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Reflectance models capture many types of visual appearances. The most plausible reflectance models follow the Microfacet theory, which is specifically based on statistical representations, with an analytic visibility term. This visibility term has a significant impact on appearance. Visibility computed with the masking term proposed by Smith (1967), and revisited by Ashikhmin et al. (2000), is nowadays considered as the most plausible in the literature. It is simple and efficient to evaluate for statistical distributions, but it relies on assumptions that are not necessarily respected by real surfaces. This article proposes an in-depth study of masking for meshed height-field surfaces, generated either from measured real-world materials or from functions derived from distributions of surface normals. We experimentally estimate the masking (and shadowing) of surfaces using a ray-casting technique, and compare their measurements with the theoretical model from Smith and Ashikhmin et al. We show that their assumptions are too restrictive for a majority of real-world surfaces. We propose a model capable of predicting how close the theoretical masking term can be from the masking term estimated by a ray-casting approach. Although most surfaces break their assumptions, our results show that the term from Smith and Ashikhmin et al. can still be reasonably employed for a fraction in a set of more than 400 measured surfaces, with low errors compared to a ray-casting masking estimation, much lower computation times, and very similar visual appearances. Our model can be used to predict the incurred error on a physically-based rendering simulation with a microfacet-based BRDF created from real-world surfaces, instead of explicitly calculating the masking term from its height field.

The addition of hydrochlorothiazide (HCTZ) to furosemide in the CLOROTIC (Combining Loop with Thiazide Diuretics for Decompensated Heart Failure) trial improved the diuretic response in patients with acute heart failure (AHF).

In this study, a platform guiding single-moded light at wavelengths of 480 nm, 520 nm and 633 nm (blue, green and red) is proposed and designed with several components being fabricated and characterised for the specific wavelength of 633 nm. A waveguide with propagation losses of 3.6 dB/cm is obtained, with a high confinement factor of 90.5% and a tight bending radius of 60 $\mu$m with 0.2 dB losses per bend, offering a good trade-off between losses, confinement factor and compactness. Also, a 1 × 2 MMI is demonstrated, with a footprint of 5 × 161 $\mu$m2, and losses of 0.2 dB. Finally, a silicon nitride single-layer grating coupler has been validated to allow the fibre-to-chip coupling, with losses smaller than 11.7 dB. A comparison of the proposed platform with other state-of-the-art stoichiometric silicon nitride technologies performing in the range of the spectrum of 630–660 nm is shown. The present platform demonstrates losses in the order of the state-of-the-art single-mode waveguides, but with an enhancement of the confinement factor from 61% to 90.5%, which allows to decrease the bending radius by 20 $\mu$m or more compared with other state-of-the-art technologies.

AbstractInsect pollinators frequently forage with conspecifics in nature, thus it is important to understand their behavioral responses to the presence of conspecifics on flowers. Plant-pollinator interactions can be influenced by neighboring flowers, and these neighborhood effects can have important implications for plant fitness. Research about neighborhood effects generally tests how plant traits or different plant communities affect plant-pollinator or plant-herbivore interactions. However, neighborhood effects can also be considered from the point of view of an insect pollinator and how the presence of their own conspecifics on plants alters their perceptions of plant quality. We used the Western honey bee, Apis mellifera, to test whether neighborhood effects affect honey bee foraging behavior. In this context, we refer to neighborhood effects as the relative number of bees on neighboring flowers compared to the number of bees on a focal flower. We found that in a floral neighborhood, the relative number of honey bees present on neighboring flowers has a weak effect, such that more bees on neighboring flowers increase the likelihood of visits to a focal flower. Our results suggest that high numbers of bees on neighboring flowers increase the attractiveness of the entire neighborhood and low numbers of bees on the neighboring flowers decrease the attractiveness of the neighborhood, highlighting that bee activity on neighboring flowers may have significant impacts on pollination services.

Marynowicz, J, Lango, M, Horna, D, Kikut, K, Konefał, M, Chmura, P, and Andrzejewski, M. Within-participant principal component analysis of external training load and intensity measures in youth soccer training. J Strength Cond Res37(12): 2411–2416, 2023—The aim of this study was to identify which combination of external training load (EL) and external intensity (EI) metrics during youth soccer training sessions captured similar or unique information. Data were collected from 18 youth soccer players during an 18-week in-season competition period using a 10-Hz global positioning system, rating of perceived exertion (RPE), and session-RPE (sRPE). External training load measures included total distance (TD, in meters), PlayerLoad (PL, in arbitrary units), high-speed running distance (HSR, in meters), and number of accelerations (ACC, n). All EL metrics were also divided by session duration (minutes) to obtain EI values. A total of 804 training observations were undertaken (43 ± 17 sessions per player). The analysis was performed by use of the principal component analysis technique. The first principal component (PC) captured 49–70% and 68–89% of the total variance in EI and EL, respectively. The findings show that from the 5 EI metrics, most of the information can be explained by either TD per minute or PL per minute, with a loading from 0.87 to 0.98 and from 0.76 to 0.95, respectively. The majority of EL information can be explained by PL (loading: 0.93–0.98), TD (loading: 0.95–0.99), ACC (loading: 0.71–0.91), or sRPE (loading: 0.70–0.93). The second PC for EL metrics is most strongly correlated with HSR, with loadings from 0.53 to 0.84. The results suggest that the majority of the information contained in the EL variables can be captured in 1 PC without losing much information. The findings suggest that stakeholders who intend to provide a fast and holistic view of EL information in a daily training environment should report TD, PL, ACC, or sRPE plus HSR to coaching staff as a metrics that provides additional unique information.

AbstractBackgroundWe aimed to characterise and compare the clinical profile of heart failure (HF) with mid-range (HFmrEF), reduced (HFrEF) and preserved (HFpEF) left-ventricular ejection fraction.MethodsWe conducted a descriptive, observational study in 267 HF patients admitted to the Internal Medicine department of a tertiary hospital during 2010–2016. The study population was divided into three groups according to the ejection fraction rate: HFrEF (<40%), HFmrEF (40–49%), and HFpEF (≥50%). We analysed and compared their demographic, clinical, and analytical characteristics.ResultsThe mean age of the study population was 79.5 (standard deviation, 8.14) years; 56.6% were males. The most common phenotype was HFpEF (58.1%), followed by HFrEF (21.7%) and HFmrEF (20.2%). Ischaemic cardiopathy was the primary aetiology in the HFmrEF and HFrEF groups, and arterial hypertension in the HFpEF group. The most common comorbidities among HFmrEF patients were diabetes (43.4%), chronic obstructive pulmonary disease (35.8%), and anaemia (35.8%); 49.1% had impairment of segmental myocardial contractility, and 35.8% ventricular dilatation. No differences in HF outcomes were observed among the three phenotypes.ConclusionHFmrEF shows characteristics similar to both HFpEF and HFrEF. Further large-scale studies with longer follow-up are needed to ascertain if it is worth distinguishing this phenotype in clinical practice in terms of management and prognosis.

We present a checklist of species of Lepanthes(Orchidaceae) from Peru, based on published reports supplemented by personal observations and the review of some herbarium specimens. Of the 81 species here reported from Peru, five are new records for the country and 44 are endemic. For each recorded species, we provide the accepted name, publication data, type, synonymy, and distribution in Peru by department and extralimital distributions by country. A map showing the numerical distribution of species by department and photographs of the five newly recorded and one recently described species are also provided. One lectotype is designated.

Analizar los factores sociales asociados a la salud autopercibida durante el confinamiento en la población residente en Chile según la perspectiva de género.

Graphical AbstractIn the context of acute heart failure, patients with intraabdominal hypertension (>12 mmHg), showed higher levels of CA125 at admission. A baseline concentration of CA125 below 17.1 U/mL will increase the odds of identifying a subset of patients with normal IAP.

La termodilución es un método ampliamente usado para la medición del flujo de acceso vascular (QA). Entre las posibilidades de la termodilución, el método inverso (MI) puede ser beneficioso en el tiempo de ejecución, sin repercusión en la eficacia dialítica (Kt). Sin embargo, no es una técnica lo suficientemente estudiada.

La desnutrición es frecuente en los pacientes con insuficiencia cardíaca (IC). Dicha situación contribuye al incremento de la congestión sistémica dificultando el manejo clínico. Cuantificar la desnutrición y su relación con la congestión sistémica, es importante para optimizar el tratamiento durante la fase aguda.

El aumento de la presión intraabdominal (PIA) se ha correlacionado con elevación de la creatinina en pacientes con insuficiencia cardíaca con fracción de eyección ventricular izquierda gravemente deprimida (ICFEr). Sin embargo, dicha variable no se ha explorado en pacientes más estables o con insuficiencia cardíaca y fracción de eyección preservada (ICFEp).

Flow cytometric detection of T‐cell clonality is challenging. The current available methodology for T‐cell receptor (TCR) Vβ repertoire evaluation is a complex assay and has limited sensitivity especially for detecting low levels of disease. Therefore, there is an unmet need for a reliable, simple, and rapid assay to identify T‐cell clonality. The rearrangement of the TCRB gene involves the random and mutually exclusive expression of one of two constant β chain genes (TRBC1 and TRBC2), analogous to the kappa and lambda gene utilization by B cells. Here, we used a single TRBC1 antibody, in conjunction with other T‐cell associated markers, to detect T‐cell clonality in tissue biopsies and body fluids. A total of 143 tissue/body fluid specimens from 46 patients with a definitive diagnosis of a T‐cell neoplasm and 97 patients with no T‐cell malignancy were analyzed with a cocktail of monoclonal antibodies including CD2/CD3/CD4/CD5/CD7/CD8/CD45/TCRγδ/TRBC1. We examined TRBC1 expression on neoplastic T‐cell populations identified based on their immunophenotypic aberrancies, and monotypic TRBC1 expression was identified in all 46 known T‐cell lymphoma cases. We applied a similar gating strategy to the 97 cases without T‐cell neoplasms, and arbitrarily dissected T‐cell populations into immunophenotypically distinct subsets; in this group, we found that all cases revealed an expected polytypic TRBC1 expression in all subsets. Single TRBC1 antibody detection of T‐cell clonality by flow cytometry is a simple, rapid, and robust assay that could be routinely utilized in flow cytometric laboratories.

El examen físico presenta una rentabilidad limitada en la estimación de la congestión venosa sistémica y en la predicción de la mortalidad de los pacientes con insuficiencia cardiaca. Hemos evaluado la utilidad del fragmento amino terminal del péptido natriurético cerebral (NT-proBNP), del antígeno de cáncer 125 (CA125), los hallazgos de la ecografía pulmonar, la estimación del volumen plasmático relativo (VPr) y el cociente urea/creatinina, como parámetros subrogados de congestión venosa y predictores de mortalidad.

Introducing a sensitive and specific peripheral blood flow cytometric assay for Sézary syndrome and mycosis fungoides (SS/MF) requires careful selection of assay design characteristics, and translation into a laboratory developed assay through development/optimization, validation, and continual quality monitoring. As outlined in a previous article in this series, the recommended design characteristics of this assay include at a minimum, evaluation of CD7, CD3, CD4, CD8, CD26, and CD45, analyzed simultaneously, requiring at least a 6 color flow cytometry system, with both quantitative and qualitative components. This article provides guidance from an international group of cytometry specialists in implementing an assay to those design specifications, outlining specific considerations, and best practices. Key points presented in detail are: (a) Pre‐analytic components (reagents, specimen processing, and acquisition) must be optimized to: (i) identify and characterize an abnormal population of T‐cells (qualitative component) and (ii) quantitate the abnormal population (semi/quasi‐quantitative component). (b)Analytic components (instrument set‐up/acquisition/analysis strategy and interpretation) must be optimized for the identification of SS/MF populations, which can vary widely in phenotype. Comparison with expert laboratories is strongly encouraged in order to establish competency. (c) Assay performance must be validated and documented through a validation plan and report, which covers both qualitative and semi/quasi‐quantitative assay components (example template provided). (d) Ongoing assay‐specific quality monitoring should be performed to ensure consistency.

A peripheral blood flow cytometric assay for Sézary syndrome (SS) or circulating mycosis fungoides (MF) cells must be able to reliably identify, characterize, and enumerate T‐cells with an immunophenotype that differs from non‐neoplastic T‐cells. Although it is also important to distinguish SS and MF from other subtypes of T‐cell neoplasm, this usually requires information in addition to the immunophenotype, such as clinical and morphologic features. This article outlines the approach recommended by an international group with experience and expertise in this area. The following key points are discussed: (a) At a minimum, a flow cytometric assay for SS and MF should include the following six antibodies: CD3, CD4, CD7, CD8, CD26, and CD45. (b) An analysis template must reliably detect abnormal T‐cells, even when they lack staining for CD3 or CD45, or demonstrate a phenotype that is not characteristic of normal T‐cells. (c) Gating strategies to identify abnormal T‐cells should be based on the identification of subsets with distinctly homogenous immunophenotypic properties that are different from those expected for normal T‐cells. (d) The blood concentration of abnormal cells, based on any immunophenotypic abnormalities indicative of MF or SS, should be calculated by either direct enumeration or a dual‐platform method, and reported.

This review discusses the definition and major categories of cutaneous T‐cell lymphoma, Sézary syndrome and mycosis fungoides, and the role of immunophenotyping in their diagnosis. The following key points are raised: (a) Sézary syndrome and mycosis fungoides cells most often have a characteristic CD3+ CD4+ CD7− and/or CD26− immunophenotype. (b) This immunophenotype is not specific, but can assist in the distinction from non‐neoplastic T cells and other subtypes of mature T‐cell neoplasm. (c) However, small subsets of normal and reactive T‐cells can have an overlapping immunophenotype, and can be distinguished by evaluating for additional changes in antigen expression.

El diagnóstico de daño renal agudo (DRA) durante los episodios de insuficiencia cardiaca aguda (ICA) sigue siendo un desafío. Analizamos la incidencia y el pronóstico del DRA y la importancia de los aumentos pequeños de creatinina durante los episodios de ICA y tras su estabilización.

Benign clonal T-cell expansions in reactive immune responses often complicate the laboratory diagnosis T-cell neoplasia. We recently introduced a novel flow cytometry assay to detect T-cell clones in blood and bone marrow, based on the identification of a monophasic T-cell receptor (TCR) β chain constant region-1 (TRBC1) expression pattern within a phenotypically distinct TCRαβ T-cell subset. In routine laboratory practice, T-cell clones of uncertain significance (T-CUS) were detected in 42 of 159 (26%) patients without T-cell malignancy, and in 3 of 24 (13%) healthy donors. Their phenotype (CD8+/CD4−: 78%, CD4−/CD8−: 12%, CD4+/CD8+: 9%, or CD4+/CD8−: 2%) closely resembled that of 26 cases of T-cell large granular lymphocytic leukemia (T-LGLL) studied similarly, except for a much smaller clone size (p< 0.0001), slightly brighter CD2 and CD7, and slightly dimmer CD3 expression (p< 0.05). T-CUS was not associated with age, gender, comorbidities, or peripheral blood counts. TCR-Vβ repertoire analysis confirmed the clonality of T-CUS, and identified additional clonotypic CD8-positive subsets when combined with TRBC1 analysis. We hereby report the phenotypic features and incidence of clonal T-cell subsets in patients with no demonstrable T-cell neoplasia, providing a framework for the differential interpretation of T-cell clones based on their size and phenotypic properties.

Benign clonal T-cell expansions in reactive immune responses often complicate the laboratory diagnosis T-cell neoplasia. We recently introduced a novel flow cytometry assay to detect T-cell clones in blood and bone marrow, based on the identification of a monophasic T-cell receptor (TCR) β chain constant region-1 (TRBC1) expression pattern within a phenotypically distinct TCRαβ T-cell subset. In routine laboratory practice, T-cell clones of uncertain significance (T-CUS) were detected in 42 of 159 (26%) patients without T-cell malignancy, and in 3 of 24 (13%) healthy donors. Their phenotype (CD8+/CD4−: 78%, CD4−/CD8−: 12%, CD4+/CD8+: 9%, or CD4+/CD8−: 2%) closely resembled that of 26 cases of T-cell large granular lymphocytic leukemia (T-LGLL) studied similarly, except for a much smaller clone size (p< 0.0001), slightly brighter CD2 and CD7, and slightly dimmer CD3 expression (p< 0.05). T-CUS was not associated with age, gender, comorbidities, or peripheral blood counts. TCR-Vβ repertoire analysis confirmed the clonality of T-CUS, and identified additional clonotypic CD8-positive subsets when combined with TRBC1 analysis. We hereby report the phenotypic features and incidence of clonal T-cell subsets in patients with no demonstrable T-cell neoplasia, providing a framework for the differential interpretation of T-cell clones based on their size and phenotypic properties.

A pesar de los avances en el diagnóstico y el tratamiento, la insuficiencia cardiaca (IC) sigue teniendo una alta morbimortalidad. El tratamiento de las comorbilidades y la educación sanitaria se han demostrado eficaces, así como la atención multidisciplinar, en unidades especializadas, aunque ello implica un esfuerzo organizativo y estructural no siempre disponible. Presentamos los resultados de una consulta ambulatoria simple, centrada en la atención monográfica a la IC.

We report a case of refractory acute myeloid leukemia with DEK-NUP214rearrangement showing circulating monocytic blasts with abundant green cytoplasmic granules on the Wright-Giemsa stain. The granules were strongly positive for Perls’ Prussian blue, consistent with hemosiderin deposits. This previously unreported finding is suggestive of siderophage activity by leukemic blasts, likely associated with monocytic differentiation.

The diagnosis of T‐cell neoplasms is often challenging, due to overlapping features with reactive T‐cells and limitations of currently available T‐cell clonality assays. The description of an antibody specific for one of two mutually exclusive T‐cell receptor (TCR) β‐chain constant regions (TRBC1) provide an opportunity to facilitate the detection of clonal TCRαβ T‐cells based on TRBC‐restriction. Twenty patients with mature T‐cell neoplasms and 44 patients without evidence of T‐cell neoplasia were studied. Peripheral blood (51), bone marrow (10), and lymph node (3) specimens were evaluated by 9‐color flow cytometry including TRBC1 (CD2/CD3/CD4/CD5/CD7/CD8/CD45/TCRγδ/TRBC1 and/or CD2/CD3/CD4/CD5/CD7/CD8/CD26/CD45/TRBC1). Monophasic TRBC1 expression on any immunophenotypically distinct CD4‐positive or CD8‐positive/TCRγδ‐negative T‐cell subset was considered indicative of clonality. Monophasic (clonal) TRBC1 expression was identified on immunophenotypically abnormal T‐cells from all 20 patients with T‐cell malignancies (100% sensitivity), including 17 cases with either >97% or <3% TRBC1‐positive events, and three cases with monophasic homogenous TRBC1‐dim expression. All immunophenotypically distinct CD4‐positive and CD8‐positive/TCRγδ‐negative T‐cell subsets from 44 patients without T‐cell malignancies showed the expected mixture of TRBC1‐positive and TRBC‐1‐negative subpopulations (non‐clonal), except for seven patients (16%) with very small CD8‐positive T‐cell subsets exhibiting a monophasic (clonal) pattern. Inclusion of a single anti‐TRBC1 antibody into a diagnostic T‐cell flow cytometry panel facilitates the rapid identification of T‐cell neoplasms, in addition to small monotypic CD8‐positive subsets of uncertain significance. © 2019 International Clinical Cytometry Society

El aumento de la presión intraabdominal (PIA) que tiene lugar durante la insuficiencia cardiaca aguda parece estar directamente relacionado con un empeoramiento de la función renal, lo que conduce a peores resultados clínicos. Nuestro objetivo fue analizar la relación entre la PIA y los determinantes de la función renal para la insuficiencia cardiaca aguda descompensada (ICAD) durante el ingreso en un pabellón de medicina interna convencional.

Mycosis fungoides (MF) and Sézary Syndrome (SS) are clinically distinct cutaneous T‐cell lymphomas with strikingly similar morphologic and phenotypic features. Prior studies have suggested phenotypic differences based on markers of antigen experience, suggesting a different cell of origin. Seventy‐nine involved peripheral blood or bone marrow samples from 33 patients with SS and 19 patients with MF were studied by 10‐color flow cytometry, including CD62L, CD45RA, CCR4, and PD‐1. Gated tumor events were classified as naïve (TN), central memory (TCM), effector memory (TEM), or effector memory with reacquired CD45RA (TEMRA); based on CD62L+/CD45RA+, CD62L+/CD45RA−, CD62L−/CD45RA−, or CD62L−/CD45RA+phenotype, respectively. Sequential specimens were compared to assess for phenotypic stability. The naïve/memory phenotype of the neoplastic T‐cells was markedly heterogeneous, with a dominant TN, TCM, TEM, or TEMRAsubset on 11 (14%), 32 (41%), 30 (38%), and 6 (8%) cases, respectively. There was no correlation between the diagnosis of MF or SS and putative cell of origin (P= 0.4). Overexpression of CCR4 and PD1 was observed in most cases, with higher intensity in SS compared to MF. The naïve/memory phenotype remained the same for 10 patients up to 273 days after the initial analysis; while on six patients, the naïve/memory phenotype was different from the original phenotype. Both SS and MF can have phenotypic features of any of the major naïve/memory T‐cell subsets, which questions the current principle of “cell‐of‐origin” distinction between SS and MF. Phenotypic shifts within these subsets are common, suggesting a functional state rather than a cell‐of‐origin surrogate. © 2018 International Clinical Cytometry Society

This research article aims to use Universal Design for Learning (UDL) and digital fabrication (DF) to create a tool for the inclusive teaching of chemistry, with the specific purpose of enhancing the teaching-learning process in organizing chemical elements. The Design-Based Research (DBR) methodology was employed. This methodology facilitated the design of a tool based on an alternative ordering to the traditional periodic table. Utilizing the principles of Universal Design for Learning and the implementation of digital fabrication technologies, especially 3D printing, it has been possible to link student-centered learning, inquiry-based learning, and hands-on learning. Experimental activities have been carried out with students and teachers from three schools in Catalonia, Spain, as well as validation with experts from the Spanish National Organization for the Blind (ONCE). The assessment discussion and analysis made by students, teachers and experts using mixed methods (quantitative and qualitative) is given. This research has exposed the synergy between universal design for learning and digital fabrication in learning and its contribution to improve the inclusive teaching-learning process.

Flow cytometric identification of circulating neoplastic cells (Sezary cells) in patients with mycosis fungoides and Sezary syndrome is essential for diagnosis, staging, and prognosis. Although recent advances have improved the performance of this laboratory assay, the complex immunophenotype of Sezary cells and overlap with reactive T cells demand a high level of analytic expertise. We utilized machine learning to simplify this analysis using only 2 predefined Sezary cell–gating plots. We studied 114 samples from 59 patients with Sezary syndrome/mycosis fungoides and 66 samples from unique patients with inflammatory dermatoses. A single dimensionality reduction plot highlighted all TCR constant β chain–restricted (clonal) CD3+/CD4+T cells detected by expert analysis. On receiver operator curve analysis, an aberrancy scale feature computed by comparison with controls (area under the curve = 0.98) outperformed loss of CD2 (0.76), CD3 (0.83), CD7 (0.77), and CD26 (0.82) in discriminating Sezary cells from reactive CD4+T cells. Our results closely mirrored those obtained by exhaustive expert analysis for event classification (positive percentage agreement = 100%, negative percentage agreement = 99%) and Sezary cell quantitation (regression slope = 1.003, R squared = 0.9996). We demonstrate the potential of machine learning to simplify the accurate identification of Sezary cells.

Glucocorticoids for primary therapy of acute GVHD have limited responses. A phase I/II trial tested 4 weeks of deacetylase inhibitor panobinostat started within 48 h of glucocorticoids (1 mg/kg/day prednisone or equivalent) as primary treatment for patients with either classic acute GVHD (n= 16) or acute GVHD overlapping with chronic (n= 6). Four patients received 2.5 mg/m2IV three times a week (TIW). Subsequent to discontinuation of IV panobinostat, patients received oral doses (PO). Two patients treated with 10 mg TIW (PO level 1) had progressive GVHD, after which patients were treated with 5 mg TIW (PO level −1; n= 16); 31/41 adverse events were possibly related, including thrombocytopenia (n= 13), leukopenia (n= 7), hypercholesterolemia (n= 3), hypertriglyceridemia (n= 5), anemia (n= 1), fatigue (n= 1), and hepatobiliary disorder (n= 1). GVHD responses were complete (n= 12) or partial (n= 3), with 1 progression at PO level −1. T-regulatory cells increased at day 8, CD4/CD8 and monocytes exhibited enhanced H3 acetylation, and CD4 or CD8 numbers remained unchanged with a decreased interleukin 12p40 plasma level. Panobinostat in combination with prednisone is safe and warrants further testing in GVHD.

El empeoramiento de la función renal es un índice de mal pronóstico en pacientes con insuficiencia cardiaca aguda (ICA). El cociente urea/creatinina (U/C) podría tener significación pronóstica en la ICA.

Determinar la asociación entre la puntuación de la escala de Norton (que valora el riesgo de padecer úlceras por presión) y la mortalidad a corto, medio y largo plazo en los pacientes hospitalizados en Medicina Interna.

Combustion in soft and compliant materials may enable new methods for underwater locomotion. Inspired by the motion of the soft bodied cephalopods, we developed a combustion-powered hydro-jet engine (CPHJE) using an expandable silicone bladder. The CPHJE used high energy density methane combustion to expand a silicone bladder and accelerate water into a hydro-jet that propelled the CPHJE. Cephalopods demonstrate the epitome of underwater soft robot capabilities. Their use of hydrojetting as a mode of high-speed underwater motion resembles high-power combustion events. This paper describes a soft combustion engine that propels a ∼0.7 kg body, with hydrodynamic surfaces in the likeness of an ellipsoid shaped squid, at instantaneous velocities of at least 0.8 m s−1and single-pulse average velocities of 0.1 m s−1. High-speed videography informs a model for the CPHJE’s motion in time; the imaging also reveals that the hydrojetting generates a ring vortex. Tracking of this vortex results in an estimate that the working fluid is ejected in excess of 6.7 m s−1. We demonstrate the CPHJE motion is both repeatable and able to produce multiple actuations with the same bladder. These results demonstrate a new method of underwater propulsion using combustion in soft and compliant bladders.

Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare T-cell lymphoma that arises around breast implants. Most patients manifest with periprosthetic effusion, whereas a subset of patients develops a tumor mass or lymph node involvement (LNI). The aim of this study is to describe the pathologic features of lymph nodes from patients with BI-ALCL and assess the prognostic impact of LNI. Clinical findings and histopathologic features of lymph nodes were assessed in 70 patients with BI-ALCL. LNI was defined by the histologic demonstration of ALCL in lymph nodes. Fourteen (20%) patients with BI-ALCL had LNI, all lymph nodes involved were regional, the most frequent were axillary (93%). The pattern of involvement was sinusoidal in 13 (92.9%) cases, often associated with perifollicular, interfollicular, and diffuse patterns. Two cases had Hodgkin-like patterns. The 5-year overall survival was 75% for patients with LNI and 97.9% for patients without LNI at presentation (P=0.003). Six of 49 (12.2%) of patients with tumor confined by the capsule had LNI, compared with LNI in 8/21 (38%) patients with tumor beyond the capsule. Most patients with LNI achieved complete remission after various therapeutic approaches. Two of 14 (14.3%) patients with LNI died of disease compared with 0/56 (0%) patients without LNI. Twenty percent of patients with BI-ALCL had LNI by lymphoma, most often in a sinusoidal pattern. We conclude that BI-ALCL beyond capsule is associated with a higher risk of LNI. Involvement of lymph nodes was associated with decreased overall survival. Misdiagnosis as Hodgkin lymphoma is a pitfall.

Background: Identification of minimal residual disease (MRD) in acute myeloid leukemia (AML) is essential for assessing risk of relapse and guiding therapeutic management. While molecular assays have streamlined AML MRD detection, flow cytometric immunophenotyping (FCI) remains the only available test modality for approximately 50% of patients lacking traceable molecular MRD targets. Unfortunately, due to the high level of expertise required, long manual analysis time and complexity of AML MRD FCI data, only a few reference laboratories offer this as an orderable test.

Existe una relación inversa entre las cifras de presión arterial en las descompensaciones y el pronóstico de la insuficiencia cardiaca (IC). Las características de esta relación no son bien conocidas. El objetivo del estudio fue analizar si esta relación se mantiene en una cohorte no seleccionada de pacientes con IC y si el tratamiento la modifica.

Expression of HDAC11 may be involved in myeloid cell biology. Epigenetic changes in chromatin structure have been recently associated with the deregulated expression of critical genes in normal and malignant processes. HDAC11, the newest member of the HDAC family of enzymes, functions as a negative regulator of IL-10 expression in APCs, as previously described by our lab. However, at the present time, its role in other hematopoietic cells, specifically in neutrophils, has not been fully explored. In this report, for the first time, we present a novel physiologic role for HDAC11 as a multifaceted regulator of neutrophils. Thus far, we have been able to demonstrate a lineage-restricted overexpression of HDAC11 in neutrophils and committed neutrophil precursors (promyelocytes). Additionally, we show that HDAC11 appears to associate with the transcription machinery, possibly regulating the expression of inflammatory and migratory genes in neutrophils. Given the prevalence of neutrophils in the peripheral circulation and their central role in the first line of defense, our results highlight a unique and novel role for HDAC11. With the consideration of the emergence of new, selective HDAC11 inhibitors, we believe that our findings will have significant implications in a wide range of diseases spanning malignancies, autoimmunity, and inflammation.

•Molecular characterisation of the first KPC-2-producing Klebsiella pneumoniaeisolated in Peru.•K. pneumoniaewas classified as belonging to the KpI phylogenetic group within ST340, which belongs to the high-risk CC258.•A non-conjugative blaKPC-2gene was detected, carried in a non-classical genetic structure.

La prevalencia de insuficiencia cardiaca aumenta con la edad y se acompaña de otras enfermedades, englobadas en un «fenotipo cardiometabólico». Su interrelación modifica la evolución y tratamiento que cada una tendría aisladamente. El paciente con insuficiencia cardiaca y comorbilidad es un enfermo frágil y complejo. Precisa una valoración integral, no solo biomédica, que incluya aspectos funcionales, cognitivos, afectivos y psicosociales. El tratamiento global, no recogido en las guías de práctica clínica, ha de adaptarse a todas y cada unas de las comorbilidades. Debe evitarse, en lo posible, la polifarmacia, por sus interacciones y la disminución de adherencia. Es necesario optimizar y adaptar el tratamiento a la fase evolutiva de la enfermedad y las necesidades específicas de cada paciente. La complejidad del proceso asistencial del paciente con insuficiencia cardiaca y comorbilidades exige la coordinación de los proveedores de salud, el apoyo familiar y del entorno.

Valorar la utilidad de la medición del diámetro y colapso de la vena cava inferior (VCI) en la insuficiencia cardiaca aguda (ICA), su relación con el pronóstico y con biomarcadores séricos de congestión.

Plasmacytomas could involve any organ, and at times might pose a diagnostic challenge when the site of involvement is unusual, or if the presentation is similar to other diseases. We describe a 48-year-old man presenting with worsening shortness of breath and chest discomfort with radiologic evidence of mediastinal enlargement, mimicking a lymphoma with mediastinal involvement. An excisional biopsy of a mediastinal lymph node showed a plasma-cell infiltrate strongly positive for CD138, with a flow-cytometry analysis showing a population of lambda-restricted neoplastic plasma cells. He failed to respond to 50Gy involved-field radiotherapy, but achieved a partial response to combination chemotherapy. He underwent high-dose chemotherapy with melphalan (200mg/m2) followed by lenalidomide maintenance, and is in complete remission 18months postautografting. This case illustrates a unique and rare presentation of primary lymph-node plasmacytomas involving the mediastinum potentially mistaken as lymphoid malignancy. Clinicians should be aware of the plasma-cell origin of the mediastinal neoplastic process.

The objective of this study was to evaluate the effect of a novel consensus bacterial 6-phytase variant (PhyG) on egg productivity, eggshell quality, and body composition of laying hens fed inorganic phosphate-free diets with reduced energy and nutrients from 23 to 72 wk of age. Five treatments were randomly assigned, performing 28 replicates per treatment with 4 hens each, totaling 560 Hy-Line W80 birds. A positive control (PC) feed was formulated to contain adequate levels of energy and nutrients. A negative control (NC) feed was formulated without added inorganic phosphate (0.12% nonphytic phosphorus [nPP]) and reduced in Ca, Na, dig AA, and metabolizable energy in comparison with PC feed. Phytase was supplemented in the NC feed at 0, 300, 600, and 900 FTU/kg of feed. The responses evaluated were performance, egg quality, economic analysis, body composition, and tibia composition. Data were analyzed by a 2-factor (diet and age) repeated measure analysis. Overall, the feed intake, hen-day egg production, egg mass, and egg revenue were reduced by the complete removal of dicalcium phosphate (DCP) (P< 0.05). Supplement phytase in the NC diet elicits a positive response on each one of those variables. Laying hens consuming the NC feed with 900 FTU/kg of phytase produced more eggs per hen-housed compared with the phytase dosages of 300 and 600 FTU/kg. Body composition was not affected by dietary nPP, Ca, Na, dig AA, and energy reductions (P> 0.05). At 72-wk-old, tibia ash was reduced in hens consuming the NC diet vs. PC (P< 0.05) and no difference was observed between hens supplemented with phytase and the PC feed. Margin over feeding cost increased in a dose-dependent manner with phytase supplementation. Supplementation with 900 FTU/kg of phytase is recommended to improve the number of eggs produced per hen-housed and the number of marketable eggs produced through 23 to 72 wk of age, under this dietary setting.

Natural killer (NK) cells develop a complex inhibitory and/or activating NK-cell receptor system, including killer cell immunoglobulin-like receptors (KIRs or CD158) and CD94/NKG2 dimers, which are variably combined to generate the individual’s NK-cell receptor repertoire. Establishing NK-cell receptor restriction by flow cytometric immunophenotyping is an important step in diagnosing NK-cell neoplasms, but reference interval data for interpreting these studies are lacking. Specimens from 145 donors and 63 patients with NK-cell neoplasms were used to identify discriminatory rules based on 95% and 99% non-parametric reference intervals for CD158a+, CD158b+, CD158e+, KIR-negative and NKG2A+ NK-cell populations to establish NK-cell receptor restriction. These 99% upper reference interval limits (NKG2a >88% or CD158a >53% or CD158b >72% or CD158e >54% or KIR-negative >72%) provided optimal discrimination between NK-cell neoplasm cases and healthy donor controls with an accuracy of 100% compared with the clinicopathological diagnosis. The selected rules were applied to 62 consecutive samples received in our flow cytometry laboratory that were reflexed to an NK-cell panel due to an expanded NK-cell percentage (exceeding 40% of total lymphocytes). Twenty-two (35%) of 62 samples were found to harbor a very small NK-cell population with restricted NK-cell receptor expression based on the rule combination, suggestive of NK-cell clonality. A thorough clinicopathological evaluation for the 62 patients did not reveal diagnostic features of NK-cell neoplasms; therefore, these potential clonal populations of NK cells were designated as NK-cell clones of uncertain significance (NK-CUS). In this study, we established decision rules for NK-cell receptor restriction from the largest published cohorts of healthy donors and NK-cell neoplasms. The presence of small NK-cell populations with restricted NK-cell receptors does not appear to be an uncommon finding, and its significance requires further exploration.

A combination of geological, palaeontological and geophysical investigations has been carried out to investigate Cretaceous deposits, resting on gneisses and covered by Quaternary sediments in the Osterzgebirge between Bad Gottleuba and Börnersdorf (Saxony). Beside the interpretation of already existing drill logs, 15 new shallow wells were drilled, and seismic, geoelectrics, magnetic and gravimetric data were acquired along several profile lines. Borehole samples were taken for micropalaeontological analyses. The existence of Upper Cretaceous marls with an extent of about 600 by 650 m was proven. Due to the results of the seismic and stratigraphic interpretation, a sedimentary thickness of about 250 m was inferred. The foraminifera assemblage indicates Early to Middle Coniacian age of the marls. From the occurrence of Cenomanian and Lower Turonian sandstones nearby a fairly complete Upper Cretaceous succession can be concluded. The origin of such a narrow delimited basin, with comparatively large depth cannot be fully explained yet. From seismic investigations it appears that the structure is limited by concentric boundaries dipping moderate towards its centre. The gravity and the geomagnetic anomalies present a sub circular structure. The gravity minimum and the geomagnetic maximum coincide and are therefore the strongest argument for a maar origin. The age of this structure is still uncertain and under discussion. The marine sediments do not fit well into a maar origin. A genesis under terrestrial conditions would have been possible until the youngest Early Cretaceous. If the cretaceous sediments are reworked and not in situ, an age younger than Coniacian seems possible. Even a tectonic origin of this structure cannot be completely excluded.

The new rhodium(i) complexes [Rh(Cl)(COD)(R-NHC-(CH2)3Si(OiPr3)3)] (R = 2,6-diisopropylphenyl (2a); n-butyl (2b)) have been synthesised and fully characterised. The study of their application as ketone hydrosilylation catalysts showed a clear N-substituent effect, 2abeing the most active catalyst precursor. Complex 2ahas been immobilised in the mesoporous materials MCM-41 and KIT-6. The new hybrid materials have been fully characterised and used as catalyst precursors for the preparation of poly(silyl ether)s by catalytic hydrosilylation. The heterogeneous catalytic systems based on the materials 2a–MCM-41 and 2a–KIT-6 afford polymers with high average molecular weight (Mw) Mw= 2.61 × 106g mol−1(2a–MCM-41) and Mw= 4.43 × 105g mol−1(2a–KIT-6).

On‐line LC‐EC/ESI‐MS has been established as a fast and simple method to mimic some types of oxidation reaction of various drugs and to study the formation and structure of the resulting products. This technique has been applied to a 2,6,9‐trisubstituted purine, R‐roscovitine, which is known to be an inhibitor of some cyclin‐dependent kinases (CDKs) and a potential anticancer drug. Oxidation of R‐roscovitine in an electrochemical cell (EC), operated under various conditions, resulted in appearance of 6 major products. These were further analyzed by high‐resolution mass spectrometry, their structures were elucidated by accurate mass measurement and compared to previously identified R‐roscovitine in vitro/in vivo metabolites. Although none of the observed products was structurally identical to those identified previously in vitro/in vivo, all of them, except for the methoxylated products, resembled similarity due to appearing through the same reaction type. R‐roscovitine in the EC cell underwent N‐dealkylation of the isopropyl moiety, hydroxylation of the aromatic side‐chain, dihydroxylation, methoxylation and dimer formation. The hydroxylation product was identified as Olomoucine II, a R‐roscovitine derivative, which displays 10‐times higher CDK‐inhibiting activity than R‐roscovitine and the occurrence of which, as R‐roscovitine product, has not yet been observed in vitro/in vivo.

The main aim of this paper is to utilize high performance liquid chromatography with electrochemical detection for determination of thiols content in plants tissues of lettuce treated with lead(II) ions (0, 0.5 and 1 mM). We used two HPLC‐ED instruments: HPLC coupled with one channel amperometric detector and HPLC coupled with twelve channel coulometric detector to detect simultaneously twelve thiols. The detection limits of thiols measured by CoulArray detector were about two magnitudes lower in comparison to those measured by Coulochem III detector and were from tens to hundreds pM. Under the optimal conditions, we utilized HPLC‐CoulArray detector for analysis of tissues from lettuce plants. In addition, distribution and accumulation of lead ions with high spatial resolution was monitored using laser induced breakdown spectroscopy.