Salivary 8-hydroxy-2'-deoxyguanosine levels in patients with oral cancer: a systematic review and meta-analysis.

BACKGROUND: DNA is an important target for oxidative attack and its modification may increase the risk of mutagenesis. The aim of this study was to evaluate and compare salivary levels of the oxidative stress biomarker 8-hydroxy-2'-deoxyguanosine (8-OHdG) in patients with oral cancer (OC) compared to the control group by a comprehensive search of the available literature. METHODS: The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was registered in Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/X3YMR. Four electronic databases were used to identify studies for this systematic review: PubMed, Scopus, ScienceDirect, and Web of Science from January 15, 2005, to April 15, 2021. The Joanna Briggs Institute (JBI) tool was used to assess article quality. RESULTS: Of the 166 articles identified, 130 articles were excluded on the basis of title and abstract screening (duplicates, reviews, etc.). Thirty-six articles were evaluated at full text and 7 articles met the inclusion criteria. Of these, only 5 studies had compatible data for quantitative analysis. An increase in salivary 8-OHdG levels was found in patients with OC compared to healthy subjects, but without statistical significance. 8-OHdG: SMD = 2,72 (95%CI= -0.25-5.70); *p = 0.07. CONCLUSIONS: This systematic review and meta-analysis suggests a clear trend of increased 8-OHdG levels in saliva of OC patients compared to the control group. However, further studies are required to clarify and understand the altered levels of this oxidative stress marker.

Podoplanin immunoexpression in odontogenic lesions: a systematic review, meta-analysis, and integrated bioinformatic analysis.

BACKGROUND: Podoplanin (PDPN) is a transmembrane glycoprotein implicated in the pathogenesis of odontogenic lesions (OL). It is localized at the membrane and cytoplasmic level, and its interaction with other proteins could trigger cell proliferation, invasion and migration. The main objective of this systematic review is to explore the immunoexpression pattern of podoplanin in OL. In addition, as secondary objectives, we aimed to compare the immunostaining intensity of PDPN in OL, to analyze its interaction networks by bioinformatic analysis and to highlight its importance as a potential diagnostic marker useful in the pathogenesis of OL. METHODS: The protocol was developed following PRISMA and Cochrane guidelines. The digital search was performed in the databases: PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science and Google Schoolar from August 15, 2010 to June 15, 2023. We included cross-sectional and cohort studies that will analyze the pattern of PDPN immunoexpression in OL. Two investigators independently searched for eligible articles, selected titles and abstracts, analyzed full text, conducted data collection, and performed assessment of study quality and risk of bias. In addition, part of the results were summarized through a random-effects meta-analysis. STRING database was used for protein-protein interaction analysis. RESULTS: Twenty-nine relevant studies were included. The ages of the subjects ranged from 2 to 89 years, with a mean age of 33.41 years. Twenty-two point two percent were female, 21.4% were male, and in 56.4% the gender of the participants was not specified. A total of 1,337 OL samples were analyzed for PDPN immunoexpression pattern. Ninety-four (7.03%) were dental follicles and germs, 715 (53.47%) were odontogenic cysts, and 528 (39.49%) were odontogenic tumors. Meta-analysis indicated that the immunostaining intensity was significantly stronger in odontogenic keratocysts compared to dentigerous cysts (SMD=3.3(CI=1.85-4.82, p=0.000*). Furthermore, bioinformatic analysis revealed that PECAM-1, TNFRF10B, MSN, EZR and RDX interact directly with PDPN and their expression in OL was demonstrated. CONCLUSIONS: The results of the present systematic review support the unique immunoexpression of PDPN as a potential useful diagnostic marker in the pathogenesis of OL.

Activity and levels of TNF-α, IL-6 and IL-8 in saliva of children and young adults with dental caries: a systematic review and meta-analysis.

BACKGROUND: Cytokines play an important role in the immunopathogenesis of dental caries. A systematic review and meta-analysis was carried out with the following three objectives: 1)To deepen and discuss through a comprehensive analysis of the literature the effects of dental caries on the activity and levels of TNF-α, IL-6 and IL-8 in saliva of children and young adults, 2)To compare the levels of this cytokines in saliva of the exposure group (moderate-severe dental caries) with the control group (caries-free or mild dental caries), and 3)To determine whether the levels of these cytokines could be used as a complementary clinical diagnostic tool to assess the severity of dental caries. METHODS: The protocol followed PRISMA and Cochrane guidelines and was registered in the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/MF74V . A digital search was performed in PubMed/MEDLINE, Cochrane, Scopus, and Google Schoolar databases from February 15th, 2012, to January 13th, 2024. The methodological validity of the selected studies was assessed using Joanna Briggs Institute (JBI) tool. A meta-analysis was performed using a random-effects model to evaluate the association between dental caries/health, and the concentration of TNF-α, IL-6 and IL-8. RESULTS: The search strategy provided a total of 126 articles, of which 15 investigations met the inclusion criteria. The total number of patients studied was 1,148, of which 743 represented the case/exposure group, and 405 represented the control group. The age of the patients ranged from 3 to 25 years. IL-6 was the most prevalent cytokine in the saliva of children and young adults with active dental caries. The meta-analysis revealed that there are significant differences between the levels of IL-6 and TNF-α in saliva of children with active dental caries compared to their control groups. CONCLUSIONS: The findings suggest that IL-6 and TNF-α levels may have potential as complementary biomarkers for assessing dental caries severity. However, further research is needed to validate these findings in larger and more diverse populations before clinical application.

Impacto de ejercicios bilaterales y unilaterales en la potenciación aguda del salto horizontal en futbolistas profesionales / Impact of Bilateral and Unilateral Exercises on Acute Enhancement of Horizontal Jump Performance in Professional Soccer Player / Impacto dos Exercícios Bilaterais e Unilaterais no Aumento Agudo do Desempenho do Salto Horizontal em Jogadores Profissionais de Futebol

Resumen Objetivo: Analizar el efecto de una activación realizada a través de ejercicios de fuerza y pliometría ejecutados de forma bilateral o unilateral sobre el rendimiento en salto horizontal. Metodología: En el estudio participaron 15 futbolistas masculinos, altamente entrenados (edad, 24.7 ± 3.1 años; altura, 181.2 ± 4.7 cm; peso, 79.7 ± 3.4 kg) pertenecientes al mismo equipo, que competía en liga nacional. Su rutina de entrenamiento regular constaba de 4 sesiones y 1 partido competitivo por semana. Los participantes llevaron a cabo 1 protocolo control (CON) y 3 protocolos de activación, siguiendo un diseño contrabalanceado, basados en ejercicios específicos de fútbol (SIN), ejercicios de fuerza y pliometría ejecutados de forma bilateral (BIL) y unilateral (UNI). Después de cada protocolo los jugadores realizaron la prueba de salto horizontal (HZB). Resultados: Los resultados de la prueba ANOVA de medidas repetidas mostraron efectos positivos significativos sobre el HZB de los protocolos SIN (p<0.01; dif = 2.95(2.00)%), BIL (p<0.01; dif = 3.22(2.61) %); y UNI (p<0.01; dif = 6.80(3.40) %) con respecto a CON. Además, HZB fue, significativamente, mayor después del protocolo UNI que del SIN (p<0.01; dif = 3.74(2.62) %) y BIL (p<0.01; dif = 3.47(1.94) %). El análisis de la respuesta individual reflejó efectos positivos en HZB de los protocolos SIN, BIL y UNI respecto al CON, mientras que el 89 % de los jugadores tuvieron mejor rendimiento en HZB después de UNI que de BIL. Conclusiones: Una activación que incorpora estímulos de fuerza y pliometría ejecutados, de forma unilateral, tiene un efecto positivo mayor sobre la capacidad de salto horizontal, que una activación que involucra ejercicios generales, específicos de fútbol y de ejecución bilateral.

Abstract Objective: To analyze the effect of activation through bilateral or unilateral strength and plyometric exercises on horizontal jump performance. Methodology: The study involved 15 highly trained male soccer players (age, 24.7 ± 3.1 years; height, 181.2 ± 4.7 cm; weight, 79.7 ± 3.4 kg) from the same team competing in the national league. Their regular training routine consisted of 4 sessions and 1 competitive match per week. Participants performed 1 control protocol (CON) and 3 activation protocols following a counterbalanced design based on specific soccer exercises (SIN), bilateral (BIL), and unilateral (UNI) strength and plyometric exercises. After each protocol, players underwent the horizontal jump test (HZB). Results: The repeated measures ANOVA revealed significant positive effects on HZB for the SIN (p<0.01; diff = 2.95(2.00) %), BIL (p<0.01; diff = 3.22(2.61) %), and UNI (p<0.01; diff = 6.80(3.40) %) protocols compared to CON. Furthermore, HZB was significantly higher after the UNI protocol than after SIN (p<0.01; diff = 3.74(2.62) %) and BIL (p<0.01; diff = 3.47(1.94) %). Individual response analysis reflected positive effects on HZB for SIN, BIL, and UNI compared to CON, while 89 % of players showed better HZB performance after UNI than after BIL. Conclusions: Activation incorporating unilateral strength and plyometric stimuli has a greater positive effect on horizontal jump capacity than activation involving general, soccer-specific, and bilateral exercises.

Resumo Objetivo: Analisar o efeito da ativação por meio de exercícios de força e pliométricos bilaterais ou unilaterais no desempenho do salto horizontal. Metodologia: O estudo envolveu 15 jogadores de futebol masculinos altamente treinados (idade, 24.7 ± 3.1 anos; altura, 181.2 ± 4.7 cm; peso, 79.7 ± 3.4 kg) da mesma equipe competindo na liga nacional. Sua rotina de treinamento regular consistia em 4 sessões e 1 jogo competitivo por semana. Os participantes realizaram 1 protocolo de controle (CON) e 3 protocolos de ativação seguindo um desenho contrabalanceado com base em exercícios específicos de futebol (SIN), exercícios de força e pliométricos bilaterais (BIL) e unilaterais (UNI). Após cada protocolo, os jogadores foram submetidos ao teste de salto horizontal (HZB). Resultados: A ANOVA de medidas repetidas revelou efeitos positivos significativos no HZB para os protocolos SIN (p<0.01; diff = 2.95(2.00) %), BIL (p<0.01; diff = 3.22(2.61) %) e UNI (p<0.01; diff = 6.80(3.40) %) em comparação com CON. Além disso, o HZB foi significativamente maior após o protocolo UNI do que após SIN (p<0.01; diff = 3.74(2.62) %) e BIL (p<0.01; diff = 3.47(1.94) %). A análise de resposta individual refletiu efeitos positivos no HZB para SIN, BIL e UNI em comparação com CON, enquanto 89 % dos jogadores mostraram melhor desempenho de HZB após UNI do que após BIL. Conclusões: A ativação incorporando estímulos de força e pliométricos unilaterais tem um efeito positivo maior na capacidade de salto horizontal do que a ativação envolvendo exercícios gerais, específicos do futebol e bilaterais.

Conocimientos, hábitos y aptitudes en fotoprotección para prevenir el cáncer de piel

Fundamento: El cáncer de piel es una de las neoplasias más frecuentes, con un considerable aumento en las últimas dos décadas. Las campañas de fotoprotección han tenido un impacto positivo en la población y permiten a las personas sanas el cuidado de su piel y la prevención del cáncer. Objetivo: Describir los principales resultados obtenidos en los estudios científicos relacionados con los conocimientos, hábitos y aptitudes en fotoprotección para la prevención del cáncer de piel en población de riesgo mayor de 18 años. Método: Se realizó una revisión sistemática en las bases de datos Scopus y Pubmed en (inglés), Scielo y CUIDEN en (español), con perfil de acceso desde la biblioteca electrónica de la Universidad de Granada en el período de estudio comprendido desde mayo de 2018 hasta julio de 2022. Se elaboró la pregunta guía a través del acrónimo PICOT, términos de búsqueda y se utilizaron los descriptores en Ciencias de la Salud y del Medical Subject Headings, respectivamente. Resultados: Conocer las conductas de riesgo y de protección es útil para orientar las intervenciones individuales o a nivel comunitario para disminuir la morbilidad asociada a la exposición solar. Se ha demostrado que las campañas de prevención del cáncer de piel son eficaces y rentables. Los médicos de atención primaria juegan un papel importante en la prevención del cáncer de piel. El asesoramiento sobre factores de riesgo modificables y estrategias para evitar el sol, en pacientes con antecedentes personales o familiares de cáncer de piel, debe ser parte de la medicina preventiva. Conclusiones: Los estudios científicos que abordan conocimientos, hábitos y aptitudes en relación con la fotoprotección para la prevención del cáncer de piel, destacan entre sus principales resultados, que la principal conducta para garantizar una adecuada acción protectora saludable es direccionar programas de educación en la prevención primaria de salud.

Foundation: Skin cancer is one of the most common neoplasms, with an increase in the last two decades. Photoprotection campaigns have had a positive impact on the population and allow healthy people to care for their skin and prevent cancer. Objective: To describe the main results obtained in scientific studies related to knowledge, habits and skills in photoprotection for the prevention of skin cancer in a population at risk over 18 years of age. Method: A systematic review was carried out in the databases Scopus and Pubmed in (English), Scielo and CUIDEN in (Spanish), with access profile from the electronic library of the University of Granada in the study period from May 2018 to July 2022. The guiding question was developed through the PICOT acronym, search terms and the descriptors in Health Sciences and Medical Subject Headings were used, respectively. Results: Knowing risk and protective behaviors is useful to guide individual or community-level interventions to reduce morbidity associated with sun exposure. Skin cancer prevention campaigns have been shown to be effective and cost-effective. Primary care physicians play an important role in skin cancer prevention. Counseling on modifiable risk factors and strategies to avoid the sun, in patients with a personal or family history of skin cancer, should be part of preventive medicine. Conclusions: Scientific studies that address knowledge, habits and skills in relation to photoprotection for the prevention of skin cancer, highlight among their main results that the main conduct to guarantee adequate healthy protective action is to direct education programs in primary prevention of health.

Optimizing Heart Failure Management: A Review of the Clinical Pharmacist Integration to the Multidisciplinary Health Care Team.

Heart failure (HF) stands as a prevalent chronic ailment, imposing a substantial burden on global healthcare systems due to recurrent hospitalizations, intricate management, persistent symptoms, and polypharmacy challenges. The augmentation of patient safety and treatment efficacy across various care stages, facilitated by a multidisciplinary HF team inclusive of a clinical pharmacist, emerges as paramount. Evidence underscores that the collaborative engagement of a physician and a clinical pharmacist engenders proficient and secure management, forestalling avoidable adversities stemming from drug reactions and prescription inaccuracies. This synergistic approach tailors treatments optimally to individual patients. Post-discharge, the vulnerability of HF patients to re-hospitalization looms large, historically holding sway as the foremost cause of 30-day readmissions. Diverse strategies have been instituted to fortify patient well-being, leading to the formulation of specialized transitional care programs that shepherd patients effectively from hospital to outpatient settings. These initiatives have demonstrably curtailed readmission rates. This review outlines a spectrum of roles assumed by clinical pharmacists within the healthcare cohort, spanning inpatient care, transitional phases, and outpatient services. Moreover, it traverses a compendium of studies spotlighting the affirmative impact instigated by integrating clinical pharmacists into these fields.

Analysis of subgingival microbiota and IL-1ß, TNF-α and CX3CL1 levels in gingival crevicular fluid of fixed dental prostheses.

Prosthetic biomaterials can affect the composition of the subgingival microbiota and consequently the production of proinflammatory cytokines, causing damage to the periodontium. A total of 40 patients were divided into two groups: 20 with monolithic zirconia (MZ) prostheses and 20 with porcelain fused to metal (PFM) with nickel-chromium (Ni-Cr) alloy prostheses. Subgingival plaque and gingival crevicular fluid samples were taken. The Checkerboard technique for DNA-DNA hybridization and the enzyme-linked immunosorbent assay technique were performed. Teeth with MZ presented a lower percentage of bleeding on probing and tooth mobility compared to teeth with PFM with Ni-Cr alloy. Prosthodontic teeth harbored higher total levels of the 18 bacterial species than non-prosthodontic teeth. There was a higher prevalence of S. gordonii and V. parvula species in PFM with Ni-Cr alloy compared to MZ. There was an increase in IL-1ß, TNF-α and CX3CL1 levels in PFM with Ni-Cr alloy compared to MZ. MZ is a candidate biomaterial with fewer negative effects on the periodontium, allowing for longer prostheses longevity in the mouth.

The role of the CX3CL1/CX3CR1 axis as potential inflammatory biomarkers in subjects with periodontitis and rheumatoid arthritis: A systematic review.

OBJECTIVE: This systematic review aimed to investigate the role of the C-X3-C motif ligand 1/chemokine receptor 1 C-X3-C motif (CX3CL1/CX3CR1) axis in the pathogenesis of periodontitis. Furthermore, as a secondary objective, we determine whether the CX3CL1/CX3CR1 axis could be considered complementary to clinical parameters to distinguish between periodontitis and rheumatoid arthritis (RA) and/or systemically healthy subjects. METHODS: The protocol used for this review was registered in OSF (10.17605/OSF.IO/KU8FJ). This study was designed following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Records were identified using different search engines (PubMed/MEDLINE, Scopus, Science Direct, and Web of Science) from August 10, 2006, to September 15, 2023. The observational studies on human subjects diagnosed with periodontitis and RA and/or systemically healthy were selected to analyze CX3CL1 and CX3CR1 biomarkers. The methodological validity of the selected articles was assessed using NIH. RESULTS: Six articles were included. Biological samples (gingival crevicular fluid [GCF], saliva, gingival tissue biopsies, serum) from 379 subjects (n = 275 exposure group and n = 104 control group) were analyzed. Higher CX3CL1 and CX3CR1 chemokine levels were found in subjects with periodontitis and RA compared with periodontal and systemically healthy subjects. CONCLUSION: Very few studies highlight the role of the CX3CL1/CX3CR1 axis in the pathogenesis of periodontitis; however, increased levels of these chemokines are observed in different biological samples (GCF, gingival tissue, saliva, and serum) from subjects with periodontitis and RA compared with their healthy controls. Future studies should focus on long-term follow-up of subjects and monitoring changes in cytokine levels before and after periodontal therapy to deduce an appropriate interval in health and disease conditions.

FOXM1 Participates in Trophoblast Migration and Early Trophoblast Invasion: Potential Role in Blastocyst Implantation.

Successful implantation requires coordinated migration and invasion of trophoblast cells into a receptive endometrium. Reduced forkhead box M1 (FOXM1) expression limits trophoblast migration and angiogenesis in choriocarcinoma cell lines, and in a rat model, placental FOXM1 protein expression was significantly upregulated in the early stages of pregnancy compared to term pregnancy. However, the precise role of FOXM1 in implantation events remains unknown. By analyzing mice blastocysts at embryonic day (E3.5), we have demonstrated that FOXM1 is expressed as early as the blastocyst stage, and it is expressed in the trophectoderm of the blastocyst. Since controlled oxygen tension is determinant for achieving normal implantation and placentation and a chronic hypoxic environment leads to shallow trophoblast invasion, we evaluated if FOXM1 expression changes in response to different oxygen tensions in the HTR-8/SVneo first trimester human trophoblast cell line and observed that FOXM1 expression was significantly higher when trophoblast cells were cultured at 3% O2, which coincides with oxygen concentrations in the uteroplacental interface at the time of implantation. Conversely, FOXM1 expression diminished in response to 1% O2 that resembles a hypoxic environment in utero. Migration and angiogenesis were assessed following FOXM1 knockdown and overexpression at 3% O2 and 1% O2, respectively, in HTR-8/SVneo cells. FOXM1 overexpression increased transmigration ability and tubule formation. Using a 3D trophoblast invasion model with trophospheres from HTR-8/SVneo cells cultured on a layer of MATRIGEL and of mesenchymal stem cells isolated from menstrual fluid, we observed that trophospheres obtained from 3D trophoblast invasion displayed higher FOXM1 expression compared with pre-invasion trophospheres. Moreover, we have also observed that FOXM1-overexpressing trophospheres increased trophoblast invasion compared with controls. HTR-8/SVneo-FOXM1-depleted cells led to a downregulation of PLK4, VEGF, and MMP2 mRNA expression. Our current findings suggest that FOXM1 participates in embryo implantation by contributing to trophoblast migration and early trophoblast invasion, by inducing transcription activation of genes involved in these processes. Maternal-fetal communication is crucial for trophoblast invasion, and maternal stromal cells may induce higher levels of FOXM1 in trophoblast cells.

Implant-supported prosthetic rehabilitation after Ameloblastomas treatment: a systematic review.

BACKGROUND: Ameloblastoma (AM), the benign counterpart of ameloblastic carcinoma, is a benign odontogenic tumor of epithelial origin, naturally aggressive, with unlimited growth potential and a high tendency to relapse if not adequately removed. Patients with AM treated surgically can benefit from dental implant therapy, promoting oral rehabilitation and improving their quality of life. The present study aimed to determine the survival rate of dental implants placed after surgical treatment of patients affected by AM. In addition, there were two secondary objectives: 1) To evaluate which dental implant loading protocols are most frequently used and 2) To determine the type of prosthetic restoration most commonly used in these patients. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed during the study. Searches were performed in three databases (PubMed/MEDLINE, Scopus, and Google Scholar) until November 2023. Additionally, the electronic search was enriched by an iterative hand search of journals related to oral pathology and medicine, maxillofacial surgery, and oral prosthodontics and implantology. Only reports and case series in English from January 2003 to date were included. The Joanna Briggs Institute tool (JBI-Case Reports/Case Series) was used for the study quality assessment. RESULTS: The total number of patients and implants studied were 64 and 271, respectively, all with surgically treated AM. The patient's ages ranged from 8 to 79 years, with a mean (SD) age of 37.3 ± 16.4. Fifty-three percent were male and 47% were female. The range of follow-up duration was 1 to 22 years. An implant survival/success rate of 98.1% was reported. In addition, most of them were conventionally loaded (38.3%). Hybrid implant-supported fixed dentures were the most commonly used by prosthodontists (53%). CONCLUSIONS: Oral rehabilitation with dental implants inserted in free flaps for orofacial reconstruction in surgically treated patients with AM can be considered a safe and successful treatment modality.

El papel de la Ivabradina y la titulación de los betabloqueadores en la insuficiencia cardíaca: una serie de casos y revisión de la literatura / The role of Ivabradine and beta-blocker titration in heart failure: a case series and literature review

RESUMEN Introducción y objetivos : La insuficiencia cardíaca (IC) es una preocupación creciente de salud pública. Si bien los betabloqueantes (BB) son la base del tratamiento, lograr reducciones objetivo de frecuencia cardíaca puede ser difícil debido a los efectos secundarios y la tolerancia limitada. La ivabradina, un inhibidor único de la corriente If, ofrece un enfoque complementario para controlar la frecuencia cardíaca sin afectar la contractilidad. El objetivo de este estudio fue evaluar la eficacia de agregar ivabradina a la terapia BB en pacientes con IC. Métodos: Se realizó un estudio observacional retrospectivo en un hospital privado en San José, Costa Rica se analizaron 7 casos de pacientes tratados con BB a los cuales posteriormente se les adicionó ivabradina. Se recopilaron datos demo- gráficos, las características clínicas, la frecuencia cardíaca previa y posterior a la ivabradina, la clase funcional NYHA y los valores de laboratorio seleccionados. Resultados: La ivabradina redujo significativamente la frecuencia cardíaca en reposo en un promedio de 26,87 latidos por minuto. El 42,86% alcanzó la dosis meta de su BB inicial después de agregar ivabradina. La clase funcional NYHA se mantuvo estable o mejoró en todos los casos. Conclusiones: Estos resultados sugieren que agregar ivabradina a la terapia BB puede ser una estrategia eficaz para optimizar el control de la frecuencia cardíaca en pacientes con IC. Este enfoque puede mejorar la tolerabilidad de BB, lo que lleva a un mayor manejo de la dosis meta y posiblemente mejores resultados clínicos.

ABSTRACT Introduction and objectives: Heart failure (HF) is a growing public health concern. While beta-blockers (BBs) are the cornerstone of treatment, achieving target heart rate reductions can be difficult due to side effects and limited tolerance. Ivabradine, a unique inhibitor of the If current, offers a complementary approach to controlling heart rate without affecting contractility. This study aimed to evaluate the effectiveness of adding ivabradine to BB therapy in patients with HF. Methods : A retrospective observational study was conducted at a private hospital in San José, Costa Rica. Seven cases of patients treated with BBs who were subsequently added to ivabradine were analyzed. Demographic data, clinical characteristics, heart rate before and after ivabradine, NYHA functional class, and selected laboratory values were collected. Results : Ivabradine significantly reduced resting heart rate by an average of 26.87 beats per minute. Forty-two-point eight-six percent (42.86%) achieved the target dose of their initial BB after adding ivabradine. NYHA functional class remained stable or improved in all cases. Conclusions: These results suggest that adding ivabradine to BB therapy may be an effective strategy to optimize heart rate control in patients with HF. This approach may improve BB tolerability, leading to greater target dose management and possibly better clinical outcomes.

Mature iPSC-derived astrocytes of an ALS/FTD patient carrying the TDP43A90V mutation display a mild reactive state and release polyP toxic to motoneurons.

Astrocytes play a critical role in the maintenance of a healthy central nervous system and astrocyte dysfunction has been implicated in various neurodegenerative disorders, including amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). There is compelling evidence that mouse and human ALS and ALS/FTD astrocytes can reduce the number of healthy wild-type motoneurons (MNs) in co-cultures or after treatment with astrocyte conditioned media (ACM), independently of their genotype. A growing number of studies have shown that soluble toxic factor(s) in the ACM cause non-cell autonomous MN death, including our recent identification of inorganic polyphosphate (polyP) that is excessively released from mouse primary astrocytes (SOD1, TARDBP, and C9ORF72) and human induced pluripotent stem cells (iPSC)-derived astrocytes (TARDBP) to kill MNs. However, others have reported that astrocytes carrying mutant TDP43 do not produce detectable MN toxicity. This controversy is likely to arise from the findings that human iPSC-derived astrocytes exhibit a rather immature and/or reactive phenotype in a number of studies. Here, we have succeeded in generating a highly homogenous population of functional quiescent mature astrocytes from control subject iPSCs. Using identical conditions, we also generated mature astrocytes from an ALS/FTD patient carrying the TDP43A90V mutation. These mutant TDP43 patient-derived astrocytes exhibit key pathological hallmarks, including enhanced cytoplasmic TDP-43 and polyP levels. Additionally, mutant TDP43 astrocytes displayed a mild reactive signature and an aberrant function as they were unable to promote synaptogenesis of hippocampal neurons. The polyP-dependent neurotoxic nature of the TDP43A90V mutation was further confirmed as neutralization of polyP in ACM derived from mutant TDP43 astrocytes prevented MN death. Our results establish that human astrocytes carrying the TDP43A90V mutation exhibit a cell-autonomous pathological signature, hence providing an experimental model to decipher the molecular mechanisms underlying the generation of the neurotoxic phenotype.

Pielonefritis xantogranulomatosa: un reto actual para la laparoscopia.

OBJECTIVE: To present the results of our case series on laparoscopic nephrectomy in xanthogranulomatous pyelonephritis (XGP). METHODS: A retrospective study was conducted that included 143 patients treated with laparoscopic nephrectomy for non-functioning kidney, of whom 15 had XGP, within the time frame of 2011 to 2019. The demographic and clinical data were collected, along with the intraoperative results, complications, and days of hospital stay. RESULTS: Transperitoneal laparoscopic nephrectomy was successfully performed on 15 patients with XGP, with no need for conversion. Mean intraoperative time was 124.4 minutes (range 70-240) and intraoperative blood loss was 148.5 ml (range 30-550), with no blood transfusion required. No intraoperative complications occurred but there was one postoperative complication (6.6%), classified as Clavien-Dindo I (surgical wound infection). Mean hospital stay was 2.85 days (range 2-7). CONCLUSIONS: Nephrectomy is the definitive management for XGP, and the laparoscopic approach should be considered a treatment modality, despite the fact that the pathology involves a severe chronic inflammatory process. Its benefits are reduced surgery duration, less blood loss, a lower complication rate, and fewer days of hospital stay, when performed by a skilled and experienced surgeon.

OBJETIVO: Presentar los resultados de nuestra serie de nefrectomía laparoscópica en pielonefritis xantogranulomatosa (PXG). MÉTODO: Se realizó un estudio retrospectivo que incluyó 143 pacientes tratados con nefrectomía laparoscópica por exclusión renal, de los cuales 15 fueron por PXG, en el periodo comprendido de 2011 a 2019. Se recolectaron datos demográficos y clínicos, resultados transoperatorios, complicaciones y días de estancia hospitalaria. RESULTADOS: Se realizó nefrectomía laparoscópica transperitoneal de forma exitosa en 15 pacientes con PXG, sin necesidad de conversión. El tiempo transoperatorio promedio fue de 124.4 minutos (rango: 70-240). El sangrado transoperatorio fue de 148.5 ml (rango: 30-550), sin requerimiento de transfusión sanguínea. No se reportaron complicaciones transoperatorias; se presentó una complicación en el posoperatorio (6.6%) clasificada como Clavien-Dindo I (infección de la herida quirúrgica). La estancia hospitalaria promedio fue de 2.85 días (rango: 2-7). CONCLUSIONES: El manejo definitivo de la PXG es la nefrectomía, y el abordaje laparoscópico debe ser considerado como una modalidad de tratamiento a pesar de ser una patología que presenta un proceso inflamatorio grave y crónico, obteniéndose beneficios como disminución en el tiempo quirúrgico, menor sangrado, menor tasa de complicaciones y menos días de estancia hospitalaria cuando es realizado por un cirujano experimentado.

Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial.

BACKGROUND: Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country. METHODS: We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers and catalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy. RESULTS: Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics. Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was 5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups. CONCLUSIONS: An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina's primary care setting within the public healthcare system. TRIAL REGISTRATION NUMBER: NCT04293315.

Validación de una estrategia de preparación para el desempeño gerencial en una Facultad de Enfermería / Validation of a preparation strategy for managerial performance in a Nursing Faculty

Introducción: Reconocida es la urgencia de mejorar el desempeño gerencial y elevar la calidad en la gestión. La preparación gerencial en las universidades es un factor estratégico, declarado en la V Conferencia Iberoamericana de Educación. Objetivo: Validar una estrategia de preparación para el desempeño gerencial en la Facultad de Enfermería Lidia Doce. Métodos: Estudio mixto (CUAL-cuan), con diseño exploratorio secuencial, realizado en la Facultad de Enfermería "Lidia Doce", de la Universidad de Ciencias Médicas de La Habana, Cuba, del año 2020 al 2021. En un universo de 22 dirigentes y 20 reservas. Se diseñó la estrategia con el método del Ciclo Deming, se validó con el método Delphi por 31 expertos a los que se determinó el coeficiente de competencia, Los datos se procesaron mediante análisis de contenido, distribuciones de frecuencias absolutas y relativas, (porcentajes, medias, promedios). Resultados: La estrategia quedó configurada por la misión, cuatro fases según el ciclo Deming, con objetivos y acciones. Fue evaluada por los expertos, desde la primera ronda de muy adecuada, con valores entre -0,9072 y -0,236. Conclusiones: Se validó una estrategia de preparación para el desempeño gerencial que contribuye a cambios favorables en la concepción del sistema de trabajo con los cuadros y reservas, fortalece su desarrollo, acorde a la política trazada por el país y las necesidades identificadas en la Facultad de Enfermería "Lidia Doce". La estrategia propuesta aporta a la ciencia de la Enfermería la preparación de los directivos para los procesos formativos en esta área del conocimiento(AU)

Introduction: The urgency to improve management performance and raise the quality of management is recognized. Management preparation in universities is a strategic factor, declared at the V Ibero-American Conference on Education. Objective: Validate a preparation strategy for managerial performance at the "Lidia Doce" Faculty of Nursing. Methods: Mixed study (CUAL-cuan), with a sequential exploratory design, carried out at the "Lidia Doce" Faculty of Nursing, of the University of Medical Sciences of Havana, Cuba, from 2020 to 2021. In a universe of 22 leaders and 20 reserves. The strategy was designed with the Deming Cycle method, it was validated with the Delphi method by 31 experts for whom the competence coefficient was determined. The data were processed through content analysis, distributions of absolute and relative frequencies (percentages, means, averages). Results: The strategy was configured by the mission, four phases according to the Deming cycle, with objectives and actions. It was evaluated by the experts, from the first round, as very adequate, with values between -0.9072 and -0.236. Conclusions: A preparation strategy for managerial performance was validated that contributes to favorable changes in the conception of the work system with cadres and reserves, strengthens its development, in accordance with the policy outlined by the country and the needs identified in the Faculty of "Lidia Doce" Infirmary. The proposed strategy contributes to Nursing science by preparing managers for training processes in this area of knowledge(AU)

Advantages and Short-Term Outcomes of Laparoscopic-Assisted Renal Surgery in Elderly Patients.

OBJECTIVE: To compare the perioperative results of adult and elderly patients undergoing laparoscopic renal surgery. METHODOLOGY: Retrospective, analytical study. 448 who underwent kidney surgery for benign or malignant pathologies between 2011-2019 were included in the General Hospital of Mexico "Dr. Eduardo Liceaga". They were categorized into two groups: Group 1 <60 years and Group 2 >60 years. Descriptive statistics and bivariate analysis were performed, the calculations were performed with 95% reliability and a value of p (<0.05). RESULTS: In the group over 60 years of age, the following was found: Age: 67.1 years (60-83). IMC 28.3 kg/m2 (19-48.7). Intra and postsurgical outcomes: intraoperative bleeding = 184.4cc (5-1700). Surgical Time = 112.6min (30-240). Days of hospital stay = 2 (1-7). Complications in 2.6% (Clavien-Dindo: I = 2; II = 1), no conversion was required in any patient. There were no statistically significant differences with group 1, an exception for intraoperative bleeding. CONCLUSIONS: Our study is a pioneer in Latin America in the evaluation of the geriatric population and outcomes with laparoscopic surgery and we recommend that renal procedures with a laparoscopic approach should be considered as the best strategy in the management of benign or malignant renal pathology in geriatric patients.

Satisfacción del profesional de enfermería con una intervención de cuidados como vía para la gestión del conocimiento / The Nursing Professional's Satisfaction with a Care Intervention as a Means for Knowledge Management

Introducción: La satisfacción es el cumplimiento de expectativas en una actividad dada, determinada por las respuestas positivas que sobre esa actividad den los usuarios o participantes, lo que ratifica el cumplimiento de las exigencias de la intervención propuesta. Objetivo: Evaluar la satisfacción del profesional de enfermería con una intervención de cuidados como vía para la gestión del conocimiento. Métodos: Investigación cuantitativa de diseño observacional, descriptivo y transversal en Atención Primaria de Salud de la provincia Mayabeque en el período enero-abril de 2021. Universo de 44 profesionales de enfermería que brindan cuidados enfermeros a personas con infarto agudo de miocardio. Se aplicó una encuesta descriptiva de satisfacción validada por expertos a través del coeficiente de V de Aiken y se aplicó la técnica de Iadov para calcular el índice de satisfacción individual y grupal al utilizar el cuadro lógico de Iadov. Resultados: Se constató que 86,36 por ciento alcanzaron clara satisfacción con la intervención de cuidados enfermeros, 9,09 por ciento estaba más satisfecho que insatisfecho, 2,27 por ciento dieron respuestas no definidas y contradictorias. El Índice de Satisfacción Grupal obtiene un valor de 0,90, que se ubica en el rango de muy satisfecho. Conclusiones: El proceso de evaluación del profesional de enfermería con una intervención de cuidados como vía para la gestión del conocimiento resultó satisfactorio, expresado en el alto Índice de Satisfacción Grupal y en los criterios emitidos, donde evidencian la importancia que le conceden a la intervención propuesta(AU)

Introduction: Satisfaction is the achievement of expectations in a given activity, determined by the positive responses about that activity given by users or participants, which ratifies the fulfillment of the requirements proposed for any intervention. Objective: To assess the nursing professional's satisfaction with a care intervention as a means for knowledge management. Methods: A quantitative research of observational, descriptive and cross-sectional design was carried out at the primary healthcare level in Mayabeque Province in the period January-April 2021. The universe was made up of 44 nursing professionals who provide nursing care to people with acute myocardial infarction. A descriptive satisfaction survey validated by experts was applied using Aiken's V coefficient, and the Iadov's technique was applied to calculate the individual and group satisfaction index using Iadov's logical chart. Results: It was found that 86.36 percent of the respondents showed clear satisfaction with the nursing care intervention, 9.09 percent were more satisfied than dissatisfied, 2.27 percent gave undefined and contradictory answers. The group satisfaction score showed a value of 0.90, within the range of very satisfied. Conclusions: The assessment of the nursing professional's satisfaction with a care intervention as a means for knowledge management was satisfactory, as expressed in the high group satisfaction score and the given criteria, which evidence the importance that they attribute to the proposed intervention(AU)

Residential proximity to industrial pollution and mammographic density.

BACKGROUND: Mammographic density (MD), expressed as percentage of fibroglandular breast tissue, is an important risk factor for breast cancer. Our objective is to investigate the relationship between MD and residential proximity to pollutant industries in premenopausal Spanish women. METHODS: A cross-sectional study was carried out in a sample of 1225 women extracted from the DDM-Madrid study. Multiple linear regression models were used to assess the association of MD percentage (and their 95% confidence intervals (95%CIs)) and proximity (between 1 km and 3 km) to industries included in the European Pollutant Release and Transfer Register. RESULTS: Although no association was found between MD and distance to all industries as a whole, several industrial sectors showed significant association for some distances: "surface treatment of metals and plastic" (ß = 4.98, 95%CI = (0.85; 9.12) at ≤1.5 km, and ß = 3.00, 95%CI = (0.26; 5.73) at ≤2.5 km), "organic chemical industry" (ß = 6.73, 95%CI = (0.50; 12.97) at ≤1.5 km), "pharmaceutical products" (ß = 4.14, 95%CI = (0.58; 7.70) at ≤2 km; ß = 3.55, 95%CI = (0.49; 6.60) at ≤2.5 km; and ß = 3.11, 95%CI = (0.20; 6.01) at ≤3 km), and "urban waste-water treatment plants" (ß = 8.06, 95%CI = (0.82; 15.30) at ≤1 km; ß = 5.28; 95%CI = (0.49; 10.06) at ≤1.5 km; ß = 4.30, 95%CI = (0.03; 8.57) at ≤2 km; ß = 5.26, 95%CI = (1.83; 8.68) at ≤2.5 km; and ß = 3.19, 95%CI = (0.46; 5.92) at ≤3 km). Moreover, significant increased MD was observed in women close to industries releasing specific pollutants: ammonia (ß = 4.55, 95%CI = (0.26; 8.83) at ≤1.5 km; and ß = 3.81, 95%CI = (0.49; 7.14) at ≤2 km), dichloromethane (ß = 3.86, 95%CI = (0.00; 7.71) at ≤2 km), ethylbenzene (ß = 8.96, 95%CI = (0.57; 17.35) at ≤3 km), and phenols (ß = 2.60, 95%CI = (0.21; 5.00) at ≤2.5 km). CONCLUSIONS: Our results suggest no statistically significant relationship between MD and proximity to industries as a whole, although we detected associations with various industrial sectors and some specific pollutants, which suggests that MD could have a mediating role in breast carcinogenesis.

Alcoholic Liver Disease Among Patients with Wernicke Encephalopathy: A Multicenter Observational Study.

BACKGROUND: data regarding the association between Wernicke encephalopathy (WE) and alcoholic liver disease (ALD) are scarce in spite of alcohol consumption being the main risk factor for WE. AIMS: to describe the frequency of ALD in a cohort of patients diagnosed with WE and alcohol use disorders (AUDs) and to compare the characteristics of WE patients with and without ALD. METHODS: we conducted an observational study in 21 centers through a nationwide registry of the Spanish Society of Internal Medicine. WE Caine criteria were applied and demographic, clinical, and outcome variables were analyzed. RESULTS: 434 patients were included in the study, of which 372 were men (85.7%), and the mean age was 55 ± 11.8 years. ALD was present in 162 (37.3%) patients and we found a higher percentage of cases with tremor, flapping and hallucinations in the ALD group. A total of 22 patients (5.0%) died during admission (7.4% with ALD vs 3.7% without ALD; P = 0.087). Among the ALD patients, a relationship between mortality and the presence of anemia (Odds ratio [OR]=4.6 Confidence interval [CI]95% 1.1-18.8; P = 0.034), low level of consciousness (OR=4.9 CI95% 1.1-21.2; P = 0.031) and previous diagnosis of cancer (OR=10.3 CI95% 1.8-59.5; P = 0.009) was detected. Complete recovery was achieved by 27 patients with ALD (17.8%) and 71 (27.8%) without ALD (P = 0.030). CONCLUSION: the association of WE and ALD in patients with AUDs is frequent and potentially linked to differences in clinical presentation and to poorer prognosis, as compared to alcoholic patients with WE without ALD.