Single center assessment of the role of Oakland score among patients admitted for acute lower gastrointestinal bleeding.

BACKGROUND/OBJECTIVES: The Oakland score was developed to predict safe discharge in patients who present to the emergency department with lower gastrointestinal bleeding (LGIB). In this study, we retrospectively evaluated if this score can be implemented to assess safe discharge (score ≤ 10) at WellStar Atlanta Medical Center (WAMC). METHODS: A retrospective cohort study of 108 patients admitted at WAMC from January 1, 2020 to December 30, 2021 was performed. Patients with LGIB based on the ICD-10 codes were included. Oakland score was calculated using 7 variables (age, sex, previous LGIB, digital rectal exam, pulse, systolic blood pressure (SBP) and hemoglobin (Hgb)) for all patients at admission and discharge from the hospital. The total score ranges from 0 to 35 and a score of ≤ 10 is a cut-off that has been shown to predict safe discharge. Hgb and SBP are the main contributors to the score, where lower values correspond to a higher Oakland score. Descriptive and multivariate analysis was performed using SPSS 23 software. RESULTS: A total of 108 patients met the inclusion criteria, 53 (49.1%) were female with racial distribution was as follows: 89 (82.4%) African Americans, 17 (15.7%) Caucasian, and 2 (1.9%) others. Colonoscopy was performed in 69.4% patients; and 61.1% patients required blood transfusion during hospitalization. Mean SBP records at admission and discharge were 129.0 (95% CI, 124.0-134.1) and 130.7 (95% CI,125.7-135.8), respectively. The majority (59.2%) of patients had baseline anemia and the mean Hgb values were 11.0 (95% CI, 10.5-11.5) g/dL at baseline prior to hospitalization, 8.8 (95% CI, 8.2-9.5) g/dL on arrival and 9.4 (95% CI, 9.0-9.7) g/dL at discharge from hospital. On admission, 100/108 (92.6%) of patients had an Oakland score of > 10 of which almost all patients (104/108 (96.2%)) continued to have persistent elevation of Oakland Score greater than 10 at discharge. Even though, the mean Oakland score improved from 21.7 (95% CI, 20.4-23.1) of the day of arrival to 20.3 (95% CI, 19.4-21.2) at discharge, only 4/108 (3.7%) of patients had an Oakland score of ≤ 10 at discharge. Despite this, only 9/108 (8.33%) required readmission for LGIB during a 1-year follow-up. We found that history of admission for previous LGIB was associated with readmission with adjusted odds ratio 4.42 (95% CI, 1.010-19.348, p = 0.048). CONCLUSIONS: In this study, nearly all patients who had Oakland score of > 10 at admission continued to have a score above 10 at discharge. If the Oakland Score was used as the sole criteria for discharge most patients would not have met discharge criteria. Interestingly, most of these patients did not require readmission despite an elevated Oakland score at time of discharge, indicating the Oakland score did not really predict safe discharge. A potential confounder was the Oakland score did not consider baseline anemia during calculation. A prospective study to evaluate a modified Oakland score that considers baseline anemia could add value in this patient population.

Incidence, Burden, and Predictors of Readmission for Acute Alcoholic Pancreatitis: A National Analysis over 11 Months.

BACKGROUND/OBJECTIVES: Data regarding incidence, health-care burden, and predictors for readmission in patients with acute alcoholic pancreatitis (AAP) is scarce. We aim to identify incidence, health-care burden, and predictors of readmission over an 11-month period. METHODS: Retrospective cohort study using the 2016 National Readmission Database of adult patients admitted with a principal diagnosis of AAP in January and 11-month readmission follow up for all-cause readmission. Incidence of all-cause readmission, mortality rate, morbidity, length of stay (LOS), total hospitalization charges and costs were evaluated. Independent risk factors for all-cause readmission were identified using a Cox multivariate logistic regression analysis. RESULTS: A total of 6633 patients were included in the study. The mean age was 45.7 years and 28.9% of patients were female. 73.1% of patients had a modified BISAP score of 0. The 11-month readmission rate was 43.1%. The main cause of readmission was another episode of AAP. The mortality rate of readmission was 0.5% and the mortality rate during the index admission (IA) was 1.1% (P = 0.03). The mean LOS, total hospitalization charges and costs for readmission were 4.5 days, $34,307 and $8958, respectively. Independent predictors of readmission were Charlson Comorbidity Index score of ≥ 3, associated chronic alcoholic pancreatitis, and chronic pancreatitis (CP) from other causes. CONCLUSION: Among patients admitted with AAP, the 11-month readmission rate was 43.1%. Over one-third of readmissions were due to another episode of AAP. Readmission associated with significant resource utilization. Special attention should be placed in patients with underlying CP due to the increased risk of readmission.

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support.

BACKGROUND: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. STUDY DESIGN: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. RESULTS: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0-76.0), median injury severity score was 34.0 (IQR, 27.0-43.0), and the median duration of ECMO support was 11 days (IQR, 7.5-20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). CONCLUSIONS: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

Is calcium deficiency the real cause of bitter pit? A review.

Bitter pit is a disorder affecting the appearance of apples. Susceptibility is genetically controlled by both the cultivar and rootstock, with both environmental and horticultural factors affecting its severity and proportional incidence. Symptoms appear more frequently at the calyx end of the fruit and consist of circular necrotic spots, which take on a "corky" appearance visible through the peel. Bitter pit may develop before harvest, or after harvest, reducing the proportions of marketable fruit. In this review, current knowledge of the factors associated with the occurrence of bitter pit in apples is summarized and discussed along with their interactions with Ca uptake and distribution to fruit. This disorder has been previously linked with localized Ca deficiencies in fruit during its development. However, these relationships are not always clear. Even with over a century of research, the precise mechanisms involved in its development are still not fully understood. Additional factors also contribute to bitter pit development, like imbalances of mineral nutrients, low concentration of auxins, high concentration of gibberellins, changes in xylem functionality, or physiological responses to abiotic stress. Bitter pit remains a complex disorder with multiple factors contributing to its development including changes at whole plant and cellular scales. Apple growers must carefully navigate these complex interactions between genetics, environment, and management decisions to minimize bitter pit in susceptible cultivars. Accordingly, management of plant nutrition, fruit crop load, and tree vigor still stands as the most important contribution to reducing bitter pit development. Even so, there will be situations where the occurrence of bitter pit will be inevitable due to cultivar and/or abiotic stress conditions.

Non-coronary atherosclerosis: a marker of poor prognosis in patients undergoing coronary artery bypass surgery.

Introduction: The presence of non-coronary atherosclerosis (NCA) in patients with coronary artery disease is associated with a poor prognosis. We have studied whether NCA is also a predictor of poorer outcomes in patients undergoing coronary artery bypass grafting (CABG). Materials and methods: This is an observational study involving 567 consecutive patients who underwent CABG. Variables and prognosis were analysed based on the presence or absence of NCA, defined as previous stroke, transient ischaemic attack (TIA), or peripheral artery disease (PAD) [lower extremity artery disease (LEAD), carotid disease, previous lower limb vascular surgery, or abdominal aortic aneurysm (AAA)]. The primary outcome was a combination of TIA/stroke, acute myocardial infarction, new revascularization procedure, or death. The secondary outcome added the need for LEAD revascularization or AAA surgery. Results: One-hundred thirty-eight patients (24%) had NCA. Among them, traditional cardiovascular risk factors and older age were more frequently present. At multivariate analysis, NCA [hazard ratio (HR) = 1.84, 95% confidence interval (CI) 1.27-2.69], age (HR = 1.35, 95% CI 1.09-1.67, p = 0.004), and diabetes mellitus (HR = 1.50, 95% CI 1.05-2.15, p = 0.025), were positively associated with the development of the primary outcome, while estimated glomerular filtration rate (HR = 0.86, 95% CI 0.80-0.93, p = 0.001) and use of left internal mammary artery (HR = 0.36, 95% CI 0.15-0.82, p = 0.035), were inversely associated with this outcome. NCA was also an independent predictor of the secondary outcome. Mortality was also higher in NCA patients (27.5% vs. 9%, p < 0.001). Conclusions: Among patients undergoing CABG, the presence of NCA doubled the risk of developing cardiovascular events, and it was associated with higher mortality.

Intrahepatic Biliary Colloid Carcinoma: A Rare Site for Recurrence.

A new biliary duct (BD) stricture raises questions about the presence of malignancy, especially with a history of metastatic pancreatic cancer. A few cases of colloid carcinoma (CC) of the pancreas have been published, but none have described recurrence in the biliary tract. We report a case of intrahepatic biliary CC that recurred after two years after the last dose of immunotherapy for pancreatic CC. In addition to a unique biliary cancer case presentation, this case raises awareness of the best strategy for cancer surveillance.

A Case of Zieve's Syndrome With the Development of Delirium Tremens.

A 50-year-old man presented to the emergency department with dark urine and altered mental status. Upon examination, the patient was found to be jaundiced with normal vitals. Laboratory investigation demonstrated macrocytic anemia and abnormal liver function tests. During his hospitalization, he developed delirium tremens in addition to the discovery of acute hemolytic anemia, hypercholesterolemia, and hypertriglyceridemia. Therefore, he was diagnosed with Zieve's syndrome (ZS), a rarely reported disease characterized by hemolytic anemia, cholestatic jaundice, and transient hyperlipidemia. Physicians encountering acute hemolytic anemia in a patient with concomitant acute liver injury should consider ZS as a differential diagnosis, as prompt recognition of the syndrome can help prevent unnecessary procedures and therapy.

Sensitivity and specificity of diagnostic modalities in pouchitis: a systematic review and meta-analysis.

Restorative proctocolectomy (RPC) is the most common surgical procedure to restore gastrointestinal continuity after surgical resection of the colon and rectum. Pouchitis is a common complication with several different modalities that can be used to aid diagnosis. This systematic review and meta-analysis aimed at exploring the sensitivity and specificity these diagnostic modalities. The medical literature was searched using MEDLINE, EMBASE and EMBASE classic and PubMed from 1978 to June 2022. We calculated descriptive statistics using sensitivity, specificity, and false-positive rate of the primary studies and also their positive and negative likelihood ratios, and their diagnostic odds ratios. The screen found 5477 records with 13 studies being included. Faecal lactoferrin was found to have the highest pooled sensitivity and specificity of 98% and 88% respectively with imaging modalities coming in second and faecal calprotectin third with pooled sensitivities and specificities of 87% and 79% and 74% and 81% respectively. Faecal biomarkers particularly lactoferrin and imaging modalities may have an important role to play in diagnosing pouchitis. Importantly due to delays in availability of pouchoscopy, our data supports early ordering of these tests to help delineate from other causes. Further studies are required with larger cohort sizes to further validate these tests.

Trunk Water Potential Measured with Microtensiometers for Managing Water Stress in "Gala" Apple Trees.

The weather variations around the world are already having a profound impact on agricultural production. This impacts apple production and the quality of the product. Through agricultural precision, growers attempt to optimize both yield and fruit size and quality. Two experiments were conducted using field-grown "Gala" apple trees in Geneva, NY, USA, in 2021 and 2022. Mature apple trees (Malus × domestica Borkh. cv. Ultima "Gala") grafted onto G.11 rootstock planted in 2015 were used for the experiment. Our goal was to establish a relationship between stem water potential (Ψtrunk), which was continuously measured using microtensiometers, and the growth rate of apple fruits, measured continuously using dendrometers throughout the growing season. The second objective was to develop thresholds for Ψtrunk to determine when to irrigate apple trees. The economic impacts of different irrigation regimes were evaluated. Three different water regimes were compared (full irrigation, rainfed and rain exclusion to induce water stress). Trees subjected the rain-exclusion treatment were not irrigated during the whole season, except in the spring (April and May; 126 mm in 2021 and 100 mm in 2022); that is, these trees did not receive water during June, July, August and half of September. Trees subjected to the rainfed treatment received only rainwater (515 mm in 2021 and 382 mm in 2022). The fully irrigated trees received rain but were also irrigated by drip irrigation (515 mm in 2021 and 565 mm in 2022). Moreover, all trees received the same amount of water out of season in autumn and winter (245 mm in 2021 and 283 mm in 2022). The microtensiometer sensors detected differences in Ψtrunk among our treatments over the entire growing season. In both years, experimental trees with the same trunk cross-section area (TCSA) were selected (23-25 cm-2 TCSA), and crop load was adjusted to 7 fruits·cm-2 TCSA in 2021 and 8.5 fruits·cm-2 TCSA in 2022. However, the irrigated trees showed the highest fruit growth rates and final fruit weight (157 g and 70 mm), followed by the rainfed only treatment (132 g and 66 mm), while the rain-exclusion treatment had the lowest fruit growth rate and final fruit size (107 g and 61 mm). The hourly fruit shrinking and swelling rate (mm·h-1) measured with dendrometers and the hourly Ψtrunk (bar) measured with microtensiometers were correlated. We developed a logistic model to correlate Ψtrunk and fruit growth rate (g·h-1), which suggested a critical value of -9.7 bars for Ψtrunk, above which there were no negative effects on fruit growth rate due to water stress in the relatively humid conditions of New York State. A support vector machine model and a multiple regression model were developed to predict daytime hourly Ψtrunk with radiation and VPD as input variables. Yield and fruit size were converted to crop value, which showed that managing water stress with irrigation during dry periods improved crop value in the humid climate of New York State.

From nuclear track characterization to machine learning based image classification in neutron autoradiography for boron neutron capture therapy.

Knowledge of the 10B microdistribution is of great relevance in BNCT studies. Since 10B concentration assesment through neutron autoradiography depends on the correct quantification of tracks in a nuclear track detector, image acquisition and processing conditions should be controlled and verified, in order to obtain accurate results to be applied in the frame of BNCT. With this aim, an image verification process was proposed, based on parameters extracted from the quantified nuclear tracks. Track characterization was performed by selecting a set of morphological and pixel-intensity uniformity parameters from the quantified objects (area, diameter, roundness, aspect ratio, heterogeneity and clumpiness). Their distributions were studied, leading to the observation of varying behaviours in images generated by different samples and acquisition conditions. The distributions corresponding to samples coming from the BNC reaction showed similar attributes in each analyzed parameter, proving to be robust to the experimental process, but sensitive to light and focus conditions. Considering those observations, a manual feature extraction was performed as a pre-processing step. A Support Vector Machine (SVM) and a fully dense Neural Network (NN) were optimized, trained, and tested. The final performance metrics were similar for both models: 93%-93% for the SVM, vs 94%-95% for the NN in accuracy and precision respectively. Based on the distribution of the predicted class probabilities, the latter had a better capacity to reject inadequate images, so the NN was selected to perform the image verification step prior to quantification. The trained NN was able to correctly classify the images regardless of their track density. The exhaustive characterization of the nuclear tracks provided new knowledge related to the autoradiographic images generation. The inclusion of machine learning in the analysis workflow proves to optimize the boron determination process and paves the way for further applications in the field of boron imaging.

Epidemiology of Fabry disease in patients in hemodialysis in the Madrid community.

This study screened for Fabry disease (FD) in patients in hemodialysis (HD) in the region of Madrid (CAM) with a cross-sectional design to evaluate HD-prevalent patients, followed by a three-year period prospective design to analyze HD-incident patients. INCLUSION CRITERIA: patients older than 18 years on HD in the CAM, excluding patients diagnosed with any other hereditary disease with renal involvement different from FD, that sign the Informed Consent (IC). EXCLUSION CRITERIA: underaged patients or not agreeing or not being capable of signing the IC. RESULTS: 3470 patients were included, 63% males and with an average age of 67.9±9.7 years. 2357 were HD-prevalent patients and 1113 HD-incident patients. For HD-prevalent patients, average time in HD was 45.2 months (SD 51.3), in HD-incident patients proteinuria was present in 28.4%. There were no statistical differences in plasmatic alpha-galactosidase A (α-GAL-A) activity or Lyso-GL-3 values when comparing HD-prevalent and HD-incident populations and neither between males and females. A genetic study was performed in 87 patients (2.5% of patients): 60 male patients with decreased enzymatic activity and 27 female patients either with a decreased GLA activity, increased Lyso-Gl3 levels or both. The genetic variants identified were: p.Asp313Tyr (4 patients), p.Arg220Gln (3 patients) and M290I (1 patient). None of the identified variants is pathogenic. CONCLUSIONS: 76% of HD Centers of the CAM participated in the study. This is the first publication to describe the prevalence of FD in the HD-population of a region of Spain as well as its average α-GAL-A-activity and plasmatic Lyso-Gl3 levels. It is also the first study that combines a cross-sectional design with a prospective follow-up design. This study has not identified any FD patient.

Observation versus antiplatelet therapy as primary prophylaxis for thrombosis in low-risk essential thrombocythemia.

The effectiveness of antiplatelet therapy as primary prophylaxis for thrombosis in low-risk essential thrombocythemia (ET) is not proven. In this study, the incidence rates of arterial and venous thrombosis were retrospectively analyzed in 300 low-risk patients with ET treated with antiplatelet drugs as monotherapy (n = 198) or followed with careful observation (n = 102). Follow-up was 802 and 848 person-years for antiplatelet therapy and observation, respectively. Rates of thrombotic events were 21.2 and 17.7 per 1000 person-years for antiplatelet therapy and observation, respectively (P = .6). JAK2 V617F-positive patients not receiving antiplatelet medication showed an increased risk of venous thrombosis (incidence rate ratio [IRR]: 4.0; 95% CI: 1.2-12.9; P = .02). Patients with cardiovascular risk factors had increased rates of arterial thrombosis while on observation (IRR: 2.5; 95% CI: 1.02-6.1; P = .047). An increased risk of major bleeding was observed in patients with platelet count greater than 1000 x 10(9)/L under antiplatelet therapy (IRR: 5.4; 95% CI: 1.7-17.2; P = .004). In conclusion, antiplatelet therapy reduces the incidence of venous thrombosis in patients with JAK2-positive ET and the rate of arterial thrombosis in patients with associated cardiovascular risk factors. In the remaining low-risk patients, this therapy is not effective as primary prophylaxis of thrombosis, and observation may be an adequate option.

Pedestrians' perceptions of walkability and safety in relation to the built environment in Cali, Colombia, 2009-10.

OBJECTIVE: To assess pedestrians' perceptions of the walkability of the urban environment and pedestrian safety in Cali, Colombia. DESIGN: Standardised intercept interviews were conducted of 400 pedestrians walking in 20 randomly selected urban zones to ascertain frequency of walking, and perceptions of safety, the built environment and security. Four focus group meetings were held with community members and students addressing these issues in an open-ended forum. The study analysed quantitative data collected in street interviews and qualitative information from focus groups addressing respondents' views on problems for pedestrians, how the built environment affects walking and ideal walking conditions. RESULTS: Access to public transportation was deemed the most positive characteristic of the built environment and 61% of respondents liked walking in the street. When disaggregating street conditions, the majority of pedestrians were dissatisfied with their walking experiences. Pedestrians cited lack of respect for norms, personal safety and built environment characteristics as their main concerns. Among frequent walkers, residents tended to rate their neighbourhoods more negatively compared with non-residents. Through qualitative interviews it became apparent that narrow sidewalks that are frequently obstructed by motor vehicles are a key reason for pedestrian dissatisfaction. A perception of overall insecurity further determines how pedestrians assess or modulate their walking in this city. CONCLUSIONS: Overall, walking in Cali was perceived negatively by pedestrians because of built environment characteristics and perceptions of insecurity. Qualitative information used to complement intercept surveys can provide a better way to identify pedestrian-specific transport-related problems.

Transient Neurogenic Bowel Dysfunction in a Case of Cocaine-Induced Spinal Cord Infarction.

A 23-year-old male presented to the hospital with altered mental status (AMS) and hypoglycemia requiring admission to the ICU. He had improvement in AMS after administration of dextrose 50% and naloxone and endorsed the use of alcohol, cocaine, and marijuana that morning. It was confirmed with a positive urine toxicology screen for cocaine and tetrahydrocannabinol (THC). During this hospital admission, his physical examination was notable for paraplegia with no motor abilities from the T6 dermatome and below. Sensation was intact throughout all dermatomes but he was found to have urinary retention. Workup included an abnormal MRI showing T2 signal spanning from T2-T8, raising a high suspicion of a probable acute ischemic spinal cord infarction. Several hours after admission, the patient began to exhibit the first signs of abnormal bowel function and experienced one episode of hematemesis, prolonging his ICU stay.

Indocyanine green fluorescence: A surgeon's tool for the surgical approach of gallstone ileus.

Fluorescence cholangiography has been shown to improve biliary anatomy identification. A case of 60-year-old man with intestinal obstruction is reported, an entero-biliary fistula is suspected, and intravenous application of indocyanine green is decided, despite the great inflammatory process and fibrotic tissues found during the procedure, safe open cholecystectomy was achieved.

Cystic adventitial disease of popliteal artery, the both sides of the coin: Arterial resection vs cyst excision.

Adventitial cystic disease (ACD) is a rare form of non-atherosclerotic arterial stenosis. This entity accounts only for 0.1% of all vascular diseases and affects the popliteal artery unilaterally in 85% of the cases. The options for treatment ACD include excision of cysts, removal of the affected arterial segment with vein graft reconstruction or radiological aspiration. We present two cases of ACD of the popliteal artery and its subsequent management and discuss the pros and cons of the treatment's strategies.

Spectroscopic study of terrestrial analogues to support rover missions to Mars - A Raman-centred review.

The 2020s could be called, with little doubt, the "Mars decade". No other period in space exploration history has experienced such interest in placing orbiters, rovers and landers on the Red Planet. In 2021 alone, the Emirates' first Mars Mission (the Hope orbiter), the Chinese Tianwen-1 mission (orbiter, lander and rover), and NASA's Mars 2020 Perseverance rover reached Mars. The ExoMars mission Rosalind Franklin rover is scheduled for launch in 2022. Beyond that, several other missions are proposed or under development. Among these, MMX to Phobos and the very important Mars Sample Return can be cited. One of the key mission objectives of the Mars 2020 and ExoMars 2022 missions is the detection of traces of potential past or present life. This detection relies to a great extent on the analytical results provided by complementary spectroscopic techniques. The development of these novel instruments has been carried out in step with the analytical study of terrestrial analogue sites and materials, which serve to test the scientific capabilities of spectroscopic prototypes while providing crucial information to better understand the geological processes that could have occurred on Mars. Being directly involved in the development of three of the first Raman spectrometers to be validated for space exploration missions (Mars 2020/SuperCam, ExoMars/RLS and RAX/MMX), the present review summarizes some of the most relevant spectroscopy-based analyses of terrestrial analogues carried out over the past two decades. Therefore, the present work describes the analytical results gathered from the study of some of the most distinctive terrestrial analogues of Martian geological contexts, as well as the lessons learned mainly from ExoMars mission simulations conducted at representative analogue sites. Learning from the experience gained in the described studies, a general overview of the scientific outcome expected from the spectroscopic system developed for current and forthcoming planetary missions is provided.

Palatoplasty as the technique of choice for prevention of obstructive sleep apnea secondary to surgery for velopharyngeal insufficiency.

OBJECTIVE: The aim of this study is to compare patients treated with pharyngoplasty and those treated with palatoplasty for velopharyngeal insufficiency to establish what surgical procedure poses the highest risk for developing sleep apnea. The hypothesis tested in this study is that the incidence of obstructive sleep apnea syndrome associated with pharyngoplasty is greater than that associated with palatoplasty for velopharyngeal insufficiency. SUBJECTS: Twenty patients were taken from the Institution FISULAB. DESIGN: Observational cohort analytic study. MAIN OUTCOME MEASURES: An overnight polysomnographic study was used to determine the incidence and severity of obstructive sleep apnea syndrome. RESULTS: The incidence of obstructive sleep apnea syndrome following pharyngoplasty was shown to be significantly higher than after palatoplasty. The apnea-hypopnea index, also called the respiratory disturbance index, was 12.7 in the pharyngoplasty group and 1.35 in the palatoplasty group (p < .001). When obstructive sleep apnea syndrome was stratified into different levels of severity according to the values of respiratory disturbance index, there were noticeable differences between these two groups. In the palatoplasty group, one patient had mild obstructive sleep apnea syndrome. In the pharyngoplasty group, two patients had mild obstructive sleep apnea syndrome, one patient had moderate obstructive sleep apnea syndrome, and two patients had severe obstructive sleep apnea syndrome. CONCLUSIONS: When comparing the apnea-hypopnea index (i.e., respiratory disturbance index) of patients treated for velopharyngeal insufficiency with palatoplasty versus pharyngoplasty, we observed an important difference between the groups, with the highest indices in the pharyngoplasty group.

Adjustable conduits for guided peripheral nerve regeneration prepared from bi-zonal unidirectional and multidirectional laminar scaffold of type I collagen.

Shortness of donor nerves has led to the development of nerve conduits that connect sectioned peripheral nerve stumps and help to prevent the formation of neuromas. Often, the standard diameters of these devices cannot be adapted at the time of surgery to the diameter of the nerve injured. In this work, scaffolds were developed to form filled nerve conduits with an inner matrix with unidirectional channels covered by a multidirectional pore zone. Collagen type I dispersions (5 mg/g and 8 mg/g) were sequentially frozen using different methods to obtain six laminar scaffolds (P1 to P5) formed by a unidirectional (U) pore/channel zone adjacent to a multidirectional (M) pore zone. The physicochemical and microstructural properties of the scaffolds were determined and compared, as well as their biodegradability, residual glutaraldehyde and cytocompatibility. Also, the Young's modulus of the conduits made by rolling up the bizonal scaffolds from the unidirectional to the multidirectional zone was determined. Based on these comparisons, the proliferation and differentiation of hASC were assessed only in the P3 scaffolds. The cells adhered, aligned in the same direction as the unidirectional porous fibers, proliferated, and differentiated into Schwann-like cells. Adjustable conduits made with the P3 scaffold were implanted in rats 10 mm sciatic nerve lesions to compare their performance with that of autologous sciatic nerve grafted lesions. The in vivo results demonstrated that the tested conduit can be adapted to the diameter of the nerve stumps to guide their growth and promote their regeneration.

Rapid decline of anti-SARS-CoV-2 antibodies in patients on haemodialysis: the COVID-FRIAT study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients on haemodialysis (HD) have high mortality. We investigated the value of reverse transcription polymerase chain reaction (RT-PCR) and the dynamic changes of antibodies (enzyme-linked immunosorbent assay immunoglobulin M (IgM) + IgA and/or IgG) in a large HD cohort. METHODS: We conducted a prospective observational study in 10 Madrid HD centres. Infection rate, anti-SARS-CoV-2 antibody dynamics and the incidence of asymptomatic SARS-CoV-2 infection (defined by positive RT-PCR, IgM + IgA and/or IgG) were assessed. RESULTS: From 1 March to 15 April 2020, 136 of 808 (16.8%) HD patients were diagnosed with symptomatic COVID-19 by RT-PCR of nasopharyngeal swabs and 42/136 (31%) died. In the second fortnight of April, RT-PCR and anti-SARS-CoV-2 antibodies were assessed in 763 of the surviving patients. At this point, 69/91 (75.8%) symptomatic COVID-19 patients had anti-SARS-CoV-2 antibodies. Four weeks later, 15.4% (10/65) of initially antibody-positive patients had become negative. Among patients without prior symptomatic COVID-19, 9/672 (1.3%) were RT-PCR positive and 101/672 patients (15.0%) were antibody positive. Four weeks later, 62/86 (72.1%) of initially antibody-positive patients had become negative. Considering only IgG titres, serology remained positive after 4 weeks in 90% (54/60) of patients with symptomatic COVID-19 and in 52.5% (21/40) of asymptomatic patients. The probability of an adequate serologic response (defined as the development of anti-SARS-CoV-2 antibodies that persisted at 4 weeks) was higher in patients who had symptomatic COVID-19 than in asymptomatic SARS-CoV-2 infection {odds ratio [OR) 4.04 [95% confidence interval (CI) 2.04-7.99]} corrected for age, Charlson comorbidity index score and time on HD. Living in a nursing home [OR 5.9 (95% CI 2.3-15.1)] was the main risk factor for SARS-CoV-2 infection. CONCLUSIONS: The anti-SARS-CoV-2 antibody immune response in HD patients depends on clinical presentation. The antibody titres decay earlier than previously reported for the general population. This inadequate immune response raises questions about the efficacy of future vaccines.