Analysis of the impact of green urban areas in historic fortified cities using Landsat historical series and Normalized Difference Indices

Urban green areas minimize the negative effects of climatic change and improve the sustainability of historic cities. Despite this, green areas have traditionally been considered a threat to heritage buildings because they cause humidity changes, that accelerate degradation processes. Within this context, this study evaluates the trends in the inclusion of green areas in historic cities and the effects it causes on humidity and conservation of earthen fortifications. To achieve this goal, vegetative and humidity information has been obtained since 1985 from Landsat satellite images. The historical series of images has been statistically analysed in Google Earth Engine to obtain maps that show the means, 25th, and 75th percentiles of the variations registered in the last 35 years. The results allow visualizing spatial patterns and plotting the seasonal and monthly variations. In the decision-making process, the proposed method allows to monitor whether the presence of vegetation is an environmental degradation agent in the nearby earthen fortifications.The analysis of the historic fortified cities of Seville and Niebla (Spain) shows a gradual increase in green areas and an interest in locating them near the earthen fortifications. The impact on the fortifications is specific to each type of vegetation and can be positive or negative. In general, the low humidity registered indicates low danger, and the presence of green areas favours drying after heavy rains. This study suggests that increasing green spaces to historic cities does not necessarily endanger the preservation of earthen fortifications. Instead, managing both heritage sites and urban green areas together can encourage outdoor cultural activities, reduce the impacts of climate change, and enhance the sustainability of historic cities.

Climate change, large fires, and cultural landscapes in the mediterranean basin: An analysis in southern Spain

Understanding the factors that influence fire regimes in Mediterranean climates is essential to reduce their risk. This research uses Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) and Moderate-Resolution Imaging Spectroradiometer (MODIS) satellite resources to evaluate recent changes in land surface temperature, precipitation, and vegetation and their effects in the occurrence of large fires in the Mediterranean Basin. The results of the analysis of 335 fire events occurred in southern Spain from 2001 to 2020 show an increase in hazardous meteorological factors linked to droughts and thermal anomalies. The study also examines the potential of preserving traditional landscapes to minimize such risk. In fact, the maintenance and recovering of traditional agro-pastoral activities is an effective option to reduce flammability and increase the resilience of cultural landscapes in hazardous climatic conditions.

Endourological treatment of ectopic ureterocele. Our experience in the last 15 years

OBJECTIVE

To assess the efficacy of the endourological treatment of ectopic ureterocele in children in a large series and with a long-term follow-up.

MATERIALS AND METHODS

A retrospective, descriptive study of patients with ectopic ureterocele who had undergone surgery in our institution in the last 15 years was carried out. All patients were treated using an endourological approach, both for ureterocele and postoperative vesicoureteral reflux (VUR).

RESULTS

40 patients were treated -55% with left involvement and 5% with bilateral involvement. Mean age at diagnosis was 4.97 months, with diagnosis being established prenatally in 54.1% of cases. In all patients but one, endourological puncture of the ureterocele was conducted. Mean age at surgery was 6.96 months (0-1.11). Surgery was performed on an outpatient basis in 94.9% of patients. No perioperative complications were recorded. In the last 30 patients, preoperative voiding cystourethrography was not carried out. 72.5% of patients had postoperative VUR (44.8% into the upper pyelon, 10.3% into the lower pyelon, 17.2% into both, 6.9% into the contralateral system, and 20.7% into the bilateral system), but it was resolved with a single endoscopic procedure in 48.1% of cases (65% of patients were healed with two procedures). VUR was not endoscopically resolved in 3 patients who required ureteral re-implantation. 6 patients required heminephrectomy (n=3) or nephrectomy (n=3) as a result of functional impairment and infections.

CONCLUSION

The endourological treatment of ectopic ureterocele is a little aggressive and little invasive technique that allows the obstruction to be resolved on an outpatient basis, which means bladder surgery -if required- can be performed outside the neonatal period.

Cancer care for Ukrainian refugees: Strategic impact assessments in the early days of the conflict

BACKGROUND

The invasion of Ukraine by Russia in February 2022 has resulted in destruction of healthcare infrastructure and triggered the largest wave of internally displaced populations and refugees since World War Two. Conflicts in transitioned countries such as Ukraine create new non-communicable disease (NCD) challenges, especially for cancer care for refugees and humanitarian assistance in host countries. In the early days, rapid attempts were made to model possible impacts.

METHODS

By evaluating open source intelligence used in the first three months of the conflict through snowball search methods, we aimed to address: (i) burden of cancer in Ukrainian population, specifically considering translating to the refugees population, and its cancer care capacity; ii) baseline capacity/strengths of cancer systems in initial host countries. Moreover, using a baseline scenario based on crude cancer incidence in Ukraine, and considering data from UNHCR, we estimated how cancer cases would be distributed across host countries. Finally, a surveillance assessment instrument was created, intersecting health system's capacity and influx of internally displaced populations and refugees.

FINDINGS AND CONCLUSIONS

The total new cancer patients per month in pre-conflict Ukraine was estimated as 13,106, of which < 1 % are paediatric cases. The estimated cancer cases in the refugee population (combining prevalent and incident), assuming 7.5 million refugees by July 2022 and a female:male ratio of 9:1, was 33,121 individuals (Poland: 19284; Hungary: 3484; Moldova: 2651; Slovakia: 2421; Romania: 5281). According to our assessments, Poland is the only neighbouring country classified as green/yellow for cancer capacity, i.e. sufficient ablility to absorb additional burden into national health system; Slovakia we graded as yellow, Hungary and Romania as yellow/red and Moldova as red.

Buried penis secondary to ectopic scrotum

INTRODUCTION

Ectopic scrotum is a rare clinical entity, potentially associated with other congenital abnormalities. We present the case of a patient with buried penis secondary to ectopic scrotum. The surgical technique was described, and a literature review was carried out.

CLINICAL CASE

1-year-old patient with ectopic right hemiscrotum and the testes within the scrotal sac. A double Z-plasty was performed with two flaps - one above the penis, surrounding the ectopic scrotum, and the other one at the scrotum to modify the bifid scrotum. The upper flap was rotated downwards, which allowed ectopy to be repaired, and the lower flap was used to repair bifidity. No postoperative complications were recorded. Follow-time was 6 months, with good final cosmetic results.

DISCUSSION

Ectopic scrotum is an infrequent congenital malformation. Cutaneous rotation flaps with Z-plasties are a valid treatment option, with good long-term cosmetic results.

P-080 Intrauterine insemination (IUI) success rates in patients with suboptimal total processed motile sperm count (TPMSC) using a second consecutive semen sample

Study question

Is it effective to request a second consecutive semen sample in patients with less than 1 million TPMSC in a first semen sample for IUI?

Summary answer

In men with TPMSC under one million, the issuing of a second consecutive sample reached pregnancy rates similar to those published for IUI.

What is known already

IUI offers a comparable cumulative live birth rate in 3-4 cycles compared to IVF and can be preferred as a cost-effective first-line treatment in mild male factor or unexplained infertility. The quality of the processed semen sample is an important factor for the IUI success.

The WHO recommends an abstinence period to ensure best quality of semen samples. However, it has been observed that when men with moderate male factor who are unable to meet the minimum requirements for IUI are asked to produce a second sample better counts are obtained; questioning the time correlation between abstinence and semen quality.

Study design, size, duration

This was a retrospective study conducted in the reproductive medicine unit of a private hospital in Chile between July 2015 and March 2021. All patients who underwent IUI in the study period that had an TPMSC less than 1 million in the eyaculate and to whom a second consecutive sample was requested were included.

Participants/materials, setting, methods

118 patients who underwent 140 IUI cycles were included in the study. All the patients with an PMSC under 1 million at the time of the IUI were requested a second consecutive semen sample within an hour or two from the previous eyaculate. The second samples were processed and used for insemination. The primary outcome was pregnancy rate. The secondary outcomes were semen quality (TPMSC of first and second semen samples).

Main results and the role of chance

Between 2015 and 2021 there were 140 IUI cycles in which a second consecutive semen sample was requested, including 118 patients. Overall 17 pregnancies were achieved. The pregnancy rate per cycle was 12,14% and the pregnancy rate per patient was 14,4%. The live birth rate per patient was 10,2%.

Regarding the sperm sample analysis, the median TPMSC of the first semen sample was 261.437. The median PMSC of the second consecutive sample was 7.315.000. 126 patients had an TPMSC of 0 in the first semen sample while only 9 patients had an IMSC of 0 in the second sample. In five cases a third consecutive sample was requested of which 4 patients had their cycles canceled because they did not meet the target PMSC. One patient had an TPMSC of 1.687.000 in the third sample.

Finally, of the 118 patients who did not meet the requirements for IUI with the first sample, only 19 cycles were canceled.

Limitations, reasons for caution

The study has the limitation of being a retrospective and descriptive study with no contol group. Also the group is heterogeneous because it includes patients with different female factors for infertility.

Wider implications of the findings

In developing countries and low-income settings the IUI remains a more accessible alternative in patients with infertility. Routinely recollecting a second semen sample in men with TPMSC &lt;1 million would reduce cycle cancellation rates due to not achieving an optimal TPMSC, reaching pregnancy rates similar to those published for IUI.

Trial registration number

Not applicable

Blood Transcriptome Profiling Reveals Diet-Induced Changes in Metabolic Pathway Gene Expression

Objectives

This study explored the effects of diet-induced (almonds vs. crackers) changes on blood transcriptome profiles of young adults.

Methods

Young adults (age: 18–22 years) were randomly assigned to consume either almonds (2 oz./d, n = 13) or an isocaloric control snack of graham crackers (325 kcal/d, n = 10) daily for 4 weeks. Blood samples were collected at baseline and 4 weeks after intervention. Total leukocyte RNA was extracted and sequenced. Gene expression profiling was carried out using a 3′ Tag-RNA-Seq protocol. Barcoded sequencing libraries were prepared using the QuantSeq FWD kit for multiplexed sequencing. Data were preprocessed, STAR aligned, and count tables generated using the QuantSeq FWD-UMI pipeline. Differential expression (DE) analysis was conducted on the time x diet model using the limma-voom packages in R. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis on the DE p-values was conducted using the Wilcoxon rank-sum test in R. P-values were adjusted for false discovery rate correction (FDR).

Results

Out of 13,018 filtered genes, 69 were differentially expressed (FDR &lt; 0.1). Glutamic-oxaloacetic transaminase 2 (GOT2), diacylglycerol kinase alpha (DGKA), and glutaryl-CoA dehydrogenase (GCDH) genes were upregulated with almond consumption. GOT2 plays a role in amino acid metabolism and the urea and tricarboxylic acid cycles, DGKA is involved in lipid metabolism, and GCDH is involved in lysine degradation and tryptophan metabolism. Cracker consumption resulted in greater upregulation of TGF-beta activated kinase 1 gene (MAP3K7) binding protein 3 (TAB3) gene which is involved in the NF-kappaB signal transduction pathway and a greater downregulation in the immunoglobulin superfamily member 8 (IGSF8) gene. Enrichment analyses indicate gene annotations to 341 KEGG pathways. Thermogeneic and ribosomal pathways were significantly enriched (FDR &lt; 0.1). Pathways related to oxidative phosphorylation, sphingolipid signaling, and tryptophan, propanoate, and starch and sucrose metabolism were also differentially enriched (P &lt; 0.05, FDR &lt; 0.3).

Conclusions

These findings indicate that diet (almond vs cracker) potentially alters metabolism through changes in gene transcription. The implications of these findings and associations with health and disease outcomes need to be investigated further.

Funding Sources

NIH

Risk and vulnerability assessment in coastal environments applied to heritage buildings in Havana (Cuba) and Cadiz (Spain)

In this paper, diagnostic tools are utilized to conduct a vulnerability analysis of monuments located in a coastal environment in accordance with a raft of standards drawn up by the International Organization for Standardization (ISO) 31000, in order to identify the main risks for Cultural Heritage in Havana (Cuba) and Cadiz (Spain). Vulnerability analysis is based on a Leopold matrix, which models the relationship between major hazards and pathologies in order to evaluate coastal influence and the risks for the conservation of cultural heritage. The quantitative matrix allows for a cause-effect analysis to be conducted for the main scenarios, related to the state of conservation. These relationships are a key step in risk assessment and treatment strategies. Major hazards have been identified by different public bodies and agencies to provide information about the probability and intensity of these variables in the vulnerability matrix. The combination of vulnerability index assessment, which depends on intrinsic variables and environmental scenarios, and knowledge of the main hazards in Havana and Cadiz, has provided useful tools to conduct risk assessments for cultural heritage conservation in coastal environments, where climate conditions, geomorphology and social issues are the main hazards, while vulnerability is associated with conservation plans. These tools provide information that will enable decision-makers in different coastal environments to prioritize strategies for cultural heritage preservation.

Cost-effectiveness of Lutetium [177Lu] oxodotreotide versus best supportive care with octreotide in patients with midgut neuroendocrine tumors in France

BACKGROUND AND AIMS

In France, there are approximately 2,400 new cases of neuroendocrine tumors (NETs) annually. Peptide receptor radionuclide therapy with ¹⁷⁷Lu-Dotatate plus long-acting repeatable [LAR] octreotide 30 mg has been shown to significantly improve progression-free survival and overall survival relative to high-dose octreotide LAR 60 mg in patients with unresectable or metastatic progressive midgut NETs. A long-term cost-effectiveness analysis was performed to assess whether ¹⁷⁷Lu-Dotatate is a cost-effective option versus octreotide 60 mg for patients with unresectable/metastatic progressive midgut NETs from the perspective of French healthcare payer.

METHODS

The analysis was performed using a three-state partitioned survival model. In the base case analysis ¹⁷⁷Lu-Dotatate plus octreotide LAR 30 mg was compared with high-dose octreotide LAR 60 mg in patients with midgut NETs. Survival data were obtained from the phase III NETTER-1 trial in patients with metastatic midgut NETs. Future costs and clinical outcomes were discounted at 4% per annum. One-way deterministic and probabilistic sensitivity analyses were performed.

RESULTS

In the base case analysis, for patients with midgut NETs, ¹⁷⁷Lu-Dotatate treatment improved quality-adjusted life expectancy by 1.21 quality-adjusted life years (QALYs) relative to octreotide LAR 60 mg and the lifetime treatment costs were EUR 50,784 higher with ¹⁷⁷Lu-Dotatate resulting in an incremental cost-effectiveness ratio (ICER) of EUR 42,106 per QALY gained versus octreotide LAR 60 mg. When compared with everolimus, ¹⁷⁷Lu-Dotatate was associated with an ICER of EUR 59,769 per QALY gained. Sensitivity analyses showed that the results were sensitive to methods used to extrapolate survival data.

CONCLUSIONS

For patients with advanced progressive midgut NETs ¹⁷⁷Lu-Dotatate is likely to be considered a cost-effective option versus octreotide 60 mg from the perspective of the French healthcare payer.

Almond Snacking For 8 Weeks Differentially Altered the Serum Omics Profiles of Young Adults in Comparison to a Control Snack

Objectives

Almond consumption can improve cardiometabolic health. However, the mechanisms underlying those physiological changes are not well characterized. This study explored the effects of consuming a snack of almonds for 8 weeks on changes in omics profiles in young adults.

Methods

Newly enrolled, college students (n = 73, age: 18–19 years, BMI: 18–41 kg/m2) were randomly assigned to consume a morning snack, i.e., either almonds (2 oz./d, n = 38) or an isocaloric control snack of graham crackers (325 kcal/d, n = 35) daily for 8 weeks (Clinical trials: NCT03084003). Blood samples were collected every 4 weeks over the 8 week intervention. Metabolite abundances in the serum were quantified by hydrophilic Interaction chromatography (HILIC) quadrupole (Q) time-of-flight (TOF) mass spectrometry (MS/MS), gas chromatography time-of-flight (GCTOF) MS, and CSH-ESI (electrospray) QTOF MS/MS. Data were reported as quantitative ion peak heights and were normalized by systematic error removal using random forest (SERRF) normalization. The baseline-adjusted means of the almond and cracker groups at week 8 were analyzed using ChemRICH which is a chemical similarity enrichment analysis software for metabolomics datasets that uses medical subject headings and Tanimoto substructure chemical similarity coefficients to cluster metabolites into non-overlapping chemical groups. Statistically significant p-values for clusters were obtained by self-contained Kolmogorov–Smirnov tests.

Results

Out of the 5716 features detected, 857 were identified as known compounds. ChemRICH mapped 660 of the identified metabolites to 63 nonoverlapping chemical classes, of which 2 were found to be significantly different between the almond and cracker groups (false discovery rate adjusted P value (FDR) &lt; 0.05). Almond snacking for 8 weeks was associated with altered unsaturated lipid metabolism represented by significantly increased levels of unsaturated triglycerides and unsaturated lysophosphatidylcholines compared with cracker snacking (cluster FDR &lt; 0.05).

Conclusions

These findings indicate that almond and cracker snacking for 8 weeks differentially altered lipid metabolism.

Funding Sources

Research supported by Almond Board of California and NIH-NIMHD.

Effects of dietary inclusion of Opuntia ficus-indica on the glycemia and productive performance in lactating sows

Sows with increased blood glucose during late gestation may have decreased feed intake in lactation. Supplying dietary fibre to the sow reportedly modulates blood glucose and improves feed intake. The objective of this study was to evaluate the effects of dietary inclusion of cactus (Opuntia ficus-indica) on the regulation of blood glucose and productive performance in lactating sows. Data from 52 hybrid sows were analysed. The sows were divided into two groups, namely a control group (CG), that is, sows fed conventionally; and an experimental group (EG), that is, sows fed commercial feed plus cacti. Blood glucose in late gestation, and feed intake, milk production and milk quality, development of the piglet, energy balance, post-weaning body weight balance and the interval from weaning to oestrus were recorded. Preprandial blood glucose was 55.9 mg per dL in EG and 71.4 in CG. Sows on EG had greater daily feed intake and lower negative energy balance (5.4 kg/day and -2.8 MJ/day) than those on CG (4.5 kg/day and -9.4 MJ/day). Sows fed EG produced more milk (8.6 L/day) than those on CG (8.1 L/day). The quality of milk produced and the weaning weight of piglets were similar for the two groups. Body weight balance after weaning was greater for sows fed EG, 3.5% versus -1.5% in those fed CG. The weaning to oestrus interval was 0.6 days less for sows fed EG than those fed CG. Feeding cactus to lactating sows regulated blood glucose, which improved most of their productive indicators.Keywords: cactus, dietary fibre, energy balance, hypophagia, piglet

Incorporation of a Morning Snack (Almonds vs. Crackers) Differentially Altered Serum Primary Metabolite Profiles of Breakfast Skipping Young Adults (FS03-03-19)

Objectives

Almond consumption can improve the cardiometabolic phenotype in young college students that routinely skip breakfast. However, the mechanisms underlying the above physiological changes are not well characterized. The study aimed to explore the effects of consuming a morning snack of almonds (high-fat) vs. crackers (high-carbohydrate) for 8 weeks on primary metabolites such as sugars, amino acids, sterols, hormones, catecholamines, hydroxyl acids, fatty acids, aromatics and other intermediates of primary metabolism in young adults.

Methods

Newly enrolled, college students (n = 73, age: 18–19 years, BMI: 18–41 kg/m2), primarily breakfast skippers, were randomly assigned to consume a morning snack, i.e., either almonds (2 oz./d, n = 38) or an isocaloric graham cracker snack (325 kcal/d, n = 35) daily for 8 weeks (Clinical trials: NCT03084003). Fasted blood samples were collected at baseline, mid-point and at the end of the 8-week intervention. Metabolite abundances in the serum were quantified by gas chromatography time-of-flight (GCTOF) mass spectrometry (MS). Data were reported as quantitative ion peak heights and were normalized by the sum intensity of all annotated metabolites. Linear mixed model analyses were conducted to assess the effects of the snack groups on the metabolites over the 8-week intervention. The P-values were adjusted for false discovery rate (FDR).

Results

Out of the 542 features detected, 160 were identified as known compounds. Aspartic acid, phenylalanine and taurine (amino acids), azelaic acid (dicarboxylic acid), octadeconol (fatty alcohol), threonic acid (sugar acid) increased (time effect, P < 0.05) while linoleic acid, myristic acid and palmitoleic acid (fatty acids) decreased (time effect, P < 0.05) over the 8-week snacking intervention. In addition, alpha-tocopherol (biomarker of almond consumption) and aconitic acid (TCA cycle intermediate) increased over 8 weeks in the almond group but not in the cracker group (time x snack effect, P < 0.05, Figure 1).

Conclusions

Consumption of a morning snack for 8 weeks altered the abundance of specific primary metabolites including those involved in biochemical pathways such as aconitic acid (almond snacking only) in routinely breakfast skipping young adults. The findings on the whole indicate a differential shift in metabolism with almond and cracker snacking which will be further analyzed through associations with glucoregulatory and cardiovascular outcomes.

Funding Sources

Almond Board of California, NIH-NIMHD.

Supporting Tables, Images and/or Graphs

OR04-5 Stimulation of Protein Disulfide Isomerase Activity by Activation of The Renin-Angiotensin System

Understanding the molecular and cellular mechanisms that are affected by activation of the renin-angiotensin system (RAS) are important for development of novel therapeutic strategies to more specifically treat hypertension and reduce cardiovascular risk. RAS regulates blood pressure (BP) in part via its effector molecule, angiotensin II (AngII), a potent vasopressor that stimulates the production of reactive oxygen species (ROS). Protein disulfide isomerase (PDI) is a multifunctional oxidoreductase that catalyzes thiol/disulfide interchange reactions within the endoplasmic reticulum and regulates ROS production. Also, PDI is present in circulation and at the cell surface of platelets, lymphocytes, erythrocytes and endothelial cells and plays a critical role in initiating thrombus formation. However, the interaction of RAS and PDI remain unclear. We hypothesized that RAS activation would lead to increased PDI levels thus contributing to oxidative stress. First, we studied the in vitro effects of AngII on EA.hy926, a human endothelial cell line, and measured PDI activity. Our results show that AngII dose and time dependently increased extracellular PDI activity (p<0.05, n=6); an event that was reduced to baseline levels by preincubation with 0.5 uM losartan, an AngII type 1 receptor antagonist (ARB). Consistent with these results, AngII stimulated: 1) a 3-fold rise of extracellular PDI levels as determined by ELISA (p<0.05, n=4); 2) a 2.5-fold increase in PDI mRNA levels by RT-PCR (p<0.05, n=4); and 3) increased PDI protein levels by western blot analyses that were blocked by losartan. We also studied the effect of AngII on extracellular PDI activity in differentiated HL-60 cells, a human polymorphonuclear neutrophil cell line, and observed significantly increased extracellular PDI activity following incubation with AngII (p<0.05, n=4). We then characterized the in vivo effects of exogenous AngII infusion on PDI in Sprague-Dawley rats, a model of increased BP, inflammation and target organ damage. We studied three conditions: (1) control; (2) AngII infused (80 ng/min x 28 days); (3) AngII + ARB (10 mg losartan/kg/day x 21 days). AngII infusion led to significant increases in plasma PDI levels that were reduced by 20% following ARB treatment (p<0.05, n=5/group). We then studied a model of naturally increased AngII and hypertension, the Otsuka Long Evans Tokushima Fatty rats (OLETF) and their strain controls that were randomly assigned to the following groups: (1) untreated strain controls; (2) untreated OLETF; (3) OLETF + ARB. OLETF rats had increased BP and significantly greater circulating PDI activity than control rats that was likewise blocked by ARB treatment (p<0.05; n=6/group). Thus, RAS activation represents a novel mechanism for increased PDI levels and activity that may contribute to the deleterious effects of disordered RAS in cardiovascular disease.

Condición corporal en caballos de rodeo chileno de elite: estudio preliminar

El objetivo de este estudio fue caracterizar la condición corporal de caballos de rodeo chileno de elite en competencia. Se eligieron al azar 48 caballos raza chilena (15 hembras, 24 machos enteros y 9 machos castrados) participantes del 64º Campeonato Nacional de Rodeo Chileno. La condición corporal de cada caballo se evaluó por inspección visual y palpación según el sistema de Henneke. El rendimiento deportivo se registró como clasificados o no clasificados en la final del campeonato. Se construyeron tablas de frecuencia para la condición corporal por género y por rendimiento deportivo, se calcularon modas como descriptores de tendencia central y se comparó la condición corporal por género y rendimiento deportivo mediante la prueba de Kruskal-Wallis (p < 0,05). La condición corporal presentó una moda de 7, con un rango de 5 a 8. El 87,5% de los caballos tenía condición corporal entre 6 y 7 y se detectó un 6,3% de individuos obesos. No se encontraron diferencias significativas en relación al género ni rendimiento deportivo. Este es el primer estudio que reporta la condición corporal en caballos de rodeo chileno de élite y los resultados sugieren que los valores más frecuentes para esta variable en la raza están entre 6 a 7 puntos.

The UALE project: a cross-sectional approach for trends in HIV/STI prevalence among key populations attending STI clinics in Guatemala

OBJECTIVE

To describe and compare trends in prevalence, sexual behaviour and HIV transmission knowledge data related to sexually transmitted infections (STI) and HIV in patients attending three STI clinics over an 8-year period in Escuintla Department, Guatemala.

METHODS

STI clinic attendees were classified into transmission groups as follows: female sex workers (FSW), men who have sex with men (MSM) and 'high-risk heterosexuals' (HRH). Annual cross-sectional analysis and multivariable Poisson regression adjusted for sociodemographic variables were used for prevalence comparisons and adjusted prevalence trends for HIV/STI outcomes and used for adjusted trends in proportions in sexual behaviour and HIV transmission knowledge outcomes. Endocervical swabs were obtained to detect trichomonas, chlamydia and neisseria infections. Serologies for syphilis and HIV were performed using rapid tests. For reactive HIV samples, positivity was confirmed by an ELISA. All reactive syphilis samples were further confirmed for diagnosis of active syphilis disease.

RESULTS

From a total of 4027 clinic attendees, 3213 (79.78%) were FSW, 229 (5.69%) were MSM and 585 (14.53%) were HRH. The proportion of FSW, MSM and HRH who had a single visit was 56.42%, 57.23% and 91.10%, respectively. Overall, HIV prevalence was 2.10% in FSW, 8.17% in MSM and 4.12% in HRH. Prevalence trends in HIV and syphilis decreased in FSW. Prevalence trends in gonorrhoea did not decrease over time neither in FSW nor in HRH. Chlamydia and trichomonas infections in HRH showed an increase prevalence trend. In FSW, trends in condom use in last sexual intercourse with regular and occasional clients were above 93%.

CONCLUSIONS

FSW show a decreasing trend in HIV, syphilis and chlamydia prevalence. Gonorrhoea prevalence in FSW and HRH did not decrease over time. HRH is a hard to engage population with low follow-up rates and high potential to act as a bridge population.

[Long-term results of the early endoscopic treatment of acquired tracheal-subglottic stenosis: 10 years of experience]

INTRODUCTION

Acquired stenosis of the airway is a common complication after endotracheal intubation. Endoscopic dilation has been accepted as the treatment of choice in cases detected precociously. Our goal is to know the current status of the patients treated in our hospital with endoscopic dilation in the last 10 years.

MATERIAL AND METHODS

Retrospective cohort study of patients with subglottic and tracheal acquired stenosis (STAS) early treated endoscopically with balloon dilation at our center in the last 10 years. Bronchoscopy control at 2 weeks, a month, 3 and 6 months post-dilation were performed and later on depending on the symptoms.

RESULTS

32 patient were treated in the period considered. The median age was 4.5 (3-120) months. There were necessary 2.5 (1-5) dilations per patient. All cases were extubated in the operating room or in the following 24 hours. There were no complications during the procedure. Follow-up time was 6 (1-10) years. Only 1 of the 32 patients have had recurrence of stenosis 2 years after, it was secondary to reintubations due to new surgical interventions; which it was dilated successfully.

CONCLUSIONS

Early endoscopic dilation in the acquired airway stenosis is a safe and effective long-term procedure. The results support the use of this technique as a treatment of choice in these patients.

Equine mesenchymal stem cells derived from endometrial or adipose tissue share significant biological properties, but have distinctive pattern of surface markers and migration

Adult stromal mesenchymal stem cells (MSCs) have been postulated as responsible for cell renewal in highly and continuously regenerative tissues such as the endometrium. MSCs have been identified in the endometrium of many species including humans, rodents, pets and some farm animals, but not in horses. The objective of this work was to isolate such cells from the endometrium of mares and to compare their main biological attributes with horse adipose-derived MSCs. Here we successfully isolated and characterized endometrial MSCs (eMSCs) from mares. Said cells showed fibroblast-like morphology, grew on plastic, had doubling population times of 46.4 ± 3.38 h, underwent tri-lineage (osteo, chondro and adipogenic) differentiation after appropriate inductions, migrated toward the attraction of fetal calf serum and displayed a pattern of surface markers commonly accepted for horse MSCs. All these are properties of MSCs. Some of these attributes were shared with equine adipose-derived MSCs, but the migration pattern of eMSC at 12 and 24 h after stimulation was reduced in comparison with adipose MSCs. Also, expression of CD44, CD90 and MHCI surface markers were dramatically down-regulated in eMSCs. In conclusion, equine-derived endometrial MSC share biological attributes with adipose MSC of this species, but displayed a different surface marker phenotype and an impaired migration ability. Conceivably, this phenotype is distinctive for MSC of this origin.

Therapeutic possibilities for urolithiasis in childhood

OBJECTIVES

We present our case studies on paediatric urolithiasis, the techniques employed in its treatment and its results.

MATERIAL AND METHODS

A retrospective study of paediatric urolithiasis of the upper urinary tract (UUT) treated at our centre between 2003 and 2014. We recorded demographic, clinical, diagnostic and therapeutic data and the complications. The therapeutic plan was recorded as isolated (extracorporeal lithotripsy, ureterorenoscopy, nephrolithotomy or surgery) or combined therapy.

RESULTS

We examined 41 renal/urethral units in 32 patients. The median age was 5 years (range, 11 months-14 years). The mean size was 12.9cm (±7.3mm). The locations were as follows: 23 (56%) in the renal pelvis (staghorn in 15 cases), 10 (24) in lower calyx and 8 (20%) in the urethra. We performed 80 procedures, with no differences in the age groups, which resulted in 12 complications (15%) but no septic condition secondary to lithotripsy. Stone removal from the urethra had a 100% success rate with the ureterorenoscopy. The overall cure rate was 90%.

CONCLUSION

The paediatric urolithiasis approach offers multiple alternatives. It is therefore important to tailor the procedure according to the size, location and composition of the stone. In our centre, the use of paediatric extracorporeal shock wave lithotripsy is safer. Ureterorenoscopy, semirigid or flexible, provides excellent results in ureters. Percutaneous nephrolithotomy with minimal access can be performed on small children and nursing infants.

Late diagnosis of posterior urethral valves

CLINICAL PROBLEM

We diagnosed 8 patients with late-stage posterior urethral valves (PUV) between 1 and 14 years of age. Five patients complained of symptoms related to voiding dysfunction. The other 3 patients required urethrocystoscopy for other reasons (hypospadias fistulae, difficulty with catheterisation and high-grade vesicoureteral reflux [VUR]). A second review of the first 2 patients' medical history showed voiding dysfunction symptoms. All patients underwent preoperative ultrasonography: 3 patients had normal results and 5 had renal or vesical disorders. The diagnosis was reached through voiding cystourethrogram (VCUG), and 4 patients underwent urodynamic studies. The diagnosis was confirmed by urethrocystoscopy, performing valve electrofulguration. We performed urethrocystoscopy during the check-ups at 3-6 weeks and observed no stenosis. The symptoms disappeared for all patients after 20 months of follow-up. The patient with VUR was cured. The ultrasounds showed no progression of the renal involvement and showed improvement in the vesical involvement. The velocimetries during check-ups presented curves within normal ranges.

DISCUSSION

Most children with PUV are diagnosed through ultrasound during the neonatal period. Some patients present PUV at later ages with diverse symptoms, which impedes its diagnosis. We should suspect PUV in male patients with symptoms of voiding dysfunction, either when they have normal or pathological results from ultrasounds or VCUG. We recommend performing urethrocystoscopy to rule out urethral obstruction.

[Cervico-sternotomy for thoracic inlet conditions in children]

BACKGROUND/AIM

Neither cervicotomy nor postero-lateral thoracotomy allow safe surgical access to the lower cervical spine and high posterior mediastinum with full control of the vascular and neural structures involved. We report our favorable experience with cervico-sternotomy for accessing this region.

PATIENTS AND METHODS

Six patients were operated upon between 1998 and 2011 for either removal of huge cervico-thoracic neural ganglioneuromas (n = 2) or anterior arthrodesis for congenital (n = 2), neuropathic (n = 1) or osteolytic scoliosis (n = 1). In all cases, cervicotomy was followed by sternotomy, thymectomy, division of the innominate vein and dissection of jugular veins, carotid arteries and vagus nerves.

RESULTS

The tumors measured 10.9 x 3.9 x 8.7 cm and 8 x 6 x 5 cm, and involved the paravertebral chain from the aortic arch to the base of the skull and from the left lung hilus to the thyroid region respectively. In the scoliosis patients, anterior vertebral fixation between C5 and T5 was readily feasible. Blood transfusion was avoided. Horner's syndrome and transient lymphedema were the only complications. Median operative time was 210 minutes (range 180-240 minutes) and median estimated blood loss was 2.7 cc/kg (0-13.8 cc/kg). Median hospital stay was 7 days (range 5-18 days).

CONCLUSIONS

Cervico-sternotomy is an optimal approach for this anatomical region in children. It offers better exposure of the anterior cervico-thoracic spine and the thoracic inlet than cervicotomy or thoracotomy. Control of the nervous and vascular structures was safely achieved in all cases and postoperative discomfort was surprisingly limited.

Switching from twice-daily raltegravir plus tenofovir disoproxil fumarate/emtricitabine to once-daily elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate in virologically suppressed, HIV-1-infected subjects: 48 weeks data

BACKGROUND

Pill burden, dosing frequency, and concerns about safety and tolerability are important obstacles to maintaining adequate medication adherence. Raltegravir (RAL) is indicated for twice-daily dosing and when taken with emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF), it becomes a twice-daily multiple-tablet regimen. Elvitegravir (EVG)/cobicistat (COBI)/FTC/TDF, STB, is the first approved once-a-day integrase strand transfer inhibitor (INSTI) containing single-tablet regimen that combines EVG, an INSTI, and COBI, a novel pharmacoenhancer, with the preferred nucleos(t)ide backbone of FTC/TDF.

METHODS

This was a 48-week prospective, single-arm open-label study of the switch to STB in virologically sup-pressed HIV-1-infected adult patients on FTC/TDF and twice-daily RAL for at least 6 months. Objectives were to evaluate the tolerability and safety of a regimen simplification to once-a-day STB, while maintaining viral suppression through 48 weeks.

RESULTS

Forty-eight individuals in the United States were enrolled. The median age was 44 years, 96% were male, and 83% were White. The median time on RAL + FTC/TDF treatment prior to enrollment was 34 months. Ninety-six percent of participants cited regimen simplification as the reason to enroll in the switch study. At base-line, the median CD4 count was 714 cell/µL and estimated glomerular filtration rate (eGFR) was 105 mL/min. At week 48, all assessed study participants remained viro-logically suppressed to the lower limit of quantification (HIV-1 RNA<50 copies/mL) and maintained high CD4 cell count (median, 751 cells/mL) and stable eGFR (median, 100.5 mL/min). STB was well tolerated with no discontinuations, no study drug-related serious adverse events, and no study drug-related grade 3/4 adverse events.

CONCLUSIONS

All participants switching to 1 tablet once-a-day STB from a twice-daily RAL + FTC/TDF regimen remained virologically suppressed. STB was well tolerated. Switching to STB may be a viable option for virologically suppressed patients wanting to simplify from a twice-daily RAL-containing regimen.