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The process interaction worldview (PI) provides a description of a simulation model based on the life cycles of its entities. PI has traditionally been described under two perspectives: active resource and active transaction. While many simulation languages support the active transaction approach, the active resource has generally been adopted by M&S formalisms aimed to support modular models. In this paper we introduce the Unified Process Interaction Worldview (UPI) as a representation enabling the benefits of both active resource and active transaction perspectives. UPI is based on $\pi $ π HyFlow, a formalism for representing hybrid systems using the process interaction worldview. To show UPI capabilities, we provide a simplified model of an oven with unbounded capacity. The solution of the ordinary differential equations (ODEs) describing oven and inside items temperatures, is computed by exponential time differentiating (ETD) integrators that are also represented in the $\pi $ π HyFlow formalism. [ABSTRACT FROM AUTHOR]

Future climate change predictions for tropical forests highlight increased frequency and intensity of extreme drought events. However, it remains unclear whether large and small trees have differential strategies to tolerate drought due to the different niches they occupy. The future of tropical forests is ultimately dependent on the capacity of small trees (<10 cm in diameter) to adjust their hydraulic system to tolerate drought. To address this question, we evaluated whether the drought tolerance of neotropical small trees can adjust to experimental water stress and was different from tall trees. We measured multiple drought resistance-related hydraulic traits across nine common neotropical genera at the world's longest-running tropical forest throughfall-exclusion experiment and compared their responses with surviving large canopy trees. Small understorey trees in both the control and the throughfall-exclusion treatment had lower minimum stomatal conductance and maximum hydraulic leaf-specific conductivity relative to large trees of the same genera, as well as a greater hydraulic safety margin (HSM), percentage loss of conductivity and embolism resistance, demonstrating that they occupy a distinct hydraulic niche. Surprisingly, in response to the drought treatment, small trees increased specific hydraulic conductivity by 56.3% and leaf:sapwood area ratio by 45.6%. The greater HSM of small understorey trees relative to large canopy trees likely enabled them to adjust other aspects of their hydraulic systems to increase hydraulic conductivity and take advantage of increases in light availability in the understorey resulting from the drought-induced mortality of canopy trees. Our results demonstrate that differences in hydraulic strategies between small understorey and large canopy trees drive hydraulic niche segregation. Small understorey trees can adjust their hydraulic systems in response to changes in water and light availability, indicating that natural regeneration of tropical forests following long-term drought may be possible. [ABSTRACT FROM AUTHOR]

Ex situ conservation is a complementary strategy to in situ efforts and is vital for safeguarding endangered species through maintenance and breeding in captivity with potential for reintroductions into natural environments. However, it is crucial to recognize that prolonged captivity can lead to diminished abilities of organisms over generations. Factors linked to the impact of phenotypic plasticity during development, such as restricted movement, may affect organism performance during ex situ conservation efforts, potentially making reintroduction into the wild unfeasible. Consequently, it is imperative to analyze physiological differences between captive‐bred and wild individuals. Therefore, this study investigates how captivity influences locomotor performance, morphology, and metabolic capacities of adults and juveniles of the threatened treefrog Ololygon alcatraz, in comparison to natural populations. We obtained proportional measurements of individuals and assessed their locomotor performance through jumping exercise. We also measured the metabolic capacities of the frogs by examining the activity of enzymes involved in energetic metabolic pathways in their skeletal muscle fibers. We found that wild adult frogs had larger limbs, greater jumping abilities, and a more glycolytic profile, while captive adult frogs had smaller limbs and increased aerobic enzyme activity compared to their wild counterparts. These differences probably arise from phenotypic plasticity in ontogenetic development that differs between captive and natural environments, as juveniles do not show such differences. These results highlight the need for innovative strategies in managing captive O. alcatraz populations, which will aid in their successful translocation to the wild and strengthen ex situ conservation efforts. [ABSTRACT FROM AUTHOR]

Attentional executive functions, representing a set of self-regulatory cognitive skills, can be a potential Attention-Deficit/Hyperactivity Disorder (ADHD) endophenotype useful for exploring the huge heterogeneity associated to the disorder. Specific biological pathways like the oxytocin-vasopressin pathway (OT-AVP) can unreel ADHD polygenicity. Here, we test the association between genome-wide ADHD polygenic score (PGS) (ADHD-PGS) and both ADHD symptoms and attentional executive functions in the participants of the 2004 Pelotas (Brazil) birth cohort study (N = 4231). We also investigated whether the OT-AVP genomic pathway (OT/AVP ADHD -PGS) is involved in the etiology of ADHD and whether it influences the specificity of attentional functions. ADHD symptoms were assessed through the Strength and Difficulties Questionnaire (SDQ) and the attentional executive functions were evaluated by the Test-of-Everyday-Attention-for-Children (TEA-Ch) at 11 years follow-up. The ADHD-PGS and OT/AVP ADHD -PGS were constructed based on the most recent ADHD GWAS meta-analytic statistics. The OT/AVP ADHD -PGS included only functional relevant genes for the pathway using KEGG repository. ADHD-PGS was associated with ADHD symptoms and attentional control/switching domain. OT/AVP ADHD -PGS showed an enrichment for selective attention domain [number of targets (β = - 0.09, 95% CI = - 0.17; - 0.02, competitive-P = 0.025); attention score (β = 0.11, 95% CI = 0.001; 0.23, competitive-P = 0.050), and in attentional control/switching domain [verbal processing speed (β = 0.27, 95% CI = 0.05; 0.50, competitive-P = 0.041); attentional control (β = 0.42, 95% CI = 0.12; 0.73, competitive-P = 0.033). Our results show a specific role of the OT/AVP pathway in attentional executive functions and suggest that increasing both phenotypic and genetic specificity is of great value. These findings have clinical relevance since OT/AVP have a role in attention toward social cues and shared attentions, which are impaired in children with ADHD., Competing Interests: Declarations. Conflict of interest: LAR has received grant or research support from, served as a consultant to, and served on the speakers’ bureau of Abdi-Ibrahim, Abbott, Aché, Adium, Aspen, Bial, Medice, Novartis/Sandoz, Pfizer/Upjohn, and Shire/Takeda in the last three years. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by LAR have received unrestricted educational and research support from the following pharmaceutical companies in the last three years: Novartis/Sandoz and Shire/Takeda. LAR has received authorship royalties from Oxford Press and ArtMed. The other authors declare that they have no conflict of interest. Ethical approval: The research protocol for all stages of the 2004 Pelotas Birth Cohort Study was approved by the Research Ethics Committee of the Faculty of Medicine at the Federal University of Pelotas and by the Ethics Committee for the Analysis of Research Projects of the University of São Paulo under the number of approvals 40602124 and 889,753. The Brazilian National Commission for Research Ethics also approved the use of genomic data for multifactorial characteristics. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Consent to participate: Written informed consent was obtained from the mothers or legal guardians, and adolescents also signed an informed consent form., (© 2025. Springer-Verlag GmbH Germany, part of Springer Nature.)

This study aimed to test for an association between hair cortisol, as an indicator of chronic stress, and possible sleep bruxism among children participating in the 2015 Pelotas Birth Cohort Study. Data from 3229 children were analysed. Possible sleep bruxism was identified based on caregivers' reports when the child was 4 years old. Trained fieldworkers collected hair samples from children, and a standardized protocol was used for hormone extraction and cortisol quantification from the hair. Information on socioeconomic, demographic, psychological and behavioural characteristics was gathered through questionnaires. Poisson regression with robust variance was used to evaluate the impact of hair cortisol concentration on the occurrence of possible sleep bruxism, guided by a directed acyclic graph. The prevalence of possible sleep bruxism was 21.46% (n = 693); median hair cortisol concentration was 7.8 pg mg -1 . Hair cortisol concentration was not found to be associated with the occurrence of sleep bruxism. However, the presence of sleep bruxism was linked to higher maternal education (p = 0.027), maternal stress level (p = 0.032), excessive use of electronic devices (p = 0.007), and child emotional and behavioural problems (p = 0.003). Furthermore, female sex was associated with a lower frequency of possible sleep bruxism (p = 0.003). There was no association between chronic stress, as measured by hair cortisol concentration, and the occurrence of possible sleep bruxism. This study underscores the role of sociodemographic factors and children's mental health in the occurrence of sleep bruxism among children in this population., (© 2024 European Sleep Research Society.)

Remote sensing (RS) is a widely used technology for monitoring mangrove forests, but there are some inconsistencies in their capacity to assess mangrove ecosystem health status. Our review aims to investigate how RS and in situ data are being applied together in assessments of mangrove forest health conditions. Our results showed that commonly the concept of mangrove ecosystem health was not defined and indicators that were not clearly related to it were applied. Furthermore, low to medium spatial resolution satellites were more used to detect changes in the mangrove forests' environmental condition than the high spatial resolution ones, and the use of RS with data collected in situ was present in only 39% of the articles. We concluded that studies consider vegetation indexes the same as vigor, so the mangrove ecosystem health; and vigor as the only indicator needed, not using in situ data to validate the mangrove health status., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JULIANA NASCIMENTO NERES reports financial support was provided by FUNDO BRASILEIRO PARA A BIODIVERSIDADE - FUNBIO, and HUMANIZE INSTITUTE. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease in the world and was recently renamed to emphasize its metabolic component., Aims: This article seeks to fill the gap in specific guidelines for patients with obesity and MASLD who will undergo bariatric surgery., Methods: A systematic search for guidelines was carried out on PubMed and Embase platforms., Results: A total of 544 articles were found, of which 11 were selected according to inclusion and exclusion criteria. All 11 guidelines are from clinical societies; therefore, they do not include some necessary interpretations for bariatric patients., Conclusions: We recommend that every patient undergoing bariatric and metabolic surgery be screened initially with the Fibrosis-4 (FIB-4) score, followed by transient hepatic elastography (vibration-controlled transient elastography, VCTE), especially for those with FIB-4>1.3. However, interpreting VCTE results in obese patients requires further studies to define the actual cutoff values. Enhanced Liver Fibrosis® shows promise but its availability is limited. The indication for liver biopsy during surgery needs to be individualized but it is recommended for those with changes in FIB-4 and/or VCTE. Family screening is recommended for relatives of young patients with already advanced fibrosis. Liver transplantation is an option for patients with advanced MASLD but the optimal timing for bariatric surgery with transplantation is still unclear. Regular follow-up and VCTE examination are recommended to monitor disease progression after surgery.

Pediatric spine surgery is a high complexity procedure that can carry risks ranging from pain to neurological damage, and even death. This comprehensive mini review explores current best practice obtaining valid and meaningful informed consent (IC) prior to pediatric spinal surgery, including modalities that support effective comprehension and understanding. An evaluation of the literature was performed to explore understanding of surgical IC by patients or their guardians and the role of multimedia tools as a possible facilitator. The evidence discussed throughout this review, based on legal and ethical perspectives, reveals challenges faced by patients and guardians in achieving comprehension and understanding, especially when facing stressful medical situations. In this context, the introduction of multimedia tools emerges as a patient-centered strategy to help improve comprehension and decrease pre-operative uncertainty. This review highlights the need for a tailored approach in obtaining IC for pediatric patients and suggests a potential role of shared decision-making (SDM) in the surgical discussion process., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Rosa Filezio, Sharma, Thull-Freedman, Ferri-de-Barros and Santana.)

The purpose of this study was to analyze the volume and area of sphenoid sinuses of Brazilian individuals' cone-beam computed tomography (CBCT) images using the beta version of the DDS-Pro™ 2.14.2&#95;2022 software (DPP Systems, Czestochowa, Poland), to assess a potential correlation to sex, age, skin color, and nutritional status, and to evaluate differences between the right and left sides. Three-dimensional volume and area measurements were made with the software using CBCT images of 113 living Brazilian individuals of both sexes (67 females and 46 males). TEM, rTEM, and R were used to assess the reproducibility of inter- and intra-examiner measurements. The measurement means were estimated with 95% confidence intervals according to sex and age group. There were no significant differences between the left and right sides for both volume and area and between the sexes and black and white individuals. Volume and area were significantly higher in 18 years or older (p < 0.05) and in individuals with normal body mass index (BMI) (p < 0.05). The obtained results do not allow indicating the use of sphenoid sinuses volume and area measurements to estimate sexual dimorphism, and the same occurred for skin color. However, such measures can help to estimate age. Further studies are suggested with a larger sample, especially for the nutritional status variable., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The InBIO Barcoding Initiative (IBI) Orthoptera dataset contains records of 420 specimens covering all the eleven Orthoptera families occurring in Portugal. Specimens were collected in continental Portugal from 2005 to 2021 and were morphologically identified to species level by taxonomists. A total of 119 species were identified corresponding to about 77% of all the orthopteran species known from continental Portugal., New Information: DNA barcodes of 54 taxa were made public for the first time at the Barcode of Life Data System (BOLD). Furthermore, the submitted sequences were found to cluster in 129 BINs (Barcode Index Numbers), 35 of which were new additions to the Barcode of Life Data System (BOLD). All specimens have their DNA barcodes publicly accessible through BOLD online database. Stenobothruslineatus is recorded for the first time for continental Portugal. This dataset greatly increases the knowledge on the DNA barcodes and distribution of Orthoptera from Portugal. All DNA extractions and most specimens are deposited in the IBI collection at CIBIO, Research Center in Biodiversity and Genetic Resources., (Sílvia Pina, Joana Pauperio, Francisco Barros, Cátia Chaves, Filipa MS Martins, Joana Pinto, Joana Veríssimo, Vanessa A Mata, Pedro Beja, Sónia Ferreira.)

This study describes the bioaccessibility in terms of total phenolic content (TPC) and antioxidant capacity before and after in vitro digestion from blackcurrant press cake extracts (BPC) and the bioactivity in cell culture, human erythrocytes as well as the in silico analysis. Chemical analysis of BPC presented an increase in TPC (270%) and anthocyanins (136%) after in vitro digestion, resulting in an improvement of antioxidant activity (DPPH 112%; FRAP: 153%). This behavior may be related to the highest activity of cyanidin-3-rutinoside, as confirmed by in silico analysis. The digested BPC did not exert cytotoxicity in cells and showed less antioxidant activity against the oxidative damage induced in endothelial cells and human erythrocytes compared to the non-digested extract. The results raise a question about the reliability we should place on results obtained only from crude samples, especially those that will be used to produce foods or nutraceuticals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Cohort studies have demonstrated an association between prolonged and/or frequent breastfeeding and early childhood caries (ECC)., Aim: To investigate the association between prolonged breastfeeding and ECC at 48 months, while considering the interaction between prolonged breastfeeding and ultraprocessed foods (UPF)., Design: Data from a birth cohort study conducted in southern Brazil were used (n = 3645). Poisson regression was used to evaluate the influence of breastfeeding and UPF consumption on the prevalence and experience of caries. To measure the interaction on the additive scale between breastfeeding and UPF consumption on the prevalence and experience of ECC, the relative excess risk due to interaction (RERI) was calculated., Results: Prolonged breastfeeding was associated with higher prevalence (PR = 1.82; CI:1.59-2.08) and experience (RR = 2.47; CI:1.97-3.10) of ECC. Greater prevalence (PR = 1.16; CI: 1.04-1.30) and experience of ECC (RR = 1.22; CI: 1.00-1.48) were found in children who had high consumption of UPFs. Negative RERIs were observed for the prevalence and experience of ECC (-0.25 and -0.001)., Conclusion: High UPF consumption and prolonged breastfeeding were associated with ECC. No interaction, however, was observed, showing that the two exposures have independent effects. To prevent ECC, policies and programs are needed to support breastfeeding until the age of 2 years and to limit the consumption of UPF., (© 2023 BSPD, IAPD and John Wiley & Sons Ltd.)

The Bio-Radar is herein presented as a non-contact radar system able to capture vital signs remotely without requiring any physical contact with the subject. In this work, the ability to use the proposed system for emotion recognition is verified by comparing its performance on identifying fear, happiness and a neutral condition, with certified measuring equipment. For this purpose, machine learning algorithms were applied to the respiratory and cardiac signals captured simultaneously by the radar and the referenced contact-based system. Following a multiclass identification strategy, one could conclude that both systems present a comparable performance, where the radar might even outperform under specific conditions. Emotion recognition is possible using a radar system, with an accuracy equal to 99.7% and an F1-score of 99.9%. Thus, we demonstrated that it is perfectly possible to use the Bio-Radar system for this purpose, which is able to be operated remotely, avoiding the subject awareness of being monitored and thus providing more authentic reactions.

Maternal depressive symptoms are associated with poorer sleep quality in their children. Although parasomnias can occur at any age, this group of sleep disorders is more common in children. The aim of this study was to assess whether maternal depression trajectories predict parasomnias at the age of 11 years. Data were from a Birth Cohort of 4231 individuals followed in the city of Pelotas, Brazil. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 12, 24, and 48 months, and 6 and 11 years postpartum. Maternal depression trajectories were calculated using a group-based modelling approach. Information on any parasomnias (confused arousals, sleepwalking, night terrors, and nightmares) was provided by the mother. Five trajectories of maternal depressive symptoms were identified: chronic-low (34.9%), chronic-moderate (41.4%), increasing (10.3%), decreasing (8.9%), and chronic-high (4.4%). The prevalence of any parasomnia at the age of 11 years was 16.8% (95% confidence interval [CI] 15.6%-18.1%). Confusional arousal was the most prevalent type of parasomnia (14.5%) and varied from 8.7% to 14.7%, 22.9%, 20.3%, and 27.5% among children of mothers at chronic-low, moderate-low, increasing, decreasing, and chronic-high trajectories, respectively (p < 0.001). Compared to children from mothers in the chronic-low trajectory, the adjusted prevalence ratio for any parasomnia was 1.58 (95% CI 1.29-1.94), 2.34 (95% CI 1.83-2.98), 2.15 (95% CI 1.65-2.81), and 3.07 (95% CI 2.31-4.07) among those from mothers in the moderate-low, increasing, decreasing, and chronic-high trajectory groups, respectively (p < 0.001). In conclusion, parasomnias were more prevalent among children of mothers with chronic symptoms of depression., (© 2023 European Sleep Research Society.)

Background: Focal osteoporotic bone marrow defect (FOBMD) is a rare and poorly documented pathology corresponding to an unusual hematopoietic tissue in maxillary bones. Several studies have investigated FOBMD but reported different and heterogenous approaches to a correct diagnosis. Therefore, this systematic review evaluated the relevance of imaging exams in aiding FOBMD diagnosis and the implications in surgical planning for dental implants.The research question was: What is the relevance of imaging tests in aiding FOBMD diagnosis?, Methods: Online databases were searched to select articles based on eligibility criteria. The studies included in the systematic review were submitted to bias and applicability assessments using the Joanna Briggs Institute tool for study quality assessment., Results: A total of 383 articles were obtained from all the databases, 27 studies were included, and all performed biopsies to confirm the diagnosis. The selected studies evaluated 698 patients, including approximately 80% of women, corroborating the literature that notes a higher prevalence of this lesion in women. The reviewed articles showed a low risk of bias for case series, moderate for case reports, and low for cross-sectional studies., Conclusion: The studies considered in this systematic review have shown that radiographic characteristics may sufficiently identify the lesion and provide a periodic radiographic follow-up. However, it is worth noting the need for CBCT for planning oral rehabilitation through implants to minimize the risks of such complications., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 THE AUTHORS.)

Introduction: Risk factors for developing pancreatitis due to thiopurines in patients with inflammatory bowel disease (IBD) are not clearly identified. Our aim was to evaluate the predictive pharmacogenetic risk of pancreatitis in IBD patients treated with thiopurines., Methods: We conducted an observational pharmacogenetic study of acute pancreatitis events in a cohort study of IBD patients treated with thiopurines from the prospectively maintained ENEIDA registry biobank of GETECCU. Samples were obtained and the CASR, CEL, CFTR, CDLN2, CTRC, SPINK1, CPA1, and PRSS1 genes, selected based on their known association with pancreatitis, were fully sequenced., Results: Ninety-five cases and 105 controls were enrolled; a total of 57% were women. Median age at pancreatitis diagnosis was 39 years. We identified 81 benign variants (50 in cases and 67 in controls) and a total of 35 distinct rare pathogenic and unknown significance variants (10 in CEL, 21 in CFTR, 1 in CDLN2, and 3 in CPA1). None of the cases or controls carried pancreatitis-predisposing variants within the CASR, CPA1, PRSS1, and SPINK1 genes, nor a pathogenic CFTR mutation. Four different variants of unknown significance were detected in the CDLN and CPA1 genes; one of them was in the CDLN gene in a single patient with pancreatitis and 3 in the CPA1 gene in 5 controls. After the analysis of the variants detected, no significant differences were observed between cases and controls., Conclusion: In patients with IBD, genes known to cause pancreatitis seem not to be involved in thiopurine-related pancreatitis onset., (© 2024 S. Karger AG, Basel.)

Mangroves and saltmarshes are two of the most relevant coastal habitats for humans. These ecosystems offer several services like coastal protection, climate mitigation, and nursery habitats for many artisanal and commercially exploited fish, crabs, and shellfish. They mostly dominate different latitudinal ranges but in several places around the world they co-occur and interact. Here, we summarize the current scientific knowledge on mangrove-saltmarsh ecological interactions and propose a conceptual model. We screened 1410 articles from 1945 to 2022 and selected 29 experiments that assessed mangrove-saltmarsh ecological interactions. Both positive and negative interactions are observed but there is variation along different mangrove life stages. Higher retention and establishment of mangrove propagules are found inside saltmarshes than on bare flats, i.e. facilitation, and these effects are higher at grass than at succulent saltmarsh species. Mangrove seedlings, saplings, or trees mostly compete with saltmarshes, negatively affecting mangrove growth. We propose a model with different outcomes considering the interaction between different mangrove's life stages and saltmarsh forms and discussed these interactions in the light of anthropogenic threats and climate change., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Study Design: Prospective experimental study., Objective: To compare the accuracy of O-Arm-acquired radiographic and computed tomography (CT) evaluation of thoracic pedicle screw placement with open laminectomy in a simulation laboratory., Summary of Background Data: Improving surgical safety and procedural efficiency during thoracic posterior spine instrumentation is essential for decreasing complication rates and possible related risks. The most common way of verifying the position of pedicle screws during the surgical procedure and immediately postoperatively is to acquire intraoperative fluoroscopic images and plain radiographs of the spine, respectively. Laboratory simulated surgery is a valuable tool to evaluate the accuracy of those exams., Methods: Twenty simulation models of scoliosis from T3 to T7 were instrumented by five spine fellows (total of 200 pedicle screws), followed by radiographic and CT images acquired with the assistance of the O-Arm which were evaluated by three independent raters. A fellowship-trained spine neurosurgeon performed laminectomies on the instrumented levels and assessed pedicle integrity (gold standard)., Results: Forty-eight breaches were identified in the axial direct view after laminectomy. Of those, eighteen breaches were classified as unacceptable. Regarding the sagittal direct view, four breaches were observed, three of which were classified as unacceptable. Overall, both O-arm radiographic and CT evaluations had a significantly high negative predicted value but a low positive predicted value to identify unacceptable breaches, especially in the sagittal plane. The frequency of missed breaches by all three examiners was high, particularly in the sagittal plane., Conclusion: Postoperative evaluation of pedicle screws using O-arm-acquired radiographic or CT images may underdiagnose the presence of breaches. In our study, sagittal breaches were more difficult to diagnose than axial breaches. Although most breaches do not have clinical repercussions, this study suggests that this modality of postoperative radiographic assessment may be inaccurate., Level of Evidence: 4., Competing Interests: The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Guillain-Barré syndrome (GBS) is a rare autoimmune disorder of the peripheral nervous system that causes progressive weakness and sensory disturbances, usually following an infection or immunization. It has been associated with multiple causes, including bacterial and viral infections. Hepatitis E virus (HEV) is a common cause of acute viral hepatitis that can rarely develop neurological complications. We report a case of a 72-year-old man who developed GBS secondary to an acute HEV infection. He presented with numbness and weakness of the lower limbs that rapidly evolved into respiratory failure requiring mechanical ventilation and intravenous immunoglobulin therapy (IVIg). This case adds to the literature on the association between HEV infection and GBS and the importance of early detection of this rapidly progressive condition., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rodrigues et al.)

This work describes the kinetic study of different types (spontaneous, lactic and alcoholic) of açai fermentation in terms of total phenolics and total anthocyanins, as well as antioxidant capacity, before and after simulated digestion (SD). Cytotoxicity (A549, HCT8 and IMR90 cells) and formation of reactive oxygen species (A549 cells) were also evaluated. The results revealed that spontaneous fermentation (SF) for 24 h, followed by SD, generated a product with greater bioaccessibility of phenolics (52.68%) and cyanidin-3-glucoside (27.01%) than unfermented açai. Likewise, lactic fermentation (LF) for 72 h improved the bioavailability of phenolics (64.49%) and cyanidin-3-rutinoside (20.00%). On the other hand, alcoholic fermentation (AF) decreased the bioaccessibility of phenolic compounds and anthocyanins after SD. The SF 24 h (10.16 ± 1.25 μmol Trolox /g) and LF 72 h (15.90 ± 0.51 μmol Trolox /g) significantly increased the antioxidant capacity after SD, when compared to unfermented açai (SF 0 h, 4.00 ± 0.09 μmol Trolox /g; LF 0 h, 10.57 ± 0.91 μmol Trolox /g). It was concluded that the samples did not show cytotoxicity in the cell lines tested and, in addition, AF 24 h showed antioxidant and antimutagenic effects in vitro, reducing about 40% of chromosomal aberrations. The results obtained provide important information that can be used to produce foods with greater bioaccessibility of bioactive compounds., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Neurodevelopment disorders can result in facial dysmorphisms. Therefore, the analysis of facial images using image processing and machine learning techniques can help construct systems for diagnosing genetic syndromes and neurodevelopmental disorders. The systems offer faster and cost-effective alternatives for genotyping tests, particularly when dealing with large-scale applications. However, there are still challenges to overcome to ensure the accuracy and reliability of computer-aided diagnosis systems. This article presents a systematic review of such initiatives, including 55 articles. The main aspects used to develop these diagnostic systems were discussed, namely datasets - availability, type of image, size, ethnicities and syndromes - types of facial features, techniques used for normalization, dimensionality reduction and classification, deep learning, as well as a discussion related to the main gaps, challenges and opportunities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Bariatric surgery is the best treatment option for patients with obesity. As a result of the advancement of technology, the robotic gastric bypass presents promising results, despite its still high costs., Aims: The aim of this study was to compare patients submitted to a robotic versus a laparoscopic gastric bypass at a single center by a single surgeon., Methods: This retrospective study collected data from the medical records of 221 patients (121 laparoscopic procedures versus 100 with daVinci platform). The variables analyzed were sex, age, body mass index, comorbidities, surgical time, length of stay, and complications., Results: The mean surgical time for patients in the robotic group was shorter (102.41±39.44 min versus 113.86±39.03 min, p=0.018). The length of hospital stay in robotic patients was shorter (34.12±20.59 h versus 34.93±11.74 h, p=0.007). There were no serious complications., Conclusions: The group submitted to the robotic method had a shorter surgical time and a shorter hospital stay. No difference was found regarding strictures, bleeding, or leakage.

CYP2D6 analysis prior to the prescription of pimozide is required above a certain dose by the Food and Drug Administration in order to detect individuals with the poor metabolizer status. This precautionary measure aims to prevent the occurrence of serious adverse drug reactions. This study presents a case of a patient diagnosed with schizophrenia spectrum disorder. The patient suffered re-admission in the psychiatry ward because of severe secondary symptoms due to the antipsychotic drug pimozide, previously prescribed on a first admission. In order to assess the patient's medication profile, real-time PCR was performed to analyze the main genes responsible for its metabolization, namely, CYP2D6 and CYP3A4 . The pharmacogenetic study revealed that the patient is a poor metabolizer for CYP2D6 , presenting deletion of both copies of the gene (diplotype *5/*5). Fortunately, the symptomatology disappeared after the withdrawal of the responsible drug. In conclusion, abiding by the pharmacogenetic clinical practice guidelines and the pharmacogenetic analysis of CYP2D6 when prescribing pimozide would have probably saved the patient from the consequences of severe side effects and the health system expenditure. There is an important need for more training in the pharmacogenetic field for specialists in psychiatry., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Facal, Portela, Gil-Rodríguez, Barros, Maroñas and Carracedo.)

Background: Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal., Methods: Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of patients arriving at postanesthesia care unit (PACU) with a TOF ratio <0.9., Results: A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine. Twenty patients displayed a TOF ratio <0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%-7.8%). Only two patients displayed a TOF ratio <0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex ( P = .114). In patients with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%-8%), which varied significantly according to the type of monitoring ( P = .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate)., Conclusions: The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event., Competing Interests: S. Esteves, F. Abelha, H. Machado, N. Fernandes, and V. Pinho-Oliveira received consultant and lecture fees from MSD Portugal. The remaining authors have no conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of PBJ-Associação Porto Biomedical/Porto Biomedical Society.)

Backgorund: The production of red fruits, such as blueberry, has been threatened by several stressors from severe periods of drought, nutrient scarcity, phytopathogens, and costs with fertilization programs with adverse consequences. Thus, there is an urgent need to increase this crop's resilience whilst promoting sustainable agriculture. Plant growth-promoting microorganisms (PGPMs) constitute not only a solution to tackle water and nutrient deficits in soils, but also as a control against phytopathogens and as green compounds for agricultural practices., Methods: In this study, a metagenomic approach of the local fungal and bacterial community of the rhizosphere of Vaccinium corymbosum plants was performed. At the same time, both epiphytic and endophytic microorganisms were isolated in order to disclose putative beneficial native organisms., Results: Results showed a high relative abundance of Archaeorhizomyces and Serendipita genera in the ITS sequencing, and Bradyrhizobium genus in the 16S sequencing. Diversity analysis disclosed that the fungal community presented a higher inter-sample variability than the bacterial community, and beta-diversity analysis further corroborated this result. Trichoderma spp., Bacillus spp., and Mucor moelleri were isolated from the V. corymbosum plants., Discussion: This work revealed a native microbial community capable of establishing mycorrhizal relationships, and with beneficial physiological traits for blueberry production. It was also possible to isolate several naturally-occurring microorganisms that are known to have plant growth-promoting activity and confer tolerance to hydric stress, a serious climate change threat. Future studies should be performed with these isolates to disclose their efficiency in conferring the needed resilience for this and several crops., Competing Interests: The authors declare that they have no competing interests., (© 2023 Gomes et al.)

One of the key technologies in smart cities is the use of next generation networks such as 5G networks. Mainly because this new mobile technology offers massive connections in densely populated areas in smart cities, thus playing a crucial role for numerous subscribers anytime and anywhere. Indeed, all the most important infrastructure to promote a connected world is being related to next generation networks. Specifically, the small cells transmitters is one of the 5G technologies more relevant to provide more connections and to attend the high demand in smart cities. In this article, a smart small cell positioning is proposed in the context of a smart city. The work proposal aims to do this through the development of a hybrid clustering algorithm with meta-heuristic optimizations to serve users, with real data, of a region satisfying coverage criteria. Furthermore, the problem to be solved will be the best location of the small cells, with the minimization of attenuation between the base stations and its users. The possibilities of using multi-objective optimization algorithms based on bioinspired computing, such as Flower Pollination and Cuckoo Search, will be verified. It will also be analyzed by simulation which power values would allow the continuity of the service with emphasis on three 5G spectrums used around the world: 700 MHz, 2.3 GHz and 3.5 GHz., Competing Interests: The authors declare that they have no competing interests., (© 2023 Ferreira et al.)

Tropical ecosystems are central to the global focus on halting and reversing habitat destruction as a means of mitigating carbon emissions. Brazil has been highlighted as a vital part of global climate agreements because, whilst ongoing land-use change causes it to be the world's fifth biggest greenhouse gas emitting country, it also has one of the greatest potentials to implement ecosystem restoration. Global carbon markets provide the opportunity of a financially viable way to implement restoration projects at scale. However, except for rainforests, the restoration potential of many major tropical biomes is not widely recognised, with the result that carbon sequestration potential may be squandered. We synthesize data on land availability, land degradation status, restoration costs, area of native vegetation remaining, carbon storage potential and carbon market prices for 5475 municipalities across Brazil's major biomes, including the savannas and tropical dry forests. Using a modelling analysis, we determine how fast restoration could be implemented across these biomes within existing carbon markets. We argue that even with a sole focus on carbon, we must restore other tropical biomes, as well as rainforests, to effectively increase benefits. The inclusion of dry forests and savannas doubles the area which could be restored in a financially viable manner, increasing the potential CO 2 e sequestered >40 % above that offered by rainforests alone. Importantly, we show that in the short-term avoiding emissions through conservation will be necessary for Brazil to achieve it's 2030 climate goal, because it can sequester 1.5 to 4.3 Pg of CO 2 e by 2030, relative to 0.127 Pg CO 2 e from restoration. However, in the longer term, restoration across all biomes in Brazil could draw down between 3.9 and 9.8 Pg of CO 2 e from the atmosphere by 2050 and 2080., Competing Interests: Declaration of competing interest There is no competing interest to declare., (Copyright © 2023. Published by Elsevier B.V.)

Phase shift is characterized by an abrupt change in the structure of a community in response to a disturbance that can break its resistance, displacing it from its natural variation. This phenomenon has been recognized in several ecosystems and often points to human activities as the main cause. However, reactions of shifted communities to anthropogenic impacts have been less studied. In recent decades, heatwaves resulting from climate change have strongly affected coral reefs. Mass coral bleaching events are recognized as the main cause of coral reef phase shifts on a global scale. In 2019, an unprecedented heatwave hit the southwest Atlantic Ocean causing mass coral bleaching in non-degraded and phase-shifted reefs of Todos os Santos Bay, at an intensity never recorded in a 34-year historical series. We analyzed the effects of this event on the resistance of phase-shifted reefs, dominated by the zoantharian Palythoa cf. variabilis. Using benthic coverage data from 2003, 2007, 2011, 2017, and 2019, we analyzed three non-degraded reefs and three phase-shifted reefs. We estimated the coverage and bleaching of corals and P. cf. variabilis on each reef. There was a reduction in coral coverage in non-degraded reefs before the 2019 mass bleaching event (i.e., heatwave). However, there was no significant coral coverage variation after the event and the structure of non-degraded reef communities did not change. In phase-shifted reefs the coverage of zoantharians did not change significantly before the 2019 event, however, after the mass bleaching, there was a significant reduction in the coverage of these organisms. Here we revealed that the resistance of the shifted community was broken, and its structure was altered, indicating that reefs in this condition were more susceptible to bleaching disturbance than non-degraded reefs., Competing Interests: Declaration of competing interest None declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction and Objectives: Liver stiffness measurement (LSM) by transient elastography has been validated to predict high-risk varices (HRV). We aimed to evaluate the accuracy of shear-wave elastography (SWE) and platelet count (Baveno VI criteria) to rule out HRV in patients with compensated advanced chronic liver disease (c-ACLD)., Methods: This retrospective study analyzed data of patients with c-ACLD (transient elastography ≥ 10 kPa) submitted to two-dimensional SWE (2D-SWE) (GE-LOGIQ-S8) and/or point SWE (p-SWE) (ElastPQ) who had a gastrointestinal endoscopy within 24 months. HRV definition was a large size and presence of red wale marks or sequelae from previous treatment. Optimal thresholds of SWE systems for HRV were identified. The proportion of spared gastrointestinal endoscopies and missing HRV considering a favorable SWE Baveno VI criteria were assessed., Results: Eighty patients [36% male, median age = 63 (interquartile range, 57-69) years] were included. The prevalence of HRV was 34% ( n  = 27/80). The optimal thresholds to predict HRV were 10 kPa and 12 kPa for 2D-SWE and p-SWE, respectively. A favorable 2D-SWE Baveno VI criteria (LSM < 10 kPa and platelets count > 150 × 10 9 /mm 3 ) avoided 19% of gastrointestinal endoscopies without missing HRVs. A favorable p-SWE Baveno VI criteria (LSM < 12 kPa and platelets count > 150 × 10 9 /mm 3 ) spared 20% of gastrointestinal endoscopy without missing HRVs. Using a lower threshold of platelet count (<110 × 10 9 /mm 3 , expanded Baveno VI), 2D-SWE (<10 kPa) avoided 33% of gastrointestinal endoscopy with 8% of missing HRVs, while p-SWE (<12 kPa) avoided 36% of gastrointestinal endoscopy with 5% of missing HRVs., Conclusion: LSM by p-SWE or 2D-SWE combined with platelet count (Baveno VI criteria) can spare a considerable number of gastrointestinal endoscopies missing a negligible proportion of HRV., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Aims: Previous epidemiological evidence identified a concerning increase in behavioural problems among young children from 1997 to 2008 in Brazil. However, it is unclear whether behavioural problems have continued to increase, if secular changes vary between sociodemographic groups and what might explain changes over time. We aimed to monitor changes in child behavioural problems over a 22-year period from 1997 to 2019, examine changing social inequalities and explore potential explanations for recent changes in behavioural problems between 2008 and 2019., Methods: The Child Behaviour Checklist was used to compare parent-reported behavioural problems in 4-year-old children across three Brazilian birth cohorts assessed in 1997 (1993 cohort, n  = 633), 2008 (2004 cohort, n  = 3750) and 2019 (2015 cohort, n  = 577). Response rates across all three population-based cohorts were over 90%. Moderation analyses tested if cross-cohort changes differed by social inequalities (demographic and socioeconomic position), while explanatory models explored whether changes in hypothesized risk and protective factors in prenatal development (e.g., smoking during pregnancy) and family life (e.g., maternal depression and harsh parenting) accounted for changes in child behavioural problems from 2008 to 2019., Results: Initial increases in child behavioural problems from 1997 to 2008 were followed by declines in conduct problems (mean change = -2.75; 95% confidence interval [CI]: -3.56, -1.94; P  < 0.001), aggression (mean change = -1.84; 95% CI: -2.51, -1.17; P  < 0.001) and rule-breaking behaviour (mean change = -0.91; 95% CI: -1.13, -0.69 P  < 0.001) from 2008 to 2019. Sex differences in rule-breaking behaviour diminished during this 22-year period, whereas socioeconomic inequalities in behavioural problems emerged in 2008 and then remained relatively stable. Consequently, children from poorer and less educated families had higher behavioural problems, compared to more socially advantaged children, in the two more recent cohorts. Changes in measured risk and protective factors partly explained the reduction in behavioural problems from 2008 to 2019., Conclusions: Following a rise in child behavioural problems, there was a subsequent reduction in behavioural problems from 2008 to 2019. However, social inequalities increased and remained high. Continued monitoring of behavioural problems by subgroups is critical for closing the gap between socially advantaged and disadvantaged children and achieving health equity for the next generation.

Objective: We examined weather a protocol for fraction of inspired oxygen (FiO 2 ) adjustment can reduce hyperoxemia and excess oxygen use in COVID-19 patients mechanically ventilated., Design: Prospective cohort study., Setting: Two intensive care units (ICUs) dedicated to COVID-19 patients in Brazil., Patients: Consecutive patients with COVID-19 mechanically ventilated., Interventions: One ICU followed a FiO 2 adjustment protocol based on SpO 2 (conservative-oxygen ICU) and the other, which did not follow the protocol, constituted the control ICU., Main Variables of Interest: Prevalence of hyperoxemia (PaO 2  >100 mmHg) on day 1, sustained hyperoxemia (present on days 1 and 2), and excess oxygen use (FiO 2  > 0.6 in patients with hyperoxemia) were compared between the two ICUs., Results: Eighty two patients from the conservative-oxygen ICU and 145 from the control ICU were included. The conservative-oxygen ICU presented lower prevalence of hyperoxemia on day 1 (40.2% vs. 75.9%, p  < 0.001) and of sustained hyperoxemia (12.2% vs. 49.6%, p  < 0.001). Excess oxygen use was less frequent in the conservative-oxygen ICU on day 1 (18.3% vs. 52.4%, p  < 0.001). Being admitted in the control ICU was independently associated with hyperoxemia and excess oxygen use. Multivariable analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FiO 2 use and adverse clinical outcomes., Conclusions: Following FiO 2 protocol was associated with lower hyperoxemia and less excess oxygen use. Although those results were not associated with better clinical outcomes, adopting FiO 2 protocol may be useful in a scenario of depleted oxygen resources, as was seen during the COVID-19 pandemic., (© 2022 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)