Longitudinal outcomes of obeticholic acid therapy in ursodiol-nonresponsive primary biliary cholangitis: Stratifying the impact of add-on fibrates in real-world practice.

BACKGROUND: Suboptimal response to ursodeoxycholic acid occurs in 40% of primary biliary cholangitis (PBC) patients, affecting survival. Achieving a deep response (normalisation of alkaline phosphatase [ALP] and bilirubin ≤0.6 upper limit of normal) improves survival. Yet, the long-term effectiveness of second-line treatments remains uncertain. AIMS: To evaluate the long-term effectiveness of obeticholic acid (OCA) ± fibrates. Focusing on biochemical response (ALP ≤1.67 times the upper limit of normal, with a decrease of at least 15% from baseline and normal bilirubin levels), normalisation of ALP, deep response and biochemical remission (deep response plus aminotransferase normalisation). METHODS: We conducted a longitudinal, observational, multicentre study involving ursodeoxyccholic acid non-responsive PBC patients (Paris-II criteria) from Spain and Portugal who received OCA ± fibrates. RESULTS: Of 255 patients, median follow-up was 35.1 months (IQR: 20.2-53). The biochemical response in the whole cohort was 47.2%, 61.4% and 68.6% at 12, 24 and 36 months. GLOBE-PBC and 5-year UK-PBC scores improved (p < 0.001). Triple therapy (ursodeoxycholic acid plus OCA plus fibrates) had significantly higher response rates than dual therapy (p = 0.001), including ALP normalisation, deep response and biochemical remission (p < 0.001). In multivariate analysis, triple therapy remained independently associated with biochemical response (p = 0.024), alkaline phosphatase normalisation, deep response and biochemical remission (p < 0.001). Adverse effects occurred in 41.2% of cases, leading to 18.8% discontinuing OCA. Out of 55 patients with cirrhosis, 12 developed decompensation. All with baseline portal hypertension. CONCLUSION: Triple therapy was superior in achieving therapeutic goals in UDCA-nonresponsive PBC. Decompensation was linked to pre-existing portal hypertension.

Direct mosquito feedings on dengue-2 virus-infected people reveal dynamics of human infectiousness.

Dengue virus (DENV) transmission from humans to mosquitoes is a poorly documented, but critical component of DENV epidemiology. Magnitude of viremia is the primary determinant of successful human-to-mosquito DENV transmission. People with the same level of viremia, however, can vary in their infectiousness to mosquitoes as a function of other factors that remain to be elucidated. Here, we report on a field-based study in the city of Iquitos, Peru, where we conducted direct mosquito feedings on people naturally infected with DENV and that experienced mild illness. We also enrolled people naturally infected with Zika virus (ZIKV) after the introduction of ZIKV in Iquitos during the study period. Of the 54 study participants involved in direct mosquito feedings, 43 were infected with DENV-2, two with DENV-3, and nine with ZIKV. Our analysis excluded participants whose viremia was detectable at enrollment but undetectable at the time of mosquito feeding, which was the case for all participants with DENV-3 and ZIKV infections. We analyzed the probability of onward transmission during 50 feeding events involving 27 participants infected with DENV-2 based on the presence of infectious virus in mosquito saliva 7-16 days post blood meal. Transmission probability was positively associated with the level of viremia and duration of extrinsic incubation in the mosquito. In addition, transmission probability was influenced by the day of illness in a non-monotonic fashion; i.e., transmission probability increased until 2 days after symptom onset and decreased thereafter. We conclude that mildly ill DENV-infected humans with similar levels of viremia during the first two days after symptom onset will be most infectious to mosquitoes on the second day of their illness. Quantifying variation within and between people in their contribution to DENV transmission is essential to better understand the biological determinants of human infectiousness, parametrize epidemiological models, and improve disease surveillance and prevention strategies.

[Topical use of tranexamic acid in total hip arthroplasties: retrospective analysis of its advantages]. / Uso tópico de ácido tranexámico en artroplastías totales de cadera: análisis retrospectivo de sus ventajas.

INTRODUCTION: intravenous (IV) tranexamic acid (TXA) has shown its usefulness to prevent postsurgical anemia, but few studies have analyzed its topical administration. Seven years ago, we implemented a new topical administration (moistening three gauzes with 1.5 g of TXA) in our primary total hip arthroplasties (THA). The objective of this study was to compare blood loss, hospital stay and complications without the use of TXA, topical use or 10 mg/kg IV plus topical. MATERIAL AND METHODS: consecutive retrospective series of 274 patients undergoing CTA (mean 70 years [59-76], 59% women) operated from 2014 to 2019. Loss of hemoglobin and hematocrit, blood transfusions, hospital stay, thromboembolic complications were compared and 30-day mortality among three groups: non-tranexamic (44.2%), topical (45.6%), topical + IV (9.9%). RESULTS: after 24 and 48 hours, hemoglobin and hematocrit decreased less (p < 0.05) in patients treated with TXA (topical and/or IV). Blood transfusion was required in 32% of patients without TXA, 12% of those treated with topical TXA only (RR = 3.24 [95% CI: 1.69-6.20]), and 0% of patients who received IV TXA (p = 0.005) (RR = 4.07 [95% CI: 2.14-7.48]). Hospital stay was reduced three days with TXA (p < 0.001). We have not observed any adverse effects related to TXA. CONCLUSIONS: the use of TXA in CTA significantly reduces anemia, transfusions and hospital stay without increasing complications. Isolated topical TXA (hemostatic pads) is less effective than topical IV + topical use, but both significantly improve anemia, transfusions, and hospital stay compared to no use.

INTRODUCCIÓN: el ácido tranexámico (ATX) intravenoso (IV) ha demostrado su utilidad para evitar la anemia postquirúrgica, pero pocos estudios han analizado su administración tópica. Hace siete años implementamos una nueva administración tópica (humedeciendo tres compresas con 1.5 g de ATX) en nuestras artroplastías totales de cadera (ATC) primarias. El objetivo de este estudio ha sido comparar la pérdida de sangre, estancia hospitalaria y complicaciones sin uso de ATX, uso tópico o 10 mg/kg IV más tópico. MATERIAL Y MÉTODOS: serie retrospectiva consecutiva de 274 pacientes intervenidos de ATC (promedio 70 años [59-76], 59% mujeres) operados de 2014 a 2019. Se compararon pérdida de hemoglobina y hematocrito, transfusiones de sangre, estancia hospitalaria, complicaciones tromboembólicas y mortalidad a 30 días entre tres grupos: no tranexámico (44.2%), tópico (45.6%), tópico + IV (9.9%). RESULTADOS: después de 24 y 48 horas, la hemoglobina y el hematocrito disminuyeron menos (p < 0.05) en los pacientes tratados con ATX (tópico y/o IV). Se requirió transfusión de sangre en 32% de los pacientes sin ATX, 12% de los tratados sólo con ATX tópico (RR = 3.24 [IC de 95%: 1.69-6.20]) y 0% de los pacientes que recibieron ATX IV (p = 0.005) (RR = 4.07 [IC de 95%: 2.14-7.48]). La estancia hospitalaria se redujo en tres días con ATX (p < 0.001). No hemos observado efectos adversos relacionados con ATX. CONCLUSIONES: el uso del ATX en ATC reduce significativamente la anemia, las transfusiones y la estancia hospitalaria sin aumentar las complicaciones. El ATX tópico aislado (compresas hemostáticas) es menos eficaz que el uso tópico IV + tópico, pero ambos mejoran significativamente la anemia, las transfusiones y la estancia hospitalaria en comparación con su no utilización.

Proyecto PREVENCOT: ¿Seguimos las recomendaciones internacionales para la prevención de la infección del sitio quirúrgico en cirugía ortopédica programada? / PREVENCOT project: Do we follow international guidelines to prevent surgical site infection in orthopedic elective surgery?

Antecedentes y objetivo: La prevención de las infecciones postoperatorias en el sitio quirúrgico es realmente factible. El objetivo de este trabajo es analizar la adhesividad a las guías internacionales para la prevención de las infecciones en cirugía ortopédica protésica electiva a través de una encuesta sobre una muestra representativa de cirujanos ortopédicos españoles, con el fin de establecer unas recomendaciones generales. Material y método: Se realiza una encuesta poblacional en formato online compuesta por 78 preguntas para analizar la práctica clínica habitual de los cirujanos ortopédicos españoles ante las infecciones periprotésicas de cadera y rodilla, y la adhesividad de los mismos a las guías internacionales. Resultados: Los resultados de la encuesta (n=138) muestran que en práctica clínica existe una alta adhesividad de los cirujanos ortopédicos españoles a la mayoría de las recomendaciones internacionales. Conclusiones: La integración de la práctica clínica individual con la mejor evidencia científica disponible a partir de las recomendaciones de las guías internacionales es la mejor vía para el manejo adecuado de la prevención de infección periprotésica en cirugía electiva.(AU)

Background and objective: Prevention of postoperative surgical site infections is indeed feasible. The aim of this work is to analyses adherence to international guidelines for the prevention of infections in elective orthopedic prosthetic surgery by means of a survey of a representative sample of Spanish orthopedic surgeons, with the purpose to establish general recommendations. Material and method: A population survey was conducted in online format consisting of 78 questions to analyze the usual clinical practice of Spanish orthopedic surgeons in the face of periprosthetic infections of the hip and knee, and their adherence to international guidelines. Results: The results of the survey (n=138) show in clinical practice of Spanish orthopedic surgeons a high adherence to most of the international recommendations. Conclusions: The integration high adherence of individual clinical practice with the best available scientific evidence based on the recommendations of international guidelines is the best way to adequately manage the prevention of periprosthetic infection in elective surgery.(AU)

PREVENCOT project: Do we follow international guidelines to prevent surgical site infection in orthopaedic elective surgery? / Proyecto PREVENCOT: ¿Seguimos las recomendaciones internacionales para la prevención de la infección del sitio quirúrgico en cirugía ortopédica programada?

Background and objective: Prevention of postoperative surgical site infections is indeed feasible. The aim of this work is to analyses adherence to international guidelines for the prevention of infections in elective orthopedic prosthetic surgery by means of a survey of a representative sample of Spanish orthopedic surgeons, with the purpose to establish general recommendations. Material and method: A population survey was conducted in online format consisting of 78 questions to analyze the usual clinical practice of Spanish orthopedic surgeons in the face of periprosthetic infections of the hip and knee, and their adherence to international guidelines. Results: The results of the survey (n=138) show in clinical practice of Spanish orthopedic surgeons a high adherence to most of the international recommendations. Conclusions: The integration high adherence of individual clinical practice with the best available scientific evidence based on the recommendations of international guidelines is the best way to adequately manage the prevention of periprosthetic infection in elective surgery.(AU)

Antecedentes y objetivo: La prevención de las infecciones postoperatorias en el sitio quirúrgico es realmente factible. El objetivo de este trabajo es analizar la adhesividad a las guías internacionales para la prevención de las infecciones en cirugía ortopédica protésica electiva a través de una encuesta sobre una muestra representativa de cirujanos ortopédicos españoles, con el fin de establecer unas recomendaciones generales. Material y método: Se realiza una encuesta poblacional en formato online compuesta por 78 preguntas para analizar la práctica clínica habitual de los cirujanos ortopédicos españoles ante las infecciones periprotésicas de cadera y rodilla, y la adhesividad de los mismos a las guías internacionales. Resultados: Los resultados de la encuesta (n=138) muestran que en práctica clínica existe una alta adhesividad de los cirujanos ortopédicos españoles a la mayoría de las recomendaciones internacionales. Conclusiones: La integración de la práctica clínica individual con la mejor evidencia científica disponible a partir de las recomendaciones de las guías internacionales es la mejor vía para el manejo adecuado de la prevención de infección periprotésica en cirugía electiva.(AU)

PREVENCOT project: Do we follow international guidelines to prevent surgical site infection in orthopedic elective surgery? / Proyecto PREVENCOT: ¿Seguimos las recomendaciones internacionales para la prevención de la infección del sitio quirúrgico en cirugía ortopédica programada?

BACKGROUND AND OBJECTIVE: Prevention of postoperative surgical site infections is indeed feasible. The aim of this work is to analyses adherence to international guidelines for the prevention of infections in elective orthopedic prosthetic surgery by means of a survey of a representative sample of Spanish orthopedic surgeons, with the purpose to establish general recommendations. MATERIAL AND METHOD: A population survey was conducted in online format consisting of 78 questions to analyze the usual clinical practice of Spanish orthopedic surgeons in the face of periprosthetic infections of the hip and knee, and their adherence to international guidelines. RESULTS: The results of the survey (n=138) show in clinical practice of Spanish orthopedic surgeons a high adherence to most of the international recommendations. CONCLUSIONS: The integration high adherence of individual clinical practice with the best available scientific evidence based on the recommendations of international guidelines is the best way to adequately manage the prevention of periprosthetic infection in elective surgery.

Uso tópico de ácido tranexámico en artroplastías totales de cadera: análisis retrospectivo de sus ventajas / Topical use of tranexamic acid in total hip arthroplasties: retrospective analysis of its advantages

Resumen: Introducción: El ácido tranexámico (ATX) intravenoso (IV) ha demostrado su utilidad para evitar la anemia postquirúrgica, pero pocos estudios han analizado su administración tópica. Hace siete años implementamos una nueva administración tópica (humedeciendo tres compresas con 1.5 g de ATX) en nuestras artroplastías totales de cadera (ATC) primarias. El objetivo de este estudio ha sido comparar la pérdida de sangre, estancia hospitalaria y complicaciones sin uso de ATX, uso tópico o 10 mg/kg IV más tópico. Material y métodos: Serie retrospectiva consecutiva de 274 pacientes intervenidos de ATC (promedio 70 años [59-76], 59% mujeres) operados de 2014 a 2019. Se compararon pérdida de hemoglobina y hematocrito, transfusiones de sangre, estancia hospitalaria, complicaciones tromboembólicas y mortalidad a 30 días entre tres grupos: no tranexámico (44.2%), tópico (45.6%), tópico + IV (9.9%). Resultados: Después de 24 y 48 horas, la hemoglobina y el hematocrito disminuyeron menos (p < 0.05) en los pacientes tratados con ATX (tópico y/o IV). Se requirió transfusión de sangre en 32% de los pacientes sin ATX, 12% de los tratados sólo con ATX tópico (RR = 3.24 [IC de 95%: 1.69-6.20]) y 0% de los pacientes que recibieron ATX IV (p = 0.005) (RR = 4.07 [IC de 95%: 2.14-7.48]). La estancia hospitalaria se redujo en tres días con ATX (p < 0.001). No hemos observado efectos adversos relacionados con ATX. Conclusiones: El uso del ATX en ATC reduce significativamente la anemia, las transfusiones y la estancia hospitalaria sin aumentar las complicaciones. El ATX tópico aislado (compresas hemostáticas) es menos eficaz que el uso tópico IV + tópico, pero ambos mejoran significativamente la anemia, las transfusiones y la estancia hospitalaria en comparación con su no utilización.

Abstract: Introduction: Intravenous (IV) tranexamic acid (TXA) has shown its usefulness to prevent postsurgical anemia, but few studies have analyzed its topical administration. Seven years ago, we implemented a new topical administration (moistening three gauzes with 1.5 g of TXA) in our primary total hip arthroplasties (THA). The objective of this study was to compare blood loss, hospital stay and complications without the use of TXA, topical use or 10 mg/kg IV plus topical. Material and methods: Consecutive retrospective series of 274 patients undergoing CTA (mean 70 years [59-76], 59% women) operated from 2014 to 2019. Loss of hemoglobin and hematocrit, blood transfusions, hospital stay, thromboembolic complications were compared and 30-day mortality among three groups: non-tranexamic (44.2%), topical (45.6%), topical + IV (9.9%). Results: After 24 and 48 hours, hemoglobin and hematocrit decreased less (p < 0.05) in patients treated with TXA (topical and/or IV). Blood transfusion was required in 32% of patients without TXA, 12% of those treated with topical TXA only (RR = 3.24 [95% CI: 1.69-6.20]), and 0% of patients who received IV TXA (p = 0.005) (RR = 4.07 [95% CI: 2.14-7.48]). Hospital stay was reduced three days with TXA (p < 0.001). We have not observed any adverse effects related to TXA. Conclusions: The use of TXA in CTA significantly reduces anemia, transfusions and hospital stay without increasing complications. Isolated topical TXA (hemostatic pads) is less effective than topical IV + topical use, but both significantly improve anemia, transfusions, and hospital stay compared to no use.

Citizen seismology helps decipher the 2021 Haiti earthquake.

On 14 August 2021, the moment magnitude (Mw) 7.2 Nippes earthquake in Haiti occurred within the same fault zone as its devastating 2010 Mw 7.0 predecessor, but struck the country when field access was limited by insecurity and conventional seismometers from the national network were inoperative. A network of citizen seismometers installed in 2019 provided near-field data critical to rapidly understand the mechanism of the mainshock and monitor its aftershock sequence. Their real-time data defined two aftershock clusters that coincide with two areas of coseismic slip derived from inversions of conventional seismological and geodetic data. Machine learning applied to data from the citizen seismometer closest to the mainshock allows us to forecast aftershocks as accurately as with the network-derived catalog. This shows the utility of citizen science contributing to our understanding of a major earthquake.

Seismic Stereometry Reveals Preparatory Behavior and Source Kinematics of Intermediate-Size Earthquakes.

Although moderate-size earthquakes are poorly studied by lack of near-fault observations, they can provide key information about larger damaging earthquakes. Here we propose a new approach, inspired by double-difference relocation, that uses high-coherency waveforms recorded at neighboring sensors, to study the preparation phase and dynamics of moderate-size earthquakes. We validate this technique by analyzing the 2016, M w 5.2 Borrego Springs earthquake in Southern California and find consistent rupture velocities of 2 km/s highlighting two main rupture asperities. The analysis of the 2019, Ml5.2 Le Teil earthquake in France reveals slow nucleation at depth that migrates to the surface and propagates northward with a velocity of ∼2.8 km/s, highlighting two main rupture events also imaged by InSAR. By providing unprecedented resolution in our observation of the rupture dynamics, this approach will be useful in better understanding the preparation phase and rupture of both tectonic and induced earthquakes.

Influence of cognitive impairment on mortality, complications and functional outcome after hip fracture: Dementia as a risk factor for sepsis and urinary infection.

PURPOSE: To analyze the relation between cognitive impairment on arrival at hospital in patients older than 65 years with a hip fracture, and their mortality, medical and surgical complications, and functional outcomes. PATIENTS AND METHODS: Observational study of a single-center prospective consecutive cohort of 955 patients older than 64 years diagnosed of hip fracture from December/2012 to December/2015. Average age was 86±7.2 (65-104) years and 725 (75.9%) were female. Fractures were extracapsular in 538 cases (56.3%) and intracapsular in 417 (43.7%). Patients were controlled clinically and radiographically in outpatient clinic after 1, 3, 6, and 12 months. Data about basal cognitive status, walking ability before the fracture, medical and surgical complications, functional outcomes and mortality were collected for the year following the fracture. STATISTICAL ANALYSIS: Bivariate analysis (Pearson, Fisher, Mann-Whitney, Wilcoxon) was applied to study statistically significant relations, and contingence coefficients (CC) were calculated. RESULTS: Patients with cognitive impairment showed a higher overall mortality, (p = 0,000; CC=0,197) even after hospital discharge (p = 0.000; CC=0.198). Similarly, patients with dementia presented a higher rate of respiratory infections (p = 0,029; CC=0,093), urinary tract infections (p = 0,008; CC=0,108) and sepsis (p = 0,011; CC=0,105). On the contrary, we found no correlations between mental status and surgical complications, even for prosthesis dislocation (p = 0.136). Patients with dementia started from poorer functional situations (p = 0,000; CC=0,367) and ended follow-up with lower walking ability (p = 0,000; CC=0,43), but cognitive impairment did not relate statistically with a worse functional recovery (p = 0,304): that is, the proportion of patients who maintained their previous ability to walk was similar in both groups, those with altered mental status and those without it. CONCLUSIONS: Cognitive impairment is a risk factor for mortality in patients with a hip fracture. It is also a risk factor for suffering respiratory and urinary tract infection and sepsis. These two late risks factors have not been published previously. Functional recovery is not conditioned by cognitive impairment, although further studies need to be developed to evaluate the actual role of cognitive impairment on postoperative progression of patients.

Distributed sensing of earthquakes and ocean-solid Earth interactions on seafloor telecom cables.

Two thirds of the surface of our planet are covered by water and are still poorly instrumented, which has prevented the earth science community from addressing numerous key scientific questions. The potential to leverage the existing fiber optic seafloor telecom cables that criss-cross the oceans, by using them as dense arrays of seismo-acoustic sensors, remains to be evaluated. Here, we report Distributed Acoustic Sensing measurements on a 41.5 km-long telecom cable that is deployed offshore Toulon, France. Our observations demonstrate the capability to monitor with unprecedented details the ocean-solid earth interactions from the coast to the abyssal plain, in addition to regional seismicity (e.g., a magnitude 1.9 micro-earthquake located 100 km away) with signal characteristics comparable to those of a coastal seismic station.

Outcome of a hemispherical porous-coated acetabular component with a proximally hydroxyapatite-coated anatomical femoral component: an update at 23 to 26 years' follow-up

AIMS: We previously reported the long-term results of the cementless Duraloc-Profile total hip arthroplasty (THA) system in a 12- to 15-year follow-up study. In this paper, we provide an update on the clinical and radiological results of a previously reported cohort of patients at 23 to 26 years´ follow-up. PATIENTS AND METHODS: Of the 99 original patients (111 hips), 73 patients (82 hips) with a mean age of 56.8 years (21 to 70) were available for clinical and radiological study at a minimum follow-up of 23 years. There were 40 female patients (44 hips) and 33 male patients (38 hips). RESULTS: All acetabular and femoral components were well fixed and showed signs of bone ingrowth. Nine acetabular components were revised due to wear-osteolysis-related problems and four due to late dislocation. The probability of not having component revision at 25 years was 83.2% (95% confidence interval (CI) 74.5 to 91.8; number at risk 41). Acetabular osteolysis was observed in ten hips. The mean femoral head penetration was 1.52 mm (sd 0.8) at 15 years and 1.92 mm (sd 1.2) at 25 years. Receiver operating characteristic (ROC) analysis revealed that mean femoral penetration with a value of 0.11 mm/year or more was associated with the appearance of osteolysis. The 25-year Kaplan-Meier survival with different endpoints was 89.9% for acetabular osteolysis (95% CI 83.3 to 96.5), 92.1% for proximal femoral osteolysis (95% CI 86.1 to 98.2), and 75.5% for femoral osteopenia (95% CI 66.5 to 84.5). CONCLUSION: The Duraloc-Profile THA system showed excellent long-term bone fixation. Nevertheless, monitoring is recommended in order to detect wear and late dislocations in this population that was relatively young at the time of surgery. Cite this article: Bone Joint J 2019;101-B:378-385.

The hidden simplicity of subduction megathrust earthquakes.

The largest observed earthquakes occur on subduction interfaces and frequently cause widespread damage and loss of life. Understanding the rupture behavior of megathrust events is crucial for earthquake rupture physics, as well as for earthquake early-warning systems. However, the large variability in behavior between individual events seemingly defies a description with a simple unifying model. Here we use three source time function (STF) data sets for subduction zone earthquakes, with moment magnitude Mw ≥ 7, and show that such large ruptures share a typical universal behavior. The median STF is scalable between events with different sizes, grows linearly, and is nearly triangular. The deviations from the median behavior are multiplicative and Gaussian-that is, they are proportionally larger for larger events. Our observations suggest that earthquake magnitudes cannot be predicted from the characteristics of rupture onsets.

Genetic diversity of armored scales (Hemiptera: Diaspididae) and soft scales (Hemiptera: Coccidae) in Chile.

Scale insects (Sternorrhyncha: Coccoidea) are one of the most invasive and agriculturally damaging insect groups. Their management and the development of new control methods are currently jeopardized by the scarcity of identification data, in particular in regions where no large survey coupling morphological and DNA analyses have been performed. In this study, we sampled 116 populations of armored scales (Hemiptera: Diaspididae) and 112 populations of soft scales (Hemiptera: Coccidae) in Chile, over a latitudinal gradient ranging from 18°S to 41°S, on fruit crops, ornamental plants and trees. We sequenced the COI and 28S genes in each population. In total, 19 Diaspididae species and 11 Coccidae species were identified morphologically. From the 63 COI haplotypes and the 54 28S haplotypes uncovered, and using several DNA data analysis methods (Automatic Barcode Gap Discovery, K2P distance, NJ trees), up to 36 genetic clusters were detected. Morphological and DNA data were congruent, except for three species (Aspidiotus nerii, Hemiberlesia rapax and Coccus hesperidum) in which DNA data revealed highly differentiated lineages. More than 50% of the haplotypes obtained had no high-scoring matches with any of the sequences in the GenBank database. This study provides 63 COI and 54 28S barcode sequences for the identification of Coccoidea from Chile.

Effectiveness and safety of sofosbuvir-based regimens plus an NS5A inhibitor for patients with HCV genotype 3 infection and cirrhosis. Results of a multicenter real-life cohort.

Patients with HCV genotype 3 (GT3) infection and cirrhosis are currently the most difficult to cure. We report our experience with sofosbuvir+daclatasvir (SOF+DCV) or sofosbuvir/ledipasvir (SOF/LDV), with or without ribavirin (RBV) in clinical practice in this population. This was a multicenter observational study including cirrhotic patients infected by HCV GT3, treated with sofosbuvir plus an NS5A inhibitor (May 2014-October 2015). In total, 208 patients were included: 98 (47%) treatment-experienced, 42 (20%) decompensated and 55 (27%) MELD score >10. In 131 (63%), treatment was SOF+DCV and in 77 (37%), SOF/LDV. Overall, 86% received RBV. RBV addition and extension to 24 weeks was higher in the SOF/LDV group (95% vs 80%, P=.002 and 83% vs 72%, P=.044, respectively). A higher percentage of decompensated patients were treated with DCV than LDV (25% vs 12%, P=.013). Overall, SVR12 was 93.8% (195/208): 94% with SOF+DCV and 93.5% with SOF/LDV. SVR12 was achieved in 90.5% of decompensated patients. Eleven treatment failures: 10 relapses and one breakthrough. RBV addition did not improve SVR (RR: 1.08; P=.919). The single factor associated with failure to achieve SVR was platelet count <75×10E9/mL (RR: 3.50, P=.019). In patients with MELD <10, type of NS5A inhibitor did not impact on SVR12 (94% vs 97%; adjusted RR: 0.49). Thirteen patients (6.3%) had serious adverse events, including three deaths (1.4%) and one therapy discontinuation (0.5%), higher in decompensated patients (16.7% vs 3.6%, P<.006). In patients with GT3 infection and cirrhosis, SVR12 rates were high with both SOF+DCV and SOF/LDV, with few serious adverse events.

Role of assessing liver fibrosis in management of chronic hepatitis C virus infection.

Fibrosis progression is common in hepatitis C. Both host and viral factors influence its natural history. Liver fibrosis is a key predictive factor for advanced disease including endpoints such as liver failure, cirrhosis and hepatocellular carcinoma (HCC). METAVIR fibrosis stages F3-F4 have been considered as the threshold for antiviral therapy. However, this aspect is controversial after the advent of new direct-acting antivirals (DAAs) because they show an excellent efficacy and safety profile. Moreover, in the DAA era, fibrosis stage seems not to be a predictive factor of a sustained virological response (SVR). Viral eradication decreases liver damage by improving the inflammation, as well as by regressing fibrosis irrespective of the treatment regimen. Non-invasive methods are useful in the assessment of liver fibrosis, replacing liver biopsy in clinical practice; but their usefulness for monitoring fibrosis after SVR needs to be demonstrated. Fibrosis regression has been demonstrated after the eradication of hepatitis C virus infection and is associated with a lower risk of hepatic cirrhosis and liver cancer. However, patients showing advanced fibrosis and cirrhosis must be followed-up after SVR, as risks of portal hypertension and HCC remain.

Réplica a: Factores de riesgo para la infección en prótesis de rodilla, incluyendo la fractura intraoperatoria y la trombosis venosa profunda, no descritos previamente / Reply to: risk factors for infection in total knee artrhoplasty, including previously unreported intraoperative fracture and deep venous thrombosis

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Diagnosis of spacer-associated infection using quantitative cultures from sonicated antibiotics-loaded spacers: implications for the clinical outcome.

Recent studies showed that a positive microbiological result from sonication of the PMMA spacer was associated with poor outcome of patients, but no quantitative analysis has yet been performed. For this purpose, a prospective analysis of 50 spacers (46 patients) was performed. All spacers were processed according to a previously described protocol, including centrifugation and quantitative culture. Clinical data and outcome were also analysed. A statistical relationship between the results of the cultures and the outcome of the patient was assessed. Sixteen patients were diagnosed with spacer-associated infection. Thirteen out of 50 spacers gave a positive culture. Nine of 13 presented with growth of an organism not isolated in the first-stage cultures, and in 7 out of 13 the organisms count was high (>10,000 CFU/ml). We have detected a significant statistical relationship between poor outcome and positive cultures, high colony counts, isolation of different organisms, positive periprosthetic cultures and spacer-associated infection. The detection in a sonicated, antibiotic-loaded PMMA spacer of organisms other than those isolated in the first surgical samples or high colony counts of any organisms is diagnostic with regard to spacer-associated infection.