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Future mobile networks are envisioned to become multi-service systems, enabling the dynamic deployment of services with vastly different performance requirements, accommodating the needs of diverse service providers. Virtualizing the mobile network infrastructure is of fundamental importance for realizing this vision in a cost-effective manner. While there have been extensive research efforts in virtualization for the mobile core network, virtualization in the radio access network (RAN) is still at an early stage. In this paper, we present AIRTIME, a new RAN slicing system that enables the dynamic on-the-fly virtualization of RANs, with the programmability required by service providers to customize any aspect of their virtual RAN to meet their service needs. We present a prototype implementation of AIRTIME and evaluate the: (i) capacity to create virtual RANs on-the-fly, (ii) performance experienced by slice owners, (iii) isolation among multiple virtual RANs sharing the same physical infrastructure, and (iv) scalability to accommodate a large number of virtual RANs. Accepted version

We report a 64-year-old caucasian woman diagnosed with membranous nephropathy secondary to alpha-1 antitrypsin deficiency (AATD). AATD is a rare autosomal codominant genetic disorder. Its clinical manifestations are mostly observed in the lungs, with early-onset emphysema. Nephropathy due to AATD is still very rare and only a few cohort studies have been reported. It has been recognised that alpha-1 antitrypsin has a protective role in the kidneys which enhances the possibility of development of kidney failure, such as nephrotic syndrome, in cases of AATD. Further clinical investigation is needed to understand the relationship between the development of nephropathy, namely membranous nephropathy, and AATD.

Among several fruits, mangaba (Hancornia speciosa Gomes), it aroused the interest of producers and consumers due to its attractive sensory characteristics and health beneficial properties (high nutritional value and presence of bioactive substances), thus, this work evaluates the nutritional factors of the flour residue of mangaba processing that is despised by the food industry, and the influence of temperature on its production. The mangaba processing residue was splited in two main groups: in natura sample (control), and other for preparation of flour that was dried at 50 °C and divided into two other groups: treatment A (flour with roasts at 110 °C and 130 °C) and treatment B (flour from drying at 50 °C). The nutritional characteristics of flours were analyzed considering the chemical parameters: pH, titratable total acidity and soluble solids, in addition to the determination of moisture content, total lipids, total dietary fiber and ash, total energy value, antioxidant activity, phytochemical screening, quantification of phenolic compounds and flavonoids, as well as technological functional properties (water absorption index (WAI), water solubility index (WSI), milk absorption index (MAI) and milk solubility index (MSI) and oil absorption index (OAI). The results showed that the bioactive compounds present in the extracts do not have significant properties of acting as free radical kidnappers. The heat treatment, performed in the flour of mangaba processing residues, influenced the nutritional factors and properties of absorption and solubility, which showed statistical differences. These results show that the flour is a viable alternative for the energy enrichment of diets, contributing to the development of new products, the reduction of the disposal of these residues and consequently to the minimization of the environmental impact. Resumo Dentre as diversas frutas a mangaba (Hancornia speciosa Gomes), despertou interesse de produtores e consumidores devido às suas características sensoriais atrativas e propriedades benéficas à saúde (elevado valor nutricional e presença de substâncias bioativas), assim, o trabalho avaliar os fatores nutricionais do resíduo da farinha de processamento de mangaba que é desprezado pela indústria alimentícia e, a influência da temperatura na sua produção. O resíduo de processamento da mangaba foi dividido em dois lotes, sendo um deles utilizado para as análises in natura (amostra controle) e o outro para a confecção da farinha que foi seca a 50 °C, e dividida em dois lotes: tratamento A (farinha com torras a 110 °C e 130 °C) e no tratamento B (farinha oriunda da secagem a 50 °C). Analisou-se as características nutricionais de farinhas considerando os parâmetros químicos: pH, acidez total titulável e sólidos solúveis, além da determinação do teor de umidade, lipídios totais, fibra alimentar total e cinzas, valor energético total, atividade antioxidante, triagem fitoquímica, quantificação de compostos fenólicos e flavonoides, bem como as propriedades funcionais tecnológicas (índice de absorção de água (IAA), índice de solubilidade em água (ISA), índice de absorção de leite (IAL) e índice de solubilidade em leite (ISL) e índice de absorção de óleo (IAO). Na análise foi inferido que os compostos bioativos presentes nos extratos não possuem propriedades significativas de agir como sequestradores de radicais livres. O tratamento térmico, realizado na farinha de resíduos de processamento de mangaba, influenciou nos dados dos fatores nutricionais e das propriedades de absorção e solubilidade, os quais apresentaram diferenças estatísticas. Estes resultados credenciam a farinha como uma alternativa viável para o enriquecimento energético de dietas, contribuindo para o desenvolvimento de novos produtos, a redução do descarte desses resíduos e consequentemente para a minimização do impacto ambiental.

This work has as main objective to propose the identification of a small scale non-linear system through the Neural Network AutoRegressive with eXternal input. The use of this network requires an adequate methodology for its configuration and, consequently, a good training set. Then, it is proposed that the main definitions of the network parameters be obtained through the analysis of nonintrusive performance indices. Additionally, using a database based on the system’s response, excited by the Pseudo-Random Binary Sequence signal. The methodology will be applied in two specific open-loop identification situations: numerical simulation of a fourth order polynomial system (Case 01), and an experimental system that controls a nonlinear water tank level (Case 02). The results of the identified models were able to represent the system dynamics with high fidelity, presenting an average identification error of less than 0:14 and 0:34% for Case 1 and 2, respectively. Also, it is observed that the learning and generalization evidence could represent the process intrinsic nonlinearities satisfactorily. Besides, it will be possible to find the potentiality and usefulness of the developed network in nonlinear system identification.

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The solid oxide fuel cell (SOFC) has become a promising energy conversion technology due to its high efficiency and low environmental impact. Though there are several reviews on the topic of SOFCs, comprehensive reports that simultaneously combine the latest developments in materials and integration strategies are very limited. This paper not only addresses those issues but also discusses the SOFCs working principles, design types, the fuels used, and the required features for electrodes and electrolytes. Furthermore, the implementation of this type of fuel cell on a commercial scale is analyzed. It is concluded that decreasing the SOFCs working temperature can reduce some of its current constraints, which will have a positive impact on SOFCs commercialization. Considering that SOFCs are already being successfully implemented in combined heat and power systems and off-grid power generation, the current status and prospects of this technology are thoroughly discussed.

Food Allergy (FA) is now one of the most common chronic diseases of childhood often lasting throughout life and leading to significant worldwide healthcare burden. The precise mechanisms responsible for the development of this inflammatory condition are largely unknown; however, a multifactorial aetiology involving both environmental and genetic contributions is well accepted. A precise understanding of the pathogenesis of FA is an essential first step to developing comprehensive prevention strategies that could mitigate this epidemic. As it is frequently preceded by atopic dermatitis and can be prevented by early antigen introduction, the development of FA is likely facilitated by the improper initial presentation of antigen to the developing immune system. Primary oral exposure of antigens allowing for presentation via a well-developed mucosal immune system, rather than through a disrupted skin epidermal barrier, is essential to prevent FA. In this review, we present the data supporting the necessity of 1) an intact epidermal barrier to prevent epicutaneous antigen presentation, 2) the presence of specific commensal bacteria to maintain an intact mucosal immune system and 3) maternal/infant diet diversity, including vitamins and minerals, and appropriately timed allergenic food introduction to prevent FA.

The application of explosives has never been considered as a major influencing factor during either the designing of a mine or the selection of the mining method. However, this has changed with the launch of WebGenTM wireless blasting system, which allowed underground mines to exploit their orebody applying methods previously not possible due to limitations imposed by the use of wired detonators. The wireless blasting system is based on magnetic induction communication, and its signal is capable of overcoming hundreds of meters through rock, water, and air, to reach individual primers in the blastholes without any physical connection.A noble application of wireless detonators is being used in Vazante mine, Brazil, an underground zinc mine where ore pillars are left in the mined stope to secure stability and minimize dilution by limiting the hydraulic radius. The recovery of these pillars is financially desirable but involves extra time and costs associated with scaling, backfilling, reinstalling infrastructure, accessing areas previously blasted (less stable), drilling, charging with explosives, and subsequently, firing and mucking out the blasted material with expected high dilution. Applying 100% wireless detonators made it possible to safely preload the pillar together with production blasts before losing access to the area, a method named Temporary Rib Pillar (TRP). After all the stope is mined and the pillar accomplished its objectives, the primers are initiated without neither the need for the extra cycles described previously, nor the need to re-enter the area. Thus, it was possible to reduce the exposure of people and equipment, reduce operational cycles, and increase ore recovery, directly contributing to anticipate the ore production while guaranteeing the safety of the teams involved.

BACKGROUND: Low-level laser therapy (LLLT) and human amniotic membrane (HAM) application have been shown to be viable options for use in wound healing. PURPOSE: This study sought to compare LLLT and HAM to a control treatment (hydrogel, saline, and gauze) in persons with diabetes mellitus (DM) and foot ulcers. METHODS: Using a prospective pilot clinical study design, patients receiving care at a health center that specializes in the treatment of diabetic foot wounds between November 2016 and August 2017 were recruited. Eligible patients had to be 30 to 59 years of age; diagnosed with type 2 DM (postprandial capillary glucose levels between 140 and 350 mg/dL); and have uninfected, granulating stage 2 or 3 foot ulcers measuring less than 7 cm by 3 cm. Immunosuppressed and malnourished patients or those with neoplasms or in critical condition were not eligible to participate. Patients received the control treatment (2 mg hydrogel, saline, and gauze), HAM (patches of thawed HAM, applied with overlapping edges), or LLLT (phototherapy session, 2 mg hydrogel, saline, and gauze) for 28 days. Variables, wound area measurements, Pressure Ulcer Scale for Healing (PUSH) scores, and Visual Analog Scale (VAS) scores were used to assess wound improvement progress and pain on days 7, 14, 21, and 28. Descriptive statistics were used to analyze the participant anthropometric and clinical profiles. The Kolmogorov-Smirnov test was used to analyze the sample distribution. The Kruskal-Wallis test with Dunn’s post-test was used to evaluate differences in PUSH and VAS scores and wound size for intergroup analysis, and the Mann-Whitney U test was used for the same outcomes in intragroup analysis. The level of significance was 5% (P < .05). RESULTS: Twenty-seven (27) patients participated (mean age, 51.4 years; mean body mass index, 26.5 kg/m2), with 9 patients in each treatment group. No statistically significant differences were noted in clinical or anthropometric variables among the groups, but mean baseline wound areas were different (2.6 cm² for the control, 1.9 cm² for the LLLT, and 5.5 cm² for the HAM groups). Intragroup comparisons showed a significant reduction in PUSH score in the LLT group between days 0 and 21 (8.2 vs 4.9; P < .01) and days 21 to 28 (4.9 vs 3.2; P < .001). In all treatment groups the percent reduction was significantly different between days 7 and 28. No outcomes were significantly different between groups. CONCLUSION: Diabetic foot ulcer wound area as well as PUSH and VAS scores showed more improvement for patients with DM receiving LLLT or HAM than for the control group, but the differences were not significant. Larger studies are needed to compare these treatment modalities.

The present study investigated whether and to what extent caffeine chronic use can influence the brain oxidative status and the behavioral activity of the C57BL/6 female mice. For this, fifteen animals were randomized in the following groups: Control, Caf10: 10 mg/kg caffeine, and Caf50: 50 mg/kg caffeine. The animals received one daily caffeine dose by i.p route by 120 days. Twenty-four hours after the last administration, the animals were subjected to behavioral tests and euthanized. The blood was used by biochemical analysis and the brain to evaluate the oxidative status and micromineral levels. The caffeine does not influence the anthropometric parameters, lipid profile, and the C-reactive protein levels. In the same way, SOD and glutathione-s-transferase (GST) activities maintained the same response profile. On the other hand, catalase (CAT) activity was decreased in both groups receiving caffeine. Despite this, malondialdehyde and carbonyl protein levels did not change among the groups, as well as the distribution of the chemical elements. In the same way, none caffeine dose was caused increased anxiety degree in the animals. Considering the time of caffeine administration, we believe that there was the cellular adaptation triggered by its use, tending to a protective effect on the brain. Amplamente consumida nos alimentos e como suplemento alimentar, a cafeína tem sido estudada devido aos seus efeitos farmacológicos, principalmente no sistema nervoso central (SNC). O presente estudo investigou se o uso crônico da cafeína pode influenciar o estado oxidativo do cérebro e a atividade comportamental de camundongos fêmeas C57BL/6. Para isso, quinze animais foram randomizados nos seguintes grupos: Controle (solução salina à 0,9%), Caf10 (10 mg / kg de cafeína) e Caf50 (50 mg / kg de cafeína). Os animais receberam uma dose diária de cafeína por via i.p. durante 120 dias. Vinte e quatro horas após a última administração, os animais foram submetidos a testes comportamentais e foram eutanasiados. O sangue foi utilizado para análises bioquímicas. No cérebro, foi avaliado o estado oxidativo e os níveis de microminerais. A cafeína não influenciou os parâmetros antropométricos, perfil lipídico e níveis de proteína Creativa. Ademais, as atividades de superóxido dismutase (SOD) e glutationa-Stransferase (GST) mantiveram o mesmo perfil de resposta. Em contrapartida, a atividade da catalase (CAT) diminuiu em ambos os grupos que receberam cafeína. Já os níveis de malondialdeído e proteína carbonilada não se alteraram entre os grupos, assim como a distribuição dos microminerais. Nenhuma dose de cafeína desencadeou comportamento do tipo ansioso nos animais. Portanto, considerando o tempo de administração da cafeína, acreditamos que houve a adaptação celular desencadeada pelo seu uso, tendendo a um efeito protetor no cérebro. Além disso, o espaço amostral reduzido foi uma limitação para entendimentos mais acurados sobre os efeitos da cafeína no SNC. Palavras-chave: Cafeína. Espécies reativas de oxigênio. Comportamento Animal.

BACKGROUND Anaphylaxis is a recognized public health issue. There is no doubt that food-induced anaphylaxis (FIA) has tremendous impact on the quality of life of patients and their families and increases direct and indirect costs. FIA is associated with increasing rates of emergency department admissions and hospitalizations and implies the risk of death. Morbidity epidemiological data are a key to tailor public health actions to this non-communicable disease. The aim of this article was to review published morbidity epidemiological data relating to FIA and potential risk factors, in order to provide evidence-based recommendations to reduce the risk of severe adverse outcomes. METHODS We identified published studies available in PUBMED/MEDLINE (1966-2020), EMBASE (1980-2020) and CINAHL (1982-2020). The systematic review was carried out using MeSH terms related to FIA ED admissions and hospitalizations. RESULTS A total of 25 articles were selected, 80% published in the last 5 years. After critical analysis of methodological and clinical characteristics reported in the data selected, we were able to propose preventive strategies. CONCLUSION Anaphylaxis is a recognized public health issue. FIA is associated with increasing rates of ED admissions and hospitalizations and imply in risk of death. More than reviewing and critically interpreting the key patterns related to FIA morbidity published data, we proposed strategies in order to promote quality care of patients suffering from FIA. Our World Health Organization Collaborative Center is deeply involved in this process, and we believe that the proposed strategies will inform future healthcare policies on anaphylaxis. The long-term objective would be to improve clinical care and quality of life of patients and their families, and develop risk-stratified, cost-effective preventive measures.

In places without adequate health facilities, community health workers (CHWs) are employed by local governments to help families with health promotion activities. However, amidst the difficulties, mobile health applications (mHealth) are being increasingly developed in order to facilitate the work of the CHW. This work is a systematic review (SR) of the use of mHealth and the impact it has had so far in improving the health system and service delivery by the CHWs. This SR was based on the 27 PRISMA recommendations. We used the PICOS tool to specify the components of this review (eligibility criteria, keywords, etc.) and the StArt software to organize and control the articles exported from digital databases (PubMed, SciELO, etc.) from 2009 to 2019. The studies accepted for reading in their entirety underwent an analysis of their risk of bias, through the Cochrane risk of bias tool. The studies showed that mobile health intervention has a strong link with health care, mainly in the provision of community care services, maternal and child health care, sexual diseases, and infectious diseases, among others. This happens especially in rural or other areas of difficult access, such as countries in Africa, which occupies 61% of selected articles. However, it is believed that these applications have great potential and could help CHWs provide better disease prevention care. The use of mHealth by CHWs has become typical in many regions of the world and is believed to have the potential to improve health service delivery in hard-to-reach or resource-limited settings.

The basophil activation test (BAT) is a functional assay that measures the degree of degranulation following stimulation with allergen or controls by flow cytometry. It correlates directly with histamine release. From the dose-response curve resulting from BAT in allergic patients, basophil reactivity (%CD63(+) basophils) and basophil sensitivity (EC50 or similar) are the main outcomes of the test. BAT takes into account all characteristics of IgE and allergen and thus can be more specific than sensitization tests in the diagnosis of allergic disease. BAT reduces the need for in vivo procedures, such as intradermal tests and allergen challenges, which can cause allergic reactions of unpredictable severity. As it closely reflects the patients' phenotype in most cases, it may be used to support the diagnosis of food, venom and drug allergies and chronic urticaria, to monitor the natural resolution of food allergies and to predict and monitor clinical the response to immunomodulatory treatments, such as allergen-specific immunotherapy and biologicals. Clinical application of BAT requires analytical validation, clinical validation, standardization of procedures and quality assurance to ensure reproducibility and reliability of results. Currently, efforts are ongoing to establish a platform that could be used by laboratories in Europe and in the USA for quality assurance and certification.

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.

Food allergy is a major public health issue with growing prevalence in the urbanized world and significant impact on the lives of allergic patients and their families. Research into the risk factors that have contributed to this increase and their underlying immune mechanisms could lead us to definitive ways for treatment and prevention of food allergy. For the time being, introduction of peanut and other allergenic foods in the diet at the time of weaning seems to be an effective way to prevent the development of food allergy. Improved diagnosis and appropriate management and support of food allergic patients are central to patient care with food immunotherapy and biologics making the transition to clinical practice. With the new available treatments, it is becoming increasingly important to include patients' and family preferences to provide a management plan tailored to their needs.

The objective of this work was to investigate the ways of disposing of medicines by residents in the municipality of Vale do Jequitinhonha, Minas Gerais, Brazil. A cross-sectional study was carried out, like a household population survey, with a random sample of 382 residents, using a self-made questionnaire, with the following variables: socio-demographic, health conditions, medications in use and access to the health service and the medicine. The participants were predominantly female (73.6%), self-declared brown (59.4%), with low education (40.8% incomplete elementary school), married or living with a partner (51.0%), in good health (61.0%), non-smokers (70.9%) and who did not practice regular physical activity (53.1%). When asked about access to health services, 91.9% and 91.4% lived less than five kilometers from the basic health unit and the basic pharmacy, respectively. In relation to the last medical consultation, 40.8% had done it in the last month. Regarding the destination of the remnants of medicines, 64.1% throw them in the domestic garbage and 17.3% did discard the losers in the toilet. It was concluded that there was an inadequate practice of drug disposal. From this perspective, the importance of a management program on appropriate disposal practices is recognized. Thus, strategies for improving relations between health units in the care network must be developed in an attempt to safely dispose of medicines and raise awareness for protecting the environment.

This work contributed to a detailed study on a better understanding of the Jominy test, adopted a proportion of study to create the Jominy test device, exhibited favorable conceptions for the development of a prototype of the device, covering the four aspects of the project, being they: test device, test body heating system, test automation and instrumentation using embedded electronics and financial analysis for the elaboration of this project in Brazil. It was possible to observe in the results that the system is efficient, simple and functional, it was possible to obtain the first test carried out in the controlled environment the temperature data in degrees centigrade, the recorded data were automatically launched in Microsoft Excel by the PLX DAQ software, making the acquisition of the data. In the matter of preparing the test device, the drawings are presented in the 3D modeling software, cost tables of the materials used for assembly in Brazil. In terms of the heating system, a heating system was adopted that uses electromagnetic induction, the cost of materials related to the heating system design was also presented. Another relevant factor that contributes to the research and improvement of the prototype is the municipality, located in the Paraiba Valley region, located in the state of Sao Paulo, consisting of a fertile and relevant scenario of regional, national, international and multinational statistics, thus concluding the effectiveness for the mainly metallurgical industries. The results obtained were satisfactory and consistent, when they were created for the Jominy test device with the ability to submit small pieces for testing and mainly essential in the didactic point of view for a higher education institution of engineering and technology.

Purpose: To analyze the impact of technological evolution on industrial production capacity and how Industry 4.0 can be developed for the Brazilian industrial scenario. Design/methodology/approach: Data collection was through the selection of studies - scientific articles, books, dissertation, among others - current and relevant on the topic, through an exploratory descriptive research, as well as the use of an electronic platform such as Google Scholar, Journals CAPES, Scielo and Scopus. The analysis took place through reading, comparison and discussion between the different authors and studies found. Findings: The results evidenced, show that the Brazilian context falls short of what would make the country a player of world production. The roles in this process process an integrating responsibility between governments, companies and international partnerships, for a more agile adaptation to the latest world production model. Practical Implications: Investments by political-governmental segments are still ineffective, compromising the generation of wealth, taxes and fees in Brazilian companies. Social Implications: Thematic contemporary to the reality of the country, in order to offer new alternatives for research and knowledge to be used by companies, academics and society. Originality/Value: It consists of investigating the current level of industry 4.0 dimensions in the Brazilian context, and proportional improvement for national companies in global markets.

Network slicing is one of the key enabling techniques for 5G, allowing Mobile Network Operators (MNOs) to support services with diverging requirements on top of their physical network infrastructure. The MNOs should be able to offer Network Slices (NSs) as a Service (NSaaS) and provide customisable and independent virtual networks to tenants. In this paper, we address the functionality and challenges for enabling Radio Access Network (RAN) as a Service (RANaaS) through radio virtualisation. We analyse the requirements for using radio hypervisors to support RANaaS, and we evaluate how the current state-of-the-art on radio virtualisation meets such requirements. We identify, formalise and address the key resource management functionality missing from existing radio hypervisors. Then, we present eXtensible Virtualisation Layer (XVL), a software layer that provides the missing resource management functionality for enabling RANaaS and can be added on top of existing radio hypervisors. We integrated XVL with a radio hypervisor, forming a RANaaS platform that can provision heterogeneous RAN slices as a service. We outline XVL’s architecture and design choices, as well as evaluate its performance in terms of the computational overhead, the delay to provision virtual radios, the delay introduced to forward IQ samples, and the signal degradation. Our results show that XVL enables leveraging existing radio hypervisors for supporting the RANaaS paradigm.

Monitoring the conversion of native vegetation has challenged Brazilian government and scientists since the 1980s. In the case of the Amazonian forests, the Amazon Gross Deforestation Monitoring Project - PRODES has developed an effective methodology that provides consistent annual data on deforestation areas on a scale of 1:250,000, since 1988. In this article, we present some aspects of the evolution of this methodology, the key processes to produce accurate deforestation maps during the last 30 years and the new challenges that the Project would face. A central lesson is that no computational technique has, to date, been able to achieve the quality of deforestation maps produced by visual interpretation of satellite images and manual mapping.

Typical distal symptoms in anti-myelin-associated glycoprotein (anti-MAG) neuropathy are believed to be due to the binding of immunoglobulin M to distal nerve terminals. We describe the case of a 56-year-old man diagnosed with immunoglobulin M anti-MAG neuropathy in the setting of Waldenström macroglobulinemia, which developed acute neurological worsening presenting as cauda equina syndrome. Lumbosacral magnetic resonance imaging revealed enlarged nerve roots with diffuse heterogeneous gadolinium enhancement. Treatment with steroids resulted in substantial clinical improvement. Increased recognition of atypical presentations may lead to improved characterization of anti-MAG neuropathy as a more widespread disease.

Enhancement of luminescence properties to improve and/or control both the absorption and emission of lanthanide (Ln)-activated glasses, ceramics and glass-ceramics, can be achieved with the development of smart photonic systems. Among different possible strategies, a prospective proof of concept for photoluminescence (PL) enhancement based on a one-dimensional photonic crystal (PC) was designed to tailor the up-conversion (UC) emission of Er3+ from a microcavity (MC) with an aluminosilicate glass film co-doped with Er3+/Yb3+ sandwiched between alternating layers of undoped aluminosilicate and TiO2. For the fabrication, the layers of different materials were deposited by sol-gel (SG), in order to mimic the PC structure obtained by simulation for a pre-defined position of the pass band defect (547 nm) within the stop band. An enhancement of up to 13 times of the Er3+ green UC was observed for the MC in comparison with a system without the PC structure.

The present work proposes a careful study of the effects of different operational factors on the electrocoagulation process of synthetic oil-water emulsions. The experimental conditions used were the pH of the solution, current density, electrolyte concentration, oil concentration, and distance between the electrodes. The results showed that the proposed process is efficient for de-emulsification and oil removal, as it reached 100% removal in some conditions. Furthermore, the experiments showed that the first two variables were the most impactful ones in the efficiency of COD removal. To determine the optimal conditions in which the electrocoagulation should operate, two different models were developed: a polynomial one, using Genetic Algorithm to optimize its coefficients, and an Artificial Neural Network one, which used the input variables to predict the amount of oil removed. The modelling results showed good agreements, as the polynomial and ANN models had R2 values of 0.89 and 0.99, respectively, showing that the neural model is the most suitable one to predict the COD removal and optimize the operational conditions. The SSE values of 1979.08 (polynomial) and 4.92 (ANN) also indicate the neural model is the best one.

Aim To asses if telemedicine with telemonitoring is a clinically useful and safe tool for monitoring patients with COVID-19. Methods A prospective observational study of patients with COVID-19 diagnosed via a positive PCR test who were considered high-risk and who were monitored with telemedicine and telemonitoring in the Lugo Healthcare Area between March 17th and April 17th, 2020, was conducted. Two groups of patients were included: those in outpatient monitoring from the beginning and those in outpatient monitoring following hospital discharge. Every patient completed a clinical questionnaire with his or her temperature once per day and oxygen saturation levels three times per day. Proactive monitoring was done by getting in touch with every patient at least once a day. Results A total of 313 patients (52.4% female) with a mean age of 60.9 (SD 15.9) years were included. Two patients refused to participate in the program. Finally, 224 were monitored from the beginning and 89 patients were monitored after discharged. In the first group, 38 (16.90%) were referred to the Emergency department on 43 occasions; 18 (8.03%) were hospitalized, and two died. There were no deaths or lifethreatening at home. Including the patients monitored after hospitalization, monitoring was performed in 304 cases. One patient was readmited (0.32%) and another left the program (0.32%). The mean time of monitoring was 11.64 (SD 3.58) days and 224 (73.68%) patients were discharged during the 30 days the study lasted. Conclusions Our data suggest that telemedicine with at-home telemonitoring, when used proactively, allows for clinically useful and safe monitoring of high-risk patients with COVID-19.

Food allergy is increasing in prevalence, affecting up to 10% of children in developed countries. Food allergy can significantly affect the quality of life and well-being of patients and their families; therefore, an accurate diagnosis is of extreme importance. Some food allergies can spontaneously resolve in 50%-60% of cow's milk and egg-allergic, 20% of peanut-allergic and 9% of tree nut-allergic children by school age. For that reason, food-allergic status should be monitored over time to determine when to reintroduce the food back into the child's diet. The gold-standard to confirm the diagnosis and the resolution of food allergy is an oral food challenge; however, this involves the risk of causing an acute-allergic reaction and requires clinical experience and resources to treat allergic reactions of any degree of severity. In the clinical setting, biomarkers have been used and validated to enable an accurate diagnosis when combined with the clinical history, deferring the oral food challenge, whenever possible. In this review, we cover the tools available to support the diagnosis of food allergies and to predict food allergy resolution over time. We review the latest evidence on different testing modalities and how effective they are in guiding clinical decision making in practice. We also evaluate predictive test cut-offs for the more common food allergens to try and provide guidance on when challenges might be most successful in determining oral tolerance in children.

Purpose We report the results of low back pain treatment using a combination of nucleotides, uridine (UTP), cytidine (CMP) and vitamin B12, vs a combination of vitamins B1, B6, and B12. Patients and Methods Randomized, double-blind, controlled trial, of a 60-day oral treatment: Group A (n=317) receiving nucleotides+B12 and Group B (n=317) receiving B vitamins. The primary endpoint was the percentage of subjects in each group presenting adverse events (AEs). Secondary endpoints were visual analog scale (VAS) pain scores at Visit 2 (day 30) and Visit 3 (day 60) in relation to pretreatment values, Roland–Morris Questionnaire (RMQ) scores and finger-to-floor distance (FFD) (percentage of subjects per group presenting improvement ≥5 points and ≥3cm, respectively). Results Seventy-five (24%) and 105 (33%) subjects (P=0.21) presented 133 and 241 AEs, with 3159% of subjects presenting ≥2 AEs (P=0.0019) in Group A and Group B, respectively. Twenty-four subjects in Group B were discontinued due to AEs, while no AE-related discontinuations occurred in Group A (P

Food allergy is increasing in prevalence and the severity of allergic reactions is unpredictable. Identifying food-allergic patients at high risk of severe reactions would allow us to offer a personalized and improved management for these patients.We review the evidence for using the levels of specific IgE, the nature of the allergen, and cellular tests to identify patients at high risk of developing severe allergic reactions to foods.The evidence about whether the quantity of allergen-specific IgE reflects the severity of allergic reactions to foods is conflicting, with some positive and some negative studies. For some foods, specific IgE to individual components (e.g. Ara h 2 in peanut) can provide additional information. However, more important than the quantity of IgE is possibly the quality of IgE, which can be captured by individual measurements of affinity/avidity, diversity, and specific activity, but is best measured overall using the basophil and mast cell activation tests, which assess the function of IgE in its ability to induce cell activation, degranulation, and mediator release. Biomarkers look at a single aspect of the allergic response and should be interpreted in the broader clinical context for each individual patient assessed.

Food allergy can be life threatening, and there is currently no curative treatment. The prevalence of food allergy and the number of hospital admissions for food-induced anaphylaxis have increased ...

© 2020 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited., Background: Understanding the discrepancy between IgE sensitization and allergic reactions to peanut could facilitate diagnosis and lead to novel means of treating peanut allergy. Objective: To identify differences in IgE and IgG4 binding to peanut peptides between peanut-allergic (PA) and peanut-sensitized but tolerant (PS) children. Methods: PA (n = 56), PS (n = 42) and nonsensitized nonallergic (NA, n = 10) patients were studied. Synthetic overlapping 15-mer peptides of peanut allergens (Ara h 1-11) were spotted onto microarray slides, and patients' samples were tested for IgE and IgG4 binding using immunofluorescence. IgE and IgG4 levels to selected peptides were quantified using ImmunoCAP. Diagnostic model comparisons were performed using likelihood-ratio tests between each specified nominal logistic regression models. Results: Seven peptides on Ara h 1, Ara h 2, and Ara h 3 were bound more by IgE of PA compared to PS patients on the microarray. IgE binding to one peptide on Ara h 5 and IgG4 binding to one Ara h 9 peptide were greater in PS than in PA patients. Using ImmunoCAP, IgE to the Ara h 2 peptides enhanced the diagnostic accuracy of Ara h 2-specific IgE. Ratios of IgG4/IgE to 4 out of the 7 peptides were higher in PS than in PA subjects. Conclusions: Ara h 2 peptide-specific IgE added diagnostic value to Ara h 2-specific IgE. Ability of peptide-specific IgG4 to surmount their IgE counterpart seems to be important in established peanut tolerance., This work was supported by the Medical Research Council (MRC Clinical Research Training Fellowship G090218, MRC Centenary Early Career Award and MRC Clinician Scientist Fellowship MR/M008517/1, all awarded to A. F. Santos), the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust; the US Department of Agriculture, Agricultural Research Service (USDA-ARS6054-43440-046-00D; USDA-NIFA) and the National Peanut Board (GRANT12229460).

In order to increase the efficiency of photovoltaic solar cells, photon absorption in an extended range of the solar spectrum is necessary, for example by means of up-conversion (UC) of sub-bandgap photons to minimize transparency losses. While lanthanide (Ln)-doped luminescent layers may be deposited on cell materials to achieve spectral conversion by methods like CVD or PVD, sol-gel (SG) processing is a low-cost technology which may be a good alternative for this purpose. In this work, Ln-doped SG-derived active layers have been deposited by spin-coating onto c-Si substrates for frequency conversion, with particular emphasis on UC, involving host matrices like aluminosilicate glass and titania ceramic doped with the activator/sensitizer pair Er/Yb. White light emitting diodes (WLEDs) based on Ln-doped phosphors still have efficiency limitations, namely because the Stokes shift from UV/blue LED excitation to the emitted lower frequency visible light converts some of the pump energy into heat. However, if white light generation (WLG) is achieved through IR-pumped UC instead, the cost of the LED lamp will be reduced, while the energy loss from Stokes shift can be minimized. SG synthesis of Ln-doped oxide phosphors for UC in WLG has been achieved (Er/Yb and Tm/Er/Yb doping), based on aluminosilicate glass matrices. Photonic crystal-assisted UC emission has also been demonstrated in a Tm/Yb-doped Fabry–Perot microcavity (MC). The different materials have been characterized by XRD, SEM, ellipsometry and photoluminescence (PL) spectroscopies and their light emission has been analyzed with the help of CIE chromaticity diagrams.

Today’s wired networks have become highly flexible, thanks to the fact that an increasing number of functionalities are realized by software rather than dedicated hardware. This trend is still in its early stages for wireless networks, but it has the potential to improve the network’s flexibility and resource utilization regarding both the abundant computational resources and the scarce radio spectrum resources. In this work we provide an overview of the enabling technologies for network reconfiguration, such as Network Function Virtualization, Software Defined Networking, and Software Defined Radio. We review frequently used terminology such as softwarization, virtualization, and orchestration, and how these concepts apply to wireless networks. We introduce the concept of Virtual Radio Function, and illustrate how softwarized/virtualized radio functions can be placed and initialized at runtime, allowing radio access technologies and spectrum allocation schemes to be formed dynamically. Finally we focus on embedded Software-Defined Radio as an end device, and illustrate how to realize the placement, initialization and configuration of virtual radio functions on such kind of devices.

Background Peanut, tree nut, and sesame allergies are responsible for most life-threatening food-induced allergic reactions. Rates of coexistent allergy between these foods have been from mostly retrospective studies that include only a limited number of tree nuts or were not based on oral food challenges. Objective The Pronuts study is a multicenter European study (London, Geneva, and Valencia) assessing the challenge-proven rate of coexistent peanut, tree nut, and/or sesame seed allergy. Methods Children aged 0 to 16 years with at least 1 confirmed nut or sesame seed allergy underwent sequential diagnostic food challenges to all other nuts and sesame seed. Results Overall, the rate of coexistent peanut, tree nut, and sesame seed allergy was 60.7% (n = 74/122; 95% CI, 51.4% to 69.4%). Peanut allergy was more common in London, cashew and pistachio nut allergies were more common in Geneva, and walnut and pecan allergies were more common in Valencia. Strong correlations were found between cashew-pistachio, walnut-pecan, and walnut-pecan-hazelnut-macadamia clusters. Age (>36 months) and center (Valencia > Geneva > London) were associated with an increased odds of multiple nut allergies. By pursuing the diagnostic protocol to demonstrate tolerance to other nuts, participants were able to introduce a median of 9 nuts. Conclusion We found a higher rate of coexistent nut and sesame seed allergies than previously reported. Performing sequential food challenges was labor intensive and could result in severe allergic reactions; however, it reduced dietary restrictions. Age was a significant predictor of multiple nut allergies, and thus the secondary spread of nut allergies occurred in older children.

PURPOSE OF REVIEW To review recent evidence on the capacity of vitamin D to prevent atopic disease, focussing on food allergy and asthma, and potential underlying mechanisms. RECENT FINDINGS The incidence of allergic disease continues to increase worldwide. Vitamin D status is influenced by sun exposure and dietary intake. Vitamin D deficiency is linked to an increased incidence of allergic disease and asthma. These associations are generally strongest in early life. The capacity of vitamin D to enhance antimicrobial pathways, promote peripheral immunological tolerance and maintain mucosal barrier integrity may underlie these associations. Interventional studies have addressed the capacity of vitamin D supplementation in utero and early life to reduce the incidence of disease. Ancillary studies have provided insights into potential biological mechanisms linked to these effects. SUMMARY Observational studies show an inverse association between vitamin D levels and development of food allergy and asthma. Secondary analyses of two recent interventional studies suggest that achieving vitamin D sufficiency throughout pregnancy reduces the incidence of asthma/recurrent wheeze at 3 years. Longitudinal studies of vitamin D requirements in utero and postnatally, better understanding of factors that influence bioavailability of vitamin D and mechanistic insights into vitamin D effects on neonatal-specific immune pathways are awaited.

Contains fulltext : 249977.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies. METHODS: We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977. FINDINGS: In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p(interaction)=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p(interaction)=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p(interaction)=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups. INTERPRETATION: Empagliflozin reduced serious heart failure outcomes across doses and combinations of disease-modifying therapies for HFrEF. Clinically, these data suggest that empagliflozin might be considered as a foundational therapy in patients with HFrEF regardless of their existing background therapy. FUNDING: Boehringer Ingelheim and Eli Lilly and Company.

Atopic dermatitis (AD) typically develops in infancy and affects up to 20% of children in high-income countries (1). Immediate (IgE-mediated) food allergy (FA) affects around 3% of children (2). Children with AD are at higher risk of immediate-type FA (3, 4). Up to a third of children with moderate to severe AD have FA (3). A Danish population-based study, evaluating children from birth to 6 years, showed that 15% of all children with AD had concomitant FA and almost all children with FA had concomitant AD (4).

En: Allergy. e-ISSN. 1398-9995 2021, 31 may : 1-17 Progressive knowledge of allergenic structures resulted in a broad availability of allergenic molecules for diagnosis. Component resolved diagnosis allowed a better understanding of patient sensitization patterns, facilitating allergen immunotherapy decisions. In parallel to the discovery of allergenic molecules, there was a progressive development of a regulation framework that affected both in vitro diagnostics and Allergen Immunotherapy products. With a progressive understanding of underlying mechanisms associated to Allergen immunotherapy and an increasing experience of application of molecular diagnosis in daily life, we focus in analyzing the evidencesof the value provided by molecular allergology in daily clinical practice, with a focus on Allergen Immunotherapy decisions.

End users have become active participants in local electricity market transactions because of the growth of the smart grid concept and energy storage systems (ESS). This participation is optimized in this article using a stochastic two-stage model considering the day-ahead and real-time electricity market data. This model optimally schedules the operation of a Smart Home (SH) to meet its energy demand. In addition, the uncertainty of wind and photovoltaic (PV) generation is considered along with different appliances. In this paper, the participation of an EV (electric vehicle), together with the battery energy storage systems, which allow for the increase in bidirectional energy transactions are considered. Demand Response (DR) programs are also incorporated which consider market prices in real-time and impact the scheduling process. A comparative analysis of the performance of a smart home participating in the electricity market is carried out to determine an optimal DR schedule for the smart homeowner. The results show that the SH’s participation in the real-time pricing, scheme not only reduces the operating costs but also leads to better than expected profits. Moreover, total, day-ahead, and real-time expected profits are better in comparison with existing literature. The objective of this paper is to analyze the SH performance within the electrical market context so as to increase the system’s flexibility whilst optimizing DR schedules that can mitigate the variability of end-users generation and load demand.

There are significant changes occurring both in the electricity system and the natural gas system. These two energy carries can be combined to form what is known as an energy hub. These energy hubs can play a significant role in the energy system and thus understanding of their optimization, especially their costs, is important. This paper proposes a risk management framework for an energy-hub through the utilization of the information-gap decision theory (IGDT). The uncertainties introduced from the various load profiles, such as the electric and heating loads, are considered in this risk management framework. The modeled energy-hub consists of several distributed generation systems such as a micro-combined heat and power (μCHP), electric heat pump (EHP), electric heater (EH), absorption chiller (AC) and an energy storage system (ESS). A demand response (DR) program is also considered to shift a percentage of electric load away from the peak period to minimize the operational cost of the hub. A feasible test system is also applied to demonstrate the proposed model’s effectiveness.

Post-stroke patients present various gait abnormalities such as drop foot, stiff-knee gait (SKG), and knee hyperextension. Functional electrical stimulation (FES) improves drop foot gait although the mechanistic basis for this effect is not well understood. To answer this question, we evaluated the gait of a post-stroke patient walking with and without FES by inverse dynamics analysis and compared the results to an optimal control framework. The effect of FES and cause-effect relationship of changes in knee and ankle muscle strength were investigated; personalized muscle–tendon parameters allowed the prediction of pathologic gait. We also predicted healthy gait patterns at different speeds to simulate the subject walking without impairment. The passive moment of the knee played an important role in the estimation of muscle force with knee hyperextension, which was decreased during FES and knee extensor strengthening. Weakening the knee extensors and strengthening the flexors improved SKG. During FES, weak ankle plantarflexors and strong ankle dorsiflexors resulted in increased ankle dorsiflexion, which reduced drop foot. FES also improved gait speed and reduced circumduction. These findings provide insight into compensatory strategies adopted by post-stroke patients that can guide the design of individualized rehabilitation and treatment programs.

Chronic cytomegalovirus (CMV) infection is a trigger factor for the development of immunosenescence and negatively impacts the immune response to influenza virus vaccination (IVV) in older adults. However, the role of physical exercise training in this context is unknown. Thus, the aim of this study was to investigate whether the regular practice of combined exercise training can improve the specific antibody response to IVV in CMV-seropositive older adults. Eighty older adults were distributed into two groups—non-practitioners (NP, n = 31, age = 74.06 ± 6.4 years) and practitioners of combined exercise training (CET, n = 49, age = 71.7 ± 5.8 years)—for at least 12 months. Both volunteer groups were submitted to IVV and blood samples were collected before (pre) and 30 days after (post) the vaccination. Concerning the specific antibody response to IVV, higher serum levels of specific immunoglobulin A (IgA) were found in the CET group post- than pre-vaccination (p < 0.01), whereas higher levels of specific immunoglobulin M (IgM) were observed both in the NP (p < 0.05) and CET (p < 0.001) groups post-vaccination as compared to the pre-vaccination values. Serum levels of specific immunoglobulin G (IgG) for IVV and CMV, as well as interleukin 6 (IL-6) and IL-10, were similar between the time points evaluated. However, the IL-10/IL-6 ratio post-vaccination was higher (p < 0.05) in the CET group than that before vaccination. Negative correlations were observed between the specific IgG levels for IVV and CMV only in the CET group, both pre- and post-vaccination. In addition, negative correlations were found between IL-10 and specific IgG for CMV in all volunteer groups pre- and post-vaccination, whereas a positive correlation between IL-10 and specific-IgG for IVV pre- and post-vaccination was observed in the CET group. In addition, with the hemagglutination inhibition (HAI) assay, it was found that 32.2% of the NP group and 32.6% of the CET group were responders to IVV and displayed reductions in the CMV serostatus (p < 0.05 and p < 0.001, respectively) and increases in naive and effector CD8+ T cells post-vaccination (p < 0.01). However, only the responders from the CET group showed significant reductions in the ratio of effector to naive CD8+ T cells (p < 0.05) and increased IL-10 levels post-vaccination (p < 0.001). In summary, this study demonstrates that the improvement in the response to IVV in CMV-seropositive older adults was related to an anti-inflammatory status and enhancement of naive CD8+ T cells, particularly associated with regular practice of CET.

Background: Chagas disease (caused by Trypanosoma cruzi infection) evolves to chronic chagasic cardiomyopathy (CCC) affecting 1.8 million people worldwide. This is the first randomized, placebo-controlled, double-blinded, clinical trial designed to estimate efficacy and safety of selenium (Se) treatment in CCC. Methods: 66 patients with CCC stages B1 (left ventricular ejection fraction [LVEF] > 45% and no heart failure; n = 54) or B2 (LVEF < 45% and no heart failure; n = 12) were randomly assigned to receive 100 mcg/day sodium selenite (Se, n = 32) or placebo (Pla, n = 34) for one year (study period: May 2014-September 2018). LVEF changes over time and adverse effects were investigated. Trial registration number: NCT00875173 (clinicaltrials.gov). Findings: No significant differences between the two groups were observed for the primary outcome: mean LVEF after 6 (β= +1.1 p = 0.51 for Se vs Pla) and 12 months (β= +2.1; p = 0.23). In a subgroup analysis, statistically significant longitudinal changes were observed for mean LVEF in the stage B2 subgroup (β= +10.1; p = 0.02 for Se [n = 4] vs Pla [n = 8]). Se treatment was safe for CCC patients, and the few adverse effects observed were similarly distributed across the two groups. Interpretation: Se treatment did not improve cardiac function (evaluated from LVEF) in CCC. However, in the subgroup of patients at B2 stage, a potential beneficial influence of Se was observed. Complementary studies are necessary to explore diverse Se dose and/or associations in different CCC stages (B2 and C), as well as in A and B1 stages with longer follow-up. Funding: Brazilian Ministry of Health, Fiocruz, CNPq, FAPERJ.

Background Chronic kidney disease (CKD) is a very common co-morbidity in patients with cardiovascular disease, particularly in those with atrial fibrillation (AF). There is an increasing number of patients on haemodialysis who have AF and its impact is not fully understood. Purpose To assess the prevalence of AF in patients on haemodialysis, trying to identify predictors of AF development. Methods Unicentric, retrospective study including all patients admitted to the Nephrology ward from October 2020 to December 2020 who had CKD. Cardiovascular risk factors, known cardiac disease, time on haemodialysis, type of vascular access and demographic data were analysed. The control group was comprised of hospitalized CKD patients who were not on renal replacement therapies. Results A total of 126 patients were included, 57 on dialysis. Mean age for the renal replacement therapy group was 71.07±15.68 years and for the control group was 72.59±14.74 years old (p=0.575). There was an increased proportion of patients with type 2 diabetes mellitus in the control group (39 vs 20, p=0.021). No statistically significant differences were found regarding hypertension, heart failure, coronary disease or sleep apnoea between groups. The prevalence of AF was similar in both the haemodialysis and the control group (26.3% vs 24.6%, p=0.829). Age, heart failure and coronary disease were significant risk factors for AF, irrespective of the studied group (p Using the Youden index, an age of 80.5 years was determined as the cut-off for an increased prevalence of AF, irrespective of the study group (sensitivity of 66.7%; Specificity of 78.8%). Using ROC curves, an area under the curve (AUC) of 0.74 was obtained for age and the likelihood of AF (figure 1). Regarding time on dialysis, a cut-off point of 4.5 years was obtained with an AUC of 0.67 (sensitivity of 73% and specificity of 68.7%) (figure 2). Conclusion AF is very common in patients with end-stage renal disease, with a prevalence estimated to be 4 times greater than the general population. Our results suggested that, while haemodialysis may not be a risk factor for AF by itself, a longer time on haemodialysis may contribute to its onset. Age was also a contributing factor. Further prospective studies with more homogeneous groups are needed to clarify its role as an independent risk factor for AF. Funding Acknowledgement Type of funding sources: None. Figure 1. Age as predictor of AFFigure 2. Time on dyalisis as predictor of AF

Introducao Aproximadamente dois bilhoes de pessoas sofrem de anemia no mundo. Pesquisas sugerem que compostos endovenosos sao mais tolerados que os orais, com tempo de atuacao mais rapido, bem como a correcao dos estoques. Carboximaltose ferrica e utilizada em grande parte dos pacientes, por seu perfil de tolerabilidade, posologia facilitada e reposicao rapida dos estoques, porem um dos efeitos colaterais e a hipofosfatemia, que ocorre entre 2-5 semanas da administracao. Nosso intuito e relatar o caso de um paciente com diagnostico de osteomalacia associada ao uso cronico de carboximaltose ferrica. Apresentacao do caso: Paciente, 51a, admitida em janeiro de 2021 por historia de lombalgia associada a febre. Apresentava refratariedade a tratamentos tradicionais com analgesicos, necessitando de abordagens com neuromodulacao e infiltracao. Investigacoes revelaram anemia, com discreta plaquetose, perfil de ferro dentro da normalidade, com marcadores de hemolise negativos. Pelo diagnostico de Telangiectasia hemorragica hereditaria, paciente apresentava-se com anemia ferropriva cronica recidivante e necessidade de uso de terapia com ferro endovenoso (carboximaltose ferrica desde 2017). Constatou-se que paciente apresentava quadro de espondilodiscite (L2-L3) em ressonância magnetica. Foi solicitado painel osteometabolico pelo quadro de osteoporose, onde se evidenciou aumento importante do PTH, com hiperparatireoidismo secundario, hipofosfatemia e calcio dentro dos valores de normalidade. Devido ao uso cronico de carboximaltose ferrica por mais de quatro anos, com frequencia mensal, aventou-se a possibilidade de Osteomalacia secundaria a carboximaltose ferrica. Em relacao aos exames laboratoriais osteo metabolicos, constatou-se um hiperparatireoidismo secundario, com calcio normal e hipofosfatemia, tambem hipovitaminose D, corroborando para o diagnostico de osteomalacia por hipofosfatemia secundaria ao uso de Carboximaltose Ferrica. A paciente foi tratada para espondilodiscite com antimicrobianos e foram realizadas reposicao oral de fosforo, calcio e vitamina D alem da suspensao da Carboximaltose ferrica e preferencia por reposicao de ferro por via oral e transfusoes se necessario. Tambem iniciou uso de antifibrinoliticos topicos e enterais, quando necessario. E nas semanas subsequentes, apresentou melhora da dor, com queda dos valores de PTH, normalizacao do calcio e fosforo. Discussao Em uma revisao sistematica sobre hipofosfatemia associada a terapias de ferro intravenoso para anemia ferropriva, que incluiu 40 estudos, a hipofosfatemia ocorreu em ate 92.1% das reposicoes feitas com Carboximaltose ferrica, com incidencias muito inferiores para sucrose, ferumoxitol e dextran. Pacientes com hipofosfatemia aguda desenvolviam principalmente fadiga e aqueles com necessidade repetida de reposicao de ferro com Carboximaltose ferrica desenvolveram hipofosfatemia cronica associada a osteomalacia e deformidades osseas. Na literatura nao ha padronizacao para monitorar os niveis de fosfato. Apesar de multiplos casos documentados de consequencias clinicas graves associadas a certas composicoes endovenosas de ferro, os trabalhos nao trazem informacoes consistentes sobre frequencia e severidade, podendo subestimar sua prevalencia. Conclusao O diagnostico da hipofosfatemia requer suspeita clinica. Em pacientes com reposicao endovenosa cronica de ferro sugerimos monitoramento dos niveis de fosfato, PTH, calcio ionico e vitamina D para que iniciemos as profilaxias ou alternativas terapeuticas antes de causar maleficio no paciente, seguindo a recomendacao do Pai da Medicina: Primo non nocere. Palavras-chave: Anemia ferropriva; Ferropenia; Osteomalacia; Teleangectasia; Hemorragica hereitaria.

Although regular combined aerobic-resistance exercises can ameliorate the inflammatory status and redox balance in elderly population, it is unclear whether protein or specific amino acid supplementation could improve such benefits. Therefore, we aimed to evaluate the inflammatory status and redox indexes through of the saliva of 34 elderly subject nonpractitioners (NP group, 73.3±6.6 years) and 49 elderly subject practitioners of a combined-exercise training in moderate intensity (CET group, 71.9±5.8 years) before (pre) and after (post) 30 days of supplementation with L-glutamine (Gln) or placebo (PL). Our results showed that, both in pre- and postsupplementation, the salivary levels of nitric oxide (NO⋅) and TNF-α were lower, whereas the levels of uric acid and IL-10 (as well as IL-10/TNF-α ratio) were higher in the CET groups than in the NP groups. In postsupplementation, both groups supplemented with Gln (NP-Gln and CET-Gln) showed higher salivary uric acid levels compared to baseline. In addition, lower NO⋅ levels were found in the CET-Gln group postsupplementation than presupplementation values. Whereas the CET-Gln group showed lower GSH levels postsupplementation, NP-Gln subjects showed lower GSSG levels at the same time point, both compared to baseline. Interestingly, salivary peroxidase activity was lower only in NP groups (NP-PL and NP-Gln) postsupplementation than baseline values. A positive significant correlation between salivary peroxidase activity and GSH levels, and also between salivary peroxidase activity and uric acid levels were observed in the CET-Gln group both pre- and postsupplementation. No differences were found in albumin, total antioxidant activity (TEAC), and reducing power analysis between groups, pre- or postsupplementation. In conclusion, the elderly subjects from the CET group showed a better inflammatory response and redox balance and, for the first time, it was shown that daily supplementation with Gln for 30 days can improve these benefits with putative association with a healthy aging.

Objectives We sought to describe the outcomes of BVS use from a single-center experience in which scaffold implantation was guided by intravascular imaging (ultrasound and/or optical coherence tomography) to identify and treat mechanical factors potentially related to BVS failure. Background The Absorb bioresorbable vascular scaffold (BVS) has been associated with an unexpectedly high incidence of thrombosis. Methods Between 11/2014 and 10/2016, 100 patients were treated with BVS. Intravascular imaging assessment before and after BVS implantation was performed in all cases. Results Mean age was 58.1 years; 88% were male, 31% had diabetes, and 28% presented with acute coronary syndromes. A total of 171 lesions in 141 vessels were treated with 190 BVS (mean 1.9 scaffolds/patient). Further intervention following intravascular imaging to optimize BVS implantation was required in 31% of patients. Procedure success was 100%. All patients completed a 1-year follow-up. The 1-year rate of target lesion failure was 4%, and there were no cases (0%) of scaffold thrombosis, myocardial infarction, or death. Conclusions In this real-world experience, the use of intravascular imaging to guide BVS implantation was associated with a high 1-year event-free survival rate, with no scaffold thrombosis.

Conventional electrical networks are slowly changing. A strong sense of policy urges as well as commitments have recently been surfacing in many countries to integrate more environmentally friendly energy sources into electrical systems. In particular, stern efforts have been made to integrate more and more solar and wind energy sources. One of the major setbacks of such resources arises as a result of their intermittent nature, creating several problems in the electrical systems from a technical, market, operation, and planning perspectives. This work focuses on the operation of an electrical system with large-scale integration of solar and wind power. In order to cope with the intermittency inherent to such power sources, it is necessary to introduce more flexibility into the system. In this context, demand response, energy storage systems, and dynamic reconfiguration of the system are introduced, and the operational performance of the resulting system is thoroughly analyzed. To carry out the required analysis, a stochastic mixed-integer linear programming operational model is developed, whose efficacy is tested on an IEEE 119-bus standard network system. Numerical results indicate that the joint deployment and management of various flexibility mechanisms into the system can support a seamless integration of large-scale intermittent renewable energies.

Economic development and changing lifestyles are leading to the extensive use of energy-intensive technologies by consumers. As a result, this has led to a dramatically increased demand for electricity. In addition, the consumers’ increasing demand for a more reliable and uninterrupted energy supply is posing enormous challenge for service providers. This necessitates the development of novel solutions that should be at the system operators’ disposal, particularly at distribution levels. One way to partly address this concern is by automating distribution systems and equipping them with intelligent technologies–a transformation to smart distribution systems. Such a transformation should improve system reliability and operational efficiency because such systems will be capable of operating and immediately restoring discontinued service to consumers. To facilitate this, it is necessary to replace manual switches by remotely controlled ones, improving the system restoration capability, which is one of the key features of smart grids. This paper presents a new framework to determine the minimal set of switches that have to be replaced or optimally allocated in order to automate the system. This is supported by a sensitivity analysis. Different topologies are also assessed taking into account various reliability indices and power losses in system operation following the system's automation. Such an optimization work is done under a massive integration of renewable energy sources and energy storage systems. All this simultaneously addresses the economic and functional requirements of the automated system, ultimately improving system's reliability. The standard IEEE 119-bus standard system is used as a case study, where different types of loads are considered (residential, commercial, and industrial).

Brazil is a low-and-middle income country (LMIC) that, despite having a large population and continental dimensions, has been able to successfully fight HIV/AIDS through a number of governmental and societal measures. These included an early response to the epidemic, the development of a universal and free public health system, incisive discussions with pharmaceutical companies to reduce antiretroviral (ARV) drug prices, investments towards the development of generic drugs and compulsory licensing of ARVs. Through such measures, Brazil is among the leading LMIC towards achieving the 90-90-90 UNAIDS goals in the years to come. In this review, we analyze Brazil’s progress throughout the HIV/AIDS epidemic to achieve state-of-the-art ARV treatment and to reduce AIDS mortality in the country. The top-quality HIV/AIDS research in Brazil towards HIV prophylactic and functional cure, the next step towards the economic sustainability of the battle against HIV, is also discussed.