Association of Preoperative Lung Function with Complications after Lobectomy Using Race-Neutral and Race-Specific Normative Equations.

Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non-small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98-0.99]; P < 0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98-0.98]; P < 0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98-0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98-0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications.

Cultural adaptation and validation of the Quality of Dying in Long-term Care (QoD-LTC and QoD-LTC-C) scales by caregivers in nursing homes.

BACKGROUND: There is a lack of tools that can evaluate quality of dying in nursing homes from the perspective of deceased patients' caregivers. The aim of this study was to adapt and validate the caregivers' versions of the Quality of Dying in Long-Term Care (QoD-LTC) and Quality of Dying in Long-Term Care Complete (QoD-LTC-C) scales in the Spanish context. METHODS: This was a cultural adaptation and validation study. The scales were translated from English to Spanish and vice versa, and 13 experts in end-of-life care participated in a two-round Delphi panel. Caregivers of 69 deceased residents from seven nursing homes in southern Spain completed both scales. Reliability, feasibility, and concurrent validity with global quality of dying perception and symptom burden (Edmonton Symptom Assessment Scale), were evaluated. RESULTS: Spanish caregivers' version of the QoD-LTC scale showed good internal consistency for the total scale (α = 0.74) and each of its three factors, and good inter-rater reliability (ICC = 0.50) and test-retest reliability (ICC = 0.81). The Spanish QoD-LTC-C scale for caregivers showed good internal consistency for the total scale (α = 0.81) and for its component factors, and good test-retest reliability (ICC = 0.89) and inter-rater reliability (ICC = 0.66). Both scales correlated with family caregivers' global perception of deceased residents' quality of dying (r = 0.39; r = 0.32), but not with the ESAS score. CONCLUSIONS: Both scales presented an adequate factorial structure, internal consistency, and reliability to assess caregivers' perception of the quality of dying in Spanish nursing homes.

Incidence and Risk Factors for Pneumonitis Associated With Checkpoint Inhibitors in Advanced Non-Small Cell Lung Cancer: A Single Center Experience.

INTRODUCTION: Immune checkpoint inhibitor (ICI) pneumonitis causes substantial morbidity and mortality. Estimates of real-world incidence and reported risk factors vary substantially. METHODS: We conducted a retrospective review of 419 patients with advanced non-small cell lung cancer (NSCLC) who were treated with anti-PD-(L)1 with or without anti-CTLA-4 therapy. Clinical, imaging, and microbiological data were evaluated by multidisciplinary adjudication teams. The primary outcome of interest was grade ≥2 (CTCAEv5) pneumonitis. Clinicopathologic variables, tobacco use, cancer therapies, and preexisting lung disease were assessed for univariate effects using Cox proportional hazards models. We created multivariate Cox proportional hazards models to assess risk factors for pneumonitis and mortality. Pneumonitis, pneumonia, and progression were modeled as time-dependent variables in mortality models. RESULTS: We evaluated 419 patients between 2013 and 2021. The cumulative incidence of pneumonitis was 9.5% (40/419). In a multivariate model, pneumonitis increased the risk for mortality (HR 1.6, 95% CI, 1.0-2.5), after adjustment for disease progression (HR 1.6, 95% CI, 1.4-1.8) and baseline shortness of breath (HR 1.5, 95% CI, 1.2-2.0). Incomplete resolution was more common with more severe pneumonitis. Interstitial lung disease was associated with higher risk for pneumonitis (HR 5.4, 95% CI, 1.1-26.6), particularly in never smokers (HR 26.9, 95% CI, 2.8-259.0). CONCLUSION: Pneumonitis occurred at a high rate and significantly increased mortality. Interstitial lung disease, particularly in never smokers, increased the risk for pneumonitis.

Sarcoidosis and Airway Disease After Immune Checkpoint Inhibitor Therapy: Case Study and Review of the Literature.

Pulmonary toxicity from immune checkpoint inhibitor therapy is typically a severe and potentially fatal complication, but these observations are driven by the most common toxicity, pneumonitis. Rarer pulmonary immune related adverse events, like airway disease and sarcoidosis, may have a more benign course. In this case report, we present a patient in whom therapy with the PD-1 inhibitor pembrolizumab resulted in severe eosinophilic asthma and sarcoidosis. This is the first case showing that anti-IL-5 inhibition may be safe in patients who develop eosinophilic asthma after ICI therapy. We further show that sarcoidosis does not necessarily require treatment cessation. This case highlights relevant nuances when clinicians face pulmonary toxicities other than pneumonitis.

Quality of dying among elderly people diagnosed with dementia in nursing homes: A mixed methods study.

WHAT IS KNOWN ON THE SUBJECT: Nurses working at nursing homes can play a pivotal role in mental health as a high proportion of residents diagnosed with dementia are in these facilities. Many institutionalized residents diagnosed with dementia develop clinical complications and symptoms that reduce the quality of dying. A mixed-methods approach can help nurses with the difficult task of assessing the quality of dying among these residents and identify inconsistencies that cannot be found using scales alone, but no studies were found in this topic. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Through the Quality of dying in Long-Term Care Scale (QoD-LTC), nurses described symptom management, quality of care, and end-of-life appearance as adequate and end-of-life communication as lacking. Generally speaking, the scores on the scale were consistent with the data from semi-structured interviews conducted with nurses. In the semi-structured interviews, some of the concepts on the scale, including 'dignity', 'holistic' care, 'good relationships with healthcare professionals', and 'a peaceful death', are complex and not fully incorporated into nurses' practice in nursing homes when assessing residents diagnosed with dementia. This could be improved by using the SENSES Model or person-centred care frameworks. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is evidence of shortcomings among professionals in the correct use of concepts linked to psychological wellbeing, communication, therapeutic relationship, safety and participation, preservation of dignity, decision-making, and resident autonomy, which can be addressed using specific theoretical approaches developed in the field of mental health nursing. ABSTRACT: Introduction The complex nature of end-of-life assessment of individuals diagnosed with dementia would benefit from a mixed-methods approach that simultaneously assess the perception and response of nurses to standardized tools. Aim/Question To examine nursing professionals' perceptions of the quality of dying among residents diagnosed with dementia using the Quality of Dying in Long-Term Care settings (QoD-LTC) questionnaire and to identify consistencies and inconsistencies in their narratives. Method Mixed-methods study using concurrent triangulation with data integration for results and interpretation. Nurses from eight nursing homes assessed 117 residents diagnosed with dementia who died in the previous 3 months using the QoD-LTC scale. After informed consent was obtained (nurses/caregivers), 17 semi-structured scale-based interviews were conducted. Results Symptom management, quality of care, and end-of-life appearance were found to be adequate, while end-of-life communication was deemed insufficient. The qualitative and quantitative data were consistent for most of the items on the QoD-LTC. Discussion Concepts such as dignity, holistic care, good relationships, and peaceful death are complex and not fully incorporated into professional practice. Implications for Practice The results highlight the need for greater involvement of mental health nurses as well as improved communication, training, and specific tools tailored to residents diagnosed with dementia.

[Temporomandibular manifestation in patients with Ehlers-Danlos syndrome: a systematic review]. / Manifestaciones temporomandibulares en pacientes con síndrome de Ehlers-Danlos: una revisión sistemática.

Introduction: Ehlers-Danlos Syndrome (EDS) consists of a group of diseases that imply a disorder among individuals connective tissue due to an altered collagen production. Fibrocartilaginous structures, support ligaments, disc and retrodiscal from the temporomandibular joint are composed primarily of collagen. Objective: Identify TMJ manifestations in patients with different types of EDS. Materials and Methods: a systematic review of the literature was performed on PubMed, Scopus and Web of Science databases. Observational studies and case series reports published either in spanish or panish were included up until January 2023. Results: 12 articles met the inclusion criterial. The prevalence of temporomandibular disorders varies from 26.6% to 100%, being EDSh the most reported subtype, whereas disc displacement with or without reduction and joint hypermobility were the most reported joint disorders. Conclusion: Temporomandibular pathologies are common in patients with EDS, especially in those with the EDSh subtype.

Sociocultural drivers of mycological knowledge: insights from Wixarika and Mestizo groups in western Mexico.

BACKGROUND: Traditional mycological knowledge (TMK) is complex, not distributed equally among the entire population, and constantly adapting to current social situations. There are sociocultural factors that could influence the fact that some people retain a greater wealth of knowledge, for instance, cultural affiliation, migration, occupation, level of schooling, and person's age. METHODS: We analyze the distribution of the TMK based on sociocultural variables and 12 indicators to quantify the TMK based on a literature review. We chose two sites where there was a Wixarika and Mestizo population with records of use and consumption of wild mushrooms. In each site, 150 semi-structured interviews were conducted. The format of the semi-structured interviews was made up of sociocultural questions plus 12 questions corresponding to each of the indicators. With the data obtained, we performed linear regression tests and principal components analysis (PCA); furthermore, the significance of the groupings obtained by PCA was tested with a discriminant function analysis. RESULTS: We find that TMK was determined by the cultural group to which a person belongs. Contrary to what was expected, age and formal schooling did not influence people's level of knowledge. Likewise, migration and occupation were not determining factors either, although in some specific cases they did influence the differences in knowledge about mushrooms between people. The indicators that most helped to differentiate between the Wixarika people, and the Mestizos were knowledge of the nutritional contribution, propagation methods, and knowledge about toxic mushrooms. CONCLUSIONS: In general, sociocultural differences did not affect the transmission of the TMK due to the valorization of this knowledge among the young generations and the maintenance of the use of wild resources. Specifically, the Wixaritari had and preserved a greater TMK thanks to their pride in their cultural identity, which had allowed them to adapt to modernity while preserving their traditions and knowledge. On the other hand, the Mestizos increasingly disused wild resources due to urbanization. The indicators proposed here provided a good tool to quantify TMK; however, to replicate the study in other sites it is necessary to adapt the indicators to the context of the place.

The cultural role played by the ethnomycological knowledge of wild mushrooms for the peoples of highlands and lowlands in Tlaltenango, Zacatecas, Mexico.

The greatest diversity of culturally relevant fungi in Mexico has been recorded in temperate forests. Likewise, it has been proven that people who live in such environments possess greater ethnomycological knowledge, compared with people in the lowlands. In this study, we investigated whether the uses and perceptions of fungi were different between people living near forests in highlands and those living in lowlands near grasslands and subtropical scrublands. We selected seven communities from the municipality of Tlaltenango, Zacatecas, Mexico, where we conducted guided tours, 35 semistructured interviews, and free lists to 420 people. Since highlands surrounded by temperate forests give rise to high species diversity, we expected that the inhabitants, in comparison with those of the lowlands where there is less diversity, would recognize a larger number of fungi. To test this hypothesis, we employed discriminant function analysis, principal coordinate analysis, Mann-Whitney U test, and linear regression. The cultural importance of each species was calculated based on the frequency with which it was mentioned and the first principal coordinate. Although the highlanders have a deeper knowledge of mushrooms, lowlanders and highlanders had similar fungal backgrounds and preferred the same species, regardless of the fungi surrounding their territory. The lack of differences among communities was due in part to the fact that the most culturally important species were those that grew in grasslands and subtropical scrub areas. Agaricus campestris was the most culturally prevalent and only commercialized species both in the highlands and lowlands, followed by Pleurotus djamor and Volvariella bombycina. None of the mushrooms growing in the pine-oak forest had a high cultural importance value, even for the communities living in the vicinity of this forest, forcing them to travel long distances to collect Agaricus campestris. Further investigations are needed in order to assess the relevance of sociocultural factors, and their potential influence in the preference for particular mushrooms in this region.

[Clinical, obstetric and perinatal characteristics of Mexican pregnant women with COVID-19]. / Características clínicas, obstétricas y perinatales de embarazadas mexicanas con Covid-19.

Background: COVID-19 disease is the leading cause of maternal death in Mexico. The data published to date indicate that pregnancy favors severe forms of the disease. Objective: To describe the clinical, obstetric and perinatal characteristics of pregnant women with COVID-19 disease treated at the UMAE "Luis Castelazo Ayala" of the Instituto Mexicano del Seguro Social. Material and methods: Observational, cross-sectional and retrospective study of pregnant women with COVID-19 treated from March to December 2020. The epidemiological characteristics, complications and perinatal results were analyzed with descriptive and inferential statistics. Results: 133 patients included: 84.5% with mild disease, 8 % moderate and 8.5% severe and critical. Pre-existing comorbidities: obesity, diabetes and hypothyroidism. Main symptoms: cough, headache, fever, rhinorrhea and anosmia. In severe and critical cases, tachycardia, tachypnea, and hypoxemia were present. Lymphoneutropenia, hyperglycemia, and transaminasemia were seen in severe and critical forms. Fibrinogen and D dimer stayed unchanged. Preterm delivery, oligohydramnios, gestational hypertension, severe preeclampsia, and pneumonia were the main complications. 75% of the newborns without complications. Conclusions: The clinical behavior of the disease was mostly mild and even in moderate cases, and even in moderate as well as severe and complicated cases, the binomial results were favorable. There was no maternal death.

Introducción: la enfermedad COVID-19 en el embarazo es la primera causa de muerte materna en México, y se ha reportado que favorece las formas graves de la enfermedad. Objetivo: describir las características clínicas, obstétricas y perinatales de pacientes embarazadas con enfermedad COVID-19 atendidas en la UMAE "Luis Castelazo Ayala" del Instituto Mexicano del Seguro Social (IMSS). Material y métodos: estudio observacional, transversal y retrospectivo de pacientes embarazadas con COVID-19 atendidas de marzo a diciembre del 2020. Las características epidemiológicas, complicaciones y resultados perinatales se analizaron con estadística descriptiva e inferencial. Resultados: se incluyeron 133 pacientes: 84.5% presentaron enfermedad leve, 8% moderada y 8.5% severa y crítica. Las comorbilidades preexistentes fueron: obesidad, diabetes e hipotiroidismo. Los principales síntomas: tos, cefalea, fiebre, rinorrea y anosmia. En casos severos y críticos la taquicardia, taquipnea e hipoxemia estuvieron presentes. En las formas severa y crítica se observaron: linfoneutropenia, hiperglucemia y transaminasemia. El fibrinógeno y dímero D sin cambios. El parto pretérmino, el oligohidroamnios, la hipertensión gestacional, la preeclampsia severa y la neumonia fueron las principales complicaciones. El 75% de los recién nacidos no preentaron complicaciones. Conclusiones: el comportamiento clínico de la enfermedad fue, en su mayoría, leve, e incluso en los casos moderados así como en los severos y complicados los resultados del binomio fueron favorables. No hubo muerte materna ni se evidenció transmisión vertical.

Características clínicas, obstétricas y perinatales de embarazadas mexicanas con COVID-19 / Clinical, obstetric and perinatal characteristics of Mexican pregnant women with COVID-19

Introducción: la enfermedad COVID-19 en el embarazo es la primera causa de muerte materna en México, y se ha reportado que favorece las formas graves de la enfermedad. Objetivo: describir las características clínicas, obstétricas y perinatales de pacientes embarazadas con enfermedad COVID-19 atendidas en la UMAE "Luis Castelazo Ayala" del Instituto Mexicano del Seguro Social (IMSS). Material y métodos: estudio observacional, transversal y retrospectivo de pacientes embarazadas con COVID-19 atendidas de marzo a diciembre del 2020. Las características epidemiológicas, complicaciones y resultados perinatales se analizaron con estadística descriptiva e inferencial. Resultados: se incluyeron 133 pacientes: 84.5% presentaron enfermedad leve, 8% moderada y 8.5% severa y crítica. Las comorbilidades preexistentes fueron: obesidad, diabetes e hipotiroidismo. Los principales síntomas: tos, cefalea, fiebre, rinorrea y anosmia. En casos severos y críticos la taquicardia, taquipnea e hipoxemia estuvieron presentes. En las formas severa y crítica se observaron: linfoneutropenia, hiperglucemia y transaminasemia. El fibrinógeno y dímero D sin cambios. El parto pretérmino, el oligohidroamnios, la hipertensión gestacional, la preeclampsia severa y la neumonía fueron las principales complicaciones. El 75% de los recién nacidos no presentaron complicaciones. Conclusiones: el comportamiento clínico de la enfermedad fue, en su mayoría, leve, e incluso en los casos moderados así como en los severos y complicados los resultados del binomio fueron favorables. No hubo muerte materna ni se evidenció transmisión vertical.

Background: COVID-19 disease is the leading cause of maternal death in Mexico. The data published to date indicate that pregnancy favors severe forms of the disease. Objective: To describe the clinical, obstetric and perinatal characteristics of pregnant women with COVID-19 disease treated at the UMAE "Luis Castelazo Ayala" of the Instituto Mexicano del Seguro Social. Material and methods: Observational, cross-sectional and retrospective study of pregnant women with COVID-19 treated from March to December 2020. The epidemiological characteristics, complications and perinatal results were analyzed with descriptive and inferential statistics. Results: 133 patients included: 84.5% with mild disease, 8 % moderate and 8.5% severe and critical. Pre-existing comorbidities: obesity, diabetes and hypothyroidism. Main symptoms: cough, headache, fever, rhinorrhea and anosmia. In severe and critical cases, tachycardia, tachypnea, and hypoxemia were present. Lymphoneutropenia, hyperglycemia, and transaminasemia were seen in severe and critical forms. Fibrinogen and D dimer stayed unchanged. Preterm delivery, oligohydramnios, gestational hypertension, severe preeclampsia, and pneumonia were the main complications. 75% of the newborns without complications. Conclusions: The clinical behavior of the disease was mostly mild and even in moderate cases, and even in moderate as well as severe and complicated cases, the binomial results were favorable. There was no maternal death.

Phlebopus beniensis (Singer & Digilo) Heinem. & Rammeloo (Boletinellaceae, Basidiomycota, Fungi): new record from São Paulo State, Brazil and ethnomycological notes / Phlebopus beniensis (Singer & Digilo) Heinem. & Rammeloo (Boletinellaceae, Basidiomycota, Fungi): novo registro para o Estado de São Paulo, Brasil e notas etnomicológicas

Phlebopus is a genus of boletoid fungi that produces conspicous basidiomes with large dimensions. The genus is represented in Brazil by six species distributed in eight States, with P. beniensis being here newly reported from the State of São Paulo, Southeastern Brazil. Therefore, the aim of this study is to report the occurrence of this species in São Paulo State based on specimens from Southwestern region of the State, as well as to present ethnomycological notes, including the first report of the species edibility.

Phlebopus é um gênero de fungos boletoides que produz basidiomas conspícuos, de grandes dimensões. O gênero está representado no Brasil por seis espécies distribuídas em oito Estados, porém, P. beniensis ainda não havia sido registrada para o Estado de São Paulo, Sudeste do Brasil. Sendo assim, o objetivo deste trabalho é registrar a ocorrência da espécie para o Estado de São Paulo com base em espécimes da região sudoeste do Estado, assim como apresentar notas etnomicológicas, incluindo o primeiro registro de comestibilidade da espécie

Automanejo en personas con multimorbilidad: aportes desde la salutogénesis y el modelo de activos en salud / Self-management in people with multimorbility: Contributions from salutogenesis and health assets model

Diferentes modelos de cuidado en contexto de cronicidad y multimorbilidad incorporan a la comunidad, sistema de salud, práctica clínica, políticas sanitarias, prevención y promoción de salud. Entre estos se señala el rol facilitador del equipo de salud en el automanejo, siendo las personas protagonistas de su proceso. El abordaje de la multimorbilidad se realiza mayormente desde un enfoque centrado en el riesgo y la enfermedad, limitando la exploración de los recursos de las personas y su entorno. Incorporar un enfoque de salud positiva puede aportar a una mayor integralidad. El propósito de este artículo es proponer un abordaje desde el modelo sinérgico de salud, integrando la salutogénesis y el modelo de activos, para facilitar el automanejo promoviendo la capacidad de agencia de las personas. Se presentan potenciales áreas de aplicación de estos modelos en el contexto de multimorbilidad, fomentando condiciones de salud y bienestar en las personas y sus familias.(AU)

Different models of care in context of chronicity and multimorbidity include community, health system, clinical practice, health policies, prevention, and health promotion. Among these, the role of the health team as a facilitator of self-management is pointed out, being people the protagonists of their process. Multimorbidity approach is mostly carried out from a risk and disease focused point of view, which limits the exploration of resources of people and their environment. Incorporating a positive health approach can contribute to a greater comprehensiveness. The purpose of this article is to propose an approach from the synergy model of health, integrating salutogenesis and health assets model, to help facilitate self-management promoting people's agency capacity. Potential areas of application of these models are presented to work in the context of multimorbidity, promoting health and well-being conditions in people and their families.(AU)

[Self-management in people with multimorbility: Contributions from salutogenesis and health assets model]. / Automanejo en personas con multimorbilidad: aportes desde la salutogénesis y el modelo de activos en salud.

Different models of care in context of chronicity and multimorbidity include community, health system, clinical practice, health policies, prevention, and health promotion. Among these, the role of the health team as a facilitator of self-management is pointed out, being people the protagonists of their process. Multimorbidity approach is mostly carried out from a risk and disease focused point of view, which limits the exploration of resources of people and their environment. Incorporating a positive health approach can contribute to a greater comprehensiveness. The purpose of this article is to propose an approach from the synergy model of health, integrating salutogenesis and health assets model, to help facilitate self-management promoting people's agency capacity. Potential areas of application of these models are presented to work in the context of multimorbidity, promoting health and well-being conditions in people and their families.

Ligadura de arterias hipogástricas previo al alumbramiento o a la histerectomía obstétrica modificada en inserción anómala de placenta / Ligation of hypogastric arteries prior to delivery or modified obstetric hysterectomy in anomalous insertion of the placenta

Resumen: OBJETIVO: Evaluar las ventajas de practicar o no la ligadura de arterias hipogástricas antes del alumbramiento o previo a la histerectomía modificada en el tratamiento quirúrgico de la inserción anómala de la placenta. MATERIALES Y MÉTODOS: Estudio de serie de casos, retrospectivo, transversal y comparativo efectuado en la Unidad Médica de Alta Especialidad, Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, de 2013 a 2019. Criterios de inclusión: pacientes con inserción anómala de placenta a quienes se practicó o no ligadura de arterias hipogástricas antes del alumbramiento o previo a la histerectomía modificada. Criterios de exclusión: pacientes que no finalizaron el embarazo en el hospital o la información en el expediente estaba incompleta. Parámetros de estudio: sangrado transoperatorio, transfusión sanguínea, morbilidad posoperatoria e ingreso a cuidados intensivos. Los desenlaces se analizaron con estadística descriptiva e inferencial. RESULTADOS: Se evaluaron 285 pacientes; 57% (n = 164) con placenta previa, 27% (n = 78) marginal y 15% (n = 43) normoinserta. El espectro de placenta acreta se encontró en 34% (n = 91) de la muestra. En el grupo de placenta previa la aplicación de la técnica disminuyó el sangrado transoperatorio (p = 0.005) y la transfusión sanguínea (p = 0.05). En pacientes con espectro de placenta acreta hubo una reducción del sangrado transoperatorio (p < 0.01), menores transfusión sanguínea (p = 0.01), ingreso a cuidados intensivos (p < 0.001) y días de estancia en cuidados intensivos (p = 0.0001). CONCLUSIONES: La ligadura de arterias hipogástricas antes del alumbramiento o previo a la histerectomía modificada en el tratamiento quirúrgico de la inserción anómala de la placenta mostró un máximo beneficio en los grupos de placenta previa y espectro de placenta acreta.

Abstract OBJECTIVE: To evaluate the advantages of performing and not performing "Hypogastric artery ligation prior to delivery or modified hysterectomy" in the surgical management of anomalous placental insertion. MATERIALS AND METHODS: A retrospective, cross-sectional, comparative, retrospective case series study conducted at the Unidad Médica de Alta Especialidad, Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, from 2013 to 2019. Inclusion criteria: patients with abnormal placental insertion who underwent hypogastric artery ligation before delivery or before modified obstetric hysterectomy, compared with those who did not have hypogastric artery ligation. Exclusion criteria: patients who did not terminate the pregnancy in the hospital or the information in the file was incomplete. Study parameters: transoperative bleeding, blood transfusion, postoperative morbidity and admission to intensive care. Outcomes were analyzed with descriptive and inferential statistics. RESULTS: 285 patients were evaluated; 57% (n = 164) with placenta previa, 27% (n = 78) marginal and 15% (n = 43) normoinsert. The placenta accreta spectrum was found in 34% (n = 91) of the sample. In the placenta previa group, the application of the technique decreased transoperative bleeding (p = 0.005) and blood transfusion (p = 0.05). In patients with placenta accreta spectrum there was a reduction of transoperative bleeding (p < 0.01), lower blood transfusion (p = 0.01), intensive care admission (p < 0.001) and days of intensive care stay (p = 0.0001). CONCLUSIONS: Hypogastric artery ligation before delivery and before modified hysterectomy in the surgical treatment of anomalous placental insertion showed maximum benefit in the placenta previa and spectrum of placenta accreta groups.

The Primate Cultural Significance Index: applications with Popoluca Indigenous people at Los Tuxtlas Biosphere Reserve.

BACKGROUND: The study of the cultural significance (CS) of biodiversity provides key information to develop conservation strategies consistent with traditions and perceptions of human communities. In Los Tuxtlas Biosphere Reserve (TBR) in Mexico, the mantled howler monkeys (Alouatta palliata mexicana) and the black-handed spider monkeys (Ateles geoffroyi vellerosus) have historically coexisted with Popoluca Indigenous Peoples. This study sought to determine how the presence of a natural protected area (TBR location) and a range of sociodemographic factors (gender, age, origin, language proficiency, education level, religion) relate to the CS held by the Popoluca Indigenous People in relation to these two endangered primate species. METHODS: The first Primate Cultural Significance Index (PCSI) was designed as a composed index of 11 cultural variables (sub-indices) and was applied randomly to a representative size sample of people over 15 years old in two Popolucas communities, one within the TBR (Piedra Labrada = 81 people) and another outside (Los Mangos = 91). U Mann-Whitney tests were used to compare the PCSI between communities and Generalized Linear Models (GLM) to evaluate the sociodemographic factors of participants that influenced the sub-indices in the PCSI. RESULTS: The cultural significance of spider monkeys held by the Popolucas was higher for the community within the TBR than for the community outside, while for howler monkeys it was higher outside. For both primate species across the two communities, the most relevant sub-indices were (1) interest in conservation and (2) touristic significance of primates. Sociodemographic factors of participants influenced nine sub-indices of cultural significance out of the possible 10 sub-indices applied for each primate species. The demographic factors that most influenced each sub-index for both species were location and gender. CONCLUSIONS: The main differences found between communities may be linked to the conservation and sustainable development programs promoted by the reserve, as well as the greater persistence of Popolucan ancestral traditions within the boundaries of the reserve. We recommend that conservation efforts should focus on people less interested about primate conservation (women, non-natives and residents outside the reserve), and turn to the leadership of people more interested (native men who reside inside the reserve).

Traditional knowledge, uses, and perceptions of mushrooms among the Wixaritari and mestizos of Villa Guerrero, Jalisco, Mexico.

The relationship between humans and nature is defined by culture. Accordingly, the use, conceptions, and perceptions of resources differ among cultural groups, even among those inhabiting the same region or those who come into contact with the same biota. In particular, mushrooms evoke a wide range of sentiments. During ethnobiological tours in Mexico, semi-structured interviews were carried out with 37 individuals of each community, from ten Wixarika and mestizo communities, living in the same locality and sharing similar resources, in the municipality of Villa Guerrero in northern Jalisco, Mexico. Furthermore, informal interviews with four Wixarika and five mestizo key informants were conducted. The topics treated were regarding the traditional nomenclature and classification, uses, and knowledge of mushrooms and related practices. Wixarika names of 37 mushroom species with edible, medicinal, and recreational uses were recorded. In addition, the Wixaritari were found to associate toxic mushrooms with the divine, as evidenced by one case of the use of mushrooms as a hierophanic agent. Each culture's knowledge of the phenology and ecology of mushrooms was recorded in addition to data highlighting the cultural exchange between the Wixaritari and mestizos. However, a loss in the knowledge and practices concerning mushrooms was observed as a result of social changes. Even so, both cultures prefer mushrooms to other foods, including meat, especially Volvariella bombycina and Pleurotus djamor.

Negative correlation between testosterone and TNF-α in umbilical cord serum favors a weakened immune milieu in the human male fetoplacental unit.

Clinical and epidemiological evidence supports that pregnancies carrying a male fetus are more vulnerable to infections and preterm birth, probably due to testosterone immunosuppressive properties. In human placentas, testosterone lowers the expression of CYP27B1, the vitamin D (VD)-activating enzyme, diminishing cathelicidin synthesis, a potent VD-dependent antimicrobial peptide (AMP). VD also stimulates other AMPs, including defensins. To get insights into the increased male vulnerability mechanisms, we investigated the relationship between fetal sex and the immunoendocrine milieu at the fetoplacental unit. For this, umbilical vein serum and placental samples were collected from healthy newborns. In males' serum, testosterone levels were significantly higher and negatively associated with TNF-α, a cytokine that strengthens the immune response. Males showed lower serum TNF-α and increased levels and gene expression of the immunosuppressive cytokine IL-10. Only in female samples there was a positive association (P < 0.05) between AMPs and both TNF-α and CYP27B1 and between 25-hydroxyvitamin D3 and IL-1ß serum levels. Accordingly, VD-metabolites (25-hydroxyvitamin D3, calcitriol) significantly stimulated IL-1ß gene expression in cultured trophoblasts. Interestingly, IL-1ß mRNA correlated positively with defensins (P < 0.05) in males, but not with cathelicidin expression, which was significantly diminished in comparison to females. Our data suggest that high umbilical serum testosterone and IL-10 in males could explain reduced TNF-α levels and lack of association between VD-dependent innate immunity markers and proinflammatory cytokines expression in the fetoplacental unit. Altogether, our observations imply a restricted basal immune milieu in males compared to females, which may help understand the higher male susceptibility to adverse perinatal outcomes.

Sociodemographic differences in the cultural significance of edible and toxic mushrooms among Tsotsil towns in the Highlands of Chiapas, Mexico.

BACKGROUND: Mushrooms are important forest resources, mostly as food, despite the serious health threat posed by toxic species. In the Highlands of Chiapas, numerous wild mushroom intoxications have been registered. While Chiapas has been vastly studied from an ethnomycological perspective, no certainty exists as to how nomenclature systems differentiate edible and toxic species, which species are most culturally significant, and whether sociodemographic factors relate to how well-known they are in the Highlands of Chiapas. This paper evaluates which are the most culturally significant edible and toxic wild mushroom species in seven Tsotsil communities from this region and whether differences exist in their knowledge relating to different sociodemographic subsets (gender, schooling, and occupation). The hypothesis that there is a difference in the number of species that people mention, as well as the number of times each ethno-taxon is mentioned, between people from different social groups was tested. METHODS: With consent, 133 Tsotsil people from seven communities were interviewed. Interviews focused on local systematics and free listings of edible and toxic mushrooms. Qualitative and quantitative analyses were performed, including multivariate methods and non-parametric statistics. RESULTS: Twenty-five edible and 15 toxic taxa were mentioned. Some directly correspond to Linneanean species, while others are subdifferentiated or supradifferentiated. Only 62% of the interviewees named toxic mushrooms. The most frequently mentioned edible taxa were Amanita hayalyuy and A. jacksoniii, Agaricus spp., and Armillaria mellea. The most frequently mentioned toxic species were Amanita muscaria, Suillellus luridus, and Russula emetica. Significant differences in the number of mentioned edible ethnotaxa were found only among different occupations and schooling. The models including schooling interacting with either gender or occupation are better supported. Significant differences in the number of times toxic ethnotaxa are mentioned were found only between men and women. CONCLUSIONS: The Tsotsil region of the Highlands of Chiapas is where the most average mushroom species are recognized state-wide. Schooling and occupation seem most determinant for people to know more or less species of mushrooms, while gender appears irrelevant. People with no studies and field-related occupations name more species. Identification criteria to distinguish edible from toxic species seem to rest not on detailed recognition of the second set but precise knowledge of the first.

Lipopolysaccharide and cAMP modify placental calcitriol biosynthesis reducing antimicrobial peptides gene expression.

PROBLEM: Calcitriol, the hormonal form of vitamin D3 (VD), stimulates placental antimicrobial peptides expression; nonetheless, the regulation of calcitriol biosynthesis in the presence of bacterial products and its consequence on placental innate immunity have scarcely been addressed. METHOD OF STUDY: We investigated how some bacterial products modify placental VD metabolism and its ability to induce antimicrobial peptides gene expression. RESULTS: Cultured human trophoblasts biosynthesized calcitriol only in the presence of its precursor calcidiol, a process that was inhibited by cyclic-AMP but stimulated by lipopolysaccharide (LPS). Intracrine calcitriol upregulated cathelicidin, S100A9, and ß-defensins (HBDs) gene expression, while LPS further stimulated HBD2 and S100A9. Unexpectedly, LPS significantly repressed cathelicidin basal mRNA levels and drastically diminished calcidiol ability to induce it. Meanwhile, cyclic-AMP, which is used by many microbes to avoid host defenses, suppressed calcitriol biosynthesis, resulting in significant inhibition of most VD-dependent microbicidal peptides gene expression. CONCLUSION: While LPS stimulated calcitriol biosynthesis, cyclic-AMP inhibited it. LPS downregulated cathelicidin mRNA expression, whereas cyclic-AMP antagonized VD-dependent-upregulation of most antimicrobial peptides. These findings reveal LPS and cyclic-AMP involvement in dampening placental innate immunity, highlighting the importance of cyclic-AMP in the context of placental infection and suggesting its participation to facilitate bacterial survival.

Cultural significance of the flora of a tropical dry forest in the Doche vereda (Villavieja, Huila, Colombia).

BACKGROUND: In Colombia, ethnobotanical studies regarding plant cultural significance (CS) in tropical dry forests are scarce and mainly focused on the Caribbean region. Different authors have indicated that the plants with the most uses are those of greater cultural importance. Additionally, gender differences in knowledge and interest in natural resources has been widely recorded. This study evaluated the cultural significance of plants in the Doche community, in the Department of Huila. Furthermore, it evaluates the richness of plant knowledge among local inhabitants, looking for testing the hypothesis that the CS of plants positively correlates to the number of uses people inform about, and that there are significant differences on the richness of ethnobotanical knowledge between men and women in this community. METHODS: The ethnobotanical categories: "food," "condiment," "economy," "fodder," "firewood," "timber", "medicine," and "others" were established to carry out semi-structured interviews, social cartography, and ethnobotanical walks. The frequency of mention was calculated as a measure of CS. The richness of knowledge of each collaborator was obtained. Non-parametric tests were performed to determine whether differences between the numbers of mentioned species existed between genders and ethnobotanical categories. Finally, Pearson correlation tests determined the relationship between CS and the number of ethnobotanical categories. RESULTS: A hundred useful species were registered in crops and forests. The most abundant categories were medicinal (45 species), firewood (30), and fodder (28). The most culturally significant species according to frequency of mention were Pseudosamanea guachapele, Guazuma ulmifolia, Manihot esculenta, and Musa balbisiana. The species with the most registered uses (five) were Guazuma ulmifolia and Gliricidia sepium. We found a correlation between CS and the number of uses per ethnobotanical category, but no significant difference between genders regarding ethnobotanical knowledge. CONCLUSION: Frequency of mention provides relevant information about the CS of species. Furthermore, it aids to establish sustainable use of tropical dry forests without loss of resources parting from strategies designed from within the Doche community and based on their ethnobotanical knowledge. We found that the number of uses of a plant is correlated with its degree of cultural importance. On the other hand, no significant differences were found between genders regarding ethnobotanical knowledge; that is, both men and women have similar roles in the community, which allows them to recognize the same uses per species.