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Background: Magnetic resonance cholangiopancreatography (MRCP) is the gold standard for diagnosis of patients with primary sclerosing cholangitis (PSC). The semi-quantitative MRCP-derived Anali scores proposed for risk stratification, have poor-to-moderate inter-reader agreement. Aims: To evaluate the prognostic performance of quantitative MRCP metrics in PSC. Methods: This is a retrospective study of PSC patients undergoing MRCP. Images were processed using MRCP+ software (Perspectum Ltd, Oxford) that provides quantitative biliary features, semi-automatically extracted by artificial intelligence-driven analysis of MRCP-3D images. The prognostic value of biliary features has been assessed for all hepato-biliary complications. Results: 87 PSC patients have been included in the analysis. Median follow-up from MRCP to event/censoring of 30.9 months (Q1-Q3=13.6–46.6). An adverse outcome occurred in 27 (31.0%) patients. The number of biliary strictures (HR=1.05 per unit, 95%CI 1.02–1.08, p < 0.0001), spleen length (HR=1.16 per cm, 95%CI 1.01–1.34, p = 0.039), adjusted for height, age at MRCP, and time from diagnosis to MRCP predicted higher risk of hepatobiliary complications. These were incorporated into a the quantitative MRCP-derived PSC (qMRCP-PSC) score (C-statistic=0.80). After 3-fold cross-validation, qMRCP-PSC outperformed the Anali score in our cohort (C-statistic of 0.78 vs 0.64) and enabled the discrimination of survival of PSC patients (log-rank p < 0.0001). Conclusions: The qMRCP-PSC score identified patients at higher risk of hepatobiliary complications and outperformed the available radiological scores. It represents a novel quantitative biomarker for disease monitoring and a potential surrogate endpoint for clinical trials.

An overview of the recent operations and the main results of cesium injection in the Source for the Production of Ions of Deuterium Extracted from Rf plasma (SPIDER) negative ion source are described in this contribution. In experiments without cesium injection, all SPIDER plants were tested to verify the basic expectations on the operational parameters (e.g., electron cooling effectiveness of magnetic filter field) and to determine its operational region. For beam properties, it was shown that the current density varies across the beam in the vertical direction. In preliminary cesium experiments, the expected increase of negative ion current and simultaneous decrease of co-extracted electrons were found, along with the influence of the control parameters (polarization of the plasma electrodes, magnetic filter field) on the SPIDER beam uniformity in the horizontal and vertical directions. It was shown that non-Gaussian tails can be identified in the angular distribution on the plane perpendicular to the beam propagation direction. Stray particles, nonhomogeneous beam and large divergence might result in unexpected heat and particle loads over ITER neutral beam injector (NBI) accelerator grids; it is the goal of SPIDER to assess and possibly to identify suitable methods for controlling these beam features. A major shutdown, planned for late 2021, to solve the issues identified during the operation and to carry out scheduled modifications, is outlined. Such improvements are expected to allow SPIDER to pursue the ITER requirements in terms of negative ion current, electron-to-ion ratio, and beam duration.

Vasculitis is defined by a state of inflammation of the blood vessel walls. It can result in formation of either aneurysms or stenosis with ischemia and necrosis. The heterogeneity of clinical presentation depends on the type and size of the vessels involved, which leads to different patterns of organ damage. The skin is usually involved but not necessarily as a first manifestation of disease. Indeed, significant organ damage may occur at any time in the disease course and may precede other symptoms with significant morbidity and mortality, especially in case of diagnostic delay. The most common vasculitides in childhood are IgA-associated vasculitis (Schönlein-Henoch purpura) and Kawasaki disease. Other vasculitides are much rarer, often arising with insidious symp- toms that make them life-threatening. This paper aims to review the literature on paediatric vasculitides providing a practical guide to disentangle between different diagnoses. It also provides an overview that underlines the key differences in vasculitis presentation, management and follow-up.

O artigo tem por objetivo refletir sobre desafios e possibilidades para a educação, diante da realidade político-econômica e social do país. Nessa direção, considerando a natureza capitalista da produção e as decorrentes crises da economia mundial, enfoca, inicialmente, a ascensão da política autoritária no país, sob a ideologia da nova direita, e a moldura conferida à política social e à educacional na atualidade. Na sequência, a fim de abordar a conjuntura da educação, desde o âmbito nacional e da atuação do governo federal na educação básica, ocupa-se do apontamento e análise acerca do atendimento educacional nesse nível de ensino, concentrando-se, para tanto, em metas e dados do monitoramento do atual Plano Nacional de Educação e em dados relativos ao financiamento público, pelo governo federal, nos últimos anos. Conclui assinalando serem muitas as urgências quando se trata de salvaguardar e fortalecer a educação pública, gratuita, laica, democrática, inclusiva e de qualidade social, tendo no horizonte os princípios constitucionais do direito à educação de qualidade, o que não se separa da necessidade de combate à desigualdade social no país.

A ascensão de governos neoliberais e de movimentos ultraconservadores vem reforçando a heterocisnormatividade e o racismo, produzindo desigualdade e infligindo ainda mais sofrimento e riscos letais às minorias. Conjurando imposição de regimes de austeridade, limites da presença do Estado e esvaziamento da propriedade social à autorresponsabilização pela gestão da própria vida e saúde, a questão da diferença passou a ser forjada como ponto de instabilidade e ameaça a tais propósitos e pressupostos político-econômicos. Uma das consequências é a ampla circulação de discursos de ódio e desprezo pela diversidade. Este trabalho buscou, assim, compreender como então se estabelecem intersecções enunciativas entre marcadores de diferença e a racionalidade liberal na economia e conservadora nos costumes, tomando como foco a (des)articulação em torno da precarização de parentalidades e conjugalidades diversas. Os resultados desta investigação apontam que, quanto maior a densidade democrática de uma sociedade ou relação sociocultural, maiores as possibilidades de afirmação positiva da alteridade e diferença, bases importantes para a produção da saúde e da cidadania (racial, sexual, de gênero e ambiental).

O presente estudo trata da regulação na perspectiva que enfatiza a produção de resultados no campo educacional, consoante ao que o Banco Mundial (BM) concebe e imprime em seus encaminhamentos para a educação de diversos países. Para tanto, apreende e analisa argumentos constantes em uma amostra das publicações da agência, como forma de evidenciar sua concepção sobre essa perspectiva de regulação, que assume centralidade com as mudanças na dinâmica do capital a partir das décadas finais do século XX. Fundamentando-se no materialismo histórico e em subsídios teórico-metodológicos que incluem o discurso enquanto texto, prática discursiva e prática social, o artigo destaca que, apesar da atualização das recomendações do BM, a ideia de uma educação de qualidade para todos é uma preocupação central na amostra de documentos examinada. Também destaca que suas redefinições ao longo do tempo incluem prioridades e estratégias que situam a orientação por resultados como algo necessário à educação contemporânea e que é um dos fundamentos das reformas que esse organismo econômico estimula, propõe e realiza. Conclui assinalando que, por um lado, o BM corrobora o fortalecimento da hegemonia burguesa, atuando em favor de uma concepção de regulação educacional com foco nos resultados e que, por outro, a sua agenda está em evolução. Nesse movimento, o próprio conceito de regulação por resultados é uma lógica em expansão.

Heart failure is a leading cause of morbidity and mortality, with relevant social and economic burden on global healthcare system. Although the development of novel diagnostic tools and the advance in therapies have deeply influenced the diagnosis and treatment of this disease, improving both prognosis and life expectancy of patients, hospitalization is still high, and mortality remains considerable. MicroRNAs are small endogenous RNA molecules that post-transcriptionally regulate gene expression in both physiological and pathological processes. In recent years, microRNA have arisen as attractive therapeutic targets in the treatment of a wide spectrum of pathologies, including heart failure. In cardiac pathology, deregulation of microRNAs expression and function is associated to adverse outcome and heart failure progression. Circulating levels of specific microRNAs have emerged as useful biomarkers for the diagnosis of heart failure or as prognostic indicators. In the present review, we summarize the state of current research on the role of miRNAs as biomarkers for diagnosis and prognosis in patients with heart failure and their use as potential therapeutic targets for this condition.

Purpose Heart failure (HF) is a primary cause of morbidity and mortality worldwide, with significant impact on life quality and extensive healthcare costs. Assessment of myocardial sympathetic innervation function plays a central role in prognosis assessment in HF patients. The aim of this review is to summarize the most recent evidence regarding the clinical applications of iodine-123 metaiodobenzylguanidine (123I-MIBG) imaging in patients with HF and related comorbidities. Methods A comprehensive literature search was conducted on PubMed and Web of Science databases. Articles describing the impact of 123I-MIBG imaging on HF and related comorbidities were considered eligible for the review. Results We collected several data reporting that 123I-MIBG imaging is a safe and non-invasive tool to evaluate dysfunction of cardiac sympathetic neuronal function and to assess risk stratification in HF patients. HF is frequently associated with comorbidities that may affect cardiac adrenergic innervation. Furthermore, HF is frequently associated with comorbidities and chronic conditions, such as diabetes, obesity, kidney disease and others, that may affect cardiac adrenergic innervation. Conclusion Comorbidities and chronic conditions lead to more severe impairment of sympathetic nervous system in patients with HF, with a negative impact on disease progression and outcome. Cardiac imaging with 123I-MIBG can be a useful tool to reduce morbidity and prevent adverse events in HF patients.

Sirenomelia consiste em uma anomalia congênita rara, que pode ser considerada como a forma mais grave de disgenesia caudal e é definida por uma fusão dos membros inferiores bilaterais normalmente pareados em um único membro mediano (em sereia) devido um defeito no desenvolvimento primário que afeta diversas estruturas primordiais da linha média, com etiologia variada e ainda não totalmente esclarecida. As anormalidades do desenvolvimento embriológico ocorrem em torno da terceira a quarta semana de vida intrauterina e encontra-se isoladamente ou associada a distúrbios gênito-urinários, gastrointestinais, cardiovasculares, respiratórios ou neurológicos, incluindo agenesia renal, de ureteres e da bexiga, ânus imperfurado e ausência da genitália externa, consideradas malformações graves que podem levar à morte no período perinatal. Sirenomelia é fatal na maioria dos casos devido a hipoplasia pulmonar característica e da agenesia renal bilateral. Sua incidência varia entre 1-5 a cada 100.000 nascidos vivos com maior frequência em gêmeos monozigóticos, com razão sexual de 3 meninos para 1 menina.

Deep reinforcement learning has achieved impressive results in recent years; yet, it is still severely troubled by environments showcasing sparse rewards. On top of that, not all sparse-reward environments are created equal, i.e., they can differ in the presence or absence of various features, with many of them having a great impact on learning. In light of this, the present work puts together a literature compilation of such environmental features, covering particularly those that have been taken advantage of and those that continue to pose a challenge. We expect this effort to provide guidance to researchers for assessing the generality of their new proposals and to call their attention to issues that remain unresolved when dealing with sparse rewards.

O presente trabalho vai discutir o conto Os Três Porquinhos com base na perspectiva psicanalítica. O estudo buscará reconhecer quais elementos psicanalíticos estão presentes no conto. O método utilizado foi revisão bibliográfica, e terá como base textos de Freud, Betelheim e Corso. O artigo possibilitou agrupar diversas informações de como o conto Os Três Porquinhos reflete na emoção e personalidade da criança.

The community at the Marturia Oesapa Selatan Church has a population of 600 people and 26 of them work as farmers, retirees and traders. Based on observations and surveys conducted in February 2023, the problems encountered are still using inorganic fertilizers for agriculture, fertilizing ornamental plants and fertilizing horticultural plants in the yard of the house for more practical reasons, but the community does not yet know the impact of using inorganic fertilizers. The purpose of holding this PKM activity is to increase public understanding of the negative impacts of using inorganic fertilizers, increase understanding of the benefits of using organic fertilizers and provide training on how to process household waste into organic fertilizer. This community service took place at the Marturia Oesapa Selatan Church in Kupang City on Wednesday 1 March 2023 with 26 participants. The first stage is to conduct field observations and coordinate with the Head of the Marturia Oesapa Selatan Church regarding the cooperation agreement and the place and time of implementation. The second stage is preparing training materials. The third stage is the implementation of training on processing household waste into organic fertilizer. As a result of PKM activities, participants understand the importance of organic fertilizer for plantations, ornamental plants, horticultural crops and utilization of natural resources around them to be processed into bokashi organic fertilizer. Participants also have the skills to make bokashi organic fertilizer after participating in this activity, judging from the success of carrying out the work steps given during counseling and technical instructions in making organic fertilizer. Keywords: Household waste, bokashi organic fertilizer

O retalho de padrão axial representa uma importante opção na cirurgia reconstrutiva, sendo composto por uma artéria e uma veia cutânea direta em sua base, permitindo que uma grande área de pele possa constituir o retalho para recobrir a ferida. Entretanto, a técnica pode apresentar complicações, principalmente com a necrose devido ao comprometimento vascular. Nesse contexto, a ozonioterapia pode ser utilizada para acelerar o processo de cicatrização de feridas pouco vascularizadas e contaminadas. Com o presente estudo, objetivou-se avaliar os efeitos e o reparo do retalho axial dorsal em ratos Wistar, empregando tratamento com óleo ozonizado de alta peroxidação. Utilizaram-se 18 ratos, distribuídos em dois grupos com 9 animais, grupo GG (óleo de girassol comum) e grupo GO (óleo de girassol ozonizado). Durante o período experimental foram realizadas avaliações macroscópicas e microscópicas a fim de observar a cicatrização e a reparação da ferida cirúrgica. Os dados foram submetidos a análise estatística. O aspecto cosmético em GO foi significativamente melhor que GG, e a contagem de vasos sanguíneos, hemorragia e reepitelização foram significativamente maiores em GO quando comparado ao GG. A presença de necrose não diferiu entre os grupos. A média da área total dos retalhos entre os grupos diferiu estatisticamente, sendo maior nos retalhos em GO. Os resultados evidenciaram que a utilização do óleo ozonizado em retalhos de padrão axial resulta em aspecto favorável e melhor reepitelização.

A core part of the rehabilitation scheduling process consists of planning rehabilitation physiotherapy sessions for patients, by assigning proper operators to them in a certain time slot of a given day, taking into account several legal, medical and ethical requirements and optimizations, e.g., patient's preferences and operator's work balancing. Being able to efficiently solve such problem is of upmost importance, in particular after the COVID-19 pandemic that significantly increased rehabilitation's needs. In this paper, we present a two-phase solution to rehabilitation scheduling based on Answer Set Programming, which proved to be an effective tool for solving practical scheduling problems. We first present a general encoding, and then add domain specific optimizations. Results of experiments performed on both synthetic and real benchmarks, the latter provided by ICS Maugeri, show the effectiveness of our solution as well as the impact of our domain specific optimizations. Under consideration in Theory and Practice of Logic Programming (TPLP)., Under consideration in Theory and Practice of Logic Programming (TPLP)

Tropical peatlands cycle and store large amounts of carbon in their soil and biomass1–5. Climate and land-use change alters greenhouse gas (GHG) fluxes of tropical peatlands, but the magnitude of these changes remains highly uncertain6–19. Here we measure net ecosystem exchanges of carbon dioxide, methane and soil nitrous oxide fluxes between October 2016 and May 2022 from Acacia crassicarpa plantation, degraded forest and intact forest within the same peat landscape, representing land-cover-change trajectories in Sumatra, Indonesia. This allows us to present a full plantation rotation GHG flux balance in a fibre wood plantation on peatland. We find that the Acacia plantation has lower GHG emissions than the degraded site with a similar average groundwater level (GWL), despite more intensive land use. The GHG emissions from the Acacia plantation over a full plantation rotation (35.2 ± 4.7 tCO2-eq ha−1 year−1, average ± standard deviation) were around two times higher than those from the intact forest (20.3 ± 3.7 tCO2-eq ha−1 year−1), but only half of the current Intergovernmental Panel on Climate Change (IPCC) Tier 1 emission factor (EF)20 for this land use. Our results can help to reduce the uncertainty in GHG emissions estimates, provide an estimate of the impact of land-use change on tropical peat and develop science-based peatland management practices as nature-based climate solutions.

Introduction. Sleep disturbance and insomnia are some of the most frequent complaints in patients suffering from depression. Some common antidepressant with excitatory effects may worsen sleep qualities, whereas others (like mirtazapine), thanks to their antihistaminergic action, are associated with sedative properties and can quickly improve sleep quality. In the case of mirtazapine, even if its mechanisms of action on sleep remain controversial, beneficial changes in sleep pattern may be observable since the first dose and are associated with a faster onset of the antidepressive action. Case Presentation. Despite these documented beneficial effects, we reported five cases of elderly patients (age ranging from 69 to 79) with various diagnoses and comorbidities (severe or recurrent depression, general anxiety disorder, borderline personality disorder, and Parkinson’s disease) assessed during clinical daily routine for whom the use of mirtazapine was linked to the onset of nightmares so impressive and dramatic that made it necessary to interrupt the treatment. Discussion. This peculiar side effect is still scarcely documented, and the literature on this topic remains conflicting; however, considering that the cases were collected in a short range of time, the exacerbation of nightmares caused by mirtazapine may be more frequent than previously believed. Furthermore, some common features shared by all the cases reported have been highlighted such as the onset of the nightmares being chronologically associated with the initiation of the therapy with mirtazapine, the disappearance with the interruption, the similar age range of all, and the occurrence of the episodes described during fall season.

Very small case series of patients with apolipoprotein A1 (ApoA1) amyloidosis are available. We described the clinical and echocardiographic characteristics of individuals with the pathogenic APOA1 variant Leu75Pro (p. Leu99Pro), referred for cardiac screening. We enrolled 189 subjects, 54% men, median age 55 years (interquartile range 42–67), 39% with concomitant renal disease and 31% with liver disease. Median left ventricular ejection fraction was 60% (55–66). Overall, these subjects did not show overt diastolic dysfunction nor left ventricular (LV) hypertrophy. Age correlated with interventricular septal (IVS) thickness (r = 0.484), LV mass index (r = 0.459), E/e’ (r = 0.501), and right ventricular free wall thickness (r = 0.594) (all p < 0.001). Some individuals displayed red flags for cardiac amyloidosis (CA), and 14% met non-invasive criteria for CA. Twenty-nine subjects died over 5.8 years (4.1–8.0), with 10 deaths for cardiovascular causes. Individuals meeting echocardiographic criteria for CA had a much higher risk of all-cause death (p = 0.009), cardiovascular death (p = 0.001), cardiovascular death or heart failure (HF) hospitalisation (p < 0.001). Subjects with both renal and liver involvement had a more prominent cardiac involvement, and shortest survival. Subjects with the APOA1 Leu75Pro variant displayed minor echocardiographic signs of cardiac involvement, but 14% met echocardiographic criteria for CA. Subjects with suspected CA had a worse outcome.

This work shows how the N 1s photoemission (PE) spectrum of self-associated melamine molecules in aqueous solution has been successfully rationalized using an integrated computational approach encompassing classical metadynamics simulations and quantum calculations based on density functional theory (DFT). The first approach allowed us to describe interacting melamine molecules in explicit waters and to identify dimeric configurations based on π–π and/or H-bonding interactions. Then, N 1s binding energies (BEs) and PE spectra were computed at the DFT level for all structures both in the gas phase and in an implicit solvent. While pure π-stacked dimers show gas-phase PE spectra almost identical to that of the monomer, those of the H-bonded dimers are sensibly affected by NH···NH or NH···NC interactions. Interestingly, the solvation suppresses all of the non-equivalences due to the H-bonds yielding similar PE spectra for all dimers, matching very well our measurements.

Os búfalos foram originalmente inseridos no Brasil em meados do século XIX. A Associação Brasileira de Criadores de Búfalos (ABCB) tem por função incentivar a bubalinocultura no país, por meio da organização dos principais interesses dos produtores. A criação de bubalinos destina-se principalmente a produção de carne, mas percebesse o crescimento na exploração leiteira. Os búfalos estão sujeitos a doenças zoonóticas assim como os bovinos, sendo assim carecem de cuidados médicos mão de obra especializada, para que a criação possa apresentar um estado de saúde física e mental completa, em equilíbrio com o ambiente em que vive. Mesmo com a predominância da bovinocultura, a bubalinocultura é um campo promissor ao agronegócio. Este trabalho tem por objetivo conhecer a bubalinocultura no Brasil, suas principais raças, bem-estar animal e sua importância ao agronegócio. Cabe aos profissionais do agronegócio a correta orientação aos produtores e proprietários rurais sobre as características de criação da bubalinocultura no Brasil.

RESUMO Objetivo: Na prática clínica, é importante diferenciar problema e conflito, porque os passos sugeridos na técnica de resolução de problemas costumam não ser suficientes para auxiliar o cliente a lidar com conflitos. Esta revisão sistemática teve como objetivos: investigar como a terapia cognitivo-comportamental (TCC) pode auxiliar na resolução de problemas e na mediação de conflito; sugerir uma estratégia que favoreça a melhor capacidade de mediar conflitos (QPD). Métodos: Foi realizada uma busca nas bases de dados: PubMed, PsycINFO, Web of Science (ISI) e Scopus. O método prisma foi utilizado, e foram selecionados para leitura na íntegra artigos experimentais. Resultados: Trezentos e sessenta e quatro ensaios clínicos aplicaram a resolução de problemas, apontando a eficácia dessa técnica juntamente com outras estratégias/intervenções da TCC. Livros-guias de TCC: não diferenciam problema e conflito; descrevem detalhadamente passos para resolução de problemas, focando na perspectiva do cliente, no momento presente e no uso da razão lógica; não abordam a mediação de conflitos pela TCC. Sugerimos uma estratégia que pode ajudar na mediação de conflitos: auxiliando na coleta/organização de informações; melhorando a comunicação – empática e assertiva; favorecendo escolhas com o intuito de causar o menor dano possível a todas as partes envolvidas no conflito. Conclusões: Para treinar terapeutas para aplicarem a resolução de problemas, há descrição detalhada dos passos a serem seguidos. Entretanto, para capacitar os terapeutas para mediarem conflitos, práticas clínicas que têm sido frequentemente descritas/utilizadas nas terapias cognitivas contextuais podem ser necessárias: aceitação psicológica, mindfulness , entender valores individuais, vivenciar/considerar a emoção em tomadas de decisão, ativar a compaixão/autocompaixão.

To compare the Swedish Interactive Thresholding Algorithm (SITA) Standard (SS) and SITA Faster (SFR) strategies in normal individuals undergoing standard automated perimetry (SAP) for the first time.Randomized, comparative, observational case series.Seventy-four perimetry-naïve healthy individuals.All individuals underwent SAP 24-2 testing with the Humphrey Field Analyzer III (model 850 Zeiss) using the SS and SFR strategies. One eye of each individual was tested. Test order between strategies was randomized, and an interval of 15 minutes was allowed between the tests.The following variables were compared: test time, foveal threshold, false-positive errors, number of unreliable tests, mean deviation (MD), visual field index (VFI), pattern standard deviation (PSD), glaucoma hemifield test (GHT), and number of depressed points deviating at P5%, P2%, P1%, and P 0.5% on the total and pattern deviation probability maps. Specificity of the SS and SFR strategies were compared using Anderson's criteria for abnormal visual fields.The SFR tests were 60.4% shorter in time compared with SS (P0.001) and were associated with a significantly lower PSD (1.75 ± 0.80 decibel [dB] vs. 2.15 ± 1.25 dB; P = 0.016). There were no significant differences regarding the MD, VFI, foveal threshold, GHT, and number of points depressed at P5%, P2%, P 1%, and P0.5% on the total deviation and pattern deviation probability maps between SS and SFR. When all exams were analyzed and any of Anderson's criteria was applied, the specificity was 68% with SFR and 61% with SS (P = 0.250). The specificities observed with SFR and SS when only the first or second exams were analyzed were also similar (63% vs. 64% and 72% vs. 58%, respectively, P0.05).The SS and SFR were associated with similar specificities in perimetry-naïve individuals. The SFR did not increase the number of depressed points in the total and pattern deviation probability maps. Ophthalmologists should be aware that both strategies are associated with disturbingly high false-positive rates in perimetry-naïve individuals.

INTRODUCTION: Clinically significant prostate cancer (csCaP) with Gleason ≥3 + 4 is found in 10% negative prebiopsy multiparametric (mp) MRI cases and varies widely for equivocal mpMRI cases. The objective of this study was to investigate long-term outcomes of patients with negative and equivocal mpMRIs and to develop a predictive score for csCaP risk stratification in this group. PATIENTS AND METHODS: Patients who underwent an upfront mpMRI between May 2015 and March 2018 with an MRI score Likert 1 to 3 were included in the study. Patients had either a CaP diagnosis at MRI-targeted biopsy or were not diagnosed and attended follow-up in the community. Outcomes were analysed through the Kaplan-Meier estimator and Cox Model. Regression coefficients of significant variables were used to develop a Risk of significant Cancer of the Prostate score (RosCaP). RESULTS: At first assessment 281/469 patients had mpMRI only and 188/469 mpMRI and biopsy, 26 csCaP were found at biopsy, including 10/26 in Likert 3 patients. 12/371 patients discharged without CaP after first assessment were diagnosed with csCaP during a median of 34.2 months' follow-up, 11/12 diagnosis occurred in patients omitting initial biopsy. csCaP diagnosis-free survival was 95.7% in the MRI group and 99.1% in the biopsy group. From these outcomes, a continuous RosCaP score was developed: RosCaP = 0.083 x Age - 0.202 x (1/PSA Density) + 0.786 (if Likert 3), and 4 risk classes were proposed. Limitations include retrospective design and absence of external validation. CONCLUSION: Age, PSA Density and MRI Likert score were significantly associated to the risk of csCaP and utilised to devise the novel RosCap predictive score focused to support risk assessment in patients with negative or equivocal mpMRI results.

β-Amyloid is one of the main pathological hallmarks of Alzheimer’s disease and plays a major role in synaptic dysfunction. It has been demonstrated that β-amyloid can elicit aberrant excitatory activity in cortical-hippocampal networks, which is associated with behavioral abnormalities. However, the mechanism of the spreading of β-amyloid action within a specific circuitry has not been elucidated yet. We have previously demonstrated that the motion of microglia-derived large extracellular vesicles carrying β-amyloid, at the neuronal surface, is crucial for the initiation and propagation of synaptic dysfunction along the entorhinal-hippocampal circuit. Here, using chronic EEG recordings, we show that a single injection of extracellular vesicles carrying β-amyloid into the mouse entorhinal cortex could trigger alterations in the cortical and hippocampal activity that are reminiscent of those found in Alzheimer’s disease mouse models and human patients. The development of EEG abnormalities was associated with progressive memory impairment as assessed by an associative (object-place context recognition) and non-associative (object recognition) task. Importantly, when the motility of extracellular vesicles, carrying β-amyloid, was inhibited, the effect on network stability and memory function was significantly reduced. Our model proposes a new biological mechanism based on the extracellular vesicles mediated progression of β-amyloid pathology and offers the opportunity to test pharmacological treatments targeting the early stages of Alzheimer’s disease.

Statin-induced autoimmune myositis (SIAM) represents a rare clinical entity that can be triggered by prolonged statin treatment. Its pathogenetic substrate consists of an autoimmune-mediated mechanism, evidenced by the detection of antibodies directed against the 3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR Ab), the target enzyme of statin therapies. To facilitate the diagnosis of nuanced SIAM clinical cases, the present study proposes an “experience-based” diagnostic algorithm for SIAM. We have analyzed the clinical data of 69 patients diagnosed with SIAM. Sixty-seven patients have been collected from the 55 available and complete case records regarding SIAM in the literature; the other 2 patients represent our direct clinical experience and their case records have been detailed. From the analysis of the clinical features of 69 patients, we have constructed the diagnostic algorithm, which starts from the recognition of suggestive symptoms of SIAM. Further steps provide for CK values dosage, musculoskeletal MR, EMG/ENG of upper-lower limbs and, Anti-HMGCR Ab testing and, where possible, the muscle biopsy. A global evaluation of the collected clinical features may suggest a more severe disease in female patients. Atorvastatin proved to be the most used hypolipidemic therapy.

Understanding the performance of strawberry cultivars in response to the evolving environment and growth medium is a key factor in choosing materials with the aptitude to serve the consumer market. Here, we investigated whether strawberry cultivars in soilless cultivation and greenhouse differ in their agronomic potential. We have studied seven cultivars in an experiment designed in randomized blocks, with four replications. We used analysis of variance and multivariate to examine production attributes, the chemical quality of fruits, and their phytochemical profile. Among the seven cultivars, three heterogeneous groups were formed, gathering the materials mainly due to the similarity in terms of the content of total polyphenols (TPO) and average fresh fruit mass (AFFM). ‘Aromas’ produced the greatest number of strawberries. ‘Fronteras’ and ‘Monterey’, in turn, were the most productive cultivars, and ‘Albion’ and ‘Fronteras’ produced the largest fruits. ‘Albion’ produced the sweetest and tastiest fruits, with an adequate relationship between sugar and acidity. ‘Camino Real’ produced fruits with higher phytochemical content. We conclude that the seven strawberry cultivars in soilless cultivation and greenhouse have contrasting agronomic potential, which indicates that the producers can establish their crops with different materials. We suggest the use of ‘Fronteras’ to obtain greater yield and fruit size, ‘Albion’ to producers looking to grow sweeter and tastier fruits, and ‘Camino Real’ to obtain strawberries rich in secondary metabolites.

O analista financeiro possui condições de reduzir a assimetria de informações entre empresas e investidores ao emitir previsões de resultados, contribuindo para o funcionamento do mercado de capitais, peça importante para o crescimento e financiamento das empresas. Nesse contexto, não foram encontrados estudos que relacionassem, de maneira direta, a existência de goodwill nas empresas brasileiras com a acurácia dos analistas financeiros. Portanto, o objetivo do estudo foi analisar a relação entre o goodwill e a acurácia da previsão de resultado por analistas financeiros. O foco foram as empresas brasileiras e norte-americanas de capital aberto, no período trimestral de 2010 a 2019, utilizando como método a regressão com dados em painel. Os resultados indicaram que, no Brasil, a existência de goodwill impacta negativamente na acurácia da previsão dos analistas, mas positivo no mercado norte-americano. Testes de confirmação foram aplicados considerando o grupo de ativo intangível, cujos resultados corroboraram com os encontrados para goodwill. Assim o estudo evidencia que o uso goodwill pode impactar de forma diferente a acurácia dos analistas diante de mercado distintos, especificamente quanto à origem legal, desenvolvimento do mercado de capitais, poder de enforcement, entre outros fatores. Isso deve ser levado em consideração nas decisões de investimento de instituições financeiras e participantes do mercado de capitais. Também contribui com a literatura na linha de pesquisa, ao sinalizar que a subjetividade presente no goodwill pode influenciar de modo distinto a acurácia dos analistas, fato que deve ser controlado em seus modelos de previsão.

Protection of amine groups by amide formation is still among the preferred strategies for multifunctional molecular synthesis despite its waste production, especially the enormous quantities of organic solvents used.

Ao analisar tanto discursos de orgulho como de preconceito aos nordestinos, objetivamos compreender, neste artigo, os modos de dizer o nordeste e o nordestino que sustentam tais discursos. Como forma de recortar esses discursos, nosso corpus foi construído a partir da escuta de sujeitos nordestinos acerca dos modos de significação de dois enunciados: “orgulho de ser nordestino” e “tinha que ser nordestino”. Ancoradas na Análise de Discurso com filiação em Pêcheux, observamos, a partir das análises, como os sujeitos entrevistados, ao falarem sobre esses dois enunciados, se subjetivam e, ao mesmo tempo, mobilizam sentidos cristalizados de dizeres já sedimentados socialmente sobre o “ser nordestino”. No jogo entre o orgulho e o preconceito, agitam-se as redes de memória, a filiação ideológica pela repetição-reestruturação-desestabilização de sentidos já dados.

Dentre o que poderia simplesmente ser compreendido como subestimação ao ser colocada na oficina têxtil da Bauhaus, ao invés do ateliê de pintura, a atuação de Anni Albers na icônica escola alemã demonstrou a excelência em criar a partir dos desafios e superar-se constantemente. Assim, o presente texto foi desenvolvido para se compreender melhor a trajetória da artista, bem como as metodologias de ensino e as práticas dos projetos desenvolvidos por ela. O estudo de seus próprios registros enquanto documentos de processo, bem como de textos de Otto & Rössler, Ambler, e de Salles, constituem os aportes teóricos para o trabalho aqui apresentado, de modo a compreender sua trajetória e pensamento, tão relevantes para a arte e o design na contemporaneidade.

Introduction. Lithium is considered a first-line therapy for both the acute phase and the maintenance of bipolar disorder. Many studies highlighted its neuroprotective and neuroplastic capacity suggesting a potential usefulness in the treatment of neurodegenerative diseases. Despite the undeniable efficacy, lithium clearly presents several adverse effects including neurotoxicity, also known as lithium encephalopathy, regarding both neurological, psychiatric, and cognitive side effects. In this case, adverse reactions are not always related to its serum levels, possibly appearing within the therapeutic range. Case Presentation. We analyzed the case of a bipolar patient who has been uncontinuosly treated with lithium salts since the onset of the psychopathological picture. Over the years, the average values of lithemia always remained around 0.60-0.70 mEq/L, but in 2019, the patient begun to manifest distal tremors and in the mandibular district accompanied, in the following months, by psychomotor slowdown, generalized tremors, reduced alertness, spatiotemporal disorientation, and aphasia. While alterations referable to neurodegenerative diseases were excluded, EEG maintained rhythm alteration 1 year after the probable intoxication. Discussion. This case confirms the central role of EEG for lithium neurotoxicity, while its dosages are in therapeutic range, being plasma levels are not always indicative of liquoral and neuronal lithium’s levels. We highlight the importance of an early diagnosis of lithium encephalopathy proposing EEG as an indispensable tool for assessing lithium neurotoxicity both in acute and chronic intoxication.

Analytical Hierarchy Process(AHP) merupakan suatu pemecahan permasalahan yang kompleks dalam suatu struktur multilevel, dimana level pertama adalah tujuan, level kedua adalah level faktor yang terdiri dari kriteria dan subkriteria, dan level terakhir yaitu alternatif. Langkah awal dari metode ini adalah membuat struktur hierarki dari permasalahan yang akan diteliti. Kemudian dilanjut dengan menyusun matriks perbandingan berpasangan yang selanjutnya akan menghasilkan vektor eigen dan nilai eigen maksimum. Pada proses penentuan faktor pembobotan hierarki maupun faktor evaluasi, harus dilakukan uji konsistensi yaitu CR ≤ 0,1. Skripsi ini bertujuan untuk pengambilan keputusan dalam memilih prioritas pantai yang dapat dijadikan wisata unggulan didaerah tersebut. Hasil dari penelitian terhadap permasalahan diatas dengan menggunakan metode AHP dapat disimpulkan bahwa kriteria yang paling penting dalam proses rencana pengembangan daerah wisata pantai adalah kriteria kuliner dengan bobot 0,25 atau 25%, yang kedua kriteria fasilitas dengan bobot 0,24 atau 24% , ketiga keindahan dan kebersihan dengan bobot kriteria 0,21 atau 21%, yang keempat kriteria akses jalan dengan bobot 0,17 atau 17%, selanjutnya yang terakhir adalah kriteria pelayanan dengan bobot 0,13 atau 13%. Dan pantai yang menjadi prioritas pengembangan adalah pantai sialang buah dengan persentasi 23% , peringkat kedua yaitu pantai mutiara indah dengan persentase 22%, peringkat ketiga pantai sentang 21%, peringkat keempat pantai bogak indah 18%, dan peringkat terakhir pantai taluh dengan persentase 15%. Kata kunci:Metode Analytical Hierarchy Process (AHP), Uji Konsiteni,Vector Eigen.

El concepto de Antropoceno ha sido ampliamente analizado por las ciencias naturales como lo ilustran estudios en la física, la biología, la química, o la astrofísica, que apuntan principalmente a comprender el estado actual de la situación global y los posibles caminos para remediar, o a lo menos detener, el cambio climático. Sin embargo, como se trata, a la vez, de una categoría epistemológica cultural, sostenemos que debe ser objeto de análisis histórico. En este sentido, el presente artículo postula la necesidad de integrar el Antropoceno como categoría historiográfica con miras a profundizar en las líneas política e institucional, sugiriendo una nueva periodización histórica que analice y devele críticamente la relación de la humanidad, agente geológico, con la naturaleza.

After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together.