The impact of prolonging extinction on the ABC "super renewal" of instrumental responses in rats.

Two free operant conditioning experiments with rats examined the impact of conducting a large amount of extinction training on situations that enhance the ABC renewal effect (ABC super renewal). In Experiment 1, ABC renewal was strengthened by conducting acquisition in multiple contexts. All rats were trained to press a lever for food. One group was trained in one context, while the other two groups were trained in three contexts. Then, all rats received extinction in context B. For two groups this phase lasted 4 sessions, whereas it lasted 36 sessions for the other group. In Experiment 2, ABC renewal was strengthened by using a large number of acquisition sessions. Rats were trained to perform an operant response to obtain food in context A. One group received a moderate amount of training, while the rest of the rats received a larger number of acquisition sessions. Responses underwent extinction in context B. Two groups received 4 sessions, while 36 extinction sessions were used for the remaining group. In both experiments, rats were tested in context B (extinction context) and C (renewal context). Greater ABC renewal occurred both when acquisition training was conducted in multiple contexts (Experiment 1) and by increasing the amount of acquisition training (Experiment 2). Nevertheless, we found that conducting a large number of extinction sessions reduced ABC super renewal in Experiment 1 only.

Mapas delictivos y análisis espacial de la criminalidad ambiental: México 2006-2018 / Crime Maps and Spatial Analysis of Environmental Crime: Mexico 2006-2018 / Mapas do Crime e Análise Espacial do Crime Ambiental: México 2006-2018

Entre los distintos problemas de seguridad pública en México, los delitos ambientales han ocupado un lugar periférico en las agendas de gobierno, la estadística nacional y en las investigaciones académicas. Estos factores han derivado en que no existan estudios sobre la prevalencia de delitos ambientales en el país, ni de su distribución territorial, por lo tanto, el presente artículo tiene como objetivo ex-plorar la distribución geográfica de delitos ambientales en el país, así como la identificación de paraísos verdes de la delincuencia ambiental en México. Para ello se analizaron las cifras de delitos ambienta-les reportadas por la Fiscalía General de la República en el periodo 2006-2018 y se cotejaron espacialmente con variables ambientales, económicas y sociales. Los hallazgos muestran que los paraísos verdes de criminalidad ambiental se concentran en estados de las regiones noroeste, occidente, centro y sur del país, por lo que las estrategias de actuación institucional y de políticas públicas pueden orientarse en estas regiones y estados.

Among the various public security problems in Mexico, environmental crime has occupied a peripheral place in government agendas, national statistics and academic research. These factors have meant that there are no studies on the prevalence of environmental crime in the country, nor on its territorial distribution. Therefore, this article aims to explore the geographical distribution of environmental crime in the country, as well as the identification of green havens of environmental crime in Mexico. To this end, the figures on environmental crime reported by the Attorney General's Office for the period 2006-2018 were analysed and spatially matched with environmental, economic and social variables. The findings show that the green havens of environmental crime are concentrated in states in the northwestern, western, central and southern regions of the country, so that strategies for institutional action and public policies can be oriented towards these regions and states.

Entre os vários problemas de segurança pública no México, o crime ambiental tem ocupado um lugar periférico nas agendas governamentais, nas estatísticas nacionais e nas pesquisas acadêmicas. Estes fatores fizeram com que não existam estudos sobre a prevalência de crimes ambientais no país, nem sobre sua distribuição territorial. Portanto, este artigo visa explorar a distribuição geográfica dos crimes ambientais no país, assim como a identificação de paraísos verdes de crimes ambientais no México. Para este fim, os números sobre crimes ambientais relatados pela Procuradoria Geral da República para o período 2006-2018 foram analisados e espacialmente combinados com variáveis ambientais, econômicas e sociais. Os resultados mostram que os paraísos verdes do crime ambiental estão concentrados nos estados das regiões noroeste, oeste, centro e sul do país, de modo que as estratégias de ação institucional e políticas públicas possam ser orientadas para essas regiões e estados.

CPLANE Complex and Ciliopathies.

Primary cilia are non-motile organelles associated with the cell cycle, which can be found in most vertebrate cell types. Cilia formation occurs through a process called ciliogenesis, which involves several mechanisms including planar cell polarity (PCP) and the Hedgehog (Hh) signaling pathway. Some gene complexes, such as BBSome or CPLANE (ciliogenesis and planar polarity effector), have been linked to ciliogenesis. CPLANE complex is composed of INTU, FUZ and WDPCP, which bind to JBTS17 and RSG1 for cilia formation. Defects in these genes have been linked to a malfunction of intraflagellar transport and defects in the planar cell polarity, as well as defective activation of the Hedgehog signalling pathway. These faults lead to defective cilium formation, resulting in ciliopathies, including orofacial-digital syndrome (OFDS) and Bardet-Biedl syndrome (BBS). Considering the close relationship, between the CPLANE complex and cilium formation, it can be expected that defects in the genes that encode subunits of the CPLANE complex may be related to other ciliopathies.

Vestibular Rehabilitation Therapy for the Treatment of Vestibular Migraine, and the Impact of Traumatic Brain Injury on Outcome: A Retrospective Study.

INTRODUCTION: Vestibular migraine (VM) is a common condition; individuals experience dizziness with migraine symptoms. Vestibular rehabilitation therapy (VRT) has been reported as an effective treatment for VM, however, evidence is limited. VM and traumatic brain injury (TBI) can co-occur, and some suggest that TBI can induce VM. There is limited evidence on the effect a history of TBI has on VRT in patients with VM. METHODS: Retrospective case series of 93 (f = 63, m = 30) participants with VM and underwent VRT (mean age 48.62; SD 15.92). Pre- and post-treatment self-reported outcome measures and functional gait assessment were extracted from the participants health records and evaluated. The impact of TBI on VRT outcome in participants with VM was analyzed. Individuals with TBI and no history of migraine (n = 40) were also extracted to act as a control. RESULTS: VRT significantly improved self-reported dizziness on the Dizziness Handicap Inventory (DHI), with a mean change of -18 points (p < 0.000) and +5 points on the functional gait assessment (FGA) (p < 0.000) in patients with VM. A history of TBI significantly impacted outcome on the DHI (p = 0.018) in patients with VM.VRT significantly improved all outcome measures for individuals with TBI, with a mean change of -16 points on the DHI (p = 0.001) and +5 points on the FGA (p < 0.000). VM presence significantly impacted outcome. CONCLUSION: VRT should be considered as a treatment option to reduce dizziness and the risk of falls in individuals with VM. TBI may negatively impact VRT outcomes in individuals with VM.

Plasticity of Extrachromosomal and Intrachromosomal BRAF Amplifications in Overcoming Targeted Therapy Dosage Challenges.

Focal amplifications (FA) can mediate targeted therapy resistance in cancer. Understanding the structure and dynamics of FAs is critical for designing treatments that overcome plasticity-mediated resistance. We developed a melanoma model of dual MAPK inhibitor (MAPKi) resistance that bears BRAFV600 amplifications through either extrachromosomal DNA (ecDNA)/double minutes (DM) or intrachromosomal homogenously staining regions (HSR). Cells harboring BRAFV600E FAs displayed mode switching between DMs and HSRs, from both de novo genetic changes and selection of preexisting subpopulations. Plasticity is not exclusive to ecDNAs, as cells harboring HSRs exhibit drug addiction-driven structural loss of BRAF amplicons upon dose reduction. FA mechanisms can couple with kinase domain duplications and alternative splicing to enhance resistance. Drug-responsive amplicon plasticity is observed in the clinic and can involve other MAPK pathway genes, such as RAF1 and NRAS. BRAF FA-mediated dual MAPKi-resistant cells are more sensitive to proferroptotic drugs, extending the spectrum of ferroptosis sensitivity in MAPKi resistance beyond cases of dedifferentiation. SIGNIFICANCE: Understanding the structure and dynamics of oncogene amplifications is critical for overcoming tumor relapse. BRAF amplifications are highly plastic under MAPKi dosage challenges in melanoma, through involvement of de novo genomic alterations, even in the HSR mode. Moreover, BRAF FA-driven, dual MAPKi-resistant cells extend the spectrum of resistance-linked ferroptosis sensitivity. This article is highlighted in the In This Issue feature, p. 873.

Analysis of Habituation Learning in Mealworm Pupae (Tenebrio molitor).

The decline of response as a consequence of repeated stimulation is known as habituation. The goal of the present experiments was extending the knowledge about habituation of abdominal contractions in the pupa of Tenebrio molitor. Both experiments consisted of two phases. During Phase 1, all groups were exposed to a continuous stimulus (light in Experiment 1 and vibration in Experiment 2). At the beginning of this phase, pupae showed a high number of abdominal contractions. However, during the last minute of Phase 1, the number of abdominal contractions was lower. In the next phase, the pupae were divided in different groups to test for response recovery. We found an increase in the abdominal contractions when subjects were exposed to a different stimulus, be it within the same or in a distinct sensory modality. In addition, we also reported response recovery when the pupae were re-exposed to the original stimuli after a resting period. Results indicate that the increase in responding cannot be explained by either sensory adaptation or fatigue. The findings are consistent with the perspective that suggests that habituation plays a major role in the survival of the species, even in non-feeding developmental stages.

HIV drug resistance among adults initiating antiretroviral therapy in Uganda.

BACKGROUND: WHO revised their HIV drug resistance (HIVDR) monitoring strategy in 2014, enabling countries to generate nationally representative HIVDR prevalence estimates from surveys conducted using this methodology. In 2016, we adopted this strategy in Uganda and conducted an HIVDR survey among adults initiating or reinitiating ART. METHODS: A cross-sectional survey of adults aged ≥18 years initiating or reinitiating ART was conducted at 23 sites using a two-stage cluster design sampling method. Participants provided written informed consent prior to enrolment. Whole blood collected in EDTA vacutainer tubes was used for preparation of dried blood spot (DBS) specimens or plasma. Samples were shipped from the sites to the Central Public Health Laboratory (CPHL) for temporary storage before transfer to the Uganda Virus Research Institute (UVRI) for genotyping. Prevalence of HIVDR among adults initiating or reinitiating ART was determined. RESULTS: Specimens from 491 participants (median age 32 years and 61.5% female) were collected between August and December 2016. Specimens from 351 participants were successfully genotyped. Forty-nine had drug resistance mutations, yielding an overall weighted HIVDR prevalence of 18.2% with the highest noted for NNRTIs at 14.1%. CONCLUSIONS: We observed a high HIVDR prevalence for NNRTIs among adults prior to initiating or reinitiating ART in Uganda. This is above WHO's recommended threshold of 10% when countries should consider changing from NNRTI- to dolutegravir-based first-line regimens. This recommendation was adopted in the revised Ugandan ART guidelines. Dolutegravir-containing ART regimens are preferred for first- and second-line ART regimens.

A randomised trial to assess the educational benefit of a smartphone otoscope in undergraduate medical training.

PURPOSE: Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate's confidence to perform otoscopy is reported as low. Smartphone otoscopes have been suggested to improve undergraduates learning of normal eardrum anatomy because unlike the traditional otoscope, the learner and educator share the same image. This study aimed to evaluate whether a smartphone otoscope could enhance medical undergraduates recognition of common ear pathology. METHODS: 52 medical students were randomised into a standard group that used a traditional otoscope and an intervention group that used a smartphone otoscope. Both groups received a short didactic presentation on the recognition of common ear pathologies and were asked to diagnose four simulated pathologies. Both groups received feedback and guidance on how to better visualise the tympanic membrane. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope. RESULTS: The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs. 39%, p = < 0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs. 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone otoscope was preferential for their learning. The same number expressed that they want to use it in future learning. The remainder were indifferent. CONCLUSIONS: The smartphone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.

Evaluation of Two Strategies for Alleviating the Impact on the Circadian Cycle of Smartphone Screens.

SIGNIFICANCE: Electronic display devices used before bed may negatively affect sleep quality through the effects of short-wavelength (blue) light on melatonin production and the circadian cycle. We quantified the efficacy of night-mode functions and blue-light-reducing lenses in ameliorating this problem. PURPOSE: The purpose of this study was to compare the radiation produced by smartphones that reaches the eye when using night-mode functions or blue-light-reducing spectacle lenses. METHODS: Radiant flux of 64 smartphones was measured with an integrating sphere. The retinal illuminance was calculated from the radiant flux of the smartphones. For the night-mode functions, the spectra produced by the smartphones were measured. The transmittance of four blue-light-reducing spectacle lenses, which filter light with either antireflective coatings or tints, was measured using a spectrometer. To determine the impact of blue-light-reducing spectacles, the radiant flux of the smartphone was weighted by the transmission spectrum of these glasses. Visual and nonvisual (circadian) parameters were calculated to compute the melatonin suppression values (MSVs) through a logistic fitting of previously published data. The MSV was used as the figure of merit to evaluate the performance of blue-light spectacles and smartphone night-mode functions. RESULTS: Night-mode functions in smartphones reduced MSVs by up to 93%. The warmest mode produced the least suppression. Blue-light-reducing spectacles reduced melatonin suppression by 33%, the coated lenses being more efficient than tinted lenses. CONCLUSIONS: All smartphones in this study emit radiant power in the short-wavelength region of the visible spectrum. Such smartphones may impair the regulation of circadian cycles at nighttime. The activation of night-mode functions was more efficient than the commercially available blue-light-reducing spectacle lenses in reducing the amount of short-wavelength light (up to 2.25 times). These results can be extrapolated to most electronic devices because they share the same type of white radiant sources with smartphones.

Reacciones adversas asociadas a la vacunación en pacientes inmunodeprimidos y en situaciones especiales de una Unidad de Vacunas hospitalaria / Vaccine-related adverse reactions in immunocompromised patients and in special situations of a hospital Vaccine Unit

OBJETIVOS: Describir el tipo de vacunas administradas en la Unidad de Vacunas de un hospital de referencia y calcular la tasa de notificación global y específica de las reacciones adversas asociadas. MÉTODOS: Estudio observacional retrospectivo, realizado en el periodo entre noviembre de 2014 y noviembre de 2017, de los pacientes que desarrollaron una reacción adversa a medicamento (RAM) tras la administración de una vacuna y que fue notificada al Sistema Español de Farmacovigilancia. Las variables analizadas fueron edad, sexo, grupo de riesgo, tipo de vacuna, coadministración y tipo de RAM. Se llevó a cabo un análisis univariante y bivariante. Se calculó la tasa de notificación de RAM global y específica para cada vacuna. RESULTADOS: Se administraron un total de 18.123 vacunas de las que el 20,7% correspondían a la vacuna frente al virus de la hepatitis B. Se notificaron 53 sospechas de RAM. En el 64,2% de las ocasiones se había administrado solamente una vacuna. El 88,7% de las notificaciones correspondieron a vacunas inactivadas. La vacuna frente neumococo polisacárida de 23 serotipos fue la que generó el mayor número de notificaciones. La tasa de notificación global de RAM fue de 0,42%. La vacuna hexavalente fue la que registró la tasa de notificación más elevada (2,81%). El 49,1% de las RAM fueron de tipo sistémico. CONCLUSIONES: La tasa de notificación global fue baja aunque superior a la registrada por otros autores. La correcta notificación de posibles reacciones adversas postvacunales es imprescindible para contribuir a la seguridad vacunal y para aumentar la confianza de la población en las vacunas

OBJECTIVES: The aim of the study was to describe the type of vaccines administered in the Vaccine Unit at a reference hospital. Calculate the overall and specific reporting rate of adverse reactions. METHODS: Retrospective observational study for the period between November 2014 and November 2017, on patients who developed an adverse drug reaction (ADR) after the administration of a vaccine and who were notified to the Spanish Pharmacovigilance System. The variables analyzed were age, sex, risk group, vaccine class, co-administration and type of ADR. A univariate and bivariate analysis was performed. The global and vaccine specific rate of ADR notification was calculated. RESULTS: A total of 18,123 vaccines were administered, of which 20.7% corresponded to hepatitis B virus vaccine. Fifty-three RAM suspects were reported. In 64.2% of cases only one vaccine was administered. Inactivated vaccines accounted for 88.7% of notifications. The highest number of notifications was generated by the 23 serotypes pneumococcal polysaccharide vaccine. The overall reporting rate was 0.42%. The hexavalent vaccine had the highest reporting rate (2.81%).49.1% of the ADR were systemic. CONCLUSIONS: The overall reporting rate was low but higher than that of other authors. Proper reporting of possible adverse post-vaccine reactions is essential to contribute to vaccine safety and to increase public confidence in vaccines

Spanish list of potentially inappropriate drugs in the elderly (ES-PIA project).

PURPOSE: In the last decades, different criteria have been developed for detecting inappropriate prescription in older patients. In Spain, translations and adaptations of international lists are available but it would be necessary a national list which could cope with the peculiarities of our health system, existing pharmaceutical market, and prescription habits. We propose in this project the creation of a Spanish potentially inappropriate drugs list which could be applicable in our clinical scenario. METHODS: We use a Delphi method involving 25 experts from different backgrounds (Clinical Pharmacology, Geriatrics, Rational Use of Drugs and Pharmacy, Primary Care and Pharmacoepidemiology, and Pharmacovigilance) that were asked to participate in two-round questionnaires. For analysis, current recommendations of Worth and Pigni were applied, and every statement was classified into one of three groups: strong, moderate, or low agreement. Statements with strong agreement were accepted to be part of the inadequate prescription list. Moderate agreement statements were selected to enter the second questionnaire, and statements with low agreement were further analyzed to determine if it was due to heterogeneity or due to dispersion in the answers. RESULTS: The first questionnaire consisted of 160 proposed sentences, of which 106 reached a high agreement, 32 a moderate agreement, and 22 a low agreement. All sentences proposed in the second questionnaire reached a strong agreement. The total accepted sentences were 138. CONCLUSIONS: We offer a list of inadequate prescription in older patients adapted to the Spanish pharmacopeia and according to the prescription habits in our environment.

Broncoespasmo y flushing tras la vacunación con neumococo polisacárida de 23 serotipos en pacientes crónicos / Bronchospasm and flushing after vaccination with 23 serotype pneumococcal polysaccharide in chronic patients

Objetivos: Describir las características clínico-epidemiológicas en una serie de casos de sospecha de reacciones adversas sistémicas registradas tras la administración de la vacuna frente a neumococo polisacárida de 23 serotipos (PNEUMOVAX23(R)). Calcular la incidencia acumulada de dicha reacción y conocer si se han descrito casos similares y/o compatibles en la literatura científica o en Farmacovigilancia. Métodos: Estudio observacional retrospectivo realizado entre 01/12/2015 y 30/09/2017 en la Unidad de Vacunas de un hospital autonómico de referencia. Se calculó la incidencia acumulada de la reacción adversa sistémica para esa vacuna. Se consultó la base de datos del Sistema Español de Farmacovigilancia (FEDRA). Resultados: Se registraron 9 sospechas de reacciones adversas sistémicas inmediatas (flushing + broncoespasmo + SatO2<95%). La incidencia acumulada fue 1,036%. El desenlace fue recuperado/resuelto para todos. No se encontraron casos similares y/o compatibles. Conclusiones: Las reacciones descritas no constan en la ficha técnica de PNEUMOVAX23(R). Epidemiológicamente no se puede establecer ninguna relación causal entre la aparición de los síntomas y las variables estudiadas. Esta información podría ser la base de investigaciones más amplias que supusieran la posible modificación de la ficha técnica

Objectives: To describe the clinical-epidemiological characteristics of a series of suspected systemic adverse reactions registered with the 23 serotype pneumococcal polysaccharide vaccine (PNEUMOVAX23(R)). Calculate the cumulative incidence of the reaction and know if similar and/or compatible cases have been described in the scientific literature or in pharmacovigilance. Methods: Observational and retrospective study realized between 01/12/2015 and 30/09/2017 in the Vaccines Unit of an autonomic reference hospital. We calculated the cumulative incidence of the adverse reaction for that vaccine. The common pharmacovigilance database (FEDRA) was consulted. Results: Nine systemic adverse reactions were recorded (flushing + bronchospasm + SatO2<95%). The cumulative incidence was 1.036%. The outcome was recovered/resolved for everyone. No similar and/or compatible cases were found. Conclusions: The reactions described do not appear in the PNEUMOVAX23(R) data sheet. Epidemiologically, no causal relationship can be established between the symptoms and the variables studied. This study could be the basis for more detailed research that could modify the vaccine data sheet

Coloración dental por índigo carmín. Excipientes: la asignatura pendiente / Indigo carmine related tooth discolouration. Excipients: a pending subject

No disponible

Evaluación de la producción científica de las revistas del área de la salud existentes en la región caribe colombiana indexadas en Publindex -Colciencias, Colombia, 2010 - 2015 / Evaluation of scientific production of Journal existing area of Health in the Colombian Caribbean region, indexed in Publindex -Colciencias, Colombia, 2010-2015

Resumen Evaluar la producción científica de las revistas del área de la salud existentes en la región Caribe colombiana en el periodo 2010 - 2015 indexadas en Publindex - Colciencias, actualización 2014-2. A través de un análisis bibliométrico de carácter retrospectivo y descriptivo se hizo la revisión de artículos publicados en las revistas Ciencia y Salud Virtual, Ciencias Biomédicas, Dua%ary, Psicogente, Psicología desde el Caribe y Salud Uninorte. Lo anterior permitió encontrar para el total de las revistas: 75 ediciones, 631 manuscritos, 2117 autores y 221 instituciones; así mismo, se pudo registrar que tres de esas publicaciones disminuyeron su periodicidad en los últimos cinco años. Los resultados obtenidos en este estudio coinciden con la clasificación otorgada a cada una de las revistas por Publindex-Colciencias 2014-2, y se revalida con la mayor participación de países e instituciones de afiliación.

Abstract To evaluate the scientific production of health journals in the Colombian Caribbean region in the period 2010-2015, indexed in Publindex - Colciencias, update 2014-2. Through a bibliometric, analysis of a retrospective and descriptive character was made the review of articles published in the journals: Science and Virtual Health, Biomedical Sciences, Duazary, Psychogenic, Psychology from the Caribbean and Health Uninorte. The total number of journals was 75 editions, 631 manuscripts, 2117 authors and 221 institutions, as well as the fact that three of these journals decreased in the last five years. The results obtained in the study coincide with the classification given to each of the journals by Publindex-Colciencias 2014-2 and is revalidated with the greater participation of countries and affiliation institutions.

Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides / Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery

INTRODUCCIÓN: La cirugía de tiroides y paratiroides (CTPT) se asocia a riesgo de lesión del nervio laríngeo recurrente, nervio laríngeo superior y cambios en la voz. La neuromonitorización intraoperatoria (NMIO), intermitente o continua, en CTPT evalúa el estado funcional de los nervios laríngeos y se utiliza progresivamente con más frecuencia. Esto obliga a adoptar puntos de acuerdo en los aspectos más controvertidos. OBJETIVO: Elaborar un documento de ayuda para orientar en la utilización de la NMIO en CTPT. MÉTODO: Consenso en grupo de trabajo mediante revisión sistemática y método Delphi. RESULTADOS: Se identificaron 7 secciones sobre las que se establecieron puntos de acuerdo: indicaciones, equipo, técnica (parámetros de programación y registro), conducta en pérdida de señal, laringoscopia, voz e implicaciones legales. CONCLUSIONES: La NMIO ayuda en la localización e identificación del nervio laríngeo recurrente, ayuda durante su disección, informa sobre su estado funcional al finalizar la cirugía y permite tomar decisiones en caso de pérdida de señal en el primer lado operado en una tiroidectomía bilateral programada o si había parálisis contralateral previa. La precisión de la NMIO depende de variables como la técnica realizada, la tecnología utilizada y la formación para la correcta ejecución de la técnica e interpretación de la señal. El documento presentado es un punto de inicio para futuros acuerdos en CTPT en cada una de las secciones de consenso

INTRODUCTION: Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary. OBJECTIVE: To develop a support document for guidance on the use of IONM in TPTS. METHOD: Work group consensus through systematic review and the Delphi method. RESULTS: Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications. CONCLUSIONS: IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus

Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery. / Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides.

INTRODUCTION: Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary. OBJECTIVE: To develop a support document for guidance on the use of IONM in TPTS. METHOD: Work group consensus through systematic review and the Delphi method. RESULTS: Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications. CONCLUSIONS: IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.

Self-Assembled Nanospheres for Encapsulation and Aerosolization of Rifampicin.

Rifampicin (RIF) is a benchmark drug for treatment of tuberculosis, but poor bioavailability, prolonged treatment, and pill burden have been linked to therapeutic failure and the development of multidrug resistant strains. To overcome these limitations, this study investigated a method of rifampicin nanoencapsulation and aerosol delivery using a commercial, hand-held nebulizer modified with a nitrogen stream.

Ephrin-A2 and ephrin-A5 guide contralateral targeting but not topographic mapping of ventral cochlear nucleus axons.

BACKGROUND: In the auditory brainstem, ventral cochlear nucleus (VCN) axons project to the contralateral, but not ipsilateral, medial nucleus of trapezoid body (MNTB), terminating in the calyx of Held. Dorsal VCN neurons, representing high frequencies, synapse with medial MNTB neurons, while low frequency-coding ventral VCN neurons synapse with lateral MNTB neurons, reflecting tonotopic organization. The mechanisms that ensure strictly contralateral targeting and topographic ordering are incompletely understood. Here we examined the roles of ephrin-A signaling in both types of targeting. RESULTS: Ephrin-A2 and ephrin-A5 are expressed in VCN cells during late embryonic and early postnatal development. At these ages ephrin-A2 is expressed in axons surrounding MNTB and ephrin-A5 is expressed in MNTB principal neurons. Ephrin-A2/A5 double knockout mice displayed axon targeting errors in which VCN axons project to MNTB on both sides of the brainstem, where they terminate in calyceal endings. Ephrin-A2 and ephrin-A5 single knockout mice showed a similar phenotype. In contrast to effects on contralateral targeting, ephrin-A2/A5 double knockout mice showed no defects in formation of tonotopically ordered projections from VCN to MNTB. CONCLUSIONS: These findings demonstrate that distinct mechanisms regulate targeting of VCN axons to the contralateral MNTB and targeting to appropriate tonotopic locations. Ephrin-A signaling plays a similar role to ephrin-B signaling in the VCN-MNTB pathway, where both classes normally prevent formation of calyceal projections to ipsilateral MNTB. These classes may rely in part on common signaling pathways.