Search

Cell therapy is a promising strategy for treating neurological pathologies but requires invasive methods to bypass the blood–brain barrier restrictions. The nose-to-brain route has been presented as a direct and less invasive alternative to access the brain. The primary limitations of this route are low retention in the olfactory epithelium and poor cell survival in the harsh conditions of the nasal cavity. Thus, using chitosan-based hydrogel as a vehicle is proposed in this work to overcome the limitations of nose-to-brain cell administration. The hydrogelʼs design was driven to achieve gelification in response to body temperature and a mucosa-interacting chemical structure biocompatible with cells. The hydrogel showed a < 30 min gelation time at 37 °C and >95 % biocompatibility with 2D and 3D cultures of mesenchymal stromal cells. Additionally, the viability, stability, and migration capacity of oligodendrocyte precursor cells (OPCs) within the hydrogel were maintained in vitro for up to 72 h. After the intranasal administration of the OPCs-containing hydrogel, histological analysis showed the presence of viable cells in the nasal cavity for up to 72 h post-administration in healthy athymic mice. These results demonstrate the hydrogel's capacity to increase the residence time in the nasal cavity while providing the cells with a favorable environment for their viability. This study presents for the first time the use of thermosensitive hydrogels in nose-to-brain cell therapy, opening the possibility of increasing the delivery efficiency in future approaches in translational medicine. This work highlights the potential of biomaterials, specifically hydrogels, in improving the effectiveness of cell therapy administered through the nose. The nose-to-brain route has been suggested as a non-invasive way to directly access the brain. However, delivering stem cells through this route poses a challenge since their viability must be preserved and cells can be swept away by nasal mucus. Earlier attempts at intranasal cell therapy have shown low efficiency, but still hold promise to the future. The hydrogels designed for this study can provide stem cells with a biocompatible environment and adhesion to the nasal atrium, easing the successful migration of viable cells to the brain. [Display omitted] [ABSTRACT FROM AUTHOR]

Spinal trauma in children and adolescents, including spinal cord injury, fractures and dislocations, is relatively uncommon, but represents the highest risk of morbidity and mortality of all paediatric injuries. Motor vehicle accidents, falls from heights and sport accidents resulting in blunt trauma are the most frequent mechanisms of injury. The average age of presentation is approximately 12 years old. Injury following spinal trauma differs according to age-specific biomechanical characteristics of the developing spine. The most common site of injury in younger children is the cervical spine, whereas injury to the thoracolumbar spine is more common in adolescents. Differential diagnosis following trauma should include physiological particularities of the developing spine. Search for concomitant lesions is mandatory as patients frequently present with more than one vertebral fracture. Injury in this population can significantly affect the developing spine leading to neurological trauma and progressive deformity. [ABSTRACT FROM AUTHOR]

Wrist fractures are common injuries associated with high disability in the early recovery period. The impact of wrist fractures on safe return to drive is not understood. (1) To compare the proportion of adults who were drivers in car crashes before and after wrist fracture; (2) To examine potential factors (demographic and/or clinical) associated with increased odds of being a driver in a car crash following wrist fracture. Retrospective cohort study. Three state-wide government datasets (MainRoads Western Australia [WA], Hospital Morbidity Data Collection and the Emergency Department Data Collection) were used to obtain and link demographic, clinical and car crash information relating to adults with a wrist fracture sustained between 2008 and 2017. McNemar's tests were used to compare the proportion of drivers in a car crash within the 2 years prior to and following the fracture date. Multivariable logistic regressions were used to identify if any variables were associated with increased odds of crashing in the post-fracture period. Data relating to 37,107 adults revealed a 3.3% (95% CI 3.0%–3.6%, p < 0.05) decrease in the proportion of drivers in a car crash following wrist fracture, persisting for the entire 2 years post-fracture, when compared to the proportion who crashed before their fracture. Those with more severe wrist fracture injury patterns had 79%(95% CI 1.07–3.0, p = 0.03) higher odds of having a crash in the first 3 months following their injury, compared to those with isolated wrist fracture injuries. These results inform and update return to drive recommendations. The reduced proportion of drivers involved in crashes following wrist fracture persisted for 2 years; longer than the expected physical recovery timeframe. It is important that hand therapists actively educate the sub-group of adults with more severe wrist fracture injury patterns of the increased likelihood of car crash for the 3 months following their fracture. • This the first paper to report on car crashes following wrist fracture. • We provide much needed information to assist with return to drive decision-making. • Those with severe injury had 79% higher odds of crashing in the initial 3-months. • Education is recommended for the sub-group with 3-months of increased crash risk. [ABSTRACT FROM AUTHOR]

Ameloblastic fibro-odontoma (AFO) is a rare, gnathic, benign, mixed odontogenic tumor that commonly presents in the first or second decade of life as a unilocular and rarely multilocular radiolucency with variable amounts of calcified material. Tumor progression is typically indolent, and generally accepted treatment is surgical enucleation and curettage. This case report describes an atypical presentation in a 14-year-old male with a multilocular, aggressive AFO requiring hemimandibulectomy with immediate osseous and dental "Jaw-in-a-Day" reconstruction. This report highlights the debate regarding whether AFO is a true neoplasm or an early-stage hamartoma in the continuum of complex odontoma formation. Regardless of the pathogenesis, maxillofacial surgeons and pathologists should be cognizant of the potential for AFO to develop locally aggressive behavior with considerable morbidity. [ABSTRACT FROM AUTHOR]

To investigate the safety and effectiveness of intranodal lymphangiography (INL) and lymphatic embolization (LE) in management of chylous ascites after oncologic surgery. Retrospective review of records of patients who underwent INL with or without LE from January 2017 to June 2022 was performed. Adult patients with chylous ascites after oncologic surgery referred to interventional radiology after failure of conservative treatment were included. Thirty-nine patients who underwent 55 procedures were included (34 males and 5 females). Data on patient demographics, procedural technique, outcomes, and follow-up were collected. Descriptive statistics were used to illustrate technical success, clinical success, and adverse events. Univariate logistic regression analysis was performed to evaluate factors predicting clinical success. INL was technically successful in 54 of 55 procedures (98%; 95% confidence interval [CI], 90%–100%). A lymphatic leak was identified in 40 procedures, and LE was attempted in 36. LE was technically successful in 33 of the 36 procedures (92%; 95% CI, 78%–98%). Clinical success, defined as resolution of ascites with no need for peritoneovenous shunt placement or additional surgery, was achieved in 22 of 39 patients (56%; 95% CI, 40%–72%). Clinical success was achieved in 18 patients after 1 procedure, and patients who required repeat procedures were less likely to achieve clinical success (odds ratio, 0.16; 95% CI, 0.04–0.66; P =.012). Four grade 1 procedural adverse events were recorded. INL with or without LE is a safe minimally invasive tool that can help patients with chylous ascites after oncologic surgery who failed conservative treatment avoid more invasive interventions. [Display omitted] [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) has been widely used to manage debilitating neurological symptoms in movement disorders such as Parkinson's disease (PD). Despite its well-established symptomatic benefits, our understanding of the mechanisms underlying DBS and its possible effect on the accumulation of pathological proteins in neurodegeneration remains limited. Accumulation and oligomerization of the protein alpha-synuclein ( α -Syn) are implicated in the loss of dopaminergic neurons in the substantia nigra in PD, making α -Syn a potential therapeutic target for disease modification. We examined the effects of high frequency electrical stimulation on α -Syn levels and oligomerization in cell and rodent models. High frequency stimulation, mimicking DBS parameters used for PD, was combined with viral-mediated overexpression of α -Syn in cultured rat primary cortical neurons or in substantia nigra of rats. Bimolecular protein complementation with split fluorescent protein reporters was used to detect and quantify α -Syn oligomers. High frequency electrical stimulation reduced the expression of PD-associated mutant α -Syn and mitigated α -Syn oligomerization in cultured neurons. Furthermore, DBS in the substantia nigra, but not the subthalamic nucleus, decreased overall levels of α -Syn, including oligomer levels, in the substantia nigra. Taken together, our results demonstrate that direct high frequency stimulation can reduce accumulation and pathological forms of α -Syn in cultured neurons in vitro and in substantia nigra in vivo. Thus, DBS therapy could have a role beyond symptomatic treatment, with potential disease-modifying properties that can be exploited to target pathological proteins in neurodegenerative diseases. • High frequency stimulation reduces α -synuclein accumulation in cultured neurons. • Deep brain stimulation of the substantia nigra reduces α -synuclein accumulation in rats. • Deep brain stimulation could have a role beyond symptomatic treatment, with potential disease-modifying properties. One sentence summary: Electrical stimulation reduces α -synuclein accumulation in vitro and in vivo. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a major public health concern in Ecuador and Peru, both settings of high burden of drug resistance TB. Molecular epidemiology tools are important to understand the transmission dynamics of Mycobacterium tuberculosis Complex (MTBC) and to track active transmission clusters of regional importance. This study is the first to address the transmission of TB between Peru and Ecuador through the population structure of MTBC lineages circulating in the Ecuadorian border province of "El Oro". A total number of 56 MTBC strains from this province for years 2012–2015 were included in the study and analyzed by 24-loci MIRU-VNTR and spoligotyping. Genotyping revealed a high degree of diversity for MTBC in "El Oro", without active transmission clusters. MTBC L4 was predominant, with less than 2% of strains belonging to MTBC L2-Beijing. These results may suggest that TB dynamics in this rural and semi-urban area would not be linked to highly transmitted strains like MTBC L2-Beijing from Peru, but related to TB relapse; although further studies with larger MTBC cultures collection from recent years are needed. Nevertheless, we recommend to reinforce TB surveillance programs in remote rural settings and border regions in Ecuador. [ABSTRACT FROM AUTHOR]

Electrocardiographic patterns of right bundle branch and fascicular blocks were comprehensively analyzed in a two-phase study. The research aimed to address the scarcity of literature and the absence of standardized diagnostic criteria for these conditions. It revealed a weak correlation between the cardiac axis and age and highlighted the high misdiagnosis rate of these blocks. Furthermore, it discussed the challenges in fulfilling existing diagnostic criteria. The study emphasizes the need for a more precise understanding of right ventricular conduction disorders and the importance of developing robust diagnostic criteria. • Scarcity of literature and lack of standardized criteria contribute to misdiagnosis of RFB. • Foundational studies by Uhley and Rivkin in 1960 pioneered anatomical understanding of RFB. • Medrano and De Micheli's 1975 study provided early insights into RFB characteristics. • Study reveals modest negative correlation between cardiac axis and age, raising questions. • Misdiagnosis rate of RFB reaches 100%, often confused with normal ECG, chamber enlargements, LFB, and myocardial infarctions. [ABSTRACT FROM AUTHOR]

Pet ownership continues to increase worldwide, with cats being the preferred species followed by dogs. Since dog-ownership practices can affect animal welfare, it is important to understand the level of owners' awareness of animal needs and current legislation. Therefore, this study aimed to describe dog owners' knowledge and practices and determine their association with behavior and health problems in dogs. An online survey was conducted, which included questions about responsible ownership practices and the level of awareness of national animal welfare and pet ownership legislation. Descriptive statistics and ordinal multivariate logistic regression analyses were performed. A total of 5,216 individuals responded, of which 3,809 were dog owners. Twenty percent of dogs were described as being overweight or obese, and dogs that were not fed leftovers were less likely to be obese. Additionally, neutered bitches were less likely to be obese than castrated male dogs. In relation to aggressive behavior, 24.6% of owners declared that their dog had shown aggressiveness toward people and 51.1% declared aggressiveness toward other animals. Taking dogs into basic training classes, not taking them out for walks, and living on a farm were all risk factors for aggressive behavior. In terms of owners' awareness of the current legislation, being moderately or not informed increased the likelihood of not having their dogs identified with a microchip and registered, not keeping their vaccinations updated, or not desexing. An effective educational strategy that uses a multidisciplinary approach is required to improve pet ownership practices in Chile. • Dog owner practices and knowledge are associated with pet welfare and behavior. • Neutered bitches were less likely to be obese than castrated male dogs. • Living on a farm, training classes and lack of exercise increased aggressive behavior. • Low awareness of legislation reduced the odds of registering and vaccinating dogs. [ABSTRACT FROM AUTHOR]

Severe COVID-19 elicits a hyperimmune response frequently amenable to steroids, which in turn increase the risk for opportunistic infections. COVID-19 associated pulmonary aspergillosis (CAPA) is a complication known to be associated with immunomodulatory treatment. The role of cumulative steroid dose in the development of CAPA is unclear. This study evaluates the relationship between cumulative steroid dose in hospitalized individuals with COVID-19 pneumonia and the risk for CAPA. This retrospective cohort study includes 135 hospitalized patients with PCR-confirmed COVID-19 pneumonia at a tertiary centre in north Mexico. Patients who developed CAPA were matched by age and gender to two controls with COVID-19 pneumonia who did not develop CAPA defined and classified as possible, probable, or proven according to 2020 ECMM/ISHAM criteria. Cumulative steroid dose in dexamethasone equivalents was obtained from admission until death, discharge, or diagnosis of CAPA (whichever occurred first). The risk of CAPA by the continuous cumulative steroid dose was assessed using a logistic regression model. Forty-five patients were diagnosed with CAPA and matched to 90 controls. Mean age was 61 ± 14 years, and 72% were male. Mean cumulative steroid dose was 66 ± 75 mg in patients without CAPA vs 195 ± 226 mg in patients with CAPA (P <0.001). The risk for CAPA increased with higher cumulative dose of steroids (OR 1.0075, 95% CI: 1.0033–1.0116). Patients who developed CAPA had a history of higher cumulative steroid dose during hospitalization. The risk for CAPA increases ∼8% for every 10 mg of dexamethasone used. [ABSTRACT FROM AUTHOR]

The main trunk of the right bundle branch divides into an anterior, middle (lateral) and posterior fascicle. This article describes the right anterior and posterior fascicular block. They present a diagnostic challenge and are often overlooked during diagnostic processes. The studied patients were young adults whose electrocardiographic tracings were registered at the Mexican Faculty of Medicine of La Salle University. The presence of delayed R-peak time in aVR and V1, along with the described ventricular complex morphologies, and a right or left deviation of the cardiac axis exceeding +60°, may be suggestive of right fascicular blocks. • Right fascicular blocks pose a diagnostic challenge in electrocardiographic tracings. • Delayed R-peak in aVR and V1 is suggestive of right fascicular blocks. • A diagnostic flow chart is proposed to identify fascicular blocks. • Many diagnosis may actually be underdiagnosed right fascicular blocks. • Right precordial and abdominal leads aid conventional ECG for accurate diagnosis. [ABSTRACT FROM AUTHOR]

• Latin American central line-associated bloodstream infections (CLABSI) rates are higher than those of high income countries. • Our objective is to identify CLABSI rates and risk factors in Latin American intensive care units (ICUs). • Length of stay, duration of central line, femoral, arterial and jugular increase CLABSI risk. • Public hospital, and Medical-surgical ICU increase CLABSI risk. • PICC was not associated with risk for CLABSI. Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P <.0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P <.0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P <.0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P <.0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P <.0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P <.0001). PICC (aOR=1.25;95%CI=0.63-2.51; P =.52) was not associated with CLABSI risk. Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations. [ABSTRACT FROM AUTHOR]

There are few studies that classify and characterize the morphometric and immunohistochemical features of goitre in bovine thyroid glands (TGs). We investigated 39 bovine TGs (fetuses [9], stillbirths [18], neonates [12]) born to dams with low T4 hormone levels and no iodine supplementation and 10 (fetuses [3], stillbirths [3], neonates [4]) born to dams with normal T4 levels and supplemented with iodine. Body weight (BW), TG weight (TGW), TGW:BW ratio and histological lesions were determined. The TGs were classified histopathologically as normal gland (G0), mild goitre (G1), moderate goitre (G2) or severe goitre (G3). Various morphological and morphometric parameters were calculated from microscopic images using image analysis software. Immunohistochemistry was performed to detect proliferating cell nuclear antigen (PCNA). There were significant differences in the TGW:BW ratio among groups (P <0.05): 0.3 ± 0.1 in G0, 0.5 ± 0.3 in G1, 0.8 ± 0.3 in G2 and 1.3 ± 0.7 in G3. In G0, large homogeneous follicles with eosinophilic colloid were seen. In the groups with lesions (G1, G2 and G3), heterogeneity in follicle shape and size, height and area of thyroid follicular cells, height of thyroid follicular epithelium and PCNA immunolabelling were directly related to histopathological grade, with significant differences among groups (P <0.001), gradually increasing from G1 to G3 compared with G0. The TGW:BW ratio and histological grade were positively correlated (P = 0.008). [Display omitted] [ABSTRACT FROM AUTHOR]

To assess short- and long-term outcomes from non-surgical management of diverticulitis with abscess formation and to develop a nomogram to predict emergency surgery. This nationwide retrospective cohort study was performed in 29 Spanish referral centers, including patients with a first episode of a diverticular abscess (modified Hinchey Ib–II) from 2015 to 2019. Emergency surgery, complications, and recurrent episodes were analyzed. Regression analysis was used to assess risk factors, and a nomogram for emergency surgery was designed. Overall, 1,395 patients were included (1,078 Hinchey Ib and 317 Hinchey II). Most (1,184, 84.9%) patients were treated with antibiotics without percutaneous drainage, and 194 (13.90%) patients required emergency surgery during admission. Percutaneous drainage (208 patients) was associated with a lower risk of emergency surgery in patients with abscesses of ≥5 cm (19.9% vs 29.3%, P =.035; odds ratio 0.59 [0.37–0.96]). The multivariate analysis showed that immunosuppression treatment, C-reactive protein (odds ratio: 1.003; 1.001–1.005), free pneumoperitoneum (odds ratio: 3.01; 2.04–4.44), Hinchey II (odds ratio: 2.15; 1.42–3.26), abscess size 3 to 4.9 cm (odds ratio: 1.87; 1.06–3.29), abscess size ≥5 cm (odds ratio: 3.62; 2.08–6.32), and use of morphine (odds ratio: 3.68; 2.29–5.92) were associated with emergency surgery. A nomogram was developed with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.77–0.85). Percutaneous drainage must be considered in abscesses ≥5 cm to reduce emergency surgery rates; however, there are insufficient data to recommend it in smaller abscesses. The use of the nomogram could help the surgeon develop a targeted approach. [ABSTRACT FROM AUTHOR]

Little data exist regarding characteristics and outcomes of pediatric patients undergoing septal myectomy. We evaluated this in a large referral population. Septal myectomy was performed in 199 consecutive patients aged ≤18 years with obstructive hypertrophic cardiomyopathy from January 1, 1976, to June 30, 2021. Median age was 13 years (interquartile range [IQR], 8-15 years). Left ventricular myectomy approaches included transaortic (163 of 198 [82%]), transapical (16 of 198 [8%]), and combined (19 of 198 [10%]). Right ventricular interventions included myectomy (13 of 199 [7%]) and patch reconstruction of the outflow tract (15 of 199 [8%]). Maximum left ventricular outflow tract gradients decreased after myectomy (prebypass: 50 mm Hg [IQR, 31-73 mm Hg] vs postbypass: 4 mm Hg [IQR, 0-9 mm Hg], P <.001), and this was sustained long-term (5 mm Hg [IQR, 5-10 mm Hg] at 10 years). Iatrogenic aortic and mitral valve injuries occurred in 13 of 199 (7%) and 1 of 199 (1%), respectively; however, all were successfully repaired. Operative mortality was 2 of 199 (1%). The cumulative incidence of redo myectomy was low, at 5.8% at 5 and 8.3% at 10 years. Redo myectomy patients had higher maximum left ventricular outflow tract gradients on echocardiography at predischarge and 1 year and were younger at the index operation (8 years [IQR, 2.5-10 years] vs 13 years [IQR, 9-16 years], P <.001). Overall survival at 10 years was 90%, relative to 47% in a previously reported pediatric nonoperative cohort. Pediatric septal myectomy provides safe, effective, and durable relief of ventricular outflow tract obstruction. Iatrogenic valve injury remains a low but nonnegligible risk. Recurrent obstruction requiring redo myectomy is infrequent and can be identified early. Long-term survival in this pediatric septal myectomy cohort appears to fare better than pediatric hypertrophic cardiomyopathy cohorts managed nonoperatively. [ABSTRACT FROM AUTHOR]

Both hyperkalemia (HK) and Acute Heart Failure (AHF) are associated with increased short-term mortality, and the management of either may exacerbate the other. As the relationship between HK and AHF is poorly described, our purpose was to determine the relationship between HK and short-term outcomes in Emergency Department (ED) AHF. The EAHFE Registry enrolls all ED AHF patients from 45 Spanish ED and records in-hospital and post-discharge outcomes. Our primary outcome was all-cause in-hospital death, with secondary outcomes of prolonged hospitalization (>7 days) and 7-day post-discharge adverse events (ED revisit, hospitalization, or death). Associations between serum potassium (sK) and outcomes were explored using logistic regression by restricted cubic spline (RCS) curves, with sK =4.0 mEq/L as the reference, adjusting by age, sex, comorbidities, patient baseline status and chronic treatments. Interaction analyses were performed for the primary outcome. Of 13,606 ED AHF patients, the median (IQR) age was 83 (76–88) years, 54% were women, and the median (IQR) sK was 4.5 mEq/L (4.3–4.9) with a range of 4.0–9.9 mEq/L. In-hospital mortality was 7.7%, with prolonged hospitalization in 35.9%, and a 7-day post-discharge adverse event rate of 8.7%. Adjusted in-hospital mortality increased steadily from sK ≥4.8 (OR = 1.35, 95% CI = 1.01–1.80) to sK = 9.9 (8.41, 3.60–19.6). Non-diabetics with elevated sK had higher odds of death, while chronic treatment with mineralocorticoid-receptor antagonists exhibited a mixed effect. Neither prolonged hospitalization nor post-discharge adverse events was associated with sK. In ED AHF, initial sK >4.8 mEq/L was independently associated with in-hospital mortality, suggesting that this cohort may benefit from aggressive HK treatment. [ABSTRACT FROM AUTHOR]

• CLABSI and VAP are independent risk factors for ICU mortality. • Female gender is an independent risk factors for ICU mortality. • Age increase risk of ICU mortality 1% per year of age. • TLength of stay increases the risk of ICU mortality by 1% per day of stay. • Central lines increase the risk of ICU mortality by 2% per day. The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients. Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and European countries. Between 07/01/1998 and 02/12/2022, 300,827 patients, followed during 2,167,397 patient-days, acquired 21,371 HAIs. Following mortality risk factors were identified in multiple logistic regression: Central line-associated bloodstream infection (aOR:1.84; P <.0001); ventilator-associated pneumonia (aOR:1.48; P <.0001); catheter-associated urinary tract infection (aOR:1.18; P <.0001); medical hospitalization (aOR:1.81; P <.0001); length of stay (LOS), risk rises 1% per day (aOR:1.01; P <.0001); female gender (aOR:1.09; P <.0001); age (aOR:1.012; P <.0001); central line-days, risk rises 2% per day (aOR:1.02; P <.0001); and mechanical ventilator (MV)-utilization ratio (aOR:10.46; P <.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34; P <.0001). Some identified risk factors are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; Central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, LOS, and MV-utilization. So, to lower the risk of death in ICUs, we recommend focusing on strategies to shorten the LOS, reduce MV-utilization, and use evidence-based recommendations to prevent HAIs. [ABSTRACT FROM AUTHOR]

A 63-year-old female presented to her oral surgeon for evaluation of a right mandibular lesion. She reported recent onset swelling and pain without associated neurosensory deficits or changes in occlusion. Her past medical history was significant for hypercholesterolemia, hypertension, and osteoporosis, which were under pharmacologic control. Her social history was neither remarkable for tobacco use nor alcohol consumption. Extraoral examination revealed mild right-sided facial swelling associated with a palpable mass of the inferior border of the mandible. Intraoral examination of the corresponding area showed an expansile mass surfaced by normal-appearing mucosa. The lesion was slightly tender to palpation, and no overt evidence of infection or purulence was observed. The patient was partially edentulous and missing all teeth posterior to the right second premolar. On further inquiry, it was disclosed that the patient had undergone a right mandibular biopsy 7 years prior, which was diagnosed as a traumatic (simple) bone cyst. A CBCT reconstructed panoramic radiograph showed a well-defined, approximately 4.0 × 2.5 cm radiolucency characterized internally by thickened bony septae and amorphous sclerotic bone that separated loculations of varying sizes (Fig 1a, (Fig. 1b). The lesion appeared to be causing superior displacement of the right first and second premolars. Axial imaging showed mild buccal and lingual expansion but no violation of the cortices (Fig. 1b). [Display omitted] A review of the first biopsy was requested and showed spicules of viable bone admixed with fibrin, neutrophils, and erythrocytes (Fig 2). The accompanying requisition form confirmed that the surgeon had entered an empty cavity intraoperatively. [Display omitted] The clinical and radiographic differential diagnosis for an expansive, multilocular radiolucency of the mandible in an older adult is extensive.1,2 A comprehensive list would include: ameloblastoma, odontogenic keratocyst, odontogenic myxoma, glandular odontogenic cyst, intraosseous mucoepidermoid carcinoma, odontogenic fibroma, calcifying epithelial odontogenic tumor, central giant cell granuloma, and intraosseous vascular malformation or hemangioma. Ameloblastoma is an aggressive but benign odontogenic tumor with a strong predilection for the posterior mandible. The majority of cases represent conventional or multicystic ameloblastoma, which may present as a unilocular radiolucency, but is often multilocular.3 Cortical expansion is a common finding as well as root resorption of adjacent teeth.2 Pain may be a presenting symptom in a minority of cases.3,4 While the multilocular appearance, cortical expansion, and presence of pain in this case would be consistent with ameloblastoma, the notable absence of root resorption of the teeth in the area of the lesion, as well as the sclerotic septations and foci of sclerotic bone, would be unusual for ameloblastoma. Odontogenic keratocyst (OKC) is a relatively common developmental cyst with the potential for aggressive clinical behavior. It is commonly found in the posterior mandible and occurs across a wide age range.2 Small OKCs are typically asymptomatic and unilocular while larger lesions may appear multilocular radiographically.5 In most cases, OKCs demonstrate minimal cortical expansion as they tend to spread along the intramedullary space.5 Resorption of adjacent tooth roots is less commonly observed in OKCs than other radiographically similar lesions such as ameloblastoma, dentigerous cyst, and radicular cyst.2 While the absence of root resorption in this case would be supportive of a radiographic diagnosis of OKC, the clinical and radiographic cortical expansion as well as sclerotic septations and foci of sclerotic bone would not. Odontogenic myxoma is a rare benign neoplasm more commonly found in the mandible than the maxilla.6 It typically occurs in young adults, with an average age of 25 to 30 years.2 A multilocular radiographic appearance is common, characterized by straight, thin or wispy septations that form rectangular or triangular spaces.6 The patient in this case is older than average for odontogenic myxoma, and the radiographic septations are markedly curvilinear, thick, and sclerotic, rather than straight and wispy. Glandular odontogenic cyst (GOC) is an uncommon benign cystic lesion of the jaws that often occurs in the anterior mandible of middle-aged adults.2 Approximately half of reported lesions present radiographically as unilocular and half as multilocular.7 Cortical expansion is a common finding in GOC.7 While lesions are typically asymptomatic, larger lesions may occasionally be associated with pain or paresthesia.2,8 The clinical and radiographic features of GOC show overlap with our case, although the posterior localization is less in favor of this diagnosis.9 Intraosseous mucoepidermoid carcinoma (IMEC) is a rare presentation of a centrally arising salivary gland malignancy occurring across a wide age range but most commonly in middle-aged adults.2 It is found more often in the mandible than the maxilla, most frequently localized to the molar-ramus area.2 Clinically, IMEC typically presents as an asymptomatic swelling; however, pain, paresthesia, and trismus are occasionally noted.10 Although the radiographic appearance of IMEC can be variable, it is most often described as a well-defined unilocular or multilocular radiolucency with or without association of an impacted tooth.11 Cortical perforation and soft tissue extension is possible. The periphery tends to be sclerotic and when present, loculations are multiple and small.11 The presence of internal sclerotic bony masses appears to be a characteristic feature of IMEC not typically present in other jaw lesions, which aligns well with the imaging in this case.11,12 Both central odontogenic fibroma (COF) and calcifying epithelial odontogenic tumor (CEOT) are rare benign tumors that may occur across a broad age range, but predominantly affect middle-aged adults.2,13 They present radiographically as unilocular or multilocular, with or without internal calcification. Cortical expansion, tooth displacement, root resorption, and association with an impacted tooth are variable features.13,14 While the multilocular nature and cortical expansion with tooth displacement are consistent with this case, pain would be an unusual symptom of both entities.2 Central giant cell granuloma (CGCG) is an uncommon pathology of the jaws that most often occurs in the mandible. CGCG may occur across a broad age range although most cases are found in patients less than 30 years of age.2,15 Lesions can present as a painless, slow-growing swellings.15 CGCG is radiographically diverse and can vary from a unilocular to multilocular radiolucency with generally well-defined but non-corticated borders.2 Displacement of anatomic structures including teeth is relatively common.16 When present, septations in CGCG are described as low-density and granular,11 which is in contrast to this case. Lastly, intraosseous vascular malformation or hemangioma is a very rare lesion in the jaws that typically affects younger patients and may present clinically with painless expansion.17 The mandible is more often affected than the maxilla.17 Intraosseous vascular lesions can appear radiographically as unilocular to multilocular, with either small or large loculations.18 The borders may be well-defined or ill-defined, but are usually not sclerotic,18 as seen in this case. An incisional biopsy of the right mandible was performed and submitted with the clinical impressions of osteomyelitis, central giant cell granuloma, and a fibro-osseous lesion. Microscopic examination revealed a glandular neoplasm consisting of variably sized cystic compartments surrounded by fibrous connective tissue and bony trabeculae. The cystic islands were lined by cuboidal, columnar, and squamous cells associated with occasional mucous cells and clear cells (Fig 3). Diagnostic considerations of a glandular odontogenic cyst versus intraosseous mucoepidermoid carcinoma were raised, and a second biopsy was recommended for further histopathologic confirmation. The second incisional biopsy showed a multicystic glandular proliferation that was overtly infiltrating the bone (Fig 4a). The tumor was composed of a more conspicuous admixture of squamous, intermediate, and mucous cells; the mucous cell component was notably more prominent compared to the previous biopsy (Fig. 4b). A diagnosis of intraosseous mucoepidermoid carcinoma was rendered. The patient subsequently underwent a segmental mandibulectomy with a free fibular flap reconstruction and modified radical neck dissection. She remains without evidence of disease at 18 months. [Display omitted] [Display omitted] Intraosseous mucoepidermoid carcinoma (IMEC) was initially described in 1939 by Lepp and reintroduced by way of literature review in 1970.19,20 The histogenesis remains at topic of debate and proposed origins include the epithelial lining of dentigerous cysts, epithelium associated with entrapped or ectopic salivary glands, and sinonasal epithelium with subsequent intraosseous extension.21–23 Overall, IMECs comprise 2-3% of all mucoepidermoid carcinomas19,20,24,25 and represent the most common salivary gland malignancy to arise centrally in the jaws.20,21,23 Lesions occur over a wide age range with a peak in the fourth and fifth decades of life. A slight female predilection has been reported, and the mandible is affected three times more frequently than the maxilla.20 The most common presenting symptoms include swelling and pain. Trismus, paresthesia, and mobility of the associated teeth have also been described. IMECs can show a varied radiographic presentation. Most cases appear as a well-defined, unilocular or multilocular radiolucency characterized internally by foci of amorphous, sclerotic bone or coarse septations.11 Lesions may cause expansion or perforation of the cortices.11 Approximately 28-54% of cases are associated with an impacted tooth or cyst.10,19,26,27 On microscopic examination, IMECs resemble their soft tissue counterparts and are composed of squamous, mucous, and intermediate cells in varying proportions. In their review of 104 cases from a literature and institutional search, Merna and colleagues found the majority of cases to be low-grade (54%); intermediate grade and high-grade lesions followed at 29% and 13% of cases, respectively.27 The histologic grading systems used in these cases were not disclosed, and it remains debated if the grading classifications utilized for soft tissue mucoepidermoid carcinomas have the same prognostic value in IMECs. Of note, a clinical staging system was developed by Brookstone and Huvos,10 which involves assessing factors such as cortical bone integrity, periosteal breakdown, and nodal spread (Table 1). These authors concluded that clinical stage was a better predictor of prognosis than histologic grade.10 Table 1 Clinical staging of intraosseous mucoepidermoid carcinomas Table 1 Stage Clinical features Stage I Intact cortical plates, no expansion Stage II Intact cortical plates, some expansion Stage III Cortical perforation, breakdown of overlying periosteum, and/or nodal spread (Adapted from Brookstone and Huvos)10 The diagnosis of IMEC requires correlation between clinical, radiographic, and histologic characteristics. The following diagnostic criteria have been proposed to aid in distinguishing IMECs from mucosal mucoepidermoid carcinomas: 1. Presence of intact cortical plates, 2. Radiographic evidence of bone destruction, 3. Exclusion of another primary tumor, 4. Histopathological confirmation, and 5. Detectable intracellular mucin.20,28,29 Several studies have evaluated MAML2 gene rearrangements in IMECs.9,10,30–34 Reddy and colleagues performed a review of the literature and found MAML2 rearrangements reported in 19 of the 28 published cases.9 The fusion partner in most cases was CRTC1; however, the CRTC3-MAML2 fusion transcript has been documented in at least one case.31 IMECs are treated by complete surgical excision with or without neck dissection. Post-operative radiation therapy and adjuvant chemotherapy have been used in select cases. A recurrence rate of 40% for conservative treatment and 4% for radical treatment have been reported.35 The overall prognosis is good, although occurrence in males, maxillary involvement, and high histological grade portend a poorer prognosis according to Merna et al.27 Notch inhibitors, EGFR inhibits, and RNA interference strategies are currently being explored and show promise as potential therapeutic avenues.30,36 [ABSTRACT FROM AUTHOR]

This observational study aims to compare the effectiveness of helmet therapy versus natural course in twin siblings suffering from nonsynostotic head deformations. A retrospective analysis of all twin couples treated with helmet therapy between March 2009 and May 2017 at an orthopedic hospital was conducted. Inclusion criteria were me if only one twin received helmet therapy. The other twin acted as control. A classification for different head shapes was used. A total of 61 twin couples was included. Change in outcome parameters of helmet therapy and natural course differed significantly: cranial vault asymmetry (CVA) −0.66 cm vs. −0.04 cm, cranial vault asymmetry index (CVAI) −5.35% vs. −0.51% (both p < 0.001), cephalic index (CI) −3.10% vs. −1.91% (p = 0.006). Helmet therapy showed a success rate (CI < 90% and CVAI ≤7% or better) of 63.6% vs. 21.1% in children with natural course (p = 0.002). Within the limitations of the study it seems that the results of this retrospective, single-center study confirm that helmet therapy to be a reliable treatment for mild to severe positional head deformation. [ABSTRACT FROM AUTHOR]

• Heart failure is a very prevalent condition in people older than 65 years and, therefore, it is important to investigate the factors that are involved in the increase of both morbidity and mortality. • In the era of vaccination in which we find ourselves, it is important to try continuously to show the protective effects of this medical tool, in this case, not only in patients with chronic heart failure but also in those with acute heart failure. • Spending time researching the methods can protect our patients who suffer from heart failure gives us more possibilities for improving their quality of life and their life expectancy. To investigate the relationship of seasonal flu vaccination with the severity of decompensation and long-term outcomes of patients with heart failure (HF). We analyzed 6147 consecutively enrolled patients with decompensated HF who presented to 33 Spanish emergency departments (EDs) during January and February of 2018 and 2019, grouped according to seasonal flu vaccination status. The severity of HF decompensation was assessed by the Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute Heart Failure (MEESSI-AHF) + MEESSI scale, need of hospitalization and in-hospital all-cause mortality. The long-term outcomes analyzed were 90-day postdischarge adverse events and 90-day all-cause death. Associations between vaccination, HF decompensation severity and long-term outcomes were explored by unadjusted and adjusted logistic and Cox regressions by using 14 covariables that could act as potential confounders. Overall median (IQR) age was 84 (IQR = 77-89) years, and 56% were women. Vaccinated patients (n = 1139; 19%) were older, had more comorbidities and had worse baseline status, as assessed by New York Heart Association class and Barthel index, than did unvaccinated patients (n = 5008; 81%). Infection triggering decompensation was more common in vaccinated patients (50% vs 41%; P < 0.001). In vaccinated and unvaccinated patients, high or very-high risk decompensation was seen in 21.9% and 21.1%; hospitalization occurred in 72.5% and 73.7%; in-hospital mortality was 7.4% and 7.0%; 90-day postdischarge adverse events were 57.4% and 53.2%; and the 90-day mortality rate was 15.8% and 16.6%, respectively, with no significant differences between cohorts. After adjusting, vaccinated decompensated patients with HF had decreased odds for hospitalization (OR = 0.823, 95%CI = 0.709–0.955). In patients with HF, seasonal flu vaccination is associated with less severe decompensations. [Display omitted] [ABSTRACT FROM AUTHOR]

Attempts at dynamic reconstruction of the upper eyelid either by neurotization or direct muscle replacement have been scarce. Substitution of the levator palpebrae superioris muscle requires the use of extremely small and pliable structures. As a proof of concept/pilot study, we present a consecutive series of patients who underwent blepharoptosis correction using the neurotized omohyoid muscle graft. Retrospective analysis of patients receiving a neurotized omohyoid muscle graft for levator palpebralis substitution between January and December 2019. Five patients were operated (2 male, 3 female); median age was 35.5 years. Median palpebral aperture was 0 mm and levator function was< 1 mm in all cases. Median denervation time for the levator muscle was 9 years. All surgeries were uneventful, and no postoperative complications were seen. Twelve months after the procedure, all patients presented with adequate palpebral aperture on activation of the spinal nerve. Median palpebral aperture was 6.5 mm Postoperative electromyography revealed muscle contraction when stimulation was applied to the spinal nerve. This study introduces the concept of severe blepharoptosis correction using the omohyoid muscle. We believe that with time and further technical refinements it could become an invaluable tool in eyelid reconstruction surgery. [ABSTRACT FROM AUTHOR]

Acute decompensated heart failure (ADHF) is one of the most frequent causes of emergency department (ED) visits. Point-of-Care Ultrasound (POCUS) is a reliable, easy-to-use, and available tool for an accurate diagnosis of ADHF. We aimed to analyze the impact of introducing POCUS as an additional tool to clinical standard diagnosis in clinical times of hospitalized heart failure patients. Retrospective cohort study comparing patients consulting to ED for heart failure acute decompensation previous to the rutinary use of POCUS versus patients who received an ultrasound-guided diagnosis at entrance. Ultrasound evaluation was additional to standard diagnosis (which included natriuretic peptides, images, etc). Cumulative incidence functions were calculated for time to treatment, time to disposition decision, and time to discharge. We used a flexible parametric model for estimate the time ratio (TR) in order to reflect the effect of POCUS. A total of 149 patients were included. The most frequent comorbid condition was hypertension (71.8%) followed by type 2 diabetes (36.2%). B type natriuretic peptide (BNP) was over 500 ng/ml. Most patients had Stevenson B profile (83.9%) at admission. In the cumulative incidence model (Fig. A), the TR (time ratio) for the outcome time to treatment was 1.539 (CI 95% 0.88 to 2.69). The TR for the outcome time to disposition decision was 0.665 (CI 95% 0.48 to 0.99). The TR for the outcome time to discharge (hospital length of stay) was 0.663 (CI 95% 0.49 to 0.90). In our study, the introduction of POCUS to ADHF patients decreases time to disposition decision and total length of hospital stay. Conversely, time to treatment augments. There is need for the evaluation of ultrasound as an intervention in clinical trials to confirm these findings. [ABSTRACT FROM AUTHOR]

In today's product development processes (PDP), the complexity that companies want to master is growing as markets expand and interdisciplinarity increases. In previous and current research, approaches and methods are being developed to achieve a validated and verified product with the corresponding estimates of cost development as early as possible in the PDP. One of today's research approaches is focusing on modelling parameter and process dependencies that can be used to identify affected stakeholders, models, and process steps in the event of a potential change in a digital PDP so that far-reaching changes can be made efficiently. By the mentioned approach, the traceability of affected parameters into some domain models is possible, such as Microsoft Excel, an analysis into script-based domain models such as Python-based models are not established so far. The already established approach contains a system model in which a digital PDP for fiber-reinforced plastics (FRP) based on load path optimized local reinforced semi-finished products, more specifically tailored textiles (TT), is present. TT offer promising potential to reduce resulting waste compared to conventional FRP. In addition to the process steps, technical parameters from other expert models already exist in the system model and the stakeholders involved are created as roles. The present work will extend this approach with a proprietary approach by which Python-based simulation models can be implemented and whose model-specific parameters can also be efficiently analyzed and traced along the digital PDP. The method presented in this paper is intended to adapt a Python script-based production model for tailored fiber placement (TFP) to the existing system model. By extending the methodology, it is possible to identify parameters right down to the Python models that are relevant for the validation of requirements in the digital PDP. Furthermore, these parameters can also be affected by possible changes and can be adapted efficiently. [ABSTRACT FROM AUTHOR]

The effect of workpiece tilt angle (0°, 30°) and tool ultrasonic vibration was evaluated when machining hardened steel with electroplated CBN grinding points (B15, B30, B54). Workpiece inclination had the greatest influence in decreasing surface roughness (Ra) by up to ∼44%, with the lowest value (∼0.32 µm) achieved at 30° tilt angle when ultrasonic assisted grinding using B30 wheels. Despite also reducing roughness, use of ultrasonic actuation generally increased specific volumetric grit loss (∼11%) and normal forces (∼14%) compared to conventional grinding when employing B15 and B30 points. No substantial microhardness modification was evident in most of the ground surfaces. [ABSTRACT FROM AUTHOR]

This study is the first record of medicinal plants in the southwest of the Coahuila state, an arid zone where extreme dry conditions prevail. One hundred twenty-two residents (in sixteen communities) were interviewed. The residents were questioned with a questionnaire-guided ethnomedical survey protocol about the various plants used. Seventy-seven species of medicinal plants belonging to 36 botanical families were cited. The highest use-value (UV) was calculated for Lippia graveolens Kunth (0.30); Aloe vera (L.) Burm.f. (0.20); Eucalyptus abdita Brooker & Hopper , Chamaemelum nobile (L.) All. (0.16); Mentha spicata L. (0.15) and Salvia officinalis L. (0.10). Informant consensus factor (ICF) about usages of medicinal plants ranges from 0.41 to 0.80; the highest level of agreement was determined between the informants and Respiratory System Diseases (0.80). The highest fidelity level (FL) values (100%) were identified in Flourensia cernua DC., Artisia ludoviciana Nutt., and Parthenium incanum Kunth to Gastro-intestinal System Diseases; Eucalyptus abdita Brooker & Hopper , Bougainvillea berberidifolia Heimerl, and Lippia graveolens Kunth to Respiratory System Diseases (RSD) and Cyclolepis genistoides D.Don and Ephedra antisyphilitica Berland. ex C.A.Mey. to Obstetrics, Gynecology and Urinary tract Diseases. These last two medicinal plant species ("palo azul" and "pitoreal") used by the rural communities in Viesca in the treatment of urinary tract infections and kidney stones have not been reported previously. These findings can provide new research directions for further phytochemical studies. The present study revealed that the residents are rich in ethno-medicinal knowledge and actively use medicinal plants to treat various diseases. New phytochemical and pharmacological research are needed to confirm the therapeutic potential and safety of the identified plants. [ABSTRACT FROM AUTHOR]

This study examines the impact of technological advancements, particularly Internet access, on labor income inequality. The Internet is a versatile technology with wide-ranging applications. We argue that in environments characterized by limited innovation and a polarized job market, Internet access can positively influence worker income, especially for those in lower income brackets. Our research conducted in Ecuador from 2010 to 2017 employs instrumental variable quantile regression to analyze how Internet access affects wages across various income levels. Our findings indicate that using the Internet at work correlates with higher wages in Ecuador, particularly benefiting workers in the higher quantiles of the income distribution. While the income gap between employees with and without Internet access is largest in the lowest quantile, it decreases in the second quantile and widens again in the third, but never surpasses the gap observed in the first quantile. Public policy should thus provide citizens, particularly in the lowest income deciles, with education on effective Internet usage to improve their conditions and reduce inequality. By concentrating on these groups, we can better distribute the advantages of Internet access, ultimately creating a more balanced and equitable society. • The individuals in the higher quantiles experience greater advantages in terms of real labor income when using the Internet. • The utilization of the Internet in the workplace in Ecuador during the years 2010 and 2017 has a positive effect on wages on average. • The disparity in income participation between the lowest and highest quantiles decreased among Internet users in the workplace, whereas this disparity increased for individuals who did not utilize this tool at work. • We conducted an analysis using quantile regression to determine the changes in the representation of each quantile of the total wage. [ABSTRACT FROM AUTHOR]

Water contamination by arsenic (As) poses a significant threat to millions of people worldwide. The development of an effective, affordable, and decentralized system for As removal remains a critical need, particularly to treat As at environmentally relevant concentrations. In this study, a self-standing electrode composed of an engineered interface of CuBi 2 O 4 /CuO/Fe 2 O 3 was synthesized on fluorine-doped tin oxide (FTO) substrate using electrodeposition and dip-coating techniques. Each layer Bi 2 O 3 , CuBi 2 O 4 , CuO, and Fe 2 O 3 was characterized photochemically and electrochemically to identify their light harvesting and electron transfer capacities. The efficacy of the CuBi 2 O 4 /CuO/Fe 2 O 3 electrode for removing 0.5 mg L−1 As (III) was evaluated under various treatment conditions, including adsorption, photocatalysis (PC), electrocatalysis (EC), and photoelectrocatalysis (PEC). The PEC treatment at 1.0 V vs Ag/AgCl under visible light irradiation exhibited outstanding As removal efficiency of 96.8 %, surpassing PC (40.4 %) and EC (54.5 %). Fundamental evaluation of the removal mechanism revealed that CuBi 2 O 4 /CuO/Fe 2 O 3 oxidizes As (III) to As (V) for enhanced adsorption onto iron oxide sites, as confirmed by X-ray photoelectron spectroscopy (XPS), which identified both As (III) and As (V) adsorbed on the surface. These findings underscore the importance of a rational design approach for photoanodes in As adsorption, highlighting the significant role of individual layers. [Display omitted] • Synergistic enhancement due to the p - n heterojunction in CuBi 2 O 4 /CuO/Fe 2 O 3. • Interlayer electrode enhances charge carrier accumulation under visible light. • Photoelectrocatalysis significantly increases As removal rate. • Oxidation/Adsorption dual mechanism revealed by XPS analysis. [ABSTRACT FROM AUTHOR]

• Physiological changes of CSF pressure are investigated during and after spine surgery. • CSF pressure rises significantly intra- to postoperative unrelated to decompression. • Increased CSF pressure persists after 24 h of monitoring. • Type of respiration, anesthesia, and level of consciousness are possible confounders. • CSF pressure may be correctly evaluated only in the same operative setting. Timely and sufficient decompression are critical objectives in degenerative cervical myelopathy (DCM) and spinal cord injury (SCI). We previously investigated intraoperative cerebrospinal fluid pressure (CSFP) for determining surgical outcomes. However, confounding factors during the intra- and postoperative setting need consideration. These are related to type of respiration (i.e., artificial vs. natural) and anesthesia, which affect CSFP dynamics through the interaction between the cardiorespiratory system and the CSF compartment. This retrospective cohort study (NCT02170155) aims to systematically investigate these factors to facilitate CSFP interpretation. CSFP was continuously measured through a lumbar catheter, intra- and postoperatively, in 21 patients with DCM undergoing decompression surgery. Mean CSFP and cardiac-driven CSFP peak-to-valley amplitude (CSFPp) were analyzed throughout the perioperative period, including the immediate extubation period in eight patients. Intraoperative mean CSFP had a median value and {interquartile range} of 10.8 {5.5} mmHg and increased 1.6-fold to 16.9 {7.1} mmHg postoperatively (p < 0.001). CSFPp increased 3-fold from 0.6 {0.7} to 1.8 {2.5} mmHg (p = 0.001). Increased CSFP persisted overnight. During extubation, there was a notable increase in CSFP and CSFPp of 14.0 {5.8} and 5.1 {3.1} mmHg, respectively. From case-based analysis, this was attributed to an arterial pCO 2 increase. There was no correlation between respirator settings and CSFP metrics. There were distinct and quantifiable changes in CSFP dynamics from the intra- to postoperative setting related to type of respiration, anesthesia, and level of consciousness. When monitoring CSFP dynamics in spine surgery across these settings, cardiorespiratory factors must be controlled for. [ABSTRACT FROM AUTHOR]

Octopus maya is an endemic species of the Yucatan Peninsula. This species sustains the octopus' fishery in the region and is the only cephalopod cultured in Mexico. It is known that O. maya harbor a large richness and abundance of metacestodes that have been tentatively identified by light microscopy alone. Since the larval stages of some orders of marine cestodes lack the taxonomic characteristics shown by the adult stages and on which cestode taxonomy is based, identification down to the species level is often unattainable. Hence, the goal of this study was to characterize the parasites, for the first time, at morphological and molecular levels. A total of 60 octopuses were collected from September to December 2017 from four fishery landing ports in Yucatán: Sisal, Progreso, Dzilam de Bravo, and Rio Lagartos (15 hosts per locality). Morphology of metacestodes was characterized by light and Scanning Electron Microscopy (SEM), while the genes 18S and 28S rDNA were sequenced for molecular characterization. Based on phenotypic characters and molecular data, seven taxa of metacestodes were identified, four of them belonging of order Trypanorhyncha: Eutetrarhynchus sp., Kotorella pronosoma , Nybelinia sp., Prochristianella sp. 1; and the three remaining taxa belonging to the order Onchoproteocephalidea: Acanthobothrium sp., Phoreiobothrium sp., and Prosobothrium sp. This work provides, for the first time, molecular support to the morphological characterization of metacestodes recorded in Octopus maya. [Display omitted] ● Seven taxa of metacestodes from Octopus maya were identified ● First morphological and molecular match in cestodes of O. maya is presented ● Phylogenetic analysis indicate octopus cestodes grouped in four different groups of trypanorhynchs and onchoproteocephalids ● Prochristianella sp. 1 is the only species with 100% prevalence [ABSTRACT FROM AUTHOR]

The rock frog species of the genus Thoropa possess nuptial pads composed of papillary epidermal projections (PEPs) on the hands of males. The morphology, number, and distribution of PEPs are employed to distinguish between species of Thoropa. Here we describe the morphology and distribution of the spine-shaped PEPs on the hands of five species of Thoropa : T. megatympanum , T. miliaris , T. petropolitana , T. saxatilis , and T. taophora. We test if PEP color is related to collection month or years in preservative. We also investigate if there is a relationship between the occurrence of spermatozoa and the appearance of PEPs, which would be a criterion to define adult males. Additionally, we test whether the number of PEPs differs among the five species, and also whether it is related to body size (snout–vent length, SVL). There is no temporal pattern in the color of PEPs. The occurrence of spermatozoa and PEPs is unrelated, with mature spermatozoa being present in males that lack PEPs. The number of PEPs is positively related to SVL. Statistically, the number of PEPs differs among species, but the ranges of intraspecific variation in this trait overlaps among species, hindering their use in diagnosing species of Thoropa. • We studied the spinous nuptial pads of Thoropa and their relationship to the occurrence of spermatozoa. • The occurrence of spermatozoa in Thoropa species is unrelated to the presence or number of nuptial pad spines. • The number and distribution of nuptial pad spines are of limited use in diagnosing species of Thoropa. [ABSTRACT FROM AUTHOR]

Revisional bariatric surgery (RS) is indicated if there is weight regain or insufficient weight loss, no improvement or reappearance of co-morbidities, or previous bariatric surgery complications. It has been associated with higher postoperative morbidity. To evaluate the early postoperative complications (<30 d) of Roux-en-Y gastric bypass RS (RYGB-RS) after primary sleeve gastrectomy (SG-1) compared with primary RYGB (RYGB-1) at a bariatric surgery referral center. Department of General and Digestive Surgery of General Universitary Hospital of Alicante, Spain. Retrospective cohort study comparing RYGB-RS after SG-1 and RYGB-1 between January 2008 and March 2021. Postoperative complications, hospital stay, mortality, and readmissions were analyzed. Six hundred and twenty-eight RYGB surgeries (48 RYGB-RS, 580 RYGB-1) were studied. The mean age of patients undergoing RYGB-RS was 50 years, compared with 46 years in the RYGB-1 group (P =.017). Mean initial body mass index was 44.2 kg/m2 (RYGB-RS) versus 47.6 kg/m2 (RYGB-1; P =.004). Cardiovascular risk factors were higher in the RYGB-1 group (P <.05). Indications for RS were weight regain or insufficient weight loss (72.9%), weight regain or insufficient weight loss plus gastroesophageal reflux disease (14.6%), and gastroesophageal reflux disease (12.5%). There were no differences in the frequency of complications (RYGB-RS 22.9% vs RYGB-1 20.5%) or in their severity (Clavien–Dindo ≥IIIa; RYGB-RS 10.4% vs RYGB-1 6.4%; P >.05). There were no differences in emergency room visits (RYGB-RS at 12.5% vs RYGB-1 at 14.9%) or in readmissions (RYGB-RS at 12.5% vs RYGB-1 at 9.4%). No differences were observed between primary RYGB and revisional RYGB in early morbidity, mortality, emergencies, or readmissions. Revisional bariatric surgery is a safe procedure at referral centers and must be done by expert hands. [ABSTRACT FROM AUTHOR]

Oral potentially malignant disorders encompass conditions with a heightened risk of progressing to oral squamous cell carcinoma (OSCC) when compared to normal mucosa. Among these, leukoplakia stands out, with a malignant transformation rate of approximately 4%. Furthermore, these lesions may exhibit various degrees of oral epithelial dysplasia (OED) or even hyperplasia without atypia upon histopathological examination. We present five cases with a clinical diagnosis of leukoplakia, all of which underwent toluidine blue (TBS) staining to aid in selecting the biopsy area. A subsequent histopathological analysis was conducted, and its findings were correlated with the TBS results, revealing a predominance of cases that tested positive for TBS and also exhibited OED or even OSCC. TBS has been a valuable tool in dentistry for many years, and studies have demonstrated its non-toxic, rapid, cost-effective, and efficient nature. It greatly assists in the diagnostic process and in selecting the biopsy site for lesions suspected of malignancy. [ABSTRACT FROM AUTHOR]

A 22-year-old male patient with a brown complexion was referred to the stomatology clinic, complaining of "swollen cheeks." His medical history did not reveal smoking, diabetes mellitus, or systemic arterial hypertension, and he was currently undergoing orthodontic treatment. Upon extra-oral examination, a sessile swelling was observed in the left cheek region, near the labial commissure, with no enlarged regional lymph nodes. Intraoral examination revealed a normochromic, well-defined, encapsulated, hardened, and painless nodule in the left jugal mucosa, measuring approximately 5 cm in diameter and having been present for six months. The initial diagnostic hypotheses considered were sebaceous cyst and pleomorphic adenoma. An excisional biopsy was performed, and the histopathological report indicated Pilomatricoma, a tumor of hair follicle origin. This type of tumor exhibits characteristics of differentiation from hair follicle matrix cells, with the presence of hair matrix basaloid cells, transitional cells, and amorphous shadow (ghost) eosinophilic cells. Thorough clinical examination and knowledge of the lesion were pivotal in achieving an accurate diagnosis and, consequently, the appropriate treatment. [ABSTRACT FROM AUTHOR]

Ameloblastic fibro-odontoma (AFO) is a rare, asymptomatic, benign, mixed odontogenic tumor that typically affects individuals in the 1st-2nd decades of life, with a predilection for the mandible. Surgical removal is conservative, and the prognosis is generally favorable. We present a case of AFO in an 8-year-old male who sought dental care due to an asymptomatic lesion surrounding tooth 47, which exhibited delayed eruption. Imaging examinations revealed a well-defined radiolucent lesion with small calcifications around the crown of tooth 47. Clinical examination identified a rounded, normochromic, irregular, firm lesion measuring 25 mm in the region of the right retromolar triangle. Initial diagnostic hypotheses included calcifying odontogenic cyst and dentigerous cyst. An aspiration puncture yielded no evident liquid content, and subsequently, an excisional biopsy of the fibrous capsule was performed while maintaining the tooth. The histopathological diagnosis confirmed AFO. The patient has been followed up for six months without evidence of recurrence. [ABSTRACT FROM AUTHOR]

• A method was developed to simulate arterial pulse waves (PWs) across ages, including different circle of Willis (CoW) variations. • A PW database comprising over 30,000 virtual subjects was created and verified using in vivo data. • Seven machine learning models were trained and tested to classify CoW topology based on carotid and vertebral flow velocity PWs. • Both the database and machine learning models are freely available. The topology of the circle of Willis (CoW) is crucial in cerebral circulation and significantly impacts patient management. Incomplete CoW structures increase stroke risk and post-stroke damage. Current detection methods using computed tomography and magnetic resonance scans are often invasive, time-consuming, and costly. This study investigated the use of machine learning (ML) to classify CoW topology through arterial blood flow velocity pulse waves (PWs), which can be noninvasively measured with Doppler ultrasound. A database of in silico PWs from 30,618 virtual subjects, aged 25 to 75 years, with complete and incomplete CoW topologies was created and validated against in vivo data. Seven ML architectures were trained and tested using 45 combinations of carotid, vertebral and brachial artery PWs, with varying levels of artificial noise to mimic real-world measurement errors. SHapley Additive exPlanations (SHAP) were used to interpret the predictions made by the artificial neural network (ANN) models. A convolutional neural network achieved the highest accuracy (98%) for CoW topology classification using a combination of one vertebral and one common carotid velocity PW without noise. Under a 20% noise-to-signal ratio, a multi-layer perceptron model had the highest prediction rate (79%). All ML models performed best for topologies lacking posterior communication arteries. Mean and peak systolic velocities were identified as key features influencing ANN predictions. ML-based PW analysis shows significant potential for efficient, noninvasive CoW topology detection via Doppler ultrasound. The dataset, post-processing tools, and ML code, are freely available to support further research. [ABSTRACT FROM AUTHOR]

Odontogenic keratocyst (OKC) is a lesion that is originated from the dental epithelium, is asymptomatic and can grow large, with a recurrence that varies from 5% to 62%. The antimetabolite 5-fluorouracil (5-FU) has shown less damage to adjacent structures and reduces the recurrence rate. Case 1: A 32-year-old female patient presented due to increased volume, an incisional biopsy was performed, obtaining a diagnosis of OKC, decompression and marsupialization were performed for 18 months, because the lesion had smaller dimensions, enucleation was performed, peripheral osteotomy and application of 5-FU with modified technique. Case 2: A 10-year-old male patient with increased volume in the maxillary region and drainage of fluid into the oral cavity, a biopsy was performed obtaining a diagnosis of OKC, enucleation, peripheral osteotomy, and application of 5-FU for 24 hours were performed, after that time, the surgical dressing was removed and the wound was closed. Case 3: A 15-year-old female patient presented with an increase in volume in the mandibular body on the left side. An incisional biopsy was performed, obtaining a diagnosis of OKC, for which enucleation, peripheral osteotomy, and application of 5-FU with a modified technique were performed. The 5-FU has obtained lower recurrence and damage to structures compared to simple enucleation and Carnoy's solution. With the application of 5-FU with the modified technique, the postoperative period is more comfortable and removal of the dressing after 24 hours is avoided. [ABSTRACT FROM AUTHOR]

• Difference-of-gammas model provides a fuller representation of prVEPs, defining individual peak widths and later peaks. • Parameters derived from the model has high test–retest reliability and stability. • Difference-of-gammas model captures changes across age that are consistent with prior studies. To introduce a novel approach to analyzing pattern reversal visual evoked potentials (prVEPs) using a difference-of-gammas model-based fitting method. prVEP was recorded from uninjured youth ages 11–19 years during pre- or post-season sports evaluation. A difference-of-gammas model fit was used to extract the amplitude, peak time, and peak width of each of four gamma components. The within session reliability and stability of fits across a 6-month period were determined. To demonstrate an application of this analysis, changes in parameters across age were determined. A difference-of-gammas model consisting of four gamma functions was fit to the prVEP of 151 youth. Peak times and amplitudes of functions corresponded to standard measures of the N75, P100, and N135 components respectively, and a late gamma peak (mean peak time 219 ms). We extracted the peak width, which increased with each subsequent temporal peak. Parameter fits were reliable within sessions (correlation coefficient > 0.92 for all measured parameters; good agreement on Bland-Altman calculation) and were stable between sessions separated by less than 6 months (correlation coefficient > 0.90). Standard peak analysis metrics extracted from the difference-of-gamma model fits were largely consistent with gold-standard peak analysis measurements. The difference-of-gammas model provides a stable and reliable within-participant representation of the global temporal variability of prVEP waveforms across a large sample of youth. Using difference-of-gammas model to characterize the global temporal variability of the prVEP waveform offers a promising direction to enhance analysis for identifying and following subtle changes in neurologic conditions. [ABSTRACT FROM AUTHOR]