Massive retroperitoneal hematoma caused by intercostal artery bleeding after blunt trauma

Massive retroperitoneal hematoma caused by intercostal artery bleeding after blunt trauma

Fuente:Journal of Cardiothoracic Surgery

Tipo de trabajo:Caso clínico

Extracto: The possibility of intercostal artery rupture should be considered in cases of retroperitoneal hematomas, and accurate diagnosis can be achieved through imaging studies. Transcatheter arterial embolization represents an effective treatment modality.

Claves:Intercostal artery, Retroperitoneal hematoma, Transcatheter arterial embolization, Trauma

Cita:J Cardiothorac Surg 2024 Apr 18; 19 (1) : 248.

Autor/es:Zhu, Ran (a)
Liu, Xiangtian (b)

institución:(a) Department of Intensive Care Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
(b) Department of Intensive Care Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1186/s13019-024-02739-2

Landscapes of gut bacterial and fecal metabolic signatures and their relationship in severe preeclampsia.

Landscapes of gut bacterial and fecal metabolic signatures and their relationship in severe preeclampsia.

Fuente:Journal of Translational Medicine

Extracto: Our research indicates that changes in metabolites, possibly due to the gut microbe Limosilactobacillus fermentum, can contribute to the development of severe preeclampsia. This study provides insights into the interaction between gut microbiome and fecal metabolites and offers a basis for improving severe preeclampsia by modulating the gut microbiome.

Claves:Biomarkers, Fecal metabolome, Gut microbiome, Metagenomic sequencing, Severe preeclampsia

Cita:J Transl Med 2024 Apr 17; 22 (1) : 360.

Autor/es:Liu, Xianxian (a)
Zeng, Xiaoming (b)

institución:(a) Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.
(b) Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, 330006, China.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1186/s12967-024-05143-5

Prevalence of diverse colorectal polyps and risk factors for colorectal carcinoma in situ and neoplastic polyps.

Fuente:Journal of Translational Medicine

Extracto: More than 3/4 of colorectal polyp patients have neoplastic polyps. Patients are more inclined to develop CCS and neoplastic polyps if they have large polyps (> 1.0 cm) or multifocal polyps. The levels of the tumor markers CA724 and CA211 show some potential usefulness for predicting CCS and may be exploited for early identification of high-risk populations.

Claves:Colorectal carcinoma in situ, Colorectal polyps, Neoplastic polyps, Prevalence, Tumor markers

Cita:J Transl Med 2024 Apr 17; 22 (1) : 361.

Autor/es:Li, Xiaojuan (a)
Hu, Mengting (b)

institución:(a) Department of Gastroenterology, Minhang Hospital, Fudan University, Shanghai, 201199, China.
(b) Department of General Medicine, Minhang Hospital, Fudan University, Shanghai, 201199, China.

Conflicto:The authors have declared that no conflict of interest exists.

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1186/s12967-024-05111-z

Effect of preoperative immunonutrition on postoperative short-term clinical outcomes in patients with gastric cancer cachexia: a prospective randomized controlled trial.

Effect of preoperative immunonutrition on postoperative short-term clinical outcomes in patients with gastric cancer cachexia: a prospective randomized controlled trial.

Fuente:World Journal of Surgical Oncology

Tipo de trabajo:Estudio aleatorizado y controlado

Extracto: Preoperative administration of immunonutrition formula has a positive impact on the incidence of infectious complications in patients with gastric cancer cachexia after surgery. It improves patients' inflammatory and immune status, shortens hospital stays, and reduces healthcare costs. Preoperative use of immunonutrition may contribute to the improvement of prognosis in this high-risk population.

Claves:Cancer cachexia, Enteral nutrition, Gastric cancer, Immunonutrition, Preoperative intervention

Cita:World J Surg Oncol 2024 Apr 17; 22 (1) : 101.

Autor/es:Yu, Junjian (a)
Yuan, Antai (b)

institución:(a) Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China.
(b) Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1186/s12957-024-03348-y

Prevalence of autoimmune thyroiditis among children with autoimmune hepatitis.

Prevalence of autoimmune thyroiditis among children with autoimmune hepatitis.

Fuente:Italian Journal of Pediatrics

Extracto: Autoimmune hepatitis in Egyptian children is commonly associated with other autoimmune diseases. Autoimmune thyroiditis is the most common to be associated with AIH in pediatric patients. As it is not usually clinically manifesting, regular screening for AIT in children with AIH is mandatory.

Claves:Autoimmune diseases, Autoimmune hepatitis, Autoimmune thyroiditis, Children

Cita:Ital J Pediatr 2024 Apr 18; 50 (1) : 72.

Autor/es:Mogahed, Engy Adel (a)
Soliman, Hend M (b)

institución:(a) Department of Pediatrics, New Children Hospital, Cairo University, Cairo, Egypt.
(b) Department of Pediatrics, New Children Hospital, Cairo University, Cairo, Egypt.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1186/s13052-024-01639-4

Single-cell transcriptomics dissects the transcriptome alterations of hematopoietic stem cells in myelodysplastic neoplasms.

Single-cell transcriptomics dissects the transcriptome alterations of hematopoietic stem cells in myelodysplastic neoplasms.

Fuente:Journal of Translational Medicine

Extracto: This study revealed the transcriptomic change of HSPCs in MDS patients along the pseudotime and indicated that PLCB1 plays a key role in the transformation of MDS into leukemia.

Claves:Hematopoietic stem cells, Leukemic transformation, Myelodysplastic neoplasms, Transcriptome alterations

Cita:J Transl Med 2024 Apr 17; 22 (1) : 359.

Autor/es:Zeng, Xiangzong (a)
Wang, Yichen (b)

institución:(a) Department of Hematology, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, 511518, China.
(b) Division of Gastroenterology, Institute of Digestive Disease, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, 511518, China.

Conflicto:All authors in this article declare that they have no conflict of interest.

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1186/s12967-024-05165-z

Four-year follow-up of psychiatric and psychosomatic profile in patients with Inflammatory Bowel Disease (IBD).

Four-year follow-up of psychiatric and psychosomatic profile in patients with Inflammatory Bowel Disease (IBD).

Fuente:Bmc Psychology

Extracto: Moreover, since psychosomatic syndromes represent vulnerability factors of diseases, further studies should target subgroups of patients presenting with persistent psychosomatic syndromes and worse course of the disease.

Claves:Diagnostic Criteria for Psychosomatic Research (DCPR), Inflammatory Bowel Disease (IBD), Lifestyle behaviors, Psychiatric diagnoses, Psychological well-being, Psychosomatic syndromes

Cita:BMC Psychol 2024 Apr 17; 12 (1) : 211.

Autor/es:Gostoli, Sara (a)
Ferrara, Francesco (b)

institución:(a) Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy.
(b) Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Bologna, Italy.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1186/s40359-024-01726-5

An early-onset specific polygenic risk score optimizes age-based risk estimate and stratification of prostate cancer

An early-onset specific polygenic risk score optimizes age-based risk estimate and stratification of prostate cancer

Fuente:Journal of Translational Medicine

Tipo de trabajo:Estudio de cohortes

Extracto: This study comprehensively profiled the distinct genetic and phenotypic architecture of EOPC. The EOPC-PRS may optimize risk estimate of PCa in young males, particularly those without family history, thus providing guidance for precision population stratification.

Claves:Age-specific genome-wide association studies, Early-onset prostate cancer, Phenome-wide association studies, Polygenic risk score, UK biobank

Cita:J Transl Med 2024 Apr 17; 22 (1) : 366.

Autor/es:Cheng, Yifei (a)
Wu, Lang (b)

institución:(a) Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Department of Environmental Genomics, School of Public Health, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
(b) The Key Laboratory of Modern Toxicology of Ministry of Education, Department of Genetic Toxicology, School of Public Health, Center for Global Health, Nanjing Medical University, Nanjing, China.

Conflicto:L.W. provided consulting service to Pupil Bio lnc. and reviewed manuscripts for Gastroenterology Report, not related to this study, and received honorarium. Other authors have no relevant financial or non-financial interests to disclose.

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1186/s12967-024-05190-y

Proton pump inhibitors increase the risk of carbapenem-resistant Enterobacteriaceae colonization by facilitating the transfer of antibiotic resistance genes among bacteria in the gut microbiome.

Proton pump inhibitors increase the risk of carbapenem-resistant Enterobacteriaceae colonization by facilitating the transfer of antibiotic resistance genes among bacteria in the gut microbiome.

Fuente:Gut Microbes

Extracto: Based on these findings, improved stewardship of PPIs as well as antibiotics can provide strategies to reduce the risk of CRE colonization, thereby potentially improving patient prognosis.

Claves:Carbapenem-resistant enterobacteriaceae, antibiotic resistance gene, gut microbiome, metagenome-assembled genome, proton pump inhibitors

Cita:Gut Microbes 2024 Jan-Dec; 16 (1) : 2341635.

Autor/es:Lee, Imchang (a)
Jo, Jae-Won (b)

institución:(a) Department of Life Science, Multidisciplinary Genome Institute, Hallym University, Chuncheon, Republic of Korea.
(b) The Korean Institute of Nutrition, Hallym University, Chuncheon, Republic of Korea.

Conflicto:No potential conflict of interest was reported by the author(s).

Formato:Informe impreso

Idioma:Inglés

País de fuente:EE.UU.

Sitio web:http://dx.doi.org/10.1080/19490976.2024.2341635

Publication authorship: A new approach to the bibliometric study of scientific work and beyond.

Publication authorship: A new approach to the bibliometric study of scientific work and beyond.

Fuente:Plos One

Extracto: Beyond this finding, publication authorship lends itself to other types of documents such as corporate reports or meeting minutes to study organizations, movements, or any other concerted activity.

Cita:PLoS One 2024; 19 (4) : e0297005.

Autor/es:Beyond this finding, publication authorship lends itself to other types of documents such as corporate reports or meeting minutes to study organizations, movements, or any other concerted activity.

institución:Beyond this finding, publication authorship lends itself to other types of documents such as corporate reports or meeting minutes to study organizations, movements, or any other concerted activity.

Conflicto:The author has declared that no competing interests exist.

Formato:Informe virtual

Idioma:Inglés

País de fuente:EE.UU.

Sitio web:http://dx.doi.org/10.1371/journal.pone.0297005

Protocol for a phase II study to evaluate the efficacy and safety of nivolumab as a postoperative adjuvant therapy for patients with esophageal cancer treated with preoperative docetaxel, cisplatin plus 5-fluorouracil treatment (PENTAGON trial).

Fuente:Plos One

Tipo de trabajo:Estudio aleatorizado y controlado

Extracto: Therefore, developing an effective postoperative adjuvant therapy has been essential for improving oncological outcomes.

Cita:PLoS One 2024; 19 (4) : e0299742.

Autor/es:Goto, Hironobu (a)
Oshikiri, Taro (b)

institución:(a) Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan.
(b) Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:EE.UU.

Sitio web:http://dx.doi.org/10.1371/journal.pone.0299742

Protocol of a pilot randomized clinical trial to evaluate nutritional support and rehabilitation on prevention of skeletal muscle mass loss during neoadjuvant chemotherapy in patients with esophageal cancer.

Fuente:Plos One

Tipo de trabajo:Estudio abierto

Extracto: The results will be utilized in assessing whether the effects of nutritional support by ISOCAL Clear are promising or not and in planning future larger clinical trials.

Cita:PLoS One 2024; 19 (4) : e0302003.

Autor/es:Miki, Yuichiro (a)
Nishi, Satoshi (b)

institución:(a) Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
(b) Department of Surgery, Fuchu Hospital, Osaka, Japan.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:EE.UU.

Sitio web:http://dx.doi.org/10.1371/journal.pone.0302003

Ovarian serous carcinoma with stomach metastasis

Ovarian serous carcinoma with stomach metastasis

Fuente:The Journal of International Medical Research

Tipo de trabajo:Revisión

Extracto: Clinicians must approach this comprehensively, relying on thorough evaluation and personal experience.

Claves:Ovarian cancer, case report, chemotherapy, gastric metastasis, gastroscopy, ovarian serous carcinoma

Cita:J Int Med Res 2024 Apr; 52 (4) : 3000605241245000.

Autor/es:Hu, Jia-Li (a)
Guo, Zhao-Jiao (b)

institución:(a) Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China.
(b) Department of Oncology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China.

Conflicto:Declaration of conflicting interestsThe authors declare that there is no conflict of interest.

Formato:Informe impreso

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1177/03000605241245000

Polygenic Risk Score Predicts Earlier-Onset Adult Systemic Lupus Erythematosus and First-Year Renal Diseases in a Taiwanese Cohort.

Polygenic Risk Score Predicts Earlier-Onset Adult Systemic Lupus Erythematosus and First-Year Renal Diseases in a Taiwanese Cohort.

Fuente:Rmd Open

Extracto: PRS of SLE is associated with earlier onset, renal involvement within the first year of SLE diagnosis and seropositivity in Taiwanese patients. Integrating PRS with clinical decision-making may enhance lupus nephritis screening and early treatment to improve renal outcomes in patients with SLE.

Claves:Lupus Nephritis, Polymorphism, Genetic, Systemic Lupus Erythematosus

Cita:RMD Open 2024 Apr 18; 10 (2)

Autor/es:Chen, Yen-Ju (a)
Hsiao, Tzu-Hung (b)

institución:(a) Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
(b) Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1136/rmdopen-2023-003293

An esophagus cell atlas reveals dynamic rewiring during active eosinophilic esophagitis and remission.

An esophagus cell atlas reveals dynamic rewiring during active eosinophilic esophagitis and remission.

Fuente:Nature Communications

Extracto: These cellular alterations in EoE and remission advance our understanding of eosinophilic inflammation and opportunities for therapeutic intervention.

Cita:Nat Commun 2024 Apr 18; 15 (1) : 3344.

Autor/es:Ding, Jiarui (a)
Garber, John J (b)

institución:(a) Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.
(b) Department of Computer Science, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.

Conflicto:R.J.X. is a co-founder of Jnana Therapeutics and Celsius Therapeutics, a scientific advisory board member at Nestlé, and board director at MoonLake Immunotherapeutics; these organizations had no roles in this study. A.R. is a founder and equity holder of Celsius Therapeutics, is an equity holder in Immunitas Therapeutics, and, until 31 August 2020, was a scientific advisory board member of... f Syros Pharmaceuticals, Neogene Therapeutics, Asimov, and ThermoFisher Scientific. Since 1 August 2020, A.R. has been an employee of Genentech, a member of the Roche Group, with equity in Roche. K.S. is a consultant to Sanofi. All other authors declare no competing interests.

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1038/s41467-024-47647-0

Drug repurposing for cancer therapy.

Fuente:Signal Transduction and Targeted Therapy

Tipo de trabajo:Revisión

Extracto: To conclude, we outline the challenges associated with repurposing drugs and consider the future prospects of these repurposed drugs transitioning into clinical application.

Cita:Signal Transduct Target Ther 2024 Apr 19; 9 (1) : 92.

Autor/es:Xia, Ying (a)
Sun, Ming (b)

institución:(a) Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, PR China.
(b) The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550001, PR China.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1038/s41392-024-01808-1

Development and validation of a nomogram to predict cancer-specific survival of elderly patients with unresected gastric cancer who received chemotherapy.

Development and validation of a nomogram to predict cancer-specific survival of elderly patients with unresected gastric cancer who received chemotherapy.

Fuente:Scientific Reports

Extracto: This nomogram created to predict the CSS of elderly patients with unresected GC who have received chemotherapy could significantly enhance treatment accuracy.

Claves:Chemotherapy, Elderly patients, Gastric cancer, Nomogram, SEER database

Cita:Sci Rep 2024 Apr 19; 14 (1) : 9008.

Autor/es:Wang, Qi (a)
Shen, Kexin (b)

institución:(a) Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
(b) Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1038/s41598-024-59516-3

Mechanoelectronic stimulation of autologous extracellular vesicle biosynthesis implant for gut microbiota modulation.

Mechanoelectronic stimulation of autologous extracellular vesicle biosynthesis implant for gut microbiota modulation.

Fuente:Nature Communications

Extracto: This in vivo controllable extracellular vesicles-produced system holds promise as platform to treat various other diseases.

Cita:Nat Commun 2024 Apr 18; 15 (1) : 3343.

Autor/es:Wan, Shuangshuang (a)
Wang, Kepeng (b)

institución:(a) State Key Laboratory of Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 210023, Nanjing, China.
(b) State Key Laboratory of Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 210023, Nanjing, China.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1038/s41467-024-47710-w

Fourteen-day vonoprazan-based bismuth quadruple therapy for H. pylori eradication in an area with high clarithromycin and levofloxacin resistance: a prospective randomized study (VQ-HP trial).

Fourteen-day vonoprazan-based bismuth quadruple therapy for H. pylori eradication in an area with high clarithromycin and levofloxacin resistance: a prospective randomized study (VQ-HP trial).

Fuente:Scientific Reports

Extracto: pylori eradication in areas with high levels of dual clarithromycin and levofloxacin resistance.

Cita:Sci Rep 2024 Apr 18; 14 (1) : 8986.

Autor/es:Tungtrongchitr, Nuttapat (a)
Bongkotvirawan, Phubordee (b)

institución:(a) Ramathibodi Medical School, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, 10540, Thailand.
(b) Department of Medicine, Faculty of Medicine, Center of Excellence in Digestive Diseases and Gastroenterology Unit, Thammasat University, Pathum Thani, 12120, Thailand.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1038/s41598-024-59621-3

Positive effect of deep diaphragmatic breathing training on gastroesophageal reflux-induced chronic cough: a clinical randomized controlled study.

Positive effect of deep diaphragmatic breathing training on gastroesophageal reflux-induced chronic cough: a clinical randomized controlled study.

Fuente:Respiratory Research

Tipo de trabajo:Estudio clínico

Extracto: DEP training can improve cough symptoms as an adjunctive treatment in GERC patients. TRIAL REGISTRATION: The protocol was registered in February 2, 2022 via the Chinese Clinical Trials Register ( http://www.chictr.org.cn/ ) [ChiCTR2200056246].

Claves:Chronic cough, Deep diaphragmatic breathing training, Diaphragm, Gastroesophageal reflux, Non-pharmacological treatment

Cita:Respir Res 2024 Apr 18; 25 (1) : 169.

Autor/es:Niu, Shanshan (a)
Zhang, Tongyangzi (b)

institución:(a) Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065, China.
(b) Department of Oncology, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.

Conflicto:Los autores declaran no tener conflictos de interés con la investigación

Formato:Informe virtual

Idioma:Inglés

País de fuente:Reino Unido

Sitio web:http://dx.doi.org/10.1186/s12931-024-02783-5