Search

The field of thoracic surgery has seen tremendous advances over the last decade with substantial progress over just the last several years. In this review, we discuss changes to lung cancer screening guidelines in the United States, briefly review ongoing trials and current screening programs in Europe and discuss the promising role of artificial intelligence (AI) in lung cancer screening. Additionally, we discuss new diagnostic techniques, including image-guided video-assisted thoracoscopic surgery (iVATS), robotic bronchoscopy, and the use of biomarkers. We review current trends towards thoracic surgery becoming increasingly minimally invasive with the evolution of uniportal VATS (U-VATS) and uniportal robotic surgery (U-RATS). Lastly, we summarize the latest immunotherapy trials, which have revolutionized both neoadjuvant and adjuvant treatment for lung cancer and have demonstrated promising potential to improve the lives of our patients. These advancements have dramatically changed the landscape of thoracic surgery in patients with lung cancer.

Addressing the sustainability challenges in the forest sector in Mozambique requires capacity building for higher education and training of new skilled expert and future decision-makers. Our approach was to develop a study module on and pedagogical approaches to industrial environmental engineering and sustainability. The idea was to develop a joint module that would eventually become a part of both PhD and MSc programmes in the Eduardo Mondlane University (UEM) in Mozambique. The basis of our development work encompassed the local priorities as identified by the UEM staff, UEM competencies in forestry engineering and the experience of the Aalto University in higher education in the fields of environmental engineering, sustainability and forest products technology. From the beginning, public authorities and industry/company representatives were involved in the development process to advance the created benefits in terms of sustainable development in Mozambique. The result of the joined work by these two higher education institutions was a study module that has been teached and completed by a class of MSc students as a part of the official UEM curricula.

Aedes aegypti transmit pathogenic arboviruses while the mosquito itself tolerates the infection. We examine a piRNA-based immunity that relies on the acquisition of viral derived cDNA (vDNA) and how this pathway discriminates between self and non-self. The piRNAs derived from these vDNAs are essential for virus control and Piwi4 has a central role in the pathway. Piwi4 binds preferentially to virus-derived piRNAs but not to transposon-targeting piRNAs. Analysis of episomal vDNA from infected cells reveals that vDNA molecules are acquired through a discriminatory process of reverse-transcription and recombination directed by endogenous retrotransposons. Using a high-resolution Ae. aegypti genomic sequence, we found that vDNAs integrated in the host genome as endogenous viral elements (EVEs), produce antisense piRNAs that are preferentially loaded onto Piwi4. Importantly, EVE-derived piRNAs are specifically loaded onto Piwi4 to inhibit virus replication. Thus, Ae. aegypti employs a sophisticated antiviral mechanism that promotes viral persistence and generates long-lasting adaptive immunity.

Higher Education mirrors the shifting nature of society and work. Mobility may provide unparalleled learning opportunities for all stakeholders; however, in order to live and work in plural societies as socially responsible and intercultural knowledgeable citizens, intercultural awareness and intercultural communication skills need to be mastered. In parallel, the relevance of a digital agenda and the studies that attest to the positive student engagement brought about by the inclusion of information and communication technologies (ICT) across all grade levels push educators to seek and incorporate technology-based learning and teaching strategies. Digital Storytelling was implemented in an undergraduate degree in Business Communication, where students discuss and reflect on key issues in Intercultural Communication. Our case study draws on the qualitative analysis of a questionnaire, which intended to understand student perceptions regarding an assignment where they are asked to create Digital Stories and consider on the their own reflection process regarding intercultural differences and communicating across cultures. Our analysis of the 140 questionnaires revealed that Digital Storytelling was able to engage students in a serious and productive debate revolving around technology-enhanced learning and cultural differences, empowering them to construct new personal and group meanings and improve their intercultural awareness.

Aedes aegypti transmit pathogenic arboviruses while the mosquito itself tolerates the infection. We examine a piRNA-based immunity that relies on the acquisition of viral derived cDNA (vDNA) and how this pathway discriminates between self and non-self. The piRNAs derived from these vDNAs are essential for virus control and Piwi4 has a central role in the pathway. Piwi4 binds preferentially to virus-derived piRNAs but not to transposon-targeting piRNAs. Analysis of episomal vDNA from infected cells reveals that vDNA molecules are acquired through a discriminatory process of reverse-transcription and recombination directed by endogenous retrotransposons. Using a high-resolution Ae. aegypti genomic sequence, we found that vDNAs integrated in the host genome as endogenous viral elements (EVEs), produce antisense piRNAs that are preferentially loaded onto Piwi4. Importantly, EVE-derived piRNAs are specifically loaded onto Piwi4 to inhibit virus replication. Thus, Ae. aegypti employs a sophisticated antiviral mechanism that promotes viral persistence and generates long-lasting adaptive immunity.

High energy X-ray diffraction can be combined with containerless techniques to provide information on the atomic arrangements in glass-forming liquids in stable and metastable regimes. The high incident energies provide bulk diffraction data to high values of scattering vector which enables significantly more robust analysis of the local and medium-range order that influences important physical properties such as viscosity and crystal nucleation.These combined techniques have been applied to a range of oxide liquids. In this contribution we illustrate addition of further dimensions to phase space by controlling the partial pressure of oxygen that permits the study liquids containing iron. The advantages of rapid data acquisition are also demonstrated in a study of tellurite glass-forming systems where a transition from ergodic to non-ergodic regimes in the deeply supercooled liquid is shown. Finally we demonstrate how descriptions of the liquid structure can be developed by combining HEXRD with molecular dynamics simulations. Keywords: X-ray diffraction, Containerless techniques, Liquid structure

The Zika virus outbreak in Brazil in 2015 affected thousands of people. Zika is now known to cause congenital malformations leading to impairments and developmental delays in affected children, including Congenital Zika Syndrome (CZS). Children with CZS have complex care needs. Caregivers require significant levels of support to meet these needs, and there are large gaps in healthcare services. This study aims to develop, pilot and assess the feasibility and scalability of a community-based Family Support Programme for caregivers of children with CZS. The programme is adapted from the Getting to Know Cerebral Palsy (GTKCP) programme for the context of CZS in Brazil. GTKCP is a 10-session programme held with 6-10 caregivers in the local community. It includes practical, educational, peer-support and psychosocial aspects, which aim to improve confidence and capacity to care for a child with CP, and quality of life and empowerment of caregivers. The research project contains four components: Ascertaining need for the caregiver programme: a mixed-methods approach that included two literature reviews, interviews with key stakeholders in country, and incorporation of findings from the Social and Economic Impact of Zika study. Adapting GTKCP for the context of CZS and Brazil: undertaken with guidance from technical experts. Pilot testing the intervention: deliver the 10-session programme to one group of caregivers of children with CZS in Rio de Janeiro and another in Greater Salvador. Update the manual through fast-track learning from participant and facilitator feedback. Assessing the feasibility of the intervention for scale up: deliver the updated programme to two groups each in Rio de Janeiro and Greater Salvador, and evaluate the acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited efficacy, through questionnaires, direct observation, semi-structured interviews and cost calculation. The project has ethics approval in both the UK and Brazil.

Objective The purpose of this study was to investigate the roles of the kallikrein-kinin system and matrix metalloproteinases (MMPs) in the development of arterial restenosis attributable to intimal hyperplasia in the femoropopliteal arteries. Methods This report describes a single-center prospective study of 27 patients with peripheral artery disease who required percutaneous transluminal angioplasty and stenting of the femoropopliteal segment using covered stent grafts. The blood concentrations of total and kininogen fractions were evaluated using immunoenzymatic methods. Plasma kallikrein was evaluated by the colorimetric method. Tissue kallikrein was evaluated by the spectrophotometric method. The activity of kininase II was measured by fluorometric analysis. Quantification of MMPs was performed by zymography, and tissue inhibitors of metalloproteinases were measured by enzyme-linked immunosorbent assay. Results Four (15%) of the treated patients developed restenosis at the 6-month follow-up evaluation. These patients had significantly lower levels of high-molecular-weight kininogens (24 hours; P < .05) and low-molecular-weight kininogens (before, P < .05; 24 hours, P < .01; 6 months, P < .05) and lower levels of tissue inhibitor of metalloproteinases-2 (6 months; P < .05) than the patients without restenosis. The activity levels of plasma and tissue kallikrein, kininase II, and MMPs did not differ significantly between the patients with and without restenosis. Conclusions This study demonstrates an involvement of the kallikrein-kinin system in in-stent restenosis, although we could not confirm the participation of metalloproteinases in the restenosis process. [ABSTRACT FROM AUTHOR]

The article presents a parasitological survey conducted on 31 specimens of 7 lizard species from five municipalities in northeastern Brazil's semiarid Ceará and Piauí states. The study identifies 8 nematode species, reports 6 new host and 7 new locality records, and finds 186 helminths representing 8 species of nematodes. The lizards include the house gecko or Hemidactylus mabouia, the common green iguana or Iguana iguana and the Brazilian gecko or Phyllopezus pollicaris.

Recent progress in determining the population structure of Campylobacter jejuni, and discerning associations between genotypes and specific niches, has emphasized the shortfall in our understanding of the ecology and epidemiology of this bacterium. We examined the natural structure of the C. jejuni community associated with cattle farmland in the UK by structured spatiotemporal sampling of habitats, including livestock and wild animal faeces, environmental water and soil, over a 10-week period within a 100 km2 area. A total of 172 isolates were characterized using multilocus sequence typing into 65 sequence types (STs). Isolates from cattle faeces were significantly over-represented in the ST-61 complex, whereas isolates from wildlife faeces and water were more likely to belong to the ST-45 complex and a number of unusual STs, many of which were first encountered during this study. Sampling within a narrow spatiotemporal window permitted the application of novel statistical methods exploring the relationship between the genetic relatedness and spatial separation of isolates. This approach showed that isolates from the same sampling squares and squares separated by <1.0 km were genetically more similar than isolates separated by greater distances. Our study demonstrates the potential of multilocus sequence typing combined with spatial modelling in exploring natural transmission pathways for C. jejuni.

Patients with angina and coronary artery disease (CAD) have many episodes of transient ST-segment depression during ordinary daily life, and these are often asymptomatic. To investigate this signal as a marker of myocardial ischemia, 30 patients with chronic stable angina and CAD underwent positron tomography, recording the regional myocardial uptake of rubidium-82, pain and ST-segment changes before, during and after 59 technically satisfactory exercise tests, 35 cold pressor tests and 22 episodes of unprovoked ST depression. Exercise resulted in 53 episodes of ST depression with angina and in 5 episodes without pain. After cold pressor tests, there were 3 episodes of ST depression and pain and 12 of painless ST depression. Only 9 episodes of unprovoked ST depression were accompanied by pain. Tomography showed independent evidence of ischemia in 63 (97%) of the total 65 episodes of ST depression with angina and in all 30 episodes of painless ST depression. In each patient perfusion defects occurred in the same myocardial segment during painful and painless ST depression and responses were significantly different from those in 16 normal subjects studied in the same way. These findings support the use of transient ST depression in continuous monitoring to assess the activity of CAD, but only in patients with typical angina pectoris, ST depression during exercise and proved CAD. They strengthen the evidence derived from ambulatory monitoring for a wider picture of the disease than is generally appreciated, with more frequent episodes of silent myocardial ischemia than of angina pectoris.

Continuous monitoring of the electrocardiogram in patients with angina pectoris and coronary artery disease (CAD) has shown episodes of asymptomatic ST-segment depression, suggesting frequent silent myocardial ischemia during normal daily life. Interpretation of this new finding depends on whether similar changes occur in normal subjects. Frequency-modulated ambulatory electrocardiographic recordings were performed in 80 asymptomatic normal volunteers (20 from each decade between 20 and 50 years and, 20 more than 50 years old) and in 20 patients with noncardiac pain, negative exercise and provocative tests and angiographically normal coronary arteries. Treadmill exercise testing was performed in all subjects more than 40 years old. Episodes of T-wave change were identified in 53 subjects. Five subjects younger than 40 years had episodes of ST elevation that were prolonged; they usually occurred at night. In 3 patients they could be reproduced by postural change. Only 2 subjects, both older than 40 years had planar ST depression during tachycardia; one of these subjects had a positive exercise test response. No patient with normal coronary arteries had significant ST depression. Tachycardia was frequently associated with upsloping ST depression (36%), which was more common in younger subjects: Five subjects also showed isolated single complexes with ST depression during baseline instability. With use of frequency-modulated recordings, transient ST depression of 0.1 mV or greater that lasted 80 ms or longer and more than 30 seconds in duration, was rare in a normal population. This finding supports the use of this signal to follow the activity of CAD out of the hospital, specifically in patients with typical angina and proved CAD.