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Atrial high-rate episodes (AHREs) are frequent in patients with cardiac implantable electronic devices. A decrease in device-detected P-wave amplitude may be an indicator of periods of increased risk of AHRE. The objective of this study was to assess the association between P-wave amplitude and AHRE incidence. Remote monitoring data from 2579 patients with no history of atrial fibrillation (23% pacemakers and 77% implantable cardioverter-defibrillators, of which 40% provided cardiac resynchronization therapy) were used to calculate the mean P-wave amplitude during 1 month after implantation. The association with AHRE incidence according to 4 strata of daily burden duration (≥15 minutes, ≥6 hours, ≥24 hours, ≥7 days) was investigated by adjusting the hazard ratio with the CHA 2 DS 2 -VASc score. The adjusted hazard ratio for 1-mV lower mean P-wave amplitude during the first month increased from 1.10 (95% confidence interval [CI], 1.05–1.15; P <.001) to 1.18 (CI, 1.09–1.28; P <.001) with AHRE duration strata from ≥15 minutes to ≥7 days independent of the CHA 2 DS 2 -VASc score. Of 871 patients with AHREs, those with 1-month P-wave amplitude <2.45 mV had an adjusted hazard ratio of 1.51 (CI, 1.19–1.91; P =.001) for progression of AHREs from ≥15 minutes to ≥7 days compared with those with 1-month P-wave amplitude ≥2.45 mV. Device-detected P-wave amplitudes decreased linearly during the 1 year before the first AHRE by 7.3% (CI, 5.1%–9.5%; P <.001 vs patients without AHRE). Device-detected P-wave amplitudes <2.45 mV were associated with an increased risk of AHRE onset and progression to persistent forms of AHRE independent of the patient's risk profile. [ABSTRACT FROM AUTHOR]

Reproductive problems in cattle are frequent and have an important impact on production. In addition, inflammatory, traumatic and other diseases may be followed by the development of tumours, which are a cause of culling of breeding males. The main types of tumours diagnosed in the bull penis are fibropapilloma and squamous cell carcinoma. The aim of this study was to characterize a case of a tumour in the glans penis of a bull from a dairy farm in Santa Fe, Argentina. The neoplastic tissue was stained with haematoxylin and eosin and then analysed by immunohistochemistry to reveal its characteristic phenotype. Results showed positivity to vimentin, neuron specific enolase, proliferating cell nuclear antigen, S100 and glial fibrillary acidic protein. This suggested that the tumour was a neoplasm of neural origin, classified as neurofibrosarcoma, a peripheral nerve sheath tumour, here reported in the penis of a bull for the first time. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) is regarded as gold-standard for intraductal papillary mucinous neoplasms (IPMNs) follow-up. Given the low risk of transformation and the increasing population under surveillance, there is growing interest in identifying optimal follow-up strategies. To evaluate reliability of abdominal ultrasound (US) for characterization of low-risk IPMN, compared to MRI. Prospective monocentric study among 79 consecutive patients with a suspected BD-IPMN on US. Each patient underwent confirmatory MRI. We evaluated Cohen's kappa statistic and concordance rate (CR) between MRI and US. Of 79 suspected IPMNs on US, MRI confirmed 71 BD-IPMNs. There was high agreement for cyst location and number (CR and kappa of 77.5 % and 81.7 % and 0.66±0.08 and 0.62±0.11 respectively). We found high agreement for cyst size (CR=96.5 %, kappa=0.93±0.05) and main pancreatic duct (MPD) dilatation (CR=100 %, kappa=1). There was a good agreement for thickened septa (CR=80.3 %, kappa=0.38±0.12). US seems inferior to MRI for the identification of mural nodules < 5 mm (CR=97.2 %, kappa=0). In a cohort of low-risk BD-IPMN, US presented high agreement rate with MRI regarding location, number, and size. There was a good agreement for MPD dilatation and thickened septa, while US underperform for detection of mural nodules < 5 mm. [ABSTRACT FROM AUTHOR]

Sarcopenic obesity is a common condition in the elderly associated with excessive adiposity and low muscle mass and strength. This study aims to establish a method for detecting bioelectrical characteristics in individuals with sarcopenic obesity through specific Bioelectrical Impedance Vector Analysis (specific BIVA), while considering the characteristics of individuals with healthy, sarcopenic, and obese conditions. The sample was composed by 915 Italian adults over 50 years of age (men: 74.6 ± 8.8 y; women:76.3 ± 8.8 y) living in Sardinia (Italy). A dataset of 1590 US adults aged 21 – 49 years retrieved from the 2003 – 2004 National Health and Nutrition Examination Survey was also considered in a final step of the study. Anthropometric (stature, weight, waist, arm, and calf circumferences) and whole-body bioelectrical variables were taken. In the Italian sample, bioelectrical impedance was applied to estimate the relative content of fat mass and skeletal muscle mass. Groups with healthy body composition (NS-NO), or consistent with sarcopenia (S), sarcopenic obesity (S-O), and obesity (O) were defined based on the cut-offs suggested by European expert guidelines (EWGSOP2 and ESPEN-EASO). Specific BIVA was applied to compare groups and to identify the area for sarcopenic obesity within young-adults tolerance ellipses. The position of the specific vector of US individuals with S-O, selected on the basis of DXA measurements, was also considered. In both sexes of the Italian sample, the bioelectrical characteristics of the four groups were different (p < 0.001). The differences were mainly related to vector length, indicative of higher fat mass, which was longer in the O and S-O groups, and phase angle, a proxy of intracellular/extracellular water and muscle mass, lower in the sarcopenic groups. Bioelectrical vectors of the S-O group fell in the right quadrant, outside of the 95 % tolerance ellipses of young adults. The mean vector of the US sample with S-O fell in the same area. Within the S-O area, women had similar bioelectrical values, while men showed phase angle variability, which was related to the severity of the condition. Specific BIVA detects body composition peculiarities of individuals with sarcopenic obesity, thus allowing their diagnosis when associated with low handgrip strength values. [ABSTRACT FROM AUTHOR]

The bioelectrical impedance vector analysis (BIVA) represents a qualitative analysis of body composition. The vector, defined by resistance (R) and reactance (Xc) standardized by stature, can be evaluated compared to the 50%,75%, and 95% tolerance ellipses representative of the reference populations. The tolerance ellipses for healthy adults have been provided in 1995 and were developed by mixing underage, adult, and elderly subjects, possibly misrepresenting the actual adult population. The current multicentric, cross-sectional study aimed to provide new tolerance ellipses specific for the general adult population and as a secondary aim to present centile curves for the bioelectrical phase angle. R, Xc, and phase angle were measured in 2137 and 2230 males and females using phase-sensitive foot-to-hand analyzers at 50 kHz. A minimum of 35 subjects were included for each sex and age category from 18 to 65 years. The new mean vectors showed a leftward shift on the R–Xc graph with respect to the former reference values (males: F = 75.3; p < 0.001; females: F = 36.6, p < 0.001). The results provided new 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentile curves for phase angle, identifying time point phases of decrement (males: −0.03° per year at 33.0–51.0 years and −0.05° per year after 51 years; females: −0.03° per year from 37.2 to 57.9 years). Compared to the original references, the new data are characterized by a different distribution within the R-Xc graph with a higher phase angle. Thirty years after the BIVA invention, the current study presents new tolerance ellipses and phase angle reference values for the adult population. [ABSTRACT FROM AUTHOR]

French guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these guidelines is currently unknown. The aim of this study was to assess compliance with the guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported. A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the guidelines. In total, 103 units (51.5%) agreed to participate. Most practices complied with the guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise. Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission. [ABSTRACT FROM AUTHOR]

Myocardial infarction (MI) with non-obstructed coronary arteries (MINOCA) is an increasingly recognized condition with challenging management. Some MINOCA patients ultimately experience recurrent acute MI (re-AMI) during follow-up; however, clinical and angiographic factors predisposing to re-AMI are still poorly defined. In this retrospective multicenter cohort study we enrolled consecutive patients fulfilling diagnostic criteria of MINOCA according to the IV universal definition of myocardial infarction; characteristics of patients experiencing re-AMI during the follow-up were compared to a group of MINOCA patients without re-AMI. 54 patients (mean age 66 ± 13) experienced a subsequent re-AMI after MINOCA and follow-up was available in 44 (81%). Compared to MINOCA patients without re-AMI (n = 695), on first invasive coronary angiography (ICA) MINOCA patients with re-AMI showed less frequent angiographically normal coronaries (37 versus 53%, p = 0.032) and had a higher prevalence of atherosclerosis involving 3 vessels or left main stem (17% versus 8%, p = 0.049). Twenty-four patients (44%) with re-AMI underwent a new ICA: 25% had normal coronary arteries, 12.5% had mild luminal irregularities (<30%), 20.8% had moderate coronary atherosclerosis (30–49%), and 41.7% showed obstructive coronary atherosclerosis (≥50% stenosis). Among patients undergoing new ICA, atherosclerosis progression was observed in 11 (45.8%), 37.5% received revascularization, only 4.5% had low-density lipoprotein cholesterol (LDL_C) under 55 mg/dL and 33% experienced a new cardiovascular disease (CVD) event (death, AMI, heart failure, stroke) at subsequent follow-up. In the present study, only a minority of MINOCA patients with re-AMI underwent a repeated ICA, nearly one out of two showed atherosclerosis progression, often requiring revascularization. Recommended LDL-C levels were achieved only in a minority of the cases, indicating a possible underestimation of CVD risk in this population. [ABSTRACT FROM AUTHOR]

• The airway clearance technique most frequently used was positioning and the least used was percussion. • Certified specialists preferred chest physiotherapy techniques applied with the mechanical ventilator rather than manual techniques. • Certified specialists used techniques that may increase the work of breathing less frequently. • These findings should be considered during the standardization of chest physiotherapy for hospitalized patients with COVID-19. Chest physiotherapy for hospitalized patients with COVID-19 has been poorly reported. Although recommendations were published to guide physiotherapists, practice might have differed depending on education and training. To analyze the differences in chest physiotherapy applied for hospitalized patients with COVID-19 between certified specialists and non-certified specialists. An online questionnaire survey was developed for physiotherapists involved in the management of hospitalized patients with COVID-19. The questionnaire inquired about professional information and characteristics of physiotherapy practice. There were 485 respondents, yielding a completion rate of 76%. Of these, 61 were certified specialists and 424 non-certified specialists. The certified specialists were older, had more years of professional experience, were more qualified, and had better job conditions. For mechanically ventilated patients, the certified specialists used the ventilator hyperinflation maneuver more frequently (50.4% vs 35.1%, p = 0.005), and the hard/brief expiratory rib cage compression (ERCC) (26.9% vs 48.3%, p = 0.016), soft/long ERCC (25.2% vs 39.1%, p = 0.047), and manual chest compression-decompression (MCCD) maneuver (22.4% vs 35.6%, p = 0.001) less often. For spontaneously breathing patients, the certified specialists used the active cycle of breathing technique (30.8% vs 67.1%, p <0.001), autogenic drainage (7.7% vs 20.7%, p = 0.017), and MCCD maneuver (23.1% vs 41.4%, p = 0.018) less frequently. Certified specialists with higher levels of expertise seem to prefer the use of chest physiotherapy techniques that are applied with the mechanical ventilator over manual techniques. Furthermore, they use techniques that could potentially increase the work of breathing less frequently, mitigating the risk of exacerbating respiratory conditions in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Freshwater reservoirs are essential owing because of their ecological, economic, and social importance. They are particularly vulnerable to contamination, as of metal and metalloids, derived from anthropogenic activities like mining. The temporal variations in trace element concentrations (arsenic (As), mercury (Hg), chromium (Cr), copper (Cu), nickel (Ni), lead (Pb), and zinc (Zn)), enrichment, fluxes, and possible sources were evaluated by studying two sediment cores from the La Angostura (ANG) Reservoir (northwest Mexico), using 210Pb geochronology. The enrichment factors showed from null to minor enrichment for most elements, but moderate to severe enrichment of mercury (Hg). Most trace element concentrations had a detrital origin, and notable Hg concentration increases since the past decade were associated with severe drought periods, likely resulting from wildfires. The observed sediment concentrations of As and Hg can cause adverse effects on biota in the ecosystem since they are above the probable effect level (PEL). Development of strategies for metal attenuation in this reservoir is recommended and metals should be controlled until specific ecotoxicological studies are performed. [ABSTRACT FROM AUTHOR]

Omicron variants with immune evasion have emerged, and they continue to mutate rapidly, raising concerns about the weakening of vaccine efficacy, and the very elderly populations are vulnerable to Coronavirus Disease 2019 (COVID-19). Therefore, to investigate the effect of multiple doses of mRNA vaccine for the newly emerged variants on these populations, cross-neutralizing antibody titers were examined against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants, including BQ.1.1 and XBB. Blood samples were taken from residents at four long-term care facilities in Hyogo prefecture, Japan (median age, 91 years), after 3rd (n = 67) and 4th (n = 48) mRNA vaccinations, from April to October 2022. A live virus microneutralization assay was performed to determine the neutralizing antibody titers in participants' sera. After 3rd vaccination, cross-neutralizing antibody prevalence against conventional (D614G) virus, Delta, Omicron BA.2, BA.5, BA.2.75, BQ.1.1, and XBB were 100%, 97%, 81%, 51%, 67%, 4%, and 21%, respectively. After 4th vaccination, the antibody positivity rates increased to 100%, 100%, 98%, 79%, 92%, 31%, and 52%, respectively. The 4th vaccination significantly increased cross-neutralizing antibody titers against all tested variants. The positivity rates for BQ.1.1 and XBB increased after 4th vaccination, although the titer value was lower than those of BA.5 and BA.2.75. Considering the rapid mutation of viruses and the efficacy of vaccines, it may be necessary to create a system that can develop vaccines suitable for each epidemic in consideration of the epidemic of the virus. [ABSTRACT FROM AUTHOR]

To determine the association between sleep quality and lack of glycemic control in a Mexican population of type 2 diabetes patients. Cross-sectional study. Two hundred two patients between 20 and 60 years old with a previous diagnosis of diabetes were included. Sleep quality was assessed with the Pittsburgh Sleep Quality Index and lack of glycemic control as a glycated hemoglobin A1c level ≥ 7 %. Univariate and multivariate analyses using logistic regression were performed. The study population showed poor sleep quality and a lack of glycemic control of 70.3 % and 69.8 %, respectively. The prevalence of patients with both conditions was 52.5 %. In multivariate analysis, poor sleep quality was significantly associated with a lack of glycemic control (OR = 2.3, p = 0.030). Other associated variables were napping (p = 0.015), diabetes duration (p = 0.011), insulin use (p = 0.024), and diastolic blood pressure ≥ 85 mmHg (p = 0.029). The prevalence of lack of glycemic control in the study population is high. Poor sleep quality significantly doubles the risk of lack of glycemic control, even in the presence of other risk factors. • Prevalence of poor sleep quality in Mexican patients with diabetes is 70 %. • 50 % of these patients have lack of glycemic control and poor sleep quality. • The poor sleep quality significantly doubles the risk of uncontrolled diabetes. [ABSTRACT FROM AUTHOR]

Elevated resting heart rate is a risk factor for cardiovascular events. The purpose of this study was to investigate the clinical significance of nocturnal heart rate (nHR) and 24-hour mean heart rate (24h-HR) obtained by continuous remote monitoring (RM) of implantable devices. We analyzed daily-sampled trends of nHR, 24h-HR, and physical activity in patients on β-blocker therapy for chronic heart failure and with implantable cardioverter-defibrillators or cardiac resynchronization therapy defibrillators (CRT-Ds). Patients were grouped by average nHR and 24h-HR quartile during follow-up to estimate the respective incidence of nonarrhythmic death and device-treated ventricular tachycardia/fibrillation (VT/VF). The study cohort included 1330 patients (median age 69 years [interquartile range 61–77 years]; 41% [n = 550] with CRT-D; median follow-up 25 months [interquartile range 13–42 months]). Compared with patients in the lowest nHR quartile (≤57 beats/min) group, patients in the highest quartile group (>65 beats/min) had an increased risk of nonarrhythmic death (adjusted hazard ratio [AHR] 2.25; 95% confidence interval [CI] 1.13–4.50; P =.021) and VT/VF (AHR 1.98; 95% CI 1.40–2.79; P <.001) and were characterized by the lowest level of physical activity (P ≤.0004 vs every other nHR quartiles). The highest 24h-HR quartile group (>75 beats/min) showed an increased risk of VT/VF (AHR 2.13; 95% CI 1.52–2.99; P <.001) and a weaker though significant association with nonarrhythmic mortality (AHR 1.80; 95% CI 1.00–3.22; P =.05) as compared with the lowest 24h-HR quartile group (≤65 beats/min). In remotely monitored patients with implantable cardioverter-defibrillator/CRT-D on β-blocker therapy for heart failure, elevated heart rates (nHR >65 beats/min and 24h-HR >75 beats/min) were associated with increased mortality and VT/VF risk. nHR showed a stronger association than 24h-HR with worst prognosis and lowest physical activity. [ABSTRACT FROM AUTHOR]

Wind disturbances and consequent salvage logging lead to drastic changes in forest soil conditions, vegetation and microclimate, potentially affecting arthropod communities. In mountain regions, topography is expected to be particularly important to modulate the effect of canopy removal and soil disturbance potentially amplifying the ecological contrast between forest and disturbed areas. Here, we studied the short-term response of ground beetles (Carabidae), spiders (Araneae), and harvestmen (Opiliones) in wind-damaged spruce forests along statistically orthogonal gradients in elevation, slope, and aspect. We addressed three main ecological questions: (i) Does the effect of wind disturbance on diversity depend on topography? (ii) Are there specific taxon-related responses to disturbances?, and (iii) What is the role of dispersal in shaping species assembly dynamics? We generally observed that increasing slope and elevation amplified the differences between undisturbed forest and windfall areas. On the one hand, the diversity of ground beetles and harvestmen seemed to be negatively affected by wind disturbance, causing a loss of specialized forest species with a low rate of colonization of species typical of open habitats. On the other hand, several novel spider species were able to rapidly colonize windfalls and community composition strongly shifted from forest to disturbed areas. Species with long-range dispersal strategies (e.g. flying and ballooning) were those more likely to colonize windfalls. Our findings suggest that disturbance effects on ground-dwelling organisms were modulated by underlying environmental gradients and that short-term response of different taxa was dependent on their dispersal ability. [Display omitted] • Wind disturbance and salvage logging affected forest ground-dwelling arthropods, driving community changes in the short term. • Changes in activity density of ground beetles, spiders and harvestmen after disturbance were mediated by elevation and slope. • Forests at high elevations and on steep slopes were more sensitive to disturbance. • Spiders showed a high species turnover rate with richer communities occurring after disturbance. • Species with long-distance dispersal strategies occurred more frequently in windfalls. [ABSTRACT FROM AUTHOR]

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Purpose: Although international guidelines exist, the clinical heterogeneity of Lennox-Gastaut syndrome (LGS) and the increasing availability of new and repurposed drugs (e.g., fenfluramine and cannabidiol) requires a practical guide to patient management in the clinical context. We report the results of a consensus survey among 42 Italian experts in the diagnosis and treatment of LGS.Methods: The consensus procedure followed a modified Delphi approach. Statements were formulated, based on the most recent published evidence and the clinicians' personal experience, then discussed, and agreed upon by the experts through a two-round voting procedure. Approval of a statement was reached with an average score ≥7.Results: Thirteen statements dealing with three main topics (i.e., clinical diagnosis and prognosis, impact on the Quality of Life (QoL), and treatment strategies) were generated. Six statements achieved a level of agreement sufficient for approval on the first voting round. Following the discussion and a few consequent amendments, most of the statements increased their level of agreement and all 13 were approved.Conclusions: Overall, the statements draw a slightly more benign picture of this rare and severe disease, highlighting the possibility of remission - albeit modest -, an apparent trend towards lower mortality, and the availability of several effective drugs, to which greater accessibility would be hoped for. Valproate remains a major therapeutic option in LGS patients although lamotrigine, rufinamide, topiramate, cannabidiol, and clobazam are popular therapeutic options in Italy, allowing for a tailor-made antiseizure therapy. [ABSTRACT FROM AUTHOR]

Edge computing on mobile marine platform is paramount for automated ecological monitoring. The goal of demonstrating the computational feasibility of an Artificial Intelligence (AI)-powered camera for fully automated real-time species-classification on deep-sea crawler platforms was searched by running You-Only-Look-Once (YOLO) model on an edge computing device (NVIDIA Jetson Nano), to evaluate the achievable animal detection performances, execution time and power consumption, using all the available cores. We processed a total of 337 rotating video scans (∼180°), taken during approximately 4 months in 2022 at the methane hydrates site of Barkley Canyon (Vancouver Island; BC; Canada), focusing on three abundant species (i.e., Sablefish Anoplopoma fimbria , Hagfish Eptatretus stoutii , and Rockfish Sebastes spp.). The model was trained on 1926 manually annotated video frames and showed high detection test performances in terms of accuracy (0.98), precision (0.98), and recall (0.99). The trained model was then applied on 337 videos. In 288 videos we detected a total of 133 Sablefish, 31 Hagfish, and 321 Rockfish nearly in real-time (about 0.31 s/image) with very low power consumption (0.34 J/image). Our results have broad implications on intelligent ecological monitoring. Indeed, YOLO model can meet operational-autonomy criteria for fast image processing with limited computational and energy loads. • Edge-computing allows robots to detect, classify and count animals in situ. • An animal detection routine was tuned to operate on the crawler Wally in the deep-sea. • 337 videos were processed with a Jetson Nano, seeking low computational load. • Processing and power consumption sustain autonomy in species monitoring. [ABSTRACT FROM AUTHOR]

This study assesses the effects of three forms of concrete: geopolymer concrete, reactive powder concrete (RPC), and ready-mix concrete (RMC) on the environment, the economy, and sustainability. Evaluating their cost-effectiveness for construction, embodied energy (EE), and embodied carbon (EC) is the aim. The research method employed involves calculating the EE, EC, and cost of materials used during the production stage only. The results show that although RMC gives ease at a high carbon emission cost, RPC delivers great strength at a high cost and emissions. Utilizing waste resources, geopolymer concrete lowers emissions while providing sustainability. Reusing waste materials improves the performance of concrete and lowers pollution. The study emphasizes that, especially when waste is used well, strength need frequently translate into expense. RMC has a major negative influence on the environment while guarantees consistent quality. Despite its strength, RPC has issues with cost and material availability. The strength and emission reduction of geopolymer concrete are excellent. In geopolymers, alkali activators and steel fibers are the source of EE and EC, whereas cement and steel fibers are the reason for their high levels in RMC and RPC. Overall, the research indicates that favorable, ecologically friendly results are feasible obtained by improving the composition of concrete. To provide cost-effective and sustainable concrete compositions and enable well-informed decision-making in building projects, ongoing research and innovation are crucial. [ABSTRACT FROM AUTHOR]

The intra-aortic balloon pump (IABP) is widely implanted as temporary mechanical circulatory support for cardiogenic shock (CS). However, its use is declining following the results of the IABP-SHOCK II trial, which failed to show a clinical benefit of the IABP in acute coronary syndrome (ACS)-related CS. Acute-on-chronic heart failure has become an increasingly recognized, distinct cause of CS (HF-CS). The pathophysiology of HF-CS differs from that of ACS-CS because it typically represents the progression from a state of congestion (with relatively preserved cardiac output) to a low-output state with hypoperfusion. The IABP is a volume-displacement pump that promotes forward flow from a high-capacitance reservoir to low-capacitance vessels, improving peripheral perfusion and decreasing left ventricular afterload in the setting of high filling pressures. The IABP can improve ventricular-vascular coupling and, therefore, myocardial energetics. Additionally, many patients with HF-CS are candidates for cardiac replacement therapies (left ventricular assist device or heart transplantation) and, therefore, may benefit from a bridge strategy that stabilizes the hemodynamics and end-organ function in preparation for more durable therapies. Notably, the new United Network for Organ Sharing donor heart allocation system has recently prioritized patients on IABP support. This review describes the role of IABP in the treatment of HF-CS. It also briefly discusses new strategies for vascular access as well as fully implantable versions for longer duration of support. [ABSTRACT FROM AUTHOR]

While UbiComp research has steadily improved the performance of localisation systems, the analysis of such datasets remains largely unaddressed. In this paper, we present a tool to facilitate querying and analysis of localisation time-series with a focus on semantic localisation. Drawing on well-established models to represent movement and mobility, we first develop a query language for localisation datasets. We then develop a software library in R that implements this querying. We use case studies to demonstrate how our programming tool can be used to query localisation datasets. Our work addresses an important gap in localisation research, by providing a flexible tool that can model and analyse localisation data programmatically and in real time. • A technology-agnostic conceptual framework for indoor localisation queries. • Preserves spatio-temporal relationships between individuals and groups. • Flexible syntax to query and track individuals, groups, across spaces and time. • Open-Source implementation and usage examples of the conceptual framework. • Based on indoor semantic localisation literature in the fields of UbiComp and GIS. [ABSTRACT FROM AUTHOR]

Background: Cardiogenic shock (CS) is a systemic disorder associated with dismal short-term prognosis. Given its time-dependent nature, mechanical circulatory support may improve survival. Intra-aortic balloon pump (IABP) had gained widespread use because of the easiness to implant and the low rate of complications; however, a randomized trial failed to demonstrate benefit on mortality in the setting of acute myocardial infarction. Acute decompensated heart failure with cardiogenic shock (ADHF-CS) represents a growing resource-intensive scenario with scant data and indications on the best management. However, a few data suggest a potential benefit of IABP in this setting. We present the design of a study aimed at addressing this research gap.Methods and Design: The Altshock-2 trial is a prospective, randomized, multicenter, open-label study with blinded adjudicated evaluation of outcomes. Patients with ADHF-CS will be randomized to early IABP implantation or to vasoactive treatments. The primary end point will be 60 days patients' survival or successful bridge to heart replacement therapy. The key secondary end point will be 60-day overall survival; 60-day need for renal replacement therapy; in-hospital maximum inotropic score, maximum duration of inotropic/vasopressor therapy, and maximum sequential organ failure assessment score. Safety end points will be in-hospital occurrence of bleeding events (Bleeding Academic Research Consortium >3), vascular access complications and systemic (noncerebral) embolism. The sample size for the study is 200 patients.Implications: The Altshock-2 trial will provide evidence on whether IABP should be implanted early in ADHF-CS patients to improve their clinical outcomes. [ABSTRACT FROM AUTHOR]

[Display omitted] Clinical efficacy of oral immunotherapy (OIT) has been associated with the induction of blocking antibodies, particularly those capable of disrupting IgE-allergen interactions. Previously, we identified mAbs to Ara h 2 and structurally characterized their epitopes. We investigated longitudinal changes during OIT in antibody binding to conformational epitopes and correlated the results with isotype and clinical efficacy. We developed an indirect inhibitory ELISA using mAbs to block conformational epitopes on immobilized Ara h 2 from binding to serum immunoglobulins from peanut-allergic patients undergoing OIT. We tested the functional blocking ability of mAbs using passive cutaneous anaphylaxis in mice with humanized FcεRI receptors. Diverse serum IgE recognition of Ara h 2 conformational epitopes are similar before and after OIT. Optimal inhibition of serum IgE occurs with the combination of 2 neutralizing mAbs (nAbs) recognizing epitopes 1.2 and 3, compared to 2 nonneutralizing mAbs (non-nAbs). After OIT, IgG 4 nAbs, but not IgG 1 or IgG 2 nAbs, increased in sustained compared to transient outcomes. Induction of IgG 4 nAbs occurs after OIT only in those with sustained efficacy. Murine passive cutaneous anaphylaxis after sensitization with pooled human sera is significantly inhibited by nAbs compared to non-nAbs. Serum IgE conformational epitope diversity remains unchanged during OIT. However, IgG 4 nAbs capable of uniquely disrupting IgE-allergen interactions to prevent effector cell activation are selectively induced in OIT-treated individuals with sustained clinical efficacy. Therefore, the induction of neutralizing IgG 4 antibodies to Ara h 2 are clinically relevant biomarkers of durable efficacy in OIT. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effects of submaximal isometric neck muscle fatigue and manual therapy on wrist joint position sense (JPS) within healthy individuals and individuals with subclinical neck pain (SCNP). Twelve healthy participants and 12 participants with SCNP were recruited. Each group completed 2 sessions, with 48 hours between sessions. On day 1, both groups performed 2 wrist JPS tests using a robotic device. The tests were separated by a submaximal isometric fatigue protocol for the cervical extensor muscles (CEM). On day 2, both groups performed a wrist JPS test, followed by a cervical treatment consisting of manual therapy (SCNP) or neck rest (20 minutes, control group) and another wrist JPS test. Joint position sense was measured as the participant's ability to recreate a previously presented wrist angle. Each wrist JPS test included 12 targets, 6 into wrist flexion and 6 into wrist extension. Kinematic data from the robot established absolute, variability, and constant error. Absolute error significantly decreased (P =.01) from baseline to post-fatigue in the SCNP group (baseline = 4.48 ± 1.58°; post-fatigue = 3.90 ± 1.45°) and increased in the control group (baseline = 3.12 ± 0.98°; post-fatigue = 3.81 ± 0.90°). The single session of manual cervical treatment significantly decreased absolute error in participants with SCNP (P =.004). This study demonstrated that neck pain or fatigue can lead to altered afferent input to the central nervous system and can affect wrist JPS. Our findings demonstrate that acute wrist proprioception may be improved in individuals with SCNP by a single cervical manual therapy session. [ABSTRACT FROM AUTHOR]

In this study, we aimed to analyse the relationship between body composition and bioelectrical variables in children and adolescents. The sample was composed of 6801 individuals (4035 males; 2766 females) aged 8–20 years included in the National Health and Nutrition Examination Survey (NHANES) years 1999–2004. Classic and specific bioelectrical impedance vector analysis (BIVA) were applied and compared with dual-energy X-ray absorptiometry (DXA) for the evaluation of fat mass (FM) and fat-free mass (FFM), and bioimpedance spectroscopy (BIS) for the evaluation of intra-cellular water (ICW), extra-cellular water (ECW), and total body water (TBW). Fat-free mass index (FFMI) was calculated. Spearman's correlation, regression, and depth-depth analyses were applied. The evaluation of body composition with BIVA agreed well with that of DXA or BIS, independently of sex, age, and ethnicity: classic BIVA was mostly sensitive to differences in TBW, ECW/ICW, whereas specific BIVA to differences in %FM, FFMI, and ECW/ICW. The depth-depth analysis confirmed the associations of classic BIVA (coeff. 0.500, p < 0.001), and specific BIVA (coeff. 0.512, p < 0.001), also considering the significant effect of age (p < 0.001). In classic BIVA the association was slightly stronger in females (by 0.03, p = 0.042) and among Blacks (0.06, p = 0.002), whereas in specific BIVA it was stronger by 0.06 (p < 0.001) in females and similar among ethnic groups. The combined use of the two BIVA approaches represents a valuable tool for complete evaluation of body composition in growth studies, for the prevention and monitoring of malnutrition, and the monitoring of the performance in young athletes. [ABSTRACT FROM AUTHOR]

• Noise-related interferences during exposureoccurred in 84% of the devices. • Potentially harmful effects were found in 34% of the ICDs. • Irreversible effects on battery life occurred in only non-MRI-compatible devices. • RTmay cause damage and malfunction in a consistent number of older-generations PMs and ICDs. Radiotherapy may cause malfunction of implantable cardioverter-defibrillators (ICDs) and pacemakers (PMs). We carried-out a multicentre randomized in-vitro study on 65 ICDs and 145 PMs to evaluate malfunctions during and after direct irradiation to doses up to 10 Gy. Three centres equipped with different linear accelerator and treatment-planning systems participated in the study. Computed Tomography (CT) acquisitions were performed to build the treatment plans. All devices were exposed to dose of 2, 5, or 10 Gy (6 MV). All devices underwent a baseline examination and 64 wireless real-time telemetry - transmissions (47 ICDs and 17 PMs) were monitored during photon exposures. All devices were interrogated after exposure and once monthly for six subsequent months. Fifty-four of the 64 wireless-enabled CIEDs (84.4%) recorded noise-related interferences during exposure. In detail, 40/47 ICDs (85.1%) reported interference, of which 16 ICDs (34%) reported potentially clinically relevant pacing inhibition and inappropriate detections. Following exposure, a soft reset occurred in 1/145 PM (0.7%) while 7/145 PMs (4.8%) reported battery issues. During the six-month follow-up, 1/145 PM (0.7%) reported a soft reset, while 12/145 more PMs (8.3%) and 1/64 ICD (1.5%) showed abnormal battery depletion. All reported issues occurred independently of exposure dose. Finally, irreversible effects on software and battery life occurred in only non-MRI-compatible devices. ICDs mostly featured real-time transient sensing issues, while PMs mostly experienced long-term battery or software issues that were observed immediately following radiation exposure and during follow-up. Irreversible effects on battery life and software occurred in only non-MRI-compatible devices. [ABSTRACT FROM AUTHOR]

[Display omitted] • Brain tissues interposed between the Focused Ultrasound transducers and the Thalamic Ventral Intermediate Nucleus (VIM) influence the effectiveness of a satisfactory target temperature. • Supratentorial – Grey Matter is positively correlated with the Accumulated Thermal Dose (ATD) in the VIM. • Supratentorial – Cerebrospinal Fluid negatively correlated with the Accumulated Thermal Dose in the VIM. • Brain tissue seems to have more effect on the ATD than the Skull Density Ratio (SDR). MRgFUS Vim thalamotomy is a novel, effective, minimally invasive therapeutic option for patients with essential tremor (ET). Among the selection criteria, some parameters related to the patient's anatomy, such as the skull density ratio (SDR), are well recognized. The role of brain tissue interposed between the target and the ultrasound transducers has never been explored. Therefore, the purpose of our study was to evaluate the correlation and the possible predictive value between brain tissue volumes (grey matter – GM, white matter – WM, and cerebrospinal fluid – CSF) and several treatment-related variables (periprocedural parameters, MRI imaging findings, and the clinical outcome). We analysed data from thirty ET patients previously submitted to MRgFUS thalamotomy. Pre-treatment images were automatically segmented in sopra-tentorial (ST) WM, GM, and CSF using SPM 12. The most significant findings were a positive correlation of the ST-GM with the Accumulated Thermal Dose (ATD) (p < 0,001) and a negative correlation of the ATD temperature with ST-CSF and ST-TIV (p < 0,001). Ultrasound propagation speed is lower in fluids than brain tissues. Also, WM has an attenuation rate of 1.5 higher than the GM. Therefore, the difference in the ATD may be explained by the different acoustic properties of normal brain tissues interposed between the transducers and the VIM. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively assess the technical feasibility, safety, and oncologic outcomes of percutaneous image-guided cryoablation (PCA) of locoregional and distant lymph node metastases (LNMs).Methods: All consecutive patients undergoing PCA of LNMs between February 2009 and December 2019 were identified using a retrospective database search. Every patient was followed up at 1, 3, 6, and 12 months after treatment using contrast-enhanced magnetic resonance imaging and at approximately 3-6-month intervals using computed tomography or positron emission tomography-computed tomography. The Kaplan-Meier method was used to calculate local tumor progression-free survival, disease-free survival, and overall survival. Locoregional and distant groups were compared using the Fisher test. Technical success, technique efficacy, complications, and oncologic outcomes were analyzed.Results: Fifty-six metachronous oligometastatic LNMs (median size, 15 mm [interquartile range, 13-15 mm; range, 9-36 mm]) were treated in 37 sessions in 29 patients and defined as locoregional (26/37 sessions) or distant (11/37 sessions). Seventeen patients had undergone prior surgery or radiotherapy. Six patients underwent 8 retreatments for locoregional progression. An additional visceral oligometastasis was treated in 4 of the 11 distant LNM PCA sessions. The technical success and primary technique efficacy rates were 100%. The complication rate was 5.4% (2 transient nerve palsies). At a median follow-up of 23 months, there were 2 instances of local tumor progression (5.6%); the 1-, 2-, and 3-year local tumor progression-free survival was 100%, 94.3%, and 94.3%, respectively. Thirteen (45%) patients demonstrated no disease progression. The 1-, 2-, and 3-year overall survival was 96.2%, 90.5%, and 70%, respectively. The patients were free from systemic oncologic therapy following 20 (54%) sessions, with a mean treatment break of 19.1 months.Conclusions: The PCA of lymph node oligometastases is feasible and safe, and offers promising local tumor control at midterm follow-up. [ABSTRACT FROM AUTHOR]

Although acute lower GI bleeding (LGIB) represents a significant healthcare burden, prospective real-life data on management and outcomes are scanty. Present multicentre, prospective cohort study was aimed at evaluating mortality and associated risk factors and at describing patient management. Adult outpatients acutely admitted for or developing LGIB during hospitalization were consecutively enrolled in 15 high-volume referral centers. Demographics, comorbidities, medications, interventions and outcomes were recorded. Overall 1,198 patients (1060 new admissions;138 inpatients) were included. Most patients were elderly (mean-age 74±15 years), 31% had a Charlson-Comorbidity-Index ≥3, 58% were on antithrombotic therapy. In-hospital mortality (primary outcome) was 3.4% (95%CI 2.5–4.6). At logistic regression analysis, independent predictors of mortality were increasing age, comorbidity, inpatient status, hemodynamic instability at presentation, and ICU-admission. Colonoscopy had a 78.8% diagnostic yield, with significantly higher hemostasis rate when performed within 24-hours than later (21.3% vs.10.8%, p = 0.027). Endoscopic hemostasis was associated with neither in-hospital mortality nor rebleeding. A definite or presumptive source of bleeding was disclosed in 90.4% of investigated patients. Mortality in LGIB patients is mainly related to age and comorbidities. Although early colonoscopy has a relevant diagnostic yield and is associated with higher therapeutic intervention rate, endoscopic hemostasis is not associated with improved clinical outcomes [ClinicalTrial.gov number: NCT 04364412]. [ABSTRACT FROM AUTHOR]