Floating plastics as integrative samplers of organic contaminants of legacy and emerging concern from Western Mediterranean coastal areas.

This study investigates the role of floating plastics as integrative samplers of organic contaminants. To this end, plastics items were collected in two Western Mediterranean coastal areas: the Mar Menor lagoon, and the last transect of Ebro river. Floating plastics were identified and characterized by attenuated total reflection Fourier-transform infrared spectrometry. Then, organic contaminants were extracted from plastic items by ultrasonic extraction with methanol, and the concentrations of 168 regulated and emerging contaminants were analysed. These compounds were analysed by stir bar sorptive extraction coupled to gas chromatography-mass spectrometry (GC-MS), except for bisphenol analogues, which were analysed with a ultraperformance liquid chromatography pump coupled to a triple quadrupole mass spectrometer (UHPLC-MS/MS), and pharmaceutical compounds, determined by UPLC coupled to hybrid triple quadrupole-linear ion trap mass spectrometer (UPLC-MS/MS). All the contaminants groups considered were detected in the samples, being particularly relevant the contribution of plastic additives. The most frequently detected contaminants were UV-filters, PAHs, pharmaceuticals and synthetic musks. Apart from plasticizers, the individual contaminants octocrylene, homosalate, galaxolide, salycilic acid and ketoprofen were frequently detected in plastics items. The results pointed out to urban and touristic activities as the main sources of pollution in the coastal areas investigated. The utility of floating plastics as integrative samplers for the detection of organic contaminants in aquatic ecosystems has been demonstrated.

Could a lipid oxidative biomarker be applied to improve risk stratification in prevention for cardiovascular disease?

BACKGROUND AND AIMS: There is evidence demonstrating the influence of oxidative stress on atherosclerosis progression and cardiovascular diseases (CVD). However, different from dyslipidemia and inflammation, nonoxidative biomarkers have been applied to analyze the primary or secondary prevention treatment of these patients. Many factors can explain this paradox: the higher complexity of the methods applied to quantify oxidative markers, the high variability observed among the studies, lack of reference values and weak correlation with clinical endpoints. METHODS: In this review, data from 116 treatments in 55 studies that evaluated oxidative stress markers under the atherosclerotic context were included RESULTS: showed that antioxidant capacity measured as Ferric Reducing Antioxidant Power (FRAP), Superoxide Dismutase (SOD), Glutathione (GSH), Malondialdehyde (MDA), oxidized LDL (oxLDL) and Isoprostanes (F2-IsoP) were the oxidative markers more present. From them, MDA, IsoPs and oxLDL are directly formed from lipid oxidation, while FRAP, SOD and GSH have their values associated to general oxidative conditions. Among the lipid oxidative markers, MDA had the highest proportion among the treatments. A higher concentration of MDA (p»0.041) in patients with CVD (17.05 ± 37.24 mmol/L, n»51) was found than in healthy individuals (5.07 ± 7.54 mmol/L, n»21), despite the high general variability (235.85%). CONCLUSIONS: Multivariate analysis suggested that MDA was an independent factor compared with traditional markers used in the algorithms to stratify the patient's risk. Thus, it is necessary to achieve a reference value for patients under prevention, and correlate MDA increase according to the disease's progression before including it in the algorithms applied to estimate CVD risk.

Combined exposure of the bivalve Mytilus galloprovincialis to polyethylene microplastics and two pharmaceuticals (citalopram and bezafibrate): Bioaccumulation and metabolomic studies.

Pharmaceuticals and microplastics constitute potential hazards in aquatic systems, but their combined effects and underlying toxicity mechanisms remain largely unknown. In this study, a simultaneous characterization of bioaccumulation, associated metabolomic alterations and potential recovery mechanisms was performed. Specifically, a bioassay on Mediterranean mussels (Mytilus galloprovincialis) was carried out with polyethylene microplastics (PE-MPLs, 1 mg/L) and citalopram or bezafibrate (500 ng/L). Single and co-exposure scenarios lasted 21 days, followed by a 7-day depuration period to assess their potential recovery. PE-MPLs delayed the bioaccumulation of citalopram (lower mean at 10 d: 447 compared to 770 ng/g dw under single exposure), although reaching similar tissue concentrations after 21 d. A more limited accumulation of bezafibrate was observed overall, regardless of PE-MPLs co-exposure (

Bioaccumulation and fate of pharmaceuticals in a Mediterranean coastal lagoon: Temporal variation and impact of a flash flood event.

Coastal ecosystems are particularly vulnerable to terrestrial inputs from human-impacted areas. The prevalence of wastewater treatment plants, unable to remove contaminants such as pharmaceuticals (PhACs), leads to their continuous input into the marine environment. In this paper, the seasonal occurrence of PhACs in a semi-confined coastal lagoon (the Mar Menor, south-eastern Spain) was studied during 2018 and 2019 by evaluating their presence in seawater and sediments, and their bioaccumulation in aquatic organisms. Temporal variation in the contamination levels was evaluated by comparison to a previous study carried out between 2010 and 2011 before the cessation of permanent discharges of treated wastewater into the lagoon. The impact of a flash flood event (September 2019) on PhACs pollution was also assessed. A total of seven compounds (out of 69 PhACs analysed) were found in seawater during 2018-2019, with a limited detection frequency (<33%) and concentrations (up to 11 ng/L of clarithromycin). Only carbamazepine was found in sediments (ND-1.2 ng/g dw), suggesting an improved environmental quality in comparison to 2010-2011 (when 24 and 13 compounds were detected in seawater and sediments, respectively). However, the biomonitoring of fish and molluscs showed a still remarkable accumulation of analgesic/anti-inflammatory drugs, lipid regulators, psychiatric drugs and ß-blocking agents, albeit not higher than in 2010. The flash flood event from 2019 increased the prevalence of PhACs in the lagoon, compared to the 2018-2019 sampling campaigns, especially in the upper water layer. After the flash flood the antibiotics clarithromycin and sulfapyridine yielded the highest concentrations ever reported in the lagoon (297 and 145 ng/L, respectively), alongside azithromycin in 2011 (155 ng/L). Flash flood events associated with sewer overflows and soil mobilisation, which are expected to increase under climate change scenarios, should be considered when assessing the risks posed by pharmaceuticals to vulnerable aquatic ecosystems in the coastal areas.

Occurrence and distribution of contaminants of legacy and emerging concern in surface waters of two Western Mediterranean coastal areas: Mar Menor Lagoon and Ebro Delta.

The occurrence and distribution of UV filters, plastic additives, synthetic musks, other personal care products (Other PCPs), triazines, polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides (OCPs), organophosphorus pesticides (OPPs), polychlorinated biphenyls (PCBs) and other current-use pesticides (Other CUPs) were characterised during summer 2018 and winter 2019 in surface waters of two sensitive areas of the Spanish coast located on the Mediterranean Sea (Mar Menor lagoon and Ebro Delta). Sixty-three organic contaminants out of a total of 100 compounds were detected, thus confirming the presence of all groups of pollutants studied in surface water at concentrations of ng/L. Both areas are affected by agricultural, urban and recreational activities, PCPs (mainly UV filters) being the predominant compounds found in both seasons which showed significant increases in concentrations in summer. The contaminants found at the highest concentrations were octocrylene, homosalate and ethylhexyl salicylate, which showed risk quotients higher than 1, indicating a potential risk to aquatic organisms, particularly in summer.

A holistic assessment of the sources, prevalence, and distribution of bisphenol A and analogues in water, sediments, biota and plastic litter of the Ebro Delta (Spain).

Bisphenol A (BPA) is one of the main ubiquitous compounds released from plastics in the environment. This compound, considered an endocrine disruptor, poses a risk to aquatic wildlife and human population, being included in multiple environmental monitoring programmes. Following the regulations restricting BPA use in the last years, BPA-like chemicals have been produced and used as BPA substitutes. However, they are not commonly included in monitoring programs yet and their presence is thus misrepresented, despite showing similar endocrine disrupting potential. In this work, an analytical method for analysing bisphenol A and five of its analogues (Bisphenol S, B, F, AF and Tetrabromobisphenol A) is described, validated for water (riverine, sea and wastewater), sediment, and biota (fish and biofilm) and applied to monitor their presence in the Ebro River Delta (NE Spain). In addition, plastic litter was also collected to evaluate their role as potential source of bisphenols. All compounds except BPF were detected in the analysed samples. Wastewater treatment plants (WWTPs) were discarded as major sources of BPs into the natural aquatic environment, as no BPs were detected in treated effluents. Indeed, the high levels of BPs in the natural environment could be related with direct discharge of raw wastewater from small rural population nucleus. The analysis of riverine plastic leachates yielded 4 out of the 6 BPs analysed, strengthening the hypothesis that plastic debris are also a source of BPs in the natural environment. Whereas Bisphenol S and BPA were detected in water and, to a limited extent, in biota, less polar analogues (mainly BPAF and TBBPA) were not found in any of the water samples. Instead, these hydrophobic BPs were found in fish tissues and biofilm, pointing out plastics and microplastics as their possible vectors. Finally, biofilm demonstrated its potential as sentinel of chemical contamination in freshwater environment.

Evolución de la cirugía bariátrica en Chile y el mundo / Bariatric Surgery's History in Chile and the World

Resumen La obesidad es reconocida como "la gran epidemia" del siglo XXI. Los primeros tratamientos fueron enfocados en el manejo médico, sin lograr los resultados esperados, por lo cual surge la cirugía bariátrica (CB) como la mejor alternativa. Inicialmente la obesidad se concibe como una figura de poder en el imperio egipcio, luego como enfermedad por Galeno e Hipócrates, reapareciendo más tarde como símbolo de fecundidad en Europa. Las primeras técnicas fueron el bypass yeyuno-colónico por Payne y De Wind modificado luego por Scopinaro, consolidándose más tarde como el bypass actual por Mason, Wittgrove e Higa. Por su parte, la gastrectomía en manga fue concebida por Gagner como puente de la derivación biliopancreática, pero dado sus excelentes resultados se consolida como técnica por sí sola. A su vez, la CB evidencia efectos metabólicos inesperados, posicionándose en la actualidad como el mejor tratamiento tanto para la obesidad como para el síndrome metabólico. En Chile la CB se inicia en 1986 con González del Hospital Van Buren con la experiencia en bypass yeyuno-ileal, continuando con Awad y Loehnert del Hospital San Juan de Dios. Luego se consolida con el desarrollo de la CB moderna tanto en la Universidad Católica como en la Universidad de Chile, llegando en la actualidad a ser un procedimiento ampliamente difundido en todo el país. El objetivo principal de la siguiente revisión es analizar el concepto de obesidad en la historia y la evolución de la CB en Chile y el mundo, rememorando sus inicios y destacando su constante desarrollo.

Obesity is recognized as "the great epidemic" of the 21st century. The first treatments were focused on medical management, failing to achieve the expected results, which is why bariatric surgery (BC) emerges as the best alternative. Obesity was initially conceived as a power figure in the Egyptian empire, later as a disease by Galen and Hippocrates, later reappearing as a symbol of fertility in Europe. The first techniques were the jejuno-colonic bypass by Payne and De Wind, later modified by Scopinaro, to finally consolidate as the current bypass by Mason, Wittgrove and Higa. For its part, sleeve gastrectomy was conceived by Gagner as a bridge for biliopancreatic diversion, but given its excellent results, it is consolidated as a technique by itself. In turn, BC shows unexpected metabolic effects, currently positioning itself as the best treatment for both obesity and metabolic syndrome. In Chile, BC started in 1986 with González at the Van Buren Hospital with his experience in jejuno-ileal bypass, continuing with Awad and Loehnert at the San Juan de Dios Hospital. Later, it was consolidated with the development of modern BC both at the Catholic University and at the University of Chile, currently becoming a widely disseminated procedure throughout the country. The main objective of the following review is to analyze the concept of obesity in history and the evolution of BC in Chile and the world, recalling its beginnings and highlighting its continuous development.

Osteotomía Le Fort III modificada en un paciente no sindrómico / Modified Le Fort III osteotomy in a non-syndromic patient

Las discrepancias dento-esqueletales severas presentan un reto para el cirujano maxilofacial, existe una versatilidad de osteotomías para las diferentes anomalías del crecimiento y desarrollo, sin embargo, son pocas las que permiten mejorar la proyección malar. La osteotomía Le Fort III modificada fue utilizada en un principio en pacientes con algún síndrome craneofacial, pero actualmente es una alternativa útil para discrepancias severas en pacientes no sindrómicos, ya que permite un avance cigomático-maxilar, favorece la proyección malar y disminuye la exposición escleral con un número limitado de complicaciones. Se presenta el caso de un paciente masculino de 33 años con antecedente de fractura orbitocigomática y piso orbitario izquierda con una discrepancia dento-esqueletal severa, la que fue tratada mediante osteotomía Le Fort III modificada, osteotomías sagitales mandibulares para un avance máxilo-malar y retroceso mandibular respectivamente y una genioplastia de avance; logrando un resultado funcional y estético adecuado.

The dento-skeletal severe discrepancies present a challenge for the maxillofacial surgeon, there is a versatility of osteotomies for the different growth and development anomalies, however, a few of them make possible to improve malar projection. The modified Le Fort III osteotomy was originally used in patients with some craniofacial syndrome, but now it is a useful alternative for severe discrepancies in non-syndromic patients, since it allows a zygomatic-maxillary advance, favors malar projection and reduces scleral exposure with a limited number of complications. The case of a 33-year-old male patient with a history of orbitozygomatic fracture and left orbital floor with a severe dento-skeletal discrepancy is presented, who was treated by modified Le Fort III osteotomy, mandibular sagittal osteotomies for maxillo-malar advancement and retrogression mandibular respectively and geniplasty for advance; achieving a suitable functional and aesthetic result.

Experiencia en el desbridamiento con Nexobrid(R) y cura húmeda con Prontosan(R) wound gel en el paciente quemado / Experience with Nexobrid(R) debridement and Prontosan(R) wound healling gel moist in the treatment of burn patients

Introducción y Objetivo. El desbridamiento tangencial y autoinjerto ha sido el tratamiento de elección de las quemaduras profundas. Actualmente, la disponibilidad de técnicas no quirúrgicas, como el desbridamiento enzimático con Nexobrid(R), introduce un cambio de concepto permitiendo mayor selectividad en la eliminación de la escara y optimizar la preservación de la dermis sana, menor cicatrización patológica, mejor resultado estético, y sobre todo menor agresión al paciente. Prontosan(R)Wound Gel es un hidrogel con propiedades antibacterianas para mantener cura húmeda, y no interfiere en la epitelización. Presentamos nuestra experiencia en desbridamiento enzimático y aplicación de cura húmeda con estos productos en quemaduras de segundo grado profundo y/o tercer grado faciales, en manos, extremidades inferiores y tronco. Material y Método. Incluimos todos los pacientes quemados de segundo grado profundo y/o tercer grado de cualquier extensión tratados con Nexobrid(R) para Unidad de Quemados entre diciembre de 2015 y febrero de 2017. Realizamos desbridamiento enzimático en las primeras 24 horas aplicándolo en un máximo del 15% de superficie corporal, seguido de cura con Prontosán(R) y oclusión con apósito hidrocoloide. Cobertura de quemaduras profundas que no curaron espontáneamente en quirófano, con injertos laminares. Las variables recogidas fueron: edad, sexo, agente causal, extensión, localización y profundidad, tiempo de hospitalización, localización, superficie corporal y profundidad de la quemadura en la zona en la que se aplicó Nexobrid®, eficacia del desbridamiento enzimático, necesidad de desbridamiento quirúrgico, necesidad de injerto, tiempo hasta epitelización y complicaciones. Resultados.Analizamos 17 pacientes con SCQ del 3 al 55%. Valoramos visualmente el desbridamiento enzimático inicial como completo en todos ellos. Solo 5 pacientes precisaron injertos laminares. En los que no precisaron desbridamiento quirúrgico, la epitelización se produjo a los 15 días como promedio. Estudio histopatológico en 3 pacientes: desbridamiento completo de la quemadura en 1 y parcial en 2, con abundante infiltrado inflamatorio linfocítico perivascular postratamiento. Los hallazgos histopatológicos se correlacionaron con la eficacia del desbridamiento valorado clínicamente en 1 de los 3 casos, y con el diagnóstico clínico de la quemadura en los 3 casos. Ningún caso precisó cirugía de secuelas tras un seguimiento medio de 7 meses. Conclusiones. Nexobrid(R) en combinación con Prontosan(R) Wound Gel en nuestra experiencia preliminar parece una alternativa viable en el tratamiento de quemaduras en cara, extremidad superior, extremidad inferior y tronco

Background and Objective. Tangential debridement and autograft have been the gold standard surgical treatment of deep burns. Nowadays, the availability of non surgical enzymatic debridement techniques, such as Nexobrid(R) has introduced a new concept in the treatment of burn patients, allowing an increase in the selectivity for the scar removal leading to the preservation of healthy dermis, reducing scarring, improving cosmetic outcome, and even more, minimizing aggression to the patient. Prontosan(R) Wound Gel is a hydrogel with antibacterial properties that can be used to keep wound bed moist, without interfering epithelialization. We present our experience with these combined products in deep dermal and/or subdermal burns affecting face, upper and lower extremities, perineal and trunk. Methods. All patients with deep dermal and/or subdermal burns treated with Nexobrid(R) in our Burn Unit between December 2015 and February 2017 were included. Enzymatic debridement was performed within the first 24 hours, applied up to 15% of body surface. After that, Prontosan(R) was applied and Varihesive(R) was used as a sealed dressing. Whenever grafting was necessary, it was performed in operating room adding split thickness grafts. Variables collected were: age, sex, agent, extension, location and depth of the burn, period of hospitalization, location, extension and depth of the burn in the area where Nexobrid ® was applied, efficacy of enzymatic debridement, needing for surgical debridement, needing of grafting, time to epithelialization and complications. Results. Seventeen patients with 3 to 55% burn body surface were included. Initial enzymatic debridement was complete in all patients. Only 5 patients needed split thickness grafting. Complete epithelialization was achieved on an average of 15 days. Histopathology studies were performed on 3 patients. Histopathology findings correlated to the clinical efficacy of the debridement in 1 out of the 3 cases, and to the clinical diagnosis of the burn in the 3 cases. After 7 months follow up, no patients required surgery for correction of sequelae. Conclusions. In our preliminary experience, combines use of Nexobrid(R) and Prontosan (R)Wound Gel seems a feasible alternative in the treatment of facial, upper and lower extremities and trunk burns

Unbalanced inflammatory reaction could increase tissue destruction and worsen skin infectious diseases - a comparative study of leishmaniasis and sporotrichosis.

The clinical presentations of skin diseases produced by different pathogens, as American tegumentary leishmaniasis (ATL) and sporotrichosis can be similar and possibly influenced by the skin immune system (SIS). The aim of the study was to understand the underlying mechanisms of skin inflammation produced by different pathogens. We used immunohistochemistry to analyze 96 patients: a- localized cutaneous leishmaniasis (LCL-ATL); b- sporotrichoid cutaneous leishmaniasis (SCL-ATL); c-lymphocutaneous (LC-SP); d- fixed (F-SP) sporotrichosis. LCL-ATL and SCL-ATL had a significantly higher percentage of CD8, FasL and NOS2 than sporotrichosis. In contrast, LC-SP had a substantially higher percentage of CD4, BCl2 and neutrophils than ATL lesions. These results indicated some differences in the profile of the in situ immune response suggesting that SIS is a complex, adaptable system capable of different responses to intracellular or extracellular pathogens. However, regardless of the etiological agents, the inflammatory reaction and clinical manifestations can be similar. SCL-ATL and LC-SP presented similarities in both clinical presentation and in situ inflammatory profile (CD3, CD22, neutrophils, macrophages). The clinical presentation of ATL and sporotrichosis could be explained by a combination of factors both of the host SIS and the etiological agent. The unbalanced host parasite relationship could result in atypical manifestations of skin disease.

Miotomía endoscópica por vía oral (POEM) para el tratamiento de la acalasia: experiencia clínica inicial y resultados a corto plazo / Per-oral endoscopic myotomy (POEM) for the treatment of achalasia: initial clinical experience and short term results

Resumen Introducción: La acalasia es el trastorno motor primario más frecuente del esófago. El estándar de tratamiento actual es la miotomía de Heller laparoscópica. En los últimos años, el desarrollo de técnicas endoscópicas avanzadas ha permitido el posicionamiento de la técnica POEM (del inglés: per-oral endoscopic myotomy) como una nueva alternativa terapéutica con resultados promisorios. Objetivo: Presentar nuestra experiencia clínica, con descripción de la técnica utilizada, resultados perioperatorios y seguimiento a corto plazo en el desarrollo de esta alternativa terapéutica. Materiales y métodos: Se realizó un análisis retrospectivo de datos obtenidos en forma prospectiva de 15 pacientes intervenidos mediante POEM en 3 hospitales docentes asociados. Se recopilaron variables demográficas preoperatorias, detalle del intraoperatorio y registro de morbimortalidad operatoria. Se realizó un seguimiento clínico dirigido registrando el puntaje de Eckardt y la presencia de síntomas de reflujo gastroesofágico. Resultados: Entre agosto de 2015 y noviembre de 2016 se realizaron 15 POEM. Seis de estos pacientes eran mujeres, y la edad promedio fue de 49 años. El tiempo operatorio promedio fue de 110 min; no hubo morbimortalidad operatoria. La estadía hospitalaria promedio fue de 2,8 días. El seguimiento fue de entre 1 y 15 meses. El puntaje de Eckardt promedio en el preoperatorio y en el postoperatorio fue de 10,5 y 0,4 puntos, respectivamente. Tres pacientes presentaban síntomas de reflujo gastroesofágico al momento del seguimiento. Conclusión: Los resultados obtenidos en nuestra serie apoyan la efectividad y seguridad del POEM a corto plazo. Se requiere de un seguimiento mayor para determinar el rol definitivo de esta técnica.

Abstract Introduction: Achalasia is the most common primary motor disorder of the esophagus. The current standard of treatment is laparoscopic Heller's myotomy. Recently the development of advanced endoscopic techniques has allowed the positioning of the POEM (per-oral endoscopic myotomy) technique as a new therapeutic alternative with promising results. Objective: To present our clinical experience in POEM, with description of the technique used, peri-operative results and short-term follow-up in the development of this therapeutic alternative. Materials and methods: We performed a retrospective analysis of data obtained prospectively from 15 patients undergoing POEM in three clinical centers in our country. Preoperative demographic variables, intraoperative detail, and operative morbidity and mortality were collected. Clinical follow-up was performed with controls recording Eckardt score and presence of gastroesophageal reflux symptoms. Results: Between August 2015 and November 2016, 15 POEM were performed, six of these patients were women, average age was 49 years. The average operative time was 110 min, we did not have any perioperative morbimortality. Hospital stay was 2.8 days. Follow-up was between 1 and 15 months, Eckardt's preoperative and postoperative score was on average 10.5 and 0.4 points, respectively. Three patients had gastroesophageal reflux symptoms at the time of follow-up. Conclusion: Our results support the effectiveness and security of POEM in short-term follow up. Further monitoring is required to determine the definitive role of this technique.

Repeat Rifaximin for Irritable Bowel Syndrome: No Clinically Significant Changes in Stool Microbial Antibiotic Sensitivity.

BACKGROUND: Rifaximin has demonstrated efficacy and safety for diarrhea-predominant irritable bowel syndrome (IBS-D). AIM: To determine the rifaximin repeat treatment effect on fecal bacterial antibiotic susceptibility. METHODS: Patients with IBS in Trial 3 (TARGET 3) study who responded to open-label rifaximin 550 mg three times daily for 2 weeks, with symptom recurrence within 18 weeks, were randomized to double-blind treatment: two 2-week repeat courses of rifaximin or placebo, separated by 10 weeks. Prospective stool sample collection occurred before and after open-label rifaximin, before and after the first repeat course, and at the end of the study. Susceptibility testing was performed with 11 antibiotics, including rifaximin and rifampin, using broth microdilution or agar dilution methods. RESULTS: Of 103 patients receiving open-label rifaximin, 73 received double-blind rifaximin (n = 37) or placebo (n = 36). A total of 1429 bacterial and yeast isolates were identified, of which Bacteroidaceae (36.7%) and Enterobacteriaceae (33.9%) were the most common. In the double-blind phase, Clostridium difficile was highly susceptible to rifaximin [minimum inhibitory concentration (MIC) range 0.008-1 µg/mL] and rifampin (MIC range 0.004-0.25 µg/mL). Following double-blind rifaximin treatment, Staphylococcus isolates remained susceptible to rifaximin at all visits (MIC50 range ≤0.06-32 µg/mL). Rifaximin exposure was not associated with long-term cross-resistance of Bacteroidaceae, Enterobacteriaceae, and Enterococcaceae to rifampin or nonrifamycin antibiotics tested. CONCLUSIONS: In this study, short-term repeat treatment with rifaximin has no apparent long-term effect on stool microbial susceptibility to rifaximin, rifampin, and nonrifamycin antibiotics. CLINICALTRIALS. GOV IDENTIFIER: NCT01543178.

Retention systems for extraoral maxillofacial prosthetic implants: a critical review.

We describe the techniques available for retention of implant-supported prostheses: bar-clips, O-rings, and magnets. We present reported preferences and, although this is limited by the heterogeneity of methods used and patients studied, we hope we have identified the best retention systems for maxillofacial prosthetic implants. If practitioners know the advantages and disadvantages of each system, they can choose the most natural and comfortable prosthesis. We searched the PubMed and Scopus databases, and restricted our search to papers published 2001-13. MeSH terms used were Maxillofacial prosthesis and Craniofacial prosthesis OR Craniofacial prostheses. We found a total of 2630 papers, and after duplicates had been removed we analysed the rest and found 25 papers for review. Of these, 12 were excluded because they were case reports or non-systematic reviews. Of the remaining 13, 10 described group analyses and seemed appropriate to find practitioner's choices, as cited in the abstract (n=1611 prostheses). Three papers did not mention the type of prosthetic connection used, so were excluded. The most popular choices for different conditions were analysed, though the sites and retention systems were not specified in all 10 papers. The bar-clip system was the most used in auricular (6/10 papers) and nasal prostheses (4/10). For the orbital region, 6/10 favoured magnets. Non-osseointegrated mechanical or adhesive retention techniques are the least expensive and have no contraindications. When osseointegrated implants are possible, each facial region has a favoured system. The choice of system is influenced by two factors: standard practice and the abilities of the maxillofacial surgeon and maxillofacial prosthetist.

Single-Incision Laparoscopy Surgery Excision of an Infected Urachal Cyst: Description of the Technique.

Background: Urachal cysts (UCs) are secondary to incomplete obliteration of the embryonic urachal duct and may become symptomatic when infected. Treatment is primarily surgical to excise the infected cyst. Surgical approaches include a lower midline laparotomy or minimally invasive (MI) techniques. Case: We present a case of a young male with an infected UC that was treated with a single-incision laparoscopy surgery. The operative technique is described. Conclusion: This approach is a safe and feasible option for the MI management of UCs.

Do Jackhammer contractions lead to achalasia? A longitudinal study.

BACKGROUND: Jackhammer esophagus (JE) is a rare esophageal motility disorder defined in the Chicago Classification of Esophageal Motility by presence of excessively high distal contractile integral (DCI) on high-resolution manometry (HRM), with unknown natural manometric course. We examined the development of achalasia over time in patients with JE. METHODS: Through a retrospective longitudinal design, patients with Jackhammer contractions who had more than one HRM between 2005 and 2015 were identified. Any change in manometric finding was assessed for the presence of achalasia. Demographic and manometric risk factors for this progression were then sought in univariate analysis. KEY RESULTS: Of 3363 HRM studies, 229 subjects had multiple manometries, accounting for 528 studies. Twelve subjects met our inclusion criteria for JE on any of the multiple tests, represented by 27 studies for a total of 347 patient-months of manometric follow-up. Subjects with JE whose manometry included impedance demonstrated consistent esophageal bolus clearance. Of 12 subjects with Jackhammer contractions, three subjects progressed to type III achalasia, over a mean of 24 months (range: 19-31 months). At the time of diagnosis with JE, impaired esophago-gastric junction relaxation was seen in all three subjects and was the only risk factor that could predict progression to achalasia (P<.01). CONCLUSIONS & INFERENCES: In this unique study of the natural course of JE, we have shown that JE can progress to achalasia. Manometric findings at the time of JE diagnosis might predict this progression.