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New-generation drug-eluting stents (DES) strongly reduce restenosis and repeat revascu- larization compared with bare-metal stents (BMS) for percutaneous coronary interven- tion. There is residual uncertainty as to whether other prognostically relevant outcomes are affected by DES versus BMS concerning initial presentation (chronic coronary syn- drome [CCS] vs acute coronary syndrome [ACS]). We performed an individual patient data meta-analysis of randomized trials comparing new-generation DES versus BMS (CRD42017060520). The primary outcome was the composite of cardiac death or myocar- dial infarction (MI). Outcomes were examined at maximum follow-up and with a 1-year landmark. Risk estimates are expressed as hazard ratio (HR) with 95% confidence inter- val (CI). A total of 22,319 patients were included across 14 trials; 7,691 patients (34.5%) with CCS and 14,628 patients (65.5%) with ACS. We found evidence that new-generation DES versus BMS consistently reduced the risk of cardiac death or MI in both patients with CCS (HR 0.83, 95% CI 0.70 to 0.98, p

The comparative effectiveness of transradial (TRA) compared with transfemoral (TFA) access in acute coronary syndrome (ACS) patients undergoing complex percutaneous coronary intervention (PCI) remains unclear.Among 8404 ACS patients in the Minimising Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX (MATRIX)-Access trial, 5233 underwent noncomplex (TRA: n = 2590; TFA: n = 2643) and 1491 complex (TRA: n = 777; TFA: n = 714) PCI. Co-primary outcomes were major adverse cardiovascular events (MACE, the composite of all-cause mortality, myocardial infarction, or stroke) and the composite of MACE and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding (net adverse cardiovascular events [NACE]) at 30 days.Rates of 30-day MACE (HR 0.94, 95% CI 0.72-1.22) or NACE (HR 0.89, 95% CI 0.69-1.14) did not significantly differ between groups in the complex PCI group, whereas both primary end points were lower (HR 0.84, 95% CI 0.70-1.00; HR 0.83, 95% CI 0.70-0.98; respectively) with TRA among noncomplex PCI patients, with negative interaction testing (PAmong ACS patients, PCI complexity did not affect the comparative efficacy and safety of TRA vs TFA, whereas the absolute risk reduction of access-site major bleeding was greater with TRA compared with TFA in complex as opposed to noncomplex PCI.

Migratory birds are implicated in dispersing haemosporidian parasites over great geographic distances. However, their role in sharing these vector-transmitted blood parasites with resident avian host species along their migration flyway is not well understood. We studied avian haemosporidian parasites in 10 localities where Chilean Elaenia, a long-distance Neotropical austral migrant species, spends part of its annual cycle to determine local parasite transmission among resident sympatric host species in the elaenia's distributional range across South America. We sampled 371 Chilean Elaenias and 1,818 birds representing 243 additional sympatric species from Brazilian wintering grounds to Argentinian breeding grounds. The 23 haemosporidian lineages found in Chilean Elaenias exhibited considerable variation in distribution, specialization, and turnover across the 10 avian communities in South America. Parasite lineage dissimilarity increased with geographic distance, and infection probability byParahaemoproteusdecreased in localities harbouring a more diverse haemosporidian fauna. Furthermore, blood smears from migrating Chilean Elaenias and local resident avian host species did not contain infective stages ofLeucocytozoon, suggesting that transmission did not take place in the Brazilian stopover site. Our analyses confirm that this Neotropical austral migrant connects avian host communities and transports haemosporidian parasites along its distributional range in South America. However, the lack of transmissive stages at stopover site and the infrequent parasite lineage sharing between migratory host populations and residents at breeding and wintering grounds suggest that Chilean Elaenias do not play a significant role in dispersing haemosporidian parasites, nor do they influence local transmission across South America.

Resumen Introduccion y objetivos El acceso transaxilar (ATx) se ha convertido en el acceso alternativo al transfemoral (ATF), mas utilizado en pacientes sometidos a implante percutaneo de valvula aortica (TAVI). El objetivo principal de este estudio es comparar la mortalidad total hospitalaria y a los 30 dias de los pacientes incluidos en el registro espanol de TAVI a los que se trato por acceso ATx frente a ATF. Metodos Se analizo a todos los pacientes incluidos en el registro espanol de TAVI tratados por ATx o ATF. Los eventos hospitalarios y a los 30 dias de seguimiento se definieron segun las recomendaciones de la Valve Academic Research Consortium. Se evaluo el impacto de la via de acceso mediante emparejamiento por puntuacion de propension segun las caracteristicas clinicas y ecograficas. Resultados Se incluyo a 6.603 pacientes, 191 (2,9%) tratados por ATx y 6.412 con ATF. Despues del ajuste (grupo de ATx, n = 113; grupo de ATF, n = 3.035), el exito del dispositivo fue similar entre ambos grupos (el 94% en el grupo de ATx frente al 95% en el de ATF; p = 0,95); sin embargo, se observo un incremento en la tasa de infarto agudo de miocardio (OR = 5,3; IC95%, 2,0-13,8; p = 0,001), complicaciones renales (OR = 2,3; IC95%, 1,3-4,1; p = 0,003) e implante de marcapasos (OR = 1,6; IC95%, 1,01-2,6; p = 0,03) en el grupo de ATx comparado con el de ATF. De mismo modo, la mortalidad hospitalaria y a los 30 dias fueron superiores en el grupo de ATx (respectivamente, OR = 2,2; IC95%, 1,04-4,6; p = 0,039; y OR = 2,3; IC95%, 1,2-4,5; p = 0,01). Conclusiones El ATx se asocia con un aumento en la mortalidad total tanto hospitalaria como a los 30 dias frente al ATF. Ante estos resultados, el ATx debe considerarse solo en caso de que el ATF no sea posible.

We identify temporal variations in surface albedo at Jezero crater using first-of-their-kind high-cadence in-situ measurements of reflected shortwave radiation during the first 350 sols of the Mars 2020 mission. Simultaneous Mars Environmental Dynamics Analyzer (MEDA) measurements of pressure, radiative fluxes, winds, and sky brightness indicate that these albedo changes are caused by dust devils under typical conditions and by a dust storm at Ls ∼ 155°. The 17% decrease in albedo caused by the dust storm is one order of magnitude larger than the most apparent changes caused during quiescent periods by dust devils. Spectral reflectance measurements from Mastcam-Z images before and after the storm indicate that the decrease in albedo is mainly caused by dust removal. The occurrence of albedo changes is affected by the intensity and proximity of the convective vortex, and the availability and mobility of small particles at the surface. The probability of observing an albedo change increases with the magnitude of the pressure drop (ΔP): changes were detected in 3.5%, 43%, and 100% of the dust devils with ΔP < 2.5 Pa, ΔP > 2.5 Pa and ΔP > 4.5 Pa, respectively. Albedo changes were associated with peak wind speeds above 15 m·s−1. We discuss dust removal estimates, the observed surface temperature changes coincident with albedo changes, and implications for solar-powered missions. These results show synergies between multiple instruments (MEDA, Mastcam-Z, Navcam, and the Supercam microphone) that improve our understanding of aeolian processes on Mars. This research has been funded by the Comunidad de Madrid Project S2018/NMT-4291 (TEC2SPACE-CM), by the Spanish State Research Agency (AEI) Project MDM-2017-0737 Unidad de Excelencia “María de Maeztu”- Centro de Astrobiología (CSIC/INTA), by the Spanish Ministry of Science and Innovation (MCIN)/State Agency of Research (10.13039/501100011033) project RTI2018-098728-B-C31, and by the project PID2021-126719OB-C41, funded by MCIN/AEI/10.13039/501100011033/FEDER, UE. RH, ASL and AM were supported by Grant PID2019-109467GB-I00 funded by MCIN/AEI/10.13039/501100011033/. Part of the research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration (80NM0018D0004). We want to thank J. Bell for processing Mastcam-Z projections showing the entire TIRS FOV and to S. Navarro and the entire team for generating the processed wind sensor data.

The Mars Environmental Dynamics Analyzer instrument on Mars 2020 has five Atmospheric Temperature Sensors at two altitudes (0.84 and 1.45 m) plus a Thermal InfraRed Sensor that measures temperatures on the surface and at ∼40 m. We analyze the measurements from these sensors to describe the evolution of temperatures in Jezero up to mission sol 400 (solar longitude LS = 13°–203°). The diurnal thermal cycle is characterized by a daytime convective period and a nocturnal stable atmosphere with a variable thermal inversion. We find a linear relationship between the daytime temperature fluctuations and the vertical thermal gradient with temperature fluctuations that peak at noon with typical values of 2.5 K at 1.45 m. In the late afternoon (∼17:00 Local True Solar Time), the atmosphere becomes vertically isothermal with vanishing fluctuations. We observe very small seasonal changes in air temperatures during the period analyzed. This is related to small changes in solar irradiation and dust opacity. However, we find significant changes in surface temperatures that are related to the variety of thermal inertias of the terrains explored along the traverse of Perseverance. These changes strongly influence the vertical thermal gradient, breaking the nighttime thermal inversion over terrains of high thermal inertia. We explore possible detections of atmospheric tides on near-surface temperatures and we examine variations in temperatures over timescales of a few sols that could be indicative of atmospheric waves affecting near-surface temperatures. We also discuss temperatures during a regional dust storm at LS = 153°–156° that simultaneously warmed the near surface atmosphere while cooling the surface. We are very grateful to the entire Mars 2020 science operations team. We would like to thank two anonymous reviewers for comments and suggestions that helped us to improve the quality of the manuscript. A. Munguira is supported by the grant PRE2020-092562 funded by MCIN/AEI/10.13039/501100011033 and by “ESF Investing in your future.” R. Hueso and A. Sánchez-Lavega are supported by Grant PID2019-109467GB-I00 funded by MCIN/AEI/10.13039/501100011033/and by Grupos Gobierno Vasco IT1742-22. US coauthors have been funded by NASA's STMD, HEOMD, and SMD. Part of the research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration (80NM0018D0004). B. Chide is supported by the Director's Postdoctoral Fellowship from the Los Alamos National Laboratory. M. Lemmon is supported by contract 15-712 from Arizona State University and 1607215 from Caltech-JPL. R. Lorenz was supported by JPL contract 1655893. G. Martínez acknowledges JPL funding from USRA Contract Number 1638782. A. Vicente-Retortillo is supported by the Spanish State Research Agency (AEI) Project No. MDM-2017-0737 Unidad de Excelencia “María de Maeztu”- Centro de Astrobiología (INTA-CSIC), and by the Comunidad de Madrid Project S2018/NMT-4291 (TEC2SPACE-CM). Researchers based in France acknowledge support from CNES for their work on Perseverance.

Understanding the determinants of parasite infection in different hosts is one of the main goals of disease ecology. Evaluating the relationship between parasite–host specificity and infection parameters within host communities and populations may contribute to this understanding. Here we propose two measures of specificity that encompasses phylogenetic and ecological relatedness among hosts and investigated how such metrics explain parasite infection prevalence and mean infection intensity (MII). We analysed the parasites associated with an anuran community in an area of Atlantic Forest and used the number of infected hosts and the net relatedness index to calculate the phylogenetic and ecological specificities of the parasites. These specificity measures were related to infection metrics (prevalence and MII) with generalized linear mixed models at community (all hosts) and population (infected host species) scales. Parasite prevalence was correlated with the number of infected hosts and, when considering only multi-host parasites, was positively related to parasite ecological specificity at community and population scales. Thus, parasite species have similar prevalences in ecologically closer hosts. No relationship was found for parasite MII. Incorporating ecological characteristics of hosts in parasite specificity analyses improves the detection of patterns of specificity across scales.

BACKGROUND The aim of this study was to analyze the feasibility of a physiological coronary evaluation with the instantaneous wave-free ratio (iFR) of nonculprit lesions in patients with acute coronary syndrome (ACS) successfully revascularized. METHODS A multicenter registry including patients of four high-volume PCI centers with ACS and underwent successful revascularization of the culprit vessel and had other nonculprit lesions that were physiologically evaluated with the iFR between January 2017 and December 2019. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, probable or definitive stent thrombosis and new revascularization (MACEs). RESULTS A total of 356 patients with 472 nonculprit lesions were included. The mean age was 66 ± 11 years. The clinical presentation was ACS without persistent ST-segment elevation (NSTE-ACS) in 235 patients (66%) and ST-segment elevation myocardial infarction (STEMI) in 121 patients (34%). After a median follow-up period of 21 (14-30) months, the primary endpoint occurred in 32 patients (9%). There were no differences in outcomes regarding clinical presentation (NSTEMI vs. NSTE-ACS, 9.1 vs. 8.9%, padj = 0.570) or iFR induced treatment strategy (patients with all lesions revascularized vs. patients with at least one lesion with an iFR > 0.89 deferred for revascularization, 10.5 vs. 8.4%, padj = 0.476). CONCLUSIONS The use of the iFR to guide percutaneous coronary intervention decision making in nonculprit lesions seems to be feasible, with an acceptable percentage of MACEs at the mid-term follow-up. Patients with deferred revascularization of lesions without physiological significance and patients undergoing complete revascularization had a similar risk of MACEs.

The RECALCAR project (Resources and Quality in Cardiology), an initiative of the Spanish Society of Cardiology, aims to standardize information to generate evidence on cardiovascular health outcomes. The objective of this study was to analyze trends in the resources and activity of cardiology units and/or services and to identify the results of cardiovascular care during the last decade in Spain.The study was based on the 2 annual data sources of the RECALCAR project: a survey on resources and activity of cardiology units and/or services (2011-2020) and the minimum data set of the National Health System (2011-2019), referring to heart failure (HF), STEMI, and non-STEMI.The survey included 70% of cardiology units and/or services in Spain. The number of hospital beds and length of stay decreased, while there was a notable increase in the number of cardiac imaging studies and percutaneous therapeutic procedures performed. Age- and sex-adjusted admissions for HF tended to decrease, despite an increase in mortality and the percentage of readmissions. In contrast, the trend in mortality and readmissions was highly favorable in STEMI; in non-STEMI, although positive, the trend was less marked.The information provided by the RECALCAR project shows a favorable trend in the last decade in resources, activity and results of certain cardiovascular processes and constitutes an essential source for future improvements and decision-making in health policy.

Wind speeds measured by the Mars 2020 Perseverance rover in Jezero crater were fitted as a Weibull distribution. InSight wind data acquired in Elysium Planitia were also used to contextualize observations. Jezero winds were found to be much calmer on average than in previous landing sites, despite the intense aeolian activity observed. However, a great influence of turbulence and wave activity was observed in the wind speed variations, thus driving the probability of reaching the highest wind speeds at Jezero, instead of sustained winds driven by local, regional, or large-scale circulation. The power spectral density of wind speed fluctuations follows a power-law, whose slope deviates depending on the time of day from that predicted considering homogeneous and isotropic turbulence. Daytime wave activity is related to convection cells and smaller eddies in the boundary layer, advected over the crater. The signature of convection cells was also found during dust storm conditions, when prevailing winds were consistent with a tidal drive. Nighttime fluctuations were also intense, suggesting strong mechanical turbulence. Convective vortices were usually involved in rapid wind fluctuations and extreme winds, with variations peaking at 9.2 times the background winds. Transient high wind events by vortex-passages, turbulence, and wave activity could be driving aeolian activity at Jezero. We report the detection of a strong dust cloud of 0.75–1.5 km in length passing over the rover. The observed aeolian activity had major implications for instrumentation, with the wind sensor suffering damage throughout the mission, probably due to flying debris advected by winds. The authors acknowledge and thank the Mars 2020 team. The authors would like to thank Editors and two anonymous reviewers for their constructive reviews, which greatly improved this manuscript. This work is supported by the Spanish Ministry of Science and Innovation, under project RTI2018-098728-B-C31. The derived data presented in this work were processed in the DPS24PA system, which is supported by project no. DV2020-ATM-A01. Part of the research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration (80NM0018D0004). The UPV/EHU team is supported by Grant PID2019-109467GB-I00 funded by 1042 MCIN/AEI/10.13039/501100011033/ and by Grupos Gobierno Vasco IT1742-22.

Di(2-ethylhexyl) phthalate (DEHP) is a chemical commonly used as a plasticizer to render polyvinyl chloride products more durable and flexible. Although exposure to DEHP has raised many health concerns due to the identification of DEHP as an endocrine disruptor, it is still used in consumer products, including polyvinyl chloride plastics, medical tubing, car interiors, and children’s toys. To investigate the impact of early life exposure to DEHP on the ovary and testes, newborn piglets were orally dosed with DEHP (20 or 200 mg/kg/day) or vehicle control (tocopherol-stripped corn oil) for 21 days. Following treatment, ovaries, testes, and sera were harvested for histological assessment and measurement of steroid hormone levels. In male piglets, progesterone and pregnenolone levels were significantly lower in both treatment groups compared to control, whereas in female piglets, progesterone was significantly higher in the 20 mg group compared to control, indicating sex-specific effects in a non-monotonic manner. Follicle numbers and gene expression of steroidogenic enzymes and apoptotic factors were not altered in treated ovaries compared to controls. In DEHP-treated testes, germ cell migration was impaired and germ cell death was significantly increased compared to controls. Overall, the results of this study suggest that neonatal exposure to DEHP in pigs leads to sex-specific disruption of the reproductive system.

Resumen Introduccion y objetivos Si bien la utilizacion de anticoagulantes orales directos (ACOD) en pacientes con fibrilacion auricular (FA) y protesis valvular biologica como alternativa a los antagonistas de la vitamina K (AVK) esta recogida en las guias, en la practica real son escasos los estudios que recogen estos pacientes, mas aun en nuestro pais, dadas las restricciones que existen a su prescripcion. Metodos Se analizo a los pacientes intervenidos de forma consecutiva en nuestro hospital de sustitucion valvular aortica por protesis biologica con indicacion de anticoagulantes orales por FA durante los anos 2013-2018. Comparamos caracteristicas clinicas basales, asi como tasas de eventos cerebrovasculares, hemorragias mayores y menores, y mortalidad de los tratados con ACOD frente a los tratados con AVK. Resultados Incluimos 132 pacientes tratados con AVK (62,6%) y 79 con ACOD (37,4%; apixaban 20%, edoxaban 10%, rivaroxaban 6% y dabigatran 3%). No hubo diferencias significativas en sus caracteristicas clinicas basales en cuanto a edad, sexo, funcion renal o escalas de riesgo embolico. El seguimiento medio fue de 32,85 ± 15 meses. La tasa de incidencia de ictus isquemico/accidente isquemico transitorio (AIT) fue de 1,5/100 pacientes/ano en el grupo ACOD frente a 1,32 en AVK. La tasa de incidencia de sangrado mayor fue de 2,02/100 pacientes/ano en el grupo ACOD frente a 3,7 en AVK. Los pacientes con AVK presentaron 6 ictus hemorragicos frente a ninguno en el grupo de pacientes con ACOD. Conclusiones La utilizacion de ACOD en pacientes con protesis cardiaca biologica e indicacion de ACO permanente por FA parece una alternativa eficaz y segura al uso de AVK.

Background In developed countries, health care delivery in dermatology is hampered by the low availability of dermatologists. Objective To analyze the feasibility of a teledermatology-based action plan to provide initial dermatologic care in areas with low availability of dermatologists. Methods A cross-sectional study describing the feasibility and cost of a 12-month action plan based on a store-and-forward teledermatology (TD) connecting primary care centers and a TD center. Teleconsultations from patients complaining of any cutaneous condition were included. The primary outcome measure was the percentage of patients not referred to the local dermatologist. Results Among the total of 15,523 teleconsultations attended in the TD-based action plan, 3360 (21.65%) required a face-to-face visit with a local dermatologist. In 32.32% (n = 5017) of the cases, a therapeutic and follow-up plan report was issued. The most common conditions managed were melanocytic nevi (15.63%, n = 2426), followed by seborrheic keratosis (14.89%, n = 2312), and actinic keratosis (8.65%, n = 1342). The average response time was 14.52 days (95% CI 14.35-15.23). The additional total investment in this action plan was $142,681.01, with a unit cost of 9.20$/patient. Limitations Noncontrolled study. Conclusions Experienced dermatologists working with store-and-forward TD can deliver a fast and effective response in health care areas with access limitations.

Introduction Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is a poorly defined concept. A recent large-scale study identified various patient- and procedure-related factors that were associated with in-hospital major adverse cardiac or cerebrovascular events (MACCE), which were used to construct a CHIP-score [1]. Purpose To investigate the predictive value of patient- and procedure related risk factors, based on the CHIP-score, in a large cohort of elderly patients. Methods This is a retrospective multicenter study of 20 centers, including patients of ≥75 years of age, that underwent PCI in the period of 2012–2019. The primary endpoint of MACCE was defined as cardiovascular death, myocardial infarction, revascularization or stroke. The follow-up time was 1 year. We created univariate and multivariate Cox regression models in order to investigate the predictive value of the CHIP-score variables (other than age, Table 2). Results A total of 2724 patients with a mean age of 81 (± 4.3) years were included in the study. Baseline characteristics are depicted in Table 1. The mean CHIP score was 1.74 (± 1.2) and 2262 (83%) had at least one CHIP criteria. At 1-year follow-up, 267 (9.8%) met the primary endpoint. Out of 11 investigated CHIP-score variables, only 5 were independent predictors of 1-year MACCE in adjusted regression models: Prior myocardial infarction (HR 1.56 (95% CI: 1.10–1.90), p=0.009), left ventricular ejection fraction Conclusions The CHIP-score retains significant prognostic value in the elderly population. The implication of a CHIP-score might be a future tool for risk stratification in clinical practice, not only for in-hospital MACCE but also on long-term follow-up. In the special population of elderly patients, 3 patient related and 2 procedure related factors showed to be especially helpful for risk assessment. Funding Acknowledgement Type of funding sources: None.

Migratory birds are implicated in dispersing haemosporidian parasites over great geographic distances. However, their role in sharing these vector-transmitted blood parasites with resident avian host species along their migration flyway is not well understood. We studied avian haemosporidian parasites in 10 localities where Chilean Elaenia, a long-distance Neotropical austral migrant species, spends part of its annual cycle to determine local parasite transmission among resident sympatric host species in the elaenia's distributional range across South America. We sampled 371 Chilean Elaenias and 1,818 birds representing 243 additional sympatric species from Brazilian wintering grounds to Argentinian breeding grounds. The 23 haemosporidian lineages found in Chilean Elaenias exhibited considerable variation in distribution, specialization, and turnover across the 10 avian communities in South America. Parasite lineage dissimilarity increased with geographic distance, and infection probability by

Introducción: El tratamiento del valgo severo es complejo. El abordaje externo descrito por Keblish es ventajoso para tratar estas deformidades. Evaluamos nuestros resultados utilizando un abordaje externo en artroplastias de rodilla con genu valgo severo. Materiales y Métodos: De 795 artroplastias primarias realizadas entre enero de 2012 y marzo de 2020, analizamos 40 que tenían un abordaje externo. Todos los pacientes tenían una deformidad en valgo >20° y un ligamento colateral medial suficiente. Se incluyó a 33 mujeres (3 bilaterales) y 4 hombres, el promedio de edad era de 71 años. La causa fue fundamentalmente osteoartrosis (82%). La deformidad prequirúrgica era de 27°. Las mediciones preoperatorias eran: KSS 15 (rango 5-42) y KFS 17 (rango 0-40). El tiempo promedio de cirugía fue de 91 minutos y el seguimiento, de 37 meses. Resultados: El ángulo femorotibial posoperatorio fue de 6,2° (rango 4-40), el KSS posoperatorio fue de 79 (rango 46-95) y el KFS, de 82 (rango 60-100). Hubo tres complicaciones (7%): una infección, un mal posicionamiento de componentes y uno de neuropraxia peronea. Conclusiones: En la artroplastia de rodilla por genu valgo, este abordaje permite restituir el eje femorotibial, lograr una adecuada estabilidad de la prótesis, aun con implantes sin mayor grado de constreñimiento, con una tasa de complicaciones equiparable a la de otras técnicas.

Introduction and objectives The pocket sized KardiaMobile (KM) is a monitoring device for ECG recording through a smartphone-based application. This system is generally aimed as screening tool to detect alterations in cardiac rhythm but its diagnostic potential for detection of ST changes remains largely unknown. This study sought to assess the diagnostic sensitivity of the KM system for detection of ST changes in patients with ST elevated myocardial infarction (STEMI). Methods Patients admitted with diagnosis of STEMI were consecutively included. Recordings with KM were obtained in leads I, II and anterior precordial. KM recordings were obtained as well from healthy individuals. All recordings were submitted for blinded assessment. Results A total of 112 patients with STEMI and 25 healthy individuals were included. Among those showing ST changes, these consisted mostly in depression (75%). Sensitivity was modest for individual leads (57-58%). The combination of 2-leads, when including the precordial, and the combination of 3-leads markedly increased sensitivity (88-98% and 100% respectively) for both inferior and anterior STEMI. Specificity was very high (96-100%) and the Youden's J statistic was excellent for the 2-leads combinations that included the precordial lead (0.84-0.94) and for the 3-leads combination (0.96). Conclusions The Kardia Mobile system with the combination of 2-leads (I + precordial or II + precordial) or 3-leads shows a very high sensitivity for both anterior and inferior STEMI.

The impact of nutritional status at diagnosis of childhood acute lymphoblastic leukemia (ALL) on survival rates was assessed in a Hispanic cohort. Children

Artificial intelligence (AI) offers great promise in cardiology, and medicine broadly, for its ability to tirelessly integrate vast amounts of data. Applications in medical imaging are particularly attractive, as images are a powerful means to convey rich information and are extensively utilized in cardiology practice. Departing from other AI approaches in cardiology focused on task automation and pattern recognition, we describe a digital health platform to synthesize enhanced, yet familiar, clinical images to augment the cardiologist’s visual clinical workflow. In this article, we present the framework, technical fundamentals, and functional applications of the methodology, especially as it pertains to intravascular imaging. A conditional generative adversarial network was trained with annotated images of atherosclerotic diseased arteries to generate synthetic optical coherence tomography and intravascular ultrasound images on the basis of specified plaque morphology. Systems leveraging this unique and flexible construct, whereby a pair of neural networks is competitively trained in tandem, can rapidly generate useful images. These synthetic images replicate the style, and in several ways exceed the content and function, of normally acquired images. By using this technique and employing AI in such applications, one can ameliorate challenges in image quality, interpretability, coherence, completeness, and granularity, thereby enhancing medical education and clinical decision-making.

Central aortic blood pressure could be helpful in the evaluation of patients with aortic stenosis (AS). The SphygmoCor XCEL device estimates central blood pressure (BP) measurement with its easy-to-use, operator-independent procedure. However, this device has not been properly validated against invasive measurement in patients with severe AS. We evaluated the relationship between cuff-brachial BP, transfer function- estimated and invasively measured central aortic pressure in patients with severe AS before and after transcatheter aortic valve replacement (TAVR). Agreement between techniques was analyzed and, according to the ARTERY Society recommendations, the minimum acceptable error was a mean difference ± SD ≤5 ± ≤8 mm Hg. A total of 94 patients with AS undergoing TAVR had simultaneous non-invasive and invasive measurements of central BP before and after the procedure. Before TAVR central systolic BP was in average slightly underestimated, though with wide variability, when using the default calibration of brachial-cuff SBP (mean difference ± SD, −3 ± 15 mm Hg), and after TAVR the degree of underestimation increased (mean difference ± SD, −9 ± 13 mm Hg). The agreement tended to improve for those patients with low aor- tic gradient stenosis compared to those with high gradient at baseline (mean dif- ference ± SD, −2 ± 11 mm Hg vs. −4 ± 17, respectively, p = .3). The cuff-brachial systolic BP yielded numerically lower degree of agreement and weaker correlation with invasive measurements than SphygmoCor XCEL. In patients with severe AS the SphygmoCor XCEL cuff device, despite showing strong correlation, does not meet the ARTERY Society accuracy criteria for non-invasive measurement of central SBP.

University systems with a high level of academic inbreeding tend to be closed to attracting (inter)national talent, while instead prioritizing retention of the human factor in the institution and t...

Data Availability Statement All Mars 2020 MEDA data necessary to reproduce each figure shown in this manuscript are available via the Planetary Data System (PDS) Atmospheres node (Rodriguez-Manfredi & de la Torre Juarez, 2021). An exception to this are the LWd values in the 5–80 μm range (Figures 8, 9, and 10 top, Figure 11 top, and Figure 15), and the aerosol opacity values derived from TIRS (Figure 10, middle and Figure 11, top), which are publicly available via the USRA Houston Repository (Martinez et al., 2022). THEMIS retrievals of thermal inertia shown in Figure 7 and TES retrievals of albedo in Figure 14 can be queried and processed using the open-source JMARS (Christensen et al., 2009) and MARSTHERM (Putzig et al., 2013) software. The Mars Environmental Dynamics Analyzer (MEDA) on board Perseverance includes first-of-its-kind sensors measuring the incident and reflected solar flux, the downwelling atmospheric IR flux, and the upwelling IR flux emitted by the surface. We use these measurements for the first 350 sols of the Mars 2020 mission (Ls ∼ 6°–174° in Martian Year 36) to determine the surface radiative budget on Mars and to calculate the broadband albedo (0.3–3 μm) as a function of the illumination and viewing geometry. Together with MEDA measurements of ground temperature, we calculate the thermal inertia for homogeneous terrains without the need for numerical thermal models. We found that (a) the observed downwelling atmospheric IR flux is significantly lower than the model predictions. This is likely caused by the strong diurnal variation in aerosol opacity measured by MEDA, which is not accounted for by numerical models. (b) The albedo presents a marked non-Lambertian behavior, with lowest values near noon and highest values corresponding to low phase angles (i.e., Sun behind the observer). (c) Thermal inertia values ranged between 180 (sand dune) and 605 (bedrock-dominated material) SI units. (d) Averages of albedo and thermal inertia (spatial resolution of ∼3–4 m2) along Perseverance's traverse are in very good agreement with collocated retrievals of thermal inertia from Thermal Emission Imaging System (spatial resolution of 100 m per pixel) and of bolometric albedo in the 0.25–2.9 μm range from (spatial resolution of ∼300 km2). The results presented here are important to validate model predictions and provide ground-truth to orbital measurements. Germán Martínez wants to acknowledge JPL funding from USRA Contract Number 1638782. A. V. R. is supported by the Spanish State Research Agency (AEI) Project MDM-2017-0737, Unidad de Excelencia “María de Maeztu”—Centro de Astrobiología (INTA-CSIC), and by the Comunidad de Madrid Project S2018/NMT-4291 (TEC2SPACE-CM). J. J. acknowledges funding from Mastcam-Z ASU subcontract 15-707. R. H., A. S. L., and A. M. were supported by Grant PID2019-109467GB-I00 funded by MCIN/AEI/10.13039/501100011033/ and by Grupos Gobierno Vasco IT1742-22. F. G. acknowledges financial support from the Agencia Estatal de Investigación of the Ministerio de Ciencia e Innovación and the European Regional Development Fund “A way of making Europe” through project the Centre of Excellence “María de Maeztu” award to the Centro de Astrobiología (MDM-2017-0737), and from the Instituto Nacional de Técnica Aeroespacial through Project S.IGS22001. L. M. was supported by CNES and IRIS-OCAV. J. P., M. H., and A.-M. H. are thankful for the Finnish Academy Grant 310509. M.-P. Z. was supported by Grant PID2019-104205GB-C21 funded by MCIN/AEI/10.13039/501100011033. M. de la T. J. acknowledges partial funding from the National Aeronautics and Space Administration (80NM0018D0004). The JPL co-authors acknowledge funding from NASA's Space Technology Mission Directorate and the Science Mission Directorate. Peerreview

We characterize vortex and dust devils (DDs) at Jezero from pressure and winds obtained with the Mars Environmental Dynamics Analyzer (MEDA) instrument on Mars 2020 over 415 Martian days (sols) (Ls = 6°–213°). Vortices are abundant (4.9 per sol with pressure drops >0.5 Pa correcting from gaps in coverage) and they peak at noon. At least one in every five vortices carries dust, and 75% of all vortices with Δp > 2.0 Pa are dusty. Seasonal variability was small but DDs were abundant during a dust storm (Ls = 152°–156°). Vortices are more frequent and intense over terrains with lower thermal inertia favoring high daytime surface-to-air temperature gradients. We fit measurements of winds and pressure during DD encounters to models of vortices. We obtain vortex diameters that range from 5 to 135 m with a mean of 20 m, and from the frequency of close encounters we estimate a DD activity of 2.0–3.0 DDs km−2 sol−1. A comparison of MEDA observations with a Large Eddy Simulation of Jezero at Ls = 45° produces a similar result. Three 100-m size DDs passed within 30 m of the rover from what we estimate that the activity of DDs with diameters >100 m is 0.1 DDs km−2sol−1, implying that dust lifting is dominated by the largest vortices in Jezero. At least one vortex had a central pressure drop of 9.0 Pa and internal winds of 25 ms−1. The MEDA wind sensors were partially damaged during two DD encounters whose characteristics we elaborate in detail. The authors are very grateful to the entire Mars 2020 science operations team. The authors would also like to thank Lori Fenton and an anonymous reviewer for many suggestions that greatly improved the manuscript. This work was supported by Grant PID2019-109467GB-I00 funded by MCIN/AEI/10.13039/501100011033/ and by Grupos Gobierno Vasco IT1742-22 and by the Spanish National Research, Development and Innovation Program, through the Grants RTI2018-099825-B-C31, ESP2016-80320-C2-1-R, and ESP2014-54256-C4-3-R. Baptiste Chide is supported by the Director's Postdoctoral Fellowship from the Los Alamos National Laboratory. M. Lemmon is supported by contract 15-712 from Arizona State University and 1607215 from Caltech-JPL. R. Lorenz was supported by JPL contract 1655893. Germán Martínez acknowledges JPL funding from USRA Contract Number 1638782. A. Munguira was supported by Grant PRE2020-092562 funded by MCIN/AEI and by “ESF Investing in your future.” A. Vicente-Retortillo is supported by the Spanish State Research Agency (AEI) Project No. MDM-2017-0737 Unidad de Excelencia “María de Maeztu”-Centro de Astrobiología (INTA-CSIC), and by the Comunidad de Madrid Project S2018/NMT-4291 (TEC2SPACE-CM). Part of the research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration (80NM0018D0004). Finnish researchers acknowledge the Academy of Finland Grant 328 310529. Researchers based in France acknowledge support from the CNES for their work on Perseverance.

Hormesis occurs as a result of biphasic dose relationship resulting in stimulatory responses at low doses and inhibitory ones at high doses. In this framework, environmental factors are often studied to understand how this exposure benefits the animal. In the current study we used anoxia, the total absence of oxygen, as the most extreme version of low oxygen hormesis. Our goal was to determine the dose, the extent of the effect, and the cost of that response in Tenebrio molitor. We identified that the hormetic range (1 to 3 h of anoxia) was similar to that of other insects. Individuals that were exposed to 3 h had high emergence, increased activity throughout life, and lived longer. Beetles that experienced 1 h of anoxia performed better than the controls while the 6-h group had compromised performance. These boosts in performance at 3 h were accompanied by significant costs. Treated individuals had a delay in development and once matured they had decreased fitness. There were also transgenerational effects of hormesis and F

Ectopic breast tissue (EBT) includes a spectrum of disease that entails other entities based on the presence of glandular tissue, nipple, or areola. The diagnosis in adolescents is infrequent.A retrospective study was performed including girls with axillary EBT (class IV or V of Kajava's Classification) operated in 2006-2020. Imagining studies, clinical and surgical reports, and histopathology were reviewed.Eleven girls from 13 to 16 years old were included. Two patients (18.2%) presented bilateral EBT. The most frequent clinical manifestation was 2-5 cm mass (100%), associating cyclic pain with menstruation (45%) and fluctuating volume (36%). Bilateral axillary ultrasonography allowed preoperative diagnosis. All of them were treated by open excision, through small incisions located in an axillary y fold. Clinical and aesthetic results were self-assessed as "very good", with normalization of the axillary y hollow and imperceptible scars. No recurrences were observed after one year of follow-up. An immediate postoperative hematoma was reported, which did not require drainage. Histopathology showed mature breast tissue without atypia.Axillary accessory breasts must be included in differential diagnosis of pediatric axillary masses. Bilateral ultrasonography is recommended for the preoperative diagnosis. Excision through minimal incision at this age seems to be safe and effective.

Rovers and landers on Mars have experienced local, regional, and planetary-scale dust storms. However, in situ documentation of active lifting within storms has remained elusive. Over 5–11 January 2022 (LS 153°–156°), a dust storm passed over the Perseverance rover site. Peak visible optical depth was ∼2, and visibility across the crater was briefly reduced. Pressure amplitudes and temperatures responded to the storm. Winds up to 20 m s−1 rotated around the site before the wind sensor was damaged. The rover imaged 21 dust-lifting events—gusts and dust devils—in one 25-min period, and at least three events mobilized sediment near the rover. Rover tracks and drill cuttings were extensively modified, and debris was moved onto the rover deck. Migration of small ripples was seen, but there was no large-scale change in undisturbed areas. This work presents an overview of observations and initial results from the study of the storm. The authors acknowledge and thank the Mars 2020 team. The research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration (80NM0018D0004). ML is supported by contract 15–712 from Arizona State University and 1607215 from Caltech-JPL. Funding for some Spain-based co-authors was provided by the Spanish Ministry of Economy and Competitiveness, through the projects No. ESP2014-54256-C4--4R and AYA2015-65041-P; Ministry of Science, Innovation and Universities, projects No. ESP2016-79612-C3-3R, ESP2016-80320-C2-1-R, RTI2018-098728-B- C33 and RTI2018-099825-B-C31; Instituto Nacional de Técnica Aeroespacial; Ministry of Science and Innovation's Centre for the Development of Industrial Technology; Grupos Gobierno Vasco IT1366-19; and European Research Council Consolidator Grant No. 818602. ASL, RH and AMR were supported by grant PID2019-109467GB-I00 funded by MCIN/AEI/10.13039/501100011033/and by Grupos Gobierno Vasco IT1366-19. A. V.-R. is supported by the Spanish State Research Agency (AEI) Project No. MDM-2017-0737 Unidad de Excelencia “María de Maeztu”- Centro de Astrobiología (INTA-CSIC). Any opinions, findings and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of funding agencies or the Space Science Institute. Peerreview

[EN] Trial Design: An interventional, phase 4, single group assignment, without masking (open label), preventive clinical trial was carried out in health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B. Methods: 67 health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B, were enrolled in the Clinical Trial. All participants were from 18 years up to 64 years old. Inclusion Criteria: NHS workers -including university students doing their internships in health centres dependent on the National Health System (inclusion of students is regulated and limited by specific instructions on labour prevention in each autonomous community)- classified as non-responders. The criteria defining them as non-responders to the conventional hepatitis B vaccine is anti HBsAb titers < 10 mUI/ml following the application of six doses of conventional vaccine at 20 lg doses (two complete guidelines). The objective of this study was to provide Health workersstaff with an additional protection tool against hepatitis B infection, and to evaluate the efficacy of the adjuvanted vaccine in healthy non-responders to conventional hepatitis B vaccine. The primary outcome was the measurement of antibody antiHBs before the first Fendrix dose and a month after the administration of each dose. Other outcome was collection of adverse effects during administration and all those that could be related to the vaccine and that occur within 30 days after each dose. In this study, only one group was assigned. There was no randomization or masking. Results: The participants were recruited between April 13, 2018 and October 31, 2019. 67 participants were enrolled in the Clinical Trial and included the analyses. The primary immunisation consists of 4 separate 0.5 ml doses of Fendrix , administered at the following schedule: 1 month, 2 months and 6 months from the date of the first dose. Once the positivity was reached in any of the doses, the participant finished the study and was not given the following doses. 68.66% (46 out 67) had a positive response to first dose of Fendrix. 57.14% (12 out 21) had a positive response to second dose of Fendrix . 22.22% (2 out 9) had a positive response to third dose of Fendrix and 42.96% (3 out 7) had a positive response to last dose of Fendrix. Overall, 94.02% (64 out 67) of participants had a positive response to Fendrix . No serious adverse event occurred. Conclusions: The use of Fendrix , is a viable vaccine alternative for NHS workers classified as ‘‘nonresponders”. Revaccination of healthy non-responders with Fendrix, resulted in very high proportions of responders without adverse events. Trial registration: The trial was registered in the Spanish National Trial Register (REEC), ClinicalTrials.gov and inclusion has been stopped (identifier NCT03410953; EudraCT-number 2016-004991-23). Funding: GRS 1360/A/16: Call for aid for the financing of research projects in biomedicine, health management and socio-health care to be developed in the centres of the Regional Health Management of Autonomous Community of Castile-Leon. In addition, this work has been supported by the Spanish Platform for Clinical Research and Clinical Trials, SCReN (Spanish Clinical Research Network), funded by the Subdirectorate General for Research Evaluation and Promotion of the Carlos III Health Institute (ISCIII), through the project PT13/0002/0039 and project PT17/0017/0023 integrated in the State Plan for R&D&I 2013–2016 and co-financed by and the European Regional Development Fund (ERDF).

Objectives This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR). Background Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated. Methods Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry. Results Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non–ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150). Conclusions Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501 )

Objectives This study sought to assess the efficacy of the drug-coated balloon (DCB) ESSENTIAL for the treatment of in-stent restenosis (ISR). Background DCBs have proven a valid therapeutic option for the management of ISR in several clinical trials, yet no class effect can be claimed. Accordingly, every new DCB model has to be individually evaluated through clinical studies. Methods This is a prospective, multicenter study including consecutive patients undergoing percutaneous coronary intervention for ISR with the ESSENTIAL DCB. A 6-month quantitative coronary angiography (QCA)/optical coherence tomography (OCT) follow-up was scheduled. The primary endpoint was OCT-derived in-segment maximal area stenosis. Secondary endpoints included QCA-derived in-segment late lumen loss (LLL) and target lesion failure (TLF) rates at 6, 12, and 24 months. TLF was defined as the composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization . Results A total of 31 patients were successfully treated with DCB, with 67% of ISR corresponding to drug-eluting stents (DES). At 6 months, 26 patients underwent the scheduled angiographic follow-up. The mean value for in-segment maximal area stenosis was 51.4 ± 13% and the median value was 53% (IQR 46.4–59.5). In the DES-ISR subgroup, these parameters were 52.6 ± 10% and 55.2% (IQR 49.3–58.5), respectively. In-segment LLL was 0.25 ± 0.43 mm with only 2 (7.7%) patients showing binary restenosis (>50%). The incidence of TLF was 10% at 6 months, 13.3% at 12 months, and 13.3% at 24 months. Conclusions In this study, the ESSENTIAL DCB showed sustained efficacy in the prevention of recurrent restenosis after treatment of ISR. Summary We sought to assess the efficacy of the drug-coated balloon ESSENTIAL for the treatment of in-stent restenosis through a prospective, multicenter study including QCA and OCT assessment at 6-month follow-up. The primary endpoint was in-segment maximal area stenosis. Among the 31 patients successfully treated with the ESSENTIAL DCB, an angiographic follow-up was conducted in 26. Mean in-segment maximal area stenosis was 51.4 ± 13% and the median value was 53% (IQR 46.4–59.5). In the DES-ISR subgroup, corresponding values were 52.6 ± 10% and 55.2% (IQR 49.3–58.5), respectively. The observed in-segment LLL was 0.25 ± 0.43 mm and binary restenosis rate was 7.7%. TLF was 10% at 6 months and 13.3% at 12 and 24 months.