Recurrent obstruction of biliary stent-in-stent: a heated solution.

Intraductal radiofrequency ablation (RFA) has been used in the management of malignant biliary obstruction and ampullary neoplasms. Some small studies refer to its role in managing benign biliary strictures with some promising results. The complications are not neglectable, namely cholangitis, pancreatitis, bleeding, and perforation, although most of them can be managed conservatively. There are two catheters available. Only the ERLA (EndoLumunal Radiofrequency Ablation, Taewoong Medical) catheter can control temperature and impedance, allowing it to reduce the risk of complications.

Green synthesis of silver nanoparticles based on using Croton urucurana and their toxicity against freshwater snail species Biomphalaria glabrata.

Green plant-based silver nanoparticles (GP-Ag NPs) have contributed to the development of ecological technologies with low environmental impact and safer for human health, as well as demonstrating potential for the control of vectors and intermediate hosts. However, knowledge about its toxicity in the early stages of gastropod development remains scarce. Therefore, the current study aimed to investigate the toxicity of GP-Ag NPs synthesized from Croton urucurana leaf extracts in snail species Biomphalaria glabrata, which is an intermediate host for Schistosoma mansoni parasite. GP-Ag NPs were synthesized using two types of plant extracts (aqueous and hydroethanolic) and characterized using multiple techniques. Bioassays focused on investigating GP-Ag NPs and plant extracts were carried out with embryos and newly hatched snails, for 144 h and 96 h, respectively; toxicity was analyzed based on mortality, hatching, development inhibition, and morphological changes. Results have shown that both GP-Ag NPs were more toxic to embryos and newly hatched snails than the investigated plant extracts. GP-Ag NPs deriving from aqueous extract have higher molluscicidal activity than those deriving from hydroethanolic extract. Both GP-Ag NPs induced mortality, hatching delay, development inhibition, and morphological changes (i.e., hydropic embryos), indicating their molluscicidal activities. Moreover, embryos were more sensitive to GP-Ag NPs than newly hatched snails. Thus, the toxicity of GP-Ag NPs to freshwater snails depends on the type of extracts and the snail's developmental stages. These findings can contribute to the development of green nanobiotechnologies applicable to control snails of medical importance.

Plasma-Driven Tuning of Dielectric Permittivity in Graphene.

Materials with tunable negative electromagnetic performance, i.e., where dielectric permittivity becomes negative, have long been pursued in materials research due to their peculiar electromagnetic (EM) characteristics. Here, this promising feature is reported in materials on the case of plasma-synthesized nitrogen-doped graphene sheets with tunable permittivity over a wide (1-40 GHz) frequency range. Selectively incorporated nitrogen atoms in a graphene scaffold tailor the electronic structure in a way that provides an ultra-low energy (0.5-2 eV) 2D surface plasmon excitation, leading to subunitary and negative dielectric constant values in the Ka-band, from 30 up to 40 GHz. By allowing the tailoring of structures at atomic scale, this novel plasma-based approach creates a new paradigm for designing 2D nanomaterials like nanocarbons with controllable and tunable permittivity, opening a path to the next generation of 2D metamaterials.

Exploring Coaches' Cognitive Perception of Football Training Tasks: A Questionnaire-Based Study and Comparison with a Framework Tool for Assessing Cognitive Demands in Small-Sided Games / Exploración de la percepción cognitiva de los entrenadores sobre las tareas de entrenamiento de fútbol: un estudio basado en cuestionarios y una comparación con una herramienta marco para evaluar las demandas cognitivas en juegos reducidos / Exploração da perceção cognitiva de tarefas de treino em futebol: Estudo baseado numquestionário e comparação com uma ferramenta para avaliar e comparar as exigências cognitivas em jogos reduzidos

La función cognitiva es crucial en entornos de rendimiento competitivo debido al tipo de tareas y carga de trabajo involucradas. Sin embargo, aún se necesita determinar cómo toda la información ambiental en un entorno competitivo afecta la carga cognitiva.Por lo tanto, el objetivo fue investigar la percepción cognitiva de los entrenadores sobre las tareas de entrenamiento de fútbol, mediante el uso de un cuestionario y comparar los resultados con una herramienta de marco para evaluar las demandascognitivas en juegos reducidos. Un total de 57 entrenadores de fútbol (a nivel nacional y regional) completaron un cuestionario para calificar las demandas cognitivas percibidas de doce situaciones diferentes de juegos en espacios reducidos. Las respuestas fueron hechas por cada entrenador a partir de un conjunto de alternativas proporcionadas por los autores utilizando una escala de uso de Likert de 10 puntos. La carga cognitiva durante los juegos reducidos se calculó mediante una ecuación que incluía el número de jugadores implicados en la tarea, la superficie ocupada por cada jugador y la duración del ejercicio. Los resultados del cuestionario mostraron que los entrenadores de nivel nacional presentaron resultados de correlación más altos, mostrando una alta concordancia entre la percepción de los entrenadores y los resultados de la carga cognitiva en comparación con los entrenadores de nivel regional. La relación establecida entre todas las variables mostró que la complejidad de las tareas aumenta utilizando formatos con mayor número de jugadores, áreas pequeñas y ejercicios de mayor duración. Por lo tanto, el marco de carga cognitiva puede ser una herramienta útil y sencilla para quelos entrenadores evalúen las demandas cognitivas durante las sesiones de entrenamiento.(AU)

Cognitive function is crucial in competitive performance environments due to the type of tasks and workload involved. Thus, the present study aimed to investigate coaches’ cognitive perception of football training tasks, through the use of a questionnaire and compare the results with a framework tool to assess cognitive demands in small-sided games. A total of 57 football coaches (national and regional levels) filled out a questionnaire to rate the perceived cognitive demands of twelve different small-sidedgame situations. The answers were made by each coach from a set of alternatives supplied by the authors using a 10-point Likert use scale. The cognitive load during small-sided games was calculated using an equation that included the number of players involved in the task, the surface area occupied by eachplayer, and the duration of the exercise. The questionnaire results have shown that national-level coaches presented higher correlation results showing a high agreement between coaches' perception and the cognitive load results when compared to regional-level coaches. The relationship established between all variables showed that the complexity of tasks increases using formats with a larger number of players, small areas, and bigger duration drills. Thus, the cognitive load framework may be a useful and simple tool to coaches assess the cognitive demands during training sessions.(AU)

A função cognitiva é crucial em ambientes de desempenho competitivo devido ao tipo de tarefas e carga de trabalho envolvidas. No entanto, ainda precisa ser determinado como todas as informações ambientais em em contexto competitivo afetam a carga cognitiva. Assim, o objetivo deste estudofoi investigar a perceção cognitiva de treinadores sobre tarefas de treino de futebol, através de um questionário e comparando os resultados com um instrumento para avaliar as exigências cognitivas durante jogos reduzidos.Um total de 57 treinadores de futebol (nível nacional e regional) preencheram um questionário para avaliar as exigências cognitivas de doze situações diferentes jogos-reduzido. As respostas foram dadas por cada treinador a partir de um conjunto de alternativas fornecidas pelos autores utilizando uma escala de Likert de 10 pontos. A carga cognitiva durante pequenos jogos foi calculada através de uma equação queincluía o número de jogadores envolvidos na tarefa, a área de superfície ocupada por cada jogadore a duração do exercício. Os resultados do questionário mostraram que os treinadores de nível nacional apresentaram resultados de correlação mais elevados, mostrando uma alta concordância entre a perceção dos treinadores e os resultados de carga cognitiva em comparação com os treinadores de nível regional. A relação estabelecida entre todas as variáveis mostrou que a complexidade das tarefas aumenta utilizandoformatos com maior número de jogadores, áreas pequenas e exercícios de maior duração. Portanto, esta ferramenta para avaliar a carga cognitiva pode ser uma forma útil e simples para os treinadores avaliarem as exigências cognitivas durante as sessões de treino.(AU)

Atuação do enfermeiro de suporte imediato de vida na dor torácica: realidades do interior norte de Portugal / The role of the immediate life support nurse in chest pain: realities in the northern interior of Portugal

[{"text": "A dor torácica (DTC) aguda é o sintoma comum de Síndrome Coronário Agudo (SCA), que mais frequentemente leva as pessoas a procurarem cuidados de emergência no mundo. Dois terços das mortes por eventos coronários agudos ocorrem por arritmias fatais, em ambiente pré-hospitalar. O reconhecimento rápido de sintomas é mandatório para redução da mortalidade. O Enfermeiro SIV tem um papel fundamental na a determinação do diagnóstico célere e, no tratamento adequado da pessoa com SCA. Objetivos: Visando conhecer a atuação do enfermeiro Suporte Imediato de Vida (SIV) nas ocorrências de DTC, na pessoa com suspeita de SCA, relativamente às ambulâncias SIV de dois distritos do interior norte de Portugal, delinearam-se como objetivos específicos: (i) Analisar as ativações das ambulâncias SIV para ocorrências de DTC, na pessoa com suspeita de SCA, relativamente às características sociodemográficas e geográficas; (ii) Identificar o perfil de risco cardiovascular (verificável) nas ocorrências de DTC, da pessoa com suspeita de SCA, por ambulâncias SIV; (iii) Identificar os fatores de risco cardiovasculares (FRCV) modificáveis (verificáveis) nas ocorrências de DTC, da pessoa com suspeita de SCA, por ambulância SIV; (iv) Conhecer os tempos de resposta do pré-hospitalar nos diferentes momentos do socorro, nas ocorrências de DTC, na pessoa com suspeita de SCA; (v) Analisar a atuação do Enfermeiro tendo por base, a utilização do protocolo da DTC e, complementares, por ambulância SIV; (vi) Verificar a melhoria de sintomatologia decorrente da atuação do enfermeiro SIV em ocorrência de DTC, da pessoa com suspeita de SCA; (vii) Identificar episódios de complicações ocorridas durante a atuação do enfermeiro SIV, em situações de DTC, na pessoa com suspeita de SCA. Metodologia: Foi realizado um estudo retrospetivo, analítico transversal, de cariz quantitativo, envolvendo uma amostra por conveniência de 75 ativações para DTC, com suspeita de SCA, nas ambulâncias SIV do interior norte de Portugal, no período compreendido entre 01 junho de 2017 e o 31 de dezembro de 2018. A recolha de dados foi efetuada através de um IRD concebido para o efeito. Resultados: É predominante o sexo masculino, nas ativações de DTC, com suspeita de SCA, sendo a idade média de 65,90 anos na SIV 1 e, na SIV 2 de 72,33 anos. Na SIV 2 verificou-se que, entre o sexo masculino e a idade, existe relação estatística significativa (p=0,013), apresentando este uma idade inferior (

Comparative floral development in Mimosa (Fabaceae: Caesalpinioideae) brings new insights into merism lability in the mimosoid clade.

The genus Mimosa L. (Leguminosae; Caesalpinioideae; mimosoid clade), comprising more than 500 species, is an intriguing genus because, like other members of the mimosoid clade, it presents an enormous variation in floral characteristics and high merism lability. Thus, this study aimed to elucidate the floral development and identify which ontogenetic pathways give rise to merism variation and andromonoecy in Mimosa caesalpiniifolia, M. pudica, M. bimucronata, and M. candollei. Floral buds at various stages of development and flowers were collected, fixed, and processed for surface analysis (SEM). The development of the buds is synchronous in the inflorescences. Sepals appear simultaneously as individualized primordia in M. caesalpiniifolia and in reversed unidirectional order in M. bimucronata, with union and formation of an early ring-like calyx. Petal primordia appear in unidirectional order, with a noticeably elliptical shape in M. caesalpiniifolia. The wide merism variation in Mimosa results from the absence of organs from inception in the perianth and androecium whorls: in dimerous, trimerous, or tetramerous flowers, the additional organs primordia to compose the expected pentamerous flowers are not initiated. The haplostemonous androecium of M. pudica results from the absence of antepetalous stamens from inception. In the case of intraspecific variations (instabilities), there is no initiation and subsequent abortion of organs in the events of reduction in merosity. In addition, extra primordia are initiated in supernumerary cases. On the other hand, staminate flowers originate from the abortion of the carpel. Mimosa proved to be an excellent model for studying merism variation. The lability is associated with actinomorphic and rather congested flowers in the inflorescences. Our data, in association with others of previous studies, suggest that the high lability in merism appeared in clades that diverged later in the mimosoid clade. Thus, phylogenetic reconstruction studies are needed for more robust evolutionary inferences. The present investigation of ontogenetic processes was relevant to expand our understanding of floral evolution in the genus Mimosa and shed light on the unstable merism in the mimosoid clade.

A rare endoscopic pattern in a patient with gastroesophageal reflux disease

A 21-year-old man, with personal history of asthma and no usual medication, was referred to gastroenterology appointment due to dysphagia for solids and previous episodes of food impaction in the last 5 months. He also reported nocturnal heartburn without any other warning signs. Upper gastroscopy revealed a peptic stenosis in the distal esophagus. Histopathologic examination showed hyperplasia and numerous intraepithelial eosinophils, without dysplasia or malignancy. Therapy with a double-dose proton pump inhibitor (PPI) was started. (AU)

Association of New-Onset Atrial Fibrillation With All-Cause Mortality in COVID-19 Patients.

Background The COVID-19 pandemic has brought about unprecedented global health challenges, with its impact extending beyond respiratory manifestations to encompass cardiovascular complications, including arrhythmias. Dysrhythmias in COVID-19 are multifactorial, ranging from direct myocardial insult due to the cytokine storm to metabolic derangements. Objective In this study, we aim to examine the incidence of new-onset atrial fibrillation and to study its association with all-cause mortality of COVID-19. Methods A cross-sectional study was conducted at Cabell Huntington Hospital, West Virginia, utilizing electronic medical records of COVID-19 patients from 2020 to 2021. Inclusion criteria comprised patients aged >18 years with COVID-19 diagnosis and cardiac arrhythmias during hospitalization. Logistic regression analysis was employed to examine the relationship between demographic and clinical variables and in-hospital mortality. Results Of the 264 eligible patients, those aged >66 years had lower odds of in-hospital mortality (p < 0.001), while gender, ejection fraction, and diabetes mellitus did not significantly predict mortality. Atrial fibrillation (p = 0.011) and heart failure (p = 0.030) were associated with increased odds of mortality, while hypertension showed no significant predictive power (p = 0.791). Conclusion This study highlights the significance of atrial fibrillation and heart failure as predictors of in-hospital mortality in COVID-19 patients. Our findings underscore the importance of recognizing and managing arrhythmias in COVID-19 and call for further research on the mechanisms and long-term effects of these cardiac complications in the context of the pandemic. These insights can guide clinical practice and interventions to optimize patient outcomes.

Eosinophilic Gastroenteritis: Still a Diagnostic Challenge.

Introduction: Eosinophilic gastroenteritis (EoG) is a rare condition with a yet poorly understood pathophysiology. Case Presentation: We report on a case of a 36-year-old woman with a history of atopy presenting with nausea, abdominal discomfort, weight loss, and ascites. Laboratorial analysis revealed peripheral eosinophilia and a slight elevation of inflammatory markers. The patient pursued medical assistance several times with a delay in the diagnosis. The pathway to the diagnosis of EoG with serosal infiltration and further management is presented. Discussion: Despite being diagnosed by exclusion, it is important to suspect EoG with subserosa involvement in patients presenting with the uncommon association of peripheral eosinophilia and ascites, particularly if there is a history of atopy.

Introdução: A gastroenterite eosinofílica é uma condição rara, com uma etiologia ainda pouco compreendida. Caso Clínico: Uma mulher de 36 anos, com antecedentes de atopia, que se apresenta com náuseas, desconforto abdominal difuso, perda ponderal e ascite de novo. As análises laboratoriais revelaram eosinofilia periférica e ligeira elevação dos parâmetros inflamatórios. A doente recorreu a cuidados de saúde repetidamente sem um diagnóstico. É apresentado o percurso até ao diagnóstico de gastroenterite eosinofílica com infiltração serosa e tratamento subsequente. Discussão: Apesar de ser um diagnóstico de exclusão, é importante suspeitar de gastroenterite eosinofílica com envolvimento subseroso perante a associação de ascite a sintomas gastrointestinais inespecíficos particularmente em doentes com história de atopia.

Infliximab Induction Strategies in Corticosteroid-Refractory Acute Severe Ulcerative Colitis: A Case Series and Literature Review.

Acute severe ulcerative colitis (ASUC) is an emergent medical condition and particularly challenging to treat efficaciously. Infliximab is one of the medical salvage treatment options after corticosteroid refractoriness, but the best induction strategy is not yet defined. With this case series, the authors intend to describe three corticosteroid-refractory ASUC cases with different intensified/accelerated infliximab induction approaches and review the literature on this topic. The first case describes an 18-year-old girl with ASUC at disease onset with rapid progression to toxic megacolon, complicated also with anemia, hypoalbuminemia, and coagulopathy. After corticosteroid failure, both accelerated and intensified (10 mg/kg) infliximab regimen was completed within 11 days, with solid clinical response and colon imaging normalization. Second, we present a 26-year-old male with left-sided ulcerative colitis known for 2 years, under mesalazine, who developed a moderate flare and was started on infliximab after partial and inconsistent response to corticosteroids. During the induction period, he presented this time an ASUC episode, which motivated an early and intensified third dose with good clinical response. Finally, we describe the case of a 78-year-old man with ulcerative proctitis for 12 years presenting ASUC with proximal disease extension as well. After unsatisfactory response to corticosteroids, infliximab was initiated on an accelerated induction regimen, completed in 13 days, with the standard dose, achieving clinical remission. Accelerated or intensified infliximab induction plans are becoming current clinical practice in corticosteroid-refractory ASUC. Current guidelines refer to the possibility of this type of strategies, not determining the optimal regimen due to lack of solid evidence. Literature is mainly based on retrospective studies, not randomized, with heterogeneous groups according to disease severity, and the effect on colectomy rates, mainly on the long term, is not clear. Additional well-supported studies are needed on this subject in order to seek a more widely uniform approach.

A agudização grave de colite ulcerosa é uma emergência médica, particularmente difícil de tratar de forma eficaz. O infliximab é uma das opções de tratamento médico de resgate após refractariedade aos corticosteróides, porém a melhor estratégia de indução ainda não está definida. Com este relato de série de casos, os autores pretendem descrever três casos de agudização grave de colite ulcerosa refratária a corticosteróides com diferentes abordagens de indução intensificada/acelerada de infliximab e rever a literatura sobre este tópico. O primeiro caso descreve uma jovem de 18 anos com agudização grave de colite ulcerosa, à apresentação da doença, com rápida progressão para megacólon tóxico, complicada também com anemia, hipoalbuminemia e coagulopatia. Após ausência de resposta a corticosteróides, foi iniciado regime acelerado e intensificado (10 mg/kg) de infliximab, concluído em 11 dias, com resposta clínica e normalização das alterações imagiológicas do cólon. Em segundo lugar, apresentamos um homem de 26 anos com colite ulcerosa esquerda conhecida há 2 anos, sob messalazina, que apresentou uma agudização moderada da doença e iniciou infliximab após resposta parcial e inconsistente aos corticosteróides. Durante o período de indução, apresentou desta vez um episódio de agudização grave, o que motivou uma terceira dose precoce e intensificada com boa resposta clínica. Por fim, descrevemos o caso de um homem de 78 anos com proctite ulcerosa há 12 anos apresentando agudização grave de colite ulcerosa, também com extensão proximal da doença. Após resposta insatisfatória a corticosteróides, foi iniciado infliximab em regime de indução acelerada, completado em 13 dias, com a dose padrão, obtendo remissão clínica. Os esquemas de indução de infliximab acelerados ou intensificados têm vindo a tornar-se prática clínica habitual nos casos de agudização grave de colite ulcerosa refratária a corticosteróides. As diretrizes atuais referem a possibilidade deste tipo de estratégias, não indicando qual o regime ideal por falta de evidência sólida. A literatura baseia-se principalmente em estudos retrospetivos, não randomizados, com heterogeneidade de grupos de estudo de acordo com a gravidade da doença e o efeito nas taxas de colectomia, sobretudo a longo prazo, não é claro. Estudos mais fundamentados são necessários sobre esta matéria de modo a que seja possível uma abordagem amplamente mais uniforme.

Evaluating the effect of low-density inhomogeneities: A comparative study of lithium fluoride detectors, radiochromic films, and collapsed cone algorithm in 6 MV photon beams.

In recent years, there has been significant advancement in the development of physical simulators for dose evaluation. Many dosimetric studies employ solid materials, equivalent to human tissues, to evaluate dose distribution. This study aims to evaluate the effectiveness of inhomogeneity correction carried out by the Monaco/Elekta radiotherapy planning software. To achieve this goal, a physical simulator was created using cork boards to simulate lung tissue and solid water to represent other tissues. This simulator was combined with a dosimetric system that utilized lithium fluoride thermoluminescent detectors - RADOS MTS-N (LiF:Mg,Ti). The thermoluminescent detectors were positioned at various depths using a precisely drilled 2.0 mm thick acrylic plate, and they were placed at predefined positions. The irradiation of the simulator was conducted using an Elekta Synergy® Platform accelerator, employing a 6 MV photon beam with a field size of 15 × 15 cm2 and a source-surface distance (SSD) of 97.5 cm. A radiation dose of 200 cGy was applied for this study. In addition to the dosimetric assessment using thermoluminescent detectors, GAFCHROMIC™ EBT-3 Dosimetry Films were utilized to evaluate the dose at the same measurement points. The dose distribution data measured with the detectors were compared with the values provided by the planning system (TPS) and the inhomogeneity correction was verified. The results support the hypothesis that there is a lack of precision in the analytical simulations performed by the TPS, particularly in cases involving dose distribution at interfaces with varying densities.

Actigraphic characterization of sleep and circadian phenotypes of PER3 gene VNTR genotypes.

The molecular circadian timing system involves genes known as "clock genes," such as the PER3 gene. Studies have demonstrated associations among a repeat polymorphism (VNTR) of the PER3 gene with chronotypes, with the occurrence of circadian rhythm disorders and with sleep homeostasis phenotypes. The aim of this study was to investigate, by actigraphy, sleep and circadian rhythm profiles of people with different genotypes for the VNTR polymorphism of the PER3 gene. We genotyped 467 individuals (46,39% male) for the PER3 VNTR polymorphism. The mean age of the participants was 21.84 ± 2.64, ranging from 18 to 30 y old. Actigraphy data were collected from a subsample of 81 subjects with PER3 4-repeats homozygous (PER34/4) or 5-repeats homozygous (PER35/5) genotypes from April to June of 2021. From this sample, 48 PER34/4 and 33 PER35/5 subjects wore a wrist actigraph between 12 and 19 d. The sleep onset (weekdays, p = 0.015; weekend, p = 0.022) and offset (weekdays, p = 0.004; weekend, p = 0.041) of the PER35/5 group occurred later than the PER34/4 group. Similar results were observed for the mid-sleep phase of weekdays (MSW) (p = 0.008) and free days (MSF) (p = 0.019), and for the mid-sleep phase corrected for sleep debt accumulated over the week (MSFsc) (p = 0.024). Despite the phase differences found between the PER34/4 and PER35/5 groups, no differences were found in sleep duration and social jet lag. However, the PER34/4 group presented, on average, a longer sleep rebound on the days off when compared to the PER35/5 (p = 0.002). The PER35/5 group showed lower interdaily stability (IS) (p = 0.032) and higher daily activity rhythm variability (IV) (p = 0.035). The findings of the present study revealed associations between the PER3 gene, sleep, and circadian rhythms. In general, we found that the gene is associated with the expression of sleep timing and duration and to the phase of the activity rhythm. The experiments carried out here occurred in the COVID-19 pandemic scenario, which should be considered as an environmental element with potential effects on the results obtained.

VUV to IR Emission Spectroscopy and Interferometry Diagnostics for the European Shock Tube for High-Enthalpy Research.

The European Shock Tube for High-Enthalpy Research is a new state-of-the-art facility, tailored for the reproduction of spacecraft planetary entries in support of future European exploration missions, developed by an international consortium led by Instituto de Plasmas e Fusão Nuclear and funded by the European Space Agency. Deployed state-of-the-art diagnostics include vacuum-ultraviolet to ultraviolet, visible, and mid-infrared optical spectroscopy setups, and a microwave interferometry setup. This work examines the specifications and requirements for high-speed flow measurements, and discusses the design choices for the main diagnostics. The spectroscopy setup covers a spectral window between 120 and 5000 nm, and the microwave interferometer can measure electron densities up to 1.5 × 1020 electrons/m3. The main design drivers and technological choices derived from the requirements are discussed in detail herein.

Insight into the Inter-Organ Crosstalk and Prognostic Role of Liver-Derived MicroRNAs in Metabolic Disease Progression.

Dysfunctional hepatic metabolism has been linked to numerous diseases, including non-alcoholic fatty liver disease, the most common chronic liver disorder worldwide, which can progress to hepatic fibrosis, and is closely associated with insulin resistance and cardiovascular diseases. In addition, the liver secretes a wide array of metabolites, biomolecules, and microRNAs (miRNAs) and many of these secreted factors exert significant effects on metabolic processes both in the liver and in peripheral tissues. In this review, we summarize the involvement of liver-derived miRNAs in biological processes with an emphasis on delineating the communication between the liver and other tissues associated with metabolic disease progression. Furthermore, the review identifies the primary molecular targets by which miRNAs act. These consolidated findings from numerous studies provide insight into the underlying mechanism of various metabolic disease progression and suggest the possibility of using circulatory miRNAs as prognostic predictors and therapeutic targets for improving clinical intervention strategies.

Neutronics Simulations for DEMO Diagnostics.

One of the main challenges in the development of a plasma diagnostic and control system for DEMO is the need to cope with unprecedented radiation levels in a tokamak during long operation periods. A list of diagnostics required for plasma control has been developed during the pre-conceptual design phase. Different approaches are proposed for the integration of these diagnostics in DEMO: in equatorial and upper ports, in the divertor cassette, on the inner and outer surfaces of the vacuum vessel and in diagnostic slim cassettes, a modular approach developed for diagnostics requiring access to the plasma from several poloidal positions. According to each integration approach, diagnostics will be exposed to different radiation levels, with a considerable impact on their design. This paper provides a broad overview of the radiation environment that diagnostics in DEMO are expected to face. Using the water-cooled lithium lead blanket configuration as a reference, neutronics simulations were performed for pre-conceptual designs of in-vessel, ex-vessel and equatorial port diagnostics representative of each integration approach. Flux and nuclear load calculations are provided for several sub-systems, along with estimations of radiation streaming to the ex-vessel for alternative design configurations. The results can be used as a reference by diagnostic designers.

Effects of Tranexamic Acid in Patients with Subarachnoid Hemorrhage in Brazil: A Prospective Observational Study with Propensity Score Analysis.

BACKGROUND: Rebleeding from a ruptured aneurysm increases the risk of unfavorable outcomes after subarachnoid hemorrhage (SAH) and is prevented by early aneurysm occlusion. The role of antifibrinolytics before aneurysm obliteration remains controversial. We investigated the effects of tranexamic acid on long-term functional outcomes of patients with aneurysmal SAH (aSAH). METHODS: This was a single-center, prospective, observational study conducted in a high-volume tertiary hospital in a middle-income country from December 2016 to February 2020. We included all consecutive patients with aSAH who either received or did not receive tranexamic acid (TXA) treatment. Multivariate logistic regression analysis using propensity score was used to evaluate the association of TXA use with long-term functional outcomes, measured by the modified Rankin Scale (mRS) at 6 months. RESULTS: A total of 230 patients with aSAH were analyzed. The median (interquartile range) age was 55 (46-63) years, 72% were women, 75% presented with good clinical grade (World Federation of Neurological Surgeons grade 1-3), and 83% had a Fisher scale of 3 or 4. Around 80% of patients were admitted up to 72 h from ictus. The aneurysm occlusion method was surgical clipping in 80% of the patients. A total of 129 patients (56%) received TXA. In multivariable logistic regression using inverse probability treatment weighting, the long-term rate of unfavorable outcomes (modified Rankin scale 4-6) was the same in the TXA and non-TXA groups (61 [48%] in TXA group vs. 33 [33%] in non-TXA group; odds ratio [OR] 1.39, 95% confidence interval [CI] 0.67-2.92; p = 0.377). The TXA group had higher in-hospital mortality (33 vs. 11% in non-TXA group; OR 4.13, 95% CI 1.55-12.53, p = 0.007). There were no differences between the groups concerning intensive care unit length of stay (16 ± 11.22 days in TXA group vs. 14 ± 9.24 days in non-TXA group; p = 0.2) or hospital (23 ± 13.35 days in TXA group vs. 22 ± 13.36 days in non-TXA group; p = 0.9). There was no difference in the rates of rebleeding (7.8% in TXA group vs. 8.9% in non-TXA group; p = 0.31) or delayed cerebral ischemia (27% in TXA group vs. 19% in non-TXA group; p = 0.14). For the propensity-matched analysis, 128 individuals were selected (64 in TXA group and 64 in non-TXA group), and the rates of unfavorable outcomes at 6 months were also similar between groups (45% in TXA group and 36% in non-TXA group; OR 1.22, 95% CI 0.51-2.89; p = 0.655). CONCLUSIONS: Our findings in a cohort with delayed aneurysm treatment reinforce previous data that TXA use before aneurysm occlusion does not improve functional outcomes in aSAH.

Blepharospasm Patients after Botulinum Toxin - Sleep Approach.

Background Blepharospasm is a focal dystonia that affects the orbicularis oculi muscles. The interest in nonmotor symptoms is due to their impact on quality of life. Objective We evaluated the frequency of sleep disorders and circadian rhythm in a sample of Brazilian blepharospasm patients. Methods A total of 51 patients, who met the clinical criteria for blepharospasm, evaluated by 2 specialists in movement disorders, were recruited from the outpatient clinic for movement disorders of two reference centers in the city of São Paulo: Universidade Federal de São Paulo and Hospital do Servidor Público do Estado de São Paulo. The selected 13 patients were evaluated from 13 days before to 13 days after using botulinum toxin. They were interviewed, underwent physical examination and actigraphy, and completed sleep diaries. Results After using botulinum toxin, the group that reported sleep improvement exhibited a 50% decrease in sleep latency. There was no change in restless leg syndrome or circadian rhythm. Patients who reported no sleep improvement after using botulinum toxin presented poorer synchronization of the light-dark cycle. Conclusion Blepharospasm patients have poor sleep quality. About 50% of the patients had sleep improvement after using botulinum toxin. The synchronization of the light-dark cycle should be influenced by this finding.