Artificial neural networks to predict the mechanical properties of natural fibre-reinforced Compressed Earth Blocks (CEBs)

The purpose of this study is to explore Artificial Neural Networks (ANNs) to predict the compressive and tensile strengths of natural fibre-reinforced Compressed Earth Blocks (CEBs). To this end, a database was created by collecting data from the available literature. Data relating to 332 specimens (Database 1) were used for the prediction of the compressive strength (ANN1), and, due to the lack of some information, those relating to 130 specimens (Database 2) were used for the prediction of the tensile strength (ANN2). The developed tools showed high accuracy, i.e., correlation coefficients (R-value) equal to 0.97 for ANN1 and 0.91 for ANN2. Such promising results prompt their applicability for the design and orientation of experimental campaigns and support numerical investigations.This work was funded by the FCT (Foundation for Science and Technology), under grant agreement UIBD/150874/2021 attributed to the first author. This work was also partly financed by Fundação “La Caixa”, under the reference PV20-00072, and FCT/MCTES through national funds (PIDDAC) under the R&D Unit Institute for Sustainability and Innovation in Structural Engineering (ISISE), under reference UIDB/04029/2020

Circadian Rhythm And Profile In Patients With Juvenile Myoclonic Epilepsy And Temporal Lobe Epilepsy.

This study intended to compare the circadian rhythm and circadian profile between patients with juvenile myoclonic epilepsy (JME) and patients with temporal lobe epilepsy (TLE). We enrolled 16 patients with JME and 37 patients with TLE from the Outpatient Clinic of UNICAMP. We applied a questionnaire about sleep-wake cycle and circadian profile. Fourteen (87%) out of 16 patients with JME, and 22 out of 37 (59%) patients with TLE reported that they would sleep after seizure (p < 0.05). Three (19%) patients with JME, and 17 (46%) reported to be in better state before 10:00 AM (p < 0.05). There is no clear distinct profile and circadian pattern in patients with JME in comparison to TLE patients. However, our data suggest that most JME patients do not feel in better shape early in the day.733-

Ritmo e perfil circadiano em pacientes com epilepsia mioclônica juvenil e epilepsia de lobo temporal

This study intended to compare the circadian rhythm and circadian profile between patients with juvenile myoclonic epilepsy (JME) and patients with temporal lobe epilepsy (TLE). Method We enrolled 16 patients with JME and 37 patients with TLE from the Outpatient Clinic of UNICAMP. We applied a questionnaire about sleep-wake cycle and circadian profile. Results Fourteen (87%) out of 16 patients with JME, and 22 out of 37 (59%) patients with TLE reported that they would sleep after seizure (p < 0.05). Three (19%) patients with JME, and 17 (46%) reported to be in better state before 10:00 AM (p < 0.05). Conclusion There is no clear distinct profile and circadian pattern in patients with JME in comparison to TLE patients. However, our data suggest that most JME patients do not feel in better shape early in the day73136Este estudo pretende comparar o ritmo circadiano e o perfil circadiano entre pacientes com epilepsia mioclônica juvenil (EMJ) e epilepsia de lobo temporal (ELT). Método Nós entrevistamos 16 pacientes com EMJ e 37 com ELT do ambulatório da UNICAMP. Nós aplicamos um questionário sobre ciclo sono-vigília e perfil circadiano. Resultados Quatorze (87%) de 16 pacientes com EMJ e 22 de 37 (59%) pacientes com ELT relataram que eles apresentam sonolência pós-crise (p < 0,05). Três (19%) pacientes com EMJ e 17 (46%) relataram um melhor estado geral antes das 10h00min (p < 0,05). Conclusão Não há uma clara diferença de ritmo e de perfil circadiano entre pacientes com EMJ e ELT. No entanto, nossos dados sugerem que a maioria dos pacientes com EMJ não se sentem em sua melhor forma cedo pela manh

Ritmo e perfil circadiano em pacientes com epilepsia mioclônica juvenil e epilepsia de lobo temporal

v. 73n.13

Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Aims Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascular ectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomized controlled trials (RCTs) on this topic. Methods A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for the treatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference [RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I2=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44]; I2=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I2=96%) and hospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I2=0%). The number of sessions required for the obliteration of lesions was higher with APC. There was no difference in the incidence of adverse events. Conclusions EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements

Randomized controlled trial comparing the incidence of adverse events after endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy with either pure cut or pulsed cut

INTRODUÇÃO: eventos adversos (EA) como pancreatite, sangramento, perfuração e infecção não são incomuns após a colangiopancreatografia retrógrada endoscópica (CPRE), sendo a pancreatite aguda pós-CPRE (PEP) o mais relevante. Apesar de sua fisiopatologia não ser completamente compreendida, a lesão térmica pela papilotomia é um fator importante a ser considerado e que também pode afetar outros EA. Este é um ensaio clínico randomizado (ECR) que compara a incidência de EA pós-CPRE com papilotomia endoscópica com os modos de corte puro e pulsado. OBJETIVO: comparar o perfil de segurança entre os modos de corte puro e pulsado (endocut) empregados na papilotomia endoscópica, baseando-se na incidência de EAs (PEP, sangramento, infecção e perfuração). MÉTODOS: entre outubro de 2019 a agosto de 2021, pacientes consecutivos submetidos à CPRE com papilotomia, preenchendo os critérios de inclusão e exclusão foram randomizados para corte puro ou pulsado após canulação transpapilar primária da via biliar. O desfecho primário é a incidência de PEP e os secundários envolvem sangramento intraprocedimento (imediato) e tardio, perfuração e infecção. RESULTADOS: o estudo incluiu 550 pacientes (272 no grupo do corte puro e 278 no corte pulsado). PEP ocorreu em 4,0% dos casos, sendo mais frequente no grupo do corte pulsado (5,8% x 2,2%; p = 0,034). A análise univariada revelou >5 tentativas de canulação (p = 0,004) e corte pulsado (p = 0,034) como fatores de risco. A análise multivariada evidenciou >5 tentativas de canulação (p = 0,004) como fator de risco, e um valor limítrofe para o corte pulsado (p = 0,052). Sangramento intraprocedimento foi mais frequente com o corte puro (p = 0,018), sendo todos os casos controlados endoscopicamente no mesmo procedimento. O sangramento tardio foi mais frequente com o corte pulsado (p = 0,047). Não houve diferença de infecção (p = 0,4999) ou perfuração (p = 1,0) entre os grupos. DISCUSSÃO: este ECR demonstrou maior incidência de PEP e sangramento tardio com o corte pulsado, enquanto o corte puro apresentou maior incidência de sangramento intraprocedimento. Não houve diferença em termos de perfuração ou infecção. Como todos os casos de sangramento intraprocedimento foram controlados durante a CPRE, a evidência atual favorece o uso do corte puro rotineiramente para a papilotomia. Adicionalmente, uma estratégia essencial para prevenir PEP é respeitar o limite de 5 tentativas para canulação da via biliarINTRODUCTION: adverse events (AE) as pancreatitis, bleeding, perforation and infection after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon. Post-ERCP acute pancreatitis (PEP) is the main AE following such procedure. Albeit its pathophysiology is not fully understood, thermal injury from biliary sphincterotomy may play an important role and also affect other AEs. Therefore, this study evaluates the outcomes of two electric current modes used during biliary sphincterotomy. AIM: to compare the safety profile of two distinct electric current modes (pulsed cut or endocut and pure cut) used during ERCP with biliary sphincterotomy based on the incidence of procedural-related AEs. METHODS: from October 2019 to August 2021, consecutive patients submitted to ERCP with native papilla fulfilling the eligibility criteria undergoing biliary sphincterotomy were randomized to either pure cut or pulsed cut after transpapillary primary cannulation. The primary outcome was PEP incidence. Secondary outcomes embrace intraprocedural and delayed bleeding, infection, and perforation. RESULTS: 550 patients were randomized (272 for pure cut and 278 for endocut). Overall PEP rate was 4.0% and it was significantly higher in the endocut arm (5.8% x 2.2%, p = 0.034). Univariate analysis revealed > 5 cannulation attempts (p = 0.004) and endocut mode (p = 0.034) as risk factors for PEP. Multivariate analysis revealed > 5 cannulation attempts (p = 0.005) and a trend for endocut mode as a risk factor for PEP (p = 0.052). Intraprocedural bleeding occurred more often with pure cut (p = 0.018) and all cases were controlled endoscopically, during the ERCP. Delayed bleeding was more frequent with endocut (p = 0.047). There was no difference in terms of perforation (p = 1.0) or infection (p = 0.4999) among groups. DISCUSSION: this randomized controlled trial (RCT) reveal that endocut is associated to higher rates of PEP and delayed bleeding, whereas pure cut is associated to increased intraprocedural bleeding. There was no difference between the groups in terms of perforation and infection. As all intraprocedural bleeding were controlled during the ERCP, pure cut should be the preferred electrocautery mode for biliary sphincterotomy. Additionally, no more than five cannulation attempts should be performed as this is strongly associated with PE

Adverse events associated with the different types of electrical current used in endoscopic sphincterotomy: systematic review and metaanalysis of randomized clinical trials

INTRODUÇÃO: A papilotomia endoscópica é um método invasivo que permite o acesso à via biliar, no entanto, este procedimento não é isento de complicações. Estudos na literatura indicam que o modo de corrente elétrica utilizado para a papilotomia pode desencadear diferentes incidências de eventos adversos, como pancreatite, hemorragia, perfuração e colangite. OBJETIVO: Avaliar a segurança dos diferentes modos de corrente elétrica (endocut, blend, corte puro, corte puro seguido de blend) empregados na realização da papilotomia com base na ocorrência de eventos adversos (sangramento, pancreatite, perfuração e colangite). MÉTODOS: A busca de artigos incluiu as seguintes bases de dados: Medline, EMBASE, Cochrane Central, Lilacs e literatura cinzenta até setembro de 2019. Os dados de estudos descrevendo diferentes tipos de corrente elétrica foram metaanalisados de acordo com o PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). As seguintes modalidades de corrente elétrica foram avaliadas: endocut, blend, corte puro, corte puro seguido de blend. RESULTADOS: Foram incluídos um total de 1.691 pacientes de 10 ensaios clínicos randomizados permitindo as seguintes comparações: 1. Endocut vs blend: nenhuma diferença estatística na incidência de sangramento (7% vs 13,4%; RD: -0,11 [-0,31; 0,08]; p = 0,27; I2 = 86%), pancreatite (4,4% vs 3,5%; RD: 0,01 [-0,03; 0.04], p = 0,62, I2 = 48%) e perfuração (sem casos em ambos os grupos). 2. Endocut vs corte puro: maior incidência de sangramento leve (sem queda nos níveis de hemoglobina, repercussão clínica ou necessidade de intervenção endoscópica) no grupo de corte puro (9,2% vs 28,8%; RD: -0,19 [-0,27; - 0,12], p < 0,00001, I2 = 0%). Sem diferença com significado estatístico na incidência de pancreatite (5,2% vs 0,9%; RD: 0,05 [-0,01; 0,11]; p = 0,12; I2 = 57%). Sem diferença em relação a perfuração (0,4% vs 0%; RD: 0,00 [-0,01; 0,02]; p = 0,7, I2 = 0%) ou colangite (1,8% vs 3,2%; RD: -0,01 [-0,09; 0,06], p = 0,7). 3. Corte puro vs blend: maior incidência de sangramento leve no grupo de corte puro (40,4% vs 16,7%; RD: 0,24 [0,15; 0,33], p < 0,00001; I2 = 0%). Nenhuma diferença estatística em relação à incidência de pancreatite e colangite. 4. Corte puro vs corte puro seguido de blend: nenhuma diferença estatística em relação à incidência de sangramento (22,5% vs 11,7%; RD: -0,10 [-0,24; 0,04], p = 0,18, I2 = 61%) e pancreatite (8,9% vs 14,8%; RD 0,06 [-0,02; 0,13], p = 0,12; I2 = 0%). 5. Blend vs corte puro seguido de blend: sem diferença estatística em relação à incidência de sangramento e pancreatite (11,3% vs 10,4%; RD -0,01 [-0,11; 0,09], p = 0,82, I2 = 0%). CONCLUSÕES: O corte puro não apresenta aumento do risco de sangramento com significado clínico em comparação com endocut e blend. Entretanto, esta modalidade também não se mostrou superior em relação as demais na prevenção de pancreatite aguda pós CPRE. Não há diferença na incidência de colangite ou perfuração entre os diferentes tipos de corrente elétrica. Não há diferença estatística na avaliação dos eventos adversos entre as comparações endocut vs blend, corte puro vs corte puro seguido de blend, e blend vs corte puro seguido de blend. Baseando-se na literatura atual, não é possível recomendar uma modalidade de corrente elétrica sobre as demais, logo, novos estudos são necessários. Tais achados sugerem não existir o modo de corrente elétrica ideal para prevenir todos os eventos adversos, sendo assim, é crucial entender os respectivos modos de ação e os fatores de risco do paciente para a tomada de decisão na prática clínicaBACKGROUND: Endoscopic biliary sphincterotomy is an invasive method that allows access to the bile ducts, however, this procedure is not exempt of complications. Studies in the literature indicate that the mode of electric current used for sphincterotomy may carry different incidences of adverse events such as pancreatitis, bleeding, perforation, and cholangitis. AIM: To evaluate the safety of different modes of electrical current (endocut, blend, pure cut, pure cut followed by blend) used during endoscopic biliary sphincterotomy based on incidence of adverse events. METHODS: We searched articles for this systematic review in Medline, EMBASE, Central Cochrane, Lilacs, and gray literature from inception to September 2019. Data from studies describing different types of electric current were meta-analysed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following electric current modalities were evaluated: endocut, blend, pure cut, pure cut followed by blend. RESULTS: A total of 1.691 patients from 10 randomized clinical trials evaluating the following comparisons: 1. Endocut vs. blend: No statistical difference in the incidence of bleeding (7% vs. 13.4%; RD: -0.11 [-0.31, 0.08], p = 0.27, I2 = 86%), pancreatitis (4.4% vs. 3.5%; RD: 0.01 [-0.03, 0.04], p = 0.62, I2 = 48%) and perforation (absence of cases in both arms). 2. Endocut vs. pure cut: higher incidence of mild bleeding (without drop in hemoglobin levels, clinical repercussion or need for endoscopic intervention) in the pure cut group (9.2% vs. 28.8%; RD: -0.19 [-0.27, -0.12], p < 0.00001, I2 = 0%). No statistical difference regarding pancreatitis (5.2% vs. 0.9%; RD: 0.05 [-0.01, 0.11], p = 0.12, I2 = 57%), perforation (0.4% vs. 0%; RD: 0.00 [-0.01, 0.02], p = 0,7, I2 = 0%) or cholangitis (1.8% vs. 3.2%; RD: -0.01 [-0.09, 0.06], p = 0,7). 3. Pure cut vs. blend: higher incidence of mild bleeding in the pure cut group (40.4% vs. 16.7%; RD: 0.24 [0.15, 0.33], p < 0.00001, I2 = 0%). No statistical difference concerning incidence of pancreatitis or cholangitis. 4. Pure cut vs. pure cut followed by blend: No statistical difference regarding incidence of bleeding (22.5% vs. 11.7%; RD: -0.10 [-0.24, 0.04], p = 0.18, I2 = 61%) and pancreatitis (8.9% vs. 14.8%; RD 0.06 [-0.02, 0.13], p = 0.12, I2 = 0%). 5. Blend vs. pure cut followed by blend: No statistical difference regarding incidence of bleeding and pancreatitis (11.3% vs. 10.4%; RD -0.01 [-0.11, 0.09], p = 0.82, I2 = 0%). CONCLUSION: Pure cut does not carry higher incidence of clinically significant bleeding compared to endocut and blend. However, this modality was not associated to a lower incidence of pancreatitis in our analysis. There is no difference in incidence of cholangitis or perforation between different types of electric current. There is lack of evidence in the literature to recommend one method over the others, therefore new studies are necessary. As there is no perfect electric current mode, the best choice in clinical practice must be based on the knowledge of the electric current mechanism and the patient risk factor

Artificial Neural Networks to Predict the Mechanical Properties of Natural Fibre-Reinforced Compressed Earth Blocks (CEBs)

The purpose of this study is to explore Artificial Neural Networks (ANNs) to predict the compressive and tensile strengths of natural fibre-reinforced Compressed Earth Blocks (CEBs). To this end, a database was created by collecting data from the available literature. Data relating to 332 specimens (Database 1) were used for the prediction of the compressive strength (ANN1), and, due to the lack of some information, those relating to 130 specimens (Database 2) were used for the prediction of the tensile strength (ANN2). The developed tools showed high accuracy, i.e., correlation coefficients (R-value) equal to 0.97 for ANN1 and 0.91 for ANN2. Such promising results prompt their applicability for the design and orientation of experimental campaigns and support numerical investigations

Diagnostic Characteristics of Serological-Based COVID-19 Testing: A Systematic Review and Meta-Analysis

Serologic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) promises to assist in assessing exposure to and confirming the diagnosis of coronavirus disease 2019 (COVID-19), and to provide a roadmap for reopening countries worldwide. Considering this, a proper understanding of serologic-based diagnostic testing characteristics is critical. The aim of this study was to perform a structured systematic review and meta-analysis to evaluate the diagnostic characteristics of serological-based COVID-19 testing. Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. Full-text observational studies that reported IgG or IgM diagnostic yield and used nucleic acid amplification tests (NAATs) of respiratory tract specimens, as a the reference standard in English language were included. A bivariate model was used to compute pooled sensitivity, specificity, positive/negative likelihood ratio (LR), diagnostic odds ratio (OR), and summary receiver operating characteristic curve (SROC) with corresponding 95% confidence intervals (CIs). Five studies (n=1,166 individual tests) met inclusion criteria. The pooled sensitivity, specificity, and diagnostic accuracy for IgG was 81% [(95% CI, 61-92);I2 =95.28], 97% [(95% CI, 78-100);I2 =97.80], and 93% (95% CI, 91-95), respectively. The sensitivity, specificity, and accuracy for IgM antibodies was 80% [(95% CI, 57-92);I2 =94.63], 96% [(95% CI, 81-99);I2 =92.96] and 95% (95% CI, 92-96). This meta-analysis demonstrates suboptimal sensitivity and specificity of serologic-based diagnostic testing for SARS-CoV-2 and suggests that antibody testing alone, in its current form, is unlikely to be an adequate solution to the difficulties posed by COVID-19 and in guiding future policy decisions regarding social distancing and reopening of the economy worldwide