Assessment of high spatial resolution satellite imagery for monitoring riparian vegetation: riverine management in the smallholding.

Riverine habitats are essential ecotones that bridge aquatic and terrestrial ecosystems, providing multiple ecosystem services. This study analyses the potential use of high-resolution satellite imagery, provided by the WorldView-2 satellite, in order to assess its viability for monitoring riparian ecosystems. It is performed by calculating the riparian strip quality index (RSQI) and calibrating it with the riparian quality index (QBR). The methodology was implemented in the Umia River, which is characterised by elevated anthropogenic pressures (located in the northwest of Spain). The results obtained by the method have a 92% of veracity and a kappa coefficient of 0.88. The average quality value obtained for the RSQI index was 71.57, while the average value for the QBR was 55.88. This difference could be attributed to the fact that the former does not differ between autochthonous and non-autochthonous vegetation. The areas with more accurate mapping corresponded to stretches of vegetation with optimal cover (80-50%), with good connectivity with the adjacent forest ecosystem and few or no presence of invasive plants. The worst-scoring sites had the next characteristics: low connectivity (< 10%), low forest cover (< 10%) and a higher presence of invasive plants. The degradation of vegetation could be explained by the presence of agriculture and deficient land use rationing caused by the type of ownership of the study area. The application of this index through satellite images will facilitate the environmental governance of multiple ecosystems and in special riparian ecosystems, obtaining a quick and objective methodology, easily replicable in other basins.

Posttranslational modifications of proteins are key features in the identification of CSF biomarkers of multiple sclerosis.

BACKGROUND: Multiple sclerosis is an inflammatory and degenerative disease of the central nervous system (CNS) characterized by demyelination and concomitant axonal loss. The lack of a single specific test, and the similarity to other inflammatory diseases of the central nervous system, makes it difficult to have a clear diagnosis of multiple sclerosis. Therefore, laboratory tests that allows a clear and definite diagnosis, as well as to predict the different clinical courses of the disease are of utmost importance. Herein, we compared the cerebrospinal fluid (CSF) proteome of patients with multiple sclerosis (in the relapse-remitting phase of the disease) and other diseases of the CNS (inflammatory and non-inflammatory) aiming at identifying reliable biomarkers of multiple sclerosis. METHODS: CSF samples from the discovery group were resolved by 2D-gel electrophoresis followed by identification of the protein spots by mass spectrometry. The results were analyzed using univariate (Student's t test) and multivariate (Hierarchical Cluster Analysis, Principal Component Analysis, Linear Discriminant Analysis) statistical and numerical techniques, to identify a set of protein spots that were differentially expressed in CSF samples from patients with multiple sclerosis when compared with other two groups. Validation of the results was performed in samples from a different set of patients using quantitative (e.g., ELISA) and semi-quantitative (e.g., Western Blot) experimental approaches. RESULTS: Analysis of the 2D-gels showed 13 protein spots that were differentially expressed in the three groups of patients: Alpha-1-antichymotrypsin, Prostaglandin-H2-isomerase, Retinol binding protein 4, Transthyretin (TTR), Apolipoprotein E, Gelsolin, Angiotensinogen, Agrin, Serum albumin, Myosin-15, Apolipoprotein B-100 and EF-hand calcium-binding domain-containing protein. ELISA experiments allowed validating part of the results obtained in the proteomics analysis and showed that some of the alterations in the CSF proteome are also mirrored in serum samples from multiple sclerosis patients. CSF of multiple sclerosis patients was characterized by TTR oligomerization, thus highlighting the importance of analyzing posttranslational modifications of the proteome in the identification of novel biomarkers of the disease. CONCLUSIONS: The model built based on the results obtained upon analysis of the 2D-gels and in the validation phase attained an accuracy of about 80% in distinguishing multiple sclerosis patients and the other two groups.

Relato de experiência de um grupo lúdico terapêutico de crianças com incongruência de gênero / An experience report of a ludic therapeutic group of children with gender incongruence

Relato sobre proposta inovadora, que se sustenta como ato terapêutico, lúdico e sequencial, objetivando encontros específicos para trabalhar de maneira psicoterápica questões ligadas às vidas e identidades, inclusive de gênero, dessas crianças. Em 2019, os pacientes de até 12 anos do Ambulatório Transdisciplinar de Identidade de Gênero e Orientação Sexual (AMTIGOS) do IPq/HC/FM/USP foram convidados a participar do Grupo de brincar. O grupo foi acompanhado por uma equipe transdisciplinar e mediado por psicólogos que apresentaram atividades estruturadas de forma a favorecer a explosão por parte das crianças e compartilhamento de suas experiências de forma lúdica.

Evaluation of the effect of triclosan coated sutures in the prevention of surgical site infections in a Spanish hospital setting: A prospective, observational study.

BACKGROUND: Surgical site infections (SSIs) are one of the most frequently reported types of hospital-acquired infection and are associated with substantial clinical and economic burden. AIM: To assess the incidence of SSIs and analyze contributing risk factors in a real-world Spanish hospital setting before and after the implementation of triclosan-coated sutures (TCS). METHODS: A prospective, observational study was conducted at Hospital Clínico Universitario de Santiago de Compostela, Spain. Enrolled patients underwent surgery in the following specialties: general surgery, urology, neurosurgery, gynaecology, and traumatology. The primary outcome of the study was SSI incidence, assessed at a 30-day follow-up. Secondary outcomes were length of hospital stay, and readmission, reintervention, and mortality rates, also at 30 days. FINDINGS: 5,081 patients were included in the study, of which 2,591 were treated using non-coated sutures (NCS) and 2,490 using TCS. After adjusting for potential confounders, TCS significantly reduced SSI rate by 36%, compared with NCS (odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.48-0.85; P<0.003). When stratified by wound classification, a statistically significant reduction in SSI incidence, in favour of TCS use, was observed for Class IV (dirty) wounds (35.6% versus 22.7% for NCS and TCS, respectively; OR: 0.53; 95% CI: 0.31-0.90). CONCLUSION: The use of TCS reduced SSI risk when compared with NCS. This reduction was significant for Class IV wounds, providing evidence that supports the use of TCS for this type of wound.

Static and Dynamic Ocular Motor Abnormalities as Potential Biomarkers in Spinocerebellar Ataxia Type 3.

While dynamic ocular motor abnormalities (e.g., gaze-evoked nystagmus (GEN), low optokinetic nystagmus (OKN), pursuit and vestibulo-ocular reflex (VOR) gains, and dysmetric saccades) have been shown to be potential biomarkers in spinocerebellar ataxia type 3 (SCA3), the value of static abnormalities (e.g., convergent [esodeviation] and divergent strabismus [exodeviation]) is unknown. Moreover, studies on dynamic abnormalities in SCA3 usually do not take into account the existence of potential abduction-adduction asymmetries in patients with degenerative ataxia. Thirty-eight patients with genetically confirmed SCA3 (24 females; mean age ± SD, 49.8± 12.2 years) and 22 healthy controls (12 females, p = 0.589; mean age ± SD, 50.7± 12.5 years, p = 0.651) underwent clinical and video-oculographic assessment. A p value < 0.002 (between- and within-group analyses) and < 0.001 (correlation analysis) was considered significant. Patients showed larger esodeviation at distance (p < 0.001), became more esodeviated in lateral gaze (p < 0.001), and their near exodeviation correlated with scale for the assessment and rating of ataxia (SARA) score (p = 0.004). Pursuit, OKN, and VOR gains were lower in patients, both for their adducting and abducting components (p < 0.001). Saccades showed higher velocities (p < 0.001), abducting saccades showed lower amplitude (p < 0.001), and adducting saccades tended to show greater vertical bias (p = 0.018) in patients. Abducting saccades showed relatively lower velocity (p < 0.001) and lower amplitude (p = 0.015) than abducting saccades within patients. All dynamic ocular motor abnormalities except saccades correlated with SARA score, CAG repeat number, and/or disease duration (p < 0.001). Static and dynamic ocular motor abnormalities are potential biomarkers in SCA3. SCA3 studies using saccades should take into account the existence of potential abduction-adduction asymmetries.

Tumefactive demyelinating lesions spectrum disorders and the potential role of contemporary disease modifying treatments: a case report.

Marburg disease is a fulminant variant of multiple sclerosis (MS), in which the diagnosis may be particularly difficult and with high rates of mortality. We describe the case of a women with a clinical picture, radiographic features, and neuropathological findings consistent with the classical descriptions of Marburg disease. Initially, our patient did not improved with the acute phase treatments but later showed a good response to natalizumab (NTZ) treatment. This report highlights not only the utility of brain biopsy in the accurate diagnosis of this challenging condition but also the potential role of NTZ as an effective therapeutic option.

Road Environment Semantic Segmentation with Deep Learning from MLS Point Cloud Data.

In the near future, the communication between autonomous cars will produce a network of sensors that will allow us to know the state of the roads in real time. Lidar technology, upon which most autonomous cars are based, allows the acquisition of 3D geometric information of the environment. The objective of this work is to use point clouds acquired by Mobile Laser Scanning (MLS) to segment the main elements of road environment (road surface, ditches, guardrails, fences, embankments, and borders) through the use of PointNet. Previously, the point cloud was automatically divided into sections in order for semantic segmentation to be scalable to different case studies, regardless of their shape or length. An overall accuracy of 92.5% has been obtained, but with large variations between classes. Elements with a greater number of points have been segmented more effectively than the other elements. In comparison with other point-by-point extraction and ANN-based classification techniques, the same success rates have been obtained for road surfaces and fences, and better results have been obtained for guardrails. Semantic segmentation with PointNet is suitable when segmenting the scene as a whole, however, if certain classes have more interest, there are other alternatives that do not need a high training cost.

A safety analysis of roundabouts and turbo roundabouts based on Petri nets.

Objective: In this work, a roundabout and a turbo roundabout model are compared and previous modeling with continuous Petri nets and safety are analyzed through indicators of complexity. Petri nets are a graphic and mathematical representation that allow a faithful modeling of urban systems. Method: The methodology has been designed for the transformation of a real system to small subgraphs that represent the maneuvers in roundabouts, approximated as roads and lanes of incorporation. Places within the roundabout have been located and defined as continuous places from their influence and visibility toward adjacent conditions. The transitions have been modeled by time and inhibitory arcs, which represent priorities and areas where drivers must pay attention. The created networks represent a faithful model of vehicle flow trajectories in the roundabouts. Results: The methodology is applied to the same real road intersection. The case study is a recent transformation from roundabout to turbo roundabout. The roundabout network complexity is corroborated by a greater number of entries and exits that lead to each roundabout place (reflected in the maneuvers that can be performed) and a greater number of inhibiting arcs. In most of the turbo roundabout places, the driver's only option is reduced to occupying next place. The possibility of choosing between several places supposes a greater trajectory intersection and an increased time for decision making. The only situation where the complexity is the same between both systems is when a vehicle accesses the inner lane of the roundabout from the left lane on a single-lane road. The main maneuvers causing accidents have been modeled and their solution in a turbo roundabout is presented. Conclusions: The reduced complexity of the turbo roundabout is due to the strict limitations in lane changes, turning turbo roundabouts into a safer model: A lower number of possible movements that can be performed by drivers and a smaller number of trajectories with collision risk. Petri nets have proven to be perfectly applicable to the representation of traffic circular systems (such as roundabouts and turbo roundabouts) and to measure the complexity and security of the system.

Ischemic stroke in patients previously anticoagulated for non-valvular atrial fibrillation: Why does it happen? / Acidente vascular cerebral isquémico em doentes previamente anticoagulados por fibrilhação auricular não valvular: por que acontece?

INTRODUCTION: Oral anticoagulants have proved to be highly effective in preventing atrial fibrillation (AF)-related strokes. The occurrence of stroke despite oral anticoagulation is unexpected and little is known about the mechanisms responsible. The aim of this study was to assess possible mechanisms for stroke occurrence, such as poor treatment adherence and inappropriate dosage, in patients chronically anticoagulated for AF. METHODS: We performed a prospective observational study of 60 consecutive patients with non-valvular AF, chronically medicated with an oral anticoagulant and admitted due to ischemic stroke. Treatment adherence was assessed through the Brief Medication Questionnaire (BMQ) and the Medição da Adesão ao Tratamento (MAT) scales. Patient characteristics, stroke etiology, and appropriacy of anticoagulant dosage were also assessed. RESULTS: Patients' mean age was 78.6±8.0 years, and 51.7% were male. Overall, the proportion of patients with good adherence to anticoagulants was 63.3%. Adherent patients were more frequently illiterate (26.3% vs. 4.5%, p=0.012). The proportion of patients under vitamin K antagonists (VKAs) with good treatment adherence was significantly higher than that of patients under novel oral anticoagulants (NOACs) (83.3% vs. 54.8%, respectively, for BMQ, p=0.035). However, 91.7% of patients under VKAs presented an admission INR <2. Subtherapeutic prescriptions were found in 43% of patients under NOACs. CONCLUSION: In the majority of patients, stroke occurrence despite chronic anticoagulation appears to be explained by subtherapeutic dosage, poor treatment adherence or non-cardioembolic etiology, and not by inefficacy of the anticoagulants.

Pregnancy outcomes in Portuguese women with multiple sclerosis: The PREGNIMS study.

INTRODUCTION: Several questions about pregnancy in women with multiple sclerosis (MS) have been discussed, but clarification is still needed in some very practical issues. Portuguese data on this subject remain scattered and need to be analyzed in order to standardize clinical practice. OBJECTIVE: This study aimed to describe and analyze the impact of MS on pregnancy and perinatal health of children born to Portuguese mothers with the disease. MATERIAL AND METHODS: This is a multicenter, retrospective study of a cohort of Portuguese women with MS who were pregnant and who gave birth between 01/01/2011 and 31/12/2015. Demographic and clinical data related to maternal disease, pregnancy progression and events, childbirth and newborn health were collected. RESULTS: Ninety-seven women were recruited and 90 live births were evaluated. The mean maternal age at conception was 32.5 years, and 63.9% had no relapses in the previous year (98.0% had a relapsing-remitting MS and the EDSS score was ≤ 3 in 92.8% of the cases). Only 50.5% of the women had a preconception specific evaluation and 60 children were exposed to immunomodulatory therapies during pregnancy. Nineteen women had relapses during pregnancy. Childbirth was induced in 22.7% of the cases, and the caesarean section rate was 34%. Children exposed to immunomodulatory drugs during pregnancy had a lower birth length (p = 0.014), and there was also a trend toward lower birth weight (p = 0.054) in these newborns. Pre-conception EDSS score negatively correlated with the duration of pregnancy (r = -0.22; p = 0.029), weight (r = -0.23; p = 0.031) and cephalic perimeter at birth (r = -0.24; p = 0.033). There was no relationship between the occurrence of relapses or progression in EDSS score during pregnancy with any variables related to the newborn. CONCLUSIONS: In our cohort, it has been confirmed that MS has no negative effect on pregnancy or on children's perinatal health. However, the use of immunomodulatory drugs may have some impact on newborns' somatometric features.

The neural basis of fatigue in multiple sclerosis: A multimodal MRI approach.

BACKGROUND: Fatigue is a frequent disabling symptom in multiple sclerosis (MS), but its pathophysiology remains incompletely understood. This study aimed to explore the underlying neural basis of fatigue in patients with MS. METHODS: We enrolled 60 consecutive patients with MS and 60 healthy controls (HC) matched on age, sex, and education. Fatigue was assessed using the Portuguese version of the Modified Fatigue Impact Scale (MFIS). All participants underwent 3T brain MRI (conventional and diffusion tensor imaging [DTI] sequences). White matter (WM) focal lesions were identified and T1/T2 lesion volumes were computed. Tract-based spatial statistics were applied for voxel-wise analysis of DTI metrics fractional anisotropy and mean diffusivity (MD) on normal-appearing WM (NAWM). Using Freesurfer software, total and regional volumes of cortical and subcortical gray matter (GM) were calculated. RESULTS: Compared to HC, patients with MS scored significantly higher on MFIS (33.8 ± 19.7 vs 16.5 ± 15.1, p < 0.001). MFIS scores were not significantly correlated with T1/T2 lesion volumes, total GM volume, or any regional volume of cortical and subcortical GM. Significant correlations were found between global scores of MFIS and MD increase of the NAWM skeleton, including corona radiata, internal capsule, external capsule, corticospinal tract, cingulum, corpus callosum, fornix, superior longitudinal fasciculus, superior fronto-occipital fasciculus, sagittal stratum, posterior thalamic radiation, cerebral peduncle, and uncinate fasciculus. CONCLUSIONS: In this study, fatigue was associated with widespread NAWM damage but not with lesion load or GM atrophy. Functional disconnection, caused by diffuse microstructural WM damage, might be the main neural basis of fatigue in MS.

Multiple Sclerosis: Implications of Obesity in Neuroinflammation.

Since the discovery of the remarkable properties of adipose tissue as a metabolically active organ, several evidences on the possible link between obesity and the pathogenesis of multiple sclerosis (MS) have been gathered. Obesity in early life, mainly during adolescence, has been proposed as a relevant risk factor for late MS development. Moreover, once MS is initiated, obesity can contribute to increase disease severity by negatively influencing disease progress. Despite the fact that clinical data are not yet conclusive, many biochemical links have been recently disclosed. The "low-grade inflammation" that characterizes obesity can lead to neuroinflammation through different mechanisms, including choroid plexus and blood-brain barrier disruption. Furthermore, it is well known that resident immune cells of central nervous system and peripheral immune cells are involved in the pathogenesis of MS, and adipokines and neuropeptides such as neuropeptide Y may mediate the cross talk between them.

Apathy in multiple sclerosis: gender matters.

Apathy has been recognized as a frequent symptom in multiple sclerosis (MS) but uncertainty remains about its prevalence and clinical correlates. Therefore, the objective of this work was to assess the prevalence of apathy in patients with MS and to identify clinical and demographic correlates. A case-control study with 30 patients and 30 healthy controls matched for age, gender and education was performed. Apathy diagnosis was established using Robert et al.'s criteria. Additionally, apathy was assessed using the 10-item short version of the clinical-rated Apathy Evaluation Scale (AES-C-10). The Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS), and Montreal Cognitive Assessment (MoCA) were used to evaluate depression, fatigue and cognitive impairment, respectively. Apathy prevalence in MS patients was 43.3%. Patients with MS had higher AES-C-10 scores than controls (13.9 vs. 12.0, p=0.015). Patients with apathy presented a higher proportion of males (53.8% vs. 11.8%, p=0.02), lower educational level (53.8% vs. 11.8% of patients with up to 9years of education), higher scores on cognitive dimension of MFIS (18.0 vs. 8.0, p=0.048) and BDI (13.0 vs. 7.0, p=0.035) and worse performance on MoCA (24.0 vs. 26.0, p=0.028). Gender was the only independent predictor of apathy, with men presenting a higher risk compared to women (OR: 9.62; 95%CI: 1.02-90.61; p=0.048). In conclusion, apathy is a common neuropsychiatric disorder in MS and it is probably underdiagnosed. Male patients seem to have an increased risk of apathy, and this finding may be related to the generally more unfavorable course of MS in men.