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Soil multifunctionality is closely tied to soil health, yet a comprehensive understanding of this link in agricultural soils is lacking. The aim of this study was to understand how long-term fertilization practices affect the provision of multiple services by comparing the multifunctionality of soils. The three objectives were to (i) determine whether the effect of fertilization is consistent across soil types, (ii) describe the effect of the different fertilizers on soil multifunctionality, and (iii) identify soil chemical properties that can be easily used proxies of soil multifunctionality. The descriptors belong to three functioning indexes associated with nutrient availability, carbon transformation, and soil structure maintenance. This study is the first to investigate the effect of a variety of organic fertilizers on the health of three soil types by combining physical, chemical, and biological indicators in sugarcane agroecosystems. An increase in soil multifunctionality was obtained, with no effect on yield. The effect of fertilizers was consistent across soil types. Filter mud and green waste compost significantly increased the multifunctionality and functioning indexes compared to mineral fertilizer. Modifications in soil properties did not fully explain the observed variations. Our results confirm the high potential of organic fertilization to improve multifunctionality and provide ecosystem services. [ABSTRACT FROM AUTHOR]

Biofuels are essential to ensure the energy transition and mitigating of climate change. However, understanding the impact of land use change (LUC) and management practices on soil organic carbon (SOC) stocks is fundamental to ensuring well‐founded policymaking and assessing the sector's carbon footprint. Here, we conducted a meta‐analysis (511 pairwise observations) to obtain Brazil's SOC stock change factors (SOCscf) for LUC and management practices in sugarcane fields. Our results showed that converting native vegetation to sugarcane reduced the SOC stock in all assessed periods. The conversion from annual crops to sugarcane showed a reduction in SOC stock in the first 10 years but with a recovery over time. The conversion of pasture to sugarcane reduced the SOC stock only in the 10–20‐year period and had a neutral effect in other periods evaluated. However, our dataset showed high variability in SOCscf, with many observations indicating an increase in SOC stock, which is related to degraded pastures. We observed that the SOC accumulation rate for each ton of sugarcane straw was affected by the interaction between soil texture and precipitation. Regarding straw management, a low removal rate (< 34%) did not affect the SOC stock, while moderate (34%–66%) and high (> 66%) removal resulted in losses of 5.0% (SOCscf 0.950) and 9.9% (SOCscf 0.901), respectively. Our results also showed that reduced tillage and vinasse application increased SOC stocks by 24.0% (SOCscf 1.24) and 10.0% (SOCscf 1.10) respectively, proving to be good strategies to support C sequestration in sugarcane fields. Finally, we highlight that our results can contribute to the improvement of public policies and also be used in future life cycle assessment (LCA) and modeling studies, as they provide robust data to establishing regional SOCscf induced by LUC and management practices, enhancing the reliability of the C footprint assessment of biofuel production. [ABSTRACT FROM AUTHOR]

Background: The management of patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is burdened by an unfavorable prognosis even with aggressive treatment. The aim of the present study is to investigate the risk factors affecting 30-day mortality in poor-grade aSAH patients. Methods: We performed a retrospective analysis of a prospectively collected database of poor-grade aSAH patients (World Federation of Neurosurgical Societies, WFNS, grades IV and V) treated at our institution from December 2010 to December 2020. For all variables, percentages of frequency distributions were analyzed. Contingency tables (Chi-squared test) were used to assess the association between categorical variables and outcomes in the univariable analysis. Multivariable analysis was performed by using the multiple logistic regression method to estimate the odds ratio (OR) for 30-day mortality. Results: A total of 149 patients were included of which 32% had WFNS grade 4 and 68% had WFNS grade 5. The overall 1-month mortality rate was 21%. On univariable analysis, five variables were found to be associated with the likelihood of death, including intraventricular hemorrhage (IVH ≥ 50 mL, p = 0.005), the total amount of intraventricular and intraparenchymal hemorrhage (IVH + ICH ≥ 90 mL, p = 0.019), the IVH Ratio (IVH Ratio ≥ 40%, p = 0.003), posterior circulation aneurysms (p = 0.019), presence of spot sign on initial CT scan angiography (p = 0.015). Nonetheless, when the multivariable analysis was performed, only IVH Ratio (p = 0.005; OR 3.97), posterior circulation aneurysms (p = 0.008; OR 4.05) and spot sign (p = 0.022; OR 6.87) turned out to be independent predictors of 30-day mortality. Conclusion: The risk of mortality in poor-grade aSAH remains considerable despite maximal treatment. Notwithstanding the limitations of a retrospective study, our report highlights some neuroradiological features that in the emergency setting, combined with leading clinical and anamnestic parameters, may support the multidisciplinary team in the difficult decision-making process and communication with family members from the earliest stages of poorgrade aSAH. Further prospective studies are warranted. [ABSTRACT FROM AUTHOR]

Background: Although percutaneous endoscopic gastrostomy (PEG) offers better access to the gastrointestinal system, in patients with previous abdominal surgery, PEG can be unsuccessful. Laparoscopically assisted percutaneous endoscopic gastrostomy (LAPEG) is indicated for such patients. However, patients with amyotrophic lateral sclerosis (ALS) may be more susceptible to anesthesia-related complications than other patients, requiring the indications for LAPEG, along with perioperative management, to be considered carefully. Case presentation: A 70-year-old, male patient with ALS was referred to our hospital for a gastrostomy for progressive dysphagia. He had undergone an open distal gastrectomy for gastric ulcer perforation in his twenties. Upper gastrointestinal endoscopy denied the transillumination sign and focal finger invagination. Because the risk of respiratory complications caused by general anesthesia was not considered serious, the decision was made to perform a LAPEG. Under careful, intraoperative airway management and neuromuscular monitoring, adhesiolysis was performed to increase mobility of the remnant stomach. A gastrostomy tube was inserted through the abdominal wall and into the remnant stomach under laparoscopic and endoscopic guidance. The patient was discharged in stable condition on postoperative day 3 without any respiratory complications. Conclusions: LAPEG was able to be performed in a patient with ALS with a previous gastrectomy. A perioperative team comprised of neurologists, endoscopists, surgeons, anesthesiologists, and nurses who are fully conversant with ALS must be assembled to deal with potentially complex medical issues related to the procedure and anesthetic and perioperative management. [ABSTRACT FROM AUTHOR]

The article focuses on recommendations of Anesthesia for Amyotrophic lateral sclerosis (ALS), a rare progressive paralytic disorder involving motor neurons. Topics include the it is associative with Environmental risk factors; patient get symptomatic treatment as there is no casual therapy; and type of anesthesia used in surgical intervention.

Amyotrophic lateral sclerosis (ALS) is a rare progressive paralytic disorder characterised by degeneration of upper and lower motor neurons in the motor cortex, brainstem and spinal cord. ALS is the most common form of degenerative motor neuron disease [1,3,6,11]. Involvement of the upper motor neurons leads to weakness, spasticity, hyperreflexia and Babinski signs. Affection of the lower motor neurons causes weakness, muscular atrophy, fasciculations and cramps [11]. Brain stem affection can lead to bulbar symptoms. The course of the disease varies according to the region first affected and clinical manifestation. Usually respiratory failure is the ultimate cause of death [4]. The worldwide incidence is approximately 1/50,000 per year and the prevalence around 1/20,000. These numbers are relatively uniform in Western countries, although foci of higher frequency have been reported in the Western Pacific [23]. Incidence as well as prevalence increase with age [1]. The mean age of onset for sporadic ALS is late 50s, but earlier onset may occur in familial cases. There is a slight male preponderance (male-to-female ratio of around 1.5-2:1) in sporadic cases, but an equal ratio in familial cases [1,23]. About 5-10 % of ALS cases are familial (typically autosomal-dominant inheritance), whereas the remaining 90-95 % of ALS cases occur sporadically, but these are phenotypically indistinguishable [1,6]. Over 100 genetic variants have been associated with the risk for developing ALS, but the pathogenetic mechanism(s) remain unknown [1]. Interestingly, different gene mutations can lead to distinct phenotypes (e.g., similar age at onset, site of onset, disease duration), while other single gene mutations can lead to multiple phenotypes [6]. Genes influencing cytoskeletal dynamics or the protein and RNA homoeostasis as well as trafficking processes play an important role in the centre of current research [1]. Environmental factors undoubtedly influence the complex pathogenesis, but this is incompletely understood. Environmental risk factors, which have been associated with ALS in varying levels of support include, for example, military service, different kinds of (head) trauma, smoking and exposure to heavy metals and pesticides [1]. There is a marked phenotypic heterogeneity between patients with respect to the onset, location and populations of involved motor neurons, resulting in diverse signs and symptoms [1,6,24]. "Classical" ALS usually begins in the limbs with focal weakness, but progresses within weeks to months to involve most muscles. Until late in the disease, neurons innervating eye muscles or the bladder are not affected [1,6]. Beside muscle weakness, muscle atrophy, fasciculations, spasticity and hyperreflexia may appear [24]. However, one-third of patients present with bulbar symptoms, e.g., difficulties in chewing, speaking, swallowing; drooling of saliva as well as a slurred speech [1,26]. Dysphagia can result in a symptomatic aspiration of solids, liquids and later of solid food [28]. Furthermore, emotional lability due to involvement of frontopontine motor neurons may indicate pseudobulbar palsy, which is characterised by facial spasticity and a tendency to laugh or cry excessively in response to minor emotional stimuli [1]. Up to 20 % of ALS patients show progressive cognitive abnormalities marked by behavioural changes, leading to (frontotemporal) dementia [1]. Beside "classical" ALS, there are several atypical ALS forms such as cases with pure limb involvement and these may have longer survival. In these atypical ALS forms, the pathological burden is predominantly at one (upper or lower) motor neuron level. These forms include primary lateral sclerosis (PLS) or progressive muscular atrophy (PMA), in which their independency or entity as a variant of ALS is under debate [5]. The degree of involvement of the upper and the lower motor neurons, the body regions affected, the degrees of involvement of other systems (e.g., cognition, behaviour) and the progression rates vary among patients [6]. The time from the first symptom of ALS to diagnosis is approximately 12 months. The diagnosis is primarily based on clinical examination. Imaging of the head and spine, electromyography and laboratory test particularly serve to exclude structural lesions and other causes for paralysis [1]. The ALSFRS-R questionnaire can be used to evaluate the course of the disease and especially the patients' functional impairment [11]. Unfortunately, there is no causal therapy for ALS. Treatment options are usually palliative directed towards managing symptoms with temporary interventions (e.g., nasogastric feeding, surgical improvement of speech disorders, cough-assist devices, diaphragmatic pacing, ventilatory support or tracheotomy). Whether feeding via gastrostomy tube has a significant survival benefit is controversial [13,22,30]. Furthermore, pros and cons as well as consequences of a tracheostomy are part of an ethical discussion in the advanced care planning of ALS patients. Tracheostomy and ventilation may allow the patient to survive despite increasing paresis, but ALS may ultimately lead to a locked-in state with the inability to communicate. Drugs like edaravone and riluzole provide limited improvement [1]. Because no therapy offers substantial clinical benefit for ALS, the prognosis is poor [1,19]. As ALS progresses, there is further weakening of the diaphragm and respiratory muscles leading to dyspnoea, orthopnoea, hypoventilation, pneumonia and finally to death due to respiratory paralysis/failure or complications such as dysphagia or immobility within 3 to 5 years [1,11,24]. Mean life expectancy after symptom onset is about three years [11]. [ABSTRACT FROM AUTHOR]

Amyotrophic lateral sclerosis, or motor neuron disease, is an uncommon progressive neurological disorder. Professionals working in the perioperative field may encounter patients with amyotrophic lateral sclerosis only rarely. The relevant published literature on amyotrophic lateral sclerosis is broad in scope, but a contemporary review focused on the perioperative period is absent. This structured narrative review seeks to provide a summary of the contemporary management of patients and then focuses on eliciting if there are perioperative management considerations specific to amyotrophic lateral sclerosis that can be optimised. A comprehensive structured narrative literature review, including grey literature searching, indicated worsening ventilatory failure is of prime concern but that patients may present with a broad range of neurological symptoms, and that cardiovascular and cognitive dysfunction specific to amyotrophic lateral sclerosis may exist and be occult. Exacerbation of neuromuscular weakness during the perioperative period is multifaceted and requires the application of a high standard of the core principles of surgical and anaesthetic management of neuromuscular disease. Standard perioperative approaches require rigorous attention and potential exists for significant alteration. There is a potential high risk of postoperative increased morbidity from neurological decline and mortality from pulmonary complications. A meticulous approach to planning preoperative assessment, shared decision-making, intraoperative and postoperative care is required. [ABSTRACT FROM AUTHOR]

Background: Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. Aim: We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". Methods: We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. Results: Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17–1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08–2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62–2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10–1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02–1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68–3.36, p value < 0.0001). Conclusion: This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium. [ABSTRACT FROM AUTHOR]

Introduction: Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium. Methods: The analyses were conducted employing the cross-sectional "Delirium Day" initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses. Results: A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]. Discussion and conclusion: Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium. [ABSTRACT FROM AUTHOR]

Purpose: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that leads to death due to respiratory failure. This report describes the perioperative characteristics of ALS patients who underwent procedures with anesthesia at our institution. Methods: We reviewed perioperative records of ALS patients who underwent procedures with anesthesia from January 1, 2014, through December 31, 2015. Results: Seventy-eight patients underwent 89 procedures (71 procedures with monitored anesthesia care and 18 with general anesthesia), including 45 gastrostomy tube placements and 18 bone marrow biopsies. Three patients had prolonged duration of postoperative intubation related to preexisting respiratory muscle weakness, and one patient with bilateral pneumothorax required tracheal reintubation for respiratory distress. Four patients had prolonged duration of hospitalization. Three patients were hospitalized for ALS-related complications, and one patient was hospitalized for respiratory distress when pneumoperitoneum developed after gastrostomy tube placement. Three of these patients died of complications attributable to ALS within 30 days of the procedure. Twenty-nine (32.6%) procedures required minimal sedation (e.g., bone marrow biopsy, cataract surgery) and were performed on an ambulatory basis. Conclusion: When caring for patients with ALS, the perioperative team must be prepared to treat potentially complex medical conditions that may not be directly related to the procedure and anesthetic management. However, minor procedures performed with minimal sedation may be safely performed on an ambulatory basis. [ABSTRACT FROM AUTHOR]

Patients with amyotrophic lateral sclerosis (ALS) present an increased risk of postoperative respiratory failure after general anesthesia. We report the case of a 71-year-old man with ALS who underwent emergency laparotomy for small bowel strangulation. After surgery, he remained intubated and was transferred to the high care unit under mechanical ventilation, due to unstable hemodynamics requiring inotropic support. On postoperative day (POD) 3, he was extubated under stable hemodynamics and respiratory status. Immediately after extubation, bilevel positive airway pressure (bilevel PAP) was prophylactically applied to prevent postoperative respiratory failure, which may have been caused by respiratory muscle fatigue, attributed to general anesthesia and surgical stress. On POD 7, bilevel PAP was smoothly weaned off because no signs and symptoms of respiratory failure were observed. On POD 10, he achieved 30 m-walk without rest. No postoperative complications were observed up to one month after surgery. Postoperative respiratory failure may lead to death in patients with neuromuscular disorder. Non-invasive ventilation (NIV) reduces respiratory muscle fatigue, resulting in easy sputum expectoration, promoting CO2 washout, and better oxygenation. Consequently, the prophylactic use of NIV to avoid postoperative respiratory insufficiency should be considered in patients with ALS after emergency operation under general anesthesia. [ABSTRACT FROM AUTHOR]

Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium., Design: Cross-sectional study nested in the 2017 "Delirium Day" project., Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy., Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters)., Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63)., Conclusions and Implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Publication of an ointment tablet dating from the end of Sixth Dynasty or later currently in the magazine of Shutb (close to the city of Assiut). [ABSTRACT FROM AUTHOR]

As palliative care physicians become increasingly involved in the care of patients with amyotrophic lateral sclerosis (ALS), they will be asked to provide guidance regarding the use of supplements, diet, exercise, and other common preventive medicine interventions. Moreover, palliative care physicians have a crucial role assisting patients with ALS in addressing health care decisions to maximize quality of life and cope with a rapidly disabling disease. It is therefore important for palliative care physicians to be familiar with commonly encountered palliative care issues in ALS. This article provides an evidenced-based review of palliative care options not usually addressed in national and international ALS guidelines. [ABSTRACT FROM AUTHOR]

As the population ages, the prevalence ofmany neurologic diseases is increasing. At the same time, older patients are undergoing more surgical procedures. This confluence of events puts neurohospitalists in a unique position to provide both pre- and postoperative guidance to minimize complications, improve clinical outcomes, and decrease health care costs in patients with neurologic comorbidities. Early preoperative consultation is recommended for patients with severe, poorly controlled, or decompensated neurologic disease, a recent stroke, or those undergoing procedures with a high risk of neurologic complications. The neurohospitalist’s role includes optimizing management of preexisting diseases, such as epilepsy, neuromuscular disorders, Parkinson’s disease, dementia, and cerebrovascular disease, as well as providing guidance for perioperative management and clarification of risks. In the postoperative period, the neurohospitalist will frequently be consulted to mitigate any negative impact of neurologic complications that do occur. [ABSTRACT FROM AUTHOR]

Frequency-selective surfaces (FSSs) have a wide spectrum of applications in airborne platforms, wireless communication systems, medical imaging instruments, and high-power microwave systems. To employ finite, electrically large, and conformal FSSs for such applications, the development of an efficient electromagnetic (EM) design and analysis technique is essential, which is a challenging task in terms of computational complexity and requirements of highend computing platforms. In view of assessing the efficacies of various EM techniques for the design and analysis of FSS structures employed for planar and conformal surfaces, a brief review is presented here. Furthermore, the design strategies of novel FSS structures including metamaterial (MTM)-element FSSs are discussed for specific applications such as highperformance radomes, radar absorbing structures (RASs), and antennas. The complex issues associated with the EM design and analysis of FSS structures are also outlined for radomes, RAS, and antennas. [ABSTRACT FROM AUTHOR]

This issue's "Historical Corner" column hosts an article by Francisco Saez de Adana of the University of Alcal? concerning the history of radar from the Spanish point of view. The history of radar often attracts interest, and several articles on the topic have appeared in IEEE Antennas and Propagation Magazine, see, e.g.,: [ABSTRACT FROM AUTHOR]

Background: We report the initial results from a phase I clinical trial for ALS. We transplanted GMP-grade, fetal human neural stem cells from natural in utero death (hNSCs) into the anterior horns of the spinal cord to test for the safety of both cells and neurosurgical procedures in these patients. The trial was approved by the Istituto Superiore di Sanità and the competent Ethics Committees and was monitored by an external Safety Board. Methods: Six non-ambulatory patients were treated. Three of them received 3 unilateral hNSCs microinjections into the lumbar cord tract, while the remaining ones received bilateral (n = 3 + 3) microinjections. None manifested severe adverse events related to the treatment, even though nearly 5 times more cells were injected in the patients receiving bilateral implants and a much milder immune-suppression regimen was used as compared to previous trials. Results: No increase of disease progression due to the treatment was observed for up to18 months after surgery. Rather, two patients showed a transitory improvement of the subscore ambulation on the ALS-FRS-R scale (from 1 to 2). A third patient showed improvement of the MRC score for tibialis anterior, which persisted for as long as 7 months. The latter and two additional patients refused PEG and invasive ventilation and died 8 months after surgery due to the progression of respiratory failure. The autopsies confirmed that this was related to the evolution of the disease. Conclusions: We describe a safe cell therapy approach that will allow for the treatment of larger pools of patients for later-phase ALS clinical trials, while warranting good reproducibility. These can now be carried out under more standardized conditions, based on a more homogenous repertoire of clinical grade hNSCs. The use of brain tissue from natural miscarriages eliminates the ethical concerns that may arise from the use of fetal material. [ABSTRACT FROM AUTHOR]