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The optimal treatment of atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF) remains unsettled. The purpose of this study was to assess the efficacy of catheter ablation (CA) and medical therapy compared to medical therapy alone in patients with AF and HFrEF. We performed a systematic review of randomized controlled trials (RCTs) comparing CA with guideline-directed medical therapy for AF in patients with HFrEF (left ventricular ejection fraction [LVEF] ≤ 40%). We systematically searched PubMed, Embase, and Cochrane for eligible trials. A random effects model was used to calculate the risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). Six RCTs comprising 1055 patients were included, of whom 530 (50.2%) were randomized to CA. Compared with medical therapy, CA was associated with a significant reduction in heart failure (HF) hospitalization (RR 0.57; 95% CI 0.45–0.72; P <.01), cardiovascular mortality (RR 0.46; 95% CI 0.31–0.70; P <.01), all-cause mortality (RR 0.53; 95% CI 0.36–0.78; P <.01), and AF burden (MD –29.8%; 95% CI –43.73% to –15.90%; P <.01). Also, there was a significant improvement in LVEF (MD 3.8%; 95% CI 1.6%–6.0%; P <.01) and quality of life (Minnesota Living with Heart Failure Questionnaire; MD –4.92 points; 95% CI –8.61 to –1.22 points; P <.01) in the ablation group. In this meta-analysis of RCTs of patients with AF and HFrEF, CA was associated with a reduction in HF hospitalization, cardiovascular mortality, and all-cause mortality as well as a significant improvement in LVEF and quality of life. [Display omitted] [ABSTRACT FROM AUTHOR]

The stochastic generalized nonlinear Schrödinger equation (SGNLSE) of third order in the Stratonovich sense is examined here. New elliptic, hyperbolic, trigonometric, and rational stochastic solutions are obtained using a modified mapping method. Because the GNLSE is extensively used in nonlinear optical phenomena, optical fiber communication systems, communication and heat pulse propagation in materials, the obtained solutions may be used to study a broad range of relevant physical phenomena. In order to interpret the effects of multiplicative noise, the dynamic performances of the various obtained solutions are displayed utilizing 3-D and 2-D graphs. We infer that multiplicative noise impacts and stabilizes the behavior of SGNLSE solutions. [ABSTRACT FROM AUTHOR]

To evaluate the outcomes and durability of drug-eluting stents (DESs) for the treatment of hemodialysis access outflow stenosis. A single-center retrospective analysis was conducted of all patients with hemodialysis vascular access outflow stenosis treated with a paclitaxel-coated DES (Eluvia; Boston Scientific, Marlborough, Massachusetts) between January 2020 and July 2022. A total of 34 DESs were implanted to treat outflow stenosis in 32 patients. Primary target lesion patency after stent deployment was the main outcome. Comparison between the time interval free from target lesion reintervention (TLR) after previous plain balloon angioplasty (PBA) and that after stent deployment for the same target lesion was considered a secondary outcome. The primary patency at 6, 12, and 18 months was 63.1%, 47.6%, and 41.7%, respectively. The secondary patency rate was 100% at 18 months. The median time interval free from TLR increased from 4.1 to 11.9 months (P <.001). No adverse events were observed during the median follow-up period of 387 days. The patency rates after use of DES for hemodialysis access outflow stenosis were comparable with results for drug-coated balloons and stent grafts, addressing recoil and minimizing the risk of jailing by a covered stent. [Display omitted] [ABSTRACT FROM AUTHOR]

Parathyroid carcinoma is a rare malignancy with high recurrence rates. Liquid biopsy is a stratifying tool in disease recurrence/progression in other malignant processes. This study sought to assess the feasibility and application of liquid biopsy in parathyroid carcinoma and its impact on surveillance. Retrospective review of a prospectively maintained database of adults treated for parathyroid carcinoma at a tertiary care center (2017–2023). Demographics, clinical characteristics, and laboratory variables were collected. Circulating cell-free deoxyribonucleic acid enrichment and circulating tumor cell enumeration were obtained from serial blood samples. A total of 25 patients were identified—64% were male patients, with a median age of 56 years (interquartile range 45–63). Fifty blood samples were collected postoperatively. At first, circulating tumor cell enumeration, 56% (14/25) of patients had no evidence of disease, and 32% (8/25) had distant metastasis. Median follow-up was 53 months (interquartile range 23–107). At the last follow-up, 40% (10/25) of patients were found to have distant metastasis. Serial circulating tumor cell enumeration was performed in 52% of patients, median highest circulating tumor cell was (interquartile range 1–22). Circulating cell-free deoxyribonucleic acid was assessed in 64% of patients (16/25). There was no difference in circulating tumor cells or circulating cell-free deoxyribonucleic acid between those with distant metastasis and those without distant metastasis. The most common mutation identified was TP53 , present in 88% of circulating cell-free deoxyribonucleic acid samples with a mutation. Circulating cell-free deoxyribonucleic acid and parathyroid hormone levels were not found to have any association (r = −0.27, P =.39), but parathyroid hormone and circulating tumor cell had a linear relationship (r = 0.76, P <.001). Liquid biopsy appears to be a feasible tool in parathyroid carcinoma surveillance. The relationship between circulating cell-free deoxyribonucleic acid and parathyroid hormone levels remains unclear, and the association between circulating tumor cell enumeration and parathyroid hormone levels may be impactful. The finding that TP53 mutation is more prevalent in patients with distant metastasis may impact further management. [ABSTRACT FROM AUTHOR]

Lymphedema in the upper limb as a complication of breast cancer may lead to shoulder pain and dysfunctions. Objective: To compare the scapular positioning, the shoulder range of motion, and muscle strength among women undergoing treatment for breast cancer with and without lymphedema and a control group. This cross-sectional study evaluated women undergoing treatment for breast cancer (N = 25) and without lymphedema (N = 25), and a control group (N = 25). Static scapular positions and shoulder range of motion were measured by using an inclinometer. The shoulder and periscapular muscle strength were measured by using a hand-held dynamometer and the Disabilities of the Arm, Shoulder, and Hand Questionnaire was applied. Linear regression of the mixed effects model was used to compare the groups. Both groups of mastectomized women had reduced shoulder range of motion, scapular upward rotation, and muscle strength for shoulder and periscapular muscles compared to the control group. Also, women undergoing treatment for breast cancer with lymphedema had reduced shoulder range of motion, scapular upward rotation, increased anterior tilt, reduced muscle strength of the upper trapezius, and greater upper limb disability compared to women without lymphedema. Women undergoing treatment for breast cancer with lymphedema had even greater shoulder and scapulothoracic impairments when compared to the control group and women without lymphedema. • Mastectomized women had shoulder and scapular motion and muscle strength changes. Presence of lymphedema showed less scapular upward rotation and higher anterior tilt. Presence of lymphedema showed less upper trapezius strength and higher disability. [ABSTRACT FROM AUTHOR]

• Endothelial dysfunction related to Ca2+ signaling loss in VEGF 165 , bFGF, PlGF, TNFα, or IL-1β treated HUVEC is improved by the Src kinase inhibor PP2. • Src kinase inhibitor PP2 also improves TNFα-mediated losses in HUVEC monolayer integrity. • The MEK/ERK signaling inhibitor U0126 offers no improvement to growth factor or cytokine-mediated endothelial dysfunction in HUVEC. Endothelial dysfunction is known to be a key characteristic of preeclampsia (PE) and can contribute to progression of symptoms and injury to multiple organ systems. Delivery is the only treatment for progression of PE, but development of an endothelial-based therapy for PE presents a promising strategy. Growth factors and cytokines are dysregulated in PE and can impact endothelial function, manifesting changes in Ca2+ signaling and interruptions in monolayer barrier function that contribute to symptoms of hypertension, proteinuria, and edema. In this study, we highlight Src kinase as a partial mediator of growth factor and cytokine mediated endothelial dysfunction. Fura-2 Ca2+ imaging and Electrical Cell Impedance Sensing (ECIS) assays are performed on growth factor or cytokine exposed human umbilical vein endothelial cells (HUVECs). Inhibitors to MEK/ERK (U0126) or Src (PP2) are used to determine the contribution of kinase signaling pathways. Decreases in HUVEC Ca2+ signaling or monolayer resistance measure endothelial dysfunction. Reversal of endothelial dysfunction by kinase inhibitors reveals the respective contibutions of MEK/ERK and Src kinase. We show that Src inhibition protects Ca2+ signaling responses against insults induced by VEGF 165 , bFGF, PlGF, TNFα, and IL-1β. Additionally, we show that Src inhibition protects the endothelial monolayer from the full impact of TNFα insult. Further, we find that MEK/ERK inhibition does not offer protection from growth factor-mediated endothelial dysfunction. The results of this study suggest cytokine and growth factor-stimulated Src kinase plays a partial role on promoting endothelial dysfunction in HUVECs. [ABSTRACT FROM AUTHOR]

[Display omitted] • The hydrofoil-flap arrangement has a positive effect on the blade performance. • Experimental tests were carried out for two different hydrokinetic turbine rotors. • CFD analyses were conducted through 6-DoF user-defined functions. • The CP value increases about 20.53% when a hydrofoil-flap arrangement is used. • The rotor optimization is crucial for reducing the energy transformation costs. In this work, the efficiency of two horizontal-axis hydrokinetic turbines, whose blades were designed with and without multi-element hydrofoil cross-sections, has been numerical and experimentally investigated for tip speed ratio (λ) values ranging between 2.5 and 9.0 to compare the experimental rotor performance with numerical results. The Eppler 420 hydrofoil was used for the design of the blades applying the blade element momentum (BEM) theory. The variation of the power coefficient curve of the turbines was analyzed by using computational fluid dynamics (CFD) and experimental tests through ANSYs Fluent software with six-degrees of freedom (6-DoF) user-defined function (UDF) method and an open hydraulic channel, respectively. Numerically, for the turbine with a multi-element hydrofoil and without a multi-element (traditional) hydrofoil, maximum power coefficients ( C Pmax ) of 0.5050 and 0.419 (at a λ value equal to 7.129 and 6.739, respectively) were obtained. It is worth noting that a reasonable agreement between the numerical and the experimental results was achieved. In this regard, the blade with a multi-element hydrofoil has a positive influence on the hydrokinetic turbine performance; therefore, it can be used for power generation in river or marine systems. [ABSTRACT FROM AUTHOR]

In this work, the adsorption capacity of the biochar obtained from Pinus patula biomass micro-gasification was studied using malachite green (MG) as the probe pollutant. For this purpose, the biomass type (wood pellets and chips) was selected to produce two kinds of biochar (BC). Afterwards, the effects of the adsorbent dose (6, 9 and 12 g/L), the solution pH (4, 7 and 10) and the BC particle size distribution (150–300, 300–450 and 450–600 μ m) for the maximization of the MG retention by the selected BC were evaluated using a faced-centered central composite design, as response surface methodology. The results indicated that the BC derived from wood chips (BWC) exhibited a higher MG dye adsorption capacity than the BC obtained from the wood pellets (BWP) gasification under the same operating conditions after having reached the equilibrium. A second-order regression model was built for describing the MG adsorption behaviour by BWC under the considered experimental domain. The model, which was validated, resulted to be statistically significant and suitable to represent the MG adsorption by the studied BC with a p-value of 0.00 and a correlation coefficient (R2) of 95.59%. Additionally, a three-dimensional response surface graph and a contour plot were utilized to analyze the interaction effects between the factors influencing the adsorption system and to discern the optimal operating conditions for the use of BWC. The maximal MG dye retention (99.70%) was found to be at an adsorbent dose, pH solution and a particle size distribution of 9.80 g/L, 10 and from 150 to 300 μ m, respectively. Therefore, the BWC tested can be utilized for the treatment of water polluted with dyes, contributing to the establishment of a circular economy. [ABSTRACT FROM AUTHOR]

Patients diagnosed with schizophrenia are characterized by early mortality compared to the general population. The main cause of this premature death reflects medical complications linked to metabolic syndrome (MetS). The use of antipsychotics such as clozapine is associated with weight gain and metabolic disturbances in certain predisposed individuals. Non-pharmacological interventions for weight control have become a key element for secondary prevention in the health of patients diagnosed with schizophrenia. Here, we aim to evaluate the physical health effects of a nurse-led non-pharmacological intervention program in patients with a diagnosis of schizophrenia treated with clozapine. Thirty-one outpatients from the outpatient clinical facility of Hospital Clinic in Barcelona, Spain diagnosed with schizophrenia and other psychotic disorders receiving clozapine treatment were enrolled in a prospective interventional study, comprising an 8-week group program of therapeutic education in a healthy lifestyle. MetS factors, physical activity, diet, and lifestyle were evaluated at baseline, post-intervention (8 weeks), and 3 months after the program. Weight, body mass index, high-density lipoprotein cholesterol, and diet patterns displayed significant differences post-intervention and after 3 months, while only waist, hip perimeter, and lifestyle improved post-intervention. Our results suggest the effectiveness of the lifestyle intervention in patients under clozapine treatment despite its long-time differential effect. Strategies to prevent weight gain and metabolic decline will help prevent premature cardiometabolic disease in this vulnerable population. • Mental health nurses are key part of outpatient facilities and can monitor cardiovascular risk and lifestyle. • Anthropometric measurements, biochemical parameters and dietary patterns significantly improved. • Nurse-led intervention programs are effective, easy to implement and with reduced economic cost. [ABSTRACT FROM AUTHOR]

• ESKAPE bacteria was related in COVID-19/VAP patients. • MDR and XDR ESKAPE bacteria were identified. • Clonal dispersion of A. baumannii was detected in COVID-19/VAP patients. A decrease of detection of outbreaks by multidrug-resistant bacteria in critical areas has been reduced due to COVID-19 pandemic. Therefore, molecular epidemiological surveillance should be a primary tool to reveal associations not evident by classical epidemiology. The aim of this work was to demonstrate the presence of hidden outbreaks in the first wave of the COVID-19 pandemic and to associate their possible origin. A population of 96 COVID-19 patients was included in the study (April to June 2020) from Hospital Juárez de México. Genetic identification and antimicrobial susceptibility testing of VAP causative agents isolated from COVID-19 patients was performed. Resistance phenotypes were confirmed by PCR. Clonal association of isolates was performed by analysis of intergenic regions obtained. Finally, the association of clonal cases of VAP patients was performed by timelines. ESKAPE and non-ESKAPE bacteria were identified as causative agents of VAP. ESKAPE bacteria were classified as MDR and XDR. Only A. baumannii and P. aeruginosa were identified as clonally distributed in 13 COVID-19/VAP patients. Time analysis showed that cross-transmission existed between patients and care areas. Acinetobacter baumannii and Pseudomonas aeruginosa were involved in outbreaks non-detected in COVID-19/VAP patients in the first wave of COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Four-class drug-resistant (4DR) people living with HIV (PLWH) are a fragile population with a high burden of disease. No data on their inflammation and T-cell exhaustion markers are currently available. Inflammation, immune activation and microbial translocation biomarkers were measured through ELISA in 30 4DR-PLWH with HIV-1 RNA ≥ 50 copies/mL, 30 non-viremic 4DR-PLWH and 20 non-viremic non-4DR-PLWH. Groups were matched by age, gender and smoking habit. T-cell activation and exhaustion markers were assessed by flow cytometry in 4DR-PLWH. An inflammation burden score (IBS) was calculated from soluble marker levels and associated factors were estimated through multivariate regression. The highest plasma biomarker concentrations were observed in viremic 4DR-PLWH, the lowest ones in non-4DR-PLWH. Endotoxin core immunoglobulin G showed an opposite trend. Among 4DR-PLWH, CD38/HLA-DR and PD-1 were more expressed on CD4+ (p = 0.019 and 0.034, respectively) and CD8+ (p = 0.002 and 0.032, respectively) cells of viremic compared to non-viremic subjects. An increased IBS was significantly associated with 4DR condition, higher values of viral load and a previous cancer diagnosis. Multidrug-resistant HIV infection is associated with a higher IBS, even when viremia is undetectable. Therapeutic approaches aimed to reduce inflammation and T-cell exhaustion in 4DR-PLWH need to be investigated. • Matched-cohort study on four-class drug-resistant (4DR) and non-4DR-PLWH. • Inflammation burden score (IBS) was calculated from plasma levels of 9 biomarkers. • IBS was higher in 4DR-PLWH, even when non-viremic, than in non-4DR-PLWH. • T cells were more 'exhausted' in viremic than non-viremic 4DR-PLWH. • Further studies on treatments targeting these pathways in 4DR-PLWH are required. [ABSTRACT FROM AUTHOR]

Knowledge Management is an essential element for the successful implementation of projects. Due to the temporary nature of the projects and the teams that participate in them, the transfer, integration, and management of knowledge among projects is vital to promote sharing best practices, and to avoid the repetition of previous mistakes, in order to increase the probability of success for the projects and the organization. For this reason, Project Management tools can play a significant role in supporting Knowledge Management. The goal of this paper is to analyze and evaluate the project management tools of the Gartner Leader quadrant (2019 Gartner Magic Quadrant) regarding their potential for the Capture, Storage, Sharing and Application of knowledge, according to the artifacts in the PMBOK [1] , and determine which are the best options. Gartner's leader tools were compared to Confluence, referenced as a great choice for knowledge and project document management. For the development of the artifact was used the Design Science Research (DSR) methodology. The application that obtained the highest score was Targetprocess. [ABSTRACT FROM AUTHOR]

• ESKAPE bacteria with biofilm-forming capacity. • Ozone showed bactericidal activity on bacteria ESKAPE. • Ozone as a disinfectant alternative. Medical devices can be reservoirs of multidrug-resistant bacteria that may be involved in the acquisition of infections since bacteria with the ability to form biofilms that are difficult to eradicate, mainly in mechanical ventilators. The aim of this work was to evaluate the efficacy of O 3 against biofilms of bacteria ESKAPE group through disinfection studies. The formation of biofilms of ESKAPE group bacteria was induced in vitro. O 3 was injected at different exposure times at a constant dose of 600 mg/h. The recovery of surviving bacteria after O 3 treatment was assessed by bacterial counts and biofilm disruption was analyzed. Finally, the viability and integrity of biofilms after O 3 treatment was determined by confocal laser scanning microscopy (CLSM). O 3 showed bactericidal activity on biofilms from 12 min/7.68 ppm for A. baumannii and C. freundii. P. aeruginosa, K. pneumoniae and S. aureus were killed after 15 min/9.60 ppm. Correlation analyses showed inversely proportional relationships between the variables "disruption versus O 3 ". CLSM revealed that death was time-dependent of biofilms upon O 3 exposure. Orthogonal plane analysis showed that bacteria located in the outer region of the biofilms were the ones that initially suffered damage from O 3 exposure. Our findings suggest that this method could be an alternative for the disinfection in mechanical ventilators colonized by bacteria biofilm forming. [ABSTRACT FROM AUTHOR]

Posterior retroperitoneoscopic adrenalectomy is an appealing approach for patients with hereditary pheochromocytoma and lends well to cortex preservation. We sought to examine pheochromocytoma recurrence in patients with hereditary pheochromocytoma in the era of posterior retroperitoneoscopic adrenalectomy and evaluate the predictors of recurrence. Patients with hereditary pheochromocytoma who underwent adrenalectomy for pheochromocytoma between 1995 and 2020 with biochemical cure and follow-up >1 year were identified. Recurrence was defined as plasma metanephrines above the upper limit of normal with radiographic evidence of disease in the ipsilateral adrenal bed. Seventy-eight hereditary pheochromocytoma patients (median age = 32.4 years; 60.3% women) underwent 114 adrenalectomies for pheochromocytoma. Of these patients, 40 had multiple endocrine neoplasia type 2A (51.3%), 10 had multiple endocrine neoplasia type B (12.8%), 17 had von Hippel-Lindau disease (21.8%), and 11 had neurofibromatosis type 1 (14.1%). Thirty-eight adrenalectomies (33.3%) were performed before the introduction of posterior retroperitoneoscopic adrenalectomy and 76 (66.7%) after. Cortical-sparing technique was performed in 62 (54.4%) adrenalectomies, with no difference in its use before and after posterior retroperitoneoscopic adrenalectomy introduction (P >.05). During a median follow-up of 80.7 months (interquartile range 43.4–151.2), 12 ipsilateral recurrences (10.5%) were identified. There was no difference in recurrence before and after the introduction of posterior retroperitoneoscopic adrenalectomy or by surgical technique or approach of the entire cohort (P >.05). Recurrence was more common in those with RET M918T mutation (23.5% vs 8.2%; P =.05). Patients with RET M918T mutations had a shorter recurrence-free survival (P =.013). On multivariate analysis, only RET M918T mutation was independently associated with an increased recurrence risk (hazard ratio = 4.30; 95% confidence interval, 1.26–14.66; P =.019). The introduction of posterior retroperitoneoscopic adrenalectomy did not influence the recurrence rate after adrenalectomy for hereditary pheochromocytoma patients. Patients with a RET M918T germline mutation are at increased risk for pheochromocytoma recurrence and may benefit from initial total adrenalectomy. [ABSTRACT FROM AUTHOR]

Despite the growing interest in psychological variables and mental health in young people with rheumatic diseases (RMDs), the impact of these conditions on self-concept, self-esteem, or body image is unclear. The purpose of this study was to synthesize existing research related to these domains in young people with RMDs. Review registered on PROSPERO as CRD42023444009. The search strategy includes all articles up to September 2023, to collect qualitative and quantitate studies assessing self-concept, self-esteem, or body image in young people with RMDs. All identified articles were described, rated and Risk of bias was assessed. We identified 350 studies, of which 11 were analysed in this study. Our results indicated that self-concept, body image and self-esteem were a common challenge in young people with RMDs and might negatively impact physical and psychosocial health-related quality of life (QoL). The social domain of self-concept was impaired, mainly in female patients. Although studies that evaluated self-esteem show varied results, it seems that self-esteem was worse in females and was associated mainly with depression, but also with poorer QoL. Glucocorticoids consistently were associate with poor body image in all conditions due to visible side-effects of medication. Visible signs of the disease also might lead to poor body image. This review identifies important gaps and areas of improvement for future research in these issues in young patients with RMDs. This review highlights the need to actively engage patients and ensure that their psychological concerns are addressed to improve their healthcare and long-term quality of life outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

The major river basins of the Iberian Peninsula that drain towards the Atlantic coast contain extensive Lower Palaeolithic (Acheulean) records associated with well-preserved fluvial terrace sequences. These open-air archaeological records are often difficult to constrain chronologically due to a lack of suitable material for dating (e.g., faunal remains) or because their Middle Pleistocene antiquity precludes the use of otherwise routinely applicable geochronometric techniques such as conventional optically stimulated luminescence (OSL) dating. As a result, many important Iberian Acheulean sites lack precise and accurate chronologies, and their existing temporal frameworks are based solely on morphostratigraphic correlations with regional fluvial terrace systems. Here we present the first application of extended-range luminescence dating – namely multi-grain post-infrared infrared stimulated luminescence (pIR-IRSL) dating of K-feldspars and single-grain thermally transferred-OSL (TT-OSL) dating of quartz – to a series of terrace sequences in the Duero basin (central sector) and Guadiana basin, as well as associated Lower Palaeolithic sites of La Maya I, II and III along the Tormes River, Burganes (and related sites) along the Tera River, and Albalá along the Guadiana River. Additionally, we present results of a parallel electron spin resonance (ESR) quartz dating study of the Tormes River terrace (Duero basin), which has been undertaken independently on the same samples to enable stratigraphically paired dating comparisons. Our study indicates that sedimentary quartz from this sector of the Duero basin produces very weak TT-OSL signals, variable Al signal repeatability and below-average Ti signal fitting uncertainties, though it is still possible to determine consistent comparative ages using the measurements protocols employed here. For samples where both pIR-IRSL and TT-OSL signals were measured, the paired luminescence dating ages are in agreement at 1σ. Agreement between the quartz ESR and TT-OSL ages is also observed for one sample from the Tormes River. However, the ESR signals (both Al and Ti) of a second sample showed insufficient bleaching and age overestimation in comparison to the paired TT-OSL dataset. Comparison of our latest dating results with published chronological datasets point to some fluvial terraces of the Duero basin potentially having diachronous formation histories. Despite this, our combined chronological results show that the terrace systems are chronologically ordered and suggest that, regionally, the +8 to +34 m terraces likely post-date marine isotope stage (MIS) 10, whilst the +50 m terraces formed prior to, or during, MIS 10. The related Acheulean sites that contain lithic material in stratigraphic position are dated to MIS 9–7 (193–314 ka at 2σ age range), and temporally overlap with the early Middle Palaeolithic records in the Duero basin, also dated here to MIS 8–7 (or 159–259 ka at 2σ). Our results are consistent with previous observations regarding the chronological overlap of these two technologies in the region, and support the possibility of a non-linear pattern of replacement for the Acheulean in the Iberian Peninsula during the Lower to Middle Palaeolithic transition. • Paired single-grain TT-OSL and multi-grain pIR-IRSL 225 ages agree for all samples. • Luminescence and quartz ESR dating ages in agreement for some samples. • Low to mid elevation fluvial terraces (+8 to +34 m) formed after MIS10. • +50 m fluvial terraces formed prior to, or during, MIS 10. • Acheulean to early Middle Palaeolithic transition likely followed non-linear pattern. [ABSTRACT FROM AUTHOR]

To provide an update on the effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors on stroke in patients with type 2 diabetes (T2D). PubMed, Embase, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing SGLT2 inhibitors versus placebo or other therapies in patients with T2D and reporting stroke endpoint. We computed the risk ratios (RRs) to binary endpoints, with 95 % confidence intervals (CIs). A total of 71 RCTs and 105,914 patients were included, of whom 62,488 (59 %) were randomized to the SGLT2 inhibitors group. The follow-up ranged from 12 weeks to 4.2 years. There were no significant differences between groups in all types of stroke (RR 0.96; 95 % CI 0.89-1.04), ischemic stroke (RR 0.89; 95 % CI 0.76-1.04), and transient ischemic attack (RR 0.96; 95 % CI 0.79-1.16). Patients on SGLT2 inhibitors experienced lower rates of hemorrhagic stroke (RR 0.62; 95 % CI 0.39-0.98). In the subgroup analysis of the type of drug, sotagliflozin significantly reduced all types of stroke (RR 0.74; 95 % CI 0.56-0.97). In this meta-analysis of 71 RCTs comprising 105,914 patients with T2D, SGLT2 inhibitors were not associated with a reduced risk of stroke and transient ischemic attack compared to placebo or other therapies; however, there was a trend toward reduced risk of hemorrhagic stroke. Among all SGLT2 inhibitors, sotagliflozin significantly reduced the risk of stroke. [ABSTRACT FROM AUTHOR]

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Neuroendocrine tumors can cause ectopic Cushing syndrome, and most patients have metastatic disease at diagnosis. We identified risk factors for outcome, evaluated ectopic Cushing syndrome management, and explored the role of bilateral adrenalectomy in this population. This was a retrospective study including patients with diagnosis of ectopic Cushing Syndrome secondary to neuroendocrine tumors with adrenocorticotropic hormone secretion treated at our quaternary referral center over a 40-year period (1980–2020). Seventy-six patients were included. Mean age at diagnosis was 46.3 ± 15.8 years. Most patients (N = 61, 80%) had metastases at ectopic Cushing syndrome diagnosis. Average follow-up was 2.9 ± 3.7 years (range, 4 months–17.2 years). Patients with neuroendocrine tumors before ectopic Cushing syndrome had more frequent metastatic disease and resistant ectopic Cushing syndrome. Patients with de novo hyperglycemia, poor neuroendocrine tumor differentiation, and metastatic disease had worse survival. Of those with nonmetastatic disease, 8 (53%) had ectopic Cushing syndrome resolution after neuroendocrine tumor resection, 3 (20%) were medically controlled, and 4 (27%) underwent bilateral adrenalectomy. In patients with metastatic neuroendocrine tumors, hypercortisolism was initially medically managed in 92%, 3% underwent immediate bilateral adrenalectomy, 2% had control after primary neuroendocrine tumor debulking, and 2% were lost to follow-up. Medical treatment resulted in hormonal control in 7 (13%) patients. Of the 49 patients with metastatic disease and medically resistant ectopic Cushing syndrome, 23 ultimately had bilateral adrenalectomy with ectopic Cushing syndrome cure in all. Patients with neuroendocrine tumors before ectopic Cushing syndrome development were more likely metastatic and had worse survival. De novo hyperglycemia and poor neuroendocrine tumor differentiation were predictive of worse prognosis. Medical control of hypercortisolism is difficult to achieve in patients with neuroendocrine tumors–ectopic Cushing syndrome. Well-selected patients may benefit from bilateral adrenalectomy early in the treatment algorithm, and multidisciplinary management is essential in this complex disease. [Display omitted] [ABSTRACT FROM AUTHOR]

Postoperative hypoparathyroidism from inadequate parathyroid hormone is of concern after multigland resections in multiple endocrine neoplasia type 1–related primary hyperparathyroidism. We evaluated risk factors, long-term outcomes, and roles of autotransplantation and cryopreservation in postoperative hypoparathyroidism in multiple endocrine neoplasia type 1. Retrospective cohort study of patients with multiple endocrine neoplasia type 1 and parathyroidectomy who were evaluated at MD Anderson from 1990 to 2020. We included 206 patients. Median follow-up after the last operation (index 65%, reoperation 35%) was 8 years. Index parathyroidectomy was subtotal in 47%, less than subtotal in 42%, and total in 12%; hypoparathyroidism was more frequent after total parathyroidectomy. Forty-seven patients (23%) had hypoparathyroidism ≥6 months; odds were significantly higher when cumulative ≥4 glands were resected (odds ratio 6 [2.96–12.24]) or when immediate postoperative parathyroid hormone was <15 pg/mL (odds ratio 13.10 [3.61–47.47]). After median 26 months postoperatively, 30% recovered parathyroid function spontaneously; this was less likely when ≥4 glands were resected (odds ratio 0.19 [0.05–0.72]). None of the 4 patients who were aparathyroid (parathyroid hormone undetectable or ≤3 pg/mL) at 6 months postoperatively recovered parathyroid function. Immediate autotransplantation success rate was 72%. Cryopreservation was performed in 96 operations with delayed autotransplantation in 10 patients (10% utilization), of whom 5 recovered parathyroid function (time to recovery 12–93 months). Odds of prolonged hypoparathyroidism are higher when cumulative ≥4 glands are resected or postoperative parathyroid hormone is <15 pg/mL. Spontaneous recovery occurred but was less likely when ≥4 glands were resected or patients were aparathyroid at 6 months postoperatively. Cryopreservation should be sparingly used, but there is value in select high-risk patients such as reoperative parathyroidectomy/cervical surgery. [ABSTRACT FROM AUTHOR]

The textile industry causes major pollution to water bodies due to the discharge of dye-containing wastewater, such as indigo carmine (IC). Biochar has been used to treat organic pollutants like dyes because of its pore structure and surface area, as well as the functional groups contained, low cost, and sustainability of this material. In this study, biochar derived from Pinus patula wood pellets was used to assess its efficiency in the elimination of IC in water. Under optimal conditions of pH, biochar dose, and particle size (3, 13.5 g/L, and 300–450 µm, respectively), a 99% removal of a 25 mg/L solution of IC was achieved. Furthermore, studies on dissolved organic carbon (DOC) revealed that Pinus patula biochar contributed to a 73.8% reduction in the organic matter present in water. The IC adsorptive process was described by the pseudo-second order kinetic and the Freundlich isotherm models. Chemical and physical adsorption mechanisms were associated with the uptake of IC by Pinus patula biochar. Hydrogen bonding, electrostatic attraction, π-π interactions, and pore-filling were regarded as the possible mechanisms involved in the adsorption system. Pinus patula wood pellets biochar was shown to be an efficient adsorbent to remove dyes from water. [Display omitted] [ABSTRACT FROM AUTHOR]

Digital transformation plays a vital role in the success of firms, especially for small and medium-sized enterprises (SMEs). The business landscape is becoming more challenging for small businesses and they must navigate this complexity by adopting digitalization. However, many of them fail in this process. Our study aims to understand the main determinants of digital transformation, and the effect of size heterogeneity within SMEs. To this end, we apply the resource-based view, the technology-organization-environment framework and the technology acceptance model to a statistically representative sample of Spanish SMEs. We show that the manager's academic background, internationalization and firm size have a positive impact on digital adoption. Knowledge resulting from professionalization and an international context plays a critical role in overcoming SMEs' limitations and achieving digital transformation. Moreover, the positive effect of size is moderated by the levels of managerial education and internationalization. We go beyond the comparison between SMEs and large companies, by providing evidence about size heterogeneity within SMEs. Our findings provide valuable guidance for SMEs' digital transformation journeys, encouraging managers to embrace new knowledge and capabilities. Additionally, SME growth can facilitate digital transformation. Policymakers should develop programs aimed at promoting SME professionalization and international expansion. • Even though digital transformation is essential for SMES, many of them fail in this process. • Manager's academic background, internationalization and firm size have a positive impact on digital adoption. • There is size heterogeneity within SMEs. • The positive effect of size is moderated by the levels of managerial education and internationalization. [ABSTRACT FROM AUTHOR]

Atlantic bonito meat has economic potential as an alternative to mackerel consumption. Thus, considering the presence of myoglobin (Mb) in red fish muscles, we report the characterisation of Atlantic bonito Mb compared to Atlantic and Tinker mackerel Mbs since this haemoprotein is implicated in lipid oxidation and fish meat preservation. A plethora of biochemical approaches were employed to purified Mb from Atlantic bonito and determine the autoxidation rate constant (0.189 ± 0.009 h−1), melting temperature (Tm = 72.84 ± 1.02 °C) and pseudoperoxidase activity in different conditions (pH and several cations). Atlantic and Tinker mackerel Mbs showed a lower Tm (∼66.85 °C), while oxyMb autoxidation rate constant was higher for Atlantic mackerel (∼1.08-fold) and lower for Tinker mackerel (∼1.35-fold) compared to Atlantic bonito. This Mb had a Michaelis-Menten constant (K m) of 38.63 ± 1.89 μM, ∼2.49-fold and 2.27-fold lower than Atlantic and Tinker mackerel Mbs, respectively. Atlantic bonito Mb primary structure has 146 amino acid residues with the N -terminal acetylated and 25 amino acid substitutions with respect to Atlantic and Tinker mackerel Mbs. In silico analysis revealed that 7 out of 25 substitutions are close to the haem-pocket, while 18 out of 25 are far from this region. All substitutions, except H20, L70 and L81 are exposed on the protein globular surface. Overall, the results of this research provide new information for future studies that will be useful to the fish industry for preservation of frozen or canned Atlantic bonito meat considering the presence of Mb as a reactive haemoprotein. [Display omitted] • The purification of myoglobin (Mb) from Atlantic bonito was carried out. • Atlantic and Tinker mackerel Mbs were used for comparison. • Atlantic bonito Mb has different autoxidation rate and pseudoperoxidase activity. • This protein has 25 out of 146 amino acid substitutions and N -terminal acetylated. • Mb structural differences for adaptation into Sarda and Scomber order are highlighted. [ABSTRACT FROM AUTHOR]

Inter-reader reliability of a new scoring system for evaluating joint inflammation and enthesitis in whole body MRI (WBMRI) in juvenile idiopathic arthritis was tested. The scoring system grades 732 item-region combinations of bone marrow and soft tissue changes for commonly involved joints and entheseal sites. Five radiologists rated 17 WBMRI scans through an online rating platform. Item-wise reliability was calculated for 117 items with non-zero scores in >10 % of readings. Interquartile ranges of the five-reader Kappa reliability coefficients were 0.58–0.73 (range: 0.36–0.88) for the joints, 0.65–0.81 (range: 0.39–0.95) for the entheses, and 0.62–0.75 (range: 0.60–0.76) for chronic nonbacterial osteomyelitis-like lesions. [ABSTRACT FROM AUTHOR]

Neonatal and infantile cholestasis (NIC) can represent the onset of a surgically correctable disease and of a genetic or metabolic disorder worthy of medical treatment. Timely recognition of NIC and identification of the underlying etiology are paramount to improve outcomes. Upon invitation by the Italian National Institute of Health (ISS), an expert working grouped was formed to formulate evidence-based positions on current knowledge about the diagnosis of NIC. A systematic literature search was conducted to collect evidence about epidemiology, etiology, clinical aspects and accuracy of available diagnostic tests in NIC. Evidence was scored using the GRADE system. All recommendations were approved by a panel of experts upon agreement of at least 75% of the members. The final document was approved by all the panel components. This position document summarizes the collected statements and defines the best-evidence diagnostic approach to cholestasis in the first year of life. [ABSTRACT FROM AUTHOR]

● ESKAPE bacteria causing pneumonia as contaminants from mechanical ventilators. ● Disinfection of mechanical ventilators contaminated with ESKAPE bacteria. ● Disinfection method reducing contamination from mechanical ventilators. ● ESKAPE bacteria were not detected after disinfection of mechanical ventilators. ● Positive impact on reducing bacterial contamination from mechanical ventilators. Mechanical ventilators are essential biomedical devices for the respiratory support of patients with SARS-CoV-2 infection. These devices can be transmitters of bacterial pathogens. Therefore, it is necessary to implement effective disinfection procedures. The aim of this work was to show the impact of the modification of a cleaning and disinfection method of mechanical ventilators of patients with SARS-CoV-2 and ventilator-associated pneumonia. A total of 338 mechanical ventilators of patients infected with SARS-CoV-2 and ESKAPE bacteria were divided in two groups. Group A and B were subjected to cleaning and disinfection with superoxidation solution-Cl/enzymatic detergent and isopropyl alcohol, respectively. Both groups were cultured for the detection of ESKAPE bacteria. The isolates were subjected to tests for identification, resistance, adherence, and genomic typing. Contamination rates of 21.6% (n = 36) were identified in group A. The inspiratory limb was the circuit involved in most cases of postdisinfection contamination. Acinetobacter baumanni, Pseudomonas aeruginosa , and multi-resistant Klebsiella pneumoniae were the pathogens involved in the contamination cases. The pathogens were highly adherent and in the case of A. baumanni , clonal dispersion was detected in 14 ventilators. Disinfection with enzymatic detergents allows a 100% reduction in contamination rates. The implementation of cleaning and disinfection with enzymatic detergents/isopropyl alcohol of mechanical ventilators of patients with SARS-CoV-2 and ESKAPE bacteria had a positive impact on postdisinfection microbial contamination rates. [ABSTRACT FROM AUTHOR]

Whole body-MRI is helpful in directing diagnostic and treatment approaches, and as a research outcome measure. We describe our initial consensus-driven phase towards developing a whole body-MRI scoring system for juvenile idiopathic arthritis. An iterative approach using three rounds of anonymous Delphi surveys followed by a consensus meeting was used to draft the structure of the whole body-MRI scoring system, including the relevant anatomic joints and entheses for assessment, diagnostic item selection, definition and grading, and selection of appropriate MRI planes and sequences. The surveys were completed independently by an international expert group consisting of pediatric radiologists and rheumatologists. Twenty-two experts participated in at least one of three rounds of Delphi surveys and a concluding consensus meeting. A first iteration scoring system was developed which ultimately included the assessment of 100 peripheral, 23 chest, and 76 axial joints, and 64 entheses, with 2–4 diagnostic items graded in each of the items, using binary (presence/absence) and 2-3-level ordinal scores. Recommendations on anatomic MRI planes and sequences were specified as the minimally necessary imaging protocol for the scoring system. A novel whole body-MRI scoring system for juvenile idiopathic arthritis was developed by consensus among members of MRI in JIA OMERACT working group. Further iterative refinements, reliability testing, and responsiveness are warranted in upcoming studies. [Display omitted] [ABSTRACT FROM AUTHOR]

• The visceral adiposity index discriminates body adipose tissue. • Visceral fat is a key factor in the etiology of metabolic changes. • Visceral adiposity index is positively associated with blood pressure. This systematic review aimed to investigate the association between VAI and blood pressure. The study was according to the PRISMA standards and the bibliographic search in the PubMed, EMBASE and Cochrane Library databases. This review included 32 articles, with 60,482 individuals – children to elderly people between 7 and 102 years old – of different age groups, most of them female (54.9%; n = 26,478). The year of publication ranged from 2010 to 2020, indicating that it is a recent theme, applied in almost all continents (America, Europe, Africa and Asia). The authors used data as continuous or into quantiles; blood pressure data also varied, with different cutoff points for the classification of arterial hypertension or continuously. The vast majority of studies have shown a positive association between VAI and blood pressure, both the sexes, in different age groups. The evaluation of the quality of the articles used by the Tool of the Joanna Briggs Institute according to their design. Individuals with increased VAI have higher blood pressure levels. Registration (PROSPERO: CRD42020205965). [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic had significant impact on radiology departments across the United States. Radiology departments have adjusted to the effects of the pandemic. This article presents the changes made by the Radiology department at the Montefiore Medical Center (MMC) of the Albert Einstein College of Medicine located in the Bronx, New York City which is one of the major hot spots of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

• Algorithm and Field or grid size are predictive of OF calculation accuracy in TPS. • Modern TPSs slightly overestimate the calculated small fields OFs. • For Monte Carlo and AAA algorithms, a grid resolution of 1 mm is recommended. The influence of basic plan parameters such as slice thickness, grid resolution, algorithm type and field size on calculated small field output factors (OFs) was evaluated in a multicentric study. Three computational homogeneous water phantoms with slice thicknesses (ST) 1, 2 and 3 mm were shared among twenty-one centers to calculate OFs for 1x1, 2x2 and 3x3 cm2 field sizes (FSs) (normalized to 10x10 cm2 FS), with their own treatment planning system (TPS) and the energy clinically used for stereotactic body radiation therapy delivery. OFs were calculated for each combination of grid resolution (GR) (1, 2 and 3 mm) and ST and finally compared with the OFs measured for the TPS commissioning. A multivariate analysis was performed to test the effect of basic plan parameters on calculated OFs. A total of 509 data points were collected. Calculated OFs are slightly higher than measured ones. The multivariate analysis showed that Center, GR, algorithm type, and FS are predictive variables of the difference between calculated and measured OFs (p < 0.001). As FS decreases, the spread in the difference between calculated and measured OFs became larger when increasing the GR. Monte Carlo and Analytical Anisotropic Algorithms, presented a dependence on GR (p < 0.01), while Collapsed Cone Convolution and Acuros did not. The effect of the ST was found to be negligible. Modern TPSs slightly overestimate the calculated small field OFs compared with measured ones. Grid resolution, algorithm, center number and field size influence the calculation of small field OFs. [ABSTRACT FROM AUTHOR]

Common peroneal nerve injury is present in 40% of knee dislocations, and foot drop is the principal complication. Posterior tibial tendon transfer is a viable solution to replace the function of the anterior tibial tendon (ATT) in the mid-foot. Several techniques for posterior tibial tendon transfer exist today, with variable results reported. However, adding augmentation with side-to-side tenorrhaphy of ATT to the transferred posterior tibial tendon (PTT) enhances anterior tissue balance and load sharing stress between native ATT enthesis and PTT tenodesis, allowing early rehabilitation and improving functional outcomes. Side-to-side tenorrhaphy is performed after PTT tenodesis in the lateral cuneiform to improve reliability in foot drop. This technique allows shorter immobilization time (from 6 to 2 weeks), earlier rehabilitation, sooner weight-bearing, and decreased risk of arthrofibrosis, scar formation, and muscle atrophy. [Display omitted] [ABSTRACT FROM AUTHOR]

• The effects of several geometric parameters were evaluated to design a Turgo turbine. • The nozzle diameter resulted to have a considerable influence on the turbine efficiency. • A Box-Behnken DOE was used for determining the optimal design conditions maximizing the Turgo turbine efficiency. The Turgo turbine is a relatively cheap, reliable and sustainable type of impulse turbine used in hydroelectric plants, which is generally suited for medium and high head applications. Nowadays, the development and use of technologies for harnessing very low-head water resources have become highly widespread due to the low negative impact generated on the environment. Additionally, the implementation of small innovative water-related projects can be an economical option for the generation of renewable energy in developing countries. Therefore, a low-cost Turgo turbine for low-head applications was designed and manufactured for evaluating the effects of several geometric parameters involved in the design and, subsequently, in the turbine efficiency. Among these parameters, the nozzle diameter, the number of nozzles and the jet impact location were studied. For this purpose, the response surface methodology based on a Box-Behnken design of experiments was used to determine the optimal operating conditions of the referred geometric factors aiming at the maximization of the turbine efficiency, as well as to investigate the effect of each parameter on the turbine efficiency. From the experimental design, a second-order regression model was generated, which was validated. The obtained findings indicated that the nozzle diameter had a considerable influence on the turbine efficiency in comparison with the other evaluated factors. Moreover, the results showed that the maximal experimental turbine efficiency was equal to 93.7% under optimal design conditions; i.e., when the nozzle diameter, number of nozzles and the jet impact location were equal to 16.685 mm, 2 and 60 mm, respectively. Therefore, the designed Turgo turbine reported a high efficiency, which could be used for the distributed power generation. [ABSTRACT FROM AUTHOR]

The design of a horizontal-axis propeller hydrokinetic turbine (HPHT) depends on several geometric parameters affecting its hydrodynamic efficiency which is measured through the power coefficient (C P). In this study, a 1 kW turbine with 1.6 m of rotor diameter (D) was used as the prototype to know the relationship between the C P and the turbine design parameters, such as the skew (ϕ) and rake (γ) angles. A full-factorial design of experiments, as a response surface methodology technique, and computational fluid dynamics simulation were used to determine the significance of the factors considered and their interaction in the maximization of the response variable (C P). A 3D computational domain in ANSYS Fluent software and the k- ω SST turbulence model were utilized, for the unsteady flow simulations. Under optimal design conditions, i.e., when ϕ and γ were equal to 13.30° and -18.06°, respectively, the highest C P was 0.4571. For these optimal values, a scaled model with 0.24 m of diameter was numerical and experimentally studied and the findings were compared. A good agreement was found between the numerical results regarding the lab-scale turbine and the experimental data for the C P values obtained as a function of the tip speed ratio. [ABSTRACT FROM AUTHOR]

According to the Solvency II directive, insurers can use internal models for solvency assessment, but regulators must approve these models. Sensitivity analysis is a crucial part of the approval process. However, the directive lacks clarity on the required sensitivity analysis. Various techniques exist in literature to assess the impact of model assumptions on output, each revealing different aspects of model behaviour. In this letter, we suggest a minimum standard for regulators to ensure model quality. We propose complementary sensitivity settings for internal model development, governance, and approval. Implementing these settings enhances the explainability of approved models and their reliability. • We evidence the importance of rigorously performing sensitivity analysis to accompany the validation of actuarial models. • We propose a benchmark for the sensitivity analysis of internal models. • We suggest the use of an ensemble of sensitivity measures to enhance model explanation. • We develop a numerical application based on non-life insurance for comparing various sensitivity methods. [ABSTRACT FROM AUTHOR]

The increasing adoption of the Industry 4.0 paradigm encompasses digitally interconnected factories which enables many advantages. However, it is still necessary to dedicate effort towards investigating protection mechanisms against cyberattacks in these scenarios. Despite the power demonstrated by Anomaly Detection-based Intrusion Detection Systems in industrial scenarios, their vulnerabilities to adversarial attacks, especially to evasion attacks, make Machine Learning and Deep Learning models ineffective for real scenarios. These type of attacks craft samples misclassified by the Intrusion Detection System and potentially reach industrial devices, causing potentially damaging impacts to factory workers and industry resources. Adversarial attacks linked to industrial scenarios are currently in early stages of development, hence most of them have the capability to craft samples misclassified by the IDS but not reach industrial devices. In this work, we present a new adversarial attack named Selective and Iterative Gradient Sign Method that overcomes the limitation of the adversarial attacks present in the literature. To complement this work we also detail a study of how the detection rate of an Intrusion Detection System is degraded and the time required by each technique to generate adversarial samples. The experiments were carried out using a dataset named Electra, collected from an Electric Traction Substation, and showed that adversarial attacks evaluated crafted samples misclassified by the IDS. However, only the method we proposed generated samples that can be understood by intermediate network devices and, therefore, reach their destination. Our experiment outputs demonstrate a lower period of time to achieve and craft adversarial samples using out our iterative based process method as opposed to other current iterative methods currently available. [ABSTRACT FROM AUTHOR]

With powerful new therapies available for management of juvenile idiopathic arthritis (JIA), early diagnosis leading to appropriate treatment may prevent long-term structural joint damage. Although magnetic resonance imaging (MRI) is typically used to assess individual body parts, indications for whole body (WB) MRI are increasing. Its utility as a diagnostic and monitoring tool has already been widely investigated in adult rheumatology patients, but less so in pediatric rheumatologic patients. This paper is a comprehensive review of scoring systems and a proposal for the conceptual development of a WB-MRI scoring system for the evaluation of JIA. In this review we identify, summarize, and critically appraise the available literature on the use of WB-MRI in inflammatory arthritis, addressing relevant considerations on components of a classification system that can lead to the development of a future pediatric WB-MRI scoring system for use in children with JIA. We also discuss advantages and challenges of developing such a WB-MRI scoring system for assessment of JIA and outline next steps toward the conceptual development of this scoring system. [ABSTRACT FROM AUTHOR]

Cabozantinib is a second-third line agent for sorafenib-experienced HCC patients. Therefore, it can be prescribed as part of a lenvatinib-sorafenib-cabozantinib or atezo/bev-sorafenib-cabozantinib sequence. Tolerability and safety are key concerns, especially for patients reaching a third-line treatment. However, dose reductions to manage adverse events (AEs) may induce fears of reduced efficacy. Analysis of the MULTICABO cohort (96 patients from 15 Italian centers). We evaluated the relative dose-intensity of cabozantinib during the first 8 weeks (8W-DI; expressed a ratio between the cumulative dose actually received and the maximum theoretical dose). The 8W-DI was correlated with disease control at the first imaging, progression-free survival (PFS), and overall survival (OS). To assess the effects of dose reductions after the first 8 weeks on the OS, multivariable time-dependent Cox regressions were carried out. Disease control rate was 63%. The median PFS and OS were and 5.2 and 11.3 months, respectively. The majority of patients (n=45) received the full 60mg daily dose during the first 8 weeks (median 8W-DI 100%, IQR 70-100%). A 90% 8W-DI (equating to a mean 54 mg/daily dose) was chosen for further analysis. A high 8W-DI did not correlate with worse radiological response (OR 1.72, 95% CI 0.72-4.15), PFS (HR 1.39, 95% CI 0.87-2.22), or OS (HR 1.06, 95% CI 0.61-1.83). Sixty-one (63.5%) and 19 (19.8%) patients permanently reduced cabozantinib to 40 and 20 mg/day to manage AEs. In the time-dependent analyses, reduction to 40 mg and 20 mg were associated with increased OS (HR 0.47, 95% CI 0.29-0.76; HR 0.41 95% CI 0.21-0.80, respectively]. Our results underline the importance of tailored dosing of cabozantinib. Dose adjustements to manage AEs should not automatically induce fears of reduced efficacy, as higher 8W-DI were not related to better outcomes while dose reductions to manage AEs were associated with increased OS. [ABSTRACT FROM AUTHOR]

Violence influences the productive activity of rural producers. One of the effects of violence is the disruption of the relationships between rural producers and the market, because violent actors attempt to control the interactions, the transportation, and the flow of products. In this study we investigate how rural producers interact with the market in a violent context. With this purpose we define integration into the market as the establishment of strong and long-term exchange relations with other market agents. In contrast to other approaches to understand the interactions with the market, this definition focuses on the established relationship instead of its inputs or outputs. We analyze the roles of both relational capital and meso-organizations' programs in the process of integration of rural producers into the market in a violent context. We find that some forms of relational capital strongly relate to the rural producers' ability to establish those exchange relations. Additional to this direct effect, there is an indirect effect when rural producers participate in meso-organization programs that focus on improving internal productive capacities and on facilitating connections with agents from outside their communities. Programs that provide subsidies and credit have no effect on integration into the market. • Integration into the market positively relates to relational capital beyond the close community. • Rural producers' relational capital favors meso-organization programs. • Programs focused on long-term benefits favor integration into the market. • Programs focused on financial support do not favor integration into the market. • Communitarian insecurity is strongly related to integration into the market. [ABSTRACT FROM AUTHOR]

Although egg-pods and egg morphology represent useful features for phylogenetic purposes, they are less well known in Pamphagidae when compared with other Orthoptera groups of Caelifera, such as Acrididae. Breeding in the lab some specimens of Acinipe deceptoria (Bolívar, 1878) and Acinipe segurensis (Bolívar, 1908), two sympatric species inhabiting the Southeastern Iberian Peninsula, allowed us to study in detail such structures. The morphology of the egg-pods of both species is very similar and almost undistinguishable. The eggs general morphology is also similar. However, some chorionic features, such as the chorionic mesh-size and the micropyle morphology, make possible to distinguish between both species thus being useful for taxonomic applications. On the other hand, our observations on presence of egg-pods and micropyles arrangement support the classical systematics of Orthoptera splitting it in two suborders. • Egg morphology and chorion sculpturing help to distinguish among Orthopteran species. • Micropile micromorphology is useful to differentiate Orthopteran species. • Egg-pods and egg morphology are phylogenetic useful features in Orthoptera. [ABSTRACT FROM AUTHOR]

This study evaluated the effect of systemic administration of omega-3 on the expression of interleukins IL-1β and IL-10 and tumour necrosis factor alpha (TNF-α) and on the thickness of cartilage in the temporomandibular joint (TMJ) inflammatory model induced by complete Freund's adjuvant (CFA). Thirty-two adult rats were divided equally into four groups: control, CFA (induced arthritis), and induced arthritis animals treated with dexamethasone or omega-3. The TMJs were then removed and assigned to histomorphometric analysis or immunoassay. The Kruskal–Wallis test with Dunn post hoc test was applied to the data; the significance level was set at 5%. IL-1β levels (median; interquartile range) were higher (P < 0.0001) in the CFA group (46.4 ng/ml; 39.4–53.3) than in the control group (1.81 ng/ml; 1.5–5.4), but there were no differences between the control, omega-3, and dexamethasone groups. TNF-α levels were also higher (P < 0.0001) in the CFA group (122.7 ng/ml; 92.9–284.7) than in the control group (29.1 ng/ml; 23.7–31.3). IL-10 levels were lowest (P < 0.0001) in the CFA group (73.5 ng/ml; 52.8–90.5), and no differences were found amongst the other groups. In conclusion, omega-3 successfully reduced the damage in the TMJ of induced arthritis rats. Further investigations are warranted to confirm whether the administration of omega-3 has a comparable effect to glucocorticoids in rheumatoid arthritis patients. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of radiofrequency (RF) on patellar ligament repair through the analysis of type I and III collagens and immunostaining for TGF-β3. To evaluate the effect of RF on patellar ligament repair of Wistar rats, cross-sectional incision (60% of the width - grade I) was performed in patellar ligaments of the groups: lesion (L, n = 7), treated with RF on the 5-day (5RF, n = 7) and 7-day (7RF, n = 7) post injury were compared to control group (C, n = 7). Histological evaluation, immunohistochemistry, morphometry and statistical analysis were performed. At 10 days post injury, ligament rupture were observed only in L. Active fibroblasts, type 3 collagen and TGF-β3 in L, 5RF and 7RF was significantly (p < 0.05) higher than control (C). Type 1 collagen was significantly (p < 0.05) higher in C than L, 5RF and 7RF. A positive correlation (p < 0.05) was observed: TGF-β3 vs active fibroblasts and TGF-β3 vs type 3 collagen; otherwise, negative correlation (p < 0.05): type I collagen vs TGF-β3. These results suggest that RF seemed to accelerate the wound healing process of the patellar ligament and may be used as a non-invasive treatment of partial ligament injuries. [ABSTRACT FROM AUTHOR]

• Hydrogen peroxide plasma could be a disinfection alternative of N95 masks. • Disinfection of N95 masks with SARS-CoV-2 and ESKAPE bacteria. • SARS-CoV-2 was not detected after disinfection of N95 masks. • ESKAPE bacteria were not detected after disinfection of N95 masks. One of the serious consequences of the SARS-CoV-2 pandemic is the shortage of protective equipment for health personnel. N95 masks are considered one of the essential protective equipment in the management of patients with COVID-19. The shortage of N95 masks implies potential health risks for health personnel and significant economic losses for the health institution. The objective of this work was to investigate the disinfection of N95 masks artificially contaminated with SARS-CoV-2 and ESKAPE bacteria by using hydrogen peroxide plasma. We examined the disinfection capacity of hydrogen peroxide plasma against the SARS-CoV-2 and 2 members of the ESKAPE bacteria (Acinetobacter baumannii and Staphylococcus aureus) through a study of artificial contamination in situ of N95 masks. Amplification of specific genes by real-time reverse transcription polymerase chain reaction of SARS-CoV-2 and microbiological culture of ESKAPE bacteria was performed before and after the disinfection process. SARS-CoV-2 was not detected in all assays using 5 different concentrations of the virus, and A baumannii and S aureus were not cultivable with inoculums of 102 to 106 CFU after disinfection tests of N95 masks with hydrogen peroxide plasma. Disinfection of N95 masks by using the hydrogen peroxide plasma technology can be an alternative for their reuse in a shortage situation. Implications for the use of disinfection technologies of N95 masks and the safety of health personnel are discussed. [ABSTRACT FROM AUTHOR]

• Ru-106 eye plaque brachytherapy (EPB) is elective treatment for small-medium ocular melanomas. • Patient specific CT-based planning in EPB is not a standard yet. • Eye organs –at-risk (eOARs) dosimetry in Ru-106 EPB by CT-based planning is performed. • The dosimetric impact of CT eye geometry vs standard eye model geometry is also evaluated. • Ru-106 EPB CT based imaging is the key for robust modeling of radiation induced complications. To evaluate the impact on dose distribution to eye organs-at-risk (eOARs) of a computed tomography (CT)-based treatment planning in eye plaque brachytherapy (EPB) treatment. We analyzed 19 ocular melanoma patients treated with ruthenium-106 plaques to a total dose of 100 Gy to tumor apex using conventional central-axis-point dose calculation. Treatments were re-planned using the Plaque Simulator (PS) software implementing two different strategies: a personalized CT-eye-model (CT-PS) and a standard-eye-model (SEM-PS) defined by Collaborative Ocular Melanoma Study. Dice coefficient and Hausdorff distance evaluated the concordance between eye-bulb-models. Mean doses (D mean) to tumor and eOARs were extracted from Dose-Volume-Histograms and Retinal-Dose-Area-Histogram. Differences between planning approaches were tested by Wilcoxon signed-rank test. In the analyzed cohort, 8 patients (42%) had posterior tumor location, 8 (42%) anterior, and 3 (16%) equatorial. The SEM did not accurately described the real CT eye-bulb geometry (median Hausdorff distance 0.8 mm, range: (0.4–1.3) mm). Significant differences in fovea and macula D mean values were found (p = 0.04) between CT-PS and SEM-PS schemes. No significant dosimetric differences were found for tumor and other eOARs. The planning scheme particularly affects the OARs closest to the tumor with a general tendency of SEM-PS to overestimate the doses to the OARs closest to the tumor. The dosimetric accuracy achievable with CT-PS EPB treatment planning may help to identify ocular melanoma patients who could benefit the most from a personalized eye dosimetry for an optimal outcome in terms of tumor coverage and eOARs sparing. Further research and larger studies are underway. [ABSTRACT FROM AUTHOR]

Transcatheter left atrial appendage occlusion is an increasingly used alternative to oral anticoagulation in selected patients with atrial fibrillation. Pre-procedural imaging is a prerequisite to a successful intervention, with transesophageal echocardiography as the current gold standard. However, cardiac computed tomography offers improved imaging with high-quality multiplanar and 3-dimensional reconstructed images. Nevertheless, the lack of a standardized imaging protocol has slowed the adoption of cardiac computed tomography into clinical practice. On the basis of current research and expert consensus, this paper provides a protocol for the preparation, acquisition, and interpretation of cardiac computed tomographic imaging in pre-procedural planning of left atrial appendage occlusion. • Cardiac CT is increasingly used to plan transcatheter LAAO. • High-quality multiplanar and 3D imaging allow accurate device sizing and efficient LAAO. • A standardized protocol for cardiac CT is paramount for a high-quality result. • Pre-procedural cardiac CT may improve the accuracy, efficacy, and safety of LAAO. [ABSTRACT FROM AUTHOR]

Hamstring tendon autograft remains a popular graft choice for anterior cruciate ligament reconstruction. Although the technique of hamstring autograft harvest is relatively straightforward, it is critical to pay attention to several technical steps to avoid iatrogenic anatomic or neurovascular damage as well as to reduce the risk of premature amputation of the graft when using a tendon stripper. We describe a technique of hamstring autograft harvesting using only 2 anatomic references that makes it a simple and reproducible technique for surgeons, especially those in training. [ABSTRACT FROM AUTHOR]

The FilmArrayⓇ Meningitis/Encephalitis Panel detects the 14 most frequent pathogens causing meningitis and/or encephalitis. The use of FilmArray ME with non-validated samples is seldom published in the literature. We describe the case of a 3-year-old child, diagnosed with acute meningoencephalitis, in whom the FilmArrayⓇ ME technique successfully identified Neisseria meningitidis in both skin biopsy and whole blood samples. [ABSTRACT FROM AUTHOR]