Sex-Related Differences in Patient Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study.

Sex-specific factors are implicated in pulmonary embolism (PE) presentation in young patients, as indicated by increased risk in pregnancy. Whether sex differences exist in PE presentation, comorbidities, and symptomatology in older adults, the age group in which most PEs occur, remains unknown. We identified older adults (aged ≥65 years) with PE in a large international PE registry replete with information about relevant clinical characteristics (RIETE registry, 2001-2021). To provide national data from the United States, we assessed sex differences in clinical characteristics and risk factors of Medicare beneficiaries with PE (2001-2019). The majority of older adults with PE in RIETE (19,294/33,462, 57.7%) and in the Medicare database (551,492/948,823, 58.7%) were women. Compared with men, women with PE less frequently had atherosclerotic diseases, lung disease, cancer, or unprovoked PE, but more frequently had varicose veins, depression, prolonged immobility, or history of hormonal therapy (p < 0.001 for all). Women less often presented with chest pain (37.3 vs. 40.6%) or hemoptysis (2.4 vs. 5.6%) but more often with dyspnea (84.6 vs. 80.9%) (p < 0.001 for all). Measures of clot burden, PE risk stratification, and use of imaging modalities were comparable between women and men. PE is more common in elderly women than in men. Cancer and cardiovascular disease are more common in men, whereas transient provoking factors including trauma, immobility, or hormone therapy are more common in elderly women with PE. Whether such differences correlate with disparities in treatment or differences in short- or long-term clinical outcomes warrants further investigation.

Incorporating medication therapy management into community pharmacy workflows.

Medication Therapy Management (MTM) is a group of pharmacist-provided services that optimize individual patients' drug therapy outcomes. Since community pharmacies' primary business platform is the dispensing of medications, and providing MTM services is a secondary source of revenue, pharmacies with limited resources are operationally challenged when trying to efficiently deliver both types of services. To address this problem, we follow a queueing network approach to develop an operational model of a community pharmacy workflow. Through our model, we derive structural results to determine conditions for a pharmacy to achieve economies of scope when providing both prescription and MTM services. We also develop a process simulation to compare different scenarios according to our economies of scope model, varying in provided services, personnel, service demand, and other operational variables. Outcomes examined include profitability, service rate, and sensitivity of some operation variables to profitability. Based on our results, we provide practical insights to help community pharmacy administrators and healthcare policy makers in their decision process.

Bacterial diversity in six species of fresh edible seaweeds submitted to high pressure processing and long-term refrigerated storage.

Seaweeds are highly perishable foods due to their richness in nutrients. High pressure processing (HPP) has been applied for extending the shelf life of fresh seaweeds but there is no information on the effect of HPP on the bacterial diversity of seaweeds. The culturable bacteria of six species of fresh edible seaweeds (green seaweeds Codium fragile and Ulva lactuca, brown seaweeds Himanthalia elongata, Laminaria ochroleuca and Undaria pinnatifida, and red seaweed Chondrus crispus) were investigated and compared to those of HPP-treated (400 and 600 MPa for 5 min) seaweeds, at the start and end of their refrigerated storage period. A total of 523 and 506 bacterial isolates were respectively retrieved from untreated and HPP-treated seaweeds. Isolates from untreated seaweeds belonged to 18 orders, 35 families, 71 genera and 135 species whereas isolates from HPP-treated seaweeds belonged to 13 orders, 23 families, 43 genera and 103 species. HPP treatment significantly reduced the number of isolates belonging to 6 families and greatly increased the number of Bacillaceae isolates. At the end of storage, decreases in bacterial diversity at the genus and species level were observed for untreated as well as for HPP-treated seaweeds.

Microbiota of Iberian dry-cured ham as influenced by chemical composition, high pressure processing and prolonged refrigerated storage.

The effect of high pressure processing (HPP) on the microbiota of ripened Iberian ham of different water activity, salt concentration and intramuscular fat content was investigated before and after a 5-month refrigeration period. At the beginning of the refrigeration period, the only significant effects of chemical composition were those of water activity on psychrotrophs and Micrococcaceae in untreated hams, and of the salt-in-lean ratio on lactic acid bacteria in HPP-treated hams. At the end of the refrigeration period, the only significant effect was that of intramuscular fat content on moulds and yeasts in HPP-treated samples. All microbial groups were significantly affected by HPP, with reductions ranging from 1.7 to 2.0 log cycles after treatment. A significant recovery of all microbial groups took place in HPP-treated hams during the refrigeration period, with increases ranging from 0.5 to 1.1 log cycles. In spite of this recovery, microbial levels in HPP-treated hams remained significantly lower than in untreated hams. Staphylococcus accounted for 93.4% of Iberian ham bacterial isolates, with S. equorum as the most abundant species. Representatives of the Tetragenococcus, Carnobacterium and Streptomyces genera, not previously reported in dry-cured ham, were also isolated. Most of the yeast isolates (75.0%) were identified as Debaryomyces hansenii.

The microbiota of eight species of dehydrated edible seaweeds from North West Spain.

The microbiota of eight species (Chondrus crispus, Himanthalia elongata, Laminaria ochroleuca, Palmaria palmata, Porphyra umbilicalis, Saccharina latissima, Ulva lactuca and Undaria pinnatifida) of edible seaweeds collected in North West Spain, marketed as dehydrated product, was quantitatively determined on nine solid media. Representative colonies were selected from solid culture media. The isolated microorganisms were identified by means of morphological characteristics, 16S rDNA sequencing and biochemical tests. U. pinnatifida was the seaweed species showing the most abundant microbial population, with counts on Marine agar up to 7.7 log cfu/g in individual samples and 5.0 log cfu/g as the mean value, and counts of coliforms up to 4.6 log cfu/g in individual samples and 2.4 log cfu/g as the mean value. The 225 identified bacterial isolates belonged to 11 families, 27 genera and 56 species. Bacillaceae was the family accounting for the highest number of isolates (111) followed by Enterobacteriaceae (60), Bacillales Family XII Incertae Sedis (20), Planococcaceae (11), Moraxellaceae (7), Paenibacillaceae (5) and Pseudomonadaceae (5). Bacterial species showing the highest occurrence in dehydrated seaweeds were Bacillus megaterium, B. licheniformis, Pantoea sp. and termoresistant Pantoea sp. Four of the Bacillus species isolated from dehydrated seaweeds (B. cereus, B. licheniformis, B. pumilus and B. subtilis) are among those containing strains considered to be foodborne pathogens and nine of the isolated non-Bacillales bacterial species have been reported to contain human opportunistic pathogenic strains.

Benzoic acid and its derivatives as naturally occurring compounds in foods and as additives: Uses, exposure, and controversy.

Benzoic acid is an aromatic carboxylic acid naturally present in plant and animal tissues, which can also be produced by microorganisms. Benzoic acid and a wide range of derivatives and related benzenic compounds, such as salts, alkyl esters, parabens, benzyl alcohol, benzaldehyde, and benzoyl peroxide, are commonly used as antibacterial and antifungal preservatives and as flavoring agents in food, cosmetic, hygiene, and pharmaceutical products. As a result of their widespread occurrence, production, and uses, these compounds are largely distributed in the environment and found in water, soil, and air. Consequently, human exposure to them can be high, common, and lengthy. This review is mainly focused on the presence and use of benzoic acid in foods but it also covers the occurrence, uses, human exposure, metabolism, toxicology, analytical methods for detection, and legal limits for benzoic acid and its derivatives. Their controversial effects and potential public health concerns are discussed.

Multinucleated giant cell reaction in lower lip squamous cell carcinoma: a clinical, morphological, and immunohistochemical study.

BACKGROUND: Multinucleated giant cell (MGC) reactions have been identified in several malignancies, but their frequency and significance in lower lip squamous cell carcinoma (SCC) are not established. This study evaluated the MGC reactions and their association with clinicopathological parameters in lower lip SCCs. The polarization profile of these cells (M1 or M2 macrophages) was also assessed. METHODS: The presence and distribution of MGC reactions in high-power fields (400×) were evaluated in hematoxylin/eosin-stained histological sections of 91 lower lip SCCs. The histopathological grade of malignancy was evaluated using two grading systems (World Health Organization [WHO] and Malignancy Grading of the Deep Invasive Margins). The histiocytic nature (CD68) and polarization profile (M1-HLA-DR+ or M2-CD163+) of MGCs were evaluated by immunohistochemistry. RESULTS: Multinucleated giant cell reaction was identified in 36 (39.6%) cases, and its frequency was 3.3 times higher in well/moderately differentiated tumors than in poorly differentiated tumors (WHO grading system) (P = 0.006). For Malignancy Grading of the Deep Invasive Margins, the frequency was 2.03 times higher in highly/moderately keratinized tumors than in tumors with minimal/no keratinization (P = 0.012). No significant associations were observed between the presence/distribution of MGCs and clinical parameters (tumor size, lymph node metastasis, distant metastasis, and clinical stage) (P > 0.05). All MGCs were positive for CD68 and there was a predominance of HLA-DR+ over CD163+ MGCs (P = 0.031). CONCLUSIONS: Multinucleated giant cell reactions may not be involved in tumor progression in lower lip SCCs. In this microenvironment, MGCs tend to exhibit a predominantly M1 phenotype and may represent a foreign body reaction to SCC keratin pearls.

Comparison of Oral Health Status and the Quality of Life in Haemodialysis Patients with Less and More than Four Years of Treatment.

PURPOSE: To evaluate and compare the quality of life and oral health indicators in patients undergoing haemodialysis considering the influence treatment duration. MATERIALS AND METHODS: One hundred patients were divided into two groups according to the duration of haemodialysis: (1) < 4 years (n = 60) and (2) ≥ 4 years (n = 40). Clinical examination of the oral cavity was performed and QoL was assessed using a validated questionnaire. RESULTS: In comparison with group 2, statistically significantly higher mean scores were observed in group 1 in the quality of life domains of psychological (p = 0.003), social relationships (p ≤ 0.001) and environment (p = 0.013) as well as in total quality of life (p = 0.001) and general health (p = 0.010). Similarly, evaluation of the Simplified Oral Hygiene Index and the Decayed, Missing, Filled Teeth index demonstrated worse oral health for group 2 (p = 0.029; p = 0.012, respectively). For both groups, there was a negative correlation between these oral health indicators and psychological and social relationships domains, as well as with the total quality of life score. CONCLUSION: This study showed that poor oral health indicators may be a reflection of an unsatisfactory overall quality of life in patients undergoing haemodialysis for a prolonged period of time.

A new technique for analysis of human sperm morphology in unstained cells from raw semen.

Sperm morphology analysis is a fundamental component of semen analysis, but its real significance has been clouded by the plethora of techniques used for its evaluation. Most involve different fixation and staining procedures that induce artefacts. Herein we describe Trumorph (Proiser R+D, Paterna, Spain), a new method for sperm morphology analysis based on examination of wet preparations of spermatozoa immobilised, after a short 60°C shock, in narrow chambers and examined by negative phase contrast microscopy. A range of morphological forms was observed, similar to those found using conventional fixed and stained preparations, but other forms were also found, distinguishable only by the optics used. The ease of preparation makes the Trumorph a robust method applicable for the analysis of living unmodified spermatozoa in a range of situations. Subsequent studies on well-characterised samples are required to describe the morphology of spermatozoa with fertilising potential.

Infection as cause of immobility and occurrence of venous thromboembolism: analysis of 1635 medical cases from the RIETE registry.

Several risk assessment models include infection and immobility among the items to be considered for venous thromboembolism (VTE) prevention. However, information on patients with infection leading to immobility and developing VTE are limited, as well as on the role of specific types of infection. Data were collected from the worldwide RIETE registry, including patients with symptomatic objectively confirmed VTE, and followed-up for at least 3 months. The overall population of RIETE at June 2013 (n = 47,390) was considered. Acute infection leading to immobility was reported in 3.9 % of non-surgical patients. Compared with patients immobilized due to dementia, patients with infection had a shorter duration of immobilization prior to VTE (less than 4 weeks in 94.2 vs. 25.9 % of cases; p < 0.001). During the 3-month follow-up, VTE patients with infection versus those with dementia had a lower rate of fatal bleeding (0.5 vs. 1.1 %; p < 0.05) or fatal PE (1.7 vs. 3.5 %; p < 0.01). Patients with respiratory tract infections had more likely PE as initial VTE presentation than other types of infection (62.3 vs. 37.7 %; p < 0.001). Significantly more patients with pneumonia than those with other respiratory infections had received VTE prophylaxis (50.2 vs. 30.6 %; p < 0.001). Following VTE, patients with sepsis showed a significantly higher risk of fatal bleeding. Based on our real-world data, infection seems to contribute to the pathogenesis of VTE by accelerating the effects of immobility. Its role as VTE risk factor probably deserves further attention and specific assessment in order to optimize VTE prophylaxis and treatment.

Association of immunoexpression of the galectins-3 and -7 with histopathological and clinical parameters in oral squamous cell carcinoma in young patients.

An increasing incidence of oral squamous cell carcinoma (OSCC) in individuals younger than 45 years has been observed in recent years. OSCC in younger patients differs in terms of biological behavior and prognosis with the disease being more aggressive than in older patients. The aim of this study was to analyze the immunohistochemical expression of galectins-3 and -7 in 32 cases of OSCC in young patients and to correlate this expression with clinical and morphological parameters. All cases of OSCC of the sample were diagnosed at oncology referral hospitals in Paraíba, Brazil, between 2002 and 2012. Clinical data were obtained from the patient records. Histological malignancy grading systems proposed by Bryne et al. (J Pathol 166:375-381, 1992) and the World Health Organization (In: Pathology and genetics of head and neck tumours: Word Health Organization classification of tumours, 2005) were used for morphological analysis. Immunohistochemistry was performed by the streptavidin-biotin technique using anti-galectin-3 and -7 antibodies. The results were analyzed statistically by the Chi-squared and Fisher exact tests (p < 0.05). Immunoexpression of galectin-3 was observed in 65.6 % of the cases analyzed, but showed no significant association with any of the variables studied (clinical staging; histological malignancy grading systems). Immunoexpression of galectin-7 was observed in 96.9 % of cases and was significantly associated with histological malignancy grading systems (p < 0.05). In conclusion, the results suggest the use of galectin-7 as marker of biological behavior and tumor progression in OSCC in young patients.

Citrate versus acetate-based dialysate in on-line haemodiafiltration. A prospective cross-over study.

BACKGROUND AND AIMS: A bicarbonate dialysate acidified with citrate (CD) has been reported to have local anticoagulant effect and improves biocompatibility. This study examines the effect of CD on dialysis efficiency, coagulation, acid-base status, electrolytes, and inflammation in patients in on-line hemodiafiltration (OL-HDF). METHODS: 35 patients in OL-HDF were enrolled in a prospective, cross-over study for a 24-week period and two phases alternating CD and acetate dialysate fluid (AD). Parameters on study were predialysis levels of bicarbonate and ionic calcium, reactive C Protein (CRP), and beta-2 microglobulin (B2MG) and postdialysis levels of activated tromboplastine time, bicarbonate, and ionized calcium. RESULTS: No significant differences in coagulation parameters, pH, and predialysis bicarbonate were found. The postdialysis bicarbonate and postdialysis calcium were lower with CD. Dialysis efficiency was greater with CD. Regarding inflammatory parameters, both CRP and B2MG were lower using CD. CONCLUSION: The use of CD is safe and effective in OL-HDF, and it improves dialysis efficacy, postdialysis alkalosis, and inflammation.

A Complex Presentation of Vestibular Paroxysmia in an Adolescent With Wolff- Parkinson-White Syndrome.

Vestibular paroxysmia is an episodic vestibular disorder resulting from compression or irritation of the eighth cranial nerve. This disorder is a rare and difficult diagnosis in children. We report the case of a 16-year-old adolescent male with a history of syncope and coronavirus disease 2019 infection four months prior who presented with intermittent episodes of vertigo and unsteadiness several times a week. These events started abruptly, and he appeared frozen. However, he remained conscious and was able to answer questions. He subsequently resumed normal activity in less than a minute without seizure stigmata or postictal period. His general and neurological examinations were unremarkable. Extensive diagnostic evaluation yielded negative results, except for an electrocardiogram consistent with Wolff-Parkinson-White syndrome. However, his symptoms persisted after cardiac ablation, suggesting they were not related to this arrhythmia. Following unsuccessful trials with various medications, his symptoms resolved with carbamazepine. Early recognition and appropriate treatment of this condition could substantially improve the quality of life for affected individuals.

Intratarsal Keratinous Cyst Clinically Misdiagnosed as a Chalazion.

The intratarsal keratinous cyst (IKC) is a recently described entity, often clinically misdiagnosed as a chalazion. We report a case of a 61-year-old male patient with a chief complaint of a small lesion on the upper eyelid that evolved over six months. On physical examination, an asymptomatic, firm nodule was identified on the left upper eyelid. The patient reported no history of trauma. A provisional diagnosis of chalazion was established, and an excisional biopsy was performed. Histopathologically, the lesion was lined with a stratified squamous epithelium, with a corrugated epithelial surface showing abrupt keratinization without keratohyalin granules, and compact keratinous-appearing material in the cystic lumen. The diagnosis was IKC. No signs of recurrence were observed after one year of follow-up. It is essential to accurately diagnose IKC and distinguish it from chalazion and epidermal inclusion cysts, because IKC requires complete surgical excision and can exhibit multiple recurrences if not properly removed.

Reducing biogenic-amine-producing bacteria, decarboxylase activity, and biogenic amines in raw milk cheese by high-pressure treatments.

Biogenic amines may reach concentrations of public health concern in some cheeses. To minimize biogenic amine buildup in raw milk cheese, high-pressure treatments of 400 or 600 MPa for 5 min were applied on days 21 and 35 of ripening. On day 60, counts of lactic acid bacteria, enterococci, and lactobacilli were 1 to 2 log units lower in cheeses treated at 400 MPa and 4 to 6 log units lower in cheeses treated at 600 MPa than in control cheese. At that time, aminopeptidase activity was 16 to 75% lower in cheeses treated at 400 MPa and 56 to 81% lower in cheeses treated at 600 MPa than in control cheese, while the total free amino acid concentration was 35 to 53% higher in cheeses treated at 400 MPa and 3 to 15% higher in cheeses treated at 600 MPa, and decarboxylase activity was 86 to 96% lower in cheeses treated at 400 MPa and 93 to 100% lower in cheeses treated at 600 MPa. Tyramine, putrescine, and cadaverine were the most abundant amines in control cheese. The total biogenic amine concentration on day 60, which reached a maximum of 1.089 mg/g dry matter in control cheese, was 27 to 33% lower in cheeses treated at 400 MPa and 40 to 65% lower in cheeses treated at 600 MPa. On day 240, total biogenic amines attained a concentration of 3.690 mg/g dry matter in control cheese and contents 11 to 45% lower in cheeses treated at 400 MPa and 73 to 76% lower in cheeses treated at 600 MPa. Over 80% of the histidine and 95% of the tyrosine had been converted into histamine and tyramine in control cheese by day 60. Substrate depletion played an important role in the rate of biogenic amine buildup, becoming a limiting factor in the case of some amino acids.

Proteolysis, lipolysis, volatile compounds and sensory characteristics of Hispánico cheeses made using frozen curd from raw and pasteurized ewe milk.

Hispánico cheese, manufactured from a mixture of cow and ewe milk, is representative of cheese varieties made using milk from more than one animal species in Mediterranean countries. The shortage of ewe milk production in autumn hinders the uniformity of Hispánico cheese composition throughout the year. To surmount this inconvenience of ewe milk seasonality, curds made in spring from raw and pasteurized ewe milk were stored frozen and used four months later for the manufacture of Hispánico cheese. Experimental cheeses were made by mixing fresh curd from pasteurized cow milk with thawed curd from raw or pasteurized ewe milk, and control cheese from a mixture of pasteurized cow and ewe milk in the same proportion. Characteristics of experimental and control cheeses throughout a 60-d ripening period were investigated. On the one hand, the experimental cheese containing frozen curd from raw ewe milk showed the highest counts of staphylococci, Gram-negative bacteria and coliforms, the highest levels of aminopeptidase and esterase activity, and the highest concentrations of free amino acids, free fatty acids, alcohols and esters. On the other, the experimental cheese containing frozen curd from pasteurized ewe milk had concentrations of free amino acids, free fatty acids and volatile compounds similar to those of control cheese, with the only exception being a higher level of ketones. Flavour intensity reached the highest scores in the experimental cheese containing frozen curd from raw ewe milk, followed by the experimental cheese containing frozen curd from pasteurized ewe milk. Flavour quality scores of both experimental cheeses were similar, and lower than those of control cheese.

Machine learning algorithms to forecast air quality: a survey.

Air pollution is a risk factor for many diseases that can lead to death. Therefore, it is important to develop forecasting mechanisms that can be used by the authorities, so that they can anticipate measures when high concentrations of certain pollutants are expected in the near future. Machine Learning models, in particular, Deep Learning models, have been widely used to forecast air quality. In this paper we present a comprehensive review of the main contributions in the field during the period 2011-2021. We have searched the main scientific publications databases and, after a careful selection, we have considered a total of 155 papers. The papers are classified in terms of geographical distribution, predicted values, predictor variables, evaluation metrics and Machine Learning model.

Basal cell adenocarcinoma of the soft palate: A closer look for an exceedingly rare salivary gland tumor.

Basal cell adenocarcinoma (BCAd) is an extremely rare primary biphasic carcinoma of the salivary glands with few well-documented cases reported in the literature. Herein, we report a rare case of a 44-year-old male patient who presented an oral medicine service with an erythematous nodular lesion on the soft palate, measuring 1.5 cm in its largest diameter, with a 5-year duration. The clinical diagnosis was pleomorphic adenoma, and an excisional biopsy was performed. Histopathological analysis revealed a biphasic infiltrative tumor composed of a mixture of central ductal cells and abluminal basal cells with slight atypia arranged in solid, trabecular, tubular and cribriform growth patterns in a loose stroma. The peripheral cells show a palisading arrangement with round hyperchromatic nuclei and scanty cytoplasm. Occasional mitotic figures were seen. Few spindle-shaped cells suggestive of myoepithelial cells were present in the stroma surrounding the basaloid tumor nests. The diagnosis was BCAd. The patient was referred to a head and neck service and has been followed up for 8 months with no signs of recurrence. In conclusion, although the diagnosis of BCAd can be challenging due to its rarity and morphological overlap with other salivary gland lesions, a meticulous morphological assessment is key for accurate diagnosis, especially in cases originating from minor salivary glands. Surgical excision with a wide safety margin is the treatment of choice and long-term follow-up is recommended to monitor possible recurrences.

Immunoexpression of CXCL12 and CXCR4 in Radicular Cysts, Dentigerous Cysts, and Odontogenic Keratocysts.

The aim of this study was to evaluate the immunoexpression of chemokine CXCL12 and its receptor CXCR4 in radicular cysts (RCs), dentigerous cysts (DCs), and odontogenic keratocysts (OKCs), and to correlate the findings with morphologic parameters of RCs (inflammatory infiltrate and cystic epithelium). Twenty RCs, 20 DCs, and 20 OKCs were submitted to immunohistochemistry. The percentages of cytoplasmic (CXCL12 and CXCR4) and nuclear (CXCR4) staining in epithelial and fibrous capsule cells were determined. RCs and DCs exhibited higher epithelial expression of CXCL12 than OKCs ( P <0.05). The expression of CXCL12 in the fibrous capsule was higher in DCs than in RCs and OKCs ( P <0.05). Higher cytoplasmic expression of CXCR4 was observed in the epithelial lining and fibrous capsule of RCs and DCs compared with OKCs ( P <0.05). In the fibrous capsule, DCs exhibited higher nuclear expression of CXCR4 than OKCs ( P <0.05). No significant differences in the immunoexpression of CXCL12 or CXCR4 were observed according to the morphologic parameters of RCs ( P >0.05). Strong positive correlations were found between cytoplasmic and nuclear expression of CXCR4 in the epithelial lining of RCs and DCs and in the fibrous capsule of all groups ( P <0.05). The results suggest the participation of CXCL12 and CXCR4 in the pathogenesis of RCs, DCs, and OKCs. These proteins may be particularly relevant for the development of odontogenic cysts with less aggressive biological behavior, irrespective of their nature (inflammatory or developmental). In RCs, the expression of CXCL12 and CXCR4 may not be related to the intensity of the inflammatory infiltrate or the status of cystic epithelium.