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Introduction: Several studies have highlighted the potential benefits of early prophylactic transjugular intrahepatic portosystemic shunt (preemptive TIPS) placement in reducing morbidity and mortality following variceal bleeding (VB). Baveno VII recommends its placement less than 72 h after VB (Child-Pugh class C 7 plus active bleeding). This study aimed to evaluate the effectiveness of preemptive TIPS compared to a control group in a referral center. Methods: The control group included cirrhotic patients with VB and Child-Pugh class C or B with active bleeding, retrospectively selected between 2016 and 2022 and divided into 2 subgroups: those that never underwent TIPS placement during the course of their illness (subgroup A) and those submitted to TIPS placement due to rebleeding (subgroup B). Additionally, patients who received preemptive TIPS placement between August 2022 and January 2024 were prospectively included into the preemptive transjugular intrahepatic portosystemic shunt (pTIPS) group. Results: A total of 47 patients were included, 19 (40.4%) in the pTIPS group and 28 (59.6%) in control group (17 in subgroup A). There were no differences in baseline characteristics between the groups, except hepatic encephalopathy that was significantly higher in the control group when compared to the pTIPS group: 19 (67.9%) versus 6 (31.6%), p = 0.014. Early rebleeding rates were significantly lower in the pTIPS group: 1 (5.3%) versus 13 (46.4%) (p = 0.002). There were no significant differences in 6-week survival between the groups: 25 (89.3%) versus 17 (89.5%), p = 0.683. Regarding hepatic encephalopathy, no significant differences were observed between the control and the pTIPS group: 6 (21.4%) versus 4 (21.1%), p = 0.632, even when comparing subgroup A (4, 23.5%) with the pTIPS group (p = 0.432). Conclusion: This real-world study highlights the potential benefits of preemptive TIPS placement in reducing early relapse of VB, thereby lowering morbidity and complications. The findings advocate for the proactive incorporation of preemptive TIPS into clinical practice to optimize patient outcomes following VB.

Enquadramento: o Coronavírus desencadeou o maior desafio dos últimos tempos para o sistema mundial de saúde. Perante este cenário inesperado, novos fatores influenciaram a carga de trabalho de enfermagem. Objetivo: avaliar a carga de trabalho de enfermagem do doente internado com infeção provocada por COVID-19 num Serviço de Medicina Intensiva através do Nursing Activities Score (NAS). Metodologia: estudo observacional e retrospetivo, realizado com doentes internados num Serviço de Medicina Intensiva Polivalente. Para a colheita das variáveis demográficas, clínicas e NAS foi efetuada consulta dos registos clínicos. Resultados: o NAS mediano obtido no doente de nível II foi de 55 com máximo de 81,7 e mínimo de 41, variando entre 81,7 e 44,1 no primeiro dia. O NAS mediano obtido no doente de nível III foi de 58 com máximo de 89,5 e mínimo de 42,8, variando entre 89,5 e 49,6 no primeiro dia. Conclusão: verificou-se que a carga de trabalho de enfermagem foi superior com doentes COVID-19. A carga de trabalho de enfermagem também foi superior nos doentes COVID-19 de nível III.

Background: The role of capsule endoscopy in the evaluation of the small bowel is well established, and current guidelines position it as a first-line test in a variety of clinical scenarios. The advent of double-headed capsules further enabled the endoscopic assessment of colonic mucosa and the opportunity for a one-step noninvasive examination of the entire bowel (pan-enteric capsule endoscopy [PCE]). Summary: We reviewed the technical procedure and preparation of patients for PCE, as well as its current clinical applications and future perspectives. In non-stricturing and non-penetrating Crohn’s disease affecting the small bowel and colon, PCE monitors disease activity by assessing mucosal healing, a major treatment outcome, with a higher diagnostic yield than cross-sectional imaging or conventional colonoscopy. Also in ulcerative colitis, double-headed capsules have been used to monitor disease activity noninvasively. Currently, validated scoring systems have been specifically devised for these double-headed capsules and permit a standardized assessment of the inflammatory burden. In suspected mid-lower digestive bleeding, some exploratory studies have demonstrated the feasibility and high diagnostic yield of PCE, which may work as a filter indicating which patients may benefit of further invasive procedures, namely, for planned hemostatic procedures. The possibility of using PCE is also discussed in the context of polyposis syndromes with simultaneous involvement of the small intestine and colon. Key Messages: PCE is a feasible, effective, and safe diagnostic procedure to evaluate the small bowel and colon. It has been increasingly explored in the setting of inflammatory bowel diseases and, more recently, in suspected mid-lower digestive bleeding. PCE is expected to reduce the demand for invasive procedures and expand the scope of noninvasive intestinal evaluation in the coming future.

Introduction: Many patients with Crohn’s Disease (CD) require surgical resection during their lifetime. Nevertheless, postoperative recurrence (POR) is common. Risk factors for POR are still yet to be completely established, but some prognostic factors have already been widely recognized. Patients that undergo early postoperative immunomodulators (EPI) (azathioprine or biological therapy) seem to have a lower risk of recurrence. We aimed at assessing whether or not EPI is effective in preventing POR and at the same time validating traditional and new risk factors for POR. Methods: A single-center retrospective cohort study was performed. Review of clinical, demographic and histopathological characteristics of patients undergoing ileocolonic resection for CD between 2015 and 2020 was performed. EPI was defined as the restarting or introduction of azathioprine or biologics within 8 weeks after surgery. Presence of recurrence was defined as Rutgeerts score ≥ i2. Results: Sixty-five patients were included. The median age at diagnosis was 25 years (inter-quartile range 20–33 years). POR was present in 44.6% of patients, and the median time from surgery to recurrence was 2 years. EPI was the therapeutic option in 36 patients (55.4%). Univariate analysis identified as predictors of POR within 2 years: the behavior of the disease and not taking azathioprine or biologics prior to the surgery. Moreover, univariate analysis identified as predictors of time to POR: behavior of disease, less than 5 years between diagnosis and surgery and the absence of immunomodulatory therapy prior to the surgery. Multivariable analysis revealed that EPI, after adjusting for other predictors, was not associated with a reduction in POR. Conclusions: EPI may not have a protective effect against recurrence. The strength of prognostic factors for POR may not be modified by EPI.

Objectives. To implement and evaluate the use of wastewater sampling for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in two coastal districts of Buenos Aires Province, Argentina. Methods. In General Pueyrredon district, 400 mL of wastewater samples were taken with an automatic sampler for 24 hours, while in Pinamar district, 20 L in total (2.2 L at 20-minute intervals) were taken. Samples were collected once a week. The samples were concentrated based on flocculation using polyaluminum chloride. RNA purification and target gene amplification and detection were performed using reverse transcription polymerase chain reaction for clinical diagnosis of human nasopharyngeal swabs. Results. In both districts, the presence of SARS-CoV-2 was detected in wastewater. In General Pueyrredon, SARS-CoV-2 was detected in epidemiological week 28, 2020, which was 20 days before the start of an increase in coronavirus virus disease 2019 (COVID-19) cases in the first wave (epidemiological week 31) and 9 weeks before the maximum number of laboratory-confirmed COVID-19 cases was recorded. In Pinamar district, the virus genome was detected in epidemiological week 51, 2020 but it was not possible to carry out the sampling again until epidemiological week 4, 2022, when viral circulation was again detected. Conclusions. It was possible to detect SARS-CoV-2 virus genome in wastewater, demonstrating the usefulness of the application of wastewater epidemiology for long-term SARS-CoV-2 detection and monitoring.

Abstract Comparing the nature of adolescent sleep across urban and more isolated, rural settings through an ecological, cross-cultural perspective represents one way to inform sleep nuances and broaden our understanding of human development, wellbeing and evolution. Here we tested the Social Jetlag Hypothesis, according to which contemporary, urban lifestyles and technological advances are associated with sleep insufficiency in adolescents. We documented the adolescent sleep duration (11–16 years old; X̅ = 13.7 ± 1.21; n = 145) in two small agricultural, indigenous and one densely urban context in Mexico to investigate whether adolescents in socio-ecologically distinct locations experience sleep deprivation. Sleep data was assembled with actigraphy, sleep diaries and standardized questionnaires. We employed multilevel models to analyze how distinct biological and socio-cultural factors (i.e., pubertal maturation, chronotype, napping, gender, working/schooling, access to screen-based devices, exposure to light, and social sleep practices) shape adolescent sleep duration. Results suggest that the prevalence of adolescent short sleep quotas is similar in rural, more traditional environments compared to highly urbanized societies, and highlight the influence of social activities on the expression of human sleep. This study challenges current assumptions about natural sleep and how adolescents slept before contemporary technological changes occurred.

RESUMO Este trabalho inserido no campo da Política Linguística (PL) tem como objetivo investigar as ideologias linguísticas sobre a língua francesa (LF) presentes em textos de alunos de francês como língua estrangeira (FLE), em seis escolas de língua, na cidade de João Pessoa. Para atingirmos tal objetivo, analisamos, qualitativamente, as respostas a uma pergunta de um questionário aplicado a 174 alunos, explorando o conteúdo temático e os elementos textuais a partir da Linguística Textual (Koch, 2000a, 2000b). A análise foi realizada conforme os pressupostos teóricos das Ideologias Linguísticas (Del Valle, 2007; Arnoux & Del Valle, 2010; e Del Valle & Meirinho-Guede, 2016). Os resultados indicaram que as ideias sobre a LF apresentam conexões diversas com dimensões sociais: estética - LF como símbolo de elegância e requinte e LF como representativa de uma cultura superior-, epistemológica - LF como língua da ciência -, identidade nacional - LF como língua da França -, identidade internacional - LF como língua da diplomacia - e laboral - LF como língua para o mercado de trabalho.

Abstract Alloying is an established strategy to tune the properties of bulk compounds for desired applications. With the advent of nanotechnology, the same strategy can be applied to 2D materials for technological applications, like single-layer transistors and solid lubricants. Here we present a systematic analysis of the phase behaviour of substitutional 2D alloys in the Transition Metal Disulfides (TMD) family. The phase behaviour is quantified in terms of a metastability metric and benchmarked against many-body expansion of the energy landscape. We show how the metastability metric can be directly used as starting point for setting up rational search strategies in phase space, thus allowing for targeted further computational prediction and analysis of properties. The results presented here also constitute a useful guideline for synthesis of TMDs binary alloys via a range of synthesis techniques.

O texto apresentado tem como objetivo dialogar com a categoria exílio interno como um acontecimento histórico e discursivo, vivenciado por mulheres em tempos de governos ditatoriais no Brasil. Como corpus de análise trabalhamos com as narrativas orais apresentadas na obra “Memórias das mulheres do exílio” publicado no ano de 1980. Metodologicamente, o trabalho foi desenvolvido na interlocução da Análise de Discurso e da História Social, possibilitando uma melhor compreensão do funcionamento da memória e seus sentidos. Para a realização deste estudo, compreendemos o discurso como a palavra em movimento, como espaço sócio histórico, um espaço de luta e resistências. As análises realizadas indicam que o exílio interno foi um acontecimento permeados de muitas memórias e histórias, vivenciadas de maneiras diferenciadas por cada narradora, mas que trazem marcas do silêncio, das dores do corpo e da perda identitária.

The initial conditions found in infrared dark clouds (IRDCs) provide insights on how high-mass stars and stellar clusters form. We have conducted high-angular resolution and high-sensitivity observations toward thirty-nine massive IRDC clumps, which have been mosaicked using the 12 and 7 m arrays from the Atacama Large Millimeter/submillimeter Array. The targets are 70 μ m dark massive (220–4900 M _⊙ ), dense (>10 ^4 cm ^−3 ), and cold (∼10–20 K) clumps located at distances between 2 and 6 kpc. We identify an unprecedented number of 839 cores, with masses between 0.05 and 81 M _⊙ using 1.3 mm dust continuum emission. About 55% of the cores are low-mass (

The sliding motion of objects is typically governed by their friction with the underlying surface. Compared to translational friction, however, rotational friction has received much less attention. Here, we experimentally and theoretically study the rotational depinning and orientational dynamics of two-dimensional colloidal crystalline clusters on periodically corrugated surfaces in the presence of magnetically exerted torques. We demonstrate that the traversing of locally commensurate areas of the moiré pattern through the edges of clusters, which is hindered by potential barriers during cluster rotation, controls its rotational depinning. The experimentally measured depinning thresholds as a function of cluster size strikingly collapse onto a universal theoretical curve which predicts the possibility of a superlow-static-torque state for large clusters. We further reveal a cluster-size-independent rotation-translation depinning transition when lattice-matched clusters are driven jointly by a torque and a force. Our work provides guidelines to the design of nanomechanical devices that involve rotational motions on atomic surfaces.