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Purpose: To determine the risk factors associated with major complications in patients with histologically confirmed Xanthogranulomatous pyelonephritis (XGP) who underwent nephrectomy. Methods: A multicenter retrospective study was performed including patients who underwent nephrectomy between 2018 and 2022 with histopathological diagnosis of XGP. Clinical and laboratory parameters at the initial presentation were evaluated. Data on extension of XGP was recorded as per the Malek clinical-radiological classification. Characteristics of nephrectomy and perioperative outcomes were obtained. The primary outcome was major complications, defined as a CD ≥ grade 3 and the need for intensive care unit (ICU) admission. Secondary outcomes included the comparison of complications evaluating the nephrectomy approach (transperitoneal, retroperitoneal, and laparoscopic). A sub-analysis stratifying patients who needed ICU admission and Malek classification was performed. Results: A total of 403 patients from 10 centers were included. Major complications were reported in 98 cases (24.3%), and organ injuries were reported in 58 patients (14.4%), being vascular injuries the most frequent (6.2%). Mortality was reported in 5 cases (1.2%). A quick Sepsis-related Organ Failure Assessment (qSOFA) score ≥ 2, increased creatinine, paranephric extension of disease (Malek stage 3), a positive urine culture, and retroperitoneal approach were independent factors associated with major complications. Conclusion: Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease. Clinical-radiological staging, such as the Malek classification may predict the risk of major complications in patients with XGP who will undergo nephrectomy. A transperitoneal open approach may be the next best option when laparoscopic approach is not feasible. [ABSTRACT FROM AUTHOR]

Background: The burden of musculoskeletal conditions continues to grow in low‐ and middle‐income countries. Among thousands of surgical outreach trips each year, few organizations electronically track patient data to inform real‐time care decisions and assess trip impact. We report the implementation of an electronic health record (EHR) system utilized at point of care during an orthopedic surgical outreach trip. Methods: In March 2023, we implemented an EHR on an orthopedic outreach trip to guide real‐time care decisions. We utilized an effectiveness‐implementation hybrid type 3 design to evaluate implementation success. Success was measured using outcomes adopted by the World Health Organization, including acceptability, appropriateness, feasibility, adoption, fidelity, and sustainability. Clinical outcome measures included adherence to essential quality measures and follow‐up numerical rating system (NRS) pain scores. Results: During the 5‐day outreach trip, 76 patients were evaluated, 25 of which underwent surgery beforehand. The EHR implementation was successful as defined by: mean questionnaire ratings of acceptability (4.26), appropriateness (4.12), feasibility (4.19), and adoption (4.33) at least 4.00, WHO behaviorally anchored rating scale ratings of fidelity (6.8) at least 5.00, and sustainability (80%) at least 60% follow‐up at 6 months. All clinical quality measures were reported in greater than 80% of cases with all measures reported in 92% of cases. NRS pain scores improved by an average of 2.4 points. Conclusions: We demonstrate successful implementation of an EHR for real‐time clinical use on a surgical outreach trip. Benefits of EHR utilization on surgical outreach trips may include improved documentation, minimization of medical errors, and ultimately improved quality of care. [ABSTRACT FROM AUTHOR]

Although cells of mushroom-producing fungi typically contain paired haploid nuclei (n + n), most Armillaria gallica vegetative cells are uninucleate. As vegetative nuclei are produced by fusions of paired haploid nuclei, they are thought to be diploid (2n). Here we report finding haploid vegetative nuclei in A. gallica at multiple sites in southeastern Massachusetts, USA. Sequencing multiple clones of a single-copy gene isolated from single hyphal filaments revealed nuclear heterogeneity both among and within hyphae. Cytoplasmic bridges connected hyphae in field-collected and cultured samples, and we propose nuclear migration through bridges maintains this nuclear heterogeneity. Growth studies demonstrate among- and within-hypha phenotypic variation for growth in response to gallic acid, a plant-produced antifungal compound. The existence of both genetic and phenotypic variation within vegetative hyphae suggests that fungal individuals have the potential to evolve within a single generation in response to environmental variation over time and space. [ABSTRACT FROM AUTHOR]

The Spanish version of the Wisconsin Stone Quality of Life (WISQOL) questionnaire was developed and validated. A double-back translation of the WISQOL was conducted and syntactic amendments were made, resulting in the Spanish version of the WISQOL (S-WISQOL) which then went through a readability analysis. Stone formers from two hospitals in Mexico (Merida and Monterrey) filled in the S-WISQOL and the Short Form 36 (SF36). Convergent validity was assessed by the correlation of both questionnaires. Internal consistency was evaluated by Cronbach's α, and external validity by comparing between centers. The impact of clinical settings on patients' health-related quality of life (HRQOL) scores was tested. Each hospital's institutional review board approved the project and informed consent was obtained from all participants. A total of 87 Spanish-speakers patients completed the S-WISQOL and SF36 and a good correlation was found between both (r = 0.75, p < 0.001). S-WISQOL readability was rated as "easy". Patients from Merida had longer median duration (years) with stones, more stone-related procedures, and hospitalizations, and scored lower on WISQOL (p = 0.006). Internal consistency was good as Cronbach's α coefficients ranged between acceptable and excellent. Stone-related admissions and duration of stones were inversely correlated with S-WISQOL score (− 0.254 and − 0.283, respectively; p < 0.005) but not to SF36. The S-WISQOL is an internally consistent, reliable, and valid instrument to assess HRQOL in Spanish-speaking patients with kidney stones. The S-WISQOL is generalizable as demonstrated by good external validity among centers. S-WISQOL scores can be added as an outcome for kidney stone treatments. [ABSTRACT FROM AUTHOR]

Evolutionary algorithms (EAs) have been with us for several decades and are highly popular given that they have proved competitive in the face of challenging problems' features such as deceptiveness, multiple local optima, among other characteristics. However, it is necessary to define multiple hyper-parameter values to have a working EA, which is a drawback for many practitioners. In the case of genetic programming (GP), an EA for the evolution of models and programs, hyper-parameter optimization has been extensively studied only recently. This work builds on recent findings and explores the hyper-parameter space of a specific GP system called neat-GP that controls model size. This is conducted using two large sets of symbolic regression benchmark problems to evaluate system performance, while hyper-parameter optimization is carried out using three variants of the iterated F-Race algorithm, for the first time applied to GP. From all the automatic parametrizations produced by optimization process, several findings are drawn. Automatic parametrizations do not outperform the manual configuration in many cases, and overall, the differences are not substantial in terms of testing error. Moreover, finding parametrizations that produce highly accurate models that are also compact is not trivially done, at least if the hyper-parameter optimization process (F-Race) is only guided by predictive error. This work is intended to foster more research and scrutiny of hyper-parameters in EAs, in general, and GP, in particular. [ABSTRACT FROM AUTHOR]

This paper presents a direct power control strategy for a variable speed axial flux permanent magnet synchronous generator. The method consists on calculating the instantaneous power by measuring the machine currents and estimating the back electromotive force (back-emf). The real-time back-emf estimation is based on tracking the no-load voltage through off-line harmonic analysis, and the mechanical position and speed, obtained with an incremental encoder. A 3 kW laboratory prototype has been built to verify the performance of the proposed strategy. Experimental results are shown and discussed. [ABSTRACT FROM AUTHOR]

Our data proposes that glucose is transferred directly to the cerebrospinal fluid (CSF) of the hypothalamic ventricular cavity through a rapid "fast-track-type mechanism" that would efficiently stimulate the glucosensing areas. This mechanism would occur at the level of the median eminence (ME), a periventricular hypothalamic zone with no blood-brain barrier. This "fast-track" mechanism would involve specific glial cells of the ME known as β2 tanycytes that could function as "inverted enterocytes," expressing low-affinity glucose transporters GLUT2 and GLUT6 in order to rapidly transfer glucose to the CSF. Due to the large size of tanycytes, the presence of a high concentration of mitochondria and the expression of low-affinity glucose transporters, it would be expected that these cells accumulate glucose in the endoplasmic reticulum (ER) by sequestering glucose-6-phosphate (G-6-P), in a similar way to that recently demonstrated in astrocytes. Glucose could diffuse through the cells by micrometric distances to be released in the apical region of β2 tanycytes, towards the CSF. Through this mechanism, levels of glucose would increase inside the hypothalamus, stimulating glucosensing mechanisms quickly and efficiently. Key messages: • Glucose diffuses through the median eminence cells (β2 tanycytes), towards the hypothalamic CSF. • Glucose is transferred through a rapid "fast-track-type mechanism" via GLUT2 and GLUT6. • Through this mechanism, hypothalamic glucose levels increase, stimulating glucosensing. [ABSTRACT FROM AUTHOR]

In this work, a series of reactive copolymers of glycidyl methacrylate (G), styrene (S) and acrylonitrile (AN), were synthesized through reversible addition-fragmentation chain transfer polymerization and evaluated as macromolecular chain extenders in reactive extrusion of recycled poly(ethylene terephthalate) (rPET). The results obtained indicate that the addition of the reactive copolymers as chain extenders modifies the chain conformation in rPET causing low crystallization rate and low crystallinity. The physical and rheological properties (melt flow and intrinsic viscosity) of chain-extended rPET improved, rendering better processability. rPET modified with polymeric chain extenders shows improved rheological properties (complex viscosity, storage and loss modulus) and also displays higher elongation at break and impact properties as the GMA content in the chain extenders increase. [ABSTRACT FROM AUTHOR]

The thermo-catalytic CO activation was studied over supported nickel catalyst (Ni/LaO) obtained by reduction of the perovskite LaNiO. At temperatures lower than 700 °C, a superficial CO activation over the catalyst was observed and a partial structural change of the support to lanthanum oxycarbonate was determined by in situ XRD. The oxycarbonate species decomposed at around 750 °C, regenerating the original support LaO and producing CO (determined by TGA-MS). Above 750 °C, CO consumption accompanied by CO production and a weight increase were observed by TGA-MS. These observations suggest the oxidation of metallic nickel to NiO. The oxidation process finished at around 1180 °C, the phases obtained were NiO/LaNiO. The mechanism of oxidized species formation was proposed according to the kinetic parameters obtained by TGA-MS under CO atmosphere. Activation energies and pre-exponential factors were calculated for the different steps of the mechanism proposed. Additionally, a kinetic compensation effect was observed for the activation of CO on NiO/LaO catalyst. This compensation effect exhibited a slope change at around 850 °C, which suggested a modification of the mechanism at this temperature. [ABSTRACT FROM AUTHOR]

In this work, we propose a two-dimensional photonic crystal-photonic crystal heterostructure that possesses the requirements for exciting an electromagnetic interface mode and investigate its interaction with photonic crystal waveguide modes. To study the interaction and coupling of both types of modes, the proper conditions to excite them are analyzed. Photonic crystal guided modes can appear in nearly any band gap when the photonic crystal has a line of defects within its lattice. Photonic crystal-photonic crystal surface modes can be excited at the junction of two different photonic crystals that share translation symmetry along the interface direction and have overlapped frequency band gaps. When this condition is met, dispersion relations of photonic crystal-photonic crystal surface modes will lie in the common region of both band gaps. Once the proper conditions are provided to excite these two modes, an interaction between them is possible. In the resulting calculations, a symmetric supercell and a plane wave basis are defined to numerically solve the wave equation. [ABSTRACT FROM AUTHOR]

Focused-ion-beam scanning electron microscopy (FIB-SEM) has become an essential tool for studying neural tissue at resolutions below 10 nm × 10 nm × 10 nm, producing data sets optimized for automatic connectome tracing. We present a technical advance, ultrathick sectioning, which reliably subdivides embedded tissue samples into chunks (20 μm thick) optimally sized and mounted for efficient, parallel FIB-SEM imaging. These chunks are imaged separately and then 'volume stitched' back together, producing a final three-dimensional data set suitable for connectome tracing. [ABSTRACT FROM AUTHOR]

In this work, the parallel implementation of a segmentation algorithm based on the gradient vector flow (GVF) deformable model in a graphics processing unit (GPU) is presented. The proposed implementation focuses on the parallelization of the computation of the GVF field. In order to make a performance comparison of the proposed GPU algorithm, an OpenMP-based implementation is presented too. We also present an analysis of the textures and global memory performance in the computing of the GVF field. To improve the efficiency and the performance of the active contour segmentation, a novel snaxel reallocation method is proposed. The main advantage of the reallocation process is the small linear system needed to perform the segmentation and its low computational load. To assure the convergence of the active contour deformation, we propose a stopping criterion based on the root mean square error for the iterative solution of the evolution equations. [ABSTRACT FROM AUTHOR]

This research aims to quantify the importance of a country's entrepreneurship level in terms of its competitiveness rates. Our hypothesis is that those countries entrepreneurship growth rates increase their competitiveness indicators and that this entrepreneurial improvement could be a key factor in reaching the next stage of development. We establish this relationship using a longitudinal database of Latin American countries that participated in the Global Entrepreneurship Monitor (GEM) and the Global Competitiveness Reports of the World Economic Forum (WEF) from 2001 to 2006. GEM and WEF construct aggregated indexes using several variables to rate each country's entrepreneurship activity and competitiveness development. We use a discriminant analysis to identify various countries' competitiveness subgroups and show how each country's entrepreneurship rates have weight in different stages of competitiveness, placing a special emphasis on Latin America. Our results suggest that Latin American countries need to gain entrepreneurial dynamics and economic (and competitiveness) development by transforming their typical self-employment or low value-added new ventures for local markets into strong, innovative networked firms competing globally. Some management and policy implications are also discussed. [ABSTRACT FROM AUTHOR]

A mathematical model for the anionic polymerization of isoprene using n-butyl lithium (n-BuLi) as initiator and N,N,N′,N′-tetramethylethylenediamine (TMEDA) as microstructure modifier, considering a system similar to a tetrapolymerization and a scheme of reaction that considers that the active sites are different in configuration, has been developed. Experimental data of conversion versus time and structure development (1,4-cis, 1,4-trans, vinyl or isopropenyl units) were taken from the literature. Since 1,4-cis structural units are difficult to measure, directly, we used reports based on indirect measurements for natural polyisoprene. The cis structural unit fraction was varied from 0.1 to 0.9 (referred to cis+trans content) in order to provide enough data for parameter estimation purposes. Rate expressions for monomer consumption as well as microstructure and dyad development were obtained from the proposed scheme of reaction. The fraction of active sites and dyad distribution were calculated using Markov chains theory, based on conditional probabilities. The kinetic model correctly describes the performance anionic polymerizations with and without TMEDA. [ABSTRACT FROM AUTHOR]

The anionic solution copolymerization of butadiene and styrene prepared by anionic living polymerization using an initiator composed of n-butyl lithium, and N,N,N′,N′-tetramethylethylenediamine as active center modifier was modeled as a tetrapolymerization. The kinetic model proposed considering that the reactivity of the active sites is different because of varying configurations cis, trans, vinyl, and styryl. From the reaction scheme expressions to rate of monomers consumption, microstructure and dyad formation were obtained. With the first-order Markov model, the expressions for the fraction of active sites and dyad distribution as a function of the conditional probabilities were obtained. Therefore, the model proposed is different to kinetic models previously reported, because it allows obtaining the parameters kinetic in order to know the distribution of the isomeric species presents in the copolymerization of butadiene and styrene, and the intrinsic reactivity of configurational active sites. The rate constants were determined by fitting to the conversion and dyad experimental data using the nonlinear least square method. The experimental data reported in the literature, monomer conversion and microstructure, in addition to dyad sequence distribution were correctly predicted. [ABSTRACT FROM AUTHOR]

Synaptic plasticity underlies the adaptability of the mammalian brain, but has been difficult to study in living animals. Here we imaged the synapses between pre- and postganglionic neurons in the mouse submandibular ganglion in vivo, focusing on the mechanisms that maintain and regulate neurotransmitter receptor density at postsynaptic sites. Normally, synaptic receptor densities were maintained by rapid exchange of receptors with nonsynaptic regions (over minutes) and by continual turnover of cell surface receptors (over hours). However, after ganglion cell axons were crushed, synaptic receptors showed greater lateral mobility and there was a precipitous decline in insertion. These changes led to near-complete loss of synaptic receptors and synaptic depression. Disappearance of postsynaptic spines and presynaptic terminals followed this acute synaptic depression. Therefore, neurotransmitter receptor dynamism associated with rapid changes in synaptic efficacy precedes long-lasting structural changes in synaptic connectivity. [ABSTRACT FROM AUTHOR]

Glycine receptors (GlyRs), together with GABA[SUBA] and nicotinic acetylcholine (ACh) receptors, form part of the ligand-activated ion channel superfamily and regulate the excitability of the mammalian brain stem and spinal cord. Here we report that the ability of the neurotransmitter glycine to gate recombinant and native ionotropic GlyRs is modulated by the G protein βγ dimer (Gβ&gamma.). We found that the amplitude of the glycine-activated Cl[SUP-] current was enhanced after application of purified Gβγ or after activation of a G protein-coupled receptor. Overexpression of three distinct G protein α subunits (Gα), as well as the Gβγ scavenger peptide ct-GRK2, significantly blunted the effect of G protein activation. Single-channel recordings from isolated membrane patches showed that Gβγ increased the GlyR open probability (nP[SUBo]). Our results indicate that this interaction of Gβγ with GlyRs regulates both motor and sensory functions in the central nervous system. [ABSTRACT FROM AUTHOR]

Objective: To assess the acute effect of a lung recruitment maneuver (LRM) on lung morphology in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).Patients: Ten patients with ALI/ARDS on mechanical ventilation.Design: Prospective clinical study.Setting: Computed tomography (CT) scan facility in a teaching hospital.Interventions: An LRM performed by stepwise increases in positive end-expiratory pressure (PEEP) of up to 30-40 cm H(2)O. Lung basal CT sections were taken at end-expiration (patients 1 to 5), and at end-expiration and end-inspiration (patients 6 to 10). Arterial blood gases and static compliance (C(st)) were measured before, during and after the LRM.Measurements and Main Results: Poorly aerated and non-aerated tissue at PEEP 10 cm H(2)O accounted for 60.0+/-29.1% of lung parenchyma, while only 1.1+/-1.8% was hyperinflated. Increasing PEEP to 20 and 30 cm H(2)O, compared to PEEP 10 cm H(2)O, decreased poorly aerated and non-aerated tissue by 16.2+/-28.0% and 33.4+/-13.8%, respectively ( p<0.05). This was associated with an increase in PaO(2) and a decrease in total static compliance. Inspiration increased alveolar recruitment at all PEEP levels. Hyperinflated tissue increased up to 2.9+/-4.0% with PEEP 30 cm H(2)O, and to a lesser degree with inspiration. No barotrauma or severe hypotension occurred.Conclusions: Lung recruitment maneuvers improve oxygenation by expanding collapsed alveoli without inducing too much hyperinflation in ALI/ARDS patients. An LRM during the CT scan gives morphologic and functional information that could be useful in setting ventilatory parameters. [ABSTRACT FROM AUTHOR]

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In recent years, the development of mobile applications for people within the autism spectrum has proliferated to help enhance skills that could be diminished in users with this condition. However, the usability of these applications does not appear to be the focus of development because users with autism can have difficulty with fine motor skills. This article focuses on evaluating the optimal drag distance and the sizes of the interaction elements for users with Autism Spectrum Disorder. To accomplish this goal, a case study was conducted that involved 20 users with Autism Spectrum Disorder and 30 users with typical development, using a prototype generated and two applications for commercial use on 7-in. tablets. For both developed applications, a slight variation can be observed between the different groups of participants. In the interaction with Proyect@ Habilidades, the application has pictograms of 65 pixels and it has a maximum trailing distance of 340 pixels. Moreover, in Proyect@ Retratos, where there is a minimum deviation between users with levels of autism 1 and 2, it also has pictograms of 65 pixels but with a drag distance of 110 pixels. For this reason, according to the results, we suggest that in order to obtain better results in the interaction with applications aimed at users diagnosed with autism spectrum disorders, the applications should have pictograms of a range of 65 pixels with a drag interaction between 110 and 340 pixels. Considering in context a 7-in. tablet with a resolution of 1280 × 800 pixels. [ABSTRACT FROM AUTHOR]