Preservación de la fertilidad en el tumor ovárico borderline / Fertility preservation in borderline ovarian tumors

Los tumores ováricos borderline (TOBL) son definidos como «tumores de bajo potencial maligno». Se trata de neoplasias epiteliales que debutan principalmente en mujeres jóvenes, siendo habitualmente diagnosticados en estadios iniciales de la enfermedad. La clave principal de su tratamiento es la cirugía, viéndose así comprometida la fertilidad de la paciente que no ha cumplido su deseo genésico. En general, la elección de la cirugía para los TOBL debe considerar las características del tumor, los deseos de fertilidad de la paciente y la extensión de la enfermedad. Las decisiones tomadas al respecto deben ser individualizadas y asesoradas por un equipo multidisciplinar. La preservación de la fertilidad (PF) juega un papel importante en el manejo de estas pacientes, existiendo distintas estrategias para mejorar y mantener su calidad de vida. El asesoramiento reproductivo debería ser una parte integral del manejo clínico, debiendo considerarse cuidadosamente los riesgos y beneficios. Dada su baja incidencia existe poca literatura al respecto, necesitándose estudios prospectivos bien diseñados para abordar los problemas específicos de fertilidad tanto en el diagnóstico inicial como en las recurrencias de los pacientes con TOBL.(AU)

Borderline ovarian tumors (BOTs) are defined as “tumors of low malignant potential”. These are epithelial neoplasms that debut mainly in young women, and are usually diagnosed in the initial stages of the disease. The main key to its treatment is surgery, thus compromising the fertility of the patient who has not fulfilled her reproductive desire. In general, the choice of surgery for BOTs should consider the characteristics of the tumor, the patient's fertility desires, and the extent of the disease. The decisions made in this regard must be individualized and advised by a multidisciplinary team. Fertility preservation (FP) plays an important role in the management of these patients, and there are different strategies to improve and maintain their quality of life. Reproductive counseling should be an integral part of clinical management, with risks and benefits carefully considered. Given its low incidence, there is little literature on the matter, requiring well-designed prospective studies to address specific fertility problems both in the initial diagnosis and in recurrences of patients with BOTs.(AU)

Environmental and health implications of Pb-bearing particles in settled urban dust from an arid city affected by Pb-Zn factory emissions.

Metal-rich particles originating from non-ferrous metallurgical activities are the primary source of atmospheric metals in urban environments. These particles vary in size, morphology, and elemental compositions and they undergo weathering processes that alter their composition and affect their toxicity. This study focuses on lead (Pb)-rich particles in settled urban dust within an arid and dusty city, Torreón in North Mexico, affected by Met-Mex Peñoles complex, one of the world's largest Ag-Cd-Pb-Zn smelting and refining facilities in operating since 1901. Torreón is characterized by arid conditions, temperature fluctuations, and low humidity. Dry atmospheric particles were collected in 2015 and 2017 from Torreón's urban area within a 3 km radius of the Met-Mex Peñoles complex. We used various analytical techniques, including scanning electron microscopy (SEM), Energy Dispersive X-ray Spectroscopy (EDS), and X-ray powder diffraction (XRD) to determine the size, morphology, elemental composition and mineralogy of Pb-bearing particles. Our analysis revealed a range of Pb-bearing particle sizes and morphologies with varying Pb (0.3 to 51-87.2%) and other element contents, such as As (0.04 to 1-3.4%), Cd (0.4 to 3.3-5.1%), Cu (0.51-14.1%), Hg (ND-0.6%), and Zn (1.7 to 79-90.3%). XRD analysis confirmed the presence of Pb and Zn sulfides, Pb carbonates, Pb sulfate, and Pb oxides in urban dust, both as individual particles and agglomerates. Primary Pb minerals were linked to fugitive feed concentrates and smelter flue gas at Met-Mex Peñoles, while secondary Pb minerals, like Pb carbonates, Pb sulfate, and Pb oxides, resulted from direct emissions and weathering processes. Compared to galena, secondary Pb minerals exhibit higher chemical availability in the environment, posing greater risks to the environment and human health. As the particles analyzed are presumed to be resuspended rather than freshly emitted by Met-Mex, the presence of secondary Pb minerals in settled urban dust is predominantly linked to weathering processes. The physical and chemical transformations in Pb-rich particles contribute to increased Pb bioavailability and toxicity in urban dust, with substantial implications for environmental and human health. These findings highlight the potential consequences of weathered Pb-rich particle in urban areas, particularly in the arid and dusty city of Torreón.

Preferences about Future Alzheimer's Disease Treatments Elicited through an Online Survey Using the Threshold Technique.

BACKGROUND: Treatments aiming at slowing down the progression of Alzheimer's disease (AD) may soon become available. However, information about the risks that people are willing to accept in order to delay the progression of the disease is limited. OBJECTIVE: To determine the trade-offs that individuals are willing to make between the benefits and risks of hypothetical treatments for AD, and the extent to which these trade-offs depend on individuals' characteristics and beliefs about medicines. DESIGN: Online, cross-sectional survey study. SETTING: Population in the UK. Public link to the survey available at the websites of Alzheimer's Research UK and Join Dementia Research. PARTICIPANTS: Everyone self-reported ≥18 years old was eligible to participate. A total of 4384 people entered the survey and 3658 completed it. MEASUREMENTS: The maximum acceptable risks (MARs) of participants for moderate and severe adverse events in exchange for a 2-year delay in disease progression. The risks were expressed on ordinal scales, from <10% to ≥50%, above a pre-existing risk of 30% for moderate adverse events and 10% for severe adverse events. We obtained the population median MARs using log-normal survival models and quantified the effects of individuals' characteristics and beliefs about medicines in terms of acceleration factors. RESULTS: For the moderate adverse events, 26% of the participants had a MAR ≥50%, followed by 25% of the participants with a MAR of 10 to <20%, giving an estimated median MAR of 25.4% (95% confidence interval [CI] 24.5 to 26.3). For the severe adverse events, 43% of the participants had a MAR <10%, followed by 25% of the participants with a MAR of 10 to <20%, resulting in an estimated median MAR of 12.1% (95%CI 11.6 to 12.5). Factors that were associated with the individuals' MARs for one or both adverse events were age, gender, educational level, living alone, and beliefs about medicines. Whether or not individuals were living with memory problems or had experience as a caregiver had no effect on the MARs for any of the adverse events. CONCLUSION: Trade-offs between benefits and risks of AD treatments are heterogeneous and influenced by individuals' characteristics and beliefs about medicines. This heterogeneity should be acknowledged during the medicinal product decision-making in order to fulfil the needs of the various subpopulations.

MUC1 Expressions and Its Prognostic Values in US Gastric Cancer Patients.

This study aims to evaluate the prognostic value of MUC expression in US GC patients. A total of 70 tumor specimens were collected from GC patients who underwent surgery or endoscopic resection between 2013 and 2019 at a tertiary referral center in the US. MUC expression status including MUC1, MUC2, MUC5AC, and MUC6 was evaluated by immunohistochemical staining. The positive rates of MUC1, MUC2, MUC5AC, and MUC6 were 71.4%, 78.6%, 74.3%, and 33.3%, respectively. Patients with positive MUC1 expression had a significantly higher rate of aggressive pathologic features including diffuse-type cancer (42.0% vs. 0%; p < 0.001), advanced GC (80.0% vs. 30.0%, p < 0.001), lymph node metastasis (62.0% vs. 20.0%; p = 0.001), and distant metastasis (32.0% vs. 5.0%; p = 0.017) compared with those with negative MUC1 expression. However, the differences in the pathologic features were not observed according to MUC2, MUC5AC, and MUC6 expression status. In early gastric cancer (EGC), patients with a high level of MUC1 expression showed a higher rate of lymphovascular invasion (71.4% vs. 21.4%; p = 0.026) and EGC meeting non-curative resection (85.7% vs. 42.9%; p = 0.061) than those with negative MUC1. In US GC patients, MUC1 expression is associated with aggressive pathological features, and might be a useful prognostic marker.

Retrospective analysis of the prognostic implications of tumor spread through air spaces in lung adenocarcinoma patients treated with surgery.

BACKGROUND: Tumor spread through air spaces (STAS) in lung adenocarcinoma is a novel mechanism of invasion. STAS has been proposed as an independent predictor of poor prognosis. The aim of this study was to evaluate the correlations between STAS status and other clinicopathologic variables and to assess the prognostic implications of STAS and the distance from the edge of the tumor to the farthest STAS in patients with resected lung adenocarcinoma. MATERIAL AND METHODS: This is a single-institution retrospective observational study. We included all patients with resected lung adenocarcinoma from January 2017 to December 2018 at La Paz University Hospital. The cut-off for the distance from the edge of the tumor to the farthest STAS was 1.5 mm and was assessed by the area under the receiver operating characteristic curve. RESULTS: A total of 73 patients were included. STAS was found in 52 patients (71.2%). Histological grade 3 (P = 0.035) and absence of lepidic pattern (P = 0.022) were independently associated with the presence of STAS. The median recurrence-free survival (RFS) was 48.06 months [95% confidence interval (CI) 33.58 months to not reached]. STAS-positive patients had shorter median RFS [39.23 months (95% CI 29.34-49.12 months)] than STAS-negative patients (not reached) (P = 0.04). STAS-positive patients with a distance from the edge of the tumor to the farthest STAS ≥1.5 mm had an even shorter median RFS [37.63 months (95% CI 28.14-47.11 months)]. For every 1 mm increase in distance, the risk of mortality increased by 1.26 times (P = 0.04). CONCLUSIONS: Histological grade 3 and absence of lepidic pattern were independently associated with the presence of STAS. STAS was associated with a higher risk of recurrence. The distance from the edge of the tumor to the farthest STAS also had an impact on overall survival.

Non-ionic surfactant formulation sequentially enhances the enzymatic hydrolysis of cellulignin from sugarcane bagasse and the production of Monascus ruber biopigments.

The effect of a non-ionic surfactant optimized formulation (SOF) obtained from an experimental design was evaluated for different influencing variables in the processing of sugarcane bagasse cellulignin to produce biopigments. The major findings in the saccharification stage using the SOF point that: at same enzyme loading, the highest glucan hydrolysis yield was 63 % (2-fold higher compared to control); the enzyme loading of 2.5 FPU/g resulted in similar yield compared to 10 FPU/g (control); 15 % (m/v) of total solids loading maintained the yield in fed-batch configuration; the hydrolysis yield is maintained at high shear force stress (800 rpm of stirring rate) and temperatures (50-70 °C). Besides, under separate and semi-simultaneous hydrolysis and fermentation, the maximum biopigments production were of 10 AU510nm/mL and 17.84 AU510nm/mL, respectively. The SOF used in this study was found to be a promising additive either in a single or sequential steps to produce biopigments in biorefineries.

Aumento de la confianza en la interpretación del PET con 18F-Florbetaben: “machine learning” basado en la aproximación cuantitativa / Increasing the confidence of 18F-florbetaben PET interpretations: Machine learning quantitative approximation

Objetivo: Determinar el valor a-adido de los parámetros semicuantitativos en el análisis visual y estudiar los patrones del depósito cerebral de 18F-Florbetaben. Material y métodos: Análisis retrospectivo de pacientes con deterioro cognitivo leve o demencia de origen incierto procedentes de un estudio multicentrico. Los PET con 18F-Florbetaben fueron interpretados de forma visual por dos observadores independientes, analizando las regiones “diana” con la finalidad de calcular el acuerdo interobservador. Se realizó análisis semicuantitativo de todas las regiones corticales con respecto a tres regiones de referencia para obtener índices de captación (SUVRs). Se analizó la capacidad de los SUVRs para predecir el resultado de la interpretación visual, la posibilidad de depósito preferencial del radiotrazador en algunas regiones “diana” así como las diferencias interhemisféricas. Resultados: Se evaluaron 135 pacientes. En la valoración visual, 72 estudios se clasificaron como positivos. El acuerdo interobservador fue excelente. Todos los SUVRs fueron significativamente superiores en pacientes con PET positivos con respecto a los negativos. Las regiones corticales correspondientes al área prefrontal y al cingulado posterior mostraron la mejor correlación con la evaluación visual, seguidas por la valoración integrada cortical. Usando análisis de ROC, los SUVRs obtenidos en las mismas regiones “diana” mostraron la mejor capacidad diagnóstica. Conclusiones: La información obtenida de las regiones “diana” parece ser de ayuda en la clasificación visual, basado en un depósito preferencial de amiloide, lo que permitiría el “machine learning”. El depósito de amiloide, aunque difuso en todas las regiones corticales, parece no ser uniforme ni simétrico (AU)

Aim: To assess the added value of semiquantitative parameters on the visual assessment and to study the patterns of 18F-Florbetaben brain deposition. Materials and methods: Retrospective analysis of multicenter study performed in patients with mild cognitive impairment or dementia of uncertain origin. 18F-Florbetaben PET scans were visually interpreted by two experienced observers, analyzing target regions in order to calculate the interobserver agreement. Semiquantification of all cortical regions with respect to three reference regions was performed to obtain standardized uptake value ratios (SUVRs). The ability of SUVRs to predict the visual evaluation, the possibility of preferential radiotracer deposition in some target regions and interhemisphere differenceswere analyzed. Results: 135 patients were evaluated. In the visual assessment, 72 were classified as positive. Interobserver agreement was excellent. All SUVRs were significantly higher in positive PET scans than in negative ones. Prefrontal area and posterior cingulate were the cortical regions with the best correlations with the visual evaluation, followed by the composite region. Using ROC analysis, the SUVRs obtained in same target locations showed the best diagnostic performance. Conclusions: The derived information from target regions seems to help the visual classification, based on a preferential amyloid deposit, allowing machine learning. The amyloid deposit, although diffuse in all cortical regions, seems not to be uniform and symmetric (AU)

Prevalencia preoperatoria de portadores asintomáticos de COVID-19 en hospitales de Cataluña durante la primera ola tras el reinicio de la actividad quirúrgica / Pre-operative prevalence of asymptomatic carriers of COVID-19 in hospitals in Catalonia during the first wave after the resumption of surgical activity

Introducción La pandemia producida por COVID-19 ocasionó la cancelación de los procedimientos quirúrgicos no esenciales en marzo de 2020. Con el reinicio de la actividad quirúrgica, los pacientes que se sometían a una cirugía fueron uno de los primeros grupos poblacionales a los que se realizó test PCR de forma sistemática. El objetivo de este estudio fue determinar la prevalencia de portadores asintomáticos de SARS-CoV-2 tras el reinicio de la actividad quirúrgica no esencial. Métodos Estudio observacional multicéntrico retrospectivo de los pacientes programados para cirugía o que se sometieron a cirugía urgente en Cataluña entre el 20 de abril y el 31 de mayo de 2020. Se revisaron los resultados microbiológicos de los test PCR preoperatorios, las historias clínicas y se realizó una encuesta epidemiológica a los pacientes con PCR positiva para SARS-CoV-2. Resultados Un total de 10.838 pacientes programados para una intervención quirúrgica o a los que se realizó una cirugía urgente fueron sometidos a cribado para COVID-19. Ciento dieciocho pacientes (1,09%) fueron positivos para SARS-CoV-2 en las 72h previas a la cirugía. La prevalencia de portadores asintomáticos fue del 0,7% (IC95%: 0,6-0,9%). La primera semana del estudio presentó la prevalencia más alta de portadores asintomáticos [1,9% (IC95%: 1,1-3,2%)]. Conclusiones Los bajos niveles de portadores asintomáticos de infección por COVID-19 obtenidos en la población quirúrgica de los hospitales de Cataluña tras el reinicio de la actividad quirúrgica muestran que la mayoría de pacientes se pudieron someter a procedimientos quirúrgicos sin los riesgos de las complicaciones asociadas al COVID-19 en el periodo perioperatorio (AU)

Introduction The COVID-19 pandemic led to the cancellation of non-essential surgical procedures in March 2020. With the resumption of surgical activity, patients undergoing surgery were one of the first population groups to be systematically tested for PCR. The aim of this study was to determine the prevalence of asymptomatic SARS-CoV-2 carriers after the resumption of non-essential surgical activity. Methods Retrospective multicenter observational study of patients scheduled for surgery or undergoing emergency surgery in Catalonia between 20 April and 31 May 2020. The microbiological results of preoperative PCR tests and clinical records were reviewed, and an epidemiological survey was conducted on patients with positive PCR for SARS-CoV-2. Results A total of 10,838 patients scheduled for surgery or who underwent emergency surgery were screened for COVID-19. One hundred and eighteen patients (1.09%) were positive for SARS-CoV-2 in the 72hours prior to surgery. The prevalence of asymptomatic carriers was 0.7% (95%CI: 0.6% - 0.9%). The first week of the study presented the highest prevalence of asymptomatic carriers [1.9% (95%CI: 1.1%-3.2%)]. Conclusions The low levels of asymptomatic carriers of COVID-19 infection obtained in the surgical population of hospitals in Catalonia after the resumption of surgical activity, shows that most patients were able to undergo surgical procedures without the risks of COVID-19 associated complications in the perioperative period (AU)

Biomaterials Used for Periodontal Disease Treatment: Focusing on Immunomodulatory Properties.

The growing use of biomaterials with different therapeutic purposes increases the need for their physiological understanding as well as to seek its integration with the human body. Chronic inflammatory local pathologies, generally associated with infectious or autoimmunity processes, have been a current therapeutic target due to the difficulty in their treatment. The recent development of biomaterials with immunomodulatory capacity would then become one of the possible strategies for their management in local pathologies, by intervening in situ, without generating alterations in the systemic immune response. The treatment of periodontal disease as an inflammatory entity has involved the use of different approaches and biomaterials. There is no conclusive, high evidence about the use of these biomaterials in the regeneration of periodontitis sequelae, so the profession keeps looking for other different strategies. The use of biomaterials with immunomodulatory properties could be one, with a promising future. This review of the literature summarizes the scientific evidence about biomaterials used in the treatment of periodontal disease.

Prevalencia e incidencia de ictus en Europa: revisión sistemática y metaanálisis / Prevalence and incidence of ictus in Europe: systematic review and meta-analysis

Fundamento. El ictus es la segunda causa de muerte y la primera causa de discapacidad en Europa. El número de pacientes con ictus muestra una tendencia de crecimiento rápido debido al aumento de la población anciana. El objetivo de este metaanálisis es estimar la prevalencia e incidencia de ictus en Europa. Método. Se buscaron artículos en las bases de datos MEDLINE, SCOPUS, CINAHL Complete y EMBASE con los términos “stroke”, “cerebrovascular accident” combinadas con “epidemiology”, “prevalence”, “incidence” y “Europe”. La calidad y el riesgo de sesgo se analizó con las escalas Hoy modificada y Newcastle Ottawa para los artículos de prevalencia e incidencia, respectivamente. El metaanálisis utilizó un modelo de efectos aleatorios con intervalos de confianza del 95% (IC95%) y el estadístico I2 para estimar la heterogeneidad. Resultados. La prevalencia de ictus en Europa ajustada por sexo fue 9,2% (IC95%: 4,4-14,0); en hombres fue 9,1% (IC95%: 4,7-16,6) y en mujeres 9,2% (IC95%: 4,1-14,4); se encontró una tendencia creciente con el aumento de la edad. La incidencia de ictus ajustada por sexo fue 191,9 por 100.000 personas-año (IC95%: 156,4-227,3); en hombres fue de 195,7 por 100.000 personas-año (IC95%: 142,4-249,0) y en mujeres 188,1 por 100.000 personas-año (IC95%: 138,6-237,7), con igual tendencia creciente con el aumento de la edad. Conclusiones. La prevalencia de ictus en Europa alcanza un 9,2%. La incidencia se sitúa en 191,9 por 100.000 personas-año. La prevalencia de ictus ha aumentado mientras que la incidencia se mantiene estable en comparación con estudios realizados a comienzos del siglo XXI.(AU)

Background. Stroke is the second cause of death and the first cause of disability in Europe. The number of stroke patients shows a rapidly increasing due to the increase in the elderly population. The aim of this meta-analysis is to evaluate the prevalence and incidence of stroke in Europe. Method. We conducted a literature search in MEDLINE, SCOPUS, CINAHL Complete and EMBASE, using the keywords “stroke”, “cerebrovascular accident”, “epidemiology”, “prevalence”, “incidence” and “Europe”. In order to evaluate the quality and risk of bias, we used the Hoy’s modified scale for prevalence studies and the Newcastle Ottawa Scale for incidence studies. A random effects model with 95% confidence intervals (95%CI) was used for the meta-analysis. The I2 statistic was applied to assess heterogeneity. Results. The prevalence of stroke in Europe adjusted for sex was estimated at 9.2% (95%CI: 4.4-14.0). The prevalence was 9.1% (95%CI: 4.7-13.6) in men and 9.2% (95%CI: 4.1-14.4) in women, and increased with age. The incidence of stroke in Europe adjusted for sex was 191.9 per 100,000 person-years (95%CI: 156.4-227.3); it was 195.7 per 100,000 person-years (95%CI: 142.4-249.0) in men and 188.1 per 100,000 person-years (95%CI: 138.6-237.7) in women. Again, these rates increased with age. Conclusion. The prevalence of stroke in Europe is 9.2%. The incidence of stroke in Europe is 191.9 per 100000 person-years. The prevalence of stroke has increased, whereas the incidence of stroke is stable in comparison with studies conducted at the beginning of the 21st century.(AU)

Tecnologías de la información y la comunicación al servicio de la atención farmacéutica: “Tu farmacéutico de guardia”, una web por y para los pacientes / Information and communication technologies at the service of pharmaceutical care: «Your pharmacist on duty», a website by and for patients

Objetivo: Alineado con la recomendación de la OMS de incorporar a la atención sanitaria diferentes estrategias de salud digital, el objetivo es doble: describir las funcionalidades y recursos de una página web creada para formar e informar a los pacientes y analizar la actividad de la herramienta tras un periodo de funcionamiento de seis años.Material y métodos: Los pasos que se siguieron en la creación de la web fueron: 1) desarrollo del logotipo y sistema de marca; 2) creación de contenidos tanto escritos como audiovisuales y 3) campaña de lanzamiento. Para evaluar su uso se realizó un estudio descriptivo retrospectivo (septiembre 2015 – noviembre 2021) en el que se recogieron los indicadores clave de rendimiento.Resultados: La web se estructuró en 11 grupos de patologías disponiendo de información escrita (179 fichas) y audiovisual (61 videos) sobre medicamentos y un repositorio de temas actuales sobre la salud a modo de noticias (515 reseñas publicadas). Desde su lanzamiento se han registrado un total de 176.530 visitas por 150.004 usuarios diferentes. En noviembre de 2020 se rediseñó la web, optimizándola para móviles con un diseño de marca renovado; hecho que reportó un importante crecimiento de las visitas, siendo el móvil (74,9%) el dispositivo de visualización más utilizado en este último periodo. (AU)

Objectives: To write the functionalities and resources of a web page created to train and inform patients and to analyze the activity of the tool after a six-year operating period. These two objectives are aligned with the WHO recommendation to incorporate different digital health strategies into health care.Material and methods: To create the web page we followed the next steps: 1) development of the logo and brand system; 2) creation of written and audiovisual content and 3) launch campaign. To evaluate the use of the web page, a retrospective descriptive study was carried out (September 2015 – November 2021) and key performance indicators were collected.Results: The website was structured into 11 groups of pathologies, including written information (179 files) and audiovisual information (61 videos) about drugs and a repository of current health topics shown as news (515 published reviews). Since its launch, a total of 176,530 visits have been registered by 150,004 different users. In November 2020 the web was redesigned, optimizing it for mobile devices and with a renewed brand design. This update reported a significant growth in visits, with mobile phones being the most used display (74.9%) in this last period. (AU)

[Prevalence and incidence of ictus in Europe: systematic review and meta-analysis].

BACKGROUND: Stroke is the second cause of death and the first cause of disability in Europe. The number of stroke patients shows a rapidly increasing due to the increase in the elderly population. The aim of this meta-analysis is to evaluate the prevalence and incidence of stroke in Europe. METHOD: We conducted a literature search in MEDLINE, SCOPUS, CINAHL Complete and EMBASE, using the keywords "stroke", "cerebrovascular accident", "epidemiology", "prevalence", "incidence" and "Europe". In order to evaluate the quality and risk of bias, we used the Hoy's modified scale for prevalence studies and the Newcastle Ottawa Scale for incidence studies. A random effects model with 95% confidence intervals (95%CI) was used for the meta-analysis. The I2 statistic was applied to assess heterogeneity. RESULTS: The prevalence of stroke in Europe adjusted for sex was estimated at 9.2% (95%CI: 4.4-14.0). The prevalence was 9.1% (95%CI: 4.7-13.6) in men and 9.2% (95%CI: 4.1-14.4) in women, and increased with age. The incidence of stroke in Europe adjusted for sex was 191.9 per 100,000 person-years (95%CI: 156.4-227.3); it was 195.7 per 100,000 person-years (95%CI: 142.4-249.0) in men and 188.1 per 100,000 person-years (95%CI: 138.6-237.7) in women. Again, these rates increased with age. CONCLUSION: The prevalence of stroke in Europe is 9.2%. The incidence of stroke in Europe is 191.9 per 100,000 person-years. The prevalence of stroke has increased, whereas the incidence of stroke is stable in comparison with studies conducted at the beginning of the 21st century.

A review on recent developments in hydrodynamic cavitation and advanced oxidative processes for pretreatment of lignocellulosic materials.

Environmental problems due to utilization of fossil-derived materials for energy and chemical generation has prompted the use of renewable alternative sources, such as lignocellulose biomass (LB). Indeed, the production of biomolecules and biofuels from LB is among the most important current research topics aiming to development a sustainable bioeconomy. Yet, the industrial use of LB is limited by the recalcitrance of biomass, which impairs the hydrolysis of the carbohydrate fractions. Hydrodynamic cavitation (HC) and Advanced Oxidative Processes (AOPs) has been proposed as innovative pretreatment strategies aiming to reduce process time and chemical inputs. Therefore, the underlying mechanisms, procedural strategies, influence on biomass structure, and research gaps were critically discussed in this review. The performed discussion can contribute to future developments, giving a wide overview of the main involved aspects.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil / Esgoto de hospital terciário como reservatório de bactérias expressando o fenótipo MDR no Brasil

High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil

Abstract High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Resumo Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil / Esgoto de hospital terciário como reservatório de bactérias expressando o fenótipo MDR no Brasil

High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Altas doses de antibióticos utilizados em hospitais podem afetar a composição microbiana dos esgotos, selecionando bactérias resistentes. Nesse sentido, avaliamos o perfil de resistência a antibióticos e o fenótipo multirresistente de bactérias isoladas em esgoto de um hospital terciário no interior do estado de São Paulo, Brasil. Para o isolamento de bactérias, foram semeados 10 µL das amostras de esgoto em meios de cultura seletivos e os isolados foram identificados usando o sistema automatizado VITEK-2. O teste de sensibilidade aos antibióticos foi realizado por disco-difusão em ágar. Elevadas porcentagens de resistência foram encontradas para amoxicilina, ampicilina, ceftazidima, clindamicina, vancomicina e o fenótipo multirresistente (MDR) foi atribuído a 60,7% dos isolados. Nossos resultados mostram bactérias classificadas como prioridade crítica/alta pela Lista de Patógenos Prioritários da OMS (Enterococcus e Staphylococcus aureus resistentes à vancomicina e Enterobacteriaceae resistentes aos carbapenêmicos) no esgoto hospitalar. Sendo assim, implementação de tecnologias de desinfecção do esgoto hospitalar reduziriam a carga bacteriana no esgoto que chegará às estações de tratamento de esgoto urbanas, minimizando a contaminação dos ecossistemas hídricos receptores e a disseminação da resistência bacteriana no ambiente.