Association of anesthetic modality and other variables on 1-year functional patency of cephalic-based arteriovenous fistulae.

OBJECTIVE: Some studies suggest that regional anesthesia provides better patency for arteriovenous fistula (AVF) for hemodialysis access as compared to local and general anesthesia. This study evaluates the impact of anesthetic modality on long term fistula function at 12 months. METHODS: A retrospective review of patients undergoing cephalic vein-based hemodialysis access in consecutive cases between 2014 and 2019 was conducted from five safety net hospitals. The primary endpoint was functional patency at 12 months. Subset analysis individually evaluated cephalic-based lower forearm and wrist vs upper arm AVFs. Bivariate and multivariate logistic regression models evaluated the relationship between anesthetic modality and fistula function at 12 months. RESULTS: There were 818 cephalic-based fistulas created during the study period. The overall 12-month functional patency rate was 78.7%, including an 81.3% patency for upper arm AVF and 73.3% for wrist AVF (P = .009). There was no statistically significant difference among patients with functional and nonfunctional AVFs at 12 months with respect to anesthetic modality when comparing regional, local, and general anesthesia (P = .343). Multivariate regression analysis identified that history of AVF/arteriovenous graft (odds ratio [OR], 0.24; P = .007), receiving intraoperative systemic anticoagulation (OR, 2.49; P < .001), and vein diameter (OR, 1.85; P = .039) as independently associated with AVF functional patency at 12 months. CONCLUSIONS: There was no association between anesthetic modality and functional patency of cephalic-based AVFs at 12 months. Further studies are needed to better define which patients may benefit from regional anesthesia.

Association of race and ethnicity with initial surgical hemodialysis access type in a safety net system.

OBJECTIVES: Prior studies have found lower arteriovenous fistula (AVF) creation rates in Black and Hispanic patients. Whether this is due to health care disparities or other differences is unclear. Our objective was to evaluate the racial/ethnic differences in initial surgical access type within a high-volume, safety net system with predominantly Black and Hispanic populations. METHODS: A retrospective review of initial hemodialysis (HD) access in consecutive cases between 2014 and 2019 was conducted from all five safety net hospitals in a health care system that primarily treats underserved patients. Patient data collected included race, ethnicity, sex, comorbidities, and initial arteriovenous (AV) access type (AV fistula [AVF] vs AV graft [AVG]). The rates of cephalic vein-based AVF (CAVF; radiocephalic, brachiocephalic) were compared with basilic and brachial vein AVF (BAVF), because the latter are performed as two stages. Bivariate and multivariate logistic regression models were adjusted for demographic and clinical variables to evaluate the relationship between race/ethnicity, surgical access type, and comorbid conditions. RESULTS: We included 1334 patients (74% Hispanic, 9% Black, 7% Asian, 2% White, 8% other) who underwent first-time surgical HD access creation. The majority were male (818 [63%]). Medical comorbidities were equal among groups, except for chronic obstructive pulmonary disease and stroke, which were higher in Black patients (P < .005 and P = .005, respectively). Overall, 1303 patients (98%) underwent AVF creation and 31 AVG creation (2%), with no difference between race/ethnicity in AVF vs AVG creation. Of the AVF cohort, 991 (76%) had a CAVF and 312 (24%) had a BAVF. Males were more likely than females to get a CAVF (65% vs 35%; P = .002). CONCLUSIONS: Within our safety net health system, where most patients are under-represented minorities, nearly all patients undergoing HD access had an AVF as their initial surgery with no difference in race/ethnicity. AVF type received differed by race, with Black patients twice as likely to undergo BAVF, which required two stages. Further studies are needed to identify the reasons for these differences.

Working memory deficits in schizophrenia are associated with the rs34884856 variant and expression levels of the NR4A2 gene in a sample Mexican population: a case control study.

BACKGROUND: Cognitive functions represent useful endophenotypes to identify the association between genetic variants and schizophrenia. In this sense, the NR4A2 gene has been implicated in schizophrenia and cognition in different animal models and clinical trials. We hypothesized that the NR4A2 gene is associated with working memory performance in schizophrenia. This study aimed to analyze two variants and the expression levels of the NR4A2 gene with susceptibility to schizophrenia, as well as to evaluate whether possession of NR4A2 variants influence the possible correlation between gene expression and working memory performance in schizophrenia. METHODS: The current study included 187 schizophrenia patients and 227 controls genotyped for two of the most studied NR4A2 genetic variants in neurological and neuropsychiatric diseases. Genotyping was performed using High Resolution Melt and sequencing techniques. In addition, mRNA expression of NR4A2 was performed in peripheral mononuclear cells of 112 patients and 118 controls. A group of these participants, 54 patients and 87 controls, performed the working memory index of the WAIS III test. RESULTS: Both genotypic frequencies of the two variants and expression levels of the NR4A2 gene showed no significant difference when in patients versus controls. However, patients homozygous for the rs34884856 promoter variant showed a positive correlation between expression levels and auditory working memory. CONCLUSIONS: Our finding suggested that changes in expression levels of the NR4A2 gene could be associated with working memory in schizophrenia depending on patients' genotype in a sample from a Mexican population.

Differences between Creativity and Gender in Students with High Abilities Attending a School with Total Grouping.

BACKGROUND: Creativity is one of the most relevant aspects in students' training. One of the purposes of the present work is to show the lack of differences between boys and girls in creativity; the other is the possibility of improving creativity among high-ability students who received specific training as part of their intra-curricular content in a total grouping program for gifted students. METHOD: The sample consisted of 42 students from first to third grade (13 females and 29 males) and 58 students from fourth to sixth grade (21 females and 37 males). Creativity was measured with the CREA test for younger students and with the PIC-N for older students. Training was carried out through an Integral Innovation and Creativity Program (PIIC). RESULTS: The results showed no differences between genders, except in one of the graphic creativity scales (Details). There were improvements due to the training in all measures of narrative creativity and in the scale of elaboration of graphic creativity. CONCLUSIONS: The main conclusions are the importance of increasing creativity with specific programs and the need to improve interventions in graphic creativity.

Parental Evaluation of the Socio-Personal Adjustment of High Ability Students in a Cluster Grouping Program.

High ability students have differential cognitive characteristics that require a specific educational response to develop their full potential. Cluster ability grouping is one of the available approaches to respond to their training. One of the main criticisms of this teaching method, also supported by the big-fish-little-pond effect (BFLPE), is that high ability students may show a decrease in their self-concept. The aim of this research is to present the evaluation carried out by parents of primary school high ability students on the effect of an educational cluster grouping program on their personal and social adjustment, comparing these variables before the beginning of the school year and at the end of it. Approximately 100 students' parents of the Educational Centre for Highly Ability Pupils participated in the evaluation. The instrument used for the evaluation was the Socialization Battery (BAS-2) for parents. The results showed that parents observed some improvements, either due to an increase in the scales measuring positive socialization variables or a decrease in the scales measuring negative socialization variables. The most substantial improvements are found in the second and third grades. We conclude that the results do not support the big-fish-little-pond effect (BFLPE).

Short Courses of Antibiotics Are Safe in Necrotizing Soft Tissue Infections.

INTRODUCTION: Necrotizing soft tissue infections (NSTIs) carry high morbidity and mortality. While early aggressive surgical debridement is well-accepted treatment for NSTIs, the optimum duration of adjunct antibiotic therapy is unclear. An increasing focus on safety and evidence-based antimicrobial stewardship suggests a value in addressing this knowledge gap. OBJECTIVE: To determine whether shorter antibiotic courses have similar outcomes compared to longer courses in patients with NSTI following adequate source control. POPULATION: 142 consecutive patients with surgically managed NSTI were identified on retrospective chart review between December 2014 and December 2018 at two academic medical centers. RESULTS: Patients were predominately male (74%) with a median age of 52 and similar baseline characteristics. The median number of debridements to definitive source control was 2 (IQR 1-3) with the short course group undergoing a greater number of debridements control 2.57 ± 1.8 vs 1.9 ± 1.2, (P = .01). Of 142 patients, 34.5% received a short course and the remaining 65.5% received a longer course of antibiotics. There was no significant difference in the incidence of bacteremia or wound culture positivity between groups. There was also no significant difference in in-hospital mortality, 8% vs 6% (P = .74), incidence of C. difficile infection, median length of stay, or 30-day readmission. CONCLUSION: Provided adequate surgical debridement, similar outcomes in morbidity and mortality suggest antibiotic courses of 7 days or less are equally safe compared to longer courses.

A Mixed Methods Research Study of Parental Perception of Physical Activity and Quality of Life of Children Under Home Lock Down in the COVID-19 Pandemic.

Household confinement due to the rapid spread of the pandemic caused by COVID-19 has brought very significant changes, such as the forced stay-at-home of children due to the closure of schools. This has meant drastic changes in the organization of daily life and restrictions on their activities, including exercise, which could affect the quality of life of the children due to its importance. In order to study the relationship between physical activity and psychological well-being of minors, a study has been carried out with Mixed Methods Research, combining survey methodology with transversal design with qualitative methodology using discourse analysis. A total of 234 parents of minors in Spain and several Spanish-speaking countries in America participated. The instrument was a questionnaire in Google Forms, which included the Kidscreen-27 quality of life scale. The results show significant differences in both the type of physical activity and its frequency due to age, and differences in parents' perception of whether their children's physical activity levels were sufficient or not, both on the health, mood and school subscales, and in the categorization of open responses referring to concerns due to the pandemic, analyzed with the ALCESTE technique. The relationship between physical activity of children and adolescents and quality of life is clearly concluded.

ZnO Nanoparticles Induce Dyslipidemia and Atherosclerotic Lesions Leading to Changes in Vascular Contractility and Cannabinoid Receptors Expression as Well as Increased Blood Pressure.

ZnO nanoparticles (ZnONPs) have been shown to have therapeutic potential in some diseases such as diabetes and cancer. However, concentration-dependent adverse effects have also been reported. Studies which evaluate the effects of ZnONPs on the cardiovascular system are scarce. This study aimed to evaluate the cardiovascular effects of a low dose of ZnONPs administered chronically in healthy rats. Changes in dyslipidemia biomarkers, blood pressure, aortic wall structure, vascular contractility, and expression of cannabinoid receptors in the aorta wall were evaluated. Healthy rats were divided into two groups: control or treated (one, two, and three months). The treated rats received an oral dose of 10 mg/kg/day. The results showed that treatment with ZnONPs induced dyslipidemia from the first month, increasing atherosclerosis risk, which was confirmed by presence of atherosclerotic alterations revealed by aorta histological analysis. In in vitro assays, ZnONPs modified the aorta contractile activity in response to the activation of cannabinoid receptors (CB1 and CB2). The expression of CB1 and CB2 was modified as well. Moreover, ZnONPs elicited an increase in blood pressure. In conclusion, long-time oral administration of ZnONPs induce dyslipidemia and atherosclerosis eliciting alterations in aorta contractility, CB1 and CB2 receptors expression, and an increase in blood pressure in healthy rats.

Physical Activity and Well-Being of High Ability Students and Community Samples During the COVID-19 Health Alert.

The health alert caused by the COVID-19 pandemic and the lockdown have caused significant changes in people's lives. Therefore, it has been essential to study the quality of life, especially in vulnerable populations, including children and adolescents. In this work, the psychological well-being, distribution of tasks and routines, as well as the physical activity done by children and adolescents from two samples: community and high abilities, have been analyzed. The methodology used was Mixed Method Research, through a survey conducted online through social networks. The informants were the parents of the children and adolescents, 209 in the community sample and 116 in the high ability sample. The instrument used was a questionnaire implemented through Google Forms, with open and closed questions, including the Kidscreen-27 scale to measure well-being. The assessment of the adequacy of the physical activity levels was analyzed through ALCESTE. The results showed the absence of differences between students from community samples and those with high capacities in well-being and physical activity. Parents residing in Spain observed less play time in the high ability sample, and more time spent on homework, whether or not they have a diagnosis of high ability. It is concluded that these results question the misconceptions held about high ability students in terms of poorer personal adjustment and better interest in physical activities.

Emotions and Reactions to the Confinement by COVID-19 of Children and Adolescents With High Abilities and Community Samples: A Mixed Methods Research Study.

The goal of this research is to know and compare the emotions and reactions to confinement due to the COVID-19 pandemic in children and adolescents with high abilities and community samples. This is a mixed study with an exploratory reach that is descriptive, and which combines survey and qualitative methodologies to examine the emotions and reactions to confinement experiences of children and adolescents aged between 5 and 14 years. An online poll was designed with 46 questions, grouped into three sections: (1) General Data, (2) Reactions to the health contingencies of COVID-19, and (3) Positive and negative emotions. This last section was included the Oros' positive emotions questionnaire (2014) and the scales of the negative effect of the PANAS Schedule positive and negative affect on children and adolescents between 8 and 14 years old (Sandin, 2003). Data were collected online with a convenience sample. Quantitative data were analyzed with the SPSS statistics program and qualitative data with Alceste software. Among the main findings is the fact that there are no significant differences between the groups by ability in terms of reactions and emotions; however, there are differences between age groups and sex. The study discusses the implications for educational intervention in situations like the current pandemic.

[Prevalence of dental fluorosis in children between 6 to 15 years old]. / Prevalencia de fluorosis dental en escolares de 6 a 15 años de edad.

BACKGROUND: dental fluorosis is a defect in the formation of the enamel by high fluoride concentrations during tooth development. It produces hypomineralization of the enamel by increasing the porosity, thus exposing the tooth to decay. OBJECTIVE: to determine the prevalence and severity of fluorosis in children aged 6 to 15 years. METHODS: a sample of 456 children was evaluated. The diagnosis of fluorosis was made through physical examination and the severity of the damage was described by using a modified version of Dean's scale. RESULTS: 270 children presented fluorosis (59.2 %). The most affected were children of 8 to 12 years, students of first to fifth year of primary school. The severity was mild and very mild in 90 % of cases. Tooth decay appeared in 55 % of children with fluorosis and in 43 % of children without fluorosis. CONCLUSIONS: the prevalence of dental fluorosis is rapidly increasing. Tooth decay affected more often children with fluorosis. Assuming that the prevalence of fluorosis is due to excessive fluoride application rather than to environmental exposure is possible.

Handshake-free zone in a neonatal intensive care unit: Initial feasibility study.

BACKGROUND: The handshake represents a social custom with special importance in health care settings. However, handshakes can transmit disease and compliance with hand hygiene protocols averages <50%. We hypothesized that a handshake-free zone (HFZ) could be established within our neonatal intensive care unit (NICU) and would be well-received by patient families and their health care providers (HCPs). METHODS: We established an HFZ and conducted a prospective cohort study in the NICU at 2 UCLA Medical Centers. Data collection tools included questionnaires for NICU families and their HCPs. RESULTS: Handshake greetings occurred more frequently before than during the HFZ, as reported by HCPs (P = .0002) and patient families (P = .05). Before the HFZ, physicians were more likely than nurses to shake hands with patient families (P = .001), and believe the handshake was extremely important (P = .002); during the HFZ physicians' behaviors and attitudes shifted toward those of the nurses. All patient families and 66% of HCPs believed the NICU should consider establishing an HFZ. CONCLUSIONS: The HFZ decreased the frequency of handshakes within the NICU. The influence of the HFZ on HCP behavior and attitudes varied with gender and profession. Patient families and most HCPs supported the implementation of an HFZ.

Detección temprana de disfunción cerebral mínima (DCM) / Early detection of minimal brain dysfunction

En niños, los síntomas más frecuentes de la disfunción cerebral mínima son los seguientes: hiperquinesia dificultad en el aprendizaje y memoria, falta de atención, impulsividad, incoordinación, desórdenes del sueño, alteraciones del leguaje, cefalea y labiliad emocional. Las diferentes manifestaciones de la disfunción cerebral mínima se debe a una disfunción de una o varias áreas del encéfalo. En el 80 por ciento, los desórdenes del sueño se presentan en la primera mitad del sueño nocturno. En el 82 por ciento de los niños con DCM se presentan alteraciones en el electroencefalograma. En el 50 por ciento, las anomalías son difusas, el 22 por ciento focales y en el 10 por ciento restante, tienen descargas paroxísticas. Algunos niños con DCM, padecen de cuadro subclínico de epilepsia