Latitudinal and temporal distribution of aerosols and precipitable water vapor in the tropical Andes from AERONET, sounding, and MERRA-2 data.

The aerosol and precipitable water vapor (PW) distribution over the tropical Andes region is characterized using Aerosol Robotic Network (AERONET) observations at stations in Medellin (Colombia), Quito (Ecuador), Huancayo (Peru), and La Paz (Bolivia). AERONET aerosol optical depth (AOD) is interpreted using PM2.5 data when available. Columnar water vapor derived from ozone soundings at Quito is used to compare against AERONET PW. MERRA-2 data are used to complement analyses. Urban pollution and biomass burning smoke (BBS) dominate the regional aerosol composition. AOD and PM2.5 yearly cycles for coincident measurements correlate linearly at Medellin and Quito. The Andes cordillera's orientation and elevation funnel or block BBS transport into valleys or highlands during the two fire seasons that systematically impact South America. The February-March season north of Colombia and the Colombian-Venezuelan border directly impacts Medellin. Possibly, the March aerosol signal over Quito has a long-range transport component. At Huancayo and La Paz, AOD increases in September due to the influence of BBS in the Amazon. AERONET PW and sounding data correlate linearly but a dry bias with respect to soundings was identified in AERONET. PW and rainfall progressively decrease from north to south due to increasing altitude. This regional diagnosis is an underlying basis to evaluate future changes in aerosol and PW given prevailing conditions of rapidly changing atmospheric composition.

The Prediction and Treatment of Bleeding Esophageal Varices in the Artificial Intelligence Era: A Review.

Esophageal varices (EVs), a significant complication of cirrhosis, present a considerable challenge in clinical practice due to their high risk of bleeding and associated morbidity and mortality. This manuscript explores the transformative role of artificial intelligence (AI) in the management of EV, particularly in enhancing diagnostic accuracy and predicting bleeding risks. It underscores the potential of AI in offering noninvasive, efficient alternatives to traditional diagnostic methods such as esophagogastroduodenoscopy (EGD). The complexity of EV management is highlighted, necessitating a multidisciplinary approach that includes pharmacological therapy, endoscopic interventions, and, in some cases, surgical options tailored to individual patient profiles. Additionally, the paper emphasizes the importance of integrating AI into medical education and practice, preparing healthcare professionals for the evolving landscape of medical technology. It projects a future where AI significantly influences the management of gastrointestinal bleeding, improving clinical decision-making, patient outcomes, and overall healthcare efficiency. The study advocates for a patient-centered approach in healthcare, balancing the incorporation of innovative technologies with ethical principles and the diverse needs of patients to optimize treatment efficacy and enhance healthcare accessibility.

Principles of Justice, Equity, Diversity, and Inclusion in Health Care Distance Simulation Education: Consensus Building via the Nominal Group Technique.

PURPOSE: Health care distance simulation (HCDS) replicates professional encounters through an immersive experience overseen by experts and in which technological infrastructure enriches the learning activity. As HCDS has gained traction, so has the movement to provide inclusive and accessible simulation experiences for all participants. However, established guidelines for best practices in HCDS regarding justice, equity, diversity, and inclusion (JEDI) are lacking. This study aimed to generate consensus statements on JEDI principles in synchronous HCDS education using the nominal group technique (NGT). METHOD: Professionals with experience in HCDS education were invited to generate, record, discuss, and vote on ideas that they considered best practices for JEDI. This process was followed by a thematic analysis of the NGT discussion to provide a deeper understanding of the final consensus statements. An independent group of HCDS educators individually reviewed and recorded their agreement or disagreement with the consensus statements created by the NGT process. RESULTS: Eleven independent experts agreed on 6 key practices for JEDI in HCDS. Educators need to (1) be aware of JEDI principles, (2) be able to define and differentiate JEDI, (3) model JEDI in their environment, (4) have expertise and comfort facilitating conversations and debriefing around JEDI issues, (5) be advocates within their organizations to ensure equitable educational experiences, and (6) achieve JEDI without compromising educational objectives. Experts were divided on the approach to technology to ensure equitable learning experiences: some believed that the most basic technology accessible to all learners should be used, and some believed that the technology used should be determined by the competency of the students or faculty. CONCLUSIONS: Structural and institutional barriers in HCDS education persist despite agreement on key JEDI practices. Conclusive research is needed to guide the optimal policy in HCDS toward creating equitable learning experiences while bridging the digital divide.

An ozonesonde evaluation of spaceborne observations in the Andean tropics.

Satellite observations of ozone in the tropics have feedback from in situ measurements at sea level stations, but the tropical Andes is a region that is yet to be included in systematic validations. In this work, ozonesondes launched from the equatorial Andes were used to evaluate total column ozone (TCO) measured by spaceborne sensors TROPOMI/S5P (2018-2021), GOME-2/MetOp-B, OMI/Aura, and OMPS/Suomi NPP (2014-2021). Likewise, we evaluated tropospheric column ozone (TrCO) measured by the first two. Additionally, we evaluated TCO and TrCO from reanalysis products MERRA-2 and CAMS-EAC4. Results indicate that TCO observations by OMPS/Suomi NPP produce the closest comparison to ozonesondes (- 0.2% mean difference) followed by OMI/Aura (+ 1.2% mean difference). Thus, they outperform the sensor with the highest spatial resolution of current satellite measurements, namely TROPOMI/S5P (+ 3.7% mean difference). This overprediction is similar to the one encountered for GOME-2/MetOp-B (+ 3.2% mean difference). A positive bias with respect to soundings was also identified in TrCO measured by TROPOMI/S5P (+ 32.5% mean difference). It was found that the climatology used by TROPOMI overpredicts ozone in the troposphere when compared with the mean of Andes measurements, while both data sets are essentially the same in the stratosphere. Regarding reanalysis products, MERRA-2 compares better to ozonesondes than CAMS, both for TCO and TrCO (mean differences are 1.9% vs. 3.3%, and 11.5% vs. 22.9%, respectively). Identifying spaceborne ozone measurements that currently perform the best over the region is relevant given the present conditions of rapidly changing atmospheric composition. At the same time, ozonesonde data in this work offer an opportunity to improve satellite observations in the Andean tropics, a challenging region for space measurements.

What the COVID-19 lockdown revealed about photochemistry and ozone production in Quito, Ecuador.

The COVID-19 lockdown presented a peculiar opportunity to study a shift in the photochemical regime of ozone production in Quito (Ecuador) before and after mobility restrictions. Primary precursors such as NO and CO dropped dramatically as early as 13 March 2020, due to school closures, but ambient ozone did not change. In this work we use a chemical box model in order to estimate regimes of ozone production before and after the lockdown. We constrain the model with observations in Quito (ozone, NOx, CO, and meteorology) and with estimations of traffic-associated VOCs that are tightly linked to CO. To this end, we use the closest observational data of VOC/CO ratios at an urban area that shares with Quito conditions of high altitude and is located in the tropics, namely Mexico City. A shift in the chemical regime after mobility restrictions was evaluated in light of the magnitude of radical losses to nitric acid and to hydrogen peroxide. With reduced NOx in the morning rush hour (lockdown conditions), ozone production rates at 08:30-10:30 increased from 4.2-17 to 9.7-23 ppbv h-1, respectively. To test further the observed shift in chemical regime, ozone production was recalculated with post-lockdown NOx levels, but setting VOCs to pre-lockdown conditions. This change tripled ozone production rates in the mid-morning and stayed higher throughout the day. In light of these findings, practical scenarios that present the potential for ozone accumulation in the ambient air are discussed.

Acetylcholine Regulates Pulmonary Pathology During Viral Infection and Recovery.

INTRODUCTION: This study was designed to explore the role of acetylcholine (ACh) in pulmonary viral infection and recovery. Inflammatory control is critical to recovery from respiratory viral infection. ACh secreted from non-neuronal sources, including lymphocytes, plays an important, albeit underappreciated, role in regulating immune-mediated inflammation. METHODS: ACh and lymphocyte cholinergic status in the lungs were measured over the course of influenza infection and recovery. The role of ACh was examined by inhibiting ACh synthesis in vivo. Pulmonary inflammation was monitored by Iba1 immunofluorescence, using a novel automated algorithm. Tissue repair was monitored histologically. RESULTS: Pulmonary ACh remained constant through the early stage of infection and increased during the peak of the acquired immune response. As the concentration of ACh increased, cholinergic lymphocytes appeared in the BAL and lungs. Cholinergic capacity was found primarily in CD4 T cells, but also in B cells and CD8 T cells. The cholinergic CD4+ T cells bound to influenza-specific tetramers and were retained in the resident memory regions of the lung up to 2 months after infection. Histologically, cholinergic lymphocytes were found in direct physical contact with activated macrophages throughout the lung. Inflammation was monitored by ionized calcium-binding adapter molecule 1 (Iba1) immunofluorescence, using a novel automated algorithm. When ACh production was inhibited, mice exhibited increased tissue inflammation and delayed recovery. Histologic examination revealed abnormal tissue repair when ACh was limited. CONCLUSION: These findings point to a previously unrecognized role for ACh in the transition from active immunity to recovery and pulmonary repair following respiratory viral infection.

Tumores encefálicos asociados con epilepsia: una serie de casos / Brain tumors most frequently associated with epilepsy: A case series

RESUMEN INTRODUCCIÓN: Las crisis epilépticas son la manifestación clínica inicial en un 30-50 % de los pacientes con tumores cerebrales. Algunos de los tumores más frecuentes, como los gliomas y los meningiomas se asocian con manifestaciones epilépticas. En el país no hay estudios que especifiquen cuáles son los tumores del encéfalo más frecuentemente relacionados con epilepsia. OBJETIVO: Determinar los tumores del encéfalo más frecuentes relacionados con epilepsia en pacientes del hospital Universitario Erasmo Meoz, en Cúcuta, Colombia entre los años 2015 y 2018. METODOLOGÍA: Estudio retrospectivo. Se recolectaron historias clínicas de pacientes mayores de 18 años que ingresaron al servicio de Neurocirugía del Hospital Universitario Erasmo Meoz, en Cúcuta, Colombia con diagnóstico de tumor del encéfalo entre el año 2015 y el 2018. RESULTADOS: Se incluyeron 220 historias, el 56 % correspondió al sexo femenino y la media de edad fue de 48 años; 98 (45 %) de los casos presentó crisis epilépticas. El tumor del encéfalo más frecuente relacionado con epilepsia fue el glioma (46 casos). El tipo de glioma que más se relacionó con crisis epilépticas fue el glioblastoma (27 casos); 82 % de los gliomas de bajo grado se manifestaron con epilepsia, y 71 % de los de alto grado (70,6 %). En los hombres el tumor más frecuente relacionado con epilepsia fue el glioblastoma y en las mujeres el meningioma. La localización tumoral más frecuente fue la región frontal (27 %). CONCLUSIONES: Los gliomas son el tipo de tumor cerebral más común relacionado con epilepsia, siendo el glioblastoma el tumor más frecuente de este grupo.

ABSTRACT INTRODUCTION: Seizures are the initial clinical symptom in 30 to 50 % of patients with brain tumors. With a high percentage, gliomas and meningiomas have been reported as tumors associated with epilepsy, these also being frequent tumors in Colombia. Currently in the country there are no studies that specify which are the most frequent brain tumors related to epilepsy, an investigation being necessary to clarify these data. OBJECTIVE: To determine the most frequent brain tumors associated with epilepsy in patients at the Erasmo Meoz University Hospital in Cúcuta. METHODS: Medical records were collected from all patients over 18 years of age who were admitted to the Neurosurgery service of the Erasmo Meoz University Hospital in Cúcuta with a diagnosis of brain tumor between 2015 and 2018. RESULTS: 220 patients were included, 56% were female. The mean age was 48 years; 98 cases (45%) presented with epilepsy. The most frequent brain tumor related to epilepsy were gliomas (46 cases). The glioma with the highest frequency of seizures was glioblastoma (27 cases). Low-grade gliomas had a higher percentage of epilepsy (82%) than high-grade gliomas (71%). In men, the most frequent tumor related to epilepsy was glioblastoma and in women, meningioma. The most frequent location was the frontal region (27%). CONCLUSIONS: Gliomas are the most common type of brain tumor associated with epilepsy, with the most common tumor in this group being glioblastoma.

INFLUENCIA DE LA HERBIVORÍA Y LA APERTURA DE CLAROS SOBRE EL CRECIMIENTO TOTAL DE Brosimum alicastrum (Moraceae) / Influence of herbivory and gap-openness on whole-plant growth of Brosimum alicastrum (Moraceae)

RESUMEN El crecimiento compensatorio y las defensas vegetales son respuestas para lidiar con la herbivoría y la luz. El estudio de la influencia de los componentes morfo-fisiológicos, de la asignación de biomasa y de la defensa vegetal podría arrojar información que ayude a entender estas respuestas. Se evaluaron los efectos de la herbivoría y la apertura de claros sobre el crecimiento, los componentes morfo-fisiológicos, la asignación de biomasa y las defensas químicas y físicas en plántulas de Brosimum alicastrum en una selva mediana subcaducifolia. Se utilizó un diseño anidado con sitios de sotobosque y claros (n = 3 en cada uno) y dentro de ellos plántulas sometidas a tres tratamientos de herbivoría: control (n = 10), simulada (n = 10) y natural (n = 10). Se registró a lo largo de seis meses la influencia de la herbivoría sobre el crecimiento (biomasa, área foliar, altura, diámetro y producción de hojas), la producción de fenoles y la dureza foliar. Se halló un crecimiento compensatorio (todas las variables de crecimiento) con la herbivoría natural, subcompensatorio (biomasa, altura y diámetro) con la simulada, y sobrecompensatorio (producción de hojas) con la herbivoría natural sólo en claros. Los componentes morfológicos como el cociente del área foliar (LAR) y el área foliar específica (SLA) fueron mayores bajo claros y el fisiológico, como la tasa de asimilación neta (NAR), en sotobosque. La proporción de biomasa en sotobosque fue mayor hacia hojas y tallos y en claros más alta hacia raíces. La herbivoría fue mayor en claros y los fenoles foliares en sotobosque. No se encontró una relación (compromiso) entre las defensas y el crecimiento, sólo una tendencia negativa con los fenoles bajo condiciones limitantes de recursos, como ocurre en el sotobosque.

ABSTRACT Compensatory plant growth and plant defense are responses to deal with herbivory and light availability. The research focused on compensatory growth responses explained through the influence of morphological and physiological components of plant growth, allocation mass, and plant defense could clarify such process. We studied the effects of herbivory and gap-openness on compensatory growth responses, morphological and physiological components, allocation mass, and chemical defenses in seedlings of Brosimum alicastrum in a subhumid tropical forest. We used a nested design with understory and gap-openness site (n = 3 each) within each replicated site seedling belong to three herbivory treatments (n = 10 each): control, simulated, and natural; and along six months we studied the influence of leaf herbivory on plant growth (mass, leaf area, height, diameter, and leaf production) and production of phenols and leaf toughness. We recorded compensatory growth responses (all plant growth variables) with natural herbivory, subcompensatory (mass, height, and diameter) with simulated and, overcompensatory (leaf production) with natural herbivory although only under gap-openness. We found a higher leaf area ratio (LAR) and specific leaf area (SLA) (both morphological components) under gap-openness and high values of net assimilation rate (NAR) on understory. The mass proportion was highest in leaves and stems on the understory and higher in roots under gap-openness. Leafherbivory was highest under gap-openness while the phenols of the leaves on understory. We did not find a relationship (trade-off) between defense with plant growth, but it was possible to underline a negative pattern of the leaf phenols under limiting resources environment such as understory.

Innate immune induction and influenza protection elicited by a response-selective agonist of human C5a.

The anaphylatoxin C5a is an especially potent mediator of both local and systemic inflammation. However, C5a also plays an essential role in mucosal host defense against bacterial, viral, and fungal infection. We have developed a response-selective agonist of human C5a, termed EP67, which retains the immunoenhancing activity of C5a at the expense of its inflammatory, anaphylagenic properties. EP67 insufflation results in the rapid induction of pulmonary cytokines and chemokines. This is followed by an influx of innate immune effector cells, including neutrophils, NK cells, and dendritic cells. EP67 exhibits both prophylactic and therapeutic protection when tested in a murine model of influenza A infection. Mice treated with EP67 within a twenty-four hour window of non-lethal infection were significantly protected from influenza-induced weight loss. Furthermore, EP67 delivered twenty-four hours after lethal infection completely blocked influenza-induced mortality (0% vs. 100% survival). Since protection based on innate immune induction is not restricted to any specific pathogen, EP67 may well prove equally efficacious against a wide variety of possible viral, bacterial, and fungal pathogens. Such a strategy could be used to stop the worldwide spread of emergent respiratory diseases, including but not limited to novel strains of influenza.