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This article focuses on the placemaking process and experimental research on the citizens’ assessment of the soundscape in Puerta del Sol in Madrid. Numerous studies conducted in recent decades have shown that sound is a crucial element capable of providing new insights into the relationship between human beings and the environment. Sound possesses physical-sensory-perceptual qualities which connect the emotional and the rational aspects of the experience of the place, overcoming the aesthetic/scientific duality. By default, the soundscape is the result of a collective production. It is the resonant expression of the multiple activities and uses that inhabit a space. The soundscape of everyday life provides a vision of life in a particular place, giving meaning and a singular character to the fact of living there. The concept and methods of the soundscape arise from sensitive experiences of the place in direct relation to a community. This exploratory research focused on in situ methods (soundwalks, improvised interview mappings, sound archives, performances, and collective sound actions) as expressions of collective listening to place. This article also focuses on how to map and share the result of this research, the technology to build a collective digital place as a place of confluence of experiences, citizen knowledge, and reflection on the situated soundscape.

IntroductionEarly identification of patients with a more unfavorable outcome in Multiple Sclerosis (MS) is crucial to optimize individualized treatment. Neutrophil-lymphocyte index (NLI) and monocyte-lymphocyte index (MLI) have been considered as potential biomarkers for disease prognosis. Our study aims to investigate the usefulness of NLI and MLI as predictors of relapse, disability progression, and lesion accumulation on magnetic resonance imaging (MRI) 1 year after diagnosis and treatment initiation, in pediatric-onset MS.MethodsA retrospective single-center study was conducted, including patients with diagnosis of MS established in pediatric age (1.89, 66.7%) and MLI (>0.21, 66.7%) values than those in the non-relapsing group (46.7%). Patients who presented new T2-hyperintense lesions on MRI after 1 year of follow-up also had higher mean, minimum, and maximum values of both biomarkers. Patients who did not achieve No Evidence of Disease Activity-3 (NEDA-3) state exhibited higher values for both ratios. However, in our sample, no statistically significant correlations were found between MLI and NLI values and the clinical and imaging variables considered.ConclusionThe ease of obtaining NLI and MLI from routine blood tests renders them useful biomarkers as a screening tool in longitudinal follow-up. Our study was based on a very small sample size, but it allowed us to verify the feasibility of the protocol used. It is intended to involve other centers in the next phase of this work, testing the possible usefulness of the indices under analysis on a larger sample.

Resumo A meritocracia escolar é um mecanismo de distinção de alunos com supostos benefícios para a motivação e o reconhecimento do esforço, mas também com uma dimensão negativa associada à intensificação e estratificação das desigualdades. Assim, o principal objetivo deste estudo é a análise da literatura sobre meritocracia escolar e as lógicas de ação das escolas nesse contexto. O método adotado é uma scoping review, com a pretensão de selecionar, analisar e sintetizar a literatura encontrada em quatro bases de dados: Web of Science, Scopus, RCAAP e Google Scholar. Os resultados mostram uma necessidade de reflexão sobre os conceitos de justiça e exclusão escolar, associada à ideologia meritocrática na lógica da igualdade de oportunidades.

Bacteria associated with marine invertebrate play a fundamental role in the biology, ecology, development and evolution of their hosts. Although many studies have been focused on the microbial populations of benthic and pelagic habitats, little is known about bacteria colonizing tube-dwelling polychaete. In this context, the current study provided the first characterization of the Melinna palmata Grube, 1870 microbiome based on Illumina sequencing of 16S rRNA gene of the polychaete tissue and proximate sediments collected from the Black Sea, Romania, along a 24.2 m – 45.4 m depth-gradient. The diversity, taxonomic composition and deduced functional profile of the tissue and sediments associated bacterial communities were compared and analyzed in relation with the environmental parameters. This polychaete harbored a distinct bacterial assemblage as compared to their sediments and independent on the depth of their habitat, including 8 phyla in tissues dominated by Proteobacteria, and 12 phyla in sediments majorly represented by Actinobacteriota, respectively. At order level, Synechococcales, Rhodobacterales and Actinomarinales were highly represented in the M. palmata microbiome, while Microtrichales, Anaerolineales and Caldilineales were mostly found in sediments. A significant correlation was observed between Cyanobacteria taxa and the dissolved oxygen concentrations in shallow waters impacted by the Danube inputs. Meanwhile, this phylum showed a positive correlation with Planctomycetota colonizing the invertebrate tissues, and a negative one with Actinobacteriota and Chloroflexi found in sediments. The deduced functional profile of these bacterial assemblages suggested the prevalence of the amino acid and carbohydrate metabolism for both analyzed matrices. This pioneering report on the M. palmata microbiome highlighted the environment contribution to bacterial species enrichment of the polychaete, and provided a glimpse on the putative role of microbial communities associated with this marine organism.

Summary: Background: This project aimed to synthesize the quantitative/qualitative evidence on the effectiveness of overweight/obesity prevention strategies implemented in Colombia and their barriers and facilitators. Methods: A scoping review was conducted by searching PubMed, SciELO, Scopus, and the grey literature (2012–2023). In-depth interviews were also conducted among key stakeholders on their perception of these strategies’ effectiveness, barriers, and facilitators. Findings: 26 records were included; four studies found positive changes in weight/body mass index, five found positive changes in physical activity, two found positive changes in food intake, and four found positive changes in healthy lifestyle knowledge, perception, attitudes, and habits. The main barrier reported was the obesogenic environment, and the facilitators were program flexibility and community engagement. Eighteen interviews were conducted (one interview per strategy); the main barriers reported were political, lack of evaluation access, economic situation, and lack of articulation; the main facilitators were incorporating the strategy into policies, articulation with stakeholders, and strong oversight. Interpretation: Moderate evidence indicates that these strategies positively impact outcomes related to overweight/obesity in Colombia, but more long-term studies are needed for overweight/obesity reduction. Lack of (1) evaluation and resources (barriers), (2) incorporation into policies (facilitators), and (3) strong stakeholder coordination (facilitators) was identified. Funding: Global Health Consortium, Department of Global Health, FIU.

Prostate cancer (PCa) continues to be the second most common malignant tumour and the main cause of oncological death in men. Investigating endogenous volatile organic metabolites (VOMs) produced by various metabolic pathways is emerging as a novel, effective, and non-invasive source of information to establish the volatilomic biosignature of PCa. In this study, headspace solid-phase microextraction combined with gas chromatography–mass spectrometry (HS-SPME/GC-MS) was used to establish the urine volatilomic profile of PCa and identify VOMs that can discriminate between the two investigated groups. This non-invasive approach was applied to oncological patients (PCa group, n = 26) and cancer-free individuals (control group, n = 30), retrieving a total of 147 VOMs from various chemical families. This included terpenes, norisoprenoid, sesquiterpenes, phenolic, sulphur and furanic compounds, ketones, alcohols, esters, aldehydes, carboxylic acid, benzene and naphthalene derivatives, hydrocarbons, and heterocyclic hydrocarbons. The data matrix was subjected to multivariate analysis, namely partial least-squares discriminant analysis (PLS-DA). Accordingly, this analysis showed that the group under study presented different volatomic profiles and suggested potential PCa biomarkers. Nevertheless, a larger cohort of samples is required to boost the predictability and accuracy of the statistical models developed.

Vitamin D deficiency has been correlated with various conditions, including the risk of developing lymphoid malignancies. This systematic review aimed to assess the association between vitamin D levels at diagnosis of lymphoid malignancies, patient outcomes, and survival. A systematic review was conducted, encompassing 15 studies published until January 2023, involving 4503 patients, examining the relationship between vitamin D and lymphoid cancers. The median age of the patients was 56.5 years, with a median follow-up duration of approximately 36 months across studies. The overall median vitamin D level at initial measurement was 20.4 ng/mL, while a

Dental-maxillary anomalies are accompanied by changes in the interbasal maxillary ratio in all reference planes, with influences on the functionality of articular structures. These joint changes not detected in time and not included in the treatment plan may worsen while wearing fixed appliances, as orthodontic treatment changes the cranio-mandibular position and causes cranio-mandibular reshaping. The articulator is an instrument that reproduces more or less all mandible movements. TMJ characteristics of skeletal dento-maxillary anomalies, especially class II sagittal pattern mainly reflected in condylar position rather than morphology. TMJ of different vertical patterns differed more in joint spaces, position of condyle and glenoid fossa than in morphologic measurements. Vertical position of glenoid fossa and proportion of posterior condyle increased gradually from hypodivergent to hyperdivergent. Highest glenoid fossa position, maximum ratio of posterior positioned condyle, smallest joint spaces, shallowest glenoid fossa depth, and narrowest condylar long axis diameter were found in skeletal class. The patients with high angle have considerable joint instable factors, and we should especially pay attention when orthodontic treatment is carried out on them. The condyle-fossa position and morphology differ with various vertical facial patterns in individuals with skeletal Class II mandibular retrognathism. These differences could be considered during temporo-mandibular diagnosis and orthodontic treatment.

A partir de uma fotografia que reúne Guattari e Glissant, e dos depoimentos sobre um livro que pretendiam escrever juntos, propomos pensar um possível pacto de cumplicidade poética que se tece entre o rastro de ambas as obras. Para isso, comparamos algumas categorias preferencialmente centradas na figura do rizoma; e destacamos a ideia de um abismo negro para dar conta de uma certa assimetria relativa às respectivas condições de enunciação. Nosso propósito é delinear, no encontro desses escritos, aquele livro não escrito que alimentaria as hipóteses sobre uma reciprocidade teórica e metodológica entre as respectivas propostas.

Lung cancer is the most commonly diagnosed cancer and the one that causes the most deaths worldwide, so there is a need for therapies that improve survival rates. Products derived from marine organisms are a source of novel and potent antitumor compounds, but they present the great obstacle of their obtaining from the natural environment and the problems associated with the synthesis and biological effects of chemical analogues. In this work, a Bengamide analogue (Bengamide II) was chemically synthesized and in vitro and in vivo studies were performed to determine its antitumor activity and mechanisms of action. It was shown to have potent antiproliferative activity in lung cancer lines in 2D and 3D models. In addition, Bengamide II-treated cells showed G2/M and G0/G1 cell cycle arrest, together with a decrease in the proliferation marker Ki67. As for the mechanism of action, the treatment was associated with increased LC3-II expression and production of acidic vesicles signaling autophagy. In addition, Bengamide II treatment was associated with caspase-3 activation and DNA fragmentation related to apoptosis. Furthermore, a reduction of VEGFA expression, related to angiogenesis, was also observed. In vivo studies showed that Bengamide II markedly reduced tumor volume and metastases increasing survival. Additionally, it revealed no systemic toxicity in in vivo models at the therapeutic doses used, which is essential for its future clinical use. Taken together, the chemically synthesized bengamide analogue Bengamide II, is a promising drug for lung cancer treatment showing relevant antitumor activity and significant safety.

We evaluated 58 patients with relapsed or refractory (r/r) acute B-lymphoblastic leukemia (B-ALL; median age 42.5 years; range, 16-69 years), treated with inotuzumab ozogamicin (INO) between 2016-2022 and who received an allogeneic hematopoietic stem cell transplantation (allo-HCT) consecutively. Forty-seven (81%) of the 58 patients were heavily pretreated receiving intensive chemotherapy +/- tyrosine kinase inhibitor, blinatumomab in 24 (41%) and allo-HCT at first-line in 11 (19%) patients. Complete remission rate prior to allo-HCT was 84%. Median follow-up was 30.5 months and median overall survival (OS) measured from start of INO was 11.2 months. One- and 2-year OS rates were 50% (95% confidence interval [CI]: 38.4-56.1) and 36.7% (95% CI: 25.5-52.9), respectively. Sinusoidal obstruction syndrome/venous occlusive disease (SOS/ VOD) after allo-HCT occurred in 17 (29%) patients. Of those, nine (53%) patients died due to SOS/VOD and multi-organ failure. Two had received >2 INO cycles (3 cycles, 5 cycles, N=1, each), all others ≤2 INO cycles prior to allo-HCT. Logistic regression analysis revealed conditioning with double alkylators (P=0.038) and allo-HCT during first-line therapy (P=0.050) as significant risk factors for SOS/VOD and in trend allo-HCT ≤60 days from last INO application (P=0.07), whereas number of INO cycles before allo-HCT and time between last INO application and allo-HCT were not significant. Relapse/progressive disease occurred in 20 (34%) patients. Of those, five (25%) patients are still alive, whereas 15 succumbed of their disease. Treatment with INO seems to be an effective approach with successful bridge-to-transplant. However, risk of SOS/VOD is high, necessitating continuous monitoring and recognition of SOS/VOD risk factors.

Nesse artigo iremos realizar uma discussão sobre a Escola Dinâmica de Escritores (EDDE), criada e dirigida pelo escritor peruano-mexicano Mario Bellatin na Cidade do México, a partir da Crítica de Processos Criativos de Cecília Almeida Salles. Em nossa análise, observamos que a EDDE se estrutura como um espaço coletivo de criação literária a partir do espelhamento de princípios criativos do escritor Mario Bellatin, por ele sistematizados e organizados na forma de conteúdos e atividades práticas. Dessa forma, a escola se fundamenta em valores que coincidem com as “tendências do processo” de Bellatin, mas, ainda assim, abre-se para a participação e contribuição de professores e alunos, incorporando em sua dinâmica o imprevisto, o acaso e a não-linearidade. Por isso, ela mesma pode ser lida como uma grande rede em construção, conforme conceituado por Salles. Com esse estudo, pretendemos, de maneira ampla, iniciar uma discussão sobre oficinas de criação como espaços privilegiados na análise e discussão dos caminhos da criação artística contemporânea em sua interface com proposições para seu ensino, assim como contribuir para o desenvolvimento de reflexões teóricas sobre processos de criação artística no campo da Crítica de Processos Criativos de Cecília Almeida Salles.

Perennial ryegrass (Lolium perenne L.) is one of the most widely used species for sports fields in temperate climates because of its high wear tolerance. However, wear tolerance of cultivars may vary according to local environmental conditions and turfgrass management. In this study, we evaluated the wear tolerance of six perennial ryegrass cultivars (Adagio, Apple SGL, Equate, Firebird, Principal 2, Tetradark) under two fertility treatments (100 or 200 kg N⋅ha−1⋅yr−1) over 2 years. The field trial was performed at the Experimental Agricultural Farm at the University of Padova in northeastern Italy in a silty loam soil. Plots were arranged in a randomized complete block with three replications and subjected to three traffic events per week using a sports field wear simulator. Turfgrass quality (TQ), percent green cover (PGC), and normalized difference vegetation index (NDVI) were recorded every 2 weeks and averaged over each month. Although perennial ryegrass cultivars responded differently to wear stress, the higher nitrogen (N) rate positively affected the TQ of them all. ‘Tetradrak’ and ‘Equate’ had the lowest TQ, especially during the active growing seasons (spring and autumn). However, ‘Tetradark’ was particularly negatively affected during the cool fall months. The impact of a higher N fertilization rate on PGC and NDVI appeared to be more pronounced in spring than in fall. Furthermore, slight differences among cultivars and treatments were observed in summer and winter when temperatures were a limiting growth factor.

La riforma universitaria italiana, iniziata nel 1999 con il Decreto ministeriale MIUR n. 509 e successivamente evolutasi attraverso vari provvedimenti legislativi, si basa su 3 principi chiave: l'autonomia delle università, l'innovazione nell'istruzione superiore e l'armonizzazione con lo Spazio Europeo dell'Istruzione Superiore (EHEA), al fine di agevolare la mobilità e l'occupabilità dei laureati all'interno del mercato del lavoro europeo. Questa riforma trova le sue radici nelle decisioni assunte dai governi dell'Unione Europea nell'ambito del c.d. “Processo di Bologna” e dell'accordo intergovernativo dell’Unione Europea sottoscritto a Bologna nel giugno 1999 (Conferenza di Bologna). L'obiettivo era creare uno Spazio Europeo dell'Istruzione Superiore basato su principi di libertà accademica, qualità, mobilità e apertura all'esterno. In questo contesto, uno degli elementi fondamentali della riforma è la struttura formativa e di titoli basata su tre cicli comprendente la laurea, la laurea magistrale e il dottorato di ricerca. La laurea e la laurea magistrale, noti in Italia anche come “sistema formativo 3+2”, ciascuna con un numero specifico di crediti, fungono da gradini formativi distinti e propedeutici per l’accesso al dottorato di ricerca che corrisponde al terzo ciclo di studi. Il Dottorato di ricerca è caratterizzato dall'acquisizione di competenze trasversali e specifiche per svolgere attività di ricerca in autonomia ed è requisito qualificante per l’accesso alla carriera accademica. L'accesso al dottorato è soggetto a selezioni pubbliche e i candidati devono essere in possesso di una laurea magistrale o equivalente quale requisito minimo. La tesi di dottorato, scritta solitamente in italiano e/o inglese, viene valutata da almeno due revisori esterni all'università erogante il titolo e il cui parere favorevole è condizione indispensabile per sostenere l’esame finale di dottorato. La discussione conclusiva per il conseguimento del titolo avviene pubblicamente, davanti a una commissione di esperti. Il dottorato costituisce inoltre un titolo necessario per partecipare al concorso pubblico per ricercatori con contratto di lavoro a tempo determinato lettera A (RTDA) e di lettera B (RTDB) dopo i quali si ha la possibilità di essere confermati come professori associati a tempo indeterminato. In conclusione, la riforma universitaria italiana ha introdotto un sistema di istruzione superiore in linea con gli standard europei, ponendo un'enfasi significativa sul dottorato di ricerca come chiave di volta per la formazione di ricercatori di alta qualità e per l'accesso alla carriera accademica. Ciò è stato reso possibile attraverso l'armonizzazione con i principi indicati dal “Processo di Bologna” e l'adozione di un sistema formativo universitario con titoli comprensibili e comparabili basato sul sistema a tre cicli.

La evaluación se ha convertido en un tema frecuente de debate didáctico y de preocupación de los distintos estamentos que integran la vida académica, mientras que la WebQuest se presenta como una herramienta de aprendizaje activo que desarrolla competencias de aprendizaje autónomo, colaborativo y digital. El objetivo de esta investigación fue el de establecer la efectividad de la WebQuest como herramienta de evaluación formativa en la educación superior. Se realizó una investigación de campo, con una muestra de 104 estudiantes de la Universidad Nacional de Chimborazo (UNACH), en el periodo 2023-1s, de enfoque mixto, alcance descriptivo y corte transversal. Se comprobó que la WebQuest es un método eficaz para evaluar la capacidad de abordar tanto el contenido conceptual, las habilidades prácticas y la actitud de los estudiantes, lo que proporciona una evaluación formativa integral que no solo mide el conocimiento teórico, sino, también la aplicabilidad en situaciones del mundo real.

IntroductionMultiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system which, when it begins before the age of 18, is defined as paediatric MS. Most common clinical presentations include long tract involvement, brainstem/cerebellum syndromes, optic neuritis and acute disseminated encephalomyelitis. Paediatric-onset MS typically has a more inflammatory-active course and a higher lesion burden in imaging studies, but an extensive post-relapse recovery, with a slower long-term disability progression. The first demyelinating clinical attack occurs before 10 years old in less than 1% of patients, and, in this special population, the condition has particularities in clinical presentation, differential diagnosis, diagnostic assessment, current treatment options and outcome.Clinical casesWe present the cases of four Caucasian children (2 girls) diagnosed with relapsing–remitting MS before the age of ten, with a mean age at the time of the first relapse of 7.4 ± 2.4 years. Clinical presentation included optic neuritis, myelitis, brainstem syndrome, and acute disseminated encephalomyelitis. Baseline MRI identified several lesions, frequently large and ill-defined. Two patients were included in clinical trials and two patients remain in clinical and imaging surveillance.ConclusionDiagnosis of MS before the age of 10 years is rare, but it has significant long-term physical and cognitive consequences, as well as a substantial impact on the current and future quality of life of the child and family. Early and correct diagnosis is essential. Prospective, randomized, large cohort studies are needed to assess the efficacy and safety of disease-modifying treatments in children under the age of ten.

The majority of recent research studies show the emotional state of language learners at the onset of the Covid-19 . Although the language students themselves identified issues limiting their learning, such as lack of interaction, lack of motivation and feedback, isolation, problems with the Internet, language teachers have admitted their concerns about students learning and confessed to being flexible, tolerant, and more humane. Today, there is a need to follow up on those student issues regarding their language learning beyond the Spring of 2020. This paper sheds light on the evolution of life, emotions, and wellbeing of the students, and their language learning beyond the rapid transition in Spring 2020 from forced unplanned teaching to the planned teaching during the pandemic of Fall 2020 and Spring 2021. This study explores the perceptions of 68 foreign language students in an American context through a survey. The results report on college language students’ needs, their emotions and wellbeing, and their recommendations to administrators based on their needs and perceptions.

If a child is chronically ill or has a disability, the entire family system is affected, and grandparents are often an important part of the family dynamic. They are frequently the main resource for families. However, little is known on the type and role of care and support provided by grandparents when a grandchild is suffering from a chronic disease or a disability. We aimed to gain insight into the i) type and role of care and ii) type of support grandparents with a grandchild with a chronic disease or disability provide. We systematically searched the databases Pubmed, PsycInfo, SCOPUS, and CINAHL for peer-reviewed original research articles. We included publications on grandchildren up to 21 years suffering from a chronic disease or a disability and presenting results on type and role of grandparents’ self-reported care or support.We included 14 articles on 12 studies. All studies were of qualitative methods. We found that grandparents provide support for the ill grandchild, the parents, and the whole family. Their role was on the sideline, but a reliable support for the entire family, both, instrumental and emotional. However, grandparents reported a lack of knowledge regarding the grandchild’s condition.Providing appropriate information about the grandchild`s disease to grandparents could help improve understanding and facilitate appropriate support and care for the family by grandparents.

RESUMO Este artigo discute a experiência e o desempenho de estudantes cotistas do curso de medicina da Universidade de Brasília. Com base em dados estatísticos e 11 entrevistas realizadas com discentes do curso, discorremos sobre desempenho acadêmico, taxa de evasão, origem familiar, preparação para os processos seletivos, vivência na faculdade e perspectivas futuras dos estudantes. O recorte empírico da pesquisa fundamentou-se no tipo de cotas de ingresso e na raça/cor dos estudantes. Concluímos o texto demonstrando que estudantes cotistas e não cotistas possuem desempenho acadêmico semelhante, bem como mostramos os alcances positivos da política e os desafios para que os corpos que vestem os jalecos brancos não sejam somente brancos, mas tenham a cor/raça da população que será atendida pelas novas gerações de médicos.

Neste artigo fazemos uma revisão da literatura sobre a temática da inovação em educação, associada ao Programa Erasmus+, a partir da leitura e análise crítica de onze artigos, por aplicação do modelo de análise Arksey e O’Malley (2005). É nosso objetivo identificar e caracterizar conceitos, desafios e aspetos potenciadores e inibidores das práticas de inovação pedagógica entre 2017 e 2021. A motivação que lhe subjaz inscreve-se no quadro do projeto de investigação de doutoramento em Ciências da Educação. Com esta intenção, a questão que nos move é: como é entendida e definida a inovação pedagógica no quadro do Erasmus+? Vivemos na era da informação e do conhecimento, onde imperam princípios de criatividade, empreendedorismo e inovação. Contudo, o debate mundial continua a incidir sobre a qualidade da educação e de como a inovação em educação pode gerar aprendizagens generativas. No presente estudo, privilegiamos o Programa Erasmus+ enquanto iniciativa, com mais de vinte anos, a marcar indelevelmente um outro tempo em educação e a oportunidade crescente para promover o desenvolvimento pessoal e social.

The present study aimed to evaluate the association of rapid weight gain (RWG) in early years with subsequent measures of adiposity in Portuguese children. We used data from a cross-sectional study of a representative sample of 5359 Portuguese children aged 3 to 5 years in 2009-10. Measures of adiposity indices included age-specific body mass index z-score (BAZ) and skinfold (suprailiac, subscapular and triceps) thickness. RWG was defined as the difference between z-scores of weightfor- age and birthweight > 0.67 Standard Deviation. Quantile regression models were used to estimate the difference in the 50th (median) and 90th (upper end) percentiles of each measure by RWG. Rapid weight gain in early years (62.5% of children) was associated with greater levels of BAZ and skinfold thickness measures, both for the median and 90th percentile. For the median, the difference was 1.08 (95% CI: 1.01-1.16) for BAZ, 1.11 mm (95% CI: 0.98-1.25) for suprailiac, 0.99 mm (95% CI: 0.87-1.11) for subscapular and 1.34 mm (95% CI: 1.11-1.57) for triceps skinfolds thickness after the adjustments. The increases in the 90th percentiles of adiposity measures associated with RWG were greater than those in median levels. RWG in childhood was associated with increased levels of adiposity measures, independent of prenatal and childhood factors.

This article introduces new discoveries into scientific circulation to help create a pertinent image of the realities of the Istro-Pontic region in the Early Medieval period. Through the method of comparative analysis, new archaeological finds were integrated into a specific chronological horizon. The results of the study confirm references in written sources that Dobrudzha was, at a certain time, the focus of attention of some nomadic populations who passed through Dobrudzha or settled here.

Summary: Introduction: Different studies have suggested that thoracoscopic treatment of congenital diaphragmatic hernia (CDH) is a safe and reproducible method. However, the patients selected for the procedure had the stomach and/or liver properly positioned within the abdomen and also with adequate cardiopulmonary stability. In our study, we used different clinical and anatomical selection criteria for thethoracoscopic approach in these neonates. Objective: Our study aims to present the clinical status and outcomes of the minimally invasive approach (MIA) in neonates with left Bochdalek CDH and their protocolized perinatal management at our center from 2015 to 2018. Materials and methods: An observational retrospective study was conducted at a tertiary pediatric hospital. Patients with a prenatal diagnosis and follow-up of isolated left CDH were counseled and treated by the same team of specialists following a predefined protocol. All fetuses underwent expectant management with in-utero transfer to the neonatal intensive care unit for scheduled delivery. Prenatal, perinatal, as well asclinical pre- and post-surgical variables were analyzed. The primary outcomes assessed were survival and the requirement for oxygen support at 90 days of life. The relevant secondary outcomes considered included days on mechanical ventilation (MV) and days of hospital stay. The data are expressed as median (range) or percentage (%). Results: 61 patients with left CDH were delivered in the operating room within the neonatal intensive care unit, nine died before reaching the surgical stage. Overall, 15/52 patients were operated using MIA. The 90-day mortality rate was 1/15 (6.7 %) due to multiorgan failure unrelated to the type of surgical approach. The duration on MV was 13 (7–22) days; patients were discharged at a mean of 37 (17–103) days of life, and no oxygen dependence was observed at 90 days. Conclusion: The thoracoscopic approach accounted for 28.8 % of the total surgeries performed and proved to be safe with a high survival rate of 93.3 % and no oxygen dependence. The presence of a type C defect and/or liver in the chest in this group of patients should be taken into account to alert the surgeon that higher conversion and recurrence rates can be expected.

The use of water‐soluble binders enables the transition to more sustainable batteries by the replacement of toxic N‐methyl‐2‐pyrrolidone (NMP) by water. Herein, two new fluorine‐free poly(ionic liquid)s are proposed as binders for LiNi0.8Mn0.1Co0.1O2 (NMC811) cathodes, based on poly(diallyldimethylammonium) (PDADMA) and two‐phosphate counter anions, which are recognized as effective corrosion inhibitors and electrolyte additives. Due to their high ionic conductivity (10−6 S cm−1 at 25 °C) and ability to prevent degradation of NMC811 particles, the PDADMA phosphate cells are able to achieve a 91% of capacity retention after 90 cycles at 0.5C, similar to the organic fluorinated polyvinylidene fluoride (PVDF) (96%) under the same conditions. However, aqueous sodium carboxymethyl cellulose (Na‐CMC) only provides 81% of capacity retention. Among the PDADMA‐based binders under study, PDADMA‐ diethyl phosphate (PDADMA‐DEP) delivers the highest discharge capacity (101.1 mAh g−1) at high C‐rate (5C). Degradation of Na‐CMC electrodes is observed in postmortem analysis and a notable increase in the charge transfer‐resistance. However, the NMC811 particles preserve their spherical shape when PDADMA‐phosphates are used as binders, also leading to lower polarization resistances and improved lithium diffusion. In conclusion, PDADMA‐phosphates manifest high performance as binders for sustainable NMC811 cathodes, while disposing of fluoropolymers and toxic solvents.

ABSTRACT Purpose: Palpebral congenital melanocytic nevi (PCMN) is a rare congenital skin lesion affecting the eyelids that can lead to cosmetic and psychological concerns and potential health risks such as malignancy. Several authors have analyzed therapeutical strategies to treat PCMN. However, there was no consensus in the literature. This systematic review aimed to evaluate the effectiveness, safety, and success of treatments of PCMN. Methods: We conducted a systematic review following PRISMA guidelines from October 2022 to April 2023. We included all types of study designs that described or compared PCMN treatments and interventions, as well as histology, recurrence, adverse events, patient satisfaction, and malignant transformation. The search strategy was based on specific search words through the following databases: PubMed, Embase, Latin American and Caribbean Health Sciences Literature (Lilacs), Web of Science, and Scopus. Ongoing studies and gray literature studies were included. Results: We analyzed 25 case reports with 148 participants. The effectiveness, success, and satisfaction with various treatments for PCMN depend on the specific treatment method and the individual patient’s case. Conclusions: Most of the studies showed that surgical procedures (exeresis) are able to treat PCMN in the eyelid. The variability in outcomes emphasizes the importance of further research to better understand the most effective and safe approaches for treating congenital melanocytic nevi.

Resumo Fundamento O nível socioeconômico tem sido associado à doença isquêmica do coração (DIC). Bairros de alta renda podem expor os indivíduos a um ambiente construído que promova caminhadas para atividades diárias (caminhabilidade). Faltam dados sobre a associação entre renda e DIC em países de renda média. Também é incerto se a caminhabilidade medeia essa associação. Objetivos Investigar se a renda está associada à DIC em um país de renda média e se a caminhabilidade dos bairros medeia a associação entre renda e DIC. Métodos O presente estudo transversal avaliou 44.589 pacientes encaminhados para imagem de perfusão miocárdica (SPECT-MPI). A renda e a caminhabilidade foram derivadas do setor censitário residencial dos participantes. A pontuação quantitativa da caminhabilidade combinou as seguintes 4 variáveis: conectividade viária, densidade residencial, densidade comercial e uso misto do solo. A DIC foi definida pela presença de perfusão miocárdica anormal durante um estudo SPECT-MPI. Utilizamos modelos ajustados com efeitos mistos para avaliar a associação entre nível de renda e DIC e realizamos uma análise de mediação para medir o percentual da associação entre renda e DIC mediada pela caminhabilidade. Consideramos valores de p abaixo de 0,01 como estatisticamente significativos. Resultados Dos 26.415 participantes, aqueles que residiam no setor censitário do tercil de menor renda eram mais fisicamente inativos (79,1% versus 75,8% versus 72,7%) quando comparados aos setores censitários do tercil de maior renda (p < 0,001). A renda foi associada à DIC (odds ratio: 0,91 [intervalo de confiança de 95%: 0,87 a 0,96] para cada aumento de 1000,00 dólares internacionais na renda), para homens e mulheres igualmente (p para interação = 0,47). Os setores censitários com maior renda estiveram associados a uma melhor caminhabilidade (p < 0,001); no entanto, a caminhabilidade não mediou a associação entre renda e DIC (porcentagem mediada = −0,3%). Conclusões A renda foi independentemente associada a maior prevalência de DIC em um país de renda média, independentemente de gênero. Embora a caminhabilidade tenha sido associada à renda do setor censitário, ela não mediou a associação entre renda e DIC.

The past decade's development of UV LEDs has fueled significant research in water disinfection, with widespread debate surrounding the potential synergies of multiple UV wavelengths. This study analyses the use of three UV sources (265, 275, and 310 nm) on the inactivation of Escherichia coli bacteria in two water matrixes. At maximum intensity in wastewater, individual inactivation experiments in a single pass set-up (Flow rate = 2 L min−1, Residence time = 0.75 s) confirmed the 265 nm light source to be the most effective (2.2 ± 0.2 log units), while the 310 nm led to the lowest inactivation rate (0.0003 ± 7.03×10−5 log units). When a combination of the three wavelengths was used, an average log reduction of 4.4 ± 0.2 was observed in wastewater. For combinations of 265 and 275 nm, the average log reductions were similar to the sum of individual log reductions. For combinations involving the use of 310 nm, a potential synergistic effect was investigated by the use of robust statistical analysis techniques. It is concluded that combinations of 310 nm with 265 nm or 275 nm devices, in sequential and simultaneous mode, present a significant synergy at both intensities due to the emission spectra of the selected LEDs, ensuring the possibility of two inactivation mechanisms. Finally, the electrical energy per order of inactivation found the three-wavelength combination to be the most energy efficient (0.39 ± 0.05, 0.36 ± 0.01 kWh m−3, at 50% and 100% dose, respectively, in wastewater) among the synergistic combinations.

Introduction During acute kidney injury (AKI) due to sepsis, the intestinal microbiota changes to dysbiosis, which affects the kidney function recovery (KFR) and amplifies the injury. Therefore, the administration of probiotics could improve dysbiosis and thereby increase the probability of KFR.Methods In this double-blind clinical trial, patients with AKI associated with sepsis were randomized (1:1) to receive probiotics or placebo for 7 consecutive days, with the objectives of evaluate the effect on KFR, mortality, kidney replacement therapy (KRT), urea, urine volume, serum electrolytes and adverse events at day 7.Results From February 2019 to March 2022, a total of 92 patients were randomized, 48 to the Probiotic and 44 to Placebo group. When comparing with placebo, those in the Probiotics did not observe a higher KFR (HR 0.93, 0.52–1.68, p = 0.81), nor was there a benefit in mortality at 6 months (95% CI 0.32–1.04, p = 0.06). With probiotics, urea values decreased significantly, an event not observed with placebo (from 154 to 80 mg/dl, p = 0.04 and from 130 to 109 mg/dl, p = 0.09, respectively). Urinary volume, need for KRT, electrolyte abnormalities, and adverse events were similar between groups. (ClinicalTrial.gov NCT03877081) (registered 03/15/2019).Conclusion In AKI related to sepsis, probiotics for 7 consecutive days did not increase the probability of KFR, nor did other variables related to clinical improvement, although they were safe.

It is not standardised what is the endometrial thickness that discriminates between normal and potentially malignant. The objective of this study was to determine the endometrial thickness cut-off point from which the risk of endometrial cancer (EC) increases in asymptomatic postmenopausal women; and to evaluate the risk factors linked to malignant endometrial pathology as well as other associated ultrasound findings. This was a retrospective observational study that included hysteroscopies performed at the Hospital Materno-Infantil on 267 asymptomatic menopausal women with an increase in endometrial thickness (AET) >5 mm, from 2015 to 2019. The results shows that the prevalence of malignant pathology in asymptomatic postmenopausal women with a casual finding of endometrial thickening was 3.7%. This percentage was 16.3% when the cut-off point of AET was established at 10 mm. There was a significant association for the diagnosis of malignant pathology with this cut-off point. There is a significant association between the 10 mm endometrial thickness cut-off point from which the risk of EC increases in asymptomatic postmenopausal women.Impact statement What is already known on this subject? Several studies have established the cut-off point for asymptomatic endometrial thickening (AET) for atypical endometrial hyperplasia and endometrial cancer at 10 mm. Although no cut-off point has optimal accuracy for the diagnosis of malignant endometrial pathology, it has been found that with a cut-off value of AET >10 mm no cases are missed. Likewise, a cut-off point of AET > 11 mm may provide a balance between cancer detection and histopathological workup extension. What do the results of this study add? A significant association was found at the cut-off point of AET > 10 mm, which suggests that screening postmenopausal women at this thickness is acceptable and unlikely to miss cases of endometrial hyperplasia and endometrial cancer. What are the implications of these findings for clinical practice and/or further research? After analysing our results we can conclude, like other published studies, that by establishing a cut-off point of 10 mm we obtain a good discrimination between benign and malignant pathology, which would allow us to diagnose 100% of malignant pathology. Above this cut-off point, the risk of endometrial cancer increases, and it would therefore be advisable to extend the study. A multicentre study is needed to confirm the cut-off point at which the risk of endometrial cancer increases in postmenopausal women with asymptomatic endometrial thickening.

Background: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. Methods: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. Results: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. Conclusions: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.

Background: The antimicrobial resistance (AMR) of Klebsiella pneumoniae recorded a steep upward trend over the last two decades, among which carbapenem-resistant Klebsiella pneumoniae (CRKP) is one of the most concerning strains considering the development and spread of AMR. The aim of this study was to analyze the evolution of AMR for Klebsiella pneumoniae and to describe the risk factors of AMR for Klebsiella pneumoniae, including the COVID-19 pandemic. Methods: We conducted a retrospective study on Klebsiella pneumoniae non-duplicative isolates collected from patients admitted to a tertiary hospital in Bucharest, Romania, from January 2019 to December 2021. We evaluated AMR changes by comparing resistance between 2019 and the mean of 2020–2021. Results: The rates of AMR increased for third-generation cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and colistin and decreased for trimethoprim/sulfamethoxazole (TMP/SMX), 45.7% in 2019 vs. 28.3% in 2021. A longer length of hospital stay (ꭓ2 = 49.68, p < 0.01); recent antibiotic consumption, RR = 1.38, 95% CI [1.21, 1.57]; and recent contact with hospital settings, RR = 1.54, 95% CI [1.32, 1.8] were risk factors for multidrug-resistant (MDR) Klebsiella pneumoniae. Conclusions: The AMR of Klebsiella pneumoniae increased during 2020–2021 for most of the potential active antibiotics; only TMP/SMX resistance decreased, and it may represent a treatment option for CRKP or MDR Klebsiella pneumoniae infections. Decreasing the excessive use of antibiotics and the implementation of prevention and control measures in healthcare settings are mandatory for avoiding further increases in the AMR rate of Klebsiella pneumoniae.

Landiolol is an ultra-short-acting, selective β1-adrenergic receptor blocker that was originally approved in Japan for the treatment of intraoperative tachyarrhythmias. It has gained attention for its use in the management of tachyarrhythmias and perioperative tachycardia, especially atrial fibrillation for both cardiac and non-cardiac surgeries. It can be the ideal agent for heart rate control due to its high β1-selectivity, potent negative chronotropic effect, a limited negative inotropic potential, and an ultrashort elimination half-life (around 4 min); moreover, it may have a potential therapeutic effects for sepsis and pediatric patients. Landiolol seems to be superior to other short-acting and selective beta-blockers such as esmolol. This review aims to provide a comprehensive overview of landiolol, a new ultra-short-acting β1 selective antagonist, including its pharmacology, clinical applications, efficacy, safety profile, and future directions in research and clinical data.

Background and Objectives: This retrospective cohort study investigates the role of genetic thrombophilia in pregnant women experiencing early pregnancy loss compared to those with late pregnancy loss. Materials and Methods: Participants were categorized into early and late pregnancy loss groups based on gestational age. A total of 156 patients were included, out of which 103 had early-trimester pregnancy losses and 96 had multiple miscarriages. Results: The study revealed a synergistic effect of Factor V Leiden (FVL G1691A) and Methylenetetrahydrofolate Reductase (MTHFR C677T) mutations (coefficient 3.42). Prothrombin (PT) G20210A and β-Fibrinogen 455 G>A mutations exhibited a significant interaction (coefficient 1.98). Additionally, MTHFR A1298C and Plasminogen Activator Inhibitor-1 (PAI-1 4G/5G) mutations showed a significant interaction (coefficient 1.65). FVL G1691A and Endothelial Protein C Receptor (EPCR) allele A1/A2 mutations also demonstrated a significant association (coefficient 2.10). Lastly, MTHFR C677T and Glycoprotein IIb/IIIa T1565C mutations interacted significantly (coefficient 1.77). Risk factor analysis identified several mutations associated with early pregnancy loss, including PAI-1 4G/5G homozygous (OR 3.01), FVL G1691A heterozygous (OR 1.85), and MTHFR A1298C heterozygous (OR 1.55). Both homozygous and heterozygous MTHFR C677T mutations were significant risk factors (OR 2.38; OR 2.06), as was PT G20210A homozygous mutation (OR 1.92). The PAI-1 4G/4G homozygous variant posed a risk (OR 1.36). Late pregnancy loss was associated with MTHFR A1298C homozygous mutation (OR 3.79), β-Fibrinogen 455 G>A heterozygous mutation (OR 2.20), and MTHFR A1298C heterozygous mutation (OR 2.65). Factor XIII G1002T heterozygous mutation (OR 1.18) and PAI-1 4G/5G homozygous mutation (OR 2.85) were also significant risk factors. EPCR allele A1/A2 (OR 1.60) and A2/A3 (OR 1.73) mutations were identified as significant risk factors for late pregnancy loss. Furthermore, FVL G1691A homozygous mutation, PT G20210A homozygous mutation, MTHFR C677T heterozygous mutation, MTHFR A1298C heterozygous mutation, and EPCR allele A1/A2 were identified as significant risk factors for multiple miscarriage. Conclusions: This study highlights significant interactions and risk factors related to genetic thrombophilia mutations in different types of pregnancy loss, contributing valuable insights for miscarriage management guidelines.

The initial clinical manifestation of acute mesenteric ischemia poses a diagnostic challenge, often leading to delays in identification and subsequent surgical intervention, contributing to adverse outcomes. Serum biomarkers, offering insights into the underlying pathophysiology, hold promise as prognostic indicators for acute mesenteric ischemia. This systematic review comprehensively explores the role of blood biomarkers in predicting clinical outcomes during follow-up for patients with mesenteric ischemia. A thorough literature search across the PubMed, Cochrane Library, and EMBASE databases yielded 33 relevant publications investigating the efficacy of serum biomarkers in predicting outcomes for mesenteric ischemia. Numerous studies underscore the utility of blood biomarkers in swiftly and accurately differentiating between causes of mesenteric ischemia, facilitating a prompt diagnosis. Elevated levels of specific biomarkers, particularly D-dimers, consistently correlate with heightened mortality risk and poorer clinical outcomes. While certain serum indicators exhibit substantial potential in associating with mesenteric ischemia, further research through rigorous human trials is imperative to enhance their consistent predictive ability during the follow-up period. This study underscores the diagnostic and prognostic significance of specific biomarkers for mesenteric ischemia, emphasizing the necessity for standardized procedures in future investigations.

Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. This study aims to evaluate the current diagnostic approach with novel non-invasive techniques, such as dermoscopy, and also the landscape of treatment options for EOLP, focusing on its efficacy, safety, and the challenges that it present in clinical practice. Through a comprehensive literature review, we explored the use of topical corticosteroids, systemic immunosuppressants, biologics, and Janus kinase (JAK) inhibitors in treating EOLP, alongside examining patient compliance, psychological impacts, and the risk of adverse effects and recurrence. Our findings reveal that while topical corticosteroids are the cornerstone of EOLP treatment, offering symptomatic relief, their long-term use is limited by side effects and tolerance development. Systemic therapies and biologics provide alternatives for refractory cases but necessitate careful adverse effect monitoring. JAK inhibitors show promise as an innovative treatment avenue but require more evidence on long-term safety and efficacy. This study highlights the necessity of personalized treatment approaches due to the variable disease course and response to treatment, underscoring the importance of a multidisciplinary strategy in managing EOLP. The complexity of EOLP treatment, compounded by its psychological and quality of life impacts, demands ongoing research into targeted therapies, the establishment of standardized treatment protocols, and the development of effective outcome measures to improve patient care and treatment outcomes.

Introduction: Ledderhose disease (LD), a rare and benign pathology, manifests in the thickening of the plantar aponeurosis, leading to the development of nodules on the plantar surfaces. First stages typically feature painless nodules, but progression may result in discomfort or pain at-tributed to inflammatory and irritating processes. Also known as plantar fibromatosis (PF), this condition is part of a spectrum of pathologies characterized by hyperproliferation of fibrous connective tissue, similar to Dupuytren contracture (palmar fibromatosis). Given that this pathology is relatively unknown but potentially disabling, we consider it im-portant to review this condition in order to manage possible complications and to expand the rehabilitation treatment, currently limited to a few physiotherapy procedures. Materials and methods: This paper presents the case of a 66-year-old patient known to have Ledderhose disease diagnosed in 2003, Dupuytren contracture of bilateral hands, osteopenia, invasive ductal carcinoma surgically treated and followed by chemotherapy and radiotherapy (2018). The patient presented to our clinic complaining of bilateral plantar pain, with the left side exhibiting greater severity, accompanied by paresthesia in a sock-like distribution and dif-ficulty with ambulation. On clinical examination, bilateral flatfoot deformity, stage 1 Dupuytren contracture of the bilateral palmar aponeurosis, mildly reduced distal muscle strength in both upper and lower extremities and plantar synovial cysts were noted, findings that were subsequently confirmed via MRI imaging. The physiotherapeutic plan was designed to reduce symptomatic manifestations, attenuate the inflammatory cascade and optimize gait pattern. However, considering the patient's medical history, we were limited in prescribing physiotherapy procedures. The patient was dynamically evaluated using the following scales: Visual analogue scale (VAS), Life Quality Assessment (QOL), The Functional Ambulation Categories (FAC), Index of Inde-pendence in Activities of Daily Living (ADL) and Medical Research Council Scale for muscle strength (MRC). Results: Considering the associated oncological pathology, our ability to prescribe physiother-apy procedures was constrained. However, the patient benefited from an individualized reha-bilitation program specific to the pathology with a favorable evolution and a promising prog-nosis. The program included physical therapy sessions targeting stretching, toning and en-hancing muscle strength for the plantar and palmar muscle groups, alongside paraffin applica-tions, low-frequency current (Transcutaneous Electrical Nerve Stimulation - TENS) and Deep oscillation applications. Conclusions: The complex rehabilitation approach in a patient with a rare medical condition, complicated with degenerative diseases, though limited in variety due to associated oncologi-cal pathology contributed in the end to a significant improvement of the patient's quality of life.

(1) Background: Vertebral osteomyelitis is an infection affecting the vertebrae, with a poten-tially devastating impact, which requires a prompt diagnosis established as quickly as possible to avoid complications such as neurological impairment, fractures, and chronic pain; (2) Meth-ods: We reported a case of a 47-year-old male patient with multiple risk factors (high blood pressure, smoking, dyslipidemia, type II diabetes) and a history of right hemiplegia post a thalamo- mesencephalic hemorrhage, admitted to the Neuromuscular Clinic Division of The Teaching Emergency Hospital “Bagdasar- Arseni” (TEHBA) Bucharest, for complete paraplegia following a surgically treated vertebral osteomyelitis at T4-T5 level with spinal epidural ab-scess; (3) Results: The patient had an oscillating and long evolution, due to long-term antibio-therapy and the imperative of minimal mobilization periods, which eventually led to favorable results, with the recovery of motor function and the ability to perform his previous daily activ-ities; (4) Conclusions: Proper management in vertebral osteomyelitis cases has a great impact on the evolution of the patient, increasing the quality of life, and preventing future complica-tions. A multidisciplinary approach is essential for this type of complex case in order to achieve significant improvements

Undetermined pancreatic cystic lesion (PCL) differentiation benefits from endoscopic ultrasound (EUS) based on morphology and cyst fluid analysis, but room for new biomarkers exists. Our aim was to assess the intracystic and serum diagnostic value of neutrophil gelatinase-associated lipocalin (Ngal) and interleukin 1 beta (IL-1β) for differentiation of PCLs. This prospective study included patients from one tertiary hospital, evaluated between April 2018 and May 2020. EUS fine-needle aspiration or pancreatic pseudocysts drainage was the source of PCL intracystic liquid. The final diagnosis was based on surgery or EUS results (morphology, cytology, glucose, and CEA—carcinoembryogenic antigen). The intracystic samples were tested for Ngal, IL-1β, glucose, and CEA, and serum for Ngal and IL-1β. We evaluated 63 cysts, 33 pseudocysts, and 30 non-inflammatory cysts. The diagnostic sensitivity and specificity for mucinous PCL was 70.8% and 92.3% for intracystic Ngal (cut-off: 500–800 ng/dL), without correlation with serum Ngal, no matter the inclusion of infected pseudocysts. After exclusion of infected pseudocysts, the sensitivity and specificity for glucose were 87% and 75%, respectively, and for CEA, they were 87.1%, and 96.8%, respectively. Intracystic Ngal shows promise in differentiating mucinous PCLs, but researchers need to conduct further studies to confirm its effectiveness. Intracystic IL-1β and serum Ngal made no diagnostic contribution.

Between 2016 and 2023, a cross-sectional study was conducted in the central region of Portugal in order to better understand the epidemiology and public health risks resulting from the handling and consumption of game animals infected with Brucella spp. The seroprevalence and risk factors for Brucella spp. seropositivity were evaluated. Antibodies against Brucella spp. were determined using a commercial enzyme-linked immunosorbent assay (ELISA) according to the manufacturer’s instructions. Results showed that in the 650 serum samples collected from red deer (n = 298) and wild boars (n = 352) in Portugal, 21.7% (n = 141; 95% CI: 18.6–25.1%) tested positive. Wild boar had a significantly higher prevalence (35.5%; 95% CI: 30.5–40.8%) than red deer (5.4%, 95% CI: 3.1–8.6%; p ≤ 0.001). Risk factors for seropositivity were investigated using multivariable logistic regression models. The odds of being seropositive was 8.39 (95% CI: 4.75–14.84; p ≤ 0.001) times higher in wild boar than in red deer. Correlations between sex, age, body condition, and seropositivity could not be observed. The higher seroprevalence in wild boar suggests that this species may primarily contribute to the Brucella spp. ecology in central Portugal.

Accurate assessment of ram sperm quality is crucial to optimizing assisted reproductive technologies in sheep. However, semen preservation can induce sperm due to osmotic, biochemical, and thermal stress. Stabilizing sperm with a suitable cooling rate and adaptation period to the extender could mitigate these effects for a more reliable evaluation. This study aimed to determine: (1) the best time to assess ram sperm quality, and (2) the factor responsible for the altered state of ram sperm during the first hours of liquid storage. In Experiment 1, ejaculated sperm were diluted and assessed for sperm motility and functionality at four preservation times: 0, 3, 6, and 24 h as sperm damage control. Both sperm motility and functionality improved after 6 h. Experiment 2 investigated the factor responsible for sperm quality change by testing the interactions of seminal plasma and extender with sperm from epididymides independently and in combination. The evaluation of sperm was performed as in Experiment 1. Sperm in groups containing the extender showed altered motility at 0 and 24 h, and lower functionality at 0 h. Thus, we could assume that extender addition initially alters ram sperm, causing sublethal damage that is reversible after 3 to 6 h of semen preservation. In conclusion, ram sperm require an adaptation time of 3 to 6 h to the extender before an accurate quality assessment can be conducted. This has practical implications for reproduction centers, enabling better workflow organization and optimal expression of ram sperm attributes when cervical artificial insemination is routinely performed.

(1) Background: This study aimed to assess the periodontitis burden in systemic sclerosis patients and the possible association between them, and the degree to which some potential risk factors and two potential diagnostic biomarkers may account for this association. (2) Methods: This cross-sectional study included a test group (systemic sclerosis patients) and a control group (non-systemic sclerosis patients). Both groups benefited from medical, periodontal examination and saliva sampling to determine the salivary flow rate and two inflammatory biomarkers (calprotectin, psoriasin). A systemic sclerosis severity scale was established. (3) Results: In the studied groups, comparable periodontitis rates of 88.68% and 85.85%, respectively, were identified. There were no significant differences in the severity of periodontitis among different systemic sclerosis severity, or in the positivity for anti-centromere and anti-SCL70 antibodies. Musculoskeletal lesions were significantly more common in stage III/IV periodontitis (n = 33, 86.84%) than in those in stage I/II (n = 1, 100%, and n = 3, 37.5%, respectively) (p = 0.007). Comparable levels of the inflammatory mediators were displayed by the two groups. There were no significant differences in calprotectin and psoriasin levels between diffuse and limited forms of systemic sclerosis. (4) Conclusions: Within the limitations of the current study, no associations between systemic sclerosis and periodontitis, or between their risk factors, could be proven.

Summary: Background: Recurrences of herpes simplex virus (HSV) in the orofacial region (herpes labialis or cold sores) impact quality-of-life. We aimed to study whether the bacille Calmette-Guérin (BCG) vaccine can attenuate cold sore recurrences through off-target immunomodulatory effects. Methods: In this nested randomised controlled trial within the multicentre, phase 3 BRACE trial, 6828 healthcare workers were randomised in 36 sites in Australia, the Netherlands, Spain, the United Kingdom and Brazil, to receive BCG-Denmark or no BCG (1:1 ratio using a web-based procedure) and followed for 12 months with 3-monthly questionnaires. Exclusion criteria included contraindication to BCG vaccine or previous vaccination with BCG within the past year, any other live-attenuated vaccine within the last month, or any COVID-specific vaccine. The intervention group received one intradermal dose of 0.1 mL of BCG-Denmark corresponding to 2−8 x 105 colony forming units of Mycobacterium bovis, Danish strain 1331. The primary outcome was the difference in restricted mean survival time (i.e., time to first cold-sore recurrence), in participants with frequent recurrent herpes labialis (≥4 recurrences/year), analysed by intention-to-treat. Secondary outcomes addressed additional questions, including analyses in other sub-populations. Adverse events were monitored closely during the first 3 months and were reported in all participants who received one dose of study drug according to intervention received. The BRACE trial is registered with ClinicalTrials.gov, NCT04327206. Findings: Between March 30, 2020 and February 18, 2021, 84 individuals with frequent recurrent cold sores were randomly assigned to BCG (n = 38) or control (n = 46). The average time to first cold-sore recurrence was 1.55 months longer in the BCG group (95% CI 0.27–2.82, p = 0.02) than the control group (hazard ratio 0.54, 95% CI 0.32–0.91; intention-to-treat). The beneficial effect of BCG was greater in the as-treated population (difference 1.91 months, 95% CI 0.69–3.12, p = 0.003; hazard ratio 0.45, 95% CI 0.26–0.76). In prespecified subgroup analyses, only sex modified the treatment effect (interaction p = 0.007), with benefit restricted to males. Over 12 months, a greater proportion of participants in the BCG group compared with the control group reported a decrease in duration (61% vs 21%), severity (74% vs 21%), frequency (55% vs 21%), and impact on quality of life (42% vs 15%) of cold sore recurrences. In participants who had ever had a cold sore, there was also a decrease in self-reported burden of recurrences in the BCG group. In participants who had never had a cold sore, there was an increased risk of a first episode in the BCG group (risk difference 1.4%; 95% CI 0.3–2.6%, p = 0.02). There were no safety concerns. Interpretation: BCG-Denmark vaccination had a beneficial effect on herpes labialis, particularly in males with frequent recurrences, but may increase the risk of a first cold sore. Funding: Bill & Melinda Gates Foundation, the Minderoo Foundation, Sarah and Lachlan Murdoch, the Royal Children's Hospital Foundation, Health Services Union NSW, the Peter Sowerby Foundation, SA Health, the Insurance Advisernet Foundation, the NAB Foundation, the Calvert-Jones Foundation, the Modara Pines Charitable Foundation, the UHG Foundation Pty Ltd, Epworth Healthcare, and individual donors.

Summary: Background: Pseudomonas aeruginosa healthcare-associated infections are one of the top antimicrobial resistance threats world-wide. In order to analyze the current trends, we performed a Spanish nation-wide high-resolution analysis of the susceptibility profiles, the genomic epidemiology and the resistome of P. aeruginosa over a five-year time lapse. Methods: A total of 3.180 nonduplicated P. aeruginosa clinical isolates from two Spanish nation-wide surveys performed in October 2017 and 2022 were analyzed. MICs of 13 antipseudomonals were determined by ISO-EUCAST. Multidrug resistance (MDR)/extensively drug resistance (XDR)/difficult to treat resistance (DTR)/pandrug resistance (PDR) profiles were defined following established criteria. All XDR/DTR isolates were subjected to whole genome sequencing (WGS). Findings: A decrease in resistance to all tested antibiotics, including older and newer antimicrobials, was observed in 2022 vs 2017. Likewise, a major reduction of XDR (15.2% vs 5.9%) and DTR (4.2 vs 2.1%) profiles was evidenced, and even more patent among ICU isolates [XDR (26.0% vs 6.0%) and DTR (8.9% vs 2.6%)] (p

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Abstract Background In older patients with acute myeloid leukemia (AML), the definition of fitness, prognosis, and risk of death represents an open question. Methods In the present study, we tested the impact on survival of disease‐ and patient‐related parameters in a large cohort of elderly AML patients homogeneously assigned to treatment with hypomethylating agents (HMAs). Results In 131 patients with a median age of 76 years, we confirmed that early response (

Abstract The mechanisms that underlie the timing of labor in humans are largely unknown. In most pregnancies, labor is initiated at term (≥ 37 weeks gestation), but in a signifiicant number of women spontaneous labor occurs preterm and is associated with increased perinatal mortality and morbidity. The objective of this study was to characterize the cells at the maternal–fetal interface (MFI) in term and preterm pregnancies in both the laboring and non-laboring state in Black women, who have among the highest preterm birth rates in the U.S. Using mass cytometry to obtain high-dimensional single-cell resolution, we identified 31 cell populations at the MFI, including 25 immune cell types and six non-immune cell types. Among the immune cells, maternal PD1+ CD8 T cell subsets were less abundant in term laboring compared to term non-laboring women. Among the non-immune cells, PD-L1+ maternal (stromal) and fetal (extravillous trophoblast) cells were less abundant in preterm laboring compared to term laboring women. Consistent with these observations, the expression of CD274, the gene encoding PD-L1, was significantly depressed and less responsive to fetal signaling molecules in cultured mesenchymal stromal cells from the decidua of preterm compared to term women. Overall, these results suggest that the PD1/PD-L1 pathway at the MFI may perturb the delicate balance between immune tolerance and rejection and contribute to the onset of spontaneous preterm labor.

Abstract Blue stragglers are anomalously luminous core hydrogen-burning stars formed through mass-transfer in binary/triple systems and stellar collisions. Their physical and evolutionary properties are largely unknown and unconstrained. Here we analyze 320 high-resolution spectra of blue stragglers collected in eight galactic globular clusters with different structural characteristics and show evidence that the fraction of fast rotating blue stragglers (with rotational velocities larger than 40 km/s) increases for decreasing central density of the host system. This trend suggests that fast spinning blue stragglers prefer low-density environments and promises to open an unexplored route towards understanding the evolutionary processes of these stars. Since large rotation rates are expected in the early stages of both formation channels, our results provide direct evidence for recent blue straggler formation activity in low-density environments and put strong constraints on the timescale of the collisional blue straggler slow-down processes.

The purpose of this article is to identify the methods of interaction of national folklore with the idioms of pop music and jazz in the creation of the vocal-instrumental group “Orizont”, led by Oleg Milstein. Based on the detailed analysis of the compositions “La morișca”, „Leana”, „Moldovan tunes”, etc. the author reveals the most representative methods of involving Romanian folklore in the sound texture of the pieces performed by the band “Orizont”. Among them it is worth mentioning: quoting popular songs, composing contrapuntal lines to folk melodies, combining themes of folkloric origin with stylistic and genre elements of pop, rock and jazz music. Special attention is paid to the treatment of vocal jazz methods used by the members of the “Orizont” band.

Abstract Background Little is known regarding associations between peripheral blood biomarkers (PBBMs) and survival, response, and toxicity in recurrent/metastatic head and neck squamous cell carcinomas (R/M HNSCC) treated with immune checkpoint inhibitors (ICIs). Methods In this single‐institution retrospective cohort study, a dataset of patients with R/M HNSCC treated with ICIs between 08/2012–03/2021 was established, including demographic and clinicopathologic characteristics. Pretreatment PBBMs were collected and evaluated for associations with grade ≥3 adverse events (G ≥ 3AE) by CTCAEv5, objective response (ORR) by RECIST 1.1, overall survival (OS), and progression‐free survival (PFS). Multivariable models for each outcome were created using elastic net variable selection. Results Our study included 186 patients, with 51 (27%) demonstrating complete or partial response to immunotherapy. Multivariable models adjusted for ECOG performance status (PS), p16, and smoking demonstrated that pretreatment higher LDH and absolute neutrophils, as well as lower percent lymphocytes correlated with worse OS and PFS. Higher LDH and lower % lymphocytes also correlated with worse ORR. Conclusions In the largest study to date examining PBBMs in ICI‐treated R/M HNSCCs, our variable selection method revealed PBBMs prognostic for survival and response to immunotherapy. These biomarkers warrant further investigation in a prospective study along with validation with CPS biomarker.

Abstract Background Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis. Methods Matched 1:1 case–control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence. Results 3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068–0.084) for medical admissions; 0.043 (95% CI 0.032–0.055) for elective surgical admissions; and 0.036 (95% CI 0.017–0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates. Conclusion The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.