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The European Union and the European Space Agency (EU/ESA) have promoted since 1998 (Baveno Manifesto*) the GMES Programme (Global Monitoring for Environment and Security), nowadays called Copernicus (www.copernicus.eu). In the agriculture domain, the use of Copernicus Sentinel imagery and its services are providing several new opportunities. The knowledge of fundamentals of Earth Observation/Geographic Information EO/GI, namely Geomatics, for the development of innovative strategies for professional skills adequacy and capacity building, supporting Copernicus user uptake, becomes mandatory (Gomarasca, 2009). The target is to help bridging gaps between supply and demand of education and training for geospatial sector (www.eo4geo.eu). The innovative and strategical novelties are the complete free access to Sentinel time series imagery and digital image processing software "Sentinel toolboxes" such as SNAP (Sentinel Application Platform) for different environments (Windows, Mac, Unix). The paper introduce topics as crop mapping and monitoring, biophysical parameters, phenology and yield estimations, through several concluded or ongoing international projects such as: ERMES -FP7 (http://www.ermes-fp7space.eu/it/homepage/, Busetto et al. 2017) and SATURNO (https://www.progettosaturno.it/, Nutini et al., 2018) devoted to the regional agricultural monitoring. As conclusion, SNAP software for image processing of Sentinel data was demonstrated and tested together with Earth Engine software for specific vertical agriculture applications. The topics reported in this paper have been part of the Summer School 'Sentinel for Applications in Agriculture' supported by the Copernicus programme, several scientific associations (AIT, ASITA, EARSeL - European Association of Remote Sensing Laboratories), the European Erasmus+ project EO4GEO, University Departments and Geo-Information Companies. [ABSTRACT FROM AUTHOR]

Purpose Foot and ankle deformities are common orthopaedic disorders in children with Down syndrome. However, radiographic measurements of the foot and ankle have not been previously reported. The aim of this study is to describe the foot and ankle deformity in children with Down syndrome. Methods Children who had foot and ankle radiographs in the standing weight-bearing position were selected. Three groups of patients were identified. The relationship of radiographic measurements with age, body mass index and pain is discussed. In all, 41 children (79 feet) had foot radiographs and 60 children (117 ankles) had ankle radiographs, with 15 children overlapping between Groups I and II. Results In Group I, hallux valgus deformity was seen before ten years of age and hallux valgus angle increased afterwards. Metatarsus adductus angle showed a significant increase (p = 0.006) with obesity and was higher in patients who had foot pain (p = 0.05). In Group II, none of the ankle measurements showed a significant difference with age or body mass index percentiles. Tibiotalar angle (TTA) and medial distal tibial angle (MDTA) were higher in patients who had ankle pain. In Group III, correlation analysis was performed between the different measurements with the strongest correlations found between TTA and MDTA. Conclusion In children with Down syndrome, radiographic evaluation of the foot and ankle reveals higher prevalence of deformities than clinical examination. However, foot and ankle radiographs are needed only for symptomatic children with pain and gait changes. [ABSTRACT FROM AUTHOR]

Purpose Data on the benefits of perioperative prophylactic antibiotics in the paediatric population are lacking. In this study, we aimed to assess the rate of infection after isolated soft-tissue procedures in patients with cerebral palsy with and without preoperative prophylactic antibiotics between 2009 and 2015. Methods We reviewed the records of all children with cerebral palsy who underwent isolated soft-tissue procedures (on the upper and lower limb) at our hospital between 2009 and 2015. Children with at least 30-day postoperative follow-up were included. Children who had groin incisions were excluded. Results Two groups were identified: the antibiotic group (77 children with 203 incisions and 343 procedures) had one surgical site infection; the no-antibiotic group (48 children with 102 incisions and 177 procedures) had no surgical site infections. Conclusion These results suggest that the use of preoperative antibiotics does not change the rate of postoperative surgical site infections. [ABSTRACT FROM AUTHOR]

The electrocardiogram (ECG) is one of the most significant outputs of a computational model of cardiac electrophysiology because it relates the numerical results to clinical data and is a universal tool for diagnosing heart diseases. One key features of the ECG is the T-wave, which is caused by longitudinal and transmural heterogeneity of the action potential duration (APD). Thus, in order to model a correct wave of repolarization, different cell properties resulting in different APDs must be assigned across the ventricular wall and longitudinally from apex to base. To achieve this requirement, a regional parametrization of the heart is necessary. We propose a robust approach to obtain the transmural and longitudinal segmentation in a general heart geometry without relying on ad hoc procedures. Our approach is based on auxiliary harmonic lifting analyses, already used in the literature to generate myocardial fiber orientations. Specifically, the solution of a sequence of Laplace boundary value problems allows parametrically controlled segmentation of both heart ventricles. The flexibility and simplicity of the proposed method is demonstrated through several representative examples, varying the locations and extents of the epicardial, midwall, and endocardial layers. Effects of the control parameters on the T-wave morphology are illustrated via computed ECGs. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We present a model to understand quantitatively the role of symmetry breaking in assembly of macromolecular aggregates in general, and the protein shells of vimses in particular. A simple dodecahedral lattice model with a quadrupolar order parameter allows us to demonstrate how symmetry breaking may reduce the probability of assembly errors and, consequently, enhance assembly efficiency. We show that the ground state is characterized by large-scale cooperative zero-energy modes. In analogy with other models, this suggests a general physical principle: the tendency of biological molecules to generate symmetric structures competes with the tendency to break symmetry in order to achieve specific functional goals. [ABSTRACT FROM AUTHOR]

In order to compare the standard swim-up semen preparation with and without test yolk buffer (TYB) incubation in intrauterine insemination (IUI), we conducted a prospective multicentre randomized trial. A total of 121 infertile couples with male factor (n = 52) or unexplained infertility (n = 69) was randomly assigned to two groups following ovulation induction. Semen was prepared by standard swim-up in group A (n = 64) and by swim-up followed by TYB incubation in group B (n = 57). A maximum of two IUI cycles was performed. A total of 104 cycles was performed in the swim-up group and 90 in the TYB group. Overall, 15 pregnancies were achieved in group A and 23 in group B, with an overall pregnancy rate of 24.8 and 50.0% per patient respectively (χ21, P < 0.05). In the male factor group, pregnancy was achieved in six out of 24 couples (25%) following standard swim-up and in six out of 28 (21.4%) following swim-up and TYB incubation (χ21, not significant). In the unexplained infertility group, pregnancy was recorded in nine out of 40 couples (22.5%) following standard swim-up and in 17 out of 29 couples (58.6%) following swim-up and TYB incubation (χ21, P < 0.05). [ABSTRACT FROM PUBLISHER]

A total of 111 women with no ultrasonographic findings of polycystic ovarian syndrome were observed between January 1989 and December 1991 in an in-vitro fertilization (IVF) programme. The treatment schedule involved ovulation induction after treatment with a gonadotrophin-releasing hormone (GnRH) agonist, using standard doses of human menopausal gonadotrophin (HMG) for 4 days, and further stepwise increments in dosage as required. Response to the treatment was defined as: (i) presence/absence of one or more follicles≥ 10 mm diameter after 4 days of treatment, and (ii) oocyte retrieval. Three indices of body mass were considered: weight (W) in kg/height (H) in metres (Quetelet‘s index), W/H1– (the National Health and Nutrition Examination Survey anthropometric index for women), W0–/H (ponderal index). Surface area was computed as 0.0235 (H in cm) (W in kg). Women in the upper tertiles of the range of anthropometric indicators more frequently tended to present no follicle ≥ 10 mm on day 7. Likewise, oocytes were retrieved less frequently in subjects in the higher tertile than in those in the lower. The odds ratio of a negative response both on day 7 and at the end of treatment increased with the tertiles of body mass indices or surface areas. This study suggests that response to ovulation induction treatment is inversely related to body mass index [ABSTRACT FROM PUBLISHER]

Multiple ovulation was induced in 122 hypogonadotrophic IVF patients with large doses of HMG. The hypogonadotrophic state, short and reversible, was obtained by nasal administration of a GnRH agonist (200 μg, five times per day). In the 97 induced cycles, a mean of 9.1 follicles was recorded. A comparison of the results obtained for 36 patients who had already been treated with clomiphene and HMG showed both significantly more follicles per cycle (8.5 versus 3.0) and an increase in oocytes retrieved (6.7 versus 1.3) when treated with the agonist and HMG. In addition 11 of 18 already poorly responsive patients had normal responses. The luteal phase was supported by either HCG or progesterone injection. Plasma progesterone profiles were satisfactory and, as expected, the highest progesterone concentrations were associated with HCG treatment. [ABSTRACT FROM PUBLISHER]

HLA-A*02:393 differs by a single nucleotide substitution from both A*02:26 ( A524G) and from A*02:40:01 ( T527A) [ABSTRACT FROM AUTHOR]

We propose a physical model for the capsids of tailed archaeal viruses as viscoelastic membranes under tension. The fluidity is generated by thermal motion of scarlike structures that are an intrinsic feature of the ground state of large particle arrays covering surfaces with nonzero Gauss curvature. The tension is generated by a combination of the osmotic pressure of the enclosed genome and an extension force generated by filamentous structure formation that drives the formation of the tails. In continuum theory, the capsid has the shape of a surface of constant mean curvature: an unduloid. Particle arrays covering unduloids are shown to exhibit pronounced subdiffusive and diffusive single-particle transport at temperatures that are well below the melting temperature of defect-free particle arrays on a surface with zero Gauss curvature. [ABSTRACT FROM AUTHOR]

Abstract: Geomorphological analysis is an essential element of many landslide monitoring and hazard assessment studies. Remote sensing techniques have long been an effective tool for such analyses. This paper presents results regarding a geomorphological investigation performed exploiting information derived from high resolution hyper-spectral airborne sensor MIVIS (Multi-spectral Infrared and Visible Imaging Spectrometer) images. The authors propose a workflow based on neural network algorithms used both for image geometric correction and classification. The case study area is the Middle Susa Valley (Italian Western-Alps). It includes the Cassas landslide, a well-known complex landslide affecting slopes on the southern side of the valley, near the town of Salbertrand. At this location several “lifelines” (railway, main roads, hydroelectric tunnels, etc.) are concentrated, and they suffer from a constant threat of landslide activity. Traditional geomorphological characterization of the landslide slope was improved by comparing field campaigns with further information extracted from remote-sensed datasets. Presented results include the identification and characterization of major elements of the present-day active unstable slope (debris-covered areas, fractured/disjointed rock walls, landslide accumulation borders), as well as of individual structural features and landforms (major faults and fractures, trenches, elongated depressions, counterslope scarps), related to long-term deep-seated gravitational slope deformation. [Copyright &y& Elsevier]

Purpose: Wearable ultrasound devices can be used to continuously monitor muscle activity. One possible application is to provide real-time feedback during physiotherapy, to show a patient whether an exercise is performed correctly. Algorithms which automatically analyze the data can be of importance to overcome the need for manual assessment and annotations and speed up evaluations especially when considering real-time video sequences. They even could be used to present feedback in an understandable manner to patients in a home-use scenario. The following work investigates three deep learning based segmentation approaches for abdominal muscles in ultrasound videos during a segmental stabilizing exercise. The segmentations are used to automatically classify the contraction state of the muscles., Methods: The first approach employs a simple 2D network, while the remaining two integrate the time information from the videos either via additional tracking or directly into the network architecture. The contraction state is determined by comparing measures such as muscle thickness and center of mass between rest and exercise. A retrospective analysis is conducted but also a real-time scenario is simulated, where classification is performed during exercise., Results: Using the proposed segmentation algorithms, 71% of the muscle states are classified correctly in the retrospective analysis in comparison to 90% accuracy with manual reference segmentation. For the real-time approach the majority of given feedback during exercise is correct when the retrospective analysis had come to the correct result, too., Conclusion: Both retrospective and real-time analysis prove to be feasible. While no substantial differences between the algorithms were observed regarding classification, the networks incorporating the time information showed temporally more consistent segmentations. Limitations of the approaches as well as reasons for failing cases in segmentation, classification and real-time assessment are discussed and requirements regarding image quality and hardware design are derived., (© 2024. The Author(s).)

Background and Objective: One possible approach to counter singularization and loneliness of older adults is the development and implementation of socially interactive robots. Little is known about the expectations and experiences of older adults with socially interactive humanoid robots., Material and Methods: In a mixed-methods design study, user expectations before interaction and the experience and evaluation of verbal and non-verbal communication after interaction with a robot were assessed. Semi-structured interviews were conducted after the interaction., Results: The majority of older adults expected verbal communication. After the interaction the evaluation of the quality of verbal communication differed. Participants did not expect any form of nonverbal communication. Nonverbal communication was highlighted as particularly positive. Gestures, facial expressions, and body movements were described as confidence building., Conclusion: The robot's ability to communicate nonverbally might positively influence older adults' experience of communication with the robot. In the development of socially interactive robots non-verbal communication should be given more consideration in order to contribute to successful human-robot interaction., (© 2024. The Author(s).)

Background: Mild cognitive impairment (MCI) involves cognitive decline beyond typical age-related changes, but without significant daily activity disruption. It can encompass various cognitive domains as the causes of MCI are diverse. MCI as well as frequent comorbid neuropsychiatric conditions like depression and anxiety affect individuals' quality of life. Early interventions are essential, and computerized cognitive training (cCT) is an established treatment method. This paper presents the protocol for the NeuroNation MED Effectiveness Study, evaluating the self-administered mobile cCT intervention ("NeuroNation MED") in individuals with MCI to assess training effects on cognitive domains, health competence, neuropsychiatric symptoms, psychological well-being, and the general application usability., Methods: This study protocol presents a single-blinded multicenter randomized controlled trial that will be carried out in six study centers in Germany and Luxembourg. We included adults with MCI (existing F06.7 ICD-10-GM diagnosis and TICS ≥ 21 and ≤ 32). The intervention group will use a mobile, multi-domain cCT ("NeuroNation MED") for 12 weeks. Meanwhile, the wait list control group will receive standard medical care or no care. The eligibility of volunteers will be determined through a telephone screening. After completion of the baseline examination, patients will be randomly assigned to one of the experimental conditions in a 2:1 ratio. In total, 286 participants will be included in this study. The primary outcome is the change of cognitive performance measured by the index score of the screening module of the Neuropsychological Assessment Battery. Secondary outcomes are changes in the Cognitive Failures Questionnaire, Hospital Anxiety and Depression Scale, Health-49, Health Literacy Questionnaire, among others. All of the primary and secondary outcomes will be assessed at baseline and after the 12-week post-allocation period. Furthermore, the intervention group will undergo an assessment of the System Usability Scale, and the training data of the NeuroNation MED application will be analyzed., Discussion: This study aims to assess the effectiveness of a mobile self-administered cCT in enhancing cognitive abilities among individuals diagnosed with MCI. Should the findings confirm the effectiveness of the NeuroNation MED app, it may confer possible benefits for the care management of patients with MCI, owing to the accessibility, cost-effectiveness, and home-based setting it provides. Specifically, the cCT program could provide patients with personalized cognitive training, educational resources, and relaxation techniques, enabling participants to independently engage in cognitive training sessions at home without further supervision., Trial Registration: German Clinical Trials Register DRKS00025133. Registered on November 5, 2021., (© 2024. The Author(s).)

Background: In addition to sociodemographic factors, action-theoretical constructs, such as technology acceptance and competence play an important role in technology use., Objective: This study aimed to examine the associations between technology use, sociodemographic factors, action-theoretical constructs, and technology interest., Material and Methods: Data were collected from 585 study participants aged over 60 years from 14 surveys conducted between 2014 and 2020. A structural equation model was used to explain the relationships., Results: The structural equation model with covariates of survey year, age, gender, and education (n = 585) yielded the following fit indices: comparative fit index (CFI) = 0.918, Tucker-Lewis index (TLI) = 0.894, Root Mean Square Error of Approximation (RMSEA) = 0.056 [95 % confidence interval: 0.050-0.063], Standardized Root Mean Square Residual (SRMR) = 0.079, χ2 = 3051.936 (p < 0.001), χ2/degrees of freedom (df) = 18.499. The strongest associations with technology use were found for technology acceptance and competence. Additionally, technology competence showed a significant association with technology interest. Gender and technology interest were not related to technology use but it was observed that men had higher levels of technology acceptance, control, competence, and interest., Discussion: Taking technology competence beliefs into account plays a crucial role in understanding the technology usage and interest of older individuals. Additionally, gender-specific differences in the theoretical constructs of action and interest in technology have been revealed in the context of the digital divide., (© 2023. The Author(s).)

Background: The number of older adults in need of care and living at home is increasing in Europe. At the same time, the number of professional caregivers is decreasing. This development reinforces the need for assistive technology to support care recipients in their own homes and promote their independence. One of the main challenges of independent living is the preparation of food. Interactive robots could assist older adults with difficulties performing physically demanding tasks. Within the project AuRorA (full German project title: Wiederverwendbare, interaktive Verhalten für proaktive Roboter im Smart Home), an interactive voice-controlled robot arm was developed as an assistance system in the kitchen., Objective: The aim of the study was to assess how older adults evaluate the AuRorA system and to collect data on actual willingness to use the technology. Older adults were asked to evaluate the system in terms of usefulness, usability, accessibility and intention to use., Material and Methods: Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, the older adults evaluated the system via an online survey. The validated questionnaire Technology Usage Inventory (short: TUI) was used in conjunction with self-developed questionnaires to collect data on study population characteristics., Results: A total of 106 participants were included in the analysis. The acceptance, usability and usefulness of the system were rated as medium, while the intention to use was rated as low. A significant strong correlation was found between the TUI subscales intention to use and usefulness., Conclusion: It can be assumed that the actual need of the individual participant for such a robotic assistive system had an influence on the evaluation of the system. The perceived usefulness may have been a crucial influence on the intention to use and the overall assessment of the system., (© 2022. The Author(s).)

Chronic back pain has a high prevalence, especially in older adults, and seriously affects sufferers' quality of life. Segmental stabilization exercise (SSE) is often used during physiotherapy to enhance core stability. The execution of SSE requires the selective contraction of deep abdominal and back muscles. Motor learning can be supported using ultrasound imaging as visual biofeedback. ULTRAWEAR is a mobile ultrasound system that provides deep learning-based biofeedback on SSE execution, which is currently under development. We interviewed 15 older chronic back pain patients (CBPPs) to investigate their pain management behavior, experience with SSE, as well as their needs and requirements for ULTRAWEAR. We also gathered information about future-usage scenarios. CBPPs reported a high willingness to use the system as a feedback tool both in physiotherapeutic practices and at home. The automated detection and evaluation of muscle contraction states was highlighted as a major benefit of the system compared to the more subjective feedback provided by traditional methods such as palpation. The system to be developed was perceived as a helpful solution to support learning about SSE.

Background: Restrictions in mobility can lead to social and health-related issues. Assistive technologies and devices can help to sustain or regain mobility in affected persons. One of the most commonly used devices is the wheelchair. Many wheelchair users experience difficulties within the provision process and with the device itself. The presented study investigated the satisfaction with the wheelchair and the corresponding provision process., Methodology: A comprehensive online survey was conducted. The questionnaire surveyed the quality of wheelchairs and the corresponding provision process among wheelchair users in Germany. Descriptive methods were used to analyse the results. Sub-groups were classified according to age, sex, waiting time for wheelchair, financing and type of wheelchair., Results: After cleaning the data, 110 datasets remained for analysis. The predominant reasons for wheelchair acquisition were independence and the replacement for a defective wheelchair. Wheelchair quality aspects as well as the corresponding provision process were rated medium. Issues were found regarding waiting times, repair services and communication between service providers., Discussion: The presented results reflect issues in the quality of wheelchairs and their provision process. Inequality between different sub groups is evident. Although some results should be considered with caution due to unequal group sizes, clear trends can be seen which confirm results from other studies throughout the literature., Conclusion: The presented cross-sectional study results give an important overview about the user satisfaction with the quality and provision process of wheelchairs. A longitudinal study accompanying users during the provision process is being recommended as a more in-depth study.IMPLICATIONS FOR REHABILITATIONLow durability and adaptability were identified as main issues regarding wheelchair quality.Waiting times for wheelchairs were perceived as too long by the users and make up the main factor for low satisfaction with the wheelchair provision process.Reduced waiting times for wheelchairs (especially for electric wheelchairs) can improve overall satisfaction with the assistive device.Waiting times could be reduced by a more efficient application and provision process.

Neurons in the brain are submerged into oscillating extracellular potential produced by synchronized synaptic currents. The dynamics of these oscillations is one of the principal characteristics of neurophysiological activity, broadly studied in basic neuroscience and used in applications. However, our interpretation of the brain waves' structure and hence our understanding of their functions depend on the mathematical and computational approaches used for data analysis. The oscillatory nature of the wave dynamics favors Fourier methods, which have dominated the field for several decades and currently constitute the only systematic approach to brain rhythms. In the following study, we outline an alternative framework for analyzing waves of local field potentials (LFPs) and discuss a set of new structures that it uncovers: a discrete set of frequency-modulated oscillatory processes-the brain wave oscillons and their transient spectral dynamics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zobaer, Domenico, Perotti, Ji and Dabaghian.)

The HLA-DPB1 locus has been demonstrated to have a significant role on patients' outcome after allogeneic HSCT, and the so-called T-cell epitope (TCE) algorithm has been incorporated in international guidelines for the selection of unrelated donors. The purpose of the present study is to measure, through a national survey conducted on behalf of the Associazione Italiana di Immunogenetica e Biologia dei Trapianti (AIBT), the extent of awareness and use of HLA-DPB1 TCE-based algorithms during the donor search. 89% of the HLA laboratories answered to a short questionnaire and the results showed a progressive increase of the laboratories typing DPB1 in patients and their potential donors during the search (from 44% to 79% during the 2010-2019 period) as well as the application of a TCE-based algorithm for the donor choice whenever possible (from 24% to 65% during the same period). The DP-permissiveness status is detailed in the official HLA typing report by 12%, 32% and 50% of laboratories in 2010, 2015 and 2019, respectively. The present data indicate an encouraging raise in the awareness of the HLA-DPB1 role in unrelated donor selection; noteworthy, mentioning the TCE-based permissiveness status in the HLA typing report of each potential unrelated donor represents a notable mean to raise awareness among transplant physicians and to support them in their task of choosing the best donor. Nonetheless, despite the compelling evidence of the predictive ability of TCE-based algorithms, further efforts are still needed to extend its application to all transplant centers in Italy., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

We report a preliminary experience of adjuvant therapy with Hemoperfusion (HP) in patients with Severe Acute Respiratory Syndrome-CoronaVirus 2 (SARS-CoV2) pneumonia. Currently, there are no approved treatments for CoronaVirus Disease 19 (COVID-19); however, therapeutic strategies based on the preclinical evidence include supportive measures, such as oxygen supplementation, antiviral, and anticoagulant agents. Despite these treatments, 10% of patients worsen and develop severe acute respiratory distress syndrome (ARDS). Since the pathogenic mechanism of ARDS is an uncontrolled inflammatory state, we speculate that removing inflammation effectors from blood may contrast tissue injury and improve clinical outcome. In a scenario of dramatic medical emergency, we conducted an observational study on 9 consecutive patients hospitalized in COVID Intensive Care Unit, where 5 of 9 consecutive patients were treated with HP, due to the emergency overload made it impossible to deliver blood purification in the other 4 patients. COVID-19 was diagnosed through the identification of virus sequences by reverse transcription-PCR on respiratory specimens. All patients had severe pneumonia requiring continuous positive airway pressure. HP was started in all patients 6-7 days after hospital admission. The treated patients (T) received 2 consecutive sessions of HP using CytoSorb cartridge. Our results show a better clinical course of T compared to control patients (C), in fact all T except 1 survived, and only 2 of them were intubated, while all C required intubation and died. Lymphocytopenia worsened in C but not in T. C-reactive protein decreased in both patients, but to a greater extent in T. IL-6, IL-8, and TNF-α decreased after HP, IL-10 did not change. Respiratory function remained stable and did not worsen in T compared to C. The limited sample size and observational study design preclude a sound statement about the potential effectiveness of HP in COVID-19 patients, but our experience suggests a potential therapeutic role of adjuvant CytoSorb HP in the early course of CO-VID-19 pneumonia. A randomized clinical trial is ongoing., (The Author(s). Published by S. Karger AG, Basel.)

Liver impairment is frequent in patients with novel coronavirus disease (COVID-19) and direct viral tropism for the liver has been proven. Since several of the currently administered drugs against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are possibly hepatotoxic, the management of patients with COVID-19 and liver failure is still an almost unexplored field. Taking this challenging case of acute HBV with persistent hyperbilirubinemia and SARS-COV-2 infection with respiratory distress as a starting point, we here loop through this condition. Where the available therapeutic options are scarce, we here propose hemoperfusion (HP) as an attractive alternative to both delay any late-stage progression of hyper inflammation process in COVID-19 and remove the toxins involved in acute liver failure., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Study Aims: The aims of this study were to determine the risk of progressive hip subluxation in children with CP after spinal fusion for scoliosis and how frequent the hips follow-up should be scheduled., Patients and Methods: Pelvis radiography [migration index (MI) and pelvic obliquity (PO)] of Gross Motor Function Classification System (GMFCS) levels IV and V children with CP who received spinal fusion and pelvic fixation were reviewed retrospectively. This population was categorized into three groups based on the MI at spinal fusion: G1 = 0-29%; G2 = 30-59%; and G3 = 60-100%., Results: Fifty children (age 7.5-15.0 years) and categorized into 3 groups (G1 = 19, G2 = 23, G3 = 8; 100 hips in total). Preoperative and last follow-up MI were 22 ± 7% and 30 ± 20% (G1), 41 ± 9% and 43 ± 22% (G2), 92 ± 15% and 97 ± 10% (G3). The MIs at spinal fusion between groups were statistically different ( p  < 0.001). In G1, the mean MI progression was 5% and 25% at 12 months and 62 months, respectively. In G2, the mean MI progression was 9% and 25% at 12 months and 32 months, respectively. The progression more than 10% occurred within 2 years in G1 and within 1 year in G2. There was no difference between groups based on preoperative degree of PO ( p  = 0.653) and correction rate in PO ( p  = 0.421)., Conclusions: In GMFCS IV and V children with the highest risk for progression occurred with increasing preoperative MI, especially over 50%. Hips should be monitored continuously after spinal fusion until hip stability is documented., Competing Interests: Conflict of interestNone declared., (© Indian Orthopaedics Association 2020.)

In this retrospective study, children with cerebral palsy underwent a unilateral femoral derotation osteotomy and had a preoperative (PO), short-term postoperative (1-3 years), and a long-term postoperative (≥5 years) gait analysis. Patients were subdivided into groups by the PO pelvic presentation and Gross Motor Function Classification System level. In children with PO pelvic external rotation, femoral derotation osteotomy decreased the hip internal rotation and decreased the pelvic external rotation. These results could influence surgical planning to achieve long-term pelvic asymmetry.

We present a constitutive modeling framework for contractile cardiac mechanics by formulating a single variational principle from which incremental stress-strain relations and kinetic rate equations for active contraction and relaxation can all be derived. The variational framework seamlessly incorporates the hyperelastic behavior of the relaxed and contracted tissue along with the rate - and length - dependent generation of contractile force. We describe a three-element, Hill-type model that unifies the active tension and active deformation approaches. As in the latter approach, we multiplicatively decompose the total deformation gradient into active and elastic parts, with the active deformation parametrizing the contractile Hill element. We adopt as internal variables the fiber, cross-fiber, and sheet normal stretch ratios. The kinetics of these internal variables are modeled via definition of a kinetic potential function derived from experimental force-velocity relations. Additionally, we account for dissipation during tissue deformation by adding a Newtonian viscous potential. To model the force activation, the kinetic equations are coupled with the calcium transient obtained from a cardiomyocyte electrophysiology model. We first analyze our model at the material point level using stress and strain versus time curves for different viscosity values. Subsequently, we couple our constitutive framework with the finite element method (FEM) and study the deformation of three-dimensional tissue slabs with varying cardiac myocyte orientation. Finally, we simulate the contraction and relaxation of an ellipsoidal left ventricular model and record common kinematic measures, such as ejection fraction, and myocardial tissue volume changes.

Background: Epidural infusion of levobupivacaine and ropivacaine provides adequate postoperative pain management by minimizing side effects related to IV opioids and improving patient outcome. The safety profile of different drugs can be better estimated by comparing their pharmacokinetic profiles than by considering their objective side effects. Because levobupivacaine and ropivacaine have different pharmacokinetic properties, our aim was to investigate whether there is a difference in the pharmacokinetic variability of the 2 drugs in a homogeneous population undergoing continuous epidural infusion. This double-blind, multicenter, randomized, controlled trial study was designed to compare the pharmacokinetics of continuous thoracic epidural infusion of levobupivacaine 0.125% or ropivacaine 0.2% for postoperative pain management in adult patients who had undergone major abdominal, urological, or gynecological surgery. This study is focused on the evaluation of the coefficient of variation (CV) to assess the equivalence in the systemic exposure and interindividual variability between levobupivacaine and ropivacaine and, therefore, the possible differences in the predictability of the plasmatic concentrations of the 2 drugs during thoracic epidural infusion., Methods: One hundred eighty-one adults undergoing major abdominal surgery were enrolled in the study. Patients were randomized to receive an epidural infusion of levobupivacaine 0.125% + sufentanil 0.75 μg/mL or of ropivacaine 0.2% + sufentanil 0.75 μg/mL at 5 mL/h for 48 hours. The primary end point of this study was to analyze the variability of plasma concentration of levobupivacaine and ropivacaine via an area under the curve within a range of 15% of the CV during 48 hours of continuous epidural infusion. The CV shows how the concentration values of local anesthetics are scattered around the median concentration value, thus indicating the extent to which plasma concentration is predictable during infusion. Secondary end points were to assess the pharmacologic profile of the local anesthetics used in the study, including an analysis of mean peak plasma concentrations, and also to assess plasma clearance, side effects, pain intensity (measured with a verbal numeric ranging score, i.e., static Numeric Rating Scale [NRS] and dynamic NRS]), and the need for rescue doses., Results: The comparison between the 2 CVs showed no statistical difference: the difference between area under the curve was within the range of 15%. The CV was 0.54 for levobupivacaine and 0.51 for ropivacaine (P = 0.725). The plasma concentrations of ropivacaine approached the Cmax significantly faster than those of levobupivacaine. Clearance of ropivacaine decreases with increasing patient age. There were no significant differences in NRS, dynamic NRS scores, the number of rescue doses, or in side effects between groups., Conclusions: Considering the CV, the interindividual variability of plasma concentration for levobupivacaine and ropivacaine is equivalent after thoracic epidural infusion in adults. We found a reduction in clearance of ropivacaine depending on patient age, but this finding could be the result of some limitations of our study. The steady-state concentration was not reached during the 48-hour infusion and the behavior of plasma concentrations of ropivacaine and levobupivacaine during continuous infusions lasting more than 48 hours remains to be investigated, because they could reach toxic levels. Finally, no differences in the clinical efficacy or in the incidence of adverse effects between groups were found for either local anesthetic.

The monolayer protecting small gold nanoparticles (monolayer-protected clusters, MPCs) is generally represented as the 3D equivalent of 2D self-assembled monolayers (SAMs) on extended gold surfaces. However, despite the growing relevance of MPCs in important applied areas, such as catalysis and nanomedicine, our knowledge of the structure of 3D SAMs in solution is still extremely limited. We prepared a large series of monodisperse Au25(SCnH2n+1)18 clusters (n=2, 4, 6, 8, 10, 12, 14, 16, 18) and studied how electrons tunnel through these monolayers. Electron transfer results, nicely supported by 1H NMR spectroscopy, IR absorption spectroscopy, and molecular dynamics results, show that there is a critical ligand length marking the transition between short ligands, which form a quite fluid monolayer structure, and longer alkyl chains, which self-organize into bundles. At variance with the truly protecting 2D SAMs, efficient electronic communication of the Au25 core with the outer environment is thus possible even for long alkyl chains. These conclusions provide a different picture of how an ultrasmall gold core talks with the environment through/with its protecting but not-so-shielding monolayer.

Background: Neuromodulation is an effective and reversible treatment option for chronic intractable pain. Spinal cord stimulation (SCS) represents a field of application of neuromodulation and is known to be effective for several conditions including complex regional pain syndrome (CRPS), failed back surgery syndrome (FBSS), and chronic leg and back pain. SCS has some technical limitations that can be bypassed through retrograde neuromodulation., Objective: To examine the safety and efficacy of retrograde neuromodulation in consecutive patients with neuropathic pain in the perineum or lower limb., Study Design: Prospective chart review analyzing one year of retrograde stimulation in our department., Methods: We present a series of 10 patients who underwent retrograde neuromodulation at the University General Hospital of Valencia (Spain). We analyzed the variables that can improve the outcome and help physicians choose retrograde neuromodulation., Results: Seven of 10 patients had an effective treatment and 3 patients had an ineffective stimulation. In the group with the effective treatment the most represented type of pain was radiculopathy and perineal pain., Limitations: This is a prospective, single-center study with a relatively small number of patients and no control group., Conclusion: Retrograde neuromodulation seems to be effective in patients that present with a well localized pain with a clear dermatome distribution. We found retrograde neuromodulation to be effective in radiculopathy related to FBSS. We found it to be limited in the treatment of perineal pain probably due to technical limitations and anatomical reasons besides the lack of knowledge of the etiology of this pain model and the exact mechanisms of action of neuromodulation.

Background: Although the ABO blood group is one of two major antigen systems of relevance for transplantation in humans, there are still conflicting data concerning the influence of ABO-incompatibility on transplant outcome. This study investigated the effect of ABO incompatibility in recipients of haematopoietic progenitor cell transplants from related donors after reduced intensity conditioning (RIC) regimens., Materials and Methods: We retrospectively analysed data from 19 multiple myeloma patients included in a prospective RIC allogeneic haematopoietic progenitor cell transplantation protocol, focusing on engraftment, transfusion requirement, Graft-versus-Host Disease, transplant-related mortality and survival., Results: Five out of the 19 patients (26%) received an ABO-incompatible transplant, with minor ABO-mismatch in two patients (10%), major ABO-mismatch in one case (5%), and bidirectional incompatibility in two cases. Neutrophil recovery was not significantly different between the ABO-compatible and ABO-incompatible groups (p=0.85). At 30 days after transplantation, 12 of 19 patients tested (63%) had engraftment with all cells of donor origin (100% chimeric), and continued to be fully chimeric on day 100+ evaluations. Patients with major/bidirectional ABO incompatibility required more red blood cell and platelet units after transplantation and were transfused for longer periods of time, as compared with patients with minor or no ABO incompatibility. Transient, mild haemolysis was noted in one patient between days 10 and 30. Graft-versus-Host Disease, disease progression and transplant-related mortality were not affected by ABO matching., Discussion: Although delayed red blood cell engraftment and increased transfusion requirements were documented, in this study ABO incompatibility after the RIC protocol used did not impair the clinical outcome.

Magnetic resonance imaging is currently the best means for confirming clinical suspicion of neurosarcoidosis as well as being useful in the follow-up of corticosteroid-treated patients. We report the case of a 34 year old male presenting suspected Heerfordt's syndrome with concentric facial hypesthesia. Mediastinal and parotid sarcoidosis was diagnosed and magnetic resonance imaging showed bilateral sarcoid involvement of Gasser's ganglion cisternae (such involvement was not revealed by computed tomography). The patient received corticosteroid therapy, with a clinical and radiological improvement. Magnetic resonance imaging showed disappearance of Gasser's ganglion lesions despite the persistence of mild facial hypesthesia. This case is noteworthy for its extremely rare lesion site. Post-treatment discrepancy between the clinical picture and imaging results is probably due to low MRI resolution threshold. 18-FDG positron emission tomography imaging might perhaps overcome the limits of magnetic resonance imaging.