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Current predictors of clinical outcomes after pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) are largely limited to preoperative clinical characteristics. N-terminal-pro-brain natriuretic peptide (NT-pro-BNP), a biomarker of right ventricular dysfunction, has not yet been well described as one such predictor. From 2017 to 2021, 816 patients with CTEPH referred to the University of California, San Diego for PTE were reviewed for differences in NT-pro-BNP to predict preoperative characteristics and postoperative outcomes up to 30 days post-PTE. For analysis, NT-pro-BNP was dichotomized to less than/equal to or greater than 1000 pg/mL based on the mean of the study population. Mean NT-pro-BNP was 1095.9 ±1783.4 pg/mL and median was 402.5 pg/mL (interquartile range: 119.5-1410.8). Of the 816 patients included, 250 had NT-pro-BNP > 1000 pg/mL. Those with NT-pro-BNP > 1000 pg/mL were significantly more likely to have worse preoperative functional class (III-IV) and worse preoperative hemodynamics. Patients with NT-pro-BNP > 1000 pg/mL also tended to have more postoperative complications including reperfusion pulmonary edema (22% vs. 5.1%, p  1000 pg/mL had a 2.48 times higher odds (95% confidence interval: 1.45-4.00) of reaching a combined endpoint that included the above complications. Preoperative NT-pro-BNP > 1000 pg/mL is a strong predictor of more severe preoperative hemodynamics and identifies patients at higher risk for postoperative complications.

Abstract Background Early detection of melanoma, a potentially lethal type of skin cancer with high prevalence worldwide, improves patient prognosis. In retrospective studies, artificial intelligence (AI) has proven to be helpful for enhancing melanoma detection. However, there are few prospective studies confirming these promising results. Existing studies are limited by low sample sizes, too homogenous datasets, or lack of inclusion of rare melanoma subtypes, preventing a fair and thorough evaluation of AI and its generalizability, a crucial aspect for its application in the clinical setting. Methods Therefore, we assessed “All Data are Ext” (ADAE), an established open-source ensemble algorithm for detecting melanomas, by comparing its diagnostic accuracy to that of dermatologists on a prospectively collected, external, heterogeneous test set comprising eight distinct hospitals, four different camera setups, rare melanoma subtypes, and special anatomical sites. We advanced the algorithm with real test-time augmentation (R-TTA, i.e., providing real photographs of lesions taken from multiple angles and averaging the predictions), and evaluated its generalization capabilities. Results Overall, the AI shows higher balanced accuracy than dermatologists (0.798, 95% confidence interval (CI) 0.779–0.814 vs. 0.781, 95% CI 0.760–0.802; p = 4.0e−145), obtaining a higher sensitivity (0.921, 95% CI 0.900–0.942 vs. 0.734, 95% CI 0.701–0.770; p = 3.3e−165) at the cost of a lower specificity (0.673, 95% CI 0.641–0.702 vs. 0.828, 95% CI 0.804–0.852; p = 3.3e−165). Conclusion As the algorithm exhibits a significant performance advantage on our heterogeneous dataset exclusively comprising melanoma-suspicious lesions, AI may offer the potential to support dermatologists, particularly in diagnosing challenging cases.

Many students with learning disabilities struggle with sentence writing fluency, the skill of quickly and accurately generating words that follow rules of semantics, spelling, syntax, and usage within sentence structures understandable to readers. Students who struggle with sentence writing fluency may face difficulty fully expressing their ideas while engaging in academic writing. In the present article, we describe how a combination of explicit instruction and fluency practice can improve the simple sentence writing fluency of students with learning disabilities. We detail how five design and delivery steps can help to create a supplemental writing intervention that addresses simple sentence structure, syntax, and usage.

Resumen: Antecedentes y objetivos: El desarrollo de lesión renal aguda (FRA) durante la hospitalización por SARS-Cov-2 se ha asociado a una elevada morbimortalidad. El Registro FRA-COVID SEN ha recogido datos de pacientes con este perfil durante los meses de la pandemia. El objetivo de este trabajo fue caracterizar la población española ingresada por COVID-19 que desarrolló FRA, con/sin necesidades de tratamiento renal sustitutivo (TRS), modalidades terapéuticas utilizadas y resultados en términos de mortalidad. Material y método: Estudio retrospectivo de datos procedentes de 30 hospitales españoles, recopilados en el Registro español FRA COVID desde mayo de 2020 hasta noviembre 2021. Se registraron variables clínicas y demográficas, datos relacionados con la gravedad de la COVID-19, con el FRA y de supervivencia. Mediante estudio de regresión multivariante se analizan los factores relacionados con la necesidad de TRS y con la mortalidad. Resultados: Se registraron datos de 730 pacientes. El 71,9% eran hombres, con edad media de 70 años (60-78). El 70,1% eran hipertensos, el 32,9% diabéticos, el 33,3% con enfermedad cardiovascular y el 23,9% presentaban algún grado de enfermedad renal crónica. Desarrollaron neumonía el 94,6%, con necesidad de soporte ventilatorio en el 54,2% e ingreso en UCI en un 44,1% de los casos.La mediana de tiempo desde el inicio de los síntomas de COVID hasta la aparición de FRA fue de 6 días (4-10). En cuanto a la gravedad: 37,1% KDIGO I, 18,3% KDIGO II y 44,6% KDIGO III; requirieron TRS 235 pacientes (33,9%). Las técnicas continuas (TCRR) fueron las más empleadas (155 pacientes), seguidas de hemodiálisis (HD) intermitente (89 pacientes), HD diaria (36 pacientes), hemodiafiltración (HDF) 17 pacientes y HD expandida (HDexp) en 24 casos. El hábito tabáquico (OR 3,41), la necesidad de soporte ventilatorio (OR 20,2), la cifra de creatinina máxima (OR 2,41) y el tiempo transcurrido desde el inicio de los síntomas hasta la aparición del FRA (OR 1,13) se identificaron como predictores de la necesidad de TRS en nuestra cohorte, mientras la edad se comporta como protector (OR: 0,95). El grupo que no requirió TRS se caracterizó por presentar mayor edad, menor gravedad de FRA y un tiempo de aparición y recuperación de la lesión renal más corto (p

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is primarily managed by pulmonary thromboendarterectomy (PTE). As advanced surgical techniques permit resection at the segmental and subsegmental level, PTE can now be curative for CTEPH mostly involving the distal pulmonary arteries.MethodsBetween January 2017 and June 2021, consecutive patients undergoing PTE were categorized according to the most proximal level of chronic thrombus resection: Level I (main pulmonary artery), Level II (lobar), Level III (segmental) and Level IV (subsegmental). Proximal disease patients (any Level I or II) were compared to distal disease (Level III or IV bilaterally) patients. Demographics, medical history, preoperative pulmonary hemodynamics, and immediate postoperative outcomes were obtained for each group.ResultsDuring the study period, 794 patients underwent PTE, 563 with proximal disease and 231 with distal disease. Patients with distal disease more frequently had a history of an indwelling intravenous device, splenectomy, upper extremity thrombosis or use thyroid replacement and less often had prior lower extremity thrombosis or hypercoagulable state. Despite more use of PAH-targeted medications in the distal disease group (63.2% vs 50.1%, p < 0.001), preoperative hemodynamics were similar. Both patient groups exhibited significant improvements in pulmonary hemodynamics postoperatively with comparable in-hospital mortality rates. Compared to proximal disease, a lower percentage of patients with distal disease showed residual pulmonary hypertension (3.1% vs 6.9%, p = 0.039) and airway hemorrhage (3.0% vs 6.6%, p = 0.047) postoperatively.ConclusionsThromboendarterectomy for distal (segmental and subsegmental) CTEPH is technically feasible and may result in favorable pulmonary hemodynamic outcomes, without increased mortality or morbidity.

BackgroundAirway hemorrhage is a known complication of pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension. Predisposing factors for postoperative airway hemorrhage have not been well described. The aims of this study were to determine the incidence and outcomes of airway hemorrhage after PTE and to identify potential risk factors.MethodsThis was a retrospective chart review of subjects undergoing PTE between 2015 and 2019. Postoperative airway hemorrhage was defined as significant endobronchial bleeding requiring withholding anticoagulation, bronchial blocker placement, and/or extracorporeal membrane oxygenation (ECMO).ResultsOf 877 subjects who underwent PTE, 58 subjects (6.6%) developed postoperative airway hemorrhage. Subjects with hemorrhage were more likely to be women (60% vs 45%, P = .03), to be older (57.8 vs 54.0 years, P = .04), and to have a higher incidence of preoperative hemoptysis (19.0% vs 7.6%, P = .006) compared with control subjects (subjects without airway hemorrhage). Those with hemorrhage had significantly higher preoperative right atrial pressure (P = .002) and pulmonary vascular resistance (P < .001) and a higher incidence of residual pulmonary hypertension (P = .005). Airway hemorrhage management included ECMO with bronchial blocker (n = 2), bronchial blocker without ECMO (n = 26), or withholding anticoagulation alone until bleeding subsided (n = 30). Mortality was significantly higher in those with airway hemorrhage compared with control subjects (13.8% vs 1.2%, P < .001).ConclusionsThe incidence of postoperative airway hemorrhage is low but associated with significant mortality. Older age, female sex, preoperative hemoptysis, and worse preoperative pulmonary hypertension were associated with an increased risk of developing postoperative airway hemorrhage.

Writing is a critical academic and life skill, but many school-age children struggle with the complexity of written expression. Given the importance of writing, there is a clear need for a systematic approach to identifying and supporting struggling writers, including writers with learning and emotional disabilities. One such approach is known as data-based instruction (DBI). This article presents an overview of DBI and guidance on how educators can use the DBI steps with assessment data to inform their classroom writing instruction. Additional resources are shared to support teachers in using DBI with their struggling writers and writers with learning and emotional disabilities.

This article provides personal and professional assessments from disciples, colleagues and friends of Jaume Porta Casanellas (Barcelona, 1944; Lleida, 2023), a prominent soil scientist. He began his agricultural engineering studies at the Polytechnic University of Madrid (UPM) where he met Marta López-Acevedo, his wife and outstanding collaborator. At UPM, he started his early work in soil science under the guidance of Professor Carlos Roquero who became his mentor and friend. Jaume Porta was a dedicated, passionate soil scientist who engaged extensively in teaching and research in Soil Science, while also excelling as a manager. He emerged as a leader due to his initiatives in promoting Soil Science in Catalonia and Spain, and for his forward-thinking vision, evident in his decisions as Rector of the University of Lleida, which have significantly contributed to the city’s development. From the beginning, he advocated for detailed (1:25,000) soil mapping of Catalonia to enhance territorial planning and agricultural progress. His primary research focus was on salt-affected soils and soils with gypsum, alongside soil erosion and conservation. Porta devoted a lot of effort to improve soil field descriptions with his Agenda de campo. He played a key role in standardizing soil analytical methods, establishing large series laboratories in Spain, notably the LAF in Sidamon (Lleida), and aligning Spanish soil labs with the international GLOSOLAN network. As president of the SECS, he energized activities and encouraged member participation. His educational publications, mainly his comprehensive textbook Edafología, are considered fundamental in Soil Science across Spanish-speaking countries, as is the Multilingual Dictionary of Soil Science, representing the pinnacle of his efforts to rigorously disseminate soil science concepts and terms in Spanish, Catalan, Galician, and Portuguese. He contributed significantly to international Soil Science courses in Mexico and played a key role in establishing the JADE postgraduate training program. He facilitated the creation and international visibility of the Spanish Journal of Soil Science. Additionally, he advocated for the establishment of the Soil Sciences Documentation Centre (Ce.SECS) to preserve historical publications and the legacy of soil scientists. Jaume Porta’s enduring impact, both professionally and personally, will be felt for years to come.

The present study uses electroencephalography (EEG) with an N-back task (0-, 1-, and 2-back) to investigate if and how individual bilingual experiences modulate brain activity and cognitive processes. The N-back is an especially appropriate task given recent proposals situating bilingual effects on neurocognition within the broader attentional control system (Bialystok and Craik, 2022). Beyond its working memory component, the N-Back task builds in complexity incrementally, progressively taxing the attentional system. EEG, behavioral and language/social background data were collected from 60 bilinguals. Two cognitive loads were calculated: low (1-back minus 0-back) and high (2-back minus 0-back). Behavioral performance and brain recruitment were modeled as a function of individual differences in bilingual engagement. We predicted task performance as modulated by bilingual engagement would reflect cognitive demands of increased complexity: slower reaction times and lower accuracy, and increase in theta, decrease in alpha and modulated N2/P3 amplitudes. The data show no modulation of the expected behavioral effects by degree of bilingual engagement. However, individual differences analyses reveal significant correlations between non-societal language use in Social contexts and alpha in the low cognitive load condition and age of acquisition of the L2/2L1 with theta in the high cognitive load. These findings lend some initial support to Bialystok and Craik (2022), showing how certain adaptations at the brain level take place in order to deal with the cognitive demands associated with variations in bilingual language experience and increases in attentional load. Furthermore, the present data highlight how these effects can play out differentially depending on cognitive testing/modalities – that is, effects were found at the TFR level but not behaviorally or in the ERPs, showing how the choice of analysis can be deterministic when investigating bilingual effects.

In this study, we investigated if the therapeutic potential of peripheral blood mononuclear cell (PBMC) therapy in a murine model of ischemic AKI is related with the survival pattern of monocyte/macrophages in tissue. CD-1 mice were subjected to bilateral renal ischemia followed by reperfusion to induce AKI. M2-polarized PBMCs isolated from CD-1 mice were administered intravenously at different time points post-injury. Our results demonstrate that early administration of PBMC therapy attenuates renal tissue damage, reduces tissue cell death and prevents fibrosis development. Reduction of tissue pyroptosis was observed by reduction on NLRP3 inflammasome activation and decreasing IL-1beta and Caspase-1 expression in the kidney. Furthermore, the therapy was shown to mitigate ferroptosis by inducing GPX4 overexpression. Early administration of PBMCs increased the survival pattern of renal tissue-macrophages, promoting a “pro-survival phenotype” resulting in decreased pyroptotic marker NLRP3, IL-1beta and Caspase 1 and increased anti-ferroptotic gene GPX4. Conversely, delayed administration of PBMC therapy exhibits diminished efficacy in preventing cell death and fibrosis in tissue and provoked a decrease in the pro-survival phenotype of both monocyte /macrophages in tissue. Our findings highlight the therapeutic potential of PBMC therapy in mitigating AKI and preventing CKD progression by modulating tissue-resident macrophage survival and reducing their cell death pathways. The fact that the effectiveness of the therapy depends on the time of administration after the injury underscores the importance of early intervention in AKI management.

ObjectiveChronic thromboembolic pulmonary hypertension is potentially curable via pulmonary thromboendarterectomy. A minority of patients experience recurrence of their symptoms and are eligible for repeat pulmonary thromboendarterectomy. However, little data exist regarding risk factors and outcomes for this patient population.MethodsWe performed a retrospective review of the University of California San Diego chronic thromboembolic pulmonary hypertension quality improvement database, including all patients who underwent pulmonary thromboendarterectomy from December 2005 to December 2020. Of the 2019 cases performed during this period, 46 were repeat pulmonary thromboendarterectomy procedures. Demographics, preoperative and postoperative hemodynamics, and surgical complications were compared between the repeat pulmonary thromboendarterectomy group and 1008 first pulmonary thromboendarterectomy group.ResultsRepeat pulmonary thromboendarterectomy recipients were more likely to be younger, to have an identified hypercoagulable state, and to have higher preoperative right atrial pressure. Etiologies of recurrent disease include incomplete initial endarterectomy, discontinuation of anticoagulation (noncompliance or for medical reasons), and anticoagulation treatment failure. Patients who received repeat pulmonary thromboendarterectomy had significant hemodynamic improvement, but less pronounced compared with patients who received first pulmonary thromboendarterectomy. Repeat pulmonary thromboendarterectomy was associated with an increased risk of postoperative bleeding, reperfusion lung injury, residual pulmonary hypertension, and increased ventilator, intensive care unit, and hospital days. However, hospital mortality was similar between the groups (2.2% vs 1.9%).ConclusionsThis is the largest reported series of repeat pulmonary thromboendarterectomy surgery. Despite an increase in postoperative complications, this study demonstrates that repeat pulmonary thromboendarterectomy surgery can result in significant hemodynamic improvement with acceptable surgical mortality in an experienced center.

Contrast-induced encephalopathy is a neurological complication related to contrast used in endovascular procedures or computed tomography (CT). The main risk factors are arterial hypertension, diabetes mellitus, chronic kidney disease (CKD), hyperosmolar contrasts, the amount of infused contrast and its direct infusion in the posterior cerebral territory, or pathologies with blood-brain barrier damage. Symptomatology is non-specific and may present as altered level of consciousness, neurological focality or seizures. Diagnosis is done by exclusion after ischemic or hemorrhagic stroke has been ruled out; CT or MRI are useful for differentiation. Generally, it appears shortly after exposure and the symptoms lasts 48−72h with complete recovery, although cases with persistence of symptoms or longer duration have been described. Treatment consists of monitoring, supportive measures and kidney replacement therapy (KRT) with hemodialysis (HD) in patients in chronic KRT program. It is important for the nephrologist to be aware of this entity given the susceptibility of the patient on HD as well as its potential therapeutic role in these patients. Resumen: La encefalopatía por contraste es una complicación neurológica relacionada con el contraste utilizado en procedimientos endovasculares o tomografía computarizada (TC). Los principales factores de riesgo son la hipertensión arterial, la diabetes mellitus, la enfermedad renal crónica (ERC), contrastes hiperosmolares, cantidad de contraste infundida y su infusión directa en el territorio cerebral posterior, o patologías que cursen con daño de barrera hematoencefálica. La sintomatología es inespecífica y puede presentarse como alteración del nivel de conciencia, focalidad neurológica o crisis comiciales. El diagnóstico es de exclusión tras haber descartado los accidentes cerebro-vasculares isquémicos o hemorrágicos, el TC o la resonancia magnética son de utilidad para su diferenciación. Generalmente, aparece poco tiempo tras la exposición y la sintomatología dura 48−72h con recuperación completa, aunque se han descrito casos con persistencia de los síntomas o mayor duración. El tratamiento es la monitorización con medidas de soporte y la terapia de sustitución renal con hemodiálisis (HD) en aquellos pacientes en programa crónico. Es importante que el nefrólogo conozca esta entidad dada la susceptibilidad del paciente en HD así como su potencial papel terapéutico en estos pacientes.

Resumen: La encefalopatía por contraste es una complicación neurológica relacionada con el contraste utilizado en procedimientos endovasculares o tomografía computarizada (TC). Los principales factores de riesgo son la hipertensión arterial, la diabetes mellitus, la enfermedad renal crónica (ERC), contrastes hiperosmolares, cantidad de contraste infundida y su infusión directa en el territorio cerebral posterior, o patologías que cursen con daño de barrera hematoencefálica. La sintomatología es inespecífica y puede presentarse como alteración del nivel de conciencia, focalidad neurológica o crisis comiciales. El diagnóstico es de exclusión tras haber descartado los accidentes cerebrovasculares (ACV) isquémicos o hemorrágicos; el TC o la resonancia magnética (RM) son de utilidad para su diferenciación. Generalmente aparece poco tiempo tras la exposición y la sintomatología dura 48-72 h con recuperación completa, aunque se han descrito casos con persistencia de los síntomas o mayor duración. El tratamiento es la monitorización con medidas de soporte y la terapia de sustitución renal con hemodiálisis (HD) en aquellos pacientes en programa crónico. Es importante que el nefrólogo conozca esta entidad, dada la susceptibilidad del paciente en HD, así como su potencial papel terapéutico en estos pacientes. Abstract: Contrast-induced encephalopathy is a neurological complication related to contrast used in endovascular procedures or computed tomography (CT). The main risk factors are arterial hypertension, diabetes mellitus, chronic kidney disease (CKD), hyperosmolar contrasts, the amount of infused contrast and its direct infusion in the posterior cerebral territory, or pathologies with blood–brain barrier damage. Symptomatology is non-specific and may present as altered level of consciousness, neurological focality or seizures. Diagnosis is done by exclusion after ischemic or hemorrhagic stroke has been ruled out; CT or MRI are useful for differentiation. Generally, it appears shortly after exposure and the symptoms lasts 48–72 h with complete recovery, although cases with persistence of symptoms or longer duration have been described. Treatment consists of monitoring, supportive measures and renal replacement therapy (RRT) with hemodialysis (HD) in patients in chronic RRT program. It is important for the nephrologist to be aware of this entity given the susceptibility of the patient on HD as well as its potential therapeutic role in these patients.

This paper delves into the challenges faced by scientists to effectively communicate regarding photoprotection and skin cancer as a result of the pervasive, harmful effects of disinforming messages. In order to do so, the Spanish population’s understanding of photoprotection and skin cancer is examined. This paper is as an extension of the COMUNICANCER initiative, the ultimate goal of which is to establish protocols for producing and disseminating accurate content that raises the awareness of skin cancer-related dangers, as well as transferring knowledge on health prevention. Therefore, we have monitored the prevalence of misinformation and lack of information regarding sun photoprotection in Spain, aiming to reflect, ultimately, on the added difficulties faced by the scholarly community to disseminate accurate content in today’s communication environment, which has become even more complex due to the distorting influence of disinformation. Employing a quantitative methodology, the research involved a comprehensive analysis of 2498 Spanish-language tweets related to skin cancer and photoprotection collected between August 2021 and August 2022. The study proves that scientists face a social media landscape, particularly on X/Twitter, where there is not only a lack of comprehensive information on the various dimensions of skin cancer, its prevention, and treatment, but which also serves as a breeding ground for the dissemination of inaccurate and misleading information regarding sun-related health risks and preventive measures. This leads to an urgent need to develop strategies aimed at fostering comprehensive and accurate information dissemination, especially regarding health information, due to the critical effect this can have on people and public health systems.

Management of chronic thromboembolic pulmonary hypertension (CTEPH) should be determined by a multidisciplinary team, ideally at a specialized CTEPH referral center. Radiologists contribute to this multidisciplinary process by helping to confirm the diagnosis of CTEPH and delineating the extent of disease, both of which help determine a treatment decision. Preoperative assessment of CTEPH usually employs multiple imaging modalities, including ventilation-perfusion (V/Q) scanning, echocardiography, CT pulmonary angiography (CTPA), and right heart catheterization with pulmonary angiography. Accurate diagnosis or exclusion of CTEPH at imaging is imperative, as this remains the only form of pulmonary hypertension that is curative with surgery. Unfortunately, CTEPH is often misdiagnosed at CTPA, which can be due to technical factors, patient-related factors, radiologist-related factors, as well as a host of disease mimics including acute pulmonary embolism, in situ thrombus, vasculitis, pulmonary artery sarcoma, and fibrosing mediastinitis. Although V/Q scanning is thought to be substantially more sensitive for CTEPH compared with CTPA, this is likely due to lack of recognition of CTEPH findings rather than a modality limitation. Preoperative evaluation for pulmonary thromboendarterectomy (PTE) includes assessment of technical operability and surgical risk stratification. While the definitive therapy for CTEPH is PTE, other minimally invasive or noninvasive therapies also lead to clinical improvements including greater survival. Complications of PTE that can be identified at postoperative imaging include infection, reperfusion edema or injury, pulmonary hemorrhage, pericardial effusion or hemopericardium, and rethrombosis. ©RSNA, 2022 Online supplemental material is available for this article.

The management of pulmonary arterial hypertension (PAH) has become more complex in recent years because of increased pharmacotherapy options and longer patient survival with increasing numbers of comorbidities. As such, more opportunities exist for drug-drug interactions between PAH-targeted medications and medications potentially used to treat comorbid conditions. In this review, we provide an overview of pharmaceutical metabolism by cytochrome P450 and discuss important drug-drug interactions for the 14 Food and Drug Administration-approved medications for PAH in the nitric oxide (NO), endothelin, and prostacyclin pathways. Among the targets in the NO pathway (sildenafil, tadalafil, and riociguat), important interactions with nitrates, protease inhibitors, and other phosphodiesterase inhibitors can cause profound hypotension. In the endothelin pathway, bosentan is associated with more drug interactions via CYP3A4 inhibition; macitentan and ambrisentan have fewer interactions of note. Although the parenteral therapies in the prostacyclin pathway bypass significant liver metabolism and avoid drug interactions, selexipag and oral treprostinil may exhibit interactions with CYP2C8 inhibitors such as gemfibrozil and clopidogrel, which can raise drug levels. Finally, we provide a framework for identifying potential drug-drug interactions and avoiding errors.

Identification of and services for students with learning disabilities share both similarities and differences across cultures, including the term(s) used to label and subsequently provide services for these students. In Arabic, the term "learning disabilities" translates to "learning difficulties." This column provides a brief overview of the current educational system in the Kingdom of Saudi Arabia, including the identification and services available for students with learning difficulties, and concludes with future directions. Much opportunity remains for supporting the needs of students with learning difficulties in the Kingdom of Saudi Arabia.

IntroductionUnderstanding the relationships between taxonomic, functional, and phylogenetic diversity and endemism across environmental gradients is essential for elucidating the eco-evolutionary mechanisms that shape local plant communities.MethodsA database was compiled from field surveys, national herbarium records, and virtual records of perennial plant specimens collected in the aridity gradient of northern Chile, between 18 and 32°S. A large-scale dated phylogeny of available perennial plants was used, and 11 functional traits were selected to construct a dendrogram using the Unweighted Pair-Group Method with Arithmetic Mean (UPGMA) method for the species present in our database. We calculated spatial patterns of a-diversity, including taxonomic (TD), functional (FD), and phylogenetic (PD) diversity, as well as weighted (WE), functional (FE), and phylogenetic (PE) endemism. We used multiscale geographically weighted regression (MGWR) to identify spatial congruencies and discrepancies among these dimensions and to test different eco-evolutionary processes.ResultsThe diversity indices TD, FD and PD showed similar geographic patterns (R2 > 0.93), with lower diversity observed in absolute desert regions. The pattern of weighted endemism (WE) showed a weak association with functional endemism (FE) and phylogenetic endemism (PE) (local R2 < 0.48). The regions with lower FD or PD than expected given the TD (i.e. FDWE and PE>WE), they are found in arid, high Andean and transitional zones, at different altitudes, which would indicate a greater presence of phylogenetic lineages and species with morpho-functional traits related to extreme environmental conditions and transitional biomes (arid-semiarid).DiscussionThese spatial discrepancies suggest different eco-evolutionary drivers between the dimensions of diversity and endemism (taxonomic, functional, and phylogenetic). Areas of high diversity and high endemism do not necessarily coincide, and both should be addressed by conservation efforts.

Rationale Nontuberculous mycobacteria (NTM) has been reported to be transmitted between people with cystic fibrosis (CF) attending CF centres. A suspected Mycobacterium abscessus outbreak was investigated at the University of Texas Southwestern (UTSW) Adult CF Program using a combination of pathogen genomic sequencing and epidemiologic methods. The objectives of the present study were to apply the Healthcare-Associated Links in Transmission of NTM (HALT NTM) study to investigate the occurrence of potential healthcare-associated transmission and/or acquisition of NTM among people with CF infected with genetically similar NTM isolates. Methods Whole-genome sequencing of respiratory M. abscessus isolates from 50 people with CF receiving care at UTSW was performed to identify genetically similar isolates. Epidemiologic investigation, comparison of respiratory and environmental isolates, and home residence watershed mapping were studied. Measurements and main results Whole-genome sequencing analysis demonstrated seven clusters of genetically similar M. abscessus (four ssp. abscessus and three ssp. massiliense). Epidemiologic investigation revealed potential opportunities for healthcare-associated transmission within three of these clusters. Healthcare environmental sampling did not recover M. abscessus, but did recover four human disease-causing species of NTM. No subjects having clustered infections lived in the same home residence watershed. Some subjects were infected with more than one M. abscessus genotype, both within and outside of the dominant circulating clones. Conclusions Healthcare-associated person-to-person transmission of M. abscessus appears to be rare at this centre. However, polyclonal infections of M. abscessus species and subspecies, not originating from the endemic hospital environment, suggest multiple shared modes of acquisition outside the healthcare setting.

C3 glomerulopathy is a rare disease caused by fluid phase dysregulation of the alternative complement pathway. Currently, treatment depends on clinical and histological severity and includes nephroprotection, unspecific immunosuppression, and terminal complement blockers (C5), without having an etiological treatment approved. C3 glomerulopathy has high recurrence rates after kidney transplantation with a high risk of graft loss. Fortunately, new molecules are being developed that specifically target the proximal alternative complement pathway, such as iptacopan, a factor B inhibitor that showed promising results in native kidneys and cases of transplant recurrence in a phase 2 clinical trial. We present 2 “real-world” cases of C3 glomerulopathy recurrence in kidney allografts treated with iptacopan, with initial excellent clinical response and safety profile, especially with early introduction. We also present follow-up biopsies that showed no C3 deposition during factor B inhibition. Our cases suggest that proximal blockade of the alternative complement pathway can be effective and safe in the treatment of C3 glomerulopathy recurrence in kidney transplantation, bringing other questions such as dual blockade (eg, in C3 and C5), the optimal patient profile to benefit from factor B inhibition or treatment duration and its potential use in other forms of membranoproliferative glomerulonephritis (eg, immune complex-mediated).