Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden.

Psychiatric disorders after liver transplantation (LT) are associated with worse patient and graft outcomes, which may be amplified by inadequate treatment. We aimed to characterize the burden of psychiatric disorders, treatment patterns, and associated financial burden among liver transplantation recipients (LTRs). IQVIA PharMetrics (R) Plus for Academics-a large health plan claims database representative of the commercially insured US population-was used to identify psychiatric diagnoses among adult LTRs and assess treatment. Multivariable logistic regression analysis identified factors associated with post-LT psychiatric diagnoses and receipt of pharmacotherapy. Patient financial liability was estimated using adjudicated medical/pharmacy claims for LTRs with and without psychiatric diagnoses. Post-LT psychiatric diagnoses were identified in 395 (29.5%) of 1338 LTRs, of which 106 (26.8%) were incident cases. Treatment varied, with 67.3% receiving pharmacotherapy, 32.1% psychotherapy, 21.0% combination therapy, and 21.5% no treatment. Among 340 LTRs on psychotropic medications before transplant, 24% did not continue them post-LT. Post-LT psychiatric diagnoses were independently associated with female sex, alcohol-associated liver disease (ALD), prolonged LT hospitalization (>2 wk), and pre-LT psychiatric diagnosis. Incident psychiatric diagnoses were associated with female sex, ALD, and prolonged LT hospitalization. Patients with a post-LT psychiatric diagnosis had higher rates of hospitalization (89.6% vs. 81.5%, p <0.001) and financial liability (median $5.5K vs. $4.6K USD, p =0.006). Having a psychiatric diagnosis post-LT was independently associated with experiencing high financial liability >$5K. Over 1 in 4 LTRs had a psychiatric diagnosis in a large national cohort, yet nearly a quarter received no treatment. LTRs with psychiatric diagnoses experienced increased health care utilization and higher financial liability. Sociodemographic and clinical risk factors could inform high-risk subgroups who may benefit from screening and mitigation strategies.

Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors.

Understanding survivorship experiences at different stages postliver transplantation (poat-LT) is essential to improving care. Patient-reported concepts including coping, resilience, post-traumatic growth (PTG), and anxiety/depression, have been implicated as important predictors of quality of life and health behaviors after LT. We aimed to descriptively characterize these concepts at different post-LT survivorship stages. This cross-sectional study featured self-reported surveys measuring sociodemographic, clinical characteristics, and patient-reported concepts including coping, resilience, PTG, anxiety, and depression. Survivorship periods were categorized as early (1 y or below), mid (1-5 y), late (5-10 y), and advanced (10 y or above). Univariable and multivariable logistic and linear regression modeling examined factors associated with patient-reported concepts. Among 191 adult LT survivors, the median survivorship stage was 7.7 years (interquartile range: 3.1-14.4) and median age was 63 years (range: 28-83); most were male (64.2%) and Caucasian (84.0%). High PTG was more prevalent in the early survivorship period (85.0%) than late survivorship (15.2%). High trait resilience was only reported by 33% of survivors and associated with higher income. Lower resilience was seen among patients with longer LT hospitalization stays and late survivorship stages. About 25% of survivors had clinically significant anxiety and depression, which was more frequent among early survivors and females with pre-LT mental health disorders. In multivariable analysis, factors associated with lower active coping included survivors ≥65 years, non-Caucasian race, lower levels of education, and nonviral liver disease. In a heterogeneous cohort including early and late LT survivors, there was variation in levels of PTG, resilience, anxiety, and depression at different survivorship stages. Factors associated with positive psychological traits were identified. Understanding determinants of LT survivorship has important implications for how we should monitor and support LT survivors.

The financial burden after liver transplantation is significant among commercially insured adults: A large US National Cohort.

Liver transplantation (LT) is lifesaving for patients with cirrhosis; however, the resultant financial burden to patients has not been well characterized. We aimed to provide a nationally representative portrayal of patient financial burden after LT. Adult recipients of LT from 2006 to 2021 were identified using IQVIA PharMetrics® Plus for Academics-a large nationally representative claims database of commercially insured Americans. Patient financial liability (ie, what patients owe) was estimated using the difference between allowed and paid costs for adjudicated medical/pharmacy claims. Descriptive statistics were provided stratified by the financial liability group within 1 year after LT. Multivariable logistic regression modeling identified factors associated with high/extreme liability adjusting for covariates. Potential indirect costs of post-LT care were estimated based on hourly wages lost for care. Among 1412 recipients of LT, financial liability was heterogeneous-~3% had no liability and 21% had extreme liability > $10K for 1-year post-LT care; most (69%) paid between $1 and 10K, with 48% having liability >$5K. Factors associated with >$5K liability included older age, insurance/enrollment type, US region, history of HCC, and simultaneous liver-kidney transplant (for liability >$10K). Medication costs comprised ~30% of outpatient financial liability. Potential indirect costs from wages lost were $2,201-$6,073 per person, depending on an hourly wage. In a large national cohort of commercially insured recipients of LT, financial liability was highly variable across sociodemographic and clinical characteristics; nearly 1 out of 2 recipients of LT owed >$5K for 1 year of post-LT care. Transplant programs should help patients anticipate potential costs and identify vulnerable populations who would benefit from enhanced financial counseling.

Evaluation of the management of marine protected areas. Comparative study in Costa Rica.

Costa Rica is one of the most biodiverse countries in the world, and stands out for its commitment to conservation. Along its two coasts, it presents a great heterogeneity of ecosystems and social realities. Social factors, more than physical-natural factors, determine the success or failure of an MPA, so they must be urgently incorporated into all phases of MPA management. The objective of this work is to analyze the management of three marine protected areas, to establish improvements. These areas are Santa Rosa National Park, Marino Ballena National Park and Cahuita National Park. The methodology used assesses 26 indicators grouped into 4 key factotres: management body, planning subprocess, public participation, and implementation subprocess. The results of this evaluation are 5 possible scenarios. These scenarios have been termed (from the ideal situation to the least favourable): proactive (1), learning (2), interactive (3), centralized (4) and formal (5) management. The results of this study show that both Santa Rosa and Cahuita present a proactive scenario (1), with high citizen participation, although in practice the way the two MPAs are managed is very different. Marino Ballena, on the other hand, is in scenario 5 (formal), and a series of measures are presented that can move it towards scenario 2 (learning). In general, MPA management in Costa Rica tends to be adaptive, with high public participation, as determined by its public policies. However, the existence of a public policy favors but does not guarantee success in MPA management, as can be seen in the difference in results. Therefore, the periodic evaluation of its management, allowing for feedback, is essential.

Trade-off between tolerance and resistance to infections: an experimental approach with malaria parasites in a passerine bird.

Avian malaria parasites are known to have negative effects on their hosts, including consequences for reproductive success and survival. However, the outcome of disease may vary greatly among individuals, due to their particular genetic background, their past history of exposure to infections, or the way they respond to infections at the physiological level. We experimentally reduced parasitemia in naturally infected birds to examine individual-level variation in physiological parameters involved in anti-parasite defense, focusing specifically on disease resistance and tolerance. As a measure of disease resistance, we used circulating levels of IgY, and as a measure of disease tolerance, we estimated haptoglobin concentrations. Our results show individual consistency in the physiological parameters studied during the experiment, that was statistically significant for body condition, and marginally significant for IgY levels, and a trade-off between physiological mechanisms involved in resistance and tolerance that seem to be mediated by parasitemia. The medication experiment with primaquine was successful in reducing parasite intensity, but was not sufficient to clear the infection, and there was a generalized improvement in body condition in all birds maintained in captivity during the experiment. We suggest that the observed changes in the association between resistance and tolerance estimates may be due to the decrease in parasitemia attained through medication, to the improved nutritional status observed during the experiment or to the combined effect of both. Our study adds to the understanding of how wild animals cope with the diseases they are exposed to in their natural environment, and ultimately the consequences of parasitism at the individual level.

[Effects of a recreational general physical activity program with short term and moderate intensity of blood pressure and other cardiovascular risk factors in hypertensive patients over 50 years old]. / Efecto de un programa lúdico de actividad física general de corta duración y moderada intensidad sobre las cifras de presión arterial y otros factores de riesgo cardiovascular en hipertensos mayores de 50 años.

OBJECTIVES: To evaluate the effects of a recreational general physical activity program with moderate intensity and short duration on blood pressure and other cardiovascular risk factors (BMI, cholesterol, Rest Heart Rate, HDL, LDL, Triglycerides) in hypertensive patients older than 50years. DESIGN: Non-randomised pre-post design, quasi-experimental study. LOCATION: Íllora, Granada, Spain. PARTICIPANTS: A total of 60 subjects aged 50-75years taking part in the Health Hypertensive Program in the Medical Centre were selected. INTERVENTION: A recreational general physical activity program, mainly aerobic capacity, of 4weeks duration, 3days/week, and an intensity of 45-55% HR Reserve. MAIN MEASUREMENTS: SBP, DBP, HR, BMI, total cholesterol, HDL, LDL, TG, and Glucose. RESULTS AND CONCLUSIONS: Statistically significant decreases (P<.05) were observed in BMI (-0.51%; 95%CI: 30.26 to 31.93units), HR (-5.57beats/min; 95%CI: 68.76 to 71.73beats/min), SBP (-14.82mmHg; 95%CI: 131.57 to 137.52mmHg), DBP (-5.33mmHg; 95%CI: 78.94 to 83.68mmHg), Glucose (-7.63mg/dL; 95%CI: 125.06 to 153.73mg/dL) and REGICOR risk (-20.46%; 95%CI: 5.45 to 6.90%). Statistically significant increases were observed in HDL (+2.82mg/dl; 95%CI: 46.78 to 52.11mmHg), and TG (+8.27mg/dl; 95%CI: 133.89 to 152.60mg/dL). Men had a wider variation in HR and DBP, and women in SBP (P<.05). Subjects with baseline SBP≥160mmHg experienced greater declines in HR, SBP, DBP, Glucose and TG (-10.67beats/min, -31mmHg, -8.27mmHg, -10.86mg/dL, and 34.66mg/dL, respectively) than those with an initial SBP<160mmHg, where there was an increase in HDL and a decrease in LDL. After this program, improvements in BP and other cardiovascular risk factors were obtained in hypertensive subjects over 50years.

Changes in abundance and composition of a Caribbean coral reef zooplankton community after 25 years.

Coral reef zooplankton represents a key community in coral ecosystems, as they are involved in trophic and biogeochemical dynamics, and recruitment processes. Zooplankton abundance, composition and biomass were surveyed at six stations within the coral reef at Cahuita National Park, Limon, Costa Rica, in order to compare with the only previous study conducted during 1984. Samples were collected monthly (September 2010-August 2011). Seston biomass (0.49-85.87 mg/m3) and total abundance (1 145-112 422 ind./m3) fluctuated among the months and the stations. Higher values of these two variables were found in the rainiest months (November 2010 and May 2011). A total of 38 taxa were identified, of which calanoid copepods abundance dominated year round (66 %), followed by appendicularians (12 %). Zooplankton mean abundance in this survey resulted 20 times higher (13 184 ± 4 104 ind./m3)than in 1984 (645 ± 84 ind./m3). Copepods and appendicularians were the groups that differed the most, relative to the 1984 study, resulting in 63 and 170 times more abundant overall, respectively. An increase in terrestrial runoff and nutrient input during the past 30 years could explain these differences. High abundances of zooplankton may constitute an important food source for coral reef organisms in Cahuita ecosystem. In addition, zooplankton abundances here reported for Cahuita are among the worldwide highest coral reef zooplankton abundances, and further trophic models can help elucidate its role in coral reef resilience in the Caribbean Coast of Central America.

Effect of hydrochar-doping on the performance of carbon felt as anodic electrode in microbial fuel cells.

In this study, the feasibility of using hydrochars as anodic doping materials in microbial fuel cells (MFCs) was investigated. The feedstock used for hydrochar synthesis was metal-polluted plant biomass from an abandoned mining site. The hydrochar obtained was activated by pyrolysis at 500 °C in N2 atmosphere. Under steady state conditions, the current exerted by the MFCs, as well as the cyclic voltammetry and polarization curves, showed that the activated hydrochar-doped anodes exhibited the best performance in terms of power and current density generation, 0.055 mW/cm2 and 0.15 mA/cm2, respectively. These values were approximately 30% higher than those achieved with non-doped or doped with non-activated hydrochar anodes which can be explained by the highly graphitic carbonaceous structures obtained during the hydrochar activation that reduced the internal resistance of the system. These results suggest that the activated hydrochar materials could significantly enhance the electrochemical performance of bioelectrochemical systems. Moreover, this integration will not only enhance the energy generated by MFCs, but also valorize metal polluted plant biomass within the frame of the circular economy.

Analysis of real time PCR amplification efficiencies from three genomic region of dengue virus.

Early diagnosis of dengue virus (DENV) infection represents a key factor in preventing clinical complications attributed to the disease. The aim of this study was to evaluate the amplification efficiencies of an in-house quantitative real time-PCR (qPCR) assay of DENV, using the non-structural conserved genomic region protein-5 (NS5) versus two genomic regions usually employed for virus detection, the capsid/pre-membrane region (C-prM) and the 3'-noncoding region (3'NC). One-hundred sixty seven acute phase serum samples from febrile patients were used for validation purposes. Results showed that the three genomic regions had similar amplification profiles and correlation coefficients (0.987-0.999). When isolated viruses were used, the NS5 region had the highest qPCR efficiencies for the four serotypes (98-100%). Amplification from acute serum samples showed that 41.1% (67/167) were positive for the universal assay by at least two of the selected genomic regions. The agreement rates between NS5/C-prM and NS5/3'NC regions were 56.7% and 97%, respectively. Amplification concordance values between C-prM/NS5 and NS5/3'NC regions showed a weak (kappa = 0.109; CI 95%) and a moderate (kappa = 0.489; CI 95%) efficiencies in amplification, respectively. Serotyping assay using a singleplex NS5-TaqMan format was much more sensitive than the C-prM/SYBR Green I protocol (76%). External evaluation showed a high sensitivity (100%), specificity (78%) and high agreement between the assays. According to the results, the NS5 genomic region provides the best genomic region for optimal detection and typification of DENV in clinical samples.

A paradigm for fostering patient-centered research in liver disease: The liver transplant patient-engagement program.

BACKGROUND: Many federal funding and regulatory agencies require patient engagement to conduct patient-centered research and drug development. We developed a liver transplantation patient-engagement program, which can serve as a model for bringing the patient perspective to digestive diseases research. METHODS: Six liver transplantation patient-engagement program advisors completed training in patient engagement; participated in several virtual sessions; and completed postsession surveys. RESULTS: Qualitative and quantitative results elucidated patient-centered liver transplantation study outcomes and barriers/facilitators to conducting clinical research. Group satisfaction was very high. CONCLUSIONS: The liver transplantation patient-engagement program model provides a paradigm for how to engage patients in the formative steps of patient-centered clinical research.

The subsidiary GntII system for gluconate metabolism in Escherichia coli: alternative induction of the gntV gene.

Two systems are involved in the transport and phosphorylation of gluconate in Escherichia coli. GntI, the main system, consists of high and low-affinity gluconate transporters and a thermoresistant gluconokinase for its phosphorylation. The corresponding genes, gntT, gntU and gntK at 76.5 min, are induced by gluconate. GntII, the subsidiary system, includes IdnT and GntV, which duplicate activities of transport and phosphorylation of gluconate, respectively. Gene gntV at 96.8 min is divergently transcribed from the idnDOTR operon involved in L-idonate metabolism. These genetic elements are induced by the substrate or 5-keto-D-gluconate. Because gntV is also induced in cells grown in gluconate, it was of interest to investigate its expression in this condition. E. coli gntK, idnOokan mutants were constructed to study this question. These idnO kan-cassete inserted mutants, unable to convert gluconate to 5-keto-D-gluconate, permitted examining gntV expression in the absence of this inducer and demonstrating that it is not required when the cells grow in gluconate. The results suggest that E. coli gntV gene is alternatively induced by 5-keto-D-gluconate or gluconate in cells cultivated either in idonate or gluconate. In this way, the control of gntV expression would seem to be involved in the efficient utilization of these substrates.

Evolution of dengue virus type 3 genotype III in Venezuela: diversification, rates and population dynamics.

BACKGROUND: Dengue virus (DENV) is a member of the genus Flavivirus of the family Flaviviridae. DENV are comprised of four distinct serotypes (DENV-1 through DENV-4) and each serotype can be divided in different genotypes. Currently, there is a dramatic emergence of DENV-3 genotype III in Latin America. Nevertheless, we still have an incomplete understanding of the evolutionary forces underlying the evolution of this genotype in this region of the world. In order to gain insight into the degree of genetic variability, rates and patterns of evolution of this genotype in Venezuela and the South American region, phylogenetic analysis, based on a large number (n = 119) of envelope gene sequences from DENV-3 genotype III strains isolated in Venezuela from 2001 to 2008, were performed. RESULTS: Phylogenetic analysis revealed an in situ evolution of DENV-3 genotype III following its introduction in the Latin American region, where three different genetic clusters (A to C) can be observed among the DENV-3 genotype III strains circulating in this region. Bayesian coalescent inference analyses revealed an evolutionary rate of 8.48 x 10⁻4 substitutions/site/year (s/s/y) for strains of cluster A, composed entirely of strains isolated in Venezuela. Amino acid substitution at position 329 of domain III of the E protein (A→V) was found in almost all E proteins from Cluster A strains. CONCLUSIONS: A significant evolutionary change between DENV-3 genotype III strains that circulated in the initial years of the introduction in the continent and strains isolated in the Latin American region in recent years was observed. The presence of DENV-3 genotype III strains belonging to different clusters was observed in Venezuela, revealing several introduction events into this country. The evolutionary rate found for Cluster A strains circulating in Venezuela is similar to the others previously established for this genotype in other regions of the world. This suggests a lack of correlation among DENV genotype III substitution rate and ecological pattern of virus spread.

[TP53 codon 72 polymorphism and gastric cancer risk: a case-control study in individuals from the central-western region of Venezuela]. / Polimorfismo del codón 72 de TP53 y riesgo de cancer gástrico: estudio caso-control en individuos de la región centroccidental de Venezuela.

Codon 72 polymorphism of the tumor suppressor gene TP53 has been associated with a higher risk in the development of several types of cancer. The polymorphism results in a variant protein with either an arginine (CGC) or a proline residue (CCC). The aim of this study was to analyze the association of the TP53 codon 72 polymorphism with the risk of developing gastric cancer in a high-risk population from the central-western region of Venezuela. DNA was extracted from paraffin-embedded gastric adenocarcinoma biopsies (n=65) and endoscopic biopsies from chronic gastritis patients (n=87). TP53 codon 72 polymorphism was determined by PCR-RFLP from all samples. Patients with gastric cancer had a significantly higher frequency (P = 0.037) of the Arg allele than those with chronic gastritis. A logistic regression analysis suggested that Arg carrier individuals had a 4.6-fold higher risk (95% CI 1.0-21.3) of developing gastric cancer. An increment of the Arg/Arg genotype was observed in poor-differentiated gastric adenocarcinoma (OR: 3.1; 95% CI 1.0-9.2), and of the Arg/Pro genotype in well/moderate-differentiated adenocarcinoma samples (OR: 3.5; 95% CI 1.1-11.0), when comparing within the gastric cancer samples; and the last group also when contrasting it with chronic gastritis patients (OR: 2.4; 95% CI 1.1-5.2). The results of this study suggest that the carriage of the Arg allele could be associated with the development of gastric cancer in this Venezuelan population.

Synthesis, primary photophysical and antibacterial properties of naphthyl ester cinoxacin and nalidixic acid derivatives.

We have synthesized two naphthyl ester quinolone derivates and determined their ability to generate reactive oxygen species (ROS) such as (1)O(2), ()OH, H(2)O(2) upon photolysis with UV-A light. The ability of cinoxacin (1) and nalidixic acid (2), and their naphthyl ester derivatives (3 and 4) to generate a dose-dependent amount of singlet oxygen and ROS (()(-)O(2), ()OH) in cell-free systems was detected by histidine assay and by luminol-enhanced chemiluminescence (LCL), respectively. Their electronic absorption and emission spectra were quantified and their photostability was determined. Their tendency to generate peroxidic derivative species showed the following order: 3>4; in contrast, their ability to generate singlet oxygen was 4>3 and these were better sensitizers than their parent quinolones 1 and 2. The antibacterial activity in darkness and under irradiation of compounds 3 and 4 was tested on Escherichia coli and compared with that of their parent compounds. An enhanced antibacterial activity by irradiation of the naphthyl esters of cinoxacin and nalidixic acid on E. coli was observed.

Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer.

OBJECTIVE: To test the accuracy of predicting life-expectancy (LE) among 19 raters, as the accurate prediction of LE in candidates for definitive therapy for localized prostate cancer is crucial, and little is known of the ability of clinicians to predict LE. SUBJECTS AND METHODS: We randomly selected the case-vignettes of 50 patients treated with either radical prostatectomy (RP, 25) or external beam radiotherapy (EBRT, 25) for prostate cancer, and who either survived for > 10 years or died earlier with no evidence of disease relapse. The median age at treatment was 67 years and the median Charlson Comorbidity Index (CCI) was 2. The raters consisted of urology staff (six), urology residents (10) and medical students (three). The case-vignettes included patient age, comorbidities and CCI score, and raters were asked to predict the survival at 10 years (yes vs no), assuming no disease relapse. RESULTS: Of the 50 cases, 20 (40%) did not survive for > 10 years; clinicians estimated a mean (range) of 23 (10-35) deaths before 10 years. The mean (95% confidence interval) overall predictive accuracy (0.5 = chance, 1.0 = perfect prediction) of LE predictions was 0.68 (0.64-0.71). Individual accuracy ranged from 0.52 (staff) to 0.78 (staff). There were no important differences among the rater groups (residents 0.69 vs staff 0.67 vs medical students 0.67). CONCLUSIONS: Clinicians are relatively poor at predicting LE; tools to predict LE might be able to improve clinicians' performance in this important part of decision-making about prostate cancer treatment. It remains to be determined whether this limitation exclusively applies to prostate cancer or also to other malignancies.

Screening men for prostate cancer and colorectal cancer: is practice evidence-based?

INTRODUCTION: Controversy persists about whether men should be screened for prostate cancer. On the other hand, the benefit of colorectal cancer screening has been proven for men starting at age 50. We aimed to examine the rate of exposure to previous screening tests for prostate cancer and colorectal cancer in a cohort of men living in Quebec. MATERIALS AND METHODS: As part of an event promoting early prostate cancer detection, 347 men aged 50 to 69 without an established diagnosis of prostate cancer agreed to reply to questions in a previously validated questionnaire. The self-administered questionnaire, which asked about previous screening tests for prostate cancer and colorectal cancer, was completed on-site. RESULTS: Among men aged 50 to 69, previous exposure to a digital rectal examination (DRE), a prostate-specific antigen (PSA) test, a fecal occult blood test (FOBT), and sigmoidoscopy were reported by 132 men (62.9%), 73 men (34.8%), 37 men (17.6%), and 39 men (18.6%) , respectively. Across all age strata (< 50, 50-69, > or = 70 years), PSA and DRE testing were highest in men aged 50 to 69 and were 2- to 3-fold higher than screening tests for colorectal cancer. CONCLUSIONS: In this cohort of asymptomatic Canadian men, overall and age-stratified exposure to tests to detect colon cancer early is far from ideal. Conversely, far more men have been subjected to PSA testing and DRE. Patients should be informed of the benefits and risks of colorectal cancer screening and PSA testing.

Respuestas del mesozooplancton a condiciones oceanográficas en diferentes escalas en Bahía Salinas, Pacífico Norte de Costa Rica, durante 2011-2013

Introducción: El Pacífico Norte de Costa Rica se caracteriza por presentar una variación de la temperatura subsuperficial del mar (TSSM) modulada por vientos superficiales de componente este, con variaciones estacionales e intra-estacional. La TSSM es fundamental para las interacciones de la interfase océano-atmósfera y de gran influencia en los procesos biológicos marinos. Los estudios de zooplancton en el Pacífico Norte son escasos y se han enfocado en la composición, abundancia y biomasa de macro y mesozooplanctonen en Bahía Culebra. No se han realizado trabajos sobre zooplancton al norte del Golfo de Papagayo. Objetivo: Analizar la variación del zooplancton de Bahía Salinas a diferentes escalas como respuesta a condiciones oceanográficas-atmosféricas. Métodos: durante algunos meses de los años 2011, 2012 y 2013, el mesozooplancton fue muestreado en siete estaciones siguiendo un gradiente costero-oceánico para determinar su abundancia, biomasa y composición de la comunidad. Se realizaron lances de CTD en cada estación, y se recopilaron datos horarios de la TSSM desde junio de 2003 a diciembre de 2017. Resultados: La temperatura superficial anual en Bahía Salinas es menor en diciembre-abril con un mínimo secundario en julio y mayor en mayo-junio, y agosto-octubre. Los eventos fríos, neutros y cálidos determinados por anomalías en la TSSM, presentaron una distribución de la temperatura en la columna de agua con estratificación horizontal, de mezcla vertical y homogénea, respectivamente. La distribución espacial del zooplancton no presentó diferencias significativas y la variación del promedio total de abundancia y biomasa mostró un comportamiento similar durante el período de estudio, con menor variación en el primer año en comparación con el segundo, siendo los copépodos la categoría predominante para todas las fechas. A escala estacional no se observó un patrón general de variación entre estación seca y lluviosa y, copépodos y otros grupos del zooplancton fueron las categorías que presentaron diferencias. A escala intra-estacional la abundancia y biomasa presentaron una relación inversa con la TSSM y se vieron afectadas de manera diferencial. Los copépodos y zooplancton gelatinoso se diferenciaron en todos los eventos. Conclusiones: El zooplancton de Bahía de Salinas responde de manera diferencial en las diferentes escalas a las condiciones climáticas que afectan la TSSM de la región. La clasificación de las fechas de muestreo en eventos permite caracterizar diferentes perfiles en la columna de agua, así como permite definer patrones de variación para el mesozooplancton, que refleja la adaptación a corto plazo en función de la variación de las condiciones ambientales. El conocimiento generado ayuda a comprender mejor los fenómenos oceanográficos y su efecto sobre las poblaciones de plancton y la biota en general, especialmente en el escenario de cambio climático y las manifestaciones modernas de su impacto, p. e. la acidificación oceánica y pérdida de biodiversidad marina.

Introduction: The North Pacific of Costa Rica is characterized by presenting a variation of the subsurface temperature of the sea (SSST) modulated by surface winds with east component, with seasonal and intra-seasonal variations. The SSST is fundamental for the interactions of the ocean-atmosphere interface and influence marine biological processes. Zooplankton studies in the North Pacific are scarce and have been focused on the composition, abundance and biomass of macro and mesozooplankton in Culebra Bay. No works on zooplankton has been carried out northward of Papagayo Gulf. Objective: To analyze the variation of the zooplankton in Bahía Salinas at different scales in response to oceanographic-atmospheric conditions. Methods: during 2011, 2012 and 2013, mesozooplankton was collected in seven stations following a coastal-ocean gradient to determine abundance, biomass, and community composition. CTD casts were also carried out in each station. Hourly data of the Sea Subsurface Temperature (SSST) were obtained from June 2003 to December 2017. Results: The annual surface temperature in Bahía Salinas was lower in December-April with a secondary minimum in July and higher in May-June and August-November. The cold, neutral and warm events determined by anomalies in the SSST, presented a distribution of the temperature in the water column with horizontal stratification, vertical mixture and homogeneous, respectively. The spatial distribution of zooplankton did not show significant differences and the variation of the total average abundance and biomass showed a similar behavior during the study period, with less variation in the first year compared to the second one, being the copepods the predominant category for all the dates. On a seasonal scale, a general pattern of variation between dry and rainy seasons was not observed, and copepods and others zooplankton groups were the categories that presented differences. On an intra-seasonal scale, abundance and biomass showed an inverse relationship with SST. Copepods and gelatinous zooplankton (GZ) were differentiated in all events. Conclusions: The zooplankton of Bahía Salinas respond differentially at different scales to the climatic conditions that affect the SSST of the region. The classification of the sampling dates into events allows characterizing different profiles in the water column it also allows to define the variation patterns for mesozooplankton that reflects short-term adaptation as a function of variation in environmental conditions. These findings help to understand how oceanographic processes determine plankton community composition and biota in general. This is relevant in times of climate change and the manifestation of its impact through processes such as ocean acidification and loss of marine biodiversity.

Validation of 1997 Partin Tables' lymph node invasion predictions in men treated with radical prostatectomy in Montreal Quebec.

OBJECTIVE: The accuracy of 1997 Partin Tables' lymph node invasion (LNI) predictions exhibits important variability in different testing populations. We explored the LNI predictive accuracy in radical prostatectomy (RP) patients from Montreal, Canada. Moreover, we assessed the extent of change in predictive accuracy related to a modification of PSA coding from categorical to continuous. METHODS: We used pretreatment serum PSA, clinical stage, and biopsy Gleason sum from 537 men treated with RP to compare predicted and observed rates of LNI. Accuracy was quantified with receiver-operating characteristics curves. RESULTS: Accuracy was 0.760 in 369 evaluable patients, when categorically coded pretreatment PSA (0-4, 4.1-10, 10.1-20, 20.1+) was combined with clinical stage and biopsy Gleason sum. A 2.7% accuracy increase was noted when categorically coded PSA was replaced with continuously coded values. CONCLUSION: Partin Tables' LNI predictions showed comparable accuracy to a community-based sample from the United States (0.766), and to a recent, multi-institutional sample (0.740). However, accuracy was lower than reported in internal (0.818), and external (0.837) academic, validation cohorts. Accuracy of LNI predictions was appreciably higher, when continuously coded PSA was used.

Exploration of health-related quality of life areas that may distinguish between continent diversion and ileal conduit patients.

OBJECTIVES: We explored the specific impact of urinary diversion type on HRQOL in men after cystectomy for bladder cancer. Our intent was to provide a basis for the development of a diversion-specific instrument. METHODS: We invited 13 ileal conduit and 12 orthotopic urinary diversion (neo-bladder) male patients to several open-ended interviews. We explored HRQOL domains that may have been affected by cystectomy and urinary diversion, and that could then be used to form a basis for a diversion-specific HRQOL measure. RESULTS: The average age of neo-bladder patients was 59 versus 65 years for ileal conduit patients. We identified 10 HRQOL domains, ranging from involuntary urine leakage to dietary modifications, which were recognized as important by ileal conduit and neobladder patients. Within each domain, a sufficient amount of overlap existed to allow developing a measure that might be applied to both groups of patients. CONCLUSIONS: Ten HRQOL domains were identified as important by ileal conduit and neobladder patients. These demonstrated a significant amount of overlap between conduit and neobladder patients. Potentially, these domains could be used to develop scales for distinguishing between conduit and neobladder-specific HRQOL detriments.