Phenotypes of Metabolic Dysfunction-Associated Steatotic Liver Disease-Associated Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) typically develops as a consequence of liver cirrhosis, but HCC epidemiology has evolved drastically in recent years. Metabolic dysfunction-associated steatotic liver disease (MASLD), including metabolic dysfunction-associated steatohepatitis, has emerged as the most common chronic liver disease worldwide and a leading cause of HCC. A substantial proportion of MASLD-associated HCC (MASLD-HCC) also can develop in patients without cirrhosis. The specific pathways that trigger carcinogenesis in this context are not elucidated completely, and recommendations for HCC surveillance in MASLD patients are challenging. In the era of precision medicine, it is critical to understand the processes that define the profiles of patients at increased risk of HCC in the MASLD setting, including cardiometabolic risk factors and the molecular targets that could be tackled effectively. Ideally, defining categories that encompass key pathophysiological features, associated with tailored diagnostic and treatment strategies, should facilitate the identification of specific MASLD-HCC phenotypes. In this review, we discuss MASLD-HCC, including its epidemiology and health care burden, the mechanistic data promoting MASLD, metabolic dysfunction-associated steatohepatitis, and MASLD-HCC. Its natural history, prognosis, and treatment are addressed specifically, as the role of metabolic phenotypes of MASLD-HCC as a potential strategy for risk stratification. The challenges in identifying high-risk patients and screening strategies also are discussed, as well as the potential approaches for MASLD-HCC prevention and treatment.

Comparison of speed-dependent time, force and spatial parameters between Franches-Montagnes and European Warmblood horses walking and trotting on a treadmill.

Speed alterations affect many gait analysis parameters. How horses adapt to speed is relevant in many equestrian disciplines and may differ between breeds. This study described changes in gait parameters in 38 Warmblood (WB) and 24 Franches-Montagnes (FM) horses subjected to an incremental speed test at walk (1.35-2.05 m/s) and trot (3.25-5.5 m/s). Time, force and spatial parameters of each limb were measured with an instrumented treadmill and analysed with regression analysis using speed as the independent variable. With higher speeds, stride rate, length, over-tracking distance and vertical ground reaction forces increased while the impulses decreased. The parameters followed the same linear or polynomial regression curves independent of breed, while the slope (linear) or incurvation (polynomial) often differed significantly between breeds. Some differences between the breeds were associated with height and speed (e.g. stride length at walk), and would disappear when scaling the data. The main differences between the breeds seem to stem from the movement of the hind limbs, with the FM obtaining long over-tracking distances despite the shorter height at withers. Some parameters relevant to gait quality could be improved in the FM to resemble WB movement by strict selection using objective measurements systems.

Prediction of continuous and discrete kinetic parameters in horses from inertial measurement units data using recurrent artificial neural networks.

Vertical ground reaction force (GRFz) measurements are the best tool for assessing horses' weight-bearing lameness. However, collection of these data is often impractical for clinical use. This study evaluates GRFz predicted using data from body-mounted IMUs and long short-term memory recurrent neural networks (LSTM-RNN). Twenty-four clinically sound horses, equipped with IMUs on the upper-body (UB) and each limb, walked and trotted on a GRFz measuring treadmill (TiF). Both systems were time-synchronised. Data from randomly selected 16, 4, and 4 horses formed training, validation, and test datasets, respectively. LSTM-RNN with different input sets (All, Limbs, UB, Sacrum, or Withers) were trained to predict GRFz curves or peak-GRFz. Our models could predict GRFz shapes at both gaits with RMSE below 0.40 N.kg-1. The best peak-GRFz values were obtained when extracted from the predicted curves by the all dataset. For both GRFz curves and peak-GRFz values, predictions made with the All or UB datasets were systematically better than with the Limbs dataset, showing the importance of including upper-body kinematic information for kinetic parameters predictions. More data should be gathered to confirm the usability of LSTM-RNN for GRFz predictions, as they highly depend on factors like speed, gait, and the presence of weight-bearing lameness.

In pursuit of full recovery in major depressive disorder.

Many individuals with major depression disorder (MDD) who achieve remission of depressive symptoms, do not perceive themselves as fully recovered. This study explores whether clinical remission is related to functional remission and to patient's perception of recovery, as well as, which factors are associated with their functional and subjective remission. 148 patients with MDD in partial clinical remission were included. Demographics and clinical variables were collected through semi-structured interviews. Objective cognition was evaluated through a neuropsychological battery and subjective cognition through a specific questionnaire. The patient's psychosocial functioning and the perception of their remission were also assessed. Apart from descriptive analysis, Pearson correlations and backward stepwise regression models explored the relationship between demographic, clinical, and cognitive factors with patients' functional and self-perceived remission. From the whole sample, 57 patients (38.5%) were considered to achieve full clinical remission, 38 patients (25.7%) showed functional remission, and 55 patients (37.2%) perceived themselves as remitted. Depressive symptoms and objective and subjective executive function were the factors associated with psychosocial functioning. Besides, depressive symptoms, objective and subjective attention, and subjective executive function were the significant explanatory variables for self-perception of remission. The concept of full recovery from an episode of MDD should not only include the clinician's perspective but also the patient's psychosocial functioning along with their self-perceived remission. As residual depressive symptoms and cognition (objective and subjective) are factors with great contribution to a full recovery, clinicians should specifically address them when choosing therapeutic strategies.

Subjective and objective evaluations of horses for fit-to-compete or unfit-to-compete judgement.

At Fédération Equestre Internationale (FEI) competitions, horses undergo veterinary inspection for judgement of 'fit-to-compete'. However, FEI Veterinary Delegates (VDs) often differ in opinion. The aim of the present study was to evaluate intra- and inter-observer agreements of fit-to-compete judgement and compare these with objective gait analysis measurements. Twelve horses were evaluated by three experienced VDs and one veterinary specialist and video-recorded for re-evaluation later. Simultaneously, quantitative gait analysis measurements were acquired. Inter-observer agreement during live evaluations was fair (κ = 0.395, 58% agreement). Intra-observer agreement between live observations and videos at one and 12 months was 71% and 73% respectively. Sensitivity and specificity of motion symmetry measured with quantitative gait analysis system were 83.3% and 66.7% respectively, against the consensus of all observers as a reference. These findings might suggest that more VDs should be used to adequately judge fit-to-compete. Quantitative-gait-analysis may be useful to support decision making during fit-to-compete judgement.

Effects of body mass on microstructural features of the osteochondral unit: A comparative analysis of 37 mammalian species.

Since Galileo's days the effect of size on the anatomical characteristics of the structural elements of the body has been a subject of interest. However, the effects of scaling at tissue level have received little interest and virtually no data exist on the subject with respect to the osteochondral unit in the joint, despite this being one of the most lesion-prone and clinically relevant parts of the musculoskeletal system. Imaging techniques, including Fourier transform infrared imaging, polarized light microscopy and micro computed tomography, were combined to study the response to increasing body mass of the osteochondral unit. We analyzed the effect of scaling on structural characteristics of articular cartilage, subchondral plate and the supporting trabecular bone, across a wide range of mammals at microscopic level. We demonstrated that, while total cartilage thickness scales to body mass in a negative allometric fashion, thickness of different cartilage layers did not. Cartilage tissue layers were found to adapt to increasing loads principally in the deep zone with the superficial layers becoming relatively thinner. Subchondral plate thickness was found to have no correlation to body mass, nor did bone volume fraction. The underlying trabecular bone was found to have thicker trabeculae (r=0.75, p<0.001), as expected since this structure carries most loads and plays a role in force mitigation. The results of this study suggest that the osteochondral tissue structure has remained remarkably preserved across mammalian species during evolution, and that in particular, the trabecular bone carries the adaptation to the increasing body mass.

Positive predictive value of breast lesions of uncertain malignant potential (B3): Can we identify high risk patients? The value of a multidisciplinary team and implications in the surgical treatment.

BACKGROUND AND AIM: The use of conventional needle core biopsy for palpable masses and vacuum-assisted needle core biopsy for microcalcifications has significantly increased the preoperative diagnosis rate, but the strategy for those patients with lesions of uncertain malignant potential (B3) still remains controversial. The aim of this study was to evaluate the positive predictive value (PPV) of the malignancy of B3 lesions in order to establish their correct management in the setting of a multidisciplinary care pathway. METHODS: Data from all patients who had a Needle Core Biopsy (NCB) or a Vacuum-Assisted Needle Core Biopsy (VANCB) between 2005 and 2014 were retrospectively collected and analyzed. The B3 patients were discussed by the Multidisciplinary Team (MDT) deciding for surgery or for follow-up, based on a score in which clinical-instrumental factors and environmental factors were considered. The PPV of malignancy of all surgically excised B3 lesions was calculated. RESULTS: One hundred and seventy-eight B3 NCBs were included in the study and Atypical Epithelial Proliferation of Ductal Type (AEDPT) was the most represented subcategory. The final histopathology report of the 128 patients operated on showed 94 benign and 34 malignant lesions. The PPV of B3 patients referred to surgery was 26.5%. CONCLUSION: B3 patients should be evaluated by a breast MDT in order to make the right therapeutic decision, in particular for patients with contrasting clinical/diagnostic findings. Larger prospective studies are required to assess the definitive PPV of each B3 subcategory.

Interaction of traveling waves with mass-with-mass defects within a Hertzian chain.

We study the dynamic response of a granular chain of particles with a resonant inclusion (i.e., a particle attached to a harmonic oscillator, or a mass-with-mass defect). We focus on the response of granular chains excited by an impulse, with no static precompression. We find that the presence of the harmonic oscillator can be used to tune the transmitted and reflected energy of a mechanical pulse by adjusting the ratio between the harmonic resonator mass and the bead mass. Furthermore, we find that this system has the capability of asymptotically trapping energy, a feature that is not present in granular chains containing other types of defects. Finally, we study the limits of low and high resonator mass, and the structure of the reflected and transmitted pulses.

Indications of microsurgery in soft tissue sarcomas.

UNLABELLED: Sarcomas are uncommon tumors and free-margin surgical resection remains the single most important treatment in the curative therapy of soft tissue sarcomas. Refinements in surgical techniques have led to increased function preservation and limb salvage. PATIENTS AND METHODS: The records of patients (n = 41) who underwent microsurgical soft tissue reconstruction subsequent to resection of soft tissue sarcoma during the period 1998 to 2010 were reviewed and compared with a general nonmicrosurgery group (n = 188) in relation to clinicopathological characteristics, surgical procedures, postoperative complications, time until start of adjuvant radiation, functional outcome (Toronto Extremity Salvage Score, TESS), local recurrence, free survival, and disease-specific survival. RESULTS: Forty-one patients (age range: 23 to 95 years) received a total of 42 free flaps. When compared with the general nonmicrosurgery group, these patients presented significant differences with regard to location, histological grade, and neoadjuvant treatments. Complications were encountered in 10 cases, including 3 patients with complete flap loss and 1 patient with partial flap loss; other complications were cervical fistulae, knee arthritis, nonconsolidation, and wound infection. Extremity salvage was achieved in 90% (19/21) of limb sarcomas, with these patients showing adequate postoperative ambulation (TESS 77 ± 16) and adequate use of the upper extremity (TESS 66 ± 26). Two patients underwent amputation after recurrence. Disease-specific survival rates at 5 and 10 years were 79.49% and 76.93%, respectively. CONCLUSION: The microsurgical repair of sarcoma defects is a reliable option that, though not free of complications, is necessary in selected cases such as patients receiving neoadjuvant treatments and those with head and neck location and high-grade tumors. The procedure enables both adequate oncosurgical resection and function preservation. Our microsurgical sarcoma reconstruction data, based on an observation period of 12 years and presenting the results of 42 free tissue transfers in 41 patients, adds further evidence to the previously published smaller series.

Hematoma subdural crônico como complicaçäo de derivaçöes ventrículo-peritoneais / Chronic subdural hematoma as complication of ventriculoperitoneal shunts

Os autores relatam sua experiência com 9 casos de derivaçäo ventrículo-peritoneal que desenvolveram hematoma subdural crônico comjo complicaçäo do procedimento. Três pacientes eram crianças, dois eram adultos com estenose do aqueduto de Sylvius e quatro, com hidrocefalia noormobárica. Nos casos de hidrocefalia crônica, os hematomas foram drenados por orifício de trépano associado a oclusäo temporária do catter distal da derivaçäo. Em dois pacientes, extremamente dependentes de válvula, optou-se por derivaçäo subduro-peritoneal e manutençäo de derivaçäo ventrículo peritoneal original, observando-se gradual e completa reabsorçäo da lesäo em tomografias computadorizadas de crânio seriadas. Em dois casos foi necessário trocar o sistema de drenagem por outro de pressäo mais elevada. Em um caso procedeu-se a craniotomia e exérese da cápsula do hematoma para tratar coleçeos recidivantes. Com exceçäo de um paciente falecido em decorrência de complicaçöes infecciosas, todos retornaram ao estado anterior ao desenvolvimento do hematoma

Influência do hospedeiro no ciclo e comprovação do ciclo heteroxeno de Anocentor nitens (Neumann, 1897) / Host influency on life cycle and comprovation of the heteroxenous cycle of Anocentor nitens (Neumann, 1897)

Steers and rabbits were used as experimental hosts for Anocenter nitens during scheduled infections, when ticks were recovered from naturally infected horses. Thus, the influence of the host species on the parasite was evaluated mainly considering parameters related to the engorgement period and pre molting of evolutive stages. It was also observed that almost 5% if the metanymphae and a few more than 1% of metalarvae fall off from the host to molt in the evironment, characterizing cycles in one or more hosts. The heteroxenous cycle is reported for the first time occuring in A. nitens.