Features and frequency of use of electronic health records in primary care across 20 countries: a cross-sectional study.

OBJECTIVES: Variation exists in the capabilities of electronic healthcare records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability. STUDY DESIGN: Cross-sectional study. METHODS: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer's V. RESULTS: Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for 'interactive patient education' (37·3%) or 'home monitoring and self-testing of chronic conditions' (34·3%). Country of practice was associated with availability of all EHRs features (Cramer's V range: 0·2-0·6), particularly with availability of tools enabling patient EHRs access (Cramer's V: 0·6, P < 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity. CONCLUSIONS: EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.

Restoration of a Vital Tooth With Extensive Crown Destruction Using Glass Fiber and Polyethylene Fiber-reinforced Composite Resin: A Clinical Case.

Conservative restorative dentistry has been evolving in the last 25 years, focusing mainly on the development of direct restorative materials. Resin-based composites remain an excellent conservative alternative for restoration of teeth with extensive caries lesions. Over time, several strategies have been proposed to improve the mechanical properties of these composites so that they can adequately withstand masticatory forces. Glass fiber-reinforced resin-based composites and their use in situations where there is great loss of tooth structure have gained popularity due to their favorable mechanical properties. Combined techniques with polyethylene fibers can further enhance their clinical performance. This study presents a brief review of their most important qualities and potential use in direct restorative procedures. In addition, a clinical case is described where a vital tooth with extensive coronal destruction was restored using polyethylene fibers embedded in glass fiber-reinforced flowable resin under resin-based composite. The reinforcement of both the remaining tooth structure and the restoration with fibers is a valid treatment option since the network structure formed by the fiber reinforcement can increase the longevity of the direct composite restorations. There are few reports in the literature describing the use of a combined technique using polyethylene fibers embedded in glass fiber-reinforced flowable resin under resin-based composite. Thus, clinical follow-up of this case is required.

Implementation of a major trauma team. Analysis of activation and care times in patients admitted to the ICU.

OBJECTIVE: To analyze the factors associated with the activation of the severe trauma care team (STAT) in patients admitted to the ICU, to measure its impact on care times, and to analyze the groups of patients according to activation and level of anatomical involvement. DESIGN: Prospective cohort study of severe trauma admitted to the ICU. From June 2017 to May 2019. Risk factors for the activation of the STAT analysed with logistic regression and CART type classification tree. SETTING: Second level hospital ICU. PATIENTS: Patients admitted consecutively. INTERVENTIONS: No. MAIN VARIABLES OF INTEREST: STAT activation. Demographic variables. Injury severity (ISS), intentionality, mechanism, assistance times, evolutionary complications, and mortality. RESULTS: A total of 188 patients were admitted (46.8% of STAT activation), median age of 52 (37-64) years (activated 47 (27-62) vs not activated 55 (42-67) P = 0.023), males 84.0%. No difference in mortality according to activation. The logistic model finds as factors: care (16.6 (2.1-13.2)) and prehospital intubation (4.2 (1.8-9.8)) and severe lower extremity injury (4.4 (1.6-12.3)). Accidental fall (0.2 (0.1-0.6)) makes activation less likely. The CART model selects the type of trauma mechanism and can separate high and low energy trauma. CONCLUSIONS: Factors associated with STAT activation were prehospital care, requiring prior intubation, high-energy mechanisms, and severe lower extremity injuries. Shorter care times if activated without influencing mortality. We must improve activation in older patients with low-energy trauma and without prehospital care.

Supraventricular cardiac conduction system exposure in breast cancer patients treated with radiotherapy and association with heart and cardiac chambers doses.

Purpose: To assess sinoatrial node (SAN) and atrioventricular node (AVN) doses for breast cancer (BC) patients treated with 3D-CRT and evaluate whether "large" cardiac structures (whole heart and four cardiac chambers) would be relevant surrogates. Material and methods: This single center study was based on 116 BCE patients (56 left-sided, 60 right-sided) treated with 3D-CRT without respiratory gating strategies and few IMN irradiations from 2009 to 2013. The heart, the left and right ventricles (LV, RV), the left and right atria (LA, RA) were contoured using multi-atlases for auto-segmentation. The SAN and the AVN were manually delineated using a specific atlas. Based on regression analysis, the coefficients of determination (R2) were estimated to evaluate whether "large" cardiac structures were relevant surrogates (R2 > 0.70) of SAN and AVN doses. Results: For left-sided BC, mean doses were: 3.60 ± 2.28 Gy for heart, 0.47 ± 0.24 Gy for SAN and 0.74 ± 0.29 Gy for AVN. For right-sided BC, mean heart dose was 0.60 ± 0.25 Gy, mean SAN dose was 1.57 ± 0.63 Gy (>85 % of patients with SAN doses > 1 Gy) and mean AVN dose was 0.51 ± 0.14 Gy. Among all "large" cardiac structures, RA appeared as the best surrogate for SAN doses (R2 > 0.80). Regarding AVN doses, the RA may also be an interesting surrogate for left-sided BC (R2 = 0.78), but none of "large" cardiac structures appeared as relevant surrogates among right-sided BC (all R2 < 0.70), except the LA for patients with IMN (R2 = 0.83). Conclusions: In BC patients treated 10 years ago with 3D-CRT, SAN and AVN exposure was moderate but could exceed 1 Gy to the SAN in many right-sided patients with no IMN-inclusion. The RA appeared as an interesting surrogate for SAN exposure. Specific conduction nodes delineation remains necessary by using modern radiotherapy techniques.

What role do endogenous retroviruses play in domestic cats infected with feline leukaemia virus?

Feline leukaemia virus (FeLV) is a retrovirus that infects domestic and wild cats around the world. FeLV infection is associated with the development of neoplasms, bone marrow disorders and immunosuppression. Viral subgroups arise from mutations in the FeLV genome or from recombination of FeLV with ancestral endogenous retroviruses in the cat genome. The retroviral endogenisation process has allowed generation of a diversity of endogenous viruses, both functional and defective. These elements may be part of the normal functioning of the feline genome and may also interact with FeLV to form recombinant FeLV subgroups, enhance pathogenicity of viral subgroups, or inhibit and/or regulate other retroviral infections. Recombination of the env gene occurs most frequently and appears to be the most significant in terms of both the quantity and diversification of pathogenic effects in the viral population, as well as affecting cell tropism and types of disease that occur in infected cats. This review focuses on available information regarding genetic diversity, pathogenesis and diagnosis of FeLV as a result of the interaction between endogenous and exogenous viruses.

Optimum timing for assessing phenotypic resistance against gastrointestinal nematodes in Pelibuey ewes.

The objective was to identify the optimal stage of production to evaluate the resistance of Pelibuey ewes against gastrointestinal nematodes (GIN). Faecal egg count (FEC) was used to classify the ewes as resistant, sensible or intermediate against GIN. Forty-seven ewes were mating during 30 d. The gestation was verified by ultrasonography, and the breeding date was used to calculate the productive stages. Faeces were taken weekly to determine the FEC. Blood samples were taken to determine the packed cell volume (PCV), the peripheral eosinophils count (PEC), plasma protein concentration (PP), and Immunoglobulin A (IgA) against Haemonchus contortus. The body condition score (BCS) was recorded at each visit. Six moments during the study (early, mid and late gestation; early, mid and late lactation) were considered. The ewes were classified according to FEC (mean FEC ± three standard errors). The higher FEC occurred during all lactation stages than during early and mid-gestation stages (P<0.05). PCV, PP, and BCS during early gestation stage were higher than shown during the lactation stages (P<0.01). The PEC and IgA were higher during all lactation stages than early and mid-gestation stages (P<0.05). Concerning the type of birth, double births showed higher FEC than single birth (P<0.01). The highest values of accuracy (100 %) and concordance (Youden's J = 1.0) were found during early lactation. Therefore, it is concluded that the optimal stage of production to evaluate phenotypic resistance against GIN infections in Pelibuey ewes was during the early lactation.

Correction: Highly efficient green up-conversion emission from fluoroindate glass nanoparticles functionalized with a biocompatible polymer.

[This corrects the article DOI: 10.1039/D2RA03171J.].

Identification of Somatic Proteins in Haemonchus Contortus Infective Larvae (L3) and Adults.

Haemonchus contortus is considered the most pathogenic nematode in sheep production systems based on grazing. Comparing infective larvae (L3) with adult parasites can lead to the identification of proteins that play an important role in parasite-host interactions. In this study, we report a list of H. contortus somatic proteins and made a comparative analysis of somatic proteins of L3 and adult worms. L3 and adult parasites were subjected to protein extraction and subsequently to peptide fractionation. Peptides were analysed by mass spectrometry and LC-MS/MS data analysis. Data analysis and search on SEQUEST and MASCOT against H. contortus from the WormBase ParaSite database resulted in the identification of 775 unique peptide sequences corresponding to 227 proteins at 1 % FDR. From these, 18 proteins were specific to L3 and 63 to adult parasites. The gene ontology (GO) enrichment analysis of the proteins specific to L3 and adult worms to gain insight into cellular components, molecular functions and biological processes that affect the parasite-host interaction showed some differences between the two parasite stages. The list of proteins found provides a database to identify target proteins that could be useful as biomarkers of the infection or in the generation of anthelmintic drugs that inhibit proteins essential for the establishment of the infection and the survival of adult parasites. They can also serve as new candidates for vaccine research.

Highly efficient green up-conversion emission from fluoroindate glass nanoparticles functionalized with a biocompatible polymer.

Up-conversion nanoparticles have garnered lots of attention due to their ability to transform low energy light (near-infrared) into high-energy (visible) light, enabling their potential use as remote visible light nano-transducers. However, their low efficiency restricts their full potential. To overcome this disadvantage, fluoroindate glasses (InF3) doped at different molar concentrations of Yb3+ and Er3+ were obtained using the melting-quenching technique, reaching the highest green emission at 1.4Yb and 1.75Er (mol%), which corresponds to the 4S3/2 → 4I15/2 (540-552 nm) transition. The particles possess the amorphous nature of the glass and have a high thermostability, as corroborated by thermogravimetric assay. Furthermore, the spectral decay curve analysis showed efficient energy transfer as the rare-earth ions varied. This was corroborated with the absolute quantum yield (QY) obtained (85%) upon excitation at 385 nm with QYEr = 17% and QYYb = 68%. Additionally, InF3-1.4Yb-1.75Er was milled and functionalized using poly(ethylene glycol) to impart biocompatibility, which is essential for biomedical applications. Such functionalization was verified using FTIR, TG/DSC, and XRD.

A cross-sectional study of gender differences in quality of life domains in patients with neurofibromatosis type 1.

BACKGROUND: There is limited data regarding gender differences in quality of life between women and men with Neurofibromatosis type 1. We aimed to study differences in quality of life domains between women and men with Neurofibromatosis type 1 living in Canada. METHODS: This is a cross sectional study of adults with Neurofibromatosis type 1 attending a tertiary NF centre at Toronto General Hospital between January 2016 to December 2017. Demographic and clinical data were collected. We compared scores of generic measures (SF-36, EQ-5D-5L, pain interference) and a disease-specific measure (PedsQL-NF1 module) between women and men. We also assessed the relationship between disease visibility scored by an examiner (Ablon's visibility index) and self-reported perceived physical appearance, stratified by gender. RESULTS: One hundred and sixty-two participants were enrolled, 92 females and 70 males. Ablon's index score 1 was in 43% and score 2 in 44%, while only 13% of patients had a score 3. Women had worse scores on the total PedsQL-NF1 scales, and also in the perceived physical appearance, anxiety and emotional health domains. In women, there was a low but significant correlation between Ablon's index and perceived physical appearance (r = - 0.27, p = 0.01, ANOVA p < 0.001). In men, there was no difference in self-reported physical appearance by Ablon's index. There were no differences between men and women in the SF-36 or EQ-5D-5L scores. CONCLUSION: Women with NF1 reported worse NF1-related quality of life than men, with worse perceived physical appearance, anxiety, and mental health. Perceived physical appearance does not always correlate to disease visibility; therefore, healthcare providers should inquire about body image, physical appearance concerns, and mental health, especially among women with NF1.

Isolation and molecular identification of native As-resistant bacteria: As(III) and As(V) removal capacity and possible mechanism of detoxification.

The study of arsenic (As)-resistant microorganisms with high As removal capacity is fundamental for the development of economically sustainable technologies used for the treatment of water contaminated with metalloid. In the current study, four bacterial strains were isolated from As-contaminated water samples of the Xichu region, Mexico. Based on 16S rRNA gene sequencing and phylogenetic analysis of the isolated strains, Rhodococcus gordoniae, Microbacterium hydrocarbonoxydans, Exiguobacterium indicum, and Pseudomonas kribbensis were identified as potential As removal strains. R. gordoniae shows the highest growth capacity in both As(III) and As(V). R. gordoniae, M. hydrocarbonoxydans, and E. indicum removed approximately 81.6, 79.9, and 61.7% of As(III), as well as 77.2, 68.9, and 74.8% of As(V), respectively. P. kribbensis removed only about 80.2% of As(V). This study contributes to the possible detoxification mechanisms employed by these bacteria. Such insight could be crucial in the successful implementation of in situ bioremediation programs using these little-known bacteria.

Finding answers in lipid profile in COVID-19 patients.

INTRODUCTION: A small percentage of patients will develop a severe form of COVID-19 caused by SARS-CoV-2 infection. Thus, it is important to predict the potential outcomes identifying early markers of poor prognosis. In this context, we evaluated the association of SARS-CoV-2 infection with lipid abnormalities and their role in prognosis. METHODS: Single-center, retrospective, observational study of COVID-19 patients admitted from March to October 2020. Clinical and laboratory data, comorbidities, and treatments for COVID-19 were evaluated. Main outcomes including intensive care unit (ICU) admission and mortality were analyzed with a multivariable Cox proportional hazards regression model. RESULTS: We selected 1489 from a total of 2038 consecutive patients with confirmed COVID-19, who had a complete lipid profile before ICU admission. During the follow-up performed in 1109 patients, we observed a decrease in T-c, HDL-c, and LDL-c in 28.6%, 42.9%, and 30.4% of patients, respectively, and an increase in TG in 76.8%. The decrease of both T-c and HDL- c was correlated with a decrease in albumin levels (r = 0.39 and r = 0.37, respectively). Kaplan-Meier survival curves found an increased ICU admission in patients with lower T-c (HR 0.55, CI 0.36-0.86), HDL-c (HR 0.61, CI 0.45-0.84), and LDL-c (HR 0.85, CI 0.74-0.97). Higher values of T-c (HR 0.45, CI 0.36-0.57), HDL-c (HR 0.66, CI 0.54-0.81), and LDL-c (HR 0.86, CI 0.78-0.94) showed a protective effect on mortality. CONCLUSIONS: Abnormalities in lipid profile are a frequent complication of SARS-CoV-2 infection and might be related to morbidity and mortality. FUNDING: Proyectos de Investigación en Salud (FIS) and cofinanced by FEDER.

Pore geometry influences growth and cell adhesion of infrapatellar mesenchymal stem cells in biofabricated 3D thermoplastic scaffolds useful for cartilage tissue engineering.

The most pressing need in cartilage tissue engineering (CTE) is the creation of a biomaterial capable to tailor the complex extracellular matrix of the tissue. Despite the standardized used of polycaprolactone (PCL) for osteochondral scaffolds, the pronounced stiffness mismatch between PCL scaffold and the tissue it replaces remarks the biomechanical incompatibility as main limitation. To overcome it, the present work was focused in the design and analysis of several geometries and pore sizes and how they affect cell adhesion and proliferation of infrapatellar fat pad-derived mesenchymal stem cells (IPFP-MSCs) loaded in biofabricated 3D thermoplastic scaffolds. A novel biomaterial for CTE, the 1,4-butanediol thermoplastic polyurethane (b-TPUe) together PCL were studied to compare their mechanical properties. Three different geometrical patterns were included: hexagonal (H), square (S), and, triangular (T); each one was printed with three different pore sizes (PS): 1, 1.5 and 2 mm. Results showed differences in cell adhesion, cell proliferation and mechanical properties depending on the geometry, porosity and type of biomaterial used. Finally, the microstructure of the two optimal geometries (T1.5 and T2) was deeply analyzed using multiaxial mechanical tests, with and without perimeters, µCT for microstructure analysis, DNA quantification and degradation assays. In conclusion, our results evidenced that IPFP-MSCs-loaded b-TPUe scaffolds had higher similarity with cartilage mechanics and T1.5 was the best adapted morphology for CTE.

Quality improvement tool for rapid identification of risk factors for SARS-CoV-2 infection among healthcare workers.

The rapid growth of the coronavirus disease 2019 (COVID-19) pandemic, limited availability of personal protective equipment, and uncertainties regarding transmission modes of severe acute respiratory syndrome coronavirus-2 have heightened concerns for the safety of healthcare workers (HCWs). Systematic studies of occupational risks for COVID-19 in the context of community risks are difficult and have only recently started to be reported. Ongoing quality improvement studies in various locales and within many affected healthcare institutions are needed. A template design for small-scale quality improvement surveys is proposed. Such surveys have the potential for rapid implementation and completion, are cost-effective, impose little administrative or workforce burden, can reveal occupational risks while taking community risks into account, and can be repeated easily with short time intervals between repetitions. This article describes a template design and proposes a survey instrument that is easily modifiable to fit the particular needs of various healthcare institutions in the hope of beginning a collaborative effort to refine the design and instrument. These methods, along with data management and analytic techniques, can be widely useful and shared globally. The authors' goal is to facilitate quality improvement surveys aimed at reducing the risk of occupational infection of HCWs during the COVID-19 pandemic.

Modelo predictivo de mortalidad en pacientes con tumor urotelial de vejiga tras cistectomía radical / Mortality prediction model for patients with bladder urothelial tumor after radical cystectomy

OBJETIVO: Elaborar un modelo predictivo de mortalidad cáncer específica (MCE) a 1, 3, y 5 años basándonos en variables clínicas precirugía y patológicas poscirugía en pacientes con tumor urotelial vesical tratados con cistectomía radical. MATERIAL Y MÉTODOS: Análisis retrospectivo de 517 pacientes diagnosticados de tumor urotelial vesical y tratados con cistectomía radical (1986 y 2009). Se recogieron variables demográficas, clínicas, quirúrgicas y patológicas, así como complicaciones acontecidas y evolución tras cistectomía radical. Análisis comparativo con test de Chi cuadrado y ANOVA. Cálculo de supervivencia con método de Kaplan-Meier y test de log-rank. Análisis univariante y multivariante mediante regresión logística para identificar las variables predictoras independientes de MCE. Se calculó la probabilidad individual de MCE a 1, 3 y 5 años según la ecuación general (función logística). La calibración se obtuvo mediante método de. Hosmer-Lemeshow y la discriminación con elaboración de una curva ROC (área bajo la misma). RESULTADOS: El tumor urotelial vesical fue la causa de muerte en 225 pacientes (45%). Se obtuvo una MCE el 1.°, 3.° y 5.° años del 17%, 39,2% y 46,3% respectivamente. El estadio pT y pN se identificaron como variables pronósticas independientes de MCE al 1.°, 3.° y 5.° años. Se construyeron 3 modelos predictivos. La capacidad predictiva fue del 70,8% (IC95% 65-77%, p = 0,000) para el 1.° año, del 73,9% (IC95% 69,2-78,6%, p = 0,000) para el 3.° año y del 73,2% (IC95% 68,5-77,9%, p = 0,000) para el 5.° año. CONCLUSIONES: El modelo predictivo permite estimar el riesgo de MCE a los 1, 3 y 5 años con fiabilidad del 70,8, 73,9 y 73,2% respectivamente

OBJECTIVE: Based on preoperative clinical and postoperative pathological variables, we aim to build a prediction model of cancer specific mortality (CSM) at 1, 3, and 5 years for patients with bladder transitional cell carcinoma treated with RC. MATERIAL AND METHODS: Retrospective analysis of 517 patients with diagnosis of cell carcinoma treated by RC (1986-2009). Demographic, clinical, surgical and pathological variables were collected, as well as complications and evolution after RC. Comparative analysis included Chi square test and ANOVA technique. Survival analysis was performed using Kaplan-Meier method and log-rank test. Univariate and multivariate analyses were performed using logistic regression to identify the independent predictors of CSM. The individual probability of CSM was calculated at 1, 3 and 5 years according to the general equation (logistic function). Calibration was obtained by the Hosmer-Lemeshow method and discrimination with the elaboration of a ROC curve (area under the curve). RESULTS: BC was the cause of death in 225 patients (45%); 1, 3 and 5-year CSM were 17%, 39.2% and 46.3%, respectively. The pT and pN stages were identified as independent prognostic variables of CSM at 1, 3 and 5 years. Three prediction models were built. The predictive capacity was 70.8% (CI 95% 65-77%, p = .000) for the 1st year, 73.9% (CI95% 69.2-78.6%, p = .000) for the third and 73.2% (CI% 68.5-77.9%, p = .000) for the 5th year. CONCLUSIONS: The prediction model allows the estimation of CSM risk at 1, 3 and 5 years, with a reliability of 70.8%, 73.9% and 73.2%, respectively

Efecto de la quimioterapia adyuvante en el carcinoma urotelial de vejiga localmente avanzado tratado con cistectomía / Effect of adjuvant chemotherapy in locally advanced urothelial carcinoma of the bladder treated with cystectomy

INTRODUCCIÓN: El papel de la quimioterapia adyuvante (QTAdy) en el tumor vesical músculo-invasivo sigue siendo controvertido actualmente. OBJETIVO: Evaluar el efecto de la QTAdy en la supervivencia cáncer específica del tumor vesical músculo-invasivo tras cistectomía radical (CR). MATERIAL Y MÉTODOS: Análisis retrospectivo de 292 pacientes diagnosticados de tumor vesical urotelial tratados con CR entre 1986-2009 con estadio pT3-4pN0/+cM0, divididas en dos cohortes:185(63,4%) pacientes tratados con QTAdy y otra con 107(36,6%) sin QTAdy. Mediana de seguimiento de 40,5 meses (IQR 55-80,5). Análisis comparativo con test Chi cuadrado y t Student/ANOVA. Cálculo de supervivencia con el método de Kaplan-Meier y test de long-rank. Análisis multivariante (regresión de Cox) para identificar variables predictoras independientes de mortalidad cáncer específica (MCE). RESULTADOS: El 42,8% de la serie presentó afectación ganglionar tras CR. Al finalizar el seguimiento, 22,9% estaban libres de tumor vesical y 54,8% habían fallecido por esa causa. La mediana de supervivencia cáncer específica fue de 30 meses. No se observaron diferencias significativas en supervivencia cáncer específica en función del tratamiento con QTAdy en pacientes pT3pN0 (p = 0,25) ni pT4pN0 (p = 0,29), pero sí en pT3-4pN+ (p = 0,001). En el análisis multivariante se identificaron el estadio patológico (p = 0,0001) y el tratamiento con QTAdy (p = 0,007) como factores pronósticos independientes de MCE. La QTAdy redujo el riesgo de MCE (HR:0,59, IC95% 0,40-0,87, p = 0,007). CONCLUSIONES: El estadio pT y pN se identificaron como variables predictoras independientes de MCE tras CR. La administración de QTAdy en nuestra serie se comportó como factor protector reduciendo el riesgo de MCE, aunque en el análisis por estadios, únicamente los pacientes pN+ se vieron beneficiados

INTRODUCTION: Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor remains controversial. OBJECTIVE:To evaluate the effect of ADJ on cancer specific survival of muscle invasive bladder tumor after radical cystectomy (RC). MATERIAL AND METHODS: Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor pT3-4pN0 / + cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55-80.5).comparative analysis was performed with Chi-square test and Student's t test /ANOVA. Survival analysis was carried out with the Kaplan-Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM). RESULTS: 42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median cancer specific survival was 30 months. No significant differences were observed in cancer specific survival regarding the treatment with ADJ in pT3pN0 (p = .25) or pT4pN0 (p = .29) patients, but it was significant in pT3-4pN+ (p = .001). Multivariate analysis showed pathological stage (p = .0001) and treatment with ADJ (p = .007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95% CI 0.40-0.87, p = .007). CONCLUSIONS: pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN+ patients were benefited in the stage análisis

Mortality prediction model for patients with bladder urothelial tumor after radical cystectomy. / Modelo predictivo de mortalidad en pacientes con tumor urotelial de vejiga tras cistectomía radical.

OBJECTIVE: Based on preoperative clinical and postoperative pathological variables, we aim to build a prediction model of cancer specific mortality (CSM) at 1, 3, and 5 years for patients with bladder transitional cell carcinoma treated with RC. MATERIAL AND METHODS: Retrospective analysis of 517 patients with diagnosis of cell carcinoma treated by RC (1986-2009). Demographic, clinical, surgical and pathological variables were collected, as well as complications and evolution after RC. Comparative analysis included Chi square test and ANOVA technique. Survival analysis was performed using Kaplan-Meier method and log-rank test. Univariate and multivariate analyses were performed using logistic regression to identify the independent predictors of CSM. The individual probability of CSM was calculated at 1, 3 and 5 years according to the general equation (logistic function). Calibration was obtained by the Hosmer-Lemeshow method and discrimination with the elaboration of a ROC curve (area under the curve). RESULTS: BC was the cause of death in 225 patients (45%). One, three and five-year CSM were 17%, 39.2% and 46.3%, respectively. The pT and pN stages were identified as independent prognostic variables of CSM at 1, 3 and 5 years. Three prediction models were built. The predictive capacity was 70.8% (CI 95% 65-77%, p=.000) for the 1st year, 73.9% (CI95% 69.2-78.6%, p=.000) for the third and 73.2% (CI% 68.5-77.9%, p=.000) for the 5th. CONCLUSIONS: The prediction model allows the estimation of CSM risk at 1, 3 and 5 years, with a reliability of 70.8, 73.9 and 73.2%, respectively.

Analysis of the effectiveness of the prophylaxis of vestibular migraine depending on the diagnostic category and the prescribed drug.

INTRODUCTION: Vestibular migraine (VM) consists of recurrent episodes of vestibular symptoms that are accompanied by migraine in at least 50% of the episodes. The criteria of the Bárány Society include two diagnostic categories: "actual" vestibular migraine and probable vestibular migraine. There is a wide range of drugs that can be prescribed for the prophylactic treatment of VM, but recommendations for the selection of the most appropriate drug are currently lacking. OBJECTIVE: To measure the extent to which the prophylactic treatment of VM reduces vestibular symptoms, headache and the number of crises depending on the diagnostic category of the Bárány Society and the drug used for prophylaxis. MATERIAL AND METHODS: This is a multicenter prospective study. Patients with VM who presented to any of the participating centers and who subsequently met the VM criteria were prescribed one of the following types of prophylaxis: acetazolamide, amitriptyline, flunarizine, propranolol or topiramate. Patients were called back for a follow-up visit 5 weeks later. This allowed the intensity of vestibular symptoms, headache and the number of crises before and during treatment to be compared. RESULTS: 31 Patients met the inclusion criteria. During the treatment, all the measured variables decreased significantly. In a visual analogue scale, the intensity of vestibular symptoms decreased by 45.8 points, the intensity of headache decreased by 47.8 points and patients suffered from 15.6 less monthly crises compared to the period before the treatment. No significant between-group differences were found when patients were divided based on their diagnostic category or the choice of prophylaxis prescribed to them. CONCLUSION: The treatment of VM produces a reduction of symptoms and crises with no significant differences based on patients' diagnostic categories or the choice of prophylaxis prescribed to them.