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The use of intelligent tutoring systems (ITSs) is growing rapidly in the field of education. In mathematics, adaptive and personalized scenarios mediated by these systems have been implemented to aid concept comprehension and skill development. This study presents a systematic review on the current status of the use of ITSs in mathematics education in higher education institutions (HEI). More specifically, it inquires about elements rarely addressed in reviews, such as the purposes, advantages, effectiveness, limitations, characteristics, and development and research methodologies in ITSs used for mathematics education. We analyzed 43 documents in 15 specialized and indexed journals in the years 2012-2022. In addition to providing a global overview of the implementation of ITSs in mathematics teaching and learning, we also present trends and opportunities for future research on building educational environments guided by these technologies.

Saponins are plant secondary metabolites comprising glycosylated triterpenoids, steroids or steroidal alkaloids with a broad spectrum of toxicity to microbial pathogens and pest organisms that contribute to basal plant defense to biotic attack. Secretion of glycosyl hydrolases that enzymatically convert saponins into less toxic products was thus far the only mechanism reported to enable fungal pathogens to colonize their saponin-containing host plant(s). We studied the mechanisms that the fungus Botrytis cinerea utilizes to be tolerant to well-characterized, structurally related saponins from tomato and Digitalis purpurea. By gene expression studies, comparative genomics, enzyme assays and testing a large panel of fungal (knockout and complemented) mutants, we unraveled four distinct cellular mechanisms that participate in the mitigation of the toxic activity of these saponins and in virulence on saponin-producing host plants. The enzymatic deglycosylation that we identified is novel and unique to this fungus-saponin combination. The other three tolerance mechanisms operate in the fungal membrane and are mediated by protein families that are widely distributed in the fungal kingdom. We present a spatial and temporal model on how these mechanisms jointly confer tolerance to saponins and discuss the repercussions of these findings for other plant pathogenic fungi, as well as human pathogens.

We studied the D3-type cyclin function during gynoecium development in Arabidopsis and how they are related to the hormone cytokinin and the transcription factor SPATULA. Growth throughout the life of plants is sustained by cell division and differentiation processes in meristematic tissues. In Arabidopsis, gynoecium development implies a multiphasic process where the tissues required for pollination, fertilization, and seed development form. The Carpel Margin Meristem (CMM) is a mass of undifferentiated cells that gives rise to the gynoecium internal tissues, such as septum, ovules, placenta, funiculus, transmitting tract, style, and stigma. Different genetic and hormonal factors, including cytokinin, control the CMM function. Cytokinin regulates the cell cycle transitions through the activation of cell cycle regulators as cyclin genes. D3-type cyclins are expressed in proliferative tissues, favoring the mitotic cell cycle over the endoreduplication. Though the role of cytokinin in CMM and gynoecium development is highly studied, its specific role in regulating the cell cycle in this tissue remains unclear. Additionally, despite extensive research on the relationship between CYCD3 genes and cytokinin, the regulatory mechanism that connects them remains elusive. Here, we found that D3-type cyclins are expressed in proliferative medial and lateral tissues. Conversely, the depletion of the three CYCD3 genes showed that they are not essential for gynoecium development. However, the addition of exogenous cytokinin showed that they could control the division/differentiation balance in gynoecium internal tissues and outgrowths. Finally, we found that SPATULA can be a mechanistic link between cytokinin and the D3-type cyclins. The data suggest that the role of D3-type cyclins in gynoecium development is related to the cytokinin response, and they might be activated by the transcription factor SPATULA.

The different commercial and open-source LMSs do not support pre-built activities for students in Augmented Reality (AR). To solve this challenge, this work combines AR technology and the Moodle platform to enhance the capabilities to motivate students during the learning process. For this, we developed and configured an AR app to receive and solve a Moodle pre-built quiz by communication (using message swap) between Moodle, Vuforia, and Unity. The post-quiz questionnaire results show the satisfaction level of 40 students in higher education after taking a quiz via AR. A descriptive statistical analysis indicated that students' satisfaction was 4.6 on a 5-point Likert Scale. The research offers empirical evidence that taking quizzes through AR helps motivate students and improve Technology-Mediated Learning (TML) processes.

The phonics dimension is essential for early literacy development and is a fundamental aspect of cognitive expansion. For this reason, phonological awareness has become a topic of great importance in education due to its significant impact on the development of reading and writing, basic learning skills. This study offers a theoretical review of a corpus of recent studies that reveal the contribution of technological resources to the development of phonological awareness in pre-school, with the intention of pointing out trends and research possibilities in this field. From a sample of 137 articles published in the last 15 years, and after a critical and systemic analysis carried out in different phases, 22 articles have been selected whose content focuses on pre-school and first year primary school children, in which ICT has been applied. The holistic analysis demonstrates the positive effect of these technologies on the development of phonological awareness. It is concluded that there is a direct relationship between phonological awareness and literacy in pre-school education, as well as the need for more rigorous research to obtain more precise results.

Resumen: Introducción y objetivo: La enfermedad venosa crónica es la entidad más frecuente de la patología vascular, y las varices originadas en los troncos safenos pueden causar importante morbilidad. El tratamiento endovascular ofrece ventajas significativas, y al menos es tan eficaz como la cirugía. Métodos: Revisión de las técnicas endovasculares térmicas (láser, radiofrecuencia, vapor y microondas) y no térmicas (cianoacrilato, espuma ecoguiada y mecano-química) en el tratamiento de la insuficiencia venosa superficial a partir de la bibliografía existente y de la experiencia propia. Resultados: A lo largo del artículo se describen cada una de las técnicas, su mecanismo de acción y los dispositivos comerciales disponibles con los procedimientos de uso estándar. Así mismo, se detalla el postoperatorio habitual de cada uno de ellos, las precauciones, las contraindicaciones, los resultados descritos en la literatura y las complicaciones frecuentes y poco frecuentes. Tras la descripción de las técnicas, se comparan los resultados de las técnicas endovasculares frente a la cirugía convencional (ligadura de cayado con o sin fleboextracción) y las técnicas endovasculares entre sí. Finalmente se proporciona una guía para la selección del mejor tratamiento en función de sus características y las del paciente, de sus indicaciones y de las limitaciones conocidas, de acuerdo a las últimas guías clínicas y revisiones. Conclusiones: El tratamiento endovascular se ha convertido en el estándar actual. Aunque las técnicas termoablativas son de primera indicación, los tratamientos no térmicos son una buena alternativa según el contexto clínico, y alguno, como el cianoacrilato, puede convertirse en terapia de primera elección en un futuro. Abstract: Introduction and objective: Chronic venous disease is the most common entity of vascular pathology and varicose veins originating in the saphenous trunks can cause significant morbidity. Endovascular treatment offers significant advantages, being at least as effective as surgery. Methods: Review of thermal (laser, radiofrequency, steam and microwave) and non-thermal (cyanoacrylate, ultrasound-guided foam and mechano-chemical) endovascular techniques in the treatment of superficial venous insufficiency based on existing literature and own experience. Results: Throughout the article, each of the techniques, their mechanism of action and the commercial devices available with standard use procedures are described. Likewise, the usual postoperative period for each of them, precautions, contraindications, results described in the literature, and frequent and uncommon complications are detailed. After the description of the techniques, the results of endovascular techniques are compared with conventional surgery (high ligation/stripping) and endovascular techniques with each other. Finally, a guide is provided for selecting the best treatment based on the characteristics of the patient, its indications and known limitations, according to the latest clinical guidelines and reviews. Conclusions: Endovascular treatment has become the current standard. Although thermoablative techniques are the first indication, non-thermal treatments are a good alternative depending on the clinical context and some such as cyanoacrylate may become first choice therapy in the future.

Introduction and aim: Chronic pancreatitis is a pathologic fibroinflammatory syndrome of the pancreas. Treatment includes medical management and endoscopic and/or surgical interventions. Our aim was to describe progression in patients with chronic pancreatitis whose initial management was either endoscopic or surgical. Material and methods: A retrospective, analytic, observational, and longitudinal study was conducted that included patients diagnosed with chronic pancreatitis treated at the Hospital de Especialidades of the Centro Médico Nacional Siglo XXI from 2015 to 2021. Results: Twenty-two patients were included in the study; 12 underwent endoscopy and 10 underwent surgery. The mean number of interventions performed was 3 in the endoscopic management group and 1.1 in the surgical management group (p = 0.001). Regarding pain remission (partial or total), results were statistically significant in favor of surgical management (p = 0.035). Of the 12 patients that initially underwent endoscopy, 7 (58.3%) eventually required surgery during follow-up. There were no statistically significant differences with respect to opioid and pancreatin use, readmissions, weight loss, steatorrhea, newly diagnosed diabetes, or deaths during follow-up. Conclusion: Pain is the main indication for invasive treatment, whether endoscopic or surgical, in patients with chronic pancreatitis. Slightly more than half of the patients that were initially managed endoscopically required surgery during follow-up. Management decisions should be multidisciplinary and individualized for each patient. Resumen: Introducción: La pancreatitis crónica es un síndrome fibroinflamatorio patológico del páncreas. El tratamiento incluye manejo médico, e intervenciones endoscópicas y/o quirúrgicas. Nuestro objetivo fue conocer la evolución, entre los pacientes con pancreatitis crónica sometidos a cirugía y aquellos tratados por endoscopia de manera inicial. Material y métodos: Estudio observacional, retrospectivo, analítico y longitudinal, incluyendo a los pacientes con diagnóstico de pancreatitis crónica atendidos en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI de 2015 a 2021. Resultados: Se incluyeron 22 pacientes, 12 en el grupo endoscópico, y 10 para el grupo quirúrgico. El promedio de intervenciones realizadas fue de 3 para el grupo endoscópico y de 1.1 para el grupo quirúrgico (p = 0.001). En la remisión del dolor (parcial o total), se encontró significancia estadística a favor del manejo quirúrgico (p = 0.035). De los 12 pacientes que de manera inicial fueron tratados con manejo endoscópico, 7 (58.3%) eventualmente requirieron cirugía durante el seguimiento. No se encontraron diferencias estadísticamente significativas en cuanto uso de opioides y pancreatina, reingresos, pérdida de peso, esteatorrea, diabetes de reciente diagnóstico o mortalidad durante el seguimiento. Conclusión: La principal indicación para tratamiento invasivo ya sea endoscópico o quirúrgico en los pacientes con pancreatitis crónica es el dolor. Poco más de la mitad de los pacientes que fueron manejados endoscópicamente de manera inicial requirieron cirugía durante el seguimiento. La decisión de que manejo ofrecer debe de tomarse de manera multidisciplinaria, e individualizarse para cada paciente.

Madariaga virus (MADV) and Venezuelan equine encephalitis virus (VEEV) are emerging arboviruses affecting rural and remote areas of Latin America. However, clinical and epidemiologic reports are limited, and outbreaks are occurring at an increasing frequency. We addressed the data gap by analyzing all available clinical and epidemiologic data of MADV and VEEV infections recorded since 1961 in Panama. A total of 168 human alphavirus encephalitis cases were detected in Panama during 1961‒2023. We described the clinical signs and symptoms and epidemiologic characteristics of those cases, and also explored signs and symptoms as potential predictors of encephalitic alphavirus infection compared with those of other arbovirus infections occurring in the region. Our results highlight the challenges for the clinical diagnosis of alphavirus disease in endemic regions with overlapping circulation of multiple arboviruses.

Abstract Background Anti-PD-(L)1 agent are approved as first- and second-line treatment options in advanced urothelial cancer (UC), but information about long-term survival is scarce. There is a need for prognostic factors, as these may help in the decision-making concerning anti-PD-(L)1 in patients with UC. Here, we examined long-term survival following anti-PD-(L)1 in advanced UC and assessed clinical factors for their correlation with survival. Methods We collected data from patients with advanced UC treated with anti-PD-(L)1 between 2013 and 2023. Overall- and progression-free survival (OS, PFS) were determined using the Kaplan-Meier method. Independent variables were analysed by uni- and multivariate Cox regression for their association with OS and PFS. Results Survival analyses included 552 patients. Patient characteristics in our cohort were consistent with those of a typical advanced UC population. After median follow-up of 49 months, five-year OS and PFS rates were 16.0% and 6.9% respectively. The absence of visceral and/or bone metastases and elevated C-reactive protein level, gamma-glutamyltransferase level and neutrophil-to-lymphocyte ratio were identified as favourable prognostic factors for OS. Conclusions A selected subset of patients with advanced UC may experience long-term clinical benefit from anti-PD-(L)1 treatment. We identified prognostic factors that might be used for risk assessment and clinical trial stratification.

Abstract Burn patients often face elevated pain, anxiety, and depression levels. Music therapy adds to integrative care in burn patients, but research including electrophysiological measures is limited. This study reports electrophysiological signals analysis during Music-Assisted Relaxation (MAR) with burn patients in the Intensive Care Unit (ICU). This study is a sub-analysis of an ongoing trial of music therapy with burn patients in the ICU. Electroencephalogram (EEG), electrocardiogram (ECG), and electromyogram (EMG) were recorded during MAR with nine burn patients. Additionally, background pain levels (VAS) and anxiety and depression levels (HADS) were assessed. EEG oscillation power showed statistically significant changes in the delta (p

Abstract We describe the geographical variation in tree species composition across Amazonian forests and show how environmental conditions are associated with species turnover. Our analyses are based on 2023 forest inventory plots (1 ha) that provide abundance data for a total of 5188 tree species. Within-plot species composition reflected both local environmental conditions (especially soil nutrients and hydrology) and geographical regions. A broader-scale view of species turnover was obtained by interpolating the relative tree species abundances over Amazonia into 47,441 0.1-degree grid cells. Two main dimensions of spatial change in tree species composition were identified. The first was a gradient between western Amazonia at the Andean forelands (with young geology and relatively nutrient-rich soils) and central–eastern Amazonia associated with the Guiana and Brazilian Shields (with more ancient geology and poor soils). The second gradient was between the wet forests of the northwest and the drier forests in southern Amazonia. Isolines linking cells of similar composition crossed major Amazonian rivers, suggesting that tree species distributions are not limited by rivers. Even though some areas of relatively sharp species turnover were identified, mostly the tree species composition changed gradually over large extents, which does not support delimiting clear discrete biogeographic regions within Amazonia.

Background: Elevated anxiety levels are common in patients on mechanical ventilation (MV) and may challenge recovery. Research suggests music-based interventions may reduce anxiety during MV. However, studies investigating specific music therapy techniques, addressing psychological and physiological well-being in patients on MV, are scarce. Methods: This three-arm randomized clinical pilot study was conducted with MV patients admitted to the intensive care unit (ICU) of Hospital San José in Bogotá, Colombia between March 7, 2022, and July 11, 2022. Patients were divided into three groups: intervention group 1 (IG1), music-assisted relaxation; intervention group 2 (IG2), patient-preferred therapeutic music listening; and control group (CG), standard care. The main outcome measure was the 6-item State-Anxiety Inventory. Secondary outcomes were: pain (measured with a visual analog scale), resilience (measured with the Brief Resilience Scale), agitation/sedation (measured with the Richmond Agitation–Sedation Scale), vital signs (including heart rate, blood pressure, oxygen saturation, and respiratory rate), days of MV, extubation success, and days in the ICU. Additionally, three patients underwent electroencephalography during the interventions. Results: Data from 23 patients were analyzed in this study. The age range of the patients was 24.0–84.0 years, with a median age of 66.0 years (interquartile range: 57.0–74.0). Of the 23 patients, 19 were female (82.6%). No statistically significant differences between the groups were observed for anxiety (P=0.330), pain (P=0.624), resilience (P=0.916), agitation/sedation (P=0.273), length of ICU stay (P=0.785), or vital signs. A statistically significant difference between the groups was found for days of MV (P=0.019). Electroencephalography measurements showed a trend toward delta and theta band power decrease for two patients and a power increase on both beta frequencies (slow and fast) in the frontal areas of the brain for one patient. Conclusions: In this pilot study, music therapy did not significantly affect the anxiety levels in patients on MV. However, the interventions were widely accepted by the staff, patients, and caregivers and were safe, considering the critical medical status of the participants. Further large-scale randomized controlled trials are needed to investigate the potential benefits of music therapeutic interventions in this population.Trial Registration ISRCTN trial registry identifier: ISRCTN16964680

Background: Alpacas have reproductive traits such as induced ovulation and a higher gestation rate in the left uterine horn. Additionally, low fertility and high embryonic mortality are significant challenges in alpaca breeding. To address these issues, it is essential to study the histological changes occurring in the uterine wall during day 8 of the luteal phase. Aim: This research aims to describe these changes in alpacas with induced ovulation using GnRH or copulation. Methods: The study was conducted on 8 sexually mature fertile alpacas with a preovulatory follicle of ≥ 7 mm. Ovulation was induced with GnRH (G1, n=3) and natural mating' (G2, n=5), confirmed by ultrasound showing the disappearance of the follicle and formation of the corpus luteum. On day 8 of the luteal phase, samples of the uterine wall from the right and left uterine horns were obtained through a midline laparotomy. A uterine lavage with PBS was also performed, and no embryo-ova was found. The tissues were fixed, processed, and stained with Hematoxylin and Eosin. Measurements of the myometrium and endometrium, the area of the superficial and deep endometrial glands, the height of the gland cells, and the height of the endometrial mucosal cells were performed using microscopy and software. The Measurements were taken in microns (um), from 12 different photographs per animal. Results: In G2 (copulation), greater thickness of the endometrium and myometrium, as well as a larger area of the superficial glands and cell height, were observed (p < 0.005). Additionally, the area of the superficial glands in the left horn was greater compared to the right. Conclusion: The thickness of the myometrium and endometrium, and the area of the superficial glands of the left uterine horn in alpacas during the luteal phase (day 8), induced by copulation (G2), show better development. This research provides new insights into changes in the histomorphometry of the alpacas uterus during this stage and is the first report in this species. [Open Vet J 2024; 14(9.000): 2398-2406]