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Introduction: Complete radical resection is crucial for successfully treating thymic carcinomas. However, when the invasion of the great vessels or the heart in Masaoka III and IV stages occurs, the management poses more challenges. The R0 resection often requires neoadjuvant treatment. We present an example of a debatable case in which a treatment decision was guided by an imminent risk to the patient's life., Case Description: We report the case of a 74-year-old female with a mediastinal mass invading the superior vena cava (SVC) and the right atrium (RA), which was successfully treated with radical resection. The procedure under the femoro-femoral CardioPulmonary Bypass (CPB) included resection of the right intra-auricular mass and the SVC followed by the interposition of a Gore-Tex conduit between the left innominate vein and RA and also wedge resection of the upper left (LUL) and right lobes (RUL). A final histopathological examination confirmed the diagnosis of squamous cell carcinoma., Conclusions: Complete radical resection is essential for successful treatment and represents the most significant prognostic factor.

To date, quantitative analysis of proanthocyanidin (PAC) containing materials including plant extracts and fractions depends on colorimetric assays or phloroglucinolysis/thiolysis combined with UV-HPLC analysis. Such assays are of limited accuracy, particularly lack specificity, require extensive sample preparation and degradation, and need appropriate physical reference standards. To address this analytical challenge and toward our broader goal of developing new plant-sourced biomaterials that chemically and mechanically modulate the properties of dental tissue for clinical interventions, we have characterized 12 different PAC DESIGNER (Depletion and Enrichment of Select Ingredients Generating Normalized Extract Resources) materials. The DESIGNER approach is carried out by using either centrifugal partition chromatography (CPC) or size-exclusion chromatography (SEC) for the selective enrichment of trimeric and tetrameric PACs. Moreover, the rare but biologically interesting A-type PAC DESIGNERs can now be generated successfully from their natural AB-type PAC precursors via phenol-oxidative intramolecular coupling initiated by a mixture of the stable radicals, 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO). Furthermore, to ensure the quality and stability of PAC DESIGNER materials, we developed a quantitative analysis of the total PAC content of the DESIGNER materials in the form of a quantitative NMR (qNMR) method using a non-PAC internal calibrant combined with diol-HPLC. The total PAC content was, thus, determined to be in a range of 67.5-96.9% by qNMR. We highlight the complementarity of diol-HPLC and qNMR to accurately assess the amount of PACs across a range of concentrations and PAC stability in the DESIGNER materials. This quantitative methodology paves the way to generate standardized DESIGNER and other PAC-containing materials and to perform rigorous quality control for dental (pre)clinical studies of PACs.

Crohn's Disease and Ulcerative Colitis, the main types of Inflammatory Bowel Disease (IBD), are life-threatening gastrointestinal disorders with no definitive cure. The establishment of biorelevant in vitro models that closely recapitulate the IBD microenvironment is of utmost importance to validate newly developed IBD therapies. To address the existing flaws in the current representation of the IBD microenvironment, we propose a novel three-dimensional (3D) in vitro model comprising a multi-layered gastrointestinal tissue with functional immune responses under inflammatory conditions. The multi-layered architecture consists of a lamina propria-like hydrogel with human intestinal fibroblasts (HIF), supporting an epithelial layer composed of Caco-2 and HT29-MTX cells, along with an endothelial layer surrogating the absorptive capillary network. A collagen-alginate composite matrix was optimized for the lamina propria-like hydrogel, preserving HIF metabolic activity and morphology over time. To achieve immune competence, pre-differentiated THP-1-derived macrophages were incorporated into the epithelial barrier. Inflammation was induced through the optimization of an inflammatory cocktail consisting of E. coli O111:B4 lipopolysaccharide combined with a specialized cytokine array (tumor necrosis factor-α, interferon-γ, and interleukin-1β). This inflammation-inducing stimulus led to a significant upregulation of pro-inflammatory cytokines commonly associated with IBD onset, including CCL20, IL-6, CXCL9 and CXCL10. Altogether, this 3D in vitro model has the potential to accelerate the drug development pipeline by providing reliable permeability and efficacy outputs for emerging therapies, reducing unnecessary animal experiments. Moreover, it offers a valuable in vitro platform for studying IBD pathophysiology and cell interplay dynamics., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Phage therapy offers a promising alternative for treating serious infections, including diabetic foot ulcers (DFUs), through the lytic action of phages. This randomized double-blind study was conducted to evaluate the safety and tolerability of the TP-102 bacteriophage cocktail in patients with DFUs non-infected and infected with Staphylococcus aureus, Pseudomonas aeruginosa, and/or Acinetobacter baumannii., Methods: Nineteen participants with DFUs were randomized after susceptibility testing. TP-102 was applied topically at 10⁹ plaque-forming units (PFUs)/mL/cm³ to the target ulcer: 1 week for non-infected DFUs and 28 days for infected DFUs (PEDIS grade 2/3). The study was conducted in Israel., Findings: Main outcomes included the incidence and severity of TP-102-related adverse events, microbiological data, and ulcer healing. Thirteen patients received TP-102. No treatment-related adverse events were reported. Although the study was underpowered to determine the superiority of TP-102 over placebo, a greater proportion of patients in the TP-102 + standard of care (SOC) group showed microbiological reduction of target bacteria (t = 26) compared to the placebo + SOC group (80% versus 50%, p = 1.000). Additionally, a higher proportion of TP-102 patients reached 50% and 75% wound closure compared to placebo (5/7 [71.4%] versus 1/3 [33.3%], p = 0.500 and 2/7 [28.6%] versus none, p = 1.000, respectively). One patient in the TP-102 group achieved wound closure., Conclusions: TP-102 was well tolerated and safe, showing potential as a groundbreaking treatment in this field. Further studies are needed to confirm its safety and efficacy in larger populations with diabetic foot infections (ClinicalTrials.gov: NCT04803708)., Funding: None to declare., Competing Interests: Declaration of interests R.N.-P. has been a scientific consultant for BiomX and has participated in and served as a PI and on data safety monitoring boards for a clinical trial by Technophage. R.B.-A. has actively contributed to clinical boards with GlaxoSmithKline and Merck Sharp and has also been involved in lecturing events associated with Teva and Gilead Sciences. S.C.-R. and C.L. participated in a clinical trial by Technophage as cohort escalation committee and safety review committee members, respectively; they are inventors in Technophage’s patents. M.G. is a board member of Technophage S.A., Vector B2B, and LxBio Pharmaceuticals S.A., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Prominent ear deformities often result from a combination of hypertrophic conchal cartilage and an underdeveloped antihelical fold. Traditional otoplasty techniques, such as antihelical folding sutures and conchal setback maneuvers, may introduce tension and risk of relapse, leading to suboptimal aesthetic outcomes. The PILLARS CONCEPT: represents an alternative surgical approach specifically designed to address hypertrophic concha, ensuring stable and natural results.This study aimed to present the Pillars Concept as an alternative method for correcting hypertrophic conchal cartilage, highlighting its advantages over traditional techniques, and evaluating its effectiveness in maintaining long-term stability of the ear's position without relapse.A retrospective analysis was conducted on 89 patients who underwent otoplasty utilizing the Pillars Concept. The technique involves selective transection of two supporting pillars located in the superior and inferior conchal regions after partial resection of the hypertrophic concha. This releases the conchal cartilage and enables tension-free repositioning of the auricular framework.Of the 89 cases, no hypertrophic concha recurrences were noted during follow-up periods. Complications were minimal, with only two patients (2.2%) experiencing a sensation of "glued ears" following complete conchal resection. Retroauricular fullness was observed in two cases (2.2%) after conchal setback, primarily due to inadequate management of the residual cartilage length. Patient satisfaction was high, and the natural aesthetic of the auricle was consistently preserved.The Pillars Concept provides a reliable, tension-free method for addressing hypertrophic conchal cartilage in otoplasty, preserving the natural ear anatomy and ensuring long-term stability without the risk of relapse. This technique should be considered a valuable addition to the armamentarium of otoplasty procedures., Competing Interests: None declared., (Thieme. All rights reserved.)

This study aims to explain our experience with dorsal preservation osteotomies, focusing on transverse, lateral, and dorsal aesthetic lines (DAL) osteotomies. We describe the utilization of a variety of surgical instruments, including osteotomes, saws, burrs, and piezo. This paper describes our concept of transcutaneous ultrasonic osteotomy, microedged-specific osteotomy, applying drills for lateral wall reshaping, and integrating piezo technology to establish new DAL. Furthermore, we present a radix-skull base computed tomography series analysis to evaluate the safety of transverse and radix osteotomies., Competing Interests: None declared., (Thieme. All rights reserved.)

In 2023, a second wave of the global mpox epidemic, which is mainly affecting men who have sex with men (MSM), was observed in some countries. Herein, we benefited from a large viral sequence sampling (76/121; 63%) and vast epidemiological data to characterise the re-emergence and circulation of the Monkeypox virus (MPXV) in Portugal during 2023. We also modelled transmission and forecasted public health scenarios through a compartmental susceptible-exposed-infectious-recovered (SEIR) model. Our results suggest that the 2023 mpox wave in Portugal resulted from limited introduction(s) of MPXV belonging to C.1.1 sublineage, hypothetically from Asia, followed by sustained viral transmission and potential exportation to other countries. We estimated that the contribution of the MSM high sexual activity group to mpox transmission was 120 (95% CrI: 30-3553) times higher than that of the low sexual activity group. However, among the high sexual activity group, vaccinated individuals likely contributed approximately eight times less [0.123 (95% CrI: 0.068-0.208)] than the unvaccinated ones. Vaccination was also linked to potential reduced disease severity, with a Mpox Severity Score of 6.0 in the vaccinated group compared to 7.0 in unvaccinated individuals. Scenario analysis indicated that transmission is highly sensitive to sexual behaviour, projecting that a slight increase in the MSM sub-population with high sexual activity can trigger new mpox waves. This study strongly supports that continued vaccination, targeted awareness among risk groups and routine genomic epidemiology is needed to anticipate and respond to novel MPXV threats (e.g. global dissemination of clade I viruses).

Vascular calcification (VC) is a complex process involving vascular smooth muscle cell (VSMC) osteogenic differentiation, inflammation, and extracellular vesicle (EV) calcification and communication networks. Gla rich protein (GRP) is a calcification inhibitor involved in most of these processes. However, the molecular mechanism of GRP in VC and the specific characteristics, cargo, and functionality of calcifying EVs require further elucidation. Here, we use a combination of human ex vivo aortic fragments and primary vascular smooth muscle cell (VSMC) models to obtain new information on GRP function in VC and EVs released by VSMCs. We demonstrate that GRP inhibits VSMC osteogenic differentiation through downregulation of bone-related proteins and upregulation of mineralization inhibitors, with decreased mineral crystallinity in EVs deposited into the tissue extracellular matrix (ECM). EVs isolated by ultracentrifugation at 30K and 100K from the cell media (CM) and deposited in the ECM from control (CTR) and mineralizing (MM) VSMCs were biochemically, physically, and proteomically characterized. Four different EV populations were identified with shared markers commonly present in all EVs but with unique protein cargo and specific molecular profiles. Comparative proteomics identified several regulated proteins specifically loaded into MM EV populations associated with multiple processes involved in VC. Functional analysis demonstrated that 30K and 100K ECM-MM EVs with higher calcium and lower GRP levels induced macrophage inflammation. Our findings reinforce the functional relevance of GRP in multiple VC processes and suggest that ECM EVs released under calcification stress function as a new signaling axis on the calcification-inflammation cycle.

Objectives: Age is an important factor weighing on revascularization decisions. We analysed long-term health outcomes of young patients with low-complexity coronary anatomy suitable for both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), according to revascularization strategy., Methods: Patients 60 years old or less, undergoing invasive coronary angiography between January 2007 and December 2015, presenting with proximal left anterior descending artery involvement, left main or multivessel disease and a SYNTAX Score ≤22 were retrospectively selected. An inverse probability of treatment weight methodology generated a pseudopopulation with well-balanced characteristics, which was used to estimate the average treatment effect between PCI (n = 374) and CABG (n = 173)., Results: Mean age was 53 ± 7 years old, 27% had diabetes mellitus and 48% presented with an acute coronary syndrome. Mean SYNTAX score was 13.6 ± 4.9 and 68% underwent PCI as index revascularization strategy. In the weighed population, the adjusted hazard of the primary end-point of all-cause death at total follow-up (median 9.3 years; interquartile range 6.9-11.7) was 0.40 (95% confidence interval 0.19-0.7) for CABG vs PCI (incidence rate 5.8 vs 14.0 deaths/1000-person-years). Accounting for death as competing risk, the cumulative hazard of new revascularization (sub-distribution hazard ratio 0.72; 95% confidence interval 0.32-1.25) and any cause hospital readmission (sub-distribution hazard ratio 0.70; 95% confidence interval 0.41-1.07) were lower in CABG patients, as opposed to death/stroke rates at 30 days which were higher with CABG (0.3% vs 1.7%; risk ratio = 5.84)., Conclusions: In this quasi-experimental analysis of young patients with coronary artery disease and an equivalent indication for both PCI and CABG, long-term health outcomes were favourably associated with CABG, as compared to PCI. These observations support the need for dedicated randomized trials with longer follow-up in order to better inform lifetime treatment options., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: Atrial septal defects (ASD) often go unrecognized until very late in life. The impact of ASD closure on life expectancy in elderly patients remains unclear. This study compares the survival of patients≥65-years who underwent ASD closure with their average life expectancy (ALE)., Methods: Single-centre retrospective study including all patients ≥65-years who underwent ostium secundum (OS) ASD closure (surgical/percutaneous) between 1998-2020. Baseline characteristics and the predicted peri-procedural ALE (as determined per pre-defined national ALE tables) for every given patient were assessed., Results: 706 patients underwent OS ASD closure, 37 (5%) had ≥65 years-mean age 69±5 years, 62% presented with heart failure. Mean ASD size=21±9mm, 22% patients had severe tricuspid regurgitation, mean systolic pulmonary artery pressure (SPAP)=50±11mmHg. Five patients were treated surgically. At a mean follow-up of 9±5 years, mortality rate was 46%, occurring 8.8±5.3 years after the procedure. 25 (68%) outlived their predicted ALE. Overall, the mean age of death did not differ from the predicted ALE (79±6 vs. 84±1 years, p=0.304), however there was a 10-year absolute difference between patients who died prematurely vs. those who surpassed ALE (77±4 vs. 87±3 years, p<0.001). Patients who failed to reach ALE had higher SPAP (58±10 vs. 46±8mmHg, p=0.001) and a higher incidence of severe tricuspid regurgitation (42 vs. 12%, p=0.040)., Conclusion: Survival after late ASD closure was comparable to the expected ALE, though one-third of the patients died prematurely. Higher SPAP and severe tricuspid regurgitation were associated with premature death. ASD closure in elderly requires a thorough evaluation to ensure maximum benefit., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Insufficient evidence regarding how maternal undernutrition affects craniofacial bone development persists. With its unique focus on the impact of gestational protein restriction on calvaria and mandible osteogenesis, this study aims to fill, at least in part, this gap. Female mice were mated and randomized into NP (normal protein) or LP (low protein) groups. On the 18th gestational day (GD), male embryos were collected and submitted to microtomography (µCT), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), PCR, and autophagy dynamic analyses. The study shows that the LP offspring exhibited lower body mass than the NP group, with µCT analysis revealing no volumetric differences in fetus's head. EDS analysis showed lower calcium and higher phosphorus percentages in mandibles and calvaria. SEM assessment evidenced higher hydroxyapatite crystal-like (HC) deposition on the calvaria surface in LP fetus. Conversely, lower HC deposition was observed on the mandible surface, suggesting delayed matrix mineralization in LP fetuses with a higher percentage of collagen fibers in the mandible bone. The autophagy process was reduced in the mesenchyme of LP fetuses. PCR array analysis of 84 genes revealed 27 genes with differential expression in the LP progeny-moreover, increased mRNA levels of Akt1, Mtor, Nfkb, and Smad1 in the LP offspring. In conclusion, the results suggest that gestational protein restriction anticipated bone differentiation in utero, before 18GD, where this process is reduced compared to the control, leading to the reduction in bone area at 15 postnatal day previously observed. These findings provide insights into the molecular and cellular mechanisms of mandible development and suggest potential implications for the Developmental Origins of Health and Disease (DOHaD)., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

This study analyzed a recently developed bone substitute biomaterial made of chitosan-xanthanhydroxyapatite-graphene oxide (CXHAG). The CXHAG particles underwent in vitro structural and morphological characterization, and in vivo testing with or without osteogenic conditioned medium from mesenchymal stem cells. Aim: The aim of this study was to determine whether the CXHAG novel biomaterial, supplemented with conditioned medium from mesenchymal stem cells, could be useful for bone regeneration. Materials and Method: For the in vitro study, cells were incubated with 20mg of CXHAG granules for 24 hours and a MTT assay was performed to tests for cytotoxicity. For the in vivo study, critical size calvarial bone defects were created in twenty-five rats. One animal had the defect unfilled (Control Group-CG) and was euthanized after 42 days. Twelve rats received the CXHAG particles (Group 1-G1) and the other twelve received the CXHAG particles supplemented with the conditioned medium (Group 2-G2). All G1/G2 grafts were covered with a CXHAG membrane. G1/G2 animals were euthanized after 14 days (T1) or 42 days (T2). The specimens were processed and histologically evaluated. Results: SEM analysis of the CXHAG particles showed granules of 300-400μm, with a rough irregular surface. They were not cytotoxic to dental pulp stem cells in vitro. The CG specimen showed loose immature connective tissue and no bone formation at the center of the defect. G1 and G2 presented remnant biomaterial particles at both time points, but only G2 had bone formation at the enter of the defect. Conclusions: The conditioned medium had a positive effect on bone regeneration in rat calvarial critical size defects when associated with the novel bone substitute biomaterial., Competing Interests: The authors declare no conflicts of interest concerning the publication of this article, (SAIO.)

Dermabacter hominis is a gram-positive facultative anaerobic agent. It is a human skin colonizer that can be responsible for opportunistic infections in immunocompromised patients. To date, the infections caused by this agent are related to bone, joint, eye, peritoneal dialysis catheters, abscesses or infected vascular grafts. Overall, it has a favorable outcome with good response to vancomycin, teicoplanin or linezolide, and so it has not been considered a concerning pathogenic agent. We present the first case in scientific literature with isolation of D. hominis in pericardial fluid in the setting of infectious bacterial pericarditis, with an aggressive course and poor evolution., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Lima Lopes et al.)

The aim of this study was to assess the effect of adding arginine at different concentrations to commercial and experimental orthodontic resins on shear bond strength (SBS), as well as on the antimicrobial activity of arginine against S. mutans. Metal brackets were bonded onto the surface of 120 bovine incisors using Transbond, OrthoCem, and an experimental resin (ER), adding 0, 2.5, 5, and 7 wt.% of arginine. The SBS test was performed in deionized water at 37 ºC for 24 h, at 0.5 mm/min. SBS test results were subjected to two-way ANOVA and Tukey's test (α = 0.05). CFU/mL data (antimicrobial assessment) were assessed by Kruskal-Wallis and Dunn's tests (α = 0.05). No statistical difference between the resins was observed in untreated groups (p > 0.05). The addition of arginine at 2.5% (27.7 MPa) and 5% (29.0 MPa) increased the SBS of Transbond when compared (p < 0.05) to OrthoCem (18.5 and 15.6 MPa, respectively) and ER (16.3 and 18.1 MPa, respectively). Arginine at 7% improved the SBS of Transbond (24.1 MPa) and ER (21.0 MPa), which was statistically higher (p < 0.05) than OrthoCem (12.6 MPa). OrthoCem did not show a statistically significant difference at the three concentrations of arginine (p > 0.05). The addition of arginine to resins reduced the count of S. mutans (p < 0.05). As for ER, all concentrations of arginine significantly decreased CFU/mL (p < 0.05). Among commercial resins, only 7% of arginine significantly reduced CFU/mL. The addition of arginine did not interfere with the bond strength and demonstrated antibacterial activity against S. mutans.

The saphenous vein graft (SVG) remains the most used conduit as a second graft in Coronary Artery Bypass Grafting (CABG).1 Traditionally, surgeons harvest SVG with an open approach, making a long incision along the medial part of the leg or thigh. This procedure can potentially result in important complications, such as delayed wound healing, postoperative pain and infection.2 Thus, less invasive techniques for vessel harvesting have grown in popularity. Endoscopic vein harvesting (EVH) is a minimally invasive harvesting procedure, which only requires a short incision, leading to less wound complications and a faster return to normal daily activities. This article intends to describe how we do EVH technique in our centre, from the preparation of the patient to the postoperative period and share some tips and tricks from our experience.

The objective of this study was to synthesize and characterize porous Cellulose Acetate (CA) scaffolds using the electrospinning technique and functionalize the surface of the scaffolds obtained through the dip-coating method with a Hydroxyapatite (HA) nanocomposite and varying concentrations of graphene oxide (GO) for application in tissue engineering regeneration techniques. The scaffolds were divided into four distinct groups based on their composition: 1) CA scaffolds; 2) CAHAC scaffolds; 3) CAHAGOC 1.0% scaffolds; 4) CAHAGOC 1.5% scaffolds. Scaffold analyses were conducted using X-ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), Raman Spectroscopy, Scanning Electron Microscopy with Energy Dispersive Spectroscopy (SEM/EDS), and in vitro cell viability assays (WST). For the biological test analysis, Variance (two-way) was used, followed by Tukey's post-test (α = 0.05). The XRD results revealed the predominant presence of CaP phases in the CAHAC, CAHAGOC 1.0%, and CAHAGOC 1.5% groups, emphasizing the presence of HA in the scaffolds. FTIR demonstrated characteristics of cellulose and PO4 bands in the groups containing HA, confirming the presence of CaP in the synthesized materials, as also indicated by XRD. Raman spectroscopy showed the presence of D and G bands, consistent with GO, confirming the successful incorporation of the HAGO nanocomposite into the scaffolds. The micrographs displayed overlapping electrospun fibers, forming the three-dimensional structure in the produced scaffolds. It was possible to observe hydroxyapatite crystals filling some of these pores, creating a suitable structure for cell adhesion, proliferation, and nutrition, as corroborated by the results of in vitro tests. All scaffolds exhibited high cell viability, with significant cell proliferation. Even after 48 h, there was a slight reduction in the number of cells, but a noteworthy increase in cell proliferation was evident in the CAHAGOC 1.5% group after 48 h ( p  < 0.05). In conclusion, it can be affirmed that the produced scaffolds demonstrated physical and biological characteristics and properties capable of promoting cell adhesion and proliferation. Therefore, they represent significant potential for application in tissue engineering, offering a new perspective regarding techniques and biomaterials applied in regenerative therapies., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Rhinoplasty is one of the most complex and challenging procedures in plastic surgery, even for experienced surgeons. Among the steps leading to an aesthetic and functional nose, there is the nasal tip improvement. Today's approach to nasal tip is the product of different techniques shifting through time, mainly from a resection tendency, to preservation and suture use to reshape cartilages. Addressing the lateral crura is vital to an aesthetic nasal tip and it is frequently obtained by adequate suture techniques. The alar-spanning suture described by Perkins is one of such. Regardless of its importance, it was not able to improve convex crura in some cases. The inverted alar-spanning suture (ISS) is an adaptation designed to treat those cases with the suture alone. ISS is a novel technique that can lead to better results treating the convex lateral crura by distributing the force vector in a more effective way. New techniques in rhinoplasty have multiplied, bringing this procedure to a new level and keeping up with the updated notion of restoration instead of excision the ISS is a new, precise, approach to an old problem., Competing Interests: None declared., (Thieme. All rights reserved.)

Left ventricular (LV) hypertrophy is a common finding in patients with severe aortic stenosis (AS). Cardiac magnetic resonance (CMR) is the gold-standard technique to evaluate LV remodeling. Our aim was to assess the prevalence and describe the patterns of LV adaptation in AS patients before and after surgical aortic valve replacement (AVR). Prospective study of 130 consecutive patients (71y [IQR 68-77y], 48% men) with severe AS, referred for surgical AVR. Patterns of LV remodeling were assessed by CMR. Besides normal LV ventricular structure, four other patterns were considered: concentric remodeling, concentric hypertrophy, eccentric hypertrophy, and adverse remodeling. At baseline CMR study: mean LV indexed mass: 81.8 ± 26.7 g/m 2 ; mean end-diastolic LV indexed volume: 85.7 ± 23.1 mL/m 2 and median geometric remodeling ratio: 0.96 g/mL [IQR 0.82-1.08 g/mL]. LV hypertrophy occurred in 49% of subjects (concentric 44%; eccentric 5%). Both normal LV structure and concentric remodeling had a prevalence of 25% among the cohort; one patient had an adverse remodeling pattern. Asymmetric LV wall thickening was present in 55% of the patients, with predominant septal involvement. AVR was performed in 119 patients. At 3-6 months after AVR, LV remodeling changed to: normal ventricular geometry in 60%, concentric remodeling in 27%, concentric hypertrophy in 10%, eccentric hypertrophy in 3% and adverse remodeling (one patient). Indexes of AS severity, LV systolic and diastolic function and NT-proBNP were significantly different among the distinct patterns of remodeling. Several distinct patterns of LV remodelling beyond concentric hypertrophy occur in patients with classical severe AS. Asymmetric hypertrophy is a common finding and LV response after AVR is diverse., (© 2024. The Author(s).)

X-ray imaging plays a crucial role in diagnostic medicine. Yet, a significant portion of the global population lacks access to this essential technology due to a shortage of trained radiologists. Eye-tracking data and deep learning models can enhance X-ray analysis by mapping expert focus areas, guiding automated anomaly detection, optimizing workflow efficiency, and bolstering training methods for novice radiologists. However, the literature shows contradictory results regarding the usefulness of eye-tracking data in deep-learning architectures for abnormality detection. We argue that these discrepancies between studies in the literature are due to (a) the way eye-tracking data is (or is not) processed, (b) the types of deep learning architectures chosen, and (c) the type of application that these architectures will have. We conducted a systematic literature review using PRISMA to address these contradicting results. We analyzed 60 studies that incorporated eye-tracking data in a deep-learning approach for different application goals in radiology. We performed a comparative analysis to understand if eye gaze data contains feature maps that can be useful under a deep learning approach and whether they can promote more interpretable predictions. To the best of our knowledge, this is the first survey in the area that performs a thorough investigation of eye gaze data processing techniques and their impacts in different deep learning architectures for applications such as error detection, classification, object detection, expertise level analysis, fatigue estimation and human attention prediction in medical imaging data. Our analysis resulted in two main contributions: (1) taxonomy that first divides the literature by task, enabling us to analyze the value eye movement can bring for each case and build guidelines regarding architectures and gaze processing techniques adequate for each application, and (2) an overall analysis of how eye gaze data can promote explainability in radiology., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: This study aimed to evaluate the influence of different manufacturing procedures (Eli annealed - hot work versus cold worked - cold work) of the raw material under mechanical properties and morphological characteristics of orthodontic miniscrews (MS)., Material and Methods: Thirty MS were randomly separated into 3 types (n=10) according to manufacturer and manufacturing process of the raw material: type A - SIN® annealed (control group); type B - Dentfix® annealed; and, type C - Dentfix® cold worked. MI were inserted in artificial bone blocks, through the manufacturer's specific manual key attached to the digital torquemeter stabilized via custom device. Data of fracture's occurrence was performed using Fisher's exact test. Comparisons between the other two types regarding insertion torque and removal torque were performed using the Mann-Whitney test. Data of fracture torque, shear stress, normal stress and torque ratio was submitted to Kruskal Wallis and Dunn tests (α=0.05). Representative images of surface morphology and fractures were selected., Results: Type C showed statistically the lowest fracture torque (N.cm) (26.11±0.41) (P=0.0012) and highest torque ratio (%) (98.74±0.85) (P=0.0007). Type C showed statistically higher calculated shear (MPa) (2,432.73±508.41) and normal stress (MPa) (1,403.86±293.39) than type B and type A, showing that they differed in relation to the mechanical strength of the material with which they were made (P=0.0007)., Conclusion: Type A fractured completely inside the most apical bone. Type B and type C fractured closer to the transmucosal profile. Cold worked process should be more prone to fractures than those annealed raw manufactured., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Inflammatory bowel disease (IBD) encompasses a set of chronic inflammatory conditions, namely Crohn's disease and ulcerative colitis. Despite all advances in the management of IBD, a definitive cure is not available, largely due to a lack of a holistic understanding of its etiology and pathophysiology. Several in vitro, in vivo, and ex vivo models have been developed over the past few decades in order to abbreviate remaining gaps. The establishment of reliable and predictable in vitro intestinal inflammation models may indeed provide valuable tools to expedite and validate the development of therapies for IBD. Three-dimensional (3D) models provide a more accurate representation of the different layers of the intestine, contributing to a stronger impact on drug screening and research on intestinal inflammation, and bridging the gap between in vitro and in vivo research. This work provides a critical overview on the state-of-the-art on existing 3D models of intestinal inflammation and discusses the remaining challenges, providing insights on possible pathways towards achieving IBD mimetic models. We also address some of the main challenges faced by implementing cell culture models in IBD research while bearing in mind clinical translational aspects., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Environmental sustainability is an increasing challenge in the pharmaceutical field, leading to the search for eco-friendly active ingredients. Among natural ingredients, propolis arises as an excellent alternative, being a complex substance with pharmacological properties. This work aims to explore the potential of propolis as a new pharmaceutical ingredient for the replacement of conventional vulvovaginal antifungals. Propolis extracts were obtained by Ultrasound-Assisted Extraction using different solvents (water, water/ethanol (50:50, v / v ), and ethanol). Afterwards, the extracts were characterized regarding total phenolic content (TPC), antioxidant/antiradical activities, radical scavenging capacity, antifungal activity against strains of Candida species, and viability effect on two female genital cell lines. The aqueous extract achieved the best TPC result as well as the highest antioxidant/antiradical activities and ability to capture reactive oxygen species. A total of 38 phenolic compounds were identified and quantified by HPLC, among which ferulic acid, phloridzin and myricetin predominated. Regarding the anti- Candida spp. activity, the aqueous and the hydroalcoholic extracts achieved the best outcomes (with MIC values ranging between 128 and 512 μg/mL). The cell viability assays confirmed that the aqueous extract presented mild selectivity, while the hydroalcoholic and alcoholic extracts showed higher toxicities. These results attest that propolis has a deep potential for vulvovaginal candidiasis management, supporting its economic valorization.

Microbial engineering is a promising way to produce3-HP using biorenewable substrates such as glycerol. However, theglycerol pathway to obtain 3-HPrequires vitamin B-12, which hinders its economic viability. The present work showed that 3-HP can be efficiently produced from glycerol through the β-alanine pathway. To develop a cell factory for this purpose, glycerol was evaluated as a substrate and showed more than two-fold improved 3-HP production compared to glucose. Next, the reducing power was modulated by overexpression of an NADP+ -dependent glyceraldehyde-3-phosphate dehydrogenase coupled with CRISPR-based repression of the endogenous gapA gene, resulting in a 91 % increase in 3-HP titer. Finally, the toxicity of 3-HP accumulation was addressed by overexpressing a putative exporter (YohJK). Fed-batch cultivation of the final strain yielded 72.2 g/L of 3-HP and a productivity of 1.64 g/L/h, which are the best results for the β-alanine pathway and are similar to those found for other pathways., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

Vulvovaginal candidiasis (VVC) persists as a worrying women's healthcare issue, often relying on suboptimal therapeutics. Novel intravaginal dosage forms focusing on improving patient acceptability and featuring improved biopharmaceutical properties could be interesting alternatives to available antifungal products. Different formulations of sponges based on chitosan (Ch), with or without crosslinking and co-formulated with poly(N-vinylcaprolactam) (PNVCL), were produced for the topical administration of clotrimazole (CTZ) and further tested for physicochemical properties, drug release, cytotoxicity and antifungal activity. Results showed that high amounts of CTZ (roughly 30-50 %) could be incorporated into sponges obtained by using a simple freeze-drying methodology. Cross-linking of Ch with ammonia affected the morphology and mechanical features of sponges and shifted the release profile from sustained (around 20 % and 60 % drug released after 4 h and 24 h, respectively) to fast-releasing (over 90 % at 4 h). The combination of PNVCL with non-crosslinked Ch also allowed tuning drug release, namely by increasing the initial amount of CTZ released in simulated vaginal fluid (roughly 40 % after 4 h), as compared to sponges featuring only non-crosslinked Ch. All formulations displayed low toxicity to cell lines derived from the female genital tract, with viability values kept above 70 % after 24 h incubation with sponge extracts. These also allowed maintaining the rapid onset of the antifungal effects of CTZ at minimum inhibitory concentrations ranging from 0.5 to 16 μg/mL for a panel of six different Candida spp. strains. Overall, proposed sponge formulations appear to be promising alternatives for the safe and effective management of VVC., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: Infective endocarditis morbidity and mortality remains high. Surgery is performed in about half of endocarditis cases, being the ideal setting to evaluate endocarditis lesions. The aim of this study was to register and describe endocarditis lesions found during surgery; find predictors of morbidity and mortality and correlate lesions found in echocardiogram vs. surgery., Materials and Methods: One hundred consecutive patients with endocarditis lesions seen during surgery were included between June 2014 and August 2018. Pathological lesions were coded prospectively using a coding form published by Pettersson et al. Other data were collected retrospectively., Results: Prosthetic endocarditis accounted for 23% of cases. Embolic events had occurred in 41% of cases, mainly to the brain (22%). The most frequent lesions found in echocardiogram were vegetations (77%). Vegetations and valve integrity anomalies were the main lesions described during surgery (70% and 71% respectively). Invasion was present in 39% of patients. In-hospital mortality was 9%. In univariable analysis, predictors of early mortality included chronic kidney disease (P= .005), prosthetic valve endocarditis (P <.001), EuroSCORE II (P <.001) and valve integrity anomalies (P=.016). Predictors of embolic events included aortic valve vegetations seen during surgery (P= .026). Sensitivity and specificity of echocardiogram findings for identification of vegetations were 84% and 40%, for valve integrity anomalies 42% and 97% and for invasion 54% and 95%, respectively., Conclusions: Diversity of lesions found in endocarditis precludes obtaining significant predictors of morbidity or mortality with small numbers of patients. Echocardiogram lacks sensitivity for valve integrity anomalies and invasion but is highly specific.

Background: 2020 ESC guidelines for non-ST elevation acute coronary syndromes (NSTE-ACS) recommend against the pretreatment with P2Y12 receptor inhibitors (P2Y12i) in patients undergoing early invasive management (<24 h). The rationale is, in part, to prevent bleeding complications and the delay of coronary artery bypass graft surgery (CABG) in patients with suitable coronary anatomy. This study aimed to analyze the theoretical impact of pretreatment with a P2Y12i on delay to CABG surgery in a real-world population with NSTE-ACS., Methods: Single-center retrospective cohort of consecutive patients with NSTE-ACS undergoing invasive evaluation in 2019. Those with previous CABG or nonobstructive coronary disease were excluded., Results: The total cohort included 262 patients (mean age 68±12 years, 69% male, 15% with unstable angina and mean GRACE score 134±35). Median time from FMC to angiography was 2 (1-4) days. Overall, 168 (64%) patients underwent percutaneous coronary intervention, 47 (18%) were proposed for CABG and the remainder received conservative management. All patients considered for CABG received pretreatment with P2Y12i (clopidogrel or ticagrelor). The median time from angiography to CABG was 12 (7-15) days. Six patients experienced recurrent angina (13%) and 2 (4%) died before surgery due to refractory ventricular fibrillation. Those who underwent CABG under P2Y12i effect were more likely to receive blood and platelets transfusions (64.7% vs. 28.6%, P=0.017 and 82.4% vs. 21.4%, P<0.001, respectively), although there were no differences regarding major bleeding., Conclusions: Pretreatment with P2Y12i was a potential but not the sole driver of CABG delay in our cohort. Adopting the new recommendations of withholding pretreatment might decrease this delay, but other factors must be considered.

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population., (© 2023. The Author(s).)

Mpox is a viral disease caused by the monkeypox virus, which marked the year of 2022 with a global outbreak. While previously considered to be a zoonosis of almost exclusive animal-to-human transmission, the current outbreak has been attributed to human-to-human transmission, particularly sexual transmission. As a new sexually transmissible disease, we studied the epidemiological and clinical features, as well as the concomitant occurrence of other sexually transmissible diseases, treatment approach, and outcome of our 291 patients, in the current outbreak. We found a total of 169 concomitant sexually transmissible infections of bacterial and viral origins, corresponding to 107 patients. Neisseria gonorrhoeae was the most common agent, particularly in the anal location. With this work, we emphasize the need for a thorough epidemiological and medical history, as well as a concomitant complete laboratorial screening for other STIs in patients with confirmed or suspected mpox.

Introduction and Objective: We performed a collective analysis of a dedicated national post-myocardial infarction ventricular septal defect (VSD) registry to further elucidate controversial areas of this clinical entity's surgical treatment., Methods: A descriptive statistical analysis was carried out and cumulative survival using the Kaplan-Meier method and multivariate logistic regression of risk factors for 30-day mortality are presented., Results: Median survival of the cohort (n=76) was 72 months (95% CI 4-144 months). Better cumulative survival was observed in patients who underwent VSD closure more than 10 days after myocardial infarction (log-rank p=0.036). Concomitant coronary artery bypass grafting (CABG), different closure techniques, location of the VSD, extracorporeal membrane oxygenation as bridge to closure, or intra-aortic balloon pump as bridge to closure showed no statistically significant differences at Kaplan-Meier analysis. Multivariate binary logistic regression for independent factors affecting status at 30 days showed a statistically significant effect of age (OR 1.08; 95% CI 1.01-1.15) and concomitant CABG (OR 0.23; 95% CI 0.06-0.90)., Conclusions: Our results are comparable with previous reports regarding mortality, risk factors and concomitant procedures. Timing of surgery remains a controversial issue. Later closure seems to be advantageous, however, there is significant observational bias., (Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aortic pseudoaneurysms can be a potentially fatal, yet rare, complication of heart surgery. Surgery is indicated but is high risk during sternotomy. Therefore, careful planning is required. We report the case of a 57-year-old patient who underwent heart surgery twice in the past and who presented with an ascending aortic pseudoaneurysm. A successful repair of the pseudoaneurysm was performed under deep hypothermia, left ventricular apical venting, periods of circulatory arrest and endoaortic balloon occlusion., (Copyright © 2023. Publicado por Elsevier España, S.L.U.)

This trial evaluated the effect of sex on the blood, growth, carcass, meat quality, and boar taint compounds in male Alentejano (AL) pigs ( n = 30). From ~40 to 130 kg LW, castrated (C) and intact pigs (I and IExp groups) were fed commercial diets ad libitum . Between ~130 and 160 kg (slaughter), C and I pigs continued on commercial diets, while IExp were fed an experimental diet containing locally produced pulses and by-products aimed at reducing boar taint. At ~160 kg, blood urea levels were higher in IExp than C pigs, triacylglycerols were lower in both intact groups, and cortisol was lower in IExp. IExp pigs exhibited faster growth, improved feed conversion ratio, carcass higher commercial yield and leaner meat than C pigs. The loin intramuscular fat in intact pigs was lower, less saturated and more polyunsaturated, while total collagen was higher. Fat androstenone content was higher in intact pigs and skatole content was similar across treatments, although they were below threshold values for consumer detection. Finally, although boar taint compounds were low in intact AL pigs raised outdoors, adding pulses and by-products to the experimental diet did not result in a reduction in fat skatole content compared to pigs fed the commercial diet.

The aim of this study was to quantify the force exerted by tandem archwires in a specific system of passive self-ligating bracket. Forty-eight thermo-activated nickel-titanium orthodontic archwires were separated into four groups (n = 12): G1 - two .014" + .014" round archwires; G2 - two .014" + .016" round archwires; G3 - .014" x .025" rectangular archwire; and. G4 - .016" x .022" rectangular archwire. Brackets were fixed onto teeth 1.5 to 2.5 using a device that represented the upper teeth, maintaining an interbracket distance of 6.0 mm. The deflection tests were performed using the structure representative of tooth 1.1 as support on the Instron testing machine at a speed of 2.0 mm/min. The archwires were evaluated at deflections of 0.5 mm, 1.0 mm, and 1.5 mm. The data were analyzed by a generalized linear model, considering values at different deflections as repeated measurements in the same experimental unit (α = 0.5%). At 0.5 mm, higher forces were observed in G2 and G3, which did not differ significantly (p > 0.05). The lowest force was observed in G4 (p < 0.05). At 1.0 mm and 1.5 mm, the highest force was observed in G3, followed by G4 and G2 (p < 0.05). The lowest force was observed in G1 (p < 0.05). In general, tandem archwires (same or different calibers) in a specific passive self-ligating bracket exerted lower force when compared with rectangular archwires.

Objective: This study assessed the presence of dental biofilm with fluorescence spectroscopy associated with porphyrin (Photogen®) in users of orthodontic appliances., Methods: This cross-sectional observational clinical trial included 21 patients with metallic orthodontic fixed appliances. The presence of biofilm was evaluated by fluorescence spectroscopy (Evince-MMÓptics. São Carlos-SP, Brazil) with a porphyrin photo-evidence device (Photogen®). Digital images of the buccal surface of the upper anterior teeth (central and lateral incisors and canines) without and with porphyrin were analyzed using the histogram R (red) function in ImageJ software. The results were analyzed using the maximum and mode values of the red pixels from the histograms. The statistical analysis considered the significance level of 5%., Results: The maximum values and modes of the red pixels were significantly higher in biofilms analyzed by porphyrin-associated optical spectroscopy compared to optical spectroscopy alone., Conclusions: Porphyrin-associated fluorescence spectroscopy was able to detect dental biofilm in the oral environment of patients with orthodontic treatment. This method better evidenced the presence of biofilm on the buccal surfaces of the upper teeth compared to that observed with fluorescence spectroscopy without porphyrin., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Abstract: Since May 2022, several nonendemic countries face a monkeypox outbreak, with clinic and epidemiological characteristics distinct from the classic ones. Primarily affecting the sexually active population, these cases present with mucocutaneous lesions mainly localized in perioral, genital, and anal areas. A retrospective study was conducted in a tertiary center in Lisbon, to characterize the population diagnosed with monkeypox infection with primarily mucosal involvement., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2022 American Sexually Transmitted Diseases Association. All rights reserved.)

The aim of this paper was to synthesize and characterize polymeric scaffolds of Chitosan/Xanthan/Hydroxyapatite-Graphene Oxide nanocomposite associated with mesenchymal stem cells for regenerative dentistry application. The chitosan-xanthan gum (CX) complex was associated with Hydroxyapatite-Graphene Oxide (HA-GO) nanocomposite with different Graphene Oxides (GO) concentration (0.5 wt%; 1.0 wt%; 1.5 wt%). The scaffolds characterizations were performed by X-ray diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), Raman spectroscopy, thermogravimetric analysis (TGA), scanning electron microscopy (SEM) and contact angle. The mechanical properties were assessed by compressive strength. The in vitro bioactivity and the in vitro cytotoxicity test (MTT test) were analyzed as well. The data was submitted to the Normality and Homogeneity tests. In vitro Indirect Cytotoxicity assay data was statistically analyzed by ANOVA two-way, followed by Tukey's test (α = 0.05). Compressive strength and contact angle data were statistically analyzed by one-way ANOVA, followed by Tukey's test (α = 0.05). XRD showed the presence of Hydroxyapatite (HA) peaks in the structures CXHA, CXHAGO 0.5%,1.0% and 1.5%. FT-IR showed amino and carboxylic bands characteristic of CX. Raman spectroscopy analysis evidenced a high quality of the GO. In the TGA it was observed the mass loss associated with the CX degradation by depolymerization. SEM analysis showed pores in the scaffolds, in addition to HA incorporated and adhered to the polymer. Contact angle test showed that scaffolds have a hydrophilic characteristic, with the CX group the highest contact angle and CXHA the lowest ( p < 0.05). 1.0 wt% GO significantly increased the compressive strength compared to other compositions. In the bioactivity test, the apatite crystals precipitation on the scaffold surface was observed. MTT test showed high cell viability in CXHAGO 1.0% and CXHAGO 1.5% scaffold. CXHAGO scaffolds are promising for regenerative dentistry application because they have morphological characteristics, mechanical and biological properties favorable for the regeneration process.

Topical preparations of hydrocortisone can be used for the anti-inflammatory treatment of the female genital area. Although the drug is a low-strength corticosteroid, systemic absorption and distribution of the drug are the most common safety risks associated with this therapy. In the current investigation, we elucidate the physicochemical properties of lipid-based drug carrier systems that govern the local bioavailability of hydrocortisone for intravaginal administration. For this purpose, we compared various proliposome formulations with a commercial cream. Depending on the availability of physiological acceptors, encapsulation and drug release from the lipid phase were found to be the most important drivers of drug bioavailability. The high permeability of hydrocortisone leads to rapid transport of the drug across the mucosal cell layer as indicated by experiments using HEC-1-A and CaSki cell monolayer models. Under sink conditions, differences in the release from the liposomes as determined in the Dispersion Releaser were almost negligible. However, under non-sink conditions, the drug release plateaued at levels corresponding to the encapsulation efficiency. After redispersion, all liposomal formulations performed better than the commercial drug product indicating that the encapsulation into the lipid phase is the main driver sustaining the release., (© 2022. Controlled Release Society.)

Wound infection treatment with antimicrobial peptides (AMPs) is still not a reality, due to the loss of activity in vivo . Unlike the conventional strategy of encapsulating AMPs on nanoparticles (NPs) leaving activity dependent on the release profile, this work explores AMP grafting to poly(D,L-lactide- co -glycolide)-polyethylene glycol NPs (PLGA-PEG NPs), whereby AMP exposition, infection targeting and immediate action are promoted. NPs are functionalized with MSI-78(4-20), an equipotent and more selective derivative of MSI-78, grafted through a thiol-maleimide (Mal) Michael addition. NPs with different ratios of PLGA-PEG/PLGA-PEG-Mal are produced and characterized, with 40%PLGA-PEG-Mal presenting the best colloidal properties and higher amounts of AMP grafted as shown by surface charge (+8.6 ± 1.8 mV) and AMP quantification (326 μg mL -1 , corresponding to 16.3 μg of AMP per mg of polymer). NPs maintain the activity of the free AMP with a minimal inhibitory concentration (MIC) of 8-16 μg mL -1 against Pseudomonas aeruginosa , and 16-32 μg mL -1 against Staphylococcus aureus . Moreover, AMP grafting accelerates killing kinetics, from 1-2 h to 15 min for P. aeruginosa and from 6-8 h to 0.5-1 h for S. aureus . NP activity in a simulated wound fluid is maintained for S. aureus and decreases slightly for P. aeruginosa . Furthermore, NPs do not demonstrate signs of cytotoxicity at MIC concentrations. Overall, this promising formulation helps unleash the full potential of AMPs for the management of wound infections.

Background: Artificial intelligence (AI) techniques and methodologies for problem solving are emerging as formal tools essential to assist in nursing care. Given their potential to improve workflows and to guide decision making, several studies have been developed; however, little is known about their impact, particularly on decision making., Objective: The aim of this study was to map the existing research on the use of AI in decision making in nursing. With this review protocol, we aimed to map the existing research on the use of AI in nursing decision making., Methods: A scoping review was conducted following the framework proposed by the Joanna Briggs Institute (JBI). The search strategy was tailored to each database/repository to identify relevant studies. The contained articles were the targets of the data extraction, which was conducted by two independent researchers. In the event of discrepancies, a third researcher was consulted., Results: This review included quantitative, qualitative and mixed method studies. Primary studies, systematic reviews, dissertations, opinion texts and gray literature were considered according to the three steps that the JBI has defined for scoping reviews., Conclusions: This scoping review synthesized knowledge that could help advance new scientific developments and find significant and valuable outcomes for patients, caregivers and leaders in decision making. This review was also intended to encourage the development of research lines that may be useful for the development of AI tools for decision making.

Background: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA., Methods: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units., Results: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group., Conclusions: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA., (© 2022. The Author(s).)

Objective: To develop a chitosan-xanthan (CX) membrane associated with Hydroxyapatite (HA) and different concentrations of graphene oxide (GO)., Methodology: The CX complex was associated with the hydroxyapatite-graphene oxide (HAGO) nanocomposite in different concentrations. The experimental groups were:1) CX; 2) Chitosan-Xanthan/Hydroxyapatite (CXHA); 3) Chitosan-Xanthan/Hydroxyapatite-Graphene Oxide 0.5% (CXHAGO 0.5%); 4) CXHAGO 1.0%; 5) CXHAGO 1.5%. The membranes characterizations were performed by X-ray diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), Raman spectroscopy, Scanning Electron Microscopy (SEM), Contact angle, Tensile Strength, in vitro Bioactivity and the in vitro Cell viability (MTT test). The data was submitted to the Normality and Homogeneity tests. In vitro Indirect Cytotoxicity assay data was statistically analyzed by two-way ANOVA and Tukey's test (α = 0.05). Tensile Strength and Contact Angle data were statistically analyzed by one-way ANOVA followed by Tukey's test (α = 0.05)., Results: XRD, FTIR and Raman spectroscopy confirmed the characteristic bands of the CX polymeric complex, the phosphate bands related to HA, and the presence of GO. SEM images demonstrated the non-porous and homogeneous surface of membranes. The contact angle test showed the hydrophilic characteristic of all membranes (p > 0.05). CX showed tensile strength significantly higher than other membranes. The apatite deposition was observed in all membranes after performing the bioactivity test. The cell viability of CXHAGO 1.0% and CXHAGO 1.5% was significantly higher than CX., Conclusion: The addition of HAGO reduced the mechanical strength of membranes, but improved its cell viability. It demonstrated the potential of CXHAGO membranes to be used in guided bone regeneration therapies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Ltd.)

Primary cardiac lymphomas are extremely rare and involve mainly the pericardium. We present the case of a 77-year-old man with a germinal center diffuse large B-cell lymphoma causing severe right ventricular inflow obstruction. Clinical presentation of isolated dyspnea and severe desaturation and cyanosis were, otherwise, unexpected. ( Level of Difficulty: Beginner. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation.)

Purpose: To evaluate in vitro the effect of gastroesophageal reflux, before and after bonding of metal brackets on composite resin surface., Materials and Methods: Two hundred and ten resin discs were divided into 5 groups (n=42), according to the time and medium of storage: 24h, 7- and -30 days in artificial saliva (AS) and hydrochloric acid (HCL). Twelve samples from each group were submitted to surface roughness analysis (n=60). The other one hundred and fifty samples were divided into 3 groups (n=50) according to the bonding material: Transbond™ XT (TXT), 3M™ Filtek™ Z250 (Z250) and 3M™ Filtek™ Z350 XT (Z350). After bonding, the samples were subdivided, one more time, into 5 groups (n=10) according to the time (24h, 7, and 30 days) and medium storage (AS, HCL). Following, the shear bond strength (SBS) analysis was accomplished. Erosive challenge was performed for 7 or 30 days, before and after bonding of orthodontic brackets, for 1min, 4 times a day. SBS was performed in a universal testing machine (Instron) at 0.5mm/min. SBS data were subjected to two-way ANOVA and Tukey's test (α=0.05)., Results: TXT showed higher SBS values in all conditions (AS - 10.9±2.0 (24h); 10.5±4.9 (7 days); 9.4±2.2 (30 days); HCL - 11.5±3.7 (7 days); 8.0±2.1 (30 days)) - (P<0.0001). No statistical difference was detected in SBS between Z250 and Z350 composite resins (Z250 SBS: AS - 7.1±1.9 (24h), 5.2±1.8 (7 days), 4.5±1.5 (30 days); HCL - 5.2±2.3 (7 days), 5.0±2.5 (30 days)) - (P<=0.063)/Z350 SBS: AS - 7.4±1.0 (24h); 3.7±1.7 (7 days); 3.4±1.7 (30 days); HCL - 3.5±3.3 (7 days); 4.4±1.2 (30 days)) - (P<=0.167), respectively). Storage times and media did not statistically influence the SBS of TXT and Z250 composite resins (P>0.05), but did influence the Z350 SBS (P<0.05)., Conclusion: Regardless of time and storage medium, TXT was the best composite resin for bonding brackets. Furthermore, the erosive challenge did not lead to surface changes in the Z250 resin at 7 and 30 days, unlike the Z350 resin., (Copyright © 2022 CEO. Published by Elsevier Masson SAS. All rights reserved.)

A new device was developed to enable the visualization and measurement of canine angulation while at the same time visualizing and measuring the force transmitted to adjacent teeth. This study aimed to evaluate the mesiodistal tilt angle of the upper canine brackets, the wire deflection, and its effects on adjacent teeth with five different slot designs of upper canines. Wires (0.020" and 0.019" x 0.025") were tested on different five bracket types at five different distal angles. The force applied to adjacent teeth was measured as the angle was increased, and its consequences were observed in the posterior and anterior regions as well. The force tension (gf) was measured in a universal testing machine. Data were submitted to a 3-way ANOVA and Tukey's test (α=0.05). For both arches, regardless of the type of tooth and bracket type, the highest means tension mean values were shown by the 20° angle, followed by the 15°,10°, and 5° angles, which differed statistically among themselves. Overall, for 5°, 10°, and 15° angles, conventional and versatile brackets showed significantly higher force values in all teeth, tip-edge and control brackets showed the lowest. The highest force values were observed in central and lateral incisors with conventional and versatile brackets and on first and second premolar teeth with self-ligating passive and control brackets. Conventional brackets presented the highest forces, tip-edge and control brackets showed the lowest. The teeth that suffered the greatest forces were lateral incisors, and those that suffered the least were second premolars.