Scalable stable comb-to-tone integrated RF photonic drive for superconducting qubits.

The recent advent of quantum computing has the potential to overhaul security, communications, and scientific modeling. Superconducting qubits are a leading platform that is advancing noise-tolerant intermediate-scale quantum processors. The implementation requires scaling to large numbers of superconducting qubits, circuit depths, and gate speeds, wherein high-purity RF signal generation and effective cabling transport are desirable. Fiber photonic-enhanced RF signal generation has demonstrated the principle of addressing both signal generation and transport requirements, supporting intermediate qubit numbers and robust packaging efforts; however, fiber-based approaches to RF signal distribution are often bounded by their phase instability. Here, we present a silicon photonic integrated circuit-based version of a photonic-enhanced RF signal generator that demonstrates the requisite stability, as well as a path towards the necessary signal fidelity.

Factores predictivos del riesgo de fractura de cadera osteoporótica en octogenarios / Predictive factors of osteoporotic hip fracture in octogenarians

Objetivo Este estudio tiene como objetivo identificar los factores de riesgo asociados con las fracturas de cadera osteoporóticas en octogenarios y busca perfeccionar las estrategias de prevención primaria para estas fracturas. Material y métodos Realizamos un estudio de casos y controles en el que participaron personas de 79 años o más con fracturas de cadera, comparándolas con controles de la misma edad y sexo sin antecedentes de fracturas de cadera. Se recogieron factores epidemiológicos, clínicos, antropométricos y analíticos. Se evaluó la presencia de osteoporosis mediante densitometría ósea. Definimos la sarcopenia según los criterios del Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores (EWGSOP2). Resultados Se analizaron 95 pacientes por grupo, con una edad media de 82 años, de los cuales 74% eran mujeres. El análisis multivariado incluyó factores estadísticamente significativos encontrados en el análisis univariado (p<0,05). Estos factores incluyeron el índice de Barthel, la evaluación nutricional mediante la herramienta CONUT, el ácido fólico, la deficiencia de vitamina D, la presencia de fracturas previas, la pérdida de agudeza visual, la circunferencia bicipital, la sarcopenia y la osteoporosis (densitometría en el cuello del fémur). El estado nutricional (OR: 0,08 [0,01-0,61]), los niveles de ácido fólico (OR 0,32 [0,1-1]) y la pérdida de agudeza visual (OR 33,16 [2,91-377,87]) fueron los factores de riesgo independientes asociados con fractura de cadera. Conclusiones La evaluación del estado nutricional en pacientes de edad avanzada, junto con una evaluación geriátrica integral, representan herramientas fácilmente reproducibles y rentables. Estas herramientas pueden ayudar eficazmente a identificar a las personas con riesgo de sufrir fracturas de cadera, contribuyendo así a medidas preventivas más específicas y eficientes. (AU)

Objective This study aims to identify the risk factors associated with osteoporotic hip fractures in octogenarians and seeks to refine primary prevention strategies for these fractures. Material and methods We conducted a case–control study involving individuals aged 79 years and older with hip fractures, comparing them to age- and sex-matched controls without a history of hip fractures. We collected epidemiological, clinical, anthropometric, and analytical factors. We evaluated the presence of osteoporosis using bone densitometry. We defined sarcopenia according the European Working Group on Sarcopenia in Older People criteria (EWGSOP2). Results Ninety-five patients per group were analyzed, with a mean age of 82 years, of which 74% were women. The multivariate analysis included statistically significant factors found in the univariate analysis (P<.05). These factors included the Barthel Index, nutritional assessment using the CONUT tool, folic acid, vitamin D deficiency, presence of previous fractures, loss of visual acuity, bicipital circumference, sarcopenia, and osteoporosis (densitometry in the neck of the femur). The nutritional state (OR: 0.08 [0.01–0.61]), the folic acid levels (OR 0.32 [0.1–1]), and a loss of visual acuity (OR 33.16 [2.91–377.87]) were the independent risk factors associated with hip fracture. Conclusions The assessment of nutritional status in elderly patients, coupled with a comprehensive geriatric assessment, represents easily reproducible and cost-effective tools. These tools can effectively aid in identifying individuals at risk of hip fractures, thereby contributing to more targeted and efficient preventive measures. (AU)

Factores predictivos del riesgo de fractura de cadera osteoporótica en octogenarios / Predictive factors of osteoporotic hip fracture in octogenarians

Objetivo Este estudio tiene como objetivo identificar los factores de riesgo asociados con las fracturas de cadera osteoporóticas en octogenarios y busca perfeccionar las estrategias de prevención primaria para estas fracturas. Material y métodos Realizamos un estudio de casos y controles en el que participaron personas de 79 años o más con fracturas de cadera, comparándolas con controles de la misma edad y sexo sin antecedentes de fracturas de cadera. Se recogieron factores epidemiológicos, clínicos, antropométricos y analíticos. Se evaluó la presencia de osteoporosis mediante densitometría ósea. Definimos la sarcopenia según los criterios del Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores (EWGSOP2). Resultados Se analizaron 95 pacientes por grupo, con una edad media de 82 años, de los cuales 74% eran mujeres. El análisis multivariado incluyó factores estadísticamente significativos encontrados en el análisis univariado (p<0,05). Estos factores incluyeron el índice de Barthel, la evaluación nutricional mediante la herramienta CONUT, el ácido fólico, la deficiencia de vitamina D, la presencia de fracturas previas, la pérdida de agudeza visual, la circunferencia bicipital, la sarcopenia y la osteoporosis (densitometría en el cuello del fémur). El estado nutricional (OR: 0,08 [0,01-0,61]), los niveles de ácido fólico (OR 0,32 [0,1-1]) y la pérdida de agudeza visual (OR 33,16 [2,91-377,87]) fueron los factores de riesgo independientes asociados con fractura de cadera. Conclusiones La evaluación del estado nutricional en pacientes de edad avanzada, junto con una evaluación geriátrica integral, representan herramientas fácilmente reproducibles y rentables. Estas herramientas pueden ayudar eficazmente a identificar a las personas con riesgo de sufrir fracturas de cadera, contribuyendo así a medidas preventivas más específicas y eficientes. (AU)

Objective This study aims to identify the risk factors associated with osteoporotic hip fractures in octogenarians and seeks to refine primary prevention strategies for these fractures. Material and methods We conducted a case–control study involving individuals aged 79 years and older with hip fractures, comparing them to age- and sex-matched controls without a history of hip fractures. We collected epidemiological, clinical, anthropometric, and analytical factors. We evaluated the presence of osteoporosis using bone densitometry. We defined sarcopenia according the European Working Group on Sarcopenia in Older People criteria (EWGSOP2). Results Ninety-five patients per group were analyzed, with a mean age of 82 years, of which 74% were women. The multivariate analysis included statistically significant factors found in the univariate analysis (P<.05). These factors included the Barthel Index, nutritional assessment using the CONUT tool, folic acid, vitamin D deficiency, presence of previous fractures, loss of visual acuity, bicipital circumference, sarcopenia, and osteoporosis (densitometry in the neck of the femur). The nutritional state (OR: 0.08 [0.01–0.61]), the folic acid levels (OR 0.32 [0.1–1]), and a loss of visual acuity (OR 33.16 [2.91–377.87]) were the independent risk factors associated with hip fracture. Conclusions The assessment of nutritional status in elderly patients, coupled with a comprehensive geriatric assessment, represents easily reproducible and cost-effective tools. These tools can effectively aid in identifying individuals at risk of hip fractures, thereby contributing to more targeted and efficient preventive measures. (AU)

Predictive factors of osteoporotic hip fracture in octogenarians.

OBJECTIVE: This study aims to identify the risk factors associated with osteoporotic hip fractures in octogenarians and seeks to refine primary prevention strategies for these fractures. MATERIAL AND METHODS: We conducted a case-control study involving individuals aged 79 years and older with hip fractures, comparing them to age- and sex-matched controls without a history of hip fractures. We collected epidemiological, clinical, anthropometric, and analytical factors. We evaluated the presence of osteoporosis using bone densitometry. We defined sarcopenia according the European Working Group on Sarcopenia in Older People criteria (EWGSOP2). RESULTS: Ninety-five patients per group were analyzed, with a mean age of 82 years, of which 74% were women. The multivariate analysis included statistically significant factors found in the univariate analysis (p < 0.05). These factors included the Barthel Index, nutritional assessment using the CONUT tool, folic acid, vitamin D deficiency, presence of previous fractures, loss of visual acuity, bicipital circumference, sarcopenia, and osteoporosis (densitometry in the neck of the femur). The Nutritional state (OR: 0.08 [0.01-0.61]), the folic acid levels (OR 0.32 [0.1-1]), and a loss of visual acuity (OR 33.16 [2.91-377.87]) were the independent risk factors associated with hip fracture. CONCLUSIONS: The assessment of nutritional status in elderly patients, coupled with a comprehensive geriatric assessment, represents easily reproducible and cost-effective tools. These tools can effectively aid in identifying individuals at risk of hip fractures, thereby contributing to more targeted and efficient preventive measures.

Estrés y ansiedad perioperatorios en padres de niños intervenidos de cardiopatías congénitas / Perioperative stress and anxiety in parents of children operated on for congenital heart disease

Introducción: Los niveles de estrés y la ansiedad que sufren los padres y madres de niños con cardiopatía congénita (PMNCC) durante el ingreso para cirugía cardíaca de sus hijos pueden ser más elevados que los que sufren otros padres y madres que pasan por la misma experiencia. Objetivo: El objetivo general de este estudio fue medir el estrés y la ansiedad que sufren los PMNCC y los padres de niños tratados mediante cirugía renal (PMNCR) en relación con la intervención de sus hijos. El objetivo específico del estudio cuantitativo fue comparar el estrés y ansiedad global con relación al sexo, el momento del periodo perioperatorio y la cohorte. El objetivo general del apartado cualitativo es explorar la vivencia que tienen los PMNCC y PMNCR durante su estancia hospitalaria e identificar los factores específicos que influyen en la génesis del estrés y la ansiedad. Método: Se realizó un estudio de cohortes en el que se incluyeron los PMNCC y los PMNCR. La parte cuantitativa se realizó comparando las puntuaciones de 3cuestionarios que miden los niveles de estrés (PSS-14), ansiedad estado (STAIE) y ansiedad rasgo (STAIR) a lo largo de 3momentos perioperatorios. Paralelamente se hizo un estudio cualitativo con entrevistas semiestructuradas y recogida de diarios sobre los que se realizó un análisis fenomenológico descriptivo, según Munhall. El análisis del texto se realizó según la propuesta de Colaizzi. Resultados: Los niveles de estrés y ansiedad fueron significativamente más altos en los PMNCC respecto a los PMNCR. Las madres de la cohorte cardíaca fueron las que presentaron las puntuaciones más altas en todas las escalas. En el estudio cualitativo emergieron 4temas: «estrés y ansiedad desde el momento del diagnóstico», «intervención quirúrgica como momento crítico», «dureza del postoperatorio en la Unidad de Cuidados Intensivos» y «alegría y agradecimiento versus dependencia y temor ante el futuro»...(AU)

Introduction: Levels of stress and anxiety suffered by parents of children with congenital heart disease (PCUCS) during their children's admission for cardiac surgery may be higher than those suffered by other parents who go through the same experience. Objective: General objective of this study was to measure the stress and anxiety suffered by PCUCS and parents of children undergoing renal surgery (PCURS) in relation to the intervention of their children. The specific objective of the quantitative study was to compare global stress and anxiety according to sex, time of the perioperative period, and cohort. The general objective of the qualitative section is to explore the experience that PCUCS and PCURS have during their hospital stay and to identify the specific factors that influence the genesis of stress and anxiety. Method: A cohort study was carried out in which PCURS and PCUCS were included. The quantitative part was performed by comparing the scores of 3questionnaires that measure stress levels (PSS-14), state anxiety (STAIE) and trait anxiety (STAIR) throughout 3perioperative moments. At the same time, a qualitative study was carried out with semi-structured interviews and collection of diaries on which a descriptive phenomenological analysis was carried out, according to Munhall. The analysis of the text was carried out according to Colaizzi. Results: Stress and anxiety levels were significantly higher in PCUCS compared to PCURS. Mothers in the cardiac cohort were those with the highest scores on all scales. In the qualitative study, 4themes emerged: “stress and anxiety from the moment of diagnosis”, “surgical intervention as a critical moment”, “harshness of the postoperative period in the Intensive Care Unit” and “joy and gratitude versus dependence and fear for the future”...(AU)

Perioperative stress and anxiety in parents of children operated on for congenital heart disease.

INTRODUCTION: Levels of stress and anxiety suffered by parents of children with congenital heart disease (PCUCS) during their children's admission for cardiac surgery may be higher than those suffered by other parents who go through the same experience. OBJECTIVE: General objective of this study was to measure the stress and anxiety suffered by PCUCS and parents of children undergoing renal surgery (PCURS) in relation to the intervention of their children. The specific objective of the quantitative study was to compare global stress and anxiety according to sex, time of the perioperative period, and cohort. The general objective of the qualitative section is to explore the experience that PCUCS and PCURS have during their hospital stay and to identify the specific factors that influence the genesis of stress and anxiety. METHOD: A cohort study was carried out in which PCURS and PCUCS were included. The quantitative part was performed by comparing the scores of three questionnaires that measure stress levels (PSS-14), state anxiety (STAIE) and trait anxiety (STAIR) throughout three perioperative moments. At the same time, a qualitative study was carried out with semi-structured interviews and collection of diaries on which a descriptive phenomenological analysis was carried out, according to Munhall. The analysis of the text was carried out according to Colaizzi. RESULTS: Stress and anxiety levels were significantly higher in PCUCS compared to PCURS. Mothers in the cardiac cohort were those with the highest scores on all scales. In the qualitative study, four themes emerged: "stress and anxiety from the moment of diagnosis", "surgical intervention as a critical moment", "harshness of the postoperative period in the Intensive Care Unit" and "joy and gratitude versus dependence and fear for the future". CONCLUSIONS: PCUCS suffer higher levels of stress and anxiety than PCURS, being the mothers of the cardiac cohort those who suffer these disorders with greater intensity. This study can constitute a starting point to develop strategies that cover these parental needs.

Deep, rapid, and durable prostate-specific antigen decline with apalutamide plus androgen deprivation therapy is associated with longer survival and improved clinical outcomes in TITAN patients with metastatic castration-sensitive prostate cancer.

BACKGROUND: The first interim analysis of the phase III, randomized, double-blind, placebo-controlled, multinational TITAN study demonstrated improved overall survival (OS) and radiographic progression-free survival (rPFS) with apalutamide added to ongoing androgen deprivation therapy (ADT) in patients with metastatic castration-sensitive prostate cancer. The final analysis confirmed improvement in OS and other long-term outcomes. We evaluated prostate-specific antigen (PSA) kinetics and the association between PSA decline and outcomes in patients with metastatic castration-sensitive prostate cancer from TITAN. PATIENTS AND METHODS: Patients received apalutamide (240 mg/day) or placebo plus ADT (1 : 1). This post hoc exploratory analysis evaluated PSA kinetics and decline in relation to rPFS (22.7 months' follow-up) and OS, time to PSA progression, and time to castration resistance (44.0 months' follow-up) in patients with or without confirmed PSA decline using a landmark analysis, the Kaplan-Meier method, and Cox proportional hazards model. RESULTS: One thousand and fifty-two patients (apalutamide, 525; placebo, 527) were enrolled. Best confirmed PSA declines (≥50% or ≥90% from baseline or to ≤0.2 ng/ml) were achieved at any time during the study in 90%, 73%, and 68% of apalutamide-treated versus 55%, 29%, and 32% of placebo-treated patients, respectively. By 3 months of apalutamide treatment, best deep PSA decline of ≥90% or to ≤0.2 ng/ml occurred in 59% and 51% of apalutamide- and in 13% and 18% of placebo-treated patients, respectively. Achievement of deep PSA decline at landmark 3 months of apalutamide treatment was associated with longer OS [hazard ratio (HR) 0.35; 95% confidence interval (CI) 0.25-0.48), rPFS (HR 0.44; 95% CI 0.30-0.65), time to PSA progression (HR 0.31; 95% CI 0.22-0.44), and time to castration resistance (HR 0.38; 95% CI 0.27-0.52) compared with no decline (P < 0.0001 for all). Similar results were observed at landmark 6 and 12 months of apalutamide treatment. CONCLUSIONS: Apalutamide plus ADT demonstrated a robust (rapid, deep, and durable) PSA decline that was associated with improved clinical outcomes, including long-term survival.

Pembrolizumab in combination with gemcitabine for patients with HER2-negative advanced breast cancer: GEICAM/2015-04 (PANGEA-Breast) study.

BACKGROUND: We evaluated a new chemoimmunotherapy combination based on the anti-PD1 monoclonal antibody pembrolizumab and the pyrimidine antimetabolite gemcitabine in HER2- advanced breast cancer (ABC) patients previously treated in the advanced setting, in order to explore a potential synergism that could eventually obtain long term benefit in these patients. METHODS: HER2-negative ABC patients received 21-day cycles of pembrolizumab 200 mg (day 1) and gemcitabine (days 1 and 8). A run-in-phase (6 + 6 design) was planned with two dose levels (DL) of gemcitabine (1,250 mg/m2 [DL0]; 1,000 mg/m2 [DL1]) to determine the recommended phase II dose (RP2D). The primary objective was objective response rate (ORR). Tumor infiltrating lymphocytes (TILs) density and PD-L1 expression in tumors and myeloid-derived suppressor cells (MDSCs) levels in peripheral blood were analyzed. RESULTS: Fourteen patients were treated with DL0, resulting in RP2D. Thirty-six patients were evaluated during the first stage of Simon's design. Recruitment was stopped as statistical assumptions were not met. The median age was 52; 21 (58%) patients had triple-negative disease, 28 (78%) visceral involvement, and 27 (75%) ≥ 2 metastatic locations. Progression disease was observed in 29 patients. ORR was 15% (95% CI, 5-32). Eight patients were treated ≥ 6 months before progression. Fourteen patients reported grade ≥ 3 treatment-related adverse events. Due to the small sample size, we did not find any clear association between immune tumor biomarkers and treatment efficacy that could identify a subgroup with higher probability of response or better survival. However, patients that experienced a clinical benefit showed decreased MDSCs levels in peripheral blood along the treatment. CONCLUSION: Pembrolizumab 200 mg and gemcitabine 1,250 mg/m2 were considered as RP2D. The objective of ORR was not met; however, 22% patients were on treatment for ≥ 6 months. ABC patients that could benefit of chemoimmunotherapy strategies must be carefully selected by robust and validated biomarkers. In our heavily pretreated population, TILs, PD-L1 expression and MDSCs levels could not identify a subgroup of patients for whom the combination of gemcitabine and pembrolizumab would induce long term benefit. TRIAL REGISTRATION: ClinicalTrials.gov and EudraCT (NCT03025880 and 2016-001,779-54, respectively). Registration dates: 20/01/2017 and 18/11/2016, respectively.

Hyper-Reflective Outer Nuclear Layer (HONL) in Vogt-Koyanagi-Harada Disease and Sympathetic Ophthalmia.

PURPOSE: To describe the optical coherence tomography (OCT) findings of hyper-reflective outer nuclear layer (HONL) in two cases of stromal choroiditis (Vogt-Koyanagi-Harada disease - VKH, and sympathetic ophthalmia - SO). METHODS: Case report. RESULTS: Clinical and imaging findings of two patients (37-year-old female with VKH and 34-year-old male with SO) have been described. Both patients showed typical features of the disease with subretinal fluid accumulation and choroidal thickening on OCT. However, OCT of both patients at the initial visit revealed HONL, which was unusual in these conditions. During follow-up, OCT scans revealed thinning and atrophy of the outer retinal layers, irregular thickening of the retinal pigment epithelium, and irregular autofluorescence pattern on autofluorescence imaging. CONCLUSIONS: The presence of HONL may serve as a poor prognostic factor in VKH and SO, resulting in thinning and atrophy of the outer retinal layers.

Linfadenectomía inguinal videoendoscópica modificada por abordaje suprafascial: descripción de la técnica y resultados quirúrgicos preliminares / Modified videoendoscopic inguinal lymphadenectomy through suprafascial approach: Technical description and preliminary surgical outcomes

Introducción: La disección de los ganglios linfáticos inguinales mediante abordaje videoendoscópico (LIVE) se ha planteado como una alternativa óptima para disminuir la morbilidad y mantener un control oncológico equivalente al del abordaje convencional. Uno de los pasos de mayor complejidad de la técnica es la elaboración de un plano de disección adecuado y entre sus ventajas está una exposición mejorada del campo quirúrgico. El objetivo de este estudio es determinar la viabilidad, en términos de seguridad y control oncológico, de una modificación de la técnica LIVE convencional, utilizando un plano de disección suprafascial, en una serie inicial de pacientes.Pacientes y métodos: Se llevó a cabo una revisión retrospectiva en un único centro de los pacientes tratados con LIVE mediante nuestra modificación de abordaje suprafascial. Se proporciona una descripción de la técnica quirúrgica paso a paso. Los datos recogidos incluyeron las características demográficas y de la enfermedad, las comorbilidades y los factores intra- y postoperatorios.Resultados: Se incluyó a un total de 7 pacientes (12 procedimientos). La edad media era de 64,42 años y el 71,42% de los pacientes eran hombres. El procedimiento se realizó de forma bilateral en el 71,4% de los casos. La mediana de pérdida de sangre estimada fue de 10mL (rango 10-25). El tiempo quirúrgico medio fue de 115 min (rango 120-170). La mediana del número de ganglios linfáticos obtenidos fue de 10,25 ganglios (rango 7-11). Solo un paciente (8,3%) experimentó una complicación de grado iiia de Clavien-Dindo, lo que requirió recambio del drenaje percutáneo. La mediana de tiempo hasta la retirada del drenaje fue de 13 días (rango 10-16). La mediana de duración de la estancia hospitalaria fue de 48 h, oscilando entre 24 y 96 h en toda la serie. (AU)

Introduction: The videoendoscopic approach to inguinal lymph node dissection (VEIL) has been suggested as an excellent alternative carrying lower morbidity but equivalent oncological control. One of its most difficult steps is the development of an appropriate plane of dissection. A suprafascial approach would allow for better exposure. The objective of this study is to determine the feasibility, in terms of safety and oncological control, of a technical modification to the classical VEIL technique using a suprafascial plane of dissection in an initial series of patients.Patients and methods: A single institution retrospective review of patients undergoing VEIL technique using our modified suprafascial approach was conducted. A step-by-step surgical description is provided. Data collected included demographics; comorbid conditions; disease characteristics; intraoperative factors; and postoperative factors.Results: A total of 7 patients (12 procedures) were included. Average age was 64.42 years old, and 71.42% of the patients were male. The procedure was performed bilaterally in 71.4% of the cases. Median estimated blood loss was 10mL (range 10-25). Mean operative time was 115 minutes (range 120-170). Median number of nodes removed was 10.25 (range 7-11). Only one of the patients (8.3%) experienced a Clavien-Dindo grade IIIa complication requiring delayed percutaneous drainage replacement. Median time until drainage removal was 13 days (range 10-16). Median length of stay was 48hours but ranged from 24-96hours within the series.Conclusions: The modified Video Endoscopic Inguinal Lymphadenectomy (VEIL) technique using a suprafascial plane of the dissection, allows a bilateral ILND in highly competitive operative times and with limited morbidity, without compromising its oncological efficacy. (AU)

Modified videoendoscopic inguinal lymphadenectomy through suprafascial approach: Technical description and preliminary surgical outcomes.

INTRODUCTION: The videoendoscopic approach to inguinal lymph node dissection (VEIL) has been suggested as an excellent alternative carrying lower morbidity but equivalent oncological control. One of its most difficult steps is the development of an appropriate plane of dissection. A suprafascial approach would allow for better exposure. The objective of this study is to determine the feasibility, in terms of safety and oncological control, of a technical modification to the classical VEIL technique using a suprafascial plane of dissection in an initial series of patients. PATIENTS AND METHODS: A single institution retrospective review of patients undergoing VEIL technique using our modified suprafascial approach was conducted. A step-by-step surgical description is provided. Data collected included demographics; comorbid conditions; disease characteristics; intraoperative factors; and postoperative factors. RESULTS: A total of 7 patients (12 procedures) were included. Average age was 64.42 years old, and 71.42% of the patients were male. The procedure was performed bilaterally in 71.4% of the cases. Median estimated blood loss was 10 mL (range 10-25). Mean operative time was 185 min (range 120-170). Median number of nodes removed was 10.25 nodes (range 7-11). Only one of the patients (8.3%) experienced a Clavien-Dindo grade IIIa complication requiring delayed percutaneous drainage replacement. Median time until drainage removal was 13 days (range 10-16). Median length of stay was 48 hours but ranged from 24-96 hours within the series. CONCLUSIONS: The modified VEIL technique using a suprafascial plane of the dissection, allows a bilateral ILND in highly competitive operative times and with limited morbidity, without compromising its oncological efficacy.

Tau Appearance from High-Energy Neutrino Interactions.

High-energy muon and electron neutrinos yield a non-negligible flux of tau neutrinos as they propagate through Earth. In this Letter, we address the impact of this additional component in the PeV and EeV energy regimes for the first time. Above 300 TeV, this contribution is predicted to be significantly larger than the atmospheric background, and it alters current and future neutrino telescopes' capabilities to discover a cosmic tau-neutrino flux. Further, we demonstrate that Earth-skimming neutrino experiments, designed to observe tau neutrinos, will be sensitive to cosmogenic neutrinos even in extreme scenarios without a primary tau-neutrino component.

Cáncer de próstata resistente a la castración no metastásico: recomendaciones de manejo / Non-metastatic castration-resistant prostate cancer: management recommendations

Introducción y objetivo: La supervivencia y calidad de vida (QoL) de los pacientes con cáncer de próstata resistente a la castración no metastásico (CPRCnm) se deteriora de forma muy significativa cuando llegan a desarrollar metástasis. Los antiandrógenos de nueva generación (apalutamida, enzalutamida y darolutamida) pueden prolongar la supervivencia libre de metástasis (SLM) y la supervivencia global (SG) en estos pacientes, manteniendo su QoL.Material y método: Tras una revisión sistemática de la literatura, un comité científico alcanzó un consenso sobre recomendaciones sencillas y prácticas que unifiquen y mejoren el manejo de los pacientes con CPRCnm en las consultas de urología.Resultados: Se dan recomendaciones sobre la frecuencia de determinación de antígeno prostático específico (PSA) y pruebas de imagen en pacientes con CPRCnm. También se destaca la importancia de las comorbilidades en el paciente con CPRCnm y se ofrecen recomendaciones sobre la valoración funcional y de la QoL que se pueden llevar a cabo en la consulta de urología. Se revisa la eficacia, seguridad y efectos sobre la QoL de los antiandrógenos de nueva generación.Conclusiones: Para la evaluación del tratamiento de pacientes con CPRCnm, es necesario tener en cuenta no solo la edad, sino también las comorbilidades y la QoL. Los antiandrógenos de nueva generación son una opción de tratamiento segura y eficaz en los pacientes con CPRCnm. Las recomendaciones de trabajo pueden servir de ayuda para optimizar su manejo de los pacientes con CPRCnm en las consultas de urología. (AU)

Introduction and objective: Survival and quality of life (QoL) of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) deteriorate significantly when they develop metastases. New generation antiandrogens (apalutamide, enzalutamide and darolutamide) can prolong metastasis-free survival (MFS) and overall survival (OS) in these patients, maintaining their QoL.Material and methods: After the performance of a systematic review of the literature, a scientific committee reached a consensus on simple and practical recommendations to consolidate and improve the management of patients with nmCRPC in urology consultations.Results: Recommendations are made on the frequency of PSA determination and imaging tests in patients with nmCRPC. The importance of co-morbidities in patients with nmCRPC is also highlighted, and recommendations are also made on functional and QoL assessment that can be carried out during urology consultations. The efficacy, safety, and effects on QoL of new generation antiandrogens are reviewed.Conclusions: To evaluate treatment of patients with nmCRPC, it is necessary to consider co-morbidities and QoL, in addition to age. New generation antiandrogens are a safe and effective treatment option for patients with nmCRPC. The recommendations of this review can be helpful in optimizing the management of nmCRPC patients in urology consultations. (AU)

Prevalencia e incidencia de ictus en Europa: revisión sistemática y metaanálisis / Prevalence and incidence of ictus in Europe: systematic review and meta-analysis

Fundamento. El ictus es la segunda causa de muerte y la primera causa de discapacidad en Europa. El número de pacientes con ictus muestra una tendencia de crecimiento rápido debido al aumento de la población anciana. El objetivo de este metaanálisis es estimar la prevalencia e incidencia de ictus en Europa. Método. Se buscaron artículos en las bases de datos MEDLINE, SCOPUS, CINAHL Complete y EMBASE con los términos “stroke”, “cerebrovascular accident” combinadas con “epidemiology”, “prevalence”, “incidence” y “Europe”. La calidad y el riesgo de sesgo se analizó con las escalas Hoy modificada y Newcastle Ottawa para los artículos de prevalencia e incidencia, respectivamente. El metaanálisis utilizó un modelo de efectos aleatorios con intervalos de confianza del 95% (IC95%) y el estadístico I2 para estimar la heterogeneidad. Resultados. La prevalencia de ictus en Europa ajustada por sexo fue 9,2% (IC95%: 4,4-14,0); en hombres fue 9,1% (IC95%: 4,7-16,6) y en mujeres 9,2% (IC95%: 4,1-14,4); se encontró una tendencia creciente con el aumento de la edad. La incidencia de ictus ajustada por sexo fue 191,9 por 100.000 personas-año (IC95%: 156,4-227,3); en hombres fue de 195,7 por 100.000 personas-año (IC95%: 142,4-249,0) y en mujeres 188,1 por 100.000 personas-año (IC95%: 138,6-237,7), con igual tendencia creciente con el aumento de la edad. Conclusiones. La prevalencia de ictus en Europa alcanza un 9,2%. La incidencia se sitúa en 191,9 por 100.000 personas-año. La prevalencia de ictus ha aumentado mientras que la incidencia se mantiene estable en comparación con estudios realizados a comienzos del siglo XXI.(AU)

Background. Stroke is the second cause of death and the first cause of disability in Europe. The number of stroke patients shows a rapidly increasing due to the increase in the elderly population. The aim of this meta-analysis is to evaluate the prevalence and incidence of stroke in Europe. Method. We conducted a literature search in MEDLINE, SCOPUS, CINAHL Complete and EMBASE, using the keywords “stroke”, “cerebrovascular accident”, “epidemiology”, “prevalence”, “incidence” and “Europe”. In order to evaluate the quality and risk of bias, we used the Hoy’s modified scale for prevalence studies and the Newcastle Ottawa Scale for incidence studies. A random effects model with 95% confidence intervals (95%CI) was used for the meta-analysis. The I2 statistic was applied to assess heterogeneity. Results. The prevalence of stroke in Europe adjusted for sex was estimated at 9.2% (95%CI: 4.4-14.0). The prevalence was 9.1% (95%CI: 4.7-13.6) in men and 9.2% (95%CI: 4.1-14.4) in women, and increased with age. The incidence of stroke in Europe adjusted for sex was 191.9 per 100,000 person-years (95%CI: 156.4-227.3); it was 195.7 per 100,000 person-years (95%CI: 142.4-249.0) in men and 188.1 per 100,000 person-years (95%CI: 138.6-237.7) in women. Again, these rates increased with age. Conclusion. The prevalence of stroke in Europe is 9.2%. The incidence of stroke in Europe is 191.9 per 100000 person-years. The prevalence of stroke has increased, whereas the incidence of stroke is stable in comparison with studies conducted at the beginning of the 21st century.(AU)

Non-metastatic castration-resistant prostate cancer: management recommendations.

INTRODUCTION AND OBJECTIVE: Survival and quality of life (QoL) of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) deteriorate significantly when they develop metastases. New generation antiandrogens (apalutamide, enzalutamide and darolutamide) can prolong metastasis-free survival (MFS) and overall survival (OS) in these patients, maintaining their QoL. MATERIAL AND METHODS: After the performance of a systematic review of the literature, a scientific committee reached a consensus on simple and practical recommendations to consolidate and improve the management of patients with nmCRPC in urology consultations. RESULTS: Recommendations are made on the frequency of PSA determination and imaging tests in patients with nmCRPC. The importance of co-morbidities in patients with nmCRPC is also highlighted, and recommendations are also made on functional and QoL assessment that can be carried out during urology consultations. The efficacy, safety, and effects on QoL of new generation antiandrogens are reviewed. CONCLUSIONS: To evaluate treatment of patients with nmCRPC, it is necessary to consider co-morbidities and QoL, in addition to age. New generation antiandrogens are a safe and effective treatment option for patients with nmCRPC. The recommendations of this review can be helpful in optimizing the management of nmCRPC patients in urology consultations.

[Prevalence and incidence of ictus in Europe: systematic review and meta-analysis].

BACKGROUND: Stroke is the second cause of death and the first cause of disability in Europe. The number of stroke patients shows a rapidly increasing due to the increase in the elderly population. The aim of this meta-analysis is to evaluate the prevalence and incidence of stroke in Europe. METHOD: We conducted a literature search in MEDLINE, SCOPUS, CINAHL Complete and EMBASE, using the keywords "stroke", "cerebrovascular accident", "epidemiology", "prevalence", "incidence" and "Europe". In order to evaluate the quality and risk of bias, we used the Hoy's modified scale for prevalence studies and the Newcastle Ottawa Scale for incidence studies. A random effects model with 95% confidence intervals (95%CI) was used for the meta-analysis. The I2 statistic was applied to assess heterogeneity. RESULTS: The prevalence of stroke in Europe adjusted for sex was estimated at 9.2% (95%CI: 4.4-14.0). The prevalence was 9.1% (95%CI: 4.7-13.6) in men and 9.2% (95%CI: 4.1-14.4) in women, and increased with age. The incidence of stroke in Europe adjusted for sex was 191.9 per 100,000 person-years (95%CI: 156.4-227.3); it was 195.7 per 100,000 person-years (95%CI: 142.4-249.0) in men and 188.1 per 100,000 person-years (95%CI: 138.6-237.7) in women. Again, these rates increased with age. CONCLUSION: The prevalence of stroke in Europe is 9.2%. The incidence of stroke in Europe is 191.9 per 100,000 person-years. The prevalence of stroke has increased, whereas the incidence of stroke is stable in comparison with studies conducted at the beginning of the 21st century.

The interaction of deep convection with the general circulation in Titan's atmosphere. Part 1: Cloud Resolving Simulations.

The deep convective cloud-environment feedback loop is likely important to Titan's global methane, energy, and momentum cycles, just as it is for Earth's global water, energy, and momentum budgets. General circulation models of Titan's atmosphere are unable to explicitly simulate deep convection and must instead parameterize the impact of this important subgrid-scale phenomenon on the model-resolved atmospheric state. The goal of this study is to better quantify through cloud resolving modeling the effects of deep convective methane storms on their environment and to feed that information forward to improve parameterizations in global models. Dozens of atmospheric profiles unstable with respect to deep moist convection are extracted from the global Titan Atmospheric Model (TAM) and used to initialize the cloud-resolving Titan Regional Atmospheric Modeling System (TRAMS). Mean profiles of heating/cooling and moistening/drying of the large-scale environment in TRAMS indicate that Titan's deep convection forces the environment in a manner analogous to Earth: Large-scale subsidence of the environmental air warms and dries the environment, but clouds can also moisten the environment through the detrainment and evaporation of condensate near cloud top. Relative humidity profiles and characteristic convective time scales are derived to guide the tuning of the deep convective parameterization implemented in TAM, as described in a companion paper. The triggering of convection, the dry convective mixing of the planetary boundary layer, and the entrainment of environmental air into rising air parcels are found to be critical to determining whether a deep convective cloud will form. Only profiles with relatively large convective available potential energy (CAPE) and well mixed planetary boundary layers with high relative humidity were found to produce storms. Environments with low level thermal inversions and planetary boundary layers with low relative humidity or rapidly decreasing moisture with height failed to generate deep convection in TRAMS despite positive CAPE.