Search

Objective: To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. Methods: This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined. Results: The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses. Conclusions: The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. Objetivo.Evaluar la precision diagnostica de diferentes indicios ecograficos para el diagnostico de la torsion anexial,utilizando la cirugia como patron de referencia. Metodos. Se trata de una revision sistematica y un metaanalisis de los estudios publicados entre enero de 1990 y noviembre de 2021 que evaluaron el edema ovarico, la masa anexial, los resultados del flujo Doppler ovarico, el ‘‘signo del remolino’’ (torsion ovarica) y el liquido pelvico como indicios ecograficos (pruebas de referencia) para detectar la torsion anexial, utilizando los resultados quirurgicos como patron de referencia. La busqueda de estudios se realizo en las bases de datos PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov y Web of Science.Para evaluar la calidad de los estudios se utilizo la herramienta de Evaluacion de Calidad de los Estudios de Precision Diagnostica-2 (QUADAS-2, por sus siglas en ingles). Se calcularon por separado los valores combinados de sensibilidad,especificidad y cocientes de verosimilitud positivos y negativos, y se determino tambien la probabilidad posterior a la prueba de la torsion anexial tras una prueba positiva o negativa. Resultados. La busqueda identifico 1267 citas, una vez excluidas las duplicadas. Se incluyeron dieciocho estudios en las sıntesis cualitativa y cuantitativa. Ocho estudios (809 pacientes) analizaron la presencia de edema ovarico, ocho estudios(1044 pacientes) analizaron la presencia de una masa anexial, 14 estudios (1742 pacientes) analizaron el flujo Doppler ovarico, seis estudios (545 pacientes) analizaron el ‘‘signo del remolino’’ y siete estudios (981 pacientes) analizaron la presencia de lıquido pelvico como indicios ecograficos de torsion anexial. En general, la calidad de la mayorıa de los estudios se considero moderada o buena. Sin embargo, hubo un alto riesgo de sesgo en una proporcion significativa de estudios en las areas de seleccion de pacientes y texto de referencia (con la excepcion del ‘‘signo del remolino’’). Los valores combinados de la sensibilidad, la especificidad y los cocientes de probabilidad positivos y negativos de cada indicio ecografico fueron del 58%, 86%, 4,0 y 0,49 para el edema ovarico, del 69%, 46%, 1,3 y 0,67 para la masa anexial, del 65%, 91%, 7,6 y 0,38 para el ‘‘signo del remolino’’, del 53%, 95%, 11,0 y 0,49 para los resultados del Doppler ovarico y del 55%, 69%, 1,7 y 0,66 para el liquido pelvico. La heterogeneidad fue elevada en todos los analisis. Conclusion. La presencia de una masa anexial o de liquido pelvico apenas tienen precision diagnostica como indicios ecograficos de torsion anexial, mientras que la presencia de edema ovarico, el ‘‘signo del remolino’’ y la disminucion o ausencia de flujo Doppler ovarico tienen una buena especificidad, pero una sensibilidad moderada para detectar la torsion anexial.

OBJECTIVES Few data regarding follow-up of patients after COVID-19 discharge are available. We aim to describe the long-term outcomes of survivors of hospitalization for COVID-19 followed up first at an outpatient facility and subsequently by telephone. METHODS Observational prospective study conducted at a tertiary general hospital. Clinical and radiological progression was assessed and data recorded on a standardized reporting form. Patients were divided into three groups according to PaO2/FiO2 at hospitalization: PaO2/FiO2 > 300, PaO2/FiO2 300-200 and PaO2/FiO2 < 200. A logistic multivariate regression model was performed to identify factors associated with persistence of symptoms. RESULTS Facility follow-up: 302 patients were enrolled. Median follow-up was 45 days after discharge; 78% (228/294) of patients had COVID-19-related symptoms (53% asthenia, 56% respiratory symptoms) and 40% (122/302) had residual pulmonary radiographic lesions. PaO2/FiO2 300 was associated with resolution of chest radiographic lesions; OR = 0.56 (0.42 to 0.74), (p, Graphical abstract Image 1

The NFL collects detailed tracking data capturing the location of all players and the ball during each play. Although the raw form of this data is not publicly available, the NFL releases a set of aggregated statistics via their Next Gen Stats (NGS) platform. They also provide charts showing the locations of pass attempts and outcomes for individual quarterbacks. Our work aims to partially close the gap between what data is available privately (to NFL teams) and publicly, and our contribution is two-fold. First, we introduce an image processing tool designed specifically for extracting the raw data from the NGS pass charts. We extract the pass outcome, coordinates, and other metadata. Second, we analyze the resulting dataset, examining the spatial tendencies and performances of individual quarterbacks and defenses. We use a generalized additive model for completion percentages by field location. We introduce a naive Bayes approach for estimating the 2-D completion percentage surfaces of individual teams and quarterbacks, and we provide a one-number summary, completion percentage above expectation (CPAE), for evaluating quarterbacks and team defenses. We find that our pass location data closely matches the NFL’s tracking data, and that our CPAE metric closely matches the NFL’s proprietary CPAE metric.

The crystal structures of gallium and indium coordinated by the sexadentate ligand 1,1,1-tris­[(salicyl­idene­amino)­meth­yl]ethane are presented as different solvates. The syntheses, melting points, infra-red (IR) spectra, high-resolution mass spectra, and 1H and 13 NMR spectra are also reported., The sexa­dentate ligand 1,1,1-tris­[(salicyl­idene­amino)­meth­yl]ethane has been reported numerous times in its triply deprotonated form coordinated to transition metals and lanthanides, yet it has been rarely employed with main-group elements, including in substituted forms. Its structures with gallium and indium are reported as solvates, namely, ({[(2,2-bis­{[(2-oxido­benzyl­idene)amino-κ2 N,O]meth­yl}prop­yl)imino]­meth­yl}phenololato-κ2 N,O)gallium(III) pyridine monosolvate, [Ga(C26H24N3O3)]·C5H5N, the aceto­nitrile 0.75-solvate, [Ga(C26H24N3O3)]·0.75C2H3N, and ({[(2,2-bis­{[(2-oxido­benzyl­idene)amino-κ2 N,O]meth­yl}prop­yl)imino]­meth­yl}phenololato-κ2 N,O)indium(III) di­chloro­methane monosolvate, [In(C26H24N3O3)]·CH2Cl2. All three metal complexes are pseudo-octa­hedral and each structure contains multiple weak C—H⋯O and/or C—H⋯N inter­molecular hydrogen-bonding inter­actions. The syntheses and additional characterization in the forms of melting points, high-resolution mass spectra, infra-red (IR) spectra, and 1H and 13C NMR spectra are also reported.

To create reference values for respiratory system resistance (Rrs) and reactance (Xrs) measured by the forced oscillation technique (FOT) in nonintubated very preterm infants.Retrospective analysis of data collected as part of prospective observational studies in two centers.Tertiary neonatal intensive care units.Non-intubated infants below 32 weeks' gestation age who did not develop bronchopulmonary dysplasia.We applied FOT using a mechanical ventilator (Fabian HFOi; Vyaire) that superimposed small-amplitude oscillations (10 Hz) on a continuous positive airway pressure of 3 and 5 cmHWe analyzed 198 measurements performed between 7 postnatal days and 40 weeks postmenstrual age (PMA) in 85 infants, with a median (Q1, Q3) gestational age of 30.43 (29.14, 31.18) weeks. Logarithmic transformations were applied to Rrs and Xrs, and the relationship between transformed impedance values and demographic factors was examined by backwards stepwise linear regression.In univariable analysis, transformed Xrs was significantly associated with PMA, postnatal age, weight, and length, while Rrs was not. The best multivariable regression model estimating transformed Xrs (cmHWe have established reference values for Rrs and Xrs at 10 Hz in nonintubated preterm neonates on continuous positive airway pressure support.

Unlike other major professional sports, American football lacks comprehensive statistical ratings for player evaluation that are both reproducible and easily interpretable in terms of game outcomes. Existing methods for player evaluation in football depend heavily on proprietary data, are not reproducible, and lag behind those of other major sports. We present four contributions to the study of football statistics in order to address these issues. First, we develop the R package nflscrapR to provide easy access to publicly available play-by-play data from the National Football League (NFL) dating back to 2009. Second, we introduce a novel multinomial logistic regression approach for estimating the expected points for each play. Third, we use the expected points as input into a generalized additive model for estimating the win probability for each play. Fourth, we introduce our nflWAR framework, using multilevel models to isolate the contributions of individual offensive skill players, and providing estimates for their individual wins above replacement (WAR). We estimate the uncertainty in each player's WAR through a resampling approach specifically designed for football, and we present these results for the 2017 NFL season. We discuss how our reproducible WAR framework, built entirely on publicly available data, can be easily extended to estimate WAR for players at any position, provided that researchers have access to data specifying which players are on the field during each play. Finally, we discuss the potential implications of this work for NFL teams., Comment: 43 pages, 21 figures, presented at NESSIS 2017

Inflammatory diseases remain critical health problems worldwide. The search for anti-inflammatory drugs is a primary activity in the pharmaceutical industry. Cacalol is a sesquiterpene with anti-inflammatory potential that is isolated from

BackgroundThe Covid-19 pandemic is characterized by extreme variability in the outcome distribution and mortality rates across different countries. Some recent studies suggested an inverse correlation with BCG vaccination at population level, while others denied this hypothesis. In order to address this controversial issue, we performed a strict epidemiological study collecting data available on a global scale, considering additional variables such as cultural-political factors and adherence to other vaccination coverages.MethodsData on 121 countries, accounting for about 99% of Covid-19 cases and deaths globally, were from John’s Hopkins Coronavirus Resource Center, World Bank, International Monetary Fund, United Nations, Human Freedom Report, and BCG Atlas. Statistical models used were Ordinary Least Squares, Tobit and Fractional Probit, implemented on Stata/MP16 software.ResultsBased on our results, countries where BCG vaccination is or has been mandated in the last decades have seen a drastic reduction in Covid-19 diffusion (−80% on average) and mortality (−50% on average), even controlling for relative wealth of countries and their governmental health expenditure. A significant contribution to this reduction (respectively −50% and −13% on average) was also associated to the outbreak onset during summer, suggesting a possible influence of seasonality. Other variables turned out to be associated, though to a lesser extent.ConclusionsRelying on a very large dataset and a wide array of control variables, our study confirms a strong and robust association between Covid-19 diffusion and mortality with BCG vaccination and a set socio-economic factors, opening new perspectives for clinical speculations and public health policies.

The Wittig reaction to synthesize olefins is a very attractive method in organic synthesis. Recently, this methodology has been achieved utilizing simple metal catalysts and diazo compounds in addition to a phosphine and an aldehyde. The following work investigates the use of a variety of metallophthalocyanines (MPc’s) to catalyze Wittig-like reactions from ethyldiazoacetate. We also examine the influence of substitution on the aromatic ring of the aldehyde as well as various phosphines, arsines and antimony complexes. We have been able to exclusively synthesize the trans-olefins in excellent yields in short periods of time (1 h).

BackgroundRheumatoid arthritis (RA) is an autoimmune, progressive disease characterized by an inflammatory process mediated by CD4+T lymphocytes leading to damage of the synovial membrane1. Its prevalence is estimated between 0.2 and 1.2% worldwide, affecting women in the fourth and fifth decades2. In 2013, the Mexican College of Rheumatology estimated a 1.6% prevalence3 in Mexico.RA may affect patients´ social, psychological, economic and physical areas. Among its psychological implications, depression is one of the most important (with a prevalence of 40%) beyond the general population4. Several studies assess either prevalence or prognosis, despite its higher prevalence and a lesser likelihood of remission in these patients. Some investigations looked for a relationship between inflammation and depressive symptoms considering only clinical or biochemical parameters, despite the evidence supporting better results with imaging methods, such as musculoskeletal ultrasound (MSU).ObjectivesTo identify the association between MSU demonstrated inflammation and the presence of depressive symptoms in RA patients.MethodsIn 2021 a cross-sectional study on RA patients (according to ACR/EULAR 2010 criteria) was conducted. The subjects were from the Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra” and Hospital Juárez de México Rheumatology out-patient clinic. Each patient underwent a clinical (SDAI, CDAI, and EVA), psychological (PHQ9 and InCaViSa questionnaires), and MSU assessment (7 joints score). Data described with central tendency and dispersion measures for quantitative variables and frequencies and proportions for qualitative variables. Kruskal Wallis, U Mann-Whitney and Spearman correlation tests for analysis done.ResultsFifty-two patients (94% women) were evaluated, with a mean age of 56.06 (±12.31) years and duration of disease 13.66 (±9.44) years. Depression prevalence was 54%. Patients with disease activity had the highest depression scores (p=0.009), those with triggering events in the last six months (p=0.177), the leading event was the death of a close relative in 30% of the patients. A moderate correlation between the depression score (PHQ9) and clinical disease activity scores (SDAI, CDAI, VAS, and painful joints) (rho=0.553 [pConclusionPatients with disease activity reported higher depression scores in comparison to remission patients. We demonstrated a relationship between depressive symptoms, social factors, disease perception and ultrasound synovitis. It is crucial to conduct longitudinal studies with a large number of patients, including a control group, and perform an adequate stratification of the demographic characteristics of the patients and their confounding variables.References[1]Karimzadeh H, Karami M, Bazgir N, Karimifar M, Yadegarfar G, Mohammadzadeh Z. Ultrasonographic findings of rheumatoid arthritis patients who are in clinical remission. J Res Med Sci 2018;23(1):38.[2]García de Yébenes M de J, Loza E. Artritis reumatoide: epidemiología e impacto sociosanitario. Reumatol Clin Supl 2018;14(2):3–6.[3]Hérnandez L del C, Querol J, De la Garza AL, Férnandez C. Artritis Reumatoide su impacto social y económico. Boletín Epidemiológico 2016;33(12):1–4.[4]Maldonado G, Ríos C, Paredes C, Ferro C, Intriago MJ, Aguirre C, et al. Depresión en artritis reumatoide. Rev Colomb Reumatol 2017;24(2):84–91.Disclosure of InterestsNone declared

BackgroundPower Doppler ultrasound (PDUS) is a sensitive non-invasive imaging tool that allows the visualisation of articular and periarticular inflammation in patients with psoriatic arthritis (PsA).1 ULTIMATE (NCT02662985) was the first large randomised clinical trial that showed the responsiveness of the Global OMERACT-EULAR ultrasound synovitis score (GLOESS) in PsA and confirmed the rapid and continued benefits of secukinumab through 52 weeks.2,3ObjectivesTo report the distribution of ultrasound-detected synovitis at joint level, by degree of severity at baseline and over time, and the contribution of each core component of GLOESS, synovial hypertrophy (SH) by greyscale (GS; B-mode) and power Doppler (PD) signal, to responsiveness.3MethodsThis was a 52-week study with a 12-week double-blind, placebo-controlled treatment period followed by a 12-week open-label period and a 6-month open-label extension secukinumab treatment period.3 The number of joints with synovitis measured by GLOESS2 was assessed up to Week 52. The assessments included distribution of synovitis based on composite PDUS score across 24 pairs of joints (with worse score of the pair of the joints used) by grade of severity (0-3) and change from baseline to Week 52 in each core component of GLOESS.3-5 Data are presented as observed.ResultsA total of 166 patients (mean age, 46.7 years; males, 45.2%) were enrolled, of which 90% (75/83) of secukinumab and 83% (69/83) of placebo-secukinumab participants completed 52 weeks. The mean (SD) number of PDUS detected synovitis at baseline was 9.2 (4.9) and 10.2 (5.2) in the secukinumab and placebo group, respectively. The most frequent locations with synovitis at baseline were: wrist, metatarsophalangeal (MTP), knees and metacarpophalangeal (MCP) joints (Table 1). An early and continued improvement in GLOESS was observed in both secukinumab and placebo-secukinumab groups after switching to active therapy, as previously reported at Week 12 and through Week 52.2,3 Among the two core components of GLOESS, SH was mainly responsible for the change in GLOESS from baseline to Week 52, in contrast with PD signal in this dataset. The distribution of synovitis by grade of severity showed that MTP joints, wrist, knee, MCP1/2 and tibiotalar joints mostly contributed to the composite PDUS at Week 12 (Figure 1). Similar patterns were observed through 52 weeks.Table 1.Proportion of patients with PDUS detected synovitis at baseline*Synovitis joint, data presented as n (%)Secukinumab (N=83)Placebo (N=83)Wrist66 (80)66 (80)MTP256 (68)65 (78)MTP158 (70)60 (72)MTP352 (63)60 (72)MTP446 (55)59 (71)Knee50 (60)47 (57.)MCP136 (43)52 (63)MCP235 (42)41 (49)MTP530 (36)41 (49)*Data for top nine pairs of joints with most frequently detected power Doppler ultrasound (PDUS) synovitis are presented here. Synovitis was scored by a OMERACT-EULAR synovitis composite score >0 for each paired joint (irrespective of right or left side). The OMERACT-EULAR composite PDUS score (for individual joints) ranged from 0 to 3 and was composed of the two core components synovial hypertrophy and power Doppler.N, total number of randomised patients; n, number of evaluable patientsConclusionThe distribution of synovitis at baseline reflected a predominance of small joints (feet and hands) and large joints (wrist and knee) and were mostly responsive to secukinumab over time in the ULTIMATE trial. Synovial hypertrophy was the most responsive core component of GLOESS driving an early and continued reduction of synovitis with secukinumab through Week 52. This finding could be useful to select a restricted number of joints in future ultrasound trials in PsA.References[1]D’Agostino MA and Coates LC. J Rheumatol. 2019;46:337–9.[2]D’Agostino MA et al. Arthritis Rheumatol. 2021;73(10).[3]D’Agostino MA, et al. Rheumatology (Oxford) 2021;keab628.[4]D’Agostino MA and Coates LC. RMD Open 2017;3:e000428.[5]Uson J, et al. Rheumatol Clin. 2018;14:27–35.Disclosure of InterestsMaria-Antonietta D’Agostino Speakers bureau: Sanofi, Novartis, BMS, Janssen, Celgene, Roche, AbbVie, UCB, and Eli Lilly, Consultant of: Sanofi, Novartis, BMS, Janssen, Celgene, Roche, AbbVie, UCB, and Eli Lilly, Maarten Boers Consultant of: Novartis, Corine Gaillez Shareholder of: Novartis and BMS, Employee of: Novartis, Carlos Gamez: None declared, LUCIO VENTURA: None declared, Javier Rosa Speakers bureau: Abbvie, Pfizer, Lilly, Janssen, Novartis and BMS, Ilaria Padovano: None declared, Peter Mandl Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Roche and UCB, Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Roche and UCB, Arnd Kleyer Speakers bureau: Abbvie, Lilly, Novartis, MEDAC; Janssen, Consultant of: Abbvie, Lilly, UCB, Novartis, BMS, Sanofi, Galapagos, Catherine Bakewell Speakers bureau: AbbVie, Novartis, Pfizer, Janssen, UCB, and Sanofi Genzyme/Regeneron, Consultant of: AbbVie, Novartis, Pfizer, Janssen, UCB, and Sanofi Genzyme/Regeneron, Weibin Bao Shareholder of: Novartis, Employee of: Novartis, Punit Goyanka Employee of: Novartis, Philip G Conaghan Speakers bureau: AbbVie, Amgen, AstraZeneca, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer and UCB, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, Roche and UCB

Obesity is associated with an increased incidence and aggressiveness of breast cancer and is estimated to increment the development of this tumor by 50 to 86%. These associations are driven, in part, by changes in the serum molecules. Epidemiological studies have reported that Metformin reduces the incidence of obesity-associated cancer, probably by regulating the metabolic state. In this study, we evaluated in a breast cancer in-vitro model the activation of the IR-β/Akt/p70S6K pathway by exposure to human sera with different metabolic and hormonal characteristics. Furthermore, we evaluated the effect of brief Metformin treatment on sera of obese postmenopausal women and its impact on Akt and NF-κB activation. We demonstrated that MCF-7 cells represent a robust cellular model to differentiate Akt pathway activation influenced by the stimulation with sera from obese women, resulting in increased cell viability rates compared to cells stimulated with sera from normal-weight women. In particular, stimulation with sera from postmenopausal obese women showed an increase in the phosphorylation of IR-β and Akt proteins. These effects were reversed after exposure of MCF-7 cells to sera from postmenopausal obese women with insulin resistance with Metformin treatment. Whereas sera from women without insulin resistance affected NF-κB regulation. We further demonstrated that sera from post-Metformin obese women induced an increase in p38 phosphorylation, independent of insulin resistance. Our results suggest a possible mechanism in which obesity-mediated serum molecules could enhance the development of luminal A-breast cancer by increasing Akt activation. Further, we provided evidence that the phenomenon was reversed by Metformin treatment in a subgroup of women.

Resumen Objetivo Determinar aquellos datos clinicos que puedan comportarse como factores de riesgo de mal pronostico en el struma ovarii, asi como establecer las directrices que nos ayuden a un precoz diagnostico en esta rara entidad, comparando nuestros resultados con la evidencia cientifica publicada hasta el momento. Metodo Estudio observacional retrospectivo de pacientes intervenidas por masa anexial con diagnostico de «struma ovarii» en el Hospital Virgen del Rocio durante el periodo comprendido entre los anos 2000-2016. Resultados Se estudiaron un total de 37 casos. La edad media fue de 43,11 anos con IMC medio de 30,43 kg/m2, 11 casos (29,73%) eran pacientes menopausicas y 26 (70,27%) estaban en edad fertil. En el 91,9% de los casos el comportamiento fue benigno y solo el 8,1%, presentaron malignidad. Clinicamente el dolor fue el motivo mas frecuente de consulta (27,02%). En 22 casos se realizo anexectomia, en 11 marsupializacion y en 4 se realizo histerectomia y doble anexectomia. Tras el estudio anatomopatologico postoperatorio 3 resultaron struma ovarii maligno (8,1%): un carcinoma tiroideo folicular, otro papilar y un tumor carcinoide estrumal. Conclusiones El struma ovarii es una rara entidad cuyo tratamiento no esta establecido. La cirugia conservadora se recomienda en tumores benignos y puede ser una opcion terapeutica en casos malignos seleccionados asociando la tiroidectomia total profilactica y radioablacion con 131I.

Agent-based models (ABMs) simulate interactions between autonomous agents in constrained environments over time. ABMs are often used for modeling the spread of infectious diseases. In order to simulate disease outbreaks or other phenomena, ABMs rely on "synthetic ecosystems," or information about agents and their environments that is representative of the real world. Previous approaches for generating synthetic ecosystems have some limitations: they are not open-source, cannot be adapted to new or updated input data sources, and do not allow for alternative methods for sampling agent characteristics and locations. We introduce a general framework for generating Synthetic Populations and Ecosystems of the World (SPEW), implemented as an open-source R package. SPEW allows researchers to choose from a variety of sampling methods for agent characteristics and locations when generating synthetic ecosystems for any geographic region. SPEW can produce synthetic ecosystems for any agent (e.g. humans, mosquitoes, etc), provided that appropriate data is available. We analyze the accuracy and computational efficiency of SPEW given different sampling methods for agent characteristics and locations and provide a suite of diagnostics to screen our synthetic ecosystems. SPEW has generated over five billion human agents across approximately 100,000 geographic regions in about 70 countries, available online.

We performed a systematic review of oNJ literature with keyword and MeSH terms referred to pain and its treatment, on PubMed and other literature sources on 2014-2018 years. out of 2957 publications citing oNJ and published in the period, 350 papers reported about pain anyhow.

Disasters cause deaths and serious disruptions in society, which call for the global community to take drastic steps to address and reduce the impacts of these inevitable calamities. That is why the government, through the Philippine Disaster Risk Reduction Management Act of 2010, requires the integration of disaster risk reduction in the school curriculum to strengthen the awareness and practice of personnel and students on calamity preparedness. Hence, the paper assessed the level of awareness and extent of practice on disaster preparedness before, during, and after the disaster of public junior high school students in Antique. Likewise, it sought to establish a difference in awareness and practice on disaster preparedness relative to sex, residence, and grade level and the relationship between awareness and practice.

A crucial subject in sports is identifying the inter-individual variation in response to training, which would allow creating individualized pre-training schedules, improving runner’s performance. We aimed to analyze heterogeneity in individual responses to two half-marathon training programs differing in running volume and intensity in middle-aged recreational women. 20 women (40 ± 7 years, 61 ± 7 kg, 167 ± 6 cm, and VO2max = 48 ± 6 mL⋅kg–1⋅min–1) underwent either moderate-intensity continuous (MICT) or high-intensity interval (HIIT) 12-week training. They were evaluated before and after training with maximal incremental tests in the laboratory (VO2max) and in the field (time to exhaustion, TTE; short interval series and long run). All the women participated in the same half-marathon and their finishing times were compared with their previous times. Although the improvements in the mean finishing times were not significant, MICT elicited a greater reduction (3 min 50 s, P = 0.298), with more women (70%) improving on their previous times, than HIIT (reduction of 2 min 34 s, P = 0.197, 50% responders). Laboratory tests showed more differences in the HIIT group (P = 0.008), while both groups presented homogeneous significant (P < 0.05) increases in TTE. Both in the short interval series and in the long run, HIIT induced better individual improvements, with a greater percentage of responders compared to MICT (100% vs 50% in the short series and 78% vs 38% in the long run). In conclusion, variability in inter-individual responses was observed after both MICT and HIIT, with some participants showing improvements (responders) while others did not (non-responders) in different performance parameters, reinforcing the idea that individualized training prescription is needed to optimize performance.

OBJECTIVE Our purpose was to apply a principal component analysis (PCA) approach to cardiorespiratory exercise to test evaluation and its sensitivity to workload accumulation. APPROACH Twenty-five healthy young adults performed a progressive and maximal cycling test, which was divided into two parts: moderate and high workload intensities, using a ventilatory threshold as a cut point. A PCA of the time series of cardiovascular and respiratory variables was performed in each part and the number of principal components (PCs), the eigenvalues of the first PC (PC1), and the information entropy were calculated. MAIN RESULTS The number of PCs increased, the eigenvalues of PC1 decreased (t = 5.32; p

Continuous-time assessments of game outcomes in sports have become increasingly common in the last decade. In American football, only discrete-time estimates of play value were possible, since the most advanced public football datasets were recorded at the play-by-play level. While measures such as expected points and win probability are useful for evaluating football plays and game situations, there has been no research into how these values change throughout the course of a play. In this work, we make two main contributions: First, we introduce a general framework for continuous-time within-play valuation in the National Football League using player-tracking data. Our modular framework incorporates several modular sub-models, to easily incorporate recent work involving player tracking data in football. Second, we use a long short-term memory recurrent neural network to construct a ball-carrier model to estimate how many yards the ball-carrier is expected to gain from their current position, conditional on the locations and trajectories of the ball-carrier, their teammates and opponents. Additionally, we demonstrate an extension with conditional density estimation so that the expectation of any measure of play value can be calculated in continuous-time, which was never before possible at such a granular level.

Summary AtxA is a critical transcriptional regulator of plasmid-encoded virulence genes in Bacillus anthracis. Bacillus cereus G9241, which caused an anthrax-like infection, has two virulence plasmids, pBCXO1 and pBC210, that each harbor toxin genes and a capsule locus. G9241 also produces two orthologs of AtxA: AtxA1, encoded on pBCXO1, and AtxA2, encoded on pBC210. The amino acid sequence of AtxA1 is identical to that of AtxA from B. anthracis, while the sequences of AtxA1 and AtxA2 are 79% identical and 91% similar to one another. We found by qRT-PCR that AtxA1 and AtxA2 function as positive regulators of toxin (AtxA1) and capsule operon (both) transcription in G9241 and that a ΔatxA1 mutant produced lower levels of the anthrax toxins and no hyaluronic acid capsule. Deletion of atxA1 or atxA2 decreased the virulence of spores administered intranasally or subcutaneously to C57BL/6 mice but not to A/J mice, and deletion of both genes rendered spores avirulent in A/J mice. In addition, unlike AtxA1, AtxA2 did not form stable homomultimers in vitro, although AtxA1 and AtxA2 formed heterodimers. Our data show that AtxA1 is the primary regulator of G9241 virulence factor expression and that AtxA1 and AtxA2 are both required for full virulence.

Background Alectinib is indicated as a second-line treatment of adult patients with advanced non-small cell lung cancer (NSCLC) anaplastic lymphoma kinase (ALK) positive, previously treated with crizotinib. Clinical safety data do not report adverse drug reactions (ADR) on the central nervous system. This drug is on the European list of medicinal products under additional monitoring. Purpose Describe a case of manic episodes in a patient with advanced NSCLC treated with alectinib. Material and methods Retrospective observation of a clinical case. The data – diagnostic tests, therapy and clinical course – were obtained by the review of medical records. Results A 46 years’ old female affected by NSCLC ALK positive with brain metastases began treatment with alectinib in December 2017. Treatment, four capsules twice a day, allowed cancer regression and metastasis disappearance. In March 2018, a CT scan with and without contrast agent (80 cc Ioversol 370 mg/mL), did not show pathological signs in intracranial space or grooves growth of the convexities. History was negative for psychiatric disorders but after the beginning of treatment, the patient developed an anxious depressive symptomatology and insomnia that worsened in the next months. Between February and May 2018, the patient was hospitalised four times at the Psychiatric Diagnosis and Treatment Service, and diagnosed with bipolar severe disorder: psychotic characteristics with persistently high mood, irritable and expanded, logorrhea, agitation, impairment of social functioning, delirium with ideas of grandeur and persecution. This ADR has been reported on the national pharmacovigilance network. Psychotic symptoms were treated with Sodium Valproate 300 mg os, Aripiprazole 400 mg ev, Lithium Carbonate 300 mg os, and high doses of Lorazepam and Olanzapine up to 30 mg. The patient responded well but had recurrences after each hospital discharge. Although initially this could be supposed as poor treatment compliance, this was impossible due to long-acting injectable therapy with normal levels of valproataemia and lithiaemia. The patient continued the therapy with Olanzapine and Lorazepam. Conclusion In the literature there are no cases of Alectinib neurological toxicity. For this reason, healthcare professionals need to monitor carefully any unexpected ADR that can manifest itself during treatment with new drugs, especially those under additional monitoring. References and/or acknowledgements Pubmed; Abstract book EJHP; RCP Alectinib and clinical studies; RNFV. No conflict of interest.

Aims: Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases. Methods: MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients. Stakeholders: Include patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors. Results: MASK is deployed in 23 countries and 17 languages. 26,000 users have registered. EU grants (2018): MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour). Lessons learnt: (i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases. © 2019 The Author(s).

Statistical analysis of defensive players in football has lagged behind that of offensive players, special teams, and coaching decisions, largely because data on individual defensive players has historically been lacking. With the introduction of player tracking data from the NFL, researchers can now tackle these problems. However, event and strategy annotations in the NFL’s tracking data are limited, especially when it comes to describing what defensive players do on each play. Moreover, methods for creating these annotations typically require extensive human labeling, which is difficult and expensive. Because of the importance of the passing game and the limited prior research on the defensive side of passing, we provide annotations for the pass coverage types of cornerbacks using unsupervised learning techniques, which require no training data. We define a set of features from the tracking data that distinguish between “man” and “zone” coverage. We use mixture models to create clusters corresponding to each group, allowing us to provide probabilistic assignments to each coverage type (or cluster). Additionally, we quantify each feature’s influence in distinguishing defensive pass coverage types. Our work makes possible several potential avenues of future NFL research into defensive backs and pass coverage strategies.

Data monitoring and reporting systems are extremely important for safety and quality of care. The use of tools to support the work of health professionals in managing clinical risk is widespread particularly in high income countries. In 2008 the World Health Organization designed a checklist for the safety during childbirth (safe Childbirth Checklist) initially dedicated to low and middle-income countries, now available also for developed countries. Two studies have been conducted by the Centre for clinical risk management and Patient safety (Florence) in hospitals in Tuscany with the aim of evaluating the impact of a modify version of the WHO checklist on clinical practice, the usability of the tool and the users’ compliance through prospective pre- and post-intervention studies based on clinical records review. The effects of the checklist on professionals’ adherence to clinical practices and on the standardization of processes have been investigated, in order to design and refine the tool. Both studies show that the presence of correctly compiled partogram tool in the clinical charts is strongly and significantly associated with the checklist implementation (OR1 = 14.9, 95% confidence interval [CI] = 3.5, 63.9 and OR2 = 2.51, 95% confidence interval [CI] = 1.41−4.47) and that the checklist promotes the interdisciplinary work.