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Abstract Background We report a rare case of a patient who presented with chest pain and was found to have a constellation of rare cardiac anomalies. Case presentation A 67-year-old patient with no past medical history presented with chest pain. He had mild troponin elevation, but no ischemic changes on ECG. He underwent a CT coronary angiogram for further evaluation. He was found to have a type 0 bicuspid aortic valve, large left sinus of Valsalva aneurysm and type R-III single coronary artery. These findings were confirmed with transesophageal echocardiogram and coronary angiogram. He underwent a successful repair of his aortic root aneurysm with a synthetic patch. Conclusions The combination of type R-III single coronary artery, bicuspid aortic valve, and left sinus of Valsalva aneurysm congenital anomalies in one individual is extremely rare and marks our case unique. Given the size of his Sinus of Valsalva aneurysm, the patient underwent surgical repair of his aneurysm and was asymptomatic when seen in follow-up.

Background: The anti-N-methyl-D-aspartate (NMDAr) encephalitis was first described in 2005 and in 2007 the antibodies against the NMDA were identified by Dalmau et al.It is estimated that it affects 1.5 per million individuals every year, but it is more frequent in young women ranging from 15 to 25 years, and 37% of them can manifest as a paraneoplasic syndrome in association with an ovarian teratoma.Case description: A 17-year-old female with personal history of left ovarian teratoma, one week after its surgical removal presents: auditory hallucinations, persecutory delusions, insomnia, anhedonia, agitation, speech impairment, orofacial dyskinesia, and gait alterations during one month. An electroencephalogram (ECG) reported severe cortical-subcortical. The cerebral Magnetic Resonance Imaging (MRI) and the Cerebrospinal Fluid (CSF) analysis, reported no findings. Given the clinical suspicion, immunosuppressive treatment with intravenous corticosteroids was initiated, along with symptomatic management antipsychotic, for agitation and anxiety; initially with midazolam infusion and then with olanzapine, risperidone, and clonazepam; obtaining satisfactory clinical improvement. Finally, the diagnosis was confirmed by a positive IgG against the N1 glutamate subunit (Glu N1) of the NMDAr. Conclusion: The anti NMDAr encephalitis is a rare and underdiagnosed condition, which can be mistaken as a primary psychiatric disease. Given a first psychotic episode, an extense interrogatory and evaluation must be done to exclude secondary causes, such as, autoimmune disorders with neurologic repercusions.

Summary: Total hip arthroplasty uses commercial devices that combine different types of biomaterials. Among them, metals, ceramics and metal oxides can be used either in the prosthesis itself or in the cement used to anchor them in the bone. Over time, all of these materials can wear out and release particles that accumulate in the periprosthetic tissues or can migrate away. We used histology blocks from 15 patients (5 titanium metallosis, 5 alumina prostheses, 5 with altered methacrylic cement) to perform a microCT study and compare it with conventional histology data. An EDS‐SEM analysis was done to characterise the atomic nature of the materials involved. A morphometric analysis was also performed in 3D to count the particles and assess their density and size. The metallic particles appeared to be the largest and the ceramic particles the finest. However, microCT could not reveal the wear particles of radiolucent biomaterials such as polyethylene and the very fine zirconia particles from cement fragmentation. MicroCT analysis can reveal the extent of the accumulation of these debris in the periprosthetic tissues. Layout Description: Hip prostheses progressively degrade in the body by releasing wear debris. They accumulate in the periprosthetic tissues. Microcomputed tomography was used to image three types of radio‐opaque wear debris: metal, ceramic and zirconia used in the bone cements. [ABSTRACT FROM AUTHOR]

Maize ranks as the second most widely produced crop globally, yielding approximately 1.2 billion tons, with corn cob being its primary byproduct, constituting 18 kg per 100 kg of corn. Agricultural corn production generates bioactive polysaccharide-rich byproducts, including xylan (Xyl). In this study, we used the redox method to modify corn cob xylan with gallic acid, aiming to enhance its antioxidant and protective capacity against oxidative stress. The conjugation process resulted in a new molecule termed conjugated xylan–gallic acid (Xyl-GA), exhibiting notable improvements in various antioxidant parameters, including total antioxidant capacity (1.4-fold increase), reducing power (1.2-fold increase), hydroxyl radical scavenging (1.6-fold increase), and cupric chelation (27.5-fold increase) when compared with unmodified Xyl. At a concentration of 1 mg/mL, Xyl-GA demonstrated no cytotoxicity, significantly increased fibroblast cell viability (approximately 80%), and effectively mitigated intracellular ROS levels (reduced by 100%) following oxidative damage induced by H2O2. Furthermore, Xyl-GA exhibited non-toxicity toward zebrafish embryos, offered protection against H2O2-induced stress, and reduced the rate of cells undergoing apoptosis resulting from H2O2 exposure. In conclusion, our findings suggest that Xyl-GA possesses potential therapeutic value in addressing oxidative stress-related disturbances. Further investigations are warranted to elucidate the molecular structure of this novel compound and establish correlations with its pharmacological activities.

For an avian migrant, refueling capacity attainable during stopovers governs the entire migration schedule and, ultimately, its fitness. Specifically, timely replenishing energy stores is critical when migration involves crossing ecological barriers, within which refueling may be limited. Here, we tested the hypothesis that fuel deposition rates (FDRs) of migratory passerines within barrier‐edge stopover sites are constrained by the density of potential competitors, irrespective of migration season, phenology, and local environmental conditions. We also evaluated diverse intra‐ and inter‐specific competition scenarios and explored a potential mediation of density‐dependence by environmental factors. The analyzed data, collected by us over 13 consecutive years (2009–2022), contain information on seven species of long‐distance migratory insectivorous passerines measured within eight desert‐edge habitats throughout autumn and spring migrations. As predicted, our analyses revealed negative density‐dependence regulation of FDRs, consistent across species and migration seasons. Notably, bird density exerted its effect above and beyond the other factors known to influence FDR, such as relative ambient temperature, phenology, temporal progress of stopover, and body mass next to landfall. As expected, FDR increased at higher relative ambient temperatures and with the stopover's progress. In spring, FDR also rose as the season advanced. These findings signify the substantial impact of competition on the refueling performance of migratory passerines during their stopover on an ecological barrier's edge, acting over and above the other environmental factors. The detected importance of competition and its interrelation with other predictors provides an insight into stopover's functioning; environmentally imposed and inescapable interspecific interference is thus a significant limiting factor of FDR, a deleterious relationship potentially remediable by informed habitat restoration and planning.

Objective The objective of this study was to describe a methodological procedure to quantify the heat production (HP) partitioning in basal metabolism or fasting heat production (FHP), heat production due to physical activity (HPA), and the thermic effect of feeding (TEF) in roosters. Methods Eighteen 54-wk-old Hy Line Brown roosters (2.916±0.15 kg) were allocated in an open-circuit chamber of respirometry for O2 consumption (VO2), CO2 production (VCO2), and physical activity (PA) measurements, under environmental comfort conditions, following the protocol: adaptation (3 d), ad libitum feeding (1 d), and fasting conditions (1 d). The Brouwer equation was used to calculate the HP from VO2 and VCO2. The plateau-FHP (parameter L) was estimated through the broken line model: HP = U×(R–t)×I+L; I = 1 if tR; Where the broken-point (R) was assigned as the time (t) that defined the difference between a short and long fasting period, I is conditional, and U is the decreasing rate after the feed was withdrawn. The HP components description was characterized by three events: ad libitum feeding and short and long fasting periods. Linear regression was adjusted between physical activity (PA) and HP to determine the HPA and to estimate the standardized FHP (st-FHP) as the intercept of PA = 0. Results The time when plateau-FHP was reached at 11.7 h after withdrawal feed, with a mean value of 386 kJ/kg0.75/d, differing in 32 kJ from st-FHP (354 kJ/kg0.75/d). The slope of HP per unit of PA was 4.52 kJ/mV. The total HP in roosters partitioned into the st-FHP, termal effect of feeding (TEF), and HPA was 56.6%, 25.7%, and 17.7%, respectively. Conclusion The FHP represents the largest fraction of energy expenditure in roosters, followed by the TEF. Furthermore, the PA increased the variation of HP measurements.

Abstract BackgroundComputerized clinical decision support systems (CDSSs) are increasingly adopted in health care to optimize resources and streamline patient flow. However, they often lack scientific validation against standard medical care. ObjectiveThe purpose of this study was to assess the performance, safety, and usability of a CDSS in a university hospital emergency department setting in Kuopio, Finland. MethodsPatients entering the emergency department were asked to voluntarily participate in this study. Patients aged 17 years or younger, patients with cognitive impairments, and patients who entered the unit in an ambulance or with the need for immediate care were excluded. Patients completed the CDSS web-based form and usability questionnaire when waiting for the triage nurse’s evaluation. The CDSS data were anonymized and did not affect the patients’ usual evaluation or treatment. Retrospectively, 2 medical doctors evaluated the urgency of each patient’s condition by using the triage nurse’s information, and urgent and nonurgent groups were created. The International Statistical Classification of Diseases, Tenth Revision ResultsIn total, our analyses included 248 patients. Regarding urgency, the mean sensitivities were 85% and 19%, respectively, for urgent and nonurgent cases when assessing the performance of CDSS evaluations in comparison to that of physicians. The mean sensitivities were 85% and 35%, respectively, when comparing the evaluations between the two physicians. Our CDSS did not miss any cases that were evaluated to be emergencies by physicians; thus, all emergency cases evaluated by physicians were evaluated as either urgent cases or emergency cases by the CDSS. In differential diagnosis, the CDSS had an exact match accuracy of 45.5% (97/213). The usability was good, with a mean System Usability Scale score of 78.2 (SD 16.8). ConclusionsIn a university hospital emergency department setting with a large real-world population, our CDSS was found to be equally as sensitive in urgent patient cases as physicians and was found to have an acceptable differential diagnosis accuracy, with good usability. These results suggest that this CDSS can be safely assessed further in a real-world setting. A CDSS could accelerate triage by providing patient-provided data in advance of patients’ initial consultations and categorize patient cases as urgent and nonurgent cases upon patients' arrival to the emergency department.

Introduction In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. Methods In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. Results During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. Conclusions The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

Polissacarídeos sulfatados (PSs) da alga vermelha comestível Gracilaria birdiae possuem atividade antioxidante. Trabalhos anteriores mostram que PSs, quando em forma de nanopartículas de prata (NpsAg), apresentam melhor atividade antioxidante do que em sua forma original. Contudo, não há dados referentes a NpsAg sintetizadas com PSs de G. birdiae. Portanto, NpsAg sintetizadas a partir dos PSs de G. birdiae foram obtidas e avaliadas como agentes antioxidantes. Foram realizadas a detecção e a medição de tamanho das NpsAg por dispersão de luz dinâmica (DLS). O extrato de PS foi avaliado quanto a sua capacidade redutora pelo teste de capacidade antioxidante total (CAT). A capacidade antioxidante das NpsAg e dos PS também foi determinada pelo teste de quelação férrica. O teor de proteínas e de açúcar foi determinado por espectrofotometria. Os PS apresentaram CAT, e isso habilitou-os para a síntese de NpsAg. As NpsAg apresentaram tamanho médio de 117,6 nm. Nenhuma contaminação proteica foi encontrada nos PSs e nas NpsAg. O teor de açúcar na suspensão de NpsAg (55,7%) foi superior ao encontrado na solução de PSs (49,7%). A suspensão com NpsAg apresentou uma atividade quelante de ferro 25% maior que a solução de PSs. Os resultados mostraram que os PSs de G. birdiae, sob a forma de nanopartículas, tiveram a sua atividade quelante de ferro potencializada, indicando que as nanopartículas de prata podem ser objeto de futuros estudos para identificar seu potencial como agentes antioxidantes em diferentes aplicações.