Ureteral stent after PCNL: is leaving the threads through the percutaneous tract safe and better tolerated?

OBJECTIVE: To assess safety, urinary symptoms, and feasibility of JJ stent removal with exteriorized threads through the percutaneous tract after percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: Prospective, transversal, comparative, experimental, randomized 1-to-1 cohort study in 52 patients who underwent "tubeless" PCNL from October 2020 to November 2022. Group A with threads through the urethra and Group B through the percutaneous tract. The validated USSQ (Ureteral Stent Symptom Questionnaire) was applied in the Urology office a week after the procedure, and the JJ stent was withdrawn by pulling the threads. Hemoglobin and urine culture, and pre- and post-surgery were evaluated. RESULTS: There is a statistically significant difference in favor of group B when comparing urinary symptoms (p = 0.008), body pain (p = 0.009), and general condition (p = 0.042), mainly for non-urgency incontinence, frequency of analgesic use, and dysuria. There were significant differences between groups (p = 0.028, p = 0.026, p = 0.027, respectively). There is no association with urinary infections (p = 0.603) nor an increased risk of bleeding (p = 0.321). CONCLUSION: The removal of the JJ stent with exteriorized threads through the percutaneous tract after PCNL in the office is a feasible and safe procedure if it is removed before 8 days and has better tolerance regarding the urinary symptoms.

Mendelian Randomisation Confirms the Role of Y-Chromosome Loss in Alzheimer's Disease Aetiopathogenesis in Men.

Mosaic loss of chromosome Y (mLOY) is a common ageing-related somatic event and has been previously associated with Alzheimer's disease (AD). However, mLOY estimation from genotype microarray data only reflects the mLOY degree of subjects at the moment of DNA sampling. Therefore, mLOY phenotype associations with AD can be severely age-confounded in the context of genome-wide association studies. Here, we applied Mendelian randomisation to construct an age-independent mLOY polygenic risk score (mloy-PRS) using 114 autosomal variants. The mloy-PRS instrument was associated with an 80% increase in mLOY risk per standard deviation unit (p = 4.22 × 10-20) and was orthogonal with age. We found that a higher genetic risk for mLOY was associated with faster progression to AD in men with mild cognitive impairment (hazard ratio (HR) = 1.23, p = 0.01). Importantly, mloy-PRS had no effect on AD conversion or risk in the female group, suggesting that these associations are caused by the inherent loss of the Y chromosome. Additionally, the blood mLOY phenotype in men was associated with increased cerebrospinal fluid levels of total tau and phosphorylated tau181 in subjects with mild cognitive impairment and dementia. Our results strongly suggest that mLOY is involved in AD pathogenesis.

Impacto del uso de las técnicas moleculares (PCR) en la detección y el éxito erradicador frente a Helicobacter pylori / Impact of the use of molecular techniques (PCR) on detection and eradication success against Helicobacter pylori

Introducción: La infección por Helicobacter pylori (H. pylori) afecta a más del 50% de la población mundial. El aumento en las resistencias antibióticas es la principal causa del fracaso del tratamiento. El objetivo principal fue analizar el éxito erradicador tras la aplicación de las nuevas recomendaciones de tratamiento ESPGHAN e introducción de la PCR como técnica de diagnóstico directo, describir la evolución del patrón local de resistencias antibióticas y valorar el coste-efectividad de la aplicación de la PCR aislada o en conjunto con el cultivo como estrategia diagnóstica. Pacientes y métodos: Estudio descriptivo retrospectivo del total de aislamientos microbiológicos de H. pylori entre 2013-2019 en nuestro centro, mediante comparación del porcentaje de resistencias y éxito erradicador entre los periodos 2013-2016 y 2017-2019. Estudio de coste-efectividad de las pruebas de diagnóstico directo, comparando 3 opciones distintas: cultivo y PCR, solo cultivo, y solo PCR. Resultados: Se incluyó a 192 pacientes, 98 fueron detectados por cultivo (2013-2016) y 94 por cultivo o PCR (2017-2019). Se instauró tratamiento antibiótico en 153 pacientes, 90 en el primer periodo (pautas ESPGHAN 2011: porcentaje erradicación 62,2%), 63 en el segundo (pautas ESPGHAN 2017: porcentaje erradicación: 73%). Se observó un aumento en las resistencias a claritromicina, pasando de un 16,3% (n=16) en el primer periodo a un 53,2% (n=48) entre 2017-2019 (98% detectadas por PCR, 60% por cultivo). No hubo diferencias en el resto de resistencias antibióticas. La solicitud aislada de la PCR presentó una ratio de análisis de coste-efectividad (CEAR) de 71,91, en comparación con un 92,16 del cultivo y un 96,35 del cultivo y la PCR de forma conjunta. (AU)

Introduction: Helicobacter pylori (H. pylori) infection affects more than 50% of the world population. Increased antibiotic resistance is the main cause of treatment failure. The main objective was to analyze the eradication success after the application of the new ESPGHAN treatment recommendations and the introduction of PCR as a direct diagnosis technique, describe the evolution of the local pattern of antibiotic resistance, and assess the cost-effectiveness of PCR application, isolated or in conjunction with culture as a diagnostic strategy. Patients and methods: retrospective descriptive study of all microbiological isolates of H. pylori in 2013-2019 in our center, by comparing the percentage of resistance and eradication success between the periods 2013-2016 and 2017-2019. Cost-effectiveness study of direct diagnostic tests, comparing 3 different options: culture and PCR; only culture; PCR only. Results: 192 patients were included, 98 were detected by culture (2013-2016) and 94 by culture and / or PCR (2017-2019). Antibiotic treatment was established in 153 patients, 90 in the first period (2011 ESPGHAN guidelines: eradication percentage 62.2%), 63 in the second (2017 ESPGHAN guidelines: eradication percentage: 73%). An increase in resistance to clarithromycin was observed, going from 16.3% (n=16) in the first period, to 53.2% (n=48) in 2017-2019 (98% detected by PCR, 60% by culture). There were no differences in the rest of antibiotic resistances. The isolated PCR application presented a cost-effectiveness analysis ratio (CEAR) of 71.91, compared to 92.16 for the culture and 96.35 for the culture and PCR combined. (AU)

Impact of the use of molecular techniques (PCR) on detection and eradication success against Helicobacter pylori.

INTRODUCTION: Helicobacter pylori infection affects more than 50% of the world population. Increased antibiotic resistance is the main cause of treatment failure. The main objective was to analyze the eradication success after the application of the new ESPGHAN treatment recommendations and the introduction of PCR as a direct diagnosis technique, describe the evolution of the local pattern of antibiotic resistance, and assess the cost-effectiveness of PCR application, isolated or in conjunction with culture as a diagnostic strategy. PATIENTS AND METHODS: Retrospective descriptive study of all microbiological isolates of Helicobacter pylori in 2013-2019 in our center, by comparing the percentage of resistance and eradication success between the periods 2013-2016 and 2017-2019. Cost-effectiveness study of direct diagnostic tests, comparing 3 different options: culture and PCR; only culture; PCR only. RESULTS: 192 patients were included, 98 were detected by culture (2013-2016) and 94 by culture and/or PCR (2017-2019). Antibiotic treatment was established in 153 patients, 90 in the first period (2011 ESPGHAN guidelines: eradication percentage 62.2%), 63 in the second (2017 ESPGHAN guidelines: eradication percentage: 73%). An increase in resistance to clarithromycin was observed, going from 16.3% (n=16) in the first period, to 53.2% (n=48) in 2017-2019 (98% detected by PCR, 60% by culture). There were no differences in the rest of antibiotic resistances. The isolated PCR application presented a cost-effectiveness analysis ratio (CEAR) of 71.91, compared to 92.16 for the culture and 96.35 for the culture and PCR combined. CONCLUSIONS: The application of the ESPGHAN 2017 guidelines achieved greater eradication success, although less than that observed in previous publications, without reaching the target of at least 90%. An increase in resistance to macrolides was observed, without being able to discriminate whether it is a real increase or a greater diagnostic sensitivity of molecular techniques, with the isolated request for PCR being the most cost-effective strategy.

[Correlation between insufficiency or deficiency of vitamin D levels and interleukins 1ß and 6]. / Correlación entre la insuficiencia o deficiencia de los niveles de vitamina D y las interleucinas 1ß y 6.

OBJECTIVES: The primary objective of this study was to define the relationship between vitamin D levels and interleukins (IL) 1ß and 6 as inflammatory markers in a healthy population. As a secondary objective, to measure the prevalence of insufficiency/ deficiency of vitamin D in the same population. METHODS: A sample of 43 healthy blood donors, without chronic-degenerative, inflammatory, or infectious diseases, and without obesity, was selected. Serum levels of IL-1ß and IL-6 were measured in individuals with insufficiency or deficiency of vitamin D. The correlation between vitamin D and interleukins was measured using Spearman's rho. RESULTS: No correlation was found between levels of vitamin D and interleukins. In addition, a prevalence of insufficiency/deficiency of vitamin D was found in 95.3% of the sample. CONCLUSIONS: In healthy subjects with deficiency or insufficiency of vitamin D, there is no association between the levels of this vitamin and IL-1ß and IL-6.

Objetivos: El objetivo primario de este estudio fue definir la relación entre los niveles de vitamina D y las interleucinas (IL) 1ß y 6, como marcadores inflamatorios en población sana. Como objetivo secundario, medir la prevalencia de insuficiencia/deficiencia de vitamina D en la misma población. Métodos: Se seleccionó una muestra de 43 donadores de sangre sanos, sin enfermedades crónico-degenerativas, inflamatorias o infecciosas, y sin obesidad. A los individuos con insuficiencia o deficiencia de vitamina D se les midieron niveles séricos de IL-1ß e IL-6. Se midió la correlación de vitamina D e interleucinas mediante rho de Spearman. Resultados: No se encontró correlación entre los niveles de vitamina D y las interleucinas. Adicionalmente, se encontró una prevalencia de insuficiencia/deficiencia de vitamina D en 95.3 % de la muestra. Conclusiones: En sujetos sanos con deficiencia o insuficiencia de vitamina D, no existe correlación entre los niveles de esta vitamina y de IL-1ß e IL-6.

Clinical Impact of the COVID-19 Pandemic in Mexican Patients with Thoracic Malignancies.

BACKGROUND: Accumulated evidence indicates that patients with lung cancer are a vulnerable population throughout the pandemic. Limited information is available in Latin America regarding the impact of the pandemic on medical care. The goal of this study was to describe the clinical and social effect of COVID-19 on patients with thoracic cancer and to ascertain outcomes in those with a confirmed diagnosis. MATERIALS AND METHODS: This cohort study included patients with thoracic neoplasms within a single institution between March 1, 2020, and February 28, 2021. All variables of interest were extracted from electronic medical records. During this period, the Depression Anxiety and Stress Scale 21 (DASS-2) was applied to evaluate and identify more common psychological disorders. RESULTS: The mean age for the total cohort (n = 548) was 61.5 ± 12.9 years; non-small cell lung cancer was the most frequent neoplasm (86.9%), advanced stages predominated (80%), and most patients were under active therapy (82.8%). Any change in treatment was reported in 23.9% of patients, of which 78.6% were due to the COVID-19 pandemic. Treatment delays (≥7 days) were the most frequent modifications in 41.9% of cases, followed by treatment suspension at 37.4%. Patients without treatment changes had a more prolonged progression-free survival and overall survival (hazard ratio [HR] 0.21, p < .001 and HR 0.28, p < .001, respectively). The mean DASS-21 score was 10.45 in 144 evaluated patients, with women being more affected than men (11.41 vs. 9.08, p < .001). Anxiety was reported in 30.5% of cases, followed by depression and distress in equal proportions (18%). Depressed and stressed patients had higher odds of experiencing delays in treatment than patients without depression (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.53-13.23, p = .006 and OR 3.18, 95% CI 1.2-10.06, p = .006, respectively). CONCLUSION: Treatment adjustments in patients with thoracic malignancies often occurred to avoid COVID-19 contagion with detrimental effects on survival. Psychological disorders could have a role in adherence to the original treatment regimen. IMPLICATIONS FOR PRACTICE: The pandemic has placed an enormous strain on health care systems globally. Patients with thoracic cancers represent a vulnerable population, with increased morbidity and mortality rates. In Mexico, treatment modifications were common during the pandemic, and those who experienced delays had worse survival outcomes. Most treatment modifications were related to a patient decision rather than a lockdown of health care facilities in which mental health impairment plays an essential role. Moreover, the high case fatality rate highlights the importance of improving medical care access. Likewise, to develop strategies facing future threats that may compromise health care systems in non-developed countries.

Percutaneous nephrolithotomy with ultrasound-assisted puncture: does the technique reduce dependence on fluoroscopic ionizing radiation?

PURPOSE: The ultrasound-guided (US) puncture in percutaneous nephrolithotomy (PCNL) has demonstrated advantages over traditional fluoroscopy access. The aim of this study was to demonstrate the reduction of fluoroscopy time using this technique during PCNL as the surgeon gained experience. METHODS: Transversal study performed on 30 consecutive patients undergoing PCNL from March to November 2019. All punctures were performed with US guidance. The patients were divided into 2 groups of 15 each according to the chronological order of the intervention. Demographic data, preoperative parameters, puncture time, fluoroscopy time, stone-free rate and complications were analyzed. RESULTS: The time of fluoroscopy was considerably reduced as the experience in the number of cases increased, reducing from 83.09 ± 47.8 s in group 1 to 22.8 ± 10.3 s in group 2 (p < 0.01), the time required to perform the puncture was reduced of 108.1 ± 68.9 s in group 1, to 92.6 ± 94.7 s in group 2 (p < 0.67). Stone free rate of 83.3% was obtained globally. CONCLUSION: US percutaneous renal access is safe and reproducible technique; the main advantage is to reduce exposure to radiation without compromising clinical results and has a short learning curve for urologists with prior experience in PCNL.

[Impact of the use of molecular techniques (PCR) on detection and eradication success against Helicobacter pylori]. / Impacto del uso de las técnicas moleculares (PCR) en la detección y el éxito erradicador frente a Helicobacter pylori.

INTRODUCTION: Helicobacter pylori (H. pylori) infection affects more than 50% of the world population. Increased antibiotic resistance is the main cause of treatment failure. The main objective was to analyze the eradication success after the application of the new ESPGHAN treatment recommendations and the introduction of PCR as a direct diagnosis technique, describe the evolution of the local pattern of antibiotic resistance, and assess the cost-effectiveness of PCR application, isolated or in conjunction with culture as a diagnostic strategy. PATIENTS AND METHODS: retrospective descriptive study of all microbiological isolates of H. pylori in 2013-2019 in our center, by comparing the percentage of resistance and eradication success between the periods 2013-2016 and 2017-2019. Cost-effectiveness study of direct diagnostic tests, comparing 3 different options: culture and PCR; only culture; PCR only. RESULTS: 192 patients were included, 98 were detected by culture (2013-2016) and 94 by culture and / or PCR (2017-2019). Antibiotic treatment was established in 153 patients, 90 in the first period (2011 ESPGHAN guidelines: eradication percentage 62.2%), 63 in the second (2017 ESPGHAN guidelines: eradication percentage: 73%). An increase in resistance to clarithromycin was observed, going from 16.3% (n=16) in the first period, to 53.2% (n=48) in 2017-2019 (98% detected by PCR, 60% by culture). There were no differences in the rest of antibiotic resistances. The isolated PCR application presented a cost-effectiveness analysis ratio (CEAR) of 71.91, compared to 92.16 for the culture and 96.35 for the culture and PCR combined. CONCLUSIONS: the application of the ESPGHAN 2017 guidelines achieved greater eradication success, although less than that observed in previous publications, without reaching the target of at least 90%. An increase in resistance to macrolides was observed, without being able to discriminate whether it is a real increase or a greater diagnostic sensitivity of molecular techniques, with the isolated request for PCR being the most cost-effective strategy.

Factors associated with residual symptom burden in patients with peritoneal dialysis: a cohort study / Factores asociados a carga sintomática residual en pacientes con diálisis peritoneal: estudio de cohorte

BACKGROUND: Patients on peritoneal dialysis have residual symptoms that reduce their quality of life. OBJECTIVE: To determine the associated factors of residual symptom burden in patients with continuous ambulatory peritoneal dialysis (CAPD). MATERIAL AND MEHOTDS: An observational, longitudinal, prospective and analytical study was carried out in patients with chronic kidney disease, who were candidates for peritoneal dialysis. The Palliative Care Outcome Scale-Symptoms Renal (POS-S Renal) questionnaire was applied in predialysis and 3 months after CAPD. The residual symptom burden was determined three months after CAPD with a value ≥ 8 points of the POS-S Renal questionnaire. The clinical and biochemical variables coded in a dichotomous manner were compared with the residual symptom burden. Relative risk (RR) with 95% confidence intervals and logistic regression models were calculated. RESULTS: Seventy patients were included. The mean of glomerular filtration rate (GFR) was 4.7 ± 2 ml/min/1.73 m2. The median of the POS-S Renal score in predialysis was 30 points, and 3 months after CAPD was 8 points. The slight symptom burden predialysis presented a RR of 0.18. CONCLUSIONS: The slight symptom burden predialysis is a protective factor independent for residual symptom burden three months after CAPD.

INTRODUCCIÓN: Los pacientes en diálisis peritoneal presentan síntomas residuales que reducen su calidad de vida. OBJETIVO: Determinar los factores asociados a la carga sintomática residual en pacientes con diálisis peritoneal continua ambulatoria (DPCA). MATERIAL Y MÉTODOS: Estudio observacional, longitudinal, prospectivo y analítico. Se incluyeron pacientes con enfermedad renal crónica candidatos a diálisis peritoneal. Se les aplicó el cuestionario Palliative Care Outcome Scale-Symptoms Renal (POS-S Renal) en prediálisis y a los 3 meses de DPCA. Se determinó la carga sintomática residual a los 3 meses de DPCA con un valor ≥ 8 puntos del cuestionario POS-S Renal. Las variables clínicas y bioquímicas codificadas de forma dicotómica fueron comparadas con la carga sintomática residual. Se calcularon el riesgo relativo (RR), los intervalos de confianza del 95% y los modelos de regresión logística. RESULTADOS: Se incluyeron 70 pacientes. La media de la tasa de filtrado glomerular fue de 4.7 ± 2 ml/min/1.73 m2. La mediana de la puntuación POS-S Renal en prediálisis fue de 30 puntos y a los 3 meses de la DPCA fue de 8 puntos. La carga sintomática leve prediálisis presentó un RR de 0.18. CONCLUSIONES: La carga sintomática leve prediálisis es un factor protector independiente de la carga sintomática residual a los 3 meses de la DPCA.

Effect of Metformin Plus Tyrosine Kinase Inhibitors Compared With Tyrosine Kinase Inhibitors Alone in Patients With Epidermal Growth Factor Receptor-Mutated Lung Adenocarcinoma: A Phase 2 Randomized Clinical Trial.

IMPORTANCE: Metformin hydrochloride is emerging as a repurposed anticancer drug. Preclinical and retrospective studies have shown that it improves outcomes across a wide variety of neoplasms, including lung cancer. Particularly, evidence is accumulating regarding the synergistic association between metformin and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs). OBJECTIVE: To assess the progression-free survival (PFS) in patients with advanced lung adenocarcinoma who received treatment with EGFR-TKIs plus metformin compared with those who received EGFR-TKIs alone. DESIGN, SETTING, AND PARTICIPANTS: Open-label, randomized, phase 2 trial conducted at the Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. Eligible patients were 18 years or older, had histologically confirmed stage IIIB-IV lung adenocarcinoma with an activating EGFR mutation. INTERVENTIONS: Patients were randomly allocated to receive EGFR-TKIs (erlotinib hydrochloride, afatinib dimaleate, or gefitinib at standard dosage) plus metformin hydrochloride (500 mg twice a day) or EGFR-TKIs alone. Treatment was continued until occurrence of intolerable toxic effects or withdrawal of consent. MAIN OUTCOMES AND MEASURES: The primary outcome was PFS in the intent-to-treat population. Secondary outcomes included objective response rate, disease control rate, overall survival (OS), and safety. RESULTS: Between March 31, 2016, and December 31, 2017, a total of 139 patients (mean [SD] age, 59.4 [12.0] years; 65.5% female) were randomly assigned to receive EGFR-TKIs (n = 70) or EGFR-TKIs plus metformin (n = 69). The median PFS was significantly longer in the EGFR-TKIs plus metformin group (13.1; 95% CI, 9.8-16.3 months) compared with the EGFR-TKIs group (9.9; 95% CI, 7.5-12.2 months) (hazard ratio, 0.60; 95% CI, 0.40-0.94; P = .03). The median OS was also significantly longer for patients receiving the combination therapy (31.7; 95% CI, 20.5-42.8 vs 17.5; 95% CI, 11.4-23.7 months; P = .02). CONCLUSIONS AND RELEVANCE: To our knowledge, this is the first study to prospectively show that the addition of metformin to standard EGFR-TKIs therapy in patients with advanced lung adenocarcinoma significantly improves PFS. These results justify the design of a phase 3, placebo-controlled study. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03071705.

Utilidad de la PET/TAC en el diagnóstico de la arteritis de Takayasu de segmento corto / Usefulness of the PET/CT scan in the diagnosis of short-segment Takayasu arteritis

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Endothelial Cells Filopodia in the Anastomosis of Central Nervous System Capillaries.

In this article we explore filopodia of endothelial cells (ECs) in the developing central nervous system (CNS) using the Golgi method and transmission electron microscopy. Filopodia of ECs play a crucial role in the anastomosis of growing capillaries of the CNS. The leading ECs filopodia from approaching capillaries interconnect forming complex conglomerates that precede the anastomotic event. The contacting filopodia form narrow spaces between them filled with proteinaceous basal lamina material. The original narrow spaces coalesce into larger ones leading to the formation of a single one that will interconnect (anastomose) the two approaching capillaries. The four leading ECs (two for each approaching capillary) become the wall of the newly formed post-anastomotic CNS capillaries. These new CNS capillaries are very small with narrow and irregular lumina that might permit the passage of fluid but not yet of blood cells. Eventually, their lumen enlarges and permits the passage of blood cells.

Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial.

OBJECTIVES: To assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group's experiences and learning preferences. METHODS: A single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N=210) to computer-based learning (N=211). Primary outcomes: communication scores during repeat interactions with MPathic-VR's intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. SECONDARY OUTCOMES: student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning. RESULTS: MPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters. CONCLUSIONS: MPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation. PRACTICE IMPLICATIONS: MPathic-VR's virtual human simulation offers an effective and engaging means of advanced communication training.

Autonomy and Firefighting: Perceived Competence and Stress.

OBJECTIVE: In workplace settings, autonomy is implicated in employee motivation as well as supervisor autonomy support. As a profession of risk, firefighters may experience greater levels of stress. METHODS: A self-determination paradigm was applied to the firefighter workplace. Of particular interest were perceived competence (to perform job duties) and the experience of stress. Firefighters' levels of autonomous and controlled regulation were surveyed, along with their perceptions of the autonomy support of their immediate supervisor. RESULTS: Autonomous regulation was positively related to perceived competence, whereas controlled regulation was negatively related. Higher levels of controlled regulation were also connected with greater stress. In contrast, greater perceived autonomy support was associated with decreased stress. CONCLUSIONS: Both perceived competence and stress are related to firefighter motivation and autonomy support. Recommendations are offered to increase autonomy support by chief officers.

[Prognostic factors of morbimortality in patients with emphysematous pyelonephritis]. / Factores pronósticos de morbimortalidad en pacientes con pielonefritis enfisematosa.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN. METHODS: It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome. RESULTS: 73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p <0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p <0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p < 0.001) were factors significantly associated with adverse outcome. CONCLUSION: Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.

Introducción: La pielonefritis enfisematosa es una infección grave del tracto urinario caracterizada por la presencia de gas en los sistemas colectores, en el parénquima renal o en el tejido perirrenal; su causa no es del todo conocida, pero se ha sugerido que se debe a la fermentación de glucosa por enterobacterias y anaerobios. El objetivo fue evaluar los factores pronósticos de morbimortalidad en pacientes con diagnóstico de pielonefritis enfisematosa. Métodos: estudio de cohorte histórica en pacientes con diagnóstico de pielonefritis enfisematosa que ingresaron a nuestro hospital de marzo de 2005 a diciembre de 2014. Se identificaron los pacientes con desenlace adverso definido como aquel que requirió estancia en unidad de cuidados intensivos, nefrectomía o muerte. Se realizó una regresión logística múltiple para obtener la relación de cada factor pronóstico con el desenlace adverso. Resultados: Fueron evaluados 73 pacientes (48 mujeres [65.8 %]). Diabetes, litiasis urinaria, infección por Escherichia coli y el estado de choque se presentaron en 68.5 %, 68.5 %, 63 % y 15.1 %, respectivamente. Fueron factores significativos para desenlace adverso la leucocitosis ≥ 12 000 µL (RM 43.65, IC 95 % 2.36-805, p < 0.001), la trombocitopenia ≤ 120 000 µL (RM 363, IC 95 % 9.2-14208, p < 0.0001), y la clase radiológica 3 de Huang (RM 62, IC 95 % 4-964, p < 0.001). Conclusión: la trombocitopenia, la leucocitosis y la clase radiológica 3 se asociaron con un desenlace adverso en los pacientes con pielonefritis enfisematosa.

Burning Out Faculty at Doctoral Research Universities.

The present study examined the importance of time allocation, pressure and support variables together as determinants of faculty burnout. Using a large sample of university faculty (N = 1439), we were able to show that time allocation variables and perceived pressure contribute to faculty burnout. As expected, decreased social support, family, sleep and leisure time were related to higher levels of burnout. Grantsmanship and service activities appeared as the most critical factors associated with faculty burnout. Faculty burnout is an important topic, and the insights provided here help offer some directions for future research as well as the development of effective institutional policies. Copyright © 2015 John Wiley & Sons, Ltd.

A Comparison of Composite Reliability Estimators: Coefficient Omega Confidence Intervals in the Current Literature.

Coefficient omega and alpha are both measures of the composite reliability for a set of items. Unlike coefficient alpha, coefficient omega remains unbiased with congeneric items with uncorrelated errors. Despite this ability, coefficient omega is not as widely used and cited in the literature as coefficient alpha. Reasons for coefficient omega's underutilization include a limited knowledge of its statistical properties. However, consistent efforts to understand the statistical properties of coefficient omega can help improve its utilization in research efforts. Here, six approaches for estimating confidence intervals for coefficient omega with unidimensional congeneric items were evaluated through a Monte Carlo simulation. The evaluations were made through simulation conditions that mimic realistic conditions that investigators are likely to face in applied work, including items that are not normally distributed and small sample size(s). Overall, the normal theory bootstrap confidence interval had the best performance across all simulation conditions that included sample sizes less than 100. However, most methods had sound coverage with sample sizes of 100 or more.

Emotional Distress, Alcohol Use, and Bidirectional Partner Violence Among Lesbian Women.

This study examined the relationship between emotional distress (defined as depression, brooding, and negative affect), alcohol outcomes, and bidirectional intimate partner violence among lesbian women. Results lend support to the self-medication hypothesis, which predicts that lesbian women who experience more emotional distress are more likely to drink to cope, and in turn report more alcohol use, problem drinking, and alcohol-related problems. These alcohol outcomes were, in turn, associated with bidirectional partner violence (BPV). These results offer preliminary evidence that, similar to findings for heterosexual women, emotional distress, alcohol use, and particularly, alcohol-related problems are risk factors for BPV among lesbian women.

Human cerebral cortex Cajal-Retzius neuron: development, structure and function. A Golgi study.

The development, morphology and possible functional activity of the Cajal-Retzius cell of the developing human cerebral cortex are explored herein. The C-RC, of extracortical origin, is the essential neuron of the neocortex first lamina. It receives inputs from afferent fibers that reach the first lamina early in development. Although the origin and function of these original afferent fibers remain unknown, their target is the first lamina sole neuron: the C-RC. This neuron orchestrates the arrival, size and stratification of all pyramidal neurons (of ependymal origin) of the neocortex gray matter. Its axonic terminals spread radially and horizontally throughout the entirety of the first lamina establishing contacts with the dendritic terminals of all gray matter pyramidal cells regardless of size, location and/or eventual functional roles. While the neuron axonic terminals spread radially and horizontally throughout the first lamina, the neuronal' body undergoes progressive developmental dilution and locating any of them in the adult brain become quite difficult. The neuron bodies are probably retained in the older regions of the neocortex while their axonic collaterals will spread throughout its more recent ones and eventually will extend to great majority of the cortical surface. The neocortex first lamina evolution and composition and that of the C-RC are intertwined and mutually interdependent. It is not possible to understand the C-RC evolving morphology without understanding that of the first lamina. The first lamina composition and its structural and functional organizations obtained with different staining methods may be utterly different. These differences have added unnecessary confusion about its nature. The essential emptiness observed in hematoxylin and eosin preparations (most commonly used) contrast sharply with the concentration of dendrites (the cortex' largest) obtained using special (MAP-2) stain for dendrites. Only Golgi preparations demonstrate the numerous dendritic and axonic terminals that compose the first lamina basic structure. High power microscopic views of Golgi preparations demonstrate the intimate anatomical and functional interrelationships among dendritic and axonic terminals as well as synaptic contacts between them. The C-RC' essential morphology does not changes but it is progressively modified by the first lamina increase in thickness and in number of terminal dendrites and their subsequent maturation. This neuron variable morphologic appearance has been the source of controversy. Its morphology depends on the first lamina thickness that may be quite variable among different mammals. In rodents (most commonly used experimental mammal), the first lamina thickness, number and horizontal expansion of dendrites is but a fraction of those in humans. This differences are reflected in the C-RC' morphology among mammals (including humans) and should not be thought as representing new types of neurons.