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Patients that have suffered a myocardial infarction are at high risk of developing ventricular tachycardia. Patient stratification is often determined by characterization of the underlying myocardial substrate by cardiac imaging methods. In this study, we show that computer modeling of cardiac electrophysiology based on personalized fast 3D simulations can help to assess patient risk to arrhythmia. We perform a large simulation study on 21 patient digital twins and reproduce successfully the clinical outcomes. In addition, we provide the sites which are prone to sustain ventricular tachycardias, i.e, onset sites around the scar region, and validate if they colocalize with exit sites from slow conduction channels.Clinical relevance- Fast electrophysiological simulations can provide advanced patient stratification indices and predict arrhythmic susceptibility to suffer from ventricular tachycardia in patients that have suffered a myocardial infarction.
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Infarto do Miocárdio , Taquicardia Ventricular , Humanos , Taquicardia Ventricular/diagnóstico , Arritmias Cardíacas , Miocárdio , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Eletrofisiologia CardíacaRESUMO
Coherent control over electron dynamics in atoms and molecules using high-intensity circularly polarized laser pulses gives rise to current loops, resulting in the emission of magnetic fields. We propose, and demonstrate with ab initio calculations, "current-gating" schemes to generate direct or alternating-current magnetic pulses in the infrared spectral region, with highly tunable waveform and frequency, and showing femtosecond-to-attosecond pulse duration. In optimal conditions, the magnetic pulse can be highly isolated from the driving laser and exhibits a high flux density (â¼1 T at a few hundred nanometers from the source, with a pulse duration of 787 attoseconds) for application in forefront experiments of ultrafast spectroscopy. Our work paves the way toward the generation of attosecond magnetic fields to probe ultrafast magnetization, chiral responses, and spin dynamics.
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The microscopic mechanism of the light-matter interactions that induce orbital angular momentum (OAM) in electromagnetic fields is not thoroughly understood. In this work, we employ Archimedean spiral vortex generators in time-resolved numerical simulations using the Octopus code to observe the behind-the-scenes of OAM generation. We send a perfect circularly-polarized plane-wave light onto plasmonic optical vortex generators and observe the resulting twisted light formation with complete spatio-temporal information. In agreement with previous works, we find that emission from the plasmonic spiral branches shapes the vortex-like structure and governs the OAM generation in the outgoing electromagnetic field. To characterize the generated beam further, we emulate the emission from vortex generators with current emitters preserving the spiral geometry. We subject a point-particle system to the generated field and record the orbital angular momentum transfer between the electromagnetic field and the point particle. Finally, we probe the OAM density locally by studying the induced classical trajectory of point particles, which provides further insight into the spatio-temporal features of the induced OAM.
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PURPOSE: Different methods are available to identify haematopoietically active bone marrow (ActBM). However, their use can be challenging for radiotherapy routine treatments, since they require specific equipment and dedicated time. A machine learning (ML) approach, based on radiomic features as inputs to three different classifiers, was applied to computed tomography (CT) images to identify haematopoietically active bone marrow in anal cancer patients. METHODS: A total of 40 patients was assigned to the construction set (training set + test set). Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography (18FDG-PET) images were used to detect the active part of the pelvic bone marrow (ActPBM) and stored as ground-truth for three subregions: iliac, lower pelvis and lumbosacral bone marrow (ActIBM, ActLPBM, ActLSBM). Three parameters were used for the correspondence analyses between 18FDG-PET and ML classifiers: DICE index, Precision and Recall. RESULTS: For the 40-patient cohort, median values [min; max] of the Dice index were 0.69 [0.20; 0.84], 0.76 [0.25; 0.89], and 0.36 [0.15; 0.67] for ActIBM, ActLSBM, and ActLPBM, respectively. The Precision/Recall (P/R) ratio median value for the ActLPBM structure was 0.59 [0.20; 1.84] (over segmentation), while for the other two subregions the P/R ratio median has values of 1.249 [0.43; 4.15] for ActIBM and 1.093 [0.24; 1.91] for ActLSBM (under segmentation). CONCLUSION: A satisfactory degree of overlap compared to 18FDG-PET was found for 2 out of the 3 subregions within pelvic bones. Further optimization and generalization of the process is required before clinical implementation.
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Neoplasias do Ânus , Medula Óssea , Humanos , Medula Óssea/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X , Neoplasias do Ânus/diagnóstico por imagem , Neoplasias do Ânus/terapia , Aprendizado de Máquina , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos , Estudos RetrospectivosRESUMO
This document is the outcome of a group of experts brought together at the request of the French Society of Sleep Research and Medicine to provide recommendations for the management of obstructive sleep apnea syndrome type 1 (OSA1) in children. The recommendations are based on shared experience and published literature. OSA1 is suspected when several nighttime respiratory symptoms related to upper airway obstruction are identified on clinical history taking. A specialist otolaryngologist examination, including nasofibroscopy, is essential during diagnosis. A sleep study for OSA1 is not mandatory when at least two nighttime symptoms (including snoring) are noted. Therapeutic management must be individualized according to the location of the obstruction. Ear, nose, and throat (ENT) surgery is often required, as hypertrophy of the lymphoid tissues is the main cause of OSA1 in children. According to clinical findings, orthodontic treatment generally associated with specialized orofacial-myofunctional therapy might also be indicated. Whatever treatment is chosen, follow-up must be continuous and multidisciplinary, in a network of trained specialists.
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Apneia Obstrutiva do Sono , Tonsilectomia , Criança , Humanos , Adolescente , Consenso , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapia , Ronco , Tonsilectomia/efeitos adversos , Polissonografia/efeitos adversosRESUMO
Tip-enhanced Raman scattering (TERS) has emerged as a powerful tool to obtain subnanometer spatial resolution fingerprints of atomic motion. Theoretical calculations that can simulate the Raman scattering process and provide an unambiguous interpretation of TERS images often rely on crude approximations of the local electric field. In this work, we present a novel and first-principles-based method to compute TERS images by combining Time Dependent Density Functional Theory (TD-DFT) and Density Functional Perturbation Theory (DFPT) to calculate Raman cross sections with realistic local fields. We present TERS results on free-standing benzene and C60 molecules, and on the TCNE molecule adsorbed on Ag(100). We demonstrate that chemical effects on chemisorbed molecules, often ignored in TERS simulations of larger systems, dramatically change the TERS images. This observation calls for the inclusion of chemical effects for predictive theory-experiment comparisons and an understanding of molecular motion at the nanoscale.
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The present white paper, referring to the 4th Assisi Think Tank Meeting on breast cancer, reviews state-of-the-art data, on-going studies and research proposals. <70% agreement in an online questionnaire identified the following clinical challenges: 1: Nodal RT in patients who have a) 1-2 positive sentinel nodes without ALND (axillary lymph node dissection); b) cN1 disease transformed into ypN0 by primary systemic therapy and c) 1-3 positive nodes after mastectomy and ALND. 2. The optimal combination of RT and immunotherapy (IT), patient selection, IT-RT timing, and RT optimal dose, fractionation and target volume. Most experts agreed that RT- IT combination does not enhance toxicity. 3: Re-irradiation for local relapse converged on the use of partial breast irradiation after second breast conserving surgery. Hyperthermia aroused support but is not widely available. Further studies are required to finetune best practice, especially given the increasing use of re-irradiation.
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/radioterapia , Neoplasias da Mama/tratamento farmacológico , Mastectomia , Excisão de Linfonodo , Biópsia de Linfonodo Sentinela , Mastectomia Segmentar , Axila/patologia , Linfonodos/patologiaRESUMO
Electromagnetic fields can be confined in the presence of metal nanostructures. Recently, subnanometer scale confinement has been demonstrated to occur at atomic protrusions on plasmonic nanostructures. Such an extreme field may dominate atomic-scale light-matter interactions in "picocavities". However, it remains to be elucidated how atomic-level structures and electron transport affect plasmonic properties of a picocavity. Here, using low-temperature optical scanning tunneling microscopy (STM), we investigate inelastic light scattering (ILS) in the vicinity of a single-atom quantum point contact (QPC). A vibration mode localized at the single Ag adatom on the Ag(111) surface is resolved in the ILS spectrum, resulting from tip-enhanced Raman scattering (TERS) by the atomically confined plasmonic field in the STM junction. Furthermore, we trace how TERS from the single adatom evolves as a function of the gap distance. The exceptional stability of the low-temperature STM allows to examine distinctly different electron transport regimes of the picocavity, namely, in the tunneling and QPC regimes. This measurement shows that the vibration mode localized at the adatom and its TERS intensity exhibits a sharp change upon the QPC formation, indicating that the atomic-level structure has a crucial impact on the plasmonic properties. To gain microscopic insights into picocavity optomechanics, we scrutinize the structure and plasmonic field in the STM junction using time-dependent density functional theory. The simulations reveal that atomic-scale structural relaxation at the single-atom QPC results in a discrete change of the plasmonic field strength, volume, and distribution as well as the vibration mode localized at the single atom. These findings give a qualitative explanation for the experimental observations. Furthermore, we demonstrate that strong ILS is a characteristic feature of QPC by continuously forming, breaking, and reforming the atomic contact and how the plasmonic resonance evolves throughout the nontunneling, tunneling, and QPC regimes.
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The objective of the present study was to validate the Short Version of French Sleepiness Scale for Adolescents (FSSA) with eight items (FSSA8). METHODS: A total of 384 adolescents, aged between 12 and 18 years, completed the FSSA8. These included 269 nonclinical adolescents and 115 adolescents admitted for overnight polysomnography and Multiple Sleep Latency Test (MSLT) because of suspected hypersomnia (85 patients with narcolepsy and 30 with other sleep disorders). Item response theory (IRT) assumptions were tested and psychometric properties were analysed. Matching on sex ratio and age was conducted to estimate concurrent criterion, diagnostic validity and cut-offs. RESULTS: IRT assumptions were validated confirming the one-dimensionality of the FSSA8. The latent continuum sleepiness for which the scale and its items are reliable encompassed most of the clinical subjects. FSSA8 is weakly correlated with MSLT. Distribution of scores for the nonclinical group and the clinical group differed significantly; the FSSA8 had very good screening validity in sleep disorders. The cut-off was seven points. CONCLUSION: The FSSA8 appeared to be more reliable for patients than for nonclinical participants and to be a good tool for screening excessive daytime sleepiness in sleep disorders.
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Distúrbios do Sono por Sonolência Excessiva , Narcolepsia , Transtornos do Sono-Vigília , Humanos , Adolescente , Criança , Sonolência , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Vigília/fisiologia , Narcolepsia/diagnóstico , Transtornos do Sono-Vigília/diagnósticoRESUMO
Introducción. Una alimentación complementaria adecuada en cantidad y calidad resulta esencial durante los primeros dos años de vida. El objetivo del estudio fue evaluar la ingesta de nutrientes y prácticas alimentarias en niños de 6 a 23 meses de una localidad del noreste argentino. Población y métodos. Estudio descriptivo transversal (segundo semestre del 2019). Se evaluaron las ingestas de 24 horas mediante recordatorios a los cuidadores de niños de 6 a 23 meses. Los datos se compararon con las ingestas dietéticas de referencia. Las prácticas alimentarias se evaluaron según los indicadores establecidos por la Organización Mundial de la Salud. Resultados. Se evaluaron 138 niños de 6 a 23 meses de edad. La energía y las vitaminas A, D y E presentaron porcentajes medios de adecuación inferiores al 100 % en todas las edades, mientras que las proteínas alcanzaron una adecuación promedio del 142,8 % y el 168,1 % para los niños de 7-12 meses y de 13-23 meses, respectivamente. Los nutrientes que presentaron una proporción considerable de casos con ingestas por debajo del requerimiento promedio estimado en todos los grupos fueron la energía y la vitamina A. En cuanto a los indicadores de prácticas alimentarias, 50,8 % de los lactantes recibió una dieta mínima aceptable. Conclusiones. Existe una alta prevalencia de inadecuación energética y de nutrientes críticos durante la alimentación complementaria en los niños de 6 a 23 meses incluidos en el estudio. Intervenciones nutricionales que promuevan prácticas alimentarias que mejoren la ingesta de micronutrientes serían de suma importancia para su salud actual y futura.
Introduction. An adequate quantity and quality of complementary feeding is essential during the first 2 years of life. The objective of this study was to assess dietary intakes and feeding practices in children aged 623 months in a town in the Northeast region of Argentina. Population and methods. Descriptive, cross-sectional study (second semester of 2019). Intakes from 24-hour dietary recall interviews conducted among caregivers of children aged 623 months were assessed. Data were compared to dietary reference intakes. Feeding practices were assessed as per the World Health Organization's indicators. Results. A total of 138 children aged 623 months were assessed. The mean adequacy ratio of energy and vitamins A, D, and E was below 100% for all ages, whereas the protein adequacy for children aged 7-12 and 13-23 months was 142.8% and 168.1%, respectively. A remarkable number of cases had energy and vitamin A intakes below the estimated average requirement. In relation to feeding practice indicators, 50.8% of infants received a minimum acceptable diet. Conclusions. There is a high prevalence of an inadequate level of energy and critical nutrient intake during complementary feeding of the children aged 623 months included in the study. Nutritional interventions that promote feeding practices to improve micronutrient intake would be highly important for children's current and future health.
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Humanos , Lactente , Micronutrientes , Comportamento Alimentar , Argentina , Estudos Transversais , Dieta , Ingestão de Alimentos , Necessidades NutricionaisRESUMO
INTRODUCTION: An adequate quantity and quality of complementary feeding is essential during the first 2 years of life. The objective of this study was to assess dietary intakes and feeding practices in children aged 6-23 months in a town in the Northeast region of Argentina. POPULATION AND METHODS: Descriptive, crosssectional study (second semester of 2019). Intakes from 24-hour dietary recall interviews conducted among caregivers of children aged 6-23 months were assessed. Data were compared to dietary reference intakes. Feeding practices were assessed as per the World Health Organization's indicators. RESULTS: A total of 138 children aged 6-23 months were assessed. The mean adequacy ratio of energy and vitamins A, D, and E was below 100% for all ages, whereas the protein adequacy for children aged 7-12 and 13-23 months was 142.8% and 168.1%, respectively. A remarkable number of cases had energy and vitamin A intakes below the estimated average requirement. In relation to feeding practice indicators, 50.8% of infants received a minimum acceptable diet. CONCLUSIONS: There is a high prevalence of an inadequate level of energy and critical nutrient intake during complementary feeding of the children aged 6-23 months included in the study. Nutritional interventions that promote feeding practices to improve micronutrient intake would be highly important for children's current and future health.
Introducción. Una alimentación complementaria adecuada en cantidad y calidad resulta esencial durante los primeros dos años de vida. El objetivo del estudio fue evaluar la ingesta de nutrientes y prácticas alimentarias en niños de 6 a 23 meses de una localidad del noreste argentino. Población y métodos. Estudio descriptivo transversal (segundo semestre del 2019). Se evaluaron las ingestas de 24 horas mediante recordatorios a los cuidadores de niños de 6 a 23 meses. Los datos se compararon con las ingestas dietéticas de referencia. Las prácticas alimentarias se evaluaron según los indicadores establecidos por la Organización Mundial de la Salud. Resultados. Se evaluaron 138 niños de 6 a 23 meses de edad. La energía y las vitaminas A, D y E presentaron porcentajes medios de adecuación inferiores al 100 % en todas las edades, mientras que las proteínas alcanzaron una adecuación promedio del 142,8 % y el 168,1 % para los niños de 7-12 meses y de 13-23 meses, respectivamente. Los nutrientes que presentaron una proporción considerable de casos con ingestas por debajo del requerimiento promedio estimado en todos los grupos fueron la energía y la vitamina A. En cuanto a los indicadores de prácticas alimentarias, 50,8 % de los lactantes recibió una dieta mínima aceptable. Conclusiones. Existe una alta prevalencia de inadecuación energética y de nutrientes críticos durante la alimentación complementaria en los niños de 6 a 23 meses incluidos en el estudio. Intervenciones nutricionales que promuevan prácticas alimentarias que mejoren la ingesta de micronutrientes serían de suma importancia para su salud actual y futura.
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Comportamento Alimentar , Micronutrientes , Humanos , Lactente , Criança , Necessidades Nutricionais , Argentina , Dieta , Ingestão de AlimentosRESUMO
The harnessing of plasmon-induced hot carriers promises to open new avenues for the development of clean energies and chemical catalysis. The extraction of carriers before thermalization and recombination is of fundamental importance to obtain appealing conversion yields. Here, hot carrier injection in the paradigmatic Au-TiO2 system is studied by means of electronic and electron-ion dynamics. Our results show that pure electronic features (without considering many-body interactions or dissipation to the environment) contribute to the electron-hole separation stability. These results reveal the existence of a dynamic contribution to the interfacial potential barrier (Schottky barrier) that arises at the charge injection pace, impeding electronic back transfer. Furthermore, we show that this charge separation stabilization provides the time needed for the charge to leak to capping molecules placed over the TiO2 surface triggering a coherent bond oscillation that will lead to a photocatalytic dissociation. We expect that our results will add new perspectives to the interpretation of the already detected long-lived hot carrier lifetimes and their catalytical effect, and concomitantly to their technological applications.
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Sleep disturbances are extremely common (40-86%) in children and adolescents, especially those with autism spectrum disorders (ASD) and are often among the first symptoms identified by parents at a very early stage of their child's development. These abnormalities are among the main parental concerns when having a child with ASD and have a significant impact on the quality of life of patients, their parents, and more broadly their siblings. Sleep disorders are essentially abnormalities of the sleep-wake rhythm - primarily sleep onset insomnia or nocturnal awakenings (with difficulty falling back to sleep). These disturbances can be accompanied by other sleep disorders, requiring notably a systematic elimination of the presence of a sleep apnea or restless legs syndrome - to ensure a personalized and efficient therapeutic approach. Physiologically, the determinants of these sleep disorders are poorly understood, even though several studies point to a significant decrease in melatonin synthesis in people with ASD. Melatonin is a hormone that facilitates falling asleep and maintaining sleep and is also involved in the endogenous synchronization of internal biological clocks. However, the causal factors of this decrease in melatonin synthesis are largely unknown, involving to a small extent the genes involved in melatonin synthesis pathway. The treatment of sleep disorders is relatively systematic: after eliminating other specific sleep disorders associated with the complaint of insomnia, as well as other possible associated comorbidities (such as seizures), a global and graduated therapeutic approach must be put in place. This treatment will be non-pharmacological as a first line, then pharmacological as a second line. A number of non-pharmacological treatment strategies for sleep disorders in typically developing children and adolescents, as well as those with ASD, have been shown to be effective. This treatment requires a combination of: 1) parental education to promote sleep development; 2) setting up bedtime rituals adapted to the child's age and particularities; 3) specific behavioral strategies including bedtime fading, gradual extinction and positive reinforcement of adapted behaviors. It is very essential that the parents are accompanied throughout this therapy. Sleep hygiene and behavioral care must also take into consideration the important role of the zeitgebers of sleep-wake rhythms, i.e. the external environmental factors involved in the synchronization of the biological clocks: regular exposure to light at adapted times, regular meal and wake-up times, social activities and times for going to school. The evidence for the effectiveness of behavioral interventions in the treatment of behavioral insomnia in the typical developmental child is strong, since 94% of children show clinically significant improvements in nighttime sleepiness and waking. By contrast, only about 25% of children with ASD are improved by an approach combining sleep hygiene and behavioral therapy. Melatonin has a special and prominent place in the drug management of sleep disorders associated with ASD. Several clinical trials have shown that melatonin is effective in treating sleep disorders in patients with ASD. This work led to the European Medicines Agency (EMA) granting marketing authorization in September 2018 for a sustained-release paediatric melatonin molecule (Slenyto®). This synthetic molecule is a prolonged release melatonin (PRM) which mimics the physiological pharmacokinetic and secretory characteristics of endogenous melatonin, having a very short blood half-life and prolonged secretion for several hours during the night. A recent study evaluated the efficacy and safety of pediatric PRM (mini-tablets) in 125 children, aged 2 to 17.5 years with mainly ASD. After 15 days on placebo, the children were randomized into two parallel groups, PRM or placebo in a double-blind design for 13 weeks. At endpoint, total sleep time was increased by an average of 57.5 minutes on PRM and only 9.14 minutes on placebo (P=0.034). This difference between the two groups was already significant after three weeks of treatment (P=0.006). Sleep latency was also improved in the PRM group (-39.6 minutes) compared to placebo (-12.51 minutes) (P=0.01). Consolidated sleep duration (uninterrupted by awakenings) was improved by 77.9 minutes for the PRM group and only 25.4 minutes for the placebo group (P<0.001). PRM was well tolerated, the most frequent side effects being headache and daytime drowsiness at the same level with PRM or placebo. In addition, the acceptability by the children for swallowing the mini-tablets was excellent (100% compliance). The efficacy and tolerability of PRM was maintained over the medium and long term in the open phase, over a total study duration of 2 years.
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Transtorno do Espectro Autista , Melatonina , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Adolescente , Transtorno do Espectro Autista/complicações , Criança , Humanos , Qualidade de Vida , Sono/fisiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/terapiaRESUMO
Complex van der Waals heterostructures from layered molecular stacks are promising optoelectronic materials offering the means to efficient, modular charge separation and collection layers. The effect of stacking in the electrodynamics of such hybrid organic-inorganic two-dimensional materials remains largely unexplored, whereby molecular scale engineering could lead to advanced optical phenomena. For instance, tunable Fano engineering could make possible on-demand transparent conducting layers or photoactive elements, and passive cooling. We employ an adapted Gersten-Nitzan model and real time time-dependent density functional tight-binding to study the optoelectronics of self-assembled monolayers on graphene nanoribbons. We find Fano resonances that cause electromagnetic induced opacity and transparency and reveal an additional incoherent process leading to interlayer exciton formation with a characteristic charge transfer rate. These results showcase hybrid van der Waals heterostructures as paradigmatic 2D optoelectronic stacks, featuring tunable Fano optics and unconventional charge transfer channels.
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The obstructive sleep apnoea syndrome (OSAS) affects 1-4% of adolescents. It represents a transitional stage between paediatric and adult OSA and is characterized by specific symptoms. BACKGROUND: The persistence of childhood OSAS during adolescence is not frequent. Risk factors are male sex, obesity and a history of tonsillectomy or adenoidectomy. Symptoms may be misleading such as tiredness and depressive disorders. In adolescence, untreated OSAS may result in neuro-behavioural and cognitive deficits, systemic inflammation, cardiovascular and metabolic disorders. The French Society of Research and Sleep Medicine organized a meeting on OSAS in adolescents. A multidisciplinary group of specialists (pulmonologists, pediatricians, ENT and maxillo-facial surgeons, dentofacial orthopedists/orthodontists, myofunctional therapists and sleep specialists) exchanged their experience, discussed publications and drew up a consensus document on the diagnosis and polysomnographic criteria for OSAS in adolescents. They proposed a practical diagnostic guideline and follow-up for these adolescents. OUTLOOK AND CONCLUSION: A good knowledge of the particularities of this pathology by the physician will lead to an early diagnosis, propose adapted multifactorial treatments and avoid the deleterious consequences of this pathology at adult age.
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Apneia Obstrutiva do Sono , Adolescente , Criança , Humanos , Masculino , Polissonografia , Fatores de Risco , Sono , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologiaRESUMO
PURPOSE: Pulmonary embolism (PE) in COVID-19 patients can play a key role in precipitating clinical conditions. We aimed to evaluate PE distribution on CTA and to investigate any possible association with D-dimer (DD), pulmonary stage of disease and prognosis. METHOD: COVID-19 patients of two affiliated Hospitals, undergone a CTA examination for PE suspicion, were retrospectively enrolled. Comorbidities, laboratory tests and clinical outcomes (hospitalization, discharge, death) were assessed. A parenchymal stage (early, progressive, peak, absorption) for lung involvement was assigned. RESULTS: A cohort of 114 patients (mean age 61 years; 26.3 % females) with severe COVID-19 pneumonia were evaluated. At last follow-up 25 (21.9 %) were hospitalized, 72 (63.2 %) discharged, 17 (14.9 %) dead. Eighty-eight patients (77.2 %) had at least one comorbidity, being cardiovascular ones the most frequent (44.7 %). CTA revealed PE in 65 patients (57 %), with concomitant pulmonary trunk and/or main arteries involvement in 16.9 %. PE defects were ubiquitous in 18.5 % of cases. The predominant parenchymal stages were the progressive (24.6 %) and peak (67.7 %). DD levels showed a significant correlation with PE occurrence and extent in pulmonary branches, despite anticoagulant therapies; trend of correlation with pulmonary stages was also noted. CONCLUSIONS: PE is a frequent complication in severe COVID-19 patients, particularly during central parenchymal stages and despite ongoing anticoagulant therapy. CTA and DD levels play a crucial role in the assessment of suspected PE, despite anticoagulant therapies, along with proper information about lung involvement extent.
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COVID-19 , Embolia Pulmonar , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , SARS-CoV-2RESUMO
Many global environmental agendas, including halting biodiversity loss, reversing land degradation, and limiting climate change, depend upon retaining forests with high ecological integrity, yet the scale and degree of forest modification remain poorly quantified and mapped. By integrating data on observed and inferred human pressures and an index of lost connectivity, we generate a globally consistent, continuous index of forest condition as determined by the degree of anthropogenic modification. Globally, only 17.4 million km2 of forest (40.5%) has high landscape-level integrity (mostly found in Canada, Russia, the Amazon, Central Africa, and New Guinea) and only 27% of this area is found in nationally designated protected areas. Of the forest inside protected areas, only 56% has high landscape-level integrity. Ambitious policies that prioritize the retention of forest integrity, especially in the most intact areas, are now urgently needed alongside current efforts aimed at halting deforestation and restoring the integrity of forests globally.
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Biodiversidade , Conservação dos Recursos Naturais/estatística & dados numéricos , Política Ambiental , Florestas , África Central , Canadá , Mudança Climática , Conservação dos Recursos Naturais/legislação & jurisprudência , Nova Guiné , Federação RussaRESUMO
Raised blood pressure (BP) was the biggest contributor to the global burden of disease in 2017, with lack of awareness and adequate control of BP identified as the main drivers of this disease burden. In 2017, an opportunistic BP screening and awareness campaign called May Measurement Month (MMM) in the UK and Republic of Ireland (RoI) highlighted that levels of undiagnosed hypertension and uncontrolled hypertension in the community screened were approximately 23% and 40%, respectively. MMM18 was undertaken to further the campaign's efforts to increase awareness and create an evidence base of population risk associated with high BP. MMM18 BP screenings were conducted in the community at places of worship, supermarkets, GP surgeries, workplaces, community pharmacies, gyms, and various other public places. A total of 5000 volunteers, aged 47.3 (±17.2) years, 60% female were screened. Of all 5000 individuals screened, 1716 (34.3%) were hypertensive, of which only 51.3% were aware of their condition, 42.8% on antihypertensive treatment, and only 51.5% of those on medication controlled to target BP of <140/90 mmHg. Furthermore, obese, overweight, and underweight participants all had significantly higher BP values compared to individuals with a healthy body mass index (BMI). The 2018 MMM campaign in the UK and the RoI confirmed approximately one in three adults were hypertensive, with more than half having uncontrolled BP. In addition, these findings show that people with low BMI are at risk of having high BP. Finally, with only one in two people aware of their high BP, awareness remains a significant public health concern.