SuperPath approach is a recommendable option in frail patients with femoral neck fractures: a case–control study

INTRODUCTION: The treatment of intracapsular femoral neck fractures (FNFs) in the elderly is usually based on hip replacement, both total hip arthroplasty (THA) and hemiarthroplasty (HA). Recently, several tissue-sparing approaches for hip arthroplasty had been described with promising results in terms of hospitalization length, blood loss and dislocation rate. The aim of the present study was to compare the blood loss and the transfusion rate in a cohort of patients with FNF treated using an HA through both the SuperPath (SP) and the traditional posterolateral (PL) approaches. MATERIALS AND METHODS: We retrospectively collected data from patients affected by FNFs between January 2018 and February 2020. All patients with intracapsular FNF treated with a single HA implant (Profemur L, MicroPort Orthopedics Inc., USA) via PL or SP approaches were included. Exclusion criteria were pathological fractures, polytrauma and preoperatively transfused patients. RESULTS: Thirty-five patients were included and analysed in the present study. 17 patients were classified in the SP group, and 18 in the PL one. The rate of antithrombotic therapy was higher in the SP group compared with the PL group [10 (58, 82%) vs 4 (22, 2%)]. While the two groups did not differ in terms of preoperative haemoglobin (Hb), 48 h postoperative Hb and Hb reduction, a significative difference was observed in terms of blood transfusion rate (1 SP vs 9 PL, p = 0.0072). CONCLUSIONS: The SuperPath approach in patients with FNF under antithrombotic therapy assures lower transfusion rate, potentially reducing complication rates and improving patients' outcomes

Zero Fluoroscopy Arrhythmias Catheter Ablation: A Trend Toward More Frequent Practice in a High-Volume Center

BACKGROUND: Awareness of radiation exposure risks associated to interventional cardiology procedures is growing. The availability of new technologies in electrophysiology laboratories has reduced fluoroscopy usage during arrhythmias ablations. The aim of this study was to describe procedures with and without X-Rays and to assess feasibility, safety, and short-term efficacy of zero fluoroscopy intervention in a high-volume center oriented to keep exposure to ionizing radiation as low as reasonably achievable. METHODS: Cardiac catheter ablations performed in our hospital since January 2017 to June 2021. RESULTS: A total of 1,853 procedures were performed with 1,957 arrhythmias treated. Rate of fluoroless procedures was 15.4% (285 interventions) with an increasing trend from 8.5% in 2017 to 22.9% of first semester 2021. The most frequent arrhythmia treated was atrial fibrillation (646; 3.6% fluoroless) followed by atrioventricular nodal reentrant tachycardia (644; 16.9% fluoroless), atrial flutter (215; 8.8% fluoroless), ventricular tachycardia (178; 17.4% fluoroless), premature ventricular contraction (162; 48.1% fluoroless), and accessory pathways (112; 31.3% fluoroless). Although characteristics of patients and operative details were heterogeneous among treated arrhythmias, use of fluoroscopy did not influence procedure duration. Moreover, feasibility and efficacy were 100% in fluoroless ablations while the rate of major complications was very low and no different with or without fluoroscopy (0.45 vs. 0.35%). CONCLUSION: Limiting the use of X-Rays is necessary, especially when the available technologies allow a zero-use approach. A lower radiation exposure may be reached, reducing fluoroscopy usage whenever possible during cardiac ablation procedures with high safety, full feasibility, and efficacy

Treatment effect variability in brain stimulation across psychiatric disorders: A meta-analysis of variance

Noninvasive brain stimulation methods such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are promising add-on treatments for a number of psychiatric conditions. Yet, some of the initial excitement is wearing off. Randomized controlled trials (RCT) have found inconsistent results. This inconsistency is suspected to be the consequence of variation in treatment effects and solvable by identifying responders in RCTs and individualizing treatment. However, is there enough evidence from RCTs that patients respond differently to treatment? This question can be addressed by comparing the variability in the active stimulation group with the variability in the sham group. We searched MEDLINE/PubMed and included all double-blinded, sham-controlled RCTs and crossover trials that used TMS or tDCS in adults with a unipolar or bipolar depression, bipolar disorder, schizophrenia spectrum disorder, or obsessive compulsive disorder. In accordance with the PRISMA guidelines to ensure data quality and validity, we extracted a measure of variability of the primary outcome. A total of 130 studies with 5748 patients were considered in the analysis. We calculated variance-weighted variability ratios for each comparison of active stimulation vs sham and entered them into a random-effects model. We hypothesized that treatment effect variability in TMS or tDCS would be reflected by increased variability after active compared with sham stimulation, or in other words, a variability ratio greater than one. Across diagnoses, we found only a minimal increase in variability after active stimulation compared with sham that did not reach statistical significance (variability ratio = 1.03; 95% CI, 0.97, 1.08, P = 0.358). In conclusion, this study found little evidence for treatment effect variability in brain stimulation, suggesting that the need for personalized or stratified medicine is still an open questio

Treatment effect variability in brain stimulation across psychiatric disorders: A meta-analysis of variance

Noninvasive brain stimulation methods such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are promising add-on treatments for a number of psychiatric conditions. Yet, some of the initial excitement is wearing off. Randomized controlled trials (RCT) have found inconsistent results. This inconsistency is suspected to be the consequence of variation in treatment effects and solvable by identifying responders in RCTs and individualizing treatment. However, is there enough evidence from RCTs that patients respond differently to treatment? This question can be addressed by comparing the variability in the active stimulation group with the variability in the sham group. We searched MEDLINE/PubMed and included all double-blinded, sham-controlled RCTs and crossover trials that used TMS or tDCS in adults with a unipolar or bipolar depression, bipolar disorder, schizophrenia spectrum disorder, or obsessive compulsive disorder. In accordance with the PRISMA guidelines to ensure data quality and validity, we extracted a measure of variability of the primary outcome. A total of 130 studies with 5748 patients were considered in the analysis. We calculated variance-weighted variability ratios for each comparison of active stimulation vs sham and entered them into a random-effects model. We hypothesized that treatment effect variability in TMS or tDCS would be reflected by increased variability after active compared with sham stimulation, or in other words, a variability ratio greater than one. Across diagnoses, we found only a minimal increase in variability after active stimulation compared with sham that did not reach statistical significance (variability ratio = 1.03; 95% CI, 0.97, 1.08, P = 0.358). In conclusion, this study found little evidence for treatment effect variability in brain stimulation, suggesting that the need for personalized or stratified medicine is still an open question

Pleural Effusion Secondary to Multiple Myeloma: Is Daratumumab an Effective Treatment? A Case Report

Extramedullary (EM) plasmacytoma disease is an aggressive presentation at diagnosis and relapse for multiple myeloma (MM) patients. EM plasmacytoma is divided into two groups: the first group comprises tumors that extend directly from osteolytic bone lesions, while the second results from plasmacytoma infiltration into soft tissues, with no relation to the bone. Despite new therapies and monoclonal antibodies, the survival for patients with EM plasmacytoma is poor. The involvement of pleural effusion is uncommon in multiple myeloma

Context-dependent foraging habitat selection in a farmland raptor along an agricultural intensification gradient

Gradients of agricultural intensification in agroecosystems may determine uneven resource availability for predators relying on these man-made habitats. In turn, these variations in resource availability may affect predators’ habitat selection patterns, resulting in context-dependent habitat selection. We assessed the effects of gradients of landscape composition and configuration on habitat selection of a colonial farmland bird of prey, the lesser kestrel (Falco naumanni), relying on 76 GPS-tracked nestling-rearing individuals from 10 populations scattered along an agricultural intensification gradient. Analyses were conducted considering two ecological levels of aggregation (the population and the individual) and two spatial scales of habitat availability (the colony surroundings and the individual home-range). Overall, non-irrigated croplands and semi-natural grasslands were the most preferred habitats at both spatial scales. At the colony scale, lesser kestrels showed a preference for grassland compared to non-irrigated crops, whereas the opposite was the case within individual home-ranges. Conversely, croplands were positively selected with comparable intensity at both spatial scales. Strong selection for grassland at the colony scale highlights the importance of this semi-natural habitat for the species. The weaker preference for grassland at the home-range scale is likely due to the phenology and structure of the vegetation in the late breeding season. Spatial scale differences in selection patterns may thus derive from spatiotemporal changes in resource availability through the breeding season. The strength of selection for the two most used habitats varied markedly among individuals. At the spatial scale of the colony, individual selection strength for grasslands increased with decreasing compositional diversity of the surrounding landscape, suggesting that agroecosystem heterogeneity may at least partly buffer the loss of semi-natural habitats. At the within homerange scale, higher cropland availability reduced the strength of individual preference for this habitat, suggesting a negative functional response possibly related to density-dependent processes acting on foraging movements. Our study provides evidence that farmland species show context-dependent habitat selection patterns in response to landscape gradients shaped by agricultural intensification as well as by intrinsic characteristics and habitat availability. Our findings highlight the importance of addressing both individual and population-level variability and considering multiple spatial scales in studies of habitat selection to inform species’ management and conservation

Year-round variation in the isotopic niche of Scopoli's shearwater (Calonectris diomedea) breeding in contrasting sea regions of the Mediterranean Sea

Top marine predators are key components of marine food webs. Among them, long-distance migratory seabirds, which travel across different marine ecosystems over the year, may experience important year-round changes in terms of oceanographic conditions and availability of trophic resources. We tested whether this was the case in the Scopoli’s shearwater (Calonectris diomedea), a trans-equatorial migrant and top predator, by sampling birds breeding in three environmentally different regions of the Mediterranean Sea. The analysis of positional data and stable isotopes (δ13 C and δ15N) of target feathers revealed that birds from the three regions were spatially segregated during the breeding period while they shared non-breeding areas in the Atlantic Ocean. Isotopic baseline levels of N and C (meso-zooplankton) were significantly different among marine regions during breeding. Such variation was reflected at the higher trophic levels of pelagic and demersal fish muscles as well as in shearwater feathers grown in the Mediterranean. δ15N- and δ13C-adjusted values of shearwaters were significantly different among populations suggesting that birds from different breeding areas relied on prey species from different trophic levels. Conversely, the non-breeding spatial and isotopic niches overlapped greatly among the three populations. Shearwater trophic niches during breeding were narrower and segregated compared to the non-breeding period, revealing a high plasticity in trophic resource use. Overall, this study highlights seasonal and region-specific use of trophic resources by Scopoli’s shearwater, suggesting a broad trophic plasticity and possibly a high adaptability to environmental changes.Fundação para a Ciência e Tecnologia - FCTinfo:eu-repo/semantics/publishedVersio

Methods to detect spatial biases in tracking studies caused by differential representativeness of individuals, populations and time

Este artículo contiene 20 páginas, 6 figuras, 4 tablas.Aim: Over the last decades, the study of movement through tracking data has grown exceeding the expectations of movement ecologists. This has posed new challenges, specifically when using individual tracking data to infer higher- level distributions (e.g. population and species). Sources of variability such as individual site fidelity (ISF), en-vironmental stochasticity over time, and space-use variability across species ranges must be considered, and their effects identified and corrected, to produce accurate estimates of spatial distribution using tracking data. Innovation: We developed R functions to detect the effect of these sources of vari-ability in the distribution of animal groups when inferred from individual tracking data. These procedures can be adapted for their use in most tracking datasets and tracking techniques. We demonstrated our procedures with simulated datasets and showed their applicability on a real-world dataset containing 1346 year- round migratory trips from 805 individuals of three closely related seabird species breeding in 34 colonies in the Mediterranean Sea and the Atlantic Ocean, spanning 10 years. We detected an effect of ISF in one of the colonies, but no effect of the environmental stochasticity on the distribution of birds for any of the species. We also identified among-colony variability in nonbreeding space use for one species, with significant effects of popu-lation size and longitude. Main conclusions: This work provides a useful, much- needed tool for researchers using animal tracking data to model species distributions or establish conservation measures. This methodology may be applied in studies using individual tracking data to accurately infer the distribution of a population or species and support the deline-ation of important areas for conservation based on tracking data. This step, designed to precede any analysis, has become increasingly relevant with the proliferation of studies using large tracking datasets that has accompanied the globalization process in science driving collaborations and tracking data sharing initiatives.We thank the following institutions for funding: EU H2020 pro-gramme through grant 634495; Seventh Framework Programme (Research Executive Agency) through Marie Curie Career Integration Grant 618841 (FP7-PEOPLE-2013- CIG); ESFRI LifeWatch Project; LIFE programme of the European Commission through projects LIFE10 NAT/MT090 and LIFE11 NAT/IT/000093; Ministerio de Ciencia e Innovación/Ministerio de Economia y Competitividad (Spain) through projects CGL2009- 11278/BOS, CGL2013-42585-P, C G L 2 0 1 3 - 4 2 2 0 3 - R , C G L 2 0 16 - 7 8 5 3 0 - R a n d C G L 2 0 17- 8 52 10 - P ; Organismo Autónomo de Parques Nacionales (Spain) through pro-ject 1248/2014; Fundação para a Ciência e a Tecnologia (MCTES, Portugal) through projects MARE-UID/MAR/04292/2019; IF/00502/2013/CP1186/CT0003, PTDC/BIA-ANM/3743/2014, PTDC/MAR-PRO/0929/2014, UID/AMB/50017/2019 and UIDP/50017/2020 + UIDB/50017/2020 (to CESAM); Office Français de la Biodiversité (France), through the Programme PACOMM, Natura2000 en mer; Hellenic Bird Ringing Centre; MSDEC (Malta). VMP was supported by pre-doctoral contract BES-2014- 068025 of the Spanish Ministerio de Industria, Economía y Competitividad; MM by grant SFRH/BPD/47047/2008 from the Portuguese Foundation for Science and Technology; JMRG by Ph.D. grant AP2009-2163 from the Spanish Ministerio de Educación; GDO and MMü by Ornis italica and by the Regione Siciliana and Assessorato Risorse Agricole e Alimentari thoriugh a grant to the Ringing Unit of Palermo; VHP by grant SFRH/BPD/85024/2012 from the Portuguese Foundation for Science and Technology; VN by grant SFRH/BPD/88914/2012 from the Portuguese Foundation for Science and Technology; and JN by the Spanish National Programme Ramón y Cajal (RYC-2015- 17809); GK and SX were partially funded by the Operational Program “Environment and Sustainable Development” (EPPERAA) of the National Strategic Reference Framework (NSRF) 2007-2013, co- financed by the ERDF and Greek EDP; FdF by a Ph.D. grant from the Coordination for the Improvement of Higher Education Personnel (CAPES—Brazilian government agency; Bex Process 1307/13-4); ZZ by a PhD grant from the University of Barcelona (APIF/2012); MCF by a PhD grant from the University of Barcelona; and RR by post-doctoral contracts of the PLEAMAR programme from MINECO and Fundación Biodiversidad (2017/2349), and Ministerio de Ciencia, in-novación y Universidades (RYC-2017- 22055). This publication is part of the project I+D+i/PID2020-117155GB-I00, funded by MCIN/ AEI/10.13039/501100011033.Peer reviewe