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Arginine, a conditionally essential amino acid, is key component in metabolic pathways including immune regulation and protein synthesis. Depletion of arginine contributes to worse outcomes in severely ill and surgical patient populations. We assessed prognostic implications of arginine levels and its metabolites and ratios in polymorbid medical inpatients at nutritional risk regarding clinical outcomes and treatment response. Within this secondary analysis of the randomized controlled Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT), we investigated the association of arginine, its metabolites and ratios (i.e., ADMA and SDMA, ratios of arginine/ADMA, arginine/ornithine, and global arginine bioavailability ratio) measured on hospital admission with short-term and long-term mortality by means of regression analysis. Among the 231 patients with available measurements, low arginine levels ≤90.05 μmol/l (n = 86; 37 %) were associated with higher all-cause mortality at 30 days (primary endpoint, adjusted HR 3.27, 95 % CI 1.86 to 5.75, p < 0.001) and at 5 years (adjusted HR 1.50, 95 % CI 1.07 to 2.12, p = 0.020). Arginine metabolites and ratios were also associated with adverse outcome, but had lower prognostic value. There was, however, no evidence that treatment response was influenced by admission arginine levels. This secondary analysis focusing on medical inpatients at nutritional risk confirms a strong association of low plasma arginine levels and worse clinical courses. The potential effects of arginine-enriched nutritional supplements should be investigated in this population of patients. clinicaltrials.gov as NCT02517476 (registered 7 August 2015). [ABSTRACT FROM AUTHOR]

To investigate the influence of postoperative complications on tumor-related (TRD), disease-free survival (DFS) and overall survival (OS) in patients undergoing liver transplant (LT) for hepatocellular carcinoma (HCC). We retrospectively evaluated 425 LTs for HCC from 2010 to 2019. Postoperative complications were classified according to Comprehensive Complication Index (CCI) and the posttransplant risk of TRD assessed through Metroticket 2.0 calculator. The population was stratified into high-risk and low-risk cohorts based on the predicted TRD risk of 80%. In a second step, we re-evaluated TRD, DFS and OS of both cohorts according to a further stratification based on 47.3 points of CCI cut-off. In the low-risk cohort, we observed a significantly better DFS (84% vs. 46%, p <0.001), TRD (3% vs. 26%, p <0.001) and OS (89% vs. 62%, p <0.001) in the group with CCI < 47.3. In the high-risk cohort, patients with CCI < 47.3 had significantly better DFS (50% vs. 23%, p = 0.003) and OS (68% vs. 42%, p = 0.02) and a comparable TRD (22% vs. 31%, p = 0.142). A complicated postoperative course negatively influenced long-term survival. This poorer oncological outcome associated with in-hospital postoperative complications suggests that every effort should be made to improve the early posttransplant course in HCC patients, including a careful donor-to recipient match and use of new perfusion technologies. [ABSTRACT FROM AUTHOR]

Magnetic resonance cholangiopancreatography (MRCP) is the gold standard for diagnosis of patients with primary sclerosing cholangitis (PSC). The semi-quantitative MRCP-derived Anali scores proposed for risk stratification, have poor-to-moderate inter-reader agreement. To evaluate the prognostic performance of quantitative MRCP metrics in PSC. This is a retrospective study of PSC patients undergoing MRCP. Images were processed using MRCP+ software (Perspectum Ltd, Oxford) that provides quantitative biliary features, semi-automatically extracted by artificial intelligence-driven analysis of MRCP-3D images. The prognostic value of biliary features has been assessed for all hepato-biliary complications. 87 PSC patients have been included in the analysis. Median follow-up from MRCP to event/censoring of 30.9 months (Q1-Q3=13.6–46.6). An adverse outcome occurred in 27 (31.0%) patients. The number of biliary strictures (HR=1.05 per unit, 95%CI 1.02–1.08, p < 0.0001), spleen length (HR=1.16 per cm, 95%CI 1.01–1.34, p = 0.039), adjusted for height, age at MRCP, and time from diagnosis to MRCP predicted higher risk of hepatobiliary complications. These were incorporated into a the quantitative MRCP-derived PSC (qMRCP-PSC) score (C-statistic=0.80). After 3-fold cross-validation, qMRCP-PSC outperformed the Anali score in our cohort (C-statistic of 0.78 vs 0.64) and enabled the discrimination of survival of PSC patients (log-rank p < 0.0001). The qMRCP-PSC score identified patients at higher risk of hepatobiliary complications and outperformed the available radiological scores. It represents a novel quantitative biomarker for disease monitoring and a potential surrogate endpoint for clinical trials. [ABSTRACT FROM AUTHOR]

We studied the COVID-19 impact in newly-diagnosed breast cancer (7,349 patients in 2019, and 5,563 in 2020). In 2020 there were two diagnostic drops: −37.2% (March–May), −15.8% (October–December). Early-stage at presentation (76.4% vs. 74.4%, p = 0.0013), conserving surgery (71.0% vs. 67.0%, p < 0.0001), chemotherapy (86.2% vs. 53.4%, p < 0.0001), and radiotherapy (65.7% vs. 42.1%, p < 0.0001) decreased in 2020 compared to 2019. COVID-19 occurred in 250 patients (4.49%). The time-dependent COVID-19 effect was associated with mortality (multivariable Cox analysis HR [95% CI] 2.26 [1.35–3.74]; p = 0.0018). Survival within the year of diagnosis was 97.6% in 2020 and 98.3% in 2019; 30-day mortality was 1.13% in 2020 (1.07 in uninfected patients), and 0.61% in 2019. The year of diagnosis lost its prognostic relevance after adjusting for stage and treatment. These findings emphasize the critical role of continuity of care, which was disrupted during the pandemic, and underscore the need for policies minimizing treatment initiation delay in newly diagnosed breast cancer patients. • Nearly 25% fewer cases of breast cancer were diagnosed due to the pandemic. • Newly diagnosed breast cancer occurred more frequently at advanced stage. • The use of conserving surgery, radio and chemotherapy declined in 2020 vs. 2019. • Survival rate within the year of diagnosis was 97.6% in 2020 and 98.3% in 2019. • Year of diagnosis was no longer prognostic after adjustment for stage and treatment. • 30-day mortality nearly doubled in 2020 even in uninfected patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the prevalence of peri-implantitis in implants inserted into pristine bone (control) to implants where autologous bone was used for grafting procedures (study). All patients who underwent implant surgery during a 20 years interval by one maxillofacial implant surgeon and received a prosthodontic rehabilitation afterwards were eligible for inclusion in the study. Periimplant bone resorption and periimplant disease were assessed. Of 421 patients 384 (91.2%) patients responded to a recall after having been treated over a 20-year period by one maxillofacial surgeon and several dentists. A total of 110 patients had 239 implants in pristine bone, and 274 patients had 607 implants placed in combination with autologous bone grafting procedures. Mean time in function was 74 months (range 15–236 months). In all, 342 implants (34.8%) were in function for longer than 7 years. A total of 64 implant sites (7.6%) in 39 patients (10.2%) showed signs of peri-implant mucositis. In addition, 17 implants (2.0%) in 14 patients (3.6%) revealed signs of peri-implantitis, of which five implants were in the control group (2.09%) whereas 12 implants were in the study group (1.98%), with no statistically significant difference (p = 0.8405). More than half of the patients with peri-implantitis had a history of periodontitis. Three implants were lost due to peri-implantitis and four implants failed for other reasons, resulting in an overall success rate of 99.2% in 846 implants. Within the limitations of the study it seems that the use of autologous bone still is a relevant option when performing augmentation procedures because of the low prevalence of peri-implantitis. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess the diagnostic utility of the Dimension EXL LOCI High-Sensitivity Troponin I (hs-cTnI-EXL) assay.Methods: This multicenter study included patients with chest discomfort presenting to the emergency department. Diagnoses were centrally and independently adjudicated by two cardiologists using all available clinical information. Adjudication was performed twice including serial measurements of high-sensitivity cardiac troponin (hs-cTn) I-Architect (primary analysis) and serial measurements of hs-cTnT-Elecsys (secondary analysis) in addition to the clinically used (hs)-cTn. The primary objective was to assess and compare the discriminatory performance of hs-cTnI-EXL, hs-cTnI-Architect and hs-cTnT-Elecsys for acute myocardial infarction (MI). Furthermore, we derived and validated a hs-cTnI-EXL-specific 0/1h-algorithm.Results: Adjudicated MI was the diagnosis in 204/1454 (14%) patients. The area under the receiver operating characteristics curve for hs-cTnI-EXL was 0.94 (95%CI, 0.93-0.96), and comparable to hs-cTnI-Architect (0.95; 95%CI, 0.93-0.96) and hs-cTnT-Elecsys (0.93; 95%CI, 0.91-0.95). In the derivation cohort (n = 813), optimal criteria for rule-out of MI were <9ng/L at presentation (if chest pain onset >3h) or <9ng/L and 0h-1h-change <5ng/L, and for rule-in ≥160ng/L at presentation or 0h-1h-change ≥100ng/L. In the validation cohort (n = 345), these cut-offs ruled-out 56% of patients (negative predictive value 99.5% (95%CI, 97.1-99.9), sensitivity 97.8% (95%CI, 88.7-99.6)), and ruled-in 9% (positive predictive value 83.3% (95%CI, 66.4-92.7), specificity 98.3% (95%CI, 96.1-99.3)). Secondary analyses using adjudication based on hs-cTnT measurements confirmed the findings.Conclusions: The overall performance of the hs-cTnI-EXL was comparable to best-validated hs-cTnT/I assays and an assay-specific 0/1h-algorithm safely rules out and accurately rules in acute MI.Clinical Trial Registration: ClinicalTrials.gov number, NCT00470587. [ABSTRACT FROM AUTHOR]

This study presents an innovative approach for simultaneous hydrogen production and wastewater remediation, integrating electrochemical treatment with solar light-driven photocatalysis. The research focuses on the use of a noble metal-free cathode, based on a electrodeposited composite of Co 2 P and elemental P, for efficient hydrogen generation from simulated wastewater through water splitting. This composite is characterized, in its optimized form, by an overpotential equal to 133.6 mV (at 10 mA cm-2) and by a Tafel slope of 60.5 mV dec-1. Challenges like the high potential required for the Oxygen Evolution Reaction (OER) and the use of expensive noble metals in electrodes are addressed by employing earth-abundant compounds for electrode fabrication. Additionally, the study explores the degradation of diclofenac (DCF) in wastewater, demonstrating that electrochemical treatment alone is insufficient for organic matter removal. Therefore, a coupled process involving a first electrochemical treatment step followed by a photocatalytic process using BiOCl is proposed. Thanks to the exposure of the (110) active face, BiOCl possesses excellent photocatalytic performances even under solar light irradiation. This hybrid approach not only enhances the efficiency of DCF degradation (about 90%) and reaches an organic matter removal of 59%, but it also improves hydrogen production, offering a sustainable solution for energy generation and water purification in the face of increasing global industrialization and water scarcity. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] Reconstructing hydrological variability is critical for understanding Lake Victoria's ecosystem history, the evolution of its diverse endemic fish community, the dynamics of vegetation in the catchment, and the dispersal of aquatic and terrestrial fauna in the East African Rift system during Latest Pleistocene and Holocene times. Whereas consensus exists on widespread desiccation of Lake Victoria ∼18 – 17 ka, the re-filling history (16 – 13 ka) has remained highly controversial. Here, we present data from four new sediment cores along a depth transect. We use lithostratigraphic core correlation, sediment facies, XRF data, wetland vegetation analysis (Typha pollen), and 14C chronologies of unprecedented precision to document Latest Pleistocene lake-level variability. At our coring site in the central basin, local Typha wetlands existed >16.7 ka, alternating with periods of desiccation. Moisture increased slightly between ca. 16.7 – 14.5 ka and wetlands with permanent, shallow ponds established simultaneously in the center and the marginal, more elevated parts of the flat lake basin. After ca. 14.0 ka, lake levels increased; wetlands in the central basin were submerged and replaced by lacustrine environments and a >50 m deep lake established ca. 13.5 ka, likely with intermittent overflow most of the time. The lake reached modern or even above-modern levels around 10.8 ka. This lake-level history is consistent with regional terrestrial paleoenvironmental reconstructions, notably the expansion of Afromontane and rainforest. Our data suggest a complex picture of paleoclimatic conditions in Eastern Africa and teleconnections to the North-Atlantic and Indian Ocean domains. [ABSTRACT FROM AUTHOR]

Reverse total shoulder arthroplasty (rTSA) improves shoulder elevation in patients treated for cuff tear arthropathy (CTA) or irreparable massive cuff tears. Patient satisfaction can be limited by reduced active external rotation (AER). Rotator cuff muscles that externally rotate the shoulder are infraspinatus and teres minor (TM). The purpose of this study was to assess the correlation between preoperative TM fatty degeneration and postoperative AER after rTSA performed for CTA or irreparable cuff tears. Constant scores and active range of motion were consecutively collected for 109 shoulders in 97 patients (mean: 75.73 ± 8.94 years; 31 male, 66 female) over a 10-year period. AER was evaluated with the humerus in adduction (AER1) and in abduction. TM muscle atrophy was scored according to Goutallier's classification, assessed on preoperative computed tomography scans. Multivariate analysis showed that TM fatty infiltration was a predictor of AER1. AER1 decreased by 4.9 degrees preoperatively and by 6.4 degrees at the final follow-up, for each increment in Goutallier grade (P =.02). Postoperatively, AER evaluated with humerus in abduction improved significantly (P <.001), but did not correlate with TM Goutallier grade. At a mean follow-up of 38 months (range: 24 to 96), mean Constant score improved from 20.5 ± 11.1 to 68.4 ± 14.9 (P <.001), as did shoulder active range of motion in all planes including AER1 (P <.001). This is the first study to quantify the inverse correlation between AER and TM Goutallier grade, both preoperatively and after rTSA; this information guides prognosis for patients with TM degeneration undergoing rTSA. Further studies are necessary to have a better understanding and find reliable solutions. Level III; Case Series [ABSTRACT FROM AUTHOR]

Four patients who underwent contrast-enhanced computed tomography (CT) scanning were infected with hepatitis C virus from a contaminated multi-dose vial of NaCl. The outbreak likely occurred due to a breach in safe injection practices, resulting in contamination of the vial. Not all patients exposed to the same vial were infected. The uneven distribution of infections could be attributed to a stochastic effect of a low infectious dose. This implies that outbreak investigations need to be extended to all patients scheduled before and after the first identified infected patient to confirm or rule out nosocomial transmission. [ABSTRACT FROM AUTHOR]

This paper reports on the study of public support for transit in Southeast Michigan. The goal was to assess Willingness to Support Public Transit (WTST) among likely voters in the region. The study developed a new tool (WTST Index) that would allow planners, policy makers, and advocates to measure the likelihood of support for transit based on a reduced set of questions, through a formula that captures the gradient from attitudes (opinion) to behaviors (action). The study investigated how sociodemographic, sociopolitical, geographical, and opinion related variables impact WTST Index. The results highlighted how wealth, education, and political and ideological beliefs impact willingness to support transit. The U-shaped distribution of the WTST Index shows the divisiveness in support and uncovers the political and ideological dimensions of transit. The results provide guidance for understanding support for transit in comparable regions where transit initiatives and policies seek to expand or improve underused transit systems. [ABSTRACT FROM AUTHOR]

The traditional approach to congenital talipes equinovarus (CTEV) has relied on stepwise manipulations, followed by surgery in severe or recurrent cases. The 3 aims of this study were: (1) to report long-term results of clubfoot treated by posterior capsulectomy and selective release (PCSR); (2) to determine the reliability of a visual scale in the assessment of intraoperative tibiotalar incongruency (TTI); and, (3) to assess the role of TTI as a prognostic factor. We reviewed data regarding 95 CTEV (65 patients) treated by PCSR at a minimum follow-up of 20 years. Patients underwent a physical and radiographic examination, and were assessed through multiple clinical scores. The inter- and intraobserver reliability for TTI evaluation was calculated on clinical photographs. Based on TTI, 52 CTEV were divided in 2 groups (30 congruent vs 22 incongruent) and compared. At a mean follow-up of 26.8 (from 24 to 31) years, 52 CTEV (38 patients) were available for the analysis. Functional results were globally satisfactory. The inter- (κ = 0.748) and intraobserver analysis (κ = 0.688) for the TTI visual assessment showed substantial agreement. In patients with incongruency, patient reported outcomes were significantly worse, with also a greater development of subtalar (p =.02), talonavicular and calcaneocuboid arthritis (p <.001 for both). In treating severe CTEV, the surgical PCSR performed in the first year of life obtains satisfactory clinical and patient-recorded outcomes at over 25 years of follow-up. The visual assessment of TTI is reproducible and potentially represents a long-term prognostic factor. [ABSTRACT FROM AUTHOR]

Ketone bodies (such as β-hydroxybutyrate or BHB) have been recently proposed as signals involved in brain regulation of energy homeostasis and obesity development. However, the precise role of ketone bodies sensing by the brain, and its impact on metabolic disorder development remains unclear. Nevertheless, partial deletion of the ubiquitous ketone bodies transporter MCT1 in mice (HE mice) results in diet-induced obesity resistance, while there is no alteration under normal chow diet. These results suggest that ketone bodies produced during the high fat diet would be important signals involved in obesity onset. In the present study we used a specific BHB infusion of the hypothalamus and analyzed the energy homeostasis of WT or HE mice fed a normal chow diet. Our results indicate that high BHB levels sensed by the hypothalamus disrupt the brain regulation of energy homeostasis. This brain control dysregulation leads to peripheral alterations of energy expenditure mechanisms. Altogether, the changes induced by high ketone bodies levels sensed by the brain increase the risk of obesity onset in mice. • High ketone bodies levels sensed by the hypothalamus are deleterious. • Ketone bodies sensing by the hypothalamus regulates energy expenditures. • Decreasing hypothalamic ketone bodies sensing might protect against diet-induced obesity. [ABSTRACT FROM AUTHOR]

There is limited evidence linking achievement of biochemical response with outcomes in Autoimmune Hepatitis (AIH), and it is unclear whether normalization of serum immunoglobulin G (IgG) levels influences prognosis. We aimed to investigate factors associated with death or liver transplantation in patients affected by AIH. We undertook a retrospective analysis of all AIH patients attending a tertiary liver unit since 1980. Patients not meeting established diagnostic criteria for AIH or with a follow-up shorter than 18 months were excluded. 107 patients meeting inclusion criteria were included in the study. Mean age at diagnosis was 44 years, 29 patients (27.1%) had cirrhosis at baseline. Median follow-up was 79 months, and 70 patients (79.5%) reached biochemical response. Biochemical response was associated with reduced hazard of liver transplant or death (HR 0.07, 95% CI 0.01–0.46), whereas cirrhosis at diagnosis was an independent predictor of liver transplantation or death (Hazard ratio (HR) 11.8, 95%, confidence interval (CI) 1.18–117.4). Lack of normalization of serum IgG levels was associated with reduced 5-year transplant-free survival (95% in patients normalizing, compared to 86%, p = 0.02). Normalization of serum IgG levels alone translates in better transplant-free survival in patients with AIH and should be a treatment target along with transaminases. [ABSTRACT FROM AUTHOR]

Background: The effect of the renin angiotensin system on blood pressure (BP) values in young adults from the general population is not well studied. We investigated the relationship between the aldosterone-to-renin ratio (ARR) and various BP indices in this population.Methods: We assembled a population-based sample of adults aged 25-41 years. Conventional and 24-hour BP recordings were obtained in all patients. Direct renin concentration and plasma aldosterone concentration were measured. Multivariable regression models were constructed to assess the relationships of ARR with BP and hypertension.Results: We included 1,353 individuals (mean age 37 years, 56% women). The median (interquartile range) ARR, direct renin concentration, and plasma aldosterone concentration were 13.8 (8.7-22.9), 7.2 ng/L (4.4-11.0) and 94 ng/L (68-134). All BP indices were higher across sex-specific ARR quartiles. Per 1-unit increase in log-transformed ARR, the multivariable-adjusted β-coefficients (95% CI) for conventional, 24-hour, daytime, and nighttime systolic BP were 1.68 (0.87-2.48), P < .0001; 2.40 (1.68-3.12), P < .0001; 2.23 (1.48-2.99), P < .0001; and 2.80 (2.03-3.58), P < .0001, respectively. Per 1-unit increase in log-transformed ARR, the multivariable-adjusted odds ratio (95% CI) for conventional, 24-hour, sustained and masked hypertension was 1.70 (1.17-2.28), P = .0004; 1.29 (1.06-1.56), P = .01; 1.82 (1.33-2.49), P = .002; and 1.14 (0.94-1.38), P = .20, respectively.Conclusions: In young adults, ARR was strongly associated with conventional and ambulatory BP. Our data suggest that an aldosterone-driven phenomenon occurs very early in the development of hypertension. [ABSTRACT FROM AUTHOR]

The aim is to learn about patients' experience of reading the diary, assess attributed meaning and explore patients' experience and memories during their stay in the intensive care unit. Eleven patients who received the diary after a stay in a nine-bed cardiac intensive care unit in Southern Switzerland, from November 2019 to October 2021. Descriptive qualitative research was performed using semi-structured interviews, followed by thematic analysis. Three research nurses conducted individual telephone or face-to-face interviews. Fifteen sub-themes emerged from the data interviews and were grouped into five main categories: a) the experience in the intensive care unit; b) Post Intensive Care Syndrome symptoms; c) the patient diary; d) new meaning of life; and e) sharing. Patients showed difficulties in remembering and understanding what happened during the hospitalization period. Reading the diary enabled them to understand the impact that the illness had on their daily experience. For some of them, reading the diary was helpful in reacting positively during moments of discouragement. Qualitative approach allowed us to assess how patients perceive the diary in the intensive care unit in a cultural context of Central and Southern Europe, which is still poorly investigated. The diary responded to the person's need to know what happened during a period that they had no memory of. Its use demonstrated important benefits, allowing people to understand the impact that the illness had on everyday life. It allowed them to relate to the difficulties encountered during the healing process. Thus, the diary played an important role during the healing process. The diary was appreciated by patients during all stages of recovery from severe and acute illness. Gaps within the narration were avoided, in order to provide patients with a better timeline of the events occurred during the time they were unconscious. [ABSTRACT FROM AUTHOR]

To assess whether gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI study is useful to estimate liver function in comparison to the presence or absence of cirrhosis, Child Pugh (CP), Model for End-stage Liver Disease (MELD), ALBI scores and biochemical test. We retrospectively reviewed all consecutive Gd-EOB-DTPA-enhanced-MRI studies performed between 2010 and 2016 in patients with focal liver lesions undergoing clinical evaluation. Patients were divided in study and control group according to the presence of cirrhosis, and then classified by CP, MELD and ALBI. Signal intensity was calculated through the liver-to-muscle ratio in portal- (SI-POR) and hepatobiliary-phase(SI-HEP). Three-hundred-three Gd-EOB-DTPA liver-enhanced-MRI studies were included. One-hundred-ninety-one patients (63%) were cirrhotic. SI-HEP was significantly lower in cirrhotic group (0.55 ± 0.29 vs 0.66 ± 0.40, p = 0.004).The SI-HEP progressively decreased from CP-A to CP-C (0.59 ± 0.28 to 0.25 ± 0.19, p < 0.0001) and a significant difference was found between MELD ≤ 9 and MELD > 9 groups (0.61 ± 0.31 vs 0.49 ± 0.28, p = 0.007). No differences between ALBI grades were evident. Among biochemical parameters a moderate correlation was found among SI-HEP and total bilirubin, AST and albumin. SI-HEP after Gd-EOB-DTPA-enhanced-MRI effectively stratified patients with different Child Pugh grades and MELD scores. This technique could hence be useful as a novel radiological marker to estimate the underlying liver function. [ABSTRACT FROM AUTHOR]

In retrospective studies an indisputable causal relationship between hyperglycemia and postoperative infections cannot be entirely disclaimed. We aimed investigate whether the time trends of blood glucose levels in the perioperative period could be a determinant of surgery-related infections. Adult patients without diabetes who were candidates for elective major abdominal operation were prospectively enrolled in a longitudinal, observational multicenter study. The blood glucose level was measured every 6 h for 3 days. We calculated the association between blood glucose (BG) levels and the risk of occurrence of surgery-related infections using a joint regression modeling for longitudinal and time-to-event outcomes which accounts for the effect of other risk factors. Between January 2016 and November 2017, we obtained 6078 BG measures distributed on different time-points in 452 patients. There was a nearly 3-fold increased risk of having hyperglycemia, defined as BG ≥ 125 mg/dL, if the BG level at admission was >100 mg/dL (OR = 2.986, P < 0.001).The hazard of infection for each 10 mg/dL increase of BG levels over time was marginal (HR = 1.065, P = 0.045). The calculated risk of having an infection was 9.6% for BG going from 110 mg/dL during surgery to 84 mg/dL at the end of day 3, 10.5% for BG decreasing from 140 to 114, 11.8% for BG decreasing from 180 to 154 and 24.5% for BG increasing from 80 to 145, 24.7% for BG increasing from 110 to 175, and 25.4% for BG increasing from 140 to 205. The time trends of BG – as opposed to the absolute concentration –are major determinants of the risk of postoperative infections. [ABSTRACT FROM AUTHOR]

Prospective studies about endoscopic retrograde cholangio-pancreatography (ERCP) in a community setting are rare. To assess success and complication rates of routinely-performed ERCP in a regional setting, and the priority quality indicators for ERCP practice. Prospective region wide observational study on consecutive patients undergoing ERCP during a 6-month period. A centralized online ERCP questionnaire was built and used for data storage. Primary quality indicators provided by the American Society of Gastrointestinal Endoscopy (ASGE) were considered. 38 endoscopists from 18 centers performed a total of 2388 ERCP. The most common indication for ERCP was choledocholitiasis (54.8%) followed by malignant jaundice (22.6%). Cannulation of the desired duct was obtained in 2293 cases (96%) and ERCP was successful in 2176 cases (91.1%). Success and ERCP difficulty were significantly related to the experience of the operator (p = 0.001 and p < 0.001, respectively). ERCP difficulty was also significantly related to volume centers (p < 0.01). The overall complication rate was 8.4%: post-ERCP pancreatitis (PEP) occurred in 4.1% of procedures, bleeding in 2.9%, infection in 0.8%, perforation in 0.4%. Mortality rate was 0.4%. All the ASGE priority quality indicators for ERCP were confirmed. The procedural questionnaire proved to be an important tool to assess and verify the quality of routinely-performed ERCP performance in a community setting. [ABSTRACT FROM AUTHOR]

Abstract The bacterium Spiroplasma ixodetis is a maternally inherited endosymbiont primarily described from ticks but also found widespread across other arthropods. While it has been identified as a male-killing agent in some insect species, the consequences of infection with S. ixodetis in ticks are entirely unknown, and it is unclear how this endosymbiont spreads across tick species. Here, we have investigated this aspect through the examination of the diversity and evolutionary history of S. ixodetis infections in 12 tick species and 12 other arthropod species. Using a multi-locus typing approach, we identified that ticks harbor a substantial diversity of divergent S. ixodetis strains. Phylogenetic investigations revealed that these S. ixodetis strains do not cluster within a tick-specific subclade but rather exhibit distinct evolutionary origins. In their past, these strains have undergone repeated horizontal transfers between ticks and other arthropods, including aphids and flies. This diversity pattern strongly suggests that maternal inheritance and horizontal transfers are key drivers of S. ixodetis spread, dictating global incidence of infections across tick communities. We do not, however, detect evidence of S. ixodetis -based male-killing since we observed that infections were widely present in both males and females across populations of the African blue tick Rhipicephalus decoloratus. [ABSTRACT FROM AUTHOR]

Abstract In this report, we describe a rare complication of an open re-rupture of the Achilles tendon following a minimally invasive Achilles tendon repair on a healthy 29-year-old active male. The reinjury happened 19 weeks following the primary surgical repair of a spontaneous rupture, performed by minimally invasive technique with the help of a jig using partially absorbable sutures and four locking stitches. The wound of the open re-rupture was transverse, in a perpendicular orientation relative to the longitudinal approach used in the index procedure. Increased scar tissue formation, the absence of an adequate layer of paratenon overlying the primary tendon repair, and foreign-body reaction to the suture may have been involved in the occurrence of this unusual complication in the surgical treatment of Achilles tendon rupture. [ABSTRACT FROM AUTHOR]

Set accumulators are cryptographic primitives used to represent arbitrarily large sets of elements with a single constant-size value and to efficiently verify whether a value belongs to that set. Accumulators support the generation of membership proofs, meaning that they can certify the presence of a given value among the elements of a set. In this paper we present an overview of the theoretical concepts underlying set accumulators, we compare the most popular constructions from a complexity perspective, and we survey a number of their applications related to blockchain technology. In particular, we focus on four different use cases: query authentication, stateless transactions validation, anonymity enhancement, and identity management. For each of these scenarios, we examine the main problems they introduce and discuss the most relevant accumulator-based solutions proposed in the literature. Finally, we point out the common approaches between the proposals and highlight the currently open problems in each field. • We present an overview of the theoretical concepts underlying set accumulators. • We compare the most popular accumulator constructions from a complexity perspective. • We survey several accumulator applications related to blockchain technology. [ABSTRACT FROM AUTHOR]

Numerous challenges – from population increase to climate change – threaten the sustainable development of cities and call for a fundamental change of urban development and green-blue resource management. Urban forests are vital in this transition, as they provide various ecosystem services and allow to re-shape and re-think cities. Based on a Europe-wide community effort with diverse experts centered around urban forests and urban greening, we propose five key research fields to generate the knowledge required to unlock fundamental changes in urban development and green-blue resource management: circular bioeconomy, climate resilience, governance, social and human environment, and biodiversity. To support the design of greener, cooler, more inclusive and resilient cities, all these research fields require inter- and transdisciplinary collaboration, engaging stakeholders in transforming urban engagement and functioning. We summarise main inter-, trans- und multi-disciplinary research paths for each field and the cross-cutting knowledge areas that can help to address the challenges many cities face (e.g., modelling and assessment of the urban microclimate). For transforming cities further knowledge is needed on e.g., urban innovation, transition, participation, and more. Finally, we address how the identified research gaps can be implemented (e.g., international coordinated research effort, interdisciplinary networks). [Display omitted] [ABSTRACT FROM AUTHOR]

The increase of the power density, improvement of fuel efficiency and minimization of the environmental impact of modern internal combustion engines form the main trend of the engine development. Turbocharging is pivotal to ensure the thermodynamical as well as commercial competitiveness of modern large diesel and gas engines. The optimization of the gas-dynamic and heat transfer characteristics of the gas flow in the intake system targeting the optimization of the gas exchange process is an important task in engine building. Numerical simulation of working process of the 8-cylinder 21/21 diesel-motor (Russia, Ekaterinburg) was performed with the ACTUS simulation software (Switzerland, Baden, ABB Turbo Systems Ltd). The numerical study showed that the geometric dimensions of the intake pipe significantly impact the flow dynamics. In particular, it is shown that the use of inlet pipe with a larger diameter (on the 8DM-21 engine) leads to the average 0.5% increase in the filling ratio. This leads to an up to 0.7 % increase in engine power and reduces the effective specific fuel consumption by about 0.50-0.75. [ABSTRACT FROM AUTHOR]

The dystrophin gene ( DMD ) is the largest gene in the human genome, mapping on the Xp21 chromosome locus. It spans 2.2 Mb and accounts for approximately 0,1% of the entire human genome. Mutations in this gene cause Duchenne and Becker Muscular Dystrophy, X-linked Dilated Cardiomyopathy, and other milder muscle phenotypes. Beside the remarkable number of reports describing dystrophin gene expression and the pathogenic consequences of the gene mutations in dystrophinopathies, the full scenario of the DMD transcription dynamics remains however, poorly understood. Considering that the full transcription of the DMD gene requires about 16 h, we have investigated the activity of RNA Polymerase II along the entire DMD locus within the context of specific chromatin modifications using a variety of chromatin-based techniques. Our results unveil a surprisingly powerful processivity of the RNA polymerase II along the entire 2.2 Mb of the DMD locus with just one site of pausing around intron 52. We also discovered epigenetic marks highlighting the existence of four novel cis ‑DNA elements, two of which, located within intron 34 and exon 45, appear to govern the architecture of the DMD chromatin with implications on the expression levels of the muscle dystrophin mRNA. Overall, our findings provide a global view on how the entire DMD locus is dynamically transcribed by the RNA pol II and shed light on the mechanisms involved in dystrophin gene expression control, which can positively impact on the optimization of the novel ongoing therapeutic strategies for dystrophinopathies. [ABSTRACT FROM AUTHOR]

Recently, we described porphyrin-based periodic mesoporous organosilica (PMO) nanoparticles synthesized from a large functional octatriethoxysilylated porphyrin precursor. The framework of the nanoparticles was formed by J-aggregates of porphyrins allowing two-photon excitation photodynamic therapy (TPE-PDT) and NIR imaging. In this study, we functionalized these PMO with polyethylene glycol (PEG) moieties and an analogue of mannose 6-phosphate functionalized on anomeric position (AMFA). These AMFA are known to efficiently target mannose 6-phosphate receptors (M6PR) which are over-expressed in various cancer cell lines (breast, prostate). Here we show that M6PR is also over-expressed in rhabdomyosarcoma (RMS) cell lines. We targeted this receptor with PMO-AMFA and efficiently performed TPE imaging and TPE-PDT of RMS cells. Furthermore the same treatment did not affect healthy myoblasts, which have a low expression of M6PR. [ABSTRACT FROM AUTHOR]

Microvascular invasion(MVI) is the main risk factor for overall mortality and recurrence after surgery for hepatocellular carcinoma(HCC). Its diagnosis can be made only postoperatively on the histological specimen. to train machine-learning models to predict MVI on preoperative CT scan (fig.1). Clinical data and 3-phases CT scans were retrospectively collected among 4 Italian centres. After an initial manual segmentation, an algorithm was developed to automatically identify the liver and the tumor on CT scans. Radiomics features were automatically extracted from the tumoral, peritumoral and healthy liver areas in each phase. Principal component analysis (PCA) was performed to reduce the dimensions of the dataset. Data were divided between training (70%) and test (30%) sets. Random-Forest (RF), fully connected Artificial neural network (neuralnet) and extreme gradient boosting (XGB) models were fitted to predict MVI. Hyperparameters tuning was made to reduce the out-of-bag error. Between 2008 and 2022, 218 consecutive preoperative CT scans of patients affected by HCC and submitted to surgery were collected. At the histological specimen 33.02% patients had MVI. The Jaccard index between manual and algorithm segmentations was 90%. First and second order radiomics features were extracted, obtaining 672 variables per patient. PCA selected 58 dimensions explaining >95% of the variance. After standardization and normalization, RF, neuralnet and XGB were fitted to predict the presence of MVI. Tuning parameters were: 1) RF: n.tree=500, mtry=30; 2) Neuralnet: 2 hidden layer with 40 and 20 neurons, learning rate= 0.001, threshold for termination= 1%, activation function= sigmoid; 3) XGB: nrounds = 100, max_depth = 3, eta = 0.3. The models were then fitted in the testset to estimate prediction accuracy by confusion-matrix. RF was the best performer (Acc=98.4%, 95%CI: 0.91-0.99, Sens: 95.2%, Spec: 100%, PPV: 100% and NPV: 97.7%, fig.2). RF model predicted automatically MVI with a never-before reached accuracy [ABSTRACT FROM AUTHOR]

In contrast to earlier long-chain (LC) omega-3 (i.e. EPA and DHA) investigations, some recent studies have not demonstrated significant effects of EPA and DHA on cardiovascular disease (CVD) outcomes. The neutral findings may have been due to experimental design issues, such as: maintenance on aggressive cardiovascular drug treatment overshadowing the benefits of LC omega-3s, high background LC omega-3 intake, too few subjects in the study, treatment duration too short, insufficient LC omega-3 dosage, increase in omega-6 fatty acid intake during the study, failure to assess the LC omega-3 status of the subjects prior to and during treatment and lack of clarity concerning which mechanisms were expected to produce benefits. At the 11th ISSFAL Congress, a workshop was held on conducting LC omega-3 clinical trials with cardiovascular outcomes, with the goal of gaining a better understanding concerning aspects of experimental design that should be considered when planning clinical studies related to EPA and DHA and potential cardiovascular benefits. [ABSTRACT FROM AUTHOR]

Approximately 120 Ma major volcanic outgassing on the Ontong Java Plateau resulted in perturbations of the global carbon cycle, in a change from cool to greenhouse climate conditions and in major changes in oceanography leading to widespread deposition of black shales during the early Aptian Oceanic Anoxic Event 1a (OAE1a). However, onset of black-shale deposition was diachronous and prior to OAE1a occurred under specific paleogeographic and paleoceanographic conditions. The goal of this study is to identify paleoceanographic constraints during coolhouse conditions that resulted in pre-OAE1a black-shale deposition and to investigate if and to what extent the short-term orbitally induced climate changes are also recorded in the sedimentary archive. We compared four lower Aptian pelagic sections from the former southern and northern continental margins of the Alpine Tethys Ocean and traced the evolution of carbon isotopes, carbonate and organic carbon content as well as palynofacies before and at the onset of OAE1a. Throughout the studied interval, the sections record frequent precession-controlled changes in carbonate content, which are reflected by limestone-marlstone alternations in the shallowest and most proximal Cismon core and by limestone-black-shale couplets in the deepest Pusiano section. Depth controlled sub-/anoxia is also suggested by the prominent OAE1a black shales, which occurred first in the deeper Pie del Dosso and Roter Sattel sections and only subsequently in the shallower Cismon core. However, contrary to expectations, the deepest Pusiano section exhibits – instead of an earliest onset of prominent OAE1a black shales – only a minor increase in TOC and a decrease in carbonate content. This suggests that the orbitally driven climate changes most strongly influenced water stratification and hence are most prominently expressed in the deepest sections. Conversely, the volcanically induced long-term climate changes seemed to more strongly affect organic matter production, the extension of the oxygen minimum zone and hence had the strongest impact on sections at intermediate depth. [ABSTRACT FROM AUTHOR]

• EPA/DHA are an active area of research. Each month, 200–250 new articles on EPA/DHA are indexed by PubMed. • Despite a vast body of existing research, there remain significant gaps in our understanding of EPA/DHA health effects. • The volume of existing research makes it challenging to conduct systematic investigations to identify or resolve those gaps. • This article introduces the GOED Clinical Study Database (CSD), a comprehensive, manually curated database that catalogs this research. It also outlines the search strategies describes the methods for gathering data describes the database capabilities and current and potential applications. Due to their multiple mechanisms of biological action, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been the focus of ongoing active research for decades. In spite of the resulting body of knowledge, there remain significant gaps in our understanding of EPA/DHA health effects. Further, the volume of existing research makes it challenging to conduct systematic investigations to identify or resolve those gaps. The purpose of this article is to introduce the GOED Clinical Study Database (CSD), a comprehensive, manually-curated relational database that catalogs this research. [ABSTRACT FROM AUTHOR]

Ochroconis gallopava is an anamorphic mould characterized by slow growth rate and production of a maroon pigment, which has been isolated worldwide from soil, thermal springs, decaying vegetation, and chicken litter. It has been reported to cause localized, mostly pulmonary, and systemic infection in severely immunocompromised patients. We describe the case of a 76-year-old woman known for ulcerative colitis-related bronchiectasis treated with low dose oral steroids, who developed a fungal bronchitis with dark, bloody-like, sputum which was initially misinterpreted as haemoptysis. A filamentary mould grew on sputum culture, and was identified by DNA analysis as Ochroconis gallopava . We observed a significant clinical improvement after 6 weeks of itraconazole therapy. [ABSTRACT FROM AUTHOR]