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We report a case of a 62-year-old woman, HIV positive, with a 3-week history of jaundice and elevated cholestatic enzymes. Imaging studies displayed intrahepatic biliary dilatation and a central liver lesion. Pathology described lesions of active cholangitis, lymphoplasmacytic infiltration and fibrosis, suggesting a hepatic inflammatory pseudotumour (IPT) IgG4 related. IgG4-related lymphoplasmacytic form of IPT belongs to IgG4-related diseases. We discuss the importance to include IgG4-related hepatic IPT as part of the differential diagnosis of any liver lesion, highlighting potential imaging clues that may help in establishing the correct diagnosis.

While exergames have been used with older adults in an attempt to promote higher physical activity (PA) levels, and its subsequent health benefits, there is a lack of research that objectively quantifies the PA levels that custom-made exergames can produce throughout an extended training program. In this paper, we describe a 3-month intervention study that aimed to measure the participants PA levels during exergames’ sessions and their effectiveness in eliciting the recommended activity levels. Over the course of the study, two groups of older adults participated in either a conventional multidimensional fitness training program of two sessions of exercise per week (n = 16) or in an equivalent combined program (n = 15), of one conventional and one exergame session per week. Both the objective PA levels (through accelerometry) and subjective effort (perceived exertion) were collected in each session. Results revealed that while participants spent more time in moderate-to-vigorous PA during exergaming than during conventional sessions, they also spent less energy, thus working out at lower intensities but for a more sustained amount of time. The self-reported exertion was consistently higher for the sessions of the combined exercise program. We showed that a set of custom-made exergames can be successfully used by trainers to set up personalized training sessions and can be used in combination with regular exercise for sustained long-term training, exposing differences between the two training regimes in terms of efficiency, elicited PA, and perceived effort.

Background Zika virus (ZIKV) infection during pregnancy may cause major congenital defects, including microcephaly, ocular, articular and muscle abnormalities, which are collectively defined as Congenital Zika Syndrome. Here, we performed an in-depth characterization of the effects of congenital ZIKV infection (CZI) in immunocompetent mice. Methods Pregnant dams were inoculated with ZIKV on embryonic day 5.5 in the presence or absence of a sub-neutralizing dose of a pan-flavivirus monoclonal antibody (4G2) to evaluate the potential role of antibody-dependent enhancement phenomenon (ADE) during short and long outcomes of CZI. Findings ZIKV infection induced maternal immune activation (MIA), which was associated with occurrence of foetal abnormalities and death. Therapeutic administration of AH-D antiviral peptide during the early stages of pregnancy prevented ZIKV replication and death of offspring. In the post-natal period, CZI was associated with a decrease in whole brain volume, ophthalmologic abnormalities, changes in testicular morphology, and disruption in bone microarchitecture. Some alterations were enhanced in the presence of 4G2 antibody. Interpretation Our results reveal that early maternal ZIKV infection causes several birth defects in immunocompetent mice, which can be potentiated by ADE phenomenon and are associated with MIA. Additionally, antiviral treatment with AH-D peptide may be beneficial during early maternal ZIKV infection. Fund This work was supported by the Brazilian National Science Council (CNPq, Brazil), Minas Gerais Foundation for Science (FAPEMIG), Funding Authority for Studies and Projects (FINEP), Coordination of Superior Level Staff Improvement (CAPES), National Research Foundation of Singapore and Centre for Precision Biology at Nanyang Technological University.

[EN] Two of the most popular mediums for virtual reality are head-mounted displays and surround-screen projection systems, such as CAVE Automatic Virtual Environments. In recent years, HMDs suffered a significant reduction in cost and have become widespread consumer products. In contrast, CAVEs are still expensive and remain accessible to a limited number of researchers. This study aims to evaluate both objective and subjective characteristics of a CAVE-like monoscopic low-cost virtual reality surround-screen projection system compared to advanced setups and HMDs. For objective results, we measured the head position estimation accuracy and precision of a low-cost active infrared (IR) based tracking system, used in the proposed low-cost CAVE, relatively to an infrared marker-based tracking system, used in a laboratory-grade CAVE system. For subjective characteristics, we investigated the sense of presence and cybersickness elicited in users during a visual search task outside personal space, beyond arms reach, where the importance of stereo vision is diminished. Thirty participants rated their sense of presence and cybersickness after performing the VR search task with our CAVE-like system and a modern HMD. The tracking showed an accuracy error of 1.66 cm and .4 mm of precision jitter. The system was reported to elicit presence but at a lower level than the HMD, while causing significant lower cybersickness. Our results were compared to a previous study performed with a laboratory-grade CAVE and support that a VR system implemented with low-cost devices could be a viable alternative to laboratory-grade CAVEs for visual search tasks outside the users personal space., This work was supported by the Fundação para a Ciência e Tecnologia through the AHA project (CMUPERI/HCI/0046/2013), by the INTERREG program through the MACBIOIDI project (MAC/1.1.b/098), LARSyS (UIDB/50009/2020), NOVA-LINCS (UID/CEC/04516/2019), by Fundació la Marató de la TV3 (201701-10), and the European Union through the Operational Program of the European Regional Development Fund (ERDF) of the Valencian Community 2014-2020 (IDIFEDER/2018/029)

It has been shown that fear conditioning improves the steady-state evoked potentials driven by a long lasting amplitude modulated tone in the inferior colliculus. In this work we tested the hypothesis that the amygdala modulates this effect, since it plays a crucial role in assessing the biological relevance of environmental stimuli. We inhibited the basolateral nucleus of the amygdala of rats by injecting a GABAa receptor agonist (muscimol) before the recall test session of an auditory fear conditioning paradigm and recorded the evoked activity in the central nucleus of the inferior colliculus. According to our results, the treatment with muscimol decreased the expression of freezing behavior during the recall test session, but did not impair the entrainment of the evoked activity in the inferior colliculus induced by fear conditioning. We repeated the injection protocol with another group of rats but without pairing the tone to an aversive stimulus and observed that the inhibition of the basolateral amygdala enhances the stimulus-driven activity in the inferior colliculus regardless of the conditioning task. Our findings suggest that the basolateral amygdala exerts a tonic modulation over the encoding of sensory information at the early stages of the sensory pathway.

Evidence suggests that the pathophysiology associated with epileptic susceptibility may disturb the functional connectivity of neural circuits and compromise the brain functions, even when seizures are absent. Although memory impairment is a common comorbidity found in patients with epilepsy, it is still unclear whether more caudal structures may play a role in cognitive deficits, particularly in those cases where there is no evidence of hippocampal sclerosis. This work used a genetically selected rat strain for seizure susceptibility (Wistar audiogenic rat, WAR) and distinct behavioral (motor and memory-related tasks) and electrophysiological (inferior colliculus, IC) approaches to access acoustic primary integrative network properties. The IC neural assemblies’ response was evaluated by auditory transient (focusing on bottom-up processing) and steady-state evoked response (ASSR, centering on feedforward and feedback forces over neural circuitry). The results show that WAR displayed no disturbance in motor performance or hippocampus-dependent memory tasks. Nonetheless, WAR animals exhibited significative impairment for auditory fear conditioning (AFC) along with no indicative of IC plastic changes between the pre-conditioning and test phases (ASSR coherence analysis). Furthermore, WAR’s IC response to transient stimuli presented shorter latency and higher amplitude compared with Wistar; and the ASSR analysis showed similar results for WAR and Wistar animals under subthreshold dose of pentylenetetrazol (pro-convulsive drug) for seizure-induction. Our work demonstrated alterations at WAR IC neural network processing, which may explain the associated disturbance on AFC memory.

The inelastic second-order behavior of steel structural columns under minor-axis bending is presented in this article. To study this behavior, a nonlinear frame element formulation is adopted in which the steel's plasticity process is accompanied at the nodal points of each finite element through the refined plastic-hinge method (RPHM). A tangent modulus approach is employed in order to consider the stiffness degradation in function of the internal forces' variation, and the second-order effects, residual stresses and geometric imperfections are considered in the modeling of column behavior. As a criterium for defining the ultimate limit state of the column cross-section, strength surfaces are adopted. These surfaces describe the interaction between the axial force and bending moment (N-M interaction diagrams). To solve the nonlinear equilibrium equation for the structural system, the Newton-Raphson method is used, coupled with continuation strategies. Columns with different slenderness, boundary and loading conditions are analyzed, and the results obtained are comparable to those found by other researchers. The results lead to the conclusion that the numerical approach adopted in this study can be used for a better behavioral understanding of the steel column under weak-axis bending.

In this article, we provide an overview of the design and features of a portable exergaming platform with augmented reality components whose intention is to fight the sedentary lifestyle and promote active aging for older people. Exergames are projected on the floor, and the user’ movements and gestures are tracked by motion-sensing technology while interacting with the games. By playing the exergames, older adults can work on their physical fitness while training the cognitive function through a rich diversification of stimuli.

The opportunity to develop new natural user interfaces has come forward due to the recent development of inexpensive full body tracking sensors, which has made this technology accessible to millions of users. In this paper, we present a comparative study between two natural user interfaces, and a cardiorespiratory training exergame developed based on the study results. The focus was on studying interfaces that could easily be used by an elderly population for interaction with floor projection displays. One interface uses both feet position to control a cursor and feet distance to trigger activation. In the alternative interface, the cursor is controlled by forearm ray casting into the projection floor and interaction is activated by hand pose. These modes of interaction were tested with 19 elderly participants in a point-and-click and a drag-and-drop task using a between-subjects experimental design. The usability, perceived workload and performance indicators were measured for each interface. Results show a clear preference towards the feet-controlled interface and a marginally better performance for this method. The results from the study served as a guide to the design of a cardiorespiratory fitness exergame for the elderly. The game “Grape Stomping” uses ground projection and mapping to display real-size winery elements. These virtual elements are used to simulate, in a playful way, the process of grape maceration through repeated stomping. A playtest session with nine elderly users was completed and its insights are presented in addition to the description of the game.

We present a case of a 68-year-old man with chronic hepatitis C infection, with no evidence of chronic liver disease during the first years of follow-up, diagnosed with a hepatocellular carcinoma (HCC) with 40 mm (α-fetoprotein (AFP) 205 ng/mL). He underwent segmental liver resection and pathology analysis was consistent with HCC and cirrhosis in the adjacent liver. Four months after surgery, AFP raised up to 126 661 ng/mL and abdominal MRI revealed a multinodular HCC. Patient rejected treatment with sorafenib and started megestrol and an herbal medicine, soursop (Annona muricata). Six months later, AFP markedly decreased (28 ng/mL) and abdominal MRI showed decreasing size and number of lesions. At 5 years of follow-up, he has no evidence of HCC. Spontaneous regression of HCC is a rare condition and the underlying mechanism is unclear. In this case there is a temporal relation between the start of megestrol and Annona muricata and HCC regression.

The unpredictability of spontaneous and recurrent seizures significantly impairs the quality of life of patients with epilepsy. Probing neural network excitability with deep brain electrical stimulation (DBS) has shown promising results predicting pathological shifts in brain states. This work presents a proof-of-principal that active electroencephalographic (EEG) probing, as a seizure predictive tool, is enhanced by pairing DBS and the electrographic seizure itself. The ictogenic model used consisted of inducing seizures by continuous intravenous infusion of pentylenetetrazol (PTZ — 2.5 mg/ml/min) while a probing DBS was delivered to the thalamus (TH) or amygdaloid complex to detect changes prior to seizure onset. Cortical electrophysiological recordings were performed before, during, and after PTZ infusion. Thalamic DBS probing, but not amygdaloid, was able to predict seizure onset without any observable proconvulsant effects. However, previously pairing amygdaloid DBS and epileptic polyspike discharges (day-1) elicited distinct preictal cortically recorded evoked response (CRER) (day-2) when compared with control groups that received the same amount of electrical pulses at different moments of the ictogenic progress at day-1. In conclusion, our results have demonstrated that the pairing strategy potentiated the detection of an altered brain state prior to the seizure onset. The EEG probing enhancement method opens many possibilities for both diagnosis and treatment of epilepsy.

The rat inferior colliculus (IC) is a major midbrain relay for ascending inputs from the auditory brain stem and has been suggested to play a key role in the processing of aversive sounds. Previous studies have demonstrated that auditory fear conditioning (AFC) potentiates transient responses to brief tones in the IC, but it remains unexplored whether AFC modifies responses to sustained periodic acoustic stimulation-a type of response called the steady-state evoked potential (SSEP). Here we used an amplitude-modulated tone-a 10-kHz tone with a sinusoidal amplitude modulation of 53.7 Hz-as the conditioning stimulus (CS) in an AFC protocol (5 CSs per day in 3 consecutive days) while recording local field potentials (LFPs) from the IC. In the preconditioning session (

Aims: Identify which nursing interventions should be implemented in the stress control of the family of the sick person in a critical condition. Methods: Integrative literature review to explore the evidence of the last five years, using the EBSCOhost electronic search platform. Of the 67 articles found, 15 were considered potentially relevant, thus joining our sample. Results: The nursing interventions found in the literature were split into five areas of “action”. These include the need of nurses to assess the Family/ Caregivers Stress and family coping, implementing nursing interventions centered on each family, establishing an empathetic relationship and trust that facilitates and promotes family involvement in the care process as well as in the decision-making processes. They should also facilitate the communication with the family promoting active listening, informing them about the care of their relative, stating their support in this process, comforting them and fostering the development of coping mechanisms. Conclusions: The nurses should include the family of the person in critical condition in their care plan as stress and suffering control strategy. An approach based on this scientific evidence should be tested and validated in future studies.

SummaryBackground Therapeutic drug monitoring is a powerful strategy known to improve the clinical outcomes and to optimise the healthcare resources in the treatment of autoimmune diseases. Currently, most of the methods commercially available for the quantification of infliximab (IFX) are ELISA-based, with a turnaround time of approximately 8 h, and delaying the target dosage adjustment to the following infusion. Aim To validate the first point-of-care IFX quantification device available in the market – the Quantum Blue Infliximab assay (Buhlmann, Schonenbuch, Switzerland) – by comparing it with two well-established methods. Methods The three methods were used to assay the IFX concentration of spiked samples and of the serum of 299 inflammatory bowel diseases (IBD) patients undergoing IFX therapy. Results The point-of-care assay had an average IFX recovery of 92%, being the most precise among the tested methods. The Intraclass Correlation Coefficients of the point-of-care IFX assay vs. the two ELISA-based established methods were 0.889 and 0.939. Moreover, the accuracy of the point-of-care IFX compared with each of the two reference methods was 77% and 83%, and the kappa statistics revealed a substantial agreement (0.648 and 0.738). Conclusions The Quantum Blue IFX assay can successfully replace the commonly used ELISA-based IFX quantification kits. This point-of-care IFX assay is able to deliver the results within 15 min makes it ideal for an immediate target concentration adjusted dosing. Moreover, it is a user-friendly desktop device that does not require specific laboratory facilities or highly specialised personnel.

Sedentarism has a negative impact on health, life expectancy and quality of life, especially in older adults. The assessment of functional fitness helps evaluating the effects of ageing and sedentarism, and this assessment is typically done through validated battery tests such as the Senior Fitness Test (SFT). In this paper we present a computer-based system for assisting and automating SFT administration and scoring in the elderly population. Our system assesses lower body strength, agility and dynamic balance, and aerobic endurance making use of a depth sensor for body tracking and multiple gesture detectors for the evaluation of movement execution. The system was developed and trained with optimal data collected in laboratory conditions and its performance was evaluated in a real environment with 22 elderly end-users, and compared to traditional SFT administered by an expert. Results show a high accuracy of our system in identifying movement patterns (>95%) and consistency with the traditional fitness assessment method. Our results suggest that this technology is a viable low cost option to assist in the fitness assessment of elderly that could be deployed for at home use in the context of fitness programs.

{agoncalves, jabrantes, gsaponaro, ljamone, alex}@isr.ist.utl.ptAbstract —Inspired by the extraordinary ability of younginfants to learn how to grasp and manipulate objects, manyworks in robotics have proposed developmental approaches toallow robots to learn the effects of their own motor actions onobjects, i.e., the objects affordances. While holding an object,infants also promote its contact with other objects, resulting inobject–object interactions that may afford effects not possibleotherwise. Depending on the characteristics of both the heldobject (intermediate) and the acted object (primary), systematicoutcomes may occur, leading to the emergence of a primitiveconcept of tool. In this paper we describe experiments witha humanoid robot exploring object–object interactions in aplayground scenario and learning a probabilistic causal modelof the effects of actions as functions of the characteristics of bothobjects. The model directly links the objects' 2D shape visualcues to the effects of actions. Because no object recognitionskills are required, generalization to novel objects is possibleby exploiting the correlations between the shape descriptors.We show experiments where an affordance model is learned ina simulated environment, and is then used on the real roboticplatform, showing generalization abilities in effect prediction.We argue that, despite the fact that during exploration noconcept of tool is given to the system, this very concept mayemerge from the knowledge that intermediate objects lead tosignicant effects when acting on other objects.

Endowing artificial agents with the ability of predicting the consequences of their own actions and effi- ciently planning their behaviors based on such predictions is a fundamental challenge both in artificial intelligence and robotics. A computationally practical yet powerful way to model this knowledge, referred as objects affordances, is through probabilistic dependencies between actions, objects and effects: this allows to make inferences across these dependencies, such as i) predicting the effects of an action over an object, or ii) selecting the best action from a repertoire in order to obtain a desired effect over an object. We propose a probabilistic model capable of learning the mutual interaction between objects in complex tasks that involve manipulation, where one of the objects plays an active tool role while being grasped and used (e.g., a hammer) while another item is passively acted upon (e.g., a nail). We consider visual affordances, meaning that we do not model object labels or categories; instead, we compute a set of visual features that represent geometrical properties (e.g., convexity, roundness), which allows to generalize previously- acquired knowledge to new objects. We describe an experiment in which a simulated humanoid robot learns an affordance model by autonomously exploring different actions with the objects present in a playground scenario. We report results showing that the robot is able to i) learn meaningful relation- ships between actions, tools, other objects and effects, and to ii) exploit the acquired knowledge to make predictions and take optimal decisions.

Anaemia can be considered the most common extra-intestinal manifestation in inflammatory bowel disease. Nevertheless, anaemia is often under-diagnosed and under-treated both in adults and children with inflammatory bowel disease. Herein, we report the consensus statements on the management of anaemia in inflammatory bowel disease developed by the Portuguese Working Group on Inflammatory Bowel Disease (known as Grupo de Estudo da Doença Inflamatória Intestinal - GEDII) to aid clinicians in daily management of inflammatory bowel disease patients.A comprehensive literature review was conducted in order to prepare consensus statements on the following topics: (1) prevalence and diagnosis of anaemia in inflammatory bowel disease, (2) iron supplementation for the prevention of anaemia in inflammatory bowel disease and (3) treatment of anaemia in inflammatory bowel disease. The final statements for each topic were discussed at a consensus meeting and rated according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.It was concluded that anaemia has a high incidence and prevalence in inflammatory bowel disease, particularly in those with active disease and hospitalised. Patients with anaemia had decreased quality of life and frequently complained of fatigue. Absolute indications for intravenous therapy should be considered: (1) moderate to severe anaemia (haemoglobin10.5 g/dL) or clearly symptomatic anaemia; (2) previous intolerance to oral iron supplements; (3) inappropriate response to oral iron; (4) active severe intestinal disease; (5) need for a quick therapeutic response (e.g. surgery in the short term); (6) concomitant therapy with erythropoiesis-stimulating agent; and (7) patient's preference.Introdução: A anemia pode ser considerada a manifestação extra-intestinal mais comum na doença inflamatória intestinal. Ainda assim, a anemia é subdiagnosticada e subtratada tanto em adultos como em crianças com doença inflamatória intestinal. Assim, apresentamos o consenso alcançado pelo Grupo de Estudo da Doença Inflamatória Intestinal - GEDII relativamente à gestão da anemia na doença inflamatória intestinal, com o objetivo de facilitar o acompanhamento clínico dos doentes com doença inflamatória intestinal. Material e Métodos: Foi conduzida uma revisão exaustiva da literatura, por forma a preparar statements de consenso nos seguintes tópicos: (1) prevalência e diagnóstico de anemia na doença inflamatória intestinal, (2) ferro da prevenção da anemia na doença inflamatória intestinal e (3) tratamento da anemia na doença inflamatória intestinal. Os statements finais para cada tópico foram discutidos na reunião de consenso e classificados de acordo com os níveis de evidência definidos em 2011 pelo Oxford Centre for Evidence-Based Medicine. Consensos: Concluiu-se que a anemia tem elevada incidência e prevalência na doença inflamatória intestinal, particularmente entre pacientes com doença ativa e hospitalizados. Indicações absolutas para terapia intravenosa devem ser consideradas quando existe: (1) anemia moderada a severa (hemoglobina10,5 g/dL) ou anemia claramente sintomática; (2) intoler'ncia prévia à terapêutica com ferro por via oral; (3) resposta inadequada à terapêutica com ferro por via oral; (4) doença intestinal ativa severa; (5) necessidade de resposta terapêutica rápida (e.g. cirurgia a curto prazo); (6) terapêutica concomitante com agente estimulante da eritropoiese; e (7) preferência do paciente.

OBJETIVO: Realizar uma análise comparativa do teste de caminhada de seis minutos em crianças e adolescentes saudáveis em pistas de diferentes metragens (30,5 e 20 metros). MÉTODOS: Foram avaliados 67 voluntários de escolas públicas de uma cidade de uma região metropolitana, com idades de 7 a 14 anos, sendo 36 meninos e 31 meninas. Todos foram submetidos a quatro testes de caminhada, sendo dois em cada uma das pistas. As variáveis analisadas foram: distância caminhada, trabalho de caminhada, pressão arterial média (PAM), frequência cardíaca (FC) e saturação de oxigênio (SaO2). Para análise estatística, foi utilizado ANOVA One-Way para medidas repetidas para um p

Physical activity has been proposed as a behavioral intervention that improves learning and memory; nevertheless, the mechanisms underlying these health benefits are still not well understood. Neuronal Calcium Sensor-1 (NCS-1) is a member of a superfamily of proteins that respond to local Ca(2+) changes shown to have an important role in learning and memory. The aim of the present study was to investigate the effects of swimming training on NCS-1 levels in the rat brain after accessing cognitive performance. Wistar rats were randomly assigned to sedentary (SG) or exercised groups (EG). The EG was subject to forced swimming activity, 30 min/day, 5 days/week, during 8 weeks. Progressive load trials were performed in the first and last week in order to access the efficiency of the training. After the 8 week training protocol, memory performance was evaluated by the novel object preference and object location tasks. NCS-1 levels were measured in the cortex and hippocampus using immunoblotting. The EG performed statistically better for the spatial short-term memory (0.73 ± 0.01) when compared to the SG (0.63 ± 0.02; P0.05). No statistically significant exercise-effect was observed in the novel object preference task (SG 0.65 ± 0.02 and EG 0.68 ± 0.02; p0.05). In addition, chronic exercise promoted a significant increase in hippocampal NCS-1 levels (1.8 ± 0.1) when compared to SG (1.17 ± 0.08; P0,05), but had no effect on cortical NCS-1 levels (SG 1.6 ± 0.1 and EG 1.5 ± 0.1; p0.05). Results suggest that physical exercise would modulate the state of the neural network regarding its potential for plastic changes: physical exercise could be modulating NCS-1 in an activity dependent manner, for specific neural substrates, thus enhancing the cellular/neuronal capability for plastic changes in these areas; which, in turn, would differentially effect ORM task performance for object recognition and displacement.