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Abstract Bariatric surgery is effective for the treatment and remission of obesity and type 2 diabetes, but pharmacological approaches which exert similar metabolic adaptations are needed to avoid post-surgical complications. Here we show how G49, an oxyntomodulin (OXM) analog and dual glucagon/glucagon-like peptide-1 receptor (GCGR/GLP-1R) agonist, triggers an inter-organ crosstalk between adipose tissue, pancreas, and liver which is initiated by a rapid release of free fatty acids (FFAs) by white adipose tissue (WAT) in a GCGR-dependent manner. This interactome leads to elevations in adiponectin and fibroblast growth factor 21 (FGF21), causing WAT beiging, brown adipose tissue (BAT) activation, increased energy expenditure (EE) and weight loss. Elevation of OXM, under basal and postprandial conditions, and similar metabolic adaptations after G49 treatment were found in plasma from patients with obesity early after metabolic bariatric surgery. These results identify G49 as a potential pharmacological alternative sharing with bariatric surgery hormonal and metabolic pathways.

Abstract Even during the third wave of the COVID-19 pandemic health professionals were facing mental health challenges. The aim of this study was to examine the mental health of doctors, nurses and other professional groups in Europe and to identify differences between the professional groups. We conducted a cross-sectional online survey in 8 European countries. We asked for demographic data, whether the participants were exposed to COVID-19 at work, for main information sources about the pandemic, the Depression Anxiety Stress Scales (DASS-21), and major stressors. A MANCOVA was carried out to find predictors of mental health among health care professionals. The sample (N = 1398) consisted of 237 physicians, 459 nurses, and 351 other healthcare professionals and 351 non-medical professionals with no direct involvement in patient care. The mean mental health of all groups was affected to a mild degree. Major predictors for depression and anxiety were the profession group with higher scores especially in the group of the nurses and working directly with COVID-patients. In the third wave of the COVID-19 pandemic, the psychological burden on health professionals has remained high, with being nurse and working directly with COVID19 patients being particular risk factors for mental distress. We found as a main result that nurses scored significantly higher on depression and anxiety than practitioners.

[Objetivo] Verificar el cumplimiento de los niveles de exposición a SO2 y H2S, de los guardaparques del Parque Nacional Volcán Poás, tomando como referencia la norma internacional OSHA. [Metodología] Se estudió la concentración del SO2 desde setiembre 2018, hasta diciembre 2019 y para el H2S de febrero 2019, hasta diciembre 2019, haciendo uso de equipos de detección portátiles MultiRae. Los puntos de muestreo se colocaron en la casa de guardaparques, la caseta de entrada, el centro de visitantes y el mirador. El nivel de riesgo químico se determinó considerando: la salud de los trabajadores, el tiempo de exposición, el equipo de seguridad, las capacitaciones y los valores de TWA y STEL obtenidos. [Resultados] El valor más alto de la concentración de SO2 fue de 16,0 ppm, se registró en el centro de visitantes, y para el de H2S fue de 45 ppm (casa de guardaparques). La concentración promedio de los gases estuvo cercana al límite de detección para ambos gases, sugiriendo que los gases, en general, no se dirigen hacia las zonas de visitación. Ningún puesto de medición superó los 2 ppm para el SO2 en 8 horas (TWA). Sin embargo, en el centro de visitantes y en el mirador para visitantes, se superó los 5 ppm de SO2 en 15 minutos (STEL), con concentraciones de 10,1 ppm y 7,4 ppm, respectivamente. [Conclusiones] Se obtuvieron niveles bajos de riesgo químico, para ambos gases, en los puntos muestreados, a excepción del punto del centro de visitantes, donde el nivel de riesgo fue medio.

Los aldehídos son compuestos presentes en la atmósfera que se forman por la degradación fotoquímica de otros compuestos orgánicos en la tropósfera, estos pueden ser emitidos por fuentes naturales o antropogénicas. [Objetivo] En el presente trabajo se implementó un método analítico para la cuantificación de muestras de aldehídos en matrices como aire y agua de lluvia. [Metodología] El muestreo y el análisis de los aldehídos utilizó la metodología TO-11 de la Agencia de Protección Ambiental de los Estados Unidos (EPA). El muestreo se realizó mediante el uso de cartuchos de adsorción recubiertos con una disolución de 2,4-DNFH, formando una hidrazona con los aldehídos presentes en el agua de lluvia y en el aire. Estos fueron analizados mediante un cromatógrafo de líquido acoplado a un detector UV-Visible (HPLC-UV/Vis). Para la validación de la técnica de análisis y la calidad analítica de los resultados se determinaron: linealidad, sensibilidad, límites de cuantificación, límites de detección, repetibilidad, reproducibilidad y porcentaje de recuperación. En el caso de la repetibilidad, se utilizó la comparación del coeficiente de variación de Horwitz con los porcentajes de desviación estándar relativo (% DER) de las muestras. [Resultados] Los límites de detección obtenidos oscilan entre 0,18 μg/m3 para el acetaldehído y 3,20 μg/m3 en el caso de la acroleína, mientras que los límites de cuantificación están entre 0,62 μg/m3 para el acetaldehído y 4,70 μg/m3 para el heptanal; datos que garantizan la calidad analítica del método. [Conclusiones] En general, el método de análisis para los aldehídos mostró una buena correlación lineal, con valores de R2 igual o mayores a 0,9991 para cada curva de calibración, y valores de porcentajes de desvío relativo menores al 2,25 %, lo cual indica una buena precisión en el análisis.

ABSTRACT Introduction and objectives: Functional assessment of coronary stenosis severity with the piezo-electric sensor pressure wire has shown a discrepancy of up to 20% between hyperemic and nonhyperemic indexes. No data are available with fiber-optic pressure wires. The aim of this study was to evaluate the incidence and factors related to the diagnostic discordance between these indexes with a fiber-optic pressure wire. Secondary aims were to assess diagnostic reproducibility in 2 consecutive measurements of fractional flow reserve (FFR) and diastolic pressure ratio (dPR) and evaluate the drift rate. Methods: We conducted a prospective, observational multicenter study in patients undergoing functional assessment with a fiber-optic pressure wire. We took 2 consecutive measurements of the dPR (cutoff point 0.89) and FFR (cut-off point 0.80) in each lesion analyzed. The diagnostic correlation between 2 measurements with the same technique and between the 2 techniques (dPR and FFR) was assessed. Clinical and angiographic factors associated with discordance (FFR−/dPR+ and FFR+/dPR−) between the 2 techniques were analyzed. Results: We included 428 cases of stenosis (361 patients). Diagnostic reproducibility was 95.8% for the dPR, with a correlation coefficient between the 2 measurements (dPR1 and dPR2) of 0.974 (P 60%. The drift rate was 5.7%. Conclusions: Although FFR and dPR measurements with a fiber-optic pressure wire have excellent reproducibility and a low drift rate, the discordance rate remains similar to those in previous studies with a piezo-electric pressure wire. FFR−/dPR+ discordance is associated with intracoronary adenosine and hypertension. FFR+/dPR− discordance is related to age < 75 years old and stenosis > 60%.

RESUMEN Introducción y objetivos: La valoración funcional de las estenosis coronarias con guías de presión de sensor piezoeléctrico ha mostrado hasta un 20% de discordancia entre los índices hiperémico y no hiperémico. No hay datos disponibles con guía de presión de sensor óptico. El objetivo del estudio es evaluar la incidencia y los factores relacionados con la discordancia diagnóstica entre estos índices con guía de presión de sensor óptico. Como objetivos secundarios se evaluó la reproducibilidad diagnóstica en dos determinaciones consecutivas de la reserva fraccional de flujo (RFF) y la diastolic pressure ratio (dPR). También se evaluó la tasa de drift. Métodos: Estudio observacional, prospectivo, multicéntrico, en pacientes a quienes se realiza una valoración funcional con guía de presión de sensor óptico. Se hicieron dos mediciones consecutivas de dPR (umbral 0,89) y RFF (umbral 0,80) en cada lesión analizada. Se valoró la correlación diagnóstica entre dos mediciones con la misma técnica y entre ambas técnicas (dPR y RFF). Se analizaron factores clínicos y angiográficos asociados a la discordancia (RFF−/dPR+ y RFF+/dPR−) entre ambas técnicas. Resultados: Se incluyeron 428 estenosis (361 pacientes). La reproducibilidad diagnóstica fue del 95,8% para dPR, con un coeficiente de correlación entre ambas mediciones (dPR1 y dPR2) de 0,974 (p < 0,0001). Para RFF la reproducibilidad diagnóstica fue del 94,9%, con un coeficiente de correlación (RFF1 y RFF2) de 0,942 (p < 0,0001). La discordancia diagnóstica fue del 18,2% (RFF+/dPR− 8,2% y RFF−/dPR+ 10%). Entre las variables analizadas, en el análisis multivariado, la hipertensión arterial y la administración intracoronaria de adenosina se asociaron de manera significativa con la discordancia RFF−/dPR+. Solo la edad < 75 años y la estenosis > 60% se asociaron de manera significativa con la discordancia RFF+/dPR−. La tasa de drift fue del 5,7%. Conclusiones: Aunque las mediciones de RFF y dPR con guía de presión de sensor óptico tienen una excelente reproducibilidad y una baja incidencia de drift, la tasa de discordancia permanece similar a la de estudios previos con guía de presión de sensor piezoeléctrico. La adenosina intracoronaria y la hipertensión arterial se asocian con la discordancia RFF−/dPR+. La edad < 75 años y la estenosis > 60% se asocian a discordancia RFF+/dPR−.

Este documento se centra en determinar el consumo cultural de teatro, productos audiovisuales, televisión y museos durante el confinamiento por Covid-19 en Colombia. Estos descriptivos y tendencias de consumo se desarrollan y estiman a partir de SPSS versión 25, en donde se realizó reducción de dimensiones por medio de análisis factorial exploratorio para el consumo cultural resultado de la Encuesta de Consumo Cultural (ECC) de 2020, realizada por el Departamento Administrativo Nacional de Estadística (DANE); cuyos resultados permiten reconocer a la televisión como el canal por el que más consumen contenido las personas (73,7 %) en el país. Entre otros resultados, las edades de mayor consumo cultural están entre los menores de edad y de los 18 hasta los 32 años, los cuales representan el 52,6 %. Esto ratifica que debe darse un mayor apoyo a las tecnologías de información y virtualización, que involucren con mayor contundencia las necesidades de contenido para estas edades y posibiliten que aumenten el acceso y uso de diferentes formas de consumo de cultura.

Short-chain fatty acids (SCFAs) represent a cornerstone of gut health, serving as critical mediators of immune modulation and overall host homeostasis. Patients with dysbiosis caused by Clostridioides difficile infection (CDI) typically exhibit lower SCFAs levels compared to healthy stool donors and, thus, the concentration of SCFAs has been proposed as a proxy marker of a healthy microbiota. However, there is no consistency in the methods used to quantify SCFAs in stool samples and usually, the results are normalized by the weight of the stool samples, which does not address differences in water and fiber content and ignores bacterial counts in the sample (the main component of stool that contributes to the composition of these metabolites in the sample). Here, we show that normalized SCFAs concentrations by the bacterial count improve discrimination between healthy and dysbiotic samples (patients with CDI), particularly when using acetate and propionate levels. After normalization, butyrate is the metabolite that best discriminates eubiotic and dysbiotic samples according to the area under the receiver operating characteristic (ROC) curve (AUC-ROC = 0.860, [95% CI: 0.786–0.934], p

Objectives: This study aimed to characterize Aeromonas veronii CTe-01 focusing on its resistance to heavy metal and antibiotics. Methods: A. veronii CTe-01 was characterized using standard microbiological and molecular techniques. Antibiotic susceptibility and heavy metal resistance were tested per standard protocols. Genomic analysis, including plasmid characterization, was conducted in silico. Results: A. veronii CTe-01 showed resistance to various heavy metals and antibiotics. Multiple resistance genes were identified, including those for beta-lactamases, heavy metal resistance, and type III secretion system components. The bacterium carries a 9 kb plasmid with repA/repB replication genes, parA/parB partitioning genes, and a type II toxin-antitoxin system for stability. Conclusions: A. veronii CTe-01 is a genetic reservoir for antibiotic resistance, heavy metal resistance genes, and virulence factors. The study offers insights into its dual role as a pathogen and heavy metal remediator in aquatic environments.

Biogeography has as a central theme, which is the study of geographic ranges of species that are determined by evolutionary history, abiotic factors, and biotic interactions. Understanding the influence of biotic interactions on geographic ranges is a topic that has been little explored, especially in a way that compares species that vary in intensity of interaction. Here, we assessed interaction intensity as a determinant of geographic range overlap between ant-following birds and army ants in Mexico and Central America. We hypothesized that the intensity of the interaction between army ants and ant-following birds, obligate or facultative, predicts the overlap of geographic ranges of interacting species, as well as the extension of geographic ranges. We generated species distribution models with MAXENT and estimated the percentage of overlap between two species of army ants and 10 species of ant-following birds. Contrary to our predictions, Bayesian regression models found no support for an estimated higher range overlap for obligate ant-following birds and army ants, or wider geographic ranges for facultative ant-following bird species. However, our results suggested trends for higher percentages of range overlap between obligate ant-following birds and army ants, and for geographic ranges of facultative ant-following birds extending to areas without the presence of army ants. Our research encourages further exploration of the biogeography of biotic interactions as part of a quantitative gradient of intensities and not as qualitative categories, integrating spatial and temporal variation in the intensity of interaction.

Aim and Background: This research aimed to compare the effectiveness of dialectical behavior therapy and analytical cognitive psychotherapy in reducing the psychological symptoms of people with borderline personality disorder. Methods and Materials: This research is an applied research based on the goal. Based on the collection and type of data, it was quantitative and cross-sectional in terms of time. In addition, it was a semi-experimental research design in the form of pre-test-post-test with a control group. The statistical sample of the research was 45 people in a non-random way. They were chosen voluntarily. Multivariate covariance analysis was used in quantitative data and SPSS version 26 statistical program was used. Findings: The research findings indicated that the scores for Borderline Personality Inventory (BPI) and Self-harm Thoughts and Behaviors (STB) were higher for individuals who underwent Cognitive Analytic Therapy (CAT) compared to those who underwent Dialectical Behavior Therapy (DBT). Conclusions: The results of the present study suggest that the Cognitive Analytic approach is more effective than Dialectical Behavior Therapy. Overall, it can be concluded that Cognitive Analytic Psychotherapy, by improving interpersonal relationships, emotional regulation, and self-concept in individuals with Borderline Personality Disorder, helps in reducing impulsive, unplanned, and thoughtless behaviors through a proper patient-therapist relationship, thereby improving the social functioning of these patients.

Este artigo examina criticamente a teoria de Gilles Lipovetsky sobre o indivíduo hipermoderno, abordando diversas facetas do individualismo contemporâneo. Analisa a noção de individualismo, o dualismo no individualismo hipermoderno e suas tendências contraditórias, o individualismo selvagem e seu vínculo com o narcisismo. Discute o conceito de hiperindividualismo e a "indiferença pura" característica do indivíduo hipermoderno. Explora o impacto da mídia, a aniquilação da sociabilidade e dos valores morais pelo individualismo exacerbado e a necessidade de uma educação que contraponha a permissividade. O artigo oferece uma perspectiva crítica sobre as implicações sociais e culturais dessa forma extrema de individualismo.

Debido al aumento de la actividad del Volcán Poás en 2017, en Costa Rica, se realizaron muestreos en los alrededores del cráter activo para cuantificar la concentración de dióxido de azufre (SO2) y las características químicas del agua de lluvia, entre mayo y octubre del 2017. Las muestras de SO2 se recolectaron con sistemas de burbujeo y las muestras de agua de lluvia con muestreadores de lluvia simples, donde se midió pH, conductividad eléctrica y concentración de aniones. En El Mirador para visitantes hubo valores de pH hasta de 2.50 y concentración de sulfatos de 239.3 mg/L. Para el SO2, los valores más significativos fueron en el Centro de visitantes y la Casa de guardaparques (entre 1 km y 2 km del cráter), con concentraciones de 10171 µg/m3 y 49360 µg/m3, en 4 horas, lo cual las personas podrían tener problemas respiratorios y afectaciones inmediatas, como vómito y sangrado nasal. Además, se utilizó el programa Aermod para modelar la dispersión del SO2 y observar las zonas más afectadas. Las mediciones dieron un punto de partida para la reapertura del Parque Nacional Volcán Poás, con capacitaciones y el monitoreo de la calidad del aire, para la seguridad para los visitantes.

A pretensão do presente artigo é apresentar, de forma analítica, um breve panorama reflexivo em torno da incontornável crítica unanimista tecida por Hountondji à etnofilosofia de Placide Tempels patente na sua obra Bantu Philosophy. Para tal, de modo sucinto, apresenta a compreensão do que seja filosofia africana como qualquer outra filosofia na perspectiva de Hountondji (não pode ser resultado da unanimidade, isto é, do consenso, fruto da visão e/ou pensamento colectivo do mundo, mas da confrontação de pensamentos individuais, ou seja, da discussão e/ou debate) e, por conseguinte, a razão de ser das críticas tecidas à obra de Tempels, sobretudo os seus pontos fortes que, juntamente com a grande obra de African Philosophy de Hountondji, criaram um movimento intelectual e que, nos últimos anos, para além de merecer uma atenção especial, têm incitado debates interessantes e bastantes vigorosos.

22-year-old male diagnosed with Tuberous Sclerosis Complex (TSC), a genetic disorder characterized by benign tumors in various organs, with a focus on neurological implications. Central to the study is the development of Subependymal Giant Cell Astrocytomas (SEGAs), leading to hydrocephalus in the patient. The diagnosis of TSC was made in the patient’s childhood, and he was monitored regularly. The study highlights a significant growth in a subependymal nodule, leading to monoventricular hydrocephalus. MRI scans played a crucial role in identifying the progression of SEGAs and the subsequent hydrocephalus. The treatment approach involved endoscopic surgical removal of the SEGA, with histopathology confirming the diagnosis. Post-surgical outcomes over an eight-year follow-up period showed a normalization in ventricular size and the stability of other subependymal nodules, without any complications. This case underscores the importance of regular monitoring for TSC patients, early intervention for complications like hydrocephalus, and the need for a multidisciplinary treatment approach. The case study provides valuable insights into the management of neurodevelopmental disorders and the complexities surrounding TSC and SEGAs.

Purpose: Moderate hypofractionated radiotherapy is the standard of care for all patients with breast cancer, irrespective of stage or prior treatments. While extreme hypofractionation is accepted for early-stage tumours, its application in irradiating locoregional lymph nodes remains controversial. Materials and methods: A prospective registry analysis from July 2020 to September 2023 included 276 patients with early-stage breast cancer treated with one-week ultra-hypofractionation (UHF) at 26 Gy in 5 fractions on the whole breast (58.3 %) or thoracic wall (41.7 %) and ipsilateral regional lymph nodes and simultaneous integrated boost (58.3 %). Primary endpoint was assessment of acute adverse events (AEs). Secondarily, onset of early-delayed toxicity was assessed. A minimum 6-month follow-up was required for assessing potential treatment-related early-delayed complications. Acute or late complications attributable to treatment were assessed at inclusion using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria. Results: With a median follow-up of 19 months (range 1–49 months), 159 (57.6 %) patients reported AEs, predominantly grade (G) 1 (n = 139, 50.4 %) and G2 (n = 20, 7.8 %). Skin acute toxicity was common (G1/2: 134, G3: 14), while breast oedema occurred in 10 patients (G1: 9, G2: 1), and 15.9 % reported breast pain (G1: 42, G2: 2). Ipsilateral arm oedema was observed in 1.8 % patients. For patients with a follow-up beyond 6 months (n = 213), 23.4 % patients reported G1/G2 skin AEs, 8.8 % had G1/G2 breast/chest wall oedema, and 8.9 % experienced arm lymphedema. There were no cases of brachial plexopathy or G3 toxicity in this group of patients. Conclusions: One-week UHF adjuvant locoregional radiation is well-tolerated, displaying low-toxicity profiles comparable to other studies using similar irradiation schedules.

Background: The upgrade of natural products for cancer treatment is essential since current anticancer drugs still pose severe side effects. Cymensifin A (Cym A) isolated from an orchid Cymbidium ensifolium has shown its potential to induce the death of several cancer cells; however, its underlying molecular mechanisms are hitherto unknown.Methods: Here, we conducted a set of in vitro preliminary tests to assess the cytotoxic effects of Cym A on non-small-cell lung cancer (NSCLC) cells (A549, H23, H292, and H460). A flow cytometry system and Western blot analyses were employed to unveil molecular mechanisms underlying cancer cell apoptosis caused by Cym A.Results: Cym A at 25–50 μM caused the death of all NSCLC cells tested, and its cytotoxicity was comparable to cisplatin, a currently used anticancer drug. The compound induced apoptosis of all NSCLC cells in a dose-dependent manner (5–50 μM), proven by flow cytometry, but H460 cells showed more resistance compared to other cells tested. Cym A-treated H460 cells demonstrated increased reactive oxygen species (ROS) and downregulated antioxidants (catalase, superoxide dismutase, and thioredoxin). The compound also upregulated the tumor suppressor P53 and the pro-apoptotic protein BAX but downregulated pro-survival proteins (BCL-2 and MCL-1) and deactivated survival signals (AKT and ERK) in H460 cells. Cym A was proven to trigger cellular ROS formation, but P53 and BAX were 2-fold more activated by Cym A compared to those treated with hydrogen peroxide. Our findings also supported that Cym A exerted its roles in the downregulation of nuclear factor erythroid 2–related factor 2 (a regulator of cellular antioxidant activity) and the increased levels of cleaved poly (ADP-ribose) polymerase (PARP) and cleaved caspase 3/7 during apoptosis.Conclusion: We propose that Cym A induces lung cancer cell death via ROS-mediated apoptosis, while the modulation of cellular ROS/antioxidant activity, the upregulation of P53 and BAX, the downregulation or deactivation of BCL-2, MCL-1, AKT, and ERK, and the increased cleavage of PARP and caspase 3/7, were the elucidated underlying molecular mechanisms of this phytochemical. The compound can be a promising candidate for future anticancer drug development.

Introduction: Clear cell sarcoma (CCS) is a rare and aggressive soft tissue sarcoma. CCS is characterized by the translocation t(12;22) (q13;q12), involving the fusion of EWSR1 and ATF1 genes, and less frequently the fusion gene EWSR1-CREB1. Usually, CCSs are considered poorly responsive to conventional chemotherapy. However, trabectedin has shown activity against translocation-related sarcomas. Furthermore, preclinical results suggest that trabectedin is a promising antitumor agent for CCS, potentially inducing melanocytic differentiation. Case Presentation: We report the case of a challenging anatomopathological diagnosis in a patient with an aggressive metastatic CCS. Following the diagnosis of CCS, the patient experienced a clinical and radiological tumor response to trabectedin after four lines of treatment. Conclusion: This is a novel report of CCS treated with trabectedin that resulted in a partial response and suggests the need for further research on trabectedin as a therapeutic option for CCS.

The rapid progress in artificial intelligence, machine learning, and natural language processing has led to increasingly sophisticated large language models (LLMs) for use in healthcare. This study assesses the performance of two LLMs, the GPT-3.5 and GPT-4 models, in passing the MIR medical examination for access to medical specialist training in Spain. Our objectives included gauging the model’s overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. Material and methods: We studied the 2022 Spanish MIR examination results after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM GPT-4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length, sequence, and performance. We also analyzed the 23 questions with images, using GPT-4’s new image analysis capability. Results: GPT-4 outperformed GPT-3.5, scoring 86.81% in Spanish (p < 0.001). English translations had a slightly enhanced performance. GPT-4 scored 26.1% of the questions with images in English. The results were worse when the questions were in Spanish, 13.0%, although the differences were not statistically significant (p = 0.250). Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, and the Pharmacology, Critical Care, and Infectious Diseases specialties showed lower performance. The error analysis revealed that while a 13.2% error rate existed, the gravest categories, such as “error requiring intervention to sustain life” and “error resulting in death”, had a 0% rate. Conclusions: GPT-4 performs robustly on the Spanish MIR examination, with varying capabilities to discriminate knowledge across specialties. While the model’s high success rate is commendable, understanding the error severity is critical, especially when considering AI’s potential role in real-world medical practice and its implications for patient safety.

Urinary tract infections (UTIs) caused by Escherichia coli represent a significant public health concern due to the high virulence and antimicrobial resistance exhibited by these pathogens. This study aimed to analyze the phylogenetic diversity and antibiotic resistance profiles of Uropathogenic E. coli (UPEC) strains isolated from UTI patients in Algeria, focusing on virulence factors such as extended β-lactamase (ESBL) production, biofilm formation, and hemolytic activity. Phylogenetic grouping of 86 clinical imipenem resistant E. coli isolates showed the prevalence of group B2 (48.9%), followed by groups E (22.1%), unknown (12.8%), A (8.1%), and B1 (4.7%), and Clade I, D, Clade I, or Clade II (1.2%). The highest resistance rates were observed towards amoxicillin (86.04%), ticarcillin (82.55%), piperacillin (73.25%), nitrofurantoin (84.88%), and trimethoprim-sulfamethoxazole (51.16%). Notably, 69.8% of UPEC strains were multidrug-resistant (MDR) and 23.2% were extensively drug-resistant (XDR). Additionally, 48.9%, 42%, and 71% of strains demonstrated ESBL production, hemolytic activity, and weak biofilm production, respectively. Continuous monitoring and characterization of UPEC strains are essential to track the spread of the most resistant and virulent phylogenetic groups over time, facilitating rapid therapeutic decisions to treat infections and prevent the emergence of new resistant organisms, helping choose the most effective antibiotics and reducing treatment failure.

Sentinel lymph node biopsy (SLNB) is currently considered as a viable alternative to elective neck dissection (END) for the management of cN0 oral cavity squamous cell carcinoma (OCSCC). However, some difficulties were detected in sentinel lymph node (SLN) identification in floor of mouth (FOM) and ventral tongue tumors because of the so-called “shine-through radioactivity” of the injection site, which may mask nodal hotspots in proximity. We assessed the feasibility and the potential strengths of combining 99mTc-Tilmanocept with indocyanine green (ICG) fluorescence lympho-angiography in a dedicated multimodal protocol for SLNB in T1/T2N0 oral cancer to evaluate the synergistic role of each of these two tracers in providing the appropriate sensitivity and ease of learning, even in such a critical anatomical subsite. A detailed, stepwise description of our multimodal protocol is provided, together with the presentation of its application in two cases of early-stage ventral tongue tumors. Radioactive guidance with 99mTc-Tilmanocept was used preoperatively to perform planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography and to define the nodal hotspot(s) and the surgical “roadmap”. In addition, it was used intraoperatively to pinpoint the SLN location within each nodal hotspot with high specificity but limited spatial resolution. Optical guidance with ICG injection at the tumor bed and near-infrared fluorescence imaging was then added, providing intuitive intraoperative guidance within each nodal hotspot with high spatial resolution. Our small experience with this protocol is illustrated and future perspectives are highlighted.

Background and objectives: The development of the oral microbiome begins in the prenatal stage. Breast milk contains antimicrobial proteins, microorganisms, metabolites, enzymes, and immunoglobulins, among others; therefore, differences have been noted in the type of microorganisms that colonize the oral cavity of children who are breastfed compared to those who are formula-fed. Our objective was to establish the relationship between breastfeeding, formula feeding, or mixed feeding (breastfeeding and formula) with the presence of S. mutans in a population of children under 6 months of age. Materials and Methods: The patients were recruited from the Child Care Center of Ciudad Juárez, Chihuahua, and from the pediatric dentistry postgraduate clinics of the Autonomous University of Ciudad Juárez; children exclusively fed maternally, with formula, and/or mixed were included. Those who had been fed within the previous hour were excluded. The sample was taken with a smear of the jugal groove using a sterile micro-brush. For the identification of Streptococcus mutans, a culture of Mitis Salivarius Agar (Millipore) was used. Results: 53.3% corresponded to females and 46.7% to males, 36.7% corresponded to maternal feeding, 23.3% corresponded to formula feeding, and 40% corresponded to mixed feeding. In 90% of the infants, the parents indicated that they did not perform oral hygiene. The CFU count showed that infants who were exclusively breastfed had an average of 9 × 10 CF/mL, formula-fed infants had an average of 78 × 10 CFU/mL, and those who had mixed feeding 21 × 10 CFU/mL. Conclusions: According to the results obtained, it was possible to corroborate that exclusive breastfeeding limits the colonization of Streptococcus mutans compared to those infants who receive formula or mixed feeding; these results could have a clinical impact on the dental health of infants by having a lower presence of one of the main etiological factors involved in dental caries and the type of microbiome established in the oral cavity.

Poás Volcano made a magmatic eruption in April 2017. The volcanic outburst resulted in an ash and vapor column towering over three kilometers high. Since that time, there has been a continual release of gases, aerosols, and more recently, ash, posing potential issues for visitors and park rangers. In this work, the potential for exposure to acid gases and aerosols faced by park rangers, officials, and visitors to the Poás Volcano National Park was evaluated, and the concentrations found were compared with the exposure limits established by the Occupational Safety and Health Administration (OSHA). The study was conducted between October 2021 and November 2022. the concentrations of HCl(g), HNO3(ac), HF(g), and H2SO4(ac) were determined at three strategic points: the ranger station, the visitor center, and the main crater viewpoint. The maximum concentrations obtained were (7.0 ± 1.6) ppb for HCl(g), (6.2 ± 2.8) ppb for HNO3(ac), and (0.029 ± 0.044) ppm for H2SO4(ac). There were no concentration values above the detection limit (0.94 μg/m3) for HF(g). By comparing the data obtained with similar studies, it is concluded that the measured values in Poás Volcano National Park are low and only show similarities to the results found in volcanoes within the national territory. The exposure limit established by OSHA (0.02 ppm) was only surpassed by H2SO4(ac), and could be the cause of health effects experienced over the years by park rangers. To minimize these risks, the use of personal protective equipment and air quality monitoring is essential.

With the United Nations Sustainable Development Goals (SDG) (2015–2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990–2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of −2.6% (95% CI −2.7; −2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.

Sin pensarlo he cogido un bolígrafo que pone Sociedad Española de Enfermería Nefrológica. Recordemos juntas sus comienzos: Era el año 1973, se celebraba en Santander la Séptima Reunión de Nefrólogos. Era Reunión porque todavía no existía la especialidad de Nefrología y se creó después de dicha reunión. Un mes antes me llamo una enfermera de Madrid, la responsable de la Diálisis del hospital Gregorio Marañon, eras tú con la intención de que también las enfermeras de España que estábamos en Diálisis pudieran reunirse. He de confesar que me dio un MIEDO enorme, del que tú te diste cuenta y me dijiste que reconocías que era un poco precipitado y que era mejor dejarlo para otra ocasión.

Summary: Nε-lysine acetylation is a common posttranslational modification observed in Escherichia coli. In the present study, integrative analysis of the proteome and acetylome was performed using label-free quantitative mass spectrometry to analyze the relative influence of three factors affecting growth. The results revealed differences in the proteome, mainly owing to the type of culture medium used (defined or complex). In the acetylome, 7482 unique acetylation sites were identified. Acetylation is directly related to the abundance of proteins, and the level of acetylation in each type of culture is associated with extracellular acetate concentration. Furthermore, most acetylated lysines in the exponential phase remained in the stationary phase without dynamic turnover. Interestingly, unique acetylation sites were detected in proteins whose presence or abundance was linked to the type of culture medium. Finally, the biological function of the acetylation changes was demonstrated for three central metabolic proteins (GapA, Mdh, and AceA).

BackgroundEvidence indicates that criminal behaviour in youth is linked with a range of negative physical, mental, and social health consequences. Despite a global decrease over the last 30 years, youth crime remains prevalent. Identifying and mapping the most robust risk and protective factors, and intervention strategies for youth crime could offer important keys for predicting future offense outcomes and assist in developing effective preventive and early intervention strategies. Current reviews in the area do not include literature discussing at risk populations such as First Nations groups from countries such as Australia, Canada and New Zealand. This is a critical gap given the disproportionally high rates of incarceration and youth detention among First Nations people globally, particularly in countries with a colonial past. The aim of this scoping review is to identify and map the key risk and protective factors, along with intervention strategies, that are essential for recognizing adolescents and young adults at risk of crime.MethodsThis scoping review protocol has been developed in line with the Arksey and O'Malley framework and the Joanna Briggs Institute (JBI) Reviewers' Manual. The review protocol was preregistered with Open Science Framework (https://osf.io/kg4q3). ProQuest, PubMed, Web of Science, Scopus, and PsycInfo were used to retrieve relevant articles. Grey literature was searched using Google searches and ProQuest dissertations databases. Original research articles examining protective factors, risk factors, and intervention strategies for prevention and reduction of crime in 12-24-year-olds were included. Two independent reviewers conducted eligibility decisions and data extraction. Findings has been reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.ConclusionAnticipated findings suggest that current research has extensively examined factors across all levels of the socioecological model, from individual to community levels, revealing a predominant focus on individual-level predictors such as substance use, prior criminal history, and moral development. The review is expected to identify effective interventions that address critical factors within each domain, including Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC), which have shown promise in reducing youth crime. Additionally, it will likely highlight significant trends in risk and protective factors, such as the dual role of academic achievement-both as a risk and protective factor-and the impact of family-based interventions. The review will also address gaps in research, particularly regarding Indigenous youth, underscoring the need for targeted studies to better understand their unique challenges. These findings will guide future research and inform the development of comprehensive prevention and early intervention programs tailored to diverse youth populations.

ObjectivesThis systematic review aimed to assess the prevalence and incidence of diabetic retinopathy in patients with diabetes of Latin America and the Caribbean.MethodsWe searched Web of Science (WoS)/Core Collection, WoS/MEDLINE, WoS/Scielo, Scopus, PubMed/Medline and Embase databases until January 16, 2023. We meta-analyzed prevalences according to type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).ResultsForty-three prevalence studies (47 585 participants) and one incidence study (436 participants) were included. The overall prevalence of retinopathy in patients with T1DM was 40.6% (95% CI: 34.7 to 46.6; I2: 92.1%) and in T2DM was 37.3% (95% CI: 31.0 to 43.8; I2: 97.7), but the evidence is very uncertain (very low certainty of evidence). In meta-regression, we found that age (T1DM) and time in diabetes (T2DM) were factors associated with the prevalence. On the other hand, one study found a cumulative incidence of diabetic retinopathy of 39.6% at 9 years of follow-up.ConclusionsTwo out of five patients with T1DM or T2DM may present diabetic retinopathy in Latin America and the Caribbean, but the evidence is very uncertain. This is a major public health problem, and policies and strategies for early detection and opportunely treatment should be proposed.

[Objetivo] Se estudió la variación de las concentraciones del sulfuro de hidrógeno (H2S) y del amoniaco (NH3) en aire, en un sistema de tratamiento de aguas residuales en Costa Rica, para conocer el posible alcance de los olores producidos, con mediciones en el lugar y un modelo de dispersión de sustancias en el aire. [Metodología] Fueron realizados 13 muestreos en periodos de 12 horas y 24 horas, entre octubre del 2016 y febrero del 2017; con las mediciones de campo, se alimentó un modelo de dispersión. Se midieron los parámetros meteorológicos: dirección y velocidad de viento, radiación global, temperatura, porcentaje de humedad relativa, precipitación y presión atmosférica. Mediante el uso de los programas Aermed View y AERMOD, se demostró la dispersión de los gases alrededor de los puntos de emisión seleccionados en la planta de tratamiento. Al Aermet View se le incorporaron los parámetros de rugosidad superficial, la proporción de Bowen y el albedo para una zona rural. Los datos recolectados se incluyeron en AERMOD. [Resultados] La concentración de los gases emitidos por la planta se encuentra por debajo de los valores de percepción de estas sustancias, 0,70 µg/m3 (< 0,50 ppb) para el H2S y 26,6 µg/m3 (< 35,5 ppb) para el NH3. Se determinó que el canal de vertido es la fuente principal de emisión. Los gases generados se dispersaron hacia las comunidades vecinas de La Carpio, María Auxiliadora y Rincón Grande, en dirección noroeste; Carvajal Castro, Rossiter Carballo, Residencial Real Santamaría y Lagunilla, en dirección noreste, y la Comisión Nacional de Emergencia, en dirección sur. Los valores de error se encontraron en un ámbito entre el 5 % y el 48 % para el H2S y entre el 8 % y el 75 % para el NH3. El índice de concordancia (IC) mostró una similitud entre los valores predichos y los valores observados, tanto para el H2S como para el NH3. [Conclusiones] Las emisiones gaseosas de H2S y NH3 provenientes del sistema de tratamiento de aguas residuales no representan un riesgo para la salud ni el medio ambiente, en las poblaciones cercanas.

Abstract DNA methylation is an epigenetic modification detected in both prokaryotic and eukaryotic genomic DNAs. In bacteria, the importance of 5-methylcytosine (m5C) in gene expression has been less investigated than in eukaryotic systems. Through dot-blot analysis employing m5C antibodies against chromosomal DNA, we have previously demonstrated that m5C influences the differentiation of Streptomyces coelicolor A(3)2 M145 in solid sporulating and liquid non-sporulating complex media. Here, we mapped the methylated cytosines of the M145 strain growing in the defined Maltose Glutamate (MG) liquid medium. Sequencing of the M145 genome after bisulfite treatment (BS-sequencing) evidenced 3360 methylated cytosines and the two methylation motifs, GGCmCGG and GCCmCG, in the upstream regions of 321 genes. Besides, the role of cytosine methylation was investigated using the hypo-methylating agent 5′-aza-2′-deoxycytidine (5-aza-dC) in S. coelicolor cultures, demonstrating that m5C affects both growth and antibiotic biosynthesis. Finally, quantitative reverse-transcription polymerase-chain-reaction (RT-qPCR) analysis of genes containing the methylation motifs in the upstream regions showed that 5-aza-dC treatment influenced their transcriptional levels and those of the regulatory genes for two antibiotics. To the best of our knowledge, this is the first study that reports the cytosine methylome of S. coelicolor M145, supporting the crucial role ascribed to cytosine methylation in controlling bacterial gene expression.

Congenital aniridia is a rare bilateral ocular malformation characterized by the partial or complete absence of the iris and is frequently associated with various anomalies, including keratopathy, cataract, glaucoma, and foveal and optic nerve hypoplasia. Additionally, nearly 50% of individuals with congenital aniridia experience symptoms of ocular dryness. Traditional treatment encompasses artificial tears and autologous serum. This study aimed to assess the effectiveness and safety of using platelet rich in growth factors (PRGF) plasma in patients with congenital aniridia and ocular dryness symptoms. Methods: The included patients underwent two cycles of a 3-month PRGF treatment. At 6 months, symptomatology was evaluated using the OSDI and SANDE questionnaires, and ocular surface parameters were analyzed. Results: The OSDI and SANDE values for frequency and severity demonstrated statistically significant improvements (p < 0.05). Ocular redness, corneal damage (corneal staining), and tear volume (Schirmer test) also exhibited statistically significant improvements (p < 0.05). No significant changes were observed in visual acuity or in the grade of meibomian gland loss. Conclusion: The use of PRGF in patients with congenital aniridia and ocular dryness symptoms led to significant improvements in symptomatology, ocular redness, and ocular damage. No adverse effects were observed during the use of PRGF.

El modelo de liderazgo total y el uso del instrumento MLQ constituyen una de las formas más usadas estudiar el liderazgo a nivel mundial. Sin embargo, modelos como el de Jensen et al (2019) han criticado la forma en que se conceptualiza y se mide el liderazgo bajo esta postura. El objetivo de este estudio fue comprobar cuatro predicciones derivadas del modelo de Jensen et al (2019) en una muestra de líderes mexicanos (n = 100) con personal a cargo y con un año como mínimo en su puesto. Se aplicó el instrumento propuesto por Jensen et al (2019) (MMLTT) en conjunto con el MLQ-6s, en su versión validada al español. Los resultados indicaron que la dimensión de liderazgo transformacional, medida con el MMLTT, se correlacionó con todas las dimensiones de liderazgo transformacional medidas con el MLQ-6s. Finalmente, las dimensiones de liderazgo transaccional, medidas con el MMLTT, se correlacionaron con la dimensión de liderazgo transaccional medida con el MLQ-6s. Un algoritmo de aprendizaje no supervisado permitió agrupar a la muestra en tres grupos con estilos de liderazgo diferentes. Los resultados son discutidos en relación con su consistencia teórica con la propuesta de Jensen et al (2019) y con hallazgos previos en la literatura.

Objetivo: analizar el acceso a derechos sexuales y (no) reproductivos de mujeres y niñas en el contexto de la pandemia por COVID-19; y las políticas implementadas (o no) por los gobiernos de la provincia de Santiago del Estero y nacional. Metodología: desde métodos cualitativos se ha indagado a través de entrevistas no estructuradas y en profundidad por medio de videollamadas por las plataformas disponibles: a funcionarias/os, agentes de salud y referentes de organizaciones sociales. Resultados: el acceso a los derechos sexuales y (no) reproductivos enfrentó graves dificultades entre las que podemos destacar las restricciones a la circulación, sobre todo durante el 2020, y la priorización en los servicios públicos a la atención de los casos de COVID-19. Las respuestas institucionales a las demandas de interrupciones legales de las niñas y mujeres embarazadas han seguido circuitos largos y laberínticos. Conclusión: los diversos obstáculos que enfrentan las mujeres y las niñas para que el Estado garantice sus derechos, deben situarse en la perduración de un contexto histórico y estructural, donde la sexualidad y la reproducción están sometidas a estricto control y el ejercicio de los derechos se enfrenta con morales restrictivas. Las respuestas ofrecidas por el Estado no fueron suficientes y las organizaciones sociales cumplieron un rol sustitutivo. Y allí en donde no hay una red de contención o una organización social, la vida de mujeres y niñas presenta mayor vulnerabilidad. Recepción: 30/04/23|Revisión: 08/10/23|Aceptación: 07/11/23

Natural history museums are vital repositories of specimens, samples and data that inform about the natural world; this Formal Comment revisits a Perspective that advocated for the adoption of compassionate collection practices, querying whether it will ever be possible to completely do away with whole animal specimen collection.

Introdução/Objetivo: Sepse pode ser definida como a presença de disfunção orgânica ameaçadora à vida em decorrência da resposta desregulada do organismo à presença de infecção. No Brasil a mortalidade chega a 65% dos casos, enquanto a média mundial está em torno de 30 a 40%. As novas diretrizes da Campanha de Sobrevivência à Sepse recomendam que as instituições tenham estratégias para a detecção de pacientes com sepse, com programas de melhoria da qualidade de atendimento baseados em indicadores bem definidos. Entendendo a relevância desta patologia, resolveu-se avaliar a efetividade do gerenciamento do protocolo de sepse. Métodos: Estudo observacional e retrospectivo de dados obtidos no Sistema de Informação Hospitalar. Foram analisados os casos que atendiam os critérios para diagnóstico de sepse de outubro de 2015 a junho de 2023, totalizando 2184 pacientes. Após a análise os dados eram tabulados em planilha de Excel. Resultado: Antes da implementação das medidas, em 2015, a taxa de mortalidade era 78%, observou-se uma redução significativa com taxas médias respectivas de 2016 a 2022 de: 40%, 25%, 20%,11%, 20%, 21%, 19% e até junho de 2023 de 20%. As taxas de mortalidade, com exceção de 2016 quando iniciou-se a implantação, apresentam-se semelhantes às taxas informadas pela Associação Nacional dos Hospitais Privados que foram de 2016 a 2021: 18,48%, 21,24%%, 16,24%, 14,21%, 20,55% e 24,46%. Conclusão: Como demonstrado em estudos a implantação de protocolos assistenciais diminui significativamente a mortalidade. Foi constatado que, apesar da pandemia, permanecemos semelhantes às taxas nacionais, mesmo com a discreta elevação em 2020 e 2021. A adequação do sistema de informação foi crucial para aumentar a adesão ao protocolo de sepse, quando em 2017 implementou-se formulários e fluxograma no prontuário eletrônico. Em 2019, com a mudança de sistema para o Tasy, evoluímos com a introdução das prescrições para o protocolo de sepse, já vinculadas à solicitação dos exames. Além destas estratégias para incentivo à adesão foi realizado: confecção de banners, stoppers, um manual compacto do protocolo de sepse para envio no whatsapp, capacitação dos profissionais; premiação e divulgação na mídia do hospital dos profissionais destaques, dentre outras. Ressalta-se a utilização para gerenciamento dos indicadores, a partir de 2018, das ferramentas da qualidade: Diagrama de Ishikawa, PDSA e planilha 5W2H, que contribuíram de forma importante para o monitoramento.

Background: A sedentary lifestyle and an unhealthy diet have considerably increased the incidence of diabetes mellitus worldwide in recent decades, which has generated a high rate of associated chronic complications. Methods: A narrative review was performed in MEDLINE, EMBASES and SciELO databases, including 162 articles. Results: Diabetic neuropathy (DN) is the most common of these complications, mainly producing two types of involvement: sensorimotor neuropathy, whose most common form is symmetric distal polyneuropathy, and autonomic neuropathies, affecting the cardiovascular, gastrointestinal, and urogenital system. Although hyperglycemia is the main metabolic alteration involved in its genesis, the presents of obesity, dyslipidemia, arterial hypertension, and smoking, play an additional role in its appearance. In the pathophysiology, three main phenomena stand out: oxidative stress, the formation of advanced glycosylation end-products, and microvasculature damage. Diagnosis is clinical, and it is recommended to use a 10 g monofilament and a 128 Hz tuning fork as screening tools. Glycemic control and non-pharmacological interventions constitute the mainstay of DN treatment, although there are currently investigations in antioxidant therapies, in addition to pain management. Conclusions: Diabetes mellitus causes damage to peripheral nerves, being the most common form of this, distal symmetric polyneuropathy. Control of glycemia and comorbidities contribute to prevent, postpone, and reduce its severity. Pharmacological interventions are intended to relieve pain.

Abstract Background Stigma affects different life aspects in people living with bipolar disorder and their families. This study aimed to examining the experience of stigma and evaluating predictors, consequences and strategies to combat stigma in people with bipolar disorder and their families. Methods We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) in 2022. We extensively reviewed six online databases (PubMed, Scopus, Medline, EMBASE, Web of Science and Google Scholar). Articles published in the English language about stigma in people living with bipolar disorders and their families were included. Results A total of 42,763 articles were retrieved, of which 40 articles from 14 countries were included in this study (n = 7417 participants). Of the 40 articles, 29 adopted quantitative methods (72.5%), two used mixed-methods (5%), eight used qualitative (20%) methods, and one was a case series (2.5%). The results of the studies were categorized into four themes: 1. Stigma experienced by people living with bipolar disorders and their families, 2. Predictors of stigma in people living with bipolar disorders and their families, 3. Consequences of stigma in people living with bipolar disorders and their families, 4. Effective interventions and strategies to reduce stigma in people living with bipolar disorders and their families. Conclusion The results of this study might be useful to design psychiatric cognitive interventions to reduce stigma in people living with bipolar disorders and their families and designing community-based interventions to normalize bipolar disorder at the community level.

For the first time ever, samples were collected from volcanic lake waters in Costa Rica using an unmanned aerial vehicle (drone), which represents a major achievement in human–machine interaction and innovation in the technology sector. A Matrice 600 Pro drone was used for remote sampling in the hyperacid crater lake of the Poás volcano, the mildly acidic Lake Botos, and the nearly neutral Lake Hule. A bailer bottle of 250 mL and a HOBO temperature probe, mounted on the drone, were deployed using a specially designed delivery retrieval system. A comparison was carried out relating to the geochemistry of lake water collected by drone as opposed to the hand-collected samples. The SO4−2/Cl ratios of the two samples at Poás hyperacid crater lake were similar, (1.1 ± 0.2) on average, an indication of a lake with homogenous water composition. The Lake Hule showed a similar composition to that registered 20 years ago. The waters from Lake Botos showed some differences, which may be explained by the influence of springs at the bottom of the lake, but the Wilcoxon's signed-rank test showed a good exhibit of a satisfactory level of similarity. Autonomous navigation proves to be very useful for faster, more efficient, reliable, and less hazardous sampling of volcanic lakes.

The purpose of this paper is to investigate decision-making in export financing services by banks in Hungary. The case studies are of one export credit agency and eight commercial banks. The data was collected through interviews and to interpret the data content analysis with an inductive approach was used. The results show that the decision-making system in export financing services in Hungary tends to be centralized and bureaucratic with a mostly participative leadership style. Effectiveness in the decision-making process is influenced by decision-related factors, human-qualification factors, and organizational contextual factors which can be amplified by certain other factors.

Abstract Background The aim of this study is to evaluate the short- and long-term effects of the universal mental health literacy intervention “EspaiJove.net” in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population. We also examine whether these effects depend on the intervention intensity. Methods A clustered school-based randomised controlled trial (cRCT) design. Subjects: 1,298 secondary pupils aged 13 and 14 were recruited from 18 schools in Barcelona (Spain) between September 2016 and January 2018. Intervention: Three programmes were assessed: 1) Sensitivity Programme (SP; 1 h); 2) Mental Health Literacy (MHL; 6 h); 3) MHL plus a first-person Stigma Reduction Programme (MHL + SR; 7 h); 4) Control group (CG): waiting list. Outcome measures: 1) MHL: EspaiJove.net EMHL Test (First part and Second Part); 2) Stigma: RIBS and CAMI; 3) Help-seeking and use of treatment: GHSQ. Analysis: The data was collected at baseline, post-intervention and 6 and 12 months later. An intention-to-treat analysis and imputation method was used to analyse the missing data. Intervention effects were analysed using multilevel modelling. Results One thousand thirty-two students were included (SP = 225; MHL = 261; MHL + SR = 295 and CG = 251). The MHL and MHL + SR interventions showed short- and long-term an increase in knowledge compared to SP and CG, but no significant change post-intervention or over time (First part p = 0.52 and Second part p = 0.62) between intervention groups and CG. No significant changes were found in stigma scores post-intervention or over time (CAMI p = 0.61 and RIBS p = 0.98) or in help-seeking scores (parent p = 0.69; teacher p = 0.23 and healthcare professional p = 0.75). The MHL + SR intervention was the best valued and recommended (p

Abstract Background One of the most challenging issues faced by families of people living with bipolar disorder is stigma. This study was conducted to explain the process of stigma experience in the families of people living with bipolar disorder using the grounded theory method. Methods Data for this study were collected through semi-structured interviews with participants in Razi Psychiatric Hospital in Tehran, Iran, via purposive sampling and field notetaking. The dependability, conformability, and transferability measures were included to support the data accuracy and robustness, and MAXQDA 2020 software was used to facilitate data coding. The Strauss–Corbin method was used to analyse the data. Results A total of 20 family members of people living with bipolar disorder, four people living with bipolar disorder, and three mental health professionals participated in this study. The analysis of participants’ experiences led to identifying 64 subcategories, 21 categories, and six main concepts, including social deprivation, being labelled, cultural deficiency and lack of awareness, economic challenges, forced acceptance of the existing situation, and social isolation. Conclusion Families of people living with bipolar disorder experience social deprivation, social isolation, and social rejection, which have irreparable consequences for them. Overcoming stigma in these families should be a priority of policymakers and planners in the field of psychosocial health.

Abstract The fission yeast mitogen-activated kinase (MAPK) Sty1 is essential for cell survival in response to different environmental insults. In unstimulated cells, Sty1 forms an inactive ternary cytoplasmatic complex with the MAPKK Wis1 and the MAPKAP kinase Srk1. Wis1 phosphorylates and activates Sty1, inducing the nuclear translocation of the complex. Once in the nucleus, Sty1 phosphorylates and activates Srk1, which in turns inhibits Cdc25 and cell cycle progression, before being degraded in a proteasome-dependent manner. In parallel, active nuclear Sty1 activates the transcription factor Atf1, which results in the expression of stress response genes including pyp2 (a MAPK phosphatase) and srk1. Despite its essentiality in response to stress, persistent activation of the MAPK pathway can be deleterious and induces cell death. Thus, timely pathway inactivation is essential to ensure an appropriate response and cell viability. Here, uncover a role for the MAPKAP kinase Srk1 as an essential component of a negative feedback loop regulating the Sty1 pathway through phosphorylation and inhibition of the Wis1 MAPKK. This feedback regulation by a downstream kinase in the pathway highlights an additional mechanism for fine-tuning of MAPK signaling. Thus, our results indicate that Srk1 not only facilitates the adaptation to stress conditions by preventing cell cycle progression, but also plays an instrumental role regulating the upstream kinases in the stress MAPK pathway.

BackgroundThe COVID-19 pandemic severely affected everyday life and working conditions for most Europeans, particularly health care professionals (HCPs). Over the past 3 years, various policies have been implemented in various European countries. Studies have reported on the worsening of mental health, work-related stress, and helpful coping strategies. However, having a closer look is still necessary to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff. ObjectiveThis study aimed to obtain quantitative information on job-related stressors of physicians and nurses and the coping strategies of HCPs and nonmedical staff at 2 periods of the COVID-19 pandemic. By further analyzing qualitative comments, we wanted to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff on different levels of experience. MethodsA cross-sectional survey was conducted at 2 time points during the COVID-19 pandemic in several European countries. The first study period (T1) lasted between April 1 and June 20, 2020, and the second study period (T2) lasted between November 25, 2021, and February 28, 2022. On a quantitative level, we used a questionnaire on stressors for physicians and nurses and a questionnaire on coping strategies for HCPs and nonmedical staff. Quantitative data were descriptively analyzed for mean values and differences in stressors and coping strategies. Qualitative data of free-text boxes of HCPs and nonmedical staff were analyzed via thematic analysis to explore the experiences of the individuals. ResultsT1 comprised 609 participants, and T2 comprised 1398 participants. Overall, 296 participants made 438 qualitative comments. The uncertainty about when the pandemic would be controlled (T1: mean 2.28, SD 0.85; T2: mean 2.08, SD 0.90) and the fear of infecting the family (T1: mean 2.26, SD 0.98; T2: mean 2.02, SD 1.02) were the most severe stressors identified by physicians and nurses in both periods. Overall, the use of protective measures (T1: mean 2.66, SD 0.60; T2: mean 2.66, SD 0.60) and acquiring information about COVID-19 (T1: mean 2.29, SD 0.82; T2: mean 1.99, SD 0.89) were identified as the most common coping strategies for the entire study population. Using thematic analysis, we identified 8 themes of personal experiences on the micro, meso, and macro levels. Measures, working conditions, feelings and emotions, and social climate were frequently mentioned topics of the participants. In T1, feelings of isolation and uncertainty were prominent. In T2, feelings of exhaustion were expressed and vaccination was frequently discussed. Moreover, unmet psychosocial needs were identified. ConclusionsThere is a need for improvement in pandemic preparedness. Targeted vocational education measures and setting up of web-based mental health support could be useful to bridge gaps in psychosocial support needs in future crises.

Background & Aims: Lipotoxicity triggers non-alcoholic fatty liver disease (NAFLD) progression owing to the accumulation of toxic lipids in hepatocytes including saturated fatty acids (SFAs), which activate pro-inflammatory pathways. We investigated the impact of hepatocyte- or circulating-derived small extracellular vesicles (sEV) secreted under NAFLD conditions on liver inflammation and hepatocyte insulin signalling. Methods: sEV released by primary mouse hepatocytes, characterised and analysed by lipidomics, were added to mouse macrophages/Kupffer cells (KC) to monitor internalisation and inflammatory responses. Insulin signalling was analysed in hepatocytes exposed to conditioned media from sEV-loaded macrophages/KC. Mice were i.v. injected sEV to study liver inflammation and insulin signalling. Circulating sEV from mice and humans with NAFLD were used to evaluate macrophage–hepatocyte crosstalk. Results: Numbers of sEV released by hepatocytes increased under NAFLD conditions. Lipotoxic sEV were internalised by macrophages through the endosomal pathway and induced pro-inflammatory responses that were ameliorated by pharmacological inhibition or deletion of Toll-like receptor-4 (TLR4). Hepatocyte insulin signalling was impaired upon treatment with conditioned media from macrophages/KC loaded with lipotoxic sEV. Both hepatocyte-released lipotoxic sEV and the recipient macrophages/KC were enriched in palmitic (C16:0) and stearic (C18:0) SFAs, well-known TLR4 activators. Upon injection, lipotoxic sEV rapidly reached KC, triggering a pro-inflammatory response in the liver monitored by Jun N-terminal kinase (JNK) phosphorylation, NF-κB nuclear translocation, pro-inflammatory cytokine expression, and infiltration of immune cells into the liver parenchyma. sEV-mediated liver inflammation was attenuated by pharmacological inhibition or deletion of TLR4 in myeloid cells. Macrophage inflammation and subsequent hepatocyte insulin resistance were also induced by circulating sEV from mice and humans with NAFLD. Conclusions: We identified hepatocyte-derived sEV as SFA transporters targeting macrophages/KC and activating a TLR4-mediated pro-inflammatory response enough to induce hepatocyte insulin resistance. Impact and Implications: Small extracellular vesicles (sEV) released by the hepatocytes under non-alcoholic fatty liver disease (NAFLD) conditions cause liver inflammation and insulin resistance in hepatocytes via paracrine hepatocyte–macrophage–hepatocyte crosstalk. We identified sEV as transporters of saturated fatty acids (SFAs) and potent lipotoxic inducers of liver inflammation. TLR4 deficiency or its pharmacological inhibition ameliorated liver inflammation induced by hepatocyte-derived lipotoxic sEV. Evidence of this macrophage–hepatocyte interactome was also found in patients with NAFLD, pointing to the relevance of sEV in SFA-mediated lipotoxicity in NAFLD.

En este trabajo analizamos desde una perspectiva feminista y decolonial, la violencia patriarcal y extractivista contra mujeres rurales en tiempos de pandemia, en una provincia del Noroeste argentino. El período de estudio abarcó desde el inicio del Aislamiento Social, Preventivo y Obligatorio a partir del decreto presidencial Nº 297 del 19 de marzo del 2020 hasta fines de diciembre del 2021. La estrategia metodológica se apoyó en un enfoque cualitativo que contempló entrevistas, trabajo de campo in situ, análisis de noticias de periódicos e informes de instituciones estatales y de organismos internacionales, y un estudio de caso instrumental. En el período analizado, a pesar de las medidas de aislamiento obligatorio, el avance del frente estatal-empresarial en los territorios campesinos e indígenas de la provincia para el desarrollo de la soja y la producción ganadera ha resultado en un proceso de expropiación en muchos sentidos y en un aumento de las violencias hacia las mujeres.

Background: Whole-breast irradiation (WBI) after breast conserving surgery (BCS) is indicated to improve loco-regional control and survival. Former studies showed that addition of tumor bed boost in all age groups significantly improved local control although no apparent impact on overall survival but with an increased risk of worse cosmetic outcome. Even though shortened regimens in 3 weeks are considered the standard, recent studies have shown the non-inferiority of a treatment regimen of 5 fractions in one-week in both locoregional control and toxicity profile, although simultaneous integrated boost (SIB) in this setting has been scarcely studied. Materials and Methods: From March-2020 to March-2022, 383 patients with early breast cancer diagnosis and a median age of 56 years-old (range 30–99)were included in a prospective registry of ultra-hypofractionated WBI up to a total dose of 26 Gy in 5.2 Gy/fraction with a SIB of 29 Gy in 5.8 Gy/fraction in 272 patients (71%), 30–31 Gy in 6–6.2 Gy/fraction in 111 patients (29%) with close/focally affected margins. Radiation treatment was delivered by conformal 3-D technique in 366 patients (95%), VMAT in 16patients (4%) and conformal 3-D with deep inspiration breath hold (DIBH) in 4patients (1%). Ninety-three per cent of patients received endocrine therapy and 43% systemic or targeted chemotherapy. Development of acute skin complications was retrospectively reviewed. Results: With a median follow-up of 18 months (range 7–31), all patients are alive without evidence of local, regional or distant relapse. Acute tolerance was acceptable, with null o mild toxicity: 182 (48%) and 15 (4%) patients developed skin toxicity grade 1 and 2 respectively; 9 (2%) and 2 (0.5%) patients breast edema grade 1and 2 respectively. No other acute toxicities were observed. We also evaluated development of early delayed complications and observed grade 1 breast edema in 6 patients (2%); grade 1 hyperpigmentation in 20 patients (5%); and grade 1 and 2 breast induration underneath boost region in 10(3%) and 2 patients (0.5%) respectively. We found a statistically significant correlation between the median PTVWBI and presence of skin toxicity (p = 0.028) as well as a significant correlation between late hyperpigmentation with the median PTVBOOST (p = 0.007) and the ratio PTVBOOST/PTVWBI (p = 0.042). Conclusion: Ultra-hypofractionated WBI + SIB in 5 fractions over one-week is feasible and well tolerated, although longer follow-up is necessary to confirm these results.

Olanzapine (OLA), a widely used second-generation antipsychotic (SGA), causes weight gain and metabolic alterations when administered orally to patients. Recently, we demonstrated that, contrarily to the oral treatment which induces weight gain, OLA administered via intraperitoneal (i.p.) in male mice resulted in body weight loss. This protection was due to an increase in energy expenditure (EE) through a mechanism involving the modulation of hypothalamic AMPK activation by higher OLA levels reaching this brain region compared to those of the oral treatment. Since clinical studies have shown hepatic steatosis upon chronic treatment with OLA, herein we further investigated the role of the hypothalamus-liver interactome upon OLA administration in wild-type (WT) and protein tyrosine phosphatase 1B knockout (PTP1B–KO) mice, a preclinical model protected against metabolic syndrome. WT and PTP1B–KO male mice were fed an OLA-supplemented diet or treated via i.p. Mechanistically, we found that OLA i.p. treatment induces mild oxidative stress and inflammation in the hypothalamus in a JNK1-independent and dependent manner, respectively, without features of cell dead. Hypothalamic JNK activation up-regulated lipogenic gene expression in the liver though the vagus nerve. This effect concurred with an unexpected metabolic rewiring in the liver in which ATP depletion resulted in increased AMPK/ACC phosphorylation. This starvation-like signature prevented steatosis. By contrast, intrahepatic lipid accumulation was observed in WT mice treated orally with OLA; this effect being absent in PTP1B–KO mice. We also demonstrated an additional benefit of PTP1B inhibition against hypothalamic JNK activation, oxidative stress and inflammation induced by chronic OLA i.p. treatment, thereby preventing hepatic lipogenesis. The protection conferred by PTP1B deficiency against hepatic steatosis in the oral OLA treatment or against oxidative stress and neuroinflammation in the i.p. treatment strongly suggests that targeting PTP1B might be also a therapeutic strategy to prevent metabolic comorbidities in patients under OLA treatment in a personalized manner.

Background: In the Americas, deaths by diseases avoidable with vaccines are a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. Objectives: this study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. Methods: This study used the coverage data for the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a Joinpoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CIs) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. Results: Overall, America saw a decrease in vaccine coverage during this period, with an APC of −1.4 (95% CI −1.8; −1.0). This trend varied across regions. In North America, the decrease was negligible (−0.1% APC). South America showed the steepest decrease, with an APC of −2.5%. Central America also declined, with an APC of −1.3%. Our findings suggest a concerning trend of declining DTP-vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was −4% between 2019 and 2022, with the most important drop being in Central America (−7%). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being −7.37%. This decline poses an important challenge to achieving the WHO’s target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. Conclusions: The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America.

Bovine tuberculosis and paratuberculosis are endemic in many areas worldwide. This work aims to study cytokines production and gene expression profiles of bovine macrophages infected with Mycobacterium bovis and Mycobacterium paratuberculosis subsp. avium (MAP) strains to identify potential diagnostic biomarkers. Bovine bone marrow stem cells were differentiated into macrophages and subsequently infected in vitro with different spoligotypes of M. bovis and MAP field strains (as single infections and coinfections), using different multiplicity of infection. Supernatant and cell pellets were collected 24 h, 48 h, and one week post-infection. Preliminarily, gene expression on cell pellets of IL-1β, IL-2, INFγ, IL-6, IL-10, IL-12, and TNFα was assessed by qRT-PCR one week p.i. Subsequently, IL-1β and IL-6 were measured by ELISA and qRT-PCR to investigated their production retrospectively 24 h and 48 h p.i. A variability in macrophages response related to the concentration of mycobacteria, the coinfection with MAP, and M. bovis spoligotypes was identified. An early and constant IL-6 increase was observed in the M. bovis infection. A lower increase in IL-1β was also detected at the highest concentration of the two M. bovis spoligotypes one week post-infection. IL-6 and IL-1 β production was reduced and differently expressed in the MAP infection. IL-6 appeared to be the earliest cytokines produced by bovine macrophages infected with M. bovis.