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Abstract Background Prostate cancer (PrCa) is the most frequently diagnosed cancer in men. Variants in known moderate- to high-penetrance genes explain less than 5% of the cases arising at early-onset (

A living donor (LD) kidney transplant is the best treatment for kidney failure, but LDs safety is paramount. We sought to evaluate our LDs cohort’s longitudinal changes in estimated glomerular filtration rate (eGFR). We retrospectively studied 320 LDs submitted to nephrectomy between 1998 and 2020. The primary outcome was the eGFR change until 15 years (y) post-donation. Subgroup analysis considered distinct donor characteristics and kidney function reduction rate (%KFRR) post-donation [−(eGFR6 months(M)–eGFRpre-donation)/eGFRpre-donation*100]. Donors had a mean age of 47.3 ± 10.5 years, 71% female. Overall, LDs presented an average eGFR change 6 M onward of +0.35 mL/min/1.73 m2/year. The period with the highest increase was 6 M–2 Y, with a mean eGFR change of +0.85L/min/1.73 m2/year. Recovery plateaued at 10 years. Normal weight donors presented significantly better recovery of eGFR +0.59 mL/min/1.73 m2/year, compared to obese donors −0.18L/min/1.73 m2/year (p = 0.020). Noteworthy, these results only hold for the first 5 years. The subgroup with a lower KFRR (

Point source detection algorithms play a pivotal role across diverse applications, influencing fields such as astronomy, biomedical imaging, environmental monitoring, and beyond. This article reviews the algorithms used for space imaging applications from ground and space telescopes. The main difficulties in detection arise from the incomplete knowledge of the impulse function of the imaging system, which depends on the aperture, atmospheric turbulence (for ground-based telescopes), and other factors, some of which are time-dependent. Incomplete knowledge of the impulse function decreases the effectiveness of the algorithms. In recent years, deep learning techniques have been employed to mitigate this problem and have the potential to outperform more traditional approaches. The success of deep learning techniques in object detection has been observed in many fields, and recent developments can further improve the accuracy. However, deep learning methods are still in the early stages of adoption and are used less frequently than traditional approaches. In this review, we discuss the main challenges of point source detection, as well as the latest developments, covering both traditional and current deep learning methods. In addition, we present a comparison between the two approaches to better demonstrate the advantages of each methodology.

INTRODUCTION: The use of statins in hemodialysis patients is a topic of ongoing research and debate. Patients with chronic kidney disease on hemodialysis constitute a large proportion of patients treated in the vascular surgery field. Clinical data of the protective statin effect on this group is scarce and conflicting results exist regarding cardiovascular, cerebrovascular and limb outcomes. METHODS: We performed a thorough electronic search of the literature using PubMed and Embase databases to understand the relationship between statin effect and cardiovascular, limb outcomes and cerebrovascular outcomes. A narrative review was constructed, based on the obtained literature. RESULTS: Although the use of statins in hemodialysis patients may provide cardiovascular benefits, the optimal dosage and safety profile of these medications in this population remain uncertain. A carefully evaluation of the risks and benefits of statins should be made based on each patient's specific requirements and circumstances. CONCLUSION: The role of statins for patients with peripheral arterial disease who are on hemodialysis remains unclear. Further analyses should focus on this subgroup of dialysis patients, who are becoming more prevalent on the vascular surgery departments, allowing for an optimized treatment with better patient outcomes.

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Abstract Background Malaria remains one of the most serious public health problems in sub-Saharan Africa and Mozambique is the world's fourth largest contributor, with 4.7% of disease cases and 3.6% of total deaths due to malaria. Its control relies on the fight against the vector and treatment of confirmed cases with anti-malarial drugs. Molecular surveillance is an important tool for monitoring the spread of anti-malarial drug resistance. Methods A cross-sectional study recruited 450 participants with malaria infection detected by Rapid Diagnostic Tests, from three different study sites (Niassa, Manica and Maputo) between April and August 2021. Correspondent blood samples were collected on filter paper (Whatman® FTA® cards), parasite DNA extracted and pfk13 gene sequenced using Sanger method. SIFT software (Sorting Intolerant From Tolerant) was used, predict whether an amino acid substitution affects protein function. Results No pfkelch13-mediated artemisinin resistance gene mutation was detected in this study settings. However, non-synonymous mutations were detected at prevalence of 10.2%, 6% and 5% in Niassa, Manica and Maputo, respectively. Most (56.3%) of the reported non-synonymous mutations were due to substitution at the first base of the codon, 25% at the second base and 18.8% at the third base. Additionally, 50% of non-synonymous mutations showed a SIFTscore bellow cut off value of 0.05, therefore, they were predicted to be deleterious. Conclusion These results do not show an emergence of artemisinin resistance cases in Mozambique. However, the increased number of novel non-synonymous mutations highlights the relevance of increasing the number of studies focused on the molecular surveillance of artemisinin resistance markers, for its early detection.

O direito à saúde é um direito fundamental, para o qual se impõe a existência de um sistema de saúde estruturado e regulado. Em Portugal, o Estado tem aumentado a interação com as entidades da economia social que prestam cuidados sociais de saúde, com destaque para as IPSS. Com este estudo pretende-se compreender a adequação da regulação prevista legalmente para as IPSS que disponibilizam respostas sociais na área da saúde e identificar a influência da regulação sobre os serviços disponibilizados por estas instituições. O estudo empírico foi desenvolvido através da metodologia qualitativa, envolvendo a análise de conteúdo às entrevistas realizadas a sete IPSS que operam na área da saúde em Portugal. A pesquisa realizada permitiu concluir que não existe uma adequação plena da regulação aplicável às IPSS que disponibilizam respostas sociais na área da saúde. A inadequação é especialmente evidenciada ao nível das comparticipações financeiras, que se revelam insuficientes, e que limitam a captação de recursos humanos, capacidade de atualização tecnológica e expansão da atividade.

INTRODUCTION: The descending thoracic aorta (DTA) has been used as inflow mostly as a secondary option for revascularization after either graft failure/infection or other intra-abdominal pathologies contraindicating a standard abdominal aortic approach. The objective of this review is to summarize current evidence on the use of this inflow site for revascularization procedures. METHODS: A comprehensive electronic literature search was performed, using PubMed and Embase databases. All literature published in English in the last 30 years was considered. The main goal was to assess the feasibility and practicality of implementing this approach in cases of severe and complex aortoiliac lesions. RESULTS: Our review comprised 11 articles. DTA has been used predominately as a secondary option. The 30-day mortality rate was 4% (9/222). Secondary graft patency at 5-years was generally high across all studies. The use of DTA as inflow has been shown to be a safe and effective option for aorto-iliac reconstruction. CONCLUSION: DTA can be used safely as an inflow for lower-limb revascularization and it remains an important tool in the vascular surgeon's armamentarium.

Background: Nephrectomy with autotransplantation (NAT) has been performed as an alternative treatment for complex renovascular lesions, intricate ureteral strictures and nephron-sparing surgery in complex renal tumors. Methods: A retrospective observational study was conducted including patients who underwent a NAT from January 2010 to September 2023. Data collected included surgery indications, surgical technique, complications according to Clavien–Dindo classification and mean hospital stay. Descriptive and inferential statistical analysis was performed using IBM® SPSS® Statistics version 28.0.1.0. Results: A total of 34 consecutive patients underwent 38 NATs at our institution. Surgery indications were complex renovascular conditions in 35 cases (92.1%), of which 24 had renal artery aneurysms, and ureteral injuries in 3 cases (7.9%). Thirty-four kidneys (89.5%) were retrieved through a laparoscopic approach. No significant difference was observed between post- and pre-operative creatinine levels (0.81 vs. 0.72, p = 0.303). Early high-grade complications developed in 12 procedures (31.6%). Median cold ischemia time was significantly longer in patients who developed complications (163.0 vs. 115.0, p = 0.010). The median hospital stay was 10 days (8–13). The median follow-up was 51.5 months. Conclusions: NAT emerges as a successful therapeutic strategy for a highly select group of patients dealing with intricate ureteral lesions and kidney vascular abnormalities, demonstrating positive outcomes that endure in the long term.

Background: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and treatment outcomes. The primary outcomes studied were implant survival rate, pocket depth, marginal peri-implant recession, bone loss, bone thickness (volumetric change), interproximal bone level, mesial and distal papilla migration, and radiographic evaluation; and the secondary parameters were Pink Esthetic Score (PES), vertical distance from implant shoulder and bone, Visual Analogue Score (VAS), Implant Stability Quotient (ISQ), and biological complications (fistulas, pain, mucositis, and peri-implantitis). Methods: The PICO strategy was used to formulate the hypothesis under study: “For patients who underwent extraction and immediate implant placement, what is the efficacy of using any type of graft (bone or soft tissue) compared to non-grafting regarding the peri-implant parameters?” The electronic search process was performed on the MedLine/PubMed and Cochrane databases. It included randomized controlled trials (RCTs) from the last 11 years (from 2012 to November 2023), which were identified and analyzed. Results: Nine RCTs (κ = 0.98) were selected (403 patients and 425 implants); they were divided into three groups: bone graft (75 patients and 75 implants inserted), bone graft and membrane (213 patients and 235 implants inserted), and without bone graft (115 patients and 115 implants inserted). Three studies calculated the mid-facial mucosa level and two reported better results when a connective tissue graft was combined with the xenograft, whereas another study found better results in the combination of a dual-zone technique with a xenograft. Three studies evaluated the total Pink Esthetic Score (PES) at 12 months, where the authors found no significant difference in using a xenogeneic graft with or without a membrane. In the same period, the facial bone thickness was assessed in two articles; the authors reported better results in graft-treated and flapless groups. The risk-of-bias assessment found four studies with low risk, four with moderate risk, and one with a high risk of bias. The meta-analysis showed a medium level of heterogeneity for the mid-facial mucosa level analysis (I2 = 46%) and an overall effect size of 0.79 (95% CI [0.18; 1.40]), a statistically significant results (p = 0.01), with a tendency to favor the experimental group. Also, there was a medium level of heterogeneity among studies regarding total PES (I2 = 45%), with no significant differences between studies (p = 0.91). Homogeneous results (I2 = 0%) were found among studies analyzing facial bone thickness, favoring the experimental group; the forest plot showed an effect of 0.37 (95% CI [0.25; 0.50]), which was statistically significant (p < 0.00001) for this parameter. Conclusions: Then, it was possible to conclude that using bone and soft tissue grafting techniques associated with immediate implant placement (IIP), even though they are not fundamental, was a valuable resource to prevent significant tissue reduction, reaching greater bone stability and higher levels in the Pink Esthetic Score (PES) and Visual Analogue Score (VAS).

Purpose: The aim of our study is to compare the perioperative, functional, and oncological outcomes of laparoscopic transperitoneal partial nephrectomy (LTPN) and laparoscopic retroperitoneal partial nephrectomy (LRPN) for posterior cT1 renal tumors. Methods: We retrospectively collected data on all patients who consecutively underwent LTPN and LRPN for posterior cT1 renal tumors in three different centers from January 2015 to January 2023. Patients with a single, unilateral, cT1 renal mass, located in the posterior renal surface were included. Patients’ data regarding perioperative, functional, and oncological outcomes were collected from medical records and statistically analyzed and compared. Results: A total of 128 patients was obtained, with 53 patients in the LPTN group and 75 patients in the LRPN group. Baseline characteristics were similar. Warm ischemia time (WIT) (18.8 vs. 22.6 min, p = 0.002) and immediate postoperative eGFR drop (−6.1 vs. −13.0 mL/min/1.73 m2, p = 0.047) were significantly lower in the LPTN group. Estimated blood loss (EBL) (100 vs. 150 mL, p = 0.043) was significantly lower in the LRPN group. All other perioperative and functional outcomes and complications were similar between the groups. The positive surgical margin (PSM) rate was lower in the LRPN group, although without statistical significance (7.2% vs. 13.5%, p = 0.258). Surgical success defined by Trifecta (WIT ≤ 25 min, no PSM, and no major postoperative complication) was similar between both approaches. Conclusions: LTPN has significantly shorter WIT and a significantly smaller drop in immediate eGFR when compared to LRPN for posterior renal tumors. On the other hand, LRPN has significantly less EBL than LTPN. LRPN demonstrated fewer PSMs than LTPN, albeit without statistical significance. In terms of overall surgical success, as defined by Trifecta, both approaches achieved similar results.

Over the last decade, genome-scale metabolic models have been increasingly used to study plant metabolic behaviour at the tissue and multi-tissue level under different environmental conditions. Quercus suber, also known as the cork oak tree, is one of the most important forest communities of the Mediterranean/Iberian region. In this work, we present the genome-scale metabolic model of the Q. suber (iEC7871). The metabolic model comprises 7871 genes, 6231 reactions, and 6481 metabolites across eight compartments. Transcriptomics data was integrated into the model to obtain tissue-specific models for the leaf, inner bark, and phellogen, with specific biomass compositions. The tissue-specific models were merged into a diel multi-tissue metabolic model to predict interactions among the three tissues at the light and dark phases. The metabolic models were also used to analyse the pathways associated with the synthesis of suberin monomers, namely the acyl-lipids, phenylpropanoids, isoprenoids, and flavonoids production. The models developed in this work provide a systematic overview of the metabolism of Q. suber, including its secondary metabolism pathways and cork formation.

Ilio-iliac arteriovenous fistula occurs in 1% of all common iliac artery aneurysms, a rare complication of this identity. A variety of symptoms appear depending on the size and location of the fistula, making the correct diagnosis quite difficult, only 37–52% of the cases are diagnosed before surgery. We report a case of an abdominal infrarenal aneurysm and right common iliac aneurysm, with fistula into the left common iliac vein, presenting with acute nocturnal paroxysmal dyspnea and left leg edema, inducing to the incorrect diagnosis of venous thromboembolism.

Descending thoracic aorta (DTA) inflow has been utilized as a secondary choice for restoring blood flow in cases of aortoiliac occlusive disease. This option is considered when graft failure, infection, or other intra-abdominal conditions contraindicates the use of the standard abdominal aortic approach. Additionally, when the abdominal aorta develops extensive and complicated circumferential calcified lesions, making it unsafe to clamp this segment, a DTA bypass can serve as a secure and effective alternative. It remains an important tool in the arsenal of vascular surgeons. The presence of coral reef aorta, a rare condition characterized by outwardly projecting calcified plaques on the juxtarenal and visceral aorta, poses a challenge in determining the best treatment approach, as it has yet to be defined.

INTRODUCTION: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) as the first line treatment for BTAI. Other controversies regarding BTAI management were reported in the literature, such as the best treatment for minimal aortic injuries with intimal tear, ideal stent graft oversizing, best timing for treatment and necessity to cover the left subclavian artery (LSA). The purpose of this review is to identify and analyze appropriate studies published so far about the management of BTAI. METHODS: We performed a thorough electronic search of the literature using PubMed and Embase databases. We used the following combination of key words in our search strategy ((aortic injury) AND (blunt thoracic trauma)) AND (vascular surgery* OR treatment* OR TEVAR*). Articles not in English were excluded. The primary subject was results of endovascular treatment. Secondary subjects were indications and results of OSR, best timing for intervention, ideal graft oversizing, need for left subclavian artery (LSA) coverage, and management of BTAI grade I (intimal tear). RESULTS: Data related to our primary and secondary subjects were extracted from the selected articles. TEVAR is considered the primary treatment for BTAI, if the patient has suitable anatomy, with good short and mid-term outcomes, with lower mortality and paraplegia rates at short and mid-term follow-up, compared to OSR. Despite good term results at short-term follow-up after TEVAR, long-term outcomes are still a concern. OSR is still a valid option in selected cases, and it should be considered for patients whose injury location is unsuitable for the endovascular approach. In most patients with BTAI, it is recommended around 10% of graft oversizing. However, a more aggressive approach with oversizing between 10-20% should be considered for patients with considerable hypotension and even >20% for patients presenting with severe hypotensive hemorrhagic shock. A necessity of LSA coverage has been reported in 30% of TEVAR for urgent treatment of BTAI, and it seems to be well tolerated. We should considered expectant approach with serial follow-up CT scans in patients with BTAI grade I injuries with asymptomatic intimal aortic tear. CONCLUSIONS: This literature review reports and synthetizes published data about the management strategies for BTAI. TEVAR seems to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

Abstract Tumour budding (TB) has been associated with adverse clinicopathological factors and poor survival in a plethora of therapy‐naïve carcinoma entities including gastric adenocarcinoma (GC). As conventional histopathological grading is usually omitted in the post‐neoadjuvant setting of GC, our study aimed to investigate the prognostic impact of TB in GCs resected after neoadjuvant therapy. We evaluated TB according to the criteria from the International Tumour Budding Consensus Conference (ITBCC) in 167 post‐neoadjuvant resections of intestinal‐type GC and correlated the results with overall survival (OS) and clinicopathological parameters. GCs were categorised into Bd1 (0–4 buds, low TB), Bd2 (5–9 buds, intermediate TB), and Bd3 (≥10 buds, high TB). Carcinomas with intermediate and high TB were significantly enriched in higher ypTNM stages and strongly associated with reduced 5‐year OS in univariable analyses (p

INTRODUCTION: Recently published studies on peripheral arterial occlusive disease (PAOD) have revealed marked sex disparities in patient selection and treatment outcomes. In a recent retrospective study with data from 11 different countries, Portugal was highlighted as one of the countries with greater sex discrepancies related to PAOD treatment. We aimed to analyze sex specific differences in the treatment of symptomatic PAOD, concerning different variables, in a single hospital center, in Portugal. METHODS: Data on treatment of symptomatic PAOD patients from October 1st, 2020, to December 31st, 2021, were retrospectively collected from clinical registries from a single hospital center in Portugal. Different variables and post-operative outcomes were analyzed dichotomized by sex, with descriptive statistics. Statistical analyses were conducted using the IBM Statistical Package for Social Sciences (SPSS) software v28. RESULTS: A total of 220 patients, 15,9% female and 84,1% male, were treated for PAOD, in the selected period, in a hospital center from Portugal. Female patients were older (mean age of 73.8 years versus 69.5 years in male); were less likely to be treated for intermittent claudication (3% versus 6% of men); more often treated at a more advanced stage of the disease with trophic lesions (91% versus 74% of men); more likely to be offered primary major amputation (14% versus 3% of male patients); less likely to be taking statins as part of PAOD medical management (65.7% versus 77.8% of male); and had a higher 90-day mortality rate (17.1% versus 6.5% in men). They were also more frequently treated with endovascular procedures (40%) than with OSR (26%). CONCLUSION: Remarkable sex discrepancies in the treatment of PAOD were found in our hospital center. This study brings awareness to the scientific medical community for sex disparities in the management of patients with PAOD.

We present a new study of Jupiter’s atmosphere dynamics using for the first time the extremely high-resolution capabilities of VLT/ESPRESSO to retrieve wind velocities in Jupiter’s troposphere, with a dedicated ground-based Doppler velocimetry method. This work is primarily a proof-of-concept for retrieving Jupiter’s winds using VLT/ESPRESSO Doppler velocities. These results are complemented by a re-analysis of Cassini’s data from its fly-by of Jupiter in December 2000, performing cloud tracking at visible wavelengths, for cross comparison with Doppler velocimetry results, along with previous cloud-tracking results. We explore the effectiveness of this refined method to measure winds in Jupiter, using high-resolution spectroscopy data obtained from ESPRESSO observations performed in July 2019, with a Doppler velocimetry method based on backscattered solar radiation in the visible range. Coupled with our ground-based results, we retrieved a latitudinal and longitudinal profile of Jupiter’s winds along select bands of the atmosphere. Comparing the results between cloud-tracking methods, based on previous reference observations, and our new Doppler velocimetry approach, we found a good agreement between them, demonstrating the effectiveness of this technique. The winds obtained in this exploratory study have a two-fold relevance: they contribute to the temporal and spatial variability study of Jupiter’s troposphere dynamics, and the results presented here also validate the use of this Doppler technique to study the dynamics of Jupiter’s atmosphere and pave the way for further exploration of a broader region of Jupiter’s disk for a more comprehensive retrieval of winds and to evaluate their spatial and temporal variability.

Introduction: Urinary tract endometriosis (UTE), a rare manifestation, encompasses bladder and ureteral involvement. Surgical intervention is commonly recommended for UTE, though the optimal surgical approach remains a subject of debate. This study aims to report our centre’s experience with UTE. Methods: We conducted a retrospective cohort study of 55 patients who underwent surgical treatment for UTE at a single tertiary centre over a 10-year period (2012–2022). Patient data, including demographics, symptoms, intraoperative findings, and complications, were collected from medical records. Data were statistically analysed, and correlations were explored. Results: The study population had a mean age of 37.11 years, with dysmenorrhea (89.1%) being the most common symptom. Bladder endometriosis was present in 27 cases, ureteral endometriosis in 25, and mixed-location in 3. Laparoscopy was the primary surgical approach, with multidisciplinary teams involving urologists. There were six patients with postoperative complications, and there were six (10.9%) recurrences of endometriosis. A positive correlation was found between age and recurrence, but no significant predictors of recurrence were identified in our analysis. Conclusions: Laparoscopic treatment of urinary endometriosis is safe and effective. Multidisciplinary collaboration plays a pivotal role in addressing this challenging condition.

Introduction: Kidney transplantation requires immunosuppression, traditionally regarded as a risk factor for progression in all malignancies. Based on the Cincinnati Registry, a waiting period before transplantation is therefore mandatory. However, recent evidence suggests this increased risk is restricted to particular tumors, whereas others like renal cell carcinoma (RCC) are not negatively affected. We aimed to compare oncological outcomes of RCC in native kidneys of end-stage renal disease (ESRD) patients, according to their transplantation or dialysis status. Material and methods: Retrospective analysis of all ESRD patients diagnosed with RCC between 2010 and 2020 in our center. Recurrence-free survival (RFS) and overall survival (OS) were estimated with Kaplan-Meier curves. Multivariable Cox regression model was used to evaluate their association with kidney transplantation. Results: Clinical and pathological characteristics were similar between groups. Kidney transplant recipients had similar risk of recurrence (hazard ratio [HR] 0.40, 95% confidence interval [CI) 0.04-4.46, p = 0.458) and overall survival (HR 0.34, 95%CI 0.07-1.77, p = 0.202) as dialyzed patients. On multivariable Cox regression model, presence or absence of transplantation was not significantly associated with RFS (p = 0.479) or OS (p = 0.236). Time on dialysis was the only independent predictor of worse survival (HR 1.86, 95%CI 1.18-2.93, p = 0.008). Conclusions: Most RCC in native kidneys of ESRD patients are low-grade, low-stage and exhibit favourable pathological and outcome features. Immunosuppression does not seem to have an impact on oncological outcomes, but an increased time on dialysis seems to be associated with worse overall survival. Therefore, waiting time for transplantation for these tumors could be reduced.

INTRODUCTION: Stylocarotid syndrome is caused by the conflict between the styloid process and the vascular structures leading to carotid artery dissection (CAD) or compression. Being headache the most common initial symptom in patients with spontaneous CAD, eagle syndrome could be one explanation for some so-called spontaneous dissections since this symptom is also common in this syndrome. METHODS: Afrer analyzing the reported cases on Pubmed and Embase databases we divided the cases in compression and CAD groups ending up with completely different groups in terms of clinical presentation, management and follow-up. RESULTS: While management of compression group seems quite straightforward, the same is not true when CAD is present. Whether delayed styloidectomy after medical management plays a role in CAD, as it does for the compression group, is something to investigate.

Background: The burden of urological diseases is rising as the worldwide population ages. Although specialist urological provision is needed, a large proportion of these conditions will be managed in primary care. The importance of including urology in medical education currently remains unclear. Objective: To provide recommendations on undergraduate medical education for urology in Europe. Design, setting, and participants: A three-round Delphi process to reach consensus on standardising the undergraduate urology curriculum in Europe was endorsed by the European School of Urology. Outcome measurements and statistical analysis: The levels of agreement were set using a nine-point scale according to the GRADE grid: 1–3, disagree; 4–6, uncertain; and 7–9, agree. Consensus was defined as at least 70% of the participants scoring within the same 3-point grouping. Results and limitations: Overall, consensus was reached for 20 of 34 statements (70.5%) across the three Delphi rounds, with agreement for 75% (n = 15) and disagreement for 25% (n = 5). The following main points were agreed. Urological teaching should be introduced before year 5 of medical school, with at least 20 h of theoretical activities and at least 30 h of practical activities. Urology should be taught as a stand-alone subject rather than combined with another surgical specialty or a nephrology programme. The participants agreed that urology should be taught according to symptoms. A urology programme should include the anatomy and physiology of the urinary tract, and students should know how to clinically assess a urological patient. Conclusions: Our recommended urology pathway will allow European medical schools to provide a more comprehensive undergraduate urology curriculum. It will also help to improve and maintain standards of urology undergraduate teaching across Europe. Patient summary: Our survey showed that urology in universities should have, at minimum, time for theoretical and practical activities and should be taught as a stand-alone subject on the basis of symptoms. Students should give feedback to facilitate constant improvement and evolution of the teaching programme.

Abstract The increasing prevalence of patients with aortic stenosis worldwide highlights a clinical need for improved and accurate prediction of clinical outcomes following surgery. We investigated patient demographic and cardiovascular magnetic resonance (CMR) characteristics to formulate a dedicated risk score estimating long-term survival following surgery. We recruited consecutive patients undergoing CMR with gadolinium administration prior to surgical aortic valve replacement from 2003 to 2016 in two UK centres. The outcome was overall mortality. A total of 250 patients were included (68 ± 12 years, male 185 (60%), with pre-operative mean aortic valve area 0.93 ± 0.32cm2, LVEF 62 ± 17%) and followed for 6.0 ± 3.3 years. Sixty-one deaths occurred, with 10-year mortality of 23.6%. Multivariable analysis showed that increasing age (HR 1.04, P = 0.005), use of antiplatelet therapy (HR 0.54, P = 0.027), presence of infarction or midwall late gadolinium enhancement (HR 1.52 and HR 2.14 respectively, combined P = 0.12), higher indexed left ventricular stroke volume (HR 0.98, P = 0.043) and higher left atrial ejection fraction (HR 0.98, P = 0.083) associated with mortality and developed a risk score with good discrimination. This is the first dedicated risk prediction score for patients with aortic stenosis undergoing surgical aortic valve replacement providing an individualised estimate for overall mortality. This model can help clinicians individualising medical and surgical care. Trial Registration ClinicalTrials.gov Identifier: NCT00930735 and ClinicalTrials.gov Identifier: NCT01755936.

Background: Vascular calcification is an ever-more-common finding in protocoled pre-transplant imaging in living kidney donors. We intended to explore whether a connection could be found between the Agatston calcification score, prior to kidney donation, and post-donation renal function. Methods: This is a retrospective analysis of 156 living kidney donors who underwent living donor nephrectomy between January 2010 and December 2016. We quantified the total calcification score (TCaScore) by calculating the Agatston score for each vessel, abdominal aorta, common iliac, and renal arteries. Donors were placed into two different groups based on their TCaScore: 2) over 5 years of follow-up was investigated. Results: The ≥100 TCaScore group consisted of 29 (19%) donors, with a median (interquartile range) calcification score of 164 (117–358). This group was significantly older, 56.7 ± 6.9 vs. 45.5 ± 10.6 (p < 0.001), had a higher average BMI (p < 0.019), and had a lower preoperative eGFR (p < 0.014). The 1-year eGFR was similarly diminished, 69.9 ± 15.7 vs. 76.3 ± 15.5 (p < 0.048), while also having an increased risk of decreased renal function during the follow-up, 22% vs. 48% (p < 0.007). Conclusions: Our study, through univariate analyses, found a relationship between a TCaScore > 100, lower 1-year eGFR, and decreased renal function in 5 years. However, a higher-than-expected vascular calcification should not be an excluding factor in donors, although they may require closer monitoring during follow-up.

In 2001, Finish investigators described a rare familiar syndrome characterized by an inherited susceptibility to cutaneous leiomyomas, uterine leiomyomas, and renal cell carcinoma (RCC). Hereditary leiomyomatosis and renal cell cancer (HLRCC) is now linked to a germline mutation in the fumarate hydratase (FH) gene that encodes a Krebs cycle enzyme, transforming fumarate to malate. The accumulation of fumarate, an oncometabolite, promotes tumorigenesis. We present a case of a 41-year-old female diagnosed with HLRCC after a radical nephrectomy due to renal cell cancer. Genetic analyses confirmed a novel FH mutation. Close follow-up allowed for a precocious diagnosis of a metachronous renal tumor and later a hepatic metastasis. Her family was also counseled and offered genetic testing. As observed in this case, the diagnosis of HLRCC is of paramount importance for patients and their families: there is a 15% cumulative lifetime risk of developing RCC, which frequently occurs in young patients and metastasizes at an early stage. Implementing a regular follow-up with adequate imaging examinations may help save lives.

Abstract Introduction Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational cohort study. Methods Serial patients with HCM underwent CMR, including adenosine first-pass perfusion, left atrial (LA) and left ventricular (LV) volumes indexed to body surface area (i) and late gadolinium enhancement (%LGE- as a % of total myocardial mass). We used a composite endpoint of HF death, cardiac transplantation, and progression to NYHA class III/IV. Results A total of 543 patients with HCM underwent CMR, of whom 94 met the composite endpoint at baseline. The remaining 449 patients were followed for a median of 5.6 years. Thirty nine patients (8.7%) reached the composite endpoint of HF death (n = 7), cardiac transplantation (n = 2) and progression to NYHA class III/IV (n = 20). The annual incidence of HF was 2.0 per 100 person-years, 95% CI (1.6–2.6). Age, previous non-sustained ventricular tachycardia, LV end-systolic volume indexed to body surface area (LVESVI), LA volume index ; LV ejection fraction, %LGE and presence of mitral regurgitation were significant univariable predictors of HF, with LVESVI (Hazard ratio (HR) 1.44, 95% confidence interval (95% CI) 1.16–1.78, p = 0.001), %LGE per 10% (HR 1.44, 95%CI 1.14–1.82, p = 0.002) age (HR 1.37, 95% CI 1.06–1.77, p = 0.02) and mitral regurgitation (HR 2.6, p = 0.02) remaining independently predictive on multivariable analysis. The presence or extent of inducible perfusion defect assessed using a visual score did not predict outcome (p = 0.16, p = 0.27 respectively). Discussion The annual incidence of HF in a contemporary ambulatory HCM population undergoing CMR is low. Myocardial fibrosis and LVESVI are strongly predictive of future HF, however CMR visual assessment of myocardial perfusion was not.

Neural injuries in cerebral malaria patients are a significant cause of morbidity and mortality. Nevertheless, a comprehensive research approach to study this issue is lacking, so herein we propose an in vitro system to study human cerebral malaria using cellular approaches. Our first goal was to establish a cellular system to identify the molecular alterations in human brain vasculature cells that resemble the blood–brain barrier (BBB) in cerebral malaria (CM). Through transcriptomic analysis, we characterized specific gene expression profiles in human brain microvascular endothelial cells (HBMEC) activated by the Plasmodium falciparum parasites. We also suggest potential new genes related to parasitic activation. Then, we studied its impact at brain level after Plasmodium falciparum endothelial activation to gain a deeper understanding of the physiological mechanisms underlying CM. For that, the impact of HBMEC-P. falciparum-activated secretomes was evaluated in human brain organoids. Our results support the reliability of in vitro cellular models developed to mimic CM in several aspects. These systems can be of extreme importance to investigate the factors (parasitological and host) influencing CM, contributing to a molecular understanding of pathogenesis, brain injury, and dysfunction.

Lemierre's syndrome is a clinical triad of acute oropharyngeal infection, secondary local invasion and vein thrombosis often involving the internal jugular vein, along with evidence of systemic septic embolism. Usually affecting otherwise healthy adolescents and young adults, anaerobic Fusobacterium spp. are often implicated; other bacterial species are sometimes found. While being a rare disease with a reported 14.4 cases per million person-years, it carries a mortality rate of 5 to 9%. Clinical presentation can be severe owing to septic shock, multiorgan dysfunction, septic embolization and acute respiratory distress syndrome requiring ICU admission. Treatment involves antibiotic therapy with anaerobic coverage and supportive care. Anticoagulation use is controversial and surgical treatment may be needed to control focus of infection. There is few quality evidence available regarding the clinical management of this syndrome. We report a case of Lemierre syndrome caused by Streptococcus hemolyticus group c, complicated with pulmonary septic embolism, necrotizing pneumonia, empyema and acute respiratory distress syndrome with a degree of severity that required the use of extracorporeal membrane oxygenation to support the patient.

Abstract This work presents the results of the evaluation of two Art Nouveau glass windows from the Casa-Museu Dr. Anastácio Gonçalves (Lisbon, Portugal) with IR-thermography during the summer solstice. According to the measurements, the surface temperature of glass depended on the outdoor environmental temperature and, mainly, on the direct solar radiation. Colored glasses presented a higher surface temperature due to the absorption of their chromophores at near-IR wavelengths. Enamels and grisailles showed higher surface temperatures than their support glasses due to both their chemical composition and color. The protective glazing, with small slits in one of the window panels, induced a hot-air pocket in its upper part due to the insufficient ventilation.

O desenvolvimento de instrumentos didáticos para os discentes da Educação Profissional e Tecnológica tem sido alvo de diversas pesquisas nos últimos anos. Esse artigo tem como objetivo apresentar reflexões sobre a produção e o uso de instrumentos didáticos voltados para o ensino-aprendizagem no curso de Automação Industrial do Instituto Federal do Maranhão/Coelho Neto. Realizou-se uma pesquisa bibliográfica em acervos virtuais (IFMA, Person, Scielo e Google acadêmico) entre os anos de 2016 a 2020. Como resultado, tem-se o desenvolvimento de um braço hidráulico com os alunos do referido curso. Logo, percebeu-se que os instrumentos didáticos facilitam a aprendizagem, pois promovem um aprendizado conjunto, interativo e motivador desde a etapa da construção até a aplicação na abordagem dos conteúdos.

Non-secretory multiple myeloma is a rare form of the disease that presents a diagnostic challenge. A 69-year-old woman presented to the emergency department with a pathological fracture of the right clavicle, along with a history of asthenia and middle back pain in the preceding three months. Workup revealed multiple focal lytic bone lesions in the clavicles, ribs, skull and thoracic- lumbar-sacral spine, without evidence of anemia, hypercalcemia or renal failure, with no abnormal immunofixation in the serum or urine and with normal serum free light chain ratios. The Iliac crest bone marrow aspiration and biopsy revealed a scarcely involved marrow, However, biopsy of one of the focal bone lesions revealed a hypercellular bone marrow with phenotypically abnormal plasmocytes, along with an intriguing, albeit aberrant, cytokeratin expression. Non-secretory multiple myeloma is in itself a rare diagnosis. However, the combination of a patchy marrow involvement and aberrant cytokeratin expression makes this a noteworthy presentation.

Colorectal cancer (CRC) is a complex condition with heterogeneous aetiology, caused by a combination of various environmental, genetic, and epigenetic factors. The presence of a homeostatic gut microbiota is critical to maintaining host homeostasis and determines the delicate boundary between health and disease. The gut microbiota has been identified as a key environmental player in the pathogenesis of CRC. Perturbations of the gut microbiota structure (loss of equilibrium and homeostasis) are associated with several intestinal diseases including cancer. Such dysbiosis encompasses the loss of beneficial microorganisms, outgrowth of pathogens and pathobionts and a general loss of local microbiota diversity and richness. Notably, several mechanisms have recently been identified how bacteria induce cellular transformation and promote tumour progression. In particular, the formation of biofilms, the production of toxic metabolites or the secretion of genotoxins that lead to DNA damage in intestinal epithelial cells are newly discovered processes by which the microbiota can initiate tumour formation. The gut microbiota has also been implicated in the metabolism of therapeutic drugs (conventional chemotherapy) as well as in the modulation of radiotherapy responses and targeted immunotherapy. These new findings suggest that the efficacy of a given therapy depends on the composition of the host’s gut microbiota and may therefore vary from patient to patient. In this review we discuss the role of host-microbiota interactions in cancer with a focus on CRC pathogenesis. Additionally, we show how gut bacteria can be exploited in current therapies and how mechanisms directed by microbiota, such as immune cell boost, probiotics and oncolytic bacteria, can be applied in the development of novel therapies.

Wading birds can be found breeding in a myriad of habitats and ecosystems across Europe that vary widely in their land-use intensity. Over the past few decades, wader breeding populations have declined steeply in habitats ranging from natural undisturbed ecosystems to intensively managed farmland. Most conservation science has focused on factors determining local population size and trends which leave cross-continental patterns and the associated consequences for large-scale conservation strategies unexplored. Here, we review the key factors underlying population decline. We find land-use intensification in western Europe and mostly agricultural extensification and abandonment in northern, central and eastern Europe to be important drivers. Additionally, predation seems to have increased throughout the breeding range and across all habitats. Using collected breeding density data from published and grey literature, we explore habitat specificity of wader species and, of the most widely distributed species, how breeding densities change across a land-use intensity gradient. We found that two-thirds of all examined wader species have relatively narrow breeding habitat preferences, mostly in natural and undisturbed ecosystems, while the remaining species occurred in most or all habitats. The most widespread generalist species (black-tailed godwit, northern lapwing, common redshank, Eurasian oystercatcher, common snipe and ruff) demonstrated peak breeding densities at different positions along the land-use intensity gradient. To conserve both diverse wader communities and viable meta-populations of species, a diversity of habitats should be targeted ranging in land-use intensity from natural ecosystems to medium intensity farmland. Alongside, strategies should be designed to moderate predation of wader clutches and chicks.

In the new Internet of Things (IoT) era, embedded Field-Programmable Gate Array (FPGA) technology is enabling the deployment of custom-tailored embedded IoT solutions for handling different application requirements and workloads. Combined with the open RISC-V Instruction Set Architecture (ISA), the FPGA technology provides endless opportunities to create reconfigurable IoT devices with different accelerators and coprocessors tightly and loosely coupled with the processor. When connecting IoT devices to the Internet, secure communications and data exchange are major concerns. However, adding security features requires extra capabilities from the already resource-constrained IoT devices. This article presents the FAC-V coprocessor, which is an FPGA-based solution for an RISC-V processor that can be deployed following two different coupling styles. FAC-V implements in hardware the Advanced Encryption Standard (AES), one of the most widely used cryptographic algorithms in IoT low-end devices, at the cost of few FPGA resources. The conducted experiments demonstrate that FAC-V can achieve performance improvements of several orders of magnitude when compared to the software-only AES implementation; e.g., encrypting a message of 16 bytes with AES-256 can reach a performance gain of around 8000× with an energy consumption of 0.1 μJ.

In this work, we describe the CRIMSON (CardiovasculaR Integrated Modelling and SimulatiON) software environment. CRIMSON provides a powerful, customizable and user-friendly system for performing three-dimensional and reduced-order computational haemodynamics studies via a pipeline which involves: 1) segmenting vascular structures from medical images; 2) constructing analytic arterial and venous geometric models; 3) performing finite element mesh generation; 4) designing, and 5) applying boundary conditions; 6) running incompressible Navier-Stokes simulations of blood flow with fluid-structure interaction capabilities; and 7) post-processing and visualizing the results, including velocity, pressure and wall shear stress fields. A key aim of CRIMSON is to create a software environment that makes powerful computational haemodynamics tools accessible to a wide audience, including clinicians and students, both within our research laboratories and throughout the community. The overall philosophy is to leverage best-in-class open source standards for medical image processing, parallel flow computation, geometric solid modelling, data assimilation, and mesh generation. It is actively used by researchers in Europe, North and South America, Asia, and Australia. It has been applied to numerous clinical problems; we illustrate applications of CRIMSON to real-world problems using examples ranging from pre-operative surgical planning to medical device design optimization.

The rapid development of Internet of Things (IoT) technology has provided ample opportunity for the implementation of intelligent agricultural production. Such technology can be used to connect various types of agricultural devices, which can collect and send data to servers for analysis. These tools can help farmers optimize the production of their crops. However, one of the main problems that arises in agricultural areas is a lack of connectivity or poor connection quality. For these reasons, in this paper, we present a method that can be used for the performance evaluation of communication systems used in IoT for agriculture, considering metrics such as the packet delivery ratio, energy consumption, and packet collisions. To achieve this aim, we carry out an analysis of the main Low-Power Wide-Area Networks (LPWAN) protocols and their applicability, from which we conclude that those most suited to this context are Long Range (LoRa) and Long Range Wide Area Network (LoRaWAN). After that, we analyze various simulation tools and select Omnet++ together with the Framework for LoRa (FLoRa) library as the best option. In the first stage of the simulations, the performances of LoRa and LoRaWAN are evaluated by comparing the average propagation under ideal conditions against moderate propagation losses, emulating a rural environment in the coastal region of Ecuador. In the second phase, metrics such as the package delivery ratio and energy consumption are evaluated by simulating communication between an increasing number of nodes and one or two gateways. The results show that using two gateways with the Adaptive Data Rate technique can actively increase the delivery ratio of the network while consuming the same amount of energy per node. Finally, a comparison is made between the results of the simulation scenario considered in this project and those of other research works, allowing for the validation of our analytical and simulation results.

Mast cells (MCs) are crucial players in the relationship between the tumor microenvironment (TME) and cancer cells and have been shown to influence angiogenesis and progression of human colorectal cancer (CRC). However, the role of MCs in the TME is controversially discussed as either pro- or anti-tumorigenic. Genetically engineered mouse models (GEMMs) are the most frequently used in vivo models for human CRC research. In the murine intestine there are at least three different MC subtypes: interepithelial mucosal mast cells (ieMMCs), lamina proprial mucosal mast cells (lpMMCs) and connective tissue mast cells (CTMCs). Interepithelial mucosal mast cells (ieMMCs) in (pre-)neoplastic intestinal formalin-fixed paraffin-embedded (FFPE) specimens of mouse models (total lesions n = 274) and human patients (n = 104) were immunohistochemically identified and semiquantitatively scored. Scores were analyzed along the adenoma-carcinoma sequence in humans and 12 GEMMs of small and large intestinal cancer. The presence of ieMMCs was a common finding in intestinal adenomas and carcinomas in mice and humans. The number of ieMMCs decreased in the course of colonic adenoma-carcinoma sequence in both species (p < 0.001). However, this dynamic cellular state was not observed for small intestinal murine tumors. Furthermore, ieMMC scores were higher in GEMMs with altered Wnt signaling (active β-catenin) than in GEMMs with altered MAPK signaling and wildtypes (WT). In conclusion, we hypothesize that, besides stromal MCs (lpMMCs/CTMCs), particularly the ieMMC subset is important for onset and progression of intestinal neoplasia and may interact with the adjacent neoplastic epithelial cells in dependence on the molecular environment. Moreover, our study indicates the need for adequate GEMMs for the investigation of the intestinal immunologic TME.

ABSTRACT Artemisinin-based combination therapies (ACTs) have been vital in reducing malaria mortality rates since the 2000s. Their efficacy, however, is threatened by the emergence and spread of artemisinin resistance in Southeast Asia. The Plasmodium falciparum multidrug resistance protein 1 (PfMDR1) transporter plays a central role in parasite resistance to ACT partner drugs through gene copy number variations (CNV) and/or single nucleotide polymorphisms (SNPs). Using genomic epidemiology, we show that multiple pfmdr1 copies encoding the N86 and 184F haplotype are prevalent across Southeast Asia. Applying genome editing tools on the Southeast Asian Dd2 strain and using a surrogate assay to measure transporter activity in infected red blood cells, we demonstrate that parasites harboring multicopy N86/184F PfMDR1 have a higher Fluo-4 transport capacity compared with those expressing the wild-type N86/Y184 haplotype. Multicopy N86/184F PfMDR1 is also associated with decreased parasite susceptibility to lumefantrine. These findings provide evidence of the geographic selection and expansion of specific multicopy PfMDR1 haplotypes associated with multidrug resistance in Southeast Asia. IMPORTANCE Global efforts to eliminate malaria depend on the continued success of artemisinin-based combination therapies (ACTs) that target Plasmodium asexual blood-stage parasites. Resistance to ACTs, however, has emerged, creating the need to define the underlying mechanisms. Mutations in the P. falciparum multidrug resistance protein 1 (PfMDR1) transporter constitute an important determinant of resistance. Applying gene editing tools combined with an analysis of a public database containing thousands of parasite genomes, we show geographic selection and expansion of a pfmdr1 gene amplification encoding the N86/184F haplotype in Southeast Asia. Parasites expressing this PfMDR1 variant possess a higher transport capacity that modulates their responses to antimalarials. These data could help tailor and optimize antimalarial drug usage in different regions where malaria is endemic by taking into account the regional prevalence of pfmdr1 polymorphisms.

Characterizing the wind speeds of Venus and their variability at multiple vertical levels is essential for a better understanding of the atmospheric superrotation, constraining the role of large-scale planetary waves in the maintenance of this superrotation, and in studying how the wind field affects clouds’ distribution. Here, we present cloud-tracked wind results of the Venus nightside, obtained with unprecedented quality using ground-based observations during July 2012 with the near-infrared camera and spectrograph (NICS) of the Telescopio Nazionale Galileo (TNG) in La Palma. These observations were performed during 3 consecutive days for periods of 2.5 h starting just before dawn, sensing the nightside lower clouds of Venus close to 48 km of altitude with images taken at continuum K filter at 2.28 μm. Our observations cover a period of time when ESA’s Venus Express was not able to observe these deeper clouds of Venus due to a failure in the infrared channel of its imaging spectrometer, VIRTIS-M, and the dates were chosen to coordinate these ground-based observations with Venus Express’ observations of the dayside cloud tops (at about 70 km) with images at 380 nm acquired with the imaging spectrometer VIRTIS-M. Thanks to the quality and spatial resolution of TNG/NICS images and the use of an accurate technique of template matching to perform cloud tracking, we present the most detailed and complete profile of wind speeds ever performed using ground-based observations of Venus. The vertical shear of the wind was also obtained for the first time, obtained by the combination of ground-based and space-based observations, during the Venus Express mission since the year 2008, when the infrared channel of VIRTIS-M stopped working. Our observations exhibit day-to-day changes in the nightside lower clouds, the probable manifestation of the cloud discontinuity, no relevant variations in the zonal winds, and an accurate characterization of their decay towards the poles, along with the meridional circulation. Finally, we also present the latitudinal profiles of zonal winds, meridional winds, and vertical shear of the zonal wind between the upper clouds’ top and lower clouds, confirming previous findings by Venus Express.

Introduction: Classical aphasia evaluation scales are too long to use in the context of acute stroke or as a monitoring tool. The Aphasia Rapid Test is a 26-point scale developed as a bedside assessment to rate aphasia severity in acute stroke patients in less than 3 minutes. We aimed to adapt and validate this scale for European Portuguese. Material and Methods: We evaluated 56 acute stroke patients in the first and in the seventh days post-stroke. In the seventh day, patients were evaluated by two independent raters, to evaluate inter-rater agreement. To study concurrent validity, the Lisbon Aphasia Examination Battery was applied to a subset of 20 patients. The predictive ability of the Aphasia Rapid Test was assessed at six months, by the aphasia subscale of the National Institutes of Health Stroke Scale. Results: Translation to European Portuguese was based in the French and English versions, considering the words’ utilization frequency. The Chronbach’s alpha was 0.796. The concordance coefficient between the two raters was excellent (0.985). Correlation between Aphasia Rapid Test and the Lisbon Aphasia Examination Battery was strong (r = -0.958, p < 0.001). The study through Bland-Altman graphs corroborated the good inter-rater agreement and concurrent validity of the test. The Aphasia Rapid Test score in the first day is an independent predictor of long-term outcome. Discussion: This study provides reliable results for European Portuguese, with adequate internal consistency, inter-rater agreement and concurrent validity. Conclusion: The Aphasia Rapid Test is a good tool for the evaluation and monitoring of aphasia in stroke patients.

Background: Special AT-rich sequence-binding protein 2 (SATB2) has emerged as an alternative immunohistochemical marker to CDX2 for colorectal differentiation. However, the distribution and prognostic relevance of SATB2 expression in colorectal carcinoma (CRC) have to be further elucidated. Methods: SATB2 expression was analysed in 1039 CRCs and correlated with clinicopathological and morphological factors, CDX2 expression as well as survival parameters within the overall cohort and in clinicopathological subgroups. Results: SATB2 loss was a strong prognosticator in univariate analyses of the overall cohort (p < 0.001 for all survival comparisons) and in numerous subcohorts including high-risk scenarios (UICC stage III/high tumour budding). SATB2 retained its prognostic relevance in multivariate analyses of these high-risk scenarios (e.g., UICC stage III: DSS: p = 0.007, HR: 1.95), but not in the overall cohort (DSS: p = 0.1, HR: 1.25). SATB2 loss was more frequent than CDX2 loss (22.2% vs. 10.2%, p < 0.001) and of higher prognostic relevance with only moderate overlap between SATB2/CDX2 expression groups. Conclusions: SATB2 loss is able to identify especially aggressive CRCs in high-risk subgroups. While SATB2 is the prognostically superior immunohistochemical parameter compared to CDX2 in univariate analyses, it appears to be the less sensitive marker for colorectal differentiation as it is lost more frequently.

The present paper defines and assesses a new simplified method to represent the photovoltaic (PV) modules’ electrical behavior, based on the commonly used one diode and three parameters (1D + 3P) model, addressing two main objectives. The first one is to quantify and assess, at different operating conditions, the PV modules electrical behavior estimations’ accuracy provided by the well-known 1D + 3P, through a comparison based on experimental and theoretical results. The second one concerns the performance assessment of the 1D + 3P model’s suggested approximation, aiming at simplifying the mathematics instead of solving complex iterative equations, which hinges on higher computational time to obtain accurate results. Hence, experimental and theoretical data were considered, aiming at performing a thorough comparison with more than 17,000 PV modules being assessed, which was achieved by using both the California Energy Commission (CEC) database and PVsyst software. The findings show that the already known 1D + 3P model delivers satisfactory power output estimations for crystalline silicon modules and high irradiance conditions. However, its performance worsens when considering Low Irradiance and thin-film technology. In comparison with the original model, accurate results were obtained with the new simplified suggested 1D + 3P for all irradiance conditions and technologies assessed, thus proving its validity and capability of circumventing the aforementioned challenges.

Abstract Background The use of coronary MR angiography (CMRA) in patients with coronary artery disease (CAD) remains limited due to the long scan times, unpredictable and often non-diagnostic image quality secondary to respiratory motion artifacts. The purpose of this study was to evaluate CMRA with image-based respiratory navigation (iNAV CMRA) and compare it to gold standard invasive x-ray coronary angiography in patients with CAD. Methods Consecutive patients referred for CMR assessment were included to undergo iNAV CMRA on a 1.5 T scanner. Coronary vessel sharpness and a visual score were assigned to the coronary arteries. A diagnostic reading was performed on the iNAV CMRA data, where a lumen narrowing >50% was considered diseased. This was compared to invasive x-ray findings. Results Image-navigated CMRA was performed in 31 patients (77% male, 56 ± 14 years). The iNAV CMRA scan time was 7 min:21 s ± 0 min:28 s. Out of a possible 279 coronary segments, 26 segments were excluded from analysis due to stents or diameter less than 1.5 mm, resulting in a total of 253 coronary segments. Diagnostic image quality was obtained for 98% of proximal coronary segments, 94% of middle segments, and 91% of distal coronary segments. The sensitivity and specificity was 86% and 83% per patient, 80% and 92% per vessel and 73% and 95% per segment. Conclusion In this study, iNAV CMRA offered a very good diagnostic performance when compared against invasive x-ray angiography. Due to the short and predictable scan time it can add clinical value as a part of a comprehensive CAD assessment protocol.

Concurrent C0 is an imperative programming language in the C family with session-typed message-passing concurrency. The previously proposed semantics implements asynchronous (non-blocking) output; we extend it here with non-blocking input. A key idea is to postpone message reception as much as possible by interpreting receive commands as a request for a message. We implemented our ideas as a translation from a blocking intermediate language to a non-blocking language. Finally, we evaluated our techniques with several benchmark programs and show the results obtained. While the abstract measure of span always decreases (or remains unchanged), only a few of the examples reap a practical benefit.

Dihydroartemisinin/piperaquine (DHA/PPQ) is increasingly deployed as an antimalaria drug in Africa. We report the detection in Mali of Plasmodium falciparum infections carrying plasmepsin 2 duplications (associated with piperaquine resistance) in 7/65 recurrent infections within 2 months after DHA/PPQ treatment. These findings raise concerns about the long-term efficacy of DHA/PPQ treatment in Africa.

La neuralgia del trigémino es característica en personas mayores de 50 años, comprometiendo principalmente el territorio V2 y V3 de dicho nervio de manera unilateral y la carbamezepina es el fármaco con mayor efectividad, pero no siempre responden. La presentación atípica y los signos de alarma ponen en consideración el estudio con resonancia magnética cerebral, pues obliga a descartar una causa secundaria, siendo necesario el análisis de neuroimágenes. Debido a esto, presentamos un caso de quiste epidermoide con neuralgia secundaria, que se presenta con signos de alarma y se deben considerar los estudios complementarios.

La enfermedad cerebrovascular es un problema de salud pública mundial, considerada dentro de las primeras causas de mortalidad. La trombosis venosa cerebral (TVC) es una de sus patologías, que a pesar de ser infrecuente puede llevar a severas complicaciones en el paciente. Es por eso que se presentan dos casos de infartos bitalámicos secundarios a trombosis venosa cerebral profunda, con hallazgos clínicos e imagenológicos inusuales que hicieron aún más difícil su diagnóstico. Debido a las diferentes funciones que posee el tálamo además de la infrecuencia de la trombosis venosa cerebral profunda, la presentación clínica sigue siendo atípica y es usual que se consideren otros diagnósticos al inicio del evento, por lo tanto, consideramos importante proyectar estudios con muestras de mayor tamaño para definir con claridad la clínica y los hallazgos radiológicos de esta patología.