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Ectopic pregnancy is a quite common and life-threatening pregnancy. The most common site of ectopic implantation of a fertilized embryo is the fallopian tube. In extremely rare situations, the embryo can implant in other locations, which makes the diagnosis and management even more complex. Although close observation of a new pregnancy is key in the diagnosis and treatment of an ectopic pregnancy, there is still a major risk of life-threatening outcomes. This is a case report of a 31-year-old patient with a history of multiple pregnancies who presented to a community hospital in the spring of 2021 with an ectopic caesarean scar pregnancy. A diagnosis of ectopic pregnancy was on a timely basis, and surgical management was advised. Upon refusal of treatment and admission, pharmacological management was initiated, but patient compliance challenged the success of the therapy. Patient non-compliance to close follow-up resulted in a ruptured uterus. Emergency laparotomy with supracervical hysterectomy was performed as a life-saving procedure.

An endoscopist’s adenoma detection rate (ADR) is inversely related to interval colorectal cancer risk and cancer mortality. Previous studies evaluating the impact of gastroenterology fellow participation in colonoscopy on ADR have generated conflicting results. We aimed to determine the impact of fellow participation, duration of fellowship training, and physician sex on ADR and advanced ADR (AADR). We retrospectively analyzed average-risk patients undergoing screening colonoscopy at Veterans Affairs New York Harbor Healthcare System Brooklyn Campus and Kings County Hospital Center. Review of colonoscopy and pathology reports were performed to obtain adenoma-specific details, including the presence of advanced adenoma and adenoma location (right vs. left colon). There were 893 colonoscopies performed by attending only and 502 performed with fellow participation. Fellow participation improved overall ADR (44.6% vs. 35.4%, p

Background: Multiple sclerosis (MS) is considered a neurodegenerative disease and an inflammatory demyelinating neuropathology in young population. Procedural memory has been poorly investigated in MS. Objective: We assessed whether the MS group was able to develop a motor-cognitive skill, using a procedural task (PLSC) developed in our laboratory, applying a manual and serial reaction time (RT) paradigm to semantic categorization. Methods: We evaluated 26 MS patients and 26 socio-demographic matched control participants using the PLSC task. Results: Using non-parametric statistical analyses, we observed a significant improvement of semantic categorization RTs with practice (p = 0.002), even with new verbal material to categorize in MS patients (p = 0.006), despite their motor and executive moderate deficits. This same profile of semantic procedural learning in MS was observed in previous studies carried out with Alzheimer’s and Parkinson’s diseases. Moreover, the visual-motor RTs remained stable or slightly improved over the five blocks in both groups, as well as in the AD groups of previous studies. The MS group showed longer visual-motor reaction times than those of the control group (p

Given the importance of the management of sedation, analgesia and delirium in Intensive Care Units, and in order to update the previously published guidelines, a new clinical practice guide is presented, addressing the most relevant management and intervention aspects based on the recent literature. A group of 24 intensivists from 9 countries of the Pan-American and Iberian Federation of Societies of Critical Medicine and Intensive Therapy met to develop the guidelines. Assessment of evidence quality and recommendations was made according to the Grading of Recommendations Assessment, Development and Evaluation Working Group. A systematic search of the literature was carried out using MEDLINE, Cochrane Library databases such as the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects, the National Health Service Economic Evaluation Database and the database of Latin American and Caribbean Literature in Health Sciences (LILACS). A total of 438 references were selected. After consensus, 47 strong recommendations with high and moderate quality evidence, 14 conditional recommendations with moderate quality evidence, and 65 conditional recommendations with low quality evidence were established. Finally, the importance of initial and multimodal pain management was underscored. Emphasis was placed on decreasing sedation levels and the use of deep sedation only in specific cases. The evidence and recommendations for the use of drugs such as dexmedetomidine, remifentanil, ketamine and others were incremented.

Alexithymia is widely recognized as the inability to identify and express emotions. It is a construct which consists of four cognitive traits such as difficulty in identifying feelings, describing feelings to others, externally oriented thinking, and limited imaginative capacity. Several studies have linked alexithymia to cognitive functioning, observing greater alexithymia scores associated with poorer cognitive abilities. Despite Alzheimer&rsquo, s disease (AD) being a neurodegenerative pathology characterized by cognitive troubles from the early stages, associated to behavioral and emotional disturbances, very few investigations have studied the alexithymia in AD. These studies have shown that alexithymia scores&mdash, assessed with Toronto Alexithymia Scale (TAS)&mdash, were greater in AD patients than healthy participants. The objective of the study was to investigate if the alexithymia was present in patients with mild AD. We hypothesized that the AD group would show more alexithymia features than the control group. We evaluated 54 subjects, including 27 patients diagnosed with mild AD and 27 normal healthy controls, using the Shalling Sifneos Psychosomatic Scale (SSPS-R) and a neuropsychological test battery. Using non-parametric statistical analyses&mdash, Wilcoxon and Mann&ndash, Whitney U tests&mdash, we observed that the SSPS-R scores were similar in the AD and control groups. All participants showed SSPS-R scores below to 10 points, which means no-alexithymia. We did not find significant correlations between SSPS-R scores and cognitive variables in both groups (p &gt, 0.22), but we observed a negative association between name abilities and alexithymia, but it does not reach to significance (p = 0.07). However, a significant correlation between SSPS-R score and mood state, assessed using Zerssen Rating Scale, was found in both groups (p = 0.01). Because we did not find a significant difference in the alexithymia assessment between both subject groups, pot hoc analyses were computed for each item of the SSPS-R. We made comparisons of alexithymic responses percentages in each SSPS-R item between AD and control groups, using Fisher&rsquo, s test. We observed that AD patients produced more alexithymic responses in some items of SSPS-R test than the control group, particularly about difficulties to find the words to describe feelings, as well as difficulties of imagination capacity and externally oriented thinking. The present results do not confirm our hypothesis and they do not support the results of previous studies revealing great alexithymia in AD.

Resumen El linfoma de Burkitt es un linfoma no Hodgkin de células B, que representa el 4% de la patología tumoral. Existen tres formas clínicas, siendo la esporádica la más frecuente en nuestro medio, sobre todo en niños o adultos jóvenes. Describimos un caso de linfoma Burkitt pancreático y ovárico, en el que la clínica de debut de ictericia asintomática es lo que determina el inicio del estudio. Como resultados y conclusión, destacar que es una entidad poco frecuente siendo importante diferenciarla del adenocarcinoma pancreático por su diferente tratamiento y evolución.

This paper presents a novel approach for the investment planning of a virtual power plant trading energy in an electricity market. The virtual power plant comprises conventional generating units, renewable generating units, storage units, and a set of flexible demands. In order to maximize its expected profit, the virtual power plant has the possibility of installing new conventional, renewable, and storage units. Such investment decisions are made under the long-term uncertainty associated with future production costs of the conventional generating units, future consumption levels of the flexible demands, and future energy market prices, as well as the short-term variability of market prices and renewable production levels. In addition, the effect of generation and storage operation on investment decisions is precisely characterized by a detailed nonconvex formulation. The resulting model is cast as a scenario-based two-stage stochastic programming problem wherein the conditional value-at-risk is used to represent the risk aversion of the owner of the virtual power plant. Numerical results from several case studies show that the virtual power plant can significantly increase its expected profit by expanding its generation and storage assets. Moreover, neglecting nonconvex operational constraints generally results in over-investment in conventional generating units. The moderate computational effort required to solve instances with up to 45 candidate assets backs the practical applicability of the proposed approach., Este artículo presenta un enfoque novedoso para la planificación de inversiones de una central eléctrica virtual que comercializa energía en un mercado eléctrico. La central eléctrica virtual comprende unidades generadoras convencionales, unidades generadoras renovables, unidades de almacenamiento y un conjunto de demandas flexibles. Para maximizar su beneficio esperado, la central eléctrica virtual tiene la posibilidad de instalar nuevas unidades convencionales, renovables y de almacenamiento. Dichas decisiones de inversión se toman bajo la incertidumbre a largo plazo asociada con los costos de producción futuros de las unidades generadoras convencionales, los niveles futuros de consumo de las demandas flexibles y los precios futuros del mercado de energía, así como la variabilidad a corto plazo de los precios de mercado y la producción renovable. niveles Además, el efecto de la operación de generación y almacenamiento en las decisiones de inversión se caracteriza precisamente por una formulación no convexa detallada. El modelo resultante se presenta como un problema de programación estocástica de dos etapas basado en escenarios en el que el valor en riesgo condicional se usa para representar la aversión al riesgo del propietario de la planta de energía virtual. Los resultados numéricos de varios estudios de casos muestran que la planta de energía virtual puede aumentar significativamente su beneficio esperado mediante la expansión de sus activos de generación y almacenamiento. Además, ignorar las restricciones operativas no convexas generalmente da como resultado una inversión excesiva en unidades generadoras convencionales. El esfuerzo computacional moderado requerido para resolver instancias con hasta 45 activos candidatos respalda la aplicabilidad práctica del enfoque propuesto. El modelo resultante se presenta como un problema de programación estocástica de dos etapas basado en escenarios en el que el valor en riesgo condicional se usa para representar la aversión al riesgo del propietario de la planta de energía virtual. Los resultados numéricos de varios estudios de casos muestran que la planta de energía virtual puede aumentar significativamente su beneficio esperado mediante la expansión de sus activos de generación y almacenamiento. Además, ignorar las restricciones operativas no convexas generalmente da como resultado una inversión excesiva en unidades generadoras convencionales. El esfuerzo computacional moderado requerido para resolver instancias con hasta 45 activos candidatos respalda la aplicabilidad práctica del enfoque propuesto. El modelo resultante se presenta como un problema de programación estocástica de dos etapas basado en escenarios en el que el valor en riesgo condicional se usa para representar la aversión al riesgo del propietario de la planta de energía virtual. Los resultados numéricos de varios estudios de casos muestran que la planta de energía virtual puede aumentar significativamente su beneficio esperado mediante la expansión de sus activos de generación y almacenamiento. Además, ignorar las restricciones operativas no convexas generalmente da como resultado una inversión excesiva en unidades generadoras convencionales. El esfuerzo computacional moderado requerido para resolver instancias con hasta 45 activos candidatos respalda la aplicabilidad práctica del enfoque propuesto. Los resultados numéricos de varios estudios de casos muestran que la planta de energía virtual puede aumentar significativamente su beneficio esperado mediante la expansión de sus activos de generación y almacenamiento. Además, ignorar las restricciones operativas no convexas generalmente da como resultado una inversión excesiva en unidades generadoras convencionales. El esfuerzo computacional moderado requerido para resolver instancias con hasta 45 activos candidatos respalda la aplicabilidad práctica del enfoque propuesto. Los resultados numéricos de varios estudios de casos muestran que la planta de energía virtual puede aumentar significativamente su beneficio esperado mediante la expansión de sus activos de generación y almacenamiento. Además, ignorar las restricciones operativas no convexas generalmente da como resultado una inversión excesiva en unidades generadoras convencionales. El esfuerzo computacional moderado requerido para resolver instancias con hasta 45 activos candidatos respalda la aplicabilidad práctica del enfoque propuesto.

Standard mathematical-programming-based models have attracted considerable attention for optimizing distribution system planning and operation due to their salient advantages. More specifically, mixed-integer linear programming (MILP) has proven very effective in modeling such problems. The availability of optimization software for efficiently solving MILP problems with guaranteed convergence to optimality while providing a measure of the distance to the optimal solution has made MILP models more popular. Although a plethora of efficient MILP formulations have been proposed for planning and operating studies of distribution grids, incorporating reliability into such models is still challenging. Recently, several innovative techniques have been proposed in the literature for optimization-based reliability evaluation of distribution networks. However, either oversimplifications or high computation costs are featured, thereby limiting the applicability of such approaches in practical problems. To overcome this issue, this paper presents an enhanced MILP model for distribution system reliability evaluation. The proposed model boosts the computational effectiveness without sacrificing solution accuracy. Numerical experience with the proposed model demonstrates its superior performance over the state of the art.

Introduction:Parents acquire information about human papillomavirus (HPV) vaccines online and encounter vaccine-critical content, especially on social media, which may depress vaccine uptake. Secondary analysis in a randomized trial of a Facebook-delivered adolescent health campaign targeting mothers with posts on HPV vaccination was undertaken with the aims of (a) determining whether the pre–post-change occurred in self-reports of the mothers on HPV vaccination of their adolescent daughters; (b) describing the comments and reactions to vaccine posts; (c) exploring the relationship of campaign engagement of the mothers assessed by their comments and reactions to posts to change in the self-reports of the mothers of HPV vaccination.Materials and Methods:Mothers of daughters aged 14–17 were recruited from 34 states of the US (n= 869). A social media campaign was delivered in two Facebook private groups that differed in that 16% of posts in one were focused on indoor tanning (IT) and 16% in the other, on prescription drug misuse, assigned by randomization. In both groups, posts promoted HPV vaccination (n= 38 posts; no randomization) and vaccination for other disease (e.g., influenza,n= 49). HPV and other vaccination posts covered the need for a vaccine, the number of adolescents vaccinated, how vaccines are decreasing the infection rates, and stories of positive benefits of being vaccinated or harms from not vaccinating. Guided by social cognitive theory and diffusion of innovations theory, posts were intended to increase knowledge, perceived risk, response efficacy (i.e., a relative advantage over not vaccinated daughters), and norms for vaccination. Some vaccination posts linked to stories to capitalize on identification effects in narratives, as explained in transportation theory. All mothers received the posts on vaccination (i.e., there was no randomization). Mothers completed surveys at baseline and 12- and 18-month follow-up to assess HPV vaccine uptake by self-report measures. Reactions (such as sad, angry) and comments to each HPV-related post were counted and coded.Results:Initiation of HPV vaccination (1 dose) was reported by 63.4% of mothers at baseline, 71.3% at 12-month posttest (pre/postp< 0.001), and 73.3% at 18-month posttest (pre/postp< 0.001). Completion of HPV vaccination (two or three doses) was conveyed by 50.2% of mothers at baseline, 62.5% at 12-month posttest (pre/postp< 0.001), and 65.9% at 18-month posttest (pre/postp< 0.001). For posts on HPV vaccines, 8.1% of mothers reacted (n= 162 total), and 68.4% of posts received a reaction (63.2% like; 13.2% love, 7.9% sad). In addition, 7.6% of mothers commented (n= 122; 51 unfavorable, 68 favorable, 1 neutral), and 50.0% of these posts received a comment. There were no differences in pre–post change in vaccine status by the count of reactions or comments to HPV vaccine posts (Ps > 0.05). Baseline vaccination was associated with the valence of comments to HPV vaccine posts (7.2% of mothers whose daughters had completed the HPV series at baseline made a favorable comment but 7.6% of mothers whose daughters were unvaccinated made an unfavorable comment).Conclusion:Effective strategies are needed in social media to promote HPV vaccines and counter misinformation about and resistance to them. Mothers whose daughters complete the HPV vaccine course might be recruited as influencers on HPV vaccines, as they may be predisposed to talk favorably about the vaccine. Comments from mothers who have not been vaccinated should be monitored to ensure that they do not spread vaccine-critical misinformation. Study limitations included lack of randomization and control group, relatively small number of messages on HPV vaccines, long measurement intervals, inability to measure views of vaccination posts, reduced generalizability related to ethnicity and social media use, and use of self-reported vaccine status.Clinical Trial Registration:www.clinicaltrials.gov, identifier NCT02835807.

Resumen La hepatotoxicidad es uno de los efectos adversos medicamentoso más frecuente y grave. Por ello, ha crecido el interés en detectarlos. Exponemos dos casos de colestasis hepática por consumo de sustancias farmacológicas, con la clínica que presentaban, pruebas complementarias realizadas y evolución. Con ello, queremos resaltar la importancia de la sospecha clínica de esta entidad, la cual está en auge. Como resultados y conclusión, es una entidad que requiere alta sospecha clínica, pudiendo presentarse de diversas formas y siendo difícil de identificar. Se realiza como diagnóstico de exclusión y se debe tener presente ya que está viéndose incrementada.

In recent years, there has been growing awareness of the distinct characteristics of adolescents and young adults (AYA) diagnosed with cancer. Soft-tissue sarcoma (STS) accounts for approximately 1% of all cancers diagnosed in adults and 8% of cancers diagnosed in AYA. To the best of our knowledge, only a few sarcoma registers include data regarding histological subtype, age at diagnosis, and detailed clinical information. Therefore, little is known regarding clinical presentation and outcomes in AYA diagnosed with STS.Using the Scandinavian Sarcoma Group Central Register, data were obtained regarding 4977 patients who were diagnosed with STS for the period between 1986 and 2011. AYA (those aged 18-39 years) were compared with older adults (OA; those aged 40-80 years) with respect to clinical presentation, treatment, and outcome.There were 868 AYA and 4109 OA. Overall and by STS subtype, there were significant differences noted between AYA and OA with regard to presentation, treatment, and survival. The distribution of STS subtypes was different between OA and AYA (eg, OA were more likely to be diagnosed with malignant fibrous histiocytoma compared with AYA [34% vs 16%; P .001]). OA also were more likely to have tumors measuring ≥5 cm (68% vs 56%; P .001) and a higher malignancy grade (75% vs 67%; P .001). In the majority of STS subtypes AYA had significantly better overall survival and less disease recurrence compared with OA, but this finding was not true for those with malignant peripheral nerve sheath tumors.There are several differences between AYA and OA with STS with regard to presentation, treatment, and survival, and such differences must be taken into consideration when designing clinical trials. Additional work also is needed to characterize the potential biological mechanisms underlying these differences.

Introduction Methylation-derived neutrophil-to-lymphocyte ratio (mdNLR) has been identified as a potential prognostic biomarker of outcomes in various cancers. We evaluated the prognostic value of blood-derived mdNLR within a retrospective cohort of pediatric medulloblastoma patients. Materials and methods DNA methylation was measured in archival peripheral blood samples collected on 56 pediatric medulloblastoma patients. Hazard ratios (HR) and 95% confidence intervals (CI) for the association between mdNLR and survival were evaluated using Cox proportional hazard models. Results Compared to patients who were alive at last follow-up (n = 43), the mean mdNLR value was slightly higher in deceased patients (n = 13) (12.3 vs. 5.2,P = 0.163). Elevated log-transformed mdNLR was suggestively associated with an increased likelihood of death in unadjusted models (HR=1.43, 95%CI: 0.92–2.22) and significantly associated with mortality in adjusted models (HR=1.61, 95%CI: 1.01–2.58). Discussion Future work is warranted to investigate the relationship between mdNLR outcomes in specific pediatric medulloblastoma molecular subgroups.

Fab Labs as manufacturing laboratories that stimulate innovation and collaboration are nowadays proliferating within universities. Given the new social challenges, framed within the Sustainable Development Goals (SDG), we formulate the following research question: Are Fab Labs an effective tool for the promotion of social innovation from universities? To answer this question, a mixed analysis has been carried out focusing on the case of ProteinLab UTEM. The approach aims to generate a model for the promotion of social innovation from universities through Fab Labs, linking the quadruple helix actors. The objective of this model is to show how Fab Labs can become an effective instrument to promote social innovation from universities. The contribution of this article lies in linking Fab Labs with social innovation through the university’s third mission. Our approach considers Fab Labs as an instrument for the development of social innovations within the university, which contribute, through the third mission, to the social and sustainable development of its environment. As a result of this research, a model is presented for the development of social innovation from universities through Fab Labs. Our research concludes that Fab Labs are an effective instrument for the promotion of social innovation from universities.

The HCV replication cycle is tightly associated with host lipid metabolism: Lipoprotein receptors SR-B1 and LDLr promote entry of HCV, replication is associated with the formation of lipid-rich membranous organelles and infectious particle assembly highjacks the very-low-density lipoprotein (VLDL) secretory pathway. Hence, medications that interfere with the lipid metabolism of the cell, such as statins, may affect HCV infection. Here, we study the interplay between lipoprotein receptors, lipid homeostasis, and HCV infection by genetic and pharmacological interventions. We found that individual ablation of the lipoprotein receptors SR-B1 and LDLr did not drastically affect HCV entry, replication, or infection, but double lipoprotein receptor knock-outs significantly reduced HCV infection. Furthermore, we could show that this effect was neither due to altered expression of additional HCV entry factors nor caused by changes in cellular cholesterol content. Strikingly, whereas lipid-lowering drugs such as simvastatin or fenofibrate did not affect HCV entry or infection of immortalized hepatoma cells expressing SR-B1 and/or LDLr or primary human hepatocytes, ablation of these receptors rendered cells more susceptible to these drugs. Finally, we observed no significant differences between statin users and control groups with regards to HCV viral load in a cohort of HCV infected patients before and during HCV antiviral treatment. Interestingly, statin treatment, which blocks the mevalonate pathway leading to decreased cholesterol levels, was associated with mild but appreciable lower levels of liver damage markers before HCV therapy. Overall, our findings confirm the role of lipid homeostasis in HCV infection and highlight the importance of the mevalonate pathway in the HCV replication cycle.

Objective: To determine the prevalence of anxiety in ophthalmologists during the COVID-19 (coronavirus disease 2019) pandemic, exposed to severe acute respiratory syndrome by coronavirus type 2 (SARS-CoV-2) working in respiratory triage and outpatient ophthalmology consultation at the Hospital Central Militar in Mexico City Material and methods: Observational, cross-sectional, descriptive and prospective study, in which a descriptive survey was applied via internet evaluating two anxiety scales (Hamilton scale and generalized anxiety disorder [GAD-7) scale) Results: Thirty-one subjects responded, 17 (54 84%) female and 14 (45 16%) male Minimum age was 25 years and maximum age was 49 years, with an average age of 34 5 years The survey consisted of 24 questions, of which 21 were obtained from both anxiety scales (Hamilton + GAD-7) and the remaining three were of epidemiological interest By rating both scales separately, we observed an average score of 5 16 for the GAD-7 scale and of 8 45 for the Hamilton scale, reflecting a minimal group anxiety Using the GAD-7 scale, we observed an anxiety prevalence of 48% (15 physicians) Of the diagnosed cases, 9 (60%) met a score listed as mild anxiety, 5 (53%) as moderate and 1 (7%) as severe On the Hamilton scale, the prevalence was of 83% (26 physicians) Of the diagnosed cases, 23 (88%) had minimal anxiety, 2 (8%) had minimal-moderate anxiety and 1 (4%) had severe anxiety Conclusion: The prevalence of anxiety in ophthalmologists, using the GAD-7 and Hamilton scales was of 48% and 83%, respectively, and most cases were of mild intensity

Objective: To determine the prevalence of anxiety in ophthalmologists during the COVID-19 (coronavirus disease 2019) pandemic, exposed to severe acute respiratory syndrome by coronavirus type 2 (SARS-CoV-2) working in respiratory triage and outpatient ophthalmology consultation at the Hospital Central Militar in Mexico City. Material and methods: Observational, cross-sectional, descriptive and prospective study, in which a descriptive survey was applied via internet evaluating two anxiety scales (Hamilton scale and generalized anxiety disorder [GAD-7) scale). Results: Thirty-one subjects responded, 17 (54.84%) female and 14 (45.16%) male. Minimum age was 25 years and maximum age was 49 years, with an average age of 34.5 years.The survey consisted of 24 questions, of which 21 were obtained from both anxiety scales (Hamilton + GAD-7) and the remaining three were of epidemiological interest. By rating both scales separately, we observed an average score of 5.16 for the GAD-7 scale and of 8.45 for the Hamilton scale, reflecting a minimal group anxiety. Using the GAD-7 scale, we observed an anxiety prevalence of 48% (15 physicians). Of the diagnosed cases, 9 (60%) met a score listed as mild anxiety, 5 (53%) as moderate and 1 (7%) as severe. On the Hamilton scale, the prevalence was of 83% (26 physicians). Of the diagnosed cases, 23 (88%) had minimal anxiety, 2 (8%) had minimal-moderate anxiety and 1 (4%) had severe anxiety. Conclusion: The prevalence of anxiety in ophthalmologists, using the GAD-7 and Hamilton scales was of 48% and 83%, respectively, and most cases were of mild intensity.

Generalized lockdown caused by COVID-19, necessary yesterday, can no longer be that of tomorrow. It will no longer be possible to cram the humblest into cramped areas, but priority must be given to prevention (certainly with physical barriers, hydro-alcoholic gel, face masks), biological diagnosis, isolation, and also the care of any infected person. COVID-19 has hit the most vulnerable first in terms of biological inequality, such as Alzheimer’s disease (AD) patients. Those with AD can have sensorial deficits and perception troubles, including visual difficulties and the inability to recognize faces and emotions. Face masks and physical distancing can disrupt facial familiarity and make it more difficult to recognize emotional facial expressions. It can provoke distress, which the visitor can perceive and feel obligated to take off the face mask. This gesture should not be considered as an act of indiscipline, but an act of empathy. Transparent face masks could improve the suffering of AD patients, distraught in the presence of their loved ones whose masks hide their faces. Wearing a mask should not be due to fear of punishment, but as an understanding of the responsibility of each individual in the control of the current pandemic. It may be necessary to convince more citizens of this civic duty, using clear and attractive messaging in order to standardize the wearing of face masks for the general public and to adapt them to the needs of patients.

Due to the increased deployment of distributed generation, it becomes important to compute the ideal expansion plan for the overall system, even though, in practice, transmission and distribution network planners solve their problems independent of each other, leading to sub-optimal solutions. Therefore, this paper addresses the integrated expansion planning problem of transmission and distribution systems where investments in network and generation assets are jointly considered. Several alternatives are available for the installation of lines as well as conventional and wind-based generators at both system levels. Thus, the optimal expansion plan identifies the best alternative for the candidate assets under uncertain demand and wind power production. The proposed model is an instance of stochastic programming wherein uncertainty is characterized through a set of scenarios that explicitly capture the correlation between the sources of uncertainty. The resulting stochastic program is driven by the minimization of the total expected cost, which comprises investment and operating cost terms. The associated scenario-based deterministic equivalent is formulated as a mixed-integer linear program for which finite convergence to optimality is guaranteed. Numerical results show the effective performance of the proposed approach.

This paper addresses the multistage or dynamic investment decision-making problem arising in a distribution system within a transactive energy environment. Under such a framework, three agents are involved, namely the distribution company (DISCO), the owner of distributed generation (DG) units (DGENCO), and the independent distribution system operator (IDSO). Here, we propose characterizing this planning problem as an instance of trilevel programming. In the upper level, the DISCO identifies the optimal investment plan in network assets and the best potential locations for DG in order to supply the customer demand at maximum profit. In the middle level, the DGENCO determines the best location, sizing, and timing for DG installation so that the corresponding profit is maximized. Finally, in the lower level, the IDSO is responsible for the optimal operation of the expanded distribution system. The resulting mixed-integer trilevel program is solved by a novel approach relying on Benders decomposition. The performance of the proposed approach has been illustrated with a case study based on a 37-node test system.

Investigating the modulation of neutrophil production of MIG and IP-10 during the inflammatory response to HSV-1 infection.AnFour of the 12 pro-inflammatory mediators screened (IL-8, IL-6, IL-1α and IL-1β) demonstrated elevated levels of production during corneal cell infection with HSV-1 and communication with neutrophils. Neutrophils were demonstrated to produce significant levels of both MIG and IP-10 under conditions of IFN-γ stimulation, and production of MIG was further upregulated by co-stimulation with IFN-γ and HSV-1. Neutralization ofOur data provide evidence demonstrating the potential for expression patterns of MIG and IP-10 to be modulated by IL-1α, during the inflammatory response to HSV-1 corneal infection. Both corneal cells and neutrophils contribute to the production of T cell recruiting chemokines. However, IL-1α has the potential to upregulate MIG production by corneal cells while down-regulating MIG production by neutrophils.

ObjectiveThere is a lack of literature on postendoscopic retrograde cholangiopancreatography (ERCP) complications in predominantly black urban populations of low socioeconomic status. The aim of this study was to determine the incidence and predictors of post-ERCP complications in this patient population.DesignRetrospective review of ERCP cases performed at two hospitals from 2007 to 2017 was performed. The categories of complications evaluated were overall complications, severe or fatal complications, pancreatitis, bleeding, infection, perforation and cardiopulmonary events. Predictors of complications were determined by univariate analysis.ResultsA total of 1079 ERCP procedures were reviewed. There were 106 complications (9.8%). Twenty-one were severe (1.9%) and 20 were fatal (1.9%). Both post-ERCP pancreatitis (PEP) and post-ERCP bleeding occurred in 18 patients (1.7%) each. Risk factors for overall complications were male sex (OR 1.54), ASA grade IV or V (OR 2.19), prior history of PEP (OR 6.98) and pancreatic duct stent placement (OR 2.75). Those who were ASA grade III or lower (OR 0.4) or who underwent biliary stone extraction (OR 0.62) had fewer complications. PEP was more likely in those with a prior history of PEP (OR 37.6). Those with a suspected or known biliary duct stone had less frequent pancreatitis (OR 0.32). Post-ERCP bleeding was more likely in the presence of cholangitis (OR 8.72).ConclusionOutcomes of ERCP in a predominantly black urban population demonstrate a lower incidence of PEP and all-cause mortality compared with historical data reported in the general population. Potential risk factors for post-ERCP complications were identified but require larger studies for validation.

BACKGROUND Treatment characteristics such as cranial radiation therapy (CRT) do not fully explain adiposity risk in childhood acute lymphoblastic leukemia (ALL) survivors. This study was aimed at characterizing genetic variation related to adult body mass index (BMI) among survivors of childhood ALL. METHODS Genetic associations of BMI among 1458 adult survivors of childhood ALL (median time from diagnosis, 20 years) were analyzed by multiple approaches. A 2-stage genome-wide association study in the Childhood Cancer Survivor Study (CCSS) and the St. Jude Lifetime Cohort Study (SJLIFE) was performed. BMI was a highly polygenic trait in the general population. Within the known loci, the BMI percent variance explained was estimated, and additive interactions (chi-square test) with CRT in the CCSS were evaluated. The role of DNA methylation in CRT interaction was further evaluated in a subsample of ALL survivors. RESULTS In a meta-analysis of the CCSS and SJLIFE, 2 novel loci associated with adult BMI among survivors of childhood ALL (LINC00856 rs575792008 and EMR1 rs62123082; PMeta < 5E-8) were identified. It was estimated that the more than 700 known loci explained 6.2% of the variation in adult BMI in childhood ALL survivors. Within the known loci, significant main effects for 23 loci and statistical interactions with CRT at 9 loci (P < 7.0E-5) were further identified. At 2 CRT-interacting loci, DNA methylation patterns may have differed by age. CONCLUSIONS Adult survivors of childhood ALL have genetic heritability for BMI similar to that observed in the general population. This study provides evidence that treatment with CRT can modify the effect of genetic variants on adult BMI in childhood ALL survivors.

X-linked agammaglobulinemia (XLA) is a primary humoral immunodeficiency characterized by severe hypogammaglobulinemia and increased risk of infection. The genetic condition results from a mutation in the Bruton tyrosine kinase (BTK) gene located on the X chromosome leading to a near absence of B cells. Patients affected by XLA are most commonly predisposed to frequent and severe bacterial infections. However, here we report the case of a 20-year-old male with XLA who presented with viral pneumonia with multiple pathogens. This coexistence has been rarely reported. The patient received intravenous immunoglobulin therapy with noted significant improvement in the two weeks of follow-up. His clinical history supports the hypothesis of increased susceptibility to viral pathogens in the absence of immunoglobulin therapy. The humoral defect is the cornerstone of this phenomenon. This case presents the importance of multiviral causes for patients with recurrent episodes of pneumonia in an immunocompromised state.

Generation scheduling in future smart grids will face significant uncertainty due to their considerable reliance on intermittent renewable-based generation such as wind power. Adaptive robust optimization provides a suitable framework to handle wind-related uncertainty in generation scheduling. However, available robust models feature relevant practical limitations including 1) the potential lack of physical implementability stemming from disregarding the nonanticipativity of the dispatch process, 2) the potential suboptimality or even infeasibility due to the use of fixed-recourse schemes, and 3) the intractable computational burden associated with a scenario-based counterpart. This paper presents a new multistage robust unit commitment approach with non-fixed recourse relying on the formulation of an alternative two-stage robust model. As a result, the least-cost generation schedule ensuring dispatch nonanticipativity is attained by solving a trilevel program of similar complexity as compared with available formulations neglecting this aspect. Moreover, an enhanced column-and-constraint generation algorithm is devised whereby lexicographic optimization is applied to accelerate the finite convergence to optimality. Numerical simulations including a practical out-of-sample validation procedure reveal that the proposed approach is 1) computationally effective even for a benchmark that is well beyond the capability of a recently published method, and 2) superior in terms of solution quality over existing two-stage robust models disregarding dispatch nonanticipativity.

Background It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with greater frequency of exacerbations, increased use of health care resources, and poor asthma control. Objective To examine the association of asthma diagnosis with symptoms of depression/anxiety and asthma control not only at baseline but also over a 6-month period of specialist supervision. Methods We enrolled 3182 patients with moderate to severe asthma. All were evaluated with spirometry, the Asthma Control Test, and the Hospital Anxiety and Depression Scale at baseline and at 6 months. Treatments were decided by specialists according to published guidelines. Results At baseline, 24.2% and 12% of the patients were diagnosed with anxiety and depression, respectively, according to the Hospital Anxiety and Depression Scale. After 6 months, anxiety and depression improved, affecting 15.3% and 8.1% of patients, respectively (P Conclusion Under standardized asthma care and after a specific visit with the specialist, patients present significant improvement in these psychological disorders and exhibit better asthma control and functional parameters.

In the restructured power industry, bulk energy storage may play a crucial role to provide the flexibility required by system operators to cater for the unprecedented levels of uncertainty. Within the context of co-optimized electricity markets for energy and reserves under wind uncertainty, this paper addresses the incorporation of bulk energy storage units in day-ahead network-constrained energy and reserve scheduling. A novel two-stage robust optimization approach is presented whereby the nonconvex and time-coupled operation of storage devices is precisely modeled while accounting for the anticipativity of the two-stage setting. The resulting robust counterpart is cast as a mixed-integer trilevel program with lower-level binary variables. In order to address the nonconvexity of the recourse problem, this paper proposes the application of an exact nested column-and-constraint generation algorithm. Numerical results illustrate the effective performance of the proposed approach.

Resumen Introduccion y objetivos Los sintomas de vertigo y mareo son frecuentes en la poblacion, se presentan como manifestacion de un amplio abanico de enfermedades y habitualmente es dificil realizar un diagnostico de certeza. El objetivo general de este estudio es obtener la informacion para evaluar estos sintomas en el entorno hospitalario. Los objetivos especificos son: estimar el peso global que representan estos sintomas en las derivaciones al hospital; conocer las caracteristicas de los pacientes derivados y detallar el flujo de las consultas. Metodos Estudio descriptivo observacional. Se buscaron las propuestas de consulta realizadas en 2011 y 2012 al hospital por el sintoma de vertigo. Se analizaron caracteristicas demograficas y clinicas de los pacientes, y administrativas de las derivaciones. Resultados Se analizaron un total de 558 propuestas correspondientes a 494 pacientes. El vertigo supuso el 0,5% del total de las derivaciones realizadas desde Atencion Primaria al hospital. El 63% de la muestra han sido mujeres, con una edad media de 58 anos. El 88% de los pacientes fue valorado por Otorrinolaringologia y el 24% por Neurologia. Un 30,8% consulto en 3 o mas ocasiones por el sintoma. El 16% fue valorado por enfermedad psiquiatrica en el hospital. Conclusiones El vertigo como sintoma supone una carga significativa en el ambito hospitalario. Los pacientes que lo presentan consultan en multiples ocasiones y son valorados en distintas especialidades. En ciertos casos, el flujo de pacientes puede resultar excesivamente dinamico e ineficaz. En nuestro entorno, Otorrinolaringologia es el principal receptor de pacientes con sintomas de vertigo y mareo.

Introduction and objectives Vertigo and dizziness as symptoms are frequent in the population. They are present in a wide range of pathologies and it is usually difficult to make an accurate diagnosis. The general objective of this study is to obtain the information to evaluate vertigo and dizziness in the hospital setting. The specific objectives are: to estimate the burden of these symptoms at the hospital; to study patients’ conditions and to detail the flow of these patients inside the hospital. Methods Observational descriptive study. We made a search of the referral proposals made in 2011 and 2012 to the hospital because of vertigo symptoms. The patients’ demographic and clinical characteristics, and the administrative details of the referrals were analysed. Results A total of 558 proposals were analysed corresponding to 494 patients. Vertigo accounted for 0.5% of all referrals made from Primary Care to the hospital. Sixty-three percent of the sample were women; the average age was 58 years. Eighty-eight percent of the patients were evaluated by Otorhinolaryngology, 24% by Neurology. Thirty point eight percent consulted on 3 or more occasions for the symptom. Sixteen percent were assessed for psychiatric conditions in the hospital. Conclusions Vertigo as a symptom is a significant burden in the hospital setting. The patients who suffer it consult on several occasions and are assessed by different specialties. This implies in some cases an excessive and ineffective flow of patients. In our setting, otorhinolaryngology is the main department to treat vertigo and dizziness patients.

Purpose To evaluate the clinical and radiological outcomes of these fractures treated through a modified posterior approach with a distal humerus plate. Material and methods Between 2013 and 2015 we performed a retrospective study of these fractures surgically treated in our centre. Inclusion criteria: older than 18 years old, no pathological fractures, follow-up 1 year at least. 23 patients underwent surgery, mean age 45 years old, with an average follow-up of 18 months. Patient characteristics, aetiology and type of fractures were recorded. The surgery was performed using Gerwin modified posterior approach with a posterolateral distal humerus plate. Clinical results were evaluated using Quick DASH, MEPS, VAS. Radiological results were also evaluated. Complications associated with treatment and radial nerve palsy incidence were recorded as well. Results Type of fracture according AO/OTA: six 12-A, seven 12-B, ten 12-C. 23 patients progressed to union. After one year: QD 6.43, VAS 0.66, MEPS 88.88. No failure of internal fixation. Two superficial infections. 15 excellent results, 5 good, and 3 fair, with no poor results. Conclusion Surgical fixation of these fractures through a modified posterior approach with a posterolateral plate minimises iatrogenic nerve injury, provides better visualisation of the proximal humerus, provides stable fixation of these injuries and results in high union rates and overall excellent functional results.

Resumen Presentamos el caso de un varón que ingresa por hemorragia digestiva alta secundaria a un leiomiosarcoma retroperitoneal que infiltra duodeno.

Gastric cancer remains third leading cause of global cancer mortality and is the fifth most common type of cancer in the United States. A select number of gastric cancers harbor alterations in EGFR and/or have amplification/overexpression in the HER2; 2–35 and 9–38%, respectively. The advent of next-generation sequencing of tissue and circulating tumor DNA has allowed for the massive expansion of targeted therapeutics to be employed in many settings. There have been a handful of trials using EGFR inhibitors with modest outcomes. Using novel strategies to target multiple co-mutations as well as identifying immunoregulatory molecule expression patterns will potentially drive future trials and improve gastric cancer patient outcomes.

This paper addresses the incorporation of transmission switching in the contingency-constrained unit commitment problem within the context of co-optimized electricity markets for energy and reserves. The proposed generation scheduling model differs from existing formulations due to the joint consideration of four major complicating factors. First, transmission switching actions are considered both in the pre- and post-contingency states, thereby requiring binary post-contingency variables. Secondly, generation scheduling and transmission switching actions are co-optimized. In addition, the time-coupled operation of generating units is precisely characterized. Finally, practical features of modern power systems, such as uncertain nodal net injections and the operation of energy storage, are also considered. The proposed model is cast as a challenging mixed-integer program for which the off-the-shelf software customarily used for simpler models may lead to intractability even for moderately-sized instances. In order to circumvent this computational issue, this paper presents an enhanced and novel application of an exact nested column-and-constraint generation algorithm featuring the inclusion of valid constraints to improve the overall computational performance. Numerical simulations based on the IEEE 118- and 300-bus systems demonstrate the effective performance of the proposed approach as well as its economic and operational advantages over existing models disregarding post-contingency transmission switching., Este documento aborda la incorporación de la conmutación de transmisión en el problema de compromiso de unidades con restricciones de contingencia en el contexto de mercados eléctricos cooptimizados para energía y reservas. El modelo de programación de generación propuesto difiere de las formulaciones existentes debido a la consideración conjunta de cuatro factores principales de complicación. En primer lugar, las acciones de conmutación de transmisión se consideran tanto en el estado anterior como posterior a la contingencia, por lo que se requieren variables binarias posteriores a la contingencia. En segundo lugar, se cooptimizan las acciones de programación de generación y conmutación de transmisión. Además, se caracteriza con precisión la operación acoplada en el tiempo de las unidades generadoras. Finalmente, también se consideran las características prácticas de los sistemas de potencia modernos, como las inyecciones netas nodales inciertas y la operación de almacenamiento de energía. El modelo propuesto se presenta como un desafiante programa de enteros mixtos para el cual el software comercial que se usa habitualmente para modelos más simples puede conducir a la dificultad incluso para instancias de tamaño moderado. Para sortear este problema computacional, este artículo presenta una aplicación mejorada y novedosa de un algoritmo de generación de restricciones y columnas anidadas exactas que presenta la inclusión de restricciones válidas para mejorar el rendimiento computacional general. Las simulaciones numéricas basadas en los sistemas de bus IEEE 118 y 300 demuestran el rendimiento efectivo del enfoque propuesto, así como sus ventajas económicas y operativas sobre los modelos existentes que no tienen en cuenta la conmutación de transmisión posterior a la contingencia.

This article belongs to the Special Issue Bioinformatics and Precision Computational Biology: Selected Papers from the X International Conference on Bioinformatics #SoIBio+10., Cancer is a complex disease affecting millions of people worldwide, with over a hundred clinically approved drugs available. In order to improve therapy, treatment, and response, it is essential to draw better maps of the targets of cancer drugs and possible side interactors. This study presents a large-scale screening method to find associations of cancer drugs with human genes. The analysis is focused on the current collection of Food and Drug Administration (FDA)-approved drugs (which includes about one hundred chemicals). The approach integrates global gene-expression transcriptomic profiles with drug-activity profiles of a set of 60 human cell lines obtained for a collection of chemical compounds (small bioactive molecules). Using a standardized expression for each gene versus standardized activity for each drug, Pearson and Spearman correlations were calculated for all possible pairwise gene-drug combinations. These correlations were used to build a global bipartite network that includes 1007 gene-drug significant associations. The data are integrated into an open web-tool called GEDA (Gene Expression and Drug Activity) which includes a relational view of cancer drugs and genes, disclosing the putative indirect interactions found for FDA-approved drugs as well as the known targets of these drugs. The results also provide insight into the complex action of pharmaceuticals, presenting an alternative view to address predicted pleiotropic effects of the drugs., This research was funded by Fondo de Investigación Sanitaria-Instituto de Salud Carlos III (FIS-ISCIII, Spanish Ministry of Health, project reference PI18/00591) where J.D.L.R. was the PI. The work within this project was also co-funded by the FEDER program of the European Union. J.D.L.R. lab acknowledges the support given by the EU COST Action Stratagem (reference: CA17104, https://www.cost.eu/actions/CA17104/). J.D.L.R. lab also acknowledges the support given by the European Project H2020 ArrestAD (Project ID: 737390, H2020-FETOPEN-1-2016-2017).

Conflicting reports exist regarding the racial and the gender distribution of rheumatoid arthritis-related interstitial lung disease (RA-ILD). In a major population study of predominately Whites, RA-ILD was reported mainly among smoker middle-aged men. However, recent data suggest that the disease is that of elderly women. Our study aimed to assess the prevalence and identify the gender differences and clinical characteristics of RA-ILD in a predominantly Black population.Cross-sectional analysis of data obtained from the records of 1142 patients with RA diagnosis by ICD codes of which 503 cases met the inclusion criteria for the study. Eighty-six patients had chronic respiratory symptoms of cough and dyspnea and were further assessed by our multidisciplinary group of investigators. Thirty-two subjects with an established diagnosis of rheumatoid arthritis met the diagnostic criteria for interstitial lung disease.Of the 32 patients with RA-ILD, mean age was 62.6 ± 2.2 (± SEM), 93.7% were females, and 89% Blacks with a BMI = 29.2 (Kg/mOur study indicates RA-ILD among Blacks is predominantly a disease of elderly females with higher rates of GERD and CVD risk factors. Further studies are needed to identify the pathogenetic differences accounting for the gender distribution of RA-ILD among Black and White populations.Key Points• First study to assess ILD among predominantly Black RA patients.• The prevalence of RA-associated ILD was 6.36%, affecting mostly women in their sixth decade with seropositive disease.• COPD was the most common airway disease among non-RA-ILD Black population.• GERD was found in approximately one-third of patients with RA-associated ILD versus one-fifth of those RA patients without any lung disease.

Red Man syndrome (RMS) occurs with the rapid infusion of intravenous (IV) vancomycin. RMS induced by oral vancomycin has been the focus of a limited number of case reports. We present a case of a 75-year-old female admitted with severe Clostridium difficile colitis who received oral vancomycin and by the second day of therapy, she developed flushing, erythema, and pruritus involving the face, neck and upper torso. Oral vancomycin was immediately withheld, and diphenhydramine was initiated. Clinical improvement was apparent 24 hours after discontinuation of oral vancomycin. Our case adds to the published literature on this rare clinical entity that should be considered when severe colitis patients prescribed oral vancomycin, as part of the standard of care, develop the typical signs and symptoms of RMS.

Background Curative therapy places childhood cancer survivors at increased risk for second primary malignancies (SPMs). However, there have been few population-based attempts to characterize differences between outcomes of SPMs in childhood cancer survivors and outcomes of first primary malignancies (FPMs). Methods Clinical and demographic information about childhood cancer survivors who developed SPMs and individuals with comparable FPMs was extracted from the Surveillance, Epidemiology, and End Results program. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards models comparing the overall survival (OS) of individuals with and without a history of childhood cancer. OS was evaluated both overall and for specific cancers diagnosed in 50 or more childhood cancer survivors. Models accounted for potential confounders, including sex, race, age, treatment decade, histology, and disease stage. Results Compared with individuals with FPMs (n = 1,332,203), childhood cancer survivors (n = 1409) with an SPM experienced poorer OS (HR, 1.86; 95% CI, 1.72-2.02) after the study had accounted for cancer type, age, sex, race, and decade of diagnosis. A history of childhood cancer remained a poor prognostic factor for all specific cancers evaluated, including breast cancer (HR, 2.07; 95% CI, 1.63-2.62), thyroid cancer (HR, 3.59; 95% CI, 2.08-6.19), acute myeloid leukemia (HR, 2.38; 95% CI, 1.87-3.05), brain cancer (HR, 2.09; 95% CI, 1.72-2.55), melanoma (HR, 2.57; 95% CI, 1.55-4.27), bone cancer (HR, 1.88; 95% CI, 1.37-2.57), and soft-tissue sarcoma (HR, 2.44; 95% CI, 1.78-3.33). Conclusions Compared with individuals without a prior cancer diagnosis, survivors of childhood cancer with an SPM experienced inferior outcomes. Survival disparities were observed for the most frequent SPMs diagnosed in childhood cancer survivors.

The aim of this study is to evaluate the cost-effectiveness and impact of gene-expression assays (GEAs) on treatment decisions in a real-world setting of early-stage breast cancer (ESBC) patients. This is a regional, prospective study promoted by the Council Health Authorities in Madrid. Enrolment was offered to women with estrogen receptor-positive, human epidermal growth factor receptor 2-negative, node-negative or micrometastatic, stage I or II breast cancer from 21 hospitals in Madrid. Treatment recommendations were recorded before and after knowledge of tests results. An economic model compared the cost-effectiveness of treatment, guided by GEAs or by common prognostic factors. 907 tests (440 Oncotype DX® and 467 MammaPrint®) were performed between February 2012 and November 2014. Treatment recommendation changed in 42.6% of patients. The shift was predominantly from chemohormonal (CHT) to hormonal therapy (HT) alone, in 30.5% of patients. GEAs increased patients’ confidence in treatment decision making. Tumor grade, progesterone receptor positivity and Ki67 expression were associated with the likelihood of change from CHT to HT (P

This paper describes the incorporation of uncertainty and reliability in the dynamic expansion planning of distribution network assets and distributed generation. Several alternatives for the installation of feeders, transformers, and distributed generation are considered. Thus, the optimal expansion plan identifies the best alternative, location, and installation time for the candidate assets under the uncertainty related to demand and renewable energy sources. To that end, an iterative algorithm is devised to yield a pool of high-quality candidate solutions in terms of total investment and operational costs. Each candidate solution results from a stochastic-programming-based model driven by the minimization of the expected investment and operational costs. The associated scenario-based deterministic equivalent is formulated as a mixed-integer linear program for which finite convergence to optimality is guaranteed and efficient off-the-shelf software is available. Standard metrics are subsequently applied to each candidate solution to characterize its reliability so that valuable information is provided to the distribution system planner. Numerical results illustrate the effective performance of the proposed approach.

Introduction: S100β protein has been proposed as a potential biomarker for both chronic and acute neurological disorders. Reference values of this protein are well defined in adults but not in children, in whom serum levels appear to vary with age. Reference values for serum S100β in children from 0 to 14 years are presented. Materials and methods: A prospective study was conducted on 257 healthy children, who were divided into three age groups (under 12 months, 12–24 months and over 24 months). Results: The study included 179 boys and 78 girls, with a mean age of 5.5 (3.75) years. The mean serum concentration of protein S100β was 0.156 (0.140–0.172) μg/L. In children under 12 months, serum S100β concentration was 0.350 (0.280–0.421) μg/L; 0.165 (0.139–0.190) μg/L in the group between 12 and 24 months and 0.121 (0.109–0.133) μg/L in children older than 24 months. An inverse relationship was observed between age and serum S100β, which declines as age increases. No differences were observed between sexes. Conclusions: The concentration of S100β remains stable after two years of age, being possible to establish a baseline of S100β for over two years. During the first two years of life, S100β serum concentration is higher, the lower the age of the child. No differences in serum S100β levels between sexes are observed. Resumen: Introducción: La proteína S100β se ha propuesto como posible biomarcador en patología neurológica, tanto crónica como aguda. Los valores normales de esta proteína están bien definidos en adultos, no así en niños, en los que los valores séricos parecen variar con la edad. Nuestro objetivo es describir valores de referencia de S100β sérica en niños de 0 a 14 años. Material y métodos: Estudio prospectivo en 257 niños sanos. Se establecieron 3 grupos por edad (menores de 12 meses, de 12 a 24 meses y mayores de 24 meses). Resultados: Se incluyó a 179 niños y 78 niñas. La edad media ± DE fue de 5,5 ± 3,75 años. La concentración sérica media de la proteína S100β en todo el grupo fue 0,156 (0,140-0,172) μg/l. En los menores de 12 meses, la concentración sérica de S100β fue de 0,350 (0,280-0,421) μg/l; 0,165 (0,139-0,190) μg/l en el grupo entre 12 y 24 meses y 0,121 (0,109-0,133) μg/l en el grupo de niños mayores de 24 meses. Se observó una relación inversa entre la edad y la concentración sérica de S100β, que desciende conforme se incrementa la edad. No se observaron diferencias en cuanto al sexo. Conclusiones: La concentración de S100β permanece estable a partir de los 2 años de edad, siendo posible establecer unos valores de referencia de S100β para mayores de 2 años. En los 2 primeros años de vida, la concentración de S100β sérica es más elevada cuanto menor es la edad del niño. No se observan diferencias en el valor de S100β sérica entre ambos sexos.

Rheumatoid arthritis (RA) patients have nearly twice the risk of cardiovascular disease (CVD) compared to the general population. We aimed to assess, in a predominantly Black population, the prevalence of traditional and RA-specific CVD risk factors and therapeutic patterns. Utilizing ICD codes, we identified 503 RA patients ≥18 years old who were seen from 2010 to 2017. Of them, 88.5% were Black, 87.9% were women and 29.4% were smokers. CVD risk factors (obesity, diabetes, hypertension, dyslipidemia) were higher than in previously reported White RA cohorts. Eighty-seven percent of the patients had at least one traditional CVD risk factor, 37% had three or more traditional CVD risk factors and 58% had RA-specific risk factors (seropositive RA, &gt, 10 years of disease, joint erosions, elevated inflammatory markers, extra-articular disease, body mass index (BMI) &lt, 20). CV outcomes (coronary artery disease/myocardial infarction, heart failure, atrial fibrillation and stroke) were comparable to published reports. Higher steroid use, which increases CVD risk, and lesser utilization of biologics (decrease CV risk) were also observed. Our Black RA cohort had higher rates of traditional CVD risk factors, in addition to chronic inflammation from aggressive RA, which places our patients at a higher risk for CVD outcomes, calling for revised risk stratification strategies and effective interventions to address comorbidities in this vulnerable population.

This paper proposes a novel model for the day-ahead self-scheduling problem of a virtual power plant trading in both energy and reserve electricity markets. The virtual power plant comprises a conventional power plant, an energy storage facility, a wind power unit, and a flexible demand. This multi-component system participates in energy and reserve electricity markets as a single entity in order to optimize the use of energy resources. As a salient feature, the proposed model considers the uncertainty associated with the virtual power plant being called upon by the system operator to deploy reserves. In addition, uncertainty in available wind power generation and requests for reserve deployment is modeled using confidence bounds and intervals, respectively, while uncertainty in market prices is modeled using scenarios. The resulting model is thus cast as a stochastic adaptive robust optimization problem, which is solved using a column-and-constraint generation algorithm. Results from a case study illustrate the effectiveness of the proposed approach., Este trabajo propone un modelo novedoso para el problema de autoprogramación diaria de una central eléctrica virtual que comercia en los mercados de energía y de reserva de electricidad. La central eléctrica virtual se compone de una central eléctrica convencional, una instalación de almacenamiento de energía, una unidad de energía eólica y una demanda flexible. Este sistema multicomponente participa en los mercados de energía y electricidad de reserva como una sola entidad para optimizar el uso de los recursos energéticos. Como característica destacada, el modelo propuesto tiene en cuenta la incertidumbre asociada a la central eléctrica virtual a la que recurre el operador del sistema para desplegar reservas. Además, la incertidumbre en la generación de energía eólica disponible y las solicitudes de despliegue de reservas se modelan utilizando límites e intervalos de confianza, respectivamente, mientras que la incertidumbre en los precios del mercado se modela utilizando escenarios. El modelo resultante se plantea como un problema de optimización robusta adaptativa estocástica, que se resuelve mediante un algoritmo de generación de columnas y restricciones. Los resultados de un estudio de caso ilustran la eficacia del enfoque propuesto.

This paper considers the self-scheduling problem of a virtual power plant trading in both energy and reserve electricity markets. The virtual power plant comprises conventional generation, wind power generation, and a flexible demand that participate in those markets as a single entity in order to optimize the use of energy resources. As a distinctive feature, the proposed model explicitly accounts for the uncertainty associated with the virtual power plant being called upon by the system operator to deploy reserves. This uncertainty and the uncertainty in available wind power generation levels are modeled using confidence bounds, while uncertain market prices are modeled using scenarios. Therefore, the proposed model is formulated as a stochastic adaptive robust optimization problem, which is solved using an effective column-and-constraint generation algorithm involving the iterative solution of a subproblem and a master problem. Results from a case study are provided to illustrate the performance of the proposed approach.