Etiopathogenesis of Psoriasis: Integration of Proposed Theories.

Psoriasis is a chronic inflammatory disease characterized by squamous and erythematous plaques on the skin and the involvement of the immune system. Global prevalence for psoriasis has been reported around 1-3% with a higher incidence in adults and similar proportions between men and women. The risk factors associated with psoriasis are both extrinsic and intrinsic, out of which a polygenic predisposition is a highlight out of the latter. Psoriasis etiology is not yet fully described, but several hypothesis have been proposed: 1) the autoimmunity hypothesis is based on the over-expression of antimicrobial peptides such as LL-37, the proteins ADAMTSL5, K17, and hsp27, or lipids synthesized by the PLA2G4D enzyme, all of which may serve as autoantigens to promote the differentiation of autoreactive lymphocytes T and unleash a chronic inflammatory response; 2) dysbiosis of skin microbiota hypothesis in psoriasis has gained relevance due to the observations of a loss of diversity and the participation of pathogenic bacteria such as Streptococcus spp. or Staphylococcus spp. the fungi Malassezia spp. or Candida spp. and the virus HPV, HCV, or HIV in psoriatic plaques; 3) the oxidative stress hypothesis, the most recent one, describes that the cell injury and the release of proinflammatory mediators and antimicrobial peptides that leads to activate of the Th1/Th17 axis observed in psoriasis is caused by a higher release of reactive oxygen species and the imbalance between oxidant and antioxidant mechanisms. This review aims to describe the mechanisms involved in the three hypotheses on the etiopathogeneses of psoriasis.

Do sport teams with greater team resilience perceive higher performance at the end of the season? A multilevel analysis.

A team's ability to respond positively to adversities, problems, and obstacles during their season is an essential part of success in collective sports. Grounded in team resilience theory and using a multilevel analytical approach, this study examined the relationship of the characteristics of resilience and vulnerability under pressure with perceived individual and team performance. Participants were 676 soccer players (530 males and 146 females) aged 15-42 years (M = 21.40, SD = 5.38), who played on 64 senior and under-18 soccer teams of several national leagues in Spain. In the final month of the season, factors related to team resilience and individual and team performance were analyzed. We estimated multilevel models by including perceived individual and team performance as dependent variables. Characteristics of resilience and vulnerability under pressure were considered as fixed and random effects (i.e., individual- and team-level intercepts and slopes). At the individual level, results showed that characteristics of resilience were positively associated with subjective individual and team performance, whereas vulnerability under pressure was negatively related to perceived team (but not individual) performance. At the team level, only characteristics of resilience positively predicted team performance. These findings suggest that more resilient teams report more successful performance from an individual and team perspective, whereas teams that are more vulnerable under pressure report poorer team performance. Taken together, the study underscores the importance of practitioners to develop strategies that improve their teams' resilience, given that team resilience helps to achieve positive subjective individual and team outcomes.

Effects of out-of-school physical activity interventions based on self-determination theory in children and adolescents: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to examine the effects of out-of-school physical activity (PA) interventions, based on Self-Determination Theory (SDT), on basic psychological needs (BPN), motivation toward PA, and PA levels in youths. DESIGN: Systematic review and meta-analyses. METHOD: We searched for intervention studies examining the effects of PA interventions based on SDT implemented outside the school published in English and Spanish in six electronic databases up to January 2022. RESULTS: Outcomes of interest were BPN, motivation, and PA levels. In total, nine studies were included in this review. Seven individual meta-analyses were conducted for each variable, revealing nonsignificant clustered effects for the outcomes autonomy satisfaction (g = 0.12, 95% CI [-0.31, 0.55]), competence satisfaction (g = 0.02, 95% CI [-0.28, 0.32]), relatedness satisfaction (g = 0.13, 95% CI [-0.43, 0.68]), autonomous motivation (g = 0.15, 95% CI [-0.38, 0.67]), controlled motivation (g = 0.12, 95% CI [-0.32, 0.55]), amotivation (g = -0.36, 95% CI [-0.88, 0.16]), and PA behavior (g = 0.02, 95% CI [-0.08, 0.12]). CONCLUSION: Meta-analyses suggest that out-of-school PA interventions based on SDT are not effective in increasing levels of needs satisfaction, types of motivation, and PA levels.

Is coaches' perceived team performance associated with their intentions to persist in coaching? The mediating role of coaches' psychological needs and motivation.

This study examined the association between team performance perceived by coaches, coaches' basic psychological needs, motivation, and their intentions to persist in coaching. Participants were 719 coaches (80 females, M = 33.49 years, SD = 10.27, range = 18-67) of different team sports (soccer = 514; basketball = 165; volleyball = 23; handball = 14; and hockey = 3) who completed questionnaire measures at the end of the season. Structural equation modelling adjusted for sex, coaches' experience, age categories, and type of sport revealed that coaches' perceptions of team performance were positively related to their need satisfaction and negatively to their need frustration. In turn, coaches' need satisfaction was positively associated with their autonomous motivation, whereas their need frustration was positively related to controlled motivation and amotivation. Finally, coaches' autonomous motivation was a positive predictor of their intentions to persist, and conversely, coaches' amotivation was a negative predictor of their intentions to persist. We found a significant positive and indirect effect between team performance perceived by coaches and their intention to persist through their need satisfaction and autonomous motivation. These findings represent the first quantitative insight into how coach-perceived team performance could function as a new antecedent relevant to coaches' motivational processes and persistence.

Teachers' Verbal and Nonverbal Communication, Students' Psychological Needs, and Positive and Negative Outcomes in Physical Education.

Focused on physical education (PE), this study examined the association between teachers' communication and students' psychological needs, enjoyment/boredom, PE usefulness, and students' grade perception. Participants were 1,000 students (572 girls; Mage = 14.58 ± 0.65) from 29 Spanish secondary schools. A path model including variables measured at three times was tested: teachers' verbal/nonverbal communication (Time 1), needs satisfaction/frustration (Time 2), and PE outcomes (Time 3). Verbal communication positively predicted needs satisfaction, which, in turn, positively predicted enjoyment, PE usefulness, and students' grade perception and negatively predicted boredom. Verbal communication negatively predicted needs frustration, which was a positive predictor of boredom. Multigroup analysis showed that gender did not moderate the associations in the path model, whereas mediating effects were found between teachers' communication and consequences via students' psychological needs. Teachers should improve their communicative capacities to satisfy students' psychological needs and promote positive PE  outcomes.

The Safety and Feasibility of Transesophageal Echocardiography in Patients With Esophageal Stricture.

OBJECTIVES: Expert guidelines consistently list esophageal stricture (ES) as a contraindication to the performance of transesophageal echocardiography (TEE), although anecdotally the authors are aware of patients with ES undergoing TEE without apparent complication. Therefore the authors sought to determine the outcomes of patients with ES who had undergone TEE at their institution. DESIGN: Single-center, retrospective review. SETTING: Academic medical center (clinic and affiliated hospital). PARTICIPANTS: Patients with documented ES who also underwent TEE. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In a 10-year period, 1,083 TEE reports were generated for 823 patients who had a diagnosis of ES. One case of esophageal perforation occurred (1/1,083 examination reports [0.09%]) in an 85-year-old male with gastroesophageal reflux disease-related ES who had undergone esophageal dilation the same day as the TEE. In 17.2% of the TEE reports reviewed, changes to the conduct of the examination occurred, such as use of a pediatric probe or avoidance of transgastric imaging. In 8% of reviewed examinations, procedural difficulty was recorded. CONCLUSIONS: Patients with nonmalignant ES commonly present for TEE (>100 per year, on average, at the authors' institution). Severe TEE-related esophageal injury rarely occurred in patients with ES. However, changes to the conduct of the TEE examination and procedural difficulty were not infrequent in this group. Clinicians contemplating TEE in patients with ES should prepare for the possibility of altered examination conduct and possible procedural difficulty.

Algorithm and Distributed Computing for the Internet of Things.

The ongoing generalization of Internet of Things and its presence and application in multiple fields is generating a large amount of data that can be used to extract knowledge, among other purposes. In this context, algorithmic techniques and efficient computer systems provide an opportunity to successfully address efficient data processing and intelligent data analysis. As a result, multiple services can be improved, resources can be optimized and real-world problems of interest can be solved. This Special Issue on Algorithm and Distributed Computing for the Internet of Things gives the opportunity to know recent advances in the application of modern technologies hardware and software to the Internet of Things.

Changes in Right Ventricle Function After Mitral Valve Repair Surgery.

BACKGROUND: Right ventricular (RV) dysfunction can occur after cardiac surgery and persist for years. We assessed perioperative RV systolic function in patients undergoing mitral valve (MV) repair and further compared minimally invasive robotic-assisted mitral valve repair (MIMVr) vs standard 'open' MV repair (MVr). Speckle tracking (RV free wall strain [RVS]) was used as a sensitive echocardiography method to assess RV function. METHODS: Retrospective analysis, over 3 years, of consecutive patients (n = 158) referred to Mayo Clinic (Rochester, MN, USA). Preoperative, pre-discharge and 1 year transthoracic echocardiograms were reviewed. A prospective pilot study was performed for sample size estimation. Primary outcome was RV free wall strain (RVS). RESULTS: Right ventricular free wall strain declined after MV repair surgery (-22.6 ± 7% vs -15 ± 6%, p < 0.001). There were smaller reductions in RVS in MIMVr vs MVr group (-6.0 ± 9% vs -10.3 ± 8%, p < 0.01), which persisted after adjusting for baseline values (RVS treatment effect 1.5%, p = 0.007). There was greater recovery in MIMVr vs MVr group at 1 year follow-up vs pre-surgery values (-3.4 ± 9% vs -8.1 ± 8% respectively, p < 0.001, RVS treatment effect 1.7%, p = 0.001). Bypass time was higher in the MIMVr group (80min ± 22 vs 40min ± 20, p < 0.0001). The echo findings remained significant correcting for age, pulmonary pressures and change in ejection fraction. CONCLUSIONS: Right ventricular systolic dysfunction is common after MV repair surgery. Deterioration in RV contraction is less pronounced following MIMVr vs MVr and is associated with enhanced RV functional recovery at 1 year, albeit not to preoperative levels. This may potentially be associated with clinical functional improvement but further studies are warranted to investigate this.

Toward a Robust Multi-Objective Metaheuristic for Solving the Relay Node Placement Problem in Wireless Sensor Networks.

During the last decade, Wireless sensor networks (WSNs) have attracted interest due to the excellent monitoring capabilities offered. However, WSNs present shortcomings, such as energy cost and reliability, which hinder real-world applications. As a solution, Relay Node (RN) deployment strategies could help to improve WSNs. This fact is known as the Relay Node Placement Problem (RNPP), which is an NP-hard optimization problem. This paper proposes to address two Multi-Objective (MO) formulations of the RNPP. The first one optimizes average energy cost and average sensitivity area. The second one optimizes the two previous objectives and network reliability. The authors propose to solve the two problems through a wide range of MO metaheuristics from the three main groups in the field: evolutionary algorithms, swarm intelligence algorithms, and trajectory algorithms. These algorithms are the Non-dominated Sorting Genetic Algorithm II (NSGA-II), Strength Pareto Evolutionary Algorithm 2 (SPEA2), Multi-Objective Evolutionary Algorithm based on Decomposition (MOEA/D), Multi-Objective Artificial Bee Colony (MO-ABC), Multi-Objective Firefly Algorithm (MO-FA), Multi-Objective Gravitational Search Algorithm (MO-GSA), and Multi-Objective Variable Neighbourhood Search Algorithm (MO-VNS). The results obtained are statistically analysed to determine if there is a robust metaheuristic to be recommended for solving the RNPP independently of the number of objectives.

Impact of New-Onset Left Ventricular Dysfunction on Outcomes in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock.

BACKGROUND:: Left ventricular systolic dysfunction (LVSD) and LV diastolic dysfunction (LVDD) are commonly seen in severe sepsis and septic shock; however, their role in patients with concurrent invasive mechanical ventilation (IMV) is less well defined. METHODS:: This was a prospective observational study on all patients admitted to all the intensive care units (ICUs) at Mayo Clinic, Rochester from August 2007 to January 2009. All adult patients with severe sepsis and septic shock and concurrent IMV without prior heart failure underwent transthoracic echocardiography within 24 hours. Patients with active pregnancy, prior congenital or valvular heart disease, and prosthetic cardiac valves were excluded. Left ventricular systolic dysfunction was defined as LV ejection fraction (LVEF) <50% and LVDD as E/e' >15. Primary outcome was hospital mortality, and secondary outcomes included IMV duration, ICU length of stay (LOS), and total LOS. Two-tailed P value of <.05 was considered statistically significant. RESULTS:: In a total of 106 patients, 58 (54.7%) met our inclusion criteria, with 17 (29.3%), 11 (19.0%), and 5 (8.6%) having LVSD, LVDD, and both, respectively. The cohorts with and without LVSD and LVDD did not differ significantly in their baseline characteristics and laboratory and ventilatory parameters. Compared to those without LVSD, patients with LVSD had higher LV end-systolic diameters but were not different in their left atrial diameters or E/e' ratio. Patients with LVDD had a higher E velocity and E/e' ratio compared to those without LVDD. Hospital mortality was not different in patients with and without LVSD (8 [47%] vs 21 [51%], P = 1.00) and LVDD (8 [73%] vs 21 [45%], P = .18). Secondary outcomes were not different between the 2 groups. CONCLUSION:: Left ventricular systolic or diastolic dysfunction did not influence in-hospital outcomes in patients with severe sepsis and septic shock and concurrent IMV.

Fine-grained parallelization of fitness functions in bioinformatics optimization problems: gene selection for cancer classification and biclustering of gene expression data.

BACKGROUND: Metaheuristics are widely used to solve large combinatorial optimization problems in bioinformatics because of the huge set of possible solutions. Two representative problems are gene selection for cancer classification and biclustering of gene expression data. In most cases, these metaheuristics, as well as other non-linear techniques, apply a fitness function to each possible solution with a size-limited population, and that step involves higher latencies than other parts of the algorithms, which is the reason why the execution time of the applications will mainly depend on the execution time of the fitness function. In addition, it is usual to find floating-point arithmetic formulations for the fitness functions. This way, a careful parallelization of these functions using the reconfigurable hardware technology will accelerate the computation, specially if they are applied in parallel to several solutions of the population. RESULTS: A fine-grained parallelization of two floating-point fitness functions of different complexities and features involved in biclustering of gene expression data and gene selection for cancer classification allowed for obtaining higher speedups and power-reduced computation with regard to usual microprocessors. CONCLUSIONS: The results show better performances using reconfigurable hardware technology instead of usual microprocessors, in computing time and power consumption terms, not only because of the parallelization of the arithmetic operations, but also thanks to the concurrent fitness evaluation for several individuals of the population in the metaheuristic. This is a good basis for building accelerated and low-energy solutions for intensive computing scenarios.

Neuromonitoring, Cerebrospinal Fluid Drainage, and Selective Use of Iliofemoral Conduits to Minimize Risk of Spinal Cord Injury During Complex Endovascular Aortic Repair.

PURPOSE: To review outcomes of continuous motor/somatosensory-evoked potential (MEP/SSEP) monitoring, cerebrospinal fluid drainage, and selective use of iliofemoral conduits in patients undergoing endovascular repair of descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysms (TAAAs). METHODS: The clinical data of 49 patients (mean age 75±8 years; 38 men) who underwent endovascular repair of DTA and TAAAs (2011-2014) were reviewed. All patients had cerebrospinal fluid drainage, permissive hypertension (mean arterial pressure ≥80 mm Hg), and MEP/SSEP monitoring. There were 44 (90%) patients with TAAAs and 5 (10%) with DTA. Types I and II TAAAs were repaired in staged procedures. Iliofemoral conduits were used for small iliac arteries and to minimize time of lower extremity ischemia in patients with difficult anatomy. In patients with changes in MEP/SSEPs, a standardized protocol was employed to optimize spinal cord perfusion and restore lower extremity blood flow. Endpoints were mortality, spinal cord injury (SCI), and lower extremity ischemic complications. RESULTS: Sixteen (33%) patients had staged TAAA repair. A total of 163 visceral arteries were targeted by fenestrations and branches (mean 3.7±1.0 vessels/patient). Temporary iliofemoral conduits were used in 16 limbs/14 patients. A stable MEP/SSEP was achieved in all patients. Thirty-one (63%) patients had a ≥75% decrease in MEP/SSEP amplitude in 50 limbs starting on average 75±28 minutes after obtaining vascular access. MEP/SSEP amplitude improved with maneuvers in 12 (39%) patients and returned to baseline with restoration of lower extremity flow in all except 1 patient who developed immediate SCI. Thirty-day mortality was 4%. Three (6%) patients had SCI, 2 permanent and 1 temporary at 14 days. There were no lower extremity ischemic complications. CONCLUSION: Neuromonitoring predicted immediate SCI and allowed use of a protocol to optimize spinal cord and lower extremity perfusion during complex endovascular aortic repair. Larger clinical experience is needed to evaluate the efficacy of neuromonitoring to prevent SCI.

Posterior reversible encephalopathy syndrome from induced hypertension during endovascular thoracoabdominal aortic aneurysm repair.

Endovascular repair of thoracoabdominal aortic aneurysm has been increasingly performed using fenestrated and branched endografts. Spinal cord injury is a complication of complex endovascular aortic repair, especially in patients with extensive aortic involvement. Maneuvers commonly used to avoid spinal cord injury include cerebrospinal fluid drainage and induced hypertension. Posterior reversible encephalopathy syndrome is associated with abnormal cerebral autoregulation through endothelial and blood-brain barrier dysfunction; the pathophysiology involves vasogenic edema, and severe hypertension is a recognized trigger. We report on a patient who developed posterior reversible encephalopathy syndrome associated with induced hypertension used to prevent spinal cord injury during endovascular repair of a type II thoracoabdominal aortic aneurysm using fenestrated and branched stent grafts.

Endovascular Repair of Saccular Ascending Aortic Aneurysm After Orthotopic Heart Transplantation Using an Investigational Zenith Ascend Stent-Graft.

PURPOSE: To report the use of an investigational stent-graft to treat an ascending aortic aneurysm in a patient with a heart transplant. CASE REPORT: A 48-year-old man presented with a 3.5×1.5-cm saccular aneurysm in the mid anterior ascending aorta, abutting the sternum. The patient's history was notable for placement of a left ventricular assist device followed by orthotopic heart transplantation 2 years prior to treat end-stage familial dilated cardiomyopathy. Under compassionate use, a custom-designed ascending aortic stent-graft (Zenith Ascend) was successfully delivered via an 18-F system and deployed just distal to the origin of the left main coronary artery under pulmonary artery catheter-guided rapid ventricular pacing. The patient was discharged the next day, and 6-month follow-up was unremarkable. Imaging at 5 months showed an excluded aneurysm sac with no endoleak or migration. CONCLUSION: The ideal ascending aortic stent-graft should be low profile, conformable to the arch anatomy, with short tip delivery system and a stepwise deployment mechanism that allows precise placement relative to the ostia of the coronary arteries and the innominate artery. This case illustrates the advancement of endovascular techniques to the most challenging segment of the aorta to decrease morbidity and mortality in high-risk patients.

Standardized practice design with electronic support mechanisms for surgical process improvement: reducing mechanical ventilation time.

BACKGROUND: Hospital surgical care is complex and subject to unwarranted variation. OBJECTIVE: As part of a multiyear effort, we sought to reduce variability in intraoperative care and management of mechanical ventilation in cardiac surgery. We identified a patient population whose care could be standardized and implemented a protocol-based practice model reinforced by electronic mechanisms. METHODS: In a large cardiac surgery practice, we built a standardized practice model between 2009 and 2011. We compared mechanical ventilation time before (2008) and after (2012) implementation. To ensure groups were comparable, propensity analysis matched patients from the 2 operative years. RESULTS: In 2012, more than 50% of all cardiac surgical patients were managed with our standardized care model; of those, 769 were one-to-one matched with patients undergoing surgery in 2008. Patients had a mix of coronary artery bypass grafting, valve surgery, and combined procedures. Our practice model reduced median mechanical ventilation duration from 9.3 to 6.3 hours (2008 and 2012) (P < 0.001) and intensive care unit length of stay from 26.3 to 22.5 hours (P < 0.001). Reintubation and intensive care unit readmission were unchanged. Variability in ventilation time was also reduced. CONCLUSIONS: We demonstrate that in more than 50% of all cardiac surgical patients, a standardized practice model can be used to achieve better results. Clinical outcomes are improved and unwarranted variability is reduced. Success is driven by clear patient identification and well-defined protocols that are clearly communicated both by electronic tools and by empowerment of bedside providers to advance care when clinical criteria are met.

Outcome prediction in sepsis: speckle tracking echocardiography based assessment of myocardial function.

INTRODUCTION: Speckle tracking echocardiography (STE) is a relatively novel and sensitive method for assessing ventricular function and may unmask myocardial dysfunction not appreciated with conventional echocardiography. The association of ventricular dysfunction and prognosis in sepsis is unclear. We sought to evaluate frequency and prognostic value of biventricular function, assessed by STE in patients with severe sepsis or septic shock. METHODS: Over an eighteen-month period, sixty patients were prospectively imaged by transthoracic echocardiography within 24 hours of meeting severe sepsis criteria. Myocardial function assessment included conventional measures and STE. Association with mortality was assessed over 12 months. RESULTS: Mortality was 33% at 30 days (n = 20) and 48% at 6 months (n = 29). 32% of patients had right ventricle (RV) dysfunction based on conventional assessment compared to 72% assessed with STE. 33% of patients had left ventricle (LV) dysfunction based on ejection fraction compared to 69% assessed with STE. RV free wall longitudinal strain was moderately associated with six-month mortality (OR 1.1, 95% confidence interval, CI, 1.02-1.26, p = 0.02, area under the curve, AUC, 0.68). No other conventional echocardiography or STE method was associated with survival. After adjustment (for example, for mechanical ventilation) severe RV free wall longitudinal strain impairment remained associated with six-month mortality. CONCLUSION: STE may unmask systolic dysfunction not seen with conventional echocardiography. RV dysfunction unmasked by STE, especially when severe, was associated with high mortality in patients with severe sepsis or septic shock. LV dysfunction was not associated with survival outcomes.

Predictive health monitoring: Leveraging artificial intelligence for early detection of infectious diseases in nursing home residents through discontinuous vital signs analysis.

This research addresses the problem of detecting acute respiratory, urinary tract, and other infectious diseases in elderly nursing home residents using machine learning algorithms. The study analyzes data extracted from multiple vital signs and other contextual information for diagnostic purposes. The daily data collection process encounters sampling constraints due to weekends, holidays, shift changes, staff turnover, and equipment breakdowns, resulting in numerous nulls, repeated readings, outliers, and meaningless values. The short time series generated also pose a challenge to analysis, preventing the extraction of seasonal information or consistent trends. Blind data collection results in most of the data coming from periods when residents are healthy, resulting in excessively imbalanced data. This study proposes a data cleaning process and then builds a mechanism that reproduces the basal activity of the residents to improve the classification of the disease. The results show that the proposed basal module-assisted machine learning techniques allow anticipating diagnostics 2, 3 or 4 days before doctors decide to start treatment with antibiotics, achieving a performance measured by the area-under-the-curve metric of 0.857. The contributions of this work are: (1) a new data cleaning process; (2) the analysis of contextual information to improve data quality; (3) the generation of a baseline measure for relative comparison; and (4) the use of either binary (disease/no disease) or multiclass classification, differentiating among types of infections and showing the advantages of multiclass versus binary classification. From a medical point of view, the anticipated detection of infectious diseases in institutionalized individuals is brand new.

Comparison of electroencephalography and cerebral oximetry to determine the need for in-line arterial shunting in patients undergoing carotid endarterectomy.

OBJECTIVE: To compare cerebral near-infrared regional spectroscopy (NIRS) with the 12-lead electroencephalogram for the detection of ischemia during carotid artery clamping for carotid endarterectomy (CEA). DESIGN: Prospective, observational. SETTING: Single, tertiary care center. PARTICIPANTS: Ninety patients older than 18 undergoing elective, unilateral CEA. INTERVENTIONS: In addition to EEG monitoring, all patients underwent continuous blinded NIRS monitoring with sensors placed bilaterally above the supraorbital ridge. MEASUREMENTS AND MAIN RESULTS: Seventeen patients were excluded, leaving 73 patients available for evaluation. Four patients (5.5%) required shunting based on EEG findings. Changes in cerebral oxygen saturation (rSO2) were assessed on the operative side using the average value for the 1 minute prior to cross-clamp and the lowest rSO2 value the first 5 minutes postclamp. Each 1% absolute decrease and each 1% relative decrease from baseline conferred a 50% increase in the need for shunt placement (OR 1.5; 95% CI (1.03-2.26); p = 0.03 and OR 1.4; 95% CI (1.02-1.81); p = 0.04 respectively). Sensitivity, specificity, and positive and negative predictive values were determined using significant cutoffs of≥5% absolute change or≥10% relative change. Positive predictive value was low (<25%) for both absolute and relative changes. CONCLUSIONS: A decrease in rSO2 during carotid cross-clamping for CEA is associated with EEG-determined need for shunting, but the positive predictive value is low. Using the above cutoffs in the current series would have resulted in an increase in the shunt rate by approximately 20% when it was not indicated by EEG.

Organogenic events during gynoecium and fruit development in Arabidopsis.

Angiosperms are the most successful group of land plants. This success is mainly due to the gynoecium, the innermost whorl of the flower. In Arabidopsis, the gynoecium is a syncarpic structure formed by two congenitally fused carpels. At the fusion edges of the carpels, the carpel margin meristem forms. This quasi-meristem is important for medial-tissue development, including the ovules. After the double fertilization, both the seeds and fruit begin to develop. Due to the importance of seeds and fruits as major food sources worldwide, it has been an important task for the scientific community to study gynoecium development. In this review, we present the most recent advances in Arabidopsis gynoecium patterning, as well as some questions that remain unanswered.