Cura por vacío (VAC), a propósito de un caso en Atención Primaria / Vacuum assisted closure (VAC), about a case in primary care

El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

Inflammatory cloacogenic polyp: differential diagnose with endoscopic malignant lesions.

Inflammatory cloacogenic polyp is an unusual anorectal lesion associated with benign polyp with malignant appearance. This pathology is associated with mucosal prolapse syndrome and inflammatory intestinal disease. The surgery is the gold standard treatment if malignancy cannot be excluded or the patient is symptomatic.

Study protocol of a proposed Neurofeedback-Assisted Mindfulness Training Program on symptoms of anxiety and psychological distress associated with smartphone use in young adults: a randomized controlled trial.

Background: Nomophobia is a specific phobia characterized by the appearance of anxiety, nervousness, discomfort and distress when the mobile phone is not used and is considered an emerging public health problem because of the negative consequences on the physical and mental health of young people and adolescents, especially women. Neurofeedback-Assisted Mindfulness Training Programs may prove beneficials for improving self-control abilities, a key ability in addressing addictive behaviors. The main objective of this study is to evaluate the impact, in a young population aged 18-35 years, of an intervention based on Neurofeedback-Assisted Mindfulness Training Program (NAMTP) on disorders associated with problematic use of mobile phones. The effect of the intervention on the total score in the nomophobia test and habits of internet and social network use, as well as on signs of depression, anxiety and stress will be analyzed. As a secondary objective, the effect of the intervention on signs of insomnia will be analyzed. Methods and design: Randomized, controlled clinical-trial with two-parallel groups. 40 young adults (18-35 years) will be included and randomly assigned to Intervention Group-NAMTP or Control Group (CG). The NAMTP will include a total of 25 sessions (2-3/week) during 3-months. Each session will have a duration of 10/15 min. The instrument to be used for the neurofeedback sessions is MUSE® (InteraXon Inc.). Study variables will be collected at the baseline visit and at the final visit (3-months after randomization). During these visits, questionnaires will be administered to evaluate the main and secondary variables that will include the Smartphone Addiction Scale-Short Version, Nomophobia Questionnaire, Depression, Anxiety and Stress Scale 21-item (DASS-21) and Athens Insomnia Scale. Discussion: This trial will make an important contribution to the need for evidence of effective education programs and other primary care interventions through new non-invasive interventions in reducing the risk of developing addictions to new technologies and alleviating the symptoms of discomfort associated with this problem. Ethics and dissemination: The project was approved by the Clinical Research Ethics Committee of the Salamanca Health Area (CEIm Code: PI 2023 071340). Clinical trial registration: ClinicalTrials.gov, http://www.Clinicaltrials.gov/ct2/show/NCT06188910.

Melanoma Breslow Thickness Classification using Ensemble-based Knowledge Distillation with Semi-supervised Convolutional Neural Networks.

Melanoma is considered a global public health challenge and is responsible for more than 90% deaths related to skin cancer. Although the diagnosis of early melanoma is the main goal of dermoscopy, the discrimination between dermoscopic images of in situ and invasive melanomas can be a difficult task even for experienced dermatologists. Recent advances in artificial intelligence in the field of medical image analysis show that its application to dermoscopy with the aim of supporting and providing a second opinion to the medical expert could be of great interest. In this work, four datasets from different sources were used to train and evaluate deep learning models on in situ versus invasive melanoma classification and on Breslow thickness prediction. Supervised learning and semi-supervised learning using a multi-teacher ensemble knowledge distillation approach were considered and evaluated using a stratified 5-fold cross-validation scheme. The best models achieved AUCs of 0.6186 ±0.0410 and of 0.7501 ±0.0674 on the former and latter classification tasks, respectively. The best results were obtained using semi-supervised learning, with the best model achieving 0.7751 and 0.8164 AUC, respectively. The results obtained show that semi-supervised learning could improve the performance of trained models in different melanoma classification tasks compared to supervised learning. Automatic deep learning-based diagnosis systems could support medical professionals in their decision, serving as a second opinion or as a triage tool for medical centers.

Hybrid Class Balancing Approach for Chemical Compound Toxicity Prediction.

INTRODUCTION: Computational methods are crucial for efficient and cost-effective drug toxicity prediction. Unfortunately, the data used for prediction is often imbalanced, resulting in biased models that favor the majority class. This paper proposes an approach to apply a hybrid class balancing technique and evaluate its performance on computational models for toxicity prediction in Tox21 datasets. METHODS: The process begins by converting chemical compound data structures (SMILES strings) from various bioassay datasets into molecular descriptors that can be processed by algorithms. Subsequently, Undersampling and Oversampling techniques are applied in two different schemes on the training data. In the first scheme (Individual), only one balancing technique (Oversampling or Undersampling) is used. In the second scheme (Hybrid), the training data is divided according to a ratio (e.g., 90-10), applying a different balancing technique to each proportion. We considered eight resampling techniques (four Oversampling and four Undersampling), six molecular descriptors (based on MACCS, ECFP, and Mordred), and five classification models (KNN, MLP, RF, XGB and SVM) over 10 bioassay datasets to determine the configurations that yield the best performance. RESULTS: We defined three testing scenarios: without balancing techniques (baseline), Individual, and Hybrid. We found that using the ENN technique in the MACCS-MLP combination resulted in a 10.01% improvement in performance. The increase for ECFP6-2048 was 16.47% after incorporating a combination of the SMOTE (10%) and RUS (90%) techniques. Meanwhile, using the same combination of techniques, MORDRED-XGB showed the most significant increase in performance, achieving a 22.62% improvement. CONCLUSION: Integrating any of the class balancing schemes resulted in a minimum of 10.01% improvement in prediction performance compared to the best baseline configuration. In this study, Undersampling techniques were more appropriate due to the significant overlap among samples. By eliminating specific samples from the predominant class that are close to the minority class, this overlap is greatly reduced.

Single inhaler combination inhaled corticosteroid-formoterol as both maintenance and reliever (SMART) compared with a step up of treatment with fixed-dose inhaled corticosteroid-long-acting ß2-agonist maintenance with a short-acting ß2-agonist as reliever in adolescents and adults with poorly controlled asthma In Colombia: a cost-utility analysis.

OBJECTIVE: The aim of the present study was to determine the cost-utility of single inhaler combination inhaled corticosteroid and a long-acting ß2-agonist (ICS/LABAs) as both maintenance and reliever (SMART) compared with a step-up maintenance treatment with a fixed medium to high dose of ICS combined with LABA and a short-acting ß2-agonist (SABA) as reliever (ICS-LABA maintenance plus SABA) among patients aged 12 years or more with poorly controlled asthma in Colombia. METHODS: A Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The main effectiveness data were obtained from a recent meta-analysis. The main outcome was the variable ''quality-adjusted life-years'' (QALYs). RESULTS: The base-case analysis showed that the budesonide/formoterol (BUD/FORM) SMART strategy was associated with lower overall treatment costs (US $3,062.37 vs. $4,462.02 average cost per patient over 12 months) and the greatest gain in QALYs (0.8511 vs. 0.8258 QALYs on average per patient over 12 months) compared with ICS-LABA maintenance plus SABA at step 4, thus leading to dominance. CONCLUSIONS: In patients aged 12 years or more with uncontrolled asthma at GINA step 3 or 4, the BUD/FORM SMART strategy at either step 3 or 4 is cost-effective compared with the ICS-LABA maintenance plus SABA at step 4 strategy, because it shows a greater gain in QALYs at lower total treatment costs.

Efficacy and safety of Janus kinase inhibitors in non-infectious inflammatory ocular diseases: a prospective cohort study from the international AIDA network registries.

Introduction: Non-infectious inflammatory ocular diseases pose significant challenges in diagnosis and management, often requiring systemic immunosuppressive therapy. Since Janus kinase (JAK) inhibitors may represent a novel therapeutic option for these disorders, the present study aimed to expand current knowledge about their efficacy and safety in patients with these conditions. Methods: This prospective cohort study included 12 adult patients from the international AutoInflammatory Disease Alliance (AIDA) Network registries dedicated to non-infectious ocular inflammatory conditions. We assessed ocular flares, visual acuity, disease course, and complications before and after initiating JAK inhibitor therapy. Results: Ocular inflammation was related to a systemic disease in 8 (66.7%) patients as follows: spondyloarthritis (n = 3), peripheral psoriatic arthritis (n = 1), rheumatoid arthritis (n = 1), antinuclear antibodies (ANA) positive juvenile idiopathic arthritis (n = 1), Behçet's syndrome (n = 1), Vogt-Koyanagi-Harada syndrome (n = 1). In total, 4 patients received baricitinib, 1 patient received tofacitinib, and 7 patients underwent upadacitinib treatment. The overall average duration of JAK inhibitors treatment was 8.6 ± 5.5 months (ranging from 3 to 20 months). At the last assessment, ocular disease control was complete in 12/12 patients. One patient discontinued baricitinib due to poor compliance after a 12-month relapse-free period. The incidence of ocular flares was 125 episodes/1.000 person-months prior to the initiation of JAK inhibitors and 28.6 episodes/1.000 person-months thereafter. The incidence rate ratio for experiencing a relapse before starting a JAK inhibitor compared to the following period was 4.37 (95% CI 1.3-14.7, p-value: 0.02). Conclusion: JAK inhibitors demonstrate efficacy and safety in controlling ocular inflammatory relapses, confirming that they represent a valuable treatment option for patients with non-infectious inflammatory ocular diseases resistant to conventional treatments.

Early Readmission and Revision After Total Joint Arthroplasty: An Analysis of Cause and Cost.

Background: Bundled payments for total joint arthroplasty (TJA) were instituted by the Centers for Medicare and Medicaid Services (CMS) to reimburse providers a lump sum for operative and 90-day postoperative costs. Gaining a better understanding of which TJA patients are at risk for early return to the operating room (OR) is critical in preoperative optimization of those with modifiable risks, which could improve bundled-payment performance. Purpose: We sought to identify the most common reason for readmissions, as well as patient characteristics and costs, associated with early return to the OR among TJA patients. Methods: This was a retrospective cohort study of Medicare patients who had undergone primary total hip or knee arthroplasty (THA or TKA) between 2013 and 2018 at a tertiary care hospital. We used the CMS research identifiable files database to identify the most common reasons for readmissions and revisions within 90 days of surgery. Total billing claims were used to determine the cost of early readmissions and revisions. Multivariate regression analysis was used to determine the characteristics associated with early readmission or revision. Results: Out of 20 166 primary TJA patients identified, we found 1349 readmissions (5.6%) and 163 (0.8%) revisions within 90 days of surgery. Dislocation was the most common indication for readmission, and periprosthetic joint infection was the most common indication for revision. Early return to the OR was associated with a mean $105,988 (standard deviation [SD] = $76,865) in CMS claims for the inpatient stay. Factors associated with a higher risk of early reoperation were female sex, THA, longer length of stay, and discharge to long-term care facility. Conclusions: This retrospective cohort study found that early return to the OR after TJA increased overall 90-day costs by 260%, suggesting that early reoperation might have a significant impact on bundled payments. Further study is warranted.

5q14.3 Microdeletion Syndrome With Simultaneous Involvement of MEF2C and RASA1. Clinical Case and Review of the Literature.

5q14.3 microdeletion syndrome is a rare condition involving multiple genes such as MEF2C and RASA1 and is potentially classified as a neurocutaneous syndrome. Deletion of the MEF2C gene accounts for the majority of clinical manifestations, including global developmental delay, intellectual disability, seizures, and behavioral disorders. RASA1 deletion is linked to capillary malformations with arteriovenous malformations (CM-AVM). Until now, only 17 cases have been described with deletions of both genes. We present the first case described in Spain with the microdeletion in the 5q14.3 cytoband simultaneously affecting both MEF2C and RASA1, exhibiting the typical manifestations of this entity, and review the published cases to date.

Is It Possible to Improve Performance in Competition After an Adductor Longus Injury in Professional Football Players?

CONTEXT: Adductor longus muscle strains are one of the most common injuries occurring in intermittent sports such as soccer. OBJECTIVE: The purpose of this study was to know the effect of a specific rehabilitation and reconditioning program, which was previously validated, after adductor longus injury in professional soccer players. METHODS: A specific rehabilitation and reconditioning program was applied to 11 injured male professional soccer players. PARTICIPANTS: Eleven male professional soccer players (age = 29.18 [4.45] y; height = 179.64 [4.97] cm; mass = 75.33 [3.84] kg). INTERVENTIONS: In the first place, the days taken to return to full team training and to return to competition (RTP) was analyzed; second, the most important performance parameters were analyzed and compared in the preinjury match (PRE) and after the return to competition at 2 different points in time (RTP1-RTP2). RESULTS: The return to full team training recorded was 11.91 (1.92) days and the RTP was 15.36 (3.04) days. Match performance parameters showed significant improvements after injury. Significant improvements were observed during RTP2, in the variables of high-speed running (P = .002), very high-speed running (P = .006), acceleration (>3 m/s2; P = .048), and high metabolic load distance (P = .009). CONCLUSION: The results allow us to conclude that this program was very effective, as it allowed the players to obtain similar and/or higher performance values in a reduced period of time after the injury.

Prognostic impact of muscle ultrasound-guided diagnosis of sarcopenia in older adults with severe aortic stenosis.

BACKGROUND: Muscle ultrasound is increasingly popular thanks to its advantages over other techniques. However, its usefulness in the diagnosis of sarcopenia in older adults with aortic stenosis (AS) has not been studied to date. OBJECTIVES: to analyze the prevalence of sarcopenia using muscle ultrasound and its impact on the health outcomes in older patients with AS. METHODS: The single-center FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry was used to study patients over 75 years with severe AS susceptible to valve replacement. Sarcopenia was suspected in those individuals with diminished grip strength, and the diagnosis was confirmed in the presence of reduced ultrasound quadriceps muscle thickness, following the recommendations of the EWGSOP2 (European-Working-Group-on-Sarcopenia-in-Older-People). The primary composite endpoint was urgent hospital admission and mortality of cardiac cause 6 months after the diagnosis. RESULTS: Of the 150 patients studied, 55.3% were females, and only 17.3% were frail; the mean age was 83.4 years. Sarcopenia was diagnosed in 42 patients (28%). The overall survival rate at 6 months was 92%. The primary endpoint was recorded in 23.2% of the cases and was more frequent in the sarcopenic patients (33.3%) than in the non-sarcopenic individuals (17.6%) (p = 0.01). The regression analysis found that sarcopenia was associated with an increased risk of the primary endpoint (HR: 2.25; 95% CI 1.19-4.45; p = 0.02), adjusting for potential confounding factors. CONCLUSIONS: The incidence of serious cardiac complications in older patients with sarcopenia and severe AS is significant. The present study describes a noninvasive, ultrasound-guided diagnostic technique that may prove efficient in its predictive capacity.

Peer Review Is Primary: Presentations, Publications, Promotions, and Practice.

Peer review is primarily thought of as the process used to determine whether manuscripts are published in medical or other academic journals. While a publication may be one outcome of peer review, this article shares a model of 4 Ps to remind faculty of some important additional applications of peer review. The 4 Ps are publication, presentation, promotion, and practice. The medical literature offers few reasons why faculty should get involved in peer review. In this article, we define peer review, illustrate the role of peer review in four important processes, describe how the volume of material to review has changed over time, and share how participation in these processes promotes career advancement. Understanding the peer review process and its benefits can encourage professionals to participate in peer review in any of the four Ps as they recognize the benefits to their discipline and their career.

Pharmacokinetic Pattern of Menbutone in Calves after Single Intravenous and Intramuscular Administration.

Menbutone is a choleretic agent currently used in Europe to treat digestive disorders in livestock and dogs. Pharmacokinetic parameters were established in 4-month Holstein calves after intravenous (IV) and intramuscular (IM) administration. The drug was administered to 12 animals (10 mg/kg) for both IV and IM routes following a crossover design. Plasma samples were collected at various time points over 24 h and analyzed by reverse-phase high-performance liquid chromatography with a photodiode-array detector, following a method validated according to European Medicines Agency guidelines. Pharmacokinetic parameters were calculated using compartmental and non-compartmental methods. Menbutone followed a two-compartment open model after IV injection, with a total clearance (Cl) of 71.9 ± 13.5 mL/h/kg, an elimination half-life (t½ß) of 4.53 ± 2.45 h, and a volume of distribution at steady-state (Vss) of 310.4 ± 106.4 mL/kg. Non-compartmental elimination half-life (t½λ) was 4.2 ± 1.1 h. After IM administration, drug pharmacokinetics was best described by a one-compartment open model. The peak plasma concentration (Cmax) was 15.1 ± 4.3 µg/mL; the time to reach Cmax (tmax), 1.66 ± 0.55 h; and the mean absorption time (MAT), 2.50 ± 1.42 h. Absorption was high, with a fraction of the dose absorbed (F) of 83.5 ± 22.4%. Menbutone was rapidly eliminated from plasma for both routes of administration, with a fast and high IM bioavailability.

Something lost, something gained: The trade-offs of Puerto Rican Hurricane Maria migrants.

In the aftermath of Hurricane María's devastating impact on Puerto Rico in September 2017, a wave of migration to the continental United States followed. Despite Puerto Rico's territorial association with the United States, its distinct culture and language often render its migrants as cultural minorities who are often treated as foreigners. Prior research has indicated that natural disasters can have a profound effect on the family unit, so examining the experiences of displacement and resettlement of Puerto Rican parents can shed light on the challenges faced by these families. Using cultural stress theory and psychological sense of community as guiding frameworks, this qualitative study aimed to explore the experience of Puerto Rican parents displaced to the United States following Hurricane María. A total of 42 Puerto Rican Hurricane María migrant parents agreed to participate in semistructured interviews. Our findings illuminate a trade-off in the lives of Puerto Rican migrants: As they departed their homeland, they exchanged social connections, support networks, and the vibrant social fabric of Puerto Rico for the promise of economic stability, reduced crime, and enhanced prospects for themselves and their children in the United States. This study represents a crucial contribution to the understanding of Puerto Ricans who have embarked on the challenging journey of relocating in the aftermath of Hurricane María. It underscores how they grapple with the multifaceted challenges and benefits inherent in their roles as cross-cultural climate migrants, transitioning from the predominantly Spanish-speaking, Latin American context of Puerto Rico to the diverse landscape of the United States. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Multiplexed Quantitative Proteomics Approach to the Human Plasma Protein Signature.

Despite the plasma proteome being able to provide a unique insight into the health and disease status of individuals, holding singular promise as a source of protein biomarkers that could be pivotal in the context of personalized medicine, only around 100 proteins covering a few human conditions have been approved as biomarkers by the US Food and Drug Administration (FDA) so far. Mass spectrometry (MS) currently has enormous potential for high-throughput analysis in clinical research; however, plasma proteomics remains challenging mainly due to the wide dynamic range of plasma protein abundances and the time-consuming procedures required. We applied a new MS-based multiplexed proteomics workflow to quantitate proteins, encompassing 67 FDA-approved biomarkers, in >1300 human plasma samples from a clinical cohort. Our results indicate that this workflow is suitable for large-scale clinical studies, showing good accuracy and reproducibility (coefficient of variation (CV) < 20 for 90% of the proteins). Furthermore, we identified plasma signature proteins (stable in time on an individual basis), stable proteins (exhibiting low biological variability and high temporal stability), and highly variable proteins (with low temporal stability) that can be used for personalized health monitoring and medicine.

Use of Milled Acanthocardia tuberculate Seashell as Fine Aggregate in Self-Compacting Mortars.

This study focuses on the feasibility of using ground Acanthocardia tuberculate seashells as fine aggregates for self-compacting mortar production. The obtained results show a promising future for coastal industries as their use eliminates waste products and improves the durability of these materials. The use of Acanthocardia tuberculate recycled aggregate, in terms of durability, improves the performance of all mixes made with seashells compared to those made with natural sand, although it decreases workability and slightly reduces mechanical strength. Proper mix design has beneficial effects, as it improves compressive strength, especially when the powder/sand ratio is 0.7. Three replacement ratios based on the volume (0%, 50%, and 100%) of natural limestone sand with recycled fine aggregate from Acanthocardia tuberculate seashells, and three different dosages modifying the powder/sand ratio (0.6, 0.7, and 0.8), were tested. The fresh-state properties of each self-compacting mixture were evaluated based on workability. The mineralogical phases of the hardened mixtures were characterised using X-ray diffraction, thermogravimetry, and differential analyses. Subsequently, the mechanical and durability properties were evaluated based on the compressive and flexural strengths, dry bulk density, accessible porosity for water and water absorption, drying shrinkage, mercury intrusion porosimetry, and water absorption by capillarity. Therefore, the use of Acanthocardia tuberculate seashells in cement-based systems contributes to circular economy.

The Fungicide Ipconazole Can Activate Mediators of Cellular Damage in Rat Brain Regions.

This study aimed to investigate the toxicity of the fungicide ipconazole on oxidative status, cell death and inflammasome complex activation in the hypothalamus, cerebral cortex, striatum and hippocampus of rats. Female albino rats were randomly divided into a control group and four groups treated with ipconazole at doses of 1, 5, 10 and 20 mg/kg b.w., administered for six days. Ipconazole significantly increased MDA and ROS levels in all brain regions studied, while reducing catalase enzyme activity. The molecular expression of cell death-related genes (AKT1, APAF1, BNIP3, CASP3 and BAX) and the inflammasome complex (CASP1, IL1ß, IL6, NLRP3, NFĸB and TNFα) was also assessed, showing increased expression in at least one brain region. The findings demonstrate that ipconazole induces central nervous system toxicity in mammals, highlighting its potential role as a risk factor in the development of neurodegenerative disorders in individuals exposed to this contaminant.

Associations between Urinary Phthalate Metabolites with BDNF and Behavioral Function among European Children from Five HBM4EU Aligned Studies.

Based on toxicological evidence, children's exposure to phthalates may contribute to altered neurodevelopment and abnormal regulation of brain-derived neurotrophic factor (BDNF). We analyzed data from five aligned studies of the Human Biomonitoring for Europe (HBM4EU) project. Ten phthalate metabolites and protein BDNF levels were measured in the urine samples of 1148 children aged 6-12 years from Italy (NACII-IT cohort), Slovakia (PCB-SK cohort), Hungary (InAirQ-HU cohort) and Norway (NEBII-NO). Serum BDNF was also available in 124 Slovenian children (CRP-SLO cohort). Children's total, externalizing and internalizing behavioral problems were assessed using the Child Behavior Checklist at 7 years of age (only available in the NACII-IT cohort). Adjusted linear and negative binomial regression models were fitted, together with weighted quantile sum (WQS) regression models to assess phthalate mixture associations. Results showed that, in boys but not girls of the NACII-IT cohort, each natural-log-unit increase in mono-n-butyl phthalate (MnBP) and Mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) was cross-sectionally associated with higher externalizing problems [incidence rate ratio (IRR): 1.20; 95% CI: 1.02, 1.42 and 1.26; 95% CI: 1.03, 1.55, respectively]. A suggestive mixture association with externalizing problems was also observed per each tertile mixture increase in the whole population (WQS-IRR = 1.15; 95% CI: 0.97, 1.36) and boys (IRR = 1.20; 95% CI: 0.96, 1.49). In NACII-IT, PCB-SK, InAirQ-HU and NEBII-NO cohorts together, urinary phthalate metabolites were strongly associated with higher urinary BDNF levels, with WQS regression confirming a mixture association in the whole population (percent change (PC) = 25.9%; 95% CI: 17.6, 34.7), in girls (PC = 18.6%; 95% CI: 7.92, 30.5) and mainly among boys (PC = 36.0%; 95% CI: 24.3, 48.9). Among CRP-SLO boys, each natural-log-unit increase in ∑DINCH concentration was associated with lower serum BDNF levels (PC: -8.8%; 95% CI: -16.7, -0.3). In the NACII-IT cohort, each natural-log-unit increase in urinary BDNF levels predicted worse internalizing scores among all children (IRR: 1.15; 95% CI: 1.00, 1.32). Results suggest that (1) children's exposure to di-n-butyl phthalate (DnBP) and di(2-ethylhexyl) phthalate (DEHP) metabolites is associated with more externalizing problems in boys, (2) higher exposure to DINCH may associate with lower systemic BDNF levels in boys, (3) higher phthalate exposure is associated with higher urinary BDNF concentrations (although caution is needed since the possibility of a "urine concentration bias" that could also explain these associations in noncausal terms was identified) and (4) higher urinary BDNF concentrations may predict internalizing problems. Given this is the first study to examine the relationship between phthalate metabolite exposure and BDNF biomarkers, future studies are needed to validate the observed associations.

From Methane to Methanol: Pd-iC-CeO2 Catalysts Engineered for High Selectivity via Mechanochemical Synthesis.

In the pursuit of selective conversion of methane directly to methanol in the liquid-phase, a common challenge is the concurrent formation of undesirable liquid oxygenates or combustion byproducts. However, we demonstrate that monometallic Pd-CeO2 catalysts, modified by carbon, created by a simple mechanochemical synthesis method exhibit 100% selectivity toward methanol at 75 °C, using hydrogen peroxide as oxidizing agent. The solvent free synthesis yields a distinctive Pd-iC-CeO2 interface, where interfacial carbon (iC) modulates metal-oxide interactions and facilitates tandem methane activation and peroxide decomposition, thus resulting in an exclusive methanol selectivity of 100% with a yield of 117 µmol/gcat at 75 °C. Notably, solvent interactions of H2O2 (aq) were found to be critical for methanol selectivity through a density functional theory (DFT)-simulated Eley-Rideal-like mechanism. This mechanism uniquely enables the direct conversion of methane into methanol via a solid-liquid-gas process.