El efecto de arroyos tributarios de menor orden sobre el perifiton de un río de llanura

Confluence zones are important places to analyze discontinuities that succeed in the river continuum, when two streams of different order link up with their collector. In this work we analyzed the periphyton composition and structure in the confluence of two mountain streams, where Chocancharava river (Cuarto river) foothill reach begins, in Córdoba province. Monthly periphyton samples were taken by scraping a known surface, in three sites located in Piedras Blancas and San Bartolomé stream confluence at 550 m a.s.l. TWINSPAN classification and sample and species ordinations by means of Canonic Correspondence Analysis (CCA) were carried out. Seventy one algae species were determined. Bacillarophyceae and Chlorophyceae presented higher species richness. Dominant species were Cocconeis placentula var. euplypta and Achnanthidium minutissimum, both exhibited an annual bimodal distribution pattern, with maximal densities in autumn and spring. CCA clusters demonstrated seasonal changes in periphyton structure. Summer species were associated to higher temperature and precipitations, and winter species (were associated) to higher conductivity and pH. The tributary of minor order, San Bartolomé stream, evidenced a wider distance in the sample grouping; its flora was different in winter months, during the phase of low water levels. From the obtained results it is concluded that at the confluence sectors the composition and structure of the higher order stream is continuous with the principal river during low water levels while, during high water levels, the periphyton of both tributaries colonize the receiving river.Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Instituto de Limnología "Dr. Raul A. Ringuelet" (ILPLA

El efecto de arroyos tributarios de menor orden sobre el perifiton de un río de llanura

Confluence zones are important places to analyze discontinuities that succeed in the river continuum, when two streams of different order link up with their collector. In this work we analyzed the periphyton composition and structure in the confluence of two mountain streams, where Chocancharava river (Cuarto river) foothill reach begins, in Córdoba province. Monthly periphyton samples were taken by scraping a known surface, in three sites located in Piedras Blancas and San Bartolomé stream confluence at 550 m a.s.l. TWINSPAN classification and sample and species ordinations by means of Canonic Correspondence Analysis (CCA) were carried out. Seventy one algae species were determined. Bacillarophyceae and Chlorophyceae presented higher species richness. Dominant species were Cocconeis placentula var. euplypta and Achnanthidium minutissimum, both exhibited an annual bimodal distribution pattern, with maximal densities in autumn and spring. CCA clusters demonstrated seasonal changes in periphyton structure. Summer species were associated to higher temperature and precipitations, and winter species (were associated) to higher conductivity and pH. The tributary of minor order, San Bartolomé stream, evidenced a wider distance in the sample grouping; its flora was different in winter months, during the phase of low water levels. From the obtained results it is concluded that at the confluence sectors the composition and structure of the higher order stream is continuous with the principal river during low water levels while, during high water levels, the periphyton of both tributaries colonize the receiving river.Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Instituto de Limnología "Dr. Raul A. Ringuelet" (ILPLA

Calidad ambiental en un río urbano de llanura

Environmental quality in a lowland urban river. Ecological integrity or health of a river is evaluated not only by the physical chemical and biological characteristics in the fluvial channel but also by the state of the riparian systems. Attributes of the benthic communities and the riparian areas are integrated to the chemical macroindicators. The objective of this work is to evaluate the environmental quality of the Chocancharava river plain reach in the urban sector and surroundings of Río Cuarto city. Three study sites were selected: in pre-urban, urban and post-urban reaches. Sampling and field data collections were made in two different hydrological periods: winter and summer. Physical and chemical data were registered and benthos samples were taken from transects across different habitats with a Hess sampler. Multimetric indices from structural attributes such as richness, composition and tolerance/intolerance were calculated. The riparian forest quality (RFQ) was evaluated. The obtained score enabled to describe the ecological status. The physical and chemical indicators showed good water quality and the multimetric indices determined a low impaired biological quality. The application of RFQ index showed an extreme degradation of the riparian system quality. The combination of the indices determined a bad ecological status. The results of this study contribute to corroborate that the Chocancharava river, in the urban sector and its surroundings, presents environmental deterioration, and that remediation and improvement measures are necessary.Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Instituto de Limnología "Dr. Raul A. Ringuelet" (ILPLA

Calidad ambiental en un río urbano de llanura

Environmental quality in a lowland urban river. Ecological integrity or health of a river is evaluated not only by the physical chemical and biological characteristics in the fluvial channel but also by the state of the riparian systems. Attributes of the benthic communities and the riparian areas are integrated to the chemical macroindicators. The objective of this work is to evaluate the environmental quality of the Chocancharava river plain reach in the urban sector and surroundings of Río Cuarto city. Three study sites were selected: in pre-urban, urban and post-urban reaches. Sampling and field data collections were made in two different hydrological periods: winter and summer. Physical and chemical data were registered and benthos samples were taken from transects across different habitats with a Hess sampler. Multimetric indices from structural attributes such as richness, composition and tolerance/intolerance were calculated. The riparian forest quality (RFQ) was evaluated. The obtained score enabled to describe the ecological status. The physical and chemical indicators showed good water quality and the multimetric indices determined a low impaired biological quality. The application of RFQ index showed an extreme degradation of the riparian system quality. The combination of the indices determined a bad ecological status. The results of this study contribute to corroborate that the Chocancharava river, in the urban sector and its surroundings, presents environmental deterioration, and that remediation and improvement measures are necessary.Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Instituto de Limnología "Dr. Raul A. Ringuelet" (ILPLA

Calidad ambiental en un río urbano de llanura

Environmental quality in a lowland urban river. Ecological integrity or health of a river is evaluated not only by the physical chemical and biological characteristics in the fluvial channel but also by the state of the riparian systems. Attributes of the benthic communities and the riparian areas are integrated to the chemical macroindicators. The objective of this work is to evaluate the environmental quality of the Chocancharava river plain reach in the urban sector and surroundings of Río Cuarto city. Three study sites were selected: in pre-urban, urban and post-urban reaches. Sampling and field data collections were made in two different hydrological periods: winter and summer. Physical and chemical data were registered and benthos samples were taken from transects across different habitats with a Hess sampler. Multimetric indices from structural attributes such as richness, composition and tolerance/intolerance were calculated. The riparian forest quality (RFQ) was evaluated. The obtained score enabled to describe the ecological status. The physical and chemical indicators showed good water quality and the multimetric indices determined a low impaired biological quality. The application of RFQ index showed an extreme degradation of the riparian system quality. The combination of the indices determined a bad ecological status. The results of this study contribute to corroborate that the Chocancharava river, in the urban sector and its surroundings, presents environmental deterioration, and that remediation and improvement measures are necessary.Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Instituto de Limnología "Dr. Raul A. Ringuelet" (ILPLA

The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses

Background. Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions. Methods. Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression. Results. After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms. Conclusions. In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem

Efficacy and durability of multifactorial intervention on mortality and MACEs:a randomized clinical trial in type-2 diabetic kidney disease

Background: Multiple modifiable risk factors for late complications in patients with diabetic kidney disease (DKD), including hyperglycemia, hypertension and dyslipidemia, increase the risk of a poor outcome. DKD is associated with a very high cardiovascular risk, which requires simultaneous treatment of these risk factors by implementing an intensified multifactorial treatment approach. However, the efficacy of a multifactorial intervention on major fatal/non-fatal cardiovascular events (MACEs) in DKD patients has been poorly investigated. Methods: Nephropathy in Diabetes type 2 (NID-2) study is a multicentre, cluster-randomized, open-label clinical trial enrolling 395 DKD patients with albuminuria, diabetic retinopathy (DR) and negative history of CV events in 14 Italian diabetology clinics. Centres were randomly assigned to either Standard-of-Care (SoC) (n = 188) or multifactorial intensive therapy (MT, n = 207) of main cardiovascular risk factors (blood pressure 40/50 mg/dL for men/women and < 175 mg/dL, respectively). Primary endpoint was MACEs occurrence by end of follow-up phase. Secondary endpoints included single components of primary endpoint and all-cause death. Results: At the end of intervention period (median 3.84 and 3.40 years in MT and SoC group, respectively), targets achievement was significantly higher in MT. During 13.0 years (IQR 12.4–13.3) of follow-up, 262 MACEs were recorded (116 in MT vs. 146 in SoC). The adjusted Cox shared-frailty model demonstrated 53% lower risk of MACEs in MT arm (adjusted HR 0.47, 95%CI 0.30–0.74, P = 0.001). Similarly, all-cause death risk was 47% lower (adjusted HR 0.53, 95%CI 0.29–0.93, P = 0.027). Conclusion: MT induces a remarkable benefit on the risk of MACEs and mortality in high-risk DKD patients. Clinical Trial Registration ClinicalTrials.gov number, NCT00535925. https://clinicaltrials.gov/ct2/show/NCT0053592

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.Methods In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.Findings Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78 center dot 6%] female patients and 4922 [21 center dot 4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1 center dot 4 [IQR 0 center dot 6-3 center dot 4]) compared with the prepandemic phase (2 center dot 0 [0 center dot 9-3 center dot 7]; p&lt;0 center dot 0001) and pandemic decrease phase (2 center dot 3 [1 center dot 0-5 center dot 0]; p&lt;0 center dot 0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69 center dot 0%] of 3704 vs 1515 [71 center dot 5%] of 2119; OR 1 center dot 1 [95% CI 1 center dot 0-1 center dot 3]; p=0 center dot 042), lymph node metastases (343 [9 center dot 3%] vs 264 [12 center dot 5%]; OR 1 center dot 4 [1 center dot 2-1 center dot 7]; p=0 center dot 0001), and tumours at high risk of structural disease recurrence (203 [5 center dot 7%] of 3584 vs 155 [7 center dot 7%] of 2006; OR 1 center dot 4 [1 center dot 1-1 center dot 7]; p=0 center dot 0039).Interpretation Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.Funding None.Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved

Why are so huge differences reported in the occurrence rate of skin lipohypertrophy? Does it depend on method defects or on lack of interest?

Lipohypertophy (LH) is the most common skin complication of incorrect injection technique which does not only represent an aesthetic defect but also severely disrupts insulin pharmacokinetics/pharmacodynamics. As a consequence of that, hormone release is delayed and unexplained/unpredictable hypoglycemia occurs, both deteriorating metabolic control while negatively affecting adherence to treatment and quality of life. The economic burden due to unwanted intra-LH injections is accounted for by inappropriately high insulin requirements, increased emergency-related hospitalizations, and loss of work days. Greater attention has to be paid by diabetes care teams to education programs with periodic refreshers to achieve better metabolic control and reduce the economic burden of diabetes

Joint structural-functional magnetic resonance imaging features are associated with diagnosis and real-world functioning in patients with schizophrenia

Objective: Earlier evidence suggested that structural–functional covariation in schizophrenia patients (SCZ) is associated with cognition, a predictor of functioning. Moreover, studies suggested that functional brain abnormalities of schizophrenia may be related with structural network features. However, only few studies have investigated the relationship between structural–functional covariation and both diagnosis and functioning in SCZ. We hypothesized that structural–functional covariation networks associated with diagnosis are related to real-world functioning in SCZ. Methods: We performed joint Independent Component Analysis on T1 images and resting-state fMRI-based Degree Centrality (DC) maps from 89 SCZ and 285 controls. Structural-functional covariation networks in which we found a main effect of diagnosis underwent correlation analysis to investigate their relationship with functioning. Covariation networks showing a significant association with both diagnosis and functioning underwent univariate analysis to better characterize group-level differences at the spatial level. Results: A structural–functional covariation network characterized by frontal, temporal, parietal and thalamic structural estimates significantly covaried with temporo-parietal resting-state DC. Compared with controls, SCZ had reduced structural–functional covariation within this network (pFDR = 0.005). The same measure correlated positively with both social and occupational functioning (both pFDR = 0.042). Univariate analyses revealed grey matter deviations in SCZ compared with controls within this structural–functional network in hippocampus, cerebellum, thalamus, orbito-frontal cortex, and insula. No group differences were found in DC. Conclusions: Findings support the existence of a phenotypical association between group-level differences and inter-individual heterogeneity of functional deficits in SCZ. Given that only the joint structural/functional analysis revealed this association, structural–functional covariation may be a potentially relevant schizophrenia phenotype