Influence of Subclinical Atherosclerosis Burden and Progression on Mortality.

BACKGROUND: Atherosclerosis is a dynamic process. There is little evidence regarding whether quantification of atherosclerosis extent and progression, particularly in the carotid artery, in asymptomatic individuals predicts all-cause mortality. OBJECTIVES: This study sought to evaluate the independent predictive value (beyond cardiovascular risk factors) of subclinical atherosclerosis burden and progression and all-cause mortality. METHODS: A population of 5,716 asymptomatic U.S. adults (mean age 68.9 years, 56.7% female) enrolled between 2008 and 2009 in the BioImage (A Clinical Study of Burden of Atherosclerotic Disease in an At Risk Population) study underwent examination by vascular ultrasound to quantify carotid plaque burden (cPB) (the sum of right and left carotid plaque areas) and by computed tomography for coronary artery calcium (CAC). Follow-up carotid vascular ultrasound was performed on 732 participants a median of 8.9 years after the baseline exam. All participants were followed up for all-cause mortality, the primary outcome. Trend HRs are the per-tertile increase in each variable. RESULTS: Over a median 12.4 years' follow-up, 901 (16%) participants died. After adjustment for cardiovascular risk factors and background medication, baseline cPB and CAC score were both significantly associated with all-cause mortality (fully adjusted trend HR: 1.23; 95% CI: 1.16-1.32; and HR: 1.15; 95% CI: 1.08-1.23), respectively (both P < 0.001), thus providing additional prognostic value. cPB performed better than CAC score. In participants with a second vascular ultrasound evaluation, median cPB progressed from 29.2 to 91.3 mm3. cPB progression was significantly associated with all-cause mortality after adjusting for cardiovascular risk factors and baseline cPB (HR: 1.03; 95% CI: 1.01-1.04 per absolute 10-mm3 change; P = 0.01). CONCLUSIONS: Subclinical atherosclerosis burden (cPB and CAC) in asymptomatic individuals was independently associated with all-cause mortality. Moreover, atherosclerosis progression was independently associated with all-cause mortality.

A Real-Time Embedded System for Driver Drowsiness Detection Based on Visual Analysis of the Eyes and Mouth Using Convolutional Neural Network and Mouth Aspect Ratio.

Currently, the number of vehicles in circulation continues to increase steadily, leading to a parallel increase in vehicular accidents. Among the many causes of these accidents, human factors such as driver drowsiness play a fundamental role. In this context, one solution to address the challenge of drowsiness detection is to anticipate drowsiness by alerting drivers in a timely and effective manner. Thus, this paper presents a Convolutional Neural Network (CNN)-based approach for drowsiness detection by analyzing the eye region and Mouth Aspect Ratio (MAR) for yawning detection. As part of this approach, endpoint delineation is optimized for extraction of the region of interest (ROI) around the eyes. An NVIDIA Jetson Nano-based device and near-infrared (NIR) camera are used for real-time applications. A Driver Drowsiness Artificial Intelligence (DD-AI) architecture is proposed for the eye state detection procedure. In a performance analysis, the results of the proposed approach were compared with architectures based on InceptionV3, VGG16, and ResNet50V2. Night-Time Yawning-Microsleep-Eyeblink-Driver Distraction (NITYMED) was used for training, validation, and testing of the architectures. The proposed DD-AI network achieved an accuracy of 99.88% with the NITYMED test data, proving superior to the other networks. In the hardware implementation, tests were conducted in a real environment, resulting in 96.55% and 14 fps on average for the DD-AI network, thereby confirming its superior performance.

Spanish cardiac catheterization and coronary intervention registry. 33rd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2023).

Introduction and objectives This article presents the 2023 activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC). Methods All interventional cardiology laboratories in Spain were invited to participate in an online survey. Data analysis was carried out by an external company and subsequently reviewed and presented by the members of the ACI-SEC board. Results A total of 119 hospitals participated. The number of diagnostic studies decreased by 1.8%, while the number of percutaneous coronary interventions (PCI) showed a slight increase. There was a reduction in the number of stents used and an increase in the use of drug-coated balloons. The use of intracoronary diagnostic techniques remained stable. For the first time, data on PCI guided by intracoronary imaging was reported, showing a 10% usage rate in Spain. Techniques for plaque modification continued to grow. Primary PCI increased, becoming the predominant treatment for myocardial infarction (97%). Noncoronary structural procedures continued their upward trend. Notably, the number of left atrial appendage closures, patent foramen ovale closures, and tricuspid valve interventions grew in 2023. There was also a significant increase in interventions for acute pulmonary embolism. Conclusions The 2023 Spanish cardiac catheterization and coronary intervention registry indicates a stabilization in coronary interventions, together with an increase in complexity. There was consistent growth in procedures for both valvular and nonvalvular structural heart diseases.

The ABCG2 Transporter Affects Plasma Levels, Tissue Distribution and Milk Secretion of Lumichrome, a Natural Derivative of Riboflavin.

The ABCG2 membrane transporter affects bioavailability and milk secretion of xenobiotics and natural compounds, including vitamins such as riboflavin. We aimed to characterize the in vitro and in vivo interaction of ABCG2 with lumichrome, the main photodegradation product of riboflavin, which has proven in vitro anti-cancer activity and a therapeutical role in antibacterial photodynamic therapy as an efficient photosensitizer. Using MDCK-II polarized cells overexpressing murine Abcg2 and human ABCG2 we found that lumichrome was efficiently transported by both variants. After lumichrome administration to wild-type and Abcg2-/- mice, plasma AUC20-120 min was 1.8-fold higher in Abcg2-/- mice compared with wild-type mice. The liver and testis from Abcg2-/- mice showed significantly higher lumichrome levels compared with wild-type, whereas lumichrome accumulation in small intestine content of wild-type mice was 2.7-fold higher than in Abcg2-/- counterparts. Finally, a 4.1-fold-higher lumichrome accumulation in milk of wild-type versus Abcg2-/- mice was found. Globally, our results show that ABCG2 plays a crucial role in plasma levels, tissue distribution and milk secretion of lumichrome potentially conditioning its biological activity.

A bibliometric review of waste management and innovation: Unveiling trends, knowledge structure and emerging research fronts.

The pressing challenges in waste management have motivated this comprehensive study examining prior research and contemporary trends concerning innovation and waste management. A meticulous investigation of 2264 documents (1968-2024) was conducted using bibliometrix R-tool to analyse Scopus and Web of Science databases, offering a holistic global perspective. Heightened societal concern about waste management, driven by soaring waste production from consumption patterns, requires urgent exploration of effective waste elimination and transformation systems. This study provides a comprehensive summary of the topic, delving deeply into its complexities. Through thorough analysis of global trends, it constitutes a significant stride towards identifying effective solutions, offering valuable contributions to both scientific understanding and practical applications. This research pioneers a comprehensive synthesis of innovation and waste management issues, showcasing originality and substantial contributions. The identified collaborative networks expose a lack of transnational cooperation, potentially hindering waste management innovation. Future research around waste management innovation should focus on synergies among competitors within the same industry and across industries to minimize waste and maximize resource utilization, 4.0 technologies, global waste chain impacts and challenges along with solutions for developing countries.

[Assessment of the impact on mortality of air pollution by particles in the city of Valencia during the period 2015-2017]. / Evaluación del impacto en mortalidad de la contaminación del aire por partículas en la ciudad de València en el periodo 2015-2017.

OBJECTIVE: Air pollution is a global public health issue, with particulate matter (PM) being the pollutant with the greatest impact on health. The main objective of this article was to estimate the impact of mortality attributable to particulate pollution in the city of Valencia during the period 2015-2017. METHODS: The Health Impact Assessment (HIA) methodology from the Aphekom project was used. Scenarios of a 5 µg/m3 reduction in the annual mean concentration of PM10 and PM2.5 were employed, along with the assumption of meeting the World Health Organization (WHO) recommendations in effect during the study period, to estimate both short- and long-term impacts. RESULTS: The estimated average concentrations for 2015-2017 were 18.4 µg/m3 for PM10 and 12.3 µg/m3 for PM2.5. The short-term HIA, assuming a reduction of 5 µg/m3 in the averages, resulted in a total of 65.4 premature deaths that could be postponed during that period (21.8 annually), corresponding to a rate of 2.8 deaths per 100,000 inhabitants. In the long term, if PM2.5 concentrations had been reduced by 5 µg/m3, 124 premature deaths could have been postponed annually. CONCLUSIONS: The annual average concentrations of these pollutants meet the limits set by European regulations. However, compared to WHO recommendations, PM2.5 levels are higher by 2.3 µg/m3. An air quality scenario in line with WHO recommendations would have resulted in a reduction of 122 premature deaths annually.

OBJETIVO: La contaminación del aire es un problema de Salud Pública de importancia global, siendo las partículas en suspensión (PM) el contaminante con mayor impacto en la salud. El objetivo principal de este artículo fue estimar el impacto en mortalidad atribuible a la contaminación por partículas en la ciudad de València en el periodo 2015-2017. METODOS: Se utilizó la metodología para la Evaluación del Impacto en Salud (EIS) del proyecto Aphekom. Se realizó un estudio descriptivo y para la correlación se emplearon los escenarios de reducción de la media anual de 5 µg/m3 en la concentración de PM10 y de PM2,5 y el supuesto de cumplir las recomendaciones de la Organización Mundial de la Salud (OMS) vigentes en el periodo a estudio para estimar el impacto a corto y largo plazo. RESULTADOS: Las concentraciones estimadas del promedio 2015-2017 para PM10 y PM2,5 fueron de 18,4 µg/m3 y 12,3 µg/m3, respectivamente. La EIS a corto plazo, en el supuesto de reducir en 5 µg/m3 las medias, tuvo como resultado un total de 65,4 muertes prematuras que se podrían posponer en ese periodo (21,8 anuales), correspondiendo con una tasa de 2,8 defunciones por cada 100.000 habitantes. A largo plazo, si se hubiesen reducido las concentraciones de PM2,5 en 5 µg/m3, se hubieran podido posponer 124 muertes prematuras anuales. CONCLUSIONES: Las concentraciones medias anuales de estos contaminantes se ajustan a los límites marcados por la normativa europea. Sin embargo, respecto a las recomendaciones de la OMS, los niveles de PM2,5 son superiores en 2,3 µg/m3. Un escenario de calidad del aire conforme a las recomendaciones de la OMS se hubiera traducido en una reducción de 122 defunciones prematuras anuales.

Coronary Microvascular Function in Asymptomatic Middle-Aged Individuals With Cardiometabolic Risk Factors.

BACKGROUND: In patients with ischemic heart disease, coronary microvascular dysfunction is associated with cardiovascular risk factors and poor prognosis; however, data from healthy individuals are scarce. OBJECTIVES: The purpose of this study was to assess the impact of cardiovascular risk factors and subclinical atherosclerosis on coronary microvascular function in middle-aged asymptomatic individuals. METHODS: Myocardial perfusion was measured at rest and under stress using cardiac magnetic resonance in 453 individuals and used to generate myocardial blood flow (MBF) maps and calculate myocardial perfusion reserve (MPR). Subclinical atherosclerosis was assessed using 3-dimensional vascular ultrasound of the carotid and femoral arteries and coronary artery calcium scoring at baseline and at 3-year follow-up. RESULTS: Median participant age was 52.6 years (range: 48.9-55.8 years), and 84.5% were male. After adjusting for age and sex, rest MBF was directly associated with the number of the metabolic syndrome components present (elevated waist circumference, systolic and diastolic blood pressure, fasting glucose, and triglycerides and low high-density lipoprotein cholesterol), insulin resistance (homeostatic model assessment for insulin resistance), and presence of diabetes. MPR was reduced in the presence of several metabolic syndrome components, elevated homeostatic model assessment for insulin resistance, and diabetes. Stress MBF was inversely associated with coronary artery calcium presence and with global plaque burden. Higher stress MBF and MPR were associated with less atherosclerosis progression (increase in plaque volume) at 3 years. CONCLUSIONS: In asymptomatic middle-aged individuals free of known cardiovascular disease, the presence of cardiometabolic risk factors and systemic (poly-vascular) subclinical atherosclerosis are associated with impaired coronary microvascular function. Better coronary microvascular function reduces atherosclerosis progression at follow-up. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).

Exploratory Analysis Using Deep Learning for Water-Body Segmentation of Peru's High-Mountain Remote Sensing Images.

High-mountain water bodies represent critical components of their ecosystems, serving as vital freshwater reservoirs, environmental regulators, and sentinels of climate change. To understand the environmental dynamics of these regions, comprehensive analyses of lakes across spatial and temporal scales are necessary. While remote sensing offers a powerful tool for lake monitoring, applications in high-mountain terrain present unique challenges. The Ancash and Cuzco regions of the Peruvian Andes exemplify these challenges. These regions harbor numerous high-mountain lakes, which are crucial for fresh water supply and environmental regulation. This paper presents an exploratory examination of remote sensing techniques for lake monitoring in the Ancash and Cuzco regions of the Peruvian Andes. The study compares three deep learning models for lake segmentation: the well-established DeepWaterMapV2 and WatNet models and the adapted WaterSegDiff model, which is based on a combination of diffusion and transformation mechanisms specifically conditioned for lake segmentation. In addition, the Normalized Difference Water Index (NDWI) with Otsu thresholding is used for comparison purposes. To capture lakes across these regions, a new dataset was created with Landsat-8 multispectral imagery (bands 2-7) from 2013 to 2023. Quantitative and qualitative analyses were performed using metrics such as Mean Intersection over Union (MIoU), Pixel Accuracy (PA), and F1 Score. The results achieved indicate equivalent performance of DeepWaterMapV2 and WatNet encoder-decoder architectures, achieving adequate lake segmentation despite the challenging geographical and atmospheric conditions inherent in high-mountain environments. In the qualitative analysis, the behavior of the WaterSegDiff model was considered promising for the proposed application. Considering that WatNet is less computationally complex, with 3.4 million parameters, this architecture becomes the most pertinent to implement. Additionally, a detailed temporal analysis of Lake Singrenacocha in the Vilcanota Mountains was conducted, pointing out the more significant behavior of the WatNet model.

Variability and error in measurement of infant formula powder and water: an experimental study.

Introduction: Formula feeding is the only viable nutrition alternative for infants 0-6mos who cannot breastfeed. Among the drawbacks of formula feeding, however, is potential dilution or concentration errors in the formula during preparation that may lead to infant health issues. The present study aimed to investigate the accuracy of caregiver measurements as they prepared infant formula under multiple conditions, compared with manufacturer specifications. Methods: A diverse sample of caregivers (N = 84) participated in this cross-over experimental study. Participants hand-scooped infant formula powder and poured water to prepare 4oz. and 7oz. feedings, using both a standardized set of infant formula products and participants' own products. Linear mixed effects models were used to estimate fixed effects of target amount (4oz. versus 7oz) and products (participant versus researcher) on mean absolute percent error (MAPE) of measurement. Results: Across all conditions MAPE was significantly greater for measuring powder than for water (9.0% vs. 4.4%; p < 0.001) with a combined powder and water MAPE at 13.0%. Greater measurement error was associated with the odd-sized 7oz. preparation and participants' own products. Discussion: We observed considerable variability and substantial error during infant formula preparation, particularly for hand-scooping of powder, which tended toward higher values than the theoretical gold standard.

Impact of natriuresis on worsening renal function during episodes of acute heart failure.

INTRODUCTION AND OBJECTIVES: Worsening renal function (WRF) is a frequent complication in acute heart failure (AHF) with a controversial prognostic value. We aimed to study the usefulness of natriuresis to evaluate WRF. METHODS: We conducted an observational, prospective, multicenter study of patients with AHF who underwent a furosemide stress test. The patients were classified according to whether WRF was present or absent and according to the median natriuretic response. The main endpoint was the combination of mortality, rehospitalization due to HF, and heart transplant at 6 months of follow-up. RESULTS: One hundred and fifty-six patients were enrolled, and WRF occurred in 60 (38.5%). The patients were divided into 4 groups: a) 47 (30.1%) no WRF/low UNa (UNa ≤ 109 mEq/L); b) 49 (31.4%) no WRF/high UNa (UNa >109 mEq/L); c) 31 (19.9%) WRF/low UNa and d) 29 (18.6%) WRF/high UNa. The parameters of the WRF/low UNa group showed higher clinical severity and worse diuretic and decongestive response. The development of WRF was associated with a higher risk of the combined event (HR, 1.88; 95%CI, 1.01-3.50; P=.046). When stratified by natriuretic response, WRF was associated with an increased risk of adverse events in patients with low natriuresis (HR, 2.28; 95%CI, 1.15-4.53; P=.019), but not in those with high natriuresis (HR, 1.18; 95%CI, 0.26-5.29; P=.826). CONCLUSIONS: Natriuresis could be a useful biomarker for interpreting and prognosticating WRF in AHF. WRF is associated with a higher risk of adverse events only in the context of low natriuresis.

Unidirectional association of clonal hematopoiesis with atherosclerosis development.

Clonal hematopoiesis, a condition in which acquired somatic mutations in hematopoietic stem cells lead to the outgrowth of a mutant hematopoietic clone, is associated with a higher risk of hematological cancer and a growing list of nonhematological disorders, most notably atherosclerosis and associated cardiovascular disease. However, whether accelerated atherosclerosis is a cause or a consequence of clonal hematopoiesis remains a matter of debate. Some studies support a direct contribution of certain clonal hematopoiesis-related mutations to atherosclerosis via exacerbation of inflammatory responses, whereas others suggest that clonal hematopoiesis is a symptom rather than a cause of atherosclerosis, as atherosclerosis or related traits may accelerate the expansion of mutant hematopoietic clones. Here we combine high-sensitivity DNA sequencing in blood and noninvasive vascular imaging to investigate the interplay between clonal hematopoiesis and atherosclerosis in a longitudinal cohort of healthy middle-aged individuals. We found that the presence of a clonal hematopoiesis-related mutation confers an increased risk of developing de novo femoral atherosclerosis over a 6-year period, whereas neither the presence nor the extent of atherosclerosis affects mutant cell expansion during this timeframe. These findings indicate that clonal hematopoiesis unidirectionally promotes atherosclerosis, which should help translate the growing understanding of this condition into strategies for the prevention of atherosclerotic cardiovascular disease in individuals exhibiting clonal hematopoiesis.

Use of social media in radiation oncology: multicenter data from the GOCO Group.

Background: The purpose of this study was to explore the usage patterns and profiles of social media (SM) platforms among Radiation Oncologists (RO) and Physicists in the scope of the Catalan-Occitan Oncology Group (GOCO). Materials and methods: From November 2022 to March 2023, a comprehensive survey was sent to Radiation Oncology professionals within the GOCO group, comprising 31 questions that covered demographics (4) and general inquiries (9), user behavior on social media (7), profile of SM activity (7), and participants' opinions (4) regarding professional use of SM. The survey reached professionals from 12 centers, encompassing 10 in Catalonia and 2 in French Occitania. Results: The survey achieved a 61.37% response rate (178/290 professionals) with an average age of 41.9 years. 120 (67%) were ROs, and 58 (33%) were Physicists. Instagram led in usage (n = 116), followed by Facebook (n = 107) and Twitter (n = 77). Age correlated inversely with the number of platforms used (Spearman's rank correlation coefficient -0.238, p = 0.001). 28% (n = 42) changed clinical practices based on SM information. A 78.5% (n = 117) didn't counter inappropriate content. Most (71.7%, n = 109) spent < 1 hour daily on professional SM use, however more Physicians exceeded 2 hours compared to Physicists (Cohen's kappa 2 = 0.07). 41.8% (n = 64) weren't emotionally concerned while 22.9% (n = 35) felt overwhelmed by SM overload. Conclusions: The study offers valuable insights into the usage patterns, preferences, and attitudes of Radiation Oncology professionals towards SM platforms. This understanding is crucial for optimizing content quality and delivering relevant information, thereby enabling more effective marketing strategies and enhancing emotional management among these professionals.

Epidemiological changes of invasive fungal disease in children with cancer: Prospective study of the National Child Program of Antineoplastic Drugs network, Chile.

BACKGROUND: Invasive fungal diseases (IFD) are high morbidity and mortality infections in children with cancer suffering episodes of high-risk febrile neutropenia (HRFN). IFD epidemiology has changed in the last two decades, with an increasing incidence in recent years due to the growing number of immunocompromised children at risk for IFD. The aim of this study was to evaluate the incidence of IFD in children with cancer in the period 2016-2020 compared to 2004-2006 in six hospitals in Chile. METHODS: Prospective, multicentre study, carried out between 2016 and 2020 in six hospitals in Chile. The defined cohort corresponds to a dynamic group of HRFN episodes in patients <18 years old with cancer, who at the fourth day of evolution still presented fever and neutropenia (persistent HRFN). Each episode was followed until resolution of FN. The incidence of IFD was calculated between 2016 and 2020 and compared with data obtained in the period 2004-2006. The incidence rate was estimated. RESULTS: A total of 777 episodes of HRFN were analysed; 257 (33.1%) were considered as persistent-HRFN occurring in 174 patients. The median age was 7 years (IQR: 3-12 years) and 52.3% (N = 91) were male. Fifty-three episodes of IFD were detected: 21 proven, 14 probable and 18 possible. Possible IFD were excluded, leaving 239 episodes of persistent-HRFN with an IFD incidence of 14.6% (95% CI 10.5-19.9) and an incidence rate of 13.6 IFD cases per 1000 days of neutropenia (95% CI 9.5-20.0). Compared to 2004-2006 cohort (incidence: 8.5% (95% CI 5.2-13.5)), a significant increase in incidence of 6.1% (95% CI 0.2-12.1, p = .047) was detected in cohorts between 2016 and 2020. CONCLUSION: We observed a significant increase in IFD in 2016-2020, compared to 2004-2006 period.

Influence of Proximal Fixation on Aneurysm Neck Evolution after Endovascular Treatment of Infrarenal Aneurysms.

BACKGROUND: We analyzed the long-term influence of fixation systems on proximal aortic neck (PAN) evolution by comparing 2 late-generation endoprostheses, Endurant (Medtronic Vascular, Minneapolis, Minn) with suprarenal fixation (SRF) and Excluder (W.L Gore & Associates, Flagstaff, Ariz) with infrarenal fixation (IRF). METHODS: Our retrospective observational study included consecutive patients undergoing endovascular aneurysm repair (EVAR) for aorto-iliac aneurysms (2011-2020). Primary end points: neck enlargement and freedom from significative PAN enlargement (5 mm). Secondary end points: neck-related reintervention, endoleaks and graft migration. Results were reported following the Society of Vascular Surgery reporting standards. RESULTS: 139 patients were included (97 in SRF group and 42 in IRF group). A difference in growth at 10 mm caudal to lowest renal artery at 2 years follow-up was found (mean growth of 1.92 ± 3.38 mm in SRF and 0.16 ± 6.86 mm in IRF; P < 0.001). A tendency to a major growth in SRF at 4 years follow-up at the lowest renal artery (1.27 ± 3.36 mm vs. 0.63 ± 2.2 mm; P = 0.06), 5 mm distal to lowest renal artery (2.17 ± 3.52 mm vs. 0.94 ± 2.76 mm; P = 0.001) and 10 mm distal to lowest renal artery (2.65 ± 3.86 mm vs. 1.12 ± 1.5 mm; P < 0.001) was shown. Freedom from PAN enlargement was 96.65% and 88.20% in SRF and 100% and 94.4% in IRF at 2 and 4 years follow-up respectively (log rank 0.041). A greater incidence of type II endoleaks in IRF was observed (40.48% vs. 15.46%; P = 0.001). Oversizing >15% showed to be a risk factor of PAN enlargement (odds ratio 6.85; 95% confident interval: 1.67-28.4; P = 0.007). CONCLUSIONS: A small but significative percentage of patients after EVAR show a progressive PAN enlargement, being significatively greater in SRF, without increasing neck-related complications 4 years after graft deployment.

Instrument to evaluate the perception of abuse and/or disrespectful treatment during childbirth: A validation study.

AIM: To design and validate a tool to assess a woman's perception of whether she has experienced a situation of abuse or disrespect during childbirth attendance: "Childbirth Abuse and Respect Evaluation-Maternal Questionnaire" (CARE-MQ). METHODS: Multidisciplinary panel of experts (gynecologists, midwives, mothers) participated in creating CARE-MQ. A cross-sectional study was carried out on 901 Spanish women who had given birth between 1 and 3 months before to determine psychometric characteristics. Finally, an exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and a convergent validity study were carried out with the Quality Questionnaire from the Patient's Perspective-Intrapartum (QPP-I), and a reliability study using internal consistency (Cronbach's α) and coefficient of intraclass correlation (CCI). FINDINGS: The KMO test gave a value of 0.935, and Bartlett's sphericity test was <0.001. The EFA identified four components ("Emotional Abuse", "Inadequate Professionalism", "Physical Abuse" y "Lost contact") that explained 55.16 % of variance. In the CFA, a good fit was observed for most of the evaluated indicators. CARE-MQ correlated negatively with QPP-I (Spearman's rho = -0.641, 95 % CI: -0.679, -0.600; p < 0.001) and was statistically associated with variables related to childbirth experience (p < 0.005) such as the use of a birth plan, use of regional analgesia, type of birth, episiotomy, presence of severe tears, skin-to-skin contact, length of hospital stay and postpartum surgical intervention. Cronbach's α value was 0.903. The ICC of absolute agreement after administering the questionnaire one week after was 0.927 (95 % CI: 0.85-0.97). CONCLUSIONS: CARE-MQ is a valid and reliable instrument to evaluate the perception of a woman regarding the situation of abuse and/or disrespect that she may have experienced during birth in a population of Spanish postpartum women.

A randomised trial of short- vs long-term androgen deprivation with salvage radiotherapy for biochemical failure following radical prostatectomy: URONCOR 06-24.

BACKGROUND: Salvage radiotherapy (SRT) and androgen-deprivation therapy (ADT) are widely used in routine clinical practice to treat patients with prostate cancer who develop biochemical recurrence (BCR) after radical prostatectomy (RP). However, there is no standard-of-care consensus on optimal duration ADT. Investigators propose three distinct risk groups in patients with prostate cancer treated with SRT in order to better define the indications and duration of ADT combined with SRT. STUDY DESIGN: The URONCOR 06-24 trial (ClinicalTrials.gov identifier NCT05781217) is a prospective, multicentre, randomised, open-label, phase III, clinical trial. The aim of the trial is to determine the impact of short-term (6 months) vs long-term (24 months) ADT in combination with SRT on distant metastasis-free survival (MFS) in patients with prostate cancer with BCR after RP (intermediate and high risk). ENDPOINTS: The primary endpoint is 5-year MFS rates in patients with prostate cancer treated with long- vs short-term ADT in combination with SRT. Secondary objectives are biochemical-relapse free interval, pelvic progression-free survival, time to start of systemic treatment, time to castration resistance, cancer-specific survival, overall survival, acute and late toxicity, and quality of life. METHODS AND ANALYSIS: Total of 534 patients will be randomised 1:1 to ADT 6 months or ADT 24 months with a luteinizing hormone-releasing hormone analogue in combination with SRT, stratified by risk group and pathological lymph node status. ETHICS AND DISSEMINATION: The study is conducted under the guiding principles of the World Medical Association Declaration of Helsinki. The results will be disseminated at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: EudraCT number 2021-006975-41.

Encorafenib and binimetinib followed by radiotherapy for patients with BRAFV600-mutant melanoma and brain metastases (E-BRAIN/GEM1802 phase II study).

BACKGROUND: Encorafenib plus binimetinib (EB) is a standard of care treatment for advanced BRAFV600-mutant melanoma. We assessed efficacy and safety of encorafenib plus binimetinib in patients with BRAFV600-mutant melanoma and brain metastasis (BM) and explored if radiotherapy improves the duration of response. METHODS: E-BRAIN/GEM1802 was a prospective, multicenter, single arm, phase II trial that enrolled patients with melanoma BRAFV600-mutant and BM. Patients received encorafenib 450 mg once daily plus binimetinib 45 mg BID, and those who achieved partial response or stable disease at first tumor assessment were offered radiotherapy. Treatment continued until progression.Primary endpoint was intracranial response rate (icRR) after 2 months of EB, establishing a futility threshold of 60%. RESULTS: The study included 25 patients with no BM symptoms and 23 patients with BM symptoms regardless of using corticosteroids. Among them, 31 patients (64.6%) received sequential radiotherapy. After two months, icRR was 70.8% (95% CI: 55.9-83.1); 10.4% complete response. Median intracranial PFS and OS were 8.5 (95% CI: 6.4-11.8) and 15.9 (95% CI: 10.7-21.4) months, respectively (8.3 months for icPFS and 13.9 months OS for patients receiving RDT). Most common grade 3-4 treatment-related adverse event was alanine aminotransferase (ALT) increased (10.4%). CONCLUSION: Encorafenib plus binimetinib showed promising clinical benefit in terms of icRR, and tolerable safety profile with low frequency of high grade TRAEs, in patients with BRAFV600-mutant melanoma and BM, including those with symptoms and need for steroids. Sequential radiotherapy is feasible but it does not seem to prolong response.

Right ventricular dysfunction: pathophysiology, experimental models, evaluation, and treatment.

Interest in the right ventricle has substantially increased due to advances in knowledge of its pathophysiology and prognostic implications across a wide spectrum of diseases. However, we are still far from understanding the multiple mechanisms that influence right ventricular dysfunction, its evaluation continues to be challenging, and there is a shortage of specific treatments in most scenarios. This review article aims to update knowledge about the physiology of the right ventricle, its transition to dysfunction, diagnostic tools, and available treatments from a translational perspective.

Rare Genetic Variants in Young Adults Requiring Pacemaker Implantation.

BACKGROUND: Genetic disease has recently emerged as a cause of cardiac conduction disorders (CCDs), but the diagnostic yield of genetic testing and the contribution of the different genes to CCD is still unsettled. OBJECTIVES: This study sought to determine the diagnostic yield of genetic testing in young adults with CCD of unknown etiology requiring pacemaker implantation. We also studied the prevalence of rare protein-altering variants across individual genes and functional gene groups. METHODS: We performed whole exome sequencing in 150 patients with CCD of unknown etiology who had permanent pacemaker implanted at age ≤60 years at 14 Spanish hospitals. Prevalence of rare protein-altering variants in patients with CCD was compared with a reference population of 115,522 individuals from gnomAD database (control subjects). RESULTS: Among 39 prioritized genes, patients with CCD had more rare protein-altering variants than control subjects (OR: 2.39; 95% CI: 1.75-3.33). Significant enrichment of rare variants in patients with CCD was observed in all functional gene groups except in the desmosomal genes group. Rare variants in the nuclear envelope genes group exhibited the strongest association with CCD (OR: 6.77; 95% CI: 3.71-13.87). Of note, rare variants in sarcomeric genes were also enriched (OR: 1.73; 95% CI: 1.05-3.10). An actionable genetic variant was detected in 21 patients (14%), with LMNA being the most frequently involved gene (4.6%). CONCLUSIONS: Unrecognized rare genetic variants increase the risk of CCD in young adults with CCD of unknown etiology. Genetic testing should be performed in patients age ≤60 years with CCD of unknown etiology. The role of genetic variants in sarcomeric genes as a cause of CCD should be further investigated.

Revealing biases in insect observations: A comparative analysis between academic and citizen science data.

Citizen Science is a powerful tool for biodiversity research, as it facilitates data recording at large scales that would otherwise be impossible to cover by standard academic research. Despite its benefits, the accuracy of citizen science data remains a subject of concern among scientists, with varying results reported so far. Neither citizen science data nor academic records are immune to biases, which can significantly impact the quality and reliability of observations. Here, using insects in the Iberian Peninsula as a case study, we compare data collected by participatory platforms to those obtained through academic research projects, and assess their taxonomic, spatial, temporal, and environmental biases. Results show a prominent taxonomic bias in both academic and citizen science data, with certain insect orders receiving more attention than others. These taxonomic biases are conserved between different participatory platforms, as well as between groups of users with different levels of contribution performance. The biases captured by leading contributors in participatory platforms mirrored those of sporadic users and academic data. Citizen science data had higher spatial coverage and less spatial clustering than academic data, showing also clearer trends in temporal seasonality. Environmental coverage over time was more stable in citizen science than in academic records. User behaviour, preference, taxonomical expertise, data collection methodologies and external factors may contribute to these biases. This study shows the multifaceted nature of biases present in academic records and citizen science platforms. The insights gained from this analysis emphasize the need for careful consideration of these biases when making use of biodiversity data from different sources. Combining academic and citizen science data enhances our understanding of biodiversity, as their integration offers a more comprehensive perspective than relying solely on either dataset alone, especially since biases in these two types of data are not always the same.