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IMPORTANCE: In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the post-resuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover In-Hospital Cardiac Arrest (Discover IHCA) study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort. OBJECTIVES: Our study collects granular data on post-IHCA treatment practices, focusing on temperature control and prognostication, with the objective of describing variation in current post-IHCA practice. DESIGN, SETTING, AND PARTICIPANTS: This is a multicenter, prospectively collected, observational cohort study of patients who have suffered IHCA and have been successfully resuscitated (achieved ROSC). There are 24 enrolling hospital systems (23 in the United States) with 69 individual enrolling hospitals (39 in the United States). We developed a standardized data dictionary, and data collection began in October 2023, with a projected 1000 total enrollments. Discover IHCA is endorsed by the Society of Critical Care Medicine. INTERVENTIONS, OUTCOMES, AND ANALYSIS: The study collects data on patient characteristics including pre-arrest frailty, arrest characteristics, and detailed information on post-arrest practices and outcomes. Data collection on post-IHCA practice was structured around current American Heart Association and European Resuscitation Council guidelines. Among other data elements, the study captures post-arrest temperature control interventions and post-arrest prognostication methods. Analysis will evaluate variations in practice and their association with mortality and neurologic function. CONCLUSIONS: We expect this study, Discover IHCA, to identify variability in practice and outcomes following IHCA, and be a vital resource for future investigations into best-practice for managing patients after IHCA.

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We herein report a case of an unusual variant of Guillain-Barré syndrome (GBS) where the patient presented with multiple bilateral cranial nerve palsies involving nerves V, VII, IX, and X, leading to difficulties with eye closure, eyebrow-raising, chewing, swallowing, and speech. Sensation and motor examination were normal. Bilateral knee reflexes were absent. Lumbar puncture showed cerebrospinal fluid albuminoid-cytologic dissociation. Prompt initiation of plasmapheresis therapy facilitated a successful recovery. This case report underscores the significance of early identification and tailored intervention for atypical GBS presentations, highlighting the potential for improved patient outcomes through targeted management strategies.

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Non-binary people face numerous stressors in their daily lives, including personal, interpersonal, and environmental. These stressors gain strength when such individuals access healthcare services, and discrimination and cisgenderism become the main barrier to obtaining gender-affirming healthcare. This study aimed to describe the experiences of non-binary people regarding the care and medical attention received in Catalonia (Spain). A qualitative phenomenological study was conducted with 21 non-binary people recruited using snowball sampling in 2022. Data were gathered through open-ended interviews and analyzed using thematic analysis. Two main themes were identified, which were further classified into two categories each: Theme 1-This is me composed of the categories, "My Name and My Pronouns" and "One's Chosen Gender," and Theme 2-I do not exist for the health system consisting of "Uneducated Health System in Sexual Health" and "Feeling Like an Outsider for Being Non-Binary." Non-binary people face multiple stressors when accessing the healthcare services that makes them feel invisible, vulnerable, and marginalized. Further widespread implementation of person-centered care is essential to promote the relationship between non-binary people and the healthcare system. In addition, further sexual health training is required for all health professionals.

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RESUMEN Fundamento: la detección y clasificación precisa del cáncer de mama mediante el diagnóstico histopatológico es de vital importancia para el tratamiento efectivo de la enfermedad. Entre los tipos de cáncer de mama, el carcinoma ductal invasivo es el más frecuente. El análisis visual de las muestras de tejido en el microscopio es un proceso manual que consume tiempo y depende del observador. Sin embargo, en muchos países, incluido Cuba, es escaso el uso de herramientas software para asistir el diagnóstico. Objetivo: desarrollar una herramienta software para detectar tejido de cáncer de mama, del subtipo carcinoma ductal invasivo, en imágenes histopatológicas. Métodos: la herramienta se implementó en Python e incluye métodos de detección de carcinoma ductal invasivo en imágenes histopatológicas, basados en algoritmos de extracción de características de color y textura en combinación con un clasificador de bosques aleatorios. Resultados: la herramienta de código abierto brinda una serie de facilidades para la lectura, escritura y visualización de imágenes histopatológicas, delineación automática y manual de zonas cancerígenas, gestión de los datos diagnósticos del paciente y evaluación colaborativa a distancia. Fue evaluada en una base de datos con 162 imágenes de pacientes diagnosticados con carcinoma ductal invasivo y se obtuvo una exactitud balanceada de 84 % y factor F1 de 75 %. Conclusiones: la herramienta permitió un análisis interactivo, rápido, reproducible y colaborativo mediante una interfaz gráfica sencilla e intuitiva. En versiones futuras se prevé incluir nuevos métodos de aprendizaje automático incremental para el análisis de imágenes histopatológicas digitales.

ABSTRACT Background: the accurate detection and classification of breast cancer through histopathological diagnosis is of vital importance for the effective treatment of the disease. Among the types of breast cancer, invasive ductal carcinoma (IDC) is the most common. Visual analysis of tissue samples under the microscope is a manual, time-consuming and observer-dependent process. However, in many countries, including Cuba, the use of software tools to assist diagnosis is scarce. Objective: to develop a software tool to detect IDC subtype breast cancer tissue in histopathological images. Methods: the tool is implemented in Python and includes IDC detection methods in histopathological images, based on algorithms for extraction of color and texture features in combination with a random forest classifier. Results: the open source tool provides a series of facilities for the reading, writing and visualization of histopathological images, automatic and manual delineation of cancer areas, management of patient diagnostic data and collaborative remote evaluation. It was evaluated in a database with 162 images of patients diagnosed with IDC, obtaining a balanced accuracy of 84 % and a F1 factor of 75 %. Conclusions: the tool allowed an interactive, fast, reproducible, precise and collaborative analysis through a simple and intuitive graphical interface. Future versions are expected to include new incremental machine learning methods for the analysis of digital histopathology images.

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We present the implementation of an efficient terahertz (THz) photoconductive antenna (PCA) emitter design that utilizes high mobility carriers in the two-dimensional electron gas (2DEG) of a modulation-doped heterostructure (MDH). The PCA design is fabricated with recessed metal electrodes in direct contact with the 2DEG region of the MDH. We compare the performance of the MDH PCA having recessed contacts with a PCA fabricated on bulk semi-insulating GaAs, on low temperature-grown GaAs, and a MDH PCA with the contacts fabricated on the surface. By recessing the contacts, the applied bias can effectively accelerate the high-mobility carriers within the 2DEG, which increases the THz power emission by at least an order of magnitude compared to those with conventional structures. The dynamic range (62 dB) and bandwidth characteristics (3.2 THz) in the power spectrum are shown to be comparable with the reference samples. Drude-Lorentz simulations corroborate the results that the higher-mobility carriers in the MDH, increase the THz emission. The saturation characteristics were also measured via optical fluence dependence, revealing a lower saturation value compared to the reference samples. The high THz conversion efficiency of the MDH-PCA with recessed contacts at low optical power makes it an attractive candidate for THz-time domain spectroscopy systems powered by low power fiber lasers.

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Introducción: el nódulo pulmonar solitario es uno de los problemas más frecuentes en la práctica del radiólogo, que constituye un hallazgo incidental habitual en los estudios torácicos realizados durante el ejercicio clínico diario. Objetivo: implementar un sistema de diagnóstico asistido por computadora que facilite la detección del nódulo pulmonar solitario en las series de imágenes de tomografía computarizada multicorte. Métodos: se utilizó Matlab para el desarrollo y evaluación de un conjunto de algoritmos que constituyen elementos necesarios de un sistema de diagnóstico asistido por computadora. En orden: un algoritmo para la extracción de las regiones de interés, algoritmo para la extracción de características y un algoritmo de detección de nódulo pulmonar solitario para el cual se probaron varios clasificadores. La evaluación de los algoritmos fue efectuada en base a las anotaciones realizada por especialistas a la colección de imágenes LIDC-IDRI (Lung Image Database Consortium). Resultados: el método de segmentación empleado para extracción de las regiones de interés permitió generar la adecuada división de las imágenes originales en regiones significativas. El algoritmo utilizado en la detección mostró para el conjunto de prueba además de buena exactitud (de 96,4 por ciento), un buen balance de sensibilidad (91,5 por ciento) para una tasa de 0,84 falsos positivos por imagen. Conclusiones: el trabajo de investigación y la implementación realizada se reflejan en la construcción de una interfaz gráfica en Matlab como prototipo del sistema de diagnóstico asistido por computadora, con el que se puede contribuir a detectar más fácilmente el NPS(AU)

Introduction: solitary pulmonary nodules are one of the most frequent problems in radiographic practice. They are a common incidental finding in chest studies conducted during routine clinical work. Objective: implement a computer-assisted diagnostic system facilitating detection of solitary pulmonary nodules in multicut computerized tomography image series. Methods: Matlab was used to develop and evaluate a set of algorithms constituting necessary components of a computer-assisted diagnostic system. The order was the following: an algorithm to extract regions of interest, another to extract characteristics, and another to detect solitary pulmonary nodules, for which several classifiers were tested. Evaluation of the algorithms was based on notes taken by specialists on the LIDC-IDRI (Lung Image Database Consortium) image collection. Results: the segmentation method used for extraction of regions of interest made it possible to create a suitable division of the original images into significant regions. The algorithm used for detection found that the test set exhibited good accuracy (96.4%), a good sensitivity balance (91.5%), and a 0.84 rate of false positives per image. Conclusions: the research and implementation work done is reflected in the construction of a Matlab graphic interface serving as a prototype for a computer-assisted diagnostic system which may facilitate detection of SPNs.

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During force production, hand muscle activity is known to be coherent with activity in primary motor cortex, specifically in the beta-band (15-30 Hz) frequency range. It is not clear, however, if this coherence reflects the control strategy selected by the nervous system for a given task, or if it instead reflects an intrinsic property of cortico-spinal communication. Here, we measured corticomuscular and intermuscular coherence between muscles of index finger and thumb while a two-finger pinch grip of identical net force was applied to objects which were either stable (allowing synergistic activation of finger muscles) or unstable (requiring individuated finger control). We found that beta-band corticomuscular coherence with the first dorsal interosseous (FDI) and abductor pollicis brevis (APB) muscles, as well as their beta-band coherence with each other, was significantly reduced when individuated control of the thumb and index finger was required. We interpret these findings to show that beta-band coherence is reflective of a synergistic control strategy in which the cortex binds task-related motor neurons into functional units.

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The quadricuspid pulmonary valve (QPV) is a rare congenital anomaly reported in the general population. There are less than 300 reported cases in the literature to date. It has been found in one in 400 to one in 2000 autopsies. We describe here the case of a 47-year-old patient who presents with a QPV with double valvular lesions (stenosis and insufficiency), causing a poststenotic dilatation of the trunk and the left branch of the pulmonary artery (PA). The diagnosis was made by transesophageal echocardiography (TEE) and confirmed by tomographic angiography (computed tomography). The English as well as the Spanish literature were reviewed. To the best of our knowledge, this is the first case of: (1) congenital QPV with double valvular lesions (stenosis and insufficiency), complicated with (2) aneurysmatic dilatation of the PA trunk as well as left branch, and (3) diagnosed by a TEE.

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El objetivo de esta investigación fue determinar el efecto de un programa de Hatha-Yoga sobre variables psicológicas (calidad de vida, ansiedad, depresión, memoria de trabajo y velocidad de procesamiento), físicas (equilibrio y flexibilidad) y funcionales (actividades básicas e instrumentales), en un grupo de pacientes con Demencia Tipo Alzheimer (DTA) de Bogotá. En la investigación participaron ocho adultos mayores con diagnóstico de DTA de 60 años, diagnosticados por el equipo médico de la Fundación Cardio Infantil y con una puntuación de 5 en la Escala de Deterioro Global de Reisberg (GDS). Para el análisis de resultados se utilizó estadística descriptiva para establecer comparaciones intraparticipante en las mediciones realizadas antes y después del programa de Hatha-Yoga y además, se usó estadística inferencial para la prueba de hipótesis a partir de la prueba de signos Wilcoxon encontrándose mejoría en las variables físicas de equilibrio y flexibilidad.

The main interest of this research was to determine the effect of Hatha Yoga program on psychological (quality of life, anxiety, depression, working memory and processing speed), physical (balance and flexibility) and functional (basic and instrumental activities) variables in Alzheimer patient group from Bogota. Eight adults 60 years old diagnosed with Moderate Alzheimer Dementia by health team from Fundación Cardio Infantil and with score of 5 in the Global Deterioration Scale (GDS) participated in this study Descriptive statistics was used to make comparisons in measurements taken before and after the Hatha Yoga program and inferential statistics were used to test hypotheses. Increases in balance and flexibility was found with Wilcoxon test.

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Lutembacher's syndrome is a rare clinical combination of congenital ostium secundum atrial septal defect associated with acquired mitral valve stenosis (usually rheumatic). This unusual cardiac entity is difficult to diagnose clinically because each lesion alters the hemodynamics and clinical characteristics of the other. The resulting clinical manifestations depend chiefly on the size of the defect, the severity of the mitral stenosis, and the compliance of the right ventricle. We present a classic case of Lutembacher's syndrome and illustrate the pitfalls and advantages of echocardiography in the correct diagnosis of the syndrome.

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BACKGROUND: Resistance to tamoxifen, a selective estrogen receptor modulator (SERM), involves changes that prevent apoptosis and enhance cell proliferation and survival. Paradoxically, estrogen treatment inhibits the growth of long-term tamoxifen-treated breast tumors. Because of the increasing use of raloxifene, another SERM, to prevent osteoporosis and potentially reduce breast cancer risk, some women will develop raloxifene-resistant breast cancer. We developed a raloxifene-resistant MCF-7 cell model (MCF-7/Ral) and investigated the nature of raloxifene-resistant breast cancer and its response to estradiol. METHODS: Raloxifene resistance and hormone responsiveness were assessed by proliferation assays and cell cycle analysis in parental MCF-7 and MCF-7/Ral cells. Nuclear factor kappaB (NF-kappaB) activity was investigated with a transient transfection assay. Apoptosis was investigated by annexin V staining, mRNA was measured by real-time polymerase chain reaction, and protein was measured by western blotting. Tumorigenesis was studied by injecting MCF-7 or MCF-7/Ral cells into ovariectomized athymic mice (10 per group) and monitoring tumor size weekly. All statistical tests were two-sided. RESULTS: Basal NF-kappaB activity was higher in MCF-7/Ral cells (1.6 U, 95% confidence interval [CI] = 1.2 to 2.0 U) than in MCF-7 cells (0.8 U, 95% CI = 0.4 to 1.1 U; P =.004). When cultured with 1 microM raloxifene, MCF-7/Ral cells grew statistically significantly (P<.001) faster than MCF-7 cells. Estradiol treatment of MCF-7/Ral cells arrested cells in G(2)/M phase of the cell cycle, decreased NF-kappaB activity (0.2 U, 95% CI = 0.2 to 0.3 U; P<.001), increased expression of Fas protein and mRNA (4.5-fold, 95% CI = 2.8- to 6.3-fold versus 0.5-fold, 95% CI = 0.3- to 0.8-fold for control treatment; P<.001), and induced apoptosis. Treatment with either raloxifene or tamoxifen stimulated MCF-7/Ral tumor growth, suggesting that such tumors were resistant to both drugs. When a 9-week raloxifene or tamoxifen treatment was followed by a 5-week estradiol treatment, estradiol statistically significantly reduced the size of tumors stimulated by raloxifene or tamoxifen (at week 14, P =.004 for raloxifene and P<.001 for tamoxifen). CONCLUSIONS: Growth of raloxifene-resistant MCF-7/Ral cells in vitro and in vivo is repressed by estradiol treatment by a mechanism involving G2/M-phase arrest, decreased NF-kappaB activity, and increased Fas expression to induce apoptosis.

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American society favors life style habits that lead to a plethora of physical disabilities, i.e., poor nutrition and a lack of exercise contribute to chronic disabilities and disease. Even though our life expectancies have increased, chronic disorders such as sarcopenia, diabetes, stroke and cardiovascular disease have become more prevalent. Nevertheless, Americans are slowly becoming more educated in health practices. A variety of therapies and nutritional supplements are being investigated to prevent and/or counteract chronic health disorders and aging. Muscle wasting referred to as "sarcopenia" commonly occurs in the elderly. This is very unfortunate, because the aging human body has the intrinsic ability to maintain itself in a healthy state, e.g., maintain muscle. Proper physical activity and a healthful diet in the elderly are the best ways to counteract the sarcopenia and other aspects of the aging phenomenon. In addition, potential replacement therapy and supplements are fervently being researched in hope of finding the next "Fountain of Youth." With important discoveries made everyday, progress is being made towards a future where both the young and old will have an improved quality of life based on improved knowledge of fitness, nutrition, replacement and supplemental therapy.

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Amino acid Asp-351 in the ligand binding domain of estrogen receptor alpha (ERalpha) plays an important role in regulating the estrogen-like activity of selective estrogen receptor modulator-ERalpha complexes. 4-Hydroxytamoxifen is a full agonist at a transforming growth factor alpha target gene in situ in MDA-MB-231 human breast cancer cells stably transfected with the wild-type ERalpha. In contrast, raloxifene (Ral), which is also a selective estrogen receptor modulator, is a complete antiestrogen in this system. Because D351G ERalpha allosterically silences activation function-1 activity in the 4-hydroxytamoxifen-ERalpha complex with the complete loss of estrogen-like activity, we examined the converse interaction of amino acid 351 and the piperidine ring of the antiestrogen side chain of raloxifene to enhance estrogen-like action. MDA-MB-231 cells were either transiently or stably transfected with Asp-351 (the wild type), D351E, D351Y, or D351F ERalpha expression vectors. Profound differences in the agonist and antagonist actions of Ralcenter dotERalpha complexes were noted only in stable transfectants. The agonist activity of the Ralcenter dotERalpha complex was enhanced with D351E and D351Y ERalpha, but raloxifene lost its agonist activity with D351F ERalpha. The distance between the piperidine nitrogen of raloxifene and the negative charge of amino acid 351 was critical for estrogen-like actions. The role of the piperidine ring in neutralizing Asp-351 was addressed using compound R1h, a raloxifene derivative replacing the nitrogen on its piperidine ring with a carbon to form cyclohexane. The derivative was a potent agonist with wild type ERalpha. These results support the concept that the side chain of raloxifene shields and neutralizes the Asp-351 to produce an antiestrogenic ERalpha complex. Alteration of either the side chain or its relationship with the negative charge at amino acid 351 controls the estrogen-like action at activating function 2b of the selective estrogen receptor modulator ERalpha complex.

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