High Specificity of HPV Cell-Free DNA Tests in Persons With HIV for the Detection of HPV-Related Cancer.

INTRODUCTION: Persons with HIV (PWH) experience high rates of human papillomavirus (HPV)-associated cancers compared with the general population. Plasma HPV cell-free DNA (cfDNA) tests are sensitive in patients with known HPV-associated cancers. It is not known whether these tests can screen for invasive cancers in populations with high burdens of nonmalignant HPV disease such as PWH. It was not known whether HPV infection and/or noninvasive anal high-grade squamous intraepithelial lesions (HSIL) alone in this population would result in detectable HPV cfDNA, which would result in a high number of false positives if HPV cfDNA is used to screen for invasive cancers. METHODS: We conducted a prospective study of PWH in 2 cohorts: 20 without anal HSIL and 20 with anal HSIL. We tested anal and vaginal swabs for HPV infection, and HPV genotyped the biopsies of anal HSIL. Finally, we performed HPV cfDNA droplet digital polymerase chain reaction to test for HPV16/18/33 from plasma samples. RESULTS: In the combined cohorts, the median age was 56 years, 12.5% were cisgender women, and none had detectable HIV. In total, 84.6% had prevalent anovaginal HPV infection, including 10 participants with HPV16, 13 with HPV18, and 2 with HPV33 infections. Five and 2 participants had HPV16 and HPV33 detected in anal HSIL, respectively. Despite the high prevalence of HPV infection and anal HSIL, no participant had HPV16/18/33 detectable cfDNA by droplet digital polymerase chain reaction. CONCLUSIONS: These results provide a strong rationale for investigating the use of HPV cfDNA in a screening setting for suspected HPV-related invasive cancers in PWH.

Reparación de válvula mitral y cierre de comunicación interauricular, asistida por robot: experiencia inicial / Robotic mitral valve repair and closure of atrial septal defect: report of 13 procedures

Background Robot-assisted minimally invasive heart surgery is an effective alternative when compared with classical approaches. It has a low mortality and postoperative complications and its long-term durability is comparable with conventional techniques. Aim: To report short- and long-term results with the use of a robot-assisted transthoracic approach. Patients and Methods: Review of patients undergoing heart surgery between 2015 and 2019 using a robot assisted minimally invasive technique in a single center. We analyzed demographic characteristics, surgical and early ultrasound results. Results: Thirteen procedures were reviewed, nine mitral valve repairs (MVR) in patients aged 61 ± 21 years (seven males) and four atrial septal defect (ASD) closures in patients aged from 24 to 52 years (three men). For MVR, the average extracorporeal circulation and myocardial ischemia times were 120 ± 20.9 and 89 ± 21 minutes, respectively. The median hospitalization was four days. Two cases of MVR had postoperative complications. There was no mortality. All cases showed improvement in their symptoms. Ultrasound findings showed no postoperative mitral insufficiency except in one case. Conclusions: We report very good results in both complex mitral repair and CIA closure, comparable to centers with high standards in minimally invasive robot-assisted heart surgery.

[Robotic mitral valve repair and closure of atrial septal defect. Report of 13 procedures]. / Reparación de válvula mitral y cierre de comunicación interauricular, asistida por robot: experiencia inicial.

Background Robot-assisted minimally invasive heart surgery is an effective alternative when compared with classical approaches. It has a low mortality and postoperative complications and its long-term durability is comparable with conventional techniques. AIM: To report short- and long-term results with the use of a robot-assisted transthoracic approach. PATIENTS AND METHODS: Review of patients undergoing heart surgery between 2015 and 2019 using a robot assisted minimally invasive technique in a single center. We analyzed demographic characteristics, surgical and early ultrasound results. RESULTS: Thirteen procedures were reviewed, nine mitral valve repairs (MVR) in patients aged 61 ± 21 years (seven males) and four atrial septal defect (ASD) closures in patients aged from 24 to 52 years (three men). For MVR, the average extracorporeal circulation and myocardial ischemia times were 120 ± 20.9 and 89 ± 21 minutes, respectively. The median hospitalization was four days. Two cases of MVR had postoperative complications. There was no mortality. All cases showed improvement in their symptoms. Ultrasound findings showed no postoperative mitral insufficiency except in one case. CONCLUSIONS: We report very good results in both complex mitral repair and CIA closure, comparable to centers with high standards in minimally invasive robot-assisted heart surgery.

The effect of shock wave therapy on patellar ligament desmitis after tibial plateau leveling osteotomy.

OBJECTIVE: To determine if shock wave therapy (SWT) after tibial plateau leveling osteotomy (TPLO) has a beneficial effect on patellar ligament inflammation assessed by thickening of the ligament and ligament fiber disruption. STUDY DESIGN: Prospective, randomized, controlled clinical trial. ANIMALS: Dogs (n = 30). MATERIALS AND METHODS: Dogs that had TPLO (July 1, 2009 to June 1, 2010) were enrolled. The affected stifle was examined by radiographs and ultrasonography preoperatively and 4, 6, and 8 weeks after TPLO. At 4 and 6 weeks, dogs in the treatment group were briefly anesthetized and treated with SWT. Patellar ligament thickness on a lateral radiographic projection was measured at 1/4, 1/2, 3/4 of the distance from origin to insertion. Ultrasound images were evaluated for patellar ligament disruption and periligament edema. RESULTS: There was significant difference in thickness (P = .0264) only at the distal point; therefore, only this point was used to measure difference between the control and treatment groups. A significant difference between groups was reached at 6 and 8 weeks (P = .0059 and P = .0095, respectively) postoperatively. No significant ultrasonographic differences were found. CONCLUSION: Based on these results, SWT decreases the radiographic signs of patellar ligament desmitis.

Curación asistida por presión negativa comparada con curación convencional en el tratamiento del pie diabético amputado. Ensayo clínico aleatorio / Negative-pressure wound therapy versus standard wound dressing in the treatment of diabetic foot amputation. A randomised controlled trial

Introducción Las heridas del pie diabético secundarias a amputación son complejas y de difícil tratamiento. Actualmente, la curación asistida por presión negativa (CAPNE) es ampliamente utilizada para el tratamiento de diversos tipos de heridas. Sin embargo, en la literatura médica hay escasas pruebas científicas sólidas sobre la aplicación de este tipo de curación en heridas del pie diabético amputado. El objetivo de este estudio es comparar la efectividad de la CAPNE con la de la curación convencional en heridas del pie diabético secundarias a amputación. Pacientes y método Ensayo clínico aleatorio. Sujetos mayores de 18 años, diabéticos de tipo II, con herida por amputación del pie, asignados a curación con CAPNE (grupo A) o a curación convencional (grupo B). La variable respuesta fue el tiempo en alcanzar el 90% de granulación. Se estimó un tamaño de muestra de 11 pacientes por grupo. La CAPNE se preparó con una espuma de éster de poliuretano, sonda Nelaton n.o 16, apósito transparente adhesivo y aspiración central a 100mmHg. La herida se curó cada 48 a 72h y se evaluó semanalmente. Se utilizó estadística descriptiva y analítica. Resultados Veinticuatro sujetos con un promedio de edad de 61,8 ± 9,0 años (79% varones), 12 sujetos en cada grupo. El tiempo promedio para alcanzar el 90% de granulación fue significativamente menor en el grupo A (18,8 ± 6 días frente a 32,3 ± 14 días), p=0,007. Conclusión La CAPNE reduce en un 40% el tiempo de granulación de la herida en el pie diabético amputado comparado con el de la curación convencional

Introduction Foot amputation wounds in patients with diabetes are complex and treatment is often difficult. At the moment negative pressure wound therapy (NPWT) is widely used for the treatment of several types of wounds. Nevertheless, the clinical evidence to support the application of this dressing in foot amputation wounds in patients with diabetes is scarce. The aim of this study was to evaluate the efficacy of NPWT compared with standard wound dressing to treat diabetic foot amputation wounds. Patients and method Randomised controlled trial. Diabetic patients aged 18 years or older with a foot amputation wound were assigned to treatment with NPWT (A group) or standard wound dressing (B group). Primary efficacy end point was time in reaching 90% of wound granulation. A size of sample of 11 patients per group was used. NPWT was prepared with a polyurethane ether foam dressing, a Nelaton catheter, a transparent adhesive drape and continuous negative pressure of 100mmHg. The wound was treated every 48–72h and evaluated weekly. Descriptive and analytical statistics were used. Results There were 24 patients, with a mean age of 61.8±9 years (79% men), 12 in each group. The average time to reach 90% of granulation was lower in A group (18.8±6 days versus 32.3±13.7 days), a statistically significant difference (P=0.007). Conclusion NPWT reduces the granulation time of diabetic foot amputation wounds by 40%, compared with the standard wound dressing (AU)

[Negative-pressure wound therapy versus standard wound dressing in the treatment of diabetic foot amputation. A randomised controlled trial]. / Curación asistida por presión negativa comparada con curación convencional en el tratamiento del pie diabético amputado. Ensayo clínico aleatorio.

INTRODUCTION: Foot amputation wounds in patients with diabetes are complex and treatment is often difficult. At the moment negative pressure wound therapy (NPWT) is widely used for the treatment of several types of wounds. Nevertheless, the clinical evidence to support the application of this dressing in foot amputation wounds in patients with diabetes is scarce. The aim of this study was to evaluate the efficacy of NPWT compared with standard wound dressing to treat diabetic foot amputation wounds. PATIENTS AND METHOD: Randomised controlled trial. Diabetic patients aged 18 years or older with a foot amputation wound were assigned to treatment with NPWT (A group) or standard wound dressing (B group). Primary efficacy end point was time in reaching 90% of wound granulation. A size of sample of 11 patients per group was used. NPWT was prepared with a polyurethane ether foam dressing, a Nelaton catheter, a transparent adhesive drape and continuous negative pressure of 100 mmHg. The wound was treated every 48-72 h and evaluated weekly. Descriptive and analytical statistics were used. RESULTS: There were 24 patients, with a mean age of 61.8 +/- 9 years (79% men), 12 in each group. The average time to reach 90% of granulation was lower in A group (18.8 +/- 6 days versus 32.3 +/- 13.7 days), a statistically significant difference (P = 0.007). CONCLUSION: NPWT reduces the granulation time of diabetic foot amputation wounds by 40%, compared with the standard wound dressing.

Vertical patellar position in large-breed dogs with clinically normal stifles and large-breed dogs with medial patellar luxation.

OBJECTIVE: To further define vertical patellar position, as measured by the ratio of patellar ligament length to patellar length (L:P), in large-breed dogs with clinically normal stifles and compare that to the L:P of large-breed dogs with medial patellar luxation (MPL). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Large-breed dogs (n = 50) with clinically normal stifle joints and 30 large-breed dogs with MPL. METHODS: Large-breed dogs with clinically normal stifle joints or MPL were identified and divided into groups (NORM and MPL, respectively). L:P values were determined for each dog by 4 observers from single lateral stifle radiographs. L:P was compared between NORM and MPL groups and 95% confidence intervals (CIs) were calculated. RESULTS: All 4 observers found a significantly higher L:P (more proximally positioned patella) for the MPL group compared with the NORM group. Overall mean (+/-SEM) L:P were: NORM, 1.71+/-0.020 and MPL, 1.87+/-0.025. The 95% CI was determined to be 1.45-1.97 for the NORM group and 1.57-2.17 for the MPL group. CONCLUSIONS: Large-breed dogs with MPL had a significantly more proximal vertical patellar position compared with large-breed dogs with clinically normal stifles. Large-breed dogs with L:P values >1.97 are considered to have patella alta. CLINICAL RELEVANCE: Proximal displacement of the patella within the femoral trochlear groove may play a role in MPL in large-breed dogs.