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A male term neonate was admitted to the neonatal intensive care unit in the first hours of life with central cyanosis. Echocardiogram showed severe biventricular hypertrophy, markedly right-sided, tricuspid regurgitation, a patent foramen ovale and a closed ductus arteriosus (CDA). The mother recalled being treated with a single dose of intravenous diclofenac for low back pain 2 weeks earlier. The newborn was started on propranolol with symptomatic improvement and was discharged on day 10. At 1-month follow-up, he showed complete resolution of ventricular hypertrophy and suspended propranolol. In the literature, of the 22 cases of CDA after intrauterine exposure to diclofenac, 11 resolved in utero, 3 required ventilatory and inotropic support and 1 evolved to persistent pulmonary hypertension. In this case, a thorough anamnesis was key to identify the probable cause of an otherwise unexplained transient ventricular hypertrophy. This case also alerts to the fetal risks of non-steroidal anti-inflammatory drugs during the third trimester, requiring close monitoring.

Background: Tuberculosis (TB) is one of the top ten causes of death worldwide, while Chagas disease (CD) is the parasitic disease that kills the largest number of people in the Americas. TB is the leading cause of death for patients with AIDS; it kills 1.5 million people and causes 10 million new cases every year. The lack of newly developed chemotherapeutic agents and insufficient access to health care services for a diagnosis increase the incidence of multidrug-resistant TB (MDRTB) cases. Although CD was identified in 1909, the chronic stages of the disease still lack adequate treatment. Objective: The purpose of this work was to design and synthesize two new series of 2-nitroimidazole 5a-e and imidazooxazoles 6a-e with 1H-1,2,3-triazolil nucleus and evaluate their activities against Tc and Mycobacterium tuberculosis (Mtb). Methods: Two series of five compounds were synthesized in a 3 or 4-step route in moderated yields, and their structures were confirmed by NMR spectral data analyses. The in vitro antitrypanosomal evaluation of products was carried out in an intracellular model using L929 cell line infected with trypomastigotes and amastigote forms of Tc of β-galactosidase-transfected Tulahuen strain. Their antimycobacterial activity was evaluated against Mtb strain H37Rv. Results: In general, 2-nitroimidazolic derivatives proved to be more potent in regard to antitrypanocidal and antimycobacterial activity. The non-cytotoxic 2-nitroimidazole derivative 5b was the most promising with a half maximum inhibitory concentration of 3.2 μM against Tc and a minimum inhibitory concentration of 65.3 μM against Mtb. Conclusion: Our study reinforced the importance of 2-nitroimidazole and 1H-1,2,3-triazole nuclei in antimicrobial activity. In addition, derivative 5b proved to be the most promising, presenting important activity against Tc and Mtb and could be used as a starting point for the development of new agents against these diseases.

© The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/ by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com, Several CSF and blood biomarkers for genetic frontotemporal dementia have been proposed, including those reflecting neuroaxonal loss (neurofilament light chain and phosphorylated neurofilament heavy chain), synapse dysfunction [neuronal pentraxin 2 (NPTX2)], astrogliosis (glial fibrillary acidic protein) and complement activation (C1q, C3b). Determining the sequence in which biomarkers become abnormal over the course of disease could facilitate disease staging and help identify mutation carriers with prodromal or early-stage frontotemporal dementia, which is especially important as pharmaceutical trials emerge. We aimed to model the sequence of biomarker abnormalities in presymptomatic and symptomatic genetic frontotemporal dementia using cross-sectional data from the Genetic Frontotemporal dementia Initiative (GENFI), a longitudinal cohort study. Two-hundred and seventy-five presymptomatic and 127 symptomatic carriers of mutations in GRN, C9orf72 or MAPT, as well as 247 non-carriers, were selected from the GENFI cohort based on availability of one or more of the aforementioned biomarkers. Nine presymptomatic carriers developed symptoms within 18 months of sample collection ('converters'). Sequences of biomarker abnormalities were modelled for the entire group using discriminative event-based modelling (DEBM) and for each genetic subgroup using co-initialized DEBM. These models estimate probabilistic biomarker abnormalities in a data-driven way and do not rely on previous diagnostic information or biomarker cut-off points. Using cross-validation, subjects were subsequently assigned a disease stage based on their position along the disease progression timeline. CSF NPTX2 was the first biomarker to become abnormal, followed by blood and CSF neurofilament light chain, blood phosphorylated neurofilament heavy chain, blood glial fibrillary acidic protein and finally CSF C3b and C1q. Biomarker orderings did not differ significantly between genetic subgroups, but more uncertainty was noted in the C9orf72 and MAPT groups than for GRN. Estimated disease stages could distinguish symptomatic from presymptomatic carriers and non-carriers with areas under the curve of 0.84 (95% confidence interval 0.80-0.89) and 0.90 (0.86-0.94) respectively. The areas under the curve to distinguish converters from non-converting presymptomatic carriers was 0.85 (0.75-0.95). Our data-driven model of genetic frontotemporal dementia revealed that NPTX2 and neurofilament light chain are the earliest to change among the selected biomarkers. Further research should investigate their utility as candidate selection tools for pharmaceutical trials. The model's ability to accurately estimate individual disease stages could improve patient stratification and track the efficacy of therapeutic interventions., This study was supported in the Netherlands by two Memorabel grants from Deltaplan Dementie (The Netherlands Organisation for Health Research and Development and Alzheimer Nederland; grant numbers 733050813,733050103 and 733050513), the Bluefield Project to Cure Frontotemporal Dementia, the Dioraphte foundation (grant number 1402 1300), the European Joint Programme—Neurodegenerative Disease Research and the Netherlands Organisation for Health Research and Development (PreFrontALS: 733051042, RiMod-FTD: 733051024); V.V. and S.K. have received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 666992 (EuroPOND). E.B. was supported by the Hartstichting (PPP Allowance, 2018B011); in Belgium by the Mady Browaeys Fonds voor Onderzoek naar Frontotemporale Degeneratie; in the UK by the MRC UK GENFI grant (MR/M023664/1); J.D.R. is supported by an MRC Clinician Scientist Fellowship (MR/M008525/1) and has received funding from the NIHR Rare Disease Translational Research Collaboration (BRC149/NS/MH); I.J.S. is supported by the Alzheimer’s Association; J.B.R. is supported by the Wellcome Trust (103838); in Spain by the Fundació Marató de TV3 (20143810 to R.S.V.); in Germany by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy—ID 390857198) and by grant 779357 ‘Solve-RD’ from the Horizon 2020 Research and Innovation Programme (to MS); in Sweden by grants from the Swedish FTD Initiative funded by the Schörling Foundation, grants from JPND PreFrontALS Swedish Research Council (VR) 529–2014-7504, Swedish Research Council (VR) 2015–02926, Swedish Research Council (VR) 2018–02754, Swedish Brain Foundation, Swedish Alzheimer Foundation, Stockholm County Council ALF, Swedish Demensfonden, Stohnes foundation, Gamla Tjänarinnor, Karolinska Institutet Doctoral Funding and StratNeuro. H.Z. is a Wallenberg Scholar.

BACKGROUND Accurate diagnosis of epidermolysis bullosa (EB) has significant implications for prognosis, management, and genetic counseling. OBJECTIVE To describe diagnostic testing patterns and assess diagnostic concordance of transmission electron microscopy (TEM), immunofluorescence mapping (IFM), and genetic analysis for EB. METHODS A retrospective cohort included patients enrolled in the Epidermolysis Bullosa Clinical Characterization and Outcomes Database from January 1, 2004, to July 8, 2019. Tests concluding the same EB type (EB simplex, junctional EB, dominant dystrophic EB, and recessive dystrophic EB) were considered concordant; those concluding different EB types were considered discordant; and those with nonspecific/nondefinitive results were equivocal. RESULTS A total of 970 diagnostic tests were conducted from 1984 to 2018 in 771 patients. Genetic analyses were performed chronologically later than IFM or TEM (P

Background The current classification for alopecia areata (AA) does not provide a consistent assessment of disease severity. Objective To develop an AA severity scale based on expert experience. Methods A modified Delphi process was utilized. An advisory group of 22 AA clinical experts from the United States was formed to develop this AA scale. Representatives from the pharmaceutical industry provided feedback during its development. Results Survey responses were used to draft severity criteria, aspiring to develop a simple scale that may be easily applied in clinical practice. A consensus vote was held to determine the final AA severity statement, with all AA experts agreeing to adopt the proposed scale. Limitations The scale is a static assessment intended to be used in clinical practice and not clinical trials. Conclusion The final AA disease severity scale, anchored in the extent of hair loss, captures key features commonly used by AA experts in clinical practice. This scale will better aid clinicians in appropriately assessing severity in patients with this common disease.

Background Genitourinary syndrome of menopause (GSM) can have a great impact on the quality of life (QOL), and affects between 53.8% and 90% of postmenopausal women. The literature suggests that vaginal laser therapy could be an effective treatment for GSM symptoms, but its efficacy and safety have not been established and international societies do not endorse its use. Despite that, there has been an increase in the use of vaginal laser therapy globally over the last decade. Objective The objective of this review is to evaluate the literature which assesses the efficacy and safety of the vaginal laser therapy in the treatment of GSM. Methods A comprehensive literature search was conducted electronically using Embase and PubMed to retrieve studies assessing evidence for the efficacy and safety of vaginal laser therapy for GSM or vulvovaginal atrophy up to June 2021. Results A total of 64 studies were finally included in the review. There were 10 controlled intervention studies, 7 observational cohort and cross-sectional studies and 47 before-after studies without a control group. Conclusion Vaginal laser seems to improve scores on the Visual Analogue Scale (VAS), Female Sexual Function Index (FSFI) and Vaginal Health Index (VHI) in GSM over the short term. Safety outcomes are underreported and short-term. Further well-designed clinical trials with sham-laser control groups and evaluating objective variables are needed to provide the best evidence on efficacy.

RESUMEN Introduccion y objetivos Muchos sistemas sanitarios han iniciado programas de consulta electronica, aunque poco se conoce de su impacto en acceso, seguridad y satisfaccion. El objetivo de este estudio es evaluar el impacto clinico de la puesta en marcha de un modelo de atencion ambulatoria que incluye una consulta electronica (e-consulta) inicial comparandolo con un modelo presencial de acto unico. Metodos Se selecciono a pacientes con al menos 1 consulta al servicio de cardiologia entre 2010 y 2019. Mediante un modelo de regresion de series temporales interrumpidas, se analizo el impacto de la incorporacion de la e-consulta en el modelo asistencial (iniciado en 2013), evaluando: tiempo de espera de la atencion, asistencias a urgencias, ingresos hospitalarios y mortalidad. Resultados Se analizo a 47.377 pacientes: el 61,9% de ellos atendidos incorporando la e-consulta y el 38,1% en el modelo de consulta presencial de acto unico. La mediana [intervalo intercuartilico] de la demora a la atencion en el modelo de e-consulta, 7 [5-13] dias, fue menor que en el modelo presencial: 33 [14-81] dias (p Conclusiones Un programa de atencion ambulatoria que incluye una e-consulta ha mostrado importantes reducciones en los tiempos de espera y es un modelo seguro, con menores tasas de ingresos hospitalarios y mortalidad en el primer ano.

This is an accepted manuscript of an article published by Elsevier in Renewable Energy on 30/09/2021, available online: https://doi.org/10.1016/j.renene.2021.09.104 The accepted version of the publication may differ from the final published version.

The evidence for use of direct oral anticoagulants (DOACs) in the management of post-operative cardiac surgery atrial fibrillation is limited and mostly founded on clinical trials that excluded this patient population. We performed a systematic review and meta-analysis of clinical trials and observational studies to evaluate the hypothesis that DOACs are safe compared to warfarin for the anticoagulation of patients with post-operative cardiac surgery atrial fibrillation. We searched PubMed, EMBASE, Web of Science, clinicaltrials.gov, and the Cochrane Library for clinical trials and observational studies comparing DOAC with warfarin in patients ≥18 years old who had post-cardiac surgery atrial fibrillation. Primary outcomes included stroke, systemic embolization, bleeding, and mortality. We performed a random-effects meta-analysis of all outcomes. The meta-analysis for the primary outcomes showed significantly lower risk of stroke with DOAC use (6 studies, 7143 patients, RR 0.64; 95% CI 0.50–0.81, I2: 0.0%) compared to warfarin, a trend towards lower risk of systemic embolization (4 studies, 7289 patients, RR 0.64, 95% CI 0.41–1.01, I2: 31.99%) and similar risks of bleeding (14 studies, 10182 patients, RR 0.91; 95% CI 0.74–1.10, I2: 26.6%) and mortality (12 studies, 9843 patients, relative risk [RR] 1.01; 95% CI 0.74–1.37, I2: 26.5%). Current evidence suggests that DOACs, compared to warfarin, in the management of atrial fibrillation after cardiac surgery is associated with lower risk of stroke and a strong trend for lower risk of systemic embolization, and no evidence of increased risk for hospital readmission, bleeding and mortality.

Usher syndrome (USH) is a condition characterized by ciliary dysfunction leading to retinal degeneration and hearing/vestibular loss. Putative olfactory deficits in humans have been documented at the psychophysical level and remain to be proven at the neurophysiological level. Thus, we aimed to study USH olfactory impairment using functional magnetic resonance imaging. We analyzed differences in whole-brain responses between 27 USH patients and 26 healthy participants during an olfactory detection task with a bimodal odorant (n-butanol). The main research question was whether between-group differences could be identified using a conservative whole-brain approach and in a ROI-based approach in key olfactory brain regions. Results indicated higher olfactory thresholds in USH patients, thereby confirming the hypothesis of reduced olfactory acuity. Importantly, we found decreased BOLD activity for USH patients in response to odorant stimulation in the right piriform cortex, while right orbitofrontal cortex showed increased activity. We also found decreased activity in other higher-level regions in a whole brain approach. We suggest that the hyper activation in the orbitofrontal cortex possibly occurs as a compensatory mechanism after the under-recruitment of the piriform cortex. This study suggests that olfactory deficits in USH can be objectively assessed using functional neuroimaging which reveals differential patterns of activity both in low- and high-level regions of the olfactory network.

Introdução: a gravidez embrionária é caracterizada por um saco gestacional que se forma e cresce enquanto o embrião não se desenvolve, ou seja, o óvulo foi fertilizado e implantado no útero, contudo, apenas a placenta e anexos embrionários se desenvolveram. Objetivo: evidenciar um relato de caso de gestação anembrionária, aborto incompleto e curetagem uterina por aspiração manual intra-útero. Metodologia: trata-se de um estudo de caso clínico com perspectiva qualitativa e descritiva, que consiste em uma pesquisa em que, em geral, ocorre com coleta direta de dados, cujo o pesquisador é o instrumento indispensável. Relato de caso: Trata-se de paciente do sexo feminino, 28 anos, gestante (terceira gestação), idade gestacional de 8 semanas e 6 dias, comparece ao pronto atendimento dia 15/09/21 devido resultado de ultrassonografias realizadas dias 27/08/21 e 01/09/21, que constataram gestação anembrionária. A paciente relatou cólicas e sangramento discreto há 4 dias, com melhora espontânea. Aos exames admissionais do dia 16/09/21, ultrassonografia transvaginal demonstrou útero em anteversoflexão com contornos regulares, textura homogênea, saco gestacional único intrauterino, com média de 1,2 cm, vesícula vitelínica não visualizada, ovários sem alterações e ausência de líquido livre e massas pélvicas. Ademais, aspecto ecográfico sugestivo de abortamento incompleto. Desse modo, foi realizada curetagem uterina por aspiração manual intra-útero (AMIU), com saída de moderada quantidade de material com característica de restos placentário, sem sinais de infecções e sangramento discreto e sem demais intercorrências. Conclusão: Confirmada a gestação anembrionária, inicia-se a intervenção médica, e esse é um momento que pode causar um choque na paciente e tristeza. Por isso, é indispensável um atendimento humanizado para ajudá-la a entender que não é sua culpa e conhecer as opções para a situação.

Study Objective We performed a long-term follow-up to quantify the impairment of sexual quality of life (SQL) and health-related QL (HRQL) in sexually active women after laparoscopic excision of deep infiltrating endometriosis (DIE). Design Prospective case-control study. Setting Hospital Clinic of Barcelona. Patients A total of 193 patients (after dropout and exclusions) were divided into 2 groups: one hundred twenty-nine premenopausal women with DIE (DIE group) and 64 healthy women who underwent tubal ligation (C group). Interventions All patients underwent laparoscopic surgery: laparoscopic endometriosis surgery in the DIE group and laparoscopic tubal ligation in the C group. All women were followed for at least 36 months, and they completed the Medical Outcomes Study 36-item short form questionnaire to assess their HRQL and 3 self-administered questionnaires that evaluate different aspects of SQL: the generic Sexual Quality of Life–Female questionnaire, the Female Sexual Distress Scale to evaluate “sexually related distress,” and the Brief Profile of Female Sexual Function to screen hypoactive sexual desire disorder. The patients with DIE as well as the controls completed the 4 questionnaires before surgery, and the patients with DIE also completed the questionnaires at 6 and 36 months after surgery. Measurements and Main Results A comparison of the patients and controls before surgery showed a statistically significant impairment in SQL and HRQL among the patients with DIE. A statistically significant improvement in SQL and HRQL was observed in the DIE group 6 months after surgery, with scores being similar to those of the C group. An evaluation 36 months after surgery showed that SQL and HRQL were better than presurgical SQL and HRQL in the DIE group, with a slight reduction compared with the 6-month evaluation. Conclusion SQL and HRQL improved in patients with DIE undergoing complete laparoscopic endometriosis resection and were comparable to those of healthy women at 6 months after surgery, showing a slight reduction at 36 months of follow-up.

This study intended to help practitioners selecting the appropriate motion according to their level of expertise for glide path and complete root canal preparation of curved canals in terms of instrument fracture and preparation time. A total of 160 curved root canals (angle >30°, radius

This study compares the sustainability reporting practices of family companies with those of their non-family counterparts and examines whether the former owned by billionaires engage differently w...

Patients with alopecia areata (AA) may experience episodic disease flares characterized by increasing hair loss that follow a seasonal pattern. However, no studies have examined whether specific climate factors contribute to the seasonal pattern of AA flares. Using Spearman rank correlation analyses, we assessed the association between climate variables and AA flare frequency per month in 336 children with AA in Philadelphia, Pennsylvania. Region-specific monthly values for average ambient temperature, air pressure, cloudiness, hours of sunlight, relative humidity, number of days with sun, number of days with rain, volume of precipitation, wind gust, wind speed, and UV index from January 2015 to December 2017 were obtained from World Weather Online. We found significant (P

During the COVID-19 pandemic, rapid, real-world evidence is essential for the development of knowledge and subsequent public health response. In dermatology, provider-facing and patient-facing registries focused on COVID-19 have been important sources of research and new information aimed at guiding optimal patient care. The 7 dermatology registries included in this update now include more than 8000 case reports sourced from physicians and patients from countries all over the world.

Introduction: The new coronavirus (SARS-CoV-2) pandemic has shown to cause even more severe problems among pregnant women, increasing the incidence of complications before and after childbirth, especially cardiorespiratory problems, such as the Severe Acute Respiratory Syndrome (SARS). Objectives: To describe the clinical outcome of SARS caused by SARS-CoV-2 in Brazilian pregnant women and to compare the rates of morbidity and mortality from other causes in this group, stratified by the following variables: gestational age and age group. Methodology: Observational, analytical study based on documents whose data were collected from the 2020 Epidemiological Report No. 40 in the database of the Brazilian Department of Health, from which morbidity and mortality data were extracted to calculate the lethality rate and compare rates using a binomial test with a significance level of 0.05. Results: Of the total number of pregnant women hospitalized for SARS, 4,467 (46.6%) were confirmed for COVID-19 and, of these, 233 died, corresponding to a lethality rate of 5.2%. Morbidity was higher in the third trimester of pregnancy, but the disease was more severe in the second trimester (7%), being worse in women aged 40 years and older (40–49; 8.7% and 50–59; 15.3%). A significant difference was observed in the rate of cases between the COVID-19 SARS group and the group with other causes in all gestational strata and age groups. As for deaths, a significant difference was found in the rates between the first and third trimesters, and in pregnant women aged 10 to 19 years. Conclusion: Considering the variables under analysis, evidence shows that pregnant women at an advanced age and in the second trimester of pregnancy contribute to the lethal outcome of the disease. Other variables associated with the presence of comorbidities and quality of care for pregnant women should be considered in the model in future studies.

Dengue is endemic in Brazil. The dengue surveillance system’s reliance on passive reporting may underestimate disease incidence and cannot detect asymptomatic/pauci-symptomatic cases. In this 3-year prospective cohort study (NCT01391819) in 5- to 13-year-old children from nine schools in Fortaleza (N = 2,117), we assessed dengue virus (DENV) infection seroprevalence by IgG indirect ELISA at yearly visits and disease incidence through active and enhanced passive surveillance. Real-time quantitative polymerase chain reaction (RT-qPCR) and DENV IgM/IgG capture ELISA were used for diagnosis. We further characterized confirmed and probable cases with a plaque reduction neutralization test. At enrollment, 54.1% (95% CI: 46.6, 61.4) of children were DENV IgG positive. The annual incidence of laboratory-confirmed symptomatic dengue cases was 11.0 (95% CI: 7.3, 14.7), 18.1 (10.4, 25.7), and 10.2 (0.7, 19.7), and of laboratory-confirmed or probable dengue cases with neutralizing antibody profile evocative of dengue exposure was 13.2 (6.6, 19.9), 18.7 (5.3, 32.2), and 8.4 (2.4, 19.2) per 1,000 child-years in 2012, 2013, and 2014, respectively. By RT-qPCR, we identified 14 DENV-4 cases in 2012–2013 and seven DENV-1 cases in 2014. During the course of the study, 32.8% of dengue-naive children experienced a primary infection. Primary inapparent dengue infection was detected in 20.3% (95% CI: 13.6, 29.1) of dengue-naive children in 2012, 8.7% (6.9, 10.9) in 2013, and 5.1% (4.4, 6.0) in 2014. Our results confirmed the high dengue endemicity in Fortaleza, with active and enhanced passive surveillance detecting three to five times more cases than the National System of Disease Notification.

The Knowledge Management (KM) enables the harmonization of corporate strategy and organizational structure efficiency, positively impacting on competitiveness and organizational performance. The objective of this article is to understand the perception of external control auditors about the KM processes and cultural orientation in the Courts of Accounts of Brazil. The nature of the study required the use ofthe quantitative investigation method by exploratory factor analysis. The results showed that the perception of employees of Brazilian Audit Courts revealed perspectives of KM processes in its administrative, operational and strategic actions, showing good human resources management practices of the Audit Courts of Brazil (TCs) in the categories of developing an organizational culture and to improve the results.

RESUMEN La enfermedad por coronavirus 2019 (COVID-19) fue anunciada como una pandemia mundial por la Organización Mundial de la Salud el 11 de febrero de 2020. A partir de ese momento han surgido desafíos con respecto a cómo apoyar de manera óptima el sistema inmunitario en la población en general, y especialmente en los adultos mayores. Existen muchas evidencias de que la gravedad de las infecciones por SARS-CoV-2 varía ampliamente con la edad, siendo generalmente más severa en los ancianos. Una respuesta inmunitaria óptima depende de una dieta y nutrición adecuadas para contrarrestar adecuadamente la infección. Varios estudios han demostrado la importancia de la vitamina D como un factor clave en la regulación de las respuestas inmunitarias. En esta revisión, analizamos el papel de la vitamina D en la respuesta inmunitaria durante la infección por SARS-CoV-2 con especial énfasis en los adultos mayores. ABSTRACT Coronavirus disease 2019 (COVID-19) was announced as a global pandemic by the World Health Organization on February 11, 2020. From that moment, challenges have arisen regarding how to optimally support the immune system in the general population, and especially in older adults. There is much evidence that the severity of SARS-CoV-2 infections varies widely with age, being generally more severe in the elderly. An optimal immune response depends on proper diet and nutrition to adequately counter the infection. Several studies have shown the importance of vitamin D as a key factor in regulating immune responses. In this review, we analyze the role of vitamin D in the immune response during SARS-CoV-2 infection with special emphasis on older adults.

A nefropatia diabética (ND) é atualmente a principal causa da doença renal em estágio terminal (DRET), na Europa e Estados Unidos, e a segunda causa, no Brasil. A recorrência histológica da nefropatia diabética tem sido descrita em cerca de 40% dos pacientes, sendo o diagnóstico de recorrência realizado em média de 6-8 anos pós-transplante renal, mas, com relatos de recorrência tão precoce como dois anos. Relatamos o caso de um paciente com diagnóstico prévio de diabetes mellitus que foi submetido a transplante renal com doador falecido e evoluiu à recorrência de nefropatia diabética, no primeiro ano após transplante, com diagnóstico de certeza, somente após biópsias repetidas.

Gastric cancer is the fourth most common type of cancer worldwide and the second most lethal. Gastric cancer biomarkers can be used for diagnosis, prediction of sensitivity to treatment, and prognosis. The following search terms were applied to PubMed as of December 2020: 'gastric cancer classification', 'gastric cancer epidemiology', 'cancer metastasis' and 'gastric cancer biomarker'. Only experimental studies were reported in the 'biomarkers' section. Some biomarkers can serve as therapeutic targets for antitumoral drugs. The genes analyzed include E-cadherin,Lay abstract Gastric cancer is the fourth most common type of cancer worldwide and the second most lethal. Gastric cancer biomarkers are molecules that have different expressions in tumor cells than in normal body cells, and can be used for diagnosis, prediction of sensitivity to treatment, and prognosis. Biomarkers in gastric cancer can include genes that suppress tumor progression, genes that increase tumor progression by binding to growth molecules, molecules related to the body’s immune response to the tumor, and non-coding RNA molecules (RNA molecules that do not produce proteins but regulate the cell’s genetic material). Some biomarkers can serve as therapeutic targets for anti-tumoral drugs.

Background/objective Dupilumab is highly effective in treating atopic dermatitis (AD). However, some patients experience difficulties with dupilumab therapy, such as inadequate clinical response, failure to achieve long-term disease control, or adverse events (AEs). Our objective is to assess inadequate response and AEs occurring in children on dupilumab therapy for AD. Methods This is a retrospective cohort study of children on dupilumab for AD. Collected variables included patient demographics, medical histories, and dupilumab therapy characteristics. Response analysis was conducted in those with ≥3 months of dupilumab therapy: primary poor responders were defined as those whose EASI scores did not decrease by >50%, and secondary poor responders were those who initially responded but had significant AD flares while on therapy. Results We included 200 patients on dupilumab for AD in our cohort; 192 received ≥3 months of therapy and were included in our response analysis. Twelve children experienced inadequate primary response, and 4 were secondary poor responders. Four of these 16 children discontinued therapy due to inadequate response. The most common dupilumab-associated AEs were facial erythema (n = 24, 12.0%) and injection-site reactions (n = 24, 12.0%). Female sex was significantly associated with experiencing injection-site reactions, and prior hospitalization was significantly associated with HSV infection on dupilumab. Eight patients discontinued therapy due to an AE. Conclusion A small but significant number of patients experienced treatment difficulties while on dupilumab. The risk of inadequate response to dupilumab and dupilumab-associated AEs should be discussed thoroughly with patients and their families prior to initiation.

Background: Physical activity is associated with greater odds of sunburn in adults, increasing harmful sun exposure and skin cancer risk. The authors sought to investigate parallel associations between sunburn and physical activity among US high school students. Methods: The authors examined pooled cross-sectional data from the 2015 and 2017 Youth Risk Behavior Survey. A nationally representative sample of 21,894 US high school students who responded to the sunburn question was included. Results: Prevalence of sunburn was 56.6% between 2015 and 2017. Sunburn prevalence was higher in physically active students (88.3%; 95% confidence interval [CI], 86.7%–90.0%; P P P P P P Conclusions: Many US high school students are affected by sunburn, and the odds of sunburn are elevated during physical activity and team sports participation. Efforts are needed to improve sun safety regulations, education, and resources for youth during school and physical activity.

Background Deficiencies in the skills necessary to diagnose and manage patients with skin of color may contribute to health disparities. The Pediatric Dermatology Research Alliance Special Interest Group in Pediatric Skin of Color (PSOCG) convened to generate a curriculum of topics required for basic pediatric skin of color (PSOC) education for medical students and residents in dermatology to improve the quality of education in PSOC. Methods A survey was distributed to the PSOCG members to assess expert opinion regarding critical topics for inclusion in a basic PSOC syllabus. Video conference and two rounds of survey were used to rank topics for inclusion and to highlight the underlying need for inclusion. Results Group members composed of academic pediatric dermatologists with teaching responsibilities including skin of color topics for dermatology residents and medical students. Learning objectives were developed for an educational lecture on basic science, and clinical conditions affecting PSOC were grouped by age-infantile, pediatric, and adolescent skin conditions affecting the PSOC population were identified for inclusion with rank score based on specific parameters including greater frequency in skin of color, nuances in skin of color, and need for medical workup. Conclusions Increased focus on PSOC education is needed to improve quality of care for children of color through enhanced knowledge. Inflammatory, genetic, and particularly primary pigmentary disorders should be the focus of a broad curriculum in pediatric skin of color education for medical trainees. Objectives should include improved diagnosis, treatment, and ability to educate patients and their families regarding the nature of their conditions.

Background: Leishmaniasis is a serious public health problem especially in developing countries [1]. The therapeutic potential of biotherapics against several microorganism has been described in vitro [2,3] and in vivo studies [4,5,6,7,8,9]. Considering the resistance of leishmaniasis to conventional treatment as well as previous studies with biotherapic, we evaluated the effects of Leishmania infantum 30x (BioLi30x) biotherapy. Aim: evaluate the antileishmanial effects of BioLi30x in in vivo and in vitro models. Methodology: The in vivo experiments were performed using BALB/c mice (n=138), divided into 8 groups: G1-healthy, G2-infected with L. infantum, G3-BioLi30x pre-treated, G4-BioLi30x pre/post-treated, G5-BioLi30x post-treated, G6-H2O30x post-treated, G7-Antimonium crudum 30x post-treated and G8-Glucantime® post-treated. After 49 days of treatment, the animals were submitted to euthanasia (ethical approval ECUA/UFRJ/066/14). Liver and spleen histological changes were evaluated, and serum samples were aliquoted and storage at -20°C for cytokine assays. The in vitro assays were performed using RAW 264.7 macrophages treated with BioLi30x and infected with L. infantum. The morphological aspects were evaluated by scanning electron microscopy (SEM), and the nitric oxide (NO) release was quantified in the supernatant of infected macrophages. Results: The histological analysis from 4 independent experiments showed livers with normal appearance (G1); periportal chronic hepatitis (G2,G4,G5,G8); discreet (G3,G7), moderate (G4,G5,G6), and severe (G2,G8) vacuolar hydropic degeneration; congestion and neutrophilic inflammation (G2,G4,G5,G6,G8), and possible amastigotes within macrophages (G2-G8). Spleens presented healthy appearance only in G1. All treated animals presented histological alterations, with different lesions severity, which involved spleen pulp hyperplasia with moderate disruption (G2,G8), as well as megakaryocytes and macrophages proliferation (G2- G8). SEM analyses showed BioLi30x treatments induced significant protozoan morphology alterations when compared to H2O30x. Besides, a 19% increase in the NO release was detected in RAW supernatants, when compared to H2O30x. Conclusions: BioLi30x and Antimonium crudum 30x modified the infection animal process, involving several cellular mechanisms as well as different histological damage. The in vitro experiments will be repeated in order to confirm these preliminary results.

Background Methylisothiazolinone (MI) and Methylchloroisothiazolinone (MCI) are among the most common skin sensitizers, yet the immunological events that occur during MCI/MI allergic contact dermatitis (ACD) are still poorly understood. Objectives To analyse dendrocytes, macrophage subtypes and T cells in skin during the elicitation phase of MCI/MI ACD. Methods Thirteen patients with positive patch test reactions to MCI/MI (ACD group) and 11 individuals with negative patch test results were selected. Skin biopsies were only performed at 48 hours of patch testing. Immunohistochemistry was conducted to assess T cells, dendrocytes (Factor XIIIa), M1 (p-Stat1, CD68) and M2 (c-Maf, CD163) macrophages. Transcriptional analyses were performed for cytokines and related factors, and further compared to atopic dermatitis samples (n=4). Immunofluorescence assays addressed T cells location, along with IL-4 or IL-13, within the skin. Results MCI/MI elicited dermal dendrocytes and macrophages, pronouncedly the M2 subtype. T cells, majorly CD4+ T cells, accumulated in the perivascular areas. Similarly, abundant IL-4 protein was detected in these areas. There was an upregulation of IL-4 and IL-13 mRNA expression, a mild increase in IFNG mRNA levels and a down-regulation of RORC in the ACD group. Immunofluorescence revealed dermal clusters of T cells co-localized with IL-4. Conclusions M2 macrophages and Th2 cells participate in the immunopathogenesis of MCI/MI ACD. Dermal dendrocytes and M2 macrophages may assist the formation of CD4+ T cells perivascular clusters. These findings render a mechanistic insight into the MCI/MI reaction. Further analysis at different timepoints of patch testing is required to fully comprehend this ACD kinetics.

OBJECTIVE To determine the impact of water fluoridation on the prevalence and severity of dental caries and fluorosis in individuals aged 17-20 years exposed to fluoride toothpaste. METHODS The study population consisted of 660 students from public schools, residents of areas supplied with fluoridated water (exposed group) or not (not exposed group). Students from both groups had access to fluoride toothpaste throughout life. A questionnaire about socioeconomic demographic aspects, conditions related to access and exposure to fluoridated water, and habits related to oral health was applied. Dental caries was measured by the DMFT index and dental fluorosis by the TF index. The chi-square test, t test, and subsequently logistic regression were applied for data analysis. RESULTS Caries experience (DMFT≠0) was significantly higher in students from areas not exposed to fluoridated water, after adjustments to clinical conditions, demographic socioeconomic profile, and hygiene habits. The DMFT mean (±SD) was significantly higher in students from areas not exposed to fluoridated water than exposed (3.83 [±3.28] and 2.48 [±2.71] respectively). The prevalence of very mild/mild and moderate fluorosis was 41.1% and 21% for students either exposed to fluoridated water or not, respectively. CONCLUSION Exposure to fluoridated water was associated with a lower prevalence and severity of tooth decay, in spite of the use of fluoridated toothpaste. The prevalence of dental fluorosis at all levels was higher in fluoridated areas, however, in both groups, there were few cases with esthetic implications.

El presente trabajo tuvo como propósito el diseño, implementación y evaluación de una solución web integral para la automatización del proceso de gestión de capacitaciones en la Escuela Superior Politécnica de Chimborazo, como modelo a seguir en las Instituciones de Educación Superior. Para lo cual, inicialmente se realizó un análisis de mercado y de varios trabajos de investigación en este ámbito para encontrar una posible solución que se adapte a las necesidades institucionales. Posteriormente se implementó la solución web utilizando el marco de trabajo ágil Scrum y la arquitectura SOA bajo la tecnología J2EE con un motor de base de datos PostgreSQL. Finalmente, el aplicativo fue desplegado en un servidor Payara para ser evaluado bajo los principios heurísticos de usabilidad de Nielsen, mismos que permitieron la identificación de errores y problemas de consistencia, estandarización y de funcionalidad, obteniendo como resultado una aplicación usable y accesible para los usuarios finales. The purpose of this work was the design, implementation and evaluation of a comprehensive web solution for the automation of the training management process at the Escuela Superior Politécnica de Chimborazo, as a model to follow in Higher Education Institutions. For which, initially, a market analysis and several research works in this field were carried out to find a possible solution that adapts to institutional needs. Subsequently, the web solution was implemented using the Scrum agile framework and the SOA architecture under J2EE technology with a PostgreSQL database engine. Finally, the application was deployed on a Payara server to be evaluated under the Nielsen usability heuristic principles, which allowed the identification of errors and consistency, standardization and functionality problems, resulting in a usable and accessible application for users. finals.

The aim of this study was to compare physicians' and patients' estimates of risk of relapse and toxicity. A prospective, cross-sectional, multicenter study including 735 patients with cancer and 29 oncologists. Physicians' appraisals of risk of relapse with and without chemotherapy (27.5% and 43.1%) and risk of severe toxicity (12.2%) were more realistic than those of patients (34.6%, 78.5%, and 57.4%, respectively). The greater the risk of recurrence and risk of toxicity estimated, the less physicians expressed satisfaction with SDM. Estimations of risk of relapse and toxicity are important in diagnostic and therapeutic decision-making and can help patients face their situation.

Introducción: Hoy en día gracias a la innovación y desarrollo de nuevas tecnologías es posible la automatización de procesos industriales los cuales ayudan a mejorar el proceso de producción y generar un mercado competitivo. Las empresas comerciales e industriales del Ecuador cuentan con sistemas automatizados que son capaces de facilitar el trabajo y obtener productos de calidad reduciendo costos e incrementando la producción. Metodología: Para el desarrollo y ejecución de este proyecto de Automatización de un reactor tipo batch para la obtención de biodiesel en el Laboratorio de Procesos Industriales de la Facultad de Ciencias, se revisó información sobre el proceso de producción, los reactivos que se emplean, materiales y equipos necesarios. Se aplicaron los siguientes métodos: inductivo, deductivo y experimental. Resultados: La automatización permitió la reducción del tiempo en la fase de decantación en un 81,25%; lo que ayuda a que el tiempo de producción también se reduzca en un 65,22% comparado a las 11 horas y 30 minutos cuando el proceso que era netamente manual de acuerdo con las pruebas obtenidas en la automatización se presenta una mejora en la calidad del biodiesel. Conclusión: El rendimiento del reactor automatizado se incrementa notablemente en 287,5%. Se tiene un equipo operativo con bajo consumo de corriente, reducción en la cantidad de agua empleada para el lavado del biodiesel y posee un sistema de agitación constante. El rendimiento en volumen del biodiesel obtenido depende en gran medida de la calidad del aceite de cocina reciclado y la pureza del metanol.

This study analyzes the implementation of modular petroleum mini-refineries, testing the hypothesis that these facilities can be a feasible choice in countries where fuel demand is expected to incr...

MRI-based screening in women with a ≥ 25% lifetime risk of breast cancer , but no identifiable genetic mutations may be associated with false positives. This study examined the psychological impact of abnormal screens and biopsies in non-mutation carriers participating in high-risk screening with no personal history of breast cancer. Non-mutation carriers participating in the High-Risk Ontario Breast Screening Program at two sites were mailed demographic surveys, psychological scales, and chart review consent. Scales included the Consequences of Screening in Breast Cancer questionnaire, Lerman Breast Cancer Worry Scale, and Worry Interference Scale. Missing data were managed with multiple imputation. Multivariable regression was used to assess whether abnormal screens or biopsies were associated with adverse psychological effects. After contacting 465 participants, 169 non-mutation carriers were included. Median age was 46 years (range 30–65). Over a median 3 years of screening, 63.9% of women experienced at least one abnormal screen, and 24.9% underwent biopsies. Statements relating to cancer worry/anxiety scored highest, with 19.5% indicating they worried “a lot”. Higher scores among anxiety-related statements were strongly associated with higher dejection scores. Overall, coping and daily functioning were preserved. Women indicated some positive reactions to screening, including improved existential values and reassurance they do not have breast cancer. Abnormal screens and biopsies were not significantly associated with any psychological scale, even after adjustment for patient characteristics. Non-mutation carriers undergoing MRI-based screening had considerable baseline anxiety and cancer worry, although daily functioning was not impaired. Abnormal screens and biopsies did not appear to have adverse psychological effects.

Objective To describe changes in fetal Doppler parameters during a novel approach for open fetal surgery for myelomeningocele (MMC) repair. Methods Forty-four fetuses undergoing open fetal surgery for MMC repair characterized by a mini-hysterotomy (15mm), reduced fetal manipulation, and maintenance of a constant volume of amniotic fluid were evaluated. Doppler velocimetry of the umbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR) and ductus venosus (DV) were registered at specific time points during fetal surgery and considered as abnormal with UA pulsatility index (PI) or DV-PI above the 95th centile, and MCA-PI or CPR values below the 5th centile. Results Median gestational age (GA) at procedure was 25.4 weeks (range, 22.9-27.9). Doppler recordings were successfully obtained during all time periods throughout surgery. As compared to Doppler values before surgery, there was a significant increase in the prevalence of brain vasodilation (15.9% (7/44) vs. 65.9% (29/44); p=0.001), abnormal DV-PI (0% vs. 22.7% (10/44); p=0.02), and a non-significant increase in the rate of abnormal UA-PI (0% vs. 11.4% (5/44); p=0.2). No absent or reversed end diastolic or atrial velocities in the UA or in the DV, respectively were seen in any fetus at any time. All abnormal Doppler parameters returned to normal values after surgery. Conclusions A small hysterotomy in conjunction with reduced fetal manipulation and maintenance of a normal amniotic fluid volume during open fetal surgery for MMC, seem not to significantly affect fetal Doppler parameters. The observed mild Doppler changes can be a manifestation of fetal adaptation to a stressful condition given by fetal surgery. This article is protected by copyright. All rights reserved.

AIMS To compare the dental caries prevalence using the International Caries Detection and Assessment System (ICDAS) and the caries risk by Caries Management by Risk Assessment (CAMBRA) in individuals with cerebral palsy (CP) and normoactives (NAs). METHODS AND RESULTS Sixty children and adolescents aged 6-12 years (30 CP/30 NA) were clinically evaluated by one calibrated examiner using two-digit ICDAS criteria and converted into components of dmf/DMF indices: d2mf2/D2MF2 (enamel and dentin lesions) and d3mf3/D3MF3 (dentin lesions). An adapted CAMBRA was used for risk classification. The mean d2mf2s/d2mf2t and D2MF2S/D2MF2T for CP were 17.0 �� 16.8/7.5 �� 4.3 and 10.7 �� 17.6/5.3 �� 5.8, respectively, and for NA were 17.2 �� 16.9 /6.9 �� 4.8 and 11.1 �� 11.7/5.5 �� 4.7, respectively. The mean d3mf3s/d3mf3t and D3MF3S/D3MF3T for CP were 10.1���� 16.7/3.0 �� 4.1 and 4.9 �� 15.6/0.2 �� 0.4, respectively, while for NA the mean values were 9.8 �� 13.0/3.5 �� 3.8 and 2.1 �� 5.7/0.9 �� 2.0, respectively. There were no statistically differences for caries prevalence and risk in both groups (p��>��0.05). CONCLUSIONS Dental caries was highly prevalent in CP and NA children and adolescents. Enamel and dentin lesions and high caries risk were the most common condition.

BACKGROUND Hypomineralised second primary molar (HSPM) is a developmental enamel defect associated with dental caries. AIM To evaluate the impact of HSPM on oral health-related quality of life (OHRQoL) in preschoolers through hierarchical analysis. DESIGN This population-based cross-sectional study assessed 834 5-year-old preschoolers, in Teresina, Piaui, Brazil, using sociodemographic questionnaires and Early Childhood Oral Health Impact Scale (ECOHIS). Dental examination was performed by two calibrated examiners (κ ≥ 0.80) for the diagnosis of HSPM (EAPD), dental caries (dmft and pufa indices), and malocclusion (Foster and Hamilton criteria). Analysis of the determinants of OHRQoL was stratified at three levels (P

Background Immunothrombosis and coagulopathy in the lung microvasculature may lead to lung injury and disease progression in coronavirus disease 2019 (COVID‐19). We aim to identify biomarkers of coagulation, endothelial function, and fibrinolysis that are associated with disease severity and may have prognostic potential. Methods We performed a single‐center prospective study of 14 adult COVID‐19(+) intensive care unit patients who were age‐ and sex‐matched to 14 COVID‐19(−) intensive care unit patients, and healthy controls. Daily blood draws, clinical data, and patient characteristics were collected. Baseline values for 10 biomarkers of interest were compared between the three groups, and visualized using Fisher's linear discriminant function. Linear repeated‐measures mixed models were used to screen biomarkers for associations with mortality. Selected biomarkers were further explored and entered into an unsupervised longitudinal clustering machine learning algorithm to identify trends and targets that may be used for future predictive modelling efforts. Results Elevated D‐dimer was the strongest contributor in distinguishing COVID‐19 status; however, D‐dimer was not associated with survival. Variable selection identified clot lysis time, and antigen levels of soluble thrombomodulin (sTM), plasminogen activator inhibitor‐1 (PAI‐1), and plasminogen as biomarkers associated with death. Longitudinal multivariate k‐means clustering on these biomarkers alone identified two clusters of COVID‐19(+) patients: low (30%) and high (100%) mortality groups. Biomarker trajectories that characterized the high mortality cluster were higher clot lysis times (inhibited fibrinolysis), higher sTM and PAI‐1 levels, and lower plasminogen levels. Conclusions Longitudinal trajectories of clot lysis time, sTM, PAI‐1, and plasminogen may have predictive ability for mortality in COVID‐19.

Morpho-agronomic characterization studies aiming at the discrimination and classification of lima bean accessions in relation to the centers of domestication and biological status have been of great importance for conserving the biodiversity of this species. For this purpose, researchers have widely used the multivariate analysis called discriminant analysis, which is not always capable of producing satisfactory results. Computational intelligence-based classifiers are additional tools for understanding complex classification problems. In this study, the objective was to test the use of the decision tree in the classification of lima bean according to the centers of domestication and biological status (cultivated and wild), based on eight phenotypic traits of the seed. Sixty accessions of lima bean from the Phaseolus Germplasm Bank of Universidade Federal do Piauí (BGP / UFPI) were evaluated, and classification was performed using two approaches: conventional statistics with discriminant analysis of principal components (DAPC) and computational intelligence through decision tree (DT). The results showed that the use of DT was efficient to identify patterns in the classification of lima bean accessions, due to its comprehensibility. Seed weight was one of the main descriptors used to explain the origin and diversity of the species. The results found will be useful for studies that involve the conservation of genetic resources, mainly for the maintenance of germplasm banks and in breeding programs. In addition, it is recommended to integrate machine learning algorithms in studies aimed at classifying lima bean. Estudos de caracterização morfoagronômica que visam a discriminação e classificação de acessos de feijão-fava quanto aos centros de domesticação e estado biológico têm sido de grande importância para a conservação da biodiversidade da espécie. Para esse fim, é muito utilizada a análise multivariada denominada análise discriminante, que nem sempre é capaz de produzir resultados satisfatórios. Classificadores baseados em inteligência computacional constituem-se ferramentas adicionais para a compreensão de problemas complexos de classificação. Neste estudo, objetivou-se testar o uso da árvore de decisão na classificação do feijão-fava de acordo com os centros de domesticação e estado biológico (cultivado e silvestre), com base em oito caracteres fenotípicos da semente. Foram avaliados 60 acessos de feijão-fava do Banco de Germoplasma de Phaseolus da Universidade Federal do Piauí (BGP/UFPI), em cuja classificação foram utilizadas duas abordagens: estatística convencional com análise discriminante sob componentes principais (DAPC) e inteligência computacional por meio da árvore de decisão (AD). Os resultados mostraram que o uso da AD foi eficiente para identificar padrões na classificação dos acessos de feijão-fava, devido à sua compreensibilidade. O peso da semente foi um dos principais descritores utilizado para explicar a origem e a diversidade da espécie. Os resultados encontrados serão úteis para estudos que envolvem a conservação de recursos genéticos, principalmente para a manutenção de bancos de germoplasma e em programas de melhoramento. Além disso, recomenda-se a integração de algoritmos de aprendizado de máquina em estudos voltados à classificação de feijão-fava. &nbsp

The growing prevalence of vascular diseases worldwide has emphasized the need for novel tissue-engineered options concerning the development of vascularized 3D constructs. This study reports, for the first time, the use of external magnetic fields to stimulate mesenchymal stromal cells (MSCs) to increase the production of vascular endothelial growth factor-A (VEGF-A). Polyvinylalcohol and gelatin-based scaffolds, containing iron oxide nanoparticles, were designed for optimal cell magnetic stimulation. While the application of static magnetic fields over 24 h did not impact on MSCs proliferation, viability and phenotypic identity, it significantly increased the production of VEGF-A and guided MSCs morphology and alignment. The ability to enhance MSCs angiogenic potential was demonstrated by the increase in the number of new vessels formed in the presence of MSCs conditioned media through in vitro and in vivo models. Ultimately, this study uncovers the potential to manipulate cellular processes through short-term magnetic stimulation., Graphical abstract

The external cephalic version (ECV) represents the standard for pregnancies at term with a non-cephalic presentation as it avoids planned caesareans. The aim of this study was to assess the caesarean rate and prognostic factors at birth after undergoing ECV, which was compared with scheduled caesareans for a non-cephalic presentation (SCG) and spontaneous cephalic presentations at birth (GG). No difference was observed between the caesarean rate of the ECV (n=65) and the GG (n=3711) groups (9.84% and 14.47%, respectively, p-value=0.30), and neither was found between the ECV group and both the GG and SCG (n=76) groups in the Apgar scores and postpartum pH, but for the five-minute Apgar score (9.98 and 9.84 in the ECV and SCG groups, respectively, p-value=0.04). This study provides further evidence for clinical practice regarding good perinatal outcomes after undergoing ECV. Further research is required to consistently prove the increase in the intrapartum caesarean rate after ECV that has been previously described in the literature, which has not been found in the present study. Keywords: External Cephalic Version, Breech Presentation, Caesarean Rate, Perinatal Outcomes, Apgar Score, Postpartum Ph.

Vitiligo is a skin disorder characterized by depigmentation, and 25% of children develop symptoms by age 10. Children with vitiligo have suffered from social isolation and bullying, and thus many seek treatment for re-pigmentation. However, there is limited data on the use of therapies in pediatric vitiligo patients. To address this knowledge gap, we performed a retrospective chart review of 360 patients who were diagnosed with vitiligo under the age of 18 at The Children’s Hospital of Philadelphia. The average age was 10.8 years; average age at diagnosis was 6.21 years. The median household income by zip code was $78,660. Majority were insured by private insurance (53.9%); 44.2% had Medicaid and 1.9% had no information on insurance coverage. Most subjects used topical steroids (55.6%) and/or topical pimecrolimus (58.9%); only a small proportion (17.2%) received light therapy in clinic or at home. Although vitiligo has been shown to affect patients of color more negatively, of those using Home-Based Phototherapy (HBPT) (13), 8 were self-described Caucasian. Twelve out of the 13 had private insurance and the median household income was $105,080 for those using HBPT. Our results indicate that certain groups of patients, such as children of color, those without private insurance, and those from lower-income areas, may not have equal access to the most cost-effective vitiligo therapies. These findings support the need for creation of educational resources and strategies to ensure access to cost-effective vitiligo treatments for patients from all backgrounds.

Objectives The pain related to spinal cord injury (SCI) is difficult to treat, and it is associated with significant morbidity. One aspect to improve therapeutics is to explore markers of pain and its correlates in SCI. Methods In this cross-sectional neurophysiological analysis of a randomized, double-blind controlled trial, 39 patients with SCI were included. We analyzed conditioned pain modulation (CPM) efficiency as the index of the descending pain inhibitory system, EEG variables, and clinical pain levels as measured by the Visual Analogue Scale. Regression analyses were performed to assess the relationship among EEG variables, pain levels, and CPM. Results We included 39 SCI patients, 74% reported SCI-related pain. We found that (1) less alpha and beta power are related to pain presence, (2) less alpha and beta power are associated with higher pain levels among patients with pain, (3) patients with pain have decreased peak alpha-theta frequency compared to no-pain group, (4) more relative theta power are related to the presence of low CPM efficiency, (5) higher relative theta power is associated with lower CPM efficiency. Conclusions Our results confirm and provide additional data on the relationship between decreased alpha and beta frequencies and higher pain levels. One important finding, though, was a specific and different EEG signature for the descending inhibitory pain system, as we showed that increased theta EEG power is related to decreased CPM efficiency; suggesting that, although low CPM efficiency plays a major role in pain in these participants, it does seem to be associated with a specific oscillatory brain rhythm different from clinical pain. These findings have significant implications for future research on EEG-based biomarkers of pain in post-SCI and new interventions as neurofeedback to manage pain in this population.

Background Heterozygous carriers of Parkin mutations are suggested to be at risk of developing Parkinson's disease, while biallelic variants are associated with typical autosomal recessive early-onset PD. Investigating unaffected heterozygous mutation carriers holds the potential of a deeper understanding of monogenic PD and has implications for PD in general, in particular regarding the prodromal phase. Objectives To discriminate healthy Parkin mutation carriers from healthy non-mutation carriers using a multimodal approach. Methods Twenty-seven healthy heterozygous Parkin mutation carriers (13 female. age: 48 ± 13 years) and 24 healthy non-mutation carriers (14 female. age: 48 ± 15 years) from the CHRIS study (Cooperative Health Research in South Tyrol) were recalled based on their genetic profile and underwent a blinded assessment of motor and non-motor PD symptoms, transcranial sonography and sensor-based posturography and gait analyses under different conditions with increasing difficulty. For the latter, gradient-boosted trees were used to discriminate between carriers and non-carriers. The classification accuracy and the area under the curve of the receiver-operator characteristics curve were calculated. Results We observed no differences concerning motor or non-motor symptoms and substantia nigra hyperechogenicity. The best gradient-boosted trees-based model on posturography measurements (tandem feet, eyes closed, firm surface), however, showed a classification accuracy of up to 86%. The best-performing gradient-boosted trees-based model for gait analyses showed a balanced accuracy of up to 87% (dual-tasking). Conclusions Sensor-based quantification of movements allows to discriminate unaffected heterozygous mutation carriers from mutation-free controls. Thereby, it is crucial to challenge the motor system with more difficult tasks to unmask subtle motor alterations.

Background and Purpose: To evaluate the use of prostaglandins and oxytocin in labour induction according to different indications. Perinatal outcomes, rate of vaginal delivery and complation of labour were studied and compared. Methods: Cross-sectional descriptive study from January 2012 to December 2012. 530 women who required labour induction were included. Seven groups were created according to the methods of induction. Women with twin pregnancies, induction of dead foetus, two previous caesarean sections or an incomplete clinical history were excluded. Results: The rate of vaginal deliveries in women that only received prostaglandins the first day was 84.6%; similar in women with prolonged pregnancies, 85.2%. The induction with oxytocin directly showed the highest rate of caesarean section. The rate of vaginal deliveries was 50% in women with previous caesarean section. Conclusions: A high rate of vaginal deliveries with a single dose of prostaglandin and within 24 hours of beginning induction. Administration of prostaglandins must be used when cervix is unfavorable and previous to oxytocin stymulation.

Subgingival dental restorations and periodontal health have been studied for many years; however, there is a low histological evidence on the behavior of new materials in the supracrestal tissue attachment. The aim of this study is to analyze the periodontal response when a tricalcium silicate material (TSM) or composite margin restorations is placed to 0.5 mm and 1.5 mm from the bone crest with a histomorphometric analysis in dogs. Nine mongrel dogs were used in this study: four dogs (8 canine teeth) for TSM group, 4 dogs (8 canine teeth) for composite group, and 1 dog (2 canine teeth) with cavities without restorations. Cavity preparation of 2×2×1 mm was created on the buccal aspect of the canines at 0.5 and 1.5 mm of the crestal bone. Cavities were restored with composite and TSM or were left unrestored as control. After 12 weeks of healing, the dogs were euthanized and blocks containing the tooth and soft tissues were processed. In all the specimens, the junction epithelium was stablished apical to the tooth preparations. A shorter distance to the bone (0.5 cavity) implies greater apical periodontal migration regardless of the material used. In the TSM groups, the connective tissue height and the distance between bone level and apical margin preparation were greater than those in the composite groups, while the epithelium height was less. However, there were no statistically significant differences comparing TSM and composite groups at either 0.5 mm or 1.5 mm (p > 0.05). Histologic analysis did not show periodontal reattachment to TSM or composite. In both cases, bone crest migrates apically. For that reason, it is recommended to perform composite restorations at the subgingival level whenever the distance to the bone crest is at least 2 mm. Both composite and TSM do not achieve reinsertion of the connective tissue in the biological width.

Fluorine-18 sodium fluoride (Na[18F]F) atherosclerotic plaque uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification. We aim to evaluate global cardiac microcalcification activity with Na[18F]F, as a measure of unstable microcalcification burden, in high cardiovascular (CV) risk patients. Thirty-four high CV risk individuals without previous CV events were scanned with Na[18F]F PET-CT. Cardiac Na[18F]F uptake was assessed through the global molecular calcium score (GMCS), which was calculated by summing the product of the mean standardized uptake value times the area of the cardiac regions of interest times the slice thickness for all cardiac transaxial slices, divided by the total number of slices. Mean age is 63.5 ± 7.8 years and 62% male. Median GMCS is 320.9 (240.8-402.8). Individuals with more than five CV risk factors (50%) have increased GMCS [356.7 (321.0-409.6) vs. 261.1 (225.6-342.1), P = 0.01], which is positively correlated with predicted fatal CV risk by SCORE (rs = 0.32, P = 0.04). There is a positive correlation between GMCS and weight (rs = 0.61), body mass index (rs = 0.66), abdominal perimeter (rs = 0.74), thoracic fat volume (rs = 0.47), and epicardial adipose tissue (rs = 0.41), all with P ≤ 0.01. There is no correlation between GMCS and coronary calcium score nor coronary artery wall Na[18F]F uptake. In a high CV risk group, the global cardiac microcalcification burden is related to CV risk factors, metabolic syndrome variables and cardiac fat. Cardiac GMCS is a promising risk stratification tool, combining a straightforward and objective methodology with a comprehensive analysis of both coronary and valvular microcalcification.