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INTRODUCTION: Arteriovenous Malformations (AVMs) are high-flow anomalous connections between the arterial and venous systems composed of dysplastic vessels resulting from aberrant angiogenesis. They are congenital and when symptomatic they rarely manifest before adolescence. Depending on the location, size, stage and severity of the symptoms, treatment options vary from conservative management to surgical resection. We report a case of a giant arteriovenous malformation of abdominal wall (tipe IIIb of Yakes Classification) treated with surgical resection after prior attempts of scleroembolization.. CLINICAL CASE: 54-year-old woman with known history of osteoarticular pathology and dyspepsia presented a mass on the left side of the abdominal wall with hard consistency, warm, slightly pulsating and tenderness to touch with several years of evolution. The mass showed infiltration of the internal and external oblique muscles sparing the transverse muscle. Clinically she presented easy fatigue with efforts. Due to the risk of abdominal wall herniation after excision of the AVM, scleroembolization was considered first-line treatment in this case. This strategy resulted in regression of the mass and symptoms improvement. Four years after the last intervention, the patient presented lesion growth, recurrence and worsening of symptoms with severe interference in the quality of life (QoL). After multidisciplinary discussion, she was proposed for complete resection of the AVM. She was first submitted to scleroembolization with Onyx of identified arterial afferents and sclerosis of the lesion nidus with 2% polidocanol. One month after she underwent successfully total resection of the AVM with the collaboration of General Surgery. CONCLUSION: No unified agreement exists on the best treatment of these complex high flow lesions and it is difficult to establish a comprehensive strategy given the pathology’s clinical variability, complex stratification and the risk of relapse. A case-by-case approach is needed in managing these types of lesions.

Objective To evaluate the impact of coadministering statins with direct oral anticoagulants (DOACs) on the risk of major bleeding events in patients with venous thromboembolism (VTE).Design Observational cohort analysis based on a multicentre international registry.Setting Data were extracted from the Registro Informatizado de Enfermedad TromboEmbolica Registry, which involves 205 centres across 27 countries.Participants A total of 73 659 patients diagnosed with VTE were classified based on their anticoagulant therapy (DOACs) versus low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs) and concurrent use of statins.Methods Multivariable Cox proportional hazards models adjusted for confounding variables to assess the risk of major bleeding events stratified by the type of anticoagulant use and statin use.Results From October 2013 to February 2023, 73 659 patients were recruited: 2573 were statin users on DOACs, 14 090 were statin users on LMWH or VKA therapy, 10 088 were non-statin users on DOACs and 46 908 were non-statin users on LMWH or VKA therapy. Statin users were 10 years older and more likely to have hypertension, diabetes, renal failure or prior artery disease. During anticoagulation (median, 187 days), 1917 patients (2.6%) suffered major bleeding. Rates of major bleeding per 100 patient-years were 2.33 (95% CI 1.72 to 3.09), 3.75 (95% CI 3.43 to 4.10), 1.39 (95% CI 1.13 to 1.69) and 3.10 (95% CI 2.93 to 3.27), respectively. On multivariable analysis, patients treated with DOACs had a significantly lower risk of major bleeding compared with those on LMWH or VKA therapy (adjusted HR 0.59; 95% CI 0.48 to 0.74). The adjusted HR in statin users versus non-users was 1.03 (95% CI 0.92 to 1.14), while in statin users on DOACs versus the rest of patients, it was 1.18 (95% CI 0.79 to 1.76).Conclusions In patients with VTE receiving statins, long-term anticoagulation with DOACs was associated with a reduced risk of major bleeding, regardless of the statin use. These findings support the safety profile of DOACs over VKAs or LMWH in the management of VTE in patients requiring statins.

This is the first of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of emerging mental disorders throughout the life course. By utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote the health and safety of their student population, paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.

Agricultural soils are responsible for ecological functions and services that include primary production of food, fiber and fuel, nutrient cycling, carbon cycling and storage, water infiltration and purification, among others. Fungi are important drivers of most of those ecosystem services. Given the importance of fungi in agricultural soils, in this study, we aimed to characterize and analyse the changes of the soil fungal communities of three cropping systems from Madeira Island, where family farming is predominant, and investigate the response of fungi and its functional groups to soil physicochemical properties. To achieve that, we sequenced amplicons targeting the internal transcribed spacer 1 (ITS1) of the rRNA region, to analyse soil samples from 18 agrosystems: 6 vineyards (V), 6 banana plantations (B) and 6 vegetable plantations (H). Our results showed that alpha diversity indices of fungal communities are similar in the three cropping systems, but fungal composition and functional aspects varied among them, with more pronounced differences in B. Ascomycota, Basidiomycota, and Mortierellomycota were the main phyla found in the three cropping systems. Agaricomycetes and Sordariomycetes are the predominant classes in B, representing 23.8 and 22.4%, respectively, while Sordariomycetes (27.9%) followed by Eurotiomycetes (12.3%) were the predominant classes in V and Sordariomycetes (39.2%) followed by Tremellomycetes (8.9%) in the H. Saprotrophs are the fungal group showing higher relative abundance in the three cropping systems, followed by plant pathogens. Regarding symbionts, endophytes were highly observed in B, while mycorrhizal fungi was predominant in V and H. The structure of fungal communities was mainly correlated with soil content of P, K, N, Fe, and Cu. In addition, we identified bioindicators for each cropping system, which means that cultivated crops are also drivers of functional groups and the composition of communities. Overall, the three cropping systems favored diversity and growth of taxa that play important roles in soil, which highlights the importance of conservative management practices to maintain a healthy and resilient agrosystem.

El propósito (des) cortés de los piropos suscita debate, ya que, a pesar de ser una valoración positiva de la persona destinataria, se entienden como un acto de habla arriesgado que puede poner en peligro la imagen tanto de la persona enunciadora como de la destinataria; además de ser considerados por muchas personas una práctica masculina abusiva hacia las mujeres que contribuye a la perpetuación de la desigualdad de género. Este estudio se acerca a la práctica discursiva de los piropos en gallego entre gente joven y analiza en qué contextos las/los hablantes consideran adecuado o no realizar el acto de piropear. Examina, asimismo, qué estrategias de cortesía (Brown y Levinson, 1987) eligen para enfrentar el acto de amenaza a la imagen que puede desencadenar la enunciación de un piropo, así como los factores que condicionan su elección. Los datos analizados proceden de un cuestionario tipo DCT (Discourse Completion Task), del que se analizaron las respuestas de 100 participantes. Este cuestionario está compuesto de 16 situaciones, en las que se controlan distintas variables que se prevé que pueden condicionar la actuación de las/los hablantes (distancia social, poder relativo, grado de imposición y grado de formalidad). Nuestro análisis indica que la práctica del piropo en la cultura de esta gente joven es percibida como potencialmente conflictiva y requiere de una cortesía mitigadora, que nos situaría ante una manifestación cultural de distanciamiento. Sin embargo, el grado de confianza entre las personas que participan en la interacción resulta determinante en la elección de sus estrategias, que muestran una fuerte polarización: mayoritariamente consideran que en contextos de poca confianza es un acto amenazante y prefieren evitar realizar el acto de habla; por el contrario, en contextos de confianza optan por una estrategia abierta y directa, pues lo interpretan como un acto que refuerza la cortesía y no lo perciben como peligroso.

Conventional tomato production is widely threatened by environmental changes that impose increasingly frequent and severe conditions of soil salinization and water shortage. The assessment of the wild germplasm has become an appealing strategy for the stress-resilience improvement of crops. Tomato interspecific diversity encompasses wild species that are native to the dry shores and high-elevated deserts of the Andean countries, often thriving under circumstances of drought and salinity. The present work aimed to compare the effects of moderate salinity stress under different watering regimes on the ion distribution, redox homeostasis, osmoregulation, and antioxidant defenses between a domestic cultivar of tomato (Chico III) and the wild tomato species Solanum galapagense (LA1403), Solanum habrochaites (LA1223), and Solanum neorickii (LA2194). Results showed that although wild tomato plants grew slower than the cultivar, their growth was less affected by exposure to salt or to lower water availability. S. galapagense revealed a Na+ includer behavior under salt stress, increasing Na+ levels by 6-fold over control, reaching levels 4 times higher than in the cultivar. Nonetheless, H2O2-detoxifying enzymes were activated, and shoot elongation was sustained in this species, suggesting an efficient Na+ compartmentalization. On the other hand, the domestic cultivar had the highest accumulation of Na+ in roots and showed the lowest ability to sustain growth under combined stress. Leaves of S. habrochaites showed a huge proline buildup under salt stress, whereas S. neorickii and S. galapagense seemed to prevent proline accumulation. S. habrochaites also had high levels of antioxidant metabolites and superoxide dismutase activity under control conditions but downregulated further antioxidant defenses in response to stress exposure. No oxidative damages were noticed despite the almost 2-fold increase in ROS content in the leaves of S. neorickii under salt stress, which showed a negative correlation with growth traits, but an improvement in the antioxidant potential. A principal component analysis (PCA) revealed five PCs with eigenvalues >1, explaining 84 % of the total variability, and suggesting a separation of the evaluated samples mainly in accordance with the type of redox disturbances and antioxidant defenses employed, levels of photosynthetic pigments, balance between Na+ and K+ uptake and proline accumulation. These findings show that wild tomato plants respond differently than cultivated ones under moderate salinity and reduced water availability, suggesting interesting osmoregulatory and antioxidant mechanisms in S. galapagense and S. habrochaites.

The Retirement House (1959) was a project developed by Peter Smithson that did not have the opportunity to be materialized beyond the drawing; therefore, we will use this proposal as a case study to investigate deeper into his design themes. Two texts will be considered, “The nature of home: it’s equipment and furniture” and “Container and Contained”, presented, respectively, in the publications “Ordinariness and Light” and “Alison and Peter Smithson—from the House of Future to a house of today”, as a “guide” for an interpretation of the project. The Retirement House, recognised as being set within their Appliance Houses research, is charged through the different influences and cultural references that inhabit the Smithsons’ oeuvre in the 50s. As a main objective, we intend to show in more detail the inception and design themes of the case study through the analysis of installations, texts and other projects that serve as an experimental legacy. We intend to demonstrate the functional character and interconnection of spaces present in the work of Alison and Peter Smithson that form an operative design tool, set within the capacity of a topological variation that can imprint a flexibility value, with pronounced interest in contemporary architecture and the current housing crises. The present article is part of ongoing PhD research on Alison and Peter Smithson’s work.

This article examines how mental health related deaths (MHRDs) in England and Wales are counted and accounted for. Data collated by the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) constructs such deaths as being predominantly the result of suicide. This article examines 221 Reports to Prevent Future Deaths (PFDs) issued by coroners’ courts in relation to MHRDs. It establishes that in 49% of cases suicide is not recorded as the sole cause of death. The article also provides thematic findings that emerged from the qualitative analysis of these PFDs and identifies issues with errors or deficiencies in the provision of care (in 72% of cases), communication (55%) and policy (26%). The findings emphasise that organisational and structural issues contribute to deaths of people in connection with mental healthcare and that these deaths should not solely be considered suicides. The article raises significant questions about the accuracy of mortality data and the capacity of public organisations to learn lessons that might prevent future deaths.

Abstract Enterochromaffin (EC) cells located within the intestinal mucosal epithelium release serotonin (5-HT) to regulate motility tones, barrier function and the immune system. Electroanalytical methodologies have been able to monitor steady state basal extracellular 5-HT levels but are unable to provide insight into how these levels are influenced by key regulatory processes such as release and uptake. We established a new measurement approach, amperometry approach curve profiling, which monitors the extracellular 5-HT level at different electrode–tissue (E–T) distances. Analysis of the current profile can provide information on contributions of regulatory components on the observed extracellular 5-HT level. Measurements were conducted from ex vivo murine ileum and colon using a boron-doped diamond (BDD) microelectrode. Amperometry approach curve profiling coupled with classical pharmacology demonstrated that extracellular 5-HT levels were significantly lower in the colon when compared to the ileum. This difference was due to a greater degree of activity of the 5-HT transporter (SERT) and a reduced amount of 5-HT released from colonic EC cells. The presence of an inhibitory 5-HT4 autoreceptor was observed in the colon, where a 40% increase in extracellular 5-HT was the half maximal inhibitory concentration for activation of the autoreceptor. This novel electroanalytical approach allows estimates of release and re-uptake and their contribution to 5-HT extracellular concentration from intestinal tissue be obtained from a single series of measurements.

This study investigated the effects of high-pressure processing (HPP; 600 MPa/15 min) and microbial transglutaminase-catalyzed (MTG; 30 U·g of protein−1) crosslinking on the concentration of dissolved proteins (SOL), free sulfhydryl groups (SH), surface hydrophobicity (H0), and viscosity of pea protein isolates (PPI) at different concentrations (1–13%; w/v). The SOL increased by increasing protein concentration (max. 29%). MTG slightly affected SOL. HPP decreased SOL with increasing protein concentration, and the combination MTG + HPP resulted in a lower SOL than HPP alone. The concentration of SH in untreated PPI increased with increasing protein concentration, reaching a maximum of 8.3 μmol·mg prot−1. MTG increased SH at higher protein concentrations. HPP lowered SH, but its concentration increased by increasing protein concentration. HPP + MTG offset the effect of MTG, yielding lower SH. MTG did not affect H0 at 1% concentration but increased it for concentrations from 3–5%, and there was a decrease with 7–9%. HPP increased H0 up to 37% for intermediate protein concentrations but did not affect it at higher concentrations. MTG + HPP decreased H0 at all protein concentrations. The viscosity of the dispersions increased with protein concentration. HPP increased the viscosity of the dispersions for concentrations above 7%, while MTG only caused changes above 9%. Combined MTG + HPP resulted in viscosity increase. The results underscore the opportunity for innovative development of high-protein products with improved properties or textures for industrial application.

Dehydroepiandrosterone (DHEA) and cortisol release appear to have contrasting effects on stress perception during stressful tasks. This study aimed to investigate anticipatory examination stress in college students by considering DHEA, cortisol, psycho-emotional aspects and examination performance. Seventy-six students (66 females, 10 males; age range 18–25 years) provided saliva samples and completed questionnaires in two sessions 48 hours apart. During the second session, the students performed the examination. The questionnaires used were the State-Trait Anxiety Inventory, the Positive and Negative Affect Scale, and the Brief-Coping Orientation to Problems Experienced Inventory. DHEA, cortisol, anxiety and negative affect showed an anticipatory rise before the examination (all ps < 0.001). This rise of DHEA and cortisol was associated with lower positive affect (p = 0.001 and p = 0.043, respectively). However, only the DHEA anticipatory levels were linked to poorer examination marks (p = 0.020). Higher levels of the DHEA/cortisol ratio in anticipation of the examination were related to lower scores on the support-seeking strategy (p = 0.022). There was no association between DHEA and cortisol levels and anxiety, negative affect, active and avoidant coping strategies, or academic record. These results suggest that how DHEA and cortisol respond in anticipation of examination stress significantly impacts students’ emotional well-being during examination periods and how they cope with stress. They also suggest that levels of DHEA in anticipation of an academic stressor have detrimental effects on stress management.

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The increasing prevalence of dementia demands innovative solutions; however, existing technological products often lack tailored support for individuals living with this condition. The Living Lab approach, as a collaborative innovation method, holds promise in addressing this issue by actively involving end-users in the design and development of solutions adapted to their needs. Despite this potential, the approach still faces challenges due to its lack of recognition as a research methodology and its absence of tailored guidelines, particularly in dementia care, prompting inquiries into its effectiveness. This narrative review aims to fill this gap by identifying and analysing digital health Living Labs focusing on dementia solutions. Additionally, it proposes guidelines for enhancing their operations, ensuring sustainability, scalability, and greater impact on dementia care. Fifteen Living Labs were identified and analyzed. Based on trends, best practices, and literature, the guidelines emphasize user engagement, interdisciplinary collaboration, technological infrastructure, regulatory compliance, transparent innovation processes, impact measurement, sustainability, scalability, dissemination, and financial management. Implementing these guidelines can enhance the effectiveness and long-term impact of Living Labs in dementia care, fostering new collaborations globally.

A complexidade dos comportamentos suicidas requer uma abordagem multifacetada para sua gestão, envolvendo a avaliação de fatores de risco e proteção, bem como intervenções apropriadas. A Associação Brasileira de Psiquiatria (ABP), por meio da sua Comissão de Emergências Psiquiátricas, elaborou diretrizes específicas para o manejo de pacientes com comportamento suicida, com foco em triagem, intervenção, prevenção e promoção da saúde mental. Embora a evidência disponível ainda apresente controvérsias e limitações, já é possível identificar a eficácia de certas intervenções para grupos específicos de pacientes. A recomendação atual inclui a combinação de várias técnicas, como o Plano de Segurança, que integra a avaliação de fatores de risco e proteção com medidas terapêuticas subsequentes. Destaca-se a necessidade de pesquisas adicionais para esclarecer abordagens com potencial específico para intervenção, visando sempre otimizar as estratégias de manejo do comportamento suicida e incorporá-las nas políticas públicas de saúde.

O suicídio é um grave problema de saúde pública com profundos impactos emocionais, sociais e econômicos. Este artigo aborda três estratégias essenciais para enfrentar essa questão: pós-venção, prevenção e promoção da saúde mental. Pós-venção envolve intervenções após um suicídio, oferecendo suporte às pessoas afetadas para mitigar traumas e prevenir novos casos. Programas de apoio psicológico e grupos de ajuda mútua são eficazes na redução do impacto negativo em famílias e comunidades. Prevenção consiste na identificação e redução de fatores de risco antes das tentativas de suicídio. Isso inclui triagem de risco, intervenções psicoterapêuticas, tratamento farmacológico e campanhas educativas que promovem a conscientização e reduzem o estigma dos transtornos mentais. O treinamento de profissionais de saúde e educação é crucial para a detecção precoce e intervenção. Promoção da saúde mental visa fortalecer fatores protetores e melhorar o bem-estar psicológico. Políticas públicas eficazes, acesso a serviços de saúde mental de qualidade e a criação de ambientes sociais e educacionais que promovam resiliência e apoio emocional são fundamentais. Iniciativas incluem programas de educação emocional nas escolas e campanhas comunitárias de conscientização. Este artigo enfatiza a necessidade de uma abordagem integrada que combine pós-venção, prevenção e promoção para o manejo eficaz do comportamento suicida, apresentando evidências e recomendações para a prática clínica e implementação em políticas públicas de saúde.

Objective: To evaluate the clinical longevity of Class I and II composite resin restorations with and without using sonic energy through a systematic literature review and meta-analysis. Material and Methods: Five databases were consulted: PubMed, Cochrane Library, Web of Science, Scopus, VHL-LILACS, and BBO and gray literature. The search was carried out in January 2024. The inclusion criteria comprised clinical trials evaluating the success/longevity of composite resin restorations with and without sonic energy. RoB and ROBINS-I assessed the risk of bias. The meta-analysis analyzed the number of restorations with alpha USPHS scores. Heterogeneity was assessed (I² index, p0.05) for: anatomical shape (CI=1.05 [0.95,1.15]; I²=0%; p=0.37); color stability (CI=1.02 [0.93,1.13; I²=0%, p=0.65); marginal adaptation (CI=1.05 [0.95,1.16]; I²=%; p=0.38); postoperative sensitivity (CI=1.01 [0.93,1.10]; I²=0%; p=0.80); secondary caries (CI=1.01 [0.93,1.10]; I²=0%; p=0.80); marginal discoloration (CI=1.05 [0.95,1.16]; I²=0%; p=0.38), surface texture (CI=1.09 [0.97,1.23]; I²=19%; p=0.14) and retention (CI=1.00 [1.91,1.10]; I²=0%; p=1.00). The certainty of the evidence was very low. Conclusion: No evidence supports using sonic energy for direct composite resin restorations, regardless of the technique and the restored tooth. More robust and well-conducted studies should be performed.

Objective: p63 is a transcription factor involved in multiple biological functions. In the liver, the TAp63 isoform induces lipid accumulation in hepatocytes. However, the role of liver TAp63 in the progression of metabolic dysfunction-associated steatohepatitis (MASH) with fibrosis is unknown. Methods: We evaluated the hepatic p63 levels in different mouse models of steatohepatitis with fibrosis induced by diet. Next, we used virogenetic approaches to manipulate the expression of TAp63 in adult mice under diet-induced steatohepatitis with fibrosis and characterized the disease condition. Finally, we performed proteomics analysis in mice with overexpression and knockdown of hepatic TAp63. Results: Levels of TAp63, but not of ΔN isoform, are increased in the liver of mice with diet-induced steatohepatitis with fibrosis. Both preventive and interventional strategies for the knockdown of hepatic TAp63 significantly ameliorated diet-induced steatohepatitis with fibrosis in mice fed a methionine- and choline-deficient diet (MCDD) and choline deficient and high fat diet (CDHFD). The overexpression of hepatic TAp63 in mice aggravated the liver condition in mice fed a CDHFD. Proteomic analysis in the liver of these mice revealed alteration in multiple proteins and pathways, such as oxidative phosphorylation, antioxidant activity, peroxisome function and LDL clearance. Conclusions: These results indicate that liver TAp63 plays a critical role in the progression of diet-induced steatohepatitis with fibrosis, and its inhibition ameliorates the disease.

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain.

Abstract The tumor microenvironment (TME) harbors several cell types, such as tumor cells, immune cells, and non-immune cells. These cells communicate through several mechanisms, such as cell-cell contact, cytokines, chemokines, and extracellular vesicles (EVs). Tumor-derived vesicles are known to have the ability to modulate the immune response. Monocytes are a subset of circulating innate immune cells and play a crucial role in immune surveillance, being recruited to tissues where they differentiate into macrophages. In the context of tumors, it has been observed that tumor cells can attract monocytes to the TME and induce their differentiation into tumor-associated macrophages with a pro-tumor phenotype. Tumor–derived EVs have emerged as essential structures mediating this process. Through the transfer of specific molecules and signaling factors, tumor-derived EVs can shape the phenotype and function of monocytes, inducing the expression of cytokines and molecules by these cells, thus modulating the TME towards an immunosuppressive environment.