Evaluation of imidacloprid (Confidor OD®) genotoxicity in Chrysoperla externa eggs (Neuroptera: Chrysopidae) through comet assay.

The comet assay allows the analysis of DNA damage caused by different genotoxins. This assay has recently gained interest because of its ease of studying the interactions of xenobiotics with different organisms. Chrysoperla externa (Hagen, 1861) is a species of great economic relevance because it is a predator of major agricultural pests during its larval stage. Neonicotinoids are the most important chemical class of insecticides introduced into markets. A previous imidacloprid toxicity assessment on C. externa showed that this neonicotinoid insecticide reduced the egg viability. The objective of this study was to analyze the genotoxicity of Confidor OD® (imidacloprid 20% a.i., LS, Bayer CropScience) on the biological control agent C. externa at DNA level using the comet assay as an ecotoxicological biomarker. A comet assay protocol has been developed for this species at first time. For the bioassays, the commercial product formulated Confidor OD® was used at two concentrations: 100 and 180 mg/l of the active ingredient. Selected eggs were dipped in a Confidor OD® solution for 15 s. Descriptors evaluated in the comet assay were damage index, % DNA damage, and tail length. The damage index did not show any significant differences between the different concentrations evaluated, but differences were observed for tail length, because at higher concentrations of Confidor OD®, there were greater DNA breaks. The DNA of the cells from treated eggs analyzed at 48 h and 96 h of development showed the same % DNA damage; that is, they had no recovery capacity. Application of Confidor OD® to C. externa eggs produced irreparable breaks at the DNA level. The technique adjusted for C. externa can be used in other beneficial insects to study pesticide genotoxicity using a comet assay.

A 'Total Unique Variation Analysis' for Brain-Machine Interfaces.

When designing a fully implantable brain-machine interface (BMI), the primary aim is to detect as much neural information as possible with as few channels as possible. In this paper, we present a total unique variance analysis (TUVA) for evaluating the signal unique to each channel that cannot be predicted by linear combination of signals on other channels. TUVA is a statistical method for determining the total unique variance in multidimensional data, ordering channels from most to least informative, to aid in the design of maximally-efficacious BMIs. We demonstrate how this method can be applied to the design of BMIs by comparing TUVA values computed for simulated lead-field maps for high-channel-count electrocorticography (ECoG) with values computed for recordings in the interictal period in the context of surgery planning for epileptic resection.Clinical Relevance- This paper introduces a new statistical method for comparison of neural interface designs, focused on quantifying recording efficiency by minimizing channel crosstalk, which may help improve the risk-benefit profile of invasive neural recording.

Foot injuries in sport climbers: footwear and other associated factors / Alteraciones podológicas en la escalada: pies de gato y otros factores asociados

Foot injuries are frequent among climbers. This may be due to several factors, such as the use of climbing shoes. Objectives: To perform a descriptive analysis of foot injuries in sport climbers and to examine their possible relationship with various factors, including the use of climbing shoes. Methods: 26 climbers participated in the study. General characteristics, foot pain during climbing, observed podiatric conditions and the reductions in the size (cm) of climbing shoes compared to daily footwear were noted. Results: All climbers presented foot injuries and most had foot pain. In addition, hallux valgus, grazes, and hyperkeratosis were related to the small size of climbing shoes. Conclusions: Foot disorders and foot pain are very frequent in sport climbing. Furthermore, along with other associated factors, the size of the reduction of climbing shoes increases the probability of developing various podiatric conditions. (AU)

Introducción: Los escaladores presentan alteraciones podológicas frecuentemente. Esto puede deberse a distintos factores, incluido el uso de los pies de gato. Objetivos: Realizar un análisis descriptivo de las afecciones podológicas en la escalada y analizar su posible relación con varios factores, incluidos los pies de gato. Métodos: 26 escaladores participaron en el estudio. Se anotaron sus características generales, el dolor de pies sufrido al escalar, las alteraciones podológicas presentes y la reducción del tamaño de los pies de gato respecto al calzado habitual. Resultados: Todos los escaladores padecían alteraciones podológicas y la gran mayoría escalaba con dolor. Asimismo, el hallux valgus, las rozaduras y la hiperqueratosis se relacionaron con el tamaño reducido de los pies de gato. Conclusiones: Las alteraciones y el dolor de pies son muy habituales en escaladores, siendo varias las alteraciones propiciadas por la magnitud de la reducción de los pies de gato, entre otros factores asociados. (AU)

Primary Melanoma miRNA Trafficking Induces Lymphangiogenesis.

Melanoma, the deadliest cutaneous tumor, initiates within the epidermis; during progression, cells invade into the dermis and become metastatic through the lymphatic and blood system. Before melanoma cell invasion into the dermis, an increased density of dermal lymphatic vessels is observed, generated by a mechanism which is not fully understood. In this study, we show that, while at the primary epidermal stage (in situ), melanoma cells secrete extracellular vesicles termed melanosomes, which are uptaken by dermal lymphatic cells, leading to transcriptional and phenotypic pro-lymphangiogenic changes. Mechanistically, melanoma-derived melanosomes traffic mature let-7i to lymphatic endothelial cells, which mediate pro-lymphangiogenic phenotypic changes by the induction of type I IFN signaling. Furthermore, transcriptome analysis upon treatment with melanosomes or let-7i reveals the enhancement of IFI6 expression in lymphatic cells. Because melanoma cells metastasize primarily via lymphatic vessels, our data suggest that blocking lymphangiogenesis by repressing either melanosome release or type I IFN signaling will prevent melanoma progression to the deadly metastatic stage.

Association of Circulating Tumor Cells and Tumor Molecular Profile With Clinical Outcomes in Patients With Previously Untreated Metastatic Colorectal Cancer: A Pooled Analysis of the Phase III VISNÚ-1 and Phase II VISNÚ-2 Randomized Trials.

BACKGROUND: The bCTC count is a well-established prognostic biomarker in mCRC, as well as in other tumor types. The aim of this analysis was to evaluate the prognostic/predictive role of the bCTC count (≥3 vs. <3) in previously untreated mCRC. PATIENTS AND METHODS: The study involved 589 untreated mCRC patients included in the intention-to-treat population of 2 randomized clinical trials (phase III VISNU-1 [NCT01640405] and phase II VISNU-2 [NCT01640444] studies). RESULTS: Of the 589 patients, 349 (59.2%) had bCTC≥3 and 240 (40.7%) had bCTC<3. Multivariate analysis showed that the bCTC count is an independent prognostic factor for overall survival (OS) (HR 0.59, 95% CI 0.48-0.72; P = 0.000) and potential for progression-free survival (PFS) (P = 0.0549). Median OS was 32.9 and 19.5 months in patients with bCTC<3 and bCTC≥3 (P <0.001), respectively. This effect was also observed comparing OS in RASwt patients from both studies. Other prognostic factors were: ECOG-PS, primary tumor site, number of metastatic sites and surgery of the primary tumor. Median OS was lower for patients treated with anti-VEGF versus anti-EGFR (22.3 vs. 33.3 months, P <0.0001) while there were no significant differences in PFS according to the targeted treatment received. CONCLUSION: This post-hoc analysis of 2 randomized studies confirms the poor prognosis of patients with bCTC≥3 but this is not associated with other adverse independent prognostic factors such as RAS/BRAF mutations.

The Effect of Proton Pump Inhibitors on Early Implant Failure A Retrospective Cohort Study.

Background and Objectives: Maintenance of a firm and long-term stable osseointegration is the primary goal of implant dentistry. Time is used to define implant failure characteristics. Early implant failure (EIF) occurs up to one year after loading. Recent studies indicated an association between proton pump inhibitors (PPI) therapy and failure of osseointegration. The present study assessed whether the use of PPIs is a risk factor to EIF. Materials and methods: A retrospective cohort study including 687 patients and 2971 dental implants. The study group (PPIs users) comprised 17.3% (119) individuals and 18.7% (555) implants. The remaining cohort (82.7% (568) individuals and 81.3% (2416) implants) served as control. The information was taken from the patients' files. The following information was collected: age, gender, physical status, systemic diseases, HbA1C values before and after implant-supported prosthesis delivery in cases of diabetes mellitus, smoking, implant location, number of implants per individual, bone augmentation, implant brand, length and width, and EIF. EIF was defined as implant removal within a period of up to 12 months from loading. Results: EIF in PPIs vs. non-PPIs users was 19.3% vs. 14.3% (p = 0.16) at patient level and 5.4% vs. 3.5% at implant level (p = 0.03). Univariate analysis yielded factors significantly associated with PPIs use, including older age, physical status of the American Society of Anesthesiology (ASA) 3, hypertension, hyperlipidemia, diabetes mellitus, osteoporosis, cardiovascular accident (CVA), location (anterior mandible), shorter and narrower implants, and higher number of implants per individual. Multivariate analysis yielded statistically significant OR of 1.91; p = 0.01 for EIF following PPIs use and 2.3; p < 0.001 for location in anterior mandible. Conclusions: Patients and their healthcare providers are advised to carefully consider the potential risks of taking PPIs prior to dental implant surgery. Further research is needed to confirm these risks and elucidate systemic and local factors that may be involved in such outcomes.

Clinical outcomes of single application multi-fractionated CT-guided interstitial high-dose-rate brachytherapy for locally advanced cervical cancer: A multi-institution initial experience.

Purpose: The aim of the study was to evaluate the safety and clinical outcomes of single application multi-fractionated computed tomography (CT)-guided interstitial high-dose-rate brachytherapy given in four fractions in locally advanced cervical cancer. Material and methods: Patients with locally advanced cervical cancer stage IIB-IVA treated definitively with external radiation ± weekly cisplatin, followed by single application multi-fractionated CT-guided interstitial high-dose-rate brachytherapy in four fractions were included. Dosimetry data, clinical response, and toxicity records were reviewed. Results: Between January 2018 and December 2022, twenty-two patients were included. Clinical stage distribution was as follows: IIB - 13.6%, IIIB - 27.3%, IIIC - 22.7%, and IVA - 36.4%. Mean high-risk clinical target volume (HR-CTV) was 66.19 ±32.69 cm3, and HR-CTV D90 dose was 86.8 ±1.7 Gy. 2 cc doses to bladder, rectum, and sigmoid were 84.6 ±2.8 Gy, 71.5 ±2.4 Gy, and 65.6 ±4.0 Gy, respectively. Mean overall treatment time was 66 ±21 days. With a median follow-up of 11.5 months (range, 5-44 months), median survival and local control were not achieved. One-year local control rate, one-year progression-free survival, and one-year overall survival were 82%, 66%, and 78%, respectively. Univariate analysis showed overall treatment time to be the only variable associated with all oncologic outcomes. For acute toxicity, grade 3 toxicity in four patients and grade 4 toxicity of infection in one patient were observed. For late toxicity, grade 3 gastrointestinal toxicity was noted in two patients. Conclusions: Initial results suggest that single application multi-fractionated CT-guided interstitial brachytherapy given in four fractions in locally advanced cervical cancer seems to be feasible and safe, but additional evidence is needed to generate more validated conclusions.

Descentralización de la elaboración de los tratamientos antineoplásicos. Optimización de los recursos / Decentralisation of the preparation of antineoplastic treatments. Resources

Objetivos: La metodología “Six Sigma” se basa en el análisis de los flujos de trabajo e identificación de los puntos de mejoras con el fin de lograr una máxima eficiencia en los procesos, tanto industriales como sanitarios. El objetivo de este estudio es comparar la eficiencia entre un sistema “clásico” de elaboración de quimioterapia centralizado en el Servicio de Farmacia frente a un modelo descentralizado. Material y métodos: Estudio observacional en el que se analizó la eficiencia de los modelos de elaboración de preparaciones quimioterápicas: 1.- Modelo clásico (MC), a partir del cual se suministran las preparaciones al Hospital de Día de Hematología: las campanas de elaboración de tratamientos y el farmacéutico están presentes en el Servicio de Farmacia.2.- Modelo descentralizado (MD): el farmacéutico y las campanas de preparación de la medicación se encuentran en Hospital de Día de Oncología. La eficiencia de cada sistema se evaluó mediante el tiempo transcurrido desde la recepción de la orden médica hasta la administración de la quimioterapia (TAQ).Resultados: El TAQ siguiendo el MD fue inferior que para el MC: 13,7 [5-28] minutos versus 71,0 [42-96] minutos (p<0,001) con una diferencia media de 57,3 minutos/preparación. El tiempo potencialmente ahorrado con el modelo descentralizado fue de 40,3 horas/día. Conclusiones: Con el presente trabajo hemos querido cuantificar y comparar la eficiencia de los dos modelos de elaboración de mezclas citostáticas, siendo desfavorable para el sistema clásico de centralización para la preparación de la medicación en los Servicios de Farmacia. (AU)

Aims: The «Six Sigma» methodology is based on the analysis of workflows and the identification of areas for improvement in order to achieve maximum efficiency in industrial and healthcare processes. The aim of this study is to compare the efficiency of a «classic» chemotherapy preparation system centralised in the Pharmacy Service versus a decentralised model.Material and methods: Observational study in which the efficiency of the models for the preparation of chemotherapy treatments was analysed: 1.- Classical model (MC), which has the treatment preparation cabinets and a pharmacist located in the Pharmacy Service, and from which the preparations are supplied to the Haematology Day Hospital. 2.- Decentralised model (MD), where both the pharmacist and the medication preparation cabinets are located in the Oncology Day Hospital .For the evaluation of the efficiency of each system, the time elapsed from the receipt of the medical order to the administration of chemotherapy (TAQ) was compared. Results: The TAQ following MD was less than for MC: 13.7 [5-28] minutes versus 71.0 [42-96] minutes (p<0.001) with a mean difference of 57.3 minutes/prescription. The potential time saved with the decentralised model was 40.3 hours/day. Conclusions: The aim of this study was to quantify and compare the efficiency of the two models for the preparation of cytostatic mixtures, showing that the classical centralised system for the preparation of medication in pharmacy services is unfavourable. (AU)

Sistema de puntuación uretral (U-score) simplificado para predecir la uretroplastia anterior compleja / Simplified urethral score system for predicting complex anterior urethroplasty

Objetivo: Evaluar los valores individuales del U-score como factores predictores de la cirugía uretral compleja.Métodos: Estudio transversal que incluye a los pacientes que recibieron una uretroplastia anterior entre 2011 y 2019. Se midieron las variables del U-score (etiología [1-2 puntos], número de estenosis [1-2 puntos], localización anatómica (1-2 puntos) y longitud [1-3 puntos]) de manera individual y total. La complejidad quirúrgica se definió como baja (anastomosis, injerto de mucosa oral y uretroplastia anterior ampliada) y alta (injerto doble de mucosa oral, colgajo y combinación de injerto y colgajo). Los componentes del U-score se incluyeron como predictores de cirugía compleja y como variables principales con estimaciones y comparaciones de los valores de probabilidad individuales. Se establecieron grupos según la probabilidad de riesgo de cirugía compleja.Resultados: Se incluyeron 654 pacientes. La edad media fue de 57,2 años. Se realizó cirugía de baja complejidad en 464 pacientes (259 anastomosis, 144 injertos, 61 uretroplastia anterior aumentada) y de alta complejidad en 190 (53 injerto doble de mucosa oral, 27 colgajo, 110 combinación injerto/colgajo). En el análisis multivariante, la longitud, el número de estenosis y la localización fueron predictores de complejidad. La introducción del U-score como única variable en el modelo univariante predijo una OR de 8,52 (IC 95%: 6,1-11). Los grupos del U-score simplificado obtenidos por probabilidad de complejidad fueron: riesgo bajo (4-5 puntos), riesgo intermedio (6 puntos) y riesgo alto de complejidad (7-9 puntos) La predicción del riesgo de probabilidad de cirugía compleja (IC 95%) para el grupo de riesgo bajo, medio y alto fue de 1,6 (0-2,9), 19,1 (13,8-25,9) y 77,9 (61,6-88,7), respectivamente.Conclusiones: El U-score puede utilizarse como una herramienta predictiva de la cirugía uretral compleja. Presentamos la herramienta de riesgo U-score simplificado para evaluar

Objective: To assess U-score individual values as urethral complex surgery predictors.Methods: Cross-sectional study including patients who received anterior urethroplasty from 2011 to 2019. U-score (etiology (1-2 points), number of strictures (1-2 points), anatomic location (1-2 points) and length (1-3 points)) was measured individually and globally. Surgical complexity was defined as low (anastomotic, buccal mucosal graft, and augmented anterior urethroplasty), and high complexity (double buccal mucosal graft, flap, and graft/flap combination). U-score components were included as complex surgery predictor and as main variable with individual probability values estimations and comparisons. Risk complex surgery probability groups were established.Results: 654 patients were included. Mean age was 57.2 years. Low complexity surgery was performed in 464 patients (259 anastomotic, 144 graft, 61 augmented anterior urethroplasty) and high complexity was done in 190 (53 double buccal mucosa graft, 27 flap, 110 graft/flap comb.). In multivariate analysis length, number of strictures and location were predictors of complexity. Introducing U-Score as only variable in univariate model predicted an OR 8.52 (95%CI 6.1-11). Simplified U-score grouping set obtained by complex probability was: low risk (4-5 points), medium risk (6 points) and high risk of complexity (7-9 points) Predicted risk of complex surgery probability (95%CI) for low, median and high risk group were 1.6 (0-2.9), 19.1 (13.8-25.9) and 77.9 (61.6-88.7), respectively.Conclusions: U-score can be used as a tool to predict complex urethral surgery. We present a simplified U-score risk tool to assess individual complex anterior urethroplasty probability (AU)

Hair cortisol in polycystic ovary syndrome.

The aim of the study was to evaluate adrenal axis hyperactivation measuring hair cortisol levels, and its influence on the relationship among metabolic parameters, inflammation markers and androgens in adult women with PCOS. 44 women (18-34 years) with PCOS diagnosis and a control group of 49 healthy women (19-35 years) were included. In both gropus body mass index (BMI) was calculated and waist circumference (WC) was measured. Hair cortisol, total serum testosterone (TT), serum cortisol, 25 OH vitamin D (25OHD), insulin, high sensitivity C-reactive protein (hsCRP), triglycerides (TG), HDL cholesterol (HDL), glucose and leptin were measured. Bioavailable testosterone (bioT) was calculated. Hair cortisol concentration was higher and significantly different in PCOS patients compared to the control group (130 vs 63 pg/mg of hair, p < 0.001). Subsequently, patients with PCOS were divided into two groups according to hair cortisol levels: group 1 with normal hair cortisol concentration and group 2 with levels above the upper limit of the reference values (128 pg/mg of hair). In group 2, TT significantly correlated with 25OHD, hsCRP, TG/HDL index, BMI, WC, insulin and HOMA (p < 0.05); bioT correlated with hsCRP and leptin (p < 0.05). Finally, 25OHD was inversely correlated with leptin and with TG/HDL index (p < 0.05). High hair cortisol concentration in patients with PCOS confirmed hyperactivation of the HPA axis. The associations observed were only found in patients with PCOS with high hair cortisol levels (> 128 pg/mg of hair), showing a possible effect of HPA axis in these associations.

Evaluating differential expression of fibrosis-related genes and their correlation with blood vessel density in chronic cutaneous graft-versus-host disease.

BACKGROUND: Sclerodermoid graft-versus-host disease (GVHD) is the most severe form of chronic GVHD (cGVHD) and represents a considerable therapeutic challenge. Due to the scarcity of human studies on sclerodermoid cGVHD, the pathogenesis of this entity is not fully understood. OBJECTIVE: To identify the differential expression of fibrosis-related genes in skin lesions of human lichenoid and sclerodermoid cGVHD and to assess the expression of their corresponding proteins. METHODS: PCR array analysis was performed on RNA extracted from three skin biopsies of sclerodermoid cGVHD patients and three normal skin samples, for fibrosis-related gene expression profiles followed by evaluation of their corresponding protein expressions. The expressions of Tissue inhibitor of metalloproteinase 3 (TIMP3), matrix metalloproteinase 1 (MMP1), TIMP1, and TIMP2 were further studied by immunohistochemistry. Demographic, clinical and immunohistochemical parameters of the two cGVHD groups and the control group were compared. The Pearson correlation coefficient was used to assess the correlation between data among the study groups. RESULTS: We identified 44 upregulated and 14 downregulated genes in the skin samples of sclerodermoid cGVHD compared to the control group. TIMP3 was positive in 13/21 biopsies of cGVHD and in one biopsy of the control group. The average staining intensity was significantly higher in the cGVHD group compared to the control group. TIMP3 was expressed mainly in dermal blood vessels. cGVHD specimens with positive TIMP3 staining had a statistically significantly higher total microvascular area than the negative specimens. CONCLUSION: TIMP3 levels are increased in both subtypes of cGVHD and are associated with increased dermal vascularity.

Immediate Maxillary Full-Arch Rehabilitation of Periodontal Patients with Terminal Dentition Using Tilted Implants and Bone Augmentation: A 5-Year Retrospective Cohort Study.

BACKGROUND: All-on-four protocols with tilted implants in the maxilla are used to rehabilitate the terminal dentition of the severe generalized periodontitis patients. Data on long-term biological complications are scarce. METHODS: Eighty-four axial and forty-six tilted immediate implants have been placed in the extraction sockets of 23 patients according to a four-six implants protocol combined with ridge augmentation. Within 72 h, a provisional prosthesis was cemented to the implants; after 6 months, a cemented ceramic-metallic prosthesis was delivered. The patients were followed for up to 5 years. RESULTS: The 5-year survival rate of the straight and tilted implants was 100% and 97.8, and the prosthetic one was 100%. Marginal bone loss (MBL) of the straight implants was 0.42 ± 0.67 and 0.59 ±1.01 mm on the mesial and distal sides; for the tilted, it was 0.37 ± 0.68 and 0.34 ±0.62 mm, and the differences were not statistically significant. Implant position, smoking, keratinized mucosal width, and cantilever did not affect MBL. Peri-implant mucositis involved 29.4% and 22.2% of the straight and tilted implants, respectively; peri-implantitis involved 5.8% and 4.4% of the straight and tilted implants, respectively, without statistical significance. CONCLUSIONS: This immediate loading protocol's 5-year survival and success rates were high. No difference between the straight and tilted implants was found regarding survival, success rates, and MBL.

Affective experiences during COVID-19 pandemic lockdown and posttraumatic growth: A 1-year longitudinal study in France.

BACKGROUND: The COVID-19 crisis has resulted in major restrictions on daily life that are undeniably detrimental to individual wellbeing. Nevertheless, there may be positive psychological changes over the longer term, particularly in the form of posttraumatic growth (PTG). METHODS: A total of 1075 individuals representative of the French population took part in an online survey during the first lockdown (T1: March to May 2020) and 1 year later (T2). Their affective experiences at T1 were analyzed, together with the development of PTG at T2. RESULTS: Three affective profiles were identified at T1: one associated with feelings of loneliness and depressive symptoms (Loneliness cluster), one with positive feelings (Happiness cluster), and one with rather negative feelings of anger and fear, but also a feeling of happiness (Negative-moderate cluster). PTG was generally low at T2, with the Negative-moderate cluster achieving the highest score. LIMITATIONS: This study was based on an online survey, and an exploratory cluster analysis was conducted. Complementary studies should be conducted to determine the predictive value of our findings. CONCLUSIONS: Within the space of 1 year following the first lockdown due to COVID-19, people living in France, especially those who had experienced a mixture of feelings during lockdown, appeared to develop some form of PTG. Nevertheless, PTG was rather weak overall.

Deciphering the Spectral Tuning Mechanism in Proteorhodopsin: The Dominant Role of Electrostatics Instead of Chromophore Geometry.

Proteorhodopsin (PR) is a photoactive proton pump found in marine bacteria. There are two phenotypes of PR exhibiting an environmental adaptation to the ocean's depth which tunes their maximum absorption: blue-absorbing proteorhodopsin (BPR) and green-absorbing proteorhodopsin (GPR). This blue/green color-shift is controlled by a glutamine to leucine substitution at position 105 which accounts for a 20 nm shift. Typically, spectral tuning in rhodopsins is rationalized by the external point charge model but the Q105L mutation is charge neutral. To study this tuning mechanism, we employed the hybrid QM/MM method with sampling from molecular dynamics. Our results reveal that the positive partial charge of glutamine near the C14 -C15 bond of retinal shortens the effective conjugation length of the chromophore compared to the leucine residue. The derived mechanism can be applied to explain the color regulation in other retinal proteins and can serve as a guideline for rational design of spectral shifts.

Simplified urethral score system for predicting complex anterior urethroplasty.

OBJECTIVE: To assess U-score individual values as urethral complex surgery predictors. METHODS: Cross-sectional study including patients who received anterior urethroplasty from 2011 to 2019. U-score (etiology (1-2 points), number of strictures (1-2 points), anatomic location (1-2 points) and length (1-3 points)) was measured individually and globally. Surgical complexity was defined as low (anastomotic, buccal mucosal graft, and augmented anterior urethroplasty), and high complexity (double buccal mucosal graft, flap, and graft/flap combination). U-score components were included as complex surgery predictor and as main variable with individual probability values estimations and comparisons. Risk complex surgery probability groups were established. RESULTS: 654 patients were included. Mean age was 57.2 years. Low complexity surgery was performed in 464 patients (259 anastomotic, 144 graft, 61 augmented anterior urethroplasty) and high complexity was done in 190 (53 double buccal mucosa graft, 27 flap, 110 graft/flap comb.). In multivariate analysis length, number of strictures and location were predictors of complexity. Introducing U-Score as only variable in univariate model predicted an OR 8.52 (95%CI 6.1-11). Simplified U-score grouping set obtained by complex probability was: low risk (4-5 points), medium risk (6 points) and high risk of complexity (7-9 points) Predicted risk of complex surgery probability (95%CI) for low, median and high risk group were 1.6 (0-2.9), 19.1 (13.8-25.9) and 77.9 (61.6-88.7), respectively. CONCLUSIONS: U-score can be used as a tool to predict complex urethral surgery. We present a simplified U-score risk tool to assess individual complex anterior urethroplasty probability.

New multiproxy data obtained from the sedimentary fill of the Ría de Ferrol, NW Iberia.

Several gravity cores and vibro-cores were recovered from selected sites in the inner sector of Ría de Ferrol, NW Iberia (Muñoz Sobrino et al., 2021) [1]. These sediment cores were obtained during the surveys ECOMER-2014 and ECOMER-2015, developed from 2014 to 2015 on-board the R/V Mytilus (Consejo Superior de Investigación Científica) and the Amarradores Mil (Amarradores del Puerto y Ría de Ferrol, S.L.), respectively. Sedimentary and other multiproxy data presented here belong to four selected sediment cores located in the innermost part of the study area. Two were recovered using a gravity corer and another two using a vibro-corer. The depth of the cores and samples obtained is referred to the NMMA (the mean sea level in Alicante), which is the Spanish orthometric datum. One half of each core was subjected to non-destructive analysis using an ITRAX core scanner providing X-ray fluorescence (XRF) elemental data. Particle size distribution was characterised by laser diffraction. For radiocarbon dating, well-preserved articulated valves, small remains of wood and very organic bulk sediment from one location free of biogenic gas were selected. Palynological analyses were performed on selected sections of the sediment. All samples were spiked with Lycopodium spores for absolute palynomorph estimation and analysed using 400x and 600x magnifications. The ratio of dinoflagellate cyst concentrations to pollen, fern spore and dinoflagellate cyst concentrations (D/P ratio, ranging between 0 and 1) was calculated for each sample to show the temporal variation. Combined seismic, lithological, elemental, chronological and palynological data enable reconstructing the environmental changes that occurred during the local marine transgression. Besides, the combination of evidence identified may also be applied to other areas or periods in order to perform local reconstructions of changing coastal ecosystems. This type of high-resolution spatial-temporal reconstructions of past changes in estuarine environments may be a valuable tool for modelling, predicting and managing the changes and threats linked to the global warming and sea-level rise associated.

Histologic and Histomorphometric Evaluation of a Connective Tissue Graft Retrieved with a Novel Deepithelialization Procedure: A Case Series.

Various free connective tissue graft (CTG) harvesting techniques have been reported. The lining epithelium of the palatal graft may be retrieved either intra- or extraorally. This report presents a series of root coverage cases where deepithelialization was intraorally performed before harvesting the graft with a round diamond bur mounted on a low-speed handpiece. Ten single-tooth gingival recession defects in five patients were treated, applying a surgical procedure based on a coronally advanced flap combined with a free CTG that was deepithelialized in situ by the same method. Recession and probing depths and keratinized tissue and recession widths were recorded at baseline and the follow-up evaluations. Follow-up was between 7 and 21 months (mean: 12.1 ± 5.04 months). Clinical, esthetic, and histologic evaluations were performed. Mean root coverage was 89% ± 24.86% (range: 25% to 100%), and complete root coverage was observed in 80% of cases; the esthetic score range was 6 to 9 (mean: 7.44 ± 1.01). Epithelial remnants, although different in proportions, were evident in all samples (range of prevalence: 4.57% to 29.12%). Within the limitations of the small number of clinical cases, the presented in situ deepithelialization technique for CTG seems to be valuable and may accordingly be routinely applied.

Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool.

PURPOSE: The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. METHODS: Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. RESULTS: A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008-0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65-0.91; P < 0.0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0.355; 95% CI 0.255-0.494; P < 0.0001) and IH (OR 0.394; 95% CI 0.24-0.61; P < 0.0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11.794; 95% CI 4.29-32.39; P < 0.0001). CONCLUSION: Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.

[Adequacy to diagnostic recommendations in patients with Pneumocystis jirovecii pneumonia treated with intravenous pentamidine]. / Adecuación a las recomendaciones diagnósticas en pacientes con neumonía por Pneumocystis jirovecii tratados con pentamidina intravenosa.

OBJECTIVE: To determine the rate of microbiological confirmation in the diagnosis of Pneumocystis jirovecii pneumonia in patients treated with intravenous pentamidine and the potential correlation with treatment effectiveness and safety. METHODS: Single-centre retrospective study (2010-2020), which included those patients who received intravenous pentamidine treatment for at least 48 hours. The sample collection procedure and the microbiological analysis performed were recorded. Efficacy was determined by 14-day mortality rate and admission to the Intensive Care Unit (ICU), and disease control was determined by length of hospital stay and time from completion of treatment to discharge. The safety profile was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS: A total of 17 patients with P. jirovecii pneumonia were treated with pentamidine (76.5% male (n=13); mean age [standard deviation]: 58.6 [15.5]). Microbiological confirmation of the pathogen was established in 47.1% (n=8) of cases. Targeted use of pentamidine significantly reduced the time from treatment completion to hospital discharge (p=0.019). The safety profile was acceptable, with grade I toxicity occurring in one patient. CONCLUSIONS: The study shows that more than 50% of patients receive treatment based on a presumptive diagnosis and without adhering to the established recommendations, with repercussions on the duration of admission and recovery of the patient. Future studies with a larger sample size will be necessary to consolidate the results obtained.