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In this paper we study some geometrical questions about the polytope of bi-capacities. For this, we introduce the concept of pointed order polytope, a natural generalization of order polytopes. Basically, a pointed order polytope is a polytope that takes advantage of the order relation of a partially ordered set and such that there is a relevant element in the structure. We study which are the set of vertices of pointed order polytopes and sort out a simple way to determine whether two vertices are adjacent. We also study the general form of its faces. Next, we show that the set of bi-capacities is a special case of pointed order polytope. Then, we apply the results obtained for general pointed order polytopes for bi-capacities, allowing to characterize vertices and adjacency, and obtaining a bound for the diameter of this important polytope arising in Multicriteria Decision Making.

To assess the potential eco-risk of PAHs along the study sites (Site1 – characterized by tourist influx and a religious pilgrimage centre resulting in domestic and organic pollution and massive foot traffic. Site 2 – Neendakara characterized by oil pollution since it is a fishing harbour and port with large scale motor boat / trawler traffic. Site 3 –characterized by inorganic pollution of heavy metals, trace metals, polycyclic aromatic hydrocarbons and organochlorins due to discharge of effluents from KMML Titanium dioxide industrial factory. Site 4 –control site since it is presumed to be near pristine being post tsunami and lacking any industrial / agricultural enterprise in the vicinity. The concentrations of N, B (a) A, Fl, ACN, and Ph cases were higher than effects range low (ERL) values, lower than the effects range median (ERM) values, except for Naphthalene and Acenaphthene. At site 2, the sampling areas are found to be stagnant with limited water circulation. Woefully, without attaining any pre-treatment on the issue, the regional industries and shipping harbor are still discharging their wastes into the area, resulting in high ∑ PAH concentration. An alarming fallout of the study is that site 4 also recorded appreciable concentrations of PAHs in the sediment, though it was found negligible in the water column. These results indicated that pessimistic eco-risks are likely to occur, although with a likelihood of 50% effects in this area. However, the remaining compounds were recorded below ERL values, which revealed the low risk of biological impairments. The study has disclosed various concentrations of PAH pollutants of low, moderate, and very high levels from the study sites signaling, effective sustainable management measures, and as a first step for long-term goals, the evaluation of water and sediments along the Kerala coastal ecosystem is recommended.

Highlights • Telehealth is a viable option for ambulatory care. • Numerous benefits of telehealth implementation. • Workflow provided for telehealth clinic.

Ice-templating combined with indirect 3D printing is proposed as a promising method for preparation of scaffolds with multiscale porosity, including a well-defined interconnected macro-channel network. Robocasting was used as a comparative technique to produce scaffolds with comparable porosity at the introduced macroporosity and the inter-grain microporosity levels. Porosity, phase composition and mechanical stability were measured and compared for bio-scaffolds prepared by both techniques. Comparable total porosities could only be achieved in robocasting by choosing a significantly lower sintering temperature (950 °C vs. 1200 °C). The compressive strength of robocast scaffolds was significantly greater (6.5 ± 1.19 MPa vs. 2.3 ± 1.00 MPa, respectively). However, the increased level of interconnected multiscale porosity coupled to a finer grain size of ice-templated samples sintered at 1200 °C (∼ 500 nm vs. 2.5 μm for robocast parts) could prove to be beneficial for the development of highly porous bioactive scaffolds with enhanced biological performance.

Twitter as one of the microblogging websites has gained its popularity dues to ease sharing of contents in various forms, which include text, images, and links. Social media users post and share real-time messages about their opinions or comments on a variety of topics, express their typhoon. The Supertyphoon Ompong has been considered a powerful typhoon that struck the island of Luzon on September 15, 2018. It has been the strongest typhoon to strike Luzon since Typhoon Megi in 2010. With this, many tweets have been generated expressing people’s real-time reactions and opinions whether it is positive, negative, or neutral regarding this phenomenon. Owing to the increasing high coverage and impact of Twitter, opinions of people on some issues and their emotion towards the super typhoon ompong were shared through social media can be significantly influenced. It is in this context, that the researchers conducted this study to perform the opinion to emotion mining based on the sentiment analysis towards super typhoon ompong were data was generated and collected through a post and message on Twitter. Specifically, it sought to determine the sentiments before, during, and after the landfall; and perform data visualization using a word cloud.

This paper examines the relationship between the control of airport slots by major airlines and their incentives to engage in service quality. We investigate a set of airline strategies regarding possible practices of slot hoarding and slot concentration through mergers aiming at erecting airport barriers to entry. We develop an econometric model of flight disruptions by allowing an integrated management of flight delays, cancellations, aircraft size, price and passengers per flight. We consider the case of the domestic airline industry in Brazil. We find evidence of the internalization of congestion externalities by dominant carriers. We also have some evidence of schedule padding, a strategic trade-off between delays and cancelations, and slot hoarding following a merger. Our results suggest that carriers intensify the internalization of congestion externalities when slot flight concentration increases.

In this work, a 8-hydroxyquinoline derivative, named 8-hydroxyquinoline-2-carboxaldehyde 2-furoyl hydrazone (HQFUH), was obtained. The respective compound was successfully synthesized as well as its respective Zn(II) coordination compound. Both compounds were structurally characterized, by experimental and theoretical IR and Raman spectra, XRD. Single crystal XRD showed that Zn(II) adopts a tetrahedral geometry, in which the neutral chelating ligand coordinates bidentaded by two N-atoms and the neutrality charge is achieved by two coordinated chloride ions. Topological analysis using Quantum Theory of Atoms in Molecules (QTAIM) was performed to investigate ligand interaction through O-atoms. This investigation is important regarding the determination of complex formation constant. The crystal structures of the ligand and complex are arranged according to an orthorhombic system with P212121 and Aea2 space groups, respectively. Ligand displays a E configuration around to C10 = N2 bond, while after the coordination of metal, a Z configuration is observed. Besides molecular structure description of complex, the intermolecular environment was analyzed by Hirshfeld Surface.

Introduction The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. Material and methods The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. “Radiation protection of patients and staff in interventional procedures” session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. Results Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. Conclusions Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.

Although macrophages (Mϕ) maintain intestinal immune homoeostasis, there is not much available information about their subset composition, phenotype and function in the human setting. Human intestinal Mϕ (CD45+HLA-DR+CD14+CD64+) can be divided into subsets based on the expression of CD11c, CCR2 and CX3CR1. Monocyte-like cells can be identified as CD11chighCCR2+CX3CR1+ cells, a phenotype also shared by circulating CD14+ monocytes. On the contrary, their Mϕ-like tissue-resident counterparts display a CD11c−CCR2−CX3CR1− phenotype. CD11chigh monocyte-like cells produced IL-1β, both in resting conditions and after LPS stimulation, while CD11c− Mϕ-like cells produced IL-10. CD11chigh pro-inflammatory monocyte-like cells, but not the others, were increased in the inflamed colon from patients with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Tolerogenic IL-10-producing CD11c− Mϕ-like cells were generated from monocytes following mucosal conditioning. Finally, the colonic mucosa recruited circulating CD14+ monocytes in a CCR2-dependent manner, being such capacity expanded in IBD. Mϕ subsets represent, therefore, transition stages from newly arrived pro-inflammatory monocyte-like cells (CD11chighCCR2+CX3CR1+) into tolerogenic tissue-resident (CD11c−CCR2−CX3CR1−) Mϕ-like cells as reflected by the mucosal capacity to recruit circulating monocytes and induce CD11c− Mϕ. The process is nevertheless dysregulated in IBD, where there is an increased migration and accumulation of pro-inflammatory CD11chigh monocyte-like cells.

Objective Despite caring for patients near the end-of-life (EOL), surgeons and anesthesiologists report low confidence in their ability to facilitate EOL conversations. This discrepancy exists despite competency requirements and professional medical society recommendations. The objective of this systematic review is to identify articles describing EOL communication training available to surgeons and anesthesiologists, and to assess their methodological rigor to inform future curricular design and evaluation. Methods This PRISMA-concordant systematic review identified English-language articles from PubMed, EMBASE, and manual review. Eligible articles included viewpoint pieces, and observational, qualitative, or case studies that featured an educational intervention for surgeons or anesthesiologists on EOL communication skills. Data on the study objective, setting, design, participants, intervention, and results were extracted and analyzed. The Newcastle-Ottawa Scale was used to assess methodological quality. Results Database and manual search returned 2710 articles. A total of 2268 studies were screened by title and abstract, 46 reviewed in full-text, and 16 included in the final analysis. Fifteen studies were conducted exclusively in academic hospitals. Two studies included attending surgeons as participants; all others featured residents, fellows, or a mix thereof. Fifteen studies used simulated role-playing to teach and assess EOL communication skills. Measured outcomes included knowledge, attitudes, confidence, self-rated or observer-rated communication skills, and curriculum feedback; significance of results varied widely. Most studies lacked adequate methodological quality and appropriate control groups to be confident about the significance and applicability of their results. Conclusions There are few quality studies evaluating EOL communication training for surgeons and anesthesiologists. These programs frequently use role-playing to teach and assess EOL communication skills. More studies are needed to evaluate the effect of these interventions on patient outcomes. However, evaluating the effectiveness of these initiatives poses methodological challenges.

BACKGROUND: Brain metastases are the most common central nervous system (CNS) tumors, occurring in 300,000 people per year in the US. The benefit of surgical resection, over radiosurgery, for dominant lesions remains unclear. METHODS: The University of Pennsylvania Health System database was retrospectively reviewed for patients presenting with multiple brain metastases from 1/1/16 to 8/31/18 with one dominant lesion > 2 cm in diameter, who underwent initial treatment with either resection of the dominant lesion or Gamma Knife radiosurgery (GKS). Inclusion criteria were age > 18, >1 brain metastasis, and presence of a dominant lesion (>2 cm). We analyzed factors associated with mortality. RESULTS: 129 patients were identified (surgery=84, GKS=45). The median number of intracranial metastases was 3 (IQR: 2-5). The median diameter of the largest lesion was 31 mm (IQR: 25-38) in the surgery group vs 21 mm (IQR: 20-24) in the GKS group (pCONCLUSION: In our institution, patients with multiple brain metastases and one symptomatic dominant lesion demonstrated similar survival after GKS when compared with up-front surgical resection of the dominant lesion.

The behavior of local magnetic moments and exchange coupling parameters of Fe x Co 1 - x nanostructures (nanowires and compact clusters) on the fcc Pt(1 1 1) surface is here investigated using the first-principles real-space RS-LMTO-ASA method, in the framework of the DFT. Different configurations of Fe x Co 1 - x trimers and heptamers on Pt(1 1 1) are considered, varying the positions and the concentration of Fe or Co atoms. We discuss the influence of dimensionality and stoichiometry changes on the magnetic properties, specially on the orbital moments, which are very important in establishing a nanoscopic understanding of delocalized electron systems. We demonstrate the existence of a strictly decreasing nonlinear trend of the average orbital moments with the Fe concentration for the compact clusters, different from what was found for Fe x Co 1 - x nanowires on Pt(1 1 1) and also for corresponding higher-dimensional systems ( Fe x Co 1 - x monolayer on Pt(1 1 1) and Fe x Co 1 - x bulk). The average spin moments, however, are invariably described by a linear function with respect to stoichiometry. In all studied cases, the nearest neighbors exchange couplings have shown to be strongly ferromagnetic.

Efavirenz is an anti-HIV drug that presents relevant short- and long-term central nervous system adverse reactions. Its main metabolite (8-hydroxy-efavirenz) was demonstrated to be a more potent neurotoxin than efavirenz itself. This work was aimed to understand how efavirenz biotransformation to 8-hydroxy-efavirenz is related to its short- and long-term neuro-adverse reactions. To access those mechanisms, the expression and activity of Cyp2b enzymes as well as the thiolomic signature (low molecular weight thiols plus S-thiolated proteins) were longitudinally evaluated in the hepatic and brain tissues of rats exposed to efavirenz during 10 and 36days. Efavirenz and 8-hydroxy-efavirenz plasma concentrations were monitored at the same time points. Cyp2b induction had a delayed onset in liver (p

The Latin American Giant Observatory (LAGO) is an international network of water-Cherenkov detectors (WCD) set in different sites across Latin America. On top of the Sierra Negra volcano in Mexico at an altitude of 4530 m, LAGO has completed its first out of three instrumented detector. It consists of a cylindrical water tank with a diameter of 7.3 m and a height of 1 m and a total detection area of 40 m2 that is sectioned in four equal slices. In this work we present the full calibration procedure of this detector and the initial measurements of stability in rate. We also derive the effective area to gamma-ray bursts for the complete array using the LAGO simulation chain, based on CORSIKA and GEANT4.

Eisenmenger syndrome (ES) is a complex combination of cardiovascular abnormalities defined as pulmonary hypertension with investment or bidirectional flow through an intracardiac or aortopulmonary communication, usually secondary to a congenital heart disease not resolved promptly. It carries a significant risk of perioperative mortality, with an incidence close to 30% for non-cardiac surgery. We report the anaesthetic management in a ES patient undergoing breast surgery, which was successfully performed under general anaesthesia combined with thoracic analgesic blocks. The main pathophysiological implications of this syndrome are discussed, emphasizing the importance of appropriate preoperative evaluation with thorough assessment of associated risks, careful intraoperative management, and postoperative care, which should be initially performed in a critical care unit. The need to individualize and tailor the choice of drugs and anesthetic technique to the hemodynamic condition of the patient and the surgical procedure is highlighted.

Objective To assess different aspects of sexual function in men with spinal cord injury (SCI) using the Male Sexual Quotient (MSQ), a newly developed tool to assess sexual function and satisfaction. Design Cross-sectional study. Setting Tertiary rehabilitation center. Participants Patients (N=295) older than 18 years (mean age ± SD, 40.7±14.5y) with SCI for more than 1 year (median time since SCI, 3.6y; range, 1.6–7.0y) were assessed from February to August 2012. Patients completed the MSQ questionnaire and the Sexual Health Inventory for Men (SHIM). Interventions Not applicable. Main Outcome Measures Performance in various domains of sexual function was evaluated using the MSQ and SHIM questionnaires. Results Erectile function, ejaculation, and orgasm were the most severely affected domains. The median MSQ score was 40 (range, 8–66), and the median SHIM score was 5 (range, 0–16). The diagnostic properties of the 2 instruments were similar in the discrimination of sexually active subjects. The area under the receiver operating characteristic curve was .950 (95% confidence interval [CI], .923–.979) for the MSQ and .942 (95% CI, .915–.968) for the SHIM. There was a strong correlation between the 2 instruments ( r =.826; 95% CI, .802–.878). Conclusions Different domains of sexual function are severely impaired in men with SCI, although their sexual interest remains high. The MSQ and SHIM scores strongly correlate, but the MSQ provides a more comprehensive assessment of sexual dysfunction in male patients with SCI.

Testosterone is the most important male sex hormone, and its deficiency brings many physical and mental harms. Efficiently identifying individuals with low testosterone is crucial prior to starting proper treatment. However, routine monitoring of testosterone levels can be costly in many regions, resulting in an underreporting of cases, especially in developing countries. Moreover, there are few studies that employ machine learning (ML) in prognosticating testosterone deficiency. This research, therefore, aims to offer a coherent comparative analysis of machine learning methods that can predict testosterone deficiency without having patients undergo costly medical tests. In doing so, we seek to provide to the urological community a publicly available dataset ( https://github.com/osmarluiz/Testosterone-Deficiency-Dataset ) to increase research in this yet untapped field. For this analysis, we used ten base classifiers (optimized with grid search stratified K-fold cross-validation); three ensemble methods; and eight sampling strategies to analyze a total of 3397 patients. The analysis was based on six features (age; abdominal circumference; triglycerides; high-density lipoprotein; diabetes; and hypertension), all of which were obtained by low-cost exams. We compared the sampling strategies and the classifiers' performance on an independent test set using ranking (PR-AUC), probabilistic (Brier score), and threshold metrics. We found that: (1) within the ranking metrics, sampling strategies did not enhance results in this slightly imbalanced (4:1 ratio) dataset; (2) the ensemble classifier using weighted average presented the best performance; (3) the best base classifier was XGBoost; (4) calibration showed significant improvement for the sampling strategies and slight improvements for the no sampling strategy; (5) the McNemar's test presented statistically similar results among all classifiers; and (6) abdominal circumference (AC) had by far the highest feature importance, followed by triglycerides (TG). Age showed very little significance in predicting testosterone deficiency.

Agonism of the endothelial receptor APJ (putative receptor protein related to AT1; AT1: angiotensin II receptor type 1) has the potential to ameliorate congestive heart failure by increasing cardiac output without inducing hypertrophy. Although the endogenous agonist, pyr-apelin-13 (1), has shown beneficial APJ-mediated inotropic effects in rats and humans, such effects are short-lived given its extremely short half-life. Here, we report the conjugation of 1 to a fatty acid, providing a lipidated peptide (2) with increased stability that retains inotropic activity in an anesthetized rat myocardial infarction (MI) model. We also report the preparation of a library of 15-mer APJ agonist peptide-lipid conjugates, including adipoyl-γGlu-OEG-OEG-hArg-r-Q-hArg-P-r-NMeLeuSHK-G-Oic-pIPhe-P-DBip-OH (17), a potent APJ agonist with high plasma protein binding and a half-life suitable for once-daily subcutaneous dosing in rats. A correlation between subcutaneous absorption rate and lipid length/type of these conjugates is also reported.

Characterizing wildlife conservation problems is essential to properly inform conservation planning, and requires detailed knowledge on critical life stages, such as reproduction. Large tropical raptors often require large emergent trees to build their huge nests. However, large emergents are also in heavy demand by the timber industry. Here, we review the literature to characterize nesting structures used by Earth's largest eagle, Harpy Eagles (Harpia harpyja) and examine to what extent nest-tree selectivity is targeted by selective logging. We show that Harpy Eagles selected specific forest canopy structures as nesting platforms. Nests were large (mean size 152 × 99 cm) and typically located on the main fork of 28 emergent tree species, 92.8% of which are commercially targeted by the timber industry. AIC-based stepwise regression indicated that, compared with non-nesting emergent trees, nest trees were 19.6% taller at the first bifurcation; had crowns 26.6% wider; had 33.3% fewer branches

Aquaporins (AQPs) facilitate water and glycerol movement across membranes. AQP7 is the main aquaglyceroporin in pancreatic β-cells and was proposed to play a role in insulin exocytosis. Although AQP7-null mice display adult-onset obesity, impaired insulin secretion and insulin resistance, AQP7 loss-of-function homozygous mutations in humans do not correlate with obesity nor type-2 diabetes. In addition, AQP12 is upregulated in pancreatitis. However, the implication of this isoform in endocrine pancreas inflammation is still unclear. Here, we investigated AQP7 and AQP12 involvement in cellular and inflammatory processes using RIN-m5F beta cells, a model widely used for their high insulin secretion. AQP7 and AQP12 expression were directly associated with cell proliferation, adhesion and migration. While tumor necrosis factor-alpha (TNFα)-induced inflammation impaired AQP7 expression and drastically reduced insulin secretion, lipopolysaccharides (LPS) prompted AQP7 upregulation, and both TNFα and LPS upregulated AQP12. Importantly, cells overexpressing AQP12 are more resistant to inflammation, revealing lower levels of proinflammatory markers. Altogether, these data document AQP7 involvement in insulin secretion and AQP12 implication in inflammation, highlighting their fundamental role in pancreatic β-cell function.

Many efforts are underway to develop selective inhibitors of the voltage-gated sodium channel Na V 1.7 as new analgesics. Thus far, however, in vitro selectivity has proved difficult for small molecules, and peptides generally lack appropriate pharmacokinetic properties. We previously identified the Na V 1.7 inhibitory peptide GpTx-1 from tarantula venom and optimized its potency and selectivity via structure-guided analoging. To further understand GpTx-1 binding to Na V 1.7, we have mapped the binding site to transmembrane segments 1–4 of the second pseudosubunit internal repeat (commonly referred to as Site 4) using Na V 1.5/Na V 1.7 chimeric protein constructs. We also report that select GpTx-1 amino acid residues apparently not contacting Na V 1.7 can be derivatized with a hydrophilic polymer without adversely affecting peptide potency. Homodimerization of GpTx-1 with a bifunctional polyethylene glycol (PEG) linker resulted in a compound with increased potency and a significantly reduced off-rate, demonstrating the ability to modulate the function and properties of GpTx-1 by linking to additional molecules.

This paper examines the relationship between the control of airport slots by major airlines and their incentives to engage in service quality. We investigate a set of airline strategies regarding possible practices of slot hoarding and slot concentration through mergers aiming at erecting airport barriers to entry. We develop an econometric model of flight disruptions by allowing an integrated management of flight delays, cancellations, aircraft size, price and passengers per flight. We consider the case of the domestic airline industry in Brazil. We find evidence of the internalization of congestion externalities by dominant carriers. We also have some evidence of schedule padding, a strategic trade-off between delays and cancelations, and slot hoarding following a merger. Our results suggest that carriers intensify the internalization of congestion externalities when slot flight concentration increases.

We have installed a hybrid detection system for air showers generated by cosmic rays with energies greater than 3 × 10 15 eV at Mount Chacaltaya (5200 m above the sea level), in order to study the mass composition of cosmic rays above the knee region. This detection system comprises an air shower array with 49 scintillation counters in an area of 500 m×650 m, and seven new Cherenkov light detectors installed in a radial direction from the center of the air shower array with a separation of 50 m. It is known that the longitudinal development of a particle cascade in the atmosphere strongly depends on the type of the primary nucleus, and an air shower initiated by a heavier nucleus develops faster than that by a lighter primary of the same energy, because of the differences in the interaction cross-section and the energy per nucleon. This can be measured by detecting the Cherenkov radiation emitted from charged particles in air showers at higher altitudes. In this paper we describe the design and performance of our new non-imaging Cherenkov light detectors at Mount Chacaltaya that are operated in conjunction with the air shower array. The arrival directions and energies of air showers are determined by the shower array, and information about the primary masses is obtained from the Cherenkov light data including the time profiles and lateral distributions. The detector consists of photomultiplier tube (PMT), high-speed ADCs, other control modules, and data storage device. The Cherenkov light signals from an air shower are typically 10–100 ns long, and the waveforms are digitized with a sampling frequency of 1 GHz and recorded in situ without long-distance analog signal transfers. All the Cherenkov light detectors record their time-series data by receiving a triggering signal transmitted from the trigger module of the air shower array, which is fired by a coincidence of shower signals in four neighboring scintillation counters. The optical characteristics of the detectors and the control and the data acquisition systems are discussed.

To explore in the daily clinical practice setting that antimuscarinic, Fesoterodine or Solifenacin, provides a greater clinical benefit after changing their prior Overactive Bladder (OAB) therapy with tolterodine extended-release (ER) to other novel antimuscarinic agents.A post-hoc analysis of data from an observational multicenter, cross-sectional, retrospective study. Adult patients of both sexes, with OAB and OAB-V8 score≥8, who switched to fesoterodine or solifenacin within the 3-4 months before study visit from their prior tolterodine-ER-based therapy due to poor response were included. 92 patients were selected for each treatment group, matched (1:1) according to conditioned probability using the propensity score. Benefit of treatment change perceived by the physician and patient was evaluated by means of the Clinical Global Impression of Improvement subscale (CGI-I) and Treatment Benefit Scale (TBS), respectively. Degree of worry, bother and interference with daily living activities due to urinary symptoms, level of satisfaction, and preference for current treatment were also assessed.Fesoterodine provided a significantly greater improvement than solifenacina in terms of therapeutic benefit perceived by the physician according to ICG-I. 96.7% of the patients on fesoterodine treatment vs. 81.6% of the solifenacin group showed a score of improvement in TBS (P.05). Fesoterodine was also better rated than solifenacin with regard to satisfaction and preference for the new treatment (93.4 vs. 78.2% P.05).In daily clinical practice the switch from tolterodine LP to fesoterodine seems to provide greater benefits both from the physician's and the patient's point of view compared with those provided by solifenacin.

Resumen Objetivos Explorar en la practica clinica diaria el beneficio clinico y del paciente conseguido tras cambiar su primer tratamiento para la vejiga hiperactiva (VH) con tolterodina de liberacion prolongada (LP), por otro antimuscarininico de ultima generacion. Materiales y metodos Analisis post hoc de un estudio observacional, multicentrico retrospectivo y transversal. Se incluyeron pacientes adultos de ambos sexos, con VH y puntuacion OAB-V8 ≥ 8, con respuesta insuficiente al tratamiento previo con tolterodina LP sustituido por fesoterodina o solifenacina en los 3-4 meses previos. Se seleccionaron 92 pacientes para cada grupo de tratamiento, emparejados (1:1) segun probabilidad condicionada utilizando el propensity score. Se valoraron el beneficio del cambio percibido por el medico y el paciente mediante las escalas de Impresion clinica global de mejoria (ICG-M) y del Beneficio del tratamiento (TBS) respectivamente. Tambien se analizaron el grado de preocupacion, la molestia y el impacto en la vida diaria de la VH, el grado de satisfaccion y la preferencia por la medicacion actual. Resultados Fesoterodina proporciono una mejora significativamente mayor que solifenacina en cuanto a beneficio terapeutico percibido por el medico segun la ICG-M. El 96,7% de los pacientes tratados con fesoterodina vs. 81,6% con solifenacina mostraron una puntuacion de mejoria en la TBS (p Conclusiones En la practica clinica diaria el cambio de tolterodina LP a fesoterodina parece proporcionar mayores beneficios tanto desde el punto de vista del medico como del paciente, comparado con el que aporta solifenacina.