A new species of Diolcogaster (Hymenoptera: Braconidae) from Brazil of potential use in the biological control of the pest Hypercompe brasiliensis (Stoll) (Lepidoptera: Erebidae).

Species of Diolcogaster parasitize Lepidoptera pests of commercial plants. The diversity of this genus is high, but few species of Diolcogaster have been described. The description of a new Diolcogaster species provides information for the biological control using this insect. This study presents the description and key notes on the biology of a new Diolcogaster parasitoid wasp. This species was reared from a caterpillar of Hypercompe brasiliensis collected after feeding on a Gloxinia perennis plant important to floriculture. Two complementary identification analyzes were performed on Diolcogaster adult bodies. The first was the analyses of its external morphology and the second its molecular analysis (mitochondrial DNA). The morphological analysis defined the insect as a new species of Diolcogaster, named Diolcogaster joanesi sp. nov. A maximum-likelihood (ML) analysis partially confirmed the morphological analysis, placing D. joanesi within a cluster including a previously identified species (Diolcogaster choi) and seven other morphospecies. The proximity of D. joanesi to D. choi is discussed and an updated key for all New World species of the xanthaspis group is provided. Twenty-eight adult wasps were obtained (22 females and six males) out of 50 cocoons which larvae emerged from the caterpillar host. The findings contribute to the broader understanding of Diolcogaster in the Neotropics and its potential for the biological control of lepidopteran defoliators.

Patient and Provider Satisfaction with Asynchronous Versus Synchronous Telepsychiatry in Primary Care: A Secondary Mixed-Methods Analysis of a Randomized Controlled Trial.

Background: Asynchronous telepsychiatry (ATP) consultations are a novel form of psychiatric consultation. Studies comparing patient and provider satisfaction for ATP with that for synchronous telepsychiatry (STP) do not exist. Methods: This mixed-methods study is a secondary analysis of patients' and primary care providers' (PCPs) satisfaction from a randomized clinical trial of ATP compared with STP. Patients and their PCPs completed satisfaction surveys, and provided unstructured feedback about their experiences with either ATP or STP. Differences in patient satisfaction were assessed using mixed-effects logistic regression models, and the qualitative data were analyzed using thematic analysis with an inductive coding framework. Results: Patient satisfaction overall was high with 84% and 97% of respondents at 6 months reported being somewhat or completely satisfied with ATP and STP, respectively. Patients in the STP group were more likely to report being completely satisfied, to recommend the program to a friend, and to report being comfortable with their care compared with ATP (all p < 0.05). However, there was no difference between the patients in ATP and STP in perceived change in clinical outcomes (p = 0.51). The PCP quantitative data were small, and thus only summarized descriptively. Conclusions: Patients expressed their overall satisfaction with both STP and ATP. Patients in ATP reported more concerns about the process, likely because feedback after ATP was slower than that after STP consultations. PCPs had no apparent preference for STP or ATP, and reported implementing the psychiatrists' recommendations for both groups when such recommendations were made, which supports our previous findings. Trial Registration: ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.

Intraoperative circulatory arrest secondary to high-risk pulmonary embolism. Case series and updated literature review.

BACKGROUND: Intraoperative pulmonary embolism (PE) with cardiac arrest (CA) represents a critical and potentially fatal condition. Available treatments include systemic thrombolysis, catheter-based thrombus fragmentation or aspiration, and surgical embolectomy. However, limited studies are focused on the optimal treatment choice for this critical condition. We present a case series and an updated review of the management of intraoperative CA secondary to PE. METHODS: A retrospective review of patients who developed high-risk intraoperative PE was performed between June 2012 and June 2022. For the updated review, a literature search on PubMed and Scopus was conducted which resulted in the inclusion of a total of 46 articles. RESULTS: A total of 196 174 major non-cardiac surgeries were performed between 2012 and 2022. Eight cases of intraoperative CA secondary to high-risk PE were identified. We found a mortality rate of 75%. Anticoagulation therapy was administered to one patient (12.5%), while two patients (25%) underwent thrombolysis, and one case (12.5%) underwent mechanical thrombectomy combined with thrombus aspiration. Based on the literature review and our 10-year experience, we propose an algorithm for the management of intraoperative CA caused by PE. CONCLUSION: The essential components for adequate management of intraoperative PE with CA include hemodynamic support, cardiopulmonary resuscitation, and the implementation of a primary perfusion intervention. The prompt identification of the criteria for each specific treatment modality, guided by the individual patient's characteristics, is necessary for an optimal approach.

Structure-function study of a Ca2+-independent metacaspase involved in lateral root emergence.

Metacaspases are part of an evolutionarily broad family of multifunctional cysteine proteases, involved in disease and normal development. As the structure-function relationship of metacaspases remains poorly understood, we solved the X-ray crystal structure of an Arabidopsis thaliana type II metacaspase (AtMCA-IIf) belonging to a particular subgroup not requiring calcium ions for activation. To study metacaspase activity in plants, we developed an in vitro chemical screen to identify small molecule metacaspase inhibitors and found several hits with a minimal thioxodihydropyrimidine-dione structure, of which some are specific AtMCA-IIf inhibitors. We provide mechanistic insight into the basis of inhibition by the TDP-containing compounds through molecular docking onto the AtMCA-IIf crystal structure. Finally, a TDP-containing compound (TDP6) effectively hampered lateral root emergence in vivo, probably through inhibition of metacaspases specifically expressed in the endodermal cells overlying developing lateral root primordia. In the future, the small compound inhibitors and crystal structure of AtMCA-IIf can be used to study metacaspases in other species, such as important human pathogens, including those causing neglected diseases.

Mutation of Arabidopsis SME1 and Sm core assembly improves oxidative stress resilience.

Alternative splicing is a key posttranscriptional gene regulatory process, acting in diverse adaptive and basal plant processes. Splicing of precursor-messenger RNA (pre-mRNA) is catalyzed by a dynamic ribonucleoprotein complex, designated the spliceosome. In a suppressor screen, we identified a nonsense mutation in the Smith (Sm) antigen protein SME1 to alleviate photorespiratory H2O2-dependent cell death in catalase deficient plants. Similar attenuation of cell death was observed upon chemical inhibition of the spliceosome, suggesting pre-mRNA splicing inhibition to be responsible for the observed cell death alleviation. Furthermore, the sme1-2 mutants showed increased tolerance to the reactive oxygen species inducing herbicide methyl viologen. Both an mRNA-seq and shotgun proteomic analysis in sme1-2 mutants displayed a constitutive molecular stress response, together with extensive alterations in pre-mRNA splicing of transcripts encoding metabolic enzymes and RNA binding proteins, even under unstressed conditions. Using SME1 as a bait to identify protein interactors, we provide experimental evidence for almost 50 homologs of the mammalian spliceosome-associated protein to reside in the Arabidopsis thaliana spliceosome complexes and propose roles in pre-mRNA splicing for four uncharacterized plant proteins. Furthermore, as for sme1-2, a mutant in the Sm core assembly protein ICLN resulted in a decreased sensitivity to methyl viologen. Taken together, these data show that both a perturbed Sm core composition and assembly results in the activation of a defense response and in enhanced resilience to oxidative stress.

Evaluación de la función ventricular en la hipertensión pulmonar por resonancia magnética cardíaca / Evaluation of ventricular function in pulmonary hypertension by cardiac magnetic resonance

Resumen Objetivo: Evaluar la función del ventrículo derecho (VD) e izquierdo (VI) en la hipertensión pulmonar (HP) mediante resonancia magnética cardíaca (RMC). Material y métodos: En pacientes con (grupo HP; n = 9) y sin (grupo control; n = 9) HP se evaluó volumen telediastólico (VTD) y telesistólico (VTS) y fracción de eyección (FE) de ventrículo derecho (VD) e izquierdo (VI), área de aurícula derecha (AD) e izquierda y diámetro de arteria pulmonar (AP). Resultados: En HP, el VD presentó mayor VTD y VTS y menor FE (HP 52 ± 5% vs. control 64 ± 2%; p < 0,05). Solo en HP se observó movimiento anormal del tabique interventricular y realce tardío en los puntos de inserción del VD en VI. En HP aumentó el área de AD y el diámetro de AP. En VD, solo en HP, la FE se correlacionó negativamente con VTD (Pearson r: –0,8290; p < 0,01) y VTS (Pearson r: –0,7869; p < 0,05). Conclusiones: La evaluación de pacientes con HP mediante RMC demuestra alteraciones fisiológicas y anatómicas de las cavidades derechas con disminución de la FE del VD que también afecta la interrelación VD/VI. Se recalca la importancia de una evaluación temprana y secuencial del VD con RMC para valorar la mejor estrategia terapéutica para cada caso en particular.

Abstract Objective: To evaluate the function of the right ventricle (RV) and left ventricle (LV) in pulmonary hypertension (PH) through cardiac magnetic resonance imaging (CMR). Material and method: In patients with (PH group; n = 9) and without PH (control group; n = 9), end-diastolic volume (EDV) and end-systolic volume (ESV) and ejection fraction (EF) of right (RV) and left (LV) ventricle, area of the right (RA) and left (LA) atrium and diameter of the pulmonary artery (PA) were evaluated. Results: In PH, the RV increased EDV and ESV and decreased EF (PH: 52 ± 5% vs. control: 64 ± 2%; p < 0.05). Abnormal movement of the interventricular septum and late enhancement in the insertion points of the RV in the LV were only observed in HP. HP increased the area of RA and the diameter of PA. In LV, only in HP, EF was negatively correlated with EDV (Pearson r: –0.8290; p < 0.01) and ESV (Pearson r: –0.7869; p < 0.05). Conclusions: CMR evaluation of patients with PH demonstrates physiological and anatomical alterations of the right cavities with decreased EF in RV that also affects the RV/LV interrelationship. The importance of an early and sequential evaluation of the RV with CMR is emphasized to assess the best therapeutic strategy for each particular case.

Decoding EEG rhythms offline and online during motor imagery for standing and sitting based on a brain-computer interface.

Motor imagery (MI)-based brain-computer interface (BCI) systems have shown promising advances for lower limb motor rehabilitation. The purpose of this study was to develop an MI-based BCI for the actions of standing and sitting. Thirty-two healthy subjects participated in the study using 17 active EEG electrodes. We used a combination of the filter bank common spatial pattern (FBCSP) method and the regularized linear discriminant analysis (RLDA) technique for decoding EEG rhythms offline and online during motor imagery for standing and sitting. The offline analysis indicated the classification of motor imagery and idle state provided a mean accuracy of 88.51 ± 1.43% and 85.29 ± 1.83% for the sit-to-stand and stand-to-sit transitions, respectively. The mean accuracies of the sit-to-stand and stand-to-sit online experiments were 94.69 ± 1.29% and 96.56 ± 0.83%, respectively. From these results, we believe that the MI-based BCI may be useful to future brain-controlled standing systems.

Utilidad de la resonancia magnética cardíaca en pacientes con distrofias neuromusculares (distrofia neuromuscular de Duchene/ Becker) / Usefulness of Cardiac Magnetic Resonance Imaging in Patients with Neuromuscular Dystrophies (Duchenne/Becker Muscular Dystrophy)

RESUMEN Introducción: La Resonancia Magnética Cardíaca (RMC) es cada vez más frecuentemente utilizada en pacientes con Distrofia Neuromuscular de Duchene y Becker (DMD y DMB). Por la capacidad de demostrar realce tardío con gadolinio (RTG), que identifica zonas de fibrosis de la pared media y subepicárdica, subendocárdica o global, y el cálculo de la fracción de eyección ventricular izquierda (FEVI), se considera el patrón oro en el diagnóstico y pronóstico de la afección cardíaca de estas distrofias. Objetivos: Determinar por medio de RMC la presencia de fibrosis cardíaca en pacientes con distrofia neuromuscular. Determinar el compromiso neuromuscular y cardiaco. Definir la evolución cardiovascular de estos pacientes Material y métodos: Se realizó un estudio descriptivo de corte transversal de 16 pacientes consecutivos desde marzo de 2021 a julio de 2022 en el Área de imagen cardiaca de CEMET (Centro Médico Tafi Viejo) y Diagnóstico Médico Dr. Gaya de la provincia de Tucumán. Resultados: Se evaluaron 16 pacientes, todos con diagnóstico confirmado de DMD/DMB por laboratorio, enzimas, y test genéticos. La edad promedio fue 19 años. Todos tenían estadio grave de la escala de Vignos y tratamiento neurológico. Todos tenían tratamiento con betabloqueantes o inhibidores de la enzima de conversión de la angiotensina. La RMC evidenció que 4 pacientes tenían deterioro grave de la FEVI (<35%); 8 pacientes tenían trastornos segmentarios o globales de la motilidad parietal del VI y en 12 se observó RTG, de distribución variable: difusa, mesocárdica, subendocárdica y subepicárdica. En 6 pacientes se observó miocardio no compacto y en 2 derrame pericárdico leve. Conclusión: La RMC debe ser incluida como método de cribaje para pacientes con distrofias neuromusculares. Su aporte para la estadificación clínica y terapéutica es de suma importancia.

ABSTRACT Introduction: Cardiac magnetic resonance imaging (CMR) is commonly used in patients with Duchene (DMD) and Becker (DMB) Neuromuscular Dystrophies. Late gadolinium enhancement (LGE) identifies areas of middle, subepicardial, or subendocardial wall fibrosis, and volumetric left ventricular ejection fraction (LVEF) is considered the gold standard in the diagnosis and prognosis of these dystrophies. Myocardial fibrosis occurs in patients with neuromuscular dystrophies. The purposes of our study were to determine the presence of cardiac fibrosis using CMR, to determine neuromuscular and cardiac involvement, and to evaluate the cardiovascular outcomes of these patients. Methods: A descriptive cross-sectional study of 16 consecutive patients was conducted from March 2021 to July 2022 in the Cardiac Imaging Service of Diagnóstico Médico and CEMET- Tucumán. Results: A total of 16 patients were evaluated, 100% of them with confirmed diagnosis of DMD/DMB by laboratory, enzymes and genetic tests. Mean age was 19 years. All patients had severe stage of the Vignos Scale and were under neurological treatment. All patients were also treated with beta-blockers or angiotensin-converting enzyme inhibitors. CMR revealed severe LVEF impairment <35% in 4 patients, segmental or global left ventricular (LV) wall motion disorders in 8 patients, and variable distribution pattern (diffuse, mesocardial, subendocardial and subepicardial patterns) of LGE in 12 patients. Non-compacted myocardium was observed in 6, and mild pericardial effusions in 2 patients. Conclusion: CMR should be included as a screening method in patients with neuromuscular dystrophies. Its contribution to clinical, echocardiographic and therapeutic staging is of utmost importance.

Machine learning in the loop for tuberculosis diagnosis support.

The use of machine learning (ML) for diagnosis support has advanced in the field of health. In the present paper, the results of studying ML techniques in a tuberculosis diagnosis loop in a scenario of limited resources are presented. Data are analyzed using a tuberculosis (TB) therapy program at a health institution in a main city of a developing country using five ML models. Logistic regression, classification trees, random forest, support vector machines, and artificial neural networks are trained under physician supervision following physicians' typical daily work. The models are trained on seven main variables collected when patients arrive at the facility. Additionally, the variables applied to train the models are analyzed, and the models' advantages and limitations are discussed in the context of the automated ML techniques. The results show that artificial neural networks obtain the best results in terms of accuracy, sensitivity, and area under the receiver operating curve. These results represent an improvement over smear microscopy, which is commonly used techniques to detect TB for special cases. Findings demonstrate that ML in the TB diagnosis loop can be reinforced with available data to serve as an alternative diagnosis tool based on data processing in places where the health infrastructure is limited.

Detection of Damage-Activated Metacaspase Activity by Western Blot in Plants.

Metacaspases are cysteine proteases that are present in plants, protists, fungi, and bacteria. Previously, we found that physical damage, e.g., pinching with forceps or grinding on liquid nitrogen of plant tissues, activates Arabidopsis thaliana METACASPASE 4 (AtMCA4). AtMCA4 subsequently cleaves PROPEP1, the precursor pro-protein of the plant elicitor peptide 1 (Pep1). Here, we describe a protein extraction method to detect activation of AtMCA4 by Western blot with antibodies against endogenous AtMCA4 and a PROPEP1-YFP fusion protein. It is important to (1) keep plant tissues at all times on liquid nitrogen prior to protein extraction, and (2) denature the protein lysate as fast as possible, as metacaspase activation ensues quasi immediately because of tissue damage inherent to protein extraction. In theory, this method can serve to detect damage-induced alterations of any protein-of-interest in any organism for which antibodies or fusion proteins are available, and hence, will greatly aid the study of rapid damage-activated proteolysis in the future.

Setup of multidisciplinary team discussions for patients with cholangiocarcinoma: current practice and recommendations from the European Network for the Study of Cholangiocarcinoma (ENS-CCA).

BACKGROUND: Cholangiocarcinomas (CCAs) are a rare group of malignancies characterized by dismal prognosis. There are currently no standardized guidelines for multidisciplinary teams (MDTs) in CCAs. MATERIAL AND METHODS: An online survey was built with the aim of defining the current practice of MDTs in CCAs and identifying possible areas of improvement, providing minimum standards of practice for an ideal CCA MDT. Analysis of the replies regarding current and ideal MDT practice was carried out by calculating weighted average (WA) of likelihood of every item. The survey was shared with members of the European Network for the Study of Cholangiocarcinoma and other medical centers with expertise in biliary tract cancer part of the EURO-CHOLANGIO-NET (European Cholangiocarcinoma Network: https://eurocholangionet.eu/) COST Action CA18122 initiative. RESULTS: The role of the MDT coordinator was a recognized priority in an ideal well-functioning MDT (WA 3.31/4), together with providing minimum clinical information before the meeting to secure adequate case preparation (WA 3.54/4). Optimal frequency of MDT meetings was weekly according to 76.92% of the participants; 73.06% believed that ideally all newly diagnosed patients and each new treatment should be discussed, although that happened only in less than half of the MDTs (46.15%) in current practice. Most participants stated that they always (46.15%) or often (50.00%) used guidelines, mainly international (61.00%) (European and American), followed by national/local (39.00%). We defined the ideal setup of a CCA MDT, identifying specialists whose presence is mandatory with WA >3.0 (oncologist, clinician responsible for patient's care, surgeon, diagnostic and interventional radiologist, hepatologist, pathologist, endoscopist and gastroenterologist) and those whose presence would be recommended with a WA <3.0 (palliative care, nurse, dietitian, basic researcher, psychologist and social worker). CONCLUSIONS: Our identified minimum requirements should be taken into account at the time of CCA MDT setup and quality assessment.

Primary Care Physician Adherence to Telepsychiatry Recommendations: Intermediate Outcomes from a Randomized Clinical Trial.

Objective:To compare clinical recommendations given by psychiatrists and the adherence to these recommendations by primary care physicians (PCP) following consultations conducted by asynchronous telepsychiatry (ATP) and synchronous telepsychiatry (STP).Materials and Methods:ATP and STP consultations were compared using intermediate data from a randomized clinical trial with adult participant enrollment between April 2014 and December 2017. In both study arms, PCPs received written recommendations from the psychiatrist after each encounter. Independent clinicians reviewed PCP documentation to measure adherence to those recommendations in the 6 months following the baseline consultation.Results:Medical records were reviewed for 645 psychiatrists' consult recommendations; 344 from 61 ATP consultations and 301 from 62 STP consultations. Of those recommendations, 191 (56%) and 173 (58%) were rated fully adherent by two independent raters for ATP and STP, respectively. In a multilevel ordinal logistic regression model adjusted for recommendation type and recommended implementation timing, there was no statistically significant difference in adherence to recommendations for ATP compared with STP (adjusted odds ratio = 0.91, 95% confidence interval = 0.51-1.62). The profiles of recommendation type were comparable between ATP and STP.Conclusions:This is the first PCP adherence study comparing two forms of telemedicine. Although we did not find evidence of a difference between ATP and STP; this study supports the feasibility and acceptability of ATP and STP for the provision of collaborative psychiatric care. Clinical Trial Identifier NCT02084979.

ATLANTIC ANTS: a data set of ants in Atlantic Forests of South America.

Ants, an ecologically successful and numerically dominant group of animals, play key ecological roles as soil engineers, predators, nutrient recyclers, and regulators of plant growth and reproduction in most terrestrial ecosystems. Further, ants are widely used as bioindicators of the ecological impact of land use. We gathered information of ant species in the Atlantic Forest of South America. The ATLANTIC ANTS data set, which is part of the ATLANTIC SERIES data papers, is a compilation of ant records from collections (18,713 records), unpublished data (29,651 records), and published sources (106,910 records; 1,059 references), including papers, theses, dissertations, and book chapters published from 1886 to 2020. In total, the data set contains 153,818 ant records from 7,636 study locations in the Atlantic Forest, representing 10 subfamilies, 99 genera, 1,114 ant species identified with updated taxonomic certainty, and 2,235 morphospecies codes. Our data set reflects the heterogeneity in ant records, which include ants sampled at the beginning of the taxonomic history of myrmecology (the 19th and 20th centuries) and more recent ant surveys designed to address specific questions in ecology and biology. The data set can be used by researchers to develop strategies to deal with different macroecological and region-wide questions, focusing on assemblages, species occurrences, and distribution patterns. Furthermore, the data can be used to assess the consequences of changes in land use in the Atlantic Forest on different ecological processes. No copyright restrictions apply to the use of this data set, but we request that authors cite this data paper when using these data in publications or teaching events.

Dead space ratio as a tool in nitric oxide weaning: a study in pulmonary hypertensive disease.

OBJECTIVES: To describe the association between successful weaning of inhaled nitric oxide and trends in dead space ratio during such weans in patients empirically initiated on nitric oxide therapy out of concern of pulmonary hypertensive crisis. PATIENTS: Children in a cardiac intensive care unit initiated on inhaled nitric oxide out of clinical concern for pulmonary hypertensive crisis retrospectively over 2 years. MEASUREMENTS AND MAIN RESULTS: Twenty-seven patients were included, and nitric oxide was successfully discontinued in 23/27. These patients exhibited decreases in dead space ratio (0.18 versus 0.11, p = 0.047) during nitric oxide weaning, and with no changes in dead space ratio between pre- and post-nitric oxide initiation (p = 0.88) and discontinuation (p = 0.63) phases. These successful patients had a median age of 10 months [4.0, 57.0] and had a pre-existent diagnosis of CHD in 6/23 and pulmonary hypertension in 2/23. Those who failed nitric oxide discontinuation trended with a higher dead space ratio at presentation (0.24 versus 0.10), were more likely to carry a prior diagnosis of pulmonary hypertension (50% versus 8.7%), and had longer mechanical ventilation days (5 versus 12). CONCLUSIONS: Patients empirically placed on nitric oxide out of concern of pulmonary hypertensive crisis and successfully weaned off showed unchanged or decreased dead space ratio throughout the initiation to discontinuation phases of nitric oxide therapy. Trends in dead space ratio may aid in determining true need for nitric oxide and facilitate effective weaning. Further studies are needed to directly compare trends between success and failure groups.

Preliminary Text Analysis from Medical Records for TB Diagnosis Support.

Tuberculosis is an infectious disease that is spread through the air from one person to another and is one of the top ten causes of death in the world according to the World Health Organization. From biomedical engineering, decision support systems based on artificial intelligence have shown advantages for healthcare personnel in tasks such as diagnosis and screening. A specific area of the artificial intelligence is the natural language processing, however, most of these approaches are based on available data. This paper shows the construction of a dataset based on medical records of subjects suspected of tuberculosis. In addition, an initial exploration of the contents of the constructed dataset and how this approach can be followed by a natural language processing to support tuberculosis diagnosis in data demanding scenarios are presented.Clinical Relevance- In some developing countries as Colombia, it is difficult to develop systems based on artificial intelligence due to the availability of data. This proposal holds a strategy to build a dataset to train machine learning models, and to obtain support diagnosis tools, employing natural language from the medical scenario from text written by health professionals in the medical record. In this way, trained models based on this information available can be employed in places where medical infrastructure is precarious.

Pathogenicity and virulence of Listeria monocytogenes: A trip from environmental to medical microbiology.

Listeria monocytogenes is a saprophytic gram-positive bacterium, and an opportunistic foodborne pathogen that can produce listeriosis in humans and animals. It has evolved an exceptional ability to adapt to stress conditions encountered in different environments, resulting in a ubiquitous distribution. Because some food preservation methods and disinfection protocols in food-processing environments cannot efficiently prevent contaminations, L. monocytogenes constitutes a threat to human health and a challenge to food safety. In the host, Listeria colonizes the gastrointestinal tract, crosses the intestinal barrier, and disseminates through the blood to target organs. In immunocompromised individuals, the elderly, and pregnant women, the pathogen can cross the blood-brain and placental barriers, leading to neurolisteriosis and materno-fetal listeriosis. Molecular and cell biology studies of infection have proven L. monocytogenes to be a versatile pathogen that deploys unique strategies to invade different cell types, survive and move inside the eukaryotic host cell, and spread from cell to cell. Here, we present the multifaceted Listeria life cycle from a comprehensive perspective. We discuss genetic features of pathogenic Listeria species, analyze factors involved in food contamination, and review bacterial strategies to tolerate stresses encountered both during food processing and along the host's gastrointestinal tract. Then we dissect host-pathogen interactions underlying listerial pathogenesis in mammals from a cell biology and systemic point of view. Finally, we summarize the epidemiology, pathophysiology, and clinical features of listeriosis in humans and animals. This work aims to gather information from different fields crucial for a comprehensive understanding of the pathogenesis of L. monocytogenes.

Clinical Outcomes of Asynchronous Versus Synchronous Telepsychiatry in Primary Care: Randomized Controlled Trial.

BACKGROUND: Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP) are lacking. OBJECTIVE: This study aims to determine the effectiveness of ATP in improving clinical outcomes in English- and Spanish-speaking primary care patients compared with STP, the telepsychiatry usual care method. METHODS: Overall, 36 primary care physicians from 3 primary care clinics referred a heterogeneous sample of 401 treatment-seeking adult patients with nonurgent psychiatric disorders. A total of 184 (94 ATP and 90 STP) English- and Spanish-speaking participants (36/184, 19.6% Hispanic) were enrolled and randomized, and 160 (80 ATP and 80 STP) of them completed baseline evaluations. Patients were treated by their primary care physicians using a collaborative care model in consultation with the University of California Davis Health telepsychiatrists, who consulted with patients every 6 months for up to 2 years using ATP or STP. Primary outcomes (the clinician-rated Clinical Global Impressions [CGI] scale and the Global Assessment of Functioning [GAF]) and secondary outcomes (patients' self-reported physical and mental health and depression) outcomes were assessed every 6 months. RESULTS: For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at 6-month follow-up (ATP vs STP, adjusted difference in follow-up at 6 months vs baseline differences for CGI: 0.2, 95% CI -0.2 to 0.6; P=.28; and GAF: -0.6, 95% CI -3.1 to 1.9; P=.66) or 12-month follow-up (ATP vs STP, adjusted difference in follow-up at 12 months vs baseline differences for CGI: 0.4, 95% CI -0.04 to 0.8; P=.07; and GAF: -0.5, 95% CI -3.3 to 2.2; P=.70), but patients in both arms had statistically and clinically significant improvements in both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all P values were between .17 and .96). Dropout rates were higher than predicted but similar between the 2 arms. Of those with baseline visits, 46.8% (75/160) did not have a follow-up at 1 year, and 72.7% (107/147) did not have a follow-up at 2 years. No serious adverse events were associated with the intervention. CONCLUSIONS: This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English- and Spanish-speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.

Detrimental effects of pyriproxyfen on the detoxification and abilities of Belostoma anurum to prey upon Aedes aegypti larvae.

Despite being effective in controlling mosquito larvae and a few other target organisms, the application of insecticides into aquatic systems may cause unintended alterations to the physiology or behavioral responses of several aquatic non-target organisms, which can ultimately lead to their death. Here, we firstly evaluated whether the susceptibility of the giant water bug, Belostoma anurum (Hemiptera: Belostomatidae), a predator of mosquito larvae, to pyriproxyfen would be similar to that of its potential prey, larvae of Aedes aegypti (Diptera: Culicidae). Secondly, we recorded the nominal concentrations of pyriproxyfen in water and evaluated whether sublethal exposures would lead to physiological or behavioral alterations on the B. anurum nymphs. We characterized the activities of three major families of detoxification enzymes (i.e., cytochrome P450 monooxygenases, glutathione-S-transferase, and general esterases) and further evaluated the abilities of pyriproxyfen sublethally-exposed B. anurum to prey upon A. aegypti larvae at different prey densities. Our findings revealed that nominal pyriproxyfen concentration significantly decreased (approximately 50%) over the first 24 h. Furthermore, when applied at the concentration of 10 µg a.i./L, pyriproxyfen was approximately four times more toxic to A. aegypti larvae (LT50 = 48 h) than to B. anurum nymphs (LT50 = 192 h). Interestingly, the pyriproxyfen sublethally-exposed (2.5 µg a.i./L) B. anurum nymphs exhibited reduced enzyme activities (cytochrome P450 monooxygenases) involved in detoxication processes and preyed significantly less on A. aegypti larvae when compared to unexposed predators. Collectively, our findings demonstrate that mortality-based pyriproxyfen risk assessments are not always protective of aquatic non-target organisms.

Índice leucoglucémico como marcador pronóstico de complicaciones en pacientes con infarto agudo de miocardio / Leukoglucemic index as a prognostic marker for complications in patients with acute myocardial infarction

Resumen Introducción:: El índice leucoglucémico es un factor pronóstico, poco conocido y utilizado, que relaciona la glucemia y los leucocitos registrados al ingreso hospitalario. Su importancia radica en la determinación del riesgo de complicaciones y la mortalidad en pacientes con infarto agudo de miocardio. Objetivo: Establecer al índice leucoglucémico como factor predictor de complicaciones durante la evolución intrahospitalaria en los pacientes con infarto agudo de miocardio. Método: Estudio de tipo epidemiológico, analítico, observacional y de corte transversal, en una cohorte de pacientes que ingresaron con infarto agudo de miocardio durante un período de un año y tres meses. Resultados: Se incluyó en el estudio a 205 pacientes con infarto agudo de miocardio, cuyo promedio de edad fue de 62.99 ± 12.2 años, con predominio en varones con 69.3%. El infarto agudo de miocardio con elevación del segmento ST predominó en frecuencia con 63.9% y mayor tasa de complicaciones (p < 0.001). El promedio del índice leucoglucémico fue de 1,578.41 ± 1,208.1 y el punto de corte establecido fue de 656.8, de acuerdo con la curva ROC, con sensibilidad del 95.8% y especificidad del 73% para la predicción de complicaciones intrahospitalarias, con OR de 7.89. Conclusión: Un índice leucoglucémico > 656.8 representa un riesgo de 7.89 veces de desarrollar complicaciones en la población estudiada.

Abstract Introduction: Leukoglycemic index is a poorly known and used prognostic factor that correlates blood glucose and leukocytes which are taken at hospital admission. Its importance lies in determining complications and mortality risks in patients with acute myocardial infarction. Objective: To establish the leukoglycemic index as a predictor of complications during the in-hospital evolution in patients with acute myocardial infarction. Methods: Epidemiological, observational, cross-sectional, crosssectional study on a cohort of patients admitted with acute myocardial infarction during a period of 1 year 3 months. Results: 205 patients with acute myocardial infarction were included in this study. The mean age was 62.99 ± 12.2 years old, more frequently in males by 69.3%. It was determined that acute myocardial infarction with ST elevation predominated both in frequency with 63.9%, as well as with a higher rate of complications (p < 0.001). The average of leukoglycemic index was 1578.41 ± 1208.1 and the cut-off point was 656.8, according to ROC curve, with sensitivity of 95.8% and specificity of 73% for the prediction of inhospital complications, OR 7.89. Conclusions: A leukoglycemic index greater than 656.8 represents a 7.89-fold risk of developing complications in the study population.