Clinical factors associated with early and persistent hypocalcaemia after parathyroidectomy in patients on dialysis with severe hyperparathyroidism.

AIM: Severe hypocalcaemia following parathyroidectomy for secondary or tertiary hyperparathyroidism (SHPT/THPT) is scarcely studied. We aimed to describe and identify risk factors for early and persistent hypocalcaemia after parathyroidectomy. METHODS: Retrospective pair-matched cohort study. We assessed 87 dialysis patients with SHPT (n = 73) or THPT (n = 14) paired with 146 subjects with primary hyperparathyroidism (PHPT) who underwent parathyroidectomy and were followed for 12 months. Early severe hypocalcaemia was defined as a free Ca ≤0.8 mmol/L [3.2 mg/dl] or corrected Ca ≤1.87 mmol/L [7.5 mg/dl] within 48 h. After parathyroidectomy and persistent hypocalcaemia, as an elemental Ca intake >3.0 g/day to achieve corrected Ca >2 mmol/L [8.0 mg/dl]. RESULTS: Early severe hypocalcaemia occurred in 77% (67/87) versus 6.8% (10/146) of subjects with SHPT/THPT and PHPT, respectively (p < .001). In SHPT/THPT cases, persistent hypocalcaemia occurred in 77% (49/64) and 64% (35/54) after 6 and 12 months of parathyroidectomy, respectively. In PHPT cases, persistent hypocalcaemia occurred in 6.8% (10/146) after 4-12 months of parathyroidectomy. Preoperative serum alkaline phosphatase (ALP) was the only risk factor associated to early severe hypocalcaemia (OR 7.3, 95% C.I. 1.7-10.9, p = .006) and persistent hypocalcaemia (OR 7.1, 95% C.I: 2.1-14.2, p = .011). Subjects with persistently low intact parathormone (iPTH) (<5.3 pmol/L [50 ng/ml]), suggestive of adynamic bone disease) showed higher Ca increases and less oral calcium requirements compared to those who progressively increased iPTH after parathyroidectomy. CONCLUSION: Early and persistent hypocalcaemia after parathyroidectomy in severe HPT were a common event associated directly to preoperative ALP levels. Subjects with persistently low postoperative iPTH normalized serum Ca more frequently after 1 year of follow up.

Intercostal Nerve Transfers to the Musculocutaneous-A Reliable Nerve Transfer for Restoration of Elbow Flexion in Birth-Related Brachial Plexus Injuries.

Introduction There is consensus on the need for early microsurgical reconstruction in birth palsies involving three or more roots, that is, extensive partial palsies and total palsies. The fundamental principles of these operations are complete exploration and judicious use of the ruptured stumps by nerve grafting to suitable distal targets. The frequent observation of root avulsions in such cases makes it imperative to look for extraplexual nerve donors for some functions. Intercostal nerves are readily available in such patients. Materials and Methods This is a study of 50 patients of extensive partial and total birth palsies operated upon by the senior author between 1995 and 2010. These included 33 patients with total palsies, 16 patients with near total palsies, and one patient with C56 deficit (operated upon more than 20 years ago). These children were all operated upon between 3 and 6 months of age, except for two patients in whom surgery was delayed till a year due to the phrenic nerve deficit noted at birth. Four intercostal nerves were transferred to the musculocutaneous nerve (MCN) by direct approximation with fibrin glue. Results No respiratory complication was noted from the intercostal harvest. The follow-up ranged from 8 to 20 years (mean 10 years). As many as 48 of the 50 patients regained fully independent elbow flexion. In two cases, the procedure failed completely and had to be salvaged with a free functioning muscle transfer and reuse of the intercostal nerves. Conclusion Intercostal nerve transfers can be relied upon for restoration of elbow flexion in birth palsies. The ruptured roots can then be utilized for augmenting shoulder function in partial palsies or for hand function in total palsies.

Power Performance Verification of a Wind Farm Using the Friedman's Test.

In this paper, a method of verification of the power performance of a wind farm is presented. This method is based on the Friedman's test, which is a nonparametric statistical inference technique, and it uses the information that is collected by the SCADA system from the sensors embedded in the wind turbines in order to carry out the power performance verification of a wind farm. Here, the guaranteed power curve of the wind turbines is used as one more wind turbine of the wind farm under assessment, and a multiple comparison method is used to investigate differences between pairs of wind turbines with respect to their power performance. The proposed method says whether the power performance of the specific wind farm under assessment differs significantly from what would be expected, and it also allows wind farm owners to know whether their wind farm has either a perfect power performance or an acceptable power performance. Finally, the power performance verification of an actual wind farm is carried out. The results of the application of the proposed method showed that the power performance of the specific wind farm under assessment was acceptable.

Modeling of a Robust Confidence Band for the Power Curve of a Wind Turbine.

Having an accurate model of the power curve of a wind turbine allows us to better monitor its operation and planning of storage capacity. Since wind speed and direction is of a highly stochastic nature, the forecasting of the power generated by the wind turbine is of the same nature as well. In this paper, a method for obtaining a robust confidence band containing the power curve of a wind turbine under test conditions is presented. Here, the confidence band is bound by two curves which are estimated using parametric statistical inference techniques. However, the observations that are used for carrying out the statistical analysis are obtained by using the binning method, and in each bin, the outliers are eliminated by using a censorship process based on robust statistical techniques. Then, the observations that are not outliers are divided into observation sets. Finally, both the power curve of the wind turbine and the two curves that define the robust confidence band are estimated using each of the previously mentioned observation sets.

[Tenosynovitis due to Chikungunya virus]. / Tenosinovitis por virus Chikungunya.

We report the case of a man from Dominican Republic who consulted for a tenosynovitis of the right middle finger extensor; in the immediate convalescence second febrile curve, after 48 hours of no symptoms of an acute febrile illness, with marked fatigue, itchy rash, polyarthralgia, functional impairment and general stiffness. Biochemical tests did not provide useful data for diagnosis. Dengue virus serology was negative. Detection of IgM and neutralizing antibodies (PRNT) for Chikundunya virus (CHIKV) were positive.

Paralytic Shellfish Toxins in Mollusks from Galicia Analyzed by a Fast Refined AOAC 2005.06 Method: Toxicity, Toxin Profile, and Inter-Specific, Spatial, and Seasonal Variations.

Paralytic shellfish poisoning is an important concern for mollusk fisheries, aquaculture, and public health. In Galicia, NW Iberian Peninsula, such toxicity has been monitored for a long time using mouse bioassay. Therefore, little information exists about the precise toxin analogues and their possible transformations in diverse mollusk species and environments. After the change in the European PSP reference method, a refinement of the Lawrence method was developed, achieving a 75% reduction in chromatogram run time. Since the beginning of 2021, when this refinement Lawrence method was accredited under the norm UNE-EN ISO/IEC 17025, it has been used in the area to determine the toxin profiles and to estimate PSP toxicity in more than 4500 samples. In this study, we have summarized three years of monitoring results, including interspecific, seasonal, and geographical variability of PSP toxicity and toxin profile. PSP was detected in more than half of the samples analyzed (55%), but only 4.4% of the determinations were above the EU regulatory limit. GTX1,4 was the pair of STX analogs that produced the highest toxicities, but GTX2,3 was found in most samples, mainly due to the reduction of GTX1,4 but also by the higher sensitivity of the method for this pair of analogs. STX seems to be mainly a product of biotransformation from GTX2,3. The studied species (twelve bivalves and one gastropod) accumulated and transformed PSP toxins to a different extent, with most of them showing similar profiles except for Spisula solida and Haliotis tuberculata. Two seasonal peaks of toxicity were found: one in spring-early summer and another in autumn, with slightly different toxin profiles during outbreaks in relation to the toxicity during valleys. In general, both the total toxicity and toxin profiles of the southernmost locations were different from those in the northern part of the Atlantic coast and the Cantabrian Sea, but this general pattern is modified by the PSP history of some specific locations.

Yessotoxins in Mollusks of the Galician Coast from 2014 to 2022: Variability, Biotransformation, and Resistance to Alkaline Hydrolysis.

The presence of yessotoxins (YTXs) was analyzed in 10,757 samples of Galician bivalves from 2014 to 2022. Only YTX and 45-OH YTX were found. YTX was detected in 31% of the samples, while 45-OH YTX was found in 11.6% of them. Among the samples containing YTX, 45-OH YTX was detected in 37.3% of cases. The maximum recorded levels were 1.4 and 0.16 mg of YTX-equivalentsg-1, for YTX and 45-OH YTX, respectively, which are well below the regulatory limit of the European Union. The YTX and 45-OH YTX toxicities in the raw extracts and extracts subjected to alkaline hydrolysis were strongly and linearly related. Due to the lack of homo-YTX in Galician samples, the effect of alkaline hydrolysis on homo-YTX and 45OH-Homo-YTX was only checked in 23 additional samples, observing no negative effect but a high correlation between raw and hydrolyzed extracts. Hydrolyzed samples can be used instead of raw ones to carry out YTXs determinations in monitoring systems, which may increase the efficiency of those systems where okadaic acid episodes are very frequent and therefore a higher number of hydrolyzed samples are routinely analyzed. The presence of YTX in the studied bivalves varied with the species, with mussels and cockles having the highest percentages of YTX-detected samples. The presence of 45-OH YTX was clearly related to YTX and was detected only in mussels and cockles. Wild populations of mussels contained proportionally more 45-OH YTX than those that were raft-cultured. Spatially, toxin toxicities varied across the sampling area, with higher levels in raft-cultured mussels except those of Ría de Arousa. Ría de Ares (ARE) was the most affected geographical area, although in other northern locations, lower toxin levels were detected. Seasonally, YTX and 45-OH YTX toxicities showed similar patterns, with higher levels in late summer and autumn but lower toxicities of the 45-OH toxin in August. The relationship between the two toxins also varied seasonally, in general with a minimum proportion of 45-OH YTX in July-August but with different maximum levels for raft-cultured and wild mussel populations. Interannually, the average toxicities of YTX decreased from 2014 to 2017 and newly increased from 2018 to 2021, but decreased slightly in 2022. The relationship between 45-OH YTX and YTX also varied over the years, but neither a clear trend nor a similar trend for wild and raft mussels was observed.

Influence of an armrest support on handgrip strength in different arm and shoulder flexion angles in overhead postures.

A study was undertaken in which the handgrip strength in three arm positions above the shoulder was measured to compare handgrip strength when arm support is used and when it is not used. Grip forces were generated in pairs of flexion angles, corresponding to shoulder and elbow at 90°-90°, 135°-45° and 160°-20°. Thirty-two participants completed the present study; 23 men and nine women with a median age of 23.1 (SD ±3.6) years. A manual handgrip dynamometer (0-90 kg) and an adjustable angle arm support (AAAS) were used during the data collection. Two-way analysis of variance (ANOVA) for repeated measurements indicates a significant effect of the AAAS factor on the handgrip strength, as well as on the AAAS × angle interaction. However, there is no significant effect of the angle factor on the AAAS × angle interaction.

Spirolides in Bivalve Mollusk of the Galician (NW Spain) Coast: Interspecific, Spatial, Temporal Variation and Presence of an Isomer of 13-Desmethyl Spirolide C.

Spirolides are cyclic imines whose risks to human health have not been sufficiently evaluated. To determine the possible impact of these compounds in Galicia (NW Spain), their presence and concentration in bivalve mollusk were studied from 2014 to 2021. Only 13-desmethyl spirolide C (13desmSPXC) and an isomer have been detected, and always at low concentrations. Mussel, Mytilus galloprovincialis, was the species which accumulated more spirolides, but the presence of its isomer was nearly restricted to cockle, Cerastoderma edule, and two clam species, Venerupis corrugata and Polititapes rhomboides. On average, the highest 13desmSPXC levels were found in autumn-winter, while those of its isomer were recorded in spring-summer. Both compounds showed decreasing trends during the study period. Geographically, the concentration tends to decrease from the southern to the north-eastern locations, but temporal variability predominates over spatial variability.

Twenty-Five Years of PSP Toxicity in Galician (NW Spain) Bivalves: Spatial, Temporal, and Interspecific Variations.

Twenty-five years of paralytic shellfish poisoning (PSP) toxicity in Galician bivalves have been studied. PSP was detected in 4785 out of 73,740 samples of the commercially important bivalve species analyzed from 1995 to 2020. Its general prevalence in the area was 6.5%. Only 1.6% of all samples tested were over the regulatory limit (incidence). The maximum level of PSP in the area, 40,800 µg STX 2HCl-eq kg-1, was recorded in raft mussels from Bueu (PON-II, Pontevedra) in December 2005. The highest maximum PSP values were found in mussels, which were mostly affected by Gymnodinium catenatum, but not those of prevalence and incidence which were recorded in clams, mostly affected by Alexandrium. Average levels in mussels were higher than in any other studied species. Spatially, in general, the prevalence, incidence, maximum, and average PSP toxicity during episodes tend to decrease from south to northeast, but some hot points with high levels can be identified. PCA analysis separates the southern rías, associated to G. catenatum blooms, from the middle and northern ones, associated to Alexandrium blooms. Along the year, two main peaks of the four variables are observed, the first one in late autumn-winter and the other in summer, the summer peak being much more important for the infaunal species than for raft mussels. In the seasonal pattern obtained by time series analysis of the average PSP toxicity, the autumn-winter peak was only maintained (and very reduced) in the southern rías, indicating that this peak is seasonally much less important than the summer peak. The observed seasonality is expected based on the timing of the blooms of the two PSP-producing phytoplankton groups present in the area. Over the 25 years of monitoring, large differences in PSP toxicity have been observed. Apart from some special years, an ascending trend in prevalence and incidence seems to be present from 2011 to 2020. No trend seems to exist during the same period for average or maximum toxicity.

Ramsay-Hunt syndrome: Report of two cases with identification of the varicella zoster virus genome in cerebrospinal fluid / Síndrome de Ramsay-Hunt: a propósito de dos casos en que se identificó el genoma del virus de la varicela-zóster en líquido cefalorraquídeo

Like other alpha-herpesviruses, the varicella-zoster virus (VZV) remains latent in the neural ganglia following the primary varicella infection. The reactivation of the VZV in the dorsal root ganglia results in herpes zoster. Herpes zoster eruption is characterized by localized cutaneous lesions and neuralgic pain mostly in older and immunocompromised persons, especially those living with the human immunodeficiency virus (HIV). The most commonly reported complications include VZV pneumonia, meningitis, encephalitis, and hepatitis. Several neurologic syndromes have been described associated with herpes zoster localized in cranial areas including peripheral nerve palsies and the Ramsay-Hunt syndrome, which has a varied clinical presentation and is the second most common cause of peripheral facial paralysis. Facial paralysis in this syndrome occurs in 60 to 90% of cases and it may precede or appear after the cutaneous lesions with a worse prognosis than idiopathic Bell paralysis. Here we present two cases of herpes zoster from the geniculate ganglia with peripheral facial paralysis that appeared simultaneously with vesicular herpetic otic lesions (multimetameric Ramsay-Hunt syndrome). In the two cases, amplifiable varicella-zoster viral DNA was found in the cerebrospinal fluid by RT-PCR Multiplex.

Como los otros herpesvirus alfa, el virus de la varicela-zóster (VZV) permanece en estado de latencia en los ganglios neurales después de la infección primaria (varicela). La reactivación de una infección latente por VZV en los ganglios de la raíz dorsal, produce el herpes zóster. La erupción que este provoca se caracteriza por lesiones cutáneas metaméricas que se acompañan de dolor neurítico y comprometen con mayor frecuencia a ancianos y sujetos inmunocomprometidos, en especial, aquellos infectados con el virus de la inmunodeficiencia humana (HIV). Las complicaciones que se observan en esta población de pacientes incluyen neumonía, hepatitis y compromiso del sistema nervioso central (meningitis y encefalitis). Varios síndromes clínicos se asocian con el herpes zóster de localización craneal, incluida la parálisis facial periférica y el síndrome de Ramsay-Hunt, el cual constituye la segunda causa de parálisis facial periférica y tiene una gran variedad de presentaciones clínicas. La parálisis facial se presenta en 60 a 90 % de los casos de síndrome de Ramsay-Hunt, puede preceder o aparecer después de las lesiones cutáneas y tiene peor pronóstico que la parálisis de Bell. Se describen aquí dos casos de herpes zóster del ganglio geniculado, con parálisis facial periférica que coincidió con la aparición de las lesiones cutáneas vesiculosas en el conducto auditivo externo y el pabellón auricular (síndrome de Ramsay-Hunt multimetamérico). En ambos casos, se identificó el genoma del VZV mediante PCR en el líquido cefalorraquídeo (LCR).

Gymnodimine A in mollusks from the north Atlantic Coast of Spain: Prevalence, concentration, and relationship with spirolides.

Gymnodimine A has been found in mollusks obtained along the whole northern coast of Spain from April 2017 to December 2019. This is the first time that this toxin is detected in mollusks from the Atlantic coast of Europe. The prevalence of the toxin was, in general, low, being detected on average in approximately 6% of the obtained samples (122 out of 1900). The concentrations recorded were also, in general, low, with a median of 1.3 µg kg-1, and a maximum value of 23.93 µg kg-1. The maxima of prevalence and concentration were not geographically coincident, taking place the first at the easternmost part of the sampled area and the second at the westernmost part. In most cases (>94%), gymnodimine A and 13-desmethyl spirolide C were concurrently detected, suggesting that Alexandrium ostenfeldii could be the responsible producer species. The existence of cases in which gymnodimine A was detected alone suggests also that a Karenia species could also be involved. The geographical heterogeneity of the distribution suggests that blooms of the producer species are mostly local. Not all bivalves are equally affected, clams being less affected than mussels, oysters, and razor clams. Due to their relatively low toxicity, and their low prevalence and concentration, it seems that these toxins do not pose an important risk for the mollusk consumers in the area.

Sodium-Glucose Cotransporter 2 Inhibitors Mechanisms of Action: A Review.

Sodium-Glucose Cotransporter 2 inhibitors (SGLT2i), or gliflozins, are a group of antidiabetic drugs that have shown improvement in renal and cardiovascular outcomes in patients with kidney disease, with and without diabetes. In this review, we will describe the different proposed mechanisms of action of SGLT2i. Gliflozins inhibit renal glucose reabsorption by blocking the SGLT2 cotransporters in the proximal tubules and causing glucosuria. This reduces glycemia and lowers HbA1c by ~1.0%. The accompanying sodium excretion reverts the tubuloglomerular feedback and reduces intraglomerular pressure, which is central to the nephroprotective effects of SGLT2i. The caloric loss reduces weight, increases insulin sensitivity, lipid metabolism, and likely reduces lipotoxicity. Metabolism shifts toward gluconeogenesis and ketogenesis, thought to be protective for the heart and kidneys. Additionally, there is evidence of a reduction in tubular cell glucotoxicity through reduced mitochondrial dysfunction and inflammation. SGLT2i likely reduce kidney hypoxia by reducing tubular energy and oxygen demand. SGLT2i improve blood pressure through a negative sodium and water balance and possibly by inhibiting the sympathetic nervous system. These changes contribute to the improvement of cardiovascular function and are thought to be central in the cardiovascular benefits of SGLT2i. Gliflozins also reduce hepcidin levels, improving erythropoiesis and anemia. Finally, other possible mechanisms include a reduction in inflammatory markers, fibrosis, podocyte injury, and other related mechanisms. SGLT2i have shown significant and highly consistent benefits in renal and cardiovascular protection. The complexity and interconnectedness of the primary and secondary mechanisms of action make them a most interesting and exciting pharmacologic group.

Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries.

BACKGROUND: Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. METHODS: A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. RESULTS: A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P = 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P = 0.001) presented a statistically significant association with the rupture. CONCLUSIONS: Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.

Twenty-Five Years of Domoic Acid Monitoring in Galicia (NW Spain): Spatial, Temporal and Interspecific Variations.

Prevalence, impact on shellfish resources and interspecific, spatial, and temporal variabilities of domoic acid (DA) in bivalves from Galicia (NW Spain) have been studied based on more than 25 years of monitoring data. The maximum prevalence (samples in which DA was detected) (100%) and incidence (samples with DA levels above the regulatory limit) (97.4%) were recorded in Pecten maximus, and the minimum ones in Mytilus galloprovincialis (12.6 and 1.1%, respectively). The maximum DA concentrations were 663.9 mg kg-1 in P. maximus and 316 mg kg-1 in Venerupis corrugata. After excluding scallop P. maximusdata, DA was found (prevalence) in 13.3% of bivalve samples, with 1.3% being over the regulatory limit. In general, the prevalence of this toxin decreased towards the North but not the magnitude of its episodes. The seasonal distribution was characterized by two maxima, in spring and autumn, with the later decreasing in intensity towards the north. DA levels decreased slightly over the studied period, although this decreasing trend was not linear. A cyclic pattern was observed in the interannual variability, with cycles of 4 and 11 years. Intoxication and detoxification rates were slower than those expected from laboratory experiments, suggesting the supply of DA during these phases plays an important role.

Paralytic Shellfish Poisoning (PSP) in Mussels from the Eastern Cantabrian Sea: Toxicity, Toxin Profile, and Co-Occurrence with Cyclic Imines.

In the late autumn of 2018 and 2019, some samples taken by the official monitoring systems of Cantabria and the Basque Country were found to be paralytic shellfish poisoning (PSP)-positive using a mouse bioassay. To confirm the presence of PSP toxins and to obtain their profile, these samples were analyzed using an optimized version of the Official Method AOAC 2005.06 and using LC-MS/MS (HILIC). The presence of some PSP toxins (PSTs) in that geographical area (~600 km of coast) was confirmed for the first time. The estimated toxicities ranged from 170 to 983 µg STXdiHCl eq.·kg-1 for the AOAC 2005.06 method and from 150 to 1094 µg STXdiHCl eq.·kg-1 for the LC-MS/MS method, with a good correlation between both methods (r2 = 0.94). Most samples contained STX, GTX2,3, and GTX1,4, and some also had NEO and dcGTX2. All of the PSP-positive samples also contained gymnodimine A, with the concentrations of the two groups of toxins being significantly correlated. The PSP toxin profiles suggest that a species of the genus Alexandrium was likely the causative agent. The presence of gymnodimine A suggests that A. ostenfeldii could be involved, but the contribution of a mixture of Alexandrium species cannot be ruled out.

Longitudinal Changes in the Use of PD Assistance for Patients Maintained on Peritoneal Dialysis.

Background: Home dialysis therapies, such as peritoneal dialysis (PD), offer flexibility and improved well-being, particularly for older individuals. However, a substantial proportion require assistance with personal care and health care-related tasks. We hypothesized that patients and families would require less PD assistance as they became more familiar with PD-related tasks. The study objective was to assess whether the nature of, and need for, PD assistance decreased over time. Methods: Using a multicentered, prospective, observational study design, patients aged ≥50 years were recruited from those starting PD. Patients underwent formal evaluation using validated components of a Comprehensive Geriatric Assessment at baseline, and they were followed monthly and administered a questionnaire about the need for assistance with PD-related tasks. Results: A total of 111 patients (age 69±10 years, 68% men, and 56% diabetic) were followed for a total of 609 patient-months. Of those who needed help, 40% had help from a family member, and 33% were helped by nurses. Both the quantity and nature of help received by patients remained generally stable throughout follow-up and did not vary according to age, frailty, functional dependence, or cognitive impairment (P=0.93). The proportion of patients needing help varied widely across the 13 different tasks but appeared relatively stable across time. The paid-unpaid caregiver ratio for the different tasks did not change over time. Conclusions: Older patients initiating PD in the outpatient setting have a high need for assistance with PD-related tasks, which seems to persist over the initial 6-month period.

Diversity and regional distribution of harmful algal events along the Atlantic margin of Europe.

The IOC-ICES-PICES Harmful Algal Event Database (HAEDAT) was used to describe the diversity and spatiotemporal distribution of harmful algal events along the Atlantic margin of Europe from 1987 - 2018. The majority of events recorded are caused by Diarrhetic Shellfish Toxins (DSTs). These events are recorded annually over a wide geographic area from southern Spain to northern Scotland and Iceland, and are responsible for annual closures of many shellfish harvesting areas. The dominant causative dinoflagellates, members of the morphospecies 'Dinophysis acuminata complex' and D. acuta, are common in the waters of the majority of countries affected. There are regional differences in the causative species associated with PST events; the coasts of Spain and Portugal with the dinoflagellates Alexandrium minutum and Gymnodinium catenatum, north west France/south west England/south Ireland with A. minutum, and Scotland/Faroe Islands/Iceland with A. catenella. This can influence the duration and spatial scale of PST events as well as the toxicity of shellfish. The diatom Pseudo-nitzschia australis is the most widespread Domoic Acid (DA) producer, with records coming from Spain, Portugal, France, Ireland and the UK. Amnesic Shellfish Toxins (ASTs) have caused prolonged closures for the scallop fishing industry due to the slow depuration rate of DA. Amendments to EU shellfish hygiene regulations introduced between 2002 and 2005 facilitated end-product testing and sale of adductor muscle. This reduced the impact of ASTs on the scallop fishing industry and thus the number of recorded HAEDAT events. Azaspiracids (AZAs) are the most recent toxin group responsible for events to be characterised in the ICES area. Events associated with AZAs have a discrete distribution with the majority recorded along the west coast of Ireland. Ciguatera Poisoning (CP) has been an emerging issue in the Canary Islands and Madeira since 2004. The majority of aquaculture and wild fish mortality events are associated with blooms of the dinoflagellate Karenia mikimotoi and raphidophyte Heterosigma akashiwo. Such fish killing events occur infrequently yet can cause significant mortalities. Interannual variability was observed in the annual number of HAEDAT areas with events associated with individual shellfish toxin groups. HABs represent a continued risk for the aquaculture industry along the Atlantic margin of Europe and should be accounted for when considering expansion of the industry or operational shifts to offshore areas.

Fibroblast growth factor 21 is associated with increased serum total antioxidant capacity and oxidized lipoproteins in humans with different stages of chronic kidney disease.

Background and aims: Oxidative stress (OS) induces the production of fibroblast growth factor 21 (FGF21). Previous data have revealed that FGF21 protects cells from OS injury and death, making it a potential therapeutic option for many diseases with increased OS. However, the association of this growth factor with OS markers in humans with chronic kidney disease (CKD) remains unknown. This study aims to evaluate the association of serum FGF21 with serum total antioxidant capacity (TAC) and oxidized low-density lipoproteins (OxLDL) in subjects in different stages of kidney disease. Methods: This is a cross-sectional study that included 382 subjects with different stages of CKD, irrespective of type 2 diabetes (T2D) diagnosis. Associations of serum FGF21 with OxLDL, TAC, sex, age, body mass index (BMI), fasting plasma glucose, estimated glomerular filtration rate (eGFR), T2D, and smoking, were evaluated through bivariate and partial correlation analyses. Independent associations of these variables with serum FGF21 were evaluated using multiple linear regression analysis. Results: Serum FGF21 was significantly and positively correlated with age (r = 0.236), TAC (lnTAC) (r = 0.217), and negatively correlated with eGFR (r = -0.429) and male sex (r = -0.102). After controlling by age, sex, BMI, T2D, smoking, and eGFR; both TAC and OxLDL were positively correlated with FGF21 (r = 0.117 and 0.158 respectively, p < 0.05). Using multiple linear regression analysis, eGFR, male sex, T2D, OxLDL, and TAC were independently associated with serum FGF21 (STDß = -0.475, 0.162, -0.153, 0.142 and 0.136 respectively; p < 0.05 for all) adjusted for age, BMI, smoking, and fasting plasma glucose. Conclusion: A positive association between serum FGF21 and OS has been found independently of renal function in humans. Results from the present study provide novel information for deeper understanding of the role of FGF21 in OS in humans with CKD and T2D; mechanistic studies to explain the association of serum FGF21 with oxidative stress in CKD are needed.

Relationship of superior sagittal sinus with sagittal midline: A surgical application.

BACKGROUND: Interhemispheric approach is widely used to surgical management of midline tumors and vascular lesion in and around the third ventricle. Complete exposure of the superior sagittal sinus to obtain adequate working space of midline lesion is difficult, because of the risk to inadvertent injury to the sinus and bridging veins, which may cause several neurological deficits. Understanding the SSS neuroanatomy and its relationships with external surgical landmarks avoid such complications. The objective of this study is to accurately describe the position of SSS and its displacement in relation with sagittal midline by magnetic resonance imaging. METHODS: A retrospective cross-sectional, observational study was performed. Magnetic resonance image of 76 adult patients with no pathological imaging was analyzed. The position of the halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was performed. The width and the displacement of the superior sagittal sinus accordingly to the sagittal midline were assessed in those landmarks. RESULTS: The mean width of superior sagittal sinus at halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was 5.62 ± 2.5, 6.5 ± 2.8, 7.4 ± 3.2, and 8.5 ± 2.1 mm, respectively, without gender discrepancy. The mean displacement according to the midline at those landmarks showed a statistically significant difference to the right side among sexes. CONCLUSION: In this study, we demonstrate that sagittal midline may approximate external location of the superior sagittal sinus. Our data showed that in the majority of the cases, the superior sagittal sinus is displaced to the right side of sagittal midline as far as 16.3 mm. The data we obtained provide useful information that suggest that neurosurgeons should use safety margin to perform burr holes and drillings at the sagittal midline.