Design and validation of an artificial intelligence system to detect the quality of colon cleansing before colonoscopy / Diseño y validación de un sistema de inteligencia artificial para detectar la calidad de la limpieza del colon previa a la realización de la colonoscopia

Background and aims Patients’ perception of their bowel cleansing quality may guide rescue cleansing strategies before colonoscopy. The main aim of this study was to train and validate a convolutional neural network (CNN) for classifying rectal effluent during bowel preparation intake as “adequate” or “inadequate” cleansing before colonoscopy.Patients and methodsPatients referred for outpatient colonoscopy were asked to provide images of their rectal effluent during the bowel preparation process. The images were categorized as adequate or inadequate cleansing based on a predefined 4-picture quality scale. A total of 1203 images were collected from 660 patients. The initial dataset (799 images), was split into a training set (80%) and a validation set (20%). The second dataset (404 images) was used to develop a second test of the CNN accuracy. Afterward, CNN prediction was prospectively compared with the Boston Bowel Preparation Scale (BBPS) in 200 additional patients who provided a picture of their last rectal effluent.ResultsOn the initial dataset, a global accuracy of 97.49%, a sensitivity of 98.17% and a specificity of 96.66% were obtained using the CNN model. On the second dataset, an accuracy of 95%, a sensitivity of 99.60% and a specificity of 87.41% were obtained. The results from the CNN model were significantly associated with those from the BBPS (P<0.001), and 77.78% of the patients with poor bowel preparation were correctly classified.ConclusionThe designed CNN is capable of classifying “adequate cleansing” and “inadequate cleansing” images with high accuracy. (AU)

Antecedentes y objetivos La percepción de los pacientes sobre la calidad de su limpieza intestinal puede guiar las estrategias de limpieza de rescate antes de una colonoscopia. El objetivo principal de este estudio fue entrenar y validar una red neuronal convolucional (CNN) para clasificar el efluente rectal durante la preparación intestinal como «adecuado» o «inadecuado».Pacientes y métodosPacientes no seleccionados proporcionaron imágenes del efluente rectal durante el proceso de preparación intestinal. Las imágenes fueron categorizadas como una limpieza adecuada o inadecuada según una escala de calidad de 4 imágenes predefinida. Se recopilaron un total de 1.203 imágenes de 660 pacientes. El conjunto de datos inicial (799 imágenes) se dividió en un conjunto de entrenamiento (80%) y un conjunto de validación (20%). Un segundo conjunto de datos (404 imágenes) se utilizó para evaluar la precisión de la CNN. Posteriormente, la predicción de la CNN se comparó prospectivamente con la escala de preparación colónica de Boston (BBPS) en 200 pacientes que proporcionaron una imagen de su último efluente rectal.ResultadosEn el conjunto de datos inicial, la precisión global fue del 97,49%, la sensibilidad del 98,17% y la especificidad del 96,66%. En el segundo conjunto de datos, se obtuvo una precisión del 95%, una sensibilidad del 99,60% y una especificidad del 87,41%. Los resultados del modelo de CNN se asociaron significativamente con la escala de preparación colónica de Boston (p<0,001), y el 77,78% de los pacientes con una preparación intestinal deficiente fueron clasificados correctamente.ConclusiónLa CNN diseñada es capaz de clasificar imágenes de «limpieza adecuada» y «limpieza inadecuada» con alta precisión. (AU)

The effectiveness of the TRACE online nutrition intervention in improving dietary intake, sleep quality and physical activity levels for Australian adults with food addiction: a randomised controlled trial.

BACKGROUND: Few interventions for food addiction (FA) report on dietary intake variables. The present study comprised a three-arm randomised controlled trial in adults with symptoms of FA. The aim was to evaluate dietary intake, sleep and physical activity resulting from a dietitian-led telehealth intervention at 3 months. METHODS: Adults with ≥3 symptoms of FA and a body mass index > 18.5 kg/m2 were recruited. Dietary intake including energy, nutrients and diet quality were assessed by a validated food frequency questionnaire in addition to sleep quality and physical activity (total min) and compared between groups and over time. Personalised dietary goals set by participants were examined to determine whether improvements in percent energy from core and non-core foods were reported. RESULTS: The active intervention group was superior compared to the passive intervention and control groups for improvements in percent energy from core (6.4%/day [95% confidence interval (CI) -0.0 to 12.9], p = 0.049), non-core foods (-6.4%/day [95% CI -12.9 to 0.0], p = 0.049), sweetened drinks (-1.7%/day [95% CI -2.9 to -0.4], p = 0.013), takeaway foods (-2.3%/day [95% CI -4.5 to -0.1], p = 0.045) and sodium (-478 mg/day [95% CI -765 to -191 mg], p = 0.001). CONCLUSIONS: A dietitian-led telehealth intervention for Australian adults with FA found significant improvements in dietary intake variables. Setting personalised goals around nutrition and eating behaviours was beneficial for lifestyle change.

Feeding Dairy Goats Dehydrated Orange Pulp Improves Cheese Antioxidant Content.

Agroindustrial by-products constitute an alternative source of feed livestock, and their use contributes to the sustainability of livestock systems and the circular bioeconomy. The effects of replacing cereal (0%, 40%, and 80%) with dehydrated orange pulp (DOP) in the diet of goats on the antioxidant and fatty acid (FA) contents of cheeses were evaluated. For a more suitable understanding of the role of coagulant enzymes in establishing the properties of the cheese, the effect of milk-clotting with animal and vegetable rennet was also analysed. The rennet did not substantially affect the FA or the antioxidant compounds, and the use of DOP did not affect the FA contents. However, the α-tocopherol levels, total phenolic compounds (TPC), and total antioxidant capacity (TAC) in cheeses increased as the percentage of DOP replacing cereals increased. Moreover, the high correlation obtained between the TAC and the TPC (r = 0.73) and α-tocopherol (r = 0.62) contents indicated the important role played by these compounds in improving the antioxidant capacity of the cheese. In conclusion, DOP is a suitable alternative to cereals in the diet of goats and improves the antioxidant status of the cheese produced.

Biological treatments in childhood asthma.

PURPOSE OF REVIEW: The aim is to update the information currently available for the use of biologics in severe asthma in children, in order to facilitate their prescription as far as possible. RECENT FINDINGS: The appearance of biologics for the treatment of severe asthma has meant a revolutionary change in the therapeutic approach to this disease. Currently, five biologics have been approved for severe asthma in children and/or adolescents by the regulatory agencies: omalizumab, mepolizumab, benralizumab, dupilumab and tezepelumab. But despite their positive results in terms of efficacy, there are still relevant points of debate that should induce caution when selecting the most appropriate biologic in a child with severe asthma. Indeed, safety is essential and, for several of the existing treatments, the availability of medium-term to long-term data in this regard is scarce. SUMMARY: The use of biologics can facilitate the therapeutic paradigm shift from pleiotropic treatments to personalized medicine. However, the choice of the most appropriate biologics remains a pending issue. On the other hand, to the extent that several of the biologics have been available for a relatively short time, the most robust evidence in terms of efficacy and safety in children is that of omalizumab.

Postcolonoscopy colorectal cancer: Prevalence, categorization and root-cause analysis based on the World Endoscopic Organization systemCáncer colorrectal poscolonoscopia / Prevalencia, categorización y análisis de las causas subyacentes basado en las recomendaciones de la Organización Mundial de Endoscopia

Aims: The World Endoscopy Organization (WEO) recommends that endoscopy units implement a process to identify postcolonoscopy colorectal cancer (PCCRC). The aims of this study were to assess the 3-year PCCRC rate and to perform root-cause analyses and categorization in accordance with the WEO recommendations.Patients and methods: Cases of colorectal cancers (CRCs) in a tertiary care center were retrospectively included from January 2018 to December 2019. The 3-year and 4-year PCCRC rates were calculated. A root-cause analysis and categorization of PCCRCs (interval and type A, B, C noninterval PCCRCs) were performed. The level of agreement between two expert endoscopists was assessed. Results: A total of 530 cases of CRC were included. A total of 33 were deemed PCCRCs (age 75.8±9.5 years; 51.5% women). The 3-year and 4-year PCCRC rates were 3.4% and 4.7%, respectively. The level of agreement between the two endoscopists was acceptable either for the root-cause analysis (k=0.958) or for the categorization (k=0.76). The most plausible explanations of the PCCRCs were 8 “likely new PCCRCs”, 1 (4%) “detected, not resected”, 3 (12%) “detected, incomplete resection”, 8 (32%) “missed lesion, inadequate examination”, and 13 (52%) “missed lesion, adequate examination”. Most PCCRCs were deemed noninterval Type C PCCRCs (N=17, 51.5%). Conclusion: WEO recommendations for root-cause analysis and categorization are useful to detect areas for improvement. Most PCCRCs were avoidable and were likely due to missed lesions during an otherwise adequate examination.(AU)

Objetivo: La Organización Mundial de Endoscopia recomienda que las unidades de endoscopia implementen procedimientos para identificar el cáncer colorrectal poscolonoscopia (CCRPC). Los objetivos de este estudio fueron evaluar la tasa de CCRPCP a los 3 y 4 años, realizar un análisis de causalidad potencial y categorización siguiendo las recomendaciones de la Organización Mundial de Endoscopia.Pacientes y métodos: Se incluyeron retrospectivamente los cánceres colorrectales diagnosticados de enero de 2018 a diciembre de 2019 en un hospital de tercer nivel. Se calculó la tasa de CCRPC a 3 años. Se realizó un análisis de causalidad potencial y categorización de los CCRPC (intervalo y CCRPC de no intervalo tipo A, B, C). Se evaluó la concordancia entre dos endoscopistas expertos. Resultados: Se incluyeron 530 cánceres colorrectales. Un total de 33 se consideraron CCRPC (edad 75,8±9,5 años; 51,5% mujeres). La tasa de CCRPC a 3 y 4 años fue del 3,4% y 4,7% respectivamente. La concordancia entre los dos endoscopistas fue aceptable para el análisis de causalidad (k=0,958) y para la categorización (k=0,76). La explicación probable de los CCRPC fue: 8 «probable CCRPC de novo», 1 (4%) «detectado, no resecado», 3 (12%) «detectado, resección incompleta», 8 (32%) «no detectado, examen inadecuado» y 13 (52%) «no detectado, examen adecuado». La mayoría de los CCRPC se consideraron de no intervalo tipo C (N=17, 51,5%). Conclusión: Las recomendaciones de la Organización Mundial de Endoscopia para el análisis de causalidad y la categorización son útiles para detectar áreas de mejora. La mayoría de los CCRPC eran evitables debido a lesiones no detectadas a pesar de realizar un examen adecuado.(AU)

Ergonomics, musculoskeletal disorders, treatment and return to work: a conceptual framework for intervention programs / Ergonomía, Trastornos Musculoesqueléticos, Tratamiento y Retorno al Trabajo – Marco Conceptual para programas de intervención

Musculoskeletal disorders are one of the most recurrent diseases among manual workers worldwide. The objective of this study was to analyze primary results of a systematic review on ergonomics, musculoskeletal disorders, treatment, and return to work in blue-collar work-ers to form a new conceptual framework applicable to intervention programs in this area. This study was based on the available scientific evidence we identified. Descriptive data and their trending topics areas were used to form the conceptual framework. The trend shows that working conditions can be represented as a three-axis scheme with a multidimensional conceptual framework considering ergonomic risks, the treatment of affected workers and the determinants related to working conditions. These results may help future research in the field of ergonomics as well as emerging topics focused on intervention programs.(AU)

Los trastornos musculoesqueléticos son una de las enfermedades más recurrentes entre los trabajadores que realizan operaciones manuales a nivel mundial. El objetivo de este estudio fue analizar los resultados primarios de una revisión sistemática sobre ergonomía, trastornos musculoesqueléticos, tratamiento y retorno al trabajo en trabajadores operativos para formar un nuevo marco conceptual aplicable a los programas de intervención en esta área. Este estudio se basó en la evidencia científica disponible identificada. Se utilizaron datos descriptivos y sus áreas de temas de tendencia para formar el marco conceptual. La tendencia muestra que las condiciones de trabajo pueden representarse como un esquema de tres ejes con un marco conceptual multidimensional que considera los riesgos ergonómicos, el tratamiento de los trabajadores afectados y los determinantes relacionados con las condiciones de trabajo. Estos resultados podrían ayudar a futuras investigaciones en el campo de la ergonomía, así como a temas emergentes centrados en programas de intervención.(AU)

Chemical cousins with contrasting behavioural profiles: MDMA users and methamphetamine users differ in social-cognitive functions and aggression.

Methamphetamine (METH, "Crystal Meth") and 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") share structural-chemical similarities but have distinct psychotropic profiles due to specific neurochemical actions. Previous research has suggested that their impact on social cognitive functions and social behaviour may differ significantly, however, direct comparisons of METH and MDMA users regarding social cognition and interaction are lacking. Performances in cognitive and emotional empathy (Multifaceted Empathy Test) and emotion sensitivity (Face Morphing Task), as well as aggressive social behaviour (Competitive Reaction Time Task) were assessed in samples of n = 40 chronic METH users, n = 39 chronic MDMA users and n = 86 stimulant-naïve controls (total N = 165). Self-reports and hair samples were used to obtain subjective and objective estimates of substance use patterns. METH users displayed diminished cognitive and emotional empathy towards positive stimuli, elevated punitive social behaviour regardless of provocation, and self-reported heightened trait anger relative to controls. MDMA users diverged from the control group only by exhibiting a distinct rise in punitive behaviour when faced with provocation. Correlation analyses indicated that both higher hair concentrations of MDMA and METH may be associated with reduced cognitive empathy. Moreover, greater lifetime MDMA use correlated with increased punitive behaviour among MDMA users. Our findings confirm elevated aggression and empathy deficits in chronic METH users, while chronic MDMA users only displayed more impulsive aggression. Dose-response correlations indicate that some of these deficits might be a consequence of use. Specifically, the dopaminergic mechanism of METH might be responsible for social-cognitive deficits.

Somatostatin: a possible mediator of the long-term effects of experimental vertical gastrectomy on glucose metabolism in rats?

BACKGROUND: Sleeve gastrectomy (SG) is one of the most commonly performed bariatric surgeries. SG treats type 2 diabetes mellitus better than several drugs. The mechanisms that underlie this phenomenon are not clear. This study proposed that somatostatin (SST) isoforms SST-14 and SST-28 are key in the carbohydrate after SG. METHODS: Surgeries were performed on 3 groups of Wistar rats: the fasting, surgery control, and SG groups. Plasma levels of glucose, insulin, SST-14, and SST-28 were measured at 2 survival periods after surgery. Islet SST receptor (SSTR) and cell populations were studied. We performed a pasireotide (SST-28 analogue) infusion assay in another group of rats to confirm the influence of SST-28 plasma levels on the delta-cell population. RESULTS: This study found an elevation in the insulin response after SG in animals but a decrease in the insulin response over the long term with a loss of beta-cell mass. An increase in duodenal SST-28-producing cells in the duodenum and a loss of pancreatic SST-14-producing cells were observed after SG in animals but not in controls. The expression of SSTR type 5 in delta-cell populations from each group and the ability of the pasireotide infusion assay to decrease the delta-cell population indicated the effect of SST-28 plasma levels on delta-cell maintenance. CONCLUSION: After SG initiates a compensatory response in the duodenum, beta-cell mass is depleted after loss of the brake that regulates SST-14 at the paracrine level in a nonobese, normoglycemic rat model. This was an experimental model, with no clinical translation to the human clinic, with a preliminary importance regarding new pathophysiologic perspectives or pathways.

Application of machine learning algorithms in classifying postoperative success in metabolic bariatric surgery: Acomprehensive study.

Objectives: Metabolic bariatric surgery is a critical intervention for patients living with obesity and related health issues. Accurate classification and prediction of patient outcomes are vital for optimizing treatment strategies. This study presents a novel machine learning approach to classify patients in the context of metabolic bariatric surgery, providing insights into the efficacy of different models and variable types. Methods: Various machine learning models, including Gaussian Naive Bayes, Complement Naive Bayes, K-nearest neighbour, Decision Tree, K-nearest neighbour with RandomOverSampler, and K-nearest neighbour with SMOTE, were applied to a dataset of 73 patients. The dataset, comprising psychometric, socioeconomic, and analytical variables, was analyzed to determine the most efficient predictive model. The study also explored the impact of different variable groupings and oversampling techniques. Results: Experimental results indicate average accuracy values as high as 66.7% for the best model. Enhanced versions of K-nearest neighbour and Decision Tree, along with variations of K-nearest neighbour such as RandomOverSampler and SMOTE, yielded the best results. Conclusions: The study unveils a promising avenue for classifying patients in the realm of metabolic bariatric surgery. The results underscore the importance of selecting appropriate variables and employing diverse approaches to achieve optimal performance. The developed system holds potential as a tool to assist healthcare professionals in decision-making, thereby enhancing metabolic bariatric surgery outcomes. These findings lay the groundwork for future collaboration between hospitals and healthcare entities to improve patient care through the utilization of machine learning algorithms. Moreover, the findings suggest room for improvement, potentially achievable with a larger dataset and careful parameter tuning.

Predicting carob tree physiological parameters under different irrigation systems using Random Forest and Planet satellite images.

Introduction: In the context of climate change, monitoring the spatial and temporal variability of plant physiological parameters has become increasingly important. Remote spectral imaging and GIS software have shown effectiveness in mapping field variability. Additionally, the application of machine learning techniques, essential for processing large data volumes, has seen a significant rise in agricultural applications. This research was focused on carob tree, a drought-resistant tree crop spread through the Mediterranean basin. The study aimed to develop robust models to predict the net assimilation and stomatal conductance of carob trees and to use these models to analyze seasonal variability and the impact of different irrigation systems. Methods: Planet satellite images were acquired on the day of field data measurement. The reflectance values of Planet spectral bands were used as predictors to develop the models. The study employed the Random Forest modeling approach, and its performances were compared with that of traditional multiple linear regression. Results and discussion: The findings reveal that Random Forest, utilizing Planet spectral bands as predictors, achieved high accuracy in predicting net assimilation (R² = 0.81) and stomatal conductance (R² = 0.70), with the yellow and red spectral regions being particularly influential. Furthermore, the research indicates no significant difference in intrinsic water use efficiency between the various irrigation systems and rainfed conditions. This work highlighted the potential of combining satellite remote sensing and machine learning in precision agriculture, with the goal of the efficient monitoring of physiological parameters.

Ergonomics, musculoskeletal disorders, treatment and return to work: a conceptual framework for intervention programs.

Musculoskeletal disorders are one of the most recurrent diseases among manual workers worldwide. The objective of this study was to analyze primary results of a systematic review on ergonomics, musculoskeletal disorders, treatment, and return to work in blue-collar workers to form a new conceptual framework applicable to intervention programs in this area. This study was based on the available scientific evidence we identified. Descriptive data and their trending topics areas were used to form the conceptual framework. The trend shows that working conditions can be represented as a three-axis scheme with a multidimensional conceptual framework considering ergonomic risks, the treatment of affected workers and the determinants related to working conditions. These results may help future research in the field of ergonomics as well as emerging topics focused on intervention programs.

Los trastornos musculoesqueléticos son una de las enfermedades más recurrentes entre los trabajadores que realizan operaciones manuales a nivel mundial. El objetivo de este estudio fue analizar los resultados primarios de una revisión sistemática sobre ergonomía, trastornos musculoesqueléticos, tratamiento y retorno al trabajo en trabajadores operativos para formar un nuevo marco conceptual aplicable a los programas de intervención en esta área. Este estudio se basó en la evidencia científica disponible identificada. Se utilizaron datos descriptivos y sus áreas de temas de tendencia para formar el marco conceptual. La tendencia muestra que las condiciones de trabajo pueden representarse como un esquema de tres ejes con un marco conceptual multidimensional que considera los riesgos ergonómicos, el tratamiento de los trabajadores afectados y los determinantes relacionados con las condiciones de trabajo. Estos resultados podrían ayudar a futuras investigaciones en el campo de la ergonomía, así como a temas emergentes centrados en programas de intervención.

Is Unilateral Lymphadenectomy an Option in Selected Patients with Prostate Cancer?

BACKGROUND: Evidence regarding the relationship between the laterality of lymph node invasion (LNI) and the prostatic lobe affected is limited. Our aim was to review our records of patients with exclusively unilateral localised prostate cancer (PCa) with metastatic LN involvement. METHODS: Between 2006 and 2023, after radical prostatectomy and extended pelvic lymphadenectomy at our centre, thirty patients with intermediate-high risk unilateral PCa and pN1 disease were identified. To perform a retrospective study, data were obtained from a prospective collected database approved by the ethical committee at the Valencian Oncology Institute Foundation. Descriptive and comparative statistical analysis was made using software R. The Fisher's Exact test was employed to analyse the categorical variables. In terms of continuous variables, both tumour volume and number of nodes retrieved exhibited normality; Hence Student's T-test was employed. Mann-Whitney U test was utilized for the number of positive nodes. RESULTS: The median age and prostate specific antigen (PSA) at diagnosis were 66 years old (interquartile range (IQR): 63.3-70.9) and 14.6 ng/mL (IQR: 7.4-21.5), respectively. Median follow-up time was 67 months (IQR: 35.9-92.9). Nineteen patients (63%) had a Gleason score of 7, and the rest had a Gleason score of 8-10. Most patients (73%) had locally advanced disease. Baseline characteristics were comparable between groups (p-value > 0.05). Twenty-two patients (73%) had concordance between the laterality of the PCa lesion and the LNI. All the patients with right prostatic cancer had exclusive ipsilateral LNI. CONCLUSIONS: In our experience, the majority of patients with unilateral PCa had exclusively ipsilateral LNI. However, sparing contralateral LN dissection in unilateral PCa should not be an option. To date, extended pelvic LN dissection remains the gold standard for N-staging and cannot be replaced yet by unilateral pelvic LN dissection until high quality evidence supports this scenario.

SU-101 for the removal of pharmaceutical active compounds by the combination of adsorption/photocatalytic processes.

Pharmaceutical active compounds (PhACs) are some of the most recalcitrant water pollutants causing undesired environmental and human effects. In absence of adapted decontamination technologies, there is an urgent need to develop efficient and sustainable alternatives for water remediation. Metal-organic frameworks (MOFs) have recently emerged as promising candidates for adsorbing contaminants as well as providing photoactive sites, as they possess exceptional porosity and chemical versatility. To date, the reported studies using MOFs in water remediation have been mainly focused on the removal of a single type of PhACs and rarely on the combined elimination of PhACs mixtures. Herein, the eco-friendly bismuth-based MOF, SU-101, has been originally proposed as an efficient adsorbent-photocatalyst for the elimination of a mixture of three challenging persistent PhACs, frequently detected in wastewater and surface water in ng L-1 to mg·L-1 concentrations: the antibiotic sulfamethazine (SMT), the anti-inflammatory diclofenac (DCF), and the antihypertensive atenolol (At). Adsorption experiments of the mixture revealed that SU-101 exhibited a great adsorption capacity towards At, resulting in an almost complete removal (94.1 ± 0.8% for combined adsorption) in only 5 h. Also, SU-101 demonstrated a remarkable photocatalytic activity under visible light to simultaneously degrade DCF and SMT (99.6 ± 0.4% and 89.2 ± 1.4%, respectively). In addition, MOF-contaminant interactions, the photocatalytic mechanism and degradation pathways were investigated, also assessing the toxicity of the resulting degradation products. Even further, recycling and regeneration studies were performed, demonstrating its efficient reuse for 4 consecutive cycles without further treatment, and its subsequent successful regeneration by simply washing the material with a NaCl solution.

Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO.

Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization, and natural history review. Numerous factors that may affect disease activity and patient well-being need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side-effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even "real-time," monitoring between visits. Following an approach that included needs assessment, evidence appraisal, and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision-making and care pathway design.

Is Unilateral Lymphadenectomy an Option in Selected Patients with Prostate Cancer?

Background: Evidence regarding the relationship between the laterality of lymph node invasion (LNI) and the prostatic lobe affected is limited. Our aim was to review our records of patients with exclusively unilateral localised prostate cancer (PCa) with metastatic LN involvement. Methods: Between 2006 and 2023, after radical prostatectomy and extended pelvic lymphadenectomy at our centre, thirty patients with intermediate-high risk unilateral PCa and pN1 disease were identified. To perform a retrospective study, data were obtained from a prospective collected database approved by the ethical committee at the Valencian Oncology Institute Foundation. Descriptive and comparative statistical analysis was made using software R. The Fisher’s Exact test was employed to analyse the categorical variables. In terms of continuous variables, both tumour volume and number of nodes retrieved exhibited normality; Hence Student’s T-test was employed. Mann-Whitney U test was utilized for the number of positive nodes. Results: The median age and prostate specific antigen (PSA) at diagnosis were 66 years old (interquartile range (IQR): 63.3–70.9) and 14.6 ng/mL (IQR: 7.4–21.5), respectively. Median follow-up time was 67 months (IQR: 35.9–92.9). Nineteen patients (63%) had a Gleason score of 7, and the rest had a Gleason score of 8–10. Most patients (73%) had locally advanced disease. Baseline characteristics were comparable between groups (p-value > 0.05). Twenty-two patients (73%) had concordance between the laterality of the PCa lesion and the LNI. All the patients with right prostatic cancer had exclusive ipsilateral LNI. Conclusions: In our experience, the majority of patients with unilateral PCa had exclusively ipsilateral LNI. However, sparing contralateral LN dissection in unilateral PCa should not be an option... (AU)

Prácticas enfermeras relacionadas con la evaluación y tratamiento del dolor durante la sesión de hemodiálisis: estudio nacional / Nursing practices related to assessing and treating pain during hemodialysis sessions: a national study

Introdución:Una adecuada evaluación y manejo del dolor repercute en el bienestar de los pacientes en hemodiálisis.Objetivo: Analizar el manejo del dolor por el profesional de enfermería durante la hemodiálisis a nivel nacional.Metodología: Estudio descriptivo transversal nacional, realizado en marzo-abril 2023, mediante un cuestionario online dirigido a enfermeras de hemodiálisis, previo consentimiento informado. Se recogen variables sociodemográficas, tipo de centro, experiencia laboral, procedimiento evaluación dolor y administración analgesia durante la hemodiálisis, autoevaluación conocimientos y demanda de acciones formativas. Se realizó un análisis descriptivo y bivariado (test Chi2, T-Student, U-Mann Whitney), nivel de significancia 0,05.Resultados: 241 participantes de 17 comunidades autóno-mas, 77,6% mujeres, edad media 43,70±9,99 años. Un 42,7% consideraba inadecuado el abordaje del dolor; el 80% no utilizaba protocolos específicos y el 95,9% opinaba que sería útil tenerlos. El 66% evaluaron sus conocimientos sobre el manejo del dolor como “Nada/Poco”. Un administraba el analgésico prefiltro. Un 96,7% consideraron útil recibir formación específica.Encontramos relación estadísticamente significativa entre “frecuencia evaluación dolor” y “adecuado manejo del mismo” (p<0,001) y “administrar analgésicos postfiltro” y “existencia de protocolos de manejo dolor” (p=0,002).Los profesionales con <5 años de experiencia consideran tener peor nivel de conocimientos (p=0,022), siendo aquellos con ≥5 años de experiencia quienes consideran útil recibir formación (p=0,048).Conclusión: Los profesionales valoran el manejo del dolor durante la hemodiálisis como inadecuado, demandan más formación y la existencia de protocolos específicos... (AU)

Introduction: Proper assessment and management of pain impact the well-being of patients undergoing hemodialysis.Objective: To analyze the management of pain by nursing professionals nationally during hemodialysis. Methodology: After obtaining informed consent, a national cross-sectional descriptive study was conducted in March-April 2023 using an online questionnaire addressed to hemodialysis nurses. Sociodemographic variables, type of healthcare center, work experience, pain assessment procedures, analgesia administration during hemodialysis, self-assessment of knowledge, and demand for training were collected. Descriptive and bivariate analyses (Chi-square test, Student’s t-test, Mann-Whitney U test) were performed, with a significance level 0.05.Results: There were 241 participants from 17 autonomous communities, 77.6% women, with a mean age of 43.70±9.99 years. 42.7% considered the pain management approach inadequate; 80% did not use specific protocols, and 95.9% believed they would be helpful. 66% rated their knowledge of pain management as “None/Low.” Only one administered the analgesic pre-filter. 96.7% considered it worthwhile to receive specific training. We found a statistically significant relationship between “frequency of pain assessment” and “adequate pain management” (p<0.001) and between “administration of post-filter analgesics” and “existence of pain management protocols” (p=0.002). Professionals with <5 years of experience considered themselves to have lower levels of knowledge (p=0.022), while those with ≥5 years of experience considered specific training more useful (p=0.048).Conclusion: Professionals perceive pain management during hemodialysis as inadequate, and they demand more training and the existence of specific protocols... (AU)

Cost-effectiveness Analysis of Single-Use Duodenoscope Applied to Endoscopic Retrograde Cholangiopancreatography.

OBJECTIVES: Secondary infections due to transmission via the duodenoscope have been reported in up to 3% of endoscopic retrograde cholangiopancreatographies. The use of single-use duodenoscopes has been suggested. We investigate the cost-effectiveness of these duodenoscopes use in cholangiopancreatography. MATERIALS AND METHODS: A cost-effectiveness analysis was implemented to compare the performance of cholangiopancreatographies with reusable duodenoscopes versus single-use duodenoscopes. Effectiveness was analyzed by calculating quality-adjusted life years (QALY) from the perspective of the National Health System. Possibility of crossover from single-use to reusable duodenoscopes was considered. A willingness-to-pay of €25,000/QALY was set, the incremental cost-effectiveness ratio (ICER) was calculated, and deterministic and probabilistic sensitivity analyses were performed. RESULTS: Considering cholangiopancreatographies with single-use and reusable duodenoscopes at a cost of €2900 and €1333, respectively, and a 10% rate of single-use duodenoscopes, ICER was greater than €3,000,000/QALY. A lower single-use duodenoscope cost of €1211 resulted in an ICER of €23,583/QALY. When the unit cost of the single-use duodenoscope was €1211, a crossover rate of more than 9.5% made the use of the single-use duodenoscope inefficient. CONCLUSIONS: Single-use duodenoscopes are cost-effective in a proportion of cholangiopancreatographies if its cost is reduced. Increased crossover rate makes single-use duodenoscope use not cost-effective.

Alternative splicing expands the clinical spectrum of NDUFS6-related mitochondrial disorders.

PURPOSE: We describe 3 families with Charcot-Marie-Tooth neuropathy (CMT), harboring a homozygous NDUFS6 NM_004553.6:c.309+5G>A variant previously linked to fatal Leigh syndrome. We aimed to characterize clinically and molecularly the newly identified patients and understand the mechanism underlying their milder phenotype. METHODS: The patients underwent extensive clinical examinations. Exome sequencing was done in 4 affected individuals. The functional effect of the c.309+5G>A variant was investigated in patient-derived EBV-transformed lymphoblasts at the complementary DNA, protein, and mitochondrial level. Alternative splicing was evaluated using complementary DNA long-read sequencing. RESULTS: All patients presented with early-onset, slowly progressive axonal CMT, and nystagmus; some exhibited additional central nervous system symptoms. The c.309+5G>A substitution caused the expression of aberrantly spliced transcripts and negligible levels of the canonical transcript. Immunoblotting showed reduced levels of mutant isoforms. No detectable defects in mitochondrial complex stability or bioenergetics were found. CONCLUSION: We expand the clinical spectrum of NDUFS6-related mitochondrial disorders to include axonal CMT, emphasizing the clinical and pathophysiologic overlap between these 2 clinical entities. This work demonstrates the critical role that alternative splicing may play in modulating the severity of a genetic disorder, emphasizing the need for careful consideration when interpreting splice variants and their implications on disease prognosis.

Anti-Cholinergic Effects of the Phenolic Extract from the Astragalus crenatus Plant: A Computational and Network Pharmacology Study.

Investigations into cholinesterase inhibition have received attention from researchers in recent years for the treatment of Alzheimer's disease. Cholinesterase enzymes, namely, acetylcholinesterase (AChE) and butyrylcholinesterase (BChE), hold pivotal significance in Alzheimer's disease (AD) treatment. In this study, we utilized the ethanolic extract of Astragalus crenatus followed by liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) to separate and identify at least 21 compounds in the extract. Rosmarinic acid exhibited the highest concentration (96.675 ± 1.3 mg/g extract), succeeded by hesperidin (79.613 ± 1.2 mg/g extract), hesperetin (75.102 ± 1.4 mg/g extract), rutin (68.156 ± 1.6 mg/g extract), chlorogenic acid (67.645 ± 1.5 mg/g extract), fisetin (66.647 ± 2.3 mg/g extract), and hyperoside (63.173 ± 1.5 mg/g extract). A. crenatus extract efficiently inhibited both AChE and BChE activities in a dosage-dependent manner. Molecular docking was employed to scrutinize the anticholinesterase mechanisms of the identified phytocompounds. Notably, a network pharmacology analysis was executed for the most efficacious compound. Based on binding energies, hesperidin emerged as the most potent inhibitor against both AChE and BChE, exhibiting scores of -10.5 Kcal/mol and -9.8 Kcal/mol, respectively. Due to its dual inhibition of AChE and BChE activities, hesperidin from Astragalus crenatus holds promise for the development of novel therapeutics aimed at neurological disorders, particularly AD.