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Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Visual inspection in remanufacturing, despite technological progress, is still mainly performed by humans. A rough assessment of the product's general condition and the dedicated inspection of individual product features or defects is necessary to identify the typically unknown product variant and assess the reusability of a used product and its components. Therefore, a system for automated visual inspection must be flexible and runtime-adaptive, as defects to be inspected in detail may occur anywhere on the product. In the present work, this problem is framed as a view planning problem solved by means of supervised learning and reinforcement learning using a specially developed simulation environment. Three variants of neural networks (PointNet, PointNet++, and Point Completion Network) are compared in the supervised learning case, whereas a deep learning SAC algorithm using the Point Completion Network as network structure is evaluated in the reinforcement learning case. Considering the specific boundary conditions prevailing in remanufacturing, the results are obtained from the use case of electric starter motor remanufacturing. The results show that supervised learning and reinforcement learning are suitable for determining the poses of an acquisition system at system runtime to react to an initially unknown inspection task. Our proposed framework is available open source under the following: https://github.com/Jarrypho/View-Planning-Simulation. [ABSTRACT FROM AUTHOR]

There is variation in the probability of nodal metastases from low-grade appendiceal adenocarcinomas, and the role of right colectomy is unclear. We aimed to define the prevalence and utility of lymphovascular invasion in predicting the risk of nodal metastases to help stratify patients who may benefit from right hemicolectomy. Patients with nonmetastatic low-grade appendiceal adenocarcinomas were identified from the National Cancer Database (2010–2017). The primary outcome was probability of nodal metastases. Logistic regression was used to identify independent predictors of nodal metastases. A 4-tier risk model—the COH Composite Score—was calculated by assigning 1 point each for a high-risk feature (lymphovascular invasion, T3/T4 T stage, or nonmucinous histology). Survival analysis was performed using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify independent predictors of survival. A total of 1,303 patients with nonmetastatic low-grade appendiceal adenocarcinomas (64.2% mucinous) were identified. Of the 1,133 patients with known lymphovascular invasion status, 78 (6.9%) were lymphovascular invasion positive. In multivariate analysis, lymphovascular invasion was independently associated with nodal metastases (odds ratio, 8.68; P <.001). Overall accuracy of lymphovascular invasion in predicting nodal metastases was 86%. The COH Composite Score stratified patients in 4 categories with increasing risk of nodal metastases and incrementally worse survival. For patients with the COH Composite Score of 0 (12%), the nodal metastasis rate was 3.1%, and a right hemicolectomy in this group did not improve survival. The presence of lymphovascular invasion is strongly predictive of nodal metastases. Lymphovascular invasion as part of the COH Composite Score may help guide the extent of surgery in low-grade appendiceal adenocarcinomas. [Display omitted] [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Exercise remains a hallmark treatment for post-traumatic osteoarthritis (PTOA) and may maintain joint homeostasis in part by clearing inflammatory cytokines, cells, and particles. It remains largely unknown whether exercise-induced joint clearance can provide therapeutic relief of PTOA. In this study, we hypothesized that exercise could slow the progression of preclinical PTOA in part by enhancing knee joint clearance. Surgical medial meniscal transection was used to induce PTOA in 3-month-old male Lewis rats. A sham surgery was used as a control. Mild treadmill walking was introduced 3 weeks post-surgery and maintained to 6 weeks post-surgery. Gait and isometric muscle torque were measured at the study endpoint. Near-infrared imaging tracked how exercise altered lymphatic and venous knee joint clearance during discrete time points of PTOA progression. Exercise mitigated joint degradation associated with PTOA by preserving glycosaminoglycan content and reducing osteophyte volume (effect size (95% Confidence Interval (CI)); 1.74 (0.71–2.26)). PTOA increased hind step widths (0.57 (0.18–0.95) cm), but exercise corrected this gait dysfunction (0.54 (0.16–0.93) cm), potentially indicating pain relief. Venous, but not lymphatic, clearance was quicker 1-, 3-, and 6-weeks post-surgery compared to baseline. The mild treadmill walking protocol expedited lymphatic clearance rate in moderate PTOA (3.39 (0.20–6.59) hrs), suggesting exercise may play a critical role in restoring joint homeostasis. We conclude that mild exercise has the potential to slow disease progression in part by expediting joint clearance in moderate PTOA. [ABSTRACT FROM AUTHOR]

Many surgical strategies aim to treat the symptomatic neuroma of the superficial branch of the radial nerve (SBRN). It is still difficult to treat despite many attempts to reveal a reason for surgical treatment failure. The lateral antebrachial cutaneous nerve (LACN) is known to overlap and communicate with SBRN. Our study aims to determine the frequency of spreading of LACN fibers into SBRN branches through a microscopic dissection to predict where and how often LACN fibers may be involved in SBRN neuroma. Eighty-seven cadaveric forearms were thoroughly dissected. The path of LACN fibers through the SBRN branching was ascertained using microscopic dissection. Distances between the interstyloid line and entry of LACN fibers into the SBRN and emerging and bifurcation points of the SBRN were measured. The LACN fibers joined the SBRN at a mean distance of 1.7 ± 2.5 cm proximal to the interstyloid line. The SBRN contained fibers from the LACN in 62% of cases. Most commonly, there were LACN fibers within the SBRN's third branch (59%), but they were also observed within the first branch, the second branch, and their common trunk (21%, 9.2%, and 22%, respectively). The lowest rate of the LACN fibers was found within the SBRN trunk (6.9%). The SBRN contains LACN fibers in almost 2/3 of the cases, therefore, the denervation of both nerves might be required to treat the neuroma. However, the method must be considered based on the particular clinical situation. [Display omitted] [ABSTRACT FROM AUTHOR]

Neuroinflammation evaluation after acute ischemic stroke is a promising option for selecting an appropriate post-stroke treatment strategy. To assess neuroinflammation in vivo , translocator protein PET (TSPO PET) can be used. However, the gold standard TSPO PET quantification method includes a 90 min scan and continuous arterial blood sampling, which is challenging to perform on a routine basis. In this work, we determine what information is required for a simplified quantification approach using a machine learning algorithm. We analyzed data from 18 patients with ischemic stroke who received 0–90 min [18F]GE-180 PET as well as T1-weigted (T1w), FLAIR, and arterial spin labeling (ASL) MRI scans. During PET scans, five manual venous blood samples at 5, 15, 30, 60, and 85 min post injection (p.i.) were drawn, and plasma activity concentration was measured. Total distribution volume (V T) was calculated using Logan plot with the full dynamic PET and an image-derived input function (IDIF) from the carotid arteries. IDIF was scaled by a calibration factor derived from all the measured plasma activity concentrations. The calculated V T values were used for training a random forest regressor. As input features for the model, we used three late PET frames (60–70, 70–80, and 80–90 min p.i.), the ASL image reflecting perfusion, the voxel coordinates, the lesion mask, and the five plasma activity concentrations. The algorithm was validated with the leave-one-out approach. To estimate the impact of the individual features on the algorithm's performance, we used Shapley Additive Explanations (SHAP). Having determined that the three late PET frames and the plasma activity concentrations were the most important features, we tested a simplified quantification approach consisting of dividing a late PET frame by a plasma activity concentration. All the combinations of frames/samples were compared by means of concordance correlation coefficient and Bland-Altman plots. When using all the input features, the algorithm predicted V T values with high accuracy (87.8 ± 8.3%) for both lesion and non-lesion voxels. The SHAP values demonstrated high impact of the late PET frames (60–70, 70–80, and 80–90 min p.i.) and plasma activity concentrations on the V T prediction, while the influence of the ASL-derived perfusion, voxel coordinates, and the lesion mask was low. Among all the combinations of the late PET frames and plasma activity concentrations, the 70–80 min p.i. frame divided by the 30 min p.i. plasma sample produced the closest V T estimate in the ischemic lesion. Reliable TSPO PET quantification is achievable by using a single late PET frame divided by a late blood sample activity concentration. [ABSTRACT FROM AUTHOR]

The accurate estimation of 6D pose remains a challenging task within the computer vision domain, even when utilizing 3D point cloud data. Conversely, in the manufacturing domain, instances arise where leveraging prior knowledge can yield advancements in this endeavor. This study focuses on the disassembly of starter motors to augment the engineering of product life cycles. A pivotal objective in this context involves the identification and 6D pose estimation of bolts affixed to the motors, facilitating automated disassembly within the manufacturing workflow. Complicating matters, the presence of occlusions and the limitations of single-view data acquisition, notably when motors are placed in a clamping system, obscure certain portions and render some bolts imperceptible. Consequently, the development of a comprehensive pipeline capable of acquiring complete bolt information is imperative to avoid oversight in bolt detection. In this paper, employing the task of bolt detection within the scope of our project as a pertinent use case, we introduce a meticulously devised pipeline. This multi-stage pipeline effectively captures the 6D information with regard to all bolts on the motor, thereby showcasing the effective utilization of prior knowledge in handling this challenging task. The proposed methodology not only contributes to the field of 6D pose estimation but also underscores the viability of integrating domain-specific insights to tackle complex problems in manufacturing and automation. [ABSTRACT FROM AUTHOR]

Outcome comparisons among subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients with nonischemic cardiomyopathies are scarce. The aim of this study was to evaluate differences in device-related outcomes among S-ICD recipients with different structural substrates. Patients enrolled in the i-SUSI (International SUbcutaneouS Implantable cardioverter defibrillator registry) project were grouped according to the underlying substrate (ischemic vs nonischemic) and subgrouped into dilated cardiomyopathy, hypertrophic cardiomyopathy, Brugada syndrome (BrS), arrhythmogenic right ventricular cardiomyopathy (ARVC). The main outcome of our study was to compare the rates of appropriate and inappropriate shocks and device-related complications. Among 1698 patients, the most common underlying substrate was ischemic (31.7%), followed by dilated cardiomyopathy (20.5%), BrS (10.8%), hypertrophic cardiomyopathy (8.5%), and ARVC (4.4%). S-ICD for primary prevention was more common in the nonischemic cohort (70.9% vs 65.4%; P =.037). Over a median (interquartile range) follow-up of 26.5 (12.6–42.8) months, no differences were observed in appropriate shocks between ischemic and nonischemic patients (4.8%/y vs 3.9%/y; log-rank, P =.282). ARVC (9.0%/y; hazard ratio [HR] 2.492; P =.001) and BrS (1.8%/y; HR 0.396; P =.008) constituted the groups with the highest and lowest rates of appropriate shocks, respectively. Device-related complications did not differ between groups (ischemic: 6.4%/y vs nonischemic: 6.1%/y; log-rank, P =.666), nor among underlying substrates (log-rank, P =.089). Nonischemic patients experienced higher rates of inappropriate shocks than did ischemic S-ICD recipients (4.4%/y vs 3.0%/y; log-rank, P =.043), with patients with ARVC (9.9%/y; P =.001) having the highest risk, even after controlling for confounders (adjusted HR 2.243; confidence interval 1.338–4.267; P =.002). Most S-ICD recipients were primary prevention nonischemic cardiomyopathy patients. Among those, patients with ARVC tend to receive the most frequent appropriate and inappropriate shocks and patients with BrS the least frequent appropriate shocks. [ABSTRACT FROM AUTHOR]

Patients in burns centres are at high risk of acquiring multi-drug-resistant organisms (MDROs) due to the reduced skin barrier and long hospital stay. This study reports the investigation and control of an outbreak of MDR Acinetobacter baumannii in a burns centre. The 27 patients hospitalized in the centre during the outbreak were screened regularly, and a total of 132 environmental samples were analysed to identify a potential source. Fourier-transform infra-red (FT-IR) spectroscopy and multi-locus sequence typing were applied to characterize the outbreak strain. Between August and November 2022, the outbreak affected eight patients, with 11 infections and three potentially related fatal outcomes. An interdisciplinary and multi-professional outbreak team implemented a bundle strategy with repetitive admission stops, isolation precaution measures, patient screenings, enhanced cleaning and disinfection, and staff education. FT-IR spectroscopy suggested that the outbreak started from a patient who had been repatriated 1 month previously from a country with high prevalence of MDR A. baumannii. Environmental sampling did not identify a common source. Acquisition of the outbreak strain was associated with a higher percentage of body surface area with burn lesions ≥2a [per percent increase: odds ratio (OR) 1.05, 95% confidence interval (CI) 0.99–1.12; P =0.09], and inversely associated with a higher nurse-to-patient ratio (per 0.1 increase: OR 0.34, 95% CI 0.10–1.12; P =0.06). Burn patients with a higher percentage of body surface area with burn lesions ≥2a are at high risk of colonization and infection due to MDROs, particularly during periods of high workload. A multi-faceted containment strategy can successfully control outbreaks due to MDR A. baumannii in a burns centre. [ABSTRACT FROM AUTHOR]

• This is the first report on the development and optimization of a national heart failure dashboard. • After multiple rounds of informatics optimization, the heart failure dashboard accuracy improved from 54.1% to 89.2% for the identification of heart failure with reduced ejection fraction and from 53.9% to 88.0% for the identification of heart failure with preserved ejection fraction. • We demonstrate informatics-evaluation procedures to redesign and optimize a population-management dashboard for health systems working on improving the quality of chronic disease management. In 2020, the Veterans Affairs (VA) health care system deployed a heart failure (HF) dashboard for use nationally. The initial version was notably imprecise and unreliable for the identification of HF subtypes. We describe the development and subsequent optimization of the VA national HF dashboard. This study describes the stepwise process for improving the accuracy of the VA national HF dashboard, including defining the initial dashboard, improving case definitions, using natural language processing for patient identification, and incorporating an imaging-quality hierarchy model. Optimization further included evaluating whether to require concurrent ICD-codes for inclusion in the dashboard and assessing various imaging modalities for patient characterization. Through multiple rounds of optimization, the dashboard accuracy (defined as the proportion of true results to the total population) was improved from 54.1% to 89.2% for the identification of HF with reduced ejection fraction (HFrEF) and from 53.9% to 88.0% for the identification of HF with preserved ejection fraction (HFpEF). To align with current guidelines, HF with mildly reduced ejection fraction (HFmrEF) was added to the dashboard output with 88.0% accuracy. The inclusion of an imaging-quality hierarchy model and natural-language processing algorithm improved the accuracy of the VA national HF dashboard. The revised dashboard informatics algorithm has higher use rates and improved reliability for the health management of the population. [Display omitted] [ABSTRACT FROM AUTHOR]

Radial nerve palsy after humeral shaft fractures is often associated with formation of a neuroma in continuity. The current standard of treatment is neuroma resection and nerve grafting with contentious results. Anterior transposition of the radial nerve may reduce the length of its path, allowing reconstruction by primary suture. The aim of this study was to determine the maximum length of radial nerve defect that can be treated by the anterior transposition to allow primary suture to be performed. We use 10 arms from five fresh cadavers. The radial nerve was dissected in the lateral inter-muscular septum and along the anterior aspect of the forearm. The radial nerve was transected at the level of the spiral groove and both stumps were than transposed anterior to the medial inter-muscular septum. The length of tension-free overlap that could be achieved was measured. The average length of the overlap at zero degrees of elbow flexion was 10.00 ± 1.84 mm. Theoretically, this will allow a defect of 20 ± 3.69 mm SD to be treated by primary suture. Our results suggest that anterior transposition can be used for radial nerve defects up to 2 cm; however, dissection of both stumps proved to be challenging. [ABSTRACT FROM AUTHOR]

To compare the time-zero biomechanical properties of hamstring graft preparations with or without suture augmentation for anterior cruciate ligament reconstruction (ACLR) in a full-construct cadaveric model. Hamstring grafts were harvested from 24 fresh frozen human cadavers and prepared in 1 of 3 ways: quadrupled SemiTendinosus (SemiT), and quadrupled SemiT with suture augmentation (SemiT+2.0-mm tape or SemiT+1.3-mm tape; n = 8 per group). Adjustable loop suspensory implants and cortical buttons were used for fixation on a porcine tibia and acrylic block. Testing included force-controlled cyclic loading at 250 N and 400 N followed by load to failure. The 2 suture augmentation groups had less total elongation and increased stiffness compared to the nonsuture-augmented group (P =.025). The SemiT+2.0-mm tape group had 36% less total elongation and 34% increased stiffness compared to SemiT+1.3mm tape (P <.001). Suture augmentation improves construct biomechanics at time zero following hamstring tendon ACLR. Augmentation with 2.0-mm tape suture improves construct biomechanics compared to 1.3-mm tape suture. Independent suture augmentation of a quadrupled SemiT graft improves ACLR construct biomechanics. Outcomes were improved with augmentation using 2.0-mm tape suture compared to 1.3-mm tape suture. [ABSTRACT FROM AUTHOR]

Der Artikel thematisiert eine osteopathische Praxeologie, die phänomenologisch-anthropologisch innerviert ist. Besprochen werden die Tastwelt der Osteopath*innen, eine mittels Tastsinn berührende Erlebnispraxis zwischen Osteopath*in und Patienten*in und die diese Praxis bestimmenden Regelwerke. Begründet werden soll eine Wahrnehmungs- und Handlungswissenschaft, in der Deskriptionen und Analysen der subjektiven Bewusstseinsleistung systematisch beforscht werden, am besten zu verstehen als ein Forschungsfeld, in dem die Akteur*innen der Osteopathie im Fokus stehen – weniger die Ergebnisse ihrer Handlungen, denn dies klärt die Stellung, das berufliche Selbst- und Weltverhältnis unserer Profession für den Diskurs zu anderen Wissenschaftsfeldern. Die osteopathische Forschungsgemeinschaft sollte interessiert sein, hier zu investieren. An osteopathic praxeology is discussed that is perspectively phenomenologically-anthropologically innervated. The world of touch of the osteopath with his or her acting set of rules is discussed in order to establish a science of perception and osteopathic action; thus to be understood as a future field of research in which also the actor of osteopathy is the focus of research and not only the results of his or her action. [ABSTRACT FROM AUTHOR]

Long-term outcomes of osteochondral allograft (OCA) transplantation to the humeral head have been sparsely reported in the literature. To evaluate outcomes and survivorship of OCA transplantation to the humeral head in patients with osteochondral defects at a minimum of 10 years of follow-up. A registry of patients who underwent humeral head OCA transplantation between 2004 and 2012 was reviewed. Patients completed pre and postoperative surveys including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Short Form 12 (SF-12), and the visual analog scale. Failure was defined by conversion to shoulder arthroplasty. Fifteen of 21 (71%) patients with a minimum of ten year of follow-up (mean: 14.2 ± 2.40) were identified. Mean patient age was 26.1 ± 8.8 years at the time of transplantation and eight (53%) patients were male. Surgery was performed on the dominant shoulder in 11 of the 15 (73%) cases. The use of local anesthetic delivered via an intra-articular pain pump was the most often reported underlying etiology of chondral injury (n = 9; 60%). Eight (53%) patients were treated with an allograft plug, while seven (47%) patients were treated with a mushroom cap allograft. At final follow-up, mean American Shoulder and Elbow Surgeons (49.9 to 81.1; P =.048) and Simple Shoulder Test (43.1 to 83.3; P =.010) significantly improved compared to baseline. Changes in mean SF-12 physical (41.4 to 48.1; P =.354), SF-12 mental (57.5 to 51.8; P =.354), and visual analog scale (4.0 to 2.8; P =.618) did not reach statistical significance. Eight (53%) patients required conversion to shoulder arthroplasty at an average of 4.8 ± 4.7 years (range: 0.6-13.2). Kaplan-Meier graft survival probabilities were 60% at 10 years and 41% at 15 years. OCA transplantation to the humeral head can result in acceptable long-term function for patients with osteochondral defects. While patient-reported outcomes metrics were generally improved compared to baseline, OCA graft survival probabilities diminished with time. The findings from this study can be used to counsel future patients with significant glenohumeral cartilage injuries and set expectations about the potential for further surgery. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? What are the 10-year trajectories of posttraumatic stress disorder (PTSD) symptoms in older U.S. military Veterans and what defines those at risk for increasing symptoms with aging? • What is the main finding of this study? No/Low PTSD symptoms over time was most common, followed by consistently high, consistently sub-threshold, and increasing symptoms. Those with increasing symptoms were more likely to report cognitive and functional change, negative expectations of aging, and traumatic events over the study period. • What is the meaning of the finding? Most older Veterans are resilient, but some may have continuing or increasing PTSD symptoms with aging indicating a need to consider age-related changes, internalized ageism, and the occurrence and timing of traumatic events. To examine the nature and correlates of 10-year trajectories of posttraumatic stress disorder (PTSD) symptoms in older U.S. military Veterans. A nationally representative web-based survey of older U.S. Veterans who participated in the National Health and Resilience in Veterans Study over 5 waves between 2011 and 2021. A total of 1,843 U.S. Veterans aged 50 and older (mean age = 67). PTSD symptoms were assessed using the PTSD Checklist. Self-report measures at baseline assessed sociodemographic characteristics; trauma exposures; psychiatric and substance use disorders; mental, cognitive, and physical functioning; and psychosocial factors including expectations of aging. Latent growth mixture modeling identified the nature and correlates of 10-year PTSD symptom trajectories. Most of the sample had no/low PTSD symptoms (88.7%), while 6.0% had consistently subthreshold symptoms, 2.7% consistently high symptoms, and 2.6% increasing symptoms. Relative to the no/low symptom group, the subthreshold and high symptom groups reported more medical conditions and cognitive difficulties, with younger age and more lifetime traumatic events additionally linked to the high symptom trajectory. Relative to the no/low symptom group, Veterans with increasing symptoms were more likely to report functional disability and lifetime nicotine use disorder, cognitive difficulties, negative expectations regarding physical and emotional aging, and traumatic events over the study period. Despite high rates of trauma exposure, most older Veterans do not evidence symptomatic PTSD trajectories; however, about 11% do. Results underscore the importance of assessing PTSD symptoms in this population and considering longitudinal trajectories as well as associated risk and protective factors. [ABSTRACT FROM AUTHOR]

To determine the improvements in patient-reported outcome measures (PROMs) necessary to achieve minimal clinically important difference (MCID), patient-acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) after primary meniscal allograft transplantation (MAT) at a minimum of 5-year follow-up, while identifying variables predictive of achieving clinically significant outcomes (CSOs). A retrospective review was performed to identify patients undergoing primary MAT at a single institution from 1999 to 2016. Lysholm, International Knee Documentation Committee (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales were collected before surgery and at a minimum of 5-year follow-up. A distribution-based approach was used to calculate MCID, whereas an anchor-based approach was used to calculate SCB and PASS. Multivariate logistic regression was performed to determine factors associated with CSO achievement. A total of 202 patients undergoing MAT (56% medial, 44% lateral) were included with a mean follow-up of 9.8 ± 4.1 years, age of 29.7 ± 8.5 years, and body mass index (BMI) of 26.5 ± 4.7. Thresholds for achieving MCID, PASS, and SCB, respectively, at a minimum 5-year follow-up for Lysholm (10.3, 74.5, 32.5), IKDC (12.1, 55.6, 29.1), and KOOS subscales questionnaires (Pain [11.0, 70.7, 25.1], Symptoms [11.0, 60.8, 19.6], Activities of Daily Living [10.5, 90.3, 17.9], Sport [16.2, 47.4, 37.5], and Quality of Life [13.6, 40.5, 37.3]) were calculated. Reduced odds of achieving MCID were associated with higher preoperative PROM scores, BMI, patient age, concomitant osteotomy, male sex, and worker's compensation (WC) status. Reduced odds of achieving PASS were associated with lower preoperative PROM scores, higher BMI (particularly ≥30), patient age, and WC status. Reduced odds of achieving SCB were associated with higher preoperative PROM scores and WC status. This study established the MCID, PASS, and SCB at 5-year minimum follow-up for the Lysholm score, IKDC, and KOOS subscales in patients who underwent MAT. Increased BMI and patient age, male sex, performance of concomitant osteotomy, WC status, and preoperative PROM scores were associated with failure to achieve CSOs after primary MAT at a minimum of 5-year follow-up. Level IV, therapeutic study, retrospective case series. [ABSTRACT FROM AUTHOR]

Radiation dermatitis (RD) is the most common side effect of adjuvant whole-breast or chest wall irradiation, majorly impacting quality of life in numerous patients. The use of barrier films (polyurethane dressings such as Hydrofilm® and Mepitel® film remaining on the skin for the duration of the radiation treatment) has been investigated as a prophylactic measure in several prospective trials. Here, we critically appraise the available evidence behind preventive barrier film application in the context of breast cancer treatment. International literature was reviewed and high-quality randomised controlled trials (RCTs) were included in this meta-analysis. The results of 5 RCTs (663 patients; >90% Caucasian) were analysed. Overall, barrier films lead to improved clinician- and patient-reported outcomes: fewer grade ≥2 RD (11% vs. 42%; OR = 0.16; p < 0.001) and moist desquamation (2% vs. 16%; OR = 0.12; p = 0.006), as well as less patient-reported pain (standardised mean difference [SMD] −0.51; p < 0.001), itching (SMD −0.52; p = 0.001), burning (SMD −0.41; p = 0.011), and limitations in daily activities (SMD −0.20; p = 0.007). Furthermore, barrier films have a high acceptance rate among patients, as well as a favourable cost-benefit ratio. Possible side effects due to its application are mild and mostly self-limiting. Overall, there was a lack of information on the radiation treatment techniques used. The evidence presented in this meta-analysis suggests that barrier films are an excellent tool in the prevention of RD among Caucasian patients receiving whole-breast or chest wall irradiation. Its use should therefore be considered routinely in these patients. • Meta-analysis of 5 trials investigating Hydrofilm® and Mepitel® barrier films. • Reduction of incidence and severity of radiation dermatitis and moist desquamation. • Fewer patient-reported pain, itching, burning, and limitations in daily activities. • Mild and self-limiting side effects, high acceptance, favourable cost-benefit ratio. • Mainly Caucasian patients and limited information on radiation treatment techniques. [ABSTRACT FROM AUTHOR]

This work experimentally investigates the fuel-rich combustion of CH 4 /CO 2 /O 2 mixtures in a piston engine. The focus of the experiments is to determine suitable operating parameters in terms of stable engine operation, syngas production, CO 2 conversion, and avoiding soot emissions. In particular, the spark timing, CO 2 intake mole fraction, equivalence ratio, and compression ratio were varied. Results show stable spark-ignition operation over a wide range of the investigated parameters at a compression ratio of 10. Acceptable operation could be achieved within the spark timing limits of -38° to 10 °CA after top dead center, 7 to 27% CO 2 in the inlet and equivalence ratios from 2 to 2.5. A maximum H 2 yield of 62% could be achieved at an equivalence ratio of 1.9 and a CO 2 intake mole fraction of 4% at a compression ratio of 4.5. Spark time advancing from -10 to -38 °CA enhanced the dry reforming reaction and increased the hydrogen yield per methane from 38 to 45%. A significant influence of compression ratio on the amount of soot in the product gas was observed, showing that higher compression ratios increase soot formation. [ABSTRACT FROM AUTHOR]

Latino and Black adolescent males experience sexual health inequities, and their engagement in sexual health services remains low. Parents shape adolescent sexual health behavior and other youth outcomes. However, the role of Latino and Black fathers in promoting male adolescent sexual health is understudied, in part because about one in four fathers resides apart from their children and nonresident fathers are presumed to be less influential. We examined associations of paternal communication with sexual health service use and perceived paternal role modeling among Latino and Black adolescent males with resident and nonresident fathers. We recruited 191 Latino and Black adolescent males aged 15–19 years and their fathers in the South Bronx, New York City, using area sampling methods; dyads completed surveys. We estimated bivariate and adjusted associations of paternal communication with adolescent male sexual health service use and perceived paternal role modeling using logistic and linear regressions. Effect measure modification by paternal residence was assessed. A unit increase on a five-point paternal communication scale was associated with approximately twice and 1.7 times the likelihood of clinical sexual health service use during adolescent males' lifetime and in the past 3 months, respectively; there was no significant effect measure modification by paternal residence. Paternal communication was associated with increased levels of perceived paternal role modeling and usefulness of paternal advice, with stronger associations for nonresident fathers. Both resident and nonresident Latino and Black fathers warrant greater consideration as partners in promoting male adolescent sexual health service use. [ABSTRACT FROM AUTHOR]

Neurologic complications after surgery (stroke, delirium) remain a major concern despite advancements in surgical and anesthetic techniques. The authors aimed to evaluate whether a novel index of interhemispheric similarity, the lateral interconnection ratio (LIR), between 2 prefrontal electroencephalogram (EEG) channels could be associated with stroke and delirium following cardiac surgery. Retrospective observational study. Single university hospital. A total of 803 adult patients without documentation of a previous stroke, who underwent cardiac surgery with cardiopulmonary bypass (CPB) between July 2016 and January 2018. The LIR index was calculated retrospectively from the patients' EEG database. LIR was analyzed intraoperatively every 10 seconds and compared among patients with postoperative stroke, patients with delirium, and patients without documented neurologic complications, during 5 key periods, each lasting10 minutes: (1) surgery start, (2) before CPB, (3) on CPB, (4) after CPB, and (5) surgery end. After cardiac surgery, 31 patients suffered from stroke; 48 patients were diagnosed with delirium; and 724 had no documented neurologic complications. Patients with stroke demonstrated a decrease in LIR index between the start of surgery and the postbypass period of 0.08 (0.01, 0.36 [21]; median and [interquartile range {IQR}]; valid EEG samples); whereas there was no similar decrease in the no-dysfunction group (− 0.04 [ − 0.13, 0.04; {551}], p < 0.0001). Patients with delirium showed a decrease in LIR index between the start of surgery and the end of the surgery by 0.15 (0.02, 0.30 [12]), compared with no such decrease in the no-dysfunction group (− 0.02 [ − 0.12, 0.08 {376}], p ≈ 0.001). After improvement of SNR, it might be of value to further study the index decrease as an indication for risk for brain injury after surgery. The timing of decrease (after CPB or end of surgery) may provide hints regarding the injury pathophysiology and its onset. [ABSTRACT FROM AUTHOR]

Whether ultrathin-strut stents are particularly beneficial for lesions requiring implantation of more than 1 stent is unknown. In a post-hoc lesion-level analysis of 2 randomized trials comparing ultrathin-strut biodegradable polymer Sirolimus-eluting stents (BP-SES) vs thin-strut durable polymer Everolimus-eluting stents (DP-EES), lesions were stratified into multistent lesions (MSL) vs single-stent lesions (SSL). The primary endpoint was target lesion failure (TLF), a composite of lesion-related unclear/cardiac death, myocardial infarction (MI), or revascularization, at 24 months. Among 5328 lesions in 3397 patients, 1492 (28%) were MSL (722 with BP-SES, 770 with DP-EES). At 2 years, TLF occurred in 63 lesions (8.9%) treated with BP-SES and 60 lesions (7.9%) treated with DP-EES in the MSL-group (subdistibution hazard ratio [SHR], 1.13; 95% CI, 0.77-1.64; P =.53), and in 121 (6.4%) and 136 (7.4%) lesions treated with BP-SES and DP-EES respectively (SHR, 0.86; 95% CI, 0.62-1.18; P =.35) in the SSL-group (P for interaction =.241). While the rates of lesion-related MI or revascularization were significantly lower in SSL treated with BP-SES as compared to DP-EES (3.5% vs 5.2%; SHR, 0.67; 95% CI 0.46-0.97; P =.036), no significant difference was observed in MSL (7.1% vs 5.4%; SHR, 1.31; 95% CI 0.85-2.03; P =.216) with significant interaction between groups (P for interaction =.014). Rates of TLF are similar between ultrathin-strut BP-SES and thin-strut DP-EES in MSL and SSL. The use of ultrathin-strut BP-SES vs thin-strut DP-EES did not prove to be particularly beneficial for the treatment of multistent lesions. Post-hoc analysis from the BIOSCIENCE (NCT01443104) and BIOSTEMI (NCT02579031) trials. [ABSTRACT FROM AUTHOR]

Intraductal papillary mucinous neoplasms of the pancreas are uncommon in young individuals. Management of these patients is challenging because the risk of malignancy and recurrence after surgery remains unclear. The aim of the present study was to assess the long-term risk for intraductal papillary mucinous neoplasm recurrence after surgery for intraductal papillary mucinous neoplasms in patients ≤50 years of age. Perioperative and long-term follow-up data of patients who had undergone surgery for intraductal papillary mucinous neoplasms between 2004 and 2020 were extracted from a prospective unicentric database and retrospectively analyzed. Seventy-eight patients underwent surgical treatment for benign intraductal papillary mucinous neoplasms (low-grade n = 22 and intermediate-grade n = 21) and malignant intraductal papillary mucinous neoplasms (high-grade n = 16 and intraductal papillary mucinous neoplasm–associated carcinoma n = 19). Severe postoperative morbidity (Clavien–Dindo ≥III) was found in 14 patients (18%). The median length of hospital stay was 10 days. No perioperative mortality was observed. The median length of follow-up was 72 months. Recurrence of intraductal papillary mucinous neoplasm–associated carcinoma was found in 6 patients (19%) with malignant intraductal papillary mucinous neoplasm and 1 patient (3%) with benign intraductal papillary mucinous neoplasm. Surgery for intraductal papillary mucinous neoplasm is safe and can be performed with low morbidity and potentially no mortality in young patients. Given the high rate of malignancy (45%), these patients with intraductal papillary mucinous neoplasms represent a high-risk population, and prophylactic surgical treatment should be considered in these patients with long life expectancies. Regular clinical and radiologic follow-up examinations are important to rule out disease recurrence, which is high, especially in patients with intraductal papillary mucinous neoplasm–associated carcinoma. [ABSTRACT FROM AUTHOR]

[Display omitted] Familial Mediterranean fever (FMF), caused by mutations in the pyrin-encoding MEFV gene, is characterized by uncontrolled caspase-1 activation and IL-1β secretion. A similar mechanism drives inflammation in cryopyrin-associated periodic fever syndrome (CAPS) caused by mutations in NLRP3. CAPS and FMF, however, result in largely different clinical manifestations, pointing to additional, autoinflammatory pathways involved in FMF. Another hallmark of FMF is extraordinarily high expression of S100A8 and S100A9. These alarmins are ligands of Toll-like receptor 4 and amplifiers of inflammation. However, the relevance of this inflammatory pathway for the pathogenesis of FMF is unknown. This study investigated whether mutations in pyrin result in specific secretion of S100A8/A9 alarmins through gasdermin D pores' amplifying FMF pathology. S100A8/A9 levels in FMF patients were quantified by enzyme-linked immunosorbent assay. In vitro models with knockout cell lines and specific protein inhibitors were used to unravel the S100A8/A9 secretion mechanism. The impact of S100A8/A9 to the pathophysiology of FMF was analyzed with FMF (MEFV V726A/V726A) and S100A9 −/− mouse models. Pyrin-S100A8/A9 interaction was investigated by coimmunoprecipitation, immunofluorescence, and enzyme-linked immunosorbent assay studies. The S100A8/A9 complexes directly interacted with pyrin. Knocking out pyrin, caspase-1, or gasdermin D inhibited the secretion of these S100 alarmins. Inflammatory S100A8/A9 dimers were inactivated by tetramer formation. Blocking this inactivation by targeted S100A9 deletion in a murine FMF model demonstrated the relevance of this novel autoinflammatory pathway in FMF. This is the first proof that members of the S100 alarmin family are released in a pyrin/caspase-1/gasdermin D–dependent pathway and directly drive autoinflammation in vivo. [ABSTRACT FROM AUTHOR]

S100 proteins convey important roles in innate immune responses to infection and regenerative processes. However, their role in inflammatory or regenerative processes of the human dental pulp is poorly elucidated. The aim of the present study was to detect, localize, and compare the occurrence of 8 S100 proteins in normal, symptomatic, and asymptomatic irreversibly inflamed dental pulp specimens. Human dental pulp specimens from 45 individuals were clinically assigned to 3 groups of pulpal diagnosis: normal pulp (NP, n = 17), asymptomatic irreversible pulpitis (AIP, n = 13), and symptomatic irreversible pulpitis (SIP, n = 15). The specimens were prepared and immunohistochemically stained for proteins S100A1, -A2, -A3, -A4, -A6, -A7, -A8, and -A9. Staining was classified using semiquantitative analysis and a 4-degree staining score (ie, no, decent, medium, and intense staining) at 4 different anatomic or functional regions (ie, the odontoblast layer [OL], pulpal stroma [PS], border area of calcifications [BAC], and vessel walls). The distribution of staining degrees between the 3 diagnostic groups was calculated using the Fisher exact text (P ≤.05) at the 4 regions. Significant differences in staining were observed mainly in the OL and PS and at the BAC. The most significant differences were detected in the PS and when comparing NP with 1 of the 2 irreversibly inflamed pulpal tissues (AIP or SIP). The inflamed tissues were then invariably stained more intensely than their normal counterparts at this location (S100A1, -A2, -A3, -A4, -A8, and -A9). In the OL, NP tissue was significantly stronger stained for S100A1, -A6, -A8, and -A9 compared with SIP and for S100A9 when compared with AIP. Differences between AIP and SIP in direct comparison were rare and were found only for 1 protein (S100A2) at the BAC. Also, at the vessel walls, only 1 statistical difference in staining was observed (SIP was stronger stained than NP for protein S100A3). The occurrence of proteins S100A1, -A2, -A3, -A4, -A6, -A8, and -A9 is significantly altered in irreversibly inflamed compared with normal dental pulp tissue at different anatomic localizations. Some members of S100 proteins obviously participate in focal calcification processes and pulp stone formation of the dental pulp. [ABSTRACT FROM AUTHOR]

Breast cancer patients often engage in shared decision-making to select an individualized treatment regimen from multiple options. However, dissatisfaction with treatment outcomes can lead to decision regret. We evaluated decision regret and physical and psychological well-being among breast cancer patients who underwent adjuvant radiotherapy and explored their associations with patient, tumor, treatment, and symptom characteristics. This cross-sectional study involved retrospectively obtaining clinical data and data collected through interviews carried out as part of regular long-term medical aftercare. Decision regret regarding the radiotherapy was assessed using the Ottawa Decision Regret Scale, physical and psychological well-being were assessed using the PROMIS Global Health-10 questionnaire, and patients were asked about their treatment outcomes and symptoms. The questionnaire was administered 14 months to 4 years after completion of radiotherapy. Of the 172 included breast cancer patients, only 13.9% expressed high decision regret, with most patients expressing little or no decision regret. More decision regret was associated with volumetric modulated arc therapy, chest wall irradiation, use of docetaxel as a chemotherapy agent, lymphangiosis carcinomatosa, new heart disease after radiotherapy, and lower psychological well-being. Although most patients reported little or no decision regret, we identified several patient, treatment, and symptom characteristics associated with more decision regret. Our findings suggest that psychological well-being influences patients' satisfaction with therapy decisions, implying that practitioners should pay special attention to maintaining psychological well-being during shared decision-making and ensuring that psychological assessment and treatment is provided after cancer therapy to deal with long-term effects of radiotherapy. • Breast cancer patients often engage in shared decision-making to select an individualized treatment regimen. • Dissatisfaction with treatment outcomes may lead to decision regret and psychological well-being. • Decision regret was associated with VMAT, chest wall irradiation, docetaxel usage, inflammatory carcinoma. • Practitioners should pay special attention to maintaining psychological well-being during shared decision-making. [ABSTRACT FROM AUTHOR]

Large datasets are required to ensure reliable non-invasive glioma assessment with radiomics-based machine learning methods. This can often only be achieved by pooling images from different centers. Moreover, trained models should perform with high accuracy when applied to data from different centers. In this study, the impact of reconstruction settings and segmentation methods on radiomic features derived from amino acid and TSPO PET images of glioma patients was examined. Additionally, the ability to model and thus reduce feature differences was investigated. [18F]FET and [18F]GE-180 PET data were acquired from 19 glioma patients. For each acquisition, 10 reconstruction settings and 9 segmentation methods were included to emulate multicentric data. Statistical robustness measures were calculated before and after ComBat harmonization. Differences between features due to setting variations were assessed using Friedman test, coefficient of variation (CV) and inter-rater reliability measures, including intraclass and Spearman's rank correlation coefficients and Fleiss' Kappa. According to Friedman analyses, most features (>60%) showed significant differences. Yet, CV and inter-rater reliability measures indicated higher robustness. ComBat resulted in almost complete harmonization (>87%) according to Friedman test and little to no improvement according to CV and inter-rater reliability measures. [18F]GE-180 features were more sensitive to reconstruction settings than [18F]FET features. According to Friedman test, feature distributions could be successfully aligned using ComBat. However, depending on settings, changes in patient ranks were observed for some features and could not be eliminated by harmonization. Thus, for clinical utilization it is recommended to exclude affected features. [ABSTRACT FROM AUTHOR]

Background: Transvenous lead extraction (TLE) has evolved as one of the most crucial treatment options for patients with cardiac device-related systemic infection (CDRSI).Objective: The aim of this study was to characterize the procedural outcome and risk factors of patients with CDRSI undergoing TLE.Methods: A subgroup analysis of patients with CDRSI of the GALLERY (GermAn Laser Lead Extraction RegistrY) database was performed. Predictors for complications, procedural failure, and all-cause mortality were evaluated.Results: A total of 722 patients (28.6%) in the GALLERY had "systemic infection" as extraction indication. Patients with CDRSI were older (70.1 ± 12.2 years vs 67.3 ± 14.3 years; P < .001) and had more comorbidities than patients with local infections or noninfectious extraction indications. There were no differences in complete procedural success (90.6% vs 91.7%; P = .328) or major complications (2.5% vs 1.9%; P = .416) but increased procedure-related (1.4% vs 0.3%; P = .003) and all-cause in-hospital mortality (11.1% vs 0.6%; P < .001) for patients with CDRSI. Multivariate analyses revealed lead age ≥10 years as a predictor for procedural complications (odds ratio [OR] 3.23; 95% confidence interval [CI] 1.58-6.60; P = .001). Lead age ≥10 years (OR 2.57; 95% CI 1.03-6.46; P = .04) was also a predictor for procedural failure. We identified left ventricular ejection fraction <30% (OR 1.70; 95% CI 1.00-2.99; P = .049), age ≥75 years (OR 2.1; 95% CI 1.27-3.48; P = .004), chronic kidney disease (OR 1.92; 95% CI 1.17-3.14; P = .01), and overall procedural complications (OR 5.15; 95% CI 2.44-10.84; P < .001) as predictors for all-cause mortality.Conclusion: Patients with CDRSI undergoing TLE demonstrate an increased rate of all-cause in-hospital, as well as procedure-related mortality, despite having comparable procedural success rates. Given these data, it seems paramount to develop preventive strategies to detect and treat CDRSI in its earliest stages. [ABSTRACT FROM AUTHOR]

Portable fluoroscopy devices provide point-of-care imaging in emergency and out-patient clinics. In this prospective study, we compared weightbearing images of syndesmosis obtained using a novel lightweight portable battery-powered fluoroscopy device with those obtained with a conventional radiography device. Eleven healthy participants underwent bilateral 3-view weightbearing imaging of both ankles using a radiography (X-ray group) device and a portable fluoroscopy system (LPF group). Anteroposterior, mortise, and lateral views were compared between the 2 techniques. Radiographic measurements were done by 2 observers. These measurements included talar tilt, tibiofibular clear space, tibiofibular overlap, plafond malleolar angle, medial distal tibial angle, medial clear space, lateral distal tibial angle, anterior and posterior tibiofibular distance were measured using the appropriate view. Data were compared between the 2 techniques; the interobserver agreement was calculated within each group. P <.05 was considered statistically significant. Comparing the 2 imaging modalities, there was no significant difference between the measurements in LPF and X-ray groups except plafond malleolar angle. The overall interobserver agreement was excellent between the 2 observers. There was no significant difference between the measures by the 2 observers and between the bilateral ankles. Fluoroscopy was associated with about 50% extra radiation exposure, although the absolute amount of radiation was not clinically significant. These results support the use of weightbearing images using portable fluoroscopy device as an alternative for the conventional radiography systems. [ABSTRACT FROM AUTHOR]

Non-evaporated liquid fuel films are the main cause of soot formation in gasoline direct-injection engines. In this study, a UV–vis absorption technique was developed to image the fuel-film thickness after direct injection in a heated constant-flow experiment. A six-hole GDI injector sprayed fuel at 100 bar onto a transparent plate 30 mm from the nozzle. The fuel consisted of a mixture of 30% toluene / 70% isooctane (boiling points 383 and 372 K, respectively). The gas and wall temperature were 376 and 352 K, respectively, and the gas pressure 1 bar. The evaporated part of the fuel was ignited, and the ensuing combustion next to the evaporating fuel film led to soot formation. Transmission of diffused backlighting from pulsed LED illumination was imaged on an intensified high-speed CMOS camera. The UV absorbance of liquid toluene was targeted with an LED at 265 nm. However, at this wavelength, absorption by toluene vapor, scattering by the liquid, extinction by soot and soot precursors, and soot incandescence all interfere with the liquid-fuel absorbance. To estimate the contributions of scattering and soot extinction, LEDs at 310, 365, and 520 nm were added to the beam path and pulsed to coincide with consecutive frames on the high-speed camera at a frame rate of 32 kHz. A dark frame was acquired to account for soot incandescence, such that the repetition rate of the resulting 5-image sequence was 6.4 kHz. Absorption by toluene vapor was estimated with a morphological image processing developed in a previous work to separate the diffuse, moving vapor cloud from the sharp, stationary features of the fuel film. The multi-spectral approach permitted obtaining spatio-temporally resolved fuel-film thickness measurements and additional information on the soot. [ABSTRACT FROM AUTHOR]

Resection margin status is a well-established prognosticator in pancreatic cancer. The prognostic impact of IPMN dysplasia at the pancreatic transection margin in IPMN-associated carcinoma (IPMN-Ca) remains unclear, hence institutional practices on additional resections vary. Patients undergoing partial pancreatectomy or attempted partial pancreatectomy converted to total pancreatectomy for IPMN-Ca between 04/2002 and 12/2018 were identified. Final pathology of the definitive pancreatic transection margin was identified. The association between the presence of IPMN dysplasia at the margin and overall survival (OS) was assessed. Of 302 patients with IPMN-Ca, 181 (59.9%) patients received partial pancreatoduodenectomy, 61 (20.2%) distal pancreatectomy, and 60 (19.9%) were converted to total pancreatectomy. Median OS was 98.6 months in R0 (≥1 mm), 39.3 months in R1 (<1 mm), and 22.0 months in R1(direct) resected patients, respectively (p < 0.0001). No IPMN dysplasia at the definitive margin was present in 103 (34.1%), low-grade in 131 (43.4%), and high-grade/R1 in 8 (2.6%) patients. Low-grade dysplasia or total pancreatectomy were not associated with shorter OS compared to dysplasia-free margin across the entire cohort. Sensitivity analyses confirmed a lack of prognostic relevance of low-grade IPMN dysplasia at the pancreatic margin in R0 resected IPMN-Ca and in R0 resected UICC stage IA/IB IPMN-Ca. Low-grade IPMN at the transection margin is not associated with shorter overall survival after partial pancreatectomy for IPMN-Ca. Additional resections for low-grade dysplasia, up to total pancreatectomy do not result in a survival benefit and should be omitted. Due to limited sample size, high-grade dysplasia could not be analyzed. [ABSTRACT FROM AUTHOR]

• Introduction of novel hydroxyapatite-magnesium interpenetrating phase composites. • Produced by ceramic additive manufacturing and liquid metal infiltration. • Magnesium provides mechanical strength in the range of cortical bone. • An osteoconductive hydroxyapatite scaffold is generated after magnesium degradation. • The structural and biological properties are controlled through the digital design. [Display omitted] This work explores ceramic additive manufacturing in combination with liquid metal infiltration for the production of degradable interpenetrating phase magnesium/hydroxyapatite (Mg/HA) composites. Material extrusion additive manufacturing was used to produce stoichiometric, and calcium deficient HA preforms with a well-controlled open pore network, allowing the customization of the topological relationship of the composite. Pure Mg and two different Mg alloys were used to infiltrate the preforms by means of an advanced liquid infiltration method inspired by spark plasma sintering, using a novel die design to avoid the structural collapse of the preform. Complete infiltration was achieved in 8 min, including the time for the Mg melting. The short processing time enabled to restrict the decomposition of HA due to the reducing capacity of liquid Mg. The pure Mg-base composites showed compressive yield strength above pure Mg in cast state. Mg alloy-based composites did not show higher strength than the bare alloys due to grain coarsening, but showed similar mechanical properties than other Mg/HA composites that have significantly higher fraction of metallic phase. The composites showed faster degradation rate under simulated body conditions than the bare metallic component due to the formation of galvanic pairs at microstructural level. Mg dissolved preferentially over HA leaving behind a scaffold after a prolonged degradation period. In turn, the fast production of soluble degradation products caused cell metabolic changes after 24 h of culture with not-diluted material extracts. The topological optimization and reduction of the degradation rate are the topics for future research. [ABSTRACT FROM AUTHOR]

Background: The absence of pacing capabilities may reduce the appeal of subcutaneous implantable cardioverter-defibrillator (S-ICD) devices for patients at risk for conduction disorders or with antitachycardia pacing (ATP)/cardiac resynchronization (CRT) requirements. Reports of rates of S-ICD to transvenous implantable cardioverter-defibrillator (TV-ICD) system switch in real-world scenarios are limited.Objective: The purpose of this study was to investigate the need for a subsequent transvenous (TV) device in patients implanted with an S-ICD and its predictors.Methods: All patients implanted with an S-ICD were enrolled from the multicenter, real-world iSUSI (International SUbcutaneouS Implantable cardioverter defibrillator) Registry. The need for a TV device and its clinical reason, and appropriate and inappropriate device therapies were assessed. Logistic regression with Firth penalization was used to assess the association between baseline and procedural characteristics and the overall need for a subsequent TV device.Results: A total of 1509 patients were enrolled (age 50.8 ± 15.8 years; 76.9% male; 32.0% ischemic; left ventricular ejection fraction 38% [30%-60%]). Over 26.5 [13.4-42.9] months, 155 (10.3%) and 144 (9.3%) patients experienced appropriate and inappropriate device therapies, respectively. Forty-one patients (2.7%) required a TV device (13 bradycardia; 10 need for CRT; 10 inappropriate shocks). Body mass index (BMI) >30 kg/m2 and chronic kidney disease (CKD) were associated with need for a TV device (odds ratio [OR] 2.57 [1.37-4.81], P = .003; and OR 2.67 [1.29-5.54], P = .008, respectively).Conclusion: A low rate (2.7%) of conversion from S-ICD to a TV device was observed at follow-up, with need for antibradycardia pacing, ATP, or CRT being the main reasons. BMI >30 kg/m2 and CKD predicted all-cause need for a TV device. [ABSTRACT FROM AUTHOR]

A Lagrangian-particle tracking model, Delft3D-PART, combined with hydrodynamics models are used to investigate the fate and transport of buoyant plastics from Ba Lat river mouth in Red River Delta, northern Vietnam. It was found that during the dry season (Dec–Feb), 23 % (26.43 ton) of the plastics reached the shoreline while 76.1 % (68.3 ton) moved towards the coast further south of Red River Delta. During the wet season (Jun–Aug), 42 % (56.3 ton) were transported offshore away from the coast and 20 % (26.43 ton) distributed along the shore. The two bays adjacent to the river mouth are major hotspots with the intensity skewed towards the upwind side relative to the seasonal monsoon. This phenomenon is exacerbated by storm events which reverse the typical transport and lead to formation of hotspots at the upwind side of the plastic source. Guidance of model results for targeted cleanup operations is discussed. • First attempt to model the transport, pathway, and accumulation of buoyant plastics from river to coast at Red River Delta. • Monsoon patterns drive seasonal shifts in buoyant plastic transport, moving southwest/northeast in dry/wet season. • In the wet season, shifting winds trap more macroplastics on the upwind side of the river mouth than in the dry season. • Storm events in wet season led to coastal hotspots of plastics and subsequent offshore transport. [ABSTRACT FROM AUTHOR]

Courtyards, a historical architectural feature surrounded by buildings, are common in urban housing and residential complexes. These spaces, often open-air and with rooms facing them, are crucial for daylight and natural ventilation. While courtyards are essential for introducing fresh airflow into adjacent indoor areas, the effectiveness of natural ventilation may be compromised due to potentially poor air circulation from limited openings. This raises a significant concern: could the design of courtyards inadvertently facilitate pollutant cross-transmission? Despite a wealth of research focused on airflow within courtyards, the indoor spaces in proximity to these courtyards have often been neglected in previous works, particularly concerning the exchange of pollutants between the indoor and courtyard environment. This research investigates the dynamics of indoor-outdoor pollutant cross-transmission in courtyard buildings, assessing factors like external wind flow patterns and internal pollutant sources. Wind tunnel experiments were conducted to measure internal pressure and CO 2 concentration and to validate a computational model of the courtyard with 12 rooms. The validated Computational Fluid Dynamics (CFD) models were used to simulate the dispersion of pollutants from internal rooms under different wind conditions. The results showed that the k-epsilon Realizable model accurately simulated internal surface pressure distribution and pollutant dispersion in the courtyard building. It was observed that when pollutants were released from the downwind east-facing ground floor room, CO 2 concentrations in adjacent side rooms on the same floor were significantly higher, increasing from the baseline of 400 ppm and reaching up to 3211 ppm in the north-facing room at a wind speed of 4.51 m/s and wind direction of 0°. Conversely, when pollutants originated from north- and south-facing side rooms, pollutants were minimally dispersed to adjacent rooms. Furthermore, at a wind direction of 45°, pollutants from wind-exposed rooms predominantly dispersed to downwind rooms, with peak concentrations exceeding 2400 ppm in downwind rooms. These findings demonstrate that pollutant dispersion is highly dependent on wind direction and the location of the pollutant source. The study concludes that while courtyards enhance indoor environmental quality through natural ventilation, their design must be carefully considered to prevent unintended pollutant cross-transmission, particularly under varying wind conditions and pollutant source locations. [Display omitted] • 1:50 scale model in wind tunnel, validated CFD model for 48 scenarios. • At 0° wind, upwind or downwind room pollutants mainly disperse to side rooms. • At 4.51 m/s and 0° wind, CO 2 peaks at 3211 ppm in the east-facing side room. • Ground and first floor sources pose higher cross-room pollutant transmission risk. • Ground floor rooms had the highest CO 2 concentration, regardless of source or wind. [ABSTRACT FROM AUTHOR]

Severe congenital aortic valve pathology in the growing patient remains a challenging clinical scenario. Bicuspidization of the diseased aortic valve has proven to be a promising repair technique with acceptable durability. However, most understanding of the procedure is empirical and retrospective. This work seeks to design the optimal gross morphology associated with surgical bicuspidization with simulations based on the hypothesis that modifications to the free edge length cause or relieve stenosis. Model bicuspid valves were constructed with varying free edge lengths and gross morphology. Fluid-structure interaction simulations were conducted in a single patient-specific model geometry. The models were evaluated for primary targets of stenosis and regurgitation. Secondary targets were assessed and included qualitative hemodynamics, geometric height, effective height, orifice area, and billow. Stenosis decreased with increasing free edge length and was pronounced with free edge length less than or equal to 1.3 times the annular diameter d. With free edge length 1.5 d or greater, no stenosis occurred. All models were free of regurgitation. Substantial billow occurred with free edge length 1.7 d or greater. Free edge length 1.5 d or greater was required to avoid aortic stenosis in simulations. Cases with free edge length 1.7 d or greater showed excessive billow and other changes in gross morphology. Cases with free edge length 1.5 d to 1.6 d have a total free edge length approximately equal to the annular circumference and appeared optimal. These effects should be studied in vitro and in animal studies. [Display omitted] [ABSTRACT FROM AUTHOR]