Co-occurrence of the cephalosporinase cepA and carbapenemase cfiA genes in a Bacteroides fragilis division II strain, an unexpected finding.

BACKGROUND: Bacteroides fragilis, an anaerobic gut bacterium and opportunistic pathogen, comprises two genetically divergent groups (or divisions) at the species level. Differences exist both in the core and accessory genomes and the beta-lactamase genes, with the cephalosporinase gene cepA represented only in division I and the carbapenemase gene cfiA only in division II. METHODS: Multidrug resistance in a clinical B. fragilis strain was examined by whole-genome sequencing. RESULTS: Strain CNM20200260 carried the antimicrobial resistance genes cepA, cfiA2, ant(6'), erm(F), mef(En2), est(T), tet(Q) and cat(A), along with 82-Phe mutation in gyrA (together with 47 amino acid changes in gyrA/B and parC/parE). bexA/B and other efflux pump genes were also observed. None of the detected insertion sequences was located upstream of cfiA2. The genome-based taxonomy coefficients (average nucleotide identity, DNA-DNA hybridization similarity and difference in genomic G + C%) with respect to genomes of the strains of B. fragilis division II and the novel species Bacteroides hominis (both cfiA-positive) met the criteria for CNM20200260 to belong to either species (>95%, >70% and <1%, respectively). No such similarity was seen with type strain NCTC 9343 or the representative genome FDAARGOS 1225 of B. fragilis (division I, cfiA-negative). Strain CNM20200260 harboured four out of nine Kyoto Encyclopedia of Genes and Genomes orthologues defined for division I and one of two defined for division II. CONCLUSIONS: This is the first description of the co-occurrence of cepA and cfiA in a Bacteroides strain, confirming the complexity of the taxonomy of this species.

Is biochemical pregnancy loss associated with embryo or endometrium? A retrospective cohort study in frozen single embryo transfer of own and donated oocytes.

STUDY QUESTION: Does the use of preimplantation genetic testing for aneuploidies (PGT-A), personalized embryo transfer with endometrial receptivity assay (pET-ERA), or the use of donated oocytes modify the incidence of biochemical pregnancy loss (BPL) in frozen single embryo transfer (FSET)? SUMMARY ANSWER: Following FSET, BPL incidence does not differ between own and donated oocytes, and the use of PGT-A with euploid embryo transfer or pET-ERA results in a similar incidence of BPL compared to cycles without embryo or endometrial analysis. WHAT IS KNOWN ALREADY: BPL occurs frequently after IVF, and many factors have been associated with its incidence. The etiology of BPL is not well known, but the most probable cause seems to be either a low-quality embryo or impaired endometrial maintenance. The impact of techniques diagnosing embryonic ploidy or endometrial receptivity on BPL incidence and the BPL incidence between own and donated oocytes have not been analyzed. STUDY DESIGN, SIZE, DURATION: This is a retrospective cohort study analyzing the incidence of BPL over 3741 cycles of FSET derived from own (2399 cycles) and donated (1342 cycles) oocytes between January 2013 and January 2022 in 1736 of which PGT-A, pET-ERA, or both were applied. PARTICIPANTS/MATERIALS, SETTING, METHODS: We defined BPL as a pregnancy diagnosed only by serum ß-hCG > 10 UI/l followed by a decrease that does not result in a clinical pregnancy. Clinical pregnancy was defined as the presence of gestational sac on transvaginal ultrasound. We compared BPL rates among patients undergoing 2399 FSETs from own oocytes, which comprised 1310 cycles of embryos analyzed by PGT-A, 950 cycles of untested embryos, 30 cycles of untested embryos with pET-ERA, and a subgroup of 109 cycles analyzed by both PGT-A and pET-ERA. We also included a total of 1342 FSET cycles from donated oocytes comprising 132, 1055, 140, and 15 cycles in the same groups, respectively. MAIN RESULTS AND THE ROLE OF CHANCE: In FSET from own oocytes, the overall BPL rate per embryo transfer was 8.2% (95% CI [7.09-9.33]). In untested embryo transfers, the BPL rate was 7.5% [5.91-9.37]. In the PGT-A group, the BPL rate was 8.8% [7.32-10.47]. In the pET-ERA group, the rate was 6.7% [0.82-22.07]. In the PGT-A+ERA group, the rate was 6.5% [2.65-12.90]. No significant differences were found (P = 0.626). A multivariate analysis considering clinically meaningful variables that were significantly different among groups, taking the untested embryos/endometrium group as a reference, showed comparable incidences among groups. For PGT-A, the adjusted odds ratio (AdjOR) was 1.154 [0.768-1.735] (P = 0.49) and for PGT-A+ERA 0.885 [0.330-2.375] (P = 0.808). Because of a low number of registered cases in the pET-ERA group, and to prevent statistical errors and convergence issues, this group was excluded from further analysis. In FSET of donated oocytes, the overall BPL rate per embryo transfer was 4.9% [3.76-6.14]. In the PGT-A group, the BPL rate was 6.8% [3.16-12.55]. In the pET-ERA group, the rate was 5.0% [2.03-10.03]. In untested embryo transfers, the rate was 4.7% [3.46-6.10]. No cases occurred in the PGT-A+ERA group, and no significant differences were found (P = 0.578). The multivariate analysis showed comparable incidences among groups. For PGT-A the AdjOR was 1.669 [0.702-3.972] (P = 0.247) and for pET-ERA 1.189 [0.433-3.265] (P = 0.737). The PGT-A+ERA group was eliminated from the model to prevent statistical errors and convergence issues because no BPL cases were registered in this group. In the multivariate analysis, when the sources of oocytes were compared, own versus donated, no significant differences were found in the incidence of BPL. LIMITATIONS, REASONS FOR CAUTION: This was a retrospective cohort study with potential biases. In addition, we were unable to control differences among groups due to modifications in medical or laboratory protocols during this long time period, which may modify the relationships being addressed. Factors previously associated with BPL, such as immunological conditions other than thyroid autoimmunity, were not considered in this study. Limited sample sizes of some groups may limit the statistical power for finding differences that can be present in the general population. WIDER IMPLICATIONS OF THE FINDINGS: BPL may be related to a mechanism not associated with the chromosomal constitution of the embryo or the transcriptome of the endometrium. More studies are needed to explore the factors associated with this reproductive issue. STUDY FUNDING/COMPETING INTEREST(S): No specific funding was available for this study. None of the authors have a conflict of interest to declare with regard to this study. TRIAL REGISTRATION NUMBER: This trial was registered at clinicaltrials.gov (NCT04549909).

Investigación clínica a largo plazo del tratamiento con implantes dentales / Long-term clinical research of treatment with dental implants

La implantología oral clínica ha evolucionado significativamente durante las últimas décadas. El desarrollo de los aspectos diagnósticos, quirúrgicos y prostodóncicos ha mejorado la predictibilidad de la oseointegración y los resultados clínicos a largo plazo del tratamiento con implantes. Además, algunos criterios de condiciones clínicas y radiográficas se han incorporado al concepto de éxito, como el nivel de los implantes, los tejidos periimplantarios, el nivel de la prótesis y el grado de satisfacción de los pacientes. La evidencia científica ha demostrado que el tratamiento con implantes es una excelente opción para la rehabilitación de los pacientes con parcial y total edentulismo. De hecho, los estudios a largo plazo reflejan el éxito de las rehabilitaciones fijas, sobredentaduras, puentes fijos y coronas unitaria. Sin embargo, algunas complicaciones biológicas y prostéticas han definido los conceptos diferentes de éxito y supervivencia de los implantes dentales. Conclusiones: Este trabajo indica que las restauraciones sobre implantes dentales en la rehabilitación de los pacientes parcial y totalmente edéntulos constituye un tratamiento odontológico con resultados clínicos a largo plazo con un elevado éxito. (AU)

Clinical implant dentistry has evolved significantly during last decades. The development of diagnostic, surgical and prosthetic aspects has improved the predictability of osseointegration and long-term clinical outcomes of the implant treatment. Moreover, several criteria of clinical and radiographic conditions have been incorporated in the concept of implant success, as implant level, peri-implant tissues, prosthetic level, and patient satisfaction. The scientific evidence of the literature demonstrates that implant treatment is an excellent option for the rehabilitation of patients with partial and total edentulism. In fact, long-term studies are reported the success of fixed total rehabilitation, overdentures, fixed bridges and single crowns. However, some biological and technical complications are defined the different concepts of success and survival of prosthetic and dental implants. Conclusions: This paper indicates that restorations with dental implants in the rehabilitation of partially and totally edentulous patients constitute a dental treatment with long-term clinical outcomes with a high success. (AU)

Growth in height and body proportion from birth to adulthood in hereditary hypophosphatemic rickets: a retrospective cohort study.

PURPOSE: Patients with hereditary hypophosphatemic rickets are short and disproportionate and very little information is available on segmental growth, but the body disproportion at adulthood leads us to think that the growth velocity of legs is slower. METHODS: A total of 96 children were included and molecular testing was carried out in 42. Children who reached adult height were classified into two groups according to their compliance to conventional treatment (phosphate supplement and calcitriol). Individual growth records of height and sitting height/height were plotted using Argentine reference data in 96 children and growth curves were estimated by fitting Preece-Baines Model 1 in 19 of the children. RESULTS: Molecular testing revealed sequence deleterious alterations or large deletions in 36/42 patients. During childhood, 76% of children grew below - 1.88 standard deviation score (SDS) and 97% had body disproportion. During adolescence, the mean peak height velocity for the good and poor compliance to treatment groups was 7.8 (0.6) and 5.4 (0.4) cm/year in boys and 7.0 (0.7) and 5.2 (0.8) cm/year in girls, respectively. At adulthood, the median sitting height/height ratio was 2.32 and 6.21 SDS for the good and poor compliance to treatment groups, respectively. The mean pubertal growth spurt of the trunk was -0.8 (1.4) SDS, with a short pubertal growth spurt of - 1.8 (0.4) SDS for limbs in the good compliance group. Median adult height in 13/29 males and 30/67 females was -4.56 and -3.16 SDS, respectively. CONCLUSION: For all patients the growth spurt was slower, secondary to a short growth spurt of limbs, reaching a short adult height with body disproportion that was more prominent in the poor compliance group.

Identification and antimicrobial susceptibility of Streptomyces and other unusual Actinobacteria clinical isolates in Spain.

Two hundred and eighty-six isolates from human clinical samples were identified between 1996 and 2019 as belonging to 8 families, 19 genera and 88 species of Actinobacteria. The most identified genera were Streptomyces (182 strains from 45 species), Actinomadura (29 strains, 5 species), Nocardiopsis (21 strains, 6 species) and Dietzia (18 strains, 5 species). The rest of the identified genera (15) contained 27 species with 36 isolates. Of the species studied, only 13/88 had been documented previously as isolates from clinical samples, and in some cases, as true pathogens. In this sense, a literature review of the species found in infections or in clinical samples without clear involvement in pathology has been carried out. Finally, the susceptibility to 8 antimicrobial agents has been studied. Streptomyces showed high resistance (80.8%) against cefotaxime and cotrimoxazole (55.5%), and no isolate resistance to amikacin and linezolid have been found. Lower percentages of resistance have been found in other genera, except in Dietzia (100% against cotrimoxazole and 44.4% against erythromycin). The greatest resistance in these genera was to cotrimoxazole (29.8) and erythromycin (27,9%), and no resistance to linezolid has been found in these genera. In Microbispora, Nonomuraea and Umezawaea, no resistant isolates have been found against any antibiotic studied. Only 3/104 isolates were resistant to amikacin in Amycolatopsis, Crossiella, and Micromonosopora. One isolate of Amycolatopsis was resistant to imipenem.

The RNA content of human sperm reflects prior events in spermatogenesis and potential post-fertilization effects.

Transcriptome analyses using high-throughput methodologies allow a deeper understanding of biological functions in different cell types/tissues. The present study provides an RNA-seq profiling of human sperm mRNAs and lncRNAs (messenger and long non-coding RNAs) in a well-characterized population of fertile individuals. Sperm RNA was extracted from twelve ejaculate samples under strict quality controls. Poly(A)-transcripts were sequenced and aligned to the human genome. mRNAs and lncRNAs were classified according to their mean expression values (FPKM: Fragments Per Kilobase of transcript per Million mapped reads) and integrity. Gene Ontology analysis of the Expressed and Highly Expressed mRNAs showed an involvement in diverse reproduction processes, while the Ubiquitously Expressed and Highly Stable mRNAs were mainly involved in spermatogenesis. Transcription factor enrichment analyses revealed that the Highly Expressed and Ubiquitously Expressed sperm mRNAs were primarily regulated by zinc-fingers and spermatogenesis-related proteins. Regarding the Expressed lncRNAs, only one-third of their potential targets corresponded to Expressed mRNAs and were enriched in cell-cycle regulation processes. The remaining two-thirds were absent in sperm and were enriched in embryogenesis-related processes. A significant amount of post-testicular sperm mRNAs and lncRNAs was also detected. Even though our study is solely directed to the poly-A fraction of sperm transcripts, results indicate that both sperm mRNAs and lncRNAs constitute a footprint of previous spermatogenesis events and are configured to affect the first stages of embryo development.

La eficacia clínica a largo plazo de los implantes con conexión interna y superficie arenada y grabada / Long-term clinical efficacy of implants with internal connection and sandblasted-acid-etched surface

Introducción: La implantología oral representa una opción importante en el tratamiento de los pacientes con pèrdida dental total y parcial. El estudio a largo plazo muestra la evaluación de los pacientes tratados mediante carga precoz de implantes con conexión interna y superficie arenada y grabada. Mètodos: 40 pacientes con pèrdidas dentales fueron tratados con implantes Frontier GMI ® con conexión interna y superficie arenada y grabada. Los implantes fueron cargados tras un periodo de tiempo de 6 semanas en la mandíbula y 8 semanas en el maxilar superior. Los hallazgos clínicos (implantológicos y prostodóncicos) se han seguido durante al menos 6 años. Resultados: 103 implantes fueron insertados en ambos maxilares, 46 implantes (44,7%) en el maxilar superior y 57 implantes (55,3%) en la mandíbula, para su rehabilitación prostodóncica. 37 implantes (35,9%) fueron insertados en el sector anterior y 66 implantes (64,1%) en el sector posterior. 70 implantes (68%) de forma sumergida (2 cirugías) y 33 implantes (32%) de forma no sumergida (una cirugía). Despuès de un seguimiento clínico de 92,2 meses, los resultados indican una supervivencia de los implantes del 96,2%; ya que se perdieron 4 implantes. La pèrdida ósea marginal fuè de 0,99 ± 0,84 mm. Las restauraciones prostodóncicas incluyeron 31 coronas unitarias, 15 puentes fijos, 5 sobredentaduras con bolas, 2 rehabilitaciones totales fijas y una rehabilitación completa híbrida. Las complicaciones tardías fueron 11 implantes (10,7%) con periimplantitis y 6 prótesis (11,1%) con complicaciones protèsicas. Conclusiones: Los hallazgos clínicos del estudio indican que el tratamiento con carga precoz mediante prótesis de los implantes con conexión interna y superficie arenada y grabada, representa una terapèutica odontológica con èxito. (AU)

Introduction: Implant dentistry constitute an important option in the prosthodontic treatment of patients with partial and total tooth loss. This long-term study reports the evaluation of patients treated by early loading of implants with internal connection and sandblasted-acidetched surface. Methods: 40 patients with tooth loss were treated with Frontier GMI ® sandblasted and acid-etched surface implants. Implants were loaded after a healing free-loading period of 6 weeks (mandible) and 8 weeks (maxilla). Clinical findings (implants and prosthodontics) were followed during at least 6 years. Results: 103 implants were inserted (46 maxillary (44.7%), and 57 mandibular (55.3%)) for prosthodontic rehabilitation. 37 implants (35.9%) were inserted in anterior sites and 66 implant (64.1%) in posterior sites. Seventy implants (68%) were placed submerged (two stages) while that 33 implants (32%) were placed nonsubmerged (one stage). After at a mean follow-up of 92.2 months, clinical results indicate a survival rate of implants of 96.2%. Four implants were lost during the treatment. Mean marginal bone loss were 0.99 ± 0.84 mm. Prosthodontic restorations included 31 single crowns, 15 fixed bridges, 5 overdentures, 2 fixed totally rehabilitation and an hybrid full rehabilitation. Delayed complications include 11 implants (10.7%) with peri-implantitis and 6 prostheses (11.1%) with technical complications. Conclusions: Clinical results of this study indicate that prosthodontic rehabilitation by early loading of internal connection and sandblasted and etched- implants can be a successful dental treatment. (AU)

El tratamiento con implantes en pacientes con diabetes. Un estudio comparativo a 7 años / Treatment with zygomatic implants in patients with advanced atrophy of maxilla

INTRODUCCIÓN: La implantología oral puede constituir una modalidad terapéutica en el tratamiento prostodóncico de los pacientes con compromiso médico. El estudio muestra la evaluación del tratamiento con implantes en pacientes con diabetes comparados con pacientes sin diabetes. MÉTODOS: 48 pacientes edéntulos totales (24 pacientes diabéticos y 24 no diabéticos) fueron tratados con 96 implantes con superficie arenada y grabada Galimplant ® en la mandíbula para su rehabilitación prostodóncica con sobredentaduras mandibulares. 2 implantes fueron insertados en cada paciente. Los implantes fueron cargados funcionalmente tras un periodo de tiempo de 6 semanas con retenedores de fricción. Los hallazgos clínicos (implantológicos y prostodóncicos) se han seguido durante 7 años. RESULTADOS: Los resultados indican una supervivencia de los implantes del 95,8%. Durante el periodo de seguimeinto clínico se perdieron 4 implantes (dos implantes en cada grupo). La pérdida de hueso marginal media fué de 0,7 mm en ambos grupos. El 100% de los pacientes fueron tratados mediante una sobredentadura implantorretenida con anclajes de fricción. En 14 pacientes se realizaron cambios en los componentes plásticos de los ataches. El seguimiento clínico medio fue de 82,5 meses (60-102 meses). CONCLUSIONES: Los resultados del presente estudio indican que el tratamiento con implantes dentales en pacientes diabéticos es una terapéutica exitosa sin diferencias entre los pacientes diabéticos y no diabéticos

INTRODUCTION: Implant dentistry can to constitute a therapeutic modality in the prosthodontic treatment of medically compromised patients. This study reports the evaluation of treatment with implants in patients with diabetes compared with patients without diabetes. METHODS: 48 edentulous patients (24 diabetic patients and 24 non-diabetic patients) were treated with 96 Galimplant ® sand-blasted and acid-etched surface implants for prosthodontic rehabilitation with mandibular overdentures. Two implants were inserted in each patient. Implants were loaded after a healing free-loading period between 6 weeks with locator attaches. Clinical findings (implant and prosthodontics) were followed during at 7 years. RESULTS: Clinical results indicate a survival rate of implants of 95.8% in both groups. Four implant was lost during the follow-up period (two implants in each group). Media marginal bone loss was 0.7 mm in both groups. 100% of patients were treated with overdentures retained with 2 implants with locator attaches. Changes in plastic components of attaches were reported in 14 patients. The media follow-up was of 82.5 months (60-102 months). CONCLUSIONS: Clinical results of this study indicate that treatment with dental implants in diabetic patients is a successful implant treatment without differences with nondiabetic patients

El efecto de la fatiga cíclica sobre los pilares de implantes dentales / The effect of the cyclic fatigue in dental implant abutments

INTRODUCCIÓN: La conexión implante-pilar ha sido sugerida como crucial para el éxito a largo plazo de las restauraciónes sobre implantes oseointegración y para prevenir futuras complicaciónes biológicas y mecánicas. El objetivo de este estudio fué evaluar la influencia del test de fatiga cíclica en el comportamiento de las conexiones internas implante-pilar. MÉTODOS: 36 pilares mutiposición de implantes de titanio de conexión interna fueron divididos en 2 grupos: 18 pilares slim o curvos y 10 pilares rectos con diferentes alturas. Los pilares fueron apretados con una llave de torque a 30 Ncm. Una carga cíclica entre 175 N y 100 N fué aplicada con 30º de inclinación axial al sistema de implantes durante 5 millones de ciclos. RESULTADOS: Los tests biomecánicos muestran una fractura de los implantes y de los tornillos de retención a una carga límite de 100 N de los pilares slim curvos y de 130 N en los pilares rectos. La fracturas aparecieron en la zona de unión entre el cuello y el cuerpo del implante y en los tornillos protéscios. No se han encontrado fracturas en los pilares multiposición. CONCLUSIONES: Este estudio indican que los tests de fatiga cíclica son importantes para analizar la respuesta biomecánica de los diferentes pilares en las conexiones implante-pilar de los sistemas de implantes

INTRODUCTION: The connection implant-abutment has been suggested to be crucial for the long-term success of implant restorations and to prevent future biological and mechanic complications. The aim of this study was to evaluate the influence of fatigue cyclic test in the behavior of internal connection implant-abutments. METHODS: Thirty six titanium abutments of internal connection implants were divided in two groups: 18 slim and 18 right multiunit abutments with different length. Abutments were tightened to 30 Ncm with a torque controller. A cyclic load between 175 N and 100 N according to different implant abutments at a 30-degree angle to the long axis was applied to the implants for a 5 million cycles. RESULTS: Biomechanical testing showed implant and screw retention fracture in a limit load of 100 N of slim implant abutments and 130 N of right implant abutments. Fracture cracks were located in the area between neck and body of implants and screw retention. No abutment fractures were found. CONCLUSIONS: This study indicate that fatigue cyclic test are very important to analize the biomechanical behavior of different abutments in connection implant-abutment of implants systems

Isthmocele and ovarian stimulation for IVF: considerations for a reproductive medicine specialist.

STUDY QUESTION: What is the risk of developing intracavitary fluid (ICF) during ovarian stimulation in patients with an isthmocele after previous caesarean section (CS) delivery? SUMMARY ANSWER: In patients with an existing isthmocele, the risk of developing ICF during hormonal stimulation for IVF is almost 40%; therefore, special attention has to be paid to exclude fluid accumulation during stimulation and particularly at the time of transfer, in which case the reproductive outcomes of frozen embryo transfer (FET) cycles appear to be uncompromised. WHAT IS KNOWN ALREADY: Lately, there is an increasing focus on the long-term impact of CS delivery on the health and future fertility of the mother. Development of an isthmocele is one of the sequelae of a CS delivery. The presence of ICF in combination with an isthmocele has been described previously, and the adverse effect of endometrial fluid on implantation is well recognised by reproductive medicine specialists. Accumulation of ICF has been previously described in patients with hydrosalpinx, less commonly in patients with polycystic ovary syndrome undergoing ovarian stimulation for IVF/ICSI, and even in some patients without any identifiable reason. Assisted reproductive techniques (ARTs) are a means to overcome infertility. Reproductive medicine specialists commonly see patients with secondary infertility with a history of having had one or more previous CS and with ultrasound confirmation of an isthmocele. However, the available data pertaining to the prevalence of intracavitary fluid during ovarian stimulation in patients with ultrasound confirmation of an isthmocele is limited. Furthermore, data on the influence of ICF in a stimulated cycle on the ART outcome of a subsequent FET cycle is scarce and merits further studies. STUDY DESIGN, SIZE, DURATION: A prospective observational exploratory study was performed in IVI Middle East Fertility Clinic, Abu Dhabi, from June 2018 to March 2019, and retrospective analysis of the reproductive outcomes was performed until July 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS: Patients with secondary infertility, defined as a minimum of 1 year of infertility after a previous successful pregnancy, undergoing ovarian stimulation for IVF/ICSI and having a history of one or more previous CS with ultrasonographic visible isthmocele, were included (n = 103). Patients were monitored as a clinical routine with vaginal ultrasound examinations during ovarian stimulation for IVF/ICSI treatment. All patients included in the study were asked to complete a questionnaire regarding their previous obstetric history. Development of ICF was recorded as well as changes in the measurements of the isthmocele during the course of ovarian stimulation. Reproductive outcomes of FET cycles of the patients with an isthmocele were retrospectively compared to those of patients with infertility and without isthmocele in our clinic during the same time period. MAIN RESULTS AND THE ROLE OF CHANCE: Patients with an existing isthmocele after previous CS have a risk of ~40% of developing ultrasonographic visible fluid in the endometrial cavity during the course of ovarian stimulation. Development of ICF was significantly correlated with the depth of the isthmocele on Day 2/3 (P = 0.038) and on the day of trigger (-1/-2 days) (P = 0.049), circumference of the isthmocele on the day of trigger (-1/-2 days) (P = 0.040), distance from the C-scar to the external os (P = 0.036), number of children delivered (P = 0.047) and number of previous CS (P = 0.035). There was a statistically significant increase in the parameters related to the size of the isthmocele during ovarian stimulation. No significant differences in the reproductive outcome (pregnancy rate and rates of biochemical and ectopic pregnancies, miscarriages and ongoing/delivered pregnancies) after FET were found between the patients with and without an isthmocele, when ICF was excluded prior to embryo transfer procedure. LARGE-SCALE DATA: NA. LIMITATIONS, REASONS FOR CAUTION: This study was not primarily designed to investigate the causes of ICF during ovarian stimulation or to evaluate the reproductive outcomes. Further, the small number of reported reproductive outcomes may be seen as a limitation. WIDER IMPLICATIONS OF THE FINDINGS: The data highlights the need for an increased awareness on the part of reproductive medicine specialists towards the potentially adverse impact of an isthmocele on ART treatment, as there is a potential to develop intracavitary fluid during ovarian stimulation for IVF. The increase in the circumference of the isthmocele may increase embryo transfer difficulty. STUDY FUNDING/COMPETING INTEREST(S): No funding of the study has to be reported. The authors have no competing interests. TRIAL REGISTRATION NUMBER: This prospective study was registered with clinicaltrials.gov. under the number NCT03518385.

Planificacion de tratamiento con software para cirugía guiada en implantologia oral / Treatment planning with software for guided surgery in implant dentistry

La planificación preoperatoria de la posición de los implantes constituye una parte importante de la coordinación quirúrgica y prostodóncica que se ha ido incrementando para conseguir resultados funcionales y estéticos. La cirugía guiada de implantes ha aumentado su popularidad, particularmente debido a los avances y a la utilización de la tomografia computarizada de haz cónico (CBCT) y a la planificación del tratamiento con implantes mediante programas informáticos 3D que valoran la localización del implante. De hecho, los pacientes edéntulos pueden ser diagnosticados con una CBCT y tratados con varios implantes por cirugía guiada y carga inmediata. La CBCT constituye un método no invasivo para describir las estructuras maxilofaciales evaluando la cantidad y calidad ósea de los rebordes alveolares. La incorporación de softwares específicos de implantología guiada puede mejorar la planificación virtual de la cirugía sin colgajo y los resultados de los implantes colocados con una férula quirúrgica guiada. En muchos casos, la carga inmediata optimiza el éxito de la técnica de cirugía guiada con muchos beneficios como la reducción del tiempo del tratamiento y el confort del paciente

Preoperative planning of the implant position as part of a coordinated prosthetic and surgical concept is becoming increasingly important regarding function and esthetics. Guided implant surgery is increasing in popularity, particularly due to advances and increased usage of cone beam computed tomography (CBCT) and dental implant treatment planning software allowing three-dimensional assessment of the implant site. In fact, edentulous patients can be diagnosed by a CBCT and treated with several implants for rehabilitation with guided surgery and immediate loading. The CBCT provides a noninvasive method to describe maxillofacial structures and assess bone volume and density of alveolar ridges. The introduction of specific softwares of guided implant dentistry can improve the virtual planning of flapless surgery and outcomes of dental implant placed in edentulous alveolar ridges by template guided surgery. In many cases, the immediate-loading protocol maximises the sucess of the guided surgery techniques with many benefits, such as short time and maximum patient comfort

Tratamiento de pacientes edéntulos mandibulares con cirugía guiada y carga inmediata / Treatment of mandibular edentulous patients with guided surgery and immediate loading

Introducción: El objetivo del presente estudio era presentar los resultados clínicos de la carga inmediata de implantes insertados mediante la técnica de cirugía guiada en pacientes edéntulos mandibulares. Pacientes y Métodos: Pacientes edéntulos totales mandibulares fueron diagnosticados mediante una tomografía computarizada de haz cónico y tratados con 8-10 implantes Galimplant(R) para su rehabilitación mediante la técnica de cirugía guiada y carga inmediata. Inmediatamente después de la cirugía sin colgajo se colocó una rehabilitación total inmediata provisional de resina. A los 3 meses se realizó la rehabilitación fija definitiva. El periodo de seguimiento clínico ha sido al menos de 48 meses después de la carga funcional. Resultados y Discusión: 24 pacientes fueron tratados con 206 implantes. Desde un punto de vista implantológico, los resultados indican un éxito de los implantes del 97,6% después de un seguimiento clínico medio de 62,4 meses desde la rehabilitación definitiva. 5 implantes se perdieron durante el periodo de cicatrización con la prótesis provisional. La pérdida media de hueso marginal ha sido de 1,34 mm. Los hallazgos clínicos demuestran la eficacia clínica de este protocolo de carga inmediata, donde la estabilidad primaria de los implantes y el ajuste oclusal de la prótesis inmediata son factores determinantes del éxito. Conclusiones: Este estudio indica que el tratamiento de pacientes edéntulos mandibulares con implantes dentales mediante cirugía guiada y carga inmediata constituye una alternativa terapéutica implantológica con una tasa elevada de éxito

Introduction: The aim of this study was to present the clinical outcomes of immediate loading of implants inserted by guided surgery in edentulous mandibular patients. Patients and methods: Mandibular edentulous patients were diagnosed by a cone beam tomography and treated with 8-10 Galimplant(R) implants for rehabilitation with guided surgery and immediate loading. After flapless surgery, implants were loaded with an immediate acrylic temporary prosthesis. After a period of three months, a ceramic definitive full arch prosthesis were placed. The follow-up were at least of 48 months of functional loading. Results and discussion: 24 patients were treated with 206 implants. Clinical outcomes showed a global success of 97.6% of implants after a mean follow-up of 62.4 months. Five implants were lost during the healing phase with provisional prosthesis. Mean marginal bone loss was 1.34 mm. Findings of the study showed clinical efficacy of immediate loading, primary stability and occlusal adjustment of immediate prosthesis are key determinants of success. Conclusions: This study indicate that treatment of mandibular edentulous patients by guided surgery and immediate loading constitute an implant option with a high rate of success

La evaluación topográfica de las superficies de los implantes de titanio / Topographic evaluation of the titanium implant surfaces

La superficie de los implantes es muy importante para la oseointegración. La superficie rugosa de titanio puede influir en los resultados experimentales y clínicos. Diferentes instrumentos y técnicas de mediciones pueden influir notablemente en los resultados de la caracterización topográfica de los implantes. Las superficies han sido documentadas mediante microscopio electrónico de barrido. La interferometría de luz blanca puede identificar las irregularidades en la superficie por cambios en la luz reflejada. La composición química de las superficies puede ser determinada por la técnica de espectroscopía fotoelectrónica de rayos X. La composición química refleja los procedimientos de la fabricación de los implantes. Una variedad de elementos y compuestos químicos no relacionados con la composición del titanio pueden encontrarse en algunos tipos de implantes; como material inorgánico (ej. cloruro de sodio) y compuestos orgánicos de carbono que pueden deberse a la contaminación durante la fabricación y el almacenaje. Conclusiones: Las modificaciones en la topografía y en la composición química de la superficie de los implantes constituye un importante campo en la implantologia oral experimental y clínica

Implant surface is very important for the osseointegration. Roughened surface titanium may influence in experimental and clinical results. Different measures instruments and techniques strongly influence the outcome of a topographic characterization of surface implant. Surfaces has been documented by scanning electron microscopy. White light interferometer may identify the surface irregularities that cause phase changes in the reflected light. The surfaces chemical composition was determined using a technique of X-ray photoelectron spectroscopy. Chemical composition reflect the type of fabrication procedures applied to implants. A variety of elements and chemical compounds not related to the titanium composition were found on some implant types. They ranged from inorganic material (i.e. sodium chloride) to specific organic as carbon compounds believed to be due to contamination during fabrication or storage. The experimental findings are believed to make a contribution to a better understanding of the interplay between industrial fabrication procedure and physico-chemical implant surface properties. Conclusions: The topographic and chemical composition modifications of surface implants constitute an important field in experimental and clinical implant dentistry

La oseointegración de implantes de titanio con diferentes superficies rugosas / Osseointegration of titanium implant with several rough surfaces

La superficie de los implantes es muy importante para conseguir la oseointegración. Existen muchos tipos de superficies en los implantes dentales. La investigación en superficie de implantes comienza con la superficie mecanizada. La superficie rugosa incrementa la adherencia celular y muestra una mayor área de contacto hueso-implante. El recubrimiento con plasma de titanio e hidroxiapatita fueron métodos comunes para modificar la rugosidad de la superficie. Más recientemente, el arenado (ej. alúmina) y el grabado ácido (ej. chorhídrico, sulfúrico, nítrico) son otros procesos que pueden incrementar la superficie rugosa de los implantes. Más recientemente, la tecnología ha comenzado en la implantología oral con el desarrollo de superficies porosas que manifiestan una mejor respuesta osteogénica e incrementa la unión mecánica hueso-titanio. La oseointegración parece estar influenciada por los modelos de especies animales. En el conejo el proceso es más rápido que en el perro, y en el perro es más rápido que en el hombre. La incorporación de nuevos materiales y procesos técnicos en la investigación sobre superficies de implantes ofrecen nuevas posibilidades de mejorar su respuesta tisular y su potencial óseo regenerativo. Conclusiones: El tratamiento de la superficie de los implantes constituye un importante campo en futuras investigaciones de la implantología oral mediante los estudios de experimentación

Implant surface is very important for enhance the osseointegration. They are many types of dental implant surfaces. Implant surface research begins with machined surface. Roughened surface titanium increase cell adhesion and exhibit stronger bone-implant contact area. Plasma-spray and hydroxyapatite coating were common methods for rough surface modification. Most recently, blasting (i.e. alumina) and acid-etching (i.e. hydrochloric, sulphuric and nitric) are another process by which surface roughness can be increased. Most recently, technology begins in implant dentistry with the development of porous surfaces that manifest better osteogenic response and increase bone-titanium mechanical interlocking. Osseointegration appeared to be strongly influenced by the animal species model. The rabbit model was faster compared to the dog model, and the dog model was faster the human model. The introduction of new materials and new technical process in dental surfaces research offering new possibilities for better tissue response and bone regenerative potential. Conclusions: The surface modifications of titanium constitute an important field for future research of implant dentistry by experimental studies

El tratamiento con implantes mediante la elevación transcrestal del seno maxilar. Un estudio a 3 años / Implant treatment by transcrestal maxillary sinus elevation. A 3-year follow-up study

Introducción: El objetivo del presente estudio era mostrar los resultados del tratamiento con implantes dentales insertados mediante la técnica de elevación transcrestal en el maxilar superior. Pacientes y Metodos: 47 pacientes (18 hombres y 29 mujeres) con pérdidas dentales maxilares fueron tratados con 60 implantes IPX ® Galimplant con conexión interna y superficie arenada y grabada fueron insertados mediante la técnica de elevación sinusal transcrestal para la rehabilitación del maxilar posterior. Los implantes fueron cargados después de un periodo de cicatrización de 6 meses. Resultados: Los hallazgos clínicos indican una supervivencia y éxito de los implantes del 100%. La ganancia media de hueso vertical fué de 4,8 mm (rango: 2-6,5 mm). 46,7% de los implantes se insertaron en localización molar y el 53,3% en la localización premolar. Biomateriales fueron utilizados en el 91,7% de los implantes. Después de un periodo medio de carga funcional de 37,6 meses (rango: 24-52 meses), no ha habido complicaciones tardías. El 70% de los implantes fueron rehabilitados con coronas unitarias y el 30% con puentes fijos. Conclusiones: Este estudio indica que el tratamiento con implantes dentales mediante su inserción con elevación transcrestal del seno maxilar superior constituye una terapéutica implantológica con éxito

Introduction: The aim of this study was to report the outcome of treatment with maxillary dental implants inserted by transcrestal sinus elevation. Patients and Methods: 47 patients (18 males and 29 females) with maxillary tooth loss were treated with 60 IPX ® Galimplant internal connection and sandblasted and acid-etched surface implants inserted by transcrestal sinus elevation for rehabilitation of posterior maxilla. Implants were loaded after a healing free-loading period of 6 months. Results: Clinical results indicate a survival and success rate of implants of 100%. The mean elevation height was 4.8 mm (range: 2-6.5 mm). 46.7% of implants were inserted in molar and 53.3% in premolar localization. Bone substitutes were used in 91.7% of implants. After a mean functioning period of 37.6 months (range: 24-52 months), no late complications were reported. 70% of implants were restored with single crowns and 30% with fixed bridges. Conclusions: This study indicate that treatment with dental implants inserted in maxilla by transcrestal sinus elevation constitute a successful implant treatment

Respuesta de los autores: Necesidad de un enfoque holístico y cuantitativo para el diagnóstico y mejora de los servicios de urgencia hospitalarios / Reply: Need for a holistic and quantitative approach for diagnosing and improving hospital emergency services

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Asynchronous and pathological windows of implantation: two causes of recurrent implantation failure.

STUDY QUESTION: Is endometrial recurrent implantation failure (RIF) only a matter of an asynchronous (displaced) window of implantation (WOI), or could it also be a pathological (disrupted) WOI? SUMMARY ANSWER: Our predictive results demonstrate that both displaced and disrupted WOIs exist and can present independently or together in the same RIF patient. WHAT IS KNOWN ALREADY: Since 2002, many gene expression signatures associated with endometrial receptivity and RIF have been described. Endometrial transcriptomics prediction has been applied to the human WOI in two previous studies. One study describes endometrial RIF to be the result of a temporal displacement of the WOI. The other indicates that endometrial RIF can also result from a molecularly disrupted WOI without temporal displacement. STUDY DESIGN, SIZE, DURATION: Retrospective analysis was undertaken to compare WOI endometrial transcriptomics predictions in controls (n = 72) and RIF patients (n = 43). RIF was clinically designated by the absence of implantation after four or more transfers of high quality embryos or after the placement of 10 or more embryos in multiple transfers. Endometrial tissue samples were collected from LH + 5 to LH + 8. We compared the two molecular causes of RIF to signatures currently described in the literature. We propose a new transcriptomic RIF taxonomy to fill the gap between the two hypotheses and to guide the development of clinical detection and determination of both types of RIF. PARTICIPANTS/MATERIALS, SETTING, METHODS: Utilizing 115 gene expression profiles, two different predictive designs were developed: one considering RIF versus controls removing menstrual cycle timing, called the disrupted or pathological model, and another stratifying the WOI in transcriptomic profiles related to timing for predicting displacements. The predictive value of each model was compared between all signatures selected. We propose a new genomic approach that distinguishes between both types of RIF in the same sample cohort. MAIN RESULTS AND THE ROLE OF CHANCE: From the 16 signatures analysed, we clearly predicted two causes of RIF-both a displaced WOI and an on-time but pathologically disrupted WOI. A high predictive value related to WOI profiles associated with menstrual cycle timing was found in most of the signatures. Specifically, 69% of the signatures analysed presented an accuracy higher than expected by chance in a range from 0.87 to 0.97. Displacements and disruptions were not molecularly independent, as some signatures were moderately associated with both causes. The gene and functional comparison between signatures revealed that they were not similar, although we did find functions in common and a cluster of moderate functional concordance between some of the signatures that predicted displacements (the highest Cohen's Kappa index were between 0.55 and 0.62 depending on the functional database). We propose a new transcriptomic RIF taxonomy to fill the gap between these prior studies and to establish methodology for detecting and distinguishing both types of RIF in clinical practice. Our findings indicate these two phenotypes could present independently or together in the same RIF patient. RIF patients designated by clinical criteria have been stratified transcriptomically as 18.6% with only a displaced WOI, 53.5% with a displaced and pathological WOI, 23.3% with only a disrupted WOI, and 4.7% could be a clinical RIF with non-endometrial origin. The new RIF transcriptomic taxonomy avoids menstrual cycle timing as a confounding variable that should be controlled for, distinguishing clearly between a disrupted and a displaced WOI for precision medicine in RIF. LIMITATIONS REASONS FOR CAUTION: The main objective of this study was to use transcriptomics to detect both RIF causes and to understand the role of transcriptomic signatures in these phenotypes. The predictive value in absolute terms for each signature was not indicative in these prediction designs; instead, the comparison between signatures was most important for prediction capability in the same sample cohort for both RIF causes. Clinical follow up of the RIF taxonomies proposed has not been analysed in this study, so further prospective clinical studies are necessary to determine the prevalence and penetrance of these phenotypes. WIDER IMPLICATIONS OF THE FINDINGS: The main insight from this study is a new understanding of RIF taxonomy. Understanding how to classify RIF patients to distinguish clinically between a patient who could benefit from a personalized embryo transfer day and a patient with a disrupted WOI will enable identification and stratification for the research and development of new treatments. In addition, we demonstrate that basic research designs in endometrial transcriptomics cause masking of the study variable by the menstrual cycle timing. STUDY FUNDING/COMPETING INTEREST(S): This research has been funded by IVI-RMA; the authors do not have any competing interests.

Paenibacillus spp. isolated from human and environmental samples in Spain: detection of 11 new species.

One hundred thirty-six isolates, 88 human and 48 environmental, that met the requirements to belong to the genus Paenibacillus were identified using a polyphasic taxonomic approach known as 16S rRNA plus phenotypic traits. Thirty-seven Paenibacillus species were identified; some had not been previously reported from clinical samples. The main species were P. pabuli (13 isolates), P. provencensis (11), P. phoenicis (9) and P. lautus (8). P. pabuli (11/13) and P. provencensis (8/11) were mainly environmental isolates, while P. phoenicis (9/9) and P. lautus (6/8) were mainly human isolates. Despite the difficulties in assigning to human Paenibacillus isolates a role as a pathogen or contaminant, here 25% of the isolates were involved in true infections, especially in those cases that affected abscesses, wound exudates, ocular infections and diverse fluids. In addition, 15 isolates were identified as 11 'Candidatus' to a new species, all of them from human specimens except one that was obtained from laboratory air. The antimicrobial susceptibility testing showed 95.6% of isolates were resistant to ampicillin, 44% were resistant to cotrimoxazole, 20 to 30% were resistant to cefotaxime and vancomycin and 13% were resistant to rifampicin and erythromycin.

Barreras y facilitadores para la implementación de la toma de decisiones compartidas en oncología: percepciones de los pacientes / Barriers and facilitators to implementing shared decision-making in oncology: patient perceptions

Objetivo. Conocer, desde el punto de vista del paciente oncológico, quién tomó la decisión sobre su tratamiento, así como las principales barreras y facilitadores que permiten la implementación de la toma de decisiones compartidas (TDC). Material y métodos. Estudio transversal y de asociación a partir de un cuestionario autoadministrado a pacientes oncológicos seleccionados mediante muestreo casual en diferentes consultas oncológicas y periodos aleatorios. Ciento ocho pacientes proporcionaron datos analizables. La información recogida fue sobre variables sociodemográficas y clínicas, sobre quién tomó la decisión sobre el tratamiento y el grado de acuerdo o desacuerdo con diferentes barreras y facilitadores. Resultados. El 38,1% de los pacientes afirmó haber tomado la decisión de manera compartida con su médico. Barreras como el tiempo, la dificultad de comprensión, el paternalismo, la falta de comunicación fluida y el disponer de información previa y frecuentemente errónea influyeron en la implicación en la toma de decisiones. Sin embargo, disponer o no de instrumentos suficientes de ayuda a la decisión o el interés del paciente por participar no influyeron. En lo referente a los facilitadores, la motivación del médico, su percepción de mejora y el interés del enfermo tuvieron una influencia positiva. La excepción la constituyó la posibilidad de incentivar económicamente a los médicos. Conclusiones. La nula o escasa participación percibida por los pacientes oncológicos en las decisiones sobre su salud hace necesario introducir mejoras en el modelo de atención sanitaria que permitan superar barreras y promover una actitud más participativa en el paciente (AU)

Objective. To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented. Material and methods. A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators. Results. More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors. Conclusions. The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient (AU)