Pronación consciente como parte del tratamiento de la neumonía por COVID-19 / Prone positioning in awake patients as part of treatment in patients with COVID-19 pneumonia

La pronación consciente es una de las herramientas utilizadas para reducir los ingresos a terapia intensiva (UTI) en la neumonía por COVID-19 con hipoxemia. Algunos pacientes no toleran estar en posición prono (intolerantes) y algunos que lo toleran no responden mejorando la saturación o su PO2. Presentamos una serie de 34 pacientes sometidos a pronación consciente; fueron tolerantes 18 (52,9%). Nueve pacientes pasaron a UTI (26,4%): 7 intolerantes (43,7%) y 2 tolerantes (11,1%) (p=0.038). No hallamos diferencias en la necesidad de ventilación mecánica y mortalidad entre tolerantes e intolerantes. De los 18 tolerantes se clasificó como respondedores a 10 pacientes (55,5%). No hubo diferencia estadísticamente significativa en los pases a UTI entre los respondedores y no respondedores. La pronación consciente es una herramienta factible en el paciente con neumonía por COVID-19 y nos permitió predecir el requerimiento de terapia intensiva entre aquellos intolerantes al método.

The prone positioning (PP) in awake patients is one of the tools to reduce the number of admissions to Intensive Care Unit (ICU) in cases of Covid-19 hipoxemic pneumonia. Some patients do not tolerate PP (intolerants) and others that tolerate it do not respond with improvement of PO2 or oxygen saturation. We present here a series of 34 patients who underwent PP. Eighteen of them tolerated PP (52,9%). Nine patients (26,4%) were admitted to ICU: 7 who had not tolerated PP (43,7%) and 2 who had tolerated PP (11,1%) (p= 0.038). We did not find differences in the need for mechanical ventilation and mortality between patients who tolerated and who did not tolerate PP. From those 18 who tolerated PP, 10 were classified as responders (55,5%). We did not find any significant statistical differences for admission to ICU between responders and non-responders. PP in awake patients is a feasible tool in cases of COVID-19 Pneumonia, and it allowed us to predict the requirements of ICU between those who were not tolerant to the method

Deep feature transfer learning for trusted and automated malware signature generation in private cloud environments.

This paper presents TrustSign, a novel, trusted automatic malware signature generation method based on high-level deep features transferred from a VGG-19 neural network model pretrained on the ImageNet dataset. While traditional automatic malware signature generation techniques rely on static or dynamic analysis of the malware's executable, our method overcomes the limitations associated with these techniques by producing signatures based on the presence of the malicious process in the volatile memory. By leveraging the cloud's virtualization technology, TrustSign analyzes the malicious process in a trusted manner, since the malware is unaware and cannot interfere with the inspection procedure. Additionally, by removing the dependency on the malware's executable, our method is fully capable of signing fileless malware as well. TrustSign's signature generation process does not require feature engineering or any additional model training, and it is done in a completely unsupervised manner, eliminating the need for a human expert. Because of this, our method has the advantage of dramatically reducing signature generation and distribution time. In fact, in this paper we rethink the typical use of deep convolutional neural networks and use the VGG-19 model as a topological feature extractor for a vastly different task from the one it was trained for. The results of our experimental evaluation demonstrate TrustSign's ability to generate signatures impervious to the process state over time. By using the signatures generated by TrustSign as input for various supervised classifiers, we achieved up to 99.5% classification accuracy.

Cytosolic phosphoenolpyruvate carboxykinase is expressed in α-cells from human and murine pancreas.

The pancreatic islets of Langerhans, mainly formed by glucagon-producing α-cells and insulin-producing ß-cells, are critical for glucose homeostasis. Insulin and glucagon oppositely modulate blood glucose levels in health, but a combined decline in insulin secretion together with increased glucagon secretion contribute to hyperglycemia in diabetes. Despite this bi-hormonal dysregulation, most studies have focused on insulin secretion and much less is known about glucagon secretion. Therefore, a deeper understanding of α-cell metabolism and glucagon secretion is of great interest. Here, we show that phosphoenolpyruvate carboxykinase (PCK1), an essential cataplerotic enzyme involved in metabolism and long considered to be absent from the pancreatic islet, is expressed in pancreatic α-cells of both murine and human. Furthermore, PCK1 transcription is induced by fasting and diabetes in rat pancreas, which indicates that the PCK1 activity is required for α-cell adaptation to different metabolic states. To our knowledge, this is the first evidence implicating PCK1 expression in α-cell metabolism.

Ruptura espontánea de aorta abdominal infrarrenal no aneurismática / Spontaneous rupture of the infrarenal abdominal aorta, non aneurysmal

Un hombre de 24 años, previamente sano y sin factores de riesgo conocidos, ingresa al servicio de urgencias con abdomen agudo, anemia y lipotimia. La exploración quirúrgica de emergencia revela ruptura de aorta abdominal infrarrenal. El manejo consistió en resección de pared aórtica y revascularización aórtica con tubo de dacrón, bajo arterias renales y sobre bifurcación aórtica. No se realizan exámenes imagenológicos previos a la cirugía por la urgencia del cuadro. Biopsia de pared aórtica mostró disminución de fibras elásticas en la túnica media y hematoma disecante en organización, no encontrándose necrosis quística. Evoluciona posteriormente sin complicaciones, quedando asintomático. Cuatro meses después, reingresa con dehiscencia de anastomosis proximal aortoprotésica y hemoperitoneo, falleciendo en shock y trastorno de la coagulación, posterior a exploración quirúrgica de urgencia. Se considera a la disección como factor etiológico, en la ruptura espontánea de aorta abdominal infrarrenal, con extensión proximal que explicaría la dehiscencia tardía. Esfuerzos diagnósticos y manejo de factores de riesgo, deben ser considerados en pacientes sintomáticos, en los cuales la intervención quirúrgica es necesaria, dada la alta mortalidad de la ruptura.