Adherence to oral anticancer treatments: network and sentiment analysis exploring perceived internal and external determinants in patients with metastatic breast cancer.

PURPOSE: Adherence to oral anticancer treatments (OATs) is a critical issue in metastatic breast cancer (MBC) to enhance survivorship and quality of life. The study is aimed to analyze the main themes and attributes related to OATs in MBC patients. This research is part of a project titled "Enhancing Therapy Adherence Among Metastatic Breast Cancer Patients" designed to produce a predictive model of non-adherence, a decision support system, and guidelines to improve adherence to OATs. METHODS: The study consists of an exploratory observational and qualitative analysis using a focus group method. A semi-structured interview guide was developed to handle relevant OAT themes. Wordcloud plots, network analysis, and sentiment analysis were performed. RESULTS: Nineteen female MBC patients participated in the protocol (age mean 55.95, SD = 6.87). Four main themes emerged: (theme 1) individual clinical pathway; (theme 2) barriers to adherence; (theme 3) resources to adherence; (theme 4) patients' perception of new technologies. The Wordcloud and network analysis highlighted the important role of treatment side effects and the relationship with the clinician in the modulation of adherence behavior. This result is consistent with the sentiment analysis underscoring patients experience fear of issues related to clinical values and ineffective communication and discontinuity of the doctor in charge of the patient care. CONCLUSION: The study highlighted the key role of the individual, relational variables, and side effects as internal and external determinants influencing adherence to MBC. Finally, the opportunity offered by eHealth technology to connect with other patients with similar conditions and share experiences could be a relief for MBC patients.

Characterization of the mitochondrial genomes of the Mexican endemic bats Corynorhinus mexicanus and Corynorhinus leonpaniaguae (Chiroptera: Vespertilionidae).

BACKGROUND: The genus Corynorhinus is composed of four recognized species: C. rafinesquii, C. townsendii, C. mexicanus, and C. leonpaniaguae, the latter two being endemic to Mexico. According to the IUCN, C. mexicanus is considered "Near Threatened", as its populations are dwindling and habitats are affected by anthropogenic disturbance. Corynorhinus leonpaniaguae has not been assigned to an IUCN Red List risk category due to its recent description. METHODS AND RESULTS: In this study, the mitochondrial genomes of C. mexicanus and C. leonpaniaguae were assembled and characterized in detail. The mitochondrial genomes (mtDNA) of C. mexicanus and C. leonpaniaguae have lengths of 16,470 and 16,581 bp respectively, with a predominant nucleotide usage of adenine (31.670% and 31.729%, respectively) and thymine (26.15% and 26.18%, respectively). The mtDNA of C. mexicanus and C. leonpaniaguae is composed of 37 coding and non-coding elements: 22 transfer RNAs (tRNA), 13 protein-coding genes (PCGs), two ribosomal RNAs and a non-coding region, the control region, which has a length of 933 bp and 1,149 bp, respectively. All tRNAs exhibited a cloverleaf secondary structure, with the exception of trn-Ser1 which showed a deletion of the dihydrouridine arm in the two species. All PCGs are subjected to purifying selection, with atp8 being the gene showing the highest Ka/Ks value. CONCLUSIONS: These are the first whole mitogenomic resources developed for C. mexicanus and C. leonpaniaguae and enhance our knowledge of the ecology of these species and aid in their conservation.

Prospective study for the early detection of lung carcinoma in patients with HIV infection (GESIDA study 8815).

INTRODUCTION: Lung cancer (LC) screening detects tumors early. The prospective GESIDA 8815 study was designed to assess the usefulness of this strategy in HIV + people (PLHIV) by performing a low-radiation computed tomography (CT) scan. PATIENTS AND METHODS: 371 heavy smokers patients were included (>20 packs/year), >45 years old and with a CD4+ <200 mm3 nadir. One visit and CT scan were performed at baseline and 4 for follow-up time annually. RESULTS: 329 patients underwent the baseline visit and CT (CT0) and 206 completed the study (CT1 = 285; CT2 = 259; CT3 = 232; CT4 = 206). All were receiving ART. A total >8 mm lung nodules were detected, and 9 early-stage PCs were diagnosed (4 on CT1, 2 on CT2, 1 on CT3 and 2 on CT4). There were no differences between those who developed LC and those who did not in sex, age, CD4+ nadir, previous lung disease, family history, or amount of packets/year. At each visit, other pathologies were diagnosed, mainly COPD, calcified coronary artery and residual tuberculosis lesions. At the end of the study, 38 patients quit smoking and 75 reduced their consumption. Two patients died from LC and 16 from other causes (p = 0.025). CONCLUSIONS: The design of the present study did not allow us to define the real usefulness of the strategy. Adherence to the test progressively decreased over time. The diagnosis of other thoracic pathologies is very frequent. Including smokers in an early diagnosis protocol for LC could help to quit smoking.

Técnica de Latarjet para la inestabilidad anterior de hombro: implicaciones en la inervación del músculo subescapular / Latarjet procedure for shoulder instability: Implications in the innervation of the subscapularis muscle

Introducción: El objetivo de este estudio es analizar la relación existente entre la inervación del músculo subescapular y los pasos quirúrgicos de la técnica de Latarjet. Material y método: Se realizó un estudio anatómico mediante disección de 12 hombros fijados en formol, y se analizó el patrón de inervación del músculo subescapular. Se midió el tamaño del tendón en la interlínea articular, la distancia craneocaudal desde el borde superior al borde inferior del subescapular, en la entrada de los nervios, y la distancia mediolateral, desde los nervios hasta la interlínea articular. Se realizó la técnica de Latarjet y se midieron las distancias horizontales de los nervios subescapulares a la interlínea articular y de los nervios a la división del subescapular. Se describió la zona de seguridad por la que transcurre la división del subescapular sin dañar los nervios. Resultados: El músculo subescapular está inervado por 3 ramas del nervio subescapular: superior, medio e inferior, que siguen una distribución constante. No se encontraron diferencias estadísticamente significativas en las distancias de los nervios medidas antes y después de la técnica de Latarjet. Para evitar lesionar los nervios, es preciso realizar la división del subescapular entre los dos tercios superiores y el tercio inferior a lo largo del músculo. Conclusión: El músculo subescapular presenta una triple inervación constante. No hemos apreciado cambios estadísticamente significativos en la inervación tras la cirugía de Latarjet. Por tanto, la técnica de Latarjet parece respetar esta inervación al realizar la división del subescapular en su zona de seguridad.

Introduction: Our aim was to describe whether Latarjet's technique affects subscapularis muscle innervation. Materials and methods: We studied 12 embalmed shoulders. Subscapularis muscle innervation pattern was registered. Dimensions of the subscapularis at the glenohumeral joint line and the nerves entry point were measured. Horizontal distances from the nerves to the glenohumeral joint line as well as vertical ones to the split were measured before and after Latarjet procedure. A safe zone for the split was designed to avoid damage to subscapularis innervation. Results: Subscapularis muscle is innervated by three principal branches: upper, middle, and inferior subscapularis nerves. No statistical differences were found between innervation distances before and after Latarjet procedure. To perform subscapularis split along the muscle safe zone, two thirds’ proportions throughout all the split must be maintained. Conclusions: Subscapularis muscle has a triple innervation and was not altered after Latarjet procedure. Therefore, Latarjet technique seems to respect subscapularis muscle innervation if its split is placed through the subscapularis muscle safe zone.(AU)

[Translated article] Latarjet procedure for shoulder instability: Implications in the innervation of the subscapularis muscle / Técnica de Latarjet para la inestabilidad anterior de hombro: implicaciones en la inervación del músculo subescapular

Introducción: El objetivo de este estudio es analizar la relación existente entre la inervación del músculo subescapular y los pasos quirúrgicos de la técnica de Latarjet. Material y método: Se realizó un estudio anatómico mediante disección de 12 hombros fijados en formol, y se analizó el patrón de inervación del músculo subescapular. Se midió el tamaño del tendón en la interlínea articular, la distancia craneocaudal desde el borde superior al borde inferior del subescapular, en la entrada de los nervios, y la distancia mediolateral, desde los nervios hasta la interlínea articular. Se realizó la técnica de Latarjet y se midieron las distancias horizontales de los nervios subescapulares a la interlínea articular y de los nervios a la división del subescapular. Se describió la zona de seguridad por la que transcurre la división del subescapular sin dañar los nervios. Resultados: El músculo subescapular está inervado por 3 ramas del nervio subescapular: superior, medio e inferior, que siguen una distribución constante. No se encontraron diferencias estadísticamente significativas en las distancias de los nervios medidas antes y después de la técnica de Latarjet. Para evitar lesionar los nervios, es preciso realizar la división del subescapular entre los dos tercios superiores y el tercio inferior a lo largo del músculo. Conclusión: El músculo subescapular presenta una triple inervación constante. No hemos apreciado cambios estadísticamente significativos en la inervación tras la cirugía de Latarjet. Por tanto, la técnica de Latarjet parece respetar esta inervación al realizar la división del subescapular en su zona de seguridad.

Introduction: Our aim was to describe whether Latarjet's technique affects subscapularis muscle innervation. Materials and methods: We studied 12 embalmed shoulders. Subscapularis muscle innervation pattern was registered. Dimensions of the subscapularis at the glenohumeral joint line and the nerves entry point were measured. Horizontal distances from the nerves to the glenohumeral joint line as well as vertical ones to the split were measured before and after Latarjet procedure. A safe zone for the split was designed to avoid damage to subscapularis innervation. Results: Subscapularis muscle is innervated by three principal branches: upper, middle, and inferior subscapularis nerves. No statistical differences were found between innervation distances before and after Latarjet procedure. To perform subscapularis split along the muscle safe zone, two thirds’ proportions throughout all the split must be maintained. Conclusions: Subscapularis muscle has a triple innervation and was not altered after Latarjet procedure. Therefore, Latarjet technique seems to respect subscapularis muscle innervation if its split is placed through the subscapularis muscle safe zone.(AU)

Latarjet procedure for shoulder instability: Implications in the innervation of the subscapularis muscle. / Técnica de Latarjet para la inestabilidad anterior de hombro: implicaciones en la inervación del músculo subescapular.

INTRODUCTION: Our aim was to describe whether Latarjet's technique affects subscapularis muscle innervation. MATERIALS AND METHODS: We studied 12 embalmed shoulders. Subscapularis muscle innervation pattern was registered. Dimensions of the subscapularis at the glenohumeral joint line and the nerves entry point were measured. Horizontal distances from the nerves to the glenohumeral joint line as well as vertical ones to the split were measured before and after Latarjet procedure. A safe zone for the split was designed to avoid damage to subscapularis innervation. RESULTS: Subscapularis muscle is innervated by three principal branches: upper, middle, and inferior subscapularis nerves. No statistical differences were found between innervation distances before and after Latarjet procedure. To perform subscapularis split along the muscle safe zone, two thirds' proportions throughout all the split must be maintained. CONCLUSIONS: Subscapularis muscle has a triple innervation and was not altered after Latarjet procedure. Therefore, Latarjet technique seems to respect subscapularis muscle innervation if its split is placed through the subscapularis muscle safe zone.

[Translated article] Latarjet procedure for shoulder instability: Implications in the innervation of the subscapularis muscle.

INTRODUCTION: Our aim was to describe whether Latarjet's technique affects subscapularis muscle innervation. MATERIALS AND METHODS: We studied 12 embalmed shoulders. Subscapularis muscle innervation pattern was registered. Dimensions of the subscapularis at the glenohumeral joint line and the nerves entry point were measured. Horizontal distances from the nerves to the glenohumeral joint line as well as vertical ones to the split were measured before and after Latarjet procedure. A safe zone for the split was designed to avoid damage to subscapularis innervation. RESULTS: Subscapularis muscle is innervated by three principal branches: upper, middle, and inferior subscapularis nerves. No statistical differences were found between innervation distances before and after Latarjet procedure. To perform subscapularis split along the muscle safe zone, two thirds' proportions throughout all the split must be maintained. CONCLUSIONS: Subscapularis muscle has a triple innervation and was not altered after Latarjet procedure. Therefore, Latarjet technique seems to respect subscapularis muscle innervation if its split is placed through the subscapularis muscle safe zone.

Estudio biomecánico comparativo de dos configuraciones de tornillos cementados en una fractura simulada de húmero proximal fijada con placa y tornillos bloqueados / Comparative biomechanical study of two configurations of cemented screws in a simulated proximal humerus fracture fixed with locking plate

Introducción: La utilización de tornillos cementados en la fijación interna de fracturas de húmero proximal con placas bloqueadas parece mejorar la estabilidad del implante y disminuir las complicaciones asociadas al fracaso de síntesis. Sin embargo, la combinación óptima de tornillos cementados se desconoce. El objetivo de este estudio fue analizar la estabilidad relativa de dos configuraciones de tornillos cementados sometidos a una fuerza de compresión axial en una fractura simulada de húmero proximal. Material y métodos: Se realizó una osteotomía del cuello quirúrgico en cinco pares de húmeros embalsamados con una edad media de 74 años (rango 46-93), fijados con una placa de acero inoxidable con tornillos bloqueados. En cada par de húmeros, en el húmero derecho se cementaron los tornillos A y E, y en el lado contralateral se cementaron los tornillos B y D. Cada espécimen fue testado inicialmente mediante una carga cíclica de compresión axial durante 6.000 ciclos para evaluar el movimiento interfragmentario (estudio dinámico). Al final de la prueba, los especímenes se sometieron a una carga de compresión axial progresiva para medir la rigidez de la construcción (estudio estático). Resultados: No se encontraron diferencias estadísticamente significativas en la movilidad interfragmentaria entre las dos configuraciones de tornillos cementados en el estudio dinámico (p=0,463). Cuando se sometieron a rotura, los especímenes con tornillos cementados en las hileras B y D presentaron una carga de rotura mayor (2218N vs. 2105, p=0,901) y una mayor rigidez (125N/mm vs. 106N/mm, p=0,672); sin embargo, ninguna de estas diferencias fue estadísticamente significativa. Conclusiones: La configuración de los tornillos cementados utilizadas en este estudio no influyen en la estabilidad del implante cuando se aplica una carga cíclica de baja energía. La cementación de los tornillos de las hileras B y D proporciona una resistencia similar a la cementación de los tornillos...(AU)

Introduction: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. Material and methods: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46–93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). Results: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. Conclusions: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.(AU)

[Translated article] Comparative biomechanical study of two configurations of cemented screws in a simulated proximal humerus fracture fixed with locking plate / Estudio biomecánico comparativo de 2 configuraciones de tornillos cementados en una fractura simulada de húmero proximal fijada con placa y tornillos bloqueados

Introducción: La utilización de tornillos cementados en la fijación interna de fracturas de húmero proximal con placas bloqueadas parece mejorar la estabilidad del implante y disminuir las complicaciones asociadas al fracaso de síntesis. Sin embargo, la combinación óptima de tornillos cementados se desconoce. El objetivo de este estudio fue analizar la estabilidad relativa de dos configuraciones de tornillos cementados sometidos a una fuerza de compresión axial en una fractura simulada de húmero proximal. Material y métodos: Se realizó una osteotomía del cuello quirúrgico en cinco pares de húmeros embalsamados con una edad media de 74 años (rango 46-93), fijados con una placa de acero inoxidable con tornillos bloqueados. En cada par de húmeros, en el húmero derecho se cementaron los tornillos A y E, y en el lado contralateral se cementaron los tornillos B y D. Cada espécimen fue testado inicialmente mediante una carga cíclica de compresión axial durante 6.000 ciclos para evaluar el movimiento interfragmentario (estudio dinámico). Al final de la prueba, los especímenes se sometieron a una carga de compresión axial progresiva para medir la rigidez de la construcción (estudio estático). Resultados: No se encontraron diferencias estadísticamente significativas en la movilidad interfragmentaria entre las dos configuraciones de tornillos cementados en el estudio dinámico (p=0,463). Cuando se sometieron a rotura, los especímenes con tornillos cementados en las hileras B y D presentaron una carga de rotura mayor (2218N vs. 2105, p=0,901) y una mayor rigidez (125N/mm vs. 106N/mm, p=0,672); sin embargo, ninguna de estas diferencias fue estadísticamente significativa. Conclusiones: La configuración de los tornillos cementados utilizadas en este estudio no influyen en la estabilidad del implante cuando se aplica una carga cíclica de baja energía. La cementación de los tornillos de las hileras B y D proporciona una resistencia similar a la cementación de los tornillos...(AU)

Introduction: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. Material and methods: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46–93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). Results: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. Conclusions: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.(AU)

Next Steps: Survivor Healthcare Passport - A Novel Form of Survivorship Care Plan in the Pediatric Population.

PURPOSE: Survivorship care plans (SCPs) have been instrumental in aiding transition from cancer treatment to survivorship care, which contains the diagnosis, treatment, potential late effects, and recommended follow-up. There has been paucity of research on its efficacy and lack of guidelines on development and delivery of SCPs. The Next Steps Survivorship Clinic at Children's Wisconsin uses a Survivorship Healthcare Passport (SHP), a SCP pocket-sized card. This study aims to improve understanding of patient and parent use of the SHP at a single institution. MATERIALS AND METHODS: An electronic survey was distributed to cancer survivors (14 to 28 y old) and parents/guardians who received the SCP. Data was analyzed with descriptive and correlation statistics. RESULTS: Older survivors were reliable in carrying their SHP, and endorsed greater confidence in understanding its contents leading to a notion of improved ability to coordinate care. Younger survivors tend to rely on their parents. A preference for a smartphone application as another platform was noted. CONCLUSIONS: This form of SCP has shown to benefit older survivors which directly impacts the notion of efficacy in care coordination. IMPLICATION FOR CANCER SURVIVORS: Providing easy-to-access information may encourage survivors to advocate for their health and to facilitate transition of care.

[Translated article] Comparative biomechanical study of two configurations of cemented screws in a simulated proximal humerus fracture fixed with locking plate.

INTRODUCTION: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. MATERIAL AND METHODS: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46-93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). RESULTS: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. CONCLUSIONS: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.

Prevalence and Temporal Trends of Autoimmune Diseases in People Living with HIV.

Since the introduction of modern antiretroviral treatment for HIV and hepatitis C virus (HCV), the pattern of autoimmune diseases (ADs) in people living with HIV (PWH) might have changed. This is a retrospective study in a cohort of 5,665 PWH at the HIV Clinic of Hospital Universitario La Paz (Spain) to estimate the prevalence of ADs from January 1990 to June 2020. We divided the timeline into four periods: <1996, 1996-2006, 2006-2015, and 2015-2020. In total 369 participants were diagnosed with at least one AD, with a prevalence of 5.3% (95% confidence interval 4.7-5.9). In total, 302 (81%) participants were diagnosed simultaneously or after HIV diagnosis. Most prevalent diseases were immune thrombopenia (IT) (n = 90), cutaneous psoriasis (n = 52), autoimmune thyroid disorders (n = 36), spondylarthritis (n = 24), and inflammatory bowel disease (IBD) (n = 21). There was a significant trend for more ADs in recent periods (p = .037). In recent years, participants with ADs were older, had a long time since HIV diagnosis, and had higher CD4+ T cell count and higher CD4+ T cell nadir (temporal linear trend p < .001). There was a change in the pattern of ADs over time with a decrease in IT and an increase in spondylarthritis, arthritis, IBD, and thyroid disorders. One hundred thirty-nine participants (46%) were coinfected with HCV, with a steady decline throughout the study period. Only cryoglobulinemia was statistically associated with HCV infection. AD increases over time in PWH with reasonable immune virological control. We observed a higher frequency of spondylarthritis, arthritis, autoimmune thyroid disorders, and IBD in recent years.

Comparative biomechanical study of two configurations of cemented screws in a simulated proximal humerus fracture fixed with locking plate. / Estudio biomecánico comparativo de dos configuraciones de tornillos cementados en una fractura simulada de húmero proximal fijada con placa y tornillos bloqueados.

INTRODUCTION: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. MATERIAL AND METHODS: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46-93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). RESULTS: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. CONCLUSIONS: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.

Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

OBJECTIVES: To investigate concerns surrounding the benefits of antiresorptive drugs in older adults, a systematic review was carried out to evaluate the efficacy of these treatments in the prevention of osteoporotic hip fractures in older adults. DESIGN: a systematic review and meta-analysis of randomized clinical trials. SETTING AND PARTICIPANTS: older adults ≥65 years with osteoporosis, with or without a previous fragility fracture. Studies with cancer-related and corticosteroid-induced osteoporosis, participants <65 years and no reported hip fracture were not included. METHODS: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus databases were searched. The primary outcome was hip fracture, and subgroup analysis (≥75 years, with different drug types and secondary prevention) and sensitivity analysis was carried out using a GRADE evaluation. Secondary outcomes were any type of fractures, vertebral fracture, bone markers and adverse events. The risk of bias was assessment with the Cochrane risk of bias tool. RESULTS: A total of 12 randomised controlled trials (RCTs) qualified for this meta-analysis, with 36,196 participants. Antiresorptive drugs have a statistically significant effect on the prevention of hip fracture (RR=0.70; 95%CI 0.60 to 0.81), but with a moderate GRADE quality of evidence and a high number needed to treat (NNT) of 186. For other outcomes, there is a statistically significant effect, but with a low to moderate quality of evidence. Antiresorptives showed no reduction in the risk of hip fracture in people ≥75 years. The results for different drug types, secondary prevention and sensitivity analysis are similar to the main analyses and have the same concerns. CONCLUSIONS: Antiresorptive drugs have a statistically significant effect on preventing hip fracture but with a moderate quality (unclear/high risk of bias) and high NNT (186). This small benefit disappears in those ≥75 years, but increases in secondary prevention. More RCTs in very old osteoporotic adults are needed.

Impacto económico del tratamiento a largo plazo de la incontinencia fecal grave / Economic burden of long-term treatment of severe fecal incontinence

Objetivo Conocer el coste económico a largo plazo asociado al tratamiento de la incontinencia fecal grave mediante SNS frente al tratamiento conservador sintomático y la colostomía definitiva. Métodos Estudio descriptivo pormenorizado de los costes del proceso asistencial (intervenciones, consultas, dispositivos, pruebas complementarias, hospitalización, etc.) de 3 alternativas de tratamiento de la incontinencia fecal empleando herramientas de gestión y contabilidad analítica del propio Servicio de Salud con base en datos de actividad clínica. Se estimó, en cada caso, la frecuencia de uso de recursos sanitarios o la cantidad de productos dispensados en farmacias (medicación, pañales, material de ostomía, etc.). Se incluyeron costes derivados de situaciones adversas. Se incluyeron pacientes con incontinencia fecal grave, definida por una puntación superior a 9 en la escala de severidad de Wexner, en los que han fracasado los tratamientos de primera línea. Se emplearon datos de una cohorte consecutiva de 93 pacientes a los que se realizó una SNS entre los años 2002 y 2016; de pacientes intervenidos de colostomía definitiva (n=2); hernia paraestomal (n=3) y estenosis de colostomía (n=1). Resultados El coste medio acumulado en 10 años por paciente en cada alternativa fue: 10.972,9€ para el tratamiento sintomático (62% pañales); 17.351,57€ para la SNS (95,83% intervenciones; 81,6% dispositivos), y 25.858,54€ para la colostomía definitiva (70,4% material de ostomía) Conclusiones El manejo de la incontinencia fecal grave implica un gran impacto en términos económicos. La colostomía es la alternativa que más costes directos genera, seguida de la SNS y el tratamiento sintomático (AU)

Introduction Find out the long-term economic cost associated with the treatment of severe fecal incontinence by SNS versus symptomatic conservative treatment and definitive colostomy. Methods Detailed descriptive study of the costs of the healthcare process (interventions, consultations, devices, complementary tests, hospitalization, etc.) of 3 treatment alternatives for fecal incontinence using analytical accounting tools of the Health Service based on clinical activity data. The frequency of use of health resources or the quantity of products dispensed in pharmacies (medication, diapers, ostomy material, etc.) was estimated in each case. Costs derived from adverse situations were included. Patients with severe fecal incontinence, defined by a score greater than 9 on the Wexner severity scale, in whom first-line treatments had failed, were included. Data from a consecutive cohort of 93 patients who underwent an SNS between 2002 and 2016 were used; patients who underwent definitive colostomy (n=2); parastomal hernia (n=3), and colostomy stenosis (n=1). Results The mean cumulative cost in 10 years per patient in each alternative was: € 10,972.9 symptomatic treatment (62% diapers); € 17,351.57 SNS (95.83% interventions; 81.6% devices); € 25,858.54 definitive colostomy (70.4% ostomy material and accessories). Conclusions Management of severe fecal incontinence implies a great burden in economic terms. The colostomy is the alternative that generates the most direct cost, followed by SNS and symptomatic treatment (AU)

[Real-world efficacy of switching to bictegravir/ emtricitabine/tenofovir alafenamide in pretreated patients with triple therapy containing rilpivirine]. / Eficacia en vida real del cambio a bictegravir/ emtricitabina/tenofovir alafenamida en pacientes previamente tratados con pautas triples que contienen rilpivirina.

OBJECTIVE: To analyze the efficacy and tolerability of the strategy to change from rilpivirine (RPV) based regimens to bictegravir / emtricitabine / tenofovir alafenamide (B/F/TAF). METHODS: Single-center, observational and retrospective study. Patients who made the change to B/F/TAF before February 2020 were selected, analyzing the results after 24 and 48 weeks. The percentage that remained with an undetectable viral load was determined, as well as the changes in CD4 + lymphocytes, metabolic parameters and renal function. RESULTS: A total of 42 patients were included. Thirty-two of the 35 patients (91.4%) who completed the 48 weeks of follow-up had an undetectable viral load. The CD4 + lymphocyte count remained stable at 24 and 48 weeks. The response to B/F/TAF was not influenced by the two analogs previously received. CONCLUSIONS: Switching from triple therapy with RPV to B/F/TAF is a safe and effective strategy in real life.