Minimizing neurovascular complications during image-guided percutaneous cryoablation of a cervical spinal aneurysmal bone cyst using protective doxycycline sclerotherapy: a case report.

Background: Aneurysmal bone cysts (ABC) are rare, locally aggressive bone tumors primarily observed in pediatric patients. Surgical curettage is the treatment of choice. Image-guided percutaneous cryoablation (CYOA) is a recently implemented alternative technique in cases not amenable to surgery. CYOA may be limited if the lesion is close to critical neurovascular structures. In this case report, a cervical spinal ABC was successfully treated using CYOA in combination with complementary and protective image-guided percutaneous doxycycline sclerotherapy (DS) to dissect and treat the portion of the lesion in contact with critical structures. Case Description: A 4-year-old male presented with a symptomatic ABC within the C5 vertebral body, which encompassed the right vertebral artery and contacted the right C5-C6 spinal cord and nerve roots. After ruling out surgery due to the proximity of critical neurovascular structures, treatment with CYOA was performed. However, subsequent follow-up showed recurrence in the part of the lesion contacting critical structures. A second approach was then decided, using DS to dissect and treat the most vulnerable portion and CYOA to treat the remaining tumor. Follow-up showed almost complete sclerosis of the lesion and total resolution of symptoms 3 years after treatment. Conclusions: Using DS to dissect and treat the portion of the lesion in contact with critical neurovascular structures during CYOA treatment of a cervical spinal ABC allowed for a safe and effective approach in our case.

Economic evaluation of percutaneous cryoablation vs conventional surgery in extra-abdominal desmoid tumours in the Spanish healthcare system.

BACKGROUND: Desmoid tumours (DTs) or deep fibromatosis are benign soft-tissue tumours, sometimes locally aggressive, requiring intervention on some cases. Surgery has been the gold standard, but new less invasive techniques such as percutaneous cryoablation have proved their effectiveness, reducing health resources and complications. The study aimed to compare the total cost of percutaneous cryoablation and conventional surgery for patients with extra-abdominal and/or abdominal wall DTs, candidates for local ablative treatment in Spain. METHODS: A cost-analysis model was developed. An expert panel provided data about resource consumption for the percutaneous cryoablation technique and validated the epidemiology used for target population estimation. Unitary resources cost (€ 2022) derived from local cost databases. A retrospective analysis of 54 surgical cases in 3 Spanish hospitals was performed to estimate the cost of conventional surgery based on the cost of the Diagnosis-Related group (DRG) codes identified on this patient sample, weighted by each DRG proportion. The total cost for each alternative included intervention cost and complications cost, considering debridement required in 4.5% of cases with percutaneous cryoablation and minor surgery for surgical site infection in 18.0% for conventional surgery. RESULTS: The total cost for percutaneous cryoablation (€ 5774.78/patient-year) was lower than the total cost for conventional surgery (€ 6780.98/patient-year), yielding cost savings up to € 80,002 in 1 year for the entire cohort of 80 patients with DTs eligible for intervention estimated in Spain. One-way sensitivity analyses confirmed the results' robustness. CONCLUSION: Percutaneous cryoablation versus conventional surgery would yield cost savings for the management of DT patients in Spain. CRITICAL RELEVANCE STATEMENT: This manuscript provides insight into the economic impact derived from the savings related to the use of percutaneous cryoablation for desmoid-type tumours from the perspective of the Spanish National Healthcare System, providing useful information for the health decision-making process. KEY POINTS: • Desmoid tumours are locally aggressive and may require local therapy. • Percutaneous cryoablation procedure is less invasive than the conventional surgery. • Cost comparison shows savings associated to percutaneous cryoablation use.

Imaging in interventional oncology, the better you see, the better you treat.

Imaging and image processing is the fundamental pillar of interventional oncology in which diagnostic, procedure planning, treatment and follow-up are sustained. Knowing all the possibilities that the different image modalities can offer is capital to select the most appropriate and accurate guidance for interventional procedures. Despite there is a wide variability in physicians preferences and availability of the different image modalities to guide interventional procedures, it is important to recognize the advantages and limitations for each of them. In this review, we aim to provide an overview of the most frequently used image guidance modalities for interventional procedures and its typical and future applications including angiography, computed tomography (CT) and spectral CT, magnetic resonance imaging, Ultrasound and the use of hybrid systems. Finally, we resume the possible role of artificial intelligence related to image in patient selection, treatment and follow-up.

Primary architecture and energy requirements of Type III and Type IV secretion systems.

Many pathogens use Type III and Type IV protein secretion systems to secrete virulence factors from the bacterial cytosol into host cells. These systems operate through a one-step mechanism. The secreted substrates (protein or nucleo-protein complexes in the case of Type IV conjugative systems) are guided to the base of the secretion channel, where they are directly delivered into the host cell in an ATP-dependent unfolded state. Despite the numerous disparities between these secretion systems, here we have focused on the structural and functional similarities between both systems. In particular, on the structural similarity shared by one of the main ATPases (EscN and VirD4 in Type III and Type IV secretion systems, respectively). Interestingly, these ATPases also exhibit a structural resemblance to F1-ATPases, which suggests a common mechanism for substrate secretion. The correlation between structure and function of essential components in both systems can provide significant insights into the molecular mechanisms involved. This approach is of great interest in the pursuit of identifying inhibitors that can effectively target these systems.

Relación entre la Temperatura de Superficie, la Composición Corporal e Indicadores Antropométricos de Obesidad y Sobrepeso / Relationship Between Surface Temperature, Body Composition and Anthropometric Indicators of Obesity and Overweight

La termografía por infrarrojo (TI) permite evaluar la temperatura corporal, medir los cambios en la disipación del calor corporal en superficie y relacionarlos con las características de composición corporal e índices antropométricos. Aumentar el número de registros de zonas corporales evaluadas con TI y establecer las relaciones de estas temperaturas (32 áreas corporales) con variables de composición corporal e índices antropométricos, como el índice de masa corporal (IMC), índice cintura cadera, índice cintura estatura, en hombres adultos divididos según su estado ponderal. Participaron 60 hombres, adultos sanos, divididos en 2 grupos: grupo 1 (n=30), con IMC ≤ 24,9, edad 23,2 ± 3,9 años, masa corporal 66,5 ± 6,5 kg, y talla 170,5 ± 7,4 cm; y, grupo 2 (n= 30), con IMC > 24,9, edad 29,4 ± 9,9 años, masa corporal 84,5 ± 11,9 kg, y talla 172,0 ± 7,18 cm. Se realizaron evaluaciones antropométricas y de TI. Sujetos con IMC ≤ 24,9 kg/ m2 presentaron valores mayores de temperatura superficial, en todas las zonas estudiadas, a diferencia de los sujetos con niveles de IMC > 24,9 kg/m2, donde la disipación del calor corporal fue menor. Existe una estrecha relación entre la temperatura superficial de la piel y el IMC, donde sujetos con un IMC normal mostraron una disipación de calor y valores de temperatura superficial mayores, en todas las zonas evaluadas, a diferencia de los sujetos con un IMC que se encontraba por encima del límite de normalidad.

SUMMARY: Infrared thermography (IT) makes it possible to assess body temperature, measure changes in body heat dissipation on the surface, and relate them to body composition characteristics and anthropometric indices. The objective of this study was to increase the number of records of body areas evaluated with IT and establish the relationships of these temperatures (32 body areas) with body composition variables and anthropometric indices, such as body mass index (BMI), waist-hip ratio, waist-height ratio, in adult men divided according to their weight status. A total of 60 healthy adult men participated, divided into 2 groups: group 1 (n=30), with a body mass index (BMI) ≤ 24.9, age 23.2 ± 3.9 years, body mass 66.5 ± 6.5 kg, and height 170.5 ± 7.4 cm; and, group 2 (n = 30), with BMI > 24.9, age 29.4 ± 9.9 years, body mass 84.5 ± 11.9 kg, and height 172.0 ± 7.18 cm. Anthropometric and IT assessments were performed. Subjects with BMI ≤ 24.9 kg/ m2 presented higher values of surface temperature in all areas studied, unlike subjects with BMI levels > 24.9 kg/m2, where body heat dissipation was lower. There is a close relationship between skin surface temperature and BMI, where subjects with a normal BMI showed higher heat dissipation and surface temperature values, in all evaluated areas, unlike subjects with a BMI that was above the normal limit.

Relación entre Índices Antropométricos de Obesidad y Condición Física en Escolares de 9 a 14 Años de la Región de Valparaíso, Chile / Relationship Between Anthropometric Indices of Obesity and Physical Condition in Schoolchildren Aged 9 to 14 Years From the Valparaíso Region, Chile

Los objetivos de este estudio fueron 1) describir factores antropométricos asociados a la obesidad y pruebas de condición física junto con 2) determinar la correlación entre estas variables en un grupo de escolares provenientes de la región de Valparaíso. Participaron un total de 109 escolares divididos por sexo y por grupos de edad. Los escolares fueron divididos en dos grupos entre 9 a 11 años (24 hombres= 47,98 ± 10,4 kg; 145,73 ± 7,3 cm; 25 mujeres= 45,06 ± 11,1 kg; 145,30 ± 6,6 cm) y entre 12 a 14 años (24 hombres= 54,85 ± 13,2 kg; 158,42 ± 8,8 cm; 36 mujeres= 52,21 ± 9,1 kg; 155,36 ± 6,1 cm). Se realizaron evaluaciones de la condición física utilizadas en el proceso de evaluación del Sistema de Medición de la Calidad de la Educación (SIMCE) de educación física para escolares chilenos. Estas evaluaciones incluyeron parámetros de flexibilidad, carrera, salto horizontal, y resistencia muscular. Junto con esto, se evaluaron variables antropométricas como peso, estatura y perímetro de cintura para establecer índices antropométricos de obesidad como el índice de masa corporal (IMC), el perímetro de cintura (PC) y el índice de cintura estatura (ICE). Se encontraron diferencias significativas entre los grupos de hombres de los diferentes grupos de edad en las pruebas de condición física, resistencia muscular abdominal (p = 0,001), salto horizontal (p = 0,002) y prueba de carrera (p = 0,003). Entre los grupos de mujeres se encontraron diferencias significativas en las variables de condición física, salto horizontal (p = 0,002) y carrera (p = 0,003). Tanto en hombres como en mujeres del grupo de 9 a 11 años se encontraron correlaciones significativas entre las variables antropométricas con pruebas de salto horizontal y capacidad de carrera (p = 0,03, r = -0,42 - 0,83, moderado a muy fuerte). En este mismo grupo solo las mujeres presentaron una correlación significativa entre parámetros antropométricos y la prueba de resistencia muscular en flexo extensiones de codo (p < 0,05, r = -0,42 - -0,52, moderado a fuerte) y abdominales (p < 0,05, r = -0,57 - -0,60, fuerte). Para el grupo entre 12 y 14 años se obtuvieron correlaciones negativas entre el ICE y la prueba de carrera en hombres (p < 0,016, r = -0,48, moderado), PC y la prueba de carrera en mujeres (p < 0,011, r = -0,41, moderado). Sólo en mujeres fue posible encontrar correlaciones significativas entre PC, IMC e ICE con salto horizontal (p < 0,05, r = 0,38 - 0,48, moderado). Los resultados sugieren una correlación negativa entre parámetros antropométricos de exceso de peso corporal y el rendimiento en pruebas físicas, siendo en el grupo de mayor edad las mujeres quienes presentan mayor cantidad de correlaciones significativas entre variables. Estos datos refuerzan la importancia de incluir abordajes integrales en las clases de educación física considerando estilos de vida activos y saludables en conjunto con la promoción de la actividad física.

SUMMARY: The objectives of this study were 1) to describe anthropometric factors associated with obesity and physical fitness tests and 2) to determine the correlation between these variables in a group of schoolchildren from the Valparaíso region. A total of 109 schoolchildren divided by sex and age groups participated. The schoolchildren were divided into two groups between 9 to 11 years (24 males = 47,98 ± 10,4 kg; 145,73 ± 7,3 cm; 25 females = 45,06 ± 11,1 kg; 145,30 ± 6,6 cm) and between 12 to 14 years (24 males = 54,85 ± 13,2 kg; 158,42 ± 8,8 cm; 36 females = 52,21 ± 9,1 kg; 155,36 ± 6,1 cm). Physical fitness assessments used by the Sistema de Medición de la Calidad de la Educación (SIMCE) evaluation process for physical education for Chilean schoolchildren were performed. These assessments included flexibility, sprint capacity, horizontal jump, and muscular endurance parameters. In addition, anthropometric variables such as weight, height and waist circumference were evaluated to establish anthropometric indices of obesity such as body mass index (BMI), waist circumference (WC) and waist-height index (WHI). Significant differences were found between the groups of men in the different age groups in the physical fitness tests, abdominal muscular endurance (p = 0.001), horizontal jump (p = 0.002), sprint test (p = 0.003) and the anthropometric index BMI (p = 0.048). Among the female groups, significant differences were only found in the physical condition variables, horizontal jump (p = 0.002) and sprint (p = 0.003). In both males and females in the 9- to 11- year-old group, significant correlations were found between anthropometric variables and tests of horizontal jumping and sprint ability (p = 0.03, r = -0.42 - 0.83, moderate to very high). In this same group, only females presented a significant correlation between anthropometric parameters and muscular endurance tests in elbow flexion (p < 0.05, r = -0.42 - -0.52, moderate to high) and abdominals (p < 0.05, r = -0.57 - -0.60, high). For the group between 12 and 14 years, negative correlations were obtained between WHI and the sprint test in males (p < 0.016, r = -0.48, moderate), WC and the sprint test in females (p < 0.011, r = -0.41, moderate). Only in women was it possible to find significant correlations between WC, BMI and ICE with a horizontal jump (p < 0.05, r = 0.38 - 0.48, moderate). The results suggest a negative correlation between anthropometric parameters of excess body weight and performance on physical tests, with women in the older age group presenting the highest number of significant correlations between variables. These data reinforce the importance of including integral approaches in physical education classes that consider active and healthy lifestyles together with the promotion of physical activity.

Radiomic signatures from T2W and DWI MRI are predictive of tumour hypoxia in colorectal liver metastases.

BACKGROUND: Tumour hypoxia is a negative predictive and prognostic biomarker in colorectal cancer typically assessed by invasive sampling methods, which suffer from many shortcomings. This retrospective proof-of-principle study explores the potential of MRI-derived imaging markers in predicting tumour hypoxia non-invasively in patients with colorectal liver metastases (CLM). METHODS: A single-centre cohort of 146 CLMs from 112 patients were segmented on preoperative T2-weighted (T2W) images and diffusion-weighted imaging (DWI). HIF-1 alpha immunohistochemical staining index (high/low) was used as a reference standard. Radiomic features were extracted, and machine learning approaches were implemented to predict the degree of histopathological tumour hypoxia. RESULTS: Radiomic signatures from DWI b200 (AUC = 0.79, 95% CI 0.61-0.93, p = 0.002) and ADC (AUC = 0.72, 95% CI 0.50-0.90, p = 0.019) were significantly predictive of tumour hypoxia. Morphological T2W TE75 (AUC = 0.64, 95% CI 0.42-0.82, p = 0.092) and functional DWI b0 (AUC = 0.66, 95% CI 0.46-0.84, p = 0.069) and b800 (AUC = 0.64, 95% CI 0.44-0.82, p = 0.071) images also provided predictive information. T2W TE300 (AUC = 0.57, 95% CI 0.33-0.78, p = 0.312) and b = 10 (AUC = 0.53, 95% CI 0.33-0.74, p = 0.415) images were not predictive of tumour hypoxia. CONCLUSIONS: T2W and DWI sequences encode information predictive of tumour hypoxia. Prospective multicentre studies could help develop and validate robust non-invasive hypoxia-detection algorithms. CRITICAL RELEVANCE STATEMENT: Hypoxia is a negative prognostic biomarker in colorectal cancer. Hypoxia is usually assessed by invasive sampling methods. This proof-of-principle retrospective study explores the role of AI-based MRI-derived imaging biomarkers in non-invasively predicting tumour hypoxia in patients with colorectal liver metastases (CLM).

Percepción de los usuarios sobre los comportamientos de cuidado humanizado en hospitales públicos de Corrientes / Users' perception of humanized care behaviors in public hospitals in Corrientes

Ante el riesgo de deshumanización de los profesionales que brindan el cuidado al paciente, a causa de la gran reestructuración administrativa de la mayoría de los sistemas de cuidado de salud en el mundo, se hace necesario el rescate del aspecto humano, espiritual y transpersonalObjetivo: describir la percepción de los usuarios sobre los comportamientos de cuidado humanizado en los hospitales públicos de Corrientes en el año 2022.Metodología: Se realizó un estudio descriptivo y transversal, se encuestó a usuarios atendidos en hospitales públicos de la Provincia de Corrientes, se utilizó el cuestionario "Percepción de comportamientos de cuidado humanizado de enfermería (PCHE) Clinicountry ­ 3ª versión. Para el análisis de los datos se utilizaron medidas de tendencia central y de dispersión, frecuencias absolutas y relativas.Resultados: Se encuestaron a 175 usuarios de hospitales públicos de la provincia de Corrientes, la edad media fue de 45, 69 años (DS= 16,97 años), el 64, 4 % es de género femenino. En relación al análisis general de la percepción de comportamientos de cuidado humanizado en los usuarios de servicios de salud atendidos en hospitales públicos, se observó que 131 (74,9%) usuarios percibieron el comportamiento de forma positiva.Conclusión: Se logró describir que la percepción sobre el comportamiento de cuidado humanizado de enfermería en los hospitales públicos de Corrientes fue positiva en la mayoría de los usuarios, se identificaron dimensiones que requieren de estrategias para mejorar el cuidado[AU]

Given the risk of dehumanization in patient care, due to the great administrative restructuring of most health care systems in the world, it is necessary to rescue the human, spiritual and transpersonal aspect.Objective: describe the perception of users about humanized care behaviors in public hospitals in Corrientes in the year 2022.Methodology: A descriptive and cross-sectional study was carried out, surveying users treated in public hospitals in the Province of Corrientes, using the questionnaire "Perception of humanized nursing care behaviors (PCHE) Clinicountry - 3rd version. for the analysis of the data, measures of central tendency and dispersion, absolute and relative frequencies were used.Results: 175 users of public hospitals in the province of Corrientes were surveyed, the mean age was 45.69 years (SD= 16.97 years), 64.4% are female. In relation to the general analysis of the perception of humanized care behaviors in users of health services treated in public hospitals, it was observed that 131 (74.9%) users perceived the behavior positively.Conclusion: It was possible to describe that the perception of the behavior of humanized nursing care in the public hospitals of Corrientes was positive in the majority of the users, dimensions hat require strategies to improve care were identified[AU]

Diante do risco de desumanização no atendimento ao paciente, devido à grande reestruturação administrativa da maioria dos sistemas de saúde do mundo, é necessário resgatar o aspecto humano, espiritual e transpessoal.Objetivo: descrever a percepção dos usuários sobre condutas de atendimento humanizado em hospitais públicos de Corrientes no ano de 2022.Metodologia: Realizou-se um estudo descritivo e transversal, pesquisando usuários atendidos em hospitais públicos da Província de Corrientes, utilizando o questionário "Percepção de condutas de cuidado humanizado de enfermagem (PCHE) Clinicountry - 3ª versão. para a análise dos dados, foram utilizadas medidas de tendência central e dispersão, frequências absolutas e relativas.Resultados: foram pesquisados 175 usuários de hospitais públicos da província de Corrientes, a idade média foi de 45,69 anos (DP= 16,97 anos), 64,4% são mulheres. Em relação à análise geral da percepção de comportamentos de cuidado humanizado em usuários de serviços de saúde atendidos em hospitais públicos, observou-se que 131 (74,9%) usuários perceberam o comportamento de forma positiva.Conclusão: Foi possível descrever que a percepção do comportamento de cuidado humanizado de enfermagem nos hospitais públicos de Corrientes foi positiva na maioria dos usuários, foram identificadas dimensões que requerem estratégias para melhorar o cuidado[AU]

Expectativas de madres adolescentes sobre el desarrollo de sus hijos prematuros. Corrientes 2022 / Teen mothers' expectations about their premature infant's development. Corrientes 2022

Describir las expectativas de las madres adolescentes sobre el desarrollo de sus hijos prematuros asistidos en maternidad pública de Corrientes capital, año 2022. Metodología: Cuantitativa, descriptiva y transversal; población: madres adolescentes con hijos prematuros internados en neonatología; recolección de datos mediante formulario validado. Resultados: Se estudiaron 62 madres adolescentes; edades 13 a 19 años, promedio 17±1,6; 73% adolescentes tardías. Sobre sus ideas respecto al desarrollo motor grueso sólo 31% tenían expectativas adecuadas al calendario evolutivo. En ideas sobre la habilidad para caminar el 32% expresó expectativas adecuadas; distribuidas por grupo etario, las ideas sobre capacidad de caminar fueron adecuadas en 18% de adolescentes tempranas y 46% de tardías. La capacidad de correr no mostró diferencias de importancia entre las madres tempranas y las tardías. Sobre control de esfínteres, 29% de adolescentes tempranas y 33% de las tardías tenían expectativas adecuadas. En desarrollo motor fino, 45% de las madres tenían expectativas adecuadas, sin mostrar diferencias importantes según grupos etarios maternos. En habilidad de apilar cubos, 35% de las adolescentes tempranas referían ideas adecuadas al calendario, lo que fue algo menor en las tardías (29%). Sobre el lenguaje 36% de las madres tenían expectativas adecuadas; con 21% en las tempranas y 35% en las tardías. Sobre silabeo, ideas adecuadas en 18% en adolescentes tempranas y 24% en tardías. Respecto a desarrollo afectivo, 48% de las madres expresaron ideas adecuadas; lo que alcanzó a 23% en las tempranas y 58% en tardías. Conclusión: gran parte de las madres adolescentes tienen expectativas no adecuadas al desarrollo de sus hijos prematuros, entrelazadas con ideas desajustadas al calendario evolutivo. Expectativas sobre desarrollo motor grueso, fino, lenguaje y afectivo varían según grupos etarios maternos, con ideas menos ajustadas a lo que debería suceder en adolescentes tempranas al compararlas con las tardías[AU]

Describe the expectations of adolescent mothers regarding the development of their premature children assisted in a public maternity hospital in Corrientes capital, year 2022. Methodology: quantitative, descriptive and cross-sectional; population: adolescent mothers with premature children hospitalized in neonatology; data collection through validated form. Results: 62 adolescent mothers were studied; ages 13 to 19 years, mean 17±1.6; 73% late adolescents. Regarding their ideas regarding gross motor development, only 31% had adequate expectations to the evolutionary calendar. In ideas about walking ability, 32% expressed adequate expectations. According to age group, ideas about walking ability were adequate in 18% of early adolescents and 46% of late adolescents. The ability to run did not show important differences between the early and late ones. About sphincter control, 29% of early adolescents had adequate expectations and 33% in late ones. In fine motor development, 45% of the mothers 76had adequate expectations, without showing significant differences according to maternal age groups. In the ability to stack cubes, 35% of early adolescents had ideas appropriate to the calendar and it was 29% of late adolescents. Regarding language, 36% of the mothers had adequate expectations; with 21% in the early ones and 35% in the late ones. About syllabication, adequate ideas in 18% in early adolescents and 24% in late adolescents. Regarding affective development, 48% of the mothers expressed adequate ideas; which reached 23% in the early ones and 58% in the late ones. Conclusion: a large part of adolescent mothers have inadequate expectations for the development of their premature children, intertwined with ideas that are not adjusted to the evolutionary calendar. Expectations regarding gross, fine, language, and affective motor development vary according to maternal age groups, with ideas less adjusted to what should happen in early adolescents when compared to late adolescents[AU]

Descrever as expectativas das mães adolescentes quanto ao desenvolvimento de seus filhos prematuros atendidos em uma maternidade pública de Corrientes capital, ano 2022. Metodologia: quantitativa, descritiva e transversal; população: mães adolescentes com filhos prematuros internados em neonatologia; coleta de dados por meio de formulário validado. Resultados: foram estudadas 62 mães adolescentes; idade de 13 a 19 anos, média de 17±1,6; 73% adolescentes tardios. Em relação às suas ideias sobre o desenvolvimento motor grosso, apenas 31% tinham expectativas adequadas ao calendário evolutivo. Nas ideias sobre a capacidade de caminhar, 32% expressaram expectativas adequadas. De acordo com a faixa etária, as ideias sobre a capacidade de andar eram adequadas em 18% dos adolescentes iniciais e 46% dos adolescentes tardios. A capacidade de correr não apresentou diferenças importantes entre os precoces e tardios. Sobre o controle esfincteriano, 29% dos adolescentes iniciais apresentaram expectativas adequadas e 33% dos tardios. No desenvolvimento motor fino, 45% das mães tiveram expectativas adequadas, sem apresentar diferenças significativas de acordo com as faixas etárias maternas. Na capacidade de empilhar cubos, 35% dos adolescentes iniciais tiveram ideias adequadas ao calendário e 29% dos adolescentes tardios. Em relação à linguagem, 36% das mães tiveram expectativas adequadas; com 21% nas precoces e 35% nas tardias. Sobre a silabação, ideias adequadas em 18% no início da adolescência e 24% no final da adolescência. Quanto ao desenvolvimento afetivo, 48% das mães expressaram ideias adequadas; que chegou a 23% nas precoces e 58% nas tardias. Conclusão: grande parte das mães adolescentes apresenta expectativas inadequadas para o desenvolvimento de seus filhos prematuros, entremeadas por ideias que não se ajustam ao calendário evolutivo. As expectativas quanto ao desenvolvimento motor grosso, fino, de linguagem e afetivo variam de acordo com as faixas etárias maternas, com ideias menos ajustadas ao que deveria acontecer no início da adolescência quando comparadas com a adolescência tardia[AU]

Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis.

Pain generator-based lumbar spinal decompression surgery is the backbone of modern spine care. In contrast to traditional image-based medical necessity criteria for spinal surgery, assessing the severity of neural element encroachment, instability, and deformity, staged management of common painful degenerative lumbar spine conditions is likely to be more durable and cost-effective. Targeting validated pain generators can be accomplished with simplified decompression procedures associated with lower perioperative complications and long-term revision rates. In this perspective article, the authors summarize the current concepts of successful management of spinal stenosis patients with modern transforaminal endoscopic and translaminar minimally invasive spinal surgery techniques. They represent the consensus statements of 14 international surgeon societies, who have worked in collaborative teams in an open peer-review model based on a systematic review of the existing literature and grading the strength of its clinical evidence. The authors found that personalized clinical care protocols for lumbar spinal stenosis rooted in validated pain generators can successfully treat most patients with sciatica-type back and leg pain including those who fail to meet traditional image-based medical necessity criteria for surgery since nearly half of the surgically treated pain generators are not shown on the preoperative MRI scan. Common pain generators in the lumbar spine include (a) an inflamed disc, (b) an inflamed nerve, (c) a hypervascular scar, (d) a hypertrophied superior articular process (SAP) and ligamentum flavum, (e) a tender capsule, (f) an impacting facet margin, (g) a superior foraminal facet osteophyte and cyst, (h) a superior foraminal ligament impingement, (i) a hidden shoulder osteophyte. The position of the key opinion authors of the perspective article is that further clinical research will continue to validate pain generator-based treatment protocols for lumbar spinal stenosis. The endoscopic technology platform enables spine surgeons to directly visualize pain generators, forming the basis for more simplified targeted surgical pain management therapies. Limitations of this care model are dictated by appropriate patient selection and mastering the learning curve of modern MIS procedures. Decompensated deformity and instability will likely continue to be treated with open corrective surgery. Vertically integrated outpatient spine care programs are the most suitable setting for executing such pain generator-focused programs.

Effect of chitosan with different molecular weights on the antifungal activity against Colletotrichum gloeosporioides and activation of the non-enzymatic antioxidant system on infected papaya.

Chitosan (Ch) is a biopolymer with excellent antimicrobial and antioxidant properties, capable of maintaining the organoleptic quality of fruits. These properties have been related to its molecular weight. However, the effect of different molecular weights on the non-enzymatic antioxidant system and postharvest quality of anthracnose-infected papaya is still unknown. Therefore, this study evaluated the effect of different Ch molecular weights (13, 25, and 55 kDa) on anthracnose development, antioxidant capacity, and postharvest quality of papaya. The Ch-55, Ch-25, and 13 kDa inhibited the development of Colletotrichum gloeosporioides. In comparison with thiabendazole, Ch with different molecular weights showed fungicidal effects. Ch-55 kDa reduced anthracnose incidence and severity and maintained postharvest quality parameters of papaya. In addition, Ch-55 and Ch-13 kDa favored synthesis of ascorbic acid, total phenolics, and antioxidant capacity. Therefore, Ch-55 kDa is an alternative to the protection against C. gloeosporioides and a stimulant of the non-enzymatic antioxidant system in papaya fruits during its postharvest storage. PRACTICAL APPLICATION: Ch with different molecular weights have different effects over anthracnose control and postharvest quality in papaya. In addition, they have different stimulation levels on the non-enzymatic antioxidant system of papaya fruits, in a higher level than the chemical fungicide TBZ, by regulating the growth of the fungus and the degradative processes that are generated in fungal infection. In this sense, we believe that our findings could be of interest for producers and farmers to take advantage of this biopolymer to control anthracnose, preserve the postharvest quality, and stimulate the non-enzymatic antioxidant system of papaya fruit.

Time to surgery for adolescent idiopathic scoliosis: How long does it take? A multicenter study.

Study design: Retrospective review of multicentric data. Objectives: To estimate the time from initial visit to surgery in adolescent idiopathic scoliosis (AIS) patients and the main reasons for the time to surgery in a multicenter study. Methods: This retrospective study evaluated 509 patients with AIS from 16 hospitals across six Latin American countries. From each hospital's deformity registry, the following patient data were extracted: demographics, main curve Cobb angle, Lenke Classification at the initial visit and time of surgery, time from indication-for-surgery to surgery, curve progression, Risser skeletal-maturity score and causes for surgical cancelation or delay. Surgeons were asked if they needed to change the original surgical plan due to curve progression. Data also were collected on each hospital's waiting list numbers and mean delay to AIS surgery. Results: 66.8% of the patients waited over six months and 33.9% over a year. Waiting time was not impacted by the patient's age when surgery first became indicated (p = 0.22) but waiting time did differ between countries (p < 0.001) and hospitals (p < 0.001). Longer time to surgery was significantly associated with increasing magnitude of the Cobb angle through the second year of waiting (p < 0.001). Reported causes for delay were hospital-related (48.4%), economic (47.3%), and logistic (4.2%). Oddly, waiting time for surgery did not correlate with the hospital's reported waiting-list lengths (p = 0.57). Conclusion: Prolonged waits for AIS surgery are common in Latin America, with rare exceptions. At most centers, patients wait over six months, most commonly for economic and hospital-related reasons. Whether this directly impacts surgical outcomes in Latin America still must be studied.

Características antropométricas, capacidad de salto vertical y resistencia de carrera de bomberos, en servicio activo, con relación a la edad / Anthropometric characteristics, vertical jumping capacity and running endurance, in active-duty firefighters, in relation to age

El objetivo de este estudio fue establecer relaciones entre las variables de rendimiento físico e índices antropométricos según la edad de bomberos adultos chilenos, en servicio activo, provenientes de la región de Valparaíso. Participaron 68 bomberos, hombres, sanos, en servicio activo, que fueron divididos en dos grupos según edad; 30 años (n = 32; 40,6 ± 8,5 años). Se evaluaron las variables antropométricas de masa corporal (MC), estatura, perímetro de cintura (PC), índice de masa corporal (IMC] = Peso /estatura2 [m]) e índice cintura-estatura (ICE). La capacidad de salto vertical fue evaluada con los protocolos de Squat Jump, Countermovement Jump y Abalakov Jump. La resistencia en carrera fue estimada con la prueba de Course Navette y se calculó indirectamente el consumo de oxígeno (VO2). Las variables antropométricas para el grupo > 30 años fueron mayores en comparación al grupo de menor edad en MC (p = 0.027), IMC (p = 0.015), PC (p 0.05) entre ambos grupos. Existió una correlación significativa positiva entre la edad y las variables de MC (r = 0,252), IMC (r = 0,307), ICE (r = 0,431) y PC (r= 0,401). Al comparar ambos grupos de edad hubo diferencias antropométricas, pero no en la condición física. Se sugiere reforzar programas de entrenamiento para optimizar la composición corporal y capacidad física de bomberos en servicio activo para responder a las exigentes tareas que demanda este ámbito laboral.

SUMMARY: The aim of this study was 1) to compare anthropometric characteristics, jumping ability, and running endurance according to age and 2) to determine the relationship between age and physical performance parameters in Chilean adult firefighters in active service from the Valparaíso region. Sixty-eight healthy male firefighters, in active service, were divided into two groups according to age; 30 years (n = 32; 40.6 ± 8.5 years) participated. The anthropometric variables of body mass (BM), height, waist circumference (WC), body mass index (BMI = weight/height2 [m]) and waist-to-height ratio (WHR) were evaluated. Vertical jumping ability was assessed with the Squat Jump, Countermovement Jump and Abalakov Jump protocols. Running endurance was estimated with the Course Navette test and oxygen consumption (VO2) was calculated indirectly. Anthropometric variables for the > 30 years group were higher compared to the younger age group in BM (p = 0.027), BMI (p = 0.015), WC (p 0.05). There was a significant positive correlation between age and the variables of BM (r = 0.252), BMI (r = 0.307), WHR (r = 0.431) y WC (r= 0.401). When comparing both age groups, there were anthropometric differences, but not in physical condition. It is suggested to reinforce training programs to optimize the body composition and physical capacity of firefighters in active service in order to respond to the demanding tasks demanded by this work environment.

Resilience, adverse childhood experiences, and mental health in Health Science students during the COVID-19 pandemic / Resiliencia, eventos adversos en la infancia y salud mental en estudiantes de Ciencias para la Salud en la pandemia por COVID-19

Abstract Introduction A steady rise in mental problems has been observed in the university population, particularly in the area of health, related to the COVID-19 pandemic. Protective factors such as resilience and risk factors such as adverse events in childhood have been associated with mental health outcomes. Objective Describe psychiatric symptoms and their association with adverse childhood experiences and resilience in first-semester students in the three undergraduate programs of the Faculty of Health Sciences of the University of Caldas, Colombia in 2020. Method Descriptive, cross-sectional, correlational study, using a virtual survey including the SRQ (Self Reporting Questionnaire), Wagnild and Young's Resilience Scale and questions on adverse childhood experiences. Results A total of 108 students with a mean age of 19.6 years participated in the study. Affective symptoms were found in 6.4% of subjects. The most frequent level of resilience was medium, while the most commonly reported adverse event was child abuse. An association was found between being exposed to adverse childhood experiences and the presence of symptoms that compromise mental health and alter one of the domains of resilience. A link was also found between the presence of these symptoms and the alteration of domains of resilience. Discussion and conclusion It was possible to identify a risk of mental health disorders in students, and to establish an association between adverse events in childhood and resilience.

Resumen Introducción Se ha descrito un aumento progresivo de problemas mentales en la población universitaria, especialmente en el área de la salud, relacionado con la pandemia por COVID-19. Factores protectores como la resiliencia y factores de riesgo como eventos adversos en la infancia, se han relacionado con desenlaces en la salud mental. Objetivo Describir síntomas psiquiátricos y su asociación con eventos adversos en la infancia y resiliencia, en estudiantes de primer semestre de los tres programas de pregrado de la Facultad de Ciencias para la Salud de la Universidad de Caldas, Colombia en 2020. Método Estudio descriptivo, transversal, correlacional, mediante una encuesta virtual incluyendo el SRQ (Self Reporting Questionnaire), escala de resiliencia de Wagnild y Young y preguntas relacionadas con eventos adversos en la infancia. Resultados Participaron 108 estudiantes con edad media de 19.6 años. Hubo presencia de síntomas afectivos en 6.4%. El nivel de resiliencia más frecuentemente encontrado fue "medio" y el evento adverso en la infancia más comúnmente reportado fue el maltrato. Se demostró asociación entre haber estado expuesto a eventos adversos en la infancia tanto con presencia de síntomas que comprometen la salud mental como con afectación de uno de los dominios de resiliencia. Asimismo, hubo asociación entre presencia de dichos síntomas con afectación de los dominios de la resiliencia. Discusión y conclusión Se pudo identificar riesgo de alteraciones de la salud mental en los estudiantes, resaltando la asociación con eventos adversos en la infancia y la resiliencia.

Percutaneous transhepatic biliary drainage for biliary obstruction in perihilar cholangiocarcinoma: a 10-year analysis of safety and outcomes using the CCI index.

PURPOSE: To evaluate percutaneous transhepatic biliary drainage (PTBD) safety and efficacy in patients with perihilar cholangiocarcinoma (PCCA). METHODS: This retrospective observational study included patients with PCCA and obstructive cholestasis referred for a PTBD in our institution between 2010 and 2020. Technical and clinical success rates and major complication and mortality rates one month after PTBD were used as main variables. Patients were divided and analyzed into two groups: > 30 and < 30 Comprehensive Complication Index (CCI). We also evaluated post-surgical outcomes in patients undergoing surgery. RESULTS: Out of 223 patients, 57 were included. Technical success rate was 87.7%. Clinical success at 1 week was 83.6%, before surgery 68.2%, 80.0% at 2 weeks and 86.7% at 4 weeks. Mean total bilirubin (TBIL) values were 15.1 mg/dL (baseline), 8.1 mg/dL one week after PTBD), 6.1 mg/dL (2 weeks) and 2.1 mg/dL (4 weeks). Major complication rate was 21.1%. Three patients died (5.3%). Risk factors for major complications after the statistical analysis were: Bismuth classification (p = 0.01), tumor resectability (p = 0.04), PTBD clinical success (p = 0.04), TBIL 2 weeks after PTBD (p = 0.04), a second PTBD (p = 0.01), total PTBDs (p = 0.01) and duration of drainage (p = 0.03). Major postoperative complication rate in patients who underwent surgery was 59.3%, with a median CCI of 26.2. CONCLUSION: PTBD is safe and effective in the management of biliary obstruction caused by PCCA. Bismuth classification, locally advanced tumors, and failure to achieve clinical success in the first PTBD are factors related to major complications. Our sample reported a high major postoperative complication rate, although with an acceptable median CCI.

Regulation of Cortico-Thalamic JNK1/2 and ERK1/2 MAPKs and Apoptosis-Related Signaling Pathways in PDYN Gene-Deficient Mice Following Acute and Chronic Mild Stress.

The crosstalk between the opioidergic system and mitogen-activated protein kinases (MAPKs) has a critical role in mediating stress-induced behaviors related to the pathophysiology of anxiety. The present study evaluated the basal status and stress-induced alterations of cortico-thalamic MAPKs and other cell fate-related signaling pathways potentially underlying the anxiogenic endophenotype of PDYN gene-deficient mice. Compared to littermates, PDYN knockout (KO) mice had lower cortical and or thalamic amounts of the phospho-activated MAPKs c-Jun N-terminal kinase (JNK1/2) and extracellular signal-regulated kinase (ERK1/2). Similarly, PDYN-KO animals displayed reduced cortico-thalamic densities of total and phosphorylated (at Ser191) species of the cell fate regulator Fas-associated protein with death domain (FADD) without alterations in the Fas receptor. Exposure to acute restraint and chronic mild stress stimuli induced the robust stimulation of JNK1/2 and ERK1/2 MAPKs, FADD, and Akt-mTOR pathways, without apparent increases in apoptotic rates. Interestingly, PDYN deficiency prevented stress-induced JNK1/2 and FADD but not ERK1/2 or Akt-mTOR hyperactivations. These findings suggest that cortico-thalamic MAPK- and FADD-dependent neuroplasticity might be altered in PDYN-KO mice. In addition, the results also indicate that the PDYN gene (and hence dynorphin release) may be required to stimulate JNK1/2 and FADD (but not ERK1/2 or Akt/mTOR) pathways under environmental stress conditions.

Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study.

STUDY DESIGN: Multicentric retrospective study, Level of evidence III. OBJECTIVE: The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. METHODS: Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. RESULTS: 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively (P 0.0001). CONCLUSION: The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay.

Safety and efficacy of RFA versus MWA for T1a renal cell carcinoma: a propensity score analysis.

OBJECTIVES: Percutaneous radiofrequency ablation (RFA) is stated as a treatment option for renal cell carcinoma (RCC) smaller than 4 cm (T1a). Microwave ablation (MWA) is a newer technique and is still considered experimental in some guidelines. The objective of this study was to compare the safety and efficacy of RFA and MWA for the treatment of RCC. METHODS: Patients with T1a RCC treated by RFA or MWA in two referral centers were retrospectively analyzed. Patient records were evaluated to generate mRENAL nephrometry scores. Local tumor progression (LTP) was considered when new (recurrence) or residual tumor enhancement within/adjacent to the ablation zone was objectified. Differences in LTP-free interval (residual + recurrence) between ablation techniques were assessed with Cox proportional hazards models and propensity score (PS) methods. RESULTS: In 164 patients, 87 RFAs and 101 MWAs were performed for 188 RCCs. The primary efficacy rate was 92% (80/87) for RFA and 91% (92/101) for MWA. Sixteen patients had residual disease (RFA (n = 7), MWA (n = 9)) and 9 patients developed recurrence (RFA (n = 7), MWA (n = 2)). LTP-free interval was significantly worse for higher mRENAL nephrometry scores. No difference in LTP-free interval was found between RFA and MWA in a model with inverse probability weighting using PS (HR = 0.99, 95% CI 0.35-2.81, p = 0.98) and in a PS-matched dataset with 110 observations (HR = 0.82, 95% CI 0.16-4.31, p = 0.82). Twenty-eight (14.9%) complications (Clavien-Dindo grade I-IVa) occurred (RFA n = 14, MWA n = 14). CONCLUSION: Primary efficacy for ablation of RCC is high for both RFA and MWA. No differences in efficacy and safety were observed between RFA and MWA. KEY POINTS: • Both RFA and MWA are safe and effective ablation techniques in the treatment of T1a renal cell carcinomas. • High modified RENAL nephrometry scores are associated with shorter local tumor progression-free interval. • MWA can be used as heat-based ablation technique comparable to RFA for the treatment of T1a renal cell carcinomas.

One-year mortality after hip fracture surgery: urban-rural differences in the Colombian Andes.

To determine urban-rural differences influencing mortality in patients with hip fracture in Colombian Andes Mountains over a 1-year period. PURPOSE: To identify the urban-rural differences of sociodemographic variables, fracture-related characteristics, and preoperative and postoperative clinical factors associated with 1-year mortality in patients over 60 years old who underwent hip fracture surgery in the Andes Mountains. METHODS: A total of 126 patients with a fragility hip fracture during 2019-2020 were admitted to a tertiary care hospital. They were evaluated preoperatively and followed up until discharge. Those who survived were contacted by telephone at 1, 3, and 12 months. Univariate, bivariate, and Kaplan-Meier analyses with survival curves were performed. Relative risk was calculated with a 95% confidence interval. RESULTS: A total of 32.5% of the patients died within 1 year after surgery, with a significant difference between those who resided in rural areas (43.1%) and those who resided in urban areas (23.5%) (RR 1.70; 95% CI, 1.03 to 2.80, p = 0.036). In the multivariate analysis, anemia (hemoglobin level ≤ 9.0 g/dL during hospitalization) (RR 6.61; 95% CI, 1.49-29.37, p = 0.003), a blood transfusion requirement (RR 1.47; 95% CI, 1.07 to 2.01, p = 0.015), the type of fracture (subtrochanteric fracture (RR = 4.9, 95% CI = 1.418-16.943, p = 0.005)), and postoperative acute decompensation of chronic disease (RR 1.60; 95% CI, 1.01 to 2.53, p = 0.043) were found to be independent predictive factors of 1-year mortality after surgery. CONCLUSIONS: There was a difference in 1-year mortality between patients from rural and urban areas. More studies must be conducted to determine whether rurality behaves as an independent risk factor or is related to other variables, such as the burden of comorbidities and in-hospital complications.

Single-Use or Disposable Flexible Bronchoscopy in Advanced Bronchoscopy Procedures: Experience in a Quaternary Referral Centre.

BACKGROUND: The development of single-use flexible or disposable bronchoscopes (SUFBs) has accelerated in recent years, with the reduced risk of infectious transmission and reduced need for endoscopy staffing particularly advantageous in the COVID-19 pandemic era. OBJECTIVE: The objective of this study was to assess the performance of a novel single-use bronchoscope in an academic quaternary referral centre with on-site interventional pulmonology programme. METHODS: With ethical approval in a quaternary referral centre, we prospectively collected data on sequential bronchoscopy procedures using The Surgical Company Broncoflex© range of SUFBs. Data collected included demographic, procedural, scope performance, user satisfaction, and complication parameters in a tertiary bronchoscopy service. RESULTS: 139 procedures were performed by five pulmonology faculty from January to July 2021. The majority were carried out for infection (45%) and malignancy (32%). Most were performed in the endoscopy suite and 8% were COVID positive or suspected. Most procedures reported the highest score in satisfaction (85%) with technical limitations reported in 15% (predominately related to scope suction or inadequate image quality) reverting to a reusable scope in 2.8 %. CONCLUSION: In our subset of patients in a bronchoscopy unit, SUFBs are safe, and both routine and advanced bronchoscopy procedures can be performed with high satisfaction reported.