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High-resolution post-contrast T1-weighted imaging is a workhorse sequence in the evaluation of neurological disorders. The T1-MPRAGE sequence has been widely adopted for the visualization of enhancing pathology in the brain. However, this three-dimensional (3D) acquisition is lengthy and prone to motion artifact, which often compromises diagnostic quality. The goal of this study was to compare a highly accelerated wave-controlled aliasing in parallel imaging (CAIPI) post-contrast 3D T1-MPRAGE sequence (Wave-T1-MPRAGE) with the standard 3D T1-MPRAGE sequence for visualizing enhancing lesions in brain imaging at 3 T.This study included 80 patients undergoing contrast-enhanced brain MRI. The participants were scanned with a standard post-contrast T1-MPRAGE sequence (acceleration factor [R] = 2 using GRAPPA parallel imaging technique, acquisition time [TA] = 5 min 18 s) and a prototype post-contrast Wave-T1-MPRAGE sequence (R = 4, TA = 2 min 32 s). Two neuroradiologists performed a head-to-head evaluation of both sequences and rated the visualization of enhancement, sharpness, noise, motion artifacts, and overall diagnostic quality. A 15% noninferiority margin was used to test whether post-contrast Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE. Inter-rater and intra-rater agreement were calculated. Quantitative assessment of CNR/SNR was performed.Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE for delineating enhancing lesions with unanimous agreement in all cases between raters. Wave-T1-MPRAGE was noninferior in the perception of noise (p0.001), motion artifact (p0.001), and overall diagnostic quality (p0.001).High-accelerated post-contrast Wave-T1-MPRAGE enabled a two-fold reduction in acquisition time compared to the standard sequence with comparable performance for visualization of enhancing pathology and equivalent perception of noise, motion artifacts and overall diagnostic quality without loss of clinically important information.• Post-contrast wave-controlled aliasing in parallel imaging (CAIPI) T1-MPRAGE accelerated the acquisition of three-dimensional (3D) high-resolution post-contrast images by more than two-fold. • Post-contrast Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE with unanimous agreement between reviewers (100% in 80 cases) for the visualization of intracranial enhancing lesions. • Wave-T1-MPRAGE was equivalent to the standard sequence in the perception of noise in 94% (75 of 80) of cases and was preferred in 16% (13 of 80) of cases for decreased motion artifact.

Objective/background To describe and characterize insomnia symptoms and nightmare profiles in Portugal during the first six weeks of a national lockdown due to COVID-19. Patients/methods An open cohort study was conducted to collect information of the general population during the first wave of SARS-CoV-2/COVID-19 pandemic in Portugal. We analyzed data from 5011 participants (≥16 years) who answered a weekly questionnaire about their well-being. Two questions about the frequency of insomnia and nightmares about COVID-19 were consecutively applied during six weeks (March–May 2020). Latent class analysis was conducted and different insomnia and nightmare profiles were identified. Associations between individual characteristics and both profiles were estimated using odds ratios (ORs) and 95% confidence intervals (CI). Results Five insomnia (No insomnia, Stable-mild, Decreasing-moderate, Stable-severe, Increasing-severe) and three nightmares profiles (Stable-mild, Stable-moderate, Stable-severe) were identified. Being female, younger, perceiving their income as insufficient and feelings of fear towards COVID-19 were associated with higher odds of insomnia (Women: OR = 6.98 95%CI: 4.18–11.64; ≥60 years: OR = 0.30 95%CI: 0.18–0.53; Insufficient income: adjusted OR (aOR) = 8.413 95%CI: 3.93–16.84; Often presenting fear of being infected with SARS-CoV-2 infection: aOR = 9.13 95%CI: 6.36–13.11), and nightmares (Women: OR = 2.60 95%CI: 1.74–3.86; ≥60 years: OR = 0.45 95%CI: 0.28–0.74; Insufficient income: aOR = 2.60 95%CI: 1.20–5.20; Often/almost always presenting fear of being infected with SARS-CoV-2 infection: aOR = 6.62 95%CI: 5.01–8.74). Having a diagnosis of SARS-CoV-2 virus infection was associated with worse patterns of nightmares about the pandemic. Conclusions Social and psychological individual factors are important characteristics to consider in the development of therapeutic strategies to support people with sleep problems during the COVID-19 pandemic.

Albuminuria is a hallmark of glomerular disease of various etiologies. It is not only a symptom of glomerular disease but also a cause leading to glomerulosclerosis, interstitial fibrosis, and eventually, a decline in kidney function. The molecular mechanism underlying albuminuria-induced kidney injury remains poorly defined. In our genetic model of nephrotic syndrome (NS), we have identified CHOP (C/EBP homologous protein)-TXNIP (thioredoxin-interacting protein) as critical molecular linkers between albuminuria-induced ER dysfunction and mitochondria dyshomeostasis. TXNIP is a ubiquitously expressed redox protein that binds to and inhibits antioxidant enzyme, cytosolic thioredoxin 1 (Trx1), and mitochondrial Trx2. However, very little is known about the regulation and function of TXNIP in NS. By utilizing Chop −/− and Txnip −/− mice as well as 68 Ga-Galuminox, our molecular imaging probe for detection of mitochondrial reactive oxygen species (ROS) in vivo, we demonstrate that CHOP up-regulation induced by albuminuria drives TXNIP shuttling from nucleus to mitochondria, where it is required for the induction of mitochondrial ROS. The increased ROS accumulation in mitochondria oxidizes Trx2, thus liberating TXNIP to associate with mitochondrial nod-like receptor protein 3 (NLRP3) to activate inflammasome, as well as releasing mitochondrial apoptosis signal-regulating kinase 1 (ASK1) to induce mitochondria-dependent apoptosis. Importantly, inhibition of TXNIP translocation and mitochondrial ROS overproduction by CHOP deletion suppresses NLRP3 inflammasome activation and p-ASK1–dependent mitochondria apoptosis in NS. Thus, targeting TXNIP represents a promising therapeutic strategy for the treatment of NS.

To evaluate the impact of magnetization transfer (MT) on brain tissue contrast in turbo-spin-echo (TSE) and EPI fluid-attenuated inversion recovery (FLAIR) images, and to optimize an MT-prepared EPI FLAIR pulse sequence to match the tissue contrast of a clinical reference TSE FLAIR protocol.Five healthy volunteers underwent 3T brain MRI, including single slice TSE FLAIR, multi-slice TSE FLAIR, EPI FLAIR without MT-preparation, and MT-prepared EPI FLAIR with variations of the MT-preparation parameters, including number of preparation pulses, pulse amplitude, and resonance offset. Automated co-registration and gray matter (GM) versus white matter (WM) segmentation was performed using a T1-MPRAGE acquisition, and the GM versus WM signal intensity ratio (contrast ratio) was calculated for each FLAIR acquisition.Without MT preparation, EPI FLAIR showed poor tissue contrast (contrast ratio = 0.98), as did single slice TSE FLAIR. Multi-slice TSE FLAIR provided high tissue contrast (contrast ratio = 1.14). MT-prepared EPI FLAIR closely approximated the contrast of the multi-slice TSE FLAIR images for two combinations of the MT-preparation parameters (contrast ratio = 1.14). Optimized MT-prepared EPI FLAIR provided a 50% reduction in scan time compared to the reference TSE FLAIR acquisition.Optimized MT-prepared EPI FLAIR provides comparable brain tissue contrast to the multi-slice TSE FLAIR images used in clinical practice.

We introduce and validate an artificial intelligence (AI)-accelerated multi-shot echo-planar imaging (msEPI)-based method that provides T1w, T2w,The rapid imaging technique combines a novel machine learning (ML) scheme to limit g-factor noise amplification and improve SNR, a magnetization transfer preparation module to provide clinically desirable contrast, and high per-shot EPI undersampling factors to reduce distortion. The ML training and image reconstruction incorporates a tunable parameter for controlling the level of denoising/smoothness. The performance of the reconstruction method is evaluated across various acceleration factors, contrasts, and SNR conditions. The 2-minute protocol is directly compared to a 10-minute clinical reference protocol through deployment in a clinical setting, where five representative cases with pathology are examined.Optimization of custom msEPI sequences and protocols was performed to balance acquisition efficiency and image quality compared to the five-fold longer clinical reference. Training data from 16 healthy subjects across multiple contrasts and orientations were used to produce ML networks at various acceleration levels. The flexibility of the ML reconstruction was demonstrated across SNR levels, and an optimized regularization was determined through radiological review. Network generalization toward novel pathology, unobserved during training, was illustrated in five clinical case studies with clinical reference images provided for comparison.The rapid 2-minute msEPI-based protocol with tunable ML reconstruction allows for advantageous trade-offs between acquisition speed, SNR, and tissue contrast when compared to the five-fold slower standard clinical reference exam.

Shale gas has become one of the important contributors to the global energy supply. The declining pattern of the gas production rate with time from an unconventional gas reservoir is due to the depletion of shale gas stored in the nanovoids of the shale formation. However, there are only limited ways to predict the variation of the gas production rate with time from an unconventional gas reservoir. This is due to the multiple transport mechanisms of gas in nano-scale pores and changes in shale gas permeability with pressures in nano-scale pores, which is impacted by the pore structure of the shale. In this study, the permeability-pressure (K-p) relationship for different shales (Eagle Ford, Haynesville, Longmaxi and Opalinus) were determined using an equivalent anisotropic pore network model (PNM). This PNM has REV-scale shale gas flow in randomly generated nanovoids and their connection in the shale matrix, and the multiphase flow of shale gas including viscous flow, slip flow and Knudsen diffusion. These predicted K-p correlations were then used in a finite element model (FEM) to predict the variation of the gas production rate with time (flux-time curves) at the macroscale. The simulation results show that the flux-time curves can be simplified to two linear segments in logarithmic coordinates, which are influenced by the fracture length and initial gas pressure. The predicted results using the PNM-FEM were validated by comparing them with the reported field test data. The method described in this study can be used to upscale the gas transport process from micro- to macroscale, which can provide a predictive tool for the gas production in shales.

espanolEste estudo se propos a pensar os efeitos da pandemia causada pela Covid-19 na per-manencia dos estudantes da educacao superior na Universidade Federal de Goias, no Brasil. Para responder essa questao, foi feita pesquisa documental com base em dados primarios relativos a situacao de vinculo dos estudantes em dois periodos do primeiro semestre letivo de 2020, antes e a partir da pandemia, considerando tanto o panorama geral da universidade, como as particularidades das areas do conhecimento, do ano de ingresso na instituicao e dos graus academicos. Alem disso, para subsidiar a analise dos dados, a pesquisa documental se valeu de documentos oficiais secunda-rios do Ministerio da Educacao e da Universidade Federal de Goias, principalmente, mas tambem do Instituto de Pesquisa Economica Aplicada e da Associacao Nacional dos Dirigentes das Instituicoes Federais de Ensino Superior. Ainda, foi feita pesquisa bibliografica, ancorada em autores que discutem evasao, permanencia estudantil e educacao no contexto da pandemia. Como resultado, o estudo mostrou que houve uma reducao dos vinculos ativos, provocada pelo aumento dos trancamentos e exclusoes, o que se mostrou de forma mais acentuada nas Ciencias Exatas e da Terra e com os ingressantes de 2016 a 2019. EnglishThis study aimed to think about the effects of the pandemic caused by Covid-19 on the higher education students’ stay at the Federal University of Goias (UFG) In order to answer this question, documentary research was carried out based on primary data relating to the students’ bonding situation in two periods of the first academic semester of 2020, before and after the pandemic, considering both the general scene of the university and the particularities of the university, areas of knowledge, year of entry into the institution and academic degrees. In addition, to support the analysis of the data, the documentary research made use of secondary official documents from the Ministry of Education and the UFG, mainly, but also from the Institute of Applied Economic Research and the National Association of the Directors of the Federal Institutions of University Education. Still, bibliographic research was done, anchored in authors who discuss dropout, student permanence and education in the context of the pandemic. As a result, the study showed that there was a reduction in active bonds, caused by the increase in lockouts and exclusions, which was more pronounced in the Exact and Earth Sciences and with the new entrants from 2016 to 2019 portuguesLa propuesta de este estudio es reflexionar sobre los efectos de la pandemia causada por el Covid-19 en la permanencia de los estudiantes de la educacion superior en la Universidade Federal de Goias, en Brasil. Para responder a esa cuestion se hizo una investigacion documental basada en datos primarios relativos a la situacion de vinculo de los estudiantes en dos periodos de primer semestre lectivo del 2020, antes y a partir de la pandemia, considerando tanto el panorama general de la universidad como las particularidades de las areas do conocimiento, del ano de ingreso en la institucion y de los grados academicos. Ademas, para subvencionar el analisis de los datos la investigacion documental recurrio a documentos oficiales secundarios del Ministerio da Educacao y de la Universidade Federal de Goias, principalmente, pero tambien del Instituto de Pesquisa Economica Aplicada y de la Associacao Nacional dos Dirigentes das Instituicoes Federais de Ensino Superior. Ademas, se hizo la investigacion bibliografica basada en autores que discuten evasion, permanencia estudiantil y educacion en el contexto de la pandemia. Como resultado, el estudio mostro que hubo una reduccion de los vinculos activos, provocada por el aumento de las anulaciones y exclusiones, lo que se mostro de forma mas acentuada en Ciencias Exatas e da Terra y con los alumnos de nuevo ingreso del 2016 al 2019

Background Patients on chronic dialysis (CD) due to end-stage renal disease (ESRD) with symptomatic severe aortic stenosis eligible for transcatheter aortic valve implantation (TAVI) were excluded from randomized clinical trials. Our study aimed to investigate the outcomes of patients with chronic dialysis who underwent TAVI. Methods Single center analysis on prospectively collected data of all consecutive patients who underwent TAVI between January 2011 and December 2020 according to baseline renal function: chronic dialysis group (CD) and control group (CTRL). Procedural, 30-day and 1-year outcomes were assessed. Outcomes were defined in accordance with the VARC-3 criteria. Results A total of 875 patients underwent TAVI during the study period, of whom 22 (2.5%) were on chronic dialysis. Patients on CD were younger (median age 80 years, [IQR 73–84] vs 84 years, [IQR 80–87]; p Conclusions Chronic dialysis patients submitted to TAVI had significantly higher rates of short-term life threatening and/or major bleeding, short-term and long-term mortality. Careful selection of patients who would benefit from TAVI among patients with ERDS requiring dialysis is necessary to prevent high rates of postprocedural complications and improve outcomes of this high-risk population. Funding Acknowledgement Type of funding sources: None.

Background Vascular complications at the access site are important adverse events during transcatheter aortic valve implantation (TAVI). Effective, reproducible, and safe closure of large bore arteriotomies remains challenging as management strategies vary among centers and operators. MANTAÒ is a dedicated plug-based vascular closure device (VCD) recently approved for percutaneous access site closure. This study aimed to describe our experience and to determine the safety and effectiveness of MANTAÒ for large bore arteriotomies during transfemoral TAVI. Methods Single center retrospective analysis on prospectively collected data of all consecutive patients who underwent transfemoral TAVI from 2018 to 2020. The primary safety outcomes were access-related vascular injury and bleeding complications according to VARC-3 criteria. Technical success was defined as puncture closure obtained with MANTAÒ without the use of unplanned endovascular or surgical intervention. A secondary analysis according to center experience was performed. Results Of the 535 patients that underwent transfemoral TAVI during the study period (median age = 84 [IQR 80–87], 39.4% male; median EuroSCORE II of 3.89% [IQR 2.62–5.39]), MANTAÒ VCD was deployed in 320 (59.8%). Overall, 32 (10.0%) patients suffered an access-related vascular injury and 22 (6.6%) had a bleeding complication (Figure 1A). Technical success was achieved in most cases (n=298; 93.1%). 30-day mortality rate was 1.6% (n=5). Since the first deployment in mid-2018, the rates of MANTA-related complications decreased with increasing experience and a steep learning curve effect was noted (Figure 1B). Conclusions MANTAÒ was rapidly adopted as the default strategy for vascular access site closure after TAVI at our center. A relatively steep learning was observed, suggesting that few procedures are required to acquire device proficiency. In addition, our results suggest that MANTA Ò can effectively close large bore arteriotomies with a low risk of severe complications. Funding Acknowledgement Type of funding sources: None.

The PAINESD risk score was developed in 2015 as a tool to stratify the risk of acute hemodynamic decompensation during ventricular tachycardia (VT) ablation in structural heart disease patients and further then used for post procedure 30-day mortality prediction. The original cohort however did not include Chagas disease (ChD) patients. We aim to evaluate the relevance of the score in a ChD population. The PAINESD risk score gives weighted values for specific characteristics (chronic obstructive pulmonary disease, age > 60 years, ischemic cardiomyopathy, New York Heart Association [NYHA] functional class 3 or 4, ejection fraction less than 25%, VT storm, and diabetes). The score was applied in a retrospective cohort of ChD VT ablations in a single tertiary center in Brazil. Data were collected by VT study reports and patient record analysis at baseline and on follow-up. Between January 2013 and December 2018, 157 VT catheter ablation procedures in 121 ChD patients were analyzed. Overall, 30-day mortality was 9.0%. Multivariate analysis correlated NYHA functional class (HR 1.78, 95% CI 1.03–3.08, P 0.038) and the need for urgent surgery (HR 31.5, 95% CI 5.38–184.98, P < 0.001), as well as a tendency for VT storm at presentation (HR 2.72, 95% CI 0.87–8.50, P 0.084) as risk factors for the primary endpoint. The median PAINESD risk score in this population was 3 (3–8). The area under the receiver operating characteristic (ROC) curve was 0.64 (95% CI 0.479–0.814). The PAINESD risk score did not perform well in predicting 30-day mortality in ChD patients. Pre-procedure NYHA functional class and the need for urgent surgery due to refractory pericardial bleeding were independently associated with increased 30-day mortality. Prospective studies are needed to take final conclusions in Chagas disease when using PAINESD score.

Detailed routing is one of the most time-consuming steps of physical synthesis of integrated circuits. Also, it is very challenging due to the complexity of the design rules that the router must obey. In this article, we present SmartDR, a detailed routing system that focuses on good design rule handling and fast runtime. To attend these objectives, we propose a novel pin access approach and a fast design rule aware A*-interval-based path search algorithm. The pin access method uses resource sharing ghost pin access paths with dynamic legalization check. We also propose a design rule check algorithm to detect thick metal shapes that are widely created using the proposed pin access method. The path search algorithm integrates design rule check on its core, handling many design rules that would not be possible to be solved by postprocessing. It is aware of the minimum area rule, the cut spacing of via cuts within the same path, and the via library. We also present a new technique to improve A*-based path search in detailed routing. The technique makes the path search algorithm aware of the global routing guides, accelerating the search. Using ISPD 2018 Contest benchmarks, our experiments show that our router is superior to the state-of-the-art routers that were also tested using the same benchmarks. Our router has presented, on average, 77.6% less runtime, 73.5% less design rule violations, with respect to Dr. CU 2.0, which is the better of the compared routers.

This paper presents an efficient procedure for optimizing the electric field at ground level of high surge impedance loading transmission lines. Such lines have the capacity to achieve higher power transmission rates than the conventional ones. The ellipsoidal method is applied in order to maximize the transmitted power and minimize the electric field at ground level through the variation of the conductor’s positions in the tower, given its physical and electrical constraints. By means of an efficient new approach to handle the conductors, the optimization gives birth to compact line designs combined with conventional bundles of conductors. Furthermore, it is shown that the proposed strategy can increase the transmitted power, reduce the electric field at ground level, and shorten the running time of the optimization algorithm.

Detailed Routing is one of the most time-consuming steps of physical synthesis of ICs. Also, it is very challenging due to the complexity of the design rules that the router must obey. For some of these rules, if they are handled in a postprocessing step after routing, it may be impossible to avoid design rule violations. This requires that these rules are handled by the path search algorithm used in routing. Thus, we propose DRAPS, a design rule aware path search algorithm. DRAPS is an A*-interval-based fast path search algorithm which is aware of the via library, the minimal area rule and the cut spacing rule of vias belonging to the same path. Our experiments show that DRAPS reduces the design rule violation count by 96% on average, in comparison with a non-design-rule aware path search. Besides, we have compared our detailed routing system to two state-of-the-art academic routers (Dr. CU and TritonRoute) that were tested using ISPD18 benchmarks. Our router has presented, on average, 22% less runtime and 81% less design rule violations w.r.t. Dr. CU, which was the better of the compared routers.

The high computing power of graphics processing units (GPUs) makes them attractive for safety-critical applications, where reliability is a major concern. This article uses an approximate computing perspective to relax application accuracy in order to improve the selective fault tolerance techniques. Our approach first assesses the vulnerability of a Kepler GPU to the transient effects through a neutron beam experiment. Then, it performs a fault injection campaign to identify the most critical registers and relax the result accuracy. Finally, it uses the acquired data to improve the selective fault tolerance techniques in terms of occupation and performance. The results show that it was possible to improve the GPU register file’s reliability on average by 71.6% by relaxing the application accuracy and, when compared with the selective hardening techniques, it was able to reduce the replicated registers by an average of 41.4%, while maintaining 100% fault coverage.

Purpose This paper aims to explore the limitations of the conformal finite difference time-domain method (C-FDTD or Dey–Mittra) when modeling perfect electric conducting (PEC) and lossless dielectric curved surfaces in coarse meshes. The C-FDTD is a widely known approach to reduce error of curved surfaces in the FDTD method. However, its performance limitations are not broadly described in the literature, which are explored as a novelty in this paper. Design/methodology/approach This paper explores the C-FDTD method applied on field scattering simulations of two curved surfaces, a dielectric and a PEC sphere, through the frequency range from 0.8 to 10 GHz. For each sphere, the mesh was progressively impoverished to evaluate the accuracy drop and performance limitations of the C-FDTD with the mesh impoverishment, along with the wideband frequency range described. Findings This paper shows and quantifies the C-FDTD method’s accuracy drops as the mesh is impoverished, reducing C-FDTD’s performance. It is also shown how the performance drops differently according to the frequency of interest. Practical implications With this study, coarse meshes, with smaller execution time and reduced memory usage, can be further explored reliably accounting the desired accuracy, enabling a better trade-off between accuracy and computational effort. Originality/value This paper quantifies the limitations of the C-FDTD in coarse meshes in a wideband manner, which brings a broader and newer insight upon C-FDTD’s limitations in coarse meshes or relatively small objects in electromagnetic simulation.

This work presents improvements for inclined thin wire simulation in finite-difference time-domain (FDTD). Modelling of the corners of staircase geometries is proposed by adding the accumulated charges at an edge region. This correction is important due to the delay of the electromagnetic fields propagation on the stairs. To test the validity of the proposition, the v-dipole fed by a resistive voltage source is designed and implemented. A significant improvement can be noted in the calculation of the impedance when the stairs of the geometry are more discretised and the charge correction is applied. Also, a surprising outcome is issued when the stair formed by an inclined thin wire has only one cell per stair: a perfect emulation of an inclined wire happens when the charge correction is applied, showing that a correction of the propagation time of the electromagnetic fields is automatically performed. Based on the propagation time adjustments, an effective length model has also been proposed to emulate the real size of the inclined wire by the size correction of the staircase geometry. Although the effective length depends on the FDTD parameters initial setup, it has a fast response and a low complexity implementation with good accuracy.

The system capable of harvesting RF energy from the environment through an antenna and converting it into direct current energy to deliver to a load is known as rectenna. The rectifier circuit is an important part of the rectenna and its modeling is arduous since it employs a non-linear device working at extremely low power levels. In addition, there are some losses in the system. Thus, the design of a high-efficient rectifier is a great challenge. In this work, several rectifier topologies are optimized, using the Genetic Algorithm, in order to achieve the highest efficiency and output voltage. An analysis of the influence of the variables on the output of these rectifiers was also performed. The topologies under investigation were optimized for −15 dBm input power and 2.45 GHz operating frequency, in accordance with the most suitable band for energy harvesting. Under these conditions, the Monodiode Series topology presents the best performance. When the input power is −15 dBm, it presents an output voltage of 402 mV and an efficiency of 51.3%. At that power level, the achieved efficiency is higher than that found in the literature.

The present study investigated a SARS-CoV-2 infection in placenta and fetal samples from an early pregnancy miscarriage in Midwest Brazil. The Gamma variant was isolated and fully sequenced from the placenta sample, but not from fetal samples. Our findings highlight potential adverse perinatal outcomes caused by SARS-CoV-2 Gamma infection during pregnancy.

This pilot study aimed at evaluating the effect of tonotopic (basal) stimulation on the Subjective Visual Vertical (SVV) in patients unilaterally treated with a Cochlear Implant (CI).Ten adult subjects with severe to profound sensorineural hearing loss, who were implanted with a CI from Advanced Bionics (AB, Stäfa, Switzerland), model HiRes 90KTM or newer, were included in this prospective pilot study between September and December 2020. A specific CI processor (Naída CI Q90) was used to generate five different stimulation modes: simulation of either basal, medial, or apical electrodes, all electrodes on and all electrodes off. The examination of the verticality was carried out by means of SVV goggles both in the upright body position (head position 0 degrees) and with the head tilted sideways (-30°, -15°, +15°, +30°).In each stimulation mode, there was a significant difference (p0.05) in SVV between the straight head orientation and the tilted head position. There were, however, no significant differences between the five CI settings in any given head position (p0.05). No significant differences could be found regarding the direction of SVV deviation relative to the operated ear (p0.05).SVV could not be influenced by tonotopic CI stimulation. Different stimulation settings, patterns and intensity other than the auditory strategy may have to be developed to provide an adequate stimulus to the otolith organs.

Coronavirus disease 2019 (COVID-19) is a global pandemic that has severely affected health care systems around the world. During the emergency state declared in Portugal in the months of March and April 2020, there was a severe reduction in medical activity in order to reduce the pressure on health systems. This study aimed to assess the impact of COVID-19 in gastroenterology departments across Portugal and the strategies developed to overcome this challenge.This was a cross-sectional study based on an online survey. A detailed questionnaire concerning different aspects of gastroenterology department activity was sent via e-mail to the heads of gastroenterology departments of Portuguese District Hospitals (Núcleo de Gastroenterologia dos Hospitais Distritais). Two periods were assessed, i.e., the emergency state and the recovery period between May and September. The responses were collected between September and October 2020.A total of 21 hospitals were enrolled (80.8% response rate). Twenty-eight percent of the responders reported healthcare professionals from their unit infected with COVID-19. At least 1 member (mostly fellows) of the department was deployed to another workplace in 66.7% of the hospitals. During the emergency state, 47.6% of the hospitals only performed urgent/emergent endoscopic procedures. In 38.5% of the hospitals the need to ration personal protective equipment led to the suspension of endoscopic training. Regarding the recovery period, nonurgent procedures were restarted in almost all of the centers. The same was reported for the colorectal cancer screening program. Remarkably, 81% of the responders confirmed that they had postponed procedures at patients' request for "fear of getting infected." Remote consultation was maintained in 81% of the hospitals. Globally, the fellows had resumed their training.This study provides a snapshot of the impact and consequences of the first wave of the COVID-19 pandemic across Portuguese hospitals. It is important to understand how the gastroenterology world dealt with the first impact of COVID-19 and what strategies were implemented in order to better prepare for what might follow.A doença por coronavirus 19 (COVID-19) é uma pandemia global que afetou gravemente os serviços de saúde em todo o mundo. Durante o estado de emergência declarado em Portugal nos meses de Março e Abril de 2020, verificou-se uma redução importante na atividade médica. Este estudo teve como objetivo avaliar o impacto da COVID-19 nos Serviços de Gastroenterologia portugueses e as estratégias implementadas para fazer face a este desafio.Tratou-se de um estudo transversal baseado num inquéritoResponderam 21 Hospitais (taxa de resposta: 80,8%). Vinte e oito porcento dos inquiridos tiveram profissionais da sua unidade infectados com COVID-19. Pelo menos um elemento foi mobilizado para outro local de trabalho em 66,7% dos hospitais, maioritariamente internos de formação específica de Gastroenterologia. Durante o estado de emergência, 47,6% dos Hospitais só realizaram endoscopias urgentes/emergentes. Em 38,5%, a necessidade de racionamento de equipamento de proteção individual levou à suspensão do treino em endoscopia. Relativamente ao período de recuperação, os procedimientos não urgentes foram retomados na maioria dos centros. O mesmo se verificou para o programa de rastreio do cancro colorectal. Salienta-se que 81% dos inquiridos confirmaram que adiaram exames a pedido dos doentes por “medo de ficarem infetados”. Mantiveram-se consultas nãopresenciais em 81% dos Hospitais. De modo geral, as atividades de formação dos internos foram progressivamente retomadas.Este estudo oferece o retrato do impacto e consequências da primeira vaga da pandemia nos Hospitais portugueses. É importante compreender como os Serviços de Gastrenterologia nacionais lidaram com o primeiro impacto da COVID-19 e que estratégias foram implementadas de forma a melhor preparar o que se segue.

Background: Rifampicin has been employed in various endocarditis antibiotic regimens, particularly in prosthetic, staphylococcus aureus (SA) and culture-negative cases. However, this practice is not without controversy. Purpose: To perform a meta-analysis aimed at ascertaining the efficacy and safety of adjunctive rifampicin use in endocarditis. Methods: We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar, from inception to June 1st, 2021, for studies comparing rifampicin-containing antibiotic regimens with those comprising no rifamycin derivatives, in the setting of endocarditis. The primary endpoint was all-cause death, while relapse, bail-out valvular surgery, microbiological failure (lasting positivity of blood cultures) and hepatotoxicity (fivefold or higher increase in transaminase levels) were secondary outcomes. SA infections were investigated separately, with respect to the primary endpoint. Mantel-Haenszel odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random-effects model. Results: 2 randomized, 1 non-randomized prospective and 6 retrospective studies, featuring 886 patients (of whom 322 allocated to rifampicin), were included. While 8 studies addressed staphylococcal endocarditis (with 3 of them dealing exclusively with SA infections), prosthetic and culture-negative cases were only focused on 1 study each. There were 96 deaths (from 7 studies), 32 relapses (from 6 studies), 35 bail-out valvular surgeries (from 4 studies), 14 microbiological failures (from 2 studies) and 32 hepatotoxicity cases (from 5 studies). Rifampicin use was associated with a tendency towards higher all-cause mortality (OR 1.63, 95% CI 0.85-3.12, P 0.14, i 2 12%), which held true for SA infections (OR 1.63, 95% CI 0.67-3.92, P 0.28, i 2 20%), and bail-out valve surgery (OR 2.03, 95% CI 0.65-6.34, P 0.22, i 2 5%). Relapse and microbiological failures rates were similar between groups (OR 1.25, 95% CI 0.59-2.65, P 0.56, i 2 0% and OR 1.3, 95% CI 0.24-6.90, P 0.76, i 2 41%, respectively). Hepatotoxicity odds were greater in the rifampicin arm (OR 3.24, 95% CI 1.35-7.77, P 0.008, i 2 0%). Conclusion: Currently available evidence does not support rifampicin use in endocarditis.

Background The prevalence of coronary artery disease (CAD) is high among patients with severe aortic stenosis who undergo transcatheter aortic valve replacement (TAVR). Indications for TAVR are now expanding to younger and lower risk patients. During their lifetime, these patients will be at risk of developing CAD and it is expected an increase in coronary angiography and percutaneous coronary intervention (PCI). Aortic prosthesis, particularly if in supra-annular position, may pose important technical difficulties in coronary re-engagement after TAVR. Purpose To evaluate the feasibility to reengage the coronary ostia after TAVR, describe complications and compare technical differences between coronary procedures performed before and after TAVR. Methods Retrospective analysis of 714 patients submitted to TAVR from August 2007 to December 2019. Patients who needed coronary angiography after TAVR were selected. The primary endpoint was the rate of successful coronary ostia cannulation after TAVR, defined by the possibility to selectively cannulate and inject both coronary ostia. Secondary endpoint was complications associated with coronary catheterization after TAVR. Results Among 714 patients, 25 (3.5%) patients were submitted to a total of 28 coronary angiography after TAVR. 14 patients were male (56%), mean age 78.2±6.2 years and 9 (36%) had history of previous coronary revascularization. From the 28 coronary angiographies (balloon-expandable Edwards-Sapien n=11, 44%; self-expandable CoreValve n=10, 40%; Portico n=2, 8%; Symetis n=2, 8%), 25 (89%) met the primary endpoint. Only three was semiselective (Symetis, CoreValve Evolut R and CoreValve TAVR in TAVR), with impossibility to cannulate both coronary arteries, right coronary artery and left coronary artery, respectively. 13 (46%) patients had also indication for PCI and all were successfully performed (Edwards-Sapien n=4, 31%; CoreValve n=6, 46%; Portico n=2, 15%; Symetis n=1, 8%). The main indications for coronary angiography was chronic coronary syndrome (n=12, 43%) and acute coronary syndrome without ST segment elevation (n=7, 25%). Circumflex artery was the most frequently treated vessel (n=6), followed by left anterior descending artery (n=4), right coronary artery (n=3) and left main (n=2). There were no complications reported during or post-procedure. Comparing coronary angiographies before and after TAVR, there were no significant differences regarding arterial access site, catheter diameter, fluoroscopy time and quantity of contrast used in coronary angiography. Conclusion Although the need for coronary angiography was rare in patients after TAVR, selective diagnostic coronary angiographies were possible in 89% (25/28) and PCI was feasible in all patients in whom it was indicated, without any reported complications. Further prospective studies are needed to confirm the great feasibility of performing coronary angiography after TAVR. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Vila Nova de Gaia / Espinho

Background Nowadays, in patients with aortic regurgitation (AR), aortic valve surgery is indicated when severe and symptomatic or those with depressed LVEF. However, clinical outcomes of patients with significant aortic regurgitation are not influenced by these factors only. Recently, a new staging system for severe aortic stenosis has been proposed by Généreux on the basis of the extent of anatomic and functional cardiac damage. If this model could be applicable to an unselected significant AR population has not been tested. Purpose The aim of our study was to evaluate the prevalence of the different stages of extra-aortic valvular cardiac damage by the application of Généreux staging and its impact on prognosis in a large, real world cohort of significant AR patients. Methods This study retrospectively analysed the clinical, Doppler echocardiographic and outcome data in patients with grade III or greater AR between January 2014 and September 2019. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage) or Stage 4 (right ventricular damage). Exclusion criteria were severe aortic stenosis and previous valve repair or replacement. The primary end-point was all-cause mortality. Results A total of 572 patients, aged 70.1±13.9 years, 294 (51.3%) men were enrolled. One third of patients were in NYHA I. Based on the proposed classification, 82 patients (14.3%) were classified in stage 0, 130 (22.7%) in stage 1, 276 (48.2%) in stage 2, 68 (11.8%) in stage 3 and 17 (3.0%) in stage 4. Median follow-up time was 3.3±1.9 years. There was a progressive increase in mortality rates according to staging: 8.5% in stage 0, 10.8% in stage 1, 24.9% in stage 2, 42.6% in stage 3 and 52.9% in stage 4 (p Conclusion Our study demonstrated that this new staging system studied for aortic stenosis also provides increased prognostic value to patients with significant aortic regurgitation. This staging system can be helpful to identify the degree of extra-aortic valvular cardiac damage and to optimize the time of valvular intervention. Further prospective studies are needed to confirm the benefit of the applicability of this model in clinical practice. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Vila Nova de Gaia / Espinho Distribution of stages of cardiac damageSurvival analysis according to stage

Background and aim Long-term data on the durability of transcatheter heart valves is scarce. This is of particular interest as indications expand to younger and lower surgical risk patients. We sought to assess the incidence of long-term structural valve dysfunction (SVD) and bioprosthetic valve failure (BVF) in a cohort of patients with TAVR who reached at least 5-year follow-up, as compared to surgical aortic valve replacement (SAVR), performed within the same time-frame at the same institution. Methods and results Consecutive patients with at least 5-year available follow-up, who underwent TAVR between November 2008 to December 2015 in a tertiary single center, were included. From a group of 246 patients undergoing TAVR, 126 had available follow-up data (age at implantation: 83.0 [77.8–87.0] years; EuroScore II: 4.54 [2.60–6.29]%; follow-up: 5.94 [5.06–7.67] years). First generation Corevalve® and Sapien® prosthesis were implanted in 56% and 38% patients, respectively. SVD and BVF were defined according to the new consensus statement from the EAPCI endorsed by the ESC and the EACTS. Mean transaortic pressure gradients decreased from 53.2±1.3 mmHg (pre-TAVR) to 10.4±0.4 mmHg (at discharge or up to one-year after TAVR, p As comparator, from a cohort of 587 patients submitted to biological SAVR, 247 (age 75.0 [70.0–79.0] years; EuroScore II 1.43 [1.06–2.17]%) had available long-term follow-up (6.89 [6.08–8.19] years). Moderate and severe SVD were reported in 42 and 3 patients, respectively (8-year cumulative incidence function to SVD: 3.13%; 95% CI, 2.45–4.21). These events were clinically relevant (BVF) in 19 of them: 8 performed TAVR valve-in-valve procedures and 3 redo SAVR. At the fifth-year of follow-up the incidence of SVD was not statistically different between TAVR (8%) and SAVR (15%), with a p for comparison of 0.137. Conclusions In our population of patients with symptomatic severe aortic stenosis treated with first-generation percutaneous bioprostheses, TAVR was associated with a low incidence of BVF and SVD at the long-term follow-up. These outcomes seem indistinct from those occurring in patients submitted to conventional SAVR Funding Acknowledgement Type of funding sources: None. KM curve reporting probability of SVD

Achieving thermoelectric devices with high performance based on low-cost and nontoxic materials is extremely challenging. Moreover, as we move toward an Internet-of-Things society, a miniaturized local power source such as a thermoelectric generator (TEG) is desired to power increasing numbers of wireless sensors. Therefore, in this work, an all-oxide p-n junction TEG composed of low-cost, abundant, and nontoxic materials, such as n-type ZnO and p-type SnO

Mesenchymal stem/stromal cell (MSC)-based therapies have been proposed for back pain and disc degeneration, despite limited knowledge on their mechanism of action. The impact of MSCs/their secretome on annulus fibrosus (AF) cells and tissue was analysed in bovine AF organ cultures (AF-OCs) exposed to upper-physiological cyclic tensile strain (CTS, 9 %, 1 Hz, 3 h/d) and interleukin (IL)-1β in a custom-made device. A 4 d treatment of the CTS + IL-1β-stimulated AF-OCs with MSC secretome downregulated the expression of inflammation markers [IL-6, IL-8, prostaglandin-endoperoxide synthase 2 (PTGS2)], complement system regulators [cluster of differentiation (CD)46, CD55, CD59] and matrix metalloproteinase 1 but also of tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2) and collagen type I. At the protein level, it was confirmed that IL-6, MMP-3 and collagen content was decreased in AF-OCs treated with the MSC secretome compared to the CTS + IL-1β stimulation alone. 9 d after treatment, a biomechanical peel-force test showed that the annular adhesive strength was significantly decreased by the MSC secretome treatment. Overall, MSC secretome had a stronger impact on AF tissue than MSCs in co-culture. The secretome contributed to a decrease in the inflammatory and catabolic status of AF cells activated by CTS + IL-1β and played a role in the regulation of the complement system. However, it also contributed to a decrease in collagen at the gene/protein level and in AF mechanical strength compared to the CTS + IL-1β stimulation alone. Therefore, the use of MSC secretome requires further investigation regarding its influence on disc matrix properties.

Funding Acknowledgements Type of funding sources: None. Background Randomized controlled trials comparing stress cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) suggest similar diagnostic accuracy for detecting obstructive coronary artery disease (CAD). However, there are few data on whether or not this remains true in routine clinical practice. The aim of this study was to assess the clinical and angiographic characteristics of patients undergoing invasive coronary angiography (ICA) after a positive stress CMR or positive SPECT, and to compare their positive predictive value with published results from the CE-MARC trial. Methods In this retrospective tertiary-center analysis, we included 429 patients (mean age 67 ± 10 years, 28% women, 42% diabetic) undergoing ICA between January 2016 and December 2020, after a positive stress CMR or positive SPECT. Regarding stress test, an adenosine protocol was performed in all stress CMR and in 76.4% (n = 272) of stress SPECT. Stress test results, including ischemia location and severity, were classified as reported by their primary readers. Patients with missing data on key variables, and those in whom microvascular disease was considered likely in the original stress test report were excluded. Obstructive CAD was defined as any coronary artery stenosis ≥ 50% in a vessel compatible with the ischemic territory on stress testing. Results Out of the total 429 patients, 356 (83%) were referred after a positive SPECT, and 73 (17%) after a positive stress CMR. Patients did not differ regarding age, cardiovascular risk factors, previous revascularization or left ventricular dysfunction, but patients with SPECT were more frequently male (p = 0.046). Overall, 320 patients (75%) had obstructive CAD on ICA. The prevalence of obstructive CAD was similar in patients with positive SPECT vs. positive stress CMR (76.1% vs. 80.8%, respectively, p = 0.385). There were also no significant differences in the prevalence of left main or 3-vessel disease (9.0% vs. 9.6%, p = 0.871, and 19.7% vs. 23.3% p = 0.483, respectively). Revascularization was performed or planned in 59.3% of patients in the SPECT group, and 52.1% of those in the stress CMR group (p = 0.255). The positive predictive values of both techniques were similar to those reported in the CE-MARC trial (Figure), and would increase to 88.1% and 89.4% for SPECT and stress CMR, respectively, if patients reported as having only mild ischemia were excluded. Conclusion In this tertiary center analysis, stress CMR and SPECT showed similar positive predictive values, comparable to those reported in the CE-MARC trial.

Background The preoperative differentiation between salivary gland tumor entities using computed tomography, magnetic resonance imaging (MRI) and ultrasound (US) is still limited. Biopsies are often regarded as indispensable for properly characterizing these various lesions. The aim of this study was to analyze the value of acoustic radiation force impulse (ARFI) sonoelastography as an US differentiation tool when examining parotid gland (PG) lesions. Methods We included 104 patients with PG masses in this study, employing two different US devices using quantitative ARFI-sonoelastography (Siemens Acuson-S3000, n=59; Siemens Acuson-Sequoia, n=45). The ability of sonoelastographic measurements to differentiate between different neoplasms was compared and analyzed for both US machines. Results Quantitative shear wave sonoelastography is limited in its ability to reliably differentiate between tumor entities of the PG as a stand-alone parameter. Measurement results were unsystematically distributed and not transferable between the two US devices. A significant differentiation of benign and malignant lesions was not possible with either US machine (S3000: P=0.770, Sequoia: P=0.382). A differentiation between pleomorphic adenomas (PA) and Warthin tumors was only possible with the Acuson S3000 system (P=0.001, Spearman-Rho =0.492, sensitivity 73.9%, specificity 65.0%). Conclusions A reliable identification and differentiation of PG tumors as well as clinical treatment decisions cannot be made with the sole use of ARFI-sonoelastography. The results emphasize the device-dependence and high error-proneness of this US technique when examining lesions of the PG.

Purpose The use of adjuvants can significantly strengthen a vaccine’s efficacy. We sought to explore the immunization efficacy of bacterial outer membrane vesicles (OMVs) displaying the Schistosoma mansoni antigen, SmTSP-2, through a biotin-rhizavidin coupling approach. The rationale is to exploit the nanoparticulate structure and the adjuvant properties of OMVs to induce a robust antigen-specific immune response, in light of developing new vaccines against S. mansoni. Materials and Methods OMVs were obtained from Neisseria lactamica and conjugated with biotin. The recombinant SmTSP-2 in fusion with the biotin-binding protein rhizavidin (rRzvSmTSP-2) was produced in E. coli and coupled to biotinylated OMVs to generate an OMV complex displaying SmTSP-2 on the membrane surface (OMV:rSmTSP-2). Transmission electron microscopy (TEM) and dynamic light scattering analysis were used to determine particle charge and size. The immunogenicity of the vaccine complex was evaluated in C57BL/6 mice. Results The rRzvSmTSP-2 protein was successfully coupled to biotinylated OMVs and purified by size-exclusion chromatography. The OMV:rSmTSP-2 nanoparticles showed an average size of 200 nm, with zeta potential around – 28 mV. Mouse Bone Marrow Dendritic Cells were activated by the nanoparticles as determined by increased expression of the co-stimulatory molecules CD40 and CD86, and the proinflammatory cytokines (TNF-α, IL-6 and IL-12) or IL-10. Splenocytes of mice immunized with OMV:rSmTSP-2 nanoparticles reacted to an in vitro challenge with SmTSP-2 with an increased production of IL-6, IL-10 and IL-17 and displayed a higher number of CD4+ and CD8+ T lymphocytes expressing IFN-γ, IL-4 and IL-2, compared to mice immunized with the antigen alone. Immunization of mice with OMV:rSmTSP-2 induced a 100-fold increase in specific anti-SmTSP-2 IgG antibody titers, as compared to the group receiving the recombinant rSmTSP-2 protein alone or even co-administered with unconjugated OMV. Conclusion Our results demonstrate that the SmTSP-2 antigen coupled with OMVs is highly immunogenic in mice, supporting the potential effectiveness of this platform for improved antigen delivery in novel vaccine strategies.

Background Anti-malarial drug resistance remains a key concern for the global fight against malaria. In Ghana sulfadoxine-pyrimethamine (SP) is used for intermittent preventive treatment of malaria in pregnancy and combined with amodiaquine for Seasonal Malaria Chemoprevention (SMC) during the high malaria season. Thus, surveillance of molecular markers of SP resistance is important to guide decision-making for these interventions in Ghana. Methods A total of 4469 samples from uncomplicated malaria patients collected from 2009 to 2018 was submitted to the Wellcome Trust Sanger Institute, UK for DNA sequencing using MiSeq. Genotypes were successfully translated into haplotypes in 2694 and 846 mono infections respectively for pfdhfr and pfdhps genes and the combined pfhdfr/pfdhps genes across all years. Results At the pfdhfr locus, a consistently high (> 60%) prevalence of parasites carrying triple mutants (IRNI) were detected from 2009 to 2018. Two double mutant haplotypes (NRNI and ICNI) were found, with haplotype NRNI having a much higher prevalence (average 13.8%) than ICNI (average 3.2%) across all years. Six pfdhps haplotypes were detected. Of these, prevalence of five fluctuated in a downward trend over time from 2009 to 2018, except a pfdhps double mutant (AGKAA), which increased consistently from 2.5% in 2009 to 78.2% in 2018. Across both genes, pfdhfr/pfdhps combined triple (NRNI + AAKAA) mutants were only detected in 2009, 2014, 2015 and 2018, prevalence of which fluctuated between 3.5 and 5.5%. The combined quadruple (IRNI + AAKAA) genotype increased in prevalence from 19.3% in 2009 to 87.5% in 2011 before fluctuating downwards to 19.6% in 2018 with an average prevalence of 37.4% within the nine years. Prevalence of parasites carrying the quintuple (IRNI + AGKAA or SGEAA) mutant haplotypes, which are highly refractory to SP increased over time from 14.0% in 2009 to 89.0% in 2016 before decreasing to 78.9 and 76.6% in 2017 and 2018 respectively. Though quintuple mutants are rising in prevalence in both malaria seasons, together these combined genotypes vary significantly within season but not between seasons. Conclusions Despite high prevalence of pfdhfr triple mutants and combined pfdhfr/pfdhps quadruple and quintuple mutants in this setting SP may still be efficacious. These findings are significant as they highlight the need to continuously monitor SP resistance, particularly using deep targeted sequencing to ascertain changing resistance patterns.

The PAINESD risk score was developed in 2015 as a tool to stratify the risk of acute hemodynamic decompensation during ventricular tachycardia (VT) ablation in structural heart disease patients and further then used for post procedure 30-day mortality prediction. The original cohort however did not include Chagas disease (ChD) patients. We aim to evaluate the relevance of the score in a ChD population.The PAINESD risk score gives weighted values for specific characteristics (chronic obstructive pulmonary disease, age60 years, ischemic cardiomyopathy, New York Heart Association [NYHA] functional class 3 or 4, ejection fraction less than 25%, VT storm, and diabetes). The score was applied in a retrospective cohort of ChD VT ablations in a single tertiary center in Brazil. Data were collected by VT study reports and patient record analysis at baseline and on follow-up.Between January 2013 and December 2018, 157 VT catheter ablation procedures in 121 ChD patients were analyzed. Overall, 30-day mortality was 9.0%. Multivariate analysis correlated NYHA functional class (HR 1.78, 95% CI 1.03-3.08, P 0.038) and the need for urgent surgery (HR 31.5, 95% CI 5.38-184.98, P0.001), as well as a tendency for VT storm at presentation (HR 2.72, 95% CI 0.87-8.50, P 0.084) as risk factors for the primary endpoint. The median PAINESD risk score in this population was 3 (3-8). The area under the receiver operating characteristic (ROC) curve was 0.64 (95% CI 0.479-0.814).The PAINESD risk score did not perform well in predicting 30-day mortality in ChD patients. Pre-procedure NYHA functional class and the need for urgent surgery due to refractory pericardial bleeding were independently associated with increased 30-day mortality. Prospective studies are needed to take final conclusions in Chagas disease when using PAINESD score.

Confocal laser endomicroscopy is an optical imaging technique that allows in vivo, real-time, microscope-like images of the upper aerodigestive tract's mucosa. The assessment of morphological tissue characteristics for the correct differentiation between healthy and malignant suspected mucosa requires strict evaluation criteria.This study aims to validate an eight-point score for the correct assessment of malignancy.We performed confocal laser endomicroscopy between March and October 2020 in 13 patients. 197 sequences (11.820 images) originated from the marginal area of pharyngeal and laryngeal carcinomas. Specimens were taken at corresponding locations and analyzed in HE staining as a standard of reference. A total of six examiners evaluated the sequences based on a scoring system; they were blinded to the histopathological examination. The primary endpoints are sensitivity, specificity, and accuracy. Secondary endpoints are interrater reliability and receiver operator characteristics.Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. Confocal laser endomicroscopy of malignant cells demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 83.2%, 81.3%, 85.5%, 86.7%, and 79.7%, respectively, with a κ-value of 0.64, and an area under the curve of 0.86.The results confirm that this scoring system is applicable in the laryngeal and pharyngeal mucosa to classify benign and malignant tissue. A scoring system based on defined and reproducible characteristics can help translate this experimental method to broad clinical practice in head and neck diagnosis.

This work investigates the use of softcore GPUs in SRAM-based FPGAs under emulated radiation-induced transient faults. It explores performing floating-point (FP) operations by using software and hardware implementations in the embedded GPU as a trade-off between area, performance, and reliability. A fault injection campaign is performed by emulating radiation-induced effects in the target FPGA for measuring the architectural vulnerability factor. Evaluated data is then used for calculating the mean work between failure (MWBF) for the different implementations. Experimental results show that although the reduced area has been an important criteria to improve reliability in SRAM-based FPGAs, for all applications, FP calculations performed in hardware increased the MWBF significantly, cases from 1.2 to 18.6 times the software implementation.