Protein Biomarkers in Lung Cancer Screening: Technical Considerations and Feasibility Assessment.

Lung cancer remains the leading cause of cancer-related deaths worldwide, mainly due to late diagnosis and the presence of metastases. Several countries around the world have adopted nation-wide LDCT-based lung cancer screening that will benefit patients, shifting the stage at diagnosis to earlier stages with more therapeutic options. Biomarkers can help to optimize the screening process, as well as refine the TNM stratification of lung cancer patients, providing information regarding prognostics and recommending management strategies. Moreover, novel adjuvant strategies will clearly benefit from previous knowledge of the potential aggressiveness and biological traits of a given early-stage surgically resected tumor. This review focuses on proteins as promising biomarkers in the context of lung cancer screening. Despite great efforts, there are still no successful examples of biomarkers in lung cancer that have reached the clinics to be used in early detection and early management. Thus, the field of biomarkers in early lung cancer remains an evident unmet need. A more specific objective of this review is to present an up-to-date technical assessment of the potential use of protein biomarkers in early lung cancer detection and management. We provide an overview regarding the benefits, challenges, pitfalls and constraints in the development process of protein-based biomarkers. Additionally, we examine how a number of emerging protein analytical technologies may contribute to the optimization of novel robust biomarkers for screening and effective management of lung cancer.

The Effect of Third Dose of Pfizer/BioNTech and Moderna COVID-19 mRNA Vaccines on IgG Antibody Titers.

With the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, the Centers for Disease Control and Prevention (CDC) authorized the third dose of the Pfizer-BioNTech (BNT162b2) vaccine with the rationale for prolonged elevation of anti-SARS-CoV-2 antibody titers and protection against the SARS-CoV-2 virus. To better understand how administration of the third dose of the Pfizer/BioNTech coronavirus disease 2019 (COVID-19) vaccine affects the incidence and severity of SARS-CoV-2 infections, we administered the third dose of the Pfizer-BioNTech (BNT162b2) to 189 participants. Blood samples were collected from participants during each of their scheduled visits (baseline, week two, week 12, and week 24) and tested for semi-quantitative anti-SARS-CoV-2 immunoglobulin G (IgG) titers. Our results showed that administration of the third dose of the Pfizer-BioNTech (BNT162b2) vaccine elicited elevated anti-SARS-CoV-2 IgG antibodies for the 24-week duration of the study. IgG antibody titers were greatest in week two, and progressively decreased by week 12 and week 24, with statistically significant differences between the IgG antibody titers for each collection date.

Case Report: Cedecea lapagei Infection: Report of a Case in Peru and Review of the Literature.

Cedecea lapagei is a gram-negative, non-encapsulated, facultative anaerobic bacterium that has been reported in only a few cases with varying clinical presentations, drug susceptibility, and treatment since its first isolation in 1981. This study aimed to describe a case report of C. lapagei in Peru and systematically review the documented case reports of individuals infected with C. lapagei. A 59-year-old man who had become bedridden with Parkinson's disease and had epilepsy presented with a 1-week history of fever and sore throat and was admitted. Physical examination revealed an obtundation state and abolished vesicular murmur in the right hemithorax. During hospitalization, the patient was diagnosed with various infections, including tuberculosis, for which he received broad-spectrum antibiotics. In the absence of clinical improvement, a urine culture was performed showing C. lapagei (detected by BD Phoenix M50 system, Vernon Hills, IL). The patient received amoxicillin/clavulanate and was discharged. Case reports of C. lapagei were also searched in five databases on January 28, 2023. Twenty cases of C. lapagei were reported worldwide between 2006 and 2022, 16 of which involved adults. Fever was the most common manifestation (75%), and pneumonia was the primary form of presentation (45%). Moreover, 90% of the patients had at least one comorbidity, and 15% died. Also, most of the isolates were sensitive to ciprofloxacin (81%), meropenem (62%), and amikacin (60%). Overall, C. lapagei should be suspected in compromised hosts, particularly those with pneumonia. Although the bacterium can affect various organs and the antibiotic susceptibility pattern is variable, quinolones, tetracyclines, and carbapenems seem to be the first therapeutic option.

Simple Microcontact Printing Technique to Obtain Cell Patterns by Lithography Using Grayscale, Photopolymer Flexographic Mold, and PDMS.

Microcontact printing using PDMS embossing tools and its variations have aroused the interest of a wide spectrum of research fields, hence the feasibility of defining micro and nanoscale patterns. In this work, we have proposed and demonstrated a novel lithography method based on grayscale patterns printed in a flexographic photopolymer mold and transferred to epoxy resin and a single PDMS stamp to obtain different microprint pattern structures. The geometry of the patterns can be modified by adjusting the layout and grayscale of the stamp patterns. The functionality of this contact printing methodology was validated by generating human induced pluripotent stem cells (hiPSC) patterns. These specific micropatterns can be very useful for achieving complex differentiation in cell lines such as hiPSC. Microfabrication through the new technique provides a promising alternative to conventional lithography for constructing complex aligned surfaces; these structures could be used as components of biological patterns or microfluidic devices.

Primovist® (Gadotrexate disodium) magnetic resonance use in benign and malignant kidney diagnosis. / Uso de la resonancia magnetica con Primovist® (Gadotrexate disodio) para diagnostico de lesiones renales benignas y malignas.

OBJECTIVE: To evaluate the quality of the contrast images obtained with a Primovist® (gadoxetate disodium) Magnetic Resonance Image in order to diagnose benign, malignant and malformations in the urinary tract. MATERIAL AND METHODS: A retrospective image and diagnosis review of Primovist® MRI studies performed in liver insufficient patients without apparent renal abnormalities was done, in order to evaluate the urinary tract for irregularities. RESULTS: A total of 117 Primovist® MRI studies performed between july 2014 and November 2018 were reviewed, 5 were excluded because they were incomplete. The average age was 59.6 ± 16.6 years old. The following diagnosis were encountered: 36 simple cysts, 6 perirenal fibrosis after pyelonephritis, 1 renal cancer, 1 renal atrophy, 1 proximal uretheric flexure, 1 bilateral hydronephrosis due to lower urinary obstruction because of benign prostatic hyperplasia and 1 complex cyst. No MRI study was indicated with suspicions of renal abnormalities. Relevant images are included that demonstrate the capability of Primovist® MRI to diagnose renal abnormalities. CONCLUSION: Even though none of the Primovist® MRI studies was done with suspicious of renal abnormalities it was possible to diagnose incidental benign, malignant and malformations of the urinary tract. This study shows how Primovist® MRI can be useful contrast study for urinary tract irregularities.

OBJETIVO: Evaluar la calidad de las imágenes contrastadas del tracto urinario que permitan diagnosticar patologías benignas, malignas y malformaciones con el uso de una resonancia magnética contrastada con Primovist® (gadoxetato disodio). MATERIAL Y METODOS: Se realizó una revisión de las imágenes y diagnósticos del servicio de radiología de manera retrospectiva de pacientes con una resonancia magnética contrastada con Primovist® por padecer insuficiencia hepática sin aparente patología urinaria, con el objeto de buscar diagnósticos incidentales en el tracto urinario superior e inferior. RESULTADOS: Se revisaron durante el periodo de julio del 2014 a noviembre del 2018, 117 estudios, se excluyeron 5 por no contar con el estudio completo para su revaloración. La edad promedio fue de 59,6±16,6 años. Se encontraron 48 anormalidades urinarias sin previa sospecha diagnóstica por lo que fueron considerados como incidentales. A continuación se enumeran los hallazgos renales diagnosticados: 36 quistes simples, 6 cambios perirenales compatibles con secuelas de pielonefritis, 1 cáncer renal, 1 hipotrofia renal, 1 angulación funcional del uréter proximal sin cruce vascular con pelvis extrarenal contralateral, 1 hidronefrosis bilateral secundaria a obstrucción vesical por hiperplasia prostática y 1 quiste complejo. Ningún estudio se indicó por sospecha de anormalidades del tracto urinario. CONCLUSIONES: Aun cuando no era la indicación del estudio de resonancia, fue posible encontrar algunas patologías renales como hallazgos que incluyeron patología benigna, maligna y malformaciones, demostrando que la resonancia magnética con Primovist® se podría realizar como estudio contrastado para patologías renales.

Uso de la resonancia magnetica con primovist® (gadotrexate disodio) para diagnóstico de lesiones renales benignas y malignas / Use of magnetic resonance imaging with primovist® (gadoterate disodium) for the diagnosis of benign and malignant renal lesions

Objetiv: Evaluar la calidad de lasimágenes contrastadas del tracto urinario que permitandiagnosticar patologías benignas, malignas y malformaciones con el uso de una resonancia magnética contrastada con Primovist® (gadoxetato disodio).Material y métodos: Se realizó una revisión de lasimágenes y diagnósticos del servicio de radiología demanera retrospectiva de pacientes con una resonanciamagnética contrastada con Primovist® por padecerinsuficiencia hepática sin aparente patología urinaria,con el objeto de buscar diagnósticos incidentales en eltracto urinario superior e inferior. Resultados: Se revisaron durante el periodo de juliodel 2014 a noviembre del 2018, 117 estudios, se excluyeron 5 por no contar con el estudio completo parasu revaloración. La edad promedio fue de 59,6±16,6años. Se encontraron 48 anormalidades urinarias sinprevia sospecha diagnóstica por lo que fueron considerados como incidentales. A continuación se enumeranlos hallazgos renales diagnosticados: 36 quistes simples, 6 cambios perirenales compatibles con secuelasde pielonefritis, 1 cáncer renal, 1 hipotrofia renal, 1angulación funcional del uréter proximal sin cruce vascular con pelvis extrarenal contralateral, 1 hidronefrosisbilateral secundaria a obstrucción vesical por hiperplasia prostática y 1 quiste complejo. Ningún estudio se indicó por sospecha de anormalidades del tracto urinarioConclusiones: Aun cuando no era la indicacióndel estudio de resonancia, fue posible encontrar algunas patologías renales como hallazgos que incluyeronpatología benigna, maligna y malformaciones, demostrando que la resonancia magnética con Primovist® sepodría realizar como estudio contrastado para patologías renales.(AU)

Objetive: To evaluate the quality of thecontrast images obtained with a Primovist® (gadoxetatedisodium) Magnetic Resonance Image in order to diagnose benign, malignant and malformations in the urinarytract. Material and methods: A retrospective image anddiagnosis review of Primovist® MRI studies performed inliver insufficient patients without apparent renal abnormalities was done, in order to evaluate the urinary tractfor irregularities.Results: A total of 117 Primovist® MRI studies performed between july 2014 and November 2018 werereviewed, 5 were excluded because they were incomplete. The average age was 59.6 ± 16.6 years old.The following diagnosis were encountered: 36 simplecysts, 6 perirenal fibrosis after pyelonephritis, 1 renalcancer, 1 renal atrophy, 1 proximal uretheric flexure, 1bilateral hydronephrosis due to lower urinary obstructionbecause of benign prostatic hyperplasia and 1 complexcyst. No MRI study was indicated with suspicions ofrenal abnormalities. Relevant images are included thatdemonstrate the capability of Primovist® MRI to diagnose renal abnormalities.Conclusion: Even though none of the Primovist®MRI studies was done with suspicious of renal abnormalities it was possible to diagnose incidental benign,malignant and malformations of the urinary tract. Thisstudy shows how Primovist® MRI can be useful contraststudy for urinary tract irregularities.(AU)

Machine Learning Applications and Optimization of Clustering Methods Improve the Selection of Descriptors in Blackberry Germplasm Banks.

Machine learning (ML) and its multiple applications have comparative advantages for improving the interpretation of knowledge on different agricultural processes. However, there are challenges that impede proper usage, as can be seen in phenotypic characterizations of germplasm banks. The objective of this research was to test and optimize different analysis methods based on ML for the prioritization and selection of morphological descriptors of Rubus spp. 55 descriptors were evaluated in 26 genotypes and the weight of each one and its ability to discriminating capacity was determined. ML methods as random forest (RF), support vector machines, in the linear and radial forms, and neural networks were optimized and compared. Subsequently, the results were validated with two discriminating methods and their variants: hierarchical agglomerative clustering and K-means. The results indicated that RF presented the highest accuracy (0.768) of the methods evaluated, selecting 11 descriptors based on the purity (Gini index), importance, number of connected trees, and significance (p value < 0.05). Additionally, K-means method with optimized descriptors based on RF had greater discriminating power on Rubus spp., accessions according to evaluated statistics. This study presents one application of ML for the optimization of specific morphological variables for plant germplasm bank characterization.

Redefining the Topography of the Tibial Nerve: Updated Treatment Guide for Tibial Nerve Entrapments: An Addendum to Surgical Treatment Protocol for Peripheral Nerve Dysfunction of the Lower Extremity: A Systematic Approach.

Dysfunction of the tibial nerve can progress to painful and potentially disabling conditions. There are multiple sites of entrapment along the course of the tibial nerve. Detailed knowledge of the anatomy and anatomic variations is critical for a surgeon to be able to properly diagnose and treat patients with tibial nerve injuries. Repair of tibial nerve injuries involves a thorough history, physical examination, diagnostic studies, and microsurgical techniques. This article discusses sites of tibial nerve entrapment and use of a surgical algorithm that provides a systematic approach that has been successful within the literature in treating chronic tibial neuritic pain.

Cost-effective fabrication of photopolymer molds with multi-level microstructures for PDMS microfluidic device manufacture.

This paper describes a methodology of photopolymer mold fabrication with multi-level microstructures for polydimethylsiloxane (PDMS) microfluidic device manufacture. Multi-level microstructures can be performed by varying UVA exposure time and channel width. Scanning Electron Microscopy (SEM), Atomic Force Microscopy (AFM) and profilometry techniques have been employed to characterize the molds. Multiple molds with multi-level microstructures can be formed in a unique piece. Overall height/depth of the structures reaches up to 677 µm and a minimum of 21 µm. The method provides several advantages such as reduction of fabrication time, multiple structures with diverse topologies, a great variety of depth and height in a single mold and low cost of fabrication. The effectiveness of multi-level microstructure fabrication was evaluated by constructing PDMS microfluidic devices for cell culture and proliferation.

An Archaeometric Characterization of Ecuadorian Pottery.

Ecuadorian pottery is renowned for its beauty and the particularly rich colour of its pigments. However, a major challenge for art historians is the proper assessment of the provenance of individual pieces due to their lack of archaeological context. Of particular interest is the Jama-Coaque culture, which produced fascinating anthropomorphic and zoomorphic pottery from ca. 240 B.C. until the Spanish Conquest of 1532 A.D. in the coastal region of Ecuador. Using a combination of microscopic and spectroscopic techniques, i.e., transmission electron microscopy (TEM), Raman spectroscopy, Fourier transform infrared spectroscopy (FTIR), energy-dispersive x-ray spectroscopy (EDX), and scanning electron microscopy (SEM); we are able to characterize these pieces. We have found several kinds of iron-oxide based nanostructures in all the colour pigments we investigated for the Jama-Coaque culture, suggesting the same unique volcanic source material was used for their clay. Such nanostructures were absent from the pigment samples studied from other contemporary coastal-Ecuadorian cultures, i.e., the Tumaco-La Tolita and Bahía cultures. In the yellow pigments of goethite we find carbon nanofibres, indicating these pigments were subjected to a thermal treatment. Finally, in the blue, green, and black pigments we detect modern pigments (phthalocyanine blue, lithopone, and titanium white), suggesting modern restoration. Our results demonstrate the power of TEM, Raman, FTIR, EDX, and SEM archaeometric techniques for characterizing pieces without a clear archaeological context. Furthermore, the characterization of nanostructures present in such pieces could be used as a possible fingerprint for a provenance study.

Anatomical, surgical and technical factors influencing continence after radical prostatectomy.

Radical prostatectomy (RP) is the most frequent treatment with curative intent performed for prostate cancer to date. Different surgical approaches (perineal, transperitoneal, and extraperitoneal) and techniques (laparoscopic and robot assisted) have been described to increase the efficiency and potentially diminish the postoperative complications of this procedure. The aim of this narrative review is to investigate and define the factors that influence postprostatectomy urinary continence. We highlighted the anatomical landmarks and the modifications of surgical techniques aimed at improving the continence rates and thus, patient quality of life. After RP, the long-term continence rates range from 84% to 97%. In order to achieve good continence rates, a careful dissection along with meticulous anatomical reconstruction is required. To this end, a detailed knowledge of the periprostatic anatomy is mandatory.

Tratamiento de las fracturas de húmero diafisarias distales con abordaje posterior mínimamente invasivo y placa extraarticular anatómica / Treatment of distal diaphyseal humeral fractures with minimally invasive posterior approach and anatomical extraarticular plate

Introducción Las fracturas de húmero diafisarias corresponden al 3-5% de las fracturas en general. La distribución de las fracturas que comprometen el tercio distal de la diáfisis es variable con incidencias estimadas entre el 10 y el 48%. El objetivo del estudio es evaluar los resultados funcionales y la tasa de consolidación de un grupo de pacientes con fractura diafisaria de húmero del tercio distal con técnica mínimamente invasiva por vía posterior. Materiales y métodos Entre 2013 y 2016 se intervino a 23 pacientes, con una media de edad de 36 años. La valoración funcional se realizó por medio de la Escala de Discapacidades del Hombro, el Codo y la Mano (DASH) abreviada y la medición de los arcos de movilidad de hombro y codo con goniometría; el dolor fue evaluado de acuerdo con la Escala Visual Análoga del Dolor (EVA). Resultados Todas las fracturas consolidaron de forma exitosa, excepto dos casos que presentaron retardo en la consolidación. La lesión del nervio radial previa a la intervención se recuperó de forma progresiva sin requerimiento de transferencias. Los resultados funcionales fueron satisfactorios en un grupo de diez pacientes que completaron más de 1 año de seguimiento. Discusión El abordaje posterior de humero con mínima invasión en el tratamiento de este patrón particular de fracturas parece que muestra una ventaja biológica al permitir una consolidación completa en todos los pacientes. La lesión del nervio radial iatrogénica no parece que aumente en relación con su aislamiento y protección en la porción proximal del tríceps. Nivel de evidencia clínica Nivel IV.

Background Diaphyseal humeral fractures correspond to 3-5% of all fractures. The proportion of these fractures in which the distal third of the diaphysis is involved is variable with estimated incidences between 10-48%. The aim of the study is to evaluate the functional results and rate of fracture consolidation for a group of patients with distal third diaphyseal humeral fractures managed using a minimally invasive technique through a posterior approach. Materials and methods Twenty-two patients (mean age of 36 years) were evaluated between 2013 and 2016. Functional assessment was performed using the DASH abbreviated functional scale. Shoulder and elbow mobility range of motion were measured with goniometry, and pain was measured following the VAS scale. Results All fractures consolidated successfully, with two cases exhibiting delay in consolidation. Radial nerve injury prior to the intervention was progressively recovered without the need for supplementary tendons transfers. Functional results were satisfactory for ten patients that completed more than one year of follow-up. Discussion Minimally invasive technique with posterior approach in the treatment of this particular pattern of humeral fractures seems to show a biological advantage in allowing complete consolidation in all patients. Iatrogenic radial nerve injury does not appear to increase in relation to its isolation and protection in the proximal portion of the triceps. Evidence level IV.

Costos de bolsillo de pacientes con diagnóstico de tuberculosis en Colombia / Out-of-pocket costs of patients diagnosed with tuberculosis in Colombia

Introducción. La tuberculosis (TB) es una enfermedad infecto-contagiosa producida por micobacterias; según datos de la Organización Mundial de la Salud, un tercio de la población mundial está infectada. Para combatirla se ha empleado la estrategia DOTS (Directly Observed Therapy Short Course), efectiva para el diagnóstico, tratamiento y monitoreo de la tuberculosis. Objetivo. Estimar costos de bolsillo que asumen los pacientes con tuberculosis, que reciben tratamiento bajo la estrategia DOTS. Diseño. Estudio observacional descriptivo, prospectivo. Lugar. Tres ciudades de Colombia (Medellín, Montería y Quibdó). Participantes. Pacientes con diagnóstico de TB. Intervenciones. Se utilizó un instrumento de recolección que incluía variables relacionadas con los costos de bolsillo directos e indirectos. El análisis se hizo en el programa SPSS versión 17,0 y STATA 11; a las variables cuantitativas se les estimó media y desviación estándar, mientras que a las cualitativas proporciones. Resultados. Participaron 91 pacientes que se encontraban en tratamiento bajo la estrategia DOTS. El promedio de edad fue 39,3±20 años; la mayoría vivía con sus familiares. Los ingresos mensuales de los pacientes tuvieron una media de 422 863 COP (1€ = 3 149 COP) y los gastos directos más altos generados por el tratamiento fueron los destinados al desplazamiento y ayudas diagnósticas, con una media de 8 181 y 7 630 COP, respectivamente. Conclusiones. Los costos asumidos por los pacientes bajo la estrategia DOTS fueron altos, incluso cuando el tratamiento se entrega gratuitamente. La modificación de la estrategia para evitar costos en los pacientes podría impactar disminuyendo el abandono del tratamiento por los mismos.

Introduction: Tuberculosis (TB) is a contagious disease caused by mycobacteria. According to the World Health Organization, one third of the world's population is infected. The directly observed therapy short course (DOTS) strategy has been used effective for the diagnosis, treatment and monitoring of tuberculosis. Objective: To estimate the out-of-pocket costs of TB patients who receive treatment under the DOTS strategy. Design: Descriptive prospective and observational study. Setting: Three cities in Colombia (Medellin, Monteria and Quibdo). Participants: Patients diagnosed with TB. Interventions: An instrument was used that included variables related to direct and indirect out-of-pocket costs. The analysis was done using the SPSS version 17.0 and STATA 11; mean and standard deviation were estimated for quantitative variables, and proportions for qualitative variables. Results: The DOTS strategy was applied in 91 patients. The average age was 39.3 ± 20 years; most patients lived with their families. The monthly income of the patients was 422 863 COP (1€ = 3 149 COP) in average and the higher direct costs generated by the treatment were those for traveling and diagnostic aids, with an average cost of 8 181 and 7 630 COP respectively. Conclusions: The costs assumed by patients under the DOTS strategy were high, even when treatment was provided free of charge. The modification of the strategy to avoid costs in patients could decrease treatment dropout.

Adsorption-Induced Solvent-Based Electrostatic Gating of Charge Transport through Molecular Junctions.

Recent experiments have shown that transport properties of molecular-scale devices can be reversibly altered by the surrounding solvent. Here, we use a combination of first-principles calculations and experiment to explain this change in transport properties through a shift in the local electrostatic potential at the junction caused by nearby conducting and solvent molecules chemically bound to the electrodes. This effect is found to alter the conductance of 4,4'-bipyridine-gold junctions by more than 50%. Moreover, we develop a general electrostatic model that quantitatively relates the conductance and dipoles associated with the bound solvent and conducting molecules. Our work shows that solvent-induced effects can be used to control charge and energy transport at molecular-scale interfaces.

Management of complicated urinary tract infections in a referral center in Mexico.

BACKGROUND: Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40-70 %). In Mexico, there are ciprofloxacin resistance rates of 8-73 %, to trimethoprim/sulfamethoxazole 53-71 % and cephalosporins 5-18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard. OBJECTIVE: To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance. MATERIALS AND METHODS: The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed. RESULTS: One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %. DISCUSSION: There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role. CONCLUSIONS: Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done.

Surgical site infection in surgery for benign prostatic hyperplasia: comparison of two skin antiseptics and risk factors.

BACKGROUND: Surgical site infection (SSI) is the second most common type of nosocomial infections in the United States. In Uruguay, the incidence after prostatectomies is 2.6%. The aim of our study was to compare the efficacy of two skin antiseptics and to determine possible risk factors for SSI in patients undergoing surgery for benign prostatic hyperplasia (BPH). METHODS: A randomized trial included 70 patients operated on for BPH, of whom 56 (80%) underwent open surgery. Patients were treated by the same surgical team in a tertiary general hospital that is a referral center for patients with urologic diseases. Skin antisepsis was performed randomly using either 0.5% povidone-iodine or chlorhexidine in an alcohol base (Chemisol(®)). Possible risk factors investigated were age, renal dysfunction, bladder stones, preoperative urinary catheter, positive preoperative urine culture, operative time and technique, and vesicocutaneous fistula. RESULTS: Of all patients, 41 (59%) had a urinary catheter preoperatively. Urine cultures were positive in 31 patients, of whom 29 (94%) had a urinary catheter. Surgical site infection occurred in 10 patients (18%), and 100% of the causative microorganisms were gram-negative bacteria characteristic of the urinary flora. The type of antiseptic did not affect the risk of SSI (p=1.00). The most important risk factor for infection was the presence of a urinary catheter preoperatively (p=0.003); also significant were the formation of a vesicocutaneous fistula (p=0.008), increasing age (p=0.02), and the presence of a positive preoperative urine culture (p=0.03). CONCLUSIONS: In a cohort of patients submitted to open prostatectomy, SSI was not related to the type of antiseptic. The main risk factor was the presence of a urinary catheter preoperatively. All microorganisms isolated from the SSIs were characteristic of urinary tract infections.

A comprehensive review of urologic complications in patients with diabetes.

Diabetes Mellitus (DM) is a chronic disease characterized by hyperglycemia, as a result of abnormal insulin production, insulin function, or both. DM is associated with systemic complications, such as infections, neuropathy and angiopathy, which involve the genitourinary tract. The three most significant urologic complications include: bladder cystopathy, sexual dysfunction and urinary tract infections. Almost half of the patients with DM have bladder dysfunction or cystopathy, which can be manifested in women as hypersensitivity (in 39-61% of the diabetic women) or neurogenic bladder. In males it can be experienced as lower urinary tract symptoms (in 25% of diabetic males with a nearly twofold increased risk when seen by age groups). Additionally, an increased prostate volume affects their micturition as well as their urinary tract. Involving sexual dysfunction in women, it includes reduced libido, decreased arousal, clitoral erectile dysfunction and painful or non-sensitive intercourse; and in diabetic males it varies from low libido, ejaculatory abnormalities and erectile dysfunction. Globally, sexual disorders have a prevalence of 18-42%. Erectile dysfunction is ranked as the third most important complication of DM. Urinary tract infections are observed frequently in diabetic patients, and vary from emphysematous infections, Fournier gangrene, staghorn infected lithiasis to repetitive bacterial cystitis. The most frequent finding in diabetic women has been lower urinary tract infections. Because of the high incidence of obesity worldwide and its association with diabetes, it is very important to keep in mind the urologic complication associated with DM in patients, in order to better diagnose and treat this population.

[Diagnosis and prognosis of fetal ebstein anomaly]. / Diagnóstico y pronóstico fetales de la anomalía de Ebstein.

BACKGROUND: Fetal echocardiography is possible to confirm with great certainty the diagnosis, in utero, Ebstein's anomaly, as well as determine its perinatal prognosis. OBJECTIVE: Review the experience of 16 cases diagnosed with Ebstein's anomaly, using fetal echocardiography, analyzing "forecast echocardiographic parameters" set by Pavlova, Huhta and Barre. MATERIAL AND METHOD: retrospective and descriptive analysis. We analysed echocardiographic parameters and its correlation with the perinatal development of 16 cases diagnosed with Ebstein's anomaly. RESULTS: Maternal age of our patients was 27.94 +/- 5.7 years, gestational age 31.3 +/- 3.6.) Mortality: in-utero 37.5% (n = 6), neonatal 50% (n = 8), survived 12.5% (n = 2). Cardiothoracic index 0.61 +/- 0.074, relationship foramen oval/heart atrial 0.6 +/- 0.015; obstruction to the way out of the right ventricle in 14 cases (87.5%). The deceased 81% presented degree of valvular displacement > 2.5; relationship RV/LV 2.24 +/- 0.37). CONCLUSIONS: Cardiothoracic index fetal stage > 0.55, relationship oval foramen/interatrial septum < 0.3, obstruction to the way out and a degree of valvular displacement > 2.5, absence of back flow in arteriosus ductus and a ratio RV/LV > 2 are poor prognostic factors for Ebstein's anomaly.

Effect of metal complexation on the conductance of single-molecular wires measured at room temperature.

The present work aims to give insight into the effect that metal coordination has on the room-temperature conductance of molecular wires. For that purpose, we have designed a family of rigid, highly conductive ligands functionalized with different terminations (acetylthiols, pyridines, and ethynyl groups), in which the conformational changes induced by metal coordination are negligible. The single-molecule conductance features of this series of molecular wires and their corresponding Cu(I) complexes have been measured in break-junction setups at room temperature. Experimental and theoretical data show that no matter the anchoring group, in all cases metal coordination leads to a shift toward lower energies of the ligand energy levels and a reduction of the HOMO-LUMO gap. However, electron-transport measurements carried out at room temperature revealed a variable metal coordination effect depending on the anchoring group: upon metal coordination, the molecular conductance of thiol and ethynyl derivatives decreased, whereas that of pyridine derivatives increased. These differences reside on the molecular levels implied in the conduction. According to quantum-mechanical calculations based on density functional theory methods, the ligand frontier orbital lying closer to the Fermi energy of the leads differs depending on the anchoring group. Thereby, the effect of metal coordination on molecular conductance observed for each anchoring could be explained in terms of the different energy alignments of the molecular orbitals within the gold Fermi level.