55 Ω, p = 0.93 and 0.09°, p = 0.82, respectively). Fasting and non-fasting FFMI and ASMI were similar (mean differences: -0.13 kg/m2 (p = 0.5) and -0.10 kg/m2 (p not calculated)). These results suggest that BIA does not require fasting, facilitating its routine use in hospitalized cancer patients.

Specific biomarker comparison in current smokers, e-cigarette users, and non-smokers.

INTRODUCTION: This study aims to address the existing gap in the literature, while adding evidence, by comparing tobacco-specific biomarkers (cotinine and nitrosamines: NNK, NNAL, NNN), and other biomarkers of e-cigarette use (humectants: glycerol, 1,2-PD, 1,3-PD) according to five study groups. METHODS: A pooling analysis including two different studies was conducted. In both analyses, we took saliva samples from smokers (n = 409) and non-smokers (n = 154), dual tobacco and e-cig users (n = 92), exclusive e-cig user with nicotine (n = 158), and exclusive e-cig users without nicotine (n = 38). We analyzed and compared the geometric means (GM) and geometric standard deviations (GSD) of the concentration of tobacco-specific biomarkers, and e-cigarette biomarkers among groups. We used log-linear models adjusted for sex and age to model the change percentage and their 95% confidence intervals. RESULTS: Cotinine was significantly higher in nicotine consumers and in e-cigarette users without nicotine when compared to non-smokers. TSNAs were generally significantly lower in non-smokers and higher in nicotine consumers. NNN and NNAL were lower in e-cigarette users with nicotine comparted to smokers, and NNN was higher in e-cigarette users without nicotine when compared to non-smokers. No differences were found in humectant biomarkers between e-cigarette groups. CONCLUSIONS: Although there was a reduction in TSNAs in e-cigarette exclusive users compared to smokers, and a reduction of cotinine concentrations in e-cigarette exclusive users without nicotine compared to smokers, there are still high levels of these biomarkers when compared to non-smokers, which may be a clue towards the harmful effect of e-cigarettes.

Variation in Nicotine Metabolization According to Biological Factors and Type of Nicotine Consumer.

This study aims to describe the nicotine metabolite ratio among tobacco smokers and electronic cigarette (e-cigarette) users and nonusers. We analyzed pooled data from a longitudinal and a cross-sectional study of the adult population from the city of Barcelona. The final sample included information on 166 smokers, 164 e-cigarettes users with nicotine, 41 e-cigarette users without nicotine, 95 dual users (users of both products), and 508 nonusers. We used log-linear models to control for the potential confounding effect of the daily number of cigarettes smoked. Salivary nicotine metabolic rate assessment included the rate of nicotine metabolism (cotinine/nicotine) and the nicotine metabolite ratio (trans-3'-hydroxycotinine/cotinine). Exclusive users of e-cigarette without nicotine have the lowest rate of nicotine metabolism (Geometric mean: 0.08, p-values < 0.001) while cigarette smokers have the highest (Geometric mean: 2.08, p-values < 0.001). Nonusers have lower nicotine metabolic rate than cigarette smokers (Geometric means: 0.23 vs. 0.18, p-value < 0.05). Younger individuals (18−44 years) have a higher rate of nicotine metabolism than older individuals (45−64 years and 65−89) (Geometric means: 0.53 vs. 0.42 and 0.31, respectively, p-values < 0.01) and individuals with lower body mass index (21−25 kg/m2) have a higher rate of nicotine metabolism than the rest (26−30 kg/m2 and 31−60 kg/m2) (Geometric means: 0.52 vs. 0.35 and 0.36, respectively-values < 0.01). Nicotine metabolic rates are useful biomarkers when reporting smoking status and biological differences between individuals.

[Nutritional assessment and intervention in hospitalized cancer patients at risk of or with malnutrition: evaluation of the effect on anthropometric and body composition parameters]. / Valoración e intervención nutricional en pacientes oncológicos hospitalizados en riesgo de desnutrición o con desnutrición: evaluación del efecto sobre parámetros antropométricos y de composición corporal.

Introduction: Introduction: malnutrition is a common problem in cancer patients that worsens during hospitalization and is associated with increased morbidity and mortality, and impaired quality of life. Objectives: to describe the effect of implementing a nutritional assessment and support protocol on the nutritional status of hospitalized cancer patients. Methods: a prospective, cross-sectional, non-controlled, quasi-experimental study in cancer patients admitted to an oncology service consecutively regardless of their nutritional status between September 2019 and March 2020. Anthropometric parameters, body composition, and hand grip strength were measured at admission and discharge. The percentage of patients with malnutrition, dynapenia, and sarcopenia at admission and discharge was calculated. Results: a total of 90 cancer patients participated in this study (mean age: 66 years, 67.8 % men); 33.2 % of the patients had a tumor in the gastrointestinal tract and 73.3 % of the patients were in stage IV; 95 % required nutritional support (nutritional supplementation, enteral nutrition or parenteral nutrition). After the nutritional intervention, no differences were found in the anthropometric parameters with a mean weight loss of 0.1, although improvements in body composition were observed. The percentage of malnourished patients remained stable on admission and discharge regardless of the criteria used. Conclusions: the implementation of a protocol for assessment and nutritional support at admission in cancer patients may help prevent or delay the worsening of their nutritional status during hospital stay.

Introducción: Introducción: la desnutrición es un problema frecuente en los pacientes oncológicos que empeora durante la hospitalización y se asocia con mayor morbimortalidad y deterioro de la calidad de vida. Objetivos: describir el efecto de la implantación de un protocolo de valoración y soporte nutricional sobre el estado nutricional de pacientes oncológicos hospitalizados. Métodos: estudio prospectivo, no controlado y cuasiexperimental en pacientes oncológicos ingresados en un servicio de oncología de forma consecutiva, independientemente de su estado nutricional, entre septiembre de 2019 y marzo de 2020. Se determinaron los parámetros antropométricos, la composición corporal y la fuerza prensora de la mano al ingreso y al alta. Se calculó el porcentaje de pacientes con desnutrición, dinapenia y sarcopenia al ingreso y al alta. Resultados: un total de 90 pacientes oncológicos participaron en este estudio (edad media: 66 años, 67,8 % hombres). El 33,2 % de los pacientes presentaban un tumor en el tracto gastrointestinal y el 73,3 % de los pacientes se encontraban en estadio IV. El 95 % necesitaron soporte nutricional (suplementación nutricional, nutrición enteral o nutrición parenteral). Tras la intervención nutricional no se encontraron diferencias en los parámetros antropométricos, con una pérdida de peso media de 0,1, aunque se observaron mejorías en la composición corporal. El porcentaje de pacientes desnutridos se mantuvo estable al ingreso y al alta independientemente del criterio empleado Conclusiones: la implementación de un protocolo de valoración y soporte nutricional al ingreso en pacientes oncológicos puede ayudar a evitar o retrasar el empeoramiento de su estado nutricional durante la hospitalización.

Endoscopic transorbital avenue to the skull base: Four-step conceptual analysis of the anatomic journey.

Background: In the last decades, skull base surgery had passed through an impressive evolution. The role of neuroanatomic research has been uppermost, and it has played a central role in the development of novel techniques directed to the skull base. Indeed, the deep and comprehensive study of skull base anatomy has been one of the keys of success of the endoscopic endonasal approach to the skull base. In the same way, dedicated efforts expended in the anatomic lab has been a powerful force for the growth of the endoscopic transorbital approach to the lateral skull base.Therefore, in this conceptual paper, the main steps for the anatomic description of the endoscopic transorbital approach to the skull base have been detailed. Methods: The anatomic journey for the development of the endoscopic transorbital approach to the skull base has been analyzed, and four "conceptual" steps have been highlighted. Results: As neurosurgeons, the eyeball has always represented a respectful area: to become familiar with this complex and delicate anatomy, we started by examining the orbital anatomy on a dry skull (step 1). Hence, step 1 is represented by a detailed bone study; step 2 is centered on cadaveric dissection; step 3 consists in 3D quantitative assessment of the novel endoscopic transorbital corridor; and finally, step 4 is the translation of the preclinical data in the real surgical scenario by means of dedicated surgical planning. Conclusions: The conceptual analysis of the anatomic journey for the description of the endoscopic transorbital approach to the skull base resulted in four main methodological steps that should not be thought strictly consequential but rather interconnected. Indeed, such steps should evolve following the drives that can arise in each specific situation. In conclusion, the four-step anatomic rehearsal can be relevant for the description, diffusion, and development of a novel technique in order to facilitate the application of the endoscopic transorbital approach to the skull base in a real surgical scenario.

Relation of Malnutrition and Nosocomical Infections in Cancer Patients in Hospital: An Observational Study.

Aim: To investigate the relation between malnutrition and nosocomial infections (NI) in hospitalized cancer patients. Methods: This observational, cross-sectional, noninterventional, descriptive study was conducted in a 500-bed university hospital in Valencia (Spain). Adult cancer patients admitted to the oncology ward were consecutively enrolled regardless of their nutritional status between November 2019 and March 2020. Patients were nutritionally assessed 24 to 48 hours after admission. Body weight, height and BMI, body composition through measurement of bioelectrical impedance analysis (BIA), and muscle strength and functionality using hand grip strength (HGS) were prospectively collected. The diagnosis of malnutrition and sarcopenia was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, respectively. Patients were followed up during their hospital stay or outpatient oncology visits to identify possible NI. Results: A total of 107 patients were included in this study (mean age 66 years; 66.4% were men). The most frequent reason for admission was cancer treatment (19.6%), followed by infections (18.7%) and digestive tract symptoms (18.7%). Overall, 77.5% (83/107) of the patients were malnourished at admission according to the GLIM criteria, while 52.3% (56/107) were sarcopenic. Nosocomial infections (NI) were significantly more frequent in malnourished (52.1%; 25/48) and severely malnourished (42.1%; 8/19) patients, compared with well-nourished patients without malnutrition (25%; 10/40; p=0.035). The mean length of hospital stay was 13.9 days, significantly longer in patients with an NI compared to those without infections (18.6 vs. 10.8 days, p < 0.024). Conclusion: This study evidenced the need to implement a routine protocol for the nutritional assessment and support of cancer patients at risk of malnutrition and sarcopenia to reduce the risk of NI during their hospital stay.

The S-palmitoylome and DHHC-PAT interactome of Drosophila melanogaster S2R+ cells indicate a high degree of conservation to mammalian palmitoylomes.

Protein S-palmitoylation, the addition of a long-chain fatty acid to target proteins, is among the most frequent reversible protein modifications in Metazoa, affecting subcellular protein localization, trafficking and protein-protein interactions. S-palmitoylated proteins are abundant in the neuronal system and are associated with neuronal diseases and cancer. Despite the importance of this post-translational modification, it has not been thoroughly studied in the model organism Drosophila melanogaster. Here we present the palmitoylome of Drosophila S2R+ cells, comprising 198 proteins, an estimated 3.5% of expressed genes in these cells. Comparison of orthologs between mammals and Drosophila suggests that S-palmitoylated proteins are more conserved between these distant phyla than non-S-palmitoylated proteins. To identify putative client proteins and interaction partners of the DHHC family of protein acyl-transferases (PATs) we established DHHC-BioID, a proximity biotinylation-based method. In S2R+ cells, ectopic expression of the DHHC-PAT dHip14-BioID in combination with Snap24 or an interaction-deficient Snap24-mutant as a negative control, resulted in biotinylation of Snap24 but not the Snap24-mutant. DHHC-BioID in S2R+ cells using 10 different DHHC-PATs as bait identified 520 putative DHHC-PAT interaction partners of which 48 were S-palmitoylated and are therefore putative DHHC-PAT client proteins. Comparison of putative client protein/DHHC-PAT combinations indicates that CG8314, CG5196, CG5880 and Patsas have a preference for transmembrane proteins, while S-palmitoylated proteins with the Hip14-interaction motif are most enriched by DHHC-BioID variants of approximated and dHip14. Finally, we show that BioID is active in larval and adult Drosophila and that dHip14-BioID rescues dHip14 mutant flies, indicating that DHHC-BioID is non-toxic. In summary we provide the first systematic analysis of a Drosophila palmitoylome. We show that DHHC-BioID is sensitive and specific enough to identify DHHC-PAT client proteins and provide DHHC-PAT assignment for ca. 25% of the S2R+ cell palmitoylome, providing a valuable resource. In addition, we establish DHHC-BioID as a useful concept for the identification of tissue-specific DHHC-PAT interactomes in Drosophila.

Changes in the salivary cotinine cut-offs to discriminate smokers and non-smokers before and after Spanish smoke-free legislation.

INTRODUCTION: High levels of cotinine in non-smokers indicate passive exposure to tobacco smoke. This study aims to evaluate variations in salivary cotinine cut-offs to discriminate smokers and non-smokers before and after the implementation of smoke-free legislation (Law 28/2005 and Law 42/2010) in a sample of the adult population of Barcelona, Spain. METHODS: This longitudinal study analyzes salivary cotinine samples and self-reported information from a representative sample (n = 676) of the adult population from Barcelona before and after the approval of smoke-free legislation. We calculated the receiver operating characteristic (ROC) curves, to obtain optimal cotinine cut-off points to discriminate between smokers and non-smokers overall, by sex and age, and their corresponding sensitivity, specificity, and area under the curve. We used linear mixed-effects models, with individuals as random effects, to model the percentage change of cotinine concentration before and after the implementation of both laws. RESULTS: The mean salivary cotinine concentration was significantly lower post-2010 law (-85.8%, p < 0.001). The ROC curves determined that the optimal cotinine cut-off points for discriminating non-smokers and smokers were 10.8 ng/mL (pre-2005 law) and 5.6 ng/mL (post-2010 law), with a post-2010 law sensitivity of 92.6%, specificity of 98.4%, and an area under the curve of 97.0%. The post-2010 law cotinine cut-off points were 5.6 ng/mL for males and 1.9 ng/mL for females. CONCLUSION: The implementation of Spanish smoke-free legislation was effective in reducing secondhand smoke exposure and, therefore, also in reducing the cut-off point for salivary cotinine concentration. This value should be used to better assess tobacco smoke exposure in this population.

Saliva changes in composition associated to COVID-19: a preliminary study.

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2), is usually associated with a wide variety of clinical presentations from asymptomatic to severe cases. The use of saliva as a diagnostic and monitoring fluid has gained importance since it can be used to investigate the immune response and to direct quantification of antibodies against COVID-19. Additionally, the use of proteomics in saliva has allowed to increase  our understanding of the underlying pathophysiology of diseases, bringing new perspectives on diagnostics, monitoring, and treatment. In this work, we compared the salivary proteome of 10 patients with COVID-19, (five patients with mild and five patients with severe COVID-19) and ten control healthy patients. Through the application of proteomics, we have identified 30 proteins whose abundance levels differed between the COVID-19 groups and the control group. Two of these proteins (TGM3 and carbonic anhydrase-CA6) were validated by the measurement of gGT and TEA respectively, in 98 additional saliva samples separated into two groups: (1) COVID-19 group, integrated by 66 patients who tested positive for COVID-19 (2) control group, composed of 32 healthy individuals who did not show any sign of disease for at least four weeks and were negative for COVID-19 in RT-PCR. In the proteomic study there were observed upregulations in CAZA1, ACTN4, and ANXA4, which are proteins related to the protective response against the virus disturbance, and the upregulation of TGM3, that is correlated to the oxidative damage in pulmonary tissue. We also showed the downregulation in cystatins and CA6 that can be involved in the sensory response to stimulus and possibly related to the presence of anosmia and dysgeusia during the COVID-19. Additionally, the presence of FGB in patients with severe COVID-19 but not in mild COVID-19 patients could indicate a higher viral aggregation and activation in these cases. In conclusion, the salivary proteome in patients with COVID-19 showed changes in proteins related to the protective response to viral infection, and the altered sensory taste perception that occur during the disease. Moreover, gGT and TEA could be potential biomarkers of respiratory complications that can occurs during COVID 19 although further larger studies should be made to corroborate this.

Knowledge and Opinions of Healthcare Professionals about Thirdhand Smoke: A Multi-National, Cross-Sectional Study.

There is scarce evidence on the knowledge and opinions about third-hand smoke (THS) of health care professionals. The main aim of this study was to explore the knowledge and opinions of health care professionals about THS and, secondarily, to explore the factors that are associated with this knowledge. Cross-sectional study using a snowball sample of multi-national health care professionals (n = 233). Data were obtained from an exploratory, online questionnaire. The health care professionals' knowledge and opinions on THS were described with absolute frequency and percentage. Chi-square and Fisher-Freeman-Halton exact tests, and simple logistic regression models, were used to explore the bivariate association between the knowledge of the concept THS and sex, continent of birth, educational level, occupation, years of experience, and attitude towards smoking. Finally, a multivariable logistic regression model incorporating all the above variables was fitted. A total of 65.2% of the participants were unaware of the term THS before the study began. In the bivariate analysis, an association was found between prior knowledge of the term THS and continent of birth (p-value = 0.030) and occupation (p-value = 0.014). In the multivariable logistic regression model, a significant association was observed between prior knowledge of the concept THS and sex (p-value = 0.005), continent of birth (p-value = 0.012), and occupation (p-value = 0.001). Almost two out of three health care professionals who participated in our study did not know what THS was. Educational activities on this topic should be implemented.

Compliance Surveillance of the Tobacco Control Legislation in a Spanish Region and Characterization of Passive Exposure to Tobacco Smoke and E-Cig in Children in Outdoor Spaces.

(1) Background: Exposure to environmental tobacco smoke has decreased in recent years in Spain, due to the implementation of tobacco control policies. However, there is no regulation that protects against second-hand smoke (SHS) in outdoor environments. Our goal is to describe the smoking prohibition signage in public spaces and to characterize tobacco consumption in outdoor environments describing the SHS exposure in children. (2) Methods: A cross-sectional study using direct observation was carried out with a convenience sample (n = 179) that included hospitality venues with terraces, schools and healthcare facilities in the municipality of Sant Cugat del Vallès (Barcelona, Spain). The observations were made without notifying the owners by one single field researcher between April and June 2018. The variables were evaluated by signage and signs of tobacco consumption (ashtrays, cigarette butts and presence of smokers). (3) Results: Smoke-free zone signage outside public spaces was present in 30.7% of all venues, with only 50.9% correctness. When analysing terraces of hospitality venues, in 35.8% of them there were children present with 66.7% of tobacco consumption. (4) Conclusions: Our results show a low prevalence of antismoking signage, without an impact on tobacco consumption regardless of the presence of children.

Association between biomarkers of tobacco consumption and lung cancer risk among daily smokers.

BACKGROUND: Biomarkers of tobacco consumption may play a role in the lung cancer risk assessment. However, the role of salivary biomarkers has not been well studied. The aim of this study is to assess the use of salivary biomarkers of tobacco consumption as lung cancer screening criterion. RESEARCH DESIGN AND METHODS: Data came from the Determinants of cotinine phase 3 project (Barcelona, 2013-2014). We compared the concentrations of TSNAs, including NNAL, NNN and NNK, and cotinine, in saliva samples of 142 daily smokers from the general population according to their risk of lung cancer. High risk of lung cancer was defined as per the inclusion criteria in the US National Lung Screening Trial (NLST) and in the Dutch-Belgian lung cancer screening trial (NELSON). RESULTS: Among daily smokers accomplishing the age criterion for lung cancer screening, salivary concentrations of cotinine, NNAL and NNK adjusted for sex were significantly higher (p-value < 0.05) in daily smokers at high risk of lung cancer compared to smokers not at high risk according to both NELSON and NLST criteria. CONCLUSIONS: Saliva concentrations of cotinine, NNAL and NNK may be used as additional criteria for lung cancer screening. Further research on this topic is guaranteed.

Six-year experience of microvascular free-flap reconstruction of head and neck neoplasms.

INTRODUCTION: Microvascular free-flap reconstruction is one of the treatment options after large resection of head and neck neoplasms. The objectives of this study are to identify short-term outcomes and risk factors for flap complication in patients who underwent neoplasms resection of head and neck with microvascular free-flap reconstruction. METHODS: Retrospective study of patients who underwent surgery for head and neck neoplasm with microvascular free-flap reconstruction between January 2014-2020. Complications were studied at 30-days follow-up and divided into medical and flap complications. Factors independently associated with flap complication were analyzed. RESULTS: We included 31 patients (15 men). The mean age was 60 years. Reconstruction was performed with radial-forearm flap in 74% (n=23) and with free-fibula flap in 26% (n=8). Mean surgical time was 420 minutes. Median hospital length of stay was 7 days. Medical complications were of 23%. Minor complications were of 35% and major of 32%. There was no mortality in 30-days follow-up. Flap complications were of 35%. Reintervention was of 29%, surgical site infection of 9%, dehiscence of 29% and flap loss of 9.7%.  Surgical site infection was independently associated with prolonged surgical time (Odds ratio [OR]=1.03, IC95%=0.98-1.04, p=0.02) and body mass index equal to or greater than 30 (OR=1.38, IC95%=0.84-2.26, p=0.04) while flap loss was associated with prolonged surgical time (OR=1.02, IC95%=0.99-1.04, p=0.01). CONCLUSION: Microsurgical free-flap reconstruction should be considered in our population in patients with large head and neck neoplasms. Preoperative assessment of the risk of postoperative complications is essential before selecting patients for this surgery.

Mamoplastia com técnica em "D" espelhado e lipoaspiração assistida por laser / Mammoplasty with mirrored "D" technique and laser-assisted liposuction

■ RESUMO Introdução: A mamoplastia é um procedimento estético e funcional, considerada uma cirurgia árdua, com o objetivo de melhorar as mamas na sua forma com o mínimo de cicatriz aparente e reposicionar o complexo areolopapilar. Não existe um procedimento padrão e a escolha de uma técnica depende de distintos fatores, o que justifica a diversidade de técnicas descritas. Apresentaremos a técnica em "D" espelhado, de uma maneira ampla em distintos cenários (anatômicos), junto à lipoaspiração assistida por laser com marcação padrão, o que facilita o procedimento cirúrgico com uma simetria final e manutenção de resultados estéticos, corrigindo as recidivas. Métodos: Técnica realizada em 46 pacientes, do sexo feminino, sem exclusão de raça, entre 20 a 66 anos, operadas pelos autores entre janeiro de 2017 a março 2020, no Hospital Antoninho da Rocha Marmo - São José dos Campos - Brasil. Trabalho retrospectivo com aplicação do questionário validado Breast-Q® para avaliar o grado de satisfação. Resultados: Não teve revisão cirúrgica, sem infecção pós-operatória ou necrose da placa areolopapilar, 5 casos de epidermólise da placa areolopapilar tratados com flavonoides e castanha da índia (linfa cream®), sem sequelas. Ressecção do parênquima de 80 a 1.100g média 477,1g. LAL entre 150 a 790ml, média 438,6ml. A cicatriz vertical final média 6,7cm, estável após 2 anos, com avaliação Breast-Q® de muito satisfeito (86%). Conclusão: Consideramos a técnica em "D" espelhado e lipoaspiração assistida por laser uma boa opção cirúrgica pela sistematização e versatilidade em diferentes cenários de mamoplastia, mantendo formato coniforme com cicatriz menor e manutenção dos resultados validados.

■ ABSTRACT Introduction: Mammoplasty is an aesthetic and functional procedure, considered an arduous surgery, intending to improve the breasts' shape with a minimum of apparent scarring and reposition the nipple-areola complex. There is no standard procedure, and a technique's choice depends on different factors, which justifies the diversity of techniques described. We will present the mirrored "D" technique broadly in different (anatomical) scenarios, together with laser-assisted liposuction with standard marking, which facilitates the surgical procedure with final symmetry and maintenance of aesthetic results, correcting the recurrences. Methods: Technique performed in 46 patients, female, without exclusion of race, between 20 and 66 years old, operated by the authors between January 2017 and March 2020, at the Hospital Antoninho da Rocha Marmo - São José dos Campos - Brazil. Retrospective work with the application of the validated Breast-QTM questionnaire to assess the degree of satisfaction. Results: There was no surgical revision, postoperative infection or necrosis of the papillary areolar plaque, 5 cases of papillary areolar plaque epidermolysis, treated with flavonoids and horse chestnut (linfa creamTM), without sequelae. Parenchyma resection from 80 to 1,100g, average 477.1g. Laser-assisted liposuction between 150 to 790ml, average 438.6ml. The final vertical scar averaged 6.7cm, stable after two years, with Breast-QTM evaluation of very satisfied (86%). Conclusion: We consider the mirrored "D" technique and laser-assisted liposuction a good surgical option due to its systematization and versatility in different mammoplasty scenarios, maintaining a coniform shape with a smaller scar and maintaining the validated results.

Mechnetor: a web server for exploring protein mechanism and the functional context of genetic variants.

Advances in DNA sequencing and proteomics mean that researchers must now regularly interrogate thousands of positional gene/protein changes in order to find those relevant for potential clinical application or biological insights. The abundance of already known information on protein interactions, mechanism, and tertiary structure provides the possible means to understand these changes rapidly, though a careful and systematic integration of these diverse datasets is first needed. For this purpose, we developed Mechnetor, a tool that allows users to quickly explore and visualize integrated mechanistic data for proteins or interactions of interest. Central to the system is a careful cataloguing of diverse sources of protein interaction mechanism, and an efficient means to visualize interactions between relevant and/or known protein regions. The result is a finer resolution interaction network that provides more immediate clues as to points of intervention or mechanistic understanding. Users can import protein, interactions, genetic variants or post-translational modifications and see these data in the best known mechanistic context. We demonstrate the tool with topical examples in human genetic diseases and cancer genomics. The tool is freely available at: mechnetor.russelllab.org.

Criterios de retorno al trabajo y determinación del valor de vulnerabilidad por Covid-19 / Criteria for returning to work and determination of the vulnerability value for Covid-19

Resumen: Objetivo: Establecer criterios médicos de retorno al trabajo en personal con riesgo de complicaciones por Covid-19. Material y métodos. Se realizó una revisión sistemática para identificar las condiciones y las características clínicas que influyen en el riesgo de desarrollar Covid-19 grave. Resultados: Se ha demostrado incremento del riesgo en obesidad, edad >60 años, diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiovascular, enfermedad renal crónica y cáncer. Solamente en diabetes se ha estudiado si el control previo influye. Se proponen condiciones específicas y el nivel de riesgo epidemiológico para el retorno al trabajo. Conclusiones: El retorno laboral de estos grupos debe priorizarse buscando favorecer el control de la enfermedad, identificando el estado de salud que incrementa el riesgo y protegiendo el derecho al trabajo. Se presentan recomendaciones para guiar la reincorporación al trabajo.

Abstract: Objective: To establish medical criteria for return to work to people with increased risk of severe illness from Covid-19. Materials and methods. We performed a systematic review to identify the conditions and clinical characteristics that influence the risk of developing severe Covid-19. Results: Increased risk has been shown in obesity, age >60 years old, diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, cardiovascular disease, chronic kidney disease and cancer. Only in diabetes it has been studied whether prior control influences. Specific medical conditions and epidemiological risk level for return to work are proposed. Conclusions: Return to work of vulnerable groups should be prioritized, seeking to promote disease control, identifying health conditions that increase risk, and protecting the right to work. We present recommendations to guide the return to work.

Association between nutritional risk markers and polymorphisms rs2291166 in TJP1 and VNTR (CAG)n in ATXN2 in an obese adolescent Mexican population. / Asociación entre marcadores de riesgo nutricionales con los polimorfismos rs2291166 de TJP1 y el VNTR (CAG)n de ATXN2 en población mexicana adolescente con obesidad.

OBJECTIVE: To estimate the correlation between indices of diet quality (DQIs), insulin sensitivity (QUICKI) and resistance (HOMA-IR), waist circumference (WHR) and body mass (BMI) and the alleles and genotypes of the TJP1 SNP rs2291166 and the VNTR of ATXN2 in adolescent patients. SUBJECTS AND METHOD: The study enrolled 85 subjects aged 10-20years, from the city of Tuxtepec, Oaxaca, Mexico, recruited in the period 2017-2018. DQIs, BMI, WHR, HOMA-IR, QUICKI, and diet quality index were measured. The rs2291166 polymorphism in TJP1 was determined by allele-specific PCR and the (CAG)n expansion in ATXN2 was determined by hot start PCR. PCR products were analyzed using 8% PAGE electrophoresis and silver nitrate staining. RESULTS: A correlation was found of indices DQIs, HOMA-IR, WHR and BMI with the heterozygous genotype of the TJP1 SNP rs2291166 and the long and short repeats of the ATXN2 CAG repeat in obese adolescent patients. A very strong positive correlation was seen between the TJP1 SNP and the HOMA-IR index (P<.05). A positive correlation was also found between the ATXN2 CAG repeat and the QUICKI index (P=.000) (P<.05), while the DQIs index correlated more closely with BMI and WHR. CONCLUSIONS: DQIs, TJP1 SNP rs2291166, and ATXN2 CAG repeat are determinants of obesity-related risk parameters such as BMI, WHR, QUICKI, and HOMA-IR in the adolescent population analyzed.