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Diabetic foot syndrome is often associated with inflammation. The aim of this study was to evaluate the impact of improved blood supply on the change in the clinical status and culturable bacteriota of chronic wounds. Patients with diabetic foot and peripheral arterial disease with a Rutherford score of 5 or 6 were included (n = 23). The blood supply to the limb was assessed with laboratory tests and two time-point qualitative cultures using a wound biopsy. The baseline parameters of the blood supply to the limb were Transcutaneous Oxygen Perfusion (TCPO2) of 15.0 mmHg, an Ankle Brachial Index (ABI) of 0.7, and a Toe Brachial Index (TBI) of 0.1, with an average Wound, Infection, Inflammation (WIfI) score of 5.7 (high). The most frequently isolated pathogens were Staphylococcus aureus (26.1%), followed by the Enterobacteriaceae family and Pseudomonas spp. (13.0%, each). Negative cultures were present in 47.8% (n = 11). The control parameters of blood supply improved; TCPO2 was 38.5 mmHg, the ABI was 0.9, and the TBI was 0.3, with a reduction in the average WIfI score to 3.7 (mild), while total colony-forming units (CFUs) increased by 13.5%. No cases of reocclusion or restenosis were observed during the study; however, small amputations were performed in two patients (8.7%). Five (21.7%) ulcers were significantly reduced and two (8.7%) progressed, while a negative culture at follow-up was obtained in five fewer patients than at baseline and nine patients presented growth despite having an initial negative result. Quantitative reduction was obtained in four (17.4%) cases. Pathogen distribution at follow-up resembled baseline findings. Optimizing clinical environments (enhancing blood flow and controlling inflammation) in general over focusing singularly on microbiota composition or revascularization seems to be crucial and arguably outweighed the impact of microbial change alone; in particular, reperfusion may increase the conditions to bacterial growth at the first stage. [ABSTRACT FROM AUTHOR]

In order to inhibit the growth and reproduction of microorganisms in the exudate of fresh aquatic products during storage. Absorbent paper, absorbent cotton and nylon mesh were used as the substrates, three types of clay minerals (diatomite, columnar diatomite and bentonite) were used as the water absorbing materials and a new type of unidirectional water‐conducting preservation pads was prepared. The physicochemical properties of water absorbing materials and preservation properties of pads for Lateolabrax japonicas fillets were measured. The results show that all three kinds of clay have good water absorption properties, and bentonite exhibits the highest water retention properties because of metal oxide. After absorbing water, the surface holes of diatomite and columnar diatomite particles are blocked, while the volume of bentonite particles increases. Bentonite absorbs water slowly but retains water best and can absorb 10.31 times its own mass of water. Preservation study shows that water absorption preservation pads can effectively absorb the exudate of fish fillets and slow down the deterioration of fish fillet quality. Bentonite preservation pad shows the best effective and extends the shelf life of L. japonicas fillets from 6 to 9.3 days. This research can provide the technical support for the application of preservation pads carrying clay minerals in the field of fresh aquatic products. [ABSTRACT FROM AUTHOR]

During the water dissolution polishing process of soft brittle materials, the pad's groove geometry plays a significant role in determining the performance. This not only affects the flow of the slurry but also directly impacts the overall distribution of the water core on the pad surface, thereby influencing the polishing effect. A trajectory model of the water core on the workpiece surface was established through kinematic analysis and the characteristics and effects of the pad's groove geometry in circular, radial, composite, and grid were studied combined with the trajectory analysis. The coefficient of variation and power spectral density were established to evaluate the trajectory uniformity. The trajectory density distribution was quantitatively analyzed to obtain a better understanding of the material removal uniformity. The simulation and experiment results indicated that the existence of groove geometry will greatly affect the flow of slurry and the surface quality. The grid groove had a better distribution of water core, which means better material removal. There exists a tradeoff between the number of grooves and their spacing. These insights offer a fresh perspective and serve as a valuable reference for further research and analysis into the groove characteristics of pads. • The pad's groove geometry was found to significantly impact slurry flow and water core distribution during water dissolution polishing. • A trajectory model for the water core on the workpiece surface was established through kinematic analysis to study the effects of different groove geometries including circular, radial, composite, and grid. • An optimal balance between the number and spacing of grooves was identified, offering valuable insights for further research and analysis of pad groove characteristics. • A decrease of over 98 % in the surface roughness rms (1.283 nm) of KDP crystal can be obtained by optimizing the design of the pad groove which agrees with the simulation result well. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest (OHCA) has a high global incidence and mortality rate, with early defibrillation significantly improving survival. Our aim was to assess the feasibility of autonomous drone delivery of automated external defibrillators (AED) in a non-urban area with physical barriers and compare the time to defibrillate (TTD) with bystander retrieval from a public access defibrillator (PAD) point and helicopter emergency medical services (HEMS) physician performed defibrillation. This randomized simulation-based trial with a cross-over design included bystanders performing AED retrievals either delivered by automated drone flight or on foot from a PAD point, and simulated HEMS interventions. The primary outcome was the time to defibrillation, with secondary outcomes comparing workload, perceived physical effort, and ease of use. Thirty-six simulations were performed. Drone-delivered AED intervention had a significantly shorter TTD [2.2 (95 % CI 2.0–2.3) min] compared to PAD retrieval [12.4 (95 % CI 10.4–14.4) min] and HEMS [18.2 (95 % CI 17.1–19.2) min]. The self-reported physical effort on a visual analogue scale for drone-delivered AED was significantly lower versus PAD [2.5 (1 – 22) mm vs. 81 (65–99) mm, p = 0.02]. The overall mean workload measured by NASA-TLX was also significantly lower for drone delivery compared to PAD [4.3 (1.2–11.7) vs. 11.9 (5.5–14.5), p = 0.018]. The use of drones for automated AED delivery in a non-urban area with physical barriers is feasible and leads to a shorter time to defibrillation. Drone-delivered AEDs also involve a lower workload and perceived physical effort than AED retrieval on foot. [ABSTRACT FROM AUTHOR]

BACKGROUND: Research suggests omega-3 polyunsaturated fatty acids (PUFAs) exert favorable effects on several biological processes involved in the development and progression of atherosclerotic cardiovascular disease (ASCVD). However, studies examining the relationship between omega-3 PUFAs and peripheral artery disease (PAD) are scarce. OBJECTIVES: We evaluated the associations between omega-3 PUFAs and incident PAD in a meta-analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) and Atherosclerosis Risk in Communities (ARIC) study cohorts. METHODS: Omega-3 PUFAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were measured at baseline for all MESA (n = 6495) and Minnesota ARIC participants (n = 3612). Incident clinical PAD events (MESA n = 106; ARIC n = 149) identified primarily through ICD discharge codes were assessed through follow-up of each cohort. Associations between omega-3 PUFAs (EPA, DHA, and EPA+DHA) and incident PAD were modeled in MESA and ARIC as quartiles and continuously using Cox proportional hazards regression, respectively. A fixed-effects meta-analysis was conducted to evaluate associations in the 2 cohorts combined. RESULTS: In the fully adjusted model, in 10,107 participants, no significant associations were observed between EPA, DHA, or EPA+DHA, and incident PAD modeled as quartiles or continuously for either MESA or ARIC cohorts separately or in the meta-analysis after a follow-up of approximately 15 y. CONCLUSION: This study is consistent with previous literature indicating that the beneficial effects of omega-3 PUFAs on the markers of ASCVD may not translate to a clinically meaningful decrease in PAD risk.

Abstract Background We evaluated the noncontrast MRA as an alternate method to CT angiography in assessment of patients with lower limb ischemia, 30 patients were included in a prospective cohort study; they underwent quiescent interval slice selective magnetic resonance angiography (QISS-MRA) and computed tomographic angiography (CTA). The assessment of images was evaluated by two independent consultants. The overall subjective image quality, interobserver and intermodality concordance were calculated. Results The median acquisition time in QISS-MRA was 20 min (range 18–30 min), The overall subjective image quality was rated similarly with QISS-MRA (3.13 [95% CI 2.84–3.42]) and CTA (3.23 [95% CI 2.94–3.52]; p = 0.08) with interobserver concordance for lesion ratings in QISS-MRA reached (κ = 0.987 (SD 0.006)), while for CTA it was (κ = 0.99 (SD 0.006)), while the intermodality concordance between QISS-MRA and CTA in lesion ratings were calculated on a per segment basis and was (κ = 0.944 (SD 0.013)) for reader 1 and (κ = 0.947 (SD 0.013)) for reader 2, with sensitivity 100% and specificity 97.6% Conclusions QISS-MRA is a reliable modality for assessment of patients with critical limb ischemia.

Abstract Background Cancer therapy is considered to cause accelerated ischemia. Ankle-Brachial Index (ABI) measurement is an inexpensive, simple, available test for the early diagnosis of peripheral artery disease (PAD); however, it is not performed routinely. We aimed to evaluate the role of routine ABI measurement for the diagnosis of PAD among patients diagnosed with cancer and whether it correlates with left ventricular (LV) dysfunction. Methods A retrospective, single-center study including patients diagnosed with cancer at Tel Aviv Sourasky Medical Center. The cohort included patients performing routine ABI and LV global longitudinal strain (GLS) echocardiography. The primary endpoint was the prevalence of PAD and whether it correlates with LV dysfunction, defined by LV GLS absolute value

The most common complications after percutaneous vascular interventions are complications at the site of access. The use of retrograde tibial-pedal access could reduce the risks of significant complications at the puncture site compared to traditional femoral access. Purpose: In this study, we aimed to determine the efficacy and safety of primary tibial-pedal access for revascularization of chronic total occlusion of the femoral-popliteal and infrapopliteal segments in patients with critical lower limb ischemia. Materials and Methods: We conducted a retrospective analysis of 18 patients from January 2022 to August 2024. Patients were selected according to the following criteria: patients with categories 3, 4, 5 according to the Rutherford classification and stages 3,4 according to the Fontaine classification; femoropopliteal (FP) lesion with or without involvement of the infrapopliteal (IP) segment; the presence of blood flow in one or more distal or pedal segments of the main arteries of the leg and foot; informed consent of patients for the intervention. Results: The overall procedural success rate of the intervention was 100%. The average age of patients was 74±5 years. The majority of the subjects were women (66.7%). Comorbidities such as diabetes mellitus (66.7%), arterial hypertension (55.5%), coronary artery disease (38.9%), and hyperlipidemia (77.8%) were diagnosed. The artery of choice in the majority of cases was the anterior tibial artery 13 (72.2%) Balloon angioplasty combined with stent placement was performed in 14 cases (77.8%). Minor bleeding at the puncture site occurred in 1 case (5.5%). There were no signs of major bleeding, hematomas, MALE, MACE, or death in any case. All patients experienced relief of pain of ischemic origin. Conclusion: Retrograde tibial-pedal access is technically easier with a tendency to fewer complications. This technique can be used as a primary procedure or as an alternative to antegrade femoral access in complex patients with a high risk of hematoma formation.

The financial performance of local governments (LG) in implementing regional autonomy has a central role. However, the phenomenon is that only some local governments have this financial capability. Therefore, this study examines what factors can affect financial performance. This study empirically analyzed the effect of capital expenditure, local government size, legislative size, local revenue, and audit opinion on the financial performance of local governments in districts and cities in West Java. The method used uses quantitative methods. The research data used financial reports of Regency and City Regional Governments in West Java for the period 2015 - 2022 using Purposive Sampling. A total of 216 data were analyzed using Multiple Linear Regression. The steps in this study begin with a review of literature and regulations, data collection, data tabulation, data analysis, and then reporting and publication of research results. The results showed that the size of local government, local revenue, and audit opinion had a positive effect on financial performance, while capital expenditure and legislative size did not affect financial performance. Based on the results of this study, the implication is that district and city governments in West Java must increase the size of local governments, local revenue, and audit opinion to improve their regions' financial performance. [ABSTRACT FROM AUTHOR]

The impact of diabetic foot (DF) on the healthcare system represents a major public health problem, leading to a considerable clinical and economic burden. The factors contributing to DF's development and progression are strongly interconnected, including metabolic causes, neuropathy, arteriopathy, and inflammatory changes. Sodium–glucose cotransporter 2 inhibitors (SGLT2-i), novel oral hypoglycemic drugs used as an adjunct to standard treatment, have recently changed the pharmacological management of diabetes. Nevertheless, data about the risk of limb amputation, discordant and limited to canagliflozin, which is currently avoided in the case of peripheral artery disease, have potentially discouraged the design of specific studies targeting DF. There is good evidence for the single immunomodulatory, neuroprotective, and beneficial vascular effects of SGLT2-i. Still, there is no clinical evidence about the early use of SGLT2-i in diabetic foot due to the lack of longitudinal and prospective studies proving the effect of these drugs without confounders. This narrative review aims to discuss the main evidence about the impact of SGLT2-i on the three complications of diabetes implicated in the development of DF, the state of the art, and the potential future implications. [ABSTRACT FROM AUTHOR]

Background: Peripheral artery disease (PAD) is still the least studied and evaluated form in clinical practice among atherosclerotic pathologies, despite the increased mortality and comorbidities related to it. The relationship between steatotic liver disease and an increased risk of cardiovascular disease has been extensively documented. Methods: The purpose of this work is to perform a review of the evidence linking NAFLD or MASLD to PAD, and examine possible clinical scenarios that arise from this new terminology. Results: The new definition of metabolic dysfunction-associated steatotic liver disease (MASLD) includes the presence of cardiometabolic risk factors and hepatic steatosis without any other underlying causes of hepatic steatosis; this terminology, coined in the hepatological field, could generate confusion, especially in the initial stages of its diffusion and among different medical specialists. Conclusions: Some recent data in the literature have strengthened the evidence of a pathological link between hepatic metabolic alteration (NAFLD or MAFLD) and PAD. [ABSTRACT FROM AUTHOR]

Background: We evaluated the noncontrast MRA as an alternate method to CT angiography in assessment of patients with lower limb ischemia, 30 patients were included in a prospective cohort study; they underwent quiescent interval slice selective magnetic resonance angiography (QISS-MRA) and computed tomographic angiography (CTA). The assessment of images was evaluated by two independent consultants. The overall subjective image quality, interobserver and intermodality concordance were calculated. Results: The median acquisition time in QISS-MRA was 20 min (range 18–30 min), The overall subjective image quality was rated similarly with QISS-MRA (3.13 [95% CI 2.84–3.42]) and CTA (3.23 [95% CI 2.94–3.52]; p = 0.08) with interobserver concordance for lesion ratings in QISS-MRA reached (κ = 0.987 (SD 0.006)), while for CTA it was (κ = 0.99 (SD 0.006)), while the intermodality concordance between QISS-MRA and CTA in lesion ratings were calculated on a per segment basis and was (κ = 0.944 (SD 0.013)) for reader 1 and (κ = 0.947 (SD 0.013)) for reader 2, with sensitivity 100% and specificity 97.6% Conclusions: QISS-MRA is a reliable modality for assessment of patients with critical limb ischemia. [ABSTRACT FROM AUTHOR]

Research purposes This is: (1) Analyze influence income original (PAD) on capital expenditure in South Halmahera Regency, Central Halmahera Regency, and East Halmahera Regency; (2) Analyzing influence of allocation funds general (DAU) for capital expenditure in South Halmahera Regency, Central Halmahera Regency, and East Halmahera Regency; (3) Analyzing influence of allocation funds special (DAK) for capital expenditure in South Halmahera Regency, Central Halmahera Regency, and East Halmahera Regency; (4) Analyzing The influence of profit sharing funds (DBH) on capital expenditure in South Halmahera Regency, Central Halmahera Regency, and East Halmahera Regency; (5) Analyzing the occurrence phenomenon flypaper effect in South Halmahera Regency, Central Halmahera Regency, and East Halmahera Regency. This study is study studies cases in producing areas mining in North Maluku Province. The analytical tools used in the study is analysis panel data regression. Research results show that income original areas and allocation funds special influential positive towards government spending. While the allocation fund general and profit sharing funds are not influential on government spending area. Research results show that existence phenomenon flypaper effect in Central Halmahera Regency, South Halmahera Regency, and East Halmahera Regency. [ABSTRACT FROM AUTHOR]

The vibration mechanism of railways and urban rail transit is highly intricate, particularly within the railway environment. This study employs a variety of vertical stiffness damping pads to develop an integrated damping system for a floating slab. Through optimization of damper stiffness and arrangement, the modal characteristics of the floating slab are analyzed, resulting in a reduction of the inherent frequency of the track structure and attenuation of vibration transmission. Subsequently, this damping system is implemented in an actual engineering project to assess its effectiveness. The findings indicate that lower stiffness in the vibration isolation pad corresponds to a smaller inherent frequency for the floating slab, thereby enhancing its damping efficacy. Utilizing elastic supports for vibration isolation pads within the track structure can mitigate upper structure vibrations induced by trains. [ABSTRACT FROM AUTHOR]

The research aims to assess the potential for regional taxes and levies generated through city tourism and the creative economy. It further seeks to analyze both the opportunities and challenges associated with integrating city tourism with the creative economy within Balangan Regency. Additionally, the study measures the extent to which the potential for PAD can develop from taxes and levies related to tourism and the creative economy in the region. This research uses a descriptive qualitative method by focusing on the efforts made by Regional Government Organizations as well as the factors that encourage or inhibit the development of taxes and levies to increase the PAD of Balangan Regency. The analysis techniques used by researchers are data analysis before going to the field, data analysis using the Miles and Huberman model, feasibility analysis through Potential and Constraints, and data calculation analysis. The results of this research show that Kebun Raya Balangan, with a potential visitor count of 7,477 per year, could increase PAD by Rp 48,579,480 based solely on natural and educational tourism. However, this potential can rise to Rp 51,829,980 with the integration of the creative economy. Taman Hijau Balangan, which scored the highest in the survey, has the potential to enhance PAD by Rp 69,770,692, and with its development into a rest area and creative community space, PAD could increase to Rp 81,003,192. Meanwhile, Taman Palidangan Sanggam could boost PAD from Rp 38,349,377 to Rp 41,581,877 with the addition of natural tourism facilities and a wedding venue. [ABSTRACT FROM AUTHOR]

Peripheral artery disease (PAD), primarily caused by atherosclerosis, leads to the narrowing or blockage of arteries that supply blood to the limbs. This study explores the pro-angiogenic effects of L-theanine and its underlying mechanisms in a mouse model of hindlimb ischemia (HLI). To evaluate L-theanine's pro-angiogenic effects, human umbilical vein endothelial cells (HUVECs) were subjected to tube formation, migration, sprouting, and proliferation assays. In vivo, C57BL/6 mice with induced HLI were treated with L-theanine. Blood flow recovery was measured via Doppler ultrasound, and vascular density was analyzed using immunofluorescence staining. RNA sequencing identified neuropilin-1 (NRP1) as a key regulator, and the expression levels of NRP1 and VEGFR2 were examined through qPCR and Western blotting. L-theanine significantly enhanced angiogenesis in HUVECs, as demonstrated by improved tube formation, migration, sprouting, and proliferation. In mice, L-theanine treatment resulted in increased vessel density and improved blood flow recovery. Furthermore, L-theanine was found to activate the NRP1/VEGFR2 signaling pathway in both HUVECs and the HLI mouse model. These findings indicate that L-theanine can promote angiogenesis and activate key pathways involved in vascular repair, suggesting its potential as a therapeutic agent for treating vascular defects associated with PAD.

This research aims to assess the financial independence of the Mamuju Regency Government and determine the factors that influence it. This research uses Mamuju Regency Regional Government Financial Report data for 2013 - 2023. The research method uses a qualitative case study approach by analyzing the development of Regional Original Income (PAD) Mamuju Regency acquisition from 2013 to 2023 as well as the contribution of PAD acquisition to Regional Income, then analyzing the development of Regency Transfer Income acquisition Mamuju and the proportion of its revenues to Regional Revenue from 2013 to 2023 in order to determine the level of dependence on funds from other governments (central and provincial), then calculate the Fiscal Independence Index value and classify the calculation results. The financial independence of the Mamuju District Government in the last 10 years, namely 2013- 2023, is included in the "Not Yet Independent" classification with an average value of 0.0705. Analysis of the IKF trend, there are fluctuations in the IKF value in the Mamuju Regency Regional Government, but in the last three years, the trend shows an increase or is positive. Factors that hinder regional financial independence in the Regional Government of Mamuju Regency are the lack of acquisition of Regional Original Income (PAD) and the high level of dependence on central transfer income. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, attention has been paid to forage cactus as a plant resistant to drought conditions and as an obstacle against desertification and diversification of vegetation in low rainfall ranges. The use of Opuntia ficus-indica pads as forage for cattle in the semi-arid and arid regions of the world, especially in periods of time when there is a lack of quality and quantity of fodder in the ranges, is important. Considering the importance of producing fodder plants and improving their quality under the influence of different fertilizer inputs, this experiment aims to investigate the effect of different proportions of biological, chemical and animal fertilizers and their interaction on the qualitative and quantitative characteristics of forage cactus and determine the optimal fertilizer level for this plant in the city, It was done in Khorram Abad, Lorestan. Materials and Methods: In order to investigate the effect of using biological, chemical and livestock fertilizers on Separate and combined tests were carried out on some forage cactus traits during two cropping years (2019 and 2020). The size of each plot was 6 square meters (4 x 1.5) with 4 crop lines and the plant density was 3.33 per each square meter. The main pad for planting was prepared from a three-year base and were prepared and transferred from the research farm affiliated to ICARDA (International Center for Agricultural Research in Dry Areas) in Mehran city, belonging to the Agricultural Research Center of Ilam province. The experiment was conducted in the research farm of Lorestan University's Faculty of Agriculture as a factorial in the form of a randomized complete block design with 32 treatments and 3 replications. Experimental factors include biological fertilizer (mycorrhiza) at 2 levels (use and non-use of mycorrhiza), manure at 4 levels (0, 10, 20 and 30 tons per hectare) and nitrogen fertilizer at 4 levels(0, 100, 200 and 300 kilograms per hectare). The qualitative traits included NDF, ADF, CF, ASH and CP, which were measured using a near infrared spectrometer)NIR(, (model DA 7250: manufactured by Perten Sweden) measurements were made at wavelengths between 700 and 2500 nm. (All the measurements for the quality of traits were done in the central laboratory of Lorestan University). Quantitative analysis of the data after Bartlett's test was done with SAS software Version (9.4) by compound analysis method for all traits (except wet and dry yield which were one year old), to draw graphs from Excel software and to compare the averages from the test LSD was used at a significant level of 5%. Results and Discussion: The percentage of crude protein, ash, neutral detergent fiber, acid detergent fiber, and crude fiber, fresh and dry yield was influenced by the use of manure and nitrogen fertilizer, and the simple effect and the interaction effect of the combined use of different levels of manure and nitrogen fertilizer on this trait were also significant at the level of one percent. The highest fresh forage yield and dry yield were obtained in the treatment of combined use of 300 kg of nitrogen fertilizer + 30 tons per hectare of manure in comparison with the control treatment (no use of fertilizer) with the lowest amount. The percentage of crude protein and fodder ash increased by 83.05% and 88.26% respectively in this treatment, and the percentage of traits reducing the quality of fodder, including neutral detergent fiber, acid detergent fiber, and crude fiber showed the highest decrease compared to the control treatment, showed. Based on the results of the present research, the combined use of manure and chemical fertilizers led to the improvement of quantitative and qualitative traits in forage cactus. Non significant difference was observed between treatments using mycorrhiza and not using it. The best result was obtained in the M3N3 treatment and then in the M3N2, M2N2 and M2N3 treatments, considering that no significant difference was observed between the characteristics of these treatments, the M2N2 treatment seems to be more economically efficient and more sustainable from the environmental aspect, it is recommended. As it was evident in the test results, no significant difference was observed between the treatments using mycorrhizal biofertilizer and not using this fertilizer. It seems that the beneficial effects of manure last longer compared to chemical fertilizers, and also some organic matter may remain in the soil over the years and its nutrients gradually enter the soil, and less damage is caused by using it, enters the environment. Conclusion: According to the results of this research, the integrated application of manure and nitrogen fertilizer has improved the quantitative and qualitative traits in forage cactus, non significant difference was observed between the treatments of using bio-fertilizer and not using bio-fertilizer. therefore, it is recommended that the study regarding the use of mycorrhizal fungi in multi-year and long-term supplementary experiments be investigated further. The effect of year was significant only on the trait of plant height and it did not show significant results in other traits. The combination of manure and chemical fertilizer can increase vegetative growth and forage yield, because in the integrated system, the presence of some chemical fertilizer at the beginning of growth compensates for the lack of elements in the root environment, and then during the growth period, animal fertilizers release the elements required by the plant increasing the yield of fodder in the plant. [ABSTRACT FROM AUTHOR]

Patients undergoing external beam radiation therapy for the palliative treatment of painful bony metastases may have difficulty maintaining a still position on a rigid uncovered couch top, both during CT simulation as well as during patient setup, image guidance, and treatment on the linear accelerator. For these patients, a thin foam pad or mattress is sometimes used to mitigate patient discomfort. It was desired to quantify the effect of the padding in cases in which the patient is to be treated supine with posterior beams when the majority of the beam weighting traverses both the couch and the pad. Ion chamber measurements in-phantom were acquired with 6 MV, 10 MV, and 15 MV photon beams. At depths of maximum dose, the pad resulted in a difference of signal collected ≤1%. At the phantom surface, the pad resulted in an increase in signal ranging from 1% to 6.5% for the measured beams. CT data of the pad, both with and without applied pressure, indicated that the pad had average HU values close to air. [ABSTRACT FROM AUTHOR]

Oxidative stress plays a crucial role in the pathogenesis of peripheral artery disease (PAD). This study aimed to investigate the effect of clopidogrel on oxidative stress in PAD patients. Seventy subjects were divided into three groups: PAD patients before treatment (B-PAD), PAD patients after treatment with clopidogrel (A-PAD), and healthy controls. Serum levels of superoxide dismutase (SOD), copper (Cu), zinc (Zn), manganese (Mn), and oxidized protein were measured. SOD activities were also determined. The results showed that SOD activities, and SOD specific activities were significantly decreased in PAD patients compared to healthy individuals. After treatment with clopidogrel, SOD activities, and SOD specific activities were continuously decrease in PAD patients. The SOD and oxidized protein concentrations were significantly increased in PAD patients compared to healthy individuals. After treatment with clopidogrel, the oxidized protein concentration was significantly decreased, while SOD concentration was significantly increased in PAD patients. These findings suggest that the treatment by clopidogrel stimulated the production of the enzyme but the ratio of active enzyme remained low. The decrease in oxidized protein can be explained by the treatment having antioxidant efficacy that may have compensated for the deficiency in enzyme activity and led to a decrease in oxidized protein. Additionally, the results of this study provide promising evidence that oxidative stress biomarkers including SOD concentration, T-SOD activity, Mn-SOD activity, and oxidized protein levels have potential utility in the diagnosis and management of PAD. [ABSTRACT FROM AUTHOR]

This study is a quantitative study that examines the influence of Regional Original Revenue (PAD), General Allocation Fund (DAU), and Tax Revenue Sharing on economic growth in East Nusa Tenggara province during the period 2008-2017. Secondary data from the Indonesian Bureau of Statistics (BPS) East nusa tenggara Province were used, with independent variables including PAD, DAU, and Tax revenue Sharing, and the dependent variable was economic growth. The analysis method used is multiple linear regression with the Ordinary Least Square (OLS) technique to determine the relationship between these variables. The results of this study are expected to provide an overview of how much PAD and DAU contribute to economic growth during the research period. [ABSTRACT FROM AUTHOR]

Chronic limb threatening ischemia (CLTI) poses a significant treatment challenge for vascular surgeons, interventionalists, podiatrists, and associated medical specialists. The evidence for what constitutes appropriate care is rapidly evolving and new treatment options are in constant development. This review examines the current guidelines for CLTI care, as well as reported outcomes for multiple care strategies in this patient population, including revascularization and medical optimization. We performed a literature review of the PubMed database, reviewing articles that reported outcomes for CLTI care between 2000 and 2023, and described these outcomes as they relate to the current state of CLTI treatment. Significant data are still forthcoming regarding CLTI care, but widespread adoption of appropriate CLTI care is essential for the treatment of this vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose of Review: Patients with lower extremity peripheral artery disease (PAD) are at high risk for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). This manuscript will review the current evidence for medical therapy in patients with PAD according to different clinical features and the overall cardiovascular (CV) risk. Recent Findings: The management of PAD encompasses non-pharmacologic strategies, including lifestyle modification such as smoking cessation, supervised exercise, Mediterranean diet and weight loss as well as pharmacologic interventions, particularly for high risk patients. Benefits for reduction of CV and limb outcomes have been demonstrated for new therapies, including antithrombotic therapy (i.e., low-dose rivaroxaban plus aspirin), lipid lowering therapy (i.e., proprotein convertase subtilisin/kexin type 9 inhibitors), and glucose lowering therapy (i.e., sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists). However, the adoption of these therapies in PAD remains suboptimal in practice. Implementation science studies have recently shown promising results in PAD patients. Summary: Comprehensive medical and non-medical management of PAD patients is crucial to improving patient outcomes, mitigating symptoms, and reducing the risk of MACE and MALE. A personalized approach, considering the patient's overall risk profile and preference, is essential for optimizing medical management of PAD. [ABSTRACT FROM AUTHOR]

ObjectiveOnline resources can be a valuable source of information for patients and have been shown to result in more inquiry during medical office visits, following physician medical recommendation more closely, and making self-directed lifestyle changes. The accessibility to these resources is limited by the readability level of the article and the literacy level of the population. Peripheral artery disease (PAD) is estimated to affect between 8 and 12 million people in the United States with greater disease severity among under insured or uninsured populations. As PAD continues to increase in prevalence, it is imperative that patients have access to comprehensible patient-centered health information. This study aims to evaluate the readability of online PAD patient education materials.MethodsThe search engine Google was used to collect the first 25 patient-accessible online articles pertaining to the search term "peripheral artery disease." Articles were then categorized by source type: hospital, professional society, or other. Readability was measured using the following tests: Automated Readability Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, Gunning Fog, Linsear Write Formula, and the SMOG Index. Statistical analyses were performed using Statistical Analysis Software, with P values less than .05 being statistically significant.ResultsTwenty-five articles were categorized by source and statistically analyzed. The average readability of PAD patient education materials was 10.8 and significantly above the American Medical Association, National Institutes of Health, and US Department of Health and Human Services recommended reading level of sixth grade. Readability scores among source categories were not significantly different.ConclusionsCommonly available online PAD resources are written at a grade level above that currently recommended by medical societies. Hospitals, professional societies, and other stakeholders in PAD patient education should take into consideration the readability of their materials to make medicine more accessible. Readable articles may combat the historic and structural racism often found in our health care system that marginalizes those with lower health literacy. It is imperative to develop patient education at an appropriate level to enrich patient autonomy.

Peripheral arterial disease (PAD) is an increasing cause of morbidity and its severity is graded based on clinical manifestation. To investigate the influence of the different stages on myopathy of ischemic muscle we analysed severity‐dependent effects of mitochondrial respiration in PAD. Eighteen patients with severe PAD, defined as chronic limb‐threatening ischemia, 47 patients with intermittent claudication (IC) and 22 non‐ischemic controls were analysed. High‐resolution respirometry (HRR) was performed on muscle biopsies of gastrocnemius and vastus lateralis muscle of patients in different PAD stages to investigate different respiratory states. Results from HRR are given as median and interquartile range and were normalized to citrate synthase activity (CSA), a marker for mitochondrial content. In order to account for inter‐individual differences between patients and controls, we calculated the ratio of O₂‐flux in gastrocnemius muscle over vastus muscle ('GV ratio'). CSA of the gastrocnemius muscle as a proxy for mitochondrial content was significantly lower in critical ischemia compared to controls. Mitochondrial respiration normalized to CSA was higher in IC compared to controls. Likewise, the GV ratio was significantly higher in IC compared to control. Mitochondrial respiration and CSA of PAD patients showed stage‐dependent modifications with greater changes in the mild PAD stage group (IC). [ABSTRACT FROM AUTHOR]

Background: In vascular medicine, peripheral arterial disease (PAD) and diabetic foot syndrome (DFS) are often considered synonymous with respect to the need for revascularization. In PAD patients, clinical symptoms reflect the degree of atherosclerotic disease, since peripheral innervation, including pain sensation, is not usually compromised. In DFS patients, however, symptoms of relevant foot ischemia are often absent and progression of ischemia goes unnoticed owing to diabetic polyneuropathy, the loss of nociception being the main trigger for foot ulcers. This review analyzes the fundamental differences between PAD and DFS against the background of polyneuropathy. Methods: The literature research for the 2014 revision of the German evidence-based S3-PAD-guidelines was extended to 2023. Results: Vascular examination is imperative for both, PAD and DFS. Stage-dependent revascularization is of utmost importance in PAD patients, especially those suffering from critical limb-threatening ischemia (CLTI). Successful therapy of DFS goes further, including infection and metabolic control, wound management, offloading the foot and lifelong prophylaxis in the course of a multidisciplinary treatment concept. Revascularization is not needed in all cases of DFS. Conclusions: There are fundamental differences between PAD and DFS with respect to pathophysiology, the anatomical distribution of arterial occlusive processes, the clinical symptoms, the value of diagnostic tools such as the ankle-brachial index, and classification. Also, therapeutic concepts differ substantially between the two patient populations. [ABSTRACT FROM AUTHOR]

The implementation of regional autonomy by giving broad, real and responsible authority to regions in a proportional manner is realized by regulating, distributing and utilizing national resources as well as balancing central and regional finances. Drinking water services in urban areas, PDAM Tirta Sejuk Gayo Les Regency carries out its operations according to company principles, namely efficiency and seeking profits, in order to meet the target of filling regional government coffers. The aim of this research is to understand the strategic issues of PDAM Tirta Sejuk and formulate management strategies that should be implemented in the era of autonomy in order to be able to increase the PAD of Gayo Lues Regency and to find out strategies for improving services to the community. This research method uses a qualitative descriptive approach. This research uses SWOT analysis. Conclusion Currently only 21% (10,500 connections) of Gayo Lues residents can enjoy clean water facilities from PDAM. This condition is still far from the national target which requires 60% of urban residents to be able to enjoy clean water facilities. Of all employees working at PDAM, it can be seen that the composition of the number of employees who have a D3 educational background or above is very small, only 14.01% when compared with the number of employees who have an educational background below D3 is 85.99%. Such conditions indicate that the quality of employees is still low, and the high number of water leaks certainly has a big impact on the efficiency of the PDAM itself. For the customer community, this condition is clearly detrimental because the quantity, quality and continuity of clean water needed to meet their daily needs does not meet expectations, which means reducing their satisfaction with the services provided by PDAM Tirta Sejuk. [ABSTRACT FROM AUTHOR]

The Indonesian government has decided to enhance its economic status, and one of the ways to achieve this is by utilizing the tourism ministry to maximize the tourism industry. This research aimed to investigate the contribution of the Village Government in managing tourism sites to increase locally-generated income in Suci Village, Panti District, Jember Regency. Additionally, the study identified the challenges faced by the Suci Village Government. Qualitative methods were employed for data collection, utilizing triangulation that encompasses interviews, observations, and documentation. The outcomes of this research revealed that socialization and planning for tourist area development, formation of tourism awareness groups named Pokdarwis, social media promotions, and comparative studies with other tourist villages were effective ways to improve the situation. However, several factors influence the Village Government's role in tourism management, such as natural conditions affected by seasons, insufficient infrastructure and facilities, and human resources, particularly the community's lack of knowledge and skills regarding tourism object management. Hence, training and intensive support from the Suci Government are crucial. [ABSTRACT FROM AUTHOR]

AbstractThe highly anticipated global Metaverse market presents a burgeoning arena, particularly in shopping and retail. While physical retail environments have long emphasized the details of exterior and interior servicescape design, the shift to online shopping raises questions about applying these traditional retail principles to the Metaverse setting. This research adopts conjoint analysis to delve into the potential of localized Metaverse retail design by merging consumer emotions, market segmentation, and innovative retail technologies. Using the Pleasure, Arousal, Dominance (PAD) model, we examine Metaverse servicescape attributes, based on real-world counterparts, application in segmenting store design based on consumer preferences. Like in physical retailing cases, music, crowding, and noise are the most influential Metaverse attributes affecting consumer emotion. However, three different clusters emerged according to their emotional responses. Our experiment reveals that Metaverse servicescape attributes may evoke emotional responses akin to their physical counterparts while offering a valuable opportunity for customization that better satisfies market segments. Insights are offered for retailers navigating the dynamic Metaverse landscape, where personalization and localization are now more affordable and where multiple store designs can coexist in digital form—reaching larger markets. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate the safety and effectiveness of rotational atherectomy-assisted balloon angioplasty (BTK-RA) for the treatment of isolated below the knee (BTK) atherosclerotic lesions and to compare the outcomes to plain old balloon angioplasty (POBA). Between January 2020 and September 2023, 96 consecutive patients with chronic limb threatening ischemia (CTLI) and isolated BTK-lesions underwent POBA (group A) or BTK-RA (group B). The primary outcome measures were: periprocedural technical success, primary patency, postoperative increase of the ankle branchial index (ABI), target lesion revascularization (TLR), limb salvage, minor amputation and death. Both techniques had similar technical success, operative time, intraprocedural complications and bailout stent implantations, independently of the operator's experience. Group B had significantly higher primary patency rates (93.5% vs. 72.0%, respectively, p = 0.006), TLR (2.1% vs. 24%, p = 0.057), lower in-hospital stay (2.0–3.0 vs. 4.0–6.0 days, respectively, p < 0.001) and higher postoperative ABI (0.8–0.2 vs. 0.7–0.1, respectively, p = 0.008), compared to group A. Significant differences (POBA n: 20, 40%, BTK-RA n = 3, 6.5%) were found in minor amputation rates between the two groups (p < 0.001), while the respective limb salvage rates were similar in both groups (94.0% vs. 97.8%, p = 0.35). The use of BTK-RA for the treatment of BTK-lesions in patients with CTLI showed significant clinical advantages in comparison to POBA. [ABSTRACT FROM AUTHOR]

Lower extremity peripheral artery disease (PAD) is common among patients with several risk factors, such as elderly, smoking, hypertension, and diabetes mellitus. Notably, PAD is associated with a higher risk of cardiovascular complications. Non-invasive interventions are beneficial to improve morbidity and mortality among patients with PAD. Traditional risk factors like smoking, diabetes mellitus, hypertension, and dyslipidemia play a significant role in the development of PAD. Still, additional factors such as mental health, glycemic control, diet, exercise, obesity management, lipid-lowering therapy, and antiplatelet therapy have emerged as important considerations. Managing these factors can help improve outcomes and reduce complications in PAD patients. Antiplatelet therapy with aspirin or clopidogrel is recommended in PAD patients, with clopidogrel showing more significant benefits in symptomatic PAD individuals. Managing several risk factors is crucial for improving outcomes and reducing complications in patients with PAD. Further research is also needed to explore the potential benefits of novel therapies. Ultimately, a comprehensive approach to PAD management is essential for improving morbidity and mortality among patients with this condition. [ABSTRACT FROM AUTHOR]

Diabetic peripheral arterial disease (PAD) is strongly associated with cardiovascular and cerebrovascular diseases, contributing to a high risk of mortality and morbidity. Diagnostic tests that can predict the development of diabetic PAD in the asymptomatic period are inadequate, and new potential biomarkers are needed. This study was conducted to investigate the diagnostic values of serum netrin-1, endothelin-1, oxidative stress parameters, and L-arginine/methylarginine derivatives for diabetic asymptomatic PAD. Three hundred and eighty-six type-2 diabetes mellitus patients who were clinically asymptomatic for PAD were screened for PAD by ankle-brachial index (ABI) measurement. At the same time, forty patients with PAD were included in the study group, and forty-one patients without PAD were included in the control group. Ready-to-use commercial kits were used to measure serum netrin-1, endothelin-1, and oxidative stress markers. Serum netrin-1 median values were found to be significantly higher in the group with diabetic PAD than in the group without (OR [CI 95%]: 1.434 [1.136-1.964], p: 0.036). While a significant positive correlation relationship was detected between total oxidative status and netrin-1 and LDL, a negative significant correlation relationship was detected between ADMA and eGFR. No significant difference was detected between the groups regarding serum endothelin-1, oxidative stress parameters, and L-arginine/methylarginine derivatives. As a result, this study showed that serum netrin-1 levels are high in asymptomatic diabetic PAD patients and can be a possible biomarker in the detection of asymptomatic PAD. [ABSTRACT FROM AUTHOR]

The rapid development of the region with the development of tax/fiscal activities that require the allocation of funds from local governments is a reasonable expenditure and development that requires the availability of large amounts of funds to fund these activities. This research to analyze Balancing Funds, namely DAU, DAK, DBH against Regional Expenditures and to analyze Regional Original Income against Regional Expenditures. Balancing Funds are funds sourced from APBN revenues allocated to the Regions, while Original Regional Income is a source of regional income. This research method is descriptive quantitative where data is collected through data. The sample used in this research is 60 data from the 2019-2023 DAU, DAK, DBH, PAD and Regional Expenditure Realization Reports, which are taken per month. The data will then be analyzed using the multiple regression method which meets the classical assumption test. The results of this research are that DAU and DAK do not have a significant effect on Mamasa Regency Regional Expenditures, while DBH and PAD have a significant effect on Mamasa Regency Regional Expenditures. [ABSTRACT FROM AUTHOR]

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Regional Expenditure is used by the provincial, district/city governments primarily to provide public services and to finance the implementation of government affairs authority based on statutory regulations. Regional Expenditure must include the priority of spending to be carried out by the regional government so that it directly impacts the welfare of its people. This study aims to analyze whether or not a flypaper effect has occurred in the influence of DAU, DAK, DBH, and PAD on regional Expenditure in Central Java Province in 2018-2020. This research is included in the type of quantitative research. The data collection method uses secondary data documentation techniques, namely district/city budget realization reports (LRA) in Central Java Province for the 2018-2020 fiscal year obtained from the Central Java Province BPKAD. The population and sample in this study were all district/city governments in Central Java Province, totaling 35. The sampling method was the census method. The data analysis method used is multiple linear regression with the help of SPSS 25 software. The results showed that (1) DAU has a significant positive effect on regional expenditures, (2) DAK does not have a significant effect on regional expenditures, (3) DBH has a significant effect on regional expenditures, (4) PAD has a significant positive effect on regional expenditures, (5) DAU, DAK, DBH and PAD have a simultaneous effect on regional expenditures, (6) the phenomenon of the flypaper effect occurred in Central Java Province. [ABSTRACT FROM AUTHOR]

Studi ini membahas kondisi Pendapatan Asli Daerah (PAD) yang terdiri dari kompenen pajak, retribusi, hasil kekayaan daerah yang dipisahkan dan pendapatan lain yang dianggap sah. Selain itu studi ini menekankan penyusunan strategi optimalisasi Pendapatan Asli Daerah (PAD) yang menekankan pada inovasi dan kolaborasi agar hasil dan target peningkatan PAD di Kabupaten Lombok Tengah dapat tercapai. Pentingnya inovasi sebagai transformator dan kolaborasi dalam membangun jejaring kerja Kabupaten Lombok Tengah. Studi ini menggunakan pendekatan kualitatif deskriptif dengan menggunakan beberapa data LKPD 5 tahun terakir dari tahun 2019-2023. Selain itu metode yang digunakan dalam penyusunan strategi lebih berorientasi pada hasil dan lebih positivik dengan pendekatan SOAR fokus analisisnya terhadap kekuatan, peluang, aspirasi dan hasil, sedangkan lokus studi adalah Kabupaten Lombok Tengah. Studi ini menemukan bahwa salah satu langkah penting dalam memperkuat keuangan daerah adalah optimalisasi PAD melalui kebijakan yang berkelanjutan. Pemerintah Daerah dapat meningkatkan pendapatan pajak secara berkelanjutan, mendukung pembangunan daerah, dan meningkatkan kesejahteraan masyarakat dengan menggunakan strategi yang tepat dan kebijakan yang komprehensif. Annual growth rate, persentase rata-rata pertumbuhan setiap tahunnya sebesar 10,25%, annual growth rate mengalami pertumbuhan PAD negative (-21%). Beberapa strategi yang dapat dikembangkan dalam rangka optimalisasi PAD melalui inovasi dan kolaborasi adalah menciptakan inovasi di sektor perpajakan dan retribusi daerah baik dari pemungutan maupun pencatatatnya. Selain itu memperkuat jejaring kerja dan kolaborasi dengan berbagai pihak akan mempermudah Pemerintah Daerah Kabupaten Lombok Tengah dalam memetakan sektor potensial yang dapat dimanfaatkan untuk peningkatan PAD

EMENTA: PROCESSO ADMINISTRATIVO DISCIPLINAR DESEMBARGADORA . LEVANTAMENTO DE SIGILO QUESTÃO DE ORDEM APROVADA. PREJUDICIAIS REPELIDAS. REDE SOCIAL. MANIFESTAÇÕES E COMPARTILHAMENTO DE MENSAGENS DE ÍNDOLE POLITÍCO-PARTIDÁRIA, OFENSIVAS E DEPRECIATIVAS. POSTAGENS QUE PODEM SER INTERPRETADAS COMO PRECONCEITUOSAS E DISCRIMINATÓRIAS. BUSCA INJUSTIFICADA E DESMENSURADA POR RECONHECIMENTO SOCIAL. INOBSERVÂNCIA DO DEVER DE MANTER CONDUTA IRREPREENSÍVEL NA VIDA PRIVADA DE MODO A DIGNIFICAR A FUNÇÃO. VULNERAÇÃO AO ART. 35, VIII, DA LOMAN, AOS ARTS. 8º, 13, 16 E 26, DO CÓDIGO DE ÉTICA DA MAGISTRATURA E AOS ARTS. 2º, §§ 1º E 3º, E 6º, DO PROV. CNJ Nº 71/2018 (SUCEDIDOS PELO ART. 4º, II E III, DA RES. CNJ 305/2019) CARACTERIZADA. PROCEDÊNCIA DAS IMPUTAÇÕES. GRAVIDADE DA CONDUTA. PENA DE DISPONIBILIDADE. 1. À luz da nova ordem constitucional, a publicidade dos atos processuais (na seara judicial e administrativa) constitui princípio basilar do Estado Democrático de Direito, consubstanciando regra geral, afastável apenas quando a defesa da intimidade das partes e/ou o interesse público e social o exigem (art. 5º, LX, da Carta Magna), aspecto que não se amolda à hipótese concreta dos autos, impondo-se o levantamento do sigilo. Questão de ordem aprovada. 2. Eventual manifestação em rede social, dissonante das restrições e exigências pessoais que recaem sobre os magistrados na prática dos atos da vida privada, distintas daquelas acometidas aos cidadãos em geral, pode, em tese, consubstanciar transgressão de ordem disciplinar, o que justifica a atuação concorrente deste Conselho na correspondente averiguação (art. 103-B, § 4º, III, do Texto Magno). Arguição de incompetência material rechaçada. 3. Regularmente deflagrado o procedimento disciplinar por deliberação colegiada, compete igualmente ao Plenário – e não ao relator, pela via monocrática – ordenar eventual o arquivamento do feito, na hipótese de não comprovação da infração funcional (artigos 12, 20, e §§, e 21, § único, da Resolução CNJ nº 135/2011, e art. 4º, inciso VI do RICNJ). Prefacial repelida. 4. A liberdade de manifestação, tal como consagrada na Carta Constitucional (art. 5º, incisos IV e IX, da Carta Magna), não ostenta conotação absoluta, nem tampouco ilimitada, porquanto passível de submissão a certas restrições, compatíveis com os pilares do Estado Democrático de Direito, implicando deveres e responsabilidades que visam a resguardar, no caso dos integrantes da magistratura, a necessária afirmação dos postulados e demais princípios inerentes à função judicante. Precedentes do STF e deste CNJ. 5. Na hipótese dos autos, os ataques pessoais da representada a representante de liderança política, compartilhados em rede social de largo alcance, com o intuito de descredenciá-lo perante a opinião pública, em razão de suas ideias ou ideologias, ainda mais em um cenário de polarização exacerbada, refletiram a hipótese de militância político-partidária, vedada constitucionalmente a magistrados (art. 95, parágrafo único, III, da CF/1988). 6. Sem demonstrar qualquer preocupação com a veracidade das informações veiculadas, a requerida promoveu sucessivas manifestações desrespeitosas e desabonadoras, dirigidas inclusive a integrante do poder legislativo municipal - inclusive já falecida à época dos fatos, a quem se atribuiu a prática de grave delito, tudo a revelar que tais postagens ostentaram potencial lesivo incalculável, apto a atingir atributos da personalidade afetos às figuras públicas ali referidas, em detrimento da imparcialidade e da credibilidade do próprio Poder Judiciário. 7. Paralelamente, na busca injustificada e desmensurada por reconhecimento social, a magistrada não se absteve de realizar outras publicações polêmicas, as quais podem ser interpretadas como discriminatórias de grupos historicamente estigmatizados (transexuais e portadores de síndrome de down), afrontando valores ínsitos à sociedade em geral e, particularmente, à magistratura, assim como os ideais de igualdade, justiça e cidadania vertidos pela Carta Magna. 8. Os atos praticados pela representada, na relevante condição de integrante da Corte de Justiça Estadual, distanciando-se da prudência e da cautela que deveriam nortear as suas manifestações em mídia social, ainda que de índole privada, desbordaram os limites inerentes ao exercício do livre direito de expressão do pensamento. Nesse contexto, as condutas perpetradas consubstanciaram graves faltas funcionais, as quais não merecem a complacência deste Conselho, pois violadoras dos deveres insculpidos no art. 35, VIII, da LOMAN, nos arts. 8º, 13, 16 e 26, do Código de Ética da Magistratura e nos arts. 2º, §§ 1º e 3º, e 6º, do Prov. CNJ Nº 71/2018. 9. Sopesados o elevado grau de reprovabilidade das condutas, o potencial lesivo dali decorrente e o efeito pedagógico/dissuasório da sanção, à luz da razoabilidade e da proporcionalidade, revela-se pertinente a aplicação da disponibilidade com vencimentos proporcionais ao tempo de serviço, pelo prazo de 90 (noventa) dias (art. 93, VIII, da Carta Magna, arts. 42, inc. IV, e 57, parágrafo 1º, da LOMAN, c.c art. 6º, da Resolução CNJ nº 135/2011). Precedente desta Casa. 10. Imputações que se julgam procedentes, de modo a aplicar, à magistrada processada, pena de disponibilidade com vencimentos proporcionais ao tempo de serviço.

Risk for atherosclerotic cardiovascular disease (ASCVD) shows considerable heterogeneity both in generally healthy persons and in those with known ASCVD. The foundation of preventive cardiology begins with assessing baseline ASCVD risk using global risk scores based on standard office-based measures. Persons at low risk are generally recommended for lifestyle management only and those at highest risk are recommended for both lifestyle and pharmacologic therapy. Additional "risk enhancing" factors, including both traditional risk factors and novel biomarkers and inflammatory factors can be used to further assess ASCVD risk, especially in those at borderline or intermediate risk. There are also female-specific risk enhancers, social determinants of health, and considerations for high-risk ethnic groups. Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, can further inform the treatment decision if uncertain based on the above strategies. Persons with pre-existing ASCVD also have variable risk, affected by the number of major ASCVD events, whether recurrent events have occurred recently, and the presence of other major risk factors or high-risk conditions. Current guidelines define high to very high risk ASCVD accordingly. Accurate ASCVD risk assessment is crucial for the appropriate targeting of preventive therapies to reduce ASCVD risk. Finally, the clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies to best lower ASCVD risk is central to this process. This clinical practice statement provides the preventive cardiology specialist with guidance and tools for assessment of ASCVD risk with the goal of appropriately targeting treatment approaches for prevention of ASCVD events.

The impact of diabetic foot (DF) on the healthcare system represents a major public health problem, leading to a considerable clinical and economic burden. The factors contributing to DF’s development and progression are strongly interconnected, including metabolic causes, neuropathy, arteriopathy, and inflammatory changes. Sodium–glucose cotransporter 2 inhibitors (SGLT2-i), novel oral hypoglycemic drugs used as an adjunct to standard treatment, have recently changed the pharmacological management of diabetes. Nevertheless, data about the risk of limb amputation, discordant and limited to canagliflozin, which is currently avoided in the case of peripheral artery disease, have potentially discouraged the design of specific studies targeting DF. There is good evidence for the single immunomodulatory, neuroprotective, and beneficial vascular effects of SGLT2-i. Still, there is no clinical evidence about the early use of SGLT2-i in diabetic foot due to the lack of longitudinal and prospective studies proving the effect of these drugs without confounders. This narrative review aims to discuss the main evidence about the impact of SGLT2-i on the three complications of diabetes implicated in the development of DF, the state of the art, and the potential future implications.