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Obesity is considered a chronic disease, difficult to treat, and is the first cause of death in the world that is predictable. The surgical approach is limited to patients with severe obesity but there is an intermediate group who are not candidates for immediate surgery. The BioEnterics Intragastric Balloon (BIB) is recommended for weight reduction as a bridge to bariatric surgery.

Introdução: As infecções em indivíduos imunocompetentes podem, por vezes, apresentar sintomas atípicos e confundir-se com outras condições clínicas, incluindo doenças linfoproliferativas. Este relato de caso ilustra a importância de considerar a possibilidade de uma neoplasia em pacientes com sintomas persistentes e investigação inicial negativa. Objetivo: Relatar um caso clínico que destaca a complexidade diagnóstica em pacientes imunocompetentes com sintomas persistentes, enfatizando a necessidade de uma abordagem abrangente para identificar neoplasias ocultas. Método: Metodologia de relato de caso. Resultados: Paciente do sexo feminino, 73 anos, previamente hígida, apresentou há dois meses um quadro de edema no membro inferior direito, acompanhado de dor e perda de peso. Após a exclusão de trombose venosa profunda e a normalidade dos exames de tomografia de tórax e abdome, além de exames laboratoriais, foi inicialmente tratada empiricamente com antibióticos para miosite, com alívio temporário dos sintomas. No entanto, após a suspensão do tratamento, a paciente voltou a apresentar dor e edema. A investigação prosseguiu com a solicitação de uma biópsia da lesão na coxa, que revelou uma proliferação fusocelular e de células grandes em tecido fibroadiposo e muscular, levantando a suspeita de uma doença linfoproliferativa. Durante o exame físico, foi notado um nódulo umbilical, conhecido como nódulo de Sister Mary Joseph, que é um sinal de metástase. A biópsia dessa lesão confirmou a infiltração por um adenocarcinoma, que posteriormente foi diagnosticado como um carcinoma gástrico pouco coeso através de biópsia em lesão na região do antro, realizada por endoscopia digestiva alta. Conclusão: Este caso ressalta a importância de considerar a possibilidade de uma neoplasia em pacientes com sintomas persistentes, mesmo em indivíduos imunocompetentes. As infecções podem mimetizar outras condições clínicas, incluindo doenças linfoproliferativas, o que pode levar a atrasos no diagnóstico e tratamento adequado. Uma abordagem completa, com avaliação clínica criteriosa, exames complementares e biópsias, é fundamental para identificar corretamente a causa dos sintomas e fornecer o tratamento apropriado.

Introdução: A pielonefrite enfisematosa é uma forma grave e rara de infecção do trato urinário (ITU), caracterizada pela presença de gás dentro dos tecidos renais. Fatores de risco como diabetes e uso de imunossupressores aumentam o risco para a patologia e desfechos desfavoráveis, com alto potencial de disseminação sistêmica e choque séptico. Objetivo: Relatar um caso clínico de pielonefrite enfisematosa em paciente imunossuprimida, destacando a complexidade diagnóstica e a importância de uma abordagem multidisciplinar para o manejo eficaz. Método: Metodologia de relato de caso. Resultados: Paciente do sexo feminino, 74 anos, com histórico de doença renal crônica, hipertensão, diabetes e artrite reumatoide, em uso de metotrexato e hidroxicloroquina. Procurou atendimento por piora do nível de consciência, sonolência e confusão, sendo regulada por suspeita de acidente vascular encefálico. Após admissão, familiares relataram dor abdominal em flanco direito com piora há quatro dias. Com suspeita de sepse de foco urinário e rápida piora clínica, foi realizada tomografia de abdome, que mostrou presença de gases na região da loja renal direita. Iniciada antibioticoterapia com ceftriaxona em cobertura empírica e coletadas culturas, a paciente foi encaminhada à UTI. Avaliada pela urologia, foi indicada abordagem cirúrgica para controle do foco infeccioso. Devido à instabilidade clínica, optou-se por manejo não invasivo, priorizando compensação hemodinâmica e de função renal, sendo indicada hemodiálise de urgência no segundo dia de internação por hipercalemia refratária e uremia. No terceiro dia, em reavaliação pela urologia, decidiu-se por abordagem cirúrgica de urgência. A paciente foi submetida a laparotomia, com nefrectomia à direita. Retornou à UTI após o procedimento com instabilidade hemodinâmica grave. Realizado escalonamento de antibiótico para piperacilina+tazobactam. Paciente evoluiu a óbito no quarto dia de internação por choque séptico refratário. Culturas intraoperatórias foram negativas, mas hemoculturas da admissão mostraram crescimento de Escherichia coli multi-sensível, incluindo ceftriaxona. Conclusão: Este caso ilustra a gravidade das ITUs em pacientes imunossuprimidos e ressalta a importância da suspeita e tratamento adequado. A pielonefrite enfisematosa é uma complicação rara e potencialmente fatal que requer intervenção cirúrgica imediata. A abordagem multidisciplinar, envolvendo especialistas em urologia, infectologia e terapia intensiva, é fundamental para um manejo eficaz desses casos.

Abstract Sustainable forest management (SFM) is a rational exploitation practice adopted in the Caatinga. This study aimed to evaluate the stock and the nutritional and organic composition of litter in Caatinga subjected to different forest management practices: shallow cutting (SC), selective thinning by minimum diameter (STMD), and selective thinning by species (STS), and using unmanaged Caatinga (control) as a reference, in dry and rainy seasons. There were a significant increase in total litter in STS and a decrease in stocks of STMD, shallow cutting and unmanaged forest. Forest management reduced leaves in the accumulated litter in both seasons and increased contribution from branches. The STS management promoted maintenance of the stock and nutritional and organic quality of the litter, bringing it closer to the condition of unmanaged natural forest in both climatic seasons. So, should be encouraged for a more sustainable management of the Brazilian phyto-physiognomy Caatinga.

This study investigates the application of neural networks to the evaluation of minimum-time low-thrust transfers in low Earth orbit. The findings demonstrate the effectiveness of utilizing costates to regularize the training loss, significantly enhancing the accuracy of the predictions of the neural networks, even when working with limited datasets. Remarkably precise estimates of transfer times are achieved by training the regularized networks on datasets comprising one million samples. The incorporation of a warm-started guess strategy, involving simpler neural networks to provide transfer time and costates predictions for new transfers, accelerates the data collection process, making this approach highly practical for real-world applications. Overall, the methodology employed in this research study holds significant promise for low-thrust space missions, particularly when the evaluation of multiple minimum-time transfers is necessary in mission planning. In fact, the trained neural networks significantly speed up convergence when solving optimal control problems with indirect optimization methods. Furthermore, the remarkable accuracy in estimating both minimum transfer times and costates provides the flexibility of relying entirely on neural networks for determining minimum time.

Abstract The physical protection of soil organic matter through its occlusion in aggregates is a mechanism which reduces their accessibility by microorganisms. When the physically protected carbon (C) becomes accessible to the microbiota, it generates a flow of CO2. The objective of this study was to evaluate the C mineralization rate in macro and microaggregates of macerated and non-macerated soils under different leguminous tree, pasture, and secondary forest (capoeira). The CO2 mineralization curves showed that maceration increased the amount of C mineralized in macroaggregates, mainly in leguminous tree. Maceration provided an increase of approximately 50% and 47% in acacia and ingá, respectively, and 35% in sabiá. Capoeira and pasture did not respond to maceration.

Abstract Oligodendrocyte (OL) injury and loss are central features of evolving lesions in multiple sclerosis. Potential causative mechanisms of OL loss include metabolic stress within the lesion microenvironment. Here we use the injury response of primary human OLs (hOLs) to metabolic stress (reduced glucose/nutrients) in vitro to help define the basis for the in situ features of OLs in cases of MS. Under metabolic stress in vitro, we detected reduction in ATP levels per cell that precede changes in survival. Autophagy was initially activated, although ATP levels were not altered by inhibitors (chloroquine) or activators (Torin-1). Prolonged stress resulted in autophagy failure, documented by non-fusion of autophagosomes and lysosomes. Consistent with our in vitro results, we detected higher expression of LC3, a marker of autophagosomes in OLs, in MS lesions compared to controls. Both in vitro and in situ, we observe a reduction in nuclear size of remaining OLs. Prolonged stress resulted in increased ROS and cleavage of spectrin, a target of Ca2+-dependent proteases. Cell death was however not prevented by inhibitors of ferroptosis or MPT-driven necrosis, the regulated cell death (RCD) pathways most likely to be activated by metabolic stress. hOLs have decreased expression of VDAC1, VDAC2, and of genes regulating iron accumulation and cyclophilin. RNA sequencing analyses did not identify activation of these RCD pathways in vitro or in MS cases. We conclude that this distinct response of hOLs, including resistance to RCD, reflects the combined impact of autophagy failure, increased ROS, and calcium influx, resulting in metabolic collapse and degeneration of cellular structural integrity. Defining the basis of OL injury and death provides guidance for development of neuro-protective strategies.

Introdução: Este estudo buscou abordar os impactos causados nos hábitos alimentares da população durante o isolamento social. Objetivo: Investigar o impacto da pandemia de Covid-19 nos hábitos alimentares da população. Materiais e Métodos: Trata-se de uma revisão de artigos publicados em periódicos indexados, a partir de uma busca nas bases de dados no portal Capes, Pubmed, BVS e EBSCO, utilizando os descritores “coronavírus” e “comportamentos alimentares”. Foram considerados elegíveis artigos originais e publicados em periódicos nacionais e internacionais, publicados em 2020 e 2021, disponíveis em língua portuguesa, inglesa e espanhola. Resultados: Foram identificados 376 e, após aplicados os critérios de inclusão e exclusão, foram selecionados 29 para o estudo. A literatura mostrou que houve a redução no consumo de alimentos in natura e ganho de peso. Em contrapartida, notou-se padrões opostos, com mais ingestão de frutas e vegetais in natura, menos consumo de fast food, redução da ingestão de bebidas alcoólicas e apresentação de comportamentos alimentares mais saudáveis, quando comparados aos hábitos alimentares anteriores à pandemia. Discussão: A pandemia de Covid-19 levou a condições de estresse, que causaram mudanças nos hábitos alimentares. Contudo, mantê-los saudáveis, por meio de uma dieta bem equilibrada, que contenha todos os nutrientes essenciais e compostos bioativos, é fundamental para aumentar as funções imunológicas. Conclusão: Estudos longitudinais são necessários para melhor compreender os impactos da pandemia de Covid-19 nos hábitos alimentares, bem como para orientar ações de enfrentamento à doença e aos desdobramentos desse fenômeno mundial na saúde dos brasileiros.

ABSTRACT In-depth knowledge of total soil organic phosphorus (TPO) as a potential P source for plants allows for a comprehensive understanding of the adoption of an efficient management system of phosphorus fertilization in forest plantations. Thus, we aimed to compare three TPO extraction methods (Hedley; Bowman; Bowman and Moir) in different Eucalyptus plantations on strongly weathered soils. The TPO concentrations obtained by the “Hedley” (mean of 130 mg kg–1), and “Bowman and Moir” methods (mean of 131 mg kg–1) were similar. The “Bowman” method extracted less than 50 % of the TPO content extracted by the other methods. Both “Hedley” and “Bowman and Moir” methods showed similar TPO extraction efficiency compared to TP determined by acid digestion. However, the “Hedley” method is the most expensive and time-consuming analytical technique. In view of this, the NaOH+Na2EDTA extractor (Bowman and Moir) would be the most suitable since, in addition to showing high extraction efficiency, it offers fast analysis execution, low analytical error, and lower cost.

The Ports of Los Angeles and Long Beach, collectively known as the San Pedro Bay Ports, serve as vital gateways for freight movement in the United States. The COVID-19 pandemic and other influencing factors disrupted freight movement and led to unprecedented cargo surge, vessel congestion, and increased air pollution and greenhouse gas emissions from seaport and connected freight system operations beginning in June 2020. In this study, we conducted the first comprehensive monthly assessment of the excess particulate matter, oxides of nitrogen (NO _x ), and carbon dioxide (CO _2 ) emissions due to the heightened congestion and freight transport activity from ocean-going vessels (OGVs), trucks, locomotives, and cargo handling equipment (CHE) supporting seaport operations. Excess emissions peaked in October 2021 at 23 tons of NO _x per day and 2001 tons of CO _2 per day. The strategic queuing system implemented in November 2021 significantly reduced the number of anchored and loitering OGVs and their emissions near the ports, even during continued high cargo throughput until Summer 2022. Looking forward, we analyzed projected emissions benefits of adopted California Air Resources Board regulations requiring cleaner and zero-emission trucks, locomotives, and CHE over the next decade. If a repeated port congestion event were to occur in 2035, NO _x emissions from land-based freight transport should be lessened by more than 80%. Our study underscores the potential emissions impacts of disruptions to the freight transport network and the critical need to continue reducing its emissions in California and beyond.

Objective: The purpose of this study is to analyze the texture characteristics of chronic non-bacterial osteomyelitis (CNO) bone lesions, identified as areas of altered signal intensity on short tau inversion recovery (STIR) sequences, and to distinguish them from bone marrow growth-related changes through Machine Learning (ML) and Deep Learning (DL) analysis. Materials and methods: We included a group of 66 patients with confirmed diagnosis of CNO and a group of 28 patients with suspected extra-skeletal systemic disease. All examinations were performed on a 1.5 T MRI scanner. Using the opensource 3D Slicer software version 4.10.2, the ROIs on CNO lesions and on the red bone marrow were sampled. Texture analysis (TA) was carried out using Pyradiomics. We applied an optimization search grid algorithm on nine classic ML classifiers and a Deep Learning (DL) Neural Network (NN). The model’s performance was evaluated using Accuracy (ACC), AUC-ROC curves, F1-score, Positive Predictive Value (PPV), Mean Absolute Error (MAE) and Root-Mean-Square Error (RMSE). Furthermore, we used Shapley additive explanations to gain insight into the behavior of the prediction model. Results: Most predictive characteristics were selected by Boruta algorithm for each combination of ROI sequences for the characterization and classification of the two types of signal hyperintensity. The overall best classification result was obtained by the NN with ACC = 0.91, AUC = 0.93 with 95% CI 0.91–0.94, F1-score = 0.94 and PPV = 93.8%. Between classic ML methods, ensemble learners showed high model performance; specifically, the best-performing classifier was the Stack (ST) with ACC = 0.85, AUC = 0.81 with 95% CI 0.8–0.84, F1-score = 0.9, PPV = 90%. Conclusions: Our results show the potential of ML methods in discerning edema-like lesions, in particular by distinguishing CNO lesions from hematopoietic bone marrow changes in a pediatric population. The Neural Network showed the overall best results, while a Stacking classifier, based on Gradient Boosting and Random Forest as principal estimators and Logistic Regressor as final estimator, achieved the best results between the other ML methods.

Optical properties of flame-generated black carbon (BC) containing soot particles were quantified at multiple wavelengths for particles produced using two different flames: a methane diffusion flame and an ethylene premixed flame. Measurements were made for (i) nascent soot particles, (ii) thermally denuded nascent particles, and (iii) particles that were coated and then thermally denuded, leading to the collapse of the initially lacy, fractal-like morphology. The measured mass absorption coefficients (MACs) depended on soot maturity and generation but were similar between flames for similar conditions. For mature soot, here corresponding to particles with volume-equivalent diameters > ∼ 160nm, the MAC and absorption Ångström exponent (AAE) values were independent of particle collapse while the single-scatter albedo increased. The MAC values for these larger particles were also size-independent. The mean MAC value at 532nm for larger particles was 9.1±1.1m2g-1, about 17% higher than that recommended by Bond and Bergstrom (2006), and the AAE was close to unity. Effective, theory-specific complex refractive index (RI) values are derived from the observations with two widely used methods: Lorenz-Mie theory and the Rayleigh-Debye-Gans (RDG) approximation. Mie theory systematically underpredicts the observed absorption cross sections at all wavelengths for larger particles (with x > 0.9) independent of the complex RI used, while RDG provides good agreement. (The dimensionless size parameter x = π dp/λ, where dp is particle diameter and λ is wavelength.) Importantly, this implies that the use of Mie theory within air quality and climate models, as is common, likely leads to underpredictions in the absorption by BC, with the extent of underprediction depending on the assumed BC size distribution and complex RI used. We suggest that it is more appropriate to assume a constant, size-independent (but wavelength-specific) MAC to represent absorption by uncoated BC particles within models.

Surface-active compounds present in aerosols can increase their cloud condensation nuclei (CCN) activation efficiency by reducing the surface tension (σ ) in the growing droplets. However, the importance of this effect is poorly constrained by measurements. Here we present estimates of droplet surface tension near the point of activation derived from direct measurement of droplet diameters using a continuous flow streamwise thermal gradient chamber (CFSTGC). The experiments used sea spray aerosol (SSA) mimics composed of NaCl coated by varying amounts of (i) oleic acid, palmitic acid or myristic acid, (ii) mixtures of palmitic acid and oleic acid, and (iii) oxidized oleic acid. Significant reductions in σ relative to that for pure water were observed for these mimics at relative humidity (RH) near activation (∼99.9%) when the coating was sufficiently thick. The calculated surface pressure (Ï€ Combining double low line σ H2O - σ observed) values for a given organic compound or mixture collapse onto one curve when plotted as a function of molecular area for different NaCl seed sizes and measured RH. The observed critical molecular area (A 0) for oleic acid determined from droplet growth was similar to that from experiments conducted using macroscopic solutions in a Langmuir trough. However, the observations presented here suggest that oleic acid in microscopic droplets may exhibit larger values during monolayer compression. For myristic acid, the observed A 0 compared well to macroscopic experiments on a fresh subphase, for which dissolution has an important impact. A significant kinetic limitation to water uptake was observed for NaCl particles coated with pure palmitic acid, likely as a result of palmitic acid (with coating thicknesses ranging from 67 to 132nm) being able to form a solid film. However, for binary palmitic-acid-oleic-acid mixtures there was no evidence of a kinetic limitation to water uptake. Oxidation of oleic acid had a minor impact on the magnitude of the surface tension reductions observed, potentially leading to a slight reduction in the effect compared to pure oleic acid. A CCN counter was also used to assess the impact on critical supersaturations of the substantial σ reductions observed at very high RH. For the fatty-acid-coated NaCl particles, when the organic fraction (μ org) was >0.90 small depressions in critical supersaturation were observed. However, when μ org

IntroductionX-linked adrenoleukodystrophy (X-ALD) is the most common inherited peroxisomal disorder caused by variants in the ABCD1 gene. The main phenotypes observed in men with X-ALD are primary adrenal insufficiency, adrenomyeloneuropathy, and cerebral ALD (cALD). Cerebral ALD consists of a demyelinating progressive cerebral white matter (WM) disease associated with rapid clinical decline and is fatal if left untreated. Hematopoietic stem cell transplantation is the standard treatment for cALD as it stabilizes WM degeneration when performed early in the disease. For this reason, early diagnosis is crucial, and several countries have already implemented their newborn screening programs (NBS) with the assessment of C26:0-lysophosphatidylcholine (C26:0-LPC) values as screening for X-ALD.MethodsIn June 2021, an Italian group in Lombardy launched a pilot study for the implementation of X-ALD in the Italian NBS program. A three-tiered approach was adopted, and it involved quantifying the values of C26:0-LPC and other metabolites in dried blood spots with FIA-MS/MS first, followed by the more specific ultra-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) technique and, finally, the genetic confirmation via focused NGS.DiscussionGenetically confirmed patients are set to undergo a follow-up protocol and are periodically evaluated to promptly start a specific treatment if and when the first signs of brain damage appear, as suggested by international guidelines. A specific disease monitoring protocol has been created based on literature data and personal direct experience.ConclusionThe primary aim of this study was to develop a model able to improve the early diagnosis and subsequent follow-up and timely treatment of X-ALD.EthicsThe study was approved by the local ethics committee. The research was conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest.