Variations in the threshold's values for border zone and dense scar produce significant changes in the scar parameters obtained by ADAS-3D.

BACKGROUND: ADAS-3D software elaborates Cardiac Magnetic Resonance (CMR) images to obtain a quantitative evaluation of dense scar and border zone (BZ), including BZ channels, which can be useful for ventricular tachycardia ablation and for risk-stratification. However, most prior reports with ADAS-3D used flexible thresholds (60%±5% and 40%±5% of maximum pixel signal intensity -PSI) to define dense scar and BZ. It is unknown which is the impact of such variations of the thresholds values on the measurements obtained with ADAS-3D. OBJECTIVE: To quantify the degree of change in ADAS-3D measurements when different thresholds for dense scar and BZ are employed. METHODS: Single-center retrospective observational cohort study including 87 consecutive patients with previous myocardial infarction who underwent CMR. ADAS-3D software semi-automatically processed CMR sequences. We compared the scar measurements obtained using the 9 possible combinations of thresholds (55%/60%/65% and 35%/40%/45% of maximum PSI). RESULTS: The overall comparison between thresholds showed highly significant differences (p<0.001) in all scar parameters. Not a single patient maintained the same number of BZ channels with all the thresholds settings. A percentage difference of up to 200% in BZ channels numbers and channels mass was observed in all 36 comparisons. An absolute difference of up to 10 channels was also recorded. Of note, the highest median channel mass (obtained with the thresholds 35-65) was 59-fold higher as compared to the lowest one (obtained with the 45-55 cut-offs). CONCLUSIONS: Variations in threshold values result in statistically significant and high-magnitude changes in the quantification of scar parameters by ADAS-3D.

Effects of Respiratory Muscle Training on Functional Ability, Pain-Related Outcomes, and Respiratory Function in Individuals with Low Back Pain: Systematic Review and Meta-Analysis.

Objectives: The aim of this meta-analysis was to determine the effects of respiratory muscle training (RMT) on functional ability, pain-related outcomes, and respiratory function in individuals with sub-acute and chronic low back pain (LBP). Methods: The study selection was as follows: (participants) adult individuals with >4 weeks of LBP; (intervention) RMT; (comparison) any comparison RMT (inspiratory or expiratory or mixed) versus control; (outcomes) postural control, lumbar disability, pain-related outcomes, pain-related fear-avoidance beliefs, respiratory muscle function, and pulmonary function; and (study design) randomized controlled trials. Results: 11 studies were included in the meta-analysis showing that RMT produces a statistically significant increase in postural control (mean difference (MD) = 21.71 [12.22; 31.21]; decrease in lumbar disability (standardized mean difference (SMD) = 0.55 [0.001; 1.09]); decrease in lumbar pain intensity (SMD = 0.77 [0.15; 1.38]; increase in expiratory muscle strength (MD = 8.05 [5.34; 10.76]); and increase in forced vital capacity (FVC) (MD = 0.30 [0.03; 0.58]) compared with a control group. However, RMT does not produce an increase in inspiratory muscle strength (MD = 18.36 [-1.61; 38.34]) and in forced expiratory volume at the first second (FEV1) (MD = 0.36 [-0.02; 0.75]; and in the FEV1/FVC ratio (MD = 1.55 [-5.87; 8.96]) compared with the control group. Conclusions: RMT could improve expiratory muscle strength and FVC, with a moderate quality of evidence, whereas a low quality of evidence suggests that RMT could improve postural control, lumbar disability, and pain intensity in individuals with sub-acute and chronic LBP. However, more studies of high methodological quality are needed to strengthen the results of this meta-analysis.

Long-term follow-up of total hip arthroplasty using polyethylene-ceramic composite (sandwich) liner.

INTRODUCTION: Ceramic-on-ceramic bearings have been widely used since their introduction in the 1970s. First-generation ceramics have very high fracture (breakage) rates. To overcome this, in the 1990s, modular cotyloid insert designs were developed, consisting of a ceramic and polyethylene composite (sandwich-type) liner; however, high implant fracture rates were observed in the medium term. We aimed to estimate the cumulative incidences of revision surgery (implant failure) and implant failure due to fractures, survival rates (time-to-revision surgery and time-to-fracture), and the long-term clinical and radiological outcomes in our series. METHODS: This was an observational, longitudinal, ambispective, single-centre study based on patients who underwent primary total hip arthroplasty (THA) using a sandwich-type liner (Cerasul), only available in our tertiary hospital between January 1999 and December 2002. Cumulative incidences were estimated and the 95% confidence interval (95% CI) was calculated. The Kaplan-Meier method was used to assess the time-to-revision surgery and time-to-fracture. RESULTS: 54 patients (49 men) were included, accounting for 59 sandwich-type linear implants. The mean (range) age was 47.4 (22-57) years. The primary THA indications were osteoarthritis (28 patients), osteonecrosis (14), childhood pathology sequelae (11), and inflammatory arthritis (6). The cumulative incidence of revision surgery by implants was 8.5% (5/59, 95% CI, 3.5-19.2%), 9.3% by patients (5/54, 95% CI, 4.0-19.9%), and 5.1% by implant fractures (3/59, 95%CI, 1.7-13.9%). The median (Interquartile Range, IQR) time-to-revision surgery was 158 (72.5-161) months, and the time to fracture was 182 (138-215) months. All primary THAs had good clinical and long-term survival outcomes. All implants had signs of solid fixation. CONCLUSIONS: After a 20-year follow-up period, the polyethylene-ceramic sandwich-type liner showed a long survival rate and low cumulative incidence of implant fracture; however, implant fractures remain the main complication. Orthopaedic surgeons should be aware that some patients still have this type of prosthesis and must be capable of responding quickly if a fracture occurs.

Precise glucose measurement in sodium fluoride-citrate plasma affects estimates of prevalence in diabetes and prediabetes.

OBJECTIVES: Estimates of glucose concentrations vary among types of blood samples, which impact on the assessment of diabetes prevalence. Guidelines recommend a conversion factor to calculate plasma glucose from measurements of glucose in whole blood. The American Diabetes Association recommends the use of blood drawing tubes containing sodium fluoride (NaF) and citrate, which have not yet been evaluated regarding possible differences in glucose concentration and conversion factors. Thus, we compared glucose measurements in NaF-citrate plasma and venous whole blood and estimated the impact of differences on diabetes and prediabetes prevalence. METHODS: Glucose differences were calculated by Bland-Altman analysis with pairwise comparison of glucose measurements from whole blood and NaF-citrate plasma (n=578) in clinical studies of the German Diabetes Center. Subsequently, we computed the impact of the glucose difference on diabetes and prediabetes prevalence in the population-based National Health and Nutrition Examination Survey (NHANES). RESULTS: Even upon conversion of whole blood to plasma glucose concentrations using the recommended conversion factor, mean glucose concentration difference remained 4.72 % higher in NaF-citrate plasma. Applying the higher glucose estimates, increases the population-based diabetes and prediabetes prevalence by 13.67 and 33.97 % or more than 7.2 and 13 million people in NHANES, respectively. Additional economic burden could be about 20 $ billion per year due to undiagnosed diabetes. CONCLUSIONS: The recommended conversion factor is not valid for NaF-citrate plasma. Systematic bias of glucose measurements due to sampling type leads to clinically relevant higher estimates of diabetes and prediabetes prevalence.

[Consultations to Emergency Departments for acute psychosis associated with illycit drugs use in Spain (REDUrHE Registry)]. / Consultas a Urgencias hospitalarias por psicosis aguda asociada al consumo de drogas ilegales en España (Registro REDUrHE).

OBJECTIVE: Mental health problems are increasing in Spain, and those related to drug use are a preventable aspect of public health. In Spain there are few studies on the incidence and characteristics of acute psychosis due to illegal drug use, especially at national and multicenter level, reason that motivated this paper. METHODS: A prospective multicentre study was carried out in eleven hospital Emergency Departments in Spain, lasting twenty-four months (REDUrHE Registry). Patients with acute psychosis were compared with those with organic pathology, analysing demographic aspects, drugs involved, associated clinical manifestations and evolution Quantitative variables were compared using Student's t-test and qualitative variables were compared using the chi-squared test (or Fisher's exact test as appropriate) and the magnitude of the association with the presence of psychosis using logistic regression. A p-value of less than 0.05 was considered statistically significant or if the 95%CI of the OR excluded the value 1. RESULTS: Of the 4,487 patients in the registry, 9.5% presented acute psychosis, with a median age of thirty-two years and 79% male. The main clinical features were agitation (53%, p=0.001), hallucinations (43.2%, p=0.001) and anxiety (40%, p=0.00). Psychosis was more frequent with cannabis (57.7%), cocaine (42%) and amphetamines and derivatives (26.4%), although in the analysis adjusted for co-drug use (39.5%), or in association with ethyl alcohol (57.7%), it was only statistically significant for cannabis (p=0.0). Patients with psychosis required more hospital admissions (38.1% vs. 10%, p=0.001), mainly in psychiatric units (34.1% vs. 4.2%, p=0.001), with hardly any intensive care unit admissions (0.4% vs. 2.1%, p=0.01). ED stay was high (29.3±73.8 hours vs 10.5±58.8 hours, p=0.001). CONCLUSIONS: In Spain, cannabis is the drug most associated with psychosis. This clinical condition produces more hospital admissions, although with a low risk at an organic level.

OBJETIVO: Los problemas de salud mental van en aumento en España, siendo los relacionados con el consumo de drogas una faceta prevenible en el ámbito de la Salud Pública. En España existen pocos estudios sobre la incidencia y características de la psicosis aguda por consumo de drogas ilegales, sobre todo de ámbito nacional y multicéntrico, razón que motivó este trabajo. METODOS: Se realizó un estudio multicéntrico prospectivo, de veinticuatro meses de duración, en once servicios de Urgencias hospitalarias de España (Registro REDUrHE). Se compararon los pacientes con psicosis aguda respecto a los que presentaban patología orgánica, analizando aspectos demográficos, drogas involucradas, clínica asociada y evolución. Las variables cuantitativas se compararon mediante la t de Student y cualitativas con la prueba ji al cuadrado (o el test exacto de Fisher según procediera) y la magnitud de la asociación con la presencia de psicosis mediante regresión logística. Se consideró estadísticamente significativo un valor de p menor de 0,05 o si el IC95% de la OR excluía el valor 1. RESULTADOS: De los 4.487 pacientes del registro, el 9,5% presentó psicosis aguda, con una mediana de edad de treinta y dos años y un 79% de varones. La clínica principal consistió en agitación (53%, p=0,001), alucinaciones (43,2%, p=0,001) y ansiedad (40%, p=0,00). La psicosis fue más frecuente con el consumo de cannabis (57,7%), de cocaína (42%) y de anfetaminas y derivados (26,4%), aunque en el análisis ajustado por coingesta de varias drogas (39,5%), o asociado a alcohol etílico (57,7%), sólo resultó estadísticamente significativo para el cannabis (p=0,0). Los pacientes con psicosis precisaron más ingreso hospitalario (38,1% frente a 10%, p=0,001), fundamentalmente en Unidades de psiquiatría (34,1% frente a 4,2%, p=0,001), sin apenas ingresar en unidades de cuidados intensivos (0,4% frente a 2,1%, p=0,01). La estancia en Urgencias fue más elevada (29,3±73,8 horas frente a 10,5±58,8 horas, p=0,001). CONCLUSIONES: En España, el cannabis es la droga que se relaciona en mayor medida con los casos de psicosis atendidas en Urgencias hospitalarias. Ésta clínica produce más ingresos hospitalarios, aunque con bajo riesgo a nivel orgánico.

Tunneled Island Flaps for the Reconstruction of Nasal Defects: A 21-Case Series.

(1) Background: The reconstruction of cutaneous defects following surgical procedures in the nasal pyramid presents a challenge due to the limited amount of available tissue. In cases of larger defects, skin from adjacent units is used. Traditionally, two-stage surgical flaps have been employed for reconstructing these defects. Tunnelized island flaps allow for the one-stage surgical reconstruction of nasal pyramid defects, using tissue from the forehead or cheek for the flap. (2) Methods: Descriptive retrospective study of 21 consecutive patients who underwent surgery for defects on the nasal pyramid using tunnelized island flaps. (3) Results: Surgical reconstruction was performed in 21 patients with basal cell carcinomas, 14 of them using the melolabial island flap and 7 using the paramedian forehead island flap. In all cases except one, clear histological margins were obtained. Immediate complications were mild and minor. It is worth noting the trapdoor effect complication, which improved over time in most cases, resulting in a satisfactory cosmetic outcome. No tumor recurrences were observed during an average follow-up period of 17.7 months. (4) Conclusions: Tunnelized island flaps allow for single-stage reconstruction of nasal pyramid defects, yielding excellent cosmetic results by utilizing adjacent skin. This procedure demands a certain level of skill but is associated with minimal complications, making it a valuable alternative in reconstructive dermatological surgery.

Consultas a Urgencias hospitalarias por psicosis aguda asociada al consumo de drogas ilegales en España (Registro REDUrHE) / Consultations to Emergency Departments for acute psychosis associated with illycit drugs use in Spain (REDUrHE Registry)

Fundamentos: Los problemas de salud mental van en aumento en España, siendo los relacionados con el consumo de drogas una faceta prevenible en el ámbito de la Salud Pública. En España existen pocos estudios sobre la incidencia y características de la psicosis aguda por consumo de drogas ilegales, sobre todo de ámbito nacional y multicéntrico, razón que motivó este trabajo. Métodos// Se realizó un estudio multicéntrico prospectivo, de veinticuatro meses de duración, en once servicios de Urgencias hospitalarias de España (Registro REDUrHE). Se compararon los pacientes con psicosis aguda respecto a los que presentaban patología orgánica, analizando aspectos demográficos, drogas involucradas, clínica asociada y evolución. Las variables cuantitativas se compararon mediante la t de Student y cualitativas con la prueba ji al cuadrado (o el test exacto de Fisher según procediera) y la magnitud de la asociación con la presencia de psicosis mediante regresión logística. Se consideró estadísticamente significativo un valor de p menor de 0,05 o si el IC95% de la OR excluía el valor 1. Resultados: De los 4.487 pacientes del registro, el 9,5% presentó psicosis aguda, con una mediana de edad de treinta y dos años y un 79% de varones. La clínica principal consistió en agitación (53%, p=0,001), alucinaciones (43,2%, p=0,001) y ansiedad (40%, p=0,00). La psicosis fue más frecuente con el consumo de cannabis (57,7%), de cocaína (42%) y de anfetaminas y derivados (26,4%), aunque en el análisis ajustado por coingesta de varias drogas (39,5%), o asociado a alcohol etílico (57,7%), sólo resultó estadísticamente significativo para el cannabis (p=0,0). Los pacientes con psicosis precisaron más ingreso hospitalario (38,1% frente a 10%, p=0,001), fundamentalmente en Unidades de psiquiatría (34,1% frente a 4,2%, p=0,001), sin apenas ingresar en unidades de cuidados intensivos (0,4% frente a 2,1%, p=0,01)...(AU)

Background: Mental health problems are increasing in Spain, and those related to drug use are a preventable aspect of public health. In Spain there are few studies on the incidence and characteristics of acute psychosis due to illegal drug use, especially at national and multicenter level, reason that motivated this paper. Methods: A prospective multicentre study was carried out in eleven hospital Emergency Departments in Spain, lasting twenty-four months (REDUrHE Registry). Patients with acute psychosis were compared with those with organic pathology, analysing demographic aspects, drugs involved, associated clinical manifestations and evolution Quantitative variables were compared using Student’s t-test and qualitative variables were compared using the chi-squared test (or Fisher’s exact test as appropriate) and the magnitude of the association with the presence of psychosis using logistic regression. A p-value of less than 0.05 was considered statistically significant or if the 95%CI of the OR excluded the value 1. Results: Of the 4,487 patients in the registry, 9.5% presented acute psychosis, with a median age of thirty-two years and 79% male. The main clinical features were agitation (53%, p=0.001), hallucinations (43.2%, p=0.001) and anxiety (40%, p=0.00). Psychosis was more frequent with cannabis (57.7%), cocaine (42%) and amphetamines and derivatives (26.4%), although in the analysis adjusted for co-drug use (39.5%), or in association with ethyl alcohol (57.7%), it was only statistically significant for cannabis (p=0.0). Patients with psychosis required more hospital admissions (38.1% vs. 10%, p=0.001), mainly in psychiatric units (34.1% vs. 4.2%, p=0.001), with hardly any intensive care unit admissions (0.4% vs. 2.1%, p=0.01). ED stay was high (29.3±73.8 hours vs 10.5±58.8 hours, p=0.001)...(AU)

Lower Urinary Tract Symptoms (LUTS) as a New Clinical Presentation of Histamine Intolerance: A Prevalence Study of Genetic Diamine Oxidase Deficiency.

Lower urinary tract symptoms (LUTS) are highly prevalent, and their treatment is mainly focused on the control of symptoms. Histamine intolerance (HIT) has been related to a variety of systemic symptoms. DAO deficiency has been identified as a significant factor contributing to histamine intolerance (HIT). Preclinical evidence indicates the involvement of histamine in the lower urinary tract. This study aimed to assess the prevalence of diamine oxidase deficiency (DAO) in a prospective cohort of 100 patients with at least moderate LUTS. A genetic study of four single nucleotide polymorphisms (SNPs) (c.-691G>T, c.47C>T, c.995C>T, and c.1990C>G) was performed. HIT was found in 85.9% of patients. The prevalence of at least one minor allele in the SNPs analyzed was 88%, without gender differences. Storage symptoms were more intense in the presence of HIT as well as asthenia and neurological and musculoskeletal symptoms. The presence of minor alleles of the AOC1 gene was associated with a higher intensity of symptoms. Minor alleles from c.-691G>T and c.47C>T SNPs were also associated with a greater severity of obstructive symptoms. Thirty-one percent of patients presented the four SNPS with at least one associated minor allele. The relationship between HIT and LUTS in a mixed population of men and women found in this study supports further investigations to define the pathophysiology of histamine in LUTS.

Effect of Dietary Guanidinoacetic Acid Levels on the Mitigation of Greenhouse Gas Production and the Rumen Fermentation Profile of Alfalfa-Based Diets.

The objective of this study was to evaluate the effect of different percentages of alfalfa (Medicago sativa L.) hay (AH) and doses of guanidinoacetic acid (GAA) in the diet on the mitigation of greenhouse gas production, the in vitro rumen fermentation profile and methane (CH4) conversion efficiency. AH percentages were defined for the diets of beef and dairy cattle, as well as under grazing conditions (10 (AH10), 25 (AH25) and 100% (AH100)), while the GAA doses were 0 (control), 0.0005, 0.0010, 0.0015, 0.0020, 0.0025 and 0.0030 g g-1 DM diet. With an increased dose of GAA, the total gas production (GP) and methane (CH4) increased (p = 0.0439) in the AH10 diet, while in AH25 diet, no effect was observed (p = 0.1311), and in AH100, GP and CH4 levels decreased (p = 0.0113). In addition, the increase in GAA decreased (p = 0.0042) the proportion of CH4 in the AH25 diet, with no influence (p = 0.1050) on CH4 in the AH10 and AH100 diet groups. Carbon monoxide production decreased (p = 0.0227) in the AH100 diet with most GAA doses, and the other diets did not show an effect (p = 0.0617) on carbon monoxide, while the production of hydrogen sulfide decreased (p = 0.0441) in the AH10 and AH100 diets with the addition of GAA, with no effect observed in association with the AH25 diet (p = 0.3162). The pH level increased (p < 0.0001) and dry matter degradation (DMD) decreased (p < 0.0001) when AH was increased from 10 to 25%, while 25 to 100% AH contents had the opposite effect. In addition, with an increased GAA dose, only the pH in the AH100 diet increased (p = 0.0142 and p = 0.0023) the DMD in the AH10 diet group. Similarly, GAA influenced (p = 0.0002) SCFA, ME and CH4 conversion efficiency but only in the AH10 diet group. In this diet group, it was observed that with an increased dose of GAA, SCFA and ME increased (p = 0.0002), while CH4 per unit of OM decreased (p = 0.0002) only with doses of 0.0010, 0.0015 and 0.0020 g, with no effect on CH4 per unit of SCFA and ME (p = 0.1790 and p = 0.1343). In conclusion, the positive effects of GAA depend on the percentage of AH, and diets with 25 and 100% AH showed very little improvement with the addition of GAA, while the diet with 10% AH presented the best results.

Potential Effect of Dietary Supplementation of Tannin-Rich Forage on Mitigation of Greenhouse Gas Production, Defaunation and Rumen Function.

This experiment evaluated the effect of including Acacia mearnsii leaves in a high-fiber diet (corn stover), on ruminal degradation kinetics, digestibility, microbial biomass production, and gas, CH4, and CO2 production. Four experimental diets were tested, including a control with 100% corn stover (T1), and three additional diets with corn stover supplemented at 15% A. mearnsii leaves (T2), 30% A. mearnsii leaves (T3) and 45% of A. mearnsii leaves (T4). The highest dry matter in situ degradation (p ≤ 0.001) and in vitro digestibility (p ≤ 0.001) was found in T1 (80.6 and 53.4%, respectively) and T2 (76.4 and 49.6%, respectively) diets. A higher population of holotrich and entodiniomorph ruminal protozoa was found (p = 0.0001) in T1 at 12 and 24 h. Diets of T1 and T2 promoted a higher (p = 0.0001) microbial protein production (314.5 and 321.1 mg/0.5 g DM, respectively). Furthermore, a lower amount of CH4 was found (p < 0.05) with T2, T3 and T4. It is concluded that it is possible to supplement up to 15% of A. mearnsii leaves (30.5 g TC/kg DM) in ruminant's diets. This decreased the population of protozoa (holotrich and entodiniomorph) as well as the CH4 production by 35.8 and 18.5%, respectively, without generating adverse effects on the ruminal degradation kinetics, nutrient digestibility and microbial protein production.

Structural Features of Diacyldodecaheterocycles with Pseudo-C2-Symmetry: Promising Stereoinductors for Divergent Synthesis of Chiral Alcohols.

Pseudo-C2-symmetric dodecaheterocyclic structures, which possess two acyl/aroyl groups disposed on either a cis- or trans-relative configuration, were prepared from the naturally occurring (-)-(1R)-myrtenal. Addition of Grignard reagents (RMgX) to the diastereoisomeric mixture of these compounds unexpectedly showed that nucleophilic additions to the two prochiral carbonyl centers gave the same stereochemical result in both cis/trans diastereoisomers, making unnecessary the separation of this mixture. Noticeably, both carbonyl groups showed different reactivity because one of them is attached to an acetalic carbon and the other to a thioacetalic carbon. Furthermore, addition of RMgX to the carbonyl attached to the former carbon takes place through the re face, while addition to the second one proceeds through the si face, thus affording the corresponding carbinols in a highly diastereoselective process. This structural feature allowed the sequential hydrolysis of both carbinols, yielding separately (R)- and (S)-1,2-diols after reduction with NaBH4. The mechanism of the asymmetric Grignard addition was explained by density functional theory calculations. This approach contributes to the development of the divergent synthesis of structurally and/or configurationally different chiral molecules.

The Chameleonic Nature of the Nitro Group Applied to a Base-Promoted Cascade Reaction To Afford Indane-Fused Dihydrofurans.

We disclose a Michael/Conia-ene/SN2 cascade reaction for the synthesis of Indane-fused dihydrofurans from 1,3-dicarbonyl compounds and 2-alkynylnitrostyrenes promoted by potassium carbonate in DMSO at room temperature. In this reaction, the nitro group has a chameleonic role, first as an electron-withdrawing group for the Michael addition, then the nitronate behaves as a nucleophile, and finally, the allylic nitro acts as a leaving group. The product is obtained as a single diastereomer, affording up to 82% with 1,3-keto esters and 58% with 1,3-diketones. Furthermore, DFT calculations of the reaction mechanism explained the chemoselective addition of the nitronate over the enolate to the unactivated triple bond, with the enolate addition being highly endothermic.

Influence of Azadirachta indica and Cnidoscolus angustidens aqueous extract on cattle ruminal gas production and degradability in vitro.

Introduction: Mitigation of ruminant greenhouse gas (GHG) emissions is crucial for more appropriate livestock production. Thus, there is a need of further research evaluating feed supplementation strategies to mitigate enteric GHG emissions and other gases produced within the rumen. Methods: This study was conducted as a completely randomized experimental design to determine the effectiveness of liquid extracts from A. indica (AZI), C. angustidens (CNA), or their combination (Mix. 1:1) at dosages of 0, 36, 72, and 108 mg of liquid extract/g DM substrate incubated in reducing GHG production in vitro, particularly methane (CH4), from the diet of steers during anaerobic incubation in rumen fluid. Total gas production, CH4, CO, H2S, and fermentative characteristics were all measured in vitro. Results: Treatment AZI at a dose of 108 mg of liquid extract/g DM substrate produced the highest (P < 0.05) gas volume at 6 h, whereas CNA at a dose of 72 mg of liquid extract/ g DM substrate produced the least (P < 0.05) at 6 and 24 h, and Mix. at a dose of 72 mg of liquid extract/g DM substrate produced the least (P < 0.05) at 48 h. In addition, CH4 levels at 6 and 24 h of incubation (36 mg/g DM substrate) were highest (P < 0.05) for CNA, and lowest (P < 0.05) for AZI, whereas this variable was lowest (P < 0.05) at 72 mg of liquid extract for CNA at 24 and 48 h. At 6 and 24 h, CO volume was highest (P < 0.05) for AZI at 108 mg of liquid extract and lowest (P < 0.05) for Mix. at 72 mg of liquid extract. Treatment Mix. had a high (P < 0.05) concentration of short chain fatty acids at 72 mg of liquid extract/g DM of substrate. Discussion: In general, herbaceous perennial plants, such as AZI and CNA, could be considered suitable for mitigating enteric GHG emissions from animals. Specifically, the treatment Mix. achieved a greater sustainable reduction of 67.6% in CH4 and 47.5% in H2S production when compared to either AZI. This reduction in CH4 might suggest the potential of the combination of both plant extracts for mitigating the production of GHG from ruminants.

Frontal Fibrosing Alopecia: An Observational Single-Center Study of 306 Cases.

(1) Background: Frontal fibrosing alopecia (FFA) is a scarring alopecia that predominantly affects postmenopausal women; (2) Methods: A retrospective, observational, single-center study was conducted in the Hospital General Universitario in Ciudad Real, Spain, including all patients diagnosed with FFA between 2010 and 2021; (3) Results: A total of 306 patients (296 women and 10 men) were included in our study. The mean age of onset was 59.5 years. The severity of this disease was evenly distributed between mild (147 patients) and severe (149 patients) forms. There was a positive, statistically significant, medium correlation between the severity of the disease and its time of progression. Moreover, hypothyroidism was present in 70 patients (22.9%) and classic signs of concomitant lichen planopilaris were observed in just 30 patients (9.8%), while other forms of lichen planus were uncommon. The estimated prevalence in our population is 0.15% and the incidence is 15.47 new cases per 100,000 inhabitants; (4) Conclusions: The time of progression was positively correlated with the severity of FFA. However, the presence of clinical signs, such as inflammatory trichoscopic signs, was not associated with the progression of this condition.

Stereoselective synthesis of highly substituted 1-isomorphans (1-azabicyclo[3.3.1]nonanes).

We describe the first enantioselective synthesis of highly functionalized 1-azabicyclo[3.3.1]nonanes (1-IM). The 1-IM scaffold is present in natural products and drugs and is an isomer of the morphan moiety. The proposed methodology is based on an organocatalytic Michael addition of N-protected piperidine ketoesters to nitroalkenes and an intramolecular nitro-Mannich reaction as key transformations. The 1-IMs feature 6 contiguous stereocenters, substituents at positions 2 and 4, and nitro, ester, and hydroxyl functional groups at positions 3, 5, and 6 respectively. The synthesis is straightforward, highly stereoselective (up to 98% ee, >99 : 1 d.r.), with overall yields of up to 83% and requires only two purification steps.

Prognostic impact of late gadolinium enhancement at the right ventricular insertion points in non-ischaemic dilated cardiomyopathy.

AIMS: To evaluate the baseline characteristics and the prognostic implications associated with late gadolinium enhancement limited to the right ventricular insertion points (IP-LGE) or present at both the right ventricular insertion points and the left ventricle (IP&LV-LGE) in non-ischaemic dilated cardiomyopathy (DCM). METHODS AND RESULTS: This is a retrospective observational multicentre cohort study including 1165 consecutive patients with DCM evaluated by cardiac magnetic resonance. The primary endpoint included appropriate defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest, or sudden death. The secondary outcome encompassed heart failure hospitalizations, heart transplant, left ventricular assist device implantation, and end-stage heart failure death. IP-LGE was found in 72 patients (6%), who had clinical characteristics closer to LGE- than to LGE+ patients. During follow-up (median 36 months), none of the IP-LGE patients experienced the primary endpoint. The cumulative incidence of the primary endpoint was similar between IP-LGE and LGE- patients (P = 1), while IP-LGE had significantly lower cumulative incidence when compared with LGE+ patients (P < 0.001). When compared with IP-LGE patients, the cumulative incidence of the secondary endpoint was similar in LGE- cases (P = 0.86) but tended to be higher in LGE+ patients (P = 0.06). Both clinical characteristics and outcomes were similar between IP&LV-LGE patients and the rest of LGE+ cases. CONCLUSIONS: In a large cohort of DCM patients, IP-LGE was associated with similar outcome when compared with LGE- patients and with significant lower risk of ventricular arrhythmias and sudden death when compared with LGE+ cases. Patients with IP&LV-LGE had clinical characteristics and outcomes similar to the rest of LGE+ cases.