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One of the risks of distraction osteogenesis-based techniques is the development of vascular complications, such as pseudoaneurysms associated with the osteotomies performed or the fixation elements of the external fixator used in the procedure.Pseudoaneurysm are formed when the tunica adventitia of the artery is injured, resulting in a gradual and persistent blood extravasation into the surrounding tissues that is encapsulated and connected to the arterial lumen.This report describes a rare case of a late-presentation pseudoaneurysm in the anterior tibial artery resulting from a tibial lengthening procedure aimed at addressing a leg length discrepancy in a 57-year-old female with severe peripheral neuropathy resulting from long-standing poorly controlled diabetes mellitus. We describe the diagnostic process, the treatment options and confirm how the shape of the bony callus can be a reliable indicator of this pathology, as has already been described in the literature.

IntroductionAtaxia telangiectasia (AT) is a rare disorder characterized by neurodegeneration, combined immunodeficiency, a predisposition to malignancies, and high clinical variability. Profiling of microRNAs (miRNAs) may offer insights into the underlying mechanisms of complex rare human diseases, as miRNAs play a role in various biological functions including proliferation, differentiation, and DNA repair. In this study, we investigate the differential expression of miRNAs in samples from AT patients to identify miRNA patterns and analyze how these patterns are related to the disease.MethodsWe enrolled 20 AT patients (mean age 17.7 ± 9.6 years old) and collected clinical and genetic data. We performed short non-coding RNA-seq analysis on peripheral blood mononuclear cells (PBMCs) and fibroblasts to compare the miRNA expression profile between AT patients and controls.ResultsWe observed 42 differentially expressed (DE)-miRNAs in blood samples and 26 in fibroblast samples. Among these, three DE-miRNAs, miR-342-3p, miR-30a-5p, and miR-195-5p, were further validated in additional AT samples, confirming their dysregulation.DiscussionWe identified an AT-related miRNA signature in blood cells and fibroblast samples collected from a group of AT patients. We also predicted several dysregulated pathways, primarily related to cancer, immune system control, or inflammatory processes. The findings suggest that miRNAs may provide insights into the pathophysiology and tumorigenesis of AT and have the potential to serve as useful biomarkers in cancer research.

Aerogels based on natural polymers are of increasing interest in the biomedical field due to their biocompatibility, bioactivity, biodegradability and, in certain cases, extracellular matrix biomimicry. However, sterility has been a critical quality attribute limiting the use of aerogels in biomedicine. This work introduces a new and environmental-friendly technique based on the use of CO2 called in situ sterilization that enables the manufacturing of sterile aerogel in a one-pot process. Starch aerogel cylinders and alginate aerogel beads enclosed within sterilization pouches were produced using this approach. The study involved the redesign of the flow diagram for aerogel production and the study of the effect of key parameters in the process (additive type and content, agitation, CO2 flow regime type and duration) on the resulting material. The obtained materials were evaluated regarding their texture (helium pycnometry, N2 adsorption-desorption analysis, SEM) and their sterility against three standardized bioindicators. Finally, the sterile aerogel materials were put in contact with NIH-3T3 cells assessing their cytocompatibility. Under the optimal operating conditions with 4.5 h of processing time, the aerogels were sterile, cytocompatible and had a porosity of ca. 80 % and a specific surface area of ca. 80 m2/g and 200 m2/g, for starch and alginate aerogels, respectively. Results allowed to identify the feasible operating region as well as the optimum processing values to obtain the typical nanostructure of aerogels, whilst ensuring suitable regulatory sterilization levels for aerogel implantation and cytocompatibility of the sterile material with fibroblastic cells.

Abstract Mantle cell lymphoma (MCL) is an incurable B-cell neoplasm characterized by an aggressive behavior, short responses to conventional therapies and SOX11 overexpression, which is associated with aggressive disease features and inferior clinical outcome of patients. Oxidative stress is known to induce tumorigenesis and tumor progression, whereas high expression levels of antioxidant genes have been associated with chemoresistance in different cancers. However, the role of oxidative stress in MCL pathogenesis and the involvement of SOX11 regulating redox homeostasis in MCL cells are largely unknown. Here, by integrating gene set enrichment analysis of two independent series of MCL, we observed that SOX11+ MCL had higher reactive oxygen species (ROS) levels compared to SOX11− MCL primary tumors and increased expression of Peredoxine2 (PRDX2), which upregulation significantly correlated with SOX11 overexpression, higher ROS production and worse overall survival of patients. SOX11 knockout (SOX11KO) significantly reduced PRDX2 expression, and SOX11KO and PRDX2 knockdown (PRDX2KD) had increased ROS levels and ROS-mediated tumor cell death upon treatment with drugs, compared to control MCL cell lines. Our results suggest an aberrant redox homeostasis associated with chemoresistance in aggressive MCL through SOX11-mediated PRDX2 upregulation, highlighting PRDX2 as promising target for new therapeutic strategies to overcome chemoresistance in aggressive MCLs.

Abstract Background The burden of disease of diabetes in Colombia have increased in the last decades. Secondary prevention is crucial for diabetes control. Many patients already treated remain with poor glycemic control and without timely and appropriate treatment intensification. This has been called in the literature as Clinical Inertia. Updated information regarding clinical inertia based on the Colombian diabetes treatment guidelines is needed. Objective To measure the prevalence of clinical inertia in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients in healthcare institutions in Colombia, based on the recommendations of the current official guidelines. Methods An observational and retrospective cohort study based on databases of two Health Medical Organizations (HMOs) in Colombia (one from subsidized regimen and one from contributory regimen) was conducted. Descriptive analysis was performed to summarize demographic and clinical information. Chi-square tests were used to assess associations between variables of interest. Results A total of 616 patients with T2DM (308 for each regimen) were included. Median age was 61 years. Overall clinical inertia was 93.5% (87.0% in contributory regimen and 100% in subsidized regimen). Patients with Hb1Ac ≥ 8% in the subsidized regimen were more likely to receive monotherapy than patients in the contributory regimen (OR 2.33; 95% CI 1.41–3.86). Conclusions In this study, the prevalence of overall clinical inertia was higher in the subsidized regime than in the contributory regime (100% vs 87%). Great efforts have been made to equalize the coverage between the two systems, but this finding is worrisome with respect to the difference in quality of the health care provided to these two populations. This information may help payers and clinicians to streamline strategies for reducing clinical inertia and improve patient outcomes.

Summary: Human genetic studies of critical COVID-19 pneumonia have revealed the essential role of type I interferon-dependent innate immunity to SARS-CoV-2 infection. Conversely, an association between the HLA-B∗15:01 allele and asymptomatic SARS-CoV-2 infection in unvaccinated individuals was recently reported, suggesting a contribution of pre-existing T cell-dependent adaptive immunity. We report a lack of association of classical HLA alleles, including HLA-B∗15:01, with pre-omicron asymptomatic SARS-CoV-2 infection in unvaccinated participants in a prospective population-based study in the United States (191 asymptomatic vs. 945 symptomatic COVID-19 cases). Moreover, we found no such association in the international COVID Human Genetic Effort cohort (206 asymptomatic vs. 574 mild or moderate COVID-19 cases and 1,625 severe or critical COVID-19 cases). Finally, in the Human Challenge Characterisation study, the three HLA-B∗15:01 individuals infected with SARS-CoV-2 developed symptoms. As with other acute primary infections studied, no classical HLA alleles favoring an asymptomatic course of SARS-CoV-2 infection were identified.

This special collection encompasses 10 articles that delve into the pressing aspects of seafarers’ well-being, mental health, and the workplace. The articles are categorized into 2 broad topics. The first topic, comprising 6 articles, scrutinizes the contributory factors to seafarers’ psychological well-being on board, covering sleep problems, food provisions, sexual abstinence, work-life balance, and psychosocial and work environment factors associated with seafaring. Four of these papers also focus on job satisfaction, work effectiveness, and retention in relation to seafarers’ psychological well-being. The second topic includes 4 articles on seafarers’ mental health assessment and promotion. These articles examine measurement tools for mental health, well-being, and resilience, as well as formal training and technology, including mobile apps, in seafarers’ health promotion and education. The insights gleaned from this special collection have the potential to significantly influence the practices of researchers, policymakers, and shipping companies. By shedding light on the need to enhance seafarers’ employment characteristics and address the health, safety, and well-being aspects of their work and life, this research can guide these stakeholders to better support seafarers in their crucial role as “key workers.”

VPS13A disease and Huntington’s disease (HD) are two basal ganglia disorders that may be difficult to distinguish clinically because they have similar symptoms, neuropathological features, and cellular dysfunctions with selective degeneration of the medium spiny neurons of the striatum. However, their etiology is different. VPS13A disease is caused by a mutation in the VPS13A gene leading to a lack of protein in the cells, while HD is due to an expansion of CAG repeat in the huntingtin (Htt) gene, leading to aberrant accumulation of mutant Htt. Considering the similarities of both diseases regarding the selective degeneration of striatal medium spiny neurons, the involvement of VPS13A in the molecular mechanisms of HD pathophysiology cannot be discarded. We analyzed the VPS13A distribution in the striatum, cortex, hippocampus, and cerebellum of a transgenic mouse model of HD. We also quantified the VPS13A levels in the human cortex and putamen nucleus; and compared data on mutant Htt-induced changes in VPS13A expression from differential expression datasets. We found that VPS13A brain distribution or expression was unaltered in most situations with a decrease in the putamen of HD patients and small mRNA changes in the striatum and cerebellum of HD mice. We concluded that the selective susceptibility of the striatum in VPS13A disease and HD may be a consequence of disturbances in different cellular processes with convergent molecular mechanisms already to be elucidated.

Digital Light Processing (DLP) enables intricate ceramic part production from photosensitive ceramic slurry. While ZrO2 and Al2O3 are commonly studied, their composites are underexplored despite diverse applications. This study investigates fabricating high-strength, fully dense alumina-toughened zirconia (ATZ) parts using a low-cost desktop DLP printer designed for polymer printing. Various ATZ-based ceramic slurries (30, 35, 42.5 vol%) with different binders and dispersants were prepared and evaluated for curing and rheological properties. Promising formulations underwent debinding and sintering, resulting in homogenous microstructures with a well-distributed blend of the two phases. For the doped samples, SEM analysis revealed a good distribution of dopants and elongated dopant grains infused at higher temperatures. The 35 vol% ATZ exhibited exceptional average flexural strength of 1321 MPa, surpassing previous DLP-fabricated composites. This suggests no need for increased solid loading content. The findings demonstrate the potential of DLP in producing high-performance ceramic parts with tailored properties.

Las rutas de los personajes cirqueros de Angelina Muñiz-Huberman se extienden hacia tiempos y espacios improbables que unen el pasado con el presente y el continente europeo con el americano. Viajeros incansables por España, Francia, Cuba y México, estos cirqueros, magos y alquimistas, cuestionan las normas de cada lugar visitado al punto de poner en entredicho medidas que inquebrantables como lo son las dimensiones del tiempo y el espacio. Por este motivo y con la finalidad de profundizar en las rutas de las escritoras judías en Hispanoamérica, este estudio ofrece un acercamiento a los itinerarios, los tiempos y los espacios de la vida circense en la obra muñiciana, en especial en los libros La burladora de Toledo (2008) y El último faro (2020). Si bien el circo es un tema menor en el amplio mundo literario de esta escritora perteneciente a la segunda generación del exilio republicano en México y representante de las voces del judaísmo en Hispanoamérica, se trata de un aspecto relevante en la medida que conecta los grandes temas que caracterizan su obra tales como el exilio, el judaísmo, el humorismo y la ruptura de los cánones estéticos.

Entrevista a Myriam Mascona

El relato del martirio de los santos Vicente, Sabina y Cristeta cimenta la historia de la basílica de San Vicente de Ávila y de la propia ciudad. El martirio es también el punto de partida de un monumento singular, el cenotafio de San Vicente. Las reliquias de los mártires son el centro de la ciudad, y aunque desde 1062 estas se hubiesen trasladado a Arlanza, erigir un cenotafio es toda una declaración de intenciones. Este trabajo tratará el monumento románico, abordándolo siempre con relación a su espacio topográfico, contextos y funciones. Un cenotafio que es metáfora de la ciudad, capaz de evocar en el espectador multitud de temporalidades y que ha sido readaptado a los usos y funciones litúrgicos de cada momento. En definitiva, una obra que representa perfectamente la polisemia de la imagen medieval y sus inagotables capas de significado.

Abstract Personal resources are related to positive psychological states that can translate into lower burnout among employees. However, although these personal resources can be promoted through ad hoc interventions, there are few studies that analyze this type of interventions in workers. The aim of this study was to assess the effectiveness of three interventions on personal resources on reducing employees' burnout. To this end, it was hypothesized that a positive psychological capital intervention (PsyCap), a job crafting intervention and a combined intervention would have a positive impact on burnout levels. This research used a quasi-experimental, longitudinal, pretest–posttest design, with repeated measures and a waiting list control group. Study participants (N = 144) were all workers divided into three interventions and a control group. A noteworthy aspect of the study design is that the intervention was implemented as a voluntary online training activity. This study showed that personal resources interventions were effective in reducing burnout among employees. The PsyCap intervention and the combined intervention showed the greatest efficacy. Contrary to expectations, the combined intervention did not show significantly greater efficacy than the other two experimental groups. The study concludes with a discussion of its limitations and practical implications for future personal resources intervention studies.

Este artículo resalta la importancia de la presencia universitaria en el ámbito local, considerando el diálogo de saberes como proceso clave en la dinamización de territorios sostenibles. Por tanto, el objetivo se orienta a proponer una metodología que postula el diálogo de saberes con sustento en el capital cognitivo y en el capital sinergético, como base para gestionar la sostenibilidad territorial. Al respecto, es necesario impulsar procesos de desarrollo sostenible en el ámbito local desde la interacción dialógica entre actores clave que representan fuerzas motrices para el intercambio y apropiación del saber. Metodológicamente, se aborda un enfoque cualitativo e introspectivo-vivencial que integra la prospectiva estratégica, la observación participante y los grupos focales en correspondencia con el objeto de estudio. Como resultado se configura una opción metodológica de intervención local centrada en lecciones de valor, desde la articulación de actores clave en torno a la construcción de capital cognitivo y sinergético, fortalecimiento de las organizaciones de base y la capacidad de gestión municipal fundamentada en liderazgos emergentes. Se concluye en la importancia de definir agendas formativas de carácter estratégico, cuya concreción evidencie significativos niveles de participación de los actores en la planeación y gestión del desarrollo local.

Psychological, nutritional, oral health, and physical activity habits are behavioral factors previously linked to depression. The objective of this study was to analyze differences in behavioral patterns, in terms of psychological, nutritional, oral health, and physical activity habits, in a sample of men. Six hundred and five men (36.7 ± 15 years, 25.7 ± 4.3 kg/m2) were interviewed through an online questionnaire due to the pandemic. A compendium of factors related to psychological parameters, oral health, nutritional habits, and physical activity was analyzed through a set of online questionnaires. We found that participants with higher levels of both aerobic and self-loading physical activity generally demonstrated better nutritional habits, including higher water intake (p < 0.001; Effect Size (ES) = 0.62 and p < 0.001; ES = 0.69, respectively), higher weekly consumption of meat (p = 0.007; ES = 3.10 and p < 0.001; ES = 0.40, respectively), fish (p < 0.001; ES = 3.13 and p = 0.023; ES = 0.22, respectively), eggs (p = 0.002; ES = 2.80 and p = 0.002; ES = 0.30, respectively), greater vitality (p < 0.001; ES = 0.50 and p = 0.006; ES = 0.21, respectively), and lower alcohol consumption, including beer (p = 0.007; ES = 0.25 and p < 0.001; ES = 0.36, respectively) and wine (p = 0.001; ES = 0.30 and p < 0.001; ES = 0.50), among other healthy habits compared to participants with lower levels of physical activity. We also found that participants with higher self-loading physical activity reported higher perceived stress (p = 0.003; ES = 0.02) and conscientiousness (p < 0.001; ES = 1.86).

Seafarers spend more time at sea than on land, which makes them a hard-to-reach community. Since their mental health and well-being is usually addressed from a land-based perspective, dedicated and validated methods incorporating maritime specificities are lacking. During the COVID-19 pandemic, research into seafarers’ mental health and well-being flourished. However, a systematic review of the literature to assess the type and appropriateness of assessment methods pertaining to the mental health and well-being of seafarers has yet to be undertaken. This study reviews 5 databases (ERIC, Scopus, PubMed, Google Scholar and EBSCO) to assess the methods used to examine seafarers’ mental health and well-being during the pandemic. Peer-reviewed literature alongside grey literature that applied quantitative or qualitative instruments to measure seafarers’ mental health and/or well-being, published in English between March 2020 and February 2023, was eligible for the review. Studies from all geographic regions and regardless of nationality, rank and ship type of the subjects were explored. Database searches produced 272 records. Five additional records were identified via other methods. We identified 27 studies suitable for review, including 24 published in peer-reviewed scientific journals and 3 reports and surveys produced by the industry or welfare organizations. Assessment methods used to measure seafarers’ mental health and well-being vary significantly in the literature. The frequent use of ad hoc questionnaires limits the possibility to replicate and compare the studies due to various inconsistencies. Furthermore, several validation and reliability measures needed more solidity when applied to the seafaring population. Such inadequate measuring and a mix of assessment methods impacted the comparison of results and might inflate the risks of underreporting or overstating mental complaints.

Abstract Job’s syndrome, or autosomal dominant hyperimmunoglobulin E syndrome (AD-HIES, STAT3-Dominant Negative), is a rare inborn error of immunity (IEI) with multi-organ involvement and long-life post-infective damage. Longitudinal registries are of primary importance in improving our knowledge of the natural history and management of these rare disorders. This study aimed to describe the natural history of 30 Italian patients with AD-HIES recorded in the Italian network for primary immunodeficiency (IPINet) registry. This study shows the incidence of manifestations present at the time of diagnosis versus those that arose during follow up at a referral center for IEI. The mean time of diagnostic delay was 13.7 years, while the age of disease onset was

Although advances in obstetric and neonatal care have improved the survival of preterm infants, many studies document the increased risk of motor and sensory neurodevelopmental abnormalities that can hinder school progress. The aim of this study was to analyze the differences in gross and fine motor development in children born preterm and full term aged 3 to 6 years using the Peabody Developmental Motor Scales 2 (PDMS-II). Fifteen preterm and fifteen term children, matched for age and sex, participated in this study. They were evaluated with the PDMS-II scale. The scores obtained in the PDMS-II scale showed statistically significant differences (p < 0.05) in all subscales except for the “grasping” subscale. No dissimilarities were found between children who attended an early intervention program and those who did not participate, nor was there any correlation between week of gestation and birth weight and motor development in preschool. The results obtained show that differences are found with respect to motor development, with lower scores for those born preterm compared to children born at term. No statistically significant difference was found between preterm children who attended early intervention and those who did not. No correlation was found between motor development at preschool age and birth weight and gestational age.

The relationship between multiple sclerosis (MS) and females is a crucial aspect in the development of the disease, with the ovarian hormonal cycle being a sensitive stage, especially in females with relapsing-remitting multiple sclerosis. The objectives of the study are to identify moderating variables that modify satisfaction with physical activity practice throughout the menstrual cycle (MC) in females in or out of their MC, during high-intensity interval training (HIIT) and strength training sessions and to compare the acute effects of different types of physical activity sessions in females with and without MS. This protocol is the methodology used in the EMMA Study, a randomised, single-blind crossover trial study conducted in females with MS who were matched 1:1, based on age, lifestyle factors and country of residence, with females without MS, to analyse the effect of physical activity practice on satisfaction, functionality, fatigue and inflammatory profile through their MC. Participants will visit the facilities approximately 10 times (4 preliminary familiarisation visits and 6 visits to carry out a physical activity session in each phase of the MC) for 3–4 months. A total sample of 30 females (15 females without MS and 15 with MS) is necessary for the study. The evaluation will comprise clinical, nutritional and psychological interviews, including different variables. It is hypothesised during the luteal phase, females with MS are expected to exhibit different acute responses to HIIT and strength training sessions as compared with females without the disease. Before starting the study, all participants will read and sign an informed consent form. Trial registration number: This research protocol is registered with ClinicalTrials.gov to ensure transparency and accessibility of study information (NCT06105463). The university’s ethics committee number for this study is UALBIO2022/048.

BackgroundPreventive strategies against severe COVID-19 in Inborn Errors of Immunity (IEI) include bivalent vaccines, treatment with SARS-CoV-2 monoclonal antibodies (mAbs), early antiviral therapies, and pre-exposure prophylaxis (PrEP).ObjectiveTo assess the effectiveness of the PrEP with tixagevimab/cilgavimab (AZD7442) in IEI with primary antibody defects during the COVID-19 Omicron wave.MethodsA six-month prospective study evaluated the SARS-CoV-2 infection rate and the COVID-19 severity in the AZD7442 group, in the no-AZD7442 group, and in a group of patients with a recent SARS-CoV-2 infection (< three months). Spike-specific IgG levels were measured at regular intervals.ResultsSix out of thirty-three patients (18%) and 54/170 patients (32%) became infected in the AZD7442 group and in the no-AZD7442 group, respectively. Within 90 days post-administration, the AZD7442 group was 85% less likely to be infected and 82% less likely to have a symptomatic disease than the no-AZD7442 group. This effect was lost thereafter. In the entire cohort, no mortality/hospitalisation was observed. The control group of 35 recently infected patients was 88% and 92% less likely to be infected than the AZD7442 and no-AZD7442 groups. Serum anti-Spike IgG reached the highest peak seven days post-AZD7442 PrEP then decreased, remaining over 1000 BAU/mL 180 days thereafter.ConclusionIn patients with IEI and antibody defects, AZD7442 prophylaxis had a transient protective effect, possibly lost possibly because of the appearance of new variants. However, PrEP with newer mAbs might still represent a feasible preventive strategy in the future in this population.

Building upon self-determination theory, the objective of this research was to examine the predictive associations of pre-service physical education (PE) teachers’ basic psychological need satisfaction (i.e., autonomy, competence, relatedness, and novelty) with their academic engagement via the quality of their motivation. A purposive sample of 920 pre-service PE teachers (569 men and 351 women; M age = 24.73; SD = 5.34) participated in this cross-sectional research. The results from structural equation modeling revealed that autonomy, competence, and novelty satisfaction positively predicted autonomous motivation, and negatively predicted amotivation. While competence satisfaction positively predicted controlled motivation, novelty satisfaction did it negatively. Autonomous motivation and controlled motivation positively predicted academic engagement, while amotivation was negatively associated with it. This research underscores the importance of considering pre-service PE teachers’ autonomy, competence, and, specially, novelty satisfaction in promoting their autonomous motivation and academic engagement in initial teacher education program.

El estilo interpersonal docente juega un importante papel en la actitud y motivación del alumnado, y aunque el sistema educativo actual sugiere la utilización de estilos más centrados en el estudiante, en la Educación Física (EF) se siguen utilizando principalmente estilos tradicionales. El objetivo fue analizar la relación del estilo interpersonal controlador por parte del docente y la motivación del estudiante en el contexto de las clases de EF. Se realizó una búsqueda en WOS, Ebsco, Scopus y Cochrane teniendo en consideración los diferentes criterios de inclusión especificados en el documento. Se identificaron cuarenta y dos publicaciones, de las cuales se seleccionaron seis que cumplieron los criterios de elegibilidad establecidos. Se concluyó que la adopción por parte del docente de un estilo interpersonal controlador está estrechamente relacionada con las formas menos autodeterminadas de la motivación, generando en las clases un ambiente negativo condicionado por la falta de autonomía del alumnado, por lo que se sugiere la adopción de metodologías más innovadoras y activas centradas en el alumnado.

Energy metabolism is dysregulated in obesity, and some if these changes persist after weight loss and may contribute to weight regain. Here the authors report that a vacuolar-type H+ ATPase, ATP6v0a1, is induced in adipocytes during obesity and persists after weight loss, and regulates food intake and weight gain in C. elegans and mice.

El 19 de junio de 2023 se adoptó el Acuerdo relativo a la conservación y el uso sostenible de la diversidad biológica marina de las zonas situadas fuera de la jurisdicción nacional en el marco de la Convención de las Naciones Unidas sobre el Derecho del Mar. En esta entrevista se analizan las principales aportaciones de este nuevo Acuerdo , así como los retos más importantes a los que se enfrenta.

The specific nature of the seafaring occupation keeps seafarers away from partners and shore life for long periods at sea. Therefore, seafarers suffer many challenges in the workplace including frustration of their sexual needs. This study aimed to investigate the relationship between work-induced sexual abstinence, psychological health and job satisfaction among seafarers. A mixed-method approach focusing on cross-sectional survey-based quantitative research was used. The sample included 617 Chinese active seafarers who experienced sexual abstinence on board. Hierarchical cluster analysis was conducted to divide the respondents into different groups corresponding to 14 psychological problems induced by sexual abstinence and experienced in the workplace. Multiple linear regression analysis was applied to identify the relationship between tolerance level of seafarers to sexual abstinence and their job satisfaction. Four distinct groups of seafarers, influenced differently by sexual abstinence, were identified, namely “Saint,” “Adapter,” “Average people,” and “Sufferer” clusters. Multiple linear regression analysis indicated that tolerance level of seafarers to sexual abstinence was positively influenced by overall job satisfaction, perceived working environment, ability utilization for other jobs, own choice for working as a seafarer and perceived friendliness of co-workers, while it was negatively influenced by perceived job responsibility. The study innovates by examining the relationship between sexual abstinence and the psychological health of seafarers. It also extends the function of job satisfaction, which can contribute positively to the tolerance level to sexual abstinence. Management recommendations to address sexual abstinence issues are proposed to better protect the health and psychological well-being of seafarers and enhance operational safety on board.

PURPOSEInternational twinning programs have been well-established between institutions in childhood cancer and have led to pediatric cancer units in low- and middle-income countries (LMICs) adopting multidisciplinary forms of care. To advance nutritional care in LMICs, the International Initiative for Pediatrics and Nutrition (IIPAN) provided the structural framework and personnel for the delivery of nutritional care. We describe the impact of a newly established nutrition program on the delivery of nutritional care and nutrition-related clinical outcomes in children and adolescents undergoing treatment for cancer in Nicaragua and Honduras.METHODSA prospective cohort (N = 126) collected clinical data over a 2-year period. Collection of IIPAN's nutritional services received during treatment and clinical data were abstracted from medical charts and registered in Research Electronic Data Capture (REDCap) database. Chi-square, ANOVA, and generalized linear mixed models were used; P < .05 was considered statistically significant.RESULTSNutritional assessments led to a higher number of patients receiving recommended standard of care. Children classified as underweight during treatment presented higher number of infections and toxicities, length of hospital stay, and days of treatment delays during treatment. Overall, from the start to end of treatment, 32.5% of patients improved nutritional status, 35.7% maintained it, and 17.5% worsened. On the basis of metrics, the cost per consultation was less than 4.80 US dollars (USD; Honduras) and 1.60 USD (Nicaragua).CONCLUSIONIntegration and equitable access of the nutritional care process for all patients needs to be recognized as a component of the basic management in pediatric oncology care. IIPAN's nutritional program demonstrates that nutritional care is economical and feasible in a limited resource setting.

Introduction: Transcranial direct current stimulation (tDCS) is a promising technique for brain modulation after a cerebrovascular accident (CVA). This treatment modality has been previously studied in the recovery of patients. The aim of this review is to analyse the evidence for the application of tDCS in the recovery of gait disturbance in stroke patients. Methods: This review was conducted according to the recommendations of the PRISMA statement. Three different electronic databases were searched for relevant results: PubMed, Scopus, and Cochrane, from 2015 to January 2022. We included reviews and meta-analyses that only considered randomised controlled trials (RCTs) that investigated the effects of transcranial direct current stimulation, in combination or not with other physiotherapy treatments, compared to no treatment, usual care, or alternative treatment on gait recovery. Our primary outcomes of interest were walking speed, mobility, and endurance; secondary outcomes included motor function. Results: Thirteen studies with a total of 195 RCTs were included. Data on population, outcome measures, protocols, and outcomes were extracted. The Amstar-2 scale and the GRADE system of certainty of evidence were used. Only one study received high certainty of evidence, 5 received low certainty of evidence, and 7 received critically low certainty of evidence. Moderate to low-quality evidence showed a beneficial effect of tDCS on gait parameters, but not significantly. Conclusions: Although the tDCS produces positive changes in gait recovery in spatio-temporal parameters such as mobility, endurance, strength, and motor function, there is insufficient evidence to recommend this treatment. Higher-quality studies with larger sample sizes are needed for stronger conclusions.

IntroductionThe primary aim of this study is to investigate the evolution of the clinical and laboratory characteristics during the time in a longitudinal cohort of pediatric-onset and adult-onset Common Variable Immunodeficiency (CVID) patients in order to identify early predictive features of the disease and immune dysregulation complications.MethodsThis is a retrospective-prospective monocentric longitudinal study spanning from 1984 to the end of 2021. The data of pediatric-onset vs. adult-onset patients have been compared for immunological features and for infectious and non-infectious complications assessed at diagnosis and follow-up.ResultsSeventy-three CVID patients have been enrolled, with a mean of 10.0 years (SD ± 8.17) of prospective follow-up. At diagnosis, infections were observed in 89.0% of patients and immune dysregulation in 42.5% of patients. At diagnosis, 38.6% of pediatric-onset and 20.7% of adult-onset patients presented with only infections. Polyclonal lymphoid proliferation (62.1%) and autoimmunity (51.7%) were more prevalent in the adult-onset than in the pediatric-onset group (polyclonal lymphoid proliferation 52.3% and autoimmunity 31.8%, respectively). Enteropathy was present in 9.1% of pediatric-onset and 17.2% of adult-onset patients. The prevalence of polyclonal lymphoid proliferation increased during follow-up more in pediatric-onset patients (diagnosis 52.3%—follow-up 72.7%) than in adult-onset patients (diagnosis 62.1%—follow-up 72.7%). The cumulative risk to develop immune dysregulation increases according to the time of disease and the time of diagnostic delay. At the same age, pediatric-onset patients have roughly double the risk of having a complication due to immune dysregulation than adult-onset patients, and it increases with diagnostic delay. The analysis of lymphocyte subsets in the pediatric-onset group showed that CD21 low B cells at diagnosis may be a reliable prognostic marker for the development of immune dysregulation during follow-up, as the ROC curve analysis showed (AUC = 0.796). In the adult-onset group, the percentage of transitional B cells measured at diagnosis showed a significant accuracy (ROC AUC = 0.625) in identifying patients at risk of developing immune dysregulation.DiscussionThe longitudinal evaluation of lymphocyte subsets combined with clinical phenotype can improve the prediction of lymphoid proliferation and allow experts to achieve early detection and better management of such complex disorder.