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Resumen Introduccion La mielopatia cervical degenerativa representa una entidad patologica producida por la estenosis del canal medular cervical, resultando en una compresion cronica de la medula espinal, variable y progresiva. El abordaje quirurgico de la columna cervical puede realizarse por via anterior y/o via posterior. Respecto al abordaje posterior, existen 2 tecnicas fundamentales: laminoplastia y laminectomia con fijacion posterior (LFP). En la literatura actual existe controversia acerca de cual de las 2 tecnicas permite obtener mejores resultados postoperatorios. El objetivo es el estudio de las diferencias entre laminoplastia y LFP desde el punto de vista clinico y radiologico. Materiales y metodos Se realiza un estudio de una cohorte historica de 39 pacientes (12 LFP y 27 laminoplastia) intervenidos en un periodo de 10 anos en el Hospital Universitario La Paz con un seguimiento de 12 meses tras la cirugia. Se analizan y comparan los resultados clinicos mediante la escala de Nurick y la Escala Japanese Orthopaedic Association modificada (mJOA) y los resultados radiologicos mediante el angulo de Cobb, eje sagital vertical, T1 Slope y el alineamiento (medido mediante Cobb-T1 Sloppe). Resultados Se observan diferencias significativas en la mejoria postoperatoria de la escala Nurick (p = 0,008) y mJOA (p = 0,018) en el grupo de laminoplastia. En LFP se objetiva una tendencia a una mejoria mayor, pero no se alcanza la significacion estadistica debido al bajo tamano muestral de este grupo. No se objetivan diferencias estadisticamente significativas en cuanto a la variables radiologicas. Respecto al total de complicaciones, se observo un numero mayor en el grupo de laminoplastia (7 casos) frente a LFP (un caso), pero no se vieron diferencias estadisticamente significativas. Conclusiones La laminoplastia y la LFP son ambos procedimientos seguros y efectivos en el tratamiento de la mielopatia cervical degenerativa. Los hallazgos de nuestro estudio demuestran una mejoria clinica estadisticamente significativa en base a las escalas de Nurick y mJOA en el grupo de laminoplastia. No se observan diferencias significativas en cuanto a complicaciones ni variables radiologicas entre ambas tecnicas.

Resumen Objetivo: Revisar la utilidad pronostica de la radiografia de torax en la seleccion de pacientes con sospecha de infeccion por SARS-CoV-2. Material y metodos: Estudio observacional, descriptivo y transversal, realizado en 978 pacientes con sospecha de infeccion por SARS-CoV-2 a los que se les hizo una radiografia de torax en el servicio de urgencias de un hospital terciario, en marzo de 2020. Se analizaron variables demograficas, clinicas y pronosticas por separado en pacientes con RT-PCR (reaccion en cadena de la polimerasa por transcriptasa inversa) hecha (grupo 1, n = 535) o no hecha por baja sospecha clinica (grupo 2, n = 443). Resultados: En el grupo 1 se observo una prevalencia de SARS-CoV-2 del 70,4%. La radiografia mostro una sensibilidad del 62,8%. En el grupo 2, la radiografia fue negativa en el 97,5%, corroborando la baja sospecha clinica, y fueron dados de alta;de ellos, el 5,6% volvio a consultar con formas leves de la enfermedad. En el grupo 1 no se observaron diferencias estadisticamente significativas en el porcentaje de radiografias de torax patologicas entre los pacientes ingresados en plantas hospitalarias (68,3%) y los ingresados en la unidad de cuidados intensivos (72,9%), (p = 0,22). Conclusion: En situacion de pandemia, los pacientes con baja sospecha clinica y radiografia negativa pueden ser dados de alta con baja probabilidad de volver a consultar o de desarrollar formas graves de la enfermedad. En los pacientes con SARS-CoV-2 positivo, la radiografia de torax inicial no tiene utilidad pronostica. Objective: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. Material and methods: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n=535) and those in whom RT-PCR was not done because of low clinical suspicion (n=443). Results: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion;these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p=0.22). Conclusion: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.

A 53-year-old male with no systemic disorders, other than controlled arterial hypertension, presented with asymptomatic, bilateral neurosensory retinal detachment (NRD) detected during a routine revision. The patient reported the use of tadalafil (a phosphodiesterase-5 inhibitor [PDE5I]) for erectile dysfunction. Following suspension of the drug, subretinal fluid reabsorption was confirmed, with the persistence of chronic alterations in the optical coherence tomography (OCT) and the visual field. PDE5Is have ocular side effects, including exudative retinal detachment. Although no direct causal relationship has been confirmed, PDE5 inhibition at chorioretinal level produces vasodilatation, increased choroid hydrostatic pressure, and exudation into the subretinal space. In cases of NRD, a thorough assessment of the drug treatment history is crucial. Patients who use PDE5I drugs should be alerted to their potential ocular side effects.

Objective To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. Methods A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and “formal evaluation” or “reasoned judgment” qualitative analysis techniques. Results A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers’ education. This part I shows the first 27 recommendations on the first 2 areas. Conclusions Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.

Obesity initiates a chronic inflammatory network linked to perioperative complications and increased acute rejection rates in organ transplantation. Bariatric surgery is the most effective treatment of obesity recommended for morbidly obese transplant recipients. Here, we delineated the effects of obesity and bariatric surgery on alloimmunity and transplant outcomes in diet-induced obese (DIO) mice. Allograft survival was significantly shorter in DIO-mice. When performing sleeve gastrectomies (SGx) prior to transplantation, we found attenuated T cell-derived alloimmune responses resulting in prolonged allograft survival. Administering taurodeoxycholic acid (TDCA) and valine, metabolites depleted in DIO-mice and restored through SGx, prolonged graft survival in DIO-mice comparable with SGx an dampened Th1 and Th17 alloimmune responses while Treg frequencies and CD4+ T cell-derived IL-10 production were augmented. Moreover, in recipient animals treated with TDCA/valine, levels of donor-specific antibodies had been reduced. Mechanistically, TDCA/valine restrained inflammatory M1-macrophage polarization through TGR5 that compromised cAMP signaling and inhibited macrophage-derived T cell activation. Consistently, administering a TGR5 agonist to DIO-mice prolonged allograft survival. Overall, we provide novel insights into obesity-induced inflammation and its impact on alloimmunity. Furthermore, we introduce TDCA/valine as a noninvasive alternative treatment for obese transplant patients.

PURPOSE Melphalan flufenamide (melflufen) is a first-in-class peptide-drug conjugate that targets aminopeptidases and rapidly and selectively releases alkylating agents into tumor cells. The phase II HORIZON trial evaluated the efficacy of melflufen plus dexamethasone in relapsed and refractory multiple myeloma (RRMM), a population with an important unmet medical need. PATIENTS AND METHODS Patients with RRMM refractory to pomalidomide and/or an anti-CD38 monoclonal antibody received melflufen 40 mg intravenously on day 1 of each 28-day cycle plus once weekly oral dexamethasone at a dose of 40 mg (20 mg in patients older than 75 years). The primary end point was overall response rate (partial response or better) assessed by the investigator and confirmed by independent review. Secondary end points included duration of response, progression-free survival, overall survival, and safety. The primary analysis is complete with long-term follow-up ongoing. RESULTS Of 157 patients (median age 65 years; median five prior lines of therapy) enrolled and treated, 119 patients (76%) had triple-class–refractory disease, 55 (35%) had extramedullary disease, and 92 (59%) were refractory to previous alkylator therapy. The overall response rate was 29% in the all-treated population, with 26% in the triple-class–refractory population. In the all-treated population, median duration of response was 5.5 months, median progression-free survival was 4.2 months, and median overall survival was 11.6 months at a median follow-up of 14 months. Grade ≥ 3 treatment-emergent adverse events occurred in 96% of patients, most commonly neutropenia (79%), thrombocytopenia (76%), and anemia (43%). Pneumonia (10%) was the most common grade 3/4 nonhematologic event. Thrombocytopenia and bleeding (both grade 3/4 but fully reversible) occurred concomitantly in four patients. GI events, reported in 97 patients (62%), were predominantly grade 1/2 (93%); none were grade 4. CONCLUSION Melflufen plus dexamethasone showed clinically meaningful efficacy and a manageable safety profile in patients with heavily pretreated RRMM, including those with triple-class–refractory and extramedullary disease.

Objetivo: O objetivo deste estudo foi testar a hipótese de que a suplementação de cafeína (6 mg · kg-1 de massa corporal) por 4 dias, seguida de ingestão aguda, afetaria a potência de cinco triatletas masculinos após realizarem o exercício de intensidade submáxima. Métodos: Foi realizado um estudo cruzado, randomizado, duplo-cego, placebo-controlado, placebo (4-dias) - placebo (agudo) PP, placebo (4-dias) - cafeína (agudo) PC, cafeína (4-dias) - cafeína (agudo) CC. Os participantes se abstiveram de fontes alimentares de cafeína por 4 dias e ingeriram cápsulas contendo placebo ou cafeína (6 mg.kg-1 de massa corporal por dia). Os participantes nos ensaios agudos ingeriram cápsulas contendo placebo ou cafeína (6 mg.kg-1de massa corporal) 60 minutos antes de realizar o exercício na esteira por 40 minutos (80% VO2máx) e em seguida realizaram o teste de Wingate. O lactato sanguíneo foi determinado antes, 60 minutos após a ingestão, imediatamente após o exercício na esteira e no teste de Wingate e, após 10 min. de recuperação. Resultados: Nos ensaios CC e PC não foram observadas alterações nas variáveis cardiopulmonares (P>0,05) e nas variáveis de potência anaeróbica (potência de pico, potência média e índice de fadiga) (P>0,05). No ensaio PC comparado ao PP promoveu melhorias na curva de potência no tempo de 2 segundos (31,19% - large effect-size d = 1,08; P

Resumen Objetivos Conocer la prevalencia de enfermedad renal cronica (ERC) y determinar los factores asociados al deterioro de la funcion renal en poblacion asistida en atencion primaria. Pacientes y metodo Estudio transversal y multicentrico realizado en los pacientes basales del estudio IBERICAN (identificacion de la poblacion espanola de riesgo cardiovascular y renal). Se considero ERC a un filtrado glomerular estimado (FGe) Resultados Se incluyeron 7.895 pacientes (edad media 57,9 ± 14,8 anos; 54,5% mujeres). El 14,4% (IC 95%: 13,6-15,1) presentaba ERC; en hombres un 16,1% (IC 95%: 14,9-17,3) y en mujeres un 12,9% (IC 95%: 11,9-14,0). Se observo un aumento continuo de la prevalencia con la edad (24,8% ≥ 65 anos) y con la agregacion de FRCV. Las variables que mas se asociaron a la probabilidad de padecer ERC fueron hipertrofia ventricular izquierda (OR: 1,95; p Conclusiones Catorce de cada 100 pacientes incluidos en el estudio IBERICAN presenta ERC. La prevalencia de ERC afecta a la cuarta parte de pacientes ≥ 65 anos y aumenta exponencialmente con la agregacion de FRCV.

Introduction There is subgroup analysis suggesting a lack of benefit of daratumumab use in multiple myeloma (MM) and hepatic disease (HD). The objectives of this study were to conduct a systematic review and interpretation of daratumumab-based regimen efficacy in transplant-ineligible patients with untreated MM and HD. Methods A systematic search in Pubmed® database about randomized clinical trials (RCTs) with subgroup analysis regarding hepatic function for overall survival (OS) or progression-free survival (PFS) were developed. Two methodologies were applied. One of them considered statistical interaction, prespecification, biological support and consistency of subgroup results. Second methodology was two-part validated tool: preliminary questions to reject subset analysis without minimal relevance, and a checklist relating a recommendation for applicability in clinical practice. Results It was included three records. About first methodology, statistical interaction among subgroups was found for PFS in one RCT. Subsets were prespecified in all RCTs. Biological support of efficacy differences could be reasonable. Inconsistent results were found. Second methology directly rejected applicability of subset analysis in two records. Checklist recommended “null” application of results in the remaining RCT. Conclusions No consistent heterogeneity for daratumumab-based regimen efficacy was observed among subgroups regarding hepatic function in transplant-ineligible patients with untreated MM. Patients with normal hepatic function and HD could benefit from these treatments.

Snyder-Robinson syndrome is an extremely rare genetic disorder, caused by mutations of the spermine synthase gene. We report a novel case of Snyder-Robinson syndrome, caused by a de novo mutation and first misdiagnosed with osteogenesis imperfecta. Clinical features, course, and genetic analysis are presented. The patient was treated with bisphosphonates for a decade, until developing an atypical femoral fracture. Teriparatide was then administered for 2 years and then changed to denosumab every 6 months, improving his bone density mass and preventing further fractures.

Quantum teleportation, the faithful transfer of an unknown input state onto a remote quantum system1, is a key component in long-distance quantum communication protocols2 and distributed quantum computing3,4. At the same time, high-frequency nano-optomechanical systems5 hold great promise as nodes in a future quantum network6, operating on-chip at low-loss optical telecom wavelengths with long mechanical lifetimes. Recent demonstrations include entanglement between two resonators7, a quantum memory8 and microwave-to-optics transduction9–11. Despite these successes, quantum teleportation of an optical input state onto a long-lived optomechanical memory is an outstanding challenge. Here we demonstrate quantum teleportation of a polarization-encoded optical input state onto the joint state of a pair of nanomechanical resonators. Our protocol also allows to store and retrieve an arbitrary qubit state onto a dual-rail encoded optomechanical quantum memory. This work demonstrates the full functionality of a single quantum repeater node and presents a key milestone towards applications of optomechanical systems as quantum network nodes. Quantum teleportation of a photonic qubit into mechanical modes of two silicon photonic crystal nanobeams is demonstrated. It allows to store and retrieve an arbitrary qubit state onto a dual-rail encoded long-lived optomechanical quantum memory.

Most critics and readers of Anne Brontë’s The Tenant of Wildfell Hall (1848) focus on the triangle formed by Helen Graham, her first husband Arthur Huntingdon and the second one Gilbert Markham. However, as I argue here, Brontë narrates yet another romantic story, that of Arthur and his mistress Annabella. Helen’s unhappiness is actually caused by Annabella’s earlier decision to marry a richer, aristocratic man rather than Arthur, whom she loves. Since Helen is Arthur’s second choice he never truly loves her, nor does Annabella love her husband Lord Lowborough. Arthur and Annabella’s irresistible passion and ensuing adultery ultimately destroys both marriages and are, thus, a central (but neglected) aspect of the plot. Likewise, both Annabella’s unique characterization as an adulteress and her adultery with Arthur have been overlooked as Anne Brontë’s singular contribution to the history of how this theme has been represented in British fiction.

Over the last 20 years, social entrepreneurship has attracted the attention of researchers from a wide variety of disciplines which, in turn, has generated a large variety of understandings of the meaning of social entrepreneurship. This paper maps the existing definitions, using a citation map and cluster analysis methods. Studying 307 documents that contain social entrepreneurship definitions, the analysis reveals that - contrary to what has been commonly believed -there does, in fact, exist widespread consensus within the academic community on the definition and meaning of the term social entrepreneurship and it is primarily centred on the combination of social and financial goals, community ideals and innovation.

Background Use of docetaxel in low- and high-burden metastatic hormone-sensitive prostate cancer presents considerable controversy. There is literature suggesting lack of benefit for low-volume of metastases. Objective The study aims to develop a systematic review and methodological assessment of subset analysis about use of docetaxel in metastatic hormone-sensitive prostate cancer regarding volume of metastatic disease. Methods A systematic review in the Pubmed® database was conducted up to 25 September 2020. A reference tracking was also developed. Randomised clinical trials with subgroup analysis according volume of metastatic disease for overall survival were selected. Two methodologies were used. One of them considered statistical interaction of subsets ( p(i) Results A total of 31 results were found in systematic reviews in the Pubmed® database. One result was identified in the reference tracking. Of the total of 32 results, four randomised clinical trials were included in the study. About first methodology, statistical interaction among subgroups was obtained in one randomised clinical trial. Subgroup analysis was pre-specified in two randomised clinical trials. Biological plausibility was reasonable. No external consistency among results of subgroup analyses in randomised clinical trials was observed. Preliminary questions of second methodology rejected applicability of subgroup analysis in three randomised clinical trials. A ‘null’ recommendation for applicability of subset results was obtained in the remaining randomised clinical trial. Conclusions Patients with low- and high-burden metastatic hormone-sensitive prostate cancer would benefit from docetaxel therapy. No consistent differences for overall survival were observed in subgroup analyses regarding volume of metastatic disease.

Background It is important for sport scientists and health professionals to have estimative methods for energy demand during diferent physical activities. The metabolic equivalent of task (MET) provides a feasible approach for classifying activity intensity as a multiple of the resting metabolic rate (RMR). RMR is generally assumed to be 3.5 mL of oxygen per kilogram of body mass per minute (mL O2 kg−1 min−1), a value that has been criticized and considered to be overestimated in the older adult population. However, there has been no comprehensive efort to review available RMR estimations, equivalent to 1 MET, obtained in the older adult population. Objective The aim of this review was to examine the existing evidence reporting measured RMR values in the older adult population and to provide descriptive estimates of 1 MET. Methods A systematic review was conducted by searching PubMed, Web of Science, Scopus, CINAHL, SPORTDiscus, and Cochrane Library, from database inception to July 2021. To this end, original research studies assessing RMR in adults≥60 years old using indirect calorimetry and reporting results in mL O2 kg−1 min−1 were sought. Results Twenty-three eligible studies were identifed, including a total of 1091 participants (426 men). All but two studies reported RMR values lower than the conventional 3.5 mL O2 kg−1 min−1. The overall weighted average 1 MET value obtained from all included studies was 2.7±0.6 mL O2 kg−1 min−1; however, when considering best practice studies, this value was 11% lower (2.4±0.3 mL O2 kg−1 min−1). Conclusion Based on the results of this systematic review, we would advise against the application of the standard value of 1 MET (3.5 mL O2 kg−1 min−1) in people ≥ 60 years of age and encourage the direct assessment of RMR using indirect calorimetry while adhering to evidence-based best practice recommendations. When this is not possible, assuming an overall value of 2.7 mL O2 kg−1 min−1 might be reasonable. Systematic review registration: International Prospective Register of Systematic Reviews on 30 September 2020, with registration number CRD42020206440.

Background Dexmedetomidine is frequently used for sedation during deep brain stimulator implantation in patients with Parkinson's disease, but its effect on subthalamic nucleus activity is not well known. The aim of this study was to quantify the effect of increasing doses of dexmedetomidine in this population. Methods Controlled clinical trial assessing changes in subthalamic activity with increasing doses of dexmedetomidine (from 0.2 to 0.6 μg kg−1 h−1) in a non-operating theatre setting. We recorded local field potentials in 12 patients with Parkinson's disease with bilateral deep brain stimulators (24 nuclei) and compared basal activity in the nuclei of each patient and activity recorded with different doses. Plasma levels of dexmedetomidine were obtained and correlated with the dose administered. Results With dexmedetomidine infusion, patients became clinically sedated, and at higher doses (0.5–0.6 μg kg−1 h−1) a significant decrease in the characteristic Parkinsonian subthalamic activity was observed (P Conclusions Patients needing some degree of sedation throughout subthalamic deep brain stimulator implantation for Parkinson's disease can probably receive dexmedetomidine up to 0.6 μg kg−1 h−1 without significant alteration of their characteristic subthalamic activity. If patients achieve a ‘sedated' state, subthalamic activity decreases, but they can be easily awakened with a non-pharmacological external stimulus and recover baseline subthalamic activity patterns in less than 10 min. Clinical trial registration EudraCT 2016-002680-34; NCT-02982512.

Background: A validated, standardized, and feasible test to assess muscle power in older adults has recently been reported: the sit-to-stand (STS) muscle power test. This investigation aimed to assess the relationship between relative STS power and age and to provide normative data, cut-off points, and minimal clinically important differences (MCID) for STS power measures in older women and men. Methods: A total of 9320 older adults (6161 women and 3159 men) aged 60–103 years and 586 young and middle-aged adults (318 women and 268 men) aged 20–60 years were included in this cross-sectional study. Relative (normalized to body mass), allometric (normalized to height squared), and specific (normalized to legs muscle mass) muscle power values were assessed by the 30 s STS power test. Body composition was evaluated by dual energy X-ray absorptiometry and bioelectrical impedance analysis, and legs skeletal muscle index (SMI; normalized to height squared) was calculated. Habitual and maximal gait speed, timed up-and-go test, and 6 min walking distance were collected as physical performance measures, and participants were classified into two groups: well-functioning and mobility-limited older adults. Results: Relative STS power was found to decrease between 30–50 years (-0.05 W·kg-1·year-1; P > 0.05), 50–80 years (-0.10 to -0.13 W·kg-1·year-1; P

Purpose The purpose of this study is to empirically investigate how knowledge-based organizational support (KOS) influences organizational performance through project management. Design/methodology/approach Data were obtained from a survey and from archival sources with a time lag for the dependent variable; structural equation modeling was used to analyze the data. The sample was made up of 106 organizations in Colombia, considering two key respondents from each organization: general manager and project manager. Findings Results show that KOS is an antecedent of project management and project performance. Furthermore, project management and project performance play a mediating role between KOS and organizational performance. Research limitations/implications Research limitations are the following: use of cross-sectional data with a time lag, one single unit of analysis, organizational performance analyzed only from a financial perspective. Despite these limitations, the paper puts forward relevant implications that bridge knowledge management and project management literature by clarifying the conditions under which knowledge organizational support generates a significant impact on organizational performance. Intellectual capital and knowledge management dynamic capabilities play a relevant role in this connection. Practical implications The findings have important practical implications: decision-makers are to allocate effectively hard and soft resources to configure a knowledge-based infrastructure, through the development of intellectual capital and knowledge management dynamic capabilities. Social implications The findings are generalizable to projects management in the context of non-government organizations or other social-oriented initiatives. Originality/value This study assumes and operationalizes organizational support from a knowledge-based perspective, represented by intellectual capital and knowledge management dynamic capabilities, providing empirical evidence of the way KOS influences organizational performance through project management and project performance.

Nowadays, the growing number of cases of possession and distribution of Child Sexual Abuse (CSA) material pose a significant challenge for Law Enforcement Agencies (LEAs). In this paper, we decompose the automatic CSA detection problem into two simpler ones for which it is feasible to create massive labeled datasets, especially to train deep neural networks: (i) pornographic content detection and (ii) age-group classification of a person as a minor or an adult. We propose a deep CNN architecture with a novel attention mechanism and metric learning, denoted as AttM-CNN, for these tasks. Furthermore, the pornography detection and the age-group classification networks are combined for CSA detection using two different strategies: decision level fusion for binary CSA classification and score level fusion for the re-arrangement of the suspicious images. We also introduce two new datasets: (i) Pornographic-2M, which contains two million pornographic images, and (ii) Juvenile-80k, including 80k manually labeled images with apparent facial age. The experiments conducted for age-group and pornographic classification demonstrate that our approach obtained similar or superior results compared to the state-of-the-art systems on various benchmark datasets for both tasks, respectively. For the evaluation of CSA detection, we created a test dataset comprising one million adult porn, one million non-porn images, and 5 , 000 real CSA images provided to us by Police Forces. For binary CSA classification, our method obtained an accuracy of 92.72 % , which increases the recognition rate by more than 21 % compared to a well-known forensic tool, i.e. NuDetective. Furthermore, re-arrangement of the CSA test dataset images showed that 80 % of CSA images can be found in the top 8.5 % of images in the ranked list created using our approach.

El taponamiento cardiaco es la acumulación de líquido dentro del saco pericárdico, lo que conlleva a un aumento de la presión intrapericardica, permitiendo el deterioro de la capacidad del corazón para llenarse y actuar como bomba. Entre sus causas tenemos a la tuberculosis, las colagenopatías, y el cáncer. En el embarazo se pueden enmascarar los signos y síntomas del taponamiento cardiaco por los cambios fisiológicos propios del embarazo. El Gold estándar para su detección es la ecocardiografía. El tratamiento del taponamiento cardiaco es la pericardiocentesis o el drenaje quirúrgico. Se presenta el caso de una paciente de 26 años con: embarazo de 32,6 semanas, trabajo de parto pretérmino, taponamiento cardiaco y post pericardiocentesis de 2 horas, para culminación de embarazo. El manejo anestésico es complejo tanto para la madre y el recién nacido, basándose en mantener estabilidad hemodinámica y posterior traslado a unidad de terapia intensiva.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, disabling, and complex multisystem illness of unknown etiology. The protein fibroblast growth factor 21 (FGF21) regulates g...

While genetics evaluation is increasingly utilized in adult neurology patients, its usage and efficacy are not well characterized. Here, we report our experience with 1461 consecutive patients evaluated in an adult neurogenetics clinic at a large academic medical center between January 2015 and March 2020. Of the 1461 patients evaluated, 1215 patients were referred for the purposes of identifying a genetic diagnosis for an undiagnosed condition, 90.5% of whom underwent genetic testing. The modalities of genetic testing utilized varied across referral diagnostic categories, including a range of utilization of whole exome sequencing (WES) as an initial test in 13.9% of neuromuscular patients to 52.9% in white matter disorder patients. The usage of WES increased over time, from 7.7% of initial testing in 2015 to a peak of 27.3% in 2019. Overall, genetic testing yielded a causal genetic diagnosis in 30.7% of patients. This yield was higher in certain referring diagnosis categories, such as neuromuscular (39.0%) and epilepsy (29.8%). Our study demonstrates that evaluation at an adult neurogenetics referral center can yield diagnoses in a substantial fraction of patients. Additional research will be needed to determine optimal genetic testing strategies and cost effectiveness of adult neurogenetics evaluation.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus associated with immune dysregulation. The use of immunosuppressant drugs as part of COVID-19 treatment (such as Tocilizumab or high -dose corticosteroids) increases the risk of opportunistic infections. Here we present a case of a patient without prior immunosuppression that developed a serious fungal infection after the use of high dose corticosteroids in the setting of severe COVID-19 and cryptogenic organizing pneumonia.

Maternal obesity increases the risk of nonalcoholic fatty liver disease (NAFLD) in offspring. The Roux-en-Y gastric bypass (RYBG) is effective for achieving weight loss and ameliorates NAFLD. To determine whether these benefits are maintained after pregnancy and/or lactation, and whether they modulate hepatic morphofunction in the next generation, we evaluated hepatic lipid metabolism in Western diet (WD)-obese female rats that underwent RYGB and in their F1 offspring at adulthood. Female Wistar rats consumed a WD from 21 to 130 days of age, before being submitted to RYGB (WD-RYGB-F0) or SHAM (WD-SHAM-F0) operations. After 5 weeks, these females were mated with control male breeders, and the male and female F1 offspring were identified as WD-RYGB-F1 and WD-SHAM-F1. WD-RYGB-F0 dams exhibited lower serum lipids levels, but severe hepatic steatosis and pathological features of advanced liver injury. The hepatic proteins involved in lipogenesis were reduced in WD-RYGB-F0, as were the genes related to β-oxidation and bile acids (BAs). Although the female and male WD-RYGB-F1 groups did not exhibit hepatic steatosis, the livers of female WD-RYGB-F1 demonstrated higher amounts of lipogenic genes and proteins, while male WD-RYGB-F1 presented a similar downregulation of lipogenic factors to that seen in WD-RYGB-F0 dams. In contrast, maternal and offspring groups of both sexes displayed reductions in the expressions of genes involved in BAs physiology and gluconeogenesis. As such, RYGB aggravates NAFLD after pregnancy and lactation and induces a gender-dependent differential expression of the hepatic lipogenesis pathway in offspring, indicating that female WD-RYGB-F1 may be an increased risk of developing NAFLD.

espanolEl registro de lupus de la Sociedad Espanola de Reumatologia (RELESSER) es un registro multicentrico de pacientes con lupus eritematoso sistemico seguidos en servicios de reumatologia espanoles, que contiene cuantiosa informacion sobre 4.024 pacientes. Hasta la fecha han sido publicados 14 analisis sobre la fase transversal del registro. Se describen los resultados mas relevantes, a criterio de los autores, concernientes a las caracteristicas clinicas acumuladas, nivel de actividad, tratamientos, refractariedad, dano y mortalidad. Se revisan asimismo los resultados de analisis especificos sobre el lupus incompleto, la nefritis lupica, las manifestaciones respiratorias, los eventos cardiovasculares, las infecciones graves, las neoplasias, la fibromialgia, el lupus en varones, el lupus en latinoamericanos y el lupus de inicio juvenil, comparando los diferentes subgrupos con el total de la cohorte. RELESSER se ha constituido como uno de los registros clinicos de lupus eritematoso sistemico mas importantes del mundo, resultando altamente productivo en terminos de generacion de conocimiento de la enfermedad en pacientes espanoles, util tambien para toda la comunidad cientifica. EnglishThe lupus register of the Spanish Society of Rheumatology (RELESSER) is a multicentre register of patients with systemic lupus erythematosus (SLE) under follow-up by Spanish Rheumatology Services. It contains data on a total of 4024 patients with SLE. So far, 14 studies have been published from the transversal phase of RELESSER. Here we report the more relevant contributions of those studies, according to the authors’ perspective, concerning cumulative clinical characteristics, level of activity, treatments, refractory disease, damage and mortality. We also review the main results of the analysis regarding incomplete SLE, lupus nephritis, respiratory manifestations, cardiovascular disease, serious infection, malignancies, fibromyalgia, SLE in males, SLE in Hispanics and juvenile-onset SLE, comparing the main characteristics of each subgroup to the global cohort. RELESSER has become one of the most important clinical SLE registers around the world, with a high yield in terms of knowledge generation about the disease in Spain, also useful for the entire scientific community.

The lupus register of the Spanish Society of Rheumatology (RELESSER) is a multicentre register of patients with systemic lupus erythematosus (SLE) under follow-up by Spanish Rheumatology Services. It contains data on a total of 4024 patients with SLE. So far, 14 studies have been published from the transversal phase of RELESSER. Here we report the more relevant contributions of those studies, according to the authors' perspective, concerning cumulative clinical characteristics, level of activity, treatments, refractory disease, damage and mortality. We also review the main results of the analysis regarding incomplete SLE, lupus nephritis, respiratory manifestations, cardiovascular disease, serious infection, malignancies, fibromyalgia, SLE in males, SLE in Hispanics and juvenile-onset SLE, comparing the main characteristics of each subgroup to the global cohort. RELESSER has become one of the most important clinical SLE registers around the world, with a high yield in terms of knowledge generation about the disease in Spain, also useful for the entire scientific community.

espanolFundamento. Describir la supervivencia y evolucion clinica de pacientes sometidos a cirugia de revascularizacion miocardica, identificando los factores predictores del resultado quirurgico a corto y largo plazo. Metodo. Estudio de una cohorte de 175 pacientes sometidos a cirugia de revascularizacion miocardica coronaria pura o mixta en un servicio de Cirugia Cardiaca, reclutada entre 2008 y 2010 y seguida durante diez anos. Se realizo analisis descriptivo, de regresion logistica (OR e IC95%) y de supervivencia por (Kaplan Meier y regresion de Cox uni y multivariante (HR e IC95%) a corto (un ano) y largo plazo (diez anos). Resultados. Cohorte con predominio masculino (85,1%), media de edad 67 anos (45-84), y EuroSCORE medio de 5,3%. La mortalidad fue 6,8% al ano y 26,9% a los 10 anos La media de supervivencia de los fallecidos fue 40 meses (32,2-47,8). A corto plazo, un mejor grado funcional preoperatorio NYHA≤III se asocio no significativamente a menor mortalidad (OR :0,11; IC95%: 0,01-1,08; p=0,058), mientras que el sexo femenino (OR: 2,94; IC95%: 1,01-8,57; p=0,048) y un EuroSCORE >4% (OR: 4,94; IC95%: 1,52-16,1; p=0,008) incrementaron el riesgo de presentar eventos cardiacos adversos. A largo plazo, mayor edad (HR: 1,06; IC95%: 1,01-1,10; p=0,026) y menor indice de masa corporal tras el primer ano postoperatorio (HR: 0,90; IC95%: 0,81-0,99; p=0,040) fueron predictores independientes de mortalidad. Conclusiones. La edad fue predictor independiente de mortalidad a largo plazo, mientras que el sexo femenino y un EuroSCORE >4% se asociaron con mayor riesgo de padecer eventos cardiovasculares a corto plazo. EnglishBackground. This study sets out to describe the survival and clinical evolution of patients who undergo myocardial revascularisation surgery, and identifies the short- and long-term predictive factors for surgical outcomes. Methods. Study of a cohort of 175 patients undergoing pure or mixed coronary myocardial revascularisation surgery at a heart surgery unit, recruited between 2008 and 2010 and monitored for ten years. Descriptive and logistic regression (OR and 95%CI) analysis were carried out, along with an analysis of survival by Kaplan Meier and Cox uni- and multivariate regression (HR and 95%CI) in the short- (one year) and long-term (ten years). Results. Predominantly male cohort (85.1%), mean age of 67 years (45-84), and mean EuroSCORE of 5.3%. Mortality was 6.8 and 26.9% at 1 and 10 years, respectively. Mean survival of deceased individuals was 40 months (32.2-47.8). In the short-term, a better NYHA ≤III preoperative functional level was not significantly associated with lower mortality (OR: 0.11; 95%CI: 0.01-1.08; p=0.058), while being female (OR: 2.94; 95%CI: 1.01-8.57; p=0.048) and having a EuroSCORE of >4% (OR: 4.94; 95%CI: 1.52-16.10; p=0.008) showed an increased risk of presenting adverse cardiac events. In the long-term, greater age (HR: 1.06; 95%CI: 1.01-1.10; p=0.026) and lower rates of body mass index after the first postoperative year (HR: 0.90; 95%CI: 0.81-0.99; p=0.040) were independent predictors of mortality. Conclusion. Age was an independent predictor of long-term mortality, while being female and a EuroSCORE >4% were associated with a higher risk of suffering from short-term cardiovascular events.

This study investigated the acute responses to volume-load-matched heavy-load (80% 1RM) versus light-load (40% 1RM) power-oriented resistance training sessions in well-functioning older adults. Using a randomized cross-over design, 15 volunteers completed each condition on a leg press. Neuromuscular (maximal isometric force and rate of force development) and functional performance (power during sit-to-stand test), lactate, and muscle damage biochemistry (creatine kinase, lactate dehydrogenase and C-reactive protein serum concentration) were assessed pre- and post-exercise. Performance declines were found after heavy-load (Cohen's d effect size (d); maximal isometric force=0.95 d; rate of force development=1.17 d; sit-to-stand power =0.38 d, all p0.05) and light-load (maximal isometric force=0.45 d; rate of force development=0.9 d; sit-to-stand power=1.17 d, all p0.05), while lactate concentration increased only after light-load (1.7 d, p=0.001). However, no differences were found between conditions (all p0.05). Both conditions increased creatine kinase the day after exercise (marginal effect=0.75 d, p0.001), but no other blood markers increased (all, p0.05). Irrespective of the load used, power training induced non-clinically significant decreases in sit-to-stand performance, moderate declines in maximal isometric force, but pronounced decreases in the rate of force development. Furthermore, the metabolic stress and muscle damage were minor; both sessions were generally well tolerated by well-functioning older adults without previous experience in resistance training.This study investigated the acute responses to volume-load-matched heavy-load (80% 1RM) versus light-load (40% 1RM) power-oriented resistance training sessions in well-functioning older adults. Using a randomized cross-over design, 15 volunteers completed each condition on a leg press. Neuromuscular (maximal isometric force and rate of force development) and functional performance (power during sit-to-stand test), lactate, and muscle damage biochemistry (creatine kinase, lactate dehydrogenase and C-reactive protein serum concentration) were assessed pre- and post-exercise. Performance declines were found after heavy-load (Cohen’s d effect size (d); maximal isometric force=0.95 d; rate of force development=1.17 d; sit-to-stand power =0.38 d, all p0.05) and light-load (maximal isometric force=0.45 d; rate of force development=0.9 d; sit-to-stand power=1.17 d, all p0.05), while lactate concentration increased only after light-load (1.7 d, p=0.001). However, no differences were found between conditions (all p0.05). Both conditions increased creatine kinase the day after exercise (marginal effect=0.75 d, p0.001), but no other blood markers increased (all, p0.05). Irrespective of the load used, power training induced non-clinically significant decreases in sit-to-stand performance, moderate declines in maximal isometric force, but pronounced decreases in the rate of force development. Furthermore, the metabolic stress and muscle damage were minor; both sessions were generally well tolerated by well-functioning older adults without previous experience in resistance training.

Tourism in São Francisco de Paula, in Rio Grande do Sul [Brazil] has stood out and, due to its wide territory, the need to organize tourism in rural areas emerges. Otherwise, socioeconomic and environmental sustainability may be weakened, if the presence of tourism activity is disordered. Thus, tourist routing can be an ally in promoting local, sustainable development. Therefore, the objective of this study was to develop a roadmap for rural tourism in São Francisco de Paula. The first step towards achieving this goal involved examining documents to obtain an overview of local tourism. The next two stages took place through a specific questionnaire addressed to entrepreneurs and tourists. Based on the data collected, an instrument for sustainable regional development was developed: a rural roadmap called ‘Encantos de São Chico’. The survey shows that both owners and tourists recognize the relevance of rural tourism to sustainable local development.

Background: Observational studies in Parkinson’s disease (PD) have focused on relatively small numbers of research participants who are studied extensively. The Molecular Integration in Neurological Diagnosis Initiative at the University of Pennsylvania aims to characterize molecular and clinical features of PD in every patient in a large academic center. Objective: To determine the feasibility and interest in a global-capture biomarker research protocol. Additionally, to describe the clinical characteristics and GBA and LRRK2 variant carrier status among participants. Methods: All patients at UPenn with a clinical diagnosis of PD were eligible. Informed consent included options for access to the medical record, future recontact, and use of biosamples for additional studies. A blood sample and a completed questionnaire were obtained from participants. Targeted genotyping for four GBA and eight LRRK2 variants was performed, with plasma and DNA banked for future research. Results: Between September 2018 and December 2019, 704 PD patients were approached for enrollment; 652 (92.6%) enrolled, 28 (3.97%) declined, and 24 (3.41%) did not meet eligibility criteria. Median age was 69 (IQR 63_75) years, disease duration was 5.41 (IQR 2.49_9.95) years, and 11.10%of the cohort was non-white. Disease risk-associated variants in GBA were identified in 39 participants (5.98%) and in LRRK2 in 16 participants (2.45%). Conclusions: We report the clinical and genetic characteristics of PD patients in an all-comers, global capture protocol from an academic center. Patient interest in participation and yield for identification of GBA and LRRK2 mutation carriers is high, demonstrating feasibility of PD clinic-wide molecular characterization.

Texture-based instance retrieval is typically performed on images that present a single texture pattern and is mainly applied to the retrieval of fabrics or textiles. In this work, we apply it to indoor scene images that typically present many different texture patterns, which constitutes a more challenging problem. Such retrieval systems, together with the retrieval of faces and objects, can be used as a valuable tool for evidence matching in crime scene investigation. Even though recent deep learning-based approaches have made significant improvement in many computer vision tasks, texture retrieval remains an open problem. In this work, we introduce a Fourier-based approach, in which spatial images and their discrete Fourier transform maps are combined to derive a novel texture representation. We further present a new and efficient texture-based image retrieval framework based on region proposal networks, convolutional autoencoders and transfer learning, in which we extract the features from the latent space layer of the encoder as texture descriptors. The experimental results on four datasets: TextileTube, Outex, USPtex and Stex, validated the effectiveness of our proposed method, yielding better results than the current state of the art.

Objective.Tofacitinib (TOF) is the first Janus kinase (JAK) inhibitor approved for psoriatic arthritis (PsA). It has shown efficacy in patients refractory to anti–tumor necrosis factor-α in randomized controlled trials (RCTs). Our aim was to assess efficacy and safety of TOF in clinical practice.Methods.This was an observational, open-label multicenter study of PsA patients treated with TOF due to inefficacy or adverse events of previous therapies. Outcome variables were efficacy, corticosteroid dose-sparing effect, retention rate, and safety. A comparative study of clinical features between our cohort of patients and those from the OPAL Beyond trial was performed.Results.There were 87 patients (28 women/59 men), with a mean age of 52.8 ± 11.4 years. All patients were refractory to biologic disease-modifying antirheumatic drugs (DMARDs) and/or to conventional synthetic DMARDs plus apremilast. TOF was started at 5 mg twice daily after a mean follow-up of 12.3 ± 9.3 years from PsA diagnosis. At first month, Disease Activity Score in 28 joints based on erythrocyte sedimentation rate (DAS28-ESR) decreased from median 4.8 (IQR 4.1–5.4) to 3.7 (IQR 2.8–4.7,P< 0.01), Disease Activity Index for Psoriatic Arthritis from median 28 (IQR 18.4–34.1) to 15.5 (IQR 10.1–25.7,P< 0.01), and C-reactive protein from median 1.9 (IQR 0.3–5.0) to 0.5 (IQR 0.1–2.2) mg/dL (P< 0.01). Also, TOF led to a significant reduction in prednisone dose. Mild adverse effects were reported in 21 patients (24.13%), mainly gastrointestinal symptoms. TOF retention rate at Month 6 was 77% (95% CI 65.2–86.3). Patients in clinical practice were older with longer disease duration and received biologic agents more commonly than those in the OPAL Beyond trial.Conclusion.Data from clinical practice confirm that TOF seems to be effective, rapid, and relatively safe in refractory PsA despite clinical differences with patients in RCTs.

Literature on ambidexterity emphasizes the need for both exploration and exploitation. Large firms usually choose to implement structural ambidexterity to separate both activities. We here focus on an extreme case of such structural partitioning implemented as a secret skunkworks project in a large French automotive company. A qualitative survey using both primary and secondary data shows that the major basic and initial characteristics of a skunkworks (i.e. secrecy, urgency, and autonomy) created favorable conditions for the technological exploration. However, exploitation failed due to precisely those same characteristics coupled with the fact that the project did not respond to a specific market demand: The skunkworks suffered from what we call the "Robinson Crusoe effect." We therefore contribute to the literature on skunkworks, which have remained understudied in the academic literature, as well as on ambidexterity, by showing how the interrelation between different factors is crucial for structural ambidexterity to be successful

The ADEO subsystem is a scalable drag augmentation device that uses the residual Earth atmosphere present in Low Earth Orbit (LEO) to passively de-orbit of satellites between 1 and 2000 kg. For the de-orbit maneuvre, a large surface is deployed which multiplies the drag effective surface of the satellite significantly. Thereby the drag force is increased as well causing accelerated decay in orbit altitude. Advantageous about a drag augmentation device is that it does not require any active steering and can be designed for passive attitude stabilization thereby making it applicable for non-operational, tumbling spacecrafts as well. The ADEO subsystem consists of four deployable booms that span four sail segments in a planar shaped configuration. While the sails are made of an aluminum-coated polyimide foil, its coating thickness was chosen such that it provides sufficient protection from the LEO space environment. The current activity commenced in August 2018 is going to provide a fully qualified Protoflight Model (PFM) for a follow-up “In Orbit Demonstration” (IOD) in 2021/2022 (ADEO is selected as payload on the European Commission IOD/IOV satellite programme). In May 2020, the team passed the Manufacturing Readiness Review (MRR). An extensive Breadboarding- and Engineering Model campaign including life tests had already been carried out in 2019. The first ADEO-L PFM consists of a 5 m x 5 m dragsail deployed under control of own onboard electronics. Optionally, ADEO-L systems can be equipped with a so-called “watchdog routine” inside the electronics which is able to recognize the point in time when the satellite has come to the end of its life circle. With the help of an on-board battery the sail will be deployed automatically after a certain time in orbit. Operating like this, ADEO-L can be truly called “100% passive”, a “CleanGreen Space Mission”. First commercial candidate missions to be targeted after the successful EC-IOD mission were already identified by Airbus DS (DE) and QinetiQ (BE).

Objective Despite the efforts made to determine the achieved resection grade after pituitary adenoma surgery, there is a high level of disagreement among all the available classifications and measurement methods used. Our objective is to identify the factors that preoperatively could predict a gross total resection (GTR) of a clinically nonfunctioning pituitary adenoma through an endoscopic endonasal approach. Methods Across 100 surgeries, we analyzed epidemiologic and clinical data, radiologic relevant data, extent of resection (EOR), and postoperative outcomes. The EOR was measured objectively through an accurate volumetric analysis. Results The median presurgical volume was 8.58 cm3 (range, 0.5–58 cm3), the median maximum diameter was 27.3 mm (range, 7–67 mm), and the Knosp grade was 0 in 1 patient, 1 in 23%, 2 in 31%, 3 in 23% and 4 in 22% of patients. In the multivariate logistic regression analysis, we found 3 factors that significantly predicted the chances of a successful GTR: previous sellar surgery, Knosp grade, and tumor signal in the T2-weighted magnetic resonance imaging scan. Another 10 radiologic variables were analyzed and had no effect on the EOR. Conclusions Knosp grade (P

BACKGROUND: The impact of statins on COVID-19 outcomes is important given the high prevalence of their use among individuals at risk for severe COVID-19. Our aim is to assess whether patients receiving chronic statin treatment who are hospitalized with COVID-19 have reduced in-hospital mortality if statin therapy is maintained during hospitalization. METHODS: This work is a cross-sectional, observational, retrospective multicenter study that analyzed 2921 patients who required hospital admission at 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics and COVID-19 disease outcomes between patients receiving chronic statin therapy who maintained this therapy during hospitalization versus those who did not. Propensity score matching was used to match each statin user whose therapy was maintained during hospitalization to a statin user whose therapy was withdrawn during hospitalization. RESULTS: After propensity score matching, continuation of statin therapy was associated with lower all-cause mortality (OR 0.67, 0.54-0.83, p < 0.001); lower incidence of acute kidney injury (AKI) (OR 0.76,0.6-0.97, p = 0.025), acute respiratory distress syndrome (ARDS) (OR 0.78, 0.69- 0.89, p < 0.001), and sepsis (4.82% vs 9.85%, p = 0.008); and less need for invasive mechanical ventilation (IMV) (5.35% vs 8.57, p < 0.001) compared to patients whose statin therapy was withdrawn during hospitalization. CONCLUSIONS: Patients previously treated with statins who are hospitalized for COVID-19 and maintain statin therapy during hospitalization have a lower mortality rate than those in whom therapy is withdrawn. In addition, statin therapy was associated with a decreased probability that patients with COVID-19 will develop AKI, ARDS, or sepsis and decreases the need for IMV.

Objective To describe a multicentre case series of new onset or worsening of psoriasis in patients treated with biological drugs. Material and methods Descriptive study. We reviewed the clinical history of patients with chronic inflammatory disease (CID) treated with biological drugs, who developed new onset or worsening of psoriasis during the follow-up period. Results Twenty-six cases of paradoxical psoriasis (PP) were recorded. Ninety-three percent of the patients were treated with anti-TNFα and adalimumab was responsible for 50% of the cases. Only 5 patients had a personal history of psoriasis. The biological drug was discontinued in 13 patients. Lesion recurrence was more frequent when another anti-TNFα was reintroduced. Conclusions The PP is a reversible adverse effect that can be observed in patients exposed to biological drugs, mainly anti-TNFα.

espanolObjetivo Describir una serie multicentrica de casos de induccion o empeoramiento de psoriasis en pacientes tratados con farmacos biologicos. Material y metodos Estudio descriptivo. Se reviso la historia clinica de pacientes con enfermedad inflamatoria cronica (EIC) en tratamiento con farmacos biologicos, y que presentaron durante el periodo de seguimiento, psoriasis de nueva aparicion o empeoramiento de la misma. Resultados Se registraron 26 casos de psoriasis paradojica (PP). El 93% de los pacientes estaban en tratamiento con un anti-TNFα, siendo el adalimumab el responsable del 50% de los casos. Solo 5 pacientes presentaban antecedentes personales de psoriasis. En 13 pacientes fue necesario retirar el farmaco biologico y la recidiva de las lesiones fue mas frecuente en los pacientes en los que se reintrodujo otro anti-TNFα. Conclusiones La PP es un efecto adverso reversible que se puede observar en pacientes expuestos a farmacos biologicos, principalmente a anti-TNFα. EnglishObjective To describe a multicentre case series of new onset or worsening of psoriasis in patients treated with biological drugs. Material and methods Descriptive study. We reviewed the clinical history of patients with chronic inflammatory disease (CID) treated with biological drugs, who developed new onset or worsening of psoriasis during the follow-up period. Results Twenty-six cases of paradoxical psoriasis (PP) were recorded. Ninety-three percent of the patients were treated with anti-TNFα and adalimumab was responsible for 50% of the cases. Only 5 patients had a personal history of psoriasis. The biological drug was discontinued in 13 patients. Lesion recurrence was more frequent when another anti-TNFα was reintroduced. Conclusions The PP is a reversible adverse effect that can be observed in patients exposed to biological drugs, mainly anti-TNFα.

The purpose of this article is to articulate reasoning as to why there is a pressing need for a contextually based temporal approach towards the study of entrepreneurial intentions. Having done so, a potential means by which this can be achieved is put forth through assuming a socially situated perspective that links intentions, the entrepreneurial process of new venture creation, and a model of action abstractness. A conceptual model is proposed taking into consideration the entrepreneurial intention domain ‘as is’, ‘as should be’ and ‘as could be’. Value of current practice is assessed and challenged in a bid to stimulate new thinking in the area. The dynamic model provided contributes to contemporary scholarship through aligning entrepreneurial intentions with the accepted conception of entrepreneurship as a temporally embedded process. It moves beyond the artificial closure of an inherently open phenomenon.

Brazil is one of the countries that concentrates 90% of all tegumentary and visceral leishmaniases cases and Bahia is one of the highly affected states. In the present report, we consolidated secondary data from several complementary databases that allowed us to record the sand fly species identified including areas of Leishmania spp. transmission in the state of Bahia. We then overlayed the geographical distribution data onto maps of vegetational aspects found across the state. Overall, 21 602 records of phlebotomine sand flies occurrence between 1949 and 2016 were analysed, encompassing 85% of Bahia's municipalities. Seventy-six sand fly species under 17 genera were enlisted. Among described species, 27 were proven or putative Leishmania spp. vectors and three were considered exclusively endemic in the state. Lutzomyia longipalpis, Nyssomyia intermedia and Nyssomyia whitmani were found in 74, 29 and 27% of municipalities, respectively. Salvador, the state capital and major city presented records for 21 different sand fly species, including known vectors for leishmaniasis. In particular, a wide distribution of Evandromyia sallesi was detected for this city. This consolidated account on phebotomine fauna and distribution may be explored for improving the planning and deployment of vector-focused leishmaniasis control measures in affected areas of Bahia.

Introduction: Dimethyl sulfoxide (DMSO) is the most frequently used cryoprotective agent for freezing hematopoietic progenitors for transplantation. DMSO can cause adverse effects during cellular product infusion. In this setting, we reduced the DMSO concentration from 10% to 5% as a strategy to reduce toxicity. Methods: We retrospectively analyzed the characteristics of hematopoietic progenitor products and infusion tolerance in 240 adult patients who underwent autologous peripheral blood transplantation between January 2008 and February 2019. Patients were divided into two groups according to DMSO concentrations, 10% versus 5%. Results Post-thawing cell viability was signicantly higher in the 5% DMSO group (69.15% vs. 63.85%; p=0.028). In both groups, no statistically signicant differences were observed in the total content of CD34+×106/kg progenitor cells infused (DMSO 5% 2.98 vs. DMSO 10% 3.20, p=0.409), or graft recovery and transfusion needs. In all patients, the overall rate of adverse reactions was 7.5% (n=18); the rate was 4.6% (n=5) in the 5% DMSO group compared with 9.8% (n=13) in 10% DMSO (p=0.127). Severe adverse events were observed in the 10% DMSO group. Conclusion: Reducing the DMSO concentration from 10% to 5% is safe for the patient and product, improving viability and the absence of severe adverse infusion reactions.

The covid-19 pandemic has significantly altered the organization and scheduling of high schools in Spain. Due to pandemic restrictions, most students from grades 9 to 11 come to class only on alternate days. In this situation, e-learning and distance learning have gained prominence as necessary methods of instruction. In this study 68 students from grades 9 and 10, attending on alternate days, participated in an online teaching experience for the first time in their lives. This took place during the first trimester of the 2020-2021 academic school year. On days when they did not attend class in person, students were expected to watch the mathematics classes which were broadcasted live via YouTube. Students could either watch the classes live and ask the teacher questions via an online chat, or alternatively, they could watch the pre-recorded classes at a later time. The two options were analyzed using quantitative and qualitative methods. Results showed a continuous decrease in the number of students who preferred the first option, switching progressively from online live classes to pre-recorded classes as the weeks passed. The qualitative results explained this progressive decrease as students preferred to watch the teacher’s explanations several times. Although e-learning is absolutely necessary in the 21st century, and especially during the current pandemic, controlling students’ level of application to distance work and online learning is still a challenge.

Image representations in the form of neural activations derived from intermediate layers of deep neural networks are the state-of-the-art descriptors for instance based retrieval. However, the problem that persists consists of how to retrieve identical images as the most relevant ones from a large image or video corpus. In this work, we introduce colour neural descriptors that are made of convolutional neural networks (CNN) features obtained by combining different colour spaces and colour channels. In contrast to previous works, which rely on fine-tuning pre-trained networks, we compute the proposed descriptors based on the activations generated from a pretrained VGG-16 network without fine-tuning. Besides, we take advantage of an object detector to optimize our proposed instance retrieval architecture to generate features at both local and global scales. In addition, we introduce a stride based query expansion technique to retrieve objects from multi-view datasets. Finally, we experimentally proved that the proposed colour neural descriptors, obtain state-of-the-art results in Paris 6K, Revisiting-Paris 6k, INSTRE-M and COIL-100 datasets, with mAPs of 81.70, 82.02, 78.8 and 97.9, respectively.

El uso de coadyuvantes en anestesia obstétrica es útil para disminuir la dosis de los anestésicos locales. En bogala adición de un nuevo fármaco como es la dexmedetomidina espinal que abarca de 5 μg a 10 μg en el reportemundial.Objetivos: Comparar el efecto de la administración espinal de la dexmedetomidina y morfina, más bupivacainapesada en pacientes sometidas a cesárea.Métodos: Ensayo clínico, doble ciego y prospectivo de 99 pacientes randomizados en 3 grupos: grupo D2(fentanilo 10 μg, bupivacaina 9 mg y dexmedetomidina 2 μg); grupo D3 (fentanilo 10 μg, bupivacaina 9 mg ydexmedetomidina 3 μg) y grupo M (fentanilo 10 μg, bupivacaina 9 mg y morfina 100 μg). Evaluación de parámetroshemodinámicos, duración de bloqueo motor, necesidad de vasopresores y complicaciones. Análisis estadístico:ANOVA para variables cuantitativas, para variables nominales se empleó chi cuadrado. Valor de p

Dexmedetomidina un alfa-agonista, de amplio uso y popular nivel mundial, que poco conocimiento se tiene sobre su uso de forma intratecal en la población boliviana, de manera especial en pacientes obstétricas. Objetivos: Evaluar el efecto de la dexmedetomidina intratecal en pacientes sometidas a cesárea bajo anestesia regional raquídea y observar los efectos secundarios del medicamento. Métodos: Eensayo clínico aleatorizado y simple ciego. En 3 grupos de 41 pacientes que cumplieron los criterios de inclusión. Grupo B (bupivacaina + fentanil); grupo D2 (bupivacaina + fentanil+ dexmedetomidina 2 µg) y grupo B3 (bupivacaina + fentanil+ dexmedetomidina 3 µg). Análisis estadístico: se realizó en SPSS® 25 y Microsoft Excel® 2016. Con un nivel de confianza del 95 % y margen de error del 13 %. Resultados: Duración del bloqueo motor fue de 106,5 ± 16 minutos en el grupo B; 142,3 ± 28,2 minutos en el grupo D2 y 145,6 ± 16,7 minutos en el grupo D3. Siendo significativo entre los grupos de estudio (valor p < 0,000). PAM con significancia estadística antes y después del nacimiento. Frecuencia cardiaca significativo a los 15, 30 y 45 minutos (valor p < 0,000; 0,001; 0,004; 0,000 y 0,002). Etilefrina en el grupo B fue de 3,44 ± 1,8 ml; para el grupo D3 fue de 1,8 ± 2,7 ml y grupo D2 fue de 0,85 ± 1,6 ml Conclusiones: mejor estabilidad hemodinámica con 2 µg dexmedetomidina, menor incidencia de hipotensión, uso de vasopresores, las complicaciones escasas y un excelente estado de sedación materna.

espanolFundamento. Describir los niveles de calidad de vida relacionada con la salud (CVRS) alcanzados y la magnitud del efecto de la cirugia de revascularizacion miocardica. Metodo. Estudio descriptivo prospectivo que, a traves del cuestionario de salud SF-12v2 y diferentes variables sociodemograficas y clinicas, evaluo durante dos anos de seguimiento la CVRS de pacientes sometidos a cirugia de revascularizacion miocardica en el servicio de Cirugia Cardiaca. Resultados. Se incluyeron 175 pacientes con edad media 67 anos (rango 45-84), 85,1% hombres. El 72,5% fue sometido a cirugia de revascularizacion pura y al 80,8% se les practico un bypass multiple; el EuroSCORE medio fue 5,3%. Las puntuaciones preoperatorias de los componentes sumario del SF-12v2 reflejaban menor CVRS fisica (CSF 49,4; DE: 23,4) que mental (CSM 74,8; DE: 20,2), y todas las dimensiones incrementaron al ano de la cirugia, especialmente las de salud fisica (CSF aumento un 36,8%, p Conclusiones. La CVRS durante los dos anos de seguimiento tras la revascularizacion miocardica mejoro significativamente pero sin llegar a alcanzar los niveles de la poblacion general espanola. El sexo femenino presento niveles de salud postoperatoria significativamente inferiores. EnglishBackground. To describe the levels of health-related quality of life (HRQoL) attained and the magnitude of the effect of myocardial revascularization surgery. Method. Prospective descriptive study that, using the SF-12v2 health questionnaire and different socio-demographic and clinical variables, evaluated during a twoyear follow-up the HRQoL of patients who had received myocardial revascularization surgery in the Cardiac Surgery service. Results. One hundred and seventy-five patients were included with an average age of 67 years (range 45-84), 85.1% men. Seventy-two point five percent received complete revascularization surgery and 80.8% received a multiple bypass; the average EuroSCORE was 5.3%. The preoperative scores of the summary components of the SF-12v2 reflected a lower physical HRQoL (MHQ 49.4; SD: 23.4) than mental HRQoL (PHQ 74.8; SD: 20.2), and all the dimensions increased one year after surgery, especially those for physical health (PHQ increased 36.8%, p Conclusions. HRQoL during the two-year follow-up after myocardial revascularization improved significantly but without reaching the levels of the general Spanish population. The female sex showed significantly lower levels of postoperative health.