Complications of the Superior Eyelid Endoscopic Transorbital Approach to the Skull Base: Preliminary Experience With Specific Focus on Orbital Outcome.

BACKGROUND: The endoscopic superior eyelid approach is a relatively novel mini-invasive technique that is currently investigating for skull base cancers. However, questions remain regarding specific approach-related complications when treating different skull base tumors. This study aims to analyze any surgical complications that occurred in our preliminary consecutive experience, with specific focus on orbital outcome. METHODS: A retrospective and consecutive cohort of patients treated via a superior eyelid endoscopic transorbital approach at the Division of Neurosurgery of the Hospital Clinic in Barcelona was analyzed. Patients features were described in detail. Complications were divided into 2 groups to analyze separately the approach-related complications, and those resulting from tumor removal. The ocular complications were subdivided into early ocular status (<3 weeks), late ocular status (3-8 weeks), and persistent ocular complications. The "Park questionnaire" was used to determine patient's satisfaction related to the transorbital approach. RESULTS: A total of 20 patients (5 spheno-orbital meningiomas, 1 intradiploic Meningioma, 2 intraconal lesions, 1 temporal pole lesion, 2 trigeminal schwannoma, 3 cavernous sinus lesions, and 6 petroclival lesions) were included in the period 2017-2022. Regarding early ocular status, upper eyelid edema was detected in all cases (100%) associated with diplopia in the lateral gaze in 30% of cases, and periorbital edema in 15% of cases. These aspects tend to resolve at late ocular follow-up (3-8 weeks) in most cases. Regarding persistent ocular complications, in one case of intraconal lesion, a limitation of eye abduction was detected (5%). In another patient with intraconal lesion, an ocular neuropathic pain was reported (5%). In 2 cases of petroclival menigioma, who were also treated with a ventriculo-peritoneal shunt, slight enophthalmus was observed as a persistent complication (10%). According to the Park questionnaire, no cosmetic complaints, no head pain, no palpable cranial irregularities, and no limited mouth opening were reported, and an average of 89% of general satisfaction was encountered. CONCLUSIONS: The superior eyelid endoscopic transorbital approach is a safe and satisfactory technique for a diversity of skull base tumors. At late follow-up, upper eyelid edema, diplopia, and periorbital edema tend to resolve. Persistent ocular complications are more frequent after treating intraconal lesions. Enophthalmus may occur in patients with associated ventriculo-peritoneal shunt. According to patient's satisfaction, fairly acceptable results are attained.

Endoscopic transorbital approach bone pillars: a comprehensive stepwise anatomical appraisal.

OBJECTIVE: The endoscopic superior eyelid transorbital approach has garnered significant consideration and gained popularity in recent years. Detailed anatomical knowledge along with clinical experience has allowed refinement of the technique as well as expansion of its indications. Using bone as a consistent reference, the authors identified five main bone pillars that offer access to the different intracranial targeted areas for different pathologies of the skull base, with the aim of enhancing the understanding of the intracranial areas accessible through this corridor. METHODS: The authors present a bone-oriented review of the anatomy of the transorbital approach in which they conducted a 3D analysis using Brainlab software and performed dry skull and subsequent cadaveric dissections. RESULTS: Five bone pillars of the transorbital approach were identified: the lesser sphenoid wing, the sagittal crest (medial aspect of the greater sphenoid wing), the anterior clinoid, the middle cranial fossa, and the petrous apex. The associations of these bone targets with their respective intracranial areas are reported in detail. CONCLUSIONS: Identification of consistent bone references after the skin incision has been made and the working space is determined allows a comprehensive understanding of the anatomy of the approach in order to safely and effectively perform transorbital endoscopic surgery in the skull base.

Comparison of frailty determinants in Latin America: a national representative study in Brazil and Chile.

OBJECTIVE: This study aimed to compare the prevalence and socio-economic determinants of frailty in older adults in Brazil and Chile using nationally representative survey data. STUDY DESIGN: Analytical research using data from the Brazilian Longitudinal Study of Aging (ELSI) and the Chilean National Health Survey (ENS) conducted in Brazil and Chile between 2015 and 2017. METHODS: The study included 5484 older adults aged 60 years or older in Brazil and 2031 in Chile. Frailty was measured using the FRAIL index, and logistic regression models were used to identify the determinants of frailty. RESULTS: The prevalence of frailty is 15.6% and 12.6% in Brazil and Chile, respectively. Frailty is associated with several factors, including age, sex, living alone, residing in urban areas, and decreased life satisfaction. However, the analysis revealed notable differences between countries. A greater number of significant variables were associated with frailty in Brazil, whereas Chile displayed fewer categories with significant odds. Health insurance had no significant effect in either of the two countries. CONCLUSIONS: The limitations in data sources and methodologies make it challenging to compare frailty determinants in Latin America. This study overcomes these barriers and shows that, even within the same region, significant differences exist. Levels and characteristics that are important in one country may not be so in another. The results emphasize the need to consider contextual factors in the implementation of emerging social and healthcare policies, such as home-based long-term care.

In Vitro and In Vivo Efficacy of a Stroma-Targeted, Tumor Microenvironment Responsive Oncolytic Adenovirus in Different Preclinical Models of Cancer.

More than one million women are diagnosed annually worldwide with a gynecological cancer. Most gynecological cancers are diagnosed at a late stage, either because a lack of symptoms, such as in ovarian cancer or limited accessibility to primary prevention in low-resource countries, such as in cervical cancer. Here, we extend the studies of AR2011, a stroma-targeted and tumor microenvironment responsive oncolytic adenovirus (OAdV), whose replication is driven by a triple hybrid promoter. We show that AR2011 was able to replicate and lyse in vitro fresh explants obtained from human ovarian cancer, uterine cancer, and cervical cancer. AR2011 was also able to strongly inhibit the in vitro growth of ovarian malignant cells obtained from human ascites fluid. The virus could synergize in vitro with cisplatin even on ascites-derived cells obtained from patients heavily pretreated with neoadjuvant chemotherapy. AR2011(h404), a dual transcriptionally targeted derived virus armed with hCD40L and h41BBL under the regulation of the hTERT promoter, showed a strong efficacy in vivo both on subcutaneous and intraperitoneally established human ovarian cancer in nude mice. Preliminary studies in an immunocompetent murine tumor model showed that AR2011(m404) expressing the murine cytokines was able to induce an abscopal effect. The present studies suggest that AR2011(h404) is a likely candidate as a novel medicine for intraperitoneal disseminated ovarian cancer.

[Long-term care in Costa Rica: Lessons for Latin America based on international evidenceCuidados de longa duração na Costa Rica: aprendizados para a América Latina partindo de evidências internacionais]. / Cuidados de larga duración en Costa Rica: enseñanzas para América Latina desde la evidencia internacional.

The growing prevalence of functional dependency as a result of accelerated aging and epidemiological transformation has created a pressing need to implement new systems to address the problem of long-term care (LTC) in the Region of the Americas. In March 2021, Costa Rica became the only middle-income country in the Region that has taken steps to introduce a national LTC system. The present article compares the design of this new LTC system with existing systems in Australia, Denmark, Japan, Spain, the United States of America, and Uruguay, and identifies useful lessons for the development of LTC systems in other countries of the Region. Four aspects are analyzed: the legal framework, access and coverage, types of services, and costs and financing. A search of the scientific literature and national and international reports was conducted between 1 January 2000 and 1 April 2021. The results showed that the incipient Costa Rican model follows the main trends that are seen internationally. It is progressively universal, prioritizes home care, incorporates technology tools, creates parameters for measuring the quality of services, provides monetary transfers for family members who serve as caregivers, includes respite services, and offers training for caregivers. At the same time, however, the international evidence shows that models with poor levels of funding have low coverage and offer little diversity in terms of the services provided. Insufficient funding, absence of new economic resources, and weak legal foundations are jeopardizing the expansion, development, and sustainability of the new model in the Americas.

A crescente prevalência de dependência funcional derivada do envelhecimento acelerado e da transformação epidemiológica torna inevitável a implementação de novos sistemas de cuidados de longa duração (CLD) na Região das Américas. Em março de 2021, a Costa Rica se transformou no único país de renda média na Região que iniciou a aplicação de um sistema nacional desse tipo. Neste artigo, compara-se o desenho do novo sistema de cuidados de longa duração da Costa Rica com os sistemas da Austrália, Dinamarca, Espanha, Estados Unidos da América, Japão e Uruguai, e se identificam aprendizados úteis para o desenvolvimento de outros sistemas de CLD na Região. São analisados quatro aspectos: o marco legal, o acesso e a cobertura, os tipos de serviço, os custos e o financiamento. Para isso, foi realizada uma revisão da bibliografia científica e de relatórios nacionais e internacionais entre 1º de janeiro de 2000 e 1º de abril de 2021. O modelo inicial segue as principais tendências da experiência internacional. É progressivamente universal, prioriza a atenção domiciliar, inclui ferramentas tecnológicas, cria parâmetros de qualidade para os serviços, incorpora transferências monetárias para familiares que atuam como cuidadores, inicia serviços de cuidados intermitentes e desenvolve formação para cuidadores. No entanto, a evidência internacional mostra que os modelos com menor financiamento têm baixa cobertura e pouca diversidade de serviços. A escassa generosidade fiscal, a ausência de novas fontes de recursos econômicos e a vulnerabilidade jurídica colocam em risco a ampliação, o desenvolvimento e a sustentabilidade do novo modelo nas Américas.

Poly(acrylic acid)-Coated Iron Oxide Nanoparticles interact with mononuclear phagocytes and decrease platelet aggregation.

Poly(acrylic acid)-Coated Iron Oxide Nanoparticles (PAC-IONs) did not compromise the viability of mononuclear cells and potentially interact with cells through scavenger receptors. This study evaluated: 1) The capacity of the PAC-IONs to induce platelet activation and aggregation, and 2) The effect of the PAC-IONs in two functions of Monocyte-Derived Macrophages (MDMs) when differentiated in their presence; that is, the removal of apoptotic cells (ACs) and the levels of cytokines induced by Lipopolysaccharide (LPS) and the ACs. The PAC-IONs did not affect the platelet activation but antagonized their aggregation. On the other hand, the differentiation of MDMS in the presence of PAC-IONs did not inhibit the ability of these cells to phagocytose latex beads but decreased the number of apoptotic bodies internalized by them. MDMs differentiated in the presence of PAC-IONs and stimulated with LPS or ACs exhibited an overall decrease of the cytokine levels. The altered synthesis of cytokines could be attributed to a high production of Reactive Oxygen Species (ROS) caused by the increase in the intracellular iron content. The effect of the PAC-IONs on the cell cycle of U937 and Jurkat cells was also studied; there was not either cell accumulation in any phase of the cell cycle or changes in the DNA content. It is clear that PAC-IONs affect neither the viability nor compromise some cellular functions. However, they could alter the functioning of the immune system; therefore, in the case of being used as a diagnostic tool, their permanence in the body should be considered.

Fiscal space for Health in the Americas: is economic growth sufficient?

OBJECTIVE: In 2014, the member countries of the Pan American Health Organization signed the Strategy for Universal Access to Health and Universal Health Coverage. In it, they committed to increasing public expenditure on health until reaching the benchmark of 6% of gross domestic product (GDP). The objective of this paper is to determine, for each country in the Region, whether they can reach this target through economic growth alone and, if so, how long it would take. METHODS: Using World Bank and World Health Organization data, elasticity of public health expenditure (PHE) with respect to GDP was estimated for each country. Real economic growth and International Monetary Fund projections for 2016-2021 were used to project the expenditure series and determine the year each country would reach 6% of GDP. RESULTS: Six countries have already reached the 6% target. The Latin American and Caribbean countries that have achieved it are those that have single health systems, based on universal access and coverage. If current prioritization of PHE is maintained, three countries could reach the target in the next decade. Four more countries would reach it before mid-century, 10 in the second half of the century, and one would have to wait until the next century. Finally, 13 countries would never reach the proposed target. CONCLUSIONS: This analysis demonstrates the limitations of economic growth as a source of fiscal space. Other sources will need to be tapped, such as increased tax collection, specific health taxes, and greater efficiency in public spending, which will require social and political dialogue in the countries regarding their commitment to universal health principles.

[Fiscal space for Health in the Americas: is economic growth sufficient?Espaço fiscal para saúde nas Américas: o crescimento econômico é suficiente?] / Espacio fiscal para salud en las Américas: ¿es suficiente el crecimiento económico?

OBJECTIVE: In 2014, the Pan American Health Organization member countries signed the Strategy for Universal Access to Health and Universal Health Coverage. In it, they committed to increasing public health expenditure until reaching the benchmark of 6% of gross domestic product (GDP). The objective of this paper is to determine, for each country in the Region, if they can reach this goal by economic growth alone and, if so, how long it would take. METHODS: Using World Bank and World Health Organization data, elasticity of public health expenditure with regard to GDP was estimated for each country. Real economic growth and International Monetary Fund projections for 2016-2021 were used to project the expenditure series and determine the year each country would reach 6% of GDP. RESULTS: Six countries have already reached the 6% goal. The Latin American and Caribbean countries that have achieved it are those that have single health systems, based on universal access and coverage. If current prioritization of public health expenditure is maintained, three countries could reach the goal in the next decade. Four more countries would reach it before mid-century, ten in the second half of the century, and one would have to wait until the next century. Finally, 13 countries would never reach the proposed goal. CONCLUSIONS: This analysis demonstrates the limitations of economic growth as a source of fiscal space. Other sources will need to be tapped, such as increased tax collection, specific health taxes, and greater efficiency in public spending, which will require social and political dialogue in the countries regarding their commitment to universal health principles.

OBJETIVO: Em 2014, os Estados Membros da Organização Pan-Americana da Saúde firmaram a Estratégia para o acesso universal à saúde e cobertura universal de saúde com a qual se comprometeram a aumentar o gasto público em saúde até atingir a meta de referência de 6% do produto interno bruto (PIB). O objetivo deste estudo foi determinar se cada um dos países da Região conseguiria atingir esta meta apenas com o crescimento econômico e, neste caso, em que prazo. MÉTODOS: O estudo se baseou em dados obtidos do Banco Mundial e da Organização Mundial de Saúde (OMS). Foi estimada a elasticidade do gasto público em saúde com relação ao PIB para cada país. A partir do crescimento econômico real e do crescimento projetado pelo Fundo Monetário Internacional para o período 2016­2021, foi feita a projeção dos gastos e determinado o ano em que seriam alcançados 6% do PIB. RESULTADOS: Seis países já atingiram a meta de 6%. Os países da América Latina e Caribe que atingiram esta meta são os que têm um sistema de saúde único baseado no acesso e cobertura universais. Se for mantida a priorização atual do gasto público em saúde, três países conseguiriam alcançar a meta na próxima década. Outros quatro países atingiriam a meta antes de meados do século, 10 na segunda metade deste século e um somente a alcançaria no século seguinte. E, por fim, 13 países nunca atingiriam a meta proposta. CONCLUSÕES: Esta análise demonstra as limitações do crescimento econômico como fonte de espaço fiscal. Será necessário recorrer a outras fontes, como maior arrecadação tributária, impostos próprios para a saúde e maior eficiência no gasto público, o que demanda dos países um diálogo social e político quanto ao compromisso com os princípios de saúde universal.

[Evaluation of fiscal space for health in BoliviaAvaliação do espaço fiscal para a saúde na Bolívia]. / Evaluación del espacio fiscal para salud en Bolivia.

OBJECTIVE: To assess from a technical and political point of view the capacity of Bolivia to generate fiscal space for health that allows it to sustain progress and fulfill the commitment of a public health expenditure of 6% of gross domestic product. METHODS: A review of the international evidence on fiscal space and its measurements was conducted. The technical analysis was developed through statistics and official reports from multiple national and international secondary sources. The political and social analysis was carried out through 20 interviews with representatives of organizations and institutions. RESULTS: There is capacity to create fiscal space in health for Bolivia. There are three sources with the greatest technical and political feasibility: economic growth linked to the commitment to reprioritize public spending on health; improvements in the internal sources of revenue through the reduction of informal work; and reduction of tax expenditures. External financing and an increase of Social Security contributions are less feasible. CONCLUSIONS: Bolivia is able to achieve a public health spending of 6% of gross domestic product. The timing to achieve this goal depends on maintaining the prioritization of spending in the sector, with social and political consensus and within a framework of economic growth and stability.

OBJETIVO: Avaliar do ponto de vista técnico e político a capacidade da Bolívia para gerar espaço fiscal para a saúde que lhe permita sustentar o progresso e cumprir o compromisso de uma despesa de saúde pública de 6% do Produto Interno Bruto (PIB). MÉTODOS: Foi feita uma revisão da evidência internacional sobre o espaço fiscal e suas medições. A análise técnica foi desenvolvida através do uso de estatísticas e relatórios oficiais de múltiplas fontes secundárias nacionais e internacionais. A análise política e social foi realizada através de 20 entrevistas com representantes de organizações e instituições. RESULTADOS: Existe capacidade para criar espaço fiscal em saúde para a Bolívia. As fontes com maior viabilidade técnica e política são três: crescimento econômico ligado ao compromisso de desajustar as despesas públicas em saúde, melhorias nas fontes internas de receita através da redução da informalidade e redução de despesas tributárias. Com menos viabilidade é o financiamento externo e o aumento das contribuições para a Segurança Social. CONCLUSÕES: A Bolívia é capaz de alcançar gastos de saúde pública de 6% do PIB. O tempo que atinge esse objetivo depende da manutenção da priorização dos gastos no setor, com o consenso da maioria social e política, tudo em um quadro de crescimento econômico e estabilidade.

Cesarean section rates in Ecuador: a 13-year comparative analysis between public and private health systems.

OBJECTIVE: To demonstrate the prevalence of cesearean sections (C-sections) in Ecuador and their distribution between private and public health centers. METHODS: An observational population-based study was conducted of patients discharged from public and private hospitals in Ecuador after a C-section or vaginal delivery. Data were collected by the Ecuadorian National Institute of Statistics and Census (INEC) between 2001 and 2013. RESULTS: The overall national C-section rate in the private health care system is double the rate in the public health care system. Over the 13 years of the study, C-sections accounted for 57.5% of births in the private sector, while the public sector proportion did not exceed 22.3%. Countrywide, less than 36% of C-sections were found to be clinically justified by parallel analysis of absolute or relative indications. Acute fetal distress (AFD) was more frequently reported in private centers compared to public ones (446 per 10 000 live births versus 274 per 10 000). Since 2001, the number of births by cesarean section increased by more than 50% (R2 = 0.7306, P < 0.05), with an annual growth rate of 4.03%. In Guayaquil, the largest city in Ecuador, up to 74% of live births occurred by C-section. CONCLUSION: National data show that C-sections are performed more frequently in Ecuador than the rate recommended by the World Health Organization, especially in the private health care system. Private centers also report higher rates of AFD, which implies that this diagnosis is either overused in private centers or underrecognized in public centers. Although several factors might be influencing these trends, no data are available to determine the relative importance of economics, practicality, and medical or personal concerns of mothers and physicians in deciding which method of delivery should be used.

OBJETIVO: Demostrar la prevalencia de las cesáreas en Ecuador y su distribución entre centros privados y públicos de salud. MÉTODOS: Se realizó un estudio de observación basado en la población de pacientes dadas de alta de hospitales públicos y privados en Ecuador después de una cesárea o un parto vaginal. Los datos fueron recopilados por el Instituto Nacional de Estadísticas y Censo (INEC) de Ecuador entre el 2001 y el 2013. RESULTADOS: La tasa nacional de cesáreas en el sistema privado de atención de salud es el doble de la tasa que se observa en el sistema público de salud. Durante los 13 años que duró el estudio, las cesáreas representaron 57,5% de los nacimientos en el sector privado, mientras que la proporción en el sector público no superó 22,3%. A nivel de todo el país, se observó que menos de 36% de las cesáreas estaban clínicamente justificadas con un análisis paralelo de indicaciones absolutas o relativas. Se notificaron casos de sufrimiento fetal agudo con mayor frecuencia en los centros privados comparados con los públicos (446 por 10 000 nacidos vivos frente a 274 por 10 000 n.v.). Desde el 2001, el número de nacimientos por cesárea aumentó más de 50% (R2 = 0,7306, P < 0,05), con una tasa de crecimiento anual de 4,03%. En Guayaquil, la ciudad más grande de Ecuador, hasta 74% de los nacidos vivos nacieron por cesárea. CONCLUSIONES: Los datos nacionales muestran que las cesáreas se realizan en Ecuador con una frecuencia mayor a la tasa recomendada por la Organización Mundial de la Salud, especialmente en el sistema privado de atención de salud. Los centros privados también notifican tasas más altas de sufrimiento fetal agudo, lo que implica que este diagnóstico se utiliza excesivamente en los centros privados o no se lo reconoce sufi- cientemente en los centros públicos. Aunque varios factores podrían estar influyendo sobre estas tendencias, no se tienen datos para determinar la importancia relativa de los factores económicos, la practicidad y las inquietudes médicas o personales de las madres y los médicos al decidir el método de parto.

[An assessment of fiscal space for public health in Peru]. / Evaluación del espacio fiscal para la salud en Perú.

Objective To assess the fiscal space for public health in Peru so as to attain the goal of raising health spending to 6% of gross domestic product, as agreed upon by member countries of the Pan American Health Organization in 2014. Methods The main sources of fiscal space were identified by means of a thorough literature review. Technical feasibility was determined from statistics and national and international surveys and by reviewing various documents and official reports. Political feasibility was ascertained by studying policy guidelines. Results The sources showing the greatest technical and political feasibility are economic growth, a broadening of the personal income tax base, and an increase in tobacco-specific taxes. Decreasing informality in the job market and increasing contributory coverage are considered to be less politically feasible, but there is ample technical space for these measures. Conclusions There is enough fiscal space to allow for an increase in public health spending. Nevertheless, the 6% target will be reached only if the timeline is extended, tax revenues are increased, and informality in the job market is reduced.

[Venous angiomas and headache in children. A case report]. / Angiomas venosos y cefalea en pediatría: un caso clínico.

INTRODUCTION: Venous angiomas (VA) are benign entities; however infrequent symptomatic cases may occur. OBJECTIVE: Case report and literature review. CASE REPORT: A 6 year old girl was referred with a history of bi-frontal, non-pulsatile, headache with no nausea or vomiting. Headache intensity was 4-6/10. The episodes were frequent, 3-4 times per week. Triggers include academic work. Computed tomography showed a small VA in left caudate nucleus, which was confirmed by a brain MRI, with no evidence of inflammatory or ischaemic changes, or another vascular malformation. Psychological and psycho-pedagogic techniques were used, combined with relaxation and cognitive-behavioural techniques to reduce the intensity and frequency. There was a good outcome, and the headache decreased to 10 episodes per year. The patient was monitored for 12 years until graduation from high school. The VA remained without complications. CONCLUSIONS: In the study of a headache, a VA usually is an incidental finding. The International Classification of Headache Disorders III provides specific criteria of frequent episodic tension-type headache, and allows us begin specific therapy for it. Monitoring of non-symptomatic VA cases should be clinical. The surgical management of these entities is exceptional.

[Cost of a health care system for dependent older adults in Chile, 2012-2020]. / Costo de un sistema de atención de adultos mayores dependientes en Chile, 2012-2020.

OBJECTIVE: To estimate the relative and absolute costs of a home-based health care system for dependent older adults in Chile and to consider the methodological factors to take into account in estimates for other models in other countries. METHODS: Sex- and age-specific prevalence rates were used, based on microdata from the National Dependency Survey (ENDPM 2009), and three scenarios were projected for 2012 - 2020. The beneficiary population and the demand were estimated for 12 home-based health care programs. The characteristics of the programs (number of hours and type of care) were based on expert opinions, adjusted through a literature review. Public and private system wages/hours were used. RESULTS: Overall, 20.3% of people over 65 years of age would be beneficiaries of the system; 21.7% of all women and 18.4% of all men, for a total of 336 874 people in 2012. The annual cost of the system is 1.214 billion dollars for 2012, equivalent to 0.45% of GDP (gross domestic product). This figure could increase by between 32.1% and 33.1% by 2020. CONCLUSIONS: The cost of an initial system for dependent older adults in Chile is relatively low in comparison to the models seen in industrialized countries. In terms of methodology, it is particularly important for there to be prior discussion of the desired model to be implemented and the financial capacity to achieve this. Furthermore, the option of using expert opinions as the basis for the evaluation is validated, although it is recommended that this be expanded.

Janus kinase inhibitors modify the fatty acid profile of extracellular vesicles and modulate the immune response.

Background: Janus kinase inhibitors (jakinibs) are immunomodulators used for treating malignancies, autoimmune diseases, and immunodeficiencies. However, they induce adverse effects such as thrombosis, lymphocytosis, and neutropenia that could be mediated by extracellular vesicles (EVs). These particles are cell membrane-derived structures that transport cellular and environmental molecules and participate in intercellular communication. Jakinibs can modify the content of EVs and enable them to modulate the activity of different components of the immune response. Objective: to evaluate the interactions between immune system components of healthy individuals and EVs derived from monocytic and lymphoid lineage cells generated in the presence of baricitinib (BARI) and itacitinib (ITA) and their possible effects. Methods: EVs were isolated from monocytes (M) and lymphocytes (L) of healthy individuals, as well as from U937 (U) and Jurkat (J) cells exposed to non-cytotoxic concentrations of BARI, ITA, and dimethyl sulfoxide (DMSO; vehicle control). The binding to and engulfment of EVs by peripheral blood leukocytes of healthy individuals were analyzed by flow cytometry using CFSE-stained EVs and anti-CD45-PeCy7 mAb-labeled whole blood. The effect of EVs on respiratory burst, T-cell activation and proliferation, cytokine synthesis, and platelet aggregation was evaluated. Respiratory burst was assessed in PMA-stimulated neutrophils by the dihydrorhodamine (DHR) test and flow cytometry. T-cell activation and proliferation and cytokine production were assessed in CFSE-stained PBMC cultures stimulated with PHA; expression of the T-cell activation markers CD25 and CD69 and T-cell proliferation were analyzed by flow cytometry, and the cytokine levels were quantified in culture supernatants by Luminex assays. Platelet aggregation was analyzed in platelet-rich plasma (PRP) samples by light transmission aggregometry. The EVs' fatty acid (FA) profile was analyzed using methyl ester derivatization followed by gas chromatography. Results: ITA exposure during the generation of EVs modified the size of the EVs released; however, treatment with DMSO and BARI did not alter the size of EVs generated from U937 and Jurkat cells. Circulating neutrophils, lymphocytes, and monocytes showed a 2-fold greater tendency to internalize ITA-U-EVs than their respective DMSO control. The neutrophil respiratory burst was attenuated in greater extent by M-EVs than by L-EVs. Autologous ITA-M-EVs reduced T-cell proliferation by decreasing IL-2 levels and CD25 expression independently of CD69. A higher accumulation of pro-inflammatory cytokines was observed in PHA-stimulated PBMC cultures exposed to M-EVs than to L-EVs; this difference may be related to the higher myristate content of M-EVs. Platelet aggregation increased in the presence of ITA-L/M-EVs by a mechanism presumably dependent on the high arachidonic acid content of the vesicles. Conclusions: Cellular origin and jakinib exposure modify the FA profile of EVs, enabling them, in turn, to modulate neutrophil respiratory burst, T-cell proliferation, and platelet aggregation. The increased T-cell proliferation induced by BARI-L/M-EVs could explain the lymphocytosis observed in patients treated with BARI. The higher proportion of arachidonic acid in the FA content of ITA-L/M-EVs could be related to the thrombosis described in patients treated with ITA. EVs also induced a decrease in the respiratory burst of neutrophils.

Endonasal versus supraorbital approach for anterior skull base meningiomas: Results and quality of life assessment from a single-surgeon cohort.

OBJECTIVE: In this prospective non-randomized study we reported our experience related to planum sphenoidale (PS) and tuberculum sellae (TS) meningiomas in a similar cohort of patients operated via the endonasal or the supraorbital route. A comprehensive quality of life analysis has been performed. METHODS: Being comparable in general features, between November 2017 to January 2020, a total of 20 patients with anterior skull base meningioma were included. Hence, 10 patients were treated using the supraorbital keyhole procedure (SO) while 10 patients received an endoscopic endonasal approach (EEA). Both surgical techniques were analyzed and compared. Quality of life has been analyzed with the SF-36 questionnaire. RESULTS: Twenty patients were identified who underwent either EEA (n=10) or SO (n=10). The average extent of resection achieved was not significantly different between the 2 groups. Post-operatively, the EEA group demonstrated a longer hospital stay and bed days compared with SO patients as well as a longer surgical time. There was a significant rate of more CSF leakage after EEA then after SO (20% vs 0%, p=0,0491). The follow-up period resulted shorter in the SO group, with a slight increased recurrence rate. Overall, no differences in visual outcome were detected. There were no differences in terms of quality of life between the two groups in all the explored items. CONCLUSIONS: In this single-center single-surgeon study of similarly sized and located PS and TS meningiomas, EEA showed longer hospital stays with higher degree of CSF leak compared with the SO group. Supraorbital craniotomy via eyebrow incision reported a comparable quality of life results, even if with a slightly higher percentage of recurrence and less follow-up.

Psychometric Testing of HeLD-14 in a Colombian Geriatric Population.

Introduction: The objective of this study was to test the validity and reliability of the Colombian version of the Health Literacy in Dentistry (HeLD-14) in older adults. Materials and Methods: A translation and validation study of HeLD-14 was conducted on 384 non-institutionalized older adults attending the Dental Clinic at Universidad Cooperativa from Pasto, Colombia. A cross-cultural adaptation of a multidimensional HeLD-14 was completed, and the psychometric properties of this scale were evaluated through a cross-validation method using an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). Internal consistency was measured with Cronbach's alpha (α) and Omega's McDonald (É·). The statistical significance was set at P < 0.05. Results: The EFA demonstrated that a single-factor structure with 11 items explained a cumulative 59.86% of the overall variance. The CFA confirmed that goodness of fit indices of this questionnaire had optimal adequateness (χ2S-B = 109.047; χ2S-B/(44) = 2.478, P=0.001; non-normed fit index = 0.901; comparative fit index = 0.908; root mean square error of approximation = 0.079 (90% CI (0.075, 0.083)); standardized root mean residual = 0.080). The coefficients indicated a high internal consistency for the total scale (α = 0.94; É· = 0.96). Conclusion: The developed adaptation of HeLD-14 for the Colombian population, HeLD-Col, is a unidimensional, reliable, and valid instrument to assess oral health literacy in older adults in Colombia.

Low-Temperature Synthesis of Bi2S3 Hierarchical Microstructures via Co-Precipitation and Digestive Process in Aqueous Medium.

Bismuth sulfide (Bi2S3) nanostructures have gained significant attention in the fields of catalysis, optoelectronics, and biomedicine due to their unique physicochemical properties. This paper introduces a simple and cost-effective method for producing Bi2S3 microstructures at low temperatures (25 and 70 °C). These microstructures are formed by the hierarchical self-assembly of Bi2S3 nanoparticles, which are typically 15-40 nm in size. The nanoparticles are synthesized by the co-precipitation of thioglycolic acid, thioacetamide, and bismuth nitrate in water. The study delves into the phase composition and morphological evolution of the microstructures, concerning the chemical composition of the solution and the synthesis temperature. X-ray analysis has confirmed the formation of single-phase bismuthinite Bi2S3. The synthesis process generates primary building blocks in the form of 15-40 nm Bi2S3 nanocrystals, which then go through a hierarchical self-assembly process to produce a range of micrometer-sized structures. A scanning electron microscopy examination revealed that the primary nanoparticles self-assemble into quasi-1D worm-like nanostructures, which then self-assemble to create sponge-shaped microstructures. These structures subsequently self-organize and refine into either flower- or dandelion-like microstructures, mostly depending on the synthesis temperature and the chemistry of the digestion medium.

Flexible Unipolar IGZO Transistor-Based Integrate and Fire Neurons for Spiking Neuromorphic Applications.

In this article, three different implementations of an Axon-Hillock circuit are presented, one of the basic building blocks of spiking neural networks. In this work, we explored the design of such circuits using a unipolar thin-film transistor technology based on amorphous InGaZnO, often used for large-area electronics. All the designed circuits are fabricated by direct material deposition and patterning on top of a flexible polyimide substrate. Axon-Hillock circuits presented in this article consistently show great adaptability of the basic properties of a spiking neuron such as output spike frequency adaptation and output spike width adaptation. Additional degrees of adaptability are demonstrated with each of the Axon-Hillock circuit varieties: neuron circuit threshold voltage adaptation, differentiation between input signal importance, and refractory period modulation. The proposed neuron can change its firing frequency up to three orders of magnitude by varying a single voltage brought to a circuit terminal. This allows the neuron to function, and potentially learn, at vastly different timescales that coincide with the biologically meaningful timescales, going from milliseconds to seconds, relevant for circuits meant for interaction with the environment. Thanks to careful design choices, the average measured power consumption is kept in the nW range, realistically allowing upscaling towards the spiking neural networks in the future. The spiking neuron with refractory period modulation presented in this work has an area of 607.3 µm × 492.2 µm, it experimentally demonstrated firing rates as low as 11.926 mHz, and its energy consumption per spike is ≈ 700 pJ at 30 Hz.

Oral Health Literacy and Tooth Loss and Replacement in Older Adults at a University Dental Clinic in Colombia.

BACKGROUND: Oral health literacy (OHL) is the ability of individuals to obtain, process, and understand oral health information and services, allowing them to make appropriate oral health decisions. The association between OHL and tooth loss and replacement have not been well understood. OBJECTIVES: We aimed to determine the association between OHL and tooth loss and replacement in a Colombia population. METHODS: A cross-sectional study of 384 older adults age 65 to 89 years from Pasto, Colombia was carried out. The number of lost and replaced teeth was assessed intraorally; sociodemographic and prosthetic characteristics were collected, and the Health Literacy in Dentistry questionnaire was used to evaluate OHL. Generalized linear models were estimated to assess associations between independent variables (including OHL) and the number of lost and replaced teeth. KEY RESULTS: There were 224 (58.3%) men and 160 (41.7%) women. The mean (standard deviation [SD]) number of lost and replaced teeth was 27.78 (4.03) and 12.53 (9.89), respectively. One hundred fifty five (40.4%) individuals had full removable dental protheses, 122 (31.8%) partial removable dental protheses, 68 (17.7%) fixed prosthetics, and 36 (9.4%) dental implants. OHL was 33.29 (6.59) and significantly positively associated with the number of replaced teeth (ß = 0.65, 95% confidence interval [CI]: 0.52-0.78, p < .001), but not with lost teeth. CONCLUSIONS: OHL may foster individuals' capabilities to replace lost teeth, although we did not find it associated with reduced tooth loss, likely as tooth loss was highly common in this older population. [HLRP: Health Literacy Research and Practice. 2024;8(1):e21-e28.].

PLAIN LANGUAGE SUMMARY: The association between OHL and tooth loss and replacement has not been well understood. A study of 384 older adults was designed to evaluate the number of lost and replaced teeth and the association with OHL. We found that OHL may foster tooth replacement but was not associated with tooth loss itself.

Impact Evaluation of Cash-For-Care in Latin America's New Long-Term Care Policies: A Randomized Controlled Trial Pilot Study in Costa Rica.

Latin America is aging rapidly. Thus, governments in the region are reformulating their social protection policies. In 2022, Costa Rica passed a national long-term care law. A discussion developed on how to provide such care, whether through public or private in-kind benefits or cash-for-care (CfC) to beneficiaries. CfC has been used in developed countries with various outcomes. However, there are still no evaluations of its effects in middle-income countries. The objective of this study was to evaluate the impact of CfC pilot study on female caregivers in a middle-income country. The expectations of the program were to find positive effects of CfC on caregivers. After conducting a literature review, we developed four domains of analysis: labor market participation, time for personal activities, use of CfC, and caregiver burnout. The results indicate that CfC has no significant impact on caregivers' integration into the labor market, or ability to have leisure time. However, there was a positive effect on the funding of basic needs and mitigation of factors predicting burnout.