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Abstract High-resolution anorectal manometry (HR-ARM) is the gold standard for anorectal functional disorders’ evaluation, despite being limited by its accessibility and complex data analysis. The London Protocol and Classification were developed to standardize anorectal motility patterns classification. This proof-of-concept study aims to develop and validate an artificial intelligence model for identification and differentiation of disorders of anal tone and contractility in HR-ARM. A dataset of 701 HR-ARM exams from a tertiary center, classified according to London Classification, was used to develop and test multiple machine learning (ML) algorithms. The exams were divided in a training and testing dataset with a 80/20% ratio. The testing dataset was used for models’ evaluation through its accuracy, sensitivity, specificity, positive and negative predictive values and area under the receiving-operating characteristic curve. LGBM Classifier had the best performance, with an accuracy of 87.0% for identifying disorders of anal tone and contractility. Different ML models excelled in distinguishing specific disorders of anal tone and contractility, with accuracy over 90.0%. This is the first worldwide study proving the accuracy of a ML model for differentiation of motility patterns in HR-ARM, demonstrating the value of artificial intelligence models in optimizing HR-ARM availability while reducing interobserver variability and increasing accuracy.

Background and objective: Radiation-induced cystitis (RIC) is an important consequence of pelvic radiotherapy that can cause high morbidity and, in extreme cases, mortality. The lack of a widely accepted classification system makes it difficult to compare treatment regimens. Our aim was to develop a new classification system covering the RIC spectrum to improve treatment comparisons and accurate incidence estimates for systematic use in clinical and research settings. Methods: A three-phase project was planned. Phase 1 involved a literature review and development of the Portuguese Navy Radiation-induced Cystitis (PNRC) scale. In phase 2 the scale was applied to 20 clinical cases. Phase 3 involved assessment of the applicability, relevance, inter-rater reliability, and usability of the scale using numerical and graphical methods to achieve consensus among international experts. Key findings and limitations: In phase 1, the panel analysed 13 existing classification systems and developed the PNRC scale, a comprehensive system encompassing five clinical domains: haematuria, other lower urinary tract symptoms, functional impairment, endoscopic findings, and therapeutic interventions. In phase 2, 114 experts from 30 countries completed the first validation round. Consensus was reached for 85% of cases. In phase 3, consensus was reached among 61 experts on the relevance and appropriateness of each domain, and on the exhaustiveness, hierarchy, clarity, mutual exclusivity, and clinical utility of the PNRC scale. Study limitations are the inclusion of only Medline-indexed manuscripts in the review and minor dispersion of responses, indicating subjectivity in the analysis of clinical case scenarios. Conclusions and clinical implications: The PNRC scale showed reliability and face and construct validity in the stratification of RIC severity for clinical cases. Patient summary: Radiation-induced cystitis is a debilitating complication of pelvic radiotherapy. A uniform classification system is needed to assess the incidence of this disease and to compare the results for different treatment options. We developed the Portuguese Navy Radiation-induced Cystitis (PNRC) scale, which was validated by an independent group of experts from 30 different countries.

Abstract Diabetes is a pandemic disease that causes the loss of control of glucose regulation in the organism, in consequence of dysfunction of insulin production or functionality. In this work, the antidiabetic bioactivity of 182 fractions from 19 cyanobacteria strains derived from the LEGE Culture Collection were analysed using the 2-NBDG assay in zebrafish larvae. From this initial screening, two fractions (57 (06104_D) and 107 (03283_B)) were identified as promising insulin mimetics. These were further characterized by measuring glucose levels in whole larvae, the expression of glucose transporters (GLUT 1–3) using western blot, and the mRNA expression levels of the glut2, pepck, and insa genes using real-time qPCR. Both fractions showed a decrease in free glucose levels. Furthermore, exposure to fraction 06104_D decreased GLUT1 and increased insa mRNA levels. The chemical composition of these fractions was determined using LC-HRESIMS/MS and compared to inactive fractions of the same polarity in order to identify the unique bioactive molecules. The molecular networks constructed using the GNPS platform revealed that fraction 06104_D contained mass clusters primarily composed of chlorins, lipids, and terpenoids, while fraction 03283_B contained xanthophylls, peptides, and terpenoids. To correlate the observed activity with the chemical composition of fraction 06104_D, pheophorbide a was chosen as a representative of chlorophyll derivatives. Exposure to zebrafish larvae at 10 and 20 µM confirmed the increased glucose uptake on the 2-NBDG assay. These findings highlight the bioactivity of chlorophyll derivatives as insulin mimetic compounds, as well as cyanobacteria as a source of potential therapeutic diabetes applications.

Background and objective: While programmes such as the European Basic Laparoscopic Urological Skills have made strides in foundational training, a significant gap exists for intermediate and advanced laparoscopy education. Our objective is to develop and validate the European laparoscopic intermediate urological skills (LUSs2) curriculum, which will establish uniformity in the training of urological laparoscopic procedures and facilitate proficiency among practitioners. Methods: The study combines a literature review, cognitive task analysis development by a steering group, and a two-round Delphi survey involving international experts in urological laparoscopy. Consensus was defined as agreement of ≥70% among experts. The survey included statements on various laparoscopic procedures, assessed on a Likert scale from 1 (strongly disagree) to 9 (strongly agree). Key findings and limitations: The Delphi process achieved consensus on 85% (235/275) of statements, indicating a strong agreement on the curriculum’s content. Areas covered include renal hilum dissection, major vessel injury management, enucleation and renorrhaphy, vesicourethral anastomosis, and pyeloplasty. Limitations include the nonsystematic nature of the literature review and potential biases inherent in expert-based consensus methods. Conclusions and clinical implications: The LUSs2 curriculum significantly advances the standardised training of laparoscopic urological skills. It offers a detailed, consensus-validated framework that addresses the need for uniformity in surgical education and aims to enhance surgical proficiency and patient care. Patient summary: This study presents the development of a new standardised training curriculum for urological laparoscopic surgery. We intend this curriculum to improve the quality of surgical training and ensure high-quality patient care.

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

Introduction: According to the Portuguese clinical guidelines published in 1999, patients with traumatic brain injury and coagulopathies should remain in-hospital for 24 hours for clinical and image surveillance, despite having an admission computed tomography (CT) scan showing no intracranial lesions. Growing evidence suggests this practice is not only void of clinical relevance, but that it can also be potentially harmful for the patient. Nevertheless, up until now there is no published data concerning the economic impact of this clinical practice. Methods: A cost analysis compared retrospective data from patients admitted to our emergency department during 2022 with a hypothetical scenario in which a patient with an admission CT scan without traumatic lesions was discharged. Clinical data was also retrieved concerning the rate of a delayed intracranial bleeding on 24-hour CT scan and mortality at a six-month-period after discharge. Direct costs for the national health service were determined in terms of funding and time invested by medical teams. Results: From a sample of 440 patients, 436 remained in-hospital for a 24-hour clinical and image surveillance, of which only two (0.5%) showed a new intracranial lesion on the second CT-scan. Neither of these two patients required therapeutic measures to control bleeding and were discharged 36 hours after admission. Out of 440 patients, one patient (0.2%) died of cardiac arrest during the 24-hour surveillance period, despite having an initial normal CT scan showing no brain lesions. Our current surveillance practice directly amounted to €163 157.00, whereas the cost of our hypothetical scenario amounted to €29 480.00: a difference of €133 677.00. The application of our surveillance guideline also meant that nine emergency shifts were devoted to this task, compared to 4.6 hypothetical shifts if patients were discharged after an initial CT scan without traumatic intracranial lesions. Conclusion: In spite of apparently not adding any clinical value to our practice, our in-hospital surveillance may represent a significant financial and time-consuming burden, costing five times as much and demanding our medical teams twice as much work when compared to a scenario without clinical surveillance and 24-hour CT scans.

There is a growing literature on meat consumption and reduced meat diets, given the negative impacts of meat on the environment. However, much of the literature has focussed on global North countries, limiting cross-cultural generalisability and overlooking the role of cultural differences in motivating food choices. The present paper provides a cross-cultural comparison of the motivations for meat consumption and vegetarianism in Brazil and the United Kingdom. This was done by conducting a total of 63 semi-structured interviews with meat-eaters, vegetarians, and vegans in Brazil (n = 41) and the UK (n = 22). The data was analysed thematically and the findings were compared across the participant samples. The findings showed that meat consumption was similarly motivated and justified in each country through the 4 N’s of justification for meat consumption. However, participants’ experiences of reducing meat consumption varied between the two countries, influenced by distinct motivations, aversions, and constraints. In the UK, price served as a motivation for choosing meatless meals, whereas in Brazil it acted as a constraint to reducing meat consumption. Additionally, in the UK, disgust was identified as a significant aversion particularly towards eating parts of meat that visibly resembled the animal of origin — a sentiment not observed in the Brazilian sample. Lastly, while environmental concerns were not a primary reason for adopting a plant-based diet in either country, they often became a significant motivator for maintaining it after dietary change.

Introduction: International societies recommend microbiological surveillance of endoscopes to reduce the incidence of endoscope-associated infections, particularly for duodenoscopes. However, surveillance protocols are not internationally standardized, both regarding sample collection, processing, and culture. This study aims to provide a framework protocol encompassing the experience of a tertiary large volume endoscopy center and the microbiology laboratory for collecting and culturing of endoscope samples for microbiological surveillance. Methods: A sample collection and processing protocol was designed as a result of a cooperation between the Endoscopy Center of the Gastroenterology Department and the Microbiology Laboratory of the Department of Clinical Pathology. This protocol reflects international recommendations in this topic and the human and technological resources of the involved departments. Results: The established protocol for collecting samples varies according to the type and model of endoscope. The specimens are collected as sterile saline liquid samples, as well as swabs (with and without transport media). Together with the collection of samples from the endoscope, samples from the final rinse water as well as the water bottle are also collected. For duodenoscopes and curvilinear echoendoscopes, we perform microbiological surveillance every 3 months; for gastroscopes and colonoscopes, at least, once a year; and for specific endoscopes, such as the pediatric or dual-channel therapeutic endoscopes, enteroscopes, or radial echoendoscopes, every 6 months. Conclusion: Endoscopy units should have detailed protocols for microbiological surveillance of endoscopes. These protocols should be drawn up by a multidisciplinary team that includes endoscopy nurses, gastroenterologists, microbiologists, and the antimicrobial stewardship team, following international recommendations, adapted to each institution resources.

Abstract Repetitive sequences can lead to variation in DNA quantity and composition among species. The Orchidaceae, the largest angiosperm family, is divided into five subfamilies, with Apostasioideae as the basal group and Orchidoideae and Epidendroideae showing high diversification rates. Despite their different evolutionary paths, some species in these groups have similar nuclear DNA content. This study focuses on one example to understand the dynamics of major repetitive DNAs in the nucleus. We used Next-Generation Sequencing (NGS) data from Apostasia wallichii (Apostasioideae) and Ludisia discolor (Orchidoideae) to identify and quantify the most abundant repeats. The repetitive fraction varied in abundance (27.5% in L. discolor and 60.6% in A. wallichii) and composition, with LTR retrotransposons of different lineages being the most abundant repeats in each species. Satellite DNAs showed varying organization and abundance. Despite the unbalanced ratio between single-copy and repetitive DNA sequences, the two species had the same genome size, possibly due to the elimination of non-essential genes. This phenomenon has been observed in other Apostasia and likely led to the proliferation of transposable elements in A. wallichii. Deep genome information in the future will aid in understanding the contraction/expansion of gene families and the evolution of sequences in these genomes.

A imunização é uma das principais estratégias para garantir a proteção de seres humanos contra determinadas doenças infectocontagiosas. Sabe-se que a indução artificial de imunidade humana contra enfermidades ocorre desde os primeiros dias de vida, exigindo, portanto, a participação efetiva dos pais de recém nascidos nesse processo de proteção. Nesse contexto, destaca-se, expressivamente, a atuação das figuras maternas, o que confere a necessidade de se promover ações educativas as quais induzem e instruem figuras paternas a terem maior contato com a vacinação de seus descendentes. O presente artigo tem o objetivo de relatar a vivência de estudantes de medicina ao promoverem um momento educativo para figuras paternas acerca de sua participação na vacinação de seus filhos. Trata-se de um relato de experiência, que expõe a percepção de estudantes de Medicina ao planejarem e executarem um evento educativo-extensionista. Tal acontecimento embasou-se na distribuição de panfletos e apresentação de banners, os quais continham informações acerca da necessidade da participação paterna na imunização infantil, bem como acerca do reaparecimento de doenças erradicadas. Após as atividades educativas, percebeu-se que a ação foi bem sucedida, que o público alvo aceitou e envolveu-se nessa proposta de comunicação em saúde e que as informações foram passadas de forma eficiente. Ainda, ficou claro que muitos personagens paternos convivem com muitas dúvidas acerca da importância da imunização e admitem não serem atuantes na imunização de seus filhos.

INTRODUCTION: Fenestrated and branched stent graft technology has come a long way over the past few years, enabling the treatment of complex juxtarenal aneurysms, thoracoabdominal aneurysms, and arch pathologies. Many innovations have been developed, namely device and delivery optimization and technical tricks. These concepts have proven to work well when there is sufficient time to plan and manufacture a custom-made device for the patient. However, this is different in urgent or emergent cases. Using parallel graft techniques or off-the-shelf stent grafts may be efficient in urgent situations, but it is also associated with selection limitations. Recent publications have demonstrated similar mid-term technical and clinical results between physician-modified endografts (PMEGs) and customized devices. The authors aim to describe their institutional series of PMEGs. METHODS: The clinical files of all patients undergoing PMEGs were consulted, and demographic data as surgery outcomes were collected. Technical success: creating the intended number of fenestrations, target vessel catheterization, and patency. Procedural success: technical success with adequate aneurysm exclusion and without endoleak in the final angiography. 30-day complications and mortality were also evaluated. Technical and procedural success were assessed, as well as morbidity and mortality. RESULTS: Between December 2020 and December 2022, 3 patients underwent PMEGs. The indications were a juxtarenal aortic aneurysm, a type V thoracoabdominal aneurysm and a persistent type 1a endoleak. All patients were symptomatic, with one stable rupture. All cases were performed with technical and procedural success and no morbidity and mortality at 30 days. CONCLUSION: Stent graft modification is a valuable and valid tool in emergencies and should be a vascular surgeon's trump card when dealing with complex aortic pathologies. Nevertheless, due to the absence of long-term evidence, it should be reserved for acute patients unfit for open repair and in aneurysms with unfavorable anatomy for an off-the-shelf device.

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

Climate change poses a growing threat to human health and well-being, with emerging evidence pointing to its intricate relationship with liver diseases. Indeed, climate change influences liver diseases through various direct and indirect mechanisms. Alcohol-related liver disease, Metabolic dysfunction-associated liver disease (MASLD), and viral hepatitis are the three most common causes of liver disease, and all are susceptible to the effects of climate change. Shifts in dietary habits driven by altered food availability, substance abuse exacerbated by social instability, extreme weather events affecting healthcare access, and the emergence of waterborne infections are among the factors exacerbating liver disease incidence and severity. On the flip side, healthcare systems, including liver units, significantly contribute to climate change through energy consumption, medical waste, and transportation emissions. The need for sustainable healthcare practices, telemedicine, and waste reduction strategies is becoming increasingly evident. Recognizing this intricate interplay and addressing the dual interaction between climate change and liver disease is imperative for safeguarding human health and reducing the environmental footprint of healthcare facilities. As climate change continues to unfold, understanding its implications for liver disease is critical for public health and environmental sustainability.

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

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

Pancreatic neuroendocrine tumors (panNETs) are a group of neoplasms with heterogenous biological and clinical phenotypes. Although historically regarded as rare, the incidence of these tumors has been increasing, mostly owing to improvements in the detection of small, asymptomatic tumors with imaging. The heterogeneity of these lesions creates significant challenges regarding diagnosis, staging, and treatment. Endoscopic ultrasound (EUS) has improved the characterization of pancreatic lesions. Furthermore, EUS nowadays has evolved from a purely diagnostic modality to allow the performance of minimally invasive locoregional therapy for pancreatic focal lesions. The choice of treatment as well as the treatment goals depend on several factors, including tumor secretory status, grading, staging, and patient performance status. Surgery has been the mainstay for the management of these patients, particularly for localized, low-grade, large panNETs >2 cm. Over the last decade, a significant body of evidence has been accumulated evaluating the role of EUS for the ablative therapy of panNETs, namely by the use of chemoablative agents and radiofrequency. Although endoscopic techniques are not routinely recommended by international guidelines, they may be considered for the treatment of smaller lesions in patients who are unwilling or unfit for pancreatic surgery. In this review, we summarize the existing evidence on the interventional techniques for the treatment of patients with panNETs, focusing on the EUS-guided and surgical approaches.

Developments on code-compliant Topology Optimisation methodologies for the steel construction industry have recently been proposed. Also, it has been found that topologically optimised steel bolted connection parts – which behave non-linearly to a very significant degree of damage – do not waive physically non-linear analyses to assess an ultimate capacity that can be lower than what is predicted by the optimisation procedure linear analyses. These two circumstances brought urgency to the experimental testing of such optimised parts. The herein depicted experimental programme assessed topologically optimised and previously numerically analysed bolted parts of a well-known steel connection. The results allowed redefining the material trilinear model to be used in further numerical analysis and, very significantly, validated the numerical simulations results as well as the application of Eurocode formulae for connections component resistance. The difference between the previous numerically predicted ultimate resistance and the experimentally defined did not exceed 2.6 %.

Pancreatic cystic lesions (PCLs) pose a diagnostic challenge due to their increasing incidence and the limitations of cross-sectional imaging and endoscopic-ultrasound-guided fine-needle aspiration (EUS-FNA). EUS-guided through the needle biopsy (EUS-TTNB) has emerged as a promising tool for improving the accuracy of cyst type determination and neoplastic risk stratification. EUS-TTNB demonstrates superior diagnostic performance over EUS-FNA, providing critical preoperative information that can significantly influence patient management and reduce unnecessary surgeries. However, the procedure has risks, with an overall adverse event rate of approximately 9%. Preventive measures and further prospective studies are essential to optimize its safety and efficacy. This review highlights the potential of EUS-TTNB to enhance the diagnostic and management approaches for patients with PCLs. It examines the current state of EUS-TTNB, including available devices, indications, procedural techniques, specimen handling, diagnostic yield, clinical impact, and associated adverse events.

This research addresses the social exclusion of elderly citizens in terms of lifelong education via an interdisciplinary STEAM (science, technology, engineering, arts, and mathematics) approach. Technological literacy among older people is a critical factor in social exclusion. This study seeks to provide senior citizens with competencies in scientific, artistic, mathematical, and technological domains by enhancing scientific and technological literacy. The research developed a series of non-formal education sessions on the golden ratio using a STEAM educational approach. A quantitative methodology approach was carried out by using a diagnostic survey of the participants’ conceptions and a subsequent quasi-experimental study to evaluate the impact of the intervention. This study, conducted with 37 senior citizens (n = 37), found positive results aligning with the existing literature on the potential of the STEAM approach. The STEAM approach proved to be engaging for seniors, offering a holistic and interdisciplinary educational experience. Despite the limited availability of science educational programs for seniors and the scarcity of studies on lifelong learning using the STEAM approach, this research highlights the need for such initiatives, especially given the growing senior population. Applying STEAM education shows promise in enhancing scientific literacy and motivation among adult learners. By integrating mathematical concepts, such as the golden ratio, with practical applications in arts and natural sciences, STEAM education can provide a rich, motivating, and accessible learning experience, promoting active and healthy ageing through lifelong learning. Further research and development in this area could maximise educational benefits for the senior population.

Analisa como a implementação do processo digital, por meio do Sistema de Automação da Justiça (SAJ), impactou no rendimento e eficiência do Tribunal de Justiça de São Paulo (TJSP), a maior Corte do país em volume de processos. A partir da definição conceitual de desempenho e de sua mensuração nos eixos de eficiência e celeridade do relatório Justiça em Números do CNJ, este estudo analisa os resultados apresentados pelos tribunais classificados como de grande porte no período de 2010-2014 (anterior ao processo digital) e de 2016-2022 (posterior ao processo digital), comparando com os resultados e índices do TJSP. Foi possível verificar que nesse último período, o índice de atendimento à demanda na fase de conhecimento cresceu 28,5% e que a duração média do processo reduziu 24%, resultado similar à média dos outros tribunais de grande porte em 2022, mas diferente da situação apresentada em 2015, que era 71,4% superior.

INTRODUCTION: Endovascular aortic repair (EVAR) has become the technique of choice in most vascular centres for abdominal aortic aneurysms (AAA). However, due to its low incidence, literature regarding secondary aortoenteric fistula (AEF) as an EVAR complication is still scarce. We aim to summarise the latest evidence on the topic through a narrative review. METHODS: We conducted a MEDLINE literature search and included studies on secondary aortoenteric fistula, abdominal aortic aneurysms and endovascular aneurysm repair. Relevant studies were selected by reading of the titles and abstracts. Only English literature was considered. RESULTS: Despite secondary AEF after EVAR first being reported in 1998, its incidence is hard to calculate, but is recognized to be lower (

Introduction and objective: This study aimed to evaluate the efficacy of babassu mesocarp flour (Orbignya pharelata Mart.) supplementation on muscle damage, pain, and effort perception in futsal athletes. Materials and methods: This is a randomized, single-blind, placebo-controlled trial. Ten recreational futsal athletes consumed water, maltodextrin, and babassu mesocarp flour supplement in three different occasions before the training protocol. There was a 5-day washout period between sessions. Afterwards, they underwent a plyometric training session and the futsal-specific intermittent shuttle protocol test (FISP). Blood samples were collected for creatine kinase (CK) analysis. Results: There was a significant increase in CK levels after the babassu supplementation of 11.25% (p=0.02, d=0.26), whereas the Maltodextrin had a non-significant increase of 29% (p=0.08). The reported muscle soreness was smaller after the ingestion of babassu for the jump and FISP tests (p=0.03 e p=0.01, respectively) compared to water intake. No significant difference was found between Babassu and Maltodextrin intake regarding muscle soreness. Conclusion: Babassu mesocarp flour supplementation reduced biomarkers of muscle damage and effort perceptions. However, there was a greater decrease in CK levels after maltodextrin intake compared to babassu mesocarp flour supplementation.

ABSTRACT Background Sleep bruxism (BS) is defined as involuntary jaw movements characterized by grinding and clenching teeth. Objective To verify the association between chronotype, sleep quality, and self-reporting of BS in dental students. Method A cross-sectional study was conducted with 214 undergraduate dental students at a public university in northeast Brazil. The participants answered the Munich Chronotype Questionnaire for the identification of chronotype and another questionnaire regarding daily aspects to collect information about sleep quality, self-reported sleep bruxism, the use of sleeping pills, snoring, concentration during daily activities and energy upon waking. Results The prevalence of self-reported sleep bruxism was 11.0%. In the final model, the eveningness chronotype (OR = 23.00; 95% CI: 2.36-223.84, p = 0.007), habitual snoring (OR = 3.12; 95% CI: 1.31-7.39, p = 0.01) and low energy upon waking in the morning (OR = 2.37; 95% CI: 1.96-5.58, p = 0.040) were associated with self-reported sleep bruxism. Conclusion The evening chronotype, presence of snoring, and low energy when waking up in the morning influenced self-reporting of sleep bruxism among undergraduate dental students.

Abstract The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43–2.86), mouth breathing (OR = 1.04; 95%CI: 1.02–1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37–4.85), and obesity (OR = 1.54; 95%CI: 1.02–2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

Introduction Quality monitoring is a critical component of high-performing cancer care systems. Quality indicators (QIs) are standardised, evidence-based measures of healthcare quality that allow healthcare systems to track performance, identify gaps in healthcare delivery and inform areas of priority for strategic planning. Social structures and economic systems that allow for unequal access to power and resources that shape health and health inequities can be described through the social determinants of health (SDoH) framework. Therefore, granular analysis of healthcare quality through SDoH frameworks is required to identify patient subgroups who may experience health inequity. Given the high burden of disease of colorectal cancer (CRC) and well-defined cancer care pathways, CRC is often the first disease site targeted by health systems for quality improvement. The objective of this review is to examine how SDoH have been integrated into QIs for CRC surgery. This review aims to address three primary questions: (1) Have SDoH been integrated into the development, reporting and assessment of CRC surgery QIs? (2) When integrated, what measures and statistical methods have been applied? (3) In which direction do individual SDoH influence QIs outputs?Methods This review will follow Arksey and O’Malley frameworks for scoping reviews. We will search MEDLINE, EMBASE, HealthSTAR databases for papers that examine QIs for CRC surgery applicable to healthcare systems from database inception until January 2023. Interventional trials, prospective and retrospective observational studies, reviews, case series and qualitative study designs will be included. Two authors will independently review all titles, abstracts and full texts to determine which studies meet the inclusion criteria.Ethics & dissemination No ethics approval is required for this review. Results will be disseminated through scientific presentation and relevant conferences targeted for researchers examining healthcare quality and equity in cancer care.Registration details osf.io/vfzd3-Open Science Framework.

The Vera C. Rubin Observatory will, over a period of 10 yr, repeatedly survey the southern sky. To ensure that images generated by Rubin meet the quality requirements for precision science, the observatory will use an active-optics system (AOS) to correct for alignment and mirror surface perturbations introduced by gravity and temperature gradients in the optical system. To accomplish this, Rubin will use out-of-focus images from sensors located at the edge of the focal plane to learn and correct for perturbations to the wave front. We have designed and integrated a deep-learning (DL) model for wave-front estimation into the AOS pipeline. In this paper, we compare the performance of this DL approach to Rubin’s baseline algorithm when applied to images from two different simulations of the Rubin optical system. We show the DL approach is faster and more accurate, achieving the atmospheric error floor both for high-quality images and low-quality images with heavy blending and vignetting. Compared to the baseline algorithm, the DL model is 40× faster, the median error 2× better under ideal conditions, 5× better in the presence of vignetting by the Rubin camera, and 14× better in the presence of blending in crowded fields. In addition, the DL model surpasses the required optical quality in simulations of the AOS closed loop. This system promises to increase the survey area useful for precision science by up to 8%. We discuss how this system might be deployed when commissioning and operating Rubin.

The role of capsule endoscopy and enteroscopy in managing various small-bowel pathologies is well-established. However, their broader application has been hampered mainly by their lengthy reading times. As a result, there is a growing interest in employing artificial intelligence (AI) in these diagnostic and therapeutic procedures, driven by the prospect of overcoming some major limitations and enhancing healthcare efficiency, while maintaining high accuracy levels. In the past two decades, the applicability of AI to gastroenterology has been increasing, mainly because of the strong imaging component. Nowadays, there are a multitude of studies using AI, specifically using convolutional neural networks, that prove the potential applications of AI to these endoscopic techniques, achieving remarkable results. These findings suggest that there is ample opportunity for AI to expand its presence in the management of gastroenterology diseases and, in the future, catalyze a game-changing transformation in clinical activities. This review provides an overview of the current state-of-the-art of AI in the scope of small-bowel study, with a particular focus on capsule endoscopy and enteroscopy.

We present a comprehensive recalibration of narrowband/medium-band and broadband photometry from the Southern Photometric Local Universe Survey (S-PLUS) by leveraging two approaches: an improved Gaia XP synthetic photometry (XPSP) method with corrected Gaia XP spectra, and the stellar color regression (SCR) method with corrected Gaia Early Data Release 3 photometric data and spectroscopic data from LAMOST Data Release 7. Through the use of millions of stars as standards per band, we demonstrate the existence of position-dependent systematic errors, up to 23 mmag for the main survey region, in the S-PLUS iDR4 photometric data. A comparison between the XPSP and SCR methods reveals minor differences in zero-point offsets, typically within the range of 1–6 mmag, indicating the accuracy of the recalibration, and a twofold to threefold improvement in the zero-point precision. During this process, we also verify and correct for systematic errors related to CCD position. The corrected S-PLUS iDR4 photometric data will provide a solid data foundation for conducting scientific research that relies on high-precision calibration. Our results underscore the power of the XPSP method in combination with the SCR method, showcasing their effectiveness in enhancing calibration precision for wide-field surveys when combined with Gaia photometry and XP spectra, to be applied for other S-PLUS subsurveys.

The surge in the implementation of artificial intelligence (AI) in recent years has permeated many aspects of our life, and health care is no exception. Whereas this technology can offer clear benefits, some of the problems associated with its use have also been recognised and brought into question, for example, its environmental impact. In a similar fashion, health care also has a significant environmental impact, and it requires a considerable source of greenhouse gases. Whereas efforts are being made to reduce the footprint of AI tools, here, we were specifically interested in how employing AI tools in gastroenterology departments, and in particular in conjunction with capsule endoscopy, can reduce the carbon footprint associated with digestive health care while offering improvements, particularly in terms of diagnostic accuracy. We address the different ways that leveraging AI applications can reduce the carbon footprint associated with all types of capsule endoscopy examinations. Moreover, we contemplate how the incorporation of other technologies, such as blockchain technology, into digestive health care can help ensure the sustainability of this clinical speciality and by extension, health care in general.

Gastroenterology is increasingly moving towards minimally invasive diagnostic modalities. The diagnostic exploration of the colon via capsule endoscopy, both in specific protocols for colon capsule endoscopy and during panendoscopic evaluations, is increasingly regarded as an appropriate first-line diagnostic approach. Adequate colonic preparation is essential for conclusive examinations as, contrary to a conventional colonoscopy, the capsule moves passively in the colon and does not have the capacity to clean debris. Several scales have been developed for the classification of bowel preparation for colon capsule endoscopy. Nevertheless, their applications are limited by suboptimal interobserver agreement. Our group developed a deep learning algorithm for the automatic classification of colonic bowel preparation, according to an easily applicable classification. Our neural network achieved high performance levels, with a sensitivity of 91%, a specificity of 97% and an overall accuracy of 95%. The algorithm achieved a good discriminating capacity, with areas under the curve ranging between 0.92 and 0.97. The development of these algorithms is essential for the widespread adoption of capsule endoscopy for the exploration of the colon, as well as for the adoption of minimally invasive panendoscopy.

Introduction: Dysglycemic events are common occurrences in preterm infants. This imbalance of blood glucose levels could lead to an increased risk of death, sepsis, neurosensorial impairment, retinopathy of prematurity, among other unfavorable consequences. Continuous glucose monitoring (CGM) allows for early detection of dysglycemic events. This systematic review aims to assess the impact of CGM in glycemic values of preterm infants. Methods: We thoroughly searched several electronic databases from August 2020 to February 2021, we included randomized control trials regarding newborn infants with birth weight < 1,500 g, gestational age < 37 weeks, and postnatal life < 28 days, that compared intermittent methods vs continuous methods concerning glucose measurement. Primary outcomes were percentage of time spent in euglycemic range, number of dysglycemic episodes, and mortality. Results: Three studies were included after screening, comprising a combined total of 278 preterm newborns. Two studies reported an increase in time spent in euglycemic range in the CGM group (83% vs 71% and 94% vs 84%). There were limitations in study design of included studies, interventions and outcomes evaluated differed between included studies; as such, comparisons between studies were difficult. Conclusions: CGM allows for better glycemic control, reduces the number of painful readings, allows for early detection of dysglycemic events, and reduces time spent in dysglycemic states (both hyperglycemia and hypoglycemia) when combined with corrective measures. Further research needs to be conducted to evaluate the long-term impact of CGM in the neurosensorial and physical development of preterm infants.

Penile melanoma in situ is a very rare malignant neoplasm. Surgical treatment is the standard approach, although there are no recommendations regarding the extent and best technique.A 28-year-old male presented with a dark-brown macule on the glans, whose biopsy revealed melanoma in situ. A local excision followed by a partial resurfacing was performed, with follow-up revealing no sign of recurrence and good quality of life.Melanoma is a very dangerous tumor due to its metastization potential. The main challenge is early diagnosis. Surgical treatment is the best approach, although it is difficult to balance resection and organ preservation.

Introduction Patient-centred care is valued by patients and providers. As management of cancer becomes increasingly complex, the value of providing care that incorporates an individual’s values and preferences along with demographic and tumour factors is increasingly important. To improve care, patients with cancer need easily accessible information on the outcomes important to them. The patient-centred outcome, days at home (DAH), is based on a construct that measures the time a patient spends alive and out of hospitals and healthcare institutions. DAH is accurately measured from various data sources and has shown construct validity with many patient-centred outcomes. There is significant heterogeneity in terms used and definitions for DAH in cancer care. This scoping review aims to consolidate information on the outcome DAH in cancer care and to review definitions and terms used to date to guide future use of DAH as a patient-centred care, research and policy tool.Methods and analysis This scoping review protocol has been designed with joint guidance from the JBI Manual for Evidence Synthesis and the expanded framework from Arksey and O’Malley. We will systematically search MEDLINE, Embase and Scopus for studies measuring DAH, or equivalent, in the context of active adult cancer care. Broad inclusion criteria have been developed, given the recent introduction of DAH into cancer literature. Editorials, opinion pieces, case reports, abstracts, dissertations, protocols, reviews, narrative studies and grey literature will be excluded. Two authors will independently perform full-text selection. Data will be extracted, charted and summarised both qualitatively and quantitively.Ethics and dissemination No ethics approval is required for this scoping review. Results will be disseminated through scientific publication and presentation at relevant conferences.

Background and Aims: Capsule endoscopy (CE) revolutionized the study of the small intestine, overcoming the limitations of conventional endoscopy. Nevertheless, reviewing CE images is time-consuming. Convolutional Neural Networks (CNNs) are an artificial intelligence architecture with high performance levels for image analysis. Protruding lesions of the small intestine exhibit enormous morphologic diversity in CE images. We aimed to develop a CNN-based algorithm for automatic detection of varied small-bowel protruding lesions. Methods: A CNN was developed using a pool of CE images containing protruding lesions or normal mucosa/other findings. A total of 2565 patients were included. These images were inserted into a CNN model with transfer learning. We evaluated the performance of the network by calculating its sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Results: A CNN was developed based on a total of 21,320 CE images. Training and validation data sets comprising 80% and 20% of the total pool of images, respectively, were constructed for development and testing of the network. The algorithm automatically detected small-bowel protruding lesions with an accuracy of 97.1%. Our CNN had a sensitivity, specificity, positive, and negative predictive values of 95.9%, 97.1%, 83.0%, and 95.7%, respectively. The CNN operated at a rate of approximately 355 frames per second. Conclusion: We developed an accurate CNN for automatic detection of enteric protruding lesions with a wide range of morphologies. The development of these tools may enhance the diagnostic efficiency of CE.

A 37-year-old female underwent an emergent implant of a covered self-expandable stent graft (8mm x 10cm Viabahn, W. L. Gore) due to acute bleeding from a femoral access following closure of a patent foramen ovale. Over the following months, intermittent claudication developed, progressively more incapacitant. Work-up revealed near-occlusion of the stent graft due to edge stenosis. Elective explant of the stent graft was performed, revealing extensive proximal and distal edge miointimal hyperplasia (marked with *). Endarterectomy was performed and the arterial defect was corrected with a bovine pericardium patch.

INTRODUÇÃO: Com o crescente uso das técnicas endovasculares, seja para fins diagnósticos ou terapêuticos, o pseudoaneurisma iatrogénico da artéria femoral é uma complicação cada vez mais frequente. A par deste aumento de incidência foram surgindo alternativas à cirurgia convencional para o seu tratamento, nomeadamente soluções percutâneas e endovasculares. Em 2003 foi descrito pela primeira vez um novo método minimamente invasivo, rápido e de baixo custo: a oclusão percutânea com tumescência através da injeção peri-aneurismática eco-guiada de soro fisiológico. OBJETIVO: Este trabalho tem como principal objetivo analisar a literatura existente e comparar os protocolos utilizados pelos diferentes autores que descreveram este método, a fim de avaliar a sua eficácia, segurança e os outcomes a curto e longo-prazo, bem como a possível utilização deste procedimento nos serviços de Angiologia e Cirurgia Vascular. MÉTODOS: A revisão foi conduzida segundo a metodologia PRISMA. Foi realizada uma pesquisa nas bases de dados PubMed/MEDLINE e ClincalKey de forma a identificar todas as publicações focadas no tratamento de pseudoaneurismas femorais iatrogénicos com tumescência. Não foram aplicadas quaisquer restrições de busca. Apenas foram consideradas publicações originais em revistas científicas com revisão por pares. RESULTADOS: Foram incluídos cinco trabalhos originais. Três consistem em séries de casos com a descrição do protocolo utilizado, as características dos pseudoaneurismas e resultados. Apenas um trabalho comparou a tumescência com outra técnica - a compressão eco-guiada. Um outro consistiu num estudo coorte em que foram analisadas diferentes características dos pseudoaneurismas por forma a perceber a sua relação com a taxa de sucesso e insucesso. Todos os trabalhos mostraram uma alta taxa de sucesso imediato e às 24h pós- procedimento (entre 87,5% e 100%), à exceção de um trabalho que diferiu de todos os outros, uma vez que não foi utilizada anestesia local peri-procedimento. Neste trabalho verificou-se uma taxa de sucesso de apenas 43% às 24h, apesar de uma taxa de sucesso de 100% imediatamente após o tratamento. CONCLUSÃO: Comparando a injeção de solução salina peri-aneurismática com as outras opções, este método apresenta vantagens: é uma alternativa simples, rápida e barata que pode ser realizada à cabeceira do doente, e está associada a alta taxa de sucesso, baixa taxa de recorrência e de complicações, segundo a literatura analisada. No entanto, são necessários estudos de maior dimensão, idealmente randomizados, para comprovar o custo- benefício e custo-eficácia em relação aos outros métodos, principalmente em relação à injeção de trombina, que é o procedimento atualmente aceite como gold standard no tratamento dos pseudoaneurismas femorais.

Objetivo: Este trabalho tem o objetivo de analisar as emissões de CO2 e um possível aumento de consumo de combustíveis fósseis, num contexto que estuda o Trilema de Energia e desenvolvimento dos países dos BRICS. Metodologia/Abordagem: A partir de conhecimento empírico e dados disponíveis no portal da Agência Internacional de Energia (IEA) e Relatório de Trilema de Energia, a pesquisa analisa matriz energética, elétrica, população, emissões, produto interno bruto (PIB) e índice de desenvolvimento humano (IDH). Conclusões: Não foi observado um padrão entre desenvolvimento e participação de energia renovável. Porém, países com alto IDH apresentam um sistema energético mais bem avaliado. Houve piora do Brasil nas emissões per capita, intensidade energética e carbônica. Entretanto, essa mudança não está relacionada com o crescimento no consumo de gás natural. Limitações da Pesquisa: As bases de dados limitaram o estudo, pela diferença de linha temporal do Conselho de Energia Mundial (WEC) e a Agência Internacional de Energia (IEA) e pela falta do detalhe do cálculo da nota do Trilema de Energia. Originalidade/Valor do artigo: Uma análise comparativa que relaciona o Brasil com países semelhantes, como por exemplo os do grupo dos BRICS, contribuindo para a equidade energética o que diminui o custo da eletricidade sem prejuízo ecológico.

Ingestion of foreign bodies (IFB) and ingestion of caustic agents are frequent non-hemorrhagic causes of endoscopic urgencies, with the potential for severe complications. This study aimed to evaluate the predicting factors of the clinical outcomes of patients hospitalized as a result of IFB or ingestion of caustics (IC). This was a retrospective single-center study of patients admitted for IFB or IC between 2000 and 2019 at a tertiary center. Demographic and clinical data, as well as preliminary exams, were evaluated. Also, variables of the clinical outcomes, including the length of stay (LS) and other inpatient complications, were assessed. Sixty-six patients were included (44 IFB and 22 IC). The median LS was 7 days, with no differences between the groups (p = 0.07). The values of C-reactive protein (CRP) upon admission correlated with the LS in the IFB group (p < 0.01) but not with that of those admitted after IC. In the IFB patients, a diagnosis of perforation on both an endoscopy (p = 0.02) and CT scan (p < 0.01) was correlated with the LS. The Zargar classification was not correlated with the LS in the IC patients (p = 0.36). However, it was correlated with antibiotics, nosocomial pneumonia and an increased need for intensive care treatment. CT assessment of the severity of the caustic lesions did not correlate with the LS. In patients admitted for IFB, CRP values may help stratify the probability of complications. In patients admitted due to IC, the Zargar classification may help to predict inpatient complications, but it does not correlate with the LS.

In this work, Non-penalisation Smooth-Edged Material Distribution for Optimising Topology (np-SEMDOT) algorithm was developed as an alternative to well-established Topology Optimisation (TO) methods based on the solid/void approach. Its novelty lies in its smoother edges and enhanced manufacturability, but it requires validation in a real case study rather than using simplified benchmark problems. To such an end, a Sheikh-Ibrahim steel girder joint’s tension cover plate was optimised with np-SEMDOT, following a methodology designed to ensure compliance with the European design standards. The optimisation was assessed with Physical Nonlinear Finite Element Analyses (PhNLFEA), after recent findings that topologically optimised steel construction joint parts were not accurately modelled with linear analyses to ensure the required highly nonlinear ultimate behaviour. The results prove, on the one hand, that the quality of np-SEMDOT solutions strongly depends on the chosen optimisation parameters, and on the other hand, that the optimal np-SEMDOT solution can equalise the ultimate capacity and can slightly outperform the ultimate displacement of a benchmarking solution using a Solid Isotropic Material with Penalisation (SIMP)-based approach. It can be concluded that np-SEMDOT does not fall short of the prevalent methods. These findings highlight the novelty in this work by validating the use of np-SEMDOT for professional applications.

Geoethics is a field of knowledge currently in full development. Researchers in geoethics are primarily concerned with the anthropogenic interaction with the Earth system. Due to its nature, geoethics holds particular importance in sustainable development due to its nature as it aims to promote ethical human behaviour that does not negatively impact the Earth system. In the present research, we implemented an intervention program addressing various issues related to the sustainability of the Earth system, such as the exploitation of geological resources, the management of geological risks, and the conservation and promotion of geopatrimony. The intervention program was applied to higher education students in the geosciences field. A sample of 90 students from various geosciences courses completed an initial questionnaire, revealing limited knowledge about geoethics. This study resorted to mixed-method research involving interviews with some students who volunteered (n = 52). The results showed that after applying the intervention programme, most students developed a deeper understanding of the topics addressed and recognised the contributions this scientific area can make to sustainable development. Additional research in geoethics education is essential to foster the integration of geoethics into the curricula of higher education institutions.

Cyanobacteria have demonstrated their therapeutic potential for many human diseases. In this work, cyanobacterial extracts were screened for lipid reducing activity in zebrafish larvae and in fatty-acid-overloaded human hepatocytes, as well as for glucose uptake in human hepatocytes and ucp1 mRNA induction in murine brown adipocytes. A total of 39 cyanobacteria strains were grown and their biomass fractionated, resulting in 117 chemical fractions. Reduction of neutral lipids in zebrafish larvae was observed for 12 fractions and in the human hepatocyte steatosis cell model for five fractions. The induction of ucp1 expression in murine brown adipocytes was observed in six fractions, resulting in a total of 23 bioactive non-toxic fractions. All extracts were analyzed by untargeted UPLC-Q-TOF-MS mass spectrometry followed by multivariate statistical analysis to prioritize bioactive strains. The metabolite profiling led to the identification of two markers with lipid reducing activity in zebrafish larvae. Putative compound identification using mass spectrometry databases identified them as phosphatidic acid and aromatic polyketides derivatives—two compound classes, which were previously associated with effects on metabolic disorders. In summary, we have identified cyanobacterial strains with promising lipid reducing activity, whose bioactive compounds needs to be identified in the future.

This paper presents a solution for an autonomously driven vehicle (a robotic car) based on artificial intelligence using a supervised learning method. A scaled-down robotic car containing only one camera as a sensor was developed to participate in the RoboCup Portuguese Open Autonomous Driving League competition. This study is based solely on the development of this robotic car, and the results presented are only from this competition. Teams usually solve the competition problem by relying on computer vision algorithms, and no research could be found on neural network model-based assistance for vehicle control. This technique is commonly used in general autonomous driving, and the amount of research is increasing. To train a neural network, a large number of labelled images is necessary; however, these are difficult to obtain. In order to address this problem, a graphical simulator was used with an environment containing the track and the robot/car to extract images for the dataset. A classical computer vision algorithm developed by the authors processes the image data to extract relevant information about the environment and uses it to determine the optimal direction for the vehicle to follow on the track, which is then associated with the respective image-grab. Several trainings were carried out with the created dataset to reach the final neural network model; tests were performed within a simulator, and the effectiveness of the proposed approach was additionally demonstrated through experimental results in two real robotics cars, which performed better than expected. This system proved to be very successful in steering the robotic car on a road-like track, and the agent’s performance increased with the use of supervised learning methods. With computer vision algorithms, the system performed an average of 23 complete laps around the track before going off-track, whereas with assistance from the neural network model the system never went off the track.

Introduction: Capsule endoscopy has revolutionized the management of patients with obscure gastrointestinal bleeding. Nevertheless, reading capsule endoscopy images is time-consuming and prone to overlooking significant lesions, thus limiting its diagnostic yield. We aimed to create a deep learning algorithm for automatic detection of blood and hematic residues in the enteric lumen in capsule endoscopy exams. Methods: A convolutional neural network was developed based on a total pool of 22,095 capsule endoscopy images (13,510 images containing luminal blood and 8,585 of normal mucosa or other findings). A training dataset comprising 80% of the total pool of images was defined. The performance of the network was compared to a consensus classification provided by 2 specialists in capsule endoscopy. Subsequently, we evaluated the performance of the network using an independent validation dataset (20% of total image pool), calculating its sensitivity, specificity, accuracy, and precision. Results: Our convolutional neural network detected blood and hematic residues in the small bowel lumen with an accuracy and precision of 98.5 and 98.7%, respectively. The sensitivity and specificity were 98.6 and 98.9%, respectively. The analysis of the testing dataset was completed in 24 s (approximately 184 frames/s). Discussion/Conclusion: We have developed an artificial intelligence tool capable of effectively detecting luminal blood. The development of these tools may enhance the diagnostic accuracy of capsule endoscopy when evaluating patients presenting with obscure small bowel bleeding.

Brazil can expect significant benefits from joining the Organization for Economic Cooperation and Development (OECD). The organization has shown to effectively promote better policies and institutions among its members countries, with significant positive effects. Considering the evidence that institutions are behind a large share of long-term increases in welfare standards, the benefits of membership go well beyond the modest costs involved in participating in the organization. Among the studied benefits are increases in trade – which are larger than those due to other international organizations such as the World Trade Organization (WTO) or the International Monetary Fund (IMF) –, increases in foreign direct investment, improvements in education, and better results in governance. Risks are small compared to potential benefits. We estimate the benefits by benchmarking against an estimate of the benefits of acceding to an institution with similar goals and policies – the European Union (EU) – and find them to be very large.

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INTRODUÇÃO: Nas últimas duas décadas, a abordagem de tratamento de aneurisma da aorta abdominal (AAA) mudou drasticamente de cirurgia aberta para cirurgia endovascular. A diminuição de cirurgia de AAA convencional , open aneurysm repair (OAR), levanta preocupações relativamente à competência dos futuros cirurgiões vasculares para executar este procedimento complexo e de alto risco. O principal objetivo deste estudo foi avaliar as tendências de tratamento de AAA entre internos de Cirurgia Vascular, ao longo de 15 anos, a nível nacional. MÉTODOS: Identificação dos médicos que terminaram o internato de Angiologia e Cirurgia Vascular entre 2002 e 2017, inclusive, a nível nacional e colheita dos dados através da consulta dos currículos para a prova final de conclusão do internato complementar. Foram avaliados o total de cirurgias por AAA, tanto por OAR e por EVAR e contabilizadas aquelas realizadas como 1o cirurgião. A correlação entre o número de cirurgias abertas de AAA e o ano de conclusão do internato complementar foi testada usando o coeficiente de correlação de Spearman. RESULTADOS: Em Portugal, de 2002-2017, apesar de não se verificar variabilidade no número total de OAR realizados, verificou-se um decréscimo marcado naqueles realizados como 1o cirurgião (rho=-0,363; P