Search

We propose a novel approach to speech enhancement, termed Controllable ConforMer for Speech Enhancement (CCMSE), which leverages a Conformer-based architecture integrated with a control factor embedding module. Our method is designed to optimize speech quality for both human auditory perception and automatic speech recognition (ASR). It is observed that while mild denoising typically preserves speech naturalness, stronger denoising can improve human auditory tasks but often at the cost of ASR accuracy due to increased distortion. To address this, we introduce an algorithm that balances these trade-offs. By utilizing differential equations to interpolate between outputs at varying levels of denoising intensity, our method effectively combines the robustness of mild denoising with the clarity of stronger denoising, resulting in enhanced speech that is well-suited for both human and machine listeners. Experimental results on the CHiME-4 dataset validate the effectiveness of our approach.

•In a RIETE registry analysis of 103 818 patients with VTE, 20.3% were tested for IT, showing a substantial variance in outcomes.•A thoughtful IT testing approach should consider patients’ VTE risk factors and comorbidities.

Literature describes variable rates of diplopia of associated with zygomatic maxillary complex (ZMC) fractures (6% to 40%). The aim of this study was to retrospectively assess the prevalence of diplopia in ZMC fracture patients, the usefulness of the orthoptic evaluation compared with the clinical finger-tracking examination, and to seek possible relations of this symptom with clinical parameters. Data of patients attending the Maxillofacial Surgery Units of the University of Messina and University of Naples “Federico II”, between January 2012 and December 2022 were retrieved. Statistical analysis of positive versus negative diplopia at both the clinical examination and the orthoptic evaluation and subgroup analysis were performed. 320 patients were included in the analysis. 50 (15.6%) patients reported diplopia at the clinical examination, whereas 70 (21.9%) resulted positive at the orthoptic evaluation. Statistical analysis for every determinant and subgroup did not show statistical significance (P>0.05). Performing routine preoperative orthoptic evaluation allowed an increase of 6.3% in positive reports. Although it seems that no basic clinical parameter can predict diplopia, results suggest that the orthoptic evaluation is superior in the assessment of this symptom. Clinical analysis was shown to be a moderate/low efficient test and should not be used as a decisional standard.

The growth and diversification of public debate made it possible for civil society to become more participatory in decision-making processes. In other words, it enabled citizen participation, which is the interaction between civil society and public authorities to solve problems. Furthermore, with the development of information and computer technologies, citizen participation has expanded into the digital realm, giving way to electronic participation or e-participation. However, in this context, citizen engagement still is a challenge. As a result, different researches have been carried out to identify strategies that can increase engagement so that electronic participation is effective. One of these fields aims to improve users' experience and the usability of electronic participation tools by using gamification to enliven participatory activities. The purpose of this article is to carry out a systematic mapping study of the literature as a way of better understanding the impact caused by gamification on citizen participation. Thus, 75 papers were selected and classified, allowing the identification of research methods, application contexts, forms of participation, and game elements used. This mapping enabled the following discoveries: design and prototyping is the most carried out research method for studying gamification in citizen participation, and civic engagement was the most analyzed context. Furthermore, the development of tools mainly focused on asking the population their opinions on policy issues to create a partnership between government and civil society.

Venous thromboembolism (VTE) is rare in patients aged <21 years. Young adults aged 18 to 21 years are frequently included in adult VTE studies, whereas pediatric VTE studies include patients aged up to either 18 or 21 years. The clinical characteristics of young adult patients with VTE have not been well defined.

Train braking is a critical operation for ensuring operational safety. During this operation, a large amount of kinetic energy is converted into frictional heat due to the tribological contact of brake components. The focus of this paper is the simulation of brake block and wheel temperatures during braking of freight trains and how they can be affected by Longitudinal Train Dynamics (LTD). The determination of their temperatures is important to improve operational safety, optimise system design, and streamline maintenance management. The paper presents two novel models using Finite Differences (FD) instead of the usual Finite Elements. A 2D axisymmetric FD model is presented and then a 1D radial model is presented, calibrated, validated and used in the TrainDysoftware for LTD to show how the main parameters affecting LTD also affect the thermal field of tread brakes.

Schools provide an ideal setting for delivery of disease prevention programs due to the ability to deliver health education and counseling, including health behavior interventions, to large numbers of students. However, the remote and hybrid learning models that arose during the coronavirus (COVID-19) pandemic created obstacles to these efforts. In this article, we provide insights on collaborating with schools to deliver disease prevention programming during the height of the COVID-19 pandemic, and in subsequent years. We illustrate these strategies by drawing upon our firsthand research experiences engaging high schools in a school-based cancer prevention trial focused on sun safety. Delivery of a cluster-randomized trial of a school-based skin cancer prevention program was initiated in the spring of 2020 at the onset of the COVID-19 pandemic in the U.S. We present multilevel evaluation data on strategies used to reach schools remotely and share lessons learned that may inform similar approaches moving forward during times of crises. Although the COVID-19 pandemic interrupted school-based recruitment for this trial, enrollment improved one year later and did not appear to differ between rural and urban schools. Recruitment strategies and trial-related procedures were modified to address new challenges brought about by the pandemic. Despite the COVID-19 crisis altering US classrooms, disease prevention programming can continue to be offered within schools, given close community partnerships and new adaptations to the ways in which such programming and research are conducted.

Changes in ruminal microbial community can affect animal productivity, nutrient utilization efficiency, and environmental impact. This study aimed to evaluate the effect of two levels of supplementation plus a blend of phytogenic additives (essential oils, saponins, and spices) on the ruminal bacterial community in beef cattle grazing tropical pastures. The experiment was conducted at the Beef Cattle Sector of UNESP, Jaboticabal-BR, and lasted 84 days. Nine castrated Nellore steers (body weight of 262 ± 31.2 kg) cannulated in the rumen were assigned to 3 simultaneous 3 × 3 Latin square designs. Animals were kept on pasture of Urochloa brizanthacv. Marandu during the rainy season. The treatments included ad libitum mineral supplementation (MS) as the control group, added mineral supplementation of 0.1% of body weight per day plus Cargill phytogenic blend (AMSP), and energetic-protein supplementation, 0.3% of body weight per day plus Cargill phytogenic blend (EPSP). Ruminal samples were collected on day 26 of each experimental period. A mix of liquid and solid rumen content (6 mL) was taken before supplementation and immediately frozen in liquid nitrogen. Total genomic DNA was extracted using the Quick-DNA Fecal/Soil Microbe kit. The V3-V4 hypervariable regions of the bacterial 16S rRNA gene were amplified using universal primers 341F and 806R. The PCR fragments were submitted to sequencing on an Illumina NovaSeq 6000 PE 250 platform. The sequences were processed using mothur, grouped into operational taxonomic units (OTUs) using a similarity cut-off value of 97%, and the bacterial OTUs were classified using the SILVA database. Bacterial community composition was compared between treatments using a Kruskal–Wallis test and Wilcoxon’s post-hoc test using Rstudio. A total of 27 phyla, 224 families, and 577 genera were assigned by the taxonomic analysis of the ruminal bacterial community (Figure 1). The phyla Bacteroidetes(44.45 ± 9.43) and Firmicutes(42.50 ± 7.18) represent over 86% of the total relative abundance in the rumen of Nellore steers and were not influenced by the supplementation (P≥ 0.250). The relative abundances of the Spirochaetesphylum, Spirochaetaceaefamily, and Treponema genus decreased in the rumen of AMSP supplemented animals (P≤ 0.037) and were similar between MS and EPSP (Figure 2). Additionally, the EPSP supplementation resulted in decreased relative abundances of TM7, TM7 family Incertae sedis, and TM7 genus Incertae sedisrelative abundances compared with those in MS (P= 0.031) but not between AMSP and EPSP supplementations. The addition of phytotherapy blend in the supplements led to decreased SR1, SR1 family Incertae sedis, and SR1 genus Incertae sedisabundances in the rumen (P≤ 0.012). This study indicates that the relative abundance of the dominant phyla was not affected by the supplementation levels, but the addition of the phytogenic blend in the supplement decreased the relative abundances of specific bacterial phyla, families, and genera,

The addition of phytogenic compounds that have antimicrobial activity in cattle supplements can promote changes in ruminal bacterial diversity. This study aimed to evaluate the effect of two levels of supplementation plus a blend of phytogenic additives (essential oils, saponins, and spices) on the measures of alpha and beta diversity in the rumen of beef cattle grazing tropical pasture. The experiment was carried out in the Beef Cattle Sector of UNESP, Jaboticabal-BR. The trial lasted 84 days and nine castrated Nellore steers (body weight of 262 ± 31.2 kg) cannulated in the rumen were assigned in 3 simultaneous 3 × 3 Latin square designs. Animals were kept on the pasture of Urochloa brizanthacv. Marandu in the rainy season. The treatments were: ad libitum mineral supplementation (MS) as control group; added mineral supplementation, 0.1% of body weight per day plus Cargill phytogenic blend (AMSP); and energetic-protein supplementation, 0.3% of body weight per day plus Cargill phytogenic blend (EPSP). Ruminal samples were collected on day 26 of each experimental period. A mix of liquid and solid rumen content (6 mL) was taken before supplementation, placed in cryogenic tubes, and immediately frozen in liquid nitrogen. All samples were stored at −80 °C until DNA extraction and analysis. Total genomic DNA was extracted using the Quick-DNA Fecal/Soil Microbe Miniprep kit. The V3-V4 hypervariable regions of the bacterial 16S rRNA gene were amplified primers 341F (CCTACGGGNGGCWGCAG) and 806R (GGACTACHVGGGTWTCTAAT). The PCR fragments were submitted to sequencing on an Illumina NovaSeq 6000 PE 250 platform. The sequences were processed using mothur, grouped into operational taxonomic units (OTUs) using a similarity cut-off value of 97%, and the bacterial OTUs were classified using the SILVA database. Alpha diversity indices including Shannon, Simpson, Fisher, Chao1, and ACE, were calculated using the phyloseq package, while beta diversity was determined using the vegan package, both in Rstudio. Alpha diversity indices were compared between treatments using a non-parametric Kruskal–Wallis test and Wilcoxon’s post-hoc test. Beta diversity was tested using permutational multivariate analysis of variance (PERMANOVA) based on the Bray-Curtis similarity index. The AMSP and EPSP did not affect measures of alpha diversity (Figure 1), such as Shannon and Fisher indices (P= 0.219) as well as the richness index measured using Chao1 and ACE (P≥ 0.363). A negative effect of supplementation on alpha diversity (P= 0.004) was only observed with Simpson’s Index of Diversity. Additionally, the supplementation did not change the beta-diversity of the ruminal bacterial community based on Bray–Curtis similarity index (P= 0.510; Figure 2). In conclusion, the addition of phytogenic compounds in the two levels of supplementation showed only a minor impact on the alpha diversity in the rumen of grazing beef cattle.

Hypothermic Oxygenated Perfusion (HOPE) of the liver can reduce the incidence of early allograft dysfunction (EAD) and failure in extended criteria donors (ECD) grafts, although data from prospective studies are very limited. In this monocentric, open‐label study, from December 2018 to January 2021, 110 patients undergoing transplantation of an ECD liver graft were randomized to receive a liver after HOPE or after static cold storage (SCS) alone. The primary endpoint was the incidence of EAD. The secondary endpoints included graft and patient survival, the EASE risk score, and the rate of graft or other graft‐related complications. Patients in the HOPE group had a significantly lower rate of EAD (13% vs. 35%, p= .007) and were more frequently allocated to the intermediate or higher risk group according to the EASE score (2% vs. 11%, p= .05). The survival analysis confirmed that patients in the HOPE group were associated with higher graft survival one year after LT (p= .03, log‐rank test). In addition, patients in the SCS group had a higher re‐admission and overall complication rate at six months, in particular cardio‐vascular adverse events (p= .04 and p= .03, respectively). HOPE of ECD grafts compared to the traditional SCS preservation method is associated with lower dysfunction rates and better graft survival. A single‐center randomized study shows that hypothermic oxygenated perfusion is associated with lower graft dysfunction rates and better graft survival in extended criteria donor liver transplantation.

Although events such as tooth extraction and oral surgery were considered for a while the sole triggering factor for Medication-Related Osteonecrosis of the Jaw (MRONJ), it is still unclear if trigger events may be precipitating factors that accelerate the onset of the disease that would have possibly occurred anyway. Therefore, this research aimed to retrospectively analyze MRONJ cases diagnosed in our tertiary referral hospital during the last 14 years, focusing on the onset of the disease, potential trigger events, and countermeasures to update the knowledge on their pathogenesis. An audit of patients diagnosed with MRONJ attending our department from 2008 to 2021was performed. χ2test and Fisher exact test were employed to assess the relationship between the medications used and trigger events; χ2test was also used to assess any relationship between MRONJ localization and drug, drug class, trigger, or trigger type. Seventy-six patients’ records were identified. Fifty-two records were selected for analysis. Trigger events for the onset of the disease were found in 35 cases (67.3%). χ2test showed a correlation between the drug used and trigger event occurrence (P=0.045) confirmed by Fisher exact test (P=0.34). Visual histogram analysis showed positive correlation when Alendronate (12 cases, 85.7%), Zoledronate (12 cases, 75%), and Risedronate (2 cases, 100%) were administered. Subgroup analysis per underlying disease, showed a significant correlation between the drug used and trigger event occurrence in the osteoporosis group (χ2test, P=0.021; Fisher exact test, P=0.009).

Imagine visiting the major cities on the east coast without the concern of motorized vehicles. Imagine a lengthier version of the Appalachian Trail providing access to scenic views, wildlife, and [...]

Cardiovascular disease represents the leading cause of death in patients with type 2 diabetes (1). Diabetes leads to increased vulnerability for plaque disruption and mediates increased incidence and severity of [...], The role of ubiquitin-proteasome system in the accelerated atherosclerotic progression of diabetic patients is unclear. We evaluated ubiquitin-proteasome activity in carotid plaques of asymptomatic diabetic and nondiabetic patients, as well as the effect of rosiglitazone, a peroxisome proliferator-activated receptor (PPAR)-γ activator, in diabetic plaques. Plaques were obtained from 46 type 2 diabetic and 30 nondiabetic patients undergoing carotid endarterectomy. Diabetic patients received 8 mg rosiglitazone (n = 23) or placebo (n = 23) for 4 months before scheduled endarterectomy. Plaques were analyzed for macrophages (CD68), T-cells (CD3), inflammatory cells (HLA-DR), ubiquitin, proteasome 20S activity, nuclear factor (NF)-κB, inhibitor of κB (IκB)-β, tumor necrosis factor (TNF)-α, nitrotyrosine, matrix metalloproteinase (MMP)-9, and collagen content (immunohistochemistry and enzyme-linked immunosorbent assay). Compared with nondiabetic plaques, diabetic plaques had more macrophages, T-cells, and HLA-DR+ cells (P < 0.001); more ubiquitin, proteasome 20S activity (TNF-α, and NF-κB (P < 0.001); and more markers of oxidative stress (nitrotyrosine and [O.sub.2.sup.-] production) and MMP-9 (P < 0.01), along with a lesser collagen content and IκB-β levels (P < 0.001). Compared with placebo-treated plaques, rosiglitazone-treated diabetic plaques presented less inflammatory cells (P < 0.01); less ubiquitin, proteasome 20S, TNF-α, and NF-κB (P < 0.01); less nitrotyrosine and superoxide anion production (P < 0.01); and greater collagen content (P < 0.01), indicating a more stable plaque phenotype. Similar findings were obtained in circulating monocytes obtained from the two groups of diabetic patients and cultured in the presence or absence of rosiglitazone (7.0 µmol/l). Ubiqnitin-proteasome over-activity is associated with enhanced inflammatory reaction and NF-κB expression in diabetic plaques. The inhibition of ubiquitin-proteasome activity in atherosclerotic lesions of diabetic patients by rosiglitazone is associated with morphological and compositional characteristics of a potential stable plaque phenotype, possibly by downregniating NF-κB-mediated inflammatory pathways.

For the past decade, there has been an increase in rural populations in the United States that has changed the character of these areas. Comprised of small, amenity-based communities with […]

Inadequate angiogenic response to ischemia in diabetic myocardium could result in poor collateral formation. Because hypoxia-inducible factor (HIF)-1α is a transcriptional activator of vascular endothelial growth factor (VEGF) and is critical for initiating angiogenic responses to hypoxia, we investigated the expression of HIF-1α and VEGF in specimens of human heart tissue to elucidate the molecular responses to myocardial ischemia in diabetic patients during unstable angina. Moreover, accumulation of a marker of protein nitration nitrotyrosine, as well as the superoxide anion ([O.sub.2.sup.-]) levels and inducible nitric oxide synthase (iNOS), were evaluated. Ventricular biopsy specimens from 15 type 2 diabetic and 14 nondiabetic patients presenting with unstable angina (ischemic group) and from 20 patients (11 type 2 diabetic and 9 nondiabetic patients) who underwent coronary bypass surgery without angina within the preceding 10 days (control group) were collected during coronary bypass surgery. Nondiabetic patients had higher HIF-1α and VEGF expressions compared with diabetic patients (P < 0.001). As compared with nondiabetic specimens, diabetic specimens showed higher levels of both iNOS mRNA and protein levels (P < 0.001) associated with the highest tissue levels of nitrotyrosine and [O.sub.2.sup.-] (P < 0.001). Diabetes is associated with increased myocardial tissue levels of iNOS, [O.sub.2.sup.-], and nitrotyrosine and reduced expression of myocardial angiogenesis factors during ischemia., Diabetic patients whose tests sustain a nonfatal myocardial infarction (MI) experience a more complicated course, including more frequent postinfarction angina, infarction extension, and congestive heart failure (1). The basis for [...]

OBJECTIVE--Obesity is an important risk factor for heart failure in both women and men. Dyssynchrony between right and left ventricular contract ion and relaxation has been identified as an independent [...]

OBJECTIVE--Stress hyperglycemia has been associated with increased mortality in patients with myocardial infarction (MI). We examined the association between plasma glucose levels, circulating inflammatory markers, T-cell activation, and functional cardiac [...]

Statins possess antithrombotic and profibrinolytic properties. The association between statin use and short‐term outcomes in patients with acute pulmonary embolism (PE) remains unknown. We used the data from the Registro Informatizado de Pacientes con Enfermedad TromboEmbólica registry to compare the 30‐day all‐cause mortality in patients with acute PE according to the use of statins. Secondary outcome was fatal PE. We used cancer‐related mortality as a falsification endpoint. From January 2009 to April 2021, 31 169 patients with PE were recruited. Of these, 5520 (18%) were using statins at baseline: low intensity: 829, moderate: 3636, high intensity: 1055. Statin users were older and had a higher frequency of diabetes, hypertension, or atherosclerotic disease than non‐users (P<0.001 for all comparisons). During the first 30 days, 1475 patients died (fatal PE, 255). On multivariable analysis, statin users had a lower risk of all‐cause death (odds ratio [OR]: 0.65; 95% confidence interval [CI]: 0.56–0.76) and fatal PE (OR: 0.42; 95% CI: 0.28–0.62) than non‐users. The risk for death was lower in patients using either low‐ (OR: 0.51; 95% CI: 0.34–0.77), moderate‐ (OR: 0.68; 95% CI: 0.57–0.81), or high‐intensity statins (OR: 0.68; 95% CI: 0.51–0.92). Results did not change in mixed effects logistic regression models with hospitals as a random effect. Statins were not associated with a significant chance in cancer mortality (falsification endpoint). PE patients using statins at baseline had a significantly lower risk of dying within the first 30 days than non‐users. Randomized trials are needed to confirm these data.

The shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora.

Role mining techniques are frequently used to derive a set of roles representing the current organization of a company following the RBAC model and simplifying the definition and the implementation of security policies. Constraints on the resulting roles can be defined to have valid roles, that can be efficiently managed, limiting for example the number of permissions included in a role or the users a role can be assigned to. Since the associated problems are NP hard, several heuristics have been developed to find sub-optimal solutions adopting the concurrentor the post-processing approach. In the first case, assignment matrices are obtained satisfying the given constraints during the computation, while in the second case, the intermediate solutions are obtained without considering the constraints, that are enforced successively. In this paper we present two heuristics for the Permission Usageand Role Usage Cardinality Constraints in the post-processing approach: we consider constraints limiting the number of permissions that can be included in a role in the first case, and the number of roles that can include a permission in the second case, refining the roles produced by some other technique (not considering any constraint). For both heuristics we analyze their performance after their application to some standard datasets, showing the improved results obtained w.r.t. state of the art solutions.

ABSTRACTAragonese Maps’ is the name of the remaining sheets of the large-scale topographic map series attributed to the Aragonese administration of Southern Italy (1282–1516). These maps are one of the ‘mysteries’ of the history of Europe for the layered wealth of geographical information and the technical perfection of the drawing, cartography. They offer innumerable possibilities of territorial investigation and for this reason they are at the centre of the recent research of geographers, historians and scholars of the territory tout court. The visible and invisible landscapes they depict, of which the toponyms are privileged indicators, offer the opportunity for a geographical-historical investigation in a diachronic perspective: in fact, they contain numerous details linked to previous or subsequent contexts and as many questions about their origin and historical provenance. The contribution therefore proposes a geo-cartographic reading of the material and immaterial landscape elements of the Aragonese maps, starting from three objectives: the comment of some ‘enigmatic’ details of the depicted territory; the dynamic and functional reading of the landscapes obtained from an examination of the most explanatory toponyms; a methodological proposal for the realization of a Geotoponomastic Atlas based on the semantic web.

We investigate the problem of speaker independent acoustic-to-articulatory inversion (AAI) in noisy conditions within the deep neural network (DNN) framework. In contrast with recent results in the literature, we argue that a DNN vector-to-vector regression front-end for speech enhancement (DNN-SE) can play a key role in AAI when used to enhance spectral features prior to AAI back-end processing. We experimented with single- and multi-task training strategies for the DNN-SE block finding the latter to be beneficial to AAI. Furthermore, we show that coupling DNN-SE producing enhanced speech features with an AAI trained on clean speech outperforms a multi-condition AAI (AAI-MC) when tested on noisy speech. We observe a 15% relative improvement in the Pearson’s correlation coefficient (PCC) between our system and AAI-MC at 0 dB signal-to-noise ratio on the Haskins corpus. Our approach also compares favourably against using a conventional DSP approach to speech enhancement (MMSE with IMCRA) in the front-end. Finally, we demonstrate the utility of articulatory inversion in a downstream speech application. We report significant WER improvements on an automatic speech recognition task in mismatched conditions based on the Wall Street Journal corpus (WSJ) when leveraging articulatory information estimated by AAI-MC system over spectral-alone speech features.

Background: Multiple myeloma is a plasma cell dyscrasia accounting for 1% of neoplastic diseases and is the second most common hematologic malignancy after lymphoma. Pulmonary arterial hypertension is characterized by increased blood pressure in the pulmonary circulation and the development of pulmonary vascular remodeling. Increased resistance in the pulmonary vessels strains the right ventricle, leading to right heart failure.Aim: To report a case of a 65-year-old man who presented in 2017 with immunoglobulin G–kappa multiple myeloma characterized by pulmonary arterial hypertension during carfilzomib and dexamethasone treatment that resolved after stopping therapy.Discussion: Pulmonary arterial hypertension represents one of the main problems of carfilzomib and dexamethasone treatment, especially in patients with predisposing conditions such as hypertension. Therefore, monitoring and management of patients starting therapy with carfilzomib remains a critical issue. Although cardiac and vascular related adverse events were not frequent, a preemptive strategy prior to initiating carfilzomib appears advisable, particularly in patients at risk.Conclusion: The mechanism responsible for cardiac and vascular events during carfilzomib therapy is unclear. This case report highlights that it is important to define at baseline the appropriate screening of patients undergoing carfilzomib therapy with specific monitoring and symptom management and that future large prospective controlled studies are needed to define the correct monitoring strategy in refractory and relapsed multiple myeloma and the potential mechanism of vascular events.

Some local protocols suggest using intermediate or therapeutic doses of anticoagulants for thromboprophylaxis in hospitalized patients with coronavirus disease 2019 (COVID‐19). However, the incidence of bleeding, predictors of major bleeding, or the association between bleeding and mortality remain largely unknown. We performed a cohort study of patients hospitalized for COVID‐19 that received intermediate or therapeutic doses of anticoagulants from March 25 to July 22, 2020, to identify those at increased risk for major bleeding. We used bivariate and multivariable logistic regression to explore the risk factors associated with major bleeding. During the study period, 1965 patients were enrolled. Of them, 1347 (69%) received intermediate‐ and 618 (31%) therapeutic‐dose anticoagulation, with a median duration of 12 days in both groups. During the hospital stay, 112 patients (5.7%) developed major bleeding and 132 (6.7%) had non‐major bleeding. The 30‐day all‐cause mortality rate for major bleeding was 45% (95% confidence interval [CI]: 36%‐54%) and for non‐major bleeding 32% (95% CI: 24%‐40%). Multivariable analysis showed increased risk for in‐hospital major bleeding associated with D‐dimer levels >10 times the upper normal range (hazard ratio [HR], 2.23; 95% CI, 1.38–3.59), ferritin levels >500 ng/ml (HR, 2.01; 95% CI, 1.02–3.95), critical illness (HR, 1.91; 95% CI, 1.14–3.18), and therapeutic‐intensity anticoagulation (HR, 1.43; 95% CI, 1.01–1.97). Among patients hospitalized with COVID‐19 receiving intermediate‐ or therapeutic‐intensity anticoagulation, a major bleeding event occurred in 5.7%. Use of therapeutic‐intensity anticoagulation, critical illness, and elevated D‐dimer or ferritin levels at admission were associated with increased risk for major bleeding.

The aim of this paper is to discuss the use of transcranial doppler in the pre-hospital management of stroke. In the pre-hospital organization, neurological defect scales are used, but they are often indicative of the occlusions of anterior circulation and not of the posterior circulation. Patients with posterior circulation stroke are sometimes not diagnosed and clinically treated. In the pre-hospital phase, the transcranial doppler may identify an occlusion of the large cerebral vessels and be useful for stroke patients, in particular those with posterior occlusions, for a more precise diagnosis and consequently for adequate treatment in the excellence centers for stroke.

Background: Increasing interest in identifying cerebral hemodynamics alterations as a cause of possible onset or worsening of cognitive impairment in elderly patients with vascular risk factors. Introduction: Intracranial ultrasound is a non-invasive, repeatable inexpensive method for recording variation of the cerebral vascular tree in physiological and pathological conditions and the diagnosis of vascular dementia (VaD). Methods: PubMed, Embase, Cochrane library and reference lists have been searched for articles published until March 30, 2020. Results: Clinical studies reported different Transcranial Doppler (TCD) parameters and subsequently transcranial duplex with color code (TCCD) in patients affected by vascular dementia. The number of studies using TCCD remains limited and most of the available data are still based on TCD. However, the use of transcranial Doppler could better stratify elderly patients with initial signs of cognitive impairment. Conclusion: Intracranial ultrasound employment to detect cerebral hemodynamic changes in VaD patients has been briefly discussed in this review.

Compositae accounts for ca. 10% of all flowering plants, being found in nearly all types of habitats worldwide. The family is particularly diverse in markedly dry and seasonal habitats, raising questions about what processes led to diversification in these challenging environments. The presence of C4and CAM metabolism in some Compositae taxa has been known since the 1970s, and although some of these taxa have been extensively studied, such as Flaveria, there has been no systematic effort in gathering and reviewing data about photosynthesis metabolism in the family in the last few decades. In the present paper, we gathered data from more than 50 articles, spanning several different methods, raising information on photosynthesis metabolism for more than 400 Compositae species. We also present newly acquired carbon isotope data for 66 species, mostly from previously unsampled tribes. We analyzed photosynthesis metabolism in the tribe Tageteae using a phylogeny and ancestral character reconstruction. C4photosynthesis in Compositae is restricted to two tribes: Tageteae, where it had two independent origins, and Coreopsideae, where it seems to have arisen only once. CAM metabolism is found in succulent members of tribe Senecioneae, and in Astereae and Eupatorieae, with an unknown number of evolutionary origins. We discuss the evolutionary implications of the results and propose future directions for studying photosynthesis metabolism in the family.

Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non‐massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non‐massive PE during anticoagulation and after its discontinuation. We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time‐to‐event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28–2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75–1.74) than non‐massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non‐massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51–1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P= .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82–16.24). In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.

Background: Evidence for the efficacy of radiation therapy for primary liver cancer is growing. In this context, proton therapy (PT) can potentially improve the therapeutic ratio, as demonstrated by recent clinical studies. Here we report the first European clinical experience on the use of PT for primary liver cancer.Methods: All patients treated for primary liver cancer in our center entered the analysis. Patients were simulated during deep expiration breath-hold. A 15-fraction treatment schedule was adopted using active scanning PT. Clinical outcome and toxicity were retrospectively analyzed.Results: Between January 2018 and December 2019, 18 patients were treated. Fourteen patients had hepatocellular carcinoma (HCC), three patients had intrahepatic cholangiocarcinoma (ICC), and one patient had synchronous ICC-HCC. The Child-Pugh score was A5 in the majority of patients with HCC (71.4%). Median prescription dose was 58.05 Gy (range, 50.31–67.5). Median follow-up was 10 months (range, 1–19). The majority of deaths occurred from liver tumor progression. One-year overall survival (OS) was 63%. A significant correlation between worse OS and patient performance status, vascular invasion, and tumor stage was recorded. One-year local control was 90%. Toxicity was low, with a decrease in Child-Pugh score ⩾2 points detected in one patient. No cases of classic radiation-induced liver disease occurred.Conclusions: Our initial results of active scanning PT for primary liver cancer demonstrated the feasibility, safety, and effectiveness of this advanced technique in this setting. The potential of the combination of PT with other locoregional therapies is under evaluation.

We describe a patient with liver metastases from colorectal cancer treated with chemotherapy and hepatic resection, who developed unresectable multifocal liver recurrence and who received liver transplantation using a novel planned technique: heterotopic transplantation of segment 2‐3 in the splenic fossa with splenectomy and delayed hepatectomy after regeneration of the transplanted graft. We transplanted a segmental liver graft after in‐situ splitting without any impact on the waiting list, as it was previously rejected for pediatric and adult transplantation. The volume of the graft was insufficient to provide liver function to the recipient, so we performed this novel operation. The graft was anastomosed to the splenic vessels after splenectomy, and the native liver portal flow was modulated to enhance graft regeneration, leaving the native recipient liver intact. The volume of the graft doubled during the next 2 weeks and the native liver was removed. After 8 months, the patient lives with a functioning liver in the splenic fossa and without abdominal tumor recurrence. This is the first case reported of a segmental graft transplanted replacing the spleen and modulating the portal flow to favor graft growth, with delayed native hepatectomy. Left lateral segment liver transplantation into the splenic fossa (after splenectomy) followed by native hepatectomy 2 weeks later is feasible, providing good short‐term outcomes to a patient with metastatic disease secondary to colorectal cancer.

The recent developments of information technologies, and the consequent need for access to distributed services and resources, require robust and reliable authentication systems. Biometric systems can guarantee high levels of security and multimodal techniques, which combine two or more biometric traits, warranting constraints that are more stringent during the access phases. This work proposes a novel multimodal biometric system based on iris and retina combination in the spatial domain. The proposed solution follows the alignment and recognition approach commonly adopted in computational linguistics and bioinformatics; in particular, features are extracted separately for iris and retina, and the fusion is obtained relying upon the comparison score via the Levenshtein distance. We evaluated our approach by testing several combinations of publicly available biometric databases, namely one for retina images and three for iris images. To provide comprehensive results, detection error trade-off-based metrics, as well as statistical analyses for assessing the authentication performance, were considered. The best achieved False Acceptation Rate and False Rejection Rate indices were and 3.33%, respectively, for the multimodal retina-iris biometric approach that overall outperformed the unimodal systems. These results draw the potential of the proposed approach as a multimodal authentication framework using multiple static biometric traits.

Data-driven deep learning solutions with gradient-based neural architecture, have proven useful in overcoming some limitations of traditional signal processing techniques. However, a large number of reverberant–anechoic training utterance pairs covering as many environmental conditions as possible is required to achieve robust dereverberation performance in unseen testing conditions. In this article, we propose to address the data requirement issue while preserving the advantages of deep neural structures leveraging upon hierarchical extreme learning machines (HELMs), which are not gradient-based neural architectures. In particular, an ensemble HELM learning framework is established to effectively recover anechoic speech from a reverberant one based on spectral mapping. In addition to the ensemble learning framework, we further derive two novel HELM models, namely, highway HELM [HELM(Hwy)] and residual HELM [HELM(Res)], both incorporating low-level features to enrich the information for spectral mapping. We evaluated the proposed ensemble learning framework using simulated and measured impulse responses by employing Texas Instrument and Massachusetts Institute of Technology (TIMIT), Mandarin hearing in noise test (MHINT), and reverberant voice enhancement and recognition benchmark (REVERB) corpora. The experimental results show that the proposed framework outperforms both traditional methods and a recently proposed integrated deep and ensemble learning algorithm in terms of standardized objective and subjective evaluations under matched and mismatched testing conditions for simulated and measured impulse responses.

Greenhouse gases (GHGs) emissions from livestock systems are important because of their significant contribution to global warming. Nitrogen fertilization can improve system production; however, it alters soil gas emissions. We evaluated soil nitrous oxide (N2O), methane (CH4), and carbon dioxide (CO2) emissions to investigate how they are affected by increasing levels of N fertilizer (urea) in a productive Marandu grass [Urochloa brizantha(Hochst ex A. Rich) Stapf] pasture subjected to continuous grazing by young Nellore beef cattle (Bos indicus). The N2O, CH4,and CO2emissions were significantly affected by increasing N fertilizer levels. The seasons also affected GHGs emissions. Nitrogen fertilizer favored CH4consumption relative to the control plot without N, with mean emission of 23.7 μg CH4−C m−2h−1in the fertilized plots compared to 61.6 μg CH4−C m−2h−1in the control. The N‐fertilized areas presented higher CO2emissions compared to the control plot without N. The areas that received N fertilization showed a positive linear association between the water‐filled pore space and N2O emission. Soil temperature drove CO2emissions. Increasing N fertilization in grazed marandu grass increases N2O and CO2emissions during the growing season, while reducing CH4. The effect of fertilization during the transition season was not apparent, and perhaps other factors could provide a better explanation for the GHG emissions during this period.

Myocardial scar burden impacts prognosis in patients with coronary artery disease who have experienced a myocardial infarction (MI). This has been demonstrated by late gadolinium enhancement cardiac magnetic resonance. Clinical experience with echocardiography suggests that the reflected ultrasound signal is enhanced in infarcted myocardial segments. Scar imaging with an ultrasound multipulse scheme (eScar) has been preliminarily validated in prior studies.

Phytogenic additives are used as food additives in ruminant nutrition due to their potential to alter the nitrogen (N) excretion route and minimize N emissions into the environment. This study aimed to evaluate the effect of two levels of supplementation plus a mixture of phytogenic additives (essential oils, saponins and spices) on the efficiency of N utilization by beef cattle in tropical pastures. The experiment was conducted at the Beef Cattle Sector of UNESP, Jaboticabal-BR, and lasted 84 days. Nine castrated Nelore steers (body weight 262 ± 31.2 kg) cannulated in the rumen were distributed in 3 simultaneous 3 × 3 Latin square designs. The animals were kept in pasture of Urochloa brizanthacv. Marandu during the rainy season. Treatments included ad libitum mineral supplementation (MS) as a control group, mineral supplementation added 0.1% of body weight per day plus Cargill phytogenic mixture (AMSP) and energy-protein supplementation, 0.3% of body weight per day plus Cargill phytogenic mixture (EPSP). Point urine and fecal samples were collected in the last three days of each experimental period. The concentration of total nitrogen in the urine was analyzed by the Kjeldahl procedure. The nitrogen composition of forage, supplements and feces was estimated by near-infrared spectroscopy (NIRS) using a modular FT-NIR spectrometer (NIRFlex N500, Büchi Labortechnik AG, Flawil, Switzerland). Nitrogen retention was calculated using the following equation: NR = N intake (g/d) – [N excretion in feces (g/d) + N excretion in urine (g/d)]. The nitrogen metabolism data were analyzed as a 3 × 3 Latin square with 3 replications, balanced for residual effects. Considering as fixed effect the treatment, and as random effect the Latin square, period, steer, steer × period interaction, and residues corresponding to the model. The data obtained were submitted to ANOVA and Tukey's test (P≤ 0.05), using the statistical program R, version 3.4.4. The addition of phytogenic additives in the supplements led to decreased (P< 0.036) urinary excretion of N (g/day) from 41.16 g/day to 28.38 g/day and urinary excretion of N (% of N intake) from 30.66% to 23.21%, but did not differ between the different levels of phytogenic supplementation (Table 1). In addition, retained N (% of N intake) was greater (P< 0.01) in animals supplemented with AMSP and EPSP compared with MS, increasing N retention from 26.78% to 33.88%. This study indicates that the different levels of supplementation plus the addition of the phytogenic mixture improved the efficiency of N utilization by decreasing the excretion of N in the urine and increasing the retained N compared with MS supplementation.

Nitrogen fertilization can improve the chemical composition of tropical forages, as nitrogen is required at all stages of plant development. The aim of this study was to verify the chemical composition of Urochloa brizanthacv. marandu fertilized with different sources of nitrogen fertilizers from the following treatments: without nitrogen fertilization (CO), fertilization with urea (UR), fertilization with ammonium nitrate (NI) and fertilization with ammonium sulfate (SA). The study was carried out from December 2021 to April 2022, in the cerrado biome of Brazil at the FCAV/UNESP Forage Sector, Jaboticabal Campus, during the rearing phase of Nelore cattle, non-castrated males kept on pasture, managed in a continuous stocking system and variable load capacity. In treatments with fertilization, 150 kg of N· ha-1were applied, divided into 3 applications. The design used was in randomized blocks (DBC). The evaluation of the chemical composition of the forage was carried out from collections every 28 days of samples of the fraction of the forage consumed by the animals through the hand-plucking method. The samples were dried at 55ºC for 72 hours and ground in a Willey mill, with a 1 mm mesh sieve. The chemical composition of the forage was estimated by spectroscopy in the near infrared light region, NIRS (Near Infrared Spectrometer), using a modular FT-NIR spectrometer. The data obtained were submitted to ANOVA and Tukey's test (P≤ 0.05), using the statistical program R, version 3.4.4. Nitrogen fertilization significantly increased the organic matter content of the forage (P= 0.001). The organic matter content of the non-fertilized treatment was 91.97%, while the average of the fertilized treatments was 92.22%. The percentage of crude protein in the forage also showed a significant difference (P <0.001) between the non-fertilized treatment, which had an average of 10.64%, and the fertilized treatments, which had an average of 17.75%. The neutral detergent fiber and acid detergent fiber components also differed from the application of nitrogen fertilizer (P <0.001) but did not differ between the types of fertilizers. The neutral detergent fiber content was significantly different (P <0.001) between the non-fertilized treatment (59.21%) and the fertilized treatments (54.30%). The observed data for acid detergent fiber were 31.46% for the treatment without the use of fertilizers and 30.24% for the treatments with the use of fertilizers. Non-fibrous carbohydrates and liguinin components were also analyzed, but showed no difference between treatments, P= 0.078 and P= 0.209, respectively. This study confirms that the chemical composition of Urochloa brizanthacv. Marandu can be significantly improved through the application of nitrogen fertilizers. However, our results showed no significant difference between the types of fertilizers tested.