Decisional Conflict Regarding Disease-Modifying Treatment Choices Among Patients with Mid-Stage Relapsing-Remitting Multiple Sclerosis.

Purpose: Shared decision-making is critical in multiple sclerosis (MS) due to the uncertainty of the disease trajectory over time and the large number of treatment options with differing efficacy, safety and administration characteristics. The aim of this study was to assess patients' decisional conflict regarding the choice of a disease-modifying therapy and its associated factors in patients with mid-stage relapsing-remitting multiple sclerosis (RRMS). Methods: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS (2017 revised McDonald criteria) and disease duration of 3 to 8 years were included. The level of uncertainty experienced by a patient when faced with making a treatment choice was assessed using the 4-item Decisional Conflict Scale. A battery of patient-reported and clinician-rated measures was administered to obtain information on symptom severity, illness perception, illness-related uncertainty, regret, MS knowledge, risk taking behavior, preferred role in the decision-making process, cognition, and self-management. Patients were recruited during routine follow-up visits and completed all questionnaires online using electronic tablets at the hospital. A multivariate logistic regression analysis was conducted. Results: A total of 201 patients were studied. Mean age (Standard deviation) was 38.7 (8.4) years and 74.1% were female. Median disease duration (Interquartile range) was 6.0 (4.0-7.0) years. Median EDSS score was 1.0 (0-2.0). Sixty-seven (33.3%) patients reported a decisional conflict. These patients had lower MS knowledge and more illness uncertainty, anxiety, depressive symptoms, fatigue, subjective symptom severity, a threatening illness perception, and poorer quality of life than their counterparts. Lack of decisional conflict was associated with MS knowledge (Odds ratio [OR]=1.195, 95% CI 1.045, 1.383, p=0.013), self-management (OR=1.049, 95% CI 1.013, 1.093, p=0.018), and regret after a healthcare decision (OR=0.860, 95% CI 0.756, 0.973, p=0.018) in the multivariate analysis. Conclusion: Decisional conflict regarding the selection of a disease-modifying therapy was a common phenomenon in patients with mid-stage RRMS. Identifying factors associated with decisional conflict may be useful to implement preventive strategies that help patients better understand their condition and strengthen their self-management resources.

Bayesian inverse problem for a fractional diffusion model of cell migration.

In the present work, both direct and inverse problems are considered for a Fisher-type fractional diffusion equation, which is proposed to describe the phenomenon of cell migration. For the direct problem, a solution is given via the Fourier method and the Laplace transform. On the other hand, we solved the inverse problem from a Bayesian statistical framework using a set of data that are the result of a cell migration experiment on a wound closure assay. We estimated the parameters of the mathematical model via Markov Chain Monte Carlo methods.

Reframing acute kidney injury as a pathophysiological continuum of disrupted renal excretory function.

Surrogate measures of glomerular filtration rate (GFR) continue to serve as pivotal determinants of the incidence, severity, and management of acute kidney injury (AKI), as well as the primary reference point underpinning knowledge of its pathophysiology. However, several clinically important deficits in aspects of renal excretory function during AKI other than GFR decline, including acid-base regulation, electrolyte and water balance, and urinary concentrating capacity, can evade detection when diagnostic criteria are built around purely GFR-based assessments. The use of putative markers of tubular injury to detect "sub-clinical" AKI has been proposed to expand the definition and diagnostic criteria for AKI, but their diagnostic performance is curtailed by ambiguity with respect to their biological meaning and context specificity. Efforts to devise new holistic assessments of overall renal functional compromise in AKI would foster the capacity to better personalize patient care by replacing biomarker threshold-based diagnostic criteria with a shift to assessment of compromise along a pathophysiological continuum. The term AKI refers to a syndrome of sudden renal deterioration, the severity of which is classified by precise diagnostic criteria that have unquestionable utility in patient management as well as blatant limitations. Particularly, the absence of an explicit pathophysiological definition of AKI curtails further scientific development and clinical handling, entrapping the field within its present narrow GFR-based view. A refreshed approach based on a more holistic consideration of renal functional impairment in AKI as the basis for a new diagnostic concept that reaches beyond the boundaries imposed by the current GFR threshold-based classification of AKI, capturing broader aspects of pathogenesis, could enhance AKI prevention strategies and improve AKI patient outcome and prognosis.

Ultrasound-Assisted Extraction of Bioactive Compounds from Broccoli By-Products.

The objective of this work was to gain insight into the operating conditions that affect the efficiency of ultrasound-assisted extraction (UAE) parameters to achieve the best recovery of bioactive compounds from broccoli leaf and floret byproducts. Therefore, total phenolic content (TPC) and the main sulfur bioactive compounds (sulforaphane (SFN) and glucosinolates (GLSs)) were assayed. Distilled water was used as solvent. For each byproduct type, solid/liquid ratio (1:25 and 2:25 g/mL), temperature (25, 40, and 55 °C), and extraction time (2.5, 5, 7.5, 10, 15, and 20 min) were the studied variables to optimize the UAE process by using a kinetic and a cubic regression model. TPC was 12.5-fold higher in broccoli leaves than in florets, while SFN was from 2.5- to 4.5-fold higher in florets regarding the leaf's extracts obtained from the same plants, their precursors (GLS) being in similar amounts for both plant tissues. The most efficient extraction conditions were at 25 °C, ratio 2:25, and during 15 or 20 min according to the target phytochemical to extract. In conclusion, the type of plant tissue and used ratio significantly influenced the extraction of bioactive compounds, the most efficient UAE parameters being those with lower energy consumption.

Effectiveness of a Prostacyclin IP Receptor Agonist in Patients With Pulmonary Arterial Hypertension in the Real-world Andalusian Setting: The RAMPHA Study.

PURPOSE: The pillar for therapeutic decisions in the evolution of pulmonary arterial hypertension (PAH) is the patients' prognostic stratification. METHODS: A retrospective cohort study was conducted in a Spanish real-world setting to assess the clinical improvement of PAH patients treated with selexipag measured as changes in the risk profile. Secondary objectives were to describe their baseline characteristics, initial risk status, and variables used to assess patient survival and adverse events. FINDINGS: Total 42 patients (mean age 52.36 [SD: 15.09] years) were included. All had received initial endothelin receptor antagonist treatment and 95.2% dual therapy with phosphodiesterase-5 inhibitor or riociguat. At 6 to 12 months from baseline, patients risk stratification tripled the percentage of patients with low risk, and a trend towards improved risk stratification (P = 0.122). World Health Organization functional class changed, with more patients in milder classes (P = 0.003), and symptom progression slowed down (P < 0.0001). At 3-years, survival was 85.7% and the estimated median survival time was 2.73 years (SD: 1.351; 95% CI: 2.51-2.95). IMPLICATIONS: Selexipag did not achieve a significant improvement in risk profile, although it did show an excellent survival rate, effectively improved functional class, and delayed symptom progression in real life. Selexipag was well tolerated and showed a favorable safety profile, supporting a clinical benefit for PAH patients.

Time series analysis of a 22-year record of 7Be, 210Pb and gross alpha activities in the Canary Islands (Spain) using Principal Component and Multifractal Detrended Fluctuation Analyses.

The long-term variability of a 22-year dataset of 7Be, 210Pb and gross alpha concentrations in surface aerosols collected in the Canary Islands has been analysed in this study. These "time series" were collected on a weekly basis. Various analytical techniques, including Principal Component Analysis (PCA), K-means clustering, correlation analyses, and back-trajectory were used to determine the variability of the data and assess the statistical importance of the source of the air masses reaching the study area. Monthly and annual variations for the time series were also studied. As expected, 7Be, 210Pb time series showed common variability, while gross alpha concentrations were strongly correlated with average PM10 concentration in air. The fractal properties of the time series were studied to gain a deeper understanding of the underlying structure and dynamics of the data. Multifractal Detrended Fluctuation Analysis (MF-DFA) and Multifractal Detrended Cross-Correlation Analysis (MF-DCCA) techniques were also used to detect and analyse the multifractal characteristics of the 7Be, 210Pb, and gross alpha time series. Multifractality was observed, with values of 0.28, 0.67, and 0.61 for 7Be, 210Pb, and gross alpha, respectively. Long-range correlation was found to be the source of the observed multifractality in the three parameters. Multifractal detrended cross-correlation analysis supports the correlation between 7Be - Alpha, 210Pb - Alpha, and 7Be - 210Pb pairs. The results from this study will help model the transport and destiny of natural radionuclides in the atmosphere at this site. The evolution and interactions between 7Be, 210Pb, and gross alpha, reported herein occurred not just locally but also across extensive temporal domains, leading to the emergence of multifractal behaviour in their concentrations. These long-range behaviours/correlations might result from various factors such as atmospheric circulation patterns, global transport mechanisms, or large-scale environmental processes.

Probing the Critical Role of Interfaces for Superior Performance in PbS Quantum Dot/Graphene Nanohybrid Broadband Photodetectors.

Colloidal quantum dots/graphene (QD/Gr) nanohybrids have been studied intensively for photodetection in a broadband spectrum including ultraviolet, visible, near-infrared, and shortwave infrared (UV-vis-NIR-SWIR). Since the optoelectronic process in the QD/Gr nanohybrid relies on the photogenerated charge carrier transfer from QDs to graphene, understanding the role of the QD-QD and QD-Gr interfaces is imperative to the QD/Gr nanohybrid photodetection. Herein, a systematic study is carried out to probe the effect of these interfaces on the noise, photoresponse, and specific detectivity in the UV-vis-NIR-SWIR spectrum. Interestingly, the photoresponse has been found to be negligible without a 3-mercaptopropionic acid (MPA) ligand exchange, moderate with a single ligand exchange after all QD layers are deposited on graphene, and maximum if it is performed after each QD layer deposition up to five layers of total QD thickness of 260-280 nm. Furthermore, exposure of graphene to C-band UV (UVC) for a short period of 4-5 min before QD deposition leads to improved photoresponse via removal of polar molecules at the QD/Gr interface. With the combination of the MPA ligand exchange and UVC exposure, optimal optoelectronic properties can be obtained on the PbS QD/Gr nanohybrids with high specific detectivity up to 2.6 × 1011, 1.5 × 1011, 5 × 1010, and 1.9 × 109 Jones at 400, 550, 1000, and 1700 nm, respectively, making the nanohybrids promising for broadband photodetection.

Effect of uric acid reduction on chronic kidney disease. Systematic review and meta-analysis.

Accumulating evidence suggests that hyperuricemia is a pathological factor in the development and progression of chronic kidney disease. However, the potential benefit afforded by the control of uric acid (UA) is controversial. Individual studies show discrepant results, and most existing meta-analysis, especially those including the larger number of studies, lack a placebo or control group as they aim to compare efficacy between drugs. On these grounds, we performed a me-ta-analysis restricted to studies including the action of any anti-gout therapies referenced to a control or placebo arm. This approach allows for a clearer association between UA reduction and renal effect. Of the twenty-nine papers included, most used allopurinol and febuxostat and, therefore, solid conclusions could only be obtained for these drugs. Both were very effective in reducing UA, but only allopurinol was able to significantly improve glomerular filtration rate (GFR), although not in a dose-dependent manner. These results raised doubts as to whether it is the hypouricemic effect of anti-gout drugs, or a pleiotropic effect, what provides protection of kidney function. Accordingly, in a correlation study that we next performed between UA reduction and GFR improvement, no association was found, which suggests that additional mechanisms may be involved. Of note, most trials show large inter-individual response variability, probably because they included patients with heterogeneous phenotypes and pathological characteristics, including different stages of CKD and comorbidities. This highlights the need to sub classify the effect of UA-lowering therapies according to the pathological scenario, in order to identify those CKD patients that may benefit most from them. Systematic Review Registration: CRD42022306646 https://www.crd.york.ac.uk/prospero/.

Biomechanical Fatigue Behavior of a Dental Implant Due to Chewing Forces: A Finite Element Analysis.

The use of titanium as a biomaterial for the treatment of dental implants has been successful and has become the most viable and common option. However, in the last three decades, new alternatives have emerged, such as polymers that could replace metallic materials. The aim of this research work is to demonstrate the structural effects caused by the fatigue phenomenon and the comparison with polymeric materials that may be biomechanically viable by reducing the stress shielding effect at the bone-implant interface. A numerical simulation was performed using the finite element method. Variables such as Young's modulus, Poisson's coefficient, density, yield strength, ultimate strength, and the S-N curve were included. Prior to the simulation, a representative digital model of both a dental implant and the bone was developed. A maximum load of 550 N was applied, and the analysis was considered linear, homogeneous, and isotropic. The results obtained allowed us to observe the mechanical behavior of the dental implant by means of displacements and von Mises forces. They also show the critical areas where the implant tends to fail due to fatigue. Finally, this type of non-destructive analysis proves to be versatile, avoids experimentation on people and/or animals, and reduces costs, and the iteration is unlimited in evaluating various structural parameters (geometry, materials, properties, etc.).

New avenues for potentially seeking microbial responses to climate change beneath Antarctic ice shelves.

The signs of climate change are undeniable, and the impact of these changes on ecosystem function heavily depends on the response of microbes that underpin the food web. Antarctic ice shelf is a massive mass of floating ice that extends from the continent into the ocean, exerting a profound influence on global carbon cycles. Beneath Antarctic ice shelves, marine ice stores valuable genetic information, where marine microbial communities before the industrial revolution are archived. Here, in this proof-of-concept, by employing a combination of single-cell technologiesand metagenomics, we have been able to sequence frozen microbial DNA (≈300 years old) stored in the marine ice core B15 collected from the Filchnner-Ronne Ice Shelf. Metagenomic data indicated that Proteobacteria and Thaumarchaeota (e.g., Nitrosopumilus spp.), followed by Actinobacteria (e.g., Actinomarinales), were abundant. Remarkably, our data allow us to "travel to the past" and calibrate genomic and genetic evolutionary changes for ecologically relevant microbes and functions, such as Nitrosopumilus spp., preserved in the marine ice (≈300 years old) with those collected recently in seawater under an ice shelf (year 2017). The evolutionary divergence for the ammonia monooxygenase gene amoA involved in chemolithoautotrophy was about 0.88 amino acid and 2.8 nucleotide substitution rate per 100 sites in a century, while the accumulated rate of genomic SNPs was 2,467 per 1 Mb of genome and 100 years. Whether these evolutionary changes remained constant over the last 300 years or accelerated during post-industrial periods remains an open question that will be further elucidated. IMPORTANCE: Several efforts have been undertaken to predict the response of microbes under climate change, mainly based on short-term microcosm experiments under forced conditions. A common concern is that manipulative experiments cannot properly simulate the response of microbes to climate change, which is a long-term evolutionary process. In this proof-of-concept study with a limited sample size, we demonstrate a novel approach yet to be fully explored in science for accessing genetic information from putative past marine microbes preserved under Antarctic ice shelves before the industrial revolution. This potentially allows us estimating evolutionary changes as exemplified in our study. We advocate for gathering a more comprehensive Antarctic marine ice core data sets across various periods and sites. Such a data set would enable the establishment of a robust baseline, facilitating a better assessment of the potential effects of climate change on key genetic signatures of microbes.

Read like a man: comparing narratives of masculinity in adolescent literature.

Recent movements like #MeToo and #TimesUp have surfaced and challenged ideas about masculinity in popular conversations. In particular, these ideas have centered around "toxic masculinity"-a version of masculinity that reflects stereotyped, dated, and even dangerous expectations for manhood. This notion of masculinity can be reinforced in a number of ways, especially through pop culture, where it runs the risk of becoming commonly accepted or normalized. This study evaluates the narratives of masculinity in three different novels that are marketed toward high school-aged students in the United States: Lord of the Flies; Gabi, A Girl in Pieces; and Aristotle and Dante Discover the Secrets of the Universe. Using a critical literacy lens, this study considers the symbols, behaviors, expectations, and meanings given to masculinity in and through each novel and considers the implications of this analysis for adolescent readership inside and outside of schooling. The study concludes that the more contemporary novels showcase a range of masculine portrayals, including positive, affirming versions of masculinity, compared to a more singular and pessimistic one found in a novel traditionally used in schools. Thus, the study concludes that formal schooling may be an important way to address and disrupt unhealthy versions of masculinity.

Vitamin A Positively Correlates with Secretory Immunoglobulin A: A Cross-Sectional Study in Omicron COVID-19 Outpatients.

Background: Respiratory tract infections remain among the leading causes of mortality worldwide. The COVID-19 pandemic has highlighted the importance of mucosal immunity in defending against infectious agents. Vitamin A is known to influence the production of secretory immunoglobulin A (SIgA) predominantly in the gut, where it is a critical component of the first line of defense on mucosal surfaces. Methods: This cross-sectional study, conducted 14 days post-positive COVID-19 diagnosis, aimed to determine the relationship between the nutritional status of vitamin A and SIgA levels in COVID-19 outpatients. Serum and saliva samples were collected. Vitamin A nutritional status was determined based on the assessment of dietary intake and the analysis of retinol-binding protein 4 (RBP4). SIgA levels were analyzed from salivary samples. In addition, serum antibodies were analyzed. Results: Dietary vitamin A intake and RBP4 levels positively correlated with SIgA. Patients with higher vitamin A intake showed higher SIgA/IgG1 and SIgA/IgG3 ratios, while those with higher RBP4 levels showed higher SIgA/IgM, SIgA/IgG1, and SIgA/IgG2 ratios. Conclusions: These findings underscore a significant correlation between vitamin A nutritional status and SIgA levels in COVID-19 outpatients, which may suggest the potential importance of maintaining optimal vitamin A levels for the prevention of viral infections.

A predator-prey fractional model with disease in the prey species.

In this paper, we study a generalized eco-epidemiological model of fractional order for the predator-prey type in the presence of an infectious disease in the prey. The proposed model considers that the disease infects the prey, causing them to be divided into two classes, susceptible prey and infected prey, with different density-dependent predation rates between the two classes. We propose logistic growth in both the prey and predator populations, and we also propose that the predators have alternative food sources (i.e., they do not feed exclusively on these prey). The model is evaluated from the perspective of the global and local generalized derivatives by using the generalized Caputo derivative and the generalized conformable derivative. The existence, uniqueness, non-negativity, and boundedness of the solutions of fractional order systems are demonstrated for the classical Caputo derivative. In addition, we study the stability of the equilibrium points of the model and the asymptotic behavior of its solution by using the Routh-Hurwitz stability criteria and the Matignon condition. Numerical simulations of the system are presented for both approaches (the classical Caputo derivative and the conformable Khalil derivative), and the results are compared with those obtained from the model with integro-differential equations. Finally, it is shown numerically that the introduction of a predator population in a susceptible-infectious system can help to control the spread of an infectious disease in the susceptible and infected prey population.

Transport and deposition of radionuclides from northern Africa to the southern Iberian Peninsula and the Canary Islands during the intense dust intrusions of March 2022.

The present study focuses on the two consecutive and markedly intense Saharan dust intrusion episodes that greatly affected southern Spain (Málaga) and, to a lesser extent, the Canary Islands (Tenerife), in March 2022. These two episodes were the result of atypical meteorological conditions in the region and resulted in record levels of aerosols in the air at the Málaga location. The activity levels of various natural and artificial radionuclides (7Be, 210Pb, 40K, 137Cs, 239Pu, 240Pu, 239+240Pu) and radioactive indicators (gross alpha and gross beta) were impacted by these events and the results are described herein. These episodes caused, for example, the activities of 137Cs in aerosol samples at the Málaga monitoring station to reach the highest concentrations ever recorded since high-volume aerosol monitoring started at this site in 2009. A link between the activity levels of 137Cs, 40K and gross alpha in the atmospheric aerosols and daily PM10 concentrations during the episodes is also reported. In addition, isotopic ratios are discussed in the context of the source and destination of the various anthropogenic radionuclides measured. The atmospheric residence time of aerosols during these episodes is also evaluated because it concerns how intrusions to the Canary Islands should be analysed. Finally, for the first time, the concentrations of 137Cs deposition by rainwater during a Saharan dust intrusion are reported and the deposition rate of these radionuclides during these episodes is discussed.

Kinetically-Controlled Ni-Catalyzed Direct Carboxylation of Unactivated Secondary Alkyl Bromides without Chain Walking.

Herein, we report the direct carboxylation of unactivated secondary alkyl bromides enabled by the merger of photoredox and nickel catalysis, a previously inaccessible endeavor in the carboxylation arena. Site-selectivity is dictated by a kinetically controlled insertion of CO2 at the initial C(sp3)-Br site by the rapid formation of Ni(I)-alkyl species, thus avoiding undesired ß-hydride elimination and chain-walking processes. Preliminary mechanistic experiments reveal the subtleties of stereoelectronic effects for guiding the reactivity and site-selectivity.

Discovery of circulating miRNAs as biomarkers of chronic Chagas heart disease via a small RNA-Seq approach.

Chagas disease affects approximately 7 million people worldwide in Latin America and is a neglected tropical disease. Twenty to thirty percent of chronically infected patients develop chronic Chagas cardiomyopathy decades after acute infection. Identifying biomarkers of Chagas disease progression is necessary to develop better therapeutic and preventive strategies. Circulating microRNAs are increasingly reliable biomarkers of disease and therapeutic targets. To identify new circulating microRNAs for Chagas disease, we performed exploratory small RNA sequencing from the plasma of patients and performed de novo miRNA prediction, identifying potential new microRNAs. The levels of the new microRNAs temporarily named miR-Contig-1519 and miR-Contig-3244 and microRNAs that are biomarkers for nonchagasic cardiomyopathies, such as miR-148a-3p and miR-224-5p, were validated by quantitative reverse transcription. We found a specific circulating microRNA signature defined by low miR-Contig-3244, miR-Contig-1519, and miR-148a-3 levels but high miR-224-5p levels for patients with chronic Chagas disease. Finally, we predicted in silico that these altered circulating microRNAs could affect the expression of target genes involved in different cellular pathways and biological processes, which we will explore in the future.

Direct Decarboxylation of Trifluoroacetates Enabled by Iron Photocatalysis.

Trifluoroacetates are the most abundant and accessible sources of trifluoromethyl groups, which are key components in pharmaceuticals and agrochemicals. The generation of trifluoromethyl reactive radicals from trifluoroacetates requires their decarboxylation, which is hampered by their high oxidation potential. This constitutes a major challenge for redox-based methods, because of the need to pair the redox potentials with trifluoroacetate. Here we report a strategy based on iron photocatalysis to promote the direct photodecarboxylation of trifluoroacetates that displays reactivity features that escape from redox limitations. Our synthetic design has enabled the use of trifluoroacetates for the trifluoromethylation of more easily oxidizable organic substrates, offering new opportunities for late-stage derivatization campaigns using chemical feedstocks, Earth-abundant catalysts, and visible-light.

RegulonDB v12.0: a comprehensive resource of transcriptional regulation in E. coli K-12.

RegulonDB is a database that contains the most comprehensive corpus of knowledge of the regulation of transcription initiation of Escherichia coli K-12, including data from both classical molecular biology and high-throughput methodologies. Here, we describe biological advances since our last NAR paper of 2019. We explain the changes to satisfy FAIR requirements. We also present a full reconstruction of the RegulonDB computational infrastructure, which has significantly improved data storage, retrieval and accessibility and thus supports a more intuitive and user-friendly experience. The integration of graphical tools provides clear visual representations of genetic regulation data, facilitating data interpretation and knowledge integration. RegulonDB version 12.0 can be accessed at https://regulondb.ccg.unam.mx.

Complicated giant colonic diverticulum: imaging-based diagnosis

A 66-year-old male from Venezuela with history of high blood pressure and diverticulosis is being studied on an outpatient basis for abdominal pain and weight loss of several months of evolution. He presented to the emergency department due to worsening abdominal pain in the last 48 hours and fever. His abdomen was mildly tender to palpation in the left hypochondrium but did not exhibit signs of peritonitis. An abdominal x-ray was performed, revealing an oval, smooth-walled mass located in the left upper quadrant that contained a gas-fluid level. An outpatient abdominal CT scan performed two months earlier showed an intraabdominal, 14.8x10x16cm air cystic lesion, proposing giant colonic diverticulum as first diagnostic possibility. Given the findings of the abdominal x-ray, urgent abdominal CT was requested (image 3) with results suggestive of sigmoid-dependent giant diverticulum, complicated by probable superinfection and torsion of the sigma at its base. Considering the suspected diagnosis, the patient underwent diverticulectomy, demonstrating purulent content inside. Histopathology confirmed the diagnosis. Evolution after surgery was favourable and the patient was discharged on the sixth postoperative day. (AU)