Transtibial Lateral Meniscal Root Repair Technique to Appose Remnant Root With Torn Body: The Double Compression Knot.

Anterior cruciate ligament reconstructions are often performed with associated procedures, most commonly for associated meniscal tears. The lateral meniscal root tear is a commonly associated injury, which increases rotational instability and results in altered tibiofemoral biomechanics. Lateral meniscectomy results in poorer functional and long-term outcomes, making repair vital. The position of the lateral root tear makes its repair technique complicated. Because of the proximity to vessels posteriorly, the all-inside technique is considered potentially unsafe, and current transtibial repair techniques fail to appose the body with the root remnant. In the lineage of Laprade, who proclaimed the use of a transtibial suture for radial tears elsewhere in the knee in order to reduce the shear force, we describe a transtibial technique that optimizes meniscal apposition, theoretically improving the repair biomechanics and is technically easier to perform in comparison to suture hook techniques with one tunnel and one suture.

Brain Functional Correlates of Recall of Life Events in Medication-Naïve Adolescents with Borderline Personality Disorder.

INTRODUCTION: Recall of autobiographical events has been found to be impaired in borderline personality disorder (BPD), but few studies have examined if this impairment has brain functional correlates. This study evaluated brain functional alterations during autobiographical recall using medication-naive adolescent patients to avoid potential confounding effects of treatment. METHODS: Thirty-two adolescent female patients with BPD who were never-medicated and without psychiatric comorbidity and 33 matched healthy females underwent fMRI while they viewed individualized cue words that evoked autobiographical memories. Control conditions included viewing non-memory-evoking cues and a low-level baseline (cross-fixation). RESULTS: During autobiographical recall, in comparison to the low-level baseline, the BPD patients showed increased brain activity in regions including the posterior hippocampus, the lingual and calcarine cortex, and the precuneus compared to the healthy controls. The BPD patients also showed a failure to deactivate the right dorsolateral prefrontal cortex during autobiographical recall. No patient-control differences were found when memory-evoking words were compared to non-memory-evoking words. DISCUSSION/CONCLUSIONS: This study finds evidence of hippocampal/lingual/calcarine/precuneus hyperactivation to stimuli that evoke autobiographical memories in patients with BPD. As the changes were seen in never-treated patients without other comorbidities, they could be considered intrinsic to the disorder. Our study also adds to existing evidence for failure of deactivation in BPD, this time outside the default mode network.

Consumo das principais substâncias psicoativas em tempos de pandemia COVID-19 nos estudantes do ensino superior / Use of the main psychoactive drugs during the COVID-19 pandemic among higher education students / Consumo de las principales sustancias psicoactivas en tiempos de la pandemia de COVID-19 en estudiantes de enseñanza superior

Resumo Enquadramento: A população estudantil do ensino superior tem especial risco de consumo e abuso de substâncias psicoativas. Objetivo: Analisar o consumo das principais substâncias psicoativas nos estudantes do ensino superior e a sua relação com as variáveis sóciodemográficas e com o surgimento da pandemia COVID-19. Metodologia: Estudo analítico, observacional e transversal. Dados recolhidos por questionário aplicado após o primeiro semestre do ano letivo 2020/2021, na população de 8875 estudantes do Instituto Politécnico de Bragança em Portugal. Amostra de 825 estratificada para cada uma das cinco escolas. Resultados: Álcool e tabaco são as mais consumidas e de forma abusiva pela prática de binge drinking/smoking. Os medicamentos psicoativos e as drogas recreativas são menos consumidos. Os consumos são afetados pelas variáveis sociodemográficas: sexo, idade, escola, portadores de doença crónica, escolaridade e profissão dos pais. Durante a pandemia COVID-19, os estudantes percecionaram aumento dos consumos exceto o álcool. Conclusão: O consumo de substâncias psicoativas pelos estudantes do ensino superior é afetado pelas variáveis sociodemográficas e pela pandemia COVID-19.

Abstract Background: The higher education student population has a special risk of use and abuse of psychoactive drugs. Objective: To analyze the use of psychoactive drugs in higher education students and their relationship with the sociodemographic variables and the COVID-19 pandemic onset. Methodology: An analytical, observational, and cross-sectional study was conducted. Data were collected through a questionnaire applied after the first semester of the 2020/2021 school year to 8875 students of the Polytechnic Institute of Bragança from Portugal. A stratified sample of 825 participants for each of the five schools. Results: Alcohol and tobacco are the most used and abused substances due to the practice of binge drinking/smoking. Psychoactive and recreational drugs are less used. Use is affected by sociodemographic variables: gender, age, school, chronic diseases, and parents' education/occupation. During the pandemic COVID-19, students perceive an increase in use except for alcohol. Conclusion: The use of psychoactive drugs in higher education students is affected by sociodemographic variables and the COVID-19 pandemic.

Resumen Marco contextual: La población estudiantil de la enseñanza superior está especialmente expuesta al riesgo de consumo y abuso de sustancias psicoactivas. Objetivo: Analizar el consumo de las principales sustancias psicoactivas entre los estudiantes de enseñanza superior y su relación con las variables sociodemográficas y la irrupción de la pandemia de la COVID-19. Metodología: Estudio analítico, observacional y transversal. Datos recogidos mediante un cuestionario realizado después del primer semestre del año académico 2020/2021, en una población de 8875 estudiantes del Instituto Politécnico de Braganza, en Portugal. Muestra de 825 estratificada para cada una de las cinco escuelas. Resultados: El alcohol y el tabaco son las sustancias más consumidas y de las que más se abusa a través de borracheras/tabaco (binge drinking/smoking). Los medicamentos psicoactivos y las drogas recreativas se consumen menos. El consumo se ve afectado por variables sociodemográficas: sexo, edad, escolaridad, enfermedad crónica, educación y profesión de los padres. Durante la pandemia de la COVID-19, los estudiantes percibieron un mayor consumo, excepto de alcohol. Conclusión: El consumo de sustancias psicoactivas de los estudiantes de enseñanza superior se ve afectado por variables sociodemográficas y por la pandemia de la COVID-19.

Oxidative genomic damage in humans exposed to high indoor radon levels in Northeast Brazil.

Radon gas inhalation is the main source of exposure to ionizing radiation by humans. There is still lack in knowledge concerning the chronic and indirect effects of exposure to this carcinogenic factor. Therefore, the aim of this work is to analyze the levels of oxidative genomic damage in inhabitants of a medium-high background radiation area (HBRA) (N = 82) in Northeastern Brazil and compare them with people living in a low background radiation area (LBRA) (N = 46). 8-hydroxy-2-deoxyguanosine (8-OHdG) was quantified in urine, Ser326Cys polymorphism was determined in the hOGG1 gene and indoor radon was measured. HBRA houses had 6.5 times higher indoor radon levels than those from LBRA (p-value < 0.001). The 8-OHdG mean (95% confidence interval) were significantly different, 8.42 (5.98-11.9) ng/mg creatinine and 29.91 (23.37-38.30) ng/mg creatinine for LBRA and HBRA, respectively. The variables representing lifestyle and environmental and occupational exposures did not have a significant association with oxidized guanosine concentrations. On the other hand, lower 8-OHdG values were observed in subjects that had one mutant allele (326Cys) in the hOGG1 gene than those who had both wild alleles (Ser/Ser (p-value < 0.05). It can be concluded that high radon levels have significantly influenced the genome oxidative metabolism and hOGG1 gene polymorphism would mediate the observed biological response.

Safety and immunogenicity of the protein-based PHH-1V compared to BNT162b2 as a heterologous SARS-CoV-2 booster vaccine in adults vaccinated against COVID-19: a multicentre, randomised, double-blind, non-inferiority phase IIb trial.

Background: A SARS-CoV-2 protein-based heterodimer vaccine, PHH-1V, has been shown to be safe and well-tolerated in healthy young adults in a first-in-human, Phase I/IIa study dose-escalation trial. Here, we report the interim results of the Phase IIb HH-2, where the immunogenicity and safety of a heterologous booster with PHH-1V is assessed versus a homologous booster with BNT162b2 at 14, 28 and 98 days after vaccine administration. Methods: The HH-2 study is an ongoing multicentre, randomised, active-controlled, double-blind, non-inferiority Phase IIb trial, where participants 18 years or older who had received two doses of BNT162b2 were randomly assigned in a 2:1 ratio to receive a booster dose of vaccine-either heterologous (PHH-1V group) or homologous (BNT162b2 group)-in 10 centres in Spain. Eligible subjects were allocated to treatment stratified by age group (18-64 versus ≥65 years) with approximately 10% of the sample enrolled in the older age group. The primary endpoints were humoral immunogenicity measured by changes in levels of neutralizing antibodies (PBNA) against the ancestral Wuhan-Hu-1 strain after the PHH-1V or the BNT162b2 boost, and the safety and tolerability of PHH-1V as a boost. The secondary endpoints were to compare changes in levels of neutralizing antibodies against different variants of SARS-CoV-2 and the T-cell responses towards the SARS-CoV-2 spike glycoprotein peptides. The exploratory endpoint was to assess the number of subjects with SARS-CoV-2 infections ≥14 days after PHH-1V booster. This study is ongoing and is registered with ClinicalTrials.gov, NCT05142553. Findings: From 15 November 2021, 782 adults were randomly assigned to PHH-1V (n = 522) or BNT162b2 (n = 260) boost vaccine groups. The geometric mean titre (GMT) ratio of neutralizing antibodies on days 14, 28 and 98, shown as BNT162b2 active control versus PHH-1V, was, respectively, 1.68 (p < 0.0001), 1.31 (p = 0.0007) and 0.86 (p = 0.40) for the ancestral Wuhan-Hu-1 strain; 0.62 (p < 0.0001), 0.65 (p < 0.0001) and 0.56 (p = 0.003) for the Beta variant; 1.01 (p = 0.92), 0.88 (p = 0.11) and 0.52 (p = 0.0003) for the Delta variant; and 0.59 (p ≤ 0.0001), 0.66 (p < 0.0001) and 0.57 (p = 0.0028) for the Omicron BA.1 variant. Additionally, PHH-1V as a booster dose induced a significant increase of CD4+ and CD8+ T-cells expressing IFN-γ on day 14. There were 458 participants who experienced at least one adverse event (89.3%) in the PHH-1V and 238 (94.4%) in the BNT162b2 group. The most frequent adverse events were injection site pain (79.7% and 89.3%), fatigue (27.5% and 42.1%) and headache (31.2 and 40.1%) for the PHH-1V and the BNT162b2 groups, respectively. A total of 52 COVID-19 cases occurred from day 14 post-vaccination (10.14%) for the PHH-1V group and 30 (11.90%) for the BNT162b2 group (p = 0.45), and none of the subjects developed severe COVID-19. Interpretation: Our interim results from the Phase IIb HH-2 trial show that PHH-1V as a heterologous booster vaccine, when compared to BNT162b2, although it does not reach a non-inferior neutralizing antibody response against the Wuhan-Hu-1 strain at days 14 and 28 after vaccination, it does so at day 98. PHH-1V as a heterologous booster elicits a superior neutralizing antibody response against the previous circulating Beta and the currently circulating Omicron BA.1 SARS-CoV-2 variants in all time points assessed, and for the Delta variant on day 98 as well. Moreover, the PHH-1V boost also induces a strong and balanced T-cell response. Concerning the safety profile, subjects in the PHH-1V group report significantly fewer adverse events than those in the BNT162b2 group, most of mild intensity, and both vaccine groups present comparable COVID-19 breakthrough cases, none of them severe. Funding: HIPRA SCIENTIFIC, S.L.U.

Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia.

INTRODUCTION: Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. PATIENTS AND METHODS: Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. RESULTS: A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, p < 0.001). Women tended to present a worse outcome at 90 days, especially for the group receiving only IVT (good outcome 56.7% vs 63.8%; p < 0.001), but not for the group of patients treated with IVT + MT or MT alone, although sex was not independently associated with clinical outcome in logistic regression analysis (OR 1.07; 95% CI, 0.94-1.23; p = 0.27) nor in the analysis after matching using the propensity score (OR 1.09; 95% CI, 0.97-1.22). DISCUSSION AND CONCLUSION: We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself.

Organizaciones límite en la infancia. Estudio de caso desde la psicoterapia focalizada en la transferencia. / Organitzacions límit a la infantesa. Estudi de cas des de la psicoteràpia focalitzada en la transferència / Borderline organizations in childhood. Case study from transference-focused psychotherapy

En el presente trabajo, se plantea si pudiera estar indicado aplicar lo que sabemos sobre la psicoterapia focalizada en la transferencia (TFP) a niños con personalidad límite, a partir de las ideas de Paulina y Otto Kernberg. Se presenta el caso de una niña de seis años en la que se observa una falta de integración interna que, como consecuencia principal, generaba graves conflictos en sus relaciones. Se le indicó una psicoterapia con frecuenciasemanal centrada en las técnicas descritas para la TFP. A través del análisis del caso, se discuten sus peculiaridades técnicas a la luz de los resultados.(AU)

n this paper, it isconsidered whether it could be indicated to apply what we know about transference-focused psychotherapy (TFP)to children with borderline personality, based on the ideas of Paulina and Otto Kernberg. The case of a six-yearold girl is presented in which a lack of internal integration was observed which, as a main consequence, generatedserious conflicts in her relationships. She was prescribed weekly psychotherapy focused on the techniques described for TFP. Through the analysis of the case, its technical peculiarities are discussed in the light of the results.(AU)

En aquesttreball, es planteja si pogués estar indicat aplicar el que sabem sobre la psicoteràpia focalitzada en la transferència (TFP) a nens amb personalitat límit, a partir de les idees de Paulina i Otto Kernberg. Es presenta el cas d'unanena de sis anys en què s'observa una manca d'integració interna que, com a conseqüència principal, generavagreus conflictes en les seves relacions. Se li va indicar una psicoteràpia amb freqüència setmanal centrada enles tècniques descrites per a la TFP. Mitjançant l'anàlisi del cas, es discuteixen les seves peculiaritats tècniquesa la llum dels resultats.(AU)

Positive end-expiratory pressure induced changes in airway driving pressure in mechanically ventilated COVID-19 Acute Respiratory Distress Syndrome patients.

BACKGROUND: The profile of changes in airway driving pressure (dPaw) induced by positive-end expiratory pressure (PEEP) might aid for individualized protective ventilation. Our aim was to describe the dPaw versus PEEP curves behavior in ARDS from COVID-19 patients. METHODS: Patients admitted in three hospitals were ventilated with fraction of inspired oxygen (FiO2) and PEEP initially adjusted by oxygenation-based table. Thereafter, PEEP was reduced from 20 until 6 cmH2O while dPaw was stepwise recorded and the lowest PEEP that minimized dPaw (PEEPmin_dPaw) was assessed. Each dPaw vs PEEP curve was classified as J-shaped, inverted-J-shaped, or U-shaped according to the difference between the minimum dPaw and the dPaw at the lowest and highest PEEP. In one hospital, hyperdistention and collapse at each PEEP were assessed by electrical impedance tomography (EIT). RESULTS: 184 patients (41 including EIT) were studied. 126 patients (68%) exhibited a J-shaped dPaw vs PEEP profile (PEEPmin_dPaw of 7.5 ± 1.9 cmH2O). 40 patients (22%) presented a U (PEEPmin_dPaw of 12.2 ± 2.6 cmH2O) and 18 (10%) an inverted-J profile (PEEPmin_dPaw of 14,6 ± 2.3 cmH2O). Patients with inverted-J profiles had significant higher body mass index (BMI) and lower baseline partial pressure of arterial oxygen/FiO2 ratio. PEEPmin_dPaw was associated with lower fractions of both alveolar collapse and hyperinflation. CONCLUSIONS: A PEEP adjustment procedure based on PEEP-induced changes in dPaw is feasible and may aid in individualized PEEP for protective ventilation. The PEEP required to minimize driving pressure was influenced by BMI and was low in the majority of patients.

Brain functional abnormality in drug treated and drug naïve adolescents with borderline personality disorder: Evidence for default mode network dysfunction.

BACKGROUND: Patients with borderline personality disorder (BPD) have been found to show functional brain abnormality, including in the medial frontal cortex and other areas of the default mode network (DMN). The current study aimed to examine activations and de-activations in drug treated and medication-free female adolescents with the disorder. METHODS: 39 DSM-5 adolescent female patients with BPD without psychiatric comorbidity and 31 matched healthy female adolescents underwent fMRI during the performance of 1-back and 2-back versions of the n-back working memory task. Linear models were used to obtain maps of within-group activations and de-activations and areas of differences between the groups. RESULTS: On corrected whole-brain analysis, the BPD patients showed failure to de-activate a region of the medial frontal cortex in the 2-back > 1-back comparison. The 30 never-medicated patients additionally showed a failure to de-activate the right hippocampus in the 2-back versus baseline contrast. CONCLUSIONS: Evidence of DMN dysfunction was observed in adolescent patients with BPD. Because the relevant medial frontal and hippocampal changes were seen in unmedicated young patients without comorbidity, they might be considered intrinsic to the disorder.

Psicoativos e sucesso escolar nos estudantes do ensino superior: uma análise em tempos de Pandemia Covid-19 / Psychoactive substances and school achievement in higher education students: an approach in times of Covid-19 pandemic

Enquadramento: na população estudantil do ensino superior, muitos comportamentos podem afetar o sucesso escolar.Objetivo: analisar a associação entre o consumo dos principais psicoativos e o sucesso escolar dos estudantes do ensino superior. Metodologia: estudo transversal, descritivo, quantitativo e analítico. Questionário online aplicado aos alunos do Instituto Politécnico de Bragança (IPB), Portugal, após o primeiro semestre letivo de 2020/2021. Amostra de 825 alunos estratificada por escola, com base numa população de 8875 alunos matriculados. Resultados: evidenciou-se relação estatisticamente significativa entre quem consome medicamentos psicoativos e/ou drogas recreativas com o menor rendimento escolar. Verificou-se que as práticas abusivas de binge drinking/smoking e a que a combinação com um terceiro psicoativo também estão associados a menor desempenho académico. Com a pandemia Covid-19 os estudantes percecionaram aumento de consumos dos principais psicoativos e diminuição do sucesso escolar. Conclusão: o consumo abusivo de psicoativos causa insucesso escolar e a pandemia COVID-19 agravou ambos problemas. (AU)

Background: Many behaviours can affect school achievement in the higher education student population. Objective: To analyse the association between the consumption of the main psychoactive substances and the school achievement of higher education students. Methodology: A cross-sectional, descriptive, quantitative, and analytical study. The questionnaire was applied to the students at the Polytechnic Institute of Bragança (IPB), Portugal, after the first semester of 2020/2021. The sample comprised 825 students, stratified by school, based on a population of 8,875 enrolled students. Results: A statistically significant relationship was found between those who consume psychoactive medicines and/or recreational drugs with the lowest school performance. Abusive binge drinking/smoking practices and the combination with a third psychoactive substance were also found to be associated with lower academic performance. With the COVID-19 pandemic, students perceived increased consumption of the main psychoactive substances and decreased school achievement. Conclusion: abusive consumption of psychoactive substances causes school failure, and the COVID-19 pandemic has further aggravated these problems. (AU)

Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population.

BACKGROUND: Acute ischemic stroke patients not referred directly to a comprehensive stroke center (CSC) have reduced access to endovascular treatment (EVT). The RACECAT trial is a population-based cluster-randomized trial, designed to compare mothership and drip-and-ship strategies in acute ischemic stroke patients outside the catchment area of a CSC. AIMS: To analyze the evolution of performance indicators in the regions that participated in RACECAT. METHODS: This retrospective longitudinal observational study included all stroke alerts evaluated by emergency medical services in Catalonia between February 2016 and February 2020. Cases were classified geographically according to the nearest SC: local SC (Local-SC) and CSC catchment areas. We analyzed the evolution of EVT rates and relevant workflow times in Local-SC versus CSC catchment areas over three study periods: P1 (February 2016 to April 2017: before RACECAT initiation), P2 (May 2017 to September 2018), and P3 (October 2018 to February 2020). RESULTS: We included 20603 stroke alerts, 10,694 (51.9%) of which were activated within Local-SC catchment areas. The proportion of patients receiving EVT within Local-SC catchment areas increased (P1 vs. P3: 7.5% (95% confidence interval (CI), 6.4-8.7) to 22.5% (95% CI, 20.8-24.4) p < 0.001). Inequalities in the odds of receiving EVT were reduced for patients from CSC versus Local-SC catchment areas (P1: odds ratio (OR) 3.9 (95% CI, 3.2-5) vs. P3: OR 1.5 (95% CI, 1.3-1.7) In Local-SC, door-to-image (P1: 24 (interquartile range (IQR) 15-36), P2: 24 (15-35), P3: 21 (13-32) min, p < 0.001) and door-to-needle times (P1: 42 (31-60), P2: 41 (29-58), P3: 35 (25-50) p < 0.001) reduced. Time from Local-SC arrival to groin puncture also decreased over time (P1: 188 [151-229], P2: 190 (157-233), P3: 168 (127-215) min, p < 0.001). CONCLUSION: An increase in EVT rates in Local-SC regions with a significant decrease in workflow times occurred during the period of the RACECAT trial.

Reliability of the Heartbeat Tracking Task to Assess Interoception.

Interoception refers to the competence in perceiving and interpreting internal sensations emerging from the body. The most common approach to assess interoception is through cardiac interoceptive tests like the heartbeat tracking task (HTT), which measures the accuracy on perceive and counting heartbeats during a period. However, the literature is scarce in providing adequate reliability evidence for this measure so that the interoception assessment may be threaten. In addition to HTT accuracy, it is possible to determine sensibility (self-reported confidence) and interoceptive awareness (correspondence between accuracy and sensibility). Thus, we measured the test-retest reliability of HTT and also investigated the behavior of HTT outcomes along the task. Therefore, 31 healthy adults (16 males) with 27.8 (9.4) years old performed two consecutive HTT interspersed by one day. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable difference (MD) analyzes showed 'Good' relative reliability for interoceptive accuracy (ICC = 0.880; SEM = 0.263; MD = 0.728; p < 0.001) and 'Moderate' for sensibility (ICC = 0.617; SEM = 0.648; MD = 1.797; p < 0.001) and awareness (ICC = 0.593; SEM = 0.227; MD = 0.628; p < 0.001). The absolute reliability shows low threshold values for observing true effects in HTT outcomes. The results also showed that reducing the number of HTT blocks did not impact the outcomes. The HTT showed to be reliable in determine the interoceptive competences in healthy adults.

Determinants and Trends of the Use of Intravenous Thrombolysis for Minor Stroke: A Population-Based Study, 2016 to 2020.

BACKGROUND: We analyzed the main factors associated with intravenous thrombolysis (IVT) in patients with minor ischemic stroke. METHODS: Data were obtained from a prospective, government-mandated, population-based registry of stroke code patients in Catalonia (6 Comprehensive Stroke Centers, 8 Primary Stroke Centers, and 14 TeleStroke Centers). We selected patients diagnosed with ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) ≤5 at hospital admission from January 2016 to December 2020. We excluded patients with a baseline modified Rankin Scale score of ≥3, absolute contraindication for IVT, unknown stroke onset, or admitted to hospital beyond 4.5 after stroke onset. The main outcome was treatment with IVT. We performed univariable and binary logistic regression analyses to identify the most important factors associated with IVT. RESULTS: We included 2975 code strokes; 1433 (48.2%) received IVT of which 30 (2.1%) had a symptomatic hemorrhagic transformation. Patients treated with IVT as compared to patients who did not receive IVT were more frequently women, had higher NIHSS, arrived earlier to hospital, were admitted to a Comprehensive Stroke Centers, and had large vessel occlusion. After binary logistic regression, NIHSS score 4 to 5 (odds ratio, 40.62 [95% CI, 31.73-57.22]; P<0.001) and large vessel occlusion (odds ratio, 16.39 [95% CI, 7.25-37.04]; P<0.001) were the strongest predictors of IVT. Younger age, female sex, baseline modified Rankin Scale score of 0, earlier arrival to hospital (<120 minutes after stroke onset), and the type of stroke center were also independently associated with IVT. The weight of large vessel occlusion on IVT was higher in patients with lower NIHSS. CONCLUSIONS: Minor stroke female patients, with higher NIHSS, arriving earlier to the hospital, presenting with large vessel occlusion and admitted to a Comprehensive Stroke Centers were more likely to receive intravenous thrombolysis.

Safety and immunogenicity of an investigational quadrivalent meningococcal tetanus toxoid conjugate vaccine (MenACYW-TT) co-administered with routine pediatric vaccines in infants and toddlers: A Phase II study.

BACKGROUND: The MenACYW-TT conjugate vaccine is approved for prevention of invasive meningococcal disease (IMD) as a single dose in individuals ≥2 years of age in the United States and ≥12 months in EU and some other countries. This Phase II study evaluated the safety and immunogenicity of this vaccine and of concomitant pediatric vaccines in infants/toddlers (6 weeks-15 months of age). METHODS: Five schedules of the MenACYW-TT conjugate vaccine were evaluated in the United States: 2, 4, 6, and 12 months; 2, 4, 6, and 15 months; 2, 4, and 12 months; 6 and 12 months; and 12 months alone. Routine pediatric vaccines (DTaP-IPV/Hib, PCV7/PCV13, MMR, and varicella) were administered per approved schedules. Proportions of participants with serum bactericidal antibodyassay with human complement (hSBA) titers ≥1:4 and ≥1:8, SBA with baby rabbit complement (rSBA) titers ≥1:8 and ≥1:128, and immune responses against concomitant vaccines were determined. RESULTS: Tenderness and irritability were the most frequent solicited injection site and systemic reactions. Similar proportions of participants achieved an hSBA titer ≥1:8 for all four serogroups regardless of whether 2 or 3 doses were administered in the first year of life. Following a second-year dose, 91-100% of participants achieved the threshold for all 4 serogroups in all schedules regardless of the number of doses in the first year of life. Similar responses were seen with rSBA. Immunogenicity and safety profile of concomitant vaccines was similar whether the MenACYW-TT conjugate vaccine was administered or not. CONCLUSION: MenACYW-TT conjugate vaccine administered with pediatric vaccines is safe and immunogenic regardless of the schedule and does not affect the immunogenicity or safety of the concomitant vaccines. CLINICAL TRIAL REGISTRY: NCT01049035.

The Role of Vascular Imaging atReferral Centers in the Drip and Ship Paradigm.

BACKGROUND: In drip-and-ship protocols, non-invasive vascular imaging (NIVI) at Referral Centers (RC), although recommended, is not consistently performed and its value is uncertain. We evaluated the role of NIVI at RC, comparing patients with (VI+) and without (VI-) vascular imaging in several outcomes. METHODS: Observational, multicenter study from a prospective government-mandated population-based registry of code stroke patients. We selected acute ischemic stroke patients, initially assessed at RC from January-2016 to June-2020. We compared and analyzed the rates of patients transferred to a Comprehensive Stroke Center (CSC) for Endovascular Treatment (EVT), rates of EVT and workflow times between VI+ and VI- patients. RESULTS: From 5128 ischemic code stroke patients admitted at RC; 3067 (59.8%) were VI+, 1822 (35.5%) were secondarily transferred to a CSC and 600 (11.7%) received EVT. Among all patients with severe stroke (NIHSS ≥16) at RC, a multivariate analysis showed that lower age, thrombolytic treatment, and VI+ (OR:1.479, CI95%: 1.117-1.960, p=0.006) were independent factors associated to EVT. The rate of secondary transfer to a CSC was lower in VI+ group (24.6% vs. 51.6%, p<0.001). Among transferred patients, EVT was more frequent in VI+ than VI- (48.6% vs. 21.7%, p<0.001). Interval times as door-in door-out (median-minutes 83.5 vs. 82, p= 0.13) and RC-Door to puncture (median-minutes 189 vs. 178, p= 0.47) did not show differences between both groups. CONCLUSION: In the present study, NIVI at RC improves selection for EVT, and is associated with receiving EVT in severe stroke patients. Time-metrics related to drip-and-ship model were not affected by NIVI.

Psicoativos e sucesso escolar em tempos de pandemia COVID-19 nos estudantes do Instituto Politécnico de Bragança / Psychoactive substances and school achievement in times of Covid-19 pandemic in students of the Polytechnic Institute of Bragança

O consumo das principais substâncias psicoativas, como o álcool, tabaco, medicamentos e drogas recreativas tem vindo a aumentar nos últimos tempos. A população estudantil do ensino superior é uma das principais afetadas por este problema, fruto de hábitos que se tem vindo a tornar cada vez mais globalizados. Por outro lado, sobre o sucesso escolar, não há universalmente modelos consensuais para o definir, as visões psicossociais mais recentes referem que o sucesso escolar não dependo só do aluno mas do apoio da família, dos pares, da comunidade escolar e das políticas de governança. Assim, num contexto mais atual, o sucesso escolar vai muito além das classificações académicas, passa também pela própria autossatisfação do aluno e da sua colocação profissional futura. Sendo o Instituto Politécnico de Bragança (IPB) uma das maiores comunidades académicas de Portugal e também uma das mais prestigiadas nacionalmente e internacionalmente, constituiu-se um desafio analisar o comportamento de risco e/ou abusivo dos seus estudantes relativo ao consumo dos principais psicoativos e de que forma interferiu no sucesso escolar, contextualizado num momento de pandemia Covid-19. Este estudo é de natureza observacional, quantitativa e analítica. O objetivo principal é analisar e relacionar o consumo de psicoativos com o sucesso escolar. Os objetivos secundários são analisar a prevalência de consumo de psicoativos e o sucesso escolar, assim como analisar a influência das variáveis sociodemográficas, académicas, de saúde e da pandemia Covid-19. Os dados foram recolhidos por um questionário online, previamente autorizado e de acordo com o consentimento informado e normas éticas vigentes, sendo aplicado aos alunos matriculados no IPB, após o primeiro semestre do ano letivo de 2020/2021. A amostra final é constituída por 825 alunos, cumprindo-se quotas por cada uma das cinco escolas do IPB, com um intervalo de confiança de 99% e uma margem de erro de 5%. Para tratamento dos dados foi utilizado o programa Statistical Package for the Social Sciences (SPSS) -Version 20.0, utilizando-se estatística descritiva e analítica, após analisados os pressupostos da normalidade populacional. Relativamente ao consumo de psicoativos, verifica-se que nos alunos do Instituto Politécnico de Bragança o consumo de álcool, medicamentos psicoativos e drogas recreativas é menor quando comparado com a maioria dos estudos nacionais e estrangeiros, exceto o consumo de tabaco que é superior. O grande problema identificado no IPB prende-se com as práticas frequentes de binge drinking e binge smoking. Com a pandemia Covid-19, os estudantes do IPB percecionaram uma diminuição do consumo de álcool e um aumento do consumo de tabaco, medicamentos psicoativos e drogas recreativas. Verifica-se que ser do género masculino e mais jovem está de facto associado a maiores consumos e a comportamentos mais exagerados, sobretudo no consumo de álcool, tabaco e drogas recreativas, pelo contrário os medicamentos psicoativos são mais consumidos pelo género feminino. Quando no agregado familiar a escolaridade é maior e quando existem profissões com maior nível intelectual e/ou relacionadas com as profissões de segurança ou forças armadas, os consumos dos educandos são significativamente maiores. Relativamente ao sucesso escolar, verifica-se um rácio de aprovação nas unidades curriculares do IPB bastante elevado e classificações enquadradas entre o satisfaz e o bom. Um dos grandes problemas para o sucesso escolar no IPB é o absentismo dos alunos às aulas, embora maioritariamente dediquem tempo ao estudo complementar e considerem bons os apoios da comunidade escolar, exceto as políticas de governança e os apoios do estado. Com a pandemia Covid-19 os alunos do IPB percecionaram uma diminuição do sucesso escolar. Verifica-se que o género feminino está proporcionalmente associado a um maior sucesso escolar, assim como os alunos mais novos. Na Escola de Saúde, nos alunos inscritos como ordinários e de origem nacional e nos agregados familiares com atividade económica é onde se verifica maior sucesso escolar dos educandos, embora a escolaridade e as profissões do agregado familiar não apresentem diferenças estatisticamente significativas. Relativamente ao objetivo principal deste estudo, verifica-se que os medicamentos psicoativos e as drogas recreativas parecem ser os mais associados ao menor desempenho académico. Por sua vez, verifica-se que o consumo regular de álcool e tabaco em quantidades baixas, não se associam ao menor sucesso escolar, no entanto o consumo em altas doses e em intervalos curtos de tempo (binge drinking e binge smoking), estão associados a um menor desempenho escolar. Um fator que influi fortemente na diminuição do sucesso escolar é o consumo regular e combinado de vários psicoativos, nomeadamente o álcool e tabaco conjugados com um terceiro psicoativo, como medicamentos e/ou drogas recreativas.

The use of the main psychoactive substances, such as alcohol, tobacco, medical and recreational drugs has been increasing in recent times. The student population of higher education is one of the main affected by this problem, as a result of habits that has become increasingly globalized. About school sucess, there are no universally consensual models to define it, the most recent psychosocial visions report that school success not only depend on the student, but also the support of the family, peers, the school community and school governance. Thus, in a more current context, school success goes far beyond academic classifications, it'a also the achievement of the student and the futur professional placement. Being the Polytechnic Institute of Bragança (IPB) one of Portugal's largest academic communities, whith more than 8 thousand students, and also one of the most prestigious portuguese and internationally, it was a challenge to analyze the abusive behavior's of its students about the psychoactive substances use and the relationshiop with school success, contextualized in a time of pandemic Covid-19. This study is observational, quantitative and analytical. The main objective was to analyze the relationship whith use of psychoactive substances with school success. The secondary objectives were to analyze the prevalence of psychoactive substances use and school success, as well as analyzing the influence of variables: sociodemographic, academic, health and the Covid-19 pandemic. The data were collected by online questionnaire, previously authorized and in accordance with informed consent and existing ethical standards, being applied to students enrolled in IPB, after the first half of the 2020/2021 school year. The final sample consists of 825 students, fulfilling quotas for each of the five schools of IPB, with a 99% confidence interval and a 5% error margin. For the treatment of data, the SPSS Statistical Package for the Social Sciences-Version 20.0 program was used, using descriptive and analytical statistics, after analyzing the population normality. Regarding the consumption of psychoactive substances, in the students of the Polytechnic Institute of Bragança, the consumption of alcohol, psychoactive drugs and recreational drugs is less than compared to most national and international studies, except the consumption of tobacco is more highter. The big problem identified in the IPB holds with frequent practices of binge drinking and binge smoking. With the Covid-19 pandemic, IPB students perceived a decrease in alcohol consumption but an increase in the consumption of tobacco, psychoactive medication and recreational drugs. It appears that being male and younger is in fact associated with higher consumption and more consumption exaggerated behaviors, especially in the consumption of alcohol, tobacco and recreational drugs, otherwise psychoactive medecines being more consumed by females. When schooling is higher in the household and when there are professions with higher intellectual level and/or related to security professions or military forces, the consumption of students are significantly higher. About academic success, is observed a very high rate in the IPB's course units and classifications that fall between regular and good. One of the major problems for school success at IPB is the absenteeism of students from classes, although most of them dedicate time to further study and consider the support provided by the school community to be good, except governance policies and government support. With the Covid-19 pandemic, IPB students perceived a decrease in school success. It appears that the female gender is proportionally associated with greater academic success, as well as younger students. In the School of Health, students registered as ordinary and of national origin and in households with economic activity, are found the students more successful, although schooling and occupations of household are not related to significant statistical differences. Regarding the main objective of this study, psychoactive medicines and recreational drugs seem to be the ones that are most associated with lower academic performance. On the other hand, it appears that the regular consumption of alcohol and tobacco in low amounts are not associated with lower academic success, however its consumption in high doses and in short periods of time (binge drinking and binge smoking) are also associated with lower academic performance. One factor that strongly influences the decrease in school success is the regular and combined consumption of various psychoactives, namely alcohol and tobacco, adding a third psychoactive, such as medication and/or recreational drugs.

Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry.

BACKGROUND AND PURPOSE:  In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. METHODS:  Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups' criteria). RESULTS:  Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). CONCLUSIONS:  Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.

Aprendiendo de la experiencia del duelo en el contexto de la pandemia por COVID-19 / Learning from the grief experience during the COVID-19 pandemic

Introducción: Este estudio transversal descriptivo con metodología cualitativa pretende aproximarnos a la comprensión de la experiencia de los familiares de pacientes fallecidos durante la pandemia por el COVID-19, así como detectar aquellos aspectos que desempeñan un papel protector ante el impacto emocional de la pérdida. Material y métodos: Se realizó, vía telefónica, una entrevista semiestructurada para la evaluación, desde la perspectiva de los familiares, de distintas variables asociadas con su proceso de acompañamiento al final de la vida y de muerte del paciente (tareas relativas a las circunstancias de la muerte, factores protectores y de riesgo de duelo con complicaciones, satisfacción con el soporte psicológico, e interés en recibir información sobre un Servicio de Soporte al Duelo). Resultados: Un análisis de contenido de 126 entrevistas permitió acercarnos a los principales factores que: 1) dificultaron la vivencia (estado de alarma y sus restricciones, pérdidas múltiples y secuenciales, y la percepción de la vulneración de una muerte digna), 2) facilitaron la vivencia (soporte familiar, recursos propios, la búsqueda de un sentido y la consideración del paciente como fuente de soporte) o 3) factores que dificultaron y facilitaron, en función de si pudieran o no estar presentes (presencia y cuidado, la atención sanitaria y la realización de rituales). Discusión: Los resultados se discuten en base a los recientes hallazgos encontrados en la literatura científica, concluyendo en la necesidad de una atención sanitaria sistémica integral e integradora. (AU)

Introduction: This descriptive, cross-sectional study with a qualitative methodology aimed to gain insight into the experience of relatives of patients who died during the COVID-19 pandemic, as well as to detect those aspects that play a protective role against the emotional impact of losing a loved one. Material and methods: A semi-structured interview was carried out by phone to assess, from the perspective of family members, a number of variables associated with the end of life process and death (tasks related to the circumstances of death, protectors and risk factors of complicated grief, satisfaction with psychological support, and interest in receiving information about a Grief Support Service). Results: A content analysis of 126 interviews allowed us to approach the main factors that (1) complicated the experience – state of alarm and its restrictions, other losses and concomitant circumstances, and perceived violation of a dignified death; (2) eased the experience – family support, own resources, search for meaning, and consideration of the patient as a source of support; or (3) factors than either complicated or eased the experience, depending on whether they were present – presence and care, health care, and performance of rituals. Discussion: The results are discussed based on recent findings collected from the scientific literature, concluding on the need for a comprehensive, integrative, systemic health care model. (AU)

External validation of putative biomarkers in eutopic endometrium of women with endometriosis using NanoString technology.

PURPOSE: To combine different independent endometrial markers to classify the presence of endometriosis. METHODS: Endometrial biopsies were obtained from 109 women with endometriosis as well as 110 control women. Nine candidate biomarkers independent of cycle phase were selected from the literature and NanoString was performed. We compared differentially expressed genes between groups and generated generalized linear models to find a classifier for the disease. RESULTS: Generalized linear models correctly detected 68% of women with endometriosis (combining deep infiltrating and ovarian endometriosis). However, we were not able to distinguish between individual types of endometriosis compared to controls. From the 9 tested genes, FOS, MMP7, and MMP11 seem to be important for disease classification, and FOS was the most over-expressed gene in endometriosis. CONCLUSION(S): Although generalized linear models may allow identification of endometriosis, we did not obtain perfect classification with the selected gene candidates.

Natural radioactivity in Brazil: a systematic review.

Natural radioactivity is a public health concern worldwide. Its deleterious effects are largely associated with emitting ionizing particles which generate innumerable toxicological consequences to human being. The present study aimed to describe the research state of the art on natural radioactivity in Brazil through a systematic review limited to articles published in the twenty-first century in the PubMed, SciELO, Lilacs, and Google Scholar databases. A total of 55 research articles were considered for this purpose. Based on the collected sample types, the radiation analysis in most of the scientific reports was performed on solid samples (soil/sediment/rocks), followed by water and air. In fact, most of the available information came from geological studies. A wide range of concentrations and a variety of radionuclides have been assessed, with radium being the most cited. Most of the studies described radiation levels above the international guidelines, and consider the Brazilian territory as a high natural background radiation region (HNBR). In comparison with other HNBR areas, the scientific information about the related risks to human health is still scarce. There is uncertainty about the real impact of natural radioactivity on human health, as there is a lack of scientific information for most of the country about this issue. The analysis and comparison of the available information highlights the potential risks linked to natural radioactivity and the need to incorporate suitable environmental management policies about this issue.