Resolving the metabolism of monolignols and other lignin-related aromatic compounds in Xanthomonas citri.

Lignin, a major plant cell wall component, has an important role in plant-defense mechanisms against pathogens and is a promising renewable carbon source to produce bio-based chemicals. However, our understanding of microbial metabolism is incomplete regarding certain lignin-related compounds like p-coumaryl and sinapyl alcohols. Here, we reveal peripheral pathways for the catabolism of the three main lignin precursors (p-coumaryl, coniferyl, and sinapyl alcohols) in the plant pathogen Xanthomonas citri. Our study demonstrates all the necessary enzymatic steps for funneling these monolignols into the tricarboxylic acid cycle, concurrently uncovering aryl aldehyde reductases that likely protect the pathogen from aldehydes toxicity. It also shows that lignin-related aromatic compounds activate transcriptional responses related to chemotaxis and flagellar-dependent motility, which might play an important role during plant infection. Together our findings provide foundational knowledge to support biotechnological advances for both plant diseases treatments and conversion of lignin-derived compounds into bio-based chemicals.

Longitudinal Gut Microbiota Composition During Perinatal period in Women with Different Intensities of Depressive Symptoms.

BACKGROUND: Depressive symptoms during perinatal significantly impact mothers and infants. Emerging evidence suggests a connection between gut microbiota and mood regulation. This study investigated whether depressive symptoms are associated with changes in the gut microbiota of women during the perinatal period. METHOD: A total of 34 pregnant women were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS) and categorized based on symptom severity. Stool samples were collected during the third trimester and at two postpartum timepoints. All samples underwent 16S rRNA gene sequencing and Quantification of Short-Chain Fatty Acids (SCFA) using a gas chromatograph-mass spectrometer (GC-MS). RESULTS: No differences in SCFA concentrations were observed between groups (p>0.05). However, postpartum women with moderate to severe symptoms (MG group) had a significant increase in Enterobacteriaceae abundance compared to the mild and absent group (AL group) (p<0.05). The Bifidobacterium genus increased significantly in both groups over time (p<0.05). The MG group showed a reduction in depressive symptoms during psychiatric treatment (p<0.05). CONCLUSION: These findings suggest a link between gut microbiota and perinatal depressive symptoms. Further research is needed to understand the broader implications for maternal health through microbiome-targeted approaches.

Effects of Testosterone Hormone on the Sexual Aspect of Postmenopausal Women: A Systematic Review.

A decrease in testosterone levels in women during the postmenopausal period is associated with a wide range of signs and symptoms that can negatively impact their sexual quality of life. Due to this, it is crucial to understand and address this hormone deficiency with appropriate medication. To summarize the effects of testosterone treatment on the sexual aspects of postmenopausal women, PubMed was searched from 1974 to the present using the following MESH terms: (((testosterone) OR (androgens)) OR (testosterone deficiency)) AND (sexual dysfunction) AND (postmenopausal women) AND (current therapy replacement))). The inclusion criteria were studies with observational and experimental approaches that evaluated the mechanism of action of testosterone in postmenopausal women. The updated data indicate that testosterone therapy alleviates many of the signs and symptoms related to sexual dysfunction in menopausal women. However, the evidence is limited due to the small sample sizes and the relatively few studies on this topic. As our understanding of the relationship between testosterone and postmenopausal women advances, there has been significant development in the use of this hormone. To validate these findings and ensure they are generalizable, further randomized controlled trials are essential. Future studies should focus on confirming the efficacy of testosterone therapy.

Investigating the Metal-TiO2 Influence for Highly Selective Photocatalytic Oxidation of Methane to Methanol.

Methane conversion to valuable chemicals is a highly challenging and desirable reaction. Photocatalysis is a clean pathway to drive this chemical reaction, avoiding the high temperature and pressure of the syngas process. Titanium dioxide, being the most used photocatalyst, presents challenges in controlling the oxidation process, which is believed to depend on the metal sites on its surface that function as heterojunctions. Herein, we supported different metals on TiO2 and evaluated their activity in methane photooxidation reactions. We showed that Ni-TiO2 is the best photocatalyst for selective methane conversion, producing impressively high amounts of methanol (1.600 µmol·g-1) using H2O2 as an oxidant, with minimal CO2 evolution. This performance is attributed to the high efficiency of nickel species to produce hydroxyl radicals and enhance H2O2 utilization as well as to induce carrier traps (Ti3+ and SETOVs sites) on TiO2, which are crucial for C-H activation. This study sheds light on the role of catalyst structure in the proper control of CH4 photoconversion.

Oral Health Knowledge and Oral Hygiene Habits in a Sample of 12-Year-Old Hispanics: A Cross-sectional Study.

OBJECTIVE: To explore the association between hygiene knowledge and habits and gingivitis in Puerto Rican school children. METHODS: Questionnaires on oral health knowledge and hygiene habits were provided to almost half of the 12-year-olds who participated in an island-wide cross-sectional oral health study. The evaluations included gingival examinations in 2 quadrants. Odds ratios (ORs) (with 95% CIs) were computed using logistic regression models and oral health-related knowledge and hygiene habits to gingivitis. RESULTS: Of the 823 participants who completed the questionnaire 53.43% were female, and 81% had gingivitis. Most reported having received instructions on brushing (98%), flossing (89.5%), and using mouthwash (90%). The majority (75%) rated their gums as healthy, and 44.68% agreed that oral health affects general health. Nearly half (44%) reported brushing their teeth at least 2 times a day, and 80.25%, flossing daily. In multivariate analysis, not having been instructed on how to brush was related to greater odds of having gingivitis (OR: 7.32; 95% CI: 1.5-35.67). Flossing more than once a day was associated with half the odds of gingivitis (OR: 0.50; 95% CI: 0.29-0.88). CONCLUSION: The children had knowledge of oral hygiene methods but were mostly unaware that gingival health could affect systemic health. Fewer than half reported brushing 2 or more times a day. Not having been instructed on how to brush was associated with higher odds of gingivitis.

Deep Learning Networks for Breast Lesion Classification in Ultrasound Images: A Comparative Study.

Accurate lesion classification as benign or malignant in breast ultrasound (BUS) images is a critical task that requires experienced radiologists and has many challenges, such as poor image quality, artifacts, and high lesion variability. Thus, automatic lesion classification may aid professionals in breast cancer diagnosis. In this scope, computer-aided diagnosis systems have been proposed to assist in medical image interpretation, outperforming the intra and inter-observer variability. Recently, such systems using convolutional neural networks have demonstrated impressive results in medical image classification tasks. However, the lack of public benchmarks and a standardized evaluation method hampers the performance comparison of networks. This work is a benchmark for lesion classification in BUS images comparing six state-of-the-art networks: GoogLeNet, InceptionV3, ResNet, DenseNet, MobileNetV2, and EfficientNet. For each network, five input data variations that include segmentation information were tested to compare their impact on the final performance. The methods were trained on a multi-center BUS dataset (BUSI and UDIAT) and evaluated using the following metrics: precision, sensitivity, F1-score, accuracy, and area under the curve (AUC). Overall, the lesion with a thin border of background provides the best performance. For this input data, EfficientNet obtained the best results: an accuracy of 97.65% and an AUC of 96.30%.Clinical Relevance- This study showed the potential of deep neural networks to be used in clinical practice for breast lesion classification, also suggesting the best model choices.

Comparison of Corticotomy and Micro-osteoperforation during Canine Retraction: A Split-Mouth Design.

OBJECTIVE: Compare the efficacy of the micro-osteoperforation (MOP) and corticotomy techniques in terms of maxillary canine retraction. METHODS: Thirteen patients (5 females, 8 males; mean age, 18.07 ± 6.74 years) with healthy permanent dentition and requiring the extraction of maxillary first premolars were included in a split-mouth randomized clinical trial. Those subjects with previous orthodontic or endodontic treatment of the canines were excluded. At least 3 months post-extraction, MOPs and corticotomies were performed distal to the canines. Mini-screws with closed-coil springs (150 g) were used for the canine retraction. Dental casts were made at baseline (T0) and 3 months post-intervention (T1). Trained and calibrated examiners measured the distances from the canines to the second premolars on both sides. A signed-rank sum test was used to compare the amount of canine retraction achieved in 3 months (T0-T1) on the 2 sides. RESULTS: Retraction (mm) at the incisal level was similar in the corticotomy (3.34 ± 1.01) and MOP patients (2.74 ± 1.10) (P = 0.11); furthermore, there were no differences in the degree of medial retraction between the corticotomy (2.56 ± 0.67) and MOP (2.27 ± 0.82) (P = 0.31) procedures. No adverse events were observed. CONCLUSION: There were not any clinically or statistically significant differences in retraction between the interventions. At 3 months, a MOP is as effective as a corticotomy in accelerating the rate of tooth movement.

Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report.

BACKGROUND: Actinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown. CASE PRESENTATION: A 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma. CONCLUSION: Esophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started.

Augmented Reality-Assisted Ultrasound Breast Biopsy.

Breast cancer is the most prevalent cancer in the world and the fifth-leading cause of cancer-related death. Treatment is effective in the early stages. Thus, a need to screen considerable portions of the population is crucial. When the screening procedure uncovers a suspect lesion, a biopsy is performed to assess its potential for malignancy. This procedure is usually performed using real-time Ultrasound (US) imaging. This work proposes a visualization system for US breast biopsy. It consists of an application running on AR glasses that interact with a computer application. The AR glasses track the position of QR codes mounted on an US probe and a biopsy needle. US images are shown in the user's field of view with enhanced lesion visualization and needle trajectory. To validate the system, latency of the transmission of US images was evaluated. Usability assessment compared our proposed prototype with a traditional approach with different users. It showed that needle alignment was more precise, with 92.67 ± 2.32° in our prototype versus 89.99 ± 37.49° in a traditional system. The users also reached the lesion more accurately. Overall, the proposed solution presents promising results, and the use of AR glasses as a tracking and visualization device exhibited good performance.

Socio-Demographic and Medical Characteristics of Patients With Odontogenic Infection Admitted to the Adult University Hospital in Puerto Rico: A Cross-sectional Study.

OBJECTIVE: We aimed to estimate the overall distribution of odontogenic infection by socio-demographic and medical characteristics in patients admitted to the Adult University Hospital (AUH) in Puerto Rico (PR). METHODS: A cross-sectional study was undertaken with the medical charts of 129 patients (≥21 years) with odontogenic infection who had been admitted (2011-2015) to the AUH and treated by the Oral and Maxillofacial Surgery Post - graduate Program of the University of PR. The patients were selected from the hospital's billing database after having been identified using the International Classification of Diseases (9th and 10th revisions). The study variables included age, gender, municipality of residence, medical insurance, infection etiology, surgical and antibiotic treatments, length of stay (LOS), and the presence of diabetes. Descriptive and frequency statistics were calculated for all the variables; chi-squared, Kruskal-Wallis, Kendall tau, and Mann-Whitney tests were performed. A P < .05 was considered statistically significant. RESULTS: The mean age of the subjects was 40.36 (SD: 14.74) years, and they ranged in age from 21 to 81 years; the majority were enrolled in the public health insurance plan of PR. The leading cause of infection was dental caries. Diabetes was associated with longer LOSs; P < .01. CONCLUSION: In our study, the relative frequency of admitted patients with an odontogenic infection, most of them with low income, increased over time with dental caries being the principal cause of infection.

Diagnóstico de un quiste duodeno-colónico con contenido inflamatorio derivado de la metástasis de adenocarcinoma de vesícula biliar: reporte de caso.

The existence of a cystic mass which walls originated from a metastatic gallbladder adenocarcinoma is infrequent. We present the case of 68-year-old male that present to the emergency department with abdominal distention, hyporexia and jaundice. Upon exploratory laparotomy, a duodeno-colonic cyst with walls formed by metastatic cells derived from a Gallbladder Adenocarcinoma. Metastatic disease from a gallbladder adenocarcinoma to transverse colon and duodenum formed adherences between both organs, leading to the formation of cystic mass. Cancer cells have multiple adaptation mechanisms in order to survive harsh environments.

La existencia de un quiste cuyas paredes se originaron de una metástasis de adenocarcinoma de vesícula biliar es infrecuente. Varón de 68 años con distensión abdominal, hiporexia e ictericia. En la laparotomía exploratoria se evidencia un quiste duodeno-colónico de paredes conformadas por células metastásicas producto de un adenocarcinoma de vesícula biliar. La metástasis del adenocarcinoma de vesícula biliar hacia colon transverso y duodeno formaron adherencias entre ambos órganos, conduciendo a la formación de una masa quística. Las células cancerígenas pueden adaptarse de muchas maneras para sobrevivir en entornos adversos.

Comparative analysis of bacterial content, levels of lipopolysaccharides and lipoteichoic acid in symptomatic and asymptomatic endodontic infections at different stages of endodontic treatment.

OBJECTIVES: This study aimed to detect the presence of specific bacteria and to evaluate the levels of lipopolysaccharides (LPS) and lipoteichoic acid (LTA) in symptomatic necrotic root canals associated with acute apical abscess (symptomatic group - GI). It also aimed to compare the findings with those presented by asymptomatic necrotic root canals (asymptomatic group - GII) in the different stages of the endodontic treatment. MATERIALS AND METHODS: Microbiological samples were collected from 20 root canals, including purulent collection from acute apical abscesses, before and after chemo-mechanical preparation (CMP) preparation (CMP) with chlorhexidine gel 2% and after 30 days of intracanal medication (ICM) with (Ca[OH]2) + chlorhexidine. The culture method was used to evaluate the efficacy of CMP and ICM. Nested PCR was used to detect the presence of 17 specific bacteria. Levels of LPS were measured by using limulus amebocyte lysate, whereas enzyme-linked immunosorbent assay was used for the quantification of LTA. RESULTS: CMP was effective in reducing the microbial load in both groups (P < 0.05). LPS levels were higher in GI than in GII (P < 0.05). There was a significant reduction in the LPS levels after CMP and ICM (P < 0.05) in GI and GII. LTA levels were significantly reduced in GI after ICM and in GII after CMP and ICM (both P < 0.05). Fusobacterium nucleatum and Enterococcus faecalis were frequently identified in both groups, alone or in combination with each other. CONCLUSION: Different species were detected in all stages of the endodontic treatment. CMP was able to reduce bacterial content and the levels of LPS, but not of LTA in the symptomatic group. High levels of LPS were correlated with spontaneous pain and pain to percussion in the symptomatic group. CLINICAL RELEVANCE: This clinical study showed that chemo-mechanical preparation was able to reduce bacterial load and levels of LPS, but not of LTA in the symptomatic group. Elevated levels of LPS were correlated with the presence of symptomatology.

Prevalence of Short Root Anomaly in a Group of Puerto Ricans.

OBJECTIVE: To estimate the prevalence of short root anomaly (SRA) in a group of Puerto Ricans at the Advanced Education Program in Orthodontics of the University of Puerto Rico. METHODS: A cross-sectional study was conducted with digital panoramic x-rays of 203 patients (112 females and 91 males; mean age: 17 years) in Puerto Rico. Utilizing the modified Lind's method, 406 maxillary right and left central incisors (1) were measured and evaluated for SRA. Root and crown length and R/C ratio were compared by sex and side. Linear regression was used to evaluate the associations between the R/C ratio and age, sex, and side (right/left). All the statistical analyses were evaluated using significance level of .05 (2). RESULTS: The prevalence of SRA was 0.49%. The average root and crown lengths for the maxillary right and left central incisors were 19.47 and 10.28 mm, respectively. Sex was associated with root and crown length, not with the R/C ratio. No differences were observed in the R/C ratio by the side. There were no significant associations between age, sex, and side and R/C ratio in the multivariate analysis. CONCLUSION: The prevalence of SRA in our population is lower than any reported in the literature. The R/C ratio in our Hispanic population was the highest compared with those of other ethnicities. Neither the sex nor the side of the incisor was associated with the R/C ratio. These findings are contrary to those of prior reports stating that males have higher R/C ratios than females.

An in-vitro study investigating the effect of air-abrasion bioactive glasses on dental adhesion, cytotoxicity and odontogenic gene expression.

OBJECTIVE: To assess the microtensile bond strength (MTBS) and interfacial characteristics of universal adhesives applied on dentine air-abraded using different powders. The analysis includes the cytotoxicity of the powders and their effect on odontogenic gene expression. METHODS: Sound human dentine specimens were air-abraded using bioglass 45S5 (BAG), polycarboxylated zinc-doped bioglass (SEL), alumina (AL) and submitted to SEM analysis. Resin composite was bonded to air-abraded or smear layer-covered dentine (SML) using an experimental (EXP) or a commercial adhesive (ABU) in etch&rinse (ER) or self-etch (SE) modes. Specimens were stored in artificial saliva (AS) and subjected to MTBS testing after 24 h and 10 months. Interfacial nanoleakage assessment was accomplished using confocal microscopy. The cytotoxicity of the powders was assessed, also the total RNA was extracted and the expression of odontogenic genes was evaluated through RT-PCR. RESULTS: After prolonged AS storage, specimens in the control (SML) and AL groups showed a significant drop in MTBS (p > 0.05), with degradation evident within the bonding interface. Specimens in BAG or SEL air-abraded dentine groups showed no significant difference, with resin-dentine interfaces devoid of important degradation. The metabolic activity of pulp stem cells was not affected by the tested powders. SEL and BAG had no effect on the expression of odontoblast differentiation markers. However, AL particles interfered with the expression of the odontogenic markers. SIGNIFICANCE: The use of bioactive glass air-abrasion may prevent severe degradation at the resin-dentine interface. Unlike alumina, bioactive glasses do not interfere with the normal metabolic activity of pulp stem cells and their differentiation to odontoblasts.

Control inadecuado del dolor agudo postoperatorio: prevalencia, prevención y consecuencias. Revisión de la situación en Latinoamérica / Inadequate management of acute postoperative pain: prevalence, prevention, and consequences. Review of the situation in Latin America

Resumen: Introducción: El dolor postoperatorio tiene un alto impacto, es una de las principales causas médicas de retraso en el alta hospitalaria. Asimismo, es causa frecuente de readmisión hospitalaria, retrasos en la recuperación y mayores costos para el sistema de salud y los pacientes. El objetivo del presente trabajo es conocer mejor la situación del dolor agudo postoperatorio en Latinoamérica mediante una revisión bibliográfica para poder establecer su prevalencia y evaluar su magnitud. Material y métodos: Se efectuó una búsqueda bibliográfica en SciELO y PubMed tratando de recopilar la información más detallada, precisa y actualizada. Resultados: En Latinoamérica la falta de políticas claras para la evaluación y el tratamiento del dolor postoperatorio, así como de formación, conduce a un control inadecuado del mismo con una prevalencia de dolor agudo postoperatorio moderado/severo superior a 40%. Conclusiones: El manejo del dolor agudo postoperatorio continúa siendo un problema en Latinoamérica. Muchos pacientes refieren dolor moderado o severo tras la cirugía, lo que puede conducir a dolor crónico. Se necesitan más estudios al respecto para poder establecer aún con mayor precisión la prevalencia del dolor agudo postoperatorio y los efectos derivados de su pobre control.

Abstract: Introduction: Postoperative pain has a profound impact. It is one of the main causes of delayed hospital discharge and it is associated with hospital readmission, recovery problems, and higher costs both for the healthcare system and the patients. The aim of this work is to shed light on the postoperative acute pain management in Latin America through a review of the literature, in order to have a better understanding of its prevalence and the extent of the problem. Material and methods: A bibliographical search was performed in SciELO and PubMed trying to gather the most precise, detailed and updated information. Results: In Latin America, the absence of clear policies for the evaluation and treatment of postoperative pain, as well as the lack of training, leads to its inadequate control with a prevalence of moderate/severe acute postoperative pain greater than 40%. Conclusions: Postoperative acute pain continues to be a problem in Latin America. Many patients still suffer moderate to severe pain after surgery, leading to a chronic or persistent painful condition. More studies are needed to get a clear picture of the prevalence of acute postoperative pain and the deleterious effects of an inadequate management.

Asociación de la violencia obstétrica, control prenatal y embarazo no planeado con la prematurez / Association of obstetric violence, prenatal control, and unplanned pregnancy with prematurity

Resumen La prematurez (PM) neonatal es un problema mayor de salud pública en el mundo, debido a su frecuencia de presentación y los años de vida potencialmente perdidos; además, es la principal causa de muerte en menores de cinco años. Entre las consecuencias negativas de la PM están las discapacidades del aprendizaje, visual y auditiva. Múltiples son los factores asociados a la PM; algunos pueden ser detectados y modificados de forma oportuna en las consultas prenatales y también, en las preconcepcionales. Por otro lado, la PM no es solamente responsabilidad del prestador de los servicios de salud, sino también del sistema de salud, el cual, debe otorgar los recursos mínimos necesarios para monitorear y mantener a la embarazada en un estado óptimo de salud para evitarla, y en caso de presentarse, debe contar con la infraestructura hospitalaria básica que permita la viabilidad del producto y evitar su muerte. Aunado a lo anterior, se debe de considerar la responsabilidad de la paciente y su pareja, debido a que en ellos recae la obligación de llevar un estilo de vida saludable y acudir a las consultas preconcepcionales y control prenatal.

Abstract Neonatal prematurity (MP) is a major public health problem in the world, due to its presentation frequency and the years of life potentially lost; In addition, it is the main cause of death in children under five years of age. Among the negative consequences of MP are learning, visual and hearing disabilities. There are multiple factors associated with MP; some can be detected and modified in a timely manner in prenatal consultations and in preconception. On the other hand, MP is not only responsibility of the health service provider, but also of the health system, which must grant the minimum resources necessary to monitor and maintain the pregnant woman in an optimal state of health to avoid it, and if it occurs, the hospital must have the basic infrastructure that allows the viability of the product and prevents its death. In addition, the responsibility of the patient and her partner must be considered since they are obliged to lead a healthy lifestyle and attend preconception consultations and prenatal care.

Xyloglucan processing machinery in Xanthomonas pathogens and its role in the transcriptional activation of virulence factors.

Xyloglucans are highly substituted and recalcitrant polysaccharides found in the primary cell walls of vascular plants, acting as a barrier against pathogens. Here, we reveal that the diverse and economically relevant Xanthomonas bacteria are endowed with a xyloglucan depolymerization machinery that is linked to pathogenesis. Using the citrus canker pathogen as a model organism, we show that this system encompasses distinctive glycoside hydrolases, a modular xyloglucan acetylesterase and specific membrane transporters, demonstrating that plant-associated bacteria employ distinct molecular strategies from commensal gut bacteria to cope with xyloglucans. Notably, the sugars released by this system elicit the expression of several key virulence factors, including the type III secretion system, a membrane-embedded apparatus to deliver effector proteins into the host cells. Together, these findings shed light on the molecular mechanisms underpinning the intricate enzymatic machinery of Xanthomonas to depolymerize xyloglucans and uncover a role for this system in signaling pathways driving pathogenesis.

Influence of treatment access on survival of metastatic renal cell carcinoma in brazilian cancer center

ABSTRACT Background: Tyrosine kinase inhibitors (TKI) and immunotherapy improved survival in metastatic renal cell carcinoma (mRCC). Disparities in treatment access are present in healthcare systems globally. The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center. Materials and Methods: Records from all mRCC patients treated with first-line TKIs from 2007-2018 were reviewed retrospectively. Categorial variables were compared by Fisher's exact test. Survival was estimated by Kaplan-Maier method and survival curves were compared using the log-rank test. Prognostic factors were adjusted by Cox regression model. Results: Of the 171 eligible patients, 37 (21.6%) were PHS patients and 134 (78.4%) were PrS patients. There were no difference in age, gender, or sites of metastasis. PHS patients had worse performance status (ECOG ≥2, 35.1% vs. 13.5%, p=0.007), poorer risk score (IMDC poor risk, 32.4% vs. 16.4%, p=0.09), and less nephrectomies (73% vs. 92.5%, p=0.003) than PrS patients. Median lines of therapy was one for PHS versus two for PrS patients (p=0.03). Median overall survival (OS) was 16.5 versus 26.5 months (p=0.002) and progression-free survival (PFS), 8.4 versus 11 months (p=0.01) for PHS and PrS patients, respectively. After adjusting for known prognostic factors on multivariate analysis, PHS patients still had a higher risk of death (HR: 1.61, 95% CI: 1.01-2.56, p=0.047). Conclusion: Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access.

Efficacy of Docosahexaenoic Acid for the Prevention of Necrotizing Enterocolitis in Preterm Infants: A Randomized Clinical Trial.

Necrotizing enterocolitis (NEC) is an inflammatory bowel disease and a leading cause of morbidity and mortality in preterm infants. In this study, a randomized double-blind parallel-group (1:1) trial was carried out in two neonatal intensive care units of two tertiary hospitals. Two hundred and twenty-five preterm newborns with an expected functional gastrointestinal tract were recruited and received an enteral dose of 75 mg of docosahexaenoic acid (DHA)/kg body weight or high-oleic sunflower oil daily for 14 days from the first enteral feed after birth. Confirmed NEC was evaluated with Bell's scale from stage ≥ IIa. Two hundred and fourteen randomized infants were analyzed in terms of the intent-to-treat (DHA-group: n = 105; control-group: n = 109); data for two hundred infants were analysed per protocol. Confirmed NEC was lower in infants from the DHA-group compared with the control-group (0/100 vs. 7/100; p = 0.007), with RR = 0.93 (95% CI 0.881 to 0.981), risk difference = -7%, (95% CI -12.00 to -1.99), and number needed-to-treat = 15 (95% CI 8.3 to 50). Intent-to-treat analysis showed a lower level of treatment failure in the DHA-group compared with the control-group (6/105 (6%) vs. 16/109 (15%); p = 0.03, RR = 0.905, (95% CI 0.826 to 0.991)). The results after multivariate-regression analysis remained significant. Adverse events (apart from the incidence of NEC) were not different between groups. A daily dose of DHA for 14 days starting with the first enteral feed may prevent NEC in preterm infants.

Lymphatic invasion is a significant indicator of poor patient outcome in canine bladder urothelial carcinoma.

BACKGROUND: Urothelial carcinoma (UC), also known as transitional cell carcinoma, is the most common malignant tumor of the canine urinary bladder and represents a model for studying human bladder cancer. However, the existing literature has limited data on the clinicopathological characteristics of these tumors and their prognostic value. AIM: The aim of this study was to evaluate such factors, correlating them with follow-up, in a group of 32 dogs with bladder UC. METHODS: Clinical data of these cases, submitted to São Paulo State University and VetPat Private Laboratory (São Paulo/Brazil), were recorded between January 2000 and November 2019. For each case, formalin-fixed and paraffin-embedded sections were stained with hematoxylin and eosin and histologically evaluated. Survival analysis was carried out, and the prognostic value of the presence of lymphatic invasion and the treatment used was determined. RESULTS: Dogs with neoplastic lymphatic vessel invasion had a lower overall survival compared to those without lymphatic invasion, and dogs that received vinblastine in addition to surgery had higher global survival when compared to animals that received carboplatin in addition to surgery. CONCLUSION: The results obtained show the importance of further studies regarding the prognostic value of the two factors demonstrated as potential survival predictors, especially the lymphatic vessel invasion.