SENECA study: staging endometrial cancer based on molecular classification.

OBJECTIVE: Management of endometrial cancer is advancing, with accurate staging crucial for guiding treatment decisions. Understanding sentinel lymph node (SLN) involvement rates across molecular subgroups is essential. To evaluate SLN involvement in early-stage (International Federation of Gynecology and Obstetrics 2009 I-II) endometrial cancer, considering molecular subtypes and new European Society of Gynaecological Oncology (ESGO) risk classification. METHODS: The SENECA study retrospectively reviewed data from 2139 women with stage I-II endometrial cancer across 66 centers in 16 countries. Patients underwent surgery with SLN assessment following ESGO guidelines between January 2021 and December 2022. Molecular analysis was performed on pre-operative biopsies or hysterectomy specimens. RESULTS: Among the 2139 patients, the molecular subgroups were as follows: 272 (12.7%) p53 abnormal (p53abn, 1191 (55.7%) non-specific molecular profile (NSMP), 581 (27.2%) mismatch repair deficient (MMRd), 95 (4.4%) POLE mutated (POLE-mut). Tracer diffusion was detected in, at least one side, in 97.2% of the cases; with a bilateral diffusion observed in 82.7% of the cases. By ultrastaging (90.7% of the cases) or one-step nucleic acid amplification (198 (9.3%) of the cases), 205 patients were identified with affected sentinel lymph nodes, representing 9.6% of the sample. Of these, 139 (67.8%) had low-volume metastases (including micrometastases, 42.9%; and isolated tumor cells, 24.9%) while 66 (32.2%) had macrometastases. Significant differences in SLN involvement were observed between molecular subtypes, with p53abn and MMRd groups having the highest rates (12.50% and 12.40%, respectively) compared with NSMP (7.80%) and POLE-mut (6.30%), (p=0.004); (p53abn, OR=1.69 (95% CI 1.11 to 2.56), p=0.014; MMRd, OR=1.67 (95% CI 1.21 to 2.31), p=0.002). Differences were also noted among ESGO risk groups (2.84% for low-risk patients, 6.62% for intermediate-risk patients, 21.63% for high-intermediate risk patients, and 22.51% for high-risk patients; p<0.001). CONCLUSIONS: Our study reveals significant differences in SLN involvement among patients with early-stage endometrial cancer based on molecular subtypes. This underscores the importance of considering molecular characteristics for accurate staging and optimal management decisions.

Separating N2O production and consumption in intact agricultural soil cores at different moisture contents and depths.

Agricultural soils are a major source of the potent greenhouse gas and ozone depleting substance, N2O. To implement management practices that minimize microbial N2O production and maximize its consumption (i.e., complete denitrification), we must understand the interplay between simultaneously occurring biological and physical processes, especially how this changes with soil depth. Meaningfully disentangling of these processes is challenging and typical N2O flux measurement techniques provide little insight into subsurface mechanisms. In addition, denitrification studies are often conducted on sieved soil in altered O2 environments which relate poorly to in situ field conditions. Here, we developed a novel incubation system with headspaces both above and below the soil cores and field-relevant O2 concentrations to better represent in situ conditions. We incubated intact sandy clay loam textured agricultural topsoil (0-10 cm) and subsoil (50-60 cm) cores for 3-4 days at 50% and 70% water-filled pore space, respectively. 15N-N2O pool dilution and an SF6 tracer were injected below the cores to determine the relative diffusivity and the net N2O emission and gross N2O emission and consumption fluxes. The relationship between calculated fluxes from the below and above soil core headspaces confirmed that the system performed well. Relative diffusivity did not vary with depth, likely due to the preservation of preferential flow pathways in the intact cores. Gross N2O emission and uptake also did not differ with depth but were higher in the drier cores, contrary to expectation. We speculate this was due to aerobic denitrification being the primary N2O consuming process and simultaneously occurring denitrification and nitrification both producing N2O in the drier cores. We provide further evidence of substantial N2O consumption in drier soil but without net negative N2O emissions. The results from this study are important for the future application of the 15N-N2O pool dilution method and N budgeting and modelling, as required for improving management to minimize N2O losses.

The role of ruminant urine and faeces in the recycling of nutrients by forages.

This study addresses the effect of using animal excreta on the nutritional content of forages, focusing on macro- and micro-element concentrations (nitrogen; N, phosphorus; P, sulphur; S, copper; Cu, zinc; Zn, manganese; Mn, selenium; Se) from animal feed to excreta, soil, and plants. Data were collected from pot and field trials using separate applications of sheep or cattle urine and faeces. Key findings indicate that soil organic carbon (SOC) and the type of excreta significantly influences nutrient uptake by forages, with varied responses among the seven elements defined above. Although urine contributes fewer micronutrients compared to faeces (as applied at a natural volume/mass basis, respectively), it notably improves forage yield and micronutrient accumulation, thus potentially delivering positive consequences at the farm level regarding economic performance and soil fertility when swards upon clayey soil types receive said urine in temperate agro-climatic regions (i.e., South West England in the current context). In contrast, faeces application in isolation hinders Se and Mn uptake, once again potentially delivering unintended consequences such as micronutrient deficiencies in areas of high faeces deposition. As it is unlikely that (b)ovine grazing fields will receive either urine or faeces in isolation, we also explored combined applications of both excreta types which demonstrates synergistic effects on N, Cu, and Zn uptake, with either synergistic or dilution effects being observed for P and S, depending largely on SOC levels. Additionally, interactions between excreta types can result in dilution or antagonistic effects on Mn and Se uptake. Notably, high SOC combined with faeces reduces Mn and Se in forages, raising concerns for grazed ruminant systems under certain biotic situations, e.g., due to insufficient soil Se levels typically observed in UK pastures for livestock growth. These findings underscore the importance of considering SOC and excreta nutritional composition when designing forage management to optimize nutrient uptake. It should be noted that these findings have potential ramifications for broader studies of sustainable agriculture through system-scale analyses, as the granularity of results reported herein elucidate gaps in knowledge which could affect, both positively and negatively, the interpretation of model-based environmental impact assessments of cattle and sheep production (e.g., in the case of increased yields [beneficial] or the requirement of additional synthetic supplementation [detrimental]).

Microplastics in dermatology: Potential effects on skin homeostasis.

BACKGROUND: Microplastics (MPs) and nanoplastics (NPs) have become a growing concern in dermatology due to their widespread presence in cosmetic formulations and the environment. These minuscule synthetic polymer particles prompt an essential exploration of their potential impact on dermatological homeostasis. AIMS: This study aims to investigate the effects of MPs and NPs on the integumentary system. Specifically, it seeks to understand the potential cutaneous alterations, inflammatory responses, and disruptions to the skin's physiological functions caused by these synthetic particles. PATIENTS/METHODS: The investigation involves a comprehensive analysis of emerging research on MPs and NPs. This includes their presence in cosmetic formulations and environmental pervasiveness. The study delves into their capacity to breach the cutaneous barrier, raising concerns about the implications of prolonged exposure. RESULTS: Evidence suggests that MPs and NPs may indeed incite cutaneous alterations, provoke inflammatory responses, and disturb the homeostasis of the skin's physiological functions. Their small dimensions enhance their capability to breach the cutaneous barrier, further emphasizing the apprehensions associated with prolonged exposure. CONCLUSIONS: While a precise understanding of the implications of MPs and NPs on dermatological health remains an ongoing scientific endeavor, this study underscores the growing significance of these synthetic particles. The findings emphasize the need for proactive measures to safeguard both individual well-being and environmental preservation in the context of dermatological health.

Systematic review and comparative analysis of pediatric nutrition screening tools validated in Europe and Canada / Revisión sistemática y análisis comparativo de las herramientas de tamizaje nutricional en pediatría validadas en Europa y Canadá

Abstract Introduction: Nutritional screening is a useful tool for determining the risk of hospital malnutrition; therefore, reviewing the guidelines on its use in the pediatric population is of great importance. Objective: To provide recommendations on the use of nutrition screening tools validated in Canada and Europe in the Colombian pediatric population. Materials and method: A systematic review was conducted using the PRISMA methodology. The quality of the evidence found in the review was assessed using the U.S. Preventive Services Task Force (USPSTF) tool, which was established by the Canadian Task Force on the Periodic Health Examination for assessing preventive actions. Results: Fifteen studies were included in the review as they met the inclusion criteria. In addition, 7 nutrition screening tools were identified (PYMS, iPYMS, PeDiSMART, PNR, STAMP, PMST and STRONGkids). According to guidelines of the European Society for Clinical Nutrition and Metabolism, the PYMS, iPYMS and STRONGkids tools simultaneously assess prognostic variables such as current nutritional status, stability, expected improvement or worsening of the condition, and the influence of the disease process in nutritional deterioration. Regarding concurrent validity, data analysis shows that PYMS, iPYMS and PMST have sensitivities >85%, and that PYMS has a specificity >85%. In terms of reproducibility, PEDISMART, STRONGkids, STAMP and PYMS have an acceptable interobserver agreement (k>0.41). Conclusion: Based on the evidence found, which was analyzed in terms of prognostic variables, concurrent validity and reproducibility, the use of the PYMS tool in the clinical practice is suggested. In contrast, hospitals must assess the applicability of the STAMP and iPYMS tools.

Resumen Introducción. El tamizaje nutricional es una herramienta efectiva que permite establecer el riesgo de desnutrición hospitalaria, por consiguiente es importante revisar las directrices respecto a su uso en pediatría. Objetivo. Ofrecer recomendaciones sobre el uso de las herramientas de tamizaje nutricional validadas en Canadá y Europa en población colombiana. Materiales y métodos. Se realizó una revisión sistemática siguiendo la metodología PRISMA. Para la evaluación de la calidad de la evidencia se utilizó la herramienta U.S Preventive Services Task Force, formulada para medir acciones preventivas por la Canadian Task Force on the Periodic Health Examination. Resultados. Se incluyeron 15 estudios que cumplían los criterios de selección y se identificaron 7 herramientas (PYMS, iPYMS, PeDiSMART, PNR, STAMP, PMST y STRONGkids). Según los lineamientos de la Sociedad Europea de Nutrición Clínica y Metabolismo, la PYMS, la iPYMS y la STRONGkids evalúan simultáneamente variables pronósticas como estado nutricional actual, estabilidad, progresión esperada e influencia de la enfermedad. En cuanto a validez concurrente, el análisis de datos muestra que la PYMS, la iPYMS y la PMST tienen sensibilidades >85% y que la PYMS tiene especificidad >85%. Respecto a reproducibilidad, la PEDISMART, la STRONGkids, la STAMP y la PYMS tienen una concordancia inter-observadores aceptable (k>0.41). Conclusión. Según la evidencia analizada en términos de variables pronósticas, validez concurrente y reproducibilidad, se sugiere el empleo en la práctica clínica de la herramienta PYMS, mientras que para el uso de la STAMP y la iPYMS las instituciones deben evaluar su aplicabilidad.

Factores de riesgo de parto pretérmino en Bogotá D. C., Colombia / Risk factors for preterm birth in Bogota D. C., Colombia

Resumen Introducción. El parto pretérmino es aquel que ocurre antes de la semana 37 de gestación. Este tipo de parto se asocia a múltiples factores de riesgo, algunos de los cuales pueden ser prevenidos. En Colombia son escasos los estudios sobre los factores de riesgo asociados al parto pretérmino, de ahí la importancia de su análisis. Objetivo. Identificar los factores de riesgo para parto pretérmino en un grupo de gestantes de Bogotá D.C., Colombia. Materiales y métodos. Estudio de cohorte retrospectivo. La muestra estuvo compuesta por 452 pacientes que habían participado en un estudio primario y que ya habían dado a luz. Resultados. La incidencia de parto pretérmino fue de 10.40% (IC95%: 7.60-13.20) y los factores de riesgo asociados fueron los siguientes: ser diagnosticada con preeclampsia severa, con un riesgo relativo (RR) de 7.47 (IC95%: 4.59-11.95); tener preeclampsia (severa y no severa), con un RR=5.05 (IC95%: 3.0-8.51), y ocurrencia de restricción del crecimiento intrauterino (RCIU), con un RR=4.40 (IC95%: 2.44-7.98). Conclusiones. De acuerdo con los hallazgos reportados en el presente estudio, es necesario planear e implementar estrategias y políticas públicas en Bogotá D.C. que promuevan mejores prácticas de atención prenatal que, a su vez, permitan la detección temprana de condiciones como la preeclampsia y la RCIU, lo que hará posible reducir la incidencia de partos pretérmino en la ciudad y utilizar la experiencia y resultados obtenidos en el resto del país.

Abstract Introduction: A preterm birth occurs before the 37th week of pregnancy. It is associated with multiple risk factors, some of which can be prevented. In Colombia, few studies have addressed the risks factors associated with preterm birth, hence the importance of analyzing them. Objective: To identify risk factors for preterm birth in a population of pregnant women in Bogotá D.C., Colombia. Materials and methods: Retrospective cohort study. The sample was composed of 452 patients who had participated in a primary study and had already given birth. Results: The incidence of preterm birth was 10.40% (95%CI: 7.60-13.20). The following risk factors associated with preterm delivery were found: being diagnosed with severe preeclampsia, with a relative risk (RR)=7.47 (95%CI: 4.59-11.95); having preeclampsia (severe and non-severe), with a RR=5.05 (95%CI: 3.0-8.51); and occurrence of intrauterine growth restriction (IUGR), with a RR=4.40 (95%CI: 2.44-7.98). Conclusions: According to the findings reported in this study, it is necessary to plan and implement strategies and public policies in Bogotá D.C. that promote better prenatal care practices that, in turn, allow the early detection of conditions such as preeclampsia and IUGR. This will reduce the incidence of preterm birth in the city and will allow using the experience and results obtained here in the rest of the country.

Manejo del dolor agudo en el paciente gran quemado: Revisión no sistemática de la literatura / Management of acute pain in extensive burn injury: Nonsystematic review of the literature

Abstract Introduction: Management of acute pain is essential in the treatment of burned patients. Current pain management approaches focus on the control of the somatic component reflecting the insult. However, the injury comprises emotional, physical, and psychological components that require multi-disciplinary management, including pharmacological and nonpharmacological interventions to break the vicious circle of pain and its complications. Objective: To perform a nonsystematic review of the literature on the pharmacological and nonpharmacological management of pain in patients with extensive burns. Methods: Nonsystematic review of the literature published between 2000 and 2016 in MEDLINE/PubMed, Embase, Sciencedirect, SciELO, LILACS, Google Scholar, academic books, and institutional management guidelines. Results: After analyzing the literature, it was found that the management of acute pain in the patients with severe burn injury should be based on a multidisciplinary approach. Conclusions: Management of acute pain in patients with severe burn injury should not focus only on the somatic components of pain but should also encompass the emotional, physical, and psychosocial components, in order to provide comprehensive management, both pharmacological and nonpharmacological.

Resumen Introducción: El manejo del dolor agudo es fundamental en el tratamiento de los pacientes quemados. Los esquemas actuales de manejo de dolor se enfocan en el control del componente somático que refleja la noxa, sin embargo es un evento con componentes emocionales, físico y psíquicos, que requiere manejo multidisciplinario incluyendo intervenciones farmacológicas y no farmacológicas, para romper el círculo vicioso del dolor y sus complicaciones. Objetivo: Realizar una revisión no sistemática de la literatura sobre el manejo farmacológico y no farmacológico del dolor agudo en el paciente gran quemado. Metodología: Se realizó una revisión no sistemática en MEDLINE/PubMed, Embase, Science Direct, SciELO, LILACS, Google Scholar, libros académicos, guías de manejo institucionales, desde el año 2000 hasta el 2016. Resultados: Luego de analizar la literatura se encuentra que el manejo del dolor agudo en el paciente gran quemado debe recibir un enfoque multidisciplinario. Conclusiones: El manejo agudo del dolor en el paciente gran quemado no se debe centrar solamente en los componentes somáticos del mismo, sino que debe extenderse a los componentes emocionales físicos y psicosociales, para brindar un manejo integral, tanto farmacológico como no farmacológico.

Recuento de actinomyces en saliva como predictores microbiológico de caries / Count of actinomyces in saliva as microbiological predictors of caries

Introduction: La caries dental es definida como un proceso infeccioso, multifactorial y crónico. Actualmente se realiza el recuento en saliva del grupo Streptococcus mutans, Lactobacillus y Candida. El género Actinomyces se considera agente etiológico de caries, pero no existen pruebas que hayan evaluado el nivelde este microorganismo en saliva. El objetivo de este trabajo es determinar la correlación entre los nivelesde Actinomyces en saliva y los indicadores clínicos de riesgo y actividad cariogénica para utilizar el recuentode estos microorganismos como predictor de riesgo de caries. Métodos: 33 estudiantes entre 19 y 24 años, de ambos sexos, fueron incluidos en este estudio. Los mismos se clasificaron en 3 grupos: sanos, con riesgo cariogénico y con actividad cariogénica según los siguientes indicadores clínicos: Índice O?Leary, Nº decaries amelodentinarias abiertas, frecuencia de cepillado y momentos de azúcar. Muestras de saliva fueron sembradas en Agar Brucella con hemina, vitamina K y 5% de sangre. Se incubó en anaerobiosis por 7 díasy se realizó el recuento de Actinomyces y microbiota acompañante. Resultados: Hubo diferencias estadísticamente significativas en el recuento de la microbiota total y los niveles en saliva de Actinomyces, entre losestudiantes sanos con los que poseen riesgo y aquellos con actividad cariogénica. Conclusión: El presenteestudio conduce a proponer la utilización del recuento de Actinomyces como predictores de riesgo de caries conjuntamente con el recuento del grupo Streptococcus mutans, Lactobacillus y Candida

Reabsorción apical en dientes con periodontis apical crónica / Apical resorption of teeth with chronic apical periodontitis

El propósito de este estudio fue establecer si se debe modificar la longitud apical en dientes con periodontitis apical crónica, que presenta reabsorción apical del cemento, de dentina radicular o de dentina intraconducto, o de la combinación de estas, y que pueden afectar la unión cemento dentinarias se tomaron 18 dientes humanos que se dividieron en 10 casos experimentales y 8 controles. Se sometieron a un proceso de desmineralización y fijación para obtener placas histológicas que se observaron al microscopio de luz. En el grupo control no hubo inflamación apical en el 100 por ciento y, el 50 por ciento presento reabsorción superficial que afectó solamente el cemento, el 12.5 por ciento mostró reabsorción intraconducto.