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Limb salvage surgeries utilizing endoprostheses and allografts are performed for a variety of oncologic conditions. These reconstructions can fail and require revision for many reasons, which are outlined and classified into mechanical failures (soft tissue failures, aseptic loosening, structural failure), non-mechanical failures (infection, tumor progression), and pediatric failures (physeal arrest, growth dysplasia). Distinct radiologic and clinical findings define specific failure subtypes but are sparsely illustrated in the radiology literature. Specifically, an understanding of the organizational structure of the failure modes can direct radiologists’ search for post-reconstruction complications, enhance an appreciation of their prognostic significance, and facilitate research by standardizing the language and conceptual framework around outcomes. The purpose of this review is to highlight the key radiologic findings and imaging studies of each failure mode in orthopedic oncologic reconstructive surgery in the context of risk factors, failure rates, prognosis and survival statistics, and clinical decision-making regarding chemotherapy, radiation, and revision surgery.

Category: Ankle; Other Introduction/Purpose: Foot and ankle soft tissue sarcomas (STS) are rare neoplasms associated with a high risk of local recurrence and metastasis. Although amputation is often performed, its impact on prognosis remains unknown. The aims of our systematic review were identifying risk factors for (1) disease-specific death, (2) local recurrence, (3) metastasis, and assessing (4) whether the type of surgery (amputation or limb-salvage) affected disease-specific survival. Methods: This systematic review was conducted following PRISMA guidelines. The PubMed, Embase and Scopus databases were searched. Our study was registered in PROSPERO (ID: 415624). Quality appraisal was done using STROBE guidelines. Results: A total of 7 studies and 123 patients were included. Metastasis was the only risk factor for disease-specific death (OR=107.85, p< 0.001). Previous unplanned excision (OR=22.29, p=0.009) and positive margins (OR=64.48, p=0.011) were associated with higher risk local of recurrence. Patients with high-grade tumors (OR=13.22, p=0.023) and tumors ≥ 6 cm (OR=7.40, p=0.022) were more likely to develop metastases. After adjusting for confounders (age, sex, and presence of metastasis), amputation was not associated with poorer disease-specific survival. Conclusion: Metastasis was the single most important risk factor for death with foot and ankle soft tissue sarcoma. Positive margins and history of previous unplanned excision are risk factors for local recurrence. The most important risk factors for metastasis are tumor grade and size ≥ 6 cm. Amputation was not associated with poorer disease-specific survival.

Este trabalho objetiva encontrar encadeamentos relacionados por semitom na peça em epígrafe seguindo o modelo do espaço atonal de encadeamentos. A partir da tese de doutorado de Deborah How identifica-se problemas analíticos ao escandir a série e faz-se uma perquirição das propriedades dos tetracordes e seus tricordes derivados. Escolhe-se trechos selecionados para investigar a presença de encadeamentos por semitom, colhe-se os dados avaliando suas possíveis configurações, faz-se um levantamento de distribuição estatística e conclui-se compilando os dados relevantes em perspectiva.

Las primeras formulaciones de cultura organizacional referían a la producción cultural específica de cada organización. Los estudiosos del tema le asignaban una función de amalgama que mantenía el tejido social y posibilitaba la emergencia de prácticas compartidas. En los últimos años, sin embargo, la noción parece perder sentido frente al ideario neoliberal que concibe a la acción colectiva como sumatoria de acciones individuales. El neoliberalismo interpela a las personas, en tanto que les plantea un ideal de sujeto integrado por imperativos sociales —ser empresario de sí, reinventarse constantemente o ser resiliente, entre otros— a los cuales quizás no puedan o no quieran amoldarse. Interpela, asimismo, a la gestión al considerar al nosotros organizacional como una simple identidad sui generis. El fortalecimiento de la cultura organizacional —necesaria para hacer frente a los entornos actuales— requiere hoy de un aprendizaje crítico que reoriente el foco hacia la acción colectiva.

Luego de repasar algunos datos de la vida y obra de Margaret Guenther, en una primera parte; el texto revisita en un segundo punto, un artículo que va a tener diez años el año próximo: María Marcela Mazzini, «Mística en la trama de la vida cotidiana». Se señalan aspectos fundamentales de aquel escrito y se cuestionan algunas afirmaciones, procurando su actualización. En la tercera parte se intenta dar un paso de profundización, a la luz de un concepto que Guenther desarrolla en uno de sus artículos y que podría considerarse una expresión equivalente a la mística de lo cotidiano: atender a lo sagrado. Esa idea se despliega en sus diversos aspectos en el resto del texto y se esbozan algunas ideas que apuntan a descubrir lo sagrado tanto en la propia vida como en la de aquellos y aquellas a quienes acompañamos.

Since the beginning of the XIX century, Grotta Romanelli gained recognition in European stratigraphy as an important site for the Late Pleistocene, due to the attribution of its basal sediments to the Last Interglacial (MIS 5e). Its abundant archaeological and paleontological findings made the cave a key reference point for the study of human evolution and faunal dynamics in the larger Mediterranean area over approximately the last 130,000 years. After a century, a new chronostratigraphic reassessment of Grotta Romanelli revised the timeframe of its lower levels, predating them to the late Middle Pleistocene.In this study, we re-evaluate selected historical museum collections from the so-called “lower complex” of Grotta Romanelli and examine the new fossils excavated between 2015 and 2022. We identify three main mammal assemblages associated with three different interglacial periods spanning the last 350,000 years. Our findings offer new insights into terrestrial ecosystems in Mediterranean Europe from the late Middle Pleistocene to early Late Pleistocene. Additionally, they provide valuable information to the biochronological framework of the European large mammal faunas.

Reflectance spectral libraries are essential reference databases for the mineralogical characterization of geological samples analyzed using visible and infrared spectroscopy. Since 2011, the Geological Survey of Brazil has been actively developing a comprehensive database of reflectance spectral signatures, based on samples collected from systematic geological mapping and mineral resource projects across the Brazilian territory. This spectral library is now available on a digital platform hosted by the Geological Survey of Brazil's geoscientific database, providing quantitative data for the numerical characterization of lithological types and their alteration products, whether due to weathering or hydrothermal processes.

Vesteris is a large (33 × 27 km) and young (summit age: 0.65–0.010 Ma) intraplate seamount in the Greenland Sea, formed from ocean island basalt (OIB) magmatism. The volcano is composed of alkali basalt, basanite/tephrite, phonotephrite, mugearite, and benmoreite. Its phenocryst assemblage includes clinopyroxene, plagioclase, olivine, amphibole, rare haüyne, and oxides (Ti–magnetite and Cr–spinel), with phenocrysts hosting inclusions of apatite, sulfides (pyrrhotite), and melt. Despite its geological significance, the processes governing magma storage, ascent, and eruption dynamics remain poorly understood. To address this, we conducted detailed micro–chemical analyses of phenocrysts, groundmass microcrysts, melt inclusions, and groundmass glass. Using mineral–melt thermobarometry, we characterized the pre– to syn–eruptive crystallization conditions and reconstructed the architecture of the volcanic plumbing system. Our findings indicate that basanite liquids were primarily stored in the upper mantle (∼6.4 kbar; ∼22 km depth) with evidence of multi-level storage extending to ∼9 kbar (∼30 km depth). Textural and compositional zoning in clinopyroxenes suggests rapid magma ascent, while mafic recharge emerged as a key mechanism for remobilizing evolved clinopyroxene mush. Mafic recharge magmas also introduced early olivine crystals, which were later overgrown by high-Mg clinopyroxene upon mixing with more evolved melts. These results demonstrate that major crystal fractionation occurs in the upper mantle beneath Vesteris, resembling processes observed in low-flux ocean island basalt volcanoes. The evidence for rapid magma ascent highlights the dynamic nature of magma movement within the plumbing system, driven by mafic recharge and crystal-melt interactions.

La maloclusión dental se define como una condición patológica que se caracteriza por no darse una relación normal entre dientes, es decir, los dientes no se encuentran en una posición correcta y funcional. La maloclusión Clase II se basa en la cúspide mesiovestibular del primer molar superior ocluye anterior al surco vestibular del primer molar inferior. Este tipo de maloclusión se divide en división 1 y división 2, puede ser esquelética o dental y unilateral o bilateral. Su protocolo de diagnóstico clínico se basa en la evaluación de la posición del maxilar y la mandibular. El tratamiento de la maloclusión clase II consta de la aplicación de aparatología fija o removible, ortodoncia u ortopedia y en algunos casos cirugía ortognática. Objetivo: Desarrollar una revisión bibliográfica del análisis clínico para el diagnóstico de la maloclusión Clase II y alternativas de tratamiento. Metodología: Se realizó un estudio de tipo descriptivo y cualitativo sobre las características, clasificación, diagnóstico y alternativas de tratamiento de la Clase II en base a evidencias científicas recientes, recopilando datos bibliográficos relacionados al tema. Conclusión: En función del tratamiento los autores mencionaron la aplicación de algunas opciones terapéuticas tales como ortodoncia y ortopedia considerado uno de los tratamientos más comunes para corregir la maloclusión clase II, aparatos funcionales empleados en pacientes con potencial de crecimiento y desarrollo de maloclusión clase II, extracciones dentales, cirugía ortognática y terapia miofuncional. Para aplicar cada tratamiento es necesario tener en cuenta la edad del paciente para llegar a observar cambios favorables.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder, hallmarked by the gradual deterioration of motor neurons, culminating in muscle weakness and fatal paralysis. The exact etiology of ALS remains elusive, and there is a critical need for reliable biomarkers to aid in diagnosis and monitoring of disease progression. Extracellular vesicles (EVs) have emerged as promising candidates for biomarker discovery in neurodegenerative diseases such as ALS, giving access to pathologically relevant tissues otherwise typically challenging or invasive to sample. Indeed, EVs can derive by many cell types within the central nervous system, cross the blood-brain barrier and reach the blood, where they can be easily measured. One of the central mechanisms implicated in ALS pathology is glutamate excitotoxicity, which involves excessive glutamate accumulation due to impaired uptake by astrocytes and other glial cells, leading to neuronal damage. GLAST is a key glutamate transporter responsible for maintaining extracellular gluta-mate levels, and its dysregulation is thought to contribute significantly to ALS development and associated neuropathogenesis. Here, we applied a quick and validated method, to evaluate GLAST+ EVs in ALS patients’ plasma and age-matched healthy controls. We found an increase in GLAST+ EVs that holds promise for uncovering novel diagnostic and therapeutic avenues in ALS research.

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) are broad diagnoses that encompass a range of sudden-onset neuropsychiatric symptoms in children, which can include obsessive-compulsive disorder (OCD), tics, anxiety, emotional instability, and cognitive difficulties. Unlike PANDAS, PANS is not strictly linked to group A streptococcal infections but can be triggered by various infectious or environmental factors. Lights and shadows remain upon the management of children with PANS and PANDAS and there is no clear consensus regarding definition, diagnostic criteria, treatment, and follow-up. The aim of the present study was to evaluate the level of agreement on PANS and PANDAS definition, diagnostic criteria, treatment and follow-up and to assess on the basis of recent studies whether there is a need to modify the current recommendations used by primary care pediatricians and hospital pediatricians in clinical practice in order to improve outcomes. Using the Delphi method, this consensus provides shared indications on PANS and PANDAS management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date information on the diagnosis of PANS and PANDAS, as well as consensus statements about several aspects of clinical care. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best management, also in terms of adequate follow-up examinations and period of observation.

Background: The diagnosis of amyotrophic lateral sclerosis (ALS) is primarily clinical, supported by the electromyographic examination to reveal signs of lower motor neuron damage. Identifying reliable markers of upper motor neuron (UMN) involvement is challenging. On this regard, the role of transcranial magnetic stimulation-induced motor-evoked potentials (TMS-MEPs), and its relationship with UMN burden, is still under investigation. Objective: To evaluate the ability of TMS-MEPs in delineating the neurophysiological UMN damage, and to determine the relationship between TMS-MEPs and [18F]FDG-PET measures of neural dysfunction. Methods: We retrospectively selected 13 ALS patients who underwent, during the diagnostic process, the TMS-MEPs and [18F]FDG-PET scans. Demographic and clinical data were collected. For the MEP evaluation, we considered normal MEP, absent MEP, or significantly increased central-motor-conduction-time. For [18F]FDG-PET, we conducted voxel-wise analyses, both at single-subject and group levels, exploring hypometabolism and hypermetabolism patterns in comparison with a large dataset of healthy controls (HC). Results: Based on TMS-MEPs, we identified 4/13 patients with normal MEP in all limbs (GROUP-NO), while 9/13 had an abnormal MEP in at least one limb (GROUP-AB). Despite the [18F]FDG-PET single-subject analysis revealed heterogenous expression of regional hypo- and hyper-metabolism patterns in the patients, the group-level analysis revealed a common hypometabolism, involving the precentral gyrus and the supplementary motor area, the paracentral lobule and the anterior cingulate cortex in the GROUP-AB. Moreover, exclusively for the GROUP-AB compared with HC, a relative hypermetabolism was observed in the right cerebellum, right inferior and middle temporal gyrus. The GROUP-NO showed no specific cluster of hypo- and hyper-metabolism compared to HC. Conclusion: This study showed altered brain metabolism only in the ALS group with abnormal MEPs, suggesting an association between the two biomarkers in defining the UMN damage.

A propagação da palmeira jerivá (Syagrus romanzoffiana) ocorre por meio de sementes, cuja germinação se dá de forma desuniforme e lenta. Assim, as sementes encontram-se sujeitas a múltiplos estresses, como o hídrico e o salino, que limitam a embebição e suas chances de germinação. Objetivou-se avaliar a germinação de sementes da palmeira jerivá submetidas aos estresses hídrico e salino. O delineamento utilizado foi o inteiramente casualizado, com quatro repetições, em esquema fatorial (2 × 5), sendo dois agentes osmocondicionantes (NaCl e PEG 6000) e cinco potenciais osmóticos (0,0 - controle, -0,3, -0,6, -0,9 e -1,2 MPa). Ao final do experimento, calculou-se: porcentagem de germinação, índice de velocidade de germinação e tempo médio de germinação. Com relação aos potenciais osmóticos, para porcentagem de germinação, houve efeito significativo de maneira isolada somente para NaCl, com diminuição na porcentagem de acordo com a redução do potencial osmótico da solução. A partir do potencial -0,6 MPa, houve redução significativa na germinação das sementes. O índice de velocidade e o tempo médio de germinação das sementes foram afetados negativamente pelos potenciais osmóticos das soluções, independente do agente osmocondicionante. No estresse hídrico simulado pelo PEG 6000, as sementes começaram a germinar mais tarde e por um período mais prolongado, quando comparado àquelas submetidas ao estresse de NaCl. Concluiu-se que as sementes da palmeira jerivá apresentam tolerância aos estresses hídrico e salino, pois conseguiram germinar até mesmo no potencial osmótico mais negativo (-1,2 MPa).

BackgroundDynapenic obesity (DO) is the coexistence of excess adipose tissue/body weight and low muscle strength. This condition is associated with an increased risk of suffering from various chronic diseases and physical deterioration in older people.AimTo analyze the association between DO phenotypes and physical performance in middle-aged women living in the community.MethodsThis cross-sectional study was conducted on middle-aged and older women (≥50 years) residing in Guayaquil, Ecuador. Dynapenia was diagnosticated by a handgrip strength (HGS)

Abstract The pericellular matrix (PCM), with its hallmark proteins collagen type VI (COLVI) and fibronectin (FN), surrounds chondrocytes and is critical in transducing the biomechanical cues. To identify genetic variants that change protein function, exome sequencing is performed in a patient with symptomatic OA at multiple joint sites. A predicted damaging variant in COL6A3 is identified and introduced by CRISPR‐Cas9 genome engineering in two established human induced pluripotent stem cell‐derived in‐vitro neocartilage organoid models. The downstream effects of the COL6A3 variant on the chondrocyte phenotypic state are studied by a multi‐omics (mRNA and lncRNA) approach in interaction with hyper‐physiological mechanical loading conditions. The damaging variant in COL6A3 results in significantly lower binding between the PCM proteins COLVI and FN and provokes an osteoarthritic chondrocyte state. By subsequently exposing the neocartilage organoids to hyperphysiological mechanical stress, it is demonstrated that the COL6A3 variant in chondrocytes abolishes the characteristic inflammatory signaling response after mechanical loading with PTGS2, PECAM1, and ADAMTS5, as central genes. Finally, by integrating epigenetic regulation, the lncRNA MIR31HG is identified as key regulator of the characteristic inflammatory signaling response to mechanical loading.

El canino permanente, considerado pieza angular de la arcada dentaria al constituir la denominada guía canina, es la última pieza en erupcionar del sector anterior, por lo que suele enfrentarse a problemas de espacio, siendo obligada a cambiar de trayecto eruptivo y ocupar una posición incorrecta o ectópica. Objetivo general. Determinar la prevalencia de la erupción ectópica de canino superior en escolares de 11 a 14 años de edad que acuden a la unidad educativa Rina Ortiz de Bucaram, en Durán-Ecuador durante el periodo lectivo 2024- 2025. Materiales y Métodos: de enfoque cuantitativo, de tipo descriptivo. Se realizó la aplicación de fichas de observación clínica en la escuela Unidad Educativa Rina Ortiz Bucaram en el cantón Durán- Ecuador, con un universo de 500 estudiantes y una muestra de 98 alumnos estudiados. Resultados: Se halló que 16,32% de la muestra estudiada, tenía el canino superior permanente en posición ectópica (pieza 13 con 10,20% y pieza 23 con 6,12%). Conclusión: La prevalencia de erupción ectópica de canino superior permanente de la muestra fue de 16,32%, siendo más frecuente en el sexo femenino con edad promedio de 13 años.

Abstract The concept of resilience has gained immense popularity as a way to frame social and environmental challenges. However, its empirical operationalization and the integration of social and ecological dimensions continue to present difficulties. In this paper, we conduct a systematic review of existing empirical studies of resilience in social, ecological and social‐ecological systems (SESs) and examine how and to what extent these studies have achieved the operationalization of the concept of resilience. We evaluate the operationalization of resilience in 463 papers based on whether they define the system of interest and disturbances, whether they define resilience, whether they evaluate resilience, and for papers focusing on SESs, whether that evaluation integrates social and ecological dimensions. We find that 51% of empirical studies do not meet at least one of these operationalization criteria, and that even those that do often lack key features for effective operationalization, such as clear system boundaries and baseline state or an effective integration of social and ecological dimensions. Of the papers examining SESs and evaluating resilience, only 54% integrate social and ecological dimensions in that evaluation. Building on these findings, we propose some design guidelines for operationalizing future empirical studies of resilience. Read the free Plain Language Summary for this article on the Journal blog.

The paper presents results of gas-geochemical studies of bottom sediments and petroleum potential assessment of Baikal Rift Basin. During the expeditions of the Class@Baikal project in 2014–2019, gases from the Lake Baikal bottom sediments were analyzed. The results showed a clear difference in chemical and isotopic composition of the seeping gases collected in the northwestern and southeastern parts of the lake. The seepage released from northwest part were relatively enriched by methane and had a low concentration of C2+ compounds. The seepage gases had relatively lighter carbon isotopes composition of CH4 (from -72,7 to -50,1 ‰ VPDB) and the high variability of δ13C in C2 H6 (from -65 to -22 ‰ VPDB). The gases released from southeastern part of the lake had an increase in C2+ compounds and had relatively lighter carbon isotopes composition of methane (from –57,2 to –41,0 ‰ VPDB). The carbon isotopes composition of ethane varies from -32 to -25 ‰ VPDB. Asymmetric structure of the Baikal rift basin and various processes of gas migration within it might cause the variations. Diffusive process led to the lighter carbon isotopes composition of the seepage gases from the northwestern part of lake and the gas molecular composition enrichment by methane. Such molecular and isotopic fractionations caused by geochemical processes helps to understand the migration of gas from source rocks to the earth’s surface. Similar geochemical indicators of fractionation should be taken into consideration when assessing oil and gas source rocks and basin potential from gas geochemical studies data.

Delirium, a multifactorial condition with an acute onset and diverse clinical manifestations, poses a significant challenge in the care of hospitalized individuals aged 65 years and older. This study aimed to evaluate the level of knowledge among nursing healthcare personnel regarding the diagnosis, recognition of complications, and treatment of delirium. A paper questionnaire consisting of 18 multiple-choice questions was distributed to nurses in twelve operational units located in four facilities within a local hospital in a specific geographical region under the jurisdiction of the Romagna Local Health Authority in Italy. Out of 194 respondents, the overall acceptance rate was 64.2%. The findings revealed an insufficient understanding of delirium among the nursing staff, with more than 40% of respondents answering incorrectly to five out of nine questions related to delirium knowledge, diagnosis, prevention, and treatment. Notably, gender emerged as a significant determinant, with female participants exhibiting a substantial odds ratio (OR) of 3.50 (p = 0.011 and CI95% = 1.34–9.16) compared to their male counterparts, indicating a higher likelihood of receiving delirium training among females. Furthermore, prolonged tenure within the same work context was associated with a reduced likelihood of receiving delirium training compared to those with less than two years of experience (OR = 0.21, p = 0.034, and CI95% = 0.05–0.89 for 6–10 years of tenure; OR = 0.22, p = 0.038, and CI95% = 0.05–0.92 for over 10 years of tenure). This study underscores the urgent need for enhanced delirium education and improved strategies among nurses to effectively manage patients with delirium. The results advocate regular educational sessions utilizing diverse formats to comprehensively address knowledge gaps among nursing staff. This study was not registered.

Although Barrett's metaplasia of the esophagus (BE) is the only known precursor lesion to esophageal adenocarcinomas (EACs), drivers of cellular transformation in BE remain incompletely understood. We use an artificial intelligence-guided network approach to study EAC initiation and progression. Key predictions are subsequently validated in a human organoid model, in patient-derived biopsy specimens of BE, a case-control study of genomics of BE progression, and in a cross-sectional study of 113 patients with BE and EACs. Our model classified healthy esophagus from BE and BE from EACs in several publicly available gene expression data sets (n = 932 samples). The model confirmed that all EACs must originate from BE and pinpointed a CXCL8/IL8↔neutrophil immune microenvironment as a driver of cellular transformation in EACs and gastroesophageal junction adenocarcinomas. This driver is prominent in White individuals but is notably absent in African Americans (AAs). Network-derived gene signatures, independent signatures of neutrophil processes, CXCL8/IL8 expression, and an absolute neutrophil count (ANC) are associated with risk of progression. SNPs associated with changes in ANC by ethnicity (e.g., benign ethnic neutropenia [BEN]) modify that risk. Findings define a racially influenced immunological basis for cell transformation and suggest that BEN in AAs may be a deterrent to BE→EAC progression.