Problematic use or addiction? A scoping review on conceptual and operational definitions of negative social networking sites use in adolescents.

The aim of this study was to assess the conceptual and operational descriptions of negative social networking site (SNS) use in adolescents. A search was conducted among four databases, following the guidelines set forth in the PRISMA-ScR. The search resulted in 1503 articles, of which 112 met the inclusion criteria. The results showed that the negative use of SNS has been conceptualised from two approaches: (1) the component model of addiction and (2) a cognitive-behavioural problematic use paradigm. Thirty-seven instruments assessing this problem were found, with the Bergen Facebook Addiction Scale and its adaptations being the most widely used ones. These instruments dimensions were vaguely defined and often overlapped with one another. In conclusion, no standardised theoretical framework exists to assess negative SNS use in adolescents. This lack of a theoretical definition makes it difficult to compare results among studies and determine the true extent of the problem.

Using parametric model order reduction for inverse analysis of large nonlinear cardiac simulations.

Predictive high-fidelity finite element simulations of human cardiac mechanics commonly require a large number of structural degrees of freedom. Additionally, these models are often coupled with lumped-parameter models of hemodynamics. High computational demands, however, slow down model calibration and therefore limit the use of cardiac simulations in clinical practice. As cardiac models rely on several patient-specific parameters, just one solution corresponding to one specific parameter set does not at all meet clinical demands. Moreover, while solving the nonlinear problem, 90% of the computation time is spent solving linear systems of equations. We propose to reduce the structural dimension of a monolithically coupled structure-Windkessel system by projection onto a lower-dimensional subspace. We obtain a good approximation of the displacement field as well as of key scalar cardiac outputs even with very few reduced degrees of freedom, while achieving considerable speedups. For subspace generation, we use proper orthogonal decomposition of displacement snapshots. Following a brief comparison of subspace interpolation methods, we demonstrate how projection-based model order reduction can be easily integrated into a gradient-based optimization. We demonstrate the performance of our method in a real-world multivariate inverse analysis scenario. Using the presented projection-based model order reduction approach can significantly speed up model personalization and could be used for many-query tasks in a clinical setting.

Left Diaphragmatic Herniation following Orthotopic Liver Transplantation in an Adult.

Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient's condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms.

Rehabilitación de músculos orofaríngeos con ejercicios y electroterapia para el síndrome de apnea-hipoapnea obstructiva del sueño / Rehabilitation of oropharyngeal muscles with muscle reeducation and electrostimulation in obstructive sleep apnea syndrome

Introducción. El síndrome de apnea obstructiva del sueño (SAOS) tiene repercusiones importantes en la morbimortalidad de los pacientes. Los tratamientos alternos a la presión positiva continua en la vía aérea (CPAP) han resultado poco eficaces, poco seguros o de alta complejidad. Objetivo. Describir los efectos de un programa ambulatorio de reeducación de la musculatura orofacial y extralaríngea y aplicación de electroestimulación (TENS) aplicado a pacientes con SAOS en un hospital universitario de nivel III. Diseño. Estudio de serie de casos incidentes, prospectivo, con pacientes seleccionados consecutivamente. Material y métodos. Diecisiete pacientes con SAOS leve, moderado o severo que asistieron a 24 sesiones (3 semanales) de 30 minutos, de ejercicios orofaríngeos y electroestimulación. Los pacientes fueron evaluados al inicio y al final de la intervención mediante antropometría, polisomnografía, escala de somnolencia de Epworth, SAQLI y tolerancia al CPAP. La tolerancia al CPAP fue evaluada por una escala visual calificada de 1 a 10 (10 correspondía a tolerancia máxima). Las variables cualitativas se describieron en frecuencias y las variables cuantitativas en promedios o medianas dependiendo del tipo de distribución. Resultados. El índice de apnea-hipoapnea mejoró de 22 a 13 por hora, el SAQLI mejoró de 4,65 a 5,33 y Epworth pasó de 7 a 5 después de la intervención. La tolerancia al CPAP mejoró de 3 a 9. Las sesiones fueron bien toleradas, no se presentaron eventos adversos importantes. Cuatro pacientes presentaron dolor muscular facial. Conclusiones. Los ejercicios de reeducación con electroterapia son fáciles, reproducibles, seguros y potencialmente beneficiosos para el SAOS, con mínimos efectos secundarios (AU)

Introduction. Obstructive sleep apnea syndrome (OSA) is associated with increased morbidity and mortality. Alternative interventions to continuous positive airway pressure (CPAP) lack efficacy and safety or are highly complex. Objective. To describe the effects of an outpatient program of orofacial and extralaryngeal muscle re-education combined with electro-stimulation (TENS) of the same muscle groups in patients with OSA attending a tertiary level university hospital. Design. Prospective, incident case series, with consecutively selected patients. Methods. Participants consisted of 17 patients with mild, moderate or severe OSA who attended 24 thirty-minute sessions (three per week) of oropharyngeal exercises and electro-stimulation. The patients were evaluated at the beginning and end of the intervention by anthropometry, polysomnography, the Epworth sleepiness scale, and the Calgary Sleep Apnea Quality of Life (SAQLI) index. CPAP tolerance was evaluated by a visual scale rated from 1 to 10 (10 indicating maximum tolerance). Qualitative variables were described by frequencies, and quantitative variables by means and medians, depending on the type of distribution. Results. After the intervention, the apnea - hypopnea index improved from 22 to 13 per hour, the SAQLI index improved from 4.65 to 5.33, and the Epworth scale from 7 to 5. CPAP tolerance increased from 3 to 9. The sessions were well tolerated with no adverse events of importance. Four patients reported facial muscular pain. Conclusions. Electrotherapy plus active exercises of the oropharyngeal muscles are easy, feasible, safe, and potentially beneficial for OSA, with minimal side effects (AU)

Risk factors of hepatocellular carcinoma recurrence after liver transplantation: accuracy of the alpha-fetoprotein model in a single-center experience.

BACKGROUND: Recurrence of hepatocellular carcinoma (HCC) and cirrhosis after a liver transplantation (LT) is a major concern, and a strict Milan criteria selection of candidates does not accurately discriminate the relapse rate after LT. PURPOSE: This study sought to analyze the risk factors affecting tumor recurrence after LT for related cirrhosis HCC and the application of the French prognostic model (preLT alpha-fetoprotein [AFP], size, number) in a single center. METHODS: In a retrospective observational study of LT for HCC and cirrhosis, clinicopathological features were analyzed. Also, the preoperative and postoperative AFP model score was calculated with a cutoff of 2. RESULTS: Of 480, 109 patients underwent cadaveric LT for HCC. Eight of them had a relapse (7%). High AFP level, AFP model score >2, high pathological tumor-node-metastasis (pTNM) stage, poor differentiation, macrovascular-microvascular invasion, infiltration, and R1 margin were statistically significant (P < .05) for recurrence. Also, in the preoperative model, AFP score >2 was a predictor of worse survival (1-, 3-, 5-, 10-year survival of 81%, 51%, 30%, 30% vs 90%, 76%, 73%, 69% in ≤2, with P = .005). Regarding the postoperative model, similar results were found (1-, 3-, 5-, 10-year survival of 84%, 47%, 37%, 37% vs 90%, 78%, 73%, 52%, P = .028) between AFP model score >2 and ≤2, respectively. However, Milan and up-to-7 criteria were not accurate in recurrence nor in survival. CONCLUSIONS: The French AFP model has proven to be a more discerning prognostic tool than other established criteria in the prediction of recurrence and survival. Also, in postoperative prognosis, pathological risk factors for relapse such as pTNM, differentiation grade, macrovascular-microvascular invasion, infiltration, and R1 margin have been predictors of recurrence.

"Very early" intrahepatic cholangiocarcinoma in cirrhotic patients: should liver transplantation be reconsidered in these patients?

A retrospective cohort multicenter study was conducted to analyze the risk factors for tumor recurrence after liver transplantation (LT) in cirrhotic patients found to have an intrahepatic cholangiocarcinoma (iCCA) on pathology examination. We also aimed to ascertain whether there existed a subgroup of patients with single tumors ≤2 cm ("very early") in which results after LT can be acceptable. Twenty-nine patients comprised the study group, eight of whom had a "very early" iCCA (four of them incidentals). The risk of tumor recurrence was significantly associated with larger tumor size as well as larger tumor volume, microscopic vascular invasion and poor degree of differentiation. None of the patients in the "very early" iCCA subgroup presented tumor recurrence compared to 36.4% of those with single tumors >2 cm or multinodular tumors, p = 0.02. The 1-, 3- and 5-year actuarial survival of those in the "very early" iCCA subgroup was 100%, 73% and 73%, respectively. The present is the first multicenter attempt to ascertain the risk factors for tumor recurrence in cirrhotic patients found to have an iCCA on pathology examination. Cirrhotic patients with iCCA ≤2 cm achieved excellent 5-year survival, and validation of these findings by other groups may change the current exclusion of such patients from transplant programs.

Intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma in patients undergoing liver transplantation: a Spanish matched cohort multicenter study.

OBJECTIVE: To evaluate the outcome of patients with hepatocellular-cholangiocarcinoma (HCC-CC) or intrahepatic cholangiocarcinoma (I-CC) on pathological examination after liver transplantation for HCC. BACKGROUND: Information on the outcome of cirrhotic patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study is limited. METHODS: Multicenter, retrospective, matched cohort 1:2 study. STUDY GROUP: 42 patients undergoing a transplant for HCC and with a diagnosis of HCC-CC or I-CC by pathological study; and control group: 84 patients with a diagnosis of HCC. I-CC subgroup: 27 patients compared with 54 controls; HCC-CC subgroup: 15 patients compared with 30 controls. Patients were also divided according to the preoperative tumor size and number: uninodular tumors 2 cm or smaller and multinodular or uninodular tumors 2 cm or larger. Median follow-up: 51 (range, 3-142) months. RESULTS: The 1-, 3-, and 5-year actuarial survival rate differed between the study and control groups (83%, 70%, and 60% vs 99%, 94%, and 89%, respectively; P < 0.001). Differences were found in 1-, 3-, and 5-year actuarial survival rates between the I-CC subgroup and their controls (78%, 66%, and 51% vs 100%, 98%, and 93%; P < 0.001), but no differences were observed between the HCC-CC subgroup and their controls (93%, 78%, and 78% vs 97%, 86%, and 86%; P = 0.9). Patients with uninodular tumors 2 cm or smaller in the study and control groups had similar 1-, 3-, and 5-year survival rate (92%, 83%, 62% vs 100%, 80%, 80%; P = 0.4). In contrast, patients in the study group with multinodular or uninodular tumors larger than 2 cm had worse 1-, 3-, and 5-year survival rates than their controls (80%, 66%, and 61% vs 99%, 96%, and 90%; P < 0.001). CONCLUSIONS: Patients with HCC-CC have similar survival to patients undergoing a transplant for HCC. Preoperative diagnosis of HCC-CC should not prompt the exclusion of these patients from transplant option.

Assessing mobile food vendors (a.k.a. street food vendors)--methods, challenges, and lessons learned for future food-environment research.

OBJECTIVES: Mobile food vendors (also known as street food vendors) may be important sources of food, particularly in minority and low-income communities. Unfortunately, there are no good data sources on where, when, or what vendors sell. The lack of a published assessment method may contribute to the relative exclusion of mobile food vendors from existing food-environment research. A goal of this study was to develop, pilot, and refine a method to assess mobile food vendors. STUDY DESIGN: Cross-sectional assessment of mobile food vendors through direct observations and brief interviews. METHODS: Using printed maps, investigators canvassed all streets in Bronx County, NY (excluding highways but including entrance and exit ramps) in 2010, looking for mobile food vendors. For each vendor identified, researchers recorded a unique identifier, the vendor's location, and direct observations. Investigators also recorded vendors answers to where, when, and what they sold. RESULTS: Of 372 identified vendors, 38% did not answer brief-interview questions (19% were 'in transit', 15% refused; others were absent from their carts/trucks/stands or with customers). About 7% of vendors who ultimately answered questions were reluctant to engage with researchers. Some vendors expressed concerns about regulatory authority; only 34% of vendors had visible permits or licenses and many vendors had improvised illegitimate-appearing set-ups. The majority of vendors (75% of those responding) felt most comfortable speaking Spanish; 5% preferred other non-English languages. Nearly a third of vendors changed selling locations (streets, neighbourhoods, boroughs) day-to-day or even within a given day. There was considerable variability in times (hours, days, months) in which vendors reported doing business; for 86% of vendors, weather was a deciding factor. CONCLUSIONS: Mobile food vendors have a variable and fluid presence in an urban environment. Variability in hours and locations, having most comfort with languages other than English, and reluctance to interact with individuals gathering data are principal challenges to assessment. Strategies to address assessment challenges that emerged form this project may help make mobile-vendor assessments more routine in food-environment research.

Statistical quality control charts for liver transplant process indicators: evaluation of a single-center experience.

Liver transplantation, the best option for many end-stage liver diseases, is indicated in more candidates than the donor availability. In this situation, this demanding treatment must achieve excellence, accessibility and patient satisfaction to be ethical, scientific, and efficient. The current consensus of quality measurements promoted by the Sociedad Española de Trasplante Hepático (SETH) seeks to depict criteria, indicators, and standards for liver transplantation in Spain. According to this recommendation, the Canary Islands liver program has studied its experience. We separated the 411 cadaveric transplants performed in the last 15 years into 2 groups: The first 100 and the other 311. The 8 criteria of SETH 2010 were correctly fulfilled. In most indicators, the outcomes were favorable, with an actuarial survivals at 1, 3, 5, and 10 years of 84%, 79%, 76%, and 65%, respectively; excellent results in retransplant rates (early 0.56% and long-term 5.9%), primary nonfunction rate (0.43%), waiting list mortality (13.34%), and patient satisfaction (91.5%). On the other hand, some indicators of mortality were worse as perioperative, postoperative, and early mortality with normal graft function and reoperation rate. After the analyses of the series with statistical quality control charts, we observed an improvement in all indicators, even in the apparently worst, early mortality with normal graft functions in a stable program. Such results helped us to discover specific areas to improve the program. The application of the quality measurement, as SETH consensus recommends, has shown in our study that despite being a consuming time process, it is a useful tool.

Hepatocellular carcinoma and liver transplantation: a 12-year experience.

BACKGROUND: Orthotopic liver transplantation (OLT) for patients with cirrhosis and concomitant hepatocellular carcinoma (HCC) in early stages is the treatment of choice, with an acceptable recurrence rate and excellent survival. AIM: We sought to evaluate (1) the accuracy of preoperative imaging; (2) the impact of pre-OLT treatments on survival and recurrence; and (3) the influence of beyond Milan criteria selection on global outcomes. METHODS: We studied a cohort of 65 patients with HCC among 300 consecutive OLTs over a single 12-year experience. We analyzed the overall outcomes of survival and recurrence, the accuracy of preoperative diagnosis and staging the influence of neoadjuvant treatment prior to OLT, and the effect on overall outcomes beyond the Milan criteria in our series. RESULTS: The 65 transplants were performed for HCC, mostly in association with hepatitis C virus and alcoholic cirrhosis with HTP. At a mean follow-up of 40.32 months, the recurrence rate was 5.7% among the 61 HCC confirmed by histopathology. The overall survival was 30.07. Actuarial survivals at 1, 5, and 10 years were 82%, 77%, and 62%, respectively. Six retransplants occurred among the seven graft losses albeit with poor survival after the second graft. Most explants showed low pTNM stages with favorable microscopic features. Preoperative imaging tests failed to achieve an accurate diagnosis in 15.38% of the series. The role of alpha-fetoprotein (AFP) and hepatic biopsy was irrelevant. Unfavorable histopathologic factors predicted a greater recurrence rate, but had no influence on survival. Neither recurrence nor survival were modified by pre-OLT therapy. CONCLUSIONS: In our series, AFP, hepatic biopsy, and pre-OLT treatment had limited roles. Radiological imaging techniques underestimated HCC staging and lead to a misdiagnosis to an expected degree. Despite these findings, this single institution experience with OLT for HCC showed excellent survivals with a low recurrence rate including cases of patients beyond the Milan criteria.

Development of explicit criteria for cholecystectomy.

OBJECTIVE: Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cholecystectomy. New diagnostic and treatment techniques have been developed in the last decade, so an updated appropriateness of indications tool was developed for cholecystectomy in patients with non-malignant diseases. The validity and reliability of panel results using this tool were tested. METHODS: Criteria were developed using a modified Delphi panel judgement process. The level of agreement between the panelists (six gastroenterologists and six surgeons) was analysed and the ratings were compared with those of a second different panel using weighted kappa statistics. RESULTS: The results of the main panel were presented as a decision tree. Of the 210 scenarios evaluated by the main panel in the second round, 51% were found appropriate, 26% uncertain, and 23% inappropriate. Agreement was achieved in 54% of the scenarios and disagreement in 3%. Although the gastroenterologists tended to score fewer scenarios as appropriate, as a group they did not differ from the surgeons. Comparison of the ratings of the main panel with those of a second panel resulted in a weighted kappa statistic of 0.75. CONCLUSIONS: The parameters tested showed acceptable validity and reliability results for an evaluation tool. These results support the use of this algorithm as a screening tool for assessing the appropriateness of cholecystectomy.

Traducción y validación del índice de calidad de vida gastrointestinal (GIQLI) / Translation and valida tion of the Gastrointestinal Quality of Life Index (GIQLI)

Objetivo: traducir al español y validar el GIQLI, un cuestionario de medición de calidad de vida relacionada con la salud para patología gastrointestinal Pacientes y métodos: en el estudio se incluyen todos los pacientes con diagnóstico de colelitiasis, en lista de espera para ser intervenidos de colecistectomía, en tres hospitales públicos. A todos los pacientes se les pidió que cumplimentaran los cuestionarios GIQLI y SF-36 antes de la intervención y a los 3 meses de la misma. Se estudió la validez, fiabilidad y sensibilidad al cambio del GIQLI. Resultados: completaron ambos cuestionarios, antes y después de la colecistectomía, 353 pacientes. El GIQLI fue capaz de detectar diferencias según nivel de gravedad, medido por el número de cólicos previos, entre aquéllos con menos de 6 cólicos (puntuación total del GIQLI: 102,7) o más de 6 (89,2). Las áreas del GIQLI correlacionaron bien con el SF-36 (coeficiente de correlación de Pearson de 0,58 a 0,79). La consistencia interna de sus áreas fue buena ( de Cronbach de 0,70 a 0,86). La sensibilidad al cambio, medida por la media de respuesta estandarizada, de las áreas del GIQLI fue de 0,45 a 0,82, mejor que la del cuestionario genérico SF-36 (0,20 a 0,56).Conclusiones: la traducción de GIQLI al español proporciona una nueva herramienta de medición de la cálida de vida, para su uso en patología gastrointestinal. Nuestros resultados apoyan la validez, fiabilidad y sensibilidad al cambio de este cuestionario (AU)

Translation and validation of the gastrointestinal Quality of Life Index (GIQLI).

OBJECTIVE: To translate into Spanish and validate the GIQLI, a health related quality of life questionnaire for gastrointestinal diseases. PATIENTS AND METHODS: All patients with a diagnosis of cholelithiasis, on waiting list to undergo a cholecystectomy, from three public hospitals, were included in this study. All patients were requested to fulfill the GIQLI and the SF-36 before and three months after the intervention. The validity, reliability and responsiveness of the GIQLI were studied. RESULTS: 353 patients completed both questionnaires before and after the intervention. The GIQLI was able to discriminate among levels of severity, measured by the number of previous biliary colics, between those with less (total GIQLI score: 102.7) or more than 6 colics (89.2). GIQLI domains correlated with those of the SF-36 (Pearson correlation coefficient from 0.58 to 0.79). Internal consistency of its domains was good (Cronbach alpha from 0.70 to 0.86). Responsiveness, measured by the standardized response mean, of the GIQLI ranged between 0.45 to 0.82, better than the generic questionnaire SF-36 (0.20 a 0.56). CONCLUSIONS: GIQLI translation into Spanish provides with a new tool to measure quality of life on gastrointestinal diseases. Our results support the validity, reliability and responsiveness of the GIQLI Spanish version.

Characterisation of Micrococcaceae isolated from different varieties of chorizo.

A total of 426 strains of Micrococcaceae bacteria isolated from chorizo (a traditional Spanish fermented sausage) were identified. The chorizos were sampled from three regions of Castilla and León in Spain: Burgos, Segovia and Salamanca. Two factories were chosen in each region and the samples were taken at three stages of ripening. Staphylococcus xylosus was the most predominant species isolated (95%). Twelve strain types of S. xylosus were established according to their fermentation patterns, and two of them, S. xylosus type 2 and S. xylosus type 5, made up the majority of the strains of S. xylosus isolated (27 and 52%). Production of acetoin, nitrate reductase, urease activity, proteolytic and lipolytic activity were determined for all isolates. The percentage of strains of S. xylosus producing acetoin depends on the manufacturing location. In general, the proteolytic and lipolytic activities of the S. xylosus isolated from chorizo from Castilla and León were low and moderate; 97% of the strains showed nitrate reductase and urease activity. According to our results and to previous investigations, it seems that S. xylosus type 5, showing nitrate reductase and urease activity, low-moderate proteolytic and lipolytic activities and not producing acetoin would be suitable as a starter culture. Of the strains isolated in this study, 38% comply with these requirements.

[Hepatic inflammatory pseudotumor: apropos a case with a response to steroid treatment]. / Seudotumor inflamatorio hepático: a propósito de un caso con respuesta a tratamiento esteroideo.

A new case of hepatic inflammatory pseudotumor (HIP) is reported. A 66-year-old woman presented with fever and toxic syndrome. Analysis demonstrated an elevation in erythrocyte sedimentation, CRP, leukocytosis and normocytic anemia. A lesion was observed on ultrasonography in the right hypoechoic hepatic lobe with echos within (mosaic pattern). The lesion was hypodense on CT scan and was hypervascularized on angiography. NMR was hypointense on T1 and hyperintense on T2. The patient underwent surgery with intraoperative biopsy being performed. Hepatectomy was not carried out given negativity of malignancy. Following surgery the patient remained asymptomatic and the analytical alterations normalized. After a asymptomatic 5-year period the clinical-analytical alterations reappeared following erysipelas. Fever showed partial response to non steroid antiinflammatory drugs and a satisfactory response to corticoids. Studies are required to evaluate the role of corticoid treatment in this disease.

[Gastric tuberculosis: a report of 2 cases]. / Tuberculosis gástrica: presentación de dos casos.

Two patients with gastric tuberculosis are described. The first presented toxic syndrome, multiple abdominal adenopathies, microcytic anemia and a subcardial ulcer with malignant characteristics at endoscopy. Diagnosis was based on the positivity of Ziehl-Neelsen staining and on the growth of Mycobacterium tuberculosis in the culture of the gastric mucosa. The second patient presented toxic syndrome, fever and a miliary pattern on thoracic radiography. Endoscopy demonstrated an ulcerated nodular lesion with granulomas with acid alcohol resistant bacillus being observed on biopsy. Mycobacterium tuberculosis was found in both the sputum and bronchoaspirate. The evolution of both cases was favorable with specific treatment.