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• Serum biomarkers such as GFAP, UCH-L1 predict neurological outcomes after spontaneous subarachnoid hemorrhage (sSAH). • sSAH blood volume and serum biomarker show a robust correlation. • A structured blood sampling of serum biomarkers with automated immunoassay of chemiluminescence creates a framework for understanding neurological failure. • Threshold levels of GFAP and UCH-L1 describe predictive parameters for clinical outcomes. • The use of serum biomarkers is crucial in neurocritical care to prevent patients' clinical deterioration. Spontaneous non-traumatic subarachnoid hemorrhage (sSAH) is a severe brain vascular accident. Glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) can be theoretically assayed to predict a patient's progression, picturing different aspects of clinical failure after sSAH. The study aims to: a) explore the correlation between sSAH blood volume and biomarkers variation; b) evaluate if these can be predictive of the neurogenic response after sSAH and be prognostic of patient outcome; c) establish eventual threshold levels of biomarkers to define patients' clinical outcome. Blood volumetry at CT scan upon admission, GFAP and UCH-L1 were collected at 24 h, at 72 h, and after 7 days from hemorrhage. Trends and cut-off serum sampling were determined. Clinical outcome was assessed with mRS scale at 14 days. A strong correlation between GFAP and UCH-L1 and blood diffusion volume in all explored serum intervals related to unfavorable outcome. GFAP and UCH-L1 were very early predictors of unfavorable outcomes at 24 h from sSAH (p = 0.002 and 0.011 respectively). Threshold levels of UCH-L1 apparently revealed a very early, early and late predictor of unfavorable outcomes. GFAP and UCH-L1 represent a potential tool for prompt monitoring and customization of therapies in neurosurgical patients. [ABSTRACT FROM AUTHOR]

Contrast media extravasation (CME) is a well-known adverse event that can occur during the computerized tomography (CT). Studies about the risk factors related to these events are necessary to prevent its occurrence. The purpose of the study was to identify risk factors and possible related causes associated with CME in patients undergoing CT. A retrospective and quantitative study performed in a hospital in southern Brazil. Data from patients who had undergone intravenous contrast computer tomography scanning between March 2022 and May 2023 were collected and descriptive statistics was used. This study demonstrated that the highest incidence of CME occurred in males and inpatients, with age >60 being the greatest risk factor (82%). Additional risk factors such as fragile veins and contrast infusion rates >3 mL/sec were associated with more than 75% of the extravasations. In the absence of severe injury, all patients were treated with conservative medical management. Risk factors such as male, inpatient, age >60, and fragile veins are likely to predispose the patient to a higher incident of a CME event. Although severe injuries are rare, identifying the risk factors is important to minimize its incidence. • Older patients and inpatients are more susceptible to contrast media extravasation. • High infusion rates of contrast media can increase the risk of extravasation. • Most cases of extravasation were moderate and conservative management was indicated. [ABSTRACT FROM AUTHOR]

Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors have an extremely important impact on the treatment of hormone-sensitive breast cancer (BC) and have radically changed the first-line treatment for metastatic disease with increased rates of treatment response, overall survival (OS), and progression-free survival (PFS). We performed a pooled analysis of randomized trials to validate or refute the hypothesis that there is a significant survival benefit of adding anti-CDK4/6 inhibitors to standard endocrine therapy (ET) in older patients with advanced BC. We selected only English-language phase II/III randomized controlled trials that compared ET alone with ET with anti-CDK4/6 inhibitors in the treatment of advanced BC, with subgroups reporting the outcomes of elderly patients (usually at least 65 years). The primary endpoint was OS. The review process led to the inclusion of 12 articles and two meeting abstracts, including a total of 10 trials. The addition of CDK4/6 inhibitors to ET (letrozole or fulvestrant) significantly reduced mortality risk by 20% in younger patients (fixed-effect model; HR 0.80; 95% CI 0.72–0.9; p < 0.01) and 21% in older BC patients (HR 0.79; 95% CI 0.69–0.91; p < 0.01). No OS data were available for patients ≥70 years. This large, pooled analysis is the first to demonstrate that CDK4/6 inhibitors confer OS and PFS benefits in elderly patients (those aged ≥65 years) with advanced ER + BC and to indicate that it should be discussed with and offered to all patients after geriatric assessment and according to the toxicity profile. • Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors have changed the treatment of hormone-sensitive breast cancer (BC). • We performed a pooled analysis to validate the survival benefit of adding anti-CDK4/6 inhibitors in older patients. • The review process led to the inclusion of 12 articles and two meeting abstracts, including a total of 10 trials. • The addition of CDK4/6 inhibitors significantly reduced the mortality risk by 21% in older BC patients. • This pooled analysis demonstrates that CDK4/6 inhibitors confer OS benefit in elderly patients with advanced ER+ BC. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of different physical therapy interventions that could validate decisions taken by health care providers in the field of rehabilitation of patients with hemophilia according to the International Classification of Functioning, Disability and Health (ICF), including body functions and structures, activity, and participation. Seven databases—PubMed, Cochrane Library, Scopus, Web of Science, Physiotherapy Evidence Database, Google Scholar, and Clinicaltrials.gov—were systematically searched for randomized controlled trials evaluating any physical therapy modality to manage hemophilia. After abstract and full-text filtration, a methodological quality assessment was performed using the Physiotherapy Evidence Database scale for the studies that met the eligibility criteria. Relevant data were extracted from eligible studies and outcomes were categorized according to the ICF. Using Review Manager and Microsoft Excel, a quantitative analysis using standardized mean differences with the 95% confidence interval was completed. Statistical heterogeneity between studies was explored using the I2 test. A fixed effect model was applied to all data analyses. If heterogeneity was statistically significant, the Der Simonian and Laird random effects models were used instead. 35 randomized controlled trials with 1216 participants were included in this systematic review; 13 of them dealt with pediatric patients. Most of the studies were of good quality; 12 studies were of low quality. Meta-analysis showed a significant difference in favor of manual therapy, laser, and therapeutic exercises on selected outcomes of body function and structure, activity, and participation categories of the ICF model. This systematic review recommends using manual therapy and therapeutic exercise modalities to improve join health status in combination with educational sessions to improve the quality of life of patients with hemophilic arthropathy. For pediatric patients with hemophilic arthropathy, using laser therapy is promising for improving functional capacity. [ABSTRACT FROM AUTHOR]

Objective: Pectus excavatum (PE) repair is burdened by severe postoperative pain. This retrospective study aimed to determine whether the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) plus standard intravenous analgesia (SIVA) might be superior to SIVA alone in pain control after PE surgical repair via Ravitch or Nuss technique. Design: A retrospective cohort study. Setting: At a university hospital. Participants: All participants were scheduled for surgical repair of PE. Interventions: From January 2017 to December 2019, all patients who received ESPB plus SIVA or SIVA alone were investigated retrospectively. A 2:1 propensity-score matching analysis considering preoperative variables was used to compare analgesia efficacy in 2 groups. All patients received a 24-hour continuous infusion of tramadol, 0.1 mg/kg/h, and ketorolac, 0.05 mg/kg/h, via elastomeric pump, and morphine, 2 mg, intravenously as a rescue drug. The ESPB group received preoperative bilateral ESPB block. Postoperative pain, reported using a numerical rating scale at 1, 12, 24, and 48 hours after surgery; the number of required rescue doses; total postoperative morphine milligram equivalents consumption; and the incidence of postoperative nausea and vomit were analyzed. Measurement and Main Results: A total of 105 patients were identified for analysis. Propensity-score matching resulted in 38 patients in the SIVA group and 19 patients in the ESPB group. Postoperative pain, the number of rescue doses, and postoperative nausea and vomit incidences were lower in the ESPB group (p < 0.005). Conclusions: Erector spinae plane block may be an effective option for pain management after surgical repair of PE as part of a multimodal approach. This study showed good perioperative analgesia, opioid sparing, and reduced opioid-related adverse effects. [ABSTRACT FROM AUTHOR]

To describe the clinical and laboratory characteristics of patients with primary and secondary antiphospholipid syndrome (APS) in an Egyptian cohort. Sixty APS patients were enrolled. 12 had primary APS and 48 had secondary. Patients were further classified according to the presence of double or triple antiphospholipid antibodies (aPL). The study included 55 (91.7 %) females and 5 (8.3 %) males, with a mean age of 33.9 ± 9.1 years, and mean disease duration of 6.2 ± 93.04 years. The obstetric complication in the form of fetal loss was the commonest manifestation of APS (70 %), followed by lower limb deep venous thrombosis (DVT) (50 %), recurrent abortion (45 %), thrombocytopenia (25 %), cutaneous manifestations (20 %), and Raynaud's phenomenon (18.3 %). Urinary findings are mostly related to secondary APS. 15 (25 %) patients were thrombocytopenic and 1 (1.7 %) had autoimmune hemolytic anemia. Primary APS patients showed higher frequency of cutaneous manifestations compared to secondary (50 % vs 12.5 %; p = 0.04), and higher levels of β2 glycoprotein I IgG (71.8 ± 22.4 U/ml vs 59.3 ± 17.1 U/ml; p = 0.047). Secondary APS patients showed positive antinuclear antibodies (ANA) and anti-double stranded deoxyribonucleic acid antibodies (anti-dsDNA) in 97.9 % and 93.8 % respectively and were negative in all primary APS patients. On comparing patients with double (n = 34) and triple (n = 26) aPL, no differences were found between both groups except for platelet count being significantly lower in the triple aPL (p = 0.045). Egyptian APS patients showed a high frequency of obstetric complications and lower limb DVT. Primary APS patients had higher frequency of cutaneous manifestations. [ABSTRACT FROM AUTHOR]

Barley (Hordeum vulgare L.) stands out for its special nutritional value compared to other cereals, garnering significant attention in recent years. In this study, a comprehensive chemical and biological evaluation of different barley cultivars extracted with different solvents was performed. Ultra-high performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry (UHPLC-ESI-QTOF-MS/MS) was used in the phytochemical study. The molecular docking with absorption, distribution, metabolism, excretion, and toxicity (ADMET) study and multivariate analysis alongside the quantification of total phenolic contents (TPC) were performed. Furthermore, the anti-inflammatory action was in vitro assessed by measuring COX-1, COX-2, and 5-LOX inhibition. This study seeks to establish a suitable solvent for extracting anti-inflammatory properties from diverse barley cultivars. The methanol extract obtained from the G.131 cultivar, followed by the 80% methanol extract from the G.136 cultivar, exhibited the most favorable IC 50 values in comparison to the reference drugs indomethacin and celecoxib. The phytochemical profile revealed more than 60 compounds that belonged to nitrogen-containing compounds, phenolic compounds, organic acids, flavonoids, and their glycosides, hordatines, and other classes. The TPC and COX-2 inhibition was positively correlated with isoscoparin, coumaroyle–OH–eagmatine, isoorientin, isovitexin 7- O -rhamnosylglucoside, isoscoparin 7- O -glucoside, and isoorientin-7- O -[6-feruloyl]-glucoside. These findings along with their pharmacodynamics study suggested a potential synergistic and significant contribution of these compounds with the anti-inflammatory activity. [Display omitted] [ABSTRACT FROM AUTHOR]

The expanding use of Unmanned Aerial Vehicle (UAVs)/drones has been noticeable in recent years. Drones have several uses in a wide range of industries, including the military, delivery, agricultural, and surveillance. This led to a visible increase in malicious activities targeting drones' network. Consequently, it has become imperative to develop intrusion detection systems. The network intrusion detection system (NIDS) uses deep learning to identify network anomalies. In this paper, a new approach is proposed to enhance IDS in drone communications. The proposed model utilizes the Recurrent Neural Network (RNN) with a Long Short-Term Memory Network (LSTM) combined with pre-processing algorithms. Simulating real network traffic was necessary to do benchmark datasets to evaluate the IDS performance. Due to the artificial part in datasets, there is unbalancing between the normal and attack traffic. Training models on high-dimensional datasets with redundant features can be computationally expensive, need more storage, and lead to low performance. The cleaning of the dataset is accompanied by the most effective pre-processing techniques. SMOTE for unbalancing, one-hot encoding, and min–max scaling techniques are used to mitigate the dataset issues. The model is evaluated using the most up-to-date version of the dataset CICIDS2017 (13 May 2023). The model successfully achieves 99.84 % classification accuracy, 99.84 % F1-score, 99.99 % Precision, and 99.70 % recall. The proposed model outperformed the Naïve Bayes and five other legacy protocols in accuracy and False Positive rate. [ABSTRACT FROM AUTHOR]

Wine's high economic value requires the development of methods to assess its quality. Anyway, winemaking is often managed by operators that decode the physicochemical phenomena occurring during manufacture. Integrating their skills in a control framework would represent an enhancement of the quality control procedure. The anthocyanin amount in wine is influenced by the fermentation process parameters, is responsible for red wine colour and suitable for intensity and tonality classification. In this paper, an artificial neural network was implemented to predict the intensity and tonality of wine's colour as a function of different parameters, which occur during the fermentation process. [ABSTRACT FROM AUTHOR]

This pilot study (ClinicalTrials.gov NCT04543851) investigates a novel breast positioning device using a low density, high tensile carbon-fiber cradle to support the breast, remove the inframammary fold, and reduce dose to organs at risk for whole breast radiation therapy in the supine position. Thirty patients with inframammary folds ≥1 cm or lateral ptosis in supine treatment position were planned with standard positioning and with a carbon-fiber Adjustable Reusable Accessory (CARA) breast support. Twenty patients received whole breast with or without regional nodal irradiation with 42.5 Gy in 16 fractions or 50 Gy in 25 fractions using CARA. Median body mass index was 32 in this study. CARA removed all inframammary folds and reduced V20Gy ipsilateral lung, V105% breast , and V50% body , without compromising target coverage. Median (range) V20Gy ipsilateral lung for whole breast radiation therapy was 12.3% (1.4%-28.7%) with standard of care versus 10.9% (1.2%-17.3%) with CARA (Wilcoxon P =.005). Median V105% breast was 8.0% (0.0%-29%) with standard of care versus 4.0% (0.0%-23%) with CARA (P =.006) and median V50% body was 3056 mL (1476-5285 mL) versus 2780 mL (1415-5123 mL) with CARA (P =.001). CARA was compatible with deep inspiration breath hold and achieved median V25Gy heart = 0.1% (range 0%-1.9%) for all patients with left breast cancer. Skin reactions with CARA were consistent with historical data and daily variation in treatment setup was consistent with standard supine positioning. CARA can reduce V105% breast , lung and normal tissue dose, and remove the inframammary fold for breast patients with large or pendulous breasts and high body mass index treated in the supine position, without compromising target coverage. CARA will undergo further study in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

This study aimed to develop propolis and tea tree oil nanoemulsion loaded with clindamycin hydrochloride to heal wound effectively. Nanoemulsion formulae were prepared and characterized by droplet size analysis, zeta potential, viscosity, ex-vivo permeation, and skin deposition. The optimal formula was evaluated in terms of morphology, cytotoxicity, and in-vitro wound healing assay. Also, the efficacy of the optimal formula was evaluated by in-vivo wound healing and histopathological studies. The optimal formula (F3) was composed of 9% tea tree oil and 0.4% propolis extracts with mean droplet size 19.42 ± 1.7 nm, zeta potential value −24.5 ± 0.2 mV, and viscosity 69.4 ± 1.8 mP. Furthermore, the optimal formula showed the highest skin deposition value 550.00 ± 4.9 µg/cm2 compared to other formulae. The TEM micrograph of the optimal formula showed that the nanoemulsion droplet has an almost spherical shape. Also, the optimal formula did not show noticeable toxicity to the human skin fibroblast cells. The in-vitro and in-vivo wound healing assay showed unexpected results that the un-loaded drug nanoemulsion formula had a comparable wound healing efficacy to the drug-loaded nanoemulsion formula. These results were confirmed with histopathological studies. Our results showed that the propolis and tea tree oil nanoemulsion, whether loaded or unloaded with an antibiotic, is an efficient local therapy for wound healing. [ABSTRACT FROM AUTHOR]

[Display omitted] • The differences between two main charging methodologies in FO circuits are depicted. • The delivered charge, energy loss, and efficiency for FO circuits are studied. • Optimal charging of three FO RC networks is obtained using compositional functional. • Approximate solutions are reached using a prototype CPE voltage function and CS. Optimal charging of RC circuits is a well-studied problem in the integer-order domain due to its importance from economic and system temperature hazards perspectives. However, the fractional-order counterpart of this problem requires investigation. This study aims to find approximate solutions of the most energy-efficient input charging function in fractional-order RC circuits. This paper uses a meta-heuristic optimization technique called Cuckoo search optimizer to attain the maximum charging efficiency of three common fractional-order RC circuits. An analytical expression of the fractional capacitor voltage is suggested such that it satisfies the boundary conditions of the optimal charging problem. The problem is formulated as a fractional-order calculus of variations problem with compositional functional. The numerical solutions are obtained with the meta-heuristic optimization algorithm's help to avoid the complexities of the analytical approach. he efficiency surfaces and input voltage charging curves are discussed for fractional-order in the range 0.5 < α ≤ 1. The optimized charging function can approximate the optimal charging curve using at most 4 terms. The charging time and the resistive parameters have the most dominant effect on charging efficiency at constant fractional-order α. [ABSTRACT FROM AUTHOR]

Background: The use of electronic health record (EHR) systems encourages and facilitates the use of data for the development and surveillance of quality indicators, including pain management. Aim: to conduct an integrative review on pain management research using data extracted from EHR in order to synthesize and analyze the following elements: pain management (assessments, interventions, and outcomes) and study results with potential clinical implications, data source, clinical sample characteristics, and method description. Design: An integrative review of the literature was undertaken to identify exemplars of scientific research studies that explore pain management using data from EHR, using Cooper's framework. Results: Our search of 1,061 records from PubMed, Scopus, and Cinahl was narrowed down to 28 eligible articles to be analyzed. Conclusion: Results of this integrative review will make a critical contribution, assisting others in developing research proposals and sound research methods, as well as providing an overview of such studies over the past 10 years. Through this review it is therefore possible to guide new research on clinical pain management using EHR. [ABSTRACT FROM AUTHOR]

Foods for Special Medical Purposes (FSMPs) are formulated to support the nutritional needs of subjects with impaired capacity to ingest, digest or absorb ordinary food or nutrients. Polglumyt® is a proprietary highly purified, high quality glycogen obtained from mussels. Here we report the results of a single-center, single dose, open label, single arm study carried out to investigate acceptance (i.e. gastrointestinal tolerance and palatability), metabolic profile and safety of a low osmolarity, high-density energy Polglumyt®-based drink (the investigational product, IP) as a novel FSMP. Twelve healthy subjects received a single oral administration of the IP under fasting conditions. The study endpoints were: changes in gastrointestinal system tolerability at 3 h, 6 h and 24 h after IP intake; IP palatability evaluation; metabolic evaluation through the kinetic profile of circulating glucose, insulin and C-peptide from 0 h to 6 h after IP intake and changes from baseline in circulating triglycerides at 3 h and 6 h after IP intake. The IP showed a good gastrointestinal tolerability and an acceptable palatability. The IP did not affect the physiological glycemic profile and the triglycerides levels 6 h after the intake. The IP was well tolerated by study subjects, with no or minor adverse events. The study results encourage additional clinical investigations on the IP as a novel FSMP in patients with impaired digestion or gastrointestinal absorption, unable to assume an ordinary diet, e.g. patients undergoing invasive gastrointestinal surgery, elderly or oncological patients, even with certain metabolic disorders. [ABSTRACT FROM AUTHOR]

Bioelectrical impedance analysis (BIA) and anthropometric predictive equations have been proposed to estimate whole-body (SMM) and appendicular skeletal muscle mass (ASM) as surrogate for dual energy X-ray absorptiometry (DXA) in distinct population groups. However, their accuracy in estimating body composition in non-dialysis dependent patients with chronic kidney disease (NDD-CKD) and kidney transplant recipients (KTR) is unknown. The aim of this study was to investigate the accuracy and reproducibility of BIA and anthropometric predictive equations in estimating SMM and ASM compared to DXA, in NDD-CKD patients and KTR. A cross-sectional study including adult NDD-CKD patients and KTR, with body mass index (BMI) ≥18.5 kg/m2. ASM and estimated SMM were evaluated by DXA, BIA (Janssen, Kyle and MacDonald equations) and anthropometry (Lee and Baumgartner equations). Low muscle mass (LowMM) was defined according to cutoffs proposed by guidelines for ASM, ASM/height2 and ASM/BMI. The best performing equation as surrogate for DXA, considering both groups of studied patients, was defined based in the highest Lin's concordance correlation coefficient (CCC) value, the lowest Bland–Altman bias (<1.5 kg) combined with the narrowest upper and lower limits of agreement (LoA), and the highest Cohen's kappa values for the low muscle mass diagnosis. Studied groups comprised NDD-CKD patients (n = 321: males = 55.1%; 65.4 ± 13.1 years; eGFR = 28.8 ± 12.7 ml/min) and KTR (n = 200: males = 57.7%; 47.5 ± 11.3 years; eGFR = 54.7 ± 20.7 ml/min). In both groups, the predictive equations presenting the best accuracy compared to DXA were SMM-BIA-Janssen (NDD-CKD patients: CCC = 0.88, 95%CI = 0.83–0.92; bias = 0.0 kg; KTR: CCC = 0.89, 95%CI = 0.86–0.92, bias = −1.2 kg) and ASM-BIA-Kyle (NDD-CKD patients: CCC = 0.87, 95%CI = 0.82–0.90, bias = 0.7 kg; KTR: CCC = 0.89, 95%CI = 0.86–0.92, bias = −0.8 kg). In NDD-CKD patients and KTR, LowMM frequency was similar according to ASM-BIA-Kyle versus ASM-DXA. The reproducibility and inter-agreement to diagnose LowMM using ASM/height2 and ASM/BMI estimated by BIA-Kyle equation versus DXA was moderate (kappa: 0.41–0.60), in both groups. Whereas female patients showed higher inter-agreement (AUC>80%) when ASM/BMI index was used, male patients presented higher AUC (70–74%; slightly <80%) for ASM/height2 index. The predictive equations with best performance to assess muscle mass in both NDD-CKD patients and KTR was SMM-BIA by Janssen and ASM-BIA by Kyle. The reproducibility to diagnose low muscle mass, comparing BIA with DXA, was high using ASM/BMI in females and ASM/height2 in males in both groups. • Bioelectrical impedance is a reliably alternative technique to assess muscle mass in CKD patients. • Appendicular-muscle mass/body mass index has discriminative power to detect low muscle mass in male patients. • Appendicular-muscle mass/height2 has discriminative power to detect low muscle mass in female patients. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) has quickly spread globally, causing a real pandemic. In this critical scenario, lung cancer patients scheduled for surgical treatment need to continue to receive optimal care while protecting them from an eventual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Adequate use of personal protective equipment (PPE) during aerosol-generating procedures (AGPs) and a COVID-19 specific intraoperative management are paramount in order to prevent cross infections. New suggestions or improvement of existing contagion control guidance are needed, even in case of non-symptomatic patients, possibly responsible for virus spread. [ABSTRACT FROM AUTHOR]

Computed tomography angiography (CTA) is a method widely used to investigate vascular disease. One of its limitations is obtaining a safe intravenous access for contrast media injection, mainly in pediatric patients. This study aims to describe an adverse event in a pediatric patient submitted to CTA using central venous catheter (CVC) for contrast injection. This study reinforced the idea that an adequate access is very important to perform a safe examination. Moreover, it was demonstrated that it is essential to respect the manufacturer's instructions about the devices use and to follow specific protocols for CTA examinations using CVCs to avoid adverse events. • Computed tomography is essential for the diagnosis and treatment of pediatric diseases. • The manufacturer's instructions about devices must be followed to a safe examination. • Adequate protocols for central venous catheter use are fundamental to avoid adverse events. [ABSTRACT FROM AUTHOR]

Several nerve block procedures are available for post-thoracotomy pain management. In this randomized trial, the authors aimed to determine whether the analgesic effect of preoperative ultrasound-guided erector spinae plane block (ESPB) might be superior to that of intraoperative intercostal nerve block (ICNB) in pain control in patients undergoing minithoracotomy. University hospital. Sixty consecutive adult patients scheduled to undergo minithoracotomy for lung resection were enrolled. Patients were allocated randomly in a 1:1 ratio to receive either single-shot ESPB or ICNB. The primary outcome was the intensity of postoperative pain at rest, assessed with the numeric rating scale (NRS). The secondary outcomes were (1) dynamic NRS values (during cough); (2) perioperative analgesic requirements; (3) patient satisfaction, on the basis of a verbal scale (Likert scale); and (4) respiratory muscle strength, considering the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) variation from baseline. The ESPB group showed lower postoperative static and dynamic NRS values than the ICNB group (p < 0.05). Total remifentanil consumption and requirements for additional analgesics were lower in the ESPB group (p < 0.05). Patient satisfaction was higher in the ESPB group (p < 0.001). A significant overall time effect was found in MIP and MEP variation (p < 0.001); ESPB values were higher at all points, reaching a statistically significant level at the first and sixth hours for MIP, and at the first, 12th, 24th, and 48th hours for MEP (p < 0.05). ESPB was demonstrated to provide superior analgesia, lower perioperative analgesic requirements, better patient satisfaction, and less respiratory muscle strength impairment than ICNB in patients undergoing minithoracotomy. [ABSTRACT FROM AUTHOR]

To investigate the performance of various algorithms for deformable image registration (DIR) for propagating regions of interest (ROIs) using multiple commercial platforms, from computed tomography to cone beam computed tomography (CBCT) and megavoltage computed tomography. Fourteen institutions participated in the study using 5 commercial platforms: RayStation (RaySearch Laboratories, Stockholm, Sweden), MIM (Cleveland, OH), VelocityAI and SmartAdapt (Varian Medical Systems, Palo Alto, CA), and ABAS (Elekta AB, Stockholm, Sweden). Algorithms were tested on synthetic images generated with the ImSimQA (Oncology Systems Limited, Shrewsbury, UK) package by applying 2 specific deformation vector fields (DVF) to real head and neck patient datasets. On-board images from 3 systems were used: megavoltage computed tomography from Tomotherapy and 2 kinds of CBCT from a clinical linear accelerator. Image quality of the system was evaluated. The algorithms' accuracy was assessed by comparing the DIR-mapped ROIs returned by each center with those of the reference, using the Dice similarity coefficient and mean distance to conformity metrics. Statistical inference on the validation results was carried out to identify the prognostic factors of DIR performance. Analyzing 840 DIR-mapped ROIs returned by the centers, it was demonstrated that DVF intensity and image quality were significant prognostic factors of DIR performance. The accuracy of the propagated contours was generally high, and acceptable DIR performance can be obtained with lower-dose CBCT image protocols. The performance of the systems proved to be image quality specific, depending on the DVF type and only partially on the platforms. All systems proved to be robust against image artifacts and noise, except the demon-based software. [ABSTRACT FROM AUTHOR]

• Physical characterisation of FFF beam profiles in presence of a magnetic field. • Multicentric experience to propose normalization factors for 6 MV FFF beam MR-linac. • Equal measurements set on three ViewRay-MRIdian acquired with same equipment. • Value of the unflatness and slope calculated for different depths and field sizes. • Set of renormalization parameters to analyse the FFF beam was effectively proposed. The physical characterisation of FFF-beam profiles in the presence of a magnetic field requires a new standardization procedure and formulation. The aim of this multicentric experience is to propose new normalisation factors to allow for the calculation of standard parameters typical of flattened beams, such as dosimetric field size and penumbra, for a 6 MV FFF beam from an MR-linac. The measurements were carried out on three ViewRay-MRIdian systems. An equal set of measurements was acquired using the same equipment. Transverse beam profiles were acquired at seven different depths and for six beam dimensions. The inflection point was estimated as the position of the maximum of a Gaussian fit obtained from the first derivative of the profiles. The position of the minimum and maximum points of the second derivative of the above Gaussian described the fall-off region, and the external peaks of the third derivative were considered as the in-field and out-field points. The profile normalisation was determined by imposing a 55% dose level at the inflection point and the renormalisation factors were calculated. The position of the inflection point, and the second and third derivatives peaks were analysed, and the renormalisation factors as a function of field size and depth were determined. The values of the unflatness and the slope have been calculated for different depths and field sizes. This study represents the first multi-centric evaluation of the profiles on different low-field MR-Linac systems and the set of renormalisation parameters to analyse the FFF-beam on that system was effectively proposed. [ABSTRACT FROM AUTHOR]

Abstract Objective This study aims to compare, both qualitatively and quantitatively, the medication dispensed to elderly patients in a primary health care center (PHC) and a community pharmacy (CP) in Argentina and to identify the prescription of potentially inappropriate medications (PIMs). Methods A cross-sectional observational study. Data were acquired from 886 prescriptions in the PHC and 2368 in the CP between February and April 2015. Dispensed medications were coded according to the Anatomical, Therapeutic, and Chemical (ATC) classification system. The frequency of prescriptions for each of them was determined. The number and monthly average of drugs dispensed were calculated for each patient. The use of PIMs was identified using Beers Criteria. Results In both institutions, the means of medications dispensed per individual and month were similar: 3.69 ± 1.93 in the PHC and 3.46 ± 2.18 in the CP. Most of the medications corresponded to cardiovascular system agents. In the CP, 111 prescriptions (4.69%) dispensed to 51 patients (19.39%) were identified as PIMs. In the PHC, 72 prescriptions (8.13%) dispensed to 27 patients (28.42%) were identified as PIMs. In patients with major polymedication the possibility of consuming these drugs was 2.55 times higher in the CP and 2.60 times higher in the PHC. The percentage of PIM prescriptions was significantly higher in the PHC, although the percentage of patients receiving them did not differ significantly. Conclusions The prevalence of PIMs found in this population is relevant enough to implement measures that address the problem in an integral way, to improve the quality of prescriptions and the health outcomes of patients. [ABSTRACT FROM AUTHOR]

Background Lung metastases occur in 10% to 20% of patients with colorectal cancer (CRC). Lung metastatic pathways of CRC are poorly known, and the optimal management for recurrent lung metastases remains uncertain. Methods Long-term oncologic outcomes of 203 patients with CRC lung metastases who underwent metastasectomy were investigated in this multicenter retrospective study. Ninety-two patients (45.3%) with tumor relapse underwent repeated metastasectomy and 11 (5.4%) received a third metastasectomy for a second relapse. Demographic and clinical data, including histologic grade of primary tumor, presence of CRC liver metastases, type of primary tumor resection, number, size, location, and resection type of pulmonary metastases, were evaluated. Overall survival (OS) and disease-free survival were analyzed. Cox regression model was performed to identify variables that influenced OS. Results One hundred seventy-three patients (85.2%) received a wedge resection, 21 (10.3%) underwent pulmonary lobectomy, and 9 (4.4%) underwent other procedures (pneumonectomy, bilobectomy). The mean follow-up was 39 months (range: 7 to 154 months). One-, 3-, and 5-year global OS from CRC diagnosis was 99%, 80%, and 60%, respectively, and 97%, 60%, and 34% from the first metastasectomy, respectively. Log-rank test between OS (one versus repeated metastasectomy) did not show significant differences ( p = 0.659). Cox regression model showed that nodal status (hazard ratio [HR] 17.7, p = 0.008) and administration of adjuvant chemotherapy (HR 0.33, p = 0.026) are risk and protective factors, respectively, for OS. Conclusions Repeated pulmonary metastasectomy should be offered to patients with metastatic CRC because there are no differences in terms of OS between patients undergoing single and repeated metastasectomy. Adjuvant chemotherapy should be suggested in case of metastatic CRC. [ABSTRACT FROM AUTHOR]

Abstract While endovascular aortic aneurysm repair (EVAR) has proven to be a safer alternative to open surgical repair for infrarenal abdominal aortic aneurysms (AAA) repair, the development of stent-graft complications mandates follow-up computed tomography imaging to minimize AAA-related mortality. In this single-institution report, adverse EVAR events identified in 150 consecutive patients are detailed. Early morbidity was low (<3%), with only 1 patient death on post-procedure day 2. After discharge (mean follow-up of 24 months), 2 patients died from cancer and one AAA-related mortality occurred after open conversion for stent-graft migration. Although computed tomography imaging detected no EVAR endoleak at 30 days, 19 patients developed an endoleak, including three Type I and four Type III leaks. Our institutional series review confirmed that EVAR of infrarenal AAA is a safe and valid alternative to open surgical repair, but sac embolization at the primary procedure in patients judged to be at high risk for Type II endoleak should be considered. [ABSTRACT FROM AUTHOR]

Fullerenes have been extensively used for more than two decades for the development of organic photovoltaics (OPV). While OPV seems to be a technology almost ready for the market, in the last few years fullerenes are attracting a big interest for the improvement they afford on the already well-performing perovskite solar cells (PSCs). Thanks to PSC integration, interest in fullerenes is rising again, opening up new exciting perspectives for photovoltaics. This review article aims at analyzing the landmark contributions that gave birth to the novel application of fullerenes in PSCs and to the technological solutions that are emerging with them. [ABSTRACT FROM AUTHOR]

Bradyrhizobium comprises most tropical symbiotic nitrogen-fixing strains, but the correlation between symbiotic and core genes with host specificity is still unclear. In this study, the phylogenies of the nodY/K and nifH genes of 45 Bradyrhizobium strains isolated from legumes of economic and environmental importance in Brazil ( Arachis hypogaea , Acacia auriculiformis , Glycine max , Lespedeza striata , Lupinus albus , Stylosanthes sp. and Vigna unguiculata ) were compared to 16S rRNA gene phylogeny and genetic diversity by rep-PCR. In the 16S rRNA tree, strains were distributed into two superclades— B. japonicum and B. elkanii —with several strains being very similar within each clade. The rep-PCR analysis also revealed high intra-species diversity. Clustering of strains in the nodY/K and nifH trees was identical: 39 strains isolated from soybean grouped with Bradyrhizobium type species symbionts of soybean, whereas five others occupied isolated positions. Only one strain isolated from Stylosanthes sp. showed similar nodY/K and nifH sequences to soybean strains, and it also nodulated soybean. Twenty-one representative strains of the 16S rRNA phylogram were selected and taxonomically classified using a concatenated glnII - recA phylogeny; nodC sequences were also compared and revealed the same clusters as observed in the nodY/K and nifH phylograms. The analyses of symbiotic genes indicated that a large group of strains from the B. elkanii superclade comprised the novel symbiovar sojae, whereas for another group, including B. pachyrhizi , the symbiovar pachyrhizi could be proposed. Other potential new symbiovars were also detected. The co-evolution hypotheses is discussed and it is suggested that nodY/K analysis would be useful for investigating the symbiotic diversity of the genus Bradyrhizobium . [ABSTRACT FROM AUTHOR]

Abstract Background Endocrine therapy is the main treatment in hormonosensitive breast cancer; the most frequent side effects are arthralgia, osteoporosis, depression, dyslipidemia and hypertension. G8 is a simple test developed to identify older patients who could benefit from a comprehensive geriatric assessment (CGA). The aim of this study is to evaluate the possible role of G8 in predicting side effects from treatment with aromatase inhibitor in women ≥65 years old. Matherial and method Women ≥65 years old affected by breast cancer about to start a therapy with an aromatase inhibitor, in the adjuvant setting, were evaluated with the G8 tool. Patients were classified as "fit" with G8 score > 14 or "vulnerable" with G8 score ≤ 14; they then started treatment and clinical-instrumentalfollow-up. Results From April 2016 to February 2018, 50 consecutive patients were screened. Median age was 75.1 (range 65–86). G8 identified 30 patients (60%) as "fit" (score > 14) and 20 (40%) as "vulnerable" (score ≤ 14). The grade of concordance between G8 score and the appearance/absence of adverse events were statistically significant (41/50 patients, 82%, p = 0.0002); sensitivity resulted in 78% and specificity was 81%; positive predictive value was 70% and negative predictive value was 87%. The most frequent adverse event was arthromyalgia. Conclusion The G8 screening tool has a potential role in predicting side effects during a treatment with aromatase inhibitor. G8 could be very useful in everyday clinical practice for this population. [ABSTRACT FROM AUTHOR]

Freehand sketching – as one of the methods to discover cities – plays main role to understand the image of the heritage city. It is considered as an important tool to analyze and document heritage buildings. The image produced by freehand sketching heightens awareness of these buildings. Previous studies conducted on the methods of architectural heritage documentation revealed that very little researches have been undertaken to use freehand sketching in the process of data survey and documentation. These researches break the deadlock in the textual documents and express the human experience clearly unlike other methods of documentation. Therefore, this article intends to document ten heritage buildings in the study area, Gamal Abdel Nasser street, Alexandria city, Egypt. – One of the most ancient streets in Alexandria that still maintain its old character and identity – using analytical freehand sketches, the sketches and analysis was created by the researcher. The results showed that these buildings seem homogeneous and have a common character despite their different architectural styles which means it respects each other within building regulations. Briefly, the results help to find out how freehand sketching successfully analyzes these buildings that assist the architects and planners to understand the design principles used in ancient times. [ABSTRACT FROM AUTHOR]

Background Vitamin K is necessary for the functional activation of vitamin K dependent proteins via gamma-carboxylation process. These proteins are present in bone and cartilage beside their participation in coagulation cascade. Aim of the work This study aimed to assess plasma vitamin K1 (phylloquinone) concentrations in primary early osteoarthritis (KOA) patients and to correlate these levels with clinical parameters and radiological progression using plain radiography and musculoskeletal ultrasound (MSUS). Patients and methods We measured baseline vitamin K1 in the plasma from 40 early KOA patients and from 20 healthy controls. In the patients, numerical rating scale of pain (NRSP) and The Western Ontario McMaster scale (WOMAC) were recorded. The Thomas grading score and MSUS examination were performed at baseline and after 12 months to assess radiological progression. Results The KOA patients had a mean age of 50.4 ± 4.9 years, 36 females: 4 males and had a disease duration of 12.7 ± 5.7 months. In KOA patients plasma vitamin K1 levels (1.6 ± 0.9 nmol/l) were highly significantly decreased compared to healthy control (2.04 ± 0.7 nmol/l) ( p < 0.05). In KOA patients, the plasma levels of vitamin K1 significantly correlated with baseline medial condyle cartilage thickness ( r = 0.46, p < 0.05), and vitamin K deficiency had a significantly increased risk of radiological progression as assessed by MSUS ( p = 0.004) (twofold increased risk, RR 2.08). Conclusions Knee osteoarthritis patients have significantly decreased plasma levels of vitamin K that was remarkably associated with radiological progression of early disease suggesting that it could be a useful marker to reflect OA severity and implies a possible role in the disease pathogenesis. [ABSTRACT FROM AUTHOR]

• Tasmanian devil and eastern quoll abundance increased with timber plantation extent. • Piles of woody debris are important to marsupial carnivores in plantations. • Neither species responded to partial harvesting in native forest. • Results can be used by production forest managers to guide carnivore conservation. Production forest landscapes provide important habitat for wildlife but expose them to disturbances from forestry practices. Understanding how threatened carnivores use production forests can inform management practices to improve their conservation. While there have been many studies of eutherian carnivores in production forests, the use of these landscapes by marsupial carnivores is poorly understood. Using a network of remote cameras, we investigated the use of forestry landscape features by two endangered marsupial carnivores, Tasmanian devils (Sarcophilus harrisii) and eastern quolls (Dasyurus viverrinus). Devil and quoll abundance increased with the extent of timber plantations within production forest landscapes. Overall, devils were positively associated with higher tree density and eastern quolls with indicators of open habitat such as less understorey, fewer trees and more grassland. Within plantations, devil abundance increased with the volume of windrows (piles of woody debris from harvesting arranged in rows), as did eastern quoll abundance in pine plantations. Eastern quoll abundance was higher in pine plantations established on pasture than those established on cleared native forest land, and in eucalypt plantations, higher with windrows comprised of plantation debris. Neither species showed a strong response to logging-related features in native forest such as time since harvest, though eastern quolls were positively associated with log cover. Our results demonstrate that plantations provide valuable habitat for marsupial carnivores and that they can persist in harvested native forests. Windrows likely benefit devils and eastern quolls by providing denning, shelter and foraging opportunities, and should be managed as important habitat features for carnivores. These findings can be used by forest managers to guide decisions and help maintain threatened carnivore populations in human-modified landscapes. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the frequency of Neospora spp. infection, as well as its associated risk factors, in horses in the state of Alagoas, Brazil. In total, 427 samples from 36 properties in 23 districts, covering three mesoregions, were studied. An immunofluorescence assay was used to quantify anti- Neospora caninum immunoglobulin G antibodies, and risk factors were assessed through investigative questionnaires that focused on the productive, reproductive, and sanitary management of herds. Data from the questionnaires were evaluated by two statistical analyses. The total frequency of anti- Neospora spp. antibodies found was 18% (95% confidence interval [95% CI]: 14.4–22.1). At least one seropositive horse was found in 72.2% of the farms evaluated (26 of 36). The following risk factors were associated with infection: the access of other species to the horses' water source ( P = .017; odds ratio [OR] = 1.84; 95% CI: 1.11–3.04); no to consume hay ( P = .000; OR = 3.33; 95% CI: 1.87–5.94); the informal purchase of animals ( P = .000; OR = 8.43; 95% CI: 3.06–23.16); and an absence of quarantine management ( P = .000; OR = 8.70; 95% CI: 3.10–24.39). The results of the present study show that horses in the state of Alagoas are at risk for Neospora spp. infection, and care should be implemented based on identified risk factors to prevent infection in horses. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of two-dimensional and three-dimensional preoperative morphologic features analyzed on computed tomography (CT) angiography on midterm outcome in patients with abdominal aortic aneurysms (AAAs) treated with endovascular aneurysm repair (EVAR).Materials and Methods: A retrospective analysis was conducted using a prospectively collected database. Morphologic features considered as potentially influencing outcomes were maximum aortic diameter, thrombus area, overall aneurysm volume, and intrasac thrombus volume. Outcome measures were all perioperative and midterm AAA-related reinterventions and all-cause mortality.Results: Investigators reviewed 191 preoperative CT angiography scans. Mean maximum aortic diameter was 58 mm; thrombus area, 49.6%; aortic volume, 159.36 cm(3); and thrombus volume, 58.6%. Technical success was achieved in all cases. No reintervention was required in the perioperative period, and there was no perioperative mortality. At a mean follow-up of 32 months ± 16.8 (range, 3-66 mo), mortality rate was 9.4%, AAA-related death was 0, and reintervention rate was 8.9%. Causes of reintervention included type I endoleak (n = 3 [1.6%]), type II endoleak (n = 7 [3.7%]), type III endoleak (n = 1 [0.5%]), endograft limb thrombosis (n = 4 [2.1%]), and access vessel thrombosis (n = 2; 1%). Greater thrombus area (> 60%) and thrombus volume (> 59%) were predictors for reintervention (P = .005 and P = .0034). Greater maximum aortic diameter (> 59 mm) and aortic volume (> 159 cm(3)) were related to higher reintervention rate without statistical significance (P = .62 and P = .12). Aortic volume was a predictor of any adverse event, reintervention, and all-cause mortality after EVAR (P = .03).Conclusions: Thrombus area and volume are related to higher rates of reintervention. Maximum aortic diameter was related to a higher reintervention rate, but this was not significant. [ABSTRACT FROM AUTHOR]

Background The relationship between the free margin distance and the recurrence rate and overall survival after R0 wedge resection for non-small cell lung cancer (NSCLC) is still not clear. We retrospectively evaluated the long-term oncologic outcome of patients who had undergone wedge resection for NSCLC to assess the prognostic effect of margin distance in this setting. Methods Between 2003 and 2013, 243 consecutive patients with a functional contraindication to major lung resection underwent wedge resection with systematic lymph node dissection for clinical stage I NSCLC. The study enrolled 182 patients with pathologic stage I and R0 resection and divided them into three subgroups according to margin distance of less than 1 cm (n = 30), 1 to 2 cm (n = 80), and more than 2 cm (n = 72). Results The histologic assessment was adenocarcinoma in 112 patients, squamous cell in 30, and other in 40. Postoperative morbidity was 18.7%, and postoperative mortality was 1.1%. The median follow-up was 31 months (range, 2 to 133 months). The locoregional (lung parenchyma, hilum, mediastinum) recurrence rate was 26.4% (n = 48). The distant recurrence rate was 11% (n = 20). Overall 5-year survival was 70.4%. Disease-free 5-year survival was 51.7%. There was no statistical difference in locoregional ( p = 0.9) and distant ( p = 0.3) recurrence rate and no difference in overall survival ( p = 0.07) when the three groups were compared. Conclusions Wedge resection is a viable option for the surgical treatment of stage I NSCLC when lobectomy is contraindicated. The distance between the tumor and the parenchymal suture margin does not influence recurrence or the survival rate when an R0 resection is achieved. [ABSTRACT FROM AUTHOR]

Carbon nanotubes are attractive candidates for the development of scaffolds able to support neuronal growth and differentiation thanks to their ability to conduct electrical stimuli, to interface with cells and to mimic the neural environment. We developed a biocompatible composite scaffold, consisting of multi-walled carbon nanotubes dispersed in a poly- l -lactic acid matrix able to support growth and differentiation of human neuronal cells. Moreover, to mimic guidance cues from the neural environment, we also designed synthetic peptides, derived from L1 and LINGO1 proteins. Such peptides could positively modulate neuronal differentiation, which is synergistically improved by the combination of the nanocomposite scaffold and the peptides, thus suggesting a prototype for the development of implants for long-term neuronal growth and differentiation. From the Clinical Editor The study describes the design and preparation of nanocomposite scaffolds with multi-walled carbon nanotubes in a poly-L-lactic acid matrix. This compound used in combination with peptides leads to synergistic effects in supporting neuronal cell growth and differentiation. [ABSTRACT FROM AUTHOR]

Disease is often considered a key threat to species of conservation significance. For some, it has resulted in localised extinctions and declines in range and abundance. However, for some species, the assertion that a disease poses a significant threat of extinction is based solely on correlative or anecdotal evidence, often inferred from individual clinical case reports. While a species' susceptibility to a disease may be demonstrated in a number of individuals, investigations rarely extend to measuring the impact of disease at the population level and its contribution, if any, to population declines. The eastern quoll (Dasyurus viverrinus) is a medium-sized Australian marsupial carnivore that is undergoing severe and rapid decline in Tasmania, its last refuge. Reasons for the decline are currently not understood. Feral cats (Felis catus) may be undergoing competitive release following the ongoing decline of the Tasmanian devil (Sarcophilus harrisii), with cats suppressing eastern quolls through increased predation, competition, exclusion or exposure to diseases such as toxoplasmosis. To investigate the effects of Toxoplasma gondii infection, eastern quoll populations at four sites were regularly screened for the seroprevalence of T. gondii-specific IgG antibodies. Seroprevalence was approximately five times higher at sites with declining quoll populations, and there was a negative association between seroprevalence and quoll abundance. However, T. gondii infection did not reduce quoll survival or reproduction. Despite a high susceptibility to T. gondii infection, eastern quoll populations do not appear to be limited by the parasite or its resultant disease. Significantly higher seroprevalence is a signal of greater exposure to feral cats at sites where eastern quolls are declining, suggesting that increased predation, competition or exclusion by feral cats may be precipitating population declines. [ABSTRACT FROM AUTHOR]

This study aims to characterize the effect of shading techniques on the fatigue behavior of a 4YSZ ceramic (4 mol% yttrium stabilized zirconia) adhesively bonded to a dentin analogue (fiber-reinforced epoxy resin). 4YSZ ceramic discs (IPS e.max ZirCAD, Ø = 10 mm and 1 mm of thickness) were allocated according to the factor 'shading technique' into 4 groups: Brush – unshaded ceramic disc (IPS e.max ZirCAD BL) pigmented at the pre-sintered stage with pigment solution applied manually using a round liner brush; Immersion – unshaded ceramic disc pigmented through immersion in the solution for 1 s on only one side of the ceramic disc; Manufacturer – specimens already shaded by the manufacturer (IPS e.max ZirCAD MT A2 – Manufacturer group); Control – a control condition with absence of pigment (i.e. non-pigmented specimens). The specimens were sintered and a spectrophotometer (SP60, EX- Rite) was used to ensure that the same perceived color (i.e. pigment saturation) was achieved in the different shading strategies (Manufacturer, Brush or Immersion groups). To do so, the color differences (ΔE 00) were calculated using the CIEDE 2000 equation; and an ΔE 00 of up to 1.77 was considered as an acceptability threshold. Dentin analogue discs were obtained (Ø = 10 mm and 2.5 mm of thickness) and randomly allocated into pairs with the 4YSZ ceramic discs. Next, the pairs were adhesively bonded using a resin cement (Multilink N). The bonded assemblies (n = 15) were tested for fatigue using the step-stress test method (frequency of 20 Hz; 10,000 cycles per step, initial load 200 N; step-size of 100 N, up to 700 N; and after, step-size of 50 N, until specimen failure/fracture or radial cracks). Fatigue failure load (FFL) and number of cycles for failure (CFF) were recorded for statistical analysis. Fractographic features were accessed, and complementary roughness, topography, grain size and phase content analyses were performed. No statistical differences were observed in the fatigue behavior among the non-shaded condition (Control group – 880 N) and the shaded specimens (Manufacturer – 887 N, Brush – 820 N, and Immersion – 850 N groups; p > 0.05). However, the use of a brush shading technique induced slightly inferior fatigue mechanical behavior of the restorative set compared to the specimens already shaded by the manufacturer (p = 0.027). No differences in Weibull modulus were observed among the tested groups. The specimens pigmented by the brush technique demonstrated a rougher surface, with statistically higher Rz values, in addition to a larger grain size in comparison to all other conditions (p< 0.05). No m -phase content was identified (only t and c phases were detected). Thus, the shading techniques used to provide a Vita classic A2 shade does not negatively affect the mechanical fatigue properties of a bonded 4YSZ ceramic. However, the brush technique has detrimental effect on the fatigue behavior compared to when the ceramic was already provided in a shaded format by its manufacturer. • Shading techniques do not impair the fatigue behavior of bonded 4YSZ. • The brush shading technique induced the worst fatigue behavior compared to manufacturer shading. • The immersion technique behaved equally to manufacturer shading in terms of fatigue behavior. • The zirconia grain size increases in response to the brush shading technique in a 4YSZ ceramic. [ABSTRACT FROM AUTHOR]

Bladder exstrophy–epispadias complex (BEEC) comprises a spectrum of anterior midline congenital malformations, involving the lower urinary tract. BEEC is usually sporadic, but families with more than one affected member have been reported, and a twin concordance study supported a genetic contribution to pathogenesis. Moreover, diverse chromosomal aberrations have been reported in a small subset of individuals with BEEC. The commonest are 22q11.2 microduplications, identified in approximately 3% of BEEC index cases. We aimed to refine the chromosome 22q11.2 locus, and to determine whether the encompassed genes are expressed in normal developing and mature human urinary bladders. Using DNA from an individual with CBE, the 22q11.2 duplicated locus was refined by identification of a maternally inherited 314 kb duplication (chr22:21,147,293–21,461,017), as depicted in this image. Moreover, the eight protein coding genes within the locus were found to be expressed during normal developing and mature bladders. To determine whether duplications in any of these individual genes were associated with CBE, we undertook copy number analyses in 115 individuals with CBE without duplications of the whole locus. No duplications of individual genes were found. The current study has refined the 22q11.2 locus associated with BEEC and has shown that the eight protein coding genes are expressed in human bladders both during antenatal development and postnatally. Nevertheless, the precise biological explanation as to why duplication of the phenocritical region of 22q11 confers increased susceptibility to BEEC remains to be determined. The fact that individuals with CBE without duplications of the whole locus also lacked duplication of any of the individual genes suggests that in individuals with BEEC and duplication of the 22q11.2 locus altered dosage of more than one gene may be important in BEEC etiology. The study has refined the 22q11.2 locus associated with BEEC and has shown that the eight protein coding genes within this locus are expressed in human bladders. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract: Ground source heat pumps are a valid technology for heating and cooling in residential application, since they allow to have a stable temperature of the heat source/sink by means of ground heat exchangers, generally named as Boreholes. In particular, U- pipe heat exchangers are interesting when working with two-phase fluids, especially during the heating season, when natural circulation might occur. This work presents the model of a borehole heat exchanger working with carbon dioxide as secondary fluid in a U-pipe loop. A closed system of equations is introduced with appropriate correlations for heat transfer and pressure drops, accounting for transient heat conduction due to ground temperature variation. Maps of performance varying the main operating parameters are presented and discussed, showing the potential of the model as tool for sensitivity analysis and as sub- model to find the matching between the heat pump and the borehole heat exchanger. [Copyright &y& Elsevier]

Abstract: Changing ecosystem dynamics are increasing the threat of disease epidemics arising in wildlife populations. Several recent disease outbreaks have highlighted the critical need for understanding pathogen dynamics, including the role host densities play in disease transmission. In Australia, introduced feral cats are of immense concern because of the risk they pose to native wildlife through predation and competition. They are also the only known definitive host of the coccidian parasite, Toxoplasma gondii, the population-level impacts of which are unknown in any species. Australia’s native wildlife have not evolved in the presence of cats or their parasites, and feral cats may be linked with several native mammal declines and extinctions. In Tasmania there is emerging evidence that feral cat populations are increasing following wide-ranging and extensive declines in the apex predator, the Tasmanian devil, from a consistently fatal transmissible cancer. We assess whether feral cat density is associated with the seroprevalence of T. gondii in native wildlife to determine whether an increasing population of feral cats may correspond to an increased level of risk to naive native intermediate hosts. We found evidence that seroprevalence of T. gondii in Tasmanian pademelons was lower in the north-west of Tasmania than in the north-east and central regions where cat density was higher. Also, samples obtained from road-killed animals had significantly higher seroprevalence of T. gondii than those from culled individuals, suggesting there may be behavioural differences associated with infection. In addition, seroprevalence in different trophic levels was assessed to determine whether position in the food-web influences exposure risk. Higher order carnivores had significantly higher seroprevalence than medium-sized browser species. The highest seroprevalence observed in an intermediate host was 71% in spotted-tailed quolls (Dasyurus maculatus), the largest mammalian mesopredator, in areas of low cat density. Mesopredator release of cats may be a significant issue for native species conservation, potentially affecting the population viability of many endangered species. [Copyright &y& Elsevier]

Abstract: Peng–Robinson equation of state is widely used with the classical van der Waals mixing rules to predict vapor liquid equilibria for systems containing hydrocarbons and related compounds. This model requires good values of the binary interaction parameter kij . In this work, we developed a semi-empirical correlation for kij partly based on the Huron–Vidal mixing rules. We obtained values for the adjustable parameters of the developed formula for over 60 binary systems and over 10 categories of components. The predictions of the new equation system were slightly better than the constant-kij model in most cases, except for 10 systems whose predictions were considerably improved with the new correlation. [Copyright &y& Elsevier]

Abstract: Objective: To predict presence of invasive component and nodal involvement in women diagnosed preoperatively with ductal carcinoma in situ (DCIS) by vacuum-assisted breast biopsy (VABB). Materials and methods: We retrospectively analyzed 733 patients with preoperatively diagnosed DCIS, investigating the association of clinical–radiological variables with invasive component and nodal involvement. Results: Mammographic size >20 mm and residual lesion on post-VABB mammogram were related to invasive component (both p < 0.0001) and nodal involvement (p = 0.001, p = 0.03). Age <40 years was associated with presence of invasive component (p = 0.003). By multivariate analysis residual disease was associated with invasive component, and mammographic tumor size >20 mm with nodal involvement, both highly significant. Conclusions: Older age, lesion <20 mm, and no residual lesion predict absence of invasion and no nodal involvement in VABB-diagnosed DCIS. However it would be imprudent to routinely forego sentinel node biopsy in such patients as non-negligible proportions of them have invasive disease. [Copyright &y& Elsevier]

Summary: Introduction: Hypertonia is prevalent in anti-gravity muscles, such as the biceps brachii. Neural mobilization is one of the techniques currently used to reduce spasticity. Objective: The aim of the present study was to assess electromyographic (EMG) activity in spastic biceps brachii muscles before and after neural mobilization of the upper limb contralateral to the hemiplegia. Materials and Methods: Repeated pre-test and post-test EMG measurements were performed on six stroke victims with grade 1 or 2 spasticity (Modified Ashworth Scale). The Upper Limb Neurodynamic Test (ULNT1) was the mobilization technique employed. Results: After neural mobilization contralateral to the lesion, electromyographic activity in the biceps brachii decreased by 17% and 11% for 90° flexion and complete extension of the elbow, respectively. However, the results were not statistically significant (p gt; 0.05). Conclusions: When performed using contralateral techniques, neural mobilization alters the electrical signal of spastic muscles. [Copyright &y& Elsevier]

Abstract: A 6-year-old spayed female ferret (Mustela putorius furo) exhibiting clinical signs of weakness, anorexia, lethargy, weight loss, and frequent urination was presented for a veterinary evaluation to determine the underlying cause of the aforementioned abnormal behavior and clinical condition. Physical examination revealed a large, firm, painless, movable subcutaneous mass at the base of the tail. Radiographic and ultrasound images confirmed the presence of a soft tissue mass compressing the sacrococcygeal vertebrae, but there was no evidence of metastatic lesions. Because of the poor prognosis and progressive deterioration of the animal''s clinical condition, the ferret was humanely euthanized. Gross necropsy revealed a 4 × 4 × 3.5 cm, firm, yellow-tan, ovoid, subcutaneous mass wrapped around the rectum and the anus. The mass did not appear to breach the serosa. Evaluation of the abdominal cavity revealed a pale yellow liver, possibly associated with hepatic lipidosis with no gross evidence of metastasis in the body cavity. The histopathological features of the mass were consistent with a liposarcoma. To the best of the authors'' knowledge, this is the first case of subcutaneous liposarcoma reported in a ferret. [Copyright &y& Elsevier]

Summary: Introduction: Proprioceptive exercises are performed on a daily basis in physiotherapy with the use of different unstable platforms in order to improve joint stability using the mechanical and sensory properties of ligaments, joint capsule and integrated activity of the muscles surrounding the joint. Changes in the myoelectrical characteristics of the muscles during activity can be identified using surface electromyography (EMG), which provides important information on the behavior of muscles submitted to different types of load. Objectives: The aim of the present study was to analyze the electromyographic activity of the tibialis anterior, tibialis posterior, peroneus longus, gastrocnemius lateralis and gastrocnemius medialis on stable and unstable surfaces with eyes open and closed. Methodology: Twenty-five active, healthy, male and female individuals were submitted to an anthropometric evaluation and a protocol involving warm up and the electromyographic assessment of muscle activity on different surfaces. The order of the data collection was chosen randomly by lots [on stable ground or unstable platforms (trampoline, balance platform, proprioceptive disk and proprioceptive board) with eyes open and on a trampoline, balance platform and stable ground with eyes closed]. The individuals remained balanced on these surfaces for 15 s with the knee at 30° flexion in order to provide greater instability. Results: There was a significant increase (p < 0.05) in muscle activity on the unstable surfaces, with the exception of the trampoline, which did not achieve statistically significant differences in relation to the stable ground. The tibialis anterior and peroneus longus exhibited the greatest electromyographic activity on all surfaces. The proprioceptive tests performed with eyes closed exhibited significantly greater electromyographic activity than with eyes open. Conclusion: Proprioceptive exercises on unstable surfaces generated a significant increase in electromyographic activity, especially with eyes closed, and are therefore a valuable resource in the sensory-motor rehabilitation of the ankle. [Copyright &y& Elsevier]