Traqueotomía versus traqueostomía, la necesidad de una aclaración lexicográfica / Tracheotomy versus tracheostomy, the need for lexicographical clarification

Con frecuencia se usan en el ámbito sanitario los términos traqueotomía y traqueostomía, pudiendo generar dudas entre los propios profesionales sobre qué definición corresponde a cada término o cuál de ellos debe considerarse más correcto en casos concretos. Se ha realizado una búsqueda de los términos «traqueotomía» y «traqueostomía» en los diccionarios generalistas en idioma español del Diccionario de la Real Academia Española (DRAE) y del Diccionario Histórico de la Lengua Española de la Real Academia Española (DHLE), y de los términos en inglés «tracheotomy» y «tracheostomy» en los diccionarios generalistas en idioma inglés del Oxford Dictionary, del Cambridge Dictionary y del Collins English Dictionary. Asimismo, se ha hecho una búsqueda en los diccionarios de términos médicos en español del Diccionario de Términos Médicos de la Real Academia Nacional de Medicina (DTM) y en inglés del Farlex Dictionary. Los términos se buscaron también en el buscador generalista de Internet Google®. Se analizaron las definiciones desde el punto de vista lexicográfico y etimológico. Las definiciones que aparecen en los diccionarios generalistas, tanto en español como en inglés, son imprecisas, limitadas y adolecen de ambigüedad por mezclar indicaciones desactualizadas con criterios alejados de la etimología. Sin embargo, las definiciones en los diccionarios de términos médicos en ambos idiomas están más ajustadas a la etimología. La traqueotomía identifica estrictamente el procedimiento quirúrgico de realización de una apertura en la cara anterior de la tráquea. La traqueostomía identifica la realización de un orificio que comunica la tráquea con el exterior e implica una modificación del tracto aéreo superior al proporcionar una entrada adicional de la vía respiratoria. Solo en las laringectomías totales la traqueostomía es la única vía de entrada al tracto aéreo. Ambos términos pueden utilizarse sinónimamente cuando una traqueotomía culmina con una traqueostomía. No convendrá utilizar el término traqueostomía cuando se produce el cierre de los planos al final del procedimiento y este no resulta en la creación de un estoma. Los traqueostomas pueden ser cualificados con adjetivos de tiempo de permanencia (temporal/permanente), tamaño (grande/pequeño), forma (redondo/elíptico), o profundidad por sí mismos, sin vincularse a ningún tipo de enfermedad o de indicación quirúrgica. No todos los traqueostomas permanentes tienen lugar en laringectomías totales ni tienen sistemáticamente un carácter irreversible.(AU)

In the healthcare field, the terms “traqueotomía” and “traqueostomía” are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms “traqueotomía” and “traqueostomía” in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms “tracheotomy” and “tracheostomy” in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. “Traqueotomía” strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. “Traqueostomía” identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. “Traqueostomía” becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term “traqueostomía” when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.(AU)

Comparison of the MIPS technique versus linear incision with tissue preservation in osseointegrated implants in the Ponto model®.

BACKGROUND AND OBJECTIVES: The surgery of osseointegrated implants has undergone different modifications over the years with the aim of achieving better results and facilitating the surgical technique. Today the most commonly used technique is the linear incision with tissue preservation and placement of the abutment and implant. The long-term success of this technique has served as the basis for the development of the so-called minimally invasive surgical approach (MIPS). This study compares the short-, medium- and long-term results between the classic linear incision technique and the MIPS technique. MATERIAL AND METHODS: A prospective study was conducted on patients who had an osseointegrated implant placed between February 2016 and February 2020. A total of 59 surgeries were performed, 32 surgeries according to the linear incision technique with tissue preservation and 27 with MIPS technique. Outcomes were evaluated at one week, one month and one year. RESULTS: Statistically significant differences were achieved between the 2 groups at one week after surgery. Eighty per cent of the MIPS patients had Holgers grades 0-1 compared to 35% of the linear technique patients (p = 0.001). No statistically significant differences were observed at one month (p = 0.457) and one year (p = 0.228). One case with grade 4 was recorded which resulted in implant extrusion one month after surgery with the MIPS technique. A new osseointegrated implant was placed 2 months after the fall using the same MIPS technique with good results. We were also able to verify that the duration of surgery was much shorter with the MIPS technique and better tolerated in terms of postoperative discomfort by the patient. CONCLUSIONS: In our experience, the MIPS technique is the technique of choice for surgery of osseointegrated Ponto model implants as it is simpler, faster and presents fewer problems in the immediate postoperative period, with similar long-term postoperative results.

The IRELAnD study-investigating the role of early low-dose aspirin in diabetes mellitus: a double-blinded, placebo-controlled, randomized trial.

BACKGROUND: Although aspirin therapy is being increasingly advocated with the intention of risk modification for a wide range of pregnancy complications, women with prepregnancy diabetes mellitus are commonly excluded from clinical trials. OBJECTIVE: The primary aim of this study was to examine the effect of aspirin therapy on a composite measure of adverse perinatal outcome in pregnancies complicated by pregestational diabetes mellitus. STUDY DESIGN: A double-blinded, placebo-controlled randomized trial was conducted at 6 university-affiliated perinatology centers. Women with type 1 diabetes mellitus or type 2 diabetes mellitus of at least 6 months' duration were randomly allocated to 150-mg daily aspirin or placebo from 11 to 14 weeks' gestation until 36 weeks. Established vascular complications of diabetes mellitus, including chronic hypertension or nephropathy, led to exclusion from the trial. The primary outcome was a composite measure of placental dysfunction (preeclampsia, fetal growth restriction, preterm birth <34 weeks' gestation, or perinatal mortality). The planned sample size was 566 participants to achieve a 35% reduction in the primary outcome, assuming 80% statistical power. Secondary end points included maternal and neonatal outcomes and determination of insulin requirements across gestation. Data were centrally managed using ClinInfo and analyzed using SAS 9.4. The 2 treatment groups were compared using t tests or chi-square tests, as required, and longitudinal data were compared using a repeated-measures analysis. RESULTS: From February 2020 to September 2022, 191 patients were deemed eligible, 134 of whom were enrolled (67 randomized to aspirin and 67 to placebo) with a retrospective power of 64%. A total of 101 (80%) women had type 1 diabetes mellitus and 25 (20%) had type 2 diabetes mellitus. Reaching the target sample size was limited by the impact of the COVID-19 pandemic. Baseline characteristics were similar between the aspirin and placebo groups. Treatment compliance was very high and similar between groups (97% for aspirin, 94% for placebo). The risk of the composite measure of placental dysfunction did not differ between groups (25% aspirin vs 21% placebo; P=.796). Women in the aspirin group had significantly lower insulin requirements throughout pregnancy compared with the placebo group. Insulin requirements in the aspirin group increased on average from 0.7 units/kg at baseline to 1.1 units/kg by 36 weeks' gestation (an average 83% within-patient increase), and increased from 0.7 units/kg to 1.3 units/kg (a 181% within-patient increase) in the placebo group, over the same gestational period (P=.002). Serial hemoglobin A1c levels were lower in the aspirin group than in the placebo group, although this trend did not reach statistical significance. CONCLUSION: In this multicenter, double-blinded, placebo-controlled randomized trial, aspirin did not reduce the risk of adverse perinatal outcome in pregnancies complicated by prepregnancy diabetes mellitus. Compared with the placebo group, aspirin-treated patients required significantly less insulin throughout pregnancy, indicating a beneficial effect of aspirin on glycemic control. Aspirin may exert a plausible placenta-mediated effect on pregestational diabetes mellitus that is not limited to its antithrombotic properties.

α-Boryl Carbanions: The Influence of Geminal Heteroatoms in C-C Bond Formation.

The wide applications of alpha-boryl carbanions in selective coupling with organohalides, imines/carbonyls and conjugated unsaturated substrates has become an interesting tool for organic synthesis. Strategically, the inclusion of heteroatoms, such as Si, S, N, F, Cl, Br and I in the alpha position opens a new venue towards multifunctionalities in molecular design. Here, a conceptual and practical view on powerful carbanions, containing α-silicoboron, α-thioboron, α-haloboron and α-aminoboron is given, as well as a prespective on their efficient application for selective electrophilic trapping.

Remote 1,4-Carbon-to-Carbon Boryl Migration: From a Mechanistic Challenge to a Valuable Synthetic Application of Bicycles.

The present paper reports a remote carbon-to-carbon boryl migration via an intramolecular 1,4-B/Cu shift, which establishes an in situ stereospecific electrophilic trap on the alkene moiety. The synthetic application is developed to prepare functionalized cyclopentenes by means of a palladium-catalyzed regioselective intramolecular coupling that completes a strategic cyclopropanation and generates valuable structural bicyclic systems. The mechanism is characterized by DFT (density functional theory) calculations which showed that the 1,4-migration proceeds through an intramolecular, nucleophilic attack of the copper-alkyl moiety on the boron atom bonded to the C(sp2), leading to a 5-membered boracycle structure. The computation of the 1,3- and 1,4-B/Cu shifts is also compared as is the impact of the endo- or exocyclic alkene on the reaction kinetics.

Speeding-up the Determination of Protein-Ligand Affinities by STD NMR: The Reduced Data Set STD NMR Approach (rd-STD NMR).

STD NMR spectroscopy is a powerful ligand-observed NMR tool for screening and characterizing the interactions of small molecules and low molecular weight fragments with a given macromolecule, identifying the main intermolecular contacts in the bound state. It is also a powerful analytical technique for the accurate determination of protein-ligand dissociation constants (KD) of medium-to-weak affinity, of interest in the pharmaceutical industry. However, accurate KD determination and epitope mapping requires a long series of experiments at increasing saturation times to carry out a full analysis using the so-called STD NMR build-up curve approach and apply the "initial slopes approximation". Here, we have developed a new protocol to bypass this important limitation, which allows us to obtain initial slopes by using just two saturation times and, hence, to very quickly determine precise protein-ligand dissociation constants by STD NMR.

Tracheotomy versus tracheostomy, the need for lexicographical clarification.

In the healthcare field, the terms "traqueotomía" and "traqueostomía" are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms "traqueotomía" and "traqueostomía" in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms "tracheotomy" and "tracheostomy" in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. "Traqueotomía" strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. "Traqueostomía" identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. "Traqueostomía" becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term "traqueostomía" when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.

Clinical practice guideline of the spanish society of oral surgery for oral surgery in patients with coagulation disorders / Guía de práctica clínica de la sociedad española de cirugía bucal para cirugía oral en pacientes con trastornos de la coagulación

Background: The number of patients treated with coagulation disorders, and more specifically with anticoagulanttherapy, has increased worldwide in recent years due to increased life expectancy in developed countries. Theprotocols for managing this type of patient in oral surgery has varied over recent years, especially after the appear-ance of new direct-acting oral anticoagulants (DOACs). The assessment of risk of bleeding in this type of patientwhen undergoing a surgical procedure continues to be a controversial issue for patients, dentists and general prac-titioners. The objective of this document is to offer recommendations, based on evidence, for decision making forpatients with coagulopathies who require dental surgical intervention. Material and Methods: Based on the indications of the “Preparation of Clinical Practice guidelines in the NationalHealth System. Methodological manual”, we gathered a group of experts who agreed on 15 PICO questions basedon managing patients with coagulation disorders in dental surgical procedures, such as fitting of implants or dentalextractions.Results: The 15 PICO questions were answered based on the available evidence, being limited in most cases due tothe lack of a control group. Two of the PICO questions were answered by the experts with a grade C recommendation,while the rest were answered with grade D.Conclusions: The results of this review highlight the need to undertake well designed clinical trials with controlgroups and with a representative sample size.(AU)

Ultrarapid Insulin Use Can Reduce Postprandial Hyperglycemia and Late Hypoglycemia, Even in Delayed Insulin Injections: A Connected Insulin Cap-Based Real-World Study.

Objectives: Reaching optimal postprandial glucose dynamics is a daily challenge for people with type 1 diabetes (T1D). This study aimed to analyze the postprandial hyperglycemic excursion (PHEs) and late postprandial hypoglycemia (LPH) risk according to prandial insulin time and type. Research Design and Methods: Real-world, retrospective study in T1D using multiple daily injections (MDI) analyzing 5 h of paired continuous glucose monitoring and insulin injections data collected from the connected cap Insulclock®. Meal events were identified using the rate of change detection methodology. Postprandial glucometrics and LPH (glucose <70 mg/dL 2-5 h after a meal) were evaluated according to insulin injection time and rapid (RI) or ultrarapid analog, Fiasp® (URI), use. Results: Meal glycemic excursions (n = 2488), RI: 1211, 48.7%; UR: 1277, 51.3%, in 82 people were analyzed according to injection time around the PHE: -45 to -15 min; -15 to 0 min; and 0 to +45 min. In 63% of the meals, insulin was injected after the PHE started. Lower PHE was observed with URI versus RI (glucose peak-baseline; mg/dL; mean ± standard deviation): 106.7 ± 35.2 versus 111.2 ± 40.3 (P = 0.003), particularly in 0/+45 injections: 111.6 ± 40.2 versus 118.1 ± 43.3; (P = 0.002). One third (29.1%) of participants added a second (correction) injection. The use of URI and avoiding a second injection were independently associated with less LPH risk, even in delayed injections (0/+45), (-36%, odds ratio [OR] 0.641; confidence interval [CI]: 0.462-0.909; P = 0.012) and -56% (OR 0.641; CI: 0.462-0.909 P = 0.038), respectively. Conclusions: URI analog use as prandial insulin reduces postprandial hyper- and hypoglycemia, even in delayed injections.

Real-world safety and effectiveness of dapagliflozin in people living with type 1 diabetes in Spain: The Dapa-ON multicenter retrospective study.

OBJECTIVE: To assess real-world safety and effectiveness of dapagliflozin in people living with type 1 diabetes mellitus (T1DM). METHODS: We conducted a multicenter retrospective study in Spain including data from 250 people living with T1DM receiving dapagliflozin as add-on therapy to insulin (80.8 % on-label use). The number of diabetic ketoacidosis (DKA) events was calculated over a 12-month follow-up (primary outcome). Changes in body weight, HbA1c, total daily insulin dose, and continuous glucose monitoring (CGM) metrics from baseline (at dapagliflozin prescription) to 12 months were also evaluated. RESULTS: A total of five DKA events (2.4 % [95 % CI 0.3;4.5] were reported in patients with a 12-month follow-up, n = 207): two events related to insulin pump malfunction, two events related to concomitant illnesses, and one event related to insulin dose omission. DKA events were more frequent among insulin pump users than among participants on multiple daily injections (7.7 % versus 1.2 %). Four of the reported DKA events occurred within the first six months after initiation of dapagliflozin. No deaths or persistent sequelae due to DKA were reported. No severe hypoglycemia episodes were reported. Significant reductions in mean body weight (-3.3 kg), HbA1c (-0.6 %), and total daily insulin dose (-8.6 %), P < 0.001, were observed 12 months after dapagliflozin prescription. Significant improvements in TIR (+9.3 %), TAR (-7.2 %), TBR (-2.5 %), and coefficient of variation (-5.1 %), P < 0.001, were also observed in the subgroup of patients with available CGM data. Finally, an improvement in urinary albumin-to-creatinine ratio (UACR) was found among participants with UACR ≥ 30 mg/g at baseline (median decrease of 99 mg/g in UACR, P = 0.001). CONCLUSION: The use of dapagliflozin in people living with T1DM has an appropriate safety profile after careful selection of participants and implementation of strategies to reduce the risk of DKA (i.e., prescribed according to the recommendations of the European Medicines Agency), and also leads to clinical improvements in this population.

Sex- and age-related patterns in the use of analgesics in older patients in the emergency department.

BACKGROUND: Treatment of acute pain in older patients is a common challenge faced in emergency departments (EDs). Despite many studies that have investigated chronic analgesic use in the elderly, data on patterns of acute use, especially in EDs, of analgesics according to patient characteristics is scarce. OBJECTIVE: To investigate sex- and age-related patterns of analgesic use in the Spanish EDs and determine differences in age-related patterns according to patient sex. DESIGN: A secondary analysis of the Emergency Department and Elderly Needs (EDEN) multipurpose cohort. SETTING: Fifty-two Spanish EDs (17% of Spanish EDs covering 25% of Spanish population). PARTICIPANTS: All patients' ≥65 years attending ED during 1 week (April 1-7, 2019). Patient characteristics recorded included age, sex, chronic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and opiates, comorbidity, dependence, dementia, depression, ability to walk and previous falls. Analgesics used in the ED were categorized in three groups: non-NSAID non-opioids (mainly paracetamol and metamizole, PM), NSAIDs, and opiates. OUTCOME MEASURES: Frequency of analgesic use was quantified, and the relationship between sex and age and analgesic use (in general and for each analgesic group) was assessed by unadjusted and adjusted logistic regression and restricted cubic spline models. Interaction between sex and age was explored. MAIN RESULTS: We included 24 573 patients, and 6678 (27.2%) received analgesics in the ED: 5551 (22.6%) PM, 1661 (6.8%) NSAIDs and 937 (3.8%) opiates (1312 received combinations). Analgesics were more frequently used in women (adjusted OR = 1.076, 95%CI = 1.014-1.142), as well as with NSAID (1.205, 1.083-1.341). Analgesic use increased with age, increasing PM and decreasing NSAIDs use. Opiate use remained quite constant across age and sex. Interaction of sex with age was present for the use of analgesics in general ( P  = 0.006), for PM ( P  < 0.001) and for opiates ( P  = 0.033), with higher use of all these analgesics in women. CONCLUSION: Use of analgesics in older individuals in EDs is mildly augmented in women and increases with age, with PM use increasing and NSAIDs decreasing with age. Conversely, opiate use is quite constant according to sex and age. Age-related patterns differ according to sex, with age-related curves of women showing higher probabilities than those of men to receive any analgesic, PM or opiates.

Stereoselective Control of the Cu Activation of ß,ß-Diboryl Acrylates for Allylic Coupling Protocols with Concomitant Lactonization.

The key to a successful C-B activation is to discriminate between two geminal boryl moieties that are exposed to the same reaction conditions. Here we describe a stereoselective C-B activation of ß,ß-diboryl acrylates forming exclusively the (Z)-α-borylalkenyl copper(I) key intermediate, for subsequent allylic alkylation reactions. The new borylated (Z)-skipped dienoates followed a feasible iodo-lactonization sequence for the preparation of borylated lactone cores, which can be used in drug discovery.

Periostin in the relation between periodontal disease and atherosclerotic coronary artery disease: A pilot randomized clinical study.

OBJECTIVE: The aim of this study was to analyze the effects of periodontal treatment on markers of atherosclerotic coronary artery disease and circulating levels of periostin. BACKGROUND: Periostin is necessary for periodontal stability, but it is highly present in atherosclerotic plaques. Treatment of periodontal disease, with low levels of local periostin, is thought to reduce systemic levels of periostin. Thus, this may contribute to cardiovascular health. METHODS: A pilot randomized controlled clinical trial was designed to include patients with severe periodontal disease and history of atherosclerotic coronary artery disease. Samples of gingival crevicular fluid (GCF) and serum were collected before and after periodontal treatment by periodontal surgery or non-surgical therapy. The levels of several markers of inflammation and cardiovascular damage were evaluated including CRP, IFN-γ, IL-1ß, IL-10, MIP-1α, periostin, and TNF-α in GCF and CRP, Fibrinogen, IFN-γ, IL-1ß, IL-6, IL-10, L-Selectin, MIP-1α, Periostin, TNF-α, and vWF in serum. RESULTS: A total of 22 patients with an average of 56 years old were recruited for participating in this study. Twenty of them were male. Most of them (82%) had suffered an acute myocardial event and underwent surgery for placing 1, 2, or 3 stents in the coronary arteries more than 6 months ago but less than 1 year. The treatment of periodontal disease resulted in an overall improvement of all periodontal parameters. Regarding the evaluation of GCF and serum, a significant increase of periostin in the GCF was observed after periodontal surgery. In contrast, although other markers in GCF and serum improved, no significant correlations were found. CONCLUSION: Treatment of periodontal disease through periodontal surgery induces a local and transient increase in the levels of periostin in the gingival crevicular fluid. The effects on systemic markers of inflammation and cardiovascular function have not been confirmed.

On the [Formula: see text]-anonymity of networks via their k-metric antidimension.

This work focuses on the [Formula: see text]-anonymity of some networks as a measure of their privacy against active attacks. Two different types of networks are considered. The first one consists of graphs with a predetermined structure, namely cylinders, toruses, and 2-dimensional Hamming graphs, whereas the second one is formed by randomly generated graphs. In order to evaluate the [Formula: see text]-anonymity of the considered graphs, we have computed their k-metric antidimension. To this end, we have taken a combinatorial approach for the graphs with a predetermined structure, whereas for randomly generated graphs we have developed an integer programming formulation and computationally tested its implementation. The results of the combinatorial approach, as well as those from the implementations indicate that, according to the [Formula: see text]-anonymity measure, only the 2-dimensional Hamming graphs and some general random dense graphs are achieving some higher privacy properties.

The relationship between palliative radiotherapy and opioid prescribing patterns among patients with metastatic cancer.

BACKGROUND: While randomized trials have established that palliative radiotherapy, especially to bone, can improve qualitative measures of pain, its quantitative relationship to opioid prescribing patterns has remained underexplored. We aimed to identify the association of palliative radiotherapy on opioid prescriptions received among patients with metastatic cancer. METHODS: The Virginia Commonwealth University Institutional Review Board approved retrospective analysis extracted prescription data from all adult patients with metastatic cancer who underwent outpatient palliative external beam radiation therapy at Virginia Commonwealth University Health System from 2008-2018. Institutional prescribing data were used to calculate the average opioid oral morphine milligram equivalent (MME) dose 30, 60 and 90 days both before and after radiotherapy. Univariate and bivariate ordinary least squares (OLS) regression models were used to estimate the relationship of MME changes with clinical, radiation-related, and demographic patient factors. RESULTS: A total of 182 patients met inclusion criteria. Overall, patients required higher opioid doses after radiotherapy, with mean MME 30, 60, and 90 days prior to radiotherapy of 24.6, 20.2, and 16.8 mg, respectively; which increased to 62.9, 77.7 and 82.4 mg post-radiation therapy (P<0.01). Multivariate OLS models predicting the change of MME 60 days pre- and post-radiation treatment showed that younger age and comorbid depression predicted increased MME after radiotherapy. CONCLUSIONS: Patients with metastatic cancer face a relatively high opioid burden, which increases over time, even among those who receive palliative radiation therapy. Patients who are younger and have comorbid depression may have a higher risk of increased opioid burden after radiotherapy.

A selenoureido-iminoglycolipid transported by zeolitic-imidazolate framework nanoparticles: a novel antioxidant therapeutic approach.

A selenium-containing metal-organic framework with remarkable antioxidant capacity and ROS-scavenging activity was constructed by a controlled de novo encapsulation approach of a glycoconjugate mimetic, specifically a sp2-iminoglycolipid bearing a selenoureido fragment (DSeU), within a zeolitic-imidazolate framework exoskeleton. Biocompatible and homogeneous nanosized particles of ∼70 nm (DSeU@ZIF8) were obtained, which could be efficiently internalized in cells, overcoming the poor solubility in biological media and limited bioavailability of glycolipids. The ZIF-particle served as nanocarrier for the intracellular delivery of the selenocompound to cells, promoted by the acidic pH inside endosomes/lysosomes. As demonstrated by in vitro studies, the designed DSeU@ZIF8 nanoparticles displayed a high antioxidant activity at low doses; lower intracellular ROS levels were observed upon the uptake of DSeU@ZIF8 by human endothelial cells. Even more interesting was the finding that these DSeU@ZIF8 particles were able to reverse to a certain level the oxidative stress induced in cells by pre-treatment with an oxidizing agent. This possibility of modulating the oxidative stress in living cells may have important implications in the treatment of diverse pathological complications that are generally accompanied with elevated ROS levels.

Feasibility and Short-Term SpO2/FiO2 Changes in Hospitalized Adults with COVID-19 Pneumonia after Chest Physiotherapy with Threshold PEP Valve: A Cross-Sectional Study.

BACKGROUND: One of the main features of COVID-19 pneumonia is hypoxemic acute respiratory failure (ARF), often requiring ventilatory support. The influence of chest physiotherapy in patients with ARF is not extensively studied. The aim of the study was to analyze the short-time effects of chest physiotherapy using a 10 cm H2O threshold valve in patients with COVID-19 and ARF. Methods; Quasi-experimental cross-sectional study, in hospitalized patients from March to May 2020. The fractions of inspired oxygen, oxygen saturation, heart rate, respiratory rate and dyspnea were collected before and after the starting session (day 1) and after the 5th day of therapy. RESULTS: The final sample size included 125 patients. Significant differences (p < 0.01) were found in the pre-post intervention SpO2/FiO2 ratio (250 ± 88.4 vs. 275.6 ± 97.5, p < 0.001), reaching 354.4 ± 110.2 after 5 days of therapy (p < 0.001 with respect to the baseline). The respiratory and heart rate dyspnea level did not change during the intervention. In patients needing FiO2 > 0.4, the SpO2/FiO2 ratio improvement was higher than in patients with milder severity (46.85 ± 77.69, p < 0.01). CONCLUSIONS: Chest physiotherapy with a 10 cm H2O threshold valve seems to be a safe and tolerated intervention with short-term improvement in oxygenation in patients with COVID-19 pneumonia.

Association of exposure to perfluoroalkyl substances (PFAS) and phthalates with thyroid hormones in adolescents from HBM4EU aligned studies.

BACKGROUND: Perfluoroalkyl substances (PFAS) and phthalates are synthetic chemicals widely used in various types of consumer products. There is epidemiological and experimental evidence that PFAS and phthalates may alter thyroid hormone levels; however, studies in children and adolescents are limited. AIM: To investigate the association of exposure to PFAS and phthalate with serum levels of thyroid hormones in European adolescents. METHODS: A cross-sectional study was conducted in 406 female and 327 male adolescents (14-17 years) from Belgium, Slovakia, and Spain participating in the Aligned Studies of the HBM4EU Project (FLEHS IV, PCB cohort, and BEA, respectively). Concentrations of perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), free thyroxine (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) were measured in sera from study participants, and urinary metabolites of six phthalates (DEP, DiBP, DnBP, BBzP, DEHP, and DiNP) and the non-phthalate plasticizer DINCH® were quantified in spot urine samples. Associations were assessed with linear regression and g-computational models for mixtures. Effect modification by sex was examined. RESULTS: In females, serum PFOA and the PFAS mixture concentrations were associated with lower FT4 and higher FT3 levels; MEP and the sums of DEHP, DiNP, and DINCH® metabolites (∑DEHP, ∑DiNP, and ∑DINCH) were associated with higher FT4; ∑DEHP with lower FT3; and the phthalate/DINCH® metabolite mixture with higher FT4 and lower FT3. In males, PFOA was associated with lower FT4 and the PFAS mixture with higher TSH levels and lower FT4/TSH ratio; MEP and ∑DiNP were associated with higher FT4; and MBzP, ∑DEHP, and the phthalate/DINCH® metabolite mixture with lower TSH and higher FT4/TSH. PFOA, mono-(2-ethyl-5-hydroxyhexyl) phthalate (OH-MEHP), mono-(2-ethyl-5-oxohexyl) phthalate (oxo-MEHP), and monocarboxyoctyl phthalate (MCOP) made the greatest contribution to the mixture effect. CONCLUSIONS: Results suggest that exposure to PFAS and phthalates is associated with sex-specific differences in thyroid hormone levels in adolescents.