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Background Current breastfeeding recommendations focus on the physical benefits of breastfeeding but do not take into account the influence of a history of childhood maltreatment on mothers’ experiences breastfeeding. A better understanding of this relationship is important to be able to better support mothers during this critical time. Research aim To review current research that examined how women’s personal experiences of childhood maltreatment has affected their breastfeeding outcomes and experiences. Methods A scoping review was conducted to evaluate current literature on breastfeeding and childhood maltreatment. We screened 275 articles, of which eight met the sample selection criteria and were included in this review. These articles were analyzed based on common themes that emerged: Breastfeeding intention, initiation, duration, and exclusivity; medical conditions associated with breastfeeding; and participants’ experiences related to breastfeeding. Results History of childhood maltreatment was associated with decreased and shorter duration of breastfeeding. Participants’ experiences of breastfeeding varied: Some found it empowering, and others experienced great distress while breastfeeding. Challenges during this period included managing touch, struggling with the power differential between providers and participants, and coping with trauma symptoms (e.g., dissociation). Conclusions For some participants, it was possible to breastfeed successfully after childhood maltreatment, but others found the experience extremely difficult, even traumatizing. There is a need for a trauma-informed approach to lactation care for women with a childhood maltreatment history.

Published data on vitamin D and the quality of life of asthma patients are scarce and disparate. The ACVID clinical trial, published in 2020, showed the efficacy of calcifediol in improving asthma control in asthma patients with vitamin D deficiency. Data on vitamin D and quality of life measured by the Mini-AQLQ questionnaire were analysed: supplemented patients showed improved quality of life compared with a placebo group, and the initial mini-AQLQ scores were improved for both groups.

Background:SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is an acronym created with the aim of encompassing within the same entity the findings present in a heterogeneous group of patients with various osteoarticular and cutaneous disorders. For years it has been debated whether it is an entity itself or if, on the contrary, it is a specific phenotype of psoriatic arthritis.Objectives:Determine the relationship between SAPHO syndrome and psoriatic arthritis by comparing the classic criteria of SAPHO with CASPAR in patients previously diagnosed with SAPHO.Methods:A retrospective study where patients with a diagnosis of SAPHO in the same center (1984-2018) were reviewed. Of a total of 95 patients that met the criteria of Benhamou et al., 46 were excluded due to lack of information to complete the minimum necessary data, so 39 patients were finally included in the study. Demographic data were registered, age at diagnosis, CASPAR criteria (active psoriasis, history of own or familial psoriasis, nail psoriasis, negative RF, dactylitis and new formation/juxta-articular bone proliferation), classical criteria of SAPHO and HLAB27. For the statistical analysis, a Chi-square is applied to determine the differences between the groups with / without CASPAR criteria.Results:Of the sample of 39 subjects diagnosed with SAPHO, 15 patients (38%) met CASPAR criteria (4M/11W), with a median age at diagnosis of 42 years (range 21-50). Of them, 8 (60%) had active cutaneous psoriasis, 10 (73%) had a family or personal history of psoriasis, 6 (40%) had psoriatic nail dystrophy, 14 (93%) had negative FR, 3 (20%) had presented some episode of dactylitis and 10 (73%) had juxta-articular new bone formation. Of the 15 patients who met CASPAR criteria, 9 (67%) had synovitis, 2 (13%) acne, 4 (26%) pustulosis, 13 (87%) hyperostosis and 12 (80%) osteitis. HLAB27 was positive in 1 patient (2.5%) of the group that met CASPAR criteria. Of the patients who did not fulfill CASPAR criteria (9M/15W), the median age at diagnosis was 44.5 years (range 10-70). None of them had active cutaneous psoriasis, psoriatic nail distrophy or dactylitis, 1 (4%) had a family or personal history of psoriasis, all had RF- and 3 (12.5%) had juxta-articular bone new formation (Table 1). Synovitis was observed more frequently in patients who met CASPAR criteria than in those who did not (67% vs 25%, p 0.01). In contrast, osteitis was present more frequently in patients who did not meet CASPAR criteria (80% vs 96% p 0.05) and pustulosis, although it was not statistically significant (50% vs 26%, p 0.07). Among patients who did not meet CASPAR criteria only 1 met the 5 classic SAPHO criteria and another 3 met 4.Table 1.Conclusion:Approximately one third (38%) of patients diagnosed with SAPHO meet criteria for psoriatic arthritis, the most notable variables being active psoriasis or a history of psoriasis. Synovitis manifests more frequently in patients with CASPAR criteria and osteitis more present in patients who did not meet them.Acknowledgments:Rheumatology Service of the Germans Trias i Pujol HospitalDisclosure of Interests:None declared

BackgroundWe aimed to determine the impact of tocilizumab use in severe COVID-19 pneumonia mortality.MethodsWe performed a multicentre retrospective cohort study in 18 tertiary hospitals in Spain, from March to April 2020. Consecutive patients admitted with severe COVID-19 treated with tocilizumab were compared to patients not treated with tocilizumab, adjusting by Inverse Probability of the Treatment Weights (IPTW). Tocilizumab effect in patients receiving steroids during the 48h following inclusion was analyzed.ResultsDuring the study period, 506 patients with severe COVID-19 fulfilled inclusion criteria. Among them, 268 were treated with tocilizumab and 238 patients were not. Median time to tocilizumab treatment from onset of symptoms was 11 days (IQR 8-14). Global mortality was 23.7%. Mortality was lower in patients treated with tocilizumab than in controls (16.8% versus 31.5%, HR 0.514 [95CI 0.355-0.744], p< 0.001; weighted HR 0.741 [95CI 0.619-0.887], p = 0.001). Tocilizumab treatment reduced mortality by 14.7% relative to no tocilizumab treatment (RRR 46.7%). We calculated a number necessary to treat of 7. Among patients treated with steroids, mortality was lower in patients treated with tocilizumab than in those treated with steroids alone (10.9% versus 40.2%, HR 0.511 [95CI 0.352-0.741], p = 0.036; weighted HR 0.6 [95CI 0.449-0.804], p< 0.001) (Interaction p = 0.094).ConclusionsThese results show that survival of patients with severe COVID-19 is higher in patients treated with tocilizumab than in those not treated, and that tocilizumab effect adds to that of steroids administered to non-intubated cases with COVID-19 during the first 48 hours of presenting with respiratory failure despite of oxygen therapy. Randomised controlled studies are needed to confirm these results.SummaryWe investigated in-hospital mortality of patients with severe SARS-CoV-2 pneumonia in a multicenter series of patients treated with tocilizumab compared to controls, and adjusted using IPTW. Our results show a beneficial impact of tocilizumab treatment in SARS-CoV-2 pneumonia, that adds to that of steroids.

Foster youth become pregnant at 2–3 times the rate of the general U.S. adolescent population. Yet, there is a dearth of literature exploring experiences of pregnancy and birth among such young women. This phenomenological study included 18 in-depth interviews with six mothers aged 19–22 years in or transitioning from foster care. Interpretative Phenomenological Analysis, the specific phenomenological method used in this study, proceeded through six steps: 1. reading and re-reading; 2. initial noting; 3. developing emergent themes; 4. developing superordinate themes; 5. repeating steps 1–4 for each case; and 6. developing a set of final themes. This process yielded three themes characterizing how young women in foster care experience the phenomenon of pregnancy and birth: 1) Personal Pain, Personal Renewal; 2) Unplanned Pregnancies, Intentional Births; and 3) Powerful Bodies, Powerful Families. Findings extend the existing literature on adolescent pregnancy and childbirth, particularly among foster youth; related implications are discussed.

Introduction The organ and tissue donation interview is a vital step in obtaining the donation. Therefore, it is important to obtain as much information as possible regarding the relatives of the potential donor prior to this interview and know if there is a health care professional among the relatives who may act as an interlocutor. Objective The objective of this study is to assess the influence that relatives who are health care professionals may have if present at the interview for the organ and tissue donation request. Methods This is a descriptive study of all the organ donations from 1996 to 2019. Variables of the interview record form were completed by the Regional Transplant Coordination Office. Quantitative variables are expressed as mean (standard deviation) or median (interquartile range), and qualitative variables are expressed in percentage. The χ2 test was used for inferential statistics. Results Health care professionals were present as interlocutors in 8.4% of the total interviews conducted (9279). Organ donation was accepted in 86% of these interviews, while the relative who was a health care professional gave a 93.8% (729) positive response to the donation. Having a health care professional as an interlocutor favors the acceptance of the donation (odds ratio 9.325, 95% confidence interval: 5.054-17.205; P Conclusion Health care professionals have a very positive attitude toward donation. This attitude positively impacts other relatives’ acceptance of the donation.

Background: The rapidly evolving landscape of systemic treatment for metastatic breast cancer (MBC) during the 1990s led to meaningful improvements in the overall survival (OS) of MBC patients[1]. Despite ongoing and expanded access to new treatments, it remains unclear if this has translated into further advances in survival. Moreover, the prognosis of MBC patients based on subtype, over time, are also important to differentiate. Methods: The BC Cancer Breast Cancer Outcomes Unit (BCOU) database was utilized to identify patients referred to BC Cancer who were diagnosed with MBC during 3 time cohorts (cohort 1:2003-2005; cohort 2:2007-2009; cohort 3:2011-2013), to reflect changes in MBC treatment over these separate time periods. Baseline clinical and pathological criteria were compiled, in addition to adjuvant treatments received, as well as number of lines of treatment in the metastatic setting. OS was compared across time cohorts for all patients and then between subtypes using Kaplan-Meier survival curves. Results: A total of 3,953 patients met the inclusion criteria, consisting of 2,440 (61.7%) estrogen-receptor positive (ER+), 778 (19.7%) HER2 positive and 542 (13.7%) triple-negative breast cancer (TNBC) patients. One hundred and ninety-three patients (4.9%) were unable to be subtyped and were therefore excluded from the analysis . A total of 2,205 (90.4%) ER+ patients received at least 1 line of systemic therapy, with 80.0% receiving at least 1 line of hormonal therapy. The median time on hormonal treatment was 8.9 months (range 0.03 - 156.7) for first-line and 6.1 months (range 0.1 – 173.3) for second-line. In the HER2+ group, 665 (85.5%) patients received at least 1 line of treatment, with a median of 2 lines of treatment (range 1-16). Median duration of anti-HER2 treatment was 6.7 months (range 0.03 - 163.8) with a median of 1 line of anti-HER2 directed treatment (range 1-5). For TNBC patients, 357 (65.9%) received at least 1 line of treatment, with a median of 2 (range 1-10). No significant differences in OS were observed between the 3 time cohorts, with a median overall survival (mOS) of 1.63 years, 1.37 years and 1.57 years in cohorts 1-3, respectively (p=0.12).When comparing across subtypes, the ER+ group faired best with a mOS of 1.96 years (95% CI 1.8-2.1), consistent across time cohorts (p=0.72). This was followed by the HER2+ group with a mOS of 1.53 years (95% CI 1.3-1.7), also consistent across time cohorts (p=0.31). The TNBC group faired worst, with a mOS of 0.67 years (95% CI 0.6-0.8) over time (p=0.87). Conclusions: Despite advances in systemic therapy since the early 2000s, no meaningful improvements in overall survival were observed over time, regardless of subtype. It remains to be seen if developments since 2013 will lead to gains in overall survival for MBC patients, at a real life, population-based level. [1]Chia SK, Speers CH, D'yachkova Y, et al. Cancer 2007;110:973-979. Citation Format: LeVasseur N, Fiorino L, Speers CH, Aparicio M, Lohrisch C, Chia SK. Prognosis and survival in metastatic breast cancer – Ten years in review, a population-based analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-16-05.

Background In the US, young mothers are the least likely to breastfeed their children. Mothers who have a history of child abuse and neglect also face barriers when trying to breastfeed their children and are less likely to do so. Little is known about the experiences that young mothers who have a history of maltreatment face when making decisions around infant feeding. Objective To determine what challenges young maltreated mothers face when trying to breastfeed their children. Study Design, Settings, Participants In-depth semi-structured interviews (N = 23) were conducted with young maltreated mothers (ages 18-25), their caregivers, and the professionals that work with them. Mothers were on average 17.8 when they gave birth and most were African American (78%) followed by Latina (22%). All of the young mothers received WIC and 78% initiated breastfeeding. The median length of breastfeeding was 2.5 months (range: 3 days to 2 years). Professionals (mean age: 33.9) had worked with an average of over 40 parenting youth. Measurable Outcome/Analysis Interviews were transcribed verbatim and analyzed using a 5-step thematic analysis approach: familiarization with the data, initial coding, generation and refinement of themes and subthemes, and finalized themes. Results Participants discussed the lack of support both from health professionals and the mothers’ communities. Main sources of support and information included obstetricians, WIC, and the internet, but resources were often insufficient. Reasons for breastfeeding cessation included lack of support, difficulties with breastfeeding, discomfort with feeding in public, and substance use. Conclusion Young mothers with a history of maltreatment face significant barriers yet show resilience in attempting to breastfeed their children. Many experienced a systemic lack of support and low expectations for continued breastfeeding. Initial findings suggest optimum opportunities for improving systemic support may be among medical professionals and WIC staff. Funding University of Maryland.

Background:There are several studies assessing bone mass and osteoporosis (OP) development of patients with giant cell arteritis (GCA) during glucocorticoid treatment, however data at time of diagnosis is scarce.Objectives:To analyze bone metabolism, bone mineral density (BMD) and trabecular microarchitecture by measuring trabecular bone score (TBS) in patients with recent diagnosis of GCA.Methods:Retrospective observational study in which we included all patients with GCA and bone metabolism assessment at diagnosis. We recorded: risk factors for OP (previous fractures and anti-OP treatments), bone metabolism (calcium, phosphate, PTH, 25-vitaminD [25-OHD]) and the DXA results (Lunar, DPX) at the time of diagnosis and during the follow-up. The statistic analysis was made with SPSS.Results:36 patients (27 W: 9M) with a mean age of 76±9 years were included. The clinical characteristics of the GCA at diagnoses were: headache (81%), constitutional syndrome (58%), allodynia (42%), visual loss (42%, binocular in 2 patients), jaw claudication (39%), polymyalgic syndrome (28%), amaurosis fugax (25%) and lingular necrosis (n=1, 3%). Additional diagnosis tests included: temporal biopsy (86%, being pathologic in 55%), temporal ultrasound (97%, pathologic 34%), extra-cranial arteries ultrasound (81%, pathologic 7%) and PET/CT (19%, pathologic 86%). Up to 61% received three metilprednisolone bolus (mean dose 1700mg). 7 patients (19%) had previous OP and 3 had already suffered a fragility fracture (Colles, vertebral and femur). Only 4 patients were receiving anti-OP treatment (2 oral bisphosphonate, 2 zoledronate).At time of diagnosis of GCA, the mean of 25OHD was 17±13ng/mL (88%, Conclusion:Low bone mass and vitamin D insufficiency are frequent in patients with recent diagnoses of GCA and up to 38% have poor bone microarchitecture at baseline. Thus, it’s important to perform a bone mass assessment in all patients with recent diagnose of ACG and initiate therapeutic or preventive anti-OP treatment if required.Disclosure of Interests:None declared

Background:The incidence and factors related to an inadequate response to denosumab (Dmab) treatment remain unclear.Objectives:To describe clinical, analytical and densitometric characteristics of patients with inadequate response (IR) to Dmab in clinical practice. IR was defined as the presence of a new fracture [fxs-IR] or a significant decrease in BMD (≥5% lumbar or ≥4% femoral) [BMD-IR].Methods:retrospective study of patients with IR to Dmab treatment. Data of demographic variables, risk factors for osteoporosis, history of fractures, previous anti-osteoporotic treatment, densitometric and analytical parameters were collected before and after IR.Results:22 patients were included (19W:3M) with mean age of 75±10years. The causes of osteoporosis were: postmenopausal (50%), induced by glucocorticoids (22.7%), alcoholic (9.09%) and multifactorial (18.8%). Most patients were previously treated with bisphosphonates (59.09%, duration 5.2±2.6y) and had previous vertebral fractures (54.54% %, median 3).During Dmab treatment, 10 patients presented a BMD-IR (with a mean bone loss up to -3.5% at femur and -5.8% at lumbar spine) and 12 had fxs-IR (vertebral [n=8], humerus [n=1], pelvis [n=1], tibia [n=1]). No significant differences were observed in duration of Dmab between both IR groups (Fxs-IR: 3,2±1,9 vs BMD-IR: 2,4 ± 1,2y). In the BMD-IR, the BMD loss was higher at lumbar spine than at total hip (-6.6%±3.7 vs -1.9%±4.8). Only 1 patient of the fxs-IR had a secondary cause of IR (mieloma multiple).In the fxs-IR group, most patients started combined treatment with teriparatide (n=4), 1 changed to teriparatide and 7 remained with Dmab. In the BMD-IR group, most mantained Dmab treatment (n=8) and 2 switched to zoledronate.Conclusion:Most patients who developed IR to Dmab had been previously treated with bisphosphonates and had previous fragility fractures and appears within the first 3 years of treatment. BMD loss seems to be more marked at spine than total hip. Only one patient had a secundary cause of IR.Disclosure of Interests:None declared

We compared transcranial direct-current stimulation (tDCS) with a selective serotonin-reuptake inhibitor for the treatment of depression.In a single-center, double-blind, noninferiority trial involving adults with unipolar depression, we randomly assigned patients to receive tDCS plus oral placebo, sham tDCS plus escitalopram, or sham tDCS plus oral placebo. The tDCS was administered in 30-minute, 2-mA prefrontal stimulation sessions for 15 consecutive weekdays, followed by 7 weekly treatments. Escitalopram was given at a dose of 10 mg per day for 3 weeks and 20 mg per day thereafter. The primary outcome measure was the change in the 17-item Hamilton Depression Rating Scale (HDRS-17) score (range, 0 to 52, with higher scores indicating more depression). Noninferiority of tDCS versus escitalopram was defined by a lower boundary of the confidence interval for the difference in the decreased score that was at least 50% of the difference in the scores with placebo versus escitalopram.A total of 245 patients underwent randomization, with 91 being assigned to escitalopram, 94 to tDCS, and 60 to placebo. In the intention-to-treat analysis, the mean (±SD) decrease in the score from baseline was 11.3±6.5 points in the escitalopram group, 9.0±7.1 points in the tDCS group, and 5.8±7.9 points in the placebo group. The lower boundary of the confidence interval for the difference in the decrease for tDCS versus escitalopram (difference, -2.3 points; 95% confidence interval [CI], -4.3 to -0.4; P=0.69) was lower than the noninferiority margin of -2.75 (50% of placebo minus escitalopram), so noninferiority could not be claimed. Escitalopram and tDCS were both superior to placebo (difference vs. placebo, 5.5 points [95% CI, 3.1 to 7.8; P0.001] and 3.2 points [95% CI, 0.7 to 5.5; P=0.01], respectively). Patients receiving tDCS had higher rates of skin redness, tinnitus, and nervousness than did those in the other two groups, and new-onset mania developed in 2 patients in the tDCS group. Patients receiving escitalopram had more frequent sleepiness and obstipation than did those in the other two groups.In a single-center trial, tDCS for the treatment of depression did not show noninferiority to escitalopram over a 10-week period and was associated with more adverse events. (Funded by Fundação de Amparo à Pesquisa do Estado de São Paulo and others; ELECT-TDCS ClinicalTrials.gov number, NCT01894815 .).

Objective We report a prospective study of repairs using the Rives technique of the more difficult primary inguinal hernias, focusing on the immediate post-operative period, clinical recurrence, testicular atrophy, and chronic pain. A mesh placed in the preperitoneal space can reduce recurrences and chronic pain. Methods For the larger primary inguinal hernias (Types 3, 4, 6, and some 7), we favour preperitoneal placement of a mesh, covering the myopectineal orifice by means of a transinguinal (Rives technique) approach. The Rives technique was performed on 943 patients (1000 repairs), preferably under local anaesthesia plus sedation in ambulatory surgery. Results The mean operative time was 31.8 min. Pain assessment after 24 h with an Andersen scale and a categorical scale gave two patients with intense pain on the Andersen scale, and four patients who thought their state was bad. Surgical wound complications were below 1%, and urinary retention was 1.2% mostly associated with spinal anaesthesia and, in one case, bladder perforation. There was spermatic cord and testicular oedema with some degree of orchitis in 17 patients. The clinical follow-up of 849 repairs (86.4%), mean (range) 30.0 (12–192) months, gave five recurrences (0.6%), three cases (0.4%) of testicular atrophy, and 37 (4.3%) of post-operative chronic pain (8 patients with visual analogue scale of 3–10). Conclusions The Rives technique requires a sound knowledge of inguinal preperitoneal space anatomy, but it is an excellent technique for the larger and difficult primary inguinal hernias, giving a low rate of recurrences and chronic pain.

Objective To evaluate whether and to which extent skin redness (erythema) affects investigator blinding in transcranial direct current stimulation (tDCS) trials. Material and Methods Twenty-six volunteers received sham and active tDCS, which was applied with saline-soaked sponges of different thicknesses. High-resolution skin images, taken before and 5, 15, and 30 min after stimulation, were randomized and presented to experienced raters who evaluated erythema intensity and judged on the likelihood of stimulation condition (sham vs. active). In addition, semi-automated image processing generated probability heatmaps and surface area coverage of erythema. Adverse events were also collected. Results Erythema was present, but less intense in sham compared to active groups. Erythema intensity was inversely and directly associated to correct sham and active stimulation group allocation, respectively. Our image analyses found that erythema also occurs after sham and its distribution is homogenous below electrodes. Tingling frequency was higher using thin compared to thick sponges, whereas erythema was more intense under thick sponges. Conclusions Optimal investigator blinding is achieved when erythema after tDCS is mild. Erythema distribution under the electrode is patchy, occurs after sham tDCS and varies according to sponge thickness. We discuss methods to address skin erythema-related tDCS unblinding.

[Background] Concerns have been raised about the possibility that inhibitors of the renin–angiotensin–aldosterone system (RAAS) could predispose individuals to severe COVID-19; however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19., [Methods] In this case-population study, we consecutively selected patients aged 18 years or older with a PCR-confirmed diagnosis of COVID-19 requiring admission to hospital from seven hospitals in Madrid, who had been admitted between March 1 and March 24, 2020. As a reference group, we randomly sampled ten patients per case, individually matched for age, sex, region (ie, Madrid), and date of admission to hospital (month and day; index date), from Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), a Spanish primary health-care database, in its last available year (2018). We extracted information on comorbidities and prescriptions up to the month before index date (ie, current use) from electronic clinical records of both cases and controls. The outcome of interest was admission to hospital of patients with COVID-19. To minimise confounding by indication, the main analysis focused on assessing the association between COVID-19 requiring admission to hospital and use of RAAS inhibitors compared with use of other antihypertensive drugs. We calculated odds ratios (ORs) and 95% CIs, adjusted for age, sex, and cardiovascular comorbidities and risk factors, using conditional logistic regression. The protocol of the study was registered in the EU electronic Register of Post-Authorisation Studies, EUPAS34437., [Findings] We collected data for 1139 cases and 11 390 population controls. Among cases, 444 (39·0%) were female and the mean age was 69·1 years (SD 15·4), and despite being matched on sex and age, a significantly higher proportion of cases had pre-existing cardiovascular disease (OR 1·98, 95% CI 1·62–2·41) and risk factors (1·46, 1·23–1·73) than did controls. Compared with users of other antihypertensive drugs, users of RAAS inhibitors had an adjusted OR for COVID-19 requiring admission to hospital of 0·94 (95% CI 0·77–1·15). No increased risk was observed with either angiotensin-converting enzyme inhibitors (adjusted OR 0·80, 0·64–1·00) or angiotensin-receptor blockers (1·10, 0·88–1·37). Sex, age, and background cardiovascular risk did not modify the adjusted OR between use of RAAS inhibitors and COVID-19 requiring admission to hospital, whereas a decreased risk of COVID-19 requiring admission to hospital was found among patients with diabetes who were users of RAAS inhibitors (adjusted OR 0·53, 95% CI 0·34–0·80). The adjusted ORs were similar across severity degrees of COVID-19., [Interpretation] RAAS inhibitors do not increase the risk of COVID-19 requiring admission to hospital, including fatal cases and those admitted to intensive care units, and should not be discontinued to prevent a severe case of COVID-19., This study was funded by a research grant from the Institute of Health Carlos III (COV20/00027).

Background: Transcranial direct current stimulation (tDCS) has emerged as a promising therapeutic tool to improve balance and optimize rehabilitation strategies. However, current literature shows the methodological heterogeneity of tDCS protocols and results, hindering any clear conclusions about the effects of tDCS on postural control. Objective: Evaluate the effectiveness of tDCS on postural control, and identify the most beneficial target brain areas and the effect on different populations. Methods: Two independent reviewers selected randomized tDCS clinical-trials studies from PubMed, Scopus, Web of Science, and reference lists of retrieved articles published between 1998 and 2017. Most frequently reported centre of pressure (COP) variables were selected for meta-analysis. Other postural control outcomes were discussed in the review. Results: Thirty studies were included in the systematic review, and 11 were submitted to a meta-analysis. A reduction of COP displacement area has been significantly achieved by tDCS, evidencing an improvement in balance control. Individuals with cerebral palsy (CP) and healthy young adults are mostly affected by stimulation. The analysis of the impact of tDCS over different brain areas revealed a significant effect after primary motor cortex (M1) stimulation, however, with no clear results after cerebellar stimulation due to divergent results among studies. Conclusions: tDCS appears to improve balance control, more evident in healthy and CP subjects. Effects are observed when primary MI is stimulated. Cerebellar stimulation should be better investigated.

Chromosomal DNA elements are organized into spatial domains within the eukaryotic nucleus. Sites undergoing DNA replication, high-level transcription, and repair of double-strand breaks coalesce into foci, although the significance and mechanisms giving rise to these dynamic structures are poorly understood. InS. cerevisiae, replication origins occupy characteristic subnuclear localizations that anticipate their initiation timing during S phase. Here, we link localization of replication origins in G1 phase with Fkh1 activity, which is required for their early replication timing. Using a Fkh1-dependent origin relocalization assay, we determine that execution of Dbf4-dependent kinase function, including Cdc45 loading, results in dynamic relocalization of a replication origin from the nuclear periphery to the interior in G1 phase. Origin mobility increases substantially with Fkh1-driven relocalization. These findings provide novel molecular insight into the mechanisms that govern dynamics and spatial organization of DNA replication origins and possibly other functional DNA elements.

This study examined the rates and correlates of first and repeat births in a national sample of females emancipating from foster care in the United States (N = 3,699). Data from the National Youth in Transition Database and the Adoption and Foster Care Analysis and Reporting System were used to evaluate birth rates between ages 19 and 21, and explore the risk, protective, and child welfare factors associated with first and repeat births. Findings revealed that about 30% of females in the current sample had given birth between ages 19 and 21. Of these females, about one-third had at least one previous birth, generally between the ages of 17 and 19. Higher risk of both first and repeat births between ages 19 and 21 was associated with disconnection from school and employment, increased placement instability, and earlier exit from foster care. In contrast, lower risk of first and repeat births was associated with receiving educational financial assistance. Implications for policy, practice, and research are discussed.

Eser, Sultan (Balikesir Author), Background In 2015, the second cycle of the CONCORD programme established global surveillance of cancer survival as a metric of the effectiveness of health systems and to inform global policy on cancer control. CONCORD-3 updates the worldwide surveillance of cancer survival to 2014. Methods CONCORD-3 includes individual records for 37.5 million patients diagnosed with cancer during the 15-year period 2000-14. Data were provided by 322 population-based cancer registries in 71 countries and territories, 47 of which provided data with 100% population coverage. The study includes 18 cancers or groups of cancers: oesophagus, stomach, colon, rectum, liver, pancreas, lung, breast (women), cervix, ovary, prostate, and melanoma of the skin in adults, and brain tumours, leukaemias, and lymphomas in both adults and children. Standardised quality control procedures were applied; errors were rectified by the registry concerned. We estimated 5-year net survival. Estimates were age-standardised with the International Cancer Survival Standard weights.Findings For most cancers, 5-year net survival remains among the highest in the world in the USA and Canada, in Australia and New Zealand, and in Finland, Iceland, Norway, and Sweden. For many cancers, Denmark is closing the survival gap with the other Nordic countries. Survival trends are generally increasing, even for some of the more lethal cancers: in some countries, survival has increased by up to 5% for cancers of the liver, pancreas, and lung. For women diagnosed during 2010-14, 5-year survival for breast cancer is now 89.5% in Australia and 90.2% in the USA, but international differences remain very wide, with levels as low as 66.1% in India. For gastrointestinal cancers, the highest levels of 5-year survival are seen in southeast Asia: in South Korea for cancers of the stomach (68.9%), colon (71.8%), and rectum (71.1%); in Japan for oesophageal cancer (36.0%); and in Taiwan for liver cancer (27.9%). By contrast, in the same world region, survival is generally lower than elsewhere for melanoma of the skin (59.9% in South Korea, 52.1% in Taiwan, and 49.6% in China), and for both lymphoid malignancies (52.5%, 50.5%, and 38.3%) and myeloid malignancies (45.9%, 33.4%, and 24.8%). For children diagnosed during 2010-14, 5-year survival for acute lymphoblastic leukaemia ranged from 49.8% in Ecuador to 95.2% in Finland. 5-year survival from brain tumours in children is higher than for adults but the global range is very wide (from 28.9% in Brazil to nearly 80% in Sweden and Denmark). Interpretation The CONCORD programme enables timely comparisons of the overall effectiveness of health systems in providing care for 18 cancers that collectively represent 75% of all cancers diagnosed worldwide every year. It contributes to the evidence base for global policy on cancer control. Since 2017, the Organisation for Economic Co-operation and Development has used findings from the CONCORD programme as the official benchmark of cancer survival, among their indicators of the quality of health care in 48 countries worldwide. Governments must recognise population-based cancer registries as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems for all patients diagnosed with cancer., American Cancer Society Centers for Disease Control and Prevention Swiss Re Swiss Cancer Research foundation Swiss Cancer League Institut National du Cancer La Ligue Contre le Cancer Rossy Family Foundation US National Cancer Institute Susan G Komen Foundation

The voices of mothers of color who have been affected by the child welfare system are typically marginalized and are largely left unheard. Yet, attending to their experiences may yield a wealth of strategies for system change and for other women to change their path or avoid child welfare system involvement altogether. Using augmented qualitative analytic methods from two phenomenological studies that utilized the life histories approach, the current study lifts up the voices of 15 women of color with past child welfare involvement as foster youth (and, for many, as mothers). The study findings highlight experiences within two broad themes: a) immense insecurity; and b) resilience, across domains in the lives of child welfare affected women. The mothers in this study share their insights into the aftermath of complex trauma and substance abuse within their families, particularly the relational, housing, and financial insecurity it wreaked as well as how they garnered resilience through perseverance, faith and empathy, and establishing stable homes. Implications for practice, policy, and future research are discussed.

Background Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation investigated as a treatment for several neuropsychiatric disorders. Notwithstanding tDCS-induced adverse events (AEs) are considered to be low and transient, systematic review analyses on safety and tolerability of tDCS derive mostly from single-session studies. Objective To investigate the tolerability (rate of AEs) and acceptability (rate of dropouts) of tDCS. Methods Systematic review and meta-analysis of tDCS randomized, sham-controlled trials in healthy or neuropsychiatric adult samples from the first date available to March 9, 2016. We only included parallel studies performing at least 5 tDCS sessions. An adapted version of CONSORT guidelines for reporting harms outcomes was used to evaluate AE reporting. Results Sixty-four studies (2262 participants) were included. They had a low risk of publication bias and methodological bias for the items assessed. Dropout rates in active and sham tDCS groups were, respectively, 6% and 7.2% (OR = 0.82 [0.59–1.14]). However, almost half of studies reported no dropouts and only 23.4% reported its reasons; when reported, the most frequent reasons were AEs and protocol violation. A tolerability meta-analysis was not performed, as most studies did not report AEs. The quality of AEs reporting was also limited, particularly in smaller studies and stroke studies. Conclusions Although overall dropout rate was low and similar in active and sham groups, studies did not adequately describe AEs. An updated questionnaire and guidelines for assessment of AEs in tDCS trials are proposed in order to standardize the reporting of AE in the field.

This qualitative pilot study examined first-generation Latina mothers' experiences of supplementing home-based Early Head Start (EHS) services with the evidence-based Attachment and Biobehavioral Catch-up (ABC; M. Dozier, O. Lindheim, & J. Ackerman, 2005) program. Ten low-income, first-generation Latina mothers with infants and toddlers enrolled in home-based EHS were provided 10 ABC home visits by a supplemental parent coach. Following delivery of ABC, mothers participated in in-depth, semistructured, qualitative interviews about their experiences. Interview themes included positive experiences of both EHS and the ABC, a high value placed on receiving both programs, and cultural relevance of the ABC program for Latino families. Participants offered several suggestions for improved program delivery. Study findings suggest that a model of EHS supplemented by ABC delivered to the Latino community is feasible, valuable to participants, and culturally relevant. Considerations for sustainability of this supplemental model are discussed.

Objective: Noninvasive brain stimulation (NIBS) techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), are increasingly being used to treat mental disorders, particularly major depression. The aim of this comprehensive review is to summarize the main advances, limitations, and perspectives of the field. Methods: We searched PubMed and other databases from inception to July 2017 for articles, particularly systematic reviews and meta-analyses, evaluating the use of NIBS in psychiatric disorders. Results: We reviewed the mechanisms of action, safety, tolerability, efficacy, and relevant clinical parameters of NIBS. Repetitive TMS is already an established technique for the treatment of depression, and there is theoretically room for further methodological development towards a high-end therapeutic intervention. In contrast, tDCS is a technically easier method and therefore potentially suitable for wider clinical use. However the evidence of its antidepressant efficacy is less sound, and a recent study found tDCS to be inferior to antidepressant pharmacotherapy. Clinical trials using rTMS for other mental disorders produced mixed findings, whereas tDCS use has not been sufficiently appraised. Conclusion: The most promising results of NIBS have been obtained for depression. These techniques excel in safety and tolerability, although their efficacy still warrants improvement.

CONTEXT Research has documented elevated rates of early childbirth among adolescents who have spent time in foster care, and a better understanding is needed of the characteristics of vulnerable individuals and the circumstances of their time in care. METHODS California birth records for 1999-2010 were probabilistically linked to state child welfare service records spanning the same date range to identify females aged 12-19 who had spent time in foster care and had had a first birth before age 20. Latent class analysis was used to identify subgroups based on age at most recent entry into care, length of this stay and three indicators of placement instability. The probability of a first birth being related to class membership was assessed as a distal outcome, and differences across classes were assessed using chi-square tests. RESULTS Four distinct classes of foster youth were identified: Later Entry/High Instability (20% of individuals), Later Entry/Low Instability (43%), Earlier Entry/High Instability (12%) and Earlier Entry/Low Instability (25%). The probability of a first childbirth ranged from 31% (class 1) to 15% (class 4); classes 2 and 3 experienced moderate risk (23% and 24%, respectively). Two groups were further characterized by high rates of reentry into care, with 56% of class 1 and 41% of class 3 individuals experiencing more than one episode in care. CONCLUSIONS Identifiable subgroups of female foster youth are at heightened risk of early childbirth and may benefit from early intervention, enhanced support and access to reliable, ongoing sexual and reproductive health care.

Background Cardiac block in neonatal lupus is associated with placental transfer of anti-Ro antibodies. The effect of these antibodies on cardiac conduction disorders in adult patients is controversial. The association between anti-Ro antibodies and heart rhythm disorders have been described in isolated cases. However, there are just a few studies that analyse the relationship between autoimmune diseases and electrocardiographic disturbances. Objectives To determine if there are differences in cardiac conduction of SLE patients in presence of anti-Ro antibodies. Methods All patients included fulfilled the SLE criteria, SLICC 2012 and they were followed up in a single centre. The inclusion was consecutive and voluntary. Patients who took drugs that altered the conduction (except antimalarial drugs), and those who had heart or thyroid disease were discarded. All patients were assessed blindly by a cardiologist who performed an interrogation and physical examination, an electrocardiogram, an echocardiogram and a 24 hour Holter study. Besides, a rheumatologist performed a clinical and analytical assessment including a qualitative analysis by immunoblotting of anti-Ro Ab and a quantification by chemiluminescence of the anti-Ro52 and Ro60 Ab. The presence of other SLE specific Ab (ANA, DNA, antiphospholipids), was also analysed. Clinical, analytical and, activity and damage indexes, were collected (SLEDAI and SLICC). The data were compared by Student’s t test, Fisher’s test and Chi square using 21 SPSS version. The level of significance was established at 5%. Results 145 patients were included: 91.7% women, average age 45±12, average disease duration 11 years. The patients were undergoing the following treatments: antimalarial 91%, mycophenolate 20%, azathioprine 12%, biological treatment 5% and glucocorticoids 70%. The clinical characteristics are summarised in table 1. There were no significant differences between the group of positive and negative anti-Ro Ab in terms of gender, age, clinical characteristics or cardiovascular risk factors. None of the patients was affected by an atrio-ventricular block and the rest of the electrocardiographic alterations had no clinical significance and did not predominate in the positive Ro Ab group. Additionally, no differences in heart rate, ventricular extrasystoles or PR, QT or QRS intervals were detected between both groups. The echocardiogram’s findings were not relevant and there were no differences between groups. Since the majority of patients with SLE are double positive, differences between the two subspecificities of Ro (52 and 60) could not be analysed. On the other hand, no differences were found in cardiac conduction regarding the treatments received, the activity or damage indexes, or the analytical or clinical characteristics of the patients. Conclusions The study results show that there are no differences in cardiac conduction according to the presence of anti-Ro antibodies in SLE patients. Thus, the cardiac screening in SLE patients with anti-Ro positive antibodies seems not helpful in clinical practice. Disclosure of Interest None declared

Background There are few recent large cohort epidemiological studies that analyse the clinical profile of patients with psoriatic arthritis (PsA) who require biological treatment, as well as pharmacological survival and reasons for the suspension of these treatments. Objectives To describe the clinical, demographic, epidemiological and radiographic characteristics of patients with PsA in our centre, as well as pharmacological survival and reasons for the suspension of different biological treatments. Methods Retrospective analysis of patients with PsA treated between 1985 and 2015 at a University Hospital with a referral area of 8 50 000 inhabitants. Demographic, clinical, laboratory and imaging data, as well as patients’ clinical and medical treatment records. Results The main characteristics of the cohort are summarised in table 1: Approximately one third of patients with PsA (32.3%) required treatment with a biological drug during the course of their disease. The most frequently prescribed first-line drugs (89.5%) were tumour necrosis factor-α inhibitors (TNFi). During the course of their disease, 27 (21.9%) patients who started biological treatment received a biological drug other than TNFi. Of the 124 patients who started treatment with a biological DMARD, more than half (65, 52.8%) required a change to a second drug, and of these, 27 (41.5%) changed to a third, with up to 7 different biological drugs required in one case. The mean survival time for the first bDMARD was 42.8±42.3 months, with secondary failure the most frequent cause of treatment change (37.8%), followed by adverse effects (27.1%) and primary failure (18.9%). The adverse effects registered were: 20% infections, 20% appearance of neoplasms, 5% allergic reactions and 55% other causes. Conclusions PsA presents a similar distribution by sex and is usually diagnosed at around the age of 50, having been preceded by cutaneous involvement. PsA is an entity of considerable severity and up to a third of patients will require biological treatments during its evolution. More than half of them will receive a second biological treatment. The retention rate of each drug varies but tends to decrease with each drug change. Disclosure of Interest None declared

Background Pulmonary affection is a serious complication in Rheumatoid Arthritis (RA) with an important impact on mortality and morbidity. Objectives To describe the clinical and radiographic characteristics of patients with RA in our centre, and specifically from those with interstitial lung disease (ILD). Methods Retrospective analysis of patients with RA and pulmonary affection from a University Hospital with a referral area of 85.000 inhabitants. Clinical, laboratory, imaging and pulmonary function test (PFT) data was recorded. Results Data from 85 patients, 37 (43.5%) male and 48 (56.5%) female, were recorded. The mean time from RA diagnosis to pulmonary disease was 9.2 years, with mainly erosive (58.8%) and seropostive (84.7% were positive rheumatoid factor (RF) and 84.2% anti-citrullinated protein antibodies (ACPA)) disease. The 56.5% of the patients were smokers or ex-smokers. PFT results were documented in 75.3% of the patients: diffusing capacity for carbon monoxide (DCLO) baseline values were over 60% in a 38.8% of cases and forced vital capacity (FVC) baseline values were over 50% in a 69.4% of patients. The most frequent High Resolution CT scan pattern was the presence of bronchiectasis (64.7%), followed by ILD (31.8%) and, specifically, the Usual Interstitial Pneumonia pattern (UIP, 66.6%); lung infections (25.8%), rheumatoid lung nodules (22.4%), pleural effusion (15.3%), lung tumours (9.4%) and bronchiolitis (5.8%). The presence of extra articular manifestations as rheumatoid nodules (27%), epieschleritis (2.3%) and vasculitis (9.4%) was registered. The coexistence of Chronic Obstructive Pulmonary Disease (COPD) was recorded too (24.7%). Related to treatment, 84.7% of patients had received Methotrexate and in a 40% of cases, at least one biological disease-modifying antirheumatic drug had been administrated. Though the causes were not registered, a 25.9% of deaths were documented. In parallel we did a subanalysis of ILD related to RA cases, summarised in table 1 (n=27): Conclusions Bronchiectasis is the most common pulmonary manifestation of RA patients in our area. The most frequent clinical profile is a non-smoker woman with seropositive disease. ILD affects approximately one third of RA patients in our area and is an underdiagnosed entity. We consider that it is necessary to establish a screening program to diagnose and treat it early. Disclosure of Interest None declared

Background Uveitis is the most common ocular inflammatory disease. According to the classification, non-infectious uveitis 70% of the total, presenting a chronic course and with it, an increased risk of complications. The phased therapeutic approach in ophthalmology is well established and is based on the efficacy of synthetic and biological immunosuppressive therapy.1 However, we do not have evidence-based protocols that allow us to know how long to maintain them, or when to interrupt them. Objectives The main objective is to evaluate the free time without ocular inflammatory activity after the withdrawal of the synthetic and/or biological immunosuppressive treatment in patients with non-infectious uveitis. As secondary objectives are collected the epidemiological and clinical characteristics, the distribution of the different immunosuppressive drugs employed and analysed the cases of recurrence after the interruption of treatment, and the need of reintroduction. Methods A retrospective cohort multicenter study was conducted in patients with a diagnosis of non-infectious uveitis followed in a multidisciplinary unit, that after two or more years of ocular and extraocular inactivity, the inmunossuppresive treatment was suspended. It was defined inactive uveitis as cell Tyndall 0 in anterior and vitreous chamber, as well as the absence of other signs of active inflammation (retinal infiltrates, choroid and vasculitis and/or papillitis with angiographic leakage). Demographic characteristics, anatomical location and laterality of the uveitis, visual acuity at the beginning and end of the study and the drugs used were recorded. Results We analysed 48 patients with an average age at the onset of immunosuppressive treatment of 39.3 years (±16 years). 85.4% of the uveitis were bilateral. The main diagnoses are described in table 1. In 56.3% of cases a single immunosuppressant was used. Cyclosporine was the most employed (72.9%) and methotrexate was the most used in monotherapy (83.3%). 83% of patients received corticosteroids and 12% treatment with Infliximab. The mean duration of immunosuppressive treatment was 6.9 years (±5, 7anos). The percentage of total and ocular recurrence was 37.5% and 31.25% respectively. The mean duration of follow-up after treatment suspension was 4.3 years (±4.5 years), being more than 1 year in 77.1% of patients. We found that 75% of patients remained free of recurrence at least 27 months. The administration of two or more immunosuppresive drugs proved to be a risk factor for recurrence (p=0,048) and reintroduction of treatment after it (p=0,008), which was performed in 39% of the ocular recurrences. Visual acuity did not suffer variation in 78.6% of recurrences and 80.3% of those that did not recur. Conclusions In our cohort, patients with no ocular inflammatory activity for at least two years could benefit from the suspension of immunosuppressive treatment without a visual risk. The use of one or more immunosuppressive drugs has been identified as a risk factor for recurrence. Reference [1] Update on the principles and novel local and systemic therapies for the treatment of non-infectious uveitis. Inflamm Allergy Drug Targets2013;12(1):38–45. Disclosure of Interest None declared

Background The efficacy of transcranial direct current stimulation (tDCS) as a continuation therapy for the maintenance phase of the depressive episode is low and insufficiently investigated in literature. We investigated whether it could be enhanced by using a more intensive treatment regimen compared to previous reports. Methods Twenty-four patients (16 with unipolar depression and eight with bipolar depression) who presented acute tDCS response (≥50% depression improvement in the Hamilton Depression Rating Scale [HDRS]) after receiving 15 tDCS sessions were followed for up to 6 months or until relapse, defined as clinical worsening and/or HDRS > 15. Sessions were performed twice a week (maximum of 48 sessions) over 24 weeks. The anode and the cathode were positioned over the left and right dorsolateral prefrontal cortex (2 mA current, 30 min sessions were delivered). We performed Kaplan-Meier survival analysis and Cox proportional hazards ratios to evaluate predictors of relapse. Results Out of 24 patients, 18 completed the follow-up period. tDCS treatment was well tolerated. The mean survival duration was 17.5 weeks (122 days). The survival rate at the end of follow-up was 73.5% (95% confidence interval, 50-87). A trend (P = 0.09) was observed for lower relapse rates in nontreatment- vs. antidepressant treatment-resistant patients (7.7% vs. 45.5%, respectively). No differences in efficacy between unipolar and bipolar depression were observed. Conclusion An intensive tDCS treatment regimen consisting of sessions twice a week achieved relatively low relapse rates after a 6-month follow up of tDCS responders, particularly for nontreatment-resistant patients.

The growing body of research on teenage motherhood in foster care has largely focused on the risks involved for both mother and child, yet these mothers depict a much more complex picture of their own experience of becoming and being mothers. The current study employed interpretative phenomenological analysis to explore 18 in-depth, qualitative interviews from six participants on the meaning and experience of motherhood among teenage mothers in foster care and in the years immediately after ageing out. This study focused on a particular dimension of motherhood: participants' efforts to break the cycle of child abuse and neglect with their own children. Two themes emerged as characteristic of these experiences: (i) treating children well/parenting differently and avoiding the system; and (ii) reducing isolation and enhancing support. Given the increased likelihood of the children of teen mothers - particularly those who have been maltreated - becoming involved with the child welfare system, study findings suggest possible strategies for disrupting cycles of intergenerational child welfare involvement generated by young mothers themselves. Practice implications for addressing possible substance abuse, mental health and relational and parenting needs are discussed. Language: en

Racial and ethnic inequities persist in teenage pregnancy rates, prompting examinations of how to provide better attuned teen pregnancy prevention in key affected communities. The current study focused on sociocultural factors of teen pregnancy in Latino communities, using in-depth, semi-structured qualitative interviews to elicit the experiences and perspectives of young adult Latino/as (some who prevented and others who directly experienced teen pregnancy in their own lives). Using a grounded theory approach to data analysis, avoiding teen pregnancy emerged as related to 7 facets of youth experience. Findings offer a critical window into the complex interplay of these experiences in Latino teens' lives, particularly when using a gender-sensitive lens. Implications and future research directions are discussed.

Background: The presence of a family history implies an increased risk for developing colorectal cancer (CRC), and may require a different screening strategy. The aim of this study was to evaluate lesions found during colonoscopies of patients that had a family history of CRC. Material and methods: A retrospective study was conducted that included consecutive colonoscopies performed on patients with a family history of CRC at a referral center within the period from April 2000 to January 2012. The colonoscopic findings were analyzed in relation to sex, age, and the presence or absence of symptoms. Results: Data from 3,792 colonoscopies were collected. The mean age of the patients was 53.14 years (SD 12.22), and 57.4% were women. Colonoscopy was normal in 71.7% of the cases, with hyperplastic polyps being detected in 7.1%, and adenomatous polyps in 19.8% (39.4% of them were high risk). There was a 1.5% presence of adenocarcinomas in the subjects. Polyps and CRC were predominant in men (P=.001 and P=.027, respectively) and there was a linear increase with age. Symptomatic patients had a higher CRC detection rate (P

The present study employed Interpretative Phenomenological Analysis (IPA) to explore the experiences and meaning of motherhood among teen mothers in foster care. Through a series of 18 in-depth, semi-structured interviews exploring experiences of both being mothered and mothering, the six young women in this study shared their stories of living the reality of becoming mothers under extremely challenging circumstances and doing their best to thrive. Themes of darkness and despair, (e.g., substance abuse, poverty, and child maltreatment) glimpses of light in the darkness (e.g., relationships with their partner's family), and new beginnings (e.g., identity as mother) emerged as characteristic of their experience. Implications for practice, policy, and research in the areas of teen pregnancy prevention and support for family strengthening are offered.

Transcylindrical cholecystectomy (TC) can be performed under local anaesthesia and sedation (LAS) in ambulatory surgery (AS). The aim of this study was to assess the feasibility and results of TC under LAS. TC under LAS was proposed to 583 consecutive patients with cholelithiasis in an AS unit. For the TC procedure, a cylindrical retractor with a transparent plunger was inserted into the hepatocystic triangle, and cholecystectomy was performed through the retractor with reusable open instruments. Pre-, intra-, and post-operative variables were prospectively registered, including complications, reasons for conversion to general anaesthesia (GA), non-programmed admissions, readmissions, pain assessments, and satisfaction with the procedure. Five hundred patients were eligible for LAS, with GA being required in 128 (25.6%) of them. AS was programmed for 447 patients. The rates of non-programmed admissions, readmissions, and conversion to laparotomy were 8.7% (39), 0.8% (4), and 2.6% (13), respectively. There was no main bile duct injury. At 24 h, physical status was good or excellent in 80.4% of the patients. A history of acute cholecystitis, male sex, a body mass index (BMI) ≥ 39.5 kg/m2, and non-suspected acute cholecystitis were found to be independent variables associated with conversion to GA. TC under LAS is a safe procedure in AS and is feasible in 74% of cholelithiasis patients. Male sex, BMI, gallbladder wall thickness, and a history of acute cholecystitis are factors that increase the probability of conversion to GA. This prospective study was approved by the ethics committee of Badajoz for patient protection for biomedical research and has been retrospectively registered under the research registry UIN: researchregistry3979.

A high yielding regio- and diastereoselective 7-endo 2,3-epoxyamides and 2,3-aziridine carboxamide cyclization is reported. Several aryl and alkyl trans-2,3-epoxyamides were reacted with BF3·OEt2 to afford the corresponding 4-hydroxy-5-alkyl/aryl-tetrahydro-2-benzazepin-3-ones. In addition, arene cyclization with aryl 2,3-aziridine carboxamides was investigated.

Single-cell mRNA sequencing, which permits whole transcriptional profiling of individual cells, has been widely applied to study growth and development of tissues and tumors. Resolving cell cycle for such groups of cells is significant, but may not be adequately achieved by commonly used approaches. Here we develop a traveling salesman problem and hidden Markov model-based computational method named reCAT, to recover cell cycle along time for unsynchronized single-cell transcriptome data. We independently test reCAT for accuracy and reliability using several data sets. We find that cell cycle genes cluster into two major waves of expression, which correspond to the two well-known checkpoints, G1 and G2. Moreover, we leverage reCAT to exhibit methylation variation along the recovered cell cycle. Thus, reCAT shows the potential to elucidate diverse profiles of cell cycle, as well as other cyclic or circadian processes (e.g., in liver), on single-cell resolution., In single-cell RNA sequencing data of heterogeneous cell populations, cell cycle stage of individual cells would often be informative. Here, the authors introduce a computational model to reconstruct a pseudo-time series from single cell transcriptome data, identify the cell cycle stages, identify candidate cell cycle-regulated genes and recover the methylome changes during the cell cycle.

Despite gains in reducing teenage pregnancy during the past 20 years, disparities in teenage pregnancy rates persist: The teenage pregnancy rate in Latino communities is now nearly double the average rate of teenage pregnancy in the United States. Considering the significant risks teenage pregnancy and parenting pose to both the teenager and the child, and that social workers are already often working in communities with populations at risk, this is not only a major public health issue, but one that the field of social work is well positioned to actively address. This article synthesizes pertinent literature on some of the social and cultural influences important for understanding this phenomenon. Implications for social work practice are discussed.

Female youth experiencing homelessness are at high risk for pregnancy due to a host of individual, family, and community-level risk factors. This embedded mixed-method quasi-experimental pilot study examined the initial outcomes of Wahine (woman) Talk, a comprehensive sexual health program delivered by an interdisciplinary team to female youth experiencing homelessness. Wahine Talk includes provision of and connection to basic needs resources, peer mentoring, group based sexual health education, and linkage to and provision of sexual health care. Process and outcome data were collected throughout and for six months after Wahine Talk from a diverse group of 14–22-year-old female youth (N = 51) experiencing homelessness. In-depth individual and focus group interview data were collected from providers and youth after Wahine Talk, and analyzed using Template Analysis. Over half (62.7%) of participants were linked to sexual health care during Wahine Talk and birth control usage tripled following the program. Depo-Provera and long acting reversible contraception (LARC) usage, in particular, increased during Wahine Talk (1–19% and 0–25.5%, respectively). Within six months, 31.4% of youth had adopted LARC and 3.9% were using Depo-Provera. Individual and focus group interviews with providers and youth affirm program acceptability and appropriateness.

Objective This study uses the Life Course Model for Spina Bifida (SB) to advance knowledge of factors associated with change in quality-of-life (QOL) among emerging adults with SB. Design Forty-eight participants (mean [SD], 22.04 [2.16] yrs) completed self-report questionnaires at two time points, 15 mos apart. Four QOL domains (physical health, psychological, social relationships, and environment) were measured using the World Health Organization QOL-BREF version. SB clinical data were collected via chart reviews. Paired t tests and reliable change indices evaluated group- and individual-level QOL change, respectively. Multiple regression analyses tested the contributions of the Life Course variables in explaining change in QOL over time. Results No significant group-level differences in the QOL domains were found between time 1 and time 2, but there was substantial individual variation in QOL over time. SB severity was related to a decline only in psychological QOL (B = -0.68, P = 0.02). Increased pain was associated with reduced physical health (B = -0.29, P = 0.049) and psychological (B = -0.29, P = 0.03) QOL at time 2, whereas greater family satisfaction was related to improved QOL in several domains. Conclusions Clinicians should be aware of the negative impact of pain and the protective influence of family satisfaction on QOL in emerging adults with SB.

espanolObjetivo: Valorar los resultados del tratamiento de la artrosis de rodilla mediante una inyeccion intrarticular de acido hialuronico en lo que se refiere a reduccion del dolor, mejoria de la funcion articular y duracion de los efectos. Metodo: Pacientes con diagnostico clinico y radiologico de artrosis en diferentes fases de evolucion en una o ambas rodillas, tratados en la Unidad del Dolor de un hospital de tercer nivel. Se recogio prospectivamente la informacion facilitada por el paciente siguiendo la practica clinica habitual: caracteristicas sociodemograficas y clinicas. Se realizaron valoraciones pre y postratamiento del dolor en reposo, a la deambulacion y al subir/bajar escaleras, rigidez matutina, tiempo caminando y las horas/calidad del descanso nocturno. En la visita postratamiento se registraron, ademas, el grado de mejoria experimentada, duracion de la misma y la satisfaccion del investigador. El tratamiento consistio en una unica inyeccion de acido hialuronico por via intrarticular, con posibilidad de una dosis de recuerdo. Resultados: Se incluyeron 29 pacientes (52 rodillas); en 23 se trataron ambas rodillas (n = 46) y en 6 una rodilla. El 92,3 % corresponden a articulaciones artrosicas con un tiempo de evolucion > 12 meses, con grado clinico 4-5 en el 61,6 % de las rodillas tratadas (n = 32) y grado radiologico III-IV de Kellgren y Lawrence en el 67,7 % (n = 35), por lo que un 55,8 % de los casos fueron calificados como severos por los investigadores. Hubo una mejoria significativa en todos los parametros de dolor y funcionalidad considerados (p EnglishObjective: To evaluate the results of treatment of knee osteoarthritis with a single intra-articular injection of hyaluronic acid in terms of pain reduction, joint function improvement and duration of effects. Method: Patients with clinical and radiological diagnosis of osteoarthritis at different stages of evolution in one or both knees were treated at the Pain Unit of a tertiary hospital. Sociodemographic and clinical characteristics provided by the patient following the usual clinical practice were prospectively collected. Pain at rest, walking, up and down stairs, morning stiffness, time walking as well as time/quality sleep were recorded pre and post-treatment. At post-treatment visit the degree and duration of improvement experienced, as well as the investigator assessment were also recorded. The treatment consisted of a single intra-articular injection of hyaluronic acid, with the possibility of a booster. Results: A total of 29 patients (52 knees) were included. Both knees were treated in 23 of them (n = 46) and only one knee in the remaining 6. The 92.3 % were osteoarthritic joints with an evolution > 12 months, with clinical grade 4-5 in 61.6 % (n = 32) and radiological grade III-IV of Kellgren & Lawrence in 67.7 % (n = 35), making 55.8 % of cases were classified as severe by the investigators. There was a significant improvement in all parameters of pain and function considered (p

Chromosome aberrations are considered as alterations in the chromosome number or structure. They are mainly due to gametogenesis inborn error (meiosis) or occur during the zygote first cellular divisions where DNA repair processes are deficient. Two Wolf Syndrome patients and two criduchat patients or patients with deletion of the short arm of chromosome 4 and 5, respectively, and deletion of chromosome 9 in one patient, were observed among 4617 karyotype studies performed from 1992 to 2011, at the Hospital Para El Nino Poblano (Pediatric Hospital) in Mexico. These chromosome structural alterations or deletions at chromosomes 4, 5 and 9, observed among five patients from three different families were chosen to analyze their clinical characteristics, medical or surgical treatments and their medical evolution according to the genetic disease. Key words: Chromosome, deletion, chromosome aberration, structural changes, karyotype.

A regiospecific and high diastereoselective synthesis of trans-glycidic amides coming from a common pseudoephedrine sulfonium salt 2 precursor is presented. This is the first example in where the diastereoselectivity is controlled by a chiral noncyclic amide fragment. The epoxidation reaction provides alkyl or aryl glycidic amides in good to excellent yields and exclusive trans selectivity. Finally, through of a chemospecific 6-exo-tet ring closure of trans-epoxyamides we access to morpholin-3-ones densely functionalized with excellent chemical and stereochemical yields.

Chromosome aberrations are considered alterations in the chromosome number or structure. They are mainly considered due to gametogenesis inborn error or during the zygote first cellular divisions. Among 4617 chromosomal studies performed during 19 years (from 1992 to 2011), at Hospital Para El Nino Poblano in Mexico, 34.6% (1596 patients) had chromosomal alterations. Among these study populations, a male and a female pediatric patient were described, with 6;9 translocation and trisomy of chromosome 6, where chromosome changes are classified as structural or numeric alterations respectively, and a number of leukemias has been associated with specific chromosomal translocations. Both cases were described in this study analyzing their hematological, clinical features, medical treatments and prognosis. Key words: Chromosome, karyotype, leukemia, numeric and structural chromosome changesa

Resumen Objetivo Existe alto riesgo de transmitir una infeccion por virus B con el higado de donantes AgHBs (-), anti-HBc, sin embargo, este riesgo esta poco estudiado en el trasplante cardiaco. Los objetivos son conocer la influencia del anti-HBc (+) en la aceptacion del corazon para trasplante y hacer una puesta al dia de los trabajos publicados. Diseno Encuesta y revision bibliografica en bases medicas desde 1994 hasta octubre del 2011. Ambito Equipos espanoles de trasplante cardiaco. Pacientes No aplicable. Intervenciones Ninguna. Variables de interes Aceptacion para trasplante del corazon de donantes anti-Hbc (+). Resultados Doce de 15 equipos encuestados vacunan contra el VHB y 2 cuantifican los titulos anti-HBs. Siete solicitan el anti-HBc del donante. En caso de positividad, 2 no aceptan la oferta, 2 aceptan si el donante es tambien anti-HBs (+), uno selecciona el receptor en situacion de urgencia y 3 emplean profilaxis farmacologica de forma aislada o complementaria a las anteriores. Solo se ha publicado un caso de hepatitis B en un receptor anti-HBc (-), anti-HBs (-) que no recibio medidas profilacticas. Hay descritas seroconversiones de los marcadores anti-HBc y anti-HBs de dudosa etiologia. Conclusiones El anti-HBc (+) del donante influye para aceptar el corazon aunque hay disparidad de criterios. Existe escasa informacion publicada sobre la evolucion de los receptores. Hasta el momento se ha descrito un caso de infeccion postrasplante. Aunque poco frecuente, un donante anti-HBc (+) puede albergar infeccion oculta por VHB. El riesgo puede prevenirse con titulos anti-HBs adecuados o con medidas farmacologicas.

The development of new nitrogen fertilizers is necessary to optimize crop production whilst improving the environmental aspects arising from the use of nitrogenous fertilization as a cultural practice. The use of urease inhibitors aims to improve the efficiency of urea as a nitrogen fertilizer by preventing its loss from the soil as ammonia. However, although the action of urease inhibitors is aimed at the urease activity in soil, their availability for the plant may affect its urease activity. The aim of this work was therefore to evaluate the effect of two urease inhibitors, namely acetohydroxamic acid (AHA) and N-(n-butyl) thiophosphoric triamide (NBPT), on the germination of pea and spinach seeds. The results obtained show that urease inhibitors do not affect the germination process to any significant degree, with the only process affected being imbibition in spinach, thus also suggesting different urease activities for both plants. Our findings therefore suggest an activity other than the previously reported urolytic activity for urease in spinach. Furthermore, of the two inhibitors tested, NBPT was found to be the most effective at inhibiting urease activity, especially in pea seedlings. © 2012 Elsevier GmbH., This work was supported by the Spanish MICIIN (Grant No. AGL2009-13339-CO2-02 [to P.A.T.]). S.C. was supported by a doctoral fellowship from the Public University of Navarre.

We present here a regiospecific synthesis of 7-alkyl- or 7-aryl-6-hydroxy-1,4-oxazepan-5-ones and 2-[aryl(hydroxy)methyl]- or 2-(1-hydroxyalkyl)morpholin-3-ones from a diastereomeric mixture of trans-3-alkyl- or -3-aryl-N-(2-hydroxyethyl)-N-(1-phenylethyl)oxirane-2-carboxamides. This chemodivergent synthesis is easily controlled by an appropriate choice of cyclization reaction conditions.