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Abstract Purpose Here we describe a patient admitted for a stroke that was unexpectedly correlated with subclinical infective endocarditis attributable to a rarely opportunistic pathogen, Abiotrophia defectiva. Case report A 75-year-old man presented with a stroke. Transesophageal echocardiography suggested vegetation on all aortic valve cusps, despite the absence of clinical or laboratory signs of infection. Surprisingly, three sets of blood cultures collected without fever were positive for A. defectiva. Although the patient did not exhibit classic signs of infection during hospitalization, the severity of the valve condition necessitated replacement with a bioprosthesis. Conclusions This clinical case underscores the importance of investigating the infective origin of endocarditis, even in the absence of clinical or laboratory evidence. Physicians should maintain a high level of suspicion, especially in patients with highly suggestive anamnestic characteristics.

La tabaquera anatómica, una región triangular en la porción dorso-radial de la muñeca, es un punto de referencia anatómico clave. Está delimitada por los tendones del extensor largo del pulgar, extensor corto del pulgar y abductor largo del pulgar, y alberga la arteria radial y ramas nerviosas. Patologías como quistes sinoviales, fracturas y osteofitos pueden alterar su apariencia. Estudios sobre lesiones del ligamento escafolunar (SLL) muestran que el daño crónico provoca el desplazamiento dorso-radial del escafoides, iniciando un proceso degenerativo conocido como colapso avanzado escafolunar (SLAC). Esto a menudo resulta en la "desaparición" de la tabaquera anatómica, lo que facilita la identificación de pacientes con muñeca SLAC junto con síntomas como dolor y rigidez. La afección es impulsada por la formación de osteofitos, subluxación del escafoides y sinovitis, lo que conduce a inestabilidad articular y deformidad. Los tratamientos tradicionales, como la estiloidectomía, pueden no resolver completamente la inestabilidad. Nuevos enfoques que consideran la dinámica tridimensional de la muñeca podrían ser más efectivos para manejar el SLAC. Estudios biomecánicos sugieren que las lesiones del SLL, junto con la pérdida de estabilizadores secundarios, provocan que el escafoides se pronuncie y flexione, resultando en una proyección dorso-radial dentro de la fosa del escafoides. Sin tratamiento, esto puede progresar a SLAC, frecuentemente caracterizado por el "bulto dorso-radial de la muñeca".

Honey, a natural food with a rich history, is produced by honeybees and other species of bees from nectar, other plant fluids, and honeydew of sap-sucking insects. During foraging, these bees may be exposed to plant protection products (PPPs), metals, and metalloids, potentially leading to residues in honey and hive products that could have a negative impact on human safety. Recognizing the lack of an appropriate methodology for pesticide contamination of honey and other hive products, this research aims to support the need for studies on residues in pollen and bee products for human consumption to establish safe maximum residue levels (MRLs) for consumers. A UHPLC-MS/MS residues method and a modified QuEChERS extraction were applied to simultaneously determine 237 pesticide residues in honey and pollen. The study in North Sardinia analyzed honey and pollen samples from six areas for pesticide residues and verified 27 heavy metals and metalloid residues using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). The data obtained showed residues at levels close to the LOQ of the method, cycloate in a few samples of pollen, and dichlorvos, zoxamide, cycloate, and chlorantraniliprole in honey samples. All samples showed the absence of heavy metal contamination. Overall, no risk to human health was identified. The results of this study confirm that honey and pollen may be a good bioindicator of environmental contamination of a wide area surrounding honeybee hives.

Artichoke (Cynara cardunculus L.) is an herbaceous perennial plant from the Mediterranean Basin, cultivated as a poly-annual crop in different countries. Artichoke produces a considerable amount of waste at the end of the harvesting season in the field (5.2 tons/ha/year, DW) and from the industrial processing of fresh-cut products during the harvesting time (800 tons/year). The qualitative and quantitative phenolic profile and inulin content of artichoke samples from the field and industrial processing waste have been investigated after green extraction. The best operative conditions were achieved using the dried biomass extracted with water at 80 °C for 120 min and a matrix-to-solvent ratio of 1:30. The data obtained showed that the concentration of total polyphenols in fresh artichokes followed this order: stems > heads > leaves > outer bracts. Chlorogenic acid and 3,4 di-O-caffeoylquinic acid were the most concentrated caffeoylquinic derivates, whereas luteolin 7-O-malonyglucoside, luteolin 7-O-glucoside and 7-O-rutinoside were the most abundant flavonoids. The artichoke by-products showed high polyphenolic and inulin values, thus representing an important source of health-promoting biomolecules for application in pharmaceutical and cosmeceutical fields. According to the principles of circular economy, the work scheme proposed in this article, the use of waste and its processing into useful products such as nutraceutical supplies could provide a practical and economic opportunity for companies and farmers involved in the cultivation and industrial processing of artichokes.

After several years of public road testing, the commercial deployment of fully autonomous vehicles—or Automated Driving Systems (ADS)—is poised to scale substantially following significant technological advancements and recent regulatory approvals. However, the fundamental question of whether an ADS is safer than its human counterparts remain largely unsolved due to several challenges in establishing an appropriate real-world safety comparison method. As scaling ensues, the lack of an established method can contribute to misinterpretations or uncertainties regarding ADS safety and impede the continuous and consistent assessment of ADS performance. This study introduces three research developments to define a robust and replicable safety comparison method to address this critical methodological gap. First, we introduce the use of liability insurance claims data to measure the comparative safety between ADS and human drivers. Second, we use Swiss Re insurance claims data to establish the first zip code- and responsibility-calibrated human performance benchmark, composed of over 600,000 private passenger vehicle claims and 125 billion miles of driving exposure. Third, we perform a case study by applying the developed baseline to evaluate the safety impact of the Waymo Driver. We find that when benchmarked against zip code-calibrated human baselines, the Waymo Driver significantly improves safety towards other road users. The comparison method established in this study can be replicated for other regions or ADS deployments to aid the decision-making of ADS safety stakeholders such as regulators, and instill trust in the general public.

The scapholunate ligamentous complex consists of the scapholunate interosseous ligament and the surrounding extrinsic ligamentous system. In cases of chronic scapholunate instability, stabilizing the extrinsic ligaments is crucial. This article presents an arthroscopic capsuloligamentous reinforcement plicature that focuses on tightening the volar scapholunate extrinsic ligaments, namely the radioscaphocapitate ligament and long radiolunate ligament, along with indirect tightening of the volar scapholunate interosseous ligament. Although it may be challenging to differentiate the effect of the volar extrinsic plicature from a dorsal capsular reinforcement when both are applied, the volar extrinsic plicature can serve as a beneficial addition to dorsal capsular reinforcement techniques for complex scapholunate instability.

ObjectivesThe purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.MethodsNineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of '0', '5' and '10' reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of '8' or higher for 80% or more of the panellists.ResultsTen of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.ConclusionsDelphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.Key points• Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.

Artichoke (Cynara cardunculus L.) is an herbaceous perennial plant from the Mediterranean Basin, cultivated as a poly-annual crop in different countries. Artichoke produces a considerable amount of waste at the end of the harvesting season in the field (5.2 tons/ha/year, DW) and from the industrial processing of fresh-cut products during the harvesting time (800 tons/year). The qualitative and quantitative phenolic profile and inulin content of artichoke samples from the field and industrial processing waste have been investigated after green extraction. The best operative conditions were achieved using the dried biomass extracted with water at 80 °C for 120 min and a matrix-to-solvent ratio of 1:30. The data obtained showed that the concentration of total polyphenols in fresh artichokes followed this order: stems > heads > leaves > outer bracts. Chlorogenic acid and 3,4 di-O-caffeoylquinic acid were the most concentrated caffeoylquinic derivates, whereas luteolin 7-O-malonyglucoside, luteolin 7-O-glucoside and 7-O-rutinoside were the most abundant flavonoids. The artichoke by-products showed high polyphenolic and inulin values, thus representing an important source of health-promoting biomolecules for application in pharmaceutical and cosmeceutical fields. According to the principles of circular economy, the work scheme proposed in this article, the use of waste and its processing into useful products such as nutraceutical supplies could provide a practical and economic opportunity for companies and farmers involved in the cultivation and industrial processing of artichokes. [ABSTRACT FROM AUTHOR]

Honey, a natural food with a rich history, is produced by honeybees and other species of bees from nectar, other plant fluids, and honeydew of sap-sucking insects. During foraging, these bees may be exposed to plant protection products (PPPs), metals, and metalloids, potentially leading to residues in honey and hive products that could have a negative impact on human safety. Recognizing the lack of an appropriate methodology for pesticide contamination of honey and other hive products, this research aims to support the need for studies on residues in pollen and bee products for human consumption to establish safe maximum residue levels (MRLs) for consumers. A UHPLC-MS/MS residues method and a modified QuEChERS extraction were applied to simultaneously determine 237 pesticide residues in honey and pollen. The study in North Sardinia analyzed honey and pollen samples from six areas for pesticide residues and verified 27 heavy metals and metalloid residues using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). The data obtained showed residues at levels close to the LOQ of the method, cycloate in a few samples of pollen, and dichlorvos, zoxamide, cycloate, and chlorantraniliprole in honey samples. All samples showed the absence of heavy metal contamination. Overall, no risk to human health was identified. The results of this study confirm that honey and pollen may be a good bioindicator of environmental contamination of a wide area surrounding honeybee hives. [ABSTRACT FROM AUTHOR]

The triangular fibrocartilaginous complex is made of multiple components, of which the palmar and dorsal radioulnar ligaments play an important role in distal radioulnar joint stability. The ulnar wrist ligaments may be injured during forearm and wrist trauma. There are several aspects of triangular fibrocartilaginous complex management that are still open to debate. The aim of the present study was to review the current concepts and discuss emerging trends to better elucidate and treat this important ligament complex. Level of evidence: V [ABSTRACT FROM AUTHOR]

Fourth-range products are those types of fresh fruit and vegetables that are ready for raw consumption or after cooking, and belong to organic or integrated cultivations. These products are subject to mild post-harvesting processing procedures (selection, sorting, husking, cutting, and washing), and are afterwards packaged in packets or closed food plates, with an average shelf life of 5–10 days. Artichokes are stripped of the leaves, stems and outer bracts, and the remaining heads are washed with acidifying solutions. The A LC-MS/MS analytical method was developed and validated following SANTE guidelines for the detection of 220 pesticides. This work evaluated the distribution of pesticide residues among the fraction of artichokes obtained during the industrial processing, and the residues of their wastes left on the field were also investigated. The results showed quantifiable residues of one herbicide (pendimethalin) and four fungicides (azoxystrobin, propyzamide, tebuconazole, and pyraclostrobin). Pendimethalin was found in all samples, with the higher values in leaves 0.046 ± 8.2 mg/kg and in field waste 0.30 ± 6.7 mg/kg. Azoxystrobin was the most concentrated in the outer bracts (0.18 ± 2.9 mg/kg). The outer bracts showed the highest number of residues. The industrial waste showed a significant decrease in the number of residues and their concentration.

Introduction: In premature neonates, the persistence of hemodynamically significant ductus arteriosus (hsPDA) can be associated with short- and long-term consequences, impairing their outcome. The correct strategy of management for such condition is under debate, especially regarding contraindications and/or side effects. In recent years, metabolomics was applied to several perinatal, pediatric, and adult conditions to investigate potential biomarkers of disease, which have become useful for early diagnosis and/or therapeutic management.Aim of the Study: The main purpose of our exploratory study was to asses, through 1H-NMR metabolomics analysis of urinary samples at birth, possible metabolic pathways differentiating, with a significant predictive power, those preterm neonates who will subsequently develop hsPDA and neonates of comparable gestational age (GA) who will undergo spontaneous ductal closure or the persistence of an irrelevant PDA (no-hsPDA). Moreover, we investigated potential prenatal or perinatal clinical factors potentially influencing the development of hsPDA.Materials and Methods: We enrolled n = 35 preterm neonates with GA between 24 and 32 weeks; urinary samples were collected within the first 12 h of life. Patients were closely monitored regarding intensive care, respiratory support, fluid balance and administered drugs; an echocardiogram was performed at 48–72 h.Results: Our results reported a significant correlation between lower GA at birth and the development of hsPDA. Moreover, neonates with GA ≤ 30w developing hsPDA were characterized by lower Apgar scores at 1′ and 5′, higher rates of perinatal asphyxia, higher need of delivery room resuscitation and subsequent surfactant administration. Interestingly, metabolomics analysis at birth detected a clear separation between the 1H-NMR urinary spectra of subjects GA ≤ 30w not developing hsPDA (n = 19) and those of subjects born at GA ≤ 30w in which hsPDA was confirmed at 48–72 h of life (n = 5).Conclusions: This is the first study applying metabolomics to investigate the PDA condition. Although preliminary and conducted on a limited sample, our results reveal that metabolomics could be a promising tool in the early identification of hsPDA, potentially superior to the clinical or laboratory predictive tools explored to date and even to the clinical observations and correlations in our sample, through the detection of specific urinary metabolites.