Unique and fragile diversity emerges from Brazilian caves – two new amphibious species of Xangoniscus Campos-Filho, Araujo & Taiti, 2014 (Oniscidea, Styloniscidae) from Serra do Ramalho karst area, state of Bahia, Brazil

Two new troglobitic species of Xangoniscus are described from two caves of Serra do Ramalho karst area, Bambuí geomorphological group, state of Bahia. Xangoniscus lapaensissp. nov. is described from Gruna Boca da Lapa cave, and X. loboisp. nov. from Gruna da Pingueira II cave. Both species are blind and depigmented and show amphibious habits, as observed for all species of Xangoniscus described until now. Xangoniscus lapaensissp. nov. occurs in travertine pools fed by water of the upper aquifer, and X. loboisp. nov. occurs in a small stream, an upper vadose tributary. Both species occur in fragile microhabitats. Ecological and behavioral data, conservation remarks, and IUCN conservation assessments are included to provide background data for conservation efforts in this unique karst area.

Effect of Physical Activity on the Development and the Resolution of Nonalcoholic Fatty Liver in Relation to Body Mass Index

BACKGROUND Data on whether physical activity (PA) levels are related to nonalcoholic fatty liver disease (NAFLD) when considering body mass index (BMI) are scarce. We assessed whether PA affects the development or resolution of NAFLD in conjunction with BMI changes. METHODS Overall, 130,144 participants who underwent health screening during 2011-2016 were enrolled. According to the PA level in the Korean version of the validated International PA Questionnaire Short Form, participants were classified into the inactive, active, and health-enhancing PA (HEPA) groups. RESULTS In participants with increased BMI, the hazard ratio (HR) and 95% confidence interval after multivariable Cox hazard model for incident NAFLD was 0.97 (0.94-1.01) in the active group and 0.94 (0.89-0.99) in the HEPA group, whereas that for NAFLD resolution was 1.03 (0.92-1.16) and 1.04 (0.88-1.23) (reference: inactive group). With increased BMI, high PA affected only new incident NAFLD. PA enhancement or maintenance of sufficient PA prevented new incident NAFLD. In participants with decreased BMI, the HRs were 0.98 (0.90-1.07) and 0.88 (0.78-0.99) for incident NAFLD and 1.07 (0.98-1.17) and 1.33 (1.18-1.49) for NAFLD resolution in the active and HEPA groups, respectively. With decreased BMI, high PA reduced incident NAFLD and increased NAFLD resolution. Maintenance of sufficient PA led to a considerable resolution of NAFLD. CONCLUSION In this large longitudinal study, PA prevented incident NAFLD regardless of BMI changes. For NAFLD resolution, sufficient PA was essential along with BMI decrease. Maintaining sufficient PA or increasing the PA level is crucial for NAFLD prevention or resolution.

Two Cases of Iatrogenic Lumbar Foraminal Disc Herniations

Study Design. A case report. Objective. We report two cases of iatrogenic deterioration of lumbar foraminal disc herniations following lumbar disc injections. Summary of Background Data. Complications associated with discography were reported. However, only a few reports have thus far referred to the iatrogenic deterioration of lumbar foraminal disc herniations. Cases. 60-year-old and 74-year-old men were treated with MR images of L4-5 foraminal disc herniations without fragment in the spinal canal. The patients underwent discography and disc block for its diagnosis and treatment. After disc injections, both patients complained of deterioration of L4 radiculopathy. Results. On disco-CT or reexamined MR images after disc injections, herniated fragment was migrated from neural foramen to cranial central spinal canal with was not shown in previous MR images. The herniated fragments were extirpated by means of osteoplastic laminoplasty or transforaminal lumbar interbody fusion with facetectomy. The herniated fragments were migrated from neural foramen to cranial central spinal canal. Conclusions. The injection of liquid medicine into the nucleus led the intradiscal pressure increased, and the disc fragment might prolapsed through the raptured region of annulus fibrosus and migrated to cranial central spinal canal by anatomical reason. The disc injection may have a risk for deterioration of foraminal disc herniation. Our report is instructive for the management of discography for the diagnosis of foraminal disc herniations.

Endoscopic Diagnosis of Biliary Stricture Combined with Digital Cholangioscope: A Case Series

The endoscopic diagnosis of biliary tract lesions is applied as a non-invasive method; however, its diagnostic accuracy is not yet high. Moreover, digital cholangioscopy is used for directly visualizing the inside of the bile duct, resulting in a more precise biopsy. We present the case series of the outcomes of diagnosis using digital cholangioscopy in patients who underwent cholangioscopy for the evaluation of biliary stenosis in our department between January 2014 and March 2021. The controls were those who underwent a biopsy for biliary stenosis with conventional endoscopic retrograde cholangiopancreatography (ERCP). Background data for each case were collected, and the clinical outcomes by biopsy were evaluated, focusing on the accuracy of the diagnosis. Cholangioscopy was performed in 15 cases, while a conventional biopsy by ERCP was performed in 172 cases. Nine of 15 cases (60.0%) were diagnosed with cholangiocarcinoma. The number of specimens obtained through conventional ERCP and cholangioscopy was 2.5 ± 1.3 and 3.3 ± 1.5, respectively (p = 0.043). The diagnostic accuracy of conventional ERCP and cholangioscopy were 65.7% (113 of 172 cases) and 100%, respectively, which was significantly higher in the group with cholangioscopy. Digital cholangioscopy is useful when the diagnosis of the biliary stricture using the conventional ERCP method is difficult.

A novel method to predict nonvisible symptoms using machine learning in cancer palliative care

Patients with cancer at the end of life may find it difficult to express their symptoms if they can no longer communicate verbally because of deteriorating health. In this study, we assessed these symptoms using machine learning. We conducted a clinical survey of 213 cancer patients from August 2015 to August 2016. We divided the reported symptoms into two groups—visible and nonvisible symptoms. Our machine learning model used patient background data and visible symptoms to predict nonvisible symptoms: pain, dyspnea, fatigue, drowsiness, anxiety, delirium, inadequate informed consent, and spiritual issues. The highest and/or lowest values for prediction accuracy, sensitivity, and specificity, respectively, are as follows: 88.0%/55.5%, 84.9%/3·3%, and 96.7%/24.1%. This work will facilitate better assessment and management of symptoms in patients with cancer.

Comparison between Dexamethasone and Methylprednisolone Therapy in Patients with COVID-19 Pneumonia Admitted to Non-Intensive Medical Units

(1) Background: Data on different steroid compounds for the treatment of hospitalized COVID-19 (coronavirus disease 2019) patients are still limited. The aim of this study was to compare COVID-19 patients admitted to non-intensive units and treated with methylprednisolone or dexamethasone. (2) Methods: This was a single-center retrospective study that included consecutive patients with COVID-19 hospitalized in medical wards during the second wave of the pandemic. Thirty-day mortality and the need for intensive or semi-intensive care were the main clinical outcomes analyzed in patients receiving methylprednisolone (60 mg/day) compared with dexamethasone (6 mg/day). Secondary outcomes included complication rates, length of hospital stay, and time to viral clearance. (3) Results: Two-hundred-forty-six patients were included in the analysis, 110 treated with dexamethasone and 136 with methylprednisolone. No statistically significant differences were found between the two groups of patients regarding 30-day mortality (OR 1.35, CI95% 0.71–2.56, p = 0.351) and the need for intensive or semi-intensive care (OR 1.94, CI95% 0.81–4.66, p = 0.136). The complication rates, length of hospital stay, and time to viral clearance did not significantly differ between the two groups. (4) Conclusions: In patients hospitalized for COVID-19 in non-intensive units, the choice of different steroid compounds, such as dexamethasone or methylprednisolone, did not affect the main clinical outcomes.

Seismic Wave Field Anomaly Identification of Ultra-Deep Heterogeneous Fractured-Vuggy Reservoirs: A Case Study in Tarim Basin, China

Ultra-deep (7500–9000 m) Ordovician tight limestone heterogeneous fractured-vuggy reservoir is an important target of FuMan Oilfield in Tarim Basin. The strike-slip fault controlled reservoir is related to formation fracture and dissolution caused by geological stress. The seismic wave-field anomaly characteristics with different energy and irregular waveform are displayed in the seismic profile. Accurate identification of fractured-vuggy reservoirs wrapped in tight limestone is the direct scheme to improve production efficiency. Therefore, a new combination method flow of seismic wave-field anomaly recognition is proposed. In this process, the seismic data must be preprocessed initially, and on this basis, robust formation dip scanning is carried out. Secondly, the dip data is applied to the transverse smoothing filter to obtain the formation background data. Eventually, the seismic wave-field anomaly data is the residual between background data and original seismic data. This method has been applied in blocks with different structural characteristics and can effectively improve the resolution of strike-slip fault controlled reservoirs. Based on the results, the drilling success rate is increased to more than 95%, and the high-yield rate of oil tests is increased to 75% in 2021. Multiple applications indicate that the method is robust and can be popularized.

Marketisation of adult education in Sweden

The aim of this study is to analyse how formal adult education in Sweden is enacted locally. For this analysis, the data consist of a nationwide survey sent to Swedish municipalities, background data on municipalities from public statistics and interviews with representatives of 20 municipalities. Swedish formal adult education, which includes general, vocational and Swedish for immigrants courses, is a responsibility of the municipality, but courses are not necessarily organised internally by the municipality. The results show how adult education is enacted in different ways. There are systems for outsourcing courses to various other providers, typically private training companies. There are thus both private and public providers, but courses are paid for by the municipality, which is also responsible of quality assurance. The quality assurance is typically enacted with a focus on students, via surveys and statistics on outcomes, but quality measures also target providers. Swedish adult education is characterised by extensive marketisation with many private providers and a broad supply of courses, but the municipalities are experiencing quality problems among providers, and some municipalities are considering extending their internal provision. There is also a labour-market focus where training programmes to improve adults’ employability are prioritised.

The risk of cirrhosis and its complications based on PNPLA3 rs738409 G allele frequency

Background: Data regarding the influence of patatin-like phospholipase domain-containing 3 (PNPLA3) polymorphism for patients with liver cirrhosis (LC) are scarce. Objective: This study assesses the role of the PNPLA3 polymorphism for the development of LC and its complications by the findings of genetic examinations. Methods: Patients with LC caused by virus (n = 157), alcohol (n = 104), nonalcoholic fatty liver disease (NAFLD) (n = 106), or autoimmune disease (n = 33) and without LC (n = 128) were enrolled. LC were composed of the present and absent of complications, such as variceal bleeding, hepatic ascites, and/or hepatic encephalopathy. To assess the role of the PNPLA3 polymorphism, odds ratio (OR) for the rs738409 variant was calculated for the patients between (i) with LC and without LC in the entire cohort, and (ii) the present and absent of complications in the patients with LC. Results: There was a significant difference among the patients without LC and those with alcohol, NAFLD related LC in the frequency of G alleles (p < 0.001, both). According to complications of LC, the OR for NAFLD related cirrhosis significantly increased in the presence of the two mutated alleles (OR = 3.165; p = 0.046) when the wild type was used as the reference. However, there were no significant risks for the complications in the virus and alcohol related cirrhosis unless there was a presence of G alleles. Conclusion: The PNPLA3 polymorphism was associated with the risk of NAFLD related LC and its complications.

Continued Effectiveness of COVID-19 Vaccination among Urban Healthcare Workers during Delta Variant Predominance

Background: Data on COVID-19 vaccine effectiveness (VE) among healthcare workers (HCWs) during periods of delta variant predominance are limited. Methods: We followed a population of urban Massachusetts HCWs (45% non-White) subject to epidemiologic surveillance. We accounted for covariates such as demographics and community background infection incidence, as well as information bias regarding COVID-19 diagnosis and vaccination status. Results and Discussion: During the study period (December 16, 2020 to September 30, 2021), 4615 HCWs contributed to a total of 1,152,486 person-days at risk (excluding 309 HCWs with prior infection) and had a COVID-19 incidence rate of 5.2/10,000 (114 infections out of 219,842 person-days) for unvaccinated person-days and 0.6/10,000 (49 infections out of 830,084 person-days) for fully vaccinated person-days, resulting in an adjusted VE of 82.3% (95% CI: 75.1-87.4%). For the secondary analysis limited to the period of delta variant predominance in Massachusetts (i.e., July 1 to September 30, 2021), we observed an adjusted VE of 76.5% (95% CI: 40.9-90.6%). Independently, we found no re-infection among those with prior COVID-19, contributing to 74,557 re-infection-free person-days, adding to the evidence base for the robustness of naturally acquired immunity.