The Effect of Losing the Twin and Losing the Partner on Mortality

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Liability and Medico-Legal Implications in Estimating the Likelihood of Having Attained 14 Years of Age in Pediatric Clinical Practice: A Pilot Study

Accurate methods of age estimation are more essential than ever due to the rise in undocumented individuals without proper identification, often linked to illegal immigration and criminal activities. This absence of reliable records presents challenges within the legal systems, where age thresholds in the context of children’s rights vary across countries. Age 14 has global significance, as established by the UN Convention on the Rights of the Child and the EU for administrative purposes. Accurate age estimation is crucial in medical decisions, reproductive health, and forensics. This study focuses on age estimation via dental of having attained the age of 14. Orthopantomograms were analyzed from two samples, 191 Italian children (aged 5–15) and 822 Chilean subjects (aged 11–22), using dental maturity indices. These indices evaluated open tooth apices and complete root development. Statistical analysis confirmed the method’s reliability in identifying individuals aged 14 or older, with sex-specific cut-offs. The proposed method particularly advocates an approach based on dental mineralization, which could surpass those relying on bone growth. The collaboration between medical experts, including pediatricians and diagnostic imaging specialists, is vital for standardized age estimation strategies. Ethical concerns regarding radiation exposure and accountability are recognized, although the method’s low radiation doses are deemed acceptable. The proposed method will help health professionals to accurately predict whether or not the 14-year threshold has been reached, opening up new avenues of medico-legal interest and laying the foundations for a legal framework that would allow the pediatrician, when involved, to use a valid and recognize

Diferencias relacionadas con el sexo en pacientes con IAMCEST: análisis por puntuación de propensión

Supplementary data associated with this article can be found in the online version available at https://doi.org/ 10.24875/RECICE.M19000061.[EN] Introduction and objectives: Female sex is believed to be a significant risk factor for mortality among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (pPCI). Methods: We collected data on all consecutive STEMI patients treated with pPCI within 12 hours and compared the males vs the females. The primary endpoint was long-term mortality one month after hospital discharge. The secondary endpoint was 30-days mortality. Results: From March 2006 to December 2016, 1981 patients underwent pPCI at our hospital, 484 (24.4%) were females. Compared with men, women were older (mean age 71.3 ± 11.6 vs 62.9 ± 11.8 years, P < .001), less smokers (26.7% vs 72.7%; P < .001), more diabetic (28.0% vs 22.3%; P < .002), more hypertensive (69.6% vs 61.3%; P < .001), presented more often with shock at baseline (13.2% vs 9.0%; P = .006), had longer symptoms-to-balloon time frames (5.36 ± 3.97 vs 4.47 ± 3.67 hours; P < .001). Also, women were less likely to receive glycoprotein IIb-IIIa inhibitors (59.5% vs 71.4%; P < .001) and stents (79.5% vs 86.6%; P = .01). During the 30-day and long-term follow-up (mean 4.9 ± 3.2 years) the female sex was associated with a higher mortality rate (8.9% vs 4.0%, P < .001 and 23.8% vs 18.4%, P = .01, respectively). After propensity score matching, 379 men and 379 women were selected. Female sex continued to be associated with a higher death rate at 30 days (9.5% vs 5.5%; P = .039) but not in the long term among survivors (25.6% vs 21.4%; P = .170). Conclusions: Compared to men, women with STEMI undergoing pPCI had higher 30-day mortality rates. However, among survivors, the long-term mortality rate was similar. Even if residual confounding cannot be ruled out, this difference in the outcomes may be partially explained by biological sex-related differences.[ES]Introducción y objetivos: El sexo femenino se considera un importante factor de riesgo de mortalidad en el infarto agudo de miocardio con elevación del segmento ST (IAMCEST) tratado con intervención coronaria percutánea primaria (ICPp). Métodos: Se analizó a todos los pacientes consecutivos con IAMCEST tratados con ICPp dentro de las primeras 12 horas, y se compararon varones y mujeres. El objetivo principal fue la mortalidad a largo plazo en los supervivientes después del primer mes del alta, y el objetivo secundario fue la mortalidad a los 30 días. Resultados: Desde marzo de 2006 hasta diciembre de 2016 se trató con ICPp 1.981 a pacientes, de los cuales 484 (24,4%) eran mujeres. En comparación con los varones, las mujeres tenían mayor edad (edad media 71,3 ± 11,6 frente a 62,9 ± 11,8 años, p < 0,001) y la frecuencia de fumadoras era más baja (26,7 frente a 72,7%; p < 0,001), mientras que era más alta la frecuencia de diabetes (28,0 frente a 22,3%; p < 0,002), hipertensión arterial (69.6 frente a 61,3%, p < 0,001) y shock al ingreso (13,2 frente a 9,0%; p = 0,006), y más largo el tiempo desde el comienzo de los síntomas hasta la intervención con balón (5,36 ± 3,97 frente a 4,47 ± 3,67 horas; p < 0,001). Además, la frecuencia de tratamiento con inhibidores de la glucoproteína IIb-IIIa (59,5 frente a 71,4%; p < 0,001) y stent (79,5 frente a 86,6%, p = 0,01) fue inferior. Tanto a los 30 días como a largo plazo (media 4,9 ± 3,2 años), el sexo femenino se asoció con una mortalidad más alta (8,9 frente a 4,0%, p < 0,001, y 23,8 frente a 18,4%, p = 0,01, respectivamente). Se seleccionaron 379 mujeres y 379 varones emparejados por puntuación de propensión. Se mantuvo la asociación entre sexo femenino y mayor mortalidad a los 30 días (9,5 frente a 5,5%; p = 0,039), pero no a largo plazo (25,6 frente a 21,4%; p = 0,170). Conclusiones: En comparación con los varones, las mujeres con IAMCEST tratadas con ICPp tuvieron mayor mortalidad a los 30 días. Sin embargo, entre los supervivientes, la mortalidad a largo plazo fue similar. Aunque no puede descartarse el efecto de variables residuales de confusión, las diferencias en el pronóstico podrían explicarse en parte por diferencias biológicas relacionadas con el sexo.S

AUTONOMOUS SYSTEMS & SAFETY ISSUES: THE ROADMAP TO ENABLE NEW ADVANCES IN INDUSTRIAL APPLICATIONS

The paper addresses the safety issues related to the development of new solutions based on autonomous systems for industrial applications and the necessity to develop experimental environments for investigating these cases; a set of examples is proposed in order to provide cases and challenges as well as to suggest approaches to address these problems

Determinants of radiation dose during right transradial access. insights from the RAD-MATRIX study

Background The RAD-MATRIX trial reported a large operator radiation exposure variability in right radial percutaneous coronary procedures. The reasons of these differences are not well understood. Our aim was to appraise the determinants of operator radiation exposure during coronary right transradial procedures. Methods Patient arrangement during transradial intervention was investigated across operators involved in the RAD-MATRIX trial. Operator radiation exposure was analyzed according to the position of the patient right arm (close or far from the body) and in relation to the size of the upper leaded glass. Results Among the 14 operators who agreed to participate, there was a greater than 10-fold difference in radiation dose at thorax level (from 21.5 to 267 μSv) that persisted after normalization by dose-area product (from 0.35 to 3.5 μSv/Gy*cm2). Among the operators who positioned the instrumented right arm far from the body (110.4 μSv, interquartile range 71.5-146.5 μSv), thorax dose was greater than that in those who placed the instrumented arm close to the right leg (46.1 μSv, 31.3-56.8 μSv, P =.02). This difference persisted after normalization by dose-area product (P =.028). The use of a smaller full glass shield was also associated with a higher radiation exposure compared with a larger composite shield (147.5 and 60 μSv, respectively, P =.016). Conclusions In the context of the biggest radiation study conducted in patients undergoing transradial catheterization, the instrumented right arm arrangement close to the leg and greater upper leaded shield dimensions were associated with a lower operator radiation exposure. Our findings emphasize the importance of implementing simple preventive measures to mitigate the extra risks of radiation exposure with right radial as compared with femoral access

Pre-transplant CD69+ extracellular vesicles are negatively correlated with active ATLG serum levels and associate with the onset of GVHD in allogeneic HSCT patients

Graft versus host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (HSCT). Rabbit anti-T lymphocyte globulin (ATLG) in addition to calcineurin inhibitors and antimetabolites is a suitable strategy to prevent GVHD in several transplant settings. Randomized studies already demonstrated its efficacy in terms of GVHD prevention, although the effect on relapse remains the major concern for a wider use. Tailoring of ATLG dose on host characteristics is expected to minimize its side effects (immunological reconstitution, relapse, and infections). Here, day -6 to day +15 pharmacokinetics of active ATLG serum level was first assayed in an explorative cohort of 23 patients by testing the ability of the polyclonal serum to bind antigens on human leukocytes. Significantly lower levels of serum active ATLG were found in the patients who developed GVHD (ATLG_AUC(CD45): 241.52 +/- 152.16 vs. 766.63 +/- 283.52 (mu g*day)/ml, p = 1.46e(-5)). Consistent results were obtained when the ATLG binding capacity was assessed on CD3+ and CD3+/CD4+ T lymphocytes (ATLG_AUC(CD3): 335.83 +/- 208.15 vs. 903.54 +/- 378.78 (mu g*day)/ml, p = 1.92e(-4); ATLG_AUC(CD4): 317.75 +/- 170.70 vs. 910.54 +/- 353.35 (mu g*day)/ml, p = 3.78e(-5). Concomitantly, at pre-infusion time points, increased concentrations of CD69+ extracellular vesicles (EVs) were found in patients who developed GVHD (mean fold 9.01 +/- 1.33; p = 2.12e(-5)). Consistent results were obtained in a validation cohort of 12 additional ATLG-treated HSCT patients. Serum CD69+ EVs were mainly represented in the nano (i.e. 100 nm in diameter) EV compartment and expressed the leukocyte marker CD45, the EV markers CD9 and CD63, and CD103, a marker of tissue-resident memory T cells. The latter are expected to set up a host pro-inflammatory cell compartment that can survive in the recipient for years after conditioning regimen and contribute to GVHD pathogenesis. In summary, high levels of CD69+ EVs are significantly correlated with an increased risk of GVHD, and they may be proposed as a tool to tailor ATLG dose for personalized GVHD prevention

Randomized comparison of operator radiation exposure comparing transradial and transfemoral approach for percutaneous coronary procedures: Rationale and design of the minimizing adverse haemorrhagic events by TRansradial access site and systemic implementation of angioX - RAdiation Dose study (RAD-MATRIX)

Background: Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. Methods: The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimet

GENERALIZED AND SPECIFIC EMOTION IMPAIRMENTS AS POTENTIAL MARKERS OF SEVERITY IN OBSESSIVECOMPULSIVE DISORDER: A PRELIMINARY STUDY USING FACIAL ACTION CODING SYSTEM (FACS)

Background: The role of emotional deficits in the poor outcomes of patients with Obsessive-Compulsive Disorder (OCD) has been emphasized. Generalized and specific emotional abnormalities have been reported, often related to OCD severity and functional disabilities. The objective of the present study was to assess the abilities of experiencing and displaying emotions in OCD patients in response to specific stimuli in relation with the severity of their clinical condition. Subjects and methods: Thirty-six individuals participated in the study: 10 OCD patients with severe symptoms, 11 with mildmoderate symptoms, and 15 healthy controls. All participants watched emotion-eliciting video clips while their facial activity was videotaped. The congruent/incongruent feeling of emotions and the facial expression in reaction to emotions were evaluated. Results: The two subgroups of OCD patients presented similarly incongruent emotive feelings and facial expressions (significantly worse than healthy participants). Moreover, OCD patients with severe symptoms expressed the emotion of happiness and disgust significantly less appropriately than OCD patients with mild-moderate symptoms. Conclusions: The present data support the hypothesis that impaired emotional processing may: (i) represent a potential contributor to poor outcome in OCD; (ii) constitute a warning sign for clinicians to establish a more comprehensive protocol for more severe cases; (iii) influence therapeutic strategies used to treat this disorder