Multi-antimicrobial extrusion (MATE) transporter membrane proteins provide drug and toxin resistivity by expelling compounds from cells. MATE proteins can be pictured as V-shaped. To regulate its functioning, the protein structure can switch between outward-facing (OF) and inward-facing (IF). Pyrococcus furiosus MATE (PfMATE) is the only member of the multidrug/oligosaccharidyl-lipid/polysaccharide (MOP) superfamily that has available both the IF and OF crystal structures. With the availability of the both the IF and OF structures, we are able to perform computational investigations to determine how protonation of specific amino acids causes a cascade of changes in the protein conformation that allow PfMATE to change its state from OF to IF in order to regulate its antiporter function. Using a variety of computational techniques, we investigated four different systems of IF and OF PfMATE along with the native archaeal lipid bilayer, without or with protonation at the experimentally determined locations within the protein. We performed molecular dynamics (MD) simulations to investigate the flexibility of the four different PfMATE structures, and also performed targeted molecular dynamics (TMD) simulations during which we observe occluded conformations. Our analysis of hydrogen bond changes, potential of mean force, dynamic network analysis, and transfer entropy analysis provides information on how protonation can induce cascading structural changes responsible for the transition between the IF and OF configurations.

Glial fibrillary acidic protein (GFAP) is a promising biomarker for brain and spinal cord disorders. Recent studies have highlighted the differences in the reliability of GFAP measurements in different biological matrices. The reason for these discrepancies is poorly understood as our knowledge of the protein’s 3-dimensional conformation, proteoforms, and aggregation remains limited. Here, we investigate the structural properties of GFAP under different conditions. For this, we characterised recombinant GFAP proteins from various suppliers and applied hydrogen-deuterium exchange mass spectrometry (HDX-MS) to provide a snapshot of the conformational dynamics of GFAP in artificial CSF compared to the phosphate buffer. Our findings indicate that recombinant GFAP exists in various conformational species. Furthermore, we show that GFAP dimers remained intact under denaturing conditions. HDX-MS experiments show an overall decrease in H-bonding and an increase in solvent accessibility of GFAP in aCSF compared to the phosphate buffer, with clear indications of mixed EX2 and EX1 kinetics. To understand possible structural interface regions and the evolutionary conservation profiles, we combined HDX-MS results with the predicted GFAP-dimer structure by AlphaFold-Multimer. We found that deprotected regions with high structural flexibility in artificial CSF overlap with predicted conserved dimeric interface regions. Our results suggest that GFAP exists in several conformational forms. Structural property predictions combined with the HDX data show an overall deprotection and signatures of aggregation in aCSF. We anticipate that the outcomes of this research will contribute to a deeper understanding of the structural flexibility of GFAP and ultimately shed light on its behaviour in different biological matrices.

Even when the SARS-CoV-2 pandemic recedes, evidence-based researches regarding the effectiveness of pharmaceutical and non-pharmaceutical government interventions (NPIs) remain important. In this study, SARS-CoV-2 data of 30 European countries from early 2020 up to mid 2022 are analyzed using Bayesian machine learning. Four data sources containing each country’s daily NPIs (consisting of 66 government measures, virus variant distributions of 31 virus types, the vaccinated population percentages by the first five doses as well as the reported daily infections in each country) are brought together to undertake a comprehensive assessment of the impact of SARS-CoV-2 influential factors on the spread of the virus. First, a Bayesian deep learning model is constructed with a set of input factors to predict the growth rate of the virus one month ahead of the time from each day. Based on this, the importance and the marginal effect of each relevant influencing input factor on the predicted outcome of the neural network model is computed by applying the relevant algorithms. Subsequently, in order to examine the performed deep learning analysis, a Bayesian statistical inference analysis is performed within each country’s data. For each influencing input factor, the distribution of pandemic growth rates, in the days where the selected explanatory factor has been active, is compared with the distribution of the pandemic growth rates, in the days where the selected explanatory variable has not been active. The results of the statistical inference confirm the predictions of the deep learning model to a significant extent. Similar conclusions from the SARS-CoV-2 experiences of the thirty studied European countries have been drawn.

Aim: To compare care coordination in Germany and the United States, considering healthcare system structure, policies, coordination mechanisms, and country-specific challenges. Design & methods: A systematic review was conducted, analyzing peer-reviewed articles in English from 2013 to 2018 using PubMed, Cochrane, and Google Scholar. Results: Our analysis included 24 studies, with nine focusing on Germany and 15 on the United States. Case manager designations were often inconsistent or absent. Despite some electronic health record adoption, fax and paper formats persisted, causing interoperability issues. Challenges, including physician resistance, technical barriers, and a lack of financial incentives, are revealed. Conclusion: This study highlights insufficient high-quality evidence for effective care coordination in both countries. Strategies are needed to overcome barriers hindering patient information sharing across care levels and enhance healthcare coordination.

TITLE PAGEArticle TypeClinical pictureTitlePenile Injury Caused by Neodymium MagnetsAuthorsYuki Akiyama1, Ryo Ichibayashi2Affiliations1. Department of Orthopaedic Surgery, Toho University Medical Center, Sakura Hospital, Chiba, Japan2. Division of Emergency Medicine Department of Internal Medicine, Toho University Medical Center, Sakura Hospital, Chiba, JapanCorresponding AuthorRyo Ichibayashi, MD, PhDORCID iD https://orcid.org/0000-0002-1273-4875Division of Emergency Medicine Department of Internal MedicineToho University Medical Center, Sakura Hospital564-1 ShimosizuSakura-shi, Chiba 285-8741, JapanPhone: +81-43-462-8811Fax: +81-43-462-8835e-mail: ryou.ichibayashi@med.toho-u.ac.jpRunning titleDamage caused by neodymium magnetsKeywordsNeodymium magnet, Penile foreign body, Emergency, TreatmentConflict of interestThe authors have no conflict of interest to disclose.Financial supportThe author(s) received no financial support for this article’s research, authorship, and publication.Patient consentWritten informed consent was obtained from the patient to publish this report by the journal’s patient consent policy.Author contributionYA wrote and drafted the manuscript. RI helped draft the manuscript. All authors read and approved the final manuscript.Data availability statementThe data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical considerations.AcknowledgmentsNone.Key clinical messageMultiple neodymium magnets can pinch tissue and cause barotrauma. Be careful if the tissue of the penis or foreskin is pinched, as this may cause foreskin necrosis or damage to the urethra.Clinical picture11-year-old boy. He has no history of developmental disabilities or mental illness. The boy played with a neodymium magnet attached to his penis in the bathroom out of curiosity. However, the neodymium magnet remained attached to his penis and could not be removed, and he was transported to our hospital by ambulance with the chief complaint of penile pain. Emergency crews tried to remove it, but it was impossible because it was painful, and there were concerns that it might damage the foreskin. Two hours had passed since he was transferred to our hospital because he was refused admission by multiple medical institutions. At the time of his visit, his penis had two circular neodymium magnets, each approximately 1 cm in diameter, placed against the foreskin of his penis (Figure 1A). Although it was difficult to remove it by pulling it in the opposite direction, it was possible to remove it by shifting the ground surface. After the foreskin was released, there was a crushed wound, so ointment was applied（Figure 1B）. After confirming that there was no problem with the color tone of his glasses, he returned home. The next day, he returned to the outpatient clinic and confirmed that the color of his glans was standard and that he could urinate. Neodymium magnets were developed in Japan in 1982 and have become famous worldwide due to their effectiveness. It is said to be the strongest magnet currently in use. Neodymium magnets are used in various fields and children’s toys [1]. For this reason, accidents such as accidental ingestion by children and insertion into the urinary tract or anus due to sexual preference are problems in the medical field. Accidents caused by multiple neodymium magnets, especially when accidentally swallowed or inserted with a foreign object, are dangerous because they adhere to each other and pinch tissue, resulting in pressure necrosis [2]. This case also had a crush injury to the foreskin. A month later, the scar remained on my foreskin. Barotrauma caused by neodymium magnets often involves damage to thin tissues, including the intestinal tract and mucous membranes. The structures of the corpus cavernosum and the corpus cavernosum of the urethra, which form the penis, are spongy and soft tissues. This tissue becomes rigid as it fills with blood. For this reason, if not only the foreskin but also the corpus cavernosum of the penis is pinched, there is a possibility that blood flow to the corpus cavernosum and damage to the urethra may occur. After removing the neodymium magnet, it is necessary to observe the color of the glans and foreskin and the state of urination.References1. Taylor MA, Spanos SP, Fenton SJ, Russell KW. Ball Magnets Clicked Together on the Epiglottis. Cureus . 2020. 12(5): e8181. doi: 10.7759/cureus.81812. Yuksel C, Ankarali S, Aslan Yuksel N. The use of neodymium magnets in healthcare and their effects on health. North Clin Istanb . 2018; 5(3): 268-273. doi:10.14744/nci.2017.00483Figure 1A　Neodymium magnet that pinches the foreskin of the penisB　 Foreskin with a crush injury

A document by Soumaya Kachti. Click on the document to view its contents.

Downstaging case of hepatocellular carcinoma“Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy”ABSTRACTIntroduction: Transarterial chemoembolization (TACE) is the most used treatment option for patients with intermediate-stage hepatocellular carcinoma (HCC) who are not candidates for a curative approach. Through it, it is possible both to carry out palliative treatment and to reduce the size of the tumor so that the patient is eligible for a curative treatment such as a liver transplant. This modality of offering TACE to reduce the tumor stage and allow curative treatment is called “Downstaging”. Patients with HCC greater than 7 cm generally do not respond very well to chemoembolization to reduce tumor size, and generally this “downstaging” is not performed.Objective: To disseminate information in the medical community about a case of a patient with a hepatocellular carcinoma larger than 7 cm, who underwent chemoembolization to reduce staging and who met eligibility criteria for liver transplantation.Methods: Data were collected from notes in the medical records, after signing the informed consent form by the patient and approval by the Research Ethics Committee.Results: This study presents a case report of a 55-year-old man with chronic liver disease and a history of infection by the hepatitis C virus and the human immunodeficiency virus, who evolved with non-invasive hepatocellular carcinoma in segment VI/VII of the liver out of Milan criteria for curative therapeutic proposal. The patient underwent two sessions of TACE, which were effective in reducing the size of the tumor, making him eligible for curative treatment – liver transplantation.Conclusion: The case in question stands out for being a condition of atypical evolution, where often, due to the size of the tumor, the response to chemoembolization is not so significant. The case report is justified in order to provide information and enable downstaging attempts to be made in patients with similar profiles.Keywords: Hepatocellular carcinoma. Transarterial chemoembolization. TACE. Hepatitis C

Objective: To determine the characteristics, determinants, and persistent use for prescription opioid episodes initiated postpartum in British Columbia (BC), Canada. Design: Population-based cohort, 2008-2015. Setting: Linked administrative databases including outpatient and inpatient visits and outpatient prescription dispensations for all individuals in BC tested for hepatitis C or HIV. Population: Opioid-naïve individuals aged 13-49 with a delivery hospitalization record. Methods: We used modified Poisson regression to estimate risk ratios (RR) for pre-pregnancy characteristics and adjusted RR (aRR) for delivery characteristics adjusted for potential confounders. Main Outcome Measures: All and persistent (≥90 days) prescription opioid episodes initiated postpartum. Results: Among 292,684 eligible deliveries, 8.8% (95% CI: 8.7% to 8.9%) initiated a postpartum prescription opioid episode and 0.4% (0.4%- 0.5%) had a persistent episode. Persistent prescription opioid episodes were more frequent among cesarean vs. vaginal deliveries (1.0% vs. 0.2%, aRR 5.1 [4.6-5.8]). Opioid episodes varied regionally and declined from 12.8% in 2008 to 7% in 2012-2015. Persistent prescription opioid episodes were associated with pre-pregnancy: mental illness history (RR 2.4 [1.9-3.1]), psychotropic medication use (RRs 3.6-4.9), chronic pain (RR 2.7 [1.8-3.9]) and alcohol misuse (4.6 [2.2-9.7]), and delivery complications: intensive care unit admission (aRR 5.4 [3.3-8.9]), postpartum hospital readmission (aRR 3.9 [3.2-4.8]), and vaginal deliveries with hysterectomy (aRR 23.7 [6.1-91.8]) or tubal ligation/salpingectomy (aRR 14.6 [5.4-39.4]). Conclusions: Persistent prescription opioid episodes were initiated following 0.4% of deliveries. Postpartum pain management strategies should consider the strong associations between pre-pregnancy and delivery characteristics and persistent prescription opioid episodes initiated postpartum.

Climate variability influences genetic and phenotypic diversity within species, impacting biodiversity’s evolution. Gene flow and selection maintain changes in genetic and phenotypic variants along an environmental gradient. We investigated a hybrid zone in western Ecuador, involving two wren species (Aves: Troglodytidae), Campylorhynchus zonatus and C. fasciatus, and their admixed populations. We addressed two primary questions: (1) What is the relative contribution of Isolation by Distance (IBD) and Isolation by Environment (IBE) to genetic differentiation in these species along the western Ecuadorian environmental gradient? (2) Is there evidence of genetic admixture and introgression between these taxa in western Ecuador? We analyzed 4,409 SNPs from 112 blood samples sequenced using ddRadSeq. Clusters ranged from K=2-4, aligning with geographic origins, known phylogenetics, and physical or ecological constraints. IBD was evident across all models, while IBE was less pronounced but still significant for annual mean precipitation and precipitation seasonality. Genetic admixture between C. f. pallescens and C. zonatus gradually changed along the environmental gradient. Genetic differentiation in the two C. f. pallescens populations could be attributed to an unreported potential physical barrier in central western Ecuador. The proximity of the Andes to the coastline restricted lowland habitats, limiting dispersal and gene flow, especially among dry-habitat specialists. Taxonomic changes are not proposed, but the admixture in C. f. pallescens suggests it may be a hybrid between C. z. brevirostris and C. fasciatus, with varying degrees of admixture in western Ecuador and northwestern Peru. This study enhances our understanding of avian population genomics in tropical regions.

Social bees have been extensively studied for their gut microbial functions, but the significance of the gut microbiota in solitary bees remain less explored. Solitary bee, Megachile rotundata F. females provision their offspring with pollen from various plant species, harboring a diverse microbial community that colonizes larvae guts. The Apilactobacillus is the most abundant microbe, but evidence concerning the effects of Apilactobacillus and other provision microbes on growth and survival are lacking. We hypothesized that the presence of the gut microbiome, and Apilactobacullus in particular, would enhance larval and prepupal development, weight, and survival. We reared larvae on pollen provisions with naturally collected microbial communities (Natural pollen) or devoid of microbial communities (Sterile pollen). We also assessed the impact of introducing Apilactobacillus micheneri by adding it to both types of pollen provisions. Feeding larvae with sterile pollen + A. micheneri led to the highest mortality rate, followed by natural pollen + A. micheneri, sterile pollen. Larval development was significantly delayed in groups fed sterile pollen and sterile pollen + A. micheneri compared to the control. Interestingly, larval and prepupal weights did not significantly differ across treatments compared to natural pollen-fed larvae. 16S rRNA gene sequencing found a dominance of endosymbiont Sodalis when A. micheneri was introduced to natural pollen. The presence of Sodalis with abundant A. micheneri suggests potential crosstalk between both, shaping bee nutrition and health. Hence, this study highlights that the reliance on non-host specific environmental bacteria may not impact fitness of M. rotundata. Keywords: Megachile rotundata, Apilactobacillus micheneri, Sodalis, solitary bee, bee health and nutrition, bee microbiome, growth, survival

Understanding the diet preferences and prey selection of invasive species is crucial to better predict their impact on community structure and ecosystem functioning. Limnomysis benedeni, a Ponto-Caspian invasive mysid shrimp, is one of the most successful invaders in numerous European river and lake ecosystems. While existing studies suggest potentially strong trophic impact due to high predation pressure on invaded plankton communities, little is known of its prey selectivity between phyto- and zooplankton, under different prey concentrations. Here, we therefore investigated the feeding selectivity of L. benedeni on two commonly occurring prey organisms in freshwaters, the small rotifer zooplankton Brachionus calyciflorus together with the microphytoplankton Cryptomonas sp. present in increasing densities. Our results demonstrated a clear shift in diet selection, with L. benedeni switching from B. calyciflorus to Cryptomonas sp. already when the two prey species were provided in equal biomasses. Different functional responses were observed for each prey type, indicating somewhat different foraging mechanisms for each prey type. These findings provide experimental evidence on the feeding flexibility of invasive mysid shrimps and potential implications for trophic interactions in invaded ecosystems.

Title: Determinants of school absences due to respiratory tract infections among children during COVID-19 pandemic: a cross-sectional study of the Sentinel Schools Network.Antoni Soriano-Arandes1,●,○, Andreu Colom-Cadena2,3,●, Anna Bordas2,3, Fabiana Ganem2,3,4, Lucia Alonso3,5, Marcos Montoro2,3, Mireia Gascon6,7,8, Maria Subirana6,7,8, Ariadna Mas9, Jordi Sunyer6,7,8, Pere Soler-Palacin1, Jordi Casabona2,3,4,8 ; on behalf of Sentinel School Network of Catalonia*Paediatric Infectious Diseases and Immunodeficiencies Unit. Children’s Hospital. Vall d’Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain.Centre d’Estudis Epidemiològics sobre les ITS i Sida de Catalunya (CEEISCAT). Badalona, Spain.Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain.Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain.Fundació Lluita contra les infeccions, Badalona, Spain.ISGlobal, Barcelona. Spain.Universitat Pompeu Fabra (UPF), Barcelona, SpainCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) Instituto de Salud Carlos III, Madrid, Spain.Direcció Assistencial d’Atenció Primària i Comunitària, Institut Català de la Salut, Barcelona, Catalonia, Spain● Contributed equally to this work with: Antoni Soriano-Arandes, Andreu Colom-Cadena○ Corresponding author: Antoni Soriano-Arandes,toni.soriano@vallhebron.cat. ORCID: 0000-0001-9613-7228Keywords: COVID-19, respiratory infections, ventilation, school, CO2, Indoor air qualityTo the editor:Different public health measures were implemented during the COVID-19 pandemic to maintain the schools open1,2. Regarding COVID-19 vaccination, at the beginning of this study, more than 92% and 40% of population older than 12 years and children aged 5-11 years in Spain was fully vaccinated against COVID-19, respectively3.Ventilation was proposed as one of the main strategies to reduce aerosol transmission for SARS-CoV-2 during the pandemic. A study from Germany assessed the efficiency of air purifiers in reducing aerosols in high-school classrooms4. However, no clinical endpoints were investigated and, therefore, a very low certainty of evidence was graded by a Cochrane review5. In an Italian study, the authors concluded that ventilation reduced the likelihood of SARS-CoV-2 infection in classrooms by 80%6. Moreover, a survey study from the US reported that elementary schools with face masks and ventilation strategies in place had lower SARS-CoV-2 incidence rates7. In a Lancet Task Force Commission review8, the authors concluded that improving building ventilation systems may carry benefits beyond protection from COVID-19. However, there is scarce evidence that demonstrate the association of epidemiological and environmental risk factors, including CO2 concentrations, with the incidence of respiratory tract infections (RTI) in children who are attending schools.The present study is part of COVID-19 Sentinel Schools Network of Catalonia (CSSNC), a project including 23 schools and 5687 students, teachers and other school staff with the aim to monitor SARS-CoV-2 and other respiratory viruses, their determinants and preventive measures in Catalonia9. The objectives of this study are to assess the potential association of demographic and epidemiological factors, including the indoor environmental conditions (CO2levels) in the classrooms, with students’ school absence due to RTI.We conducted a cross-sectional study in two different periods, the first from April 19 to June 21, 2022, and the second from November 8 to December 21, 2022. The main outcome of the study was the absence of the child from attending the school in person due to RTI or other non-respiratory medical causes. The study population was composed of 253 students (4-11 years) belonging to 20 classrooms, 11 in spring 2022 and 9 in autumn 2022, attending 4 and 16 classrooms of preschool (4 to 5 years-old) and primary school (6 to 11 years-old) stages, respectively. A written informed consent was previously obtained from parents or guardians of children.Absences from school attendance were notified by the tutor/teacher to the study researchers. We proceed to collect epidemiological and clinical/diagnostic data within the first 48 hours through a case report form deposited on the digital platform REDCap©. All the absences (cases) were followed-up through telephone calls made by health professionals until their return to the school. RTI was registered according to the symptoms described during the telephonic interview and confirmed through the computerised health record programme of the Health Ministry (eCAP).Sensors to monitor the CO2 concentrations (DIOXCARE DX700 PDF, Smartcare Services, Spain) were installed in classrooms, recording data every 10 minutes. For the analysis we only used the measurements taken during the time in which the students were in the classroom. We obtained a median [IQR] of CO2 levels which was used to conduct our analyses. All the participating schools received an operational protocol to install the sensor correctly and download data weekly.We calculated the RTI incidence per week and for the total study period. We performed a descriptive analysis of all survey variables, stratifying them by respiratory-related absence or absence due to other causes. Additionally, we ran a univariate logistic model to study the association between the type of absence and each described variable to obtain the corresponding odds ratios, 95% confidence intervals and p-values.Furthermore, we conducted a Latent Class Analysis (LCA) to explore potential groups of students with similar symptomatology. We started exploring the optimal number of latent classes, trying two to five classes, and we selected the best model using the entropy criterion, which indicates the accuracy of the latent classes, combined with other goodness of fit criteria such as BIC, cAIC and likelihood ratio. All these measures suggested that the optimal number of classes was two. However, we also examined the rest of number of classes to see if their classification had more clinical significance. All statistical analyses were performed in R (version 4.2.2).We registered one-hundred and five school absences during the study, 43 in the first study period (spring 2022), and 62 in the last one (autumn 2022) (Figure 1S ). Among these, we could obtain data related to the diagnosis in 98 (93%) cases, the rest of them were lost during the follow-up of the absence. Seventy-one absences were respiratory-related and 27 were due to other causes, mainly with gastrointestinal symptoms (66.7%). Among the absences due to RTI, the most were upper RTI (56/71, 78.9%), and only six (8.5%) were confirmed infections, 2 caused by influenza virus and 4 due to SARS-CoV-2 infection. These results represent a RTI incidence of 15.9 and 33.1 cases per 100 population in the first and second study period, respectively. The maximum weekly RTI incidence was of 10.2 cases per 100 population in December 12-18, 2022.The clinical, epidemiological and environmental characteristics of study sample are summarized in table 1 , categorized by type of absence (respiratory versus non-respiratory). We found a statistically significant association with absences due to RTI when someone else at home had respiratory symptoms (OR=9.12, CI 95%=2.54-33.39). We found a positive association between higher median levels of CO2at class and respiratory-related absences (OR=1.2, CI 95%=0.98-1.46). Moreover, there were more respiratory absences in autumn (OR=2.4, CI 95%=0.97-5.94). However, these last two associations did not reach statistical significance at a level of 0.05; although their p-values were lower than 0.1.No other epidemiological risk factors were associated with RTI incidence, such as household floor level, number of people living at home, living with smokers, having any comorbidity or being vaccinated against COVID-19.Finally, in Figure 1 , we present the symptomatology of absences belonging to each of the two latent classes. We can see that in the first cluster, the most frequent symptoms were cough, nasal congestion and fever, whereas in the second one, fever, gastrointestinal symptoms, and fatigue predominated.Our findings confirm that the RTI incidence during the study period was very high in children attending in the CNSSC schools, and the main medical cause of school absence. Although differences on school absence due to RTI were observed between spring and autumn, they were not statistically significant and in any case they may be due to the respiratory viruses’ seasonal pattern. In fact, the most important and significantly associated risk factor for RTI was the presence of someone else at home with respiratory symptoms, suggesting that households could be the main setting for initiating of the transmission of RTI.We observed a slightly association between RTI and median of CO2 levels in classrooms (p=0.07), which is an indicator of the degree of ventilation. However, we cannot exclude other potential factors such as rainfall, ambient temperature, or air pollutants (e.g. PM2.5, NO2, etc.) influencing on this outcome, as suggested by other authors10. To our knowledge, previous studies assessed the CO2concentration as a proxy of ventilation to evaluate the risk transmission of SARS-CoV-2 in schools11,12, but they did not analyse the association between CO2 median values and RTI incidence.Finally, we studied the symptomatology associated with the school absences through a LCA. The best approach to differentiate RTI from other causes was using two latent classes, and the most frequent symptoms were cough, nasal congestion and fever.The major strength of this study is our extensive data collection on clinical, epidemiological and environmental factors related to the school and also to the households of the participants. However, there were limitations such as possible incomplete reporting of RTI or insufficient sample size to determine small effect sizes. CO2 concentration was only measured in a selection of classrooms per school, so it may not be representative for the entire study period and school.In conclusion, RTI incidence was very high during the study period being the most important and significantly associated factor with RTI to have anyone else at home with respiratory symptoms. This suggests that households and not schools could be the key epidemiological factor for initiating the transmission of RTI to the children. Improving household preventive measures could reduce childhood RTI. In the LCA, the most frequent symptoms associated with RTI were cough, nasal congestion and fever. Although we found a slightly association between RTI and reduced ventilation we cannot exclude other potential factors influencing on this outcome. The study has been crucial to assess the feasibility and potential utility of collecting both school absence and morbidity data for further developing a systematic monitoring system.

Objectives: Identifying the viral etiology of Severe Acute Respiratory Syndrome (SARS) in pediatrics during the study period, understanding the importance of each agent and its impact on different age groups, comparing clinical outcomes based on identified etiology, and educating healthcare professionals and managers for future seasonal outbreaks. Study design: This is a descriptive, retrospective, cross-sectional, and quantitative study. A total of 958 pediatric patients who underwent a panel for respiratory viruses between December 2021 and June 2022 in a Brazilian secondary public hospital were selected. The electronic medical records of those who met the criteria for SARS were studied, and data was collected, compiled, graphically grouped, analyzed, and compared based on the literature available on the subject. Results: Out of the initially selected 958 patients, 532 met the criteria for SARS. The majority required respiratory support, and the most prevalent etiology during the period was Respiratory Syncytial Virus (RSV), which was also the main contributor to unfavorable outcomes. Conclusions: This study reinforces the need for prevention measures such as the use of palivizumab and the importance of a vaccine against RSV for children. Additionally, it allows for the improvement and better training of healthcare teams that faced this increase in respiratory infections with unfavorable progression during the same period.

Introduction. Respiratory syncytial virus infection is the leading cause of lower respiratory infection globally. Recently, nirsevimab has been approved to prevent RSV infection. This study explores the economically justifiable price of nirsevimab for preventing RSV infection in Colombia’s children under one year of age. Materials and methods. A static model was developed using the decision tree microsimulation to estimate the quality-adjusted costs and life years of two interventions: a single intramuscular dose of nirsevimab versus not applying nirsevimab. This analysis was made during a time horizon of 1 year and from a societal perspective. Results The annual savings in Colombia associated with this cost per dose ranged from U$ 2.5 to 4.1 million. Based on thresholds of U$4828, U$ 5128, and U$19 992 per QALY evaluated in this study, we established economically justifiable drug acquisition prices of U$ 21.88, U$ 25.04, and U$ 44.02 per dose of nirsevimab. Conclusion the economically justifiable cost for nirsevimab in Colombia is between U$21 to U$44 per dose, depending on the WTP used to decide its implementation. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

Objective: We aimed to arouse awareness of the medical staff and surgeons of possible complications, especially lethal and rare complications, of pectus excavatum (PE) surgery. Summary background data: PE is the most common deformity of the chest wall, characterized by a sternal depression. Patients with PE typically present with cosmetic concerns due to their abnormal appearance, but some patients also report exercise intolerance and shortness of breath. The prevalence and type of life-threatening complications related to the surgical repair of PE are unknown and underreported. We presented a case of lethal cardiac event following the PE surgery. We also systematically reviewed the published case reports. Methods: We described a case of lethal complication of ventricular-fibrillation and cardiac arrest following Ravitch procedure for correction of PE in a 10-year-old boy. We also systematically reviewed relevant cases of PE surgery complications. Results: From the 506 initial records that was retrieved from databases search, 95 case reports form 88 articles were identified over the 23 years. Among them, 79 patients were male, and 17 cases were female. The average age of patients was 18.9 ± 7.7 years (range: 5-53). Complications had occurred up to 37 years from the time of surgery, with most of the cases (23%) occurred during the operation. The most common complications experienced were cardiothoracic complications and displacement of the implanted steel bar. Complications resulted in death in eight cases. Conclusion: We recommend that surgeons should be aware of rare and lethal complications of PE surgery, particularly for cosmetic indications.

Background: Tree nut allergy is usually life-long and potentially life-threatening. Standard of care consists of strict avoidance of the culprit nut and symptomatic treatment of accidental reactions. Objective: To evaluate the potential therapeutic options for desensitization of patients with IgE-mediated tree nut allergy, focusing on, but not limited to, immunotherapy. Methods: We systematically searched three bibliographic databases for studies published until July 2022 for active treatments of IgE-mediated allergy to tree nuts (walnut, hazelnut, pistachio, cashew, and almond) with allergen-specific immunotherapy (AIT) using oral (OIT), sublingual (SLIT), epicutaneous (EPIT) or subcutaneous (SCIT) delivery, or with other disease-modifying treatments. Results: We included 17 studies (three randomized, double-blinded, placebo-controlled, five quasi-experimental prospective cohorts, five prospective cohorts, two retrospective cohorts, and two case reports. Three studies investigated sublingual immunotherapy, five investigated oral immunotherapy to a single tree nut, and six used multi-food oral immunotherapy with (four) or without (two) omalizumab. The remaining studies investigated the effectiveness of monoclonal antibodies in multi-food allergic patients, including patients with a tree nut allergy. The heterogeneity of the studies prevented pooling and meta-analysis. Conclusion: Even though strict avoidance remains the standard of care for patients with tree nut allergy, alternative approaches have been tested in clinical trials and real-life studies. These new concepts require further investigation with more well-designed studies including well-characterized nut allergic patients before implementing them in daily clinical practice.

The lateral hypothalamic nucleus (LHy) is located in the dorsolateral hypothalamus of birds, and it is essential to many life processes. However, limited information is available about the role of lateral hypothalamic nucleus in mediating locomotive behaviors. Therefore, we investigated the structure and function of LHy in pigeons (Columba livia) using Nissl staining, immunohistochemical (IHC) staining methods and constant current stimulation in the current work. The results shows that LHy appears crescent in shape, and the three dimensional coordinate value range is: A: 5.0-8.0 mm, L: 0.7-1.2 mm, D: 9.5-10.3 mm. The dopaminergic neurons in the LHy were distributed in a small amount in a concentrated manner, while the glutamatergic neurons were in a large number of uniform distributions. The distribution of the two types of neurons at each coronal level showed a significant positive correlation (R 2 = 0.7516, P < 0.001). LHy mainly mediate forward movement (P < 0.01) and ipsilateral lateral movement (P < 0.001), and both of them are significantly affected by the intensity of electrical stimulation. Our results show that LHy can mediate the generation of directional behavior in birds, which provides reliable technical support for the research of animal robots.

A document by Raquel Díaz Borrego. Click on the document to view its contents.

Attached algae are important primary producers in river ecosystems and are foraged by benthic macroinvertebrates and grazing fishes. The ayu Plecoglossus altivelis is an algae-feeding fish that feeds on attached algae and is an important fishery resource and conservation species in Japanese rivers. While P. altivelis uses its comb-like teeth to graze algae off the surface of stones for feeding, fine particulate organic matter (FPOM) is generated by dislodging algae into streams. Moreover, egested feces contribute to the origin of FPOM. Therefore, in this study, the contribution of feeding on algae by P. altivelis to the production of algal-derived FPOM was investigated. The produced FPOM was then evaluated to determine whether it affected the food origin of the macroinvertebrates. To investigate the population density of P. altivelis, the biomass of primary producers and food-use fraction of consumers, field surveys in the Kamo-gawa River, Japan, were conducted in the summer season from 2018 to 2020. The carbon and nitrogen stable isotope ratios of the macroinvertebrates and food sources were also measured to estimate the composition of FPOM and the contribution of food sources to primary consumers. These results showed that the algal biomass decreased at sites with high density for P. altivelis, in which the proportion of algal-derived FPOM similarly increased. Regardless of the feeding functional groups, the algal contribution of macroinvertebrates increased at sites with high algal-derived FPOM. Structural equation modeling revealed that P. altivelis feeding behavior contributed to macroinvertebrate food utilization via the production of algal-derived FPOM. These results suggested that P. altivelis is a keystone species that not only produces algal-derived FPOM but also improves the food supply to macroinvertebrates and promotes the dynamics of river ecosystems.

Public health concerns about recent viral epidemics have motivated researchers to seek novel ways to understand pathogen infection in native, wildlife hosts. With its deep history of tools and perspectives for understanding the abundance and distribution of organisms, ecology can shed new light on viral infection dynamics. However, datasets allowing deep explorations of viral communities from an ecological perspective are lacking. We sampled 1,086 bats from two, adjacent Puerto Rican caves and tested them for infection by herpesviruses, resulting in 3,131 short, viral sequences. Using percent identity of nucleotides and a machine learning algorithm (affinity propagation), we categorized herpesviruses into 43 operational taxonomic units (OTUs), to be used in place of species in subsequent ecological analyses. Herpesvirus metacommunities demonstrated long-tailed rank frequency distributions at all analyzed levels of host organization (i.e., individual, population, and community). Although 13 herpesvirus OTUs were detected in more than one host species, OTUs generally exhibited host specificity by infecting a single core host species at a significantly higher prevalence than in all satellite species combined. We describes the natural history of herpesvirus metacommunities in Puerto Rican bats and suggest that viruses follow the general law that communities comprise few common and many rare species. To guide future efforts in the field of viral ecology, hypotheses are presented regarding mechanisms that contribute to these patterns.

The study characterises the spatial distribution of a selection of nutrients from the literature review. A relationship is also established between the selected nutrients and chlorophyll a, which is characteristic of the trophic level of a water body. We used data from water withdrawals during the high and low water seasons, linked to specific coordinates, but also surveys of 36 producers around the shores of the lake. Our results show different levels of nutrients in the water body, modelled according to the lake’s right of way. The spatial distribution of aquatic species is also disparate, as they are strongly correlated with these nutrients, and the distribution of nutrients in the water body depends on seasonality and parameters and the presence of macrophytes according to the presence of nutrients. As for the farmers, 100% of them use chemical fertilisers and organic manure in their production. These practices increase the presence of nutrients in the water body. Our results confirm the fact that the spatial analysis of the distribution of nutrients in the water body is, on the one hand, strongly linked to the agricultural activities around the shores of the lake and that they have an impact on the health of the lake. This analysis will make it possible to understand and know the most influential and problematic nutrient for the proper management of this water body.

Understanding the stable hydrogen and oxygen isotope composition of river water in the basin is of great significance for identifying the evolution mechanism of water cycle and the composition of water source. Based on the test results of δD and δ 18O of river water and precipitation samples collected from Shiyang River in August 2020, this paper analyzed the composition characteristics of δ 18O and δD of river water in Shiyang River Basin during rainy period, and further revealed the spatial evolution characteristics and influencing factors. The results show that the δ 18O and δD values of the main and tributaries of Shiyang River are gradually enriched along the river, showing an increasing trend, while the excess deuterium is decreasing along the river. The effect of δ 18O and δD in river water is significant, and the variation of δ 18O altitude gradient is smaller than that of local precipitation and global precipitation. Using the evaporation loss calculation model, it can be seen that evaporation fractionation has an obvious effect on the water isotope change of Shiyang River, and the main stream of Shiyang River has the greatest effect, followed by Jinta River and Zamu River. The evaporation of reservoir water is more intense than that of river water. Precipitation is the main source of river water, and the isotope is mainly affected by the isotopic composition of river water in tributaries, and is controlled by the elevation effect, the continuous evaporation effect along the direction of runoff, and the higher degree of evaporation effect in the rainy season.

Streambank erosion impacts rivers and reservoirs due to bank erosion. However, little information of stream bank is available due to the need for advanced planning. Dendrogeomorphology offers a post-hoc method to calculate streambank erosion providing information about past erosion events and processes. Bank retreat can be calculated by dendrogeomorphology where the distance from a channel bank of an exposed live root shows anatomical changes that are dated from the root’s growth rings. We estimated bank erosion for three different sized southern U.S. watersheds ranging in area from 4 to 3781 km 2 using dendrogeomorphology compared to modeled erosion based on critical velocity required for sediment transport. Erosion values ranging from 3.8 to 13.5 cm/yr for the smaller drainages with no difference found between root and modeled erosion rates. The large sub-basin had erosion ranging from 33.6 to 196.4 cm/yr with high variance associated with two prior 2-year flow events with significant differences found between root and modeled values. We also found distance to bank strongly and positively correlated with root exposure in straight sections of the channel in contrast to roots collected in meander bends attributed to erosion processes (i.e., scour, mass wasting) occurring at these locations. When compared with other erosion studies across the southern U.S. prairie, our values were similar in magnitude but with low correlation to drainage area indicating site specificity of erosion mechanisms. We confirm dendrogeomorphology provides reasonable estimate of bank erosion across multiple spatial scales, important for watershed management in areas lacking intentional and persistent monitoring.

River ecosystems are facing a deepening biodiversity crisis. Developing robust biotic indicators to assess ecological status across large spatial scales are important. In the subtropical Liuxi River of southern China, 34 fish indicators, including 4 genera and 30 species, were selected from 108 fish species by linear discriminant analysis. These indicators were combined into 18 groups and assigned scores according to their species-specific requirements for food resources and habitat patterns. The ecological and trophic functioning of optimized indicators can reflect not only the community diversity and food web properties but also the environmental quality of the ecosystem. Three formulas for calculating the index of fish indicators ( IFI) were developed based on the scoring of each indicator and weighted by relative abundance (individual number, i.e., IFIN) and relative biomass (wet weight, i.e., IFIB). Spearman correlation analysis showed that IFIB exhibited a more powerful explanation of biodiversity and environmental factors than IFIN and unweighted IFI. Therefore, we conclude that IFIB has absolute advantages in constructing an indicator-based environmental evaluation system since it contains comprehensive information on biology and ecology. In the future, the application of indicator scoring methods can contribute greatly to the conservation and development of aquatic ecosystems.