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Objetivo: Descrever o caso de uma paciente jovem com trombose provocada com síndrome do anticorpo antifosfolipide triplo positiva que teve múltiplos episódios de sangramento, sendo diagnosticada hipoprotrombinemia após investigação etiológica. Materiais e métodos: Dados foram extraídos do prontuário médico de consultas ambulatoriais. Relato de caso: Paciente feminina, de 45 anos, com quadro de Trombose venosa profunda em membro inferior direito em 2000 após 2 meses de uso de anticoncepcional hormonal combinado oral. Fez uso de varfarina por 2 anos. Após isso teve dois partos prematuros: o primeiro com 28 semanas concomitante a quadro de pré-eclâmpsia e o segundo com 32 semanas. Em investigação etiológica, teve diagnóstico de síndrome do anticorpo antifosfolipide por critérios clínicos somados com critérios laboratoriais, positivando anticorpo antifosfolípide, anticorpo anti-B2 microglobulina e anticorpo anti-cardiolipina. Desde então manteve quadro de sangramento uterino anormal, com miomectomia videolaparoscópica em 2015 com choque hemorrágico e conversão para laparotomia. Seguido a esse episódio, foi desencadeada investigação de histórico de sangramento, com paciente tendo 10 pontos em bleeding assessment test. Paciente inicialmente com testes de triagens de coagulação alterados com pesquisa de deficiências de fatores e inibidores, com perda de paralelismo dos fatores VII, IX e VIII, e paralelismo de curvas de fator II. Os achados caracterizaram a síndrome anticorpo antifosfolípide hipoprotrombinemia. Desde então paciente é manejada com observação clínica e uso de hidroxicloroquina pela reumatologia com objetivo de redução de risco de evento trombótico. Discussão: A entidade anticoagulante lúpico hipoprotrombinemia é uma entidade que predispõe a sangramentos pela presença do anticoagulante lúpico. A deficiência de fator II deve ser suspeitada quando há prolongação simultânea de tempo de protrombina e tempo de tromboplastina ativada. Não há recomendações do tratamento dessa síndrome atualmente. O achado dessa síndrome é incomum, tendo raros registros em periódicos. Conclusão: A síndrome antifosfolípide associada com hipoprotrombinemia é uma entidade rara, sem condutas bem definidas, cujo relato de casos similares devem ser descritos para tentativas de condutas comuns. O uso de hidroxicloroquina e a manutenção da paciente sem anticoagulação parecem ser condutas possíveis com certo sucesso clínico.

Introduction: Gender dysphoria refers to the distress or discomfort experienced when a person's gender identity does not align with the sex assigned at birth. While many transgender individuals affirm their gender identity without surgical intervention, an increasing number undergo gender-confirming surgery. It is essential to recognize and promptly treat vascular complications that can arise during these procedures. There are no previous reports addressing arterial injuries during the implantation of penile prostheses for gender-confirming surgery. Case presentation: A 33-year-old patient with gender dysphoria underwent female-to-male surgical interventions for gender confirmation. During the latest urologic procedure, which involved the implantation of a three-piece inflatable penile prosthesis, a vascular complication occurred, resulting in injury to the right common femoral artery. Given the extent of the injury and the difficulty in repairing the arterial wall, vascular surgeons resected the damaged artery segment and performed an end-to-end anastomosis. Intraoperative duplex ultrasound at the conclusion of the surgery showed a triphasic waveform in the distal vessels. The urologist decided to postpone the implantation of the penile prosthesis. The patient was discharged on the sixth postoperative day without systemic or local complications and was prescribed single antiplatelet therapy. Conclusions: With the increasing number of transgender individuals seeking gender-affirming surgery, it is important to conduct a multidisciplinary preoperative evaluation to minimize complications that could affect their quality of life.

Abstract Background Melting corneal ulcers are a serious condition that affects a great number of animals and people around the world and it is characterised by a progressive weakening of the tissue leading to possible severe ophthalmic complications, such as visual impairment or blindness. This disease is routinely treated with medical therapy and keratoplasty, and recently also with alternative regenerative therapies, such as cross-linking, amniotic membrane transplant, and laser. Plasma medicine is another recent example of regenerative treatment that showed promising results in reducing the microbial load of corneal tissue together with maintaining its cellular vitality. Since the effect of helium plasma application on corneal mechanical viscoelasticity has not yet been investigated, the aim of this study is first to evaluate it on ex vivo porcine corneas for different exposition times and then to compare the results with previous data on cross-linking treatment. Results 94 ex vivo porcine corneas divided into 16 populations (healthy or injured, fresh or cultured and treated or not with plasma or cross-linking) were analysed. For each population, a biomechanical analysis was performed by uniaxial stress-relaxation tests, and a statistical analysis was carried out considering the characteristic mechanical parameters. In terms of equilibrium normalised stress, no statistically significant difference resulted when the healthy corneas were compared with lesioned plasma-treated ones, independently of treatment time, contrary to what was obtained about the cross-linking treated corneas which exhibited more intense relaxation phenomena. Conclusions In this study, the influence of the Helium plasma treatment was observed on the viscoelasticity of porcine corneas ex vivo, by restoring in lesioned tissue a degree of relaxation similar to the one of the native tissue, even after only 2 min of application. Therefore, the obtained results suggest that plasma treatment is a promising new regenerative ophthalmic therapy for melting corneal ulcers, laying the groundwork for further studies to correlate the mechanical findings with corneal histology and ultrastructural anatomy after plasma treatment.

RESUMO Este artigo investiga os impactos da revolução digital no sistema monetário e financeiro internacional (SMFI), com ênfase nos efeitos gerados pelo lançamento da moeda digital da China, o e-CNY. Argumenta-se que, do ponto de vista de países emergentes e em desenvolvimento (PEED), as transformações da era digital implicam considerar os custos e os benefícios de se implementar as próprias moedas digitais de bancos centrais (CBDCs, na sigla em inglês), em um contexto no qual esta “nova forma” não altera substancialmente o caráter hierárquico e assimétrico do SMFI. A criação do e-CNY gera novas disjuntivas, como, por exemplo, a escolha entre desenvolver sistemas que sejam interoperáveis com o sistema chinês, ou não. Este aspecto carrega um forte componente político na atual conjuntura de questionamento do status quo em várias dimensões do sistema internacional. Para ilustrar este aspecto, o artigo traz evidências empíricas sobre a evolução nas interconexões entre a economia chinesa e os principais PEED em dimensões como convergência nos ciclos de negócios e nos ciclos financeiros. A maior integração com a China pode funcionar como um eventual fator de atração para os PEED que, assim, poderia gravitar mais em torno do e-CNY em um cenário de maior contestação da posição do dólar estadunidense.

Preeclampsia is a multifactorial gestational syndrome characterized by increased blood pressure during pregnancy associated with multiorgan involvement. The impact of this disease on maternal and neonatal health is significant, as it can lead to various fetal comorbidities and contribute to the development of maternal comorbidities later in life. Consistent evidence has shown that the microbiota acts as a regulator of the immune system, and it may, therefore, influence the development of preeclampsia by modulating immune factors. This narrative review aims to investigate the role of the immune system in the pathogenesis of preeclampsia and to summarize the most recent literature on the possible link between preeclampsia and alterations in the intestinal microbiota. To this end, we conducted a literature search, aiming to perform a narrative review, on PubMed and Embase from January 1990 to March 2024, focusing on the latest studies that highlight the main differences in microbial composition between patients with and without preeclampsia, as well as the effects of microbial metabolites on the immune system. From the review of 28 studies assessing the intestinal microbiota in preeclamptic women, preeclampsia could be associated with a state of dysbiosis. Moreover, these patients showed higher plasmatic levels of endotoxin, pro-inflammatory cytokines, and T helper 17 cells; however, the findings on specific microbes and metabolites that could cause immune imbalances in preeclampsia are still preliminary.

IntroductionThe auditory system of dolphins and whales allows them to dive in dark waters, hunt for prey well below the limit of solar light absorption, and to communicate with their conspecific. These complex behaviors require specific and sufficient functional circuitry in the neocortex, and vicarious learning capacities. Dolphins are also precocious animals that can hold their breath and swim within minutes after birth. However, diving and hunting behaviors are likely not innate and need to be learned. Our hypothesis is that the organization of the auditory cortex of dolphins grows and mature not only in the early phases of life, but also in adults and aging individuals. These changes may be subtle and involve sub-populations of cells specificall linked to some circuits.MethodsIn the primary auditory cortex of 11 bottlenose dolphins belonging to three age groups (calves, adults, and old animals), neuronal cell shapes were analyzed separately and by cortical layer using custom computer vision and multivariate statistical analysis, to determine potential minute morphological differences across these age groups.ResultsThe results show definite changes in interneurons, characterized by round and ellipsoid shapes predominantly located in upper cortical layers. Notably, neonates interneurons exhibited a pattern of being closer together and smaller, developing into a more dispersed and diverse set of shapes in adulthood.DiscussionThis trend persisted in older animals, suggesting a continuous development of connections throughout the life of these marine animals. Our findings further support the proposition that thalamic input reach upper layers in cetaceans, at least within a cortical area critical for their survival. Moreover, our results indicate the likelihood of changes in cell populations occurring in adult animals, prompting the need for characterization.

Over 50% of clinical patients affected by the systemic lupus erythematosus disease display impaired neurological cognitive functions and psychiatric disorders, a form called neuropsychiatric systemic lupus erythematosus. Hippocampus is one of the brain structures most sensitive to the cognitive deficits and psychiatric disorders related to neuropsychiatric lupus. The purpose of this study was to compare, layer by layer, neuron morphology in lupus mice model NZB/W F1 versus Wild Type mice.By a morphometric of cells identified on Nissl-stained sections, we evaluated structural alterations between NZB/W F1 and Wild Type mice in seven hippocampal subregions: Molecular dentate gyrus, Granular dentate gyrus, Polymorph dentate gyrus, Oriens layer, Pyramidal layer, Radiatum layer and Lacunosum molecular layer. By principal component analysis we distinguished healthy Wild Type from NZB/W F1 mice. In NZB/W F1 mice hippocampal cytoarchitecture, the neuronal cells resulted larger in size and more regular than those of Wild Type. In NZB/W F1, neurons were usually denser than in WT. The Pyramidal layer neurons were much denser in Wild Type than in NZB/W F1. Application of principal component analysis, allowed to distinguish NZB/W F1 lupus mice from healthy, showing as NZBW subjects presented a scattered distribution and intrasubject variability.Our results show a hypertrophy of the NZB/W F1 hippocampal neurons associated with an increase in perikaryal size within the CA1, CA2, CA3 region and the DG. These results help advance our understanding on hippocampal organization and structure in the NZB/W F1 lupus model, suggesting the hypothesis that the different subregions could be differentially affected in neuropsychiatric systemic lupus erythematosus disease. Leveraging an in-depth analysis of the morphology of neural cells in the hippocampal subregions and applying dimensionality reduction using PCA, we propose an efficient methodology to distinguish pathological NZBW mice from WT mice.”

Machine learning-based methodologies have recently been adapted to solve control problems. The Neural Lyapunov Control (NLC) method is one such example. This approach combines Artificial Neural Networks (ANNs) with Satisfiability Modulo Theories (SMT) solvers to synthesise stabilising control laws and to prove their formal correctness. The ANNs are trained over a dataset of state-space samples to generate candidate control and Lyapunov functions, while the SMT solvers are tasked with certifying the correctness of the Lyapunov function over a continuous domain or by returning a counterexample. Despite the approach’s attractiveness, issues can occur due to subsequent calls of the SMT module at times returning similar counterexamples, which can turn out to be uninformative and may lead to dataset overfitting. Additionally, the control network weights are usually initialised with pre-computed gains from state-feedback controllers, e.g. Linear-Quadratic Regulators. To properly perform the initialisation requires user time and control expertise. In this work, we present an Augmented NLC method that mitigates these drawbacks, removes the need for the control initialisation and further improves counterexample generation. As a result, the proposed method allows the synthesis of nonlinear (as well as linear) control laws with the sole requirement being the knowledge of the system dynamics. The ANLC is tested over challenging benchmarks such as the Lorenz attractor and outperformed existing methods in terms of successful synthesis rate. The developed framework is released open-source at: https://github.com/grande-dev/Augmented-Neural-Lyapunov-Control.

Upward convergence, that is an improvement of Members States’ economic and social indicators’ performance, is a core policy target of the European Union. This concept is embodied in the European Pillar of social rights (EPSR) proclaimed by EU leaders in 2017. In 2018 Eurofound has developed a methodology to measure convergence, which has been implemented in the convergEU R package described in this work (rel. 0.5.0). The package extends the original STATA toolbox developed by Eurofound beyond the calculations of the four main measures of convergence as it provides functions to download, filter, impute, smooth indicators. Country and indicator fiches are automatically prepared and compiled in HTML format. Graphical output includes qualitative patterns of change along time to emphasize the key behaviour of an indicator with respect to the average of an aggregation of Member States. Besides EU Member States, the analysis of other collections of regions is supported for general indicators if context information is provided. A user-friendly, no coding required, shiny-based web application provides policy makers with a tool to produce convergence reports on selected indicators and countries.