Pilates vs aerobic training effects in hypertensives: randomized trial / Efectos del pilates vs entrenamiento aeróbico en hipertensos: ensayo aleatorizado / Efeitos do pilates vs treinamento aeróbio em hipertensos: ensaio randomizado

ABSTRACT Introduction: The Pilates method (PM) combines slow-deep breathing with strengthening and stretching exercises. However, it has been proposed as a method of physical conditioning for several decades and only recently aroused academic/scientific interest, with few reports of the effects of this intervention in hypertensive patients. Objective: to compare PM to aerobic training (AT) effects on hypertensive subjects' blood pressure (BP), functional capacity and autonomic balance. Methods: Twenty-four hypertensive subjects were randomly allocated into two groups: ATG performed three 40 min sessions/week, moderate intensity (40-70% of reserve HR), and PMG performed two 60 min sessions/week; both during the same eight weeks period. Blood pressure (casual and for 24 hours), 6-minute walking test (6-MWT) and autonomic balance were evaluated before and after intervention. Results: There was a reduction on systolic BP (SBP, p=0.007), diastolic (p=0.032) and mean blood pressure (MBP, p=0.016), measured on 24h, on PMG. There was also a 24h SBP reduction on ATG (p=0.021). The PMG had a greater reduction on 24h SBP (-3.4 mmHg, 95% CI -6.6 to -0.2) and MBP (-3.3 mmHg, 95% CI -6.3 to -0.3) than the ATG. ATG held a longer distance in 6-MWT. Casual BP and autonomic balance had no difference. Conclusion: This PM protocol was superior to AT on BP monitored for 24 hours in hypertensive subjects, but AT was better for functional capacity. The eight weeks of training were not enough to change the autonomic balance. Level of Evidence: I; High-quality randomized clinical trial with or without statistically significant difference, but with narrow confidence intervals.

RESUMEN Introducción: el método Pilates (MP) combina la respiración lenta-profunda con ejercicios de fortalecimiento y estiramiento. Aunque se ha propuesto como un método de acondicionamiento físico durante varias décadas, solo recientemente despertó interés académico/científico, con pocos reportes de los efectos de esta intervención en pacientes hipertensos. Objetivo: comparar los efectos del MP con el entrenamiento aeróbico (EA) sobre la presión arterial (PA), la capacidad funcional y el equilibrio autónomo en sujetos hipertensos. Métodos: Veinticuatro sujetos hipertensos fueron asignados aleatoriamente en dos grupos: GEA realizó tres sesiones de 40 min/semana, intensidad moderada (40-70% de la FC de reserva), y GMP realizó dos sesiones de 60 min/semana; ambos durante el mismo período de 8 semanas. La presión arterial (casual y durante 24 horas), la prueba de marcha de 6 minutos y el equilibrio autonómico se evaluaron antes y después de la intervención. Resultados: Hubo una reducción de la PA sistólica (PAS, p = 0,007), diastólica (p = 0,032) y presión arterial media (PAM, p = 0,016), medida a las 24 h, en GMP. También hubo una reducción de PAS en 24 h en GEA (p = 0,021). El GMP tuvo una mayor reducción en la PAS de 24 h (-3,4 mmHg, CI del 95%: -6,6 a -0,2) y la PAM (-3,3 mmHg, CI del 95%: -6,3 a -0,3) que la GEA. GEA mantuvo una mayor distancia en la prueba de marcha de 6 minutos. La PA casual y el equilibrio autónomo no tuvieron diferencias. Conclusión: Este protocolo de MP fue superior al EA en la PA monitoreada durante 24 horas en sujetos hipertensos, pero el EA fue mejor para la capacidad funcional. Las ocho semanas de entrenamiento no fueron suficientes para cambiar el equilibrio autonómico. Nivel de Evidencia: I; Estudio clínico aleatorizado de alta calidad con o sin diferencia estadísticamente significativa, pero con intervalos de confianza estrechos.

RESUMO Introdução: O método Pilates (MP) combina respiração lenta e profunda com exercícios de fortalecimento e alongamento. Embora tenha sido proposto como método de condicionamento físico por várias décadas, só recentemente despertou-se o interesse acadêmico/científico, com poucos relatos dos efeitos dessa intervenção em hipertensos. Objetivos: comparar os efeitos do MP com o treinamento aeróbio (TA) sobre a pressão arterial (PA), capacidade funcional e equilíbrio autonômico em hipertensos. Métodos: Vinte e quatro hipertensos foram alocados aleatoriamente em dois grupos: O grupo GTA realizou três sessões de 40 min/semana, intensidade moderada (40-70% da FC de reserva), e o grupo GMP, que realizou duas sessões de 60 min/semana; ambos durante o mesmo período de 8 semanas. A pressão arterial (casual e após 24 horas), o teste de caminhada de 6 minutos (TC6) e o equilíbrio autonômico foram avaliados antes e depois da intervenção. Resultados: Houve redução da PA sistólica (PAS, p = 0,007), diastólica (p = 0,032) e da pressão arterial média (PAM, p = 0,016), medida em 24h, sem GMP. Também houve redução da PAS em 24h no GTA (p = 0,021). O GMP teve uma redução maior em 24h PAS (-3,4 mmHg, IC 95% -6,6 a -0,2) e PAM (-3,3 mmHg, IC 95% -6,3 a -0,3) do que o GTA. O GTA manteve uma maior distância no TC6. A PA casual e o equilíbrio autonômico não apresentaram diferenças estatísticas. Conclusão: Este protocolo de MP foi superior ao TA na PA monitorada por 24 horas em hipertensos, porém o TA foi superior para a capacidade funcional. As oito semanas de treinamento não foram suficientes para alterar o equilíbrio autonômico. Nível de Evidência: 1; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significativa, mas com intervalos de confiança estreitos.

Multiview intelligent networking based on the genetic evolution algorithm for precise 3D measurements.

The use of multi-visual network 3D measurements is increasing; however, finding ways to apply low-cost industrial cameras to achieve intelligent networking and efficient measurement is a key problem that has not been fully solved. In this paper, the multivision stereo vision 3D measurement principle and multivision networking process constraints are analyzed in depth, and an intelligent networking method based on the genetic evolution algorithm (GEA) is proposed. The genetic operation is improved, and the fitness function is dynamically calibrated. Based on the visual sphere model, the best observation distance is assigned as the radius of the visual sphere, and the required constraints are fused to establish an intelligent networking design of the centering multivision. A simulation and experiment show that the proposed algorithm is widely feasible, and its measurement accuracy meets the requirements of the industrial field. Our multiview intelligent networking algorithms and methods provide solid theoretical and technical support for low-cost and efficient on-site 3D measurements of industrial structures.

Treatment of Ruptured Wide-Necked Aneurysms Using A Microcatheter Injectable Biomaterial.

Ruptured wide-neck aneurysms (WNAs), especially in a setting of coagulopathy, are associated with significant morbidity and mortality. We show that by trapping a sub-millimeter clinical catheter inside the aneurysm sac using a flow diverter stent (FDS), we can achieve instant hemostasis by filling the aneurysm sac using a novel biomaterial rescuing catastrophic bleeding in large animal models. Here, multiple formulations of a biomaterial comprising gelatin, nanoclay, and iohexol were developed, optimized, and extensively tested in vitro to select the lead candidate for further testing in vivo in rat, porcine and canine models of WNAs, including in a subset with aneurysm rupture. The catheter-injectable and x-ray visible versions of the gel embolic agent (GEA) with the optimized mechanical properties outperformed control groups, including a subset that received a clinically used liquid embolic (Onyx, Medtronic), with and without aneurysm rupture. A combinatorial approach to ruptured WNAs with GEA and FDS may change the standard of medical practice and save lives. This article is protected by copyright. All rights reserved.

A prospective Canadian gastroesophageal cancer database: What have we learned?

BACKGROUND: Minimal literature exists on outcomes for Canadian patients with gastroesophageal adenocarcinoma (GEA). The objective of our study was to establish a prospective clinical database to evaluate demographic characteristics, presentation and outcomes of patients with GEA. METHODS: Patients diagnosed with GEA were recruited from Jan. 30, 2017, to Aug. 30, 2020. Data collected included demographic characteristics, presentation, treatment and survival. A multivariable model for overall survival in patients treated with curative intent was created using sex, lymph node status, resection margin status, age and tumour location as variables. RESULTS: A total of 122 patients with adenocarcinoma of the stomach or gastroesophageal junction were included. Median age was 65 years (interquartile range [IQR] 59-74), 70% of patients were male and 26% were born outside of Canada. Median follow-up time was 14.5 (IQR 8.0-31.0) months. Following staging computed tomography scanning, 88% of patients were deemed to have potentially resectable disease. Eighty-one (76%) received staging laparoscopy and 74 (61%) were treated with curativeintent surgery. Forty-six (62%) patients had nodal metastases. The median number of nodes harvested was 22 (IQR 18-30). The R0 resection margin rate was 82%. The 3-year overall survival for patients who received curative-intent treatment was 63% and 38% for all patients. On multivariable analysis, female sex (hazard ratio [HR] 3.88, p = 0.01), positive nodal status (HR 3.58, p = 0.02), positive margins (HR 3.11, p = 0.03) and tumour location (HR 3.00, p = 0.03) were associated with decreased overall survival. CONCLUSION: Many of the patients with GEA in this study presented with advanced disease, and only 61% were offered curative-intent surgery. A prospective multicentre national GEA database is now being established.

Evaluation of a single-use disk stack centrifuge for improved efficiency and sustainability at 1000 L GMP manufacturing scale.

Direct depth filtration is an established technology for single-use harvest operation. Advantages of direct depth filtration include familiarity with depth filtration in downstream processes and simplicity of the operation. Drawbacks include low capacity, large footprint, labor-intensive set-up, high water use, and high waste in the form of discarded filters. Single-use centrifugation is emerging as an alternative to depth filtration for the single-use harvest step. Within the single-use centrifugation space, disc stack centrifugation represents the newest entrant. In this study, we evaluated the performance of the GEA kytero single-use disc stack centrifuge to clarify two monoclonal antibody-producing cell culture fluids. The separation performance of the GEA kytero centrifuge varied between the two cell culture fluids, with differences in centrate turbidity and centrate filterability measured. A comparison was then performed to determine resource savings, compared to direct two-stage depth filtration, when using a GEA kytero centrifuge to harvest a 1000 L bioreactor. The analysis concluded that replacement of the first stage of depth filters with a GEA kytero centrifuge has the potential to decrease the required second stage depth filtration area by up to 80%. The decrease in depth filter area resulting from the use of the GEA kytero would result in a decrease in the harvest step footprint, a decrease in buffer volume required to prime and rinse depth filters, and a decrease in the volume of plastic waste. An economic comparison of the GEA kytero single-use centrifuge against a direct depth filtration step found that for a 1000 L harvest step, the GEA kytero centrifuge may reduce costs by up to 20% compared with two-stage direct depth filtration.

Efficacy of ultrasound guided superior laryngeal nerve block on sedation for delayed extubation in maxillofacial surgery with free flap reconstruction.

OBJECTIVE: Superior laryngeal nerve block (SLNB) is a regional anesthesia technique for addressing airway response. However, SLNB on the efficacy of sedation in patients with delayed extubation is unknown, particularly for maxillofacial surgery (MS). The aim of the study was to assess whether ultrasound guided (UG) SLNB reduces the incidence of moderate to severe cough for delayed extubation in MS with free flap reconstruction. METHODS: 60 patients were randomly assigned to the GEA group (control group) and the SLNB group (UG-SLNB postoperatively, study group). During the initial two postoperative hours, the incidence of moderate and severe cough, agitation, and the number of patients requiring rescue propofol and flurbiprofen were recorded. Additionally, the time spent under the target level of sedation, postoperative hemodynamics, and the total does of propofol during the postoperative 24 h were recorded. RESULTS: The data showed the SLNB group had a significantly lower incidence of moderate to severe cough and agitation (p < 0.05), and a longer sedation time (p < 0.05). The number of patients required rescue propofol and flurbiprofen, as well as the hemodynamic changes, were significantly different between the two groups (p < 0.05). CONCLUSION: The use of UG-SLNB is associated with reduced incidence of postoperative cough. Moreover, SLNB can enhance the efficacy of postoperative sedation with need of fewer agents postoperatively. CLINICAL TRIAL REGISTRATION: ChiCTR2000039982.

An appraisal to hydrochemical characterization, source identification, and potential health risks of sulfate and nitrate in groundwater of Bemetara district, Central India.

Gypsum-enriched aquifers (GEA) and intensive agriculture regions (IAR) in semi-arid regions are responsible for very high amounts of sulfate and nitrate in many groundwater systems of the world, respectively. However, in such regions, the problem of nitrate pollution and its associated health risk has been increasing and emerging as a global issue. However, along with nitrate, sulfate contamination and its potential health risks are often neglected worldwide in these regions. Therefore, considering sulfate along with nitrate as a significant threat to water quality in such regions, this study aimed to characterize hydrochemistry, factors controlling groundwater quality, and assessment of risk to human health. To accomplish this objective, 116 groundwater samples were collected over pre-monsoon (PRM) and post-monsoon (POM) (2019) seasons in Bemetara district. As per Bureau of Indian standards (BIS) for drinking, SO42- (28 and 19%) and NO3- (7 and 35%) exceeded the permissible limits in PRM and POM seasons, respectively; thereby, groundwater was not suitable for drinking. SO42- and NO3- pollution sources were identified and mainly attributed to gypsum dissolution and agricultural activities as well as domestic sewage discharge, respectively. In addition, SO42-and NO3- risk assessment results show that total 20% to 46% of all samples surpassed the permissible limit (HQ = 1) of risk to children and adults, over both seasons. To ensure drinking water security in this region, sustainable management of agricultural activities and treatment should be done to reduce the potential health risks due to SO42- and NO3-.

Fractional CO2 laser versus 1064-nm long-pulsed Nd:YAG laser for inflammatory acne vulgaris treatment: a randomized clinical trial.

Acne vulgaris is challenging to treat for several individuals. Laser therapy may be a desirable alternative to traditional therapies with limited success. This study aimed to assess efficacy of fractional CO2 laser versus Nd:YAG laser for acne vulgaris therapy. Thirty cases with acne vulgaris underwent both fractional CO2 laser and Nd: YAG laser treatments in a randomized split face design at a 14-day interval for four sessions. The clinical efficacy was evaluated by counting acne lesions and utilizing the Global Acne Severity Scale (GEA Scale). GEAs decreased significantly after both fractional CO2 and Nd:YAG modalities after treatment and at a 3-month follow-up; fractional CO2 demonstrated significant more decrease in GEAs with (P = 0.006, 0.00 (respectively. Moreover, fractional CO2 showed a significantly higher satisfaction level (P = 0.004) and a better clinical improvement percentage regarding inflammatory and noninflammatory acne lesions (P = 0.007 and 0.000, respectively) after 3 months of follow-up. Apart from transient erythema, there were insignificant adverse effects concerning both treated sides. Fractional CO2 and Nd:YAG lasers are efficient physical modalities of acne treatment. However, fractional CO2 laser was more effective and more satisfying to the patients.

Warming appears as the main risk of non-adaptedness for western Mediterranean relict fir forests under expected climate change scenarios.

Circum-Mediterranean firs are considered among the most drought-sensitive species to climate change. Understanding the genetic basis of trees' adaptive capacity and intra-specific variability to drought avoidance is mandatory to define conservation measures, thus potentially preventing their extinction. We focus here on Abies pinsapo and Abies marocana, both relict tree species, endemic from south Spain and north Morocco, respectively. A total of 607 samples were collected from eight nuclei: six from Spanish fir and two from Moroccan fir. A genotyping by sequencing technique called double digestion restriction site-associated DNA sequencing (ddRAD-seq) was performed to obtain a genetic matrix based on single-nucleotide polymorphisms (SNPs). This matrix was utilized to study the genetic structure of A. pinsapo populations and to carry out selection signature studies. In order to understand how Spanish fir and Moroccan fir cope with climate change, genotype-environment associations (GEAs) were identified. Further, the vulnerability of these species to climate variations was estimated by the risk of non-adaptedness (RONA). The filtering of the de novo assembly of A. pinsapo provided 3,982 SNPs from 504 out of 509 trees sequenced. Principal component analysis (PCA) genetically separated Grazalema from the rest of the Spanish populations. However, FST values showed significant differences among the sampling points. We found 51 loci potentially under selection. Homolog sequences were found for some proteins related to abiotic stress response, such as dehydration-responsive element binding transcription factor, regulation of abscisic acid signaling, and methylation pathway. A total of 15 associations with 11 different loci were observed in the GEA studies, with the maximum temperature of the warmest month being the variable with the highest number of associated loci. This temperature sensitivity was also supported by the risk of non-adaptedness, which yielded a higher risk for both A. pinsapo and A. marocana under the high emission scenario (Representative Concentration Pathway (RCP) 8.5). This study sheds light on the response to climate change of these two endemic species.

Adaptive divergence and genetic vulnerability of relict species under climate change: a case study of Pterocarya macroptera.

BACKGROUND AND AIMS: Understanding adaptive genetic variation and whether it can keep pace with predicted future climate change is critical in assessing the genetic vulnerability of species and developing conservation management strategies. The lack of information on adaptive genetic variation in relict species carrying abundant genetic resources hinders the assessment of genetic vulnerability. Using landscape genomics approach, this study aimed to determine how adaptive genetic variation shapes population divergence and predict the adaptive potential of Pterocarya macroptera (a vulnerable relict species in China) under future climate scenarios. METHODS: We applied restriction site-associated DNA sequencing (RAD-seq) to obtain 8,244 single nucleotide polymorphisms (SNPs) from 160 individuals across 28 populations. We examined the pattern of genetic diversity and divergence, and then identified outliers by genetic differentiation (FST) and genotype-environment association (GEA) methods. We further dissected the effect of geographic/environmental gradients on genetic variation. Finally, we predicted genetic vulnerability and adaptive risk under future climate scenarios. KEY RESULTS: We identified three genetic lineages within P. macroptera: the Qinling-Daba-Tianmu Mountains (QDT), Western Sichuan (WS), and Northwest Yunnan (NWY) lineages, which showed significant signals of isolation by distance (IBD) and isolation by environment (IBE). IBD and IBE explained 3.7-5.7% and 8.6-12.8% of the genetic structure, respectively. The identified GEA SNP-related genes were involved in chemical defence and gene regulation and may exhibit higher genetic variations to adapt to the environment. Gradient forest analysis revealed that the genetic variation was mainly shaped by temperature-related variables, indicating its adaptation to local thermal environments. A limited adaptive potential was suggested by the high levels of genetic vulnerability in marginal populations. CONCLUSIONS: Environmental gradient mainly shaped the population differentiation of P. macroptera. Marginal populations may be at high risk of extinction, and thus, proactive management measures, such as assisted gene flow, are required to ensure the survival of these populations.

UV-polymerizable methacrylated gelatin (GelMA)-based hydrogel containing tannic acids for wound healing.

Gelatin-based photopolymerizable methacrylate hydrogel (GelMA) is a promising biomaterial for in situ drug delivery, while aqueous extract of Punica granatum (AEPG) peel fruit rich in gallic acid and ellagic acid is used to improve wound healing. The aim of this study was to develop and analyze the healing properties of GelMA containing AEPG, gallic acid, or ellagic acid in a rodent model. GelMA hydrogels containing 5% AEPG (GelMA-PG), 1.6% gallic acid (GelMA-GA), or 2.1% ellagic acid (GelMA-EA) were produced and their mechanical properties, enzymatic degradation, and thermogravimetric profile determined. Wound closure rates, healing histological grading, and immunohistochemical counts of myofibroblasts were assessed over time. The swelling of hydrogels varied between 50 and 90%, and GelMA exhibited a higher swelling than the other groups. The GPG samples showed higher compression and Young's moduli than GelMA, GGA, and GAE. All samples degraded around 95% in 48 h. GPG and GGA significantly accelerated wound closure, improved collagenization, increased histological grading, and hastened myofibroblast differentiation in comparison to the control, GelMA, and GEA. GelMA containing AEPG (GPG) improved wound healing, and although gallic acid is the major responsible for such biological activity, a potential synergic effect played by other polyphenols present in the extract is evident.

Impact of a Regional Grant Program Through the Lens of Social Cognitive Career Theory: A Mixed-Method Evaluation.

PURPOSE: Evaluations of educational grant programs have focused on research productivity, with few examining impacts on grantees or effective program characteristics. This evaluation examined the regional grants program sponsored by Group on Educational Affairs (GEA) to examine if and how grantees' careers were affected by funding, and if these experiences aligned with program goals. METHOD: In this concurrent, mixed-methods theory-driven evaluation, quantitative and qualitative data were analyzed independently and then integrated to examine complementarity. Quantitative data examined differences among four geographic regions and included proposal and grantee characteristics abstracted from administrative records of 52 funded proposals from 2010-2015 grant cycles. Qualitative data from 23 interviews conducted from 2018 to 2019 explored the impact on grantees, with Social Cognitive Career Theory (SCCT) serving as a framework for deductive thematic analysis. To facilitate integration of findings, quantitative data were layered onto each interview to permit exploration of associations between the two data types. RESULTS: Although significant regional differences existed in project length and amount of funding, there were few regional differences in grantee experiences. Despite small funding amounts, grants were perceived as career launching pads. The SCCT framework accounted for grantee experiences, including researcher identity formation and subsequent research, but did not capture collaboration phenomena. Integration of the two data types identified experience patterns unique to different groups of grantees (e.g., more or less research experience). The diversity among grantees suggests that clarification of program goals and stronger alignment with criteria for funding may be warranted. CONCLUSIONS: This evaluation illuminates why small educational grant programs may or may not impact interest and productivity in research. Implications exist for funders, including clarifying program goals and providing support for less experienced grantees. Future research should explore grantee subsets (e.g., underrepresented in medicine) to further identify what fosters or inhibits careers of medical education scholars.

Proliferating Pilar Tumors in the Scalp Over a Period of 23 Years in a General Hospital in Mexico City.

BACKGROUND: Proliferating pilar tumors are an unusual skin tumor, and they have a cystic component with trichilemmal keratinization and epithelial proliferation. These arise from the outer root sheath of hair follicles. It mainly affects women. The scalp is the most affected area. Diagnosis can be made by biopsy. Surgical excision is the best treatment option. OBJECTIVE: Report the frequency of proliferating pilar tumors in the scalp in general hospital in Mexico over a period of 23 years. METHODS: The authors reviewed the database of the dermatopathology service of the General Hospital "Dr Manuel Gea González" from 1999 to August 2022, selecting diagnosticated cases of proliferating pilar tumor, pilar cyst, trichilemmal cyst, or proliferating trichilemmal cyst in the scalp. RESULTS: The authors discovered 17 cases, 13 were women, the average age was 54.9 years, all the tumors affecting the scalp, and just 3 cases were reported as malignant. CONCLUSION: In comparison with the existing data, the authors can observe that most of their patients were women and the scalp is the most affected area. Most did not present associated symptoms. As the authors can see, most are benign and long-lasting: however, the authors cannot ignore that a small percentage can be malignant.

Composite free gastroepiploic artery graft for off-pump coronary artery bypass grafting with celiac artery or superior mesenteric artery stenosis: A report of two cases.

INTRODUCTION: We report two cases of off-pump coronary artery bypass grafting (CABG) with celiac artery (CA) or superior mesenteric artery (SMA) stenosis using skeletonized gastroepiploic artery (GEA) grafts. PRESENTATION OF CASE: A 77-year-old man (case 1) and a 49-year-old man (case 2) underwent off-pump CABG for unstable angina. Preoperative ultrasonography revealed CA or SMA stenosis; therefore, we chose a free GEA composite with an internal thoracic artery (ITA) graft instead of an in-situ GEA graft. The patients were ultimately discharged uneventfully. DISCUSSION: GEA graft are remarkably reliable; however, their frequency of use seems to have decreased. In some cases, before GEA harvesting, echocardiogram shows accelerated peak systolic velocity (PSV) in the CA or SMA suggesting vascular stenosis, which prompts relinquishing GEA use. Therefore, free GEA grafts and composite of ITA graft were chosen recently. CONCLUSION: Free GEA grafts are especially advantageous for patients with peripheral artery disease who are unsuitable for saphenous vein harvesting. Free GEA grafting could be an alternative modality to avoid aortic clamping in patients with severe atherosclerotic lesions. The routine use of echocardiogram to evaluate blood flow in the CA and SMA should be advocated, as it often shows accelerated PSV (greater than 150 cm/s), which suggests vascular stenosis.

Landscape genomics analysis provides insights into future climate change-driven risk in rhesus macaque.

Climate change significantly affects the suitability of wildlife habitats. Thus, understanding how animals adapt ecologically and genetically to climate change is important for targeted species protection. Rhesus macaques (Macaca mulatta) are widely distributed and multi-climatically adapted primates. This study explored how rhesus macaques adapt to climate change by integrating ecological and genetic methods and applying species distribution models (SDMs) and a gradient forest (GF) model. The findings suggested that temperature seasonality primarily affects habitat suitability and indicated that climate change will have a dramatic impact on macaque populations in the future. We also applied genotype-environment association (GEA) analyses and selection signature analyses to identify genes associated with climate change and provide possible explanations for the adaptation of rhesus macaques to climatic environments. The population genomics analyses suggested that the Taihang population has the highest genomic vulnerability with inbreeding and low heterozygosity. Combined with the higher ecological vulnerability, additional conservation strategies are required for this population under higher risk of climate change. Our work measured the impact of climate change and enabled the identification of populations that exhibit high vulnerability to severe climate change. Such information is useful for selecting populations of rhesus macaques as subject of long-term monitoring or evolutionary rescue under future climate change.

Safety of prone emergence from general endotracheal anesthesia in patients undergoing ERCP: a randomized controlled trial.

BACKGROUND: Conventional supine emergence and prone extubation from general endotracheal anesthesia (GEA) are associated with extubation-related adverse events (ERAEs). Given the minimally invasive nature of endoscopic retrograde cholangiopancreatography (ERCP) as well as the improved ventilation/perfusion matching and easier airway opening in the prone position, we aimed to assess the safety of prone emergence and extubation in patients undergoing ERCP under GEA. METHODS: Totally, 242 eligible patients were recruited and randomized into the supine extubation group (n = 121; supine group) and the prone extubation group (n = 121; prone group). The primary endpoint was the incidence of ERAEs during emergence, including hemodynamic fluctuations, coughing, stridor, and hypoxemia requiring airway maneuvers. The secondary endpoints included the incidence of monitoring disconnections, extubation time, recovery time, room exit time, and post-procedure sore throat. RESULTS: The incidence of ERAEs was significantly lower in the prone group compared with the supine group (8.3% vs 34.7%, OR = 0.17, 95% CI 0.18-0.56; P < 0.001). Moreover, the prone group demonstrated no monitoring disconnections, shorter extubation time and room exit time, faster recovery, and, lower frequency and milder sore throat after the procedure. CONCLUSIONS: For patients undergoing ERCP under GEA, compared with supine, prone emergence, and extubation had remarkably lower rates of EAREs and better recovery, and can maintain continuous monitoring and improve efficiency.

p53/TP53 Status Assessment in Gastroesophageal Adenocarcinoma.

Chromosomal instability (CIN) is very frequent in gastroesophageal adenocarcinoma (GEA) and it is characterized by TP53 deletions/mutations resulting in p53 nuclear accumulation, as revealed by immunohistochemistry (IHC), which considers the cases with "high" staining levels to be positive. Aiming to improve aberrant TP53 detection, droplet digital PCR (ddPCR) was used to evaluate TP53 deletion in formalin-fixed, paraffin-embedded DNA (FFPE-DNA) and cell-free DNA (cfDNA). To further investigate the mutational TP53 profile, next-generation sequencing (NGS) was performed in a subset of FFPE samples. After combining "low" and "high" IHC staining level groups, the proportion of deletion events was significantly higher compared to the "intermediate" group (72.9% vs. 47.5%, p-value = 0.002). The ddPCR TP53 deletion assay was feasible for cfDNA but only had good agreement (72.7%, Cohen's kappa = 0.48) with the assay performed with FFPE-DNA of the "low-level" group. NGS analysis confirmed that, in the "low-level" group, a high percentage (66.7%) of cases were aberrant, with disruptive mutations that probably led to p53 loss. Data suggested that p53 IHC alone underestimates the CIN phenotype in GEA and that molecular analysis in both solid and liquid biopsies could be integrated with it; in particular, in cases of completely negative staining.

Lemmel's Syndrome: A Report of Two Cases at the Hospital General Dr. Manuel Gea Gonzalez in Mexico City.

The term ¨Lemmel Syndrome¨ is used to describe obstructive jaundice that is secondary to periampullary duodenal diverticula (PDD) in the absence of choledocholithiasis or neoplasia. PDD is found in 22% of the population. According to our knowledge, only two cases of Lemmel syndrome have been reported in Mexico. We report two cases of Lemmel syndrome in a 94-year-old and a 71-year-old woman who presented with clinical jaundice. One of the cases was treated with endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy, balloon sweep, and the placement of a plastic biliary prosthesis, and the other with laparoscopic biliodigestive bypass and a manual lateral end choledocho-duodenal anastomosis. Our objective is to expand the information on this rare pathology to take it into account as a diagnostic possibility of jaundice and to define appropriate management, which can be endoscopic or surgical.

An Overview on Research in a University Hospital, Using a Payback Framework Categorization Approach.

BACKGROUND AND OBJECTIVE: Little information is available on how to assess the impact of research studies conducted in government hospitals in Latin America and specifically in Mexico. We aimed to determine the returns on investment of the research projects that were carried out in the Hospital General "Dr. Manuel Gea Gonzalez" (HGMGG), a general university hospital located in Mexico City, using a categorization model. METHODS: We conducted a study including bibliometric analyses of publications associated with all research studies performed during the period 2016-2019 in the HGMGG and investigator interviews, according to the payback framework categorization model. RESULTS: All studies analyzed had a positive impact based on outcomes in 5 "payback categories": (1) knowledge; (2) research targeting, capacity building, and absorption; (3) policy and product development; (4) health benefits; and (5) broader economic benefits. CONCLUSIONS: To date, it has not been possible to establish a set of indicators that show the results of the investigations carried out by medical specialists in training, who carry out the bulk of medical care in general hospitals and in the National Institutes of Health in Mexico. We identified, in the 5 categories of the payback framework model, different areas of opportunity to improve the benefits of the hospital's medical services through the development of scientific research projects.

Ramucirumab plus irinotecan / leucovorin / 5-FU versus ramucirumab plus paclitaxel in patients with advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction, who failed one prior line of palliative chemotherapy: the phase II/III RAMIRIS study (AIO-STO-0415).

BACKGROUND: Paclitaxel in combination with ramucirumab is the standard of care second-line therapy in gastro-esophageal adenocarcinoma (GEA). As the number of taxane pretreated patients in the perioperative or first-line setting is increasing, it is unknown whether these patients benefit from re-applying a taxane in using the combination of paclitaxel and ramucirumab. Furthermore, the rates of neurotoxicity with first-line FOLFOX or FLOT range from 30%-70%, making second-line taxane-containing therapy less suitable to a meaningful portion of patients. This patient group is likely to benefit from a taxane-free second-line chemotherapy regimen, such as FOLFIRI and ramucirumab (FOLFIRI-Ram). Therefore, the RAMIRIS phase III trial evaluates the effects of the regimen of FOLFIRI-Ram in the second-line treatment after a taxane-based chemotherapy in patients with advanced GEA. METHODS: The RAMIRIS trial is a randomized, open-label, multicenter phase II/III study comparing treatment of FOLFIRI-Ram (arm A) with paclitaxel and ramucirumab (arm B). The Phase II is already closed with 111 enrolled patients. In the phase III, 318 taxane-pretreated patients with advanced GEA will be recruited and randomized 1:1 to FOLFIRI (5-FU 2400 mg/m2 over 46 h i.v., irinotecan 180 mg/m2 i.v.; 5-FU 400 mg/m2 bolus; leucovorin 400 mg/m2 i.v.; on day 1 and 15, q28) with ramucirumab 8 mg/kg every two weeks (Arm A) or paclitaxel 80 mg/m2 (days 1, 8, 15, q28) with ramucirumab 8 mg/kg every two weeks (Arm B). The primary endpoints are overall survival (OS) and objective overall response rate (ORR). Secondary endpoints are progression-free survival (PFS), disease control rate and safety and quality of life as assessed by EORTC-QLQ-C30 questionnaire. DISCUSSION: The already completed RAMIRIS phase II demonstrated feasibility and efficacy of FOLFIRI-Ram. Especially docetaxel-pretreated patients seemed to markedly benefit from FOLFIRI-Ram, with favorable response- and PFS rates and lower toxicity. This offers a rationale for the phase III trial. If the RAMIRIS III trial transfers and confirms the results, they will affect the current treatment guidelines, recommending the combination therapy of FOLFIRI-Ram for taxane-pretreated patients with advanced GEA. TRIAL REGISTRATION: NCT03081143 Date of registration: 13.11.2015.