A male predominance in Brugada syndrome (BrS) has been widely reported, but scarce information on female patients with BrS is available.
The purpose of this study was to investigate the clinical ...characteristics and long-term prognosis of women with BrS.
A multicenter retrospective study of patients diagnosed with BrS and previous electrophysiological study (EPS) was performed.
Among 770 patients, 177 (23%) were female. At presentation, 150 (84.7%) were asymptomatic. Females presented less frequently with a type 1 electrocardiographic pattern (30.5% vs 55.0%; P <.001), had a higher rate of family history of sudden cardiac death (49.7% vs 29.8%; P <.001), and had less sustained ventricular arrhythmias (VAs) on EPS (8.5% vs 15.1%; P = .009). Genetic testing was performed in 79 females (45% of the sample) and was positive in 34 (19%). An implantable cardioverter-defibrillator was inserted in 48 females (27.1%). During mean (± SD) follow-up of 122.17 ± 57.28 months, 5 females (2.8%) experienced a cardiovascular event compared to 42 males (7.1%; P = .04). On multivariable analysis, a positive genetic test (18.71; 95% confidence interval CI 1.82-192.53; P = .01) and atrial fibrillation (odds ratio 21.12; 95% CI 1.27-350.85; P = .03) were predictive of arrhythmic events, whereas VAs on EPS (neither with 1 or 2 extrastimuli nor 3 extrastimuli) were not.
Women with BrS represent a minor fraction among patients with BrS, and although their rate of events is low, they do not constitute a risk-free group. Neither clinical risk factors nor EPS predicts future arrhythmic events. Only atrial fibrillation and positive genetic test were identified as risk factors for future arrhythmic events.
To evaluate our institutional experience of minimally invasive tumor bed implantation (MITBI) during breast-conserving surgery (BCS) for ductal carcinoma
(DCIS) to deliver peri-operative ...high-dose-rate brachytherapy (PHDRBT) as accelerated minimal breast irradiation (AMBI) or anticipated boost (A-PHDRBT-boost).
Patients older than 40, with clinical and radiological unifocal DCIS < 3 cm were considered potential candidates for accelerated partial breast irradiation (APBI) and were implanted during BCS using MITBI-technique. Patients who in final pathology reports showed free margins and no other microscopic tumor foci, received AMBI with PHDRBT (3.4 Gy BID in 5 days). Patients with adverse features received A-PHDRBT-boost with post-operative external beam radiotherapy (EBRT).
Forty-one patients were implanted, and 36 were treated and analyzed. According to final pathology, 24 (67%) patients were suitable for AMBI and 12 (33%) were qualified for A-PHDRBT-boost. Reoperation rate for those with clear margins was 16.6% (6/36); this rate increased to 33% (4/12) for G3 histology, and 66% (4/6) were rescued using AMBI. Early complications were documented in 5 patients (14%). With a median follow-up of 97 (range, 42-138) months, 5-year rates of local, elsewhere, locoregional, and distant control were all 97.2%. 5-year ipsilateral breast tumor recurrence rates (IBTR) were 5.6% (2/36), 8.3% (2/24) for AMBI, and 0% (0/12) for A-PHDRBT-boost patients. Both instances of IBTR were confirmed G3 tumors in pre-operative biopsies; no IBTR was documented in G1-2 tumors. Cosmetic outcomes were excellent/good in 96% of AMBI vs. 67% in A-PHDRBT-boost (
= 0.034).
The MITBI-PHDRBT program allows selection of patients with excellent prognoses (G1-2 DCIS with negative margins and no multifocality), for whom AMBI could be a good alternative with low recurrence rate, decrease of unnecessary radiation, treatment logistics improvement, and over-treatment reduction. Patients whose pre-operative biopsy showed G3 tumor, presents with inferior local control and more risk of reoperation due to positive margins.
Common variable immunodeficiency (CVID) constitutes a heterogenic group of primary immunodeficiency disorders with a wide-ranging clinical spectrum. CVID-associated non-infectious morbidity ...constitutes a major challenge requiring a full understanding of its pathophysiology and its clinical importance and global variability, especially considering the broad clinical, genetic, and regional heterogeneity of CVID disorders. This work aimed to develop a nationwide, multicenter, retrospective study over a 3-year period describing epidemiological, clinical, laboratory, therapeutic, and prognostic features of 250 CVID patients in Spain. The mean diagnostic delay was around 10 years and most patients initially presented with infectious complications followed by non-infectious immune disorders. However, infectious diseases were not the main cause of morbimortality. Non-infectious lung disease was extraordinarily frequent in our registry affecting approximately 60% of the patients. More than one-third of the patients in our cohort showed lymphadenopathies and splenomegaly in their follow-up, and more than 33% presented immune cytopenias, especially Evans’ syndrome. Gastrointestinal disease was observed in more than 40% of the patients. Among biopsied organs in our cohort, benign lymphoproliferation was the principal histopathological alteration. Reaching 15.26%, the global prevalence of cancer in our registry was one of the highest reported to date, with non-Hodgkin B lymphoma being the most frequent. These data emphasize the importance of basic and translational research delving into the pathophysiological pathways involved in immune dysregulation and diffuse lymphocytic infiltration. This would reveal new tailored strategies to reduce immune complications, and the associated healthcare burden, and ensure a better quality of life for CVID patients.
This paper reports the influence that vegetation recovery has exerted on the soil behaviour to erosion by water during both the first and eight years after experimental fires. The work was carried ...out at La Concordia Experimental Station (Valencia, Spain), which includes nine plots (4 m wide
×
20 m long) installed on a calcareous hillside representative of Mediterranean shrubland areas. In June 1995 a set of experimental fires were carry out at two intensity levels (high and moderate) with three plots replication for each treatment. The remaining three plots were used as the control. Rain events between June 1995 to June 1996 and from June 2002 to June 2003 were monitored and their effect on soil erosion processes determined. The vegetation changes (biomass amount and plant cover) for each studied period were also assessed.
Total runoff and sediment yield measured during the first post-fire year was 19.43 L m
−
2
and 561 g m
−
2
in the intense fire, and 14.72 L m
−
2
and 326 g m
−
2
in the moderate one, which contrasts with the very low runoff (3.82 L m
−
2
) and soil loss (8.56 g m
−
2
) in control plots. Eight years after the fire, the amount of vegetation on the burned plots represents between 63 and 69% compared to the biomass present before the fire in 1995. The regeneration of plant cover, up to 30–40% eight years after the fire, facilitated a decrease in the difference of soil losses between fire treatments and between burned and unburned plots. However, runoff generation still remains greater in burned plots than in the control ones eight years after the fire.
This study examined the effects of a large-scale flipped learning (FL) approach in an undergraduate course of Digestive System Diseases.
This prospective non-randomized trial recruited 404 students ...over three academic years. In 2016, the course was taught entirely in a Traditional Lecture (TL) style, in 2017 half of the course (Medical topics) was replaced by FL while the remaining half (Surgical topics) was taught by TL and in 2018, the whole course was taught entirely by FL. Academic performance, class attendance and student's satisfaction surveys were compared between cohorts.
Test scores were higher in the FL module (Medical) than in the TL module (Surgical) in the 2017 cohort but were not different when both components were taught entirely by TL (2016) or by FL (2018). Also, FL increased the probability of reaching superior grades (scores >7.0) and improved class attendance and students' satisfaction.
The holistic FL model is more effective for teaching undergraduate clinical gastroenterology compared to traditional teaching methods and has a positive impact on classroom attendances.
The congenital midline non-union of the posterior arch of the atlas is a developmental variant present at a frequency ranging from 0.7% to 3.9%. Most of the reported cases correspond to incidental ...findings during routine medical examination. In cases of posterior non-union, hypertrophy of the anterior arch and cortical bone thickening of the posterior arches have been observed and interpreted as adaptive responses of the atlas to increased mechanical stress.
We sought to determine if the congenital non-union of the posterior arch results in a change in the shape of the atlas.
This study is an analysis of the first cervical vertebrae from osteological collections through morphometric geometric techniques.
A total of 21 vertebrae were scanned with a high-resolution three-dimensional scanner (Artec Space Spider, Artec Group, Luxembourg). To capture vertebral shape, 19 landmarks and 100 semilandmarks were placed on the vertebrae. Procrustes superimposition was applied to obtain size and shape data (MorphoJ 1.02; Klingenberg, 2011), which were analyzed through principal component analysis (PCA) and mean shape comparisons.
The PCA resulted in two components explaining 22.32% and 18.8% of the total shape variance. The graphic plotting of both components indicates a clear shape difference between the control atlas and the atlas with posterior non-union. This observation was supported by statistically significant differences in mean shape comparisons between both types of vertebra (p<.0001). Changes in shape were observed in the superior and inferior articular facets, the transverse processes, and the neural canal between the control and non-union vertebrae.
Non-union of the posterior arch of the atlas is associated with significant changes in the shape of the vertebra.
The chemical characteristics of the low-temperature geothermal system of Panticosa (Spain) were investigated in order to determine the water temperature at the reservoir and to identify the main ...geochemical processes that affect the water composition during the ascent of the thermal waters. In general, the studied waters are similar to other geothermal systems in the Pyrenees, belonging to the group of granite-related alkaline thermal waters (high pH, low total dissolved solids, very low magnesium concentration, and sodium as the dominant cation). According to the alkaline pH of these waters, they have a very low CO2 partial pressure, bicarbonate is the dominant anion and silica is partially ionized as H3SiO4−. The unusually active acid–base pairs (HCO3−/CO32− and, mainly, H4SiO4/H3SiO4−) act as homogeneous pH buffers and contribute to the total alkalinity in these alkaline waters. On the basis of the study of the conservative elements, a mixing process between a hot and a cold end-member has been identified. Additionally, in order to determinate the water temperature at the reservoir, several geothermometric techniques have been applied, including both geothermometrical modeling and classical geothermometrical calculations. The geothermometrical modeling seems to indicate that thermal waters re-equilibrate with respect to calcite and kaolinite during their ascent to the surface. Modeling results suggest that these thermal waters would be in equilibrium with respect to albite, K-feldspar, quartz, calcite, kaolinite and zoisite at a similar temperature of 90±20°C in the reservoir, which is in good agreement with the results obtained by applying the classical geothermometers.
► Application of geothermometrical techniques to determine the reservoir temperature. ► Use of geochemical calculations to elucidate the main secondary processes of waters. ► Thermal springs composition show variability as result of mixing processes. ► Re-equilibrium of the waters with respect to kaolinite during their ascent.
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