Whole-body MRI in oncology: A comprehensive review.

Whole-Body Magnetic Resonance Imaging (WB-MRI) has cemented its position as a pivotal tool in oncological diagnostics. It offers unparalleled soft tissue contrast resolution and the advantage of sidestepping ionizing radiation. This review explores the diverse applications of WB-MRI in oncology. We discuss its transformative role in detecting and diagnosing a spectrum of cancers, emphasizing conditions like multiple myeloma and cancers with a proclivity for bone metastases. WB-MRI's capability to encompass the entire body in a singular scan has ushered in novel paradigms in cancer screening, especially for individuals harboring hereditary cancer syndromes or at heightened risk for metastatic disease. Additionally, its contribution to the clinical landscape, aiding in the holistic management of multifocal and systemic malignancies, is explored. The article accentuates the technical strides achieved in WB-MRI, its myriad clinical utilities, and the challenges in integration into standard oncological care. In essence, this review underscores the transformative potential of WB-MRI, emphasizing its promise as a cornerstone modality in shaping the future trajectory of cancer diagnostics and treatment.

MRI-based nomograms and radiomics in presurgical prediction of extraprostatic extension in prostate cancer: a systematic review.

PURPOSE: Prediction of extraprostatic extension (EPE) is essential for accurate surgical planning in prostate cancer (PCa). Radiomics based on magnetic resonance imaging (MRI) has shown potential to predict EPE. We aimed to evaluate studies proposing MRI-based nomograms and radiomics for EPE prediction and assess the quality of current radiomics literature. METHODS: We used PubMed, EMBASE, and SCOPUS databases to find related articles using synonyms for MRI radiomics and nomograms to predict EPE. Two co-authors scored the quality of radiomics literature using the Radiomics Quality Score (RQS). Inter-rater agreement was measured using the intraclass correlation coefficient (ICC) from total RQS scores. We analyzed the characteristic s of the studies and used ANOVAs to associate the area under the curve (AUC) to sample size, clinical and imaging variables, and RQS scores. RESULTS: We identified 33 studies-22 nomograms and 11 radiomics analyses. The mean AUC for nomogram articles was 0.783, and no significant associations were found between AUC and sample size, clinical variables, or number of imaging variables. For radiomics articles, there were significant associations between number of lesions and AUC (p < 0.013). The average RQS total score was 15.91/36 (44%). Through the radiomics operation, segmentation of region-of-interest, selection of features, and model building resulted in a broader range of results. The qualities the studies lacked most were phantom tests for scanner variabilities, temporal variability, external validation datasets, prospective designs, cost-effectiveness analysis, and open science. CONCLUSION: Utilizing MRI-based radiomics to predict EPE in PCa patients demonstrates promising outcomes. However, quality improvement and standardization of radiomics workflow are needed.

Perceptions of Sexual Risk, PrEP Services, and Peer Navigation Support among HIV-Negative Latinx and Black Men who have Sex with Men (MSM) Residing in Western Washington.

Introduction: HIV PrEP (pre-exposure prophylaxis) is underutilized among Latinx and Black men who have sex with men (MSM) in the United States. Although peer navigation approaches may increase PrEP uptake and adherence, it remains unclear what strategies work best for MSM of color. Methods: From July 2017 to August 2018, we conducted semi-structured in-depth interviews with 25 purposively sampled Latinx and Black cisgender MSM to evaluate how the intersectionality of race/ethnicity, sexual orientation, and other identities influenced men's views on PrEP in general and on peer navigation specifically. Thematic analysis was used to identify and analyze emergent themes. Results: Emergent themes included: (1) awareness of vulnerability in intimate relationships; (2) barriers to PrEP initiation including perceived side effects, stigma, and financial concerns; (3) a wish to connect with other Latinx and Black MSM in a health and prevention space; and (4) the desire for peer matching based on identity considerations and lived experience. Younger men and Spanish-speaking Latinx men were most interested in peer navigation to access PrEP, while bisexual men had confidentiality concerns. Conclusions: In our study, Latinx and Black MSM viewed peer navigation services favorably, especially if they addressed men's desire to connect with other MSM of color. Policy Implications: Developing culturally-congruent peer navigation programming could help improve PrEP uptake and care engagement for Latinx and Black MSM. Programs should recruit peers from the racial/ethnic minority communities most impacted by HIV and prioritize matching peers to clients based on identity concerns, needs, and preferences.

Control of allergic rhinitis in four latin american countries: Rinola study.

Background: Allergic rhinitis (AR) affects up to 40% of the general population, there are large-scale multicenter studies that have described its characteristics and few studies have focused on studying patients with AR in Latin America (LA). Methodology: A cross-sectional, descriptive, multicenter study was carried out in four LA countries (Colombia, Argentina, Cuba and Peru). Patients diagnosed with AR between November 2017 and June 2020 were included. Sociodemographic and clinical data, sensitization profile and current treatment were collected in the Electronic Data Collection (BDClinic). Patients also filled out this questionnaires: Rhinitis Control Assessment Test (RCAT), Reflexive Total Nasal Symptom Score (rTNSS), Modified ARIA Criteria for AR Severity (mARIA) and ESPRINT-15. Risk of bias was examined by applying the STROBE checklist. Results: The study included 412 patients. Median age was 25 years (15-39). Two hundred and twenty four (54.3%) were women. Nasal obstruction was present in 303 (73.5%). Three hundred and thirty four (81%) had a persistent AR. One hundred and twenty one (31.3%) had associated asthma. The most frequently positive skin tests were: Dermatophagoides pteronyssinus in 365 (88.6%) and Dermatophagoides farinae in 331 (81.3%). Four hundred and eleven patients (99%) reported that AR affected their quality of life. The median score of ESPRINT-15 was 1.87 (0.93-2.93), The mean values of RCAT and rTNSS were 19.01 (±4.59) and 5.4 (±2.97) respectively. Two hundred and fifty (60%) were receiving only oral antihistamines. Physicians decided to start nasal corticosteroids in 296 (71.8%). Only seventy patients (16.9%) were receiving immunotherapy. Conclusion: These findings confirm that most of patients with AR in LA have a persistent disease with a negative impact on quality of life. Dust mites are the main sensitizers. These findings will allow to know the true impact of AR and can lead to a better disease management.

Long-Acting Injectable Antipsychotic Medication Plus Customized Adherence Enhancement in Poor Adherence Patients With Bipolar Disorder.

Objective: People with bipolar disorder (BD) often have difficulty with medication adherence. This pilot trial combined a behavioral customized adherence enhancement (CAE) approach with long-acting injectable (LAI) antipsychotic medication and assessed effects on adherence, BD symptoms, and functional status.Methods: This 6-month prospective, uncontrolled trial of the intervention (CAE with LAI) in 30 poorly adherent individuals with BD assessed adherence using the Tablets Routine Questionnaire (TRQ) and symptoms using the Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), and Clinical Global Impressions (CGI). Functioning was assessed via the Social and Occupational Functioning Assessment Scale (SOFAS) and Global Assessment of Functioning (GAF). Assessments were conducted at screening, baseline, week 12, and week 24 (6 months). The LAI was aripiprazole once monthly. The study was conducted between April 2018 and May 2020.Results: The mean age of the sample was 49.5 years (SD = 9.3), and 56.7% were Black. Nine individuals (30%) terminated the study prematurely, 1 due to side effects (tremor). The mean LAI dose was 314.3 mg (SD = 96.4). The proportion of missed medications in the past week (mean TRQ) from screen to 24 weeks significantly improved from 50.1% (SD 24.8) to 16.9% (SD = 27.0) (P < .001), and past month TRQ improved from 40.6% (SD = 23.8) to 19.2% (SD = 24.0) (a trend for significance, P = .0599). TRQ change from baseline to 24 weeks was not significant. There were significant improvements on the BPRS (P < .001), MADRS (P = .01), YMRS (P < .001), CGI (P < .001), SOFAS (P < .001), and GAF (P < .001).Conclusion: A personalized intervention to address adherence barriers combined with LAI can improve recovery outcomes in high-risk individuals with BD.Trial Registration: ClinicalTrials.gov Identifier: NCT03408873.

Phosphorus Solubilizing and Mineralizing Bacillus spp. Contribute to Rice Growth Promotion Using Soil Amended with Rice Straw.

Rice (Oryza sativa L.) is a staple food for more than two billion people worldwide. Its cultivation demands large amounts of nutrients, particularly nitrogen and phosphorus (P). Consequently, low availability of these nutrients in the soil has led to the use of chemical fertilizers, generating increases in production costs and environmental damage. Soil host microorganisms known as plant growth-promoting rhizobacteria (PGPR) colonize the rhizosphere and facilitate the uptake of nutrients by the plants. In this study, rice seeds inoculated with PGPR were grown for 30 days in an inert substrate and fertilized with modified Hoagland nutrient solution with phosphate rock as a source of P. Treatments were repeated over time, obtaining five isolates which significantly increased plant length by up to 56% and dry weight of stems and roots up to 45% and 169% respectively relative to an uninoculated control. Selected strains showed in vitro tri-calcium phosphate solubilizing activity, mineralizing phytate activity, and phosphate release from rice straw (RS). Based on the above criteria, three isolates (IBUN-02755, -02,704 and -02,724) that contained ß propeller phytase (BPP) genes, were selected to evaluate their effect as PGPR in rice seedlings. These were planted in a soil amended with RS under greenhouse conditions. The results showed that selected Bacillus spp. strains significantly increased plant length and dry weight or increased plant phosphate uptake up to two times compared to an un-inoculated control. This suggests that selected strains may have a capacity as PGPR using RS as carbon and a P amendment.

Towards more sustainable agricultural landscapes: Lessons from Northwestern Mexico and the Western Highlands of Guatemala.

A systematic process for assessing progress toward landscape sustainability goals is developed and tested. Application of the approach builds capacity and promotes continual improvements in management practices, thus enabling timely action to address changing conditions while progressing toward locally defined goals. We consider how the approach applies to agricultural landscapes, that is farm ecosystem interactions with the environment and human well-being. We present lessons learned from applying the assessment approach in two contrasting situations: large, high-input, commercial agriculture in northwestern Mexico and small, low-input family farms in the Western Highlands of Guatemala. Applying the approach reveals five attributes required for success and the means to achieve those conditions. (1) Having a capable local champion for the project is critical. (2) Implementation of the approach must be in concert with local people and organizations as well as with regional and national policies and programs. (3) Identification and engagement of key stakeholders is essential. (4) Application of the approach is not meant to be a one-time effort but rather an ongoing and systematic process. (5) Engagement and buy-in from stakeholders including multiple agency levels is essential for allocation of necessary resources and logistic support in the continuing implementation of the approach.

What's PrEP?: peer navigator acceptability among minority MSM in Washington.

BACKGROUND: Peer navigation is a promising strategy to link at-risk minority men who have sex with men (MSM) to HIV prevention services including pre-exposure prophylaxis (PrEP). METHODS: Thirty-two Black and 63 Latinx HIV-negative MSM living in western Washington completed a survey examining attitudes towards peer navigation and PrEP. Factor analysis derived a score for peer navigator acceptability, and linear regression identified associations with this outcome. RESULTS: Forty-eight percent were interested in peer navigation. Being insured, higher sexual stigma, and higher PHQ-9 score were associated with higher acceptability, while higher income and having a regular medical provider were associated with lower acceptability. In multivariable analysis, higher sexual stigma predicted higher acceptability, while higher income predicted lower acceptability. Men preferred that peers be matched on sexual orientation, race, age and culture. CONCLUSION: Peer navigation interventions to reach minority men should address stigma, focus on lower-income men, and try to match peers to clients to the extent possible.

Toxic expanded GGGGCC repeat transcription is mediated by the PAF1 complex in C9orf72-associated FTD.

An expanded GGGGCC hexanucleotide of more than 30 repeats (termed (G4C2)30+) within C9orf72 is the most prominent mutation in familial frontotemporal degeneration (FTD) and amyotrophic lateral sclerosis (ALS) (termed C9+). Through an unbiased large-scale screen of (G4C2)49-expressing Drosophila we identify the CDC73/PAF1 complex (PAF1C), a transcriptional regulator of RNA polymerase II, as a suppressor of G4C2-associated toxicity when knocked-down. Depletion of PAF1C reduces RNA and GR dipeptide production from (G4C2)30+ transgenes. Notably, in Drosophila, the PAF1C components Paf1 and Leo1 appear to be selective for the transcription of long, toxic repeat expansions, but not shorter, nontoxic expansions. In yeast, PAF1C components regulate the expression of both sense and antisense repeats. PAF1C is upregulated following (G4C2)30+ expression in flies and mice. In humans, PAF1 is also upregulated in C9+-derived cells, and its heterodimer partner, LEO1, binds C9+ repeat chromatin. In C9+ FTD, PAF1 and LEO1 are upregulated and their expression positively correlates with the expression of repeat-containing C9orf72 transcripts. These data indicate that PAF1C activity is an important factor for transcription of the long, toxic repeat in C9+ FTD.

A 6-Month, Prospective, Randomized Controlled Trial of Customized Adherence Enhancement Versus Bipolar-Specific Educational Control in Poorly Adherent Individuals With Bipolar Disorder.

OBJECTIVE: Nonadherence in bipolar disorder (BD) ranges from 20% to 60%. Customized adherence enhancement (CAE) is a brief, BD-specific approach that targets individual adherence barriers. This prospective, 6-month, randomized controlled trial conducted from October 2012 to July 2017 compared CAE versus a rigorous BD-specific educational program (EDU) on adherence, symptoms, and functional outcomes in poorly adherent individuals. METHODS: One hundred eighty-four participants with DSM-IV BD were randomized to CAE (n = 92) or EDU (n = 92). Primary outcome was adherence change measured by the Tablets Routine Questionnaire (TRQ) and BD symptoms measured by the Brief Psychiatric Rating Scale. Other outcomes were scores on the Global Assessment of Functioning, Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale, and Clinical Global Impressions Scale. Assessments were conducted at screening, baseline, 10 weeks, 14 weeks, and 6 months. RESULTS: The sample mean (SD) age was 47.40 (10.46) years; 68.5% were female, and 63.0% were African American. At screening, individuals missed a mean (SD) of 55.15% (28.22%) of prescribed BD drugs within the past week and 48.01% (28.46%) in the past month. Study attrition was < 20%. At 6 months, individuals in CAE had significantly improved past-week (P = .001) and past-month (P = .048) TRQ scores versus those in EDU. Past-week TRQ score improvement remained significant after adjustment for multiple comparisons. There were no treatment arm differences in BPRS scores or other symptoms, possibly related to low symptom baseline values. Baseline-to-6-month comparison showed significantly higher GAF scores (P = .036) for CAE versus EDU. Although both groups used more mental health services at 6 months compared to baseline, increase for CAE was significantly less than that for EDU (P = .046). CONCLUSIONS: Whereas both CAE and EDU were associated with improved outcomes, CAE had additional positive effects on adherence, functioning, and mental health resource use compared to EDU. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00183495.

[Plastia uretral y calidad de vida asociada a la técnica quirúrgica en la Unidad Médica de Alta Especialidad Mérida]. / Urethral plasticity and quality of life associated with the surgical technique in Unidad Médica de Alta Especialidad Mérida.

OBJETIVO: Determinar la calidad de vida asociada con la técnica quirúrgica en pacientes posoperados de plastia uretral. MÉTODO: Se estudiaron 29 pacientes intervenidos entre enero de 2011 y diciembre de 2015. Se aplicaron los cuestionarios Euroqol 5-D e International Prostate Symptom Score para medir calidad de vida y detectar recaídas, respectivamente. Se realizó estadística descriptiva, y se calcularon la incidencia acumulada, el riesgo relativo y la fracción atribuible. RESULTADOS: La incidencia de recaídas detectada por el International Prostate Symptom Score fue del 69% (p = 0.011); el riesgo relativo fue de 2.19 (intervalo de confianza del 95%: 2.092-2.288). La fracción atribuible a la exposición fue del 54%. La calidad de vida se asoció con la longitud de la lesión (p = 0.046), los síntomas urinarios bajos (p = 0.004) y la percepción individual del estado de salud (p = 0.003). La localización de la lesión se asoció con recaída (p = 0.008). La calidad de vida no se asoció con el tipo de plastia (p > 0.05). CONCLUSIONES: La incidencia de recurrencia posquirúrgica es alta. La calidad de vida es independiente de la técnica quirúrgica, pero está asociada con la longitud de la lesión y con los síntomas urinarios. OBJECTIVE: To determine the quality of life associated with the surgical technique in postoperative patients with urethral plasty. METHODS: 29 patients operated between January-2011 and December-2015 were studied. The questionnaires Euroqol 5-D and International Prostate Symptom Score were applied to measure quality of life and detect relapses, respectively. Descriptive statistics was performed, cumulative incidence, relative risk and attributable fraction were calculated. RESULTS: the incidence of relapse detected by the International Prostate Symptom Score was 69% (p = 0.011); the relative risk was 2.19 (95% confidence interval: 2.092-2.288). The fraction attributable to the exposure was 54%. The quality of life was associated with the length of the lesion (p = 0.046), low urinary symptoms (p = 0.004) and the individual perception of the state of health (p = 0.003). The location of the lesion was associated with relapse (p = 0.008). Quality of life was not associated with type of plasty (p > 0.05). CONCLUSIONS: The incidence of postoperative recurrence is high. The quality of life is independent of the surgical technique, but it is associated with the length of the lesion and urinary symptoms.

A 6-Month Prospective Trial of a Personalized Behavioral Intervention + Long-Acting Injectable Antipsychotic in Individuals With Schizophrenia at Risk of Treatment Nonadherence and Homelessness.

PURPOSE: Long-acting injectable antipsychotics (LAI) can optimize adherence for high-risk serious mental illness (SMI). This customized adherence-enhancement approach delivered by social worker interventionists was combined with LAI (CAE-L) of paliperidone palmitate for homeless, poorly adherent individuals with SMI. METHODS: This 6-month prospective, uncontrolled trial of CAE-L in 30 recently homeless individuals with SMI assessed adherence using the Tablets Routine Questionnaire, injection frequency, and SMI symptoms measured by the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, and Clinical Global Impressions. The Social and Occupational Functioning Assessment Scale measured social function. Standardized scales assessed extrapyramidal effects. FINDINGS: Patients' mean age was 43.6 (SD, 9.53) years, and they were mainly minorities (86.7% African American) and single/never married (72.4%). Rate of substance abuse within the past year was 40.0%, and rate of incarceration within the past 6 months was 32.1%. Four participants (13.3%) terminated the study prematurely. Customized adherence enhancement + LAI was associated with good adherence to LAI (92.9%) and improved adherence with oral drug as measured by Tablets Routine Questionnaire (P = 0.02). There were significant improvements in Positive and Negative Syndrome Scale (P < 0.01), Brief Psychiatric Rating Scale (P < 0.001), Clinical Global Impressions (P = 0.003), and Social and Occupational Functioning Assessment Scale (P = 0.005). There were no significant extrapyramidal effects. IMPLICATIONS: While findings must be tempered by the methodological limitations, CAE-L seems associated with multiple domains of improvement in homeless/recently homeless individuals with SMI. Adverse effects limit tolerability in some individuals, and not all will remain engaged. However, LAI combined with a patient-centered behavioral approach can improve outcomes for some high-risk individuals with SMI.

Diseño de un programa basado en la promoción del desarrollo positivo en la infancia para la prevención temprana de la violencia en Colombia.

Aunque algunos informes identifiquen a Colombia como ejemplo de un país que ha logrado revertir los niveles crecientes de violencia, estos siguen siendo altos. Por este motivo se han convocado acciones de promoción de la convivencia y prevención de la violencia, a las cuales responde el programa que presentamos en este artículo. Este programa está basado en la perspectiva contextual-evolutiva del modelo ecológico y en la educación para la salud, tendiente al cuidado de sí en los padres o cuidadores, y al ejercicio de una crianza, centrada en los derechos de los niños, el desarrollo infantil y la promoción de la salud mental, con el fin de promover el desarrollo saludable y prevenir comportamientos agresivos en los niños; éste es presentado como una alternativa de orientación psicosocial para el fortalecimiento de estrategias y programas dirigidos a la primera infancia.

Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder.

OBJECTIVES: This analysis of screening and baseline data from an ongoing trial examined self-report versus automated adherence monitoring and assessed the relationship between bipolar disorder (BD) symptoms and adherence in 104 poorly adherent individuals. METHODS: Adherence was measured with the Tablets Routine Questionnaire (TRQ) and the Medication Event Monitoring System (MEMS). Symptoms were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS). RESULTS: The mean age of the sample was 46.3 years [standard deviation (SD) = 9.41 years], with 72% (n = 75) women and 71% (n = 74) African American subjects. Adherence improved from screening to baseline, with a mean missed drug proportion measured by TRQ of 61.43% (SD = 26.48%) versus a baseline mean of 46.61% (SD = 30.55%). The mean proportion of missed medication using MEMS at baseline was 66.43% (SD = 30.40%). The correlation between TRQ and MEMS was 0.47. The correlation between a single index drug and all BD medications was 0.95. Symptoms were generally positively correlated with TRQ (worse adherence = more severe symptoms), but in most instances was only at a trend level (p > 0.05), with the exception of the correlations between baseline TRQ and MADRS and BPRS, which were positive (r = 0.20 and r = 0.21, respectively) and significant (p ≤ 0.05). CONCLUSIONS: In patients with BD, monitoring increased adherence by 15%. MEMS identified 20% more non-adherence than self-report. Using a standard procedure to identify a single index drug for adherence monitoring may be one way to assess global adherence in patients with BD receiving polypharmacy treatment. Greater BD symptom severity may be a clinical indicator to assess for adherence problems.

INTERACTIVE WORKSHOPS TO PROMOTE GENDER EQUITY AND FAMILY PLANNING IN RURAL COMMUNITIES OF GUATEMALA: RESULTS OF A COMMUNITY RANDOMIZED STUDY.

In Guatemala, especially in rural areas, gender norms contribute to high fertility and closely spaced births by discouraging contraceptive use and constraining women from making decisions regarding the timing of their pregnancies and the size of their families. Community workshops for men, women and couples were conducted in 30 rural communities in Guatemala to test the hypothesis that the promotion of gender equity in the context of reproductive health will contribute to gender-equitable attitudes and strengthen the practice of family planning. Communities were randomly assigned to intervention and control groups. Pre/post surveys were conducted. Odds ratios estimated with mixed effect models to account for community-level randomization and repeated measures per participant were compared. The analyses showed statistically significant effects of the intervention on two of the three outcomes examined: gender attitudes and contraceptive knowledge. Findings regarding contraceptive use were suggestive but not significant. The results suggest that it is possible to influence both inequitable gender norms and reproductive health knowledge and, potentially, behaviours in a short span of time using appropriately designed communications interventions that engage communities in re-thinking the inequitable gender norms that act as barriers to health.

[Unilateral pulmonary artery agenesis with ipsilateral pulmonary hypoplasia as incidental finding in an asthmatic patient]. / Agenesia de la arteria pulmonar derecha con hipoplasia pulmonar ipsilateral como hallazgo incidental en un paciente con asma.

Unilateral absence of a pulmonary artery is an uncommon congenital heart disease. It can be related to respiratory symptoms such as asthma, an unusual finding in some of these patients. This paper reports the case of a 4-year-old male with recurrent respiratory infections and asthma symptoms, in who further studies found agenesia of right pulmonary artery with pulmonary hypoplasia of the same side.

La ausencia unilateral primitiva de una de las arterias pulmonares es una malformación congénita poco frecuente. Entre las manifestaciones clínicas de esta entidad se pueden encontrar síntomas respiratorios, como el asma, aunque la relación es infrecuente. Se comunica el caso de un niño de cuatro años de edad con episodios de infecciones respiratorias recurrentes y diagnóstico de asma, en quien posteriormente se encontró agenesia de la arteria pulmonar derecha e hipoplasia pulmonar secundaria ipsilateral.

Prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder.

BACKGROUND: Treatment nonadherence in people with schizophrenia is associated with relapse and homelessness. Building on the usefulness of long-acting medication and our work in psychosocial interventions to enhance adherence, we conducted a prospective uncontrolled trial of customized adherence enhancement (CAE) plus long-acting injectable antipsychotic (LAI) using haloperidol decanoate in 30 homeless or recently homeless individuals with DSM-IV-defined schizophrenia or schizoaffective disorder. METHOD: Participants received monthly CAE and LAI (CAE-L) for 6 months. Primary outcomes were adherence, as measured by the Tablets Routine Questionnaire, and housing status. Secondary outcomes included psychiatric symptoms, functioning, side effects, and hospitalizations. The study was conducted from July 2010 to December 2012. RESULTS: The mean age of participants was 41.8 years (SD = 8.6); they were mainly minorities (90%, n = 27 African-American) and mainly single/never married (70%, n = 21). Most (97%, n = 29) had past or current substance abuse and had been incarcerated (97%, n = 29). Ten individuals (33%) terminated the study prematurely. CAE-L was associated with good adherence to LAI (at 6 months, 76%) and dramatic improvement in oral medication adherence, which changed from missing 46% of medication at study enrollment to missing only 10% at study end (P = .03). There were significant improvements in psychiatric symptoms (P < .001) and functioning (P < .001). Akathisia was a major side effect with LAI. CONCLUSIONS: While interpretation of findings must be tempered by the methodological limitations, CAE-L appears to be associated with improved adherence, symptoms, and functioning in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. Additional research is needed on effective and practical approaches to improving health outcomes for homeless people with serious mental illness. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01152697.

Comparación de la activación y la cinética de laplasmina bufalina con la humana / Ativação e cinética comparativa da plasmina bufalina e a humana / Comparative activation and kinetic of plasmin bufaline with the human one

El plasminógeno es el zimógeno de la plasmina, enzima activada a nivel fisiológico por el activadortisular del plasminógeno y la urokinasa, la plasmina es la enzima encargada de disolver el coágulosanguíneo. En este estudio se compararon la plasmina humana con la bufalina en su forma de activación dezimógeno a enzima y en la afinidad hacia el sustrato cromogénico. Los plasminógenos fueron purificadospor el mismo método de cromatografías de afinidad y cambio iónico. De igual manera las activaciones sehicieron utilizando urokinasa humana en ambos casos. La plasmina bufalina demostró mayor activacióny afinidad (1.35mM) que la plasmina humana (2.16 mM), siendo la bufalina 1.5 veces mas afin al sustratocromogénico que la humana. Este estudio demuestra que el método de purificación de los plasminógenospuede ser el mismo para muchas especies, se demuestra una vez más que las plasminas animales al parecerson más eficientes en la disolución del coágulo o degradación de sustratos, que la plasmina humana.Este estudio indica que la plasmina bufalina puede ser utilizada en los parámetros que se determinanclínicamente en pacientes con problemas cardiovasculares, reduciendo el tiempo de determinación de estosparámetros fibrinolíticos, que pueden dar al médico un margen de tiempo superior para actuar.

The Plasminogen is the zymogene of the Plasmin, enzyme which physiologically is activated by twodifferent enzymes, the tissue plasminogen activator and the urokinase, the plasmin is the enzyme that dissolves blood clots. In this study the human plasmin was compared to the bufaline plasmin, in theactivation from the zymogene to the enzyme form as well as in the affinity to the chromogenic substrate.The two plasminogens were purified by the same chromatographies methods: affinity and ion-exchange.Furthermore, both plasminogens were activated by human urokinase. The bufaline plasmin showed moreactivation and affinity (1.35 mM) that the human plasmin (2.16 mM), in addition, the bufaline plasmindemonstrated a 1.5 times more affinity to the chromogenic substrate that the human plasmin. This studydemonstrated that the plasminogens of several species can be purified by this method. Besides, one moretime the animal’s plasmins probably to be more efficient in the dissolution of blood clots or degradation ofsubstrates than the human plasmin. More over this study indicated that the bufaline plasmin can be usedin clinical determinations of patients with cardiovascular diseases. This also reduces the determinationtime of fibrinolytic parameters that physicians can give, having more time to take appropriate treatment.

O plasminogênio é o zymogen da plasmina, enzima ativada a nivel fisiológico pelo ativador tissulardo plasminogênio e uroquinase, plasmina é a enzima responsável de dissolver o coágulo de sanguíneo.neste estudo foi comparada a plasmina humana com a plasmina búbalina em seu modo de ativaçãode zymogen a enzima e na afinidade substrato cromogênico. Os plasminogênio foram purificados como mesmo método de cromatografia de afinidade e de troca iônica, e as ativações foram feitas usandouroquinase humana nos dois casos. A Búfalo plasmina mostrou maior ativação e afinidade (1.35 mM)que a plasmina humana (2.16 mM), sendo a bufalina 1.5 vezes mais afim ao substrato Cromogênico quea humana. Este estudo mostrou que o método de purificação do plasminogênios pode ser o mesmo paramuitas espécies, alem disso, que as plasminas animais são mais eficientes na dissolução do coáguloo degradação de substratos que a plasmina humana. Este estudo indicou que a plasmina búfalo podeser utilizada nos parâmetros determinados clínicamente em pacientes com problemas cardiovasculares,diminuindo o tempo de determinação destes parâmetros fibrinolíticos, que podem dar ao médico umintervalo de maior tempo para atuar.

Nefrectomia laparoscopica en Medellin / Laparoscopic nephrectomy in Medellin

Objetivos: La Nefrectomía Laparoscópica (NL) es un procedimiento que tiene menor morbilidad que la cirugía abierta, pero se requiere de gran experiencia para realizarla. Nosotros presentaremos nuestra revisión de las primeras 30 NL. Materiales y Métodos: Revisamos 30 pacientes a los que se les realizó NL por enfermedad benigna o maligna, entre agosto del 2001 y agosto del 2003, por un mismo cirujano. Tuvimos en cuenta el tipo de cirugía, la indicación y el acceso que se realizó. Además de las complicaciones y los resultados patológicos. Resultados: De los treinta pacientes 15 eran hombres y 15 mujeres. A dieciséis se les realizó NL izquierda, a los catorce restantes NL derecha. El acceso transperitoneal, retroperitoneal y mano asistida se realizó en el 80, 10 y 10 por ciento respectivamente. El 73.3 por ciento de los pacientes fueron llevados a cirugía por enfermedad benigna con una edad promedio de 38 años. El 26.7 por ciento restante tenían enfermedad maligna, con un promedio de edad de 59 años. De los que tenían enfermedad benigna, en el 53.3 por ciento la indicación de la cirugía fue atrofia renal. Se realizaron 21 NL simples, 7 NL radicales y 2 NL parciales. En nuestro estudio no hubo diferencias en el tiempo quirúrgico entre enfermedad benigna y maligna, 194/193 minutos respectivamente; pero si en la estancia hospitalaria. Se presentaron dos complicaciones mayores (6.6 por ciento) que fueron pacientes llevados a NL radical, una conversión (3 por ciento) por sangrado del hilio renal y un paciente que falleció al siguiente día de la cirugía por coagulopatía de consumo. Tres complicaciones fueron menores (10 por ciento), dos infecciones de herida quirúrgica. La otra complicación fue un urinoma en un caso al que se le realizó NL parcial. Dos de los 30 pacientes requirieron transfusión. El informe patológico fue pielonefritis crónica-pionefrosis 46 por ciento, hidronefrosis-Estrechez Píelo Ureteral 25 por ciento y CCR 21.4 por ciento. El tiempo de incapacidad postoperatoria fue de 7 días en enfermedad benigna y 12 en enfermedad maligna. Conclusiones: La NL es un procedimiento que se puede realizar con seguridad y eficiencia en enfermedad benigna o maligna pero se requiere de una curva de aprendizaje prolongada. Tiene una menor morbilidad que la cirugía abierta con una tasa de éxito similar