A literature review of quality assessment and applicability to HTA of risk prediction models of coronary heart disease in patients with diabetes.

This literature review had two objectives: to identify models for predicting the risk of coronary heart diseases in patients with diabetes (DM); and to assess model quality in terms of risk of bias (RoB) and applicability for the purpose of health technology assessment (HTA). We undertook a targeted review of journal articles published in English, Dutch, Chinese, or Spanish in 5 databases from 1st January 2016 to 18th December 2022, and searched three systematic reviews for the models published after 2012. We used PROBAST (Prediction model Risk Of Bias Assessment Tool) to assess RoB, and used findings from Betts et al. 2019, which summarized recommendations and criticisms of HTA agencies on cardiovascular risk prediction models, to assess model applicability for the purpose of HTA. As a result, 71 % and 67 % models reporting C-index showed good discrimination abilities (C-index >= 0.7). Of the 26 model studies and 30 models identified, only one model study showed low RoB in all domains, and no model was fully applicable for HTA. Since the major cause of high RoB is inappropriate use of analysis method, we advise clinicians to carefully examine the model performance declared by model developers, and to trust a model if all PROBAST domains except analysis show low RoB and at least one validation study conducted in the same setting (e.g. country) is available. Moreover, since general model applicability is not informative for HTA, novel adapted tools may need to be developed.

Disease severity-based subgrouping of type 2 diabetes does not parallel differences in quality of life: the Maastricht Study.

AIMS/HYPOTHESIS: Type 2 diabetes is a highly heterogeneous disease for which new subgroups ('clusters') have been proposed based on disease severity: moderate age-related diabetes (MARD), moderate obesity-related diabetes (MOD), severe insulin-deficient diabetes (SIDD) and severe insulin-resistant diabetes (SIRD). It is unknown how disease severity is reflected in terms of quality of life in these clusters. Therefore, we aimed to investigate the cluster characteristics and cluster-wise evolution of quality of life in the previously defined clusters of type 2 diabetes. METHODS: We included individuals with type 2 diabetes from the Maastricht Study, who were allocated to clusters based on a nearest centroid approach. We used logistic regression to evaluate the cluster-wise association with diabetes-related complications. We plotted the evolution of HbA1c levels over time and used Kaplan-Meier curves and Cox regression to evaluate the cluster-wise time to reach adequate glycaemic control. Quality of life based on the Short Form 36 (SF-36) was also plotted over time and adjusted for age and sex using generalised estimating equations. The follow-up time was 7 years. Analyses were performed separately for people with newly diagnosed and already diagnosed type 2 diabetes. RESULTS: We included 127 newly diagnosed and 585 already diagnosed individuals. Already diagnosed people in the SIDD cluster were less likely to reach glycaemic control than people in the other clusters, with an HR compared with MARD of 0.31 (95% CI 0.22, 0.43). There were few differences in the mental component score of the SF-36 in both newly and already diagnosed individuals. In both groups, the MARD cluster had a higher physical component score of the SF-36 than the other clusters, and the MOD cluster scored similarly to the SIDD and SIRD clusters. CONCLUSIONS/INTERPRETATION: Disease severity suggested by the clusters of type 2 diabetes is not entirely reflected in quality of life. In particular, the MOD cluster does not appear to be moderate in terms of quality of life. Use of the suggested cluster names in practice should be carefully considered, as the non-neutral nomenclature may affect disease perception in individuals with type 2 diabetes and their healthcare providers.

Application of the Nagoya Protocol to veterinary pathogens: concerns for the control of foot-and-mouth disease.

The Nagoya Protocol is an international agreement adopted in 2010 (and entered into force in 2014) which governs access to genetic resources and the fair and equitable sharing of benefits from their utilisation. The agreement aims to prevent misappropriation of genetic resources and, through benefit sharing, create incentives for the conservation and sustainable use of biological diversity. While the equitable sharing of the benefits arising from the utilisation of genetic resources is a widely accepted concept, the way in which the provisions of the Nagoya Protocol are currently being implemented through national access and benefit-sharing legislation places significant logistical challenges on the control of transboundary livestock diseases such as foot-and-mouth disease (FMD). Delays to access FMD virus isolates from the field disrupt the production of new FMD vaccines and other tailored tools for research, surveillance and outbreak control. These concerns were raised within the FMD Reference Laboratory Network and were explored at a recent multistakeholder meeting hosted by the European Commission for the Control of FMD. The aim of this paper is to promote wider awareness of the Nagoya Protocol, and to highlight its impacts on the regular exchange and utilisation of biological materials collected from clinical cases which underpin FMD research activities, and work to develop new epidemiologically relevant vaccines and other diagnostic tools to control the disease.

Manejo anestésico en la enfermedad de Steinert. A propósito de un caso / Anesthetic management in Steinert's disease: case report

Resumen: Se presenta el caso de paciente masculino, de 60 años, programado para resección transuretral de próstata. Como antecedentes destacan enfermedad de Steinert e implantación de marcapasos. La enfermedad de Steinert es el antecedente principal que guiará nuestra práctica anestésica y, tras valorar el tipo de intervención prevista, se decide anestesia locorregional, dadas las potenciales complicaciones que pueden presentar estos pacientes con la anestesia general. La conducta anestésica de los pacientes con enfermedad de Steinert supone un reto para el anestesiólogo tanto por la gran cantidad de complicaciones que pueden aparecer en el intra- y en el postoperatorio, como por la baja frecuencia de esta enfermedad. Además, el estrés quirúrgico y las técnicas utilizadas pueden interferir en el curso de la enfermedad. Por todo ello, el abordaje y los cuidados intra- y postoperatorios se deben planificar y seleccionar con cuidado con el fin de obtener los mejores resultados y extremar la seguridad del paciente.

Abstract: A 60-year-old man with prostatic hypertrophy was scheduled for transurethral resection of the prostate. Steinert's disease and implantation of a pacemaker were his previous pathology. Being Steinert's disease the most relevant clinical characteristic and the type of intervention urologist has planned, we decide locoregional anesthesia technique, avoiding the potential complications that these patients may present with general anesthesia. The anesthetic management of Steinert's disease patients is a challenge for the anesthesiologist both due to the large number of complications that may appear during intra- and postoperative time as well as the low frequency of this pathology. In addition, surgical stress and the techniques we use can interfere with the course of the disease. Therefore, the approach and immediate intra-and postoperative care should be carefully planned and selected in order to obtain the best results and maximize patient safety.

Rehabilitación del Atrapamiento Femoroacetabular tras Artroscopia (RAFA): revisión sistemática y propuesta de programa contextualizado / Rehabilitation after Arthroscopy for FemoroAcetabular impingement: a systematic review and proposal of a contextualised protocol / Reabilitação do aprisionamento femoroacetabular após artroscopia: revisão sistemática e proposta de um programa contextualizado

La artroscopia de cadera para el atrapamiento femoroacetabular es un procedimiento reciente. Se ha estudiado la etiología, diagnóstico y tratamiento artroscópico del atrapamiento femoroacetabular, no así la rehabilitación postoperatoria. Hemos examinado los estudios de la última década sobre estructura y contenidos de los programas de rehabilitación del atrapamiento femoroacetabular tras artroscopia. Se realizó una revisión sistemática de acuerdo a la declaración PRISMA, las bases de datos seleccionadas fueron Scopus, Web of Science, PubMed, Dialnet y Cochrane Library Plus, evaluándose la calidad metodológica de los trabajos mediante la escala de Coleman modificada. Se analizaron los programas de los estudios incluidos, hallándose fases, contenidos y criterios comunes, mostrando escasa evidencia y heterogeneidad metodológica, que no permite estandarizar los protocolos de rehabilitación. En conclusión, con toda la información se ha diseñado un protocolo integral dirigido al paciente para ser aplicado y medir sus resultados en el contexto socioeconómico de la población española

Hip arthroscopy to manage femoroacetabular impingement is a recent procedure. Etiology, diagnosis and arthroscopy treatment of femoroacetabular impingement has been deeply studied, but postoperative rehabilitation not. We reviewed studies from the past decade regarding structure and contents of rehabilitation programs after hip arthroscopy for femoracetabular impingement. A systematic search according to PRISMA statement was conducted. "Scopus", "Web of Science", "PubMed", "Dialnet" and "Cochrane Library Plus" were the selected databases. Study methodological quality was evaluated using the modified Coleman methodology score. Protocols of included studies were analysed and common phases, contents and criteria were extracted. Literature analysis shows a lack of evidence and methodological heterogeneity and this does not allow the rehabilitation protocols to be standardised. All the existing information has been integrated for the design of a contextualised comprehensive patient-centered protocol, for application and outcome measurement in the socio-economic context of Spanish population

A artroscopia do quadril para o impacto femoroacetabular é um procedimento recentemente expandido. A etiologia, o diagnóstico e o tratamento artroscópico do impacto femoroacetabular foram estudados, mas não a reabilitação pós-operatória. Nós examinamos os estudos da última década sobre a estrutura e os conteúdos dos programas de reabilitação para o impacto femoroacetabular após a artroscopia. Uma revisão sistemática foi realizada de acordo com a declaração PRISMA, os bancos de dados selecionados foram Scopus, Web of Science, PubMed, Dialnet e Cochrane Library Plus, avaliando a qualidade metodológica dos trabalhos utilizando a escala de Coleman modificada. Os programas dos estudos incluídos foram analisados, encontrando fases, conteúdos e critérios comuns, mostrando pouca evidência e heterogeneidade metodológica, o que não permite padronizar os protocolos de reabilitação. Em conclusão, com todas as informações, foi elaborado um protocolo integral para que o paciente seja aplicado e mensure seus resultados no contexto socioeconômico da população espanhola

Nuevas estrategias en el control del dolor postoperatorio en la cirugía de amígdalas. ¿Es oro todo lo que reluce? / New strategies for postoperative pain control in tonsillectomy surgery. Is all that glitters gold?

Introducción: La amigdalectomía es un procedimiento quirúrgico cada vez más frecuente en pacientes adultos. El dolor postoperatorio puede ser intenso, y tiene una gran impronta sobre la calidad de vida de los enfermos. El paracetamol y los antinflamatorios no esteroideos (AINE) son, a menudo, insuficientes para tratar el dolor durante las primeras 48 horas postoperatorias. La analgesia controlada por el paciente (PCA) con cloruro mórfico es una alternativa eficaz y segura para el control del dolor agudo postoperatorio. Material y métodos: El objetivo principal fue comparar la calidad analgésica de una PCA con cloruro mórfico frente a la administración pautada de paracetamol y AINE para tratar el dolor postoperatorio de pacientes adultos intervenidos de amigdalectomía. Como objetivo secundario se estudió la frecuencia de efectos adversos y satisfacción en cada grupo. Se realizó un estudio de cohortes retrospectivo con los pacientes adultos intervenidos de amigdalectomía durante el año 2017. Se registró la escala verbal numérica (EVN) en las 24 horas y en las 48 horas del postoperatorio. Se recogió la aparición de efectos secundarios. Se realizó el estudio estadístico con el programa SPSS(R). Resultados: Se evaluaron un total de 46 pacientes, 20 del grupo de tratamiento de analgesia convencional y 26 tratados con PCA de cloruro mórfico. No hallamos diferencias significativas en las características demográficas de los grupos. El grupo de PCA tuvo una EVN menor que el grupo de analgesia convencional a las 24 horas y a las 48 horas. La diferencia fue estadísticamente significativa, tanto para el dolor en reposo como para el dolor en actividad. La incidencia de efectos secundarios fue mayor en el grupo PCA (46,15 %) frente al grupo de analgesia con paracetamol y AINE (15 %). Discusión: La analgesia con un PCA de cloruro mórfico es más eficaz que la administración de paracetamol y AINE para tratar el dolor postoperatorio de la amigdalectomía del paciente adulto. Los efectos adversos son más frecuentes con la PCA de morfina

Introduction: Tonsillectomy is surgical procedure which is being every time more often in adult patients. Postoperative pain may be very intense, and it has a very important mark in the quality of life of our patients. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) may not be enough for pain management during the first 48 hours post-surgery. Morphine patient-controlled analgesia (PCA) is an effective and safe alternative for postoperative acute pain management. Material and methods: Our main goal was to compare the quality of analgesia between morphine PCA and acetaminophen and NSAIDs use for acute pain control in adult patients who had tonsillectomy surgery. Our secondary goal was to study the frequency of side effects and the satisfaction level on each group. A retrospective cohort study was performed with those adult patients who underwent tonsillectomy during the year 2017. Pain was evaluated during the first 24 and 48 hours post-surgery with the numerical rating scale (NRS). Secondary side effects were reported. The statistical study was performed with SPSS(R) programme. Results: a total of 46 patients were evaluated, 20 patients belonged to the group for conventional analgesia and 26 belonged to the group of morphine PCA. We did not find significative differences in the demographic characteristics in both groups. PCA group had a smaller NRS compared to the other conventional analgesia group during the first 24 and the 48 hours. The difference was statistically significant for pain control during activity and resting. The incidence of secondary effects was greater for the PCA group (46,15 %) than for the acetaminophen and NSAIDs group (15 %). Discussion: Analgesia with morphine PCA is more effective than the administration of acetaminophen and NSAIDs for postoperative pain control in tonsillectomy procedure in the adult patient. The adverse effects are more frequent with morphine PCA

Assessing Auditory Processing Deficits in Tinnitus and Hearing Impaired Patients with the Auditory Behavior Questionnaire.

Background and Purpose: Auditory processing disorders (APD), tinnitus and hearing loss (HL) are typical issues reported by patients in audiologic clinics. These auditory impairments can be concomitant or mutually excluding. APD are not necessarily accompanied by significant HL, whereas many adults exhibit peripheral HL and typical cognitive deficits often associated with APD. Since HL, tinnitus and APD affects to several parts of the ascending auditory pathway from the periphery to the auditory cortex, there could be some interrelationship between them. For instance, tinnitus has been reported to degrade the auditory localization capacity. Tinnitus is believed to be triggered by deafferentation of normal peripheral input to the central auditory system. This peripheral deficit can be accompanied by HL or not, since a type of permanent cochlear damage (thus deafferentation) without an elevation of hearing thresholds might persist. Therefore, a combined study of APD, tinnitus and HL on the same cohort of patients can be audiologically relevant and worthy. Methods: Statistical analysis is applied to a cohort of 305 patients attending an audiology clinic in Madrid (Spain). This group of patients is first categorized in four subgroups, namely, HLTG (with tinnitus and HL), NHLTG (with tinnitus and without HL), HLNTG (with HL but no tinnitus), and NHLNTG (neither tinnitus nor HL). The statistical variables include Age, Average Auditory Threshold (ATT), for assessing HL, Tinnitus Handicap Inventory (THI), for measuring tinnitus, and a new 25-item Auditory Behavior Questionnaire (ABQ), for scoring APD. Factor analysis is applied to arrange these items into 4 subscales. The internal consistency reliability of this ABQ is confirmed by calculating Cronbach's coefficients α. The test-retest reliability is assessed by the intraclass correlation coefficients, ICC. Statistical techniques applied to the data set include descriptive analysis of variables and Spearman rank correlations (ρ) between them. Results: Overall reliability of ABQ is confirmed by an α value of 0.89 and by an ICC of 0.91. Regarding the internal consistency reliability, the four subscales prove a fairly good consistency with α coefficients above 0.7. Average values of statistical variables show significantly lower age of patients with tinnitus and no HL, which can provide a cue of noise overexposure of this segment of population. These younger patients show also decreased ABQ and similar THI in comparison with patients in the other subgroups. A strong correlation (ρ = 0.63) was found between AAT and Age for the HLNTG subgroup. For the HLTG subgroup, a moderate correlation (ρ = 0.44) was found between ABQ and THI. Conclusion: The utilized questionnaire (ABQ), together with AAT and THI, can help to study comorbid hearing impairments in patients regularly attending an audiological clinic.

Characterization of a novel Kazal-type serine proteinase inhibitor of Arabidopsis thaliana.

Many different types of serine proteinase inhibitors have been involved in several kinds of plant physiological processes, including defense mechanisms against phytopathogens. Kazal-type serine proteinase inhibitors, which are included in the serine proteinase inhibitor family, are present in several organisms. These proteins play a regulatory role in processes that involve serine proteinases like trypsin, chymotrypsin, thrombin, elastase and/or subtilisin. In the present work, we characterized two putative Kazal-type serine proteinase inhibitors from Arabidopsis thaliana, which have a single putative Kazal-type domain. The expression of these inhibitors is transiently induced in response to leaf infection by Botrytis cinerea, suggesting that they play some role in defense against pathogens. We also evaluated the inhibitory specificity of one of the Kazal-type serine proteinase inhibitors, which resulted to be induced during the local response to B. cinerea infection. The recombinant Kazal-type serine proteinase inhibitor displayed high specificity for elastase and subtilisin, but low specificity for trypsin, suggesting differences in its selectivity. In addition, this inhibitor exhibited a strong antifungal activity inhibiting the germination rate of B. cinerea conidia in vitro. Due to the important role of proteinase inhibitors in plant protection against pathogens and pests, the information about Kazal-type proteinase inhibitors described in the present work could contribute to improving current methods for plant protection against pathogens.

DNA damage induced by bare and loaded microporous coordination polymers from their ground and electronic excited states.

We report on interactions of cell free double-stranded DNA (dsDNA) with a selected subgroup of Microporous Coordination Polymers (MCPs). In particular, we have studied the influence of different metal ion constituents and chemically modified linkers using a set of five benzene carboxylate-based MCPs. Our results suggest that the DNA moiety can be structurally modified in two different ways: by direct MCPs-dsDNA interaction and/or through photosensitized processes. The extent of the observed damage was found to be strongly dependent on the charge density of the material. The potential use of the MCPs tested as inert carriers of photosensitizers was demonstrated by analyzing the interaction between dsDNA and harmine-loaded Cr-based materials, both in the absence of light and upon UVA irradiation.

Noise control by sonic crystal barriers made of recycled materials.

A systematic study of noise barriers based on sonic crystals made of cylinders that use recycled materials like absorbing component is reported here. The barriers consist of only three rows of perforated metal shells filled with rubber crumb. Measurements of reflectance and transmittance by these barriers are reported. Their attenuation properties result from a combination of sound absorption by the rubber crumb and reflection by the periodic distribution of scatterers. It is concluded that the porous cylinders can be used as building blocks whose physical parameters can be optimized in order to design efficient barriers adapted to different noisy environments.