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Avian photopic curves show energy peaks at different wavelengths than humans, particularly in the ultraviolet, yellow, and red range. Therefore, an illumination system with a spectrum tailored for laying hens, encompassing the entire visible spectrum, can enhance performance and welfare. The primary contribution of this study was the development of two Spectral Power Distributions (SPDs) specifically designed for laying hens, with different spectral proportions (S1 and S2), and the evaluation of their effects on productive performance, egg quality, and hormonal levels, compared to conventional white lighting at 3000 K (C). The SPD with a higher emission of red light to increased egg production and egg mass. It also had a lower melatonin concentration, suggesting an inverse relationship with the egg production rate. Regarding egg quality, SPDs specifically designed for laying hens resulted in eggs with greater weight (S1), shell strength (S2), and yolk height (S1 and S2) and diameter (S2). The study's results indicate that lighting emitting wavelengths within the spectrum visible to poultry, with higher emissions at long wavelengths, appears to be more favorable for laying hens than conventional lighting. A spectrum with higher emissions at shorter wavelengths appears to impair the productive performance of laying hens., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Although there has been a large increase in the number of extensive macular atrophy with pseudodrusen (EMAP) cases, the basic aspects of this disease remain unknown. Brazilian patients have a common past history of rheumatic fever (RF) and/or benzathine penicillin (BP) treatment possibly related to the disease. We analyzed how RF and BP might be correlated with EMAP in Brazilian patients., Design: Observational, retrospective, case-control study., Methods: The databases of three private eye clinics in Brazil were searched for patients with an EMAP-like appearance. Each patient was asked about a previous history of RF and/or long-term use of BP. Patients underwent best-corrected visual acuity (BCVA) measurement, color fundus imaging, fundus autofluorescence (FAF) imaging, optical coherence tomography (OCT) imaging, and electroretinography (ERG). The following characteristics were analyzed: subretinal drusenoid deposits (SDD), pigment mottling, retinal pigment epithelial/basement membrane (RPE/BM) separation, outer retinal or RPE atrophy, and identification of a paving stone-like appearance. The choroidal thickness was measured using enhanced depth imaging OCT. The central atrophic area was measured manually on ultra-wide-field FAF., Results: A total of 154 eyes of 77 patients (women, 66.2%; mean age, 58.6 years) with EMAP were included; 90.9% of patients were diagnosed with RF; 94.8% had been treated with BP and treatment was started at an average age of 7.3 years (mean duration, 11.8 years). The treatment duration was significant for the area of atrophy (P = 0.027) in which each 1-year increase in treatment duration led to an average reduction of 6.91 mm 2 in area. The age at diagnosis of RF was significant (P = 0.026) for SDD. The increase of 1 year in the diagnosis of RF (late disease) led to a reduction of 24% in the chance of central SDD being present. On OCT, 65.5% eyes had SDD and more than 70% had a split RPE/BM and outer retinal or RPE atrophy. The choroidal thickness in patients with EMAP was significantly (P < 0.001) thinner than the control group. The ERG was abnormal in all eyes., Conclusion: These findings may suggest a relation between RF and EMAP in Brazilian patients. Patients with EMAP should be questioned about a history of RF., (© 2024. The Author(s).)

Stricture formation is common in Crohn's disease, and endoscopic intervention plays an increasingly important role in managing these strictures. A 61-year-old man with biological aortic prosthesis and a 30-year history of ileocolonic stricturing Crohn's disease, managed with azathioprine and infliximab, presented with marked occlusive symptoms. Colonoscopy revealed a descending colon stricture, prompting endoscopic balloon dilation. At the time of the procedure, no prophylactic antibiotic was given. Subsequently, he developed Streptococcus gallolyticus endocarditis, necessitating aortic valve replacement. The authors present a case of late Streptococcus gallolyticus endocarditis associated with endoscopic balloon dilation of a Crohn-related colonic stricture., (© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Climate change can have direct and indirect effects on human health. Direct effects can include an increase in extreme weather events, such as heatwaves and floods, as well as an increase in the spread of vector-borne and infectious diseases, which may lead to a set of health problems and diseases. Indirect effects can include changes in air quality, water availability, and food production and distribution. These changes can lead to an increase in respiratory problems, malnutrition, and increased food insecurity. There is a perceived need to investigate the extent to which Higher Education Institutions (HEIs) are engaged in efforts to foster a greater understanding of the connections between climate change and health. In this context, this preliminary investigation offers an overview of the relationships between climate change and health. By means of a survey among teaching staff and researchers at HEIs from 42 countries across all continents working on the connection between climate change and health. The study has investigated the extent to which current provisions for education and training on the connection between climate change and health are being considered and how current needs in terms of policy development, research, and training are being met. A series of case studies illustrate how universities worldwide are actively developing strategies and implementing measures to address climate change and health. The study concludes by providing specific recommendations aimed at facilitating the handling of issues related to climate change and health in a higher education context., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Leal Filho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Pancreatobiliary fistulas associated withntraductal Papillary Mucinous Neoplasm (IPMN) are rare and present therapeutic challenges. The authors describe the clinical course of an 81-year-old woman presenting with acute cholangitis, ultimately diagnosed with IPMN involving secondary ducts with focal high-grade dysplasia. Initial manifestations included elevated inflammatory markers, cholestasis, and imaging findings of a pancreatic lesion. Endoscopic retrograde cholangiopancreatography revealed dilation of both intrahepatic and extrahepatic bile ducts, along a cystic cluster originating from the pancreas, fistulizing into the common bile duct. Despite initial endoscopic interventions, recurrent cholestasis persisted. Subsequent multidisciplinary evaluation led to a cephalic duodenopancreatectomy. This case underscores the rarity of pancreatobiliary fistulas associated with IPMNs and the subsequent therapeutic challenges. The absence of standardized treatment algorithms for such intricate cases emphasizes the importance of individualized approaches. The fluoroscopy image displaying a cystic cluster originating from the pancreas and showing fistulization into the common bile duct is a rare image presented in our report, unique to this case.

Background: Considering the soaring health-related costs directed toward a growing, aging, and comorbid population, the health sector needs effective data-driven interventions while managing rising care costs. While health interventions using data mining have become more robust and adopted, they often demand high-quality big data. However, growing privacy concerns have hindered large-scale data sharing. In parallel, recently introduced legal instruments require complex implementations, especially when it comes to biomedical data. New privacy-preserving technologies, such as decentralized learning, make it possible to create health models without mobilizing data sets by using distributed computation principles. Several multinational partnerships, including a recent agreement between the United States and the European Union, are adopting these techniques for next-generation data science. While these approaches are promising, there is no clear and robust evidence synthesis of health care applications., Objective: The main aim is to compare the performance among health data models (eg, automated diagnosis and mortality prediction) developed using decentralized learning approaches (eg, federated and blockchain) to those using centralized or local methods. Secondary aims are comparing the privacy compromise and resource use among model architectures., Methods: We will conduct a systematic review using the first-ever registered research protocol for this topic following a robust search methodology, including several biomedical and computational databases. This work will compare health data models differing in development architecture, grouping them according to their clinical applications. For reporting purposes, a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flow diagram will be presented. CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies)-based forms will be used for data extraction and to assess the risk of bias, alongside PROBAST (Prediction Model Risk of Bias Assessment Tool). All effect measures in the original studies will be reported., Results: The queries and data extractions are expected to start on February 28, 2023, and end by July 31, 2023. The research protocol was registered with PROSPERO, under the number 393126, on February 3, 2023. With this protocol, we detail how we will conduct the systematic review. With that study, we aim to summarize the progress and findings from state-of-the-art decentralized learning models in health care in comparison to their local and centralized counterparts. Results are expected to clarify the consensuses and heterogeneities reported and help guide the research and development of new robust and sustainable applications to address the health data privacy problem, with applicability in real-world settings., Conclusions: We expect to clearly present the status quo of these privacy-preserving technologies in health care. With this robust synthesis of the currently available scientific evidence, the review will inform health technology assessment and evidence-based decisions, from health professionals, data scientists, and policy makers alike. Importantly, it should also guide the development and application of new tools in service of patients' privacy and future research., Trial Registration: PROSPERO 393126; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=393126., International Registered Report Identifier (irrid): PRR1-10.2196/45823., (©José Miguel Diniz, Henrique Vasconcelos, Júlio Souza, Rita Rb-Silva, Carolina Ameijeiras-Rodriguez, Alberto Freitas. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.06.2023.)

An 84-year-old female, with history of endometrial and gallbladder adenocarcinomas, both submitted to curative surgeries, was admitted to the emergency room with obstructive jaundice. Computed tomography and subsequent magnetic resonance cholangiopancreatography revealed a common hepatic duct stenosis with intrahepatic biliary dilatation. She underwent percutaneous transhepatic cholangiography with successful biliary drainage. During the same admission, the patient experienced episodes of hematochezia. Rectosigmoidoscopy showed a 20 mm ulcer in the distal rectum and congestion of the rectal mucosa. Computed tomography revealed rectal wall circumferential thickening. Ulcer biopsies were compatible with a neoplasia of biliary origin.

Gastric heterotopia (GHT) is a medical condition where the gastric mucosa is found at a non-phyysiological part of the body. GHT can present itself anywhere in the gastrointestinal tract from the mouth to the anorectal area, as well as in the hepatobiliary system. However, it is relatively rare to find GHT in the rectum, with only around 50 documented cases reported in medical literature. We present the case of a 51-year-old man who underwent average-risk screening colonoscopy. He had no clinically significant comorbidities and was otherwise asymptomatic, with no family history. Notable findings included a pseudopolypoid lesion in the distal rectum, adjacent to the dentate line, measuring approximately 15 mm with regular-appearing mucosa under narrow-band-imaging. Biopsy specimens showed histological characteristics of oxyntic-type gastric mucosa without inflammation or dysplasia. GHT has the potential to progress to malignancy, although the rate of malignancy is currently unknown. Awareness of this entity is important given its frequency and potential for misdiagnosis.

Purpose: The purpose of this study was to evaluate rod-mediated function with two-color dark-adapted perimetry (2cDAP) in patients with RPE65-related retinopathy treated with voretigene neparvovec-rzyl., Methods: Following dilation and dark adaptation, 2cDAP and FST were performed. The 2cDAP was measured on an Octopus 900 perimeter (Haag-Streit) with cyan (500 nm wavelength) and red (650 nm wavelength) stimuli. Hill of vision (HOV) analysis was performed on 2cDAP perimetry with Visual Field Modeling and Analysis (VFMA). Full field threshold stimulus testing (FST) was also measured as a secondary measure of rod-mediated function, and assessed on a Diagnosys Espion with the ColorDome stimulator (Diagnosys LLC)., Results: Eight eyes from 4 patients who were treated with voretigene bilaterally had rod function assessed by 2cDAP testing at least 1 year after treatment. There was statistically significant improvement in 2cDAP following gene augmentation therapy. HOV VFMA analysis showed widespread improvements that extended beyond the treatment bleb and statistically significant improvement in HOV analysis volumetric measurements post-treatment to cyan and red stimuli. FST testing performed in six eyes from three patients demonstrated statistically significant improvement to all chromatic stimuli following treatment., Conclusions: These findings demonstrated statistically significant improvement in 2cDAP and FST following treatment with voretigene., Translational Relevance: These findings provide a sensitive method of assessing rod-mediated function in a topographic manner that may be useful in future clinical trials for inherited retinal dystrophies.

Introduction: Helicobacter pylori ( H. pylori ) infection is highly prevalent in Portugal and its eradication is formally recommended. However, the indiscriminate use of antimicrobials has led to a drastic rise in antibiotic resistance, with the failure of traditional eradication schemes. A single-capsule bismuth-based quadruple therapy became recently available in Portugal. This study aims to evaluate the efficacy and safety of a bismuth-based quadruple therapy as a second-line or rescue therapy., Patients and Methods: This was a multicentric study. All consecutive patients that were treated with bismuth-based quadruple therapy, as second-line or salvage treatment between July 2017 and April 2019 were enrolled. Their medical records were reviewed and clinical and laboratorial parameters, as well as data on treatment efficacy and adverse events were retrieved. Patients were also contacted by phone after treatment to confirm compliance, adverse events, and global satisfaction with this specific therapy., Results: A total of 151 subjects were included (female-68.9%; mean age-56 ± 13.5 years). Patients were previously submitted to 212 eradication schemes (Median-1; 1-5; IQR:4): 33.5% triple clarithromycin-based, 25% sequential, 7.5% concomitant, 5.2% others, and in 28.8% it was not possible to know the previous eradication scheme(s) followed by the patient. The PPI of choice was esomeprazole (39.7%), followed by omeprazole (27.8%). Compliance was achieved in 93.4% and the overall eradication rate was 90.1% (95% CI: 84.6-94.2). Treatment-related adverse effects were experienced by 63 patients (41.7%; 95% CI: 34-49.7), being mild in 29, moderate in 19, and severe in 15. The main drawbacks of the treatment, from the patient's perspective, were the high price (47%) and the adverse effects (16.6%). Failure to eradicate H. pylori was correlated with the following: previous rifabutin-based scheme (0 vs. 100%; p  = 0.010) and a higher number of previous treatment schemes (1.5 ± 0.7 vs. 2.3 ± 1.2; p  < 0.001)., Conclusion: In this South-European country a single-capsule bismuth-based quadruple therapy is an excellent option as a second-line or rescue therapy, with acceptable compliance and side effects.

Advances in vitreoretinal surgery provide greater safety, efficacy, and reliability in the management of the several vitreoretinal diseases that benefit from surgical treatment. The advances are divided into the following topics: scleral buckling using chandelier illumination guided by non-contact visualization systems; sclerotomy/valved trocar diameters; posterior vitrectomy systems and ergonomic vitrectomy probes; chromovitrectomy; vitreous substitutes; intraoperative visualization systems including three-dimensional technology, systems for intraoperative optical coherence tomography, new instrumentation in vitreoretinal surgery, anti-VEGF injection before vitrectomy and in eyes with proliferative diabetic retinopathy, and new surgical techniques; endoscopic surgery; the management of subretinal hemorrhages; gene therapy; alternative techniques for refractory macular hole; perspectives for stem cell therapy and the prevention of proliferative vitreoretinopathy; and, finally, the Port Delivery System. The main objective of this review is to update the reader on the latest changes in vitreoretinal surgery and to provide an understanding of how each has impacted the improvement of surgical outcomes.

Purpose: To report the first Brazilian patient with RPE65 deficiency-inherited retinal dystrophy ( RPE65 -IRD) treated with voretigene neparvovec-rzyl (VN)., Methods: An adult patient with Leber congenital amaurosis-2 with a homozygous mutation in the RPE65 gene (p.Phe83Leu) was treated bilaterally with VN. The clinical and surgical aspects are described. The baseline and 4-month postoperative ophthalmologic examinations included measurement of the best-corrected visual acuity (BCVA), full-field stimulus threshold (FST) test, Octopus 900 semiautomated kinetic visual fields (VFs), and microperimetry., Results: No complications developed in this patient. The BCVA remained stable. The full-field stimulus threshold test (FST) and VFs showed clinically significant improvements bilaterally. The patient reported significant improvements in the ability to perform daily activities, mainly for those requiring the VFs and vision in a low-luminescence environment., Conclusions: The treatments were beneficial for this patient who was homozygous for RPE65 p.Phe83Leu. The first VN treatments in an adult Brazilian patient in clinical practice showed measurable improvements in visual outcomes that were meaningful for the patient's daily activities., Translational Relevance: This case reinforces the clinical trial results and proves that the procedure is feasible in countries such as Brazil.

Introduction and Objectives: Neurohormonal blockade (NB)/modulation is the combination of two renin-angiotensin-aldosterone system inhibitors (RAASi) with a beta blocker. It is the core therapy for heart failure with reduced ejection fraction (HFrEF). While improving long term prognosis, it also induces hyperkalemia (serum K + >5.0 mEq/L) due to RAASi effects. This may cause lethal arrhythmias and increase mortality in the short term. Thus, hyperkalemia frequently leads to withholding or reducing the intensity of neurohormonal blockade/modulation, which is associated with worsening long term prognosis. We assessed the relevance of hyperkalemia as a limiting factor of neurohormonal blockade/modulation in real life clinical conditions., Methods: We reviewed the medical records of HFrEF patients attending a HF clinic at a tertiary Portuguese hospital during 2018 (n=240). The number of patients not tolerating maximal neurohormonal blockade/modulation due to hyperkalemia was determined. The incidence and characteristics of hyperkalemia episodes were also assessed., Results: Only six patients (3%) achieved maximal doses of neurohormonal blockade/modulation. Hyperkalemia was the limiting factor in 48 (20%) patients. A total of 185 hyperkalemia episodes occurred in 100 (42%) patients. Forty-five (24%) episodes were moderate or severe (serum K + >5.5 mEq/L). In these HFrEF patients, the co-existence of hypertension, diabetes or renal failure was associated with the occurrence of hyperkalemia., Conclusions: In daily clinical practice, hyperkalemia is frequent and limits neurohormonal blockade/modulation by leading to the withholding or reducing of the intensity of RAAS inhibition. Considering the negative prognostic impact associated with sub-optimal neurohormonal blockade/modulation, addressing hyperkalemia is an important issue when treating HFrEF patients., (Copyright © 2022 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: Colorectal cancer generally metastasizes to the liver. Surgical resection of liver metastasis, which is associated with systemic chemotherapy, is potentially curative, but many patients will present recurrence. In selected patients, repeated hepatectomy is feasible and improves overall survival. This study aimed to analyze patients with colorectal liver metastasis (CRLM) submitted to hepatectomy in three centers from Rio de Janeiro, over the past 10 years, by comparing the morbidity of first hepatectomy and re-hepatectomy., Methods: From June 2009 to July 2020, 192 patients with CRLM underwent liver resection with curative intent in three hospitals from Rio de Janeiro Federal Health System. The data from patients, surgeries, and outcomes were collected from a prospectively maintained database. Patients submitted to first and re-hepatectomies were classified as Group 1 and Group 2, respectively. Data from groups were compared and value of p<0.05 was considered significant., Results: Among 192 patients, 16 were excluded. Of the remaining 176 patients, 148 were included in Group 1 and 28 were included in Group 2. Fifty-five (37.2%) patients in Group 1 and 13 (46.5%) in Group 2 presented postoperative complications. Comparing Groups 1 and 2, we found no statistical difference between the cases of postoperative complications (p=0.834), number of minor (p=0.266) or major (p=0.695) complications, and deaths (p=0.407)., Conclusions: No differences were recorded in morbidity or mortality between patients submitted to first and re-hepatectomies for CRLM, which reinforces that re-hepatectomy can be performed with outcomes comparable to first hepatectomy.

Background: Identification of Barrett's esophagus (BE) with the treatment of dysplasia is essential to prevent esophageal adenocarcinoma (EAC). Moreover, determination of BE prevalence is important to define subsequent management strategies. However, precise estimates on BE prevalence from several European countries are lacking. We aimed to determine BE prevalence in a Southern European country., Methods: A cross-sectional, multicenter study from November 2019 to February 2020 was performed defining BE as a columnar extent in the distal esophagus greater than or equal to 1 cm with intestinal metaplasia., Results: A total of 1550 individuals, 51% male with a mean age of 62 (SD = 15) years undergoing upper endoscopy were included. The overall BE prevalence was 1.29% (95% confidence interval: 0.73-1.85); significantly higher in men [2.05% (1.06-3.04)] vs. women [0.53% (0.01-1.04)]. Of the 20 BE patients, eight were newly diagnosed and 12 were under surveillance. The median extent was C3 (min 0; max 16) M4.5 (min 2; max 16). One patient each had EAC (0.06%) and high-grade dysplasia (0.06%) at the time of endoscopy. There was no difference in prevalence between geographical regions, centers, use of sedation or experience of endoscopists. Considering all reports, 93% used standardized terminology, 23% accurate photodocumentation and 69% photodocumented the esophagogastric junction (EGJ). Furthermore, 80% used Prague classification, 55% Seattle protocol, 60% distance to the squamocolumnar junction, 75% to the EGJ and 40% to the hiatal pinch. When considering only reports with EGJ photodocumentation or Prague classification, the prevalence was 1.78% (0.91-2.64) or 1.03% (0.53-1.53)., Conclusion: We report for the first time BE prevalence in Southern Europe and report a low overall prevalence in an unselected population. Future studies need to determine progression rates and how to improve quality metrics., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Heart failure (HF) is a growing public health problem. Sacubitril/valsartan is now recommended to be used in persistently symptomatic patients with left ventricular ejection fraction (LVEF) <40%, replacing angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs). In the present study, we aimed to characterise the challenges of sacubitril/valsartan use in everyday clinical practice., Methods: We assessed the medical records of patients with HF and reduced ejection fraction eligible for sacubitril/valsartan attending a HF clinic at a Portuguese University Hospital during 2018 (n=152). The number of eligible patients receiving the drug and the reasons for not prescribing sacubitril/valsartan were evaluated. Additionally, we assessed the tolerability of maximal doses of sacubitril/valsartan. New York Heart Association functional class (NYHA class) and LVEF before and after up-titration to maximal tolerated sacubitril/valsartan dose were compared. Median follow-up was 41 months., Results: Of the 152 included patients, 75 (49%) were prescribed the drug. The two main reasons for non-prescription were patient financial barriers (31%) and hypotension (27%). Only 33% of patients on sacubitril/valsartan did reach maximal dose. Hypotension was the main limiting factor for dose optimisation. Duration of sacubitril/valsartan treatment showed a positive association with LVEF improvement during follow-up (6.6% absolute LVEF increase/year). NYHA functional class improved significantly from baseline through the end of follow-up., Conclusions: In every-day clinical practice, although sacubitril/valsartan was associated with a marked improvement in NYHA class and in LVEF, important financial and clinical barriers to the implementation of this therapy were identified., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/cdt-21-312). All authors report that this work was supported by Novartis, via funding for third-party medical writing, review, and submission of this manuscript. AS has received speaker fees or advisory board participation fees from MSD, Merck Serono, Novartis, Servier, Bial and Pfizer outside of this work. BM has received speaker fees from AstraZeneca, Boehringer Ingelheim, Lilly, Servier, Novartis and Merck Serono outside of this work. JSC has received speaker and consultant fees, or advisory board participation fees from Abbott, AstraZeneca Pharmaceuticals, Bial, Boehringer Ingelheim, Menarini, Merck Serono, Merck Sharp & Dohme, Novartis, Orion, Pfizer, Sanofi, Servier, and Vifor Pharma outside of this work. The authors have no other conflicts of interest to declare., (2021 Cardiovascular Diagnosis and Therapy. All rights reserved.)

Introduction: Endoscopic mucosal resection (EMR) is the treatment of choice for non-invasive colorectal flat lesions. When endoscopic piecemeal mucosal resection (EPMR) is performed, endoscopic surveillance is necessary due to the risk of recurrence. The Sydney EMR Recurrence Tool (SERT) is a 0-4 scale that classifies lesions according to size, occurrence of intraprocedural bleeding (IPB) and presence of high-grade dysplasia (HGD). Our goal is to evaluate the applicability of SERT in predicting adenoma recurrence (AR) after EPMR., Methods: This is a retrospective single-centre study with inclusion of lateral spreading lesions ≥20 mm, consecutively resected by EPMR from March 2010 to February 2018, with at least 1 endoscopic re-evaluation., Results: A total of 181 lesions were included, corresponding to 174 patients with a mean age of 68 years and male gender predominance (61%; n = 106). The most frequent location was the ascending colon (34%; n = 62). Lesions were assessed according to Paris Classification (PC): 0-IIa: 39% ( n = 71); 0-IIb: 24% ( n = 43); 0-IIa + Is: 23% ( n = 42); 0-IIa + IIb: 6% ( n = 11); 0-IIa + IIc: 2% ( n = 3). The mean size of the lesions was 33 ± 11 mm, with 25 (14%) being ≥40 mm. IPB occurred in 9 cases (5%), and 44 lesions (24%) displayed HGD. Sixty-six lesions (36.5%) were classified as SMSA (size, morphology, site, and access score) level 4. Adjunctive therapy with argon plasma coagulation (APC) was used in 37% ( n = 67) of cases. The 6-month AR rate was 16% ( n = 29). According to SERT groups, the AR rate was: SERT 0: 12% (14/120); SERT 1: 17% (6/35); SERT 2: 25% (3/12); SERT 3: 30% (3/10); SERT 4: 75% (3/4). Two of the three SERT variables (size ≥40 mm and IPB) were associated with recurrence at 6 months ( p < 0.05). HGD and the remaining tested variables (age, gender, localization, accessibility, PC, use of APC/biopsy forceps and occurrence of delayed bleeding) were not associated with AR. SERT 0 lesions showed an inferior risk of 6-month AR (adjusted OR = 2.62; p = 0.035), with a negative predictive value of 88%. SMSA correlated with SERT ( p < 0.001) and SMSA level 4 was associated with 6-month AR ( p = 0.007). Lesions classified both as SERT 0 and SMSA level <4 had the lowest 6-month recurrence rate (9.2%). The 24-month recurrence rate was 23% ( n = 41). When applying the Kaplan-Meier method, cumulative recurrence was significantly lower in SERT 0 lesions ( p = 0.006, log-rank test)., Discussion/conclusion: Resection of flat colorectal lesions by EPMR has a considerable risk of recurrence, mostly in SERT 1-4 lesions. SERT 0 lesions, especially with SMSA level <4, show a lower risk of recurrent adenoma, which might allow longer intervals to first endoscopic surveillance in the future., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 by Sociedade Portuguesa de Gastrenterologia. Published by S. Karger AG, Basel.)

Introduction: Advances in endoscopy and open-access systems led to an increase in endoscopic procedures. However, overuse of endoscopy has been consistently reported. This study aims to assess the appropriateness of esophagogastroduodenoscopy (EGD) and colonoscopy referral in the private and public setting., Patients and Methods: We conducted a prospective, multicenter study at 2 public and 5 private endoscopy units. Patients scheduled for elective EGD or colonoscopy were enrolled. Clinical data and endoscopy findings were recorded. Appropriateness of endoscopy was defined according to the American Society for Gastrointestinal Endoscopy guidelines (for EGD) and the European Panel on Appropriateness of Gastrointestinal Endoscopy II (for colonoscopy)., Results: Regarding EGD: 215 patients enrolled (43.7% were males) with a mean age of 61.0 ± 15.1 years; 54.0% ( n = 116) were in public hospitals. Referral by a gastroenterologist was made for 34.9% ( n = 75). Appropriate indications were made for 62.3% ( n = 134): 42.4% in private versus 79.3% in public endoscopy units (odds ratio [OR] 5.20; 95% confidence interval [CI] 2.85-9.49; p < 0.01). Rate of appropriate EGD was 74.7% for gastroenterologist referral and 56.1% for other specialties (OR 2.31; 95% CI 1.24-4.28; p < 0.01). Diagnostic yield for relevant findings was 47.9%. No association between indication appropriateness, gastroenterologist referral, and relevant endoscopic findings was found. Regarding colonoscopy: 287 patients enrolled (49.1% were males) with a mean age of 60.4 ± 14.4 years; 48.1% ( n = 138) were in public hospitals. Referral by a gastroenterologist was made for 20.6% ( n = 59). Appropriate indications were made for 70.0% ( n = 201): 53.0% in private vs. 88.4% in public endoscopy units (OR 6.75; 95% CI 3.66-12.47; p < 0.01). Diagnostic yield was 57.1%. Relevant endoscopic diagnosis was associated with indication: 63.2% in the appropriate vs. 43.0% in the nonappropriate indication group ( p < 0.05)., Discussion: A significant percentage of endoscopies, mainly in the private setting, were performed without an appropriate indication. This influenced the diagnostic yield. The use of adequate criteria is fundamental for the rational use of an open-access system., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 by S. Karger AG, Basel.)

Biogenic amines (BAs) are well-known biomolecules, mostly for their toxic and carcinogenic effects. Commonly, they are used as an indicator of quality preservation in food and beverages since their presence in higher concentrations is associated with poor quality. With respect to BA's metabolic pathways, time plays a crucial factor in their formation. They are mainly formed by microbial decarboxylation of amino acids, which is closely related to food deterioration, therefore, making them unfit for human consumption. Pathogenic microorganisms grow in food without any noticeable change in odor, appearance, or taste, thus, they can reach toxic concentrations. The present review provides an overview of the most recent literature on BAs with special emphasis on food matrixes, including a description of the typical BA assay formats, along with its general structure, according to the biorecognition elements used (enzymes, nucleic acids, whole cells, and antibodies). The extensive and significant amount of research that has been done to the investigation of biorecognition elements, transducers, and their integration in biosensors, over the years has been reviewed.

Background: Tourniquet for right hepatectomy tightened and secured with forceps (arrow). Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique., Aim: Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube., Methods: From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps., Results: The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients., Conclusions: The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.

Although the production of extranuptial nectar is a common strategy of indirect defence against herbivores among tropical plants, the presence of extranuptial nectaries in reproductive structures is rare, especially in ant-plants. This is because the presence of ants in reproductive organs can generate conflicts between the partners, as ants can inhibit the activity of pollinators or even castrate their host plants. Here we evaluate the hypothesis that the ant-plant Miconia tococa produces nectar in its petals which attracts ants and affects fruit set. Floral buds were analysed using anatomical and histochemical techniques. The frequency and behaviour of floral visitors were recorded in field observations. Finally, an ant exclusion experiment was conducted to evaluate the effect of ant presence on fruit production. The petals of M. tococa have a secretory epidermis that produces sugary compounds. Nectar production occurred during the floral bud stage and attracted 17 species of non-obligate ants (i.e. have a facultative association with ant-plants). Ants foraged only on floral buds, and thus did not affect the activity of pollinators in the neighbouring open flowers. The presence of ants in the inflorescences increased fruit production by 15%. To our knowledge, the production of extranuptial nectar in the reproductive structures of a myrmecophyte is very rare, with few records in the literature. Although studies show conflicts between the partners in the ant-plant interaction, ants that forage on M. tococa floral buds protect the plant against floral herbivores without affecting bee pollination., (© 2020 German Society for Plant Sciences and The Royal Botanical Society of the Netherlands.)

Background: The Maternal and Child Health (MCH) handbook is an integrated home-based record (HBR) designed to record in a single document all the information regarding health services provided to a pregnant woman and her child. The MCH handbook has the potential to support continuity of care which is key to strengthening maternal, newborn and child health. However, there is a lack of an integrated system to manage the health of pregnant women and young children on an ongoing basis in Angola. Thus, the Angolan Ministry of Health is partnering with the Japan International Cooperation Agency to build the capacity of healthcare providers through trainings and implementation of the MCH handbook to improve service utilisation. In this study, we will estimate the impact of an intervention package including distribution of MCH handbook and its supplementary interventions to women, on the utilisation of services provided at healthcare facilities from pregnancy through the postnatal and early childhood period., Methods: This study is a cluster randomised controlled trial involving public healthcare facilities across all the municipalities located in Benguela Province, Angola. All women who go to participating healthcare facilities and with confirmed pregnancy around the beginning of the trial period will be included in the study. Women will be randomised according to the municipality where their primary maternity and/or childcare services are located. The intervention package will consist of MCH handbook distribution at all public healthcare facilities, MCH handbook utilisation training for healthcare providers and community mobilisation for women on the use of the MCH handbook. The intervention will be administered to all women in the intervention arm while those in the control arm will continue the traditional use of two stand-alone HBRs. The primary outcome measure for this study is to compare the proportion of women who achieve a complete continuum of care in both study arms., Discussion: The findings from the study are expected to form a basis for revising the current trial version of the Angola MCH handbook and provide a framework for policy guiding nationwide scale-up and distribution of the MCH handbook., Trial Registration: ISRCTN Registry ISRCTN20510127 . Registered on 4 June 2019.

Long period fiber gratings (LPFGs) were fabricated in a standard single mode fiber (SMF-28e) through femtosecond (fs) laser direct writing. LPFGs with longer and shorter periods were fabricated, which allows coupling from the fundamental core mode to lower and higher order asymmetric cladding modes (LP 1,6 and LP 1,12 , respectively). For the grating periods of 182.7 and 192.5 µm, it was verified that the LP 1,12 mode exhibits a TAP at approximately 1380 and 1448 nm in air and water, respectively. Characterization of the LPFGs subjected to high-temperature thermal treatment was accomplished. Fine-tuning of the resonance band's position and thermal stability up to 600 °C was shown. The temperature sensitivity was characterized for the gratings with different periods and for different temperature ranges. A maximum sensitivity of -180.73, and 179.29 pm/°C was obtained for the two resonances of the 182.7 µm TAP LPFG, in the range between 250 and 600 °C.

Competing Interests: The authors have no conflicts of interest to declare.

Competing Interests: The authors have no conflicts of interest to declare.

Habitat destruction is the single greatest anthropogenic threat to biodiversity. Decades of research on this issue have led to the accumulation of hundreds of data sets comparing species assemblages in larger, intact, habitats to smaller, more fragmented, habitats. Despite this, little synthesis or consensus has been achieved, primarily because of non-standardized sampling methodology and analyses of notoriously scale-dependent response variables (i.e., species richness). To be able to compare and contrast the results of habitat fragmentation on species' assemblages, it is necessary to have the underlying data on species abundances and sampling intensity, so that standardization can be achieved. To accomplish this, we systematically searched the literature for studies where abundances of species in assemblages (of any taxa) were sampled from many habitat patches that varied in size. From these, we extracted data from several studies, and contacted authors of studies where appropriate data were collected but not published, giving us 117 studies that compared species assemblages among habitat fragments that varied in area. Less than one-half (41) of studies came from tropical forests of Central and South America, but there were many studies from temperate forests and grasslands from all continents except Antarctica. Fifty-four of the studies were on invertebrates (mostly insects), but there were several studies on plants (15), birds (16), mammals (19), and reptiles and amphibians (13). We also collected qualitative information on the length of time since fragmentation. With data on total and relative abundances (and identities) of species, sampling effort, and affiliated meta-data about the study sites, these data can be used to more definitively test hypotheses about the role of habitat fragmentation in altering patterns of biodiversity. There are no copyright restrictions. Please cite this data paper and the associated Dryad data set if the data are used in publications., (© 2019 The Authors. Ecology © 2019 The Ecological Society of America.)

Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive sleep apnea over long periods of time. The link between respiratory disturbances at night and the incidence of acute decompensated heart failure (ADHF) is not well established. We aimed at (1) determining the ability of SAM pacemakers to evaluate the extent of left ventricular overload and (2) assess the impact of respiratory disturbances at night on the occurrence of ADHF over 1-year of follow-up. We conducted a single-center prospective study. Consecutive patients with SAM pacemakers were comprehensively assessed. SAM automatically computes a respiratory disturbance index (RDI, apneas/hypopneas per hour - AH/h) in the previous night and the percentage of nights with RDI >20 AH/h in the previous 6 months. Thirty-seven patients were included (79.3 ± 11.2 years, 46% males). A high RDI in the previous night and a higher %nights with increased RDI were associated with increased NT-proBNP values (p = 0.008 and p = 0.013, respectively) and were the sole predictors of increased noninvasive pulmonary capillary wedge pressures (PCWP) in the morning of assessment (p = 0.031 and p = 0.044, respectively). Receiver operating characteristic curve analysis revealed an area under the curve of 0.804 (95% confidence interval 0.656 to 0.953, p = 0.002) for %nights with RDI >20 AH/h in the prediction of high PCWP. Patients with >12.5% of nights with RDI >20AH/h tended to have more ADHF during follow-up (log-rank p = 0.067). In conclusion, a high burden of apneas/hypopneas at night is associated with elevated NT-proBNP and PCWP values and an increased risk of ADHF over 1 year. These patients might benefit from early tailored clinical management., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background and Aims: Accurate determination of colonic polyp size is vital to an appropriate surveillance. The main aim of this study was to evaluate variation between the polyp size reported by the endoscopist and its pathological measurement., Methods: A retrospective analysis of all colonic adenomatous polyps resected in a 12-month period was performed at our center. Endoscopic and pathological size for each polyp were compared, and overestimation rates, underestimation rates, and endoscopic-pathological variation (EPV) were calculated., Results: Among the 573 polyps that were included, the mean endoscopic and pathological sizes were 8.00 and 6.66 mm, respectively. The most frequent error, in 62.1%, was overestimation by the colonoscopist. Overestimation and EPV were associated with resection technique (higher in endoscopic mucosal resection and smaller with biopsy forceps) and colonoscopist. They were not associated with years of experience in colonoscopy. Overestimation was more frequent in larger polyps., Conclusions: Our study shows significant discordance between endoscopic and pathological size of colonic polyps with a clear tendency for endoscopic overestimation. Larger polyps are more difficult to accurately assess than smaller ones. This propensity for error was not related to colonoscopist's years of experience and seems to be an individual tendency.

Introduction: Obesity is often accompanied by psychological distress and both can reduce patients' quality of life. Bariatric surgery is proven to be a good method to reduce weight and to alleviate comorbidities, leading ultimately to an improvement in quality of life., Material and Methods: The authors studied 80 patients enrolled in the Multidisciplinary Bariatric Unit of a central hospital in Porto, Portugal. Patients submitted to Roux-en-Y gastric bypass and sleeve procedures were compared. Laboratory parameters were collected from patients' files. Quality of life and psychological state - depression and anxiety, were evaluated using the Portuguese versions of the Medical Outcomes Study SF-36 and the hospital anxiety and depression scale, respectively, within one to two years of the surgery., Results: A total of 51 patients were operated and completed a quality of life evaluation, while 21 patients were in a pre-operatory group (control). Patients subjected to bariatric surgery had higher scores of SF-36 and lower scores in both hospital anxiety and depression scale (anxiety and depression) subscales (p < 0.001); SF-36 presented a Pearson correlation coefficient of 0,475 (p = 0.004) with hemoglobin A1c. Sleeve had better results in the hospital anxiety and depression scale-depression subscale (p = 0.073)., Discussion: In this population, bariatric surgery led to better results, regarding both metabolic and psychological evaluations. No significant differences were found between gastric bypass and sleeve. However, further analyses must be performed., Conclusion: This study supports the theory that bariatric surgery contributes to the improvement of obese patients' quality of life and psychological state.

Quantum state tomography aims to determine the quantum state of a system from measured data and is an essential tool for quantum information science. When dealing with continuous variable quantum states of light, tomography is often done by measuring the field amplitudes at different optical phases using homodyne detection. The quadrature-phase homodyne measurement outputs a continuous variable, so to reduce the computational cost of tomography, researchers often discretize the measurements. We show that this can be done without significantly degrading the fidelity between the estimated state and the true state. This paper studies different strategies for determining the histogram bin widths. We show that computation time can be significantly reduced with little loss in the fidelity of the estimated state when the measurement operators corresponding to each histogram bin are integrated over the bin width.

It is presented the fabrication and characterization of optical fiber sensors for refractive index measurement based on localized surface plasmon resonance (LSPR) with gold nano-islands obtained by single and by repeated thermal dewetting of gold thin films. Thin films of gold deposited on silica (SiO₂) substrates and produced by different experimental conditions were analyzed by Scanning Electron Microscope/Dispersive X-ray Spectroscopy (SEM/EDS) and optical means, allowing identifying and characterizing the formation of nano-islands. The wavelength shift sensitivity to the surrounding refractive index of sensors produced by single and by repeated dewetting is compared. While for the single step dewetting, a wavelength shift sensitivity of ~60 nm/RIU was calculated, for the repeated dewetting, a value of ~186 nm/RIU was obtained, an increase of more than three times. It is expected that through changing the fabrication parameters and using other fiber sensor geometries, higher sensitivities may be achieved, allowing, in addition, for the possibility of tuning the plasmonic frequency.

Chronic anal fissure is a linear ulcer in the anal canal that has not cicatrized for more than 8-12 weeks of treatment. Most anal fissures are idiopathic and are located in the posterior midline. Squamous cell carcinoma of the anus commonly presents as bleeding and anal pain. It may also present as a mass, nonhealing ulcer, itching, discharge, fecal incontinence and fistulae. Not uncommonly, small and early cancers are misdiagnosed as benign anorectal disorders like anal fissures or hemorrhoids. The clinical suspicion of squamous cell carcinoma of the anus is of paramount importance in patients with nonhealing anal fissures, fissures in atypical positions or with indurated or ulcerated anal tags and in patients with risk factors for the development of anal squamous intraepithelial lesions that are precursors of invasive anal squamous cell carcinoma. The authors present 3 cases of squamous cell carcinoma of the anus initially misdiagnosed as benign chronic anal fissure.

Background: The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases., Aim: This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients., Methods: Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines., Results: Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication and periodical examination, respectively. Steroids prescription (OR=2.880) and a higher instruction level (OR=3.669) were predictors of complementary and alternative medicines use in this cohort., Conclusions: Roughly a third of Portuguese IBD patients had used CAM. Steroid treatment and an academic degree are associated with CAM use. Given the potential side effects and interactions, patient information about the benefits and limitations of conventional and complementary treatments should be reinforced., (Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Background: Chronic anal fissure is a frequent and disabling disease, often affecting young adults. Botulinum toxin and lateral internal sphincterotomy are the main therapeutic options for refractory cases. Botulinum toxin is minimally invasive and safer compared with surgery, which carries a difficult post-operative recovery and fecal incontinence risk. The long-term efficacy of Botulinum toxin is not well known., Objective: The aim of this study was to evaluate the long-term efficacy and safety of Botulinum toxin in the treatment of chronic anal fissure., Methods: This was a retrospective study at a single center, including patients treated with Botulinum toxin from 2005 to 2010, followed over at least a period of 5 years. All patients were treated with injection of 25U of Botulinum toxin in the intersphincteric groove. The response was registered as complete, partial, refractory and relapse., Results: Botulinum toxin was administered to 126 patients, 69.8% ( n  = 88) were followed over a period of 5 years. After 3 months, 46.6% ( n  = 41) had complete response, 23.9% ( n  = 21) had partial response and 29.5% ( n  = 26) were refractory. Relapse was observed in 1.2% ( n  = 1) at 6 months, 11.4% ( n  = 10) at 1 year, 2.3% ( n  = 2) at 3 years; no relapse at 5 years. The overall success rate was 64.8% at 5 years of follow-up. Botulinum toxin was well tolerated by all patients and there were no complications., Conclusion: The use of Botulinum toxin to treat patients with chronic anal fissure was safe and effective in long-term follow-up.

Maximum-likelihood quantum-state tomography yields estimators that are consistent, provided that the likelihood model is correct, but the maximum-likelihood estimators may have bias for any finite data set. The bias of an estimator is the difference between the expected value of the estimate and the true value of the parameter being estimated. This paper investigates bias in the widely used maximum-likelihood quantum-state tomography. Our goal is to understand how the amount of bias depends on factors such as the purity of the true state, the number of measurements performed, and the number of different bases in which the system is measured. For this, we perform numerical experiments that simulate optical homodyne tomography of squeezed thermal states under various conditions, perform tomography, and estimate bias in the purity of the estimated state. We find that estimates of higher purity states exhibit considerable bias, such that the estimates have lower purities than the true states.

The aim of this work was to investigate the potential of Fourier transform infrared spectroscopy (FTIR) to detect and predict the bacterial load of salmon fillets (Salmo salar) stored at 3, 8 and 30°C under three packaging conditions: air packaging (AP) and two modified atmospheres constituted by a mixture of 50%N 2 /40%CO 2 /10%O 2 with lemon juice (MAPL) and without lemon juice (MAP). Fresh salmon samples were periodically examined for total viable counts (TVC), specific spoilage organisms (SSO) counts, pH, FTIR and sensory assessment of freshness. Principal components analysis (PCA) allowed identification of the wavenumbers potentially correlated with the spoilage process. Linear discriminant analysis (LDA) of infrared spectral data was performed to support sensory data and to accurately identify samples freshness. The effect of the packaging atmospheres was assessed by microbial enumeration and LDA was used to determine sample packaging from the measured infrared spectra. It was verified that modified atmospheres can decrease significantly the bacterial load of fresh salmon. Lemon juice combined with MAP showed a more pronounced delay in the growth of Brochothrix thermosphacta, Photobacterium phosphoreum, psychrotrophs and H 2 S producers. Partial least squares regression (PLS-R) allowed estimates of TVC and psychrotrophs, lactic acid bacteria, molds and yeasts, Brochothrix thermosphacta, Enterobacteriaceae, Pseudomonas spp. and H 2 S producer counts from the infrared spectral data. For TVC, the root mean square error of prediction (RMSEP) value was 0.78logcfug -1 for an external set of samples. According to the results, FTIR can be used as a reliable, accurate and fast method for real time freshness evaluation of salmon fillets stored under different temperatures and packaging atmospheres., (Copyright © 2016 Elsevier B.V. All rights reserved.)