Decision-making analysis in cooperative environments for decentralized cognitive radio networks.

Currently, there are saturated frequency bands that affect the quality of service for new users. Cognitive radio provides an alternative solution to this problem through dynamic spectrum access. However, the solutions proposed in the current literature are focused on a centralized network and do not allow demonstrating the behavior in a multi-user environment, much less the effect that cooperation between secondary users can have. This article establishes a decision-making model for the best spectral opportunity selection with a cooperative approach in decentralized cognitive radio networks and contrasts its results with three multi-criteria decision-making algorithms: SAW, TOPSIS, and VIKOR. So, this research suggests a cooperative decision-making model based on four main modules. (1) a collaborative module for the exchange of information between SU; (2) a module for PU characterization; (3) a module of the probability of SU arrival; and (4) the SO feedback selection module. The results are obtained through simulations fed with experimental spectral occupancy data captured in a measurement campaign. Handoff and throughput were used as evaluation metrics, along with five levels of collaboration: 10%, 20%, 50%, 80%, and 100%, and eight different scenarios based on the type of network: GSM and Wi-Fi, the application type: real-time and best-effort, and the level of traffic: high and low. The contribution of this study lies in the fact that no current work includes the following relevant aspects for an adequate validation and evaluation of this proposal: First, the consideration of a decentralized cognitive radio network; second, the decision-making with cooperative strategies; third, different techniques for SO selection; fourth, the validation and evaluation with experimental spectral occupancy data captured in measurement campaigns; finally, the performance analysis in diverse networks, traffic levels, and types of applications.

Myhre syndrome: expanding its paediatric phenotypic spectrum.

Myhre syndrome is a rare disease secondary to pathogenic variants in SMAD4 gene. It is a multisystem disease characterised by short stature, deafness, joint stiffness, craniofacial dysmorphism, and potential cardiac manifestations. Herein, we report two new paediatric cases of Myhre syndrome who, additionally, presented with mid-aortic syndrome. This confirms and extends the scarce reports describing the association between these two entities.

Heavy metal(loid)s contamination in water and sediments in a mining area in Ecuador: a comprehensive assessment for drinking water quality and human health risk.

Elevated heavy metal(loid)s concentrations in water lower its quality posing a threat to consumers. This study aims to assess the human health risk caused by heavy metal(loid)s in tap water in Santa Rosa city, Ecuador, and the ecological risk of stream water and sediments in the Santa Rosa River. Concentrations of As, Cd, Cr, Cu, Ni, Pb, and Zn were evaluated in tap waters, stream waters, and sediment samples during the rainy and dry seasons. The Metal Index (MI), Geo-accumulation Index (Igeo), Potential Ecological Risk Index (PERI), and the levels of carcinogenic (CR) and non-carcinogenic risk (HQ) were determined. The results revealed severe pollution levels, mainly in Los Gringos and El Panteon streams, both tributaries of the Santa Rosa River, the primary water source for Santa Rosa inhabitants. More than 20% of the surface water samples showed severe contamination (MI > 6), and 90% of the tap water samples presented a MI value between 1 and 4, which indicates slight to moderate pollution. Drinking water displayed high levels of As, with 83% of the tap water samples collected from households in the dry season above the recommended concentration set by the World Health Organization and Ecuadorian legislation. The Igeo-Cd in the sediment samples was significantly high (Igeo > 3), and the PERI showed very high ecological risk (PERI > 600), with Cd as the main pollutant. HQ and CR were above the safe exposure threshold, suggesting that residents are at risk from tap water consumption, with As being the primary concern.

Assessment of potential contamination and acid drainage generation in uranium mining zones of Peña Blanca, Chihuahua, Mexico.

Potential pollution of mining environmental liabilities' locations can be preliminarily and efficiently assessed by the potential generation of acid mine drainage and indices of contamination. This research evaluates the potential pollution by potentially toxic elements at locations with uranium mining liability evidence, using the net acid generation test and determining the background values to estimate acid mine drainage and indices of contamination. Sixty soil samples were collected, and the mineralogy and potentially toxic elements' total contents were determined by x-ray diffraction and optical spectrometry. The findings suggest that the soils related to a specific lithology might not present potential acid mine drainage generation but potential soil and sediment contamination. Future research is recommended on applying leaching tests to identify which potentially toxic elements are effectively being solubilized. Finally, it can be concluded that the study area's potential contamination is relatively low overall.

Massive Dilatation of the Ascending Aorta in a Patient With Generalized Arterial Calcification of Infancy.

We report a case of massive ascending aortic dilatation in a patient with generalized arterial calcification of infancy (GACI). He was found to carry compound heterozygous mutations in ABCC6 gene, previously associated with pseudoxanthoma elasticum, although recently linked to GACI. Our case confirms previous reports of a genotypic overlap between both entities.

Mid-aortic Syndrome in a Pediatric Cohort.

Mid-aortic syndrome (MAS) is an uncommon condition characterized by severe narrowing of the abdominal aorta, usually involving visceral and renal arteries. Most patients are asymptomatic and typically present with incidental hypertension which might evolve into end-organ damage if untreated. Our aim was to review 8 new pediatric MAS cases. A retrospective observational study of all pediatric patients with MAS diagnosis (April 1992-November 2021) was conducted. Patients underwent systematic evaluation (medical and family history; 12-lead electrocardiogram; echocardiogram; angiography and/or computed tomography or magnetic resonance angiography). 8 pediatric patients with MAS were included. Median age at diagnosis was 2.6 [0.2-4.7] years; median follow-up time was 8.6 [6.6-10.0] years. 6/8 patients presented with incidental hypertension, 1/8 with heart murmur, and 1/8 with heart failure symptoms. All patients were on antihypertensive treatment. 1/8 patients underwent surgery and 7/8 an endovascular treatment. At the end of the study period, among the 6 patients that underwent a successful endovascular procedure, 2 achieved good blood pressure (BP) control, 2 acceptable BP control, 1 stage 1 hypertension and, another, stage 2 hypertension. There was 1 death during follow-up. BP monitoring in pediatric patients is crucial for early recognition of MAS. Treatment should be based on the individual clinical characteristics of patients with careful planning of surgical revascularisation, if possible, after adult growth is completed. Our study demonstrates that endovascular treatment might be a good alternative to surgery. Nevertheless, further trials with larger sample size and longer-term follow-up are required to determine the best treatment approach.

Polluting potential from mining wastes: proposal for application a global contamination index.

Indices of contamination (IC) are usually employed to assess the hazardousness associated with potentially toxic elements (PTE) from mining wastes (MW). For such, it is necessary to know the total concentrations of the PTE and local, regional, or global background or reference levels which are tolerable or acceptable threshold values for total content in soils. Although scientific literature is vast regarding the application of IC to MW, there is scarce research on the reference levels that must be employed in locations with no established comparison values. This study proposes basic reference levels for the global application of PTE contents in MW, leading to a global index of contamination (ICG). To this end, it was determined that the PTE to be assessed in MW should be As, Cd, Co, Cr, Cu, Hg, Mo, Ni, Pb, Sb, Se, V, and Zn. From the analysis of background and baseline values for soils, reference values for the PTE compiled from worldwide standards or studies on soil and sediment evaluation, and PTE content in MW, a classification is proposed for ICG that considers MW as very low, low, moderate, high, and very high contamination potential. The findings presented herein can be helpful in the comparison of multiple types of MW, representing the contamination hazard by particle emission due to erosion processes that reach the soils or sediments of the surrounding environment. This evaluation can aid in the decision-making process regarding the reutilization of some types of MW that receive a low classification.

Ausencia parcial de pericardio: ¿únicamente un hallazgo incidental? / Partial absence of the pericardium: Only an incidental finding?

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Probabilistic multi-pathway human health risk assessment due to heavy metal(loid)s in a traditional gold mining area in Ecuador.

Mining operations are important causes of environmental pollution in developing countries where mining waste management is not adequate. Consequently, heavy metal(loid)s are easily released into the environment, being a potential risk to human health. This study carries out a Bayesian probabilistic human health risk assessment, related to multi-pathway exposure to heavy metal(loid)s in a gold mining area in Southern Ecuador. Concentrations of As, Cd, Cr, Cu, Ni, Pb, and Zn in tap water, surface water, and soil samples, were analyzed to assess the potential adverse human health effects based on the Hazard Index (HI) and Total cancer risk (TCR). Adults and children residents were surveyed to adjust their exposure parameters to the site-specific conditions. Exposure to heavy metal(loid)s resulted in unacceptable risk levels for human health in the two age groups, both carcinogenic (TCR > 1 × 10-5) and non-carcinogenic (HI > 1) through ingestion of tap water and incidental ingestion of surface water. Sensitivity analysis showed that As concentration in waters and exposure frequency were the main contributors to risk outcome. Exposure to soil via accidental ingestion and dermal contact was below the safety limit, not posing a risk to human health. These findings can provide a baseline for the environmental management of the mining area and indicate the need for further research on As pollution in water and its implications on the health of the inhabitants of mining communities.

Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adult patients with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

resumen está disponible en el texto completo

Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Spanish registry of percutaneous VSD closure with NitOcclud Lê VSD Coil device: lessons learned after more than a hundred implants.

INTRODUCTION AND OBJECTIVES: The NitOcclud Lê VSD Coil was specifically designed for transcatheter occlusion of ventricular septal defects (VSD) and became available for this purpose in August 2010. Our objective was to describe the Spanish experience of this technique and analyze its reliability and short- to mid-term efficacy. METHODS: National multicenter observational study, which retrospectively recruited all patients (of any age) with VSD (of any location or type) who underwent percutaneous NitOcclud occlusion, using an intention-to-treat analysis, until January 2019. RESULTS: A total of 117 attempts were made to implant at least 1 NitOcclud in 116 patients in 13 institutions. The median [range] age and weight was 8.6 [0.4-69] years and 27 [5.8-97] kg, respectively. In 99 patients (85%), the VSD was an isolated congenital defect. The location was perimembranous in 95 (81%), and 74 (63%) of them were aneurysmatic. The mean fluoroscopy time was 34 [11.4-124] minutes. Of the 117 attempts, 104 were successful (89%) with a follow-up of 31.4 [0.6-59] months. At the last review, final complete occlusion of the defect without residual shunt or with only a minimal shunt was achieved in 92.3% (no shunt, n=73; trivial shunt, n=23). Four patients required a second procedure for residual shunt occlusion. Two devices had to be surgically explanted due to severe hemolysis. There were no deaths or other major complications. CONCLUSIONS: The NitOcclud device can be used successfully for a wide anatomical spectrum of VSD. The main issue is residual shunt, but its incidence decreases over time. The incidence of hemolysis was very low and no permanent changes were detected in atrioventricular conduction.

Hipertensión pulmonar grave como inicio de la enfermedad metabólica / Severe Pulmonary Hypertension as the Debut of Metabolic Disease

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A new ranking scale for assessing leaching potential pollution from abandoned mining wastes based on the Mexican official leaching test.

Potentially toxic elements (PTEs) present in abandoned mining wastes (AMW) are of great concern because of potential risks to human health and ecosystems. Indices of contamination (IC) applied to mining wastes are calculated using the total concentration of PTEs and comparing them with regional geochemical backgrounds. However, determining the total content of heavy metals is insufficient to assess the hazard of mining wastes. Therefore, in addition to total concentration, the potential risk is also evaluated through water mobility of elements. Accordingly, leaching procedures are useful tools for the geochemical characterization of soluble constituents that are mobilized. In this study, the solubility of PTEs from different types of mining wastes is comparatively assessed using three standard leaching methods (European; U.S. Geological Survey and; Mexican). The Hazard Average Quotient (HAQ) was calculated to assess the potential Toxicity Factor (TF). TF is an indicator of the relative potential toxicity of wastes and is the basis for the classification of AMW. A comparative assessment provides evidence that there are no statistically significant differences in PTEs solubility by the three leaching methods and it was also found that the pH of the eluates was dictated by the type of waste. Results suggest that the IC gives an indicator of the potential contamination of soils and sediments by erosive processes, or a long-term measure, whereas TF assesses the possibility of contaminating water in the short term. The most significant finding is the new ranking scale of TF, as a function of HAQ, applied to the Mexican standard leaching test. This factor, together with other considerations relating to risk-generating processes, might then be applied in places having large amounts of recorded AMW, such as the Iberian Peninsula and Latin America, where effective management is required to rank sites, based on preliminary environmental and human risk assessment.

Aortic thrombosis successfully treated with local recombinant tissue plasminogen activator in a newborn.

Arterial thrombosis in newborns varies depending on the location of the thrombus and can be a life-threatening emergency. We present a case of extensive aorta thrombosis with a left kidney thrombosis in a newborn successful treated with local recombinant tissue-type plasminogen activator.

Characteristics and outcomes of transposition of great arteries in the neonatal period.

INTRODUCTION AND OBJECTIVES: Transposition of the great arteries is a prevalent congenital heart defect with a high survival rate and a good long-term outcome, especially if managed with early surgical intervention during the neonatal period. In this study, our main objective was to describe patient characteristics and outcomes and to identify possible predictors of early and long-term morbidity and mortality. METHODS: Retrospective analysis through review of clinical and surgical charts of patients with transposition of the great arteries admitted to the service of neonatology during 2000-2011. RESULTS: The study included 136 patients; 119 of them had undergone corrective surgery during the neonatal period. Patients were divided into 3 groups: group I, 81 cases of isolated transposition; group II, 24 cases with ventricular septal defect; and group III, 31 with "complex" transposition of the great arteries. The overall postoperative survival was 96.7% (115 of 119 patients); no patients from group I died after surgery. Duration of surgery, intubation, inotropic treatment, and length of stay were higher in patients in groups II and III. The overall survival rate after an average of 6 years of follow-up was 90.4% 123 of 136 patients, with no deaths after discharge in group I. The most frequent residual defect during cardiac follow-up was supravalvular pulmonary stenosis, in 33 of 113 patients that had follow-up data. CONCLUSIONS: In our study, the survival rate was high in patients with transposition of great arteries and especially in those undergoing arterial switch. The number of subsequent residual heart defects was low.

Características y evolución de la transposición de grandes vasos en el periodo neonatal / Characteristics and outcomes of transposition of great arteries in the neonatal period

Introducción y objetivos. La transposición de grandes vasos es una cardiopatía congénita frecuente, con alta supervivencia y escaso número de secuelas, especialmente si se interviene precozmente, en el periodo neonatal. Nuestro objetivo es describir las características y la evolución de los pacientes afectados y determinar posibles factores pronósticos de morbimortalidad precoz y a largo plazo. Métodos. Estudio retrospectivo mediante revisión de historias clínicas y base de datos de los pacientes con transposición de grandes vasos ingresados entre los años 2000 y 2011. Resultados. Ingresaron 136 pacientes afectados de transposición de grandes vasos, de los que 119 se sometieron a cirugía correctora durante el periodo neonatal. Los pacientes se dividieron en tres grupos: grupo I , 81 transposición de grandes vasos simple; grupo II , 24 con comunicación interventricular concomitante, y grupo III , 31 transposiciones «complejas». La supervivencia postoperatoria fue de 96,7% (115 de 119 pacientes), aunque ningún paciente del grupo I falleció. La duración de la cirugía, la intubación y el uso posquirúrgico de inotrópicos y el tiempo de ingreso fueron mayores para los pacientes de los grupos II y III . Tras una media de 6 años de seguimiento, el 90,4% (123 de 136) de los pacientes estaban vivos. La lesión residual más frecuente en el seguimiento fue la estenosis supravalvular pulmonar en 33 de 113 pacientes seguidos. Conclusiones. En nuestro estudio, la supervivencia en el conjunto de pacientes con transposición de grandes vasos, y especialmente los sometidos a switch arterial, es alta. Los pacientes con formas más complejas tienen más complicaciones hospitalarias, pero no tras el seguimiento (AU)

Introduction and objectives. Transposition of the great arteries is a prevalent congenital heart defect with a high survival rate and a good long-term outcome, especially if managed with early surgical intervention during the neonatal period. In this study, our main objective was to describe patient characteristics and outcomes and to identify possible predictors of early and long-term morbidity and mortality. Methods. Retrospective analysis through review of clinical and surgical charts of patients with transposition of the great arteries admitted to the service of neonatology during 2000-2011. Results. The study included 136 patients; 119 of them had undergone corrective surgery during the neonatal period. Patients were divided into 3 groups: group I, 81 cases of isolated transposition; group II, 24 cases with ventricular septal defect; and group III, 31 with "complex" transposition of the great arteries. The overall postoperative survival was 96.7% (115 of 119 patients); no patients from group I died after surgery. Duration of surgery, intubation, inotropic treatment, and length of stay were higher in patients in groups II and III. The overall survival rate after an average of 6 years of follow-up was 90.4% 123 of 136 patients, with no deaths after discharge in group I. The most frequent residual defect during cardiac follow-up was supravalvular pulmonary stenosis, in 33 of 113 patients that had follow-up data. Conclusions. In our study, the survival rate was high in patients with transposition of great arteries and especially in those undergoing arterial switch. The number of subsequent residual heart defects was low (AU)

Utilización de un marcapasos encocavitario por bloqueo cardíaco completo debido a miocarditis por mycoplasma pneumoniae / Use of an encocavitary pacemaker in a patient with complete atrioventricular block due to myocarditis secondary to mycoplasma pneumoniae

Introducción. El bloqueo cardíaco auriculoventricular (BAV) completo en la infancia es una entidad poco frecuente pero potencialmente grave. La etiología más frecuente es la congénita, aunque también se puede presentar de forma adquirida. Hay pocos casos en la literatura de pacientes en edad pediátrica afectos de BAV como primera manifestación de una miocarditis aguda y en la cual se encuentre Mycoplasma pneumoniae como agente etiológico. También son escasas las publicaciones de pacientes pediátricos con esta patología tratados con marcapasos endocavitario. Caso clínico. Niño de 8 años de edad que presenta un episodio comicial e inestabilidad hemodinámica. El paciente es diagnosticado de BAV completo secundario a miocarditis aguda por Mycoplasma pneumoniae. Recibió tratamiento con corticoides, gammaglobulina intravenosa e infusión continua de isoproterenol endovenoso sin obtener respuesta, requiriendo la colocación de un marcapasos endocavitario temporal hasta la recuperación del ritmo sinusal. Comentarios. Determinados autoanticuerpos parece que tienen un papel fundamental en la fisiopatología de la miocarditis aguda. La infección por distintos gérmenes parece actuar como desencadenante de la respuesta autoinmune. De esta forma, parece coherente utilizar un tratamiento inmunosupresor o con gammaglobulinas, aunque no se puede recomendar su uso de forma rutinaria. En cuanto al BAV, puede ser necesario implantar un marcapasos endocavitario en espera de la restitución del ritmo sinusal(AU)

Introduction. Complete atriventricular block (CAB) is a rare but serious condition in children. It is usually congenital, but an acquired form is also well described. The literature on pediatric patients with CAB secondary to Mycoplasma pneumoniae myocarditis is scarce. Moreover, information on the use of an endocavitary pacemaker for children with CAB is very limited. Case Report. An 8-yo boy presented with a generalized tonic-clonic seizure and hemodynamic instability. He was diagnosed with CAB secondary to myocarditis caused by Mycoplasma pneumoniae. He was initially treated with steroids, intravenous immunoglobulins, and continuous infusion isoproterenol with no response, and required the placement of a temporary endocavitary pacemaker until sinus rhythm was recovered. Comments. Specific antibodies play a major role in the pathophysiology of acute myocarditis; infection by different agents could be the trigger of that immune response. The administration of intravenous immunoglobulin therapy for immunomodulation may have a role, although its routine use cannot be recommended. The use of an endocavitary pacemaker may be required until recovery of sinus rhythm(AU)