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Christian Kjer Heerfordt,1 Christian Rønn,1 Josefin Eklöf,1 Pradeesh Sivapalan,1 Zitta Barrella Harboe,2,3 Charlotte Hyldgaard,4 Andreas Fløe,5 Alexander G Mathioudakis,6,7 Mats Christian Højbjerg Lassen,8 Tor Biering-Sørensen,8,9 Jens-Ulrik Stæhr Jensen1,3,10 1Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; 2 Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Hillerød, Denmark; 3Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 4Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark; 5Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; 6Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; 7North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; 8Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; 9Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark; 10PERSIMUNE & CHIP: Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Jens-Ulrik Stæhr Jensen, Email jens.ulrik.jensen@regionh.dkBackground: Extra-fine particle inhaled corticosteroids (ICS) improve peripheral airway distribution, but their effect on risk of exacerbations and all-cause mortality in patients with chronic obstructive pulmonary disease (COPD) is unclear.Methods: This observational cohort study compares patients with COPD who received extra-fine particle ICS to those who received standard particle size ICS from 2010 to 2017 while followed in outpatient clinics. The primary outcome was the time to a COPD exacerbation that required hospitalization, with all-cause mortality as a secondary outcome. Data were analyzed using an adjusted Cox proportional hazards model and a competing risk analysis. Two predefined subgroup analyses of patients treated with pressurised metered dose inhalers (pMDIs) and patients with a previous exacerbation history, was carried out. Lastly, we created a propensity score matched cohort as a sensitivity analysis.Results: Of the 40,489 patients included, 38,802 (95.8%) received stand particle size ICS and 1,687 (4.2%) received extra-fine particle ICS. In total 7,058 were hospitalized with a COPD exacerbation, and 4,346 died. No significant protective effect of extra-fine particle ICS against hospitalization due to COPD exacerbations (HR 0.93, 95% CI 0.82– 1.05, p=0.23) or all-cause mortality (HR 1.00, 95% CI 0.85– 1.17, p=0.99) was found when compared to standard particle size ICS. However, in the subgroup analysis of patients treated with pMDIs, extra-fine particle ICS was associated with reduction in risk of exacerbations (HR 0.72, 95% CI 0.63– 0.82, p< 0.001) and all-cause mortality (HR 0.72, 95% CI 0.61– 0.86, p< 0.001).Conclusion: The administration of extra-fine particle ICS was not associated with reduced risk of exacerbations or all-cause mortality in our primary analysis. A subgroup consisting of patients treated with pMDIs suggested potential protective benefits.Keywords: COPD, Inhaled Corticosteroids, Particle size, COPD exacerbations

Abstract Background Lactational mastitis is a common painful and debilitating inflammation of breast tissue, generally treated conservatively or with pus puncture in case of breast abscess. However, treating mastitis in patients with implantable surgical material located in the affected breast region can be extremely challenging. We present an unusual case of lactational mastitis complicated by pacemaker pocket infection in a breastfeeding mother. Case presentation A 35-year-old pacemaker-dependent female developed lactational mastitis seven weeks postpartum. Initially, the condition was treated conservatively with analgesics and antibiotics. After abscess formation, pus was aspirated using fine-needle aspiration technique. Four weeks after mastitis resolution, pacemaker pocket infection developed. According to current cardiovascular implantable electronic device infection treatment guidelines a complete surgical extraction of the entire electronic system, followed by targeted antibiotic treatment and reimplantation of a new device after infection resolution, was recommended. However, after thorough discussion with the young woman and her family and after detailed review of surgery-related risks, she declined a potentially high-risk surgical procedure. Thus, only the pulse generator was explanted; pacing leads positioned in the sub-pectoral pocket; new pacemaker implanted on the contralateral side and broad-spectrum antibiotic therapy continued for six weeks. After breastfeeding cessation, and with chronic fistula development at the primary pacemaker implantation site, the possibility of delayed surgical intervention including complete extraction of retained pacemaker leads was again thoroughly discussed with her. After thoughtful consideration the woman consented to the proposed treatment strategy. A surgical procedure including transvenous lead extraction through the primary implantation venous entry site, using hand-powered bidirectional rotational sheaths, was successfully performed, removing all retained leads through the left subclavian venous entry site, and leaving the fully functional and clinically uninfected pacemaker on the contralateral site intact. Conclusion Although patients’ decisions for delayed extraction in a case of cardiovascular implantable electronic device infection should be discouraged by attending physicians and members of interdisciplinary teams, our case shows that a stepwise treatment strategy may be successful as a bailout clinical scenario in patients with specific requests, demands and / or clinical needs.

Structural Equation Model (SEM) merupakan salah satu dari teknik analisis dalam ilmu statistika dengan gabungan dua teknik multivariat yaitu analisis faktor konfirmatori, analisis regresi, dan analisis jalur. Pada penelitian ini diterapkan analisis SEM untuk menganalisa faktor yang memengaruhi masyarakat Lombok yang berdampak Covid-19 terhadap dukungan untuk pariwisata. Data yang digunakan adalah data primer yang diperoleh dengan kuesioner kepada masyarakat Lombok pada tahun 2021. Pada studi kasus ini peneliti mengambil dua faktor yang dapat memengaruhi dukungan terhadap pariwisata (ST) yaitu resiko yang dirasakan (PR) dan solidaritas emosional (ES). Tujuan dari penelitian ini untuk mengetahui pengaruh variabel PR dan ES terhadap ST. Berdasarkan hasil analisis diperoleh solidaritas emosional (ES) berpengaruh signifikan pada dukungan terhadap pariwisata. Sementara itu, resiko yang dirasakan (PR) dan solidaritas emosional (ES) bersama-sama secara signifikan mampu menjelaskan pengaruhnya dukungan terhadap pariwisata (ST) sebesar 72,6% sedangkan 27,4% dijelaskan oleh variabel lain diluar model.

(1) Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased morbidity and mortality both in the general population and heart failure patients. Inflammation may promote the initiation, maintenance and perpetuation of AF, but the impact of inflammatory molecular signaling on the association between AF and heart failure remains elusive. (2) Materials and Methods: In 111 patients with chronic stable heart failure, baseline values of conventional (IL-6 and hsCRP) and selected novel inflammatory biomarkers (IL-10, IL-6/IL-10 ratio, orosomucoid and endocan) were determined. Inflammatory biomarkers were compared with respect to the presenting cardiac rhythm. (3) Results: Patients aged below 75 years with AF had significantly higher values of IL-6 and IL-6/IL-10 ratio; IL-6 levels were a significant predictor of AF in both univariate (OR 1.175; 95%CI 1.013–1.363; p = 0.034) and multivariate logistic regression analysis when accounting for other inflammatory biomarkers (OR 1.327; 95% CI 1.068–1.650; p = 0.011). Conversely, there was no association between other novel inflammatory biomarkers and AF. (4) Conclusions: IL-6 levels and the IL-6/IL-10 ratio are associated with AF in patients with chronic stable heart failure under the age of 75 years, suggesting that inflammatory molecular signaling may play a role in the development of AF in the heart failure population.

This article presents the properties of a Ti coating (angle of grain growth, thickness of the deposited layer, adhesion, and roughness of the deposited layer) deposited on the inner surface of a steel tube. The Ti coating was deposited using the EB PVD (electron beam physical vapor deposition) method. The areas in which the measurements were carried out are defined by the height of the measured area under the target (from 305 to 425 mm) and the radius of the tube (from 100 to 140 mm). The measurements showed that the angle of grain growth is in an interval from 40 to 61°. The results of the statistical analysis demonstrate that the height of the measured area and the tube radius significantly impact the angle of grain growth and adhesion. On the other hand, the impact of the height of the measured area and the tube radius on the roughness of the applied coating was not confirmed.

Cardiac rehabilitation (CR) plays a crucial role in managing patients who have undergone coronary intervention (CI) following acute myocardial infarction. While water-based exercise is gaining recognition as an exercise modality in this patient population, its impact on the subgroup of older adults remains unexplored. In this post hoc analysis, we investigated the effects of water-based exercise on adults older than 60 years undergoing CR after CI, comparing it to land-based exercise and a control group. In total, 45 patients aged over 60 participated in 14-day exercise programs, featuring two daily 30-min sessions. We assessed exercise capacity (VO2peak), vascular function (flow-mediated vasodilation (FMD)), heart rate variability (HRV), and blood markers (Interleukins 6, 8, and 10, P-Selectin, ICAM, and High-sensitivity CRP) before and after CR. VO2peak in the water-based group improved significantly after CR in comparison with the land-based group: 1.35 kg/mL/min (95% CI [0.20–2.50], p = 0.022). The significant difference between water-based and land-based groups was observed in several HRV parameters: Total power −1129.20 ms2 (95% CI [−1951.92–−306.49], p = 0.008); peak LF 0.04 Hz (95% CI [0.00–0.08], p = 0.036); SD1 −9.02 millisecond (95% CI [−16.86–−1.18], p = 0.025); and SD2 −19.71 ms (95% CI [−35.08–−4.34], p = 0.013). FMD and blood markers did not vary significantly based on the exercise group. These findings suggest that short-term water-based CR may have potential as an alternative to traditional land-based CR, improving VO2peak and cardiorespiratory fitness among adults over 60 years undergoing CR after CI.

In connection with the growing importance of the efficiency and reliability of tools in industrial sectors, our research represents a key step in the effort to optimize production processes and increase their service life in real conditions. The study deals with the comparison of the tribological properties of three tool steels, two of which were produced by the powder metallurgy method—ASP2017 and ASP2055—and the last tool steel underwent the conventional production method—X153CrMoV12. The samples were mechanically machined with the finishing technology of turning and, finally, heat treated (Q + T). The study focused on the evaluation of hardness, resulting microstructure, wear resistance, and coefficient of friction (COF). The ball-on-disc method was chosen as part of the COF and wear resistance test. The tribological test took place at room temperature with dry friction to accelerate surface wear. The pressing material was a hardened steel ball G40 (DIN 100Cr6). Measurements were performed at loads of 10 N, 6 N, and 2 N and turning radii of 13 mm, 18 mm, and 23 mm, which represents a peripheral speed of 0.34, 0.47, and 0.60 m/s. The duration of the measurement for each sample was 20 min. The results showed that the COF of powder steels showed almost the same values, while a significant difference occurred with the increase of the radius rotation in the case of conventional steel. The results within the friction mechanism showed two types of wear, namely, adhesive and abrasive wear, depending on the Q + T process. From a tribological point of view in terms of wear, it was possible to state that the material ASP2055 after Q + T showed the lowest rate of wear of all the tested steels.

Venous aneurysms are rare vascular malformations that can lead to significant clinical complications, including thrombosis, pulmonary embolism, rupture, and even fatal outcomes when not promptly and adequately managed. This case report presents a liver transplant patient under immunosuppressive therapy who developed a rapidly progressing great saphenous vein aneurysm, ultimately requiring urgent surgical intervention due to acute bleeding from the ruptured aneurysm. Immunosuppression emerges as a potential key factor in the formation and rapid growth of the aneurysm, with the pathophysiological mechanism potentially involving increased expression of specific matrix metalloproteinases. Further research is warranted to gain a better understanding of the role of immunosuppression in the development of venous aneurysms.

In the original publication [...]

This article presents the properties of a Ti coating (angle of grain growth, thickness of the deposited layer, adhesion, and roughness of the deposited layer) deposited on the inner surface of a steel tube. The Ti coating was deposited using the EB PVD (electron beam physical vapor deposition) method. The areas in which the measurements were carried out are defined by the height of the measured area under the target (from 305 to 425 mm) and the radius of the tube (from 100 to 140 mm). The measurements showed that the angle of grain growth is in an interval from 40 to 61°. The results of the statistical analysis demonstrate that the height of the measured area and the tube radius significantly impact the angle of grain growth and adhesion. On the other hand, the impact of the height of the measured area and the tube radius on the roughness of the applied coating was not confirmed. [ABSTRACT FROM AUTHOR]

(1) Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased morbidity and mortality both in the general population and heart failure patients. Inflammation may promote the initiation, maintenance and perpetuation of AF, but the impact of inflammatory molecular signaling on the association between AF and heart failure remains elusive. (2) Materials and Methods: In 111 patients with chronic stable heart failure, baseline values of conventional (IL-6 and hsCRP) and selected novel inflammatory biomarkers (IL-10, IL-6/IL-10 ratio, orosomucoid and endocan) were determined. Inflammatory biomarkers were compared with respect to the presenting cardiac rhythm. (3) Results: Patients aged below 75 years with AF had significantly higher values of IL-6 and IL-6/IL-10 ratio; IL-6 levels were a significant predictor of AF in both univariate (OR 1.175; 95%CI 1.013–1.363; p = 0.034) and multivariate logistic regression analysis when accounting for other inflammatory biomarkers (OR 1.327; 95% CI 1.068–1.650; p = 0.011). Conversely, there was no association between other novel inflammatory biomarkers and AF. (4) Conclusions: IL-6 levels and the IL-6/IL-10 ratio are associated with AF in patients with chronic stable heart failure under the age of 75 years, suggesting that inflammatory molecular signaling may play a role in the development of AF in the heart failure population. [ABSTRACT FROM AUTHOR]

Background: Lactational mastitis is a common painful and debilitating inflammation of breast tissue, generally treated conservatively or with pus puncture in case of breast abscess. However, treating mastitis in patients with implantable surgical material located in the affected breast region can be extremely challenging. We present an unusual case of lactational mastitis complicated by pacemaker pocket infection in a breastfeeding mother. Case presentation: A 35-year-old pacemaker-dependent female developed lactational mastitis seven weeks postpartum. Initially, the condition was treated conservatively with analgesics and antibiotics. After abscess formation, pus was aspirated using fine-needle aspiration technique. Four weeks after mastitis resolution, pacemaker pocket infection developed. According to current cardiovascular implantable electronic device infection treatment guidelines a complete surgical extraction of the entire electronic system, followed by targeted antibiotic treatment and reimplantation of a new device after infection resolution, was recommended. However, after thorough discussion with the young woman and her family and after detailed review of surgery-related risks, she declined a potentially high-risk surgical procedure. Thus, only the pulse generator was explanted; pacing leads positioned in the sub-pectoral pocket; new pacemaker implanted on the contralateral side and broad-spectrum antibiotic therapy continued for six weeks. After breastfeeding cessation, and with chronic fistula development at the primary pacemaker implantation site, the possibility of delayed surgical intervention including complete extraction of retained pacemaker leads was again thoroughly discussed with her. After thoughtful consideration the woman consented to the proposed treatment strategy. A surgical procedure including transvenous lead extraction through the primary implantation venous entry site, using hand-powered bidirectional rotational sheaths, was successfully performed, removing all retained leads through the left subclavian venous entry site, and leaving the fully functional and clinically uninfected pacemaker on the contralateral site intact. Conclusion: Although patients' decisions for delayed extraction in a case of cardiovascular implantable electronic device infection should be discouraged by attending physicians and members of interdisciplinary teams, our case shows that a stepwise treatment strategy may be successful as a bailout clinical scenario in patients with specific requests, demands and / or clinical needs. [ABSTRACT FROM AUTHOR]

This research aims to 1) To see the process of appointing village officials in accordance with the principles of good governance; 2) To find out and analyze what are the inhibiting and supporting factors for Village Heads in Wori District in Recruiting Village Officials in Wori District, North Minahasa Regency; 3) To find out and analyze how the Village Head in Wori District considers improving the professionalism of village officials from a good governance perspective. This research uses qualitative research methods with the focus of the research being the process of appointing village officials in Darunu Village, Wori District, North Minahasa Regency, taking into account the principles of good governance. The results of the research show that both the selection and appointment processes have met the requirements for good governance, seen in a transparent and accountable manner, where information on selection and recommendations up to appointment follows the principles of transparency. Then, in terms of accountability, all village officials must have accountability requirements in terms of completeness of documents, education level, then they must go through the stages of screening and recommendation from the Head of the District, then the Village Head is appointed. The results of the screening, recommendations from the Head of the District and the appointment of Village Apparatus are carried out openly and then obey the law, where the consideration of the Head of Darunu Village can still be said to be sufficient because there are authorities that must be taken into account, such as the authority of the Head of the District and must be based on a clear legal umbrella and its application in the community still receives many complaints. [ABSTRACT FROM AUTHOR]

Experiments with changes in motion geometry can provide valuable data for engineering and development purposes, allowing a better understanding of the influence of tribological factors on the performance and service life of joints. The presented subject article focused on the experimental investigation of the influence of the geometry of the movement of the friction process on the change in the tribological properties of 30CrNiMo8 steel. The friction process was carried out without the use of a lubricant in contact with a steel ball of G40 material with a diameter of 4.76 mm. The steel ball performed two types of movement on the surface of the experimental material. The first method used was ball on disc, in which the ball moved reciprocally in an oval direction at an angle of 180° on a circumferential length of 35 mm at a speed of 5 mm/s. The second method consists of the same input parameters of the measurement, with the difference that the path along which the ball moved had a linear character. The load during the experiment was set at a constant value of 50 N with 1000 repetitions. The results show that with the ball on disc method, there was an increase in wear by 147% compared to the linear test method, which was approximately a coefficient of increase in wear of 2.468. EDS analysis pointed to the occurrence of oxidative wear that affected the resulting COF values, which were lower by 8% when using the ball on disc method due to a more uniform distribution of O and C on the surface of the friction groove where these elements acted as solid microlubricants. With the ball on disc method, defects in the form of microcracks occurred, which affected the reduction in the values of the depth of the affected area of microhardness. [ABSTRACT FROM AUTHOR]

Background: To help navigate the complex treatment landscape of ulcerative colitis (UC), we quantified the benefit-risk trade-offs that patients were willing to make when choosing treatment., Methods: Patients completed an online discrete choice experiment. Eligible patients had a UC diagnosis for ≥6 months, were aged ≥18 years, and resided in France, Germany, Italy, Spain, or the UK. Patients chose between 2 hypothetical treatments set up to ensure trade-offs were made. Clinical trial data, literature review, and patient interviews identified treatment attributes. Relative attribute importance (RAI) scores and maximum acceptable risks were generated. A patient-centric benefit-risk assessment of 200 mg of filgotinib was conducted as an example to show how measured trade-offs can be used., Results: Overall, 631 patients participated; patients had a mean age of 42.2 years and were predominantly male (75.3%). Achieving and maintaining clinical remission was the most important factor for patients (RAI 32.4%); to achieve this, patients were willing to accept slightly higher risks of blood clots, serious infections, and malignancies compared with lower risk treatment profiles. Patients also valued the convenience of oral treatments, avoiding steroids, and the ability to attend school/work. The patient-centric benefit-risk assessment suggested patients are significantly more likely to prefer Janus kinase 1 preferential inhibitor filgotinib over placebo., Conclusions: Achieving clinical remission was the highest treatment priority for patients. To attain this, patients were willing to accept some slightly higher risk treatment profiles. Patient choices in the benefit-risk assessment suggested patients were significantly more likely to prefer filgotinib over placebo., (© 2024 Crohn’s & Colitis Foundation. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation.)