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La experiencia, más que visitar un nuevo lugar, comprende un encuentro entre culturas, personas y entornos naturales, que impacta tanto en los viajeros como en los destinos turísticos visitados. El presente estudio propuso determinar cómo la experiencia turística promueve un turismo sostenible en la Reserva Nacional de Lachay (RNL), Lima, Perú. Se desarrolló mediante un enfoque cualitativo, fenomenológico, con casos de estudio identificados mediante la técnica de muestreo bola de nieve; se identificaron cinco profesionales con experticia en el desarrollo de experiencias turísticas, a quienes se les entrevistó mediante una guía de entrevista semiestructurada. Se concluye que la RNL es un espacio turístico natural que ofrece a los turistas la posibilidad de experimentar sensaciones agradables a través de los sentidos, principalmente el sentido auditivo y visual; además, la visita permite reconocer e interiorizar el significado e importancia del ecosistema de lomas, ayudando a comprender la necesidad de su conservación para el beneficio de las generaciones futuras. Cabe precisar que la generación de experiencia turística requiere la confluencia de distintos elementos naturales, materiales y humanos, que repercute en beneficios económicos, sociales y ambientales para los turistas y la comunidad anfitriona.

The tourist experience is not just about visiting a new place; it involves encountering different cultures, meeting new people, and interacting with natural environments, which can profoundly impact travellers and the tourist destinations they visit. In this study, we aimed to determine how the tourist experience can promote sustainable tourism in the Lachay National Reserve (LNR). Using a qualitative, phenomenological approach, we identified five professionals with expertise in developing tourist experiences through snowball sampling. We then conducted semi-structured interviews using an interview guide. Our findings indicate that the LNR is a natural tourist space that allows visitors to experience pleasant sensations through their senses, primarily the auditory and visual senses. Moreover, visiting the reserve will enable visitors to recognise and internalise the importance of the Lomas ecosystem, which helps them understand the need for its conservation to benefit future generations. It is worth noting that generating tourist experiences requires the convergence of various natural, material, and human elements that have economic, social, and environmental benefits for tourists and the host community. [ABSTRACT FROM AUTHOR]

Objective  The purpose of this study was to evaluate the clinical and functional results of simultaneous reconstruction of the ACL and PCL with bilateral hamstring autografts. We hypothesized that this reconstruction technique results in less morbidity and has similar results to the ones published in the previous literature. Methods  Eighteen patients with bicruciate lesions were selected and treated by arthroscopic surgery with autologous hamstring tendons in a single-stage procedure. The thicker semitendinosus tendon (ST) and the two gracilis tendons (G) were used for a 6-strand PCL reconstruction. The thinner ST was used for a 3-strand ACL reconstruction. The average patient age at surgery was 31 years, and the minimum follow-up was 2 years. Function of the operated knee was evaluated according to the Lysholm scale. Anterior knee laxity was examined with a KT-1000 arthrometer. Posterior laxity was evaluated using stress radiographies. Results  Statistically significant improvements were found for all three measurements ( p  < 0.001). Knee function by the Lysholm score increased from 43.8 ± 4.1 to 89.9 ± 3.8 post-surgery. The average anterior knee laxity improved from 5.2 + -0.8 mm initially to 2.4 + - 0.5 mm post-surgery. The posterior translation of the tibia relative to the femur decreased from 10 ± 3.4 mm to 3 ± 1.6 mm post-surgery. No patient showed loss of motion in extension or knee flexion. Conclusion  The simultaneous bicruciate reconstruction with bilateral hamstring autograft is a valuable option to achieve good functional outcomes and ligamentous stability., Competing Interests: Conflito de Interesses Os autores não têm conflitos de interesse a declarar., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

Introduction: The aim of this study was to analyze the waiting list for kidney transplantation in our hospital according to candidate's panel reactive antibodies (cPRA) and its outcomes., Methods: One thousand six hundred forty patients who were on the waiting list between 2015 and 2019 were included. For the analysis, hazard ratios (HR) for transplant were estimated by Fine and Gray's regression model according to panel reactivity and HR for graft loss and death after transplantation., Results: The mean age was 45.39 ± 18.22 years. Male gender was predominant (61.2%), but the proportion decreased linearly with the increase in cPRA (p < 0.001). The distribution of patients according to panels were: 0% (n = 390), 1% - 49% (n = 517), 50% - 84% (n = 269), and ≥ 85% (n = 226). Transplantation was achieved in 85.5% of the sample within a median time of 8 months (CI 95%: 6.9 - 9.1). The estimated HRs for transplantation during the follow-up were 2.84 (95% CI: 2.51 - 3.34), 2.41(95%CI: 2.07 - 2.80), and 2.45(95%CI: 2.08 - 2.90) in the cPRA range of 0%, 1%-49%, and 50%-84%, respectively, compared to cPRA ≥ 85 (p < 0.001). After transplantation, the HR for graft loss was similar in the different cPRA groups, but the HR for death (0.46 95% CI 0.24-0.89 p = 0.022) was lower in the 0% cPRA group when adjusted for age, gender, and presence of donor specific antibodies (DSA)., Conclusion: Patients with cPRA below 85% are more than twice as likely to receive a kidney transplantation with a shorter waiting time. The risk of graft loss after transplantation was similar in the different cPRA groups, and the adjusted risk of death was lower in nonsensitized recipients.

Breast cancer is a significant health concern for women, emphasizing the need for early detection. This research focuses on developing a computer system for asymmetry detection in mammographic images, employing two critical approaches: Dynamic Time Warping (DTW) for shape analysis and the Growing Seed Region (GSR) method for breast skin segmentation. The methodology involves processing mammograms in DICOM format. In the morphological study, a centroid-based mask is computed using extracted images from DICOM files. Distances between the centroid and the breast perimeter are then calculated to assess similarity through Dynamic Time Warping analysis. For skin thickness asymmetry identification, a seed is initially set on skin pixels and expanded based on intensity and depth similarities. The DTW analysis achieves an accuracy of 83%, correctly identifying 23 possible asymmetry cases out of 20 ground truth cases. The GRS method is validated using Average Symmetric Surface Distance and Relative Volumetric metrics, yielding similarities of 90.47% and 66.66%, respectively, for asymmetry cases compared to 182 ground truth segmented images, successfully identifying 35 patients with potential skin asymmetry. Additionally, a Graphical User Interface is designed to facilitate the insertion of DICOM files and provide visual representations of asymmetrical findings for validation and accessibility by physicians.

Although urban greening is universally recognized as an essential part of sustainable and climate-responsive cities, a growing literature on green gentrification argues that new green infrastructure, and greenspace in particular, can contribute to gentrification, thus creating social and racial inequalities in access to the benefits of greenspace and further environmental and climate injustice. In response to limited quantitative evidence documenting the temporal relationship between new greenspaces and gentrification across entire cities, let alone across various international contexts, we employ a spatially weighted Bayesian model to test the green gentrification hypothesis across 28 cities in 9 countries in North America and Europe. Here we show a strong positive and relevant relationship for at least one decade between greening in the 1990s-2000s and gentrification that occurred between 2000-2016 in 17 of the 28 cities. Our results also determine whether greening plays a "lead", "integrated", or "subsidiary" role in explaining gentrification., (© 2022. The Author(s).)

Background: Accurate prediction of clinical outcome is of utmost importance for choices regarding the endovascular treatment (EVT) of acute stroke. Recent studies on the prediction modeling for stroke focused mostly on clinical characteristics and radiological scores available at baseline. Radiological images are composed of millions of voxels, and a lot of information can be lost when representing this information by a single value. Therefore, in this study we aimed at developing prediction models that take into account the whole imaging data combined with clinical data available at baseline., Methods: We included 3,279 patients from the MR CLEAN Registry; a prospective, observational, multicenter registry of patients with ischemic stroke treated with EVT. We developed two approaches to combine the imaging data with the clinical data. The first approach was based on radiomics features, extracted from 70 atlas regions combined with the clinical data to train machine learning models. For the second approach, we trained 3D deep learning models using the whole images and the clinical data. Models trained with the clinical data only were compared with models trained with the combination of clinical and image data. Finally, we explored feature importance plots for the best models and identified many known variables and image features/brain regions that were relevant in the model decision process., Results: From 3,279 patients included, 1,241 (37%) patients had a good functional outcome [modified Rankin Scale (mRS) ≤ 2] and 1,954 (60%) patients had good reperfusion [modified Thrombolysis in Cerebral Infarction (eTICI) ≥ 2b]. There was no significant improvement by combining the image data to the clinical data for mRS prediction [mean area under the receiver operating characteristic (ROC) curve (AUC) of 0.81 vs. 0.80] above using the clinical data only, regardless of the approach used. Regarding predicting reperfusion, there was a significant improvement when image and clinical features were combined (mean AUC of 0.54 vs. 0.61), with the highest AUC obtained by the deep learning approach., Conclusions: The combination of radiomics and deep learning image features with clinical data significantly improved the prediction of good reperfusion. The visualization of prediction feature importance showed both known and novel clinical and imaging features with predictive values., Competing Interests: Erasmus MC received funds from AL. Amsterdam UMC received funds from Stryker for consultations by CM and YR. MUMC received funds from Stryker and Codman for consultations by WZ. CM reports grants from the TWIN Foundation, the CVON/Dutch Heart Foundation, and the European Commission. HM is cofounder and shareholder of Nico.lab. YR and CM own stock in Nico.lab. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ramos, Os, Hilbert, Olabarriaga, Lugt, Roos, Zwam, Walderveen, Ernst, Zwinderman, Strijkers, Majoie, Wermer and Marquering.)

Background: Distal segment atresia (isthmus) is an extremely rare anatomical variant of obstructive aortic arch anomalies., Case Report: We present the case of a newborn who, at 48 hours of life, presented a clinical picture of heart failure. The initial echocardiogram showed a congenital interrupted aortic arch type A, patent ductus arteriosus, and ventricular septal defect. Prostaglandins were initially indicated. Subsequently, a second echocardiogram showed the absence of ductus arteriosus; the CT angiography study confirmed this finding and revealed blood flow to the descending aorta through small intercostal blood vessels. The possibility of atresia of the distal segment (isthmus) of the aortic arch was considered and confirmed at the time of surgery., Conclusions: Aortic atresia should be considered a diagnostic possibility in the presence of type A interrupted aortic arch since the hemodynamic behavior between them is similar. Surgical medical treatment should be individualized since this condition is frequently an emergency in the neonatal period. However, this is not always the case, as other cases have been reported in schoolchildren and adults., (Copyright: © 2022 Permanyer.)

Several species of the planktonic free-living genus Oithona have been successfully used in the larviculture of marine fish and shrimp. However, few studies have been published that allow us to estimate the potential of Oithona nana culture under controlled conditions. This work evaluated the effect of the microalgae Isochrysis galbana and Chaetoceros calcitrans as single (200,000 cells/mL) and mixed diets (100,000 + 100,000 cells/mL) on population and individual growth, ingestion rate, number of spawnings, fertility, development time by stage, and sex ratio of O. nana . We cultured this copepod at 28 ± 0.5 °C, 35 PSU salinity, 125 lux, and 12:12 photoperiod. Results showed that diet had no effect on the final population level (6273-7966 ind/L) or on individual growth, nor on sex ratio, with less males than females. With C. calcitrans , O. nana had a higher filtration rate (57 ng C/ind/day). On the other hand, a mixed diet induced a higher number of spawns (0.4 events/day) and nauplii per spawn (23 ind). Similarly, a single or mixed diet, containing I. galbana, accelerated the development rate by 6.33-7.00 days. We concluded that O. nana can be cultured with both microalgae, indicating its potential use in an intensive system for production. However, more research is required to improve the productivity of O. nana rearing.

Injury to the medial compartment of the knee is the most common ligament injury to this joint. The medial approach must consider the presence of associated anteromedial instability. Untreated injury of these instabilities can result in failure of the other reconstructed ligaments. As treatment is usually associated with other ligaments, it is relevant that the technique could save grafts and synthetic material. This article aims to describe a technique for the treatment of anteromedial instabilities through semimembranosus tendon tenodesis in a more anterior and distal position, promoting the tensioning of the posteromedial structures., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

Thoracoscopic surgical ablation (SA) for atrial fibrillation (AF) has shown to be an effective treatment to restore sinus rhythm in patients with advanced AF. Identifying patients who will not benefit from this procedure would be valuable to improve personalized AF therapy. Machine learning (ML) techniques may assist in the improvement of clinical prediction models for patient selection. The aim of this study is to investigate how available baseline characteristics predict AF recurrence after SA using ML techniques. One-hundred-sixty clinical baseline variables were collected from 446 AF patients undergoing SA in our tertiary referral center. Multiple ML models were trained on five outcome measurements, including either all or a number of key variables selected by using the least absolute shrinkage and selection operator (LASSO). There was no difference in model performance between different ML techniques or outcome measurements. Variable selection significantly improved model performance (AUC: 0.73, 95% CI: 0.68-0.77). Subgroup analysis showed a higher model performance in younger patients (<55 years, AUC: 0.82 vs. >55 years, AUC 0.66). Recurrences of AF after SA can be predicted best when using a selection of baseline characteristics, particularly in young patients.

Background: Digital self-help interventions for reducing the use of alcohol tobacco and other drugs (ATOD) have generally shown positive but small effects in controlling substance use and improving the quality of life of participants. Nonetheless, low adherence rates remain a major drawback of these digital interventions, with mixed results in (prolonged) participation and outcome. To prevent non-adherence, we developed models to predict success in the early stages of an ATOD digital self-help intervention and explore the predictors associated with participant's goal achievement., Methods: We included previous and current participants from a widely used, evidence-based ATOD intervention from the Netherlands (Jellinek Digital Self-help). Participants were considered successful if they completed all intervention modules and reached their substance use goals (i.e., stop/reduce). Early dropout was defined as finishing only the first module. During model development, participants were split per substance (alcohol, tobacco, cannabis) and features were computed based on the log data of the first 3 days of intervention participation. Machine learning models were trained, validated and tested using a nested k-fold cross-validation strategy., Results: From the 32,398 participants enrolled in the study, 80% of participants did not complete the first module of the intervention and were excluded from further analysis. From the remaining participants, the percentage of success for each substance was 30% for alcohol, 22% for cannabis and 24% for tobacco. The area under the Receiver Operating Characteristic curve was the highest for the Random Forest model trained on data from the alcohol and tobacco programs (0.71 95%CI 0.69-0.73) and (0.71 95%CI 0.67-0.76), respectively, followed by cannabis (0.67 95%CI 0.59-0.75). Quitting substance use instead of moderation as an intervention goal, initial daily consumption, no substance use on the weekends as a target goal and intervention engagement were strong predictors of success., Discussion: Using log data from the first 3 days of intervention use, machine learning models showed positive results in identifying successful participants. Our results suggest the models were especially able to identify participants at risk of early dropout. Multiple variables were found to have high predictive value, which can be used to further improve the intervention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ramos, Blankers, van Wingen, de Bruijn, Pauws and Goudriaan.)

Objective: Develop and validate models that predict mortality of patients diagnosed with COVID-19 admitted to the hospital., Design: Retrospective cohort study., Setting: A multicentre cohort across 10 Dutch hospitals including patients from 27 February to 8 June 2020., Participants: SARS-CoV-2 positive patients (age ≥18) admitted to the hospital., Main Outcome Measures: 21-day all-cause mortality evaluated by the area under the receiver operator curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value. The predictive value of age was explored by comparison with age-based rules used in practice and by excluding age from the analysis., Results: 2273 patients were included, of whom 516 had died or discharged to palliative care within 21 days after admission. Five feature sets, including premorbid, clinical presentation and laboratory and radiology values, were derived from 80 features. Additionally, an Analysis of Variance (ANOVA)-based data-driven feature selection selected the 10 features with the highest F values: age, number of home medications, urea nitrogen, lactate dehydrogenase, albumin, oxygen saturation (%), oxygen saturation is measured on room air, oxygen saturation is measured on oxygen therapy, blood gas pH and history of chronic cardiac disease. A linear logistic regression and non-linear tree-based gradient boosting algorithm fitted the data with an AUC of 0.81 (95% CI 0.77 to 0.85) and 0.82 (0.79 to 0.85), respectively, using the 10 selected features. Both models outperformed age-based decision rules used in practice (AUC of 0.69, 0.65 to 0.74 for age >70). Furthermore, performance remained stable when excluding age as predictor (AUC of 0.78, 0.75 to 0.81)., Conclusion: Both models showed good performance and had better test characteristics than age-based decision rules, using 10 admission features readily available in Dutch hospitals. The models hold promise to aid decision-making during a hospital bed shortage., Competing Interests: Competing interests: The COVID-predict consortium declare to have received non-financial support from Castor, who provided access and use of their database free of charge. Pacmed occasionally provided scientific support for methodology and analysis., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Although endovascular treatment (EVT) has greatly improved outcomes in acute ischemic stroke, still one third of patients die or remain severely disabled after stroke. If we could select patients with poor clinical outcome despite EVT, we could prevent futile treatment, avoid treatment complications, and further improve stroke care. We aimed to determine the accuracy of poor functional outcome prediction, defined as 90-day modified Rankin Scale (mRS) score ≥5, despite EVT treatment. Methods: We included 1,526 patients from the MR CLEAN Registry, a prospective, observational, multicenter registry of ischemic stroke patients treated with EVT. We developed machine learning prediction models using all variables available at baseline before treatment. We optimized the models for both maximizing the area under the curve (AUC), reducing the number of false positives. Results: From 1,526 patients included, 480 (31%) of patients showed poor outcome. The highest AUC was 0.81 for random forest. The highest area under the precision recall curve was 0.69 for the support vector machine. The highest achieved specificity was 95% with a sensitivity of 34% for neural networks, indicating that all models contained false positives in their predictions. From 921 mRS 0-4 patients, 27-61 (3-6%) were incorrectly classified as poor outcome. From 480 poor outcome patients in the registry, 99-163 (21-34%) were correctly identified by the models. Conclusions: All prediction models showed a high AUC. The best-performing models correctly identified 34% of the poor outcome patients at a cost of misclassifying 4% of non-poor outcome patients. Further studies are necessary to determine whether these accuracies are reproducible before implementation in clinical practice., (Copyright © 2020 Ramos, Kappelhof, van Os, Chalos, Van Kranendonk, Kruyt, Roos, van der Lugt, van Zwam, van der Schaaf, Zwinderman, Strijkers, van Walderveen, Wermer, Olabarriaga, Majoie and Marquering.)

The problem of controlling a spreading process in a two-layer multiplex networks in such a way that the extinction state becomes a global attractor is addressed. The problem is formulated in terms of a Markov-chain based susceptible-infected-susceptible (SIS) dynamics in a complex multilayer network. The stabilization of the extinction state for the nonlinear discrete-time model by means of appropriate adaptation of system parameters like transition rates within layers and between layers is analyzed using a dominant linear dynamics yielding global stability results. An answer is provided for the central question about the essential changes in the step from a single to a multilayer network with respect to stability criteria and the number of nodes that need to be controlled. The results derived rigorously using mathematical analysis are verified using statical evaluations about the number of nodes to be controlled and by simulation studies that illustrate the stability property of the multilayer network induced by appropriate control action.

Background and Purpose: In patients with SAH, the amount of blood is strongly associated with clinical outcome. However, it is commonly estimated with a coarse grading scale, potentially limiting its predictive value. Therefore, we aimed to develop and externally validate prediction models for clinical outcome, including quantified blood volumes, as candidate predictors., Materials and Methods: Clinical and radiologic candidate predictors were included in a logistic regression model. Unfavorable outcome was defined as a modified Rankin Scale score of 4-6. An automatic hemorrhage-quantification algorithm calculated the total blood volume. Blood was manually classified as cisternal, intraventricular, or intraparenchymal. The model was selected with bootstrapped backward selection and validated with the R 2 , C-statistic, and calibration plots. If total blood volume remained in the final model, its performance was compared with models including location-specific blood volumes or the modified Fisher scale., Results: The total blood volume, neurologic condition, age, aneurysm size, and history of cardiovascular disease remained in the final models after selection. The externally validated predictive accuracy and discriminative power were high ( R 2 = 56% ± 1.8%; mean C-statistic = 0.89 ± 0.01). The location-specific volume models showed a similar performance ( R 2 = 56% ± 1%, P  = .8; mean C-statistic = 0.89 ± 0.00, P  = .4). The modified Fisher models were significantly less accurate ( R 2 = 45% ± 3%, P < .001; mean C-statistic = 0.85 ± 0.01, P  = .03)., Conclusions: The total blood volume-based prediction model for clinical outcome in patients with SAH showed a high predictive accuracy, higher than a prediction model including the commonly used modified Fisher scale., (© 2020 by American Journal of Neuroradiology.)

Background: Despite the increasing international popularity of CrossFit, there is a paucity of scientific evidence on the risk of CrossFit-related musculoskeletal injuries (CRMIs)., Purpose: To investigate the incidence (cumulative incidence proportion [IP] and incidence density [ID]) of CRMIs and the association of CRMIs with personal and training characteristics., Study Design: Descriptive epidemiology study., Methods: A prospective, 12-week descriptive epidemiology cohort study was conducted in a convenience sample of CrossFit facilities in a single Brazilian city. Printed baseline questionnaires were distributed to 13 CrossFit boxes. All participants who filled out the questionnaire and consented to participate in the study were invited to respond to an online follow-up questionnaire every 2 weeks to collect data on CrossFit training characteristics and CRMIs. A CRMI was defined as any self-reported musculoskeletal injury or pain that prevented an athlete from exercising for at least 1 day. The IP was defined as the number of new cases divided by the entire population at risk, while the ID was defined as new events divided by the total person-time exposure in hours. Logistic mixed models were developed to investigate the association of CRMIs with personal and training characteristics., Results: A total of 515 CrossFit participants filled out the baseline questionnaire and provided informed consent, and 406 (78.8%) completed at least 1 follow-up measure. There were 133 participants who reported at least 1 CRMI during the study, and a total of 247 unique and new CRMIs were reported over a total estimated person-time exposure to CrossFit of 13,041 hours. The IP was 32.8% (95% CI, 28.4%-37.5%). The ID was 18.9 (95% CI, 16.6-21.3) per 1000 hours of CrossFit exposure. The shoulders (19.0%; n = 47) and lumbar spine (15.0%; n = 37) were most affected. Muscle injuries (45.3%; n = 112) and joint pain (24.7%; n = 61) were the most common CRMI types reported. Switching between prescribed and scaled down training loads (odds ratio [OR], 3.5 [95% CI, 1.7-7.3]) and previous injuries (OR, 3.2 [95% CI, 1.4-7.7]) were risk factors for a CRMI, while CrossFit experience was identified as a protective factor (OR, 0.7 [95% CI, 0.5-1.0])., Conclusion: In this 12-week prospective study, the ID was 18.9 CRMIs per 1000 hours of exposure; switching between training loads and previous injuries was associated with 3.5- and 3.2-fold higher odds, respectively, of sustaining CRMIs., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Background: Transcatheter aortic valve implantation (TAVI) has become a commonly applied procedure for high-risk aortic valve stenosis patients. However, for some patients, this procedure does not result in the expected benefits. Previous studies indicated that it is difficult to predict the beneficial effects for specific patients. We aim to study the accuracy of various traditional machine learning (ML) algorithms in the prediction of TAVI outcomes., Methods and Results: Clinical and laboratory data from 1,478 TAVI patients from a single centre were collected. The outcome measures were improvement of dyspnoea and mortality. Three experiments were performed using (1) screening data, (2) laboratory data, and (3) the combination of both. Five well-established ML techniques were implemented, and the models were evaluated based on the area under the curve (AUC). Random forest classifier achieved the highest AUC (0.70) for predicting mortality. Logistic regression had the highest AUC (0.56) in predicting improvement of dyspnoea., Conclusions: In our single-centre TAVI population, the tree-based models were slightly more accurate than others in predicting mortality. However, ML models performed poorly in predicting improvement of dyspnoea.

The ability to enhance photosynthetic capacity remains a recognized bottleneck to improving plant productivity. Phototropin blue light receptors (phot1 and phot2) optimize photosynthetic efficiency in Arabidopsis thaliana by coordinating multiple light-capturing processes. In this study, we explore the potential of using protein engineering to improve photoreceptor performance and thereby plant growth. We demonstrate that targeted mutagenesis can decrease or increase the photocycle lifetime of Arabidopsis phototropins in vitro and show that these variants can be used to reduce or extend the duration of photoreceptor activation in planta Our findings show that slowing the phototropin photocycle enhanced several light-capturing responses, while accelerating it reduced phototropin's sensitivity for chloroplast accumulation movement. Moreover, plants engineered to have a slow-photocycling variant of phot1 or phot2 displayed increased biomass production under low-light conditions as a consequence of their improved sensitivity. Together, these findings demonstrate the feasibility of engineering photoreceptors to manipulate plant growth and offer additional opportunities to enhance photosynthetic competence, particularly under suboptimal light regimes., Competing Interests: The authors declare no conflict of interest., (Copyright © 2019 the Author(s). Published by PNAS.)

Background: Injuries to the lateral collateral ligament (LCL) are most commonly associated with anterior cruciate ligament (ACL) injury than with posterior cruciate ligament (PCL) injury. There is currently a paucity in the literature in regards to treatment and outcomes of such lesions., Methods: 30 patients underwent surgical treatment of concomitant LCL and ACL injury or concomitant LCL and PCL injury with follow-up postoperative period of two years. The Lysholm score and varus stress radiographs was calculated and analysed before and at 6, 12, and 24 months postoperatively., Results: There was a significant increase in scores between two timepoints over the follow-up period for both groups: before surgery and after 6 months, and between 6 and 12 months (p < 0.05). The lateral joint opening measured on the varus stress radiographs was greater in group 2 than in group 1 before surgery (p = 0.04). When assessing each group separately, the lateral joint opening decreased at each timepoint in the first year for both groups (p < 0.05)., Conclusion: Patients diagnosed with combined LCL and PCL injuries were shown to have a higher degree of lateral opening at the time of injury when compared to patients with combined LCL and ACL injuries. However, there was no difference in lateral joint opening on stress radiography after 12 months postoperatively in either group. Finally Lysholm scores for both groups significantly increased between the preoperative period and 6 months postoperatively, as well as between 6 months and 12 months postoperatively., Level of Evidence: III., (© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

UVR8 is a plant photoreceptor protein that regulates photomorphogenic and protective responses to UV light. The inactive, homodimeric state absorbs UV-B light, resulting in dissociation into monomers, which are considered to be the active state and comprise a β-propeller core domain and intrinsically disordered N- and C-terminal tails. The C terminus is required for functional binding to signaling partner COP1. To date, however, structural studies have only been conducted with the core domain where the terminal tails have been truncated. Here, we report structural investigations of full-length UVR8 using native ion mobility mass spectrometry adapted for photoactivation. We show that, while truncated UVR8 photoconverts from a single conformation of dimers to a single monomer conformation, the full-length protein exists in numerous conformational families. The full-length dimer adopts both a compact state and an extended state where the C terminus is primed for activation. In the monomer the extended C terminus destabilizes the core domain to produce highly extended yet stable conformations, which we propose are the fully active states that bind COP1. Our results reveal the conformational diversity of full-length UVR8. We also demonstrate the potential power of native mass spectrometry to probe functionally important structural dynamics of photoreceptor proteins throughout nature., Competing Interests: The authors declare no conflict of interest., (Copyright © 2019 the Author(s). Published by PNAS.)

Background: Endovascular treatment (EVT) is effective for stroke patients with a large vessel occlusion (LVO) of the anterior circulation. To further improve personalized stroke care, it is essential to accurately predict outcome after EVT. Machine learning might outperform classical prediction methods as it is capable of addressing complex interactions and non-linear relations between variables. Methods: We included patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry, an observational cohort of LVO patients treated with EVT. We applied the following machine learning algorithms: Random Forests, Support Vector Machine, Neural Network, and Super Learner and compared their predictive value with classic logistic regression models using various variable selection methodologies. Outcome variables were good reperfusion (post-mTICI ≥ 2b) and functional independence (modified Rankin Scale ≤2) at 3 months using (1) only baseline variables and (2) baseline and treatment variables. Area under the ROC-curves (AUC) and difference of mean AUC between the models were assessed. Results: We included 1,383 EVT patients, with good reperfusion in 531 (38%) and functional independence in 525 (38%) patients. Machine learning and logistic regression models all performed poorly in predicting good reperfusion (range mean AUC: 0.53-0.57), and moderately in predicting 3-months functional independence (range mean AUC: 0.77-0.79) using only baseline variables. All models performed well in predicting 3-months functional independence using both baseline and treatment variables (range mean AUC: 0.88-0.91) with a negligible difference of mean AUC (0.01; 95%CI: 0.00-0.01) between best performing machine learning algorithm (Random Forests) and best performing logistic regression model (based on prior knowledge). Conclusion: In patients with LVO machine learning algorithms did not outperform logistic regression models in predicting reperfusion and 3-months functional independence after endovascular treatment. For all models at time of admission radiological outcome was more difficult to predict than clinical outcome.

Interest in the use of renewable raw materials in the preparation of materials has been growing uninterruptedly in recent decades. The aim of this strategy is to offer alternatives to the use of fossil fuel-based raw materials and to meet the demand for materials that are less detrimental to the environment after disposal. In this context, several studies have been carried out on the use of lignocellulosic biomass and its main components (cellulose, hemicelluloses, and lignin) as raw materials for polymeric materials. Lignocellulosic fibers have a high content of cellulose, but there has been a notable lack of investigations on application of the electrospinning technique for solutions prepared from raw lignocellulosic biomass, even though the presence of cellulose favors the alignment of the fiber chains during electrospinning. In this investigation, ultrathin (submicrometric) and nanoscale aligned fibers were successfully prepared via electrospinning (room temperature) of solutions prepared with different contents of lignocellulosic sisal fibers combined with recycled poly(ethylene terephthalate) (PET) using trifluoroacetic acid (TFA) as solvent. The "macro" fibers were deconstructed by the action of TFA, resulting in solutions containing their constituents, i.e., cellulose, hemicelluloses, and lignin, in addition to PET. The "macro" sisal fibers were reconstructed at the nanometer and submicrometric scale from these solutions. The SEM micrographs of the mats containing the components of sisal showed distinct fiber networks, likely due to differences in the solubility of these components in TFA and in their dielectric constants. The mechanical properties of the mats (dynamic mechanical analysis, DMA, and tensile properties) were evaluated with the samples positioned both in the direction ( dir ) of and in opposition ( op ) to the alignment of the nano and ultrathin fibers, which can be considered a novelty in the analysis of this type of material. DMA showed superior values of storage modulus ( E ' at 30 °C) for the mats characterized in the preferential direction of fiber alignment. For example, for mats obtained from solutions prepared from a 0.4 ratio of sisal fibers/PET, Sisal/PET 0.40 dir presented a high E ' value of 765 MPa compared to Sisal/PET 0.40 op that presented an E ' value of 88.4 MPa. The fiber alignment did not influence the T g values (from tan δ peak) of electrospun mats with the same compositions, as they presented similar values for this property. The tensile properties of the electrospun mats were significantly impacted by the alignment of the fibers: e.g., Sisal/PET 0.40 dir presented a high tensile strength value of 15.72 MPa, and Sisal/PET 0.40 op presented a value of approximately 2.5 MPa. An opposite trend was observed regarding the values of elongation at break for these materials. Other properties of the mats are also discussed; such as the index of fiber alignment, average porosity, and surface contact angle. To our knowledge, this is the first time that the influence of fiber alignment on the properties of electrospun mats based on untreated lignocellulosic biomass combined with a recycled polymer, such as PET, has been evaluated. The mats obtained in this study have potential for diversified applications, such as reinforcement for polymeric matrices in nanocomposites, membranes for filtration, and support for enzymes, wherein the fiber alignment, together with other evaluated properties, can impact their effectiveness in these applications.

The problem of stabilizing the spreading process to a prescribed probability distribution over a complex network is considered, where the dynamics of the nodes in the network is given by discrete-time Markov-chain processes. Conditions for the positioning and identification of actuators and sensors are provided, and sufficient conditions for the exponential stability of the desired distribution are derived. Simulations results for a network of N = 10 6 corroborate our theoretical findings., Competing Interests: The authors declare no conflict of interest.

Tissue fixation, a central element in histotechnology, is currently performed with chemical compounds potentially harmful for human health and the environment. Therefore, alternative fixatives are being developed, including alcohol-based solutions. We evaluated several ethanol-based mixtures with additives to study fixative penetration rate, tissue volume changes, and morphologic effects in the bovine testis. Fixatives used were Bouin solution, 4% formaldehyde (F4), 70% ethanol (E70), E70 with 1.5% glycerol (E70G), E70 with 5% acetic acid (E70A), E70 with 1.5% glycerol and 5% acetic acid (E70AG), and E70 with 1.5% glycerol, 5% acetic acid, and 1% dimethyl sulfoxide (DMSO; E70AGD). Five-millimeter bovine testicular tissue cubes could be completely penetrated by ethanol-based fixatives and Bouin solution in 2-3 h, whereas F4 required 21 h. Bouin solution produced general tissue shrinkage, whereas the other fixatives (alcohol-based and F4) caused tissue volume expansion. Although Bouin solution is an excellent fixative for testicular tissue, ethanol-based fixatives showed good penetration rates, low tissue shrinkage, and preserved sufficient morphology to allow identification of the stages of the seminiferous epithelium cycle, therefore representing a valid alternative for histotechnology laboratories. Common additives such as acetic acid, glycerol, and DMSO offered marginal benefits for the process of fixation; E70AG showed the best preservation of morphology with excellent nuclear detail, close to that of Bouin solution.

Background: The middle genicular artery (MGA) is responsible for the blood supply to the cruciate ligaments and synovial tissue. Traumatic sports injuries and surgical procedures (open and arthroscopic) can cause vascular damage. Little attention has been devoted to establish safe parameters for the MGA., Purpose: To investigate the anatomy of the MGA and its relation to the posterior structures of the knees, mainly the posterior capsule and femoral condyles, and to establish safe parameters to avoid harming the MGA., Study Design: Descriptive laboratory study., Methods: Dissection of the MGA was performed in 16 fresh, unpaired adult human cadaveric knees with no macroscopic degenerative or traumatic changes and no previous surgeries. The specimens were meticulously evaluated with emphasis on preservation of the MGA. The distances from the MGA to the medial and lateral femoral condyles were measured. The Mann-Whitney test was used for statistical analysis., Results: In all specimens, the MGA emerged from the anterior aspect of the popliteal artery, distal to the superior genicular arteries, and had a short distal trajectory toward the posterior capsule where it entered proximal to the oblique popliteal ligament. The artery lay in the midportion between the condyles. The distance between the posterior aspect of the tibia and the point of entry of the MGA into the posterior joint capsule was 23.8 ± 7.3 mm (range, 14.72-35.68 mm). There was no correlation between an individual's height and the distance of the entrance point of the MGA into the posterior joint capsule to the posterior superior corner of the tibia., Conclusion: The middle genicular artery lies in the midportion between the medial and lateral femoral condyles., Clinical Relevance: This knowledge is important for the preservation of the blood supply during posterior knee surgical procedures and to settle a secure distance between the posterior aspect of the tibia and the MGA input. This could decrease and prevent iatrogenic vascular injury risk to the MGA., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Background: The condition known as cachexia presents in most patients with malignant tumours, leading to a poor quality of life and premature death. Although the cancer-cachexia state primarily affects skeletal muscle, possible damage in the cardiac muscle remains to be better characterized and elucidated. Leucine, which is a branched chain amino acid, is very useful for preserving lean body mass. Thus, this amino acid has been studied as a coadjuvant therapy in cachectic cancer patients, but whether this treatment attenuates the effects of cachexia and improves cardiac function remains poorly understood. Therefore, using an experimental cancer-cachexia model, we evaluated whether leucine supplementation ameliorates cachexia in the heart., Methods: Male Wistar rats were fed either a leucine-rich or a normoprotein diet and implanted or not with subcutaneous Walker-256 carcinoma. During the cachectic stage (approximately 21 days after tumour implantation), when the tumour mass was greater than 10% of body weight, the rats were subjected to an electrocardiogram analysis to evaluate the heart rate, QT-c, and T wave amplitude. The myocardial tissues were assayed for proteolytic enzymes (chymotrypsin, alkaline phosphatase, cathepsin, and calpain), cardiomyopathy biomarkers (myeloperoxidase, tissue inhibitor of metalloproteinases, and total plasminogen activator inhibitor 1), and caspase-8, -9, -3, and -7 activity., Results: Both groups of tumour-bearing rats, especially the untreated group, had electrocardiography alterations that were suggestive of ischemia, dilated cardiomyopathy, and sudden death risk. Additionally, the rats in the untreated tumour-bearing group but not their leucine-supplemented littermates exhibited remarkable increases in chymotrypsin activity and all three heart failure biomarkers analysed, including an increase in caspase-3 and -7 activity., Conclusions: Our data suggest that a leucine-rich diet could modulate heart damage, cardiomyocyte proteolysis, and apoptosis driven by cancer-cachexia. Further studies must be conducted to elucidate leucine's mechanisms of action, which potentially includes the modulation of the heart's inflammatory process.

New Findings: What is the central question of this study? Can long-term leucine supplementation prevent prolonged strenuous endurance exercise induced cardiac injury? What is the main finding and its importance? Prolonged endurance exercise does not seem to exceed cardiac energetic capacity, hence it does not represent an energy threat to this organ, at least in trained subjects. However, it may induce, in susceptible individuals, a state of cardiac electrical instability, which has been associated with ventricular arrhythmias and sudden cardiac death. This situation might be worsened when combined with leucine supplementation, which leads to increased blood pressure and cardiac injury. Leucine supplementation failed to prevent cardiac fatigue symptoms and may aggravate prolonged strenuous exercise-induced cardiovascular disturbances in trained rats. Observational studies have raised concerns that prolonged strenuous exercise training may be associated with increased risk of cardiac arrhythmia and even primary cardiac arrest or sudden death. It has been demonstrated that leucine can reduce prolonged exercise-induced muscle damage and accelerate the recovery process. The aim of this study was to investigate the effects of prolonged strenuous endurance exercise on cardiovascular parameters and biomarkers of cardiac injury in trained adult male rats and assess the use of leucine as an auxiliary substance to prevent the likely cardiac adverse effects caused by strenuous exercise. Twenty-four male Wistar rats were randomly allocated to receive a balanced control diet (18% protein) or a leucine-rich diet (15% protein plus 3% leucine) for 6 weeks. The rats were submitted to 1 h of exercise, 5 days per week for 6 weeks. Three days after the training period, the rats were submitted to swimming exercise until exhaustion, and cardiac parameters were assessed. Exercising until exhaustion significantly increased cardiac biomarker levels, cytokines and glycogen content inhibited protein synthesis signalling and led to cardiac electrical disturbances. When combined with exercise, leucine supplementation led to greater increases in the aforementioned parameters and also a significant increase in blood pressure and protein degradation signalling. We report, for the first time, that leucine supplementation not only fails to prevent cardiac fatigue symptoms, but may also aggravate prolonged strenuous exercise-induced cardiovascular disturbances in trained rats. Furthermore, we find that exercising until exhaustion can cause cardiac electrical disturbances and damage cardiac myocytes., (© 2016 The Authors. Experimental Physiology © 2016 The Physiological Society.)

Introduction: there are certain factors that influence the early cessation of breastfeeding among which are the demographic, cultural, biological and psychological., Objective: to analyze sociodemographic factors influencing the abandonment of breastfeeding in a support group to it., Methodology: descriptive, prospective, observational, cross-sectional study at the Hospital for Women in Morelia Michoacán, from September to November 2014, a total of 86 women in the postpartum period gynecology floor., Results: the reasons why the LME is abandoned are: age under 25 years (19.1%), urban locality (16.9%), and marital cohabitation (15.7%), and work (9%)., Conclusions: most of the women had that age, education level and location are the main factors that influence as to abandon breastfeeding before the recommended time., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background: Previous studies have shown that acupuncture and electroacupuncture (EA) are effective in the treatment of patients with low back pain. However, there is little evidence to support the use of one intervention over the other. The aim of this study is to compare the effect of acupuncture and electroacupuncture in the treatment of pain and disability in patients with chronic nonspecific low back pain., Methods/design: The study design is a randomized controlled trial. Patients with nonspecific chronic low back pain of more than three months duration are recruited at Rehabilitation Center of Taboao da Serra - SP (Brazil). After examination, sixty-six patients will be randomized into one of two groups: acupuncture group (AG) (n = 33) and electroacupuncture group (EG) (n = 33). Interventions will last one hour, and will happen twice a week for 6 weeks. The primary clinical outcomes will be pain intensity as measured and functional disability., Secondary Outcomes: quality of pain, quality of life. perception of the overall effect, depressive state, flexibility and kinesiophobia. All the outcomes will be assessed will be assessed at baseline, at treatment end, and three months after treatment end. Significance level will be determined at the 5 % level. Results of this trial will help clarify the value of acupuncture and electroacupuncture as a treatment for chronic low back pain and if they are different., Discussion: Results of this trial will help clarify the value of acupuncture needling and electroacupuncture stimulation of specific points on the body as a treatment for chronic low back pain., Trial Registration: Clinicaltrials.gov: NCT02039037 . Register October 30, 2013.

Objective: To evaluate the behavior of acute phase proteins and lipid profile in patients undergoing Roux-en-Y gastric bypass., Methods: We conducted a prospective study, consisting of three moments: M1 - preoperative (24 hours before surgery); M2 - 30 days after surgery; and M3 - 180 days after surgery. We carried measured height and BMI, as well as determined the concentrations of acute phase proteins (C-reactive protein (CRP), albumin and Alpha-1-acid glycoprotein) and total cholesterol, LDL-c, HDL-c and triacylglycerol., Results: participants comprised 25 individuals, with a mean age of 39.28 ± 8.07, 72% female. At all times of the study there was statistically significant difference as for weight loss and BMI. We found a significant decrease in CRP concentrations between the moments M1 and M3 (p = 0.041) and between M2 and M3 (p = 0.018). There was decrease in Alpha-1-GA concentrations between M1 and M2 (p = 0.023) and between M1 and M3 (p = 0.028). The albumin values increased, but did not differ between times. Total cholesterol and triacylglycerol decreased significantly ay all times. LDL-c concentrations decreased and differed between M1 and M2 (p = 0.001) and between M1 and M3 (p = 0.001). HDL-c values increased, however only differing between M1 and M2 (p = 0.050)., Conclusion: Roux-en-Y gastric bypass promoted a decrease in plasma concentrations of CRP and Alpha-1-acid glycoprotein, improving lipid and inflammatory profiles.

Muscle injury causes functional impairment. The healing process takes time and fibrotic tissue can result. Recurrence and delayed recovery remain as unsolved problems. Surgical intervention can be a feasible alternative to avoid early and late complications associated with complete muscle tear in attempt to improve functional results. This article hopes to provide an update about surgical treatments for muscle tears in different scenarios.

Background: Ruthenium (Ru) tetraamines are being increasingly used as nitric oxide (NO) carriers. In this context, pharmacological studies have become highly relevant to better understand the mechanism of action involved., Objective: To evaluate the vascular response of the tetraamines trans-[Ru(II)(NH3)4(Py)(NO)](3+), trans-[Ru(II)(Cl)(NO) (cyclan)](PF6)2, and trans-[Ru(II)(NH3)4(4-acPy)(NO)](3+)., Methods: Aortic rings were contracted with noradrenaline (10(-6) M). After voltage stabilization, a single concentration (10(-6) M) of the compounds was added to the assay medium. The responses were recorded during 120 min. Vascular integrity was assessed functionally using acetylcholine at 10(-6) M and sodium nitroprusside at 10(-6) M as well as by histological examination., Results: Histological analysis confirmed the presence or absence of endothelial cells in those tissues. All tetraamine complexes altered the contractile response induced by norepinephrine, resulting in increased tone followed by relaxation. In rings with endothelium, the inhibition of endothelial NO caused a reduction of the contractile effect caused by pyridine NO. No significant responses were observed in rings with endothelium after treatment with cyclan NO. In contrast, in rings without endothelium, the inhibition of guanylate cyclase significantly reduced the contractile response caused by the pyridine NO and cyclan NO complexes, and both complexes caused a relaxing effect., Conclusion: The results indicate that the vascular effect of the evaluated complexes involved a decrease in the vascular tone induced by norepinephrine (10(-6) M) at the end of the incubation period in aortic rings with and without endothelium, indicating the slow release of NO from these complexes and suggesting that the ligands promoted chemical stability to the molecule. Moreover, we demonstrated that the association of Ru with NO is more stable when the ligands pyridine and cyclan are used in the formulation of the compound.

Objective: to determine the reference points for the exit of the tibial guidewire in relation to the posterior cortical bone of the tibia., Methods: sixteen knees from fresh cadavers were used for this study. Using a viewing device and a guide marked out in millimeters, three guidewires were passed through the tibia at 0, 10 and 15 mm distally in relation to the posterior crest of the tibia. Dissections were performed and the region of the center of the tibial insertion of the posterior cruciate ligament (PCL) was determined in each knee. The distances between the center of the tibial insertion of the PCL and the posterior tibial border (CB) and between the center of the tibial insertion of the PCL and wires 1, 2 and 3 (CW1, CW2 and CW3) were measured., Results: in the dissected knees, we found the center of the tibial insertion of the PCL at 1.09 ± 0.06 cm from the posterior tibial border. The distances between the wires 1, 2 and 3 and the center of the tibial insertion of the PCL were respectively 1.01 ± 0.08, 0.09 ± 0.05 and 0.5 ± 0.05 cm., Conclusion: the guidewire exit point 10 mm distal in relation to the posterior crest of the tibia was the best position for attempting to reproduce the anatomical center of the PCL.

Study Design: A preliminary case-control study., Objective: To assess postural control in individuals with and without non-specific chronic low back pain (cLBP) during quiet standing. cLBP affects 12-33 % of the adult population. Reasons for pain chronicity are yet poorly known. Change in postural control may be a risk factor for cLBP, although available studies are not conclusive., Methods: Sample consisted of 21 individuals with cLBP and 23 controls without cLBP. Balance was assessed using a force plate (Balance Master, NeuroCom) by the modified clinical test of sensory interaction and balance, pain severity by the visual analogue scale, quality of life with the SF-36 Questionnaire, and functional disability with the Roland-Morris Questionnaire., Results: Groups were homogeneous for age, weight, height and body mass index. Relative to controls, participants in the cLBP group had deficits in the postural control, with greater postural sway in the quiet standing condition with closed eyes closed on unstable surfaces (p < 0.05) for the following parameters: total COP oscillation [cLBP 1,432.82 (73.27) vs CG 1,187.77 (60.30)], root mean square sagittal plane [cLBP 1.21 (0.06) vs CG 1.04 (0.04)], COP area [cLBP 24.27 (2.47) vs CG 16.45 (1.79)] and mean speed of oscillation [cLBP 12.97 (0.84) vs CG 10.55 (0.70)]., Conclusion: Postural control, as evidenced by increased oscillation of COP, is impaired in individuals with cLBP relative to controls. Differences are magnified by visual deprivation and unstable surface conditions.

The vapor of the new compound 1,1-dicyano-2-chloro-2,2-difluoroethyl chlorodifluoroacetate, CClF2C(O)OC(CN)2CClF2 and of the known 1,1-dicyano-2,2,2-trifluoroethyl trifluoroacetate, CF3C(O)OC(CN)2CF3, were investigated using vibrational spectroscopy tools. The existence of rotational isomerism was confirmed for CClF2C(O)OC(CN)2CClF2 when the matrix isolated compound was examined in combination with the computational results applying quantum chemical models. From the four conformers gauche-syn-gauche, gauche-syn-anti, syn-syn-anti, syn-syn-gauche (the used nomenclature is with respect to the ϕ(ClC-C(O)), ϕ((O)C-OC), and ϕ(OC-CCl) torsion angles, respectively) predicted for CClF2C(O)OC(CN)2CClF2 the first two forms can be evidenced using Ar-matrix IR spectroscopy, with the first one being the most abundant at room temperature. On the other side, the results obtained for CF3C(O)OC(CN)2CF3 reveals the existence of only one syn-syn-anti form. CClF2C(O)OC(CN)2CClF2 melts at -40 °C and its vapor pressure was fitted by the equation ln p = -4732.6 (1/T) + 10.75 (p [Atm], T [K]) in the range -20 to 20 °C. Its extrapolated boiling point is 167 °C. The first ionization potentials occur for CClF2C(O)OC(CN)2CClF2 and CF3C(O)OC(CN)2CF3 at 12.13 and 12.43 eV, respectively, and were attributed to the ejection of electrons formally located at the carbonylic oxygen lone-pair electrons (nO). The proposed interpretation of the photoelectron spectrum is consistent with related molecules reported previously, and also with the prediction of Outer Valence Green's Functions (OVGF).

Objectives: The aim of the present study was to determine the Chlamydia trachomatis prevalence and to identify the demographic, behavioural and clinical factors associated with C. trachomatis in human immunodeficiency virus infected men., Study: This was a cross-sectional study of C. trachomatis prevalence among human immunodeficiency virus-infected men enrolled at the Outpatient clinic of acquired immunodeficiency syndrome of the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado in Manaus, Amazonas, Brazil. C. trachomatis deoxyribonucleic acid from urethral samples was purified and submitted to real time polymerase chain reaction to identify the presence of C. trachomatis., Results: A total of 276 human immunodeficiency virus-infected men were included in the study. The prevalence of C. trachomatis infection was 12% (95% confidence interval 8.1%-15.7%). The mean age of the participants was 34.63 (standard deviation 10.80) years. Of the 276 human immunodeficiency virus-infected men, 93 (56.2%) had more than one sexual partner in the past year and 105 (38.0%) reported having their first sexual intercourse under the age of 15 years. Men having sex with men and bisexuals amounted to 61.2% of the studied population. A total of 71.7% had received human immunodeficiency virus diagnosis in the last three years and 55.1% were using antiretroviral therapy. Factors associated with C. trachomatis infection in the logistic model were being single (p<0.034), men having sex with men (p<0.021), and having previous sexually transmitted diseases (p<0.001)., Conclusion: The high prevalence of C. trachomatis infection among human immunodeficiency virus-infected men highlights that screening human immunodeficiency virus-infected men for C. trachomatis, especially among men having sex with men, is paramount to control the spread of C. trachomatis infection., (Copyright © 2013 Elsevier Editora Ltda. All rights reserved.)

The vapor of acetyl isocyanide, CH3C(O)NCS, and trifluoroacetyl isocyanide, CF3C(O)NCS, were isolated in solid Ar at 15 K. The existence of rotational isomerism was confirmed when the matrixes were irradiated with broad-band UV-vis light (200 ≤ λ ≤ 800 nm) and also by temperature-dependent Ar-matrix IR spectroscopy. The initial spectra showed the vapor of CH3C(O)NCS and CF3C(O)NCS consist of two conformers syn-syn and syn-anti (with the C═O bond syn with respect to the C-H or C-F bond and syn or anti with respect to the N═C double bond). When CH3C(O)NCS is irradiated, simultaneously with the randomization process, H2CCO and HSCN are produced. In the case of the photolysis of CF3C(O)NCS, the main products are CF3NCS and CO. The assignment of the IR bands to the different photoproducts was made on the basis of the usual criteria, taking account reported antecedents in the literature.

Unlabelled: The head and neck cancer in Michoacán, Mexico, ranks as the third most common cancer and accounts for 12% of deaths. The increase in malnutrition in a patient with this disease has been associated with increased mortality., Material and Methods: We studied prospectively 30 patients of both sexes, aged 18 years with head and neck cancer in the Cancer Care Center of Michoacan. In the evaluation period since August 2010 to August 2011. Formats were used VGS-Oncology (Subjective Global Assessment), NRS 2002 (Nutritional risk screen) and Guss (Gugging Swallowing Screen), through which nutritional risk was determined, and established the swallowing capacity of the study population., Results: In our study, 53.3% of the population had moderate malnutrition according to the VGS Oncology, 33% weight loss record. The NRS 2002 show that 43.3% is at risk of malnutrition. The degree of dysphagia is shown more often in older patients, cancer type and stage of illness., Conclusions: Nutritional risk scales relate directly proportional to tumor location and stage, as well, there are other different oncological factors involved in the patient's nutritional deterioration. Therefore it is of vital importance to have a nutritionist as part of the multidisciplinary team, to detect the nutritional risk and to be able to handle it in an opportune way., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)