Pollen, anther, stamen, and androecium mimicry.

Floral colours represent a highly diverse communication signal mainly involved in flower visitors' attraction and guidance, but also flower discrimination, filtering non-pollinators and discouraging floral antagonists. The divergent visual systems and colour preferences of flower visitors, as well as the necessity of cues for flower detection and discrimination, foster the diversity of floral colours and colour patterns. Despite the bewildering diversity of floral colour patterns, a recurrent component is a yellow UV-absorbing floral centre, and it is still not clear why this pattern is so frequent in angiosperms. The pollen, anther, stamen, and androecium mimicry (PASAM) hypothesis suggests that the system composed of the flowers possessing such yellow UV-absorbing floral reproductive structures, the flowers displaying central yellow UV-absorbing structures as floral guides, and the pollen-collecting, as well as pollen-eating, flower visitors responding to such signals constitute the world's most speciose mimicry system. In this review, we call the attention of researchers to some hypothetical PASAM systems around the globe, presenting some fascinating examples that illustrate their huge diversity. We will also present new and published data on pollen-eating and pollen-collecting pollinators' responses to PASAM structures supporting the PASAM hypothesis and will discuss how widespread these systems are around the globe. Ultimately, our goal is to promote the idea that PASAM is a plausible first approach to understanding floral colour patterns in angiosperms.

[Evolution of the perception of the safety culture of healthcare professionals in a pediatric emergency department]. / Evolución de la percepción de la cultura de seguridad de los profesionales sanitarios en una urgencia pediátrica.

BACKGROUND AND AIM: Safety culture (SC) is a fundamental tool for minimizing adverse events and improving safety and quality of care. Our objective, therefore was to analyze the evolution of the SC of healthcare professionals in a pediatric emergency department (PED) after the implementation of a risk management system for patient safety based on the UNE:EN:ISO 179003 Standard and the execution of new safe practices for Joint Commission International accreditation. At the same time describe the current strengths and weaknesses. METHODS: Quasi-experimental, single-center study. All PED professionals participated in the study. An initial measurement of SC was performed through the Hospital Survey on Patient Safety Culture (HSOPS) questionnaire of the Agency for Healthcare Research and Quality adapted to Spanish in 2014. Pro-patient safety strategies were implemented between 2015 and 2022. A subsequent measurement was performed in 2022. RESULTS: The response rate in 2014 was 55% and 78% in 2022. On both occasions the group with the highest participation was nurses with 35.1% and 34.8%, respectively. Five dimensions improved after the interventions: frequency of adverse events (25.2%, p<0.001), organizational learning (25%, p<0.001), feedback and communication about errors (22.3%, p<0.001), non-punitive response to errors (6.5%, p = 0.176), and management support (4%, p = 0.333). CONCLUSIONS: The actions carried out had a positive influence on organizational learning and the frequency of adverse events reported and communication within the team. In contrast, the perception of SC did not increase.

Potencia muscular y cinética de lactato en sangre entre genotipos de ACTN3 / Muscle Power and Blood Lactate Kinetics Among ACTN3

En este trabajo se estudiaron las diferencias en la potencia muscular y la cinética de las concentraciones de lactato en sangre ([LA-]b) entre genotipos de ACTN3 durante la prueba anaeróbica de Wingate, (PAnW). Participaron 35 voluntarios (18-35 años) masculinos, sanos y físicamente activos. Se analizaron la potencia muscular, las concentraciones de [LA-]b y la actividad de la Lactato Deshidrogenasa (LDH). El gen ACTN3 se determinó a partir de ADN de glóbulos blancos en sangre periférica. Independientemente del peso y masa muscular de los participantes, los portadores del genotipo RR vs. RX y XX desarrollaron mayor potencia muscular durante la PAnW (p<0.05), lo cual sugiere una mayor capacidad en este genotipo para utilizar el sistema ATP-PC durante un ejercicio supramáximo. La cinética en la potencia muscular y en las concentraciones de [LA-]b fueron semejantes entre genotipos. La PAnW no fue suficiente para causar daño muscular observado por la concentración de LDH. (AU)

In this work, the differences in the muscle power and the kinetics of blood lactate concentrations ([LA-]b) between ACTN3 genotypes were studied during the Wingate anaerobic test (PAnW). Thirty-five healthy and physically active male volunteers (18-35 years old) participated. Muscle power, [LA-] b concentrations, and Lactate Dehydrogenase (LDH) activity were analyzed. The ACTN3 gene was determined from the DNA of white blood cells in peripheral blood. Regardless of the participants' weight and muscle mass, carriers of the RR genotype vs. RX and XX developed greater muscle power during PAnW (p <0.05), suggesting a greater capacity in this genotype to use the ATP-PC system during supramaximal exercise. The kinetics in muscle power and in [LA-]b concentrations were similar between genotypes. PAnW was not enough to cause muscle damage seen by LDH concentration. (AU)

Flower morphology and plant-bee pollinator interactions are related to stamen dimorphism in Melastomataceae.

Approximately 20,000 species of flowering plant offer mainly pollen to their pollinators, generally bees. Stamen dimorphism, a floral trait commonly present in some pollen flowers, is thought to be associated with exclusive pollen provision for highly effective bee pollinators. Notwithstanding, little is known about how stamen dimorphism is related to other floral morphological traits and, consequently, plant-pollinator interactions at the community scale. Here we investigated the relationship between stamen dimorphism and other floral morphological traits, as well as the interactions with pollinators in plants of Melastomataceae. We characterized each plant species as stamen dimorphic or stamen isomorphic according to differences in size and shape between stamen sets. Data on interactions between the plants and their bee pollinators were analysed as quantitative bipartite networks. We found that petal and style size and shape were correlated to stamen dimorphism. Stamen dimorphic species present larger flowers and less variable style shapes than stamen isomorphic species. Furthermore, stamen dimorphism is associated with higher richness of visiting bees, i.e. higher ecological generalization. During the evolutionary history of Melastomataceae, the dependence on pollinators for fruit set has possibly favoured the evolution of larger flowers with dimorphic stamens, which in turn are able to make use of a larger spectrum of pollen-collecting bees, leading to ecological generalization.

[Quantitative classification of pivot-shift maneuver]. / Clasificación cuantitativa de la maniobra de pivot-shift.

INTRODUCTION: The diagnosis of ACL injury is established with the physical examination that includes the Lachman maneuver and the pivot-shift test since it has the highest positive predictive value. Imaging tests such as MRI are still used for confirmation of the same; so the quantification of clinical maneuvers is sought. MATERIAL AND METHODS: Prospective clinical study in which the maneuvers of pivot-shift and Lachman are quantified for later classification. RESULTS: Of 36 patients, 64% found a range between 0 and 3 mm when subtracting the value of the affected knee from the value of the healthy knee. It was found that 28% of the patients recorded values of KT-1000 ranging between 4 and 6 mm of displacement. In 8% of the total patients, values of KT-1000 were found that exceeded 7 mm of displacement. The data obtained are normalized and classified into 3 degrees of injury: grade 1 with partial injury; grade 2 with complete anteromedial and partial injury in posterolateral bundle; grade 3 with complete injury of both bundles. CONCLUSION: A classification is proposed for the degrees of ACL injury with future application to a more personalized reconstruction.

INTRODUCCIÓN: El diagnóstico de lesión del ligamento cruzado anterior se establece con la exploración física que incluya la maniobra de Lachman y la prueba de pivot-shift, ya que cuenta con el mayor valor predictivo positivo. Aún se recurre a pruebas de gabinete como la RMN para la confirmación del mismo; por lo que se busca la cuantificación de maniobras clínicas. MATERIAL Y MÉTODOS: Estudio clínico prospectivo en el que se cuantifican las maniobras de pivot-Shift y Lachman para su posterior clasificación. RESULTADOS: De 36 pacientes, 64% se encontró un rango entre 0 y 3 mm al restar al valor de la rodilla sana el valor de la rodilla afectada. Se encontró que 28% de los pacientes, registraron valores de KT-1000, que oscilan entre los 4 y 6 mm de desplazamiento. En 8% del total de los pacientes se encontraron valores de KT-1000 que superaron los 7 mm de desplazamiento. Se normalizan los datos obtenidos y se clasifican en 3 grados de lesión: grado 1 con lesión parcial; grado 2 con lesión completa de haz anteromedial y parcial en haz posterolateral; grado 3 con lesión completa de ambos haces. CONCLUSIONES: Se propone una clasificación para los grados de lesión del LCA con futura aplicación a una reconstrucción más personalizada.

Mejoría del control de la hipertensión en la consulta con el uso de un dispositivo oscilométrico automático de lectura diferida / Improved office blood pressure control by automatic delayed-reading oscillometric device

Introducción: La medición de la presión arterial (PA) en la consulta es un procedimiento recomendado, aunque, actualmente, se está generalizando el uso de las medidas ambulatorias. Objetivo: Conocer el grado de control de la hipertensión arterial (HTA), usando la medición en la clínica. Material y métodos: Durante noviembre del 2019, se recogieron datos demográficos, clínicos, la PA sistólica (PAS) y diastólica (PAD) en consulta con observador, usando un aparato automático con lectura diferida y datos de monitorización ambulatoria de la PA (MAPA) en caso de haberse realizado. Resultados: Se incluyeron 102 pacientes (67 varones), con edad media de 64,9 años, 30% diabéticos y 34% con complicaciones cardiovasculares. Un 70% tenían una PA clínica controlada (< 140/90 mmHg), la PAS media fue de 131 ± 16,5 mmHg y la PAD de 73 ± 9,5 mmHg. Los pacientes ancianos y diabéticos presentaban un peor control. Treinta y tres sujetos disponían de MAPA, lo que permitió clasificarlos según la PA de 24 horas en: normotensión verdadera 30%, HTA aislada en consulta 9%, HTA sostenida 15% y HTA enmascarada 45%. Conclusión: El uso de aparatos automáticos disminuye el fenómeno de bata blanca mejorando el porcentaje de pacientes con HTA controlada en la consulta. Sin embargo, este control no se confirma fuera de ella, lo que evidencia la importancia de la MAPA en la evaluación global de la HTA. La toma de la PA en la consulta es útil en la valoración inicial del paciente y aporta aspectos educativos, aunque hay que optimizar la metodología para definir su papel en la clínica. (AU)

Introduction: Office blood pressure (BP) measurement is a recommended procedure, although the out-of-office BP measurements are increasingly used. Objective: To know the degree of BP control by clinical measurement. Material and methods: During November 2019 demographic and clinical data, office attended systolic BP (SBP) and diastolic BP (DBP) measured with an automatic device with delayed reading and, if performed, data from ambulatory BP monitoring (ABPM) were collected. Results: 102 patients (67 men) were included, with a mean age of 64.9 years, 30% diabetic and 34% with cardiovascular complications. 70% had a controlled hypertesion (<140/90 mmHg) by office BP, the mean SBP was 131 ± 16.5 mmHg and the DBP was 73 ± 9.5 mmHg. Old age and diabetes were associated with uncontrolled hypertension. Thirty three patients had ABPM data, which allowed them to be classified according to the 24-hour BP into: 30% true normotension, 9% white-coat hypertension, 15% sustained hypertension, and 45% masked hypertension. Conclusion: The use of automatic devices reduces the white-coat phenomenon, improving the % of patients with office BP controlled. However, this is not confirmed outside the clinic, showing the importance of ABPM in the evaluation of hypertension control. Office BP measurement is useful in patients initial assessment and also provides educational aspects, although the methodology must be optimized to define its clinical role. (AU)

[Improved office blood pressure control by automatic delayed-reading oscillometric device]. / Mejoría del control de la hipertensión en la consulta con el uso de un dispositivo oscilométrico automático de lectura diferida.

INTRODUCTION: Office blood pressure (BP) measurement is a recommended procedure, although the out-of-office BP measurements are increasingly used. OBJECTIVE: To know the degree of BP control by clinical measurement. MATERIAL AND METHODS: During November 2019 demographic and clinical data, office attended systolic BP (SBP) and diastolic BP (DBP) measured with an automatic device with delayed reading and, if performed, data from ambulatory BP monitoring (ABPM) were collected. RESULTS: 102 patients (67 men) were included, with a mean age of 64.9 years, 30% diabetic and 34% with cardiovascular complications. 70% had a controlled hypertesion (<140/90 mmHg) by office BP, the mean SBP was 131 ± 16.5 mmHg and the DBP was 73 ± 9.5 mmHg. Old age and diabetes were associated with uncontrolled hypertension. Thirty three patients had ABPM data, which allowed them to be classified according to the 24-hour BP into: 30% true normotension, 9% white-coat hypertension, 15% sustained hypertension, and 45% masked hypertension. CONCLUSION: The use of automatic devices reduces the white-coat phenomenon, improving the % of patients with office BP controlled. However, this is not confirmed outside the clinic, showing the importance of ABPM in the evaluation of hypertension control. Office BP measurement is useful in patients initial assessment and also provides educational aspects, although the methodology must be optimized to define its clinical role.

Clasificación cuantitativa de la maniobra de pivot-shift / Quantitative classification of pivot-shift maneuver

Resumen: Introducción: El diagnóstico de lesión del ligamento cruzado anterior se establece con la exploración física que incluya la maniobra de Lachman y la prueba de pivot-shift, ya que cuenta con el mayor valor predictivo positivo. Aún se recurre a pruebas de gabinete como la RMN para la confirmación del mismo; por lo que se busca la cuantificación de maniobras clínicas. Material y métodos: Estudio clínico prospectivo en el que se cuantifican las maniobras de pivot-Shift y Lachman para su posterior clasificación. Resultados: De 36 pacientes, 64% se encontró un rango entre 0 y 3 mm al restar al valor de la rodilla sana el valor de la rodilla afectada. Se encontró que 28% de los pacientes, registraron valores de KT-1000, que oscilan entre los 4 y 6 mm de desplazamiento. En 8% del total de los pacientes se encontraron valores de KT-1000 que superaron los 7 mm de desplazamiento. Se normalizan los datos obtenidos y se clasifican en 3 grados de lesión: grado 1 con lesión parcial; grado 2 con lesión completa de haz anteromedial y parcial en haz posterolateral; grado 3 con lesión completa de ambos haces. Conclusiones: Se propone una clasificación para los grados de lesión del LCA con futura aplicación a una reconstrucción más personalizada.

Abstract: Introduction: The diagnosis of ACL injury is established with the physical examination that includes the Lachman maneuver and the pivot-shift test since it has the highest positive predictive value. Imaging tests such as MRI are still used for confirmation of the same; so the quantification of clinical maneuvers is sought. Material and methods: Prospective clinical study in which the maneuvers of pivot-shift and Lachman are quantified for later classification. Results: Of 36 patients, 64% found a range between 0 and 3 mm when subtracting the value of the affected knee from the value of the healthy knee. It was found that 28% of the patients recorded values of KT-1000 ranging between 4 and 6 mm of displacement. In 8% of the total patients, values of KT-1000 were found that exceeded 7 mm of displacement. The data obtained are normalized and classified into 3 degrees of injury: grade 1 with partial injury; grade 2 with complete anteromedial and partial injury in posterolateral bundle; grade 3 with complete injury of both bundles. Conclusion: A classification is proposed for the degrees of ACL injury with future application to a more personalized reconstruction.

Connective appendages in Huberia bradeana (Melastomataceae) affect pollen release during buzz pollination.

Floral structures, such as stamen appendages, play crucial roles in pollinator attraction, pollen release dynamics and, ultimately, the reproductive success of plants. The pollen-rewarding, bee buzz-pollinated flowers of Melastomataceae often bear conspicuous staminal appendages. Surprisingly, their functional role in the pollination process remains largely unclear. We use Huberia bradeana Bochorny & R. Goldenb. (Melastomataceae) with conspicuously elongated, twisted stamen appendages to investigate their functional role in the pollination process. We studied the effect of stamen appendages on pollinator behaviour and reproductive success by comparing manipulated flowers (appendages removed) with unmanipulated flowers. To assess bee pollinator behaviour, we measured three properties of buzzes (vibrations) produced by bees on Huberia flowers: frequency, duration and number of buzzes per flower visit. We measured male and female reproductive success by monitoring pollen release and deposition after single bee visits. Finally, we used artificial vibrations and laser vibrometry to assess how flower vibrational properties change with the removal of stamen appendages. Our results show that the absence of staminal appendages does not modify bee buzzing behaviour. Pollen release was higher in unmanipulated flowers, but stigmatic pollen loads differ only marginally between the two treatments. We also detected lower vibration amplitudes in intact flowers as compared to manipulated flowers in artificial vibration experiments. The presence of connective appendages are crucial in transmitting vibrations and assuring optimal pollen release. Therefore, we propose that the high diversity of colours, shapes and sizes of connective appendages in buzz-pollinated flowers may have evolved by selection through male fitness.

Network meta-analysis of post-exposure prophylaxis randomized clinical trials.

OBJECTIVES: We performed a network meta-analysis of PEP randomized clinical trials to evaluate the best regimen. METHODS: After MEDLINE/Pubmed search, studies were included if: (1) were randomized, (2) comparing at least 2 PEP three-drug regimens and, (3) reported completion rates or discontinuation at 28 days. Five studies with 1105 PEP initiations were included and compared ritonavir-boosted lopinavir (LPV/r) vs. atazanavir (ATV) (one study), cobicistat-boosted elvitegravir (EVG/c) (one study), raltegravir (RAL) (one study) or maraviroc (MVC) (two studies). We estimated the probability of each treatment of being the best based on the evaluation of five outcomes: PEP non-completion at day 28, PEP discontinuation due to adverse events, PEP switching due to any cause, lost to follow-up and adverse events. RESULTS: Participants were mostly men who have sex with men (n = 832, 75%) with non-occupational exposure to HIV (89.86%). Four-hundred fifty-four (41%) participants failed to complete their PEP course for any reason. The Odds Ratio (OR) for PEP non-completion at day 28 in each antiretroviral compared to LPV/r was: ATV 0.95 (95% CI 0.58-1.56; EVG/c: OR 0.65 95% CI 0.30-1.37; RAL: OR 0.68 95% CI 0.41-1.13; and MVC: OR 0.69 95% CI 0.47-1.01. In addition, the rankogram showed that EVG/c had the highest probability of being the best treatment for the lowest rates in PEP non-completion at day 28, switching, lost to follow-up or adverse events and MVC for PEP discontinuations due to adverse events. CONCLUSIONS: Our study shows the advantages of integrase inhibitors when used as PEP, particularly EVG as a Single-Tablet Regimen.

Respuesta de creatina quinasa a un ejercicio anaerobio supramáximo en genotipos de ACTN3 / Response of Creatine Kinase to an Anaerobic Supramaximal Exercise in ACTN3 Genotypes

El objetivo del presente estudio fue investigar las diferencias en la actividad de la enzima Creatina Quinasa (CK) en pre y post ejercicio anaerobio supramáximo (EASM) en portadores de los genotipos del gen de la alfa-actinina-3 (ACTN3). Se reclutaron 39 hombres sanos físicamente activos (18-35 años) y se sometieron a un EASM de 30 s (Wingate). El gen ACTN3 se determinó a partir del ADN de glóbulos blancos en sangre periférica y se evaluó la actividad de la CK en muestras sanguíneas en condiciones basales, a las 24 y 48 h post EASM. Los portadores del genotipo XX vs RR presentaron 1,4 veces menor actividad de CK en condiciones basales (p < 0,05) y una mayor actividad de CK a las 24 h post ejercicio (p < 0,05). Una serie de EASM fue capaz de causar un incremento significativo de la actividad de CK a las 24 h en los portadores del genotipo XX

The aim of the present study was to investigate the differences in the activity of the enzyme Creatine Kinase (CK) in pre and post anaerobic supramaximal exercise (ASME) on carriers of the genotypes of the alpha-actinin-3 gene (ACTN3). 39 healthy physically active men (18-35 years) were enrolled and underwent an ASME of 30 s (Wingate). The ACTN3 gene was determined from the DNA of white blood cells in peripheral blood and the CK activity was evaluated in blood samples in basal conditions, at 24 and 48 h after of ASME. The carriers of genotype XX vs RR had 1.4 times lower CK activity in basal conditions (p < 0.05) and higher CK activity at 24 h after exercise (p < 0.05). A series of ASME was capable of causing a significant increase in CK activity at 24 h in the XX genotype carriers

Post-exposure prophylaxis for HIV infection in sexual assault victims.

OBJECTIVES: Sexual assault (SA) is recognized as a public health problem of epidemic proportions. Guidelines recommend the administration of post-exposure prophylaxis (PEP) after an SA. However, few data are available about the feasibility of this strategy, and this study was conducted to assess this. METHODS: We conducted a retrospective, longitudinal, observational study in SA victims attending the Hospital Clinic in Barcelona from 2006 to 2015. A total of 1695 SA victims attended the emergency room (ER), of whom 883 met the PEP criteria. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180 in the out-patient clinic. The primary endpoint was PEP completion rate at day 28. Secondary endpoints were loss to follow-up, treatment discontinuation, occurrence of adverse events (AEs) and rate of seroconversion. RESULTS: The median age of participants was 25 years [interquartile range (IQR) 21-33 years] and 93% were female. The median interval between exposure and presentation at the ER was 13 h (IQR 6-24 h). The level of risk was appreciable in 47% (n = 466) of individuals. Of 883 patients receiving PEP, 631 lived in Catalonia. In this group, the PEP completion rate at day 28 was 29% (n = 183). The follow-up rate was 63% (n = 400) and 38% (n = 241) at days 1 and 28, respectively. Treatment discontinuation was present in 58 (15%) of 400 patients who attended at least the day 1 visit, the main reason being AEs (n = 35; 60%). AEs were reported in 226 (56%) patients, and were mainly gastrointestinal (n = 196; 49%). Only 211 (33%) patients returned for HIV testing at day 90. A single seroconversion was observed in a men who have sex with men (MSM) patient at day 120. CONCLUSIONS: Follow-up and compliance rates in SA victims were poor. In addition, > 50% of the patients experienced AEs, which were the main reason for PEP interruption. Strategies to increase follow-up testing and new better tolerated drug regimens must be investigated to address these issues.

Estudio comparativo de reconstrucción de ligamento cruzado anterior entre las técnicas de Un Haz y U-Dos / Comparative study of anterior cruciate ligament reconstruction between the One Band and U-Two techniques

Resumen: Introducción: Las lesiones del LCA se encuentran dentro de las lesiones ligamentarias más frecuentes. Esto ha llevado al desarrollo de diferentes técnicas quirúrgicas para recuperar la estabilidad de la rodilla. Material y métodos: Estudio clínico, aleatorizado, ciego comparando técnicas de reconstrucción de LCA con Un Haz y «U-Dos¼ mediante escalas clínicas y artrometría con KT-1000 y Pivot Shift Meter. Resultados: De 36 pacientes, 52.94% fue sorteado para la técnica de Un Haz y 47.06% para «U-Dos¼. En 11.76% de los pacientes se presentó un desplazamiento mayor a 11 mm en la rodilla afectada con KT-1000. En 8.82% se mostró un desplazamiento anterior igual en ambas rodillas. Un paciente presentó un desplazamiento anterior mayor posterior a la cirugía de reconstrucción con la técnica de Un Haz, pero con mejoría en las escalas clínicas. En las mediciones de Pivot Shift se encontró una diferencia en el desplazamiento mayor a los 4,000 m/s en el eje de las X tras la técnica de Un Haz en comparación con la rodilla sana calculando integrales, mientras que con U-Dos la diferencia fue menor de 600 m/s. En el eje de «Y¼ se encontró una diferencia > 3,500 m/s entre la pierna sana y la lesionada, la cual disminuye a menos de 2,000 m/s tras la reconstrucción mediante técnica de U-Dos. Conclusiones: A lo largo del estudio se han encontrado diferencias en la evolución de los pacientes que indican que la reparación mediante la técnica de U-Dos tiene mejores resultados al lograr recuperar la estabilidad anteroposterior y rotacional del miembro afectado.

Abstract: Introduction: ACL injuries are found within the most common ligament injuries. This has led to the development of different surgical techniques to restore knee stability. Material y Methods: Clinical study, randomized, blind comparing ACL reconstruction techniques with One Band and «U-Two¼ using clinical scales and arthrometria with KT-1000 and Pivot Shift Meter. Results: Of 36 patients, 52.94% was drawn for the One Band technique and 47.06% for «U-Two¼. 11.76% of patients had a displacement greater than 11mm in the affected knee with KT-1000. 8.82% showed an equal anterior displacement on both knees. One patient had a major previous displacement after reconstruction surgery with the one band technique, but with improvement on clinical scales. Pivot Shift measurements found a difference in displacement greater than 4,000 m/s on the X axis following the One Band technique compared to the healthy knee calculating integrals, while with U-Two the difference was less than 600 m/s. On the Y axis a difference of > 3,500 m/s was found between the healthy and the injured leg, which decreases to less than 2,000 m/s after reconstruction using U-Two technique. Conclusions: Differences have been found throughout the study in patient evolution, indicating that repair using the U-Dos technique has better results in recovering the anteroposterior and rotational stability of the affected limb.

Second Generation Cryoballoon vs. Radiofrequency Ablation in Paroxysmal Atrial Fibrillation: Outcomes Beyond One-Year Follow-up.

AIMS: Pulmonary vein isolation (PVI) can be accomplished using radiofrequency (RF) or second generation cryoballoon (CB2). We aimed to compare the freedom from very late recurrence (VLR) defined as recurrence beyond one year in patients who were AF-free during the first post-procedural year after PVI using CB2 or RF. METHODS: Consecutive patients who underwent PVI by RF or CB2 ablation between August 2014 and December 2015 were included. The primary endpoint was the occurrence of VLR in follow-up after 12 months. Patients who experienced recurrence between the first 3 to 12 months after PVI and those who did not complete 15-month follow-up time were excluded. RESULTS: 139 patients were included: 68 underwent PVI by CB2 and 71 using RF. The global VLR rate was of 22.15%. The freedom from VLR beyond 12-month follow-up was of 84.5% (57 patients) for the CB2 group vs. 71% (50 patients) in the RF group (p=0.037). 15 patients underwent re-ablation (11 of the RF group and 4 of the CB2 group): all of the patients who had undergone PVI by RF in the index procedure were found to have vein reconnection, whereas none of the CB2 group had reconnected veins (3 cavotricuspid isthmus and 1 mitral isthmus). CONCLUSION: In patients free of recurrence during the first post-procedural year after pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: second generation cryoballoon ablation showed a significantly lower very late recurrence rate compared to radiofrequency ablation. CONDENSED ABSTRACT: The present study evaluates the freedom from very late recurrence (VLR), defined as recurrence in patients who were arrhythmia-free during the first post-procedural year after pulmonary vein isolation using second generation cryoballoon (CB2) or radiofrequency (RF). CB2 ablation had a lower VLR rate compared to RF.

[Comparative study of anterior cruciate ligament reconstruction between the One Band and U-Two techniques]. / Estudio comparativo de reconstrucción de ligamento cruzado anterior entre las técnicas de Un Haz y U-Dos.

INTRODUCTION: ACL injuries are found within the most common ligament injuries. This has led to the development of different surgical techniques to restore knee stability. MATERIAL Y METHODS: Clinical study, randomized, blind comparing ACL reconstruction techniques with One Band and «U-Two¼ using clinical scales and arthrometria with KT-1000 and Pivot Shift Meter. RESULTS: Of 36 patients, 52.94% was drawn for the One Band technique and 47.06% for «U-Two¼. 11.76% of patients had a displacement greater than 11mm in the affected knee with KT-1000. 8.82% showed an equal anterior displacement on both knees. One patient had a major previous displacement after reconstruction surgery with the one band technique, but with improvement on clinical scales. Pivot Shift measurements found a difference in displacement greater than 4,000 m/s on the X axis following the One Band technique compared to the healthy knee calculating integrals, while with U-Two the difference was less than 600 m/s. On the Y axis a difference of 3,500 m/s was found between the healthy and the injured leg, which decreases to less than 2,000 m/s after reconstruction using U-Two technique. CONCLUSIONS: Differences have been found throughout the study in patient evolution, indicating that repair using the U-Dos technique has better results in recovering the anteroposterior and rotational stability of the affected limb.

INTRODUCCIÓN: Las lesiones del LCA se encuentran dentro de las lesiones ligamentarias más frecuentes. Esto ha llevado al desarrollo de diferentes técnicas quirúrgicas para recuperar la estabilidad de la rodilla. MATERIAL Y MÉTODOS: Estudio clínico, aleatorizado, ciego comparando técnicas de reconstrucción de LCA con Un Haz y «U-Dos¼ mediante escalas clínicas y artrometría con KT-1000 y Pivot Shift Meter. RESULTADOS: De 36 pacientes, 52.94% fue sorteado para la técnica de Un Haz y 47.06% para «U-Dos¼. En 11.76% de los pacientes se presentó un desplazamiento mayor a 11 mm en la rodilla afectada con KT-1000. En 8.82% se mostró un desplazamiento anterior igual en ambas rodillas. Un paciente presentó un desplazamiento anterior mayor posterior a la cirugía de reconstrucción con la técnica de Un Haz, pero con mejoría en las escalas clínicas. En las mediciones de Pivot Shift se encontró una diferencia en el desplazamiento mayor a los 4,000 m/s en el eje de las X tras la técnica de Un Haz en comparación con la rodilla sana calculando integrales, mientras que con U-Dos la diferencia fue menor de 600 m/s. En el eje de «Y¼ se encontró una diferencia 3,500 m/s entre la pierna sana y la lesionada, la cual disminuye a menos de 2,000 m/s tras la reconstrucción mediante técnica de U-Dos. CONCLUSIONES: A lo largo del estudio se han encontrado diferencias en la evolución de los pacientes que indican que la reparación mediante la técnica de U-Dos tiene mejores resultados al lograr recuperar la estabilidad anteroposterior y rotacional del miembro afectado.

Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study.

BACKGROUND: Healthcare-associated infections caused by Pseudomonas aeruginosa are associated with poor outcomes. However, the role of P. aeruginosa in surgical site infections after colorectal surgery has not been evaluated. The aim of this study was to determine the predictive factors and outcomes of surgical site infections caused by P. aeruginosa after colorectal surgery, with special emphasis on the role of preoperative oral antibiotic prophylaxis. METHODS: We conducted an observational, multicenter, prospective cohort study of all patients undergoing elective colorectal surgery at 10 Spanish hospitals (2011-2014). A logistic regression model was used to identify predictive factors for P. aeruginosa surgical site infections. RESULTS: Out of 3701 patients, 669 (18.1%) developed surgical site infections, and 62 (9.3%) of these were due to P. aeruginosa. The following factors were found to differentiate between P. aeruginosa surgical site infections and those caused by other microorganisms: American Society of Anesthesiologists' score III-IV (67.7% vs 45.5%, p = 0.001, odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.44-4.39), National Nosocomial Infections Surveillance risk index 1-2 (74.2% vs 44.2%, p < 0.001, OR 3.6, 95% CI 2.01-6.56), duration of surgery ≥75thpercentile (61.3% vs 41.4%, p = 0.003, OR 2.2, 95% CI 1.31-3.83) and oral antibiotic prophylaxis (17.7% vs 33.6%, p = 0.01, OR 0.4, 95% CI 0.21-0.83). Patients with P. aeruginosa surgical site infections were administered antibiotic treatment for a longer duration (median 17 days [interquartile range (IQR) 10-24] vs 13d [IQR 8-20], p = 0.015, OR 1.1, 95% CI 1.00-1.12), had a higher treatment failure rate (30.6% vs 20.8%, p = 0.07, OR 1.7, 95% CI 0.96-2.99), and longer hospitalization (median 22 days [IQR 15-42] vs 19d [IQR 12-28], p = 0.02, OR 1.1, 95% CI 1.00-1.17) than those with surgical site infections due to other microorganisms. Independent predictive factors associated with P. aeruginosa surgical site infections were the National Nosocomial Infections Surveillance risk index 1-2 (OR 2.3, 95% CI 1.03-5.40) and the use of oral antibiotic prophylaxis (OR 0.4, 95% CI 0.23-0.90). CONCLUSIONS: We observed that surgical site infections due to P. aeruginosa are associated with a higher National Nosocomial Infections Surveillance risk index, poor outcomes, and lack of preoperative oral antibiotic prophylaxis. These findings can aid in establishing specific preventive measures and appropriate empirical antibiotic treatment.

Spontaneous fertility in a male patient with testotoxicosis despite suppression of FSH levels.

Testotoxicosis is a rare cause of peripheral precocious puberty in boys caused by constitutively activating mutations of the LHCG receptor. Affected males usually have normal gonadotropin profiles and fertility in their adult life. Here, we described the long-term follow-up of a 24-year-old young man with severe testotoxicosis due to a de novo activating mutation in the third transmembrane helix of the LHCGR (p.Leu457Arg). This patient was treated with different medications, including medroxyprogesterone acetate, ketoconazole, cyproterone acetate and aromatase inhibitor from age 2.5 to 9.5 years. His basal and GnRH-stimulated gonadotropin levels were continually suppressed during and after medical treatment. At adulthood, extremely high serum testosterone levels (>35 nmol/L), undetectable gonadotropin levels (LH < 0.15 IU/L and FSH < 0.6 IU/L) and oligozoospermia were evidenced. Despite his suppressed FSH levels and an unfavorable spermogram, the patient fathered a healthy girl and biological paternity was confirmed through analysis of microsatellites. Spontaneous fertility in a young man with severe testotoxicosis and chronic suppression of FSH levels reinforces the key role of high intratesticular testosterone levels in human spermatogenesis.

Influencia de la Actividad Física en la Sintomatología del Síndrome Premenstrual en universitarias / Influence of Physical Activity on Symptoms of the Syndrome Premenstrual in college girls

RESUMEN Objetivo: Determinar la influencia de la actividad física en la sintomatología del síndrome premenstrual en un grupo de mujeres de la Facultad de Medicina de la Universidad de Concepción. Métodos: Estudio observacional, descriptivo, transversal, realizado en 340 mujeres escogidas al azar de edades entre 18 a 27 años, estudiantes de la Facultad de Medicina de la Universidad de Concepción. Se utilizaron instrumentos validados para población chilena, como los criterios para el diagnóstico del trastorno disfórico premenstrual DSM-IV-TR, la Escala Visual Análoga (EVA) para la medición del dolor y el Cuestionario Internacional de Actividad Física (IPAQ) para la intensidad de esta. Los datos se obtuvieron por medio de encuestas autoadministradas y los resultados se analizaron mediante pruebas estadísticas. Resultados: Un 55,9% (n=190) presenta Síndrome premenstrual según los criterios utilizados. Los principales síntomas manifestados fueron: fatiga y falta de energía en un 64,7% (n=220), hipersensibilidad mamaria, cefalea e hinchazón en un 62,9% (n=214) y ansiedad, tensión, agobio y colapso en un 60,9% (n=207). Del total de encuestadas, el mayor porcentaje (42,6%) (n=145) realiza actividad física moderada. Al cruzar las variables de actividad física y la sintomatología del síndrome premenstrual se estableció que no existía relación entre ellas (valor p=0,605). Conclusiones: la actividad física no tiene influencia sobre la disminución de la sintomatología del síndrome premenstrual en la población estudiada.

ABSTRACT Objectives: Determine the influence of physical activity on the symptoms of premenstrual syndrome in females students of the Faculty of Medicine, Universidad de Concepción, Concepción Campus in 2014 Methods: A cross sectional study was applied to 340 randomly selected women aged between 18-27 years old belonging to the Faculty of Medicine of the Universidad de Concepción. Data were obtained through self-administered surveys and the results were analyzed by the respective statistical techniques. Results: Of the sample (n = 340), 55.9% (n = 190) had premenstrual syndrome according to the canon used. The main symptoms manifested were fatigue and lack of energy in 64.7% (n = 220), breast tenderness, headache and swelling in 62.9% (n = 214) and anxiety, stress, overwhelm and collapse into a 60.9% (n = 207). Of the total of the participants, the highest percentage (42.6%) (n = 145) performs moderate physical activity. When the variables of physical activity and premenstrual syndrome were crossed, was established that it did not exist relationship between them (p value = 0.605). Conclusions: With the obtaining and analyzing of the results, it seems that physical activity does not have major influence on the symptoms of premenstrual syndrome in the population studied.

Predictive factors for early- and late-onset surgical site infections in patients undergoing elective colorectal surgery. A multicentre, prospective, cohort study.

BACKGROUND: Surgical site infections (SSIs) are the leading cause of healthcare-associated infections in acute care hospitals in Europe. However, the risk factors for the development of early-onset (EO) and late-onset (LO) SSI have not been elucidated. AIM: This study investigated the predictive factors for EO-SSI and LO-SSI in a large cohort of patients undergoing colorectal surgery. METHODS: We prospectively followed-up adult patients undergoing elective colorectal surgery in 10 hospitals (2011-2014). Patients were divided into three groups: EO-SSI, LO-SSI, or no infection (no-SSI). The cut-off defining EO-SSI and LO-SSI was seven days (median time to SSI development). Different predictive factors for EO-SSI and LO-SSI were analysed, comparing each group with the no-SSI patients. FINDINGS: Of 3701 patients, 320 (8.6%) and 349 (9.4%) developed EO-SSI and LO-SSI, respectively. The rest had no-SSI. Patients with EO-SSI were mostly males, had colon surgery and developed organ-space SSI whereas LO-SSI patients frequently received chemotherapy or radiotherapy and had incisional SSI. Male sex (odds ratio (OR): 1.92; P < 0.001), American Society of Anesthesiologists' physical status >2 (OR: 1.51; P = 0.01), administration of mechanical bowel preparation (OR: 0.7; P = 0.03) and stoma creation (OR: 1.95; P < 0.001) predicted EO-SSI whereas rectal surgery (OR: 1.43; P = 0.03), prolonged surgery (OR: 1.4; P = 0.03) and previous chemotherapy (OR: 1.8; P = 0.03) predicted LO-SSI. CONCLUSION: We found distinctive predictive factors for the development of SSI before and after seven days following elective colorectal surgery. These factors could help establish specific preventive measures in each group.

l-arginine modulates inflammation and muscle regulatory genes after a single session of resistance exercise in rats.

We investigated the skeletal muscle adaptation to l-arginine supplementation prior to a single session of resistance exercise (RE) during the early phase of muscle repair. Wistar rats were randomly assigned into non-exercised (Control), RE plus vehicle (RE); RE plus l-arginine (RE+L-arg) and RE plus aminoguanidine (RE+AG) groups. Animals received four doses of either vehicle (0.9% NaCl), l-arg (1 g/b.w.), or AG (iNOS inhibitor) (50 mg/b.w.). The animals performed a single RE session until the concentric failure (ladder climbing; 80% overload) and the skeletal muscles were harvested at 0, 8, 24, and 48 hours post-RE. The RE resulted in increased neutrophil infiltrate (24 hours post-RE) (3621 vs 11852; P<.0001) associated with enhanced TNF-α (819.49 vs 357.02; P<.005) and IL-6 (3.84 vs 1.08; P<.0001). Prior, l-arginine supplementation attenuates neutrophil infiltration (5622; P<.0001), and also TNF-α (506.01; P<.05) and IL-6 (2.51, P<.05) levels. AG pretreatment mediated an inhibition of iNOS levels similar to levels found in RE group. RE animals displayed increased of atrogin-1 (1.9 fold) and MuRF-1 (3.2 fold) mRNA levels, reversed by l-arg supplementation [atrogin-1 (0.6 fold; P<.001); MuRF-1 (0.8-fold; P<.001)] at 24 hours post-RE. MyoD up-regulated levels were restricted to l-arg treated animals at 24 hours (2.8 vs 1.5 fold; P<.005) and 48 hours post-RE (2.4 vs 1.1 fold; P<.001). AG pretreatment reversed these processes at 24 hours [atrogin-1 (2.1 fold; P<.0001); MuRF-1 (2.5 fold; P<.0001); MyoD (1.4 fold)]. l-arginine supplementation seems to attenuate the resolution of RE-induced muscle inflammation and up-regulates MyoD expression during the early phase of muscle repair.