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Fenestrated endografts have been a safe and effective solution in our institution for patients with juxtarenal abdominal aortic aneurysms (AAAs) that were not candidates for conventional repair and had suitable anatomy. The objective of our study was to evaluate the long-term outcomes of these interventions.

Children living in social care represent an extremely vulnerable group in society, with an increased risk of strained and unstable relationships, and increased bullying involvement. With the number of children living in social care in the UK increasing, there is an emphasis on better understanding why these children are at risk, and how we can best support them. Yet, the existing literature in this field is limited: although it is understood that these children are at risk of bullying involvement, it is unclear why they are at risk, or what role their interpersonal relationships may play in their bullying involvement. This research explored this issue, focusing on both traditional bullying and cyberbullying perpetration and victimisation. Secondary data from the Health Behaviour in School-aged Children (HBSC) survey was analysed, utilising the 2014 and 2018 datasets. Analyses were conducted on a total of 968 British children aged 11, 13, and 15 – 498 of these were males, and 470 were female. 484 of these children lived in social care (residential care and foster care), and 484 lived with biological family members. It was found that children living in social care were at an increased risk of bullying involvement regardless of their age and gender, contradicting the well-established age and gender differences seen in non-care samples. Moreover, children living in social care reported significantly poorer interpersonal relationships; these relationships – particularly those with classmates – mediated the relationship between living in social care and bullying involvement. The results will be discussed in relation to each bullying type, with cross-time replications between the datasets. These findings provide a unique insight into how living in social care impacts bullying involvement, and suggestions for how teachers and schools may support these vulnerable children are made.

Introduction: Venous catheters inserted in superficial femoral vein and with mid-thigh exit site have emerged as a feasible and safe technique for central or peripheral tip’s venous access, especially in agitated, delirious patients. The spread of multidrug-resistant bacterial (MDR) strains is an emerging clinical problem and more and more patients are being colonized by these types of bacteria. The aim of this study is to evaluate the incidence of central line associated bloodstream infections (CLABSI) or catheter related bloodstream infections (CRBSI) in mid-thigh catheters in patients with positive rectal swabs to evaluate the safety of this procedure and the real infection risk.Methods: In this retrospective observational study, we analyzed data on patients with mid-tight catheters inserted from May 2021 to November 2022. All surveillance rectal swabs were recorded. In addition, to collect data on CLABSI and CRBSI, the results of all blood and catheter tip cultures performed during the hospital stay were acquired.Results: Six hundred two patients were enrolled, 304 patients (50.5%) had a rectal swab; 128 (42.1%) swabs were positive for MDR. Nine CLABSI (only two in patients with a positive rectal swab) and three CRBSI were detected. No statistical difference in the absolute number of CLABSI and CRBSI and in the number of infections per 1000 catheter days emerged between the overall population and patients with positive rectal swabs (respectively p= 0.45 and p= 0.53). Similarly, no statistical difference in the number of CLABSI and CRBSI was found among patients with a negative swab and patients with a positive one (respectively p= 0.43 and p= 0.51).Conclusions: According to our data, cannulation of the superficial femoral vein represents a safe location in patients with positive rectal swabs.

While the World Health Organization has declared the end of the SARS-CoV-2 public health emergency, studies related to corona viruses are still under course. As of 2024, the severity of COVID-19 has diminished with current treatments and vaccinations. However, individuals can still face severe complications, highlighting the importance of ongoing research into innovative treatments for current and future coronavirus-related diseases. This study approaches the mechanism of viral entrance into the host cells and the current evidence on the use of sulfhydryl groups for the COVID-19 treatment. Certain thiol drugs, a key contributor to inflammatory processes, exhibit both viral inhibition properties and the potential to regulate cellular oxidative stress by scavenging free radicals. Herein, we developed biocompatible thiol-functionalized carbon dots (CDs) and investigated the correlation between the number of thiols and pseudo-SARS-CoV-2 inhibition, reactive oxygen species (ROS) scavenging, and anti-inflammatory response. The free-radical scavenging experiment and the ROS cellular assay indicate that thiolated CDs serve as effective reducing agents and potential regulators of cellular oxidative stress. The CDs also demonstrated good cell viability alongside significant antiviral capabilities, with inhibition levels up to 60.4%. Furthermore, the flow cytometry results suggest that in an inflammatory environment, the presence of thiolated CDs promotes an anti-inflammatory response. Overall, the results demonstrate a strong correlation between the number of thiols and the increased efficacy observed across experiments, presenting thiolated CDs as promising candidates to prevent and treat COVID-19 infection.

•In a RIETE registry analysis of 103 818 patients with VTE, 20.3% were tested for IT, showing a substantial variance in outcomes.•A thoughtful IT testing approach should consider patients’ VTE risk factors and comorbidities.

Purpose: We present a novel method for augmented reality in endoscopic endonasal surgery. Our method does not require the use of external tracking devices and can show hidden anatomical structures relevant to the surgical intervention. Methods: Our method registers a preoperative 3D model of the nasal cavity to an intraoperative 3D model by estimating a scaled-rigid transformation. Registration is based on a two-stage ICP approach on the reconstructed nasal cavity. The hidden structures are then transferred from the preoperative 3D model to the intraoperative one using the estimated transformation, projected and overlaid into the endoscopic images to obtain the augmented reality. Results: We performed qualitative and quantitative validation of our method on 12 clinical cases. Qualitative results were obtained from an ENT surgeon from visual inspection of the hidden structures in the augmented images. Quantitative results were obtained by measuring a target registration error using a novel transillumination-based approach. The results show that the hidden structures of interest are augmented at the expected locations in most cases. Conclusion: Our method was able to augment the endoscopic images in a sufficiently precise manner when the intraoperative nasal cavity did not deform considerably with respect to its preoperative state. This is a promising step towards trackerless augmented reality in endonasal surgery.

Purpose: This research endeavors to improve tumor localization in minimally invasive surgeries, a challenging task primarily attributable to the absence of tactile feedback and limited visibility. The conventional solution uses laparoscopic ultrasound (LUS) which has a long learning curve and is operator-dependent. Methods: The proposed approach involves augmenting LUS images onto laparoscopic images to improve the surgeon’s ability to estimate tumor and internal organ anatomy. This augmentation relies on LUS pose estimation and filtering. Results: Experiments conducted with clinical data exhibit successful outcomes in both the registration and augmentation of LUS images onto laparoscopic images. Additionally, noteworthy results are observed in filtering, leading to reduced flickering in augmentations. Conclusion: The outcomes reveal promising results, suggesting the potential of LUS augmentation in surgical images to assist surgeons and serve as a training tool. We have used the LUS probe’s shaft to disambiguate the rotational symmetry. However, in the long run, it would be desirable to find more convenient solutions.

Purpose: We investigate whether foundation models pretrained on diverse visual data could be beneficial to surgical computer vision. We use instrument and uterus segmentation in mini-invasive procedures as benchmarks. We propose multiple supervised, unsupervised and few-shot supervised adaptations of foundation models, including two novel adaptation methods. Methods: We use DINOv1, DINOv2, DINOv2 with registers, and SAM backbones, with the ART-Net surgical instrument and the SurgAI3.8K uterus segmentation datasets. We investigate five approaches: DINO unsupervised, few-shot learning with a linear decoder, supervised learning with the proposed DINO-UNet adaptation, DPT with DINO encoder, and unsupervised learning with the proposed SAM adaptation. Results: We evaluate 17 models for instrument segmentation and 7 models for uterus segmentation and compare to existing ad hoc models for the tasks at hand. We show that the linear decoder can be learned with few shots. The unsupervised and linear decoder methods obtain slightly subpar results but could be considered useful in data scarcity settings. The unsupervised SAM model produces finer edges but has inconsistent outputs. However, DPT and DINO-UNet obtain strikingly good results, defining a new state of the art by outperforming the previous-best by 5.6 and 4.1 pp for instrument and 4.4 and 1.5 pp for uterus segmentation. Both methods obtain semantic and spatial precision, accurately segmenting intricate details. Conclusion: Our results show the huge potential of using DINO and SAM for surgical computer vision, indicating a promising role for visual foundation models in medical image analysis, particularly in scenarios with limited or complex data

An ideal vehicle with a high transfection efficiency is crucial for gene delivery. In this study, a type of cationic carbon dot (CCD) known as APCDs were first prepared with arginine (Arg) and pentaethylenehexamine (PEHA) as precursors and conjugated with oleic acid (OA) for gene delivery. By tuning the mass ratio of APCDs to OA, APCDs-OA conjugates, namely, APCDs-0.5OA, APCDs-1.0OA, and APCDs-1.5OA were synthesized. All three amphiphilic APCDs-OA conjugates show high affinity to DNA through electrostatic interactions. APCDs-0.5OA exhibit strong binding with small interfering RNA (siRNA). After being internalized by Human Embryonic Kidney (HEK 293) and osteosarcoma (U2OS) cells, they could distribute in both the cytoplasm and the nucleus. With APCDs-OA conjugates as gene delivery vehicles, plasmid DNA (pDNA) that encodes the gene for the green fluorescence protein (GFP) can be successfully delivered in both HEK 293 and U2OS cells. The GFP expression levels mediated by APCDs-0.5OA and APCDs-1.0OA are ten times greater than that of PEI in HEK 293 cells. Furthermore, APCDs-0.5OA show prominent siRNA transfection efficiency, which is proven by the significantly downregulated expression of FANCA and FANCD2 proteins upon delivery of FANCA siRNA and FANCD2 siRNA into U2OS cells. In conclusion, our work demonstrates that conjugation of CCDs with a lipid structure such as OA significantly improves the gene transfection efficiency, providing a new idea about the designation of nonviral carriers in gene delivery systems.

Purpose We report a series of 5 cases, happened in a period of 5 months, who developed neurotrophic keratopathy (NK) following pars plana vitrectomy (PPV) and retinal endolaser for rhegmatogenous retinal detachment (RRD). In our several decennary experience of surgical center predominantly based on vitreoretinal surgery, we had rare cases of postoperative NK. These recent cases of post-surgical NK happened contextually to our change of postoperative non-steroidal anti-inflammatory drugs (NSAIDs) drops, based on Ketorolac Tromethamine 0.5% eye drops.Cases Presentation Five patients with a mean age of 61 ± 7.3 years were treated with one or more PPV with intraoperative peripheral endolaser for RRD. Nobody had previous herpetic keratitis, systemic disease like diabetes mellitus or other predisposing factors for NK. In the postoperative period, all patients received Ketorolac Tromethamine 0.5% eye drops for a mean period of 54 ± 25 days. During follow-up visits they developed NK and they were successfully treated with suspension of Ketorolac eye drops, application of therapeutic contact lens or amniotic membrane patch and topical lubricant therapy.Conclusions Postoperative Ketorolac eye drops, in patients who underwent PPV with endolaser, may reduce the corneal sensitivity, predispose to epithelial disruption and NK development. Studies are needed to explore the effect of NSAIDs on corneal sensitivity reduction in patient who will undergo PPV and extensive endolaser.

Vertical takeoff and landing (VTOL) vehicles are among the most versatile UAVs, appropriate for various missions. Given that there are still open challenges regarding the VTOL design, this paper presents the full development and test cycle of a tail-sitter. IMAV 2022 competition rules were used to define the mission. A multidisciplinary design and optimization strategy was defined with the goal of maximizing competition score considering design, manufacturing, and competition constraints. The resulting vehicle was designed to fly at 18m/s while carrying 200g of payload with a total weight of approximately 720g. It flew for roughly 13 min at IMAV2022, helping its team to achieve 1st place at the “Package delivery challenge”. Further flight tests revealed the ultimate endurance performance as 18min.

Reoperative vascular ring surgery is uncommon. Standard redo ipsilateral thoracotomy may present technical challenges and risks. We describe a patient with right aortic arch, aberrant left subclavian artery, and a Kommerell diverticulum in whom previous vascular ring division via left thoracotomy did not relieve dysphagia. Three years after the unsuccessful operation, left subclavian–carotid transposition via supraclavicular incision followed by resection of the Kommerell diverticulum via right thoracotomy with extracorporeal circulation relieved symptoms. Contralateral thoracotomy with extracorporeal circulation provides a safe, alternative approach to redo ipsilateral thoracotomy for resection of a symptomatic Kommerell diverticulum. We review the literature on the incidence, surgical indications, and operative approaches to manage symptoms from a Kommerell diverticulum.

Immunobiologicals represent an innovative therapeutic option in dermatology. They are indicated in severe and refractory cases of different diseases when there is contraindication, intolerance, or failure of conventional systemic therapy and in cases with significant impairment of patient quality of life. The main immunobiologicals used in dermatology basically include inhibitors of tumor necrosis factor-alpha (anti-TNF), inhibitors of interleukin-12 and -23 (anti-IL12/23), inhibitors of interleukin-17 and its receptor (anti-IL17), inhibitors of interleukin-23 (anti-IL23), rituximab (anti-CD20 antibody), dupilumab (anti-IL4/IL13) and intravenous immunoglobulin. Their immunomodulatory action may be associated with an increase in the risk of infections in the short and long term, and each case must be assessed individually, according to the risk inherent to the drug, the patient general condition, and the need for precautions. This article will discuss the main risks of infection associated with the use of immunobiologicals, addressing the risk in immunocompetent and immunosuppressed patients, vaccination, fungal infections, tuberculosis, leprosy, and viral hepatitis, and how to manage the patient in the most diverse scenarios.

AbstractObjectiveMost people with major depressive episodes meet the criteria for the anxious distress (AD) specifier defined by DSM-5 as the presence of symptoms such as feelings of tension, restlessness, difficulty concentrating, and fear that something awful may happen. This cross-sectional study was aimed at identifying clinical correlates of AD in people with unipolar or bipolar depression.MethodsInpatients with a current major depressive episode were included. Data on socio-demographic and clinical variables were collected. The SCID-5 was used to diagnose depressive episodes and relevant specifiers. The Montgomery–Åsberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) were used to assess the severity of depressive and manic (mixed) symptoms, respectively. Multiple logistic regression analyses were carried out to identify clinical correlates of AD.ResultsWe included 206 people (mean age: 48.4 ± 18.6 yrs.; males: 38.8%) admitted for a major depressive episode (155 with major depressive disorder and 51 with bipolar disorder). Around two-thirds of the sample (N = 137; 66.5%) had AD. Multiple logistic regression models showed that AD was associated with mixed features, higher YMRS scores, psychotic features, and a diagnosis of major depressive disorder (p< 0.05).ConclusionDespite some limitations, including the cross-sectional design and the inpatient setting, our study shows that AD is likely to be associated with mixed and psychotic features, as well as with unipolar depression. The identification of these clinical domains may help clinicians to better contextualize AD in the context of major depressive episodes.

Purpose: A stereoscopic surgical video stream consists of left–right image pairs provided by a stereo endoscope. While the surgical display shows these image pairs synchronised, most capture cards cause de-synchronisation. This means that the paired left and right images may not correspond once used in downstream tasks such as stereo depth computation. The stereo synchronisation problem is to recover the corresponding left–right images. This is particularly challenging in the surgical setting, owing to the moist tissues, rapid camera motion, quasi-staticity and real-time processing requirement. Existing methods exploit image cues from the diffuse reflection component and are defeated by the above challenges. Methods: We propose to exploit the specular reflection. Specifically, we propose a powerful left–right comparison score (LRCS) using the specular highlights commonly occurring on moist tissues. We detect the highlights using a neural network, characterise them with invariant descriptors, match them, and use the number of matches to form the proposed LRCS. We perform evaluation against 147 existing LRCS in 44 challenging robotic partial nephrectomy and robotic-assisted hepatic resection video sequences with simulated and real de-synchronisation. Results: The proposed LRCS outperforms, with an average and maximum offsets of 0.055 and 1 frames and 94.1±3.6% successfully synchronised frames. In contrast, the best existing LRCS achieves an average and maximum offsets of 0.3 and 3 frames and 81.2±6.4% successfully synchronised frames. Conclusion: The use of specular reflection brings a tremendous boost to the real-time surgical stereo synchronisation problem.

Purpose: Augmented reality guidance in laparoscopic liver resection requires the registration of a preoperative 3D model to the intraoperative 2D image. However, 3D–2D liver registration poses challenges owing to the liver’s flexibility, particularly in the limited visibility conditions of laparoscopy. Although promising, the current registration methods are computationally expensive and often necessitate manual initialisation. Methods: The first neural model predicting the registration (NM) is proposed, represented as 3D model deformation coefficients, from image landmarks. The strategy consists in training a patient-specific model based on synthetic data generated automatically from the patient’s preoperative model. A liver shape modelling technique, which further reduces time complexity, is also proposed. Results: The NM method was evaluated using the target registration error measure, showing an accuracy on par with existing methods, all based on numerical optimisation. Notably, NM runs much faster, offering the possibility of achieving real-time inference, a significant step ahead in this field. Conclusion: The proposed method represents the first neural method for 3D–2D liver registration. Preliminary experimental findings show comparable performance to existing methods, with superior computational efficiency. These results suggest a potential to deeply impact liver registration techniques.

There are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly.

Carotid artery stenting (CAS) versus carotid endarterectomy (CEA) is well issue known, but the purpose of this study is to compare CAS versus CEA in terms of asymptomatic Diffusion-weighted magnetic resonance imaging (DW-MRI) demonstrated microembolic scattering of infarction and neuropsychological assessment impairment.

Archaeological sites can represent a refuge for plant and animal species, protecting them from the pressures of urbanisation. However, sometimes these environmental resources can lead to negative consequences for the monuments. In order to investigate such contrasting effects, we selected the UNESCO World Heritage Site Etruscan necropolis known as “La Banditaccia” (Cerveteri, Italy). We performed floristic and phytosociological analyses, and observations on roots interactions with monuments on several tombs (9 tumuliand 5 cube-shaped tombs) and applied commonly used indices to evaluate damages to the structures. The study revealed rich biodiversity of the site and the presence of rare plants, but also of some invasive species. The analysis of the phytosociological sets showed differences among vegetation types found on the tumulias a function of the varying degrees of anthropization. Abundant plant colonisation was detected on the top of the tumuli, sometimes causing damages to the structures. The results of the Impact Index analysis showed that the dynamic evolution of vegetation constitutes a significant risk to the archaeological structures. We suggest that careful management of vegetation should achieve equilibrium between the management requirements for the monuments and conservation of naturalistic values. A deeper evaluation of the interactions between plants and monuments is however necessary.

Abstract: Background: Lymph node dissection and esophageal anastomosis, considered the more demanding steps of laparoscopic gastrectomy for gastric adenocarcinoma, can be performed with the use of a remote-controlled robot. Methods: Thirteen patients with a histologically proved gastric cancer (six stage I, six stage II, and one stage III) were enrolled in a prospective study to assess feasibility and safety of the Da Vinci surgical system in total and partial gastrectomy with extended lymph node dissection. Outcome measures were conversion rate, intra- and postoperative morbidity and mortality, operative time, blood loss, number of lymph nodes harvested, and macroscopic and microscopic evaluation of resection margins. Results: Eight distal, four total, and one proximal laparoscopic gastrectomies were completed without conversion. Extended lymph node dissection, and esophagojejunal and esophagogastric anastomoses were successfully carried out using the da Vinci System. Mean operative time was 286 ± 32.6 min and blood loss was 103 ± 87.5 ml. Mean number of nodes retrieved was 28.1 ± 8.3 and all resection margins were negative. There was no mortality. Trocar bleeding requiring laparoscopy was the only major complication encountered. No recurrence occurred during a mean follow-up time of 12.2 ± 4.5 months. Conclusions: Robot-assisted laparoscopic lymph node dissection and esophageal anastomosis are feasible and safe. Longer follow-up time and randomized studies are needed to evaluate long-term outcome and clinical advantages of this new technology.

This study focuses on hybrid consumption experiences that originate from encounters between the physical and the digital realms. The aim is to analyze brand-driven phygital environments to uncover the relationship between consumers and brands that is established within hybrid consumption spaces. Given its exploratory nature, the study adopts a mixed-methods qualitative type of research design; it includes a multiple-case analysis, a diary-based survey, and a focus group, and it concentrates on five phygital projects of four Italian luxury fashion brands. The analysis reveals nine relevant building blocks of phygital brand environments (PBEs) that pertain to the direction of experience, the environmental features, and customers’ reactions. Moreover, the study provides an early interpretative framework regarding the effects that these constituents of PBEs exert on the consumer-brand relationship (CBR). The work uncovers relevant managerial implications highlighting brand-driven phygital spaces as strategic tools for luxury fashion companies to provide consumers with additional relational value that is generated through encounters between physical stores, digital technology, humans and brands.

Background: During coronavirus disease 2019 (COVID-19) pandemic, Helmet Continuous Positive Airway Pressure (h-CPAP) has been widely used to treat Acute Hypoxemic Respiratory Failure (AHRF). In COVID-19 patients undergoing h-CPAP a simple short peripheral catheter could be insufficient. According to the European Recommendations for Proper Indication and Use of Peripheral venous access consensus, a stable peripheral Vascular Access Device is indicated for intravenous treatment compatible with the peripheral route scheduled for more than 1 week.Objective: The aim of this prospective study was to evaluate the performance and the potential complications of superficial femoral midline catheters (SFMC) inserted in the Superficial Femoral Vein by direct Seldinger technique with peripheral tip (Arrow®, Teleflex; 20 cm length four FR single lumen and seven FR dual lumen) in AHRF COVID-19 patient. Complications were divided in early (accidental puncture of superficial femoral artery (APSFA); accidental saphenous nerve puncture (ASNP); bleeding) and late (Catheter Related Thrombosis (CRT); Catheter-Related Bloodstream Infections (CRBSI); Accidental Removal (AR); persistent withdrawal occlusion (PWO)).Methods: From 1stOctober 2020 to 30thJune 2021 we conducted a prospective observational study in COVID-19 sub-intensive wards at Luigi Sacco Hospital (Milan).Results: Hundred seventy five SFMC (mean dwell time 11.1 ± 9.8 days) were implanted in COVID-19 patients, 107 (61.1%) during h-CPAP treatment (10.5 ± 8.9 days), the remaining 68 (38.9%) in patients with severe disease. We recorded two minor immediate/early complications (APSFA without sequelae) and no major complications. The long-term follow-up registered four CRBSI (2.3%–2.5/1000 catheters days (CD)), five CRT (2.9%: 2.6/1000 CD), 22 AR (12.6%; 11.4/1000 CD), 38 PWO (36.5%), 34 of which occurred due to fibroblastic sleeve (32.7%).Conclusions: SFMC proved to be safe, easy and time-saving. It could be implemented, after a careful benefits and risks evaluation, in particular settings such as h-CPAP, delirium, bleeding risk factors and palliative care patients.

Venous thromboembolism (VTE) is rare in patients aged <21 years. Young adults aged 18 to 21 years are frequently included in adult VTE studies, whereas pediatric VTE studies include patients aged up to either 18 or 21 years. The clinical characteristics of young adult patients with VTE have not been well defined.

Psoriasis is a chronic inflammatory disease associated with systemic inflammation and comorbidities. Changes in the composition of the intestinal microbiome are involved in the pathogenesis of inflammatory diseases and metabolic syndrome. Characterizing the intestinal microbiome of patients with psoriasis may be relevant for the understanding of its clinical course and comorbidity prevention.

ABSTRACTMini-invasive partial nephrectomy (MIPN) has many advantages. However, it is challenging for the surgeon to localise the hidden anatomical structures to be spared or resected during surgery. Augmented reality (AR) is a promising localisation assistance approach. Existing AR-MIPN methods augment the endoscopic view with 3D models from preoperative CT scan. However, they do not track the kidney in real-time, which considerably reduces usability, as AR is only temporarily available on isolated images. We propose an approach to achieve continuous live AR-MIPN. It uses classical camera calibration and manual initial registration. Its key novelty is a keypoint-based automatic kidney tracking module, with three main technical contributions. First, it performs stereo tracking-by-detection from stereo keyframes, exploiting left-right consistency to maximise robustness. Second, it only considers keypoints within the parenchyma, as segmented by a specifically trained neural network. Third, it improves keypoint detection and matching by a new process that we call stereo perspective correction (SPC). It uses the stereo depth-map and surface flattening to generate an image warp that cancels the perspective effect, improving the performance of keypoint detection and matching. We carried out experiments on semi-synthetic and real surgical datasets to compare several tracking methods, showing that our method outperforms.

Purpose: To detect specularities as elliptical blobs in endoscopy. The rationale is that in the endoscopic setting, specularities are generally small and that knowing the ellipse coefficients allows one to reconstruct the surface normal. In contrast, previous works detect specular masks as free-form shapes and consider the specular pixels as nuisance. Methods: A pipeline combining deep learning with handcrafted steps for specularity detection. This pipeline is general and accurate in the context of endoscopic applications involving multiple organs and moist tissues. A fully convolutional network produces an initial mask which specifically finds specular pixels, being mainly composed of sparsely distributed blobs. Standard ellipse fitting follows for local segmentation refinement in order to only keep the blobs fulfilling the conditions for successful normal reconstruction. Results: Convincing results in detection and reconstruction on synthetic and real images, showing that the elliptical shape prior improves the detection itself in both colonoscopy and kidney laparoscopy. The pipeline achieved a mean Dice of 84% and 87% respectively in test data for these two use cases, and allows one to exploit the specularities as useful information for inferring sparse surface geometry. The reconstructed normals are in good quantitative agreement with external learning-based depth reconstruction methods manifested, as shown by an average angular discrepancy of $12.{11}^{\circ }\pm 9.{86}^{\circ }$\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$12.11^{\circ } \pm 9.86^{\circ }$$\end{document}in colonoscopy. Conclusion: First fully automatic method to exploit specularities in endoscopic 3D reconstruction. Because the design of current reconstruction methods can vary considerably for different applications, our elliptical specularity detection could be of potential interest in clinical practice thanks to its simplicity and generalisability. In particular, the obtained results are promising towards future integration with learning-based depth inference and SfM methods.

Nous développons une technique de réalité augmentée pour la néphrectomie partielle robot assistée (NPRA). Nous rapportons les points-clés de sa mise au point illustrés sur plusieurs tests en conditions réelles.

The loss of high molecular weight multimers (HMWM) of von Willebrand factor (vWF) in aortic stenosis (AS) and continuous-flow left ventricular assist devices (cf-LVADs) is believed to be associated with high turbulent blood shear. The objective of this study is to understand the degradation mechanism of HMWM in terms of exposure time (kinetic) and flow regime (dynamics) within clinically relevant pathophysiologic conditions. A custom high-shear rotary device capable of creating fully controlled exposure times and flows was used. The system was set so that human platelet-poor plasma flowed through at 1.75 ml/sec, 0.76 ml/sec, or 0.38 ml/sec resulting in the exposure time (texp) of 22, 50, or 100 ms, respectively. The flow was characterized by the Reynolds number (Re). The device was run under laminar (Re = 1,500), transitional (Re = 3,000; Re = 3,500), and turbulent (Re = 4,500) conditions at a given texpfollowed by multimer analysis. No degradation was observed at laminar flow at all given texp. Degradation of HMWM at a given texpincreases with the Re. Re (p< 0.0001) and texp(p= 0.0034) are significant factors in the degradation of HMWM. Interaction between Re and texp, however, is not always significant (p= 0.73).

Child maltreatment has detrimental social and health effects for individuals, families and communities. The ERICA project is a pan-European training programme that equips non-specialist threshold practitioners with knowledge and skills to prevent and detect child maltreatment. This paper describes and presents the findings of a rapid review of good practice examples across seven participating countries including local services, programmes and risk assessment tools used in the detection and prevention of child maltreatment in the family. Learning was applied to the development of the generic training project. A template for mapping the good practice examples was collaboratively developed by the seven participating partner countries. A descriptive data analysis was undertaken organised by an a priori analysis framework. Examples were organised into three areas: programmes tackling child abuse and neglect, local practices in assessment and referral, risk assessment tools. Key findings were identified using a thematic approach. Seventy-two good practice examples were identified and categorised according to area, subcategory and number. A typology was developed as follows: legislative frameworks, child health promotion programmes, national guidance on child maltreatment, local practice guidance, risk assessment tools, local support services, early intervention programmes, telephone or internet-based support services, COVID-19 related good practices. Improved integration of guidance into practice and professional training in child development were highlighted as overarching needs. The impact of COVID-19 on safeguarding issues was apparent. The ERICA training programme formally responded to the learning identified in this international good practice review.

A multicentre European randomized control trial – European Uncomplicated Type B Aortic Repair (EU-TBAR) is being developed to compare pre-emptive thoracic endovascular aortic repair (TEVAR) with custom-made devices versus conventional optimal medical therapy. The pretrial set-up is confluent on different pillars, including evaluation of 1) European activity, trends, and governance; 2) outcome reporting; and 3) cost evaluation. This article aimed to demonstrate the observational cross-sectional survey results from participating centers and highlight the risk assessment, activity, practices, and governance of uncomplicated type B aortic dissection (uTBAD).

A reliable physiological biomarker for major depressive disorder is essential for developing and optimizing neuromodulatory treatment paradigms. In this study, we investigated a passive electrophysiologic biomarker that tracks changes in depressive symptom severity on the order of minutes to hours.

As many as 65% of employees say they haven't been trained on how to use AI, while 42% expressed interest in such training from their employer. [ABSTRACT FROM AUTHOR]

Background: Macrophytes may modify benthic biodiversity and biogeochemistry via radial oxygen loss from roots. This condition contrasts sediments anoxia, allows roots respiration, and facilitates aerobic microbial communities and processes in the rhizosphere. Simultaneously, the rhizosphere can stimulate anaerobic microorganisms and processes via exudates or by favoring the build-up of electron acceptors as nitrate. As eutrophication often results in organic enrichment in sediments and large internal nutrients recycling, an interesting research question is to investigate whether plants maintain the capacity to stimulate aerobic or anaerobic microbial communities and processes also under elevated organic pollution. Methods: A manipulative experiment was carried out under laboratory-controlled conditions. Microcosms containing bare sediments and sediments transplanted with the macrophyte Vallisneria spiralisL. were created. The effect of the plant was investigated on sediments with moderate (8%) and elevated (21%) organic matter content, after an acclimatization period of 30 days. Chemical and physical parameters, microbial community composition and the potential rates of nitrification, denitrification and nitrate ammonification were measured at two different depths (0–1 and 1–5 cm) after the acclimatization period to evaluate the role of roots. Results: Vallisneria spiralisgrew and assimilated pore water nutrients at the two organic matter levels and vegetated sediments had always nutrient-depleted porewaters as compared to bare sediments. Nitrifying microbes had a lower relative abundance and diversity compared to denitrifying bacteria. However, regardless of the organic content, in vegetated sediments nitrifiers were detected in deeper horizons as compared to bare sediments, where nitrification was confined near the surface. In contrast, potential denitrification rates were not affected by the presence of roots, but probably regulated by the presence of nitrate and by root-dependent nitrification. Potential nitrate ammonification rates were always much lower (&lt; 3%) than potential denitrification rates. Conclusions: Vallisneria spiralisaffects N-related microbial diversity and biogeochemistry at moderate and elevated organic matter content, smoothing bottom water–pore water chemical gradients and stimulating nitrification and nitrogen loss via denitrification. These results suggest the possibility to deploy V. spiralisas a nature-based solution to counteract eutrophication in freshwater systems impacted by high loads of organic matter, for example, downstream of wastewater treatment plants.

Graphical abstract:

Bridges are critical elements of contemporary civil infrastructure. The operational and environmental factors can cause inevitable impacts on the serviceability and safety of a bridge. This paper has developed a wireless bridge deformation measurement system to monitor the bridge health condition in real-time, which achieves wireless connectivity for communication. Meanwhile, a self-sustained power supply is designed based on a solar photovoltaic (PV) system, removing the conventional power cables or the frequent battery replacement operation, which reduces the installation and maintenance cost and enables a long-term 24 hours × 7 days uninterrupted operation. The detailed power supply design procedure is provided, including the selection of the solar panel and battery, as well as the design of the dc-dc converter for the constant-current (CC) and constant-voltage (CV) charging of a lithium battery. Experiments validate the effectiveness of the developed wireless bridge deformation monitoring system and the designed power supply. It is shown that without using the PV system, the bridge deformation monitoring system can last for 24 days, which helps the system to survive extreme weather conditions. With the help of the PV system, the battery is always maintained at a fully charged condition, validating the self-sustainability of the designed power supply.