Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy: A Single-Center Experience.

BACKGROUND: The use of surgery in patients with locally advanced pancreatic cancer (LAPC) following induction chemotherapy is increasing. However, most series do not report on the total cohort of patients undergoing surgical exploration; therefore, this single-center study investigates outcomes among all consecutive patients with LAPC who underwent surgical exploration. METHODS: We conducted a retrospective, single-center analysis including all consecutive patients with LAPC (Dutch Pancreatic Cancer Group criteria) who underwent surgical exploration with curative intent (January 2014-June 2023) after induction therapy. Primary outcomes were resection rate and overall survival (OS) from the time of diagnosis. RESULTS: Overall, 127 patients underwent surgical exploration for LAPC, whereby 100 patients (78.7%) underwent resection and 27 patients (21.3%) underwent a non-therapeutic laparotomy due to the extent of vascular involvement (n = 11, 8.7%) or occult metastases (n = 16, 12.6%). The overall in-hospital/30-day mortality rate was 0.8% and major morbidity was 31.3% (in patients after resection: 1.0% and 33.3%, respectively). The overall 90-day mortality rate was 5.5%, which included 3.1% mortality due to disease progression. Resection was associated with longer median OS {29 months (95% confidence interval [CI] 26-43) vs. 17 months (95% CI 11-26); p < 0.001} compared with patients undergoing non-therapeutic laparotomy, with corresponding 5-year OS rates of 28.4% and 7.7%. In Cox proportional hazard regression analysis, only pancreatic body/tail tumors independently predicted OS (hazard ratio 1.788 [95% CI 1.042-3.068]). CONCLUSION: This single-center series found a resection rate of 78.7% in patients with LAPC selected for surgical exploration, with a low risk of mortality and morbidity in all explored patients and a 5-year OS rate after resection of 28.4%.

Differences of ventilatory muscle recruitment and work of breathing in COPD and interstitial lung disease during exercise: a comprehensive evaluation.

Introduction: COPD and interstitial lung disease (ILD) are significant chronic respiratory disorders, impacting quality of life. Respiratory muscle roles and differences remain not entirely clear. The objective of the present study was to evaluate the degree of recruitment of the respiratory muscles and the work of breathing in COPD and ILD during exercise. Methods: We compared the sensory-mechanical relationships in COPD, ILD and healthy controls (n=20 each). They performed pulmonary function, noninvasive and invasive respiratory muscle strength, surface electromyography and work-of-breathing assessments. Results: COPD and ILD did not show lower static muscle strength compared to controls, but did show poor performance in the exercise test with increased transdiaphragmatic pressure (P di). In ILD, there was a higher increase in oesophageal pressure and a lower gastric pressure (P ga) on inspiration; in COPD, there was a significant increase in P ga on inspiration. In ILD, there is greater recruitment of accessory inspiratory muscles, whereas in COPD, there is marked use of both inspiratory and expiratory muscles. The neuromechanical inefficiency (increased neural respiratory drive without the corresponding tidal volume) was found in both diseases. In COPD, there is a considerable increase in elastic work to overcome intrinsic positive end-expiratory pressure (PEEPi) and expiratory work of breathing, whereas in ILD, non-PEEPi elastic work of breathing is the highest part of the total work of breathing. Conclusions: Early and increased activity of the respiratory muscles and work-of-breathing components significantly contribute to dyspnoea, exercise intolerance and neuromechanical inefficiency of ventilation in COPD and ILD. The mechanisms of P di generation were different between diseases.

Racial Differences in Accuracy of Predictive Models for High-Flow Nasal Cannula Failure in COVID-19.

OBJECTIVES: To develop and validate machine learning (ML) models to predict high-flow nasal cannula (HFNC) failure in COVID-19, compare their performance to the respiratory rate-oxygenation (ROX) index, and evaluate model accuracy by self-reported race. DESIGN: Retrospective cohort study. SETTING: Four Emory University Hospitals in Atlanta, GA. PATIENTS: Adult patients hospitalized with COVID-19 between March 2020 and April 2022 who received HFNC therapy within 24 hours of ICU admission were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Four types of supervised ML models were developed for predicting HFNC failure (defined as intubation or death within 7 d of HFNC initiation), using routine clinical variables from the first 24 hours of ICU admission. Models were trained on the first 60% (n = 594) of admissions and validated on the latter 40% (n = 390) of admissions to simulate prospective implementation. Among 984 patients included, 317 patients (32.2%) developed HFNC failure. eXtreme Gradient Boosting (XGB) model had the highest area under the receiver-operator characteristic curve (AUROC) for predicting HFNC failure (0.707), and was the only model with significantly better performance than the ROX index (AUROC 0.616). XGB model had significantly worse performance in Black patients compared with White patients (AUROC 0.663 vs. 0.808, p = 0.02). Racial differences in the XGB model were reduced and no longer statistically significant when restricted to patients with nonmissing arterial blood gas data, and when XGB model was developed to predict mortality (rather than the composite outcome of failure, which could be influenced by biased clinical decisions for intubation). CONCLUSIONS: Our XGB model had better discrimination for predicting HFNC failure in COVID-19 than the ROX index, but had racial differences in accuracy of predictions. Further studies are needed to understand and mitigate potential sources of biases in clinical ML models and to improve their equitability.

Physical performance changes in season are associated with GPS data in soccer players.

This study investigated the associations between preseason and in-season performance with external workload in professional soccer players. Twenty-one players completed hamstring strength, countermovement jump (CMJ), 20-m sprint, and Yo-Yo intermittent recovery tests before (preseason) and after 8 weeks (in-season). External workload (total distance, high-intensity running distance, number of sprints, and power plays) was quantified during this period, and used to divide the average above and below subgroups outcome by outcome for further analyses. Significance was accepted when P≤0.05. Hamstring strength declined from pre- to in-season [-6%; p=0.014; effect size (ES): -0.41], while Yo-Yo performance improved (46%; p=0.001; ES: 1.31). When divided by high-intensity running distance, only the below-average subgroup improved CMJ performance (5%; p=0.030). For minutes played, the above-average subgroup improved Yo-Yo performance (41%; p<0.001), but not the below-average subgroup. Furthermore, playing time correlated with improved Yo-Yo performance (p=0.040; r=0.534). Improved 20-m sprint performance associated with more sprints performed (p=0.045; r=-0.453). Physical capabilities changed over a competitive season and were related to, and differentiated by, external workload. Because hamstring strength decreased and CMJ only improved in players exposed to less high-intensity external load, practitioners should individualize approaches to counteract these conditions when high external workload is performed over the season.

Biological Activities of Species of the Genus Clusia L (Clusiaceae): A General Approach.

The genus Clusia L. is highly diverse in Central and South America, comprising about 300 species, including trees and shrubs, hemiepiphytes, epiphytes, and lianas. This genus deserves attention due to its wide range of biological activities. Clusia belongs to the Clusiaceae family, chemically characterized by the presence of xanthones, benzophenones, flavonoids, coumarins, terpenoids, and other substances with bioactive activity already described. This review aims to highlight the biological activity associated to extracts and isolated substances from species of the Clusia genus, including anti-HIV, antimicrobial, antioxidant, antinociceptive, antitumor, leishmanicidal, modulator of inflammatory processes, neutralization of toxic effects caused by snake bites, and others. This review gathered information on biological activities associated with different types of extracts and isolated substances of the genus Clusia, traditional use, chemical profile, and biological properties of plants of the genus, published in the last 23 years (1998 to 2021) and that can provide support for future research. The paper aims to provide an overview of existing knowledge about the biological properties of the genus Clusia plant species.

Candida spp. isolated from recreational coastal waters of Rio de Janeiro - Brazil: Focus on antifungal resistance and virulence attributes.

The use of recreational waters is a widespread activity worldwide, and one of the risks associated with this practice is the exposure of bathers to microorganisms that may arise due to pollution caused by inadequate infrastructure and sanitation. In the present work, we isolated Candida spp. (n = 24) from five recreational beaches in Rio de Janeiro, Brazil, in order to evaluate their susceptibility to antifungals, the production of virulence attributes and the in vivo virulence using Tenebrio molitor larvae as a model. The ITS1-5.8S-ITS2 gene sequencing identified thirteen isolates (54.1 %) as C. tropicalis, seven (29.1 %) as C. krusei (Pichia kudriavzevii), one (4.2 %) as C. rugosa (Diutina rugosa), one (4.2 %) as C. mesorugosa (Diutina mesorugosa), one (4.2 %) as C. utilis (Cyberlindnera jadinii) and one (4.2 %) as C. parapsilosis. C. tropicalis isolates showed resistance to azoles and susceptibility to amphotericin B, flucytosine and caspofungin. C. krusei isolates were resistant to fluconazole, caspofungin and itraconazole, with 42.8 % resistance to flucytosine, besides susceptibility to voriconazole and amphotericin B. The remaining species were susceptible to all tested antifungals. All Candida isolates adhered to abiotic surfaces and formed biofilm on polystyrene, albeit to varying degrees, and produced aspartic protease and hemolytic activity, which are considered fungal virulence attributes. C. tropicalis, C. krusei and C. utilis isolates produced phytase, while the only esterase producer was C. tropicalis. Regarding resistance to osmotic stress, all isolates of C. tropicalis, C. parapsilosis and C. mesorugosa grew up to 7.5 % NaCl; the remaining isolates grew up to 1.87-3.75 % NaCl. The mortality caused by fungal challenges in T. molitor larvae was variable, with C. tropicalis, C. utilis and C. parapsilosis being more virulent than C. krusei and C. rugosa complex. Collectively, the presence of these yeasts, particularly the virulent and resistant isolates, in recreational waters can pose a significant health risk to bathers.

Near-infrared spectroscopy and multivariate analysis as effective, fast, and cost-effective methods to discriminate Candida auris from Candida haemulonii.

Candida auris and Candida haemulonii are two emerging opportunistic pathogens that have caused an increase in clinical cases in the recent years worldwide. The differentiation of some Candida species is highly laborious, difficult, costly, and time-consuming depending on the similarity between the species. Thus, this study aimed to develop a new, faster, and less expensive methodology for differentiating between C. auris and C. haemulonii based on near-infrared (NIR) spectroscopy and multivariate analysis. C. auris CBS10913 and C. haemulonii CH02 were separated in 15 plates per species, and three isolated colonies of each plate were selected for Fourier transform near-infrared (FT-NIR) analysis, totaling 90 spectra. Subsequently, principal component analysis (PCA) and variable selection algorithms, including the successive projections algorithm (SPA) and genetic algorithm (GA) coupled with linear discriminant analysis (LDA), were employed to discern distinctive patterns among the samples. The use of PCA, SPA, and GA algorithms associated with LDA achieved 100% sensitivity and specificity for the discriminations. The SPA-LDA and GA-LDA algorithms were essential in selecting the variables (infrared wavelengths) of most importance for the models, which could be attributed to binding of cell wall structures such as polysaccharides, peptides, proteins, or molecules resulting from yeasts' metabolism. These results show the high potential of combined FT-NIR and multivariate analysis techniques for the classification of Candida-like fungi, which can contribute to faster and more effective diagnosis and treatment of patients affected by these microorganisms.

Stockholm3 in a Multiethnic Cohort for Prostate Cancer Detection (SEPTA): A Prospective Multicentered Trial.

PURPOSE: Asian, Black, and Hispanic men are underrepresented in prostate cancer (PCa) clinical trials. Few novel prostate cancer biomarkers have been validated in diverse cohorts. We aimed to determine if Stockholm3 can improve prostate cancer detection in a diverse cohort. METHODS: An observational prospective multicentered (17 sites) clinical trial (2019-2023), supplemented by prospectively recruited participants (2008-2020) in a urology clinic setting included men with suspicion of PCa and underwent prostate biopsy. Before biopsy, sample was collected for measurement of the Stockholm3 risk score. Parameters include prostate-specific antigen (PSA), free PSA, KLK2, GDF15, PSP94, germline risk (single-nucleotide polymorphisms), age, family history, and previous negative biopsy. The primary endpoint was detection of International Society of Urological Pathology (ISUP) Grade ≥2 cancer (clinically significant PCa, csPC). The two primary aims were to (1) demonstrate noninferior sensitivity (0.8 lower bound 95% CI noninferiority margin) in detecting csPC using Stockholm3 compared with PSA (relative sensitivity) and (2) demonstrate superior specificity by reducing biopsies with benign results or low-grade cancers (relative specificity). RESULTS: A total of 2,129 biopsied participants were included: Asian (16%, 350), Black or African American (Black; 24%, 505), Hispanic or Latino and White (Hispanic; 14%, 305), and non-Hispanic or non-Latino and White (White; 46%, 969). Overall, Stockholm3 showed noninferior sensitivity compared with PSA ≥4 ng/mL (relative sensitivity: 0.95 [95% CI, 0.92 to 0.99]) and nearly three times higher specificity (relative specificity: 2.91 [95% CI, 2.63 to 3.22]). Results were consistent across racial and ethnic subgroups: noninferior sensitivity (0.91-0.98) and superior specificity (2.51-4.70). Compared with PSA, Stockholm3 could reduce benign and ISUP 1 biopsies by 45% overall and between 42% and 52% across racial and ethnic subgroups. CONCLUSION: In a substantially diverse population, Stockholm3 significantly reduces unnecessary prostate biopsies while maintaining a similar sensitivity to PSA in detecting csPC.

Competitive exclusion products as an antimicrobial alternative to control Salmonella Heidelberg in broilers.

Intestinal infections caused by non-typhoidal Salmonella spp. along with antimicrobial resistance spread is a major food safety concern worldwide. Here, we evaluate the potential of competitive exclusion products developed by anaerobic or aerobic conditions to control systemic infection, cecal colonization, fecal excretion and improve the intestinal health in broilers challenged by Salmonella Heidelberg (SH). A total of 105 day-old chickens were randomly distributed into three experimental groups: A (untreated control); B (treated with anaerobic culture) and C (treated with aerobic culture). During 21 days, morphometric parameters of the small intestine were analyzed using microscopy, fecal excretions by cloacal swabs, systemic infection, and cecal colonization by colony-forming unit counts (CFU/g). The results indicated the lowest number of positive swabs (45.33%) recovered from Group C, followed by Group B (71.8%), and Group A (85.33%). The bacterial enumeration revealed the lowest amounts in Group C at the necropsy realized in 5-, 7-, and 14- days post-infection (DPI) (P = 0.0010, P = 0.0048 and P = 0.0094, respectively). Statistical differences between intestinal morphometrics were observed in the Group C at 21 DPI. Our results suggest that the product developed under aerobic conditions can improve intestinal health, protecting birds against SH.

Calcineurin activity in Fonsecaea pedrosoi: tacrolimus and cyclosporine A inhibited conidia growth, filamentation and showed synergism with itraconazole.

Fonsecaea pedrosoi is a melanized fungus that causes chromoblastomycosis (CBM), a tropical neglected disease responsible for chronic and disability-related subcutaneous mycosis. Given the challenging nature of CBM treatment, the study of new targets and novel bioactive drugs capable of improving patient life quality is urgent. In the present work, we detected a calcineurin activity in F. pedrosoi conidial form, employing primarily colorimetric, immunoblotting and flow cytometry assays. Our findings reveal that the calcineurin activity of F. pedrosoi was stimulated by Ca2+/calmodulin, inhibited by EGTA and specific inhibitors, such as tacrolimus (FK506) and cyclosporine A (CsA), and proved to be insensitive to okadaic acid. In addition, FK506 and CsA were able to affect the cellular viability and the fungal proliferation. This effect was corroborated by transmission electron microscopy that showed both calcineurin inhibitors promoted profound changes in the ultrastructure of conidia, causing mainly cytoplasm condensation and intense vacuolization that are clear indication of cell death. Our data indicated that FK506 exhibited the highest effectiveness, with a minimum inhibitory concentration (MIC) of 3.12 mg/L, whereas CsA required 15.6 mg/L to inhibit 100% of conidial growth. Interestingly, when both were combined with itraconazole, they demonstrated anti-F. pedrosoi activity, exhibiting a synergistic effect. Moreover, the fungal filamentation was affected after treatment with both calcineurin inhibitors. These data corroborate with other calcineurin studies in fungal cells and open up further discussions aiming to establish the role of this enzyme as a potential target for antifungal therapy against CBM infections.

Moving from stable standing to single-limb stance or an up-on-the-toes position: The importance of vision to dynamic balance control.

Understanding the contribution vision has to dynamic balance control may help in understanding where/why loss of balance occurs during everyday locomotion. The current study determined how body-centre-of-mass (BCoM) dynamics and postural stability when moving to and holding a single-limb-stance (SS) or an up-on-the-toes (UTT) position were affected by visual occlusion. From standing on a force platform, 18 adults (mean (SD) 26.7 (4.8) years; 1.73 (0.08) m; 84.0 (22.9) kg; 7 females) completed repeated trials (x3) with and without vision in which they moved to either a SS or an UTT position (order countered-balanced), and attempted to hold that position for 2 (SS) or 5 (UTT) seconds before returning to standing. UTT trials were also repeated at a fast speed, and SS trials were repeated using both the dominant and non-dominant limb. BCoM dynamics were assessed by analysing the displacement and peak velocity of the centre-of-pressure (CoP) when moving to and from the SS and UTT positions. Balance stability was the variability in the CoP displacement/velocity when holding these positions. Results indicate that under visual occlusion, the peak CoP velocity when moving to the SS or UTT position was reduced (ES, 0.67 and 0.68, respectively), suggesting greater caution. Both the variability in the CoP displacement/velocity when holding these positions and the peak CoP velocity when returning to flat-standing increased (SS: ES, 1.0 and 0.86, respectively; UTT: ES 1.26 and 0.66, respectively), suggesting, respectively, greater instability and poorer control. The poorer control in SS trials, occurred when returning to standing from the SS position held on the non-dominant limb, and correspondingly, the reduction in SS duration when vision was occluded was greater for the non-dominant limb trails (limb-vision interaction; p = 0.042). This suggests that movements initiated/controlled by the non-dominant limb are more reliant on visual feedback than those initiated/controlled by the dominant limb.

Saps1-3 Antigens in Candida albicans: Differential Modulation Following Exposure to Soluble Proteins, Mammalian Cells, and Infection in Mice.

The secreted aspartic peptidases (Saps) of Candida albicans play crucial roles in various steps of fungal-host interactions. Using a flow cytometry approach, this study investigated the expression of Saps1-3 antigens after (i) incubation with soluble proteins, (ii) interaction with mammalian cells, and (iii) infection in immunosuppressed BALB/c mice. Supplementation strategies involving increasing concentrations of bovine serum albumin (BSA) added to yeast carbon base (YCB) medium as the sole nitrogenous source revealed a positive and significant correlation between BSA concentration and both the growth rate and the percentage of fluorescent cells (%FC) labeled with anti-Saps1-3 antibodies. Supplementing the YCB medium with various soluble proteins significantly modulated the expression of Saps1-3 antigens in C. albicans. Specifically, immunoglobulin G, gelatin, and total bovine/human sera significantly reduced the %FC, while laminin, human serum albumin, fibrinogen, hemoglobin, and mucin considerably increased the %FC compared to BSA. Furthermore, co-cultivating C. albicans yeasts with either live epithelial or macrophage cells induced the expression of Saps1-3 antigens in 78% (mean fluorescence intensity [MFI] = 152.1) and 82.7% (MFI = 178.2) of the yeast cells, respectively, compared to BSA, which resulted in 29.3% fluorescent cells (MFI = 50.9). Lastly, the yeasts recovered from the kidneys of infected immunosuppressed mice demonstrated a 4.8-fold increase in the production of Saps1-3 antigens (MFI = 246.6) compared to BSA, with 95.5% of yeasts labeled with anti-Saps1-3 antibodies. Altogether, these results demonstrated the positive modulation of Saps' expression in C. albicans by various key host proteinaceous components, as well as by in vitro and in vivo host challenges.

Postoperative Complications and Mobilization Following Major Abdominal Surgery With Versus Without Fitness Tracker-based Feedback (EXPELLIARMUS): A Student-led Multicenter Randomized Controlled Clinical Trial of the CHIR-Net SIGMA Study Group.

OBJECTIVE: To determine whether daily postoperative step goals and feedback through a fitness tracker (FT) reduce the rate of postoperative complications after surgery. BACKGROUND: Early and enhanced postoperative mobilization has been advocated to reduce postoperative complications, but it is unknown whether FT alone can reduce morbidity. METHODS: EXPELLIARMUS was performed at 11 University Hospitals across Germany by the student-led clinical trial network SIGMA. Patients undergoing major abdominal surgery were enrolled, equipped with an FT, and randomly assigned to the experimental (visible screen) or control intervention (blackened screen). The experimental group received daily step goals and feedback through the FT. The primary end point was postoperative morbidity within 30 days using the Comprehensive Complication Index (CCI). All trial visits were performed by medical students in the hospital with the opportunity to consult a surgeon-facilitator who also obtained informed consent. After discharge, medical students performed the 30-day postoperative visit through telephone and electronic questionnaires. RESULTS: A total of 347 patients were enrolled. Baseline characteristics were comparable between the 2 groups. The mean age of patients was 58 years, and 71% underwent surgery for malignant disease, with the most frequent indications being pancreatic, colorectal, and hepatobiliary malignancies. Roughly one-third of patients underwent laparoscopic surgery. No imputation for the primary end point was necessary as data completeness was 100%. There was no significant difference in the CCI between the 2 groups in the intention-to-treat analysis (mean±SD CCI experimental group: 23±24 vs. control: 22±22; 95% CI: -6.1, 3.7; P=0.628). All secondary outcomes, including quality of recovery, 6-minute walking test, length of hospital stay, and step count until postoperative day 7 were comparable between the 2 groups. CONCLUSIONS: Daily step goals combined with FT-based feedback had no effect on postoperative morbidity. The EXPELLIARMUS shows that medical students can successfully conduct randomized controlled trials in surgery.

Prevalence of STEC virulence markers and Salmonella as a function of abiotic factors in agricultural water in the southeastern United States.

Fresh produce can be contaminated by enteric pathogens throughout crop production, including through contact with contaminated agricultural water. The most common outbreaks and recalls in fresh produce are due to contamination by Salmonella enterica and Shiga toxin-producing E. coli (STEC). Thus, the objectives of this study were to investigate the prevalence of markers for STEC (wzy, hly, fliC, eaeA, rfbE, stx-I, stx-II) and Salmonella (invA) in surface water sources (n = 8) from produce farms in Southwest Georgia and to determine correlations among the prevalence of virulence markers for STEC, water nutrient profile, and environmental factors. Water samples (500 mL) from eight irrigation ponds were collected from February to December 2021 (n = 88). Polymerase chain reaction (PCR) was used to screen for Salmonella and STEC genes, and Salmonella samples were confirmed by culture-based methods. Positive samples for Salmonella were further serotyped. Particularly, Salmonella was detected in 6/88 (6.81%) water samples from all ponds, and the following 4 serotypes were detected: Saintpaul 3/6 (50%), Montevideo 1/6 (16.66%), Mississippi 1/6 (16.66%), and Bareilly 1/6 (16.66%). Salmonella isolates were only found in the summer months (May-Aug.). The most prevalent STEC genes were hly 77/88 (87.50%) and stx-I 75/88 (85.22%), followed by fliC 54/88 (61.63%), stx-II 41/88 (46.59%), rfbE 31/88 (35.22%), and eaeA 28/88 (31.81%). The wzy gene was not detected in any of the samples. Based on a logistic regression analysis, the odds of codetection for STEC virulence markers (stx-I, stx-II, and eaeA) were negatively correlated with calcium and relative humidity (p < 0.05). A conditional forest analysis was performed to assess predictive performance (AUC = 0.921), and the top predictors included humidity, nitrate, calcium, and solar radiation. Overall, information from this research adds to a growing body of knowledge regarding the risk that surface water sources pose to produce grown in subtropical environmental conditions and emphasizes the importance of understanding the use of abiotic factors as a holistic approach to understanding the microbial quality of water.

The Use of a Just Noticeable Difference Approach to Improve Perceptual Acuity Ability in Male Runners.

We were interested in micro-variations in an athlete's psychophysical state that separate peak exertion from physiological collapse. Thus, we measured perceptual acuity in runners using a classic psychophysical approach, the just noticeable difference (JND) on two standard stimuli runs at treadmill speed corresponding to 70%VO2max and 80%VO2max. Thirty-four male runners (M age = 35.26, SD = 7.33 years) first performed a maximal treadmill test to determine the speed of a standard exercise bout for the JND trials. The JND trials consisted of four 5-minute running bouts on a treadmill with 5-minute rests between bouts. For bouts 1 and 3, participants ran at the standard stimuli pace, but for bouts 2 and 4, they adjusted their speeds to achieve a level of exertion at a JND above/below the SS. They achieved differences in the final 30 seconds of the VO2 between each JND bout and the previous standard stimuli at just above (JND-A) and just below (JND-B) the JND perceived exertions. We used a Generalized Linear Model analysis to compare the JND-A and JND-B within and between ventilatory threshold groups (lower/higher) in absolute and relative VO2 and in terms of the total JND magnitude. The magnitude of JND-A was greater than that of JND-B at 70%VO2max and 80%VO2max in absolute units (70%VO2 Δ = 2.62; SE = 0.37; p < .001; 80%VO2 Δ = 1.67; SE = 0.44; p = .002) and in relative units (70%VO2max Δ = 4.70; SE = 0.66; p < .001; 80%VO2max Δ = 2.96; SE = 0.80; p = .002). The total magnitude was greater in the 70%VO2max trial than 80%VO2max in absolute units (70%VO2 M = 3.78, SE = 0.31 mL·kg-1·min-1; 80%VO2 M = 2.62, SE = 0.37 mL·kg-1·min-1; p = .020) and in relative units (70%VO2max M = 6.57, SE = 0.53%VO2max; 80%VO2max M = 4.71, SE = 0.64%VO2max; p = .030). The JND range narrowed when physiologic demand increased, for both physical (speed) and psychological (RPE) variables.

Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals.

Objectives: This study contributes to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)'s effort to define 'difficult-to-treat' PsA (D2T-PsA), leveraging insights of healthcare professionals who are GRAPPA members. The primary objective is to inform GRAPPA's D2T PsA project, ensuring the consensus definition reflects clinical experience and expertise. Methods: An online survey was conducted among GRAPPA's healthcare professionals managing PsA patients. The survey covered demographic details, structured questions, and open-ended queries to gather comprehensive insights into the experts' viewpoints. Results: About 223 physicians completed the survey, comprising 179 (80.2%) rheumatologists and 40 (17.9%) dermatologists. The majority, 184 (82.5%), favoured establishing distinct definitions for D2T-PsA and complex-to-manage PsA (C2M-PsA). Furthermore, 202 (90.5%) supported a definition that includes objective inflammation signs (clinical, laboratory, imaging, among others). However, opinions varied on the criteria for prior treatment failures, with most (93, 41.7%) favouring a definition that includes at least one conventional synthetic disease-modifying anti-rheumatic drug and two or more biological- or targeted-synthetic-DMARDs with different mechanisms of action. Conclusion: The survey reveals a majority opinion among GRAPPA experts favouring the differentiation between D2T-PsA and C2M-PsA, and the inclusion of objective inflammatory markers in these definitions. However, there is less than 50% agreement on the specific treatment failure criteria, particularly regarding the number of therapies needed to classify PsA as D2T. These findings suggest a need for continued discussion to reach a more unified approach in defining D2T-PsA, reflecting the complexity of the condition.

Mechanical Properties and Failure Mode of Proximal Screw Fixation Technique Using Locking Compression Plate for Proximal Interphalangeal Arthrodesis in Horses: An Ex Vivo Study.

OBJECTIVE: The aim of this study was to measure the mechanical properties and failure mode of an ex vivo model of proximal interphalangeal arthrodesis in horses with different methods of proximal screw fixation using a locking compression plate. STUDY DESIGN: Pastern joint arthrodesis with a 3-hole 4.5-mm narrow locking compression plate was performed on 20 forelimbs of equine cadavers, randomized into four groups based on the fixation method and type of proximal screw used: unicortical cortex, bicortical cortex, unicortical locking, bicortical locking. Single-cycle axial compression testing was conducted until failure. The frequency of implant plastic deformation was recorded. Bone failure analysis was performed through computed tomography examinations and fractal analysis. RESULTS: There were no differences in the analysed mechanical variables and fractal dimension among the groups. Transarticular screws showed a higher frequency of deformation (75%) regardless of the group. Both unicortical locking and bicortical locking groups deformed the plate more frequently. CONCLUSION: The type of screw used in the proximal hole of the locking compression plate and its method of anchoring in the proximal phalanx do not affect the mechanical properties of pastern arthrodesis in equine cadavers subjected to single-cycle axial compression tests until failure.

Polymeric Fibers with High Strength and High Toughness at Extreme Temperatures.

Developing strong and simultaneously tough polymeric materials with excellent thermal stability and mechanical performance even under extreme temperatures is truly a challenge. In a disruptive progress, continuous polymeric yarns are developed with a combination of high tensile strength of (1145 ± 44) MPa and ultrahigh toughness of (350 ± 24) J g-1 and high thermomechanical properties from -196 to 200 °C. The comprehensive thermomechanical performance of this yarn surpasses that of previously developed polymeric materials and dragline spider silks. The results demonstrate that the molecular structure of polyimide (PI) with the incorporation of flexible-rigid macromolecular, hierarchically spiral-oriented fibers, and high glass transition temperature (248 °C) are keys for the yarn's notable comprehensive performance in thermomechanical properties. The materials are ideal for technical components exposed to high thermomechanical loadings, such as those encountered in spacecraft or automotive engineering for safety-critical applications.

DESCRIPTION OF ESOPHAGOSTOMY TUBE PLACEMENT IN TWO GIANT ANTEATER (MYRMECOPHAGA TRIDACTYLA) CADAVERS.

Feeding of managed populations of giant anteater (Myrmecophaga tridactyla) is challenging in injured patients that present with anorexia. This report describes an approach for esophagostomy tube placement in this species. Cadavers of two adult giant anteaters were used for technique development. The animal was positioned in dorsal recumbency, and a guide feeding tube was inserted orally into the esophagus. A ventral midline incision in the midcervical region was made to access the esophagus and to protect submandibular salivary glands. The cervical musculature was dissected and retracted laterally to the right, the vagosympathetic nerve trunk was identified and preserved, and the esophagus was incised over the guide tube. The guide tube was removed to facilitate placement of the definitive tube, which was premeasured from its insertion point in the midcervical area to the level of the seventh-ninth intercostal space. The tube was secured to the cervical skin on the left side with a finger-trap suture.