Early and late results of open surgical and endovascular treatment of infrarenal abdominal aortic aneurysms, selected according to surgical risk.

BACKGROUND: Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) surgery are alternative treatments for infrarenal abdominal aortic aneurysm (IRAAA). OBJECTIVES: To compare OSR and EVAR for the treatment of IRAAA. METHODS: 119 patients with IRAAA were electively operated by the same surgeon between January 1, 2006 and December 31, 2015, following selection for OSR or EVAR according to surgical risk. Complications, reinterventions, failures, and early and late mortality were analyzed. RESULTS: 63 OSR and 56 EVAR patients were analyzed. They were similar in terms of age (70 years), gender (92% men), and average diameter of IRAAA (6.5 cm), but with different comorbidities, surgical risk, and anatomy. EVAR was better than OSR regarding time in the operating theatre (177.5 vs. 233.3 minutes), need for transfusion (25 vs. 73%), and length of stay in ICU (1.3 vs. 3.3 days) and hospital (8.1 vs. 11.1 days). OSR allowed more associated procedures to be conducted simultaneously (19.0 vs. 1.8%). There were no significant differences between the groups with respect to complications (25.4 vs. 25.1%), reinterventions (3.2 vs. 5.2%), or early mortality (1.6 vs. 0%). During follow-up, OSR was associated with fewer revisions (3.13 vs. 4.21), angio-CTs (0.22 vs. 3.23), complications (6.4 vs. 37.5%), reinterventions (3.2 vs. 23.2%), and failures (1.6 vs. 10.7%), and had better survival (78.2 vs. 63.2%). CONCLUSIONS: Correct selection of patients achieves excellent results because it avoids OSR in patients at high risk and avoids EVAR in patients with high anatomical complexity, achieving similar results in the perioperative period, but better results for OSR over the course of follow-up.

CONTEXTO: A cirurgia aberta (CA) e o reparo endovascular de aneurisma (REVA) são tratamentos alternativos para o aneurisma da aorta abdominal infrarrenal (AAAIR). OBJETIVOS: Comparar CA e REVA no tratamento do AAAIR. MÉTODOS: Foram incluídos 119 pacientes com AAAIR, operados eletivamente pelo mesmo cirurgião entre 1 de janeiro de 2006 e 31 de dezembro de 2015, após seleção para CA ou REVA de acordo com o risco cirúrgico. Complicações, reintervenções, falhas e mortalidade precoce e tardia foram analisadas. RESULTADOS: Foram analisados 63 pacientes de CA e 56 de REVA, com semelhanças de idade (70 anos), sexo (92% homens) e diâmetro médio do AAAIR (6,5 cm), mas com diferentes comorbidades, riscos cirúrgicos e anatomias. O REVA foi melhor que a CA em relação ao tempo na sala de cirurgia (177,5 vs. 233,3 minutos), necessidade de transfusão (25 vs. 73%) e tempo de permanência na unidade de terapia intensiva (1,3 vs. 3,3 dias) e no hospital (8,1 vs. 11,1 dias). A CA permitiu que mais procedimentos associados fossem realizados simultaneamente (19,0 vs. 1,8%). Não houve diferenças significativas entre os grupos em relação a complicações (25,4 vs. 25,1%), reintervenções (3,2 vs. 5,2%) e mortalidade precoce (1,6 vs. 0%). Durante o acompanhamento, a CA apresentou menos revisões (3,13 vs. 4,21), angiotomografias (0,22 vs. 3,23), complicações (6,4 vs. 37,5%), reintervenções (3,2 vs. 23,2%) e falhas (1,6 vs. 10,7%), além de ter melhor sobrevida (78,2 vs. 63,2%). CONCLUSÕES: A seleção correta dos pacientes proporciona excelentes resultados porque evita pacientes com alto risco para CA e com complexidade anatômica para REVA. Os resultados são semelhantes no período perioperatório, mas melhores para CA durante o acompanhamento.

A Computational Model of Tonal Tension Profile of Chord Progressions in the Tonal Interval Space.

In tonal music, musical tension is strongly associated with musical expression, particularly with expectations and emotions. Most listeners are able to perceive musical tension subjectively, yet musical tension is difficult to be measured objectively, as it is connected with musical parameters such as rhythm, dynamics, melody, harmony, and timbre. Musical tension specifically associated with melodic and harmonic motion is called tonal tension. In this article, we are interested in perceived changes of tonal tension over time for chord progressions, dubbed tonal tension profiles. We propose an objective measure capable of capturing tension profile according to different tonal music parameters, namely, tonal distance, dissonance, voice leading, and hierarchical tension. We performed two experiments to validate the proposed model of tonal tension profile and compared against Lerdahl's model and MorpheuS across 12 chord progressions. Our results show that the considered four tonal parameters contribute differently to the perception of tonal tension. In our model, their relative importance adopts the following weights, summing to unity: dissonance (0.402), hierarchical tension (0.246), tonal distance (0.202), and voice leading (0.193). The assumption that listeners perceive global changes in tonal tension as prototypical profiles is strongly suggested in our results, which outperform the state-of-the-art models.

Chronic graft-versus-host disease could ameliorate the impact of adverse somatic mutations in patients with myelodysplastic syndromes and hematopoietic stem cell transplantation.

Somatic mutations in patients with myelodysplastic syndromes (MDS) undergoing allogeneic hematopoietic stem cell transplantation (HSTC) are associated with adverse outcome, but the role of chronic graft-versus-host disease (cGVHD) in this subset of patients remains unknown. We analyzed bone marrow samples from 115 patients with MDS collected prior to HSCT using next-generation sequencing. Seventy-one patients (61%) had at least one mutated gene. We found that patients with a higher number of mutated genes (more than 2) had a worse outcome (2 years overall survival [OS] 54.8% vs. 31.1%, p = 0.035). The only two significant variables in the multivariate analysis for OS were TET2 mutations (p = 0.046) and the development of cGVHD, considered as a time-dependent variable (p < 0.001), correlated with a worse and a better outcome, respectively. TP53 mutations also demonstrated impact on the cumulative incidence of relapse (CIR) (1 year CIR 47.1% vs. 9.8%, p = 0.006) and were related with complex karyotype (p = 0.003). cGVHD improved the outcome even among patients with more than 2 mutated genes (1-year OS 88.9% at 1 year vs. 31.3%, p = 0.02) and patients with TP53 mutations (1-year CIR 20% vs. 42.9%, p = 0.553). These results confirm that cGVHD could ameliorate the adverse impact of somatic mutations in patients with MDS with HSCT.

Multiclassifier Systems for Predicting Neurological Outcome of Patients with Severe Trauma and Polytrauma in Intensive Care Units.

This paper presents an ensemble based classification proposal for predicting neurological outcome of severely traumatized patients. The study comprises both the whole group of patients and a subgroup containing those patients suffering traumatic brain injury (TBI). Data was gathered from patients hospitalized in the Intensive Care Unit (ICU) of the University Hospital in Salamanca. Predictive models were induced from both epidemiologic and clinical variables taken at the emergency room and along the stay in the ICU. The large number of variables leads to a low accuracy in the classifiers even when feature selection methods are used. In addition, the presence of a much larger number of instances of one of the classes in the subgroup of TBI patients produces a significantly lesser precision for the minority class. Usual ways of dealing with the last problem is to use undersampling and oversampling strategies, which can lead to the loss of valuable data and overfitting problems respectively. Our proposal for dealing with these problems is based in the use of ensemble multiclassifiers as well as in the use of an ensemble playing the role of base classifier in multiclassifiers. The proposed strategy gave the best values of the selected quality measures (accuracy, precision, sensitivity, specificity, F-measure and area under the Receiver Operator Characteristic curve) as well as the closest values of precision for the two classes under study in the case of the classification from imbalanced data.

High-resolution copy number analysis of paired normal-tumor samples from diffuse large B cell lymphoma.

Copy number analysis can be useful for assessing prognosis in diffuse large B cell lymphoma (DLBCL). We analyzed copy number data from tumor samples of 60 patients diagnosed with DLBCL de novo and their matched normal samples. We detected 63 recurrent copy number alterations (CNAs), including 33 gains, 30 losses, and nine recurrent acquired copy number neutral loss of heterozygosity (CNN-LOH). Interestingly, 20 % of cases acquired CNN-LOH of 6p21 locus, which involves the HLA region. In normal cells, there were no CNAs but we observed CNN-LOH involving some key lymphoma regions such as 6p21 and 9p24.1 (5 %) and 17p13.1 (2.5 %) in DLBCL patients. Furthermore, a model with some specific CNA was able to predict the subtype of DLBCL, 1p36.32 and 10q23.31 losses being restricted to germinal center B cell-like (GCB) DLBCL. In contrast, 8p23.3 losses and 11q24.3 gains were strongly associated with the non-GCB subtype. A poor prognosis was associated with biallelic inactivation of TP53 or 18p11.32 losses, while prognosis was better in cases carrying 11q24.3 gains. In summary, CNA abnormalities identify specific DLBCL groups, and we describe CNN-LOH in germline cells from DLBCL patients that are associated with genes that probably play a key role in DLBCL development.

Predictive Capacity of Cloninger's temperament and character inventory (TCI-R) in alcohol use disorder outcomes. / Capacidad de predicción del inventario de temperamento y carácter de Cloninger (TCI-R) en la evolución de los trastornos por uso de alcohol.

OBJECTIVE: to investigate the ability to predict the outcome of alcohol use disorders through Cloninger's temperament and character inventory (TCI-R). METHODS: this is a prospective study consisting of 237 outpatients with alcohol use disorders who underwent follow-up treatment for 6 months and whose personality traits were studied using TCI-R. At the end of that period, the scores of each TCI-R trait were analyzed in terms of those who remained in treatment and those who dropped out. RESULTS: The whole group scored highly in novelty seeking (NS) and harm avoidance (HA) and produced low scores in self-directedness (SD), these last traits are considered prominent. The drop-out group scored significantly (p=.004) higher in novelty seeking (NS) than the follow-up group. Also, when the score was higher than the 67 percentile the likelihood of abandoning the treatment was 1.07 times higher. CONCLUSIONS: Cloninger's temperament and character inventory is a good instrument to predict the outcome of treatment of patients with alcohol use disorders and the novelty seeking (NS) dimension is strongly related to therapeutic drop-out.

Objetivo: se pretende investigar la capacidad de predicción del inventario de temperamento y carácter de Cloninger (TCI-R) en la evolución de los trastornos por uso de alcohol. Metodología: Es un estudio longitudinal de 237 pacientes con trastornos por uso de alcohol, en tratamiento ambulatorio y seguimiento durante seis meses, cuya personalidad fue estudiada mediante el inventario TCI-R. Se analizó la puntuación de cada una de las dimensiones del inventario TCI-R en función de su situación (retención o abandono) al final del estudio. Resultados: La muestra presentaba puntuaciones  elevadas en búsqueda de novedad (BN) y evitación del daño (ED) y baja en autodirección (AD), definidas, estas últimas, como prominentes. El grupo que abandonó presentaba una puntuación significativamente (p= .004) más elevada en búsqueda de novedad (BN) que el grupo en seguimiento; además cuando la puntuación era superior al percentil 67 la probabilidad de abandonar era 1,07 veces superior. Conclusiones: El inventario de temperamento y carácter de Cloninger (TCI-R) es un buen instrumento para predecir la evolución de los pacientes con trastorno por uso de alcohol y la dimensión búsqueda de novedad (BN) está fuertemente relacionada con el abandono terapéutico.

Incidence and risk factors for life-threatening bleeding after allogeneic stem cell transplant.

Bleeding is a frequent complication after allogeneic haematopoietic stem cell transplantation (HSCT) and may affect survival. The purpose of this study was to determine the incidence and risk factors for life-threatening bleeding after HSCT by retrospective evaluation of 491 allogeneic HSCT recipients. With a median follow-up of 33 months, 126 out of 491 allogeneic HSCT recipients experienced a haemorrhagic event (25·7%) and 46 patients developed a life-threatening bleeding episode (9·4%). Pulmonary and gastrointestinal bleeding were the most common sites for life-threatening bleeding, followed by central nervous system. In multivariate analyses, the presence of severe thrombocytopenia after day +28 and the development of grade III-IV acute graft-versus-host disease (GVHD) or thrombotic microangiopathy (TMA) retained their association with life-threatening bleeding events. The overall survival at 3 years among patients without bleeding was 67·1% for only 17·1% for patients with life-threatening bleeding (P < 0·001). In conclusion, life-threatening bleeding is a common complication after allogeneic HSCT. Prolonged severe thrombocytopenia, acute grade III-IV GVHD and TMA were associated with its development.

Evolution of Fentanyl Prescription Patterns and Administration Routes in Primary Care in Salamanca, Spain: A Comprehensive Analysis from 2011 to 2022.

(1) Background: The escalating use of opioids contributes to social, health, and economic crises. In Spain, a notable surge in the medical prescription of opioids in recent years has been observed. The aim of this work was to assess the consumption rate of fentanyl, categorised by the different administration routes, in Primary Care in the province of Salamanca (Spain) spanning the years 2011 to 2022, and to compare it with the national trend and with data from the US. (2) Methods: Doses per inhabitant per day (DHD) were calculated, and interannual variations, as well as consumption rates, were subject to thorough analysis. (3) Results: The prevalence of fentanyl use in Salamanca has doubled from 1.21 DHD in 2011 to 2.56 DHD in 2022, with the transdermal system (TD) as the predominant administration route. This upward trajectory mirrors the national trend, yet the rise in fentanyl use is markedly lower than the reported data in the US. This finding may be attributed to an ageing population and potentially inappropriate fentanyl prescriptions, i.e., for the management of chronic non-cancer pain and other off-label prescriptions. (4) Conclusions: The use of fentanyl in Salamanca, particularly through transdermal systems, doubled from 2011 to 2022, aligning with the national trend. Preventive measures are imperative to prevent fentanyl misuse and moderate the observed escalation in consumption rates.

Descriptive study on substance uses and risk of sexually transmitted infections in the practice of Chemsex in Spain.

Background: In recent years, there has been an increasing use of sex-related substances (known as "Chemsex") to facilitate, intensify, and prolong the sexual experience of men who have sex with men. This phenomenon poses a public health problem, increasing the risk of sexually transmitted infections (STIs) and mental disorders. Objective: The primary aim of this study was to delve into the correlation between substance use and sexual health, specifically examining the association between different substances used and the risk of sexually transmitted infections (STIs) in the context of Chemsex in Spain. Methods: An observational, descriptive, cross-sectional study was conducted among 563 Spanish participants between January and April 2023. Non-probabilistic purposive sampling was used by the investigators. The researchers administered a questionnaire to men who have sex with men who use substances, especially in the sexual sphere, in all the autonomous communities of Spain. Results: 14.7% reported having practiced slamsex in the last year, and 17.94% were diagnosed with a Sexually Transmitted Infection in the previous 6 months. Of these, 21% were on PREP treatment, with the main STIs being gonorrhea (p < 0.001), chlamydia (p < 0.001), genital herpes (p = 0.020), and syphilis (p < 0.001). The 63.7% used methamphetamines as the main drug in the practice of chemsex. Discussion: Chemsex in Spain is linked to a high prevalence of STIs, especially gonorrhea and chlamydia, even among those on PrEP treatment. The use of various drugs during chemsex, such as amyl nitrite, GHB, ecstasy, and others, correlates with higher rates of STIs, highlighting the need for interventions to reduce risk and harm. The drugs most associated with slamsex include ketamine, mephedrone, and methamphetamine, underscoring the importance of addressing the risk behaviors associated with this activity. Conclusion: This study shows that chemsex appears to be associated with a high prevalence among men who have sex with men. Who use multiple substances in a sexual context, and are particularly exposed to sexually transmitted infections (STIs), indicating a particular need for STI prevention and care in this group.

The Chem-Sex Inventory Scale (CSI): A Tool to Assess the Mental Health Risk of Chemsex Behaviors in Men Who Have Sex with Men.

Background: Chemsex has been defined as the deliberate use of drugs for prolonged sexual intercourse between gay and bisexual men and other men who have sex with men (MSM). Drugs associated with chemsex can trigger mental health problems such as anxiety, depression, risk of psychosis and suicidal ideation, social isolation, stigmatization, and even loss of impulse control and lack of coping strategies. Currently, the increase in illicit drugs in a sexual context is considered an outbreak of a public health emergency. Objective: The aim of this study is the construction and validation of the Chem-Sex Inventory (CSI), a new scale to assess the mental health risk of chemsex behaviors. Methods: A cross-sectional design was conducted to study 563 participants. Data were collected through an online questionnaire between January and April 2023, and the construct validity of the CSI was assessed through exploratory and confirmatory factor analysis. Results: The sample was, on average, 36 years old (SD: ±9.2). The majority of gender identity was cisgender (97.7%). A factor structure was found that can be summarized in four dimensions: emotional instability, risk of psychosis, altered body perception, and risk of suicide. The confirmatory factor analysis (CFA) presents adequate reliability values, with a Cronbach's alpha above 0.87 for all dimensions and a McDonald's omega above 0.88 with a good fit of the 42 items. Conclusions: Our study has shown that the Chem-Sex Inventory (CSI) scale has factorial validity and could be used in clinical practice and research to measure the behavioral contribution of the chemsex phenomenon in MSM.

Transcultural adaptation and theoretical models validation of the Spanish version of the Self-Care of Diabetes Inventory.

Background: For patients with diabetes mellitus, self-care is crucial because it prevents complications and helps preserve quality of life. Clinicians and researchers require effective tools for assessing self-care behaviors across various dimensions to identify individual needs and maximize resource allocation. The aim of this study was to evaluate the validity and reliability of the Spanish version of the Self-Care of Diabetes Inventory (SCODI). Methods: Two hundred eighteen participants with DMT1 and DMT2 who were recruited through convenience sampling from a university hospital participated in our cross-sectional study. After translation and cultural adaptation, the enrolled patients answered the questions. We performed an exploratory factor analysis (EFA) on each of the SCODI scales and Confirmatory factor analysis (CFA) was performed using our models which appropriate fit indices. Results: The original structure of the four-dimensions tool was confirmed. The overall consistency across the four scales was assessed by Cronbach's alpha: self-care maintenance (0.766), self-care monitoring (0.790), self-care management (0.771), and self-care confidence (0.936). The model fit yielded a chi-square index of 1.028 with 773 degrees of freedom. Confirmatory factor analysis showed a good fit, thereby affirming the reliability of the model. Conclusion: The internal consistency and reliability of the SCODI Spanish version are deemed adequate. This tool is appropriate when it is desired to evaluate the self-care practices of Spanish persons suffering from diabetes due to its good psychometric qualities.

Outcomes and effect of somatic mutations after erythropoiesis stimulating agents in patients with lower-risk myelodysplastic syndromes.

Background: Erythropoiesis stimulating agents (ESAs) are the first-line therapy in patients with lower-risk myelodysplastic syndromes (LR-MDS). Some predictive factors for ESAs response have been identified. Type and number of somatic mutations have been associated with prognosis and response to therapies in MDS patients. Objectives: The objective was to evaluate the outcomes after ESAs in patients with LR-MDS and to address the potential predictive value of somatic mutations in ESAs-treated patients. Design: Multi-center retrospective study of a cohort of 722 patients with LR-MDS included in the SPRESAS (Spanish Registry of Erythropoietic Stimulating Agents Study) study. Retrospective analysis of 65 patients with next generation sequencing (NGS) data from diagnosis. Methods: ESAs' efficacy and safety were evaluated in patients receiving ESAs and best supportive care (BSC). To assess the potential prognostic value of somatic mutations in erythroid response (ER) rate and outcome, NGS was performed in responders and non-responders. Results: ER rate for ESAs-treated patients was 65%. Serum erythropoietin (EPO) level <200 U/l was the only variable significantly associated with a higher ER rate (odds ratio, 2.45; p = 0.036). Median overall survival (OS) in patients treated with ESAs was 6.7 versus 3.1 years in patients receiving BSC (p < 0.001). From 65 patients with NGS data, 57 (87.7%) have at least one mutation. We observed a trend to a higher frequency of ER among patients with a lower number of mutated genes (40.4% in <3 mutated genes versus 22.2% in ⩾3; p = 0.170). The presence of ⩾3 mutated genes was also significantly associated with worse OS (hazard ratio, 2.8; p = 0.015), even in responders. A higher cumulative incidence of acute myeloid leukemia progression at 5 years was also observed in patients with ⩾3 mutated genes versus <3 (33.3% and 10.7%, respectively; p < 0.001). Conclusion: This large study confirms the beneficial effect of ESAs and the adverse effect of somatic mutations in patients with LR-MDS.

Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients.

Allogeneic hematopoietic stem cell transplantation recipients have an increasing risk of both hemorrhagic and thrombotic complications. However, the competing risks of two of these life-threatening complications in these complex patients have still not been well defined. We retrospectively analyzed data from 431 allogeneic transplantation recipients to identify the incidence, risk factors and mortality due to thrombosis and bleeding. Significant clinical bleeding was more frequent than symptomatic thrombosis. The cumulative incidence of a bleeding episode was 30.2% at 14 years. The cumulative incidence of a venous or arterial thrombosis at 14 years was 11.8% and 4.1%, respectively. The analysis of competing factors for venous thrombosis revealed extensive chronic graft-versus-host disease to be the only independent prognostic risk factor. By contrast, six factors were associated with an increased risk of bleeding; advanced disease, ablative conditioning regimen, umbilical cord blood transplantation, anticoagulation, acute III-IV graft-versus-host disease, and transplant-associated microangiopathy. The development of thrombosis did not significantly affect overall survival (P=0.856). However, significant clinical bleeding was associated with inferior survival (P<0.001). In allogeneic hematopoietic stem cell transplantation, significant clinical bleeding is more common than thrombotic complications and affects survival.

Safety and efficacy of splenectomy in over 65-yrs-old patients with immune thrombocytopenia.

AIM: Few studies specifically focus on elderly splenectomized immune thrombocytopenia (ITP) patients. Older patients with ITP and excellent health are often excluded from surgery splenectomy. We aimed to compare the safety and efficacy of splenectomy in elderly and non-elderly ITP patients and to examine the effect of age on therapeutic response. MATERIAL AND METHODS: We carried out a retrospective analysis of a series of 218 patients who had undergone splenectomy for ITP. We compared the data from the elderly group (≥65 yrs, 57 patients) with the young group (<65 yrs, 162 patients). RESULTS: Surgical technique (laparoscopy or open laparotomy splenectomy) was comparable between the two age groups. The adjusted risk of major bleeding following splenectomy for elderly patients was three times that for young patients (OR 3.05, 95% CI: 1.44-6.52). The median duration of postoperative hospital stay was longer for elderly than for young patients (8 d vs. 4 d, P < 0.001). However, we identified a subgroup of elderly ITP patients, those aged between 65 and 70 yrs who had undergone laparoscopic splenectomy, with a low risk of postoperative complications. Of the 218 patients, 89% achieved a favorable response to splenectomy. A favorable response was significantly less common in elderly than in young people (79% vs. 92%, P = 0.005). However, we observed an acceptable long-term control of ITP in the elderly group, in which the probability of maintaining response for 14 yrs after splenectomy was 56%. CONCLUSIONS: Patients aged ≥65 yrs experienced negative effects on safety and efficacy outcomes of splenectomy for ITP, but further studies are needed to identify predictors of postsplenectomy outcomes in this group.

Analysis of Psychological Well-Being from a Compositional Data Analysis Perspective: A New Approach.

Well-being is a widely studied construct in psychology. In 1989, Carol Ryff proposed the "Scale of Psychological Well-Being (SPWB)", which has been validated in multiple languages. The instrument assesses six dimensions of psychological well-being: Self-acceptance, Positive Relationships with Others, Autonomy, Environmental Mastery, Purpose in Life, and Personal Growth. In this article, we propose to enrich the traditional approach of directly interpreting the raw scores in each dimension by incorporating Compositional Data Analysis. This new approach aims to identify "what proportion" of each dimension constitutes well-being, which will allow us to analyze the interactions between the different dimensions of well-being and balance among them. To achieve this, we introduce two position ratios (PR1 and PR2) and a general adjustment indicator called the General Indicator of Subjective Psychological Well-Being (GISPW), which characterizes individuals in a compositional manner, providing a fresh perspective in the interpretation of psychological test results, specifically those related to PWB. The proposal is illustrated with three cases taken from a study involving 628 university students who completed the psychological well-being scale questionnaire. The results show that the GISPW, PR1, and PR2 obtained offer relevant information about the overall balance of each case in the different dimensions.

Predictive Value of Cervical Shear Wave Elastography in the Induction of Labor in Late-Term Pregnancy Nulliparous Women: Preliminary Results.

The prediction of induction of labor continues to be a paradigm nowadays. Bishop Score is the traditional widely spread method but with a low reliability. Ultrasound cervical assessment has been proposed as an instrument of measurement. Shear wave elastography (SWE) should be a promising tool in the prediction of the success of labor induction in nulliparous late-term pregnancies. Ninety-two women with nulliparous late-term pregnancies who were going to be induced were included in the study. A shear wave measurement of the cervix divided into six regions (inner, middle and outer in both cervical lips), cervical length and fetal biometry was performed by blinded investigators prior to routine hand cervical assessment (Bishop Score (BS)) and induction of labor. The primary outcome was success of induction. Sixty-three women achieved labor. Nine women did not, and they underwent a cesarean section due to failure to induce labor. SWE was significantly higher in the inner part of the posterior cervix (p < 0.0001). SWE showed an area under the curve (AUC): 0.809 (0.677-0.941) in the inner posterior part. For CL, AUC was 0.816 (0.692-0.984). BS AUC was 0.467 (0.283-0.651). The ICC of inter-observer reproducibility was ≥0.83 in each region of interest (ROI). The cervix elastic gradient seems to be confirmed. The inner part of the posterior cervical lip is the most reliable region to predict induction of labor results in SWE terms. In addition, cervical length seems to be one of the most important procedures in the prediction of induction. Both methods combined could replace the Bishop Score.

Exploring the Link between Interoceptive Body Awareness and Suicidal Orientation in University Students: A Cross-Sectional Study.

INTRODUCTION: The transition to college life can impact the mental health of students. There are mental health care strategies that promote connection with the body's internal signals, which can help to improve mental well-being, manage emotions, and reduce the risk of suicide in university students. AIM: This study aimed to examine the association between interoceptive body awareness variables and suicidal orientation in a sample of 169 undergraduate students in Colombia. METHODS: An observational, cross-sectional study was conducted in 2023 with Colombian students as the participants. RESULTS: The findings revealed a significant and moderately negative correlation between the Multidimensional Assessment of Interoceptive Awareness (MAIA) total score and the Inventory of Suicide Orientation (ISO-30) total score (r = -0.54, p < 0.001). Confidence and self-regulation were identified as the most influential factors in the relationship between MAIA and ISO-30. Significant correlations were observed (p < 0.001), indicating moderate correlation values ranging from -0.43 to -0.57. DISCUSSION: Our findings support the existence of a negative correlation between interoceptive body awareness and suicidal orientation. Further research is needed to better understand this relationship and to develop specific interventions based on body awareness to prevent suicide orientation. CONCLUSION: There are practical implications associated with recognizing the importance of body awareness in relation to decreasing suicidal orientation, and multidisciplinary teams addressing mental health can incorporate this knowledge.

Application of the Delphi Method for Content Validity Analysis of a Questionnaire to Determine the Risk Factors of the Chemsex.

Chemsex is understood as "the intentional use of stimulant drugs to have sex for an extended time among gay, bisexual, and other men who have sex with men". It is a public health problem because of the increased incidence of cases and because of the consequences on the physical and mental health of those who practice it. AIM: This study aimed to analyze, with the help of the Delphi method, the content validity of a new instrument to assess the risk of behaviors associated with the chemsex phenomenon. METHOD: First, a bank of items identified from the literature was elaborated. Secondly, 50 experts with knowledge of the chemsex phenomenon at the national level were contacted. A Delphi group was formed with them to carry out two rounds of item evaluation. The linguistic evaluation (comprehension and appropriateness) was assessed using a Likert scale from 1 to 5 for each item. Items that did not reach a mean score of 4 were eliminated. Content assessment was calculated using each item's content validity index (CVI) and Aiken's V (VdA). A minimum CVI and VdA value of 0.6 was established to include the items in the questionnaire. RESULTS: A total of 114 items were identified in the literature. In the first round of Delphi evaluation, 36 experts evaluated the items. A total of 58 items were eliminated for obtaining a CVI or VdA of less than 0.6, leaving 56 items. In a second Delphi round, 30 experts re-evaluated the 56 selected items, where 4 items were eliminated for being similar, and 10 items were also eliminated for not being relevant to the topic even though they had values higher than 0.6, leaving the scale finally composed of 52 items. CONCLUSION: A questionnaire has been designed to assess the risk of behaviors associated with the chemsex phenomenon. The items that make up the questionnaire have shown adequate content and linguistic validity. The Delphi method proved to be a helpful technique for the proposed objective.

Exposure to Morphine and Cocaine Modify the Transcriptomic Landscape in Zebrafish Embryos.

Morphine and other opioid analgesics are the drugs of election to treat moderate-to-severe pain, and they elicit their actions by binding to the opioid receptors. Cocaine is a potent inhibitor of dopamine, serotonin, and noradrenaline reuptake, as it blocks DAT, the dopamine transporter, causing an increase in the local concentration of these neurotransmitters in the synaptic cleft. The molecular effects of these drugs have been studied in specific brain areas or nuclei, but the systemic effects in the whole organism have not been comprehensively analyzed. This study aims to analyze the transcriptomic changes elicited by morphine (10 uM) and cocaine (15 uM) in zebrafish embryos. An RNAseq assay was performed with tissues extracts from zebrafish embryos treated from 5 hpf (hours post fertilization) to 72 hpf, and the most representative deregulated genes were experimentally validated by qPCR. We have found changes in the expression of genes related to lipid metabolism, chemokine receptor ligands, visual system, hemoglobins, and metabolic detoxification pathways. Besides, morphine and cocaine modified the global DNA methylation pattern in zebrafish embryos, which would explain the changes in gene expression elicited by these two drugs of abuse.

Prognostic impact of severe thrombocytopenia in low-risk myelodysplastic syndrome.

BACKGROUND: Thrombocytopenia is very common in myelodysplastic syndrome (MDS); however, its clinical impact in low-risk patients remains controversial. METHODS: The authors analyzed the incidence and prognostic significance of thrombocytopenia at diagnosis in 2565 de novo MDS patients included in the Spanish MDS Registry. RESULTS: Thrombocytopenia (platelet count <100 × 10(9) /L) was identified in 842 patients (32.8%). Severe thrombocytopenia (platelet count <30 × 10(9) /L) was observed in 7.1% of patients and was significantly associated with a higher-risk World Health Organization subtype (P = .026) and intermediate-2/high-risk International Prognostic Scoring System (IPSS) score (P = .046). Severe thrombocytopenia was the most important prognostic factor and had negative effects on the low/intermediate-1 risk group. Median overall survival of patients with a platelet count <30 and ≥ 30 × 10(9) /L was 16 months and 71 months, respectively (hazard ratio, 4.66; 95% confidence interval, 2.74-7.90; P < .0001). The negative effect of severe thrombocytopenia in low/intermediate-1 risk patients was caused by increased risk of bleeding. CONCLUSIONS: MDS patients with low/intermediate-1 IPSS risk score and severe thrombocytopenia should no longer be regarded as low risk, and must be considered for disease-altering approaches at diagnosis.