MRI-Based Surrogate Imaging Markers of Aggressiveness in Prostate Cancer: Development of a Machine Learning Model Based on Radiomic Features.

This study aimed to develop a noninvasive Machine Learning (ML) model to identify clinically significant prostate cancer (csPCa) according to Gleason Score (GS) based on biparametric MRI (bpMRI) radiomic features and clinical information. METHODS: This retrospective study included 86 adult Hispanic men (60 ± 8.2 years, median prostate-specific antigen density (PSA-D) 0.15 ng/mL2) with PCa who underwent prebiopsy 3T MRI followed by targeted MRI-ultrasound fusion and systematic biopsy. Two observers performed 2D segmentation of lesions in T2WI/ADC images. We classified csPCa (GS ≥ 7) vs. non-csPCa (GS = 6). Univariate statistical tests were performed for different parameters, including prostate volume (PV), PSA-D, PI-RADS, and radiomic features. Multivariate models were built using the automatic feature selection algorithm Recursive Feature Elimination (RFE) and different classifiers. A stratified split separated the train/test (80%) and validation (20%) sets. RESULTS: Radiomic features derived from T2WI/ADC are associated with GS in patients with PCa. The best model found was multivariate, including image (T2WI/ADC) and clinical (PV and PSA-D) information. The validation area under the curve (AUC) was 0.80 for differentiating csPCa from non-csPCa, exhibiting better performance than PI-RADS (AUC: 0.71) and PSA-D (AUC: 0.78). CONCLUSION: Our multivariate ML model outperforms PI-RADS v2.1 and established clinical indicators like PSA-D in classifying csPCa accurately. This underscores MRI-derived radiomics' (T2WI/ADC) potential as a robust biomarker for assessing PCa aggressiveness in Hispanic patients.

Laparoscopic surgery in 3D improves results and surgeon convenience in sleeve gastrectomy for morbid obesity.

PURPOSE: Advanced laparoscopic procedures are still challenging. One critical issue is the lack of stereoscopic vision. The aim of this surgical study is to evaluate whether 3D vision offers any advantages for surgical performance over 2D vision during sleeve gastrectomy for morbid obesity using a laparoscopic system that allows changing between 2D and 3D optics. METHODS: A total of 78 patients were analyzed, with 37 in the 2D group and 41 in the 3D group. Performance time, hospital stay, complications, and early outcomes were collected. To assess the quality of the 2D and 3D techniques, visual analog scales from 0 to 10 were designed, and image quality, depth of field, precision in performing tasks, and general ergonomics were measured. RESULTS: According to the vision system used, the mean duration of surgery was 85 ± 16.8 min for patients operated on with the 2D system and 69 ± 16.9 min for those operated on with the 3D system. There were no significant differences between the overall percentages of complications according to the type of vision used. However, postoperative complications were more severe in the 2D laparoscopy group. The average length of stay was shorter for patients in the 3D group. Regarding the differences perceived by the surgeon, the depth of field and the precision of tasks were better in the 3D vision group. CONCLUSION: The 3D system provided greater depth perception and precision in more complex tasks, enabling safer surgery. This led to a reduction in the operative time and hospital stay. Moreover, the severity of complications was less.

A Comparison of 2 Surgical Treatments for Thoracolumbar Burst Fractures: Temporary Osteosynthesis and Arthrodesis.

BACKGROUND: We compared the clinical and radiological outcomes and complications of patients treated for thoracolumbar burst fractures via temporary percutaneous osteosynthesis or open definitive arthrodesis. METHODS: A retrospective case-control study was performed including patients treated between 2017 and 2019 for a burst fracture of the thoracolumbar junction, either with percutaneous osteosynthesis (case group) or open arthrodesis (control group). Clinical, functional, and radiographic results were analyzed and compared between treatment groups. RESULTS: We included 112 patients (56 osteosynthesis/56 arthrodesis, P = 1) in our study. The mean follow-up and mean age were 20 ± 3 months (20 ± 2/20 ± 3, P = 1), and 41 ± 10 years (40 ± 11/42 ± 10, P = 0.3), respectively. Fracture level was L1/L2 in 75% and T11/T12 in 25% of patients. The osteosynthesis group showed significantly shorter operative times (104 ± 20 minutes/176 ± 18 minutes, P < 0.01) and inpatient stays (11.6 ± 1.5 days/15.6 ± 3.8 days, P < 0.01). Both groups showed similar correction over kyphosis angle at final follow-up (5.8° ± 2.8°/6° ± 0.2°, P = 0.57), but the osteosynthesis group showed increased segment mobility after hardware removal (3.8° ± 1.2°/0.9° ± 0.3°, P < 0.01). There were no significant differences in complications, although the osteosynthesis group showed a significantly lower need for blood transfusion (21%/43%, P = 0.02). CONCLUSIONS: Both methods of treatment yielded good clinical and radiological results with similar complication rates. Temporary osteosynthesis seems to be more beneficial than open arthrodesis because it requires shorter operative time and hospitalization, causes less bleeding, and facilitates spinal movement.

Land-based climate change mitigation measures can affect agricultural markets and food security.

Earlier studies have noted potential adverse impacts of land-related emissions mitigation strategies on food security, particularly due to food price increases-but without distinguishing these strategies' individual effects under different conditions. Using six global agroeconomic models, we show the extent to which three factors-non-CO2 emissions reduction, bioenergy production and afforestation-may change food security and agricultural market conditions under 2 °C climate-stabilization scenarios. Results show that afforestation (often simulated in the models by imposing carbon prices on land carbon stocks) could have a large impact on food security relative to non-CO2 emissions policies (generally implemented as emissions taxes). Respectively, these measures put an additional 41.9 million and 26.7 million people at risk of hunger in 2050 compared with the current trend scenario baseline. This highlights the need for better coordination in emissions reduction and agricultural market management policies as well as better representation of land use and associated greenhouse gas emissions in modelling.

Short- and long-term warming effects of methane may affect the cost-effectiveness of mitigation policies and benefits of low-meat diets.

Methane's short atmospheric life has important implications for the design of global climate change mitigation policies in agriculture. Three different agricultural economic models are used to explore how short- and long-term warming effects of methane can affect the cost-effectiveness of mitigation policies and dietary transitions. Results show that the choice of a particular metric for methane's warming potential is key to determine optimal mitigation options, with metrics based on shorter-term impacts leading to greater overall emission reduction. Also, the promotion of low-meat diets is more effective at reducing greenhouse gas emissions compared to carbon pricing when mitigation policies are based on metrics that reflect methane's long-term behaviour. A combination of stringent mitigation measures and dietary changes could achieve substantial emission reduction levels, helping reverse the contribution of agriculture to global warming.

Impacts of the COVID-19 Pandemic on the Global Agricultural Markets.

This paper analyses the impacts on global agricultural markets of the demand shock caused by the COVID-19 pandemic and the first wave of lockdown measures imposed by the governments in the first semester of 2020 to contain it. Specifically, we perform a scenario-based analysis on the IMF economic growth forecasts for 2020 and 2021 using a global multi-commodity agricultural market model. According to our results, the sharp decline in economic growth causes a decrease in international meat prices by 7-18% in 2020 and dairy products by 4-7% compared to a business as usual situation. Following the slowdown of the economy, biofuel prices fall strongly in 2020, followed by their main feedstocks, maize and oilseeds. Although the income losses and local supply chain disruptions associated with the pandemic undoubtedly has led to an increase in food insecurity in many developing countries, global food consumption is largely unaffected due to the inelastic demand of most agricultural commodities and the short duration of the shock. From an environmental viewpoint, the COVID-19 impacts point to a modest reduction of direct greenhouse gases from agriculture of about 1% or 50 million tonnes of carbon dioxide equivalents in 2020 and 2021.

Limiting the exposure of the most vulnerable people as a strategy to minimize deaths from COVID-19 / Limitar la exposición de las personas más vulnerables como estrategia para minimizar los fallecimientos por COVID-19

The foreseeable lifting of the containment measures that were taken in Spain to reduce the rate of contagion and avoid saturation of the health system caused by the COVID-19 pandemia, suggests making approaches to how to deal with it. Strategies are proposed until the infected population exceeds the herd immunity threshold: an initial unfiltered proportional reopening, an age-limiting one (first strategy), and a more selective one, restricting mobility by age and only to people without chronic diseases (second strategy). The results obtained show reductions in the potential number of deaths of 82.56 %, if it were limited only by age. If it were restricted by age and without chronic diseases the reduction grows up to 95.34 %. Therefore, the fatality rate would be reduced from 1.04 % to 0.18 % and 0.05 % respectively.

Cercanos al levantamiento de las medidas de confinamiento que se tomaron para reducir la velocidad de contagio y evitar la saturación del sistema sanitario provocado por la pandemia de COVID-19, sugiere hacer planteamientos de cómo afrontarlo, aplicado en este caso concreto a España. Se plantean estrategias hasta que la población contagiada supere el umbral de la inmunidad de grupo: una salida proporcional sin filtrar, una reapertura limitando por edad (primera estrategia) y un desconfinamiento más selectivo restringiendo salidas por edad a personas sin enfermedades crónicas (segunda estrategia). Los resultados obtenidos muestran reducciones en el número potencial de fallecidos del 82.56 % si se limitase la reapertura por edad y del 95.34 % si se restringiese por edad y sin enfermedades crónicas. Así, se reduciría la letalidad del 1.04 %, al 0.18 % y 0.05 % respectivamente.

[Bacteremia caused by Vibrio cholerae non-O1/non-O139 carrying a region homologous to pathogenicity island VpaI-7]. / Bacteriemia por Vibrio cholerae no-O1/no-O139 que porta una región homóloga a la isla de patogenicidad VpaI-7.

We report a case of V. cholerae non-O1 / non-O139 bacteremia in an 81-year-old woman with abdominal pain, fever, vomiting, liquid stools, choluria and jaundice, while visiting a rural area without access to potable water. The identification was made by the MALDI-TOF mass spectrometry technique and subsequently the non-toxigenic non-O1 / non-139 strain was confirmed in the national reference laboratory. The molecular characterization demonstrated the absence of the cholera toxin gene (CTX), and the TCP pilus, however, presented 5 of 6 virulence genes present in an island of homologous pathogenicity named VPaI-7 of V. parahaemolyticus (vcs N2 +, vcs C2 +, vcs V2 +, toxR-, vspD +, T vopF +) and in addition it was positive for hylAy rtxA virulence genes recognized outside the island. This is the first case reported in Chile of a clinical strain of V. cholerae non-O1, non-O139 isolated from blood culture that carries in its genome a homologous segment of the pathogenicity island named VPaI-7 of V. parahaemolyticus, which codifies for a type III secretion system (TTSS) that probably contributes to his virulence.

Bacteriemia por Vibrio cholerae no-O1/no-O139 que porta una región homóloga a la isla de patogenicidad VpaI-7 / Bacteremia caused by Vibrio cholerae non-O1/non-O139 carrying a region homologous to pathogenicity island VpaI-7

Resumen Presentamos un caso de bacteriemia por Vibrio cholerae no-O1/ no-O139 en una mujer de 81 años con un cuadro de dolor abdominal, fiebre, vómitos, diarrea, coluria e ictericia, mientras visitaba una zona rural sin acceso a agua potable. La identificación se realizó por la técnica de espectrometría de masa MALDI-TOF, confirmándose una cepa no toxigénica no-O1/no-139. La caracterización molecular del aislado demostró la ausencia del gen de la toxina del cólera (CTX), y pilus TCP; sin embargo, presentó cinco de los seis genes de virulencia presentes en la isla de patogenicidad homóloga denominada VPaI-7 del V. parahaemolyticus (vcs N2+, vcs C2+, vcs V2+,toxR-, vspD+, T vopF+). Además, el aislado presentó los genes de virulencia hylA y rtxA. Este es el primer caso reportado en Chile de una cepa clínica de V. cholerae no-O1, no-O139 aislada de hemocultivos portador de un segmento homólogo de la isla de patogenicidad denominada VPaI-7 de V. parahaemolyticus, el cual codifica para un sistema de secreción tipo III (TTSS), que probablemente contribuye a su virulencia.

We report a case of V. cholerae non-O1 / non-O139 bacteremia in an 81-year-old woman with abdominal pain, fever, vomiting, liquid stools, choluria and jaundice, while visiting a rural area without access to potable water. The identification was made by the MALDI-TOF mass spectrometry technique and subsequently the non-toxigenic non-O1 / non-139 strain was confirmed in the national reference laboratory. The molecular characterization demonstrated the absence of the cholera toxin gene (CTX), and the TCP pilus, however, presented 5 of 6 virulence genes present in an island of homologous pathogenicity named VPaI-7 of V. parahaemolyticus (vcs N2 +, vcs C2 +, vcs V2 +, toxR-, vspD +, T vopF +) and in addition it was positive for hylAy rtxA virulence genes recognized outside the island. This is the first case reported in Chile of a clinical strain of V. cholerae non-O1, non-O139 isolated from blood culture that carries in its genome a homologous segment of the pathogenicity island named VPaI-7 of V. parahaemolyticus, which codifies for a type III secretion system (TTSS) that probably contributes to his virulence.

Isolated conjunctival granuloma as a first manifestation of Parinaud's oculoglandular syndrome: A case report.

PURPOSE: Parinaud's oculo-glandular syndrome (POGS) is the most frequent manifestation of ocular bartonellosis, and usually presents with local lymphadenopathies and systemic symptoms. We present a case of isolated conjunctival granuloma as the sole manifestation of ocular bartonellosis. OBSERVATIONS: A 67-year-old female presented to the authors' eye clinic with complaints of a 2-week history of unilateral red eye and chemosis. Slit lamp examination revealed an isolated bulbar conjunctival granuloma. The remainder of the eye examination was unremarkable. Topical treatment with gatifloxacin and prednisolone acetate was started. Etiological work-up was performed. General laboratory tests revealed only a mild leukocytosis, and interferon gamma-release assay and chest computed tomography were normal. Serological testing for Bartonella henselae was positive at titers of 1:1024. Three weeks after initial symptoms, lymphadenopathies, malaise, and fever appeared. Systemic azithromycin was added, which resulted in complete regression of the disease. CONCLUSION AND IMPORTANCE: Conjunctival granulomas present a wide range of differential diagnoses to the practitioner. Ocular bartonellosis is a relevant cause of conjunctival granuloma. POGS should be suspected in cases of conjunctival granulomata non-responsive to local therapy. It is important to consider that other agents to treat POGS have been described and are available, and that appropriate serological tests should be performed.

Coordinating AgMIP data and models across global and regional scales for 1.5°C and 2.0°C assessments.

The Agricultural Model Intercomparison and Improvement Project (AgMIP) has developed novel methods for Coordinated Global and Regional Assessments (CGRA) of agriculture and food security in a changing world. The present study aims to perform a proof of concept of the CGRA to demonstrate advantages and challenges of the proposed framework. This effort responds to the request by the UN Framework Convention on Climate Change (UNFCCC) for the implications of limiting global temperature increases to 1.5°C and 2.0°C above pre-industrial conditions. The protocols for the 1.5°C/2.0°C assessment establish explicit and testable linkages across disciplines and scales, connecting outputs and inputs from the Shared Socio-economic Pathways (SSPs), Representative Agricultural Pathways (RAPs), Half a degree Additional warming, Prognosis and Projected Impacts (HAPPI) and Coupled Model Intercomparison Project Phase 5 (CMIP5) ensemble scenarios, global gridded crop models, global agricultural economics models, site-based crop models and within-country regional economics models. The CGRA consistently links disciplines, models and scales in order to track the complex chain of climate impacts and identify key vulnerabilities, feedbacks and uncertainties in managing future risk. CGRA proof-of-concept results show that, at the global scale, there are mixed areas of positive and negative simulated wheat and maize yield changes, with declines in some breadbasket regions, at both 1.5°C and 2.0°C. Declines are especially evident in simulations that do not take into account direct CO2 effects on crops. These projected global yield changes mostly resulted in increases in prices and areas of wheat and maize in two global economics models. Regional simulations for 1.5°C and 2.0°C using site-based crop models had mixed results depending on the region and the crop. In conjunction with price changes from the global economics models, productivity declines in the Punjab, Pakistan, resulted in an increase in vulnerable households and the poverty rate.This article is part of the theme issue 'The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°C above pre-industrial levels'.

Neurological complications using a novel retractor system for direct lateral minimally invasive lumbar interbody fusion.

We describe our experience using the RAVINE retractor (K2M, Leesburg, VA, USA) to gain access to the lateral aspect of the lumbar spine through a retroperitoneal approach. Postoperative neurological adverse events, utilising the mentioned retractor system, were recorded and analysed. We included 140 patients who underwent minimally invasive lateral lumbar interbody fusion (MI-LLIF) for degenerative spinal conditions between 2011 and 2015 at two major spinal centres. A total of 228 levels were treated, 35% one level, 40% two level, 20% three level and 5% 4 level surgeries. The L4/5 level was instrumented in 28% of cases. 12/140 patients had postoperative neurological complications. Immediately after surgery, 5% of patients (7/140) had transient symptoms in the thigh ranging from sensory loss, pain and paraesthesia, all of which recovered within 12weeks following surgery. There were five cases of femoral nerve palsy (3.6% - two ipsilateral and three contralateral), all of which recovered completely with no residual sensory or motor deficit within 6months. MI-LLIF done with help of the described retractor system has proved a safe and efficient way to achieve interbody fusion with minimal complications, mainly nerve related, that recovered quickly. Judicious use of the technique to access the L4/5 level is advised.

Co-occurrence of arsenic and fluoride in groundwater of semi-arid regions in Latin America: genesis, mobility and remediation.

Several million people around the world are currently exposed to excessive amounts of arsenic (As) and fluoride (F) in their drinking water. Although the individual toxic effects of As and F have been analyzed, there are few studies addressing their co-occurrences and water treatment options. Several studies conducted in arid and semi-arid regions of Latin America show that the co-occurrences of As and F in drinking water are linked to the volcaniclastic particles in the loess or alluvium, alkaline pH, and limited recharge. The As and F contamination results from water-rock interactions and may be accelerated by geothermal and mining activities, as well as by aquifer over-exploitation. These types of contamination are particularly pronounced in arid and semi-arid regions, where high As concentrations often show a direct relationship with high F concentrations. Enrichment of F is generally related to fluorite dissolution and it is also associated with high Cl, Br, and V concentrations. The methods of As and F removal, such as chemical precipitation followed by filtration and reverse osmosis, are currently being used at different scales and scenarios in Latin America. Although such technologies are available in Latin America, it is still urgent to develop technologies and methods capable of monitoring and removing both of these contaminants simultaneously from drinking water, with a particular focus towards small-scale rural operations.

Performance of Eleocharis macrostachya and its importance for arsenic retention in constructed wetlands.

INTRODUCTION: Arsenic (As) can be removed from water via rhizofiltration using phytostabilizing plants. The aim of this study was to investigate the performance of Eleocharis macrostachya in constructed wetland prototypes, as well as the plant's arsenic mass retention and the distribution of As along the wetland flow gradient and the soil in the wetland mesocosmos. MATERIALS AND METHODS: Experiments were carried out in laboratory-scale wetland prototypes, two planted with E. macrostachya and one without plants. Samples of water were taken at the inlet and outlet of the wetlands during the 33-week test period. At the end of the experiment, plants and soil (silty-sand) from each prototype were divided in three equal segments (entrance, middle and exit) and analyzed for their arsenic content. Results revealed that the planted wetlands have a higher As-mass retention capacity (87-90% of the total As inflow) than prototypes without plants (27%). RESULTS: As mass balance in the planted wetlands revealed that 78% of the total inflowing As was retained in the soil bed. Nearly 2% was absorbed in the plant roots, 11% was flushed as outflow, and the fate of the remaining 9% is unknown. In the prototype without plants, the soil retained 16% of As mass, 72% of the arsenic was accounted for in the outflow, and 12% was considered unknown. Although E. macrostachya retained only 2% of the total arsenic mass in their roots, its presence was a determining factor for arsenic retention in the wetland soil medium. CONCLUSION: Hence, planted wetlands might be a suitable option for treating As-contaminated water.

Asymmetric synthesis of chiral δ-lactones containing multiple contiguous stereocenters.

A versatile methodology for the asymmetric synthesis of chiral δ-lactones containing multiple contiguous stereocenters has been developed that relies on a series of Evans' aldol, hydroxyl-directed cyclopropanation, methanolysis, and Hg(II) mediated cyclopropane ring-opening reactions for stereocontrol.