Feasibility and accuracy of intraosseous endoscopy for inspection of thoracolumbar and lumbar pedicle drill tracts in a canine large-breed cadaveric model.

OBJECTIVE: To evaluate the feasibility of endoscopic inspection of thoracolumbar and lumbar pedicle tracts in a canine large-breed model and its accuracy for the detection of breached versus nonbreached tracts. ANIMALS: 2 greyhound cadavers. METHODS: CT scans of 2 greyhound cadavers from the sixth thoracic vertebra to the sacrum were obtained. Fifty-six pedicles were randomized to have drill tracts with different modified Zdichavsky grades (nonbreached, partial/full medial breach, or partial/full lateral breach) using 3-D-printed guides. Endoscopy was performed on a single occasion from October 9 to 10, 2023, using a 1.9-mm 0-degree needle arthroscope in a randomized blinded fashion. The grading of drill tracts was performed on postoperative CT. Specificity, sensitivity, positive and negative predictive values, and time to assign endoscopic grade were investigated. RESULTS: Postoperative CT confirmed 43 nonbreached tracts, 7 medial breaches (partial/full), and 5 lateral breaches (partial/full). One tract was excluded because of guide misplacement. Intraosseous endoscopy was successfully performed in the remaining 55 drill tracts. Sensitivity to detect medial and lateral breaches was 71.4% and 60.0%. Negative predictive value was 93.1%. Specificity was 94.2%. Positive predictive value for detection of medial and lateral breaches was 83.3% and 54.5%. Median (range) time to assign an endoscopic grade was 118 (30 to 486) seconds. CLINICAL RELEVANCE: Intraosseous endoscopy of pedicle drill tracts may be a useful adjunct technique during pedicle screw/pin placement in dogs.

Genotyping of the rs1800440 Polymorphism in CYP1B1 Gene and the rs9258883 Polymorphism in HLA-B Gene in a Spanish Cohort of 223 Patients with Frontal Fibrosing Alopecia.

The pathogenesis of frontal fibrosing alopecia has been linked to specific genetic variants. CYP1B1 codes for a component of the cytochrome p450 machinery that is involved in the metabolism of xenobiotic oestrogens. The study of the prevalence of polymorphisms in this gene may help to understand their role in the development of frontal fibrosing alopecia. The aim of this study is to describe the frequency of genetic variations in the alleles HLA-B*07:02 and CYP1B1 in patients with frontal fibrosing alopecia. A cross-sectional study was designed to evaluate blood samples from patients with frontal fibrosing alopecia who attended the Dermatology Department at University Hospital Ramón y Cajal (Madrid, Spain), in search of the polymorphisms rs9258883 and rs1800440 in the alleles HLA-B*07:02 and CYP1B1, respectively. A total of 223 patients were included in the study. Among the 83.8% of patients who carried the rs9258883 polymorphism in HLA-B*07:02, 58.7% were heterozygous for this variant and it was not present in 14.8% of the cases. The majority of patients with frontal fibrosing alopecia lacked the protective rs1800440 polymorphism in CYP1B1 (75.2%). This suggests a relevant role of this variant in development of frontal fibrosing alopecia. The genetic approach to this condition might influence patient prognosis and therapy options.

Case report: Vertical preparation protocol for veneers.

The biologically oriented preparation technique (BOPT) consists of a vertical preparation of the tooth that involves a reduction to zero of the emergence anatomy, the creation of a new finish area, and immediate temporization, so that the gingiva is supported by a suitable prosthetic restoration. To this effect, it is not the restoration that adapts to the gingiva, but the gingiva that adapts to the restoration. This technique not only allows the gingiva around the tooth to stabilise, but over time it will also facilitate the achievement of a predictable coronal migration of the gingival margin. The present paper describes the protocol from dental preparation to the cementation of the BOPT veneers, highlighting the differences with the established protocol for full coverage crowns and the protocol we have followed for many years for veneers with finish lines. Key words:Veneers, vertical preparation, BOPT.

Accuracy of pin placement in the canine thoracolumbar spine using a free-hand probing technique versus 3D-printed patient-specific drill guides: An ex-vivo study.

OBJECTIVE: To compare pin placement accuracy, intraoperative technique deviations, and duration of pin placement for pins placed by free-hand probing (FHP) or 3D-printed drill guide (3DPG) technique. SAMPLE POPULATION: Four greyhound cadavers. METHODS: Computed tomography (CT) examinations from T6-sacrum were obtained for determination of optimal pin placement and 3DPG creation. Two 3.2/2.4-mm positive profile pins were inserted per vertebra, one left and one right from T7-L7 (FHP [n = 56]; 3DPG [n = 56]) by one surgeon and removed for repeat CT. Duration of pin placement and intraoperative deviations (unanticipated deviations from planned technique) were recorded. Pin tracts were graded by two blinded observers using modified Zdichavsky classification. Descriptive statistics were used. RESULTS: A total of 54/56 pins placed with 3DPGs were assigned grade I (optimal placement) compared with 49/56 pins using the FHP technique. A total of 2/56 pins placed with 3DPGs and 3/56 pins using the FHP technique were assigned grade IIa (partial medial violation). A total of 4/56 pins placed using the FHP technique were assigned grade IIIa (partial lateral violation). No pins were assigned grade IIb (full medial violation). Intraoperative technique deviations occurred with 6/56 pins placed using the FHP technique and no pins with 3DPGs. Overall, pins were placed faster (mean ± SD 2.6 [1.3] vs. 4.5 [1.8] min) with 3DPGs. CONCLUSIONS: Both techniques were accurate for placement of spinal fixation pins. The 3DPG technique may decrease intraoperative deviations and duration of pin placement. CLINICAL RELEVANCE: Both techniques allow accurate pin placement in the canine thoracolumbar spine. The FHP technique requires specific training and has learning curve, whereas 3DPG technique requires specific software and 3D printers.

Retrospective analysis of 131 feline uroliths from the Republic of Ireland and Northern Ireland (2010-2020).

BACKGROUND: The proportions of different urolith types have not been investigated in cats from the Republic of Ireland (ROI) and Northern Ireland (NI) previously. The objective of this study was to investigate the proportions of different feline urolith types submitted to Minnesota Urolith Center from the ROI and NI from 2010 to 2020. An additional aim of this study was to identify potential risk factors associated with each urolith type in cats in this geographic area. RESULTS: One hundred and thirty-one uroliths were submitted for the studied period with 44.3% being struvite, 43.5% calcium oxalate and 7.6% compound. Only 11 uroliths were submitted in the first 4 years. The number of submissions increased after 2015, peaking in 2019 with 25 submissions. Due to low numbers no conclusions could be made about changes in incidence of urolith types over time. Cats ≤7 years of age were significantly more likely to be diagnosed with struvite uroliths (OR, 2.87 [1.37-6.06]; p = 0.007) while cats ≥7 years of age with calcium oxalate uroliths (OR, 2.67, [1.29-5.37], p = 0.004). CONCLUSIONS: This is the first epidemiologic study of urolithiasis from cats in the ROI and NI. The most prevalent types of uroliths in our study population were struvite and calcium oxalate. Due to the low number of urolith submissions, changes in the incidence of different uroliths could not be accurately determined. Increasing age was associated with calcium oxalate formation while younger cats were more commonly diagnosed with struvite urolithiasis which can be medically dissolved. Therefore, urolith dissolution is more likely to be successful in young cats than older cats.

La Calidad de Vida de las Cuidadoras Informales Principales en tiempos de COVID-19 y su Relación con la Enfermería de Atención Primaria / The quality of life of informal primary caregivers in times of covid-19 and its relation to primary care nursing

Objetivo: determinar la calidad de vida, la sobrecarga del rol del cuidador y el apoyo social percibido de las cuidado ras principales de pacientes pertenecien tes a la Cartera de Servicios de la Aten ción Domiciliaria de tres Centros de Sa lud del Área de Salud de Gran Canaria. Método: estudio descriptivo-transversal, con un muestreo aleatorio simple de cui dadoras. Participaron 89 cuidadoras, las cuáles realizaban 4 cuestionarios: uno de elaboración propia, Zarit (sobrecar ga), Duke (apoyo social percibido) y Coop-Wonca (calidad de vida). Este proyecto permite conocer la realidad psico social de las cuidadoras principales y con ello visibilizar su situación (AU)

Objective: to determine the quality of life, caregiver role overload and per ceived social support of the main caregi vers of patients belonging to the Home Care Service Portfolio of three Health Centres in the Health Area of Gran Cana ria. Method: descriptive-cross-sectional study, with simple random sampling of caregivers. Eighty-nine carers took part, completing four questionnaires: one self completed questionnaire , Zarit (overload), Duke (perceived social support) and Coop-Wonca (quality of life). This project allows us to know the psychosocial reality of the main carers and thus to make their situation more visible (AU)

Use of information and communication technologies (ICTs) in cancer multidisciplinary team meetings: an explorative study based on EU healthcare professionals.

OBJECTIVES: Multidisciplinary teams in cancer care are increasingly using information and communication technology (ICT), hospital health information system (HIS) functionalities and ICT-driven care components. We aimed to explore the use of these tools in multidisciplinary team meetings (MTMs) and to identify the critical challenges posed by their adoption based on the perspective of professionals representatives from European scientific societies. DESIGN: This qualitative study used discussion of cases and focus group technique to generate data. Thematic analysis was applied. SETTING: Healthcare professionals working in a multidisciplinary cancer care environment. PARTICIPANTS: Selection of informants was carried out by European scientific societies in accordance with professionals' degree of experience in adopting the implementation of ICT and from different health systems. RESULTS: Professionals representatives of 9 European scientific societies were involved. Up to 10 ICTs, HIS functionalities and care components are embedded in the informational and decision-making processes along three stages of MTMs. ICTs play a key role in opening MTMs to other institutions (eg, by means of molecular tumour boards) and information types (eg, patient-reported outcome measures), and in contributing to the internal efficiency of teams. While ICTs and care components have their own challenges, the information technology context is characterised by the massive generation of unstructured data, the lack of interoperability between systems from different hospitals and HIS that are conceived to store and classify information rather than to work with it. CONCLUSIONS: The emergence of an MTM model that is better integrated in the wider health system context and incorporates inputs from patients and support systems make traditional meetings more dynamic and interconnected. Although these changes signal a second transition in the development process of multidisciplinary teams, they occur in a context marked by clear gaps between the information and management needs of MTMs and the adequacy of current HIS.

Oncoplastia, reconstrucción prepectoral inmediata e injerto libre del complejo areola-pezón en paciente BRCA 1. Informe de un caso / Oncoplasty, inmediate prepectoral reconstruction and free graft of the nipple–areola complex in patient BRCA 1. Case report

La reconstrucción prepectoral inmediata supone una alternativa cada vez más extendida para las pacientes con mayor susceptibilidad genética para padecer un cáncer de mama. La técnica más utilizada para la mastectomía y reconstrucción prepectoral con malla acelular consiste en un abordaje mediante incisión lateral sin modificar las características del envoltorio cutáneo. Las pacientes con importante ptosis mamaria pueden suponer una limitación en la reconstrucción prepectoral debido a la proyección protésica en el nuevo centro mamario, que se encontrará en posición craneal al complejo areola-pezón. No existen casos documentados en la literatura científica disponible que describan reconstrucciones prepectorales inmediatas con injertos libres del complejo areola-pezón. Presentamos el caso clínico de una mujer de 34 años con importantes antecedentes familiares de cáncer de mama y diagnóstico de mutación en el gen BRCA 1. Solicitó realizar cirugía de reducción de riesgo. Se intervino mediante mastectomía subcutánea a través de un patrón de mamoplastia vertical y reconstrucción prepectoral con prótesis y malla acelular con injerto libre del complejo areola-pezón en el nuevo centro mamario. Mostramos que es posible asociar el diseño de un patrón oncoplástico con injerto libre del complejo areola-pezón a una técnica de reconstrucción inmediata prepectoral con prótesis y malla acelular. (AU)

Immediate prepectoral reconstruction is an increasingly widespread alternative for patients with a higher genetic susceptibility to breast cancer. The most commonly used technique for mastectomy and prepectoral reconstruction with acellular mesh is a lateral incision approach without changing the characteristics of the skin envelope. Patients with significant breast ptosis can be a limitation in prepectoral reconstruction due to the prosthetic projection in the new breast centre, which will be cranial to the nipple–areola complex. There are no documented cases in the available scientific literature describing immediate prepectoral reconstructions with free grafts of the nipple–areola complex. We present the clinical case of a 34-year-old woman with a family history of breast cancer and a diagnosis of BRCA 1 gene mutation. She underwent subcutaneous mastectomy through a vertical mammoplasty pattern and prepectoral reconstruction with prosthesis and acellular mesh with free grafting of the nipple–areola complex in the new breast centre. We show that it is possible to associate the design of an oncoplastic pattern with free grafting of the nipple–areola complex to an immediate prepectoral reconstruction technique with prosthesis and acellular mesh. (AU)

Burnout in Specialized Care Nurses during the First COVID-19 Outbreak in Spain.

Background: One of the most outstanding consequences of the pandemic is the impact it had on the mental health of nurses caring for patients with COVID-19 in specialised services. Aim: The aim was to analyse the burnout levels of nursing professionals during the COVID-19 pandemic in specialised care and their relationship with variables of the socio-occupational context. Method: This was a quantitative, descriptive, observational, cross-sectional study, which included a sample of 355 nursing professionals. The instrument used was a questionnaire (Maslach Burnout Inventory Human Services Survey (MBI-HSS)). Results: A mean score of 27.44 (SD = 12.01) was obtained in the subscale "Emotional exhaustion"; in "Depersonalisation", the mean score was 7.26 (SD = 6.00); and, finally, in "Personal fulfilment", the mean score was 38.27 (SD = 7.04). Statistically significant differences were found in the subscale "Emotional exhaustion", which is higher in women than in men. The subscale "Personal Accomplishment" was higher in the age group 51-65 years. Regarding the "Depersonalisation" subscale, statistically significant differences were found with respect to the years of experience in the current service, which is higher in the group aged 39 years or more. Conclusion: Intervention programmes are required in healthcare systems to improve the emotional well-being of nursing professionals.

Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain).

The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011-12) and pancreatic cancer (2012-15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients' homes and their reference centers, clinical patient and treatment data, income category, and data from the patients' district hospitals. A composite 'textbook outcome' was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium-high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15-1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51-7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival.

Centralisation of surgery for complex cancer diseases: A scoping review of the evidence base on pancreatic cancer.

BACKGROUND: Centralisation of cancer surgery is a commonly applied healthcare strategy worldwide. This study aimed to detail the design of centralisation policies, to shed light on the implications of such policies in real practice and to describe the different perspectives taken to deal with difficulties that emerged, taking pancreatic cancer as an example of a complex cancer disease requiring surgery. METHODOLOGY: A scoping review was conducted using the MEDLINE database. We systematically searched for eligible studies published between January 2000 and December 2018. RESULTS: In the 33 included studies, centralisation of pancreatic cancer surgery was implemented through three different models: designated hospitals, definition of minimum volumes per provider, and/or recommendations included in protocols and national guidelines. The presence of highly advanced technology and infrastructures, the availability of extensive service coverage and advanced care processes based on expert multidisciplinary teams, and higher caseloads were identified as key components of centralisation policy. CONCLUSIONS: Centralisation models for pancreatic cancer surgery showed that having expert centres where the care process is comprehensively guided is a foundational policy approach. External quality assessment and the accreditation of centres and professionals performing complex surgical procedures are levers that may positively impact the effectiveness of the measure. POLICY SUMMARY: while we found different experiences and three models of centralisation, all of them were guided by the will to positively impact on pancreatic cancer patients' access to expert care. Clinical research might be able to make progress in the coming years and perhaps contribute to reversing a critical situation of high mortality and growing incidence. However, policymakers must optimise health system responses considering current resources, as suggested by the recommendations proposed in the framework of the EU initiative Bratislava Statement for pancreatic cancer care.

Effectiveness of dutasteride in a large series of patients with frontal fibrosing alopecia in real clinical practice.

BACKGROUND: Dutasteride has been proposed as an effective therapy for frontal fibrosing alopecia (FFA). OBJECTIVES: We sought to describe the therapeutic response to dutasteride and the most effective dosage in FFA compared with other therapeutic options or no treatment. METHODS: This was a retrospective observational study including patients with FFA with a minimum follow-up of 12 months. Therapeutic response was evaluated according to the stabilization of the hairline recession. RESULTS: A total of 224 patients (222 females) with a median follow-up of 24 months (range 12-108 months) were included. The stabilization rate for the frontal, right, and left temporal regions after 12 months was 62%, 64%, and 62% in the dutasteride group (n = 148), 60%, 35%, and 35% with other systemic therapies (n = 20), and 30%, 41%, and 38% without systemic treatment (n = 56; P = .000, .006, and .006, respectively). Stabilization showed a statistically significant association with an increasing dose of dutasteride (88%, 91%, and 84% with a weekly treatment of 5 or 7 doses of 0.5 mg [n = 32], P < .005). Dutasteride was well tolerated in all patients. LIMITATIONS: Limitations included the observational and retrospective design. CONCLUSIONS: Oral dutasteride was the most effective therapy with a dose-dependent response for FFA in real clinical practice compared with other systemic therapies or no systemic treatment.

Bratislava Statement: consensus recommendations for improving pancreatic cancer care.

Pancreatic cancer is one of the most lethal tumours, and it is the fourth cause of cancer death in Europe. Despite its important public health impact, no effective treatments exist, nor are there high-visibility research efforts to improve care. This alarming situation is emblematic of a larger group of cancer diseases, known as neglected cancers. To address the impact of these diseases, the European Commission-supported Innovative Partnership for Action Against Cancer launched a multi-stakeholder initiative to determine key steps that healthcare systems can rapidly implement to improve their response. A working group comprising 20 representatives from European medical societies, patient associations, cancer plan organisations and other relevant European healthcare stakeholders was organised. A consensus process based on the results of different studies, discussion of research outcomes, and development and endorsement of draft statements resulted in 22 consensus recommendations (the Bratislava Statement). The statement argues that substantial improvements can be achieved in patient outcomes by centralising pancreatic cancer care around state-of-the-art reference centres, staffed by expert multidisciplinary teams capable of providing high-quality care. This organisational model requires a specific care framework encompassing primary, palliative and survivorship care, and a policy environment prioritising the use of quality criteria and performance assessments as well as research investments dedicated to prevention, risk prediction, early detection and diagnosis. In order to address the challenges posed by neglected cancers in general and pancreatic cancer in particular, a specific control strategy tailored to this reality is required.

Prescribing Habits for Androgenic Alopecia among Dermatologists in Spain in 2019-2020: A Cross-Sectional Study.

BACKGROUND: In 2017, we carried out a cross-sectional study with the aim of describing androgenic alopecia (AGA) prescription habits among dermatologists who practice in Spain. Three years later, we repeated this study with the aim of describing the current situation and comparing it with previous data. MATERIAL AND METHODS: Descriptive cross-sectional study using online questionnaires autocompleted by dermatologists working in Spain. RESULTS: The responses of 243 dermatologists were analyzed. The most common treatments prescribed for MAGA were topical minoxidil (100%), oral finasteride (92.6%), oral dutasteride (75.7%), and oral minoxidil (50.6%). For premenopausal female AGA (FAGA), the most common treatments were topical minoxidil (99%), oral contraceptives (75%), nutricosmetics (71%), and oral minoxidil (67.9%). Lastly, the most common treatments prescribed in patients with postmenopausal FAGA were topical minoxidil (99.2%), oral finasteride (79%), oral durasteride (71.6%), and oral minoxidil (63%). CONCLUSIONS: In conclusion, AGA is the most frequent alopecia in the trichology clinic. The most common treatments prescribed in male AGA (MAGA) and postmenopausal FAGA were topical minoxidil and oral finasteride, while in premenopausal FAGA, topical minoxidil, oral contraceptives, and nutricosmetics were most commonly prescribed. In the past three years, oral dutasteride and oral minoxidil have increased drastically among the most prescribed therapies for MAGA, premenopausal FAGA, and postmenopausal FAGA.