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Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children.

La hiperhidrosis se caracteriza por excesiva sudoración, habitualmente secundaria a disfunción autonómica con hipersecreción de las glándulas sudoríparas ecrinas. La hiperhidrosis primaria focal es la forma más frecuente, y afecta axilas, palmas, plantas y/o cara. Frecuentemente genera un gran impacto en la calidad de vida y en la actividad social. Su tratamiento es complejo. Los antitranspirantes tópicos son recomendados en primer lugar en la mayoría de casos de hiperhidrosis leve. Múltiples ensayos clínicos y estudios prospectivos avalan la eficacia y tolerabilidad de los anticolinérgicos orales y tópicos. En casos moderado/graves, el glicopirronio tópico, el cual ha sido evaluado en al menos 8 ensayos clínicos con más de 2.000 pacientes en total, podría ser considerado la primera línea farmacológica en la hiperhidrosis axilar mal controlada con antitranspirantes tópicos; seguido por inyecciones de toxina botulínica, sistemas de microondas y por anticolinérgicos orales. En este artículo revisamos el rol de los anticolinérgicos tópicos en el manejo de la hiperhidrosis focal en adultos y niños.

Introduction: Intraperitoneal onlay mesh (IPOM) placement for small to medium-sized hernias has garnered negative attention due to perceived long-term risk of mesh-related complications. However, sparse data exists supporting such claims after minimally invasive (MIS) IPOM repairs and most is hindered by the lack of long-term follow-up. We sought to report long-term outcomes and mesh-related complications of MIS IPOM ventral hernia repairs. Methods and procedures: Adult patients who underwent MIS IPOM ventral hernia repair at our institution were identified in the Abdominal Core Health Quality Collaborative database from October 2013 to October 2020. Outcomes included hernia recurrence and mesh-related complications or reoperations up to 6 years postoperatively. Results: A total of 325 patients were identified. The majority (97.2%) of cases were elective, non-recurrent (74.5%), and CDC class I (99.4%). Mean hernia width was 4.16 ± 3.86 cm. Median follow-up was 3.6 (IQR 2.8–5) years. Surgeon-entered or patient-reported follow-up was available for 253 (77.8%) patients at 3 years or greater postoperatively. One patient experienced an early small bowel obstruction and was reoperated on within 30 days. Two-hundred forty-five radiographic examinations were available up to 6 years postoperatively. Twenty-seven patients had hernia recurrence on radiographic examination up to 6 years postoperatively. During long-term follow-up, two mesh-related complications required reoperations: mesh removed for chronic pain and mesh removal at the time of colon surgery for perforated cancer. Sixteen additional patients required reoperation within 6 years for the following reasons: hernia recurrence (n= 5), unrelated intraabdominal pathology (n= 9), obstructed port site hernia (n= 1), and adhesive bowel obstruction unrelated to the prosthesis (n= 1). The rate of reoperation due to intraperitoneal mesh complications was 0.62% (2/325) with up to 6 year follow-up. Conclusion: Intraperitoneal mesh for repair of small to medium-sized hernias has an extremely low rate of long-term mesh-related complications. It remains a safe and durable option for hernia surgeons.

Spheroids exhibit enhanced cell–cell interactions that facilitate improved survival and mimic the physiological cellular environment in vivo. Cell spheroids have been successfully used as building blocks for engineered tissues, yet the viability of this approach with skeletal muscle spheroids is poorly understood, particularly when incorporated into three-dimensional (3D) constructs. Bioprinting is a promising strategy to recapitulate the hierarchical organization of native tissue that is fundamental to its function. However, the influence of bioprinting on skeletal muscle cell spheroids and their function are yet to be interrogated. Using C2C12 mouse myoblasts and primary bovine muscle stem cells (MuSCs), we characterized spheroid formation as a function of duration and cell seeding density. We then investigated the potential of skeletal muscle spheroids entrapped in alginate bioink as tissue building blocks for bioprinting myogenic tissue. Both C2C12 and primary bovine MuSCs formed spheroids of similar sizes and remained viable after bioprinting. Spheroids of both cell types fused into larger tissue clusters over time within alginate and exhibited tissue formation comparable to monodisperse cells. Compared to monodisperse cells in alginate gels, C2C12 spheroids exhibited greater MyHC expression after 2 weeks, while cells within bovine MuSC spheroids displayed increased cell spreading. Both monodisperse and MuSC spheroids exhibited increased expression of genes denoting mid- and late-stage myogenic differentiation. Together, these data suggest that skeletal muscle spheroids have the potential for generating myogenic tissue via 3D bioprinting and reveal areas of research that could enhance myogenesis and myogenic differentiation in future studies.

Background: Gender representation trends at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meetings and the effect of the 2018 ‘We R SAGES’ initiatives are unknown. We assessed gender trends in oral presentations at the SAGES Annual Meeting between 2012 and 2022 with a focus on assessing the impact of the 2018 initiatives. Methods: Abstracts selected for oral presentations from 2012 to 2022 were reviewed for presenter and first, second, and senior author gender. Gender was categorized as woman, man, or unknown using public professional profiles. Subsequent publications were identified using search engines. The primary outcome was the temporal trend of proportion of women in each role using interrupted time series analysis. Secondary outcomes included publication rates based on first and senior author genders in 2012–2018 versus 2019–2022. Results: 1605 abstracts were reviewed. The proportion of women increased linearly in all categories: presenter (2.4%/year, R2= 0.91), first author (2.4%/year, R2= 0.90), senior author (2%/year, R2= 0.65), and overall (2.2%, R2= 0.91), (p< 0.01 for all). Prior to 2018, the proportion of women increased annually for presenters (coefficient: 0.026, 95% CI [0.016, 0.037], p= 0.002) and first authors (coefficient: 0.026, 95% CI [0.016, 0.037], p= 0.002), but there was no significant increase after 2018 (p> 0.05). Female second author proportion increased annually prior to 2018 (coefficient: 0.012, 95% CI [0.003, 0.021], p= 0.042) and increased by 0.139 (95% CI [0.070, 0.208], p= 0.006) in 2018. Annual female senior author proportion did not significantly change after 2018 (p> 0.05). 1198 (75.2%) abstracts led to publications. Women were as likely as men to be first (79% vs 77%, p= 0.284) or senior author (79% vs 77%, p= 0.702) in abstracts culminating in publications. There was no difference in woman first author publication rate before and after 2018 (80% vs 79%, p= 1.000), but woman senior author publication rate increased after 2018 (71% vs 83%, p= 0.032). Conclusion: There was an upward trend in women surgeons’ presentations and associated publications in the SAGES Annual Meetings over the last decade.

The changes in natural ecosystems provide opportunity to increase vegetation carbon sink capacity and thereby contribute to mitigation of climate change impacts. The Indian tropics and the large ecological variation within the country afford the advantage of diverse niches and offer opportunities to reveal the role of biotic factors at different levels of organization from populations to ecosystems. The last 4 decades of research and development in the Indian space science community has been primarily application driven in response to the government space programme for national development. The expenditure in R&D over next 5 year suggest that scientific research is higher on the country's agenda. The Indo-UK Terrestrial Carbon Group (IUTCG) comprising both Indian and UK scientists, funded jointly by the Department of Science and Technology, India and the Department of Business, Innovation and Skills organised a workshop to explore ways in which Earth observation data can be effectively utilised in mitigating the impacts of climate change through vegetation management. Effective integration of field observations, collected through various monitoring networks, and satellite sensor data has been proposed to provide country-wide monitoring.

AbstractLet a random geometric graph be defined in the supercritical regime for the existence of a unique infinite connected component in Euclidean space. Consider the first-passage percolation model with independent and identically distributed random variables on the random infinite connected component. We provide sufficient conditions for the existence of the asymptotic shape, and we show that the shape is a Euclidean ball. We give some examples exhibiting the result for Bernoulli percolation and the Richardson model. In the latter case we further show that it converges weakly to a nonstandard branching process in the joint limit of large intensities and slow passage times.

The evolution and rapid adoption of the Internet of Things (IoT) led to a rise in the number of attacks that target IoT environments. IoT environments are vulnerable to several attacks because many devices lack memory, processing power, and battery. Most of these vulnerabilities are relatively easy to mitigate when best practices are followed. However, even when best practices are followed, an attack to obtain a device credential and use it to generate false data is difficult to detect. Such an attack is called a replication attack and its impact can be catastrophic in crucial IoT scenarios such as smart transportation. In this sense, this paper proposes a solution to detect these attacks by analyzing abnormal network traffic through machine learning.

IMPORTANCE: Posterior components separation (PCS) is a commonly used myofascial release technique in ventral hernia repairs. The contribution of each release with anterior and posterior fascial advancement has not yet been characterized in patients with ventral hernias. OBJECTIVE: To quantitatively assess the changes in tension on the anterior and posterior fascial elements of the abdominal wall during PCS to inform surgeons regarding the technical contribution of each step with those changes, which may help to guide intraoperative decision-making. DESIGN, SETTING, AND PARTICIPANTS: This case series enrolled patients from December 2, 2021, to August 2, 2022, and was conducted at the Cleveland Clinic Center for Abdominal Core Health. The participants included adult patients with European Hernia Society classification M1 to M5 ventral hernias undergoing abdominal wall reconstruction with PCS. INTERVENTION: A proprietary, sterilizable tensiometer measured the force needed to bring the fascial edge of the abdominal wall to the midline after each step of a PCS (retrorectus dissection, division of the posterior lamella of the internal oblique aponeurosis, and transversus abdominis muscle release [TAR]). MAIN OUTCOME: The primary study outcome was the percentage change in tension on the anterior and posterior fascia associated with each step of PCS with TAR. RESULTS: The study included 100 patients (median [IQR] age, 60 [54-68] years; 52 [52%] male). The median (IQR) hernia width was 13.0 (10.0-15.2) cm. After complete PCS, the mean (SD) percentage changes in tension on the anterior and posterior fascia were −53.27% (0.53%) and −98.47% (0.08%), respectively. Of the total change in anterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of −82.56% (0.68%), incision of the posterior lamella of the internal oblique with a change of −17.67% (0.41%), and TAR with no change. Of the total change in posterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of −3.04% (2.42%), incision of the posterior lamella of the internal oblique with a change of −58.78% (0.39%), and TAR with a change of −38.17% (0.39%). CONCLUSIONS AND RELEVANCE: In this case series, retrorectus dissection but not TAR was associated with reduced tension on the anterior fascia, suggesting that it should be performed if anterior fascial advancement is needed. Dividing the posterior lamella of the internal oblique aponeurosis and TAR was associated with reduced tension on the posterior fascia, suggesting that it should be performed for posterior fascial advancement.

Scientific evidence exists about the association between neurological diseases (i.e., Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis, depression, and memory loss) and oxidative damage. The increasing worldwide incidence of such diseases is attracting the attention of researchers to find palliative medications to reduce the symptoms and promote quality of life, in particular, in developing countries, e.g., South America and Africa. Among potential alternatives, extracts of Cannabis SativaL. are suitable for people who have neurological disorders, spasticity, and pain, nausea, resulting from diseases such as cancer and arthritis. In this review, we discuss the latest developments in the use of Cannabis, its subtypes and constituents, extraction methods, and relevant pharmacological effects. Biomedical applications, marketed products, and prospects for the worldwide use of Cannabis SativaL. extracts are also discussed, providing the bibliometric maps of scientific literature published in representative countries from South America (i.e., Brazil) and Africa (i.e., South Africa). A lack of evidence on the effectiveness and safety of Cannabis, besides the concerns about addiction and other adverse events, has led many countries to act with caution before changing Cannabis-related regulations. Recent findings are expected to increase the social acceptance of Cannabis, while new technologies seem to boost the global cannabis market because the benefits of (−)-trans-delta-9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) use have been proven in several studies in addition to the potential to general new employment.

Se presentan los resultados del Registro español de ablación con catéter correspondientes a 2022.

New synthetic hybrid materials and their increasing complexity have placed growing demands on crystal growth for single-crystal X-ray diffraction analysis. Unfortunately, not all chemical systems are conducive to the isolation of single crystals for traditional characterization. Here, small-molecule serial femtosecond crystallography (smSFX) at atomic resolution (0.833 Å) is employed to characterize microcrystalline silver n-alkanethiolates with various alkyl chain lengths at X-ray free electron laser facilities, resolving long-standing controversies regarding the atomic connectivity and odd–even effects of layer stacking. smSFX provides high-quality crystal structures directly from the powder of the true unknowns, a capability that is particularly useful for systems having notoriously small or defective crystals. We present crystal structures of silver n-butanethiolate (C4), silver n-hexanethiolate (C6), and silver n-nonanethiolate (C9). We show that an odd–even effect originates from the orientation of the terminal methyl group and its role in packing efficiency. We also propose a secondary odd–even effect involving multiple mosaic blocks in the crystals containing even-numbered chains, identified by selected-area electron diffraction measurements. We conclude with a discussion of the merits of the synthetic preparation for the preparation of microdiffraction specimens and compare the long-range order in these crystals to that of self-assembled monolayers.

IMPORTANCE: Transfascial (TF) mesh fixation in open retromuscular ventral hernia repair (RVHR) has been advocated to reduce hernia recurrence. However, TF sutures may cause increased pain, and, to date, the purported advantages have never been objectively measured. OBJECTIVE: To determine whether abandonment of TF mesh fixation would result in a noninferior hernia recurrence rate at 1 year compared with TF mesh fixation in open RVHR. DESIGN, SETTING, AND PARTICIPANTS: In this prospective, registry-based, double-blinded, noninferiority, parallel-group, randomized clinical trial, a total of 325 patients with a ventral hernia defect width of 20 cm or less with fascial closure were enrolled at a single center from November 29, 2019, to September 24, 2021. Follow-up was completed December 18, 2022. INTERVENTIONS: Eligible patients were randomized to mesh fixation with percutaneous TF sutures or no mesh fixation with sham incisions. MAIN OUTCOME AND MEASURES: The primary outcome was to determine whether no TF suture fixation was noninferior to TF suture fixation for open RVHR with regard to recurrence at 1 year. A 10% noninferior margin was set. The secondary outcomes were postoperative pain and quality of life. RESULTS: A total of 325 adults (185 women [56.9%]; median age, 59 [IQR, 50-67] years) with similar baseline characteristics were randomized; 269 patients (82.8%) were followed up at 1 year. Median hernia width was similar in the TF fixation and no fixation groups (15.0 [IQR, 12.0-17.0] cm for both). Hernia recurrence rates at 1 year were similar between the groups (TF fixation, 12 of 162 [7.4%]; no fixation, 15 of 163 [9.2%]; P = .70). Recurrence-adjusted risk difference was found to be −0.02 (95% CI, −0.07 to 0.04). There were no differences in immediate postoperative pain or quality of life. CONCLUSIONS AND RELEVANCE: The absence of TF suture fixation was noninferior to TF suture fixation for open RVHR with synthetic mesh. Transfascial fixation for open RVRH can be safely abandoned in this population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03938688

Although neurocognitive impairment has been considered as the main argument for the surgical treatment of craniosynostosis (CS), recent studies reported subtle deficits in neurological function even in operated patients. However, the cause of these deficits remains poorly understood. This systematic review sought to examine the impact of CS on the brain microstructure, mainly on functional connectivity, and comprehensively summarize the clinical and experimental research available on this topic. A systematic review was performed considering the publications of the last 20 years in PubMed and Web of Science, including relevant human and animal studies of the types of brain-microstructure disturbances in CS. Among the 560 papers identified, 11 were selected for analysis. Seven of those were conducted in humans and 4 in animal models. Resting-state functional magnetic resonance imaging, task-based magnetic resonance imaging, and diffusion tensor imaging were the main instruments used to investigate brain connectivity in humans. The main findings were increased connectivity of the posterior segment of cingulum gyri, reduced interconnectivity of the frontal lobes, and reduced diffusivity on diffusion tensor imaging, which were associated with hyperactivity behaviors and poorer performance on neurocognitive tests. Conversely, despite the lack of evidence of brain dysfunction in animal studies, they reported a tendency toward the development of hyperactive behaviors and impairment of neurocognitive function. Skull restriction caused by CS apparently chronically increases the intracranial pressure and produces white matter injuries. The current evidence supports the contention that an early surgical approach could minimize brain-connectivity impairment in this context.

Paper surface functionalization with polyamidoamine (PAMAM) dendrimers has been developed for increased sensitivity analysis of proteins by paper spray mass spectrometry (PS-MS). PAMAM is a branched polymeric compound with an ethylenediamine core linked to repeating PAMAM units that generates an outer surface rich in primary amines. These positively charged amine groups can interact electrostatically with negatively charged residues (e.g., aspartate, glutamate) on the protein surface. PAMAM inner amide moieties can also promote hydrogen bonding with protein surface oxygens, making PAMAM a useful material for protein extraction. PAMAM-functionalized PS-MS paper strips were used to extract proteins from biofluids, dipped in acetonitrile to remove unbound constituents, dried, and then measured with PS-MS. The use of this strategy was optimized and compared with unmodified paper strips. PAMAM-functionalized paper substrates provided sixfold greater sensitivity for albumin, 11-fold for hemoglobin, sevenfold for insulin, and twofold for lysozyme. The analytical performance of the functionalized paper substrate was evaluated through the analysis of albumin in urine, achieving linearity with R2> 0.99, LOD of 1.1 μg mL–1, LOQ of 3.8 μg mL–1, precision better than 10%, and relative recovery 70–83%. The method was applied to quantify urinary albumin from nine anonymous patient samples (concentrations ranged from 6.5 to 77.4 μg mL–1), illustrating its potential for the diagnosis of microalbuminuria. These data demonstrate the utility of paper modification with the PAMAM dendrimer for sensitive PS-MS analysis of proteins, opening a path for further applications in clinical diagnosis through the analysis of disease-related proteins.

En España se carece de evidencia sobre psoriasis (PsO) pediátrica en el mundo real. El objetivo de este estudio fue identificar la carga de la enfermedad reportada por el facultativo y los patrones actuales de tratamiento en una cohorte de pacientes psoriásicos pediátricos en el mundo real. Ello ampliará nuestra comprensión de la enfermedad y contribuirá al desarrollo de directrices regionales.

Real-world evidence of paediatric psoriasis (PsO) is lacking in Spain. The purpose of this study was to identify physician-reported disease burden and current treatment patterns in a real-world paediatric PsO patient cohort in Spain. This will enhance our understanding of the disease and contribute to the development of regional guidelines.

Background: For small to medium-sized ventral hernias, robotic intraperitoneal onlay mesh (rIPOM) and enhanced-view totally extraperitoneal (eTEP) repair have emerged as acceptable approaches that each takes advantage of robotic instrumentation. We hypothesized that avoiding mesh fixation in a robotic eTEP repair offers an advantage in early postoperative pain compared to rIPOM. Methods: This is a multi-center, randomized clinical trial for patients with midline ventral hernias ≤ 7 cm, who were randomized to rIPOM or robotic eTEP. The primary outcome was pain (0–10) on the first postoperative day. Secondary outcomes included same-day discharge, length of stay, opioid consumption, quality of life, surgeon workload, and cost. Results: Between November 2019 and November 2021, 100 patients were randomized (49 rIPOM, 51 eTEP) among 5 surgeons. Pain on the first postoperative day [median (IQR): 5 (4–6) vs. 5 (3.5–7), p= 0.66] was similar for rIPOM and eTEP, respectively, a difference maintained following adjustments for surgeon, operative time, baseline pain, and patient co-morbidities (difference 0.28, 95% CI − 0.63 to 1.19, p= 0.56). No differences in pain on the day of surgery, 7, and 30 days after surgery were identified. Same-day discharge, length of stay, opioid consumption, and 30-day quality of life were also comparable, though rIPOM required less surgeon workload (p< 0.001), shorter operative time [107 (86–139) vs. 165 (129–212) min, p< 0.001], and resulted in fewer surgical site occurrences (0 vs. 8, p= 0.004). The total direct costs for rIPOM and eTEP were comparable [$8282 (6979–11835) vs. $8680 (7550–10282), p= 0.52] as the cost savings for eTEP attributable to mesh use [$442 (434–485) vs. $69 (62–76), p=  < 0.0001] were offset by increased expenses for operative time [$669 (579–861) vs. $1075 (787–1367), p< 0.0001] and use of more robotic equipment [$760 (615–933) vs. $946 (798–1203), p= 0.001]. Conclusion: The avoidance of fixation in a robotic eTEP repair did not reveal a benefit in postoperative pain to offset the shorter operative time and surgeon workload offered by rIPOM.

La apendicitis aguda es la urgencia quirúrgica abdominal más frecuente en el mundo y un motivo de consulta habitual en nuestros servicios de Urgencia.

Introduction: Robotic inguinal hernia repair is growing in popularity among general surgeons despite little high-quality evidence supporting short- or long-term advantages over traditional laparoscopic inguinal hernia repair. The original RIVAL trial showed increased operative time, cost, and surgeon frustration for the robotic approach without advantages over laparoscopy. Here we report the 1- and 2-year outcomes of the trial. Methods: This is a multi-center, patient-blinded, randomized clinical study conducted at six sites from 2016 to 2019, comparing laparoscopic versus robotic transabdominal preperitoneal (TAPP) inguinal hernia repair with follow-up at 1 and 2 years. Outcomes include pain (visual analog scale), neuropathic pain (Leeds assessment of neuropathic symptoms and signs pain scale), wound morbidity, composite hernia recurrence (patient-reported and clinical exam), health-related quality of life (36-item short-form health survey), and physical activity (physical activity assessment tool). Results: Early trial participation included 102 patients; 83 (81%) completed 1-year follow-up (45 laparoscopic vs. 38 robotic) and 77 (75%) completed 2-year follow-up (43 laparoscopic vs. 34 robotic). At 1 and 2 years, pain was similar for both groups. No patients in either treatment arm experienced neuropathic pain. Health-related quality of life and physical activity were similar for both groups at 1 and 2 years. No long-term wound morbidity was seen for either repair type. At 2 years, there was no difference in hernia recurrence (1 laparoscopic vs. 1 robotic; P= 1.0). Conclusions: Laparoscopic and robotic inguinal hernia repairs have similar long-term outcomes when performed by surgeons with experience in minimally invasive inguinal hernia repairs. Graphical abstract:

Whisky adulteration is a prevalent practice driven by the high cost of these beverages. Counterfeiters commonly dilute whisky with less expensive alcoholic beverages, water, food additives, drugs or pharmaceuticals. Paracetamol (PAR), an analgesic drug that mitigates hangovers and headaches, is commonly used to adulterate whisky. Currently, the primary method for quantifying PAR levels is high-performance liquid chromatography, but this technique is both time consuming and usually generates more residues. In this context, the utilization of miniaturized and portable analytical devices becomes imperative for conducting point-of-care/need analyses. These devices offer several advantages, including portability, user-friendliness, low cost, and minimal material wastage. This study proposes the selective distance-based PAR quantification on whisky samples using a paper-based microfluidic analytical device (μPAD). Colorimetric detection on paper-based platforms offers great benefits such as affordability, portability, and the ability to detect PAR without complicated instrumentation. The optimal detection conditions were achieved by introducing 5 μL of a mixture containing 7.5 mmol L−1of Fe(iii) and K3[Fe(CN)6] into the detection zone, along with 12 μL of whisky samples into the sample zone. The method exhibited linear behavior within the concentration range from 15 to 120 mg L−1, with a determination coefficient of 0.998. PAR was quantified in adulterated samples. The results obtained with the paper-based devices were compared with a referenced method, and no significant differences were observed at a confidence level of 95%. The μPAD allowed to determine ca.1 drop of pharmaceutical medicine PAR of 200 mg mL−1in 1 L of solution, demonstrating excellent sensitivity. This method offers cost-effective and rapid analysis, reducing the consumption of samples, reagents, and wastes. Consequently, it could be considered a viable and portable alternative for analyzing beverages at criminal scenes, customs, and police operations, thereby enhancing the field of forensics.

ObjectiveA 45% threshold of right ventricular ejection fraction (RVEF) is proposed clinically relevant in patients with pulmonary arterial hypertension (PAH). We aim to determine treatment response, long-term right ventricular (RV) functional stability and prognosis of patients with PAH reaching or maintaining the RVEF 45% threshold.MethodsIncident, treatment-naive, adult PAH patients with cardiac magnetic resonance imaging at baseline and first follow-up were included (total N=127) and followed until date of censoring or death/lung transplantation. Patients were categorised into two groups based on 45% RVEF. Baseline predictors, treatment response and prognosis were assessed with logistic regression analyses, two-way analysis of variance and log-rank tests.ResultsPatients were 50±17 years old, 73% female, of which N=75 reached or maintained the 45% RVEF threshold at follow-up (RVEF≥45%@FU), while N=52 patients did not (RVEF<45%@FU). RV end-diastolic volume and N-terminal pro-B-type natriuretic peptide at baseline were multivariable predictors of an RVEF ≥45% at follow-up. A 40% pulmonary vascular resistance (PVR) reduction resulted in greater improvement in RV function (ΔRVEF 17±11 vs. 5±8; pinteraction<0.001) compared to a PVR reduction <40%, but did not guarantee an RVEF ≥45%. Finally, the 45% RVEF threshold was associated with stable RV function during long-term follow-up and better survival (HR: 1.91 (95% CI: 1.11 to 3.27)). Patients failing to reach or maintain the 45% RVEF threshold at first follow-up mostly stayed below this threshold over the next consecutive visits.ConclusionAfter treatment initiation, 60% of patients with PAH reach or maintain the 45% RVEF threshold, which is associated with a long-term stable RV function and favourable prognosis.

Identifying the determinants of walking confidence can be crucial in therapeutic terms. On these bases, interventions to improve these factors could improve, in turn, walking confidence. Objective is to explore the relationship between motor impairments and activity limitation measures and walking confidence in people with chronic stroke. Walking confidence was assessed using the modified Gait Efficacy Scale. The independent variables were: strength of the hip flexors and knee flexors/extensors (measured with a dynamometer), lower limb coordination (assessed by the Lower Extremity Motor Coordination Test), dynamic balance (assessed by the Four-Square Step Test), walking speed (from the 10-m Walk Test), aerobic capacity (from the 6-Minute Walk Test), and self-perceived locomotion ability (assessed by the ABILOCO). Pearson correlation was used to explore the relationships between the variables, and multiple linear regression to identify the independent explainers of walking confidence after stroke. Ninety chronic stroke individuals (35 men), with a mean age of 68 (SD 13) years were assessed. All independent variables were significantly correlated with walking confidence. Regarding the regression analysis, these measures explained 44% (F= 9.21; P< 0.001) of the variance in walking confidence; however, only walking speed, strength of the hip flexor muscles, aerobic capacity, and perceived locomotion ability showed significance. All motor impairment and activity limitation measures correlated with walking confidence. However, the regression analysis highlighted that only walking speed, aerobic capacity, the strength of the hip flexor muscles, and perceived locomotion were independent explainers of walking confidence after stroke.

Mitigation option are not yet being implemented at the scale required to limit global warming to well below 2°C. Various factors have been identified that inhibit the implementation of specific mitigation options. Yet, an integrated assessment of key barriers and enablers is lacking. Here we present a comprehensive framework to assess which factors inhibit and enable the implementation of mitigation options. The framework comprises six dimensions, each encompassing different criteria: geophysical, environmental-ecological, technological, economic, sociocultural, and institutional feasibility. We demonstrate the approach by assessing to what extent each criterion and dimension affects the feasibility of six mitigation options. The assessment reveals that institutional factors inhibit the implementation of many options that need to be addressed to increase their feasibility. Of all the options assessed, many factors enable the implementation of solar energy, while only a few barriers would need to be addressed to implement solar energy at scale.

Home oxygen therapy (HOT) burns carry high morbidity and mortality. Many patients are active smokers, which is the most frequent cause of oxygen ignition. We conducted a retrospective review at our institution to characterize demographics and outcomes in this patient population. An IRB-approved single-institution retrospective review was conducted for home oxygen therapy burn patients between July 2016 and January 2021. Demographic and clinical outcome data were compared between groups. We identified 100 patients with oxygen therapy burns. Mean age was 66.6 years with a male to female ratio of 1.3:1 and median burn surface area of 1%. In these patients, 97% were on oxygen for COPD and smoking caused 83% of burns. Thirteen were discharged from the emergency department, 35 observed for less than 24 hours, and 52 admitted. For admitted patients, 69.2% were admitted to the ICU, 37% required intubation, and 11.5% required debridement and grafting. Inhalational injury was found in 26.9% of patients, 3.9% underwent tracheostomy, and 17.3% experienced hospital complications. In-hospital mortality was 9.6% and 7.7% were discharged to hospice. 13.5% required readmission within 30 days. Admitted patients had significantly higher rates of admission to the ICU, intubation, and inhalational injury compared to those that were not admitted (P< .01). Most HOT-related burns are caused by smoking and can result in significant morbidity and mortality. Efforts to educate and encourage smoking cessation with more judicious HOT allocation would assist in preventing these unnecessary highly morbid injuries.

Transgender and gender diverse (TGD) individuals may undergo a wide range of care during gender transition including mental health counseling, gender-affirming hormonal therapy, and various surgeries. Hormone therapy effectively converts the hormonal milieu into that of the affirmed gender and produces measurable alterations in serum markers for coronary artery disease and other hematologic conditions (eg, erythrocytosis, venous thrombosis). Although illegal in the United States, some transgender women may receive silicone injections for breast and soft tissue augmentation, which can lead to devastating local complications, as well as silicone migration, pulmonary embolism, systemic reactions, and death. Smoking rates are higher among transgender and sexual minority populations, placing them at elevated risk of smoking-related diseases, including lung cancer. Some opportunistic infections may be more common in the TGD populations, attributable to higher rates of coexisting infection with human immunodeficiency virus. Radiologists should be aware that these patients may develop cancer of their natal organs (eg, breast, prostate), especially as some of these tissues are not completely removed during gender-affirming surgery, which may manifest with thoracic involvement by secondary neoplasia. As more TGD patients seek medical care, thoracic radiologists can reasonably expect to interpret imaging performed in this population and should be aware of possible disease processes and potential complications of hormonal and surgical therapies.

Canine distemper outbreak and coinfections in three giant anteaters and in a maned wolf has been described. Three giant anteaters developed respiratory and digestive clinical signs after the introduction of a maned wolf to a Wildlife Rehabilitation Center. The maned wolf and two anteaters died, and one anteater was euthanized. Post mortem and histopathologic exams revealed lesions associated with numerous intraepithelial inclusion bodies, mainly in the respiratory and digestive systems. Infection by distemper virus was confirmed in all animals by RT-PCR and gene sequencing, which revealed the Europe 1/ South America 1 strain, closely related to the strain from Canis familiaris. In addition to distemper, the animals had other comorbidities, such as toxoplasmosis and salmonellosis in the maned wolf and cutaneous candidiasis in an anteater. Considering the chronology of clinical manifestation in both species and the viral characterization, it is possible that the maned wolf was the source of infection to the anteaters. This study demonstrates the importance of implementing biosecurity measures in enclosures that house animals of different species, highlighting the importance of quarantine before introduction of new animals into the same environment.

The α - F composite fading distribution with pointing errors is investigated in this paper. New expressions for the probability density function and cumulative distribution function of the envelope/instantaneous signal-to-noise ratio (SNR), higher-order moments, and moment generating function of the instantaneous SNR are derived. Based on the aforementioned statistics, expressions for the outage probability, symbol error probability, and ergodic channel capacity are obtained. An asymptotic analysis is also provided. Furthermore, an application of the α - F model with pointing errors in a wireless emerging system, namely reconfigurable intelligent surfaces (RIS), is shown. Several curves, corroborated by Monte–Carlo simulations, are presented for different values that characterize the channel and pointing error parameters. [ABSTRACT FROM AUTHOR]

Exploratory outcomes of the PROVE-IT randomized clinical trial identified potential differences in 1-year quality of life and hernia recurrence favoring the robotic and laparoscopic platforms, respectively.

The present work aims to obtain a ranking of hydro generating units using the analytic hierarchy process (AHP) method, based on the maintenance indicators of the Santo Antônio Hydroelectric Plant (SAHP). The purpose of the generated classification is to provide subsidies to assist maintenance planning, determining the most critical turbines for performing preventive maintenance, in order to increase the availability of equipment, in addition to reducing the probabilities of forced shutdowns for corrective maintenance, impacting factors the plant’s availability factor. Thus, the main contribution of this work is the application of AHP to classify the SAHP generating units, using parameters and actual historical data from the plant and hydraulic turbines.

The swine industry is comprised of highly productive and healthy sows capable of weaning large litters for multiple parities. This prolificacy has resulted in greater metabolic demands during lactation due to increased capacity and demand for milk production. Modern sows also have increased genetic merit for leanness which has altered the amount of energy reserves available for mobilization to support the growing demands of lactation. Together, these factors may render modern sows more vulnerable to metabolic disorders such as postpartum dysgalactia syndrome (PDS) or mastitis-metritis-agalactia (MMA). Described as a metabolic and hormonal disturbance, a hallmark of PDS is a reduction (dysgalactia) or cessation (agalactia) in milk production after farrowing. Insufficient milk production by the sow leads to increased piglet mortality, causing substantial economic losses, reducing sow welfare, and resulting in premature removal of sows from the herd. Our prior reports have shown differences in circulating analytes and inflammatory markers between healthy sows and sows affected with PDS following parturition. However, very few differences were observed before clinical signs were evident, rendering these analytes ineffective in early detection of PDS. Therefore, the objective of the current study was to utilize gas-chromatography mass-spectrometry (GC-MS) to further characterize the biological conditions and metabolic pathways contributing to PDS in sows. Through this, we aimed to identify small molecules in circulation with the potential for use as a biomarker to aid in early detection of PDS. To accomplish this, a study was conducted on a commercial sow farm with a history of poor lactation performance. Sows (n = 36) with clinical signs of PDS were matched by parity and day of lactation with healthy control (CON) sows (n = 36) that remained unaffected. Blood samples collected at farrowing (timepoint 1) and at onset of clinical PDS (timepoint 2) were subjected to GC-MS. As expected, piglets from PDS sows had decreased (P< 0.01) average daily gain and greater mortality than piglets from control sows. Following GC-MS analysis, 16 and 41 molecules were identified as significantly different between CON and PDS sows at timepoint 1 and timepoint 2, respectively (P< 0.10). A difference in 2-hydroxybutyric acid, an early marker for insulin resistance and impaired glucose regulation, was observed at timepoint 1. Additional molecules identified as significantly different at timepoint 1 include D-pinitol, D-glucose, inositol (3,6)-bisphosphate, and others. These differentially abundant molecules at timepoint 1 represent potential biomarkers for early detection of PDS.

A deep neural network (NN) is used to simultaneously detect laser beams in images and measure their center coordinates, radii, and angular orientations. A dataset of images containing simulated laser beams and a dataset of images with experimental laser beams—generated using a spatial light modulator—are used to train and evaluate the NN. After training on the simulated dataset the NN achieves beam parameter root mean square errors (RMSEs) of less than 3.4% on the experimental dataset. Subsequent training on the experimental dataset causes the RMSEs to fall below 1.1%. The NN method can be used as a stand-alone measurement of the beam parameters or can compliment other beam profiling methods by providing an accurate region-of-interest.

Sampling method decisions are critical for the effective monitoring and management of fisheries. Deploying the most effective sampling methodologies is particularly important when responding to new invasive species, where early response efforts have the best chances for eradication. In the Laurentian Great Lakes, the invasive Grass Carp Ctenopharyngodon idellais sampled using boat electrofishing and the combination method of boat electrofishing within and around a trammel net enclosure. We conducted a field study to compare the effectiveness of the two methods. We used capture data for surrogate taxa (i.e., Common Carp Cyprinus carpioand buffalo Ictiobusspp.) to compare the two methods because few Grass Carp were collected during the study. The sampling methods were compared within an occupancy modeling framework using an information‐criteria model selection approach to evaluate seven alternative models. The base model included sampling method, year, water temperature, and sampling effort as covariates in the detection submodel and assumed that occupancy probability was constant across sites. The other six models built on the base model by including site, water body type (i.e., lentic vs. lotic), and interaction covariates in the detection submodel. The top‐performing model, built on the base model, accounted for the influence of water body type and assumed the exchangeability of site effects in the detection submodel. The results indicated that the detection probabilities for both taxa were higher for the combination method than for boat electrofishing, with a median estimated difference in detection probability between the two methods of 0.11 (95% CI: 0.04–0.22) for Common Carp and 0.18 (95% CI: 0.08–0.28) for buffalo. Given that the combination method was more effective for detecting the surrogate taxa, we expect the combination method may be preferable to only boat electrofishing for Grass Carp removal.