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**Background:** Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. **Objective:** To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. **Methods:** Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). **Results:** Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). **Conclusion:** JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.

Gold-ceria nanoparticles (Au/CeO2) are known to have antioxidant properties. However, whether these nanoparticles can provide benefits in type 2 diabetes mellitus (T2D) remains unknown. This work aimed to study the effects of Au/CeO2 nanoparticles at different rates of gold purity (10, 4.4, 1.79 and 0.82) on leukocyte–endothelium interactions and inflammation in T2D patients. Anthropometric and metabolic parameters, leukocyte–endothelium interactions, ROS production and NF-κB expression were assessed in 57 T2D patients and 51 healthy subjects. T2D patients displayed higher Body Mass Index (BMI) and characteristic alterations in carbohydrate and lipid metabolism. ROS production was increased in leukocytes of T2D patients and decreased by Au/CeO2 at 0.82% gold. Interestingly, Au/CeO2 0.82% modulated leukocyte–endothelium interactions (the first step in the atherosclerotic process) by increasing leukocyte rolling velocity and decreasing rolling flux and adhesion in T2D. A static adhesion assay also revealed diminished leukocyte–endothelium interactions by Au/CeO2 0.82% treatment. NF-κB (p65) levels increased in T2D patients and were reduced by Au/CeO2 treatment. Cell proliferation, viability, and apoptosis assays demonstrated no toxicity produced by Au/CeO2 nanoparticles. These results demonstrate that Au/CeO2 nanoparticles at 0.82% exert antioxidant and anti-inflammatory actions in the leukocyte–endothelium interaction of T2D patients, suggesting a protective role against the appearance of atherosclerosis and cardiovascular diseases when this condition exists.

Type 2 diabetes is a chronic disease widespread throughout the world, with significant human, social, and economic costs. Its multifactorial etiology leads to persistent hyperglycemia, impaired carbohydrate and fat metabolism, chronic inflammation, and defects in insulin secretion or insulin action, or both. Emerging evidence reveals that oxidative stress has a critical role in the development of type 2 diabetes. Overproduction of reactive oxygen species can promote an imbalance between the production and neutralization of antioxidant defence systems, thus favoring lipid accumulation, cellular stress, and the activation of cytosolic signaling pathways, and inducing β-cell dysfunction, insulin resistance, and tissue inflammation. Over the last few years, microRNAs (miRNAs) have attracted growing attention as important mediators of diverse aspects of oxidative stress. These small endogenous non-coding RNAs of 19–24 nucleotides act as negative regulators of gene expression, including the modulation of redox signaling pathways. The present review aims to provide an overview of the current knowledge concerning the molecular crosstalk that takes place between oxidative stress and microRNAs in the physiopathology of type 2 diabetes, with a special emphasis on its potential as a therapeutic target.

The rising prevalence of obesity and type 2 diabetes (T2D) is a growing concern worldwide. New discoveries in the field of metagenomics and clinical research have revealed that the gut microbiota plays a key role in these metabolic disorders. The mechanisms regulating microbiota composition are multifactorial and include resistance to stress, presence of pathogens, diet, cultural habits and general health conditions. Recent evidence has shed light on the influence of microbiota quality and diversity on mitochondrial functions. Of note, the gut microbiota has been shown to regulate crucial transcription factors, coactivators, as well as enzymes implicated in mitochondrial biogenesis and metabolism. Moreover, microbiota metabolites seem to interfere with mitochondrial oxidative/nitrosative stress and autophagosome formation, thus regulating the activation of the inflammasome and the production of inflammatory cytokines, key players in chronic metabolic disorders. This review focuses on the association between intestinal microbiota and mitochondrial function and examines the mechanisms that may be the key to their use as potential therapeutic strategies in obesity and T2D management.

Antecedentes: la asociación entre los inhibidores de la bomba de protones (IBP) y el riesgo de osteoporosis y fracturas óseas es un tema que ha originado, recientemente, bastante interés en la literatura médica. Los IBP son los fármacos de primera elección en enfermedades que evolucionan con incremento de la secreción ácida y, debido al aumento progresivo de su prescripción, su potencial toxicidad se investiga periódicamente. Objetivos: en la presente revisión se analizan las bases fisiofarmacológicas y la limitada evidencia clínica de una potencial relación entre la administración continuada de IBP y la aparición de osteoporosis y fracturas óseas. Ambas patologías, relacionadas con la homeostasis del calcio, son de gran importancia en pacientes de edad avanzada por su mal pronóstico general y las consecuencias invalidantes que conllevan.

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.

A pesar de su abarcadora influencia, La ciudad letrada de Ángel Rama (1984) ha sido sometida en los últimos años a una intensa crítica que ha cuestionado la relación demasiado unívoca que el argumento planteaba entre escritura y poder, así como su exclusión de las formas de alfabetización indígena, mestiza y afrodescendiente. El presente trabajo parte de estos debates para, revisando la obra crítica y los epistolarios de Rama, ofrecer una nueva genealogía intelectual del concepto que daba título al libro póstumo. En particular, se rescata el ensayo de 1980 donde Rama se refirió por primera vez a la ciudad letrada, titulado “La señal de Jonás sobre el pueblo mexicano”. La relectura del libro en diálogo con este trabajo previo nos permitirá ver que la idea de ciudad letrada no aspiraba a describir la totalidad de la realidad cultural de la América colonial, sino uno de los polos que la tensionan, uno de los lados de un conflicto cultural. “La señal de Jonás” ofrece una visión significativamente diferente de la ciudad colonial, donde la fuerza cultural de una plebe urbana y multirracial desafía los muros de la ciudad letrada y alcanza a penetrar la práctica intelectual de algunos de sus guardianes. Frente al pesimismo de La ciudad letrada, late en “La señal de Jonás” un utopismo similar al de Transculturación narrativa en América Latina respecto a las potencialidades políticas y estéticas de esa cultura urbana popular de raigambre colonial.

La incorporación de actividades de trabajo en equipo en los programas de formación universitaria es esencial, ya que es una de las habilidades más valoradas para los profesionales en el campo de la ingeniería. La selección de los grupos de trabajo por parte del profesor es una estrategia que puede conducir a un mejor desempeño en las tareas colaborativas. Este estudio presenta los resultados de una investigación sobre los criterios conscientes para la selección de grupos de trabajo basados en los roles de los estudiantes. La investigación tuvo como objetivo analizar las dinámicas de trabajo en equipo entre estudiantes de diversas disciplinas dentro de los cursos de ingeniería. Se examinaron las opiniones de más de 600 estudiantes matriculados en 10 programas de grado y posgrado. Los resultados indican que los estudiantes de cursos avanzados se sienten más cómodos asumiendo el papel de líder, mientras que los estudiantes de primer año no tienen un perfil claramente definido. La evaluación de los estudiantes con esta metodología también muestra ciertas variaciones dependiendo del año y el tipo de actividad. En general, en los grupos con mejor rendimiento, la mayoría de los miembros reciben evaluaciones similares de sus compañeros. Abstract The incorporation of teamwork activities in university training programs is essential, as it is one of the most valued skills for professionals in the field of engineering. The selection of working groups by the teacher is a strategy that can lead to better performance in collaborative tasks. This study presents the results of research on the conscious selection criteria for group work based on students’ roles. The research aimed to analyze teamwork dynamics among students from various disciplines within engineering courses. The opinions of over 600 students enrolled in 10 undergraduate and postgraduate programs were examined. The results indicate that students in advanced courses feel more comfortable taking on the role of leader, while first-year students do not have a well-defined profile. The evaluation of students using this methodology also shows certain variations depending on the year and type of activity. Overall, in the highest-performing groups, most members receive similar evaluations from their peers.

Introduction: Capsule endoscopy (CE) is a minimally invasive exam suitable of panendoscopic evaluation of the gastrointestinal (GI) tract. Nevertheless, CE is time-consuming with suboptimal diagnostic yield in the upper GI tract. Convolutional neural networks (CNN) are human brain architecture-based models suitable for image analysis. However, there is no study about their role in capsule panendoscopy. Methods: Our group developed an artificial intelligence (AI) model for panendoscopic automatic detection of pleomorphic lesions (namely vascular lesions, protuberant lesions, hematic residues, ulcers, and erosions). 355,110 images (6,977 esophageal, 12,918 gastric, 258,443 small bowel, 76,772 colonic) from eight different CE and colon CE (CCE) devices were divided into a training and validation dataset in a patient split design. The model classification was compared to three CE experts’ classification. The model’s performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the precision-recall curve. Results: The binary esophagus CNN had a diagnostic accuracy for pleomorphic lesions of 83.6%. The binary gastric CNN identified pleomorphic lesions with a 96.6% accuracy. The undenary small bowel CNN distinguished pleomorphic lesions with different hemorrhagic potentials with 97.6% accuracy. The trinary colonic CNN (detection and differentiation of normal mucosa, pleomorphic lesions, and hematic residues) had 94.9% global accuracy. Discussion/Conclusion: We developed the first AI model for panendoscopic automatic detection of pleomorphic lesions in both CE and CCE from multiple brands, solving a critical interoperability technological challenge. Deep learning-based tools may change the landscape of minimally invasive capsule panendoscopy.

Flexibility services enable distribution system operators to actively manage the grid for accommodating demand and generation growth while potentially reducing or delaying investments in grid reinforcements. This paper proposes a novel hybrid particle swarm optimization and linear programming methodology that analyzes explicit flexibility procurement as an alternative to conventional network reinforcements in electricity distribution network planning. The distribution system planning problem is decomposed into a master problem and an inner problem. Binary particle swarm optimization (BPSO) is used to determine the optimal investment decisions, binary variables, from a set of candidate grid reinforcements in the master problem. At the inner linear programming optimization problem, a market-based procurement of flexibility services is performed. The inner optimization problem obtains the total cost of flexibility and the volume of flexibility at each network bus required to defer or avoid part of the grid reinforcements. A real 500-bus medium voltage network is used to validate the proposed methodology. Results illustrate cost-effective network plans that combine flexibility procurement with network reinforcements. A sensitivity to the cost and availability of flexibility services is also conducted to calculate the thresholds where flexibility becomes an efficient alternative to reinforcing the network.

Abstract In situ spacecraft observations are critical to our study and understanding of the various phenomena that couple mass, momentum, and energy throughout near‐Earth space and beyond. However, on‐orbit telemetry constraints can severely limit the capability of spacecraft to transmit high‐cadence data, and missions are often only able to telemeter a small percentage of their captured data at full rate. This presents a programmatic need to prioritize intervals with the highest probability of enabling the mission's science goals. Larger missions such as the Magnetospheric Multiscale mission (MMS) aim to solve this problem with a Scientist‐In‐The‐Loop (SITL), where a domain expert flags intervals of time with potentially interesting data for high‐cadence data downlink and subsequent study. Although suitable for some missions, the SITL solution is not always feasible, especially for low‐cost missions such as CubeSats and NanoSats. This manuscript presents a generalizable method for the detection of anomalous data points in spacecraft observations, enabling rapid data prioritization without substantial computational overhead or the need for additional infrastructure on the ground. Specifically, Principal Components Analysis and One‐Class Support Vector Machines are used to generate an alternative representation of the data and provide an indication, for each point, of the data's potential for scientific utility. The technique's performance and generalizability is demonstrated through application to intervals of observations, including magnetic field data and plasma moments, from the CASSIOPE e‐POP/Swarm‐Echo and MMS missions.

Objectives: Adherence to healthy lifestyle recommendations has been reported to improve health-related quality of life (HRQL) in breast cancer (BC) patients, but the influence of long-term behavioral changes remains unknown. We evaluated the association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and HRQL both, at BC diagnosis and the change 7−12 years later. Design: Prospective cohort study. Settings and participants: A total of 406 breast cancer survivors, from the EpiGEICAM study, were recruited in 16 Spanish hospitals. Measurements: Epidemiological, clinical, dietary, physical activity and HRQL information was collected both at recruitment and 7−12 years later. A 7-item score to measure compliance with recommendations was assessed according to the 2018 WCRF/AICR scoring criteria. HRQL was evaluated using SF-36 questionnaire. Linear mixed models for longitudinal data were used to assess the cross-sectional and longitudinal association between adherence score and the physical and mental component summary scores. Results: At diagnosis, for each unit increase in WCRF/AICR score adherence, the HRQL physical domain increased 0.78 points (95%CI: −0.04 to 1.60; P trend:0.06). The mean change in physical HRQL from diagnosis to follow-up per unit increase in within-subject adherence score was 0.73 points (95%CI: −0.18 to 1.65; P trend: 0.12). For the mental domain, no association was observed with compliance with the recommendations at diagnosis, nor with changes in adherence over time. Conclusions: Our results suggest that Increased adherence to WCRF/AICR cancer prevention recommendations over time could contribute to slightly improved long-term physical HRQoL in BC survivors.

Introduction: Advancements in monoclonal antibodies, tyrosine kinase inhibitors, and antibody drug conjugates (ADCs) have notably enhanced outcomes for metastatic HER2-positive breast cancer patients. Despite the expanding treatment options and clinical complexities, determining the optimal sequence of HER2-targeted therapies remains partly uncertain, influenced by various factors. Methods: To refine HER2-positive metastatic breast cancer management, particularly regarding tucatinib's position, a Steering Committee of leading oncologists in breast cancer care devised a panel of statements via a Delphi approach, focusing on five key topics: general clinical management, therapeutic approaches for patients with HER2-positive breast cancer and brain metastases, treatment sequence, and tucatinib's safety and efficacy. Results: A total of 29 statements were deliberated, with strong consensus achieved for most. However, no consensus emerged regarding the management of brain progression alongside stable extracranial disease: 48 % advocated for switching to tucatinib, while 53 % favored a stereotactic brain radiotherapy (SBRT) approach if feasible. Conclusion: The unanimous consensus attained in this Delphi panel, particularly regarding tucatinib's efficacy and safety, underscores oncologists' recognition of its clinical significance based on existing trial data. These findings align closely with current literature, shedding light on areas necessitating further investigation, not thoroughly explored in prior studies. Moreover, the results underscore the scarcity of data on managing brain progression alongside stable extracranial disease, emphasizing the imperative for dedicated research to address these gaps and yield definitive insights.

Abstract In monarchE, adjuvant abemaciclib significantly improved invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS), with sustained benefit beyond the 2-year treatment period. Abemaciclib dose reductions were allowed to proactively manage adverse events. Exploratory analyses to investigate the impact of dose reductions on efficacy were conducted. Across the three patient subgroups as defined by relative dose intensity (≤66%, 66–93%, ≥93%), the estimated 4-year IDFS rates were generally consistent (87.1%, 86.4%, and 83.7%, respectively). In the time-dependent Cox proportional hazard model, the effect of abemaciclib was consistent at the full dose compared to being reduced to a lower dose (IDFS hazard ratio: 0.905; 95% confidence interval: 0.727, 1.125; DRFS hazard ratio: 0.942; 95% confidence interval: 0.742, 1.195). These analyses showed that the efficacy of adjuvant abemaciclib was not compromised by protocol mandated dose reductions for patients with node positive, hormone receptor positive, human epidermal growth factor 2-negative, high-risk early breast cancer.

Purpose: Remote control towers are the latest evolution in air traffic control at the airport level. These towers replace traditional air traffic control towers, moving the airport's air traffic controllers to a remote location called a remote control center. This concept was introduced with the main aim of combating the shortage of air traffic controllers, as well as making it possible to provide several airports with control that, until then, they did not have or were at risk of losing, because of the costs associated with this service. This makes it important to study this solution in Portugal, as there are many airdromes where having runway control may not be economically viable. The study will focus on a project by NAV Portugal, which is about to implement this solution on some islands in the Azores archipelago. Design/methodology/approach: Having identified the number of movements per month at a few chosen airports, the operational viability was studied according to the number of movements per hour to ensure that several restrictions were met. Findings: Even including the region's main airport, from the point of view of analyzing the number of movements, the installation of a remote control tower is feasible. There is also a substantial economic gain from this new solution, both in terms of implementation and operations. Originality/value: Remote control towers are a new air traffic control solution, making it possible to extend this service to countless airdromes that may be in the process of losing this service for economic reasons, or no longer are controlled by an air traffic controller.

Abstract Mycobacterium abscessus is an opportunistic, extensively drug-resistant non-tuberculous mycobacterium. Few genomic studies consider its diversity in persistent infections. Our aim was to characterize microevolution/reinfection events in persistent infections. Fifty-three sequential isolates from 14 patients were sequenced to determine SNV-based distances, assign resistance mutations and characterize plasmids. Genomic analysis revealed 12 persistent cases (0-13 differential SNVs), one reinfection (15,956 SNVs) and one very complex case (23 sequential isolates over 192 months), in which a first period of persistence (58 months) involving the same genotype 1 was followed by identification of a genotype 2 (76 SNVs) in 6 additional alternating isolates; additionally, ten transient genotypes (88-243 SNVs) were found. A macrolide resistance mutation was identified from the second isolate. Despite high diversity, the genotypes shared a common phylogenetic ancestor and some coexisted in the same specimens. Genomic analysis is required to access the true intra-patient complexity behind persistent infections involving M. abscessus.

ABSTRACTIeramilimab, a humanized anti-LAG-3 monoclonal antibody, was well tolerated in combination with the anti-PD-1 antibody spartalizumab in a phase 1 study. This phase 2 study aimed to further investigate the efficacy and safety of combination treatment in patients with selected advanced (locally advanced or metastatic) solid malignancies. Eligible patients with non-small cell lung cancer (NSCLC), melanoma, renal cell carcinoma (RCC), mesothelioma, and triple-negative breast cancer (TNBC) were grouped depending on prior anti-PD-1/L1 therapy (anti-PD-1/L1 naive or anti-PD-1/L1 pretreated). Patients received ieramilimab (400 mg) followed by spartalizumab (300 mg) every 3 weeks. The primary endpoint was objective response rate (ORR), along with safety, pharmacokinetics, and biomarker assessments. Of 235 patients, 142 were naive to anti-PD-1/L1 and 93 were pretreated with anti-PD-1/L1 antibodies. Durable responses (>24 months) were seen across all indications for patients naive to anti-PD-1/L1 and in melanoma and RCC patients pretreated with anti-PD1/L1. The most frequent study drug-related AEs were pruritus (15.5%), fatigue (10.6%), and rash (10.6%) in patients naive to anti-PD-1/L1 and fatigue (18.3%), rash (14.0%), and nausea (10.8%) in anti-PD-1/L1 pretreated patients. Biomarker assessment indicated higher expression of T-cell-inflamed gene signature at baseline among responding patients. Response to treatment was durable (>24 months) in some patients across all enrolled indications, and safety findings were in accordance with previous and current studies exploring LAG-3/PD-1 blockade.

Summary: Background: Mobile health (mHealth) systems are a promising alternative for rehabilitation of hip fracture, addressing constrained healthcare resources. Half of older adults fails to recover their pre-fracture routines, which imposes a burden on caregivers. We aimed to test the effectiveness of the 3-month ActiveHip + mHealth intervention on physical and psychological outcomes of older adults with hip fracture and their family caregivers. Methods: In a multicentre open-label randomised controlled trial conducted across 3 hospitals in Andalusia (Spain), patients older than 65 with a hip fracture, who were previously independent and lacked cognitive impairment were recruited alongside with their caregivers. Participants were randomly allocated (1:1) to the intervention group (ActiveHip+) or control (usual care) group. The intervention group underwent a 12-week health education and tele-rehabilitation programme through the ActiveHip + mHealth intervention. The primary outcome, physical performance, was assessed using the Short Physical Performance Battery at three time points: at hospital discharge (baseline), 3-month after surgery (post intervention) and 1-year after surgery follow-up. Primary analyses of primary outcomes and safety data followed an intention-to-treat approach. This study is registered at ClinicalTrials.gov, NCT04859309. Findings: Between June 1st, 2021 and June 30th, 2022 data from 105 patients and their caregivers were analysed. Patients engaged in the ActiveHip + mHealth intervention (mean 7.11 points, SE 0.33) showed higher physical performance compared with patients allocated in the control group (mean 5.71 points, SE 0.32) at 3 months after surgery (mean difference in change from baseline 1.40 points, SE 0.36; puncorrected = 0.00011). These benefits were not maintained at 1-year after surgery follow-up (mean difference in change from baseline 0.19 points, SE 0.47; puncorrected = 0.68). No adverse events, including falls and refractures, were reported during the tele-rehabilitation sessions. At 3-months, the intervention group had 2 falls, compared to 4 in the control group, with no observed refractures. At the 1-year follow-up, the intervention group experienced 7 falls and 1 refracture, while the control group had 13 falls and 2 refractures. Interpretation: This study suggests that the ActiveHip + mHealth intervention may be effective for recovering physical performance in older adults with hip fracture. Importantly, the implementation of ActiveHip + into daily clinical practice may be feasible and has already been adopted in 18 hospitals, mostly in Spain but also in Belgium and Portugal. Thus, ActiveHip + could offer a promising solution when rehabilitation resources are limited. However, its dependence on caregiver support and the exclusion of participants with cognitive impairment makes it necessary to be cautious about its applicability. In addition, the non-maintenance of the effectiveness at 1-year follow-up highlights the need of refinement the ActiveHip + intervention to promote long-lasting behavioural changes. Funding: EIT Health and the Ramón y Cajal 2021 Excellence Research Grant action from the Spanish Ministry of Science and Innovation.

Background: Capsule endoscopy (CE) is a valuable tool for assessing inflammation in patients with Crohn’s disease (CD). The current standard for evaluating inflammation are validated scores (and clinical laboratory values) like Lewis score (LS), Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI), and ELIAKIM. Recent advances in artificial intelligence (AI) have made it possible to automatically select the most relevant frames in CE. Objectives: In this proof-of-concept study, our objective was to develop an automated scoring system using CE images to objectively grade inflammation. Design: Pan-enteric CE videos (PillCam Crohn’s) performed in CD patients between 09/2020 and 01/2023 were retrospectively reviewed and LS, CECDAI, and ELIAKIM scores were calculated. Methods: We developed a convolutional neural network-based automated score consisting of the percentage of positive frames selected by the algorithm (for small bowel and colon separately). We correlated clinical data and the validated scores with the artificial intelligence-generated score (AIS). Results: A total of 61 patients were included. The median LS was 225 (0–6006), CECDAI was 6 (0–33), ELIAKIM was 4 (0–38), and SB_AIS was 0.5659 (0–29.45). We found a strong correlation between SB_AIS and LS, CECDAI, and ELIAKIM scores (Spearman’s r = 0.751, r = 0.707, r = 0.655, p = 0.001). We found a strong correlation between LS and ELIAKIM ( r = 0.768, p = 0.001) and a very strong correlation between CECDAI and LS ( r = 0.854, p = 0.001) and CECDAI and ELIAKIM scores ( r = 0.827, p = 0.001). Conclusion: Our study showed that the AI-generated score had a strong correlation with validated scores indicating that it could serve as an objective and efficient method for evaluating inflammation in CD patients. As a preliminary study, our findings provide a promising basis for future refining of a CE score that may accurately correlate with prognostic factors and aid in the management and treatment of CD patients.

Abstract The synthesis of a family of chiral and enantiomerically pure pyridyl‐diamide (pda) ligands that upon complexation with europium [Eu(CF3SO3)3] result in chiral complexes with metal centered luminescence is reported; the sets of enantiomers giving rise to both circular dichroism (CD) and circularly polarized luminescence (CPL) signatures. The solid‐state structures of these chiral metallosupramolecular systems are determined using X‐ray diffraction showing that the ligand chirality is transferred from solution to the solid state. This optically favorable helical packing arrangement is confirmed by recording the CPL spectra from the crystalline assembly by using steady state and enantioselective differential chiral contrast (EDCC) CPL Laser Scanning Confocal Microscopy (CPL‐LSCM) where the two enantiomers can be clearly distinguished.

This paper presents a promising winding technique which enables higher power-densities in partially superconducting electrical machines with a slotless stator, e.g., self-supporting windings. Firstly, the formulation for defining the skewing factor of the helical winding is given. Afterwards, the skew angle and how diverse winding configurations can be characterised as a function of this angle is explained, along with different parameters such as the skewing factor, the harmonic content of the magnetomotive force wave in the airgap or the resistance per phase of the winding. The sine-shaped winding, a particular case of helical winding, is shown, with which, thanks to the benefits of the additive manufacturing, a better electromagnetic performance is achieved. Finally, the implementation of the helical winding configuration in a slotless partially superconducting 2 MW high-power and high-voltage electric machine for electric aircraft propulsion is assessed, comparing the machine active part weight and their power density.

The solar insecticidal lamp (SIL) is an electronic device designed for physical pest control, widely utilized in orchards and farmland. Currently, the characteristic of the phototactic rhythm of pest is commonly ignored in the design of SILs, hindering pest control. This phenomenon is particularly evident in the prolonged turning on/offlamp, which leads to inefficient energy utilization due to the lack of adjustment for peak pest activity. To address this issue, four models based on the phototactic rhythm of pests are developed to adjust the insecticidal timing of SIL for precise pest control. These mathematical models are established considering the phototactic rhythm of four pests that exert the most significant impact on crops, namely Mythimna seperata, Helicoverpa armigera, Proxenus lepigone, and Cnaphalocrocis medinalis. The results indicate that mathematical modeling of the phototactic rhythm of the pest is valuable in capturing their nocturnal activity patterns. The proposed mathematical model can help to optimize the on/offtime of SIL for pest control. The integration of electronic devices, such as SIL in pest management represents a noteworthy advancement in agricultural electronics, contributing to the progress of smart and sustainable agriculture.

Abstract Background Previous studies by our group have shown that oxidative phosphorylation (OXPHOS) is the main pathway by which pancreatic cancer stem cells (CSCs) meet their energetic requirements; therefore, OXPHOS represents an Achille’s heel of these highly tumorigenic cells. Unfortunately, therapies that target OXPHOS in CSCs are lacking. Methods The safety and anti-CSC activity of a ruthenium complex featuring bipyridine and terpyridine ligands and one coordination labile position (Ru1) were evaluated across primary pancreatic cancer cultures and in vivo, using 8 patient-derived xenografts (PDXs). RNAseq analysis followed by mitochondria-specific molecular assays were used to determine the mechanism of action. Results We show that Ru1 is capable of inhibiting CSC OXPHOS function in vitro, and more importantly, it presents excellent anti-cancer activity, with low toxicity, across a large panel of human pancreatic PDXs, as well as in colorectal cancer and osteosarcoma PDXs. Mechanistic studies suggest that this activity stems from Ru1 binding to the D-loop region of the mitochondrial DNA of CSCs, inhibiting OXPHOS complex-associated transcription, leading to reduced mitochondrial oxygen consumption, membrane potential, and ATP production, all of which are necessary for CSCs, which heavily depend on mitochondrial respiration. Conclusions Overall, the coordination complex Ru1 represents not only an exciting new anti-cancer agent, but also a molecular tool to dissect the role of OXPHOS in CSCs. Results indicating that the compound is safe, non-toxic and highly effective in vivo are extremely exciting, and have allowed us to uncover unprecedented mechanistic possibilities to fight different cancer types based on targeting CSC OXPHOS.

Abstract This paper describes a dataset collected by infrared thermography, a non-contact, non-intrusive technique to acquire data and analyze the built environment in various aspects. While most studies focus on the city and building scales, an observatory installed on a rooftop provides high temporal and spatial resolution observations with dynamic interactions on the district scale. The rooftop infrared thermography observatory with a multi-modal platform capable of assessing a wide range of dynamic processes in urban systems was deployed in Singapore. It was placed on the top of two buildings that overlook the outdoor context of the National University of Singapore campus. The platform collects remote sensing data from tropical areas on a temporal scale, allowing users to determine the temperature trend of individual features such as buildings, roads, and vegetation. The dataset includes 1,365,921 thermal images collected on average at approximately 10-second intervals from two locations during ten months.

The ongoing expansion of the Industrial Internet of Things (IIoT) is enabling the possibility of effective Industry 4.0, where massive sensing devices in heterogeneous environments are connected through dedicated communication protocols. This brings forth new methods and models to fuse the information yielded by the various industrial plant elements and generates emerging security challenges that we have to face, providing ad-hoc functions for scheduling and guaranteeing the network operations. Recently, the large development of Software-Defined Networking (SDN) and Artificial Intelligence (AI) technologies have made feasible the design and control of scalable and secure IIoT networks. This paper studies how AI and SDN technologies combined can be leveraged towards improving the security and functionality of these IIoT networks. After surveying the state-of-the-art research efforts in the subject, the paper introduces a candidate architecture for AI-enabled Software-Defined IIoT Network (AI-SDIN) that divides the traditional industrial networks into three functional layers. And with this aim in mind, key technologies (Blockchain-based Data Sharing, Intelligent Wireless Data Sensing, Edge Intelligence, Time-Sensitive Networks, Integrating SDN&TSN, Distributed AI) and improve applications based on AI-SDIN are also discussed. Further, the paper also highlights new opportunities and potential research challenges in control and automation of IIoT networks.

Colon capsule endoscopy (CCE) enables a comprehensive, non-invasive, and painless evaluation of the colon, although it still has limited indications. The lengthy reading times hinder its wider implementation, a drawback that could potentially be overcome through the integration of artificial intelligence (AI) models. Studies employing AI, particularly convolutional neural networks (CNNs), demonstrate great promise in using CCE as a viable option for detecting certain diseases and alterations in the colon, compared to other methods like colonoscopy. Additionally, employing AI models in CCE could pave the way for a minimally invasive panenteric or even panendoscopic solution. This review aims to provide a comprehensive summary of the current state-of-the-art of AI in CCE while also addressing the challenges, both technical and ethical, associated with broadening indications for AI-powered CCE. Additionally, it also gives a brief reflection of the potential environmental advantages of using this method compared to alternative ones.

The growing integration of software in healthcare, particularly the rise of standalone software as a medical device (SaMD), is transforming digestive medicine, a field heavily reliant on medical imaging for both diagnosis and therapeutic interventions. This narrative review aims to explore the impact of SaMD on digestive healthcare, focusing on the evolution of these tools and their regulatory and ethical challenges. Our analysis highlights the exponential growth of SaMD in digestive healthcare, driven by the need for precise diagnostic tools and personalized treatment strategies. This rapid advancement, however, necessitates the parallel development of a robust regulatory framework to ensure SaMDs are transparent and deliver universal clinical benefits without the introduction of bias or harm. In addition, the discussion highlights the importance of adherence to the FAIR principles for data management—findability, accessibility, interoperability, and reusability. However, enhanced accessibility and interoperability require rigorous protocols to ensure compliance with data protection guidelines and adequate data security, both of which are crucial for effective integration of SaMDs into clinical workflows. In conclusion, while SaMDs hold significant promise for improving patients’ outcomes in digestive medicine, their successful integration into clinical workflow depends on rigorous data protection protocols and clinical validation. Future directions include the need for adequate clinical and real-world studies to demonstrate that these devices are safe and well-suited to healthcare settings.

Several pain scoring systems have been validated to measure pain in dogs. However, pain may not be adequately assessed since these tools are associated with high-level inter-observer variation. The aim of this study is to evaluate the agreement of pain assessment using the CMPS-SF between veterinary students, veterinary nurses, veterinary surgeons, and European College of Veterinary Anaesthesia and Analgesia (ECVAA) diplomates. Forty-five client-owned dogs presented to a teaching hospital were enrolled in this prospective, observational study. All dogs were pain-scored in vivo, while a video of the assessment was recorded and subsequently evaluated by twenty assessors, with five per group. Mean scores between groups were compared, and agreement within groups and agreement of the average scores between groups were assessed by calculating the intraclass correlation coefficient (ICC). The intervention point at which dogs were deemed to require additional analgesia was also evaluated. Overall agreement of pain assessment was poor (ICC = 0.494). Nurses had the best inter-observer agreement (ICC = 0.656), followed by ECVAA diplomates (ICC = 0.540), veterinary surgeons (ICC = 0.478), and veterinary students (ICC = 0.432). The best inter-group agreement was between veterinary surgeons and nurses (ICC = 0.951) and between ECVAA diplomates and nurses (ICC = 0.951). Students were more likely to determine that additional analgesia was required compared to other groups. Pain assessment is key for animal welfare, and training in this area should be reinforced to improve consistency.

Abstract Succession is defined as a directional change in species populations, the community, and the ecosystem at a site following a disturbance. Succession is a fundamental concept in ecology as it links different disciplines. An improved understanding of succession is urgently needed in the Anthropocene to predict the widespread effects of global change on succession and ecosystem recovery, but a comprehensive successional framework (CSF) is lacking. A CSF is needed to synthesize results, draw generalizations, advance successional theory, and make improved decisions for ecosystem restoration. We first show that succession is an integral part of socio‐ecological system dynamics and that it is driven by social and ecological factors operating at different spatial scales, ranging from the patch to the globe. We then present a CSF at the local scale (patch and landscape) at which succession takes place and explain the underlying successional processes and mechanisms operating at that scale. The CSF reflects the increasingly broader perspective on succession and includes recent theoretical advances by not only focusing on species replacement but also on ecosystem development, considering succession as part of a socio‐ecological system, and taking the effect of past and current land use, the landscape context, biotic interactions, and feedback loops into account. We discuss how the CSF can be used to integrate and synthesize successional studies, and its implications for ecosystem restoration.

Este estudio es una revisión sistemática de la literatura publicada desde el año 2018 a junio 2022 acerca del bienestar y el bienestar subjetivo y las pedagogías alternativas, respecto de los estudiantes preescolares y escolares. Cumple con el propósito de caracterizar la investigación sobre bienestar y bienestar subjetivo y educación alternativa en cuanto a la definición de bienestar y bienestar subjetivo a las que adscriben los artículos sobre la materia en las bases de datos Web of Science y Scopus. La muestra final la componen 22 artículos distribuidos en dos tipos de pedagogías alternativas: Montessori y Escuela Bosque. El concepto de bienestar mostró una variedad de connotaciones. Incluyen desde su presentación a partir de definiciones preexistentes en la literatura especializada, hasta simplemente su mención sin mayor explicación. En general, se le entiende como bienestar socioemocional, en ambas pedagogías, coincidiendo con uno de los sellos distintivos de la Educación Alternativa. El bienestar subjetivo muestra una presencia muy reducida, asociada a definiciones preexistentes. Se detectó un número creciente de publicaciones teóricas y empíricas sobre educación alternativa durante los últimos cinco años, denotando un mayor interés por este tipo de educación y sus posibilidades. Los resultados sugieren la conveniencia de seguir desarrollando investigación en esta temática.

Tropical rainforests offer a diverse array of real or potential forest products (FP). However, the ongoing conversion of these forests to agriculture raises concerns about the future availability and sustainability of FP. In this study, we examined the changes in availability (tree density and above-ground biomass) and species richness of native trees, recognized by local communities as sources of FP, with the forest-to-agriculture conversion in a Mesoamerican tropical rainforest region. Specifically, we tested hypotheses on whether species with FP had a higher, equal, or lower reduction in the availability, diversity, and probability of persistence than species without FP with the forest conversion. We interviewed landowners to identify tree species with FP and documented management practices and regulations for using these species. In fourteen 1 km2 landscapes, encompassing the entire range of forest-to-agriculture conversion (from 0 % to ∼100 % old-growth forest cover), we analyzed changes in the availability and richness of species with and without FP. In each landscape, we randomly established 30 plots (each 706.8 m2, totaling 420 plots and 29.7 ha sampling area) covered by old-growth forest, secondary forest, or agricultural fields (mostly cattle pastures). Over four years, we surveyed all trees with a diameter at breast height ≥ 10 cm in these plots. With the forest conversion, assemblages of tree species with FP exhibited a higher reduction in aboveground biomass than species without FP. However, assemblages of species with FP exhibited a significantly lower reduction in abundance, species richness, and a higher probability of persistence than assemblages of species without FP. Furthermore, we found evidence of implementing forest management practices favoring the preservation of species with FP in agricultural lands. Thus, we conclude that people intentionally foster the persistence of valuable species in their agricultural fields, which could have important implications for the structure and composition of future regenerating forests on abandoned agricultural lands. In the long term, this might lead to an overabundance of locally valuable species, as observed in old-growth tropical rainforests that native people ancestrally managed.

Introduction There are limited longitudinal data on the systemic and mucosal antibody responses to SARS-CoV-2 from Latin America, a region severely affected by COVID-19, and where vaccine strategies have been implemented during the evolving pandemic. Objective To evaluate determinants of seroprevalence and changes in levels of anti-SARS-CoV-2 antibodies longitudinally in adults with different levels of exposure to SARS-CoV-2 (defined a priori as low, medium, and high based on presumed occupational risk), in two Andean cities in Ecuador. Methods Longitudinal cohort study of 1,000 adults aged 18 years and older with questionnaire data and sample collection done at 0, 3, 6, and 12 months during the period 2020-2023. Observations collected included WHO-ISARIC questionnaire and peripheral blood and saliva samples for measurement of IgG and IgA antibodies, respectively. Planned analyses are tailored to the longitudinal nature of the outcomes defined by participants’ antibody levels and aim at estimating their average trends with time since infection in each of the occupational groups, adjusted for demographics and calendar-time levels of SARS-CoV-2 infection in the general population. The latter reflect the impact of the national control measures such as vaccinations and movement restrictions. Importance Understanding the duration and the dynamics of waning immunity to SARS-CoV-2, in the context of exposures to emerging virus variants and immunization, will inform the implementation of targeted public health strategies in the Latin American region. Ethics and Dissemination This study will observe the bioethical principles of the Declaration of Helsinki. Informed written consent will be obtained. Samples from participants will be stored for up to three years after which they will be destroyed. The study protocol was approved by the Ecuadorian Ministry of Public Health Ethics Committee for COVID-19 Research. Antibody results will be provided to participants and participating institutions and to the national health authorities.

The crisis of neoliberalism is the crisis of the West, unable to redirect its course and threatened by internal and external contradictions. The emergence of the postmodernism has generated a new uncritical ethos that relativises Western rights and freedoms. The invasion of capitalist mercantile logic into the school, under the neoliberal paradigm, has displaced any political training from the school, contributing to contemporary cultural relativity. In the present work we will review the course of neoliberalism from its origins to the present day, and we will analyse its impact on the Western school. This journey is carried out from a critical approach. Two main consequences are detected: the substitution of knowledge by labour competences, and the promotion of a homogeneity that benefits competitiveness, but deteriorates democratic culture. We conclude with the requirement for schools to abandon relative narratives and embrace democratic values in order to improve the coexistence and the political participation.

The study presented herein concerns the mechanical properties of two common polymers for potential biomedical applications, PLA and PETG, processed through fused filament fabrication (FFF)—Material Extrusion (ME). For the uniaxial tension tests carried out, two printing orientations—XY (Horizontal, H) and YZ (Vertical, V)—were considered according to the general principles for part positioning, coordinates, and orientation typically used in additive manufacturing (AM). In addition, six specimens were tested for each printing orientation and material, providing insights into mechanical properties such as Tensile Strength, Young’s Modulus, and Ultimate Strain, suggesting the materials’ potential for biomedical applications. The experimental results were then compared with correspondent mechanical properties obtained from the literature for other polymers like ASA, PC, PP, ULTEM 9085, Copolyester, and Nylon. Thereafter, fatigue resistance curves (S-N curves) for PLA and PETG, printed along 45°, were determined at room temperature for a load ratio, R, of 0.2. Scanning electron microscope observations revealed fibre arrangements, compression/adhesion between layers, and fracture zones, shedding light on the failure mechanisms involved in the fatigue crack propagation of such materials and giving design reference values for future applications. In addition, fractographic analyses of the fatigue fracture surfaces were carried out, as well as X-ray Computed Tomography (XCT) and Thermogravimetric (TGA)/Differential Scanning Calorimetric (DSC) tests.

BackgroundThe COVID-19 pandemic has caused over 68.7 million infections and 1.35 million deaths in South America. There are limited data on SARS-CoV-2 seropositivity and its determinants from Andean countries prior to mass vaccinations against COVID-19.ObjectiveTo estimate SARS-CoV-2 seropositivity and its determinants before vaccination in occupational groups of adults presumed to have different levels of exposure and associations with potential symptomatology.MethodsWe measured seropositivity of anti-SARS-CoV-2 IgG antibodies in a cross-sectional study of vaccine-naïve adults aged 18 years and older, recruited within three occupational risk groups (defined as low [LR], moderate [MR], and high [HR]) between January and September 2021 in two Andean cities in Ecuador. Associations with risk factors were estimated using logistic regression.ResultsIn a sample of 882 adults, IgG seropositivity for the three different occupational risk groups was 39.9% (CI 95% 35.3-44.6), 74.6% (CI 95% 66.4-81.4), and 39.0% (CI 95% 34.0-44.4) for the HR, MR, and LR groups, respectively. History of an illness with loss of taste and/or smell was significantly associated with seropositivity in all occupational groups, with adjusted ORs of 14.31 (95%CI, 5.83-35.12; pConclusionNotable proportions of seropositivity were seen in all occupational groups between January and September 2021 prior to mass vaccination. Loss of taste and/or smell was strongly associated with presence of anti-SARS-CoV-2 IgG antibodies irrespective of presumed occupational exposure risk.

BackgroundThere is a growing epidemic of chronic non-communicable diseases in low and middle-income countries, often attributed to urbanization, although there are limited data from marginalized rural populations. This study aimed to estimate prevalence of cardiometabolic diseases and associated risk factors in transitional rural communities.MethodsA cross-sectional study of Montubio adults aged 18-94 years living in agricultural communities in a tropical coastal region of Ecuador. Data were collected by questionnaires and anthropometry, and fasting blood was analyzed for glucose, glycosylated hemoglobin, insulin, and lipid profiles. Population-weighted prevalences of diabetes, hypertension, and metabolic syndrome were estimated. Associations between potential risk factors and outcomes were estimated using multilevel regression techniques adjusted for age and sex.ResultsOut of 1,010 adults recruited, 931 were included in the analysis. Weighted prevalences were estimated for diabetes (20.4%, 95% CI 18.3-22.5%), hypertension (35.6%, 95% CI 29.0-42.1%), and metabolic syndrome (54.2%. 95% CI 47.0-61.5%) with higher prevalence observed in women. Hypertension prevalence increased with age while diabetes and metabolic syndrome peaked in the 6th and 7th decades of life, declining thereafter. Adiposity indicators were associated with diabetes, hypertension, and metabolic syndrome.ConclusionWe observed an unexpectedly high prevalence of diabetes, hypertension, and metabolic syndrome in these marginalized agricultural communities. Transitional rural communities are increasingly vulnerable to the development of cardiometabolic risk factors and diseases. There is a need for targeted primary health strategies to reduce the burden of premature disability and death in these communities.

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

The sustainable use and protection of water resources are urgently needed. Human activity and climate change are exacerbating water-related problems and worsening the quality of riparian and wetland ecosystems, rendering them unable to provide services which are basic to human well-being and socioeconomic development. The most affected communities are those that rely on natural aquatic environments, thus suffering the worst consequences of its degradation.This is the case of the Colombian Embera indigenous people, whose populations have been forced to migrate, due to armed conflicts, to peripheral urban areas without access to safe water and sanitation. For this reason, the international cooperation project ''Baña Do Bari'' was set up to design and implement treatment wetlands (TWs) for the treatment of wastewater mainly produced in sanitary infrastructure, with the purpose of guaranteeing adequate living conditions and improved basic hygiene to indigenous communities. The sanitary infrastructure was designed collectively with the participation of the community.In this paper, the above-mentioned project is analyzed to determine if its actions can be considered Nature-based Solutions (NBS) and to identify opportunities for improvement. To this end, the IUCN Global Standard for NBS and other technical criteria were used. The main results indicate that TWs built within the ''Baña Do Bari'' project can be considered a NBS according to the technical criteria used for self-assessment. Regarding the Standard, the project strongly resolves social challenges. The criteria that could be improved are mainly related to the collection of environmental data on the biodiversity conservation status in the area.

Objective @ctivehip is a home-based multidisciplinary telerehabilitation programme for older adults with hip fracture, conducted with the assistance of their family caregivers. This programme was useful in improving their functional recovery. Nevertheless, we were concerned about how the programme might have affected caregivers, whose assistance was essential for supporting older adults in using new technologies and ensuring their safety during the exercises and activities at home. The aim of the present study was to compare the burden, psychological factors and physical fitness of the family caregivers of older adults who opted the @ctivehip telerehabilitation programme versus those family caregivers of older adults who received the face-to-face rehabilitation provided by the Andalusian Public Healthcare System (in Spain). Methods In this single-blinded, non-randomized clinical trial, participants were older adults with hip fracture and their family caregivers. The telerehabilitation group (n = 30) underwent a 12-week multidisciplinary telerehabilitation programme, and the comparative group (n = 32) received face-to-face rehabilitation. Caregivers outcomes measured were (i) the burden using the Zarit Burden Interview, (ii) the anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), and (iii) the Physical Fitness with the International Fitness Scale (IFIS). Results There were not statistically significant differences on caregiver burden between family caregivers in the @ctivehip and the comparative group, although there was a trend towards lower values [[Mean (95%CI); 14.73 (9.09 to 20.37) vs 16.03 (10.63 to 21.43); p = 0.771] as well as for anxiety and depression [5.66 (3.21 to 8.78) vs 11.19 (8.52 to 13.86); p = 0.022]. Likewise achieved better, though not statistically significant, scores in physical fitness [19.37 (17.94 to 20.81) vs 17.15 (15.77 to 18.53); p = 0.055]. Conclusion Caregiver burden is not associated with telerehabilitation. In addition, telerehabilitation is associated with lower anxiety and depression levels among family caregivers who opt for this programme. Physical fitness is not related with telerehabilitation.

Introduction: Spontaneous coronary artery dissection (SCAD) represents 1–4% of all acute coronary syndromes (ACS), and is a particularly important cause among young women and individuals with few cardiovascular risk factors. Objectives: To characterize clinical background, therapeutic management and clinical outcomes in a SCAD population. Methods: We retrospectively analyzed all consecutive patients diagnosed with SCAD at a tertiary center between August 2009 and May 2020, with a median follow-up of 40 months (IQR 14–95 months). SCAD was classified according to the Saw angiographic SCAD classification. Results: A total of 36 patients were included, 94% female, mean age 51 years (±11 years). A trigger was only detected in 8% and associated conditions in 31% of patients, mainly inflammatory or autoimmune systemic diseases and migraine. Most patients had non-ST-elevation ACS and 33% presented with ST-elevation ACS. The most frequent culprit lesion was the left anterior descending (LAD) artery (67%); mid to distal segments were the most affected (94%) and type 2 dissection the most prevalent (60%). Almost all patients were successfully medically managed, with only four undergoing percutaneous intervention. During follow-up, ischemic events recurred in 15% of patients and no patient died. Patients with type 2 dissection exhibited lower risk of recurrence compared to type 1 (p=0.049, OR=0.13). Conclusion: SCAD patients were mainly young or middle-aged women; the LAD artery was the most affected vessel and type 2 dissection the most prevalent. This report showed for the first time a correlation between type 2 SCAD and lower risk of recurrence. Resumo: Introdução: A disseção coronária espontânea (DCE) representa 1 a 4% de todas as síndromes coronárias agudas (SCA), sendo uma causa particularmente importante em jovens mulheres e indivíduos com poucos fatores de risco cardiovasculares. Objetivos: Caracterização de uma população diagnosticada com DCE, abordagem terapêutica e evolução clínica a longo prazo. Métodos: Análise retrospetiva de todos os doentes consecutivamente diagnosticados com DCE num centro terciário, entre agosto de 2009 e maio de 2020, com um seguimento médio de 40 meses (IQR 14-95 meses). A DCE foi classificada de acordo com a classificação angiográfica de Saw. Resultados: Foram incluídos 36 doentes, 94% mulheres com média de 51 anos (±11-anos). Apenas 8% apresentavam um trigger e 31% apresentavam uma condição associada, especialmente doença inflamatória ou autoimune sistémica ou história de enxaqueca. A maioria teve um SCA sem supradesnivelamento-do-segmento-ST e 33% uma SCA com supradesnivelamento-de-ST. A artéria responsável mais comum foi a descendente anterior (67%); os segmentos médios e distais foram os mais afetados (94%) e a disseção tipo 2 foi a mais prevalente (60%). A maioria foi tratada medicamente com sucesso, sendo que apenas quatro doentes foram submetidos a angioplastia. Durante o seguimento, houve recorrência de eventos em 15% dos doentes e nenhum faleceu. A disseção tipo 2 correlacionou-se significativamente com menor risco de recorrência face à disseção tipo 1 (p=0,049, OR=O,13). Conclusão: A maioria dos doentes era mulher jovem ou de meia-idade; a artéria descendente anterior foi a mais afetada e a disseção tipo 2 a mais prevalente. Este trabalho mostrou pela primeira vez uma correlação entre a DCE tipo 2 e menor risco de recorrência de eventos.

Androgen receptor signaling regulates the normal and pathological growth of the prostate. In particular, the growth and survival of prostate cancer cells is initially dependent on androgen receptor signaling. Exposure to androgen deprivation therapy leads to the development of castration-resistant prostate cancer. There is a multitude of molecular and cellular changes that occur in prostate tumor cells, including the expression of neuroendocrine features and various biomarkers, which promotes the switch of cancer cells to androgen-independent growth. These biomarkers include transcription factors (TP53, REST, BRN2, INSM1, c-Myc), signaling molecules (PTEN, Aurora kinases, retinoblastoma tumor suppressor, calcium-binding proteins), and receptors (glucocorticoid, androgen receptor-variant 7), among others. It is believed that genetic modifications, therapeutic treatments, and changes in the tumor microenvironment are contributing factors to the progression of prostate cancers with significant heterogeneity in their phenotypic characteristics. However, it is not well understood how these phenotypic characteristics and molecular modifications arise under specific treatment conditions. In this work, we summarize some of the most important molecular changes associated with the progression of prostate cancers and we describe some of the factors involved in these cellular processes.