Influence of the kinesiophobia and its pain intensity relationship in subjects with onychocryptosis.

Background: Onychocryptosis is a nail deformity that occurs when the side of the nail grows into soft tissue, which causes pain, sepsis and the formation of granulation. The aim of the study was to evaluate and compare different levels of kinesiophobia in subjects with onychocryptosis before and after surgery to eliminate this condition. Methods: A descriptive and observational study was conducted with a total sample size of 25 subjects with a mean age of 40.96 ± 18.25 years. The pretest sample was composed of the 25 subjects before the surgical treatment of onychocryptosis and the posttest sample was composed of the same 25 subjects after the surgical treatment of onychocryptosis. Kinesiophobia levels and total scores were self-reported using the Spanish version of the Tampa Scale for Kinesiophobia (TSK-11). Results: The Wilcoxon test for related samples and the Mann-Whitney U test for independent samples were used to compare the results before and after the surgical treatment. It was observed that in all the items as well as in the total score, there were significant changes in the levels of kinesiophobia, after the surgical intervention for onychocryptosis (P < 0.05) compared to the levels before surgery, except for items 4 and 11 in which there were no significant differences (P > 0.05). Before surgery, 0% of the subjects with onychocryptosis reported not being afraid of movement, 16% reported mild fear of movement, 8% reported moderate fear of movement and 76% of the subjects with onychocryptosis reported severe and maximum fear of movement. On the other hand, 100% of the subjects did not report kinesiophobia after surgical treatment (P < 0.01). Conclusions: The levels of kinesiophobia were higher in the subjects with onychocryptosis compared to the subjects after having undergone surgery to eliminate onychocryptosis.

Validation of a Clinical Scale for Early Detection of Infections at the Exit Site of Central Venous Catheters for Hemodialysis.

Introduction: Exit-site infections (ESI) of central venous catheters for hemodialysis (CVC-HD) has been associated with early catheter removal and an increased risk of CVC-HD related bacteremia. No specific clinical scales to predict ESI have previously been validated. Methods: A multicenter prospective cohort study was performed to validate the proposed scale, which is based on the following 5 signs and symptoms: (i) pain at exit site during interdialytic period; (ii) hyperemia or erythema ≥2 cm from exit site; (iii) inflammation, induration, or swelling at exit site; (iv) fever ≥38 °C not attributable to other causes, and (v) obvious abscess or purulent exudate at the exit site. Adult patients with a tunneled CVC-HD for at least 1 month after insertion has been included. During each hemodialysis session, the exit site was assessed with the proposed scale by nurses. If any item was present, a pericatheter skin swab culture was collected: positive results were gold standard. The scale was validated using receiver operating characteristic (ROC) curves and logistic regression analysis. For this purpose, the logit function was applied, and the ESI probability calculated, as elogit ESI/1 + elogit ESI. Results: Three hundred thirty-seven CVC-HDs from 310 patients were analyzed, producing 515 cultures (117 infected and 398 healthy). The final version of the scale includes the following 3 signs and symptoms, which present the greatest predictive capacity: (i) pain at exit site during interdialytic period, (ii) hyperemia or erythema ≥2 cm from exit site, and (iii) abscess or purulent exudate at the exit site. The final version generated an area under the ROC curve (AUC) of 88.3% (95% confidence interval [CI]: 85.2%-91%; P < 0.001), Youden index 0.7557 ≈ 1, sensitivity 80.34% (95% CI: 71.36%-87.71%) and specificity 95.23% (95% CI: 92.73%-97%). Conclusions: The validation shows that the scale has good predictive properties, detecting approximately 90% of ESI with very acceptable validity parameters.

Production of hypernuclei from antiproton capture within a relativistic transport model.

Production yields of single- Λ  hypernuclei from simulated peripheral annihilations of antiprotons after capture on various target nuclei are reported. The initial annihilation process and the production of excited hypernuclei are estimated within the GiBUU transport framework, while their deexcitation process is treated with the ABLA++ code. The yield of excited hypernuclei range from ∼ 0.3 % for 16 O to ∼ 1.2 % for 132 Xe per annihilation, consistent with previous measurements at LEAR, CERN. The yield of specific ground state hypernuclei after deexcitation reaches up to a few 10 - 4 per annihilation. The hypernuclei are produced in strangeness exchange reactions occuring between a nucleon of the target and the kaons originating from the annihilation in ∼ 80 % of the cases, while the strangeness pair production in secondary pion-nucleon collision contributes to the remaining ∼ 20 %. The simulations indicate that antiproton annihilations at rest on different nuclei could populate a wide range of so-far unexplored hypernuclei.

Microsurgical Clipping of a Ruptured Basilar Apex Aneurysm: Contending with a Formidable Clinical Scenario.

Basilar apex aneurysms (BAAs) represent 5%-8% of cerebral aneurysms.1-3 Treating BAAs is long established in neurosurgery.4-6 The morbid and lethal characteristics of aneurysmal subarachnoid hemorrhage coupled with potential medical complications of neurointensive care contribute to poor prognosis of patients with ruptured BAAs.7,8 A 58-year-old woman presented to the emergency department with a 1-day course of intense headaches that progressed to loss of consciousness. Noncontrast computed tomography of the head revealed extensive intraventricular hemorrhage (Fisher grade 4). Computed tomography angiography revealed an 8.7 × 6.3 mm wide-neck BAA. Preoperatively, she developed rebleeding and cerebral vasospasm and was transferred to the neurointensive care unit. After initial management and consideration of her clinical course and complex aneurysm features, she underwent a right frontotemporal craniotomy and anterior extradural clinoidectomy to perform aneurysm neck clipping (Video 1). Endovascular treatment was not considered, given that our facility belongs to a low-income public health system with limited availability of endovascular devices. Postoperatively, the patient developed cerebral vasospasm and pneumonia, which led to respiratory failure and death. BAAs are vascular entities that require arduous microsurgical treatment. Despite the increasing trend in managing these patients with endovascular treatment, the role of microsurgery is predominant in clinical settings with limited availability of alternative therapies. This clinical scenario requires neurosurgery trainees to achieve a high-level microsurgical skill set to provide optimal treatment. Nonetheless, the course of BAAs can still be poor even after adequate surgical management. This case exemplifies the burdensome nature of BAAs and the difficult clinical course of patients despite meticulous microsurgical management. Fisher grade 4, which is associated with a 31% risk of vasospasm, was a notable factor contributing to this outcome.7 Further, the patient's recovery was complicated by hospital-acquired pneumonia, which has a mortality rate of 9.7%.8 Accordingly, amid the emergent discipline of enhanced recovery after surgery, optimized protocols for postoperative management could benefit these patients.9-11.

A 6-month educational program improves sleep behaviour in community-dwelling frail older adults: A randomised controlled trial.

BACKGROUND: The prevalence of sleep-related issues among older adults is a significant concern, with half of the older population reporting these problems. Consequently, strategies to improve sleep are needed for this population. This study aims to assess the effects of a health educational program on sleep behaviour among pre-frail or frail older adults residing in the community and to explore possible associations with frailty. METHODS: This randomised controlled trial (NCT05610605) included a total of 197 community-dwelling older adults with frailty/pre-frailty, divided into control (n = 88) and educational (n = 109) groups, were assessed at baseline, after the 6-month educational program (6 months), and 6 months after the intervention (12 months). The intervention comprised four group sessions and six follow-up phone calls, focusing on frailty, physical activity, dietary habits, and cognitive training. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and wrist-worn accelerometry. RESULTS: At 6 months, a significant time-by-group interaction was found for self-reported [ß = -0.449, 95%CI (-0.844, -0.053), p = 0.026] and accelerometer-measured [ß = 0.505, 95%CI (0.085, 0.926), p = 0.019] sleep efficiency, showing improved sleep efficiency in the intervention group vs. controls. A significant time-by-group interaction at 6 months was noted for sleep awakenings [ß = -0.402, 95%CI (-0.825, -0.020), p = 0.047]. The educational program led to a significant decrease in awakenings, while the control group experienced an increase. The change in the number of awakenings (Rs = 0.183, p = 0.020) at 6 months was significantly associated with changes in frailty. Moreover, a significant time-by-group interaction was reported at the 12-month assessment [ß = -0.449, 95%CI (-0.844, -0.053), p = 0.026] for self-reported sleep quality, indicating better results in the intervention group compared to controls. CONCLUSION: The educational program improved sleep quality and sleep efficiency while reducing the number of awakenings per night among community-dwelling frail older adults, offering a practical approach to addressing sleep-related challenges in this demographic.

Artificial intelligence-assisted identification and retrieval of chronic hepatitis C patients lost to follow-up in the health area of Pontevedra and O Salnés (Spain).

OBJECTIVE: Direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV) infection offer an opportunity to eliminate the disease. This study aimed to identify and relink to care HCV patients previously lost to medical follow-up in the health area of Pontevedra and O Salnés (Spain) using an artificial intelligence-assisted system. PATIENTS AND METHODS: Active retrospective search of previously diagnosed HCV cases recorded in the Galician Health Service proprietary health information exchange database using the Herramientas para la EXplotación de la INformación (HEXIN) application. RESULTS AND CONCLUSIONS: Out of 99 lost patients identified, 64 (64.6%) were retrieved. Of these, 62 (96.88%) initiated DAA treatment and 54 patients (87.1%) achieved a sustained virological response. Mean time from HCV diagnosis was over 10 years. Main reasons for loss to follow-up were fear of possible adverse effects of treatment (30%) and mobility impediments (21%). Among the retrieved patients, almost one in three presented advanced liver fibrosis (F3) or cirrhosis (F4) at evaluation. In sum, HCV patients lost to follow-up can be retrieved by screening past laboratory records. This strategy promotes the achievement of HCV elimination goals.

Opportunistic population screening as a hepatitis elimination strategy: the CRIVALVIR-FOCUS program.

OBJECTIVES: Hepatitis B (HBV) and hepatitis C (HCV) viruses are significant causes of primary liver cancer, responsible for over a million deaths annually. We aimed to develop a screening strategy for viral hepatitis elimination in Spain, aligned with WHO's 2030 objectives. DESIGN: The CRIVALVIR-FOCUS program, conducted at the Consortium General University Hospital of Valencia, aimed to identify individuals with active blood-borne viral infections through opportunistic population screening. The hospital's Health Department serves more than 280,000 adults. RESULTS: Of the 31,995 adults screened (52% women; 15% immigrants), HBV prevalence was 0.44%, with higher rates in men (0.57%) than women (0.32%), and notably higher in migrants (1.27%) compared to Spanish nationals (0.30%). The 45-64 age group had the highest HBV prevalence (0.65%). HCV prevalence was 0.35%, again higher in men than women (0.51% vs 0.20%) and in migrants compared to Spanish nationals (0.58% vs 0.31%), with the 45-64 age group showing the highest HCV prevalence (0.76%). From the positive tests, 78.0% (110/141) of HBV cases and 71.4% (80/112) of HCV cases were patients previously unaware of their infections. CONCLUSION: Opportunistic screening effectively identifies early cases, potentially enhancing prevention of new infections. Our study highlights the need for targeted interventions for individuals aged 45-64 and migrants. Designing specific screening programs, in collaboration with social workers and cultural mediators, is critical to improve access to care. Training and involving primary care professionals are vital actions for the program's success.

Sinusoidal Obstruction Syndrome/Veno-Occlusive Disease after Unmanipulated Haploidentical Hematopoietic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide: A Study on Behalf of the Spanish Hematopoietic Stem Cell Transplantation and Cellular Therapy Group (GETH).

Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication after both autologous and allogeneic hematopoietic stem cell transplantation (HSCT). However, its characterization after haploidentical HSCT (haplo-HSCT) with post-transplantation cyclophosphamide (PT-Cy) is scarce. This study aimed to describe characteristics and outcomes of patients with SOS/VOD after haplo-HSCT with PT-Cy. We conducted a retrospective study of 797 patients undergoing a haplo-HSCT with PT-Cy between 2007 and 2019 in 9 centers in Spain. SOS/VOD was defined according to modified Seattle, Baltimore, or revised European Society for Blood and Marrow Transplantation (EBMT) criteria. Severity was graded retrospectively according to revised EBMT severity criteria into 4 categories: mild, moderate, severe, and very severe. From a total of 797 haplo-HSCTs performed, 46 patients (5.77%) were diagnosed with SOS/VOD at a median of 19 days (range, 4 to 84 days) after transplantation. Based on revised EBMT severity criteria, the SOS/VOD cases were classified as mild (n = 4; 8.7%), moderate (n = 10; 21.7%), severe (n = 12; 26.1%), and very severe (n = 20; 43.5%). Overall, 30 patients (65%) achieved SOS/VOD complete response, 25 (83%) of whom were treated with defibrotide. Twenty patients (43%) died before day +100 post-HSCT. Death was attributed to SOS/VOD in 11 patients, and 5 patients died of other causes without resolution of SOS/VOD. The incidence of SOS/VOD after haplo-HSCT with PT-Cy was comparable to those reported after HLA-identical HSCT series. Most of the patients developed very severe SOS/VOD according to revised EBMT severity criteria. Despite a promising SOS/VOD complete response (CR) rate (65%), 100-day mortality remained high (43%), indicating that further improvement in the management of this potentially fatal complication is needed.

When microsurgery becomes the only lifesaving resource: An institutional experience treating patients from low-income backgrounds affected by posterior circulation brain aneurysms.

BACKGROUND AND OBJECTIVE: Aneurysms of the posterior cerebral circulation constitute a burdensome condition with high mortality and morbidity. In the modern era, there has been a trend toward favoring an endovascular approach over microsurgery for aneurysm cases. Nevertheless, this transition has yet to be mirrored in low-to-middle-income countries where endovascular therapy may not be widely available. Herein, we aim to illustrate our experience treating these challenging conditions in patients from low-income backgrounds and discuss the relevance of the clinical setting in the treatment decision. METHODS: The authors conducted a retrospective review of the health records of patients who received microsurgical treatment for aneurysms in the posterior circulation, including the basilar artery (BA), posterior cerebral artery (PCA), and posterior inferior cerebellar artery (PICA) in an institution providing treatment to people of low-income backgrounds. Epidemiological data, microsurgical technique, and neurological function were retrieved and analyzed. RESULTS: Surgical clipping was employed for 12 patients (75% female) harboring 15 aneurysms (87% in the posterior circulation and 62% ruptured at presentation). Aneurysms were predominately located in the BA (69%), followed by the PCA (15%) and PICA (15%). Among neurological complications, 25% of patients developed oculomotor nerve palsy. The mortality rate was 17% owing to complications such as cerebral vasospasm, infarction, and severe intracranial hypertension. At the 6-month follow-up, 90% of patients had a good clinical outcome (modified Rankin scale scores of 0-2). CONCLUSION: The present case series illustrates the manifest role of microsurgical techniques for posterior circulation aneurysms, particularly in a scenario where endovascular techniques are not easily accessible. Importantly, this clinical setting pressure could exhort trainees to strive for microsurgical mastery and gain a competitive advantage.

Adenosine-assisted embolization of cerebral arteriovenous malformations: a systematic review and meta-analysis.

BACKGROUND: Cerebral arteriovenous malformations (AVMs) are complex lesions that can cause hemorrhagic stroke and significant neurological disability. Adenosine induces cardiac standstill and hypotension, which are thought to be useful during cerebral AVM embolization. Herein, we conducted a systematic review and meta-analysis of the technique's safety. METHODS: Following PRISMA guidelines, four databases were queried for studies describing the use of adenosine-assisted embolization of cerebral AVMs. Adenosine-related intraoperative complications, permanent neurological outcomes, morbidity, and mortality assessed the technique's safety. Single proportion analysis under a random-effects model was performed. Heterogeneity was assessed using I² statistics, and publication bias was evaluated through funnel plot analysis and Egger's regression test. RESULTS: Ten studies were included, involving 79 patients (55.7% male) with 79 AVMs (54.4% unruptured and 70.9% Spetzler-Martin grade III-V) who underwent 123 embolizations (80.4% and 5.9% under transarterial and transvenous approaches, respectively) with n-butyl cyanoacrylate (80.4%), ethylene vinyl alcohol (14.4%), or both (5.2%). The incidence of transient adenosine-related intraoperative complications was 0% (95% CI 0% to 3%, I2=24%). Besides, the incidence of adenosine-related morbidity, mortality, and permanent outcomes was 0% (95% CI 0% to 3%, I2=0%). During follow-up, good functional outcomes were reported for 64 patients (81%). CONCLUSIONS: Adenosine's effects on blood flow control can facilitate embolization and mitigate the risk of AVM rupture and embolic agent migration. Although current evidence stems from observational studies, the results of this meta-analysis suggest a safe drug profile due to minimal associated morbidity and mortality. Further research from larger randomized and controlled studies is warranted to attain a higher level of evidence. PROSPERO REGISTRY NUMBER: CRD42023494116.

The Art of Cerebral Revascularization: An Illustrative Case Series of Bypass Techniques for Complex Intracranial Aneurysms.

BACKGROUND: Complex intracranial aneurysms (CIAs) comprise a subset of lesions with defiant vascular architecture, difficult access, and prior treatment. Surgical management of CIAs is often challenging and demands an assessment on a case-by-case basis. The generational evolution of bypass surgery has offered a long-standing potential for effective cerebral revascularization. Herein, we aim to illustrate a single-center experience treating CIAs. METHODS: The authors conducted a retrospective analysis of clinical records of patients treated with cerebral revascularization techniques at Hospital Nacional Dos de Mayo, Lima, Peru, during 2018-2022. Relevant data were collected, including patient history, aneurysm features on imaging, preoperative complications, the intraoperative course, aneurysm occlusion rates, bypass patency, neurological function, and postoperative complications. RESULTS: Seventeen patients (70.59% female; median age: 53 years) with 17 CIAs (64.7% saccular; 76.5% ruptured) were included. The most common clinical presentation included loss of consciousness (70.6%) and headaches (58.8%). Microsurgical treatment included first-, second-, and third-generation bypass. In 47.1% of cases, an anastomosis between the superficial temporal artery and the M3 segment was predominantly used, followed by an A3-A3 bypass (29.4%), a superficial temporal artery-M2 bypass (17.6%), and an external carotid artery to M2 bypass (5.9%). The intraoperative aneurysm rupture rate was 11.8%. Postoperative complications included ischemia (40%), cerebrospinal fluid fistulas (26.7%), and pneumonia (20%). At hospital discharge, the median Glasgow Coma Scale score was 14 (range: 10-15). At the 6-month follow-up, 82.4% of patients had a modified Rankin Scale score ≤2, bypass patency was present in all cases, and the morbidity rate was 17.6%. CONCLUSIONS: CIAs represent a spectrum of defiant vascular lesions with a poor natural history. Bypass surgery offers the potential for definitive treatment. Our case series illustrated the predominant role of cerebral revascularization of CIAs with a critical case-by-case approach to provide optimal outcomes in a limited-resource setting.

Development of a scale to gain insight into the experience of living with chronic heart failure: The UNAV-Experience of Living with Chronic Heart Failure Scale.

BACKGROUND: To date, there are no tools for the nursing staff to gain systematic insight on the experience lived by patients with chronic heart failure. The objective of this study was to develop a scale for this purpose. METHODS: The study was conducted between January 2018 and December 2020 in three Spanish hospitals. The process described by DeVellis was used for the development of the scale. The items were built based on a phenomenological study and a systematic review of the literature. Next, feedback from a panel of experts was obtained, the scale was administered to a sample of patients with chronic heart failure, and a cognitive interview and an observational study were conducted to create the final version of the scale. RESULTS: The first version of the scale had in seven domains and 76 items. After its evaluation by a panel of experts, it was reduced to a second version with six domains and 55 items. Following the administration of Version 2 to 17 patients (58.8% male, mean age 59.53, 70.6% classified as NYHA functional class II), five items were modified and two eliminated. Thus, the third version of the UNAV-CHF Experience Scale was composed of six domains and 53 items. CONCLUSIONS: This study presents the development of the UNAV-experience of living with chronic heart failure scale. It is an original and novel instrument that allows systematically explore this experience. A larger-scale study is necessary to confirm the validity of our scale.

Toward a Frontierless Collaboration in Neurosurgery: A Systematic Review of Remote Augmented and Virtual Reality Technologies.

OBJECTIVE: Augmented reality (AR) and virtual reality (VR) technologies have been introduced to neurosurgery with the goal of improving the experience of human visualization. In recent years, the application of remote AR and VR has opened new horizons for neurosurgical collaboration across diverse domains of education and patient treatment. Herein, we aimed to systematically review the literature about the feasibility of this technology and discuss the technical aspects, current limitations, and future perspectives. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 4 databases (PubMed, Embase, Scopus, and Cochrane Library) were queried for articles discussing the use of remote AR and VR technologies in neurosurgery. Data were collected in various fields, including surgery type, application type, subspecialty, software and hardware descriptions, haptic device utilization, visualization technology, internet connection, remote site descriptions, technical outcomes, and limitations. Data were summarized as counts and proportions and analyzed using IBM SPSS software. RESULTS: Our search strategy generated 466 records, out of which 9 studies satisfied the inclusion criteria. The majority of AR and VR applications were used in cranial procedures (77.8%), mainly in education (63.6%), followed by telesurgical assistance (18.2%), patient monitoring (9.1%), and surgical planning (9.1%). Local collaborations were established in 55.6% of the studies, while national and international partnerships were formed in 44.4% of the studies. AR was the main visualization technology, and 3G internet connection was predominantly used (27.5%). All studies subjectively reported the utility of remote AR and VR for real-time interaction. The major technical challenges and limitations included audiovisual latency, the requirement for higher-fidelity and resolution image reconstructions, and the level of proficiency of the patient with the software. CONCLUSIONS: The results from this systematic review suggest that AR and VR technologies are dynamically advancing to offer remote collaboration in neurosurgery. Although still incipient in development and with an imperative need for technical improvement, remote AR and VR hold a frontierless potential for patient monitoring, neurosurgical education, and long-distance surgical assistance.

The Attitudinal Style and Its Potential for Hybridization with Other Pedagogical Models: A Narrative Review.

The 'Attitudinal Style' (AS) enhances the democratic and engaging learning process by improving student motivation and attitudes. Its adaptability, transferability, and applicability make it suitable for hybridization with other pedagogical models (PMs). This study explores the possibilities of blending AS with other PMs for classroom applications, emphasizing the use of formative and shared assessments to maximize efficiency. Adopting a Narrative Review methodology, the research delves into ten academic databases, identifying seven publications that meet the inclusion criteria for a detailed analysis. These publications propose pedagogical approaches for sports, body expression, natural environments, and physical conditioning. They highlight the potential of integrating AS with other PMs to not only enrich physical education (PE) experiences but also introduce innovative teaching methods for various physical activities. The evidence from these sources suggests that combining AS with other PMs serves as a robust strategy to enhance the overall educational experience in PE.

Affectation of COVID-19 pandemic on the use and abundance of wild resources in Tabasco, Mexico: A qualitative assessment.

Southern Mexico is particularly rich in natural resources, yet unemployment has risen to 8% during the COVID-19 pandemic. The effect of the pandemic on the use and abundance of Tabasco's wild resources was examined through personal surveys. By using Microsoft Forms® with cell phones 1,963 surveys were collected. Cronbach's alpha, Z-value, and chi2 were calculated using the MAXQDA Analytics Pro program. A higher abundance of wild resources before the pandemic than today (57% vs. 11%) was observed. During the pandemic, people referred more to a high use (28%) of resources than to a low use (20%). This caused the low abundance or scarcity of wild products to be greater during the pandemic than before the pandemic (43% vs. 4%). Wild foods and timber were the most used products. The pandemic has produced a greater use of natural resources probably due to the high unemployment rate in rural areas. Future studies of wild products should address the relevant products in the locality and their even sampling. Finding suitable respondents is highly recommended.

Development of Glycyrrhizinic Acid-Based Lipid Nanoparticle (LNP-GA) as An Adjuvant That Improves the Immune Response to Porcine Epidemic Diarrhea Virus Spike Recombinant Protein.

Porcine epidemic diarrhea virus (PEDV) has affected the pork industry worldwide and during outbreaks the mortality of piglets has reached 100%. Lipid nanocarriers are commonly used in the development of immunostimulatory particles due to their biocompatibility and slow-release delivery properties. In this study, we developed a lipid nanoparticle (LNP) complex based on glycyrrhizinic acid (GA) and tested its efficacy as an adjuvant in mice immunized with the recombinant N-terminal domain (NTD) of porcine epidemic diarrhea virus (PEDV) spike (S) protein (rNTD-S). The dispersion stability analysis (Z-potential -27.6 mV) confirmed the size and charge stability of the LNP-GA, demonstrating that the particles were homogeneously dispersed and strongly anionic, which favors nanoparticles binding with the rNTD-S protein, which showed a slightly positive charge (2.11 mV) by in silico analysis. TEM image of LNP-GA revealed nanostructures with a spherical-bilayer lipid vesicle (~100 nm). The immunogenicity of the LNP-GA-rNTD-S complex induced an efficient humoral response 14 days after the first immunization (p < 0.05) as well as an influence on the cellular immune response by decreasing serum TNF-α and IL-1ß concentrations, which was associated with an anti-inflammatory effect.

First-generation bypass surgery for a giant fusiform aneurysm of the middle cerebral artery: an illustrative case and surgical video.

Giant fusiform aneurysms of the middle cerebral artery (MCA) are complex and rare vascular lesions with a poor natural history and challenging treatment decision-making. We report the case of a 46-year-old male with a history of chronic hypertension and a transient ischemic attack who presented with left-sided hemiparesis. A cerebral angiotomography revealed an unruptured giant fusiform aneurysm in the M2 segment of the right MCA. After carefully evaluating the procedure's risks and benefits with the patient, he underwent a low-flow bypass surgery. An anastomosis between the superficial temporal artery and the M3 segment was performed with proximal clipping of the M2 segment. The postoperative course was uneventful, with preserved bypass patency. At follow-up, the patient was neurologically intact. This report illustrates the nuances and operative techniques for treating a giant fusiform aneurysm of the M2 segment that accounted for a preserved bypass patency and optimal patient neurological recovery.

High-Throughput Prediction of the Thermal and Electronic Transport Properties of Large Physical and Chemical Spaces Accelerated by Machine Learning: Charting the ZT of Binary Skutterudites.

Thermal and electronic transport properties are the keys to many technological applications of materials. Thermoelectric, TE, materials can be considered a singular case in which not only one but three different transport properties are combined to describe their performance through their TE figure of merit, ZT. Despite the availability of high-throughput experimental techniques, synthesizing, characterizing, and measuring the properties of samples with numerous variables affecting ZT are not a cost- or time-efficient approach to lead this strategy. The significance of computational materials science in discovering new TE materials has been running in parallel to the development of new frameworks and methodologies to compute the electron and thermal transport properties linked to ZT. Nevertheless, the trade-off between computational cost and accuracy has hindered the reliable prediction of TE performance for large chemical spaces. In this work, we present for the first time the combination of new ab initio methodologies to predict transport properties with machine learning and a high-throughput framework to establish a solid foundation for the accurate prediction of thermal and electron transport properties. This strategy is applied to a whole family of materials, binary skutterudites, which are well-known as good TE candidates. Following this methodology, it is possible not only to connect ZT with the experimental synthetic (carrier concentration and grain size) and operando (temperature) variables but also to understand the physical and chemical phenomena that act as driving forces in the maximization of ZT for p-type and n-type binary skutterudites.

Microsurgery for brain aneurysms in an accessory A2 and basilar arteries: a rare case presentation and surgical video.

We present the case of a 58-year-old male with a 3-day history of sudden onset headache, loss of consciousness, and uncontrolled vomiting. The patient had 3/5 quadriparesis and a Glasgow coma scale (GCS) score of 8, which merited neurocritical intensive care. Brain imaging suggested the presence of two lesions: (i) a fusiform aneurysm of 12 × 7 mm in an accessory A2 artery of the anterior cerebral artery and (ii) an unruptured saccular aneurysm of 3.3 × 2.8 mm in the distal segment of the basilar artery. He was deemed a candidate for microsurgical management. Postoperatively, he had 4/5 quadriparesis, paresis of the right oculomotor nerve, and a GCS score of 13. A 3-month follow-up showed a significant improvement in neurological function with a score of 2 on the modified Rankin scale. The presented case illustrates the relevance of a nuanced acquaintance to operate in diseased anatomical variants and complex pathologies of narrow corridors.

Endovascular treatment of brain aneurysms under conscious sedation: a systematic review of procedural feasibility and safety.

Over the last decades, minimally invasive techniques have revolutionized the endovascular treatment (EVT) of brain aneurysms. In parallel, the development of conscious sedation (CS), a potentially less harmful anesthetic protocol than general anesthesia (GA), has led to the course optimization of surgeries, patient outcomes, and healthcare costs. Nevertheless, the feasibility and safety of EVT of brain aneurysms under CS have yet to be assessed thoroughly. Herein, we systematically reviewed the medical literature about this procedure. In accordance with the PRISMA guidelines, four databases (PubMed, EMBASE, SCOPUS, and Cochrane Library) were queried to identify articles describing the EVT of brain aneurysms under CS. Successful procedural completion, complete aneurysm occlusion outcomes, intraoperative complications, clinical outcomes, and mortality rates assessed the feasibility and safety. Our search strategy yielded 567 records, of which 11 articles were included in the qualitative synthesis. These studies entailed a total of 1142 patients (40.7% females), 1183 intracranial aneurysms (78.4% in the anterior circulation and 60.9% unruptured at presentation), and 1391 endovascular procedures (91.9% performed under CS). EVT modalities under CS included coiling alone (63.2%), flow diversion (17.7%), stent-assisted coiling (10.6%), stenting alone (6.5%), onyx embolization alone (1.7%), onyx + stenting (0.2%), and onyx + coiling (0.2%). CS was achieved by combining two or more anesthetics, such as midazolam, fentanyl, and remifentanil. Selection criteria for CS were heterogenous and included patients' history of pulmonary and cardiovascular diseases, outweighing the benefits of CS versus GA, a Hunt and Hess score of I-II, a median score of 3 in the American Society of Anesthesiology scale, and patient's compliance with elective CS. Procedures were deemed successful or achieving complete aneurysm occlusion in 88.1% and 9.4% of reported cases, respectively. Good clinical outcomes were described in 90.4% of patients with available data at follow-up (mean time: 10.7 months). The procedural complication rate was 16%, and the mortality rate was 2.8%. No complications or mortality were explicitly attributed to CS. On the other hand, procedure abortion and conversion from CS to GA were deemed necessary in 5% and 1% of cases, respectively. The present study highlights the feasibility of performing EVT of brain aneurysms under CS as an alternative anesthetic protocol to GA. However, the limited nature of observational studies, methodological quality, the predominant absence of a comparative GA group, and clinical data during follow-up restrict a conclusive statement about the safety of EVT under CS. Accordingly, further research endeavors are warranted toward a higher level of evidence that can be translated into surgical practice.