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Objective. Continuous monitoring of the hemodynamic coherence between macro and microcirculation is difficult at the bedside. We tested the role of photoplethysmography (PPG) to real-time assessment of microcirculation during extreme manipulation of macrohemodynamics induced by the cardiopulmonary bypass (CPB). Approach. We analyzed the alternating (AC) and direct (DC) components of the finger PPG in 12 patients undergoing cardiac surgery with CPB at five moments: (1) before-CPB; (2) CPB-start, at the transition from pulsatile to non-pulsatile blood flow; (3) CPB-aortic clamping, at a sudden decrease in pump blood flow and volemia.; (4) CPB-weaning, during step-wise 20% decreases in pump blood flow and opposite proportional increases in native pulsatile blood flow; and (5) after-CPB. Main results. Nine Caucasian men and three women were included for analysis. Macrohemodynamic changes during CPB had an immediate impact on the PPG at all studied moments. Before-CPB the AC signal amplitude showed a median and IQR values of 0.0023(0.0013). The AC signal completely disappeared at CPB-start and at CPB-aortic clamping. During CPB weaning its amplitude progressively increased but remained lower than before CPB, at 80% [0.0008 (0.0005); p < 0.001], 60% [0.0010(0.0006); p < 0.001], and 40% [0.0013(0.0009); p = 0.011] of CPB flow. The AC amplitude returned close to Before-CPB values at 20% of CPB flow [0.0015(0.0008); p = 0.081], when CPB was completely stopped [0.0019 (0.0009); p = 0.348], and at after-CPB [0.0021(0.0009); p = 0.687]. The DC signal Before-CPB [0.95(0.02)] did not differ statistically from CPB-start, CPB-weaning and After-CPB. However, at CPB-aortic clamping, at no flow and a sudden drop in volemia, the DC signal decreased from [0.96(0.01)] to [0.94(0.02); p = 0.002]. Significance. The macrohemodynamic alterations brought on by CPB were consistent with changes in the finger's microcirculation. PPG described local pulsatile blood flow (AC) as well as non-pulsatile blood flow and volemia (DC) in the finger. These findings provide plausibility to the use of PPG in ongoing hemodynamic coherence monitoring., (© 2024 Institute of Physics and Engineering in Medicine. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

A prior study reported no association between prenatal smoking methylation scores and adult lung cancer risk adjusting for methylation-predicted adult smoking, without considering maternal smoking trends by birth cohort. To address this gap, we examined the association between prenatal smoking methylation scores and adult lung cancer, independent of methylation-predicted adult packyears and by birth cohort, in a study nested in CLUE II. Included were 208 incident lung cancer cases ascertained by cancer registry linkage and 208 controls matched on age, sex, and smoking. DNA methylation was measured in prediagnostic blood. We calculated two prenatal smoking scores, using 19 (Score-19) and 15 (Score-15) previously identified CpGs and a methylation-predicted adult packyears score. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusting for adult packyears score and batch effects. Score-15 was positively associated with lung cancer (per standard deviation, OR = 1.40, 95% CI = 1.10-1.79, P -trend = .006), especially in the 1930-1938 birth cohort (OR = 3.43, 95% CI = 1.55-7.60, P -trend = .002). Score-19 was associated only in the 1930-1938 birth cohort (OR = 2.12, 95% CI = 1.15-3.91). Participants with both prenatal scores below the median (vs all other combinations) had lower risk (OR = 0.44, 95% CI = 0.27-0.72), especially in the 1930-1938 birth cohort (OR = 0.16, 95% CI = 0.04-0.62). Among ever smokers, participants with higher prenatal smoking scores had higher risk, irrespective of adult packyears (low: OR = 2.81, 95% CI = 1.38-5.72, high: OR = 2.67, 95% CI = 1.03-6.95). This prospective study suggests a positive association between prenatal smoking exposure and adult lung cancer risk, especially in the 1930-1938 birth cohort, independent of active smoking. Future studies with multiple birth cohorts are needed., Competing Interests: The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication., (© The Author(s) 2024. Published by Oxford University Press.)

Background: The incidence of anesthesia-induced atelectasis in children is high and closely related to episodes of hypoxemia. The Air-Test is a simple maneuver to detect lung collapse. By a step-reduction in FiO2 to 0.21, a fall in pulse-oximetry hemoglobin saturation <97% unmasks the presence of collapse-related shunt in healthy lungs. The aim of this study was to validate the Air-Test as a diagnostic tool to detect perioperative atelectasis in children using lung ultrasound as a reference., Methods: We first assessed the Air-Test in a retrospective cohort of 88 anesthetized children (Retrospective study) followed by a prospective study performed in 72 children (45 postconceptional weeks to 16 years old) using a similar protocol (Validation study). We analyzed the performance of the Air-Test to detect atelectasis by an operating characteristic curve (ROC) analysis, using lung ultrasound consolidation score as reference., Results: Preoperative SpO2 was normal in both studies (retrospective 98.7±0.6%, validation 99.0±0.9%). The Air-Test, with a SpO2 cut point <97%, resulted positive in 67 patients in the retrospective study (SpO2 93.3±2.1%) and in 59 in the validation study (SpO2 94.9±1.8%); both P<0.0001. In the validation study, the Air-Test showed a sensitivity of 0.91 (95% CI 0.85-0.92), specificity of 1.00 (95% CI 0.84-1) and an area under the curve (AUC) of 0.98 (95% CI 0.97-1.00). AUC between both studies was similar (P=0.16)., Conclusions: The Air-Test is a noninvasive and accurate method to detect atelectasis in healthy anesthetized children. It can be used as a screening tool to individualize patients that can benefit from lung recruitment maneuvers.

Objective: Our objectives with this study were to describe the frequency of selected cooccurring health conditions and individualized education program (IEP) services and post-high school transition planning for adolescents with autism spectrum disorder and identify disparities by sex, intellectual ability, race or ethnicity, and geographic area., Methods: The study sample included 1787 adolescents born in 2004 who were identified as having autism through a health and education record review through age 16 years in 2020. These adolescents were part of a longitudinal population-based surveillance birth cohort from the Autism and Developmental Disabilities Monitoring Network from 2004 to 2020 in 5 US catchment areas., Results: Attention deficit hyperactivity disorder (47%) and anxiety (39%) were the most common cooccurring health conditions. Anxiety was less commonly identified for those with intellectual disability than those without. It was also less commonly identified among Black adolescents compared with White or Hispanic adolescents. There was wide variation across Autism and Developmental Disabilities Monitoring Network sites in the provision of school-based IEP services. Students with intellectual disability were less likely to receive school-based mental health services and more likely to have a goal for postsecondary independent living skills compared with those without intellectual disability. A total of 37% of students did not participate in standardized testing., Conclusions: We identified disparities in the identification of cooccurring conditions and school-based IEP services, practices, and transition planning. Working with pediatric health and education providers, families, and adolescents with autism will be important to identify contributing factors and to focus efforts to reduce disparities in the supports and services adolescents with autism have access to and receive., (Copyright © 2024 by the American Academy of Pediatrics.)

Background: Exaggerated lung strain and stress could damage lungs in anesthetized children. The authors hypothesized that the association of capnoperitoneum and lung collapse in anesthetized children increases lung strain-stress. Their primary aim was to describe the impact of capnoperitoneum on lung strain-stress and the effects of an individualized protective ventilation during laparoscopic surgery in children., Methods: The authors performed an observational cohort study in healthy children aged 3 to 7 yr scheduled for laparoscopic surgery in a community hospital. All received standard protective ventilation with 5 cm H2O of positive end-expiratory pressure (PEEP). Children were evaluated before capnoperitoneum, during capnoperitoneum before and after lung recruitment and optimized PEEP (PEEP adjusted to get end-expiratory transpulmonary pressure of 0), and after capnoperitoneum with optimized PEEP. The presence of lung collapse was evaluated by lung ultrasound, positive Air-Test (oxygen saturation measured by pulse oximetry 96% or less breathing 21% O2 for 5 min), and negative end-expiratory transpulmonary pressure. Lung strain was calculated as tidal volume/end-expiratory lung volume measured by capnodynamics, and lung stress as the end-inspiratory transpulmonary pressure., Results: The authors studied 20 children. Before capnoperitoneum, mean lung strain was 0.20 ± 0.07 (95% CI, 0.17 to 0.23), and stress was 5.68 ± 2.83 (95% CI, 4.44 to 6.92) cm H2O. During capnoperitoneum, 18 patients presented lung collapse and strain (0.29 ± 0.13; 95% CI, 0.23 to 0.35; P < 0.001) and stress (5.92 ± 3.18; 95% CI, 4.53 to 7.31 cm H2O; P = 0.374) increased compared to before capnoperitoneum. During capnoperitoneum and optimized PEEP, children presenting lung collapse were recruited and optimized PEEP was 8.3 ± 2.2 (95% CI, 7.3 to 9.3) cm H2O. Strain returned to values before capnoperitoneum (0.20 ± 0.07; 95% CI, 0.17 to 0.22; P = 0.318), but lung stress increased (7.29 ± 2.67; 95% CI, 6.12 to 8.46 cm H2O; P = 0.020). After capnoperitoneum, strain decreased (0.18 ± 0.04; 95% CI, 0.16 to 0.20; P = 0.090), but stress remained higher (7.25 ± 3.01; 95% CI, 5.92 to 8.57 cm H2O; P = 0.024) compared to before capnoperitoneum., Conclusions: Capnoperitoneum increased lung strain in healthy children undergoing laparoscopy. Lung recruitment and optimized PEEP during capnoperitoneum decreased lung strain but slightly increased lung stress. This little rise in pulmonary stress was maintained within safe, lung-protective, and clinically acceptable limits., (Copyright © 2023 American Society of Anesthesiologists. All Rights Reserved.)

Introduction: Older adults with advanced chronic diseases and palliative care needs are more exposed to polypharmacy and use of potentially inappropriate medication, which generates a high risk of adverse events and impaired quality of life. The objective of this study was to describe the frequency of potentially inappropriate medication use among older adults with palliative care needs receiving home care services after hospital discharge., Methods: Observational cross-sectional study of pharmacy dispensing and electronic health records, of older adults in a home care system and with palliative care needs according to the screening with the NECPAL tool or the PROFUND and/or PALIAR indexes. Dispensed medications during 180 days after admission to home care were analyzed. Medications were classified as potentially inappropriate according to the LESS-CHRON criteria., Results: We included 176 patients, mean age 87.4 years, 67% were women; 73% were pluripathologic patients and 22% had one chronic progressive disease. Mortality at 6 months was 73%. Median frequency of dispensed medications per patient was 9.1 (IQR = 4-9.7). The frequency of potentially inappropriate medication dispensation among patients was 87%, mainly antihypertensives, benzodiazepines and antipsychotics., Conclusion: This study observed that dispensation of potentially inappropriate medication among older adults with palliative care needs and home care services is very high. This emphasizes the need for effective patient-centered interventions to prevent inadequate prescription and stimulate de-prescription.

The reaction between silylamido complexes of Cr(II), Fe(II), and Co(II) and IMes·2HF salt in the presence of IMes (IMes = 1,3-dimesitylimidazol-2-ylidene) led to isolation of Cr(IMes) 2 F 2 ( 2-Cr ), Fe(IMes) 2 F 2 ( 2-Fe ), and Co(IMes) 2 F 2 ( 2-Co ). X-ray structural studies revealed that 2-Cr adopts square planar geometry, while 2-Fe and 2-Co have distorted tetrahedral geometry. Magnetic susceptibility studies of 2-Cr , 2-Fe , and 2-Co were consistent with high-spin complexes, S = 2 for 2-Cr / 2-Fe and S = 3/2 for 2-Co . We demonstrated that fluoride can be successfully exchanged for cyanide and azide using trimethylsilyl cyanide and trimethylsilyl azide ( 3-Fe and 4-Fe ). DFT studies suggest that the preference of 2-Cr to adopt square planar geometry over tetrahedral is due to its d 4 metal center, where four electrons fill the lower-lying d-orbitals.

Many textbook physical effects in crystals are enabled by some specific symmetries. In contrast to such 'apparent effects', 'hidden effect X' refers to the general condition where the nominal global system symmetry would disallow the effect X, whereas the symmetry of local sectors within the crystal would enable effect X. Known examples include the hidden Rashba and/or hidden Dresselhaus spin polarization that require spin-orbit coupling, but unlike their apparent counterparts are demonstrated to exist in non-magnetic systems even in inversion-symmetric crystals. Here, we discuss hidden spin polarization effect in collinear antiferromagnets without the requirement for spin-orbit coupling (SOC). Symmetry analysis suggests that antiferromagnets hosting such effect can be classified into six types depending on the global vs local symmetry. We identify which of the possible collinear antiferromagnetic compounds will harbor such hidden polarization and validate these symmetry enabling predictions with first-principles density functional calculations for several representative compounds. This will boost the theoretical and experimental efforts in finding new spin-polarized materials., (© 2023. Springer Nature Limited.)

Background: To test whether a Shallow Neural Network (S-NN) can detect and classify vascular tone dependent changes in arterial blood pressure (ABP) by advanced photopletysmographic (PPG) waveform analysis., Methods: PPG and invasive ABP signals were recorded in 26 patients undergoing scheduled general surgery. We studied the occurrence of episodes of hypertension (systolic arterial pressure (SAP) >140 mmHg), normotension and hypotension (SAP < 90 mmHg). Vascular tone according to PPG was classified in two ways: 1) By visual inspection of changes in PPG waveform amplitude and dichrotic notch position; where Classes I-II represent vasoconstriction (notch placed >50% of PPG amplitude in small amplitude waves), Class III normal vascular tone (notch placed between 20-50% of PPG amplitude in normal waves) and Classes IV-V-VI vasodilation (notch <20% of PPG amplitude in large waves). 2) By an automated analysis, using S-NN trained and validated system that combines seven PPG derived parameters., Results: The visual assessment was precise in detecting hypotension (sensitivity 91%, specificity 86% and accuracy 88%) and hypertension (sensitivity 93%, specificity 88% and accuracy 90%). Normotension presented as a visual Class III (III-III) (median and 1st-3rd quartiles), hypotension as a Class V (IV-VI) and hypertension as a Class II (I-III); all p < .0001. The automated S-NN performed well in classifying ABP conditions. The percentage of data with correct classification by S-ANN was 83% for normotension, 94% for hypotension, and 90% for hypertension., Conclusions: Changes in ABP were correctly classified automatically by S-NN analysis of the PPG waveform contour., (Copyright © 2022 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Problem/condition: Autism spectrum disorder (ASD)., Period Covered: 2020., Description of System: The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years. In 2020, a total of 11 sites (located in Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin) conducted surveillance of ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2020. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement in an evaluation, 2) a special education classification of autism (eligibility), or 3) an ASD International Classification of Diseases (ICD) code (revisions 9 or 10). Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had a documented qualified professional's statement indicating a suspicion of ASD. This report focuses on children aged 4 years in 2020 compared with children aged 8 years in 2020., Results: For 2020, ASD prevalence among children aged 4 years varied across sites, from 12.7 per 1,000 children in Utah to 46.4 in California. The overall prevalence was 21.5 and was higher among boys than girls at every site. Compared with non-Hispanic White children, ASD prevalence was 1.8 times as high among Hispanic, 1.6 times as high among non-Hispanic Black, 1.4 times as high among Asian or Pacific Islander, and 1.2 times as high among multiracial children. Among the 58.3% of children aged 4 years with ASD and information on intellectual ability, 48.5% had an IQ score of ≤70 on their most recent IQ test or an examiner's statement of intellectual disability. Among children with a documented developmental evaluation, 78.0% were evaluated by age 36 months. Children aged 4 years had a higher cumulative incidence of ASD diagnosis or eligibility by age 48 months compared with children aged 8 years at all sites; risk ratios ranged from 1.3 in New Jersey and Utah to 2.0 in Tennessee. In the 6 months before the March 2020 COVID-19 pandemic declaration by the World Health Organization, there were 1,593 more evaluations and 1.89 more ASD identifications per 1,000 children aged 4 years than children aged 8 years received 4 years earlier. After the COVID-19 pandemic declaration, this pattern reversed: in the 6 months after pandemic onset, there were 217 fewer evaluations and 0.26 fewer identifications per 1,000 children aged 4 years than children aged 8 years received 4 years earlier. Patterns of evaluation and identification varied among sites, but there was not recovery to pre-COVID-19 pandemic levels by the end of 2020 at most sites or overall. For 2020, prevalence of suspected ASD ranged from 0.5 (California) to 10.4 (Arkansas) per 1,000 children aged 4 years, with an increase from 2018 at five sites (Arizona, Arkansas, Maryland, New Jersey, and Utah). Demographic and cognitive characteristics of children aged 4 years with suspected ASD were similar to children aged 4 years with ASD., Interpretation: A wide range of prevalence of ASD by age 4 years was observed, suggesting differences in early ASD identification practices among communities. At all sites, cumulative incidence of ASD by age 48 months among children aged 4 years was higher compared with children aged 8 years in 2020, indicating improvements in early identification of ASD. Higher numbers of evaluations and rates of identification were evident among children aged 4 years until the COVID-19 pandemic onset in 2020. Sustained lower levels of ASD evaluations and identification seen at a majority of sites after the pandemic onset could indicate disruptions in typical practices in evaluations and identification for health service providers and schools through the end of 2020. Sites with more recovery could indicate successful strategies to mitigate service interruption, such as pivoting to telehealth approaches for evaluation., Public Health Action: From 2016 through February of 2020, ASD evaluation and identification among the cohort of children aged 4 years was outpacing ASD evaluation and identification 4 years earlier (from 2012 until March 2016) among the cohort of children aged 8 years in 2020 . From 2016 to March 2020, ASD evaluation and identification among the cohort of children aged 4 years was outpacing that among children aged 8 years in 2020 from 2012 until March 2016. The disruptions in evaluation that coincided with the start of the COVID-19 pandemic and the increase in prevalence of suspected ASD in 2020 could have led to delays in ASD identification and interventions. Communities could evaluate the impact of these disruptions as children in affected cohorts age and consider strategies to mitigate service disruptions caused by future public health emergencies., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest.

Problem/condition: Autism spectrum disorder (ASD)., Period Covered: 2020., Description of System: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code., Results: For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites.Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range = 17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota.Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months)., Interpretation: For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates are higher than previous ADDM Network estimates during 2000-2018. For the first time among children aged 8 years, the prevalence of ASD was lower among White children than among other racial and ethnic groups, reversing the direction of racial and ethnic differences in ASD prevalence observed in the past. Black children with ASD were still more likely than White children with ASD to have a co-occurring intellectual disability., Public Health Action: The continued increase among children identified with ASD, particularly among non-White children and girls, highlights the need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD. Similar to previous reporting periods, findings varied considerably across network sites, indicating the need for additional research to understand the nature of such differences and potentially apply successful identification strategies across states., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Heavy metal pollution is a worldwide environmental and human health problem. Prosopis laevigata is a hyperaccumulator legume that bioaccumulates Pb, Cu and Zn. With interest in designing phytoremediation strategies for sites contaminated with heavy metals, we isolated and characterized endophytic fungi from the roots of P. laevigata growing on mine tailings located in Morelos, Mexico. Ten endophytic isolates were selected by morphological discrimination and a preliminary minimum inhibitory concentration was determined for zinc, lead and copper. A novel strain of Aspergillus closest to Aspergillus luchuensis was determined to be a metallophile and presented a marked tolerance to high concentrations of Cu, Zn and Pb, so it was further investigated for removal of metals and promotion of plant growth under greenhouse conditions. The control substrate with fungi promoted larger size characters in P. laevigata individuals in comparison with the other treatments, demonstrating that A. luchuensis strain C7 is a growth-promoting agent for P. laevigata individuals. The fungus favors the translocation of metals from roots to leaves in P. laevigata , promoting an increased Cu translocation. This new A. luchuensis strain showed endophytic character and plant growth-promotion activity, high metal tolerance, and an ability to increase copper translocation. We propose it as a novel, effective and sustainable bioremediation strategy for copper-polluted soils.

Background: Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a lethal neonatal lung disorder characterized by the decrease of the alveolar units, abnormalities in the air-blood barrier of the lung, and impaired gas exchange. Typically, it affects a full-term newborn; the symptoms usually start within a few hours after birth, resulting in severe respiratory distress and pulmonary hypertension. In most of the cases, this disorder is refractory to conventional pulmonary support., Case Presentation: We report a case of a newborn male of 29 weeks gestational age, with birth weight of 850 g and intrauterine growth restriction. Severe respiratory distress appeared a few minutes after birth; non-invasive ventilatory support was provided in the delivery room and, as a consequence of persistent respiratory failure, he was admitted to the neonatal intensive care unit (NICU) where mechanical ventilation was required. Due to the symptoms and pulmonary ultrasound pattern suggestive of respiratory distress syndrome, surfactant treatment was administered. Lung ultrasound (LU) was used for monitoring the responsiveness to surfactant; severe pulmonary hypertension ensued, followed by respiratory failure, refractory shock, and death within 48 h. Owing to the poor response to the established therapy, ACD/MPV was suspected. The diagnosis was confirmed through autopsy. The main goal of this case report is to show the role of LU for monitoring the evolution of this disorder., Conclusion: LU could provide essential information to help diagnose and follow-up the underlying cause of persistent pulmonary hypertension of the newborn in an earlier and more effective way than chest X-ray. LU is suitable for routine monitoring of lung disease in the NICU., (© 2023. The Author(s).)

Objectives: To estimate the magnitude and importance of a process of stratification and advance care planning and the use of health resources, among patients in an integrated health care program for frail elderls in nursing homes,that were referred to the hospital with COVID-19., Material and Methods: Prospective cohort study of patients >64 years old with COVID-19 infection, in a health care program in nursing homes (from 3/15/2020 to 9/15/2020). The identification of patients with palliative needs, the performing and visible registration in electronic health records of the advance care planning and the use of intensive care were assessed., Results: We included 374 COVID-19 patients. 88% were women, the median age was 88 years old. The 79% were patients with palliative needs, of which 68% had the advance care planning (P<.001) registered in the electronic health record. Only 1% of patients with palliative needs and severity criteria were admitted to the intensive care unit. Overall mortality was 25%. Of those who died, 74% had severity criteria (P<.001) and 90% had palliative needs (P<.001)., Conclusions: Carrying out a care process based on identification of patients with palliative needs and advance care planning and a central and visible registration of advance care planning in health records, could improve the quality and safety of care and optimize the use of intensive care health resources at all times and especially in public health emergencies., (Copyright © 2022. Publicado por Elsevier España, S.L.U.)

Lung ultrasound (LU) has gained ground in the diagnosis of most respiratory conditions present since birth. It is highly sensitive to variations in air content and pulmonary fluids and functions as a true densitometer of the lung parenchyma with a sensitivity superior to that of radiological studies. A LU is a non-invasive, fast and easy tool that can be used at the patient's bedside and, unlike conventional radiology, does not pose risks of radiation. In addition, a LU provides real-time dynamic information in a variety of neonatal settings and, like heart and brain examinations, can be performed by the neonatologist. The objective of this article is to describe the main artifacts and images that can be found in the neonatal LU, as well as the different aeration patterns, and to highlight their usefulness in the study of the most frequent respiratory disorders of neonates., Competing Interests: None., (Sociedad Argentina de Pediatría.)

Objectives: To test the clinical performance of a novel continuous noninvasive cardiac output (CO) monitoring based on expired carbon dioxide kinetics in cardiac surgery patients., Design: A prospective feasibility pragmatic clinical study., Setting: A single-center, large community hospital., Participants: Thirty-two patients undergoing cardiac surgery were studied during the intraoperative (before cardiopulmonary bypass) and postoperative (in the intensive care unit before extubation) periods., Interventions: CO was measured simultaneously by the continuous capnodynamic method and by transpulmonary thermodilution during changes in the patient's hemodynamic and/or respiratory conditions., Measurements and Main Results: The current recommended comparative statistics for CO measurement methods were analyzed, including bias, precision, and percentage error obtained from Bland-Altman analysis, and concordance between methods obtained from the four-quadrant plot analysis to evaluate the trending ability. Bias ± limits of agreement and percentage error were -0.6 (-1.9 to +0.8; 95% CI of 3.73-5.25) L/min and 31% (n = 147 measurements) for the intraoperative period, -0.8 (-2.4 to +0.9; 95% CI of 3.03-5.21) L/min and 41% (n = 66) for the postoperative period, and -0.6 (-2.1 to +0.8; 95% CI of 3.74-5.00) L/min and 34% (n = 213) for the pooled data. The trending analysis obtained a concordance of 82% (n = 65) for the intraoperative and 71% (n = 24) for the early postoperative periods. Aggregation of both data sets gave a concordance of 79% (n = 89)., Conclusions: The continuous capnodynamic method was reliable and in good agreement with the reference method, and had an accuracy and trending ability good enough to make it a possible future alternative for hemodynamic monitoring in the studied population of elective adult cardiac surgery patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Pain after thoracic surgery impairs lung function and increases the rate of postoperative pulmonary complications. Ultrasound-guided percutaneous cryoanalgesia of intercostal nerves constitutes a valid option for adequate postoperative analgesia. A key issue for a successful cryoanalgesia is placing the cryoprobe tip close to the intercostal nerve. This report describes an ultrasound technique using a high-resolution ultrasound probe to accomplish this goal., Findings: Images of five anesthetized patients undergoing uniportal video-thoracoscopic surgeries are used as clinical examples. In the lateral position, a high-frequency 12 MHz probe is placed longitudinally at 5-7 cm parallel to the spine at the 4th, 5th, and 6th ipsilateral intercostal spaces. Ultrasound images detect the intercostal neurovascular bundle and a 14G angiocath is placed beside the nerve. The cryoprobe is inserted throughout the 14G catheter and the cryoanalgesia cycle is performed for 3 min. Two ultrasound signs confirm the right cryoprobe position close to the nerve: one is a color Doppler twinkling artifact that is seen as the quick shift of colors that delineates the cryoprobe contour. The other is a spherical hypoechoic image caused by the ice ball formed at the cryoprobe tip., Conclusions: Ultrasound images obtained with a high-frequency probe allow precise location of the cryoprobe tip close to the intercostal nerve for cold axonotmesis., (© 2022. The Author(s).)

Objective: To describe the reorganization of nursing work in an intensive care unit of a public hospital due to the COVID-19 pandemic., Method: Report of the experience from February to April 2020, about the reorganization of a unit., Results: The description of the experience was divided into four moments: Definition of the cohort isolation; Reorganization of the intensive care units as General and Respiratory; Health care teams and work shifts; and Wearing and removing protective clothing by the teams., Conclusion: The COVID -19 pandemic brought numerous challenges to the management of intensive care units. The socialization of management experiences can contribute to the definition of new strategies, including in the post-pandemic period.

The development of spintronic devices demands the existence of materials with some kind of spin splitting (SS). In this Data Descriptor, we build a database of ab initio calculated SS in 2D materials. More than that, we propose a workflow for materials design integrating an inverse design approach and a Bayesian inference optimization. We use the prediction of SS prototypes for spintronic applications as an illustrative example of the proposed workflow. The prediction process starts with the establishment of the design principles (the physical mechanism behind the target properties), that are used as filters for materials screening, and followed by density functional theory (DFT) calculations. Applying this process to the C2DB database, we identify and classify 358 2D materials according to SS type at the valence and/or conduction bands. The Bayesian optimization captures trends that are used for the rationalized design of 2D materials with the ideal conditions of band gap and SS for potential spintronics applications. Our workflow can be applied to any other material property., (© 2022. The Author(s).)

Magnetic materials have been applied in a large variety of technologies, from data storage to quantum devices. The development of two-dimensional (2D) materials has opened new arenas for magnetic compounds, even when classical theories discourage their examination. Here we propose a machine-learning-based strategy to predict and understand magnetic ordering in 2D materials. This strategy couples the prediction of the existence of magnetism in 2D materials using a random forest and the Shapley additive explanations method with material maps defined by atomic features predicting the magnetic ordering (ferromagnetic or antiferromagnetic). While the random forest model predicts magnetism with an accuracy of 86%, the material maps obtained by the sure independence screening and sparsifying method have an accuracy of ∼90% in predicting the magnetic ordering. Our model indicates that 3d transition metals, halides, and structural clusters with regular transition-metal sublattices have a positive contribution in the total weight deciding the existence of magnetism in 2D compounds. This behavior is associated with the competition between crystal field and exchange splitting. The machine learning model also indicates that the atomic spin orbit coupling (SOC) is a determinant feature for the identification of the patterns separating ferro- from antiferromagnetic order. The proposed strategy is used to identify novel 2D magnetic compounds that, together with the fundamental trends in the chemical and structural space, pave novel routes for experimental exploration.

Central venous accesses in neonates and pediatric patients represent a common and important procedure for both, intraoperative and postoperative care. Point-of-care ultrasound-guided technique has been proposed to increased success rate and efficiency, as well as to decrease the number of complications. Ultrasound-guided internal jugular vein cannulation is considering the "gold standard" in children. Another central venous cannulation option in neonates and children has been supraclavicular ultrasound-guided cannulation of the brachiocephalic vein using the in-plane approach. This article gives a review of the current evidence, the basic knowledge of the technique and the structured approach to follow for supraclavicular ultrasound-guided brachiocephalic vein access in children and neonates., (Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Continuous positive airway pressure (CPAP) prevents peri-operative atelectasis in adults, but its effect in children has not been quantified., Objective: The aim of this study was to evaluate the role of CPAP in preventing postinduction and postoperative atelectasis in children under general anaesthesia., Design: A randomised controlled study., Setting: Single-institution study, community hospital, Mar del Plata. Argentina., Patients: We studied 42 children, aged 6 months to 7 years, American Society of Anesthesiologists physical status class I, under standardised general anaesthesia., Interventions: Patients were randomised into two groups: Control group (n = 21): induction and emergence of anaesthesia without CPAP; and CPAP group (n = 21): 5 cmH2O of CPAP during induction and emergence of anaesthesia. Lung ultrasound (LUS) imaging was performed before and 5 min after anaesthesia induction. Children without atelectasis were ventilated in the same manner as the Control group with standard ventilatory settings including 5 cmH2O of PEEP. Children with atelectasis received a recruitment manoeuvre followed by standard ventilation with 8 cmH2O of PEEP. Then, at the end of surgery, LUS images were repeated before tracheal extubation and 60 min after awakening., Main Outcome Measures: Lung aeration score and atelectasis assessed by LUS., Results: Before anaesthesia, all children were free of atelectasis. After induction, 95% in the Control group developed atelectasis compared with 52% of patients in the CPAP group (P < 0.0001). LUS aeration scores were higher (impaired aeration) in the Control group than the CPAP group (8.8 ± 3.8 vs. 3.5 ± 3.3 points; P < 0.0001). At the end of surgery, before tracheal extubation, atelectasis was observed in 100% of children in the Control and 29% of the CPAP group (P < 0.0001) with a corresponding aeration score of 9.6 ± 3.2 and 1.8 ± 2.3, respectively (P < 0.0001). After surgery, 30% of children in the Control group and 10% in the CPAP group presented with residual atelectasis (P < 0.0001) also corresponding to a higher aeration score in the Control group (2.5 ± 3.1) when compared with the CPAP group (0.5 ± 1.5; P < 0.01)., Conclusion: The use of 5 cmH2O of CPAP in healthy children of the studied age span during induction and emergence of anaesthesia effectively prevents atelectasis, with benefits maintained during the first postoperative hour., Trial Registry: Clinicaltrials.gov NCT03461770.

Many researchers have limited access to fully equipped laboratory-scale batch bioreactors and chemostats due to their relatively high cost. This becomes particularly prohibitive when multiple replicas of the same experiment are required, but not enough bioreactors are available to operate simultaneously. Additionally, experiments using shaken flasks are common but show significant limitations in terms of maintaining homogeneous conditions in liquid cultures or installing instrumentation for monitoring. Here, we proposed to tackle this significant hurdle by providing a route to make available the manufacture of low-cost, milliliter-scale bioreactors. This approach seems plausible for enabling proof-of-concept experiments before moving to a larger scale without significant investments. The conceptually designed systems were based on external-loop bioreactors due to their flexibility, simplicity, and ease of assembling and testing. Designs were initially evaluated in silico with the aid of COMSOL Multiphysics. The successfully evaluated systems were then constructed via additive manufacturing and assembled for hydrodynamics testing via tracer methods. This was enabled by a newly home-made optical absorbance sensor (OAS) for in-line and real-time measurements. Both the in silico and experimental results indicated close to ideal mixing conditions and low shear stress. Cell growth curves were prepared by culturing Escherichia coli and following its cell density in real-time. Our cell growth rate and maximum cell density were similar to those previously obtained in closely related systems. Therefore, the proposed bioreactors are an affordable alternative for batch and continuous cell growth studies rapidly and inexpensively., (Copyright © 2020 Elsevier B.V. All rights reserved.)

To evaluate the use of non-invasive variables for monitoring an open-lung approach (OLA) strategy in bariatric surgery. Twelve morbidly obese patients undergoing bariatric surgery received a baseline protective ventilation with 8 cmH 2 O of positive-end expiratory pressure (PEEP). Then, the OLA strategy was applied consisting in lung recruitment followed by a decremental PEEP trial, from 20 to 8 cmH 2 O, in steps of 2 cmH 2 O to find the lung's closing pressure. Baseline ventilation was then resumed setting open lung PEEP (OL-PEEP) at 2 cmH 2 O above this pressure. The multimodal non-invasive variables used for monitoring OLA consisted in pulse oximetry (SpO 2 ), respiratory compliance (Crs), end-expiratory lung volume measured by a capnodynamic method (EELV CO2 ), and esophageal manometry. OL-PEEP was detected at 15.9 ± 1.7 cmH 2 O corresponding to a positive end-expiratory transpulmonary pressure (P L,ee ) of 0.9 ± 1.1 cmH 2 O. ROC analysis showed that SpO 2 was more accurate (AUC 0.92, IC95% 0.87-0.97) than Crs (AUC 0.76, IC95% 0.87-0.97) and EELV CO2 (AUC 0.73, IC95% 0.64-0.82) to detect the lung's closing pressure according to the change of P L,ee from positive to negative values. Compared to baseline ventilation with 8 cmH 2 O of PEEP, OLA increased EELV CO2 (1309 ± 517 vs. 2177 ± 679 mL) and decreased driving pressure (18.3 ± 2.2 vs. 10.1 ± 1.7 cmH 2 O), estimated shunt (17.7 ± 3.4 vs. 4.2 ± 1.4%), lung strain (0.39 ± 0.07 vs. 0.22 ± 0.06) and lung elastance (28.4 ± 5.8 vs. 15.3 ± 4.3 cmH 2 O/L), respectively; all p < 0.0001. The OLA strategy can be monitored using noninvasive variables during bariatric surgery. This strategy decreased lung strain, elastance and driving pressure compared with standard protective ventilatory settings.Clinical trial number NTC03694665.

Nanomedicine is entering a high maturity stage and is ready to reach full translation into the clinical practice. This is because of the ample spectrum of applications enabled by a large arsenal of nanostructured materials. In particular, bimetallic patchy core/shell nanoparticles offer tunable surfaces that allow multifunctional responses. Despite their attractiveness, major challenges regarding the environmental impact and biocompatibility of the obtained materials are yet to be solved. Here, we developed a green synthesis scheme to prepare highly biocompatible patchy core/shell magnetite/silver nanoparticles for biological and biomedical applications. The magnetite core was synthesized by the co-precipitation of ferric chloride and ferrous chloride in the presence of NaOH. This was followed by the patchy silver shell's growth by a green synthesis approach based on natural honey as a reducing agent. A purification process allowed selecting the target patchy nanoparticles and removing excess toxic reagents from the synthesis very efficiently. The obtained patchy magnetite/silver nanoparticles were characterized by UV-Vis spectrophotometry, dynamic light scattering (DLS), thermogravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), scanning electron microscope equipped with energy-dispersive spectroscopy (SEM + EDS), and transmission electron microscopy (TEM). The morphology, patchiness level, and size of the nanoparticles were determined via SEM and TEM. In addition, the spectrophotometric characterization confirmed the presence of the patchy silver coating on the surface of the magnetite core. The nanoparticles show high biocompatibility, as evidenced by low cytotoxicity, hemolytic effect, and platelet aggregation tendency. Our study also provides details for the conjugation of multiples chemistries on the surface of the patchy bimetallic nanoparticles, which might be useful for emerging applications in nanomedicine, where high biocompatibility is of the utmost importance.

Background: Pulmonary atelectasis in anesthetized children is easily reverted by lung recruitment maneuvers. However, the high airways pressure reached during the maneuver could negatively affect hemodynamics. The aim of this study is to assess the effect and feasibility of a postural lung recruitment maneuver (P-RM); i.e., a new maneuver that opens up the atelectatic lung areas based on changing the child's body position under constant ventilation with moderated driving pressure (12 cmH 2 O) and of positive end-expiratory pressure (PEEP, 10 cmH 2 O). Forty ASA I-II children, aged 6 months to 7 years, subjected to general anesthesia were studied. Patients were ventilated with volume control mode using standard settings with 5 cmH 2 O of PEEP. They were randomized into two groups: (1) control group (C group, n = 20)-ventilation was turned to pressure control ventilation using a fixed driving pressure of 12 cmH 2 O. PEEP was increased from 5 to 10 cmH 2 O during 3 min maintaining the supine position. (2) P-RM group (n = 20)-patients received the same increase in driving pressure and PEEP, but they were placed, respectively, in the left lateral position, in the right lateral position (90 s each), and back again into the supine position after 3 min. Then, ventilation returned to baseline settings in volume control mode. Lung ultrasound-derived aeration score and respiratory compliance were assessed before (T1) and after (T2) 10 cmH 2 O of PEEP was applied., Results: At baseline ventilation (T1), both groups showed similar aeration score (P-RM group 9.9 ± 1.9 vs C group 10.4 ± 1.9; p = 0.463) and respiratory compliance (P-RM group 15 ± 6 vs C group 14 ± 6 mL/cmH 2 O; p = 0.517). At T2, the aeration score decreased in the P-RM group (1.5 ± 1.6 vs 9.9 ± 2.1; p < 0.001), but remained without changes in the C group (9.9 ± 2.1; p = 0.221). Compliance was higher in the P-RM group (18 ± 6 mL/cmH 2 O) when compared with the C group (14 ± 5 mL/cmH 2 O; p = 0.001)., Conclusion: Lung aeration and compliance improved only in the group in which a posture change strategy was applied.

Over the past decade, gene therapies have attracted much attention for the development of treatments for various conditions, including cancer, neurodegenerative diseases, protein deficiencies, and autoimmune disorders. Despite the benefits of this approach, several challenges are yet to be solved to reach clinical implementation. Some of these challenges include low transfection rates, limited stability under physiological conditions, and low specificity towards the target cells. An avenue to overcome such issues is to deliver the therapies with the aid of potent cell-penetrating vectors. Non-viral vectors, such as nanostructured materials, have been successfully tested in drug and gene delivery. Here, we propose the development and in vitro evaluation of a nanostructured cell-penetrating vehicle based on core/shell, magnetite/silver nanoparticles. A subsequent conjugation of a pH-responsive polymer was used to assure that the vehicle can carry and release circular DNA. Additionally, the translocating peptide Buforin II was conjugated with the aid of a polyether amine polymer to facilitate translocation and endosome escape. The obtained nanobioconjugates (magnetite/silver-pDMAEMA-PEA-BUFII) were characterized by UV-Vis spectrophotometry, dynamic light scattering (DLS), thermogravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), scanning electron microscope equipped with energy dispersive spectroscopy (SEM+EDS), and transmission electron microscopy (TEM). They were also encapsulated in lecithin liposomes to form magnetoliposomes. The cell viability of Vero cells in the presence of the nanobioconjugates was above 95% and declined to 80% for the magnetoliposomes. The hemolytic tendency of nanobioconjugates and magnetoliposomes was below 10%, while the platelet aggregation approached that of the negative control (i.e., 35%). Cytoplasm coverage values of about 50% for both Vero and neuroblastoma cells confirmed significant cell penetration. Pearson's correlation coefficients for both cell lines allowed us to estimate 20-40% colocalization of the nanobioconjugates with lysotracker green, which implied high levels of endosomal escape. The developed vehicles were also capable of loading around 16% of the added DNA and releasing such cargo with 8% efficiency. The developed nanoplatform holds a significant promise to enable highly efficient gene therapies as it overcomes some of the major issues associated with their eventual translation to the pre-clinical and clinical scale.

The increasing interest and research on two-dimensional (2D) materials has not yet translated into a reality of diverse materials applications. To go beyond graphene and transition metal dichalcogenides for several applications, suitable candidates with desirable properties must be proposed. Here we use machine learning techniques to identify thermodynamically stable 2D materials, which is the first essential requirement for any application. According to the formation energy and energy above the convex hull, we classify materials as having low, medium, or high stability. The proposed approach enables the stability evaluation of novel 2D compounds for further detailed investigation of promising candidates, using only composition properties and structural symmetry, without the need for information about atomic positions. We demonstrate the usefulness of the model generating more than a thousand novel compounds, corroborating with DFT calculations the classification for five of these materials. To illustrate the applicability of the stable materials, we then perform a screening of electronic materials suitable for photoelectrocatalytic water splitting, identifying the potential candidate Sn 2 SeTe generated by our model, and also PbTe, both not yet reported for this application.

To determine whether a classification based on the contour of the photoplethysmography signal (PPGc) can detect changes in systolic arterial blood pressure (SAP) and vascular tone. Episodes of normotension (SAP 90-140 mmHg), hypertension (SAP > 140 mmHg) and hypotension (SAP < 90 mmHg) were analyzed in 15 cardiac surgery patients. SAP and two surrogates of the vascular tone, systemic vascular resistance (SVR) and vascular compliance (Cvasc = stroke volume/pulse pressure) were compared with PPGc. Changes in PPG amplitude (foot-to-peak distance) and dicrotic notch position were used to define 6 classes taking class III as a normal vascular tone with a notch placed between 20 and 50% of the PPG amplitude. Class I-to-II represented vasoconstriction with notch placed > 50% in a small PPG, while class IV-to-VI described vasodilation with a notch placed < 20% in a tall PPG wave. 190 datasets were analyzed including 61 episodes of hypertension [SAP = 159 (151-170) mmHg (median 1st-3rd quartiles)], 84 of normotension, SAP = 124 (113-131) mmHg and 45 of hypotension SAP = 85(80-87) mmHg. SAP were well correlated with SVR (r = 0.78, p < 0.0001) and Cvasc (r = 0.84, p < 0.0001). The PPG-based classification correlated well with SAP (r = - 0.90, p < 0.0001), SVR (r = - 0.72, p < 0.0001) and Cvasc (r = 0.82, p < 0.0001). The PPGc misclassified 7 out of the 190 episodes, presenting good accuracy (98.4% and 97.8%), sensitivity (100% and 94.9%) and specificity (97.9% and 99.2%) for detecting episodes of hypotension and hypertension, respectively. Changes in arterial pressure and vascular tone were closely related to the proposed classification based on PPG waveform.Clinical Trial Registration NTC02854852.

In this retrospective cohort study in Argentina, risk factors for hospital readmission of older adults, within 72 hours after hospital discharge with home care services, were analyzed. Fifty-three percent of unplanned emergency room visits within 72 hours after hospital discharge resulted in hospital readmissions, 65% of which were potentially avoidable. By multivariate logistic regression, low functionality, pressure ulcers, and age over 83 years predicted hospital readmission among emergency room attendees. It is important to identify and analyze barriers in current home care services and the high-risk population of hospital readmission to improve the strategies to avoid adverse outcomes.

Three-dimensional topological insulators protected by both the time reversal (TR) and mirror symmetries were recently predicted and observed. Two-dimensional materials featuring this property and their potential for device applications have been less explored. We find that, in these systems, the spin polarization of edge states can be controlled with an external electric field breaking the mirror symmetry. This symmetry requires that the spin polarization is perpendicular to the mirror plane; therefore, the electric field induces spin-polarization components parallel to the mirror plane. Since this field preserves the TR topological protection, we propose a transistor model using the spin direction of protected edge states as a switch. In order to illustrate the generality of the proposed phenomena, we consider compounds protected by mirror planes parallel and perpendicular to the structure, e.g., Na&#95;{3}Bi and half-functionalized (HF) hexagonal compounds, respectively. For this purpose, we first construct a tight-binding effective model for the Na&#95;{3}Bi compound and predict that HF-honeycomb lattice materials are also dual topological insulators.

Background: Capnoperitoneum and anaesthesia impair lung aeration during laparoscopy in children. These changes can be detected and monitored at the bedside by lung ultrasound (LUS)., Objective: The aim of our study was to assess the impact of general anaesthesia and capnoperitoneum on lung collapse and the potential preventive effect of lung recruitment manoeuvres, using LUS in children undergoing laparoscopy., Design: Randomised controlled study., Setting: Single-institution study, community hospital, Mar del Plata, Argentina., Patients: Forty-two children American Society of Anesthesiologists I-II aged 6 months to 7 years undergoing laparoscopy., Interventions: All patients were studied using LUS before, during and after capnoperitoneum. Children were allocated to a control group (C-group, n=21) receiving standard protective ventilation, or to a lung recruitment manoeuvre group (RM-group) (n=21), in which lung recruitment manoeuvres were performed after recording baseline LUS images before capnoperitoneum. Loss of aeration was scored by summing a progressive grading from 0 to 3 assigned to each of 12 lung areas, based on the detection of four main ultrasound patterns: normal aeration = 0, partial loss-mild = 1, partial loss-severe = 2, total loss-consolidation = 3., Main Outcome Measures: Lung aeration score and atelectasis assessed by ultrasound., Results: Before capnoperitoneum and recruitment manoeuvres in the treated group the two groups presented similar ultrasound scores (5.95 ± 4.13 vs. 5.19 ± 3.33, P = 0.5). In the RM-group, lung aeration significantly improved both during (2.71 ± 2.47) and after capnoperitoneum (2.52 ± 2.86), compared with the C-group (6.71 ± 3.54, P < 0.001, and 8.48 ± 3.22, P < 0.001, respectively). There was no statistically significant difference in the percentage of atelectasis before capnoperitoneum and recruitment manoeuvres in the RM-group (62%) and in the C-group (47%, P = 0.750). However, during capnoperitoneum, only 19% of the RM-group had atelectasis compared with 80% in the C-group (P < 0.001)., Conclusion: The majority of children undergoing laparoscopy have anaesthesia-induced atelectasis. In most cases, lung collapse due to capnoperitoneum could have been prevented by recruitment manoeuvres followed by positive-end expiratory pressure., Trial Registry Number: NCT02824146.

Purpose: The mechanism by which ocular surface squamous neoplasia (OSSN) responds to topical interferon-alpha-2b (IFNα2b) is not known. We report the cases of 3 immunosuppressed patients whose tumors did not respond to topical IFNα2b therapy. The purpose of this series is to shed light on potential mechanisms of IFNα2b in OSSN., Methods: Retrospective case series of 3 immunosuppressed patients whose biopsy-proven OSSN did not respond to topical IFNα2b treatment., Results: Three white, immunosuppressed males (mean age 70 years, range 66-76) were diagnosed with OSSN. Topical IFNα2b 1 million units/mL was administered 4 times a day and used for a mean of 5 months (range 2-7 mo) without an adequate response. All patients were then switched to 5-fluorouracil. Successful eradication of OSSN was achieved in 2 cases, and improvement of OSSN in another. The latter patient was switched to mitomycin-C with subsequent resolution of OSSN., Conclusions: These cases suggest that an intact immune system may be an important link between IFNα2b therapy and tumor resolution. As such, topical IFNα2b may not be an optimal choice for patients with underlying immunosuppression. It may be more effective in this patient population to switch to a non-immune-modulating therapy such as 5-fluorouracil or mitomycin-C.

Background: Doppler images of pulmonary vessels in pulmonary diseases associated with subpleural consolidations have been described. Color Doppler easily identifies such vessels within consolidations while spectral Doppler analysis allows the differentiation between pulmonary and bronchial arteries. Thus, Doppler helps in diagnosing the nature of consolidations. To our knowledge, Doppler analysis of pulmonary vessels within anesthesia-induced atelectasis has never been described before. The aim of this case series is to demonstrate the ability of lung ultrasound to detect the shunting of blood within atelectatic lung areas in anesthetized children., Findings: Three anesthetized and mechanically ventilated children were scanned in the supine position using a high-resolution linear probe of 6-12 MHz. Once subpleural consolidations were detected in the most dependent posterior lung regions, the probe was rotated such that its long axis followed the intercostal space. In this oblique position, color Doppler mapping was performed to detect blood flow within the consolidation. Thereafter, pulsed waved spectral Doppler was applied in the previously identified vessels during a short expiratory pause, which prevented interferences from respiratory motion. Different flow patterns were identified which corresponded to both, pulmonary and bronchial vessels. Finally, a lung recruitment maneuver was performed which leads to the complete resolution of the aforementioned consolidation thereby confirming the pathophysiological entity of anesthesia-induced atelectasis., Conclusions: Lung ultrasound is a non-invasive imaging tool that not only enables the diagnosis of anesthesia-induced atelectasis in pediatric patients but also analysis of shunting blood within this consolidation.

Transoesophageal echocardiography (TEE) has become a fundamental tool in modern cardiothoracic anaesthesia. It has an indisputable role in coronary valve surgery and revascularisations with severe impairment of ventricle function. It helps in making diagnoses that can optimise the surgical strategy and to minimal invasively dynamically monitor volaemia and cardiac function during the post-operative period, detecting complications unobservable by other methods. The McConnell sign, visualised using TEE as an akinesis of the right ventricular free wall, with a normal apex motility and enlargement of the right cavities, is characteristic of right ventricular (RV) dysfunction. This sign has a 77% sensitivity and 94% specificity for the diagnosis of acute pulmonary embolism (APE). The case is presented of a 53-year-old man scheduled for aortic valve and ascending aorta replacement surgery, with a history of severe valve aortic stenosis, aortic root and arch aneurysm, and with normal coronary arteries. Post-cardiopulmonary bypass (CBP), the patient presented with haemodynamic instability, with the TEE showing a typical image of the McConnell sign, with no pulmonary hypertension. This enabled making an early diagnosis of acute RV ischaemia, that led to a change in the surgical plan, the performing of coronary revascularisation surgery. As a result, the McConnell sign, which describes the characteristics of RV dysfunction, led to making a differential diagnosis between APE, RV infarction and acute myocardial ischaemia., (Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Ventilator-induced lung injury is a form of mechanical damage leading to a pulmonary inflammatory response related to the use of mechanical ventilation enhanced by the presence of atelectasis. One proposed mechanism of this injury is the repetitive opening and closing of collapsed alveoli and small airways within these atelectatic areas-a phenomenon called tidal recruitment. The presence of tidal recruitment is difficult to detect, even with high-resolution images of the lungs like CT scan. The purpose of this article is to give evidence of tidal recruitment by lung ultrasound., Findings: A standard lung ultrasound inspection detected lung zones of atelectasis in mechanically ventilated patients. With a linear probe placed in the intercostal oblique position. We observed tidal recruitment within atelectasis as an improvement in aeration at the end of inspiration followed by the re-collapse at the end of expiration. This mechanism disappeared after the performance of a lung recruitment maneuver., Conclusions: Lung ultrasound was helpful in detecting the presence of atelectasis and tidal recruitment and in confirming their resolution after a lung recruitment maneuver.

This study integrated accessibility and location-allocation models in geographic information systems as a proposed strategy to improve the spatial planning of public health services. To estimate the spatial accessibility, we modified the two-step floating catchment area (2SFCA) model with a different impedance function, a Gaussian weight for competition among service sites, a friction coefficient, distances along a street network based on the Dijkstra's algorithm and by performing a vectorial analysis. To check the accuracy of the strategy, we used the data from the public sterilization program for the dogs and cats of Bogot´a, Colombia. Since the proposed strategy is independent of the service, it could also be applied to any other public intervention when the capacity of the service is known. The results of the accessibility model were consistent with the sterilization program data, revealing that the western, central and northern zones are the most isolated areas under the sterilization program. Spatial accessibility improvement was sought by relocating the sterilization sites using the maximum coverage with finite demand and the p-median models. The relocation proposed by the maximum coverage model more effectively maximized the spatial accessibility to the sterilization service given the non-uniform distribution of the populations of dogs and cats throughout the city. The implementation of the proposed strategy would provide direct benefits by improving the effectiveness of different public health interventions and the use of financial and human resources.

Background: The aim of this study was to test the accuracy of lung sonography (LUS) to diagnose anesthesia-induced atelectasis in children undergoing magnetic resonance imaging (MRI)., Methods: Fifteen children with American Society of Anesthesiology's physical status classification I and aged 1 to 7 yr old were studied. Sevoflurane anesthesia was performed with the patients breathing spontaneously during the study period. After taking the reference lung MRI images, LUS was carried out using a linear probe of 6 to 12 MHz. Atelectasis was documented in MRI and LUS segmenting the chest into 12 similar anatomical regions. Images were analyzed by four blinded radiologists, two for LUS and two for MRI. The level of agreement for the diagnosis of atelectasis among observers was tested using the κ reliability index., Results: Fourteen patients developed atelectasis mainly in the most dependent parts of the lungs. LUS showed 88% of sensitivity (95% CI, 74 to 96%), 89% of specificity (95% CI, 83 to 94%), and 88% of accuracy (95% CI, 83 to 92%) for the diagnosis of atelectasis taking MRI as reference. The agreement between the two radiologists for diagnosing atelectasis by MRI was very good (κ, 0.87; 95% CI, 0.72 to 1; P < 0.0001) as was the agreement between the two radiologists for detecting atelectasis by LUS (κ, 0.90; 95% CI, 0.75 to 1; P < 0.0001). MRI and LUS also showed good agreement when data from the four radiologists were pooled and examined together (κ, 0.75; 95% CI, 0.69 to 0.81; P < 0.0001)., Conclusion: LUS is an accurate, safe, and simple bedside method for diagnosing anesthesia-induced atelectasis in children.

Multiple sclerosis (MS) is a chronic disease resulting from targeted destruction of central nervous system (CNS) myelin. MS is suggested to be an autoimmune disease involving the pathogenic activation of CD4(+) T cells by a foreign antigen in the peripheral blood. The activated CD4(+) T cells liberate inflammatory cytokines that facilitate the breakdown of the blood-brain barrier (BBB) promoting their passage into the CNS. Inside the CNS, CD4(+) T cells become re-activated by myelin proteins sharing a similar structure to the foreign antigen that initially triggered the immune response. The CD4(+) T cells continue to liberate inflammatory cytokines, such as tumor necrosis factor α (TNFα), which activates macrophages and antibodies responsible for the phagocytosis of myelin. Acute CNS lesions can be re-myelinated, however, the repair of chronic demyelinating lesions is limited, leading to permanent neurological deficits. Although current MS treatments reduce severity and slow disease progression, they do not directly repair damaged myelin. Henceforth, recent treatment strategies have focused on neurotrophins, such as nerve growth factor (NGF) for myelin repair. NGF promotes axonal regeneration, survival, protection and differentiation of oligodendrocytes (OGs) and facilitates migration and proliferation of oligodendrocyte precursors (OPs) to the sites of myelin damage. NGF also directly regulates key structural proteins that comprise myelin. Interestingly, NGF also induces the production of brain-derived neurotrophic factor (BDNF), another integral neurotrophin involved in myelination. The intricate signaling between neurotrophins and cytokines that governs myelin repair supports the role of NGF as a leading therapeutic candidate in white matter disorders, such as MS.

Peripheral neural mechanisms underlying the sensations of irritation, discomfort, and itch accompanying the eye allergic response have not been hitherto analyzed. We explored this question recording the changes in the electrical activity of corneoconjunctival sensory nerve fibers of the guinea pig after an ocular allergic challenge. Sensitization was produced by i.p. ovalbumin followed by repeated application in the eye of 10% ovalbumin on days 14 to 18. Blinking and tearing rate were measured. Spontaneous and stimulus-evoked (mechanical, thermal, chemical) impulse activity was recorded from mechanonociceptor, polymodal nociceptor and cold corneoscleral sensory afferent fibers. After a single (day 14) or repeated daily exposures to the allergen during the following 3 to 4days, tearing and blinking rate increased significantly. Also, sensitization was observed in mechanonociceptors (transient reduction of mechanical threshold only on day 14) and in polymodal nociceptors (sustained enhancement of the impulse response to acidic stimulation). In contrast, cold thermoreceptors showed a significant decrease in basal ongoing activity and in the response to cooling. Treatment with the TRPV1 and TRPA1 blockers capsazepine and HC-030031 reversed the augmented blinking. Only capsazepine attenuated tearing rate increase and sensitization of the polymodal nociceptors response to CO2. Capsazepine also prevented the decrease in cold thermoreceptor activity caused by the allergic challenge. We conclude that changes in nerve impulse activity accompanying the ocular allergic response, primarily mediated by activation of nociceptor's TRPV1 and to a lesser degree by activation of TRPA1 channels, explain the eye discomfort sensations accompanying allergic episodes., (Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

It is estimated that the city of São Paulo has over 2.5 million dogs and 560 thousand cats. These populations are irregularly distributed throughout the territory, making it difficult to appropriately allocate health services focused on these species. To reasonably allocate vaccination sites, it is necessary to identify social groups and their access to the referred service. Rabies in dogs and cats has been an important zoonotic health issue in São Paulo and the key component of rabies control is vaccination. The present study aims to introduce an approach to quantify the potential spatial accessibility to the vaccination sites of the 2009 campaign against rabies in the city of São Paulo and solve the overestimation associated with the classic methodology that applies buffer zones around vaccination sites based on Euclidean (straight-line) distance. To achieve this, a Gaussian-based two-step floating catchment area method with a travel-friction coefficient was adapted in a geographic information system environment, using distances along a street network based on Dijkstra's algorithm (short path method). The choice of the distance calculation method affected the results in terms of the population covered. In general, areas with low accessibility for both dogs and cats were observed, especially in densely populated areas. The eastern zone of the city had higher accessibility values compared with peripheral and central zones. The Gaussian-based two-step floating catchment method with a travel-friction coefficient was used to assess the overestimation of the straight-line distance method, which is the most widely used method for coverage analysis. We conclude that this approach has the potential to improve the efficiency of resource use when planning rabies control programs in large urban environments such as São Paulo. The findings emphasize the need for surveillance and intervention in isolated areas., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Gangliosides containing the N-glycolyl (NGc) form of sialic acid are tumor-associated antigens and promising candidates for cancer therapy. We previously generated the murine 14F7 monoclonal antibody (mAb), specific for the N-glycolyl-GM3 ganglioside (NGcGM3), which induced an oncosis-like type of cell death on malignant cell lines expressing this antigen and recognized breast carcinoma by immunoscintigraphy in cancer patients. As humanization is expected to enhance its use for human cancer therapy, herein we describe the design and generation of two humanized versions of the 14F7 mAb by disrupting potential human T cell epitopes on its variable region. No differences in antigen reactivity or cytotoxic properties were detected among the variants tested and with respect to the chimeric counterpart. Humanized 14F7 genes were transfected into the NGcGM3-expressing NS0 cell line. Therefore, in the industrial scaling-up of the transfectoma in serum-free medium, cell viability was lost due to the cytotoxic effect of the secreted antibody. This shortcoming was solved by knocking down the CMP-N-acetylneuraminic acid hydroxylase enzyme, thus impairing the synthesis of NGc-glycoconjugates. Humanized 14F7 mAb is of potential value for the therapy of NGcGM3-expressing tumors., (Copyright © 2011 Elsevier GmbH. All rights reserved.)

Gangliosides are sialic acid-containing glycosphingolipids present in the plasma membrane of most mammalian cells. In humans, the expression of the N-glycolylated (Neu5Gc) variant of the sialic acid has been associated with malignant transformation, constituting therefore an attractive target for cancer immunotherapy. P3 monoclonal antibody (mAb) recognizes Neu5Gc-containing gangliosides, as well as sulfatides. Heavy chain CDR3 (H-CDR3) arginine residues have been shown to be crucial for ganglioside recognition, but less important for anti-idiotypic antibody binding. Here, we describe the effect on antibody reactivity of different mutations involving a single H-CDR3 acid residue. Substitution of glutamate 99 (Kabat numbering) by arginine, aspartate or serine residues resulted in no differences in anti-idiotype binding. However, the first mutation caused increased reactivity with the antigen, including a cytotoxic effect of the antibody on ganglioside-expressing cells previously unseen for the wild type antibody. Another antibody that recognizes N-glycolyl-GM3 ganglioside (GM3(Neu5Gc)), but not other glycolipids, named 14F7, exhibits also an arginine-enriched H-CDR3 and a complement-independent cell death activity. Unlike 14F7 mAb, the cytotoxicity of the P3 E(99)→R mutant antibody did not exclusively depend on ganglioside expression on tumor cells., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Detailed information on the immunological relevance of α-type anti-idiotypic antibodies is lacking after more than 30 years since Jerne postulated his Idiotypic Network Theory. The B7Y33 mutant is a mouse-human chimeric version of the B7 MAb, a polyreactive α-type anti-idiotypic antibody, generated against an anti-GM2 ganglioside IgM Ab1 antibody. It retained the unusual self-binding activity and multispecificity of the parental murine antibody, being able to recognize several anti-ganglioside IgM antibodies as well as non-immunoglobulin antigens. Previous work with the murine B7 MAb suggested that this antibody might have immunoregulatory properties, and therefore we investigated the possible interaction of B7Y33 with immune cells. We found that B7Y33 binds to human and murine B lymphocytes. Inhibition assays using flow cytometry indicated that this antibody is capable of binding the Fc γ receptor II (FcγRII). The recognition of FcγRII-expressing K562, Raji and Daudi human cell lines, together with the capability of inhibiting the binding of an anti-human FcγRII antibody to these cells, suggest that B7Y33 interacts with both the FcγRIIa and FcγRIIb isoforms. We evaluated the contribution to the binding of different surface-exposed residues at the top of the heavy chain variable region (VH) CDR loops through the construction of mutants with substitutions in the three conventional VH CDRs (HCDRs) and the "HCDR4", located in the framework 3 (HFR3). In addition, we assessed the involvement of the Fc region by performing key mutations in the CH2 domain. Furthermore, chimeric hybrid molecules were obtained by combining the B7Y33 heavy chain with unrelated light chains. Our results indicate that the multispecificity and self-binding properties of B7Y33 are not linked to its recognition of B lineage cells, and that this phenomenon occurs in a non-classical way with the participation of both the variable and constant regions of the antibody. Two possible models for this interaction are proposed, with B7Y33 binding to two FcγRIIb molecules through the Fc and Fv regions, or simultaneously to FcγRIIb and another unknown antigen on B cells. The FcγRIIb has recently received great attention as an attractive target for therapies directed to B lymphocytes. The recognition of peripheral B lymphocytes from B cell chronic lymphocytic leukemia (B-CLL) patients by B7Y33 suggests its potential application for the treatment of B cell malignancies., (Copyright © 2010 Elsevier Ltd. All rights reserved.)