Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva / Clinical manifestations after suppression of sedoanalgesia in adult patients in intensive care

Introducción: en la unidad de cuidados intensivos (UCI), las personas asistidas con patologías relevantes se encuentran bajo sedación, una vez que estas se encuentran bajo los principios de supresión de la sedación, es importante identificar cuáles son las manifestaciones que presentan, propias de las sedaciones. Objetivo: describir las manifestaciones clínicas del síndrome de supresión de la sedoanalgesia presentes en pacientes asistidos en un Hospital Público de la Ciudad de Corrientes de enero a diciembre del 2022. Metodología: estudio cuantitativo, descriptivo, transversal y observacional. La muestra incluyó pacientes adultos de UCI. El cálculo del tamaño muestral se realizó a través del método probabilístico aleatorio simple resultando de éste una muestra de 100 historias clínicas. Para la recolección de datos se utilizó la observación y como instrumento un formulario semiestructurado, de carácter anónimo. Cada formulario contenía datos específicos donde se categorizan las variables en estudio como ser edad, sexo, comorbilidades, tiempo de sedoanalgesia, tipo de sedación, sedoanalgesia utilizada, agitación, confusión, alucinación, diaforesis, taquicardia. Resultados: en cuanto a la edad se obtuvo un promedio de 49 años, el sexo predominante fue el masculino con 52%, en cuanto a las comorbilidades más frecuentes, el 20% presentó Insuficiencia Respiratoria Aguda y el 16% Insuficiencia renal. El motivo de ingreso a UCI en mayor medida con el 33% fue por dificultad respiratoria y Post Quirúrgicos complicados 32%. Los fármacos de mayor elección fueron midazolam 94%, seguido del fentanilo 80%. En cuanto al tiempo de sedación de los pacientes, se encontró una media de 1265 horas. Las manifestaciones clínicas que se observaron en la muestra en mayor medida corresponden a taquicardia 70%, agitación 52%, un 37% confusión e hipertensión y un 24% alucinación. Conclusión: las manifestaciones que se presentaron con mayor frecuencia fueron taquicardia, agitación, confusión, hipertensión y con menor frecuencia alucinación[AU]

Introduction: in the intensive care unit (ICU), people treated with relevant pathologies are under sedation. Once they are under the principles of sedation suppression, it is important to identify the manifestations they present, typical of sedations. Objective: To describe the clinical manifestations of sedation suppression syndrome present in patients treated at a Public Hospital in the City of Corrientes from January to December 2022. Methodology: quantitative, descriptive, cross-sectional and observational study. The sample included adult ICU patients. The calculation of the sample size was carried out through the simple random probabilistic method, resulting in a sample of 100 medical records. Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva. Observation was used to collect data and a semi-structured, anonymous form was used as an instrument. Each form contained specific data where the variables under study were categorized, such as age, sex, comorbidities, sedation time, type of sedation, sedation used, agitation, confusion, hallucination, diaphoresis, tachycardia. Results: regarding age, an average of 49 years was obtained, the predominant sex was male with 52%, regarding the most frequent comorbidities, 20% presented Acute Respiratory Failure and 16% Renal failure. The reason for admission to the ICU to a greater extent with 33% was due to respiratory difficulty and complicated Post-Surgeries 32%. The drugs of greatest choice were midazolam 94%, followed by fentanyl 80%. Regarding the sedation time of the patients, an average of 1265 hours was found. The clinical manifestations that were observed in the sample to a greater extent correspond to tachycardia 70%, agitation 52%, confusion and hypertension 37% and hallucination 24%. Conclusion: the manifestations that occurred most frequently were tachycardia, agitation, confusion, hypertension and, less frequently, hallucination[AU]

Introdução: na unidade de terapia intensiva (UTI), as pessoas tratadas com patologias relevantes estão sob sedação. Uma vez sob os princípios da supressão da sedação, é importante identificar as manifestações que apresentam, típicas das sedações. Objetivo: Descrever as manifestações clínicas da síndrome de supressão da sedação presentes em pacientes atendidos em um Hospital Público da Cidade de Corrientes no período de janeiro a dezembro de 2022. Metodologia: estudo quantitativo, descritivo, transversal e observacional. A amostra incluiu pacientes adultos internados em UTI. O cálculo do tamanho amostral foi realizado pelo método probabilístico aleatório simples, resultando em uma amostra de 100 prontuários. A observação foi utilizada para a coleta de dados e um formulário semiestruturado e anônimo foi utilizado como instrumento. Cada formulário continha dados específicos onde foram categorizadas as variáveis em estudo, como idade, sexo, comorbidades, tempo de sedação, tipo de sedação, sedação utilizada, agitação, confusão, alucinação, sudorese, taquicardia. Resultados: em relação à idade obteve-se uma média de 49 anos, o sexo predominante foi o masculino com 52%, quanto às comorbidades mais frequentes, 20% apresentavam Insuficiência Respiratória Aguda e 16% Insuficiência Renal. O motivo de internação na UTI em maior proporção com 33% foi por dificuldade respiratória e pós-cirúrgicos complicados 32%. Os medicamentos de maior escolha foram midazolam 94%, seguido de fentanil 80%. Quanto ao tempo de sedação dos pacientes, foi encontrada uma média de 1265 horas. As manifestações clínicas mais observadas na amostra correspondem a taquicardia 70%, agitação 52%, confusão e hipertensão 37% e alucinação 24%. Conclusão: as manifestações que ocorreram com maior frequência foram taquicardia, agitação, confusão, hipertensão e, menos frequentemente, alucinação[AU]

Role of the video head impulse test in the evaluation of vestibulo-ocular reflex in individuals with Parkinson's disease.

Background and purpose:

Parkinson’s disease (PD) is the most common movement disorder and the second most common neu­rodegenerative disease of the central ner­vous system. Dizziness is frequently reported by PD patients, yet there is a paucity of research focusing on the vestibulo-ocular reflex (VOR) in this population using high-frequency vestibular testing. This study aims to investigate the VOR in individuals with PD using the video head thrust test with and without suppression. 

Forty individuals with PD and 40 healthy individuals were included in the study. According to the Hoehn-Yahr Scale, individuals with PD were defined as early stage with a score of 1–2.5 and middle to late stage with a score of 3 to 5. The Head Impulse Testing Paradigm (HIMP) and Suppression Head Impulse Testing Paradigm (SHIMP) were applied to all individuals.

No statistically significant difference was observed between the PD group and the control group in terms of semicircular canal (SCC) gains in both HIMP and SHIMP tests. No catch-up saccades were observed in the right anterior, right posterior, left anterior, and left posterior SCC planes in the PD and control groups. However, in the right lateral SCC plane 32 patients in the PD group had saccades, while 8 patients in the control group had saccades. In the left lateral SCC plane, 32 patients in the PD group and 9 patients in the control group had catch-up saccades. A statistically significant difference was observed in the number and amplitude of saccades in the right and left lateral SCC planes compared to the control group (p<0.05). In addition, in the PD group, the amplitude, peak velocity, and latency of the anticompensatory saccades seen in SHIMP showed a statistically significant difference compared to the control group (p<0.05).

VOR in the vertical SCC plane was not affected in individuals with PD. However, VOR in the lateral SCC plane was affected. It was concluded that when evaluating VOR with both HIMP and SHIMP in individuals with PD, the presence of catch-up saccades should be focused on and evaluated for possible vestibular dysfunction, even though SCC gains are normal. This study will contribute to a deeper understanding of vestibular function in PD, potentially informing better management strategies for dizziness in this population. 

Who and how to screen for endogenous hypercortisolism in type 2 diabetes mellitus or obesity.

PURPOSE: The current review aims to summarize and discuss the prevalence of confirmed hypercortisolism in patients with diabetes mellitus or obesity, analysing the screening tests used and their accuracy, in order to better identify whether patients with diabetes mellitus and obesity should be screened for Cushing's syndrome (CS) and how. METHODS: A narrative review was performed including publications focusing on the current knowledge on prevalence of confirmed hypercortisolism in patients with type 2 diabetes mellitus (T2DM) or obesity and on screening tests used to detect CS. RESULTS: The studies reviewed suggest that the prevalence of CS in patients with T2DM is variable, ranging from 0.6 to 9.3%. The most used screening test is the overnight cortisol after 1 mg of dexamethasone suppression test (DST), with a false positive rate ranging from 3.7 to 21%. The prevalence of CS among obese patients is generally about 1%, except for two studies which reported higher prevalence. For obese patients, 1 mg DST and late-night salivary cortisol are the most accurate screening tests for CS. CONCLUSIONS: Clinical expertise remains the mainstay to identify which subjects should be screened for CS. The evaluation of the clinical stigmata of CS and the combination with clinical comorbidities typical of CS are the stronger predictors of CS. In addition, we could hypothesize that in patients with T2DM, overnight 1 mg DST is the more accurate screening test for CS. By contrast, in patients with obesity both LNSC and overnight 1 mg DST could be equally used for the screening of hypercortisolism.

Glucocorticoid treatment and adrenal suppression in children: current view and open issues.

PURPOSE: Glucocorticoids (GCs) are commonly used for several acute and chronic pediatric diseases. However, chronic treatment may result in hypothalamic-pituitary-adrenal axis (HPA) dysfunction. Glucocorticoid-induced adrenal insufficiency (GI-AI) is indeed the most frequent cause of adrenal insufficiency (AI) in children, possibly resulting in a life-threatening event such as adrenal crisis (AC). It is generally underestimated, especially when using non-systemic glucocorticoid formulations. This review aims at summarizing current evidence on the effects of long-term GC treatment on the HPA axis, management of GC tapering and assessment of the HPA recovery. METHODS: We conducted a narrative review of the relevant literature focusing on pathogenic mechanisms, predictive factors, diagnosis and treatment of GI-AI. RESULTS: All types of GCs, whatever the route of administration, may have suppressive effects on the HPA axis, especially when compounds with higher potency and long half-life are used. Moreover, chronic GC administration is the most common cause of Cushing syndrome in children. In order to overcome the risk of GI-AI, slow withdrawal of GCs is necessary. When approaching the replacement dose, it is recommended to switch to shorter half-life formulations such as hydrocortisone. Assessment of HPA axis recovery with basal and stimulated cortisol levels may help detecting children at risk of AC that may require hydrocortisone supplementation. CONCLUSION: The management of GI-AI in children is challenging and many areas of uncertainty remain. Improving the knowledge on long-term GC effects on HPA in children, the management of steroid discontinuation and emergency dosing may help preventing GI-AI symptoms and acute hospital admission for AC.

Menstrual management using the etonogestrel implant in individuals with intellectual disabilities in Joinville, Brazil.

OBJECTIVE: This study aimed to describe the use of etonogestrel (ENG) implants for menstrual management (i.e., management of bleeding and symptoms associated with menstruation) in individuals with intellectual disabilities. METHODS: This study retrospectively analyzed a cohort of individuals with intellectual disabilities who began using ENG implants between 2003 and 2018, in Joinville, Brazil. We collected sociodemographic, clinical, and reproductive data from the medical records, along with information related to ENG implant use. RESULTS: In total, 369 implants were placed in 130 individuals with intellectual disabilities. The median age at the first implant was 20 (interquartile range [IQR], 17-26) years, and 43.8% of the patients were adolescents. By December 2018, 90 patients had received two or more subsequent implants. The median duration of current ENG implant use was 19 (IQR, 12.8-22) months. More than 40% of the patients had comorbidities, with epilepsy being the most common. During the use of the current implant, 80% of the patients had a favorable bleeding profile (no bleeding or ≤1 bleeding episode per month), and 53.8% (70/130) had no bleeding within 3 months before their last medical visit. Among patients experiencing dysmenorrhea and premenstrual syndrome (PMS), 79% (64/81) and 82% (54/66) reported complete improvement, respectively. The premature implant removal rate was 8.9% (33/369). Unfavorable bleeding was the main reason for premature implant removal (20 out 33 removals). CONCLUSIONS: ENG implants might be a suitable option for individuals with intellectual disabilities who require management of menstrual bleeding and symptoms associated with menstruation. Most patients had a favorable bleeding profile and experienced significant improvements in dysmenorrhea and PMS, contributing to the high continuation rates of ENG implants.

Efficacy of anti-suppression therapy in improving binocular vision in children with small-angle Esotropia

Purpose: To evaluate the efficacy of anti-suppression exercises in children with small-angle esotropia in achieving binocular vision. Methods: A retrospective review of patients aged 3–8 years who underwent anti-suppression exercises for either monocular or alternate suppression between January 2016 and December 2021 was conducted. Patients with esotropia less than 15 prism diopters (PD) and visual acuity ≥ 6/12 were included. Patients with previous intra-ocular surgery or less than three-month follow-up were excluded. Success was defined as the development of binocular single vision (BSV) for distance, near, or both (measured clinically with either the 4 prism base out test or Worth four dot test) and maintained at two consecutive visits. Qualified success was defined as the presence of diplopia response for both distance and near. Additionally, improvement in near stereo acuity was measured using the Stereo Fly test. Results: Eighteen patients with a mean age of 5.4 ± 1.38 years (range 3–8 years) at the time of initiation of exercises were included in the study. The male female ratio was 10:8. The mean best corrected visual acuity was 0.18 LogMAR unit(s) and the mean spherical equivalent was +3.8 ± 0.14 diopters (D). The etiology of the esotropia was fully accommodative refractive esotropia (8), microtropia (1), post–operative infantile esotropia (4), partially accommodative esotropia (1), and post-operative partially accommodative esotropia (4). Patients received either office-based, home-based, or both modes of treatment for an average duration of 4.8 months (range 3–8). After therapy, BSV was achieved for either distance or near in 66.6 % of patients (95 % CI = 40.03–93.31 %). Binocular single vision for both distance and near was seen in 50 % of children. Qualified success was observed in 38.46% of patients. Persistence of suppression was observed in one patient (5.5 %)... (AU)

Utility of bone suppression imaging for the detection of pneumonia on chest radiographs.

INTRODUCTION: Chest X-rays (CXR) are routinely used to diagnose lung and heart conditions. AI based Bone suppression imaging (BSI) aims to enhance accuracy in identifying chest anomalies by eliminating bony structures such as the ribs, clavicles, and scapula from CXRs. The aim of this retrospective study was to assess the clinical value of BSI in detecting pneumonia. METHODS: Ninety-nine emergency patients with suspected pneumonia underwent erect postero-anterior CXRs. The BSI processing system was used to generate corresponding bone-suppressed images for the 99 radiographs. Each patient had undergone a computed tomography (CT) examination within 48 h, considered the standard of reference. Two blinded readers separately analyzed images, indicating confidence levels regarding signs of pneumonia for each lung separated in three fields, first with standard images, then with BSI. Sensitivity, specificity, predictive values, and readers' certitude were calculated, and inter-reader agreement was evaluated with the kappa statistic. RESULTS: Out of the 99 included cases, 39 cases of pneumonia were diagnosed (39.4%). Of the remaining 60 patients, 14 presented only pleural effusions (14.1%). BSI images led to a significant increase in false positives (+251%) and significantly affected one reader's diagnosis and certitude, decreasing accuracy (up to 17%) and specificity (up to 14%). Sensitivity increased by 66% with BSI. Inter-reader agreement ranged from weak to moderate (0.113-0.53) and did not improve with BSI. For both readers, BSI images were read with significantly lesser certitude than standard images. CONCLUSION: BSI did not add clinical value in pneumonia detection on CXR due to a significant increase in false positive results and a decrease one readers' certitude. IMPLICATION FOR PRACTICE: The study emphasizes the importance of proper clinical training before implementing new post-processing and artificial intelligence (AI) tools in clinical practice.

Single overall 'H-shaped' multifunctional compound achieves fire safety, durability, enhanced strength, and smoke suppression of cotton fabrics.

Challenges currently faced by phosphorus-based flame retardants for cotton fabrics include reduced fabric strength after treatment, high smoke release during combustion, formaldehyde release from commercial phosphorus-based flame retardants and poor flame retardant durability after treatment. In the present work, a P/N/B synergistic flame retardant TBST is synthesized using phosphoric acid, cyanuric acid, boric acid, pentaerythritol, etc. The phosphorus­nitrogen­boron atomic ratio is 2:3:1, and it is successfully prepared on cotton fabric to prepare TBST/Cotton. When the weight gain rate is 29.8 %, the LOI value is 41.6 ±â€¯0.3 %, indicating that TBST/Cotton has excellent flame retardant performance. At the same time, in the vertical flame test, the length of residual carbon is 5.6 cm. In addition, the THR and HRR are reduced by 58.4 % and 91.9 % respectively compared to Cotton, indicating that TBST/Cotton has excellent combustion performance. In addition, compared to the residual carbon content of Cotton at 710 °C, the residual carbon content of TBST/Cotton in nitrogen increased by 27.79 %. For a 30 % increase in weight, the increase in longitudinal mechanical strength is 23.1 %. Inferred the decomposition mechanism and flame retardant mechanism of TBST/Cotton. TBST/Cotton has the advantages of good flame retardant durability and enhanced mechanical properties, and the reinforcement mechanism of TBST has been speculated.

Optimized fast non-singular integral terminal sliding mode control of immune response and HCMV infection of renal transplant recipient.

Kidneys are the most commonly transplanted organs, and renal transplant is the best treatment for patients with advanced stages of renal disease. Immunosuppressive drugs are used after renal transplant to prevent the body from rejecting the transplanted kidney and ensure its proper kidney functioning. However, suppression of the immune system increases the risk of viral infections and other complications. Therefore, careful monitoring and management of immunosuppressive and antiviral drugs are essential for the success of the transplants. This article presents a hybrid fast non-singular integral terminal sliding mode control technique to adjust the efficacies of these drugs in renal transplant recipients, ensuring successful transplants and preventing viral infections. The proposed strategy tracks system trajectories to reference values and adjusts the treatment plan accordingly. The Lyapunov stability theorem is used to prove the asymptotic stability of the closed-loop system. Several simulation studies are conducted in MATLAB/Simulink environment to evaluate the performance of the proposed control technique in maintaining a balance between over-suppression and under-suppression. Genetic Algorithm is used to optimize the gain values to further improve the performance of the proposed control technique. Its performance is compared with two other variants of terminal sliding mode controllers to demonstrate its effectiveness against them.

Roles of HMGB1 on life-threatening traumatic brain injury and sequential peripheral organ damage.

Traumatic brain injury (TBI) has been found to be associated with certain peripheral organ injuries; however, a few studies have explored the chronological influences of TBI on multiple organs and the systemic effects of therapeutic interventions. Particularly, high-mobility group box 1 (HMGB1) is a potential therapeutic target for TBI; however, its effects on peripheral organs remain unclear. Therefore, this study aimed to determine whether severe TBI can lead to multiple organ injury and how HMGB1 inhibition affects peripheral organs. This study used a weight drop-induced TBI mouse model and found that severe TBI can trigger short-lived systemic inflammation, in the lungs and liver, but not in the kidneys, regardless of the severity of the injury. TBI led to an increase in circulating HMGB1 and enhanced gene expressions of its receptors in every organ. Anti-HMGB1 antibody treatment reduced neuroinflammation but increased inflammation in peripheral organs. This study also found that HMGB1 inhibition appears to have a beneficial role in early neuroinflammation but could lead to detrimental effects on peripheral organs through decreased peripheral immune suppression. This study provides novel insights into the chronological changes in multiple organs due to TBI and the unique roles of HMGB1 between the brain and other organs.

Ferroelectric Interfaces for Dendrite Prevention in Zinc-Ion Batteries.

Aqueous rechargeable zinc-ion batteries (ZIBs) are increasingly recognized as promising energy storage systems for mini-grid and mini-off-grid applications due to their advantageous characteristics such as high safety, affordability, and considerable theoretical capacity. However, the long-term cycling performance of ZIBs is hampered by challenges including the uncontrolled dendrite formation, the passivation, and the occurrence of the hydrogen evolution reaction (HER) on the Zn anode. In this study, enhancing ZIB performance by implementing oxide material coatings on Zn metal, serving as a physical barrier at the electrode-electrolyte interfaces to mitigate dendrite growth and suppress the HER is concentrated. Specifically, the mechanisms through which the n-type semiconductor TiO2 coated Zn anode establishes ohmic contact with Zn, and the high-dielectric BaTiO3 (BTO) coated Zn anode fosters Maxwell-Wagner polarization with ferroelectric properties, significantly inhibiting dendrite growth and side reactions, thereby resulting in a highly stable Zn anode for efficient aqueous ZIBs is explored. This advanced BTO/Zn electrode demonstrates an extended lifespan of over 700 h compared to bare Zn and TiO2/Zn anodes. Additionally, full-cell aqueous ZIBs incorporating BTO/Zn//VO2 (B) batteries exhibit superior rate capabilities, high capacity, and sustained cycle life.

The curious case of the hypothalamic-pituitary-gonadal axis dysfunction in subordinate female naked mole-rats (Heterocephalus glaber): No apparent role of opioids and glucocorticoids.

The naked mole-rat (Heterocephalus glaber) is a unique model mammal in which to study socially induced inhibition of the hypothalamic-pituitary-gonadal (HPG) axis. Naked mole-rat groups exhibit a high degree of reproductive bias in which breeding is restricted to one female (the queen) and one male, with subordinate non-breeding colony members rarely, if ever, having the opportunity to reproduce due to a dysfunctional HPG axis. It is posited that aggression directed at subordinates by the queen suppresses reproduction in these subordinates, yet the underlying physiological mechanisms causing this dysfunction are unknown. This study aimed to investigate the possible factors contributing to the dysfunction of the HPG axis in subordinate female naked mole-rats with a specific focus on the role of ovarian feedback and stress-related factors such as circulating glucocorticoid and endogenous opioid peptides. The results showed that stress-related factors appear to not mediate the suppression of reproductive function in subordinate female naked mole rats. Indeed, in some cases, the activation of the stress axis may lead to reproductive activation instead of deactivation. At the same time, the role of ovarian sex steroid feedback in reproductive suppression is likely limited and not clearly delineated. This study highlights the need for detailed studies to elucidate the mechanism of reproductive suppression in this unique model mammalian species which may shed light on, and reveal novel mechanisms, in the social regulation of reproduction.

Simultaneously Flame Retarding and Toughening of Epoxy Resin Composites Based on Two-Dimensional Polyhedral Oligomeric Silsesquioxane/Polyoxometalate Supramolecular Nanocrystals with Ultralow Loading.

For industrial practical applications, it is difficult to simultaneously endow epoxy resin (EP) composites with superior flame retardancy, smoke suppression, toughness, and low-dielectric constants. Herein, unique polyhedral oligomeric silsesquioxane/polyoxometalate (POM(Mo)-POSS(ibu-Li)) nanosheets were synthesized via a simple one-pot method using laboratory-made lithium-containing hepta-isobutyl-POSS (ibu-Li-POSS) and the low-cost industrial chromogenic agent H3PMo12O40 as raw materials. The incorporation of 2 wt % POM(Mo)-POSS(ibu-Li) nanoflakes into EP significantly enhanced the compatibility between nanoadditives and the EP matrix. Compared with EP, the flexural and impact strengths increased by 36.2 and 78.2%, respectively. Therefore, POM(Mo)-POSS(ibu-Li) has significant advantages in enhancing the toughness of EP compared with existing flame retardants. The dielectric constant and loss were apparently reduced to meet the increasing requirements of EP-type electronic packaging materials and components. Notably, the synthesized POM(Mo)-POSS(ibu-Li) contained various flame-retardant and smoke-suppression elements such as P, Mo, and Si. The ultralow loading (2 wt %) of POM(Mo)-POSS(ibu-Li) significantly reduced the peak heat release rate, peak of smoke production rate, and CO production rate by 43.9, 40.6, and 65.8%, respectively. Meanwhile, the value of LOI increased directly from 24.0% for EP to 30.2% and passed the V-0 rating in the UL-94 test. However, incorporating 5 wt % POSS derivatives into EP alone to ensure that the prepared composites pass the V-0 rating of the UL-94 test has always been an extraordinarily difficult problem. Therefore, the dilemmas of poor dielectric properties, inherent flammability, and brittleness of EP were completely overcome through the successful application of POM(Mo)-POSS(ibu-Li) supramolecular nanosheets.

The strength of anticipated distractors shapes EEG alpha and theta oscillations in a Working Memory task.

Working Memory (WM) requires maintenance of task-relevant information and suppression of task-irrelevant/distracting information. Alpha and theta oscillations have been extensively investigated in relation to WM. However, studies that examine both theta and alpha bands in relation to distractors, encompassing not only power modulation but also connectivity modulation, remain scarce. Here, we depicted, at the EEG-source level, the increase in power and connectivity in theta and alpha bands induced by strong relative to weak distractors during a visual Sternberg-like WM task involving the encoding of verbal items. During retention, a strong or weak distractor was presented, predictable in time and nature. Analysis focused on the encoding and retention phases before distractor presentation. Theta and alpha power were computed in cortical regions of interest, and connectivity networks estimated via spectral Granger causality and synthetized using in/out degree indices. The following modulations were observed for strong vs. weak distractors. In theta band during encoding, the power in frontal regions increased, together with frontal-to-frontal and bottom-up occipital-to-temporal-to-frontal connectivity; even during retention, bottom-up theta connectivity increased. In alpha band during retention, but not during encoding, the power in temporal-occipital regions increased, together with top-down frontal-to-occipital and temporal-to-occipital connectivity. From our results, we postulate a proactive cooperation between theta and alpha mechanisms: the first would mediate enhancement of target representation both during encoding and retention, and the second would mediate increased inhibition of sensory areas during retention only, to suppress the processing of imminent distractor without interfering with the processing of ongoing target stimulus during encoding.

Glutaminase 2 as a therapeutic target in glioblastoma.

Glioblastoma (GBM) is the most common malignant primary adult brain tumor. Despite standard-of-care treatment, which consists of surgical resection, temozolomide (TMZ) treatment, and radiotherapy, the prognosis for GBM patients remains poor with a five-year survival rate of 5 %. With treatment, the median survival time is 14 months, suggesting the dire need for new, more effective therapies. Glutaminolysis, the metabolic pathway by which cells can convert glutamine to ATP, is essential for the survival of GBM cells and represents a putative target for treatment. Glutamine replenishes tricarboxylic acid (TCA) cycle intermediates through glutaminolysis. The first step of glutaminolysis, the deamination of glutamine, can be carried out by either glutaminase 1 (GLS) or glutaminase 2 (GLS2). However, it is becoming increasingly clear that these enzymes have opposing functions in GBM; GLS induces deamination of glutamine, thereby acting in an oncogenic fashion, while GLS2 has non-enzymatic, tumor-suppressive functions that are repressed in GBM. In this review, we explore the important role of glutaminolysis and the opposing roles of GLS and GLS2 in GBM. Further, we provide a detailed discussion of GLS2's newly discovered non-enzymatic functions that can be targeted in GBM. We conclude by considering therapeutic approaches that have emerged from the understanding of GLS and GLS2's opposing roles in GBM.

Factors associated with completion of intensive adherence counseling among people living with HIV at a large referral hospital in Uganda: a retrospective analysis.

BACKGROUND: Among people living with HIV(PHIV) with unsuppressed viral load after six or more months of anti-retroviral therapy (ART), three intensive adherence counseling sessions (IAC) sessions are recommended. However, there is limited information about IAC completion rates. We investigated the factors associated with IAC completion among PLHIV with an unsuppressed viral load on first and second-line ART in mid-western Uganda. METHODS: In this retrospective review of medical records, we abstracted routine HIV data between January 2018 and September 2019 at the Fort Portal Regional Hospital. IAC completion was the primary outcome measured as the receipt of ≥ 3 consecutive good ART adherence scores of ≥ 95.0% during the IAC sessions, spaced one month apart within three months. The modified Poisson regression analysis with robust standard errors was used to determine factors associated with the outcome, reported as risk ratio (RR) and 95% confidence interval (CI). RESULTS: We studied 420 participants of whom 204 (48.6%) were aged 20-39 years (mean age, 33.6 ± 13.3 years) and 243 (57.9%) were female. 282 (67.1%) participants completed their IAC sessions. Secondary or higher levels of education (Adjusted RR (aRR) 0.79, 95% CI 0.64-0.98), no follow-up for IAC (aRR 0.76, 95% CI 0.67-0.87), malnutrition (aRR 0.65, 95% CI 0.43-0.99) were associated with a lower likelihood of IAC completion while being in a separated/widowed or divorced relationship (aRR 1.23, 95% CI 1.01-1.49) was associated with a higher likelihood of IAC completion. CONCLUSIONS: We found a low IAC completion rate compared to the desired target of 100%. Nutritional support for malnourished PLHIV receiving IAC, follow-ups, and targeted health education on the importance of IAC are needed to improve the IAC completion rate.

Courier delivery of antiretroviral therapy: a cohort study of a South African private-sector HIV programme.

INTRODUCTION: Courier delivery has become a popular antiretroviral therapy (ART) distribution method in some HIV care settings, yet data on ART courier delivery and how it relates to ART outcomes are scarce. We studied the differences in viral suppression rates between individuals from a South African private sector HIV programme receiving ART by courier delivery and those receiving ART through traditional retail dispensing. METHODS: Individuals aged 15 years or older who were actively enrolled in the Aid for AIDS programme between January 2011 and July 2022 were eligible for the analysis. The outcome of interest was viral suppression defined as a viral load (VL) <400 copies per ml. We calculated adjusted odds ratios (OR) for the association between the ART distribution method and viral suppression, comparing those receiving refills through courier pharmacies versus retail dispensing at the time of the VL testing. We used generalized estimating equations to account for repeated VL testing of the same individual. The models were adjusted for age, sex, calendar year, ART regimen, history of mental illness and medical insurance scheme. We computed adjusted ORs for the calendar periods 2011-2013, 2014-2016, 2017-2019, 2020-2022 and overall. RESULTS: We extracted 442,619 VL measurements from 68,720 eligible individuals, 39,406 (57.3%) were women. The median number of VL measurements per individual was 6 (IQR 3-10). VL suppression was detected in 398,901 (90.1%) tests, and 185,701 (42.0%) of the tests were taken while the individual was receiving ART by courier delivery. Overall, courier delivery was associated with 5% higher odds of viral suppression than retail dispensing (adjusted OR 1.05, 95% CI 1.02-1.08). The strength and direction of this association varied by calendar period, with an adjusted OR of 1.37 (95% CI 1.27-1.48) in 2011-2013 and 1.02 (95% CI 0.97-1.07) in 2020-2022. CONCLUSIONS: Courier delivery of ART is a viable alternative to retail dispensing in the South African private sector, as it was associated with higher viral suppression until 2016 and similar suppression rates in recent years. Further research is needed to investigate the potential benefits and drawbacks of courier delivery of ART in both private and public healthcare settings.

Design of a Compact Multiband Monopole Antenna with MIMO Mutual Coupling Reduction.

In this article, the authors present the design of a compact multiband monopole antenna measuring 30 × 10 × 1.6 mm3, which is aimed at optimizing performance across various communication bands, with a particular focus on Wi-Fi and sub-6G bands. These bands include the 2.4 GHz band, the 3.5 GHz band, and the 5-6 GHz band, ensuring versatility in practical applications. Another important point is that this paper demonstrates effective methods for reducing mutual coupling through two meander slits on the common ground, resembling a defected ground structure (DGS) between two antenna elements. This approach achieves mutual coupling suppression from -6.5 dB and -9 dB to -26 dB and -13 dB at 2.46 GHz and 3.47 GHz, respectively. Simulated and measured results are in good agreement, demonstrating significant improvements in isolation and overall multiple-input multiple-output (MIMO) antenna system performance. This research proposes a compact multiband monopole antenna and demonstrates a method to suppress coupling in multiband antennas, making them suitable for internet of things (IoT) sensor devices and Wi-Fi infrastructure systems.

Fat-free noncontrast whole-heart CMR with fast and power-optimized off-resonant water excitation pulses.

BACKGROUND: Cardiovascular MRI (CMR) faces challenges due to the interference of bright fat signals in visualizing structures like coronary arteries. Effective fat suppression is crucial, especially when using whole-heart CMR techniques. Conventional methods often fall short due to rapid fat signal recovery, leading to residual fat content hindering visualization. Water-selective off-resonant radiofrequency (RF) pulses have been proposed but come with tradeoffs between pulse duration, which increases scan time, and increased RF energy deposit, which limits their applicability due to specific absorption rate (SAR) constraints. The study introduces a lipid-insensitive binomial off-resonant (LIBOR) RF pulse, which addresses concerns about SAR and scan time, and aims to provide a comprehensive quantitative comparison with published off-resonant RF pulses for CMR at 3T. METHODS: A short (1ms) LIBOR pulse, with reduced RF power requirements, was developed and implemented in a free-breathing respiratory-self-navigated 3D radial whole-heart CMR sequence at 3T. A binomial off-resonant rectangular (BORR) pulse with matched duration, as well as previously published lipid-insensitive binomial off-resonant excitation (LIBRE) pulses (1ms and 2.2ms), were implemented and optimized for fat suppression in numerical simulations and validated in volunteers (n=3). Whole-heart CMR was performed in volunteers(n=10) with all four pulses. The signal-to-noise ratio (SNR) of ventricular blood, skeletal muscle, myocardium, and subcutaneous fat and the coronary vessel detection rates and sharpness were compared. RESULTS: Experimental results validated numerical findings and near homogeneous fat suppression was achieved with all four pulses. Comparing the short RF pulses (1ms), LIBOR reduced the RF power nearly two-fold compared with LIBRE, and three-fold compared with BORR, and LIBOR significantly decreased overall fat SNR from cardiac scans, compared to LIBRE and BORR. The reduction in RF pulse duration (from 2.2ms to 1ms) shortened the whole-heart acquisition from 8.5min to 7min. No significant differences in coronary arteries detection and sharpness were found when comparing all four pulses. CONCLUSION: LIBOR pulses enabled whole-heart CMR under 7minutes at 3T, with large volume fat signal suppression, while reducing RF power compared with LIBRE and BORR pulses. LIBOR is an excellent candidate to address SAR problems encountered in CMR sequences where fat suppression remains challenging and short RF pulses are required. AVAILABILITY OF DATA AND MATERIALS: An online repository containing the anonymized human MRI raw data, as well as RF pulse shapes used in this study is publicly available at: https://zenodo.org/records/8338079(PART 1: KNEE V1-V3, HEART V1-V5) https://zenodo.org/records/10715769 (PART 2: HEART V6-V10) Matlab code to 1) simulate the different RF pulses within a GRE sequence and 2) to read and display the anonymized raw data is available from: https://github.com/QIS-MRI/LIBOR_LIBRE_BORR_SimulationCode The compiled research sequence can be requested through the Teamplay platform of Siemens Healthineers.

Rationally Engineering a Quasi-Solid-State Flexible Self-Healing Secondary Battery Using Hydrogel-Based Water-in-Salt Electrolyte and Electrochemically Deposited Electrodes.

High safety and low cost are essential for energy-storage systems. Here, an aqueous zinc ion battery composed of a hydrogel-based water-in-salt electrolyte prepared by photoinitiated polymerization of acrylamide in ZnCl2 solution (named as PZC) and flexible electrodes is developed. The stable performance in Zn||Zn symmetric cells and high Coulombic efficiency of PZC in Zn||Cu asymmetric cells verify dendrite suppression. VO2 nanobelts coated with polyaniline (PANI) are grown on a carbon cloth (CC). The battery shows a capacity of 221.5 mAh g-1 after 200 cycles. The batteries present high recovery performance after bending/cutting. After bending of 60°, 90°, and 180°, capacities remain at 240.0, 205.4, and 175.2 mAh g-1, respectively; while the battery healed from 1, 2, 3, and 4 times of cutting shows 197.5, 174.3, 124.7, and 101.2 mAh g-1, respectively. Our findings enable the engineering of a quasi-solid-state battery to have good capability for flexible and portable electronics.