High frequency of endoluminal thrombus in patients with ischaemic stroke following AARS-CoV-2 infection.

BACKGROUND: Ischaemic stroke may be a major complication of SARS-CoV-2 infection. Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. METHODS: Data were collected retrospectively on consecutive patients with COVID-19 who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). RESULTS: During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack). Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%). We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). CONCLUSIONS: In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.

Efectos adversos relacionados con la administración de norepinefrina por accesos venosos periféricos cortos: una revisión de alcance / Adverse effects related with norepinephrine through short peripheral venous access: Scoping review

La administración de norepinefrina por vía periférica es restringida, por la asociación de la extravasación con necrosis tisular. Método: Revisión de alcance con el objetivo de describir los efectos adversos relacionados con la administración de norepinefrina por acceso venoso periférico corto y las características de administración del fármaco en pacientes hospitalizados en servicios de UCI, cirugía y urgencias. Resultados: Se incluyeron 12 estudios de características heterogéneas por tamaño y tipo de población. La proporción de complicaciones asociadas a la administración de norepinefrina por vía periférica fue inferior al 12% en los estudios observacionales y menor al 2% en aquellos que utilizaron dosis menores a 0,13μg/kg/min y concentraciones inferiores a 22,3μg/ml. La principal complicación asociada fue la extravasación y no se presentó ningún caso de necrosis tisular en el sitio de venopunción. El tratamiento farmacológico utilizado para su manejo fue con terbutalina o nitroglicerina tópica; el tiempo de administración del fármaco osciló entre 1 y 528 horas, con una media ponderada de 2,78 horas. Conclusión: El principal efecto adverso fue la extravasación, no se presentaron complicaciones adicionales, la fentolamina y terbutalina parecen ser útiles en estos casos; su disponibilidad es una necesidad para una administración periférica segura. Es necesario que la enfermera realice una valoración estrecha y un cuidado integral en los pacientes que reciben norepinefrina por vía periférica.(AU)

Peripheral administration of norepinephrine is restricted due to the association of extravasation with tissue necrosis. Method: scoping review with the objective of describing the adverse effects related to the administration of norepinephrine through short peripheral venous access and the characteristics of drug administration in patients hospitalized in ICU, surgery, and emergency services. Results: 12 studies with heterogeneous characteristics by size and type of population were included. The proportion of complications associated with peripheral norepinephrine administration was less than 12% in observational studies and it was less than 2% in those that used doses less than 0.13μg/kg/min, and concentrations less than 22.3μg/ml. The main associated complication was extravasation and there were no cases of tissue necrosis at the venipuncture site, some extravasation cases were treated with phentolamine, terbutaline or topical nitroglycerin. The drug administration time ranged between 1-528hours with a weighted mean of 2.78h. Conclusion: The main adverse effect was extravasation, no additional complications occurred, phentolamine and terbutaline seem to be useful, and its availability is a necessity. It is essential for the nursing staff to carry out a close assessment and comprehensive care in patients receiving norepinephrine by peripheral route.(AU)

Adverse effects related with norepinephrine through short peripheral venous access: Scoping review.

Peripheral administration of norepinephrine is restricted due to the association of extravasation with tissue necrosis. METHOD: Scoping review with the objective of describing the adverse effects related to the administration of norepinephrine through short peripheral venous access and the characteristics of drug administration in patients hospitalized in ICU, surgery, and emergency services. RESULTS: 12 studies with heterogeneous characteristics by size and type of population were included. The proportion of complications associated with peripheral norepinephrine administration was less than 12% in observational studies and it was less than 2% in those that used doses less than 0.13µg/kg/min, and concentrations less than 22.3µg/mL. The main associated complication was extravasation and there were no cases of tissue necrosis at the venipuncture site, some extravasation cases were treated with phentolamine, terbutaline or topical nitroglycerin. The drug administration time ranged between 1 and 528hours with a weighted mean of 2.78h. CONCLUSION: The main adverse effect was extravasation, no additional complications occurred, phentolamine and terbutaline seem to be useful, and its availability is a necessity. It is essential for the nursing staff to carry out a close assessment and comprehensive care in patients receiving norepinephrine by peripheral route.

Long term detection and quantification of SARS-CoV-2 RNA in wastewater in Bahrain.

Wastewater-based epidemiology is a corroborated environmental surveillance tool in the global fight against SARS-CoV-2. The analysis of wastewater for detection of SARS-CoV-2 RNA may assist policymakers to survey a specific infectious community. Herein, we report on a long-term quantification study in Bahrain to investigate the incidence of the SARS-CoV-2 RNA in wastewater during the COVID-19 pandemic. The ∼260,000 population of Muharraq Island in Bahrain is served by a discrete sewerage catchment, and all wastewater flows to a single large Sewage Treatment Plant (STP) with a capacity of 100,000 m3/day. The catchment is predominately domestic, but also serves several hospitals and Bahrain's international airport. Flow-weighted 24-h composite wastewater samples for the period February 2020 to October 2021 were analyzed for the presence of SARS-CoV-2 N1, N2 and E genes. A Spearman rank correlation demonstrated a moderate correlation between the concentration of SARS-CoV-2 N1, N2 and E genes in the wastewater samples and the number of COVID-19 cases reported on the same day of the sampling. SARS-CoV-2 viral genes were detected in wastewater samples shortly after the first cases of COVID-19 were reported by the health authorities in Bahrain by reverse transcription-polymerase chain reaction (RT-qPCR). The viral genes were detected in 55 of 65 samples (84.62%) during the whole study period and the concentration range was found to be between 0 and 11,508 RNA copies/mL across the viral genes tested (in average N1: 518.4, N2: 366.8 and E: 649.3 copies/mL). Furthermore, wastewater samples from two COVID-19-dedicated quarantine facilities were analysed and detected higher SARS-CoV-2 gene concentrations (range 27-19,105 copies/mL; in average N1: 5044, N2: 4833 and E: 8663 copies/mL). Our results highlight the potential use of RT-qPCR for SARS-CoV-2 detection and quantification in wastewater and present the moderate correlation between concentration of SARS-CoV-2 genes with reported COVID-19 cases for a specified population. Indeed, this study identifies this technique as a mechanism for long term monitoring of SARS-CoV-2 infection levels and hence provides public health and policymakers with a useful environmental surveillance tool during and after the current pandemic.

Opuntia ficus-indica Extract and Isorhamnetin-3-O-Glucosyl-Rhamnoside Diminish Tumor Growth of Colon Cancer Cells Xenografted in Immune-Suppressed Mice through the Activation of Apoptosis Intrinsic Pathway.

This study aimed to evaluate the effects of Opuntia ficus-indica extract (OFI-E) and its glycoside isorhamnetin-3-O-glucosyl-rhamnoside (IGR) on the growth of human colorectal adenocarcinoma cells and in a xenografted-immunosuppressed mice model. The IC50 values of OFI-E and IGR on colon cancer cells (HT-29 RFP) were determinate, as well as their effects on the cell cycle and apoptosis induction. OFI-E and IGR produced an increased in apoptosis induction, ROS production and a G0/G1 cell cycle arrest. In xenografted-inmunosupressed mice, OFI-E and IGR reduced the tumor growth rate, myeloperoxidase activity and total cholesterol levels. OFI-E and IGR reduced the tumor growth through the overexpression of cleaved Caspase-9, Hdac11, and Bai1 proteins. OFI-E reduced the expression of bcl-2. Results demonstrated the chemopreventive effects of OFI-E, and its purified compound IGR, showing their potential as an alternative in the treatment of colorectal cancer.

Modification of Oxalis tuberosa starch with OSA, characterization and application in food-grade Pickering emulsions.

The emulsifying properties of Oxalis tuberosa starch (native and chemically modified) were evaluated in Pickering emulsions based on the emulsification index, emulsion stability over time and emulsion morphology. The best conditions of chemical modification were found by esterification of starch with octenyl succinic anhydride (OSA) at a concentration of 3% and a reaction time of 2 h, achieving a degree of substitution of 0.033 ± 0.001. The results obtained using Fourier-transform infrared spectroscopy, a Rapid Visco Analyzer, and differential scanning calorimetry, indicated that the starch underwent a change in its structure and that the insertion of the OSA groups was achieved. The amphipathic characteristics of OSA starch were evaluated by forming oil-in-water emulsions. Various concentrations of OSA-starch granules (1, 2.5 and 5 wt%) were used. A higher concentration of particles produced a smaller droplet size of emulsions (76.5 ± 0.9 µm) compared to those formed at a lower concentration of 1% (92.5 ± 1.0 µm). Therefore, the starch modified with OSA displayed the necessary characteristics to be adsorbed at the oil-water interface, achieving Pickering emulsion stabilization.

High frequency of endoluminal thrombus in patients with ischaemic stroke following SARS-CoV-2 infection. / Alta frecuencia de trombo endoluminal en pacientes con ictus isquémico tras la infección por coronavirus 2019.

BACKGROUND: Ischaemic stroke may be a major complication of SARS-CoV-2 infection. Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. METHODS: Data were collected retrospectively on consecutive patients with SARS-CoV-2 infection who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). RESULTS: During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack). Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%). We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). CONCLUSIONS: In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.

[Guillain-Barre syndrome in pregnancy]. / Síndrome de Guillain-Barré en el embarazo.

TITLE: Síndrome de Guillain-Barré en el embarazo.

Myocardial Inflammatory Changes Before and After Antiretroviral Therapy Initiation in People With Advanced Human Immunodeficiency Virus Disease.

Because of the high frequency of late presentation of human immunodeficiency virus (HIV) disease in our population, we decided to explore the presence of myocarditis among people with HIV infection and advanced immunosuppression (less than 200 CD4+ cells/µL) and to describe the inflammatory changes observed after combined antiretroviral therapy initiation in an observational, longitudinal, prospective cohort. We performed both cardiovascular magnetic resonance imaging and doppler transthoracic echocardiogram.

IR characterization of plant leaves, endemic to semi-tropical regions, in two senescent states.

We are developing a robust and economic electro-optical remote sensing methodology to monitor the state of health and hydration of trees, endemic to subtropical regions. We measured reflectance spectra with Fourier transform infrared (FTIR) of three samples of two different oak trees. We find that spectral bands suitable for monitoring the state of the health and senescence of the oak include intervals around 0.9 µm and 1.8 µm. The easiest and the most cost-effective strategy would be to implement an electro-optical remote sensing radiometric system featuring a commercial camera incorporating a traditional charge-coupled device (CCD) or complementary metal-oxide-semiconductor (CMOS) detectors and a wideband transmission filter, from about 0.8 to 1 µm.

Osteotomía calcánea con cuña de sustracción dorsal como tratamiento quirúrgico en la tendinopatía insercional de Aquiles / Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy

OBJETIVO: La osteotomía calcánea con cuña de sustracción dorsal tiene como objetivo reducir la longitud del calcáneo, elevando la inserción del tendón de Aquiles, reduciendo así la tensión en su inserción por la verticalización del calcáneo. El objetivo del estudio es evaluar los resultados clínicos de esta osteotomía en pacientes con tendinopatía insercional de Aquiles y un ángulo de inclinación del calcáneo elevado. MATERIAL Y MÉTODOS: Estudio retrospectivo de 18 pacientes con diagnóstico de tendinopatía insercional del tendón de Aquiles. Realizamos una doble osteotomía calcánea en forma de cuña dorsal, exéresis de esta y síntesis con 2 tornillos canulados. Se evaluaron los resultados clínicos-funcionales mediante las escalas EVA, AOFAS, VISA-A y satisfacción del paciente pre- y posquirúrgicas. Los parámetros radiológicos analizados fueron el ángulo de inclinación del calcáneo, la longitud del calcáneo y ángulo de Fowler-Philips. Se realizó un análisis estadístico mediante Stata 15. La media de seguimiento fueron 18,3 meses (rango 14-36). RESULTADOS: Todos los pacientes presentaron mejoría objetiva de los síntomas y de las escalas EVA (de 8,25 a 2,16 puntos) y AOFAS (de 41,5 a 86,5 puntos) con significación estadística (p < 0,05). La persistencia de calcificaciones intratendinosas en las radiografías postoperatorias no influyó en la mejoría sintomática. CONCLUSIONES: Con los resultados obtenidos consideramos que la osteotomía calcánea con cuña de sustracción dorsal es una técnica alternativa válida en el tratamiento de la tendinopatía insercional de Aquiles, sobre todo en los casos con un ángulo de inclinación del calcáneo elevado

OBJECTIVE: The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle. MATERIAL AND METHODS: This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36). RESULTS: All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement. CONCLUSIONS: Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion

Influence of germination time on the morphological, morphometric, structural, and physicochemical characteristics of Esmeralda and Perla barley starch.

The aim of this study was to analyzing the impact of germination time on the morphology, crystallinity, gelatinization and viscosity properties on the starch of Esmeralda and Perla barley variety. The two barley were germinated for 1 to 8 days, at 26 °C and 65% relative humidity. Micrographs showed the presence of pinholes and eroded surfaces. Starch in Esmeralda was hydrolyzed completely at 8 days of germination. Birefringence was reduced from day 4, losing molecular structuring of the crystalline area. Morphometric data: fractal dimension, area, perimeter, circularity, and roundness decreased significantly along germination time in both varieties. The entropy increased significantly, from 0.79 to 10.09 in Esmeralda and from 0.46 to 7.57 in Perla. Relative crystallinity decreased significantly in the Perla from 24.7% to 23.6%. Viscosity peaks were also significantly reduced, pasting temperature was constant in Esmeralda but in Perla was significantly reduced from 95.43 to 95.19 °C with germination, the gelatinization temperature increased significantly in the Esmeralda while in Perla it remained constant. Enthalpy decreased significantly to 75.8% and 37% in Esmeralda and Perla respectively. The study of germination impact on structural and physicochemical properties is important to identify the use of hydrolyzed starches in the food industry or others.

N-doped oxidized carbon dots for methanol sensing in alcoholic beverages.

Methanol (MeOH) adulteration in alcoholic beverages resulting in irreparable health damage demands highly sensitive and cost-effective sensors for its quantification. As carbon dots are emerging as new biocompatible and sustainable light-emitting detectors, this work demonstrates the hydrothermally prepared nitrogen-doped oxidized carbon dots (NOCDs) as on-off fluorescent nanoprobes to detect MeOH traces in water and alcoholic beverages. The presence of 1% of MeOH in distilled water is found to decrease the NOCD fluorescent emission intensity by more than 90% whereas up to 70% ethanol (EtOH) content changes the signal to within 20% of its initial value. HR-TEM analysis reveals the agglomeration of the nanoprobes suspended in MeOH. Due to their selectivity towards MeOH, the fluorescent nanoprobes were successfully tested using a few MeOH spiked branded and unbranded Mexican alcoholic beverages. Varying degrees of signal quenching is observed from the fluorescent nanoprobes dispersed in different pristine beverages with a detection limit of less than 0.11 v%. Herein, we establish a new perspective towards economically viable non-toxic fluorescent probes as a potential alternative for the detection of MeOH in alcoholic beverages.

Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy. / Osteotomía calcánea con cuña de sustracción dorsal como tratamiento quirúrgico en la tendinopatía insercional de Aquiles.

OBJECTIVE: The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle. MATERIAL AND METHODS: This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36). RESULTS: All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement. CONCLUSIONS: Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion.

Widespread infection of Areospora rohanae in southern king crab (Lithodes santolla) populations across south Chilean Patagonia.

Cottage cheese disease is caused by microsporidian parasites that infect a wide range of animal populations. Despite its potential to affect economically important activities, the spatial patterns of prevalence of this disease are still not well understood. Here, we analyse the occurrence of the microsporidian Areospora rohanae in populations of the king crab Lithodes santolla over ca 800 km of the southeastern Pacific shore. In winter 2011, conical pots were deployed between 50 and 200 m depth to capture crabs of a wide range of sizes. The infection was widely distributed along the region, with a mean prevalence of 16%, and no significant association between prevalence and geographical location was detected. Males, females and ovigerous females showed similar prevalence values of 16.5 (13-18.9), 15 (9.2-15) and 16.7% (10-19%), respectively. These patterns of prevalence were consistent across crab body sizes, despite the ontogenetic and sex-dependent variations in feeding behaviour and bathymetric migrations previously reported for king crabs. This study provided the first report of the geographical distribution of A. rohanae infecting southern king crabs.

Cn29, a novel orphan peptide found in the venom of the scorpion Centruroides noxius: Structure and function.

A peptide (Cn29) from the venom of the scorpion Centruroides noxius (about 2% of the soluble venom) was purified and its primary and three-dimensional structures were determined. The peptide contains 27 amino acids with primary sequence: LCLSCRGGDYDCRVKGTCENGKCVCGS. The peptide is tightly packed by three disulfide linkages formed between C2-C23, C5-C18 and C12-C25. Since the native peptide was obtained in limited amounts, the full synthetic peptide was prepared using the standard F-moc-based solid phase synthesis method of Merrifield. The native and synthetic peptides were shown to be identical by sequencing, HPLC separation and mass spectrometry. The solution structure of the peptide solved from NMR data shows that it consists of a well-defined N-terminal region without regular secondary structure extending from Leu 1 to Asp 9, followed by a short helical fragment from Tyr10 to Val14 and two short ß strands (Thr17-Glu19 and Lys22-Val24). The primary and tertiary structures of Cn29 are different from all other scorpion peptides described in the literature. Transcriptome analysis of RNA obtained from C. noxius confirmed the expression of a gene coding for Cn29 in its venom gland. Initial experiments were conducted to identify its possible function: lethality tests in mice and insects as well as ion-channel binding using in vitro electrophysiological assays. None of the physiological or biological tests displayed any activity for this peptide, which at present is considered to be another orphan peptide found in scorpion venoms. The peptide is thus the first example of a novel structural component present in scorpion venoms.

Comparative Analysis of Clinical Outcomes and Procedural Costs between the Conventional Two-stage Technique and 4D Brachytherapy for Early Prostate Cancer.

AIMS: To assess long-term outcomes and resource use of 4D Brachytherapy, a one-stage real-time implant for the treatment of prostate cancer that uses stranded and loose iodine-125 seeds, and to compare with the conventional two-stage (2S) technique. MATERIALS AND METHODS: Prospectively collected data of men who underwent 2S and 4D low dose rate brachytherapy in a single institution were analysed. Survival estimates were analysed using the Kaplan-Meier method and Log-rank test. Treatment failure rates were further compared by Cox proportional hazards (Coxph) regression or by a surrogate prostate-specific antigen value cut-off of 0.4 ng/ml 48 months post-implant. Treatment toxicity outcomes were also evaluated. Comparative costs were based on published English National Health Service data. RESULTS: We compared outcomes of 690 men treated with 2S and 1031 men with 4D brachytherapy. Median follow-up times were 10.4 and 5.2 years (P < 0.001) for 2S and 4D cases, respectively. Day 0 post-implant dosimetry was improved in 4D brachytherapy patients. Five years post-implant ≥98% of cases were alive and ≥95% were free from disease relapse irrespective of technique. Coxph regression showed the risk of relapse after 4D brachytherapy was similar to the 2S technique (hazard ratio 0.67, 95% confidence interval 0.44-1.03, P = 0.065). Forty-eight months post-implant there was a significantly greater proportion of 4D brachytherapy cases with a prostate-specific antigen below 0.4 ng/ml relative to the 2S technique. Urinary and bowel symptom scores showed reduced toxicity after 4D implants and potency conservation was similar to the 2S technique. The reduction in time and resource use decreased the cost of 4D brachytherapy by 40% compared with the 2S technique. CONCLUSION: Two-stage and 4D brachytherapy are both highly effective for the control of localised prostate cancer. However, relative to the 2S technique, the 4D technique was associated with improved dosimetry, reduced treatment-related toxicity and reduced cost. Further follow-up will assess disease control superiority of 4D brachytherapy beyond 5 years post-implant.