Localized intratumoral delivery of immunomodulators for oral cancer and oral potentially malignant disorders.

Immunotherapy has developed into an important modality of modern cancer treatment. Unfortunately, checkpoint inhibitor immunotherapies are currently delivered systemically and require frequent administration, which can result in toxicity and severe, sometimes fatal, adverse events. Localized delivery of immunomodulators for oral cancer and oral potentially malignant disorders offers the promise of maximum therapeutic potential and reduced systemic adverse effects. This review will discuss the limitations of current standard-of-care systemic therapies and highlight research advances in localized, intratumoral delivery platforms for immunotherapy for oral cancer and oral potentially malignant disorders.

Holistic approach to care for patients with endometriosis.

PURPOSE OF REVIEW: Endometriosis is a chronic, often debilitating, disease which is typically managed with surgery and hormonal medications. However, many patients feel they lack agency when managing endometriosis symptoms. The purpose of this review is to discuss the mental and physical management strategies, the long-term health consequences, and the role of a multidisciplinary team in the treatment of endometriosis. RECENT FINDINGS: Evidence is becoming more robust regarding the role of complementary care and physical activity in the management of endometriosis. Health risks such as infertility are well known and newer evidence is evolving regarding perinatal and cardiovascular health risks. There are also trends towards multiple specialist involvement in the care of endometriosis and the benefit of interdisciplinary collaboration. SUMMARY: Endometriosis is a frequently recurrent condition requiring not only meticulous medical and surgical care, but also coordinated longitudinal disease management and impact mitigation. Gynecologists should be aware of the short-term and long-term implications of the disease to empower patients on the management of their overall health.

Validation of a Simulation Model for Robotic Myomectomy.

STUDY OBJECTIVE: Several simulation models have been evaluated for gynecologic procedures such as hysterectomy, but there are limited published data for myomectomy. This study aimed to assess the validity of a low-cost robotic myomectomy model for surgical simulation training. DESIGN: Prospective cohort simulation study. SETTING: Surgical simulation laboratory. PARTICIPANTS: Twelve obstetrics and gynecology residents and 4 fellowship-trained minimally invasive gynecologic surgeons were recruited for a 3:1 novice-to-expert ratio. INTERVENTIONS: A robotic myomectomy simulation model was constructed using <$5 worth of materials: a foam cylinder, felt, a stress ball, bandage wrap, and multipurpose sealing wrap. Participants performed a simulation task involving 2 steps: fibroid enucleation and hysterotomy repair. Video-recorded performances were timed and scored by 2 blinded reviewers using the validated Global Evaluative Assessment of Robotic Skills (GEARS) scale (5-25 points) and a modified GEARS scale (5-40 points), which adds 3 novel domains specific to robotic myomectomy. Performance was also scored using predefined task errors. Participants completed a post-task questionnaire assessing the model's realism and utility. MEASUREMENTS AND MAIN RESULTS: Median task completion time was shorter for experts than novices (9.7 vs 24.6 min, p = .001). Experts scored higher than novices on both the GEARS scale (median 23 vs 12, p = .004) and modified GEARS scale (36 vs 20, p = .004). Experts made fewer task errors than novices (median 15.5 vs 37.5, p = .034). For interrater reliability of scoring, the intraclass correlation coefficient was calculated to be 0.91 for the GEARS assessment, 0.93 for the modified GEARS assessment, and 0.60 for task errors. Using the contrasting groups method, the passing mark for the simulation task was set to a minimum modified GEARS score of 28 and a maximum of 28 errors. Most participants agreed that the model was realistic (62.5%) and useful for training (93.8%). CONCLUSION: We have demonstrated evidence supporting the validity of a low-cost robotic myomectomy model. This simulation model and the performance assessments developed in this study provide further educational tools for robotic myomectomy training.

Correlación entre la Velocidad de Marcha y Largo del Paso en Personas Mayores de la Cuarta Edad que Viven en la Comunidad / Correlation between Walking Speed and Step Length in Seniors Living in the Community

Introducción. La población de personas mayores de la cuarta edad (≥80 años) crece a gran velocidad. Esta se diferencia de la tercera edad en cuanto a su funcionalidad. Es sabido que mientras menor sea la velocidad de la marcha en esta población, mayor es el riesgo de deterioro cognitivo, sarcopenia, discapacidad e institucionalización. La velocidad de marcha disminuida es un predictor importante de deterioro en el rendimiento físico. Objetivo. Determinar la correlación entre la velocidad de marcha, fuerza de miembros inferiores y largo del paso en personas mayores de cuarta edad que viven en la comunidad. Métodos. Estudio transversal en personas mayores saludables de la cuarta edad (n=14; 8 mujeres; 88 ± 3 años; 26,3 ± 3,4 kg·m-2) que fueron sometidas a evaluaciones de rendimiento físico, tales como largo del paso; fuerza de miembros inferiores a través de 1 Repetición Máxima (1RM) de extensión de rodilla en ambos miembros inferiores y velocidad de marcha en 4 metros. Los datos se presentan como media±desviación estándar. Se consideró un valor de P significativo < 0.05. Resultados. Se observó una correlación positiva moderada entre el largo del paso y la velocidad de marcha (R=0,794; P=0,001). No existieron correlaciones entre la fuerza de miembros inferiores y largo del paso (R=0,478; P=0,084), tampoco entre las variables de fuerza y velocidad de marcha (R=0,441; P=0.115). Conclusión. Las personas mayores de cuarta edad presentan una correlación positiva entre su velocidad de marcha y largo del paso.

Background. The population of people older than the fourth age (≥80 years) is growing rapidly. This differs from the third age in terms of its functionality. It is known that the lower the gait speed in this population, the greater the risk of cognitive impairment, sarcopenia, disability and institutionalization. Decreased gait speed is an important predictor of deterioration in physical performance. Objetive. To determine the correlation between gait speed, lower limb strength and stride length in fourth age people (≥80 years) who live in the community. Methods. Cross-sectional study in healthy older people of the fourth age (n=14; 8 women; 88 ± 3 years; 26.3 ± 3.4 kg·m-2) who underwent physical performance evaluations, such as long of the step; strength of lower limbs through 1 Maximum Repetition (1RM) of knee extension in both lower limbs and walking speed in 4 meters. Data are presented as mean ± standard deviation. A significant P value < 0.05 was considered. Results. A moderate positive correlation was observed between stride length and gait speed (R=0.794; P=0.001). There were no correlations between the strength of the lower limbs and stride length (R=0.478; P=0.084), nor between the variables of strength and gait speed (R=0.441; P=0.115). Conclusion. Fourth age older people older present a positive correlation between their walking speed and stride length.

Coinvestigación con NNA: una revisión sistemática de literatura según las directrices Prisma / Co-research with children and adolescents: a systematic literature review using the Prisma statement

(analítico) Se realiza una revisión que examina la participación de niños, niñas y adolescentes como coinvestigadores. El estudio se apoya en la declaración para revisión sistemática de literatura Prisma y analiza las producciones científicas entre 2019 y 2022. Los artículos revisados revelan tendencias en los roles y las denominaciones que se asignan a los niños, niñas y adolescentes en la investigación, así como metodologías participativas que los reconocen como sujetos de derechos y expertos de su entorno, capaces de participar en la co-construcción de conocimiento con los adultos investigadores. También se identifican desafíos metodológicos, éticos y políticos que enfatizan la necesidad de una reflexión crítica sobre el propósito y las implicaciones de la participación infantil, las dinámicas de poder involucradas y el reconocimiento de las capacidades y perspectivas de los niños, niñas y adolescentes.

(analytical) This article conducts a systematic literature review of children and adolescents' participation as co-researchers. The study uses the PRISMA statement and analyzes scientific publications between 2019 and 2022. The reviewed articles reveal different trends regarding the roles and names assigned to children and adolescents as co-researchers. The authors also encountered a number of participatory methodologies that recognize this population as subjects of rights and experts in relation to their own settings who are capable of actively participating in the co-construction of knowledge with adult researchers. Methodological, ethical, and political challenges that occur with this research modality are identified in the reviewed articles. This highlights the need for critical reflection about the purpose and implications of child and adolescent participation in research, the power dynamics involved, and the importance of recognizing this population's diverse capacities and perspectives as part of this process.

(analítico) É realizada uma revisão sistemática da literatura da categoria co-investigação utilizada em metodologias participativas com crianças e adolescentes, seus papéis e as etapas dos processos investigativos em que intervêm. O estudo é baseado na declaração Prisma, e analisa as produções científicas no período de 2019 a 2022. Os artigos revisados revelam tendências nos papéis atribuídos a crianças e adolescentes nas pesquisas, bem como metodologias participativas que os reconhecem como sujeitos de direitos e especialistas em seu contexto, capazes de participar da co-construção do conhecimento com os adultos pesquisadores. Também são identificados desafios metodológicos, éticos e políticos, que enfatizam a necessidade de reflexão crítica sobre o propósito e as implicações da participação infantil, as dinâmicas de poder envolvidas e o reconhecimento das capacidades e perspectivas das crianças.

Calidad de vida, nivel de actividad física y pruebas funcionales en personas adultas y mayores laboralmente activas / Quality of life, level of physical activity and functional tests in actively working adults and older people

BACKGROUND: The population of actively working older people is growing rapidly. The relationship between quality of life, levels of physical activity and functionality in this population is not entirely clear. AIM: To determine the association between quality of life, levels of physical activity and functional tests in actively working adults and older people. MATERIAL AND METHODS: Cross sectional assessment of 138 adults aged 40 to 50 years (53% women) and 119 older people aged 60 to 75 years (53% women) who were actively working in two public services. Quality of life was measured with the SF-36 questionnaire and usual physical activity was assessed with the International Physical Activity Questionnaire (IPAQ-short). Handgrip strength, the timed up and go (TUG) and chair stand test (CST) were used as functional tests. RESULTS: Compared to older people, adults had better physical functional tests (P < 0.01). Older people had better scores in the mental health component (MHC) of quality of life (p < 0.05). In adults, the physical health component of quality of life (CSF) had a positive association with physical activity (Spearman Rho (rs)= 0.270; p = 0.01), grip strength (rs = 0.330; p < 0.01) and the TUG (rs = −0.229; p < 0.01). In older patients, CSM and CST were positively correlated (rs = 0.201; P = 0.029). In both groups, a correlation was observed between CSM, grip strength (adults rs = 0.283; p < 0.01; older people rs = 0.211; P = 0.02) and with TUG (adults rs = −0.197; P = 0.021; older people rs = - 0.212; p = 0.02). CONCLUSIONS: There is a positive correlation between quality of life and level of physical activity in working adults, which is not observed in older people. Adequate performance in physical functional tests is positively correlated with better quality of life (CSF and CSM) in adults and only with the mental health component in older people.

The Impact of Race and Ethnicity on Use of Minimally Invasive Surgery for Myomas.

STUDY OBJECTIVE: To determine whether minimally invasive surgery (MIS) for uterine myomas is used differentially based on race and ethnicity. DESIGN: Retrospective cohort study. SETTING: Quaternary care academic hospital in the United States. PATIENTS: Patients undergoing hysterectomy or myomectomy for uterine myomas between March 15, 2015, and March 14, 2020 (N = 1311). Cases involving correction of pelvic organ prolapse, malignancy, peripartum hysterectomy, or combined procedures with nongynecologic specialties were excluded. Racial/ethnic composition of the study population was 40.0% non-Hispanic white (white), 27.9% non-Hispanic black (black), 14.0% Hispanic, 13.7% non-Hispanic Asian (Asian), and 4.3% non-Hispanic American Indian/Alaska Native/Pacific Islander/Other. INTERVENTIONS: Hysterectomy, myomectomy. MEASUREMENTS AND MAIN RESULTS: Of the 1311 cases, 35.9% were minimally invasive hysterectomy, 16.4% abdominal hysterectomy, 35.6% minimally invasive myomectomy, and 12.1% abdominal myomectomy. MIS rates were 94.7% among fellowship-trained minimally invasive gynecologic surgery subspecialists, 44.2% among obstetrics and gynecology specialists, and 46.8% among gynecologic oncologists. There were disparities in surgeon type based on race/ethnicity, with 59.8% of white patients having undergone surgery with a minimally invasive gynecologic surgery subspecialist vs 44.0% of black patients and 45.7% of Hispanic patients. Black and Hispanic patients were less likely to undergo MIS overall vs white patients (adjusted odds ratio [aOR] 0.33, 95% confidence interval [CI] 0.22-0.48 and aOR 0.44, 95% CI 0.28-0.72, respectively). Black and Hispanic patients undergoing hysterectomy were less likely than white patients to undergo MIS (aOR 0.33, 95% CI 0.21-0.51 and aOR 0.35, 95% CI 0.20-0.60, respectively). There were no significant differences in rates of MIS based on race/ethnicity for myomectomies nor differences in major or minor complications by race/ethnicity overall. CONCLUSION: At a quaternary care institution, black and Hispanic patients were significantly less likely than white patients to undergo MIS for uterine myomas, particularly for hysterectomy.

Rates of Complications and Reoperation after Myomectomy-the Impact of Surgical Approach: A Statewide Population-based Cohort Study from 2005-2018.

STUDY OBJECTIVE: To assess rates of and factors associated with complications and reoperation after myomectomy. DESIGN: Population-based cohort study. SETTING: All non-Veterans Affairs facilities in the state of California from January 1, 2005, to December 31, 2018. PARTICIPANTS: Women undergoing abdominal or laparoscopic myomectomy for myoma disease were identified from the Office of Statewide Health Planning and Development datasets using appropriate International Classification of Diseases, Ninth and Tenth Revision and Current Procedural Terminology codes. INTERVENTIONS: Demographics, surgery facility type, facility surgical volume, and surgical approach were identified. Primary outcomes included complications occurring within 60 days of surgery and reoperations for myomas. Patients were followed up for over an average of 7.3 years. Univariate and multivariable associations were explored between the above factors and rates of complications and reoperation. All odds ratios (ORs) are adjusted ORs. MEASUREMENTS AND MAIN RESULTS: Of the 66 012 patients undergoing myomectomy, 5265 had at least one complication (8.0%). Advanced age, black, Asian race, MediCal and Medicare payor status, academic facility, and medical comorbidities were associated with increased odds of a complication. Minimally invasive myomectomy (MIM) was associated with decreased complications compared with abdominal myomectomy (AM) (OR, 0.29; 95% confidence interval [CI], 0.25-0.33; p <.001). Overall, 17 377 patients (26.3%) underwent reoperation. Medicare and MediCal payor status and medical comorbidities were associated with increased odds of a repeat surgery. Reoperation rates were higher in the MIM group over the entire study period (OR, 2.33; 95% CI, 1.95-2.79; p <.001). However, the odds of reoperation after MIM decreased each year (OR, 0.93; 95% CI 0.92-0.95; p <.001), with the odds of reoperation after AM surpassing MIM in 2015. CONCLUSION: This study identifies outcome disparities in the surgical management of myomas and describes important differences in the rates of complications and reoperations, which can be used to counsel patients on surgical approach. These findings suggest that MIM can be considered a lasting and safe approach in properly selected patients.

Development and validation of a simulation model for laparoscopic myomectomy.

BACKGROUND: Simulation is an important adjunct to traditional surgical training, allowing for repetitive practice of new skills without compromising patient safety. Although several simulation models have been described and evaluated for gynecologic procedures, there is a lack of such models for laparoscopic myomectomy. OBJECTIVE: This study aimed to design a low-cost, low-fidelity laparoscopic myomectomy simulation model and to assess the model's validity as a training tool. STUDY DESIGN: The model was constructed using a "cup turner" foam cylinder, felt, a 2-inch stress ball, self-adhesive bandage wrap, multipurpose sealing wrap, red marker, and hook-and-loop fastener. Participants were recruited at a quaternary care academic center and at the Society for Gynecologic Surgeons Annual Scientific Meeting. The simulation task involved the following 2 steps: fibroid enucleation and hysterotomy repair. Validity evidence was collected by comparing expert and novice simulation task performances. Video recordings were scored by 2 blinded reviewers using the Global Operative Assessment of Laparoscopic Skills scale (5-20 points) and a modified Global Operative Assessment of Laparoscopic Skills scale (5-35 points), incorporating 3 novel domains specific to laparoscopic myomectomy. The Mann-Whitney U test was used to compare the task completion times and performance scores. Interrater reliability of scoring was assessed using the interclass correlation coefficient. Validity was also assessed with a post-task survey regarding the model's realism, utility, and educational effect. RESULTS: The total cost to construct each model was under $5. A 3:1 ratio was used to recruit 15 novices and 5 experts. The median time to task completion was shorter for experts than for novices (11.8 vs 20.1 minutes; P=.004). The experts scored higher than the novices on both the Global Operative Assessment of Laparoscopic Skills scale (median 19 [range 13-20] vs 10 [6-17.5]; P=.007) and the modified Global Operative Assessment of Laparoscopic Skills scale (31.5 [21.5-33.5] vs 18.5 [13.5-32]; P=.009). The interclass correlation coefficient was 0.95 for the Global Operative Assessment of Laparoscopic Skills scores and 0.96 for the modified Global Operative Assessment of Laparoscopic Skills scores. Most of the participants agreed that the model closely approximated the feel of fibroid enucleation (70% [14/20]) and suturing the uterus (80% [16/20]). All the participants agreed that the model was useful for learning or teaching laparoscopic myomectomy. CONCLUSION: This study demonstrates evidence supporting the validity of a novel, low-cost laparoscopic myomectomy model and a novel assessment scale for laparoscopic myomectomy training. This simulation model provides a targeted training tool that allows learners to focus on the key aspects of laparoscopic myomectomy and may improve readiness for the operating room.

Participación en medios y TIC: intereses y expectativas de niños y niñas / Participation in media and ICTs: children's interests and expectations Abstract / Participação nos meios e nas TIC: os interesses e as expectativas das crianças

Resumen (analítico) La presencia de medios análogos y digitales en la vida de los niños, niñas y adolescentes redimensiona la discusión sobre participación infantil, centrándola en lo que ocurre en las pantallas. Realizamos un estudio cualitativo de corte descriptivo con 75 niños, niñas y adolescentes, de 7 a 14 años, de tres ciudades (Barranquilla, Cali y Bogotá). Los resultados indican que los niños, niñas y adolescentes tienen formas complejas y diversas de pensar la participación, que superan las divisiones, escalas y prescripciones adultas e institucionales, para incluir acciones de ocio, socialización y consumo cultural. Se trata de una participación heterogénea, convergente y multiplataforma que incluye actividades como generar contenidos, dar likes, hacer suscripciones, navegar, buscar tareas o simplemente ver vídeos, fotos, jugar, divertirse y socializar, mostrando intereses, subjetividades y formas de socialización infantiles en medios y TIC.

Abstract (analytical) The presence of analogue and digital media in the lives of children and adolescents reshapes discussions on child participation, with an emphasis on participation that is facilitated through screens. A qualitative descriptive study was carried out with 75 children and adolescents aged 7 to 14 years old in three cities (Barranquilla, Cali and Bogotá). The results suggest that children and adolescents have complex and diverse ways of thinking about participation that go beyond adultcentric and institutional concepts such as divisions and different scales. Children conceive their own participation in terms of leisure, socialization and cultural consumption activities. Theirs is a heterogeneous, convergent and multi-platform participation that includes activities such as creating content, liking, subscribing, browsing the web, doing homework, as well as watching videos, looking at pictures, playing games, having fun and socializing. These results show children's interests, subjectivities and forms of socialization using media and ICTs.

Resumo (analítico) A presença da mídia analógica e digital na vida das crianças e adolescentes, redimensiona a discussão sobre a participação infantil enfocando o que acontece nas telas. Foi realizado um estudo qualitativo descritivo com 75 crianças de 7 a 14 anos em três cidades (Barranquilla, Cali e Bogotá). Os resultados indicam que as crianças e adolescentes têm formas complexas e diversas de pensar a participação, assim como seus papéis na mídia e no cenário digital, que vão além das divisões, escalas e prescrições de adultos e instituições. Esta participação é heterogênea, convergente e multiplataforma, que inclui atividades como a criação de conteúdo, dar likes, fazer trabalhos escolares ou simplesmente olhar vídeos, fotos, jogar, brincar e socializar; mostrando os interesses, subjetividades e formas de socialização das crianças na mídia e nas TIC.

Nivel de conocimiento de manejo de niños y actitud frente a desastres en pediatras del Servicio de Emergencia Pediátrica del Centro Médico Naval del Callao, 2018-2019 / Level of knowledge on disaster management for children and attitude towards disasters of pediatricians from the Pediatric Intensive Care Unit of the Centro Médico Naval - Callao, 2018-2019

RESUMEN Objetivo: Determinar la correlación entre el nivel de conocimiento de manejo de niños en situación de desastre y la actitud frente a los desastres de los médicos pediatras del Servicio de Emergencia Pediátrica del Centro Médico Naval del Callao durante el período de diciembre de 2018 a febrero de 2019. Materiales y métodos: El nivel de conocimiento se determinó con un cuestionario basado en el Curso de Desastres de la Academia Americana de Pediatría. La actitud frente a los desastres fue establecida con un formulario autoadministrado con respuestas en escala tipo Likert validada, que midió los aspectos en las áreas cognitiva, conductual y afectiva. En el análisis estadístico, se utilizó el programa SPSS v.25. Las frecuencias y los porcentajes se emplearon en la estadística descriptiva. Para la estadística inferencial, se utilizó el coeficiente de correlación de Spearman, con un nivel de significancia p < 0,05. Resultados: El 80,00 % de los pediatras tuvo un nivel medio de conocimiento, y el 76,00 % manifestó una actitud indiferente. Se obtuvo un nivel de correlación positivo intermedio (0,505) con significancia estadística (p < 0,05). Conclusiones: Se demostró una correlación entre el nivel de conocimiento y la actitud frente a los desastres. Por ello, es necesario incidir en la capacitación del personal de emergencia, sobre todo, en los pediatras.

ABSTRACT Objective: To determine the correlation between the level of knowledge on disaster management for children and the attitude towards disasters of pediatricians from the Pediatric Intensive Care Unit of the Centro Médico Naval - Callao from December 2018 to February 2019. Materials and methods: The level of knowledge was established using a questionnaire based on a course on disaster management from the American Academy of Pediatrics. The attitude towards disasters was determined using a validated self-administered Likert-scale questionnaire that measured the cognitive, behavioral and affective areas. The IBM SPSS Statistics V25 was used for the statistical analysis. Frequencies and percentages were employed for the descriptive statistics. The Spearman's correlation coefficient with a significance level of p < 0.05 was used for the inferential statistics. Results: Eighty percent (80 %) of the study population had a moderate level of knowledge and 76 % had an indifferent attitude. A moderate positive correlation level (0.505) with a significance level of p < 0.05 was found. Conclusions: A correlation between the level of knowledge and the attitude towards disasters was demonstrated. Therefore, it is necessary to train the emergency personnel, particularly the pediatricians.

Anthropometric parameters, lower limb functionality and quality of life after high-intensity interval training in healthy young people versus older adults / Parámetros antropométricos, funcionalidad de miembros inferiores y calidad de vida posterior al entrenamiento interválico de alta intensidad en jóvenes versus personas mayores

SUMMARY: The aim of this study was to determine the effects of High-intensity interval training (HIIT) on the quality of life in healthy young people (YNG) and older adults (OLD)and its correlation with physical health status (anthropometric parameters and lower limb functionality) YNG (21 ? 2 years, BMI 26.37 ? 2.69 n = 12) and OLD (67 ? 5 years, BMI 27.16 ? 3.04 n = 12) groups underwent 12weeks of HIIT. Before and after the HIIT, anthropometric assessments, lower limb functionality tests, and SF-36 quality-of-life questionnaire were performed. There were no significant changes in the SF-36 dimensions (P>0.05). After HIIT, there were improvement percentage changes in Mental Component Summary (MCS) (YNG, +8.51 ? 25.80 % vs. OLD, +2.30 ? 9.05 %) and in Physical Component Summary (PCS) (YNG, +2.66 ? 20.54 % vs. OLD, +4.34 ? 22.71 %). Negative correlations were observed between body mass index (BMI) with PCS (R=-0.570, P=0.009) and with MCS (R=-0.649, P=0.002) in OLD as well as between MCS and waist circumference (R=-0.557, P?0.001) in both groups. Also, correlations were observed between PCS and the sit-to-stand test (R=-0.424, P=0.006) in both groups and gait speed (R=0.458, P=0.042) only in YNG. HIIT promotes positive percentage changes in quality of life, with YNG showing better results in PCS and OLD in MCS. Quality of life and physical health status were correlated in both groups.

RESUMEN: Determinar los efectos del entrenamiento interválico de alta intensidad (HIIT) sobre la calidad de vida en jóvenes sanos (YNG) y personas mayores (OLD) y su correlación con el estado de salud física (parámetros antropométricos y funcionalidad de miembros inferiores). Ambos grupos, YNG (21 ? 2 años, IMC 26,37 ? 2,69 n = 12) y OLD (67 ? 5 años, IMC 27,16 ? 3,04 n = 12) realizaron 12 semanas de HIIT. Antes y después del HIIT, se realizaron evaluaciones antropométricas, pruebas de funcionalidad de miembros inferiores y cuestionario de calidad de vida SF-36. No hubo cambios significativos en las dimensiones del SF-36 (P >0,05). Después del HIIT, hubo cambios porcentuales de mejora en el componente sumario mental (MCS) (YNG, +8.51 ? 25.80 % vs. OLD, +2.30 ? 9.05 %) y el componente sumario física (PCS) (YNG, +2,66 ? 20,54 % vs. OLD, +2,30 ? 9,05 %), correspondientes a la calidad de vida. Se observaron correlaciones negativas entre el índice de masa corporal (IMC) con PCS (R=-0,570; P=0,009) y con MCS (R=0,649; P=0,002) en OLD, así como entre MCS y circunferencia de cintura (R = - 0,557, P?0,001) en ambos grupos. Además, se observaron correlaciones entre PCS y la prueba de sentarse y levantarse (R = -0,424; P = 0,006) en ambos grupos y la velocidad de la marcha (R = 0,458; P = 0,042) solo en YNG. HIIT promueve cambios porcentuales positivos en la calidad de vida, con YNG mostrando mejores resultados en PCS y OLD en MCS. La calidad de vida y el estado de salud física se correlacionaron en ambos grupos.

Postoperative Urinary Retention after Benign Gynecologic Surgery with a Liberal versus Strict Voiding Protocol.

STUDY OBJECTIVE: Surgeons employ various methods for evaluating what is considered a common occurrence after gynecologic operations, postoperative urinary retention (POUR). Few have reported the incidence of POUR with a liberal voiding protocol (no requirement to void before discharge). The primary objective of this study was to evaluate the risk of POUR after benign gynecologic surgery, comparing a liberal voiding protocol with more strict voiding protocols. Secondary outcomes included length of hospital stay (LOS) and urinary tract infection (UTI). DESIGN: Retrospective cohort study. SETTING: Quaternary-care academic hospital in the United States. PATIENTS: Patients undergoing hysterectomy or myomectomy at Cedars-Sinai Medical Center from August 2017 through July 2018 (n = 652). Cases involving incontinence operations, correction of pelvic organ prolapse, malignancy, or peripartum hysterectomy were excluded. INTERVENTIONS: Hysterectomy, myomectomy. MEASUREMENTS AND MAIN RESULTS: POUR, defined as the need for recatheterization within 24 hours of catheter removal, along with UTI and LOS were compared between liberal and strict voiding protocols. A subgroup analysis was performed for those undergoing minimally invasive surgery (MIS). A total of 303 (46.5%) women underwent surgery with a liberal postoperative voiding protocol and 349 (53.5%) women with a strict voiding protocol. Overall, the incidence of POUR was low at 3.8% and not different between the groups (2.6% liberal vs. 4.9% strict, p = .14). UTIs also occurred infrequently (2.8% overall, 2.6% liberal vs. 2.9% strict, p = .86). Similar results were seen specifically among those who underwent MIS: POUR (3.7% overall, 2.8% liberal vs. 5.3% strict, p = .17) and UTI (3.3% overall, 2.4% liberal vs. 4.7% strict, p = .28). The median LOS (interquartile range) was much shorter for MIS patients with a liberal voiding protocol (median 15 hours overall [interquartile range 15 hours], 9 [4] hours liberal vs. 36 [34] hours strict, p <.01). Among those discharged the same day (72.6% of the MIS cases), patients with a liberal voiding protocol had a significantly shorter LOS than those with strict (mean [standard deviation] 9.4 [2.5] hours vs. 10.6 [35] hours, p <.01). Postoperative complications occurred less frequently in those with MIS procedures (11.8% in MIS vs. 20.2% in laparotomies, p <.01) and those with liberal voiding protocols (11.2% liberal vs. 16.9% strict p = .04). CONCLUSION: Overall, POUR occurs infrequently after major benign gynecologic surgery and does not differ between those with liberal and strict voiding protocols. Our data suggest that same-day discharge after MIS hysterectomy and myomectomy without a requirement to void does not increase the risk of POUR and shortens LOS. Eliminating voiding protocols after these procedures may facilitate greater efficiency in the postanesthesia recovery unit and may contribute to enhanced recovery after surgery protocols.

Toxoplasmosis congénita en gemelos / Congenital toxoplasmosis in twins: case report

Resumen La toxoplasmosis congénita en embarazos gemelares es infrecuente. Presentamos el caso de un embarazo gemelar monocigótico, monocorial con una infección materna por toxoplasmosis diagnosticada a las 33 semanas de gestación mediante detección de IgM e IgG reactivas y test de baja avidez de IgG. No pudo realizarse la detección del parásito en líquido amniótico debido a que no se hizo amniocentesis. Las recién nacidas (RN) de término presentaron calcificaciones cerebrales y coriorretinitis activa bilateral, sin otras manifestaciones clínicas asociadas. Tuvieron IgG e IgM reactiva para toxoplasmosis. No se realizó RPC para Toxoplasma gondii en placenta ni en sangre de cordón. Recibieron tratamiento durante el primer año de vida con pirimetamina, sulfadiazina y ácido folínico, sin eventos adversos asociados a la terapia. La metodología diagnóstica y el tratamiento no difieren de los embarazos con feto único. Uno o ambos RN pueden estar comprometidos. Es fundamental el seguimiento multidisciplinario para la detección precoz de reactivaciones o progresión de las lesiones.

Abstract Congenital toxoplasmosis in twin pregnancies is infrequent. We present the case of a monozygotic and monocorial twin pregnancy with maternal toxoplasmosis infection diagnosed at 33 weeks gestation by detecting reactive IgM and IgG and low avidity test for IgG. The detection of the parasite in amniotic fluid could not be performed because the amniocentesis was not done. The term newborns presented cerebral calcifications and bilateral active chorioretinitis without other associated clinical manifestations. They had IgG and IgM reactive for toxoplasmosis. The detection of Toxoplasma gondii was not performed by placental PCR or cord blood. They received treatment during the first year of life with pyrimethamine, sulfadiazine and folinic acid. They had no adverse events associated with the therapy. The diagnostic assessment and treatment does not differ from pregnancies with a single fetus. One or both newborns may be compromised. Multidisciplinary monitoring is essential for the early detection of reactivations or progression of lesions.

Mycotoxins at the Start of the Food Chain in Costa Rica: Analysis of Six Fusarium Toxins and Ochratoxin A between 2013 and 2017 in Animal Feed and Aflatoxin M1 in Dairy Products.

Mycotoxins are secondary metabolites, produced by fungi of genera Aspergillus, Penicillium and Fusarium (among others), which produce adverse health effects on humans and animals (carcinogenic, teratogenic and immunosuppressive). In addition, mycotoxins negatively affect the productive parameters of livestock (e.g., weight, food consumption, and food conversion). Epidemiological studies are considered necessary to assist stakeholders with the process of decision-making regarding the control of mycotoxins in processing environments. This study addressed the prevalence in feed ingredients and compound feed of eight different types of toxins, including metabolites produced by Fusarium spp. (Deoxynivalenol/3-acetyldeoxynivalenol, T-2/HT-2 toxins, zearalenone and fumonisins) and two additional toxins (i.e., ochratoxin A (OTA) and aflatoxin M1 (AFM1)) from different fungal species, for over a period of five years. On the subject of Fusarium toxins, higher prevalences were observed for fumonisins (n = 80/113, 70.8%) and DON (n = 212/363, 58.4%), whereas, for OTA, a prevalence of 40.56% was found (n = 146/360). In the case of raw material, mycotoxin contamination exceeding recommended values were observed in cornmeal for HT-2 toxin (n = 3/24, 12.5%), T-2 toxin (n = 3/61, 4.9%), and ZEA (n = 2/45, 4.4%). In contrast, many compound feed samples exceeded recommended values; in dairy cattle feed toxins such as DON (n = 5/147, 3.4%), ZEA (n = 6/150, 4.0%), T-2 toxin (n = 10/171, 5.9%), and HT-2 toxin (n = 13/132, 9.8%) were observed in high amounts. OTA was the most common compound accompanying Fusarium toxins (i.e., 16.67% of co-occurrence with ZEA). This study also provided epidemiological data for AFM1 in liquid milk. The outcomes unveiled a high prevalence of contamination (i.e., 29.6-71.1%) and several samples exceeding the regulatory threshold. Statistical analysis exposed no significant climate effect connected to the prevalence of diverse types of mycotoxins.

Physicochemical Compatibility of Amiodarone with Parenteral Nutrition.

BACKGROUND: Y-site administration of total parenteral nutrition (TPN) and drugs is frequently required in the intensive care setting. Amiodarone is commonly administered by continuous intravenous infusion and subject to be co-administered via a Y-site with TPN. The aim of this study is to determine the physicochemical stability of amiodarone Y-site administered with TPN. METHODS: Two standard TPN and 2 amiodarone solutions were designed. The 2 TPN differed in the lipid source (Lipofundin MCT/LCT® 20% or SMOFlipid® 20%). The 2 amiodarone solutions were prepared at different concentrations (900 mg and 1200 mg in 250 mL of dextrose 5% in water). Each TPN and amiodarone solutions ran at a rate that simulated a 24-hour Y-site infusion to obtain different admixture samples. Each sample was then visually examined and further tested to determine the mean lipid droplet size distribution by dynamic light scattering and amiodarone concentrations by HPLC. RESULTS: No alterations were detected by visual inspection. Average droplet size remained below 500 nm (252.5 ± 5.9 nm for Lipofundin MCT/LCT® TPN and 327.7 ± 14.4 nm for SMOFlipid® TPN). For the samples obtained after running 900 mg and 1200 mg amiodarone solutions with TPN, the concentrations observed at 24 hours were 0.4491 ± 0.0111 mg/mL and 0.5773 ± 0.0214 mg/mL, respectively. These results represent approximately 100% of the zero-time concentrations and are within ±15% of the predicted values. No degradation products were observed in the chromatograms. CONCLUSION: Amiodarone is physicochemically compatible with standard TPN via a Y-site administration at the tested amiodarone concentrations.

The impact of parallel regulatory-health technology assessment scientific advice on clinical development. Assessing the uptake of regulatory and health technology assessment recommendations.

AIMS: The parallel regulatory-health technology assessment scientific advice (PSA) procedure allows manufacturers to receive simultaneous feedback from both EU regulators and health technology assessment (HTA) bodies on development plans for new medicines. The primary objective of the present study is to investigate whether PSA is integrated in the clinical development programmes for which advice was sought. METHODS: Contents of PSA provided by regulators and HTA bodies for each procedure between 2010 and 2015 were analysed. The development of all clinical studies for which PSA had been sought was tracked using three different databases. The rate of uptake of the advice provided by regulators and HTA bodies was assessed on two key variables: comparator/s and primary endpoint. RESULTS: In terms of uptake of comparator recommendations at the time of PSA in the actual development, our analysis showed that manufacturers implemented comparators to address both the needs of regulators and of at least one HTA body in 12 of 21 studies. For primary endpoints, in all included studies manufacturers addressed both the needs of the regulators and at least one HTA body. CONCLUSIONS: One of the key findings of this analysis is that manufacturers tend to implement changes to the development programme based on both regulatory and HTA advice with regards to the choice of primary endpoint and comparator. It also confirms the challenging choice of the study comparator, for which manufacturers seem to be more inclined to satisfy the regulatory advice. Continuous research efforts in this area are of paramount importance from a public health perspective.

Medellín y el sueño de Ciudad Saludable: construcción técnica y colectiva / Medellín and the dream of a healthy city: a technical and collective construction

RESUMEN Objetivo Definir para Medellín el alcance del concepto y de la estrategia de Ciudad Saludable. Material y Métodos Estudio mixto con revisión de literatura, análisis documental y participación de actores. Resultados En la construcción del concepto se llega a "una ciudad para vivir más y mejor" y se identifican quince características atribuidas a Medellín Ciudad Saludable. La población califica la situación actual como regular y da mayor importancia a las características de medio ambiente, seguridad, acceso a servicios de salud, vivienda y empleo. Aun así, la ciudad presenta avances y esfuerzos importantes para ser reconocida como Ciudad Saludable, pues mantiene programas y proyectos en estas y otras características que contribuyen a elevar el estado de salud. Discusión La construcción de una Ciudad Saludable es particular a cada contexto y en cualquier caso demanda la combinación de trabajo técnico y participación ciudadana en aras de elaborar su propio imaginario e identificar prioridades. En el caso de Medellín, es necesario asumir la estrategia de manera sistemática para que se mantenga en el futuro y hacer explícitas metas y acciones a emprender con el concurso de diferentes sectores del desarrollo local.(AU)

ABSTRACT Objective To define the scope and the strategy of the Healthy City concept for Medellín. Material y Methods Mixed study with literature review, document analysis and involvement of actors. Results The construction of the concept leads to "a city to live more and better". Fifteen characteristics were identified and attributed to "Medellín, a Healthy City". The population assesses the current situation as average and gives more importance to the environment, safety, access to health services, housing and employment. In spite of this perception, and due to the programs and projects directed to increase health quality, the city has advanced towards the implementation of efforts to be acknowledged as a Healthy City. Discussion The construction of a Healthy City is specific for each context, and, in any case, it demands a combination of technical work and citizen participation, with the purpose of creating an own imaginary and identifying priorities. In the case of Medellín, assuming the strategy in a systematic manner is necessary to continue in the long term and to propose explicit goals and take actions to work along with different sectors of social development.(AU)

Detection of aflatoxin M1 in milk, cheese and sour cream samples from Costa Rica using enzyme-assisted extraction and HPLC.

Aflatoxins are toxic fungal metabolites, which can be found in feed. Aflatoxin M1 (AFM1) is excreted into milk when ruminants ingest aflatoxin B1 contaminated feedstuffs. Due to its carcinogenic potential, contamination of milk and dairy products with AFM1 may pose a risk for consumers. Hence, it is considered a public health concern. In this survey, the level of AFM1 contamination of dairy products marketed in Costa Rica was determined by enzyme-assisted extraction, immunoaffinity clean-up and high-performance liquid chromatography coupled with a fluorescent detector (HPLC-FLD) in fluid milk (n = 70), fresh cheese (n = 70) and sour cream (n = 70) collected at local convenience stores and supermarkets. AFM1 concentrations in milk and fresh cheese ranged from 19 to 629 ng/L and from 31 to 276 ng/L, with mean values of 136 ng/L and 74 ng/L, respectively, whereas none of the sour cream samples analysed tested positive for this aflatoxin. In 30 milk samples, and 10 cheese samples, AFM1 concentrations surpassed threshold concentrations as established by the European Commission. Thus, sour cream and - to a lesser extent - cheese manufacturing seems to reduce the amount of AFM1 present in milk, possibly due to fraction redistribution or microbiological degradation. The survey results reveal improper quality control procedures in the Costa Rican dairy industry. Therefore, a surveillance programme for dairy products in our country is recommended.

Expression of recombinant proteins lacking methionine as N-terminal amino acid in plastids: human serum albumin as a case study.

Removal of the N-terminal methionine of a protein could be critical for its function and stability. Post-translational modifications of recombinant proteins expressed in heterologous systems may change amino-terminal regions. We studied the expression of mature proteins lacking methionine as the N-terminal amino acid in tobacco chloroplasts, using human serum albumin (HSA) as an example. Two approaches were explored. First, we fused the Rubisco small subunit transit peptide to HSA. This chimeric protein was correctly processed in the stroma of the chloroplast and rendered the mature HSA. The second approach took advantage of the endogenous N-terminal methionine cleavage by methionine aminopeptidase. Study of this protein processing reveals a systematic cleavage rule depending on the size of the second amino acid. Analysis of several foreign proteins expressed in tobacco chloroplasts showed a cleavage pattern in accordance to that of endogenous proteins. This knowledge should be taken into account when recombinant proteins with N-terminus relevant for its function are expressed in plastids.