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BACKGROUND: Accurate diagnosis of TB infection (TBI) is challenging due to the lack of a gold standard. Tuberculin skin test (TST) and interferon-gamma release assay (IGRA) are currently useful in TBI diagnosis, but both have several limitations. This study aims to evaluate inter-operator variability in TST measurements and determine its impact on TBI diagnosis and treatment.METHODS: This was a retrospective analysis of patients screened for TBI using at least TST at a public outpatient clinic specialised in TB from January 2019 to August 2021. TST readings performed by five experienced nurses were compared.RESULTS: A total of 671 screenings were analysed. TST positivity rate (P < 0.001) and mean TST measurements obtained by our nurses were significantly different (P < 0.001). Concordance of TST and IGRA results was of 83.4% in the overall population (κ = 0.479). However, TST/IGRA agreement was significantly different among nurses (P = 0.003).CONCLUSION: Our analysis of TST measurements by experienced nurses shows significant differences in TST positivity rate, mean measured values and overall concordance with IGRA. This led to significant different outcomes in TBI diagnosis and subsequent treatment. TST measurement differences could potentially be more pronounced if we considered untrained operators or those with occasional reading experience.

Supplemental Figure 1: TfnR and CD8 internalization as measured by In-Cell ELISA.

Supplemental Figure 5: Relationship between endocytic activity and cancer cell properties.

Supplemental Figure 4: Relationship between endocytic activity and proliferation.

Supplemental Figure Legends

Supplemental Figure 3: Relationship between endocytic activity and genetic alteration associated with cancer cell oncogenic transformation

Supplemental Figure 6: Relationship between endocytic activity and adhesion.

Supplement Table 1: Rates of uptake at 5 minutes for each endocytic pathway with standard deviation (STDV) in 29 NSCLC cell lines

Supplement Table 2: NSCLC cell line properties

Supplemental Figure 7: Comparison of internalization and total surface binding of endocytic markers between cluster 1 and cluster 2.

Serological assays have been widely used to detect anti-SARS-CoV-2 antibodies, which are generated from previous exposure to the virus or after vaccination. The presence of anti-SARS-CoV-2 Nucleocapsid antibodies was recently reported in patients´ urine using an in-house urine-based ELISA-platform, allowing a non-invasive way to collect clinical samples and assess immune conversion. In the current study, we evaluated and validated another in-house urine-based ELISA for the detection of anti-SARS-CoV-2 Spike antibodies. Three partial recombinant SARS-CoV-2 Spike proteins comprising the Receptor Binding Domain, expressed in eukaryotic or prokaryotic systems, were tested in an ELISA platform against a panel of over 140 urine and paired serum samples collected from 106 patients confirmed positive for SARS-CoV-2 by qRT-PCR. The key findings from our study were that anti-SARS-CoV-2 Spike antibodies could be detected in urine samples and that the prokaryotic expression of the rSARS-CoV-2 Spike protein was not a barrier to obtain relatively high serology efficiency for the urine-based assay. Thus, use of a urine-based ELISA assay with partial rSARS-CoV-2 Spike proteins, expressed in a prokaryotic system, could be considered as a convenient tool for screening for the presence of anti-SARS-CoV-2 Spike antibodies, and overcome the difficulties arising from sample collection and the need for recombinant proteins produced with eukaryotic expression systems.

Quinoline and its derivatives comprise an important group of heterocyclic compounds that exhibits a wide range of pharmacological properties such as antibacterial, antiviral, anticancer, antiparasitic, anti-Alzheimer and anticholesterol. The quinoline nucleus is found in the structure of many drugs and rational design in medicinal chemistry for the discovery of novel bioactive molecules. Persistent efforts have been made over the years to develop novel congeners with superior biological activities and minimal potential for undesirable side effects. This review highlights some discoveries on the development of quinoline-based compounds in recent years (2013-2019), focusing on their biological activities, including anticancer, antitubercular, antimalarial, anti-ZIKV, anti-DENV, anti- Leishmania and anti-Alzheimer’s disease.

O pirarucu (Arapaima gigas) e considerado o maior peixe de escama de agua doce da Amazonia e uma especie importante economicamente para comunidades tradicionais, devido a ameaca de sobrepesca do estoque pesqueiro, o manejo do pirarucu e indispensavel, pois contribui para multiplicacao dos seus estoques. Alem disso, e necessario informar ao Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renovaveis (IBAMA) a existencia de quantidade suficiente que autoriza captura. A contagem manual e um processo importante e constante para determinar o estoque, com isso, este artigo apresenta metodos para automatizar a deteccao e contagem do pirarucu usando visao computacional. O artigo apresenta uma comparacao entre a contagem manual e valores obtidos pelos metodos, considerando 1.129 imagens do video. Os resultados mostraram em alguns casos 100% de acuracia. Concluindo, que o metodo de segmentacao utilizando filtro mediana mostrou ser confiavel e util para estudos de monitoramento do pirarucu.

A identificação de caracteres Braille é uma das habilidades fundamentais que professores que possuem alunos com deficiência visual nas suas turmas precisam ter. No entanto, enquanto o número de matrículas de alunos com deficiência aumenta, a taxa de alfabetização em Braille dessa parte da população vem caindo consideravelmente nos últimos anos. Assim, neste trabalho, é apresentado o Muiraquitã Braille, um aplicativo móvel que visa auxiliar na aprendizagem do Sistema Braille e na tradução de textos em Braille para Português.

Introduction Calcium score of the aortic valve (CaScAoV) is recommended as a supporting tool to assist in the grading of aortic stenosis (AS) severity when echocardiographic assessment is inconclusive. However, a significant proportion of patients have CaScAoV values within a “grey zone” between the “unlikely” and “likely” thresholds. The purpose of this study was to assess the potential usefulness of indexing CaScAoV to the area of the aortic annulus, in order to improve the discriminative power of CaScAoV in this subset of patients. Methods Consecutive patients evaluated at a single center TAVI program were retrospectively identified and included in the analysis if cardiac CT and echocardiography were performed within a 6-month timeframe. Those with LVEF Results A total of 655 patients were included (282 men (43.1%), median age 83 years [IQR 79–86]). AS was considered severe by echocardiographic criteria in 587 patients (89.6%), and moderate in the remainder. Median transvalvular gradient was 49 mmHg (IQR 43–59), and median CaScAoV values were 3329 (IQR 2356–4500) for men, and 1995 (IQR 1462–2781) for women. Overall, 77 patients (11.7%) had CaScAoV values in the “grey zone”, of which 24 (31.2%) had moderate AS (Figure 1). Patients within this region of uncertainty were no different form the others in terms of age, sex, annulus size and body surface area. In this subset of patients, indexing CaScAoV to aortic annulus area showed good discriminative power to identify severe AS (AUC 0.69, 95% CI 0.56–0.81, p=0.008). Using previously established thresholds (>300 AU/cm2 for women and >500 AU/cm2 for men), 48 patients (62.3%) were correctly reclassified (net reclassification index of 0.45, p=0.03). These findings were similar for both sexes. Conclusion In patients undergoing cardiac CT for known or suspected severe AS with CaScAoV values within the “grey zone”, indexing CaScAoV to the area of the aortic annulus improves the classification of AS severity and may decrease diagnostic uncertainty. Funding Acknowledgement Type of funding sources: None.

Background/Objective:Coronavirus disease 2019 (COVID-19) has been associated with various neurological and atypical head/eyes/ears/nose/throat (HEENT) manifestations. We sought to review the evidence for these manifestations.Methods:In this systematic review and meta-analysis, we compiled studies published until March 31, 2021 that examined non-respiratory HEENT, central, and peripheral nervous system presentations in COVID-19 patients. We included 477 studies for qualitative synthesis and 59 studies for meta-analyses.Results:Anosmia, ageusia, and conjunctivitis may precede typical upper/lower respiratory symptoms. Central nervous system (CNS) manifestations include stroke and encephalopathy, potentially with brainstem or cranial nerve involvement. MRI studies support CNS para-/postinfectious etiologies, but direct neuroinvasion seems very rare, with few cases detecting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the CNS. Peripheral nervous system (PNS) manifestations include muscle damage, Guillain–Barre syndrome (GBS), and its variants. There was moderate-to-high study heterogeneity and risk of bias. In random-effects meta-analyses, anosmia/ageusia was estimated to occur in 56% of COVID-19 patients (95% CI: 0.41–0.71, I2:99.9%), more commonly than in patients without COVID-19 (OR: 14.28, 95% CI: 8.39–24.29, I2: 49.0%). Neurological symptoms were estimated to occur in 36% of hospitalized patients (95% CI: 0.31–0.42, I2: 99.8%); ischemic stroke in 3% (95% CI: 0.03–0.04, I2: 99.2%), and GBS in 0.04% (0.033%–0.047%), more commonly than in patients without COVID-19 (OR[stroke]: 2.53, 95% CI: 1.16–5.50, I2: 76.4%; OR[GBS]: 3.43,1.15–10.25, I2: 89.1%).Conclusions:Current evidence is mostly from retrospective cohorts or series, largely in hospitalized or critically ill patients, not representative of typical community-dwelling patients. There remains a paucity of systematically gathered prospective data on neurological manifestations. Nevertheless, these findings support a high index of suspicion to identify HEENT/neurological presentations in patients with known COVID-19, and to test for COVID-19 in patients with such presentations at risk of infection.

Made available in DSpace on 2021-06-25T12:16:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-19 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Six lipases were immobilized on a styrene-divinylbenzene support and evaluated on the batch esterification reaction of stearic acid with fusel oil. After a screening design, the two most appropriate lipases were assayed on a packed-bed system, achieving high conversion rates (90-93%) and productivities of isoamyl stearate up to 3144 mmol g(-1) min(-1), which can be used as a substitute to fossil-derived lubricants. Graphic Univ Sao Paulo, Engn Sch Lorena, Lorena, SP, Brazil Sao Paulo State Univ, Sch Pharmaceut Sci, Araraquara, SP, Brazil EARTH Univ, Guacimo, Limon, Costa Rica Univ Fed Rural Rio de Janeiro, Seropedica, RJ, Brazil Univ Fed Alfenas, Inst Chem, Alfenas, MG, Brazil Sao Paulo State Univ, Sch Pharmaceut Sci, Araraquara, SP, Brazil FAPESP: 2016/10636-8 FAPESP: 2020/15513-7 CAPES: 001

Resume Objectif L’objectif de cette etude est de presenter l’evolution des donnees d’incidence et de mortalite du cancer des organes genitaux externes de l’homme dans l’Herault a partir des donnees du Registre des tumeurs de l’Herault (RTH) sur une periode de 30 ans. Materiel et methodes A partir de la base de donnees du RTH, nous avons etudie l’evolution des tumeurs germinales du testicule (TGT) et du cancer du penis (CP) sur 30 ans (de 1987 a 2016). Nous avons analyse les donnees d’incidence et de mortalite de ces tumeurs. Nous avons compare ces resultats aux donnees francaises, europeennes et mondiales. Resultats En 30 ans d’enregistrement nous avons recense 725 cas de TGT et 175 cas de CP. Le taux standardise sur la population mondiale (TSM) d’incidence des TGT a double entre 1987 et 2016 (4,2/100 000 en 1987 et 9,3/100 000 en 2016). Il a ete multiplie par 2,63 dans la population des patients de 30 a 44 ans. On observe une baisse du taux de mortalite avec un TSM a 0,8/100 000 en 1987, et 0,4/100 000 en 2016. Le TSM d’incidence des CP est stable entre 1987 et 2016 (TSM entre 0,4 et 0,9/100 000). La mortalite est stable avec un TSM entre 0,1 et 0,3/100 000 entre 1987 et 2016. Conclusion L’incidence des TGT a fortement augmente dans l’Herault durant les 30 dernieres annees alors que l’on observe une diminution de la mortalite. La proportion des tumeurs germinales seminomateuses augmente ; elle est passee de 53 % a 60 % en 30 ans dans l’Herault. L’incidence et la mortalite du CP etaient stables dans l’Herault durant les 30 dernieres annees.

A compact parabolic reflector antenna aiming at radar applications in the K‐band is presented. It is mainly composed of a thermoplastic material and using classical additive techniques (also known as 3D printing), the proposed high‐gain antenna exhibits a novel and unique form factor, particularly of interest for applications with low payload capacity, for example unmanned aerial vehicles. The antenna is composed of four parts: (i) a paraboloid shape embodied in a supporting polylactic acid (PLA) material; (ii) a metallic coating applied to the paraboloid surface of (i), to enable it with electromagnetic reflecting properties; (iii) a PLA spacer that ensures the physical separation (i.e. focal distance) between parts (i) and (iv) and, finally, (iv) a microstrip patch antenna with a reduced ground plane to reduce feed blockage. Subsequently to an overview on the theoretical formulation of parabolic reflector antennas, an antenna targeting 20 dBi and a minimum bandwidth of 500 MHz operating in the 24 GHz ISM radar band have been dimensioned, optimised in CST Microwave Studio and validated against measurements performed on a physical prototype. The simulation and experimental results are in good agreement with the prototype yielding 18.3 dBi of gain and 2.2 GHz of useful bandwidth, clearly demonstrating the potential of the proposed antenna design.

We report that decreased expression of miR-30c in tumor compared to adjacent tissue is sex-dependent in colorectal cancer (CRC) patients. High expression of miR-30c was associated with better survival in the whole cohort. When the cohort was split into male and female subcohorts, decreased miR-30c expression in tumor compared to adjacent tissue was observed only in males. Expression of miR-30c was decreased in CRC tumor tissue in male patients with nodes involvement compared to those without metastases in nodes and this difference was not observe in females. Next dependency of miR-30c expression on oestrogen receptor beta (ERbeta) mRNA levels in tumor was tested. In males with low expression of ERbeta, we observed a significant decrease in miR-30c levels in patients with nodes involvement compared to those without nodes involvement. This difference was not observed in males with high ERbeta mRNA levels and in females. Accordingly, males with low expression of ERbeta and high expression of miR-30c showed a better survival that those with low expression ERbeta and low expression of miR-30c. It is possible to conclude that whole cohort survival dependence on miR-30c is mostly generated by a subcohort of males with low expression of ERbeta mRNA in tumor tissue.

The generalized gamma-generated family adds one shape parameter to a baseline distribution. We define the gamma-Chen and derive some of its mathematical properties. Its hazard rate may have increasing, decreasing, bathtub and unimodal shapes due to the extra parameter, which portrays a positive point of the proposed model. We perform Monte Carlo simulations to prove that the asymptotic properties of the maximum likelihood estimators hold. We show empirically that the new distribution is better than ten others known distributions using engineering-related data sets.

Serum-based ELISA (enzyme-linked immunosorbent assay) has been widely used to detect anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. However, to date, no study has investigated patient urine as a biological sample to detect SARS-CoV-2 virus-specific antibodies. An in-house urine-based ELISA was developed using recombinant SARS-CoV-2 nucleocapsid protein. The presence of SARS-CoV-2 antibodies in urine was established, with 94% sensitivity and 100% specificity for the detection of anti–SARS-CoV-2 antibodies with the urine-based ELISA and 88% sensitivity and 100% specificity with a paired serum-based ELISA. The urine-based ELISA that detects anti–SARS-CoV-2 antibodies is a noninvasive method with potential application as a facile COVID-19 immunodiagnostic platform, which can be used to report the extent of exposure at the population level and/or to assess the risk of infection at the individual level.

Resume Objectifs On observe dans l’Herault une nette augmentation de l’incidence des cancers urologiques. Le registre des tumeurs de l’Herault (RTH) a recueilli 1961 tumeurs urologiques en 2016, soit 21,4 % de l’ensemble des tumeurs de l’Herault pour cette annee-la. La creation d’un registre specialise en onco-urologie nous est apparue necessaire. L’objectif de cet article est de decrire le fonctionnement de RHESOU et de donner quelques exemples de resultats. Materiel et methodes En novembre 2018, RHESOU (Registre de l’herault specialise en onco-urologie) a ete cree sur le meme mode de fonctionnement qu’un registre. Il permet de completer les donnees du RTH sur beaucoup d’autres parametres oncologiques. Pour chaque type de cancer urologique et genital masculin et urologique feminin, une fiche de recueil a ete realisee pour recueillir le maximum de donnees presentes dans le dossier des cas signales. Cette etude a evalue les donnees concernant les patients domicilies dans l’Herault pour l’annee 2017. Resultats Nous avons denombre pour l’annee 2017, 970 cancers de la prostate, 581 tumeurs de vessie, 212 cancers du rein, 51 tumeurs de la voie excretrice superieure, 28 cancers du testicule et 9 cancers du penis. Le recueil de ces donnees permet de creer des requetes et de fournir des analyses pertinentes et detaillees sur les cancers urologiques et genitaux masculins. Nous rapportons les donnees analysees sur le rein, la vessie et la prostate. Conclusions RHESOU est un outil accessible pour permettre une vue d’ensemble sur les cancers en urologie dans l’Herault et leur prise en charge. Avec l’apparition de nouveaux traitements, il saura s’adapter en permettant une evolution des fiches. Niveau de preuve 3.

Made available in DSpace on 2020-12-10T17:34:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-08-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Biodiesel quality is dependent upon the fatty acids distribution of the raw material used in the trans/esterification reactions. While microalgae cells are regarded as potential oil suppliers for the biodiesel production chain, a common criticism is related to the low lipid productivities and often to a poor fatty acid distribution. In the present work we propose to submit microalgal cultivation to a second stage with nutritional stress by a simple addition of a 70% nitrate source depleted medium at the beginning of stationary phase, without harvesting cells, saving time and water. Chlorella minutissima was cultivated in a novel unconventional photobioreactor, named Internally Illuminated Integrated Photobioreactor (ILIPBR), to verify the efficiency of the proposed strategy. Biomass concentration, lipid content and volumetric lipids productivity increased 24.9%, 120.7% and 55.6%, respectively, from Stage 1 to Stage 2, when ILI-PBR was illuminated by constant blue LED and 0.5 vvm of aeration. The fatty acid profiles, evaluated in terms of LED illumination (white, red and blue), showed a predominance of palmitic acid in all cases (59.49%, 57.28% and 46.51%, respectively), which allowed to enhance some biodiesel properties such as cetane number, cold filter plugging point, density and kinematic viscosity, according to international specifications. (C) 2020 Elsevier Ltd. All rights reserved. Univ Sao Paulo, Engn Sch Lorena, Lorena, SP, Brazil Univ Fed Ouro Preto, Inst Exact & Biol Sci, Dept Chem, Lab Technol & Environm Chem, Ouro Preto, MG, Brazil Ctr Fed Educ Tecnol Celso Suckow Fonseca, Angra Dos Reis, RJ, Brazil Univ Fed Sao Joao del Rei, Alto Paraopeba Campus, Ouro Branco, MG, Brazil Univ Estadual Paulista, Engn Fac Guaratingueta, Guaratingueta, SP, Brazil Univ Estadual Paulista, Engn Fac Guaratingueta, Guaratingueta, SP, Brazil

Microalgae have been widely considered as a promising alternative to renewable feedstock to biofuel production. Considering the many oleaginous strains of microalgae, this work assessed the potential of two species, Chlorella minutissima and Nannochloropsis gaditana, to be tested as raw material for ethyl esters production of biodiesel value. This work demonstrates an efficient pilot-size photoautotrophic growth of the two strains using 40-L bubble-column photobioreactors, providing lipid productivities of around 15.2 and 8.7 mg L−1 day−1 for C. minutissima and N. gaditana, respectively. The lipid-bearing biomass, which presented fatty acids composition similar to vegetable oils, such as soybean, rich in palmitic, oleic, and linoleic acids, was then assayed in direct trans/esterification reactions using ethanol as acyl donor, lipid extracting and solvent for the liquid phase in a pressurized reactor. The reactions, which were catalyzed by a heterogeneous acid catalyst (12-molybdophosphoric acid supported onto aluminum oxide), demonstrated an efficient route for producing a product mixture containing ester contents greater than 96.5 wt%, total conversion of triacylglycerols, and low levels of mono- and diacylglycerols, promoting an ethyl ester mixture with possible integration within the biodiesel market specifications.

The utilization of novel materials within the scope of biofuel synthesis has been represented as a significant step in the development of remarkable catalysts. The use of lipases in biodiesel production is often found as a cost-limiting step, as the operational expenditures in recovering such catalysts may lead to unfeasible market expectations. Herein, magnetic-polymer composites were evaluated as supports to immobilize commercial lipase, following the application in ethyl ester syntheses. A matrix of polysiloxane-polyvinyl alcohol (SiO2-PVA) was selected as the polymeric structure, following Fe3O4 and γFe2O3 coating and incorporation assays to the support backbone. Characterization of the produced catalyst support materials was performed via analysis of X-ray powder diffraction, pore size, Scanning electron microscopy, Fourier transform infrared spectroscopy, and vibrating sample magnetometry. Burkholderia cepacia was then immobilized on the matrices, following transesterification of coconut oil with ethanol. The biodiesel samples generated were all within commercial standards, achieving conversion ester contents higher than 96.5%. The purified product samples (biodiesel) were essentially odorless and translucent appearance. Other properties such as density (873–876 kg m−3) and viscosity (3.76–3.93 mm2 s−1) meet the specifications required by the ASTM to be used as a biofuel.

Mucor circinelloides is a filamentous fungus capable of producing mycelium-bound lipase and lipids and able to assimilate a wide array of substrates, like agricultural wastes and industrial effluents. A biotechnological valorization of cheese whey is described herein, in which simultaneous reduction of the organic loading and conversion of the various compounds of the by-product into added-value microbial metabolites is obtained. M. circinelloides URM 4182 was tested for the ability of producing biomass containing lipids and mycelium-bound lipase using raw cheese whey as culture medium. The fungal cultivation assays were performed in non-supplemented cheese whey at pH 4.5, 26 °C, 250 rpm for 120 h providing biomass concentration of 4.7 g L−1 containing lipids (22.5% of dry biomass weight) and lipolytic activities up to 160 U g−1. The mycelium-bound lipase was characterized in terms of its biochemical and kinetic parameters and tested on biogas production assays of cheese whey as a way to enhance the lipid hydrolysis, the limiting step in anaerobic digestion. Results demonstrate that the addition of M. circinelloides lipase on cheese whey reduced the lag phase of anaerobic digestion up to 43.7%, and the biogas production was increased by up to ninefold when compared with the control experiments.

Redshift measurement has always been a constant need in modern astronomy and cosmology. And as new surveys have been providing an immense amount of data on astronomical objects, the need to process such data automatically proves to be increasingly necessary. In this article, we use simulated data from the Dark Energy Survey, and from a pipeline originally created to classify supernovae, we developed a linear regression algorithm optimized through novel automated machine learning (AutoML) frameworks achieving an error score better than ordinary data pre-processing methods when compared with other modern algorithms (such as xgboost). Numerically, the photometric prediction RMSE of type Ia supernovae events was reduced from 0.16 to 0.09 and the RMSE of all supernovae types decreased from 0.20 to 0.14. Our pipeline consists of four steps: through spectroscopic data points we interpolate the light curve using Gaussian process fitting algorithm, then using a wavelet transform we extract the most important features of such curves; in sequence we reduce the dimensionality of such features through principal component analysis, and in the end we applied super learning techniques (stacked ensemble methods) through an AutoML framework dedicated to optimize the parameters of several different machine learning models, better resolving the problem. As a final check, we obtained probability distribution functions (PDFs) using Gaussian kernel density estimations through the predictions of more than 50 models trained and optimized by AutoML. Those PDFs were calculated to replicate the original curves that used SALT2 model, a model used for the simulation of the raw data itself.

Anaerobic digestion is a process regulated by several classes of Bacteria and Archaea, which, through a complex ecological succession, is used to treat wastewater, manure, and solid waste. The bioprocesses involved in the anaerobic degradation of organic matter achieved, in the last decades, an important status in the social aspects of rural energy in different parts of developing regions of the world, including many countries in Latin America, with its combined potential of producing effective fertilizers through the treatment of waste materials. The agricultural tradition of the region has been linked to remarkable developments of biodigesters since the 1970s, especially in areas traditionally lacking basic infrastructure in terms of energy storage and distribution. In this sense, most of the technologies applied to the region are based on low-cost and decentralized systems, which can provide biogas as fuel primarily for direct burning use. Nonetheless, considering the potential of anaerobic digestion in the region, with the abundant feedstock and warm climate in most parts and the growing energy requirement of the population, there seems to be a lack of long-term effective governmental programs that could fulfill such needs. In this sense, this chapter presents some of the core concepts involved in anaerobic digestion, with some insights in terms of production, commercial status, and the role of the technology in the Latin American region, providing some opportunities and challenges for the years to come.

Background The SMART-REACH score (SRS) was developed to predict the risk of major adverse cardiovascular events in ambulatory patients with established cardiovascular disease, although it has not been extensively validated. Patients at higher risk of recurrent ischemic events may benefit from novel, more intensive treatment options, and earlier identification of these patients can potentially improve outcomes. Purpose We aimed to validate the SRS and evaluate its performance in a population recently admitted with acute coronary syndrome. Methods In this single-centre retrospective cohort, we included 320 patients aged 45 to 80 years, who were discharged following admission for an acute coronary syndrome between 2016 and 2018. To calculate the SRS for each patient, we considered clinical data on admission (age, gender, smoking, diabetes, prior history of vascular disease, heart failure or atrial fibrillation), lipid values obtained within the first 24 hours of hospitalization, serum creatinine level at baseline and once the patient was deemed clinically stable, and discharge medication. The outcome of interest was defined as stroke, myocardial infarction or cardiovascular death (MACE) at two years of follow-up. SRS was assessed for discrimination and calibration. Results Mean age was 63±9 years, and 240 (75%) were male. There was high prevalence of cardiovascular risk factors: 71% had hypertension, 32% had diabetes mellitus, 42% were active smokers and 25% had previously established cardiovascular disease. The outcome of interest was observed in 38 patients (22 cardiovascular deaths, 6 strokes and 14 myocardial infarctions). SRS showed good discrimination of the estimated MACE risk with overall C-statistic of 0.646 (95% CI, 0.554–0.737, p=0.004) (picture 1) and calibration (p-value for the goodness-of-fit test of 0.544). The global estimated risk of MACE at 2-years was 4.8% (3.8%-6.8%). The expected/ observed ratio was 0.56 for the occurrence MACE (picture 2). Conclusions Over the first two years after discharge from an acute coronary syndrome, one of every 8 patients developed a potentially fatal recurrent ischemic event. The SRS performed reasonably well in discriminating those at highest risk of MACE, suggesting that this score may help select patients at discharge for ad initium more intensive pharmacological therapy. Funding Acknowledgement Type of funding sources: None. ROC curve for the SMART-REACH scoreExpected versus observed MACE