Qualitative study about the perception of patients with inflammatory bowel disease: A descriptive observational study.

The main aim of this study was to identify the perceptions of people suffering from inflammatory bowel diseases (IBD) regarding the need for specialised nursing care, based on their opinions from their own experience. A qualitative design with an inductive approach based on constructivist grounded theory was conducted using a questionnaire. Almost 63 % of respondents felt that a nursing intervention was necessary for the patient's self-care and supported the care of the environment of the patient with IBD in need of care. Approximately 75 % of respondents felt that the initial nursing consultation following diagnosis of IBD was essential to address all aspects of the patient's daily life and environment for quality care and follow-up. More than 87 % of respondents felt it was important for nurses to recognise the need for referral to other professionals when caring for IBD patients and their environment to maximise their wellbeing. The percentage of females who answered yes to this last question was significantly higher than that of males (p = 0.025). Some 67.1 % of respondents felt that nurses should be responsible for informing the patient and those around them of the steps to be taken following diagnosis and what these consist of. More than 94 % of all respondents felt that IBD patients and their carers should have a plan and time for specific and appropriate education on this topic. More than 80 % of respondents agreed that the progression, monitoring, and management of their IBD should be supervised by a nurse in addition to their specialist doctor to achieve an optimal level of quality. In conclusion, this study shows that patients suffering from IBD consider the role of the nurse to be crucial in the diagnosis, management and treatment of their disease and highlights the need for specialised nurses in inflammatory bowel disease who can provide patients with high-quality healthcare.

Oncological outcomes of intraperitoneal chemotherapy in advanced ovarian cancer: BRCA mutation role.

INTRODUCTION: The knowledge of BRCA status offers a chance to evaluate the role of the intraperitoneal route in patients selected by biomolecular profiles after primary cytoreduction surgery in advanced ovarian cancer. MATERIALS AND METHODS: We performed a retrospective, multicenter study to assess oncological outcomes depending on adjuvant treatment (intraperitoneal [IP] vs intravenous [IV]) and BRCA status (BRCA1/2 mutated vs. BRCA wild type [WT]). The primary endpoint was to determine progression-free survival. The secondary objectives were overall survival and toxicity. RESULTS: A total of 288 women from eight centers were included: 177 in the IP arm and 111 in the IV arm, grouped into four arms according to BRCA1/2 status. Significantly better PFS was observed in BRCA1/2-mutated patients with IP chemotherapy (HR: 0.35; 95% CI, 0.16-0.75, p = 0.007), which was not present in BRCA1/2-mutated patients with IV chemotherapy (HR: 0.65; 95% CI, 0.37-1.12, p = 0.14). Significantly better OS was also observed in IP chemotherapy (HR: 0.17; 95% CI, 0.06-043, p < 0.0001), but was not present in IV chemotherapy in relation with BRCA mutation (HR: 0.52; 95% CI, 0.22-1.27, p = 0.15). For BRCA WT patients, worse survival was observed regardless of the adjuvant route used. The IP route was more toxic compared to the IV route, but toxicity was equivalent at the long-term follow-up. CONCLUSION: This retrospective study suggests that BRCA status can help to offer an individualized, systematic treatment after optimal primary surgery for advanced ovarian cancer, but is limited by the small sample size. Prospective trials are essential to confirm these results.

Impact of initiation of SGLT2 inhibitor treatment on the development of arrhythmias in patients with implantable cardiac devices.

INTRODUCTION AND OBJECTIVES: Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) have been associated with improved prognosis in patients with heart failure, but their impact on atrial arrhythmic (AA) and ventricular arrhythmic (VA) events is not fully understood. METHODS: This multicenter retrospective study included patients with implantable cardioverter-defibrillators who initiated treatment with SGLT2i. AA and VA events were compared in 2 time periods for each patient: 1 year before and 1 year after starting SGLT2i. RESULTS: The study included 195 patients (66.8 [61.3-73.1] years, 18.5% women). In the post-SGLT2i period, there was a reduction in the percentage of patients with any VA (pre: 52.3% vs post: 30.3%; P<.001) and clinically relevant VA (excluding nonsustained ventricular tachycardia) (pre: 21.5% vs post: 8.7%; P<.001). There was also a decrease in the number of episodes per patient/y of nonsustained ventricular tachycardia (pre: 2 (1-5) vs post: 1 (0-2); P<.001) and sustained ventricular tachycardia (pre: 1 (1-3) vs post: 0 (0-2); P=0.046). However, no differences were observed in the prevalence of AA (24.7% vs 18.8%; P=.117) or the burden of atrial fibrillation (pre: 0% (0-0.1) vs post: 0% (0-0); P=.097). CONCLUSIONS: Initiation of SGLT2i treatment was associated with a decrease in the percentage of patients with relevant VA but this effect was not observed for AA.

Accuracy of ICG compared with technetium-99 m for sentinel lymph node biopsy in vulvar cancer.

PURPOSE: Sentinel lymph node biopsy with radioactive tracer is the standard-of-care in lymph node status assessment in vulvar cancer. Indocyanine green fluorescence-ICG is a promising detection method, due to its advantages over technetium-99 m. In vulvar cancer, the procedure is controversial due to study heterogeneity and the small sample size in previous studies. This study evaluates ICG sentinel lymph node detection compared with the criterion-standard with technetium (dual modality method). METHODS: Preoperative technetium and intraoperative ICG for sentinel lymph node have been prospectively evaluated in early-stage vulvar cancer. The primary endpoint was to determine accuracy in the detection rate for ICG compared with technetium. Secondary objectives included tracer modality relationship with obesity, tumor size and location. RESULTS: In total, 75 patients participated at 8 centers; 38 had lateral and 37 had midline vulvar tumors. The overall sentinel lymph node detection rate was 85.3 % for technetium and 82.7 % for ICG. For lateral tumors, the detection rate was 84.2 % vs. 89.5 %, while it was 86.5 % vs. 75.7 % for middle tumors, using technetium and ICG, respectively. The median sentinel node harvest was 1.7 (range 1-4), with 24 % metastatic involvement. The sensitivity and positive predictive value for ICG based on the standard technique with technetium was 91.08 % (95 % CI, 83.76-95.84) and 94.8 % (95 % CI, 84.84-96.48), respectively. No significant differences were found comparing the two tracers in patients with midline lesions, obesity (body mass index ≥ 30) and tumor size ≥ 2-4 cm. CONCLUSION(S): ICG shows comparable performance parameters to the gold-standard of radioisotope localization.

Optimal cytoreduction: is a CT's picture worth a surgeon's word?

INTRODUCTION: The presence of residual disease after cytoreductive surgery is subjectively determined by the surgeon at the end of the operation. Nevertheless, in up to 21-49% of CT scans, residual disease can be found. The aim of this study was to establish the relationship between post-surgical CT findings after optimal cytoreduction in patients with advanced ovarian cancer and oncological outcome. MATERIAL AND METHODS: Patients with advanced ovarian cancer (FIGO II and IV), diagnosed between 2007 and 2019 in Hospital La Fe Valencia, in whom cytoreductive surgery was performed, achieving R0 or R1, were assessed for eligibility (n = 440). A total of 323 patients were excluded because a post-operative CT scan was not performed between the third and eighth post-surgery week and prior to the start of chemotherapy. RESULTS: 117 patients were finally included. The CT findings were classified into three categories: no evidence, suspicious or conclusive of residual tumour/progressive disease. 29.9% of CT scans were "conclusive of residual tumour/progressive disease". No differences were found when the DFS (p = 0.158) and OS (p = 0.215) of the three groups were compared (p = 0.158). CONCLUSION: After cytoreduction in ovarian cancer with no macroscopic disease or residual tumour < 1 cm result, up to 29.9% of post-operative CT scans before chemotherapy found measurable residual or progressive disease. Notwithstanding, a worse DFS or OS was not associated with this group of patients.

Knee Isokinetic Profiles and Reference Values of Professional Female Soccer Players.

Few studies have previously evaluated isokinetic parameters in female soccer players in comparison to those in males. The aim of this study was to describe normative quadriceps (Q) and hamstring (H) muscle strength values in professional female soccer players and to examine differences between dominant leg (DL) and nondominant leg (NDL). A standardized test protocol of concentric knee extension and flexion test protocol was conducted using the dynamometer isokinetic system (IsoMEd 2000). All the participants were healthy female professional soccer players from Spanish first and second division teams. Players were assessed for peak torque (PT) and maximum work (MW) values at 60°/s, 180°/s, and 240°/s. The mean difference was 7.17 (p-value = 0.0036), 4.4 (p-value = 0.0386), and 4.25 Nm (p-value = 0.0241) at speed 60°, 180°, and 240°/s, respectively. No statistically significant differences were detected for H-Q values between DL and NDL. This difference was 6.44 (p-value = 0.0449), and 5.87 J (p-value = 0.0266) at speed 60°, and 180°/s. The present study can be a tool that health professionals working with female professional soccer players in their care can use to assess and monitor a particular player.

Measures of accommodative function in secondary school year 9 and year 13: a 4-year longitudinal study.

PURPOSE: To characterize accommodative function in secondary school children in year 9 and year 13 and assess the possible relationship between daily working conditions (number of near work hours and distances) and accommodation variables related to accommodative excess. METHODS: This was a prospective study. Participants were 43 subjects who were first examined in year 9 and then again when they were in year 13. The accommodation variables measured in each session were as follows: accommodation amplitude (AA), accommodative response (AR), monocular and binocular accommodation flexibility (MAF and BAF), negative relative accommodation (NRA), and positive relative accommodation (PRA). Other data recorded were the number of hours spent working at near vision tasks and the distances used for these tasks. Participants were classified as those with accommodation variables within the normal range (NA) and those with variables suggesting accommodative excess (AE). RESULTS: Several accommodative function variables were below normative values in both year 9 and year 13. The number of subjects classified as having AE went from 27.9% in year 9 to 58.1% in year 13 according to AR (p < 0.005) and from 23.3 to 46.5% according to MAF (p = 0.024). More near work was reported in year 13 (44.6 h/week) than year 9 (32.7 h/week) (p < 0.001). It emerged that subjects in year 13 spent more hours working at near if they had AE than if they were assigned to the NA group. No differences were detected in near work distances used by subjects in the NA and AE groups in both years. CONCLUSIONS: In both school years, values outside the norm were detected in several accommodative function measures. Also, devoting more hours to near work was linked to a greater extent of accommodative excess. We would therefore recommend regular accommodative function assessment in secondary school children.

Radioterapia paliativa pediátrica / Pediatric palliative radiotherapy

Introducción: La radioterapia es un recurso infrautilizado en los cuidados paliativos pediátricos; sin embargo, tiene utilidad para aliviar diversos síntomas al final de la vida. Pacientes y métodos: Se muestra un estudio retrospectivo de 30 pacientes pediátricos que han recibido radioterapia por motivos paliativos. El objetivo fue revisar si la radioterapia resultó efectiva. Resultados: La radioterapia fue útil para aliviar los síntomas, mostrando una respuesta global en el 85 % de los casos y presentando toxicidades leves. Las respuestas más pobres fueron en gliomas con alivio sintomático en el 56 % de los casos, mostrando toxicidades en el 89 % de los mismos. La necesidad de anestesia supuso un factor de riesgo para el desarrollo de toxicidades. Conclusiones: El uso de la radioterapia paliativa es beneficiosa y debe incluirse en el manejo multidisciplinar del niño en cuidados paliativos. (AU)

Introduction: Radiotherapy is an underutilized resource in pediatric palliative care; however, it has utility in relieving various symptoms at the end of life. Patients and methods: A retrospective study of 30 pediatric patients who received radiotherapy for palliative reasons is reported. The objective was to review whether radiotherapy was effective. Results: Radiotherapy was useful in relieving symptoms, showing an overall response in 85 % of cases and presenting mild toxicities. The poorest responses were found in gliomas, with symptomatic relief in 56 % of cases, showing toxicities in 89 % of cases. The need for anesthesia represented risk factor for the development of toxicities. Conclusions: The use of palliative radiotherapy is beneficial and should be included in the multidisciplinary management of children in palliative care. (AU)

Analysis of the Different Scenarios of Coach's Anger on the Performance of Youth Basketball Teams.

In spite of the negative effects of anger, coaches are often seen becoming angry during games. This is especially worrying in U18 categories. Thus, the objective of this study was to identify the influence that the coach's anger has on the performance of a basketball team in competition. For this, an ad hoc observation tool was designed, in which 587 moments of anger from the coaching staff (64 coaches) were recorded in the 24 semi-final and final matches of the Spanish Autonomous Region Team Championships in 2019 and 2020 in the infantil (M = 14 years old) and cadete (M = 16 years old) categories. The results show that, in response to most incidents of coach anger, the performance of the team did not change. Significant differences were identified in some scenarios, with low- or medium-intensity anger targeted at the defence, where the team performance improved. However, anger towards the referee in the last quarter with scores level had a negative influence on the team's performance.

AT2R stimulation with C21 prevents arterial stiffening and endothelial dysfunction in the abdominal aorta from mice fed a high-fat diet.

The aim of the present study was to evaluate the effect of Compound 21 (C21), a selective AT2R agonist, on the prevention of endothelial dysfunction, extracellular matrix (ECM) remodeling and arterial stiffness associated with diet-induced obesity (DIO). Five-week-old male C57BL/6J mice were fed a standard (Chow) or high-fat diet (HF) for 6 weeks. Half of the animals of each group were simultaneously treated with C21 (1 mg/kg/day, in the drinking water), generating four groups: Chow C, Chow C21, HF C, and HF C21. Vascular function and mechanical properties were determined in the abdominal aorta. To evaluate ECM remodeling, collagen deposition and TGF-ß1 concentrations were determined in the abdominal aorta and the activity of metalloproteinases (MMP) 2 and 9 was analyzed in the plasma. Abdominal aortas from HF C mice showed endothelial dysfunction as well as enhanced contractile but reduced relaxant responses to Ang II. This effect was abrogated with C21 treatment by preserving NO availability. A left-shift in the tension-stretch relationship, paralleled by an augmented ß-index (marker of intrinsic arterial stiffness), and enhanced collagen deposition and MMP-2/-9 activities were also detected in HF mice. However, when treated with C21, HF mice exhibited lower TGF-ß1 levels in abdominal aortas together with reduced MMP activities and collagen deposition compared with HF C mice. In conclusion, these data demonstrate that AT2R stimulation by C21 in obesity preserves NO availability and prevents unhealthy vascular remodeling, thus protecting the abdominal aorta in HF mice against the development of endothelial dysfunction, ECM remodeling and arterial stiffness.

Isokinetic profiles and reference values of professional soccer players / Perfil isocinético y valores de referencia de futbolistas profesionales / Perfis isocinéticos e valores de referência dos jogadores de futebol profissional

ABSTRACT Introduction: Isokinetics is a tool commonly used in professional soccer. There is ongoing debate among researchers as to the isokinetic reference values a player should have. Objectives: To determine the absolute peak torque (PT) and average work of professional soccer players in relation to their positions on the field, and to establish the reference values for these variables. Methods: Purposeful sampling was used to select 289 professional soccer players. The sample included 32 goalkeepers, 100 defenders, 98 midfielders, and 59 strikers. The participants were measured preseason. The players were asked to perform a 10-minute warm-up on an exercise bike, and then to perform 5 repetitions at low speed, 10 at medium speed, and 25 at high speed, with 30 to 40-s of rest between each set of repetitions. The contraction method was concentric-concentric in a dynamometer Isomed 2000. Results: The average age, weight, and height of the players was 21.9 years, 74.3 kilograms, and 1.8 meters, respectively. The goalkeepers presented higher PT at the 3 measured speeds, and the higher average work at 180°/s and 240°/s in relation to defenders and midfielders. The strikers presented higher average work at 240°/s in relation to midfielders, and higher PT in relation to the defenders and midfielders. Absolute values were shown and reference values were established. Conclusions: The goalkeepers and strikers were the players that showed the greatest differences in their favor in relation to the other positions. The peak torque values and average work were described in relation to the player's position on the field. This study resulted in the creation of a tool for health professionals working with professional soccer players, providing reference values for these players in relation to their position on the field that can be used as benchmarks, by health professionals, to optimize soccer players' performance. Level of evidence II, Prospective comparative study.

RESUMEN Introducción: La evaluación isocinética es una herramienta de uso común en el fútbol profesional. Sigue existiendo debate entre los investigadores sobre los valores isocinéticos de referencia que debe tener un jugador. Objetivos: Determinar el torque máximo (TM) y el trabajo promedio de los futbolistas profesionales en relación a sus posiciones en el campo y establecer los valores de referencia para estas variables. MÉTODOS: Se seleccionó una muestra subjetiva de 289 futbolistas profesionales. Se incluyeron 32 porteros, 100 defensas, 98 centrocampistas y 59 delanteros. Los participantes fueron examinados en la pretemporada. Se solicitó a los participantes que realizaran un calentamiento de 10 minutos en bicicleta estática y luego realizar 5 repeticiones a baja velocidad, 10 a velocidad media y 25 a alta velocidad con 30 a 40 segundos de descanso entre cada serie de repeticiones. El método de contracción fue concéntrico-concéntrico en dinamómetro Isomed 2000. Resultados: La edad, el peso y la altura promedios de los jugadores fue de 21,9 años, 74,3 kilogramos y 1,8 metros, respectivamente. Los porteros presentaron TM más elevado en las 3 velocidades medidas y un mayor trabajo promedio a 180°/s y 240°/s en relación a defensas y centrocampistas. Los delanteros presentaron un mayor trabajo promedio a 240°/s en relación con los centrocampistas y TM más elevado en relación a defensas y centrocampistas. Se mostraron los valores absolutos y se establecieron los valores de referencia. Conclusiones: Los porteros y delanteros fueron los que mostraron mayores diferencias a su favor en relación al resto. Los valores de torque máximo y el trabajo promedio fueron descritos en relación a la posición del jugador en el campo. Los resultados del presente estudio son una herramienta para los profesionales de la salud que trabajan con futbolistas profesionales y proporcionó valores de referencia para estos futbolistas en lo que respecta a su posición que pueden utilizarse como referencia para optimizar el rendimiento. Nivel de evidencia II, Estudio comparativo retrospectivo.

RESUMO Introdução: A isocinética é uma ferramenta comum usada no futebol profissional. Entre os pesquisadores, há um debate contínuo sobre os valores isocinéticos de referência que um jogador deve ter. Objetivos: Determinar o pico de torque (PT) absoluto e o trabalho médio de jogadores de futebol profissional com relação às posições em campo e estabelecer os valores de referência para essas variáveis. MÉTODOS: Foi selecionada uma amostra subjetiva de 289 jogadores de futebol profissional. A amostra incluiu 32 goleiros, 100 zagueiros, 98 meio-campistas e 59 atacantes. Os participantes foram testados na pré-temporada. Os participantes foram solicitados a realizar aquecimento de 10 minutos em bicicleta ergométrica e, a seguir, realizar cinco repetições em baixa velocidade, 10 em velocidade média e 25 em alta velocidade com 30 a 40 segundos de descanso entre cada série de repetições. O método de contração foi concêntrico-concêntrico em um dinamômetro Isomed 2000. Resultados: A média de idade, peso e estatura dos jogadores foi de 21,9 anos, 74,3 quilos e 1,8 metros, respectivamente. Os goleiros apresentaram maior PT nas três velocidades medidas e maior média de trabalho a 180°/s e 240°/s com relação aos zagueiros e meio-campistas. Os atacantes tiveram maior trabalho médio a 240°/s com relação aos meio-campistas e maior PT com relação aos zagueiros e meio-campistas. Os valores absolutos foram mostrados e os valores de referência foram estabelecidos. Conclusões: Os goleiros e atacantes apresentaram as maiores diferenças a seu favor com relação às demais posições. Os valores de pico de torque e trabalho médio foram descritos com relação à posição do jogador em campo. Este estudo resultou na criação de uma ferramenta para profissionais de saúde que atuam com jogadores de futebol profissional e forneceu valores de referência para esses jogadores com relação à posição em campo que podem ser usados como referência para otimizar o desempenho dos jogadores de futebol. Nível de evidência II, Estudo retrospectivo comparativo.

Material y sedoanalgesia en el procedimiento de punción lumbar neonatal / Material and sedation-analgesia in the neonatal lumbar puncture procedure

Introducción: La punción lumbar (PL) es un procedimiento que se realiza con frecuencia durante el período neonatal. Efectuar correctamente esta técnica puede evitar gran parte de sus complicaciones. Objetivo: Evaluar el procedimiento de PL en neonatos en los hospitales españoles, estudiando el tipo de material empleado y la sedoanalgesia utilizada. Material y métodos: Estudio transversal basado en una encuesta escrita distribuida por correo electrónico a través de la Red de Hospitales Segurneo-SEN y la Sociedad Española de Neonatología, que recogía datos sobre la técnica de PL en neonatos. Resultados: Se analizaron 301 encuestas respondidas. La mayoría de profesionales utilizaban aguja tipo trocar con estilete como primera opción (89,7%). No obstante, cuando la PL era fallida o hemática el 32,2% cambiaba el tipo de aguja. Del total de médicos, 143 reflejaron su sensación subjetiva sobre el tipo de aguja: el 41,3% solo empleaban agujas tipo trocar, al 32,2% la técnica les resultaba más fácil empleando agujas de tipo «palomilla», para el 7,7% existía menor probabilidad de PL hemática o fallida usando agujas de tipo «palomilla», el 10,5% elegían aguja dependiendo del tamaño del neonato, y un 8,4% eran indiferentes a utilizar un tipo u otro de aguja. El 99% de los encuestados usaban algún tipo de analgesia. Las medidas más utilizadas fueron anestésicos tópicos (90,3%) y sacarosa (82,2%). Conclusiones: Actualmente, el procedimiento de PL en neonatos se realiza de forma mayoritaria utilizando agujas tipo trocar con estilete y con un uso extendido de diferentes medidas analgésicas para llevar a cabo la técnica. (AU)

Introduction: Lumbar puncture (LP) is a frequent procedure during the neonatal period. Correctly performing this technique can avoid many of its complications. Objective: To evaluate the LP procedure in neonates in Spanish hospitals, studying the type of material and the sedation-analgesia used. Material and methods: Cross-sectional study conducted in Spain gathering data through a survey research distributed by email through the Segurneo-SEN Hospital Network and the Spanish Neonatal Society. Data on the LP technique in neonates were collected. Results: A total of 301 participants were analysed. Most professionals used a trocar needle with a stylet as the first option (89.7%); however, when the LP failed or was blood-stained, 32.2% changed the type of needle. A total of 143 doctors gave their subjective feeling about the type of needle: they only use trocar needles with stylet (41.3%), the technique is easier using scalp-vein needles (32.2%), there is less probability of a blood-stained LP, or failed using scalp-vein needles (7.7%), they choose the type of needle depending on the size of the new-born (10.5%), indifference when using one type or another needle (8.4%). Almost all (99%) of the surveyed doctors used some type of analgesia. The most widely used measures were topical anaesthetics (90.3%) and sucrose (82.2%). Conclusions: Currently, the LP procedure in the neonatal period is mainly performed with a trocar needle with a stylet and with the widespread use of different analgesic measures. (AU)

Material and sedation-analgesia in the neonatal lumbar puncture procedure.

INTRODUCTION: Lumbar puncture (LP) is a frequent procedure during the neonatal period. Correctly performing this technique can avoid many of its complications. OBJECTIVE: To evaluate the LP procedure in neonates in Spanish hospitals, studying the type of material and the sedation-analgesia used. MATERIAL AND METHODS: Cross-sectional study conducted in Spain gathering data through a survey research distributed by email through the Segurneo-SEN Hospital Network and the Spanish Neonatal Society. Data on the LP technique in neonates were collected. RESULTS: A total of 301 participants were analysed. Most professionals used a trocar needle with a stylet as the first option (89.7%); however, when the LP failed or was blood-stained, 32.2% changed the type of needle. A total of 143 doctors gave their subjective feeling about the type of needle: they only use trocar needles with stylet (41.3%), the technique is easier using scalp-vein needles (32.2%), there is less probability of a blood-stained LP, or failed using scalp-vein needles (7.7%), they choose the type of needle depending on the size of the newborn (10.5%), indifference when using one type or another needle (8.4%). Almost all (99%) of the surveyed doctors used some type of analgesia. The most widely used measures were topical anaesthetics (90.3%) and sucrose (82.2%). CONCLUSIONS: Currently, the LP procedure in the neonatal period is mainly performed with a trocar needle with a stylet and with the widespread use of different analgesic measures.

Pediatric home confinement due to COVID-19: Somatic and anxiety spectrum consequences.

AIMS AND OBJECTIVES: We aimed to determine the impact of COVID-19 related home confinement on the paediatric population by focusing on anxiety, behavioural disturbances and somatic symptoms. BACKGROUND: To limit the spread of the COVID-19 outbreak, governments have imposed nationwide lockdowns to prevent direct contact; this has affected everyday lives and activities such as attending school classes. Such isolation may have impacted children's anxiety levels. DESIGN AND METHODS: We conducted a cross-sectional observational study using a web-based anonymous questionnaire from 22-26 April, 2020, among children (N = 2,292) in Spain. For children below 7 years of age, parents reported the children's behavioural, emotional and somatic symptoms and family environment data on a questionnaire designed by the researchers. Children over 7 years answered the Revised Children's Manifest Anxiety Scale either independently or with their parents' assistance. RESULTS: Children over 7 years, boys in particular, scored high on the anxiety spectrum. Moreover, participants who knew someone who had suffered from COVID-19 at home or whose parent was directly involved in the pandemic, obtained higher Total Anxiety scores. Significantly high values were found in all aspects of anxiety among those who feared infection or whose parents been unemployed. Of the children below 7 years, 56.3% had four or more anxiety-related symptoms, the most frequent of which were tantrums, emotional changes, restlessness and fear of being alone. The number of symptoms reported was significant when someone in the family home had been infected with COVID-19. CONCLUSIONS: The COVID-19 home confinement had a significant impact on children, causing anxiety, behavioural problems and somatic manifestations. RELEVANCE TO CLINICAL PRACTICE: Nurses play a key role in screening children who have experience confinement owing to the COVID-19 pandemic in order to detect early anxiety symptoms using tele-health. Suitable direct interventions can then be implemented or interdisciplinary manage could be started.

The impact of submucosal fatty tissue during colon endoscopic submucosal dissection in a western center.

OBJECTIVES: Obesity is associated with submucosal fatty tissue. The main aim of this study was to assess the impact of submucosal fatty tissue on the success of colonic endoscopic submucosal dissection (C-ESD) in a western population. METHODS: This was a retrospective analysis of 125 consecutive C-ESDs performed between October 2015 and July 2017. Fatty tissue sign was defined as positive when the submucosal layer was covered with fatty tissue. The complexity of performing an ESD was assessed by the performing endoscopist, defined by the occurrence of intraprocedural perforation, inability to complete an en-bloc resection or a procedure time exceeding 180 min. RESULTS: Fatty tissue sign positive was present in 44.8% of the procedures. There were 28 (22.4%) c-ESD defined as complex. Factors associated with complex ESD included; fatty tissue sign [odds ratio (OR) 12.5; 95% confidence interval (CI), 1.9-81.9; P = 0.008], severe fibrosis (OR 148.6; 95% CI, 6.6-3358.0; P = 0.002), poor maneuverability (OR 267.4; 95% CI, 11.5-6212.5; P < 0.001) and polyp size ≥35 mm (OR 17.2; 95% CI, 2.6-113.8; P = 0.003). In patients demonstrating the fatty tissue sign, BMI and waist-to-height ratio (WHtR) were higher (27.8 vs. 24.7; P < 0.001 and 0.56 vs. 0.49; P < 0.001, respectively) and en-bloc resection was achieved less frequently (76.8 vs. 97.1%, P = 0.001). Multivariate analysis revealed higher risk of fatty tissue sign positive associated with WHtR ≥0.52 (OR 26.10, 95% CI, 7.63-89.35, P < 0.001). CONCLUSION: This study demonstrates that the fatty tissue sign contributes to procedural complexity during C-ESD. Central obesity correlates with the likelihood of submucosal fatty tissue and as such should be taken into account when planning procedures.

A Predictive Score of Antitumour Activity of Novel Agents in Cancer Patients Treated in Early Phase Studies.

INTRODUCTION: Phase I trials aim to determine the maximum-tolerated dose of a particular drug while minimizing the number of patients exposed to either sub-therapeutic doses or severe toxicity. Thus, patient selection for phase I trials is a key component of any clinical trial design. Though several studies have been made to address this issue, patient selection still represents a major clinical challenge that needs further investigation. METHODS: Twenty-nine baseline clinical and analytical characteristics of 773 consecutive patients treated in phase I trials between 2008 and 2016 in START Madrid-CIOCC were analysed and correlated to objective response (OR), progression-free survival, median overall survival, toxicity, and treatment type. The ones associated to OR in the univariate analysis were included in the stepwise logistic regression multivariate and Cox analysis. The statistically significant ones were included in a predictive score (named here as the Madrid score) of antitumour activity. RESULTS: Body mass index (BMI) >25 (p = 0.027), two or less previous lines of treatment (p = 0.007), and normal levels of alkaline phosphatase (ALP) (p = 0.007) were found to positively correlate to radiological response. A Madrid score was generated using these three factors as predictive parameters: compared to a score of 2-3 (where 2 or 3 of these variables are altered), a score of 0-1 is associated with longer survival time (11.6 vs. 8.6 months; p = 0.005) and overall response (17 vs. 7.6%; p = 0.003). CONCLUSION: The predictive Madrid score, based on the BMI, number of prior lines of treatment, and ALP levels, might be helpful to accurately select patients who would benefit from oncology phase I clinical trials.

A New Pipeline for Designing Phage Cocktails Based on Phage-Bacteria Infection Networks.

In recent years, the spread of antibiotic-resistant bacteria and efforts to preserve food microbiota have induced renewed interest in phage therapy. Phage cocktails, instead of a single phage, are commonly used as antibacterial agents since the hosts are unlikely to become resistant to several phages simultaneously. While the spectrum of activity might increase with cocktail complexity, excessive phages could produce side effects, such as the horizontal transfer of genes that augment the fitness of host strains, dysbiosis or high manufacturing costs. Therefore, cocktail formulation represents a compromise between achieving substantial reduction in the bacterial loads and restricting its complexity. Despite the abovementioned points, the observed bacterial load reduction does not increase significantly with the size of phage cocktails, indicating the requirement for a systematic approach to their design. In this work, the information provided by host range matrices was analyzed after building phage-bacteria infection networks (PBINs). To this end, we conducted a meta-analysis of 35 host range matrices, including recently published studies and new datasets comprising Escherichia coli strains isolated during ripening of artisanal raw milk cheese and virulent coliphages from ewes' feces. The nestedness temperature, which reflects the host range hierarchy of the phages, was determined from bipartite host range matrices using heuristic (Nestedness Temperature Calculator) and genetic (BinMatNest) algorithms. The latter optimizes matrix packing, leading to lower temperatures, i.e., it simplifies the identification of the phages with the broadest host range. The structure of infection networks suggests that generalist phages (and not specialist phages) tend to succeed in infecting less susceptible bacteria. A new metric (Φ), which considers some properties of the host range matrices (fill, temperature, and number of bacteria), is proposed as an estimator of phage cocktail size. To identify the best candidates, agglomerative hierarchical clustering using Ward's method was implemented. Finally, a cocktail was formulated for the biocontrol of cheese-isolated E. coli, reducing bacterial counts by five orders of magnitude.

Corrigendum: Diversity and Local Coadaptation of Escherichia coli and Coliphages From Small Ruminants.

[This corrects the article DOI: 10.3389/fmicb.2020.564522.].

Diversity and Local Coadaptation of Escherichia coli and Coliphages From Small Ruminants.

Bacteriophages are highly specific predators that drive bacterial diversity through coevolution while striking tradeoffs among preserving host populations for long-term exploitation and increasing their virulence, structural stability, or host range. Escherichia coli and other coliform bacteria present in the microbiota of milk and during early ripening of raw milk cheeses have been linked to the production of gas, manifested by the appearance of eyes, and the development of off-flavors; thus, they might cause early blowing and cheese spoilage. Here, we report the characterization of coliphages isolated from manure from small ruminant farms and E. coli strains isolated from goat and sheep raw milk cheese. Additionally, the virulence and host range of locally isolated and laboratory collection phages were determined by comparing the susceptibility of E. coli strains from different sources. In agreement with the high genetic diversity found within the species E. coli, clustering analysis of whole-cell protein revealed a total of 13 distinct profiles but none of the raw milk cheese isolates showed inhibition of growth by reference or water-isolated coliphages. Conversely, 10 newly isolated phages had a broad host range (i.e., able to lyse ≥50% of bacterial hosts tested), thus exhibiting utility for biocontrol and only one cheese-isolated E. coli strain was resistant to all the phages. Whereas there was a high positive correlation between bacterial susceptibility range and lysis intensity, the phages virulence decreased as range increased until reaching a plateau. These results suggest local gene-for-gene coevolution between hosts and phages with selective tradeoffs for both resistance and competitive ability of the bacteria and host-range extension and virulence of the phage populations. Hence, different phage cocktail formulations might be required when devising long-term and short-term biocontrol strategies.