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Abstract Structuring sensory events in time is essential for interacting with the environment and producing adaptive behaviors. Over the past years, the microstructure of temporality received increasing attention, recognized as a fundamental factor influencing cognitive, affective, and social abilities, whose alteration can underlie the etiopathogeneses of some clinical symptoms in psychiatric disorders. The present research investigated multisensory temporal processing in individuals with schizophrenia (N = 21), bipolar disorder (N = 20) and healthy controls (N = 21) in order to explore a plausible link between multisensory alterations in the temporal order of events and the psychopathological dimensions underlying psychosis. We asked participants to temporally order audio-tactile, visual-tactile, and audio-visual stimuli, and we administered different psychopathological scales to explore depressive, manic and psychotic symptoms. Results demonstrated that both subjects with schizophrenia and bipolar disorder are less precise in temporal order judgment independently of the sensory modalities involved. Interestingly, reduced precision in temporal processing of patients is positively associated with the presence and severity of positive symptoms. Our findings support the hypothesis that low-level sensory alterations in temporal structure may contribute to the emergence of clinical symptoms such as delusions, hallucinations, and disorganized behaviors.

Abstract Background To assess anatomical and functional outcomes of retrolental cohesive ophthalmic viscoelastic injection (“Viscolift technique”) in patients with severely subluxated cataracts. Methods In the present prospective study, we included patients older than 18 years with severely subluxated cataracts and phacodonesis. Full medical history was obtained at the baseline ophthalmological assessment. A single 25-gauge valved trocar was inserted 4 mm from the limbus and a 27G angled cannula was introduced through the trocar into the retrolental space, while cohesive viscoelastic was progressively injected, in order to center and elevate the cataract to facilitate capsulorhexis. After complete phacoemulsification, a 3-piece intraocular lens (IOL) with a scleral fixated Cionni ring or FIL-SSF scleral fixated IOL was implanted. Patients follow-up interval was 6 months after surgery. Results Thirteen eyes of 13 patients were enrolled in the study, mean age was 61.5 ± 9.4 years and 53.8% were females. The “Viscolift technique” resulted in centered and more stable cataracts in all cases (100%). After complete phacoemulsification, 61.5% of patients were implanted with a 3-piece IOL with Cionni ring, and 38.5% with a FIL-SSF scleral fixated IOL after complete 25G vitrectomy. Mean BCVA improved from 0.5 ± 0.1 LogMar (20/63 Snellen) to 0.1 ± 0.1 LogMar (20/25 Snellen) (p

Abstract Finding the optimal beam pair and update time in 5G systems operating at mmWave frequencies is time-intensive and resource-demanding. This intricate procedure calls for the proposal of more intelligent approaches. Therefore, this work proposes a machine learning-based method for optimizing beam pair selection and its update time. The method is structured around three main modules: spatial characterization of beam pair service areas, training of a machine learning model using collected beam pair data, and an algorithm that uses the decision function of the trained model to compute the optimal update time for beam pairs based on the spatial position and velocity of user equipment. When the machine learning model is deployed in a network with a single gNB equipped with a $$8\times 8$$ 8 × 8 UPA and one UE equipped with a $$1\times 2$$ 1 × 2 UPA in an mmWave scenario simulated in NS3, improvements in SINR and throughput up to $$407\%$$ 407 % , were observed. Improvements are gathered because of a reduction of $$85.7\%$$ 85.7 % in beam pair selections because of an increase of approximately $$1543\%$$ 1543 % in the effective time between successive beam pair searches. This method could offer real-time optimization of the beam pair procedures in 5G networks and beyond.

Introducción: La furosemida es un diurético de asa perteneciente al grupo de las sulfonamidas, y su principal indicación es el tratamiento de la sobrecarga de volumen y edemas. Debido a su mecanismo de acción, puede desencadenar diversas reacciones adversas, siendo una de las menos comunes las toxicodermias o dermatosis inducidas por fármacos, que pueden afectar la piel, mucosas o anexos cutáneos. Estas reacciones representan entre el 1 y el 3% de las dermatosis en el ámbito hospitalario y el 2,6% en el ámbito ambulatorio. Aunque su diagnóstico se basa principalmente en criterios clínicos, presentan un gran desafío debido a su aparición variable. Presentación del caso: se describe un caso clínico de un paciente masculino que presentó un cuadro clínico caracterizado por lesiones eritematosas generalizadas, pruriginosas, asociadas a edema bipalpebral y escrotal, y un único episodio febril con una temperatura máxima de 40°C. Estas manifestaciones comenzaron después de iniciar el tratamiento con furosemida oral. Los estudios paraclínicos mostraron un hemograma con leucocitosis a expensas de eosinofilia y alteraciones en el perfil hepático. Tras la suspensión de la medicación, se observó una mejoría paulatina de los síntomas. Discusión: este caso resalta que la furosemida, como fármaco tipo sulfonamida puede inducir reacciones de hipersensibilidad. El manejo adecuado de estos casos, que incluye la suspensión del fármaco y el uso de corticosteroides, es fundamental para evitar complicaciones. Dado que la evidencia es limitada, es esencial seguir documentando casos clínicos similares para comprender mejor el perfil de seguridad de la furosemida.

Introducción. Las variedades de cacao (Theobroma cacao L.) que se catalogan en el mercado mundial como finas y de aroma, representan un 6 % y se comercializan a un precio diferenciado. Estas variedades poseen características únicas determinadas por su genotipo, su complejidad de aromas es un factor fundamental que las distingue. Objetivo. Integrar información actualizada que proporcione evidencia científica sobre el cacao fino y de aroma, identificar los compuestos clave que le confieren esta denominación y describir su comportamiento durante las etapas de fermentación, secado y tostado. Desarrollo. El cacao fino y de aroma es muy apreciado en el mercado por su sabor y aromas únicos, es valorado en la elaboración de productos de tipo gourmet. El cacao de esta categoría es cultivado por pequeños productores de la región mesoamericana, que emplean sistemas de producción familiar, orgánicos y sostenibles. Esta región, la principal productora de cacao fino y de aroma, enfrenta el riesgo de perder su valiosa biodiversidad. Es crucial conservar la diversidad genética del cacao y comprender sus componentes fisicoquímicos, especialmente los volátiles responsables de sus atributos sensoriales. Conclusión. El procesamiento primario del cacao, en particular las etapas de fermentación y secado, influye significativamente en su perfil aromático. Controlarlo y estandarizarlo es esencial para que los productores obtengan su grano de cacao con una calidad diferenciada y así sea valorizado en el mercado por sus características sensoriales únicas. Futuros estudios deberían enfocarse en desarrollar métodos estandarizados para la fermentación y el secado, así como en la conservación de la diversidad genética del cacao fino y de aroma.

A new four-dimensional, multiyear, and near-global climate data record of the fine-mode (submicrometer in terms of diameter) and coarse-mode (supermicrometer in terms of diameter) components of atmospheric pure dust is presented. The separation of the two modes of dust in detected atmospheric dust layers is based on a combination of (1) the total pure-dust product provided by the well-established European Space Agency (ESA) “LIdar climatology of Vertical Aerosol Structure” (LIVAS) database and (2) the coarse-mode component of pure dust provided by the first step of the two-step POlarization LIdar PHOtometer Networking (POLIPHON) technique, developed in the framework of the European Aerosol Research Lidar Network (EARLINET). Accordingly, the fine-mode component of pure dust is extracted as the residual between the LIVAS total pure dust and the coarse-mode component of pure dust. Intermediate steps involve the implementation of regionally dependent lidar-derived lidar ratio values and AErosol RObotic NETwork (AERONET)-based climatological extinction-to-volume conversion factors, facilitating conversion of dust backscatter into extinction and subsequently extinction into mass concentration. The decoupling scheme is applied to observations from the Cloud–Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO) at 532 nm. The final products consist of the fine mode and coarse mode of atmospheric pure dust, quality-assured profiles of backscatter coefficient at 532 nm, extinction coefficient at 532 nm, and mass concentration for each of the two components. The datasets are established primarily with the original L2 horizontal (5 km) and vertical (60 m) resolution of the Cloud–Aerosol Lidar with Orthogonal Polarization (CALIOP) along the CALIPSO orbit path and secondly in averaged profiles of seasonal–temporal resolution, 1° × 1° spatial resolution, and the original vertical resolution of CALIPSO, focusing on the latitudinal band extending between 70° S and 70° N and covering more than 15 years of Earth observations (June 2006–December 2021). The quality of the CALIPSO-based fine-mode and coarse-mode dust products is assessed through the use of AERONET fine-mode and coarse-mode aerosol optical thickness (AOT) interpolated to 532 nm and the AERosol properties – Dust (AER-D) campaign airborne in situ particle size distributions (PSDs) as reference datasets during atmospheric conditions characterized by dust presence. The near-global fine-mode and coarse-mode pure-dust climate data record is considered unique with respect to a wide range of potential applications, including climatological, time series, and trend analysis over extensive geographical domains and temporal periods, validation of atmospheric dust models and reanalysis datasets, assimilation activities, and investigation of the role of airborne dust in radiation and air quality.

Autoimmune diseases and thrombophilic disorders, notably antiphospholipid syndrome (APS) and protein S deficiency, present a formidable challenge in pregnancy, substantially increasing the risk of thromboembolic complications by up to 20%. Pulmonary thromboembolism (PTE), characterized by a significantly higher maternal mortality rate, is of particular concern.APS, defined by the presence of antiphospholipid antibodies, emerges as a pivotal risk factor for PTE during pregnancy, especially in women exhibiting triple negativity. Concurrently, protein S deficiency further amplifies vulnerability to thromboembolic events, establishing a high-risk scenario for pregnant individuals.In a case involving a 29-year-old pregnant woman with a history of generalized lupus erythematosus, triple-negative antiphospholipid syndrome, and protein S deficiency, sudden-onset dyspnea prompted thorough investigation. Despite her complex medical history, a multidisciplinary approach led to the accurate diagnosis and successful management of subsegmental pulmonary thromboembolism, ensuring the well-being of both mother and fetus.Effectively managing PTE during pregnancy demands a comprehensive, multidisciplinary approach involving collaboration among obstetricians, internists, rheumatologists, and hematologists. Accurate diagnosis, tailored anticoagulation strategies, and continuous monitoring stand as indispensable pillars for maternal and fetal well-being.

Autoimmune hepatitis (AIH) is a varied inflammatory chronic liver disease. AIH’s prevalence varies and has increased recently. Diagnosis involves the discovery of histologic features following liver biopsy and serologic testing. Clinical features vary, and up to 40% of patients may be asymptomatic. Evaluating thiopurine methyltransferase (TMPM) activity before treatment is crucial for an optimal response. The primary treatment goal is biochemical remission, normalized serum IgG, and liver enzymes. Induction therapy typically involves azathioprine and corticosteroids. Close monitoring of liver function tests and serum immunoglobulin levels is essential. Medications can be tapered after achieving biochemical remission. Liver transplantation may be required for refractory disease or cirrhosis. Further therapeutic approaches are needed, particularly for non-responders to first-line treatments.

BackgroundPeripersonal Space (PS) is represented as the immediate area surrounding an individual. The extent of PS changes in relation to several factors, including emotional states, type of relationship or psychopathology. Attachment anxiety has an impact on the social adaptability of peripersonal space and anxiety and fear are associated with an expansion of peripersonal space, possibly serving as a mechanism of self-protection. Peripersonal space appears to be intricately linked to various psychiatric conditions like anxiety disorders and converging evidence suggests that social maladjustment may predict or exacerbate eating disorder symptoms expression.MethodsFifty-eight healthy adolescents (38F, 20M) performed a comfort distance estimation task to assess peripersonal space. The Adolescent/Adult Sensory Profile (AASP) was used to assess sensory profiles and the SAFA protocol to investigate psychopathological aspects. Data was analysed using Network Analysis, estimating a Gaussian Graphical Models with a Bayesian approach.ResultsWe found that the task related to comfort estimation distance demonstrated a correlation with the visual scale of the Adolescent/Adult Sensory Profile (AASP). Additionally, a correlation was observed with the Eating Disorder scale of the SAFA protocol. The touch scale also was negatively correlated with Eating disorder symptoms but not with the comfort estimation task.ConclusionOur results demonstrate a relation between peripersonal space and eating disorder symptoms in healthy adolescents in line with previous findings in adults with eating disorders diagnosis. These findings suggest that socio-emotional difficulties may be possible precursors or reinforce for the development of an eating disorder symptoms.

Persistence of the rebound-competent viral reservoir (RCVR) within the CD4+ T cell compartment of people living with HIV remains a major barrier to HIV cure. Here, we determined the effects of the pan-lymphocyte-depleting monoclonal antibody (mAb) alemtuzumab on the RCVR in SIVmac239-infected rhesus macaques (RM) receiving antiretroviral therapy (ART). Alemtuzumab administered during chronic ART or at the time of ART initiation induced >95% depletion of circulating CD4+ T cells in peripheral blood and substantial CD4+ T cell depletion in lymph nodes. However, treatment was followed by proliferation and reconstitution of CD4+ T cells in blood, and despite ongoing ART, levels of cell-associated SIV DNA in blood and lymphoid tissues were not substantially different between alemtuzumab-treated and control RM after immune cell reconstitution, irrespective of the time of alemtuzumab treatment. Upon ART cessation, 19 of 22 alemtuzumab-treated RM and 13 of 13 controls rebounded with no difference in the time to rebound between treatment groups. Time to rebound and reactivation rate was associated with plasma viral loads (pVLs) at time of ART initiation, suggesting lymphocyte depletion had no durable impact on the RCVR. However, 3 alemtuzumab-treated RM that had lowest levels of pre-ART viremia, failed to rebound after ART withdrawal, in contrast to controls with similar levels of SIV replication. These observations suggest that alemtuzumab therapy has little to no ability to reduce well-established RCVRs but may facilitate RCVR destabilization when pre-ART virus levels are particularly low.

Abstract While epigenetic modifications have been implicated in ADHD through studies of peripheral tissue, to date there has been no examination of the epigenome of the brain in the disorder. To address this gap, we mapped the methylome of the caudate nucleus and anterior cingulate cortex in post-mortem tissue from fifty-eight individuals with or without ADHD. While no single probe showed adjusted significance in differential methylation, several differentially methylated regions emerged. These regions implicated genes involved in developmental processes including neurogenesis and the differentiation of oligodendrocytes and glial cells. We demonstrate a significant association between differentially methylated genes in the caudate and genes implicated by GWAS not only in ADHD but also in autistic spectrum, obsessive compulsive and bipolar affective disorders through GWAS. Using transcriptomic data available on the same subjects, we found modest correlations between the methylation and expression of genes. In conclusion, this study of the cortico-striatal methylome points to gene and gene pathways involved in neurodevelopment, consistent with studies of common and rare genetic variation, as well as the post-mortem transcriptome in ADHD.

In this study, we present a new approach for the determination of polarization parameters of the Nicosia Cimel CE376 lidar system, using the PollyXT in Limassol as a reference instrument. The method is applied retrospectively to the measurements obtained during the 2021 Cyprus Fall Campaign. Lidar depolarization measurements represent valuable information for aerosol typing and for the quantification of some specific aerosol types such as dust and volcanic ash. An accurate characterization is required for quality measurements and to remove instrumental artifacts. In this article, we use the PollyXT, a widely used depolarization lidar, as our reference to evaluate the CE376 system's gain ratio and channel cross-talk. We use observations of transported dust from desert regions for this approach, with layers in the free troposphere. Above the boundary layer and the highest terrain elevation of the region, we can expect that, for long-range transport of aerosols, local effects should not affect the aerosol mixture enough for us to expect similar depolarization properties at the two stations (separated by ∼ 60 km). Algebraic equations are used to derive polarization parameters from the comparison of the volume depolarization ratio measured by the two systems. The applied methodology offers a promising opportunity to evaluate the polarization parameters of a lidar system, in cases where a priori knowledge of the cross-talk parameters is not available, or to transfer the polarization parameters from one system to the other.

La Lex Criptográfica, que surge en el ámbito de la tecnología blockchain, plantea la posibilidad de conferir empoderamiento a las personas a través de la promoción de la libertad individual y la emancipación. El propósito fundamental de la presente investigación radica en llevar a cabo un análisis exhaustivo de los componentes que integran la Lex Criptográfica, con el fin de delimitarla y, de esta manera, lograr una comprensión más precisa de sus efectos y alcances. El método de análisis-síntesis se empleó como enfoque para desglosar sus elementos constituyentes y, posteriormente, sintetizarlos con miras a su definición y demarcación. Los resultados obtenidos revelan que la Lex Criptográfica se compone de aspectos esenciales, a saber: código, contratos inteligentes, blockchain y criptografía. Adicionalmente, se advierte que la regulación de esta estructura es un desafío de envergadura que requiere de un equilibrio entre el poder tecnológico y los valores de las libertades individuales, la democracia y la libertad de expresión. La imperiosa necesidad de adoptar un enfoque legal renovado se vislumbra como la vía para fomentar el crecimiento económico, consolidar las instituciones democráticas y salvaguardar las libertades individuales, al tiempo que se mitigan los riesgos potenciales.

La investigación aborda la protección jurídica del derecho a la libertad de expresión en la historia constitucional nicaragüense desde el siglo XIX hasta nuestros días, haciendo un estudio pormenorizado en las constituciones políticas que Nicaragua ha tenido como República. Es importante señalar que la inestabilidad reinante en todos los procesos jurídicos, políticos e institucionales son los puntos de coincidencia encontrados en este análisis constitucional, además del tratamiento constitucional sistemático y uniforme otorgado a este derecho. El estudio de las diferentes fundamentaciones teóricas de la libertad de expresión se centra en los límites constitucionales que el ordenamiento jurídico nicaragüense establece a este derecho fundamental.

El objetivo de este trabajo fue diseñar una tipología de redes sociales de excombatientes y víctimas del conflicto armado en Colombia, con miras a entender las dinámicas propias de composición de esta población en cuanto a sus procesos de integración social con la comunidad. Mediante un estudio explicativo transversal se evaluó 120 excombatientes y 120 víctimas de conflicto armado colombiano, primero sus redes sociales personales, las cuales se construyeron con una matriz cuadrada de datos, luego se evaluó sus niveles de apoyo social con el ASSIS. Los resultados mostraron diferencias significativas entre las redes de víctimas y excombatientes de acuerdo con el género e indicadores estructurales, por lo cual se proponen tres grupos de redes: Tipo 1. conformado por excombatientes con mediano nivel de apoyo social y altos indicadores de centralización e intermediación y poca densidad. Tipo 2. conformado por redes densas de víctimas con bajo nivel de apoyo. Tipo 3. con niveles modestos de indicadores estructurales, pero alto nivel de apoyo social. Al final, se entregan comentarios para enlazar dichas características al diseño de programas de intervención con estas poblaciones, las cuales surtan a la comunidad académica y organizaciones gubernamentales de mecanismos para el éxito de los programas.

Introduction and Objectives: Autoimmune liver diseases (AILDs): autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) have different survival outcomes after liver transplant (LT). Outcomes are influenced by factors including disease burden, medical comorbidities, and socioeconomic variables. Materials and Methods: Using the United Network for Organ Sharing database (UNOS), we identified 13,702 patients with AILDs listed for LT between 2002 and 2021. Outcomes of interest were waitlist removal, post-LT patient survival, and post- LT graft survival. A stepwise multivariate analysis was performed adjusting for transplant recipient gender, race, diabetes mellitus, model for end-stage liver disease (MELD) score, and additional social determinants including the presence of education, reliance on public insurance, working for income, and U.S. citizenship status. Results: Lack of college education and having public insurance increased the risk of waitlist removal (HR, 1.13; 95 % CI, 1.05–1.23, and HR, 1.09; 95 % CI, 1.00–1.18; respectively), and negatively influenced post-LT patient survival (HR, 1.16; 95 % CI, 1.06–1.26, and HR, 1.15; 95 % CI, 1.06–1.25; respectively) and graft survival (HR, 1.13; 95 % CI, 1.05–1.23, and HR, 1.15; 95 % CI, 1.06–1.25; respectively). Not working for income proved to have the greatest detrimental impact on both patient survival (HR, 1.41; 95 % CI, 1.24–1.6) and graft survival (HR, 1.21; 95 % CI, 1.09–1.35). Conclusions: Our study highlights that lack of college education and public insurance have a detrimental impact on waitlist mortality, patient survival, and graft survival. Not working for income negatively affects post-LT survival outcomes. Not having U.S. citizenship does not affect survival outcomes in AILDs patients.

Background/Objective: Guidelines on obesity management reinforce regular exercise to reduce body fat. Exercise modalities, including high-intensity interval training (HIIT), appear to produce a similar effect to continuous aerobic training (CAT) on body fat. However, they have not addressed the chronic effect of HIIT vs. CAT on body fat assessed by dual energy X-ray absorptiometry (DEXA). Thus, we compared the effectiveness of CAT vs. HIIT protocols on body fat (absolute or relative) (%BF) and abdominal visceral fat reduction, assessed by DEXA, in adults with overweight and obesity. Methods: We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) including both female or male adults with excess body weight. We performed searches in the databases MEDLINE (PubMed), EMBASE, Scopus, LILACS, Web of Science and Cochrane. Results: In our analysis (11 RCTs), we found no greater benefit on %BF of HIIT vs. CAT (MD –0.55%, 95% CI –1.42 to 0.31; p = 0.209). As for abdominal visceral fat, no training modality was superior (SMD: −0.05, 95% CI –0.29 to 0.19; p = 0.997). Regarding secondary outcomes (body weight, BMI, VO2 max, glycemic and lipid profiles), HIIT shows greater benefit than CAT in increasing VO2 max and fasting blood glucose and reducing total cholesterol. Conclusion: HIIT is not superior to CAT in reducing %BF or abdominal visceral fat in individuals characterized by excess weight. However, HIIT showed beneficial effects on cardiorespiratory fitness, total cholesterol and fasting blood glucose when compared to CAT.

Background: Safety and outcome of atezolizumab/bevacizumab in Child-Pugh B patients with hepatocellular carcinoma (HCC) have not been completely characterized. Objectives: In this study, we aimed at addressing safety and efficacy of atezolizumab/bevacizumab in Child-Pugh B patients by reviewing the available data and analyzing them by meta-analysis. Methods: We compared the safety and efficacy of atezolizumab/becavizumab treatment in patients with unresectable HCC and various degrees of liver dysfunction. A total of 8 retrospective, non-randomized, cohort studies were included in this meta-analysis, for a total of 1,071 Child-Pugh A and 225 Child-Pugh B patients. The albumin-bilirubin (ALBI) grade was also used to assess liver function, when available. Results: Grade ≥3 adverse events were observed in 11.8% of Child-Pugh class A and 26.8% class B patients (p = 0.0001), with an odds ratio (OR) of 0.43 (confidence interval [CI] 0.21–0.90; p = 0.02). Progression-free survival (PFS) at both 6 months (4.90 ± 2.08 vs. 4.75 ± 2.08 months; p = 0.0004) and 12 months (8.83 ± 2.32 vs. 7.26 ± 2.33 months; p = 0.002) was lower in Child-Pugh class B patients. A trend toward a higher objective response rate (ORR) was observed in Child-Pugh class A patients (219/856, 25.6%) as compared to Child-Pugh class B patients (25/138, 18.1%; p = 0.070), while the probability of obtaining an ORR was significantly greater in Child-Pugh A patients (OR 1.79, CI 1.12–2.86; p = 0.02). Median overall survival (OS) was 16.8 ± 2.0 and 6.8 ± 3.2 months in Child-Pugh A and B patients, respectively (mean difference 9.06 months, CI 7.01–11.1, p < 0.0001). Lastly, OS was longer in patients with ALBI grades 1–2 than in those with grade 3 (8.3 ± 11.4 vs. 3.3 ± 5.0 months, p = 0.0008). Conclusions: Oncological efficacy of atezolizumab/bevacizumab is moderate in Child-Pugh class B patients, and the shorter PFS and OS associated with the greater likelihood of experiencing treatment-related adverse events observed in these patients suggest great caution and individualization of treatment, possibly with the support of the ALBI grade.

Abstract Functional pituitary adenomas (FPAs) are associated with hormonal hypersecretion resulting in systemic endocrinopathies and increased mortality. The heterogenous composition of the FPA population has made modeling predictive factors of postoperative disease remission a challenge. Here, we aim to define a novel scoring system predictive of disease remission following transsphenoidal surgery (TSS) for FPAs and validate our process using supervised machine learning (SML). 392 patients with FPAs treated at one of the three Mayo Clinic campuses were retrospectively reviewed. Variables found significant on multivariate analysis were incorporated into our novel Pit-SCHEME score. The Pit-SCHEME score with a cut-off value ≥ 6 achieved a sensitivity of 86% and positive likelihood ratio of 2.88. In SML models, without the Pit-SCHEME score, the k-nearest neighbor (KNN) model achieved the highest accuracy at 75.6%. An increase in model sensitivity was achieved with inclusion of the Pit-SCHEME score with the linear discriminant analysis (LDA) model achieving an accuracy of 86.9%, which suggests the Pit-SCHEME score is the variable of most importance for prediction of postoperative disease remission. Ultimately, these results support the potential clinical utility of the Pit-SCHEME score and its prospective future for aiding in the perioperative decision making in patients with FPAs.

El Lupus Eritematoso Sistémico (LES) es uno de los prototipos de las enfermedades autoinmunes, compromete principalmente al sexo femenino, con una proporción 9:1 mujer-hombre. Se caracteriza por la formación de autoanticuerpos con la participación de la inmunidad adaptativa e innata, en interacción con los factores genéticos y medioambientales. Estos autoanticuerpos son parte central de la fisiopatología de la enfermedad, causando desde compromiso orgánico leve hasta compromiso multisistémico grave. El diagnóstico es clínico, orientado por una anamnesis detallada, un examen físico exhaustivo y los marcadores de autoinmunidad; eventualmente podría apoyarse en criterios clasificatorios de algunas sociedades científicas. La actual revisión pretende destacar las generalidades sobre la enfermedad, haciendo énfasis en su fisiopatología, presentación clínica, y su abordaje diagnóstico y terapéutico, sirviendo de apoyo para la formación médica integral en beneficio de los pacientes.

Despite newly available therapies for acute stroke and innovative prevention strategies, stroke remains the third leading cause of disability-adjusted life-years (DALYs) lost worldwide, mostly because more than half of stroke survivors aged 65 and over exhibit an incomplete functional recovery of the paretic limb. Given that a repeated sensory input is one of the most effective modulators of cortical motor and somatosensory structures, focal muscle vibration (fMV) is gaining growing interest as a safe, well-tolerated, and non-invasive brain stimulation technique to promote motor recovery after stroke with a long-lasting and clinically relevant improvement in strength, step symmetry, gait, and kinematics parameters. In this narrative review, we first summarize the structural (neural plasticity) and functional changes (network relearning) triggered by the stroke lesion and carried out at a brain and spinal cord level in an attempt to recover from the loss of function. Then, we will focus on the fMV’s plasticity-based mechanisms reporting evidence of a possible concurrently acting multisite plasticity induced by fMV. Finally, to understand what the most effective fMV rehabilitation protocol could be, we will report the most recent evidence regarding the different clinical approaches and timing of the fMV treatment, the related open issues, and prospects.

Introducción. El manejo perioperatorio de las urgencias hepatobiliares por parte del cirujano general es una competencia esperada y se considera un reto por su relativa frecuencia, impacto en la salud del individuo y la economía, así como las implicaciones en el ejercicio clínico confiable y de alta calidad. Se desconocen los aspectos formales de la educación en cirugía hepatobiliar para el cirujano general en Colombia. El objetivo del presente estudio fue explorar la perspectiva de los cirujanos hepatobiliares sobre esta problemática. Métodos. Se realizó un estudio cualitativo, mediante entrevistas semiestructuradas con 14 especialistas en cirugía hepatobiliar colombianos, en donde se exploraron los desafíos del entrenamiento, el tiempo y las características de una rotación, la evaluación de la confiabilidad, el número de procedimientos y el rol de la simulación. Se hizo un análisis temático de la información. Resultados. Los expertos mencionaron la importancia de la rotación obligatoria por cirugía hepatobiliar para los cirujanos en formación. El tiempo ideal es de tres meses, en el último año de residencia, en centros especializados, con exposición activa y bajo supervisión. Conclusiones. Por las características epidemiológicas del país y la frecuencia de enfermedades hepatobiliares que requieren tratamiento quirúrgico, es necesario que el cirujano general cuente con una formación sólida en este campo durante la residencia. El presente estudio informa sobre las características ideales del entrenamiento en este campo desde la visión de los expertos colombianos.

El Cannabis sativa reporta más de 500 compuestos cannabinoides, lo cual ha alcanzado más de 192 millones de consumidores en el mundo. Su actividad en los receptores cannabinoides tipo 1 (CB1) y tipo 2 (CB2) está involucrada en diferentes actividades biológicas, incluyendo su implicación cardiovascular. Reconocer el impacto del uso de cannabis en el desarrollo de alteraciones cardiovasculares en adultos. Se realizó una revisión sistemática mediante la guía PRISMA durante 2017-2023, empleando los repositorios: ScienceDirect, PubMed/MEDLINE y EBSCO. Se emplearon las palabras clave “Cannabis” y “cardiovascular diseases”. Finalmente, se realizó una evaluación del riesgo de sesgo mediante Critical Appraisal Skills Programme. Se obtuvieron 831 artículos, a los cuales se les aplicaron criterios de inclusión y exclusión, obteniendo siete estudios definitivos publicados en los últimos cinco años. Adicionalmente, esta revisión señala una dualidad en los efectos cardiovasculares del cannabis, que pueden depender de la forma de consumo y potenciales metabolitos. Algunos estudios sugieren efectos protectores en la progresión vascular, mientras otros relacionan su consumo con riesgos cardiovasculares, como arritmias y arteriosclerosis. La evidencia es limitada y contradictoria, y se destaca la necesidad de estudios longitudinales para entender la relación causal con los eventos cardiovasculares.

A 51-year-old male underwent vitrectomy with retrobulbar anesthesia for retinal detachment. Post surgery, he experienced systemic hypotension which normalized after 3 h. The day after, he complained of a central scotoma in the operated eye. Intraocular pressure was normal, but fundus examination revealed hemorrhages and whitening along the papillomacular bundle and macula, with additional whitening in the upper midperipheral region. Multimodal imaging confirmed branch retinal vein, artery, and cilioretinal artery occlusion. Further examination revealed mild-to-moderate obstructive sleep apnea syndrome. Vascular occlusions are potential complications of vitreoretinal surgery, warranting thorough preoperative assessment for underlying risk factors, even if causative mechanism is still unknown.