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Background/Aims Patient safety culture is the product of values, beliefs, attitudes, perceptions, competencies and individual and collective behaviour patterns. Nurses often have the most contact with patients, so their perceptions of patient safety are crucial. This study aimed to assess perceptions of patient safety culture among nurses at a hospital in Spain. Methods A cross-sectional study was conducted using an adapted version of the Hospital Survey on Patient Safety Culture questionnaire. All 244 nurses working in a hospital in Spain took part. Respondents reported their perceptions of patient safety culture in their department in 12 domains using a 5-point Likert scale, with additional questions measuring overall perceptions of patient safety culture, personal and professional characteristics, and the proportion of respondents who had reported a patient safety incident in the previous year. Univariate and bivariate data analysis was performed using Jamovi software to identify relationships between variables. Results None of the 12 domains had a positive response rate (over 75%), indicating a generally weak patient safety culture. Perceptions of patient safety culture varied between departments, and were also affected by respondents' professional characteristics, such as their years of experience and whether they held a managerial role. Conclusions Further research and intervention is needed to improve patient safety cultures. It may be useful to assess patient safety culture and tailor strategies for improvement according to the specific needs of individual departments.

STUDY QUESTION Can artificial intelligence (AI) algorithms developed to assist embryologists in evaluating embryo morphokinetics be enriched with multi-centric clinical data to better predict clinical pregnancy outcome? SUMMARY ANSWER Training algorithms on multi-centric clinical data significantly increased AUC compared to algorithms that only analyzed the time-lapse system (TLS) videos. WHAT IS KNOWN ALREADY Several AI-based algorithms have been developed to predict pregnancy, most of them based only on analysis of the time-lapse recording of embryo development. It remains unclear, however, whether considering numerous clinical features can improve the predictive performances of time-lapse based embryo evaluation. STUDY DESIGN, SIZE, DURATION A dataset of 9986 embryos (95.60% known clinical pregnancy outcome, 32.47% frozen transfers) from 5226 patients from 14 European fertility centers (in two countries) recorded with three different TLS was used to train and validate the algorithms. A total of 31 clinical factors were collected. A separate test set (447 videos) was used to compare performances between embryologists and the algorithm. PARTICIPANTS/MATERIALS, SETTING, METHODS Clinical pregnancy (defined as a pregnancy leading to a fetal heartbeat) outcome was first predicted using a 3D convolutional neural network that analyzed videos of the embryonic development up to 2 or 3 days of development (33% of the database) or up to 5 or 6 days of development (67% of the database). The output video score was then fed as input alongside clinical features to a gradient boosting algorithm that generated a second score corresponding to the hybrid model. AUC was computed across 7-fold of the validation dataset for both models. These predictions were compared to those of 13 senior embryologists made on the test dataset. MAIN RESULTS AND THE ROLE OF CHANCE The average AUC of the hybrid model across all 7-fold was significantly higher than that of the video model (0.727 versus 0.684, respectively, P = 0.015; Wilcoxon test). A SHapley Additive exPlanations (SHAP) analysis of the hybrid model showed that the six first most important features to predict pregnancy were morphokinetics of the embryo (video score), oocyte age, total gonadotrophin dose intake, number of embryos generated, number of oocytes retrieved, and endometrium thickness. The hybrid model was shown to be superior to embryologists with respect to different metrics, including the balanced accuracy (P ≤ 0.003; Wilcoxon test). The likelihood of pregnancy was linearly linked to the hybrid score, with increasing odds ratio (maximum P-value = 0.001), demonstrating the ranking capacity of the model. Training individual hybrid models did not improve predictive performance. A clinic hold-out experiment was conducted and resulted in AUCs ranging between 0.63 and 0.73. Performance of the hybrid model did not vary between TLS or between subgroups of embryos transferred at different days of embryonic development. The hybrid model did fare better for patients older than 35 years (P LIMITATIONS, REASONS FOR CAUTION Participant centers were located in two countries, thus limiting the generalization of our conclusion to wider subpopulations of patients. Not all clinical features were available for all embryos, thus limiting the performances of the hybrid model in some instances. WIDER IMPLICATIONS OF THE FINDINGS Our study suggests that considering clinical data improves pregnancy predictive performances and that there is no need to retrain algorithms at the clinic level unless they follow strikingly different practices. This study characterizes a versatile AI algorithm with similar performance on different time-lapse microscopes and on embryos transferred at different development stages. It can also help with patients of different ages and protocols used but with varying performances, presumably because the task of predicting fetal heartbeat becomes more or less hard depending on the clinical context. This AI model can be made widely available and can help embryologists in a wide range of clinical scenarios to standardize their practices. STUDY FUNDING/COMPETING INTEREST(S) Funding for the study was provided by ImVitro with grant funding received in part from BPIFrance (Bourse French Tech Emergence (DOS0106572/00), Paris Innovation Amorçage (DOS0132841/00), and Aide au Développement DeepTech (DOS0152872/00)). A.B.-C. is a co-owner of, and holds stocks in, ImVitro SAS. A.B.-C. and F.D.M. hold a patent for ‘Devices and processes for machine learning prediction of in vitro fertilization’ (EP20305914.2). A.D., N.D., M.M.F., and F.D.M. are or have been employees of ImVitro and have been granted stock options. X.P.-V. has been paid as a consultant to ImVitro and has been granted stocks options of ImVitro. L.C.-D. and C.G.-S. have undertaken paid consultancy for ImVitro SAS. The remaining authors have no conflicts to declare. TRIAL REGISTRATION NUMBER N/A.

In RbSn2Br5 halide, prepared by mechano-chemistry, the 5s2 lone electron pairs of Sn2+ were located from NPD and SXRD data. Among the thermoelectric properties, a huge Seebeck coefficient and an extremely low thermal conductivity are determined.

This study aimed to evaluate the extent of benefits gained by the indigenous people of the resettlement area in Barangay Camias, Municipality of Porac, Pampanga, in the community-based development programs and projects of the University of Makati as to entrepreneurial and livelihood programs, infrastructure developments, health services, and social welfare projects. Descriptive-survey design was used to describe the present situation of the barangay and the help that these community-based programs and projects gave after these were realized. The findings revealed that the program-recipients benefited from the community-based development programs and projects; positive feedback was received from them; and perceptions and responses of the program-recipients, therefore, attested the responsiveness of the community-based development program and projects of the University of Makati to the needs of the Aeta Community. The researchers humbly recommend that a periodic impact assessment must be conducted (at least annually) in order to maintain and sustain the community-based development program and projects of the University; and immersion and community-based extension programs for adopted communities shall be conducted regularly and continuously which involves all colleges, centers, administrative departments and students of the University.

To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016.Post-hoc analysis of four cohort studies.138 Spanish ICUs.2141 patients scheduled extubated.None.Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality.There was a significant increase (p 0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p = 0.435).There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.

Nanomaterials based on metal oxides are extensively studied for several applications due to their versatility. Improvements in their performances can be obtained due to specific structural modifications. One possible modification is by doping the crystal structure, which can affect the materials structure and properties, especially in nanosized particles. Electronic features are among the properties that can be modified through the doping process, consequently morphological and optical parameters can also be controlled by this process. In this sense, this review presents some modifications to tin dioxide (SnO2), one the most studied materials, mainly through the doping process and their impact on several properties. The article starts by describing the SnO2 structural features and the computational models used to explain the role of the doping process on these features. Based on those models, some applications of doped SnO2, such as photocatalytic degradation of pollutants, CO2 reduction, and desulfurization of fossil fuels are presented and discussed. Additionally, the review describes many biological applications related to antimicrobial activity for doped SnO2 and its nanostructures. Although most of the examples presented in this article are based on the doped SnO2, it also presents examples related to SnO2 composites with other nanomaterials forming heterojunctions. The metal oxides SnO2, doped-SnO2 and their nanostructures are promising materials, with results reported in many fields presented in this review, such as theoretical and computational chemistry, environmental remediation, nanoparticle morphology control, fossil fuels improvement, and biomedical applications. Although widely explored, there are still fields for innovation and advances with tin dioxide nanostructures, for example, in transparent conducting oxides, in forensics as materials for latent fingerprints visualization, and sensors in medicine for detection of exhaled volatile organic compounds. Therefore, this article aims to be a reference regarding correlating the doping processes and the properties presented by the SnO2 nanostructures.

We examine whether the requirements of analytical skills and physical strength in jobs held by immigrant women in five major European destinations (France, Italy, Spain, Sweden, and the UK) converge to those of jobs of native-born women in their first ten years in the destination country. To this aim, we combine data from the European Labour Force Survey (2005–2015) of immigrant women arriving in these five countries and information about skill requirements from the Occupational Information Network (O*NET). At arrival, migrants in Spain and France use much less analytical skills, but for the period before the Great Recession, that gap closes relatively fast over time compared to other destinations, particularly in the low end of the skill distribution. Physical strength requirements of immigrant’s jobs increase over time and the gaps open in countries where immigrants depart from relatively more strength-intense jobs, while they close in Spain where immigrants use less strength than natives at arrival. Our estimates are also robust to selection into employment both at the average and across the skill distribution using recent techniques. Since the Labour Force Survey does not have information on wages, we use wage information from the European Union Structure of Earnings Survey to proxy average immigrant-native wage gaps implied by our estimated skill gaps by country.

Table S2. Principal component analysis loadings for plots shown in Figure 1C and Figure 1D, included as separate Excel file.

Figures S1-S5

Cancer cells can exhibit altered dependency on specific metabolic pathways and targeting these dependencies is a promising therapeutic strategy. Triple-negative breast cancer (TNBC) is an aggressive and genomically heterogeneous subset of breast cancer that is resistant to existing targeted therapies. To identify metabolic pathway dependencies in TNBC, we first conducted mass spectrometry–based metabolomics of TNBC and control cells. Relative levels of intracellular metabolites distinguished TNBC from nontransformed breast epithelia and revealed two metabolic subtypes within TNBC that correlate with markers of basal-like versus non-basal–like status. Among the distinguishing metabolites, levels of the cellular redox buffer glutathione were lower in TNBC cell lines compared to controls and markedly lower in non-basal–like TNBC. Significantly, these cell lines showed enhanced sensitivity to pharmacologic inhibition of glutathione biosynthesis that was rescued by N-acetylcysteine, demonstrating a dependence on glutathione production to suppress ROS and support tumor cell survival. Consistent with this, patients whose tumors express elevated levels of γ-glutamylcysteine ligase, the rate-limiting enzyme in glutathione biosynthesis, had significantly poorer survival. We find, further, that agents that limit the availability of glutathione precursors enhance both glutathione depletion and TNBC cell killing by γ-glutamylcysteine ligase inhibitors in vitro. Importantly, we demonstrate the ability to this approach to suppress glutathione levels and TNBC xenograft growth in vivo. Overall, these findings support the potential of targeting the glutathione biosynthetic pathway as a therapeutic strategy in TNBC and identify the non-basal-like subset as most likely to respond. Mol Cancer Ther; 17(1); 264–75. ©2017 AACR.

All-inorganic lead halide perovskites like CsPbBr3, CsPbI3, or RbPbI3 are good replacements for the classical hybrid organic–inorganic perovskites like CH3NH3PbI3, susceptible to fast degradation in the presence of humid air. They also exhibit outstanding light absorption properties suitable for solar energy applications. Here, we describe the synthesis of RbPbI3 by mechanochemical procedures with green credentials, avoiding toxic or expensive organic solvents; this specimen exhibits excellent crystallinity. We report neutron powder diffraction data, essential to revisit some subtle structural features around room temperature (200–400 K). In all these regimes, the orthorhombic Pnma crystal structure is characterized by the presence along the b direction of the crystal of double rows of edge-sharing PbI6 octahedra. The lone electron pairs of Pb2+ ions have a strong stereochemical effect on the PbI6 octahedral distortion. The relative covalency of Rb–I versus Pb–I bonds shows that the Pb–I-related motions are more rigid than Rb–I-related vibrations, as seen in the Debye temperatures from the evolution of the anisotropic displacements. The optical gap, measured by diffuse reflectance UV–vis spectroscopy, is ∼2.51 eV and agrees well with abinitio calculations. The thermoelectric Seebeck coefficient is 3 orders of magnitude larger than that of other halide perovskites, with a value of ∼117,000 μV·K–1 at 460 K.

Biodentine (BD) is a bioactive material with many indications in endodontic therapy. The purpose of this study was to compile and review the outcomes of in vitro and in vivo studies of BD in terms of antimicrobial effectiveness. An electronic search was carried out in PubMed, from January 2009-April 2021 using the keywords: (Biodentine or dentine substitute or "Ca

Resumen: Antecedentes: La urticaria crónica (UC) es una enfermedad debilitante cuyo tratamiento es principalmente sintomático. El estudio UCREX tuvo como objetivo identificar el perfil de los pacientes con UC, el manejo de la enfermedad y la calidad de vida (CdV) en la práctica clínica diaria en España. Métodos: Estudio observacional, prospectivo, multicéntrico de 12 meses, que incluyó pacientes con UC de novo o establecida que acudieron a la consulta de dermatología/alergología de 39 hospitales españoles. Las variables principales fueron: el Urticaria Activity Score (UAS) y el UAS por siete días (UAS7). Las variables secundarias fueron: el cuestionario de CdV de urticaria crónica (CU-Q2oL), el EuroQol-5 Dimensiones (EQ-5D), la escala Medical Outcomes Study Sleep (MOS-Sleep) y la escala hospitalaria de ansiedad y depresión (HADS). Resultados: Se incluyeron 361 pacientes, de los cuales 176 (48,8%) formaron parte del análisis del objetivo principal. La edad media (DE) fue de 46,6 (14,2) años y el 71,8% eran del sexo femenino. El año anterior al periodo de inclusión de los pacientes, la mayoría de ellos (57,1%) se habían tratado con antihistamínicos H1 no sedantes (AHNS-H1). En la basal, se registró una media (DE) de 3,6 (6,8) de visitas a atención primaria. La media (DE) del UAS7 en la basal fue de 14,3 (11,0) y del CU-Q2oL 24,1 (17,0), observándose una tendencia en la mejoría en 8,6 (9,7) y 13,9 (15,0), respectivamente, a los 12 meses. El MOS-Sleep y el EQ-5D se mantuvieron estables durante el estudio, excepto por el dolor/malestar y la ansiedad/depresión que pasaron de 58,7 y 49,6% a 29,6 y 26,9%, respectivamente. En situación basal, el HADS mostró una ansiedad media (DE) de 8,7 (4,5) y una depresión de 5,1 (4,4), disminuyendo respectivamente a 7,0 (4,3) y 4,7 (4,3) a los 12 meses. Conclusiones: Aunque la mayoría de los pacientes son tratados con AHNS-H1, la actividad de la enfermedad sigue siendo importante, afectando negativamente a su CdV, su actividad laboral y repercutiendo negativamente en el uso de recursos sanitarios. Un manejo adecuado de la enfermedad podría ser la base para alcanzar el control de los síntomas, la mejora de la CdV y la optimización de los recursos sanitarios necesarios. Abstract: Background: Chronic Urticaria (CU) is a debilitating disease whose treatment is mainly symptomatic. UCREX study aimed to identify CU patients’ profile, disease management and quality-of-life (QoL) in daily clinical practice in Spain. Methods: Observational, 12-months prospective, multicenter study, included de novo or established CU patients attending to dermatology/allergy consultations in 39 Spanish hospitals. Main variables: Urticaria Activity Score (UAS), UAS over 7 days (UAS7). Secondary variables: CU-QoL Questionnaire (CU-Q2oL), EuroQol-5 dimensions (EQ-5D), Medical Outcomes Study Sleep (MOS-Sleep) scale, Hospital Anxiety and Depression Scale (HADS). Results: 361 patients included. Of them, 176 (48.8%) considered for the main objective analysis. Mean age (SD) of 46.6 (14.2) years and 71.8% women. The year prior to inclusion, most patients (57.1%) were treated with non-sedating H1-antihistamines (NS-H1AH). At baseline, mean (SD) 3.6 (6.8) visits were registered to primary care. Mean (SD) UAS7 at baseline was 14.3 (11.0) and CU-Q2oL 24.1 (17.0) which tended to improve by 8.6 (9.7) and 13.9 (15.0), respectively, at 12-months. MOS-Sleep and EQ-5D remained steady during the study, except pain/discomfort and anxiety/depression which went from 58.7% and 49.6% to 29.6% and 26.9%, respectively. At baseline, HADS showed a mean (SD) anxiety of 8.7 (4.5) and depression 5.1 (4.4), decreasing to 7.0 (4.3) and 4.7 (4.3), respectively, at 12-months. Conclusions: Although most CU patients are treated with NS-H1AH, disease activity is still important, negatively affecting patients’ QoL, work activity and healthcare resources use. An appropriate disease management could be the basis for symptoms control, QoL improvement and resources optimization.

RbPb2Br5 was studied by SXRD and NPD data from 15 to 573 K, yielding information on Rb–Br and Pb–Br chemical bonds. The electron lone pair of Pb2+ is visualized. Photoluminescence excitation and emission spectra suggest applications in photovoltaics.

Calcium Molybdate (CMO) is a material used in several technological applications. In this work, we explored the correlation between the optical and electrical properties of CMO in solar cell photoanodes....

Resumen La mayoría de los casos de inflamación diverticular son leves y solo requieren tratamiento médico con dieta líquida y antibióticos. Hasta hace poco, este tratamiento requería ingreso hospitalario con los consiguientes costes. El tratamiento ambulatorio de estos pacientes con diverticulitis no complicada ha demostrado ser eficaz y seguro. El objetivo de esta revisión es describir el tratamiento ambulatorio con antibiótico oral y los resultados publicados.

Resumen Tras un episodio de diverticulitis aguda la realización de una colonoscopia de rutina ha sido defendida en las guías de práctica clínica de numerosas sociedades. Sin embargo, en los últimos años en contraposición a esto, numerosos estudios han intentado demostrar que no existe esta necesidad en todos los casos. ya que la incidencia de adenomas de alto grado (AA) y cáncer colorrectal (CCR) en la diverticulitis aguda no complicada es bajo y prácticamente similar al que encontramos en la población sometida a programas de screening, mientras que sería necesaria en pacientes con diverticulitis aguda complicada.

Resumen La enfermedad diverticular es uno de los trastornos gastrointestinales más frecuentes en el mundo occidental, y su presentación aguda se desarrollará en un 10-25% de los pacientes diagnosticados. Se presenta, a continuación, una revisión de conjunto sobre el tratamiento laparoscópico actual de la diverticulitis aguda, así como del lavado y drenaje laparoscópico.

Gold and silver subnanoclusters with few atoms are prominent candidates for catalysis-related applications, primarily because of the large fraction of lower-coordinated atoms exposed and ready to interact with external chemical species. However, an in-depth energetic analysis is necessary to characterize the relevant terms within the molecular adsorption process that can frame the interactions within the Sabatier principle. Herein, we investigate the interaction between Ag

La trayectoria de los Villalobos-Manrique, familia prototípica de beneméritos, tanto peninsulares como criollos, corre pareja al proceso de conquista y colonización que planeó sobre las Indias durante todo el siglo XVI. Llegados a la Española, en los prolegómenos de la centuria, su núcleo familiar fue basculando gradualmente —tal y como lo hizo el mismísimo epicentro del sistema imperial— desde las Antillas, primero, hasta el litoral del continente y el interior de Tierra Firme, después. A partir del análisis de este caso específico, la investigación intentará retratar de manera muy sucinta el modus operandi bajo el que funcionaron las complejas y tupidas redes sociales y clientelares tejidas por los primeros pobladores y sus descendientes, así como las distintas estrategias que fueron adoptando para prolongarse efectivamente en el tiempo y el espacio.

The objective of this study was to explore the relationship between sociodemographic factors and fear of COVID-19 in a Cuban population. A web-based study with a cross-sectional design was conducted. The sample comprised 1145 participants. To explore fear, the Fear of COVID-19 Scale was used. Our results suggest that women were more likely to experience medium to high levels fear compared to men. Additionally, knowing a person positive to COVID-19 significantly increases fear levels in Cuban participants.

OBJECTIVES Few data regarding follow-up of patients after COVID-19 discharge are available. We aim to describe the long-term outcomes of survivors of hospitalization for COVID-19 followed up first at an outpatient facility and subsequently by telephone. METHODS Observational prospective study conducted at a tertiary general hospital. Clinical and radiological progression was assessed and data recorded on a standardized reporting form. Patients were divided into three groups according to PaO2/FiO2 at hospitalization: PaO2/FiO2 > 300, PaO2/FiO2 300-200 and PaO2/FiO2 < 200. A logistic multivariate regression model was performed to identify factors associated with persistence of symptoms. RESULTS Facility follow-up: 302 patients were enrolled. Median follow-up was 45 days after discharge; 78% (228/294) of patients had COVID-19-related symptoms (53% asthenia, 56% respiratory symptoms) and 40% (122/302) had residual pulmonary radiographic lesions. PaO2/FiO2 300 was associated with resolution of chest radiographic lesions; OR = 0.56 (0.42 to 0.74), (p, Graphical abstract Image 1

During domestication, the selection of cultivated plants often reduces microbiota diversity compared with their wild ancestors. Microbiota in compartments such as the phyllosphere or rhizosphere can promote fruit tree health, growth, and development.

Background Mechanical complications (MC) give a poor prognosis for ST elevation myocardial infarction (STEMI). Its prevalence had decreased in the era of primary angioplasty, at the expense of free wall rupture (FWR). Purpose To analyse the prevalence of post-STEMI MC for two periods, before and after the COVID-19 pandemic. Methods Unicentric prospective registration of patients with STEMI admitted between January-2018 and December-2021. They are classified into two groups according to the onset of the pandemic by COVID-19: Pre-COVID: January-2018 to December-2019, and Post-COVID: January-2020 to December-2021. The prevalence of post-STEMI MC is analysed, including ventricular septal rupture (VSR), papillary muscle rupture (PMR) and FWR, and 30-day mortality. Results 1507 consecutive patients with STEMI (Pre-COVID n=775, Post-COVID n=732) are included. Age 62.9 years vs 63.3 years (p=0.5097). Men 78.1% Vs 79.5% (p=0.493). No differences in cardiovascular risk factors, previous heart infarction or anterior wall STEMI. Primary angioplasty was similar in both groups (92%). The Post-COVID group has a higher prevalence of Killip>I (21.7% vs 17.2% p=0.025) and LVEF ≤40% (27.2% vs 20% p=0.001), and longer symptom onset to balloon dilatation interval (316 min vs 257 min p=0.0004). MC are most developed in Post-COVID (2.6% vs 1.2% p=0.039), at the expense of FWR (1.91% vs 0.3% p=0.001). No significant changes in VSR and PMR prevalence or 30-day mortality. Multivariate analysis identifies the independent predictors of FWR: Age (OR 1.05, p=0.024), Primary angioplasty (OR 0.09, p Conclusions The COVID-19 pandemic is independently associated with a higher prevalence of FWR, probably due to delayed reperfusion. Funding Acknowledgement Type of funding sources: None.

Identifying adaptive mechanisms of metastatic cancer cells remains an elusive question in the treatment of metastatic disease, particularly in pancreatic cancer (PDA), where the majority of patients present with metastatic lesions at the time of diagnosis. A loss-of-function shRNA targeted screen in metastatic-derived cells identifiedGstt1, a member of the glutathione S-transferase superfamily, as uniquely required for metastasis and dissemination however dispensable for primary tumor growth.Gstt1is expressed in early disseminated tumor cells (DTCs), is retained within a subpopulation of slow-cycling cells within established metastases and its inhibition led to a regression of macrometastatic lesions. This distinct Gstt1highpopulation is highly metastatic and retains slow-cycling phenotypes, EMT features, and DTC characteristics compared to the Gstt1lowpopulation. Mechanistic studies indicate that in this subset of cells, Gstt1 maintains metastases by binding to and modifying intracellular fibronectin, regulating Fibronectin secretion from cancer cells and deposition into the metastatic microenvironment. We identified Gstt1 as a novel mediator of metastasis, highlighting the importance of metastatic heterogeneity and its influence on the metastatic tumor microenvironment.

Niobium pentoxide (Nb2O5) was synthesized by the microwave-assisted hydrothermal method using two different niobium precursors: niobium ammoniacal oxalate (P1) and niobium chloride (P2). The XRD result confirms the presence of Nb2O5 with low crystallinity for both precursor samples. The SEM images show differences between the material morphologies but with the same aggregation particle characteristics. Photocatalytic degradation of the rhodamine B (RhB) dye was performed using both samples of Nb2O5 as a photocatalyst under UVC illumination using a 24 factorial design experimental method. The studied variables were the type of precursor (P1 and P2), the RhB concentration (1 × 10−5 and 3 × 10−5 M), the Nb2O5 photocatalyst dosage (25 and 50 mg), and the time of the photocatalysis analysis (30 and 60 min), verifying the influence on the RhB dye removal efficiency. The factorial design showed that all variables had a significant effect on the process, but the variables with the most influence were RhB concentration and photocatalysis time. For both precursors, the samples that showed greater removal efficiency were those under conditions 1 × 10−5 M, 50 mg, and 60 min, obtaining 92.87% and 98.99%, respectively. The high rate of RhB removal suggests that the Nb2O5 obtained by microwave-assisted hydrothermal synthesis has the potential to be used in photocatalytic processes to remove organic pollutants from effluents.

Resumen El soporte respiratorio no invasivo (SRNI) comprende 2 modalidades de tratamiento, la ventilacion meca-nica no invasiva (VMNI) y la terapia de alto flujo con canulas nasales (TAFCN) que se aplican en pacientes adultos, pediatricos y neonatales con insuficiencia respiratoria aguda (IRA). Sin embargo, el grado de acuerdo entre las distintas especialidades sobre el beneficio de estas tecnicas en diferentes escenarios clinicos es controvertido. El objetivo del presente consenso fue elaborar una serie de recomendaciones de buena practica clinica para la aplicacion de soporte no invasivo en pacientes con IRA, avaladas por todas las sociedades cientificas involucradas en el manejo del paciente adulto y pediatrico/neonatal con IRA. Para ello se contacto con las diferentes sociedades implicadas, quienes designaron a su vez a un grupo de 26 profesionales con suficiente experiencia en su aplicacion. Se realizaron 3 reuniones presenciales para consensuar las recomendaciones (hasta un total de 71) fundamentadas en la revision de la literatura y en la actualizacion de la evidencia disponible en relacion con 3 categorias: indicaciones, monitorizacion yseguimiento del SRNI. Finalmente, se procedio a votacion telematica de cada una de las recomendaciones, por parte de los expertos de cada sociedad cientifica implicada. Para la clasificacion del grado de acuerdo se opto por un sistema analogico de clasificacion facil e intuitivo de usar, y que expresara con claridad si el procedimiento relacionado con el SRNI debia hacerse, podia hacerse o no debia hacerse.

Study question Is the endogenous progesterone level (EPL) on the day of hCG administration associated with pregnancy outcomes in modified natural cycles before embryo transfer? Summary answer The present analysis suggested the negative effect of EPL on clinical pregnancy when progesterone was above 1,1 ng/ml on the day of HCG triggering. What is known already Endogenous progesterone levels (EPL) experience an abrupt increase following the ovulatory LH surge. It is described that this change in basal EPL contributes to modulating the endometrial receptivity in preparation for embryo implantation. Several authors reported a negative impact on the pregnancy of high serum EPL on the day of HCG. These studies revealed accelerated endometrial changes and a subsequent decoupling of the implantation window. These observations involved only patients who underwent ovarian stimulation before the embryo transfer. However, studies based on EPL in modified natural cycles before blastocyst transfer are very limited. Study design, size, duration The present non-interventional pilot cohort study aimed to determine the EPL in patients undergoing an endometrium preparation for frozen-thawed embryo transfer in non-stimulated cycles, and its association with clinical pregnancy rates. A total of 46 participants were included in this analysis. To reduce variability, the mean EPL was calculated excluding 2 outlier values in our dataset. The cut-off value of EPL was established using the Youden-index, and the T-student was used for further statistical comparisons. Participants/materials, setting, methods Patients following our IVF program, who underwent frozen-thawed embryo transfer during the period of study. Our data includes cycles with own and with donated oocytes. The total oocyte average age was 33,5±6,7. All transfers were performed at blastocyst stage. Main results and the role of chance The overall clinical pregnancy rate per embryo transfer was 70,5% (31/44), with an implantation rate of 66,7% (32/48). The mean number of transferred embryos was 1,09, with a single embryo transfer rate of 90,9%. The total mean of EPL was 0,31±0,26 [IC95% 0,23-0,39], with patients who achieved a clinical pregnancy (0,30±0,21; n = 31) showing significantly lower EPL (p-value=0,04) than the non-pregnant participants (0,41±0,40; n = 10). Three out of 44 patients had a biochemical pregnancy, with a mean EPL of 0,12±0,01. EPL cut-off value was establish at 1,1 ng/ml. The evaluation of the total dataset (n = 46 patients, including 2 outliers) showed that 8,7 % of a total of these cases had an EPL above the threshold of 1,1 ng/ml. The clinical pregnancy rate in this subgroup of patients was 25,0%. Limitations, reasons for caution This study includes a limited number of cases. Further analysis is required to confirm the present results and to allow data stratification for additional inter-group comparisons. Wider implications of the findings Evaluating EPL may contribute to improving the clinical outcome in natural modified cycles. We observed that EPL is expected to be lower in non-stimulated than in stimulated cycles, compared to previously published studies. These observations highlight the importance to manage treatment-related EPL thresholds, in particular, to establish transfer decision-making policies. Trial registration number n/a

Study question Can AI algorithms assist embryologists in evaluating embryos from any time-lapse system (TLS) along with clinical data to better predict pregnancy outcomes and reduce time-to-pregnancy? Summary answer Our algorithm (Embryoly) significantly increases accuracy in predicting clinical pregnancy by 26.9% amongst embryos deemed of fair and good quality when clinical data is included. What is known already Embryologists routinely use defined morpho-kinetic criteria to decide which embryo to transfer, and yet, many embryos deemed of good quality fail to lead to a pregnancy. Thus, AI algorithms to assist embryologists in objectively selecting the most promising embryos are in demand. To date, several reports indicate that AI algorithms are capable of predicting pregnancy clinical outcomes but to the best of our knowledge they only consider visual data (or together with a small set of clinical features) from individual TLI systems to generate their predictions. Study design, size, duration A dataset of 6790 embryos (97.82% known clinical pregnancy outcome, 31.47% frozen transfers) from 2519 patients from 11 European fertility centers recorded with 4 different TLS (GERI-Merck, Embryoscope & EmbryoscopePlus-Vitrolife and MIRI-Esco) was used to train and validate Embryoly. Nine out of 93 clinical factors were identified as being the most predictive, including woman age, woman and man BMI and AMH levels. Performances were evaluated on a separate test dataset (393 videos). Participants/materials, setting, methods Clinical pregnancy outcome was predicted using a 3D convolutional neural network that analyzed up to 5 days of embryo development. The output score was further analyzed considering the clinical features to generate a second clinical score. Both predictions were compared to those of 10 senior embryologists made on the same test dataset (with and without clinical features). Embryo quality was assessed as: poor, fair, good. Unless specified otherwise, McNemar test was used for statistical tests. Main results and the role of chance Overall accuracy of embryologists in predicting clinical pregnancy based on videos alone was 57.25% (CI 95% : 52.34% - 62.16%) compared to 60.56% (CI 95% : 55.71% - 65.41%) for Embryoly (p = 0.35). When videos were analyzed together with the clinical factors, overall accuracy of embryologists was significantly lower than Embryoly (60.05% [CI 95% : 55.19% - 64.91%] vs 68.19% [CI 95% : 63.57% - 72.82%], p-value=0.015, respectively). Clinical factors significantly increased our accuracy by 7.63% (p-value=0.030). More specifically, Embryoly algorithms fared better in terms of detecting false positives (31.30% vs 19.34%) compared to embryologists, with a specificity of 74.4% vs. 58.6%, respectively. If we consider only embryos of fair and good quality (71.50% of our test dataset) Embryoly’s accuracy was 13.52% higher than that of embryologists. This translates into AI having an even better ability to detect false positives for embryos that could be seen as good candidates for transfer (20.28% false positives against 42.70% for the embryologists). Embryoly performs differently across selected TLS when analyzing videos alone, but not when clinical data was also considered (chi2 test, p Limitations, reasons for caution As of today, Embryoly’s accuracy in predicting the outcome of poor-quality embryos is not different to that of embryologists (79.46% vs 84.96%; p-value=0.19). We are improving this by exposing Embryoly to more “poor quality” embryos, so as to also identify poor quality embryos with unexpected potential for implantation. Wider implications of the findings Our pioneering findings support the use of AI for a standardized and couple-centered care in clinical embryology, integrating male and female factors with embryo development analyses from multiple TLS. Our approach has the potential to cost-effectively reduce time to pregnancy and is another step toward a personalized embryo transfer strategy. Trial registration number Not applicable

Bacterial anti-phage systems are frequently clustered in microbial genomes, forming defense islands. This property enabled the recent discovery of multiple defense systems based on their genomic co-localization with known systems, but the full arsenal of anti-phage mechanisms remains unknown. We report the discovery of 21 defense systems that protect bacteria from phages, based on computational genomic analyses and phage-infection experiments. We identified multiple systems with domains involved in eukaryotic antiviral immunity, including those homologous to the ubiquitin-like ISG15 protein, dynamin-like domains, and SEFIR domains, and show their participation in bacterial defenses. Additional systems include domains predicted to manipulate DNA and RNA molecules, alongside toxin-antitoxin systems shown here to function in anti-phage defense. These systems are widely distributed in microbial genomes, and in some bacteria, they form a considerable fraction of the immune arsenal. Our data substantially expand the inventory of defense systems utilized by bacteria to counteract phage infection.

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Germans Trias i Pujol Background Cardiogenic shock (CS) is a severe complication of myocardial infarction (MI) and carries a high mortality. Clinical profile and prognosis of these patients could differ depending on the electrocardiographic pattern at admission. The objective of this study is to demonstrate these differences. Methods Prospective register of patients with MI complicated with CS admitted to the acute cardiac care unit of a tertiary hospital between 2010 and 2019. Clinical characteristics and mortality at 30-day and 5-year were compared according to the presence (STEMI) or absence (NSTEMI) of ST-segment elevation. Results This study included 239 patients, 79.5% had STEMI and 20.5% had NSTEMI. There were no differences in age (69 vs. 71 years, p=0.330), gender distribution (22.4% vs. 27.4% women, p=0.486) and ejection fraction (33% vs. 30%, p=0.231). However, patients with STEMI had more extensive MI (CK-MB peak 279 vs. 85 ng/ml, p STEMI patients had higher 30-day mortality (59.5% vs 36.7%; p=0.004), but this difference progressively diminished. As a result, 5-year survival had no significant differences. After adjusting for main clinical predictors, STEMI was independently associated with 30-day mortality (HR 1.99), but this association disappeared when the follow-up was extended to 5 years. Conclusions Patients with CS and STEMI had more extensive infarcts and with more mechanical complications than NSTEMI. Patients with NSTEMI and CS had more cardiovascular risk factors, previous coronary artery disease, and multi-vessel involvement. 30-day mortality of STEMI with CS was higher than in NSTEMI, although 5-year mortality did not offer significant differences.