Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey.

BACKGROUND: The methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown. The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. METHODS: Using a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. RESULTS: The survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population. Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients' discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. CONCLUSIONS: This study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.

Miniaturized flexible micro-tube plasma ionization source for the effective ionization of non-easily ionizable pesticides in food with liquid chromatography/mass spectrometry.

In this article, we have studied the potential of flexible microtube plasma (FµTP) as ionization source for the liquid chromatography high-resolution mass spectrometry detection of non-easily ionizable pesticides (viz. nonpolar and non-ionizable by acid/basic moieties). Phthalimide-related compounds such as dicofol, dinocap, o-phenylphenol, captan, captafol, folpet and their metabolites were studied. Dielectric barrier discharge ionization (DBDI) was examined using two electrode configurations, including the miniaturized one based on a single high-voltage (HV) electrode and a virtual ground electrode configuration (FµTP), and also the two-ring electrode DBDI configuration. Different ionization pathways were observed to ionize these challenging, non-easily ionizable nonpolar compounds, involving nucleophilic substitutions and proton abstraction, with subtle differences in the spectra obtained compared with APCI. An average sensitivity increase of 5-fold was attained compared with the standard APCI source. In addition, more tolerance with matrix effects was observed in both DBDI sources. The importance of the data reported is not just limited to the sensitivity enhancement compared to APCI, but, more notably, to the ability to effectively ionize nonpolar, late-eluting (in reverse-phase chromatography) non-ionizable compounds. Besides o-phenylphenol ([M - H]-), all the parent species were efficiently ionized through different mechanisms involving bond cleavages through the effect of plasma reagent species or its combination with thermal degradation and subsequent ionization. This tool can be used to figure out overlooked nonpolar compounds in different environmental samples of societal interest through non-target screening (NTS) strategies.

Comparative proteomic analysis of the hemolymph and salivary glands of Rhodnius prolixus and R. colombiensis reveals candidates associated with differential lytic activity against Trypanosoma cruzi Dm28c and T. cruzi Y.

BACKGROUND: Immune response of triatomines plays an important role in the success or failure of transmission of T. cruzi. Studies on parasite-vector interaction have shown the presence of trypanolytic factors and have been observed to be differentially expressed among triatomines, which affects the transmission of some T. cruzi strains or DTUs (Discrete Typing Units). METHODOLOGY/PRINCIPAL FINDINGS: Trypanolytic factors were detected in the hemolymph and saliva of R. prolixus against epimastigotes and trypomastigotes of the Y strain (T. cruzi II). To identify the components of the immune response that could be involved in this lytic activity, a comparative proteomic analysis was carried out, detecting 120 proteins in the hemolymph of R. prolixus and 107 in R. colombiensis. In salivary glands, 1103 proteins were detected in R. prolixus and 853 in R. colombiensis. A higher relative abundance of lysozyme, prolixin, nitrophorins, and serpin as immune response proteins was detected in the hemolymph of R. prolixus. Among the R. prolixus salivary proteins, a higher relative abundance of nitrophorins, lipocalins, and triabins was detected. The higher relative abundance of these immune factors in R. prolixus supports their participation in the lytic activity on Y strain (T. cruzi II), but not on Dm28c (T. cruzi I), which is resistant to lysis by hemolymph and salivary proteins of R. prolixus due to mechanisms of evading oxidative stress caused by immune factors. CONCLUSIONS/SIGNIFICANCE: The lysis resistance observed in the Dm28c strain would be occurring at the DTU I level. T. cruzi I is the DTU with the greatest geographic distribution, from the south of the United States to central Chile and Argentina, a distribution that could be related to resistance to oxidative stress from vectors. Likewise, we can say that lysis against strain Y could occur at the level of DTU II and could be a determinant of the vector inability of these species to transmit T. cruzi II. Future proteomic and transcriptomic studies on vectors and the interactions of the intestinal microbiota with parasites will help to confirm the determinants of successful or failed vector transmission of T. cruzi DTUs in different parts of the Western Hemisphere.

Gravitational Raman Scattering in Effective Field Theory: A Scalar Tidal Matching at O(G

We present a framework to compute amplitudes for the gravitational analog of the Raman process, a quasielastic scattering of waves off compact objects, in worldline effective field theory. As an example, we calculate third post-Minkowskian order [O(G^{3})], or two-loop, phase shifts for the scattering of a massless scalar field including all tidal effects and dissipation. Our calculation unveils two sources of the classical renormalization-group flow of dynamical Love numbers: a universal running independent of the nature of the compact object, and a running self-induced by tides. Restricting to the black hole case, we find that our effective field theory phase shifts agree exactly with those from general relativity, provided that the relevant static Love numbers are set to zero. In addition, we carry out a complete matching of the leading scalar dynamical Love number required to renormalize a universal short scale divergence in the S wave. Our results pave the way for systematic calculations of gravitational Raman scattering at higher post-Minkowskian orders.

Jagged2 targeting in lung cancer activates anti-tumor immunity via Notch-induced functional reprogramming of tumor-associated macrophages.

Signaling through Notch receptors intrinsically regulates tumor cell development and growth. Here, we studied the role of the Notch ligand Jagged2 on immune evasion in non-small cell lung cancer (NSCLC). Higher expression of JAG2 in NSCLC negatively correlated with survival. In NSCLC pre-clinical models, deletion of Jag2, but not Jag1, in cancer cells attenuated tumor growth and activated protective anti-tumor T cell responses. Jag2-/- lung tumors exhibited higher frequencies of macrophages that expressed immunostimulatory mediators and triggered T cell-dependent anti-tumor immunity. Mechanistically, Jag2 ablation promoted Nr4a-mediated induction of Notch ligands DLL1/4 on cancer cells. DLL1/4-initiated Notch1/2 signaling in macrophages induced the expression of transcription factor IRF4 and macrophage immunostimulatory functionality. IRF4 expression was required for the anti-tumor effects of Jag2 deletion in lung tumors. Antibody targeting of Jagged2 inhibited tumor growth and activated IRF4-driven macrophage-mediated anti-tumor immunity. Thus, Jagged2 orchestrates immunosuppressive systems in NSCLC that can be overcome to incite macrophage-mediated anti-tumor immunity.

Effective Field Theory for Extreme Mass Ratio Binaries.

We derive an effective field theory describing a pair of gravitationally interacting point particles in an expansion in their mass ratio, also known as the self-force (SF) expansion. The 0SF dynamics are trivially obtained to all orders in Newton's constant by the geodesic motion of the light body in a Schwarzschild background encoding the gravitational field of the heavy body. The corrections at 1SF and higher are generated by perturbations about this configuration-that is, the geodesic deviation of the light body and the fluctuation graviton-but crucially supplemented by an operator describing the recoil of the heavy body as it interacts with the smaller companion. Using this formalism we compute new results at third post-Minkowskian order for the conservative dynamics of a system of gravitationally interacting massive particles coupled to a set of additional scalar and vector fields.

A phased genome assembly of a Colombian Trypanosoma cruzi TcI strain and the evolution of gene families.

Chagas is an endemic disease in tropical regions of Latin America, caused by the parasite Trypanosoma cruzi. High intraspecies variability and genome complexity have been challenges to assemble high quality genomes needed for studies in evolution, population genomics, diagnosis and drug development. Here we present a chromosome-level phased assembly of a TcI T. cruzi strain (Dm25). While 29 chromosomes show a large collinearity with the assembly of the Brazil A4 strain, three chromosomes show both large heterozygosity and large divergence, compared to previous assemblies of TcI T. cruzi strains. Nucleotide and protein evolution statistics indicate that T. cruzi Marinkellei separated before the diversification of T. cruzi in the known DTUs. Interchromosomal paralogs of dispersed gene families and histones appeared before but at the same time have a more strict purifying selection, compared to other repeat families. Previously unreported large tandem arrays of protein kinases and histones were identified in this assembly. Over one million variants obtained from Illumina reads aligned to the primary assembly clearly separate the main DTUs. We expect that this new assembly will be a valuable resource for further studies on evolution and functional genomics of Trypanosomatids.

New Ascomycetes from the Mexican Tropical Montane Cloud Forest.

The tropical montane cloud forest is the most diverse and threatened vegetation type in Mexico. In the last decade, the number of described Ascomycetes species has notably increased, reaching more than 1300 species. This study describes six new species based on their molecular and morphological characteristics. Our results suggest that Mexico has the highest number of described species in the Neotropics. However, many other Mexican lineages still need to be described.

Non-reciprocal and non-Newtonian mechanical metamaterials.

Non-Newtonian liquids are characterized by stress and velocity-dependent dynamical response. In elasticity, and in particular, in the field of phononics, reciprocity in the equations acts against obtaining a directional response for passive media. Active stimuli-responsive materials have been conceived to overcome it. Significantly, Milton and Willis have shown theoretically in 2007 that quasi-rigid bodies containing masses at resonance can display a very rich dynamical behavior, hence opening a route toward the design of non-reciprocal and non-Newtonian metamaterials. In this paper, we design a solid structure that displays unidirectional shock resistance, thus going beyond Newton's second law in analogy to non-Newtonian fluids. We design the mechanical metamaterial with finite element analysis and fabricate it using three-dimensional printing at the centimetric scale (with fused deposition modeling) and at the micrometric scale (with two-photon lithography). The non-Newtonian elastic response is measured via dynamical velocity-dependent experiments. Reversing the direction of the impact, we further highlight the intrinsic non-reciprocal response.

Behavioral signatures of face perception emerge in deep neural networks optimized for face recognition.

Human face recognition is highly accurate and exhibits a number of distinctive and well-documented behavioral "signatures" such as the use of a characteristic representational space, the disproportionate performance cost when stimuli are presented upside down, and the drop in accuracy for faces from races the participant is less familiar with. These and other phenomena have long been taken as evidence that face recognition is "special". But why does human face perception exhibit these properties in the first place? Here, we use deep convolutional neural networks (CNNs) to test the hypothesis that all of these signatures of human face perception result from optimization for the task of face recognition. Indeed, as predicted by this hypothesis, these phenomena are all found in CNNs trained on face recognition, but not in CNNs trained on object recognition, even when additionally trained to detect faces while matching the amount of face experience. To test whether these signatures are in principle specific to faces, we optimized a CNN on car discrimination and tested it on upright and inverted car images. As we found for face perception, the car-trained network showed a drop in performance for inverted vs. upright cars. Similarly, CNNs trained on inverted faces produced an inverted face inversion effect. These findings show that the behavioral signatures of human face perception reflect and are well explained as the result of optimization for the task of face recognition, and that the nature of the computations underlying this task may not be so special after all.

Zika virus infection induces expression of NRF2 and antioxidant systems in trophoblast cells.

The nuclear factor erythroid 2-related factor 2 (NRF2) is a transcription factor that plays a critical role in the xenobiotic and stress responses. During viral infection, NRF2 can modulate the host metabolism and innate immunity; however, the most common activity of NRF2 in viral diseases is controlling reactive oxygen species (ROS). The Zika virus (ZIKV) is involved in a vertical infection in pregnancy, with reported fetal health consequences. However, the possibility that ZIKV regulates NRF2 expression in placental trophoblasts has not been investigated. In this report, we evaluated the upregulation of NRF2 and antioxidant enzymes in a trophoblast-like cell. These findings could help us understand the antioxidant mechanism underlying the ZIKV infection in the placenta during pregnancy.

Micro-Scale Mechanical Metamaterial with a Controllable Transition in the Poisson's Ratio and Band Gap Formation.

The ability to significantly change the mechanical and wave propagation properties of a structure without rebuilding it is currently one of the main challenges in the field of mechanical metamaterials. This stems from the enormous appeal that such tunable behavior may offer from the perspective of applications ranging from biomedical to protective devices, particularly in the case of micro-scale systems. In this work, a novel micro-scale mechanical metamaterial is proposed that can undergo a transition from one type of configuration to another, with one configuration having a very negative Poisson's ratio, corresponding to strong auxeticity, and the other having a highly positive Poisson's ratio. The formation of phononic band gaps can also be controlled concurrently which can be very useful for the design of vibration dampers and sensors. Finally, it is experimentally shown that the reconfiguration process can be induced and controlled remotely through application of a magnetic field by using appropriately distributed magnetic inclusions.

Dielectric Barrier Discharge Ionization Mechanisms: Polycyclic Aromatic Hydrocarbons as a Case of Study.

Dielectric barrier discharge ionization (DBDI) is a versatile tool for small-molecule mass spectrometry applications, helping cover from polar to low polar molecules. However, the plasma gas-phase interactions are highly complex and have been scarcely investigated. The ionization mechanisms of plasmas have long been assumed to be somewhat similar to atmospheric pressure chemical ionization (APCI). Here, we evaluated the ionization mechanisms of a two-ring DBDI ion source, using different discharge gases to analyze vaporized liquid samples. Polycyclic aromatic hydrocarbons (PAHs) were used as model analytes to assess the mechanisms' dominance: protonation, [M + H]+, or radical ion species formation, [M]·+. In the present work, two different ionization trends were observed for APCI and DBDI during the PAH analysis; the compounds with proton affinities (PA) over 856 kJ/mol were detected as [M + H]+ when APCI was used as ionization source. Meanwhile, independently of the PA, DBDI showed the prevalence of charge exchange reactions. The addition of dopants in the gas-phase region shifted the ionization mechanisms toward charge exchange reactions, facilitating the formation of [M]·+ ion species, showing anisole a significant boost of the PAH radical ion species signals, over nine times for Ar-Prop-DBDI analysis. The presence of high-energy metastable atoms (e.g., HeM) with high ionization potentials (IE = 19.80 eV) did not show boosted PAH abundances or extensive molecule fragmentation. Moreover, other species in the plasma jet region with closer and more appropriate IE, such as N2 B3Πg excited molecules, are likely responsible for PAH Penning ionization.

Nonperturbative Double Copy in Flatland.

We derive a nonperturbative, Lagrangian-level formulation of the double copy in two spacetime dimensions. Our results elucidate the field theoretic underpinnings of the double copy in a broad class of scalar theories which can include masses and higher-dimension operators. An immediate corollary is the amplitudes-level double copy at all orders in perturbation theory. Applied to certain integrable models, the double copy defines an isomorphism between Lax connections, Wilson lines, and infinite towers of conserved currents. We also implement the double copy at the level of nonperturbative classical solutions, both analytically and numerically, and present a generalization of the double copy map that includes a fixed tower of higher-dimension corrections given by the Moyal algebra.

3D Auxetic Metamaterials with Elastically-Stable Continuous Phase Transition.

In solid state physics, phase transitions can influence material functionality and alter their properties. In mechanical metamaterials, structural-phase transitions can be achieved through instability or buckling of certain structural elements. However, these fast transitions in one mechanical parameter typically affect significantly the remaining parameters, hence, limiting their applications. Here, this limitation is addressed by designing a novel 3D mechanical metamaterial that is capable of undergoing a phase transition from positive to negative Poisson's ratio under compression, without significant degradation of Young's modulus (i.e. the phase transition is elastically-stable). The metamaterial is fabricated by two-photon lithography at the micro-scale and its mechanical behavior is assessed experimentally. For another choice of structural parameters, it is then shown that the auxetic behavior of the considered 3D metamaterial class can be maintained over a wide range of applied compressive strain.

Ablation of the endoplasmic reticulum stress kinase PERK induces paraptosis and type I interferon to promote anti-tumor T cell responses.

Activation of unfolded protein responses (UPRs) in cancer cells undergoing endoplasmic reticulum (ER) stress promotes survival. However, how UPR in tumor cells impacts anti-tumor immune responses remains poorly described. Here, we investigate the role of the UPR mediator pancreatic ER kinase (PKR)-like ER kinase (PERK) in cancer cells in the modulation of anti-tumor immunity. Deletion of PERK in cancer cells or pharmacological inhibition of PERK in melanoma-bearing mice incites robust activation of anti-tumor T cell immunity and attenuates tumor growth. PERK elimination in ER-stressed malignant cells triggers SEC61ß-induced paraptosis, thereby promoting immunogenic cell death (ICD) and systemic anti-tumor responses. ICD induction in PERK-ablated tumors stimulates type I interferon production in dendritic cells (DCs), which primes CCR2-dependent tumor trafficking of common-monocytic precursors and their intra-tumor commitment into monocytic-lineage inflammatory Ly6C+CD103+ DCs. These findings identify how tumor cell-derived PERK promotes immune evasion and highlight the potential of PERK-targeting therapies in cancer immunotherapy.

Characteristics and factors associated with mortality due to rare diseases in Chile, 2002-2017 / Caracterización y factores asociados a la mortalidad debida a enfermedades huérfanas en Chile, 2002-2017.

Introduction: Rare diseases are characterized by their low prevalence, chronically debilitating and life-threatening nature. Objective: To determine the characteristics and factors associated with mortality due to rare diseases in Chile from 2002 to 2017. Materials and methods: We conducted an analytical cross-sectional study based on secondary mortality database from the Departamento de Estadística e Información en Salud (DEIS), Ministerio de Salud de Chile (Department of Statistics and Health Information, Chile Ministry of Health) from 2002 to 2017. The specific mortality rates adjusted by age and sex were calculated. A normality analysis was conducted using the Kolmogorov-Smirnov test. In addition, a chi-square test of independence for associations and multivariate logistic regression was applied to determine the probability of death. Results: Between 2008 and 2012 there were 10,718 deaths due to rare diseases, 53.2% of them occurred among women. The average annual mortality rate was 3.9 per 100,000 inhabitants: 4.1 in women and 3.8 in men. The main causes of mortality among women were Creutzfeldt-Jakob disease, anencephaly and autoinmune hepatitis, and among men, Creutzfeldt-Jakob disease, muscular dystrophy and anencephaly. Women are 1.75 times more likely to die than men (adjusted Odds Ratio (aOR) = 1.75; 95% CI: 1.69 - 1.82). The highest probability of dying occurred among children aged 0-4 years (aOR = 15.30; 95% CI: 14.10 - 19.20). Conclusion: Overall, the burden of mortality due to rare disease was higher among women of all ages in Chile between 2002 and 2017.

Introducción. Las enfermedades huérfanas se caracterizan por su baja prevalencia, comúnmente son de evolución crónica, debilitantes y potencialmente mortales. Objetivo. Determinar las características y los factores asociados a la mortalidad por enfermedades huérfanas en Chile, entre 2002 y 2017. Materiales y métodos. Es un estudio transversal y analítico a partir de datos secundarios oficiales del Departamento de Estadística e Información en Salud (DEIS) del Ministerio de Salud de Chile. Se calcularon las tasas de mortalidad específica, y las ajustadas por sexo y edad. Se efectuó un análisis de normalidad mediante la prueba de Kolmogórov-Smirnov. Se aplicaron la prueba de ji al cuadrado de independencia para las asociaciones y el análisis de regresión logística multivariada para determinar la probabilidad de muerte. Resultados. Durante el periodo de estudio, 10.718 defunciones se atribuyeron a enfermedades huérfanas; 53,2 % ocurrieron en mujeres. La tasa media anual de mortalidad fue de 3,9 por 100.000 habitantes: 4,1 en mujeres y 3,8 en hombres. Las principales causas de muerte, en mujeres, fueron enfermedad de Creutzfeldt-Jakob, anencefalia, hepatitis autoinmunitaria y, en hombres, enfermedad de Creutzfeldt-Jakob, distrofia muscular y anencefalia. Las mujeres tienen 1,75 más veces la posibilidad de fallecer por este grupo de enfermedades en comparación con los hombres (OR ajustado=1,75; IC95% 1,69-1,82). La mayor probabilidad de morir se presentó en los menores de 0 a 4 años (OR ajustado=15,30; IC95% 14,10-19,20). Conclusión. En Chile, las mujeres constituyeron el grupo de población de mayor riesgo de morir por enfermedades huérfanas durante los años 2002 y 2017.

Liquid chromatography-dielectric barrier discharge ionization mass spectrometry for the analysis of neutral lipids of archaeological interest.

Dielectric barrier discharge ionization has gained attention in the last few years due to its versatility and the vast array of molecules that can be ionized. In this study, we report on the assessment of liquid chromatography coupled to dielectric barrier discharge ionization with mass spectrometry for neutral lipid analysis. A set of different neutral lipid subclasses (triacylglycerides, diacylglycerides, and sterols) were selected for the study. The main species detected from our ionization source were [M-H2 O+H]+ , [M+H]+ or [M-R-H2 O+H]+ , attributed to sterol dehydration, protonation or the fragmentation of an acyl chain accompanied by a water loss of the glycerolipids, respectively. In terms of sensitivity, the dielectric barrier discharge displayed overall improved abundances and comparable or better limits of quantitation than atmospheric pressure chemical ionization for both acylglycerols and sterols. As a case study, different archaeological samples with variable content in neutral lipids, particularly triacylglycerides, were studied. The identification was carried out by combining accurate mass and the tentative formula associated with the exact mass, retention time matching with standards, and additional structural information from in-source fragmentation. The high degree of unsaturation and the presence of sterols revealed the potential vegetal origin of the material stored in the analyzed samples.

Single-Step-Lithography Micro-Stepper Based on Frictional Contact and Chiral Metamaterial.

Stepper motors and actuators are among the main constituents of control motion devices. They are complex multibody systems with rather large overall volume due to their multifunctional parts and elaborate technological assembly processes. Miniaturization of individual parts is still posing assembly problems. In this paper, a single-step lithography process to fabricate a micro-stepper engine with an accurate micrometric rotation axis and an overall sub-millimeter size is demonstrated. The device is based on the frictional contacts and chiral metamaterials to get rid of the dependence on the accuracy of parts. The functional aspects of fabricated samples are discussed for many rotation cycles and for different frictional surfaces.

Plasma neurofilament light chain levels suggest neuroaxonal stability following therapeutic remyelination in people with multiple sclerosis.

BACKGROUND: Chronic demyelination is a major contributor to axonal vulnerability in multiple sclerosis (MS). Therefore, remyelination could provide a potent neuroprotective strategy. The ReBUILD trial was the first study showing evidence for successful remyelination following treatment with clemastine in people with MS (pwMS) with no evidence of disease activity or progression (NEDAP). Whether remyelination was associated with neuroprotection remains unexplored. METHODS: Plasma neurofilament light chain (NfL) levels were measured from ReBUILD trial's participants. Mixed linear effect models were fit for individual patients, epoch and longitudinal measurements to compare NfL concentrations between samples collected during the active and placebo treatment period. RESULTS: NfL concentrations were 9.6% lower in samples collected during the active treatment with clemastine (n=53, geometric mean=6.33 pg/mL) compared to samples collected during treatment with placebo (n=73, 7.00 pg/mL) (B=-0.035 [-0.068 to -0.001], p=0.041). Applying age- and body mass index-standardised NfL Z-scores and percentiles revealed similar results (0.04 vs 0.35, and 27.5 vs 33.3, p=0.023 and 0.042, respectively). Higher NfL concentrations were associated with more delayed P100 latencies (B=1.33 [0.26 to 2.41], p=0.015). In addition, improvement of P100 latencies between visits was associated with a trend for lower NfL values (B=0.003 [-0.0004 to 0.007], p=0.081). Based on a Cohen's d of 0.248, a future 1:1 parallel-arm placebo-controlled study using a remyelinating agent with comparable effect as clemastine would need 202 subjects per group to achieve 80% power. CONCLUSIONS: In pwMS, treatment with the remyelinating agent clemastine was associated with a reduction of blood NfL, suggesting that neuroprotection is achievable and measurable with therapeutic remyelination. TRIAL REGISTRATION NUMBER: NCT02040298.