Impacto de la pandemia de COVID-19 en las tendencias de mortalidad por enfermedades cardiovasculares en México, 2000-2022 / Impact of the COVID-19 pandemic on cardiovascular disease mortality trends in Mexico, 2000–2022

Objetivo: Estimar el impacto de la pandemia de COVID-19 en tendencia de la mortalidad por enfermedad cardiovascular (ECV) en México. Métodos: Se realizó un estudio ecológico donde se analizaron las defunciones por ECV reportadas en México bajo la clasificación CIE-10 con los códigos I10 al I99 para el periodo 2000 al 2022. Se calcularon las tasas de mortalidad estandarizadas por edad a nivel nacional y estatal, y posteriormente se estimó la variación porcentual anual mediante el análisis de joinpoint para conocer los cambios en la tendencia de la mortalidad en el periodo estudiado. Resultados: Se presentó un incremento de 27,96 muertes por cada 100.000 habitantes del 2000 al 2022 en México. El análisis joinpoint muestra en el periodo 2019 a 2021 un cambio porcentual anual a nivel nacional de 17.398, y posteriormente se presenta una tendencia negativa entre los años 2021-2022. Los estados como Guanajuato, Tlaxcala y Querétaro mostraron los mayores incrementos en las tendencias de la mortalidad por ECV durante la pandemia por COVID-19. Conclusiones: La tendencia de la mortalidad por ECV en México se incrementó de manera importante durante la pandemia por COVID-19.(AU)

Objective: To estimate the impact of the COVID-19 pandemic on cardiovascular disease (CVD) mortality trends in Mexico. Methods: An ecological study was conducted where deaths from CVD reported in Mexico under the ICD-10 classification with codes I10 to I99 for the period 2000–2022 were analyzed. Age-standardized mortality rates were calculated at the national and state levels, then the annual percentage variation was estimated using joinpoint analysis to know the changes in the mortality trend in the period studied. Results: There was an increase of 27.96 deaths per 100,000 inhabitants from 2000 to 2022 in Mexico. The joinpoint analysis shows in the period 2019–2021 an annual percentage change at the national level of 17,398 and subsequently a negative trend is presented between the years 2021–2022. The states of Guanajuato, Tlaxcala and Querétaro showed the largest increases in CVD mortality trends during the COVID-19 pandemic. Conclusions: The trend in CVD mortality in Mexico increased significantly during the COVID-19 pandemic.(AU)

Intraovarian platelet-rich plasma injection and IVF outcomes in patients with poor ovarian response: a double-blind randomized controlled trial.

STUDY QUESTION: Does platelet-rich plasma (PRP) intraovarian injection increase the number of retrieved oocytes in successive ovarian punctions among patients with poor ovarian reserve (POR)? SUMMARY ANSWER: The injection of PRP increases the number of retrieved oocytes without increasing the quality of developed blastocysts. WHAT IS KNOWN ALREADY: Management of women with reduced ovarian response to stimulation is one of the significant challenges in reproductive medicine. Recently, PRP treatment has been proposed as an adjunct in assisted reproduction technology, with controversial results. STUDY DESIGN, SIZE, DURATION: This placebo-controlled, double-blind, randomized trial included 60 patients with POR stratified according to the POSEIDON classification groups 3 and 4. It was conducted to explore the efficacy and safety of intraovarian PRP injection. Patients were proposed to undergo three consecutive ovarian stimulations to accumulate oocytes and were randomized to receive either PRP or placebo during their first oocyte retrieval. Randomization was performed using computer-generated randomization codes. Double blinding was ensured so that neither the participant nor the investigators knew of the treatment allotted. All patients underwent three ovarian stimulations and egg retrieval procedures. ICSI was performed after a third ovarian puncture. The primary endpoint was the number of mature oocytes retrieved after PRP or placebo injection in successive ovarian punctures. PARTICIPANTS/MATERIALS, SETTING, METHODS: Sixty women (30-42 years) fulfilling inclusion criteria were randomized in equal proportions to the treatment or control groups. MAIN RESULTS AND THE ROLE OF CHANCE: The baseline demographic and clinical characteristics [age, BMI, anti-Müllerian hormone (AMH) levels] were comparable between the groups. Regarding the primary endpoint, the cumulative number (mean ± SEM) of retrieved mature oocytes was slightly higher in the treatment group: 10.45 ± 0.41 versus 8.91 ± 0.39 in the control group, respectively (95% CI of the difference 0.42-2.66; P = 0,008). The number of mature oocytes obtained among all patients increased in successive egg retrievals: 2.61 ± 0.33 (mean ± SEM) in punction 1 (P1), 3.85 ± 0.42 in P2, and 4.73 ± 0.44 in P3. However, the increase was higher among patients receiving the assessed PRP treatment. In P2, the number of retrieved mature oocytes was 4.18 ± 0.58 versus 3.27 ± 0.61 in controls (95% CI of the difference: -0.30 to 2.12; P = 0.138) and in P3, 5.27 ± 0.73 versus 4.15 ± 0.45 (95% CI of the difference: 0.12-2.12; P = 0.029). The mean ± SEM number of developed and biopsied blastocysts was 2.43 ± 0.60 in the control group and 1.90 ± 0.32 in the treatment group, respectively (P = 0.449). The mean number of euploid blastocysts was 0.81 ± 0.24 and 0.81 ± 0.25 in the control and treatment groups, respectively (P = 1.000). The percentages of patients with euploid blastocysts were 53.33% (16 out of 30) and 43.33% (13 out of 30) for patients in the control and treatment groups, respectively (Fisher's exact test P = 0.606). The overall pregnancy rate per ITT was 43% (26 out of 60 patients). However, the percentage of clinical pregnancies was higher in the control group (18 out of 30, 60%) than in the treatment group (8 out of 30, 27%) (P = 0.018). There was also a trend toward poorer outcomes in the treatment group when considering full-term pregnancies (P = 0.170). There were no differences between control and treatment groups regarding type of delivery, and sex of newborns. LIMITATIONS, REASONS FOR CAUTION: The mechanism of the potential beneficial effect of PRP injection on the number of retrieved oocytes is unknown. Either delivered platelet factors or a mechanical effect could be implicated. Further studies will be needed to confirm or refute the data presented in this trial and to specify the exact mechanism of action, if any, of PRP preparations. WIDER IMPLICATIONS OF THE FINDINGS: The increasing number of women with a poor response to ovarian stimulation supports the exploration of new areas of research to know the potential benefits of therapies capable of increasing the number of oocytes available for fertilization and improving the quality of developed blastocysts. An increase in the retrieved oocytes in both arms of the trial suggests that, beyond the release of growth factor from platelets, a mechanical effect can play a role. However, neither improvement in euploid blastocyst development nor pregnancy rates have been demonstrated. STUDY FUNDING/COMPETING INTEREST(S): This trial was supported by Basque Government and included in HAZITEK program, framed in the new Euskadi 2030 Science and Technology Plan (PCTI 2030). These aids are co-financed by the European Regional Development Fund (FEDER). The study funders had no role in the study design, implementation, analysis, manuscript preparation, or decision to submit this article for publication. No competing interests are declared by all the authors. TRIAL REGISTRATION NUMBER: Clinical Trial Number EudraCT 2020-000247-32. TRIAL REGISTRATION DATE: 3 November 2020. DATE OF FIRST PATIENT'S ENROLLMENT: 16 January 2021.

[Impact of the COVID-19 pandemic on cardiovascular disease mortality trends in Mexico, 2000-2022]. / Impacto de la pandemia de COVID-19 en las tendencias de mortalidad por enfermedades cardiovasculares en México, 2000-2022.

OBJECTIVE: To estimate the impact of the COVID-19 pandemic on cardiovascular disease (CVD) mortality trends in Mexico. METHODS: An ecological study was conducted where deaths from CVD reported in Mexico under the ICD-10 classification with codes I10 to I99 for the period 2000-2022 were analyzed. Age-standardized mortality rates were calculated at the national and state levels, then the annual percentage variation was estimated using joinpoint analysis to know the changes in the mortality trend in the period studied. RESULTS: There was an increase of 27.96 deaths per 100,000 inhabitants from 2000 to 2022 in Mexico. The joinpoint analysis shows in the period 2019-2021 an annual percentage change at the national level of 17,398 and subsequently a negative trend is presented between the years 2021-2022. The states of Guanajuato, Tlaxcala and Querétaro showed the largest increases in CVD mortality trends during the COVID-19 pandemic. CONCLUSIONS: The trend in CVD mortality in Mexico increased significantly during the COVID-19 pandemic.

Effects of androgen deprivation therapy on elderly men with high-risk prostate cancer: PROSARC observational study.

INTRODUCTION: Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, frailty, or sarcopenia, which can negatively affect the patient's quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis. MATERIALS AND METHODS: PROSARC is a national (Spain) prospective observational study (May-2022-May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up. RESULTS: A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (p=0.666), decreased mean value of appendicular muscle mass (p=0.01) and increased percentage of fat mass (p=0.012). CONCLUSION: In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.

Arthroscopic rotator cuff repair using a single or double row technique: A meta-analysis of randomized clinical trial. / Reparación artroscópica del manguito rotador mediante una técnica de hilera simple o doble hilera: un metaanálisis de los ensayos clínicos aleatorizados.

PURPOSE: To compare the double row technique versus the single row technique for arthroscopic rotator cuff repair, in order to assess whether there are clinical differences. METHODS: Systematic review of randomized clinical trials comparing the clinical results of the double-row technique versus the single-row technique in arthroscopic rotator cuff repair. Demographic, clinical, and surgical variables were analyzed, including functional scores, tendon healing rate, and re-tear rate. RESULTS: Thirteen randomized clinical trials were selected. 437 patients in the single row group (50.7%) and 424 patients in the double row group (49.3%) were analyzed. No significant differences were found between the two groups in terms of age (P=.84), sex (P=.23) and loss to follow-up (P=.52). Significant differences were found for the better results of the double row technique at the UCLA level (P=.01). No significant differences were found on the Constant-Murley scale (P=.87) or on the ASES scale (P=.56). Similarly, there was a higher healing rate (P=.006) and less risk of rotator cuff re-tears with the double row technique (P=.006). CONCLUSIONS: In rotator cuff repair, the double row technique was found to be superior to the single row technique in terms of better UCLA score, better tendon healing rate, and lower re-tear rate. No clinically significant differences were found on the Constant-Murley scale or on the ASES scale.

The diabetes education material on diabetes for website: Results of a validation process.

OBJECTIVE: To validate an educational material on diabetes through an expert consensus for its implementation into a web site. MATERIAL AND METHODS: An observational study was carried out in a group of health professionals, for which an educational material was developed for patients with diabetes. Topics included nutrition, physical exercise, control indicators, complications, pharmacological treatment, among others. The language, text and figures were focused on easy comprehension, additionally, a section of didactic activities to be answered by the patient with diabetes at the end of each module was included. To evaluate the educational material by health professionals, an instrument was designed and validated. Once all the educational material was available, each of the modules was sent by e-mail to at least three clinical experts in the assigned topic, as well as the instrument for the evaluation of the module. RESULTS: Thirty-seven experts were included in the study, 76% rated the educational modules evaluated as highly adequate, while only 24% rated them as adequate. The instrument used obtained a good level of internal consistency, with a Cronbach's alpha coefficient of 0.92. In the dimensions of the instrument, the lowest Cronbach's alpha score was that of "call-to-action", with a value of 0.71. CONCLUSION: The diabetes educational material was rated as highly appropriate by the clinical experts. The developed instrument has an adequate content validity, as well as a good level of internal consistency.

Estudio observacional, prospectivo y multicéntrico sobre el uso de citrato de fentanilo transmucosa en la práctica clínica habitual para el control de las crisis de dolor irruptivo en pacientes oncológicos / Observational, prospective and multicenter study on the use of transmucosal fentanyl citrate in regular clinical practice for the control of breakthrough pain crises in cancer patients

Objetivo: Evaluar el grado de satisfacción de los pacientes y/o cuidadores con el tratamiento de citrato de fentanilo transmucosa en la gestión de las crisis de dolor irruptivo oncológico en términos de facilidad de uso. Métodos: Se realizó un estudio observacional, prospectivo y multicéntrico con 48 pacientes sometidos a tratamiento de mantenimiento con opioides para el dolor crónico basal provocado por el cáncer y que, además, sufrían crisis de dolor irruptivo para las que estaban recibiendo tratamiento con citrato de fentanilo. La variable principal del estudio fue el grado de satisfacción de los pacientes y/o sus cuidadores con el citrato de fentanilo en el manejo de las crisis de dolor irruptivo oncológico, evaluadas mediante cuestionarios Escala Visual Analógica (EVA). Resultados: El 90,6 % de los pacientes/cuidadores muestran un elevado grado de satisfacción con el empleo de citrato de fentanilo en términos de facilidad de uso (valor medio EVA de 8,2). Por su parte, tanto la valoración general por parte de los pacientes/cuidadores como por parte de los sanitarios ha sido muy positiva (valor medio EVA 7,7). Conclusiones: El citrato de fentanilo es una terapia fácil de usar y eficaz para el tratamiento de las crisis de dolor irruptivo oncológico, con amplia aceptación tanto por parte de pacientes y cuidadores como de los profesionales sanitarios.(AU)

Objective: To assess the degree of satisfaction of patients and/or caregivers with transmucosal fentanyl citrate treatment in the management of breakthrough cancer pain crises in terms of ease of use. Methods: An observational, prospective and multicenter study was carried out with 48 patients undergoing maintenance treatment with opioids for baseline chronic cancer pain and who, in addition, suffered breakthrough pain crises for those who were receiving treatment with fentanyl citrate. The main variable of the study was the degree of satisfaction of the patients and/or their caregivers with fentanyl citrate in the management of breakthrough cancer pain crises, evaluatedby means of Visual Analogue Scale (VAS) questionnaires. Results: 90.6 % of patients/caregivers show a high degree of satisfaction with the use of fentanyl citrate in terms of ease of use (mean VAS value of 8.2). For its part, both the general assessment by the patients/caregivers and by the healthcare professionals has been very positive (mean VAS value 7.7). Conclusions: Fentanyl citrate is an easy-to-use and effective therapy for the treatment of breakthrough cancer pain crises, widely accepted by both patients and caregivers as well as health professionals.(AU)

Persistence of N-oxides transformation products of tertiary amine drugs at lab and field studies.

This work aimed at studying the formation and persistence of N-oxides transformation products (TPs) of tertiary amine drugs by combining laboratory and field studies relevant for surface water. A monitoring study using passive samplers was first achieved for assessing attenuation of selected pharmaceuticals and their related N-oxides and N-, O-dealkylated TPs (i.e., venlafaxine, tramadol, amisulpride and sulpiride) along a 1.7 km river stretch between two sampling sites. This study revealed the stability of tramadol-N-oxide, amisulpride-N-oxide and the fast dissipation of O-desmethylvenlafaxine-N-oxide, as well as the significance of N-oxidized TPs in comparison to N-dealkylated TPs and parent compounds in river. Lab-scale experiments were then implemented for a better understanding of their mechanisms of formation and degradation under aerobic water/sediment testing and under simulated solar photochemistry. N-oxidation reactions were always a minor transformation pathway under both degradation conditions with respect to N-and O-dealkylation reactions. The amount of generated N-oxides were similar for venlafaxine, tramadol and sulpiride and peaked in the 8.4-12.8% and <4% of their initial concentration (100 µg/L), during photodegradation and biodegradation experiments, respectively. Other transformation pathways such as hydroxylation and α-C-hydroxylation followed by oxidation to amide or dehydration were also identified. Investigated N-oxides TPs (except O-desmethylvenlafaxine-N-oxide) were found stable under solar photolysis and aerobic biodegradation with a very slight reverse reaction to parent compound observed for tramadol-N-oxide and amisulpride-N-oxide. Lab-scale degradation experiments were not able to anticipate the high occurrence levels of N-oxide compounds in the environment. This was most likely due to faster degradation kinetics and/or higher sorption to sediment of parent compounds and dealkylated TPs over N-oxide TPs, resulting in higher relative accumulation of the latter.

Measurement of Low-Energy Resonance Strengths in the

The ^{18}O(α,γ)^{22}Ne reaction is an essential part of a reaction chain that produces the ^{22}Ne(α,n)^{25}Mg neutron source for both the weak and main components of the slow neutron-capture process. At temperatures of stellar helium burning, the astrophysically relevant resonances in the ^{18}O(α,γ)^{22}Ne reaction that dominate the reaction rate occur at α particle energies E_{lab} of 472 and 569 keV. However, previous experiments have shown the strengths of these two resonances to be very weak, and only upper limits or partial resonance strengths could be obtained. This Letter reports the first direct measurement of the total resonance strength for the 472- and 569-keV resonances, 0.26±0.05 and 0.63±0.30 µeV, respectively. New resonance strengths for the resonances at α particle energies of 662.1, 749.9, and 767.6 keV are also provided. These results were achieved in an experiment optimized for background suppression and detection efficiency. The experiment was performed at the Sanford Underground Research Facility, in the 4850-foot underground cavity dedicated to the Compact Accelerator System for Performing Astrophysical Research. The experimental end station used the γ-summing High EffiCiency TOtal absorption spectrometeR. Compared to previous works, the results decrease the stellar reaction rate by as much as ≈46_{-11}^{+6}% in the relevant temperature range of stellar helium burning.

Clinical course of neonatal acute kidney injury: multi-center prospective cohort study.

BACKGROUND: Neonatal acute kidney injury (AKI) has been associated with unfavorable outcomes, including increased mortality. We aimed to describe the clinical course and outcomes during the first 7 days after diagnosis in newborns with AKI in three neonatal intensive care units in Popayán-Colombia. METHODS: Multi-center prospective cohort study conducted between June 2019 and December 2020 in three NICUs after ethical approval. We included newborns between 2 and 28 days of life, first diagnosed with AKI using the KDIGO classification modified for newborns which consider increased serum creatinine values over baseline values as well as urine output over time in hours or both. Patients with chromosomal abnormalities, major kidney malformations, and complex congenital heart disease were excluded. Patients were followed for up to 7 days after diagnosis and the maximum KDIGO stage, recovery of kidney function, need for renal replacement therapy and cumulative incidence of death were evaluated. RESULTS: Over the 18 months of the study, 4132 newborns were admitted to the NICUs, and 93 patients (2.25, 95% CI 1.82-2.75%) developed neonatal AKI. 59.1% of the newborns were premature and there were no differences in severity according to gestational age. During follow-up, the maximum KDIGO was 64.5% for AKI-stage 1, 11.8% for AKI-stage 2, and 23.7% for AKI-stage 3. Kidney function recovery was higher in AKI-stage 1 patients vs. AKI-severe (AKI-stage 2 and 3) (95% vs. 48.5%). Five patients (5.4%) received renal replacement therapy and 15 died (16.1%), four in AKI-stage 1 vs. 11 in AKI-severe (6.7% vs 33.3%). CONCLUSIONS: Newborns admitted to the NICUs can develop AKI regardless of gestational age, and it is more frequent between the second and ninth days of life. More patients whit AKI-stage 1 recover and die less than those in a severe stage.

Rnd3 is necessary for the correct oligodendrocyte differentiation and myelination in the central nervous system.

Rho small GTPases are proteins with key roles in the development of the central nervous system. Rnd proteins are a subfamily of Rho GTPases, characterized by their constitutive activity. Rnd3/RhoE is a member of this subfamily ubiquitously expressed in the CNS, whose specific functions during brain development are still not well defined. Since other Rho proteins have been linked to the myelination process, we study here the expression and function of Rnd3 in oligodendrocyte development. We have found that Rnd3 is expressed in a subset of oligodendrocyte precursor cells and of mature oligodendrocytes both in vivo and in vitro. We have analyzed the role of Rnd3 in myelination using mice lacking Rnd3 expression (Rnd3gt/gt mice), showing that these mice exhibit hypomyelination in the brain and a reduction in the number of mature and total oligodendrocytes in the corpus callosum and striatum. The mutants display a decreased expression of several myelin proteins and a reduction in the number of myelinated axons. In addition, myelinated axons exhibit thinner myelin sheaths. In vitro experiments using Rnd3gt/gt mutant mice showed that the differentiation of the precursor cells is altered in the absence of Rnd3 expression, suggesting that Rnd3 is directly required for the differentiation of oligodendrocytes and, in consequence, for the correct myelination of the CNS. This work shows Rnd3 as a new protein involved in oligodendrocyte maturation, opening new avenues to further study the function of Rnd3 in the development of the central nervous system and its possible involvement in demyelinating diseases.

Corpus callosum size by neurosonography in fetuses with congenital heart defect and relationship with expected pattern of brain oxygen supply.

OBJECTIVE: To evaluate corpus callosum (CC) size by neurosonography (NSG) in fetuses with an isolated major congenital heart defect (CHD) and explore the association of CC size with the expected pattern of in-utero oxygen supply to the brain. METHODS: A total of 56 fetuses with postnatally confirmed isolated major CHD and 56 gestational-age-matched controls were included. Fetuses with CHD were stratified into two categories according to the main expected pattern of cerebral arterial oxygen supply: Class A, moderately to severely reduced oxygen supply (left outflow tract obstruction and transposition of the great arteries) and Class B, near normal or mildly impaired oxygenated blood supply to the brain (other CHD). Transvaginal NSG was performed at 32-36 weeks in all fetuses to evaluate CC length, CC total area and areas of CC subdivisions in the midsagittal plane. RESULTS: CHD fetuses had a significantly smaller CC area as compared to controls (7.91 ± 1.30 vs 9.01 ± 1.44 mm2 ; P < 0.001), which was more pronounced in the most posterior part of the CC. There was a significant linear trend for reduced CC total area across the three clinical groups, with CHD Class-A cases showing more prominent changes (controls, 9.01 ± 1.44 vs CHD Class B, 8.18 ± 1.21 vs CHD Class A, 7.53 ± 1.33 mm2 ; P < 0.05). CONCLUSIONS: Fetuses with major CHD had a smaller CC compared with controls, and the difference was more marked in the CHD subgroup with expected poorer brain oxygenation. Sonographic CC size could be a clinically feasible marker of abnormal white matter development in CHD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Chiari network diagnosis intraoperative based on echocardiography.

We report a case of a Chiari network as a possible cause of intraoperative supraventricular tachycardia with potential cardiac flow obstruction and hemodynamic collapse. The intraoperative diagnostic analysis considered detects cardiac abnormalities associated to this congenital remnant and discard common intraoperative causes of hemodynamic alterations.

Combination of white matter hyperintensities and Aß burden is related to cognitive composites domain scores in subjective cognitive decline: the FACEHBI cohort.

BACKGROUND: To explore whether the combination of white matter hyperintensities (WMHs) and amyloid-beta (Aß) deposition is associated with worse cognitive performance on cognitive composites (CCs) domain scores in individuals with subjective cognitive decline (SCD). METHODS: Two hundred participants from the FACEHBI cohort underwent structural magnetic resonance imaging (MRI), 18F-florbetaben positron emission tomography (FBB-PET), and neuropsychological assessment. WMHs were addressed through the Fazekas scale, the Age-Related White Matter Changes (ARWMC) scale, and the FreeSurfer pipeline. Eight CCs domain scores were created using the principal component analysis (PCA). Age, sex, education, and apolipoprotein E (APOE) were used as adjusting variables. RESULTS: Adjusted multiple linear regression models showed that FreeSurfer (B - .245; 95% CI - .1.676, - .393, p = .016) and ß burden (SUVR) (B - .180; 95% CI - 2.140, - .292; p = .070) were associated with face-name associative memory CCs domain score, although the latest one was not statistically significant after correction for multiple testing (p = .070). There was non-significant interaction of these two factors on this same CCs domain score (p = .54). However, its cumulative effects on face-name associative performance indicated that those individuals with either higher WMH load or higher Aß burden showed the worst performance on the face-name associative memory CCs domain score. CONCLUSIONS: Our results suggest that increased WMH load and increased Aß are independently associated with poorer episodic memory performance in SCD individuals, indicating a cumulative effect of the combination of these two pathological conditions in promoting lower cognitive performance, an aspect that could help in terms of treatment and prevention.

Timing of adjuvant chemotherapy after laparotomy for Wilms tumor and neuroblastoma.

PURPOSE: To describe the timing of chemotherapy initiation after surgery for Wilms tumor (WT) and neuroblastoma within a dedicated children's cancer center. METHODS: A single-institution retrospective cohort study identified patients that underwent resection of unilateral WT or high-risk neuroblastoma and received adjuvant chemotherapy treatment. Adjuvant chemotherapy initiation and postoperative complications were recorded. RESULTS: Among 47 WT patients, the median time to chemotherapy initiation was 11 days [interquartile range IQR 7-14]. 3 WT patients had post-operative complications, but all preceded chemotherapy. Among 83 patients treated for high-risk neuroblastoma, the median time to chemotherapy was 11 days [IQR 9-14]. High-risk neuroblastoma patients with 30-day postoperative complications had a significantly longer time to initiation of adjuvant chemotherapy (odds ratio 1.13; p = 0.008). Many of these complications preceded and delayed the initiation of post-operative chemotherapy. No complications occurred in the group of 12 (25%) WT patients or 16 (19.3%) neuroblastoma patients who started chemotherapy ≤ 7 days after surgery. CONCLUSION: There is no association between early initiation of adjuvant chemotherapy and post-operative complications including wound healing. Early initiation of chemotherapy (≤ 7 days) is feasible in unilateral WT or high-risk neuroblastoma patients who are otherwise doing well without resulting in a preponderance of wound healing complications.

Diagnostic, treatment, and follow-up of osteoporosis-position statement of the Latin American Federation of Endocrinology.

The Latin American Federation of Endocrinology position statement on osteoporosis was developed by endocrinologists from 9 countries. It encompasses the definition, diagnosis, treatment, and follow-up of the disease, the identification of barriers to healthcare, and proposals to improve the disease care in the region. INTRODUCTION: There is a gap in the understanding of osteoporosis in Latin America. The objective of this work is to state the position of the Latin American Federation of Endocrinology on osteoporosis care in postmenopausal women to better bridge this gap. METHODS: An experts' panel was formed comprising of 11 endocrinologists from 9 countries. A data search was conducted with a conceptual approach and data selection was based on the hierarchy of the EBHC pyramid. Unpublished data was considered for local epidemiological data and expert opinion for the identification of barriers to healthcare. An expert consensus based on the Delphi methodology was carried out. Experts were asked to respond on a 5-point Likert Scale to two provided answers to guiding questions. RESULTS: Consensus was agreed on the answer for the questions with the higher median on the Likert scale and synthetized on 16 statements covering the definition of osteoporosis, diagnostic approach, treatment options, and follow-up. Besides clinical topics, unmet needs in osteoporosis were identified in relation to local epidemiological data, barriers to treatment, and misclassification of programs within health systems. CONCLUSIONS: Through a process based on recognized methodological tools, FELAEN's position on osteoporosis was developed. This made it possible to state an optimum scenario for the care of the disease and helped to identify knowledge gaps. There is great variability in the approach to osteoporosis in Latin America and barriers in all the stages of healthcare persist.

Intrapulmonary artery Doppler to predict mortality and morbidity in fetuses with mild or moderate left-sided congenital diaphragmatic hernia.

OBJECTIVES: In fetuses with isolated left-sided congenital diaphragmatic hernia (LCDH), prenatal detection of severe pulmonary hypoplasia is important, as fetal therapy can improve survival. Cases with mild or moderate lung hypoplasia still carry a considerable risk of mortality and morbidity, but there has been less interest in the accurate prediction of outcome in these cases. In this study of fetuses with mild or moderate isolated LCDH, we aimed to investigate: (1) the association between intrapulmonary artery (IPA) Doppler findings and mortality at discharge; (2) whether adding IPA Doppler findings improves the prediction of mortality based on lung size and liver herniation; and (3) the association between IPA Doppler findings and early neonatal morbidity. METHODS: This was a retrospective study of all consecutive fetuses assessed at the BCNatal and UZ Leuven hospitals between 2008 and 2020 with a prenatal diagnosis of isolated, non-severe LCDH, defined as observed-to-expected lung-to-head ratio (o/e-LHR) > 25%, that were managed expectantly during pregnancy followed by standardized neonatal management. An additional inclusion criterion was the availability of IPA Doppler measurements. The primary outcome was the association between IPA Doppler findings and mortality at discharge. Other predictors included o/e-LHR, liver herniation and gestational age at birth. Secondary outcomes were the association between IPA Doppler findings and the presence of pulmonary hypertension (PHT), need for supplemental oxygen at discharge and need for extracorporeal membrane oxygenation. IPA pulsatility index (PI) values were converted into Z-scores. Logistic regression analysis was performed to investigate the associations between predictor variables and outcome, and the best model was chosen based on the Nagelkerke R2 . RESULTS: Observations for 70 non-severe LCDH cases were available. Fifty-four (77%) fetuses survived until discharge. On logistic regression analysis, higher IPA-PI was associated with an increased risk of mortality (odds ratio (OR), 3.96 (95% CI, 1.62-9.70)), independently of o/e-LHR (OR, 0.87 (95% CI, 0.79-0.97)). An IPA-PI Z-score cut-off of 1.8 predicted mortality with a detection rate of 69% and specificity of 93%. Adding IPA-PI to o/e-LHR improved significantly the model's performance (Nagelkerke R2 , 46% for o/e-LHR + IPA-PI vs 28% for o/e-LHR (P < 0.002)), with a detection rate of 81% at a 10% false-positive rate. IPA-PI was associated with PHT (OR, 2.20 (95% CI, 1.01-4.59)) and need for oxygen supplementation at discharge (OR, 1.90 (95% CI, 1.10-3.40)), independently of lung size. CONCLUSIONS: In fetuses with mild or moderate LCDH, IPA-PI was associated with mortality and morbidity, independently of lung size. A model combining o/e-LHR with IPA-PI identified up to four in five cases that eventually died, despite being considered to have non-severe pulmonary hypoplasia. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Utilidad de la quimioterapia neoadyuvante en el carcinoma vesical músculo invasivo no metastásico / Usefulness of neoadjuvant chemotherapy in non-metastatic muscle-invasive bladder cancer

Objetivo: Analizamos el perfil de pacientes candidatos a quimioterapia neoadyuvante (QTn) en estadio pT2-4aN0M0, la tolerabilidad y adherencia de nuestro protocolo basado en cisplatino y los resultados oncológicos.Material y métodosEstudio observacional de cohortes retrospectivo que incluye a pacientes con diagnóstico de carcinoma vesical músculo infiltrante tratados con QTn. Se analizaron las características clínicas, histopatológicas, terapéuticas y evolutivas de los pacientes. El uso de la QTn se evaluó mediante la respuesta completa en la pieza quirúrgica (pT0). Este y otros factores anatomopatológicos se relacionaron con la supervivencia global y el tiempo libre de progresión.ResultadosIncluimos a 90 pacientes con carcinoma vesical músculo invasivo (estadio clínico T2a-T4aN0M0) que recibieron algún esquema de QTn basado en cisplatino, entre enero de 2011 y diciembre de 2018, antes del tratamiento quirúrgico radical. El 40% de los pacientes presentaron alguna reacción adversa al tratamiento, con un cumplimiento del protocolo de QTn del 92,2%. No se presentaron muertes relacionadas con el tratamiento sistémico y ninguna reacción adversa al tratamiento imposibilitó la realización de la cistectomía radical. Tras la cistectomía radical, se objetivó la presencia de respuesta completa (pT0) en 20 pacientes (21%), un estadio inferior en pieza quirúrgica ( p = 0,012), en enfermos con afectación ganglionar respecto a pN0 (65,4 vs. 28,2 meses; p=0,014) y en aquellos con bordes quirúrgicos afectos respecto a los que presentaban márgenes libres de tumor (63,5 vs. 8,5 meses; p=0,021).ConclusiónLa selección adecuada de los pacientes con carcinoma vesical músculo infiltrante ha mostrado una buena tolerancia a la QTn, con una alta tasa de cumplimiento previo a la CR. La mejoría en la tasa de respuesta completa implica una mayor supervivencia en este grupo de pacientes. La afectación ganglionar y los bordes quirúrgicos positivos son factores pronósticos importantes. (AU)

Objective: We analyzed the profile of patients who were candidates for neoadjuvant chemotherapy (NACT) in stage pT2-4aN0M0, the tolerability and adherence of our cisplatin-based protocol and oncological outcomes.Material and methodsRetrospective observational cohort study including patients diagnosed with muscle-invasive bladder carcinoma treated with NACT. Clinical, histopathological, therapeutic and evolutionary characteristics of the patients were analyzed. The use of NACT was evaluated by the complete response in the surgical specimen (pT0). This and other pathological factors were related to overall survival and progression-free survival.ResultsWe included 90 patients with muscle-invasive bladder carcinoma (clinical stage T2a-T4aN0M0) who received a cisplatin-based NACT regimen between January 2011 and December 2018, prior to radical surgery. Forty percent of patients presented an adverse reaction, with a compliance with the NACT regimen of 92.2%. There were no deaths related to systemic treatment and no adverse reaction to treatment made radical cystectomy impracticable. After performing radical cystectomy, the presence of complete response (pT0) was observed in 20 patients (21%), lower stage in the surgical specimen ( P=0.012), in patients with lymph node involvement compared to pN0 (65.4 vs. 28, 2 months, P=0.014) and in those with positive surgical margins compared to those with tumor-free margins (63.5 vs. 8.5 months, P=0.021).ConclusionThe adequate selection of patients with muscle-invasive bladder carcinoma has shown a good tolerance to NACT, with a high compliance rate prior to RC. The improvement in the complete response rate implies a greater survival in this group of patients, with lymph node involvement and positive surgical margins being important prognostic factors. (AU)

Chiari network diagnosis intraoperative based on echocardiography. / Diagnóstico intraoperatorio de red de Chiari basado en ecocardiografía.

We report a case of a Chiari network as a possible cause of intraoperative supraventricular tachycardia with potential cardiac flow obstruction and hemodynamic collapse. The intraoperative diagnostic analysis considered detects cardiac abnormalities associated to this congenital remnant and discard common intraoperative causes of hemodynamic alterations.

Usefulness of neoadjuvant chemotherapy in non-metastatic muscle-invasive bladder cancer. / Utilidad de la quimioterapia neoadyuvante en el carcinoma vesical músculo invasivo no metastásico.

OBJECTIVE: We analyzed the profile of patients who were candidates for neoadjuvant chemotherapy (NACT) in stage pT2-4aN0M0, the tolerability and adherence of our cisplatin-based protocol and oncological outcomes. MATERIAL AND METHODS: Retrospective observational cohort study including patients diagnosed with muscle-invasive bladder carcinoma treated with NACT. Clinical, histopathological, therapeutic and evolutionary characteristics of the patients were analyzed. The use of NACT was evaluated by the complete response in the surgical specimen (pT0). This and other pathological factors were related to overall survival and progression-free survival. RESULTS: We included 90 patients with muscle-invasive bladder carcinoma (clinical stage T2a-T4aN0M0) who received a cisplatin-based NACT regimen between January 2011 and December 2018, prior to radical surgery. Forty percent of patients presented an adverse reaction, with a compliance with the NACT regimen of 92.2%. There were no deaths related to systemic treatment and no adverse reaction to treatment made radical cystectomy impracticable. After performing radical cystectomy, the presence of complete response (pT0) was observed in 20 patients (21%), lower stage in the surgical specimen (