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Aggregatibacter actinomycetemcomitans (Aa), a Gram-negative coccobacillus commonly associated with endocarditis, poses a rare diagnostic challenge in pediatric cases. The presentation of two pediatric cases—myositis and chest mass—highlights novel aspects, including unusual symptom presentations in children which can be mistaken for malignancy. The limited sensitivity of standard blood tests complicates diagnosis, leading to delayed diagnosis and treatment. Representative samples must be taken, especially if blood cultures are negative. Despite advances in detection methods, diagnosing Aa infection remains difficult due to its rarity in children and variable clinical presentation. In conclusion, a comprehensive understanding of Aa infection in children is essential for early and effective diagnostic and therapeutic management.

“Neural coding” is a popular metaphor in neuroscience, where objective properties of the world are communicated to the brain in the form of spikes. Here I argue that this metaphor is often inappropriate and misleading. First, when neurons are said to encode experimental parameters, the neural code depends on experimental details that are not carried by the coding variable (e.g., the spike count). Thus, the representational power of neural codes is much more limited than generally implied. Second, neural codes carry information only by reference to things with known meaning. In contrast, perceptual systems must build information from relations between sensory signals and actions, forming an internal model. Neural codes are inadequate for this purpose because they are unstructured and therefore unable to represent relations. Third, coding variables are observables tied to the temporality of experiments, whereas spikes are timed actions that mediate coupling in a distributed dynamical system. The coding metaphor tries to fit the dynamic, circular, and distributed causal structure of the brain into a linear chain of transformations between observables, but the two causal structures are incongruent. I conclude that the neural coding metaphor cannot provide a valid basis for theories of brain function, because it is incompatible with both the causal structure of the brain and the representational requirements of cognition.

Over the past two decades, there has been a growing interest in the use of plasmonic nanoparticles as sources of heat remotely controlled by light, giving rise to the field of thermoplasmonics. The ability to release heat on the nanoscale has already impacted a broad range of research activities, from biomedicine to imaging and catalysis. Thermoplasmonics is now entering an important phase: some applications have engaged in an industrial stage, while others, originally full of promise, experience some difficulty in reaching their potential. Meanwhile, innovative fundamental areas of research are being developed. In this Review, we scrutinize the current research landscape in thermoplasmonics, with a specific focus on its applications and main challenges in many different fields of science, including nanomedicine, cell biology, photothermal and hot-electron chemistry, solar light harvesting, soft matter and nanofluidics. Thermoplasmonics is based on the use of plasmonic nanoparticles as sources of heat remotely controlled by light. This Review discusses its current applications and challenges in a broad range of scientific fields, from nanomedicine to hot-electron chemistry and nanofluidics.

A bstract Starting from gravity in asymptotically flat spacetime, the BMS momentum fluxes are constructed. These are non-local expressions of the solution space living on the celestial Riemann surface. They transform in the coadjoint representation of the extended BMS group and correspond to Virasoro primaries under the action of bulk superrotations. The relation between the BMS momentum fluxes and celestial CFT operators is then established: the supermomentum flux is related to the supertranslation operator and the super angular momentum flux is linked to the stress-energy tensor of the celestial CFT. The transformation under the action of asymptotic symmetries and the OPEs of the celestial CFT currents are deduced from the BMS flux algebra.

Background Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. Methods A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. Results A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. Conclusions  These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.

Clinical decision support systems are software tools that help clinicians to make medical decisions. However, their acceptance by clinicians is usually rather low. A known problem is that they often require clinicians to manually enter a lot of patient data, which is long and tedious. Existing solutions, such as the automatic data extraction from electronic health record, are not fully satisfying, because of low data quality and availability. In practice, many systems still include long questionnaire for data entry. In this paper, we propose an original solution to simplify patient data entry, using an adaptive questionnaire, i.e. a questionnaire that evolves during user interaction, showing or hiding questions dynamically. Considering a rule-based decision support systems, we designed methods for determining the relationships between rules and translating the system’s clinical rules into display rules that determine the items to show in the questionnaire, and methods for determining the optimal order of priority among the items in the questionnaire. We applied this approach to a decision support system implementing STOPP/START v2, a guideline for managing polypharmacy. We show that it permits reducing by about two thirds the number of clinical conditions displayed in the questionnaire, both on clinical cases and real patient data. Presented to clinicians during focus group sessions, the adaptive questionnaire was found “pretty easy to use”. In the future, this approach could be applied to other guidelines, and adapted for data entry by patients.

Accumulating evidence suggests that diet and lifestyle can play an important role in delaying the onset or halting the progression of age-related health disorders and can improve cognitive function. Exercise has been promoted as a possible prevention for neurodegenerative diseases. Exercise will have a positive influence on cognition and it increases the brain-derived neurotrophic factor, an essential neurotrophin. Several dietary components have been identified as having effects on cognitive abilities. In particular, polyphenols have been reported to exert their neuroprotective actions through the potential to protect neurons against injury induced by neurotoxins, an ability to suppress neuroinflammation, and the potential to promote memory, learning, and cognitive function. Dietary factors can affect multiple brain processes by regulating neurotransmitter pathways, synaptic transmission, membrane fluidity, and signal-transduction pathways. Flavonols are part of the flavonoid family that is found in various fruits, cocoa, wine, tea and beans. Although the antioxidant effects of flavonols are well established in vitro, there is general agreement that flavonols have more complex actions in vivo. Several cross-sectional and longitudinal studies have shown that a higher intake of flavonoids from food may be associated with a better cognitive evolution. Whether this reflects a causal association remains to be elucidated. Several studies have tried to ‘manipulate’ the brain in order to postpone central fatigue. Most studies have clearly shown that in normal environmental circumstances these interventions are not easy to perform. There is accumulating evidence that rinsing the mouth with a carbohydrate solution will improve endurance performance. There is a need for additional well controlled studies to explore the possible impact of diet and nutrition on brain functioning.

The reproductive ground plan hypothesis (RGPH) proposes that the physiological pathways regulating reproduction were co-opted to regulate worker division of labor. Support for this hypothesis in honeybees is provided by studies demonstrating that the reproductive potential of workers, assessed by the levels of vitellogenin (Vg), is linked to task performance. Interestingly, contrary to honeybees that have a single Vg ortholog and potentially fertile nurses, the genome of the harvester ant Pogonomyrmex barbatus harbors two Vg genes (Pb_Vg1 and Pb_Vg2) and nurses produce infertile trophic eggs. P. barbatus, thus, provides a unique model to investigate whether Vg duplication in ants was followed by subfunctionalization to acquire reproductive and non-reproductive functions and whether Vg reproductive function was co-opted to regulate behavior in sterile workers. To investigate these questions, we compared the expression patterns of P. barbatus Vg genes and analyzed the phylogenetic relationships and molecular evolution of Vg genes in ants. qRT-PCRs revealed that Pb_Vg1 is more highly expressed in queens compared to workers and in nurses compared to foragers. By contrast, the level of expression of Pb_Vg2 was higher in foragers than in nurses and queens. Phylogenetic analyses show that a first duplication of the ancestral Vg gene occurred after the divergence between the poneroid and formicoid clades and subsequent duplications occurred in the lineages leading to Solenopsis invicta, Linepithema humile and Acromyrmex echinatior. The initial duplication resulted in two Vg gene subfamilies preferentially expressed in queens and nurses (subfamily A) or in foraging workers (subfamily B). Finally, molecular evolution analyses show that the subfamily A experienced positive selection, while the subfamily B showed overall relaxation of purifying selection. Our results suggest that in P. barbatus the Vg gene underwent subfunctionalization after duplication to acquire caste- and behavior- specific expression associated with reproductive and non-reproductive functions, supporting the validity of the RGPH in ants.

Background Polypharmacy can be both a public health and an economic issue. Medication reviews are structured interviews of the patient by the pharmacist, aiming at optimizing the drug treatment and deprescribing potentially inappropriate medications. However, they remain difficult to perform and time-consuming. Several clinical decision support systems were developed for helping clinicians to reduce inappropriate polypharmacy. However, most were limited to the implementation of clinical practice guidelines. In this work, our objective is to design an innovative clinical decision support system for medication reviews and polypharmacy management, named ABiMed. Methods ABiMed associates several approaches: guidelines implementation, but also the automatic extraction of patient data from the GP’s electronic health record and its transfer to the pharmacist, and the visual presentation of contextualized drug knowledge using visual analytics. We performed an ergonomic assessment and qualitative evaluations involving pharmacists and GPs during focus groups and workshops. Results We describe the proposed architecture, which allows a collaborative multi-user usage. We present the various screens of ABiMed for entering or verifying patient data, for accessing drug knowledge (posology, adverse effects, interactions), for viewing STOPP/START rules and for suggesting modification to the treatment. Qualitative evaluations showed that health professionals were highly interested in our approach, associating the automatic guidelines execution with the visual presentation of drug knowledge. Conclusions The association of guidelines implementation with visual presentation of knowledge is a promising approach for managing polypharmacy. Future works will focus on the improvement and the evaluation of ABiMed.

Rechargeable magnesium batteries are appealing as safe, low-cost systems with high-energy-density storage that employ predominantly dendrite-free magnesium metal as the anode. While significant progress has been achieved with magnesium electrolytes in recent years, the further development of Mg-ion batteries, however, is inherently limited by the lack of suitable cathode materials, mainly due to the slow diffusion of high-charge-density Mg-ions in the intercalation-type host structures and kinetic limitations of conversion-type cathodes that often causes poor cyclic stability. Nanostructuring the cathode materials offers an effective means of mitigating these challenges, due to the reduced diffusion length and higher surface areas. In this context, we present the highly reversible insertion of Mg-ions into nanostructured conversion-type CuS cathode, delivering high capacities of 300 mAh g −1 at room temperature and high cyclic stability over 200 cycles at a current density of 0.1 A g −1 with a high coulombic efficiency of 99.9%. These materials clearly outperform bulk CuS, which is electrochemically active only at an elevated temperature of 50 °C. Our results not only point to the important role of nanomaterials in the enhancement of the kinetics of conversion reactions but also suggest that nanostructuring should be used as an integral tool in the exploration of new cathodes for multivalent, i.e., (Mg, Ca, Al)-ion batteries.