Women Breast Cancer: Knowledge, Attitudes, Practices and Factors Associated with Early Screening in the Municipality of Abomey-Calavi in Benin in 2018

Background: Breast cancer is the dominant cancer in women in both developed and developing countries. The objective of this study was to assess the knowledge, attitudes, practices and factors associated with early breast cancer screening among women in the Municipality of Abomey-Calavi in Benin. Methods: This was a cross-sectional, descriptive, analytical study with prospective data collection from October 1 to 8, 2018, involving 1740 women in the Municipality of Abomey-Calavi, aged 18 years or older and selected by WHO four-stage random cluster sampling. Consenting women who were mentally competent, 18 years of age or older at the time of the survey, and residing continuously in the Municipality of Abomey-Calavi for the last six months prior to the survey were included. On the other hand, women who belonged to a breast cancer prevention service, women in whom secondary screening was noted, or non-consenting women were not included. The initial minimum size was estimated by the Schwartz formula with a cluster effect of k = 2. Information was collected by questionnaire survey, entered with Epidata 3.1. Fr and analyzed with R Studio 3.5.1. software. Results: The mean age of the women surveyed was 32.0 ± 11.5 years with a range of 18 and 71 years. Regarding knowledge, the clinical manifestation known by the majority of women was the presence of a nodule (68.50%). In the series, 1308 (75.17%) declared having heard about breast cancer once before, either on the radio, television or from friends and 726 (55.50%) had heard about breast cancer screening. Five hundred and twelve (70.52%) of the 726 who had heard of breast cancer said they knew that breast cancer could be screened earlier. Breast self-examination was the most cited screening method (67.58%). The disease is of natural origin according to 37.84% of them. Regarding attitudes and practices, the prevalence of early breast cancer screening was 12.93%, of which 11.67% declared that they had checked themselves to know whether they were carriers of the disease or not. The main means of the early screening used was breast self-examination (85.78%). Factors associated with early breast cancer screening found in multivariate analysis were age (≤50 years), education level (increasingly higher), marital status (married/coupled), place of residence (downtown), and socioeconomic level (average/high). Conclusion: The frequency of early breast cancer screening among women is still low in the municipality of Abomey-Calavi, although they have a good knowledge of the disease. This raises the need to strengthen awareness of early breast cancer screening.

Prevalence and Factors Associated with Anemia among People Living with Human Immunodeficiency Virus Followed at the Outpatient Treatment Centre of Panzi General Referral Hospital in Eastern Democratic Republic of Congo

Introduction: Anemia in people living with human immunodeficiency virus (PLHIV) is a major health problem. Although anemia often responds to combination antiretroviral therapy, many patients remain anemic despite treatment, and such persistent anemia continues to adversely affect prognosis, regardless of drug response. Scientists have identified some of the factors involved. However, the mechanisms put in place have not been effective in overcoming them. Examples include the withdrawal of zidovudine from antiretroviral treatment lines, iron and folate supplementation, etc. Anemia is still a major concern in HIV-positive patients. The aim of this study is to assess the prevalence of anemia and its associated factors among PLHIV followed up at the outpatient treatment centre (CTA) of the Panzi General Reference Hospital (HGR) in South Kivu, Democratic Republic of Congo (DRC). Method: We conducted a cross-sectional, comparative study of 276 HIV-infected adults on antiretroviral therapy (ART) followed up at the CTA of Panzi HGR. Socio-demographic and nutritional parameters were collected using a survey questionnaire, and clinical assessment and nutritional status were performed at the centre. Hemoglobin, seric albumin and viral load determinations were performed at the HGRP laboratory. We constructed univariate and multivariate logistic regression models to assess factors associated with anemia in people living with HIV/AIDS. Results: We found a prevalence of anemia of 39.4%, including 4.1% severe anemia, 17.7% moderate anemia and 17.5% mild anemia. After multivariate adjustment, the factors associated with anemia in our PLHIV were: moderate undernutrition (aOR = 1.26;95% CI: 1.50 - 4.20;p = 0.001), severe undernutrition (aOR = 115.4;95% CI: 2.04 - 164.52;p = 0.021), hypoalbuminemia (aOR = 2.11;95% CI: 1.87 - 5.10;p = 0.004) and the lower degree of dietary diversity (aOR = 1.56;95% CI: 1.10 - 4.32;p = 0.034). Conclusion: The prevalence of anemia in PLHIV on ART is high. This greatly affects quality of life and increases the need for care. Early detection tools and management algorithms are essential in the follow-up of PLWHIV.

Detection and Recuperation of Mental Fatigue

Mental fatigue is a complex state that results from prolonged cognitive activity. Symptoms of mental fatigue can include change in mood, motivation, and temporary deterioration of various cognitive functions involved in goal-directed behavior. Extensive research has been done to develop methods for recognizing physiological and psychophysiological signs of mental fatigue. This has allowed the development of many AI-based models to classify different levels of fatigue, using data extracted from eye-tracking device, EEG, or ECG. In this paper, we present an experimental protocol which aims to both generate/measure mental fatigue and provide effective strategies for recuperation via VR sessions paired with EEG and eye tracking devices. This paper first provides a comprehensive state-of-the-art of mental fatigue predictive factors, measurement methods, and recuperation strategies. Then the paper presents an experimental protocol resulting from the state-of-the-art to 1) generate and measure mental fatigue and 2) evaluate the effectiveness of virtual therapy for fatigue recuperation, using a virtual reality (VR) simulated environment. In our work, we successfully generated mental fatigue through completion of cognitive tasks in a virtual simulated environment. Participants showed significant decline in pupil diameter and theta/alpha score during the various cognitive tasks. We trained an RBF SVM classifier from Electroencephalogram (EEG) data classifying mental fatigue with 95% accuracy on the test set. Finally, our results show that the time allocated for virtual therapy did not improve pupil diameter in post-relaxation period. Further research on the impact of relaxation therapy on relaxation therapy should allocate time closer to the standard recovery time of 60 min.

Commentary Potential Enhancement by 3-Deazauridine of the Antiviral Activity of Molnupiravir in Patients with COVID-19

Background: Molnupiravir, N4-hydroxycytidine-5’-isopropyl ester, is an oral prodrug of N4-deoxycytidine (NHC), a nucleoside analog, which has in vitro activity against SARS-CoV-2. NHC is phosphorylated in cells to NHC triphosphate (NHC-TP), which is incorporated into viral RNA, leading to epigenetic catastrophe of the viral genome and inhibition of viral replication. The antiviral activity against SARS-CoV-2 is dependent on the number of molecules of NHC-TP incorporated into viral RNA. Clinical studies in patients with COVID-19 showed that treatment with molnupiravir for 5 days decreases the risk of hospitalization and death as compared with placebo. Objective: It should be possible to enhance the antiviral activity of NHC-TP against SARS-CoV-2 by the use of the biochemical modulator, 3-deazauridine (3DU). 3DU is an inhibitor of CTP synthetase. Inhibition of this enzyme results in a reduction in the intracellular pool size of CTP. Since NHC-TP competes with CTP for incorporation into viral RNA in the reaction catalyzed by the SARS-CoV-2 viral RNA-dependent RNA polymerase, the reduction in the level of CTP should result in a significant enhancement of the incorporation of NHC-TP into viral RNA and an enhancement of its antiviral activity. Methods: Analysis of the publications of 3DU and cytosine nucleoside analogues support the hypothesis that 3DU enhances the pharmacological action of the analogues. Results: 3-DU increased the incorporation of 5-azacytidine into RNA and 5-aza-deoxycytidine into DNA of leukemic cells with an enhancement of their antineoplastic action. 3-DU potentiated the antiviral activity against HIV-1 activity by the cytosine nucleoside analogues: 2’-deoxy-3’-thiacytidine (3TC;lamivudine) and 2’,3’-dideoxycytidine (ddC). This anti-HIV-1 activity of 3DU was associated with a reduction in the intracellular pool size of dCTP and increased incorporation of triphosphates of 3TC and ddC into DNA by the HIV-1 reverse transcriptase. The reduction of CTP levels in cells by 3-DU also leads to a reduction in dCTP since CTP is its precursor. Conclusion: The preclinical studies on 3-DU indicate that it can enhance the pharmacological activity of both ribo- and deoxyribonucleoside analogues against neoplastic cells and viral infected cells. These observations suggest that 3-DU also has the potential to enhance the antiviral activity of molnupiravir and arrest the progression of the disease in patients with COVID-19.

Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery: A review of current methods

Background: Augmented reality(AR) technology is used to reconstruct three-dimensional(3D) images of hepatic and biliary structures from computed tomography and magnetic resonance imaging data, and to superimpose the virtual images onto a view of the surgical field. In liver surgery, these superimposed virtual images help the surgeon to visualize intrahepatic structures and therefore, to operate precisely and to improve clinical outcomes.Data Sources: The keywords "augmented reality", "liver", "laparoscopic" and "hepatectomy" were used for searching publications in the Pub Med database. The primary source of literatures was from peer-reviewed journals up to December 2016. Additional articles were identified by manual search of references found in the key articles.Results: In general, AR technology mainly includes 3D reconstruction, display, registration as well as tracking techniques and has recently been adopted gradually for liver surgeries including laparoscopy and laparotomy with video-based AR assisted laparoscopic resection as the main technical application. By applying AR technology, blood vessels and tumor structures in the liver can be displayed during surgery,which permits precise navigation during complex surgical procedures. Liver transformation and registration errors during surgery were the main factors that limit the application of AR technology.Conclusions: With recent advances, AR technologies have the potential to improve hepatobiliary surgical procedures. However, additional clinical studies will be required to evaluate AR as a tool for reducing postoperative morbidity and mortality and for the improvement of long-term clinical outcomes. Future research is needed in the fusion of multiple imaging modalities, improving biomechanical liver modeling,and enhancing image data processing and tracking technologies to increase the accuracy of current AR methods.

Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries:A systematic review and meta-analysis

AIM To compare endoscopic submucosal dissection(ESD) outcomes between Eastern and Western countries.METHODS A systematic review and meta-analysis was performed using Pub Med,MEDLINE,Web of Science,CINAHL and EBM reviews to identify studies published between 1990 and February 2016. The primary outcome was the efficacy of ESD based on information about either curative resection,en bloc or R0 resection rates. Secondary outcomes were complication rates,local recurrence rates and procedure times. RESULTS Overall,238 publications including 84318 patients and 89512 gastrointestinal lesions resected using ESD were identified. 90% of the identified studies reporting ESDon 87296 lesions were conducted in Eastern countries and 10% of the identified studies reporting ESD outcomes in 2216 lesions were from Western countries. Meta-analyses showed higher pooled percentage of curative,en bloc,and R0 resection in the Eastern studies; 82%(CI: 81%-84%),95%(CI: 94%-96%) and 89%(CI: 88%-91%) compared to Western studies; 71%(CI: 61%-81%),85%(CI: 81%-89%) and 74%(CI: 67%-81%) respectively. The percentage of perforation requiring surgery was significantly greater in the Western countries(0.53%; CI: 0.10-1.16) compared to Eastern countries(0.01%; CI: 0%-0.05%). ESD procedure times were longer in Western countries(110 min vs 77 min).CONCLUSION Eastern countries show better ESD outcomes compared to Western countries. Availability of local ESD expertise and regional outcomes should be considered for decision making to treat gastrointestinal lesions with ESD.

Effect of adipose-derived mesenchymal stem cells on hepatocellular carcinoma: In vitro inhibition of carcinogenesis

AIM To investigate the effect of adipose-derived mesenchymal stem cells(ADMSCs)and their conditioned media(CM) on hepatocellular carcinoma(HCC) cell tumorigenesis.METHODS The proliferation rate of HepG2 and PLC-PRF-5 HCC cancer cells was measured using the trypan blue exclusion method and confirmed using the cell-counting kit8(commonly known as CCK-8) assay. Apoptosis was detected by flow cytometry using annexin V-FITC. Protein and mRNA expression was quantified by ELISA and real time PCR, respectively. Migration and invasion rates were performed by Transwell migration and invasion assays. Wound healing was examined to confirm the data obtained from the migration assays.RESULTS Our data demonstrated that when co-culturing HCC cell lines with ADMSCs or treating them with ADMSC CM, the HCC cell proliferation rate was significantly inhibited and the apoptosis rate increased. The decreased proliferation rate was accompanied by an upregulation of P53 and Retinoblastoma mRNA and a downregulation of c-Myc and hTERT mRNA levels. More notably, ADMSCs and their CM suppressed the expression of the two important markers of HCC carcinogenicity, alpha-fetoprotein and Des-gamma-carboxyprothrombin. In addition, the migration and invasion levels of HepG2 and PLC-PRF-5 cells significantly decreased, potentially through increased expression of the tissue inhibitor metalloproteinases TIMP-1, TIMP-2 and TIMP-3.CONCLUSION These findings shed new light on a protective and therapeutic role for ADMSCs and their CM in controlling HCC invasiveness and carcinogenesis.

Genetic testing in congenital heart disease:A clinical approach

Congenital heart disease(CHD) is the most common type of birth defect. Traditionally, a polygenic model defined by the interaction of multiple genes and environmental factors was hypothesized to account for different forms of CHD. It is now understood that the contribution of genetics to CHD extends beyond a single unified paradigm. For example, monogenic models and chromosomal abnormalities have been associated with various syndromic and non-syndromic forms of CHD. In such instances, genetic investigation and testing may potentially play an important role in clinical care. A family tree with a detailed phenotypic description serves as the initial screening tool to identify potentially inherited defects and to guide further genetic investigation. The selection of a genetic test is contingent upon the particular diagnostic hypothesis generated by clinical examination. Genetic investigation in CHD may carry the potential to improve prognosis by yielding valuable information with regards to personalized medical care, confidence in the clinical diagnosis, and/or targeted patient followup. Moreover, genetic assessment may serve as a tool to predict recurrence risk, define the pattern of inheritance within a family, and evaluate the need for further family screening. In some circumstances, prenatal or preimplantation genetic screening could identify fetuses or embryos at high risk for CHD. Although genetics may appear to constitute a highly specialized sector of cardiology, basic knowledge regarding inheritance patterns, recurrence risks, and available screening and diagnostic tools, including their strengths and limitations, could assist the treating physician in providing sound counsel.

Covariation between personalities and individual differences in coping with stress:Converging evidence and hypotheses

In the past decade there has been a profusion of studies highlighting covariation between individual differences instress physiology and behavioural profiles, here called personalities. Such individual differences in ways of coping with stress arerelevant both in biomedicine, since different personalities may experience a different stress and disease vulnerability, and in behaviouralecology, since their adaptive value and evolutionary maintenance are the subject of debate. However, the precise way inwhich individual stress differences and personalities are linked is unclear. Here we provide an updated overview of this covariationacross different species and taxa, consider its functional significance and present working hypotheses for how behaviouraland physiological responses to stress might be causally linked, affecting life-history traits such as dispersal and

Feasibility and safety of cryoballoon ablation for atrial fibrillation inpatients with congenital heart disease

BACKGROUND The prevalence of atrial fibrillation (AF) is on the rise in the aging population with congenital heart disease (CHD). A few case series have described the feasibility and early outcomes associated with radiofrequency catheter ablation of AF centered on electrically isolating pulmonary veins (PV) in patients with CHD. In contrast, cryoballoon ablation has not previously been studied in this patient population despite its theoretical advantages, which include a favorable safety profile and shorter procedural time. AIM To assess the safety and feasibility of cryoballoon ablation for AF in an initial cohort of patients with CHD. METHODS The study population consisted of consecutive patients with CHD and cryoballoon ablation for AF at the Montreal Heart Institute between December 2012 and June 2017. Procedural complications, acute success, and 1-year freedom from recurrent AF after a single procedure with or without antiarrhythmic drugs were assessed. Procedures were performed under conscious sedation. Left atrial access was obtained via a single transseptal puncture or through an existing atrial septal defect (ASD). Cryoballoon occlusion was assessed by distal injection of 50% diluted contrast into the pulmonary vein. At least one 240-second cryothermal application was performed upon obtaining complete pulmonary vein occlusion. Following ablation, patients were routinely followed at outpatient visits at 1, 3, 6, and 12 mo, and then annually. RESULTS Ten patients, median age 57.9 (interquartile range 48.2-61.7) years, 60% female, met inclusion criteria and were followed for 2.8 (interquartile range 1.4-4.5) years.Two had moderately complex CHD (sinus venosus ASD with partial anomalous pulmonary venous return;aortic coarctation with a persistent left superior vena cava), with the remainder having simple defects. AF was paroxysmal in 8 (80.0%) and persistent in 2 (20.0%) patients. The pulmonary vein anatomy was normal in 6 (60.0%) patients. Four had left common PV (n = 3) and/or 3 right PV (n = 2). Electrical pulmonary vein isolation (PVI) was acutely successful in all. One patient had transient phrenic nerve palsy that recovered during the intervention. No major complication occurred. One year after a single ablation procedure, 6 (60%) patients remained free from AF. One patient with recurrent AF had recovered pulmonary vein conduction and underwent a second PVI procedure. A second patient had ablation of an extra-pulmonary vein trigger for AF. CONCLUSION Cryoballoon ablation for AF is feasible and safe in patients with simple and moderate forms of CHD, with an excellent acute success rate and modest 1-year freedom from recurrent AF.

Value of a comprehensive geriatric assessment for predicting one-year outcomes in patients undergoing transcatheter aortic valve implantation: results from the CGA-TAVI multicentre registry

Background In a three-month report from the CGA-TAVI registry, we found the Multidimensional Prognostic Index (MPI) and Short Physical Performance Battery (SPPB) to be of value for predicting short-term outcomes in elderly patients undergoing transcatheter aortic valve implantation (TAVI). In the present analysis, we examined the association of these tools with outcomes up to one year post-TAVI. Methods CGA-TAVI is an international, observational registry of geriatric patients undergoing TAVI. Patients were assessed using the MPI and SPPB. Efficacy of baseline values and any postoperative change for predicting outcome were established using logistic regression. Kaplan- Meier analysis was carried out for each comprehensive geriatric assessment tool, with survival stratified by risk category. Results One year after TAVI, 14.1% of patients deceased, while 17.4% met the combined endpoint of death and/or non-fatal stroke, and 37.7% the combined endpoint of death and/or hospitalisation and/or non-fatal stroke. A high-risk MPI score was associated with an increased risk of all-cause mortality (aOR = 36.13, 95% CI: 2.77–470.78, P = 0.006) and death and/or non-fatal stroke (aOR = 10.10, 95% CI: 1.48–68.75, P = 0.018). No significant associations were found between a high-risk SPPB score and mortality or two main combined endpoints. In contrast to a worsening SPPB, an aggravating MPI score at three months post-TAVI was associated with an increased risk of death and/or non-fatal stoke at one year (aOR = 95.16, 95% CI: 3.41–2657.01). Conclusions The MPI showed value for predicting the likelihood of death and a combination of death and/or non-fatal stroke by one year after TAVI in elderly patients.

Spatial and temporal analysis of beta diversity in the Barro Colorado Island forest dynamics plot, Panama

Background: Ecologists are interested in assessing the spatial and temporal variation in ecological surveys repeated over time. This paper compares the 1985 and 2015 surveys of the Barro Colorado Forest Dynamics plot(BCI), Panama,divided into 1250(20 m × 20 m) quadrats.Methods, spatial analysis: Total beta diversity was measured as the total variance of the Hellinger-transformed community data throughout the BCI plot. Total beta was partitioned into contributions of individual sites(LCBD indices), which were tested for significance and mapped.Results, spatial analysis: LCBD indices indicated the sites with exceptional community composition. In 1985,they were mostly found in the swamp habitat. In the 2015 survey, none of the swamp quadrats had significant LCBDs.What happened to the tree community in the interval?Methods, temporal analysis: The dissimilarity in community composition in each quadrat was measured between time 1(1985) and time 2(2015). Temporal Beta Indices(TBI) were computed from abundance and presence-absence data and tested for significance. TBI indices can be decomposed into B = species(or abundances-per-species) losses and C = species(or abundances-per-species) gains. B-C plots were produced; they display visually the relative importance of the loss and gain components, through time, across the sites.Results, temporal analysis: In BCI, quadrats with significant TBI indices were found in the swamp area, which is shrinking in importance due to changes to the local climate. A published habitat classification divided the BCI forest plot into six habitat zones. Graphs of the B and C components were produced for each habitat group. Group 4(the swamp) was dominated by species(and abundances-per-species) gains whereas the five other habitat groups were dominated by losses, some groups more than others.Conclusions: We identified the species that had changed the most in abundances in the swamp between T1 and T2.This analysis supported the hypothesis that the swamp is drying out and is invaded by species from the surrounding area. Analysis of the B and C components of temporal beta diversity bring us to the heart of the mechanisms of community change through time: losses(B) and gains(C) of species, losses and gains of individuals of various species. TBI analysis is especially interesting in species-rich communities where we cannot examine the changes in every species individually.

Carotid Endothelial VCAM-1 Is an Early Marker of Carotid Atherosclerosis and Predicts Coronary Artery Disease in Swine

Objective: The aim was to determine if endothelial VCAM-1 (eVCAM-1) expression in the common carotid artery (CCA) would correlate with predictive markers of atherosclerotic disease, would precede reduction of markers of endothelial cell function and would predict coronary artery disease (CAD). Methods and results: Carotid arterial segments (bifurcation, proximal and distal CCA) were harvested from 14 and 24 month-old male castrated familial hypercholesterolemic (FH) swine, a model of spontaneous atherosclerosis. Quantification of local expression of eVCAM-1, intimal macrophage accumulation, oxidative stress, intima-media (I/M) ratio, intima-media thickness (IMT), endothelial nitric oxide synthase (eNOS) and phosphorylated eNOS (p-eNOS) in selected regions of the carotids revealed a relationship between local inflammation and atherosclerotic plaque progression. Importantly, inflammation was not uniform throughout the CCA. Endothelial VCAM-1 expression was the greatest at the bifurcation and increased with age. Finally, eVCAM-1 best estimated the severity of CAD compared to blood levels of glucose, hypercholesterolemia, carotid IMT, and p-eNOS. Conclusion: Our data suggested that eVCAM-1 was closely associated with atherosclerotic plaque progression and preceded impairment of EDD. Thus, this study supported the use of carotid VCAM-1 targeting agents to estimate the severity of CAD.

Renal biopsy practice:What is the gold standard?

Renal biopsy(RB) is useful for diagnosis and therapy guidance of renal diseases but incurs a risk of bleeding complications of variable severity,from transitory haematuria or asymptomatic hematoma to life-threatening hemorrhage.Several risk factors for complications after RB have been identified,including high blood pressure,age,decreased renal function,obesity,anemia,low platelet count and hemostasis disorders.These should be carefully assessed and,whenever possible,corrected before the procedure.The incidence of serious complications has become low with the use of automated biopsy devices and ultrasound guidance,which is currently the "gold standard" procedure for percutaneous RB.An outpatient biopsy may be considered in a carefully selected population with no risk factor for bleeding.However,controversies persist on the duration of observation after biopsy,especially for native kidney biopsy.Transjugular RB and laparoscopic RB represent reliable alternatives to conventional percutaneous biopsy in patients at high risk of bleeding,although some factors limit their use.This aim of this review is to summarize the issues of complications after RB,assessment of hemorrhagic risk factors,optimal biopsy procedure and strategies aimed to minimize the risk of bleeding.

Presence of <i>Actinobacillus pleuropneumoniae, Streptococcus suis, Pasteurella multocida, Bordetella bronchiseptica, Haemophilus parasuis and Mycoplasma hyopneumoniae</i>in upper respiratory tract of swine in farms from Aguascalientes, Mexico

Respiratory diseases are one of the most important health problems in pig herds. The porcine respiratory disease complex (PRDC) is the term used to describe pneumonic diseases caused by multiple infectious agents that provoke weight loss in animals or death. In the PRDC multiple pathogens (bacteria and/or viruses) work in combination to induce this respiratory disease. Within this complex, Actinobacillus pleuropneumoniae, Streptococcus suis, Pasteurella multocida, Bordetella bronchiseptica, Haemophilus parasuis and Mycoplasma hyopneumoniae are the main bacterial pathogens involved in great economic losses to the swine industry. The aim of this work was to estimate the presence of A. pleuropneumoniae, S. suis, P. multocida, B. bronchiseptica, H. parasuis and M. hyopneumoniae in the upper respiratory tract of pigs in representative swine farms inAguascalientes,Mexico, using PCR technique. The study was performed in 14 swine farms. We obtained a total of 212 nasal swabs. Near 20% of samples were positive for A. pleuropneumoniae (located in the 79% of farms);17% were positive for S. suis (in 86% of farms), of these, 3% were S. suis serovar 2;30% were positive for H. parasuis (93% of farms);23% of the samples to P. multocida (in 79% of farms);and 19% to M. hyopneumoniae (in 64% of farms). B. bronchiseptica was not detected in this study. The results obtained show that bacterial pathogens of PRDC were present in the upper respiratory tract of pigs in all farms studied;therefore, these pathogens are widely disseminated in pig farms of Aguascalientes, Mexico.

Understanding and Promoting Clinical Reasoning in Chronic and Multimorbid Conditions: A Call for GPs and Healthcare Professionals

Multimorbidity, defined as 2 or more chronic diseases, is of increasing importance for health professionals. Many factors are at play when it comes to multimorbidity, but we still know very little about how clinicians actually weigh up the different factors—medical, social, and psychological—to reach a particular course of action. Further research is therefore required to explore the ways in which clinical reasoning processes are involved in the follow up of patients suffering from multimorbidities, to highlight their potential risks of errors. A better understanding of these clinical processes will also enrich supervision of trainees and collaboration between healthcare professionals involved in primary care.

Effect of emotional valence on episodic memory stages as indexed by event-related potentials

Several investigations have shown that emotional events show superior recall than non-emotional ones. However, the cortical mechanisms underlying the episodic recall of emotional scenes are still poorly understood. Our main aim was to compare the magnitude of the Event-Related brain Potentials (ERP) old-new effect related to emotionally unpleasant, pleasant and neutral photographic images. As expected, correct recognition of all types of images elicited three topographically distinct ERP components sensitive to the classical old-new recognition effect. The results revealed that the behavioral performances were mainly sensitive to arousal, while the ERP old/new effect over posterior regions (300 - 1000 ms) was exclusively affected by unpleasantness. A later component (1000 - 1400 ms) showed an inverted old/ new effect at parietal sites, which was also sensitive to unpleasantness. These results imply that ERP reflecting episodic conscious recollection and post-retrieval monitoring are clearly affected both by valence and arousal.

Vaccines in Non-Small Cell Lung Cancer

Immunotherapy as an option of treatment in cancer has experienced an important development with the inclusion of vaccines. In lung cancer this type of treatment has emerged and vaccines can be classified in three groups: antigen-specific vaccines, tumor cell vaccines, and dendritic cell vaccines. Emepepimut (L-BLP25) and MAGE-A3 have been the vaccines most widely studied. Their promising results with benefit in survival and limited toxicity in preclinical and clinical trials have led to phase III trials with results eagerly awaited. Other vaccines have been investigated, but results were not favorable or are still pending. Hopefully, vaccines could be an additional instrument for the treatment of lung cancer in the adjuvant or metastatic setting as time will unveil the results of current and future trials.

EEG Analysis of the Contribution of Music Therapy and Virtual Reality to the Improvement of Cognition in Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia, affecting nearly 9.9 million new people every year. The disease provokes important memory and cognitive impairment, eventually causing individuals to forget their loved ones and rendering them completely dependent on their caretakers. Alzheimer’s patients typically experience more negative emotions, such as frustration and apathy, than healthy older adults. There is currently no cure for the disease. Our research group explores how the integration of virtual reality (VR) and an EEG-based intelligent agent in music therapy can alleviate psychological and cognitive symptoms of the disease. We propose a theory explaining how, through activation of the brain reward system, music can reduce negative emotions, increase positive emotions and as a result increase performance on cognitive tasks. The results of our experimental study concord with our theory: emotional states of participants are improved, as per recorded through EEG, and performances on memory tasks show improvement following the intervention. We believe that the combination of EEG brain assessment, VR and music therapy is a promising method for emotional states and cognitive symptoms of Alzheimer’s disease.

Comparison of inhaled milrinone, nitric oxide and prostacyclin in acute respiratory distress syndrome

AIM To evaluate the safety and efficacy of inhaled milrinone in acute respiratory distress syndrome(ARDS).METHODS Open-label prospective cross-over pilot study where fifteen adult patients with hypoxemic failure meeting standard ARDS criteria and monitored with a pulmonary artery catheter were recruited in an academic 24-bed medico-surgical intensive care unit. Random sequential administration of i NO(20 ppm) or nebulized epoprostenol(10 μg/mL) was done in all patients. Thereafter, inhaled milrinone(1 mg/mL) alone followed by inhaled milrinone in association with inhaled nitric oxide(iN O) was administered. A jet nebulization device synchronized with the mechanical ventilation was use to administrate the epoprostenol and the milrinone. Hemodynamic measurements and partial pressure of arterial oxygen(PaO_2) were recorded before and after each inhaled therapyadministration.RESULTS The majority of ARDS were of pulmonary cause(n = 13) and pneumonia(n = 7) was the leading underlying initial disease. Other pulmonary causes of ARDS were: Post cardiopulmonary bypass(n = 2), smoke inhalation injury(n = 1), thoracic trauma and pulmonary contusions(n = 2) and aspiration(n = 1). Two patients had an extra pulmonary cause of ARDS: A polytrauma patient and an intra-abdominal abscess Inhaled nitric oxide, epoprostenol, inhaled milrinone and the combination of inhaled milrinone and i NO had no impact on systemic hemodynamics. No significant adverse events related to study medications were observed. The median increase of PaO 2 from baseline was 8.8 mmH g [interquartile range(IQR) = 16.3], 6.0 mm Hg(IQR = 18.4), 6 mm Hg(IQR = 15.8) and 9.2 mm Hg(IQR = 20.2) respectively with i NO, epoprostenol, inhaled milrinone, and i NO added to milrinone. Only i NO and the combination of inhaled milrinone and i NO had a statistically significant effect on PaO 2. CONCLUSION When comparing the effects of inhaled NO, milrinone and epoprostenol, only NO significantly improved oxygenation. Inhaled milrinone appeared safe but failed to improve oxygenation in ARDS.