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Vehicle-to-Everything (V2X) communication, essential for enhancing road safety, driving efficiency, and traffic management, must be robust against cybersecurity threats for successful deployment and acceptance. This survey comprehensively explores V2X security challenges, focusing on prevalent cybersecurity threats such as jamming, spoofing, Distributed Denial of Service (DDoS), and eavesdropping attacks. These threats were selected due to their prevalence and ability to compromise the integrity and reliability of V2X systems. Jamming can disrupt communications, spoofing can lead to data and identity manipulation, DDoS attacks can saturate system resources, and eavesdropping can compromise user privacy and information confidentiality. Addressing these major threats ensures that V2X systems are robust and secure for successful deployment and widespread acceptance. This work makes significant contributions to the field of V2X cybersecurity, starting with a thorough review and categorization of existing survey papers, providing a clear map of the current research landscape, and identifying areas needing further study. An extensive review uncovered a global landscape of V2X cybersecurity research. We highlight contributions from the leading countries in scientific publications and patent innovations, with notable advancements from leading corporations. This work educates and informs on the current state of V2X cybersecurity and identifies emerging trends and future research directions based on a year-by-year analysis of the literature and patents. The findings underscore the evolving cybersecurity landscape in V2X systems and the importance of continued innovation and research in this critical field. The survey navigates the complexities of securing V2X communications, emphasizing the necessity for advanced security protocols and technologies, and highlights innovative approaches within the global scientific and patent research context. By providing a panoramic view of the field, this survey sets the stage for future advancements in V2X cybersecurity.

Otago Exercise Program (OEP) is a rehabilitation program for older adults to improve frailty, sarcopenia, and balance. Accurate monitoring of patient involvement in OEP is challenging, as self-reports (diaries) are often unreliable. The development of wearable sensors and their use in Human Activity Recognition (HAR) systems has lead to a revolution in healthcare. However, the use of such HAR systems for OEP still shows limited performance. The objective of this study is to build an unobtrusive and accurate system to monitor OEP for older adults. Data was collected from 18 older adults wearing a single waist-mounted Inertial Measurement Unit (IMU). Two datasets were recorded, one in a laboratory setting, and one at the homes of the patients. A hierarchical system is proposed with two stages: 1) using a deep learning model to recognize whether the patients are performing OEP or activities of daily life (ADLs) using a 10-minute sliding window; 2) based on stage 1, using a 6-second sliding window to recognize the OEP sub-classes. Results showed that in stage 1, OEP could be recognized with window-wise f1-scores over 0.95 and Intersection-over-Union (IoU) f1-scores over 0.85 for both datasets. In stage 2, for the home scenario, four activities could be recognized with f1-scores over 0.8: ankle plantarflexors, abdominal muscles, knee bends, and sit-to-stand. These results showed the potential of monitoring the compliance of OEP using a single IMU in daily life. Also, some OEP sub-classes are possible to be recognized for further analysis.

Resumo Fundamento A estratificação ode risco é uma importante etapa na avaliação perioperatória. No entanto, os principais escores de risco não incorporam biomarcadores em seus conjuntos de variáveis. Objetivo Avaliar o poder incremental da troponina à estratificação de risco tradicional. Métodos Um total de 2230 pacientes admitidos na unidade de terapia intensiva após cirurgia não cardíaca foram classificados de acordo com três tipos de risco: Risco Cardiovascular (RCV), Índice de Risco Cardíaco Revisado (IRCR), e Risco Inerente da Cirurgia (RIC). O principal desfecho foi mortalidade por todas as causas. A regressão de Cox foi usada, assim como a estatística C antes e após a adição de troponina ultrassensível (pelo menos uma medida até três dias após a cirurgia). Finalmente, o índice de reclassificação líquida e a melhoria de discriminação integrada foram usadas para avaliar o poder incremental da troponina para a estratificação de risco. O nível de significância usado foi de 0,05. Resultados A idade média dos pacientes foi 63,8 anos e 55,6% eram do sexo feminino. A prevalência de lesão miocárdica após cirurgia não cardíaca (MINS) foi 9,4%. Pacientes com um RCV elevado apresentaram uma maior ocorrência de MINS (40,1% x 24,8%, p

Pulmonary embolism (PE) is a pathological entity characterised by venous thromboembolism in the pulmonary arteries. It is a common entity in daily clinical practice and is the third most common cause of cardiovascular death. Correct diagnostic work-up is pivotal to ensure timely institution of appropriate therapy. This requires recognition of the characteristic imaging findings and awareness of the role and peculiarities of the different imaging techniques involved in the diagnostic and therapeutic process. This review aims to showcase the most commonly encountered imaging findings associated with pulmonary thromboembolism for each imaging modality, outline their advantages and disadvantages, and define the specific role of these techniques in the clinical setting. The latest innovations concerning the diagnostic work-up of PE will be also briefly discussed, yielding a perspective on the future developments and challenges that the radiologist will have to face in the coming years.

Abstract Background Focal cortical dysplasia (FCD) is a common cause of drug-resistant epilepsy. Electroencephalography (EEG) biomarkers that predict good postoperative outcomes are essential for identifying patients with focal epilepsies. Case presentation We report the case of a 21-year-old female with seizure onset at the age of 9, characterized by left-hand dystonic posturing and impaired awareness, which evolved to bilateral tonic-clonic seizures, evaluated in a neurological referral center in Lima, Peru. During 6-h video-EEG, interictal EEG revealing focal brief potentially ictal rhythmic discharges (BIRDs) over the right frontal central region, lasting less than 10 s. The ictal features were characterized by low-voltage fast activity over the same area. Brain magnetic resonance imaging (MRI) demonstrated a focal lesion of focal cortical dysplasia type II in the right frontal lobe. The patient underwent a lesionectomy guided by electrocorticography, which showed continuous polyspikes. BIRDs showing a brief burst of spikes lasting longer than 0.5 s, were also identified on intraoperative electrocorticography (ECoG) and helped define the extent of resection. The patient obtained an Engel Outcome Class IA at 6 years of follow-up. Conclusions The atypical BIRDs on ECoG can be used as a prognostic biomarker for prolonged seizure-freedom outcome in patients with epilepsy. Additional reports are needed in developing countries with and without brain MRI lesions to advance outpatient presurgical evaluations despite limited resources.

Abstract Lava overflows are highly hazardous phenomena that can occur at Stromboli. They can destabilize the crater area and the “Sciara del Fuoco” unstable slope, formed by several sector collapses, which can generate potentially tsunamigenic landslides. In this study, we have identified precursors of the October-November 2022 effusive crisis through seismic and thermal camera measurements. We analyzed the lava overflow on October 9, which was preceded by a crater-rim collapse, and the overflow on November 16. In both cases, seismic precursors anticipating the overflow onset have been observed. The analysis of the seismic and thermal data led to the conclusion that the seismic precursors were caused by an escalating degassing process from the eruptive vent, which climaxed with the overflows. Volcano deformation derived from ground-based InSAR and strainmeter data showed that inflation of the crater area accompanied the escalating degassing process up to the beginning of the lava overflows. The inflation of the crater area was especially evident in the October 9 episode, which also showed a longer seismic precursor compared to the November 16 event (58 and 40 min respectively). These results are important for understanding Stromboli’s eruptive mechanisms and open a perspective for early warning of potentially dangerous phenomena.

The Clinical Techniques, Imaging and Endoscopy Assembly is involved in the diagnosis and treatment of several pulmonary diseases, as demonstrated at the 2023 European Respiratory Society (ERS) International Congress in Milan, Italy. From interventional pulmonology, the congress included several exciting results for the use of bronchoscopy in lung cancer, including augmented fluoroscopy, robotic-assisted bronchoscopy and cryobiopsies. In obstructive lung disease, the latest results on bronchoscopic treatment of emphysema with hyperinflation and chronic bronchitis were presented. Research on using cryobiopsies to diagnose interstitial lung disease was further explored, with the aims of elevating diagnostic yield and minimising risk. For imaging, the latest updates in using artificial intelligence to overcome the increased workload of radiologists were of great interest. Novel imaging in sarcoidosis explored the use of magnetic resonance imaging, photon-counting computed tomography and positron emission tomography/computed tomography in the diagnostic work-up. Lung cancer screening is still a hot topic and new results were presented regarding incorporation of biomarkers, identifying knowledge gaps and improving screening programmes. The use of ultrasound in respiratory medicine is an expanding field, which was demonstrated by the large variety in studies presented at the 2023 ERS Congress. Ultrasound of the diaphragm in patients with amyotrophic lateral sclerosis and myasthenia gravis was used to assess movements and predict respiratory fatigue. Furthermore, studies using ultrasound to diagnose or monitor pulmonary disease were presented. The congress also included studies regarding the training and assessment of competencies as an important part of implementing ultrasound in clinical practice.

Objective Prehospital rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in low-risk patient with a point-of-care troponin measurement reduces healthcare costs with similar safety to standard transfer to the hospital. Risk stratification is performed identical for men and women, despite important differences in clinical presentation, risk factors and age between men and women with NSTE-ACS. Our aim was to compare safety and healthcare costs between men and women in prehospital identified low-risk patients with suspected NSTE-ACS.Methods In the Acute Rule-out of non-ST-segment elevation acute coronary syndrome in the (pre)hospital setting by HEART (History, ECG, Age, Risk factors and Troponin) score assessment and a single poInt of CAre troponin randomised trial, the HEAR (History, ECG, Age and Risk factors) score was assessed by ambulance paramedics in suspected NSTE-ACS patients. Low-risk patients (HEAR score ≤3) were included. In this substudy, men and women were compared. Primary endpoint was 30-day major adverse cardiac events (MACE), secondary endpoints were 30-day healthcare costs and the scores for the HEAR score components.Results A total of 863 patients were included, of which 495 (57.4%) were women. Follow-up was completed in all patients. In the total population, MACE occurred in 6.8% of the men and 1.6% of the women (risk ratio (RR) 4.2 (95% CI 1.9 to 9.2, p

Objetivo: Avaliar o conhecimento dos enfermeiros da Unidade de Terapia Intensiva de uma unidade hospitalar na Amazônia sobre os tipos de desbridamento de feridas. Métodos: Trata-se de uma pesquisa descritiva, exploratória, qualitativa. Os dados foram coletados por meio de entrevista presencial. Foram respeitados os aspectos éticos do Conselho Nacional de Saúde e a pesquisa aprovada pelo comitê de Ética da Universidade Federal do Amapá. Resultados: Categoria I: Há algum domínio sobre avaliação de feridas por alguns profissionais, entretanto, outros possuem uma carga literária pouco fundamentada; Categoria II: Os enfermeiros dispõem de determinado conhecimento acerca dos tipos de desbridamento. No entanto, observa-se uma deficiência quanto à compreensão de todos os tipos disponíveis; Categoria III: Os enfermeiros executam com maior predominância os desbridamentos mecânico e enzimático, contudo relatam fragilidade e insegurança quanto ao conhecimento profissional; Categoria IV: As falas dos enfermeiros descreveram que há falta de capacitação e educação continuada no setor onde trabalham; Categoria V: As narrativas demonstram que a falta de material adequado constitui-se como principal fator limitante à realização do desbridamento pelos entrevistados. Considerações finais: Sugere-se uma iniciativa, por meio do Núcleo de Educação Permanente da unidade hospitalar, que ofereça de forma gratuita uma capacitação voltada ao tema “Desbridamento de feridas competentes ao enfermeiro”, para atender aqueles que julgam ter dificuldade ou pouco conhecimento sobre desbridamento.

BackgroundStress-related mental disorders are highly prevalent and pose a substantial burden on individuals and society. Improving strategies for the prevention and treatment of mental disorders requires a better understanding of their risk and resilience factors. This multicenter study aims to contribute to this endeavor by investigating psychological resilience in healthy but susceptible young adults over 9 months. Resilience is conceptualized in this study as the maintenance of mental health or quick recovery from mental health perturbations upon exposure to stressors, assessed longitudinally via frequent monitoring of stressors and mental health. ObjectiveThis study aims to investigate the factors predicting mental resilience and adaptive processes and mechanisms contributing to mental resilience and to provide a methodological and evidence-based framework for later intervention studies. MethodsIn a multicenter setting, across 5 research sites, a sample with a total target size of 250 young male and female adults was assessed longitudinally over 9 months. Participants were included if they reported at least 3 past stressful life events and an elevated level of (internalizing) mental health problems but were not presently affected by any mental disorder other than mild depression. At baseline, sociodemographic, psychological, neuropsychological, structural, and functional brain imaging; salivary cortisol and α-amylase levels; and cardiovascular data were acquired. In a 6-month longitudinal phase 1, stressor exposure, mental health problems, and perceived positive appraisal were monitored biweekly in a web-based environment, while ecological momentary assessments and ecological physiological assessments took place once per month for 1 week, using mobile phones and wristbands. In a subsequent 3-month longitudinal phase 2, web-based monitoring was reduced to once a month, and psychological resilience and risk factors were assessed again at the end of the 9-month period. In addition, samples for genetic, epigenetic, and microbiome analyses were collected at baseline and at months 3 and 6. As an approximation of resilience, an individual stressor reactivity score will be calculated. Using regularized regression methods, network modeling, ordinary differential equations, landmarking methods, and neural net–based methods for imputation and dimension reduction, we will identify the predictors and mechanisms of stressor reactivity and thus be able to identify resilience factors and mechanisms that facilitate adaptation to stressors. ResultsParticipant inclusion began in October 2020, and data acquisition was completed in June 2022. A total of 249 participants were assessed at baseline, 209 finished longitudinal phase 1, and 153 finished longitudinal phase 2. ConclusionsThe Dynamic Modelling of Resilience–Observational Study provides a methodological framework and data set to identify predictors and mechanisms of mental resilience, which are intended to serve as an empirical foundation for future intervention studies. International Registered Report Identifier (IRRID)DERR1-10.2196/39817

O presente estudo tem por objetivo analisar, do ponto de vista jurídico, as consequências que circundam as plataformas digitais que utilizam aplicações de algoritmos conhecidas como “filtro bolha”, que criam um ambiente exclusivo de informações para cada usuário, alterando completamente a maneira com a qual as informações são consumidas. Partindo nossa análise do ponto de vista sociopolítico, demonstrando a tendência natural e psicossocial do ser humano em se desenvolver e exercer suas faculdades intelectuais mediante a necessidade de formação de um coletivo, demonstramos como essa necessidade humana pode ser explorada por provedores de aplicação algorítmica, na medida que intencionalmente induzem a criação de bolhas digitais. Uma bolha de filtro não passa de um estado de isolamento intelectual e reforço ideológico que pode resultar de pesquisas personalizadas, em que um algoritmo de determinados sites selecionam quais informações um usuário gostaria de ver com base em informações fornecidas pelo próprio usuário, como localização, cliques anteriores, comportamento na internet e histórico de pesquisa. Com base no conjunto normativo vigente, pertinentes a compreensão da matéria abordada, infere-se que aplicações de “filtros bolhas” ferem dessa forma o exercício de direitos e garantias individuais, previstos em ordenamento constitucional e normas difusas acarretando em uma responsabilidade civil pelo agravo cometido.

Abstract Background: In recent years, ultrasound has represented a new field of application for nursing. Point of Care UltraSound (POCUS) has been defined as an essential skill in the pre-hospital setting. The primary objective of this scoping review is to describe what are the main ultrasound techniques applied by nurses in the pre-hospital emergency setting. The secondary objective is to identify the different training courses implemented in the various studies selected to learn the necessary ultrasound skills. Methods: We conducted a scoping review. The following databases were consulted: PubMed, Cochrane Library, CINAHL and Google Scholar. For the extraction of useful articles, after identifying the inclusion and exclusion criteria, the PRISMA methodology was used, two authors independently analyzed the identified records, in the event of a conflict a third author intervened. Results: The identified records were initially 815. After the duplicates removal, and screening made by the researcher for inclusion criteria, 6 articles were retrieved for qualitative analysis. The most discussed topic is the recognition of pneumothorax: two studies analyzed a specific educational program on ultrasound for flight nurses, three articles evaluated the us of US to verify the correct insertion of devices, and two explored the skills of nurses in performing ultrasound scans. The first study stated that nurses had 86.4% accuracy, 66.6% sensitivity and 100% specificity in ultrasound using; in the second one, nurses had a sensitivity and specificity of 100% in non-traumatized patients and a sensitivity of 60% and a specificity of 93% in trauma patients. Conclusions: Despite the methodological differences of the selected records, the main ultrasound techniques implemented by nurses in the Emergency Medical Service (EMS) are Focused Assessment with Sonography for Trauma (FAST), Extendend Focused Assessment with Sonography for Trauma (E-FAST), evaluation of pneumothorax and visualization of correct insertion of devices (Endotracheal Tube, Nasogastric Tube). At the level of training in the ultrasound field, on the other hand, a certain heterogeneity is highlighted in the structuring of training courses, both in terms of hours of theory and of controlled practice.

Abstract Background Although most guidelines suggest performing a positron emission tomography/computed tomography (PET/CT) with somatostatin receptor (SSTR) ligands for staging of pulmonary carcinoid tumours (PC), only a limited number of studies have evaluated the role of this imaging tool in this specific patient population. The preoperative differentiation between typical carcinoid (TC) and atypical carcinoid (AC) and the extent of dissemination (N/M status) are crucial factors for treatment allocation and prognosis of these patients. Therefore, we performed a pathology-based retrospective analysis of the value of SSTR PET/CT in tumour grading and detection of nodal and metastatic involvement of PC and compared this with the previous literature and with [18F]FDG PET/CT in a subgroup of patients. Methods SSTR PET/CT scans performed between January 2007 and May 2020 in the context of PC were included. If available, [18F]FDG PET/CT images were also evaluated. The maximum standardized uptake (SUVmax) values of the primary tumour, of the pathologically examined hilar and mediastinal lymph node stations, as well as of the distant metastases, were recorded. Tumoural SUVmax values were related to the tumour type (TC versus AC) for both SSTR and [18F]FDG PET/CT in diagnosing and differentiating both tumour types. Nodal SUVmax values were compared to the pathological status (N+ versus N−) to evaluate the diagnostic accuracy of SSTR PET/CT in detecting lymph node involvement. Finally, a mixed model analysis of all pathologically proven distant metastatic lesions was performed. Results A total of 86 SSTR PET/CT scans performed in 86 patients with PC were retrospectively analysed. [18F]FDG PET/CT was available in 46 patients. Analysis of the SUVmax values in the primary tumour showed significantly higher SSTR uptake in TC compared with AC (median SUVmax 18.4 vs 3.8; p = 0.003) and significantly higher [18F]FDG uptake in AC compared to TC (median SUVmax 5.4 vs 3.5; p = 0.038). Receiver operating characteristic (ROC) curve analysis resulted in an area under the curve (AUC) of 0.78 for the detection of TC on SSTR PET/CT and of 0.73 for the detection of AC on [18F]FDG PET/CT. A total of 267 pathologically evaluated hilar and mediastinal lymph node stations were analysed. ROC analysis of paired SSTR/[18F]FDG SUVmax values for the detection of metastasis of TC in 83 lymph node stations revealed an AUC of 0.91 for SSTR PET/CT and of 0.74 for [18F]FDG PET/CT (difference 0.17; 95% confidence interval − 0.03 to 0.38; p = 0.10). In a sub-cohort of 10 patients with 12 distant lesions that were pathologically examined due to a suspicious aspect on SSTR PET/CT, a positive predictive value (PPV) of 100% was observed. Conclusion Our findings confirm the higher SSTR ligand uptake in TC compared to AC and vice versa for [18F]FDG uptake. More importantly, we found a good diagnostic performance of SSTR PET/CT for the detection of hilar and mediastinal lymph node metastases of TC. Finally, a PPV of 100% for SSTR PET/CT was found in a small sub-cohort of patients with pathologically investigated distant metastatic lesions. Taken together, SSTR PET/CT has a very high diagnostic value in the TNM assessment of pulmonary carcinoids, particularly in TC, which underscores its position in European guidelines.

Objetivo: investigar o nível de dor, pressão arterial e frequência cardíaca antes e após a musicoterapia. Métodos: Pesquisa quantitativa e quase-experimental, realizada em uma unidade básica de saúde. Contou com amostra intencional com N=10. A coleta de dados, realizada em três momentos, foi utilizada como instrumentos a Escala Visual Analógica de Dor e formulário para coleta das variáveis: pressão arterial, batimentos cardíacos por minuto, idade, tipo de ferida e sexo. Os dados coletados foram tabulados no Microsoft Excel for Windows 2016 e a análise estatística foi realizada no SPSS 20.0. Resultados: Houve distribuição igualitária de sexo, predomínio de úlceras diabéticas (80%) e de idade entre 40-59 anos (50%). Não houve diferença estatística significativa nos níveis de dor. A pressão arterial apresentou mudanças significativas com as sessões de musicoterapia. Conclusão: A intervenção musical demonstrou potencial de redução da pressão arterial de pacientes com feridas crônicas no momento de realização do curativo.

El objetivo general es investigar la inhabilitación o desconocimiento de agentes de tratamiento en el marco de determinadas operaciones de tratamiento conjunto. Tiene como objetivo responder a la siguiente pregunta de investigación: ¿en qué supuestos de tratamiento conjunto es posible descalificar al agente de tratamiento? El trabajo analiza brevemente los agentes de tratamiento tal y como establece la Ley General de Protección de Datos (LGPD) en comparación con el Reglamento General Europeo de Protección de Datos (RGPD) y otras normativas relevantes. Se estudian las hipótesis de inhabilitación del agente de tratamiento previstas en la Ley General de Protección de Datos, procediendo a la hermenéutica de los respectivos enunciados normativos. Considerando la ausencia de criterios hermenéuticos en Brasil, se consideran los criterios establecidos en la Agencia Europea de Protección de Datos. Se utilizan metodologías empíricas dogmáticas, teóricas y cualitativas. El artículo ofrece una explicación detallada de lo que debe considerarse como hipótesis válidas para la inhabilitación del responsable del tratamiento y del operador, con base en la estricta legalidad de la principal legislación que incide en la LGPD.

BackgroundChronic stress and depressive symptoms have both been linked to increased heart rate (HR) and reduced HR variability. However, up to date, it is not clear whether chronic stress, the mechanisms intrinsic to depression or a combination of both cause these alterations. Subclinical cases may help to answer these questions. In a healthy working population, we aimed to investigate whether the effect of chronic stress on HR circadian rhythm depends on the presence of depressive symptoms and whether chronic stress and depressive symptoms have differential effects on HR reactivity to an acute stressor.Methods1,002 individuals of the SWEET study completed baseline questionnaires, including psychological information, and 5 days of electrocardiogram (ECG) measurements. Complete datasets were available for 516 individuals. In addition, a subset (n = 194) of these participants completed a stress task on a mobile device. Participants were grouped according to their scores for the Depression Anxiety Stress Scale (DASS) and Perceived Stress Scale (PSS). We explored the resulting groups for differences in HR circadian rhythm and stress reactivity using linear mixed effect models. Additionally, we explored the effect of stress and depressive symptoms on night-time HR variability [root mean square of successive differences (RMSSD)].ResultsHigh and extreme stress alone did not alter HR circadian rhythm, apart from a limited increase in basal HR. Yet, if depressive symptoms were present, extreme chronic stress levels did lead to a blunted circadian rhythm and a lower basal HR. Furthermore, blunted stress reactivity was associated with depressive symptoms, but not chronic stress. Night-time RMSSD data was not influenced by chronic stress, depressive symptoms or their interaction.ConclusionThe combination of stress and depressive symptoms, but not chronic stress by itself leads to a blunted HR circadian rhythm. Furthermore, blunted HR reactivity is associated with depressive symptoms and not chronic stress.

Background Immune checkpoint inhibitor (ICI)-related pneumonitis is the most frequent fatal immune-related adverse event associated with programmed cell death protein-1/programmed death ligand-1 blockade. The pathophysiology however remains largely unknown, owing to limited and contradictory findings in existing literature pointing at either T-helper 1 or T-helper 17-mediated autoimmunity. In this study, we aimed to gain novel insights into the mechanisms of ICI-related pneumonitis, thereby identifying potential therapeutic targets.Methods In this prospective observational study, single-cell RNA and T-cell receptor sequencing was performed on bronchoalveolar lavage fluid of 11 patients with ICI-related pneumonitis and 6 demographically-matched patients with cancer without ICI-related pneumonitis. Single-cell transcriptomic immunophenotyping and cell fate mapping coupled to T-cell receptor repertoire analyses were performed.Results We observed enrichment of both CD4+ and CD8+ T cells in ICI-pneumonitis bronchoalveolar lavage fluid. The CD4+ T-cell compartment showed an increase of pathogenic T-helper 17.1 cells, characterized by high co-expression of TBX21 (encoding T-bet) and RORC (ROR-γ), IFN-G (IFN-γ), IL-17A, CSF2 (GM-CSF), and cytotoxicity genes. Type 1 regulatory T cells and naïve-like CD4+ T cells were also enriched. Within the CD8+ T-cell compartment, mainly effector memory T cells were increased. Correspondingly, myeloid cells in ICI-pneumonitis bronchoalveolar lavage fluid were relatively depleted of anti-inflammatory resident alveolar macrophages while pro-inflammatory ‘M1-like’ monocytes (expressing TNF, IL-1B, IL-6, IL-23A, and GM-CSF receptor CSF2RA, CSF2RB) were enriched compared with control samples. Importantly, a feedforward loop, in which GM-CSF production by pathogenic T-helper 17.1 cells promotes tissue inflammation and IL-23 production by pro-inflammatory monocytes and vice versa, has been well characterized in multiple autoimmune disorders but has never been identified in ICI-related pneumonitis.Conclusions Using single-cell transcriptomics, we identified accumulation of pathogenic T-helper 17.1 cells in ICI-pneumonitis bronchoalveolar lavage fluid—a phenotype explaining previous divergent findings on T-helper 1 versus T-helper 17 involvement in ICI-pneumonitis—,putatively engaging in detrimental crosstalk with pro-inflammatory ‘M1-like’ monocytes. This finding yields several novel potential therapeutic targets for the treatment of ICI-pneumonitis. Most notably repurposing anti-IL-23 merits further research as a potential efficacious and safe treatment for ICI-pneumonitis.

Implementing large-scale quantum networks is one of the challenges at the core of quantum communication. Here, the authors present NetSquid, a quantum network simulator that allows studying how such networks can be built, including physical hardware modelling, modularity, scalability, and examples.

The COVID-19 pandemic has been a catalyst for the implementation of decentralized clinical trials (DCTs) enabled by digital health technologies (DHTs) in the field while curtailing in-person interactions and putting significant demands on health care resources. DHTs offer improvements in real-time data acquisition remotely while maintaining privacy and security. Here, we describe the implications of technologies, including edge computing, zero-trust environments, and federated computing in DCTs enabled by DHTs. Taken together, these technologies—in the setting of policy and regulation that enable their use while protecting the users—extend the scope and accelerate the pace of clinical research.

Reconstruction of extensive bone loss in the foot requires a set of strategies involving various surgical techniques and orthopedic devices. Semicircular Ilizarov external fixator combined with a structural homologous bone graft may be advantageous in pediatric patients. This case report describes the technique of reconstructing an extensive bone loss of the first metatarsal with osteodistraction and homologous graft in an immature skeleton. The combination of the external fixator and the homologous graft provided sufficient bone volume without recurrent infection, minimal complications, substantial length gain of the metatarsal bone, and improved soft tissue conditions. It is a viable treatment option for severe foot injuries in immature skeletons. Level of Evidence V, Therapeutic Studies, Expert Opinion.

Invasive alien plants (IAPs) are increasingly threatening biodiversity worldwide; thus, early detection and monitoring tools are needed. Here, we explored the potential of unmanned aerial vehicle (UAV) images in providing intermediate reference data which are able to link IAP field occurrence and satellite information. Specifically, we used very high spatial resolution (VHR) UAV maps of A. saligna as calibration data for satellite-based predictions of its spread in the Mediterranean coastal dunes. Based on two satellite platforms (PlanetScope and Sentinel-2), we developed and tested a dedicated procedure to predict A. saligna spread organized in four steps: 1) setting of calibration data for satellite-based predictions, by aggregating UAV-based VHR IAP maps to satellite spatial resolution (3 and 10 m); 2) selection of monthly multispectral (blue, green, red, and near infra-red bands) cloud-free images for both satellite platforms; 3) calculation of monthly spectral variables depicting leaf and plant characteristics, canopy biomass, soil features, surface water and hue, intensity, and saturation values; 4) prediction of A. saligna distribution and identification of the most important spectral variables discriminating IAP occurrence using a fandom forest (RF) model. RF models calibrated for both satellite platforms showed high predictive performances (R2 > 0.6; RMSE

Reconstruction of extensive bone loss in the foot requires a set of strategies involving various surgical techniques and orthopedic devices. Semicircular Ilizarov external fixator combined with a structural homologous bone graft may be advantageous in pediatric patients. This case report describes the technique of reconstructing an extensive bone loss of the first metatarsal with osteodistraction and homologous graft in an immature skeleton. The combination of the external fixator and the homologous graft provided sufficient bone volume without recurrent infection, minimal complications, substantial length gain of the metatarsal bone, and improved soft tissue conditions. It is a viable treatment option for severe foot injuries in immature skeletons. Level of Evidence V, Therapeutic Studies, Expert Opinion.

In recent decades, the Campi Flegrei caldera (Italy) showed unrest characterized by increases in seismicity, ground uplift, and hydrothermal activity. Currently, the seismic and hydrothermal phenomena are mostly concentrated in the Solfatara–Pisciarelli area, which presents a wide fumarolic field and mud emissions. The main fumarole in Pisciarelli is associated with a boiling mud pool. Recently, episodes of a sudden increase in hydrothermal activity and expansion of mud and gas emissions occurred in this area. During these episodes, which occurred in December 2018 and September 2020, Short Duration Events (SDEs), related to the intensity of mud pool boiling, were recorded in the fumarolic seismic tremor. We applied a Self-Organizing Map (SOM) neural network to recognize the occurrence of SDEs in the fumarolic tremor of Campi Flegrei, which provides important information on the state of activity of the hydrothermal system and about the possible phreatic activity. Our method, based on an ad hoc feature extraction procedure, effectively clustered the seismic signals containing SDEs and separated them from those representing the normal fumarolic tremor. This result is useful for improving the monitoring of the Solfatara–Pisciarelli hydrothermal area which is a high-risk zone in Campi Flegrei.

ABSTRACT The diversity of endophytic fungi in healthy coconut palm leaves (Cocos nucifera) was assessed by analyzing fungal isolates from three coconut cultivars (yellow dwarf, green dwarf, and a hybrid cultivar PB121) used agriculturally in Brazil. The influence of season (rainy or dry) on the endophytic fungal community was also analyzed. Overall, 318 fungal isolates were obtained from 972 coconut leaf fragments. The rDNA ITS region was sequenced from representative species of the isolated endophytic fungi and the most common species identified were Nigrospora oryzae, Pestalotiopsis sp., and Zasmidium musae. The alpha diversity of the endophytic fungi was also calculated. Nonmetric multidimensional scaling (NMDS) ordination and permutational analysis of variance (PERMANOVA) revealed significant seasonal effects on the composition of the endophyte community. However, practically no influence was observed on the fungal communities for the different cultivars of coconut.

ABSTRACT Mass vaccination campaigns are essential to control the ongoing novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) pandemic. The Covishield vaccine consists of the replication-deficient simian adenovirus vector ChAdOx1, which contains the full-length structural spike protein of SARS-CoV-2. Occasionally, it can lead to cutaneous reactions that contribute to fear of vaccination, hesitancy, and incomplete vaccination schedules. We report a case of facial angioedema following the first dose of Covishield in a 63-year-old woman with no previous history of allergies or hypersensitivity to drugs or vaccines. No rebound of angioedema was recorded after the second homologous and third heterologous doses.

Background Long-term outcome data of coronavirus disease 2019 (COVID-19) survivors are needed to understand their recovery trajectory and additional care needs. Methods A prospective observational multicentre cohort study was carried out of adults hospitalised with COVID-19 from March through May 2020. Workup at 3 and 12 months following admission consisted of clinical review, pulmonary function testing, 6-min walk distance (6MWD), muscle strength, chest computed tomography (CT) and quality of life questionnaires. We evaluated factors correlating with recovery by linear mixed effects modelling. Results Of 695 patients admitted, 299 and 226 returned at 3 and 12 months, respectively (median age 59 years, 69% male, 31% severe disease). About half and a third of the patients reported fatigue, dyspnoea and/or cognitive impairment at 3 and 12 months, respectively. Reduced 6MWD and quadriceps strength were present in 20% and 60% at 3 months versus 7% and 30% at 12 months. A high anxiety score and body mass index correlated with poor functional recovery. At 3 months, diffusing capacity for carbon monoxide (DLCO) and total lung capacity were below the lower limit of normal in 35% and 18%, decreasing to 21% and 16% at 12 months; predictors of poor DLCO recovery were female sex, pre-existing lung disease, smoking and disease severity. Chest CT improved over time; 10% presented non-progressive fibrotic changes at 1 year. Conclusion Many COVID-19 survivors, especially those with severe disease, experienced limitations at 3 months. At 1 year, the majority showed improvement to almost complete recovery. To identify additional care or rehabilitation needs, we recommend a timely multidisciplinary follow-up visit following COVID-19 admission.

Abstract Climate change is currently affecting both biodiversity and human activities; land use change and greenhouse gas emissions are the main drivers. Many agricultural services are affected by the change, which in turn reflects on the basic provisioning services, which supply food, fibre and biofuels. Biofuels are getting increasing interest because of their sustainability potential. Jatropha curcas gained popularity as a biodiesel crop, due to its ease of cultivation even in harsh environmental conditions. Notwithstanding its high economic importance, few studies are available about its co‐occurrence with pests of the genus Aphthona in sub‐Saharan Africa, where these insects feed on J. curcas, leading to relevant economic losses. Using ecological niche modelling and GIS post‐modelling analyses, we infer the current and future suitable territories for both these taxa, delineating areas where J. curcas cultivations may occur without suffering the presence of Aphthona, in the context of future climate and land use changing. We introduce an area‐normalized index, the ‘Potential‐Actual Cultivation Index’, to better depict the ratio between the suitable areas shared both by the crop and its pest, and the number of actual cultivations, in a target country. Moreover, we find high economic losses (~−50%) both in terms of carbon sequestration and in biodiesel production when J. curcas co‐occur with the Aphthona cookei species group.

Wildfires are currently one of the most important environmental problems, as they cause disturbance in ecosystems generating environmental, economic and social costs. The Sentinel-2 from Copernicus Program (Sentinel satellites) offers a great tool for post-fire monitoring. The main objective of this study is to evaluate the potential of Sentinel-2 in a peculiar mountainous landscape by measuring and identifying the burned areas and monitor the short-term response of the vegetation in different ‘burn severity’ classes. A Sentinel-2 dataset was created, and pre-processing operations were performed. Relativized Burn Ratio (RBR) was calculated to identify ‘burn scar’ and discriminate the ‘burn severity’ classes. A two-year monitoring was carried out with areas identified based on different severity classes, using Normalized Difference Vegetation Index (NDVI) to investigate the short-term vegetation dynamics of the burned habitats; habitats refer to Annex I of the European Directive 92/43/EEC. The study area is located in ‘Campo Imperatore’ within the Gran Sasso – Monti della Laga National Park (central Italy). The first important result was the identification and quantification of the area affected by fire. The RBR allowed us to identify even the less damaged habitats with high accuracy. The survey highlighted the importance of these Open-source tools for qualitative and quantitative evaluation of fires and the short-term assessment of vegetation recovery dynamics. The information gathered by this type of monitoring can be used by decision-makers both for emergency management and for possible environmental restoration of the burned areas.

BackgroundThere are 1.1 billion smokers worldwide, and each year, more than 8 million die prematurely because of cigarette smoking. More than half of current smokers make a serious quit every year. Nonetheless, 90% of unaided quitters relapse within the first 4 weeks of quitting due to the lack of limited access to cost-effective and efficient smoking cessation tools in their daily lives. ObjectiveThis study aims to enable quantified monitoring of ambulatory smoking behavior 24/7 in real life by using continuous and automatic measurement techniques and identifying and characterizing smoking patterns using longitudinal contextual signals. This work also intends to provide guidance and insights into the design and deployment of technology-enabled smoking cessation applications in naturalistic environments. MethodsA 4-week observational study consisting of 46 smokers was conducted in both working and personal life environments. An electric lighter and a smartphone with an experimental app were used to track smoking events and acquire concurrent contextual signals. In addition, the app was used to prompt smoking-contingent ecological momentary assessment (EMA) surveys. The smoking rate was assessed based on the timestamps of smoking and linked statistically to demographics, time, and EMA surveys. A Poisson mixed-effects model to predict smoking rate in 1-hour windows was developed to assess the contribution of each predictor. ResultsIn total, 8639 cigarettes and 1839 EMA surveys were tracked over 902 participant days. Most smokers were found to have an inaccurate and often biased estimate of their daily smoking rate compared with the measured smoking rate. Specifically, 74% (34/46) of the smokers made more than one (mean 4.7, SD 4.2 cigarettes per day) wrong estimate, and 70% (32/46) of the smokers overestimated it. On the basis of the timestamp of the tracked smoking events, smoking rates were visualized at different hours and were found to gradually increase and peak at 6 PM in the day. In addition, a 1- to 2-hour shift in smoking patterns was observed between weekdays and weekends. When moderate and heavy smokers were compared with light smokers, their ages (P

Coastal dune ecosystems are highly threatened, and one of the strongest pressures is invasive alien plants (IAPs). Mitigating the negative effects of IAPs requires development of optimal identification and mapping protocols. Remote sensing offers innovative tools that have proven to be very valuable for studying IAPs. In particular, unmanned aerial vehicles (UAVs) can be very promising, especially in the study of herbaceous invasive species, yet research in UAV application is still limited. In this study, we used UAV images to implement an image segmentation approach followed by machine learning classification for mapping a dune clonal invader (Carpobrotus sp. pl.), calibrating a total of 27 models. Our study showed that: (a) the results offered by simultaneous RGB and multispectral data improve the prediction of Carpobrotus; (b) the best results were obtained by mapping the whole plant or its vegetative parts, while mapping flowers was worse; and (c) a training area corresponding to 20% of the total area can be adequate for model building. Overall, our results highlighted the great potential of using UAVs for Carpobrotus mapping, despite some limitations imposed by the particular biology and ecology of these taxa.

This review aims to bring a more general view of the technological and biological challenges regarding production and use of probiotic bacteria in promoting human health. After a brief description of the current concepts, the challenges for the production at an industrial level are presented from the physiology of the central metabolism to the ability to face the main forms of stress in the industrial process. Once produced, these cells are processed to be commercialized in suspension or dried forms or added to food matrices. At this stage, the maintenance of cell viability and vitality is of paramount for the quality of the product. Powder products requires the development of strategies that ensure the integrity of components and cellular functions that allow complete recovery of cells at the time of consumption. Finally, once consumed, probiotic cells must face a very powerful set of physicochemical mechanisms within the body, which include enzymes, antibacterial molecules and sudden changes in pH. Understanding the action of these agents and the induction of cellular tolerance mechanisms is fundamental for the selection of increasingly efficient strains in order to survive from production to colonization of the intestinal tract and to promote the desired health benefits.

Aims Rice is a staple food for many countries, being fundamental for a large part of the worlds’ population. In sub-Saharan Africa, its importance is currently high and is likely to become even more relevant, considering that the number of people and the per-capita consumption are both predicted to increase. The flea beetles belonging to the Chaetocnema pulla species group (pulla group), a harmful rice pest, are an important vector of the Rice Yellow Mottle Virus, a disease which leads even to 80–100% yield losses in rice production. We present a continental-scale study aiming at: (1) locating current and future suitable territories for both pulla group and rice; (2) identifying areas where rice cultivations may occur without suffering the presence of pulla group using an Ecological Niche Modelling (ENM) approach; (3) estimating current and future connectivity among pulla group populations and areas predicted to host rice cultivations, based on the most recent land-use estimates for future agricultural trends; (4) proposing a new connectivity index called “Pest Aggression Index” (PAI) to measure the agricultural susceptibility to the potential future invasions of pests and disease; (5) quantifying losses in terms of production when rice cultivations co‐occur with the pulla group and identifying the SSA countries which, in the future inferred scenarios, will potentially suffer the greatest losses. Location Sub-Saharan Africa. Methods Since the ongoing climate and land-use changes affect species’ distributions, we first assess the impact of these changes through a spatially-jackknifed Maxent-based Ecological Niche Modelling in GIS environment, for both the pulla group and rice, in two climatic/socioeconomic future scenarios (SSP_2.45 and 3.70). We then assess the connectivity potential of the pulla group populations towards rice cultivations, for both current and future predictions, through a circuit theory-based approach (Circuitscape implemented in Julia language). We finally measure the rice production and GPD loss per country through the spatial index named “Pest Aggression Index”, based on the inferred connectivity magnitude. Results The most considerable losses in rice production are observed for Liberia, Sierra Leone and Madagascar in all future scenarios (2030, 2050, 2070). The future economic cost, calculated as USD lost from rice losses/country’s GDP results are high for Central African Republic (−0.6% in SSP_2.45 and −3.0% in SSP_3.70) and Guinea–Bissau (−0.4% in SSP_2.45 and −0.68% in SSP_3.70), with relevant losses also obtained for other countries. Main conclusions Since our results are spatially explicit and focused on each country, we encourage careful land-use planning. Our findings could support best practices to avoid the future settlement of new cultivations in territories where rice would be attacked by pulla group and the virus, bringing economic and biodiversity losses.

ABSTRACT Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up. Aim: To assess the impact on behavior of esophageal varices and bleeding recurrence after post-operative endoscopic treatment of patients submitted to EGDS. Methods: Thirty-six patients submitted to EGDS were followed for more than five years. They were divided into two groups, according to the portal pressure drop, more or less than 30%, and compared with the behavior of esophageal varices and the rate of bleeding recurrence. Results: A significant reduction on the early and late post-operative varices caliber when compared the pre-operative data was observed despite an increase in diameter during follow-up that was controlled by endoscopic therapy. Conclusion: The drop in portal pressure did not significantly influence the variation of variceal calibers when comparing pre-operative and early or late post-operative diameters. The comparison between the portal pressure drop and the rebleeding rates was also not significant.

BackgroundAlthough it is well-known that older individuals with certain comorbidities are at the highest risk for complications related to COVID-19 including hospitalization and death, we lack tools to identify communities at the highest risk with fine-grained spatial resolution. Information collected at a county level obscures local risk and complex interactions between clinical comorbidities, the built environment, population factors, and other social determinants of health. ObjectiveThis study aims to develop a COVID-19 community risk score that summarizes complex disease prevalence together with age and sex, and compares the score to different social determinants of health indicators and built environment measures derived from satellite images using deep learning. MethodsWe developed a robust COVID-19 community risk score (COVID-19 risk score) that summarizes the complex disease co-occurrences (using data for 2019) for individual census tracts with unsupervised learning, selected on the basis of their association with risk for COVID-19 complications such as death. We mapped the COVID-19 risk score to corresponding zip codes in New York City and associated the score with COVID-19–related death. We further modeled the variance of the COVID-19 risk score using satellite imagery and social determinants of health. ResultsUsing 2019 chronic disease data, the COVID-19 risk score described 85% of the variation in the co-occurrence of 15 diseases and health behaviors that are risk factors for COVID-19 complications among ~28,000 census tract neighborhoods (median population size of tracts 4091). The COVID-19 risk score was associated with a 40% greater risk for COVID-19–related death across New York City (April and September 2020) for a 1 SD change in the score (risk ratio for 1 SD change in COVID-19 risk score 1.4; P

[This corrects the article DOI: 10.1371/journal.pcbi.1008412.].

Background: Abnormalities of heart rate (HR) and its variability are characteristic of major depressive disorder (MDD). However, circadian rhythm is rarely taken into account when statistically exploring state or trait markers for depression.Methods: A 4-day electrocardiogram was recorded for 16 treatment-resistant patients with MDD and 16 age- and sex-matched controls before, and for the patient group only, after a single treatment with the rapid-acting antidepressant ketamine or placebo (clinical trial registration available on https://www.clinicaltrialsregister.eu/ with EUDRACT number 2016-001715-21). Circadian rhythm differences of HR and the root mean square of successive differences (RMSSD) were compared between groups and were explored for classification purposes. Baseline HR/RMSSD were tested as predictors for treatment response, and physiological measures were assessed as state markers.Results: Patients showed higher HR and lower RMSSD alongside marked reductions in HR amplitude and RMSSD variation throughout the day. Excellent classification accuracy was achieved using HR during the night, particularly between 2 and 3 a.m. (90.6%). A positive association between baseline HR and treatment response (r = 0.55, p = 0.046) pointed toward better treatment outcome in patients with higher HR. Heart rate also decreased significantly following treatment but was not associated with improved mood after a single infusion of ketamine.Limitations: Our study had a limited sample size, and patients were treated with concomitant antidepressant medication.Conclusion: Patients with depression show a markedly reduced amplitude for HR and dysregulated RMSSD fluctuation. Higher HR and lower RMSSD in depression remain intact throughout a 24-h day, with the highest classification accuracy during the night. Baseline HR levels show potential for treatment response prediction but did not show potential as state markers in this study.Clinical trial registration: EUDRACT number 2016-001715-21.

Studying seismicity in a volcanic environment provides important information on the state of activity of volcanoes. The seismicity of the Neapolitan volcanoes, Campi Flegrei, Vesuvius, and Ischia, shows distinctive characteristics for each volcano, covering a wide range of patterns and types. In this study we relocated some significant volcano-tectonic earthquake swarms that occurred in Campi Flegrei and Vesuvius. Moreover, we compared the earthquake occurrence evolution, the magnitude and the seismic energy release of the three volcanoes. Also, we considered the results of seismic analysis in the light of geochemical and ground deformation data that contribute to defining the state of activity of volcanoes. In Campi Flegrei, which is experiencing a long term unrest, we identified a seismogenic structure at shallow depth in Pisciarelli zone that has been activated repeatedly. The increasing seismicity accompanies an escalation of the hydrothermal activity and a ground uplift phase. At Vesuvius a very shallow seismicity is recorded, which in recent years has shown an increase in terms of the number of events per year. Earthquakes are usually located right beneath the crater axis. They are concentrated in a volume affected by the hydrothermal system. Finally, Ischia generally shows a low level of seismicity, however, in Casamicciola area events with a moderate magnitude can occur and these are potentially capable of causing severe damage to the town and population, due to their small hypocentral depth (typically < 2.5 km). After the seismic crisis of August 21, 2017 (mainshock magnitude M = 4), the seismicity returned to a low level in terms of occurrence rate and magnitude of earthquakes. The seismicity of these three different volcanic areas shows some common aspects that highlight a relevant role of hydrothermal processes in the seismogenesis of volcanic areas. However, while the main swarms in Campi Flegrei and most of the Vesuvian earthquakes are distributed along conduit-like structures, the seismicity of Ischia is mainly located along faults. Furthermore, the temporal evolution of seismicity in Neapolitan volcanic area suggests a concomitant increase in the occurrence of earthquakes both in Campi Flegrei and Vesuvius in recent years.

Objectives: To analyze computed tomography (CT) characteristics predictive for diagnostic accuracy and pneumothorax in CT fluoroscopy-guided transthoracic biopsy (CTF-TTB) of lung lesions using non-coaxial biopsy needle technique. Methods: Retrospectively 274 lung lesion biopsies with confirmed histology were included in our study. CTF-TTB was done using an 18-gauge non-coaxial cutting needle. Diagnostic accuracy rates were calculated per lesion size and CT and procedural characteristics were evaluated for their predictive value regarding diagnostic accuracy and development of pneumothorax (maximal nodule diameter, distance to pleura, location per lung segment, nodule composition, benign versus malignant histology, and number of specimens). Results: Overall diagnostic accuracy of CTF-TTB was high (93%). Diagnostic accuracy for lesions ≤10 mm was 81%. Maximal nodule diameter was the only predictive CT characteristic for diagnostic success (p = 0.03). Pneumothorax occurred in 27%. Distance of lesion to pleura was the only risk factor for pneumothorax (p < 0.00001). Pneumothorax rates were significantly lower in subpleural lesions (14%) compared to those located 1−10 mm (47%), 10−20 mm (33%), and >20 mm from pleura (29%). Conclusions: High diagnostic accuracy rates were achieved with CTF-TTB using non-coaxial biopsy technique, even for lesions ≤10 mm. Pneumothorax rates were comparable with other studies. Lesion size was the only predictive CT characteristic for diagnostic accuracy. Distance to pleura was the only risk factor for pneumothorax.

Introducción. En Perú, los trastornos hipertensivos del embarazo son la segunda causa de mortalidad materna. Objetivo. La presente guía de práctica clínica basada en evidencias (GPC-BE) brinda recomendaciones para la prevención y tratamiento de la pre-eclampsia y eclampsia. Métodos. Se elaboró una GPC-BE adaptada mediante un proceso sistemático, riguroso y transparente con un grupo elaborador conformado por metodólogos y profesionales de la salud expertos en el manejo de la enfermedad. La guía cuenta con dieciséis preguntas clínicas y dieciséis recomendaciones. Se realizó la búsqueda y preselección de GPC, las mismas que fueron evaluadas mediante el instrumento “Appraisal of Guidelines for Research and Evaluation II” (AGREEII), para su adaptación. La búsqueda sistemática de evidencias para responder las preguntas clínicas se realizó en múltiples bases de datos: MEDLINE/PubMed, EMBASE/Ovid, Cochrane Library, LILACS y SciELO. Las evidencias fueron seleccionadas y analizadas críticamente por pares clínicos y metodológicos; las recomendaciones fueron elaboradas mediante la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados. Con la participación de un panel de expertos clínicos del Instituto Nacional Materno Perinatal, redes de salud y otras instituciones de referencia, se elaboraron 16 recomendaciones dirigidas a la prevención y tratamiento de mujeres gestantes en riesgo de pre-eclampsia, gestantes con pre-eclampsia, eclampsia o enfermedad hipertensiva. Conclusiones. Este artículo resume la guía de práctica clínica basada en evidencias para la prevención y tratamiento de pre-eclampsia y eclampsia en gestantes en el instituto de referencia nacional en salud materna y neonatal del Perú.

La encefalitis autoinmune por anticuerpos contra el receptor N-metil-D-aspartato (anti-NMDAR) es un desorden mediado por anticuerpos contra antígenos de superficie neuronal, cuyo diagnóstico temprano y tratamiento oportuno mejoran el pronóstico de la enfermedad. Se presentan cuatro casos con el diagnóstico definitivo de encefalitis autoinmune por anti-NMDAR, tratados en el Instituto Nacional de Ciencias Neurológicas en Lima-Perú. Todos los pacientes presentaron crisis epilépticas y tres casos desarrollaron un estado epiléptico refractario. Asimismo, tres pacientes presentaron alteraciones neuropsiquiátricas, discinesias y disautonomías. Dos casos requirieron soporte ventilatorio. Todos presentaron un electroencefalograma anormal, dos casos tuvieron pleocitosis en líquido cefalorraquídeo, y sólo uno mostró anormalidades cerebrales en la resonancia magnética. Respecto al tratamiento, todos los pacientes recibieron inmunoterapia con metilprednisolona y sólo dos de ellos requirieron plasmaféresis por respuesta ineficaz al tratamiento con corticoides. A los 12 meses del alta hospitalaria, tres pacientes quedaron libre de crisis epilépticas y sólo un caso no logró la independencia funcional. Estos casos muestran que la encefalitis anti-NMDAR es una condición tratable y su reconocimiento temprano junto con un tratamiento adecuado (inmunoterapia/plasmaféresis) son esenciales para una evolución favorable.

Presentes na formação histórica, política e cultural do país, os mecanismos censórios estiveram sempre alertas à produção artística nacional nos últimos 500 anos, como forma de exercer o poder político, enquanto estatal, e disseminada na sociedade como no período atual, chamada de pós-censura. Este artigo tem por finalidade refletir sobre esses processos a partir das pesquisas que o Observatório de Comunicação, Liberdade de Expressão e Censura (OBCOM), da Escola de Comunicações e Artes da USP vem realizando nos últimos 18 anos.

Coupling the geographic distribution and the ecological requirements of species often supports taxonomy and biogeography. In this contribution, we update the distribution of two flea beetle species of ethno-entomological interest, Polyclada bohemani and P. pectinicornis, by analyzing original data. In addition, we supply their main morphological diagnostic characters, describing their aedeagal and spermathecal shapes for the first time. We also assess their niche differences in terms of climatic and vegetation needs, by means of ecological niche modelling and remote sensing techniques. Several new localities were identified to improve knowledge of the geographical distribution of both species. Moreover, we located a wide climatic suitability overlap in East Africa for these two flea beetle species, while in other areas they show a clear separation. Our analysis also reports that P. bohemani is associated with areas of denser tree cover than P. pectinicornis. Finally, the lectotypes of Diamphidia bohemani Baly, 1861, Clytra pectinicornis Olivier, 1791, and Diamphidia compacta Fairmaire, 1887 are here designated and the new synonymy Clytra pectinicornis Olivier = Diamphidia compacta Fairmaire syn.nov. is proposed.

Objectives: Fast diagnosis of Coronavirus Disease 2019 (COVID-19), and the detection of high-risk patients are crucial but challenging in the pandemic outbreak. The aim of this study was to evaluate if deep learning-based software correlates well with the generally accepted visual-based scoring for quantification of the lung injury to help radiologist in triage and monitoring of COVID-19 patients. Materials and methods: In this retrospective study, the lobar analysis of lung opacities (% opacities) by means of a prototype deep learning artificial intelligence (AI)-based software was compared to visual scoring. The visual scoring system used five categories (0: 0%, 1: 0–5%, 2: 5–25%, 3: 25–50%, 4: 50–75% and 5: >75% involvement). The total visual lung injury was obtained by the sum of the estimated grade of involvement of each lobe and divided by five. Results: The dataset consisted of 182 consecutive confirmed COVID-19 positive patients with a median age of 65 ± 16 years, including 110 (60%) men and 72 (40%) women. There was a correlation coefficient of 0.89 (p < 0.001) between the visual and the AI-based estimates of the severity of lung injury. Conclusion: The study indicates a very good correlation between the visual scoring and AI-based estimates of lung injury in COVID-19.

Purpose: To investigate the role of low-dose chest computed tomography (CT) imaging in the triage of patients suspected of coronavirus disease 2019 (COVID-19) in an emergency setting. Materials and Methods: Data from 610 patients admitted to our emergency unit from March 20, 2020, until April 11, 2020, with suspicion of COVID-19 were collected. Diagnostic values of low-dose chest CT for COVID-19 were calculated using consecutive reverse-transcription polymerase chain reaction (RT-PCR) tests and bronchoalveolar lavage (BAL) as reference. Comparative analysis of the 199 COVID-19 positive versus 411 COVID-19 negative patients was done with identification of risk factors and predictors of worse outcome. Results: Sensitivity and specificity of low-dose CT for the diagnosis of COVID-19 respectively ranged from 75% (150/199) to 88% (175/199) and 94% (386/411) to 99% (386/389), depending on the inclusion of inconclusive results. On multivariate analysis, a higher body mass index (BMI), fever, and dyspnea on admission were risk factors for COVID-19 (all p-values < 0.05). The mortality rate was 12.6% (25/199). Higher age and high levels of C-reactive protein (CRP) and D-dimers were predictors of worse outcome (all p-values < 0.05). Conclusion: Low-dose chest CT has a high specificity and a moderate to high sensitivity in symptomatic patients with suspicion of COVID-19 and could be used as an effective tool in setting of triage in high-prevalence areas.

How epithelial cells coordinate their polarity to form functional tissues is an open question in cell biology. Here, we characterize a unique type of polarity found in liver tissue, nematic cell polarity, which is different from vectorial cell polarity in simple, sheet-like epithelia. We propose a conceptual and algorithmic framework to characterize complex patterns of polarity proteins on the surface of a cell in terms of a multipole expansion. To rigorously quantify previously observed tissue-level patterns of nematic cell polarity (Morales-Navarrete et al., eLife 2019), we introduce the concept of co-orientational order parameters, which generalize the known biaxial order parameters of the theory of liquid crystals. Applying these concepts to three-dimensional reconstructions of single cells from high-resolution imaging data of mouse liver tissue, we show that the axes of nematic cell polarity of hepatocytes exhibit local coordination and are aligned with the biaxially anisotropic sinusoidal network for blood transport. Our study characterizes liver tissue as a biological example of a biaxial liquid crystal. The general methodology developed here could be applied to other tissues and in-vitro organoids.

Two paroxysmal explosions occurred at Stromboli on 3 July and 28 August 2019, the first of which caused the death of a young tourist. After the first paroxysm an effusive activity began from the summit vents and affected the NW flank of the island for the entire period between the two paroxysms. We carried out an unsupervised analysis of seismic and infrasonic data of Strombolian explosions over 10 months (15 November 2018–15 September 2019) using a Self-Organizing Map (SOM) neural network to recognize changes in the eruptive patterns of Stromboli that preceded the paroxysms. We used a dataset of 14,289 events. The SOM analysis identified three main clusters that showed different occurrences with time indicating a clear change in Stromboli’s eruptive style before the paroxysm of 3 July 2019. We compared the main clusters with the recordings of the fixed monitoring cameras and with the Ground-Based Interferometric Synthetic Aperture Radar measurements, and found that the clusters are associated with different types of Strombolian explosions and different deformation patterns of the summit area. Our findings provide new insights into Strombolian eruptive mechanisms and new perspectives to improve the monitoring of Stromboli and other open conduit volcanoes.

Socioeconomic and cultural factors coupled with an inability to control many endemic and emerging diseases have resulted in a growing incidence of epilepsy cases in Latin America. This study aimed to analyze and describe scientific research output trends in epilepsy research for the period 1989–2018. Publications were extracted from Scopus indexed journals. Bibliometric analysis was used to analyze scientific output including number of annual publications, documents, and publication characteristics. A mapping analysis using VOSviewer software visualized collaborative network analysis, co-citation analysis, and keyword co-occurrence analysis. SciVal quantitatively analyzed distribution of countries, institutions, citation counts, H-index, and research collaborative partnerships. A total of 176507 records were initially retrieved after which 5636 were analyzed. Overall, an increasing trend for publication output was observed from 19 articles in 1989 to 342 in 2018; the number of publications significantly increased over the past 20 years (p = 0.0065). The majority of publications were original articles (74.4%). Brazil had the most scientific production (55.2%), followed by Mexico (15.4%) and Argentina (10%). Extra-regional collaboration was primarily with the United States, United Kingdom, and Canada; intraregional collaboration was low. The most common area of investigation by co-occurrences was ''diagnostic research'' (37.2%), with studies based on electroencephalography and nuclear magnetic resonance. Epilepsy research in Latin America has seen a steady growth with significant increases over the past 20 years. Brazil, Mexico, and Argentina are the most productive countries in the field collaborating primarily with extra-regional countries of high-income.

A Política Nacional de Resíduos Sólidos (PNRS), instituída pela Lei nº 12.305/10, tem como meta a redução do percentual de resíduos úmidos disposto em aterros em aproximadamente 50% até 2031. Tal medida será responsável pelo aumento da vida útil dos aterros sanitários amenizando o problema de falta de locais apropriados para a instalação de novos aterros principalmente próximos a grandes centros urbanos. As usinas de triagem e compostagem e outros métodos descentralizados são alternativas para alcançar essa meta que depende de um esforço de todos que geram esse tipo de resíduo para que o processo seja otimizado. A separação na fonte por parte dos gestores e consumidores aliada a uma coleta seletiva eficaz, e um método de compostagem eficiente e economicamente viável, são os pilares que sustentam uma gestão sanitária esperada dos resíduos sólidos domésticos. A compostagem é uma técnica simples de tratamento de resíduos sólidos orgânicos mas que precisa de conhecimento e controle de alguns parâmetros para garantir a qualidade do composto final. Nesse trabalho foi avaliado o estado da arte do processo de monitoramento de compostagem de resíduos sólidos urbanos no Brasil baseado no levantamento e análise de material bibliográfico. Desses 122 documentos foram selecionados 32 tendo como critério a utilização de experimento em que tivesse ocorrido o monitoramento, para identificar os materiais e parâmetros mais utilizados, compreendendo um recorte temporal de 2000 a 2017. Os principais parâmetros que quando alterados podem influenciar na compostagem são: a temperatura, umidade, pH, aeração, relação carbono:nitrogênio, granulometria, dimensão das leiras e os microrganismos envolvidos no processo. Entretanto, os mais utilizados para monitoramento são o pH, a temperatura e a umidade. É importante ressaltar que esses parâmetros apontam para os limites operacionais do processo, ou seja, a má condução técnica da compostagem pode acarretar desde a produção de um composto final de baixa qualidade, a morosidade do processo até a impossibilidade de se realizar a compostagem.

Abstract The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.

ABSTRACT It is essential for health care providers to be familiared with the full spectrum of clinical presentations of syphilis. We present herein a case of syphilide psoriasiforme, an uncommon but well recognized clinical presentation of secondary syphilis. A 46-year-old HIV-infected female patient was referred to our attention with a presumptive diagnosis of palmoplantar psoriasis. On examination, there were exuberant pinkish-red papules and plaques covered with a thick silvery scale in the palms, flexor surfaces of the wrists, and the medial longitudinal arches of the feet. Serological and histopathological analyses uncovered the diagnosis of syphilis. Clinical remission was obtained after treatment. A detailed review of the literature on syphilide psoriasiforme, including descriptions from older syphilology textsis provided. The present case report emphasizes the need for clinicians to have a heightened awareness of the varied and unusual clinical phenotypes of syphilis.