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Cardiac catheterization remains the gold standard for the diagnosis and management of pediatric pulmonary hypertension (PH). There is lack of consensus regarding optimal anesthetic and airway regimen. This retrospective study describes the anesthetic/airway experience of our single center cohort of pediatric PH patients undergoing catheterization, in which obtaining hemodynamic data during spontaneous breathing is preferential. A total of 448 catheterizations were performed in 232 patients. Of the 379 cases that began with a natural airway, 274 (72%) completed the procedure without an invasive airway, 90 (24%) received a planned invasive airway, and 15 (4%) required an unplanned invasive airway. Median age was 3.4 years (interquartile range [IQR] 0.7-9.7); the majority were either Nice Classification Group 1 (48%) or Group 3 (42%). Vasoactive medications and cardiopulmonary resuscitation were required in 14 (3.7%) and eight (2.1%) cases, respectively; there was one death. Characteristics associated with use of an invasive airway included age

Introduction: Benzodiazepines are frequently prescribed and misused therefore urine drug screening (UDS) is performed in many patient populations. Most current benzodiazepine immunoassays have poor sensitivity, particularly for detecting the metabolites of newer benzodiazepines such as lorazepam in urine. Objectives: We aimed to verify the clinical performance of the new qualitative Roche Benzodiazepines II (BNZ2) immunoassay, as well as compare its performance to the Roche Benzodiazepines Plus (BENZ) assay in two patient populations: UDS in the emergency department (ED) and compliance monitoring. Methods: An initial verification study was performed, selecting for samples containing clonazepam and lorazepam metabolites. Performance of the BNZ2 and BENZ assays was compared to liquid chromatography-tandem mass spectrometry (LC-MS/MS) as the reference method. Sensitivity, specificity, false positive rate (FPR) and false negative rate (FNR) were determined. Results: We verified the performance claims in the initial verification and demonstrated similar precision, with coefficient of variations (CVs) of 12.8% and 7.7% for negative and positive controls, respectively. Furthermore, we observed higher clinical sensitivity and lower FNR with the BNZ2 assay in both the ED and compliance monitoring populations due to improved cross-reactivity for lorazepam and clonazepam metabolites. Despite these improvements, the BNZ2 assay was unable to detect 27% of specimens positive by LC-MS/MS, including specimens from patients using benzodiazepines without prescription. Discussion: Due to its improved performance and rapid turnaround time, the BNZ2 assay should be implemented for UDS in the ED. However, the assay should not replace LC-MS/MS testing for compliance monitoring, as unsuspected benzodiazepine use may go undetected.

Enlargement of the endolymphatic sac, duct, and vestibular aqueduct (EVA) is the most common inner ear malformation identified in patients with sensorineural hearing loss. EVA is associated with pathogenic variants in SLC26A4. However, in European-Caucasian populations, about 50% of patients with EVA carry no pathogenic alleles of SLC26A4. We tested for the presence of variants in CHD7, a gene known to be associated with CHARGE syndrome, Kallmann syndrome, and hypogonadotropic hypogonadism, in a cohort of 34 families with EVA subjects without pathogenic alleles of SLC26A4. In two families, NM_017780.4: c.3553A > G [p.(Met1185Val)] and c.5390G > C [p.(Gly1797Ala)] were detected as monoallelic CHD7 variants in patients with EVA. At least one subject from each family had additional signs or potential signs of CHARGE syndrome but did not meet diagnostic criteria for CHARGE. In silico modeling of these two missense substitutions predicted detrimental effects upon CHD7 protein structure. Consistent with a role of CHD7 in this tissue, Chd7 transcript and protein were detected in all epithelial cells of the endolymphatic duct and sac of the developing mouse inner ear. These results suggest that some CHD7 variants can cause nonsyndromic hearing loss and EVA. CHD7 should be included in DNA sequence analyses to detect pathogenic variants in EVA patients. Chd7 expression and mutant phenotype data in mice suggest that CHD7 contributes to the formation or function of the endolymphatic sac and duct.

La ciudad india de Fatehpur Sikri presenta una configuración urbana y territorial que entra en conflicto geométrico con el promontorio rocoso donde se asienta. Sin embargo, esta disposición, heredera de la tradición cultural islámica e hindú, es capaz también de crear un brillante recorrido espacial alejado de la configuración axial donde el giro y la sorpresa producen un interesante itinerario al atravesar sus palacios y sus edificios de arenisca roja. Asimismo, los edificios de la ciudad no son ajenos a este particular ordenamiento, y una serie de pabellones individuales organizan el recorrido por el espacio urbano actuando como puntos de referencia. Este artículo propone un estudio en cuanto al espacio urbano y arquitectónico de la ciudad manifestando cómo uno depende del otro indefectiblemente. De este modo, analiza cómo las ideas espaciales de los pabellones están entrelazadas con la idea madre de la ciudad. Para ello, los autores redibujan los planos de emplazamiento de Fatehpur Sikri y los planos de planta y sección de los pabellones con medidas y levantamientos tomados in situ.

Abstract Background Pulmonary ionocytes have been identified in the airway epithelium as a small population of ion transporting cells expressing high levels of CFTR (cystic fibrosis transmembrane conductance regulator), the gene mutated in cystic fibrosis. By providing an infinite source of airway epithelial cells (AECs), the use of human induced pluripotent stem cells (hiPSCs) could overcome some challenges of studying ionocytes. However, the production of AEC epithelia containing ionocytes from hiPSCs has proven difficult. Here, we present a platform to produce hiPSC-derived AECs (hiPSC-AECs) including ionocytes and investigate their role in the airway epithelium. Methods hiPSCs were differentiated into lung progenitors, which were expanded as 3D organoids and matured by air-liquid interface culture as polarised hiPSC-AEC epithelia. Using CRISPR/Cas9 technology, we generated a hiPSCs knockout (KO) for FOXI1, a transcription factor that is essential for ionocyte specification. Differences between FOXI1 KO hiPSC-AECs and their wild-type (WT) isogenic controls were investigated by assessing gene and protein expression, epithelial composition, cilia coverage and motility, pH and transepithelial barrier properties. Results Mature hiPSC-AEC epithelia contained basal cells, secretory cells, ciliated cells with motile cilia, pulmonary neuroendocrine cells (PNECs) and ionocytes. There was no difference between FOXI1 WT and KO hiPSCs in terms of their capacity to differentiate into airway progenitors. However, FOXI1 KO led to mature hiPSC-AEC epithelia without ionocytes with reduced capacity to produce ciliated cells. Conclusion Our results suggest that ionocytes could have role beyond transepithelial ion transport by regulating epithelial properties and homeostasis in the airway epithelium.

Abstract We revisit the Next-to-Leading Order (two-loop) contributions to the Anomalous Dimensions of ∆F = 1 four-quark operators in QCD. We devise a test for anomalous dimensions, that we regard as of general interest, and by means of which we detect a problem in the results available in the literature. Deconstructing the steps leading to the available result, we identify the source of the problem, which is related to the operator known as Q 11. We show how to fix the problem and provide the corrected anomalous dimensions. With the insight of our findings, we propose an alternative approach to the one used in the literature which does not suffer from the identified disease, and which confirms our corrected results. We assess the numerical impact of our corrections, which happens to be in the ballpark of 5% in certain entries of the evolution matrix. Our results are important for the correct resummation of Next-to-Leading Logarithms in analyses of physics beyond the Standard Model in ∆F = 1 processes, such as the decays of Kaons and B-mesons.

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft‐tissue sarcomas with a poor survival rate, presenting either sporadically or in the context of neurofibromatosis type 1 (NF1). The histological diagnosis of MPNSTs can be challenging, with different tumors exhibiting great histological and marker expression overlap. This heterogeneity could be partly responsible for the observed disparity in treatment response due to the inherent diversity of the preclinical models used. For several years, our group has been generating a large patient‐derived orthotopic xenograft (PDOX) MPNST platform for identifying new precision medicine treatments. Herein, we describe the expansion of this platform using six primary tumors clinically diagnosed as MPNSTs, from which we obtained six additional PDOX mouse models and three cell lines, thus generating three pairs of in vitro–in vivo models. We extensively characterized these tumors and derived preclinical models, including genomic, epigenomic, and histological analyses. Tumors were reclassified after these analyses: three remained as MPNSTs (two being classic MPNSTs), one was a melanoma, another was a neurotrophic tyrosine receptor kinase (NTRK)‐rearranged spindle cell neoplasm, and, finally, the last was an unclassifiable tumor bearing neurofibromin‐2 (NF2) inactivation, a neuroblastoma RAS viral oncogene homolog (NRAS) oncogenic mutation, and a SWI/SNF‐related matrix‐associated actin‐dependent regulator of chromatin (SMARCA4) heterozygous truncated variant. New cell lines and PDOXs faithfully recapitulated histology, marker expression, and genomic characteristics of the primary tumors. The diversity in tumor identity and their specific associated genomic alterations impacted treatment responses obtained when we used the new cell lines for testing compounds against known altered pathways in MPNSTs. In summary, we present here an extension of our MPNST precision medicine platform, with new PDOXs and cell lines, including tumor entities confounded as MPNSTs in a real clinical scenario. This platform may constitute a useful tool for obtaining correct preclinical information to guide MPNST clinical trials.

While the impact of authentic research experiences in STEM on student engagement and interest in science has been documented, less is known about the role of peer communities in fostering this interest and engagement. This research explores the idea that a strong peer community can catalyze deep learning and engagement in scientific research among high school students. The program engaged 20 high school students in a year-long community-based participatory research project in public health each year. The study used a mixed methods approach, combining data from focus group discussions, observations, and surveys to describe the program's impact on participants. Analysis across three years reveals that (a) the program was associated with a statistically significant shift in students' identity as researchers, with a medium growth effect size (Cohen's d) for the second and third years, which moderated by the end of the program, and (b) the peer community played a central role in the participants' engagement in the program, on their identity as researchers, and strengthened their interest in STEM. These findings convey the importance of designing STEM experiences that build strong peer communities around science practices and how such communities can have profound impacts on students' identities in STEM.

BACKGROUND: Technetium-99m-labeled Tilmanocept, a multivalent mannose, is readily internalized by the CD206 surface receptor on macrophages and dendritic cells which are abundantly present in lymph nodes. We want to examine the drainage patterns of Technetium-99m-labeled Tilmanocept to sentinel lymph nodes (SLNs) in melanoma patients following the 10% rule. METHODS: Multi-center retrospective review of patients with cutaneous melanoma undergoing SLN biopsy using Technetium-99m-labeled Tilmanocept between 2008 and 2014 was conducted. Statistical methods were used for data analyses. RESULTS: Of the 564 patients (mean age of 60.3 and 62% male) with preoperative lymphoscintigraphy showing at least one SLN, several primary tumor sites were included: 27% head/neck, 33% trunk, 21% upper extremity and 19% lower extremity. For the head/neck primary site, 36.5% of patients had multiple draining basins; for the trunk site, 36.4% of patients; for the upper extremity site, 13% of patients; and for the lower extremity, 27.4% of patients. A median of 3 (range 1-18) SLNs were identified and resected. Overall, 78% of patients had >1 SLN identified by Technetium-99m-labeled Tilmanocept. In a multivariate model, patients with >1 SLN were significantly associated with age, Breslow depth, tumor location and higher AJCC tumor stage. A total of 17.7% of patients (100/564) had a positive SLN identified. A total of 145 positive SLNs were identified out of 1,812 SLNs with a positive SLN rate of 8%. Positive SLN status was significantly associated with younger age, greater Breslow depth, mitosis rate, higher AJCC tumor stage, presence of ulceration and angiolymphatic invasion. CONCLUSIONS: Using the 10% rule, Technetium-99m-labeled Tilmanocept detects multiple SLNs in most melanoma patients.

We employ numerical models to explore the connection between subduction zone coupling or megathrust rupture and upper plate faults in the northern Cascadia forearc. Active forearc faults north of the Olympic Peninsula exhibit similar characteristics: west-northwest strike, oblique right-lateral slip senses, and low slip rates (

Summary: A diet lacking dietary fibers promotes the expansion of gut microbiota members that can degrade host glycans, such as those on mucins. The microbial foraging on mucin has been associated with disruptions of the gut-protective mucus layer and colonic inflammation. Yet, it remains unclear how the co-utilization of mucin and dietary fibers affects the microbiota composition and metabolic activity. Here, we used 14 dietary fibers and porcine colonic and gastric mucins to study the dynamics of mucin and dietary fiber utilization by the human fecal microbiota in vitro. Combining metaproteome and metabolites analyses revealed the central role of the Bacteroides genus in the utilization of complex fibers together with mucin while Akkermansia muciniphila was the main utilizer of sole porcine colonic mucin but not gastric mucin. This study gives a broad overview of the colonic environment in response to dietary and host glycan availability.

IntroductionScarce real-life data exists for COVID-19 management in hematologic disease (HD) patients in the Omicron era.PurposeTo assess the current clinical management and outcome of SARS-CoV-2 infection diagnosed, identify the risk factors for severe outcomes according to the HD characteristics and cell therapy procedures in a real-world setting.MethodsA retrospective observational registry led by the Spanish Transplant Group (GETH-TC) with 692 consecutive patients with HD from December 2021 to May 2023 was analyzed.ResultsNearly one-third of patients (31%) remained untreated and presented low COVID-19-related mortality (0.9%). Nirmatrelvir/ritonavir was used mainly in mild COVID-19 cases in the outpatient setting (32%) with a low mortality (1%), while treatment with remdesivir was preferentially administered in moderate-to-severe SARS-CoV-2 infection cases during hospitalization (35%) with a mortality rate of 8.6%. The hospital admission rate was 23%, while 18% developed pneumonia. COVID-19-related mortality in admitted patients was 14%. Older age, autologous hematopoietic stem cell transplantation (SCT), chimeric antigen receptor T-cell therapy, corticosteroids and incomplete vaccination were factors independently associated with COVID-19 severity and significantly related with higher rates of hospital admission and pneumonia. Incomplete vaccination status, treatment with prior anti-CD20 monoclonal antibodies, and comorbid cardiomyopathy were identified as independent risk factors for COVID-19 mortality.ConclusionsThe results support that, albeit to a lower extent, COVID-19 in the Omicron era remains a significant problem in HD patients. Complete vaccination (3 doses) should be prioritized in these immunocompromised patients. The identified risk factors may help to improve COVID-19 management to decrease the rate of severe disease, ICU admissions and mortality.

Octadecylphosphonic acid self-assembled monolayers were used as a combined carbon and hydrogen source to grow graphene films on sapphire substrates via hot filament chemical vapor deposition. The functionalized substrates were sealed with a thin Cu film and heated to 950°C under Ar flow. After synthesis, the Cu was etched away. The graphene samples then underwent a hydrogenation treatment in the same reactor setup, exposed to a CH4/H2 gas mixture at 820°C for 2 hours. The structure and properties of the graphene films before and after hydrogenation were characterized. Raman spectroscopy was employed to probe the defect-related bands and C-H bonding. X-ray diffraction provided insights into the crystalline structure and interlayer spacing. The ferromagnetic response was measured using a PPMS system across a range of temperatures and magnetic fields. XPS was used to assess the chemical composition and bonding. This multi-step process enabled a detailed evaluation of the novel synthesis protocol and its effects on the resulting hydrogenated graphene material.

Introduction: chronic kidney disease is an aggravating condition for the public health system. The detection and timely monitoring of the triggering and progression factors of the disease are a priority in each health system. Objective: to characterize chronic kidney disease in patients with type 2 diabetes mellitus with poor metabolic control. Method: a descriptive, cross-sectional study was carried out on patients with type 2 diabetes mellitus who entered the chronic kidney disease program of the Hospital “Dr. Miguel Enríquez” from October 2021 to January 2023. The population was made up of 175 patients; the sample selected was of 74 patients, who met the inclusion criteria after signing the informed consent. Results: there was a predominance of chronic kidney disease in young patients (64% in 18 to 49 years olds); likewise, the female sex represented a 65.3%; and a duration of type 2 diabetes mellitus of 1 to 5 years in 49.3%; the most frequent comorbidities were: dyslipidemia, arterial hypertension and heart failure with a prevalence of 89.3%, 79.3% and 41.3% respectively. The predominant kidney damage stage was grade 2 in a 20.0%; 4% of patients required renal replacement treatment. Conclusions: kidney disease usually progresses more in women and in patients with multiple cardiovascular risk factors. Inadequate glycemic control is associated with the progression of kidney disease. Damage to kidney function largely depends on metabolic control.

Fundamento: La educación con enfoque inclusivo en Cuba es prioridad, ella está en el centro de los estudios que realizan psicólogos, pedagogos y especialistas; por ello es necesaria la preparación de profesores en esta dirección. En el caso del profesor de Educación Física en los distintos niveles educativos debe aprovechar las posibilidades que ofrece el deporte para la estimulación de potencialidades en los escolares con situación de discapacidad, lo que ayudaría a mejorar este proceso en la escuela primaria contemporánea. Objetivo: Proponer un sistema de actividades para la preparación de los profesores de Educación Física de manera que favorezca el desarrollo de habilidades, conocimientos y motivaciones para la dirección del Deporte para Todos con enfoque inclusivo. Metodología: Se trabajó con los 20 profesores de Educación Física que pertenecen a las 8 escuelas generales que están inmersas en el proceso de inclusión y la escuela especial en el municipio Cabaiguán, específicamente en el sector urbano. Se emplearon diferentes métodos de investigación, como la observación, análisis de documentos, entrevista y criterio de especialistas. Resultado: La propuesta de actividades de preparación para los profesores de Educación Física permite un eficiente trabajo en la organización, desarrollo y dirección del Deporte para Todos en un contexto deportivo inclusivo y sostenible, incentiva la creatividad e innovación, mejora el nivel de preparación del profesor permitiendo transformar la práctica educativa. Los especialistas consideraron las actividades como bastante adecuado para la preparación del profesor de Educación Física, pues sus perspectivas inclusivas ofrecen respuestas a la necesidad de organizar y desarrollar el Deporte para Todos con escolares en situación de discapacidad en las escuelas. Conclusiones: El sistema de actividades para la preparación de los profesores de Educación Física puede incidir de manera favorable, permitiendo el desarrollo de habilidades, conocimientos y nuevas motivaciones en la dirección del Deporte para Todos con enfoque inclusivo.

Lithium–sulfur batteries (LiSBs) offer high energy density, cost-effectiveness, and eco-friendliness, making them promising for future energy storage. This study explores using BiFeO3 (BFO) nanoparticles (NPs) to tackle challenges such as lithium polysulfides (LiPs) and shuttle issues in LiSBs. It employs a solid-state melt diffusion technique, encapsulates sulfur in single-walled carbon nanotubes (SCNTs), and utilizes BFO for effective polysulfide control. Herein, composite cathodes of sulfur (S)/SCNTs (abbr. SCNT) were fabricated, and cells were designed using a BFO-coated separator (SCNT-BFS). In addition, a cathode modification was performed with composite S/SCNTs/BFO (SCNT-BF), and a comparative analysis was conducted to assess the effectiveness of the BFO in the separator and the cathode. Cyclic voltammetry measurements revealed that the increased current peak intensity at lower reduction potential in SCNT-BF and SCNT-BFS indicated control of higher-order LiPs (Li2Sx, where 4 ≤ x ≤ 8), resulting in the generation of more stable lower-order products (Li2S2/Li2S). The charge/discharge analysis revealed controlled LiPs, resulting in high-capacity retention in SCNT-BF (∼75%) and SCNT-BFS (∼88%) over 200 cycles, which yielded capacities of 526 and 700 mAh/g at C/8 (1C = 1675 mA/g). These promising results suggest that incorporating BFO into the cathode and separator can advance the commercialization of durable LiSBs.

El resultado de este trabajo trató sobre los beneficios y riesgos de los sistemas de iluminación LED en el ámbito económico, social y medioambiental y la valoración de las condiciones para su empleo en Cuba. Se profundiza en la relación de las ventajas de esta tecnología con los beneficios que ofrece su aplicación en diferentes sectores de la sociedad y la economía. También, se aborda su impacto en la industria de la iluminación y en las comunidades no conectadas a la red eléctrica en los países en desarrollo. Además, se exponen los principales riesgos que implica su utilización, identificando los campos de investigación abiertos relacionados en esta dirección, y se demuestra la importancia de considerar en los proyectos, los riesgos de la iluminación LED. Finalmente, se exponen las condiciones existentes en Cuba, para el desarrollo de la iluminación LED y su contribución a la sostenibilidad e independencia energética.

La investigación se centró en el proceso de comunicación interna como problemática que incide en la comunicación organizacional de la Facultad de Ciencias Técnicas y Agropecuarias de La Universidad de Las Tunas y que tributa al logro de los objetivos estratégicos de la organización, en la que toman partido los estudiantes de la carrera Licenciatura en Turismo. El objetivo del artículo es fortalecer la comunicación interna en dicha facultad para mejorar la comunicación organizacional y contribuir al cumplimiento de su misión. Para su aplicación se empleó la complementariedad metodológica con métodos y técnicas cualitativas y cuantitativas. Este estudio constituyó el primero de comunicación organizacional efectuado en la facultad, de ahí su importancia y pertinencia. El diseño de la Estrategia de Comunicación Interna contribuye a perfeccionar las prácticas comunicativas basadas en los problemas y potencialidades identificados en el estudio.

Tin dioxide (SnO2) is a low-cost and high-capacity anode material for lithium-ion batteries, but the fast capacity fading significantly limits its practical applications. Current research efforts have focused on preparing sophisticated composite structures or optimizing functional binders, both of which increase material manufacturing costs. Herein, we utilize pristine and commercially available SnO2 nanopowders and enhance their cycling performance by simply narrowing the potential range and optimizing electrolytes. Specifically, a narrower potential range (0–1 V) mitigates the capacity fading associated with the conversion reaction, whereas an ether-based electrolyte further suppresses the volume expansion related to the alloy reaction. Consequently, this SnO2 anode delivers a promising battery performance, with a high capacity of ~650 mAhg−1 and stable cycling for 100 cycles. Our work provides an alternative approach to developing high-capacity and long-cycling metal oxide anode materials.