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Abstract It is now well established that the microstructure of Fe-based chalcogenide K x Fe2−y Se2 consists of, at least, a minor (~15 percent), nano-sized, superconducting K s Fe2Se2 phase and a major (~85 percent) insulating antiferromagnetic K2Fe4Se5 matrix. Other intercalated A 1−x Fe2−y Se2 (A = Li, Na, Ba, Sr, Ca, Yb, Eu, ammonia, amide, pyridine, ethylenediamine etc.) manifest a similar microstructure. On subjecting each of these systems to a varying control parameter (e.g. heat treatment, concentration x,y, or pressure p), one obtains an exotic normal-state and superconducting phase diagram. With the objective of rationalizing the properties of such a diagram, we envisage a system consisting of nanosized superconducting granules which are embedded within an insulating continuum. Then, based on the standard granular superconductor model, an induced variation in size, distribution, separation and Fe-content of the superconducting granules can be expressed in terms of model parameters (e.g. tunneling conductance, g, Coulomb charging energy, E c , superconducting gap of single granule, Δ, and Josephson energy J = πΔg/2). We show, with illustration from experiments, that this granular scenario explains satisfactorily the evolution of normal-state and superconducting properties (best visualized on a $${\boldsymbol{g}}{\boldsymbol{-}}\frac{{{\boldsymbol{E}}}_{{\boldsymbol{c}}}}{{\boldsymbol{\Delta }}}{\boldsymbol{-}}{\boldsymbol{T}}$$ g−EcΔ−T phase diagram) of A x Fe2−y Se2 when any of x, y, p, or heat treatment is varied.

Molecularly Imprinted Polymers (MIPs) were synthesised for the selective detection of amoxicillin in aqueous samples. Different functional monomers were tested to determine the optimal composition via batch rebinding experiments. Two different sensor platforms were tested using the same MIP solution; one being bulk synthesized and surface modified Screen Printed Electrodes (SPEs) via drop casting the microparticles onto the electrode surface and the other being UV polymerized directly onto the SPE surface in the form of a thin film. The sensors were used to measure amoxicillin in conjunction with the Heat-Transfer Method (HTM), a low-cost and simple thermal detection method that is based on differences in the thermal resistance at the solid−liquid interface. It was demonstrated that both sensor platforms could detect amoxicillin in the relevant concentration range with Limits of Detection (LOD) of 1.89 ± 1.03 nM and 0.54 ± 0.10 nM for the drop cast and direct polymerisation methods respectively. The sensor platform utilising direct UV polymerisation exhibited an enhanced response for amoxicillin detection, a reduced sensor preparation time and the selectivity of the platform was proven through the addition of nafcillin, a pharmacophore of similar shape and size. The use of MIP-modified SPEs combined with thermal detection provides sensors that can be used for fast and low-cost detection of analytes on-site, which holds great potential for contaminants in environmental aqueous samples. The platform and synthesis methods are generic and by adapting the MIP layer it is possible to expand this sensor platform to a variety of relevant targets.

This article presents a complex case of total pharyngoesophageal defect reconstruction in a patient with recurrent supraglottic squamous cell carcinoma. After failed attempts with free microsurgical techniques due to complications, a tubed myocutaneous pectoralis major flap was successfully employed. The procedure aimed to achieve alimentary continuity, speech, and swallowing functionality. Despite initial challenges and concerns about stenosis, the reconstruction of a total pharyngolarygectomy defect resulted in a good functional outcome, although minor deficits in neck mobility and aesthetic donor zone deformities were noted. The case highlights the broad armamentarium of reconstruction techniques that plastic and aesthetic surgery teams must be trained, namely the myocutaneous pectoralis major flap which in selected cases can be the end solution., (© 2024 The Author(s).)

Lumbar pain is a very common symptom that derives from benign musculoskeletal conditions, rheumatic inflammatory diseases, neoplasms, and referred and/or nociplastic pain. A 70-year-old man with psoriatic arthritis presented with early-onset lumbosacral pain without evident red flags. Symptomatic treatment was unhelpful. Radiographic imaging showed subtle signs of a disease that could easily be missed. Magnetic resonance imaging revealed a massive prostatic malignancy with bone (sacral and iliopubic) metastasis. Awareness must be given not to disregard every lumbar pain as part of the preexisting rheumatic inflammatory disease (spondyloarthropathy in this case) or a common muscle/ligament/articular disarrangement. Persistence of pain, albeit not inflam-matory nor sharp in nature, despite adequate treatment might be just as important as an acute red flag and requires proper follow-up.

Introduction: Thyroid nodules are lesions that are radiologically distinct from the thyroid parenchyma. Cervical ultrasound diagnoses 19-67% of nodules and is crucial in identifying those that lack cytological characterisation. Approximately 25% of biopsies reveal an indeterminate cytological result (Bethesda III), in which the risk of malignancy is variable (5-15%). The clinical importance of the diagnostic strategy used for thyroid nodules results from the need to exclude malignancy. The aim of this study was to evaluate the usefulness of serum thyroid-stimulating hormone (TSH) levels as a predictor of malignancy in cytologically indeterminate thyroid nodules., Methods: Our retrospective study included 40 patients with cytologically indeterminate thyroid nodules seen in our hospital between January 2013 and December 2017. Clinical parameters were reviewed, including age, gender, serum TSH levels, family history of thyroid carcinoma, radiation exposure and some sonographic features of the nodules. Statistical analysis was performed using SPSS. Statistical significance was defined as p <0.05., Results: Female gender was predominant (85%) and the mean (SD) age was 53.3 (15) years. Thyroid carcinoma was confirmed in 28% of patients. Median TSH levels were higher in patients with malignant (2.73µIU/ml) compared with benign (1.56µIU/ml) nodules ( p <0.05). We demonstrated an increased risk of malignancy in patients with TSH levels of 2.68µIU/ml or above ( p <0.05)., Conclusion: Higher serum TSH levels are associated with an increased risk of thyroid carcinoma in cytologically indeterminate nodules. TSH can become a fundamental diagnostic tool in stratifying the risk of malignancy and assist in diagnostic and therapeutic approaches to these nodules.

Background and Purpose: Gender bias is a known issue in healthcare and academia. We analysed the gender of patients reported in the literature with 'man-in-the-barrel' syndrome or equivalent semiological terms., Methods: A search in the PubMed database was conducted using the terms 'man-in-the-barrel', 'person-in-the-barrel', 'woman-in-the-barrel', 'brachial diplegia', 'flail arm' and 'cruciate paralysis'. All articles published between 1969 and 2020 containing a detailed description compatible with the original description of man-in-the-barrel syndrome were included., Results: Ninety-five patients with a clinical picture compatible with man-in-the-barrel syndrome were included. Up to 33% of patients were female. Overall, the proportion of female patients with man-in-the-barrel syndrome was 25%., Discussion and Conclusions: The term man-in-the-barrel may disenfranchise up to a third of women presenting with brachial diplegia with undesirable consequences. We propose a gender-neutral alternative such as 'person-in-the-barrel'., (© 2020 European Academy of Neurology.)

The Ria Formosa is a sheltered large coastal lagoon located on the Atlantic South Coast of Portugal, that has been classified as a natural park since 1987. The lagoon hosts a diverse and abundant fish community and other species of commercial importance. Several economical activities are supported by shipping, and as such, vessel traffic within the Ria Formosa lagoon is very intense at some locations during particular seasons of the year, creating high levels of underwater noise. Recently, strong efforts are being made to turn the main inlet of the lagoon, the Faro-Olhão Inlet, a testing site for small scale tidal stream turbines, which will bring an additional source of underwater noise. Underwater noise can be one of a number of factors causing habitat degradation, as it can perturb fish behavior and cause physiological damage. Therefore, in order to comply with underwater noise pollution regulations, tidal energy technology developers are very interested in minimising the introduction of acoustic energy in the environment during the operation of their devices. Under the scope of project SCORE, which involved the deployment and operation of a floating tidal energy converter, this paper presents and discusses the first baseline noise monitoring performed at Ria Formosa. The acoustic data were collected in two occasions over several days, one in the winter and the other in the summer, in 2017. The obtained analysis results highlight the potential impact of the intense boat traffic in Ria Formosa, and the wide range of sound levels introduced in that ecosystem, and the high diurnal and seasonal variability., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

This paper compares the results of standard chemical analytical processes and electrochemical impedance spectroscopy (EIS) in the characterization of different beverages, namely ground coffee, soluble coffee, coffee substitutes, barley, cow milk, vegetable drinks, tea, plant infusions and plant mixtures. For the two approaches, the similarities between the experimental data are assessed by means of the Euclidean and Canberra distances. The resulting information is processed by means of the multidimensional scaling (MDS) clustering and visualization algorithm. The results of the chemical analytical processes and EIS reveal identical clusters for the two adopted distances. Furthermore, the robustness of the experimental and computational scheme are assessed by means of the Procrustes technique. The results confirm the effectiveness of combining the EIS and MDS., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Nanoparticles have properties that depend critically on their dimensions. There are a large number of methods that are commonly used to characterize these dimensions, but there is no clear consensus on which method is most appropriate for different types of nanoparticles. In this work four different characterization methods that are commonly applied to characterize the dimensions of nanoparticles either in solution or dried from solution are critically compared. Namely, transmission electron microscopy (TEM), scanning electron microscopy (SEM), atomic force microscopy (AFM), and dynamic light scattering (DLS) are compared with one another. The accuracy and precision of the four methods applied nanoparticles of different sizes composed of three different core materials, namely gold, silica, and polystyrene are determined. The suitability of the techniques to discriminate different populations of these nanoparticles in mixtures are also studied. The results indicate that in general, scanning electron microscopy is suitable for large nanoparticles (above 50 nm in diameter), while AFM and TEM can also give accurate results with smaller nanoparticles. DLS reveals details about the particles' solution dynamics, but is inappropriate for polydisperse samples, or mixtures of differently sized samples. SEM was also found to be more suitable to metallic particles, compared to oxide-based and polymeric nanoparticles. The conclusions drawn from the data in this paper can help nanoparticle researchers choose the most appropriate technique to characterize the dimensions of nanoparticle samples., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Eugenol is natural oil that has excellent antibacterial properties but cannot be used to fabricate many products that require thermal processing. One possible alternative to the use of the eugenol molecules in high-temperature processes is the encapsulation of these molecules in a structure that is not toxic and is resistant to thermal treatment. This work investigated the encapsulation process of eugenol molecules in β-cyclodextrine and the antibacterial properties of eugenol-β-cyclodextrine (the eugenol-βCD complex) against Escherichia coli and Staphylococcus aureus. The FTIR, DSC, MEV and TGA results show that the encapsulation method is an excellent alternative to increase the thermal stability of eugenol molecules. A value of 241.32L.mol -1 was determined for the formation constant (Kc) of the eugenol-βCD complex, which confirmed the success of the encapsulation process. The MEV analysis shows the formation of approximately 12μm microcapsules. After the thermal treatment of the eugenol-βCD complex at a temperature of 80°C for 2h, the complex retained significant antibacterial action, which confirms the thermal protection of the eugenol molecules. The minimum inhibitory concentration (MIC) and agar diffusion results show that the microcapsules containing 17.08mmol.L -1 of eugenol exhibited excellent antibacterial action against Escherichia coli and Staphylococcus aureus after thermal treatment., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: In patients recovering from an ST-segment elevation myocardial infarction (STEMI), it is not clear whether the negative impact of stent thrombosis (ST) is different from a non-stent-related recurrent myocardial infarction (NSRMI). This study sought to assess the long-term incidence and prognostic impact of recurrent myocardial infarction (MI) after percutaneous coronary intervention (PCI) for STEMI by comparing outcomes of ST versus NSRMI., Patients and Methods: From 2001 to 2007, 1025 patients undergoing PCI for STEMI were prospectively followed up. Patients with ST, with NSRMI, and those free from recurrent MI were compared regarding mortality and major adverse cardiac and cerebrovascular events (MACCE)., Results: Recurrent MI decreased from 37 events per 1000 person/months in the first month to 3.3 events per 1000 person/months after the first year. The cumulative 5‑year incidence of ST and NSRMI was 5.27 % and 13.2 %, respectively. MACCE at 60 months after recurrence were not significantly different for patients with reinfarction but were significantly higher than for patients free from any recurrent MI (both log-rank p < 0.001). However, the cumulative all-cause death rate did not differ between the three groups (27.8 vs. 26.7 vs. 23.0 %). Compared with ST occurring in the first 30 days after PCI for STEMI, early NSRMI was associated with a significantly reduced risk for all-cause death (HR, 0.21; 95 % CI, 0.33-3.30) but this association did not persist for recurrent MIs occurring in the late (HR, 1.05; 95 % CI, 0.33-3.30) or very late follow-up periods., Conclusion: Although ST was associated with a significant increase in adverse events in the early recovery period, in the long term, MACCE and all-cause mortality rates were comparable to those for NSRMI.

Background: Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries., Method: We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief., Results: Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1)., Conclusions: Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.

Background: Adult separation anxiety (ASA) symptoms are prevalent amongst young women in low and middle-income countries and symptoms may be common in pregnancy. No studies have focused on defining distinctive patterns of ASA symptoms amongst pregnant women in these settings or possible associations with trauma exposure and ongoing stressors., Methods: In a consecutive sample of 1672 women attending antenatal clinics in Dili, Timor-Leste (96% response), we assessed traumatic events of conflict, ongoing adversity, intimate partner violence (IPV), ASA, post-traumatic stress disorder (PTSD) and severe psychological distress. Latent Class Analysis was used to identify classes of women based on their distinctive profiles of ASA symptoms, comparisons then being made with key covariates including trauma domains of conflict, intimate partner violence (IPV) and ongoing stressors., Results: LCA yielded three classes, comprising a core ASA (4%), a limited ASA (25%) and a low symptom class (61%). The core ASA class reported exposure to multiple traumatic losses and IPV and showed a pattern of comorbidity with PTSD; the limited ASA class predominantly reported exposure to ongoing stressors and was comorbid with severe psychological distress; the low symptom class reported relatively low levels of exposure to trauma and stressors., Limitations: The study is cross-sectional, cautioning against inferring causal inferences., Conclusions: The core ASA group may be in need of immediate intervention given the high rate of exposure to IPV amongst this class. A larger number of women experiencing a limited array of non-specific ASA symptoms may need assistance to address the immediate stressors of pregnancy., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objectives: To identify the 6-year trajectories of post-traumatic stress symptoms (PTSS) and psychological distress symptoms, and examine for associations with timing of trauma exposure, ongoing adversity and with the sense of injustice in conflict-affected Timor-Leste., Setting: A whole-of-household survey was conducted in 2004 and 2010 in Dili, the capital of Timor-Leste., Participants: 1022 adults were followed up over 6 years (retention rate 84.5%). Interviews were conducted by field workers applying measures of traumatic events (TEs), ongoing adversity, a sense of injustice, PTS symptoms and psychological distress., Results: Latent transition analysis supported a 3-class longitudinal model (psychological distress, comorbid symptoms and low symptoms). We derived 4 composite trajectories comprising recovery (20.8%), a persisting morbidity trajectory (7.2%), an incident trajectory (37.2%) and a low-symptom trajectory (34.7%). Compared with the low-symptom trajectory, the persistent and incident trajectories reported greater stress arising from poverty and family conflict, higher TE exposure for 2 historical periods, and a sense of injustice for 2 historical periods. The persistent trajectory was unique in reporting greater TE exposure in the Indonesian occupation, whereas the incident trajectory reported greater TE exposure during the later internal conflict that occurred between baseline and follow-up. Compared with the low-symptom trajectory, the incident trajectory reported a greater sense of injustice relating to the periods of the Indonesian occupation and independence. The persistent trajectory was characterised by a sense of injustice relating to the internal conflict and contemporary times. The recovery trajectory was characterised by the absence of these risk factors, the only difference from the low-symptom trajectory being that the former reported a sense of injustice for the period surrounding independence., Conclusions: Our findings suggest that the timing of both TE exposure and the focus of a sense of injustice may differentiate those with persisting and new-onset mental health morbidity in settings of recurrent conflict., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

A major pathological hallmark in several neurodegenerative disorders, like polyglutamine disorders (polyQ), including Machado-Joseph disease (MJD), is the formation of protein aggregates. MJD is caused by a CAG repeat expansion in the ATXN3 gene, resulting in an abnormal protein, which is prone to misfolding and forms cytoplasmic and nuclear aggregates within neurons, ultimately inducing neurodegeneration. Treatment of proteinopathies with drugs that up-regulate autophagy has shown promising results in models of polyQ diseases. Temsirolimus (CCI-779) inhibits the mammalian target of rapamycin (m-TOR), while lithium chloride (LiCl) acts by inhibiting inositol monophosphatase, both being able to induce autophagy. We have previously shown that chronic treatment with LiCl (10.4 mg/kg) had limited effects in a transgenic MJD mouse model. Also, others have shown that CCI-779 had mild positive effects in a different mouse model of the disease. It has been suggested that the combination of mTOR-dependent and -independent autophagy inducers could be a more effective therapeutic approach. To further explore this avenue toward therapy, we treated CMVMJD135 transgenic mice with a conjugation of CCI-779 and LiCl, both at concentrations known to induce autophagy and not to be toxic. Surprisingly, this combined treatment proved to be deleterious to both wild-type (wt) and transgenic animals, failing to rescue their neurological symptoms and actually exerting neurotoxic effects. These results highlight the possible dangers of manipulating autophagy in the nervous system and suggest that a better understanding of the potential disruption in the autophagy pathway in MJD is required before successful long-term autophagy modulating therapies can be developed., (Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.)

This study focuses on spatiotemporal variations in the type of dissolved organic matter (DOM) and copper binding ability both upstream and downstream of Paris. It also compares the relative influence of both natural DOM upstream of Paris and effluent dissolved organic matter (EfDOM) output from a wastewater treatment plant (WWTP) on trace metal speciation and bioavailability in aquatic systems. In addition to the typical high- and low-affinity binding sites, a third family of very high-affinity binding sites has been highlighted for EfDOM. In receiving waters downstream of Paris during low-flow periods, the percentage of high- and very high-affinity sites originating from EfDOM reaches nearly 60 %. According to the speciation computation, the free copper concentration upstream of Paris exceeds the downstream Paris concentration by a factor of 2 to 4. As regards copper bioavailability, the highest EC50tot values were observed for EfDOM and downstream DOM, with a very low aromaticity and low UV absorbance. This finding suggests that specific ultraviolet absorbance (SUVA) is unlikely to be useful in assessing metal speciation and toxicity in aquatic systems subject to strong urban pressures. These results also highlight that the copper speciation computation for surface water exposed to considerable human pressures should include not only the humic and/or fulvic part of dissolved organic carbon but more hydrophilic fractions as well, originating for example from EfDOM.

Alport syndrome (AS) is caused by pathogenic mutations in the genes encoding α3, α4 or α5 chains of collagen IV (COL4A3/COL4A4/COL4A5), resulting in hematuria, chronic renal failure (CRF), sensorineural hearing loss (SNHL) and ocular abnormalities. Mutations in the X-linked COL4A5 gene have been identified in 85% of the families (XLAS). In this study, 22 of 60 probands (37%) of unrelated Portuguese families, with clinical diagnosis of AS and no evidence of autosomal inheritance, had pathogenic COL4A5 mutations detected by Sanger sequencing and/or multiplex-ligation probe amplification, of which 12 (57%) are novel. Males had more severe and earlier renal and extrarenal complications, but microscopic hematuria was a constant finding irrespective of gender. Nonsense and splice site mutations, as well as small and large deletions, were associated with younger age of onset of SNHL in males, and with higher risk of CRF and SNHL in females. Pathogenic COL4A3 or COL4A4 mutations were subsequently identified in more than half of the families without a pathogenic mutation in COL4A5. The lower than expected prevalence of XLAS in Portuguese families warrants the use of next-generation sequencing for simultaneous COL4A3/COL4A4/COL4A5 analysis, as first-tier approach to the genetic diagnosis of collagen type IV-related nephropathies., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Pathogenic mutations in genes COL4A3/COL4A4 are responsible for autosomal Alport syndrome (AS) and thin basement membrane nephropathy (TBMN). We used Sanger sequencing to analyze all exons and splice site regions of COL4A3/COL4A4, in 40 unrelated Portuguese probands with clinical suspicion of AS/TBMN. To assess genotype-phenotype correlations, we compared clinically relevant phenotypes/outcomes between homozygous/compound heterozygous and apparently heterozygous patients. Seventeen novel and four reportedly pathogenic COL4A3/COL4A4 mutations were identified in 62.5% (25/40) of the probands. Regardless of the mutated gene, all patients with ARAS manifested chronic renal failure (CRF) and hearing loss, whereas a minority of the apparently heterozygous patients had CRF or extrarenal symptoms. CRF was diagnosed at a significantly younger age in patients with ARAS. In our families, the occurrence of COL4A3/COL4A4 mutations was higher, while the prevalence of XLAS was lower than expected. Overall, a pathogenic COL4A3/COL4A4/COL4A5 mutation was identified in >50% of patients with fewer than three of the standard diagnostic criteria of AS. With such a population background, simultaneous next-generation sequencing of all three genes may be recommended as the most expedite approach to diagnose collagen IV-related glomerular basement membrane nephropathies., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

To evaluate the effect of adding transcranial direct current stimulation (tDCS) to exercises for chronic pain, dysfunction and quality of life in subjects with temporomandibular disorders (TMD). Participants were selected based on the RDC/TMD criteria and assessed for pain intensity, pressure pain threshold over temporomandibular joint and cervical muscles and quality of life. After initial assessment, all individuals underwent a 4-week protocol of exercises and manual therapy, together with active or sham primary motor cortex tDCS. Stimulation was delivered through sponge electrodes, with 2 mA amplitude, for 20 min daily, over the first 5 days of the trial. A total of 32 subjects (mean age 24.7 ± 6.8 years) participated in the evaluations and treatment protocol. Mean pain intensity pre-treatment was 5.5 ± 1.4 for active tDCS group, and 6.3 ± 1.2 for sham tDCS. Both groups showed a decrease in pain intensity scores during the trial period (time factor--F(4.5,137.5) = 28.7, P < 0.001; group factor--F(1.0,30.0 = 7.7), P < 0.05). However, there were no differences between the groups regarding change in pain intensity (time*group interaction--F(4.5,137.5) = 1.5, P = 0.137). This result remained the same after 5 months (t-test t = 0.29, P > 0.05). Pressure pain thresholds decrease and improvement in quality of life were also noticeable in both groups, but again without significant differences between them. Absolute benefit increase was 37.5% (CI 95%: -15.9% to 90.9%), and number needed to treat was 2.66. This study suggests that there is no additional benefit in adding tDCS to exercises for the treatment of chronic TMD in young adults., (© 2015 John Wiley & Sons Ltd.)

Gastrointestinal duplications are rare congenital malformations seldom diagnosed in adulthood. They may vary greatly in size and location, with the small intestine being their major focus. Their clinical presentation is widely variable and unspecific, mimicking more common pathologies, thus making preoperative diagnosis very difficult. The intraoperative surgeon's experience and knowledge are crucial in recognising these lesions so that they can be correctly managed. In this report, the authors present a case of a 36-year-old man with an acute intestinal obstruction as the first presentation of ileal duplication., (2015 BMJ Publishing Group Ltd.)

Human oocyte dysmorphisms attain a large proportion of retrieved oocytes from assisted reproductive technology (ART) treatment cycles. Extracytoplasmic defects involve abnormal morphology of the zona pellucida (ZP), perivitelline space and first polar body. The aim of the present study was to describe a novel dysmorphism affecting the ZP, indented ZP. We also evaluated the clinical, embryological and ultrastructural features of these cases. We evaluated all ART treatment cycles during 7 consecutive years and found 13 treatment cycles (six patients) with all oocytes presenting an indented ZP. In addition, these oocytes presented total or partial absence of the perivitelline space, absence of resistance to ZP and oolemma penetration during microinjection, and low ooplasm viscosity during aspiration. This novel described dysmorphism was recurrent and attained all oocytes in three cases that had more than one treatment cycle. When compared with controls, data showed significant low oocyte maturity (42% versus 81.6%) and high cycle cancellation (30.8% versus 8.5%) rates, normal degeneration (3.4% versus 6.3%) and fertilization rates (69% versus 69.5%), and low pregnancy (15.4% versus 33.3%) and live-birth delivery (7.7% versus 27.7%) rates per cycle. Ultrastructure analysis revealed a zona pellucida structure with large empty electrolucent regions, an outer ZP layer with an indented surface with protuberances and a thick inner ZP that obliterated the perivitelline space. There was evidence of exocytosis of ZP material by the oocyte. In conclusion, oocytes with this novel described dysmorphism (indented ZP) are associated with low maturity, pregnancy and live-birth delivery rates.

Exposure to elevated levels of glucocorticoids (GCs) during neurodevelopment has been identified as a triggering factor for the development of reward-associated disorders in adulthood. Disturbances in the neural networks responsible for the complex processes that assign value to rewards and associated stimuli are critical for disorders such as depression, obsessive–compulsive disorders, obesity and addiction. Essential in the understanding on how cues influence behavior is the Pavlovian–instrumental transfer (PIT), a phenomenon that refers to the capacity of a Pavlovian stimulus that predicts a reward to elicit instrumental responses for that same reward. Here, we demonstrate that in utero exposure to GCs (iuGC) impairs both general and selective versions of the PIT paradigm, suggestive of deficits in motivational drive. The iuGC animals presented impaired neuronal activation pattern upon PIT performance in cortical and limbic regions, as well as morphometric changes and reduced levels of dopamine in prefrontal and orbitofrontal cortices, key regions involved in the integration of Pavlovian and instrumental stimuli. Normalization of dopamine levels rescued this behavior, a process that relied on D2/D3, but not D1, dopamine receptor activation. In summary, iuGC exposure programs the mesocorticolimbic dopaminergic circuitry, leading to a reduction in the attribution of the incentive salience to cues, in a dopamine-D2/D3-dependent manner. Ultimately, these results are important to understand how GCs bias incentive processes, a fact that is particularly relevant for disorders where differential attribution of incentive salience is critical.

Background: Although bacterial spondylodiscitis is one of the most serious complications in hemodialysis patients, it is often underdiagnosed, and few reports describe its course and clinical management., Patients and Methods: We retrospectively reviewed 11 hemodialysis patients diagnosed with spondylodiscitis, during a 5-year period, and compared them with the general population followed at our center. Nine patients presented with fever on admission. Blood cultures were positive in all patients and Staphylococcus aureus was identified in 8. Ten patients had a central venous catheter as access for hemodialysis and the number of vascular accesses in the patients´ medical history was superior to the rest of our HD population., Results: Four patients (36%) died during follow-up. None of the patients that underwent vancomycin and gentamicin antibiotic therapy died., Conclusion: Bacterial spondylodiscitis must be suspected whenever a patient on hemodialysis is admitted with fever and/or back pain. The presence of a central venous catheter and a history of multiple vascular accesses may be important risk factors. Prolonged antibiotic therapy with initial broad-spectrum coverage seems to be the best therapeutic approach.