Imágenes Doppler de arterias intrapulmonares dentro de la atelectasia y su impacto en la poscarga del ventrículo derecho con ecocardiografía transesofágica / Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography

La cirugía cardíaca por toracoscopia videoasistida (VATS) requiere ventilación unipulmonar (VUP) y monitorización con ecografía transesofágica (ETE). Utilizando Doppler color y espectral es posible estudiar el patrón de flujo sanguíneo en los vasos pulmonares dentro del pulmón atelectasiado. El objetivo de este reporte de casos es evidenciar la habilidad de la ETE para detectar el flujo sanguíneo dentro del pulmón atelectásico, así como también valorar la resistencia vascular pulmonar (RVP) y poscarga del ventrículo derecho, utilizando esta misma herramienta. Hallazgos: Tres adultos anestesiados y ventilados mecánicamente programados para cirugía cardíaca por VATS fueron escaneados con ETE cardiopulmonar. Una vez que se realizó la VUP quedando el pulmón derecho sin ventilar, la sonda se giró desde el corazón para lograr un escaneo pulmonar 2D y con Doppler color para detectar el flujo de sangre dentro del parénquima pulmonar consolidado. Se pudo identificar el patrón de flujo correspondiente a las ramas de la arteria intrapulmonar. La RVP fue registrada aplicando Doppler pulsado cardíaco, basal luego de la inducción de anestesia general, a los 20min de la VUP y al finalizar la VUP, luego de realizar una maniobra de reclutamiento alveolar (MRA) que condujo a la resolución completa de la consolidación mencionada. Conclusiones: La ETE cardiopulmonar es una herramienta de imagen semiinvasiva que permite no solo el diagnóstico y estudio de atelectasias inducidas por VUP, sino también el análisis del shunt dentro de esta consolidación y sus posibles consecuencias en la RVP.(AU)

Video-assisted thoracoscopy (VATS) cardiac surgery requires one-lung ventilation (OLV) and transoesophageal ultrasound (TOE) monitoring. Colour and spectral Doppler make it possible to study the pattern of blood flow in the pulmonary vessels within the atelectatic lung. In this case report we describe how TOE can be used to detect blood flow within the atelectatic lung and to assess pulmonary vascular resistance (PVR) and right ventricular afterload. Findings: Three anaesthetised, mechanically ventilated adults scheduled for VATS cardiac surgery were monitored using TOE. After left OLV, the transducer was rotated away from the heart to obtain 2D colour Doppler images of blood flow within the consolidated lung parenchyma. We were able to identify the flow pattern of the intrapulmonary branches of the pulmonary artery. PVR was recorded using pulsed cardiac Doppler at baseline, after induction of general anaesthesia, 20min after OLV and at the end of OLV, and after performing an alveolar recruitment manoeuvre (ARM) that led to complete resolution of the aforementioned consolidation. Conclusions: TOE is a semi-invasive imaging tool that can be used to diagnose and study PVR-induced atelectasis and to analyse the resulting pulmonary shunt and its possible effect on PVR.(AU)

Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography.

Video-assisted thoracoscopy (VATS) cardiac surgery requires one-lung ventilation (OLV) and transoesophageal ultrasound (TOE) monitoring. Colour and spectral Doppler make it possible to study the pattern of blood flow in the pulmonary vessels within the atelectatic lung. In this case report we describe how TOE can be used to detect blood flow within the atelectatic lung and to assess pulmonary vascular resistance (PVR) and right ventricular (RV) afterload. FINDINGS: Three anaesthetised, mechanically ventilated adults scheduled for cardiac surgery by VATS were scanned with TOE. After left OLV, the transducer was rotated away from the heart to obtain 2D colour Doppler images of blood flow within the consolidated lung parenchyma. We were able to identify the flow pattern of the intrapulmonary branches of the pulmonary artery. PVR was recorded using pulsed cardiac Doppler at baseline, after induction of general anaesthesia, 20 min after OLV and at the end of OLV, and after performing an alveolar recruitment manoeuvre (ARM) that led to complete resolution of the aforementioned consolidation. CONCLUSIONS: TOE is a semi-invasive imaging tool that can be used to diagnose and study PVR-induced atelectasis and to analyse the resulting pulmonary shunt and its possible effect on PVR.

The connection between diverticulosis and colonic superficial neoplastic lesions in patients who underwent screening colonoscopy.

PURPOSE: If could be a potential pathophysiological connection between colonic diverticula and colonic superficial neoplastic lesions, beyond the shared risk factors, has been a subject of debate in the last years. This study tries to evaluate the association between diverticulosis and colonic neoplastic lesions. METHODS: This is a cross-sectional study including asymptomatic patients who underwent a screening colonoscopy (patients with a positive fecal occult blood test under the regional program of colorectal cancer (CRC) screening), surveillance after polypectomy resection, or familiarity (first-degree relatives) between 2020 and 2021 to evaluate the association between diverticula and colonic polyps. A multivariate analysis with multiple logistic regression and odds ratio (OR) to study the independent association between adenomas and adenocarcinomas was performed. RESULTS: One thousand five hundred one patients were included. A statistically significant association between adenomas or CRC alone and colonic diverticula was found (p = 0.045). On a multivariate analysis of demographic (age, gender) and clinical parameters (familiarity for diverticula and adenoma/CRC), only age was significantly associated with the development of colorectal adenomas or cancer (OR 1.05, 95% CI 1.03-1.07, p < 0.0001). CONCLUSIONS: This study showed a statistically significant association between diverticula and colonic adenomas. However, it is impossible to establish a cause-effect relationship due to the intrinsic characteristics of this study design. A study with a prospective design including both patients with diverticulosis and without colonic diverticula aimed at establishing the incidence of adenoma and CRC could help to answer this relevant clinical question, since a potential association could indicate the need for closer endoscopic surveillance.

MRI-derived radiomics to guide post-operative management of glioblastoma: Implication for personalized radiation treatment volume delineation.

Background: The glioblastoma's bad prognosis is primarily due to intra-tumor heterogeneity, demonstrated from several studies that collected molecular biology, cytogenetic data and more recently radiomic features for a better prognostic stratification. The GLIFA project (GLIoblastoma Feature Analysis) is a multicentric project planned to investigate the role of radiomic analysis in GB management, to verify if radiomic features in the tissue around the resection cavity may guide the radiation target volume delineation. Materials and methods: We retrospectively analyze from three centers radiomic features extracted from 90 patients with total or near total resection, who completed the standard adjuvant treatment and for whom we had post-operative images available for features extraction. The Manual segmentation was performed on post gadolinium T1w MRI sequence by 2 radiation oncologists and reviewed by a neuroradiologist, both with at least 10 years of experience. The Regions of interest (ROI) considered for the analysis were: the surgical cavity ± post-surgical residual mass (CTV_cavity); the CTV a margin of 1.5 cm added to CTV_cavity and the volume resulting from subtracting the CTV_cavity from the CTV was defined as CTV_Ring. Radiomic analysis and modeling were conducted in RStudio. Z-score normalization was applied to each radiomic feature. A radiomic model was generated using features extracted from the Ring to perform a binary classification and predict the PFS at 6 months. A 3-fold cross-validation repeated five times was implemented for internal validation of the model. Results: Two-hundred and seventy ROIs were contoured. The proposed radiomic model was given by the best fitting logistic regression model, and included the following 3 features: F_cm_merged.contrast, F_cm_merged.info.corr.2, F_rlm_merged.rlnu. A good agreement between model predicted probabilities and observed outcome probabilities was obtained (p-value of 0.49 by Hosmer and Lemeshow statistical test). The ROC curve of the model reported an AUC of 0.78 (95% CI: 0.68-0.88). Conclusion: This is the first hypothesis-generating study which applies a radiomic analysis focusing on healthy tissue ring around the surgical cavity on post-operative MRI. This study provides a preliminary model for a decision support tool for a customization of the radiation target volume in GB patients in order to achieve a margin reduction strategy.

Spring and latch dynamics can act as control pathways in ultrafast systems.

Ultrafast movements propelled by springs and released by latches are thought limited to energetic adjustments prior to movement, and seemingly cannot adjust once movement begins. Even so, across the tree of life, ultrafast organisms navigate dynamic environments and generate a range of movements, suggesting unrecognized capabilities for control. We develop a framework of control pathways leveraging the non-linear dynamics of spring-propelled, latch-released systems. We analytically model spring dynamics and develop reduced-parameter models of latch dynamics to quantify how they can be tuned internally or through changing external environments. Using Lagrangian mechanics, we test feedforward and feedback control implementation via spring and latch dynamics. We establish through empirically-informed modeling that ultrafast movement can be controllably varied during latch release and spring propulsion. A deeper understanding of the interconnection between multiple control pathways, and the tunability of each control pathway, in ultrafast biomechanical systems presented here has the potential to expand the capabilities of synthetic ultra-fast systems and provides a new framework to understand the behaviors of fast organisms subject to perturbations and environmental non-idealities.

Epidemiology of sepsis in Internal Medicine Units of Apulia: results of SEMINA (SEpsis Management in INternal medicine Apulia) study.

Background: The prevalence and mortality of sepsis in Internal Medicine Units (IMUs) is poorly understood as most of the data derive from studies conducted in Intensive Care Units. Aim of SEpsis Management in INternal medicine Apulia (SEMINA) study was to determine the prevalence of sepsis and the characteristics and outcomes of patients with Sepsis-3 criteria admitted in Apulia's Internal Medicine Units for over six months. Methods: The SEpsis Management in INternal medicine of Apulia study was a prospective, multicentre, observational study. Adult admissions to the 13 Apulia Region's Internal Medicine Units between November 15, 2018 and May 15, 2019 were screened for sepsis according to the Sepsis-3 criteria. Medical data were collected in electronic case report form. Results: Out of 7,885 adult patients of the Internal Medicine Units, 359 (4.55%) fulfilled the inclusion criteria, and 65 of them (18.1%) met the septic shock criteria. The patients enrolled were elderly, suffering from chronic poly-pathologies and from cognitive and functional impairment. The respiratory system was the most common site of infection and the most common pathogens isolated from blood cultures were Staphylococcus spp., E. coli, Klebsiella spp., Enterococcus spp. and Acinetobacter spp. The in-hospital fatality rate was 31.2% and was significantly higher for septic shock. Sequential Organ Failure Assessment score, dementia and infections from Acinetobacter spp. were independent risk factors for mortality. Conclusions: A high prevalence of sepsis and a high fatality rate were detected in Apulia Region's Internal Medicine Units. The high fatality rate observed in our study could be related to the underlying diseases and to the vulnerability of elderly patients admitted to our Internal Medicine Units.

Microstructural features assessment of different waterlogged wood species by NMR diffusion validated with complementary techniques.

Wood is a hygroscopic, multi-scale and anisotropic natural material composed of pores with different size and differently oriented. In particular, archaeologically excavated wood generally is waterlogged wood with very high moisture content (400%-800%) that need to have a rapid investigation at the microstructural level to obtain the best treatment with preservative agents. Time-dependent diffusion coefficient D(t) quantified by Pulse Field Gradient (PFG) Nuclear Magnetic Resonance (NMR) techniques provides useful information about complex porous media, such as the tortuosity (τ) describing pore connectivity and fluid transport through media, the average-pore size, the anisotropic degree (an). However, diffusion NMR is intrinsically limited since it is an indirect measure of medium microstructure and relies on inferences from models and estimation of relevant diffusion parameters. Therefore, it is necessary to validate the information obtained from NMR diffusion parameters through complementary investigations. In this work, the structures of five waterlogged wood species were studied by PFG of absorbed water. D(t) and τ of water diffusing along and perpendicular to vessels/tracheids main axes together with relaxation times and an were quantified. From these parameters, the pore sizes distribution and the wood microstructure characterization were obtained. Results among wood species were compared, validated and integrated by micro-imaging NMR (µ-MRI), environmental-scanning electron-microscope (ESEM) images, wood dry density and imbibition times measurement of all woods. The work suggests that an vs τ rather than the estimated pore size diversifies and characterize the different wood species. As a consequence diffusion-anisotropy vs tortuosity could be an alternative method to characterize and differentiate wood species of waterlogged wood when high resolution images (µ-MRI and ESEM) are not available. Moreover, the combined use of D(t) and micro-MRI expands the scale of dimensions observable by NMR covering all the interesting length scales of wood.

Snaps of a tiny amphipod push the boundary of ultrafast, repeatable movement.

Surprisingly, the fastest motions are not produced by large animals or robots. Rather, small organisms or structures, including cnidarian stinging cells, fungal shooting spores, and mandible strikes of ants, termites, and spiders, hold the world acceleration records.1-5 These diverse systems share common features: they rapidly convert potential energy - stored in deformed material or fluid - into kinetic energy when a latch is released.4-6 However, the fastest of these are not repeatable, because mechanical components are broken or ejected.5,6 Furthermore, some of these systems must overcome the added challenge of moving in water, where high density and viscosity constrain acceleration at small sizes. Here we report the kinematics of repeatable, ultrafast snaps by tiny marine amphipods (Dulichiella cf. appendiculata). Males use their enlarged major claw, which can exceed 30% of body mass, to snap a 1 mm-long dactyl with a diameter equivalent to a human hair (184 µm). The claw snaps closed extremely rapidly, averaging 93 µs, 17 m s-1, and 2.4 x 105 m s-2. These snaps are among the smallest and fastest of any documented repeatable movement, and are sufficiently fast to operate in the inertial hydrodynamic regime (Reynolds number (Re) >10,000). They generate audible pops and rapid water jets, which occasionally yield cavitation, and may be used for defense. These amphipod snaps push the boundaries of acceleration and size for repeatable movements, particularly in water, and exemplify how new biomechanical insights can arise from unassuming animals. VIDEO ABSTRACT.

Evidence for improved systemic and local vascular function after long-term passive static stretching training of the musculoskeletal system.

KEY POINTS: Vascular function and arterial stiffness are important markers of cardiovascular health and cardiovascular co-morbidity. Transitional phases of hypoemia and hypermia, with consequent fluctuations in shear rate, occuring during repetitive passive stretching adminstration (passive stretching training) may constitute an effective stimulus to induce an amelioration in vascular function, arterial stiffness and vascular remodelling by improving central and local blood flow control mechanisms. Vascular function, arterial stiffness and vascular remodelling were evaluated before and after 12 weeks of passive stretching training and after 6 weeks from training cessation, in the femoral, popliteal (treated with stretching), and brachial arteries (untreated) of both sides. After passive stretching training, vascular function and arterial remodelling improved, and arterial stiffness decreased in all the arteries, suggesting modifications of both central and local blood flow control mechanisms. Passive stretching-induced improvements related to central mechanisms seemed to have a short duration, as they returned to pre-training baseline within 6 weeks from training cessation, whereas those more related to a local mechanism persisted in the follow-up. ABSTRACT: Acute passive stretching (PS) effects on blood flow ( Q̇ ), shear rate ( Ẏ ), and vascular function in the feeding arteries of the stretched muscle have been extensively investigated; however, few data are available on vascular adjustments induced by long-term PS training. We investigated the effects of PS training on vascular function and stiffness of the involved (femoral and popliteal) and uninvolved (brachial) arteries. Our hypothesis was that PS-induced changes in Q̇ and Ẏ would improve central and local mechanisms of Q̇ control. Thirty-nine participants were randomly assigned to bilateral PS (n = 14), monolateral PS (n = 13) or no PS training (n = 12). Vascular function was measured before and after 12 weeks of knee extensor and plantar flexor muscles' PS training by single passive limb movement and flow-mediated dilatation (FMD). Central (carotid-femoral artery PWV, PWVCF ) and peripheral (carotid-radial artery PWV, PWVCR ) arterial stiffness was measured by pulse-wave velocity (PWV), together with systolic (SBP) and diastolic (DBP) blood pressure. After PS training, increases of 30%, 25% and 8% (P < 0.05) in femoral Δ Q̇ , popliteal and brachial artery FMD%, respectively, occurred in both PS training groups. A decrease in PWVCF , PWVCR , SBP and DBP (-25%, -17%, -4% and -8%, respectively; P < 0.05) was noted. No changes occurred in controls. Vascular function improved and arterial stiffness reduced in the arteries involved and uninvolved with PS training, suggesting modifications in both central and local Q̇ control mechanisms. PS-induced improvements had a short duration in some of vascular function parameters, as they returned to baseline within 6 weeks of PS training cessation.

Changes in energy system contributions to the Wingate anaerobic test in climbers after a high altitude expedition.

PURPOSE: The Wingate anaerobic test measures the maximum anaerobic capacity of the lower limbs. The energy sources of Wingate test are dominated by anaerobic metabolism (~ 80%). Chronic high altitude exposure induces adaptations on skeletal muscle function and metabolism. Therefore, the study aim was to investigate possible changes in the energy system contribution to Wingate test before and after a high-altitude sojourn. METHODS: Seven male climbers performed a Wingate test before and after a 43-day expedition in the Himalaya (23 days above 5.000 m). Mechanical parameters included: peak power (PP), average power (AP), minimum power (MP) and fatigue index (FI). The metabolic equivalents were calculated as aerobic contribution from O2 uptake during the 30-s exercise phase (WVO2), lactic and alactic anaerobic energy sources were determined from net lactate production (WLa) and the fast component of the kinetics of post-exercise oxygen uptake (WPCr), respectively. The total metabolic work (WTOT) was calculated as the sum of the three energy sources. RESULTS: PP and AP decreased from 7.3 ± 1.1 to 6.7 ± 1.1 W/kg and from 5.9 ± 0.7 to 5.4 ± 0.8 W/kg, respectively, while FI was unchanged. WTOT declined from 103.9 ± 28.7 to 83.8 ± 17.8 kJ. Relative aerobic contribution remained unchanged (19.9 ± 4.8% vs 18.3 ± 2.3%), while anaerobic lactic and alactic contributions decreased from 48.3 ± 11.7 to 43.1 ± 8.9% and increased from 31.8 ± 14.5 to 38.6 ± 7.4%, respectively. CONCLUSION: Chronic high altitude exposure induced a reduction in both mechanical and metabolic parameters of Wingate test. The anaerobic alactic relative contribution increased while the anaerobic lactic decreased, leaving unaffected the overall relative anaerobic contribution to Wingate test.

Beyond power amplification: latch-mediated spring actuation is an emerging framework for the study of diverse elastic systems.

Rapid biological movements, such as the extraordinary strikes of mantis shrimp and accelerations of jumping insects, have captivated generations of scientists and engineers. These organisms store energy in elastic structures (e.g. springs) and then rapidly release it using latches, such that movement is driven by the rapid conversion of stored elastic to kinetic energy using springs, with the dynamics of this conversion mediated by latches. Initially drawn to these systems by an interest in the muscle power limits of small jumping insects, biologists established the idea of power amplification, which refers both to a measurement technique and to a conceptual framework defined by the mechanical power output of a system exceeding muscle limits. However, the field of fast elastically driven movements has expanded to encompass diverse biological and synthetic systems that do not have muscles - such as the surface tension catapults of fungal spores and launches of plant seeds. Furthermore, while latches have been recognized as an essential part of many elastic systems, their role in mediating the storage and release of elastic energy from the spring is only now being elucidated. Here, we critically examine the metrics and concepts of power amplification and encourage a framework centered on latch-mediated spring actuation (LaMSA). We emphasize approaches and metrics of LaMSA systems that will forge a pathway toward a principled, interdisciplinary field.

Effectiveness of aerobiological dispersal and microenvironmental requirements together influence spatial colonization patterns of lichen species on the stone cultural heritage.

Dispersal patterns of lichen species in monumental and archaeological sites and their relationships with spatial population structure are almost unknown, hampering predictions on colonization dynamics that are fundamental for planning conservation strategies. In this work, we tested if the local abundance and distribution pattern of some common lichen species on carbonate stones of heritage sites may be related to their patterns of propagule dispersal. We combined analyses of the spatial population structure of eight species on the calcareous balustrade of a heritage site in Torino (NW Italy) with aerobiological analyses. In situ and laboratory analyses were mainly focused on the ejection of ascospores and their air take-off and potential dispersal at short and long distance. Results indicate that the spatial distribution of lichens on the stone surfaces is influenced by both species-specific patterns of propagule dispersal and microenvironmental requirements. In particular, apotheciate species that have a higher ejection of ascospores with higher potential for long range dispersal are candidate for a much aggressive spreading on the monumental surfaces. Moreover, their occurrence on natural or artificial stone surfaces in the surroundings of the stone monumental surface may easily support recolonization dynamics after cleaning interventions, as an effective supply of propagules is expected. On the other hand, species with a lower dispersal rate have a more clustered distribution and are less effective in rapid recolonization, thus representing a minor threat for cultural heritage conservation. These results support the idea that information on the reproductive strategy and dispersal patterns of lichens should be coupled with traditional analyses on stone bioreceptivity and microclimatic conditions to plan effective restoration interventions of stone surfaces.

[Electrocardiographic and hemodynamic profile of patients with psychotic disorder]. / Profil électrocardiographique et hémodynamique des patients ayant des troubles psychotiques.

INTRODUCTION: Cardiac mortality among patients diagnosed with mental disorders is higher compared to the general population. Some authors suggest that cardiovascular risk is related to intrinsic factors specific to psychiatric disease. Nevertheless, the interpretation of these results is limited by the concomitant prescription of antipsychotics which have a cardiovascular effect. Studies evaluating the hemodynamic and electrocardiographic profile of drug naïve or drug-free patients suffering from mental disorders remain few. AIMS: The aims of this work were to study the electrocardiographic and hemodynamic profile of drug naïve or drug-free patients with mental disorders and to determine clinical and biological factors associated with any electrocardiographic abnormalities. SUBJECTS AND METHODS: It was a descriptive and evaluative cross-sectional study. We enrolled drug naïve or drug-free patients for at least two months. All subjects were inpatients and had at admission clinical, biological and electrocardiographic evaluation. RESULTS: Forty-four percent of the sample had asymptomatic electrocardiographic abnormalities. These subjects had lower serum thyroid hormone levels compared to healthy group (P=0.066). Hemodynamic profile showed that 12% of the population had orthostatic hypotension. CONCLUSION: Electrocardiographic and hemodynamic abnormalities are common among drug-free or drug naïve patients diagnosed with psychotic disorders. The association of electrocardiographic abnormalities with low levels of thyroxin requires more investigation.

IMproved MAnagement (IM-MA study) in cancer-related pain: the value of a joint approach by an integrated team of radiotherapist and anesthetist.

PURPOSE: Purpose of this study was to retrospectively review our experience of multidisciplinary clinic providing a joint approach by radiation oncologist and anesthetist for patients with cancer pain to evaluate the adequacy and the IMprovement in MAnagement (IM-MA study) of this symptom. METHODS: A Team for Pain Management (TPM) represented by radiation oncologist and anesthetist weekly provided consultations to patient presenting cancer pain. TPM prospectively reported epidemiologic, symptomatic, and pharmacological data. TPM modified pain therapy and indicated antalgic radiotherapy. Patients were evaluated at baseline and after 4 weeks after intervention. RESULTS: From November 2015 to April 2016, 65 patients were evaluated by TPM. At the baseline, 18 patients (27.7%) were undertreated (i.e., receiving inadequate pain management); furthermore, 27 patients (41.5%) despite receiving strong opioids had uncontrolled pain. After 4 weeks from intervention, undertreated patients were reduced to 1.53%. For those patients undergone to radiotherapy, response at 34 weeks was scored as follows: complete response 28.8%, partial response 46.7%, pain progression 0.95%, indeterminate response 23.8%. CONCLUSIONS: A multidisciplinary Team for Pain Management improved the clinical management, optimizing pain control and increasing adequacy of pharmacological management. The TPM intervention seems particularly worth for patients presenting specific features including BTcP, neuropathic pain, severe pain due to bone metastases, and any potential candidate to radiotherapy. Larger series and QoL questionnaires are required to confirm these results.

Tromboembolismo intracardíaco durante trasplante hepático / Intracardiac tromboembolism during liver transplantation

Describimos un caso de trombosis cardíaca intraoperatoria durante una cirugía de trasplante ortotópico hepático que derivó en muerte intraoperatoria. Mediante ecocardiografía transesofágica, colocada durante la descompensación del paciente, se pudo determinar la causa del problema y observar con precisión el mecanismo de migración de trombos desde la circulación venosa hacia el corazón izquierdo

We describe a case of intraoperative cardiac trombosis during orthotopic liver transplant surgery that resulted in intraoperative death. By using transesophageal echocardiography, the cause of the descompensation of the patient could be determined and the mechanism of trombus migration from thrombi from the venous circulation to the left heart was accurately observed

Context-dependent effects of fire and browsing on woody alien invasion in mountain ecosystems.

Anthropogenic activities have increased disturbances and alien woody invasion in mountain ecosystems worldwide. Whether disturbances promote or counteract upward movement of woody aliens is poorly understood. We assessed if the most successful woody invader of low mountains of central Argentina (Gleditsia triacanthos) might expand its elevational distribution in response to the principal disturbances of these ecosystems (fire and livestock browsing) across increasing climatic severity. We assessed seedling emergence, growth and mycorrhizal colonization on sown plots distributed in burned and unburned sites, with and without browsing at the lower and upper elevation belts (i.e. 1000 and 2400 m a.s.l.). Additionally, several abiotic variables were measured to relate their influence on the seedling establishment. Disturbances reduced seedling emergence at both elevations. Burned conditions increased seedling growth and arbuscular colonization only in the lower belt. Seedling success (total seedling biomass per plot) was not modified by disturbances at the upper elevation, but was reduced by browsing and enhanced by fire in the lower elevation. The overall reduction in seedling emergence and growth in the upper elevation despite the higher soil nutrient content places climate as the strongest regulator of G. triacanthos seedling establishment. Accordingly, climate rather than disturbances would be the main limiting factor of upward expansion of this woody alien. Our findings differ from general patterns described for mountain invasion by herbaceous species, highlighting that mountain invasibility is highly growth-form dependent, and that upper range expansion by woody aliens interacting with multiple disturbances should be assessed worldwide.

Evidence of balance training-induced improvement in soccer-specific skills in U11 soccer players.

The present study aimed to determine the role of balance training improving technical soccer skills in young players. Two U11 soccer teams were randomly assigned one to either balance training (BT; n = 22) or control group (Ctrl; n = 21). At the end of their habitual soccer training (identical in BT and Ctrl), BT underwent additional balance training for 12 weeks (3 sessions/week, 20 minutes per session), while Ctrl had a 20-minute scrimmage. Before and after the intervention, BT and Ctrl underwent two soccer-specific tests (Loughborough Soccer Passing, LSPT, and Shooting, LSST, Tests), and bipedal and unipedal balance evaluations. After intervention, both groups decreased the trials time and improved passing accuracy, with larger improvements in BT than Ctrl (LSPT penalty time [CI95% ]: -2.20 seconds [-2.72/-1.68]; ES [CI95% ]: -2.54 seconds [-3.34/-1.74]). Both groups improved balance ability, with BT showing larger increments in bipedal tests than Ctrl (static balance: -29 mm [-42/-16]; ES: -1.39 [-2.05/-0.72]; limit of stability: 4% [3/5]; ES 3.93 [2.90/4.95]; unipedal quasi-dynamic balance: 0.07 a.u. [0.03/0.11]; ES: 1.04 [0.40/1.67] and active range of motion: -5% [-8/-2]; ES -0.89 [-1.51/-0.26]). Low-to-moderate correlations between the players' technical level and unipedal balance ability were retrieved, particularly in the non-dominant limb (R from 0.30 to 0.48). Balance training improved some technical soccer skills more than habitual soccer training alone, suggesting that young soccer players may benefit from additional balance training added to their traditional training.

A systematic methodology for the robust quantification of energy efficiency at wastewater treatment plants featuring Data Envelopment Analysis.

This article examines the potential benefits of using Data Envelopment Analysis (DEA) for conducting energy-efficiency assessment of wastewater treatment plants (WWTPs). WWTPs are characteristically heterogeneous (in size, technology, climate, function …) which limits the correct application of DEA. This paper proposes and describes the Robust Energy Efficiency DEA (REED) in its various stages, a systematic state-of-the-art methodology aimed at including exogenous variables in nonparametric frontier models and especially designed for WWTP operation. In particular, the methodology systematizes the modelling process by presenting an integrated framework for selecting the correct variables and appropriate models, possibly tackling the effect of exogenous factors. As a result, the application of REED improves the quality of the efficiency estimates and hence the significance of benchmarking. For the reader's convenience, this article is presented as a step-by-step guideline to guide the user in the determination of WWTPs energy efficiency from beginning to end. The application and benefits of the developed methodology are demonstrated by a case study related to the comparison of the energy efficiency of a set of 399 WWTPs operating in different countries and under heterogeneous environmental conditions.

Intracardiac tromboembolism during liver transplantation. / Tromboembolismo intracardíaco durante trasplante hepático.

We describe a case of intraoperative cardiac trombosis during orthotopic liver transplant surgery that resulted in intraoperative death. By using transesophageal echocardiography, the cause of the descompensation of the patient could be determined and the mechanism of trombus migration from thrombi from the venous circulation to the left heart was accurately observed.