Successful implementation of handheld reflectance confocal microscopy as the standard of care in the (surgical) management of lentigo maligna (melanoma).

BACKGROUND: Reflectance confocal microscopy (RCM) has shown promise in predicting surgical outcomes by non-invasively detecting subclinical lentigo maligna (melanoma) (LM/LMM). OBJECTIVES: To assess the effects of presurgical mapping using handheld RCM (HH-RCM) on surgical treatment, follow-up outcomes and management decisions. METHODS: A total of 117 consecutive LM/LMM cases (2015-2023) were included. The diagnostic accuracy of HH-RCM in detecting subclinical LM and invasive components was evaluated. The primary endpoints included histological margin status and changes in management based on the outcomes of the HH-RCM mapping procedure. Margin and follow-up outcomes were compared to a historical cohort before HH-RCM was introduced in our center (n = 94) (2003-2014). RESULTS: HH-RCM detected subclinical LM in 60% (n = 60) of cases. The median mapping duration was 14 min (range 4-50). In 27% (n = 33), the mapping procedure resulted in modified management, the majority consisting of limited surgery with adjuvant imiquimod (n = 15) or imiquimod monotherapy (n = 14). The remaining cases (n = 84) underwent HH-RCM-assisted surgery. Histological margins were cleared in 96.5% of the patients with a median histological margin of 3.0 mm, significantly higher than 81% in the historical cohort (median 2.0 mm) (p = 0.001). The sensitivity and specificity for detecting the extent of subclinical LM were 94% (95% CI 80.4-99.3) and 84% (95% CI 70.3-92.7), respectively. The negative predictive value for the detection of LMM was 94% (95% CI 84.4-97.7), and 75% of the initially missed LMM (n = 12) were identified during the HH-RCM mapping procedure. The study cohort had a 1.6% local recurrence rate compared with 25% in the historical cohort. CONCLUSIONS: Integrating HH-RCM as the standard of care could lead to more personalized treatment strategies for LM/LMM and allows for the selection of patients suitable for nonsurgical treatment.

Environmental drivers of breeding sites in blackfly species of medical and veterinary importance in eastern Spain.

Geographical distribution and abundance of the pupae of six blackfly species of medical and veterinary concern were studied in eastern Spain according to three different sets of explanatory variables including in-stream variables, both (i) abiotic (i.e., physicochemical) and (ii) biotic (i.e., richness and abundance of either taxonomically or ecologically close related taxa), as well as (iii) meteorological and landscape variables. The results showed specific habitat requirements for pupation in Simulium (Boophthora) erythrocephalum (De Geer, 1776) and Simulium (Wilhelmia) equinum (Linnaeus, 1758), two of the six species studied regarding elevation and temperature. While the rest of the species showed a certain degree of ecological overlap, co-occurrence was in general low, which suggested that antagonistic biotic factors may be important in structuring blackfly assemblages. In effect, biotic predictors explained a high proportion (50%-70%) of the variability in the abundance of the pupae of the most generalist blackfly species, although further studies are needed to disentangle the sign of interspecific interactions. At the landscape level, S. (W.) equinum and S. (W.) pseudequinum Séguy, 1921 breeding habitats were associated with the presence of pig farms, and S. (Simulium) reptans (Linnaeus, 1758) and S. (B.) erythrocephalum with the presence of cattle.

Mosquito Magnet® traps as a potential means of monitoring blackflies of medical and veterinary importance.

Mosquito Magnet® traps, deployed in widespread parts of England as part of nationwide mosquito surveillance projects, also caught blackflies. As many as 1242 blackflies were caught in a trapping session lasting 4 days. Principal among the species caught were Simulium equinum, Simulium lineatum and Simulium ornatum s.l. As S. ornatum s.l. is a vector that transmits Onchocerca linealis to cattle and S. equinum is responsible for dermatitis ('sweet itch') in cattle and horses, it is suggested that Mosquito Magnet® traps could be used to monitor and partially control these pests, as well as nuisance anthropophilic blackflies such as Simulium posticatum that can cause simuliidosis in southern England.

Indirect genomic predictions for milk yield in crossbred Holstein-Jersey dairy cattle.

The objective of this study was to predict genomic breeding values for milk yield of crossbred dairy cattle under different scenarios using single-step genomic BLUP (ssGBLUP). The data set included 13,880,217 milk yield measurements on 6,830,415 cows. Genotypes of 89,558 Holstein, 40,769 Jersey, and 22,373 Holstein-Jersey crossbred animals were used, of which all Holstein, 9,313 Jersey, and 1,667 crossbred animals had phenotypic records. Genotypes were imputed to 45K SNP markers. The SNP effects were estimated from single-breed evaluations for Jersey (JE), Holstein (HO) and crossbreds (CROSS), and multibreed evaluations including all Jersey and Holstein (JE_HO) or approximately equal proportions of Jersey, Holstein, and crossbred animals (MIX). Indirect predictions (IP) of the validation animals (358 crossbred animals with phenotypes excluded from evaluations) were calculated using the resulting SNP effects. Additionally, breed proportions (BP) of crossbred animals were applied as a weight when IP were estimated based on each pure breed. The predictive ability of IP was calculated as the Pearson correlation between IP and phenotypes of the validation animals adjusted for fixed effects in the model. Regression of adjusted phenotypes on IP was used to assess the inflation of IP. The predictive ability of IP for CROSS, JE, HO, JE_HO, and MIX scenario was 0.50, 0.50, 0.47, 0.50, and 0.46, respectively. Using BP was the least successful, with a predictive ability of 0.32. The inflation of the IP for crossbred animals using CROSS, JE, HO, JE_HO, MIX, and BP scenarios were 1.17, 0.65, 0.55, 0.78, 1.00, and 0.85, respectively. The IP of crossbred animals can be predicted using single-step GBLUP under a scenario that includes purebred genotypes.

Genomic evaluation for wellness traits in US Jersey cattle.

The number of Jersey cows in the United States has been steadily increasing in recent years according to Council on Dairy Cattle Breeding statistics. To help producers reduce the risk of health disorders in their Jersey animals, Zoetis has developed genomic predictions for wellness traits in Jersey cattle using producer-recorded data. The traits included mastitis (MAST), metritis, retained placenta, displaced abomasum (DA), ketosis, lameness, and milk fever in cows and respiratory disease, scours, and calf livability (DEAD) in calves. Phenotypic data on health events, pedigree, and genotypes were collected directly from producers upon obtaining their permission. Each trait was defined as a binary event, having a value of 1 if an animal has been recorded with a disorder and 0 otherwise. The number of phenotypic records ranged from 216,166 for DA to 628,958 for MAST for cow traits and from 186,505 for scours to 380,429 for DEAD for calf traits. The number of genotyped animals was 41,271. All traits were analyzed using a univariate threshold animal model. The model for cow wellness traits included the fixed effect of parity and random effects of herd × year × season of calving, animal, and permanent environment. The model for calf wellness traits included the fixed effect of year of birth × calving season × region and random effects of herd × year of birth and animal. A total of 45,163 SNP were used in genomic analyses. Animals genotyped with low-density chips were imputed to the required number of markers. All analyses were based on the single-step genomic BLUP. Heritabilities ranged from 0.061 for DA to 0.120 for lameness. Predicted transmitting abilities were expressed in percentage points as deviations from the average estimated probability of a disorder in the base population. Reliabilities of genomic predicted transmitting abilities had average values between 32% (DA) and 51% (MAST and DEAD). The results indicate that a direct evaluation of cow and calf wellness traits under a genomic threshold model is feasible and offers predictions with average reliabilities comparable with other lowly heritable traits for Jersey cattle.

Genomic evaluation for calf wellness traits in Holstein cattle.

Reducing calf morbidity and mortality is important for attaining financial sustainability and improving animal welfare on commercial dairy operations. Zoetis (Kalamazoo, MI) has developed genomic predictions for calf wellness traits in Holsteins that include calf respiratory disease (RESP; recorded between 0 and 365 d of age), calf scours (DIAR; recorded between 2 and 50 d of age), and calf livability (DEAD; recorded between 2 and 365 d of age). Phenotype and pedigree data were from commercial dairies and provided directly by producers upon obtaining their permission. The number of records ranged from 741,484 for DIAR to 1,926,261 for DEAD. The number of genotyped animals was 325,025. All traits were analyzed using a univariate threshold animal model including fixed effect of year of birth × calving season × region, and random effects of herd × year of birth and animal. A total of 45,425 SNP were used in genomic analyses. Animals genotyped with low-density chips were imputed to the required number of SNP. All analyses were conducted using single-step genomic BLUP implementing the "algorithm for proven and young" (APY) animals designed to accommodate very large numbers of genotypes. Estimated heritabilities were 0.042, 0.045, and 0.060 for RESP, DIAR, and DEAD, respectively. The genomic predicted transmitting abilities ranged between -8.0 and 24.0, -11.5 and 28.5, and -6.5 to 22.8 for RESP, DIAR, and DEAD, respectively. Reliabilities of breeding values were obtained by approximation based on partitioning of a function of reliability into contributions from records, pedigree, and genotypes, where the genotype contribution was approximated using the diagonal value of the genomic relationship matrix. The average reliabilities for the genotyped animals were 41.9, 42.6, and 47.3% for RESP, DIAR, and DEAD, respectively. Estimated genomic predicted transmitting abilities and reliabilities were approximately normally distributed for all analyzed traits. Approximated genetic correlations of calf wellness with Zoetis dairy wellness traits and traits included in the US national genetic evaluation were low to moderate. The results indicate that direct evaluation of calf wellness traits under a genomic threshold model is feasible and offers predictions with average reliabilities comparable to other lowly heritable traits. Genetic selection for calf wellness traits presents a compelling opportunity for dairy producers to help manage herd replacement costs and improve overall profitability.

Attenuation of pro-inflammatory cytokines and oxidative stress by misoprostol in renal ischemia/reperfusion in rats.

The ischemia/reperfusion (I/R) process alters metabolic pathways, releasing reactive oxygen species and pro-inflammatory cytokines that cause tissue necrosis and activate cellular apoptotic pathways. Misoprostol (MSP) is a prostaglandin E1 analog that has demonstrated a cytoprotective role in the I/R process. The study objective was to evaluate the effects of MSP on the regulation of pro-inflammatory and oxidative stress mediators in an I/R-induced acute kidney injury rat model. Wistar rats were divided into 3 groups. Sham and I/R were given 1 mL/day of physiological solution; MSP+I/R was given intragastric MSP (300 µg/kg) for 3 days. For I/R and MSP+IR, the renal hilum was clamped for 45 min, followed by 15 h of reperfusion. Renal function tests, pro-inflammatory cytokines, mediators of oxidative stress, and histological analysis were evaluated. Pro-inflammatory cytokine activity was significantly attenuated in the MSP+I/R group. However, there was no statistically significant difference between Sham and MSP. Regarding antioxidant activity, MSP+I/R showed a significant decrease in these mediators compared with Sham and I/R. Histologically, scarce medullary necrosis was observed with a preserved renal cortex in the MSP group.

Mass-Up: an all-in-one open software application for MALDI-TOF mass spectrometry knowledge discovery.

BACKGROUND: Mass spectrometry is one of the most important techniques in the field of proteomics. MALDI-TOF mass spectrometry has become popular during the last decade due to its high speed and sensitivity for detecting proteins and peptides. MALDI-TOF-MS can be also used in combination with Machine Learning techniques and statistical methods for knowledge discovery. Although there are many software libraries and tools that can be combined for these kind of analysis, there is still a need for all-in-one solutions with graphical user-friendly interfaces and avoiding the need of programming skills. RESULTS: Mass-Up, an open software multiplatform application for MALDI-TOF-MS knowledge discovery is herein presented. Mass-Up software allows data preprocessing, as well as subsequent analysis including (i) biomarker discovery, (ii) clustering, (iii) biclustering, (iv) three-dimensional PCA visualization and (v) classification of large sets of spectra data. CONCLUSIONS: Mass-Up brings knowledge discovery within reach of MALDI-TOF-MS researchers. Mass-Up is distributed under license GPLv3 and it is open and free to all users at http://sing.ei.uvigo.es/mass-up.

Indocyanine green fluorescence angiography in colorectal surgery: A retrospective case-control analysis in Mexico.

INTRODUCTION AND AIMS: An anastomotic leak is one of the most dreaded complications in colorectal surgery because it increases postoperative morbidity and mortality. The aim of the present study was to identify whether indocyanine green fluorescence angiography (ICGFA) reduced the anastomotic dehiscence rate in colorectal surgery. MATERIAL AND METHODS: A retrospective study on patients that underwent colorectal surgery with colonic resection or low anterior resection and primary anastomosis, within the time frame of January 2019 and September 2021, was conducted. The patients were divided into the case group, in which ICGFA was performed for the intraoperative evaluation of blood perfusion at the anastomosis site, and the control group, in which ICGFA was not utilized. RESULTS: A total of 168 medical records were reviewed, resulting in 83 cases and 85 controls. Inadequate perfusion that required changing the surgical site of the anastomosis was identified in 4.8% of the case group (n = 4). A trend toward reducing the leak rate with ICGFA was identified (6% [n = 5] in the cases vs 7.1% in the controls [n = 6] [p = 0.999]). The patients that underwent anastomosis site change due to inadequate perfusion had a 0% leak rate. CONCLUSIONS: ICGFA as a method to evaluate intraoperative blood perfusion showed a trend toward reducing the incidence of anastomotic leak in colorectal surgery.

[Use of cinacalcet in secondary hyperparathyroidism: assessment of nutritional, lipid and inflammatory status in chronic kidney disease]. / Uso de cinacalcet en hiperparatiroidismo secundario: evaluación del estado nutricional, lipídico e inflamatorio en enfermedad renal crónica.

Introduction: Introduction: observations in cell lines suggest that the use of cinacalcet could be associated with increase in body fat, inflammatory state, and alteration in lipid metabolism. However, when scaling the model to the clinical level, the occurrence of these effects is unknown. Objectives: to analyze the effect of cinacalcet therapy on anthropometric, inflammatory and lipid parameters in renal patients with secondary hyperparathyroidism (SHPT). Methods: observational study with two approaches. The retrospective study included 89 patients who started cinacalcet treatment since 2018 with a maximum follow-up of 36 months. Body mass index (BMI) variables, waist circumference, tricipital skinfold, parathyroid hormone (PTH), and biochemical profile were analyzed. The prospective study included 52 patients who started cinacalcet treatment since 2020 with a 12-month follow-up. BMI, PTH, lipid profile, and PCR variables were analyzed. Results: in the retrospective study, BMI was 27 kg/m2, with 62 % overweight and 65 % of patients with high cardiovascular risk. Cinacalcet reduced PTH by 12 % after six months (p < 0.01) and serum calcium decreased by 3.4 % at the end of follow-up (p = 0.04). According to the prospective study, BMI was 26.8 kg/m2, with 60 % overweight. PTH decreased by 8.4 % after six months. Total cholesterol, LDL cholesterol, and triglycerides decreased by 6.8 %, 12.5 %, and 5.5 %, respectively, at the end of follow-up. Conclusions: the prevalent nutritional status is excess weight. In patients with SHPT, cinacalcet improves PTH control without causing changes in anthropometric, lipid, and inflammatory parameters.

Introducción: Introducción: observaciones en líneas celulares sugieren que el uso de cinacalcet podría asociarse con un aumento de grasa corporal y del estado inflamatorio y una alteración del metabolismo lipídico. Sin embargo, al escalar el modelo a nivel clínico se desconoce la ocurrencia de estos efectos. Objetivos: analizar el efecto de la terapia con cinacalcet sobre parámetros antropométricos, inflamatorios y lipídicos en pacientes renales con hiperparatiroidismo secundario (HPT2). Métodos: estudio observacional con dos aproximaciones. El estudio retrospectivo incluyó 89 pacientes que iniciaron tratamiento de cinacalcet desde el año 2018 con un seguimiento máximo de 36 meses. Se analizaron variables de índice de masa corporal (IMC), circunferencia de cintura, pliegue tricipital, paratohormona (PTH) y perfil bioquímico. El estudio prospectivo incluyó 52 pacientes que iniciaron tratamiento con cinacalcet desde el año 2020 con un seguimiento de 12 meses. Se analizaron variables de IMC, PTH, perfil lipídico y proteína C reactiva (PCR). Resultados: en el estudio retrospectivo, el IMC fue de 27 kg/m2, con un 62 % de exceso de peso y un 65 % de los pacientes con riesgo cardiovascular elevado. Cinacalcet redujo la PTH un 12 % luego de seis meses (p < 0,01) y el calcio sérico disminuyó un 3,4 % al final del seguimiento (p = 0,04). En el estudio prospectivo, el IMC fue de 26,8 kg/m2, con un 60 % de exceso de peso. La PTH disminuyó un 8,4 % luego de seis meses. El colesterol total, el colesterol LDL y los triglicéridos disminuyeron en un 6,8 %, 12,5 % y 5,5 %, respectivamente, al finalizar el seguimiento. Conclusiones: el estado nutricional prevalente es el exceso de peso. En pacientes con HPT2 cinacalcet mejora el control de la PTH sin provocar cambios en parámetros antropométricos, lipídicos e inflamatorios.

[Satisfaction and utility of rehabilitative treatment through educational material in patients with COVID-19]. / Satisfacción y utilidad del tratamiento rehabilitador a través de material educativo en pacientes con COVID-19.

OBJECTIVE: In Madrid, during the pandemic, due to hospital saturation, medicalisation of hotels was required for the transfer of patients infected by SARS-CoV-2 with favourable evolution. Their typical clinical situation was one of fatigue and physical deconditioning, requiring and benefiting from a rehabilitative approach. The Rehabilitation Department developed educational material in paper format on therapeutic exercise adapted to the different functional situations detected. To describe the profile of patients admitted to a medicalised hotel and to analyse the degree of satisfaction, utility and adherence to the exercise prescribed during hospitalisation and at home and the related factors. MATERIAL AND METHOD: We conducted a descriptive study of patients admitted to the Hotel Colon during April and May 2020. We analysed the socio-demographic and clinical variables, as well as the responses to the adherence and satisfaction questionnaires about rehabilitation management during admission and at discharge. RESULTS: 100 patients participated in the study with a mean age of 52±14.5 years, where 61% (n=61) were women. 99% (n=99) reported they understood the material with a 90% (n=90) adherence to exercise during admission and 58% (n=58) at discharge. 92% (n=92) were "very satisfied" with the educational material and considered it easy to perform in 100% (n=100) of cases. CONCLUSION: The use of paper-based educational material of therapeutic exercise appears to be an effective resource in the management of patients with SARS-CoV-2 infection during admission, thus minimising the exposure of healthcare staff.

Supported Diagnosis of Attention Deficit and Hyperactivity Disorder from EEG Based on Interpretable Kernels for Hidden Markov Models.

As a neurodevelopmental pathology, Attention Deficit Hyperactivity Disorder (ADHD) mainly arises during childhood. Persistent patterns of generalized inattention, impulsivity, or hyperactivity characterize ADHD that may persist into adulthood. The conventional diagnosis relies on clinical observational processes yielding high rates of overdiagnosis due to varying interpretations among specialists or missing information. Although several studies have designed objective behavioral features to overcome such an issue, they lack significance. Despite electroencephalography (EEG) analyses extracting alternative biomarkers using signal processing techniques, the nonlinearity and nonstationarity of EEG signals restrain performance and generalization of hand-crafted features. This work proposes a methodology to support ADHD diagnosis by characterizing EEG signals from hidden Markov models (HMM), classifying subjects based on similarity measures for probability functions, and spatially interpreting the results using graphic embeddings of stochastic dynamic models. The methodology learns a single HMM for EEG signal from each patient, so favoring the inter-subject variability. Then, the Probability Product Kernel, specifically developed for assessing the similarity between HMMs, fed a support vector machine that classifies subjects according to their stochastic dynamics. Lastly, the kernel variant of Principal Component Analysis provided a means to visualize the EEG transitions in a two-dimensional space, evidencing dynamic differences between ADHD and Healthy Control children. From the electrophysiological perspective, we recorded EEG under the Stop Signal Task modified with reward levels, which considers cognitive features of interest as insufficient motivational circuits recruitment. The methodology compares the supported diagnosis in two EEG channel setups (whole channel set and channels of interest in frontocentral area) and four frequency bands (Theta, Alpha, Beta rhythms, and a wideband). Results evidence an accuracy rate of 97.0% in the Beta band and in the channels where previous works found error-related negativity events. Such accuracy rate strongly supports the dual pathway hypothesis and motivational deficit concerning the pathophysiology of ADHD. It also demonstrates the utility of joining inhibitory and motivational paradigms with dynamic EEG analysis into a noninvasive and affordable diagnostic tool for ADHD patients.

Enhancing sepsis management through machine learning techniques: A review.

Sepsis is a major public health problem and a leading cause of death in the world, where delay in the beginning of treatment, along with clinical guidelines non-adherence have been proved to be associated with higher mortality. Machine Learning is increasingly being adopted in developing innovative Clinical Decision Support Systems in many areas of medicine, showing a great potential for automatic prediction of diverse patient conditions, as well as assistance in clinical decision making. In this context, this work conducts a narrative review to provide an overview of how specific Machine Learning techniques can be used to improve sepsis management, discussing the main tasks addressed, the most popular methods and techniques, as well as the obtained results, in terms of both intelligent system accuracy and clinical outcomes improvement.

[Pet ownership and health status of pets from immunocompromised children, with emphasis in zoonotic diseases]. / Tenencia y estado de salud de mascotas de niños inmunocomprometidos, con énfasis en enfermedades zoonóticas.

OBJECTIVE: To characterize pet ownership and pet health status in families of immunocompromised (IS) children, with emphasis in zoonotic diseases. POPULATION AND METHODS: Families of IS children from two hospitals in Santiago, Chile, were interviewed and their pets were evaluated by veterinary examination, coproparasitologic and skin dermatophytes test. In specific cases, other laboratory tests were performed in IS children or their relatives. RESULTS: 47 out of 70 contacted families had pets, 42 participated in the study. Several risk factors for IS children were observed, as having a turtle as a pet and to clean cat or turtle faeces. Lack of adequate veterinary control, immunizations and deparasitation of pets were observed. Some animals showed zoonotic diseases or agents, as Brucella canis, Cryptosporidium sp, Giardia intestinalis, Toxocara canis and scabies. 44% of dogs had ticks and 37% had fleas, both potential vectors of infections. CONCLUSIONS: Our results suggest that policies to provide safer pet contact in IS children are needed.

Differences in the presentation and treatment of primary liver tumors at a hepatology center and an oncology center.

INTRODUCTION AND AIMS: Primary liver cancer is a public health problem in Mexico and the world. Liver transplantation (LT) is the ideal treatment for early hepatocellular carcinoma (HCC). Our aim was to evaluate the characteristics of patients with HCC and cholangiocarcinoma (CC) at two centers and identify transplantation candidates. MATERIALS AND METHODS: A retrospective observational study was conducted at the Hepatology Center (HC) and the University Center Against Cancer (UCAC), within the time frame of 2012-2018. HCC or intrahepatic CC was confirmed in 109 patients. Staging classifications, transplant selection models, and a predictive model for post-LT recurrence were applied to the HCC patients. RESULTS: Of the total population, 93% (n=102) presented with cirrhosis, 86% (n=94) had HCC (HC: 58%, UCAC: 42%), and 14% (n=15) had intrahepatic CC (HC: 40%, UCAC: 60%). Of the HC patients with HCC, Okuda I-II, BCLC A-B, and AFP levels <100ng/m predominated, whereas Okuda II-III, BCLC C-D, and AFP levels >1000ng/mL predominated in the UCAC patients. Half of the HC population with HCC met the criteria for LT, in contrast to 23% of the UCAC patients. Fifteen patients were evaluated for LT, and at present, six have undergone transplantation. CONCLUSIONS: The most frequent primary liver tumor was HCC. Patients from the HC presented with earlier-stage disease and a high number of them met the criteria for LT. Only patients from the HC underwent transplantation.

Differences in the presentation and treatment of primary liver tumors at a hepatology center and an oncology center. / Diferencias de la presentación y tratamiento en las neoplasias primarias de hígado en un centro de hepatología y un centro oncológico.

INTRODUCTION AND AIMS: Primary liver cancer is a public health problem in Mexico and the world. Liver transplantation (LT) is the ideal treatment for early hepatocellular carcinoma (HCC). Our aim was to evaluate the characteristics of patients with HCC and cholangiocarcinoma (CC) at two centers and identify transplantation candidates. MATERIALS AND METHODS: A retrospective observational study was conducted at the Hepatology Center (HC) and the University Center Against Cancer (UCAC), within the time frame of 2012-2018. HCC or intrahepatic CC was confirmed in 109 patients. Staging classifications, transplant selection models, and a predictive model for post-LT recurrence were applied to the HCC patients. RESULTS: Of the total population, 93% (n = 102) presented with cirrhosis, 86% (n = 94) had HCC (HC: 58%, UCAC: 42%), and 14% (n = 15) had intrahepatic CC (HC: 40%, UCAC: 60%). Of the HC patients with HCC, Okuda I-II, BCLC A-B, and AFP levels < 100 ng/m predominated, whereas Okuda II-III, BCLC C-D, and AFP levels > 1,000 ng/mL predominated in the UCAC patients. Half of the HC population with HCC met the criteria for LT, in contrast to 23% of the UCAC patients. Fifteen patients were evaluated for LT, and at present, six have undergone transplantation. CONCLUSIONS: The most frequent primary liver tumor was HCC. Patients from the HC presented with earlier-stage disease and a high number of them met the criteria for LT. Only patients from the HC underwent transplantation.

Astrochemical relevance of VUV ionization of large PAH cations.

CONTEXT: As a part of interstellar dust, polycyclic aromatic hydrocarbons (PAHs) are processed by the interaction with vacuum ultra-violet (VUV) photons that are emitted by hot young stars. This interaction leads to the emission of the well-known aromatic infrared bands but also of electrons, which can significantly contribute to the heating of the interstellar gas. AIMS: Our aim is to investigate the impact of molecular size on the photoionization properties of cationic PAHs. METHODS: Trapped PAH cations of sizes between 30 and 48 carbon atoms were submitted to VUV photons in the range of 9 to 20 eV from the DESIRS beamline at the synchrotron SOLEIL. All resulting photoproducts including dications and fragment cations were mass-analyzed and recorded as a function of photon energy. RESULTS: Photoionization is found to be predominant over dissociation at all energies, which differs from an earlier study on smaller PAHs. The photoionization branching ratio reaches 0.98 at 20 eV for the largest studied PAH. The photoionization threshold is observed to be between 9.1 and 10.2 eV, in agreement with the evolution of the ionization potential with size. Ionization cross sections were indirectly obtained and photoionization yields extracted from their ratio with theoretical photoabsorption cross sections, which were calculated using time-dependent density functional theory. An analytical function was derived to calculate this yield for a given molecular size. CONCLUSIONS: Large PAH cations could be efficiently ionized in H i regions and provide a contribution to the heating of the gas by photoelectric effect. Also, at the border of or in H ii regions, PAHs could be exposed to photons of energy higher than 13.6 eV. Our work provides recipes to be used in astronomical models to quantify these points.

Enhancing sepsis management through machine learning techniques: A review.

Sepsis is a major public health problem and a leading cause of death in the world, where delay in the beginning of treatment, along with clinical guidelines non-adherence have been proved to be associated with higher mortality. Machine Learning is increasingly being adopted in developing innovative Clinical Decision Support Systems in many areas of medicine, showing a great potential for automatic prediction of diverse patient conditions, as well as assistance in clinical decision making. In this context, this work conducts a narrative review to provide an overview of how specific Machine Learning techniques can be used to improve sepsis management, discussing the main tasks addressed, the most popular methods and techniques, as well as the obtained results, in terms of both intelligent system accuracy and clinical outcomes improvement.

Periodicity of extinctions in the geologic past: deterministic versus stochastic explanations.

The temporal spacing and the magnitude of major extinctions over the past 250 and 570 million years, based on the use of different metrics of extinction probability, are analyzed by comparing deterministic and stochastic explanations. The best-fitting time series model is a stochastic autoregressive model that displays a pseudoperiodic behavior with a cycle length of 31 million years for the past 250 million years, regardless of the metric of extinction probability. The periodicity lengthens and weakens when the analysis is extended to the entire Phanerozoic. The history of the probability of extinction for the entire Phanerozoic, based on time series analysis, does not support the reported bipartite distribution of Van Valen. Rather, the probability of extinction has decreased uniformly over Phanerozoic time whereas the inertia or stability of the biotic system after the Late Permian crisis has increased.

Submicrometer metallic barcodes.

We synthesized multimetal microrods intrinsically encoded with submicrometer stripes. Complex striping patterns are readily prepared by sequential electrochemical deposition of metal ions into templates with uniformly sized pores. The differential reflectivity of adjacent stripes enables identification of the striping patterns by conventional light microscopy. This readout mechanism does not interfere with the use of fluorescence for detection of analytes bound to particles by affinity capture, as demonstrated by DNA and protein bioassays.