Resultados obstétricos y neonatales relacionados con la hidratación intraparto en mujeres atendidas de parto de bajo riesgo / Obstetric and neonatal results associated with intrapartum hydration for women with low-risk labour

Objetivo: determinar la influencia de la hidratación intraparto en los resultados obstétricos y neonatales en mujeres nulíparas atendidas por parto de bajo riesgo.Métodos: se realizó un estudio observacional prospectivo en el Hospital Universitario Puerta de Hierro Majadahonda (Madrid, España). Se incluyeron mujeres nulíparas con gestación única atendidas por parto de bajo riesgo. Se recogieron variables maternas (sociodemográficas, clínicas al ingreso, intraparto y en el puerperio inmediato, resultados obstétricos) y neonatales (datos al nacimiento, a las 24 y 48 horas). Se realizó análisis descriptivo y univariante con los test estadísticos correspondientes. Se valoró la influencia de la hidratación en los resultados obstétricos y neonatales estableciendo un punto de corte en la hidratación recibida intraparto (mediana volumen total administrado por hora: 300 mL/h).Resultados: se incluyeron 148 mujeres. Edad media (DE) 32 (4,4) años, edad gestacional media (DE) 39 (1,4) semanas. Al ingreso, la dilatación media fue de 2 cm. Parto inducido en 65,5% (n= 97). Los resultados obstétricos y neonatales fueron más favorables en las mujeres que recibieron un volumen mayor(> 300 mL/h), con diferencias significativas en la duración total del parto (mediana 526 vs. 735 min; p< 0,001), incidencia de parto por cesárea (14,3% frente 18,7%), fiebre (5,5% frente a 7,7%), incidencia de pérdida de peso neonatal superior al 7% a las 48 horas (28,6% frente a 39,8%), lactancia materna (94,6% frente a 82,4%).Conclusiones: la administración de un mayor volumen de líquidos a mujeres nulíparas durante el parto de bajo riesgo se asoció con mejores resultados obstétricos y neonatales.(AU)

Objective: to determine the influence of intrapartum hydration on obstetric and neonatal results in nulliparous women during low-risk labour.Methods: an observational prospective study was conducted at the Hospital Universitario Puerta de Hierro Majadahonda (Madrid, Spain). The study included nulliparous women with single pregnancy and low-risk labour. Maternal variables were collected (sociodemographic, clinical signs at admission, intrapartum and immediately post-partum, obstetric results) as well as neonatal variables (data at birth, at 24 and 48 hours). Descriptive and univariate analysis was conducted with the relevant statistic tests. The influence of hydration was assessed in obstetric and neonatal results, determining a cut-off point for the hydration received intrapartum (median total volume administered per hour: 300 mL/h).Results: the study included 148 women, with a mean age (SD) of 32 (4.4) years, and a mean gestational age (SD) of 39 (1.4) weeks. At admission, mean dilation was of 2 cm. There was induced labour in 65.5% of cases (n= 97). Obstetric and neonatal results were more favourable in those women who received a higher volume (≥ 300 mL/h), with significant differences in the total duration of labour (median 526 vs. 735 min; p< 0.001), incidence of Caesarean births (14.3% vs. 18.7%), fever (5.5% vs. 7.7%), incidence of neonatal weight loss >7% at 48 hours (28.6% vs. 39.8%), breastfeeding (94.6% vs. 82.4%).Conclusions: administration of a higher volume of fluids to nulliparous women during low-risk labour was associated with better obstetric and neonatal results.(AU)

Pharmacokinetics, the Immunological Impact, and the Effect on HIV Ex-Vivo Infectivity of Maraviroc, Raltegravir, and Lopinavir in Men Who Have Sex with Men Using Postexposure Prophylaxis.

Most of the studies using the colorectal tissue explants challenge model have been conducted after one single dose and before reaching a steady state. We consider that longer exposure as in 28-day postexposure prophylaxis (PEP) course and in an at-risk setting, such as after a sexual risk exposure to HIV could give us valuable information about these drugs. In a substudy we assessed pharmacokinetics, changes on immune system and ex-vivo rectal mucosal susceptibility to HIV-1 infection after taking maraviroc (MVC), raltegravir (RAL), and ritonavir-boosted lopinavir (LPV/r) PEP-based regimens in 30 men who have sex with men. Participants received 28 days of twice-daily MVC (n = 11), RAL (n = 10) or LPV/r (n = 9) all with tenofovir/emtricitabine (TDF/FTC) backbone. Blood, rectal fluid, and rectal tissue samples were collected at days 7, 28, and 90 after starting PEP. The samples obtained at day 90 were considered baseline. All studied antiretrovirals were quantifiable at 7 and 28 days in all tissues. Activation markers were increased in CD4 mucosal mononuclear cells (MMCs) after 28 days of MVC: CD38 + 68.5 versus 85.1, p = .008 and CD38+DR +16.1 versus 26.7, p = .008. Exposure to MVC at both endpoints (7 and 28 days) was associated with significant suppression of HIV-1BAL (p = .005 and p = .028), but we did not observe this effect with RAL or LPV/r. Merging together changes in MMC in all arms, we found a positive correlation in the CD8 T cell lineage between the infectivity at day 7 and activation (CD38+ r = 0.43, p = .025, DR + r = 0.547, p = .003 and 38+DR+ r = 0.526, p = .05), senescence (CD57+CD28- r = 0.479, p = .012), naive cells (RA+CCR7+ r = 0.484, p = .01), and CCR5 expression (r = 0.593, p = .001). We conclude that MVC in combination with TDF/FTC was associated with viral suppression in rectal explants and that overall ex-vivo HIV infectivity correlated with activation and senescence in CD8 MMCs.

Fecal Calprotectin for Small Bowel Crohn's Disease: Is It a Cutoff Issue?

(1) Background: Fecal calprotectin (FC) correlates well with colonic inflammatory activity of Crohn's disease (CD); data about relation of FC and small bowel (SB) lesions are still contradictory. The main aim was to analyze the relationship between FC levels and SB inflammatory activity in patients with established or suspected Crohn's disease, assessed by small bowel capsule endoscopy (SBCE) or magnetic resonance enterography (MRE). (2) Methods: Two cohorts of patients were included: 1. Prospective data were collected from patients with established or suspected CD who underwent SBCE and FC (Cohort A); 2. A retrospective cohort of patients who underwent MRE and FC determination (Cohort B). Different cutoffs for FC were tested in both cohorts. (3) Results: 83 patients were included and 66 were finally analyzed. A total of 69.6% had SB lesions seen by SBCE (n = 25) or MRE (n = 21). FC mean levels were 605.74 + 607.07 µg/g (IQ range: 99.00−878.75), being significantly higher in patients with SB lesions compared to patients without lesions (735.91 + 639.70 µg/g (IQ range: 107.75−1366.25) vs. 306.35 + 395.26 µg/g (IQ range: 78.25−411.0), p < 0.005). For cohort A, 25 out of 35 patients had SB lesions and a significant correlation between Lewis Score and FC levels was achieved (R2: 0.34; p = 0.04). FC sensitivity (S), specificity (E), positive predictive value (PPV), and negative predictive values (NPV) for predicting SB lesions were 80%, 50%, 80%, and 50%, respectively, for FC > 100 µg/g. For cohort B, inflammatory SB activity, measured by MaRIA score, was detected in 21 out of 31 patients (67.7%). Patients with positive findings in MRE had significantly higher values of FC than those with no lesions (944.9 + 672.1 µg/g vs. 221 + 212.2 µg/g, p < 0.05). S, E, PPV, and NPV of FC were 89%, 50%, 77.2%, and 71.4% for FC levels > 100 µg/g. The higher sensitivity and specificity of the FC levels for the detection of SB lesions with SBCE and MRE was obtained for an FC cutoff >265 µg/g and >430 µg/g, respectively. (4) Conclusions: FC has a good correlation with the presence of SB lesions, assessed by SBCE and MRE, in patients with established or suspected Crohn's disease. However, the ideal cutoff is here proven to be higher than previously reported. Multicenter and large prospective studies are needed in order to establish definitive FC cutoff levels.

Short-term rental market crisis management during the COVID-19 pandemic: Stakeholders' perspectives.

Contingency plans and crisis management strategies have been implemented by the short-term rental industry to deal with the COVID-19 pandemic. This paper examines the strategies adopted by three key groups of stakeholders: short-term rental platforms (e.g. Airbnb, Booking.com), service providers (represented by property management companies and short-term rental associations) and policymakers/tourism experts. The professional service providers, in particular, constitute a significant share of the short-term rental industry, but have not received much scholarly attention. In this respect, our study fills this gap by bringing attention to unexplored segments of the short-term rental industry. By examining and comparing the responses from these key groups, the paper contributes to the ongoing research about the workings of the short-term rental industry and its responses to the COVID-19 crisis.

Óleo essencial de Pataqueira (Conobea scoparioides Cham. & Schltdl.) como conservante natural em Cosméticos / Pataqueira essential oil (Conobea scoparioides Cham. & Schltdl.) as a natural preservative in cosmetics

Um dos principais grupos de conservantes utilizados na maioria dos cosméticos são os parabenos que em muitos estudos demonstraram que podem provocar reações alérgicas como dermatite de contato, entre outras sensibilizações cutâneas. A fim de minimizar esses problemas, a indústria está produzindo cosméticos livres de conservantes ou de origem natural e em associações aos sintéticos. Dentre os conservantes naturais utilizados, podemos citar os óleos essenciais como uma alternativa viável. Diante deste contexto o presente trabalho visa avaliar experimentalmente o potencial antimicrobiano do óleo essencial de Conobea scoparioides Cham. & Schltdl., conhecida popularmente como pataqueira, o efeito de sua associação com parabenos e de sua eficácia como conservante em bases cosméticas. A composição do óleo essencial foi avaliada, indicando que este é composto em sua maior parte por terpenos, tendo éter metílico do timol (39,2%), timol (33,8 %) e α-felandreno (15,9%) como compostos majoritários. A atividade antimicrobiana do óleo essencial e do timol foi acessada através da concentração inibitória mínima (CIM), cujos resultados em µg/mL para o óleo essencial e o timol foram respectivamente: Staphylococcus aureus 650,70 e 284,90, Escherichia coli 721,53 e 271,20, Pseudomonas aeruginosa 1748,00 e > 2.000, Burkholderia cepacia 833,03 e 1.077,70, Candida albicans 521,43 e 172,61 e Aspergillus brasiliensis 300 e 400. O efeito sinérgico da associação do óleo essencial com os parabenos foi realizado através de um delineamento experimental centroide simplex para uma mistura de metilparabeno, propilparabeno e óleo essencial frente aos mesmos micro-organismos utilizados na determinação da atividade antimicrobiana. As concentrações ideais obtidas pela análise estatística para cada componente em µg/mL foram: 1120 para o metilparabeno, 350 para o propilparabeno e 675 para o óleo essencial. O teste de eficácia do sistema conservante em formulação cosmética foi efetuado empregando as concentrações ideais e mais duas concentrações superiores e uma abaixo do ideal. Para todas as cepas microbianas desafiadas o resultado do teste foi de redução total da carga microbiana inoculada nos sete dias de ensaio e nenhum aumento até o vigésimo oitavo dia o que demonstra a eficácia da associação do óleo essencial com os conservantes sintéticos. O óleo essencial de C. scoparioides apresentou um potencial antimicrobiano importante tanto sozinho como em associação com conservantes sintéticos. Estes resultados sugerem que esse óleo pode ser usado para compor um sistema conservante para formulações cosméticas contendo uma menor quantidade de sintéticos

One of the main groups of preservatives used in most cosmetics are parabens, that many studies have shown that they can cause allergic reactions such as contact dermatitis, among other skin sensitizations. To minimize these problems, the industry is producing cosmetics preservative free or using natural products instead and their combination with the synthetics. Among the natural preservatives used, we can mention essential oils as a viable alternative. In this context, the present work aims to experimentally evaluate the antimicrobial potential of the Conobea scoparioides Cham. & Schltdl. essential oil, popularly known as pataqueira, the effect of its association with parabens and its effectiveness as a preservative in cosmetic bases. The essential oil composition was analyzed, indicating that it is composed mostly of terpenes, with thymol methyl ether (39.2%), thymol (33.8%) and -phelandrene (15.9%) as major compounds. The antimicrobial activity of essential oil and thymol was accessed through the minimum inhibitory concentration (MIC), whose results in µg/mL for essential oil and thymol were respectively: Staphylococcus aureus 650.70 and 284.90, Escherichia coli 721, 53 and 271.20, Pseudomonas aeruginosa 1748.00 and > 2,000, Burkholderia cepacia 833.03 and 1,077.70, Candida albicans 521.43 and 172.61 and Aspergillus brasiliensis 300 and 400. The synergistic effect of the association of essential oil with parabens was performed through a centroid simplex experimental design for a mixture of methylparaben, propylparaben and essential oil against the same microorganisms used in the antimicrobial activity evaluation The ideal concentrations obtained by statistical analysis for each component in µg/mL were: 1120 for methylparaben, 350 for propylparaben and 675 for essential oil. The effectiveness test of the preservative system in cosmetic formulation was carried out using the ideal concentrations plus two higher concentrations and one below the ideal. For all challenged microbial strains, the test result was a total reduction of the inoculated microbial load in the seven days of testing and no increase until the twenty-eighth day, which demonstrates the effectiveness of the association of essential oil with synthetic preservatives. C. scoparioides essential oil showed an important antimicrobial potential both alone and in association with parabens. These results demonstrated that it can be used to compose a preservative system for cosmetic formulations containing lower amounts of synthetics

Impacts of Covid-19 on peer-to-peer accommodation platforms: Host perceptions and responses.

The Covid-19 pandemic has brought international tourism at a standstill. Peer-to-peer (P2P) accommodation, in particular, has been greatly affected with platforms being heavily criticised for lacking a strategic response to users' needs. Drawing from semi-structured interviews with P2P accommodation hosts, this study aims to explore: a) their perceptions of the short-term impacts of the pandemic on their hosting practice, b) their responses to the pandemic and c) their perceptions of the long-term impacts of the pandemic on the P2P accommodation sector. The study offers a continuum of host pandemic responses which illustrates different types of hosts in relation to their market perspective and intention to continue hosting on P2P platforms. The continuum carries theoretical implications as it offers insights to academics exploring crisis impacts on P2P accommodation. It is also of practical value to platforms and practitioners as it may lead to improved crisis management strategies.

Colon capsule endoscopy versus CT colonography in FIT-positive colorectal cancer screening subjects: a prospective randomised trial-the VICOCA study.

BACKGROUND: Colon capsule endoscopy (CCE) and CT colonography (CTC) are minimally invasive techniques for colorectal cancer (CRC) screening. Our objective is to compare CCE and CTC for the identification of patients with colorectal neoplasia among participants in a CRC screening programme with positive faecal immunochemical test (FIT). Primary outcome was to compare the performance of CCE and CTC in detecting patients with neoplastic lesions. METHODS: The VICOCA study is a prospective, single-centre, randomised trial conducted from March 2014 to May 2016; 662 individuals were invited and 349 were randomised to CCE or CTC before colonoscopy. Endoscopists were blinded to the results of CCE and CTC. RESULTS: Three hundred forty-nine individuals were included: 173 in the CCE group and 176 in the CTC group. Two hundred ninety individuals agreed to participate: 147 in the CCE group and 143 in the CTC group. In the intention-to-screen analysis, sensitivity, specificity and positive and negative predictive values for the identification of individuals with colorectal neoplasia were 98.1%, 76.6%, 93.7% and 92.0% in the CCE group and 64.9%, 95.7%, 96.8% and 57.7% in the CTC group. In terms of detecting significant neoplastic lesions, the sensitivity of CCE and CTC was 96.1% and 79.3%, respectively. Detection rate for advanced colorectal neoplasm was higher in the CCE group than in the CTC group (100% and 93.1%, respectively; RR = 1.07; p = 0.08). Both CCE and CTC identified all patients with cancer. CCE detected more patients with any lesion than CTC (98.6% and 81.0%, respectively; RR = 1.22; p = 0.002). CONCLUSION: Although both techniques seem to be similar in detecting patients with advanced colorectal neoplasms, CCE is more sensitive for the detection of any neoplastic lesion. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02081742 . Registered: September 16, 2013.

Comprehensive Custom NGS Panel Validation for the Improvement of the Stratification of B-Acute Lymphoblastic Leukemia Patients.

BACKGROUND: B-acute lymphoblastic leukemia (B-ALL) is a hematological neoplasm of the stem lymphoid cell of the B lineage, characterized by the presence of genetic alterations closely related to the course of the disease. The number of alterations identified in these patients grows as studies of the disease progress, but in clinical practice, the conventional techniques frequently used are only capable of detecting the most common alterations. However, techniques, such as next-generation sequencing (NGS), are being implemented to detect a wide spectrum of new alterations that also include point mutations. METHODS: In this study, we designed and validated a comprehensive custom NGS panel to detect the main genetic alterations present in the disease in a single step. For this purpose, 75 B-ALL diagnosis samples from patients previously characterized by standard-of-care diagnostic techniques were sequenced. RESULTS: The use of the custom NGS panel allowed the correct detection of the main genetic alterations present in B-ALL patients, including the presence of an aneuploid clone in 14 of the samples and some of the recurrent fusion genes in 35 of the samples. The panel was also able to successfully detect a number of secondary alterations, such as single nucleotide variants (SNVs) and copy number variations (CNVs) in 66 and 46 of the samples analyzed, respectively, allowing for further refinement of the stratification of patients. The custom NGS panel could also detect alterations with a high level of sensitivity and reproducibility when the findings obtained by NGS were compared with those obtained from other conventional techniques. CONCLUSIONS: The use of this custom NGS panel allows us to quickly and efficiently detect the main genetic alterations present in B-ALL patients in a single assay (SNVs and insertions/deletions (INDELs), recurrent fusion genes, CNVs, aneuploidies, and single nucleotide polymorphisms (SNPs) associated with pharmacogenetics). The application of this panel would thus allow us to speed up and simplify the molecular diagnosis of patients, helping patient stratification and management.

Polyp fingerprint: automatic recognition of colorectal polyps' unique features.

BACKGROUND: Content-based image retrieval (CBIR) is an application of machine learning used to retrieve images by similarity on the basis of features. Our objective was to develop a CBIR system that could identify images containing the same polyp ('polyp fingerprint'). METHODS: A machine learning technique called Bag of Words was used to describe each endoscopic image containing a polyp in a unique way. The system was tested with 243 white light images belonging to 99 different polyps (for each polyp there were at least two images representing it in two different temporal moments). Images were acquired in routine colonoscopies at Hospital Clínic using high-definition Olympus endoscopes. The method provided for each image the closest match within the dataset. RESULTS: The system matched another image of the same polyp in 221/243 cases (91%). No differences were observed in the number of correct matches according to Paris classification (protruded: 90.7% vs. non-protruded: 91.3%) and size (< 10 mm: 91.6% vs. > 10 mm: 90%). CONCLUSIONS: A CBIR system can match accurately two images containing the same polyp, which could be a helpful aid for polyp image recognition.

Antibiotic Prophylaxis Is Not Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions, Based on a Randomized Trial.

BACKGROUND & AIMS: Guidelines recommend routine antibiotic prophylaxis for patients undergoing endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of pancreatic cysts, but there is conflicting evidence for its necessity. We investigated whether performing the procedure without antimicrobial prophylaxis increases the incidence of infection. METHODS: We performed a multicenter, randomized, noninferiority trial to compare prophylaxis with ciprofloxacin vs placebo in patients with a pancreatic cyst requiring EUS-FNA at multiple centers in Spain. From September 2014 to June 2018, patients were randomly assigned to groups that received the prophylaxis with ciprofloxacin (n = 112) or saline solution (n = 114, placebo). We recorded patients' demographic data, lesion characteristics, and procedure data and followed patients for 21 days. A total of 205 patients completed the trial (90.7%), receiving ciprofloxacin or the control, with no statistically significant differences in demographics, baseline data, or procedure characteristics between groups. The primary outcome was FNA-related infection. Secondary outcomes were incidence of fever, procedure complications, and medication-related adverse events. RESULTS: The only case of FNA-related infection (0.44%) occurred in a patient in the placebo group (0.87%); this patient developed acute pancreatitis and bacteremia after the procedure. Prevention of infection was not inferior in the control group; the difference between proportions was 0.87% (95% confidence interval, -0.84% to 2.59%). There were no differences between groups in fever (2 patients in each group: 1.78% vs 1.76%; P = 1.00) or other adverse events. CONCLUSIONS: In a randomized trial of patients undergoing EUS-FNA for pancreatic cyst evaluation, we found the risk of infection to be low. The incidence of infections did not differ significantly with vs without ciprofloxacin prophylaxis. (ClinicalTrials.gov, Number: NCT02261896).

White-Light Endoscopy Is Adequate for Lynch Syndrome Surveillance in a Randomized and Noninferiority Study.

BACKGROUND & AIMS: Dye-based pancolonic chromoendoscopy is recommended for colorectal cancer surveillance in patients with Lynch syndrome. However, there is scarce evidence to support its superiority to high-definition white-light endoscopy. We performed a prospective study assess whether in the hands of high detecting colonoscopists, high-definition, white-light endoscopy is noninferior to pancolonic chromoendoscopy for detection of adenomas in patients with Lynch syndrome. METHODS: We conducted a parallel controlled study, from July 2016 through January 2018 at 14 centers in Spain of adults with pathogenic germline variants in mismatch repair genes (60% women; mean age, 47 ± 14 years) under surveillance. Patients were randomly assigned to groups that underwent high-definition white-light endoscopy (n = 128) or pancolonic chromoendoscopy (n = 128) evaluations by 24 colonoscopists who specialized in detection of colorectal lesions in high-risk patients for colorectal cancer. Adenoma detection rates (defined as the proportion of patients with at least 1 adenoma) were compared between groups, with a noninferiority margin (relative difference) of 15%. RESULTS: We found an important overlap of confidence intervals (CIs) and no significant difference in adenoma detection rates by pancolonic chromoendoscopy (34.4%; 95% CI 26.4%-43.3%) vs white-light endoscopy (28.1%; 95% CI 21.1%-36.4%; P = .28). However, pancolonic chromoendoscopy detected serrated lesions in a significantly higher proportion of patients (37.5%; 95% CI 29.5-46.1) than white-light endoscopy (23.4%; 95% CI 16.9-31.4; P = .01). However, there were no significant differences between groups in proportions of patients found to have serrated lesions of 5 mm or larger (9.4% vs 7.0%; P = .49), of proximal location (11.7% vs 10.2%; P = .68), or sessile serrated lesions (3.9% vs 5.5%; P = .55), respectively. Total procedure and withdrawal times with pancolonic chromoendoscopy (30.7 ± 12.8 minutes and 18.3 ± 7.6 minutes, respectively) were significantly longer than with white-light endoscopy (22.4 ± 8.7 minutes and 13.5 ± 5.6 minutes; P < .001). CONCLUSIONS: In a randomized parallel trial, we found that for Lynch syndrome surveillance, high-definition white-light endoscopy is not inferior to pancolonic chromoendoscopy if performed by experienced and dedicated endoscopists. ClinicalTrials.gov no: NCT02951390.

Dual role of FGF in proliferation and endoreplication of Drosophila tracheal adult progenitor cells.

Adult progenitor cells activation is a key event in the formation of adult organs. In Drosophila, formation of abdominal adult trachea depends on the specific activation of tracheal adult progenitors (tracheoblasts) at the Tr4 and Tr5 spiracular branches. Proliferation of these tracheoblasts generates a pool of tracheal cells that migrate toward the posterior part of the trachea by the activation of the branchless/fibroblast growth factor (Bnl/FGF) signaling to form the abdominal adult trachea. Here, we show that, in addition to migration, Bnl/FGF signaling, mediated by the transcription factor Pointed, is also required for tracheoblast proliferation. This tracheoblast activation relies on the expression of the FGF ligand bnl in their nearby branches. Finally, we show that, in the absence of the transcription factor Cut (Ct), Bnl/FGF signaling induces endoreplication of tracheoblasts partially by promoting fizzy-related expression. Altogether, our results suggest a dual role of Bnl/FGF signaling in tracheoblasts, inducing both proliferation and endoreplication, depending on the presence or absence of the transcription factor Ct, respectively.

Efficacy of "optimal hydration" during labor: HYDRATA study protocol for a randomized clinical trial.

There is a lack of consensus in the international scientific community with respect to the most suitable hydration strategies when attending nulliparous women during low-risk births. This paper describes the protocol for a randomized controlled trial to compare two hydration strategies and their influence on maternal and neonatal morbidity. The study population consists of nulliparous women admitted to the obstetrics department of a University Hospital. The women are being randomized into two groups: the "optimal hydration" group, which will be guaranteed 300 ml/hr liquids (crystalloids and bottled mineral water) with a minimum diuresis of 35 ml/hr; and the "variability in hydration" group, which will receive intravenous (alternating normal saline, Ringer's lactate solution, glucose, or Voluven®) and clear (bottled mineral water or isotonic drinks [Aquarius®]) liquids, without any established perfusion rate, and without established minimum diuresis. Outcomes for mothers include duration of labor, cesarean section, fever, and dehydration. Outcomes for newborns are respiratory distress, hypoglycemia, hyponatremia, jaundice, weight loss over 48 hr, and breastfeeding difficulties. Analysis will be per-protocol. Administering optimal hydration may improve health and safety for mothers and their newborn and reduce maternal and neonatal morbidity. The study is registered at www.clinicaltrials.gov. The project received funding by the Ministry of Health of Spain and is approved by the Research Ethics Committee.

Endocuff-assisted colonoscopy for surveillance of serrated polyposis syndrome: a multicenter randomized controlled trial.

BACKGROUND AND STUDY AIMS: Serrated polyposis syndrome (SPS) is a condition with high risk for colorectal cancer. The Endocuff device has been shown to increase adenoma detection in the general and screening population. We aimed to ascertain whether Endocuff-assisted colonoscopy increases detection of serrated lesions in comparison with standard colonoscopy during the surveillance of patients with SPS.  METHODS: In a multicenter randomized controlled study, patients who met SPS criteria I and/or III under surveillance (previous resection of all serrated lesions ≥ 4 mm) were consecutively randomly allocated 1:1 to Endocuff-assisted colonoscopy or standard colonoscopy, performed by expert endoscopists. The main outcome was the mean number of serrated lesions detected per patient. RESULTS: 122 patients (standard colonoscopy n = 60; Endocuff-assisted colonoscopy n = 62; 59 % men; mean age 60.6 (standard deviation [SD] 7.5) were included at 4 centers. Baseline variables (demographic data, SPS phenotype, colorectal cancer [CRC] history, cumulative polyps, and follow-up), cecal intubation rate, and withdrawal time were similar between groups. There was no statistically significant difference between Endocuff-assisted colonoscopy and standard colonoscopy for the mean number of serrated lesions detected per patient: 5.8 (95 % confidence interval [95 %CI] 4.4 - 7.2) and 5.0 (3.9 - 6.1), respectively (P = 0.36). There were also no differences between Endocuff-assisted and standard colonoscopy for detection of sessile serrated lesions (mean number per patient 2.5 [1.3 - 3.6] vs. 2.0 [1.1 - 3.0], P = 0.54) and adenomas (0.9 [0.5 - 1.3] vs. 0.5 [0.3 - 0.7], P = 0.12). CONCLUSION: Use of Endocuff-assisted colonoscopy did not significantly increase the number of serrated lesion detected per patient during surveillance of SPS.

El índice palliative performance scale como escala pronóstica en atención domiciliaria / The Palliative Performance Scale as a prognostic scale in home care

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Rectal Aberrant Crypt Foci in Humans Are Not Surrogate Markers for Colorectal Cancer Risk.

INTRODUCTION: Over the past 20 years, aberrant crypt foci (ACF) have emerged as potential precursors and biomarkers for colorectal cancer (CRC). However, data regarding their molecular pathogenesis, as well as their endoscopic and histological identification, remain inconsistent. METHODS: A wide cohort of ACF from 100 control subjects and 100 case patients, including patients with adenoma and CRC, were characterized for endoscopic, morphologic, and molecular features. RESULTS: We observed that among all the endoscopic features evaluated, only the number of large ACF correlated with CRC risk (P = 0.003), whereas the histological classification, as assessed by 2 different pathologists, was inconsistent and did not differ between control and case patients. Moreover, only a few APC and BRAF mutations and no microsatellite instability were detected in our samples. KRAS mutations were detected in 16.3% of ACF samples, which also exhibited increased MGMT hypermethylation. However, none of those events were found to be predictive of CRC risk. DISCUSSION: Although ACF might be preneoplastic lesions of the colon, they are not suitable biomarkers for assessing CRC progression.

Successful outcomes of a new combined solution of hyaluronic acid, chondroitin sulfate and poloxamer 407 for submucosal injection: animal survival study.

Background and study aims Endoscopic resection requires use of submucosal injection. This study was conducted to assess efficacy and impact on early healing of hyaluronic acid combined with chondroitin sulfate and poloxamer 407 (Ziverel) when used as a solution for submucosal injection. Materials and methods Prospective and comparative study of gastric endoscopic mucosal resection (EMR) with three groups of two Yorkshire pigs. Six submucosal cushions were created in each animal by injecting 2 mL of Ziverel (Group 1) or succinylated gelatin (SG) (Group 2), enabling 12 EMR in each group. Submucosal cushions were created with Ziverel in Group 3, without resection. Electrosurgery unit settings were the same in all cases. EMR defects and injection sites were marked with clips. The animals were sacrificed 7 days later. EMR specimen size and duration of procedure were recorded. EMR specimens and EMR scars and injection sites were evaluated by a blinded pathologist. Results We successfully performed 24 EMR (15 en-bloc and 9 piecemeal, without differences between groups 1 and 2). Mean EMR specimen dimensions were significantly larger in Group 1 (median 19 mm, range 6 - 40 vs 16.6 mm, range 5­25; P  = 0.019), without changing the electrocautery unit settings. Blinded histopathologist assessment of EMR specimens showed less fibrosis in the submucosa and a trend to fewer cautery artifacts with Ziverel and did not identify any significant differences in early healing of resection sites. Conclusion The combination of Ziverel enables EMR and does not negatively affect early healing.

Adaptación transcultural y validación del cuestionario PG-13 para la detección precoz de duelo prolongado / Cross-cultural adaptation and validity of the prolonged grief PG-13 questionnaire: a tool for early diagnosis

OBJETIVO: Adaptar y validar al castellano el cuestionario PG-13. DISEÑO: Fase 1. Adaptación trascultural de cuestionarios. Fase 2: Validación de pruebas diagnósticas. EMPLAZAMIENTO: Atención primaria, equipo de soporte a la atención domiciliaria paliativa y tres hospitales de cuidados paliativos de Madrid. PARTICIPANTES: Fase 1. Tres traductores inglés-castellano, tres traductores castellano-inglés. Comité multidisciplinar: Tres psicólogos, médica y enfermera de Cuidados Paliativos, médica de atención primaria. Fase 2: Se ofreció participar a 329 personas mayores de edad que habían sufrido una pérdida hacía más de seis meses pero menos de 18, elegidos por muestreo no probabilístico. Rechazaron 23, respuesta incompleta 7, participantes 299. MÉTODO: Fase 1. Traducción-retrotraducción del cuestionario. Elaboración de versión inicial, estudio piloto y elaboración de la versión definitiva. Fase 2. Estudio de fiabilidad test-retest (n = 26) repitiendo el cuestionario siete días después de la primera entrevista y calculando el coeficiente kappa. Fiabilidad de la escala mediante el alfa de Cronbach. Validez lógica y de contenido mediante comité multidisciplinar. Validez de constructo: análisis factorial y asociación de DP con Trastorno de Ansiedad Generalizada (TAG), Episodio Depresivo Mayor (EDM), apoyo social percibido de Duke, presencia de DP medido con Inventario Texas Revisado de Duelo (ITRD) usando coeficiente phi de Pearson. Validez de criterio mediante comparación con entrevista clínica estandarizada (n = 84). RESULTADOS: Fiabilidad test-retest: Kappa = 1. Consistencia interna: Alfa de Cronbach = 0,9183. Validez de constructo: Correlación significativa de DP con TAG, EDM, DP medido con ITRD y apoyo social percibido bajo. En el análisis factorial dos ítems explicaron el 62,4 % de varianza. Prevalencia DP: 7,04 %. Validez de criterio: Al comparar diagnóstico de DP con entrevista clínica con PG-13: Sensibilidad 50 %, Especificidad 94,29 %, VPP 63,64 %, VPN 90,41 %, RVP 8,75, RVN 0,53. CONCLUSIONES: El cuestionario PG-13 es una herramienta apta para el cribado de DP

OBJECTIVES: This study aims to make the cross-cultural adaptation of the PG-13 and to study the validity and reliability of the Spanish version. DESIGN: Phase 1: Cross-cultural adaptation. Phase 2: Study of validity and reliabilitiy of this test. LOCATION: Primary Care service, Home palliative care service and three Hospices. PARTICIPANTS: Phase 1. Three English-Spanish traductors, three Spanish-English traductors. Panel of experts: Three Psychologists, one doctor and nurse from a home palliative care team and one primary care doctor. Phase 2: We invited 329 adults who had lost a loved person for more than 6 months but less than 18 months to participate, chosen with consecutive sampling. Decline to participate = 23, missing data = 7, participants 299. METHODS: Phase 1: Translation and back-translation to obtain a first draft. Pilot study and corrections to elaborate the final version. Phase 2: Intraobserver reliability study: 26 subjects repeated the questionnaire 7 days after the first evaluation, kappa coefficient was calculated. Cronbach's alpha was used to measure the reliability of the scale. Logic validity and content was studied by a panel of experts. Construct validity was studied by factorial analysis and Pearson's Phi association of results of PG-13 test with General Anxiety Disorder (GAD), Mayor Depressive Disorder (MDD), Duke's Social Perceived Support, and PG meassured by Texas Revised Inventory of Grief (TRIG). Criterion validity was studied using standarized clinical interview (n = 84). RESULTS: Intraobserver reliability study: Kappa=1. Cronbach's alpha = 0,9183. Statistical correlation was demonstrated between PG measured by PG-13 and GAD, MDD, low perceived social support and PG measured with TRIG. Factorial analysis showed that two items explained 62,4 % of variance. PG prevalence was 7,04 %. Comparing PG-13 questionnaire versus standarized clinical interview: Sensitivity 50 %, Specifity 94,29 %, Positive predictive value 63,64 %, Negative predictive value 90,41 %, Positive likelihood ratio 8,75, Negative likelihood ratio 0,53. CONCLUSION: PG-13 questionnaire is a suitable tool for PG screening

Cessation of breastfeeding in association with oxytocin administration and type of birth. A prospective cohort study.

BACKGROUND: Some studies have suggested an association between synthetic oxytocin administration and type of birth with the initiation and consolidation of breastfeeding. AIM: This study aimed to test whether oxytocin administration and type of birth are associated with cessation of exclusive breastfeeding at different periods. A second objective was to investigate whether the administered oxytocin dose is associated with cessation of exclusive breastfeeding. METHODS: We conducted a prospective cohort study (n=529) in a tertiary hospital. Only full-term singleton pregnancies were included. Four groups were established based on the type of birth (vaginal or cesarean) and the intrapartum administration of oxytocin. Follow-up was performed to evaluate the consolidation of exclusive breastfeeding at 1, 3 and 6months. FINDINGS: During follow-up, the proportion of exclusive breastfeeding decreased in all groups. After adjusting for confounding variables, the group with cesarean birth without oxytocin (planned cesarean birth) had the highest risk of cessation of exclusive breastfeeding (odds ratio [95% confidence interval], 2.51 [1.53-4.12]). No association was found between the oxytocin dose administered during birth and puerperium period and the cessation of exclusive breastfeeding. CONCLUSION: Planned cesarean birth without oxytocin is associated with the cessation of exclusive breastfeeding at 1, 3 and 6months of life. It would be desirable to limit elective cesarean births to essentials as well as to give maximum support to encourage breastfeeding in this group of women. The dose of oxytocin given during birth and puerperium period is not associated with cessation of exclusive breastfeeding.