Assessment of Factors Influencing Personal Exposure to Air Pollution on Main Roads in Bogota: A Mixed-Method Study.

Background and Objectives: Particulate Matter (PM), particles of variable but small diameter can penetrate the respiratory system via inhalation, causing respiratory and/or cardiovascular diseases. This study aims to evaluate the association of environmental particulate matter (PM2.5) and black carbon (BC) with respiratory health in users of different transport modes in four roads in Bogotá. Materials and Methods: this was a mixed-method study (including a cross sectional study and a qualitative description of the air quality perception), in 300 healthy participants, based on an exploratory sequential design. The respiratory effect was measured comparing the changes between pre- and post-spirometry. The PM2.5 and black carbon (BC) concentrations were measured using portable devices. Inhaled doses were also calculated for each participant according to the mode and route. Perception was approached through semi-structured interviews. The analysis included multivariate models and concurrent triangulation. Results: The concentration of matter and black carbon were greater in bus users (median 50.67 µg m-3; interquartile range (-IR): 306.7). We found greater inhaled dosages of air pollutants among bike users (16.41 µg m-3). We did not find changes in the spirometry parameter associated with air pollutants or transport modes. The participants reported a major sensory influence at the visual and olfactory level as perception of bad air quality. Conclusions: We observed greater inhaled doses among active transport users. Nevertheless, no pathological changes were identified in the spirometry parameters. People's perceptions are a preponderant element in the assessment of air quality.

Effectiveness and safety of nab-paclitaxel/gemcitabine in locally advanced or metastatic pancreatic adenocarcinoma.

BACKGROUND: Treatment based on nab-paclitaxel plus gemcitabine is one of the standard treatments for locally advanced or metastatic pancreatic adenocarcinoma. Not much information is available about its use in clinical practice. Looking for prognostic markers may aid in improving treatment plans for patients. OBJECTIVE: To describe the effectiveness and safety profile of nab-paclitaxel/gemcitabine in locally advanced or metastatic pancreatic adenocarcinoma. We also tried to evaluate prognostic markers of response to treatment. SETTING: Retrospective descriptive study carried out in a tertiary hospital of Spain. METHOD: Patients with locally advanced or metastatic pancreatic adenocarcinoma treated with nab-paclitaxel/gemcitabina between January 2014 and December 2017 were included in the analyses. MAIN OUTCOME MEASURE: Effectiveness was measured in terms of overall survival, progression-free survival and response rate. To evaluate the safety profile, every adverse event from the start of the treatment and up to 10 days after its completion was registered. RESULTS: Fifty patients were included. Thirty-three (66%) had metastatic disease. Median overall survival was 8.8 months (95%CI: 5.1-12.5) and the median progression-free survival was 5.6 months (95%CI: 4.3-6.9). Relevance of carbohydrate antigen 19-9 baseline levels as prognostic response marker was confirmed, while neutrophil-to-lymphocyte ratio did not show conclusive results for overall survival. Safety profile was similar to that observed in clinical trials, with a single case of treatment discontinuation due to grade 3 neuropathy. CONCLUSION: The studied schedule for locally advanced or metastatic pancreatic adenocarcinoma seems to be an effective therapeutic option, with an easy to manage toxicity profile, similar to other schedules used in pancreatic adenocarcinoma.

Event-Based Gesture Recognition through a Hierarchy of Time-Surfaces for FPGA.

Neuromorphic vision sensors detect changes in luminosity taking inspiration from mammalian retina and providing a stream of events with high temporal resolution, also known as Dynamic Vision Sensors (DVS). This continuous stream of events can be used to extract spatio-temporal patterns from a scene. A time-surface represents a spatio-temporal context for a given spatial radius around an incoming event from a sensor at a specific time history. Time-surfaces can be organized in a hierarchical way to extract features from input events using the Hierarchy Of Time-Surfaces algorithm, hereinafter HOTS. HOTS can be organized in consecutive layers to extract combination of features in a similar way as some deep-learning algorithms do. This work introduces a novel FPGA architecture for accelerating HOTS network. This architecture is mainly based on block-RAM memory and the non-restoring square root algorithm, requiring basic components and enabling it for low-power low-latency embedded applications. The presented architecture has been tested on a Zynq 7100 platform at 100 MHz. The results show that the latencies are in the range of 1 µ s to 6.7 µ s, requiring a maximum dynamic power consumption of 77 mW. This system was tested with a gesture recognition dataset, obtaining an accuracy loss for 16-bit precision of only 1.2% with respect to the original software HOTS.

Extraction of Galphimines from Galphimia glauca with Supercritical Carbon Dioxide.

The anti-depressive and anxiolytic effect of galphimine B (isolated from Galphimia glauca) has been demonstrated by researchers. Therefore, it is necessary to explore extraction techniques that produce materials with adequate quality for pharmaceutical applications. In this work, supercritical extractions of galphimines from Galphimia glauca were performed in the presence of carbon dioxide. Pressure, temperature, particle diameter, and flow rate effects were examined to explore the conditions with the highest yield and the concentration profile of galphimines in the studied interval. The identification of the nor-seco triterpenoids and galphimine B and E was carried out by HPLC analyses. The mathematical modeling of the extraction curves was attained by the approaches proposed by Sovová and Papamichail et al. According to results, the highest yield 2.22% was obtained at 323.15 K, 326 µm, 3 L/min, and 33.75 MPa. Meanwhile, the content of galphimine B in the extract was, on average, 19.5 mg·g-1.

Alarmones as Vestiges of a Bygone RNA World.

All known alarmones are ribonucleotides or ribonucleotide derivatives that are synthesized when cells are under stress conditions, triggering a stringent response that affects major processes such as replication, gene expression, and metabolism. The ample phylogenetic distribution of alarmones (e.g., cAMP, Ap(n)A, cGMP, AICAR, and ZTP) suggests that they are very ancient molecules that may have already been present in cellular systems prior to the evolutionary divergence of the Archaea, Bacteria, and Eukarya domains. Their chemical structure, wide biological distribution, and functional role in highly conserved cellular processes support the possibility that these modified nucleotides are molecular fossils of an epoch in the evolution of chemical signaling and metabolite sensing during which RNA molecules played a much more conspicuous role in biological catalysis and genetic information.

Abdominal Operations After Left Ventricular Assist Device Implantation and Heart Transplantation.

BACKGROUND: Left ventricular assist devices (LVADs) are increasingly used to supplant the limited number of orthotopic heart transplantation (OHT). The present study aimed to perform a contemporary analysis of emergency abdominal operations after LVAD and OHT at a national level. METHODS: The 2005-2015 National Impatient Sample, the largest all-payer hospitalization database in the United States, was used to identify all adult patients who had received LVAD or OHT. The primary outcome of interest was the rate of emergency general surgery (EGS), which included laparotomy, small or large bowel resection, peptic ulcer operation, adhesiolysis, and cholecystectomy, during the same hospitalization as LVAD or OHT. Logistic regression was used to determine risk factors for EGS as well as the association between EGS and mortality in both the LVAD and OHT populations. RESULTS: Of the estimated 19,395 OHT and 23,441 LVAD performed, 445 (2.3%) OHT and 719 (3.1%) LVAD patients required EGS. The incidence of EGS in LVAD decreased from 5.4 to 3.3%, whereas it increased among OHT patients from 1.9 to 3.7%, P = 0.003. Occurrence of EGS after OHT and LVAD was associated with significantly higher inpatient risk-adjusted mortality (OHT adjusted odds ratio, 3.0; P = 0.004; LVAD adjusted odds ratio, 2.5; P < 0.001), incremental hospitalization costs (OHT, $106,778; P < 0.001; LVAD, $61,965; P < 0.001), and length of stay (OHT, 27.9 d; P < 0.001; LVAD, 20.8 d; P < 0.001). CONCLUSIONS: EGS remains an infrequent but high mortality and cost complication of OHT and LVAD. Further investigation of the impact of immunosuppression, anticoagulation, and perfusion strategies on incidence of abdominal complications is warranted.

Morphological and physiological responses of the external mycelium of Rhizophagus intraradices to water stress.

Most studies dealing with mycorrhizal associations and drought have focused on the plants, not on the fungi, and tolerance and adaptations of arbuscular mycorrhizal (AM) fungi to cope with water stress are virtually unknown. This study was conducted to assess how water stress directly affects an AM fungus isolate, particularly through morphological and physiological changes in the external mycelium. We used two-compartment pots separated by mesh and an air gap that allowed us to apply water stress treatments only to the external mycelium. Clover (Trifolium subterraneum L.) plants inoculated with Rhizophagus intraradices grew at high humidity until external mycorrhizal mycelium developed in the mycelium compartment. Then, we started three watering treatments: high (H, 70% of soil water holding capacity), low (L, 10%), and mixed watering (HLHL, 70-10-70-10%) only in the hyphal compartment. The HLHL treatment was rewetted once to 70% after 42 days. We measured total mycelium length, hyphal length in diameter categories, respiration activity, and protoplasm fragmentation 42 and 76 days after starting the treatments. Rhizophagus intraradices mycelium responded to water stress by reducing its length, maintaining larger diameter hyphae, and concentrating protoplasm activity in fragments in the HLHL and L treatments. In both water stress treatments, changes suggested a trade-off between avoiding desiccation and storing resources, and maintaining soil exploration and water uptake capacity.

Improved patency after axillofemoral bypass for aortoiliac occlusive disease.

OBJECTIVE: Axillofemoral bypasses (AxFBs) have been used since 1962 to treat aortoiliac disease. In the past, reported patency rates (37%-76%) for these extra-anatomic grafts have been inferior to those for anatomic aortic grafting. Reported low survival rates after AxFB (40%-50%) have confirmed that these procedures have been used primarily in patients at high risk for complications from aortofemoral bypass. However, modern medical and anesthesia management, preoperative scanning, donor artery preparation, postoperative graft surveillance, and graft technology may improve outcomes after AxFB, possibly supporting expansion of its use. We therefore report our last 15-year experience with AxFB. METHODS: Ring-reinforced, 8-mm expanded polytetrafluoroethylene grafts were used in all cases. The cross-femoral limb of axillobifemoral bypass (AxBFB) grafts was preconstructed. Heparin was administered intraoperatively, with protamine reversal. Loss of primary patency was defined as graft thrombosis of part or all of the inserted graft. Five-year primary patency rates were calculated by Kaplan-Meier analysis. RESULTS: Between February 1991 and June 2016, a total of 161 grafts were inserted (85 AxBFBs and 76 axillounifemoral bypasses [AxUFBs]) in 91 male and 70 female patients (median age, 72.6 years; mean age, 73 years; range, 41-94 years). Indications for treatment were rest pain (49.6%), ischemic lesions (26%), claudication (22.3%), failed prior revascularization (9.3%), infection (3.7%), and dissecting aneurysm (1.2%). Reasons for performing AxFB rather than aortofemoral bypass were hostile aorta (44.1%), high risk (19.2%), prior failed reconstruction (12.4%), advanced age (8.7%), infection (4.3%), hostile abdomen (4.3%), aortic dissection (0.6%), and morbid obesity (0.6%). During follow up, 63 patients died, 17 within the first year; but only 3 patients died within 30 days of surgery (performed to treat an acute aortic occlusion). The 5-year survival rate was 55%. Five-year patency rates were 83.7% for all procedures, 81.8% for AxBFB, and 85.5% for AxUFB; the difference between AxBFB and AxUFB was not significant. CONCLUSIONS: Our data indicate that AxBFB and AxUFB performed with the use of modern protocols and technology may render them an acceptable valid primary intervention in patients in whom endovascular treatment has failed or is unlikely to offer long-term success. The simplicity of performing these grafts and their low mortality and morbidity lend their application to surgeons with limited open aortic experience. Because AxUFB and AxBFB have similar patency rates, AxBFB should be reserved for bilateral indications.

Methanogenesis on Early Stages of Life: Ancient but Not Primordial.

Of the six known autotrophic pathways, the Wood-Ljungdahl pathway (WL) is the only one present in both the acetate producing Bacteria (homoacetogens) and the methane producing Archaea (hydrogenotrophic methanogens), and it has been suggested that WL is one of the oldest metabolic pathways. However, only the so-called carbonyl branch is shared by Archaea and Bacteria, while the methyl branch is different, both in the number of reactions and enzymes, which are not homologous among them. In this work we show that some parts of the methyl branch of archaeal Wood-Ljungdahl pathway (MBWL) are present in bacteria as well as in non-methanogen archaea, although the tangled evolutionary history of MBWL cannot be traced back to the Last Common Ancestor. We have also analyzed the different variants of methanogenesis (hydrogenotrophic, acetoclastic and methylotrophic pathways), and concluded that each of these pathways, and every different enzyme or subunit (in the case of multimeric enzymes), has their own intricate evolutionary history. Our study supports the scenario of hydrogenotrophic methanogenesis being older than the other variants, albeit not old enough to be present in the last archaeal common ancestor.

Heparin-bonded expanded polytetrafluoroethylene femoropopliteal bypass grafts outperform expanded polytetrafluoroethylene grafts without heparin in a long-term comparison.

OBJECTIVE: Expanded polytetrafluoroethylene (ePTFE) grafts have become an acceptable prosthetic alternative to autologous vein for infrainguinal arterial reconstructions. Recently, heparin bonding to the graft's luminal surface has been used as an adjunctive method of improving graft patency. We retrospectively evaluated a prospective experience with heparin-bonded ePTFE (HePTFE) vs the results of a prior experience with standard ePTFE (SePTFE) to compare patency rates in above-knee (AK) and below-knee (BK) femoropopliteal bypass through the 5-year follow-up. METHODS: Prosthetic femoropopliteal bypasses performed by our four-surgeon group were constructed using 6-mm SePTFE grafts before August 2007. Subsequently, all such bypasses were constructed using 6-mm HePTFE (Propaten graft; W. L. Gore & Associates, Flagstaff, Ariz). The surgical technique used in all cases throughout the study was similar irrespective of surgeon or graft material. Loss of primary patency was defined by graft thrombosis; duplex scan confirmed graft failure. Descriptive estimation of patency rates was carried out using standard Kaplan-Meier methods. Cox proportional hazards regression was used to analyze relationships between predictors and time to loss of patency. RESULTS: There were 192 AK (87 Propaten, 105 SePTFE) and 60 BK (42 Propaten, 18 SePTFE) grafts. Overall primary patency for Propaten was statistically better than SePTFE at years 1 (93.6% vs 84.2%), 2 (79.7% vs 73.8%), 3 (79.7% vs 69.5%), 4 (74.5% vs 59.9%) and 5 (74.5% vs 56.2%; log-rank test, P = .036). Five-year primary patency was superior for Propaten AK grafts (85.2% vs 59.3%; log-rank test, P = .028) and for Propaten BK grafts (59.6% vs 0.0/undeterminable; log-rank test, P = .016). Variables significantly associated with loss of patency for Propaten and SePTFE were claudication (hazard ratio [HR], 0.41), age (HR, 0.95), isolated popliteal artery (HR, 3.1-4.4), and ankle-brachial index after the procedure (HR, 0.10). Controlling for conduit effect, clopidogrel use did not significantly affect patency (P = .076). No grafts were associated with heparin-induced thrombocytopenia. CONCLUSIONS: These data show that the Propaten HePTFE graft offered significantly better long-term patency over the SePTFE graft, suggesting Propaten as the prosthetic graft of choice for bypasses to the femoropopliteal artery when autologous vein is unavailable or inappropriate.

Worldwide data sets constrain the water vapor uptake coefficient in cloud formation.

Cloud droplet formation depends on the condensation of water vapor on ambient aerosols, the rate of which is strongly affected by the kinetics of water uptake as expressed by the condensation (or mass accommodation) coefficient, αc. Estimates of αc for droplet growth from activation of ambient particles vary considerably and represent a critical source of uncertainty in estimates of global cloud droplet distributions and the aerosol indirect forcing of climate. We present an analysis of 10 globally relevant data sets of cloud condensation nuclei to constrain the value of αc for ambient aerosol. We find that rapid activation kinetics (αc > 0.1) is uniformly prevalent. This finding resolves a long-standing issue in cloud physics, as the uncertainty in water vapor accommodation on droplets is considerably less than previously thought.

[Virtual Campus of Public Health: six years of human resources education in Mexico]. / El Campus Virtual de Salud Pública: seis años de formar recursos humanos en México.

This paper discusses the gestation process, implementation methodology, and results obtained from the initiative to use e-learning to train human resources for health, six years after the launch of the Virtual Campus of Public Health of the University of Guadalajara (Mexico); the discussion is framed by Pan American Health Organization (PAHO) standards and practices. This is a special report on the work done by the institutional committee of the Virtual Campus in western Mexico to create an Internet portal that follows the guidelines of the strategic model established by Nodo México and PAHO for the Region of the Americas. This Virtual Campus began its activities in 2007, on the basis of the use of free software and institutional collaboration. Since the initial year of implementation of the node, over 500 health professionals have been trained using virtual courses, the node's educational platform, and a repository of virtual learning resources that are interoperable with other repositories in Mexico and the Region of the Americas. The University of Guadalajara Virtual Campus committee has followed the proposed model as much as possible, thereby achieving most of the goals set in the initial work plan, despite a number of administrative challenges and the difficulty of motivating committee members.

Impact of Gabapentin on Postoperative Hypotension in Enhanced Recovery after Surgery Protocols for Microvascular Breast Reconstruction.

Background: Enhanced recovery after surgery (ERAS) protocols have been associated with hypotensive episodes after autologous breast reconstruction. Gabapentin (Gaba), a nonopioid analgesic used in ERAS, has been shown to attenuate postoperative hemodynamic responses. This study assesses ERAS's impact, with and without Gaba, on postoperative hypotension after microvascular breast reconstruction. Methods: Three cohorts were studied: traditional pathway, ERAS + Gaba, and ERAS no-Gaba. We evaluated length of stay, inpatient narcotic use [morphine milligram equivalents (MME)], mean systolic blood pressure, hypotension incidence, and complications. The traditional cohort was retrospectively reviewed, whereas the ERAS groups were enrolled prospectively after the initiation of the protocol in April 2019 (inclusive of Gaba until October 2022). Results: In total, 441 patients were analyzed. The three cohorts, in the order mentioned above, were similar in age and bilateral reconstruction rates (57% versus 61% versus 60%). The ERAS cohorts, both with and without Gaba, had shorter stays (P < 0.01). Inpatient MME was significantly less in the ERAS + Gaba cohort than the traditional or ERAS no-Gaba cohorts (medians: 112 versus 178 versus 158 MME, P < 0.01). ERAS + Gaba significantly increased postoperative hypotensive events on postoperative day (POD) 1 and 2, with notable reduction after Gaba removal (P < 0.05). Across PODs 0-2, mean systolic blood pressure was highest in the traditional cohort, followed by ERAS no-Gaba, then the ERAS + Gaba cohort (P < 0.05). Complication rates were similar across all cohorts. Conclusions: Postmicrovascular breast reconstruction, ERAS + Gaba reduced overall inpatient narcotic usage, but increased hypotension incidence. Gaba removal from the ERAS protocol reduced postoperative hypotension incidence while maintaining similar stay lengths and complication rates.

Chapter 2: What Is Life?

The question "What is life?" has existed since the beginning of recorded history. However, the scientific and philosophical contexts of this question have changed and been refined as advancements in technology have revealed both fine details and broad connections in the network of life on Earth. Understanding the framework of the question "What is life?" is central to formulating other questions such as "Where else could life be?" and "How do we search for life elsewhere?" While many of these questions are addressed throughout the Astrobiology Primer 3.0, this chapter gives historical context for defining life, highlights conceptual characteristics shared by all life on Earth as well as key features used to describe it, discusses why it matters for astrobiology, and explores both challenges and opportunities for finding an informative operational definition.

Chapter 1: The Astrobiology Primer 3.0.

The Astrobiology Primer 3.0 (ABP3.0) is a concise introduction to the field of astrobiology for students and others who are new to the field of astrobiology. It provides an entry into the broader materials in this supplementary issue of Astrobiology and an overview of the investigations and driving hypotheses that make up this interdisciplinary field. The content of this chapter was adapted from the other 10 articles in this supplementary issue and thus represents the contribution of all the authors who worked on these introductory articles. The content of this chapter is not exhaustive and represents the topics that the authors found to be the most important and compelling in a dynamic and changing field.

Low complexity regions (LCRs) contribute to the hypervariability of the HIV-1 gp120 protein.

Low complexity regions (LCRs) are sequences of nucleic acids or proteins defined by a compositional bias. Their occurrence has been confirmed in sequences of the three cellular lineages (Bacteria, Archaea and Eucarya), and has also been reported in viral genomes. We present here the results of a detailed computer analysis of the LCRs present in the HIV-1 glycoprotein 120 (gp120) encoded by the viral gene env. The analysis was performed using a sample of 3637 Env polyprotein sequences derived from 4117 completely sequenced and translated HIV-1 genomes available in public databases as of December 2012. We have identified 1229 LCRs located in four different regions of the gp120 protein that correspond to four of the five regions that have been identified as hypervariable (V1, V2, V4 and V5). The remaining 29 LCRs are found in the signal peptide and in the conserved regions C2, C3, C4 and C5. No LCR has been identified in the hypervariable region V3. The LCRs detected in the V1, V2, V4, and V5 hypervariable regions exhibit a high Asn content in their amino acid composition, which very likely correspond to glycosylation sites, which may contribute to the retroviral ability to avoid the immune system. In sharp contrast with what is observed in gp120 proteins lacking LCRs, the glycosylation sites present in LCRs tend to be clustered towards the center of the region forming well-defined islands. The results presented here suggest that LCRs represent a hitherto undescribed source of genomic variability in lentivirus, and that these repeats may represent an important source of antigenic variation in HIV-1 populations. The results reported here may exemplify the evolutionary processes that may have increased the size of primitive cellular RNA genomes and the role of LCRs as a source of raw material during the processes of evolutionary acquisition of new functions.

Enhanced Recovery after Surgery Protocol Decreases Length of Stay and Postoperative Narcotic Use in Microvascular Breast Reconstruction.

Background: Enhanced recovery after surgery (ERAS) protocols have demonstrated efficacy following microvascular breast reconstruction. This study assesses the impact of an ERAS protocol following microvascular breast reconstruction at a high-volume center. Methods: The ERAS protocol introduced preoperative counseling, multimodal analgesia, early diet resumption, and early mobilization to our microvascular breast reconstruction procedures. Data, including length of stay, body mass index, inpatient narcotic use, outpatient narcotic prescriptions, inpatient pain scores, and complications, were prospectively collected for all patients undergoing microvascular breast reconstruction between April 2019 and July 2021. Traditional pathway patients who underwent reconstruction immediately before ERAS implementation were retrospectively reviewed as controls. Results: The study included 200 patients, 99 in traditional versus 101 in ERAS. Groups were similar in body mass index, age (median age: traditional, 54.0 versus ERAS, 50.0) and bilateral reconstruction rates (59.6% versus 61.4%). ERAS patients had significantly shorter lengths of stay, with 96.0% being discharged by postoperative day (POD) 3, and 88.9% of the traditional cohort were discharged on POD 4 (P < 0.0001). Inpatient milligram morphine equivalents (MMEs) were smaller by 54.3% in the ERAS cohort (median MME: 154.2 versus 70.4, P < 0.0001). Additionally, ERAS patients were prescribed significantly fewer narcotics upon discharge (median MME: 337.5 versus 150.0, P < 0.0001). ERAS had a lower pain average on POD 0-3; however, this finding was not statistically significant. Conclusion: Implementing an ERAS protocol at a high-volume microvascular breast reconstruction center reduced length of stay and postoperative narcotic usage, without increasing pain or perioperative complications.

Distributed smart device for monitoring, control and management of electric loads in domotic environments.

This paper presents a microdevice for monitoring, control and management of electric loads at home. The key idea is to compact the electronic design as much as possible in order to install it inside a Schuko socket. Moreover, the electronic Schuko socket (electronic microdevice + Schuko socket) has the feature of communicating with a central unit and with other microdevices over the existing powerlines. Using the existing power lines, the proposed device can be installed in new buildings or in old ones. The main use of this device is to monitor, control and manage electric loads to save energy and prevent accidents produced by different kind of devices (e.g., iron) used in domestic tasks. The developed smart device is based on a single phase multifunction energy meter manufactured by Analog Devices (ADE7753) to measure the consumption of electrical energy and then to transmit it using a serial interface. To provide current measurement information to the ADE7753, an ultra flat SMD open loop integrated circuit current transducer based on the Hall effect principle manufactured by Lem (FHS-40P/SP600) has been used. Moreover, each smart device has a PL-3120 smart transceiver manufactured by LonWorks to execute the user's program, to communicate with the ADE7753 via serial interface and to transmit information to the central unit via powerline communication. Experimental results show the exactitude of the measurements made using the developed smart device.

A multidisciplinary case of ureteroiliac fistula after radical cystectomy.

Ureteroiliac fistula is a rare complication associated with ureteral stenting and iliac artery reconstruction and can lead to life-threatening hemorrhage. We report a case of acute bleeding from a ureteroiliac fistula in an 89-year-old man with bladder cancer who had undergone pelvic radiation, radical cystectomy, and ileal conduit complicated by ureteral strictures requiring routine stent exchanges. Multidisciplinary diagnostic therapies revealed the fistula, which was treated with hypogastric artery coiling and covered stent placement. No further bleeding issues had resulted from the fistula at 11 months of follow-up. The presence of a ureteroiliac fistula should be considered in any patient with a similar history.

Current Trends in Breast Reconstruction following Bilateral Prophylactic Mastectomy.

Background: Individuals with genetic susceptibility to breast cancer may pursue bilateral prophylactic mastectomy (BPM) and subsequent breast reconstruction. This study aimed to characterize immediate reconstructive trends following BPM. Methods: The ACS-NSQIP database (2010 -2019) was used to examine differences in demographics and operative outcomes based on breast reconstruction technique following BPM and factors predicting reconstruction type. Results: Of 1945 patients (mean age, 43.8 ± 11.3 years), implant-based reconstruction (IBR) was most frequently (71.8%) performed following BPM. Patients who underwent IBR (n = 1396) were younger (42.6 years, P < 0.001), more likely to be White (P < 0.05), and more likely to have a BMI less than 25 (P < 0.001). Patients who underwent autologous reconstruction (AR) (n = 186, 45.8 years) were more likely to be Black or African American and have a BMI of 25-30. Patients who underwent mastectomy only (MO) without immediate reconstruction (n = 363) were older (47.6 years), more likely to be Asian, and more likely to have a BMI greater than 35. The MO cohort had the highest frequency of diabetes or smoking history. AR was associated with longer operations, longer lengths of stay, and increased complications. Increasing age and BMI were predictive of AR or MO compared to IBR. Smoking was predictive of MO. Conclusion: This is the first large-scale study of genetically susceptible patients who underwent BPM demonstrating a significant relationship between patient demographics, operative outcomes, and immediate reconstruction technique. These results provide valuable insight for surgeons and patients during the shared decision-making process.