Interplay between the oxidation process and cytotoxic effects of antimonene nanomaterials.

Pnictogen nanomaterials have recently attracted researchers' attention owing to their promising properties in the field of electronic, energy storage, and nanomedicine applications. Moreover, especially in the case of heavy pnictogens, their chemistry allows for nanomaterial synthesis using both top-down and bottom-up approaches, yielding materials with remarkable differences in terms of morphology, size, yield, and properties. In this study, we carried out a comprehensive structural and spectroscopic characterization of antimony-based nanomaterials (Sb-nanomaterials) obtained by applying different production methodologies (bottom-up and top-down routes) and investigating the influence of the synthesis on their oxidation state and stability in a biological environment. Indeed, in situ XANES/EXAFS studies of Sb-nanomaterials incubated in cell culture media were carried out, unveiling a different oxidation behavior. Furthermore, we investigated the cytotoxic effects of Sb-nanomaterials on six different cell lines: two non-cancerous (FSK and HEK293) and four cancerous (HeLa, SKBR3, THP-1, and A549). The results reveal that hexagonal antimonene (Sb-H) synthesized using a colloidal approach oxidizes the most and faster in cell culture media compared to liquid phase exfoliated (LPE) antimonene, suffering acute degradation and anticipating well-differentiated toxicity from its peers. In addition, the study highlights the importance of the synthetic route for the Sb-nanomaterials as it was observed to influence the chemical evolution of Sb-H into toxic Sb oxide species, playing a critical role in its ability to rapidly eliminate tumor cells. These findings provide insights into the mechanisms underlying the dark cytotoxicity of Sb-H and other related Sb-nanomaterials, underlining the importance of developing therapies based on controlled and on-demand nanomaterial oxidation.

Modifications in Upper Airway Collapsibility during Sleep Endoscopy with a Mandibular Positioner: Study in Snorers and Obstructive Sleep Apnea Patients.

BACKGROUND: Mandibular advancement devices (MADs) are an effective treatment for patients with sleep-related breathing disorders, with variable response. Increasingly more research points to the predictive value of Drug-Induced Sleep Endoscopy (DISE) in patient selection. This study aims to analyze the changes in upper airway collapsibility using a titratable MAD simulator during DISE. METHODS: This study included 104 patients with simple snoring and obstructive sleep apnea (OSA). The VOTE scale was used to assess the presence of collapses during the DISE both without and with the MAD simulator. RESULTS: In snorers, there was a decrease in collapses at the level of the soft palate and oropharynx when the advancement was achieved. Patients with mild OSA also showed a decrease in collapses at the base of the tongue. Patients with moderate/severe OSA exhibited significant amelioration at all levels. The levels at which there were residual collapses despite the maneuver were, in order, the velopharynx, oropharynx, epiglottis, and tongue. CONCLUSIONS: The MAD simulator reduces collapsibility at all levels and in all severity groups. Residual collapses suitable for combined treatments were able to be identified. This highlights the need for individualized patient selection, as upper airway collapsibility exhibits variable improvement or worsening with the MAD simulator regardless of the severity of the condition.

DISE with CPAP: a useful procedure to evaluate upper airway collapsibility.

PURPOSE: Drug-induced sleep endoscopy (DISE) is commonly performed in patients suffering obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) intolerance. We aimed to evaluate the effects of adding CPAP to DISE to provide understanding of the reason of its failure and better guidance in future therapeutic decisions. METHODS: A retrospective observational descriptive study was conducted on CPAP-intolerant patients with moderate-severe OSA. DISE was used to evaluate upper airway collapsibility, and CPAP was tested to better describe anatomical sites of obstruction and to measure the opening pharyngeal pressure. RESULTS: Sample size consisted of 38 patients with a mean age of 49 ± 9 years. Mean BMI was 28.4 ± 2.4 kg/m2, mean apnea-hypopnea index (AHI) was 35.4 events per hour ± 20.1, and mean saturation under 90% (TSat90) was 14.5%. In DISE we found a collapse at Velum in 92% of patients, at Oropharyngeal level in 89%, at tongue in 42%, and at epiglottis in 36%. In the subgroup of patients with clinical failure with CPAP, we observed 100% of epiglottic collapse and 50% of tongue obstruction. In this specific population, we recommended personalized surgery and myofunctional therapy. CONCLUSION: DISE-CPAP is a useful tool to select the treatment that better fits to each patient taking care all information available. It improves our ability to prescribe a multilevel treatment with an exhaustive topographic evaluation of upper airway collapsibility that complements CPAP classic titration, and it can be helpful to distinguish better candidates for surgery, myofunctional therapy or CPAP.

Hexagonal Hybrid Bismuthene by Molecular Interface Engineering.

High-quality devices based on layered heterostructures are typically built from materials obtained by complex solid-state physical approaches or laborious mechanical exfoliation and transfer. Meanwhile, wet-chemically synthesized materials commonly suffer from surface residuals and intrinsic defects. Here, we synthesize using an unprecedented colloidal photocatalyzed, one-pot redox reaction a few-layers bismuth hybrid of "electronic grade" structural quality. Intriguingly, the material presents a sulfur-alkyl-functionalized reconstructed surface that prevents it from oxidation and leads to a tuned electronic structure that results from the altered arrangement of the surface. The metallic behavior of the hybrid is supported by ab initio predictions and room temperature transport measurements of individual nanoflakes. Our findings indicate how surface reconstructions in two-dimensional (2D) systems can promote unexpected properties that can pave the way to new functionalities and devices. Moreover, this scalable synthetic process opens new avenues for applications in plasmonics or electronic (and spintronic) device fabrication. Beyond electronics, this 2D hybrid material may be of interest in organic catalysis, biomedicine, or energy storage and conversion.

Chemistry of two-dimensional pnictogens: emerging post-graphene materials for advanced applications.

The layered allotropes of group 15 (P, As, Sb and Bi), also called two-dimensional (2D) pnictogens, have emerged as one of the most promising families of post-graphene 2D-materials. This is mainly due to the great variety of properties they exhibit, including layer-dependent bandgap, high charge-carrier mobility and current on/off ratios, strong spin-orbit coupling, wide allotropic diversity and pronounced chemical reactivity. These are key ingredients for exciting applications in (opto)electronics, heterogeneous catalysis, nanomedicine or energy storage and conversion, to name a few. However, there are still many challenges to overcome in order to fully understand their properties and bring them to real applications. As a matter of fact, due to their strong interlayer interactions, the mechanical exfoliation (top-down) of heavy pnictogens (Sb & Bi) is unsatisfactory, requiring the development of new methodologies for the isolation of single layers and the scalable production of high-quality flakes. Moreover, due to their pronounced chemical reactivity, it is necessary to develop passivation strategies, thus preventing environmental degradation, as in the case of bP, or controlling surface oxidation, with the corresponding modification of the interfacial and electronic properties. In this Feature Article we will discuss, among others, the most important contributions carried out in our group, including new liquid phase exfoliation (LPE) processes, bottom-up colloidal approaches, the preparation of intercalation compounds, innovative non-covalent and covalent functionalization protocols or novel concepts for potential applications in catalysis, electronics, photonics, biomedicine or energy storage and conversion. The past years have seen the birth of the chemistry of pnictogens at the nanoscale, and this review intends to highlight the importance of the chemical approach in the successful development of routes to synthesise, passivate, modify, or process these materials, paving the way for their use in applications of great societal impact.

Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol.

Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, BMI of 27.90 (SD = 4.19) kg/m2, and a mean AHI of 26.51 (SD = 21.23). The results showed no relationship between severity and MAD recommendation. Furthermore, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the interexaminer bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.

Canalization technique to obtain deep tissue biopsy of gastrointestinal subepithelial tumors as an alternative to conventional known techniques.

BACKGROUND AND OBJECTIVES: The most accurate technology to detect and diagnose subepithelial tumors (SETs) is the endoscopic ultrasonography (EUS) combined with puncture techniques, such as the endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) or the endoscopic ultrasonography-guided fine-needle biopsy. Going further in the improvement of the results of tumor samples obtained endoscopically to diagnose the SETs, the canalization technique guided by miniprobes (MPs) to obtain biopsies of SET could be an alternative to EUS-FNA. The objective of this study is to analyze the results of samples obtained by this procedure. MATERIALS AND METHODS: A multicenter, retrospective study of a review of a database of 32 consecutive patients with a SET in the digestive tract, from 2000 to 2015 was conducted. All patients underwent EUS-performed by MP, to define the size, internal echostructure, and layer of origin of tumor. Once the echostructure was defined, it proceeded to the canalization technique to arrive to the tumor tissue. RESULTS: The average diameter of SETs in this series (32 patients) was about 21.6±11 mm (range: 5-41 mm). The diagnostic accuracy was 28/32, 87.50% (Confidence interval 95%: 76.04%-98.99%), and there were no major complications. All procedures were performed on outpatients, none of which required additional hospitalization. The 50% of patients were operated or endoscopically resected and in all cases, the previous pathological diagnosis was confirmed. CONCLUSIONS: This is a feasible, safe, and effective procedure that allows to access to inside of SET to obtain deep biopsies. Tumor samples obtained by deep biopsy, with prior performing of the canalization technique guided by MP, were sufficient for histopathological and immunohistochemical diagnosis and similar to those obtained with other known methods (FNA Trucut, ProCore®, etc.). However, more prospective comparative studies with a larger number of patients and different specialists carrying out the procedure to reach a higher statistical significance are necessary.

HIV infection early diagnosis experience in primary care.

INTRODUCTION: Traditional screening system focus on classic risk factors "lost" a substantial proportion of HIV-infected patients. Several organizations such as CDC or USPS Task Force favour universal screening for HIV infection for good cost-effectiveness profile. In a previous study prevalence of HIV infection in patients attending our infectious diseases department was high (5.4%). OBJECTIVE: To determine prevalence of HIV infection in patients aged 20-55 years in primary care (PC). MATERIAL AND METHODS: A propsective observational study was undertaken between February and June 2013. We performed a screening of HIV infection type "Opt-out" (offering voluntary rejection) in 4 PC centers (32 Physicians) in San Juan-Alicante. Sample size (n=318) for a prevalence of 1% and a confidence level of 97% was calculated. Nevertheless, other PC physician not recruiting patients performed HIV testing according clinical risk factors. RESULTS: HIV testing was offered to 508 patients. Mean age 38.9±10 years (58.5% female). Overall, 430 (83.8%) agreed to participate. Finally, 368 patients (71.7% of total) were tested for HIV. No patient had a positive result (100% ELISA HIV negative). However, following clinical practice, 3 patients were diagnosed of HIV in the same period by non-recruiting physicians. In 2 cases, serology was performed at the patient's request and in one case by constitutional syndrome. The 3 patients were MSM. CONCLUSIONS: 1) In our study, we detected no new cases of HIV infection through universal screening. 2) Our screened population could be lower-risk because of high percentage of women included (58.5%). 3) Performing HIV opt-in screening (clinical practice), we detected 3 cases in the same period, all having HIV risk factors (MSM). 4) These results suggest that opt-out screening should be developed in high-risk populations. It is still to be determined what is the best screening strategy in low-risk populations such as ours.

CTX-M-15-producing urinary Escherichia coli O25b-ST131-phylogroup B2 has acquired resistance to fosfomycin.

OBJECTIVES: To describe trends in fosfomycin resistance in urinary isolates of Escherichia coli producing extended-spectrum beta-lactamases (ESBLs) in relation to fosfomycin consumption and to characterize representative fosfomycin-resistant isolates. METHODS: In 2007-08, an unexpected increase in fosfomycin resistance in ESBL-producing urinary E. coli was observed. Laboratory records were reviewed and a prospective surveillance study was initiated on all urinary tract infections caused by ESBL-producing, fosfomycin-resistant E. coli. bla(ESBL) types, phylogroups, genetic environment and afa/dra operon were determined by PCR and sequencing. Molecular epidemiology was analysed by PFGE and multilocus sequence typing. To elucidate possible mechanisms of fosfomycin resistance, uhpT, glpT, uhpA, ptsI, cyaA and murA genes were analysed. Fosfomycin consumption was determined as recommended by WHO. RESULTS: From 2004 to 2008, fosfomycin consumption increased by 50%, while fosfomycin resistance in ESBL producers increased from 2.2% to 21.7%. Of 26 isolates studied, 24 produced CTX-M-15 and belonged to the O25b-ST131-phylogroup B2 clonal strain. PFGE revealed two clusters. Cluster I included 18 isolates, 16 of them indistinguishable from strains producing CTX-M-15 previously described in Madrid. The five isolates of Cluster II had the IS26 linked to bla(CTX-M-15) and the afa/dra operon. In Cluster I isolates, no mutations in glpT, uhpT, uhpA, ptsI, cyaA and murA were detected. Cluster II isolates showed a 15 bp deletion (A(169)-C(183)) in uhpA. CONCLUSIONS: Fosfomycin resistance in urinary E. coli has increased due to the acquisition of this resistance by a previously circulating CTX-M-15-producing E. coli O25b-ST131-phylogroup B2 strain. This happened during a period when the use of fosfomycin increased by 50%.

Melanoma maligno amelanótico de la mucosa nasal / Amelanotic malignant melanoma of nasal cavity

El melanoma maligno de origen mucoso del tractosinonasal es un tumor infrecuente. De las localizacionesmucosas ORL la cavidad nasal es la mas común. Noobstante la inespecificidad de los síntomas y la inaccesibilidadde la fosa nasal para el autoexamen retrasan eldiagnóstico. El tratamiento de elección es la asociaciónde cirugía y radioterapia. El pronóstico es malo debido ala alta incidencia de recidiva local y de metástasis tardías.Presentamos el caso clínico de un paciente varónde 60 años, su manejo clínico y terapéutico

Primary mucosal malignant melanoma of the nasal cavityis an unusual tumour. Interestingly, the nasal cavityrepresents the most common site of mucosal melanomain Otolaryngology. However, the symptoms are non-specificand the relative inaccessibility of the nasal cavity to selfexamination,often delays diagnosis. Surgery, accompaniedby radiation, is the election treatment. Theprognosis is poor because a high rate of local recurrenceand late metastasis. We present the case of a male patient60 years old, describing the diagnostic and therapeuticsmethods that we´re carry on

Cuerpos extraños esofágicos en adultos. Análisis de 308 pacientes / Esophageal foreign bodies in adults. Analysis of 308 patients

Hemos realizado un estudio retrospectivo sobre 308 pacientes adultos que acudieron al servicio de urgencias con sospecha de cuerpo extraño esofágico. Analizamos las siguientes variables: edad, sexo, antecedentes personales, sintomatología clínica inicial, tipo de cuerpo extraño referido, localización, tratamiento realizado y evolución hospitalaria. 49 casos se resolvieron espontáneamente o mediante tratamiento médico. 203 cuerpos extraños (65,9 por ciento) fueron extraídos mediante endoscopia digestiva mientras que 56 pacientes (18,2 por ciento) fueron ingresados y precisaron esofagoscopia rígida por nuestro servicio. En el postoperatorio constatamos 5 casos de perforación esofágica de los que 3 se resolvieron con tratamiento médico conservador, 1 precisó reintervención y otro más se complicó con mediastinitis. El resto evolucionaron bien (AU)

Otitis externa aguda por Citrobacter Freundii. A propósito de un caso clínico

Citrobacter Freundii es una Enterobacteria oportunista que se aisla rara vez de procesos patológicos, fundamentalmente infecciones urinarias y respiratorias. Presentamos el caso de una mujer de 67 años diagnosticada de una otitis externa aguda derecha, sin antecedentes personales de interés, y en cuyo frotis ótico el Laboratorio de Microbiología aisló este germen. Se trata de una asociación extremadamente rara con pocas referencias en la literatura. La paciente fue tratada con netilmicina (4 días) y metilprednisolona IM (3 días), continuando posteriormente con tratamiento tópico una semana más. La evolución fue satisfactoria con remisión completa de la sintomatología (AU)

Histiocitosis de células de Langerhans / Langerhans’ cells histiocytosis

La Histiocitosis X o de células de Langerhans, es una enfermedad poco frecuente caracterizada por el acúmulo de histiocitos en diferentes órganos y tejidos formando granulomas. De expresión clínica y tratamiento variable, presentamos el caso de una paciente joven que debuta con sintomatología ótica de varios meses de evolución. Pretendemos resaltar la importancia de esta patología en la esfera ORL y hacer una revisión de la literatura actual (AU)

Hiperparatiroidismo terciario. A propósito de 3 casos / Tertiary hyperparathyroidism. About three cases

Presentamos tres casos de hiperparatiroidismo terciario recogidos estadísticamente durante 10 años. Analizamos el estado clínico pre y postquirúrgico de los tres pacientes que fueron sometidos por nuestro Servicio a distintos tipos de cirugía con objeto de mejorar su enfermedad de base. En todos los casos desapareció la hipercalcemia con mejoría significativa de las manifestaciones osteoarticulares avanzadas que sufrían antes de la intervención quirúrgica. La anatomía patológica (AP) reveló la presencia de hiperplasia de paratiroides en dos casos y constató un adenoma en el tercero. Realizamos una revisión de la literatura sobre esta patología poco frecuente pero que repercute claramente sobre la calidad de vida de los pacientes (AU)