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Purpose The closure of a stoma is frequently associated with an acceptable morbidity and mortality. One of the most frequent complications is incisional hernia at the stoma site, which occurs in 20%–40% of cases, higher than incisions in other parts of the abdomen. The objective of this study was to identify the risk factors associated with the presentation of incisional hernia after stoma closure, this in order to select patients who are candidates for prophylactic mesh placement during closure. Methods An unpaired case–control study was conducted. This study involved 164 patients who underwent a stoma closure between January 2014 and December 2019. Associated factors for the development of incisional hernia at the site of the stoma after closure were identified, for which it was performed a logistic regression analysis. Results 41 cases and 123 controls were analyzed, with a mean follow-up of 35.21 ± 18.42 months, the mean age for performing the stoma closure was 65.28 ± 14.07 years, the most frequent cause for performing the stoma was malignant disease (65.85%). Risk factor for the development of incisional hernia at the stoma site after its closure was identified as a history of parastomal hernia (OR 5.90, CI95% 1.97–17.68). Conclusions The use of prophylactic mesh at stoma closure should be considered in patients with a history of parastomal hernia since these patients present a significantly higher risk of developing a hernia.

There is a worrying lack of epidemiological data on the sex differential in COVID-19 fatality rates. We ex-amined the Global Health 50/50 tracks of sex-disag-gregated infection and mortality COVID-19 data from 73 countries through May 20, 2021. We compared the infection fatality rate (IFR) in men vs. women and risk of death from COVID-19 by country. Of all cases in 73 countries, 42,933,757 were in women and 40,187,894 in men;1,274,663 men and 971,899 women died. The IFR was higher in males (3.17%) than in women (2.26%). The IFR in males vs. females varied from country to country, and it was higher in men in Brazil, Yemen, Mexico, Ecuador, Scotland, Peru, Guatemala, North Macedonia and Afghanistan. Overall, men had a higher odd of death from COVID-19 (OR, 1.22;95% CI, 1.13–1.32;=0.00001) and in 49 countries, compared to women. Men in Albania and Guatemala had twice the risk of death from COVID-19. Our findings show higher fatality rates among men than among women. These rates vary widely by country, and men have a higher odd of death from COVID-19. © 2021, EDIMES Edizioni Medico Scientifiche. All rights reserved.

Blood cysts in valves are very rare entities in adults, which can be distinguished through their echocardiographic features. A 57-year-old woman developed sudden dyspnea while hospitalized in the context of urinary sepsis; high-risk pulmonary embolism was diagnosed and she was prescribed systemic thrombolysis. She persisted with fever raising the suspicion of bacterial endocarditis. Transthoracic echocardiography did not report any masses, but later transesophageal imaging revealed a vegetation that was finally characterized as a blood cyst of the mitral valve based on ultrasound features. The patient evolved satisfactorily and did not require surgery.

Introduction: With the evolution of diagnostic techniques in traumatic brain injury (TBI), the study of neurological injury has made progress based on the concepts of primary and secondary injury, leading to the era of proteomics to understand the complex molecular events involved in the process. Objectives: This narrative review is intended to discuss the state of the art of the most frequently used biomarkers in TBI, their clinical utility, and the implications for therapeutic decision-making protocols. Materials and methods: In order to fulfill the objective of this paper, a literature review was conducted of the most important databases. Results: Several biomarkers have been studied as prognostic factors in patients with TBI. Learning about their sensitivity and specificity in neurological injury, and its post-trauma evolution over time, has been the goal of various papers in the past few years. Conclusion: Breakthroughs in the study of protein degradation make it necessary to broaden the spectrum and knowledge of new diagnostic methods in TBI. Further studies are needed to define the role of biomarkers and to promote protocols integrating specific values. Resumen Introducción: Con la evolución de las técnicas diagnósticas en el trauma craneoencefálico, el estudio de la lesión neurológica ha progresado sobre los conceptos de lesión primaria y secundaria, para entrar así en la era de la proteómica y, con ella, entender los complejos eventos moleculares existentes en su proceso. Objetivos: En esta revisión narrativa se pretende presentar el estado actual de los biomarcadores que más se usan en lesión cerebral traumática, su utilidad clínica y las implicaciones en protocolos de decisión terapéutica. Materiales y métodos: Para dar respuesta al objetivo de este trabajo, se realizó una revisión de la literatura en las principales bases de datos. Resultados: Se han estudiado varios biomarcadores como factor pronóstico en pacientes con trauma craneoencefálico. Conocer su sensibilidad y especificidad para la lesión neurológica, así como su evolución en el tiempo tras el traumatismo, ha sido el objetivo de diversos trabajos en los últimos años. Conclusión: El avance en el estudio de los productos de degradación de las proteínas hace necesario ampliar el espectro y el conocimiento en el campo de los nuevos métodos diagnósticos en el trauma craneoencefálico. Se requieren más estudios para definir la función de los biomarcadores y proponer protocolos que integren valores específicos.

Background The main limitation of the six-minute walk test (6-MWT) is that not all pulmonary function testing facilities have an indoor flat, 30-m-long corridor. Therefore, this study aimed 1) to evaluate the correlation and agreement of the distances walked in 30-m- vs. 15-m-long corridors by subjects with chronic lung diseases (CLD group) and 2) to compare the levels of oxygen saturation (nSpO2), blood pressure (BP), heart rate recovery at minute one post-exercise (HRR1), and Borg scale scores for dyspnea and fatigue between the two distances walked. Methods A prospective, cross-sectional study was conducted at the National Institute of Respiratory Diseases in Mexico City. Subjects with chronic lung diseases and healthy adults were invited to participate. The distance of the 6-MWT was randomly assigned based on whether the first test was in the 15-m or 30-m corridor. Results Ninety individuals were included; the correlation in meters walked between the two corridors was r = 0.96 in CLD; the 95% limits of agreement for the 6-MWT ranged from −73 to +37 m. Most subjects walked further in the 30-m corridor (82%); however, the percent predicted values for the CLD group were 3.5% lower for the 15-m corridor than the 30-m corridor. Only 10.5% of the subjects with CLD would have been falsely classified as having a normal 6-MWT (false negative). No significant differences in the nSpO2, Borg scale, BP or HRR1 were found between the two 6-MWT corridor lengths. Conclusion The 6-MWT can be performed using a 15-m corridor in subjects with CLD, and the results for the distance walked, HRR1, nSpO2, and Borg scale scores are similar to between the 15-m and 30-m corridors.

Background: Eye-related neoplasms in dogs have a significant impact on visual ability, comfort, and longevity. Therapeutic alternatives and prognosis vary according to type of neoplasm and its anatomical location. Objective: To describe the frequency and distribution of eye-related neoplasms affecting dogs in Aburrá valley (Antioquia province, Colombia). Methods: A retrospective collection of eye-related neoplasms in dogs, diagnosed at the Animal Pathology Laboratory of Universidad de Antioquia (Colombia), was conducted. Data spanning from years 2005 to 2017 were used. Records included age, sex, breed, neoplasm type and location, and cellular origin of neoplasm. A total of 250 eye-related-neoplasm reports affecting 246 dogs were analyzed -one report per animal, with the exception of four animals with both eyes simultaneously affected by the same type of neoplasm. Results: Animals between 8 and 11 years of age were more frequently affected by eye-related neoplasms (43.9%). Labrador retriever (19.1%), mixed-breed dogs (13.4%), and Poodle (12.2%) were the most frequently affected breeds. Neoplasms affected the eyelid in 76.8% of cases. Meibomian gland adenoma was the most frequent neoplasm (22.8%), followed by Meibomian gland epithelioma (20.0%), squamous cell carcinoma (8.8%), and melanocytoma (7.2%). The cellular origin of neoplasms [i]was epithelial in 73.6% of the cases. Conclusion: Meibomian gland adenoma was the most common eye-related neoplasm. To our knowledge, this is the first retrospective report aimed to eye-related neoplasms in dogs published in Colombia.

Currently, the global healthcare system is facing a crisis caused by coronavirus disease 2019 (COVID-19), with a significant number of patients requiring supportive care, particularly to fulfill their respiratory requirements. The current oxygen delivery systems may fail to meet the needs of certain patients or are associated with the appearance of sequelae following their use, such as in cases receiving invasive mechanical ventilation. Hyperbaric oxygen therapy (HBOT) poses an attractive alternative to the current oxygen delivery systems available for patients with COVID-19. HBOT has been previously used in various types of infectious diseases, providing inflammatory relief and facilitating the reversal of hypoxemia, qualities that may also prove beneficial to patients with COVID-19. At present, a significant propor- tion of the population worldwide is overweight or obese, and these comorbidities are considered to increase the severity of COVID-19 symptoms. The present study aimed to investigate whether HBOT may benefit a representative sample of this aforementioned population (n=36 patients). After the first HBOT session, 7 patients were immediately relieved from shortness of breath, while in 22 patients, this symptom was markedly alleviated after 7.57±0.63 days of HBOT. Moreover, the remaining patients (n=7) had a slow breath recovery after performing activity, suggesting that they should continue HBOT. On the whole, the present study demonstrates that daily HBOT for 7.57±0.63 days improved COVID-19 symptoms in over half of the enrolled patients, indicating that it may be a useful alternative in the treatment of this illness. © 2020 Penn State University Press. All rights reserved.

Aim: This study aimed to describe the prescription patterns of second-line medications for patients with diabetes from selected centers in Costa Rica and Panama. Methods: DISCOVER is a registry of patients with type 2 diabetes switching from first- to second-line medications. We analyzed medication choice and the reasons to switch for each country. Results: A total of 219 patients were included during 2014-2016, 127 in Costa Rica and 92 in Panama. The most frequently prescribed first-line medication was metformin, followed by sulphonylureas in Panama, and a combination of metformin and dipeptidyl peptidase-4 inhibitor (iDPP4) in Costa Rica. DPP4 inhibitors plus metformin was the most commonly prescribed second-line medication, followed by metformin combined with sodium-glucose transport protein-2 inhibitor (iSGLT2) in Costa Rica and iDPP4 in monotherapy in Panama. The main reason to switch being efficacy. When choosing the second-line medication, the main reasons behind the switch were efficacy, weight loss, and hypoglycemia risk in both countries (tolerability being also common in Panama). Conclusions: According to the DISCOVER registry, in Costa Rica and Panama, efficacy is the most common reason to switch to second-line medication. Metformin plus iDPP4 was the most commonly prescribed agent.

espanolIntroduccion y objetivos: Actualmente es cada vez mas habitual realizar procedimientos sin retirar la anticoagulacion oral (ACO), pero la necesidad o no de suspender la ACO antes del cateterismo cardiaco sigue siendo una cuestion controvertida. Se evaluan la eficacia y la seguridad de la realizacion de un cateterismo transradial en pacientes ambulatorios sin retirar los anticoagulantes orales de accion directa (ACOD). Metodos: Estudio observacional, prospectivo, que incluye 270 pacientes sometidos a cateterismo transradial electivo desde enero de 2013 hasta noviembre de 2017, divididos en 3 grupos de 90 pacientes: grupo A (sin ACO), grupo B (con antagonista de la vitamina K), grupo C (con ACOD), emparejados segun la fecha de realizacion del cateterismo. No se suspendio la ACO antes del procedimiento. Se evaluan las complicaciones del acceso radial en las primeras 24 h y un mes despues del cateterismo. Resultados: Habia mas varones tratados con ACOD que con un antagonista de la vitamina K (71,1 frente a 47,8%; p = 0,01) y los pacientes eran mas jovenes en el grupo sin ACO (63,45 ± 11,47 frente a 70,22 ± 9,35 anos; p = 0,03). En el grupo B hubo menos diabeticos (22,2 frente a 36,67% en el grupo C; p = 0,03). En el grupo A, los pacientes tenian mas antecedentes de cardiopatia isquemica que los pacientes con anticoagulacion (27,84 frente a 14,44% en el grupo C; p = 0,028), ademas de la toma concomitante de farmacos antiplaquetarios. El acceso fue radial en la mayoria de los pacientes (98,2%). No hubo diferencias significativas en las complicaciones del acceso vascular, con una tasa de hematoma o hemorragia al alta del 1,1% en el grupo con ACOD y tasas de oclusion arterial tanto al alta como al mes del 0-2,2%. Conclusiones: En nuestra experiencia, la realizacion de un cateterismo diagnostico transradial sin interrupcion de los ACOD es seguro, con tasas bajas de complicaciones tromboticas y hemorragicas, sin diferencias respecto a los pacientes en tratamiento con un antagonista de la vitamina K o sin ACO. EnglishIntroduction and objectives: Today it has become increasingly common to perform procedures without withdrawing oral anticoagulation. However, the need to withdraw oral anticoagulants prior to cardiac catheterization in patients chronically anticoagulated (OACs) remains controversial. We evaluated the efficacy and safety of performing transradial catheterization in outpatients without withdrawing direct-action oral anticoagulants (DOACs). Methods: Prospective and observational study where 270 patients who underwent elective transradial cardiac catheterization were included from January 2013 through November 2017, divided into 3 groups of 90 patients based on their anticoagulant intake: group A (without OAC), with group B (with vitamin K antagonist), and group C (with DOACs), and matched according to the date of completion. In no case was the OAC discontinued before the procedure. We evaluated the complications of radial access within the first 24 h and 1 month after the procedure. Results: The group of patients on DOACs had a higher proportion of men compared to the vitamin K antagonist group (71.1% vs 47.8%; p = .01) and patients were younger in the group without OAC (63.45 ± 11.47 vs 70.22 ± 9.35; p = .03). Group B had a lower percentage of diabetic patients (22.2% vs 36.67% in group C, p = .03). In group A, patients were more prone to having a history of ischemic heart disease compared to the groups of anticoagulated patients (27.84% vs 14.44% in group C, p = .028) in addition to a more frequent intake of antiplatelet drugs. Radial access was the access of choice in most patients (98.2%). There were no significant differences when it comes to vascular access complications among the groups being the rate of hematoma and/or bleeding at discharge equal to 1.1% in the DOACs group and the arterial occlusion rates both at discharge and at 1 month between 0% and 2.2%. Conclusions: In our experience performing transradial diagnostic cardiac catheterizations without discontinuation of DOACs is safe, with low rates of thrombotic and hemorrhagic complications, without any differences with vitamin K antagonist and no OAC.

La obesidad es un problema de salud pública. La cirugía bariátrica juega un papel importante en el manejo de estos pacientes. Con la llegada de estas técnicas quirúrgicas, los procedimientos endoscópicos digestivos y en especial la colangiopancreatografía retrógrada endoscópica (CPRE) se convierten en un desafío constante. Se describe un caso de CPRE transgástrica asistida por laparoscopia para el manejo de cálculos de la vía biliar principal en un paciente con antecedente de derivación gástrica en Y de Roux (BPGYR).

Background Sclerotherapy has been carried out since 1516 and is accepted and performed worldwide according to many references from books and journals. Mexican doctors participated in other consensuses in order to obtain various agreements, references, methods and procedures that are universally accepted to establish this document, including the European consensus of sclerotherapy 2003 and its last revision in 2006, the Clinical practice guidelines for prevention, diagnosis and treatment of chronic venous insufficiency in 2009 in México, the Argentine and Latin American consensus for sclerotherapy in 2012, European sclerotherapy guidelines in chronic venous diseases of 2013,and various literature sources as well. The first Mexican consensus on sclerotherapy published in January 2014 which was reviewed and updated in this document. Objective Review and update the general bases of Endovenous Chemical Ablation (ECA) also known as Sclerotherapy, according to evidence-based medicine updating the previously published consensus. Method General questions about Endovenous Chemical Ablation (ECA) were established concerning: indications, contraindications, types of sclerosing agents and the concentrations used, patient position, methods of application, way to prepare and preserve the sclerosants, necessary equipment, injection volumes, differents administration ways, compressive therapy and special comments. To answer these questions the existing literature and the topics in which the reports showed uniformity were consulted. A panel of experts was constituted who provided their personal experience, the answers were formulated in the form of clinical guidelines or general recommendations to provide concrete answers to the specific questions, in some issues we include possible accepted variations.

Las enfermedades respiratorias en porcinos tienen un gran impacto económico, considerándose uno de los principales problemas en la producción intensiva porcina. El objetivo de este estudio fue evaluar macroscópicamente los diferentes lóbulos pulmonares en una planta de beneficio del centro-occidente de Risaralda, usando un modelo de calificación porcentual. Mediante un estudio descriptivo, se evaluaron 358 pulmones durante la fase de eviscerado, provenientes de 9 lotes de diferentes granjas; se recolectaron datos porcentuales según el grado de lesión macroscópica observada para cada uno de los lóbulos pulmonares. Con estos datos se calcularon los promedios para cada uno de los lóbulos y se compararon entre el total de muestras observadas y para cada uno de los lotes. El análisis de las observaciones macroscópicas permitió establecer una prevalencia de lesiones pulmonares del 85% (305/358), mientras que el 15% (53/358) no evidenciaron ningún tipo de lesión. El 13% (43/358) presentaron lesiones indicativas de pleuritis y el 71% (253/358) de cicatrización. La comparación de los promedios de lesión entre los diferentes lóbulos pulmonares mostró que el más afectado fue el cardiaco derecho, con un valor promedio de 2,1%, mientras que el menos afectado fue el accesorio con un valor promedio de 0,97%. En este estudio se encontró que los lóbulos cardiacos derecho e izquierdo fueron los más afectados del total de pulmones evaluados, estos resultados se pueden relacionar con los signos respiratorios, el estado sanitario y los parámetros productivos de los diferentes lotes en la granja, lo que contribuye a establecer, junto con otras pruebas complementarias un diagnóstico presuntivo en el caso de afecciones respiratorias. Mostrando que el método de evaluación porcentual podría ser una herramienta rápida y eficaz de estudio de lesiones postmorten en plantas de beneficio. Respiratory diseases in pigs have a great economic impact, considering it is one of the main problems in intensive swine production. The objective of this study was to macroscopically evaluate the different pulmonary lobes in a processing plant located center-west of Risaralda, using a percentage qualification model. Through a descriptive study, 358 lungs were evaluated during the evisceration phase, the specimens came from 9 lots of different farms. Data was collected according to the degree of macroscopic lesion observed for each of the pulmonary lobes in percentages. With this data, averages were taken for each of the lobes and compared between the total of samples observed and for each of the lots. In addition, more specific lesions were evaluated on a scale of 0-5 as indicators of pleurisy and scarring. The analysis of the macroscopic observations showed that the majority of the lungs, presented some degree of lesion with an 85% (305/358) while only 15% (53/358) showed no type of lesion. 13% (43/358) presented lesions indicative of pleurisy and 71% (253/358) showed scarring. The comparison of the lesion averages between the different pulmonary lobes showed that the most affected was the right cardiac lobe with an average value of 2.10% while the least affected was the accessory lobe with an average value of 0.97%. In this study it was found that the right and left cardiac lobes were the most affected out of the totality of lungs evaluated, these results can be related to the respiratory signs, the health status and the productive parameters of the different batches in the farm, helping to determine a presumptive or final etiological diagnosis. This shows that the percentage evaluation method could be a quick and effective tool for the study of postmortem lesions in processing plants.

Aims: to describe the prescriptions patters of second line medications in patients with diabetes in Costa Rica and Panama.Methods: DISCOVER is a registry of patients with type 2 diabetes that are switching from first- to second-line medications. We analyzed medication choice and reasons to switch by country. Results: 219 patients were included, 127 in Costa Rica and 92 in Panama. The most frequently prescribed first-line medication was metformin, followed by sulphonylureas in Panama and a combination of metformin and dipeptidyl peptidase-4 inhibitors (iDPP4) in Costa Rica. DPP4 inhibitors plus metformin was the most commonly prescribed second line medication in both countries, followed by metformin combined with SGLT2 inhibitors in Costa Rica and iDPP4 in monotherapy in Panama. The main reason to switch was efficacy. When choosing the second-line medication, the main reasons were efficacy, weight loss, and hypoglycemia risk in both countries (tolerability was also common in Panama). Conclusions: In these two Latin American countries the main reason to switch to second line medication was efficacy and the most prescribed agent was metformin plus iDPP4.

Background and aim Obesity increases the risk of atrial fibrillation (AF) while it may impact the outcome of patients with AF. The clinical implications of this relationship are not completely clear. We aimed to analyze the association of traditional anthropometric measures of excessive adiposity with 12 month case fatality rate (CFR) in patients with AF. Methods This was a multicenter, longitudinal, observational study on adults with documented AF, excluding records of AF secondary to reversible causes. Anthropometric variables were registered at baseline, and a central committee validated the 12 month outcomes. Results We studied 1193 patients (median age: 69.14 years, 55.2% women). At baseline, rhythm control was established for 476 (39.9%) subjects, while frequency control was offered to 717 (60.1%) participants. The 12 month all-cause CFR was 8.9%. A high basal body mass index (BMI), waist-to-height ratio (WHtR) and waist circumference (WC) were associated with lower CFR in bivariate analyses. In a Cox-proportional hazards model, variables associated with 12 month all-cause CFR were BMI categories (HR: 0.736, 95% CI: 0.584–0.928), chronic heart failure (HR: 1.738, 95% CI: 1.127–2.680), chronic kidney disease (HR: 2.269, 95% CI: 1.162–4.429) and carotid stenosis >50% (HR: 5.342, 95% CI: 1.661–17.181). Conclusion The risk of death at one year in patients with AF is inversely associated with a high BMI and directly associated with the presence of chronic kidney disease, carotid stenosis, and chronic heart failure in this cohort of patients with AF. The causes and implications of this apparent obesity paradox should be addressed in the future.

Background Stroke can lead to varying degrees of oropharyngeal dysphagia, respiratory muscle dysfunction and even increase medical complications such as aspiration, malnutrition and death. Recent studies suggest that inspiratory and expiratory respiratory muscle training (IEMT) can improve swallowing efficacy and may reduce aspiration events. The main purpose of this study is to examine whether an 8-week IEMT programme can improve respiratory muscle strength and swallow dysfunction severity in subacute stroke patients with dysphagia. Methods Retornus-2 is a two-arm, prospectively registered, randomized controlled study with blinded assessors and the participation of fifty individuals who have suffered a stroke. The intervention group undergoes IEMT training consisting of 5 sets of 10 repetitions, three times a day for 8 weeks. Training loads increase weekly. The control group undergoes a sham-IEMT protocol. The primary outcome examines the efficacy of the IEMT protocol to increase respiratory muscle strength and reduce dysphagia severity. The secondary outcome assesses the longitudinal impact of dysphagia on body composition and nutritional assessment over a 6-month follow-up. Discussion IEMT induces an improvement in respiratory muscle strength and might be associated with relevant benefits in dysphagia patterns, as well as a reduction in the number of aspiration events confirmed by videofluoroscopy or fiberoptic endoscopic evaluation of swallowing. The description of the impact of swallowing impairment on nutritional status will help develop new strategies to face this known side-effect. Trial registration Clinicaltrials.gov NCT03021252. Registered on 10 January 2017. https://clinicaltrials.gov/ct2/results?cond=retornus+2&term=&cntry=ES&state=&city=&dist= WHO trial Registration data set: Due to heavy traffic generated by the COVID-19 outbreak, the ICTRP Search Portal does not respond. The portal recommends other registries such as clinicaltrials.gov. Protocol version: RETORNUS 2_ PROTOCOL_2.

The energy analysis of injection moulding processes is influenced by complex interactions amongst the moulded part, its material, the injection machine, the process parameters and the environmental...

The objective was to evaluate the supplementation effect of selenium (Se) and DL-tocopherol (E) on blood lactate (LAC), cortisol (COR), and malondialdehyde (MDA), in horses moderately exercised in a polluted environment. Police horses of Mexico City were arranged in a balanced factorial trial (2 × 2) with repeated measures. Low (L) and high (H) levels of Se and E supplementation were evaluated (LSe, 0.1; HSe, 0.3 mg Se/kg dry matter; LE, 1.6; HE, 2.0 IU vitamin E/kg body weight). Experimental groups were LSeLE, LSeHE, HSeLE, and HSeHE. The study that lasted 77 days was distributed as follows: adaptation (28 days), exercise (28 days, three consecutive days of moderate exercise were alternated with four days of inactivity), rest (7 days), and recovery without supplementation for readjustment to police handling (14 days). Once a week (11 week), blood samples for LAC, COR, MDA, blood selenium (B-Se), and α-tocopherol (TOC) quantifications were taken. Data were analyzed with a model for fixed (Se, E, day, and their interactions) and random (the horse nested within the treatment) effects. The relationships between Mexico City's criteria air pollutants (CAPs) concentrations and blood analytes were analyzed by multiple sequential regression analysis. Concentrations of all blood analytes were affected (P .05). Relationships were observed between LAC, COR, MDA, CAP, and day (P

The objective was to compare the performance of the updated Charlson comorbidity index (uCCI) and classical CCI (cCCI) in predicting 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB). All cases of SAB in patients aged ⩾14 years identified at the Microbiology Unit were included prospectively and followed. Comorbidity was evaluated using the cCCI and uCCI. Relevant variables associated with SAB-related mortality, along with cCCI or uCCI scores, were entered into multivariate logistic regression models. Global model fit, model calibration and predictive validity of each model were evaluated and compared. In total, 257 episodes of SAB in 239 patients were included (mean age 74 years; 65% were male). The mean cCCI and uCCI scores were 3.6 (standard deviation, 2.4) and 2.9 (2.3), respectively; 161 (63%) cases had cCCI score ⩾3 and 89 (35%) cases had uCCI score ⩾4. Sixty-five (25%) patients died within 30 days. The cCCI score was not related to mortality in any model, but uCCI score ⩾4 was an independent factor of 30-day mortality (odds ratio, 1.98; 95% confidence interval, 1.05–3.74). The uCCI is a more up-to-date, refined and parsimonious prognostic mortality score than the cCCI; it may thus serve better than the latter in the identification of patients with SAB with worse prognoses.

Braided steel cables have the potential for improving the mechanisms providing them several advantages in comparison with rigid elements. Nevertheless, a limitation in the use of cable mechanism is that due to the inherent flexibility, the problem of vibration arises. In this research, we investigate the axial viscoelastic behavior of 1/32″ braided steel cables. The essential idea is to determine the parameters of elasticity (k) and viscosity (b) as a function of the length of the cable in its axial direction. It was achieved through the design and construction of a test bench and the design of an experiment. The test bench is a free vibration particular design machine. One end of the cable is fixed to the structure, and in the other end, a load is attached. Then, the load is released, and the free vibration of the cable in the axial direction is registered. The factor of the experiment is the length of the cable. There are six levels, and these were repeated four times. We demonstrated that the braided steel cables have a viscoelastic behavior like a Kelvin-Voigt. Also, we found a relation between the effective length of the cables and the parameters of elasticity and viscosity.

Introduction Inferior vena cava agenesis (IVCA) is one of the many anomalies of this vessel. It is one of the most uncommon anomalies, with an estimated prevalence of 0.0005–1% in the general population. Around 5% of the patients younger than 30 years with a diagnosis of deep vein thrombosis (DVT) have a total or segmental IVCA. Report Here two unique cases of young and previously healthy male patients are reported: one with bilateral lower extremity DVT, the second with lower extremity DVT and pulmonary embolism. Both patients were found to have segmental agenesis of the inferior vena cava on computed tomography angiography (CTA). Treatment consisted of ultrasound enhanced thrombolysis (EKOS + alteplase) and venous angioplasty. Both patients were discharged with long-term (up to 24 months) oral anticoagulation and compression stockings. Follow up at 3 and 12 months revealed no new thrombotic episode. Discussion IVCA can be asymptomatic but the majority of the symptomatic patients present with DVT. IVCA confers a risk factor for DVT. IVCA should be considered and ruled out as a rare but important risk factor and cause of DVT in previously young healthy patients. Once diagnosed, aggressive treatment must be started because of the high risk of post-thrombotic syndrome., Highlights • Two unique cases of inferior vena cava agenesis are presented. • Inferior vena cava agenesis should be considered a cause of DVT in previously healthy young patients. • Treatment can be challenging due to the unique anatomy of each patient. • Ultrasound enhanced thrombolysis is a safe and effective way to treat DVT in this group of patients.

Service-learning is an important and effective educational pedagogy that has grown tremendously in Spain. Research shows that service-learning has positive effects on the professional and personal development of future teachers. Since future teachers, in turn, influence the education of the next generation, it is important to understand how service-learning may influence the life purposes of student-teachers themselves, specifically, how emotions influence this development process. Statistical analyses of 198 Madrileno student-teachers’ responses to online questionnaires suggested that service-learning involves positive emotions like interest, enthusiasm, inspiration and determination. Surprisingly, these positive emotions decrease during service, except for the 53 student-teachers whose purposes changed. Most reported positive changes in all dimensions of life purpose, with some also noting strengthened relationships between 10 pairs of dimensions, such as between stronger impetus to help others ...

Introduction Radical Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), has been proposed as the current standard of treatment for metastatic peritoneal disease by several tumors. Despite its widely utilization, there seems to be a great variability in their organization, clinical practice, and safety among centers. Aim of the study To obtain updated information on clinical practice in different perioperative areas of the CRS-HIPEC. Patients and methods All 25 members of the Spanish Surface Peritoneal Malignancy (GECOP), were invited to answer an online survey, to describe their usual practice in different perioperative areas of the CRS-HIPEC. Results Survey was responded by 100% of centers. This study represents more than 800 patients treated annually. Seventy per cent of respondents perform CRS-HIPEC for more than 5 years. The most frequent technique was Coliseum (88%). Routinely non-invasive monitoring of cardiac output is used by 92% of centers. More than 50% of centers administer oxaliplatin (74%), or mitomycin-C (65%) in colorectal cancer; cisplatin in gastric cancer (73%) and mesothelioma (74%). Ovarian cancer is treated with cisplatin and various combinations, in 64% or paclitaxel in 54.5%. Spillage protocol was available in 100% centers. Conclusions Data showed an important variability in volume of patients per center, selection of cytostatic agents, professional training and safety measures applied. The standardization of CRS/HIPEC procedures based on the best available evidence, the individualization of patients and the consensus among professionals, constitute an important part of the basis that will allow us to improve results of this complex procedure.

Lactation embodies a natural model of morphological, neurochemical, and functional brain plasticity. In this reproductive stage, the hippocampus of the female is less sensitive to excitotoxins in contrast to nulliparity. Growth hormone (GH) and insulin-like growth factor 1 (IGF1) are known to be neuroprotective in several experimental models of brain lesion. Here, activation of the GH–IGF1 pituitary–brain axis following kainic acid (7.5 mg/kg i.p. KA) lesion was studied in lactating and nulliparous rats. Serum concentrations of GH and IGF1 were uncoupled in lactation. Compared to virgin rats, the basal concentration of GH increased up to 40% but IGF1 decreased 58% in dams, and only GH increased further after KA treatment. In the hippocampus, basal expression of GH mRNA was higher (2.8-fold) in lactating rats than in virgin rats. GH mRNA expression in lactating rats increased further after KA administration in the hippocampus and in the hypothalamus, in parallel to GH protein concentration in the hippocampus of KA-treated lactating rats (43% vs lactating control), as detected by Western blot and immunofluorescence. Except for the significantly lower mRNA concentration in the liver of lactating rats, IGF1 expression was not altered by the reproductive condition or by KA treatment in the hippocampus and hypothalamus. Present results indicate upregulation of GH expression in the hippocampus after an excitotoxic lesion, suggesting paracrine/autocrine actions of GH as a factor underlying neuroprotection in the brain of the lactating dam. Since no induction of IGF1 was detected, present data suggest a direct action of GH.

Objective To assess the rate of endophthalmitis after intravitreal injection (IVI) in a “clean room” of a single health center, following the guidelines of the Spanish Vitreo-Retinal Society (SERV). An analysis was performed on the culture specimens, response to treatment, and final outcomes (guidelines). Material and methods A retrospective, observational study was conducted on a consecutive case series of patients diagnosed with infectious endophthalmitis after IVI in a single health center between 2010 and 2015. Intravitreal and systemic treatment was given following the SERV guidelines. The patients were followed up the case was resolved. Results There were 5 cases of endophthalmitis out of 9467 IVI (incidence 0.053%). Positive cultures were obtained in aqueous and/or vitreous fluid in all cases, with Staphylococcus epidermidis being involved in 4 out of 5 cases. In 2 cases, final visual acuity was non-light perception due to intractable retinal detachments after resolution of the infectious process. Conclusions IVI performed in a “clean room” have a low incidence of endophthalmitis. The most common infectious agent was Staphylococcus species. In 2 cases the functional prognosis was poor.

SUMMARYA latent tuberculosis infection (LTBI) prevalence survey was conducted using tuberculin skin test (TST) and Quantiferon test (QFT) in 1218 healthcare workers (HCWs) in Medellín, Colombia. In order to improve the prevalence estimates, a latent class model was built using a Bayesian approach with informative priors on the sensitivity and specificity of the TST. The proportion of concordant results (TST+,QFT+) was 41% and the discordant results contributed 27%. The marginal estimate of the prevalence P(LTBI+) was 62·1% [95% credible interval (CrI) 53·0–68·2]. The probability of LTBI+ given positive results for both tests was 99·6% (95% CrI 98·1–99·9). Sensitivity was 88·5 for TST and 74·3 for QFT, and specificity was 87·8 for TST and 97·6 for QFT. A high LTBI prevalence was found in HCWs with time-accumulated exposure in hospitals that lack control plans. In a context of intermediate tuberculosis (TB) incidence it is recommended to use only one test (either QFT or TST) in prevalence surveys or as pre-employment tests. Results will be useful to help implement TB infection control plans in hospitals where HCWs may be repeatedly exposed to unnoticed TB patients, and to inform the design of TB control policies.

Background and aims Myotonic dystrophy type 1 (DM1) or Steinert’s disease is an autosomal dominant neuromuscular disease characterized by muscle weakness mainly of distal, axial, facial, pharyngeal and respiratory muscles. It is also accompanied by cardiac arrhythmias. The risk of general anesthesia in these patients includes cardiac rhythm disturbances, myotonic crisis and respiratory complications with increased sensibility to opioids, hypnotic and muscle relaxants; therefore, short-acting agents and regional anesthesia are frequently used. Methods We present a 43-year-old female with diagnosis of DM1 who underwent elective shoulder arthroscopy. She showed muscle weakness in upper extremities and recurrent myotonia but no cardiac or respiratory symptoms. We performed an ultrasound-guided interscalene brachial plexus block with 5 ml of 5% lidocaine aiming for minimal or short-timed phrenic nerve blockade. In addition we performed an ultrasound-guided suprascapular nerve and supraclavicular nerve block to provide postoperative analgesia with 15 ml and 3 ml of 0,5% bupivacaine, respectively. We observed no hemi-diaphragmatic paresis by M-mode ultrasonography. Due to patient anxiety, we induced general anesthesia with propofol and remifentanil perfusion and a single dose of rocuronium. We monitored ASA standard parameters, temperature and neuromuscular blockade (NMB) with TOF-Cuff® monitor. Results After surgery, NMB was reversed with sugammadex 2 mg/kg (T4/T1= 100%) and the patient was extubated without respiratory complications. Visual analogue scale (VSA) for pain was 0/1 immediately afterwards and 1–2/10 after 24 hours. No rescue analgesia was requested. Conclusions It is possible to perform interescalenic brachial plexus blocks with low-volume and high-concentration of LA for shoulder arthroscopy with good intraoperative analgesia and minimum respiratory complications in patients with DM1.

[Background]: Genomic prediction (GP) is a method whereby DNA polymorphism information is used to predict breeding values for complex traits. Although GP can significantly enhance predictive accuracy, it can be expensive and difficult to implement. To help design optimum breeding programs and experiments, including genome-wide association studies and genomic selection experiments, we have developed SeqBreed, a generic and flexible forward simulator programmed in python3., [Results]: SeqBreed accommodates sex and mitochondrion chromosomes as well as autopolyploidy. It can simulate any number of complex phenotypes that are determined by any number of causal loci. SeqBreed implements several GP methods, including genomic best linear unbiased prediction (GBLUP), single-step GBLUP, pedigree-based BLUP, and mass selection. We illustrate its functionality with Drosophila genome reference panel (DGRP) sequence data and with tetraploid potato genotype data., [Conclusions]: SeqBreed is a flexible and easy to use tool that can be used to optimize GP or genome-wide association studies. It incorporates some of the most popular GP methods and includes several visualization tools. Code is open and can be freely modified. Software, documentation, and examples are available at https://github.com/miguelperezenciso/SeqBreed., This work was supported by a PhD grant from the Ministry of Economy and Science (MINECO, Spain) to LMZ, by MINECO grant AGL2016-78709-R and from the EU through the BFU2016-77236-P (MINECO/AEI/FEDER, EU) to MPE and the “Centro de Excelencia Severo Ochoa 2016–2019” award SEV-2015-0533. LCRA is funded by “Don Carlos Antonio López” Graduate program (BECAL) from Paraguay.

In this study, we addressed the sex- and tissue-specific expression patterns of odorant-binding proteins (OBPs) and chemosensory proteins (CSPs) in Hylamorpha elegans (Burmeister), an important native scarab beetle pest species from Chile. Similar to other members of its family, this scarab beetle exhibit habits that make difficult to control the pest by conventional methods. Hence, alternative ways to manage the pest populations based on chemical communication and signaling (such as disrupting mating or host finding process) are highly desirable. However, developing pest-control methods based on chemical communication requires to understand the molecular basis for pheromone recognition/chemical perception in this species. Thus, with the aim of discovering olfaction-related genes, we obtained the first reference transcriptome assembly of H. elegans. We used different tissues of adult beetles from males and females: antennae and maxillary palps, which are well known for embedded sensory organs. Then, the expression of predicted odorant-binding proteins (OBPs) and chemosensory proteins (CSPs) was analyzed by qRT-PCR. In total, 165 transcripts related to chemoperception were predicted. Of these, 16 OBPs, including one pheromone-binding protein (PBP), and four CSPs were successfully amplified by qRT-PCR. All of these genes were differentially expressed in the sensory tissues with respect to the tibial tissue that was used as a control. The single predicted PBP found was highly expressed in the antennal tissues, particularly in males, while several OBPs and one CSP showed male-biased expression patterns, suggesting that these proteins may participate in sexual recognition process. In addition, a single CSP was expressed at higher levels in female palps than in any other studied condition, suggesting that this CSP would participate in oviposition process. Finally, all four CSPs exhibited palp-biased expression while mixed results were obtained for the expression of the OBPs, which were more abundant in the palps than in the antennae. These results suggest that these chemoperception proteins would be interesting novel targets for control of H. elegans, thus providing a theoretical basis for further studies involving new pest control methods.

The way innovation is know has started to change, shifting from a closed to an open approach. Open innovation has been creating new ways of working in innovation ecosystems, giving the actors more opportunities to obtain new tools, knowledge and more benefits by collaborating with other actors involved in the same network. These innovation ecosystems have their support on innovation platforms, which have different rules and protocols that describe the way interaction should take place. Based on this, this work is motivated in knowing why actors would participate in open innovation platforms. The approach for this paper is to define the motivators and interests of the actors–Government, Businesses and Universities–in their participation in open innovation platforms, as well as to represent how this can benefit them. A case is presented

The case of China’s non-market economy treatment at the WTO might be the typical case where (economic) reality outdoes (legal) theory or, perhaps, expectations. By 2001, when the WTO let China in, its Protocol of Accession (PoA) included special trade remedies provisions regarding China’s economic model. Today, China and other members fight fiercely at WTO, and elsewhere, over the validity and scope of some PoA's expired rules that set out the commitments by which -arguably- China was expected to become a market economy by December 2016. Aimed at contributing to the debate, this paper analyzes and thus proposes elements for a reform to the WTO’s trade remedies legal framework, so as to solve those conflicts by means of multilateral negotiations in lieu of complex judicial adjudications. Negotiation is hence suggested as the most legitimate, pragmatic, and long-lasting means to ensure the preservation of the trade remedies mechanism. Otherwise, the use of de facto measures, coupled with increasing bilateral disputes, shall steadily undermine its creditworthiness. WTO, trade remedies, China, negotiation, pragmatism, market economy.

Objetivo: Proponer la adición de flavonoides a alimentos, y su obtención usando como fuente residuos agroindustriales. Diseño/Metodología/Aproximación: Se realizó una revisión bibliográfica, analizando diversas fuentes y actividades biológicas de flavonoides, así como las tecnologías que se emplean para la elaboración y formulación de alimentos enriquecidos. Resultados: Se relaciona el estado nutricional del consumidor con la calidad de vida, donde los flavonoides pueden ser usados como compuestos bioactivos debido sus diferentes actividades biológicas benéficas en la salud, pudiendo ser incorporados en alimentos funcionales mediante el uso de nanotecnología dependiendo de sus propiedades fisicoquímicas de cada grupo de flavonoides. A su vez se destaca el uso de residuos agroalimentarios como una fuente alternativa sustentable para la obtención de los flavonoides. Limitaciones del estudio/Implicaciones: Desarrollar la tecnología necesaria para obtener flavonoides a partir de residuos agroindustriales, así como su incorporación de flavonoides en alimentos funcionales. Hallazgos/Conclusiones: La elaboración y formulación de alimentos enriquecidos sigue siendo una vertiente relevante para el desarrollo de alimentos funcionales donde los flavonoides son compuestos importantes que pueden proveer un valor agregado a los alimentos mediante el uso de nanotecnología y además su obtención puede ser sustentable con el uso de residuos agroindustriales.

Objetivo: Fomentar el conocimiento sobre estilos de vida saludable, que ayude a disminuir los factores de riesgo, causantes de enfermedades cardiovasculares, obesidad, diabetes, hipertension e hiperlipidemias, mediante la Educacion para la Salud (EpS). Material y metodo: Entre noviembre y diciembre 2014 en el Centro Penitenciario (CP) de Soria, se realizo una intervencion de EpS en enfermedades cardiovasculares. Se ofrecio la participacion a los 160 internos del Centro. La intervencion consistio en entrevista individual con valoracion antropometrica, revision de historias clinicas y tres sesiones grupales, con contenido teorico-practico sobre las enfermedades citadas, asi como recomendaciones dieteticas, dieta mediterranea y ejercicio fisico. Se valoraron los conocimientos adquiridos mediante encuesta elaborada para tal fin. Resultados: Participaron 33 internos (21% del total de internos). EM 38,2 anos (35,2- 41,3). Prevalencia normo peso (IMC: 18 a 24,9): 18 internos (54,5%), sobrepeso (IMC: 25 a 29,9): 11(33,3%), obesidad (IMC> 30): 4 (12,1%). Riesgo cardiovascular (RCV) segun ICC (Indice cintura cadera): 10 (30%) riesgo elevado, REGICOR 4 (12,1%) riesgo moderado. Riesgo relativo de comorbilidad 2 (6%) presentaban un riesgo ligeramente aumentado, 4 (12,1%) presentaba riesgo aumentado. Conclusiones: Las intervenciones en EpS son necesarias y efectivas en la modificacion de estilos de vida. El calculo de RCV ha de servir para poner en marcha medidas preventivas que disminuyan los factores de riesgo cardiovasculares. Palabras clave: Prisiones; Educacion sanitaria; Agentes cardiovasculares; Diabetes Mellitus; Obesidad; Hipertension; Estilo de vida; Alimentacion; Ejercicio; Comorbilidad.

Background Thrombin generation assay (TGA) is useful as a global functional test for assessing bleeding or thrombotic risk and its modification with therapy. We investigated TGA to assess anticoagulation status compared with the international normalized ratio (INR) system in patients with primary thrombophilia receiving and not undergoing thromboprophylaxis. Materials and methods We studied 50 patients with at least one thrombotic event and a confirmed diagnosis of inherited thrombophilia. Thrombin generation was measured in platelet-poor plasma by calibrated automated thrombography (CAT). Results Patients in optimal anticoagulation (INR: 2.0–3.0) showed an endogenous thrombin potential (ETP) of 14–56% of normal and a peak of 18–55% of normal. A significant inverse relationship between INR and thrombin generation parameters (ETP, peak and velocity index) and a linear correlation for lag time was found in patients treated with vitamin-K antagonists (VKA). Receiver-operating characteristics (ROC) analysis showed that the optimal cutoff for ETP was 1600.2 nM·min (111.6% of normal, with a sensitivity of 96.6% and a specificity of 92.9%) and for the peak was 298.3 nM (112.1% of normal, with a sensitivity of 96.4% and a specificity of 100%). According to this analysis, ETP was able to identify patients with increased thrombotic and hemorrhagic risk, correlating with severe clinical complications. Conclusion TGA showed excellent sensitivity and specificity for assessing anticoagulation status in patients with primary thrombophilia receiving VKA, with significant advantages with regard to INR. Clinical data strongly support ETP as a valuable indicator of thrombotic or hemorrhagic risk in patients receiving or not receiving thromboprophylaxis.

Food demand is increasing every year and, usually animal-derived products are generated far from consumer-places. New technologies are being developed to preserve quality characteristics during processing and transportation. One of them is electrolyzed water (EW) that helps to avoid or decrease the development of foodborne pathogens, or losses by related bacteria. Initially, EW was used in ready-to-eat foods such as spinach, lettuce, strawberries, among others; however, its application in other products is under study. Every product has unique characteristics that require an optimized application of EW. Different sanitizers have been developed; unfortunately, they could have undesirable effects like deterioration of quality or alterations in sensory properties. Therefore, EW is gaining popularity in the food industry due to its characteristics: easy application and storage, no corrosion of work surfaces, absence of mucosal membrane irritation in workers handling food, and it is considered environmentally friendly. This review highlights the advantages of using EW in animal products like chicken, pork, beef, eggs and fish to preserve their safety and quality.

Microwave ablation (MWA) by using coaxial antennas is a promising alternative for breast cancer treatment. A double short distance slot coaxial antenna as a newly optimized applicator for minimally invasive treatment of breast cancer is proposed. To validate and to analyze the feasibility of using this method in clinical treatment, a computational model, phantom, and breast swine in vivo experimentation were carried out, by using four microwave powers (50 W, 30 W, 20 W, and 10 W). The finite element method (FEM) was used to develop the computational model. Phantom experimentation was carried out in breast phantom. The in vivo experimentation was carried out in a 90 kg swine sow. Tissue damage was estimated by comparing control and treated micrographs of the porcine mammary gland samples. The coaxial slot antenna was inserted in swine breast glands by using image-guided ultrasound. In all cases, modeling, in vivo and phantom experimentation, and ablation temperatures (above 60°C) were reached. The in vivo experiments suggest that this new MWA applicator could be successfully used to eliminate precise and small areas of tissue (around 20–30 mm2). By modulating the power and time applied, it may be possible to increase/decrease the ablation area.

Background Obesity has been associated with reduced dexmedetomidine clearance, suggesting impaired hepatic function or reduced hepatic blood flow. The aim of this study was to clarify the effect of obesity in dexmedetomidine metabolic clearance. Methods Forty patients, ASA I–III, 18–60 yr old, weighing 47–126 kg, scheduled for abdominal laparoscopic surgery, were enrolled. Anaesthetic agents (propofol, remifentanil, and dexmedetomidine) were dosed based on lean body weight measured by dual X-ray absorptiometry. Serial venous samples were drawn during and after dexmedetomidine infusion. A pharmacokinetic analysis was undertaken using non-linear mixed-effect models. In the modelling approach, the total body weight, lean body weight, and adjusted body weight were first tested as size descriptors for volumes and clearances. Hepatic blood flow, liver histopathology, liver enzymes, and gene expression of metabolic enzymes (UGT2B10 and UGT1A4) were tested as covariates of dexmedetomidine metabolic clearance. A decrease in NONMEM objective function value (ΔOFV) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. Results A total of 637 dexmedetomidine serum samples were obtained. A two-compartmental model scaled to measured lean weight adequately described the dexmedetomidine pharmacokinetics. Liver blood flow was a covariate for dexmedetomidine clearance (ΔOFV=–5.878). Other factors, including fat mass, histopathological damage, and differential expression of enzymes, did not affect the dexmedetomidine clearance in the population studied (ΔOFV Conclusions We did not find a negative influence of obesity in dexmedetomidine clearance when doses were adjusted to lean body weight. Liver blood flow showed a significant effect on dexmedetomidine clearance. Clinical trial registration NCT02557867.

Objective To determine the efficacy of sitagliptin alone or in combination with metformin in women with polycystic ovary in terms of ovarian cyclicity, fertility and cardiometabolic profile compared to metformin alone. Rationale polycystic ovarian syndrome (PCOS) affects a percentage of 5–10% of women of reproductive age worldwide and has a prevalence of 6.6% (95% CI: 2.3–10.9%) in Mexican women and most common cause of infertility in developed countries. Treatment with insulin sensitizing drugs (metformin and pioglitazone) has been shown to improve menstrual cyclicity and fertility in the metabolic profile with polycystic ovarian patients. Incretins and DPP-4 inhibitors have been shown to enhance pancreatic β cell activity, increasing weight loss by its anorexic effect and resulting in an adequate weight control and improved fertility. Previous evidence has compared the effect of exenatide and alone or in combination with metformin in the treatment of PCOS, in this article we will compare sitagliptin and metformin alone or in combination. Study design Blind, controlled and randomized clinical trial. Patients Women between 18 and 40 years of age, with a BMI >20 and diagnosed with PCOS with the Rotterdam criteria. Results In the normalized index of menstruations it was found that there was a statistically significant intragroup increase in each one of the treatments. With a higher percentage of change, that of metformin with 80%, followed by that of sitagliptin with 65% and then COMBO with 30%. No statistically significant differences were found between treatment groups. Conclusion Therapeutic effect of sitagliptin was observed in patients with PCOS comparable to metformin and the combination of metformin-sitagliptin is more effective in terms of ovulation than the other two treatments alone.

The Smith Watson and Topper (SWT) model was used for determining the fatigue life of an automotive steel. Nowadays, the need to make lighter vehicles demands greater effort in the design of components that are subject to cyclical loads and external forces. The ratio of maximum and minimum load in reversible tests allows to know the circumstances under which a component can support during service. Samples of low carbon alloy were prepared and tested according to ASTM E466 and E606 standard for high cycle fatigue (HCF) and low cycle fatigue (LCF) respectively. The SWT model was applied for the data of the strain and stress registered during the tests, this approach assumes that the life for any situation of mean stress depends on the product, this parameter was calculated with the fatigue life properties at σm = 0.

In this article a GHG and energy analysis for the plastic injection process of an ABS medium sized injected part carried out in a hybrid injection molding machine is reported. A power consumption process pattern for an ABS medium-size part is defined as well as the energy usage of components, the energy used for the injection process is calculated for the injection cycle and for the process setup. The reported study includes a hybrid machine analysis working under an electric network that relies mainly on thermoelectric energy generation. The GHG emissions assessment was estimated using the 2015 emission factor applied for Mexico. The results provide new experimental data for ABS plastic injected parts in hybrid injection machines. This paper describes the outcomes of a GHG emissions and energy assessment for an ABS medium-sized injected part carried out in a HIMM at UNAM. The approach followed by the authors in this assessment was aimed at providing information about the energy usage and GHG emissions for the process and the part. The main contribution of this paper is the insight related to energy usage indicators in the process, the energy usage and the GHG emissions within components. The product used as a case study and the results of its GHG emissions and energy assessment are presented.

BACKGROUND: Significant advances in the management of patients with lymphoid and myeloid malignancies entered clinical practice in the early 2000's. The EUROCARE-5 study database provides an opportunity to assess the impact of these changes at the population level by country in Europe. We provide survival estimates for clinically relevant haematological malignancies (HM), using the International Classification of Diseases for Oncology 3, by country, gender and age in Europe. METHODS: We estimated age-standardised relative survival using the complete cohort approach for 625, 000 adult patients diagnosed in 2000-2007 and followed up to 2008. Survival information was provided by 89 participating cancer registries from 29 European countries. Mean survival in Europe was calculated as the population weighted average of country-specific estimates. RESULTS: On average in Europe, 5-year relative survival was highest for Hodgkin lymphoma (81% ; 40, 625 cases), poorest for acute myeloid leukaemia (17% ; 57, 026 cases), and intermediate for non- Hodgkin lymphoma (59% ; 329, 204 cases), chronic myeloid leukaemia (53% ; 17, 713 cases) and plasma cell neoplasms (39% ; 94, 024 cases). Survival was generally lower in Eastern Europe and highest in Central and Northern Europe. Wider between country differences (>10%) were observed for malignancies that benefited from therapeutic advances, such as chronic myeloid leukaemia, chronic lymphocytic leukaemia, follicular lymphoma, diffuse large B-cell lymphoma and multiple myeloma. Lower differences (

Background Primary malignant brain tumours are rare but represent a serious health burden due to their poor survival. This manuscript describes the survival of malignant brain tumours in adults diagnosed 2000–2007 in Europe. Methods For this study we analysed patients archived in 86 European population-based cancer registries, followed up to 31st December 2008. Only primary malignant neuroepithelial brain tumours (with pathological confirmation) and primary malignant unspecified brain tumours without pathological confirmation were included. We estimated 1-year and 5-year relative survival (RS) weighted by age group and country. We also estimated country-specific and age-specific survival, together with survival differences between time periods (for 1999–2001, 2002–2004 and 2005–2007). Results Glioblastoma represents 49% of all brain tumours, followed by other/unspecified astrocytoma (18%), oligodendroglioma/oligoastrocytoma (9%), ependymoma (1.5%) and embryonal tumours (1%). Five-year RS was 20% for all tumours combined, but ranged from 58% for ependymoma to only 6% for glioblastoma and sharply decreased with increasing age. Differences between countries were relatively small, but generally RS in Ireland/United Kingdom (UK) and Eastern Europe was below the average. An increase in 1-year RS (up to 10–12%) was noted over time, being largest in Central and Northern Europe in patients between 45 and 74 years of age. Conclusions Despite an increase in 1-year RS in most European regions, the survival of primary malignant brain tumours is still poor. Disparities between countries were evident, being even larger at the end of the study period than at the beginning, suggesting differences in availability of the latest treatment modalities.

ResumenLos diseños de investigación clínica, cuyo propósito es responder preguntas sobre causalidad, se pueden clasificar en relación con cuatro ejes: el número de grupos de estudio, la aplicación de una maniobra experimental, la direccionalidad causa-efecto y la fuente de la que se recaban los datos. Los diseños básicos más utilizados en epidemiología son el ensayo clínico, el estudio de cohortes, el estudio de casos y controles y la encuesta transversal. Este texto pretende facilitar la identificación y comprensión de cada uno de estos diseños mediante ejemplos relacionados con la asociación entre la vacunación con rotavirus y la invaginación intestinal.AbstractDesign of clinical research whose purpose is to answer questions about causality can be classified in relation to four axes: the number of study groups, the implementation of an experimental maneuver, cause-effect directionality and source from which the data are collected. The basic designs used in epidemiology are the clinical trial, the cohort study, the case-control study and the cross-sectional survey. This text aims to facilitate the identification and understanding of each of these designs through examples related to the association between rotavirus vaccination and intussusception.

This article introduces A2EPG, a new software application capable of automatically analyse signals derived from the electrical penetration graphs (EPG), a technique widely used to monitoring the plant probing behaviour of hemipterean insects. EPG records contain different well-known waveform patterns that are associated to specific behavioural activities inside the plant tissues, which are usually manually labelled in the present. A2EPG incorporates search engines for five EPG waveforms (Np, C, pd, G and E1) and provides output information indicating the time spans of each recognised waveform, which can be easily confirmed or manipulated by an expert user, reducing the overall time devoted to the analysis of EPG data. The application will be useful for researchers aimed to study the probing behaviour of piercing/sucking mouth parts, particularly aphids. The effectiveness of A2EPG was studied in EPG records obtained from individuals of two aphid species, exhibiting a substantial recognition efficacy for most of the considered waveforms. In general, A2EPG constitutes a useful tool for a rapid evaluation of EPG data over currently available software in the field.

BACKGROUND: Survival differences across Europe for patients with cancers of breast, uterus, cervix, ovary, vagina and vulva have been documented by previous EUROCARE studies. In the present EUROCARE-5 study we update survival estimates and investigate changes in country-specific and over time survival, discussing their relationship with incidence and mortality dynamics for cancers for which organised screening programs are ongoing. METHODS: We analysed cases archived in over 80 population-based cancer registries in 29 countries grouped into five European regions. We used the cohort approach to estimate 5-year relative survival (RS) for adult (⩾15years) women diagnosed 2000-2007, by age, country and region ; and the period approach to estimate time trends (1999-2007) in RS for breast and cervical cancers. RESULTS: In 2000-2007, 5-year RS was 57% overall, 82% for women diagnosed with breast, 76% with corpus uteri, 62% with cervical, 38% with ovarian, 40% with vaginal and 62% with vulvar cancer. Survival was low for patients resident in Eastern Europe (34% ovary-74% breast) and Ireland and the United Kingdom [Ireland/UK] (31-79%) and high for those resident in Northern Europe (41-85%) except Denmark. Survival decreased with advancing age: markedly for women with ovarian (71% 15-44years ; 20% ⩾75years) and breast (86% ; 72%) cancers. Survival for patients with breast and cervical cancers increased from 1999-2001 to 2005-2007, remarkably for those resident in countries with initially low survival. CONCLUSIONS: Despite increases over time, survival for women's cancers remained poor in Eastern Europe, likely due to advanced stage at diagnosis and/or suboptimum access to adequate care. Low survival for women living in Ireland/UK and Denmark could indicate late detection, possibly related also to referral delay. Poor survival for ovarian cancer across the continent and over time suggests the need for a major research effort to improve prognosis for this common cancer.