Usefulness of thoracic ultrasound in the assessment of removal of indwelling pleural catheter in patients with malignant pleural effusion.

INTRODUCTION: There are no defined criteria for deciding to remove a non-functioning indwelling pleural catheter (IPC) when lung re-expansion on chest X-ray is incomplete. Chest computed tomography (chest CT) is usually used. The objective of this work is to validate the usefulness of chest ultrasound performed by a pulmonologist and by a radiologist compared to chest CT. PATIENTS AND METHODS: Prospective, descriptive, multidisciplinary and multicenter study including patients with malignant pleural effusion and non-functioning IPC without lung reexpansion. Decisions made on the basis of chest ultrasound performed by a pulmonologist, and performed by a radiologist, were compared with chest CT as the gold standard. RESULTS: 18 patients were analyzed, all of them underwent ultrasound by a pulmonologist and chest CT and in 11 of them also ultrasound by a radiologist. The ultrasound performed by the pulmonologist presents a sensitivity of 60%, specificity of 100%, PPV 100% and NPV 66% in the decision of the correct removal of the IPC. The concordance of both ultrasounds (pulmonologist and radiologist) was 100%, with a kappa index of 1. The 4 discordant cases were those in which the IPC was not located on the ultrasound. CONCLUSIONS: Thoracic ultrasound performed by an expert pulmonologist is a valid and simple tool to determine spontaneous pleurodesis and remove a non-functioning IPC, which would make it possible to avoid chest CT in those cases in which lung reexpansion is observed with ultrasonography.

Changes in sugar-sweetened beverage purchases across the price distribution after the implementation of a tax in Mexico: a before-and-after analysis.

BACKGROUND: A tax of one-Mexican peso per liter of sugar-sweetened beverage (SSB) came into effect in January 2014 in Mexico as a national health policy to tackle the high overweight and obesity prevalence. Previous studies have shown an overall reduction in SSB purchases after the tax implementation. However, it remains unknown whether and to what extent SSB consumers switched to cheaper taxed beverages, attenuating the potential effect of the policy. Our study's objective was to estimate changes in household purchases of taxed SSBs by tertiles of SSB prices (low, middle, and high) in urban areas after the SSB tax implementation in 2014. METHODS: Based on purchase data for 2012-2015 from households living in 54 Mexican cities with a population > 50,000 inhabitants, we calculated unit-value SSB prices for the full period and sorted them on a monthly basis to create monthly price tertiles. We merged these price tertiles to household purchases and created average monthly ml/capita/day SSB purchases by price tertile at the city level. We assessed SSB purchase switching patterns before and after the tax implementation through price-tertile stratified linear models. The main variable in the models was a dummy indicator that allowed us to identify the pre-tax period (2012-13) and post-tax period (2014-15). We controlled our models for time trends and contextual economic variables. RESULTS: In the regression adjusted models, we found a statistically significant purchase reduction ranging between 10.80 and 13.79 ml/capita/day (p-value < 0.001) across taxed beverages from the middle-price SSB after the tax implementation. We observed no statistically significant reductions in purchases of low-price SSBs and high-price SSBs. CONCLUSIONS: Our findings show purchase reductions in the middle-price SSBs, which represents ≈30% of the overall SSB purchases in urban Mexico. Future studies should be conducted to test if the redesign of the current the tax, by either doubling the tax amount or taxing sugar content, might reduce more effectively purchases across all SSBs.

Low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope: Monte Carlo treatment planning and dose measurements in a postmortem subject.

Objective.The goal of this study was to use Monte Carlo (MC) simulations and measurements to investigate the dosimetric suitability of an interventional radiology (IR) c-arm fluoroscope to deliver low-dose radiotherapy to the lungs.Approach.A previously-validated MC model of an IR fluoroscope was used to calculate the dose distributions in a COVID-19-infected patient, 20 non-infected patients of varying sizes, and a postmortem subject. Dose distributions for PA, AP/PA, 3-field and 4-field treatments irradiating 95% of the lungs to a 0.5 Gy dose were calculated. An algorithm was created to calculate skin entrance dose as a function of patient thickness for treatment planning purposes. Treatments were experimentally validated in a postmortem subject by using implanted dosimeters to capture organ doses.Main results.Mean doses to the left/right lungs for the COVID-19 CT data were 1.2/1.3 Gy, 0.8/0.9 Gy, 0.8/0.8 Gy and 0.6/0.6 Gy for the PA, AP/PA, 3-field, and 4-field configurations, respectively. Skin dose toxicity was the highest probability for the PA and lowest for the 4-field configuration. Dose to the heart slightly exceeded the ICRP tolerance; all other organ doses were below published tolerances. The AP/PA configuration provided the best fit for entrance skin dose as a function of patient thickness (R2 = 0.8). The average dose difference between simulation and measurement in the postmortem subject was 5%.Significance.An IR fluoroscope should be capable of delivering low-dose radiotherapy to the lungs with tolerable collateral dose to nearby organs.

If you were a policymaker, which treatment would you disinvest? A participatory value evaluation on public preferences for active disinvestment of health care interventions in the Netherlands.

INTRODUCTION: Currently, it is not known what attributes of health care interventions citizens consider important in disinvestment decision-making (i.e. decisions to discontinue reimbursement). Therefore, this study aims to investigate the preferences of citizens of the Netherlands toward the relative importance of attributes of health care interventions in the context of disinvestment. METHODS: A participatory value evaluation (PVE) was conducted in April and May 2020. In this PVE, 1143 Dutch citizens were asked to save at least €100 million by selecting health care interventions for disinvestment from a list of eight unlabeled health care interventions, described solely with attributes. A portfolio choice model was used to analyze participants' choices. RESULTS: Participants preferred to disinvest health care interventions resulting in smaller gains in quality of life and life expectancy that are provided to older patient groups. Portfolios (i.e. combinations of health care interventions) resulting in smaller savings were preferred for disinvestment over portfolios with larger savings. CONCLUSION: The disinvestment of health care interventions resulting in smaller health gains and that are targeted at older patient groups is likely to receive most public support. By incorporating this information in the selection of candidate interventions for disinvestment and the communication on disinvestment decisions, policymakers may increase public support for disinvestment.

Monte Carlo simulations and phantom validation of low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope.

PURPOSE: To use MC simulations and phantom measurements to investigate the dosimetry of a kilovoltage x-ray beam from an IR fluoroscope to deliver low-dose (0.3-1.0 Gy) radiotherapy to the lungs. MATERIALS AND METHODS: PENELOPE was used to model a 125 kV, 5.94 mm Al HVL x-ray beam produced by a fluoroscope. The model was validated through depth-dose, in-plane/cross-plane profiles and absorbed dose at 2.5-, 5.1-, 10.2- and 15.2-cm depths against the measured beam in an acrylic phantom. CT images of an anthropomorphic phantom thorax/lungs were used to simulate 0.5 Gy dose distributions for PA, AP/PA, 3-field and 4-field treatments. DVHs were generated to assess the dose to the lungs and nearby organs. Gafchromic film was used to measure doses in the phantom exposed to PA and 4-field treatments, and compared to the MC simulations. RESULTS: Depth-dose and profile results were within 3.2% and 7.8% of the MC data uncertainty, respectively, while dose gamma analysis ranged from 0.7 to 1.0. Mean dose to the lungs were 1.1-, 0.8-, 0.9-, and 0.8- Gy for the PA, AP/PA, 3-field, and 4-field after isodose normalization to cover âˆ¼ 95% of each lung volume. Skin dose toxicity was highest for the PA and lowest for the 4-field, and both arrangements successfully delivered the treatment on the phantom. However, the dose distribution for the PA was highly non-uniform and produced skin doses up to 4 Gy. The dose distribution for the 4-field produced a uniform 0.6 Gy dose throughout the lungs, with a maximum dose of 0.73 Gy. The average percent difference between experimental and Monte Carlo values were -0.1% (range -3% to +4%) for the PA treatment and 0.3% (range -10.3% to +15.2%) for the 4-field treatment. CONCLUSION: A 125 kV x-ray beam from an IR fluoroscope delivered through two or more fields can deliver an effective low-dose radiotherapy treatment to the lungs. The 4-field arrangement not only provides an effective treatment, but also significant dose sparing to healthy organs, including skin, compared to the PA treatment. Use of fluoroscopy appears to be a viable alternative to megavoltage radiation therapy equipment for delivering low-dose radiotherapy to the lungs.

Olive mill wastewater-evaporation ponds long term stored: Integrated assessment of in situ bioremediation strategies based on composting and vermicomposting.

During the last two decades, the method most widely used to manage olive mill wastewater (OMW) derived from olive oil production has been its disposal in evaporation ponds. Long-term storage of OMW leads to the accumulation of toxic sediments (OMWS) rich in recalcitrant compounds with phytotoxic and antimicrobial properties, which limit their use for agronomic purpose. The aim of this study was to compare the effect of two in situ bioremediation strategies (composting and a combination of composting followed by vermicomposting) to remove the potential toxicity of the sediments derived from long-term stored OMW. The results obtained showed that the composting method assisted with the earthworms enhanced the depletion of phenolic compounds and OMWS ecotoxicity more than composting, especially during the maturation stage. Moreover, vermicomposting was more effective in the reduction of the OMWS salinity. However, a pre-composting process to the OMWS is necessary prior to vermicomposting to provide the suitable conditions for earthworms survival and activity. Furthermore, the final compost showed a phytostimulating effect. Therefore, these in situ bioremediation strategies can be considered potential tools for decontamination and recovery of long-term stored OMWS in evaporation ponds, which currently poses an unsolved environmental problem.

Clinical assessment of acid-base balance in Netherland Dwarf rabbit.

Pet rabbits have increased their popularity in a lot of countries. However, most of the laboratory profiles in rabbit medicine come from the observations made in rabbit as biomodels or meat production. So that further researches are necessary to obtain reference values for hematology and biochemical profiles in pet rabbits and the different breeds, especially, in relation to acid-base balance. The aim of this report was to offer the mean values of the main parameters connected with acid-base profile in Netherland Dwarf breed. Thirty-five healthy rabbits (15 males and 20 females) were studied. Venous blood sample from lateral saphenous vein was analyzed to measure: haematocrit, haemoglobin, blood urea nitrogen, glucose, blood pH, partial pressure of CO2 (pCO2), total CO2, ions bicarbonate, chloride, sodium, potassium, base excess and anion Gap. Results showed a shorter range that those reported by different researchers. Moreover, differences between genders were showed in pCO2, its values were higher in males. It may be associated with a greater cellular metabolism. Values obtained in this research should be taken into account by veterinary clinicians for this breed in their clinical assessments. Besides, these values provide new results in parameters with few reference values.

Radiologic assessment of abdominal aortic calcifications, atherosclerotic burden levels and statistical bias affecting the reliability.

INTRODUCTION: AAC-8 and AAC-24 are two widely used scales to evaluate abdominal aortic calcification (AAC) on X-ray images. Levels of ≥3 (AAC-8) and ≥5 points (AAC-24) are of high relevance since they are associated with greater risk of cardiovascular events. Given that it is unknown, our aim was to determine the reliability of both scales at those levels of atherosclerotic burden. METHODS: The sample (93 subjects, 67.3 ± 9.7 years, BMI 28.8 ± 3.8, 57.6% smokers, 64.1% with hypertension) was classified according to quartiles of calcification. Six clinicians evaluated AAC independently with both scales on lateral lumbar spine X-ray images. We analyzed inter-rater agreement with the intraclass correlation coefficient (ICC) and the Bland-Altman scatterplots. RESULTS: We assessed 15 pairs of raters. Scores in both scales were significantly correlated with cardiovascular risk (r = 0.31 and r = 0.32; p < 0.005). Agreement was very high in the first quartile and moderate in the rest (p < 0.05). At cut-off points, ICC = 0.70 (95%CI, 0.54-0.86) and ICC = 0.68 (95%CI, 0.60-0.85) with AAC-8 and AAC-24. With the Bland-Altman method, mean of the differences ranged between 0 and 0.4 (AAC-8), and between 0.2 and 1 (AAC-24), while 95% limits of agreement showed values between 2.9 and 4.4 (AAC-8), and between 6 and 11.2 (AAC-24). Analyzing entire scales, ICC = 0.97 (95%CI, 0.97-0.98) and ICC = 0.98 (95%CI, 0.97-0.98) for AAC-8 and AAC-24, respectively. CONCLUSION: Both scales presented only moderate reliability at levels of atherosclerotic burden. Analyzing quartiles with ICC and the Bland-Altman plot showed concordant results. High global ICC values traditionally reported with both scales are likely biased. IMPLICATIONS FOR PRACTICE: AAC predicts subsequent vascular morbidity and mortality and should implicate evaluation of cardiovascular risk. Optimal visualisation of AAC and its correct assessment are mandatory in order to maximize patient care.

Clinical assessment of acid-base balance in Netherland Dwarf rabbit / Avaliação clínica do equilíbrio ácido-básico em coelhos Anã Holandês

Pet rabbits have increased their popularity in a lot of countries. However, most of the laboratory profiles in rabbit medicine come from the observations made in rabbit as biomodels or meat production. So that further researches are necessary to obtain reference values for hematology and biochemical profiles in pet rabbits and the different breeds, especially, in relation to acid-base balance. The aim of this report was to offer the mean values of the main parameters connected with acid-base profile in Netherland Dwarf breed. Thirty-five healthy rabbits (15 males and 20 females) were studied. Venous blood sample from lateral saphenous vein was analyzed to measure: haematocrit, haemoglobin, blood urea nitrogen, glucose, blood pH, partial pressure of CO2 (pCO2), total CO2, ions bicarbonate, chloride, sodium, potassium, base excess and anion Gap. Results showed a shorter range that those reported by different researchers. Moreover, differences between genders were showed in pCO2, its values were higher in males. It may be associated with a greater cellular metabolism. Values obtained in this research should be taken into account by veterinary clinicians for this breed in their clinical assessments. Besides, these values provide new results in parameters with few reference values.

A popularidade de coelhos como animais de estimação aumentou em muitos países. No entanto, a maioria dos perfis de laboratório em medicina de coelhos advém das observações de biomodelos animais ou da produção de carne. Assim, são necessárias pesquisas adicionais para obter valores de referência para hematologia e perfis bioquímicos em coelhos de estimação, e das diferentes raças, especialmente, em relação ao equilíbrio ácido-base. O objetivo deste relatório foi oferecer os valores médios dos principais parâmetros ligados ao perfil ácido-base na raça Anã Holandês. Trinta e cinco coelhos saudáveis ​​(15 machos e 20 fêmeas) foram estudados. A amostra de sangue venoso da veia safena lateral foi analisada para mensuração: hematócrito, hemoglobina, nitrogênio ureico sanguíneo, glicose, pH sanguíneo, pressão parcial de CO2 (pCO2), CO2 total, íons bicarbonato, cloreto, sódio, potássio, excesso de base e ânion Gap. Os resultados apresentaram um intervalo menor do que aqueles relatados por diferentes pesquisadores. Além disso, as diferenças entre os gêneros foram mostradas na pCO2, seus valores foram maiores no sexo masculino. Pode estar associado a um maior metabolismo celular. Os valores obtidos nesta pesquisa devem ser levados em consideração pelos clínicos veterinários para esta raça em suas avaliações clínicas. Além disso, esses valores fornecem novos resultados em parâmetros com poucos valores de referencia.

Effect of Noble Metal Addition on the Disorder Dynamics of Ni3Al by Means of Monte Carlo Simulation.

In this work, the effect of the addition of noble metals on the order-order disorder process of the L12 structure corresponding to the intermetallic Ni3Al is analyzed. Stoichiometric, nonstoichiometric, and quasi-binary compositions doped with noble metals such as Ag, Au, Pd, and Pt (1 at%) were analyzed. It was observed that depending on the composition, there is a modification in the activation energies calculated from the two time constants that characterize the disorder process. The statistic of atomic jumps was typified based on the configuration of the window to be crossed and, with this, it was identified that the origin of the negative activation energy of the long disorder process is due to an increase in the corresponding energy of the AlAl-Ni jump through unnatural windows.

#PlasticSurgery: A Comparative Deep Dive Analysis into Social Media and Plastic Surgery.

BACKGROUND: As social media have become pervasive in contemporary society, plastic surgery content has become commonplace. Two of the most engaging and popular platforms are Instagram and Twitter, and much research has been performed with respect to Twitter. Currently, there are no studies comparing and contrasting the two platforms. The aim of this study was to robustly sample plastic surgery posts on Twitter and Instagram to quantitatively and qualitatively evaluate platform content differences. METHODS: The hashtag #PlasticSurgery was systematically queried twice per day, for 30 consecutive days, on Twitter and Instagram. Account type, specific media content, possible patient-identifying information, content analysis, and post engagement were assessed. Post volume and engagement between Instagram and Twitter posts were compared. Post characteristics garnering high engagement from each platform were also evaluated. RESULTS: A total of 3867 Twitter posts and 5098 Instagram posts were included in this analysis. Daily total post volume for the 1-month duration of the study was significantly higher on Instagram compared with Twitter. Overall post engagement was significantly higher on Instagram compared with Twitter. Plastic surgeons and plastic surgery clinics represented the majority of accounts posting on both platforms with #PlasticSurgery. Identifiable patient features were much more prevalent on Instagram. The majority of Instagram posts were promotional in nature, outcome-based, or unrelated to plastic surgery. Alternatively, tweets were predominantly educational in nature. CONCLUSIONS: For physicians to harness the power of social media in plastic surgery, we need to understand how these media are currently being used and how different platforms compare to one another. This study has highlighted the inherent similarities and differences between these two highly popular platforms.

BNCT research activities at the Granada group and the project NeMeSis: Neutrons for medicine and sciences, towards an accelerator-based facility for new BNCT therapies, medical isotope production and other scientific neutron applications.

The Granada group in BNCT research is currently performing studies on: nuclear and radiobiological data for BNCT, new boron compounds and a new design for a neutron source for BNCT and other applications, including the production of medical radioisotopes. All these activities are described in this report.

Validation of histogram-based virtual source models for different IGRT kV-imaging systems.

PURPOSE: Image-guided radiotherapy (IGRT) improves tumor control but its intensive use may entrain late side effects caused by the additional imaging doses. There is a need to better quantify the additional imaging doses, so they can be integrated in the therapeutic workflow. Currently, no dedicated software enables to compute patient-specific imaging doses on a wide range of systems and protocols. As a first step toward this objective, we propose a common methodology to model four different kV-imaging systems used in radiotherapy (Varian's OBI, Elekta's XVI, Brainlab's ExacTrac, and Accuray's Cyberknife) using a new type of virtual source model based on Monte Carlo calculations. METHODS: We first describe our method to build a simplified description of the photon output, or virtual source models (VSMs), of each imaging system. Instead of being constructed using measurement data, as it is most commonly the case, our VSM is used as the summary of the phase-space files (PSFs) resulting from a first Monte Carlo simulation of the considered x-ray tube. Second, the VSM is used as a photon generator for a second MC simulation in which we compute the dose. Then, the proposed VSM is thoroughly validated against standard MC simulation using PSFs on the XVI system. Last, each modeled system is compared to profiles and depth-dose-curve measurements performed in homogeneous phantom. RESULTS: Comparisons between PSF-based and VSM-based calculations highlight that VSMs could provide equivalent dose results (within 1% of difference) than PSFs inside the imaging field-of-view (FOV). In contrast, VSMs tend to underestimate (for up to 20%) calculated doses outside of the imaging FOV due to the assumptions underlying the VSM construction. In addition, we showed that the use of VSMs allows reducing calculation time by at least a factor of 2.8. Indeed, for identical simulation times, statistical uncertainties on dose distributions computed using VSMs were much lower than those obtained from PSF-based calculations. CONCLUSIONS: For each of the four imaging systems, VSMs were successfully validated against measurements in homogeneous phantoms, and are therefore ready to be used for future preclinical studies in heterogeneous or anthropomorphic phantoms. The cross system modeling methodology developed here should enable, later on, to estimate precisely and accurately patient-specific 3D dose maps delivered during a large range of kV-imaging procedures.

Monte Carlo track-structure for the radionuclide Copper-64: characterization of S-values, nanodosimetry and quantification of direct damage to DNA.

TOPAS-nBio was used to simulate, collision-to-collision, the complete trajectories of electrons in water generated during the explicit simulation of 64Cu decay. S-values and direct damage to the DNA were calculated representing the cell (C) and the cell nucleus (N) with concentric spheres of 5 µm and 4 µm in radius, respectively. The considered 'target'←'source' configurations, including the cell surface (Cs) and cytoplasm (Cy), were: C←C, C←Cs, N←N, N←Cy and N←Cs. Ionization cluster size distributions were also calculated in a cylinder immersed in water corresponding to a DNA segment of 10 base-pairs in length (diameter 2.3 nm, length 3.4 nm), modeling a radioactive point source moving from the central axis to the edge of the cylinder. For that, the first moment (M1) and cumulative probability of having a cluster size of 2 or more ionizations in the cylindrical volume (F2) were obtained. Finally, the direct damage to the DNA was estimated by quantifying double-strand breaks (DSBs) using the clustering algorithm DBSCAN. The S-values obtained with TOPAS-nBio for 64Cu were 7.879 × 10-4 ± 5 × 10-7, 4.351 × 10-4 ± 6 × 10-7, 1.442 × 10-3 ± 1 × 10-6, 2.596 × 10-4 ± 8 × 10-7, 1.127 × 10-4 ± 4 × 10-7 Gy Bq-s-1 for the configurations C←C, C←Cs, N←N, N←Cy and N←Cs, respectively. The difference of these values, compared with previously reported S-values for 64Cu with the code MNCP and software MIRDCell, ranged from -4% to -25% for the configurations N←N and N←Cs, respectively. On the other hand, F2 was maximum with the source at the center of the cylinder 0.373 ± 0.001, and monotonically decreased until reaching a value of 0.058 ± 0.001 at 2.3 nm. The same behavior was observed for M1 with values ranging from 2.188 ± 0.004 to 0.242 ± 0.002. Finally, the DBSCAN algorithm showed that the mean number of DNA DSBs per decay were 0.187 ± 0.001, 0.0317 ± 0.0005, and 0.0125 ± 0.0002 DSB-(Bq-s)-1 for the configurations N←N, N←Cs, and N←Cy, respectively. In conclusion, the results of the S-values show that the absorbed dose strongly depends on the distribution of the radionuclide in the cell, the dose being higher when 64Cu is internalized in the cell nucleus, which is reinforced by the nanodosimetric study by the presence of DNA DSBs attributable to the Auger electrons emitted during the decay of 64Cu.

Just Because (Most) Hospitals Are Publishing Charges Does Not Mean Prices Are More Transparent.

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) recently mandated that all hospitals publish their charge description masters (CDMs) online, in a machine-readable format, by January 1, 2019. In addition, CMS recommended that CDM data be made available in a manner that was consumer friendly and accessible to patients. OBJECTIVE: This study aimed to (1) examine all hospitals across the state of Pennsylvania to understand policy compliance and (2) use established metrics to measure accessibility and consumer friendliness of posted CDM data. METHODS: A cross-sectional analysis was conducted to quantify hospital website compliance with the recent CMS policies requiring hospitals to publish their CDM. Data were collected from all Pennsylvania hospital websites. Consumer friendliness was assessed based on searchability, number of website clicks to data, and supplemental educational materials accompanying CDMs such as videos or text. RESULTS: Most hospitals (189/234, 80.1%) were compliant, but significant variation in data presentation was observed. The mean number of website clicks to the CDM was 3.7 (SD 1.3; range: 1-8). A total of 23.1% of compliant hospitals provided no supplemental educational material with their CDM. CONCLUSIONS: Although disclosure of charges has improved, the data may not be sufficient to meaningfully influence patient decision making.

Are Medical Students of Non-Spanish Nationality Studying in Spain as Sensitized to Transplantation as Those of Spanish Nationality?

INTRODUCTION: Awareness of organ donation among Spanish doctors and medical students is very positive. However, the emerging group of professionals of non-Spanish nationality studying in Spain has not been analyzed. OBJECTIVE: To analyze the differences in the attitudes toward the different types of donation among medical students, according to their nationality. METHODS: The population under study is medical students in Spanish universities using the database of the International Collaborative Donor Project, stratified by geographic area and academic year. Groups under study include students of non-Spanish nationality as group 1 (n = 1570) and students of Spanish nationality as Group 2 (n = 7705). Instruments are validated questionnaires of attitude toward donation "PCID-DTO-Ríos," "PCID-DVR-Ríos," "PCID-DVH-Ríos," and "PCID-XenoTx-Ríos." RESULTS: The attitude toward the donation of own organs after death is similar in both groups (P = .703). Non-Spaniards are 79.2% in favor compared to 79.6% of Spaniards. Living kidney donation, both unrelated (33.3% vs 29.3% in favor; P = .001) and related (91.2% vs 89, 6% in favor; P = .047), is more favorable among non-Spanish students. There are no differences regarding non-related living liver donation (29.7% vs 29.3% in favor; P = .063), but there are differences in the results for related living liver donation (94.1% vs 88%; P < .001). The attitude toward xenotransplantation of organs is similar (80.8% vs 80.8%; P = .999). CONCLUSIONS: Awareness of the donation of organs among Spanish medical students is similar to non-Spanish students studying in Spain, except the attitude toward living donation.

Cutting through the fat: a retrospective analysis of clinical outcomes, cost, and quality of life with the addition of panniculectomy to ventral hernia repair in overweight patients.

BACKGROUND: Due to the increased prevalence of overweight patients with ventral hernia, abdominal wall reconstruction combining ventral hernia repair (VHR) with panniculectomy (VHR-PAN) in overweight patients is increasingly considered. We present a retrospective comparison between VHR-PAN and VHR alone in overweight patients by examining costs, clinical outcomes, and quality of life (QoL). METHODS: Patients with body mass index (BMI) > 25.0 kg/m2 underwent VHR-PAN or VHR alone between September 2015 and May 2017 with a single surgeon and were matched into cohorts by BMI and age (n = 24 in each cohort). QoL was assessed using the Hernia-related Quality of Life Survey (HerQLes). Cost was assessed using billing data. Statistical analyses were performed using Fisher's exact tests, Mann-Whitney U tests, and regression modeling. RESULTS: Hernia defect size (p = 0.127), operative time (p = 0.140), mesh placement (p = 0.357), and recurrence rates (p = 0.156) did not vary significantly between cohorts at average follow up of one year. 60% of patients completed QoL surveys, with 61% net improvement in VHR-PAN postoperatively (p = 0.042) vs 36% in VHR alone (p = 0.054). Mean total hospitalization costs were higher for VHR alone (p = 0.019). Regression modeling showed no significant independent contribution of procedure performed due to differences in cost, wound complications, or hernia recurrence. CONCLUSIONS: At mean follow up of 2 years, VHR-PAN patients reported a comparable increase in QoL to those who received VHR alone without significantly different cost and complication rates. Concurrent VHR-PAN may therefore be a safe approach for overweight patients presenting with hernia and excess abdominal skin.

Head-space gas chromatography coupled to mass spectrometry for the assessment of the contamination of mayonnaise by yeasts.

Head-space (HS) gas chromatography (GC) coupled to mass spectrometry (MS) is proposed for the assessment of the contamination of mayonnaise as an alternative to plate counting, which is the technique commonly used for evaluating microbial contamination. More specifically, this method was applied in the detection of Candida metapsilosis and Zygosaccharomyces bailii, both of great importance in term of food spoilage since they are resistant to many of the common methods of food preservation. Different chemometric models were investigated using the data obtained by GC-MS (m/z profile, area of the chromatographic peaks and entire chromatographic profile), in order to obtain the highest classification success. The best results were obtained using the chromatographic profile (success rate of 92%). Contaminated samples could also be classified according to the concentration of yeast, obtaining a success rate of 87.5%. Finally, a chemometric model was constructed in an attempt to differentiate between strains.