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Recently, there has been an increase in the representation of women within the cardiothoracic surgery workforce, with discussions about gender equity garnering interest. We sought to identify whether this increase is accompanied by commensurate selection for representation at national meetings. Online archives of The Society of Thoracic Surgeons (STS) Annual Meetings were reviewed from 2015 to 2024. Data regarding the moderator's gender were abstracted. The gender distribution of moderators across the various session categories was surveyed, and subgroup analyses were performed. During the years of study, the STS Annual Meeting Taskforce selected 983 moderators to participate in the conference, including 218 women. The representation of women moderators demonstrated a favorable, upward trend. In 2015, 12.1% of moderators were women, with a consistent rate from 2015 to 2018. There was a noticeable rise in invited women moderators in 2019, with 25.4% of moderators being women. This proportion increased to 36.9% women in 2024. General Thoracic sessions have consistently included a greater percentage of women moderators compared with other sessions. Other topic areas, such as Education and Quality Improvement and Critical Care, transitioned to greater representation of women in recent years. There has been an increase over time in women moderators selected for participation in the STS Annual Meeting, with progress in gender diversity seen in most session types. Although the overall proportion of women within cardiothoracic surgery remains low, the STS has increasingly worked toward encouraging inclusivity. Efforts to further support well-rounded representation are of important benefit. [Display omitted] [ABSTRACT FROM AUTHOR]

Randomized studies have endorsed nonabsorbable prosthetics for contaminated ventral hernia surgery, yet the broader applicability and impact on patient-reported outcomes are still questioned. Here, we evaluated the long-term outcomes of elective contaminated ventral hernia repairs (based on Centers of Disease Control and Prevention [CDC] wound classification) using real-world data from a multicenter US cohort, focusing on quality of life and postoperative pain. The Abdominal Core Health Quality Collaborative database was queried for patients undergoing elective contaminated (CDC class II–IV) ventral hernia repair (2013–2023). After propensity matching, we compared long-term differences in patient-reported quality of life and pain scores (by HerQLes and PROMIS questionnaires) among those who underwent repair with nonabsorbable, absorbable synthetic, and biologic mesh. A total of 1,073 patients were included, of whom 920 (86%), 56 (5%), and 97 (9%) underwent repair with nonabsorbable, absorbable synthetic, and biologic mesh, respectively. Among them, the median age was 62 years (interquartile range [IQR] 53–70), and 523 (49%) were male. The median length and width of the defect were 20 cm (IQR 12–25) and 13 cm (IQR 8–16), respectively. A transversus abdominis release was performed in 716 patients (67% of all cases). In most cases, the mesh was positioned in the retro-rectus (85%) and/or the preperitoneal space (45%). Before and after propensity matching (n = 185), the change from baseline in HerQLes and PROMIS scores at 6 months and at 1, 3, 5, and 6 years was comparable between different types of mesh. Lastly, there were no differences in readmission, surgical site infection, or surgical site occurrence at 30 days. Recurrence at 1 year was also comparable among groups. In the long term, there were no differences in quality of life or pain scores with nonabsorbable, absorbable synthetic, or biologic mesh for elective ventral hernia repair in contaminated fields. [Display omitted] [ABSTRACT FROM AUTHOR]

In the context of the COVID-19 pandemic, the early and accurate identification of patients at risk of deterioration was crucial in overcrowded and resource-limited emergency departments. This study conducts an external validation for the evaluation of the performance of the National Early Warning Score 2 (NEWS2), the S/F ratio, and the ROX index at ED admission in a large cohort of COVID-19 patients from Colombia, South America, assessing the net clinical benefit with decision curve analysis. A prospective cohort study was conducted on 6907 adult patients with confirmed COVID-19 admitted to a tertiary care ED in Colombia. The study evaluated the diagnostic performance of NEWS2, S/F ratio, and ROX index scores at ED admission using the area under the receiver operating characteristic curve (AUROC) for discrimination, calibration, and decision curve analysis for the prediction of intensive care unit admission, invasive mechanical ventilation, and in-hospital mortality. We included 6907 patients who presented to the ED with confirmed SARS-CoV-2 infection from March 2020 to November 2021. Mean age was 51 (35–65) years and 50.4% of patients were males. The rate of intensive care unit admission was 28%, and in-hospital death was 9.8%. All three scores have good discriminatory performance for the three outcomes based on the AUROC. S/F ratio showed miscalibration at low predicted probabilities and decision curve analysis indicated that the NEWS2 score provided a greater net benefit compared to other scores across at a 10% threshold to decide ED admission at a high-level of care facility. The NEWS2, S/F ratio, and ROX index at ED admission have good discriminatory performances in COVID-19 patients for the prediction of adverse outcomes, but the NEWS2 score has a higher net benefit underscoring its clinical utility in optimizing patient management and resource allocation in emergency settings. [ABSTRACT FROM AUTHOR]

The circumstances under which pneumonectomy should be performed are controversial. This study aims to investigate national trends in pneumonectomy use to determine which patients, in what geographic areas, and under what clinical circumstances pneumonectomy is performed in the United States. We queried the National Cancer Database and included all patients undergoing anatomic surgical resection for non–small cell lung cancer (2015–2020). The association between demographic and clinical factors and the use of pneumonectomy were investigated. Who: A total of 128,421 patients were identified, of whom 738 (0.6%) underwent pneumonectomy. Those patients were younger (median 65 vs 68 years, P <.001), more often male (59.9% vs 44.9%, P <.001), more likely to be below median income level (44.2% vs 38.6%, P =.002), and more likely to have lower education indicators (53% vs 48.6%, P =.02) than those who underwent other anatomic resections. Notably, there was a decreasing trend in pneumonectomy use during the study period (0.9% down to 0.4%, P <.001). Where: Patients undergoing pneumonectomy were less likely to live in metropolitan areas (77.9% vs 81.7%, P =.008) and to live closer (<12 miles) to their treating facility (45% vs 49%, P =.02). Regional geographic differences also were identified (P <.001). Why: Patients who underwent pneumonectomy were more likely to have received neoadjuvant therapy (20.6% vs 5.3%, P <.001), to be clinically N (+) (39.3% vs 12.3%, P <.001), and to have more advanced tumors (cT3-4: 46.3% vs 11.3%, P <.001). Although primarily driven by advanced oncologic features, socioeconomic and geographic factors also were associated independently with the use of pneumonectomy. Standardizing pneumonectomy indications nationwide is crucial to prevent widening outcome gaps for patients with lung cancer. [Display omitted] [ABSTRACT FROM AUTHOR]

Breathing elevated oxygen partial pressures (PO 2) prior to SCUBA diving increases the risk of developing central nervous system oxygen toxicity (CNS-OT), which could impair performance or result in seizure and subsequent drowning. We aimed to study the dynamics of electrodermal activity (EDA) while breathing elevated PO 2 in the hyperbaric environment (HBO 2) as a possible means to predict impending CNS-OT. To this end, we used machine learning to automatically detect and predict the onset of symptoms associated with CNS-OT in humans by using features derived from EDA in both time and frequency domains. We collected electrodermal activity (EDA) data from forty-nine exposures to HBO 2 while subjects were undergoing cognitive load and exercise in a hyperbaric oxygen chamber. Four independent experts were present during the experiment to monitor and classify any symptoms associated with hyperbaric oxygen toxicity. We computed a highly sensitive time varying spectral EDA index, named TVSymp, and extracted informative features from skin conductance responses (SCRs). Machine learning algorithms were trained and validated for classifying features from SCRs and TVSymp as CNS-OT related or non-CNS-OT related. Machine learning models were validated using a subject-independent leave one subject out (LOSO) validation scheme. Our machine learning model was able to classify EDA dynamics related to CNS-OT with 100 % sensitivity and 84 % specificity via LOSO validation. Moreover, the median prediction time for CNS-OT symptoms was ∼ 250 s preceding the occurrence of actual symptoms. This study shows that EDA can potentially be used for early prediction of CNS-OT in divers with a high sensitivity and sufficient prediction time for countermeasures. While the study results are promising, independent validation datasets are warranted to confirm the findings. However, the current results are well corroborated in an animal study, which consistently showed seizure prediction time of 2 min prior to seizure. [ABSTRACT FROM AUTHOR]

Inclusivity is a fundamental principle of education worldwide as it fosters the general well-being of students, educators, and other parties in the education sector. Moreover, inclusive education is a multidimensional phenomenon that many factors can influence. Thus, understanding the underlying interactions between those factors fostering inclusivity may help to inform decisions taken by the involved parties, such as education-related policymakers. This study examines the relationship between self-efficacy and the attitudes of higher education teachers toward inclusive education. We applied two psychometric survey-like instruments: the Self-Efficacy Scale for Inclusive Teaching Practices and the University and Disability Issues Scale. The study cohort comprised 68 higher education professors from universities in Barranquilla on the Colombian North Coast. We found that professors exhibiting favorable attitudes to adjusting the curricula, as well as higher sensitization and relationships with students in situations of disability, are prone to perceive higher self-efficacy and less extra burden arising from the tasks associated with inclusive education. [ABSTRACT FROM AUTHOR]

Closure of the appendiceal stump is a critical step during an appendectomy. There is a lack of knowledge about the feasibility of using electrosurgical devices for the occlusion of the appendix. This study aims to determine the safety of this technique in pediatric patients. We performed a cross-sectional analytical study in patients less than 18 years of age treated at Hospital Militar Central Colombia between 2012 and 2021. Our institution's ethics committee approved the study. We analyzed the data using SPSS 22 statistical program. We present frequencies for qualitative variables and measures of central tendency or dispersion for quantitative variables depending on the distribution measured by the Kolmogorov-Smirnov test. In addition, we measured the association of nominal variables with the Chi-square test or Fisher's exact test. For numerical variables, the difference of means with the Student's t -test or the difference of medians with the Mann-Whitney U test. We treated 209 patients. One hundred sixteen (55.5%) were boys, and the mean age was 9.7 years (SD 3.2). The median intraoperative time was 60 min, and the hospital stay was 2.8 days on average. There were no cases of stump leakage, and only two patients (1%) had an organ-space surgical site infection, which was unrelated to the closure technique. We found no association between procedural complications and appendicular status (p = 0.450). Our research suggests that using a bipolar sealing device (Ligasure, Medtronic, USA) for appendiceal stump closure in pediatric patients undergoing laparoscopic appendectomy is feasible and should be further studied. Treatment study. Level III [ABSTRACT FROM AUTHOR]

The timely graduation of undergraduate students is a topic of special interest for higher education institutions, especially because it is an item that is used to evaluate their quality. Although the institutions have streamlined their processes and developed alternatives to achieve this timely graduation, along the way they have identified a group of factors, which affect the achievement of this objective. Through the present research, factors were analyzed, specifically to establish which of them affect the students of one university aim of study, compiling the required information from the application of qualitative techniques to the different actors related to this process, also making a detailed analysis of investigations previously known. Results demonstrated that the factors with the greatest impact are economic and institutional; based on this, an innovative value proposition was developed from the Business Model Canvas tool that allowed the creation of a model aimed at the two factors for the timely graduation of undergraduate students, focused on Crowdfunding and institutional accompaniment. [ABSTRACT FROM AUTHOR]

Over the past decade, the use of human stem cell-derived β cells (SC-β cells) to model pancreatic β cell development, function and disease has become increasingly common. Though protocols are rapidly improving, current directed differentiation strategies do not yield a pure population of insulin-positive SC-β cells in vitro. Therefore, it is experimentally advantageous to have reporter lines that allow for live sorting of insulin-positive populations. To aid in these studies, we have knocked mNeonGreen fluorescent protein into the endogenous insulin locus of the commonly used H1 (WA01) human embryonic stem cell line. [ABSTRACT FROM AUTHOR]

One of the most prevailing foods in the Mexican diet is the tortilla. Annually, 56.7 and 79.5 kg of tortillas are consumed in urban and rural areas. The objective of this study is to evaluate the environmental impacts of tortillas from white (WM) and yellow maize (YM) consumed in the Monterrey Metropolitan Area (MMA) in northeastern Mexico, using a prospective life cycle assessment approach (LCA). Four different sources of maize were chosen according to their production importance. The life cycle inventory included the national and foreign agricultural production, transportation, and tortilla-processing plant modules. The premise python package and the Superstructure were used to transform the ecoinvent database v3.8 to the prospective approach using the Shared Socioeconomic Pathway 2 (SSP2). It was found that the production of 1 kg of tortillas from national YM and WT has a climate change indicator of 0.731 and 0.575 kg CO 2 eq, respectively. Tortillas from foreign YM have up to 31% less climate change impact than the national WM. Maize agricultural production is the activity with the highest environmental impact, representing 65% of the environmental impact of the process. The contribution of electricity in the tortillas production system could be reduced from 22% to 4% if the energetic transition in Mexico follows the SSP2. This work provides the first approach to use the prospective LCA towards a cleaner production of the tortilla industry. The next step should be to develop fertilization reduction strategies with a prospective LCA approach. [ABSTRACT FROM AUTHOR]

Objective: We sought to determine if soluble levels of C5b-9, the terminal complement complex, correlate with end-organ injury in preeclampsia.Study Design: Project COPA (Complement and Preeclampsia in the Americas), a multi-center observational study in Colombia from 2015 to 2016, enrolled hypertensive pregnant women into four groups: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia with severe features. Trained coordinators collected clinical data, blood and urine. End-organ injury was defined by serum creatinine ≥ 1.0 mg/dl, aspartate transaminase ≥ 70U/L, platelet count < 150,000/µl, or lactate dehydrogenase ≥ 500 U/L. Data were analyzed by χ2 or Fisher's exact test with significance at P < 0.05.Main Outcome Measure: C5b-9 concentrations in plasma and urine, using enzyme linked immunosorbent assays.Results: In total, 298 hypertensive participants were enrolled. Plasma and urine C5b-9 levels were measured in all participants and stratified by quartile (Q1-4), from lowest to highest C5b-9 concentration. Participants with low plasma C5b-9 levels (Q1) were more likely to have end-organ injury compared to those with higher levels (Q2-Q4) [platelet count < 150,000/μl (20.8% vs. 8.4%, P = 0.01); elevated serum creatinine ≥ 1.0 mg/dl (14.9% vs. 4.5%, P = 0.009)]. In contrast, participants with high urinary C5b-9 levels (Q4) were more likely to have end-organ injury compared to those with lower levels (Q1-Q3) [platelet count < 150,000/μl (19.7% vs. 7.4%, P = 0.003); elevated serum creatinine ≥ 1.0 mg/dl (12.3% vs. 4.4%, P = 0.025)].Conclusion: We identified a pattern of increased urine and low plasma C5b-9 levels in patients with preeclampsia and end-organ injury. Soluble C5b-9 levels may be used to identify complement-mediated end-organ injury in preeclampsia. [ABSTRACT FROM AUTHOR]

Open spina bifida is the most common congenital anomaly of the central nervous system compatible with life. Prenatal repair of open spina bifida via open maternal-fetal surgery has been shown to improve postnatal neurologic outcomes, including reducing the need for ventriculoperitoneal shunting and improving lower neuromotor function. Fetoscopic repair of open spina bifida minimizes the maternal risks while providing similar neurosurgical outcomes to the fetus. The following 2 fetoscopic techniques are currently in use: (1) the laparotomy-assisted approach, and (2) the percutaneous approach. The laparotomy-assisted fetoscopic technique appears to be associated with a lesser risk of preterm birth than the percutaneous approach. However, the percutaneous approach avoids laparotomy and uterine exteriorization and is associated with lesser anesthesia risk and improved maternal postsurgical recovery. The purpose of this article was to describe our experience with a modified surgical approach, which we call percutaneous/mini-laparotomy fetoscopy, in which access to the uterus for one of the ports is done via a mini-laparotomy, whereas the other ports are inserted percutaneously. This technique draws on the benefits of both the laparotomy-assisted and the percutaneous techniques while minimizing their drawbacks. This surgical approach may prove invaluable in the prenatal repair of open spina bifida and other complex fetal surgical procedures. [ABSTRACT FROM AUTHOR]

Studies determining the main predictors of masticatory performance by using mixing ability tests are sparse. The purpose of this clinical study was to identify potential determinants of masticatory performance assessed by analyzing a patient's masticatory ability using bicolored chewing gum and visual, quantitative, and interactive methods. Nondental participants attending healthcare centers were consecutively recruited in Granada, Spain. The inclusion criteria were older than18 years and resident in the coverage area of the reference healthcare centers for at least the previous 6 months. The participants were excluded if they had received dental treatment in the previous 6 months or they were unable to communicate. The masticatory performance was determined by using 2-colored chewing gum (Kiss 3 white and blue; Smint) that was masticated for a total of 20 strokes. The masticated gum was crushed between 2 transparent glass slides, creating a 1-mm-thick specimen that was subsequently scanned. The mixed-color area was calculated as a percentage by using Photoshop as described by Schimmel et al and designated as the standard method. In addition, all images made were analyzed by using the Web application the Chewing Performance Calculator. In addition, the masticated bolus was inspected visually, and mastication performance was classified as being poor, moderate, or good. Sociodemographic data, as well as data on behaviors, medical and nutritional status, health-related quality of life, saliva, and general oral health, were collected for all participants to identify the main determinants of masticatory performance. One hundred thirty-seven participants were enrolled. The masticatory performance values obtained using both methods (standard method and Chewing Performance Calculator) were significantly greater for well masticated gum (P <.001), which had been visually classified as being poorly masticated (69.1% for standard method and 43.5% for Chewing Performance Calculator), moderately masticated (89.7% for standard method and 67.3% for Chewing Performance Calculator), and well masticated (97.3% for standard method and 80.3% for Chewing Performance Calculator). The bivariate analyses revealed that masticatory performance was significantly higher in younger people (<65 years) (P =.008), who also had a higher basal salivary flow rate (P <.001), were nondenture users (P =.002), and had more standing teeth and occlusal units (P <.001). However, the multiple regression analyses showed that the number of occlusal units was the only significant predictor of masticatory performance. In addition, the mean masticatory performance (95% confidence interval: 47.7% to 56.8%) was found to be greatly improved (by 1.2% to 2.2%), with each occlusal unit, in accordance with the Chewing Performance Calculator and between 0.8% and 1.8% according to the standard method; the basal masticatory performance was calculated as 72.1% to 81.2% (95% confidence interval). The number of occlusal units is one of the main predictors of masticatory performance when a 2-color bolus is used to test mixing ability. [ABSTRACT FROM AUTHOR]

Plant flammability research has proven pivotal in comprehending the contribution of vegetation to the flammability of forest ecosystems. Yet, the relationship between many leaf chemical traits and plant flammability is poorly understood. While terpenes and some leaf nutrients in plants have been extensively studied for their role in flammability, a wide array of other secondary metabolites remain unexplored in this context. Here, we present the volatile secondary metabolites composition of fresh leaves from nine dominant species from central Chile, both native and exotic, and determine whether there is variability within and among species in chemical composition and flammability. Moreover, we investigate how these compounds influence various leaf flammability traits. The Chilean Mediterranean ecosystem emerges as a useful study site given its unique endemic flora, increased frequency of forest fires, proliferation of invasive plants and extensive land conversion that favors the spread of fire-prone exotic species, and significant scarcity of phytochemical research dedicated to this ecosystem. A total of 118 volatile chemical compounds were quantified, belonging to over ten groups of volatile secondary metabolites. Terpenes, ketones, and hydrocarbons comprised 75 % of these compounds, and each species displayed a unique phytochemical profile. Surprisingly, some native species (Citronella mucronata , Cryptocarya alba) exhibited equivalent or higher leaf flammability than the well-known flammable exotics Eucalyptus globulus and Pinus radiata , respectively. Leaf flammability was best explained by the concentration of aldehydes, ketones, green leaf volatiles, and aromatic compounds. Interestingly, terpenes as well as moisture content were not significantly correlated with flammability. In conclusion, our results highlight the importance of considering a broader range of phytochemicals, beyond terpenes, to fully understand leaf flammability among species. Consequently, a deeper understanding -within and across ecosystems- of the influence exerted by diverse groups of phytochemicals on flammability is an urgent need for forest management planning in an increasingly flammable world. [Display omitted] • Volatile secondary metabolites of leaves influence plant flammability. • Ketones, aldehydes and GLVs significantly influence leaf flammability. • Aliphatic hydrocarbons are crucial for understanding plant flammability risk. [ABSTRACT FROM AUTHOR]

Currently, it has become very relevant that machine learning techniques can provide an explanation of the results they generate, which is even more relevant in certain domains, called critical, such as health and energy, among others. For this reason, several explainability methods have been generated in the literature. Some of them are Local Interpretable Model-Agnostic Explanations (LIME) and Feature Importance, which have been used in a wide range of problems. The objective of this work is to analyze the explainability capacity of the Learning Algorithm for Multivariate Data Analysis (LAMDA) and Fuzzy Cognitive Maps (FCM), which have been used with great interest due to their interpretability, management of uncertainty during the inference process, simplicity in its use, among other things. For the development of this work, data from two critical domains have been considered, health (COVID-19 and Dengue datasets) and energy (energy price dataset), for which prediction/classification models have been developed using LAMDA and FCM techniques. Afterward, two explainability techniques were used to analyze the explainability provided by each method, one based on the LIME method and the other on the feature importance method, the latter adapted to our work by being based on the permutation of values. Finally, the work proposes two new explainability methods, one based on causal inference and the other on the degrees of membership of the variables to the classes. The latter, in particular, allows doing an explainability analysis by class. The new explainability methods reproduce the results of well-known explainability methods in the literature such as LIME and feature importance, with less execution cost, and also, with an explainability analysis by class. This work opens the doors to new work on class explainability. Furthermore, we see that machine learning approaches based on causal or fuzzy relationships are quite self-explanatory, but specific explainability methods such as those we propose in the work allow us to study particular aspects, such as highly important variables, which general explainability methods do not allow us to do, such as LIME and feature importance. • Analyze the explainability of LAMDA and Fuzzy Cognitive Maps. • An explainability method based on causal inference for fuzzy cognitive maps. • An explainability method based on the degrees of membership of variables to classes. • These explainability methods allow studying the importance of variables by class. [ABSTRACT FROM AUTHOR]

Intraoperative blood transfer between twins during laser surgery for twin-twin transfusion syndrome can vary by surgical technique and has been proposed to explain differences in donor twin survival. This trial compared donor twin survival with 2 laser techniques: the sequential technique, in which the arteriovenous communications from the volume-depleted donor to the volume-overloaded recipient are laser-occluded before those from recipient to donor, and the selective technique, in which the occlusion of the vascular communications is performed in no particular order. A single-center, open-label, randomized controlled trial was conducted in which twin-twin transfusion syndrome patients were randomized to sequential vs selective laser surgery. Nested within the trial, a second trial randomized patients with superficial anastomoses (arterioarterial and venovenous) to ablation of these connections first (before ablating the arteriovenous anastomoses) vs last. The primary outcome measure was donor twin survival at birth. A total of 642 patients were randomized. Overall donor twin survival was similar between the 2 groups (274 of 320 [85.6%] vs 271 of 322 [84.2%]; odds ratio, 1.12 [95% confidence interval, 0.73–1.73]; P =.605). Superficial anastomoses occurred in 177 of 642 cases (27.6%). Donor survival was lower in the superficial anastomosis group vs those with only arteriovenous communications (125 of 177 [70.6%] vs 420 of 465 [90.3%]; adjusted odds ratio, 0.33 [95% confidence interval, 0.20–0.54]; P <.001). In cases with superficial anastomoses, donor survival was independent of the timing of ablation or surgical technique. The postoperative mean middle cerebral artery peak systolic velocity was lower in the sequential vs selective group (1.00±0.30 vs 1.06±0.30 multiples of the median; P =.003). Post hoc analyses showed 2 factors that were associated with poor overall donor twin survival: the presence or absence of donor twin preoperative critical abnormal Doppler parameters and the presence or absence of arterioarterial anastomoses. Depending on these factors, 4 categories of patients resulted: (1) Category 1 (347 of 642 [54%]), no donor twin critical abnormal Doppler + no arterioarterial anastomoses: donor twin survival was 91.2% in the sequential and 93.8% in the selective groups; (2) Category 2 (143 of 642 [22%]), critical abnormal Doppler present + no arterioarterial anastomoses: donor survival was 89.9% vs 75.7%; (3) Category 3 (73 of 642 [11%]), no critical abnormal Doppler + arterioarterial anastomoses present: donor survival was 94.7% vs 74.3%; and (4) Category 4 (79 of 642 [12%]), critical abnormal Doppler present + arterioarterial anastomoses present: donor survival was 47.6% vs 64.9%. Donor twin survival did not differ between the sequential vs selective laser techniques and did not differ if superficial anastomoses were ablated first vs last. The donor twin's postoperative middle cerebral artery peak systolic velocity was improved with the sequential vs the selective approach. Post hoc analyses suggest that donor twin survival may be associated with the choice of laser technique according to high-risk factors. Further study is needed to determine whether using these categories to guide the choice of surgical technique will improve outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] • U-Th-Pb zircon ages constrain the intrusion of the complex at ca. 75 Ma. • Geochemical data indicate subduction-related magmatic activity. • Double subduction in the northwestern margin of South America at the late Cretaceous. The Tampanchi Ultramafic–Mafic Complex (TUMC), located in the central segment of the Cordillera Real (Ecuador), is an oval-shaped intrusive body of approximately 18 km2 emplaced within a Cretaceous metavolcano-sedimentary sequence. Field investigations, zircon geochronology, mineral and whole-rock elemental and isotopic compositions constrain the nature of the parental magma as well as the physical conditions of emplacement, age of crystallization and tectonic setting of formation of the TUMC. The Complex consist of wehrlite and olivine-hornblende clinopyroxenite crosscut by hornblende gabbros and minor dikes/veins of diorite and granite. Hornblendites formed mainly at the contact between the olivine-hornblende clinopyroxenite and the intrusive hornblende gabbros by reaction-replacement processes. Geochemical data for both the wehrlites and pyroxenites define a trend with dominantly olivine and clinopyroxene accumulation, whereas a second trend is formed by hornblende gabbros that differentiated to leucocratic rocks, with amphibole as the dominant fractionating mafic phase. The trace elements show enrichment in large-ion lithophile elements, depletion in high field strength elements (Nb, Zr, Ti) and P, and enrichment in Pb, Sr and Ba relative to primitive mantle, indicating subduction-related parental liquids. The Nd and Sr isotopic composition suggests a uniform mantle source metasomatized by subducted crustal components. Thermobarometric estimations constrain emplacement and crystallization at intermediate to shallow continental crust levels (∼12.5 km depth) of hydrated basaltic melt under oxygen fugacity conditions above the nickel-nickel oxide buffer (ΔNNO = 0 to 2). Zircon SHRIMP U-Th-Pb age data constrain crystallization at 75.1–76.0 Ma, with scarce inherited zircons that record limited recycling of the Cordillera Real basement. These results confirm magmatic arc activity at the continental margin of South America during the late Cretaceous as a result of an E-dipping subduction zone prior to the accretion of the Ecuadorian-Colombian-Caribbean oceanic plateau, and support simultaneous double subduction at the northwest margin of South America during the Cretaceous. [ABSTRACT FROM AUTHOR]

Kratom (Mitragyna speciosa) is an opioid-like psychoactive substance not approved by the U.S. Food and Drug Administration that could be used due to its euphoric, stimulant, and analgesic effects. Kratom is gaining popularity in the U.S. and becoming a reason of concern among pediatricians. Data from the 2019 National Survey on Drug Use and Health were analyzed to estimate the prevalence and identify correlates of lifetime and past 12-month kratom use among 13,397 U.S. adolescents. Multivariable logistic regression models were conducted to assess the associations of interest. Lifetime and past 12-month prevalence of kratom use was.44% (95% confidence interval [CI].32–.60) and.27% (95% CI.18–.40), respectively. Past 12-month cigarette use was associated with lifetime kratom use (adjusted odds ratio 2.60, 95% CI 1.07–6.35). Past 12-month cannabis use was associated with past 12-month kratom use (adjusted odds ratio 2.48, 95% CI 1.15–5.35). This first report on the epidemiology of adolescent kratom use provides a baseline to assess kratom use trends in future years and identify potential correlates of use among adolescents. [ABSTRACT FROM AUTHOR]

Emotion assessment plays a vital role in understanding and enhancing various aspects of human life, from mental well-being and social interactions to decision-making processes. Electrodermal Activity (EDA) is widely used for emotion assessment, as it is highly sensitive to sympathetic nervous system activity. While numerous existing approaches are available for EDA-based emotion assessment, they often fall short in capturing the dynamic non-linear variations and time-varying characteristics of EDA. These limitations hinder their effectiveness in accurately classifying emotional states along the Arousal and Valence dimensions. This study aims to address these shortcomings by introducing Transition Network Analysis (TNA) as a novel approach to EDA-based emotion assessment. To explore the dynamic non-linear variations in EDA and their impact on the classification of Arousal and Valence dimensions, we decomposed EDA data into its phasic and tonic components. The phasic information is represented over a transition network. From the transition network, we extracted seven features. These features were subsequently used for classification purposes employing four different machine learning classifiers: logistic regression, multi-layer perceptron, random forest, and support vector machine (SVM). The performance of each classifier was evaluated using Leave-One-Subject-Out cross-validation. The study evaluated the performance of these classifiers in characterizing emotional dimensions. The results of this research reveal significant variations in Degree Centrality and Closeness Centrality within the transition network features, enabling effective characterization of Arousal and Valence dimensions. Among the classifiers, the SVM achieved F1 scores of 71% and 72% for Arousal and Valence classification, respectively. This study holds significant implications as it not only enhances our understanding of EDA's non-linear dynamics but also demonstrates the potential of TNA in addressing the limitations of existing techniques for EDA-based emotion assessment. The findings open exciting opportunities for the advancement of wearable EDA monitoring devices in naturalistic settings, bridging a critical gap in the field of affective computing. Furthermore, this research underlines the importance of recognizing the limitations in current EDA-based emotion assessment methods and suggests an innovative path forward in the pursuit of more accurate and comprehensive emotional state classification. • Analyzed EDA signals for Arousal and Valence dimensions of emotions using Transition Network Analysis (TNA). • Symbolic sequences simplify EDA signal data, enhancing computational efficiency. • Seven key features from transition networks classify Arousal and Valence dimensions. • Degree and Closeness Centrality features differentiate Arousal and Valence dimensions accurately. • TNA enhances wearable EDA devices, improving emotion classification in real-world settings. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) develops from a combination of genetic and environmental factors. The aim of this study was to determine the contribution of established environmental risk factors and genetic risk on age of IBD diagnosis in a diverse cohort. IBD patients in clinic completed detailed questionnaires. Blood was drawn for genetic analysis. Environmental risk factors and age of diagnosis were analyzed by ethnicity (Hispanic/Latinx or non-Hispanic White [NHW] individuals) and IBD subtype (ulcerative colitis or Crohn's disease [CD]). Weighted genetic risk scores and environmental risk scores were developed. We examined the relationship between environmental risk scores, genetic risk scores, and age of diagnosis. A total of 2952 patients were included: 58.9% had CD. A total of 46.83% were of Hispanic background. Early life exposures like cesarean delivery and being born in a developed country were associated with a younger age of IBD diagnosis. Childhood exposures such as frequent plastic water bottle use and having more than 1 bathroom at home were associated with a younger age of IBD. Hispanic and NHW individuals shared similar susceptibilities to environmental exposures. Environmental factors explained 21% of the variance in age of CD diagnosis and 39% in ulcerative colitis. In models incorporating genetic risk score and environmental risk score, the environment was the only significant factor associated with younger age of IBD diagnosis in all groups. Early life and childhood exposures impact IBD diagnosis and influence Hispanic and NHW individuals similarly. A cumulative environmental risk score contributes more to age of IBD diagnosis than genetic risk. [ABSTRACT FROM AUTHOR]

The four pillars for treatment of heart failure with reduced ejection fraction (HFrEF) patients include angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin-receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker (BB), mineralocorticoid receptor antagonist (MRA) and sodium-glucose cotransporter-2 inhibitor (SGLT2i), unless contraindicated or not tolerated. They should be started or up titrated to maximally tolerated doses recommended in current guidelines. Despite proven benefits and strong guideline recommendations, their use and dosing in routine clinical practice have traditionally fallen below the levels achieved in clinical trials. This analysis seeks to establish medication use and optimal dosage according to the clinical practice guidelines in HFrEF patients included in the RECOLFACA registry during recruitment and after six-month follow-up. Factors that limit its use could be identified in subsequent analysis. The RECOLFACA registry was performed between 2017 and 2019. A descriptive analysis is performed considering the medication used in HFrEF patients (ACE-I/ARB/ARNI, BB, and/or MRA) and their dosage (<50%, 50-100% or 100% of the dosage recommended in guidelines) during recruitment and at 6-month follow-up. SGLT2i are not included in this analysis because were not available during this period. The registry included 2528 patients, and this analysis included 1661 HFrEF patients from this registry. Among these patients 89.4%, 93.4% and 70.1% received ACE-I/ARB/ARNI, BB and ARM respectively during registry recruitment. At six-month follow-up, a decrease in its use was observed (57.9%, 53.3% and 44.2% respectively). Among patients with established medication during registry recruitment, only 10.4%, 16.5% and 4.7% received target doses of ACE-I/ARB/ARNI, BB or ARM respectively, which increased at six-month follow-up in ACE-I/ARB/ARNI and BB group (12.6% and 21.5% respectively) and decreased in ARM group (3.7%) (Figure 1). Less than 1% of patients were simultaneously receiving target doses of ACE-I/ARB/ARNI, BB and MRA during registry. In HFrEF patients included in this registry, the use and dosage of the three groups of medications evaluated (ACEI/ARB/ARNI, BB and ARM) and that are recommended in current guidelines is low and more worrisome is that after time (6-month follow-up), this percentage is lower, as mentioned in other trials. There is minor increases in the number of patients reaching maximal doses of those therapies during follow-up. We need to continue working to be able to identify factors associated with low adherence, access to medication, and using maximal recommended/tolerated doses. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) diagnosis relies on plasma creatinine concentration (Crpl), a relatively insensitive, surrogate biomarker of glomerular filtration rate that increases only after significant damage befalls. However, damage in different renal structures may occur without increments in Crpl, a condition known as subclinical AKI. Thus, detection of alterations in other aspects of renal function different from glomerular filtration rate must be included in an integral diagnosis of AKI. With this aim, we adapted to and validated in rats (for preclinical research) the furosemide stress test (FST), a tubular function test hitherto performed only in humans. We also tested its sensitivity in detecting subclinical tubular alterations. In particular, we predisposed rats to AKI with 3 mg/kg cisplatin and subsequently subjected them to a triggering insult (ie, 50 mg/kg/d gentamicin for 6 days) that had no effect on nonpredisposed animals but caused an overt AKI in predisposed rats. The FST was performed immediately before adding the triggering insult. Predisposed animals showed a reduced response to the FST (namely, reduced furosemide-induced diuresis and K+ excretion), whereas nonpredisposed animals showed no alteration, compared to the controls. Computational modeling of epithelial transport of solutes and water along the nephrons applied to experimental data suggested that proximal tubule transport was only minimally reduced, the sodium-chloride symporter was upregulated by 50%, and the renal outer medullary potassium channel was downregulated by 85% in predisposed animals. In conclusion, serial coupling of the FST and computational modeling may be used to detect and localize subclinical tubular alterations. [ABSTRACT FROM AUTHOR]

Leptophlebiidae is a diverse family of mayflies (Ephemeroptera) and in Terpidinae the species identification is difficult due to the similarity of male genitalia. In this study, we evaluated the chorion morphology of the eggs of 10 species of Terpidinae in different developmental stages, in order to explore the potential of the oocytes characteristics for the taxonomy of genera and species as well as species association. Eggs were analyzed via scanning electron microscope. The association of the nymph and adult using egg characters was possible for T. sooretamae and T. echinovaris. In the genera Terpides and Tikuna, variations in chorion sculpture allowed species differentiation, whereas in Fittkaulus amazonicus and F. cururuensis it was not possible. Egg features, including shape, chorion sculpture, location and number of micropylar areas, and attachment structures are useful characters to be also used in the taxonomy of these insects. [ABSTRACT FROM AUTHOR]

Aims: To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes.Methods: A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008-2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated.Results: Mean follow-up was 3.2 years and 506 deaths and 1720 hospitalizations were recorded. The cumulative risk for the individual events increased as eGFR levels decreased. The PAR associated with having an eGFR of 60mL/min/1.73m2 or less was 11.4% (95% CI 4.8-18.3) for all-cause mortality, 9.2% (95% CI 5.3-13.4) for coronary heart disease, and 2.6% (95% CI -1.8 to 7.4) for stroke.Conclusions: Reduced eGFR levels were associated with a larger proportion of avoidable deaths and cardiovascular hospitalizations in people with diabetes compared to previously reported results in people with other cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

There is a need to quantitatively differentiate between impaired and normal mastication by using straightforward and reliable methods because currently available methods are expensive, complex, and time-consuming. The purpose of this clinical study was to assess the reliability, validity, and clinical utility of a new Web-based software program designed to calculate masticatory performance, the Chewing Performance Calculator (CPC) measuring masticatory performance (MP), by analyzing the area of mixed bicolored chewing gum. One hundred and ten participants were consecutively recruited from the School of Dentistry of the University of Salamanca. MP was determined by using 2-colored chewing gum that was masticated for a total of 20 strokes. The masticated gum was then flattened between 2 transparent glass tiles, generating a 1-mm-thick specimen that was scanned to calculate the percentage of area where the 2 colors were mixed. The area was calculated by using a photo-editing software program as described by Schimmel et al (standard method). In addition, all the images were analyzed by using the CPC Web application, which took as input the image of the masticated bolus enclosed in a custom plastic platen that allowed 3 parts of the image to be selected interactively: the platen, the bolus background, and the mixed color fraction of the bolus. The application then computed MP as a percentage. Additionally, an oral examination was carried out to record the number of occlusal units. These data were used to assess the validity of CPC by using the Pearson correlation coefficient. Construct validity was assessed by using ANOVA by comparing the MP scores obtained for masticated gums, classified upon inspection as being poorly, moderately, or highly mixed. The time spent evaluating the specimens with GSM and CPC methods was also recorded and used to indicate the usefulness of the procedure. The MP was found to range between 5.2% and 100% (95% CI: 80.8–88.8) with the GSM and between 9.2% and 96.4% (95% CI: 60.0–67.6) with the CPC. The time needed to calculate MP by using the GSM was significantly higher (235.2 versus 260.5 seconds) than that with the CPC (42.3 to 48.6 seconds). Both methods were significantly intercorrelated (r=0.65; P <.001) and correlated with the number of occlusal units (r=0.54 for CPC and r=0.40 for GSM). The correlation coefficient of MP calculated by using CPC (r=0.54; P <.001) was greater than that calculated by using GSM (r=0.40; P <.001). Moreover, both methods showed adequate construct validity because the values calculated for MP significantly increased as the mixing of the masticated gums also increased, subjectively classified as poor, moderate, and high. The CPC software program allowed MP to be determined in a valid and easy-to-use manner by using 2-colored chewing gum. [ABSTRACT FROM AUTHOR]

Despite the high morbidity and mortality of metastatic colorectal cancer (mCRC) in older patients, they have been underrepresented in clinical trials and their optimal treatment is yet to be determined. This open-label phase II study evaluated the benefits of panitumumab and capecitabine as a first-line chemotherapy regimen in older patients with wild-type [WT] RAS mCRC. Patients (≥70 years; ECOG≤2) received 3-week cycles of panitumumab (9 mg/kg on day 1) plus capecitabine (850 mg/m2 twice daily on days 1–14) until disease progression or unacceptable toxicity. Response was evaluated every 9 weeks according to RECIST_1.1. Outcome measures were: objective response rate (ORR), duration of response (DoR), time to response (TTR), progression (TTP) and treatment failure (TTF), progression-free survival (PFS), overall survival (OS), and safety. Twenty-seven patients (11 women; median age: 78 years; ECOG: 0 [26%], 1 [67%], 2 [7%]) were evaluated. Median follow-up was 17.7 months. Confirmed ORR (95%CI) was 44.4% (25.7–63.2), with 25.9% of patients achieving at least stable disease. Median (95%CI) DoR was 8.7 (5.5–10.4) months, and median TTR was 2.2 (1.9–2.8) months. Median TTP was 9.6 (4.8–11.5) months, with a median TTF of 5.2 (2.8–7.2) months. The median PFS was 7.5 (4.4–10.4) months, and the median OS was 23.7 (7.4–27.5) months. Seventeen (63%) patients reported panitumumab and/or capecitabine-related adverse events grade 3–4, with skin toxicity (18.5%) being the most common. Two (7.4%) deaths were treatment-related. This study suggests that panitumumab plus capecitabine is a safe and effective regimen in older patients with WT RAS mCRC. • Panitumumab has a low rate of immunogenicity compared with other antibodies against EGFR because of its fully human nature. • The combination of panitumumab and capecitabine was suggested to be effective in older patients with WT RAS mCRC. • The good tolerability and safety profile of the combination were in line to previous studies in older patients. • Panitumumab with capecitabine may provide an alternative to other anti-EGFR regimens in older patients with WT RAS mCRC. [ABSTRACT FROM AUTHOR]

Variceal hemorrhage can be a life-threatening adverse event of chronic liver disease. In contrast to the well-described guidelines for the management of portal hypertension (PH) in adults, there is limited evidence about the optimal prophylactic management of variceal bleeding in children. This study was carried out to assess the efficacy of endoscopic variceal ligation (EVL) as primary prophylaxis to prevent upper GI bleeding in children with PH. From January 2014 to April 2018, all pediatric patients with PH disease and medium to large esophageal varices or reddish spots, regardless of the grade of the varix, were prospectively included in the protocol of primary prophylaxis with EVL. A second retrospective group of patients was made after reviewing medical records of 32 pediatric patients with PH that presented esophageal varices in the upper endoscopy and had received propranolol as primary prophylaxis. Twenty-four patients (75%) reached varices eradication in the EVL group, with a median of 2 procedures (range, 1-4) before eradication and a median time to eradication of 3.40 months (range, 1.10-13.33). No EVL-related adverse events were observed. Statistically significant differences were observed in the bleeding rate at 3 years between propranolol and EVL groups (6/32 [21.9%] vs 1/32 [3.2%], P <.02). The hazard ratio for bleeding for patients treated with propranolol compared with those treated with EVL was 2.6 (95% confidence interval, 1.53-3.67). EVL is a safe and effective treatment to prevent upper GI bleeding in pediatric patients with PH. (Clinical trial registration number: NCT03943784.) [ABSTRACT FROM AUTHOR]

Many applications of different materials are related to the properties of their surface. Wettability is a key property affecting applications in all fields: adhesives, lubricants, detergents, all types of coatings, implant integration, heat transmission, corrosion, etc. Laser texturing has been demonstrated to be an excellent technique to modify surface wettability of many different materials: polymers, metals, ceramics, or even natural stones. The relative simplicity and robustness of the results, together with the widespread availability of affordable industrial laser sources made laser texturing a very promising tool for modifying the surface of parts in manufacturing plants. In this paper we introduce the basics of the technique and show some examples of applications. On one hand, treating the surface of different polymers for biomedical applications. And on the other hand, the production of surfaces with extreme wettability properties is shown: superhydrophilic, superhydrophobic and omniphobic surfaces were obtained by laser texturing. [ABSTRACT FROM AUTHOR]

When patients have symptomatic recurrent atrial tachyarrhythmias after 2 months following pulmonary vein antral isolation, a repeat ablation should be considered. Patients might present with isolated pulmonary veins posterior wall. In these patients, posterior wall isolation is extended, and non-pulmonary vein triggers are actively sought and ablated. Moreover, in those with non-paroxysmal atrial fibrillation or a known higher prevalence of non-pulmonary vein triggers, empirical isolation of the superior vena cava, coronary sinus, and/or left atrial appendage might be performed. In this review, we will focus on ablation of non-pulmonary vein triggers, summarizing our current approach for their mapping and ablation. [ABSTRACT FROM AUTHOR]

Although most cases of Brugada syndrome have been described in adults, pediatric patients with the disease have been reported since the original article from Josep and Pedro Brugada. Herein is presented the case series of Brugada syndrome in pediatric population of the National Institute of Cardiology Ignacio Chavez. One boy and two adolescent males had palpitations as clinical presentation of the disease. Atrial arrhythmias were documented in two, in the third case there was a high clinical suspicion and quinidine abolished symptoms. The aim of this report is to highlight the importance of performing a detailed clinical history as well as the usefulness of high precordial leads for the diagnosis of this entity. [ABSTRACT FROM AUTHOR]