Removal of black tattoos by Picosecond Q-switched Nd-YAG laser in the middle eastern skin type IV: prospective study.

Tattoo removal is considered a challenging field in cosmetic dermatology. Picosecond Q-switched Nd-YAG lasers targeting unique chromophores effectively manage this condition without serious complications. To evaluate the efficacy and safety of Picosecond Q-switched Nd-YAG laser in the treatment of black tattoos in the skin of middle eastern mostly skin type IV. The study was carried out on 20 patients with skin type IV the most common in middle eastern area with professional black tattoos. They were treated by Picosecond Nd-YAG laser (2 sessions 8 weeks apart). The percentage of improvement ranged from 20.0 to 95.0 (with a mean of 61 ± 24.6). 8 patients (40%) showed excellent improvement, 4 patients (20%) showed marked improvement, 4 patients (20%) showed moderate improvement, and 4 patients (20%) showed mild improvement. No severe side effects were detected. Picosecond Nd-YAG laser was an effective and safe technique in the treatment of professional black tattoos; with only 2 sessions most patients reached excellent to moderate response with minimal side effects.

Clinical research text summarization method based on fusion of domain knowledge.

OBJECTIVE: The objective of this study is to integrate PICO knowledge into the clinical research text summarization process, aiming to enhance the model's comprehension of biomedical texts while capturing crucial content from the perspective of summary readers, ultimately improving the quality of summaries. METHODS: We propose a clinical research text summarization method called DKGE-PEGASUS (Domain-Knowledge and Graph Convolutional Enhanced PEGASUS), which is based on integrating domain knowledge. The model mainly consists of three components: a PICO label prediction module, a text information re-mining unit based on Graph Convolutional Neural Networks (GCN), and a pre-trained summarization model. First, the PICO label prediction module is used to identify PICO elements in clinical research texts while obtaining word embeddings enriched with PICO knowledge. Then, we use GCN to reinforce the encoder of the pre-trained summarization model to achieve deeper text information mining while explicitly injecting PICO knowledge. Finally, the outputs of the PICO label prediction module, the GCN text information re-mining unit, and the encoder of the pre-trained model are fused to produce the final coding results, which are then decoded by the decoder to generate summaries. RESULTS: Experiments conducted on two datasets, PubMed and CDSR, demonstrated the effectiveness of our method. The Rouge-1 scores achieved were 42.64 and 38.57, respectively. Furthermore, the quality of our summarization results was found to significantly outperform the baseline model in comparisons of summarization results for a segment of biomedical text. CONCLUSION: The method proposed in this paper is better equipped to identify critical elements in clinical research texts and produce a higher-quality summary.

What happened to my Index Medicus?

From its first printing in 1879 to when publication ceased in 2004, the Index Medicus had proved invaluable for persons wishing to conduct healthcare-related research. With the loss of this resource and the rapid expansion of alternative, online sources, it is vital that persons understand how to appropriately search for and use this information. The purpose of this review is to outline the information sources available, discuss how to use current search technology to best obtain relevant information while minimizing nonproductive references, and give the author's opinion on the reliability of the various informational sources available. Topics to be discussed will include Medical Subject Headings and PICO searches and sources ranging from the National Library of Medicine and Cochrane Reviews to Wikipedia and other sites, such as associations and commercial interest sites.

Quasi-steady aerodynamic modeling and dynamic stability of mosquito-inspired flapping wing pico aerial vehicle.

Recent exploration in insect-inspired robotics has generated considerable interest. Among insects navigating at low Reynolds numbers, mosquitoes exhibit distinct flight characteristics, including higher wingbeat frequencies, reduced stroke amplitudes, and slender wings. This leads to unique aerodynamic traits such as trailing edge vortices via wake capture, diminished reliance on leading vortices, and rotational drag. This paper shows the energetic analysis of a mosquito-inspired flapping-wing Pico aerial vehicle during hovering, contributing insights to its future design and fabrication. The investigation relies on kinematic and quasi-steady aerodynamic modeling of a symmetric flapping-wing model with a wingspan of approximately 26 mm, considering translational, rotational, and wake capture force components. The control strategy adapts existing bird flapping wing approaches to accommodate insect wing kinematics and aerodynamic features. Flight controller design is grounded in understanding the impact of kinematics on wing forces. Additionally, a thorough analysis of the dynamic stability of the mosquito-inspired PAV model is conducted, revealing favorable controller response and maneuverability at a small scale. The modified model, incorporating rigid body dynamics and non-averaged aerodynamics, exhibits weak stability without a controller or sufficient power density. However, the controller effectively stabilizes the PAV model, addressing attitude and maneuverability. These preliminary findings offer valuable insights for the mechanical design, aerodynamics, and fabrication of RoboMos, an insect-inspired flapping wing pico aerial vehicle developed at UPM Malaysia.

EU HTA Regulation and Joint Clinical Assessment-Threat or Opportunity?

The vision of a unified European HTA is by no means a new endeavor. At its core are the publicly declared ambitions to harmonize assessments of clinical data within the EU and avoid the duplication of efforts. Not surprisingly, these ambitions are publicly announced to be motivating the new 2022 EU HTA regulation. However, industry experts typically see more of a risk for additional bureaucracy resulting in delays, further scrutiny, and one additional EU (clinical) dossier to submit on top of all national HTA dossiers, which could be considered a duplication of effort and therefore counterproductive. Regardless of how the details of the process will be defined and how the entire process will work in practice, we can be sure that EU officials will refer to the EU HTA and Joint Clinical Assessment (JCA) in particular as a learning system. The purpose of this article is to take a closer look at the new EU HTA regulation and analyze threats and opportunities for manufacturers and what the resulting opportunities and threats will be at the affiliate level throughout the EU.

PICO questions and DELPHI methodology for improving the management of patients with acute hepatic porphyria.

BACKGROUND: Acute hepatic porphyrias (AHPs) are a group of rare diseases that encompasses acute intermittent porphyria, variegate porphyria, hereditary coproporphyria, and 5-aminolaevulinic acid dehydratase deficiency porphyria. Symptoms of AHP are nonspecific which, together with its low prevalence, difficult the diagnosis and follow-up of these patients. MATERIAL AND METHODS: This project used DELPHI methodology to answer PICO questions related to management of patients with AHPs. The objective was to reach a consensus among multidisciplinary porhyria experts providing answers to those PICO questions for improving diagnosis and follow-up of patients with AHP. RESULTS: Ten PICO questions were defined and grouped in four domains: 1. Biochemical diagnosis of patients with AHP. 2. Molecular tests for patients with AHP. 3. Follow-up of patients with AHP. 4. Screening for long-term complications of patients with AHP. CONCLUSIONS: PICO questions and DELPHI methodology have provided a consensus on relevant and controversial issues for improving the management of patients with AHP.

Comparing generative and extractive approaches to information extraction from abstracts describing randomized clinical trials.

BACKGROUND: Systematic reviews of Randomized Controlled Trials (RCTs) are an important part of the evidence-based medicine paradigm. However, the creation of such systematic reviews by clinical experts is costly as well as time-consuming, and results can get quickly outdated after publication. Most RCTs are structured based on the Patient, Intervention, Comparison, Outcomes (PICO) framework and there exist many approaches which aim to extract PICO elements automatically. The automatic extraction of PICO information from RCTs has the potential to significantly speed up the creation process of systematic reviews and this way also benefit the field of evidence-based medicine. RESULTS: Previous work has addressed the extraction of PICO elements as the task of identifying relevant text spans or sentences, but without populating a structured representation of a trial. In contrast, in this work, we treat PICO elements as structured templates with slots to do justice to the complex nature of the information they represent. We present two different approaches to extract this structured information from the abstracts of RCTs. The first approach is an extractive approach based on our previous work that is extended to capture full document representations as well as by a clustering step to infer the number of instances of each template type. The second approach is a generative approach based on a seq2seq model that encodes the abstract describing the RCT and uses a decoder to infer a structured representation of a trial including its arms, treatments, endpoints and outcomes. Both approaches are evaluated with different base models on a manually annotated dataset consisting of RCT abstracts on an existing dataset comprising 211 annotated clinical trial abstracts for Type 2 Diabetes and Glaucoma. For both diseases, the extractive approach (with flan-t5-base) reached the best F 1 score, i.e. 0.547 ( ± 0.006 ) for type 2 diabetes and 0.636 ( ± 0.006 ) for glaucoma. Generally, the F 1 scores were higher for glaucoma than for type 2 diabetes and the standard deviation was higher for the generative approach. CONCLUSION: In our experiments, both approaches show promising performance extracting structured PICO information from RCTs, especially considering that most related work focuses on the far easier task of predicting less structured objects. In our experimental results, the extractive approach performs best in both cases, although the lead is greater for glaucoma than for type 2 diabetes. For future work, it remains to be investigated how the base model size affects the performance of both approaches in comparison. Although the extractive approach currently leaves more room for direct improvements, the generative approach might benefit from larger models.

AlpaPICO: Extraction of PICO frames from clinical trial documents using LLMs.

In recent years, there has been a surge in the publication of clinical trial reports, making it challenging to conduct systematic reviews. Automatically extracting Population, Intervention, Comparator, and Outcome (PICO) from clinical trial studies can alleviate the traditionally time-consuming process of manually scrutinizing systematic reviews. Existing approaches of PICO frame extraction involves supervised approach that relies on the existence of manually annotated data points in the form of BIO label tagging. Recent approaches, such as In-Context Learning (ICL), which has been shown to be effective for a number of downstream NLP tasks, require the use of labeled examples. In this work, we adopt ICL strategy by employing the pretrained knowledge of Large Language Models (LLMs), gathered during the pretraining phase of an LLM, to automatically extract the PICO-related terminologies from clinical trial documents in unsupervised set up to bypass the availability of large number of annotated data instances. Additionally, to showcase the highest effectiveness of LLM in oracle scenario where large number of annotated samples are available, we adopt the instruction tuning strategy by employing Low Rank Adaptation (LORA) to conduct the training of gigantic model in low resource environment for the PICO frame extraction task. More specifically, both of the proposed frameworks utilize AlpaCare as base LLM which employs both few-shot in-context learning and instruction tuning techniques to extract PICO-related terms from the clinical trial reports. We applied these approaches to the widely used coarse-grained datasets such as EBM-NLP, EBM-COMET and fine-grained datasets such as EBM-NLPrev and EBM-NLPh. Our empirical results show that our proposed ICL-based framework produces comparable results on all the version of EBM-NLP datasets and the proposed instruction tuned version of our framework produces state-of-the-art results on all the different EBM-NLP datasets. Our project is available at https://github.com/shrimonmuke0202/AlpaPICO.git.

The quality of antimicrobial susceptibility test discs and implications for clinical outcomes.

Disc diffusion remains the main technique for evaluating antibiotic activity in clinical microbiology laboratories. However, the assay protocol endorsed by the FDA, DIN, and WHO is invalid. Despite decades of research and practice in this field, the quantitative quality of manufactured discs is largely unknown, potentially leading to adverse clinical outcomes. The usual standards expected for new medical devices in terms of quality control, QA, and evidence-based assessment of outcomes are almost completely lacking. Recent data indicate that a large proportion of discs do not meet the specifications, and that disc diffusion is a poor predictor of clinical outcomes. In addition, lack of harmonisation between EUCAST and CLSI, despite many years of effort, strongly suggests that there are serious flaws in these systems. This area lacks scientific rigour, which may have also contributed to adverse clinical outcomes and the emergence of antimicrobial resistance.

A span-based model for extracting overlapping PICO entities from randomized controlled trial publications.

OBJECTIVES: Extracting PICO (Populations, Interventions, Comparison, and Outcomes) entities is fundamental to evidence retrieval. We present a novel method, PICOX, to extract overlapping PICO entities. MATERIALS AND METHODS: PICOX first identifies entities by assessing whether a word marks the beginning or conclusion of an entity. Then, it uses a multi-label classifier to assign one or more PICO labels to a span candidate. PICOX was evaluated using 1 of the best-performing baselines, EBM-NLP, and 3 more datasets, ie, PICO-Corpus and randomized controlled trial publications on Alzheimer's Disease (AD) or COVID-19, using entity-level precision, recall, and F1 scores. RESULTS: PICOX achieved superior precision, recall, and F1 scores across the board, with the micro F1 score improving from 45.05 to 50.87 (P ≪.01). On the PICO-Corpus, PICOX obtained higher recall and F1 scores than the baseline and improved the micro recall score from 56.66 to 67.33. On the COVID-19 dataset, PICOX also outperformed the baseline and improved the micro F1 score from 77.10 to 80.32. On the AD dataset, PICOX demonstrated comparable F1 scores with higher precision when compared to the baseline. CONCLUSION: PICOX excels in identifying overlapping entities and consistently surpasses a leading baseline across multiple datasets. Ablation studies reveal that its data augmentation strategy effectively minimizes false positives and improves precision.

Quality Control Assessment of Human Adipose-Derived Hydrogels.

Decellularized human-adipose tissue (hDAT) can serve as an alternative to two-dimensional monolayer culture and current ECM hydrogels due to its unlimited availability and cytocompatibility. A major hurdle in the clinical translation and integration of hDAT and other hydrogels into current in vitro culture processes is adherence to current good manufacturing practices (cGMP). Transferring of innovative technologies, including hydrogels, requires the establishing standardized protocols for quality assurance and quality control (QA/QC) of the material.Integration of basic characterization techniques, including physiochemical characterization, structural/morphological characterization, thermal and mechanical characterization, and biological characterization, in addition to the reduction of batch-to-batch variability and establishment of proper sterilization, storage, and fabrication processes verifies the integrity of the hydrogel. Obatala Sciences has established a characterization protocol that involves a series of assays including the evaluation of gelation properties, protein content, glycosaminoglycan content, soluble collagen content, and DNA content of hDAT.

Cardiorespiratory fitness and mortality risk in patients receiving hemodialysis: a prospective cohort / Aptidão cardiorrespiratória e risco de mortalidade em pacientes em hemodiálise: uma coorte prospectiva

ABSTRACT Background: Kidney failure reduces life expectancy by one-third compared with the general population, and cardiovascular complications and poor cardiorespiratory fitness (CRF) are the main causes. We aimed to evaluate the association between severely low CRF and all-cause mortality risk in HD patients. Methods: This observational prospective cohort study followed-up patients receiving HD from August 2015 until March 2022. Cardiorespiratory fitness was evaluated through the cardiopulmonary exercise test, and the peak oxygen uptake (VO2peak) value was used to determine severely low CRF (< 15 mL∙kg−1∙min−1). Cox regression and univariate Kaplan-Meier analysis were used to evaluate the association of severely low CRF with mortality risk and survival rate. Results: Forty-eight patients were followed-up for a median of 33.0 [14.3 - 49.3] months. A total of 26 patients had severely low CRF. During the follow-up period, 11 patients (22.92%) died from all causes. From these, eight (30.8%) had severely low CRF. Even so, severely low CRF was not associated with crude death rates for patients stratified by CRF levels (p = 0.189), neither in unadjusted (HR 2.18; CI 95% 0.58−8.23) nor in adjusted (HR 1.32; CI 95% 0.31−5.59) Cox proportional hazard models. As a continuous variable, VO2peak was not associated with mortality risk (HR 1.01; CI 95% 0.84−1.21). Univariate Kaplan-Meier analysis showed that patients with severely low CRF did not have significantly worse survival rates than those with mild-moderate CRF (p = 0.186). Conclusion: Our findings indicated that severely low CRF was not associated with all-cause mortality in patients on HD. Despite severely low CRF being prevalent, larger cohort studies are needed to establish strong conclusions on its association with all-cause mortality.

RESUMO Introdução A insuficiência renal reduz a expectativa de vida em um terço comparada à população em geral. Complicações cardiovasculares e baixa aptidão cardiorrespiratória (ACR) são as principais causas. Avaliamos a associação entre ACR muito baixa e risco de mortalidade por todas as causas em pacientes em HD. Métodos Este estudo de coorte prospectivo observacional acompanhou pacientes em HD de agosto/2015 a março/2022. Avaliou-se a aptidão cardiorrespiratória pelo teste de exercício cardiopulmonar, e o valor do pico do consumo de oxigênio (VO2pico) foi usado para determinar ACR muito baixa (< 15 mL∙kg−1∙min−1). Utilizamos regressão de Cox e análise univariada de Kaplan-Meier para avaliar associação da ACR muito baixa com o risco de mortalidade e taxa de sobrevida. Resultados Acompanhamos 48 pacientes por uma média de 33,0 [14,3 - 49,3] meses. Um total de 26 pacientes apresentaram ACR muito baixa. No período de acompanhamento, 11 pacientes (22,92%) foram a óbito por todas as causas. Destes, oito (30,8%) apresentavam ACR muito baixa. Mesmo assim, ACR muito baixa não foi associada a taxas brutas de mortalidade para pacientes estratificados por níveis de ACR (p = 0,189), nem em modelos de risco proporcional de Cox não ajustados (HR 2,18; IC 95% 0,58-8,23) ou ajustados (HR 1,32; IC 95% 0,31-5,59). Como variável contínua, VO2pico não foi associado ao risco de mortalidade (HR 1,01; IC 95% 0,84-1,21). A análise univariada de Kaplan-Meier mostrou que pacientes com ACR muito baixa não apresentaram taxas de sobrevida significativamente piores do que aqueles com ACR leve-moderada (p = 0,186). Conclusão Nossos achados indicaram que a ACR muito baixa não foi associada à mortalidade por todas as causas em pacientes em HD. Apesar de ACR muito baixa ser prevalente, são necessários estudos de coorte maiores para estabelecer conclusões sólidas sobre sua associação com mortalidade por todas as causas.

Enhancing systematic reviews in orthodontics: a comparative examination of GPT-3.5 and GPT-4 for generating PICO-based queries with tailored prompts and configurations.

OBJECTIVES: The rapid advancement of Large Language Models (LLMs) has prompted an exploration of their efficacy in generating PICO-based (Patient, Intervention, Comparison, Outcome) queries, especially in the field of orthodontics. This study aimed to assess the usability of Large Language Models (LLMs), in aiding systematic review processes, with a specific focus on comparing the performance of ChatGPT 3.5 and ChatGPT 4 using a specialized prompt tailored for orthodontics. MATERIALS/METHODS: Five databases were perused to curate a sample of 77 systematic reviews and meta-analyses published between 2016 and 2021. Utilizing prompt engineering techniques, the LLMs were directed to formulate PICO questions, Boolean queries, and relevant keywords. The outputs were subsequently evaluated for accuracy and consistency by independent researchers using three-point and six-point Likert scales. Furthermore, the PICO records of 41 studies, which were compatible with the PROSPERO records, were compared with the responses provided by the models. RESULTS: ChatGPT 3.5 and 4 showcased a consistent ability to craft PICO-based queries. Statistically significant differences in accuracy were observed in specific categories, with GPT-4 often outperforming GPT-3.5. LIMITATIONS: The study's test set might not encapsulate the full range of LLM application scenarios. Emphasis on specific question types may also not reflect the complete capabilities of the models. CONCLUSIONS/IMPLICATIONS: Both ChatGPT 3.5 and 4 can be pivotal tools for generating PICO-driven queries in orthodontics when optimally configured. However, the precision required in medical research necessitates a judicious and critical evaluation of LLM-generated outputs, advocating for a circumspect integration into scientific investigations.

The MOVECLIM - AZORES project: Bryophytes from Pico Island along an elevation gradient.

Background: In September 2012, a comprehensive survey of Pico Island was conducted along an elevational transect, starting at Manhenha (10 m a.s.l.) and culminating at the Pico Mountain caldera (2200 m a.s.l.). The primary objective was to systematically inventory the bryophytes inhabiting the best-preserved areas of native vegetation environments. Twelve sites were selected, each spaced at 200 m elevation intervals. Within each site, two 10 m x 10 m plots were established in close proximity (10-15 m apart). Within these plots, three 2 m x 2 m quadrats were randomly selected and sampled for bryophytes using microplots measuring 10 cm x 5 cm, which were then collected into paper bags. Six substrates were surveyed in each quadrat: rock, soil, humus, organic matter, tree bark and leaves/fronds. Three replicates were obtained from all substrates available and colonised by bryophytes, resulting in a maximum of 18 microplots per quadrat, 54 microplots per plot, 108 microplots per site, and a total of 1296 microplots across the 12 sites on Pico Island. New information: Two-thirds of the maximum expected number of microplots (n = 878; 67.75%) were successfully collected, yielding a total of 4896 specimens. The vast majority (n = 4869) were identified at the species/subspecies level. The study identified a total of 70 moss and 71 liverwort species or subspecies. Elevation levels between 600-1000 m a.s.l., particularly in the native forest plots, exhibited both a higher number of microplots and greater species richness. This research significantly enhanced our understanding of Azorean bryophyte diversity and distribution, contributing valuable insights at both local and regional scales. Notably, two new taxa for the Azores were documented during the MOVECLIM study, namely the pleurocarpous mosses Antitrichiacurtipendula and Isotheciuminterludens.

Image-activated pico-injection for single-cell analysis.

The addition of reagents into preformed droplets is a crucial yet intricate task in droplet-based applications where sequential reactions is required. Pico-injection offers high throughput and robustness in accomplishing this task, but the existing pico-injection techniques work in an indiscriminate manner, making it difficult to target particular groups of droplets. Here we report image-activated pico-injection (imgPico) for label-free, on-demand reagent supplementation into droplets. The imgPico detects the droplets of interest by real-time image analysis and makes decisions for the downstream pico-injection operation. We studied the performance of different algorithms for the image analysis and optimized the experimental settings of the imgPico. In the validation experiment, the imgPico successfully injected fluorescent dyes into droplets encapsulating one, two, and three cells, respectively, as expected. We further demonstrated the utility of imgPico by targeting droplets encapsulating single cells in droplet-based single-cell RNA sequencing (scRNA-seq) using exceedingly high cell density, and the results showed that the imgPico effectively reduced the presence of doublets in the scRNA-seq data. With the merits of being label-free and versatile, the imgPico represents a technical advance with potential applications in single-cell analysis.

Representation of published core outcome sets in practice guidelines.

OBJECTIVES: A core outcome set (COS) is an agreed standardized set of outcomes that should be measured and reported, as a minimum, in specific areas of health or health care. A COS is developed through a consensus process to ensure health care outcomes to be measured are relevant to decision-makers, including patients and health-care professionals. Use of COS in guideline development is likely to increase the relevance of the guideline to those decision-makers. Previous work has looked at the uptake of COS in trials, systematic reviews, health technology assessments and regulatory guidance but to date there has been no evaluation of the use of COS in practice guideline development. The objective of this study was to investigate the representation of core outcomes in a set of international practice guidelines. STUDY DESIGN AND SETTING: We searched for clinical guidelines relevant to ten high-quality COS (with focus on the United Kingdom, Germany, China, India, Canada, Denmark, United States and World Health Organisation). We matched scope between COS and guideline in terms of condition, population and outcome. We calculated the proportion of guidelines mentioning or referencing COS and the proportion of COS domains specifically, or generally, matching to outcomes specified in each guideline populations, interventions, comparators and outcome (PICO) statement. RESULTS: We found 38 guidelines that contained 170 PICO statements matching the scope of the ten COS and of sufficient quality to allow data extraction. None of the guidelines reviewed explicitly mentioned or referenced the relevant COS. The median (range) of the proportion of core outcomes covered either specifically or generally by the guideline PICO was 30% (0%-100%). CONCLUSION: There is no evidence that COS are being used routinely to inform the guideline development process, and concordance between outcomes in published guidelines and those in COS is limited. Further work is warranted to explore barriers and facilitators in the use of COS when developing clinical guidelines.

Aggregating Synechococcus contributes to particle organic carbon export in coastal estuarine waters: Its lineage features and assembly processes.

The release and deposition of phytoplankton-derived particulate organic matter is crucial in marine carbon export, yet the roles of picoplankton in these processes were seldom considered. Therefore, this study aimed to shed light on the matter by investigating the aggregating (AG) lifestyle of Synechococcus, a main group of picoplankton, in the coastal waters of the Yellow River Estuary with ample sediments acting as ballast minerals. We revealed that AG Synechococcus constituted a substantial portion, maximally reaching up to 85.4 %, of the total Synechococcus population. Pearson correlations and random forest (RF) regression analyses found significant connections (p < 0.01) between AG Synechococcus and the content of particulate organic carbon (POC), which emphasized its underlying role in facilitating POC export in this region. Furthermore, by employing high-throughput sequencing of the RNA polymerase gene (rpoC1), it was demonstrated that S5.1 clade I exhibited a significantly higher proportion in the AG fraction than in the free-living (FL) fraction (p < 0.05). This suggests distinct inclinations in the phylogenetic preference for different Synechococcus lineages between different lifestyles in the studied area. Finally, we ascertained "small-world" and higher robustness attributes of aggregates formed through the co-occurrence construction between Synechococcus and heterotrophic bacteria, likely facilitated by the reciprocal exchange of carbon and nitrogen elements. Overall, these findings have implications for our understanding of the role of Synechococcus in the ecology and biogeochemistry of marine ecosystems, and they are significant for more accurately evaluating the contribution of picophytoplankton in ocean carbon export.

Beak deformity in three bird species from the southwest of the Brazilian Amazon / Deformidad del pico en tres especies de aves del sudoeste de la Amazonia brasileña

Abstract Beak deformity have a frequency of 0.5% in wild bird populations. In addition to being rare, beak deformities are also poorly reported in the Brazilian scientific literature. Here we report beak deformities in the species: Dendrocincla merula, Amazona ochrocephala and Pheugopedius genibarbis, all of which occurred in southwestern Brazilian Amazon. Dendrocolaptids make intensive use of their beaks in the search for insects and small vertebrates, where they explore in cracks in wood with lateral blows. In the case presented here, this behaviour may have been the cause of the breakage of the tip of this individual's maxilla. In Brazilian territory, few species of parrots were recorded with deformity in the beak and in the individual in this work, everything indicates that Amazona ochrocephala was a captive animal, as it was excessively thin and its diet probably had a low content of vitamins and calcium, where their deficiency even when the animal was a puppy may have contributed to the deformity of the maxilla. Cases of beak deformities in species of the Troglodytidae family are rare, but the individual in this work presented an unusual curvature in the maxilla not observed in other individuals in museum collections. Only with more reports will we be able to better understand the occurrence and causes of these beak deformities in wild birds.

Resumen La deformidad del pico es una característica rara y tiene una frecuencia baja, con 0.5% de casos en poblaciones de aves silvestres. Además de ser raras, las deformidades del pico también son escasamente reportadas en la literatura científica brasileña. Reportamos aquí deformidades en los picos de aves de las especies: Dendrocincla merula, Amazona ochrocephala y Pheugopedius genibarbis, en los cuales todos los registros ocurrieron en el sudoeste de la Amazonia brasileña. Los dendrocoláptidos hacen uso intensivo del pico en la búsqueda de insectos y pequeños vertebrados, explorando en grietas de la madera con golpes laterales. En el caso aquí presentado, este comportamiento de exploración pudo haber sido la causa de la rotura de la punta del maxilar de este individuo. En el territorio brasileño, pocas especies de loros fueron registradas con deformidad en el pico y en el individuo de este trabajo, todo indica que Amazona ochrocephala era un animal de cautiverio, ya que estaba excesivamente delgado y su dieta probablemente tenía un bajo contenido de vitaminas y calcio, donde su deficiencia incluso cuando el animal era un joven puede haber contribuido a la deformidad del maxilar. Los casos de deformidades del pico en especies de la familia Troglodytidae son raros, pero el individuo de este trabajo presentaba una curvatura inusual en el maxilar no observada en otros individuos de esta especie depositados en la colección científica. Sólo con más informes podremos entender mejor la ocurrencia y las causas de estas deformidades del pico en aves silvestres.

Multidisciplinary Treatment of Hepatocellular Carcinoma in 2023: Italian practice Treatment Guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of Hepato-Bilio-Pancreatic Surgery (AICEP), Italian Association of Hospital Gastroenterologists (AIGO), Italian Association of Radiology and Clinical Oncology (AIRO), Italian Society of Pathological Anatomy and Diagnostic Cytology (SIAPeC-IAP), Italian Society of Surgery (SIC), Italian Society of Gastroenterology (SIGE), Italian Society of Medical and Interventional Radiology (SIRM), Italian Organ Transplant Society (SITO), and Association of Patients with Hepatitis and Liver Disease (EpaC) - Part I - Surgical treatments.

Worldwide, hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death. The remarkable improvements in treating HCC achieved in the last years have increased the complexity of HCC management. Following the need to have updated guidelines on the multidisciplinary treatment management of HCC, the Italian Scientific Societies involved in the management of this cancer have promoted the drafting of a new dedicated document. This document was drawn up according to the GRADE methodology needed to produce guidelines based on evidence. Here is presented the first part of guidelines, focused on the multidisciplinary tumor board of experts and surgical treatments of HCC.