Increased glutamatergic neurotransmission between the retinohypothalamic tract and the suprachiasmatic nucleus of old mice.

Circadian rhythms synchronize to light through the retinohypothalamic tract (RHT), which is a bundle of axons coming from melanopsin retinal ganglion cells, whose synaptic terminals release glutamate to the ventral suprachiasmatic nucleus (SCN). Activation of AMPA-kainate and NMDA postsynaptic receptors elicits the increase in intracellular calcium required for triggering the signaling cascade that ends in phase shifts. During aging, there is a decline in the synchronization of circadian rhythms to light. With electrophysiological (whole-cell patch-clamp) and immunohistochemical assays, in this work, we studied pre- and postsynaptic properties between the RHT and ventral SCN neurons in young adult (P90-120) and old (P540-650) C57BL/6J mice. Incremental stimulation intensities (applied on the optic chiasm) induced much lesser AMPA-kainate postsynaptic responses in old animals, implying a lower recruitment of RHT fibers. Conversely, a higher proportion of old SCN neurons exhibited synaptic facilitation, and variance-mean analysis indicated an increase in the probability of release in RHT terminals. Moreover, both spontaneous and miniature postsynaptic events displayed larger amplitudes in neurons from aged mice, whereas analysis of the NMDA and AMPA-kainate components (evoked by RHT electrical stimulation) disclosed no difference between the two ages studied. Immunohistochemistry revealed a bigger size in the puncta of vGluT2, GluN2B, and GluN2A of elderly animals, and the number of immunopositive particles was increased, but that of PSD-95 was reduced. All these synaptic adaptations could be part of compensatory mechanisms in the glutamatergic signaling to ameliorate the loss of RHT terminals in old animals.

Mejora en el manejo de la sospecha del síndrome aórtico agudo en urgencias mediante un algoritmo clínico y el estudio de factores predictivos / Improvement in the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors

Antecedentes y objetivo: El síndrome aórtico agudo (SAA) es poco frecuente y difícil de diagnosticar, con una gran variabilidad en su cuadro clínico inicial. Los objetivos son: 1) desarrollar un algoritmo informático, o un sistema de apoyo a las decisiones clínicas (SADC), para el manejo y la solicitud de estudios de diagnóstico por imagen en el servicio de Urgencias, en concreto de una tomografía computarizada (TC) de la aorta, ante la sospecha de SAA, 2) determinar el efecto de la implantación de este sistema, y 3) determinar los factores asociados a un diagnóstico radiológico positivo que mejoren la capacidad predictiva de los hallazgos de la TC de aorta. Material y métodos: Tras desarrollar e implementar un algoritmo basado en la evidencia, se estudiaron casos de sospecha de SAA. Se utilizó el test de la χ2 para analizar la asociación entre las variables incluidas en el algoritmo y el diagnóstico radiológico, con 3 categorías: sin hallazgos relevantes, positivo para SAA y diagnósticos alternativos. Resultados: Se identificaron 130 solicitudes; 19 (14,6%) tenían SAA y 34 (26,2%) tenían otra patología aguda. De las 19 con SAA, 15 habían sido estratificadas como de alto riesgo y 4 como de riesgo intermedio. La probabilidad de SAA era 3,4 veces mayor en los pacientes con aneurisma aórtico conocido (p=0,021, IC del 95%: 1,2-9,6) y 5,1 veces mayor en los pacientes con un soplo de insuficiencia vascular aórtica de novo(p=0,019, IC del 95 %: 1,3-20,1). La probabilidad de tener una enfermedad aguda grave alternativa fue 3,2 veces mayor en los pacientes con hipotensión o choque (p=0,02, IC del 95 %: 1,2-8,5). Conclusión: El uso de un SADC en el servicio de Urgencias puede ayudar a optimizar el diagnóstico del SAA. Se demostró que la presencia de un aneurisma aórtico conocido y de insuficiencia valvular aórtica de nueva aparición aumentan significativamente la probabilidad de SAA. Se necesitan más estudios para establecer una regla de predicción clínica.(AU)

Background and objective: Acute aortic syndrome (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the emergency department, specifically computerized tomography of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings. Materials and methods: After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses. Results: 130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known aortic aneurysm (P=.021, 95% CI 1.2–9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur (P=.019, 95% CI 1.3–20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock (P=.02, 95% CI 1.2–8.5). Conclusion: The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.(AU)

Improvement in the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors.

BACKGROUND AND OBJECTIVE: Acute aortic syndrome (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the emergency department, specifically computerized tomography of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings. MATERIALS AND METHODS: After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses. RESULTS: 130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known aortic aneurysm (P = .021, 95% CI 1.2-9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur (P = .019, 95% CI 1.3-20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock (P = .02, 95% CI 1.2-8.5). CONCLUSION: The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.

Tomografía computarizada coronaria en urgencias: importancia de la experiencia del radiólogo / Coronary computed tomography in emergencies: the importance of the radiologist's experience

Introducción: La incorporación de la angiografía coronaria por tomografía computarizada (ACTC) a la atención sanitaria en las urgencias hospitalarias hace necesaria una adecuada capacitación para la interpretación de esta prueba de imagen. Esta capacitación puede afectar al grado de concordancia interobservador de los radiólogos que evalúan dichos estudios. Objetivo: Evaluar la concordancia interobservador en función de la experiencia en la interpretación de ACTC realizadas a pacientes que acuden a urgencias por dolor torácico agudo (DTA) con probabilidad baja-intermedia de síndrome coronario agudo (SCA). Materiales y método: Estudio de concordancia interobservador en la evaluación de ACTC realizadas en contexto urgente utilizando CAD-RADS como registro de resultados. Se crearon parejas de observadores entre un total de 8 evaluadores (4 staff y 4 en formación). Se estimó el grado de concordancia global y entre subgrupos de acuerdo con su experiencia mediante el coeficiente kappa. Resultados: La concordancia fue sustancial entre radiólogos experimentados y en formación (k= 0,627; IC95%: 0,436-0,826), así como para todas las parejas de evaluadores (k=0,661; IC95%: 0,506-0,823) para todas las categorías CAD-RADS en conjunto. El grado de acuerdo del grupo de radiólogos experimentados fue superior al de los radiólogos en formación en todos los análisis realizados. La concordancia fue excelente para CAD-RADS global (k= 0,950; IC95%: 0,896-1) y para CAD-RADS ≥ 4 (k = 1), observando un menor acuerdo para CAD-RADS ≥ 3 (k= 0,754; IC95%: 0,246-1,255). Los valores del personal en formación para estas categorías fueron k= 0,623, k= 0,596 y k= 0,473, respectivamente. Conclusión: La concordancia entre radiólogos staff en la evaluación de ACTC realizadas a pacientes en el contexto de urgencias es excelente. El grado de acuerdo es menor cuando el personal inexperto forma parte de las parejas analizadas...(AU)

Introduction: Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists’ skills can affect the interobserver agreement in evaluating these studies. Objective: To determine the interobserver agreement according to radiologists’ experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome. Materials and methods: We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience. Results: The agreement was substantial between experienced radiologists and residents (k = 0.627; 95%CI: 0.436 – 0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506 – 0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896 – 1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k = 0.754; 95% CI: 0.246 – 1.255). The agreement for the residents for these categories was k= 0.623, k=0.596, and k=0.473, respectively. Conclusion: The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists...(AU)

Coronary computed tomography in emergencies: The importance of the radiologist's experience.

INTRODUCTION: Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists' skills can affect the interobserver agreement in evaluating these studies. OBJECTIVE: To determine the interobserver agreement according to radiologists' experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome. MATERIALS AND METHODS: We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience. RESULTS: The agreement was substantial between experienced radiologists and residents (k=0.627; 95%CI: 0.436-0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506-0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896-1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k=0.754; 95% CI: 0.246-1.255). The agreement for the residents for these categories was k=0.623, k=0.596, and k=0.473, respectively. CONCLUSION: The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists. These findings should be taken into consideration when implementing coronary CTA in emergency departments and in the organisation of radiological staff for interpreting and reporting this imaging test.

Obesity and female sexual dysfunctions: A systematic review of prevalence with meta-analysis.

Obesity represents a major global health challenge. Female sexual dysfunctions have a negative impact on quality of life and overall health balance. A higher rate of female sexual dysfunctions in obese women has been suggested. This systematic review summarized the literature on female sexual dysfunction prevalence in obese women. The review was registered (Open Science Framework OSF.IO/7CG95) and a literature search without language restrictions was conducted in PubMed, Embase and Web of Science, from January 1990 to December 2021. Cross-sectional and intervention studies were included, the latter if they provided female sexual dysfunction rate data in obese women prior to the intervention. For inclusion, studies should have used the female sexual function index or its simplified version. Study quality was assessed to evaluate if female sexual function index was properly applied using six items. Rates of female sexual dysfunctions examining for differences between obese vs class III obese and high vs low quality subgroups were summarized. Random effects meta-analysis was performed, calculating 95% confidence intervals (CI) and examining heterogeneity with I2 statistic. Publication bias was evaluated with funnel plot. There were 15 relevant studies (1720 women participants in total with 153 obese and 1567 class III obese women). Of these, 8 (53.3%) studies complied with >4 quality items. Overall prevalence of female sexual dysfunctions was 62% (95% CI 55-68%; I2 85.5%). Among obese women the prevalence was 69% (95% CI 55-80%; I2 73.8%) vs 59% (95% CI 52-66%; I2 87.5%) among those class III obese (subgroup difference p=0.15). Among high quality studies the prevalence was 54% (95% CI 50-60%; I2 46.8%) vs 72% (95% CI 61-81%; I2 88.0%) among low quality studies (subgroup difference p=0.002). There was no funnel asymmetry. We interpreted that the rate of sexual dysfunctions is high in obese and class III obese women. Obesity should be regarded as a risk factor for female sexual dysfunctions.

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For the first time, the (d,^{2}He) reaction was successfully used in inverse kinematics to extract the Gamow-Teller transition strength in the ß^{+} direction from an unstable nucleus. The new technique was made possible by the use of an active-target time-projection chamber and a magnetic spectrometer, and opens a path to addressing a range of scientific challenges, including in astrophysics and neutrino physics. In this Letter, the nucleus studied was ^{14}O, and the Gamow-Teller transition strength to ^{14}N was extracted up to an excitation energy of 22 MeV. The data were compared to shell-model and state-of-the-art coupled-cluster calculations. Shell-model calculations reproduce the measured Gamow-Teller strength distribution up to about 15 MeV reasonably well, after the application of a phenomenological quenching factor. In a significant step forward to better understand this quenching, the coupled-cluster calculation reproduces the full strength distribution well without such quenching, owing to the large model space, the inclusion of strong correlations, and the coupling of the weak interaction to two nucleons through two-body currents.

Revisiones sistemáticas en cinco pasos: V. Cómo interpretar la evidencia / Systematic reviews in five steps: V. Interpreting the findings

El último paso en una revisión sistemática es interpretar la evidencia de forma que pueda ser útil para sustentar la toma de resultados. Es importante presentar los resultados de forma claramente diferenciada, asignar el nivel de fuerza de la evidencia que respalda cada uno de ellos teniendo en cuenta factores como el diseño de los estudios, su calidad metodológica y el sesgo de publicación. También es necesario considerar las variaciones en la fuerza de la asociación. El objetivo es detectar en qué tipo de pacientes la intervención analizada será más o menos efectiva, tendrá mayor o menor impacto una exposición determinada, o será de mayor utilidad una prueba diagnóstica. En esta fase, para facilitar la interpretación de los resultados, se puede añadir una estimación de la magnitud de la asociación, bien global o bien estratificada en función de las características de los participantes. Toda esta información ayudará a la hora de formular recomendaciones prácticas con utilidad clínica. (AU)

The last step in a systematic review is the interpretation of the findings. The important findings need to be explicitly identified. A level of strength of evidence should be assigned to support each key finding, based on factors such as study design, methodological quality and risk of publication bias. Variations in the magnitude of associations observed also need to be explored. The aim of this analysis is to determine in which clinical groups the intervention is more or less effective, the impact of exposure is greater or lesser, or a diagnostic test is more useful. At this stage, for better interpretation of the findings, the magnitude of the association can be estimated either globally or stratified according to the characteristics of the participants. All this is helpful in formulating recommendations for clinical practice and policy. (AU)

Developmental light deprivation transiently reduces the expression of vGluT2 and GluN2B in the rat ventral suprachiasmatic nucleus.

The suprachiasmatic nucleus (SCN) is the most important circadian clock in mammals. The SCN synchronizes to environmental light via the retinohypothalamic tract (RHT), which is an axon cluster derived from melanopsin-expressing intrinsic photosensitive retinal ganglion cells. Investigations on the development of the nonimage-forming pathway and the RHT are scarce. Previous studies imply that light stimulation during postnatal development is not needed to make the RHT functional at adult stages. Here, we examined the effects of light deprivation (i.e., constant darkness (DD) rearing) during postnatal development on the expression in the ventral SCN of two crucial proteins for the synchronization of circadian rhythms to light: the presynaptic vesicular glutamate transporter type 2 (vGluT2) and the GluN2B subunit of the postsynaptic NMDA receptor. We found that animals submitted to DD conditions exhibited a transitory reduction in the expression of vGluT2 (at P12-19) and of GluN2B (at P7-9) that was compensated at older stages. These findings support the hypothesis that visual stimulation during early ages is not decisive for normal development of the RHT-SCN pathway.

[Systematic reviews in five steps: V. Interpreting the findings]. / Revisiones sistemáticas en cinco pasos: V. Cómo interpretar la evidencia.

The last step in a systematic review is the interpretation of the findings. The important findings need to be explicitly identified. A level of strength of evidence should be assigned to support each key finding, based on factors such as study design, methodological quality and risk of publication bias. Variations in the magnitude of associations observed also need to be explored. The aim of this analysis is to determine in which clinical groups the intervention is more or less effective, the impact of exposure is greater or lesser, or a diagnostic test is more useful. At this stage, for better interpretation of the findings, the magnitude of the association can be estimated either globally or stratified according to the characteristics of the participants. All this is helpful in formulating recommendations for clinical practice and policy.

Preliminary study of elastic-tension digital neoprene orthoses for proximal interphalangeal joint flexion contracture.

Flexion contracture of the proximal interphalangeal joint (PIPJ) is one of the most frequent complications in finger trauma. Orthoses are the most widely used method to optimize total end-range time (TERT). No previous studies showed that an elastic tension orthosis could be applied for longer than 12 h. We aimed to demonstrate that the elastic-tension digital neoprene orthosis (ETDNO) can achieve higher TERT and therefore better range of motion than other elastic-tension orthoses (ETO) described in the literature. A prospective study of treatment of PIPJ flexion contracture included 10 PIP joints in 8 patients who met the selection criteria. They were instructed to use the ETDNO for around 23 h per day as far as possible, during a period of 3 weeks. Patients reported a mean TERT of 20.6 h a day. PIPJ contracture improved by a mean Torque Range of Motion (TROM) of 23.5° at 500 g and 22.9° at 800 g of passive extension force during the 3-week treatment. Based on the results of this study, the ETDNO appears to offer a highly effective approach for improving PIPJ flexion contracture, increasing range of motion in extension. ETDNO's efficacy probably lies in the significantly improved comfort and low-profile design, enabling excellent compliance and thus optimizing TERT. LEVEL OF EVIDENCE: Level III.

Revisiones sistemáticas en cinco pasos: IV. Cómo sintetizar los resultados / Systematic reviews in five steps: IV. Summarizing the evidence

En este artículo, el cuarto de una serie de cinco sobre revisiones sistemáticas, se muestra cómo recopilar y resumir los resultados de los estudios incluidos en una revisión. La síntesis de los datos extraídos consiste en tabular las características y la calidad de los estudios incluidos, y resumir los efectos y la magnitud de las asociaciones encontradas. Opcionalmente pueden utilizarse métodos estadísticos para explorar la heterogeneidad y sus fuentes. La magnitud de la heterogeneidad puede plantear la duda de si es viable realizar un metaanálisis general o es preferible hacerlo en subgrupos. Por último, se proporcionan recursos para evaluar las razones clínicas y metodológicas de la heterogeneidad (AU)

This fourth in a series of five articles on systematic reviews demonstrates how to compile and summarize the results of the studies included in a review. The synthesis of the extracted data consists of tabulating the characteristics, and the quality of the included studies, with the effects or the magnitude of the associations found in them. Statistical methods can be used to explore the differences between studies and the reasons for the inconsistencies. The magnitude of this heterogeneity influences whether it is feasible to perform an overall or subgroup meta-analysis. Finally, information is provided both to assessment of clinical and methodological reasons for heterogeneity (AU)

Revisiones sistemáticas en cincopasos: III. Cómo evaluar la calidad de los estudios / Systematic reviews in fivesteps: III. Assessing the quality of the literature

La evaluación de la calidad de los estudios desempeña un papel fundamental en cada paso del proceso de realización de una revisión sistemática. Para realizar una evaluación precisa se utilizan listas de comprobación que incluyen las cuestiones genéricas relevantes al diseño de los estudios incluidos en la revisión. Los elementos de la lista utilizada pueden modificarse en relación con los componentes específicos que definen la pregunta de la revisión. La evaluación de calidad se utiliza para describir los estudios seleccionados, explicar la heterogeneidad, decidir acerca de la idoneidad de un metaanálisis, evaluar la solidez de la evidencia recopilada (existencia de sesgos) y formular recomendaciones para futuras investigaciones (AU)

Study quality assessment plays a key role in every step of the process when conducting a systematic review. Checklists are used to perform an accurate quality assessment. They include generic questions relevant to the design of the studies included in the review. The checklist items can be modified in relation to the question-specific components related to participants, interventions and outcomes. Quality assessment is used to describe the selected studies, explain heterogeneity, decide on the feasibility of undertaking a meta-analysis, assess the strength of the collated evidence, and make recommendations for future research (AU)

Revisiones sistemáticas en cinco pasos: II. Cómo identificar los estudios relevantes / Systematic reviews in five steps: II. Identifying relevant literature

Este artículo, el segundo de la serie de revisiones sistemáticas, se centra en lo que debería ser el segundo paso: cómo identificar y seleccionar los estudios relevantes para la revisión planificada. La búsqueda bibliográfica, en la que se emplean términos relacionados con la pregunta formulada en el primer paso, habrá de ser exhaustiva y amplia. Es importante establecer criterios de selección para incluir los estudios relevantes y descartar aquellos que no responden a la pregunta formulada. Detalles como ampliar el espectro de bases de datos consultadas, evitar restringir las búsquedas a un solo idioma, gestionar correctamente las referencias y registrar las decisiones tomadas durante todo el proceso son factores ganadores para que la identificación de estudios sea satisfactoria (AU)

This article focuses on the second step of a systematic review, i.e. how to identify relevant studies for the planned review. The search, using terms related to the questions framed in the previous step, should be comprehensive. However, it is important to establish selection criteria to include relevant studies and to exclude those that might present a risk of bias at this stage. Details such as broadening the spectrum of electronic databases consulted, avoiding restricting searches to a single language, managing references correctly, and recording decisions made throughout the process are winning factors for successful study identification (AU)

Dendrodacrys: a new genus for species with branched hyphidia in Dacrymyces s.l., with the description of four new species.

A new genus named Dendrodacrys is proposed for a monophyletic group in Dacrymycetaceae, containing species with pulvinate to depressed basidiocarps, distinctly branched hymenial hyphidia, and up to 3-septate mature basidiospores. Four taxa in this group, occurring in Europe, are proposed as new species, viz. De. ciprense, De. concrescens, De. ellipsosporum, and De. oblongisporum, based both on morphological and DNA data (nrDNA, RPB1, RPB2, TEF-1α, 12S). These new species are all described in detail, illustrated, and compared with other published taxa that with which they can be confounded. The new combination De. paraphysatum is proposed after revising the type material of Dacrymyces paraphysatus, but other combinations or potentially new non-European species descriptions are postponed pending further studies of additional specimens. Citation: Zamora JC, Savchenko A, González-Cruz Á, Prieto-García F, Olariaga I, Ekman S (2022). Dendrodacrys: a new genus for species with branched hyphidia in Dacrymyces s.l., with the description of four new species. Fungal Systematics and Evolution 9: 27-42. doi: 10.3114/fuse.2022.09.04.

Revisiones sistemáticas en cinco pasos: I. Cómo formular una pregunta para la que se pueda obtener una respuesta válida / Systematic reviews in five steps: I. Framing questions to obtain valid answers

Este es el primero de una serie de cinco artículos en los que se describen los pasos a seguir para realizar, con éxito, una revisión sistemática. En este primer artículo se aborda el primer paso: ¿cómo formular correctamente la pregunta previa a una revisión sistemática? En él se va a tratar cómo estructurar la pregunta de forma adecuada en función de los componentes principales: los participantes, las intervenciones o exposiciones comparadas, el desenlace y el diseño de los estudios; cómo detectar y considerar las posibles variaciones en cada uno de los componentes que puedan surgir antes o durante la revisión, y finalmente, cómo, dónde y por qué es conveniente registrar el protocolo de la revisión sistemática (AU)

This is the first in a series of five articles on the steps to follow to conduct a successful systematic review. This first article addresses how to formulate the right questions to initiate a systematic review. The key issues are: how to structure the questions appropriately according to the main components: the participants, the interventions or exposures compared, the outcomes measured and the study design; how to anticipate and consider possible variations in each of the components that may arise during the review; and finally, how to prospectively register the protocol of the systematic review (AU)

Evidence of a Near-Threshold Resonance in

A narrow near-threshold proton-emitting resonance (E_{x}=11.4 MeV, J^{π}=1/2^{+}, and Γ_{p}=4.4 keV) was directly observed in ^{11}B via proton resonance scattering. This resonance was previously inferred in the ß-delayed proton emission of the neutron halo nucleus ^{11}Be. The good agreement between both experimental results serves as a ground to confirm the existence of such exotic decay and the particular behavior of weakly bound nuclei coupled to the continuum. R-matrix analysis shows a sizable partial decay width for both, proton and α (Γ_{α}=11 keV) emission channels.

[Systematic reviews in fivesteps: III. Assessing the quality of the literature]. / Revisiones sistemáticas en cincopasos: III. Cómo evaluar la calidad de los estudios.

Study quality assessment plays a key role in every step of the process when conducting a systematic review. Checklists are used to perform an accurate quality assessment. They include generic questions relevant to the design of the studies included in the review. The checklist items can be modified in relation to the question-specific components related to participants, interventions and outcomes. Quality assessment is used to describe the selected studies, explain heterogeneity, decide on the feasibility of undertaking a meta-analysis, assess the strength of the collated evidence, and make recommendations for future research.

[Systematic reviews in five steps: I. Framing questions to obtain valid answers]. / Revisiones sistemáticas en cinco pasos: I. Cómo formular una pregunta para la que se pueda obtener una respuesta válida.

This is the first in a series of five articles on the steps to follow to conduct a successful systematic review. This first article addresses how to formulate the right questions to initiate a systematic review. The key issues are: how to structure the questions appropriately according to the main components: the participants, the interventions or exposures compared, the outcomes measured and the study design; how to anticipate and consider possible variations in each of the components that may arise during the review; and finally, how to prospectively register the protocol of the systematic review.

REMOVED: Treatment with Ivermectin Is Associated with Decreased Mortality in COVID-19 Patients: Analysis of a National Federated Database.

 : This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the authors. The abstract was presented as a poster in the IMED last year. Our study was about the association of Ivermectin with reduction in mortality in COVID, a retrospective study with many limitations (which is innate in these types of studies). As in any retrospective study, we could not control for all the confounding variables, mainly severity of disease in patients treated with either ivermectin or remdesivir. Another important caveat is that it was conducted in July 2021, eight months ago, when we did not have all the clinical evidence we have right now about ivermectin in COVID-19. We were very clear in the abstract conclusions that our results are only showing an "association", they are not definitive, and further randomized clinical trials must be done to prove the efficacy of Ivermectin. However, the study has been misinterpreted by a significant number of people in the scientific community and the general population, stating that based on our study, ivermectin is effective to reduce COVID-19 mortality. We are really concerned about this problem because the patients may start taking or demanding this medication from their physicians, which can potentially be harmful. We know that a retrospective study like ours cannot be used to change or guide clinical practice. Retrospective studies are only helpful to formulate hypothesis that can be utilized to design clinical trials. This misrepresentation of the study may lead to a huge public health problem, since Ivermectin is a medication that is not FDA approved for COVID treatment, and currently has proven to be ineffective in clinical trials, which are truly the gold standard to evaluate the efficacy of a medication.