Dynamic shifts of functional diversity through climate-Resilient strategies and farmland restoration in a mountain protected area.

Land-use land-cover (LULC) change contributes to major ecological impacts, particularly in areas undergoing land abandonment, inducing modifications on habitat structure and species distributions. Alternative land-use policies are potential solutions to alleviate the negative impacts of contemporary tendencies of LULC change on biodiversity. This work analyzes these tendencies in the Montesinho Natural Park (Portugal), an area representative of European abandoned mountain rural areas. We built ecological niche models for 226 species of vertebrates (amphibians, reptiles, birds, and mammals) and vascular plants, using a consensus modelling approach available in the R package 'biomod2'. We projected the models to contemporary (2018) and future (2050) LULC scenarios, under four scenarios aiming to secure relevant ecosystem services and biodiversity conservation for 2050: an afforestation and a rewilding scenario, focused on climate-smart management strategies, and a farmland and an agroforestry recovery scenario, based on re-establishing human traditional activities. We quantified the influences of these scenarios on biodiversity through species habitat suitability changes for 2018-2050. We analyzed how these management strategies could influence indices of functional diversity (functional richness, functional evenness and functional dispersion) within the park. Habitat suitability changes revealed complementary patterns among scenarios. Afforestation and rewilding scenarios benefited more species adapted to habitats with low human influence, such as forests and open woodlands. The highest functional richness and dispersion was predicted for rewilding scenarios, which could improve landscape restoration and provide opportunities for the expansion and recolonization of forest areas by native species. The recovery of traditional farming and agroforestry activities results in the lowest values of functional richness, but these strategies contribute to complex landscape matrices with diversified habitats and resources. Moreover, this strategy could offer opportunities for fire suppression and increase landscape fire resistance. An integrative approach reconciling rewilding initiatives with the recovery of extensive agricultural and agroforestry activities is potentially an harmonious strategy for supporting the provision of ecosystem services while securing biodiversity conservation and functional diversity within the natural park.

Smartpaddle® as a New Monitoring Feature: A Comparison Between Inertial Measurement Unit- and Strain Gauge-Based Devices on Tethered Swimming Forces.

Smartpaddle® is a novel wearable device based on inertial measurement units (IMU) for in-field arm-stroke kinetics and kinematics analysis in swimming. However, the lack of data regarding its agreement and reliability, coupled with restricted access to raw data, emphasizes the need to evaluate it against a well-established strain gauge (SG) reference method for assessing swimming forces. Thus, this study aimed to investigate the agreement and reliability between the Smartpaddle® and strain gauge in a 30-s all-out arms-only tethered swimming test. Twelve trained young adult swimmers performed a test-retest 30-s all-out arms-only tethered swimming trial. Peak and mean forces were obtained from IMU (PFIMU and MFIMU) and SG (PFSG and MFSG) simultaneously. Statistical differences and correlations were found in both peak (PFSG = 158.46 ± 48.85 N, PFIMU = 75.47 ± 12.05 N, p < 0.001, r = 0.88) and mean (MFSG = 69.62 ± 16.36 N, MFIMU = 30.06 ± 5.42 N, p < 0.001, r = 0.84) forces between devices, presenting elevated systematic errors for both variables. No differences were found in IMU data between test-retest conditions in both peak (PFIMU = 75.47 ± 12.05 N, PFIMU = 75.45 ± 11.54 N, p = 0.99, ICC = 0.96) and mean (MFIMU = 30.06 ± 5.42 N, MFIMU = 30.21 ± 5.83 N, p = 0.80, ICC = 0.95) forces, with negligible systematic errors. In conclusion, although the Smartpaddle® device is not directly comparable to the strain gauge reference method, it has demonstrated high reliability levels in test-retest trials.

Secondary Meniscectomy Rates and Risk Factors for Failed Repair of Ramp Lesions Performed at the Time of Primary ACL Reconstruction: An Analysis of 1037 Patients From the SANTI Study Group.

BACKGROUND: Studies evaluating secondary meniscectomy rates and risk factors for failure of ramp repair are sparse and limited by small numbers and heterogeneity. PURPOSES/HYPOTHESIS: The purposes were to determine the secondary meniscectomy rate for failure of ramp repair performed using a posteromedial portal suture hook at the time of anterior cruciate ligament reconstruction (ACLR) and to identify risk factors for secondary meniscectomy. It was hypothesized that patients who underwent ACLR combined with a lateral extra-articular procedure (LEAP) would experience significantly lower rates of secondary meniscectomy compared with those undergoing isolated ACLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Patients undergoing primary ACLR and ramp repair between 2013 and 2020 were included in the study. Final follow-up for each patient was defined by his or her last appointment recorded in a prospective database (with a study end date of March 2023). The database and medical records were used to determine whether patients had undergone secondary meniscectomy for failure of ramp repair. Survivorship of ramp repair (using secondary meniscectomy as an endpoint) was determined using the Kaplan-Meier method. Multivariate analysis was used to investigate possible risk factors. RESULTS: A total of 1037 patients were included in the study. The secondary meniscectomy rate after ramp repair was 7.7% at a mean final follow-up of 72.4 months. Patients without combined ACLR + LEAP were >2-fold more likely to undergo a secondary medial meniscectomy compared with those with combined ACLR + LEAP (hazard ratio, 2.455; 95% CI, 1.457-4.135; P = .0007). Age, sex, preoperative Tegner score, and time between injury and surgery were not significant risk factors for failure. CONCLUSION: The rate of secondary meniscectomy after ramp repair performed through a posteromedial portal at the time of primary ACLR was low. Patients who underwent isolated ACLR (rather than ACLR + LEAP) were >2-fold more likely to undergo a secondary medial meniscectomy for failure of ramp repair. Additional risk factors for failure of ramp repair were not identified.

Classical and Nonclassical Nucleation Mechanisms of Insulin Crystals.

Although the Classical Nucleation Theory (CNT) is the most consensual theory to explain protein nucleation mechanisms, experimental observations during the shear-induced assays suggest that the CNT does not always describe the insulin nucleation process. This is the case at intermediate precipitant (ZnCl2) solution concentrations (2.3 mM) and high-temperature values (20 and 40 °C) as well as at low precipitant solution concentrations (1.6 mM) and low-temperature values (5 °C). In this work, crystallization events following the CNT registered at high precipitant solution concentrations (3.1 and 4.7 mM) are typically described by a Newtonian response. On the other hand, crystallization events following a nonclassical nucleation pathway seem to involve the formation of a metastable intermediate state before crystal formation and are described by a transition from Newtonian to shear-thinning responses. A dominant shear-thinning behavior (shear viscosity values ranging more than 6 orders of magnitude) is found during aggregation/agglomeration events. The rheological analysis is complemented with different characterization techniques (Dynamic Light Scattering, Energy-Dispersive Spectroscopy, Circular Dichroism, and Differential Scanning Calorimetry) to understand the insulin behavior in solution, especially during the occurrence of aggregation/agglomeration events. To the best of our knowledge, the current work is the first study describing nonclassical nucleation mechanisms during shear-induced crystallization experiments, which reveals the potential of the interdisciplinary approach herein described and opens a window for a clear understanding of protein nucleation mechanisms.

Fire suppression and land-use strategies drive future dynamics of an invasive plant in a fire-prone mountain area under climate change.

Woody invasive alien species can have profound impacts on ecosystem processes and functions, including fire regulation, which can significantly affect landscape resilience. Acacia dealbata, a widespread invasive alien plant in the Iberian Peninsula, holds well-known fire-adaptation traits (e.g., massive soil seed banks and heat-stimulated seed germination). In this study, we assess to what extent fire suppression and land-use strategies could affect the potential distribution of A. dealbata in a fire-prone transboundary protected mountain area of Portugal and Spain, using Habitat Suitability Models. Specifically, we predicted changes in habitat suitability for A. dealbata between years 2010 and 2050. We explored the potential impacts of two land-use strategies ('Business-as-usual' or 'High Nature Value farmlands') combined with three levels of fire suppression effectiveness using the biomod2 package in R. We also considered the potential effects of two climate change scenarios (RCP4.5 and RCP8.5). Our modeling approach demonstrated a strong capacity to predict habitat suitability using either climate or land-cover information alone (AUC climate = 0.947; AUC LC = 0.957). According to climate-based models, A. dealbata thrives under conditions characterized by higher precipitation seasonality, higher precipitation in the warmest month, and higher minimum temperature in the coldest month. Regarding land cover, A. dealbata thrives mainly in landscapes dominated by urban areas and evergreen forest plantations. Our models forecasted that habitat suitability by 2050 could either increase or decrease depending on the specific combinations of fire suppression, land-use, and climate scenarios. Thus, a combination of business-as-usual and fire-exclusion strategies would enhance habitat suitability for the species. Conversely, management promoting High Nature Value farmlands would decrease the available suitable habitat, particularly under low fire suppression efforts. These findings suggest that promoting sustainable farming activities could impede the spread of A. dealbata by reducing habitat availability, while strategies aiming at fire-exclusion could facilitate its expansion, likely by enabling establishment and large seed production. This study highlights the complex interplay between fire-prone invasive species, fire and land-use strategies, and climate change; and thus the need to consider the interactions between land-use and fire management to promote invasive species control and landscape resilience.

Biodiversity dataset and atlas of the special area of conservation Montesinho/Nogueira, Portugal.

Background: The special area of conservation Montesinho/Nogueira (SAC-MN) is a key area for biodiversity conservation in the Iberian Peninsula. Covering an area of approximately 1081 km² in the northeast of Portugal mainland, the SAC-MN is home to a wide range of species, including several endemic and endangered species and priority habitats. Despite its ecological significance and importance for conservation, there is a lack of publicly available biodiversity data, which urges the need to create a comprehensive and up-to-date biodiversity dataset for the SAC-MN. New information: To bridge the knowledge gap on biodiversity in SAC-MN, we undertook a thorough data collection process, including species occurrence records and conservation status information at regional (Portugal) and European levels, from multiple sources. We collected and compiled this information for five major taxonomic groups (amphibians, birds, flora - vascular plants, mammals and reptiles) in SAC-MN, resulting in a total of 31,871 records with 1,312 documented species. In addition, we developed an easy-to-navigate web-based geographic information system (Web GIS). In this article, we present an in-depth report on the process of compiling and preparing data, as well as the development and design of our Web GIS to increase awareness and enhance understanding of the importance of preserving biodiversity in SAC-MN.

Acute Compartment Syndrome of the Thigh After Contusion in a Football Player.

Acute compartment syndrome of the thigh is an exceptionally uncommon condition that can have severe consequences if not promptly and effectively treated. A 19-year-old man presented to our emergency department with severe and progressive pain in his left thigh after sustaining a direct trauma during a football game 24 hours prior. Compartment pressure was assessed, confirming the diagnosis of compartment syndrome arising from a sizable intramuscular hematoma without detection of any other contributing factors. Fasciotomy incisions were closed using the shoelace technique with excellent functional results. This case highlights the importance of high suspicion and intra-compartmental pressure measurement to diagnose this condition accurately.

Incidence of and Risk Factors for Medial Meniscal Lesions at the Time of ACL Reconstruction: An Analysis of 4697 Knees From the SANTI Study Group Database.

BACKGROUND: Medial meniscal (MM) lesions (MMLs) are a common finding at the time of anterior cruciate ligament reconstruction (ACLR). It is recognized that evaluation of the posteromedial compartment reduces the rate of missed MML diagnoses. PURPOSE: To determine the incidence of MMLs in patients undergoing ACLR, when using a standardized arthroscopic approach that included posteromedial compartment evaluation, as well as to determine how the incidence of MMLs changed with increasing time intervals between injury and surgery, and to investigate what risk factors were associated with their presence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective analysis of prospectively collected data was performed. All patients who underwent primary ACLR between January 2013 and March 2023 were considered for study eligibility. The epidemiology was defined by categorizing and reporting the incidence and categorizing the spectrum of MM tear types. Risk factors associated with MMLs were analyzed using a logistic regression model. RESULTS: MMLs were identified in 1851 (39.4%) of 4697 consecutive patients undergoing ACLR. The overall incidence of MMLs was 33.1% for the period of 0 to 3 months, 38.7% for the period of 3 to 12 months, and 59.6% for the period of >12 months. The overall incidence of MMLs increased with longer durations of time between injury and surgery, along with significant increases in complex, bucket-handle, ramp, and/or flap lesions. The largest increase in incidence of MMLs was observed for complex MM tear patterns. Risk factors associated with MMLs included time between injury and surgery >3 months (odds ratio [OR], 1.320; 95% CI, 1.155-1.509; P < .0001) and >12 months (OR, 3.052; 95% CI, 2.553-3.649; P < .0001), male sex (OR, 1.501; 95% CI, 1.304-1.729; P < .0001), body mass index (BMI) ≥25 (OR, 1.193; 95% CI, 1.046-1.362; P = .0088), and lateral meniscal lesion (OR, 1.737; 95% CI, 1.519-1.986; P < .0001). CONCLUSION: Overall, MMLs were identified in 39.4% of 4697 patients undergoing ACLR when posteromedial compartment evaluation was performed in addition to standard anterior viewing. The incidence of MMLs and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACLR. Secondary risk factors associated with an increased incidence of medial meniscal tears include male sex, increased BMI, and lateral meniscal lesions.

Non-vaccination of dogs is linked to uncompleted COVID-19 vaccination protocols of owners.

Despite the known importance of vaccines as one of the greatest achievements in medical science, vaccine hesitancy has been increasing in the last decade and has become a major threat to global health. The growth of vaccine hesitancy worldwide became more evident with the onset of COVID-19 and raised the fear that this hesitancy would also impact companion animal vaccination. This study aimed to characterize vaccine-hesitant groups regarding companion animals and human vaccinations, as well as to explore the possible association between vaccine hesitancy in pets and their owners. An anonymous online survey containing 27 closed questions was conducted, including questions about dog health, such as vaccination, neutering, and homeopathy use, as well as questions about the COVID-19 vaccination status of the owner and motivations for vaccinating or not vaccinating their pets. Most participants (81.5 %) reported receiving three or more doses of the COVID-19 vaccine. Not vaccinating against COVID-19 or having an incomplete vaccination protocol was associated with an increase in the age range of participants (odds ratio [OR] = 1.43), not having higher education (OR = 7.70), and being in extreme income ranges (less than two minimum wages [OR = 7.57] and more than 10 [OR = 5.20]). The use of homeopathy in humans (OR = 3.24) and dogs (OR = 3.74) was associated with non-vaccination against COVID-19. Owners who were not fully vaccinated against COVID-19 were almost six times more likely to not vaccinate their dogs (OR = 5.94). Non-vaccination of dogs was also associated with non-neutering (OR = 3.56), keeping the dog in contact with other dogs (OR = 2.09), and an increase in the number of dogs in the house increased the chance of not vaccinating the animals (OR = 1.30). The present study revealed a strong association between non-vaccination against COVID-19 and non-vaccination in companion dogs, raising the hypothesis that vaccination hesitancy is a growing challenge in veterinary medicine. In addition, the characteristics of Brazilians who are reluctant to be vaccinated against COVID-19 or immunize their companion animals are described here for the first time.

A worm in the toilet bowl! What does it tell us about the challenges in the identification of supposed human parasites in practical parasitology?

Non-parasitic vermiform organisms can circumstantially be associated with humans and their identification can be challenging for medical professionals. The present report describes the finding of a worm in the toilet bowl by a patient from Brazil, who thought he had expelled it in his feces. The gross analyses in a clinical laboratory reveal the worm was different from other macroscopic organisms routinely identified, and the laboratory staff requested assistance in an academic laboratory specialized in helminthology. After preliminary analysis in a stereomicroscope, the supposed human worm was identified as an oligochaete annelid (earthworm). The patient was contacted to investigate a possible case of pseudoparasitism. However, we were informed that the organism had been collected in a toilet bowl from a rural environment where the untreated water comes from a cistern indicating our finding was circumstantial. The methodology revisited herein allowed a quick microscopic analysis of easy-to-view morphological structures, which are useful to separate oligochaete annelids from helminths and can prevent misdiagnosis in similar situations. We discuss the overly restricted view on human parasites by health professionals in collecting clinical history and laboratory analysis, providing some epistemological insights on the necessary interdisciplinarity between parasitology and other basic knowledge with health practice.

Teaching basic life support for medical students: Assessment of learning and knowledge retention.

BACKGROUND: Education mediated by simulation is a widely used method for teaching basic life support (BLS). The American Heart Association recommends protocols based on scientific evidence to reduce sequelae and mortality. We aimed to assess learning and retention of knowledge of BLS in students of the first semester of the medical course using teaching methods of dialogic expository class (group 1), expository and demonstrative class (group 2), and the two previous methodologies associated with simulated practice (group 3), and after 3 months, memory retention. MATERIALS AND METHODS: This was an experimental, prospective, randomized study. Participants were assessed in terms of performance in theoretical and simulated practical tests, satisfaction with training (Likert scale), and knowledge retention. RESULTS: The practical test results were analyzed by two experienced observers. Students had 20% progression in knowledge and 80% retention of knowledge after 3 months of exposure comparing the theoretical pre- and posttest. The students in group 3 performed better than the others (P = 0.007) in the posttest. With the simulated practice, the knowledge acquired was maintained after 3 months with a mean performance of 90%, but in the test of the infant age group, there was a loss of learning retention by 10%. There was no difference of the results between the two evaluators (P < 0.001). The training was positively assessed by the participants. CONCLUSION: The use of different methodologies promoted knowledge progression, with emphasis on simulated practice. Learning retention was maintained after 3 months. In order to teach BLS to infants, it may be necessary to improve teaching techniques.

Time-series analyses of land surface temperature changes with Google Earth Engine in a mountainous region.

Studying changes in temperature is fundamental for understanding its interactions with the environment and biodiversity. However, studies in mountainous areas are few, due to their complex formation and the difficulty of obtaining local data. We analysed changes in temperature over time in Montesinho Natural Park (MNP) (Bragança, Portugal), an important conservation area due to its high level of biodiversity. Specifically, we aimed to analyse: i) whether temperature increased in MNP over time, ii) what environmental factors influence the Land Surface Temperature (LST), and iii) whether vegetation is related to changes in temperature. We used annual summer and winter mean data acquired from the Moderate-Resolution Imaging Spectroradiometer (MODIS) datasets/products (e.g. LST, gathered at four different times: 11am, 1pm, 10pm and 2am, Enhance vegetation index - EVI, and Evapotranspiration - ET), available on the cloud-based platform Google Earth Engine between 2003 and 2021). We analysed the dynamics of the temporal trend patterns between the LST and local thermal data (from a weather station) by correlations; the trends in LST over time with the Mann-Kendall trend test; and the stability of hot spots and cold spots of LST with Local Statistics of Spatial Association (LISA) tests. The temporal trend patterns between LST and Air Temperature (Tair) data were very similar (ρ > 0.7). The temperature in the MNP remained stable over time during summer but increased during winter nights. The biophysical indices were strongly correlated with the summer LST at 11am and 1pm. The LISA results identified hot and cold zones that remained stable over time. The remote-sensed data proved to be efficient in measuring changes in temperature over time.

Corrigendum: Relocation of bioclimatic suitability of Portuguese grapevine varieties under climate change scenarios.

[This corrects the article DOI: 10.3389/fpls.2023.974020.].

Relocation of bioclimatic suitability of Portuguese grapevine varieties under climate change scenarios.

Introduction: Climate change has been driving warming trends and changes in precipitation patterns and regimes throughout Europe. Future projections indicate a continuation of these trends in the next decades. This situation is challenging the sustainability of viniculture and, thus, significant efforts towards adaptation should be then carried out by local winegrowers. Method: Ecological Niche Models were built, using the ensemble modelling approach, to estimate the bioclimatic suitability of four main wine-producing European countries, namely France, Italy, Portugal, and Spain, in the recent past (1989-2005), for the cultivation of twelve Portuguese grape varieties. The models were then used to project the bioclimatic suitability to two future periods (2021- 2050 and 2051-2080) to better understand the potential shifts related to climate change (modeled after Intergovernmental Panel on Climate Change's Representative Concentration Pathways 4.5 and 8.5 scenarios). The models were obtained with the modeling platform BIOMOD2, using four bioclimatic indices, namely the "Huglin Index", the "Cool Night index", the "Growing Season Precipitation index", and the "Temperature Range during Ripening index" as predictor variables, as well as the current locations of the chosen grape varieties in Portugal. Results: All models performed with high statistical accuracy (AUC > 0.9) and were able to discriminate several suitable bioclimatic areas for the different grape varieties, in and around where they are currently located but also in other parts of the study area. The distribution of the bioclimatic suitability changed, however, when looking at future projections. For both climatic scenarios, projected bioclimatic suitability suffered a considerable shift to the north of Spain and France. In some cases, bioclimatic suitability also moved towards areas of higher elevation. Portugal and Italy barely retained any of the initially projected varietal areas. These shifts were mainly due to the overall rise in thermal accumulation and lower accumulated precipitation in the southern regions projected for the future. Conclusion: Ensemble models of Ecological Niche Models were shown to be valid tools for winegrowers who want to adapt to a changing climate. The long-term sustainability of viniculture in southern Europe will most likely have to go through a process of mitigation of the effects of increasing temperatures and decreasing precipitation.

Single AnteroMedial Bundle Biological Augmentation: SAMBBA Plus Technique for Combined ACL Repair and Reconstruction.

This technical note presents the single-anteromedial bundle biological augmentation (SAMBBA)-plus technique, which is a combined anterior cruciate ligament (ACL) repair and ACL reconstruction. Preservation of the native ACL fibers improves vascularity by encircling the ACL graft with synovium that is abundant in vascular-derived stem cells. Retaining the proprioceptive fibers of the native ACL can improve the recovery of joint positioning.

Organização do trabalho e burnout entre profissionais de enfermagem na pandemia: estudo de método misto / Work organization and burnout among nursing professionals during the pandemic: a mixed-methods study

OBJETIVO: avaliar as repercussões da pandemia de COVID-19 na organização do trabalho e no Burnout dos profissionais de enfermagem em um hospital da região sul do Brasil. MÉTODO: desenho misto explanatório sequencial, em cinco unidades de internação adulta, realizado de agosto a novembro de 2020. Na etapa quantitativa, numa amostra de 78 participantes, foi aplicado o Inventário de Burnout de Maslach e os dados foram analisados por meio de estatística descritiva e analítica. Na etapa qualitativa, foram realizadas entrevistas semiestruturadas online, por amostragem intencional, com nove profissionais, e os dados foram submetidos à análise de conteúdo categorial temática. RESULTADOS: 99% dos profissionais atenderam pacientes suspeitos ou confirmados com a doença; 64% afastaram-se por suspeita e 35% por confirmação de COVID-19; 11,5% apresentaram a Síndrome de Burnout. O medo, o compromisso com o trabalho, as falhas nos protocolos e na comunicação institucional foram temas das categorias. CONCLUSÃO: apesar de a Síndrome de Burnout ter apresentado baixa frequência entre os trabalhadores de enfermagem, constatou-se que a pandemia de COVID-19 repercutiu sobremaneira na organização do trabalho desses profissionais.

OBJECTIVE: this study aims to assess the repercussions of the COVID-19 pandemic on work organization and burnout among nursing professionals in a hospital in the southern region of Brazil. METHOD: a sequential explanatory mixed-methods design was employed across five adult inpatient units from August to November 2020. In the quantitative phase, a sample of 78 participants completed the Maslach Burnout Inventory, and the data were subjected to descriptive and analytical statistical analysis. In the qualitative phase, online semi-structured interviews were conducted with nine purposively selected professionals, and the data underwent thematic categorical content analysis. RESULTS: 99% of the professionals attended to suspected or confirmed COVID-19 patients; 64% took leave due to suspicion, and 35% due to confirmed COVID-19 cases; 11.5% exhibited symptoms of Burnout Syndrome. The themes emerging from the analysis included fear, commitment to work, protocol failures, and institutional communication breakdowns. CONCLUSION: despite the relatively low frequency of Burnout Syndrome among nursing personnel, it was observed that the COVID-19 pandemic significantly impacted the work organization of these professionals.

Accuracy, Reliability, and Repeatability of a Novel Artificial Intelligence Algorithm Converting Two-Dimensional Radiographs to Three-Dimensional Bone Models for Total Knee Arthroplasty.

BACKGROUND: With the emergence of advanced technology, such as robotics, three-dimensional (3D) imaging is necessary to execute preoperative surgical plans accurately. However, 3D imaging adds cost and potential risk to patients. This study determined the measurement accuracy, reliability, and repeatability of a novel artificial intelligence (AI) algorithm which converts two-dimensional (2D) radiographs to 3D bone models. METHODS: An AI algorithm was developed to convert 2D radiographs to 3D bone model reconstructions. The accuracy of the AI algorithm was evaluated by comparing mean absolute error in measurements performed on 3D bone reconstructions, 3D computed tomography (CT) scans, and manual measurements on five cadaveric knees. Reliability and repeatability of the AI algorithm were evaluated by assessing the inter-observer and intra-observer agreement between measurements performed on 3D bone reconstructions, respectively. RESULTS: Accuracy of the AI algorithm was considered excellent with mean absolute errors <2mm in 9 of 12 anatomical parameters compared with measurements performed on CTs and manual calipers. All inter-observer and intra-observer correlation coefficients were greater than 0.90 representing a high level of measurement reliability and repeatability by independent observers and the same observers. CONCLUSION: This particular AI algorithm demonstrated a high degree of accuracy, reliability, and repeatability for converting 2D radiographs to 3D bone reconstructions similar to a CT-scan. Study results suggest this AI algorithm has the potential for use in preoperative surgical planning due to its efficiencies related to cost and time and reduced radiation exposure without the use of 3D imaging.

Transtornos mentais comuns durante a Pandemia da Covid-19: frequência e fatores associados / Common mental disorders during the COVID-19 Pandemic: frequency and associated factors / Trastornos mentales comunes durante la Pandemia de Covid-19: frecuencia y factores asociados

Este estudo teve por objetivo avaliar a frequência de sintomas de transtornos mentais comuns e os fatores associados a eles na população brasileira no início da pandemia da coronavirus disease 2019 (Covid-19). Uma amostra de 1.482 adultos, com idade média de 34,68 anos (DP = 13,66), 76,8% do sexo feminino, respondeu a um questionário sociodemográfico, à Escala de Depressão, Ansiedade e Estresse ­ 21 (Depression, Anxiety, and Stress Scale-21 [DASS-21]) e à Escala de Atenção e Consciência Plena. Foram observados níveis elevados e atípicos de transtornos comuns, bem como automutilação, ideação suicida e tentativas de suicídio. O traço mindful foi o principal fator associado negativamente tanto a sintomas de ansiedade quantos a sintomas de depressão. Pior condição financeira e orientação sexual não normativa predisseram sintomas de ansiedade e depressão, mas não foram encontradas diferenças entre o grupo que seguiu e o que não seguiu as regras do distanciamento social. O efeito pandêmico pode ser inferido a partir dos níveis clínicos elevados, mas estudos longitudinais podem ajudar a compreender efeitos de longo prazo.

Este estudio tuvo como objetivo evaluar la frecuencia y factores asociados a los síntomas de trastornos mentales comunes en la población brasileña al comienzo de la pandemia de coronavirus disease 2019 (CO-VID-19). Una muestra de 1.482 adultos, con edad media de 34,68 años (DE = 13,66), 76,8% mujeres, res-pondieron un cuestionario sociodemográfico, la Escala Depresión, Ansiedad y Estrés ­ 21 (Depression, Anxiety, and Stress Scale-21 [DASS-21]) y la Escala de Atención y Conciencia Plena. Se observaron niveles altos atípicos de trastornos comunes, así como automutilación, ideación suicida e intentos de suicidio. La atención plena fue el principal factor asociado negativamente tanto a los síntomas de ansiedad como a los síntomas de depresión. La peor situación económica y orientación sexual no normativa predijeron sínto-mas de ansiedad y depresión, pero no se encontraron diferencias entre el grupo que siguió y el que no si-guió las reglas del distanciamiento social. A partir de los altos índices clínicos, se puede inferir el efecto pandémico, pero estudios longitudinales podrían ayudar a comprender los efectos a largo plazo

This study aimed to assess the frequency and associated factors of symptoms of common mental disor-ders in the Brazilian population at the beginning of the coronavirus disease 2019 (COVID-19) pandemic. A sample of 1,482 adults, with a mean age of 34.68 years (SD = 13.66 years), 76.8% female, answered a so-ciodemographic questionnaire, the Depression, Anxiety, and Stress Scale-21 (DASS-21), and the Mindful Attention and Awareness Scale. Atypical high levels of symptoms of common disorders were observed, as well as self-mutilation, suicidal ideation, and suicide attempts. The mindful trait was the main factor negatively associated with both anxiety and depression symptoms. Worse financial conditions and non-normative sexual orientation predicted symptoms of anxiety and depression, but no differences were found between the group that followed and the one that did not follow the social distancing measures. From the high clinical indices, the pandemic effect can be inferred, but longitudinal studies could help understand long-term effects.

Whole-genome analysis of monozygotic Brazilian twins discordant for type 1 narcolepsy: a case report.

BACKGROUND: Narcolepsy type 1 (NT1) is a rare and chronic neurological disease characterized by sudden sleep attacks, overwhelming daytime drowsiness, and cataplexy. When associated with a sudden loss of muscle tone (cataplexy) narcolepsy is classified as type 1, while the absence of cataplexy indicates type 2. Genetic, degenerative, and immunological hypotheses to explain the pathophysiology of NT1 are still a matter of debate. To contribute to the understanding of NT1 genetic basis, here we describe, for the first time, a whole genome analysis of a monozygotic twin pair discordant for NT1. CASE PRESENTATION: We present the case of a pair of 17-year-old male, monozygotic twins discordant for NT1. The affected twin had Epworth Sleepiness Scale (ESS) of 20 (can range from 0 to 24), cataplexy, hypnagogic hallucinations, polysomnography without abnormalities, multiple sleep latency tests (MSLT) positive for narcolepsy, a mean sleep latency of 3 min, sleep-onset REM periods SOREMPs of 5, presence of allele HLA-DQB1*06:02, and Hypocretin-1 level of zero pg/mL (normal values are > 200 pg/mL). The other twin had no narcolepsy symptoms (ESS of 4), normal polysomnography, MSLT without abnormalities, presence of allele HLA-DQB1*06:02, and Hypocretin-1 level of 396,74 pg/mL. To describe the genetic background for the NT1 discordant manifestations in this case, we present the whole-genome analysis of this monozygotic twin pair. The whole-genome comparison revealed that both twins have identical NT1 pathogenic mutations in known genes, such as HLA-DQB1*06:02:01, HLA-DRB1*11:01:02/*15:03:01. The affected twin has the expected clinical manifestation while the unaffected twin has an unexpected phenotype. The unaffected twin has significantly more frameshift mutations as compared to the affected twin (108 versus 75) and mutations that affect stop codons (61 versus 5 in stop gain, 26 versus 2 in start lost). CONCLUSIONS: The differences observed in frameshift and stop codon mutations in the unaffected twin are consistent with loss-of-function effects and protective alleles, that are almost always associated with loss-of-function rare alleles. Also, overrepresentation analysis of genes containing variants with potential clinical relevance in the unaffected twin shows that most mutations are in genes related to immune regulation function, Golgi apparatus, MHC, and olfactory receptor. These observations support the hypothesis that NT1 has an immunological basis although protective mutations in non-HLA alleles might interfere with the expression of the NT1 phenotype and consequently, with the clinical manifestation of the disease.

Clinical Outcomes After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction With Bone-Patellar Tendon-Bone Grafts: A Matched-Pair Analysis of 2018 Patients From the SANTI Study Group.

BACKGROUND: Bone-patellar tendon-bone (BPTB) autografts are widely considered the standard for anterior cruciate ligament reconstruction (ACLR). PURPOSE/HYPOTHESIS: The aims of this study were to compare the clinical outcomes after ACLR with gold standard BPTB autografts versus combined ACLR + anterolateral ligament reconstruction (ALLR) with hamstring tendon (HT) autografts at medium-term follow-up in a large series of propensity-matched patients. The hypothesis was that combined ACLR + ALLR with HT autografts would result in lower graft rupture rates and non-graft rupture-related reoperation rates. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients undergoing combined ACLR + ALLR using HT autografts between January 2003 and December 2019 were propensity matched in a 1:1 ratio to patients undergoing isolated ACLR using BPTB autografts. At the end of the study period, graft ruptures, contralateral knee injuries, and any other reoperations or complications after the index procedure were identified by a search of a prospective database and a review of medical records. RESULTS: A total of 1009 matched pairs were included. The mean duration of follow-up was 101.3 ± 59.9 months. Patients in the isolated group were >3-fold more likely to have graft failure than those in the combined group (hazard ratio, 3.554 [95% CI, 1.744-7.243]; P = .0005). Patients aged <20 years were at a particularly high risk of graft ruptures compared with patients aged >30 years (hazard ratio, 5.650 [95% CI, 1.834-17.241]; P = .0002). Additionally, there was a significantly higher reoperation rate after isolated ACLR than after combined ACLR + ALLR (20.5% vs 8.9%, respectively; P < .0001). The overall rate of subsequent contralateral ruptures was 9.1% after index surgery (isolated: 10.2%; combined: 8.0%; P = .0934), indicating that the risk profiles for both groups were similar. CONCLUSION: Patients who underwent isolated ACLR with BPTB autografts experienced significantly worse graft survivorship and overall reoperation-free survivorship compared with those who underwent combined ACLR + ALLR with HT autografts. The risk of graft ruptures was >3-fold higher in patients who underwent isolated ACLR using BPTB autografts.