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Abstract Sensing-based deep brain stimulation should optimally consider both the motor and neuropsychiatric domain to maximize quality of life of Parkinson’s disease (PD) patients. Here we characterize the neurophysiological properties of the subthalamic nucleus (STN) in 69 PD patients using a newly established neurophysiological gradient metric and contextualize it with motor symptoms and apathy. We could evidence a STN power gradient that holds most of the spectral information between 5 and 30 Hz spanning along the dorsal-ventral axis. It shows elevated power in the sub-beta range (8-12 Hz) toward the ventral STN, and elevated dorsal beta power (16–24 Hz) indicative for the hemispheres contralateral to the more affected hemi-body side. The rigidity response to DBS was highest dorsally on the axis. Importantly, apathetic symptoms can be related to reduced ventral alpha power. In conclusion, the STN spectral gradient may inform about the motor and neuropsychiatric domain, supporting integrative closed-loop strategies.

Eyespot patterns have evolved in many prey species. These patterns were traditionally explained by the eye mimicry hypothesis, which proposes that eyespots resembling vertebrate eyes function as predator avoidance. However, it is possible that eyespots do not mimic eyes: according to the conspicuousness hypothesis, eyespots are just one form of vivid signals where only conspicuousness matters. They might work simply through neophobia or unfamiliarity, without necessarily implying aposematism or the unprofitability to potential predators. To test these hypotheses and explore factors influencing predators’ responses, we conducted a meta-analysis with 33 empirical papers that focused on bird responses to both real lepidopterans and artificial targets with conspicuous patterns (i.e. eyespots and non-eyespots). Supporting the latter hypothesis, the results showed no clear difference in predator avoidance efficacy between eyespots and non-eyespots. When comparing geometric pattern characteristics, bigger pattern sizes and smaller numbers of patterns were more effective in preventing avian predation. This finding indicates that single concentric patterns have stronger deterring effects than paired ones. Taken together, our study supports the conspicuousness hypothesis more than the eye mimicry hypothesis. Due to the number and species coverage of published studies so far, the generalisability of our conclusion may be limited. The findings highlight that pattern conspicuousness is key to eliciting avian avoidance responses, shedding a different light on this classic example of signal evolution.

A method is proposed here for distinguishing the sexes of Cetti’s warblers in their first calendar year (Euring age code=3) based on the use of discriminant analysis. In the initial phase of the study, 118 subjects of known sex (62 males and 56 females), captured and marked in the Palude Brusà, were subjected to analysis as a calibration sample. The analysis yielded a discriminant function based on the two most significant variables (third primary length, tarsus length), enabling the sexes to be classified with a 99.2%. The function was subsequently tested on the validation sample (n=106), composed of 54 males and 52 females of known sex ringed in Punte Alberete (north-eastern Italy) and the Trasimeno Emissary (central Italy), obtaining an accuracy classification equal to 99.1%. A global discriminant analysis was subsequently conducted, integrating the data from the three locations into a unified sample (n=224). This analysis yielded a function that accurately classified 99.1% of the females and 100% of the males. The resulting equation represents a rapid and precise method for distinguishing the sexes of first-calendar year Cetti’s warblers. Additionally, it can assist in the appropriate selection of ring size, which differs between the sexes.

IntroductionCoronavirus disease 2019 (COVID-19) affects the population unequally, with a greater impact on older and immunosuppressed people.MethodsHence, we performed a prospective experimental cohort study to characterise the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in immune-compromised patients (older adults and oncohaematologic patients), compared with healthy counterparts, based on deep characterisation of the circulating immune cell subsets.Results and discussionWhile acquired humoral and cellular memory did not predict subsequent infection 18 months after full vaccination, spectral and computational cytometry revealed several subsets within the CD8+ T-cells, B-cells, natural killer (NK) cells, monocytes and TEMRA Tγδ cells that were differentially expressed in individuals who were subsequently infected and not infected not just following immunisation, but also prior to vaccination. Of note, we found up to seven clusters within the TEMRA Tγδ cell population, with some of them being expanded and others decreased in subsequently infected individuals. Moreover, some of these cellular clusters were also related to COVID-19-induced hospitalisation in oncohaematologic patients. Therefore, we have identified a cellular signature that even before vaccination is related to COVID-19 vulnerability as opposed to the acquisition of cellular and/or humoral memory following vaccination with SARS-CoV-2 messenger RNA (mRNA) vaccines.

BackgroundWith increasing healthcare service utilization and the introduction of costly therapies, healthcare organizations are pressured to deliver cost-effective services within constrained budgets. Rising costs and the need for efficient healthcare delivery are major concerns for governments, insurers, and health plans.ObjectivesIt aims to understand the impact of these intangible assets on creating value and organizational resilience in healthcare, informing better practices and strategies for VBHC implementation.MethodsAn applied research approach using the Work Breakdown Structure (WBS) methodology was adopted. The research was divided into seven interconnected Work Packages (WPs), each designed to investigate different aspects of the integration between VBHC and intangible assets, with a focus on enhancing organizational resilience through innovative health processes. Key methodologies included literature reviews and qualitative analyses, employing Open Innovation and Design Thinking.ResultsThe study revealed a dynamic interplay between VBHC, organizational resilience, and intangible assets. It showed that managerial effectiveness is influenced by direct patient outcomes and elements like intellectual capital and organizational reputation. Data integration from various Work Packages provided new insights into how intangible assets underpin VBHC strategies, proposing novel management approaches. Findings highlight the essential role of intangible assets in enhancing service delivery and fostering sustainable healthcare practices.DiscussionThe study highlights a significant oversight in the integration of intangible assets within healthcare organizations, despite their crucial role in optimizing VBHC. It supports literature emphasizing the importance of intellectual capital and organizational culture in enhancing healthcare management efficiency and resilience. A paradigm shift in VBHC to include these assets is needed for building a more adaptable and sustainable healthcare system. This integration can lead to better clinical outcomes, patient satisfaction, and overall healthcare efficiency, aligning more closely with VBHC goals.ConclusionRecognizing and effectively managing intangible assets are paramount for the successful implementation of VBHC and enhanced organizational resilience. Strategic integration of these assets into healthcare management practices can significantly improve patient outcomes and create a more sustainable, patient-centered, and resilient healthcare system. Future studies should develop methodologies for robust measurement and integration of these assets to fully realize the potential of VBHC.

Objetivo: Identificar en la literatura científica el rol de equipo de enfermería en los equipos de respuesta rápida en la atención del paro cardiorrespiratorio, en las diferentes regiones continentales. Metodología: Se realizó una revisión integrativa de la literatura con búsqueda en las bases de datos PubMed, Web of Science, Scopus, Lilacs y CINAHL, utilizando los descriptores: equipo de respuesta rápida, cuidados de enfermería, atención de enfermería, equipo multiprofesional, paro cardíaco y enfermería. Se incluyeron estudios en portugués, inglés y español, publicados entre 2010 y 2020, que describieran el papel de la enfermería en los equipos de respuesta rápida. Resultados: La muestra comprendió 6 artículos y abarcó prácticamente la mitad del continente americano, específicamente en América del Norte. El papel de los enfermeros en los equipos de respuesta rápida incluye dos dimensiones: la asistencial, que abarca la atención directa al paciente crítico hasta la llegada del profesional médico, y la administrativa, relacionada con actividades de educación continua, elaboración de protocolos clínicos y comunicación entre sectores, equipos y gestión de la asistencia. Conclusiones: El equipo de enfermería, en los equipos de respuesta rápida, desarrolla el papel de coordinador de múltiples actividades asistenciales y de gestión para los pacientes hospitalizados con signos de empeoramiento clínico y que necesitan intervención inmediata.

No abstract available.

BackgroundCarbon dioxide (CO2), traditionally viewed as a mere byproduct of cellular respiration, plays a multifaceted role in human physiology beyond simple elimination through respiration. CO2 may regulate the tumor microenvironment by significantly affecting the release of oxygen (O2) to tissues through the Bohr effect and by modulating blood pH and vasodilation. Previous studies suggest hypercapnia (elevated CO2 levels) might trigger optimized cellular mechanisms with potential therapeutic benefits. The role of CO2 in cellular stress conditions within tumor environments and its impact on O2 utilization offers a new investigative area in oncology.ObjectivesThis study aims to explore CO2’s role in the tumor environment, particularly how its physiological properties and adaptive responses can influence therapeutic strategies.MethodsBy applying a structured translational approach using the Work Breakdown Structure method, the study divided the analysis into six interconnected work packages to comprehensively analyze the interactions between carbon dioxide and the tumor microenvironment. Methods included systematic literature reviews, data analyses, data integration for identifying critical success factors and exploring extracellular environment modulation. The research used SMART criteria for assessing innovation and the applicability of results.ResultsThe research revealed that the human body’s adaptability to hypercapnic conditions could potentially inform innovative strategies for manipulating the tumor microenvironment. This could enhance O2 utilization efficiency and manage adaptive responses to cellular stress. The study proposed that carbon dioxide’s hormetic potential could induce beneficial responses in the tumor microenvironment, prompting clinical protocols for experimental validation. The research underscored the importance of pH regulation, emphasizing CO2 and carbonic acid’s role in modulating metabolic and signaling pathways related to cancer.ConclusionThe study underscores CO2 as vital to our physiology and suggests potential therapeutic uses within the tumor microenvironment. pH modulation and cellular oxygenation optimization via CO2 manipulation could offer innovative strategies to enhance existing cancer therapies. These findings encourage further exploration of CO2’s therapeutic potential. Future research should focus on experimental validation and exploration of clinical applications, emphasizing the need for interdisciplinary and collaborative approaches to tackle current challenges in cancer treatment.

Introduction: In addition to childhood obesity status, the family history of cardiovascular disorders might be used as a tool for screening youth to identify those at the highest risk of developing metabolic impairments later in life. Thus, the aim of the present study was to examine associations between parental history of cardiovascular disease risk factors and childhood cardiometabolic risk, and to examine the role of cardiorespiratory fitness (CRF) and obesity in mediating the relationship between parental history and global cardiometabolic risk. Methods: A cross-sectional study was developed with 2,213 Brazilian youth. The cardiometabolic risk factor (CMRF) score, CRF, and waist circumference (WC) were evaluated. Parental family history of cardiovascular risk factors was obtained through a self-reported questionnaire. Results: Family history of hypertension, high cholesterol, diabetes, and obesity were associated with a higher CMRF score. Also, hypertensive father and high maternal cholesterol, and obesity in both parents increased the prevalence rates of these conditions in the offspring. WC was a mediator in some of these associations, while CRF was a protector for a lower metabolic risk. Conclusion: Evaluating family history, along with WC and CRF is essential for determining pediatric cardiometabolic risk.

Background: Despite the current data on morbidity and mortality, a growing number of patients with a diagnosis of cancer survive due to an early diagnosis and advances in treatment modalities. This study aimed to compare the quality of life and coping strategies in three groups of patients with cancer and identify associated clinical and sociodemographic characteristics. Methods: A comparative study was conducted with outpatients at a public hospital in the state of São Paulo, Brazil. The 300 participants were assigned to three groups: patients in palliative care (Group A), patients in post-treatment follow-up with no evidence of disease (Group B), and patients undergoing treatment for cancer (Group C). Data collection involved the use of the McGill Quality of Life Questionnaire and the Ways of Coping Questionnaire. No generic quality-of-life assessment tool was utilized, as it would not be able to appropriately evaluate the impact of the disease on the specific group of patients receiving palliative care. Results: Coping strategies were underused. Participants in the palliative care group had poorer quality of life, particularly in the psychological well-being and physical symptom domains. Age, currently undergoing treatment, and level of education were significantly associated with coping scores. Age, gender, income, and the absence of pharmacological pain control were independently associated with quality-of-life scores. Moreover, a positive association was found between coping and quality of life. Conclusion: Cancer patients in palliative care generally report a lower quality of life. However, male patients, those who did not rely on pharmacological pain control, and those with higher coping scores reported a better perception of their quality of life. This perception tended to decrease with age and income level. Patients currently undergoing treatment for the disease were more likely to use coping strategies. Patients with higher education and quality-of-life scores also had better coping scores. However, the use of coping strategies decreased with age.

Abstract Background Wild boars (Sus scrofa) may cause substantial damage to crops and can spread zoonotic parasites to domestic animals, posing a risk to health and animal production. Metastrongylus spp. can negatively affect the wild boar population, increasing piglet mortality. In addition to that, studies with Metastrongylus genetic characterization are still scarce in Brazil. The present study aims to characterize Metastrongylus spp. from wild boars hunted in the states of São Paulo, Paraná, and Rio Grande do Sul, Brazil, using traditional morphological description and DNA sequences in an integrative taxonomic approach. Methods After nematode collection from 58 wild boars, the parasites were morphologically identified and genetically characterized by the amplification of 18S ribosomal DNA (rDNA), 28S rDNA, internal transcribed spacer (ITS) region, and cox-1 mitochondrial DNA (mtDNA). Descriptors of infection were determined and Pearson's Chi-square test was applied to compare the prevalence of infections among the identified parasite species, host age group (juveniles and adults), and sex. The Mann–Whitney U test was performed to compare the mean intensity between the age groups and sex. Results Metastrongylus salmi, Metastrongylus apri, and Metastrongylus pudendotectus were identified in 77.6% (45/58) of the necropsied wild boars. Metastrongylus salmi was the most prevalent and abundant species (70.7%, 11.1), followed by M. pudendotectus (18.9%, 4.3) and M. apri (17.2%, 2.2). Metastrongylus pudendotectus showed the highest mean intensity and range (25.2, 1–93), followed by M. salmi (15.7, 1–58) and M. apri (12.6, 3–27). We found a significantly higher prevalence of Metastrongylus spp. and M. salmi in adult wild boars, probably associated with a more prolonged time of exposure to intermediate host species. The phylogenetic analysis revealed that ITS2 region and cox-1 mtDNA are the most suitable genetic markers for Metastrongylus species characterization. Genetic variability between M. apri and M. salmi isolates was verified. Conclusions We expand the knowledge about the Metastrongylus community in the non-captive wild boar population from Brazil as well as the importance of this exotic species in the maintenance of Metastrongylus spp. in its areas of occurrence. The novel genetic sequences obtained may help further studies to understand the genetic diversity in other nematode populations from Brazil and other countries. Graphical Abstract

MicroRNAs (miRNAs) can act as biomarkers and descriptors of the association between infections and other diseases, such as hepatitis and COVID-19. This study aims to investigate the role of miRNA serum expression according to laboratory data concerning hepatitis and COVID-19. Seventy individuals recruited in Southern and Southeastern Brazil donated serum samples and were divided into four groups: (i) 20 negative subjects, (ii) 20 presenting hepatitis, (iii) 19 with COVID-19 and (iv) 11 with hepatitis and COVID-19. Three miRNAs (miR-122, miR-143 and miR-223) were evaluated using real-time PCR. Hematological and biochemical markers were also analyzed. MiR-143 and miR-223 were downregulated among the hepatitis/COVID-19 group (p < 0.05). A positive correlation was observed between miR-223 and lymphocytes. There was a negative correlation between alanine transaminase (ALT) and aspartate transaminase (AST) for miR-143 and miR-223 and gamma-glutamyl transferase (GGT), alkaline phosphatase (AP) and neutrophil/lymphocyte ratio (NLR) only for miR-223 (p < 0.05). For hepatic fibrosis (FIB-4), miR-122 and miR-143 had a greater association and miR-223 was more associated with a history of vaccination against COVID-19. MicroRNAs 143 and 223 could be useful as biomarkers for hepatitis coinfection with COVID-19.

ObjectivesConfocal laser endomicroscopy (CLE) is an intraoperative real-time cellular resolution imaging technology that images brain tumor histoarchitecture. Previously, we demonstrated that CLE images may be interpreted by neuropathologists to determine the presence of tumor infiltration at glioma margins. In this study, we assessed neurosurgeons’ ability to interpret CLE images from glioma margins and compared their assessments to those of neuropathologists.MethodsIn vivo CLE images acquired at the glioma margins that were previously reviewed by CLE-experienced neuropathologists were interpreted by four CLE-experienced neurosurgeons. A numerical scoring system from 0 to 5 and a dichotomous scoring system based on pathological features were used. Scores from assessments of hematoxylin and eosin (H&E)-stained sections and CLE images by neuropathologists from a previous study were used for comparison. Neurosurgeons’ scores were compared to the H&E findings. The inter-rater agreement and diagnostic performance based on neurosurgeons’ scores were calculated. The concordance between dichotomous and numerical scores was determined.ResultsIn all, 4275 images from 56 glioma margin regions of interest (ROIs) were included in the analysis. With the numerical scoring system, the inter-rater agreement for neurosurgeons interpreting CLE images was moderate for all ROIs (mean agreement, 61%), which was significantly better than the inter-rater agreement for the neuropathologists (mean agreement, 48%) (p < 0.01). The inter-rater agreement for neurosurgeons using the dichotomous scoring system was 83%. The concordance between the numerical and dichotomous scoring systems was 93%. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 78%, 32%, 62%, and 50%, respectively, using the numerical scoring system and 80%, 27%, 61%, and 48%, respectively, using the dichotomous scoring system. No statistically significant differences in diagnostic performance were found between the neurosurgeons and neuropathologists.ConclusionNeurosurgeons’ performance in interpreting CLE images was comparable to that of neuropathologists. These results suggest that CLE could be used as an intraoperative guidance tool with neurosurgeons interpreting the images with or without assistance of the neuropathologists. The dichotomous scoring system is robust yet simple and may streamline rapid, simultaneous interpretation of CLE images during imaging.

IntroductionAssessing the treatment response of glioblastoma multiforme during immunotherapy (IT) is an open issue. Treatment response assessment maps (TRAMs) might help distinguish true tumor progression (TTP) and pseudoprogression (PsP) in this setting.MethodsWe recruited 16 naïve glioblastoma patients enrolled in a phase II trial consisting of the Stupp protocol (a standardized treatment for glioblastoma involving combined radiotherapy and chemotherapy with temozolomide, followed by adjuvant temozolomide) plus IT with dendritic cells. Patients were followed up till progression or death; seven underwent a second surgery for suspected progression. Clinical, immunological, and MRI data were collected from all patients and histology in case of second surgery. Patients were classified as responders (progression-free survival, PFS > 12 months), and non-responders (PFS ≤ 12), HIGH-NK (natural killer cells, i.e., immunological responders), and LOW-NK (immunological non-responders) based on immune cell counts in peripheral blood. TRAMs differentiate contrast-enhancing lesions with different washout dynamics into hypothesized tumoral (conventionally blue-colored) vs. treatment-related (red-colored).ResultsUsing receiver operating characteristic (ROC) curves, a threshold of −0.066 in VBlue/VCE (volume of the blue portion of tumoral area/volume of contrast enhancement) variation between values obtained in the MRI performed before PsP/TTP and at TTP/PSP allowed to discriminate TTP from PsP with a sensitivity of 71.4% and a specificity of 100%. Among HIGH-NK patients, at month 6 there was a significant reduction compared to baseline and month 2 in median “blue” volumes.DiscussionIn conclusion, in our pilot study TRAMs support the discrimination between tumoral and treatment-related enhancing features in immunological responders vs. non-responders, the distinction between PsP and TTP, and might provide surrogate markers of immunological response.

Background Subthalamic nucleus deep brain stimulation (STN-DBS) is a well-established treatment for motor complications in Parkinson’s disease (PD). However, its effects on neuropsychiatric symptoms remain disputed. The aim of this study was to evaluate the effects of STN-DBS on neuropsychiatric symptoms in PD.Methods We retrospectively assessed 26 patients with PD who underwent a preoperative levodopa challenge and postoperative levodopa and stimulation challenges 1 year after STN-DBS. Based on the Neuropsychiatric Fluctuations Scale, Neuropsychiatric State Scores and Neuropsychiatric Fluctuation Indices (NFIs) were calculated. Mixed-effects models with random effects for intercept were used to examine the association of Neuropsychiatric State Score and NFI with the different assessment conditions.Results In acute challenge conditions, there was an estimated increase of 15.9 points in the Neuropsychiatric State Score in stimulation ON conditions (95% CI 11.4 to 20.6, p

This study aimed to identify contamination sources in raw milk and cheese on small farms in Brazil by isolating Escherichia coli at various stages of milk production and cheese manufacturing. The study targeted EAEC, EIEC, ETEC, EPEC, STEC, and ExPEC pathotypes, characterizing isolates for the presence of virulence genes, phylogroups, antimicrobial susceptibility, and phylogenetic relationships using PFGE and MLST. The presence of antimicrobial resistance genes and serogroups was also determined. Three categories of E. coli were identified: pathogenic, commensal, and ceftriaxone-resistant (ESBL) strains. Pathogenic EPEC, STEC, and ExPEC isolates were detected in milk and cheese samples. Most isolates belonged to phylogroups A and B1 and were resistant to antimicrobials such as nalidixic acid, ampicillin, kanamycin, streptomycin, sulfisoxazole, and tetracycline. Genetic analysis revealed that E. coli with identical virulence genes were present at different stages within the same farm. The most frequently identified serogroup was O18, and MLST identified ST131 associated with pathogenic isolates. The study concluded that E. coli was present at multiple points in milk collection and cheese production, with significant phylogroups and high antimicrobial resistance. These findings highlight the public health risk posed by contamination in raw milk and fresh cheese, emphasizing the need to adopt hygienic practices to control these microorganisms.

Gamma-ray bursts (GRBs) can be probes of the early Universe, but currently, only 26% of GRBs observed by the Neil Gehrels Swift Observatory have known redshifts ( z ) due to observational limitations. To address this, we estimated the GRB redshift (distance) via a supervised statistical learning model that uses optical afterglow observed by Swift and ground-based telescopes. The inferred redshifts are strongly correlated (a Pearson coefficient of 0.93) with the observed redshifts, thus proving the reliability of this method. The inferred and observed redshifts allow us to estimate the number of GRBs occurring at a given redshift (GRB rate) to be 8.47–9 yr ^−1 Gpc ^−1 for 1.9 < z < 2.3. Since GRBs come from the collapse of massive stars, we compared this rate with the star formation rate, highlighting a discrepancy of a factor of 3 at z < 1.

The modular approach is widely used in architecture, and simplifying complex structures to enhance flexibility is one of the many reasons for choosing the module as a design tool, particularly in healthcare construction. This article presents an applied research project where modularity is employed in designing Community Houses, i.e. particular local socio-health structures introduced by the Italian National Recovery and Resilience Plan (PNRR). Functional schemes, developed in collaboration with healthcare professionals from a Piedmontese Local Health Authority (ASL), ensure different configurations of elementary spatial units. The paper aims to understand, through experimentation, the effectiveness and potential of the modular approach in implementing these new local socio-health services, analysing their background, application, and results. Article info Received: 15/09/2023; Revised: 03/10/2023; Accepted: 04/11/2023