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ABSTRACTThis work proposes a new mathematical model describing the dynamics of growing bacterial cultures. The model, described by a first order non-linear differential equation, as a generalization of the logistic equation, was compared with the most studied mathematical models. All models were numerically implemented and fitted to the experimental data, collected from the incubation of a bacterial strain of Pseudomonas fluorescens, to obtain the growth parameters. The experimental data showed the lowest fit error for both the Baranyi–Roberts and new models, which turned out to be equivalent. Simulations of the fitting algorithm were also implemented and repeated for a large number of initial guesses of the parameters, chosen in order to test the fitting and convergence performances. The innovative feature that makes the new model easier to use than Baranyi–Roberts model is definitely its simple and manageable analytical form and its good performance in terms of convergence time.

A realidade social, política e educacional do Brasil, nos últimos anos, vem cobrando novos posicionamentos do campo que articula a Psicanálise e a Educação no país. Com o artigo, buscamos modos da Psicanálise, como uma teoria crítica, em diálogo com o campo da educação e da política, contribuir com um melhor entendimento dos sintomas sociais que se apresentam nas questões educacionais e, em especial, na onda de violência que atualmente assola as instituições escolares. Entendemos que os recentes ataques às escolas têm que ser vistos no contexto de vários outros ataques, desde a ausência histórica de investimentos em educação no país, até ao espectro de morte que ronda o cotidiano escolar, com as altas taxas de homicídios e suicídios de adolescentes, expressões e consequências da necropolítica e do Estado suicidário que se instala na sociedade brasileira. Para discutir aspectos educacionais é ainda necessário articular questões das ciências, da natureza, da economia e da política. À guisa de conclusão, o escrito provoca a necessidade de que se possa fazer, aos jovens, a transmissão pelo desejo de imaginar outros mundos e sonhar outros sonhos.

Monitoring heart rate (HR) through photoplethysmography (PPG) signals is a challenging task due to the complexities involved, even during routine daily activities. These signals can indeed be heavily contaminated by significant motion artifacts resulting from the subjects’ movements, which can lead to inaccurate heart rate estimations. In this paper, our objective is to present an innovative necklace sensor that employs low-computational-cost algorithms for heart rate estimation in individuals performing non-abrupt movements, specifically drivers. Our solution facilitates the acquisition of signals with limited motion artifacts and provides acceptable heart rate estimations at a low computational cost. More specifically, we propose a wearable sensor necklace for assessing a driver’s well-being by providing information about the driver’s physiological condition and potential stress indicators through HR data. This innovative necklace enables real-time HR monitoring within a sleek and ergonomic design, facilitating seamless and continuous data gathering while driving. Prioritizing user comfort, the necklace’s design ensures ease of wear, allowing for extended use without disrupting driving activities. The collected physiological data can be transmitted wirelessly to a mobile application for instant analysis and visualization. To evaluate the sensor’s performance, two algorithms for estimating the HR from PPG signals are implemented in a microcontroller: a modified version of the mountaineer’s algorithm and a sliding discrete Fourier transform. The goal of these algorithms is to detect meaningful peaks corresponding to each heartbeat by using signal processing techniques to remove noise and motion artifacts. The developed design is validated through experiments conducted in a simulated driving environment in our lab, during which drivers wore the sensor necklace. These experiments demonstrate the reliability of the wearable sensor necklace in capturing dynamic changes in HR levels associated with driving-induced stress. The algorithms integrated into the sensor are optimized for low computational cost and effectively remove motion artifacts that occur when users move their heads.

IntroductionThe clinical evolution of steroid-sensitive forms of pediatric idiopathic nephrotic syndrome (INS) is highly heterogeneous following the standard treatment with prednisone. To date, no prognostic marker has been identified to predict the severity of the disease course starting from the first episode.MethodsIn this monocentric prospective cohort study we set up a reproducible and standardized flow cytometry panel using two sample tubes (one for B-cell and one for T-cell subsets) to extensively characterized the lymphocyte repertoire of INS pediatric patients. A total of 44 children with INS at disease onset were enrolled, sampled before and 3 months after standard induction therapy with prednisone and followed for 12 months to correctly classify their disease based on relapses. Age-matched controls with non immune-mediated renal diseases or with urological disorders were also enrolled. Demographical, clinical, laboratory and immunosuppressive treatment data were registered.ResultsWe found that children with INS at disease onset had significantly higher circulating levels of total CD19+ and specific B-cell subsets (transitional, mature-naïve, plasmablasts/plasmacells, CD19+CD27+, unswitched, switched and atypical memory B cells) and reduced circulating levels of Tregs, when compared to age-matched controls. Prednisone therapy restored most B- and T-cell alterations. When patients were subdivided based on disease relapse, relapsing patients had significantly more transitional, CD19+CD27+ memory and in particular unswitched memory B cells at disease onset, which were predictive of a higher risk of relapse in steroid-sensitive patients by logistic regression analysis, irrespective of age. In accordance, B-cell dysregulations resulted mainly associated with steroid-dependence when patients were stratified in different disease severity forms. Of note, Treg levels were reduced independently from the disease subgroup and were not completely normalized by prednisone treatment.ConclusionWe have set up a novel, reproducible, disease-specific flow cytometry panel that allows a comprehensive characterization of circulating lymphocytes. We found that, at disease onset, relapsing patients had significantly more transitional, CD19+CD27+ memory and unswitched memory B cells and those who are at higher risk of relapse had increased circulating levels of unswitched memory B cells, independently of age. This approach can allow prediction of clinical evolution, monitoring of immunosuppression and tailored treatment in different forms of INS.

The gut microbiota is a complex ecosystem of microorganisms residing in the human gastrointestinal tract, playing a crucial role in various biological processes and overall health maintenance. Dysbiosis, an imbalance in the composition and function of the gut microbiota, is linked to systemic autoimmune diseases (SAD). Short-chain fatty acids (SCFAs), especially butyrate, produced by the gut microbiota through the fermentation of dietary fibers, play a significant role in immunomodulation and maintaining intestinal homeostasis. Butyrate is essential for colonocyte energy, anti-inflammatory responses, and maintaining intestinal barrier integrity. Studies show reduced butyrate-producing bacteria in SAD patients, suggesting that increasing butyrate levels could have therapeutic benefits. Butyrate’s anti-inflammatory effects and its potential therapeutic role have been studied in rheumatoid arthritis, Sjogren’s syndrome, systemic lupus erythematosus, systemic sclerosis, and Behçet’s disease. Despite promising in vitro and animal model results, human studies are limited, and the optimal strategies for modulating dysbiosis in SADs remain elusive. This review explores the current evidence on the immunoregulatory role of butyrate and its potential therapeutic effects in SAD.

Abstract Sea ice is a heterogeneous, evolving mosaic of individual floes, varying in spatial scales from meters to tens of kilometers. Both the internal dynamics of the floe mosaic (floe‐floe interactions), and the evolution of floes under ocean and atmospheric forcing (floe‐flow interactions), determine the exchange of heat, momentum, and tracers between the lower atmosphere and upper ocean. Climate models do not represent either of these highly variable interactions. We use a novel, high‐resolution, discrete element modeling framework to examine ice‐ocean boundary layer (IOBL) turbulence within a domain approximately the size of a climate model grid. We show floe‐scale effects could cause a marked increase in the production of fine‐scale three‐dimensional turbulence in the IOBL relative to continuum model approaches, and provide a method of representing that turbulence using bulk parameters related to the spatial variance of the ice and ocean: the floe size distribution and the ocean kinetic energy spectrum.

Wastewater surveillance could provide a means of monitoring SARS-CoV-2 prevalence that does not rely on testing individuals. Here, the authors report results from England’s national wastewater surveillance program, use it to estimate prevalence, and compare estimates with those from population-based prevalence surveys.

(1) Background: Previous studies have reported a correlation between serum anti-Thyroglobulin-antibodies (TgAb) and papillary thyroid carcinoma. The aim of our study was to evaluate whether serum TgAb and anti-thyroid-peroxidase antibody (TPO) positivity was also related to pre-neoplastic histological changes such as papillary-like nuclear features (PLNF) and with the presence of lymphocytic infiltrate (LI) in thyroid surgical specimens. (2) Methods: The study was retrospectively carried out on 70 consecutively recruited patients who underwent thyroidectomy for benign process and whose TgAb and TPOAb values were retrieved from clinical records. Histological sections of thyroid surgical samples were revised, looking for PLNF and lymphocytic infiltrate. HBME1 expression was assessed by immunohistochemistry. (3) Results: Our results showed a significant association between TgAb, PLNF, and lymphocytic infiltrate. The presence of TgAb was highly specific, but less sensitive, in predicting the presence of PLNF (sensitivity = 0.6, specificity = 0.9; positive predictive value (PPV) = 0.88; negative predictive value (NPV) = 0.63). TgAb positivity showed a good association with the presence of lymphocytic infiltrate (sensitivity = 0.62, specificity = 0.9; PPV = 0.88 and NPV = 0.68). HBME1 immunoreactivity was observed in the colloid of follicles showing PLNF and/or closely associated with LI. (4) Conclusions: The presence of PLNF and LI is associated with serum TgAb positivity. The presence of TgAb and of LI could be triggered by an altered thyroglobulin contained in the HBME1-positive colloid, and could be a first defense mechanism against PLNF that probably represent early dysplastic changes in thyrocytes.

In this paper, the efficiency of the carbonic anhydrase (CA) enzyme in accelerating the hydration of CO2 is evaluated using a measurement system which consists of a vessel in which a gaseous flow of mixtures of nitrogen and CO2 is bubbled into water or water solutions containing a known quantity of CA enzyme. The pH value of the solution and the CO2 concentration at the measurement system gas exhaust are continuously monitored. The measured CO2 level allows for assessing the quantity of CO2, which, subtracted from the gaseous phase, is dissolved into the liquid phase and/or hydrated to bicarbonate. The measurement procedure consists of inducing a transient and observing and modelling the different kinetics involved in the steady-state recovery with and without CA. The main contribution of this work is exploiting dynamical system theory and chemical kinetics modelling for interpreting measurement results for characterising the activity of CA enzymes. The data for model fitting are obtained from a standard bioreactor, in principle equal to standard two-phase bioreactors described in the literature, in which two different techniques can be used to move the process itself away from the steady-state, inducing transients.

PurposeObstructive sleep apnea (OSA) is a common, prevalent, and underdiagnosed disorder. Its lack of diagnosis and treatment is associated with increased morbidity and mortality. Previous screening questionnaires investigated parameters including body mass index, age, neck circumference, and sex, in addition to symptoms. This study aimed to validate a new Italian, self-administered, and easy-to-use six-item questionnaire that evaluates only subjective symptoms.Patients and methodsThe present study included 2622 patients (male, 2011; female, 611). Patients who were at least 18 years old, spoke Italian, referred to our sleep clinic for possible OSA, and completed the self-administered SANReSP questionnaire were recruited for the study. The predictive performance of the questionnaire was also evaluated.ResultsNocturnal study showed 89.9% of OSA patients had apnea-hypopnea index (AHI) ≥ 5/h; 68.7%, AHI ≥ 15/h; and 48.2%, AHI ≥ 30/h. The optimal SANReSP score for AHI ≥ 5/h was >3 with a sensitivity and specificity of 74.76% and 67.92%, respectively, and an area under receiver operating characteristic curve (ROC) of 0.76. For moderate-severe OSA, the optimal SANReSP score was >3 (sensitivity, 78.18%; specificity, 46.53%; ROC, 0.66). For severe OSA, the optimal SANReSP score was >4 (sensitivity, 59.10%; specificity, 64.73%; ROC, 0.65). The probability of OSA increased with higher SANReSP scores (98.7% and 97.9% in men and women, respectively).ConclusionThe SANReSP questionnaire is a short, easy-to-use, and self-administered screening tool for OSA. Its performance is similar to that of other widely used questionnaires; furthermore, it is advantageous in that it does not require anthropometric measurements.

In this series of two papers, the humidity sensing of a carbon nanotube’s (CNTs) network-based material is studied through quartz crystal microbalance (QCM) sensors. To this aim, quartzes functionalized with different amounts of sensing material were realized, exposed to different humidity levels, and characterized. In this first paper, the theoretical framework is presented, whereas the second one presents the experimental study. This paper discusses at first the water adsorption and desorption on single-wall carbon nanotube (SWCNT) networks, and subsequently deeply investigates the behavior of QCM-based measurements. Numerical simulations based on the equivalent electrical model of the quartz were used for predicting the vibrational behavior of functionalized QCMs when exposed to different humidity levels, accounting for the effect of the different water adsorption mechanisms: chemisorption, physisorption, and capillary condensation.

In this series of two papers, the humidity sensing of a carbon nanotube (CNT) network-based material is transduced and studied through quartz crystal microbalance (QCM) measurements. To this aim, quartzes functionalized with different amounts of sensing material were realized, exposed to different humidity levels, and characterized. In this second paper, the experimental results are presented and discussed. The sensing mechanisms are elucidated exploiting the theory presented in the first paper of this series. The presented results show that the investigated material functionalization induces a large response of QCM to humidity in terms of resonant frequency even at low RH levels, with a sensitivity of about 12 Hz/%RH (at RH < 30% and room temperature and 10 ug of deposited SWCNT solution) and an increase in sensitivity in the high RH range typical of nanostructured film. Regarding the response in terms of motional resistance, a large response is obtained only at intermediate and high humidity levels, confirming that condensation of water in the film plays an important role in the sensing mechanism of nanostructured materials.

Background Large fat embolus is a rare but potential reversible cause of ischaemic stroke.Methods and results We describe the neurosurgical management of a complete right internal carotid artery occlusion due to a large fat embolus, caused by a mitral valve replacement.Conclusion Knowledge of acute cerebral ischaemia due to large fat embolism and its hallmark ‘hypodense artery’ is mandatory. Extracranial to intracranial bypass is a feasible rescue treatment after failure of endovascular embolectomy.

Anti-CD20 therapy is effective in idiopathic nephrotic syndrome (INS). However, transient or sustained hypogammaglobulinemia predisposing to an increased risk of infectious diseases can follow treatment in some patients. We analyzed the long-term effects of anti-CD20 therapy on immunological memory in 27 frequently-relapsing/steroid-dependent INS pediatric patients after more than 4 years from the first and at least 2 years from the last anti-CD20 infusion. Twenty-one INS children, never treated with anti-CD20 and under an intense oral immunosuppression with prednisone, mycophenolate mofetil, and calcineurin inhibitors were also included as control group. Levels of circulating B-cell subpopulations, total serum immunoglobulins and IgG and memory B cells directed against hepatitis B virus (HBV) and tetanus were determined and correlated with clinical characteristics. Nine patients never relapsed after more than 2 years from the last anti-CD20 administration (5 after the first, 3 after the second, and 1 after the fifth infusion). At last follow-up, most patients showed a complete recovery and normalization of total (27/27), transitional (27/27), and mature-naïve B cells (25/27). However, a sustained and significant reduction of total memory (20/27) and switched memory (21/27) B cells was found in most patients. 11/27 patients showed hypogammaglobulinemia at last follow-up and, among these, four presented with a severe hypogammaglobulinemia (IgG < 160 mg/dl). In contrast, no patient in the control group developed a severe hypogammaglobulinemia. Age at the time of first anti-CD20 administration was positively associated with IgG levels at last follow-up (p = 0.008); accordingly, younger patients had an increased risk of hypogammaglobulinemia (p = 0.006). Furthermore, severe hypogammaglobulinemia and delayed switched memory B-cell reconstitution were more frequent in non-relapsing patients. Reduced IgG levels against HBV and tetanus were observed at baseline and further declined at last follow-up. Antigen-specific memory B-cells were induced by re-immunization, but specific IgG titers remained low. In conclusion, anti-CD20 therapy can be disease-modifying in some INS patients. However, a prolonged impairment of immunological memory occurs frequently, independently from the number of anti-CD20 infusions, particularly in younger patients. Re-immunization may be necessary in these patients.

This work proposes a model describing the dynamic behavior of sensing films based on functionalized MWCNT networks in terms of conductivity when exposed to time-variable concentrations of NO2 and operating with variable working temperatures. To test the proposed model, disordered networks of MWCNTs functionalized with COOH and Au nanoparticles were exploited. The model is derived from theoretical descriptions of the electronic transport in the nanotube network, of the NO2 chemisorption reaction and of the interaction of these two phenomena. The model is numerically implemented and then identified by estimating all the chemical/physical quantities involved and acting as parameters, through a model fitting procedure. Satisfactory results were obtained in the fitting process, and the identified model was used to further the analysis of the MWCNT sensing in dynamical conditions.

TiO2 nanoparticles coating has been proven to be an extremely performing sensing material for relative humidity (RH) measurements. The chemical activity of TiO2 toward water vapor adsorption and the very large surface to volume ratio typical of nanostructures are ideal characteristics for the development of RH fast and sensitive sensors. Different sensor technologies can be used in conjunction with this material to realize devices with satisfactory performance. In this paper, the authors aim to describe and discuss the main different possible choices and highlight the advantages and disadvantages, and linking them both to the underlying mechanism of water adsorption on the TiO2 sensing layer and to the modification of the electrical behavior due to the water adsorption. In particular, the authors start from results obtained by depositing TiO2 nanoparticles on a novel MEMS microbalance operating at low frequency, which allows to sense only the adsorbed water mass, and they exploit the sensor output to obtain a dynamic model of the water adsorption. They also link these results to those obtained with a Quartz Crystal Microbalance (QCM) functionalized with the same material operating at 10 MHz as a part of an oscillator. Finally, they establish a link with the results obtained by an RH impedance sensor, which exploits the same active material and the same deposition technique. With this sensor technology, the conductive and electrical behavior of the sensing and adsorbed films play a role. The whole work tries to unravel the different phenomena that contribute to the response of RH sensors not only based on TiO2 nanoparticles but also, more generally, based on nanostructured metal oxide materials.

In this paper, NO2 sensing by means of single-wall carbon nanotubes (SWCNT) networks, decorated with nanoparticles of TiO2 and Au, is proposed. In particular, it is shown that the performance of these materials can be enhanced using pulsed temperature mode. This sensing strategy effectiveness is theoretically and experimentally assessed. In this paper, in fact, a dynamic model for conductive gas sensors formed by networks of nanowires, considering the junctions between different wires as the main contribution to sensor conductance, and in the presence of the target gas, is presented and validated. The model accounts for variable temperature and gas concentration and sheds some light on the mechanisms leading to the sensor response improvement related to temperature pulsed working mode. It is also shown how the addition of a different material can be modeled through different surface adsorption kinetics.

Type 1 diabetes and thyroid disease are T cell-dependent autoimmune endocrinopathies. The standard substitutive administration of the deficient hormones does not halt the autoimmune process; therefore, development of immunotherapies aiming to preserve the residual hormonal cells, is of crucial importance. PTPN22 C1858T mutation encoding for the R620W lymphoid tyrosine phosphatase variant, plays a potential pathophysiological role in autoimmunity. The PTPN22 encoded protein Lyp is a negative regulator of T cell antigen receptor signaling; R620W variant, leading to a gain of function with paradoxical reduced T cell activation, may represent a valid therapeutic target. We aimed to develop novel wild type PTPN22 short interfering RNA duplexes (siRNA) and optimize their delivery into Jurkat T cells and PBMC by using liposomal carriers. Conformational stability, size and polydispersion of siRNA in lipoplexes was measured by CD spectroscopy and DLS. Lipoplexes internalization and toxicity evaluation was assessed by confocal microscopy and flow cytometry analysis. Their effect on Lyp expression was evaluated by means of Western Blot and confocal microscopy. Functional assays through engagement of TCR signaling were established to evaluate biological consequences of down-modulation. Both Jurkat T cells and PBMC were efficiently transfected by stable custom lipoplexes. Jurkat T cell morphology and proliferation was not affected. Lipoplexes incorporation was visualized in CD3+ but also in CD3- peripheral blood immunotypes without signs of toxicity, damage or apoptosis. Efficacy in affecting Lyp protein expression was demonstrated in both transfected Jurkat T cells and PBMC. Moreover, impairment of Lyp inhibitory activity was revealed by increase of IL-2 secretion in culture supernatants of PBMC following anti-CD3/CD28 T cell receptor-driven stimulation. The results of our study open the pathway to future trials for the treatment of autoimmune diseases based on the selective inhibition of variant PTPN22 allele using lipoplexes of siRNA antisense oligomers.

OBJECTIVES: To investigate the usefulness of measuring upper airway collapsibility with a negative expiratory pressure application as a screening test for severe obstructive sleep apnea (OSA). INTRODUCTION: OSA is a risk factor for cardiovascular disease, and it may have serious consequences. Its recognition may have important implications during the perioperative period. Increased upper airway collapsibility is one of the main determinants of OSA, and its evaluation could be useful for identifying this condition. METHODS: Severe OSA and normal subjects (24 in each group) were matched by body mass index and referred to our sleep laboratory. The subjects were enrolled in an overnight sleep study, and a diurnal negative expiratory pressure test was performed. Flow drop (DV) and expiratory volume were measured in the first 0.2 s (V02) of the negative expiratory pressure test. RESULTS: DV (%) and V02 (%) values were statistically different between normal and OSA subjects. OSA patients showed a greater decrease in flow than normal subjects. In addition, severely OSA patients exhaled during the first 0.2 s of the negative expiratory pressure application was an average of only 11.2% of the inspired volume compared to 34.2% for the normal subjects. Analysis of the receiver operating characteristics showed that V02 (%) and DV (%) could accurately identify severe OSA in subjects with sensitivities of 95.8% and 91.7%, respectively, and specificities of 95.8% and 91.7%, respectively. CONCLUSIONS: V02 (%) and DV (%) are highly accurate parameters for detecting severe OSA. The pharyngeal collapsibility measurement, which uses negative expiratory pressure during wakefulness, is predictive of collapsibility during sleep.

OBJECTIVE: Obstructive sleep apnea is characterized by increased upper airway collapsibility during sleep. The present study investigated the use of the negative expiratory pressure test as a method to rule out obstructive sleep apnea. METHODS: Flow limitation was evaluated in 155 subjects. All subjects underwent a diurnal negative expiratory pressure test and a nocturnal sleep study. The severity of sleep apnea was determined based on the apneahypopnea index. Flow limitation was assessed by computing the exhaled volume at 0.2, 0.5, and 1.0 s (V0.2, V0.5, and V1.0, respectively) during the application of a negative expiratory pressure and expressed as a percentage of the previous exhaled volume. Receiver-operating characteristic curves were constructed to identify the optimal threshold volume at 0.2, 0.5, and 1.0 s for obstructive sleep apnea detection. RESULTS: Mean expiratory volumes at 0.2 and 0.5 s were statistically higher (p

We assessed whether obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with severity of liver fibrosis and carotid atherosclerosis in patients with biopsy-proven NAFLD and low prevalence of morbid obesity. Secondary aim was to explore the association of OSA and hypoxemia with NASH and severity of liver pathological changes.Consecutive patients (n = 126) with chronically elevated ALT and NAFLD underwent STOP-BANG questionnaire to estimate OSA risk and ultrasonographic carotid assessment. In patients accepting to perform cardiorespiratory polygraphy (PG, n = 50), OSA was defined as an apnea/hypopnea index ≥5. A carotid atherosclerotic plaque was defined as a focal thickening >1.3 mm.Prevalence of high OSA risk was similar in patients refusing or accepting PG (76% vs 68%, p = 0.17). Among those accepting PG, overall OSA prevalence was significantly higher in patients with F2-F4 fibrosis compared to those without (72% vs 44%; p = 0.04). Significant fibrosis was independently associated with mean nocturnal oxygen saturation (SaO2)1 (OR 6.30, 95%C.I. 1.02-12.3; p = 0.01).In NAFLD patients with chronically elevated ALT at low prevalence of morbid obesity, OSA was highly prevalent and indexes of SaO2 resulted independently associated with severity of liver fibrosis and carotid atherosclerosis. These data suggest to consider sleep disordered breathing as a potential additional therapeutic target in severe NAFLD patients.

Type 1 diabetes is an autoimmune disease caused by the destruction of pancreatic beta cells by autoreactive T cells. Among the genetic variants associated with type 1 diabetes, the C1858T (Lyp) polymorphism of the protein tyrosine phosphatase non-receptor type 22 (PTPN22) gene alters the function of T cells but also of B cells in innate and adaptive immunity. The Lyp variant was shown to diminish interferon production and responses upon Toll-like receptor stimulation in macrophages and dendritic cells, possibly leading to uncontrolled infections as triggers of the diabetogenic process. The aim of this study was to unravel the yet uncharacterized effects that the variant could exert on the immune and autoimmune responses, particularly regarding the B cell phenotype, in the peripheral blood lymphocytes of diabetic patients and healthy controls in basal conditions and after unmethylated bacterial DNA CpG stimulation. The presence of the Lyp variant resulted in a significant increase in the percentage of transitional B cells in C/T carriers patients and controls compared to C/C patients and controls, in C/T carrier patients compared to C/C controls and in C/T carrier patients compared to C/C patients. A significant reduction in the memory B cells was also observed in the presence of the risk variant. After four days of CpG stimulation, there was a significant increase in the abundance of IgM+ memory B cells in C/T carrier diabetics than in C/C subjects and in the groups of C/T carrier individuals than in C/C individuals. IgM- memory B cells tended to differentiate more precociously into plasma cells than IgM+ memory B cells in heterozygous C/T subjects compared to the C/C subjects. The increased Toll-like receptor response that led to expanded T cell-independent IgM+ memory B cells should be further investigated to determine the putative contribution of innate immune responses in the disease pathogenesis.

A 20% increase in REM sleep duration has been proposed as a threshold to identify REM rebound in patients with obstructive sleep apnea (OSA) who start continuous positive airway pressure (CPAP) treatment. We describe the case of one patient with OSA who showed an unexpectedly high degree of REM rebound during titration of CPAP. A 34-year-old man was diagnosed with OSA. He remained untreated for many years, during which he developed systemic hypertension, depression, and severe daytime somnolence. When he was reevaluated sixteen years later, his Epworth sleepiness score was 18, and his OSA had greatly worsened (apnea/hypopnea index: 47, lowest nocturnal saturation: 57%). He underwent a successful CPAP titration during nocturnal polysomnography. Electroencephalographic analysis of the sleep recording revealed a huge amount of REM sleep, accounting for 72% of the total sleep time. When asked, the patient referred that he had suddenly interrupted paroxetine assumption three days before the polysomnography. The very large REM rebound observed in this patient could be due to additional effects of initiation of CPAP therapy and suspension of antidepressive treatment. This case does not report any dangerous consequence, but sudden antidepressive withdrawal could be dangerous for patients with OSA who develop hypoventilation during REM sleep with CPAP application.

ABSTRACT Objective: To determine whether the use of a gel pillow with side cutouts designed to accommodate a continuous positive airway pressure (CPAP) mask and reduce head temperature improves the efficacy of and adherence to auto-CPAP therapy. Methods: Twenty-three consecutive CPAP-naïve patients with obstructive sleep apnea were enrolled in the study. Patients were given an auto-CPAP machine with an appropriate CPAP mask and were instructed to use CPAP for 15 nights. They were instructed to sleep with their own pillow (the control pillow) from nights 1 to 5 and with either a foam pillow or a gel pillow, both of which had side cutouts, for 5 consecutive nights each, in random order. After night 15, auto-CPAP machine data were downloaded and patients rated their satisfaction with each pillow on a visual analog scale. Results: Twenty-two patients completed the protocol. The pressures administered, residual apnea-hypopnea index, air leaks, and mean duration of CPAP use did not differ among the periods during which each pillow was used. Patients were significantly more satisfied with the gel pillow than with the control pillow and the foam pillow (p = 0.022 and p = 0.004, respectively), their level of satisfaction with the gel pillow correlating significantly with excessive daytime sleepiness (r2 = 0.19; p = 0.0443). Conclusions: Among obstructive sleep apnea patients treated with nasal CPAP, the use of a gel pillow with side cutouts appears to have no impact on treatment effectiveness. Nevertheless, such patients seem to prefer a gel pillow over other types of pillows.

Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery for internal carotid artery (ICA) occlusive disease necessarily requires sufficient external carotid artery (ECA) blood flow. Surgical bypass is therefore precluded if there is common carotid artery (CCA) occlusion. Here we present two such cases: one patient had a CCA occlusion and the other had an ICA occlusion and ECA stenosis. Both had failed medical management, and were therefore treated with angioplasty and stenting of the ECA, followed by STA-MCA bypass. We describe the clinical and radiologic outcomes of these cases, and remark on the potential pitfalls associated with this novel approach. [ABSTRACT FROM AUTHOR]

Abstract Decision-making for temporomandibular disorders (TMDs) is reported being a clinical challenge, partly due to uncertainities in assessment of long-term prognosis. Therefore, our aim was to explore variations over time in TMD symptoms and possible sex or age differences. In this cohort study, data were prospectively collected 2010–2017 from the general population in Västerbotten, Northern Sweden. Adults were eligible if they had undergone at least two routine dental check-ups that included screening for TMDs (3Q/TMD) from which states were defined as absence or presence of TMD pain and/or jaw catching/locking. The rate of transitions was estimated between TMD states within a time span of one year. A total of 94,769 individuals were included (49.9% women) with 205,684 repeated visits and 9,006 state transitions recorded over the 8-year period. Compared to men, women had higher rates of transitions from no TMDs to any TMD symptoms. Furthermore, women had a lower rate of transition from TMD pain only to no TMDs. The finding of a poorer prognosis in women, as well as previously reported potential gender differences in pain perception and reporting, reinforces that gender differences should be accounted for in the treatment planning stage for patients with onset of TMDs.

Abstract Background Sleep is substantial issue for hospital inpatients and can negatively affect healing and recovery. There is a good evidence-base for interventions which can improve sleep, however currently they are not being implemented into NHS practice. To address the evidence-practice gap, we have conducted early-phase development for an inpatient sleep intervention (ASLEEP); a multi-level intervention to improve inpatient sleep in UK hospital wards. Methods We used an iterative development process incorporating Patient and Public Involvement and Engagement, ward staff surveys and stakeholder consultations (orthopaedic and acute medicine), and theoretical mapping using behaviour change theories. Development took place in four stages: identification of existing patient-level intervention components to improve sleep in hospital; identification of environmental barriers and facilitators to sleep in hospital; consultation with health professional stakeholders; and final theoretical mapping using the COM-B model and Theoretical Domains Framework, also considering who holds ‘change power’ for each change construct. Results We identified 18 variables contributing to inpatient sleep, which are malleable to change universally across hospital wards. Central domains for change were identified as the ward environment context and resources; to reduce noise from equipment (material resources), and social influence; to modulate staff and patient noise awareness and behaviours (group norms). Change power mapping identified key stakeholders as patients, ward staff, procurement/estates, and NHS management. Conclusions Improving sleep in hospital requires a whole-systems approach which targets environmental factors, staff behaviour, and patient behaviour. We have provided recommendations for a multi-level intervention, highlighting core areas for change and essential stakeholders who must be involved to progress implementation. The next stage of development will involve operationalising recommendations and piloting, including evaluating mechanisms of change. It will be important to continue working with a broad range of stakeholders to bridge the evidence-practice gap and support sustainable practice adoption.

Summary: Accurately assessing flap volume and thickness is a crucial aspect of breast reconstruction using the deep inferior epigastric perforator (DIEP) flap, especially in challenging cases such as thin or large-breasted women or bilateral reconstruction. To address this, we present an innovative image processing tool utilizing computed tomography angiography (CTA) to measure DIEP flap volume and thickness. Our approach incorporates an elliptical equation validated on DIEP reconstruction patients. Preoperative abdominal CTA images were obtained from 70 patients who underwent DIEP flap breast reconstruction at Hospital Universitari de Bellvitge from 2017 to 2021. The image processing tool was employed for preoperative quantification, utilizing elliptical approximations, to determine the volume to be harvested and assess the central thickness of the flap. Subsequently, a non-parametric statistical retrospective analysis was conducted to examine these parameters in relation to immediate complications. The mean maximum recruitable volume (MRV) was 1017.15 ± 325.51 cm³, with a mean thickness of 3.65 ± 1.14 cm. No significant correlation was found between postoperative complications and MRV or thickness values. The processing tool offers a reliable solution for accurately measuring the volume and thickness of the DIEP flap from CTA images, aiding surgeons in breast reconstruction decision-making. This innovative approach enhances surgical planning by addressing quantitative values of thickness and volume of the DIEP flap, which is critical for accurate flap assessment.