Synergic control of the minimum toe clearance in young and older adults during foot swing on treadmill walking in different speeds.

BACKGROUND: The vertical toe position at minimum toe clearance (MTC) in the swing phase is critical for walking safety. Consequently, the joints involved should be strictly controlled and coordinated to stabilize the foot at MTC. The uncontrolled manifold (UCM) hypothesis framework has been used to determine the existence of synergies that stabilize relevant performance variables during walking. However, no study investigated the presence of a multi-joint synergy stabilizing the foot position at MTC and the effects of age and walking speed on this synergy. RESEARCH QUESTIONS: Is there a multi-joint synergy stabilizing MTC during treadmill walking? Does it depend on the persons' age and walking speed? METHODS: Kinematic data from 23 young and 15 older adults were analyzed using the UCM approach. The participants walked on a treadmill at three speeds: slow, self-selected, and fast. The sagittal and frontal joint angles from the swing and stance legs and pelvis obliquity were used as motor elements and the vertical toe position at MTC was the performance variable. The variances in the joint space that affected (VORT, 'bad' variance) and did not affect (VUCM, 'good' variance) the toe position at MTC and the synergy index (ΔV) were computed. RESULTS: The ΔV>0 was revealed for all subjects. Walking speed did not affect ΔV in older adults, whereas ΔV reduced with speed in young adults. ΔV was higher for older than for young adults at self-selected and fast speeds, owing to a lower VORT in the older group. SIGNIFICANCE: The vertical toe position at MTC was stabilized by a strong multi-joint synergy. In older adults, this synergy was stronger, as they were better at limiting VORT than young adults. Reduced VORT in older adults could be caused by more constrained walking, which may be associated with anxiety due to walking on a treadmill.

Characterization of Magnetoresistive Shunts and Its Sensitivity Temperature Compensation.

The main purpose of the paper is to show how a magnetoresistive (MR) element can work as a current sensor instead of using a Wheatstone bridge composed by four MR elements, defining the concept of a magnetoresistive shunt (MR-shunt). This concept is reached by considering that once the MR element is biased at a constant current, the voltage drop between its terminals offers information, by the MR effect, of the current to be measured, as happens in a conventional shunt resistor. However, an MR-shunt has the advantage of being a non-dissipative shunt since the current of interest does not circulate through the material, preventing its self-heating. Moreover, it provides galvanic isolation. First, we propose an electronic circuitry enabling the utilization of the available MR sensors integrated into a Wheatstone bridge as sensing elements (MR-shunt). This circuitry allows independent characterization of each of the four elements of the bridge. An independently implemented MR element is also analyzed. Secondly, we propose an electronic conditioning circuit for the MR-shunt, which allows both the bridge-integrated element and the single element to function as current sensors in a similar way to the sensing bridge. Third, the thermal variation in the sensitivity of the MR-shunt, and its temperature coefficient, are obtained. An electronic interface is proposed and analyzed for thermal drift compensation of the MR-shunt current sensitivity. With this hardware compensation, temperature coefficients are experimentally reduced from 0.348%/°C without compensation to -0.008%/°C with compensation for an element integrated in a sensor bridge and from 0.474%/°C to -0.0007%/°C for the single element.

One-Pot Microfluidics to Engineer Chitosan Nanoparticles Conjugated with Antimicrobial Peptides Using "Photoclick" Chemistry: Validation Using the Gastric Bacterium Helicobacter pylori.

Surface bioconjugation of antimicrobial peptides (AMP) onto nanoparticles (AMP-NP) is a complex, multistep, and time-consuming task. Herein, a microfluidic system for the one-pot production of AMP-NP was developed. Norbornene-modified chitosan was used for NP production (NorChit-NP), and thiolated-AMP was grafted on their surface via thiol-norbornene "photoclick" chemistry over exposure of two parallel UV LEDs. The MSI-78A was the AMP selected due to its high activity against a high priority (level 2) antibiotic-resistant gastric pathogen: Helicobacter pylori (H. pylori). AMP-NP (113 ± 43 nm; zeta potential 14.3 ± 7 mV) were stable in gastric settings without a cross-linker (up to 5 days in pH 1.2) and bactericidal against two highly pathogenic H. pylori strains (1011 NP/mL with 96 µg/mL MSI-78A). Eradication was faster for H. pylori 26695 (30 min) than for H. pylori J99 (24 h), which was explained by the lower minimum bactericidal concentration of soluble MSI-78A for H. pylori 26695 (32 µg/mL) than for H. pylori J99 (128 µg/mL). AMP-NP was bactericidal by inducing H. pylori cell membrane alterations, intracellular reorganization, generation of extracellular vesicles, and leakage of cytoplasmic contents (transmission electron microscopy). Moreover, NP were not cytotoxic against two gastric cell lines (AGS and MKN74, ATCC) at bactericidal concentrations. Overall, the designed microfluidic setup is a greener, simpler, and faster approach than the conventional methods to obtain AMP-NP. This technology can be further explored for the bioconjugation of other thiolated-compounds.

FTA-LAMP based biosensor for a rapid in-field detection of Globodera pallida-the pale potato cyst nematode.

The combination of a sensitive and specific magnetoresistive sensing device with an easy DNA extraction method and a rapid isothermal amplification is presented here targeting the on-site detection of Globodera pallida, a potato endoparasitic nematode. FTA-cards were used for DNA extraction, LAMP was the method developed for DNA amplification and a nanoparticle functionalized magnetic-biosensor was used for the detection. The combinatorial effect of these three emerging technologies has the capacity to detect G. pallida with a detection limit of one juvenile, even when mixed with other related species. This combined system is far more interesting than what a single technology can provide. Magnetic biosensors can be combined with any DNA extraction protocol and LAMP forming a new solution to target G. pallida. The probe designed in this study consistently distinguished G. pallida (∆Vac binding/Vac sensor above 1%) from other cyst nematodes (∆Vac binding/Vac sensor below 1%). It was confirmed that DNA either extracted with FTA-cards or Lab extraction Kit was of enough quantity and quality to detect G. pallida whenever present (alone or in mixed samples), ensuring probe specificity and sensitivity. This work provides insights for a new strategy to construct advanced devices for pathogens in-field diagnostics. LAMP runs separately but can be easily integrated into a single device.

Necrotizing Pneumonia: A Rare Outcome of a Rare Complication.

Necrotizing pneumonia is a rare complication of community-acquired pneumonia, characterized by lung parenchymal destruction in affected areas. It has been sporadically documented over the years, mostly with insidious progression and a higher incidence among individuals with risk factors. Its diagnosis relies on clinical, analytical, and imaging data, and the treatment encompasses medical and surgical measures. The persistently high morbidity and mortality result from delayed diagnosis and the intricate therapeutic approach. In this report, the authors describe an unusual case of necrotizing pneumonia in a patient without risk factors.

Implementation of the Lean Healthcare System in the Emergency Room of the Clinical Hospital of the Federal University of Uberlândia: A Case Study.

The objective of this study was to analyze the effectiveness of the implementation of the lean healthcare system at the emergency room of the Clinical Hospital of the Federal University of Uberlândia, based on a comparison of hospital indicators obtained over the three phases corresponding to the period of one year before the implementation (T1), the year during the implementation (T2) and one year after implementation (T3). The methodology applied through this study can be classified as a case study that is exploratory and descriptive and developed in stages. Based herein on the search for hospital indicators, as occurred in the implementation of a lean process at the Clinical Hospital Emergency Department, along with a description of the implemented lean system. During the collection period of data relevant to the National Emergency Department Overcrowding Score and Length of Stay Indicator, the motivation of the teams grew, but with a notable tension between municipal management and hospital management. It was found that, despite the fluctuations, the patient length of stay in the Emergency Room remained high. With the exception of the variable of female deaths before 24 h of hospitalization, all other variables showed percentage increases before and after the intervention. This study reported the difficulties encountered by HC-UFU in implementing the lean project in an emergency room, thus ensuring that other institutions that intend to implement this project do not make the same types of mistakes.

Assessment of landmark detection in cephalometric radiographs with different conditions of brightness and contrast using the an artificial intelligence software.

OBJECTIVES: To evaluate the reliability and reproducibility of an artificial intelligence (AI) software in identifying cephalometric points on lateral cephalometric radiographs considering four settings of brightness and contrast. METHODS AND MATERIALS: Brightness and contrast of 30 lateral cephalometric radiographs were adjusted into four different settings. Then, the control examiner (ECont), the calibrated examiner (ECal), and the CEFBOT AI software (AIs) each marked 19 cephalometric points on all radiographs. Reliability was assessed with a second analysis of the radiographs 15 days after the first one. Statistical significance was set at p < 0.05. RESULTS: Reliability of landmark identification was excellent for the human examiners and the AIs regardless of the type of brightness and contrast setting (mean intraclass correlation coefficient >0.89). When ECont and ECal were compared for reproducibility, there were more cephalometric points with significant differences on the x-axis of the image with the highest contrast and the lowest brightness, namely N(p = 0.033), S(p = 0.030), Po(p < 0.001), and Pog'(p = 0.012). Between ECont and AIs, there were more cephalometric points with significant differences on the image with the highest contrast and the lowest brightness, namely N(p = 0.034), Or(p = 0.048), Po(p < 0.001), A(p = 0.042), Pog'(p = 0.004), Ll(p = 0.005), Ul(p < 0.001), and Sn(p = 0.001). CONCLUSIONS: While the reliability of the AIs for cephalometric landmark identification was rated as excellent, low brightness and high contrast seemed to affect its reproducibility. The experienced human examiner, on the other hand, did not show such faulty reproducibility; therefore, the AIs used in this study is an excellent auxiliary tool for cephalometric analysis, but still depends on human supervision to be clinically reliable.

A magnetic nanoparticle-based microfluidic device fabricated using a 3D-printed mould for separation of Escherichia coli from blood.

Herein, A microfluidic device is described, produced with a 3D-printed master mould that rapidly separates and concentrates Escherichia coli directly from whole blood samples, enabling a reduction in the turnaround time of bloodstream infections (BSIs) diagnosis. Moreover, it promotes the cleansing of the blood samples whose complexity frequently hampers bacterial detection. The device comprises a serpentine mixing channel with two inlets, one for blood samples (spiked with bacteria) and the other for magnetic nanoparticles (MNPs) functionalized with a (bacterio)phage receptor-binding protein (RBP) with high specificity for E. coli. After the magnetic labelling of bacteria throughout the serpentine, the microchannel ends with a trapping reservoir where bacteria-MNPs conjugates are concentrated using a permanent magnet. The optimized sample preparation device successfully recovered E. coli (on average, 66%) from tenfold diluted blood spiked within a wide range of bacterial load (102 CFU to 107 CFU mL-1). The non-specific trapping, tested with Staphylococcus aureus, was at a negligible level of 12%. The assay was performed in 30 min directly from diluted blood thus presenting an advantage over the conventional enrichment in blood cultures (BCs). The device is simple and cheap to fabricate and can be tailored for multiple bacterial separation from complex clinical samples by using RBPs targeting different species. Moreover, the possibility to integrate a biosensing element to detect bacteria on-site can provide a reliable, fast, and cost-effective point-of-care device.

Resveratrol-Loaded Polymeric Nanoparticles: The Effects of D-α-Tocopheryl Polyethylene Glycol 1000 Succinate (TPGS) on Physicochemical and Biological Properties against Breast Cancer In Vitro and In Vivo.

Resveratrol (RSV), a phytoalexin from grapes and peanuts, has been reported to exhibit antiproliferative effects on various cancer cell lines. In breast cancer, RSV has been demonstrated to exert an antiproliferative effect on both hormone-dependent and hormone-independent breast cancer cell lines. However, RSV is a lipophilic drug, and its therapeutic effect could be improved through nanoencapsulation. Functionalizing polymeric nanoparticles based on polycaprolactone (PCL) with polyethylene glycol 1000 tocopheryl succinate (TPGS) has been reported to prolong drug circulation and reduce drug resistance. However, the effect of TPGS on the physicochemical properties and biological effects of breast cancer cells remains unclear. Therefore, this study aimed to develop RSV-loaded PCL nanoparticles using nanoprecipitation and investigate the effect of TPGS on the nanoparticles' physicochemical characteristics (particle size, zeta potential, encapsulation efficiency, morphology, and release rate) and biological effects on the 4T1 breast cancer cell line (cytotoxicity and cell uptake), in vitro and in vivo. The optimized nanoparticles without TPGS had a size of 138.1 ± 1.8 nm, a polydispersity index (PDI) of 0.182 ± 0.01, a zeta potential of -2.42 ± 0.56 mV, and an encapsulation efficiency of 98.2 ± 0.87%, while nanoparticles with TPGS had a size of 127.5 ± 3.11 nm, PDI of 0.186 ± 0.01, zeta potential of -2.91 ± 0.90 mV, and an encapsulation efficiency of 98.40 ± 0.004%. Scanning electron microscopy revealed spherical nanoparticles with low aggregation tendency. Differential Scanning Calorimetry (DSC) and Fourier Transform Infrared Spectroscopy (FTIR) identified the constituents of the nanoparticles and the presence of drug encapsulation in an amorphous state. In vitro release studies showed that both formulations followed the same dissolution profiles, with no statistical differences. In cytotoxicity tests, IC50 values of 0.12 µM, 0.73 µM, and 4.06 µM were found for the formulation without TPGS, with TPGS, and pure drug, respectively, indicating the potentiation of the cytotoxic effect of resveratrol when encapsulated. Flow cytometry and confocal microscopy tests indicated excellent cellular uptake dependent on the concentration of nanoparticles, with a significant difference between the two formulations, suggesting that TPGS may pose a problem in the endocytosis of nanoparticles. The in vivo study evaluating the antitumor activity of the nanoparticles confirmed the data obtained in the in vitro tests, demonstrating that the nanoparticle without TPGS significantly reduced tumor volume, tumor mass, maintained body weight, and improved survival in mice. Moreover, the biochemical evaluation evidenced possible hepatotoxicity for formulation with TPGS.

Fish Oil Supplementation Improves the Repeated-Bout Effect and Redox Balance in 20-30-Year-Old Men Submitted to Strength Training.

Herein, we investigated the effect of fish oil supplementation combined with a strength-training protocol, for 6 weeks, on muscle damage induced by a single bout of strength exercise in untrained young men. Sixteen men were divided into two groups, supplemented or not with fish oil, and they were evaluated at the pre-training period and post-training period. We investigated changes before and 0, 24, and 48 h after a single hypertrophic exercise session. Creatine kinase (CK) and lactate dehydrogenase (LDH) activities, plasma interleukin-6 (IL-6) and C-reactive protein (CRP) levels, and the redox imbalance were increased in response to the single-bout session of hypertrophic exercises at baseline (pre-training period) and decreased during the post-training period in the control group due to the repeated-bout effect (RBE). The fish oil supplementation exacerbated this reduction and improved the redox state. In summary, our findings demonstrate that, in untrained young men submitted to a strength-training protocol, fish oil supplementation is ideal for alleviating the muscle injury, inflammation, and redox imbalance induced by a single session of intense strength exercises, highlighting this supplementation as a beneficial strategy for young men that intend to engage in strength-training programs.

Dependence of Sensitivity, Derivative of Transfer Curve and Current on Bias Voltage Magnitude and Polarity in Tunneling Magnetoresistance Sensors.

The sensitivity of tunneling magnetoresistance sensors is an important performance parameter. It depends on the derivative of resistance versus magnetic field (transfer curve) and the current and is expressed as the product of the two factors. Previous research has demonstrated that the bias voltage has a significant impact on the sensitivity. However, no research has been conducted into the dependence of current and the derivative on bias voltage magnitude and polarity, and their contribution to the sensitivity. Thus, this paper investigates the dependence of sensitivity, derivative of resistance versus magnetic field curve and current on bias voltage magnitude and polarity in CoFeB/MgO/CoFeB-based tunneling magnetoresistance sensors with weak, strong and no voltage-controlled perpendicular magnetic anisotropy modification. It demonstrates that the sensitivity dependence on bias voltage for sensors with voltage controlled magnetic anisotropy modification showed no saturation up to 1 V. Moreover, the sensitivity asymmetry with respect to bias polarity changed significantly with bias, reaching a ratio of 6.7. Importantly, the contribution of current and the derivative of resistance versus magnetic field curve to the sensitivity showed a crossover. The current dominated the bias dependence of sensitivity below the crossover voltage and the derivative above the voltage. Furthermore, the crossover voltage in sensors without voltage controlled magnetic anisotropy modification did not depend on polarity, whereas in sensors with voltage controlled magnetic anisotropy modification, it appeared at significantly higher voltage under positive than negative polarity.

A Lab-on-a-Chip Approach for the Detection of the Quarantine Potato Cyst Nematode Globodera pallida.

The potato cyst nematode (PCN), Globodera pallida, has acquired significant importance throughout Europe due to its widespread prevalence and negative effects on potato production. Thus, rapid and reliable diagnosis of PCN is critical during surveillance programs and for the implementation of control measures. The development of innovative technologies to overcome the limitations of current methodologies in achieving early detection is needed. Lab-on-a-chip devices can swiftly and accurately detect the presence of certain nucleotide sequences with high sensitivity and convert the presence of biological components into an understandable electrical signal by combining biosensors with microfluidics-based biochemical analysis. In this study, a specific DNA-probe sequence and PCR primers were designed to be used in a magnetoresistive biosensing platform to amplify the internal transcribed spacer region of the ribosomal DNA of G. pallida. Magnetic nanoparticles were used as the labelling agents of asymmetric PCR product through biotin−streptavidin interaction. Upon target hybridization to sensor immobilized oligo probes, the fringe field created by the magnetic nanoparticles produces a variation in the sensor's electrical resistance. The detection signal corresponds to the concentration of target molecules present in the sample. The results demonstrate the suitability of the magnetic biosensor to detect PCR target product and the specificity of the probe, which consistently distinguishes G. pallida (DV/V > 1%) from other cyst nematodes (DV/V < 1%), even when DNA mixtures were tested at different concentrations. This shows the magnetic biosensor's potential as a bioanalytical device for field applications and border phytosanitary inspections.

Exploring the ability of strength and dexterity tests to detect hand function impairment in individuals with Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) can affect hand function since the beginning of the motor symptoms. OBJECTIVE: To compare the ability of different hand function tests to: 1) distinguish individuals with PD from healthy controls; 2) differentiate stages of the disease; and 3) indicate changes over time due to disease progression. METHODS: Twenty-four individuals with PD (Hoehn and Yahr: I-III) and 24 age- and sex-matched controls performed the Jebsen-Taylor Hand Function Test (JTHFT), the Nine-Hole Peg Test (9HPT), and the maximum grip and the maximum pinch strength tests using their right and left hands. Eight individuals with PD (six females and two males) were reassessed after 18 months. The ROC analyses and Mann-Whitney U tests (for disease progression) using the average performance of the hands were done. RESULTS: Individuals with PD presented worse test performances than controls, except for the writing subtest of the JTHFT and the grip strength test. The JTHFT without the writing subtest (JTHFTnoW) was the most accurate to discriminate PD from controls (AUC = 0.899; sensitivity 75% and specificity 95.8%). The 9HPT and the simulated feeding and moving large, light objects JTHFT subtests were sensitive to distinguish stages, while the 9HPT, the moving small, common objects JTHFT subtest, and the grip strength were sensitive to changes with disease progression. CONCLUSION: The JTHFTnoW was highly discriminative of the hand function impairments in PD. TwoJTHFT subtests were the most sensitives to distinguish PD stages (i.e. simulated feeding JTHFT subtest) and disease progression (i.e. moving small, common objects JTHFT subtest).

A Single Bout of High Heels Dancing Causes an Increase in Circulating Markers of Muscle Tissue Degradation and MMP-3 in Young Healthy Women.

Prolonged wearing of high heels can cause chronic injury and inflammation. Herein, we investigated the presence of muscle injury, inflammation, and neutrophil function in young women after a single bout of stiletto dance class. Sixteen volunteers (23.4 ± 3.8 years; 61.7 ± 8.1 kg; 23.4 ± 2.3 kg/m2; and 27.2 ± 3.8% body fat) participated in the study. The plasma biomarkers matrix metalloproteinase 3 (MMP-3), muscle damage (myoglobin (Mb), total creatine kinase (CK), and lactate dehydrogenase (LDH)), and inflammation (interleukin 8 (IL-8), tumour necrosis factor-alpha (TNF-α), interleukin (IL]-1ß, and IL-6) were quantified before and immediately after a single stiletto class (60 min) of moderate intensity. After class, our data showed that the plasma concentration of MMP-3, Mb, and CK increased by 56% (p = 0.04; d = 0.8), 113% (p = 0.007; d = 1.1), and 21% (p < 0.001; d = 0.4), respectively. Reactive oxygen species produced by neutrophils and the plasma concentration of IL-8, TNF-α, IL-1ß, and IL-6 were not affected under the study conditions. We concluded that a single bout of stiletto dance class caused muscle damage but did not alter the plasma concentration of proinflammatory cytokines. These findings are crucial in preventing the progress of chronic injuries that are often noted in dancers with synovitis and arthritis.

Understanding the risk of developing weight-related complications associated with different body mass index categories: a systematic review.

BACKGROUND: Obesity and overweight are major risk factors for several chronic diseases. There is limited systematic evaluation of risk equations that predict the likelihood of developing an obesity or overweight associated complication. Predicting future risk is essential for health economic modelling. Availability of future treatments rests upon a model's ability to inform clinical and decision-making bodies.  This systematic literature review aimed to identify studies reporting (1) equations that calculate the risk for individuals with obesity, or overweight with a weight-related complication (OWRC), of developing additional complications, namely T2D, cardiovascular (CV) disease (CVD), acute coronary syndrome, stroke, musculoskeletal disorders, knee replacement/arthroplasty, or obstructive sleep apnea; (2) absolute or proportional risk for individuals with severe obesity, obesity or OWRC developing T2D, a CV event or mortality from knee surgery, stroke, or an acute CV event. METHODS: Databases (MEDLINE and Embase) were searched for English language reports of population-based cohort analyses or large-scale studies in Australia, Canada, Europe, the UK, and the USA between January 1, 2011, and March 29, 2021. Included reports were quality assessed using an adapted version of the Newcastle Ottawa Scale. RESULTS: Of the 60 included studies, the majority used European cohorts. Twenty-nine reported a risk prediction equation for developing an additional complication. The most common risk prediction equations were logistic regression models that did not differentiate between body mass index (BMI) groups (particularly above 40 kg/m2) and lacked external validation. The remaining included studies (31 studies) reported the absolute or proportional risk of mortality (29 studies), or the risk of developing T2D in a population with obesity and with prediabetes or normal glucose tolerance (NGT) (three studies), or a CV event in populations with severe obesity with NGT or T2D (three studies). Most reported proportional risk, predominantly a hazard ratio. CONCLUSION: More work is needed to develop and validate these risk equations, specifically in non-European cohorts and that distinguish between BMI class II and III obesity. New data or adjustment of the current risk equations by calibration would allow for more accurate decision making at an individual and population level.

O que mudou entre os períodos de pico e de platô durante a primeira onda do SARS-CoV-2? Estudo multicêntrico português em unidades de cuidados intensivos / What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

RESUMO Objetivo: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal. Métodos: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô. Resultados: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001). Conclusão: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

ABSTRACT Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.

Local thermoelectric response from a single Néel domain wall.

Spatially resolved thermoelectric detection of magnetic systems provides a unique platform for the investigation of spintronic and spin caloritronic effects. Hitherto, these investigations have been resolution-limited, confining analysis of the thermoelectric response to regions where the magnetization is uniform or collinear at length scales comparable to the domain size. Here, we investigate the thermoelectric response from a single trapped domain wall using a heated scanning probe. Following this approach, we unambiguously resolve the domain wall due to its local thermoelectric response. Combining analytical and thermal micromagnetic modeling, we conclude that the measured thermoelectric signature is unique to that of a domain wall with a Néel-like character. Our approach is highly sensitive to the plane of domain wall rotation, which permits the distinct identification of Bloch or Néel walls at the nanoscale and could pave the way for the identification and characterization of a range of noncollinear spin textures through their thermoelectric signatures.

Starting gastrointestinal endoscopy in a lower middle-income country in Africa: Training, creating an endoscopy facility and developing telemedicine.

Background and study aims The prevalence of digestive diseases seems to be high in African countries. Nonetheless, the human and material resources are scarce. The aim of the Portuguese volunteering project described in this report was to develop the specialty of digestive endoscopy in Sao Tome and Principe, a lower-middle-income country in Africa. Methods Beginning by assessing the local needs and available resources and managing immediate issues related to this field, we aimed to provide the tools necessary to improve gastroenterological and endoscopic care in the country. The first step included training of the local teams, through the development and accomplishment of an adapted curriculum for a 3-year medical gastroenterological fellowship and a short-term nursing fellowship, both in Portugal, and the organization of regular gastroenterological and endoscopic theoretical and practical sessions in Sao Tome and Principe. Second, the endoscopy facilities of the unit were significantly optimized. Third, a web platform was designed to provide telemedicine incorporating real-time endoscopic imaging available remotely. Results Through these sequential steps achieved in collaboration with Portuguese and local teams, this 5-year project provided the basis for gastroenterology care in this country. Conclusions At the present time, Sao Tome and Principe has an autonomous, efficient and skilled team and unit to provide care for patients with gastrointestinal diseases who need endoscopic procedures.

Non-invasive diagnosis and monitoring tool of children's mental health: A point-of-care immunosensor for IL-6 quantification in saliva samples.

Mental disorders are commonly featured as chronic conditions with often onset during childhood. In this context, inflammation has been associated with a higher risk of developing physical and mental health problems. Interleukin (IL)-6 is a key mediator of inflammatory responses and plays a pivotal role in immune and nervous system interaction. High levels of IL-6 during childhood are associated with mental problems, indicating that the IL-6 molecular pathway may represent a new target for monitoring and treating these conditions. Here, we report the detection of IL-6 in saliva samples from children (N = 118, mean age 4.4 years old) with behavioral problems using an immunosensor based on electrochemical impedance spectroscopy. This work demonstrates that the proposed immunosensor requires smaller sample volumes and is significantly faster and more sensitive than conventional ELISA while maintaining comparable levels of specificity and reproducibility. The point-of care immunosensor for detection of IL-6 in saliva samples presented herewith is, therefore, an attractive solution to the clinical practice as a rapid non-invasive, high-sensitive monitoring tool of mental health problems, especially in vulnerable patient populations such as children.

Labeling on a Chip of Cellular Fibronectin and Matrix Metallopeptidase-9 in Human Serum.

We present a microfluidic chip for protein labeling in the human serum-based matrix. Serum is a complex sample matrix that contains a variety of proteins, and a matrix is used in many clinical tests. In this study, the device performance was tested using commercial serum samples from healthy donors spiked with the following target proteins: cellular fibronectin (c-Fn) and matrix metallopeptidase 9 (MMP9). The microfluidic molds were fabricated using micro milling on acrylic and using stereolithography (SLA) three-dimensional (3D) printing for an alternative method and comparison. A simple quality control was performed for both fabrication mold methods to inspect the channel height of the chip that plays a critical role in the labeling process. The fabricated microfluidic chip shows a good reproducibility and repeatability of the performance for the optimized channel height of 150 µm. The spiked proteins of c-Fn and MMP9 in the human serum-based matrix, were successfully labeled by the functionalized magnetic nanoparticles (MNPs). The biomarker labeling occurring in the serum was compared using a simple matrix sample: phosphate buffer. The measured signals obtained by using a magnetoresistive (MR) biochip platform showed that the labeling using the proposed microfluidic chip is in good agreement for both matrixes, i.e., the analytical performance (sensitivity) obtained with the serum, near the relevant cutoff values, is within the uncertainty of the measurements obtained with a simple and more controlled matrix: phosphate buffer. This finding is promising for stroke patient stratification where these biomarkers are found at high concentrations in the serum.