A lifestyle adjustments program in long COVID-19 improves symptomatic severity and quality of life. A randomized control trial.

OBJECTIVE: To evaluate the efficacy of a therapeutic intervention based on self-adjustment strategies for improving of symptomatic severity and quality of life. METHODS: The study was a randomised single-blind clinical trial. Quality of life, disability, and functional impairment were collected. The control group received a leaflet with information on the main symptoms of Long-COVID-19 syndrome, in addition to standard medical treatment. The intervention group received treatment following a dual approach; on the one hand, monitoring and recognition of symptomatology and on the other hand, adaptation and functional improvement. RESULTS: A total of 54 participants were included, 27 were included in the intervention group and 27 in the control group. At the beginning of the study, no significant differences were found between groups. After intervention, the quality of life variable showed significant differences between groups in the self-care and anxiety/depression dimensions. Significant between-groups differences were also found for the self-care subscale of the disability variable. The intervention group showed significant differences from baseline on some subscales of the quality of life, disability, and functional impairment variables. CONCLUSION: Strategies based on lifestyle adjustments are adequate for the improvement of quality of life and symptom severity in the long COVID-19 population. PRACTICE IMPLICATION: The findings suggest that applying an intervention focused in self-adjustment for long COVID patients can have positive effects.

Spatial distribution and source identification of phthalates and organochlorine compounds in Galician mussels (NW Spain).

The spatial distribution of five phthalate esters (PAEs) and 17 organochlorine compounds (OCs) in wild and raft mussels from Galician littoral collected in 2020, and its relationship with anthropogenic activities was studied in this work. The Rías de Foz and Muros-Noia were the most polluted by PAEs, while the Rías de Ferrol and Barqueiro by PCBs. The highest levels of all contaminants were present in wild mussel, except DEHP that were predominant in raft mussel. The levels of most PAEs were negatively correlated with levels of the lower chlorinated PCBs and OCPs. The spatial distribution of pollutants confirmed by PCA was affected by the proximity to anthropogenic sources, phthalates by urban wastewater and PCBs by industrial inputs, mainly. The study of human exposure assessment suggests that Risk Quotient values were < 1, so the consumption of Galician raft mussels did not pose a risk to human health.

Der p 23 sensitisation in patients with house dust mite respiratory allergy.

Summary: Background. The sensitization profile of patients allergic to house dust mites (HDM) and its molecular diagnosis may determine treatment and evolution of the disease. The present study investigates the prevalence of Der p 23 sensitization and its relation to asthma in a population of HDM-allergic patients. Methods. We conducted a cross-sectional study of 891 patients with HDM allergy with symptoms of rhinitis and 52.1% of them with asthma. Total and specific IgE (sIgE) was measured against Dermatophagoides pteronyssinus and its molecular components (Der p 1, Der p 2 and Der p 23) and the storage mite Lepidoglyphus destructor using ImmunoCAP. Prevalence of sensitization and levels of sIgE were analysed according to asthma diagnosis and asthma severity. Results. Der p 23 was the predominant allergen in this population (83.7%) but IgE levels were lower than those of sIgE to Der p 1 and Der p 2. A good correlation was found between sIgE to Der p 23 and the other allergens. A total of 8.2% patients were monosensitized to Der p 23. Asthma was more frequent in patients with positive sIgE against Der p 23 than in patients without this sensitization (52.8% vs 42.8%, p = 0.027). A tendency to increase both total IgE and sIgE was observed in relation to the severity of asthma from intermittent mild asthma to persistent moderate asthma but a substantial decrease in total IgE and sIgE was detected in more severe asthmatics. Conclusions. Der p 23 might be a prevalent allergen in regions with high rates of HDM exposure. Even though sIgE levels against this allergen are usually low, its presence could increase the risk of asthma.

Walking-and Running and Jumping-with Dinosaurs and Their Cousins, Viewed Through the Lens of Evolutionary Biomechanics.

Archosauria diversified throughout the Triassic Period before experiencing two mass extinctions near its end ∼201 Mya, leaving only the crocodile-lineage (Crocodylomorpha) and bird-lineage (Dinosauria) as survivors; along with the pterosaurian flying reptiles. About 50 years ago, the "locomotor superiority hypothesis" (LSH) proposed that dinosaurs ultimately dominated by the Early Jurassic Period because their locomotion was superior to other archosaurs'. This idea has been debated continuously since, with taxonomic and morphological analyses suggesting dinosaurs were "lucky" rather than surviving due to being biologically superior. However, the LSH has never been tested biomechanically. Here we present integration of experimental data from locomotion in extant archosaurs with inverse and predictive simulations of the same behaviours using musculoskeletal models, showing that we can reliably predict how extant archosaurs walk, run and jump. These simulations have been guiding predictive simulations of extinct archosaurs to estimate how they moved, and we show our progress in that endeavour. The musculoskeletal models used in these simulations can also be used for simpler analyses of form and function such as muscle moment arms, which inform us about more basic biomechanical similarities and differences between archosaurs. Placing all these data into an evolutionary and biomechanical context, we take a fresh look at the LSH as part of a critical review of competing hypotheses for why dinosaurs (and a few other archosaur clades) survived the Late Triassic extinctions. Early dinosaurs had some quantifiable differences in locomotor function and performance vs. some other archosaurs, but other derived dinosaurian features (e.g., metabolic or growth rates, ventilatory abilities) are not necessarily mutually exclusive from the LSH; or maybe even an opportunistic replacement hypothesis; in explaining dinosaurs' success.

A new cynodont from the Upper Triassic Los Colorados Formation (Argentina, South America) reveals a novel paleobiogeographic context for mammalian ancestors.

Probainognathia is a derived lineage of cynodonts which encompass Mammalia as their crown-group. The rich record of probainognathians from the Carnian of Argentina contrasts with their Norian representation, with only one named species. Here we describe a new probainognathian, Tessellatia bonapartei gen. et sp. nov., from the Norian Los Colorados Formation of the Ischigualasto-Villa Unión Basin of Argentina. The new taxon, represented by a partial cranium with associated lower jaws, was analyzed through neutron and X-rays micro-tomography (µCT). The high-resolution neutron µCT data allowed the identification of a unique character combination, including features inaccessible through traditional techniques. We constructed the largest phylogenetic data matrix of non-mammalian cynodonts. The new species and its sister taxon, the Brazilian Therioherpeton cargnini, are recovered as probainognathians, closely related to Mammaliamorpha. We conducted the first quantitative paleobiogeographic analysis of non-mammalian cynodonts, focusing in probainognathians. The results indicate that Probainognathia and Mammaliamorpha originated in southwestern Gondwana (in the Brazilian Paraná Basin), which was an important center of diversification during the Triassic. Finally, the Chinese Lufeng Basin is identified as the ancestral area of Mammaliaformes. These new findings, besides adding to the knowledge of the poorly represented Norian cynodonts from the Los Colorados Formation, are significant to improve our understanding of probainognathian diversity, evolution, and paleobiogeographic history.

Biofilms en instalaciones alimentarias militares. Comparación de técnicas rápidas de vigilancia y verificación / Biofilms in military food facilities. Comparison of rapid surveillance and verification techniques

Introducción:Los patógenos formadores de biofilms incrementan el riesgo de contaminación biológica de los alimentos en las industrias alimentarias, por lo que es necesario cuantificar y cualificar los peligros presentes en los mismos.Objetivo:Se pretende demostrar la presencia de biofilms bacterianos en las superficies de trabajo de instalaciones alimentarias militares (IAM) mediante distintas técnicas rápidas de control higiénico.Material y métodos:Se analizaron un total de 550 muestras entre las 10 IAM: Cada IAM contó con 5 puntos de muestreo (n = 50) y en cada uno de ellos se obtuvieron 11 muestras sobre una superficie de 100 cm2, para poner de manifiesto la presencia de biofilms y establecer la correlación entre las siguientes técnicas analíticas: determinación de adenosín trifosfato (ATP) mediante luminómetro 3M Clean-Trace™ NG3, valoración de residuos proteicos con hisopos Clean-Trace™ Surface Protein Plus, recuentos de microorganismos aerobios mesófilos (AC) mediante sistema TEMPO® y Petrifilm™, y visualización de biofilms mediante reacción enzimática con Biofinder®.Resultados:Se encontró correlación estadísticamente significativa (p < 0,05) entre las determinaciones de ATP y la presencia de biofilms y de residuos proteicos. También se halló linealidad con significación estadística (R2 0,422, p < 0,05) entre el ATP y el recuento de AC por TEMPO®. Se observó correlación y concordancia entre los recuentos de AC mediante el sistema TEMPO® y a través de Petrifilm™ (coeficiente de correlación intraclase 0,463, IC 95%: 0,179-0,673, p < 0,05). En ningún punto de muestreo (PM) se detectaron bacterias patógenas.Conclusión:Se detectaron biofilms en una tercera parte de los PM inspeccionados. Su monitorización combinando técnicas rápidas debe tenerse en consideración en los procedimientos de vigilancia del sistema de Análisis de Peligros y Puntos de Control Crítico (APPCC). (AU)

Introduction:Biofilm-forming pathogens increase the risk of biological food contamination in food industries, thus it is necessary to quantify and qualify the dangers present in them.Objective:To demonstrate the presence of bacterial biofilms on the work surfaces of military food facilities using different rapid hygienic control techniques.Materials and methods:An amount of 550 samples were analyzed among 10 military food facilities: Each one had 5 sampling points (n = 50) and in each of them 11 samples were obtainded on a surface of 100 cm2 to assess the presence of biofilms and to establish the correlation between different analytical techniques: determination of adenosin triphosphate (ATP) using 3M Clean-Trace ™ NG3 luminometer, protein residue titration with Clean-Trace ™ Surface Protein Plus swabs, mesophilic aerobic microorganism (AC) counts using TEMPO® and Petrifilm ™ system, and visualization of biofilms using enzymatic reaction with Biofinder®.Results:A statistically significant correlation (p <0.05) was found between ATP determinations and the presence of biofilms and protein residues. Linearity with statistical significance (R2 0.422, p <0.05) was also found between ATP and AC count by TEMPO®. Correlation and concordance between AC counts were observed using the TEMPO® system and through Petrifilm ™ (intraclass correlation coefficient 0.463, 95% CI: 0.179-0.673, p <0.05). At no sampling point (SP) were pathogenic bacteria detected.Conclusion:Combining quick techniques should be considered in surveillance procedures of Hazard Analysis and Critical Control Points (HACCP). (AU)

Experiencia de entrenadores deportivos y padres en el proceso de inclusión de niños y jóvenes con síndrome de Down en Puerto Rico / Experience of sports coaches and parents in the inclusion process of children and youth with Down syndrome in Puerto Rico

Introducción Los jóvenes con discapacidad suelen ser menos activos físicamente que los jóvenes sin discapacidad y existen barreras que limitan el nivel de actividad física en su diario vivir. El propósito de esta investigación cualitativa con diseño fenomenológico fue explorar y describir la experiencia de los padres y entrenadores de equipos deportivos en Puerto Rico, en el proceso de inclusión de niños y jóvenes con síndrome de Down. Método Los participantes fueron 3 entrenadores deportivos y 3 padres de niños y/o jóvenes con síndrome de Down, cuyos hijos fueran estudiantes de los entrenadores. Se llevaron a cabo entrevistas semiestructuradas en las que se encontró que la experiencia para los padres fue positiva en términos de los beneficios físicos y sociales que brinda el realizar actividad física junto con niños o jóvenes típicos. Resultados Pudieron ser identificados diferentes barreras y facilitadores para el proceso de inclusión y los entrenadores se consideran una herramienta clave en este proceso. Los fisioterapeutas fueron identificados como facilitadores de la inclusión, por su rol como promotores de salud, desarrollo y actividad física. Conclusiones Existe un espacio de oportunidad para la creación y promoción de más programas de deporte inclusivo, y se resaltó la importancia de que profesionales de la salud como los fisioterapeutas estén involucrados en la promoción de la inclusión y educación a los padres de niños o jóvenes con síndrome de Down sobre alternativas disponibles para que sus hijos estén físicamente activos (AU)

Introduction Children and young people with disabilities are usually less physically active than young people without disabilities with barriers that limit the levels of physical activity in their daily lives. The purpose of this qualitative research with phenomenological design was to explore and describe the experience of parents and coaches of sports teams in Puerto Rico, in the inclusion process of children and young people with Down syndrome. Method The participants were 3 sports coaches and 3 parents of children and/or young people with Down syndrome, whose children were students of the coaches. Semi-structured interviews were carried out in which it was found that the experience for the parents was positive in terms of the physical and social benefits provided by performing physical activity together with typical children or young people. Results Different barriers and facilitators were identified for the inclusion process and the sports coaches are considered a key tool in this process. Physiotherapists were identified as facilitators of inclusion, due to their role as promoters of health, development, and physical activity. Conclusions There is a window of opportunity for the creation and promotion of more inclusive sports programmes, and the importance is highlighted of health professionals such as physiotherapists being involved in promoting the inclusion and education of parents of children or young people with Down syndrome on available alternatives for their children to be physically active (AU)

Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic.

BACKGROUND: Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. METHODS: Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. RESULTS: Some 5307 patients were included in the study (183 COVID-19-positive and 2132 COVID-19-negative during pandemic; 2992 treated before pandemic). During the pandemic, patients with COVID-19 infection had greater 30-day mortality than those without (12.6 versus 4.6 per cent), but this difference was not statistically significant after propensity score matching (odds ratio (OR) 1.58, 95 per cent c.i. 0.88 to 2.74). Those positive for COVID-19 had more complications (41.5 versus 23.9 per cent; OR 1.61, 1.11 to 2.33) and a higher likelihood of failure to rescue (30.3 versus 19.3 per cent; OR 1.10, 0.57 to 2.12). Patients who were negative for COVID-19 during the pandemic had similar rates of 30-day mortality (4.6 versus 3.2 per cent; OR 1.35, 0.98 to 1.86) and complications (23.9 versus 25.2 per cent; OR 0.89, 0.77 to 1.02), but a greater likelihood of failure to rescue (19.3 versus 12.9 per cent; OR 1.56, 95 per cent 1.10 to 2.19) than prepandemic controls. CONCLUSION: Patients with COVID-19 infection undergoing emergency general and gastrointestinal surgery had worse postoperative outcomes than contemporary patients without COVID-19. COVID-19-negative patients operated on during the COVID-19 pandemic had a likelihood of greater failure-to-rescue than prepandemic controls.

Biogas production from slaughterhouse waste: Effect of blood content and fat saponification.

The effect of fat saponification and the inclusion or exclusion of blood in slaughterhouse mixtures were assessed in terms of anaerobic digestion performance. Mixtures of animal by-products (ABP) were collected for 1 year, whereby following the daily activity and waste generation at a slaughterhouse facility, seasonal fluctuations were found. The blood content of ABP mixtures was variable, affecting both the methane yield and the production rate (287.8-320.5 NLCH4 kgCOD-1 and 80.3-94.7 and NLCH4 kgCOD-1 d-1, respectively). The saponification of fatty ABP materials was studied to assess the methane production rate, singularly or combined, with and without the addition of blood. Data showed that saponification significantly reduced the lag phase, from 2.2 to 1.5 days in winter mixtures and from 1.5 to 0.9 days in summer mixtures (all with blood), and from 0.3 to 0.1 days in summer mixtures without blood. Finally, the percentage of energy demand at the slaughterhouse potentially covered by net biogas energy was estimated, finding that the facility could be 100% energy self-sufficient in winter, whereas this would be reduced to 85% in the summer due to different methane yields of ABP mixtures based on season.

[Hypothalamotomy in patients with treatment-resistant aggressiveness: functional outcomes]. / Hipotalamotomía en pacientes con agresividad refractaria: resultados funcionales.

INTRODUCTION: Aggressiveness is part of the behavioural manifestations associated with some mental disorders; it is a symptom that is difficult to manage and is often resistant to pharmacological measures. Surgery for behavioural disorders emerges as a therapeutic alternative. This procedure consists in performing interventions on different structures of the limbic system in order to correct the alteration of the circuit involved in producing the symptoms. AIM: To describe the clinical outcomes of a posterior hypothalamotomy with gamma knife to control aggressiveness in 20 patients resistant to treatment, who underwent surgery at the Imbanaco Medical Centre between 2013 and 2018. PATIENTS AND METHODS: The severity of the aggressiveness was quantified using the Overt Aggression Scale (OAS) and the Clinical Global Impression Scale (CGI-SI), and its functional impact is evaluated using the Global Assessment of Functioning scale (GAF). RESULTS: Control over aggressiveness was observed in all patients treated by posterior hypothalamotomy with gamma knife, evidenced by a decrease in the scores on the OAS and CGI-SI and an improvement in the GAF. CONCLUSIONS: Posterior hypothalamotomy gives rise to few complications, is a safe procedure and offers good results, suggesting that it could be a good alternative treatment in cases of treatment-resistant aggressiveness where it seems that all the possible pharmacological and therapeutic measures have failed.

TITLE: Hipotalamotomía en pacientes con agresividad refractaria: resultados funcionales.Introducción. La agresividad forma parte de las manifestaciones comportamentales asociadas a algunos trastornos mentales, es un síntoma de difícil manejo y, con frecuencia, es refractaria a las medidas farmacológicas. La cirugía de los trastornos del comportamiento surge como una alternativa terapéutica. Este procedimiento consiste en realizar intervenciones sobre distintas estructuras del sistema límbico, con el fin de corregir la alteración del circuito que estaría implicado en la producción de los síntomas. Objetivo. Describir los resultados clínicos de la hipotalamotomía posterior con gamma knife en el control de la agresividad en 20 pacientes refractarios al tratamiento, intervenidos en el Centro Médico Imbanaco entre 2013 y 2018. Pacientes y métodos. La gravedad de la agresividad se cuantificó mediante la escala de agresividad manifiesta (OAS) y la escala de impresión clínica global (CGI-SI), y su impacto funcional, a través de la escala de evaluación de la actividad global (EEAG). Resultados. El control de la agresividad se observó en todos los pacientes tratados con hipotalamotomía posterior con gamma knife, evidenciado por la disminución en las puntuaciones de la OAS y la CGI-SI y la mejoría en la EEAG. Conclusiones. La hipotalamotomía posterior muestra bajas complicaciones, seguridad en el procedimiento y buenos resultados, lo cual sugiere que podría ser una buena alternativa de tratamiento en los casos de agresividad refractaria donde las medidas farmacológicas y terapéuticas parecen agotarse.

Impacto del estrés por calor en terneros de tambo sobre parámetros fisiológicos y conductuales / Heat stress impact on physiological and behavioral parameters in dairy calves

Resumen Dentro de los factores de estrés a los que puede estar expuesto el ganado lechero el relativo al calor es uno de los más conocidos y estudiados en vacas lecheras por el impacto que tiene sobre la producción láctea. Sin embargo, este nivel de conocimiento no se repite en relación a los terneros en crianza, por tal motivo el objetivo del presente trabajo fue el de estudiar el impacto del estrés por calor en esta categoría. Se monitorearon 246 terneros pertenecientes a 19 tambos en días con ITH ≥ 72 para la franja horaria de 12 a 15. Se categorizaron los registros obtenidos en: estrés ligero, moderado o severo. Se registró la posibilidad o no de acceder a sombra, el disponer o no de agua para consumo, la posición y la actividad principal que desarrollaba, también se evaluó la temperatura rectal (TR) y la frecuencia respiratoria (FR). Los datos fueron analizados mediante ANOVA. La comparación entre medias se realizó con el test Tukey (α=0,05) y el análisis de correlación con el test de Spearman. Se utilizó el programa InfoStat versión 2019p. En lo que refiere a actividad, no se observaron diferencias estadísticamente significativas. Sin embargo, sí se detectaron diferencias (p=0,0138) en la posición de aquellos animales expuestos a condiciones de estrés moderado vs. severo. La TR promedio fue diferente (p=0,0063) entre los animales de la categoría estrés lijero respecto a las otras dos categorías (> 39,2 °C). El valor promedio relativo a la FR resultó superior (p<0,0001) en los terneros bajo estrés severo (>80 rpm). La correlación hallada para la variable ITH respecto de TR resultó de 0,25 (p=0,0001), mientras que para FR fue de 0.33 (p<0,0001). En relación a las prácticas implementadas se registró que el 26 % de los terneros no contaban con sombra ni agua al momento de la visita.

Abstract Heat stress impact on physiological and behavioral parameters in dairy calves. Among the stress factors to which dairy cattle is exposed heat is one of the most studied due to the impact it has on milk production. However, there is lack of information regarding this stress condition in calves compared to the one related to adult animals. The aim of this paper was to study the relevance of heat stress in dairy calves. For the experiment 246 dairy calves from 19 dairy farms were monitored in days with Temperature Humidity Index (ITH) above 72 between 12:00 pm and 03:00 pm. Heat stress related to ITH was categorized in three degrees: low, moderate and sever stress. Additional information was taken during the visit: shade access, water availability, body position, activity being developed, rectal temperature (TR) and respiratory rate (FR). Data were analyzed using ANOVA. Comparison between median values was analyzed with Tukey´s test (α=0,05) and correlation analysis with Spearman´s test. The software used to analyze statistical data was Infostat version 2019. Differences were found in the body position between animals exposed to sever stress versus those with moderate stress (p=0.0138). However, there were no differences in animal activity in any of the temperature exposures. Results on average rectal temperature (TR) showed differences (p=0.0063) between animals with low stress and those with severe and moderate stress (> 39.2 °C). Relative average of FR was higher (p<0.0001) on calves under sever heat stress, reaching above 80 breaths per minute. The correlation coefficient between ITH and TR was 0.25 (p=0.0001), and between ITH and TR was 0.33 (p<0.0001). Regarding the practices implemented on the farms was noted that 26% of calves did not have shade or water available at the moment data was taken.

3D printed soft surgical planning prototype for a biliary tract rhabdomyosarcoma.

Biliary tract rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor which is located in the biliary tract. Although this tumor represents less than 1% of the total amount of childhood cancers, when localized, a >70% overall 5-year survival rate, the resection is clinically challenging and complications might exist during the biliary obstruction. Although surgery remains a mainstay, complete tumor resection is generally difficult to achieve without mutilation and severe long-term sequelae. Therefore, manufacturing multi-material 3D surgical planning prototypes of the case provides a great opportunity for surgeons to learn beforehand what they can expect. Additionally, practicing before the operation enhances the probability of success. That is why different compositions of materials have been characterized to match the mechanical properties of the liver. To do this, Dynamic Mechanical Analysis (DMA) tests and Shore hardness tests have been carried out. Amongst the material samples produced, 6%wt PVA (poly vinyl alcohol)/1%wt PHY (Phytagel)-1FT (Freeze-Thaw cycles) and 1%wt agarose appear as the best options for mimicking the liver tissue in terms of viscoelasticity. Regarding the Shore hardness, the best solution is 1%wt agarose. Additionally, a surgical planning prototype using this last material mentioned was manufactured and validated using a CT (Computed Tomography) scanner. In most of the structures the difference between the 3D model and the organ in terms of dimensions is less than 3.35 mm, which represents a low dimensional error, around 1%. On the other hand, the total manufacturing cost of the 3D physical model was €513 which is relatively low in comparison with other technologies.

Influence of the technique and comorbidities in hypofractionated radiotherapy for prostate cancer.

PURPOSE: To analyze the differences in toxicity and biochemical relapse-free survival with hypofractionated radiotherapy with three-dimensional radiotherapy (3D-CRT) or volumetric arc therapy (VMAT) for prostate cancer taking into account comorbidity measured using the Charlson Comorbidity Index (CCI). METHODS: From January 2011 to June 2016, 451 patients with prostate cancer were treated with 60 Gy (20 daily fractions). VMAT or 3D-CRT was used. Distribution by stage: 17% low-risk, 27.2% intermediate-risk; 39.2% high-risk, 16.6% very high-risk. Mean CCI was 3.4. RESULTS: With a median follow up of 51 months, most patients did not experience any degree of acute GI toxicity (80.9%) compared to 19.1%, who experienced some degree, mainly G-I /II. In the multivariate analysis, only technique was associated with acute GI toxicity ≥ G2. Patients treated with VMAT had greater acute GI toxicity compared with those who received 3D-CRT (23.9% vs. 13.5%, p = 0.005). With respect to acute GU toxicity, 72.7% of patients experienced some degree, fundamentally G-I/II. Neither age, CCI, nor androgen deprivation therapy (ADT) were associated with greater toxicity. Overall survival at 2, 5 and 7 years was 97%, 88% and 83% respectively. The only factor with statistical significance was CCI, with a greater number of events in individuals with a CCI ≥ 4 (p < 0.03). CONCLUSIONS: Hypofractionated radiotherapy for prostate cancer is an effective, well-tolerated treatment even for elderly patients with no associated comorbidity. Longer follow up is needed in order to report data on late toxicity.

Efficacy and safety of a simplified SBRT regimen for central and peripheral lung tumours.

BACKGROUND: Evaluate the safety, toxicity and efficacy of an institutional-simplified SBRT protocol with two short SBRT regimens (three or five fractions) for the treatment of lung cancer and oligometastases, according to the volume and localization of tumours. METHODS: Patients with stage I (T1 or T2) non-small cell lung cancer or lung oligometastases were treated from August 2011 to October 2015. Patients were required to be considered medically inoperable and were discussed in a multidisciplinary team. RESULTS: 100 patients were analysed, 59 had a peripheral location (P), and 41 a central location (C).All patients finished their SBRT course without interruptions related to acute toxicity. The most frequent acute toxicity was grade 1 asthenia, only one patient developed grade 3 toxicity (pneumonitis) and there were no grade 4 or 5 acute toxicities. Three asymptomatic radiation-induced rib fractures were identified, the 1 and 2-year rib fracture-free survival were 97% and 94%, respectively. Two-year progression-free survival and 2-year overall survival of all patients were 52% and 70%, respectively, with a median PFS and OS of 26 and 43 months. Survival free of local progression (SFLP) at 2 years was 89%. A higher PFS in primary lung cancer compared with metastatic tumours was observed, with a median of 35 months with 19 months (p = 0.01). However, no statistical difference was observed in terms of OS between both diseases. CONCLUSIONS: SBRT in lung cancer with three sessions for peripheral tumours and five sessions for central tumours may be safely delivered, with low morbidity.

3D Printing in Medicine for Preoperative Surgical Planning: A Review.

The aim of this paper is to review the recent evolution of additive manufacturing (AM) within the medical field of preoperative surgical planning. The discussion begins with an overview of the different techniques, pointing out their advantages and disadvantages as well as an in-depth comparison of different characteristics of the printed parts. Then, the state-of-the-art with respect to preoperative surgical planning is presented. On the one hand, different surgical planning prototypes manufactured by several AM technologies are described. On the other hand, materials used for mimicking different living tissues are explored by focusing on the material properties: elastic modulus, hardness, etc. As a result, doctors can practice before performing surgery and thereby reduce the time needed for the operation. The subject of patient education is also introduced. A thorough review of the process that is required to obtain 3D printed surgical planning prototypes, which is based on different stages, is then carried out. Finally, the ethical issues associated with 3D printing in medicine are discussed, along with its future perspectives. Overall, this is important for improving the outcome of the surgery, since doctors will be able to visualize the affected organs and even to practice surgery before performing it.

Metal Compounds in the Development of Antiparasitic Agents: Rational Design from Basic Chemistry to the Clinic.

Metal compounds seem to be a promising approach in the search of new therapeutic solutions for neglected tropical diseases. In this chapter, efforts in the design of prospective metal-based drugs for the treatment of Chagas disease, human African trypanosomiasis, and leishmaniasis are discussed. Careful selection of the metal center (including organometallic cores) and the types and number of coordinated ligands is essential for controlling the reactivity of the complexes and hence, tuning their biological properties. In a target-based approach, some targets that have been validated for organic antiparasitic compounds are expected to remain targets for metal complexes of these compounds. In addition, specific targets for metal compounds, like parasitic enzymes or DNA, would also be included for these metal complexes leading to potential additive or even synergistic effects between organic ligand and metal ion. However, even though a good number of prospective antiparasitic metal-based drugs have been developed, further systematic efforts are needed for these metal compounds to accomplish the regulatory guidelines that let them reach the different stages of clinical trials.

How Do Hepatologists Gain Access to Liver Transplant Units?

Liver transplantation has evolved from an experimental treatment to be considered as the most effective therapy for end-stage liver disease and selected cases of hepatocellular carcinoma. Transplant hepatologists must have specific knowledge and abilities to treat those patients who receive a liver transplant. In Spain, approximately 1100 liver transplants are performed each year, and most centers assume both postoperative care and long-term follow-up, which has led to a significant work load in liver transplant units. Despite previous attempts to establish an official training program in hepatology, the Spanish health system does not presently have a specific liver transplant training program to guarantee that future needs of physicians are covered. Collaboration between health authorities and scientific societies is required to guarantee adequate assistance to liver transplant recipients in the future.

Transanal total mesorectal excision for rectal cancer with indocyanine green fluorescence angiography.

BACKGROUND: The aim of this study was to evaluate the impact of fluorescence angiography (FA) on any change in proximal resection margin and/or anastomotic leak (AL) following transanal total mesorectal excision (TaTME) for rectal cancer (RC). METHODS: This retrospective cohort study was conducted at two centers by three senior surgeons. Both institutions' prospectively maintained Institutional Review Board-approved databases were retrospectively queried for all consecutive patients between July 2015 and May 2017 who had laparoscopic hybrid trans-abdominal total mesorectal excision (TME) and TaTME for RC with colorectal or coloanal anastomosis < 10 cm from the anal verge. All patients had intraoperative FA to assess colonic perfusion of the planned proximal resection margin before bowel transection and after construction of the anastomosis. Primary outcomes measured any changes in proximal resection margins and AL rates. RESULTS: Fifty-four patients (31 males; mean age 63 ± 12 years) were included; 30 (55%) of whom received neoadjuvant chemoradiation. The average anastomotic height was 3.6 cm from the anal verge and 8 (14.5%) patients required intersphincteric dissection. Forty-six patients (85%) had loop ileostomy. FA led to a change in the proximal resection margin in 10 patients (18.5%), one of whom had AL on postoperative day 3 requiring diagnostic laparoscopy and loop ileostomy. A second patient, without a change in the proximal resection margin, also had an AL. The overall AL rate was 3.7%. CONCLUSIONS: FA changed the planned proximal resection margin in 18.5% of patients, possibly accounting for the relatively low AL rate. FA is imperfect, and subjective but does have the potential to improve outcomes.

Versatile organoaluminium catalysts based on heteroscorpionate ligands for the preparation of polyesters.

A series of alkyl aluminium complexes based on heteroscorpionate ligands were designed as catalysts for the ring-opening polymerisation of cyclic esters and ring-opening copolymerisation of epoxides and anhydrides. Treatment of AlX3 (X = Me, Et) with ligands bpzbeH [bpzbe = 1,1-bis(3,5-dimethylpyrazol-1-yl)-3,3-dimethyl-2-butoxide], bpzteH [bpzte = 2,2-bis(3,5-dimethylpyrazol-1-yl)-1-para-tolylethoxide], and (R,R)-bpzmmH [(R,R)-bpzmm = (1R)-1-{(1R)-6,6-dimethyl-bicyclo[3.1.1]-2-hepten-2-yl}-2,2-bis(3,5-dimethylpyrazol-1-yl)ethoxide] for 2 hours at 0 °C afforded the mononuclear dialkyl aluminium complexes [AlMe2{κ2-bpzbe}] (1), [AlEt2{κ2-bpzbe}] (2), [AlMe2{κ2-(R,R)-bpzmm}] (3) and [AlEt2{κ2-(R,R)-bpzmm}] (4), and the dinuclear dialkyl complexes [AlMe2{κ2-bpzte}]2 (5) and [AlEt2{κ2-bpzte}]2 (6). The molecular structures of the new complexes were determined by spectroscopic methods and confirmed by X-ray crystallography. The alkyl-containing aluminium complexes can act as highly efficient single-component initiators for the ring-opening polymerisation of ε-caprolactone and l-lactide and for the ring-opening copolymerisation of cyclohexene oxide and phthalic anhydride to give a range of biodegradable polyesters.