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Abstract The araza, also known as quince or Amazon guava, is a climacteric fruit typical of the Ecuadorian Amazon region. The fruit has a vitamin A, B1, and C content of 7.75%, 9.84%, and 74%, respectively, with the vitamin C content being twice that of the orange. However, as a fruit that needs to be stored at 90% humidity, it is very perishable. Therefore, the current study was carried out to determine the physicochemical characteristics, thermal properties, and freezing time of the fruit through mathematical models using the RStudio software to simulate the freezing process and thus preserve the vitamin content. The arazá freezing time was 2.98 hr at –18ºC, which is well within the normal parameter for freezing fruits while maintaining their nutritional characteristics.

Objectives The aim of this study is to evaluate the seroprevalence of antibodies of Borrelia burgdorferi sensu lato ( Bb sl) and Leptospira interrogans sensu lato ( Li sl) and their possible concurrence in domestic cats living in variable conditions in South Moravia in the district of Brno and its environs. Additional objectives were to discover possible differences in seroprevalence between groups of cats living in different living conditions, and to determine the spectrum of Leptospira serogroups in cats in the same places. Material and methods A total of 360 blood sera from domestic cats of 3 different sets were collected during the period 2013–2015. All samples were examined using ELISA for the detection of IgM and IgG antibodies against Bb sl, and the microscopic agglutination test (MAT) for the detection of antibodies against 8 serogroups of Li sl. Results The ELISA method determined 15.8%, 4.8% and 10.3% IgM anti-Borrelia antibodies in the patient group, shelter cats and street cats, respectively. IgG anti-Borrelia antibodies were found in 6.2%, 9.5%, 5.2%, respectively. Antibodies specific for 5 Leptospira serogroups were detected by the use of MAT in 8.8%, 9.5% and 10.3% of cats from the investigated groups. The total positivity of all examined cats for anti-Borrelia antibodies was 18.0% and for anti-Leptospira – 9.2%. Conclusions Cats can be infected with both Bb sl and Li sl. The obtained results are exclusive to the city of Brno and its environs, and are comparable to the limited previous studies. There is a need for further studies of clinical signs of both infections and the possible transmission of Leptospira by ticks.

Nuclear data is in constant evolution as more experimental data is gathered, computational capabilities increase, and evaluators verify its validity by means of stochastic and deterministic simulations. The focus here is on the analog Monte Carlo simulation of nuclear reactions that produce more than two particles in the outgoing channel, which needs specific considerations to ensure the correlations between the particles and thus the conservation of energy and of translational and angular momenta. It is possible to adapt nuclear data and its exploitation to implement realistic reactions from the phenomenological point of view (as opposed to the historical need of variance reduction techniques), which increases computation time but allows the expansion of the transport codes capabilities. Simulation anomalies were found concerning the kinematical calculations of photon energies emitted from neutron-induced inelastic scattering (n,n’γ), as well as concerning the photon multiplicity of 155Gd(n,γ) due to the presence of a rotational band in 156Gd. Recommendations are given for potential solutions for both anomalies.

Abstract Background Infection by HIV and other STIs and unplanned pregnancies are among the most serious problems associated with sexuality. Male and female condoms are the only dual-purpose devices to control both unplanned pregnancies and STIs, and studying people’s attitudes toward the use of these devices are excellent ways to predict their use. Therefore, the purpose of the present study was to adapt and validate the Female Condom Attitude Scale for Spanish language and to evaluate the use of female condoms in Colombian population. Methods For that purpose, a total of 387 Colombian women aged 23.68 years in average were asked to respond to the Female Condom Attitude Scale, the Sexual Opinion Survey, and the UCLA Multidimensional Condom Attitudes Scale. Results The use of female condom in Colombia is very low; only 5.10% of the surveyed women had used it at least once. On the other hand, results revealed a five-factor dimensionality (Sexual pleasure enhancement, Inconvenience, Improved prophylaxis, Sexual pleasure inhibition, and Insertion reluctance) with alphas between .81 and .96. The scale also showed adequate psychometric properties and criterion validity. No relationship was found between attitudes toward female condom and attitudes toward male condom. Conclusions The Spanish adaptation of the Female Condom Attitude Scale was found to be reliable and valid in a sample of young women.

Objetivos: Analizar la opinión que tienen las enfermeras que trabajan con población infanto-juvenil sobre los problemas de conducta del niño y adolescente, los factores de riesgo para el desarrollo de estos problemas y los cuidados enfermeros que precisan.Metodología: Se trata de un estudio cualitativo descriptivo fenomenológico, en el marco de la Teoría de las Transiciones de Meleis. La estrategia de recogida de datos es el grupo de discusión y la entrevista en profundidad.Resultados y discusión: Los resultados indican que el aumento de problemas de conducta relacionados con la auto y heteroagresividad preocupa a las enfermeras, que detectan múltiples y complejos factores de riesgo familiares, personales y cognitivos y socio-culturales, sobre los que intervenir, que favorecen estos problemas de conducta.Conclusión: Se apunta a la necesidad de mejorar la coordinación entre enfermeras y la necesidad de contar con la enfermera escolar al ser la escuela un contexto de socialización determinante en el desarrollo del niño y del adolescente.

Roxana E Ruiz Valenzuela, José A Ponce, Gloria Guadalupe Morales-Figueroa, Karina Aguilar Muro, Virginia Ramírez Carreón, Heliodoro Alemán-Mateo Nutrition and Metabolism Department, Division of Nutrition, Research Center for Food and Development, Hermosillo, Sonora, México Background: Both low dietary protein intake and inadequate distribution of protein over the three mealtimes have been reported in older Caucasian adults, but the association between protein intake at each meal and muscle mass has not been studied. The purpose of this study was to evaluate dietary protein intake and distribution by mealtimes, and to explore their association with appendicular skeletal muscle mass in apparently healthy older adults. Methods: This was a cross-sectional pilot study that included 78 people over the age of 60 years. Caloric and protein intake were estimated on the basis of three nonconsecutive 24-hour diet recalls and appendicular skeletal muscle mass by dual-energy X-ray absorptiometry. Results: Men consumed 13.4 g of protein/day more than women (P < 0.05). The estimated value of dietary protein intake was 0.9 g/kg/day. In this sample, 28% of subjects did not cover 100% of the dietary reference intake for protein. Lower consumption of dietary protein was found at breakfast and dinnertime compared with the recommended amount of 25–30 g (P < 0.05). Also, the study observed that appendicular skeletal muscle mass in men and women who consumed 25 g of protein at one, two, or three mealtimes. Conclusion: While protein intake was higher than current recommendations, it failed to achieve the values reported as necessary to prevent sarcopenia. In addition, there was under-consumption of protein per mealtime, especially at breakfast and dinner. Keywords: dietary protein intake, older adults, appendicular skeletal muscle mass

La construcción, además de ser indispensable para el desarrollo de la sociedad, es también uno de los principales responsables de la generación de residuos, contaminación, transformación del entorno y uso considerable de energía. Estas razones no le permiten ser indiferente a la actual problemática ambiental. El presente artículo, dirigido a la comunidad académica y profesional, presenta a manera de diagnóstico la situación actual del sector de la construcción en Colombia, en relación al impacto ambiental que genera. Para ello, expone un contexto general de la construcción en relación con su impacto ambiental, hace un recorrido cronológico a través de las prácticas y estrategias que, tanto históricamente como en la actualidad, contribuyen a la disminución del impacto ambiental y, por último, presenta los resultados de una encuesta realizada a una muestra representativa de empresas constructoras del Valle del Aburrá, Antioquia, donde se indagan aspectos referentes al concepto que se tiene de la construcción sostenible y de las acciones que la empresa desarrolla en torno al tema ambiental.

Saber cómo llegar y para quién se escribe sin perder el nivel de complejidad, sacándolo del metalenguaje científico y haciéndolo comprensible, es una ardua tarea que aprovecha las plataformas tecnológicas y diferentes estrategias de comunicación para lograr el acceso al conocimiento, de esta forma y siendo coherentes con la responsabilidad social que tienen las Instituciones de Educación Superior de llevar la educación a todas partes, y en congruencia con su función sustantiva y sus ejes misionales: docencia, investigación y extensión; con miras a cumplir el objetivo, las instituciones gestionan procesos editoriales con el fin de consolidar y potenciar una propuesta de visibilidad Institucional, más que de rentabilidad.

En el presente estudio se analizan los proyectos productivos apoyados por el Programa 3x1 Para Migrantes en Zacatecas durante el periodo 2002-2007 a fin de determinar dentro del concepto de cultura emprendedora la identificación del giro en que les agradaría emprender a los líderes de los proyectos productivos y reconocer el perfil de los emprendedores.Se seleccionó el enfoque de métodos mixtos porque tiende a concepciones pragmáticas del conocimiento. Recurre a preguntas abiertas y cerradas, enfoques emergentes y predeterminados, datos y los respectivos análisis (Creswell, 2003).La estrategia de indagación que se utilizó fue la secuencial exploratoria, debido a sus características, en la obtención y análisis de los datos cualitativos, seguida por la obtención y análisis de los datos cuantitativos.Los resultados fue que la gran mayoría desea continuar con la actividad en la que actualmente está trabajando y el nuevo emprendimiento consolidaría su actual situación, emprenderían en otra rama como la agricultura controlada como el caso del invernadero para evitar las adversidades climatológicas, o como el caso de la fruticultura, el avanzar hacia la envasadora de frutas y las conservas.No hay un solo perfil sino una diversidad con ciertos rasgos característicos propios del entorno del estado de Zacatecas.

Abstract Background The role of gender differences in Health Related Quality Life (HRQL) in coronary patients is controversial, so understanding the specific determinants of HRQL in men and women might be of clinical importance. The aim of this study was to know the gender differences in the evolution of HRQL at 3 and 6 months after a coronary event, and to identify the key clinical, demographic and psychological characteristics of each gender associated with these changes. Methods A follow-up study was carried out, and 175 patients (112 men and 63 women) with acute myocardial infarction (AMI) or unstable angina were studied. The SF-36v1 health questionnaire was used to assess HRQL, and the GHQ-28 (General Health Questionnaire) to measure mental health during follow-up. To study the variables related to changes in HRQL, generalized estimating equation (GEE) models were performed. Results Follow-up data were available for 55 men and 25 women at 3 months, and for 35 men and 12 women at 6 months. Observations included: a) Revascularization was performed later in women. b) The frequency of rehospitalization between months 3 and 6 of follow-up was higher in women c) Women had lower baseline scores in the SF-36. d) Men had progressed favourably in most of the physical dimensions of the SF-36 at 6 months, while at the same time women's scores had only improved for Physical Component Summary, Role Physical and Social Functioning; e) the variables determining the decrease in HRQL in men were: worse mental health and angina frequency; and in women: worse mental health, history of the disease, revascularization, and angina frequency. Conclusions There are differences in the evolution of HRQL, between men and women after a coronary attack. Mental health is the determinant most frequently associated with HRQL in both genders. However, other clinical determinants of HRQL differed with gender, emphasizing the importance of individualizing the intervention and the content of rehabilitation programs. Likewise, the recognition and treatment of mental disorders in these patients could be crucial.

Abstract Background Non cephalic presentation in childbirth involves various risks to both the mother and the foetus. The incidence in Spain is 3.8% of all full-term pregnancies. The most common technique used to end the gestation in cases of non cephalic presentation is that of caesarian section, and although it provokes a lower rate of morbi-mortality than does vaginal delivery in such situations, there remains the possibility of traumatic injury to the foetal head and neck, while maternal morbidity is also increased. The application of heat (moxibustion) to an acupuncture point, in order to correct non cephalic presentation, has been practised in China since ancient times, but as yet there is insufficient evidence of its real effectiveness. Methods/Design The experimental design consists of a multi-centre randomised controlled trial with three parallel arms, used to compare real moxibustion, sham moxibustion and the natural course of events, among pregnant women with a non cephalic presentation and a gestational duration of 33–35 weeks (estimated by echography). The participants in the trial will be blinded to both interventions. The results obtained will be analyzed by professionals, blinded with respect to the allocation to the different types of intervention. In addition, we intend to carry out a economic analysis. Discussion This trial will contribute to the development of evidence concerning moxibustion in the correction of non cephalic presentations. The primary outcome variable is the proportion of cephalic presentations at term. As secondary outcomes, we will evaluate the proportion of cephalic presentations at week 38 of gestation, determined by echography, together with the safety of the technique, the specificity of moxibustion and the control of the blinding process. This study has been funded by the Health Ministry of the Andalusian Regional Government. Trial registration Current Controlled Trials ISRCTN10634508.

Abstract Background Molecular typing of Mycobacterium tuberculosis strains has become a valuable tool in the epidemiology of tuberculosis (TB) by allowing detection of outbreaks, tracking of epidemics, identification of genotypes and transmission events among patients who would have remained undetected by conventional contact investigation. This is the first genetic biodiversity study of M. tuberculosis in Venezuela. Thus, we investigated the genetic patterns of strains isolated in the first survey of anti-tuberculosis drug-resistance realised as part of the Global Project of Anti-tuberculosis Drug Resistance Surveillance (WHO/IUATLD). Results Clinical isolates (670/873) were genotyped by spoligotyping. The results were compared with the international spoligotyping database (SpolDB4). Multidrug resistant (MDR) strains (14/18) were also analysed by IS6110-RFLP assays, and resistance to isoniazid and rifampicin was characterised. Spoligotyping grouped 82% (548/670) of the strains into 59 clusters. Twenty new spoligotypes (SITs) specific to Venezuela were identified. Eight new inter-regional clusters were created. The Beijing genotype was not found. The genetic network shows that the Latin American and Mediterranean family constitutes the backbone of the genetic TB population-structure in Venezuela, responsible of >60% of total TB cases studied. MDR was 0.5% in never treated patients and 13.5% in previously treated patients. Mutations in rpoB gene and katG genes were detected in 64% and 43% of the MDR strains, respectively. Two clusters were found to be identical by the four different analysis methods, presumably representing cases of recent transmission of MDR tuberculosis. Conclusion This study gives a first overview of the M. tuberculosis strains circulating in Venezuela during the first survey of anti-tuberculosis drug-resistance. It may aid in the creation of a national database that will be a valuable support for further studies.

Tongue neoplasms are common in the head and neck region and are primarily treated through surgical interventions. Various reconstruction techniques, such as primary closure, skin grafts, skin substitute biomaterials, and free tissue transfer, are used to address the resulting defects. This study provides an overview of our experience utilizing extracellular matrix-based biomaterials (ECM) for the reconstruction of tongue defects and evaluates the mean volumetric size of postsurgical tongue. This retrospective case series evaluated subjects with tongue defects secondary to benign or malignant resections who underwent reconstruction with ECM-based biomaterials at Ascension Hospital from July 2022 to May 2023. Descriptive variables were collected, and descriptive statistical analyses were conducted. The primary outcome was the volume of postsurgical defect reconstructed. Twenty-five subjects were included: 10 had benign pathology and 15 had malignancy. The mean reconstructed defect volume was 12.65 cm 3 , ranging between 2 and 35 cm 3 . Postoperative bleeding, mainly linked to anticoagulation medication, occurred in 20% (n=5) of the cases, and the rate of need for additional procedures was 8%. In conclusion, ECM-based biomaterials are suitable for reconstructing varying sizes of postsurgical tongue defects with no donor-site morbidity. Carefully considering patient factors, including anticoagulation medication use and defect volume, is essential in optimizing outcomes., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

The methylenetetrahydrofolate reductase ( MTHFR ) gene 677C➔T polymorphism is capable of altering folate metabolism and can modify certain neoplasia risk. Reports have suggested that folate can have an influence on bone development and so it is of interest to know if the MTHFR 677C➔T polymorphism is associated with the malignant transformation process of this tissue. The polymorphism was determined in 55 patients with osteosarcoma and in 180 healthy individuals. Compared with C/T+C/C genotypes, a 3.7-fold reduction in osteosarcoma probability is possible with the T/T genotype (OR 0.27, CI 95% 0.07-0.82). Undoubtedly, further studies, utilizing large samples and carried out on different populations, are necessary to confirm these results.

Background: Dr. Ney Bienvenido Arias Lora emerged not only as a pioneer in neurosurgery but a community leader in the Dominican Republic (DR), contributing significantly to a region where both fundamental and neurosurgical resources were scarce. This account aims to shed light on the remarkable life and career of Dr. Arias Lora, emphasizing the critical role he played in establishing and advancing neurosurgery in the DR., Methods: This paper relies on original bibliographic materials, providing an in-depth analysis of Dr. Arias Lora's life. Through a thorough examination of his career, we aim to highlight his pioneering efforts in the Caribbeans where neurosurgical expertise was nearly nonexistent during his time., Results: Dr. Arias Lora, born in 1926, and became the first neurosurgeon in the DR in 1959. He played a pivotal role in establishing the Neurosurgery Residency Program at the Hospital Salvador B. Gautier and was instrumental in the development of neurosurgery training in his home country and the Caribbeans. Beyond his medical contributions, Dr. Arias Lora served as an educator, authoring significant works, and holding prestigious academic positions. His legacy is reflected in the "Dr. Ney Arias Lora Traumatology Hospital" in Santo Domingo, a testament to his dedication to neurosurgery and public service., Conclusions: Dr. Ney Bienvenido Arias Lora's life and achievements stand as a testament to the transformative impact dedicated individuals can have on the advancement of neurosurgery. Despite the intricacies inherent in the field of neurosurgery and broader societal challenges, his story serves as an inspiration., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Synaptic plasticities, such as long-term potentiation (LTP) and depression (LTD), tune synaptic efficacy and are essential for learning and memory. Current studies of synaptic plasticity in humans are limited by a lack of adequate human models. Here, we modeled the thalamocortical system by fusing human induced pluripotent stem cell-derived thalamic and cortical organoids. Single-nucleus RNA sequencing revealed that >80% of cells in thalamic organoids were glutamatergic neurons. When fused to form thalamocortical assembloids, thalamic and cortical organoids formed reciprocal long-range axonal projections and reciprocal synapses detectable by light and electron microscopy, respectively. Using whole-cell patch-clamp electrophysiology and two-photon imaging, we characterized glutamatergic synaptic transmission. Thalamocortical and corticothalamic synapses displayed short-term plasticity analogous to that in animal models. LTP and LTD were reliably induced at both synapses; however, their mechanisms differed from those previously described in rodents. Thus, thalamocortical assembloids provide a model system for exploring synaptic plasticity in human circuits., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Abstract: Personalized cancer vaccines designed to target neoantigens represent a promising new treatment paradigm in oncology. In contrast to classical idiotype vaccines, we hypothesized that "polyvalent" vaccines could be engineered for the personalized treatment of follicular lymphoma (FL) using neoantigen discovery by combined whole-exome sequencing (WES) and RNA sequencing (RNA-seq). Fifty-eight tumor samples from 57 patients with FL underwent WES and RNA-seq. Somatic and B-cell clonotype neoantigens were predicted and filtered to identify high-quality neoantigens. B-cell clonality was determined by the alignment of B-cell receptor (BCR) CDR3 regions from RNA-seq data, grouping at the protein level, and comparison with the BCR repertoire from healthy individuals using RNA-seq data. An average of 52 somatic mutations per patient (range, 2-172) were identified, and ≥2 (median, 15) high-quality neoantigens were predicted for 56 of 58 FL samples. The predicted neoantigen peptides were composed of missense mutations (77%), indels (9%), gene fusions (3%), and BCR sequences (11%). Building off of these preclinical analyses, we initiated a pilot clinical trial using personalized neoantigen vaccination combined with PD-1 blockade in patients with relapsed or refractory FL (#NCT03121677). Synthetic long peptide vaccines targeting predicted high-quality neoantigens were successfully synthesized for and administered to all 4 patients enrolled. Initial results demonstrate feasibility, safety, and potential immunologic and clinical responses. Our study suggests that a genomics-driven personalized cancer vaccine strategy is feasible for patients with FL, and this may overcome prior challenges in the field. This trial was registered at www.ClinicalTrials.gov as #NCT03121677., (© 2024 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

There is an urgent need to derive quantitative measures based on coherent neurobiological dysfunctions or 'biotypes' to enable stratification of patients with depression and anxiety. We used task-free and task-evoked data from a standardized functional magnetic resonance imaging protocol conducted across multiple studies in patients with depression and anxiety when treatment free (n = 801) and after randomization to pharmacotherapy or behavioral therapy (n = 250). From these patients, we derived personalized and interpretable scores of brain circuit dysfunction grounded in a theoretical taxonomy. Participants were subdivided into six biotypes defined by distinct profiles of intrinsic task-free functional connectivity within the default mode, salience and frontoparietal attention circuits, and of activation and connectivity within frontal and subcortical regions elicited by emotional and cognitive tasks. The six biotypes showed consistency with our theoretical taxonomy and were distinguished by symptoms, behavioral performance on general and emotional cognitive computerized tests, and response to pharmacotherapy as well as behavioral therapy. Our results provide a new, theory-driven, clinically validated and interpretable quantitative method to parse the biological heterogeneity of depression and anxiety. Thus, they represent a promising approach to advance precision clinical care in psychiatry., (© 2024. The Author(s).)

Vitamin D3 or calcitriol (VitD3) has been shown to have anticancer and anti-inflammatory activity in in vitro models and clinical studies. However, its effect on HPV-16-related cancer has been sparsely explored. In this study, we aimed to determine whether monotherapy or combination therapy with cisplatin (CP) reduces tumor growth and affects survival and systemic inflammation. Treatments were administered to C57BL/6 mice with HPV-16-related tumors (TC-1 cells) as follows: (1) placebo (100 µL vehicle, olive oil, orally administered daily); (2) VitD3 (3.75 µg/kg calcitriol orally administered daily); (3) CP (5 mg/kg intraperitoneally, every 7 days); and (4) VitD3+CP. Tumor growth was monitored for 25 days, survival for 60 days, and the neutrophil-to-lymphocyte ratio (NLR) was evaluated on days 1 (baseline), 7, and 14. VitD3+CP showed greater success in reducing tumor volume compared to CP monotherapy ( p = 0.041), while no differences were observed between CP and VitD3 monotherapy ( p = 0.671). Furthermore, VitD3+CP prolonged survival compared to CP ( p = 0.036) and VitD3 ( p = 0.007). Additionally, at day 14 the VitD3 and VitD3+CP groups showed significantly lower NLR values than the CP group ( p < 0.05, for both comparisons). Vitamin D3 could be a promising adjuvant in the treatment of cervical cancer or solid tumors and deserves further investigation.

In many contexts, responsibility for exit-level assessment design and implementation in undergraduate medical programmes lies with individuals who convene clinical clerkships. Their assessment practice has significant consequences for students' learning and the patients and communities that graduates will serve. Interventions to enhance assessment must involve these assessors, yet little is known about factors influencing their assessment practice. The purpose of this study was to explore factors that influence assessment practice of clerkship convenors in three varied low-and-middle income contexts in the global South. Taking assessment practice as a behaviour, Health Behaviour Theory (HBT) was deployed as a theoretical framework to explore, describe and explain assessor behaviour. Thirty-one clinician-educators responsible for designing and implementing high-stakes clerkship assessment were interviewed in South Africa and Mexico. Interacting personal and contextual factors influencing clinician-educator assessment intention and action were identified. These included attitude, influenced by impact and response appraisal, and perceived self-efficacy; along with interpersonal, physical and organisational, and distal contextual factors. Personal competencies and conducive environments supported intention to action transition. While previous research has typically explored factors in isolation, the HBT framing enabled a systematic and coherent account of assessor behaviour. These findings add a particular contextual perspective to understanding assessment practice, yet also resonate with and extend existing work that predominantly emanates from high-income contexts in the global North. These findings provide a foundation for the planning of assessment change initiatives, such as targeted, multi-factorial faculty development., (© 2024. The Author(s).)

Clinical data from hospital admissions are typically utilized to determine the prognostic capacity of Coronavirus disease 2019 (COVID-19) indices. However, as disease status and severity markers evolve over time, time-dependent receiver operating characteristic (ROC) curve analysis becomes more appropriate. The present analysis assessed predictive power for death at various time points throughout patient hospitalization. In a cohort study involving 515 hospitalized patients (General Hospital Number 1 of Mexican Social Security Institute, Colima, Mexico from February 2021 to December 2022) with COVID-19, seven severity indices [Pneumonia Severity Index (PSI) PaO 2 /FiO 2 arterial oxygen pressure/fraction of inspired oxygen (Kirby index), the Critical Illness Risk Score (COVID-GRAM), the National Early Warning Score 2 (NEWS-2), the quick Sequential Organ Failure Assessment score (qSOFA), the Fibrosis-4 index (FIB-4) and the Viral Pneumonia Mortality Score (MuLBSTA were evaluated using time-dependent ROC curves. Clinical data were collected at admission and at 2, 4, 6 and 8 days into hospitalization. The study calculated the area under the curve (AUC), sensitivity, specificity, and predictive values for each index at these time points. Mortality was 43.9%. Throughout all time points, NEWS-2 demonstrated the highest predictive power for mortality, as indicated by its AUC values. PSI and COVID-GRAM followed, with predictive power increasing as hospitalization duration progressed. Additionally, NEWS-2 exhibited the highest sensitivity (>96% in all periods) but showed low specificity, which increased from 22.9% at admission to 58.1% by day 8. PSI displayed good predictive capacity from admission to day 6 and excellent predictive power at day 8 and its sensitivity remained >80% throughout all periods, with moderate specificity (70.6-77.3%). COVID-GRAM demonstrated good predictive capacity across all periods, with high sensitivity (84.2-87.3%) but low-to-moderate specificity (61.5-67.6%). The qSOFA index initially had poor predictive power upon admission but improved after 4 days. FIB-4 had a statistically significant predictive capacity in all periods (P=0.001), but with limited clinical value (AUC, 0.639-0.698), and with low sensitivity and specificity. MuLBSTA and IKIRBY exhibited low predictive power at admission and no power after 6 days. In conclusion, in COVID-19 patients with high mortality rates, NEWS-2 and PSI consistently exhibited predictive power for death during hospital stay, with PSI demonstrating the best balance between sensitivity and specificity., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Mendoza-Hernandez et al.)

The authors present a case report of a 73-year-old male on dual antiplatelet therapy with a retropharyngeal hematoma after a motor vehicle accident. We highlight the clinical, radiographic manifestations, and surgical management of retropharyngeal hematomas, especially on an initially asymptomatic patient. Additionally, we demonstrate the importance of establishing a secure airway early on, and multidisciplinary collaboration to maximize patient outcomes., (Copyright © 2024 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Moringa oleifera (MO) is a native tree of Asia and is cultivated in some areas of Mexico as part of traditional horticulture. The aim of the present study was to compare the efficacy of MO infusion vs. MO ethanolic extract for the simultaneous treatment of nonalcoholic fatty liver (NAFLD), hyperlipidemia, and hyperglycemia in a murine model fed with a high-fat diet (HFD). BALB/c mice were fed a balanced diet (healthy control) or an HFD for 6 months. With this, the NAFLD model was established before starting a therapeutic intervention with MO for two months. The phytochemical analysis by nuclear magnetic resonance in 1 H and 13 C experiments showed signals for pyrrole alkaloids and triterpenes as the main constituents of the extract and infusion preparation. A significant reduction of SGPT, SGOT, lipids, urea, and glucose in blood among NAFLD groups treated with MO (infusion or extract) was found, when compared to the NAFLD-placebo group. Steatosis and liver inflammation were found to be decreased in the MO groups, as infusion or ethanolic extract. Infusion produced a better therapeutic effect than the extract in all parameters, except glycemic control, where the extract was better. As an additional finding, it is noteworthy that treatment with MO, particularly through infusion, resulted in improved motor activity. Moreover, a reduction in anxiety-like behavior was observed exclusively with the administration of infusion. These observations provide valuable insights into the potential broader effects of Moringa oleifera beyond the primary aim of the study., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Salma I. Cortes-Alvarez et al.)

COVID-19 vaccines primarily prevent severe illnesses or hospitalization, but there is limited data on their impact during hospitalization for seriously ill patients. In a Mexican cohort with high COVID-19 mortality, a study assessed vaccination's effects. From 2021 to 2022, 462 patients with 4455 hospital days were analyzed. The generalized multivariate linear mixed model (GENLINMIXED) with binary logistic regression link, survival analysis and ROC curves were used to identify risk factors for death. The results showed that the vaccinated individuals were almost half as likely to die (adRR = 0.54, 95% CI = 0.30-0.97, p = 0.041). When stratifying by vaccine, the Pfizer group (BNT162b2) had a 2.4-times lower risk of death (adRR = 0.41, 95% CI = 0.2-0.8, p = 0.008), while the AstraZeneca group (ChAdOx1-S) group did not significantly differ from the non-vaccinated (adRR = 1.04, 95% CI = 0.5-2.3, p = 0.915). The Pfizer group exhibited a higher survival, the unvaccinated showed increasing mortality, and the AstraZeneca group remained intermediate ( p = 0.003, multigroup log-rank test). Additionally, BNT162b2-vaccinated individuals had lower values for markers, such as ferritin and D-dimer. Biochemical and hematological indicators suggested a protective effect of both types of vaccines, possibly linked to higher lymphocyte counts and lower platelet-to-lymphocyte ratio (PLR). It is imperative to highlight that these results reinforce the efficacy of COVID-19 vaccines. However, further studies are warranted for a comprehensive understanding of these findings.

Mounting evidence suggests metabolism instructs stem cell fate decisions. However, how fetal metabolism changes during development and how altered maternal metabolism shapes fetal metabolism remain unexplored. We present a descriptive atlas of in vivo fetal murine metabolism during mid-to-late gestation in normal and diabetic pregnancy. Using 13 C-glucose and liquid chromatography-mass spectrometry (LC-MS), we profiled the metabolism of fetal brains, hearts, livers, and placentas harvested from pregnant dams between embryonic days (E)10.5 and 18.5. Our analysis revealed metabolic features specific to a hyperglycemic environment and signatures that may denote developmental transitions during euglycemic development. We observed sorbitol accumulation in fetal tissues and altered neurotransmitter levels in fetal brains isolated from hyperglycemic dams. Tracing 13 C-glucose revealed disparate fetal nutrient sourcing depending on maternal glycemic states. Regardless of glycemic state, histidine-derived metabolites accumulated in late-stage fetal tissues. Our rich dataset presents a comprehensive overview of in vivo fetal tissue metabolism and alterations due to maternal hyperglycemia., Competing Interests: Declaration of interests H.R.C. is a member of the Cell Advisory Board., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The flow of water through a horizontal small-scale Venturi tube of rectangular cross-section is simulated using a modified version of the open-source code DualSPHysics, which is based on Smoothed Particle Hydrodynamics (SPH) methods. Water is simulated using the Murnaghan-Tait equation of state so that weak compressibility is allowed. The hydrodynamics is coupled to a Large-Eddy Simulation (LES) turbulence model. The convergence properties of SPH are improved by adopting a C[Formula: see text] Wendland function as the interpolation kernel, increased number of neighboring particles and non-reflective open boundary conditions at the outlet of the Venturi tube. The flow structure and differential pressure as well as the mainstream velocity profiles at different stations are compared with calibrated experimental data. A resolution independence test shows that good convergence to the experimental measurements is achieved using four million particles. At this resolution the simulations predict the experimental centerline velocity profile along the Venturi meter for a volumetric flow rate of ten liters per minutes (lpm) with a root-mean-square error of 4.3%. This error grows to 7.1% when the volumetric flow rate increases to 25 lpm. The predicted differential pressure matches the experimental data with errors varying from 1.4% (for 10 lpm) to 6.8% (for 25 lpm). Cross-sectional velocity profiles within the throat and divergent sections differ from the experimental measurements in less than 5.5%. In general, it is shown that the SPH model can provide an efficient and accurate method for recalibrating flow meters at moderately high Reynolds numbers instead of using costly experimental tests., (© 2023. The Author(s).)

The malignant Hodgkin and Reed Sternberg (HRS) cells of classical Hodgkin lymphoma (cHL) are scarce in affected lymph nodes, creating a challenge to detect driver somatic mutations. As an alternative to cell purification techniques, we hypothesized that ultra-deep exome sequencing would allow genomic study of HRS cells, thereby streamlining analysis and avoiding technical pitfalls. To test this, 31 cHL tumor/normal pairs were exome sequenced to approximately 1,000× median depth of coverage. An orthogonal error-corrected sequencing approach verified >95% of the discovered mutations. We identified mutations in genes novel to cHL including: CDH5 and PCDH7, novel stop gain mutations in IL4R, and a novel pattern of recurrent mutations in pathways regulating Hippo signaling. As a further application of our exome sequencing, we attempted to identify expressed somatic single-nucleotide variants (SNV) in single-nuclei RNA sequencing (snRNA-seq) data generated from a patient in our cohort. Our snRNA analysis identified a clear cluster of cells containing a somatic SNV identified in our deep exome data. This cluster has differentially expressed genes that are consistent with genes known to be dysregulated in HRS cells (e.g., PIM1 and PIM3). The cluster also contains cells with an expanded B-cell clonotype further supporting a malignant phenotype. This study provides proof-of-principle that ultra-deep exome sequencing can be utilized to identify recurrent mutations in HRS cells and demonstrates the feasibility of snRNA-seq in the context of cHL. These studies provide the foundation for the further analysis of genomic variants in large cohorts of patients with cHL., Significance: Our data demonstrate the utility of ultra-deep exome sequencing in uncovering somatic variants in Hodgkin lymphoma, creating new opportunities to define the genes that are recurrently mutated in this disease. We also show for the first time the successful application of snRNA-seq in Hodgkin lymphoma and describe the expression profile of a putative cluster of HRS cells in a single patient., (© 2023 The Authors; Published by the American Association for Cancer Research.)

Purpose: Head and neck cancer (HNCA), as well as the sequelae of its treatment, has a significant negative impact on the quality of life (QOL) for patients. We aim to identify patient and surgical factors negatively influencing QOL of patients with HNCA., Materials and Methods: A cross-sectional study was used to identify specific risk factors associated with a poorer QOL. The University of Michigan Head and Neck Quality of Life (HNQOL) instrument was used to assess QOL. Predictor variables included risk factors (smoking, alcohol, past medical history), demographic (sex, age, marital status), anatomical features (tumor location, tumor stage), perioperative adjuncts (utilization of a feeding tube, tracheostomy, neck dissection), and postoperative adjuncts (chemotherapy or radiation therapy utilization). The primary outcome variable was the HNQOL score. Descriptive statistics were completed for all the variables. Association between the predictor variables and HNQOL scores were examined using bivariate statistics, and statistical significance was set at P < .05., Results: The study sample composed of 78 patients with HNCA who underwent surgery at Head and Neck Maxillofacial and Reconstructive Surgery Clinic at Ascension Macomb-Oakland from January 2017 to August 2018. Of the 78 patients meeting inclusion, 31 patients completed the HNQOL survey. The median HNCA QOL score was 18 with a maximum score of 80, representing a worse QOL. Radiation therapy (21 vs 5.5, P = .033), and perioperative feeding tube (31 vs 9, P = .012) had statistically significant negative impacts on QOL scores. Variables associated with poorer QOL scores in descending order: radiation therapy perioperative feeding tube utilization of chemotherapy (12.5 vs 9.0, P = .60), male gender (17 vs 9.5, P = .39), perioperative tracheostomy (26 vs 14.5 P = .26), tobacco use (19.5 vs 11.5, P = .81), single marital status (27 vs 16, P = .48), neck dissection (17.5 vs 15.5, P = .91), and alcohol use (18.5 vs 16.0, P = .65)., Conclusions: Feeding tube and radiotherapy utilization had a statistically significant decrease of QOL scores among patients with HNCA. Additional risk factors associated with poorer QOL include chemotherapy, male sex, tracheostomy utilization, tobacco use, single or divorced marital status, neck dissection, and alcohol abuse., (Published by Elsevier Inc.)

Introduction: In the UK alone, the incidence of cervical cancer is increasing, hence an urgent need for early and rapid detection of cancer before it develops. Spectroscopy in conjunction with machine learning offers a disruptive technology that promises to pick up cancer early as compared to the current diagnostic techniques used., Areas Covered: This review article explores the different spectroscopy techniques that have been used for the analysis of cervical cancer. Along with the extensive description of spectroscopic techniques, the various machine learning techniques are also described as well as the applications that have been explored in the diagnosis of cervical cancer. This review delimits the literature specifically associated with cervical cancer studies performed solely with the use of a spectroscopy technique, and machine learning., Expert Opinion: Although there are several methods and techniques to detect cervical cancer, the clinical sector requires to introduce new diagnostic technologies that help improve the quality of life of patients. These innovative technologies involve spectroscopy as a qualitative method and machine learning as a quantitative method. In this article, both the techniques and methodologies that allow and promise to be a new screening tool for the detection of cervical cancer are covered.

Neoantigens are tumor-specific peptide sequences resulting from sources such as somatic DNA mutations. Upon loading onto major histocompatibility complex (MHC) molecules, they can trigger recognition by T cells. Accurate neoantigen identification is thus critical for both designing cancer vaccines and predicting response to immunotherapies. Neoantigen identification and prioritization relies on correctly predicting whether the presenting peptide sequence can successfully induce an immune response. Because most somatic mutations are single-nucleotide variants, changes between wild-type and mutated peptides are typically subtle and require cautious interpretation. A potentially underappreciated variable in neoantigen prediction pipelines is the mutation position within the peptide relative to its anchor positions for the patient's specific MHC molecules. Whereas a subset of peptide positions are presented to the T cell receptor for recognition, others are responsible for anchoring to the MHC, making these positional considerations critical for predicting T cell responses. We computationally predicted anchor positions for different peptide lengths for 328 common HLA alleles and identified unique anchoring patterns among them. Analysis of 923 tumor samples shows that 6 to 38% of neoantigen candidates are potentially misclassified and can be rescued using allele-specific knowledge of anchor positions. A subset of anchor results were orthogonally validated using protein crystallography structures. Representative anchor trends were experimentally validated using peptide-MHC stability assays and competition binding assays. By incorporating our anchor prediction results into neoantigen prediction pipelines, we hope to formalize, streamline, and improve the identification process for relevant clinical studies.

Objective: The aim of the study was to assess the impact of CT-based lung pathological opacities volume on critical illness and inflammatory response severity of patients with COVID-19., Methods: A retrospective, single center, single arm study was performed over a 30-day period. In total, 138 patients (85.2%) met inclusion criteria. All patients were evaluated with non-contrast enhanced chest CT scan at hospital admission. CT-based lung segmentation was performed to calculate pathological lung opacities volume (LOV). At baseline, complete blood count (CBC) and inflammation response biomarkers were obtained. The primary endpoint of the study was the occurrence of critical illness, as defined as, the need of mechanical ventilation and/or ICU admission. Mann-Whitney U test was performed for univariate analysis. Logistic regression analysis was performed to determine independent predictors of critical illness. Spearman analysis was performed to assess the correlation between inflammatory response biomarkers serum concentrations and LOV., Results: Median LOV was 28.64% (interquartile range [IQR], 6.33-47.22%). Correlation analysis demonstrated that LOV was correlated with higher levels of D-dimer (r = 0.51, p < 0.01), procalcitonin (r = 0.47, p < 0.01) and IL6 (r = 0.48, p < 0.01). Critical illness occurred in 51 patients (37%). Univariate analysis demonstrated that inflammatory response biomarkers and LOV were associated with critical illness (p < 0.05). However, multivariate analysis demonstrated that only D-dimer and LOV were independent predictors of critical illness. Furthermore, a ROC analysis demonstrated that a LOV equal or greater than 60% had a sensitivity of 82.1% and specificity of 70.2% to determine critical illness with an odds ratio of 19.4 (95% CI, 4.2-88.9)., Conclusion: Critical illness may occur in up to 37% of the patients with COVID-19. Among patients with critical illness, higher levels of inflammatory response biomarkers with larger LOVs were observed. Furthermore, multivariate analysis demonstrated that pathological lung opacities volume was an independent predictor of critical illness. In fact, patients with a pathological lung opacities volume equal or greater than 60% had 19.4-fold increased risk of critical illness., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Purpose: Eagle syndrome is an uncommon disorder that significantly impacts the quality of life (QoL) of patients. No formal QoL study has been carried out on a population of Eagle syndrome patients treated via transcervical approach. We aim to evaluate and analyze the outcomes of the patients with Eagle syndrome treated with transcervical styloidectomy via our modified QoL survey., Methods: A retrospective cohort study was utilized for patients with Eagle syndrome who underwent transcervical styloidectomy at our institution from January 2008 until December 2018. Two QoL surveys were sent to subjects. Patients were asked preoperatively and postoperatively about the presence and intensity of pain, alteration of speech, diet or chewing, limitations of daily activity, mobility or recreation, and the presence of anxiety or mood disturbances related to the disease. The styloid length on preoperative computed tomography scans and the length of the surgical specimen were obtained, and correlations with the Numeric Pain Rating Scale (NPRS) were analyzed. Spearman's rank correlation coefficient was used to determine numerical correlation. Data are expressed as mean ± standard deviation, and P value less than .05 was considered statistically significant., Results: The study sample comprised 10 patients with Eagle syndrome who underwent transcervical styloidectomy. Eight patients underwent unilateral styloidectomy, and 2 patients were bilateral. Most patients were female (80%) with a mean age of 46.0. Preoperative NPRS score averaged 5.5 ± 2.7 (range 1 to 10) and postoperative NPRS was 2.1 ± 1.4 (range 0 to 4) (P = .008). No correlation was found between preoperative or postoperative NRPS score and preoperative styloid length and length of styloid resected. QoL survey showed a significant improvement in neck mobility and the anxiety felt by the patients. The survey showed that all patients would recommend surgery to a friend or family member with similar symptoms. Seven patients (70%) would recommend the operation as primary treatment, and the rest would recommend it after conservative options fail., Conclusions: Transcervical styloidectomy was associated with a statistically significant decrease in NPRS and positive QoL changes for patients operated for Eagle syndrome at our institution., (Copyright © 2022 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Breast cancer is one the main death causes for women worldwide, as 16% of the diagnosed malignant lesions worldwide are its consequence. In this sense, it is of paramount importance to diagnose these lesions in the earliest stage possible, in order to have the highest chances of survival. While there are several works that present selected topics in this area, none of them present a complete panorama, that is, from the image generation to its interpretation. This work presents a comprehensive state-of-the-art review of the image generation and processing techniques to detect Breast Cancer, where potential candidates for the image generation and processing are presented and discussed. Novel methodologies should consider the adroit integration of artificial intelligence-concepts and the categorical data to generate modern alternatives that can have the accuracy, precision and reliability expected to mitigate the misclassifications.

Klebsiella pneumoniae is part of the human gastrointestinal microbiota. It is also a well-known cause of community and nosocomial infections, involving mainly the lung and urinary tract. An invasive syndrome with liver abscess due to a new hypervirulent strain of K. pneumoniae was recently described. Several cases have been reported, mainly in Asia. Here, we show a case of a patient with an extrahepatic involvement affecting the lung and prostate., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Fresh vegetables are an important part of a healthy diet, however, they can also be agents of transmission of intestinal parasites. This study aimed to evaluate the presence of parasite contamination in vegetable farms as a source of transmission in selected rural communities in Laguna, Philippines. A total of 168 vegetable, 55 soil and 15 water samples collected from four selected farms and a reference farm were processed through various standard parasitological techniques. Of these, 17.3% of vegetables, 47.3% soil and 73.3% water samples were found contaminated with parasites’ eggs or cysts. Interestingly, leafy vegetables, such as lettuce, were found to be more contaminated. Results showed that strongylids/hookworms (egg/larva) showed the highest prevalence in farm soil (38.2%) and vegetable (13.1%); other helminth parasite eggs were also recovered such as Toxocara sp., Ascaris sp., Trichiuris, Trichostrongylus sp. and protozoan cysts of Balantidium coli. Cryptosporidium sp. oocysts of and Giardia sp. cysts were observed in all water samples in the farms. Furthermore, results revealed that some farming practices such as the use of improperly treated animals manure as fertilizers, unhygienic practice of farmers and sanitation issues were factors that contribute to parasite contamination in the farms. These findings have implications on food safety in poor-resource communities posing public health risks. Recommendations were discussed in the study for the control and prevention of parasite contamination at the farm level.

Background: Although the COVID-19 pandemic has been shown to worsen anxiety and depression symptoms, we do not understand which behavioral and neural factors may mitigate this impact. To address this gap, we assessed whether adaptive and maladaptive coping strategies affect symptom trajectory during the pandemic. We also examined whether pre-pandemic integrity of brain regions implicated in depression and anxiety affect pandemic symptoms., Methods: In a naturalistic sample of 169 adults (66.9% female; age 19-74 years) spanning psychiatric diagnoses and subclinical symptoms, we assessed anhedonia, tension, and anxious arousal symptoms using validated components (21-item Depression, Anxiety, and Stress Scale), coping strategies (Brief-Coping Orientation to Problems Experienced), and gray matter volume (amygdala) and cortical thickness (hippocampus, insula, anterior cingulate cortex) from magnetic resonance imaging T1-weighted scans. We conducted general linear mixed-effects models to test preregistered hypotheses that 1) maladaptive coping pre-pandemic and 2) lower structural integrity pre-pandemic would predict more severe pandemic symptoms; and 3) coping would interact with neural structure to predict pandemic symptoms., Results: Greater use of maladaptive coping strategies was associated with more severe anxious arousal symptoms during the pandemic ( p  = .011, false discovery rate-corrected p [ p FDR ] = .035), specifically less self-distraction ( p  = .014, p FDR  = .042) and greater self-blame ( p  = .002, p FDR  = .012). Reduced insula thickness pre-pandemic predicted more severe anxious arousal symptoms ( p  = .001, p FDR  = .027). Self-distraction interacted with amygdala volume to predict anhedonia symptoms ( p  = .005, p FDR  = .020)., Conclusions: Maladaptive coping strategies and structural variation in brain regions may influence clinical symptoms during a prolonged stressful event (e.g., COVID-19 pandemic). Future studies that identify behavioral and neural factors implicated in responses to global health crises are warranted for fostering resilience., (© 2021 The Authors.)