Search

Tokamak à configuration variable (TCV), recently celebrating 30 years of near-continual operation, continues in its missions to advance outstanding key physics and operational scenario issues for ITER and the design of future power plants such as DEMO. The main machine heating systems and operational changes are first described. Then follow five sections: plasma scenarios. ITER Base-Line (IBL) discharges, triangularity studies together with X3 heating and N2 seeding. Edge localised mode suppression, with a high radiation region near the X-point is reported with N _2 injection with and without divertor baffles in a snowflake configuration. Negative triangularity (NT) discharges attained record, albeit transient, β _N ∼ 3 with lower turbulence, higher low-Z impurity transport, vertical stability and density limits and core transport better than the IBL. Positive triangularity L-Mode linear and saturated ohmic confinement confinement saturation, often-correlated with intrinsic toroidal rotation reversals, was probed for D, H and He working gases. H-mode confinement and pedestal studies were extended to low collisionality with electron cyclotron heating obtaining steady state electron iternal transport barrier with neutral beam heating (NBH), and NBH driven H-mode configurations with off-axis co-electron cyclotron current drive. Fast particle physics. The physics of disruptions, runaway electrons and fast ions (FIs) was developed using near-full current conversion at disruption with recombination thresholds characterised for impurity species (Ne, Ar, Kr). Different flushing gases (D2, H2) and pathways to trigger a benign disruption were explored. The 55 kV NBH II generated a rich Alfvénic spectrum modulating the FI fas ion loss detector signal. NT configurations showed less toroidal Alfvén excitation activity preferentially affecting higher FI pitch angles. Scrape-off layer and edge physics. gas puff imaging systems characterised turbulent plasma ejection for several advanced divertor configurations, including NT. Combined diagnostic array divertor state analysis in detachment conditions was compared to modelling revealing an importance for molecular processes. Divertor physics. Internal gas baffles diversified to include shorter/longer structures on the high and/or low field side to probe compressive efficiency. Divertor studies concentrated upon mitigating target power, facilitating detachment and increasing the radiated power fraction employing alternative divertor geometries, optimised X-point radiator regimes and long-legged configurations. Smaller-than-expected improvements with total flux expansion were better modelled when including parallel flows. Peak outer target heat flux reduction was achieved (>50%) for high flux-expansion geometries, maintaining core performance ( H _98 > 1). A reduction in target heat loads and facilitated detachment access at lower core densities is reported. Real-time control. TCV’s real-time control upgrades employed MIMO gas injector control of stable, robust, partial detachment and plasma β feedback control avoiding neoclassical tearing modes with plasma confinement changes. Machine-learning enhancements include trajectory tracking disruption proximity and avoidance as well as a first-of-its-kind reinforcement learning-based controller for the plasma equilibrium trained entirely on a free-boundary simulator. Finally, a short description of TCV’s immediate future plans will be given.

Within the 9th European Framework programme, since 2021 EUROfusion is operating five tokamaks under the auspices of a single Task Force called ‘Tokamak Exploitation’. The goal is to benefit from the complementary capabilities of each machine in a coordinated way and help in developing a scientific output scalable to future largre machines. The programme of this Task Force ensures that ASDEX Upgrade, MAST-U, TCV, WEST and JET (since 2022) work together to achieve the objectives of Missions 1 and 2 of the EUROfusion Roadmap: i) demonstrate plasma scenarios that increase the success margin of ITER and satisfy the requirements of DEMO and, ii) demonstrate an integrated approach that can handle the large power leaving ITER and DEMO plasmas. The Tokamak Exploitation task force has therefore organized experiments on these two missions with the goal to strengthen the physics and operational basis for the ITER baseline scenario and for exploiting the recent plasma exhaust enhancements in all four devices (PEX: Plasma EXhaust) for exploring the solution for handling heat and particle exhaust in ITER and develop the conceptual solutions for DEMO. The ITER Baseline scenario has been developed in a similar way in ASDEX Upgrade, TCV and JET. Key risks for ITER such as disruptions and run-aways have been also investigated in TCV, ASDEX Upgrade and JET. Experiments have explored successfully different divertor configurations (standard, super-X, snowflakes) in MAST-U and TCV and studied tungsten melting in WEST and ASDEX Upgrade. The input from the smaller devices to JET has also been proven successful to set-up novel control schemes on disruption avoidance and detachment.

An overview is presented of the progress since 2021 in the construction and scientific programme preparation of the Divertor Tokamak Test (DTT) facility. Licensing for building construction has been granted at the end of 2021. Licensing for Cat. A radiologic source has been also granted in 2022. The construction of the toroidal field magnet system is progressing. The prototype of the 170 GHz gyrotron has been produced and it is now under test on the FALCON facility. The design of the vacuum vessel, the poloidal field coils and the civil infrastructures has been completed. The shape of the first DTT divertor has been agreed with EUROfusion to test different plasma and exhaust scenarios: single null, double null, X-divertor and negative triangularity plasmas. A detailed research plan is being elaborated with the involvement of the EUROfusion laboratories.

Psoriasis is a chronic immune-mediated disease that is linked to an increased risk of cancer. Although numerous studies have explored whether neoplasms are concurrent conditions or are induced by psoriasis, a definitive definition remains elusive. In this study, we conducted a comprehensive narrative literature review to offer practical guidance to oncologists and dermatologists regarding the initiation and discontinuation of biologics for psoriasis. The findings indicate that a customized approach is recommended for each patient, and that a history of malignancies does not constitute an absolute contraindication for biologics. Growing evidence supports the treatment of selected patients, emphasizing a nuanced assessment of benefits and risks. There is a lack of data specifying a safe timeframe to initiate biologics following a neoplasm diagnosis due to influences from cancer-related and patient-specific characteristics impacting prognosis. Some patients may continue anti-psoriasis therapy during cancer treatments. Enhanced comprehension of the biological mechanisms in cancer progression and the immune microenvironment of psoriasis holds promise for refining therapeutic strategies. In conclusion, a personalized treatment approach necessitates collaboration between oncologists and dermatologists, considering factors such as cancer prognosis, psoriasis clinical manifestations, patient characteristics, and preferences when making treatment decisions.

BackgroundGermline variants in the melanocortin 1 receptor gene (MC1R) might increase the risk of childhood and adolescent melanoma, but a clear conclusion is challenging because of the low number of studies and cases. We assessed the association of MC1R variants with childhood and adolescent melanoma in a large study comparing the prevalence of MC1R variants in child or adolescent patients with melanoma to that in adult patients with melanoma and in healthy adult controls.MethodsIn this retrospective pooled analysis, we used the M-SKIP Project, the Italian Melanoma Intergroup, and other European groups (with participants from Australia, Canada, France, Greece, Italy, the Netherlands, Serbia, Spain, Sweden, Turkey, and the USA) to assemble an international multicentre cohort. We gathered phenotypic and genetic data from children or adolescents diagnosed with sporadic single-primary cutaneous melanoma at age 20 years or younger, adult patients with sporadic single-primary cutaneous melanoma diagnosed at age 35 years or older, and healthy adult individuals as controls. We calculated odds ratios (ORs) for childhood and adolescent melanoma associated with MC1R variants by multivariable logistic regression. Subgroup analysis was done for children aged 18 or younger and 14 years or younger.FindingsWe analysed data from 233 young patients, 932 adult patients, and 932 healthy adult controls. Children and adolescents had higher odds of carrying MC1R r variants than did adult patients (OR 1·54, 95% CI 1·02-2·33), including when analysis was restricted to patients aged 18 years or younger (1·80, 1·06-3·07). All investigated variants, except Arg160Trp, tended, to varying degrees, to have higher frequencies in young patients than in adult patients, with significantly higher frequencies found for Val60Leu (OR 1·60, 95% CI 1·05-2·44; p=0·04) and Asp294His (2·15, 1·05-4·40; p=0·04). Compared with those of healthy controls, young patients with melanoma had significantly higher frequencies of any MC1R variants.InterpretationOur pooled analysis of MC1R genetic data of young patients with melanoma showed that MC1R r variants were more prevalent in childhood and adolescent melanoma than in adult melanoma, especially in patients aged 18 years or younger. Our findings support the role of MC1R in childhood and adolescent melanoma susceptibility, with a potential clinical relevance for developing early melanoma detection and preventive strategies.FundingSPD-Pilot/Project-Award-2015; AIRC-MFAG-11831.

Background and aim: The knowledge about the acute kidney injury (AKI) incidence in patients with coronavirus disease 2019 (COVID-19) can help health teams to carry out a targeted care plan. This study aimed to determine the AKI incidence in patients hospitalized with COVID-19. Methods: The electronic search covered research published until June 20, 2020, and included five databases, PubMed, Embase, Web of Science, Scopus, and Lilacs (Latin American and Caribbean Health Sciences Library). Eligible studies were those including data from AKI occurrence in adult patients hospitalized with COVID-19. The primary outcome was AKI incidence, and the secondary outcome assessed was the AKI mortality. Additionally, the estimated incidence of renal replacement therapy (RRT) need also was verified. Using a standardized form prepared in Microsoft Excel, data were extracted by two independents authors, regarding the description of studies, characteristics of patients and clinical data on the AKI occurrence. Results: We included 30 studies in this systematic review, of which 28 were included in the meta-analysis. Data were assessed from 18.043 adult patients with COVID-19. The AKI estimate incidence overall and at the ICU was 9.2% (4.6–13.9) and 32.6% (8.5–56.6), respectively. AKI estimate incidence in the elderly patients and those with acute respiratory disease syndrome was 22.9% (−4.0–49.7) and 4.3% (1.8–6.8), respectively. Patients with secondary infection, AKI estimate incidence was 31.6% (12.3–51.0). The estimate incidence of patients that required RRT was 3.2% (1.1–5.4) and estimate AKI mortality was 50.4% (17.0–83.9). Conclusion: The occurrence of AKI is frequent among adult patients hospitalized with COVID-19, and affects on average, up to 13.9% of these patients. It is believed that AKI occurs early and in parallel with lung injury. Resumen: Antecedentes y objetivo: El conocimiento de la incidencia de lesión renal aguda (LRA) en pacientes con enfermedad por coronavirus 2019 (COVID-19) puede ayudar a los equipos de atención médica a llevar a cabo un plan de atención específico. Este estudio tuvo como objetivo determinar la incidencia de LRA en pacientes hospitalizados con COVID-19. Métodos: La búsqueda electrónica cubrió la investigación publicada hasta el 20 de junio del 2020 e incluyó 5 bases de datos: PubMed, Embase, Web of Science, Scopus y Lilacs (Biblioteca de Ciencias de la Salud de América Latina y el Caribe). Los estudios elegibles fueron aquellos que incluyeron datos sobre la aparición de LRA en pacientes adultos hospitalizados con COVID-19. El resultado primario fue la incidencia de LRA y el resultado secundario evaluado fue la mortalidad por LRA. Además, también se verificó la incidencia estimada de necesidad de terapia de reemplazo renal (TRR). Mediante un formulario estandarizado elaborado en Microsoft Excel, los datos fueron extraídos por 2 autores independientes, haciendo referencia a la descripción de los estudios, las características de los pacientes y los datos clínicos sobre la ocurrencia de LRA. Resultados: En esta revisión sistemática se incluyeron 30 estudios, de los cuales 28 se incluyeron en el metaanálisis. Se evaluaron los datos de 18.043 pacientes adultos con COVID-19. La incidencia estimada de LRA en general y en la UCI fue del 9,2% (4,6-13,9) y del 32,6% (8,5-56,6), respectivamente. La incidencia estimada de LRA en pacientes ancianos y pacientes con síndrome de enfermedad respiratoria aguda fue del 22,9% (–4,0-49,7) y del 4,3% (1,8-6,8), respectivamente. En pacientes con infección secundaria, la incidencia estimada de LRA fue del 31,6% (12,3-51,0). La incidencia estimada de pacientes que requirieron TRR fue del 3,2% (1,1-5,4) y la mortalidad estimada por LRA fue del 50,4% (17,0-83,9). Conclusión: La ocurrencia de LRA es frecuente en pacientes adultos hospitalizados con COVID-19 y afecta, en promedio, hasta al 13,9% de estos pacientes. Se cree que la LRA ocurre temprano y en paralelo con la lesión pulmonar.

Abstract The development of different generations of BCR-ABL1 tyrosine kinase inhibitors (TKIs) has led to the high overall survival of chronic myeloid leukemia (CML) patients. However, there are CML patients who show resistance to TKI therapy and are prone to progress to more advanced phases of the disease. So, implementing an alternative approach for targeting TKIs insensitive cells would be of the essence. Dihydroorotate dehydrogenase (DHODH) is an enzyme in the de novo pyrimidine biosynthesis pathway that is located in the inner membrane of mitochondria. Here, we found that CML cells are vulnerable to DHODH inhibition mediated by Meds433, a new and potent DHODH inhibitor recently developed by our group. Meds433 significantly activates the apoptotic pathway and leads to the reduction of amino acids and induction of huge metabolic stress in CML CD34+ cells. Altogether, our study shows that DHODH inhibition is a promising approach for targeting CML stem/progenitor cells and may help more patients discontinue the therapy.

Basosquamous carcinoma (BSC), an uncommon and aggressive nonmelanoma skin cancer exhibiting characteristics ranging from basal cell carcinoma (BCC) to squamous cell carcinoma (SCC), is a subject of controversy in terms of its classification, pathogenesis, histologic morphology, biologic behavior, prognosis, and management. This narrative review is based on an electronic search of English-language articles in PubMed that included the terms “basosquamous carcinoma” and/or “metatypical carcinoma of the skin” in their titles. The review aims to succinctly present and assess current data on the epidemiology, clinical presentation, dermoscopic, LC-OCT, and histopathologic characteristics, as well as the genetics and management of BSC, providing insight into this intriguing entity. As a conclusion, dermoscopy, deep incisional biopsies, and immunohistologic techniques should be applied in clinically suspicious lesions to achieve an early diagnosis and better prognosis of this tumor. Surgical treatments, including wide excision and Mohs’ micrographic surgery, remain the treatment of choice. Finally, Hedgehog pathway inhibitors and checkpoint inhibitors, must be thoroughly investigated with large controlled trials, since they may offer an alternative solution to irresectable or difficult-to-treat locally advanced cases of basosquamous carcinoma.

This study investigated the associations between total and regional body composition with performance in the special judo fitness test (SJFT), as well as strength and power tests (countermovement vertical jump—CMJ, squat jump—SJ, plyometric push-up—PPU, and force push-up—FPU). Twenty-three high-level judo athletes participated in this study. Initially, they underwent dual-energy X-ray absorptiometry, after which they performed the CMJ, SJ, PPU, and FPU tests. On another day, the SJFT was carried out. Correlations were tested using Pearson’s test. The performance in the SJFT was correlated with the total and arm %fat mass (r = −0.759), torso fat mass (r = −0.802), torso %fat mass (r = −0.822) and in the lower limb regions with the leg fat mass (r = −0.803) and leg %fat (r = −0.745). In the strength and power tests, there were also negative correlations observed between regional fat and performance. There was a negative correlation between the percentage of total fat and performance in the SJFT (r = −0.824), SJ (r = −0.750), CMJ (r = −0.742), PPU (r = −0.609), and FPU (r = −0.736). Fat, both total fat and regional fat in the arms, torso, and legs, is strongly correlated with a poor performance in the SJFT and poor strength and power.

Background: The incidence of cutaneous squamous cell carcinoma (cSCC) is rapidly increasing, paralleling the aging of the population. cSCC predominantly affects chronically sun-exposed areas, such as the head and neck region. At our tertiary center, a multidisciplinary approach to non-melanoma skin cancer is provided for locally advanced cSCC. Methods: We retrospectively revised all patients with locally advanced/metastatic cSCC treated with anti-PD1 antibody (Cemiplimab) at our Institution from January 2020 to March 2023 (minimum follow-up of 4 months on treatment). Results: Overall, we consecutively treated 20 ultra-octogenarian patients, of whom 15 were males and 5 were females (median age: 86.9 years). Despite age, a median number of concomitant drugs, and comorbidities, efficacy, and safety were superimposable with the available literature. No patients reported treatment-related adverse events of grade 3 or higher. Grade 2 adverse events were reported in 25% of patients. Overall, the response rate was 65%, with 50% partial responses and 20% long-lasting stable disease. The median duration of response was 14 months. The G8 elderly score was assessed in all patients, and the median score was 12 (range 9–14). Conclusions: Among ultra-octogenarian patients, a clinical benefit from Cemiplimab was obtained in most, including tumor shrinkage and pain relief. Cemiplimab confirmed its effectiveness in elderly patients in a real-life setting, with no new safety concerns.

Non-linear inverse Compton scattering (NICS) is of significance in laser-plasma physics and for application-relevant laser-driven photon sources. Given this interest, we investigated this synchrotron-like photon emission in a promising configuration achieved when an ultra-intense laser pulse interacts with a double-layer target (DLT). Numerical simulations with two-dimensional particle-in-cell codes and analytical estimates are used for this purpose. The properties of NICS are shown to be governed by the processes characterizing laser interaction with the near-critical and solid layers composing the DLT. In particular, electron acceleration, laser focusing in the low-density layer, and pulse reflection on the solid layer determine the radiated power, the emitted spectrum, and the angular properties of emitted photons. Analytical estimates, supported by simulations, show that quantum effects are relevant at laser intensities as small as ∼1021 W/cm2 Target and laser parameters affect the NICS competition with bremsstrahlung and the conversion efficiency and average energy of emitted photons. Therefore, DLT properties could be exploited to tune and enhance photon emission in experiments and future applications.

PurposeTo assess dosimetry predictors of gastric and duodenal toxicities for locally advanced pancreatic cancer (LAPC) patients treated with chemo-radiotherapy in 15 fractions.MethodsData from 204 LAPC patients treated with induction+concurrent chemotherapy and radiotherapy (44.25 Gy in 15 fractions) were available. Forty-three patients received a simultaneous integrated boost of 48–58 Gy. Gastric/duodenal Common Terminology Criteria for Adverse Events v. 5 (CTCAEv5) Grade ≥2 toxicities were analyzed. Absolute/% duodenal and stomach dose–volume histograms (DVHs) of patients with/without toxicities were compared: the most predictive DVH points were identified, and their association with toxicity was tested in univariate and multivariate logistic regressions together with near-maximum dose (D0.03) and selected clinical variables.ResultsToxicity occurred in 18 patients: 3 duodenal (ulcer and duodenitis) and 10 gastric (ulcer and stomatitis); 5/18 experienced both. At univariate analysis, V44cc (duodenum: p = 0.02, OR = 1.07; stomach: p = 0.01, OR = 1.12) and D0.03 (p = 0.07, OR = 1.19; p = 0.008, OR = 1.12) were found to be the most predictive parameters. Stomach/duodenum V44Gy and stomach D0.03 were confirmed at multivariate analysis and found to be sufficiently robust at internal, bootstrap-based validation; the results regarding duodenum D0.03 were less robust. No clinical variables or %DVH was significantly associated with toxicity. The best duodenum cutoff values were V44Gy < 9.1 cc (and D0.03 < 47.6 Gy); concerning the stomach, they were V44Gy < 2 cc and D0.03 < 45 Gy. The identified predictors showed a high negative predictive value (>94%).ConclusionIn a large cohort treated with hypofractionated radiotherapy for LAPC, the risk of duodenal/gastric toxicities was associated with duodenum/stomach DVH. Constraining duodenum V44Gy < 9.1 cc, stomach V44Gy < 2 cc, and stomach D0.03 < 45 Gy should keep the toxicity rate at approximately or below 5%. The association with duodenum D0.03 was not sufficiently robust due to the limited number of events, although results suggest that a limit of 45–46 Gy should be safe.

Introdução: A população em situação de rua é vulnerabilizada por diversos fatores que determinam ou condicionam sua saúde e ocasionam aumento dos índices de comorbidades clínicas, entre elas as doenças mentais, crônicas e infectocontagiosas. A marginalização dos indivíduos que se encontram em situação de rua abre uma lacuna na assistência em saúde que, por vezes, é suprida por organizações sem fins lucrativos que exercem um papel social elementar. Objetivo: Mapear o perfil clínico da população em situação de rua de Curitiba (PR) atendida por iniciativa voluntária no período de um ano. Métodos: Trata-se de um estudo observacional descritivo de base documental realizado com fichas clínicas dos 509 pacientes maiores de 18 anos e que tiveram seu primeiro atendimento médico realizado pela Associação Médicos do Mundo, filial Curitiba (PR), no ano de 2019. Resultados: Indivíduos do sexo masculino, de etnia branca, faixa etária entre 36 e 45 anos, que cursaram o ensino fundamental e que se encontravam havia menos de um ano em situação de rua foram as condições sociodemográficas predominantes. As principais queixas motivadoras da procura pelo atendimento foram dor (45,19%), lesões cutâneas (15,71%) e queixas oftalmológicas (6,68%). Parte dos indivíduos mostrou acometimento crônico por hipertensão arterial sistêmica (9,03%), HIV/AIDS (3,53%) e diabetes mellitus (3,53%). Também foi identificada quantidade significativa de relatos de histórico de traumas físicos (59%). Encontrou-se correlação estatística entre hipertensão e medicamentos de uso contínuo (p=0,001). Menos que 10% dos indivíduos procuraram atendimento médico por queixas de saúde mental. Das mulheres que fizerem parte do estudo, 70% relataram fazer uso de substâncias e aproximadamente metade delas, uso regular de medicamentos. Já o uso de anticoncepcionais foi relatado por uma minoria delas (18,57%). Conclusões: As queixas de dor, as lesões cutâneas e as demandas oftalmológicas foram os principais motivadores da procura por ajuda médica pela população em situação de rua, além da prevalência de hipertensão arterial sistêmica como doença crônica. Os achados podem auxiliar e direcionar ações em saúde voltadas para essa população marginalizada.

Abstract Background Human disturbance alters animal movement globally and infrastructure, such as roads, can act as physical barriers that impact behaviour across multiple spatial scales. In ungulates, roads can particularly hamper key ecological processes such as dispersal and migration, which ensure functional connectivity among populations, and may be particularly important for population performance in highly human-dominated landscapes. The impact of roads on some aspects of ungulate behaviour has already been studied. However, potential differences in response to roads during migration, dispersal and home range movements have never been evaluated. Addressing these issues is particularly important to assess the resistance of European landscapes to the range of wildlife movement processes, and to evaluate how animals adjust to anthropogenic constraints. Methods We analysed 95 GPS trajectories from 6 populations of European roe deer (Capreolus capreolus) across the Alps and central Europe. We investigated how roe deer movements were affected by landscape characteristics, including roads, and we evaluated potential differences in road avoidance among resident, migratory and dispersing animals (hereafter, movement modes). First, using Net Squared Displacement and a spatio-temporal clustering algorithm, we classified individuals as residents, migrants or dispersers. We then identified the start and end dates of the migration and dispersal trajectories, and retained only the GPS locations that fell between those dates (i.e., during transience). Finally, we used the resulting trajectories to perform an integrated step selection analysis. Results We found that roe deer moved through more forested areas during the day and visited less forested areas at night. They also minimised elevation gains and losses along their movement trajectories. Road crossings were strongly avoided at all times of day, but when they occurred, they were more likely to occur during longer steps and in more forested areas. Road avoidance did not vary among movement modes and, during dispersal and migration, it remained high and consistent with that expressed during home range movements. Conclusions Roads can represent a major constraint to movement across modes and populations, potentially limiting functional connectivity at multiple ecological scales. In particular, they can affect migrating individuals that track seasonal resources, and dispersing animals searching for novel ranges.

El presente trabajo de investigación tiene como objetivo general, establecer la relación entre la atención y el aprendizaje en el área de Comunicación en una Institución Educativa, Lima - 2019. Dicha investigación es de carácter cuantitativo, de tipo básico y diseño correlacional. La población de estudio fue de 77 y la muestra de 67 docentes del nivel secundaria. Para la recolección de información se aplicó la técnica de la encuesta siendo el instrumento utilizado el cuestionario, aplicando previamente una prueba piloto para determinar la confiabilidad mediante el Alfa de Cronbach. Posteriormente del estudio minucioso e interpretación de los resultados y conclusiones de la contrastación de las hipótesis, se arribó a la siguiente conclusión: Existe relación significativa entre atención y el aprendizaje en el área de Comunicación, habiéndose obtenido en la prueba de correlación un p= ,000 y un rho= ,703.

L’obiettivo principale di questo studio è comparare coefficienti tecnici calcolati a prezzi correnti e a prezzi deflazionati secondo tre differenti metodologie (deflatore singolo, deflatori settoriali e deflatori specifici), allo scopo di identificare l’impatto che queste strategie di calcolo alternative possono avere per l’analisi del cambio strutturale. Il confronto è effettuato per il Brasile e il Messico, sulla base delle World Input-Output Tables (WIOT) riferite agli anni tra il 2000 e il 2014. L’ipotesi centrale è che, a seconda del metodo di deflazione utilizzato, i settori che presentano una variazione significativa dei prezzi relativi possono subire una variazione dei coefficienti tecnici senza che ciò sia dovuto ad una variazione nelle quantità di input. La conclusione più importante è che i risultati osservati per le due economie non sono indifferenti al metodo di deflazione utilizzato, con implicazioni per l'analisi dei cambiamenti strutturali.

Net erosion of plasma-facing materials was investigated at the low-field-side (outer) strike-point area of the ASDEX Upgrade (AUG) divertor during H-mode discharges with small and frequent ELMs. To this end, Au and Mo marker samples with different surface morphologies and geometries were exposed to plasmas using the DIM-II divertor manipulator. The results were compared to existing erosion and deposition patterns from various L- and H-mode experiments, in the latter case the main difference was the size and frequency of the ELMs.We noticed that increasing surface roughness reduces net erosion but less than what is the case in L-mode. On the other hand, net-erosion rates in H-mode are generally 2–5 times higher than the corresponding L-mode values, in addition to which exposure in H-mode conditions results in strong local variations in the poloidal and toroidal erosion/deposition profiles. The latter observation we associate with the large migration length, on the order of several cm, of the eroded material, resulting in strong competition between erosion and re-deposition processes especially at poloidal distances > 50 mm from the strike point. Considerable net erosion was measured throughout the analysed poloidal region unlike in L-mode where the main erosion peak occurs in the vicinity of the strike point. We attribute this qualitative difference to the slow decay lengths of the plasma flux and electron temperature in the applied H-mode scenario.Both erosion and deposition require detailed analyses at the microscopic scale and the deposition patterns may be drastically different for heavy and light impurities. Generally, the rougher the surface the more material will accumulate on locally shadowed regions behind protruding surface features. However, rough surfaces also exhibit more non-uniformities in the quality or even integrity of marker coatings produced on them, thus complicating the analyses of the experimental data.We conclude that local plasma parameters have a huge impact on the PFC erosion rates and, besides incident plasma flux, surface morphology and its temporal evolution have to be taken into account for quantitative estimates of erosion rates and PFC lifetime under reactor-relevant conditions.

Objetivo: analisar o perfil sociodemográfico e laboral dos profissionais de enfermagem atuantes na unidade de internação COVID-19, que apresentaram, concomitantemente, ansiedade, depressão e estresse. Método: estudo descritivo, transversal realizado de maio a julho de 2020, via formulário eletrônico, contendo um instrumento de caracterização sociodemográfico e laboral, bem como uma escala para avaliar ansiedade, depressão e estresse - Depression Anxiety and Stress Scale-21. Aplicou-se análise descritiva e inferencial. Resultados: A média de ansiedade foi de 19,5; 20,0 para depressão; e 26,2 para estresse. Observou-se alta correlação entre a subescalas depressão e ansiedade (p=0,004). Considerações finais: Os profissionais apresentaram níveis elevados de ansiedade, depressão e estresse. Não foram identificadas variáveis independentes com valores estatisticamente significantes que pudessem esclarecer os fatores associados à ansiedade, depressão e estresse entres os profissionais da enfermagem. Foi possível observar correlação estatisticamente significante entre as subescalas depressão e ansiedade.

In Quebec French, /a ~ ɑ/ and /ε ~ aε/ are phonemic, whereas in Hexagonal French, these vowels are merged to /a/ and /ε/, respectively. We tested the effects of extended exposure to Quebec French (QF) as a second dialect (D2) on Hexagonal French (HF) speakers’ abilities to perceive these contrasts. Three groups of listeners were recruited: (1) non-mobile HF speakers born and living in France (HF group); (2) non-mobile QF speakers born and living in Quebec (QF group); and mobile HF speakers having moved from France to Quebec (HF>QF group). To determine any fine-grained effects of second dialect (D2) exposure on the perception of vowel contrasts, participants completed a same–different discrimination task in which they listened to stimuli paired at different levels of acoustic similarity. As expected, QF listeners showed a significant advantage over the HF group in discriminating between /a ~ ɑ/ and /ε ~ aε/ pairs, thus suggesting an own-dialect advantage in perceptual discrimination. Interestingly, this own-dialect advantage appeared to be greater for the /ε ~ aε/ contrast. The QF listeners also showed an advantage over the HF>QF group, and, surprisingly, this advantage was greater than over the HF group. In other words, the results suggested that the acquisition of a second dialect did not enhance the abilities of listeners to perceive differences between phonemic contrasts in that D2. If anything, the acquisition of the D2 disadvantaged the perceptual abilities of the HF>QF group. This might be because these phonemes have, over time, become less acoustically marked for the HF>QF participants and have, potentially, become integrated into their D1 phonemic categories.

Photon activation analysis is a non-destructive technique for material characterization that require high photon energies. Here, laser-driven accelerator is considered as a high-energy photon source and its optimization for photon activation analysis explored theoretically.

Body size variation is an enigma. We do not understand why species achieve the sizes they do, and this means we also do not understand the circumstances under which gigantism or dwarfism is selected. We develop size-structured integral projection models to explore evolution of body size and life history speed. We make few assumptions and keep models simple: all functions remain constant across models except for the one that describes development of body size with age. We set sexual maturity to occur when size attains 80% of the asymptotic size, which is typical of a large mammal, and allow negative density dependence to only affect either reproduction or juvenile survival. Fitness -- the quantity that is maximized by adaptive evolution -- is carrying capacity in our models, and we are consequently interested in how it changes with size at sexual maturity, and how this association varies with development rate. The simple models generate complex dynamics while providing insight into the circumstances when extremes of body size evolve. The direction of selection leading to either gigantism or dwarfism crucially depends on the proportion of the population that is sexually mature, which in turn depends on how the development function determines the survivorship schedule. The developmental trajectories consequently interact with size-specific survival or reproductive rates to determine the best life history and the optimal body size emerges from that interaction. These dynamics result in trade-offs between different components of the life history, with the form of the trade-off that emerges depending upon where in the life history density dependence operates most strongly. Empirical application of the approach we develop has potential to help explain the enigma of body size variation across the tree of life.

ABSTRACT BACKGROUND: The coronavirus 19 (COVID-19) pandemic has reached services, systems, and world society. Despite its certified efficiency, the Brazilian National Transplant System is not exempt from the side effects of COVID-19. OBJECTIVE: To compare kidney transplantation activity registered in Brazil between the pandemic (2020) and pre-pandemic (2019) periods. DESIGN AND SETTING: A descriptive study was conducted in March 2021. The annual reports of the Brazilian Transplantation Registry for 2019 and 2020 were included in this study. METHODS: We conducted a descriptive study of kidney transplant activity in Brazil in 2019 and 2020. RESULTS: A 23.9% decrease in kidney transplants per million population was observed during the pandemic period (22.9 in 2020 versus 30.1 in 2019). Kidney transplants with a living donor (-58.8%) and in the North Region (-79.5%) experienced the greatest declines. The pandemic waiting list increased by 6.8%, and deaths during the waiting period increased by 36.8%. The number of patients on the waiting list and transplant teams decreased by 31.3% and 9.5%, respectively. CONCLUSION: The COVID-19 pandemic drastically affected Brazil and had a significant negative impact on KT activities in the country.

Bladder masses are an infrequent occurrence rarely suspected in cases of pediatric hematuria. Inflammatory myofibroblastic tumors represent one differential diagnosis that is difficult to characterize as purely benign and should therefore be given special consideration. Although uncommon, this is an important entity to recognize for potential bladder sparing and minimally invasive surgical approaches.

Introduction. The constant increase in the incidence of non-melanoma skin cancers (NMSC) makes their treatment a topic of paramount interest. Because most of NMSC tend to develop in visible areas such as head-neck area, it is a priority to choose the less destructive therapy and more appropriate reconstructive technique. Mohs Micrographic Surgery (MMS) represents the treatment of choice for skin tumors in critical sites, recurrent tumors and tumors with aggressive histologic features. Patients and Methods: We collected patients affected by NMSC who underwent MMS at the Dermatology Unit of IRCCS Fondazione Ca' Granda, Milan, in the period March 2017 - December 2021.Results. 159 patients were enrolled in this retrospective observational study. The excision margins were chosen based on a dermoscopic evaluation. The main histological diagnoses were basal cell carcinoma (145, 91.2%) and squamous cell carcinoma (10, 6.3%), in areas with high functional or anatomical value. 121 out of 159 surgeries did not require further enlargement after the removal of the clinically and dermoscopically visible lesion, but in 38 cases (23.9% of cases) the Pathologist required at least one subsequent enlargement, due to the persistence of neoplasm at the bottom or at the margins of the lesion. Only one recurrence has been reported so far. Conclusions: MMS is a pathology-controlled surgery with high intrinsic value because of the low risk of recurrences and should be routinely adopted for high-risk NMSC.

Basal cell carcinoma (BCC) is the most common form of skin cancer, affecting more often elderly patients, but sometimes even younger ones, particularly if immunocompromised or genetically predisposed. Specifically, the Gorlin-Goltz syndrome, an autosomal dominant genodermatosis, also known as nevoid basal cell carcinoma syndrome, characterizes for multiple early onset BCCs. It is caused by a germline mutation in PTCH1, a tumor suppressor gene whose product is the key component of Hedgehog (Hh) signaling pathway, which also appears somatically mutated in more than 85% of sporadic BCCs. Hh pathway inhibitors vismodegib and sonidegib are currently indicated for BCC, in adults with advanced or recurred tumor following surgery or radiation therapy. The principal mechanism of action of these drugs is the inhibition of Smoothened (SMO), a transmembrane protein involved in Hh signal transduction, that plays a role in both cellular differentiation and cancer development. Some studies have reported effects of Hh pathway inhibitors at different levels of the immune response, from cytotoxic T cells to a modified local cytokines pattern. Given the specific relation between immune system and BCC development in some conditions, we will review BCC with focus on immune system changes mediated by Hh signaling pathway and induced by the inhibitors vismodegib and sonidegib in the treatment of BCC. Thus, we will give an overview of their effects on the local immune response, as well as a brief note on the supposed function of Hh pathway inhibition on the systemic one.

Background: A peculiar complication of endometriosis is a superinfection. However, the superinfection of extra-ovarian endometriosis is anecdotal, and only a few cases have been described. We wanted to present the first cases of the superinfection of rectovaginal endometriosis and to perform a literature review of the superinfection of extra-ovarian endometriosis. Methods: We present a case of a 24-year-old woman who was referred to our Pelvic Floor Unit for rectal–perineal pain, dyspareunia, and recurrent episodes of dense purulent vaginal discharge for one year, in which the superinfection of rectovaginal endometriosis was diagnosed. Moreover, we performed a systematic search of the literature indexed on PubMed up to 31 January 2023. Results: Laparoscopic drainage was successful in managing this condition. In the literature, clinical presentation and instrumental and microbiological findings are very heterogeneous. However, the gold standard of management is represented by surgical or percutaneous drainage. Conclusions: In the case of a pelvic abscess, the superinfection of endometriosis lesions should be suspected, and this can represent the onset symptom of endometriosis. Ultrasonography may show nodular or flat hypoechoic lesions with hyperechoic debris and peripheral positive color/power Doppler intensities. The goal of management is to drain the abscess, either percutaneously or via traditional surgery, followed by proper hormonal therapy to reduce recurrence.

Surfactants are among the main chemical contaminants in greywater (GW) and can cause severe health issues in humans and aquatic organisms. We assessed the performance of a multistage constructed wetland system (EvaTAC) for GW treatment and capacity of the microbial community in linear alkyl benzene sulfonate (LAS) biodegradation. Physicochemical analyses were performed over 497 d, and biomass samples were collected for high-throughput DNA sequencing. The system was predominated by anaerobic conditions and received an average chemical oxygen demand (COD) and LAS of 374 and 32 mg·L−1, with removal rates of 66% and 43%, respectively. A positive correlation between COD and LAS suggested COD as a design parameter for LAS removal. We identified microbial genera participating in hydrolysis, fermentation, syntrophy, acetogenesis, methanogenesis, surfactant degradation, and sulphate reduction. Among the 15 surfactant-degrading genera, Pseudomonas was predominant. Community richness and diversity indices were comparable between subsystems, with a slight decrease in diversity observed towards the outlet. Among the LAS degraders, Rhodopseudomonas palustris had the highest relative abundance of operational taxonomic unit (OTU)s in all samples and the highest richness in the anaerobic chamber. The patterns in microbial community composition and environmental conditions suggest that LAS biodegradation occurred throughout the EvaTAC system.

Aim: We report molecular subtype impact on 1325 early breast cancer (BCa) patients treated with whole breast hypofractionated (WBH) adjuvant forward-planned intensity modulated radiotherapy (F-IMRT) without boost. Methods and materials: From 02/2009-05/2017 1325 patients with pTis-pT3, pNx-N1aM0 BCa who underwent breast conservation surgery were treated with WBHF-IMRT in our institute, to a total dose of 40 Gy/15 fractions, without boost. Median age: 62 (interquartile range-IQR-:51.14–70.53) years. Histology: 8% in situ carcinoma (ISC), 92% invasive tumors. Molecular subtypes (invasive tumors): 49.9% Luminal A, 33.1% Luminal B Her2 negative (−), 6.2% Luminal B Her2 positive (+), 3.6% Hormone Receptor (HR)- Her2+, 7.1% Triple negative (TNBC), and 0.2% HR+. Chemotherapy (CT) was prescribed in 28% of patients, hormonal therapy in 80.3%, monoclonal antibodies (MAb) in 86.8% of Luminal B Her2+ and 97.7% of HR- Her2+ patients. Results: Median follow up was 72.43 (IQR: 44.63–104.13) months. The 5-year Kaplan-Meier estimates of local relapse-free survival (LRFS) was 97.8%, regional-(RRFS) 98.6%, loco-regional- (LRRFS) 96.9%, distant- (DRFS) 96.6%, disease-free survival (DFS) 94.8% and overall survival (OS) 95.5%. Considering molecular subtypes, 5-year LRFS was: 99.8% for Luminal A, 96.7% for Luminal B Her2-, 94.1% for Luminal B Her2+, 87.9% for HR- Her2+, 95.1% for TNBC and 99.1% for in situ carcinoma. Conclusion: While the overall estimated probability of LR within 5 years after WBHF-IMRT without boost is good (2.2%), molecular subtypes have a strong impact, despite MAb therapy in Her2+ patients, and CT for TNBC patients, and could be used as a parameter in deciding the boost prescription.

Long non-coding RNAs (lncRNAs) are an important class of epigenetic regulators involved in both physiological processes and cancer development. Preliminary evidence suggested that lncRNAs could act as accurate prognostic and diagnostic biomarkers. Parathyroid cancer is a rare endocrine neoplasia, whose management represents a clinical challenge due to the lack of accurate molecular biomarkers. Our previous findings showed that human parathyroid tumors are characterized by a different lncRNAs signature, suggesting heterogeneity through the different histotypes. Particularly, we found that the lncRNA BC200/BCYRN1 could represent a candidate biomarker for parathyroid carcinomas (PCas). Here we aimed to extend our preliminary data evaluating whether BC200 could be an accurate non-invasive biomarker of PCas to support the clinical management of patients affected by parathyroid tumors at diagnosis, prognosis and follow-up. To provide a non-invasive point-of-care for parathyroid carcinoma diagnosis and follow-up, we analyzed BC200 expression in patients’ serum through digital PCR. Our results show that BC200 counts are higher in serum from patients harboring PCa (n=4) compared to patients with parathyroid adenoma (PAd; n=27). Further, in PAd patients circulating BC200 levels are positively correlated with serum total calcium. Then, we found that BC200 is overexpressed in metastatic PCas (n=4) compared to non-metastatic ones (n=9). Finally, the lncRNA expression in PCa patients’ serum drops are reduced after parathyroidectomy, suggesting its possible use in the post-operative setting for patients follow-up. Overall, these findings extend the knowledge on BC200 in parathyroid tumors, supporting its role as a useful biomarker for management of PCa.