Cellular Response of Adapted and Non-Adapted Tetrahymena thermophila Strains to Europium Eu(III) Compounds.

Europium is one of the most reactive lanthanides and humans use it in many different applications, but we still know little about its potential toxicity and cellular response to its exposure. Two strains of the eukaryotic microorganism model Tetrahymena thermophila were adapted to high concentrations of two Eu(III) compounds (EuCl3 or Eu2O3) and compared to a control strain and cultures treated with both compounds. In this ciliate, EuCl3 is more toxic than Eu2O3. LC50 values show that this microorganism is more resistant to these Eu(III) compounds than other microorganisms. Oxidative stress originated mainly by Eu2O3 is minimized by overexpression of genes encoding important antioxidant enzymes. The overexpression of metallothionein genes under treatment with Eu(III) compounds supports the possibility that this lanthanide may interact with the -SH groups of the cysteine residues from metallothioneins and/or displace essential cations of these proteins during their homeostatic function. Both lipid metabolism (lipid droplets fusing with europium-containing vacuoles) and autophagy are involved in the cellular response to europium stress. Bioaccumulation, together with a possible biomineralization to europium phosphate, seems to be the main mechanism of Eu(III) detoxification in these cells.

Factores condicionantes de la lactancia materna en tiempos de COVID-19 / Conditioning factors for breastfeeding in times of COVID-19

Objetivo: identificar los condicionantes del establecimiento y duración de la lactancia materna (LM) durante la COVID-19 desde la perspectiva de las matronas de la provincia de Castellón (España).Métodos: estudio cualitativo realizado en 2021 mediante la realización de cuatro grupos focales (GF) con matronas de la provincia de Castellón. La recolección de la información se hizo mediante videoconferencias con grabación de voz, que fueron transcritas para posterior análisis del discurso con el programa ATLAS.ti.Resultados: las matronas identificaron como facilitadores de la LM, la puesta en valor de la LM ante las madres y el fomento de la accesibilidad a recursos para solucionar situaciones problemáticas, entre otros. Como barreras refirieron ideas maternas sobre alimentación con fórmulas artificiales construidas desde su biografía, consideración social sesgada sobre el amamantamiento, falta de protocolos para extracción de calostro y déficit en la calidad de información en las redes sociales, principalmente. Reconocen que la pandemia COVID-19 produjo impactos positivos y negativos en la LM. Surgieron medidas para optimizar la promoción de la LM como aumentar la ratio matronas/madres gestantes, asistencia domiciliaria a las 24 h del alta, unificación de protocolos intercentros, ampliación a seis meses el tiempo de incorporación al trabajo y adaptación de la promoción de la LM en redes sociales.Conclusiones: se reportaron condicionantes de la lactancia emergentes del escenario sociosanitario español que sirven de base para diseñar acciones específicas de promoción. Los impactos de la pandemia COVID-19 sobre la LM deben considerarse en situaciones de confinamiento prolongado de la madre. (AU)

Objective: to identify the conditioning factors for implementation and duration of breastfeeding during COVID-19 from the perspective of midwives from the Castellón province (Spain).Methods: a qualitative study conducted in 2021 through four focus groups (FGs) with midwives from the Castellón province. Data collection was carried out via videoconferences with audio recording, which were transcribed for subsequent discourse analysis with the Atlas Ti program.Results: the enablers for breastfeeding identified by midwives were the promotion of breastfeeding for mothers and the development of access to resources to solve troublesome situations, among others. They reported as barriers the maternal beliefs regarding feeding with artificial formulas based on their biography, a biased social consideration on breastfeeding, lack of protocols for colostrum extraction, and deficient quality of information in social networks, mostly. They acknowledged that the COVID-19 pandemic had positive and negative impacts on breastfeeding. Some measures came up to optimize breastfeeding promotion, such as an increase in the midwife/pregnant mother ratio, home care 24 hours after discharge, unification of protocols among centres, extending to six months the time for incorporation to work, and adaptation of breastfeeding promotion in social networks.Conclusions: conditioning factors for breastfeeding were reported, originating in the Spanish sociosanitary scenario, which are useful as the basis for designing specific promotion actions. The impact of the COVID-19 pandemic on breastfeeding must be considered in situations of prolonged lockout of mothers. (AU)

Computer-aided diagnostic for classifying chest X-ray images using deep ensemble learning.

BACKGROUND: Nowadays doctors and radiologists are overwhelmed with a huge amount of work. This led to the effort to design different Computer-Aided Diagnosis systems (CAD system), with the aim of accomplishing a faster and more accurate diagnosis. The current development of deep learning is a big opportunity for the development of new CADs. In this paper, we propose a novel architecture for a convolutional neural network (CNN) ensemble for classifying chest X-ray (CRX) images into four classes: viral Pneumonia, Tuberculosis, COVID-19, and Healthy. Although Computed tomography (CT) is the best way to detect and diagnoses pulmonary issues, CT is more expensive than CRX. Furthermore, CRX is commonly the first step in the diagnosis, so it's very important to be accurate in the early stages of diagnosis and treatment. RESULTS: We applied the transfer learning technique and data augmentation to all CNNs for obtaining better performance. We have designed and evaluated two different CNN-ensembles: Stacking and Voting. This system is ready to be applied in a CAD system to automated diagnosis such a second or previous opinion before the doctors or radiology's. Our results show a great improvement, 99% accuracy of the Stacking Ensemble and 98% of accuracy for the the Voting Ensemble. CONCLUSIONS: To minimize missclassifications, we included six different base CNN models in our architecture (VGG16, VGG19, InceptionV3, ResNet101V2, DenseNet121 and CheXnet) and it could be extended to any number as well as we expect extend the number of diseases to detected. The proposed method has been validated using a large dataset created by mixing several public datasets with different image sizes and quality. As we demonstrate in the evaluation carried out, we reach better results and generalization compared with previous works. In addition, we make a first approach to explainable deep learning with the objective of providing professionals more information that may be valuable when evaluating CRXs.

Umbilical cord clamping time and maternal satisfaction.

OBJECTIVE: Clamping of the umbilical cord is part of the third stage of delivery. Delayed cord clamping (DCC) is recommended due to its contribution to prevention of anaemia. There is no evidence on the effect of DCC on maternal satisfaction. The aim of this study is to evaluate the effect of different sociodemographic and obstetric factors, including the timing of cord clamping, on maternal satisfaction with the birth experience in our healthcare system. DESIGN: Pragmatic non-drug intervention study with simple random assignment of participating mothers (Clinical Trials N°: NCT03624335). SETTING: A public, university-level hospital in Villarreal city, eastern Spain. PARTICIPANTS: Childbearing woman, gestation week between 35 and 42 weeks, with regular medical pregnancy checks, single pregnancy and vaginal delivery (N = 198, 80% of the women recruited). INTERVENTIONS: umbilical cord clamping within 60 seconds of the birth (Early cord clamping, ECC) versus umbilical cord clamping after pulsation had been ceased (Delayed cord clamping, DCC). MEASUREMENTS: Birth satisfaction was measured using the Mackey Childbirth Satisfaction Rating Scale (MCSRS). Additionally, sociodemographic data, degree of knowledge about the moment of clamping and type of breastfeeding data were recorded. The Mann-Whitney and Kruskal-Wallis tests for comparison of the mean of two, three, or more groups, respectively, and Chi-square and Spearman for comparison of two qualitative and quantitative variables, respectively, were used. To determine the weight of each factor of MCSRS, an exploratory factor analysis was carried out using the maximum likelihood method for factor extraction and the varimax method for factor rotation. The adequacy of the factor analysis was checked by mean of Kaiser-Meyer-Olkin test and Bartlett sphericity test. The level of significance was set at a p-value of < 0.05. FINDINGS: The average degree of satisfaction was 4.55/5 (SD: 0.37). No statistically significant difference was observed between mothers' satisfaction according to mother level of study or mother's place of birth, while it changed significantly with age (p = 0.0398). Within the obstetric variables, satisfaction was significantly associated with spontaneous amniorrhexis, the duration of the second stage of delivery, and the Apgar value of the newborn at the first minute of life, and was independent of the number of previous pregnancies and deliveries, use of intrapartum oxytocin, epidural analgesia, episiotomy, the weight of the child at birth and type of breastfeeding. Furthermore, there was no relationship between the time of clamping and satisfaction (p = 0.5178). KEY CONCLUSIONS: Maternal satisfaction with the birth experience varies with the age of the childbearing woman, and some intrapartum factors and the result is not influenced by the time of clamping of the umbilical cord. Therefore, this component of the physiological management of childbirth provides additional benefits for the health of the neonate, without negative consequences on the final perception of the maternal health care received. IMPLICATIONS FOR PRACTICE: If there are no reasons that justify an early umbilical cord clamping, delaying it brings benefits to the neonate, without negatively affecting the maternal assessment of the experience of childbirth.

GPU-accelerated iterative reconstruction for limited-data tomography in CBCT systems.

BACKGROUND: Standard cone-beam computed tomography (CBCT) involves the acquisition of at least 360 projections rotating through 360 degrees. Nevertheless, there are cases in which only a few projections can be taken in a limited angular span, such as during surgery, where rotation of the source-detector pair is limited to less than 180 degrees. Reconstruction of limited data with the conventional method proposed by Feldkamp, Davis and Kress (FDK) results in severe artifacts. Iterative methods may compensate for the lack of data by including additional prior information, although they imply a high computational burden and memory consumption. RESULTS: We present an accelerated implementation of an iterative method for CBCT following the Split Bregman formulation, which reduces computational time through GPU-accelerated kernels. The implementation enables the reconstruction of large volumes (>10243 pixels) using partitioning strategies in forward- and back-projection operations. We evaluated the algorithm on small-animal data for different scenarios with different numbers of projections, angular span, and projection size. Reconstruction time varied linearly with the number of projections and quadratically with projection size but remained almost unchanged with angular span. Forward- and back-projection operations represent 60% of the total computational burden. CONCLUSION: Efficient implementation using parallel processing and large-memory management strategies together with GPU kernels enables the use of advanced reconstruction approaches which are needed in limited-data scenarios. Our GPU implementation showed a significant time reduction (up to 48 ×) compared to a CPU-only implementation, resulting in a total reconstruction time from several hours to few minutes.

FUX-Sim: Implementation of a fast universal simulation/reconstruction framework for X-ray systems.

The availability of digital X-ray detectors, together with advances in reconstruction algorithms, creates an opportunity for bringing 3D capabilities to conventional radiology systems. The downside is that reconstruction algorithms for non-standard acquisition protocols are generally based on iterative approaches that involve a high computational burden. The development of new flexible X-ray systems could benefit from computer simulations, which may enable performance to be checked before expensive real systems are implemented. The development of simulation/reconstruction algorithms in this context poses three main difficulties. First, the algorithms deal with large data volumes and are computationally expensive, thus leading to the need for hardware and software optimizations. Second, these optimizations are limited by the high flexibility required to explore new scanning geometries, including fully configurable positioning of source and detector elements. And third, the evolution of the various hardware setups increases the effort required for maintaining and adapting the implementations to current and future programming models. Previous works lack support for completely flexible geometries and/or compatibility with multiple programming models and platforms. In this paper, we present FUX-Sim, a novel X-ray simulation/reconstruction framework that was designed to be flexible and fast. Optimized implementation for different families of GPUs (CUDA and OpenCL) and multi-core CPUs was achieved thanks to a modularized approach based on a layered architecture and parallel implementation of the algorithms for both architectures. A detailed performance evaluation demonstrates that for different system configurations and hardware platforms, FUX-Sim maximizes performance with the CUDA programming model (5 times faster than other state-of-the-art implementations). Furthermore, the CPU and OpenCL programming models allow FUX-Sim to be executed over a wide range of hardware platforms.

El seguro de responsabilidad civil en los ensayos clínicos: reflexiones a propósito de una reclamación / Liability insurance in clinical trials: Claim-based reflections

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