NFC-enabled photothermal-based microfluidic paper analytical device for glucose detection.

This study introduces the development of a photothermal-based microfluidic paper analytical device (PT-µPAD) integrated with near-field communication (NFC) technology and smartphone readout for enzyme-free glucose quantification in human samples. With the properties of gold nanoparticles (AuNPs) both as a nanozyme and as a photothermal substrate, there is no need for costly reagents like enzymes or a readout instrumentation for the selective and sensitive detection of glucose. In PT-µPADs, AuNPs are etched by hydrogen peroxide (H2O2) generated from glucose catalysis. Photothermal detection from the plasmonic heating of these AuNPs when illuminated by a 533nm LED light source is achieved by inserting the PT-µPAD sensor into a portable NFC platform suitable for smartphone readout. Temperature variation is directly proportional to the glucose concentration. After optimization, we acquired a linear range between 5.0 and 20.0 µmol L-1 (R2 = 0.9967) and a limit of detection (LOD) of 25.0 nmol L-1 for glucose. Additionally, while our sensor does not utilize any enzyme, it is remarkably selective to glucose with no effects from interferences. Recovery studies in various human control samples indicated a range of 99.73-102.66% with the highest RSD of 3.53%, making it highly accurate and precise. Moreover, our method is more sensitive than other methods relying on conventional µPADs for glucose sensing. By integrating the potential benefits of microfluidics, nanomaterials as nanozymes, and NFC technology for wireless readout, our sensor demonstrates great promise as an accessible, affordable, and shelf-stable device for glucose quantification. Moreover, this concept can be extended to detect other molecules of interest as a point-of-care (POC) diagnostics device.

Superparamagnetic iron oxide (SPIO) for sentinel lymph node detection in vulvar cancer.

OBJECTIVES: Sentinel lymph node (SLN) detection with superparamagnetic iron oxide (SPIO) nanoparticles has been widely studied and standardized for breast and prostate cancer, but there is scarce evidence concerning its use in vulvar cancer. The objective of this study was to compare SLN detection using a SPIO tracer injected at the time of the surgery detected by a magnetometer, with the standard procedure of using a technetium 99 radioisotope (Tc99) detected by a gamma probe, in patients with vulvar cancer. METHODS: The SPIO vulvar cancer study was a single-center prospective interventional non-inferiority study of SPIO compared to Tc99, conducted between 2016 and 2021 in patients who met the GROINSS-V study inclusion criteria for selective sentinel lymph node dissection in vulvar cancer. RESULTS: We included 18 patients and a total of 41 SLNs. The level of agreement between tracers was 92.7% (80.6%-97.4%), corresponding to 38 out of 41 SLNs, which confirms the non-inferiority of SPIO compared to Tc99. The SLN detection rate per groin was 96.3 (81.7%-99.3) using Tc99 and 100% (87.5%-100%) using SPIO. Both tracers had a detection rate of 100% for positive lymph nodes. CONCLUSIONS: The use of SPIO as a tracer for detecting SLNs in patients with vulvar cancer has shown to be non-inferior to that of the standard radiotracer, with the advantages of not requiring nuclear medicine and being able to inject it at the time of surgery after induction of anesthesia.

Simple distance-based thread analytical device integrated with ion imprinted polymer for Zn2+ quantification in human urine samples.

This article presents the development of a distance-based thread analytical device (dTAD) integrated with an ion-imprinted polymer (IIP) for quantitative monitoring of zinc ions (Zn2+) in human urine samples. The IIP was easily chemically modified onto the thread channel using dithizone (DTZ) as a ligand to bind to Zn2+ with methacrylic acid (MAA) as a functional monomer and ethylene glycol dimethacrylate (EGDMA) as well as 2,2-azobisisobutyronitrile (AIBN) as cross-linking agents to enhance the selectivity for Zn2+ detection. The imprinted polymer was characterized using Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) spectroscopy and Scanning Electron Microscopy-Energy Dispersive X-ray Spectroscopy (SEM-EDS). Under optimization, the linear detection range was from 1.0 to 20.0 mg L-1 (R2 = 0.9992) with a limit of detection (LOD) of 1.0 mg L-1. Other potentially interfering metal ions and molecules did not interfere with this approach, leading to high selectivity. Furthermore, our technique exhibits a remarkable recovery ranging from 100.48% to 103.16%, with the highest relative standard deviation (% RSD) of 5.44% for monitoring Zn2+ in human control urine samples, indicating high accuracy and precision. Similarly, there is no significant statistical difference between the results obtained using our method and standards on zinc supplement sample labels. The proposed method offers several advantages in detecting trace Zn2+ for point-of-care (POC) medical diagnostics and environmental sample analysis, such as ease of use, instrument-free readout, and cost efficiency. Overall, our developed dTAD-based IIP method holds potential for simple, affordable, and rapid detection of Zn2+ levels and can be applied to other metal ions' analysis.

Distance-based paper analytical device for multiplexed quantification of cytokine biomarkers using carbon dots integrated with molecularly imprinted polymer.

This article introduces distance-based paper analytical devices (dPADs) integrated with molecularly imprinted polymers (MIPs) and carbon dots (CDs) for simultaneous quantification of cytokine biomarkers, namely C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) in human biological samples for diagnosis of cytokine syndrome. Using fluorescent CDs and MIP technology, the dPAD exhibits high selectivity and sensitivity. Detection is based on fluorescence quenching of CDs achieved through the interaction of the target analytes with the MIP layer on the paper substrate. Quantitative analysis is easily accomplished by measuring the distance length of quenched fluorescence with a traditional ruler and naked eye readout enabling rapid diagnosis of cytokine syndrome and the underlying infection. Our sensor demonstrated linear ranges of 2.50-24.0 pg mL-1 (R2 = 0.9974), 0.25-3.20 pg mL-1 (R2 = 0.9985), and 1.50-16.0 pg mL-1 (R2 = 0.9966) with detection limits (LODs) of 2.50, 0.25, and 1.50 pg mL-1 for CRP, TNF-α, and IL-6, respectively. This sensor also demonstrated remarkable selectivity compared to a sensor employing a non-imprinted polymer (NIP), and precision with the highest relative standard deviation (RSD) of 5.14%. The sensor is more accessible compared to prior methods relying on expensive reagents and instruments and complex fabrication methods. Furthermore, the assay provided notable accuracy for monitoring these biomarkers in various human samples with recovery percentages ranging between 99.22% and 103.58%. By integrating microfluidic systems, nanosensing, and MIPs technology, our developed dPADs hold significant potential as a cost-effective and user-friendly analytical method for point-of-care diagnostics (POC) of cytokine-related disorders. This concept can be further extended to developing diagnostic devices for other biomarkers.

Soft Injectable Sutures for Dose-Controlled and Continuous Drug Delivery.

Transdermal drug delivery offers a promising alternative to traditional methods such as oral ingestion and hypodermic injection. Hypodermic injections are painful, while oral ingestion requires higher doses due to enzymatic degradation and poor absorption. While microneedles address the pain issue, they are limited to delivering small amounts of drugs and can be impractical due to peeling off with motion and sweat. Herein, this work proposes soft injectables using drug-carrying sutures for painless and localized sustained delivery in the dermis. These sutures can remain in place during delivery and are suitable for all skin types. Surgical sutures can also serve as open capillary microfluidic channels carrying drug from a wearable drug reservoir to enable long-term (weeks to months) transdermal drug delivery. The experiments focus on delivering 5-fluorouracil (5-FU), a cancer drug, and rhodamine B, a drug model. A fixed-length suture of 60 cm delivers 0.43 mg of 5-flurouracil in 15 min. The experiments also demonstrate a continuous drug delivery of rhodamine B for over 8 weeks at a rate of 0.0195 mL h-1 . The results highlight that soft injectable sutures are promising candidates for long-term sustained delivery of varying quantities of drugs over weeks period compared to hypodermic injection, oral ingestion, or microneedles.

Gold Nanomaterial-Based Microfluidic Paper Analytical Device for Simultaneous Quantification of Gram-Negative Bacteria and Nitrite Ions in Water Samples.

This study presents a rapid microfluidic paper-based analytical device (µPAD) capable of simultaneously monitoring Gram-negative bacteria and nitrite ions (NO2-) for water quality monitoring. We utilize gold nanoparticles (AuNPs) functionalized with polymyxin molecules (AuNPs@polymyxin) to cause color change due to aggregation for the detection of Gram-negative bacteria, and antiaggregation in the presence of o-phenylenediamine (OPD) for NO2- detection. In this study, Escherichia coli (E. coli) serves as the model of a Gram-negative bacterium. Using the developed µPADs, the color changes resulting from aggregation and antiaggregation reactions are measured using a smartphone application. The linear detection ranges from 5.0 × 102 to 5.0 × 105 CFU/mL (R2 = 0.9961) for E. coli and 0.20 to 2.0 µmol/L (R2 = 0.995) for NO2-. The detection limits were determined as 2.0 × 102 CFU/mL for E. coli and 0.18 µmol/L for NO2-. Notably, the newly developed assay exhibited high selectivity with no interference from Gram-positive bacteria. Additionally, we obtained acceptable recovery for monitoring E. coli and NO2- in drinking water samples with no significant difference between our method and a commercial assay by t test validation. The sensor was also employed for assessing the quality of the pond and environmental water source. Notably, this approach can also be applied to human urine samples with satisfactory accuracy. Furthermore, the assay's stability is extended due to its reliance on AuNPs rather than reagents like antibodies and enzymes, reducing costs and ensuring long-term viability. Our cost-effective µPADs therefore provide a real-time analysis of both contaminants, making them suitable for assessing water quality in resource-limited settings.

Ingestible pH sensing device for gastrointestinal health monitoring based on thread-based electrochemical sensors.

There exists a strong correlation between the pH levels of the gastrointestinal (GI) tract and GI diseases such as inflammatory bowel disease (IBS), ulcerative colitis, and pancreatis. Existing methods for diagnosing many GI diseases predominantly rely on invasive, expensive, and time-consuming techniques such as colonoscopy and endoscopy. In this study, an autonomous ingestible smart biosensing system in a pill format with integrated pH sensors is reported. The smart sensing pills will measure the pH profile as they transit through the GI tract. The data is then downloaded from the pills after they are collected from the feces. The sensor is based on electrodeposited PANI on carbon-coated conductive threads providing high pH sensitivity. Engineering innovations allowed integration of thread-based sensors on 3D-printed pill surfaces with front-end readout electronics, memory, and microcontroller assembled on mm-size circular printed circuit boards. The entire smart sensing pill possesses an overall length of 22.1 mm and an outer diameter of 9 mm. The modular biosensing system allows integration of thread-based biosensors to monitor other biomarkers in GI tract that mitigates the complex sensor fabrication process as well as overall pill assembly.

Highly Sensitive Photothermal Microfluidic Thread-Based Duplex Immunosensor for Point-of-Care Monitoring.

Herein, we successfully developed a thread-based analytical device (µTAD) for simultaneous immunosensing of two biomolecules with attomolar sensitivity by using a photothermal effect. A photothermal effect exploits a strong light-to-heat energy conversion of plasmonic metallic nanoparticles at localized surface plasmon resonance. The key innovation is to utilize the cotton thread to realize this sensor and the use of chitosan modification for enhancing the microfluidic properties, for improving the efficiency of photothermal conversion, and for sensor stability. The developed µTAD sensor consists of (i) a sample zone, (ii) a conjugation zone coated with gold nanoparticles bound with an antibody (AuNPs-Ab2), and (iii) a test zone immobilized with a capture antibody (anti-Ab1). The prepared µTAD is assembled in a custom three-dimensional (3D) printed device which holds the laser for illumination and the thermometer for readout. The 3D-printed supportive device enhances signal response by focusing light and localizing the heat generated. For proof of concept, simultaneous sensing of two key stress and inflammation biomarkers, namely, cortisol and interleukin-6 (IL-6), are monitored using this technique. Under optimization, this device exhibited a detection linear range of 2.0-14.0 ag/mL (R2 = 0.9988) and 30.0-360.0 fg/mL (R2 = 0.9942) with a detection limit (LOD) of 1.40 ag/mL (∼3.86 amol/L) and 20.0 fg/mL (∼950.0 amol/L) for cortisol and IL-6, respectively. Furthermore, the analysis of both biomolecules in human samples indicated recoveries in the range of 98.8%-102.88% with the highest relative standard deviation being 3.49%, offering great accuracy and precision. These results are the highest reported sensitivity for these analytes using an immunoassay method. Our PT-µTAD strategy is therefore a promising approach for detecting biomolecules in resource-limited point-of-care settings.

Aortic sentinel node detection in endometrial cancer: 6 year prospective study.

OBJECTIVE: The aim of this study was to describe our final results using dual cervical and fundal indocyanine green injection for the detection of sentinel lymph nodes (SLNs) in endometrial cancer along parametrial and infundibular drainage pathways. METHODS: We conducted a prospective observational study between 26 June 2014 and 31 December 2020 enrolling 332 patients that underwent laparoscopic surgery for endometrial cancer at our hospital. In all cases, we performed SLN biopsy with dual cervical and fundal indocyanine green injection identifying pelvic and aortic SLNs. All SLNs were processed with an ultrastaging technique. A total of 172 patients also underwent total pelvic and para-aortic lymphadenectomy. RESULTS: The detection rates were as follows: 94.0% overall for SLNs; 91.3% overall for pelvic SLNs; 70.5% for bilateral SLNs; 68.1% for para-aortic SLNs, and 3.0% for isolated paraaortic SLNs. We found lymph node involvement in 56 (16.9%) cases, macrometastasis in 22, micrometastasis in 12 and isolated tumor cells in 22. Fourteen patients had isolated aortic nodal involvement, representing 25% of the positive cases. There was one false negative (SLN biopsy negative but lymphadenectomy positive). Applying the SLN algorithm, the sensitivity of the dual injection technique for SLN detection was 98.3% (95% CI 91-99.7), specificity 100% (95% CI 98.5-100), negative predictive value 99.6% (95% CI 97.8-99.9), and positive predictive value 100% (95% CI 93.8-100). Overall survival at 60 months was 91.35%, with no differences between patients with negative nodes, isolated tumor cells and treated nodal micrometastasis. CONCLUSIONS: Dual sentinel node injection is a feasible technique that achieves adequate detection rates. Additionally, this technique allows a high rate of aortic detection, identifying a non-negligible percentage of isolated aortic metastases. Aortic metastases in endometrial cancer account for as many as a quarter of the positive cases and should be considered, especially in high-risk patients.

Jusvinza, an anti-inflammatory drug derived from the human heat-shock protein 60, for critically ill COVID-19 patients. An observational study.

This paper presents the results of an observational and retrospective study on the therapeutic effects of Jusvinza, an immunomodulatory peptide with anti-inflammatory properties for critically ill COVID-19 patients. This peptide induces regulatory mechanisms on the immune response in experimental systems and in patients with Rheumatoid Arthritis. Exploratory research in COVID-19 patients revealed that Jusvinza promotes clinical and radiological improvement. The aim of this study is to describe the clinical outcome and variations of several inflammatory biomarkers in a cohort of critically ill COVID-19 patients, divided into two groups during the observational research: one group received Jusvinza and the other did not. Research physicians extracted the patients´ data from their hospital's clinical records. The study analyzed 345 medical records, and 249 records from critically ill patients were included. The data covered the demographic characteristics, vital signs, ventilatory parameters and inflammatory biomarkers. Survival outcome was significantly higher in the group receiving Jusvinza (90.4%) compared to the group without Jusvinza (39.5%). Furthermore, in patients treated with Jusvinza there was a significant improvement in ventilatory parameters and a reduction in inflammation and coagulation biomarkers. Our findings show that Jusvinza could control the extent of inflammation in COVID-19 patients. This study indicates that Jusvinza is a helpful drug for the treatment of diseases characterized by hyperinflammation.

Identification of palliative care requirement in hospital inpatients in internal medicine services in a peruvian reference hospital / Identificación de requerimiento de cuidados paliativos en pacientes hospitalizados en los servicios de medicina interna de un hospital de referencia peruano

Introduction: Hospitals of greater complexity tend to care for patients with advanced chronic diseases, which is why it is important to recognize the need for palliative care. Objective: To identify the proportion of patients who require palliative care in the medicine department of a Peruvian referral hospital. Methods: Observational, analytical, cross-sectional study. All hospitalized patients were studied in the Department of Internal Medicine of the Peruvian hospital during the period April-May 2018. To determine the need for palliative care, the NECPAL CCOMS-ICO © instrument was used. The quantitative variables are presented as median and interquartile range (IQR); and numerical variables, such as frequencies and percentages. For the comparison of numerical variables, the Mann Whitney test was used and the chi-square test for categorical variables.  Results: They were evaluated in 281, where 102 (37.9%) required palliative care. The median age in patients requiring palliative care was 69.5 (IQR: 58-81) years. The median hospital stay in patients with and without the need for palliative care was 7 days (IQR: 4-11) and 9 days (IQR: 5-19) respectively, the mortality in patients with and without the need for palliative care was 37.25% and 4.19% respectively. Conclusions: There is a high frequency of need for palliative care in patients hospitalized in internal medicine wards, the requirement for palliative care was associated with higher mortality and hospital stay, which evidences the need for comprehensive and personalized care based on medical services specialized.

Introducción: Los hospitales de mayor complejidad suelen atender a pacientes con enfermedades crónicas avanzadas, es por ello importante el reconocimiento de la necesidad de cuidados paliativos. Objetivo: Identificar la proporción de pacientes que requieren cuidados paliativos en el departamento de medicina de un hospital de referencia peruano. Métodos: Estudio observacional, analítico, transversal. Se estudió a todos los pacientes hospitalizados en el Departamento de Medicina Interna del hospital peruano durante el periodo abril-mayo del 2018. Para determinar la necesidad de cuidados paliativos se usó el instrumento NECPAL CCOMS-ICO©. Las variables cuantitativas se presentan como mediana y rango intercuartil (RIC); y las variables numéricas, como frecuencias y porcentajes. Para la comparación de variables numéricas se utilizó la prueba de Mann Whitney y para las categóricas la prueba de chi cuadrado.   Resultados: Se evaluaron 281, donde 102 (37,9%) requerían cuidado paliativo. La mediana de edad en pacientes con requerimiento de cuidados paliativos fue 69,5 (RIC: 58-81) años. La mediana de estancia hospitalaria en pacientes con y sin requerimiento de cuidados paliativos fue de 7 días (RIC: 4-11) y 9 días (RIC: 5-19) respectivamente, la mortalidad en los pacientes con y sin requerimiento de cuidados paliativos fue 37,25% y 4,19% respectivamente.   Conclusiones: Se evidencia una alta frecuencia de necesidad de atención paliativa en pacientes hospitalizados en salas de medicina interna, el requerimiento de cuidados paliativos se asoció a mayor mortalidad y estancia hospitalaria, lo que evidencia la necesidad de atención integral y personalizada en base a servicios médicos especializados.

Feature Selection With Maximal Relevance and Minimal Supervised Redundancy.

Feature selection (FS) for classification is crucial for large-scale images and bio-microarray data using machine learning. It is challenging to select informative features from high-dimensional data which generally contains many irrelevant and redundant features. These features often impede classifier performance and misdirect classification tasks. In this article, we present an efficient FS algorithm to improve classification accuracy by taking into account both the relevance of the features and the pairwise features correlation in regard to class labels. Based on conditional mutual information and entropy, a new supervised similarity measure is proposed. The supervised similarity measure is connected with feature redundancy minimization evaluation and then combined with feature relevance maximization evaluation. A new criterion max-relevance and min-supervised-redundancy (MRMSR) is introduced and theoretically proved for FS. The proposed MRMSR-based method is compared to seven existing FS approaches on several frequently studied public benchmark datasets. Experimental results demonstrate that the proposal is more effective at selecting informative features and results in better competitive classification performance.

Introduction to the special issue on the role of operational research in future epidemics/ pandemics.

In this special issue, 23 research papers are published focusing on COVID-19 and operational research solution techniques. First, we detail the process from advertising the call for papers to the point where the best papers are accepted. Then, we provide a summary of each paper focusing on applications, solution techniques and insights for practitioners and policy makers. To provide a holistic view for readers, we have clustered the papers into different groups: transmission, propagation and forecasting, non-pharmaceutical intervention, healthcare network configuration, healthcare resource allocation, hospital operations, vaccine and testing kits, and production and manufacturing. Then, we introduce other possible subjects that can be considered for future research.

Transperitoneal vs extraperitoneal approach for aortic sentinel node detection in endometrial cancer.

BACKGROUND: Although the sentinel lymph node technique in endometrial cancer is currently replacing pelvic and aortic lymphadenectomy for the evaluation of lymph node status in endometrial cancer, its performance is not yet standardized. OBJECTIVE: This study aimed to describe the detection rates and locations of aortic sentinel lymph node detection after dual cervical and fundal indocyanine green injection in patients with endometrial cancer, using the transperitoneal and extraperitoneal approaches. STUDY DESIGN: Between June 26, 2014 and December 31, 2019, 278 patients underwent laparoscopic surgery for endometrial cancer at our institution. In all cases, we performed sentinel lymph node biopsy with dual cervical and fundal indocyanine green injection, and back-up lymphadenectomy in high-risk cases. A post hoc analysis was performed to evaluate differences between the transperitoneal and extraperitoneal approach to aortic sentinel lymph nodes. RESULTS: The detection rates were as follows: overall detection rate: 93.2% (259/278); pelvic detection rate: 90.3% (251/278); bilateral pelvic detection rate: 68.0% (189/278); aortic detection rate: 66.9% (186/278); and isolated aortic detection rate: 2.88% (8/278). Transperitoneal and extraperitoneal aortic detection rates were similar (65.0% and 69.6%, respectively), with no significant differences (P=.441). Isolated aortic metastases were similar in both groups (2% vs 4.7%, respectively; P=.185). The laterality of aortic sentinel lymph node detection was influenced by the surgical approach (P=.002), but not its location above or below the inferior mesenteric artery (P=.166 and P=.556, respectively). CONCLUSION: The detection rates at the aortic level were similar between the transperitoneal and extraperitoneal approaches, with no impact on subsequent pelvic detection. The transperitoneal approach detected more laterocaval, precaval, and interaortocaval nodes, whereas the extraperitoneal approach detected more preaortic and left lateroaortic nodes.

Recent progress in electrospun nanomaterials for wearables.

Wearables have garnered significant attention in recent years not only as consumer electronics for entertainment, communications, and commerce but also for real-time continuous health monitoring. This has been spurred by advances in flexible sensors, transistors, energy storage, and harvesting devices to replace the traditional, bulky, and rigid electronic devices. However, engineering smart wearables that can seamlessly integrate with the human body is a daunting task. Some of the key material attributes that are challenging to meet are skin conformability, breathability, and biocompatibility while providing tunability of its mechanical, electrical, and chemical properties. Electrospinning has emerged as a versatile platform that can potentially address these challenges by fabricating nanofibers with tunable properties from a polymer base. In this article, we review advances in wearable electronic devices and systems that are developed using electrospinning. We cover various applications in multiple fields including healthcare, biomedicine, and energy. We review the ability to tune the electrical, physiochemical, and mechanical properties of the nanofibers underlying these applications and illustrate strategies that enable integration of these nanofibers with human skin.

Manejo de Encefalitis anti-NMDAR con Rituximab: Reporte de caso en un Hospital Público de Lima, Perú

Introducción: La encefalitis autoinmune comprende un amplio espectro de desórdenes inmunológicos, entre ellos el anti-NMDAR es el más frecuente. El manejo de esta patología es complejo debido a múltiples circunstancias. Reporte de caso: Mujer de 19 años que inicia cuadro subagudo con trastorno conductual y neurológico asociado: Alucinaciones, heteroagresividad, mutismo acinético, crisis epilépticas, discinesias orofaciales, fiebre y arritmia cardiaca transitoria reportada. La resonancia fue normal, el EEG registró ondas delta brush, Los estudios de LCR y séricos fueron negativos para causas secundarias. Se inició tratamiento con Aciclovir, medicamento anticrisis y psicofármacos, posteriormente se inicia metilprednisolona con inmunoglobulina sin respuesta satisfactoria. Inicia tratamiento con Rituximab presentando una respuesta favorable. El panel en LCR fue positivo a NMDA. Se indica control con desescalamiento progresivo de medicamentos anticrisis y psicofármacos. Conclusión: Es importante reconocer tempranamente las manifestaciones clínicas de esta entidad para así realizar un manejo oportuno que podría mejorar el pronóstico.

Introduction: Autoimmune encephalitis comprises a wide spectrum of immunological disorders, among them anti-NMDAR is the most frequent. The management of this pathology is complex due to multiple circumstances. Case report: A 19-year-old woman who started a subacute clinical picture with associated behavioral and neurological disorder: hallucinations, heteroaggressiveness, akinetic mutism, epileptic seizures, orofacial dyskinesias, fever and reported transient cardiac arrhythmia. MRI was normal, EEG recorded delta brush waves, CSF and serum studies were negative for secondary causes. Treatment was started with Acyclovir, an anti-crisis drug, and psychotropic drugs, later methylprednisolone with immunoglobulin was started without a satisfactory response. She starts treatment with Rituximab presenting a favorable response. The CSF panel was positive for NMDA. Control with progressive de-escalation of anti-crisis medications and psychotropic drugs is indicated. Conclusion: It is important to recognize early the clinical manifestations of this entity in order to carry out timely management that could improve the prognosis.

Necesidad del desarrollo de competencias en cuidados paliativos durante el pregrado de la carrera de medicina / Need for the development of competencies in palliative care during the undergraduate of the medical career

Sr. Editor: Los Cuidados Paliativos (CP) tienen como finalidad mejorar la calidad de vida y aliviar el sufrimiento de los pacientes con padecimientos graves e incurables. Con el envejecimiento de la población y la mayor prevalencia de las enfermedades crónicas, el número de personas con necesidad de estos cuidados se ha incrementado. Los CP tienen carácter multidimensional e interdisciplinario, se pueden brindar en diferentes niveles de atención y están a cargo tanto de médicos generales como especialistas. Se requiere por lo tanto de una adecuada formación en esta disciplina durante el pregrado de la carrera de medicina, que permita el desarrollo de las competencias necesarias para su aplicación en la práctica médica.

Dear editor, Palliative Care (PC) aims to improve the quality of life and alleviate the suffering of patients with serious and incurable conditions. With the aging of the population and the higher prevalence of chronic diseases, the number of people in need of this care has increased. PC is multidimensional and interdisciplinary; and can be provided at different levels of care by both general practitioners and specialists. Therefore, adequate training in this discipline must be required during the medicine degree to allow the development of the necessary skills for its application in medical practice.

Early laparoscopic cholecystectomy in oldest-old patients: a propensity score matched analysis of a nationwide registry.

The role of early laparoscopic cholecystectomy (ELC) in "oldest-old" patients with acute calculous cholecystitis (ACC) is still controversial. The aim of this study is to assess the safety of ELC for ACC in ≥ 85-year-old patients. Multicentric retrospective study that analysed data of patients who underwent ELC for ACC between 2013 and 2018. Patients ≥ 85-year-old (oldest-old patients) were compared with younger patients, before and after propensity score matching (PSM). The main outcomes were mortality, post-operative complications, length of stay (LOS), and readmissions. The study included 1670 patients. The unmatched comparison revealed a selection bias towards the oldest-old group, which was associated with higher Charlson Comorbidity Index (5 vs 1, p < 0.001), more ASA III/IV subjects (54.2% vs 19.3%, p < 0.001), class II/III ACC (80.1% vs 69.1%, p = 0.016) and higher Chole-Risk Score (p > 0.001). The oldest-old also required more conversion to open surgery (20% vs 10.3%, p = 0.005). Postoperatively, they had a higher 90-day mortality rate (7.6% vs 1%, p < 0.001), more total complications (40.6% vs 17.7%, p < 0.001), complications ≥ IIIa Clavien-Dindo (14.4% vs 5.8%, p = 0.002), longer LOS (6 vs 5 days, p < 0.001), and more readmissions (6.6% vs 2.6%, p < 0.001). After PSM (n = 206), the two groups were comparable in terms of baseline characteristics and intraoperative outcomes. No differences were observed in post-operative complications; bile leak; incisional, intrabdominal, urinary or respiratory tract infections; LOS or readmissions. In the oldest-old, ELC for ACC is still associated with significant morbidity and mortality. However, it seems to be safe in selected patients. Therefore, age itself should not be regarded as a contraindication to ELC for ACC.

Ingestible pH Sensing Capsule with Thread-Based Electrochemical Sensors.

Existing techniques for diagnosing gastrointestinal disorders in stomach, small and large intestines, and colon depend on biopsy, endoscopy or colonoscopy methods which are invasive, expensive and time-consuming. In fact, such methods also lack the ability to access large parts of the small intestine. In this article, we demonstrate a smart ingestible biosensing capsule that is capable of monitoring pH activity in small and large intestines. pH is a known biomarker for several gastrointestinal disorders such as inflammatory bowel disease. Functionalized threads utilized as pH sensing mechanism are integrated with front-end readout electronics and 3D-printed case. This paper demonstrates a modular sensing system design that alleviates the sensor fabrication difficulties as well as the overall assembly of the ingestible capsule.

A Survey on Sparse Learning Models for Feature Selection.

Feature selection is important in both machine learning and pattern recognition. Successfully selecting informative features can significantly increase learning accuracy and improve result comprehensibility. Various methods have been proposed to identify informative features from high-dimensional data by removing redundant and irrelevant features to improve classification accuracy. In this article, we systematically survey existing sparse learning models for feature selection from the perspectives of individual sparse feature selection and group sparse feature selection, and analyze the differences and connections among various sparse learning models. Promising research directions and topics on sparse learning models are analyzed.