Restoring bottom-up communication in brain-heart interplay after trauma-focused psychotherapy in breast cancer patients with post-traumatic stress disorder.

BACKGROUND: The psychological impact of breast cancer (BC) is substantial, with a significant number of patients (up to 32 %) experiencing post-traumatic stress disorder (PTSD). Exploring the emotional aspects of PTSD through the functional brain-heart interplay (BHI) offers valuable insights into the condition. BHI examines the functional interactions between cortical and sympathovagal dynamics. This study aims to investigate changes in functional directional BHI after trauma-focused (TF) psychotherapy, specifically Eye Movement Desensitization and Reprocessing (EMDR), in comparison to treatment as usual (TAU) among BC patients with PTSD. To our knowledge, this study represents the first examination of such changes. METHODS: We enrolled thirty BC patients who met the criteria for a PTSD diagnosis, with fourteen receiving EMDR and fifteen receiving TAU over a two- to three-month period. We analyzed changes in the emotional response during a script-driven imagery setting. Quantification of the functional interplay between EEG and sympathovagal dynamics was achieved using the synthetic data generation model (SDG) on electroencephalographic (EEG) and heartbeat series. Our focus was on the difference in the BHI index extracted at baseline and post-treatment. RESULTS: We found statistically significant higher coupling in the heart-to-brain direction in patients treated with EMDR compared to controls. This suggests that the flow of information from the autonomic nervous system to the central nervous system is restored following EMDR-induced recovery from PTSD. Furthermore, we observed a significant correlation between improvements in PTSD symptoms and an increase in functional BHI after EMDR treatment. CONCLUSIONS: TF psychotherapy, particularly EMDR, appears to facilitate the restoration of the bottom-up flow of interoceptive information, which is dysfunctional in patients with PTSD. The application of BHI analysis to the study of PTSD not only aids in identifying biomarkers of the disorder but also enhances our understanding of the changes brought about by TF treatments.

Martian CO2 Ice Observation at High Spectral Resolution With ExoMars/TGO NOMAD.

The Nadir and Occultation for MArs Discovery (NOMAD) instrument suite aboard ExoMars/Trace Gas Orbiter spacecraft is mainly conceived for the study of minor atmospheric species, but it also offers the opportunity to investigate surface composition and aerosols properties. We investigate the information content of the Limb, Nadir, and Occultation (LNO) infrared channel of NOMAD and demonstrate how spectral orders 169, 189, and 190 can be exploited to detect surface CO2 ice. We study the strong CO2 ice absorption band at 2.7 µm and the shallower band at 2.35 µm taking advantage of observations across Martian Years 34 and 35 (March 2018 to February 2020), straddling a global dust storm. We obtain latitudinal-seasonal maps for CO2 ice in both polar regions, in overall agreement with predictions by a general climate model and with the Mars Express/OMEGA spectrometer Martian Years 27 and 28 observations. We find that the narrow 2.35 µm absorption band, spectrally well covered by LNO order 189, offers the most promising potential for the retrieval of CO2 ice microphysical properties. Occurrences of CO2 ice spectra are also detected at low latitudes and we discuss about their interpretation as daytime high altitude CO2 ice clouds as opposed to surface frost. We find that the clouds hypothesis is preferable on the basis of surface temperature, local time and grain size considerations, resulting in the first detection of CO2 ice clouds through the study of this spectral range. Through radiative transfer considerations on these detections we find that the 2.35 µm absorption feature of CO2 ice clouds is possibly sensitive to nm-sized ice grains.

Identification of extraocular extension in uveal melanoma by ophthalmological ultrasound.

BACKGROUND AND PURPOSE: Uveal melanoma is the most common primary malignant intraocular tumour in the adult population, with a survival rate of 50% despite advances in treatment and knowledge of this disease. The presence of extraocular extension (EE) worsens the prognosis of these patients, so its proper identification can ensure its management and early intervention. Ophthalmological ultrasound is the technique of choice for the diagnosis and follow-up of these patients, both of the anterior EE using ultrasonic biomicroscopy (UBM), and the posterior EE using A and B ultrasound. The aim of this study is to describe the ultrasound characteristics of the BMU and the A and B ultrasound. MATERIAL AND METHODS: A descriptive and retrospective study is carried out on patients diagnosed with uveal melanoma (UM) and EE from 2003 to 2019. The ultrasound characteristics of the local disease and the follow-up after treatment were recorded completely and at each visit. In the case of anterior EE, photographs of the anterior segment and UBM were taken, while those involving the posterior segment were explored under A and B mode ultrasound. All enucleated eyes were sent for anatomopathological study. RESULTS: Ten patients with an average age of 72.3 years were included. The largest proportion of them were medium-sized tumours, followed by large and small ones. The most frequent morphology of the primary tumour was cupuliform. All the EE presented lower internal reflectivity compared to the primary tumour. No trans-scleral connection bridges were found between the primary tumour and the EE in the ultrasound studies. 50% of patients underwent primary enucleation at the time of diagnosis of intraocular MU due to the presence of the EE, and the remaining 50% presented the EE after initial treatment of the primary tumour with I125 brachytherapy. Sixty percent of the patients presented with posterior EE, and were therefore diagnosed with ultrasound A and B. The most frequent histopathological pattern with 87.5% of patients was the epithelioid pattern. DISCUSSION: Ultrasound scanning in patients with MU is mandatory for diagnosis and follow-up of EE. BMU and A and B ultrasound are the test of choice for anterior and posterior EE, respectively. EE have particular ultrasound characteristics such as low internal reflectivity, regularity of their contour and their location usually adjacent to the base of the primary intraocular tumor.

Identificación de extensión extraocular en el melanoma uveal mediante ecografía oftalmológica / Identification of Extraocular Extension in Uveal Melanoma by Ophthalmological Ultrasound

Antecedentes y objetivoEl melanoma uveal es el tumor primario maligno intraocular más frecuente en la población adulta, con una tasa de supervivencia del 50% a pesar de los avances en el tratamiento y conocimiento de esta enfermedad. La presencia de extensión extraocular (EE) empeora el pronóstico de estos pacientes, por lo que su correcta identificación puede asegurar su manejo e intervención temprana. La ecografía oftalmológica es la técnica de elección para el diagnóstico y seguimiento de estos pacientes, tanto de la EE anterior mediante biomicroscopía ultrasónica (UBM), como de la EE posterior mediante ecografía A y B. El objetivo de este estudio es describir las características ecográficas de la UBM y de la ecografía A y B.Material y métodosSe realiza un estudio descriptivo y retrospectivo de los pacientes diagnosticados de melanoma uveal (UM) y EE desde 2003 hasta 2019. Las características ecográficas de la enfermedad local y el seguimiento luego del tratamiento se registraron de maneracompleta y en cada visita. En caso de EE anteriores se realizaron fotografías de segmento anterior y BMU, por el contrario las que involucran el segmento posterior se exploraron bajo ecografía modo A y B. Todos los ojos enucleados se enviaron para su estudio anatomopatológico.

Background and purposeUveal melanoma is the most common primary malignant intraocular tumour in the adult population, with a survival rate of 50% despite advances in treatment and knowledge of this disease. The presence of extraocular extension (EE) worsens the prognosis of these patients, so its proper identification can ensure its management and early intervention. Ophthalmological ultrasound is the technique of choice for the diagnosis and follow-up of these patients, both of the anterior EE using ultrasonic biomicroscopy (UBM), and the posterior EE using A and B ultrasound. The aim of this study is to describe the ultrasound characteristics of the BMU and the A and B ultrasound.Material and methodsA descriptive and retrospective study is carried out on patients diagnosed with uveal melanoma (UM) and EE from 2003 to 2019. The ultrasound characteristics of the local disease and the follow-up after treatment were recorded completely and at each visit. In the case of anterior EE, photographs of the anterior segment and UBM were taken, while those involving the posterior segment were explored under A and B mode ultrasound. All enucleated eyes were sent for anatomopathological study.

Contrary effects of flow intermittence and land uses on organic matter decomposition in a Mediterranean river basin.

Flow interruption in intermittent rivers (IRs) generates a mosaic of terrestrial and aquatic habitats across the river network affecting ecosystem processes, as organic matter (OM) decomposition. Water use for farming in arid and semi-arid climates intensifies the dry conditions and affects local river characteristics. In that way, flow intermittence and the distribution of land uses may affect the OM processing along the river. To understand the role of IRs in global OM dynamics and how global change affecting water flow regimes determines these dynamics, it is important to estimate OM-processing rates at a basin scale. The aim of this study was to evaluate the effect of the intensity of flow intermittence on OM processing, and how this effect was modulated by local environmental factors related to land uses across a Mediterranean river basin. To do this, wood decomposition (mass loss and fungal biomass) was selected as a functional indicator. Drying duration and frequency were measured to characterize flow intermittence in different reaches along the river, as well as local environmental factors. Linear models stablished the role of factors on decomposition. The results showed that differences in decomposition rates across the river network were negatively related to the duration of flow interruption. Dissolved inorganic nitrogen associated with agriculture counteracted the negative effect of intermittence on mass loss (increasing by up to three times); but with a higher duration of dry conditions, its effect was insignificant. An increase of 20% of canopy (higher in natural areas) resulted in increases of up to 5% of mass loss. Overall, our study is relevant to understanding the interaction between flow intermittence and land uses on OM processing, especially considering the intensification of flow intermittence and its increased distribution to other regions, which is expected to be a consequence of climate warming and human activities.

Clinical effectiveness of Lactobacillus reuteri in the treatment of peri-implant diseases: a systematic review and meta-analysis.

In the last decades, the presence of peri-implant diseases (PD) has increased. One of the therapies currently used is probiotics with Lactobacillus reuteri (LR). The aim of this article is to determinate, through a systematic review and meta-analysis, the clinical effectiveness of LR in the treatment of PD. We searched the literature until January 2021, in the biomedical databases: Pubmed, Embase, Scielo, Science Direct, Scopus, SIGLE, LILACS, Google Scholar and Cochrane Central Registry of Clinical Trials. The selection criteria of the studies were: randomized controlled clinical trials, without language and time restriction, reporting the clinical effects (depth to probing, plaque index and bleeding index) of the LR in the PD treatment. The risk of study bias was analyzed through the Cochrane tool for randomized studies using Review Manager software. The search strategy resulted in 6 articles of which four investigated peri-implantitis and three peri-implant mucositis. All studies reported that there was a difference in the depth of the probing in the treatment of PD, in favor of the group using LR, though not always achieving significance. The use of LR can be clinically effective in terms of pocket depth reduction in the treatment of PD.

Withdrawal of active treatments in terminally ill heart failure patients.

INTRODUCTION: Heart failure (HF) constitutes a growing public health problem in aging societies: when pharmacological therapies fail, HF can be sustained intensively if patients are eligible for either orthotopic heart transplantation (OHT) or mechanical ventricular assistance, otherwise additional treatments could be inappropriate. In December 2017 Italian Legislator brought in the provisions regarding the end-of-life choices, including indications for withdrawing and withholding life-sustaining therapies. The aim of our study was to provide an overview of the daily practice of our center with regard to terminally ill HF patients. METHODS AND RESULTS: In April 2019 the 7 intensivist cardiologists and 21 nurses of a tertiary ICCU were asked in, to complete a questionnaire relating to a hypothetical terminally ill HF patient for whom the decision to withdraw active treatment had been made. To assess current practice, we also identified patients who died in the previous 12 months. Out of 29 deceased patients, 18 were identified as terminally ill HF, with no indications for therapy upgrading. We observed a striking disparity between belief and practice. CONCLUSIONS: Our survey showed that the care of terminally ill HF patients in our ICCU was characterized by aggressive use of medical therapy and invasive technology. The wide disparity between belief and practice could be in part a consequence of lack of professional training, with regard to law, ethics and communication techniques.

Prevalence of cocaine use and cocaine use disorder among adult patients with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis.

We conducted this systematic review and meta-analysis (registered with PROSPERO CRD42020142039) of the literature to estimate the lifetime prevalence of cocaine use and cocaine use disorder among adult patients with attention-deficit/hyperactivity disorder (ADHD). The literature search was performed on the electronic databases PubMed and PsychINFO without date or language restrictions. Additional studies were identified by hand searching of citations. Inclusion criteria were: studies involving adult patients with ADHD and reporting cocaine use and/or cocaine use disorders. Data were pooled in the meta-analyses using a generalized linear mixed model with random effects. Statistical heterogeneity was assessed using the Cochran Q test. Sensitivity analyses were conducted. Twelve studies were included in the review: six in the meta-analysis of cocaine use and nine in the meta-analysis of cocaine use disorder. The estimated prevalence of cocaine use was 26.0% (95% CI 0.18-0.35) and the estimated prevalence of cocaine use disorder was 10.0% (95% CI 0.08-0.13). Heterogeneity in both meta-analyses was high but decreased to non-significance in the meta-analysis on cocaine use disorder after excluding the outlier study. In conclusion, one out of four adult patients with ADHD use cocaine and one out of ten develop a lifetime cocaine use disorder. Since cocaine use can lead to more severe and complex disorders of impaired systemic functioning, adult patients with ADHD should be assessed for cocaine use disorder and promptly referred for treatment.

Hydrological variations shape diversity and functional responses of streambed microbes.

Microbiota inhabiting the intermittent streambeds mediates several in-stream processes that are essential for ecosystem function. Reduced stream discharge caused by the strengthened intermittency and increased duration of the dry phase is a spreading global response to changes in climate. Here, the impacts of a 5-month desiccation, one-week rewetting and punctual storms, which interrupted the dry period, were examined. The genomic composition of total (DNA) and active (RNA) diversity, and the community level physiological profiles (CLPP) were considered as proxies for functional diversity to describe both prokaryotes and eukaryotes inhabiting the surface and hyporheic streambeds. Comparisons between the genomic and potential functional responses helped to understand how and whether the microbial diversity was sensitive to the environmental conditions and resource acquisition, such as water stress and extracellular enzyme activities, respectively. RNA expression showed the strongest relationship with the environmental conditions and resource acquisition, being more responsive to changing conditions compared to DNA diversity, especially in the case of prokaryotes. The DNA results presumably reflected the legacy of the treatments because inactive, dormant, or dead cells were included, suggesting a slow microbial biomass turnover or responses of the microbial communities to changes mainly through physiological acclimation. On the other hand, microbial functional diversity was largely explained by resources acquisition, such as metrics of extracellular enzymes, and appeared vulnerable to the hydrological changes and duration of desiccation. The data highlight the need to improve the functional assessment of stream ecosystems with the application of complementary metrics to better describe the streambed microbial dynamics under dry-rewet stress.

Maternal caesarean section infection (MACSI) in Sierra Leone: a case-control study.

Sierra Leone is the country with highest maternal mortality and infections are the underlying cause in 11% of maternal deaths, but the real burden remains unknown. This study aims to determine the incidence and risk factors of surgical site infection (SSI) post-caesarean section (CS) in women admitted to Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. A prospective case-control (1:3 ratio) study was implemented from 1 May 2018 to 30 April 2019 and 11 women presenting with suspected or confirmed infection post-CS were screened for inclusion as a case. For each case, three patients undergoing CS on the same day and admitted to the same ward, but not presenting with SSI, were selected as controls. The post-CS infection rate was 10.9%. Two hundred and fifty-four clinically confirmed cases were enrolled and matched with 762 control patients. By multivariable analysis, the risk factors for SSI were: being single (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.36-1.66), low education level (OR 1.68, 95% CI 1.55-1.84), previous CS (OR 1.27, 95% CI 1.10-1.52), presenting with premature membranes rupture (OR 1.49, 95% CI 1.18-1.88), a long decision-incision time (OR 2.08, 95% CI 1.74-2.24) and a high missing post-CS antibiotic doses rate (OR 2.52, 95% CI 2.10-2.85).

Nutritional assessment of an Italian population of elderly hip fracture patients: a comparison between sexes and types of fractures.

Malnutrition is highly prevalent in elderly patients with hip fractures (HF) (intracapsular and extracapsular). Many factors influence the patterns of HF, but the role of nutrition is not yet clear. In this investigation, an analysis of the body compositions of geriatric patients with HF was conducted, to identify differences in the nutritional status between male and female patients with intra- and extra-capsular HF. The nutritional assessment of patients was performed using three different techniques: anthropometrics measurement, plicometry, and bioimpedance analysis. The most prevalent type of fracture in females was the extracapsular type, while the intracapsular type is more common in males. Males showed a lower BMI, fat percentage and a greater length of hospital stay (LOS). Patients with intracapsular fractures are more malnourished compared with patients with extracapsular fractures. Males with HF have a higher prevalence of intracapsular fractures compared to women and stayed in hospital longer.

Ionized or Total Magnesium levels, what should we measure in critical ill patients?

Monitoring and measuring magnesium (Mg) values are essential to prevent the development of numerous complications in perioperative medicine and critically ill patients. Although previous studies suggest that measuring free ionized magnesium (iMg) is more useful for estimating Mg status, clinicians currently rely on measurement of total serum magnesium to determine if supplemental magnesium is needed. In this review, we analyzed the recent literature to decide whether it is better to measure ionized serum Mg or total serum Mg when assessing magnesium status, whether iMg predicts clinical outcome, and what are the difficulties in measuring serum iMg levels in intensive care patients and perioperative medicine.

Distinct responses from bacterial, archaeal and fungal streambed communities to severe hydrological disturbances.

Stream microbes that occur in the Mediterranean Basin have been shown to possess heightened sensitivity to intensified water stress attributed to climate change. Here, we investigate the effects of long-term drought (150 days), storms and rewetting (7 days) on the diversity and composition of archaea, bacteria and fungi inhabiting intermittent streambed sediment (surface and hyporheic) and buried leaves. Hydrological alterations modified the archaeal community composition more than the bacterial community composition, whereas fungi were the least affected. Throughout the experiment, archaeal communities colonizing sediments showed greater phylogenetic distances compared to those of bacteria and fungi, suggesting considerable adaptation to severe hydrological disturbances. The increase in the class abundances, such as those of Thermoplasmata within archaea and of Actinobacteria and Bacilli within bacteria, revealed signs of transitioning to a drought-favoured and soil-like community composition. Strikingly, we found that in comparison to the drying phase, water return (as sporadic storms and rewetting) led to larger shifts in the surface microbial community composition and diversity. In addition, microhabitat characteristics, such as the greater capacity of the hyporheic zone to maintain/conserve moisture, tended to modulate the ability of certain microbes (e.g., bacteria) to cope with severe hydrological disturbances.

Levosimendan in Acute and Advanced Heart Failure: an Expert Perspective on Posology and Therapeutic Application.

Levosimendan, a calcium sensitizer and potassium channel-opener, is widely appreciated by many specialist heart failure practitioners for its effects on systemic and pulmonary hemodynamics and for the relief of symptoms of acute heart failure. The drug's impact on mortality in large randomized controlled trials has been inconsistent or inconclusive but, in contrast to conventional inotropes, there have been no indications of worsened survival and some signals of improved heart failure-related quality of life. For this reason, levosimendan has been proposed as a safer inodilator option than traditional agents in settings, such as advanced heart failure. Positive effects of levosimendan on renal function have also been described. At the HEART FAILURE 2018 congress of the Heart Failure Association of the European Society of Cardiology, safe and effective use levosimendan in acute and advanced heart failure was examined in a series of expert tutorials. The proceedings of those tutorials are summarized in this review, with special reference to advanced heart failure and heart failure with concomitant renal dysfunction. Meta-analysis of clinical trials data is supportive of a renal-protective effect of levosimendan, while physiological observations suggest that this effect is exerted at least in part via organ-specific effects that may include selective vasodilation of glomerular afferent arterioles and increased renal blood flow, with no compromise of renal oxygenation. These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.

Septoplasty: is it possible to identify potential "predictors" of surgical success?

Septoplasty is one of the most frequent surgical procedures performed by otolaryngologists. Despite successful surgical correction, many patients are not satisfied with their outcomes. So far, in clinical practice there is no consensus of opinion about the reliability of objective measurements of nasal patency and the correlation between objective measurements and subjective nasal patency symptoms. This study aims to assess the reasons for patient dissatisfaction after septoplasty and optimise pre-operative diagnostic management to predict surgical outcomes. We analysed 494 patients undergoing septoplasties with turbinoplasty by subjective Nasal Obstruction Symptom Evaluation questionnaire (NOSE) and objective active anterior rhinomanometric measurements before surgery and after 6 months. In our series, 17% had postoperative septal re-displacement; all patients had an anterior deviations at baseline. We found that the type of septal deviation, anterior vs posterior, was a significant predictor of postoperative functional improvement, whereas demographic characteristics as age, gender and smoke habit were not. Our data suggest that the anterior segment of the nasal septum was the most critical area for nasal airway resistance and more difficult to manage because it is likely to re-displace vs the posterior one and for this reason it represents a negative predictor of postoperative satisfaction.

Análisis de resultados de artrodesis Tibioastragalinocalcánea con clavo retrógrado intramedular / Outcomes of tibiotalocalcaneal arthrodesis with retrograde intramedullary nail

Introducción y objetivos: La artrodesis tibioastragalinocalcánea sigue siendo el gold-standard como tratamiento para las artropatías severas de tobillo. El objetivo es analizar los resultados funcionales y radiográficos obtenidos de la artrodesis de tobillo mediante clavo intramedular retrógado. Material y método: Estudio observacional, descriptivo y retrospectivo sobre 21 casos de artrodesis de tobillo. Se recogieron variables epidemiológicas, etiología, factores de riesgo y fecha de intervención. Los resultados funcionales se valoraron mediante la Escala Visual Analógica, grado de satisfacción y la escala: American Orthopaedic Foot and Ankle Society (AOFAS) postquirúrgica, así como tasa de consolidación. Analizamos las complicaciones ocurridas y su tratamiento. Resultados: La causa más frecuente de artrosis de tobillo fue la artropatía postraumática, con el 62%. El 82% de nuestros pacientes se encuentran satisfechos con la intervención. Aplicando la escala AOFAS obtuvimos una media en la escala global de 61,88 (rango 43-86). La tasa de consolidación fue de 94%. La tasa total de complicaciones fue del 53%. Considerando las complicaciones mayores encontramos una tasa del 26%, mientras que las menores supusieron el 26% del total. Conclusión: La artrodesis tibioastragalinocalcánea mediante clavo intramedular retrógrado es una técnica satisfactoria en pacientes con artropatía severa de tobillo, pero no exenta de complicaciones

Background: Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail is the gold standard treatment for severe ankle arthropathies. The aim was to analyze the results of arthrodesis obtained using retrograde intramedullary nail. This study reports the rate of consolidation, functional outcomes and complications. Methods: An observational, descriptive and retrospective study on 21 cases of ankle arthrodesis. Epidemiological variables, etiology, risk factors and date of intervention were collected. The functional results were assessed using the Visual Analogue Scale, satisfaction rating and the American Orthopaedic Foot and Ankle Society (AOFAS) scale, as well as the consolidation rate. We analyze the complications and their treatment. Results: Sixty two percent of our patients had a posttraumatic arthropathy. Eighty two percent of them were satisfied or very satisfied with the intervention. We obtained an average of 61.88 (range, 43-86) in AOFAS score. The consolidation rate was 94%. We had a total complication of 53%. If we considered major complication, we found 26%. While the minor one, was 26% of the total. Conclusion: Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail is a satisfactory technique in patients with severe ankle arthropathy, although it has several complications