Guía mexicana para el diagnóstico y el tratamiento del hemangioma infantil.

Infantile hemangioma is a benign vascular tumor, the most common in childhood, whose natural evolution is the disappearance of the lesion in the pediatric age and which has effective and safe treatments that limit its growth and favor its disappearance at younger ages. Infantile hemangioma continues to be a reason for attention to complications, due to erroneous diagnoses, lack of knowledge of the condition, late referral or fear of the effects of the medications used for its treatment. Furthermore, its presence is normalized without taking into account that it can cause uncertainty, anxiety, feelings of guilt and, as a consequence, a significant impact on the quality of life, mainly in the parents or caregivers of the child. The need for a clinical practice guideline in our country arises from the high presentation of late-remitted complications in infantile hemangioma even with the availability of adequate treatments, the continuous evolution of medicine and the appearance of new evidence. Throughout the guide you will find recommendations regarding the diagnosis, treatment and follow-up of patients with infantile hemangioma, taking into account the paraclinical tests that can be performed, topical or systemic management options, as well as adjuvant therapies. For the first time, objective tools for patient follow-up are included in a guide for the management of infantile hemangioma, as well as to help the first contact doctor in timely referral.

El hemangioma infantil es un tumor vascular benigno, el más frecuente de la infancia, cuya evolución natural favorece la desaparición de la lesión en la misma edad pediátrica y que cuenta con tratamientos eficaces y seguros que limitan su crecimiento y favorecen su desaparición a edades más tempranas. Continúa siendo motivo de atención de complicaciones, debido a diagnósticos erróneos, desconocimiento del padecimiento, referencia tardía o temor de los efectos de los fármacos utilizados para su tratamiento. Además, se normaliza su presencia sin tomar en cuenta que puede llegar a causar incertidumbre, ansiedad, sentimientos de culpa y, como consecuencia, importante afectación de la calidad de vida, principalmente en los padres o cuidadores del niño. La necesidad de una guía de práctica clínica en nuestro país surge ante la alta presentación de complicaciones del hemangioma infantil referidas de manera tardía aun con la disponibilidad de tratamientos adecuados, la evolución continua de la medicina y la aparición de nueva evidencia. A lo largo de la guía se encontrarán recomendaciones en relación con el diagnóstico, el tratamiento y el seguimiento de los pacientes con hemangioma infantil, tomando en cuenta los paraclínicos que pueden realizarse, las opciones de manejo tópico o sistémico, y las terapias adyuvantes. Por primera vez se incluyen en una guía para el manejo del hemangioma infantil herramientas objetivas para el seguimiento de los pacientes, así como para ayudar al médico de primer contacto en su referencia oportuna.

Parallel Algorithm for Discovering and Comparing Three-Dimensional Proteins Patterns.

Identifying conserved (similar) three-dimensional patterns among a set of proteins can be helpful for the rational design of polypharmacological drugs. Some available tools allow this identification from a limited perspective, only considering the available information, such as known binding sites or previously annotated structural motifs. Thus, these approaches do not look for similarities among all putative orthosteric and or allosteric bindings sites between protein structures. To overcome this tech-weakness Geomfinder was developed, an algorithm for the estimation of similarities between all pairs of three-dimensional amino acids patterns detected in any two given protein structures, which works without information about their known patterns. Even though Geomfinder is a functional alternative to compare small structural proteins, it is computationally unfeasible for the case of large protein processing and the algorithm needs to improve its performance. This work presents several parallel versions of the Geomfinder to exploit SMPs, distributed memory systems, hybrid version of SMP and distributed memory systems, and GPU based systems. Results show significant improvements in performance as compared to the original version and achieve up to 24.5x speedup when analyzing proteins of average size and up to 95.4x in larger proteins.

A Family with EEC Syndrome in the Son and ADULT Syndrome in His Father Caused by the c.797G>A (p.Arg266Gln) Pathogenic Variant in the TP63 Gene.

Introduction: To our knowledge, there are few examples of intrafamilial variability involving two different TP63-linked morphopathies within a same family. Here, we describe a Mexican family in which the son had ectrodactyly, ectodermal dysplasia, and cleft lip/palate syndrome 3 (EEC3), and his father acro-dermato-ungual-lacrimal-tooth (ADULT) syndrome, both heterozygous for the p.Arg266Gln pathogenic variant in TP63. Additionally, we reviewed the clinical information reported for this TP63 genotype. Case Presentation: The son of this family presented ectodermal defects (thin and sparse hair, mild nail dysplasia), tetramelic ectrodactyly, syndactyly, and nasolacrimal duct obstruction (NLDO), indicative of an EEC3 diagnosis. His father, however, exhibited severe NLDO, facial freckling, dental abnormalities, mild nail dysplasia, and a history of micturition problems, compatible with ADULT syndrome. Both were heterozygous for the NM_003722.5(TP63):c.797G>A (p.Arg266Gln) pathogenic variant in TP63. Discussion: This report expands the spectrum of intrafamilial variability confirming that this can include the expression of distinct types of TP63-related disorders among different members of the same family, whose implications should be also considered in genetic counseling. From our review, we observed that p.Arg266Gln variant seems to correlate particularly with the presence of NLDO, sparse hair/eyebrows, ridged/dystrophic nails, anodontia/hypodontia, and micturition difficulties, as well as for a minor frequency of cleft lip/cleft palate.

Comparative Study of Predictive Models for the Detection of Patients at High Risk of Inadequate Colonic Cleansing.

Background: Various predictive models have been published to identify outpatients with inadequate colonic cleansing who may benefit from intensified preparations to improve colonoscopy quality. The main objective of this study was to compare the accuracy of three predictive models for identifying poor bowel preparation in outpatients undergoing colonoscopy. Methods: This cross-sectional study included patients scheduled for outpatient colonoscopy over a 3-month period. We evaluated and compared three predictive models (Models 1-3). The quality of colonic cleansing was assessed using the Boston Bowel Preparation Scale. We calculated the area under the curve (AUC) and the corresponding 95% confidence interval for each model. Additionally, we performed simple and multiple logistic regression analyses to identify variables associated with inadequate colonic cleansing and developed a new model. Results: A total of 649 consecutive patients were included in the study, of whom 84.3% had adequate colonic cleansing quality. The AUCs of Model 1 (AUC = 0.67, 95% CI [0.63-0.70]) and Model 2 (AUC = 0.62, 95% CI [0.58-0.66]) were significantly higher than that of Model 3 (AUC = 0.54, 95% CI [0.50-0.58]; p < 0.001). Moreover, Model 1 outperformed Model 2 (p = 0.013). However, the new model did not demonstrate improved accuracy compared to the older models (AUC = 0.671). Conclusions: Among the three compared models, Model 1 showed the highest accuracy for predicting poor bowel preparation in outpatients undergoing colonoscopy and could be useful in clinical practice to decrease the percentage of inadequately prepared patients.

Agreement between the perception of colon cleansing reported by patients and colon cleansing assessed by a validated colon cleansing scale.

AIMS: Patients' perception of their cleansing quality can guide strategies to improve cleansing during colonoscopy. There are no studies assessing the agreement between the quality of cleansing perceived by patients and cleansing quality assessed during colonoscopy using validated bowel preparation scales. The main aim of this study was to compare the cleansing quality reported by patients with the quality during colonoscopy using the Boston Bowel Preparation Scale (BBPS). PATIENTS AND METHODS: Consecutive patients referred to an outpatient colonoscopy were included. Four drawings representing different degrees of cleansing were designed. Patients chose the drawing that most resembled the last stool. The predictive ability of the patient's perception and agreement between the patient's perception and the BBPS were calculated. A BBPS score of <2 points in any segment was considered inadequate. RESULTS: Six hundred and thirty-three patients were included (age: 62.8±13.7 years, male: 53.4%). Overall, 107 patients (16.9%) had inadequate cleansing during colonoscopy, and in 12.2% of cases, the patient's perception was poor. The patient's perception compared to the quality of cleanliness during colonoscopy presented a positive and negative predictive value of 54.6% and 88.3%, respectively. The agreement between patient perception and the BBPS was significant (P<0.001), although fair (k=0.37). The results were similar in a validation cohort of 378 patients (k=0.41). CONCLUSIONS: The cleanliness perceived by the patient and the quality of cleanliness using a validated scale were correlated, although fair. However, this measure satisfactorily identified patients with adequate preparation. Cleansing rescue strategies may target patients who self-report improper cleaning. Registration number of the trial: NCT03830489.

Design and validation of an artificial intelligence system to detect the quality of colon cleansing before colonoscopy.

BACKGROUND AND AIMS: Patients' perception of their bowel cleansing quality may guide rescue cleansing strategies before colonoscopy. The main aim of this study was to train and validate a convolutional neural network (CNN) for classifying rectal effluent during bowel preparation intake as "adequate" or "inadequate" cleansing before colonoscopy. PATIENTS AND METHODS: Patients referred for outpatient colonoscopy were asked to provide images of their rectal effluent during the bowel preparation process. The images were categorized as adequate or inadequate cleansing based on a predefined 4-picture quality scale. A total of 1203 images were collected from 660 patients. The initial dataset (799 images), was split into a training set (80%) and a validation set (20%). The second dataset (404 images) was used to develop a second test of the CNN accuracy. Afterward, CNN prediction was prospectively compared with the Boston Bowel Preparation Scale (BBPS) in 200 additional patients who provided a picture of their last rectal effluent. RESULTS: On the initial dataset, a global accuracy of 97.49%, a sensitivity of 98.17% and a specificity of 96.66% were obtained using the CNN model. On the second dataset, an accuracy of 95%, a sensitivity of 99.60% and a specificity of 87.41% were obtained. The results from the CNN model were significantly associated with those from the BBPS (P<0.001), and 77.78% of the patients with poor bowel preparation were correctly classified. CONCLUSION: The designed CNN is capable of classifying "adequate cleansing" and "inadequate cleansing" images with high accuracy.

Antibacterial and Cytotoxic Study of Hybrid Films Based on Polypropylene and NiO or NiFe2O4 Nanoparticles.

This study presents an in vitro analysis of the bactericidal and cytotoxic properties of hybrid films containing nickel oxide (NiO) and nickel ferrite (NiFe2O4) nanoparticles embedded in polypropylene (PP). The solvent casting method was used to synthesize films of PP, PP@NiO, and PP@NiFe2O4, which were characterized by different spectroscopic and microscopic techniques. The X-ray diffraction (XRD) patterns confirmed that the small crystallite sizes of NiO and NiFe2O4 NPs were maintained even after they were incorporated into the PP matrix. From the Raman scattering spectroscopy data, it was evident that there was a significant interaction between the NPs and the PP matrix. Additionally, the Scanning Electron Microscopy (SEM) analysis revealed a homogeneous dispersion of NiO and NiFe2O4 NPs throughout the PP matrix. The incorporation of the NPs was observed to alter the surface roughness of the films; this behavior was studied by atomic force microscopy (AFM). The antibacterial properties of all films were evaluated against Pseudomonas aeruginosa (ATCC®: 43636™) and Staphylococcus aureus (ATCC®: 23235™), two opportunistic and nosocomial pathogens. The PP@NiO and PP@ NiFe2O4 films showed over 90% bacterial growth inhibition for both strains. Additionally, the effects of the films on human skin cells, such as epidermal keratinocytes and dermal fibroblasts, were evaluated for cytotoxicity. The PP, PP@NiO, and PP@NiFe2O4 films were nontoxic to human keratinocytes. Furthermore, compared to the PP film, improved biocompatibility of the PP@NiFe2O4 film with human fibroblasts was observed. The methodology utilized in this study allows for the production of hybrid films that can inhibit the growth of Gram-positive bacteria, such as S. aureus, and Gram-negative bacteria, such as P. aeruginosa. These films have potential as coating materials to prevent bacterial proliferation on surfaces.

Cranial and extracranial giant cell arteritis do not exhibit differences in the IL6 -174 G/C gene polymorphism.

OBJECTIVES: Since interleukin-6 (IL-6) is a pivotal proinflammatory cytokine implicated in the pathogenesis of giant cell arteritis (GCA), we aimed to determine the potential association of the functional IL6 -174 G/C polymorphism with GCA as well as if the single base change variation at the promoter region in the human IL-6 gene may account for differences in the clinical spectrum of GCA between cranial and extracranial large vessel vasculitis (LVV)-GCA. METHODS: The IL6 -174 G/C polymorphism (rs1800795) was genotyped in 191 patients with biopsy-proven GCA who had typical cranial manifestations of the disease, 109 patients with extracranial LVV-GCA, without cranial ischaemic manifestations of GCA, and 877 ethnically matched unaffected controls. A comparative study was carried out between patients with cranial and extracranial LVV-GCA and controls. RESULTS: No significant differences in genotype and allele frequencies of IL6 -174 G/C polymorphism were found between the whole cohort of GCA patients and healthy controls. It was also the case when cranial and extracranial LVV-GCA were compared or when each of these subgroups was compared to controls. Moreover, no significant results in genotype and allele frequencies of IL6 -174 G/C polymorphism were disclosed when the whole cohort of GCA patients were stratified according to the presence of polymyalgia rheumatica, severe ischaemic manifestations, including permanent visual loss and peripheral arteriopathy, and HLA-DRB1*04:01 status. CONCLUSIONS: Our results show that the IL6 -174 G/C polymorphism does not influence the phenotypic expression of GCA.

Patients with hepatocellular carcinoma that die during the first year of liver transplantation have high blood sFasL concentrations.

BACKGROUND: Fas ligand (FasL) is one ligand that activates extrinsic apoptosis pathway. High expression in lymphocytes of FasL have been found in patients with acute rejection of liver transplantation (LT). No high blood concentrations of soluble FasL (sFasL) have been found in patients with acute LT rejection; however, the samples size of those studies was small. AIM: To determine whether patients with hepatocellular carcinoma (HCC) that dead during the first year of LT have higher blood sFasL concentrations previously to LT that those who that remain alive in a study of higher sample size. METHODS: Patients underwent LT due to HCC were included in this retrospective study. Serum sFasL levels prior to LT were measured and one-year LT mortality was registered. RESULTS: Non-surviving patients (n = 14) showed higher serum sFasL levels [477 (269-496) vs 85 (44-382) pg/mL; P < 0.001] than surviving patients (n = 113). Serum sFasL levels (pg/mL) were associated with mortality (OR = 1.006; 95%CI = 1.003-1.010; P = 0.001) independently of age of LT donor in the logistic regression analysis. CONCLUSION: We report for the first time that HCC patients who die within the first year of HT have higher blood sFasL concentrations prior to HT than those who remain alive.

Serum Fas levels during first week of sepsis are associated with severity and mortality.

INTRODUCTION: The aim of our study was to explore whether there is an association of serum sFas (cell death apoptosis receptor) concentrations during the first week of sepsis with sepsis severity and sepsis mortality. METHODS: In this observational study, septic patients were recruited. Serum sFas concentrations were determined on days 1, 4, and 8 of sepsis diagnosis. Thirty-day mortality was the outcome variable. RESULTS: Surviving patients (n = 181) compared to non-survivors (n = 101) presented lower serum sFas levels on day 1 (p < 0.001), day 4 (p < 0.001) and day 8 (p < 0.001), and lower SOFA on day 1 (p < 0.001), day 4 (p < 0.001) and day 8 (p < 0.001). Logistic regression analyses showed associations between 30-day mortality and serum sFas levels controlling for SOFA on day 1 (OR = 1.005; 95% CI = 1.003-1.007; p < 0.001), day 4 (OR = 1.044; 95% CI = 1.029-1.060; p < 0.001) and day 8 (OR = 1.012; 95% CI = 1.002-1.022; p = 0.02). CONCLUSIONS: The association of serum sFas concentrations during the first week of sepsis with sepsis severity and sepsis mortality were our new findings.

Usefulness of a novel computer-aided detection system for colorectal neoplasia: a randomized controlled trial.

BACKGROUND AND AIMS: Artificial intelligence-based computer-aid detection (CADe) devices have been recently tested in colonoscopies, increasing the adenoma detection rate (ADR), mainly in Asian populations. However, evidence for the benefit of these devices in the occidental population is still low. We tested a new CADe device, namely, ENDO-AID (OIP-1) (Olympus, Tokyo, Japan), in clinical practice. METHODS: This randomized controlled trial included 370 consecutive patients who were randomized 1:1 to CADe (n = 185) versus standard exploration (n = 185) from November 2021 to January 2022. The primary endpoint was the ADR. Advanced adenoma was defined as ≥10 mm, harboring high-grade dysplasia, or with a villous pattern. Otherwise, the adenoma was nonadvanced. ADR was assessed in both groups stratified by endoscopist ADR and colon cleansing. RESULTS: In the intention-to-treat analysis, the ADR was 55.1% (102/185) in the CADe group and 43.8% (81/185) in the control group (P = .029). Nonadvanced ADRs (54.8% vs 40.8%, P = .01) and flat ADRs (39.4 vs 24.8, P = .006), polyp detection rate (67.1% vs 51%; P = .004), and number of adenomas per colonoscopy were significantly higher in the CADe group than in the control group (median [25th-75th percentile], 1 [0-2] vs 0 [0-1.5], respectively; P = .014). No significant differences were found in serrated ADR. After stratification by endoscopist and bowel cleansing, no statistically significant differences in ADR were found. CONCLUSIONS: Colonoscopy assisted by ENDO-AID (OIP-1) increases ADR and number of adenomas per colonoscopy, suggesting it may aid in the detection of colorectal neoplastic lesions, especially because of its detection of diminutive and flat adenomas. (Clinical trial registration number: NCT04945044.).

Cranial and extracranial large-vessel giant cell arteritis share a genetic pattern of interferon-gamma pathway.

OBJECTIVES: Two main different clinical phenotypes of giant cell arteritis (GCA) have been described, the classic cranial pattern and the extracranial large-vessel (LV) pattern. Since interferon gamma (IFNG) has shown to be a pivotal cytokine in the pathophysiology of GCA, our aim was to evaluate for the first time the influence of IFNG and IFNG receptor 1 (IFNGR1) polymorphisms in the different clinical phenotypes of GCA. METHODS: Two IFNG polymorphisms (rs2069718 G/A and rs1861493 A/G) and one polymorphism in IFNGR1 (rs1327474 G/A) were genotyped in 191 patients with biopsy-proven cranial GCA, 109 with extracranial LV-GCA and 490 healthy controls. A comparative study was conducted between patients with cranial and extracranial LV-GCA. RESULTS: No significant differences in genotype, allele, and haplotype frequencies of IFNG polymorphisms were found between GCA patients with the classic cranial pattern and the extracranial LV-GCA pattern. Similar results were found for genotype and allele frequencies of IFNGR1 polymorphism. It was also the case when patients with extracranial LV-GCA were compared with healthy controls. CONCLUSIONS: Our results show that IFNG and IFNGR1 polymorphisms do not influence the clinical phenotype of expression of GCA. Classic cranial GCA and extracranial LV-GCA seem to share a genetic pattern of IFNG pathway.

Estudio de cohorte para evaluar la asociación entre el tiempo de inicio de nutrición con días de ventilación mecánica invasiva en pacientes con choque séptico / Cohort study to evaluate the association between the start time of nutrition with days of invasive mechanical ventilation in patients with septic shock / Estudo de coorte para avaliar a associação entre o tempo de início da nutrição com os dias de ventilação mecânica invasiva em pacientes com choque séptico

Resumen: Introducción: estudio de cohorte para evaluar la asociación entre el tiempo de inicio de nutrición con los días de ventilación mecánica invasiva (VMI) en pacientes con choque séptico. La ventilación mecánica (VM) es un soporte que mantiene al paciente mientras la lesión estructural o funcional por la que se indicó se corrige. La sepsis es una causa de disfunción diafragmática que contribuye a insuficiencia respiratoria; sin embargo, se dispone de pocos datos sobre la interacción entre sepsis y VM prolongada. Actualmente, aunque la nutrición se ha establecido como un pilar de apoyo y tratamiento en pacientes críticamente enfermos, el impacto de esta intervención es poco clara. Objetivo: verificar la existencia de la asociación entre el tiempo de inicio de la nutrición y la duración de la VMI en pacientes con choque séptico. Material y métodos: se realizó un estudio de cohorte prolectivo en pacientes con choque séptico y VMI, se documentó el tiempo de inicio de la nutrición, esta decisión fue independiente del estudio. Se dio seguimiento diario con respecto a los días que requirieron VMI y el inicio de nutrición enteral o parenteral. La nutrición temprana es cuando se inicia en las primeras 48 horas del ingreso a terapia intensiva. Se empleó Stata para el análisis estadístico, en el cual se utilizaron pruebas χ2 y regresión logística. Resultados: se incluyeron 131 pacientes con choque séptico y VMI, a 110 pacientes se les inició nutrición temprana y a 21 nutrición tardía. La edad promedio fue de 69 años, 23% (31) del total de los pacientes tenía diabetes mellitus (DM), que se presentó con mayor frecuencia en el grupo de nutrición tardía. En cuanto a la gravedad, no se encontró diferencia entre ambos grupos. La duración promedio con ventilación fue de dos días, con mayor tiempo en el grupo de inicio tardío de la nutrición (dos días vs cinco días, p = 0.012). No obstante, al ajustar por regresión logística, no se encontró diferencia estadísticamente significativa (OR 0.13, IC 95% 0.14-1.17, p = 0.69). Conclusiones: aunque la nutrición se considera un pilar de apoyo necesario en todo paciente crítico, de acuerdo con nuestros resultados, el momento de inicio no afecta directamente los días de VMI.

Abstract: Introduction: cohort study to evaluate the association between the start time of nutrition with the days of invasive mechanical ventilation (IMV) in patients with septic shock. Mechanical ventilation (MV) is a support that maintains the patient while the structural or functional injury for which it was indicated is corrected. Sepsis is a cause of diaphragmatic dysfunction, contributing to respiratory failure; however, few data are available on the interaction between sepsis and prolonged MV. Currently, although nutrition has been established as a mainstay of support and treatment in critically ill patients, the impact of this intervention is unclear. Objective: to verify the existence of the association between the start time of nutrition and the duration of IMV in patients with septic shock. Material and methods: a prolective cohort study was carried out in patients with septic shock and IMV was documented at the start of nutrition, this decision being independent of the study. Daily follow-up was given regarding the days that required IMV and the start of enteral or parenteral nutrition. Early nutrition is when it is started within the first 48 hours of admission to intensive care. Stata was used for statistical analysis in which χ2 tests and logistic regression were used. Results: 131 patients with septic shock and IMV were included, 110 patients started early nutrition and 21 delayed nutrition. The average age was 69 years, 23% (31) of the total patients had diabetes mellitus (DM), presenting more frequently in the late nutrition group. Regarding severity, no difference was found between the two groups. The average duration with ventilation was two days, with a longer time in the late start of nutrition group (2 days vs 5 days, p = 0.012). However, when adjusting for logistic regression, no statistically significant difference was found (OR 0.13, CI 95% 0.14-1.17, p = 0.69). Conclusions: although nutrition is considered a necessary support pillar in all critical patients, according to our results, the start time does not directly affect the days of invasive mechanical ventilation.

Resumo: Introdução: estudo de coorte para avaliar a associação entre o tempo de início da nutrição com os dias de ventilação mecânica invasiva (VMI) em pacientes com choque séptico. A ventilação mecânica (VM) é um suporte que mantém o paciente enquanto se corrige a lesão estrutural ou funcional para a qual foi indicada. A sepse é a causa da disfunção diafragmática, contribuindo para a insuficiência respiratória; no entanto, poucos dados estão disponíveis sobre a interação entre sepse e VM prolongada. Atualmente, embora a nutrição tenha se estabelecido como pilar de suporte e tratamento em pacientes críticos, o impacto dessa intervenção não está claro. Objetivo: verificar a existência de associação entre o tempo de início da nutrição e a duração da VMI em pacientes com choque séptico. Material e métodos: foi realizado um estudo de coorte proletivo em pacientes com choque séptico e VMI, o tempo para iniciar a nutrição foi documentado, sendo esta decisão independente do estudo. Foi feito acompanhamento diário dos dias que necessitaram de VMI e início de nutrição enteral ou parenteral. A nutrição precoce é quando é iniciada nas primeiras 48 horas de internação na terapia intensiva. Utilizou-se o Stata para a análise estatística em que foram utilizados os testes χ2 e regressão logística. Resultados: foram incluídos 131 pacientes com choque séptico e VMI, 110 pacientes iniciaram nutrição precoce e 21 nutrição tardia. A média de idade foi de 69 anos, 23% (31) do total de pacientes apresentavam diabetes mellitus (DM), apresentando-se com maior frequência no grupo de nutrição retardada. Em relação à gravidade, não foi encontrada diferença entre os dois grupos. A duração média da ventilação foi de 2 dias, com maior tempo no grupo de nutrição de início tardio (2 dias vs 5 dias, p = 0.012). No entanto, ao ajustar por regressão logística, não foi encontrada diferença estatisticamente significativa OR 0.13, IC (0.14-1.17) p = 0.69. Conclusões: embora a nutrição seja considerada um pilar de suporte necessário em todos os pacientes críticos, de acordo com nossos resultados, o horário de início não afeta diretamente os dias de ventilação mecânica invasiva.

DNA and RNA oxidative damage in hepatocellular carcinoma patients and mortality during the first year of liver transplantation.

BACKGROUND: Oxidative damage of DNA and RNA has been associated with mortality of patients with different diseases. However, there is no published data on the potential use of DNA and RNA oxidative damage to predict the prognosis of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT). AIM: To determine whether patients with increased DNA and RNA oxidative damage prior to LT for HCC have a poor LT prognosis. METHODS: Patients with HCC who underwent LT were included in this observational and retrospective study. Serum levels of all three oxidized guanine species (OGS) were measured prior to LT since guanine is the nucleobase that forms DNA and RNA most prone to oxidation. LT mortality at 1 year was the end-point study. RESULTS: Surviving patients (n = 101) showed lower serum OGS levels (P = 0.01) and lower age of the liver donor (P = 0.03) than non-surviving patients (n = 13). An association between serum OGS levels prior to LT and 1-year LT (odds ratio = 2.079; 95% confidence interval = 1.356-3.189; P = 0.001) was found in the logistic regression analysis. CONCLUSION: The main new finding was that high serum OGS concentration prior to LT was associated with the mortality 1 year after LT in HCC patients.

Perspectiva del cuidado en la ciberpsicología: reflexiones éticas / Care Approach to Cyberpsychology: Ethical Considerations / Perspectiva do cuidado em ciberpsicologia: reflexões éticas

Introducción. El despliegue de nuevas tecnologías de la información y la comunicación lleva a plantear la ciberpsicología como la integración de los medios digitales a la vida y las relaciones humanas, así como la inmersión tecnológica en la práctica profesional; esto implica retos en la comprensión de los cambios que ha producido la tecnología en el desarrollo individual y social. El objetivo del presente artículo fue plantear una reflexión sobre los aspectos éticos en la ciberpsicología y las implicaciones prácticas, a la luz de una perspectiva del cuidado que integra el principio del bienestar en un entorno virtual. Temas de reflexión. En primer lugar, se analizan las principales normativas en el marco de los principios éticos y bioéticos, con énfasis en el contexto colombiano. En segundo lugar, se reflexiona sobre la perspectiva del cuidado y algunas consideraciones en los medios digitales. Finalmente, se revisan algunas implicaciones prácticas de la ciberpsicología. Conclusiones. La perspectiva del cuidado y su aplicación en la ciberpsicología es uno de los anclajes éticos orientados a la promoción de relaciones basadas en el bienestar. Las discusiones éticas desde la perspectiva del cuidado en medios digitales integra la competencia técnico-profesional a la competencia ética. Esto implica un constante análisis de la apropiación de las tecnologías como espacio de encuentro y también como parte del compromiso con el cuidado propio y de los usuarios

Introduction. The spread of new information and communication technologies results in cyberpsychology being proposed as the integration of new digital media into human relationships and life, also, as technological immersion in professional practices. This implies challenges in understanding the changes that technology has produced in individual and social development. The objective of this article was to propose a reflection on the ethical aspects of cyberpsychology and its practical implications, according to a care approach which integrates the wellbeing principle in a virtual environment. Topics of reflection. Firstly, the main regulations for cyberpsychology are analyzed in the framework of the ethical and bioethical principles, with emphasis on the Colombian context. Secondly, we reflect on the care approach and some considerations for digital media. Finally, some practical implications of cyberpsychology are reviewed. Conclusions. The care approach and its application to cyberpsychology is one of the ethical anchors aimed at the promotion of wellbeing-based relationships. Ethical discussions from the care approach to digital media integrate technical-professional competency with ethical competency. This implies a constant analysis of the appropriation of technologies as a meeting space and as part of the commitment to self and user care.

Introdução. A implantação de novas tecnologias de informação e comunicação leva a postular a ciberpsicologia como a integração das mídias digitais na vida e nas relações humanas, bem como a imersão tecnológica na prática profissional. Isso implica desafios na compreensão das mudanças que a tecnología tem produzido no desenvolvimento individual e social. O objetivo deste artigo foi propor uma reflexão sobre os aspectos éticos na ciberpsicologia e as implicações práticas, à luz de uma perspectiva assistencial que integre o princípio do bem-estar no ambiente virtual. Tópicos de reflexão. Em primeiro lugar, analisamse as principais regulamentações no marco dos princípios éticos e bioéticos, com ênfase no contexto colombiano. Em segundo lugar, reflete-se sobre a perspectiva do cuidado e algumas considerações nos meios digitais. Finalmente, são revisadas algumas implicações práticas da ciberpsicologia. Conclusões. A perspectiva do cuidado e sua aplicação na ciberpsicologia é uma das âncoras éticas voltadas à promoção de relações baseadas no bem-estar. As discussões éticas na perspectiva do cuidado em mídia digital integram competência técnico-profissional com a competência ética. Isso implica uma análise constante da apropriação das tecnologias como espaço de encontro, assim como parte do compromisso com o autocuidado e dos usuários

A New Strategy for Multitarget Drug Discovery/Repositioning Through the Identification of Similar 3D Amino Acid Patterns Among Proteins Structures: The Case of Tafluprost and its Effects on Cardiac Ion Channels.

The identification of similar three-dimensional (3D) amino acid patterns among different proteins might be helpful to explain the polypharmacological profile of many currently used drugs. Also, it would be a reasonable first step for the design of novel multitarget compounds. Most of the current computational tools employed for this aim are limited to the comparisons among known binding sites, and do not consider several additional important 3D patterns such as allosteric sites or other conserved motifs. In the present work, we introduce Geomfinder2.0, which is a new and improved version of our previously described algorithm for the deep exploration and discovery of similar and druggable 3D patterns. As compared with the original version, substantial improvements that have been incorporated to our software allow: (i) to compare quaternary structures, (ii) to deal with a list of pairs of structures, (iii) to know how druggable is the zone where similar 3D patterns are detected and (iv) to significantly reduce the execution time. Thus, the new algorithm achieves up to 353x speedup as compared to the previous sequential version, allowing the exploration of a significant number of quaternary structures in a reasonable time. In order to illustrate the potential of the updated Geomfinder version, we show a case of use in which similar 3D patterns were detected in the cardiac ions channels NaV1.5 and TASK-1. These channels are quite different in terms of structure, sequence and function and both have been regarded as important targets for drugs aimed at treating atrial fibrillation. Finally, we describe the in vitro effects of tafluprost (a drug currently used to treat glaucoma, which was identified as a novel putative ligand of NaV1.5 and TASK-1) upon both ion channels' activity and discuss its possible repositioning as a novel antiarrhythmic drug.

Blood Bcl-2 levels to predict the mortality of septic patients.

Aim: To determine whether blood concentrations of Bcl-2 during the 1st week of sepsis could help predict mortality. Methods: Serum Bcl-2 concentrations were determined at the 1st, 4th and 8th days of sepsis diagnosis. Results: Thirty-day surviving patients (n = 168) showed higher serum Bcl-2 levels at the 1st (p = 0.002), 4th (p < 0.001) and 8th days (p < 0.001) of sepsis diagnosis than non-surviving patients (n = 91). An association between serum Bcl-2 concentrations at the 1st (p = 0.003), 4th (p < 0.001) and 8th days (p = 0.01) and 30-day mortality after controlling for diabetes mellitus, Sepsis-related Organ Failure Assessment, lactic acid and age was found in the multiple logistic regression analysis. Conclusions: The novel finding is that blood Bcl-2 concentrations at any time in the 1st week of sepsis are associated with mortality.

Vascular endothelial growth factor haplotypes are associated with severe ischaemic complications in giant cell arteritis regardless of the disease phenotype.

OBJECTIVES: To determine whether functional vascular endothelial growth factor (VEGF) polymorphisms influence the expression of the clinical phenotype of giant cell arteritis (GCA). We also evaluated whether VEGF polymorphism is associated with the development of severe ischaemic manifestations in patients with GCA regardless of the clinical phenotype, classic cranial GCA or predominantly extracranial GCA large vessel vasculitis (LVV). METHODS: VEGF rs833061 T/C, rs2010963 G/C and rs3025039 C/T polymorphisms were genotyped in 185 patients with biopsy-proven cranial GCA, 105 with extracranial LVV-GCA and 490 healthy controls. Allelic combinations (haplotypes) of VEGF were carried out. Comparisons were performed between patients with GCA and healthy controls as well as between patients with GCA stratified according to the clinical phenotype and the presence of severe ischaemic manifestations. RESULTS: No significant differences in genotype, allele, and haplotype frequencies of VEGF were found between patients with GCA and healthy controls as well as between GCA patients with the classic cranial pattern and the extracranial LVV-GCA pattern of the disease. However, the VEGF CGC haplotype (OR= 1.63 [1.05-2.53]) and the CGT haplotype (OR= 2.55 [1.10-5.91]) were significantly more frequent in GCA patients with severe ischaemic complications compared to those patients without these complications. CONCLUSIONS: VEGF haplotypes seem to play a role in the development of severe ischaemic manifestations in GCA patients, regardless of the clinical phenotype of expression of the disease.

Predictive factors for inadequate bowel cleansing in colon capsule endoscopy.

BACKGROUND AND AIMS: Achieving adequate bowel cleansing is of utmost importance for the efficiency of colon capsule endoscopy (CCE). However, information about predictive factors is lacking. The aim of this study was to assess the predictive factors of poor bowel cleansing in the CCE setting. METHODS: In this observational study, 126 patients who underwent CCE at two tertiary care hospitals were included between June 2017 and January 2020. Participants prepared for bowel cleansing with a 1-day clear liquid diet, a 4-L split-dose polyethylene glycol regimen and boosters with sodium phosphate, sodium amidotrizoate and meglumine amidotrizoate. Domperidone tablets and bisacodyl suppositories were administered when needed. Overall and per-segment bowel cleansing was evaluated using a CCE cleansing score. Simple and multiple logistic regression analysis were carried out to assess poor bowel cleansing and excretion rate predictors. RESULTS: Overall bowel cleansing was optimal in 53 patients (50.5%). Optimal per-segment bowel cleansing was achieved as follows: cecum (86 patients; 74.8%), transverse colon (91 patients; 81.3%), distal colon (81 patients; 75%) and rectum (64 patients; 66.7%). In the univariate analysis, elderly (OR, 1.03; 95% CI (1.01-1.076)) and constipation (OR, 3.82; 95% CI (1.50-9.71)) were associated with poor bowel cleansing. In the logistic regression analysis, constipation (OR, 3.77; 95% CI (1.43-10.0)) was associated with poor bowel cleansing. No variables were significantly associated with the CCE device excretion rate. CONCLUSION: Our results suggest that constipation is the most powerful predictor of poor bowel cleansing in the CCE setting. Tailored cleansing protocols should be recommended for these patients.

The Superficial Inferior Epigastric Artery Interpolated Flap for Closure of Large Anterolateral Thigh Flap Donor Site Defects.

ABSTRACT: The Anterolateral Thigh (ALT) flap has a critical role in head, neck, and extremity reconstruction. Unfortunately, when the ALT flap is dimensionally large, it leaves an open donor site that may not respond optimally to primary or secondary closure. Traditionally, skin grafting has been used to close large ALT flap donor site defects. However, skin grafting offers less than desirable aesthetic and functional results. The purpose of this article is to present the first reported case of a 70-year-old woman with a large ATL donor site defect, not responsive to direct primary closure, which was successfully reconstructed using a superficial inferior epigastric artery (SIEA) interpolated flap. After 3 weeks, the SIEA interpolated flap was divided, with the patient reporting good outcomes after a 3-month follow-up. The authors suggest that a SIEA interpolated flap as a novel potential approach to optimally repair large ALT donor site defects.