Accurate and safe diagnosis and treatment of neoplastic biliary lesions using a novel 9F and 11F digital single-operator cholangioscope.

Background and study aims Digital single-operator cholangioscopy (DSOC) allows the diagnosis of biliary duct disorders and treatment for complicated stones. However, these technologies have limitations such as the size of the probe and working channel, excessive cost, and low image resolution. Recently, a novel DSOC system (eyeMAX, Micro-Tech, Nanjing, China) was developed to address these limitations. We aimed to evaluate the usefulness and safety of a novel 9F and 11F DSOC system in terms of neoplastic diagnostic accuracy based on visual examination, ability to evaluate tumor extension and to achieve complete biliary stone clearance, and procedure-related adverse events (AEs). Patients and methods Data from ≥ 18-year-old patients who underwent DSOC from July 2021 to April 2022 were retrospectively recovered and divided into a diagnostic and a therapeutic cohort. Results A total of 80 patients were included. In the diagnostic cohort (n = 49/80), neovascularity was identified in 26 of 49 patients (46.9%). Biopsy was performed in 65.3% patients with adequate tissue sample obtained in 96.8% of cases. Biopsy confirmed neoplasia in 23 of 32 cases. DSOC visual impression achieved 91.6% sensitivity and 87.5% specificity in diagnosing neoplasms. In the therapeutic cohort (n = 43/80), 26 of 43 patients required lithotripsy alone. Total stone removal was achieved in 71% patients in the first session. Neither early nor late AEs were documented in either the diagnostic or therapeutic cohort. Conclusions The novel DSOC device has excellent diagnostic accuracy in distinguishing neoplastic biliary lesions as well as therapeutic benefits in the context of total stone removal, with no documented AEs.

Assessing Endoscopic Ultrasound-Guided Radiofrequency Ablation in Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Center Historic Cohort Study.

BACKGROUND: /aims: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as an alternative for the local treatment of unresectable pancreatic ductal adenocarcinoma (PDAC). We aim to assess the feasibility and safety of EUS-RFA in patients with unresectable PDAC. METHODS: The following was a historic cohort compounded by locally advanced (LA) and metastatic (m) PDAC naïve patients, who underwent EUS-RFA between October 2019 to March 2022. EUS-RFA was performed with a 19-g needle electrode with a 10 mm active tip for energy delivery. Study primary endpoints were feasibility, safety, and clinical follow-up; secondary endpoints were performance status (PS), local control (LC) and overall survival (OS). RESULTS: Twenty-six patients were selected: 15/26 LA-PDAC and 11/26 mPDAC. Technical success was achieved in all patients with no major adverse events. Six months after EUS-RFA, OS was 11/26 (42.3%), with significant PS improvement (P=.03). LC was achieved, with tumor reduction from 39.5 to 26 mm (P=.04). Post-treatment hypodense necrotic area was observed at six-month follow-up in 11/11 alive cases. Metastatic disease was a significant factor for OS worsening (HR 5.021; IC 95% 1.589 - 15.87; P=.004) CONCLUSIONS: EUS-RFA of pancreatic adenocarcinoma is a minimally invasive and safe technique that may have an important role as targeted therapy for local treatment of unresectable cases, as well as an alternative for poor surgical candidates. Also, RFA may play a role in downstaging cancer with potential OS increase in non-metastatic cases. Large prospective cohorts are required to evaluate this technique in clinical practice.

Artificial intelligence-powered discovery of small molecules inhibiting CTLA-4 in cancer.

BACKGROUND/OBJECTIVES: Checkpoint inhibitors, which generate durable responses in many cancer patients, have revolutionized cancer immunotherapy. However, their therapeutic efficacy is limited, and immune-related adverse events are severe, especially for monoclonal antibody treatment directed against cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), which plays a pivotal role in preventing autoimmunity and fostering anticancer immunity by interacting with the B7 proteins CD80 and CD86. Small molecules impairing the CTLA-4/CD80 interaction have been developed; however, they directly target CD80, not CTLA-4. SUBJECTS/METHODS: In this study, we performed artificial intelligence (AI)-powered virtual screening of approximately ten million compounds to identify those targeting CTLA-4. We validated the hits molecules with biochemical, biophysical, immunological, and experimental animal assays. RESULTS: The primary hits obtained from the virtual screening were successfully validated in vitro and in vivo. We then optimized lead compounds and obtained inhibitors (inhibitory concentration, 1 micromole) that disrupted the CTLA-4/CD80 interaction without degrading CTLA-4. CONCLUSIONS: Several compounds inhibited tumor development prophylactically and therapeutically in syngeneic and CTLA-4-humanized mice. Our findings support using AI-based frameworks to design small molecules targeting immune checkpoints for cancer therapy.

A chromosome-level genome assembly of a free-living white-crowned sparrow (Zonotrichia leucophrys gambelii).

The white-crowned sparrow, Zonotrichia leucophrys, is a passerine bird with a wide distribution and it is extensively adapted to environmental changes. It has historically acted as a model species in studies on avian ecology, physiology and behaviour. Here, we present a high-quality chromosome-level genome of Zonotrichia leucophrys using PacBio and OmniC sequencing data. Gene models were constructed by combining RNA-seq and Iso-seq data from liver, hypothalamus, and ovary. In total a 1,123,996,003 bp genome was generated, including 31 chromosomes assembled in complete scaffolds along with other, unplaced scaffolds. This high-quality genome assembly offers an important genomic resource for the research community using the white-crowned sparrow as a model for understanding avian genome biology and development, and provides a genomic basis for future studies, both fundamental and applied.

Íleo biliar complicado con infección con SARS-CoV-2. Reporte de caso

Introducción: El Íleo biliar (IB) es una obstrucción intestinal mecánica muy poco frecuente, del 1 al 4 % de todas las obstrucciones intestinales, y es más común en pacientes de edad avanzada. Se produce a través de una fístula bilioentérica en el intestino delgado, sobre todo en el íleon distal. Luego de tener un enfoque diagnóstico mediante imagenología, en su gran mayoría, se opta por el tratamiento quirúrgico para eliminar el o los cálculos impactados. El éxito de esta intervención depende en gran medida del tamaño del cálculo biliar, de la ubicación de la obstrucción intestinal y comorbilidades preexistentes. Caso clínico: Mujer de 78 años con cuadro clínico de obstrucción intestinal, emesis de contenido fecaloide y sintomática respiratoria; se evidenció una masa concéntrica a nivel de íleon distal y proceso neumónico concomitante por tomografía toracoabdominal. Se realizó laparotomía exploratoria con enterolitotomía, extracción de cálculo y anastomosis íleo-ileal y fue trasladada a la UCI en donde presentó falla ventilatoria y requerimiento de ventilación mecánica; se confirmó infección viral por SARS-CoV-2 mediante RT - PCR. Discusión: El IB es una obstrucción intestinal que ocurre con mayor frecuencia en pacientes de edad avanzada. Se habla de la fisiopatología y mecanismo de producción de la fístula entérica y se presentan opciones diagnósticas, terapéuticas y quirúrgicas para dirigir el manejo clínico más apropiado. Conclusión: El IB es difícil de diagnosticar. Debido a su baja incidencia, no existe un consenso que paute el manejo a seguir en los pacientes con diagnóstico de IB. Aunque el tratamiento estándar es la intervención quirúrgica, hay diversas opiniones en cuanto al tipo de cirugía a realizar.

Introduction: Biliary ileus (BI) is a very rare mechanical intestinal obstruction, responsible for 1-4% of all intestinal obstructions and more frequent in elderly patients. It occurs through a bilioenteric fistula in the small bowel, mainly in the distal ileum. After a diagnostic imaging approach, the vast majority opt for surgical treatment to remove the impacted stone or stones. The success of this intervention depends largely on the size of the stone, the location of the bowel obstruction and pre-existing comorbidities. Case report: 78-year-old woman with clinical symptoms of intestinal obstruction, fecaloid emesis, respiratory symptoms, concentric mass at the level of the distal ileum and concomitant pneumonic process in the thoraco-abdominal CT scan. Exploratory laparotomy was performed, with total lithotomy, extraction of the calculus and ileo-ileal anastomosis, and she was transferred to the ICU, where she presented ventilatory failure and required mechanical ventilation. SARS-CoV-2 infection was confirmed with RT-PCR. Discussion: IB is an intestinal obstruction that occurs more frequently in elderly patients. The pathophysiology and the mechanism of production of enteric fistula are discussed and diagnostic, therapeutic and surgical options are presented to guide the most appropriate clinical management. Conclusion: Enteric fistula is difficult to diagnose. Due to its low incidence, there is no consensus on the management of patients diagnosed with IB. Although the standard treatment is surgical intervention, there are divergent opinions as to the type of surgery to be performed.

[Burnout syndrome due to workload in the care for cancer patients]. / Síndrome de quemarse por el trabajo en atención de pacientes oncológicos.

Background: The burnout syndrome (BS) is defined as a response to chronic work stress. It appears as a subjective phenomenon and its main symptoms are the loss of enthusiasm towards work, a feeling of professional failure, feelings of guilt, emotional exhaustion and indifference to patients' problems. Objective: To evaluate the prevalence of BS in health personnel who care for cancer patients in a tertiary hospital. Material and methods: Descriptive cross-sectional study. The sample consisted of 41 health professionals dedicated to providing direct care to cancer patients, which were selected through an intentional non-probabilistic sampling. The Questionnaire for the Evaluation of the Burnout Syndrome was applied. Results: In the sample studied, BS presented a prevalence of 51.21% at the medium level, 9.75% at the high level and 2.43% at the critical level. Significant differences were found between groups by service and work seniority. Conclusions: A high prevalence of symptoms of BS was found in the study participants, derived mainly from the excessive workload, the type of care provided, as well as experiences related to contact with people living with cancer, the hospital environment, and the type of interpersonal relationships that emerge there. The personnel most affected was that one belonging to Medical Oncology, Psychology, and Social Work.

Introducción: el síndrome de quemarse por el trabajo (SQT) se define como una respuesta al estrés laboral crónico. Aparece como un fenómeno subjetivo y sus principales síntomas son la pérdida de ilusión hacia el trabajo, la sensación de fracaso profesional, sentimientos de culpa, agotamiento emocional e indiferencia hacia los problemas de los pacientes. Objetivo: evaluar la prevalencia del SQT en personal sanitario que atiende pacientes oncológicos en un hospital de tercer nivel. Material y métodos: estudio transversal de tipo descriptivo. La muestra estuvo compuesta por 41 profesionales de la salud que brindan atención directa a pacientes oncológicos y que fueron seleccionados por un muestreo intencional no probabilístico. Se aplicó el Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo. Resultados: en la muestra estudiada el SQT presentó una prevalencia del 51.21% en nivel medio, 9.75% en nivel alto y 2.43% en nivel crítico. Hubo diferencias significativas entre grupos por servicio y antigüedad laboral. Conclusiones: se encontró una alta prevalencia de síntomas de SQT en los participantes del estudio, que puede atribuirse a la carga excesiva de trabajo, el tipo de atención brindada, las experiencias relacionadas con el contacto con las personas que viven con cáncer, al ambiente hospitalario, y al tipo de relaciones interpersonales que ahí emergen. Asimismo, el personal más afectado fue el de Oncología Médica, Psicología y Trabajo Social.

Calidad percibida en adultos mayores sobre el proceso de vacunación contra la Covid-19 en Jalisco, México / Perceived quality in older adults about the vaccination process against covid-19 in Jalisco, Mexico

El adulto mayor (AM) percibe la calidad a partir de las acciones ejecutadas al momento de brindarle algún servicio de salud. El propósito fue identificar la calidad percibida por los adultos mayores durante el proceso para la aplicación de la vacuna contra la COVID-19. El estudio fue cuantitativo-descriptivo, transversal, N=14,508 AM, n=494, muestreo aleatorio, se utilizó estadística descriptiva; prueba U de Mann-Whitney y Chi-cuadrado de Pearson, fijando el valor de significancia de p=≤0.05. El estudio contempló los principios de Helsinki. La muestra se compuso de 494 AM. (58.5%) fueron mujeres y (41.5%) eran hombres. La edad mínima fue de 60 años y la máxima de 93 años. La primera causa de enfermedad que dijo padecer el AM fue la enfermedad hipertensiva (35.6%), a través de Chi-cuadrado de Pearson, se estableció que no existen diferencias estadísticamente significativas entre el sexo y enfermedad, sig. 0.293 (p= ≤0.05). 0.05), la percepción del AM sobre el trato recibido por parte del personal de enfermería, durante la aplicación de la vacuna lo describieron como bueno 312 (63.2%), sig.=0.002 (p= ≤0.05). Los AM manifiestan que el personal de enfermería brindó información sobre el proceso para la aplicación de la vacuna y refieren estar totalmente satisfechos 399 (92.4%), sig.=0.001 (p= ≤0.05). Los resultados son novedosos, ya que evidencian el reconocimiento de la calidad de las intervenciones que las enfermeras realizan al proporcionar el cuidado, y permiten identificar que los AM tuvieron buena percepción de calidad durante el proceso de vacunación y total satisfacción con el trato recibido por enfermería. (AU)

The older adult perceives the quality from the actions carried out at the time of providing a health service. The purpose was to identify the quality perceived by older adults during the process for the application of the COVID-19 vaccine, the study was quantitative descriptive, cross-sectional, N=14,508 AM, n=494, random sampling, descriptive statistics were used; Mann-Whitney U test and Pearson’s Chi-square, fixing the significance value of p=≤0.05. The Helsinki principles were applied. The sample consisted of 494 older adult (58.5%) were women and (41.5%) were men. The minimum age was 60 years, and the maximum was 93 years. The first cause of disease reported to suffer from participants was hypertensive disease (35.6%), through Pearson’s Chi-square, it was established that there are no statistically significant differences between sex and disease, sig. 0.293 (p= ≤0.05). 0.05), the perception of the participants about the treatment received by the nursing staff, during the application of the vaccine was described as good by 312 (63.2%), sig.=0.002 (p= ≤0.05).The older adult state that the nursing staff provided information on the process for the application of the vaccine and reported being totally satisfied 399 (92.4%), sig.=0.001 (p= ≤0.05). The results are novel since they show the recognition of the quality of the interventions that nurses carry out when providing care and allow to identify that the older adult had a good perception of quality during the vaccination process and total satisfaction with the treatment received by nursing. (AU)

Artificial intelligence for diagnosing neoplasia on digital cholangioscopy: development and multicenter validation of a convolutional neural network model.

BACKGROUND: We aimed to develop a convolutional neural network (CNN) model for detecting neoplastic lesions during real-time digital single-operator cholangioscopy (DSOC) and to clinically validate the model through comparisons with DSOC expert and nonexpert endoscopists. METHODS: In this two-stage study, we first developed and validated CNN1. Then, we performed a multicenter diagnostic trial to compare four DSOC experts and nonexperts against an improved model (CNN2). Lesions were classified into neoplastic and non-neoplastic in accordance with Carlos Robles-Medranda (CRM) and Mendoza disaggregated criteria. The final diagnosis of neoplasia was based on histopathology and 12-month follow-up outcomes. RESULTS: In stage I, CNN2 achieved a mean average precision of 0.88, an intersection over the union value of 83.24 %, and a total loss of 0.0975. For clinical validation, a total of 170 videos from newly included patients were analyzed with the CNN2. Half of cases (50 %) had neoplastic lesions. This model achieved significant accuracy values for neoplastic diagnosis, with a 90.5 % sensitivity, 68.2 % specificity, and 74.0 % and 87.8 % positive and negative predictive values, respectively. The CNN2 model outperformed nonexpert #2 (area under the receiver operating characteristic curve [AUC]-CRM 0.657 vs. AUC-CNN2 0.794, P < 0.05; AUC-Mendoza 0.582 vs. AUC-CNN2 0.794, P < 0.05), nonexpert #4 (AUC-CRM 0.683 vs. AUC-CNN2 0.791, P < 0.05), and expert #4 (AUC-CRM 0.755 vs. AUC-CNN2 0.848, P < 0.05; AUC-Mendoza 0.753 vs. AUC-CNN2 0.848, P < 0.05). CONCLUSIONS: The proposed CNN model distinguished neoplastic bile duct lesions with good accuracy and outperformed two nonexpert and one expert endoscopist.

Functional inhibition of deep brain non-visual opsins facilitates acute long day induction of reproductive recrudescence in male Japanese quail.

For nearly a century, we have known that brain photoreceptors regulate avian seasonal biology. Two photopigments, vertebrate ancient opsin (VA) and neuropsin (OPN5), provide possible molecular substrates for these photoreceptor pathways. VA fulfills many criteria for providing light input to the reproductive response, but a functional link has yet to be demonstrated. This study examined the role of VA and OPN5 in the avian photoperiodic response of Japanese quail (Coturnix japonica). Non-breeding male quail were housed under short days (6L:18D) and received an intracerebroventricular infusion of adeno-associated viral vectors with shRNAi that selectively inhibited either VA or OPN5. An empty viral vector acted as a control. Quail were then photostimulated (16L:8D) to stimulate gonadal growth. Two long days significantly increased pituitary thyrotrophin-stimulating hormone ß-subunit (TSHß) and luteinizing hormone ß-subunit (LHß) mRNA of VA shRNAi treated quail compared to controls. Furthermore, at one week there was a significant increase, compared to controls, in both hypothalamic gonadotrophin releasing hormone-I (GnRH-I) mRNA and paired testicular mass in VA shRNAi birds. Opn5 shRNAi facilitated the photoinduced increase in TSHß mRNA at 2 days, but no other differences were identified compared to controls. Contrary to our expectations, the silencing of deep brain photoreceptors enhanced the response of the reproductive axis to photostimulation rather than preventing it. In addition, we show that VA opsin plays a dominant role in the light-dependent neuroendocrine control of seasonal reproduction in birds. Together our findings suggest the photoperiodic response involves at least two photoreceptor types and populations working together with VA opsin playing a dominant role.

Seroconversión posterior a la aplicación de vacuna Pfizer anticovid-19 en personal de la salud / Seroconversión rates following covid-19 Pfizer vaccine application among health personnel

Introducción: la pandemia por COVID-19 constituyó un problema de salud que requirió la realización de esfuerzos sin precedentes para la fabricación de vacunas en tiempo récord. Dada la emergencia no se podían llevar a cabo los protocolos establecidos que componen la fármacovigilancia, razón por la cual es importante realizar estudios locales que contribuyan al conocimiento y vigilancia clínica y farmacológica. Objetivos: evaluar los niveles de anticuerpos desarrollados en quienes recibieron la vacuna Pfizer, determinar los efectos secundarios más frecuentes y describir la mortalidad por todas las causas a un año en este grupo. Métodos: estudio prospectivo, de corte transversal de una cohorte de 105 pacientes, se realizó estadística descriptiva en el análisis univariado y bivariado para los niveles de anticuerpos, se describe la correlación de la edad con los niveles de anticuerpos y la mortalidad cruda de los pacientes a 1 año. Resultados: la edad media de los 105 pacientes fue 36,45 años (DE 10,11), con tendencia al aumento de los niveles de anticuerpos en la segunda toma y descenso en la tercera; se encontró una correlación negativa significativa entre edad y niveles de anticuerpos en la segunda toma. Conclusiones: en los sujetos más jóvenes se presentaron mayores títulos de anticuerpos que disminuyeron con el tiempo, la variabilidad en la titulación puede depender de varios factores como edad, género, imnunosupresores y comorbilidades. Es necesaria la medición para realizar una vacunación periódica e individualizarla. La mortalidad a un año fue de 0%.

Introduction: the COVID-19 pandemic prompted unprecedented efforts to manufacture vaccines in record time. Given the emergency, to conduct the established pharmacovigilance protocols was not possible, thus, the importance of carrying out local studies which contribute to gain understanding and clinical and pharmacological surveillance. Objectives: to evaluate antibody levels developed in subjects who received the Pfizer vaccine; to determine the most frequent side effects; and describe all-cause 1-year mortality in this group. Methods: a prospective, cross-sectional study in a cohort of 105 patients. Descriptive statistics were conducted by univariate and bivariate analyses of antibody levels. The correlation between age and antibody levels and the crude 1-year mortality rate among patients is described. Results: mean age was 36.45 years (SD 10.11), with a tendency for antibody levels to increase with the second dose and decrease with the third dose. A significant negative correlation was found between age and antibody levels in the second dose. Conclusions: younger subjects had higher antibody titers, which decreased over time. The variability of titer estimates may depend on several factors such as, age, gender, immunosuppressive therapies and comorbidities. Measurements are essential for periodic and individualized vaccination. One-year mortality rate was 0%.

Light receptors in the avian brain and seasonal reproduction.

Detection and transduction of photic cues by nonvisual photoreceptors, located in the deep brain, is a critical component of timing seasonal reproduction in birds. However, the precise identity of the photoreceptors responsible for detection of salient photic cues remains uncertain and debated. Here I review of the existing evidence for each of the three candidate photoreceptive opsins: Vertebrate Ancient Opsin, Melanopsin, and Neuropsin, including localization, action spectrum, and data from experimental manipulation of opsin expression. These findings are compared to an updated list of key criteria established in the literature as a litmus for classifying an opsin as the "breeding photoreceptor." Integrating evidence for each of the candidate photoreceptors with respect to these criteria reveals support for all three opsins in regulation of seasonal reproduction. Taken together these findings strongly suggest that transduction of seasonal photoperiodic information involves the activity of multiple photoreceptor types and populations functioning in concert. This review also highlights the need to shift attention from simply identifying "the breeding photoreceptor" to a more integrative approach aiming to parse the contribution of specific photoreceptor populations within the brain.

Gene expression of sex steroid metabolizing enzymes and receptors in the skeletal muscle of migrant and resident subspecies of white-crowned sparrow (Zonotrichia leucophrys).

Circulating sex steroid concentrations vary dramatically across the year in seasonally breeding animals. The ability of circulating sex steroids to effect muscle function can be modulated by changes in intracellular expression of steroid metabolizing enzymes (e.g., 5α-reductase type 2 and aromatase) and receptors. Together, these combined changes in plasma hormones, metabolizing enzymes and receptors allow for seasonally appropriate changes in skeletal muscle function. We tested the hypothesis that gene expression of sex steroid metabolizing enzymes and receptors would vary seasonally in skeletal muscle and these changes would differ between a migrant and resident life history strategy. We quantified annual changes in plasma testosterone and gene expression in pectoralis and gastrocnemius skeletal muscles using quantitative polymerase chain reaction (qPCR) in free-living migrant (Zonotrichia leucophrys gambelii) and resident (Z. l. nuttalli) subspecies of white-crowned sparrow during breeding, pre-basic molt, and wintering life history stages. Pectoralis muscle profile was largest in migrants during breeding, while residents maintained large muscle profiles year-round. Circulating testosterone peaked during breeding in both subspecies. Pectoralis muscle androgen receptor mRNA expression was lower in females of both subspecies during breeding. Estrogen receptor-α expression was higher in the pectoralis muscle, but not gastrocnemius, of residents throughout the annual cycle when compared to migrants. Pectoralis aromatase expression was higher in resident males compared to migrant males. No differences were observed for 5α-reductase 2. Between these two subspecies, patterns of plasma testosterone and androgen receptors appear to be conserved, however estrogen receptor gene expression appears to have diverged.

Revisiting TSHß's Role in Avian Seasonal Reproduction, Insights, and Challenges from Mammalian Models.

The core neuroendocrine pathways regulating seasonal reproduction in vertebrates were characterized over a decade ago. This has led to the development of a "consensus" model of seasonal reproduction that appears to be largely conserved across mammals, birds, amphibians, reptile and fish. This model centers around the photoinduced increase in TSHß expression in the pars tuberalis of the anterior pituitary gland as the key transducer of photic information from sensory cells to the critical switch in hypothalamic deiodinase enzyme expression that drives changes in localized thyroid hormone signaling. These changes in localized thyroid hormone signaling in the medial basal hypothalamus ultimately activate the reproductive axis. This model has in turn, been consistently supported by studies in a variety of taxa. As such, it has become the standard against which subsequent work is compared, particularly in the non-mammalian literature. However, as new studies move away from the handful of canonical model systems and begin to explore the effects of naturalistic rather than artificial photoperiod manipulations, a more nuanced picture has begun to emerge. Yet, progress in elucidating the detailed events of reproductive photostimulation has been uneven across the research community. In this perspective, I draw on emerging data from studies in free living animals that challenges some of the established assumptions of the avian consensus model of reproduction. Specifically, the role of TSHß and its dissociation from deiodinase signaling. I then discuss how these apparently surprising findings can be contextualized within the context of the mammalian seasonal literature. In turn, this ability to contextualize from the mammalian literature highlights the breadth of the current gap versus our understanding of the molecular neuroendocrine mechanisms of seasonality in mammals versus birds and other non-mammalian seasonal breeders.

Comportamiento clínico del parto vertical y en posición de litotomía en dos centros de salud de Cusco, Perú / Clinical behavior of vertical delivery and in lithotomy position in two Health Centers of Cusco, Peru

Resumen OBJETIVO: Comparar el comportamiento clínico del parto vertical con el horizontal en embarazadas atendidas en dos centros de salud de Cusco, Perú. MATERIALES Y MÉTODOS: Estudio descriptivo, comparativo y prospectivo con un componente correlacional efectuado en dos centros de salud de la ciudad de Cusco, Perú, del 1 de septiembre del 2020 al 31 de enero del 2021, en mujeres embarazadas que tuvieron parto vertical u horizontal. El cálculo del tamaño de muestra se estableció con el programa estadístico EPIDAT mediante la comparación de medias de grupos independientes. RESULTADOS: Se estudiaron 212 pacientes (106 en parto vertical y 106 en posición de litotomía). En las pacientes con parto horizontal se registraron 3 casos de activación de código rojo (1.42%) con sangrado máximo de 2500 cc. El grado de desgarro vaginal más frecuente fue 1, en 103 mujeres (48.58%). La involución uterina en los dos grupos, a las 6 h, fue de 13 cm en 80 mujeres (37.74%), a las 12 h de 12 cm en 83 mujeres (39.15%) y para las 24 h de 11 cm en 84 mujeres (39.62%). Las horas mínimas de trabajo de parto fueron 2.38 h en el grupo de parto vertical; el puntaje Apgar más bajo fue 7 al primer minuto (1.42%) y al minuto 5 (0.47%). CONCLUSIONES: El parto vertical puede ofrecer ventajas significativas en comparación con el horizontal en algunas variables: trabajo de parto más corto, Apgar al minuto e involución uterina. Para las demás variables estudiadas no se encontraron diferencias estadísticamente significativas.

Abstract OBJECTIVE: To compare the clinical behavior of vertical delivery and delivery in the lithotomy position in pregnant women attended in two health centers in Cusco, Peru. MATERIALS AND METHODS: Descriptive, comparative and prospective study with a correlational component carried out in two health centers in the city of Cusco, Peru, from September 1, 2020 to January 31, 2021 in pregnant women who delivered vertically or horizontally. The sample size was calculated using the EPIDAT statistical program by comparing the means of independent groups. RESULTS: 212 patients were studied (106 in vertical delivery and 106 in lithotomy position). In horizontal delivery patients there were 3 cases of code red activation (1.42%) with maximum bleeding of 2500 cc. The most frequent vaginal tear grade was 1, in 103 women (48.58%). Uterine involution in the two groups, at 6 h, was 13 cm in 80 women (37.74%), at 12 h 12 cm in 83 women (39.15%) and by 24 h 11 cm in 84 women (39.62%). Minimum labor hours were 2.38 h in the vertical delivery group; the lowest Apgar score was 7 at 1 min (1.42%) and at 5 min (0.47%). CONCLUSIONS: Vertical delivery may offer significant advantages compared to horizontal delivery in some variables: shorter labor, Apgar at minute and uterine involution. For the other variables studied, no statistically significant differences were found.

Parental methyl-enhanced diet and in ovo corticosterone affect first generation Japanese quail (Coturnix japonica) development, behaviour and stress response.

The role of maternal investment in avian offspring has considerable life history implications on production traits and therefore potential for the poultry industry. A first generation (G1) of Japanese quail (Coturnix japonica) were bred from a 2 × 2 factorial design. Parents were fed either a control or methyl-enhanced (HiBET) diet, and their eggs were treated with a vehicle or corticosterone injection during day 5 of incubation. A subset of G1 birds were subjected to an open field trial (OFT) and capture-restraint stress protocol. Significant effects of HiBET diet were found on parental egg and liver weights, G1 hatch, liver and female reproductive tract weights, egg productivity, latency to leave the OFT central zone, male baseline 11-dehydrocorticosterone, and female androstenedione plasma concentrations. In ovo treatment significantly affected latency to return to the OFT, male baseline testosterone and androstenedione, and change in androstenedione plasma concentration. Diet by treatment interactions were significant for G1 liver weight and male baseline plasma concentrations of corticosterone. These novel findings suggest significant positive effects on reproduction, growth, precociousness, and hypothalamic-pituitary-adrenal axis function from enhanced methyl diets, and are important in understanding how in ovo stressors (representing maternal stress), affect the first offspring generation.

Rapid Lipid Content Screening in Neochloris oleoabundans Utilizing Carbon-Based Dielectrophoresis.

In this study, we carried out a heterogeneous cytoplasmic lipid content screening of Neochloris oleoabundans microalgae by dielectrophoresis (DEP), using castellated glassy carbon microelectrodes in a PDMS microchannel. For this purpose, microalgae were cultured in nitrogen-replete (N+) and nitrogen-deplete (N-) suspensions to promote low and high cytoplasmic lipid production in cells, respectively. Experiments were carried out over a wide frequency window (100 kHz-30 MHz) at a fixed amplitude of 7 VPP. The results showed a statistically significant difference between the dielectrophoretic behavior of N+ and N- cells at low frequencies (100-800 kHz), whereas a weak response was observed for mid- and high frequencies (1-30 MHz). Additionally, a finite element analysis using a 3D model was conducted to determine the dielectrophoretic trapping zones across the electrode gaps. These results suggest that low-cost glassy carbon is a reliable material for microalgae classification-between low and high cytoplasmic lipid content-through DEP, providing a fast and straightforward mechanism.

Enteroscopia de doble balón: experiencia inicial en un hospital universitario / Double balloon enteroscopy: Initial experience in a university hospital

Resumen Introducción: el estudio de intestino delgado es un desafío, motivo de avance médico y de interés. La enteroscopia de doble balón (EDB) permite una visualización directa del intestino delgado. Objetivo: describir indicaciones, características del procedimiento, hallazgos, complicaciones y seguimiento de pacientes llevados a EDB en el Hospital de San José de Bogotá, entre noviembre de 2011 y abril de 2019. Metodología: estudio de serie de casos. Se incluyeron pacientes con indicación clínica o por imágenes diagnósticas sugerentes de lesión a nivel de intestino delgado. Se empleó estadística descriptiva. Resultados: se realizaron 45 enteroscopias a 44 pacientes, con una mediana de edad de 58 años. La principal indicación fue hemorragia digestiva potencial de intestino delgado (53,3 %) y diarrea crónica (11,1 %); fueron más frecuentes los procedimientos por vía anterógrada. La mayoría de los resultados fue normal (46,7 %); entre los hallazgos más frecuentes estuvieron los tumores (11,1 %), enfermedad de Crohn (8,9 %) y úlceras/erosiones (6,7 %). El rendimiento diagnóstico fue 53,3 %, la correlación con la videocápsula endoscópica (VCE) fue 37,5 % y con estudios de imagen, 42,9 %. No se presentaron complicaciones. Se hizo seguimiento al 91,1 % de los pacientes con una mediana de 56 meses y se observó la resolución de síntomas en el 78,1 %. La finalidad de la enteroscopia fue diagnóstica en el 84,4 %. Conclusiones: La EDB es útil en la evaluación del intestino delgado con posibilidad terapéutica. Los resultados son similares a los reportados en la literatura mundial. Si se realiza seguimiento, se puede definir la necesidad de repetición del procedimiento, realización de estudios adicionales u observar resolución de los síntomas.

Abstract Introduction: The study of the small bowel is a challenging task that has sparked interest and progress in medicine. In this context, double balloon enteroscopy (DBE) has allowed the direct visualization of the small intestine. Objective: To describe indications, procedure characteristics, findings, complications, and follow-up of patients taken to DBE at the Hospital de San José, Bogotá, between November 2011 and April 2019. Methodology: Case series study. Patients with a clinical indication or diagnostic images suggestive of small bowel lesion were included. Descriptive statistics were used. Results: 45 enteroscopies were performed in 44 patients, with a median age of 58 years. The main indication was potential small bowel bleeding (53.3%) and chronic diarrhea (11.1%). Anterograde procedures were more frequent. Most of the results were normal (46.7%); tumors (11.1%), Crohn's disease (8.9%), and ulcers/erosions (6.7%) were among the most frequent findings. The diagnostic yield was 53.3% and the correlation with capsule endoscopy (CE) was 37.5%, and with imaging studies 42.9%. There were no complications. 91.1 % of patients were followed up on after a median of 56 months, with 78.1 % reporting symptom remission. The aim of enteroscopy was diagnostic in 84.4%. Conclusions: DBE is useful in the evaluation of the small intestine with a therapeutic possibility. The results are similar to those reported in the world literature. Follow-up can define the need for repeating the procedure, performing further studies, or symptom resolution.

Seasonal differences in hypothalamic thyroid-stimulating hormone ß, gonadotropin-releasing hormone-I and deiodinase expression between migrant and resident subspecies of white-crowned sparrow (Zonotrichia leucophrys).

Across taxa, the seasonal transition between non-breeding and breeding states is controlled by localised thyroid hormone signalling in the deep brain via reciprocal switching of deiodinase enzyme expression from type 3 (DIO3) to type 2 (DIO2). This reciprocal switch is considered to be mediated by increasing thyroid-stimulating hormone ß (TSHß) release from the pars tuberalis, which occurs in response to a change in photoperiod. Although well characterised in a handful of model organisms in controlled laboratory settings, this pathway remains largely unexplored in free-living animals under natural environmental conditions. In this comparative gene expression study, we investigated hypothalamic thyroid hormone signalling in two seasonally breeding subspecies of white-crowned sparrow (Zonotrichia leucophrys), across the entirety of their annual cycles. The migratory Gambel's (Z. l. gambelii) and resident Nuttall's (Z. l. nuttalii) subspecies differ with respect to timing of reproduction, as well as life history stage and migratory strategies. Although DIO3 mRNA expression was elevated and DIO2 mRNA expression was reduced in the wintering period in both subspecies, DIO2 peaked in both subspecies prior to the onset of reproduction. However, there was differential timing between subspecies in peak DIO2 expression. Intriguingly, seasonal modulation of TSHß mRNA was only observed in migrants, where expression was elevated at the start of breeding, consistent with observations from other highly photoperiodic species. There was no correlation between TSHß, DIO2 and gonadotropin-releasing hormone-I mRNA or reproductive metrics in residents. Based on these observed differences, we discuss potential implications for our understanding of how changes in medial basal hypothalamic gene expression mediates initiation of seasonal reproduction.

Adherencia a las recomendaciones de tromboprofilaxis post-cesárea: estudio de corte transversal / Compliance with post-cesarean section thromboprophylaxis recommendations. A cross sectional study in 233 women

Background: Cesarean section increases four times the risk of venous thromboembolism compared to vaginal delivery. The Royal College of Obstetricians and Gynecologists guidelines are used at our service. A written alert was designed to stratify patients at high, intermediate or low risk making a suggestion for thromboprophylaxis. Aim: To assess the compliance with the guidelines and to evaluate the impact of a written alert in the thromboprophylaxis compliance in women subjected to caesarean section. Patients and Methods: Review of medical records of 233 women aged 19 to 32 years, subjected to a caesarean section in a Gynecology Service, between 2016-2017. Results: Compliance with recommendations was observed in 29% of patients (68/233), 86% in the low-risk group, 26% in the intermediate risk group and 100% in the high risk group. In 41/233 (18%) of patients, a written alert was included in the medical record. Compliance with recommendations in the presence of the written alert was 61% (25/41 women) compared to 22% (43/192) in those lacking the alert (p < 0.01). In women whose emergency caesarean section was the only risk factor, the compliance with the recommendation was 8%, compared with 30% among those who had at least one thrombotic risk factor associated with caesarean section (p < 0.01). Conclusions: In this cross-sectional study, we observed a low compliance with thromboprophylaxis guidelines in cesarean women. We observed that the use of a written alert improved the compliance with thromboprophylaxis.

Charge Carrier Mobility Improvement in Diketopyrrolopyrrole Block-Copolymers by Shear Coating.

Shear coating is a promising deposition method for upscaling device fabrication and enabling high throughput, and is furthermore suitable for translating to roll-to-roll processing. Although common polymer semiconductors (PSCs) are solution processible, they are still prone to mechanical failure upon stretching, limiting applications in e.g., electronic skin and health monitoring. Progress made towards mechanically compliant PSCs, e.g., the incorporation of soft segments into the polymer backbone, could not only allow such applications, but also benefit advanced fabrication methods, like roll-to-roll printing on flexible substrates, to produce the targeted devices. Tri-block copolymers (TBCs), consisting of an inner rigid semiconducting poly-diketo-pyrrolopyrrole-thienothiophene (PDPP-TT) block flanked by two soft elastomeric poly(dimethylsiloxane) (PDMS) chains, maintain good charge transport properties, while being mechanically soft and flexible. Potentially aiming at the fabrication of TBC-based wearable electronics by means of cost-efficient and scalable deposition methods (e.g., blade-coating), a tolerance of the electrical performance of the TBCs to the shear speed was investigated. Herein, we demonstrate that such TBCs can be deposited at high shear speeds (film formation up to a speed of 10 mm s-1). While such high speeds result in increased film thickness, no degradation of the electrical performance was observed, as was frequently reported for polymer-based OFETs. Instead, high shear speeds even led to a small improvement in the electrical performance: mobility increased from 0.06 cm2 V-1 s-1 at 0.5 mm s-1 to 0.16 cm2 V-1 s-1 at 7 mm s-1 for the TBC with 24 wt% PDMS, and for the TBC containing 37 wt% PDMS from 0.05 cm2 V-1 s-1 at 0.5 mm s-1 to 0.13 cm2 V-1 s-1 at 7 mm s-1. Interestingly, the improvement of mobility is not accompanied by any significant changes in morphology.