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ABSTRACTAmanitais one of the most salient mushroom genera due to its cultural, economic, and medical importance. Recently, many new Amanitaspecies have been described worldwide, increasing the genus richness. However, several clades have cryptic diversity, and many species complexes have not yet been resolved. This is the case of the rubescent species in the Validaesection, which have been widely cited under the name Amanita rubescenss.l. We used a four-locus matrix (nuc rDNA internal transcribed spacer [ITS] and 28S regions and genes for RNA polymerase II subunit 2 [rpb2], translation elongation factor 1-α [tef1-α], and β-tubulin [tub2]) to solve the phylogenetic relationships within the Amanitasection Validae. To analyze the diversity and distribution patterns of species, we used an extensive ITS sequence sampling including environmental DNA databases. The phylogenetic analyses demonstrated that the Validaesection is divided into three monophyletic and highly supported major clades: Mappae, Validae, and Rubescentes. At least 11 species-level clades within the Rubescentesclade were highly supported: A. cruentilemurumnom. prov. A. brunneolocularis, A. rubescenss.s. (European clade), A. rubescenss.s. (Asiatic clade), A. orsoniis.s. A. ‘orsonii,’ A. aureosubuculanom. prov., A. novinupta, A. flavorubens, and two undescribed North American species. We proved that A. rubescenss.s. has two segregated populations (European and Asiatic) and it is not naturally distributed in America. Furthermore, we found that America has more cryptic species within the Rubescentesclade than Eurasia.

IMPORTANCE: Although patient-reported outcomes provide valuable insights, these subjective data may not align with objective test results. Hearing loss is a pervasive problem, such that concordance between subjective perceptions of hearing ability and objective audiogram assessments would be beneficial. OBJECTIVES: To determine (1) whether psychological status is an effect modifier of the association between subjective patient reports of hearing ability and objective audiometry results, and (2) whether any effect modification observed in standard static questionnaires would be either mitigated or exacerbated by adaptive testing based on Item Response Theory analyses. DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study at a tertiary care center and community-based practice included consecutive adults who presented with queries related to hearing loss. Participants were recruited and enrolled and data analyses occurred from 2022 to 2024. EXPOSURES: Participants prospectively reported their hearing-specific abilities through either a standard static or adaptive version of the Inner Effectiveness of Auditory Rehabilitation (EAR) scale, alongside validated measures of their mental health and audiometry. Word recognition scores (WRS) and pure tone averages (PTA) were used to analyze audiometric testing. MAIN OUTCOMES AND MEASURES: The association between subjective Inner EAR results and audiometry was evaluated. Stratified analyses were used to assess for effect modification by psychological status. The results of standard static and adaptive testing were compared. RESULTS: In this study of 395 patients (mean [range] age, 55.9 [18-89] years; 210 [53.2%] female), standard static Inner EAR mean scores were appropriately higher in patients with higher (better) WRS (50.7, 95% CI, 46.4-54.9), compared with patients with lower (worse) WRS (34.7, 95% CI, 24.3-45.1). However, among patients with worse mental health, there was no association between standard static Inner EAR scores and WRS. In contrast, adaptive Inner EAR mean scores were significantly higher for those with better WRS, regardless of mental health status. Thus, effect modification was observed in standard static assessments, whereas adaptive testing remained durably associated with audiometry, regardless of mental health. CONCLUSIONS AND RELEVANCE: Psychological status was an effect modifier of the association between standard Inner EAR scale scores and audiometry, with a positive association observed only in those with better mental health. Adaptive testing scores, however, remained significantly associated with audiometry, even when mental status was worse. Adaptive testing may stabilize the association between subjective and objective hearing outcomes.

IMPORTANCE: Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study. OBJECTIVE: To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent. MAIN OUTCOMES AND MEASURES: Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes). RESULTS: The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score ≥45) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman ρ = 0.73), depression (ρ = 0.61), anxiety (ρ = 0.54), and poor peer relationships (ρ = −0.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen d = −0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen d = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.

En la población pediátrica, los defectos de la esteroidogénesis suprarrenal constituyen la principal causa de insuficiencia suprarrenal (IS) primaria, mientras que la retirada súbita del tratamiento glucocorticoide crónico es la principal causa de IS central. Los programas de cribado neonatal de las hiperplasias suprarrenales congénitas son de vital importancia, ya que permitirán realizar un diagnóstico precoz e instaurar las intervenciones terapéuticas oportunas para garantizar la supervivencia de los neonatos afectados. Unas concentraciones basales de cortisol sérico inferiores a 3μg/dl son diagnósticas de IS, mientras que valores superiores a 15-18μg/dl la descartarían. En caso de valores indeterminados, estaría indicada la evaluación dinámica de la reserva suprarrenal. La prueba de estimulación corta con 250μg de 1-24-ACTH es el patrón oro en pacientes con IS primaria y está recomendada también en la evaluación de pacientes con IS central. La prueba de hipoglucemia insulínica es el patrón oro en la evaluación de la IS de origen central.

A nivel de la corteza suprarrenal, nos podemos encontrar desde patología benigna como los adenomas corticoadrenales a patología maligna como el carcinoma o las metástasis suprarrenales. En cuanto a su funcionalidad, el espectro de patologías es muy variable: desde adenomas no funcionantes, pacientes con secreción autónoma de cortisol (SAC), hiperaldosteronismo primario (HAP), síndrome de Cushing ACTH independiente, exceso de secreción de hormonas sexuales, hiperplasia suprarrenal congénita (HSC) e insuficiencia suprarrenal (IS). El estudio hormonal es esencial para la adecuada caracterización de estos trastornos, siendo necesarias tanto pruebas hormonales basales como estudios funcionales en algunos casos para llegar al diagnóstico definitivo de sospecha. Para el cribado de síndrome de Cushing, el cortisol libre urinario, el cortisol salival nocturno o la prueba de supresión con 1mg de dexametasona (PSD) son las pruebas de elección; para la SAC la PSD; para el HAP el cálculo del cociente entre la concentración plasmática de aldosterona y la actividad o concentración de renina; para la IS la determinación del cortisol plasmático entre las 8-9 a.m. y tras estímulo con cosintropina, y para HSC la medición de la 17-hidroxiprogesterona plasmática.

Los feocromocitomas son tumores neuroendocrinos poco frecuentes que derivan de las células de la médula adrenal. Ante la sospecha de un feocromocitoma, el primer paso es demostrar que existe una producción excesiva de catecolaminas. De entre las distintas determinaciones disponibles para el diagnóstico de feocromocitoma, las de mayor capacidad diagnóstica son las metanefrinas fraccionadas en orina o en plasma. Si se han descartado falsos positivos que justifiquen la elevación de metanefrinas, el siguiente paso es el diagnóstico de localización, considerándose la TC la prueba inicial de elección. Las pruebas de medicina nuclear son de utilidad para la estadificación tumoral inicial, así como para detectar lesiones no localizadas por las modalidades de imagen convencionales. Una vez confirmado el diagnóstico y teniendo en cuenta que entre el 15%-40% de los feocromocitomas son hereditarios, se recomienda solicitar un estudio genético a todos los pacientes, idóneamente mediante técnicas de secuenciación masiva (NGS).

El hipercortisolismo de origen suprarrenal es un trastorno hormonal causado por la exposición crónica a un exceso de glucocorticoides por una sobreproducción suprarrenal de cortisol. Existe un amplio espectro de presentación clínica, desde casos de hipercortisolismo aparentemente subclínico hasta casos floridos, dependiendo de la duración y la intensidad del hipercortisolismo. En consecuencia, el diagnóstico puede resultar complejo, dado que la mayoría de los signos y síntomas son inespecíficos. Las manifestaciones clínicas se relacionan con un perfil cardiometabólico desfavorable, lo que determina el aumento de la morbimortalidad en estos pacientes. El diagnóstico bioquímico se basa en confirmar la producción autónoma de glucocorticoides demostrando la ausencia de supresión fisiológica del cortisol con la prueba de supresión con dexametasona. La concentración de hormona adrenocorticotropa (ACTH) se solicita de cara a establecer el diagnóstico etiológico. Una vez confirmado el diagnóstico bioquímico, el siguiente paso es el estudio radiológico, considerándose la tomografía computarizada (TC) suprarrenal sin contraste como primera modalidad de imagen. La causa más común de hipercortisolismo endógeno independiente de ACTH es el adenoma suprarrenal unilateral productor de cortisol. El tratamiento se individualizará en función de la causa y el grado de hipercortisolismo, así como de las comorbilidades asociadas.

Los síndromes de neoplasia endocrina múltiple (MEN) engloban un grupo de trastornos hereditarios heterogéneos caracterizados por una predisposición genética a desarrollar tumores que afectan principalmente a glándulas endocrinas. Los cuatro síndromes reconocidos (MEN1, MEN2A, MEN2B y MEN4) son de herencia autosómica dominante y se distinguen fenotípicamente por el desarrollo de tumores sincrónicos o metacrónicos con presentaciones clínicas variadas. Conocer la genética y la evolución de cada síndrome resulta de utilidad para determinar los plazos de detección de los tumores. Los tratamientos para cada manifestación dependen de la ubicación, el riesgo de malignidad o recurrencia, el exceso hormonal y la morbilidad quirúrgica, y precisan de un manejo multidisciplinar.

La insuficiencia suprarrenal es una patología endocrina de baja prevalencia, pero potencialmente mortal en ausencia de tratamiento. Es causada por un déficit en la producción de cortisol por las glándulas suprarrenales, por un déficit en la producción de ACTH hipofisaria, o tras la supresión brusca del aporte de glucocorticoides. El colapso hemodinámico es la presentación clínica habitual en la crisis suprarrenal aguda. El diagnóstico consiste en demostrar el déficit de cortisol, para lo que disponemos de pruebas dinámicas que permiten evaluar la reserva suprarrenal. Es de interés conocer el método empleado en la determinación bioquímica del cortisol, con el fin de establecer rangos de referencia apropiados. La reposición de la volemia y el uso de glucocorticoides por vía intravenosa constituyen el manejo inicial de la crisis aguda y nunca debe retrasarse ante la sospecha clínica. En formas crónicas, se inicia tratamiento glucocorticoide por vía oral en dosis fisiológicas. El tratamiento mineralocorticoideo está indicado solo en la etiología primaria.

El hiperaldosteronismo primario (HAP) es la causa más frecuente de hipertensión arterial (HTA) secundaria. Además, se asocia con un mayor riesgo cardiometabólico y de mortalidad que el observado en pacientes con HTA esencial. Se recomienda realizar el cribado de HAP mediante la determinación del cociente aldosterona/renina en pacientes con HTA grave y/o resistente, HTA con hipopotasemia, HTA e incidentaloma adrenal, HTA y antecedentes familiares de primer grado de HAP y en HTA asociada con fibrilación auricular no explicable por otras causas. Si se confirma un cociente de aldosterona/renina patológico se deben realizar pruebas dinámicas para establecer el diagnóstico de confirmación; habitualmente la prueba de sobrecarga salina o la prueba de captopril. Estas pruebas pueden obviarse en pacientes con HAP franco (aldosterona plasmática superior a 20 ng/dl, renina suprimida e hipopotasemia). El último paso en el diagnóstico es el estudio de localización, siendo la tomografía computarizada (TC) de suprarrenales la prueba inicial de elección. No obstante, en la mayoría de los pacientes en los que se plantee una cirugía suprarrenal, será necesario realizar un cateterismo de las venas adrenales (CVA) para establecer la lateralidad del HAP. No se considera necesario el CVA en casos de sospecha de carcinoma adrenocortical productor de aldosterona y/o HAP en paciente menores de 35 años con una lesión unilateral clara en la TC/resonancia magnética (RM). El tratamiento del HAP depende de los resultados del estudio de localización: en las formas unilaterales el tratamiento de elección es la adrenalectomía unilateral y en las formas bilaterales lo serán los antagonistas del receptor de mineralocorticoides.

La Endocrinología y Nutrición (EyN) es una especialidad médica ambulatoria y hospitalaria. Mediante este estudio se pretende conocer la evolución de la actividad de interconsulta (IC) en planta de hospitalización por el servicio de EyN de un hospital de tercer nivel, comparando su evolución con respecto al resto de especialidades médicas y comparando la IC por motivo endocrinológico con respecto al nutricional.

IMPORTANCE: Image guidance is an important adjunct for endoscopic sinus and skull base surgery. However, current systems require bulky external tracking equipment, and their use can interrupt efficient surgical workflow. OBJECTIVE: To evaluate a trackerless surgical navigation system using 3-dimensional (3D) endoscopy and simultaneous localization and mapping (SLAM) algorithms in the anterior skull base. DESIGN, SETTING, AND PARTICIPANTS: This interventional deceased donor cohort study and retrospective clinical case study was conducted at a tertiary academic medical center with human deceased donor specimens and a patient with anterior skull base pathology. EXPOSURES: Participants underwent endoscopic endonasal transsphenoidal dissection and surface model reconstruction from stereoscopic video with registration to volumetric models segmented from computed tomography (CT) and magnetic resonance imaging. MAIN OUTCOMES AND MEASURES: To assess the fidelity of surface model reconstruction and accuracy of surgical navigation and surface-CT model coregistration, 3 metrics were calculated: reconstruction error, registration error, and localization error. RESULTS: In deceased donor models (n = 9), high-fidelity surface models of the posterior wall of the sphenoid sinus were reconstructed from stereoscopic video and coregistered to corresponding volumetric CT models. The mean (SD; range) reconstruction, registration, and localization errors were 0.60 (0.24; 0.36-0.93), 1.11 (0.49; 0.71-1.56) and 1.01 (0.17; 0.78-1.25) mm, respectively. In a clinical case study of a patient who underwent a 3D endoscopic endonasal transsphenoidal resection of a tubercular meningioma, a high-fidelity surface model of the posterior wall of the sphenoid was reconstructed from intraoperative stereoscopic video and coregistered to a volumetric preoperative fused CT magnetic resonance imaging model with a root-mean-square error of 1.38 mm. CONCLUSIONS AND RELEVANCE: The results of this study suggest that SLAM algorithm–based endoscopic endonasal surgery navigation is a novel, accurate, and trackerless approach to surgical navigation that uses 3D endoscopy and SLAM-based algorithms in lieu of conventional optical or electromagnetic tracking. While multiple challenges remain before clinical readiness, a SLAM algorithm–based endoscopic endonasal surgery navigation system has the potential to improve surgical efficiency, economy of motion, and safety.

About 30–50% of Primary Care (PC) users in Spain suffer mental health problems, mostly mild to moderate anxious and depressive symptoms, which account for 2% of Spain's total Gross domestic product and 50% of the costs associated to all mental disorders. Mobile health tools have demonstrated to cost-effectively reduce anxious and depressive symptoms while machine learning (ML) techniques have shown to accurately detect severe cases. The main aim of this project is to develop a comprehensive ML digital support platform (PRESTO) to cost-effectively screen, assess, triage, and provide personalized treatments for anxious and depressive symptoms in PC.

Purpose: To summarize the available data on the prevalence, clinical repercussion, and diagnosis of primary aldosteronism (PA) and to discuss the SPAIN-ALDO registry’s findings, which is the largest PA patient registry in Spain. Methods: A comprehensive review of the literature focused on the prevalence, clinical presentation and diagnosis of PA was performed. Results: PA is the most common cause of secondary arterial hypertension. In addition, PA patients have a higher cardio-metabolic risk than patients with essential arterial hypertension matched by age, sex, and blood pressure levels. However, despite its high prevalence and associated metabolic and cardiovascular complications, PA remains largely under-recognized, with less than 2% of people in at-risk populations ever tested. The diagnostic investigation is a multistep process, including screening, confirmatory testing, and subtype differentiation of unilateral from bilateral PA forms. Data from the SPAIN-ALDO registry have shed light on the cardiometabolic impact of PA and about the limitations in the PA diagnosis of these patients in Spain. Conclusions: The most common cause of secondary hypertension is PA. One of the most challenging aspects of the diagnosis is the differentiation between unilateral and bilateral PA because adrenal venous sampling is a difficult procedure that should be performed in experienced centers. Data from the SPAIN-ALDO registry have provided important information on the nationwide management of this pathology.

The legitimacy of democracy and civil rights is based upon laws and administrative procedures. The presence of a legal framework and its application by bureaucrats in their daily decisions are prerequisites for the democratic rule of law. This explains why, in contexts of democratic backsliding, legal frameworks are under attack. Scholars observed the role of public administration in processes of democratic backsliding, but there is still a gap in understanding the disputes around the legal framework. Here, we analyze the conflicts between politicians and bureaucrats around the legal framework in a context of democratic backsliding. Analyzing the case of Brazil under Bolsonaro’s Government, we draw on 164 interviews with bureaucrats to understand how both bureaucrats and politicians dispute the legitimacy, uses, and interpretations of the legal framework to attack or protect democratic institutions and civil rights. On one side, bureaucrats defend themselves and their legitimacy through existing rules and procedures. On the other side, politicians change or reinterpret the rules to fragilize bureaucrats’ decisions. In this process, both politicians and bureaucrats learn how to improve their strategies around the uses of legal frameworks. These findings contribute to understanding how the dynamics around the legal framework explain processes of democratic backsliding.

Cardiac implantable electronic device (CIED) infection is a costly and highly morbid complication. Perioperative interventions, including the use of antibiotic pouches and intensified perioperative antibiotic regimens, have demonstrated marginal efficacy at reducing CIED infection. Additional research is needed to identify additional interventions to reduce infection risk.

ABSTRACT:Background and Objectives:Neurological involvement associated with SARS-CoV-2 infection is increasingly recognized. However, the specific characteristics and prevalence in pediatric patients remain unclear. The objective of this study was to describe the neurological involvement in a multinational cohort of hospitalized pediatric patients with SARS-CoV-2.Methods:This was a multicenter observational study of children <18 years of age with confirmed SARS-CoV-2 infection or multisystemic inflammatory syndrome (MIS-C) and laboratory evidence of SARS-CoV-2 infection in children, admitted to 15 tertiary hospitals/healthcare centers in Canada, Costa Rica, and Iran February 2020–May 2021. Descriptive statistical analyses were performed and logistic regression was used to identify factors associated with neurological involvement.Results:One-hundred forty-seven (21%) of 697 hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Headache (n= 103), encephalopathy (n= 28), and seizures (n= 30) were the most reported. Neurological signs/symptoms were significantly associated with ICU admission (OR: 1.71, 95% CI: 1.15–2.55; p= 0.008), satisfaction of MIS-C criteria (OR: 3.71, 95% CI: 2.46–5.59; p< 0.001), fever during hospitalization (OR: 2.15, 95% CI: 1.46–3.15; p< 0.001), and gastrointestinal involvement (OR: 2.31, 95% CI: 1.58–3.40; p< 0.001). Non-headache neurological manifestations were significantly associated with ICU admission (OR: 1.92, 95% CI: 1.08–3.42; p= 0.026), underlying neurological disorders (OR: 2.98, 95% CI: 1.49–5.97, p= 0.002), and a history of fever prior to hospital admission (OR: 2.76, 95% CI: 1.58–4.82; p< 0.001).Discussion:In this study, approximately 21% of hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Future studies should focus on pathogenesis and long-term outcomes in these children.

Purpose: To evaluate whether the clinical, biochemical and radiological features of patients with primary aldosteronism (PA) can predict both main subtypes of PA. Methods: A retrospective multicenter study of PA patients followed in 27 Spanish tertiary hospitals (SPAIN-ALDO Register). Only patients with confirmed unilateral or bilateral PA based on adrenal venous sampling (AVS) and/or postsurgical biochemical cure after adrenalectomy were included. Supervised regression techniques were used for model development. Results: 328 patients [270 unilateral PA (UPA), 58 bilateral PA (BPA)] were included. The area under the curve (AUC) for aldosterone/potassium ratio and aldosterone responses following saline infusion test were 0.602 [95%CI 0.520 to 0.684] and 0.574 [95% CI 0.446–0.701], respectively, to differentiate UPA from BPA. The AUC was 0.825 [95% 0.764–0.886] when the prediction model with seven parameters – comorbidities (dyslipidemia, cerebrovascular disease, sleep apnea syndrome [SAS]), systolic blood pressure (SBP), plasma aldosterone levels (PAC), hypokalemia and unilateral adrenal nodule >1 cm and normal contralateral adrenal gland on CT/MRI – was used. In patients without comorbidities, hypokalemia, SBP > 160 mmHg, PAC > 40 ng/dL, and unilateral adrenal lesions were associated with a likelihood of having a UPA of 98.5%. The chance of BPA was higher in individuals with comorbidities, SBP &lt; 140 mmHg, normokalemia, low PAC levels, and no adrenal tumors on the CT/MRI (91.5%). Conclusion: A combination of high PAC, SBP > 160 mmHg, low serum potassium, a unilateral adrenal nodule>1 cm and no comorbidities could predict a UPA with a 98.5% accuracy.

ObjectiveWe aimed to compare the response rates between two different hepatitis B virus vaccination schedules for cirrhotic subjects who were non-responders to the first three 40 µg doses (month 0-1-2), and identify factors associated with the final response.DesignA total of 120 cirrhotic patients (72.5% decompensated) were randomised at a 1:1 ratio to receive a single 40 µg booster vaccination at month 6 (classical arm) versus an additional round of three new 40 µg doses administered at monthly intervals (experimental arm). The main outcome was the rate of postvaccinal anti-hepatitis B surface antibodies levels ≥10 mIU/mL.ResultsEfficacy by ITT analysis was higher in the experimental arm (46.7%) than in the classical one (25%); OR 2.63, p=0.013. The experimental arm increased response rates compared with the classical one from 31% to 68% (OR 4.72; p=0.007), from 24.4% to 50% (OR 3.09; p=0.012) and from 24.4% to 53.8% (OR 3.62; p=0.007), in Child A, Model for End-Stage Liver Disease (MELD) <15 and MELD-Na<15 patients, respectively. Patients with more advanced liver disease did not benefit from the reinforced scheme. Both regimens showed similar safety profiles. Multivariable analysis showed that the experimental treatment was independently response associated when adjusted across three logistic regression models indicating equivalent cirrhosis severity.ConclusionFor cirrhotic patients, the revaccination of non-responders to the first three dose cycle, with three additional 40 µg doses, achieved significantly better response rates to those obtained with an isolated 40 µg booster dose.Trial registration numberNCT01884415.

The pinto bean (Phaseolus vulgarisL.) cultivar ‘USDA Diamondback’ (Reg. no. CV‐353, PI 698822) was released by the USDA‐ARS in 2022 as a high‐yielding cultivar with an upright architecture and the slow‐darkening seed coat trait. It was bred for tolerance to multiple abiotic stresses in a “purgatory” plot purposely managed to have compacted soil, low soil fertility, and intermittent drought conditions. Conversely, selection for high yield potential was conducted in non‐stress trials with tillage, irrigations, and fertilizers applied for optimal production. USDA Diamondback exhibits wide adaption to production regions across the United States, as evidenced by an average seed yield of 3808 kg ha−1across 14 location‐years in the Cooperative Dry Bean Nursery. Virus testing and resistance gene–linked markers indicate USDA Diamondback has a three‐gene combination (bc‐ud, bc‐1, and bc‐3) that confers durable resistance to all known strains of Bean common mosaic virusand Bean common mosaic necrosis virus. A similar combination of pathogen and marker testing indicated that USDA Diamondback possesses the Ur‐3and Ur‐6genes for resistance to bean rust. The seed size, appearance, and canning quality characteristics of USDA Diamondback meets the industry standards for packaging and processing. USDA Diamondback was bred for high yield potential under both favorable and stressful environments.USDA Diamondback has the slow‐darkening trait that maintains seed coat brightness during prolonged storage.USDA Diamondback has above‐average canning quality.USDA Diamondback is resistant to all known strains of Bean common mosaic virusand Bean common mosaic necrosis virus.

Pituitary tumors (PTs) are a heterogeneous group of lesions of the central nervous system that are usually benign. Most of them occur sporadically, but 5% can do so within family syndromes, usually at a young age. There are differences by sex, age, race, and genetic factors in the prevalence of different tumor cell types and clinical presentation. Functioning-PTs (FPTs) are usually diagnosed earlier than non-functioning PTs (NFPTs). However, this depends on the PT type. Headaches and visual disturbances are the most frequent mass-effect symptoms, but seizures or hydrocephalus may also occur. Pituitary apoplexy is another possible mode of presentation, and it requires special attention because of its potential severity. PTs in pregnancy, childhood, and old age present a series of clinical peculiarities that must be taken into account when evaluating these patients. Ectopic PTs (EPTs) are uncommon and share the same clinical-epidemiological data as eutopic PTs, but, depending on their location, other types of clinical manifestations may appear. Silent PTs are often detected as an incidentaloma or due to neurologic symptoms related to mass-effect. Aggressive PTs and pituitary carcinomas (PCs), which are very rare, are characterized by multiple local recurrences and metastases, respectively. This review addresses the epidemiology and clinical presentation of PTs, from the classical hormonal and mass-effect symptoms to the different rare presentations, such as pituitary apoplexy, hydrocephalus, or diabetes insipidus. Moreover, special situations of the presentation of PTs are discussed, namely, PTs in pregnancy, childhood, and the elderly, EPTs, silent and aggressive PTs, and PCs.

Acrobasis nuxvorellaNeuzing (Lepidoptera: Pyralidae) is a monophagous pest of Carya illinoinensis(Wangenh) K. Koch, a plant rich in tannins. When the tannins degrade, high concentrations of gallic acid are released, which are harmful to some insects. However, Acrobasis nuxvorellalarvae are not affected by feeding on the plant when gallic acid is released. Therefore, it may be expected that Acrobasis nuxvorellalarval gut microbiota may produce the enzyme laccase, enabling them to biotransform gallic acid into other useful molecules. Thus, the intestinal content of the insect was recovered. Among 175 bacterial isolates, 8 showed laccase activity in the range of 0.52–3.9 U/µg of protein. The isolates with laccase activity were identified as the Bacillusspecies: Bacillus pumilus, Bacillus safensis, Bacillus altitudinis, andBacillus xiamenensisthrough 16S ribosomal RNA gene sequencing. In addition, the cotAgene coding for the laccase enzyme was found in the genomic DNA of these eight Bacillusisolates.

RationaleThere is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical guidelines.ObjectivesTo describe and compare the content and quality of clinical guidelines for the management of acute exacerbations of asthma in children between geographic regions.MethodsObservational study of guidelines for the management of acute paediatric asthma from institutions across a global collaboration of six regional paediatric emergency research networks.Measurements and main results158 guidelines were identified. Half provided recommendations for at least two age groups, and most guidelines provided treatment recommendations according to asthma severity.There were consistent recommendations for the use of inhaled short-acting beta-agonists and systemic corticosteroids. Inhaled anticholinergic therapy was recommended in most guidelines for severe and critical asthma, but there were inconsistent recommendations for its use in mild and moderate exacerbations. Other inhaled therapies such as helium-oxygen mixture (Heliox) and nebulised magnesium were inconsistently recommended for severe and critical illness.Parenteral bronchodilator therapy and epinephrine were mostly reserved for severe and critical asthma, with intravenous magnesium most recommended. There were regional differences in the use of other parenteral bronchodilators, particularly aminophylline.Guideline quality assessment identified high ratings for clarity of presentation, scope and purpose, but low ratings for stakeholder involvement, rigour of development, applicability and editorial independence.ConclusionsCurrent guidelines for the management of acute paediatric asthma exacerbations have substantial deficits in important quality domains and provide limited and inconsistent guidance for severe exacerbations.

The objective of this study was to assess the effect of an optimized hot water treatment (OHWT) on the conservation of fresh eggplants (Solanum melongenaL.), which was carried out through the Response Surface Methodology (RSM). Activity of pectin methylesterase (PME), color difference and firmness parameters, as well as the anthocyanin content were optimized according to a rotatable central composite design [process variables: temperature (30–50 °C) and time (5–15 min)]. The RSM results showed an activation on PME activity (1.333–2.922 U/g FW) along with a retention on the quality attributes and optimized conditions of 40 °C and 15 min. In addition, significant differences in bioactive compound contents were observed between treatments, where a greater amount of total phenolic (17.76 mg GAE/100 g) and chlorogenic acid (5.9715 µg CA/mg ME), and fewer anthocyanins were found at OHWT compared to control. Therefore, the application of the optimized conditions (40 °C, 15 min) would be the most suitable to maintain the quality of fresh eggplants.

Attention deficit hyperactivity disorder (ADHD) is the most common childhood neurodevelopmental disorder, with an estimated prevalence in adulthood of 2.5–3.4%. The Attention Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS) is an 18-item self-administered scale that assesses attention deficit and hyperactivity/impulsivity symptoms of ADHD in adults. This study aims to validate the ADHD-RS in Spanish according to the diagnostic criteria established by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Background: To evaluate fluid balance, biomarkers of renal function and its relation to mortality in patients with acute kidney injury (AKI) diagnosed before, or within 24 h of intensive care unit admission. Methods: A prospective cohort study considered 773 critically ill patients observed over six years. Pre-intensive care unit-onset AKI was defined as AKI diagnosed before, or within 24 h of intensive care unit admission. Body weight-adjusted fluid balance and fluid balance-adjusted biomarkers of renal function were measured daily for the first three days of intensive care unit admission. Primary outcome was mortality in the intensive care unit. Results: Prevalence of pre-intensive care unit-onset AKI was 55.1%, of which 55.6% of cases were hospital-acquired and 44.4% were community-acquired. Fluid balance was higher in AKI patients than in non-AKI patients (p&lt; 0.001) and had a negative correlation with urine output (p&lt; 0.01). Positive fluid balance and biomarkers of renal function were independently related to mortality. Multivariate analysis identified the following AKI-related variables associated with increased mortality: (1) In AKI patients: type 1 cardiorenal syndrome (OR 2.00), intra-abdominal hypertension (OR 1.71), AKI stage 3 (OR 2.15) and increase in AKI stage (OR 4.99); 2) In patients with community-acquired AKI: type 1 cardiorenal syndrome (OR 5.16), AKI stage 2 (OR 2.72), AKI stage 3 (OR 4.95) and renal replacement therapy (OR 3.05); and 3) In patients with hospital-acquired AKI: intra-abdominal hypertension (OR 2.31) and increase in AKI stage (OR 4.51). Conclusions: In patients with pre-intensive care unit-onset AKI, positive fluid balance is associated with worse renal outcomes. Positive fluid balance and decline in biomarkers of renal function are related to increased mortality, thus in this subpopulation of critically ill patients, positive fluid balance is not recommended and renal function must be closely monitored. Graphical abstract:

Background: Oral cancer is the sixteenth most common malignant neoplasm worldwide, with a high mortality rate, greater than 50% at five years, and high morbidity. The effect of oncological treatment in the oral cavity is broad and has multiple levels, therefore knowing these effects and preventing them is essential for avoiding an increase in the oral pathology related with oncological therapy, maintaining the quality of life of the patient, and improving the efficacy of the treatment itself. Material and Methods: A group of experts belonging to the fields of Dentistry, Maxillofacial Surgery and Oncology of the University of Seville and the Virgen del Rocío University Hospital of Seville in collaboration with the University of Valencia, University of Barcelona, and University of the Basque Country, developed this Clinical Practice Guideline for the proper clinical management of patients diagnosed with oral cancer. The clinical questions were formulated in PICO format. The databases consulted were Medline/PubMed and Embase/Elsevier. The systematic reviews published on the topic were identified on Tripdatabase, Cochrane Library and CRD (Centre for Reviews and Dissemination). The recommendations were prepared based on the GRADE methodology. Results: Various recommendations were defined, derived from the 21 PICO questions, referring to prevention, treatment and care for alterations arising from the pathology of oral cancer itself and its treatment. Conclusions: The preparation of this clinical practice guideline allows recommendations to be generated based on the scientific evidence available, on dentistry actions in patients with oral cancer and undergoing oncological treatment, which may be of use to the multidisciplinary team treating this type of patient. [ABSTRACT FROM AUTHOR]