Intracardiac vascular access in haemodialysis: A last resort for exhausted traditional access.

Depletion of veins for dialysis access is a challenging life threatening situation for patients in need of haemodialysis. The utilisation of intracardiac catheter is a rare procedure with scarce reported experience. We describe the case of a 68-year-old male that contributes to the limited knowledge of performing a life-saving intracardiac catheter placement for emergency haemodialysis in a patient without immediate alternative renal replacement therapy available. We also retrospectively analyse the experience reported so far and summarise complications and outcomes. In our case, the patient was able to pursue haemodialysis after intracardiac catheter placement without any complications. Two weeks later, the patient successfully received a kidney transplant from a deceased donor and has a serum creatinine of 1.7 mg/dL after 2 years of follow-up. There are only four reported cases of kidney transplantation after the procedure, including our own. Intracardiac catheter is an emerging option that could be considered in certain patients as the last resort. Further investigation with regards to patient candidacy and procedure security are necessary.

Treatment and Healing of Leishmaniasis in a Wolf in Semi-Captivity Regime from an Educational Center of Zamora Province (Spain).

Leishmaniasis in wild canids is a vector-borne disease caused in Europe by the protozoan parasite Leishmania infantum. To date, there is limited information on clinical signs and laboratory abnormalities in wolves due to leishmaniasis. The current clinical case report described a female Iberian wolf (Canis lupus signatus) housed in semi-captivity conditions at the Centro del Lobo Ibérico "Félix Rodríguez de la Fuente", in Robledo de Sanabria, Zamora (Spain), with an interdigital ulcerous wound at the right forepaw, hyper-gammaglobulinemia, and abnormal liver blood parameters. Definitive serodiagnosis of leishmaniasis was established using antileishmanial serum antibodies and PCR analysis of different biological samples. A gold-standard anti-L. infantum treatment protocol consisting in subcutaneous meglumine antimoniate and oral allopurinol combination was installed. However, the presence of pain at the site of injection due to meglumine antimoniate administration forced its substitution by oral miltefosine. A progressive reduction of the levels of anti-L. infantum serum antibodies and the concentrations of gamma-globulin fraction was detected after antileishmanial treatment as well as a decline of liver GPT. To our knowledge, this is the first case of leishmaniasis diagnosed in a wolf housed in semi-captivity conditions, with the condition subsequently treated and successfully cured.

Elastic and inelastic strain in submicron-thick ZnO epilayers grown on r-sapphire substrates by metal-organic vapour phase deposition.

A significant part of the present and future of optoelectronic devices lies on thin multilayer heterostructures. Their optical properties depend strongly on strain, being essential to the knowledge of the stress level to optimize the growth process. Here the structural and microstructural characteristics of sub-micron a-ZnO epilayers (12 to 770 nm) grown on r-sapphire by metal-organic chemical vapour deposition are studied. Morphological and structural studies have been made using scanning electron microscopy and high-resolution X-ray diffraction. Plastic unit-cell distortion and corresponding strain have been determined as a function of film thickness. A critical thickness has been observed as separating the non-elastic/elastic states with an experimental value of 150-200 nm. This behaviour has been confirmed from ultraviolet photoelectron spectroscopy, X-ray photoelectron spectroscopy and high-resolution transmission electron microscopy measurements. An equation that gives the balance of strains is proposed as an interesting method to experimentally determine this critical thickness. It is concluded that in the thinnest films an elongation of the Zn-O bond takes place and that the plastic strained ZnO films relax through nucleation of misfit dislocations, which is a consequence of three-dimensional surface morphology.

The impact of emotional valence on generalization gradients.

Generalization enables individuals to respond to novel stimuli based on previous experiences. The degree to which organisms respond is determined by their physical resemblance to the original conditioned stimulus (CS+), with a stronger response elicited by more similar stimuli, resulting in similarity-based generalization gradients. Recent research showed that cognitive or conceptual dimensions also result in gradients similar to those observed with manipulations of physical dimensions. Such findings suggest that attributes beyond physical similarity play a role in shaping generalization gradients. However, despite its adaptive relevance for survival, there is no study exploring the effectiveness of affective dimensions in shaping generalization gradients. In two experiments (135 Spanish and 150 English participants, respectively), we used an online predictive learning task, in which different stimuli (words and Gabor patches) were paired with the presence - or absence - of a fictitious shock. After training, we assessed whether valence (i.e., hedonic experience) conveyed by words shape generalization gradients. In Experiment 1, the outcome expectancy decreased monotonically with variations in valence of Spanish words, mirroring the gradient obtained with the physical dimension (line orientation). In Experiment 2, conducted with English words, a similar gradient was observed when non-trained (i.e., generalization) words varied along the valence dimension, but not when words were of neutral valence. The consistency of these findings across two different languages strengthens the reliability and validity of the affective dimension as a determinant of generalization gradients. Furthermore, our data highlight the importance of considering the role of affective features in generalization responses, advancing the interplay between emotion, language, and learning.

Efficacy and Safety of Indwelling Catheter for Malignant Pleural Effusions Related to Timing of Cancer Therapy: A Systematic Review

Introduction: To compare the efficacy and safety of indwelling pleural catheters (IPC) in relation with the timing of systemic cancer therapy (SCT) (i.e., before, during, or after SCT) in patients with malignant pleural effusion (MPE). Methods: Systematic review of randomized controlled trials (RCT), quasi-controlled trials, prospective and retrospective cohorts, and case series of over 20 patients, in which the timing of IPC insertion in relation to that of SCT was provided. Medline (via PubMed), Embase, and Cochrane Library were systematically searched from inception to January 2023. The risk of bias was assessed using the Cochrane Risk of Bias (ROB) tool for RCTs and the ROB in non-randomized studies of interventions (ROBINS-I) for non-randomized designs. Results: Ten studies (n=2907 patients; 3066 IPCs) were included. Using SCT while the IPC was in situ decreased overall mortality, increased survival time, and improved quality-adjusted survival. Timing of SCT had no effect on the risk of IPC-related infections (2.85% overall), even in immunocompromised patients with moderate or severe neutropenia (relative risk 0.98 [95%CI: 0.93–1.03] for patients treated with the combination of IPC and SCT). The inconsistency of the results or the lack of analysis of all outcome measures in relation to the SCT/IPC timing precluded drawing solid conclusions about time to IPC removal or need of re-interventions. Conclusions: Based on observational evidence, the efficacy and safety of IPC for MPE does not seem to vary depending on the IPC insertion timing (before, during, or after SCT). The data most likely support early IPC insertion. (AU)

Efficacy and Safety of Indwelling Catheter for Malignant Pleural Effusions Related to Timing of Cancer Therapy: A Systematic Review.

INTRODUCTION: To compare the efficacy and safety of indwelling pleural catheters (IPC) in relation with the timing of systemic cancer therapy (SCT) (i.e., before, during, or after SCT) in patients with malignant pleural effusion (MPE). METHODS: Systematic review of randomized controlled trials (RCT), quasi-controlled trials, prospective and retrospective cohorts, and case series of over 20 patients, in which the timing of IPC insertion in relation to that of SCT was provided. Medline (via PubMed), Embase, and Cochrane Library were systematically searched from inception to January 2023. The risk of bias was assessed using the Cochrane Risk of Bias (ROB) tool for RCTs and the ROB in non-randomized studies of interventions (ROBINS-I) for non-randomized designs. RESULTS: Ten studies (n=2907 patients; 3066 IPCs) were included. Using SCT while the IPC was in situ decreased overall mortality, increased survival time, and improved quality-adjusted survival. Timing of SCT had no effect on the risk of IPC-related infections (2.85% overall), even in immunocompromised patients with moderate or severe neutropenia (relative risk 0.98 [95%CI: 0.93-1.03] for patients treated with the combination of IPC and SCT). The inconsistency of the results or the lack of analysis of all outcome measures in relation to the SCT/IPC timing precluded drawing solid conclusions about time to IPC removal or need of re-interventions. CONCLUSIONS: Based on observational evidence, the efficacy and safety of IPC for MPE does not seem to vary depending on the IPC insertion timing (before, during, or after SCT). The data most likely support early IPC insertion.

Adapting a Dental Anxiety Measure to Encourage Empathy.

Introduction: The aim of this study was to improve upon the Modified Dental Anxiety Scale (MDAS) by developing the empathy-based International-Modified Dental Anxiety Scale (I-MDAS). This new measure was then utilized to compare the dental anxiety of patients cross-culturally. Methodology. This study was a descriptive cross-sectional study adapting the MDAS into the I-MDAS by adding the International scale. The study surveyed 465 participants from a dental clinic, SurveySwap, and distributed flyers. Data was collected through Qualtrics through the self-administered I-MDAS and analyzed through the SPSS computer software version 28. Participants were categorized into two subgroups where 41.3% received dental care only within the United States and are termed the domestic population, and 58.7% received dental care outside of the United States and are labeled the nondomestic population. Information about demographics, past negative dental experiences, and current dental anxiety was collected. The conducted analyses utilized an independent sample t-test to compare the subgroups' anxiety levels, a bivariate correlation to find the Pearson correlation, a Cronbach's coefficient α, and a one way ANOVA test to compare the genders' I-MDAS scores. Results: There was no significant difference in dental anxiety levels between the domestic population (M = 12.73, SD = 5.13) and the nondomestic population (M = 12.76, SD = 5.06); t (463) = -0.58, p = 0.95). The I-MDAS shows evidence of validity and reliability. There was a significant and positive relationship between the International scale items and the MDAS scale items (r (463) = 0.60, p < 0.001), indicating the criterion validity of the I-MDAS. Content validity was strengthened by expanding the inquired topics in the new measure. The Cronbach's α value of 0.85 shows that the I-MDAS is reliable for clinical applications. Conclusions: The I-MDAS improves upon the MDAS by providing dentists with a tool for encouraging empathy. Dental clinicians across nations can use the I-MDAS to combat the vicious cycle of dental anxiety.

Long-Term Effects of a Short Juvenile Feeding Period with Diets Enriched with the Microalgae Nannochloropsis gaditana on the Subsequent Body and Muscle Growth of Gilthead Seabream, Sparus aurata L.

Currently, microalgae are used in fish diets, but their long-term growth effect is unknown. In this experiment, juvenile seabream specimens were fed with microalgae-enriched diets for three months, and then transferred to a microalgae-free diet for 10 months to assess long-term effects up to commercial size (≈27 cm and ≈300 g). The juvenile diets contained Nannochloropsis gaditana at 2.5 or 5% inclusion levels, either raw (R2.5 and R5 groups) or cellulose-hydrolyzed (H2.5 and H5 groups). The body length and weight were measured in 75 fish group-1 at commercial stage. The size, number, and fibrillar density of white muscle fibers and the white muscle transverse area were measured in nine fish group-1 at commercial stage. The results showed the highest body weight in H5 at commercial stage. The white muscle transverse area and the white fibres hyperplasia and density also showed the highest values in H5, followed by H2.5. In contrast, the highest hypertrophy was observed in C and R2.5, being associated with the lowest muscle growth in both groups. These results showed a microalgae concentration-dependent effect in hydrolyzed diets as well as an advantageous effect of the hydrolyzed versus raw diets on the long-term growth of Sparus aurata.

Implicit Negativity Bias Leads to Greater Loss Aversion and Learning during Decision-Making.

It is widely accepted there is the existence of negativity bias, a greater sensitivity to negative emotional stimuli compared with positive ones, but its effect on decision-making would depend on the context. In risky decisions, negativity bias could lead to non-rational choices by increasing loss aversion; yet in ambiguous decisions, it could favor reinforcement-learning and better decisions by increasing sensitivity to punishments. Nevertheless, these hypotheses have not been tested to date. Our aim was to fill this gap. Sixty-nine participants rated ambiguous emotional faces (from the NimStim set) as positive or negative to assess negativity bias. The implicit level of the bias was also obtained by tracking the mouse's trajectories when rating faces. Then, they performed both a risky and an ambiguous decision-making task. Participants displayed negativity bias, but only at the implicit level. In addition, this bias was associated with loss aversion in risky decisions, and with greater performance through the ambiguous decisional task. These results highlight the need to contextualize biases, rather than draw general conclusions about whether they are inherently good or bad.

Design and Development of a Heterogeneous Active Assisted Living Solution for Monitoring and Following Up with Chronic Heart Failure Patients in Spain.

Heart failure is the most common disease among elderly people, and the risk increases with age. The use of smart Internet of Things (IoT) systems for monitoring patients with chronic heart failure (CHF) in a non-intrusive manner can result in better control of the disease, improving proactive healthcare through real-time and historical patient's data, promoting self-care in patients, reducing unneeded interaction between patients and doctors, reducing the number of hospitalizations and saving healthcare costs. This work presents an active assisted living (AAL) solution based on the IoT to provide a tele-assistance platform for CHF patients from the public health service of the region of Murcia in Spain, with formal and informal caregivers and health professionals also as key actors. In this article, we have detailed the methodology, results, and conclusions of the prevalidation phase for the set of IoT technologies to be integrated in the AAL platform, the first mandatory step before the deployment of a large-scale pilot that will lead to improving the innovation of the system from its current technology readiness level to the market. The work presented, in the framework of the H2020 Pharaon project, aims to serve as inspiration to the R&D community for the design, development, and deployment of AAL solutions based on heterogeneous IoT technologies, or similar approaches, for smart healthcare solutions in real healthcare institutions.

Physicochemical Water Quality Influence on the Parasite Biodiversity in Juvenile Tilapia (Oreochromis spp.) Farmed at Valle Del Mezquital in the Central-Eastern Socioeconomic Region of Mexico.

Aquaculture parasite biodiversity dependents on multiple environmental characteristics, including water quality. The analysis of this relationship aims to support improvements in the production management of tilapia. For this purpose, a total of 100 juvenile fishes (Oreochromis spp.) and 30 water samples were collected at Valle del Mezquital in the Central-Eastern socioeconomical region of Mexico. A study of parasite biodiversity was carried out and water quality parameters were determined. Biodiversity in the habitat was measured using the Simpson diversity index, which considers the number of species present and the abundance of each one; we also calculate the Berger-Parker index to estimate the proportional importance of the most abundant species. In general, it was found that 86% of the examined specimens were parasitized. Parasite biodiversity was 11 genera (Simpson index = 0.55). Trichodina spp. (Ciliophora) was the dominant genus (Berger-Parker index = 0.51). The protozoa Apiosoma spp. was associated with the water hardness (Berger-Parker index = 0.57). Furthermore, the presence of monogeneans showed a positive correlation with the levels of nitrites and ammonium in the water (Berger-Parker index = 0.06-0.55). This characterization may represent a useful tool in the comprehensive management of parasites that affect the farmed tilapia. However, new data is necessary to expand the knowledge about the environment-host-parasite relationship.

Translation of a tissue epigenetic signature to circulating free DNA suggests BCAT1 as a potential noninvasive diagnostic biomarker for lung cancer.

Lung cancer patients are diagnosed at late stages when curative treatments are no longer possible; thus, molecular biomarkers for noninvasive detection are urgently needed. In this sense, we previously identified and validated an epigenetic 4-gene signature that yielded a high diagnostic performance in tissue and invasive pulmonary fluids. We analyzed DNA methylation levels using the ultrasensitive digital droplet PCR in noninvasive samples in a cohort of 83 patients. We demonstrated that BCAT1 is the candidate that achieves high diagnostic efficacy in circulating DNA derived from plasma (area under the curve: 0.85). Impact of potentially confounding variables was also explored.

Local full-thickness excision for sessile adenoma and cT1-2 rectal cancer: long-term oncological outcome.

PURPOSE: We analyzed all patients who underwent local transanal surgery at our institution to determine oncological outcomes and perioperative risk. METHODS: In 1997, we developed a prospective protocol for rectal tumors: transanal local full-thickness excision was considered curative in patients with benign adenoma and early cancers. In this analysis, 404 patients were included. To analyze survival, only those patients exposed to the risk of dying for at least 5 years were considered for the study. RESULTS: The final pathological analysis revealed that 262 (64.8%) patients had benign lesions, whereas 142 had malignant lesions. Postoperative complications were recorded in 12.6%. At the median time of 21 months, 14% of the adenomas and 12% of cancers had recurred, half of which were surgically resected. The overall 5-year survival rate was 94%. CONCLUSION: With similar outcomes and significantly lower morbidity, we found local surgery to be an adequate alternative to radical surgery in selected cases of early rectal cancer.

Prognostic Factors of Clinical and Economic Outcomes of Hip Arthroplasty in a Developing Country: A Multilevel Analysis with a 4-Year Cohort Study.

Introduction: This study is aimed at estimating the 30-day postoperative mortality rate and total costs of the medical episode, as well as determining prognostic factors associated with these outcomes for adult patients who have undergone total hip arthroplasty (THA) in Colombia's contributory health system. Methods: This was a retrospective cohort using administrative data and included adult patients enrolled in Colombia's contributory health system who underwent THA between the years 2011 and 2014. Outcomes were 30-day mortality ICU admissions, and the 1-year rate of fractures and revisions as well as the total cost of the medical episode incurred by the third-payer for 90 days following the procedure. Multilevel linear regression models were also generated to determine the prognostic factors associated with the outcomes presented. Results: The study included 17,289 patients, with an average age of 67 years. Outcome rates were calculated per 100 surgeries, resulting in 2.15 for mortality, 3.41 for ICU admissions, 2.42 for revision hip arthroplasty and 0.62 for periprosthetic fractures. This study found the age and Charlson Comorbidity Index were associated with mortality and complications, and that being female and performing the procedure in the capital city were protective factors. It also found that the median total cost of the medical episode was USD $ USD$2742.161 (p25-p75: 353.092-3291.747). The multivariate model found increasing trends in cost as age and CCI scores rose, and higher costs in the Atlantic region. Conclusions: Colombia has higher rates of complications from THA than other countries but lower health system costs. For these patients, age, CCI and the geographic region are factors that are associated with mortality, complications, and health system costs.

Teachers' perceptions of digital competence at the lifelong learning stage.

In recent years, the educational landscape has been in a period of constant change due to the advent of Information and Communication Technologies (ICT). As a result, training in digital competence has become one of the challenges to be met by the teaching staff, in order to incorporate these skills into their professional practice. As a result of this, the present work aimed to analyse the level of digital competence presented by a sample of 140 teachers of the Lifelong Learning stage in the Autonomous Community of Andalusia (Spain). To this end, a transversal methodological design of a quantitative nature was advocated, based on the configuration of an ad hoc questionnaire developed from the European conceptual frameworks on teaching digital competence. The results showed that the level shown by teachers is low, especially in terms of creation, information literacy and problem solving, although they did show optimal skills in communication and collaboration of digital content. The findings also determined the importance of factors such as age, teacher training and school type in further developing this compendium of skills.

Q-CHAT-NAO: A robotic approach to autism screening in toddlers.

The use of humanoid robots as assistants in therapy processes is not new. Several projects in the past several years have achieved promising results when combining human-robot interaction with standard techniques. Moreover, there are multiple screening systems for autism; one of the most used systems is the Quantitative Checklist for Autism in Toddlers (Q-CHAT-10), which includes ten questions to be answered by the parents or caregivers of a child. We present Q-CHAT-NAO, an observation-based autism screening system supported by a NAO robot. It includes the six questions of the Q-CHAT-10 that can be adapted to work in a robotic context; unlike the original system, it obtains information from the toddler instead of from an indirect source. The detection results obtained after applying machine learning models to the six questions in the Autistic Spectrum Disorder Screening Data for Toddlers dataset were almost equivalent to those of the original version with ten questions. These findings indicate that the Q-CHAT-NAO could be a screening option that would exploit all the benefits related to human-robot interaction.