Explore the vast range of titles available.

In Spain, Leishmania infantum is endemic, human visceral and cutaneous leishmaniasis cases occurring both in the Peninsula, as well as in the Balearic Islands. We aimed to describe the clinical characteristics of leishmaniasis patients and the changes in the disease evolution after the introduction of antiretroviral therapy in 1997. In this descriptive study, we used Spanish Centralized Hospital Discharge Database for the hospitalized leishmaniasis cases between 1997 and 2011. We included in the analysis only the records having leishmaniasis as the first registered diagnosis and calculated the hospitalization rates. Disease trend was described taking into account the HIV status. Adjusted odds-ratio was used to estimate the association between clinical and socio-demographic factors and HIV co-infection. Of the total 8010 Leishmaniasis hospitalizations records, 3442 had leishmaniasis as first diagnosis; 2545/3442 (75.6%) were males and 2240/3442 (65.1%) aged between 14-65 years. Regarding disease forms, 2844/3442 (82.6%) of hospitalizations were due to visceral leishmaniasis (VL), while 118/3442 (3.4%) hospitalizations were cutaneous leishmaniasis (CL). Overall, 1737/2844 of VL (61.1%) were HIV negatives. An overall increasing trend was observed for the records with leishmaniasis as first diagnosis (p=0.113). Non-HIV leishmaniasis increased during this time period (p=0.021) while leishmaniasis-HIV co-infection hospitalization revealed a slight descending trend (p=0.717). Leishmaniasis-HIV co-infection was significantly associated with male sex (aOR=1.6; 95% CI: 1.25-2.04), 16-64 years age group (aOR=17.4; 95%CI: 2.1-143.3), visceral leishmaniasis aOR=6.1 (95%CI: 3.27-11.28) and solid neoplasms 4.5 (95% CI: 1.65-12.04). The absence of HIV co-infection was associated with lymph/hematopoietic neoplasms (aOR=0.3; 95%CI:0.14-0.57), other immunodeficiency (aOR=0.04; 95% CI:0.01-0.32) and transplant (aOR=0.01; 95%CI:0.00-0.07). Our findings suggest a significant increase of hospitalization in the absence of HIV co-infection, with a predomination of VL. We consider that clinicians in Spain should be aware of leishmaniasis not only in the HIV population but also in non HIV patients, especially for those having immunosuppression as an associate condition.

In the new version of the World Health Organization (WHO), water reuse guidelines helminth ova are considered one of the main target pollutants to be removed from wastewater reuse for agriculture and aquaculture purposes. In spite of this, along with the fact that helminth ova have been considered the main health risk to wastewater reuse for agriculture for at least 20 years, relatively little research has been done to control helminth ova in the wastewater treatment field. This paper addresses (1) characteristics of helminth ova and differences with microorganisms; (2) the most frequent helminth ova genus found in wastewater; (3) helminth ova content in developed and developing countries wastewater; (4) reasons why conventional disinfection methods cannot be applied; (5) main removal mechanisms; and (6) processes that in practice have effectively removed or inactivated helminth ova.

The 11 September 2001 (9/11) attacks were unprecedented in magnitude and mental health impact. While a large body of research has emerged since the attacks, published reviews are few, and are limited by an emphasis on cross-sectional research, short time frame, and exclusion of treatment studies. Additionally, to date, there has been no systematic review of available longitudinal information as a unique data set. Consequently, knowledge regarding long-term trajectories of 9/11-related post-traumatic stress disorder (PTSD) among highly exposed populations, and whether available treatment approaches effectively address PTSD within the context of mass, man-made disaster, remains limited. The present review aimed to address these gaps using a systematic review of peer-reviewed reports from October 2001 to May 2016. Eligible reports were of longitudinal studies of PTSD among highly exposed populations. We identified 20 reports of 9/11-related PTSD, including 13 longitudinal prevalence studies and seven treatment studies. Findings suggest a substantial burden of 9/11-related PTSD among those highly exposed to the attack, associated with a range of sociodemographic and back-ground factors, and characteristics of peri-event exposure. While most longitudinal studies show declining rates of prevalence of PTSD, studies of rescue/recovery workers have documented an increase over time. Treatment studies were few, and generally limited by methodological shortcomings, but support exposure-based therapies. Future directions for research, treatment, and healthcare policy are discussed.

The presence of hypoxic regions in solid tumors is an adverse prognostic factor for patient outcome. Here, we show that hypoxia induces the expression of Ephrin-A3 through a novel hypoxia-inducible factor (HIF)-mediated mechanism. In response to hypoxia, the coding EFNA3 mRNA levels remained relatively stable, but HIFs drove the expression of previously unknown long noncoding (lnc) RNAs from EFNA3 locus and these lncRNA caused Ephrin-A3 protein accumulation. Ephrins are cell surface proteins that regulate diverse biological processes by modulating cellular adhesion and repulsion. Mounting evidence implicates deregulated ephrin function in multiple aspects of tumor biology. We demonstrate that sustained expression of both Ephrin-A3 and novel EFNA3 lncRNAs increased the metastatic potential of human breast cancer cells, possibly by increasing the ability of tumor cells to extravasate from the blood vessels into surrounding tissue. In agreement, we found a strong correlation between high EFNA3 expression and shorter metastasis-free survival in breast cancer patients. Taken together, our results suggest that hypoxia could contribute to metastatic spread of breast cancer via HIF-mediated induction of EFNA3 lncRNAs and subsequent Ephrin-A3 protein accumulation.

With improvement in mastectomy skin flap viability and increasing recognition of animation deformity following sub-pectoral implant placement, there has been a transition toward pre-pectoral breast reconstruction. While studies have explored the cost effectiveness of implant-based breast reconstruction, few investigations have evaluated cost with respect to pre-pectoral versus sub-pectoral breast reconstruction. A retrospective review of 548 patients who underwent mastectomy and implant-based breast reconstruction was performed from 2017 to 2020. The demographic and surgical characteristics of the pre-pectoral and sub-pectoral cohorts were well matched, except for reconstructive staging, as patients who underwent pre-pectoral reconstruction were more likely to undergo single-stage instead of two-stage reconstruction. Comparison of institutional cost ratios by reconstructive technique revealed that the sub-pectoral approach was more costly (1.70 ± 0.44 vs 1.58 ± 0.31, p < 0.01). However, further stratification by laterality and reconstructive staging failed to demonstrate difference in cost by reconstructive technique. These results were confirmed by multivariable linear regression, which did not reveal reconstructive technique to be an independent variable for cost. This study suggests that pre-pectoral breast reconstruction is a cost-effective alternative to sub-pectoral breast reconstruction and may confer cost benefit, as it is more strongly associated with direct-to-implant breast reconstruction.

Particle therapy has received increasing attention in the treatment of breast cancer due to its unique physical properties that may enhance patient quality of life and reduce the late effects of therapy. In this review, we will examine the rationale for the use of proton and carbon therapy in the treatment of breast cancer and highlight their potential for sparing normal tissue injury. We will discuss the early dosimetric and clinical studies that have been pursued to date in this domain before focusing on the remaining open questions limiting the widespread adoption of particle therapy.

We prove the hydrodynamic limit for the symmetric exclusion process with long jumps given by a mean zero probability transition rate with infinite variance and in contact with infinitely many reservoirs with density α at the left of the system and β at the right of the system. The strength of the reservoirs is ruled by κN-θ>0. Here N is the size of the system, κ>0 and θ∈R. Our results are valid for θ≤0. For θ=0, we obtain a collection of fractional reaction–diffusion equations indexed by the parameter κ and with Dirichlet boundary conditions. Their solutions also depend on κ. For θ<0, the hydrodynamic equation corresponds to a reaction equation with Dirichlet boundary conditions. The case θ>0 is still open. For that reason we also analyze the convergence of the unique weak solution of the equation in the case θ=0 when we send the parameter κ to zero. Indeed, we conjecture that the limiting profile when κ→0 is the one that we should obtain when taking small values of θ>0.

In the recent decades, the increase in irrigated agricultural areas has been a constant trend in the Mediterranean region, being concurrent with a reduction in the availability of water resources, due not only to an increase in demand but also to a reduction in supply as a result of the climate crisis. This study has analysed the evolution in land use changes between 1991 and 2021 in the Mediterranean region of southern Spain; the increase in the areas occupied by irrigated crops has been quantified; the climatic and edaphic dynamics linked to water risks have been identified, analysing the evolution of the annual precipitation, the number of rainy days and the distance to the wilting point of the soil; and, finally, it has been determined which factors are the most explanatory in this dynamic of land use. Using several machine learning methods, we could state how the current dynamics of land use are not in accordance with the availability and evolution of water resources, and how the areas where irrigated crops have increased the most are those where the climatic pattern shows a greater decrease in water resources, indicating how decisions on land uses are not done considering climatological conditions, but economic benefits. Short Increase in irrigated crops by 151,029 hectares (66%) in the last 30 years. Significant reduction of water resources in the Andalusian Mediterranean region between 1997 and 2021. Major increase in irrigated crops where a major decrease in water availability is identified. The distribution of irrigated crops does not reflect climatic dynamics. Axarquia and Costa Tropical are the regions with the highest soil water stress.

Purpose Patients undergoing external beam accelerated partial breast irradiation (APBI) receive permanent tattoos to aid with daily setup alignment and verification. With the advent of three‐dimensional (3D) body surface imaging and two‐dimensional (2D) x‐ray imaging‐based matching to surgical clips, tattoos may not be necessary to ensure setup accuracy. We compared the accuracy of conventional tattoo‐based setups to a patient setup without tattoos. Materials/methods Twenty consecutive patients receiving APBI at our institution from July 10, 2017 to February 13, 2018 were identified. All patients received tattoos per standard of care. Ten patients underwent setup using tattoos for initial positioning followed by surface imaging and 2D matching of surgical clips. The other ten patients underwent positioning using surface imaging followed by 2D matching without reference to tattoos. Overall setup time and orthogonal x‐ray‐based shifts after surface imaging per fraction were recorded. Shift data were used to calculate systematic and random error. Results Among ten patients in the “no tattoo” group, the average setup time per fraction was 6.83 min vs 8.03 min in the tattoo cohort (P < 0.01). Mean 3D vector shifts for patients in the “no tattoo” group were 4.6 vs 5.9 mm in the “tattoo” cohort (P = NS). Mean systematic errors in the “no tattoo” group were: 1.2 mm (1.5 mm SD) superior/inferior, 0.5 mm (1.6 mm SD) right/left, and 2.3 mm (1.9 mm SD) anterior/posterior directions. Mean systematic errors in the “tattoo” group were: 0.8 mm (2.2 mm SD) superior/inferior, 0.3 mm (2.5 mm SD) right/left, and 1.4 mm (4.4 mm SD) anterior/posterior directions. The random errors in the “no tattoo” group ranged from 0.6 to 0.7 mm vs 1.2 to 1.7 mm in the “tattoo” group. Conclusions Using both surface imaging and 2D matching to surgical clips provides excellent accuracy in APBI patient alignment and setup verification with reduced setup time relative to the tattoo cohort. Skin‐based tattoos may no longer be warranted for patients receiving external beam APBI.

Background The role of adjuvant chemotherapy in small, node‐negative triple‐negative breast cancer (TNBC) has not been formally assessed in clinical trials. We aimed to evaluate the benefit of adjuvant chemotherapy in this population. Methods This is a retrospective study using the National Cancer Database (NCDB). We included women with pathologic T1N0M0 (pT1N0M0) TNBC diagnosed between 2010 and 2019. Kaplan–Meier methods and Cox proportional models were used to compare overall survival (OS) between chemotherapy and no chemotherapy cohorts. Results In patients with pT1N0M0 TNBC, adjuvant chemotherapy improved OS (HR, 0.51; 95% CI, 0.47–0.55). The benefit of adjuvant chemotherapy was evidenced across all tumor sizes; T1a HR 0.51 (95% CI 0.34–0.75), T1b HR 0.55 (95% CI 0.47–0.64), and T1c HR 0.48 (95% CI 0.43–0.53). Despite similar HRs associated with chemotherapy across tumor sizes, T1c had the worst OS without chemotherapy, thus the most gain in 5‐year OS: 5‐year OS rates for chemotherapy vs. no chemotherapy for T1a, T1b and T1c tumors were 98% vs. 93%, 96% vs. 89%, and 93% vs. 80%, respectively. Although there were no ethnoracial differences in chemotherapy receipt, Non‐Hispanic Black women (HR 0.65, 95% CI 0.54–0.76) derived less benefit compared to Non‐Hispanic White women (HR 0.49, 95% CI 0.44–0.53). Conclusions Adjuvant chemotherapy improves survival in patients with pT1N0M0 TNBC. The magnitude of the benefit is greatest for T1c tumors than for T1b and T1a tumors. Future studies are required to identify biomarkers to select patients who derive the most chemotherapy benefit.