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Until two decades ago, brown adipose tissue (BAT) was studied primarily as a thermogenic organ of small rodents in the context of cold adaptation. The discovery of functional human BAT has opened new opportunities to understand its physiological role in energy balance and therapeutic applications for metabolic disorders. Significantly, the role of BAT extends far beyond thermogenesis, including glucose and lipid homeostasis, by releasing mediators that communicate with other cells and organs. The field has made major advances by using new model systems, ranging from subcellular studies to clinical trials, which have also led to debates. In this perspective, we identify six fundamental issues that are currently controversial and comprise dichotomous models. Each side presents supporting evidence and, critically, the necessary methods and falsifiable experiments that would resolve the dispute. With this collaborative approach, the field will continue to productively advance the understanding of BAT physiology, appreciate the importance of thermogenic adipocytes as a central area of ongoing research, and realize the therapeutic potential. The explosive growth in the study of human BAT has led over time to lively debates over central physiological concepts. This perspective discusses six areas of current disagreement and proposes experiments to achieve resolutions and move the field forward. [ABSTRACT FROM AUTHOR]

There is growing evidence for the role of cold piecemeal EMR (C-EMR) in the treatment of colorectal lesions ≥10 mm. However, it is unclear if C-EMR is equally efficacious for all histologic subtypes and sizes. This retrospective study compares the efficacy and safety of C-EMR in the resection of medium (10-19 mm) and large (≥20 mm) serrated and adenomatous lesions. A retrospective analysis was performed of Paris IIa colonic lesions resected by using a C-EMR technique over a 3.5-year period at our center. C-EMR was performed for 242 lesions in 151 patients. Lesion size ranged between 10 and 50 mm, with a median size of 20 mm. Ninety-five polyps were adenomatous, with 147 sessile serrated lesions (SSLs). At 6-month surveillance colonoscopy, the combined recurrence rate was 6.2%. Adenomas ≥20 mm showed a higher rate of recurrence (16.1%) compared with large SSLs (4.1%), medium adenomas (3.0%), and medium SSLs (1.4%). There were no adverse events reported after C-EMR. C-EMR seems to be less effective for the resection of large adenomas compared with medium adenomas or large SSLs. C-EMR is equally safe for all lesion sizes and histology. [ABSTRACT FROM AUTHOR]

The functional tolerancing process involves the allocation of the tolerance derived from each functional requirement, expressed at the assembly level, into multiple functional tolerances at the part level. For each part, the manufacturing tolerancing process transfers each functional tolerance into multiple manufacturing tolerances on the dimensions produced throughout the entire process. However, this transfer faces challenges when dealing with tight functional tolerances and constrained process capability. This article proposes an innovative method for adaptively optimizing the production process to enhance its capabilities. Rather than relying on a static manufacturing transfer, this approach involves intermediate measurements of each workpiece during production, modelling its digital shadow. By dynamically adjusting the targets of the upcoming manufacturing dimensions, individual adjustments aim to maximize the likelihood of conformity. This adaptive strategy allows for the allocation of tighter functional tolerances while ensuring workpiece conformity and maintaining the same manufacturing process. Concurrent engineering is thereby facilitated. [ABSTRACT FROM AUTHOR]

In their works, in 2014, N. Anwer & al. introduced the concept of Skin Model Shape (SMS). Their main idea was to propose parts representations with geometric deviations in the discrete geometry framework for CAT. In this paper, an application of the SMS to a full product/process tolerancing assembly analysis process of composite parts is proposed, with a numerical workflow between softwares. The RTM process simulation of composite parts, with systematic shape distortions estimation, is realized with PAM-RTM/DISTORTION®. The product/process uncertainties propagation ensures to capture the random geometrical variations, using OpenTurns®. The assessment of the tolerances is done with virtual coordinates measurements, from extracted nodal points of the FEA meshing. The final effects of the tolerances of the parts are then measured on a mechanical assembly by a tolerancing stack-ups analysis, using MECAmaster®. [ABSTRACT FROM AUTHOR]

In NOMA achieving fairness in data transmission for all users is one of the key challenges. It implies a fair allocation of resources among users according to a given criterion. NOMA systems are based on the discreteness of the data source, since the specific nature of data allows to extract information in overloaded systems. Well-known C.E. Shannon capacity equation does not take into account the discrete nature of NOMA group signals, considering them as Gaussian source of information. Therefore, it does not take into account the characteristics of discrete signals used in NOMA systems, which makes it difficult to solve the optimization problem, especially for types of NOMA that use code division. For this task it is necessary to use DCMC capacity. When optimizing total capacity of DCMC, individual properties of users are not taken into account, as a result of which the allocation of resources with such optimization might not be fair. This paper proposes an approach to optimizing NOMA based on the analysis of an-individual mutual information (capacity). The proposed optimization approach allows analyzing the individual characteristics of each user in order to improve NOMA system performance by optimizing NOMA signals parameters. [ABSTRACT FROM AUTHOR]

We aimed to investigate the effects of ankle taping on lower extremity biomechanics related to injury development and how these effects change after sports-specific use. Randomized, repeated measures design with three conditions: Barefoot, tape applied fresh, and tape after sports-specific use (between-subject factor: sex). Twenty-five healthy participants (ten female) performed sports-specific movements, including running, drop jumping, and 180° change of direction, under the three conditions. Kinetic and kinematic data were collected using 3D motion capturing and force platforms. Tape applied fresh and tape after sports-specific use significantly reduced peak ankle inversion. Biomechanical risk factors for anterior cruciate ligament or running overuse injuries were either unchanged or decreased with tape applied fresh, except for the peak loading rate of the resultant ground reaction force, which increased between 4% and 18% between movement types. After 15 minutes of sports-specific use of the tape, the alterations induced by tape applied fresh remained for some biomechanical risk factors while they became closer to barefoot again for others, indicating a differential response to prolonged use of taping for different biomechanical variables. Ankle taping protects the ankle joint by reducing biomechanical risk factors associated with ankle sprains, and most biomechanical risk factors for anterior cruciate ligament or running overuse injuries are not increased. Further research is needed to explore the duration of protective effects, variations across sports, and its impact on patients with chronic ankle instability, contributing to a more comprehensive understanding of ankle taping's influence on lower extremity biomechanics. [ABSTRACT FROM AUTHOR]

There is emerging evidence that current 8th edition of the American Joint Committee staging system is not sensitive enough to predict parotid gland carcinoma (PGC) survival outcomes. The present study aimed to analyze pathological nodal factors related to survival and treatment outcomes in a cohort of patients surgically treated with PGC. We performed a retrospective cohort study of consecutive patients surgically treated with PGC at the authors' institution from January 1993 to December 2018. The inclusion criteria were as follows: confirmed high-grade parotid gland malignancy on histopathology first surgical treatment of the parotid cancer with neck dissection with curative intent at the study clinic; and sufficient data for review. The exclusion criteria were previous treatment in another institution, low-grade carcinomas, cases where neck dissection was not performed, incurable local disease and distant metastases at the time of first diagnosis, and patients lost to follow-up. Predictor variable comprised pathological nodal factors grouped as the number of cervical node metastases, extranodal extension (ENE), largest diameter of nodal metastasis, and involvement of parotid lymph nodes. Outcomes evaluated were overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), locoregional recurrence-free survival, and distant metastasis-free survival (DMFS). OS was calculated from the day of biopsy or definitive surgery to the last known hospital follow-up date or the date of death found in the hospital records or social security data. DSS was calculated from the day of biopsy or definitive surgery until the last known follow-up or death from PGC reported in the patient record. Patients who died from causes other than the disease being studied are not counted in this measurement. Treatment outcome was evaluated through the occurrence of locoregional relapse of the disease or development of distant metastases. RFS was defined as the time from the date of biopsy or definitive surgery to the date of locoregional recurrence free survivalor DMFS reported in the patient record. Covariates were composed of a set of heterogeneous variables grouped into the following categories: demographic, pathologic, and clinical. Unadjusted and adjusted hazard ratios for each variable were calculated with univariate and multivariable Cox regression. The tatistical significance was defined at a P value of <.05. The cohort of 112 patients included 62 males (55%) and 50 (45%) females. The mean age of the patients was 60.52 ± 15.22 years. The median follow-up time was 59 months (3-221 months). Adenoid cystic carcinoma was the most common tumor type with the incidence of 45%. Cumulative OS for the 5-and 10-year follow-up period was 75 and 61%, respectively. Locoregional recurrences occurred with 27 patients (24%), distant metastases occurred with 25 patients (22%), and both were diagnosed with 5 patients (6%). The number of metastatic nodes was the most important nodal prognostic factor related to OS (P =.02; HR = 2.67; CI = 0.03-6.35), DSS (P =.011; HR = 2.55; CI =.61-6.83), and DMFS (P =.005; HR = 2.85; CI = 0.12-4.76). The presence of pathological parotid nodes was associated with poorer RFS (P =.015; HR = 3.45; CI = 0.25-6.02). The number of metastatic lymph nodes, instead of ENE and largest nodal diameter, was the contributing factor associated with survival and treatment outcomes of surgically treated patients with high-grade PGC. Since the main function of staging system is to predict outcomes, the significance of ENE and nodal dimension in salivary gland cancer staging system requires further clarification. An important finding in the present study was that the presence of positive parotid lymph nodes was associated to locoregional treatment failure. [ABSTRACT FROM AUTHOR]

To issue recommendations for reduced energy consumption in controlled environment zones (CEZ) in operating theaters and interventional sectors. A committee bringing together seven experts from the SFAR, AFC, SF2H, ASPEC and SOFCOT was convened by CERES. A conflict-of-interest statement was developed at the beginning of the process and enforced throughout the elaboration of the reference document. The experts received no financing from any company commercializing a healthcare product (medicine or medical device). The committee was called upon to follow and respect the GRADE® (grading of recommendations assessment, development and evaluation) method to evaluate quality of the factual data on which the recommendations were based. We analyzed the relevant literature and formulated the recommendations in accordance with the GRADE® methodology by identifying three different fields. Each question was formulated in accordance with the PICO (patients, intervention, comparison, outcome) format. The experts' attempts at synthesis and application of the GRADE® method led to 16 recommendations. In cases where GRADE® method could not be applied, the recommendations were formulated as expert advice. Once strong agreement among the experts had been reached, we formulated 15 recommendations for decreased energy consumption and reduced environmental impact in the controlled environment zones of operating theaters and interventional sectors. [ABSTRACT FROM AUTHOR]

Adoption of transcarotid artery revascularization (TCAR) by surgeons has been variable, with some still performing traditional carotid endarterectomy (CEA), whereas others have shifted to mostly TCAR. Our goal was to evaluate the association of relative surgeon volume of CEA to TCAR with perioperative outcomes. The Vascular Quality Initiative CEA and carotid artery stent registries were analyzed from 2021 to 2023 for symptomatic and asymptomatic interventions. Surgeons participating in both registries were categorized in the following CEA to CEA+TCAR volume percentage ratios: 0.25 (majority TCAR), 0.26 to 0.50 (more TCAR), 0.51 to 0.75 (more CEA), and 0.76 to 1.00 (majority CEA). Primary outcomes were rates of perioperative ipsilateral stroke, death, cranial nerve injury, and return to the operating room for bleeding. There were 50,189 patients who underwent primary carotid revascularization (64.3% CEA and 35.7% TCAR). CEA patients were younger (71.1 vs 73.5 years, P <.001), with more symptomatic cases, less coronary artery disease, diabetes, and lower antiplatelet and statin use (all P <.001). TCAR patients had lower rates of smoking, obesity, and dialysis or renal transplant (all P <.001). Postoperative stroke after CEA was significantly impacted by the operator CEA to TCAR volume ratio (P =.04), with surgeons who perform majority TCAR and more TCAR having higher postoperative ipsilateral stroke (majority TCAR odds ratio [OR]: 2.15, 95% confidence interval [CI]: 1.16-3.96, P =.01; more TCAR OR: 1.42, 95% CI: 1.02-1.96, P =.04), as compared with those who perform majority CEA. Similarly, postoperative stroke after TCAR was significantly impacted by the CEA to TCAR volume ratio (P =.02), with surgeons who perform majority CEA and more CEA having higher stroke (majority CEA OR: 1.51, 95% CI: 1.00-2.27, P =.05; more CEA OR: 1.50, 95% CI: 1.14-2.00, P =.004), as compared with those who perform majority TCAR. There was no association between surgeon ratio and perioperative death, cranial nerve injury, and return to the operating room for bleeding for either procedure. The relative surgeon CEA to TCAR ratio is significantly associated with perioperative stroke rate. Surgeons who perform a majority of one procedure have a higher stroke rate in the other. Surgeons offering both operations should maintain a balanced practice and have a low threshold to collaborate as needed. [ABSTRACT FROM AUTHOR]

In the context of worldwide biodiversity and wild bee decline, it is increasingly important to better understand the effect of land-use changes on wild bee communities at a global scale. To do so, we studied the effect of city area and urban green spaces layout on wild bee species richness and community composition, as well as on wild bee species with an unfavorable UICN conservation status. This study was based on a large European dataset encompassing 20 cities from France, Belgium and Switzerland. We found a mean wild bee species richness in cities of 96 ± 48 (SD), showing that this species richness was highly variable among cities. The main factor positively influencing wild bee species richness in cities was the area of the city. Conversely, species richness was not significantly related to the total area of urban green spaces in a given city, measured as the spatial extent of urban parks, wastelands and other semi-natural habitats, excluding urban private gardens. Species with conservation status were quite scarce in urban environments, especially when compared to the European Red List of Bees, and we could not link their presence to either city or urban green space area. Dissimilarities in wild bee species community compositions were not associated with any of the studied characteristics of cities. We found that the dissimilarity of wild bee community composition among cities was mainly driven by the rarest species, as the most common ones were found in a majority of the cities sampled. Overall, these results emphasize that larger cities host more wild bee species, but are no refuge for the ones with concerning conservation status. Thus, stakeholders are encouraged to design their cities in favor of biodiversity to better support wild bee communities, and perhaps mitigate the established effect of the urban ecological filter. [ABSTRACT FROM AUTHOR]

Modular dual mobility (DM) bearings have a junction between a cobalt chrome alloy (CoCrMo) liner and titanium shell, and the risk of tribocorrosion at this interface remains a concern. The purpose of this study was to determine whether liner malseating and liner designs are associated with taper tribocorrosion. We evaluated 28 retrieved modular DM implants with a mean in situ duration of 14.6 months (range, 1 to 83). There were 2 manufacturers included (12 and 16 liners, respectively). Liners were considered malseated if a distinct divergence between the liner and shell was present on postoperative radiographs. Tribocorrosion was analyzed qualitatively with the modified Goldberg Score and quantitatively with an optical coordinate-measuring machine. An acetabular shell per manufacturer was sectioned for metallographic analysis. There were 6 implants (22%) that had severe grade 4 corrosion, 6 (22%) had moderate grade 3, 11 (41%) had mild grade 2, and 5 (18.5%) had grade 1 or no visible corrosion. The average volumetric material loss at the taper was 0.086 ± 0.19 mm3. There were 7 liners (25%) that had radiographic evidence of malseating, and all were of a single design (P =.01). The 2 liner designs were fundamentally different from one another with respect to the cobalt chrome alloy type, taper surface finish, and shape deviations. Malseating was an independent risk factor for increased volumetric material loss (P =.017). DM tribocorrosion with quantifiable material loss occurred more commonly in malseated liners. Specific design characteristics may make liners more prone to malseating, and the interplay between seating mechanics, liner characteristics, and patient factors likely contributes to the shell/liner tribocorrosion environment. Level III. [ABSTRACT FROM AUTHOR]

Cutting tool materials are the backbone of machining and play a vital role in the manufacturing industry. Innovation in cutting tools is important for customized and demanding applications. This state-of-the-art review is focused on innovations and future research directions for cutting tools covering i) tool materials/microstructure/property relationships, ii) coatings and their effect on tool performance, iii) cutting edge and functional surface preparation and effect on tool performance, iv) tool geometry for high performance and stable machining considering rapid machining, sustainability, and circularity aspects. The vision is to identify tool material/coating/geometry/functional surface relationships for significant improvement in machining performance. This paper includes perspectives from several research groups with a detailed discussion on current advances, capabilities, and challenges in engineered design of cutting tools, materials, coatings, structures and sets a new agenda for future tooling and research directions. [ABSTRACT FROM AUTHOR]

Rhythm control is a cornerstone of atrial fibrillation (AF) management. Shorter time between diagnosis of AF and receipt of catheter ablation is associated with greater rates of therapy success. Previous work considered diagnosis-to-ablation time as a binary or categorical variable and did not consider the unique risk profile of patients after a referral for ablation was made. The purpose of this study was to comprehensively assess the impact of diagnosis-to-ablation and referral-to-ablation time on postprocedural outcomes at a population level. This observational cohort study included patients who received catheter ablation to treat AF in Ontario, Canada. Patient demographics, medical comorbidities, AF diagnosis date, ablation referral date, and ablation date were collected. The primary outcomes of interest included a composite of death and hospitalization/emergency department visit for AF, heart failure, or ischemic stroke. Multivariable Cox models assessed the impact of diagnosis-to-ablation and referral-to-ablation times on the primary outcome. Our cohort included 7472 patients who received ablation for de novo AF between April 1, 2016, and March 31, 2022. Median [interquartile range] diagnosis-to-ablation time was 718 [399–1274] days and median referral-to-ablation time was 221 [117–363] days. Overall, 911 patients (12.2%) had the composite endpoint within 1 year of ablation. Increasing diagnosis-to-ablation time was associated with a greater incidence for the primary outcome (hazard ratio [HR]1.02; 95% confidence interval [CI] 1.01–1.02 per month). Increasing referral-to-ablation time did not impact the primary outcome (HR 1.00; 95% CI 0.98–1.01 per month). Delays between AF diagnosis and ablation referral may contribute to adverse postprocedural outcomes and provide an opportunity for health system quality improvements. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] • No hard data comparing risk of death in patients with/without lymphoma. • No hard data comparing cardiovascular event risk in patients with/without lymphoma. • Rates of all-cause death and major bleeding higher in lymphoma group. • Rates of cardiovascular death, MI, ischaemic stroke and AF lower in lymphoma group. There are few data assessing the risk of death and cardiovascular events in patients with lymphoma. Using a nationwide hospitalization database, we aimed to address cardiovascular outcomes in patients with lymphoma. From 01 January to 31 December 2013, 3,381,472 adults were hospitalized in French hospitals; 22,544 of these patients had a lymphoma. The outcome analysis (all-cause or cardiovascular death, myocardial infarction, ischaemic stroke, bleedings, new-onset heart failure and new-onset atrial fibrillation) was performed over a 5-year follow-up period. Each patient with lymphoma was matched with a patient without a lymphoma or other cancer (1:1). A competing risk analysis was also performed. After adjustment on all risk factors, cardiovascular and non-cardiovascular co-morbidities, the subdistribution hazard ratios for all-cause death, major bleeding, intracranial bleeding, new-onset heart failure and new-onset atrial fibrillation were higher in patients with lymphoma; conversely, the subdistribution hazard ratios for cardiovascular death, myocardial infarction and ischaemic stroke were lower in patients with lymphoma. In the matched analysis, the risk of all-cause death (subdistribution hazard ratio 1.936, 95% confidence interval 1.881–1.992) and major bleeding (subdistribution hazard ratio 1.117, 95% confidence interval 1.049–1.188) remained higher in patients with lymphoma. In this large nationwide cohort study, patients with lymphoma had a higher incidence of all-cause death and major bleeding. [ABSTRACT FROM AUTHOR]

Triplet chemotherapy plus cetuximab showed promising results in phase II trials in unsystematically selected RAS population. We evaluated FOLFIRINOX+cetuximab efficacy as first-line treatment in extended RAS wild-type metastatic colorectal cancer (mCRC) patients. We retrospectively analyzed patients treated with FOLFIRINOX+cetuximab, using data from clinical trials and real-life practice. Extended mutation analysis was performed when RAS/BRAF status was unavailable. The primary endpoint was progression-free survival (PFS). Seventy patients (61.4 % male, median age 58.7 years) were analyzed. Eighty percent had left-sided mCRC and 97.1 % had liver metastases. Median PFS and overall survival (OS) were 13.3 and 48.5 months, respectively. The objective response rate was 85.7 %, with 20 % complete response. Primary tumor location did not affect OS and PFS. BRAF wild-type patients (n = 65) had longer PFS (13.3 vs. 6.0 months; p = 0.005) and OS (50.1 vs. 21.2 months; p = 0.007) than BRAF mutated patients (n = 5, including four BRAFV600E). Median OS was significantly longer in resected patients (n = 39, 55.1 vs. 30.7 months; p = 0.030). Main toxicities were diarrhea (31.4 %) and neutropenia (21.4 %). FOLFIRINOX+cetuximab provides good PFS, high response rate and prolonged disease control in initially unresectable extended RAS wild-type mCRC. This combination is particularly interesting for selected patients with liver-limited disease eligible to secondary resection. [ABSTRACT FROM AUTHOR]

[Display omitted] • Contemporary epidemiology and outcomes of AMI in France. • Identification of emerging risk factors and new prognostic determinants of AMI. • Long-term follow-up by automated link with the French national health database. • Healthcare consumption and medico-economic impact of myocardial infarction. • Platform for cohort-nested studies, both observational and randomized. Despite major advances in prevention and treatment, cardiovascular diseases – particularly acute myocardial infarction – remain a leading cause of death worldwide and in France. Collecting contemporary data about the characteristics, management and outcomes of patients with acute myocardial infarction in France is important. The main objectives are to describe baseline characteristics, contemporary management, in-hospital and long-term outcomes of patients with acute myocardial infarction hospitalized in tertiary care centres in France; secondary objectives are to investigate determinants of prognosis (including periodontal disease and sleep-disordered breathing), to identify gaps between evidence-based recommendations and management and to assess medical care costs for the index hospitalization and during the follow-up period. FRENCHIE (FRENch CoHort of myocardial Infarction Evaluation) is an ongoing prospective multicentre observational study (ClinicalTrials.gov Identifier: NCT04050956) enrolling more than 19,000 patients hospitalized for acute myocardial infarction with onset of symptoms within 48 hours in 35 participating centres in France since March 2019. Main exclusion criteria are age < 18 years, lack of health coverage and procedure-related myocardial infarction (types 4a and 5). Detailed information was collected prospectively, starting at admission, including demographic data, risk factors, medical history and treatments, initial management, with prehospital care pathways and medication doses, and outcomes until hospital discharge. The follow-up period (up to 20 years for each patient) is ensured by linking with the French national health database (Système national des données de santé), and includes information on death, hospital admissions, major clinical events, healthcare consumption (including drug reimbursement) and total healthcare costs. FRENCHIE is also used as a platform for cohort-nested studies – currently three randomized trials and two observational studies. This nationwide large contemporary cohort with very long-term follow-up will improve knowledge about acute myocardial infarction management and outcomes in France, and provide a useful platform for nested studies and trials. [ABSTRACT FROM AUTHOR]

[Display omitted] • The MyocarditIRM cohort is the largest prospective database on AM worldwide. • It includes 803 patients with CMR-proven AM in 49 participating centres (2016–2019). • CMR images will be analysed centrally by a certified core laboratory. • Accurate follow-up ensured by national database link (up to 10 years per patient). • Linkage of this kind has never been performed in AM. • The MyocarditIRM cohort will provide robust data on AM. • It will also improve knowledge of AM epidemiology and prognostic determinants. Acute myocarditis usually presents as chest pain with rising troponin and normal coronary arteries. Despite frequent favourable evolution at the acute phase, it is associated with heart failure and ventricular rhythm disorders, and is considered the leading cause of sudden cardiac death in young, apparently healthy, adults. There are no specific recommendations for acute myocarditis diagnosis and management, only expert consensus, given the lack of large databases. The main objective is to describe the contemporary presentation of acute myocarditis, its management and in-hospital outcomes. Secondary objectives are to investigate survival and event-free survival for up to 10 years of follow-up, the determinants of prognosis, the modalities of treatment and follow-up and the gaps between expert consensus and real-life management. MyocarditIRM is a prospective multicentre cohort that enrolled 803 consecutive patients with acute myocarditis in 49 participating centres in France between 01 May 2016 and 28 February 2019. The diagnosis of acute myocarditis was acknowledged by cardiac magnetic resonance, using the Lake Louise Criteria. Exclusion criteria were age < 18 years, lack of health coverage, contraindication to cardiac magnetic resonance and refusal to participate. Detailed information was collected prospectively, starting at admission. Cardiac magnetic resonance imaging (diagnosis and follow-up) is analysed centrally by the certified core laboratory IHU ICAN. Ten years of follow-up for each patient is ensured by linking with the French National Health Database, and includes information on death, hospital admissions, major clinical events and drug consumption. This prospective cohort with long-term follow-up represents the largest database on acute myocarditis worldwide, and will improve knowledge about its presentation, management and outcomes. [ABSTRACT FROM AUTHOR]

Autologous vein is the preferred bypass conduit for extremity arterial injuries owing to superior patency and low infection risk; however, long-term data on outcomes in civilians are limited. Our goal was to assess short- and long-term outcomes of autologous vein bypass for upper and lower extremity arterial trauma. A retrospective review was performed of patients with major extremity arterial injuries (2001-2019) at a level I trauma center. Demographics, injury and intervention details, and outcomes were recorded. Primary outcomes were primary patency at 1 year and 3 years. Secondary outcomes were limb function at 6 months, major amputation, and mortality. Multivariable analysis determined risk factors for functional impairment. There were 107 extremity arterial injuries (31.8% upper and 68.2% lower) treated with autologous vein bypass. Mechanism was penetrating in 77% of cases, of which 79.3% were due to firearms. The most frequently injured vessels were the common and superficial femoral (38%), popliteal (30%), and brachial arteries (29%). For upper extremity trauma, concomitant nerve and orthopedic injuries were found in 15 (44.1%) and 11 (32.4%) cases, respectively. For lower extremities, concomitant nerve injuries were found in 10 (13.7%) cases, and orthopedic injuries in 31 (42.5%). Great saphenous vein was the conduit in 96% of cases. Immediate intraoperative bypass revision occurred in 9.3% of patients, most commonly for graft thrombosis. The in-hospital return to operating room rate was 15.9%, with graft thrombosis (47.1%) and wound infections (23.5%) being the most common reasons. The median follow-up was 3.6 years. Kaplan-Meier analysis showed 92% primary patency at 1 year and 90% at 3 years. At 6 months, 36.1% of patients had functional impairment. Of patients with functional impairment at 6 months, 62.9% had concomitant nerve and 60% concomitant orthopedic injuries. Of those with nerve injury, 91.7% had functional impairment, compared with 17.8% without nerve injury (P <.001). Of patients with orthopedic injuries, 51.2% had functional impairment, vs 25% of those without orthopedic injuries (P =.01). On multivariable analysis, concomitant nerve injury (odds ratio, 127.4; 95% confidence interval, 17-957; P <. 001) and immediate intraoperative revision (odds ratio, 11.03; 95% confidence interval, 1.27-95.55; P =.029) were associated with functional impairment. Autologous vein bypass for major extremity arterial trauma is durable; however, many patients have long-term limb dysfunction associated with concomitant nerve injury and immediate intraoperative bypass revision. These factors may allow clinicians to identify patients at higher risk for functional impairment, to outline patient expectations and direct rehabilitation efforts toward improving functional outcomes. [ABSTRACT FROM AUTHOR]

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The use of cardiac CT (CCT) has increased dramatically in recent years among patients with pediatric and congenital heart disease (CHD), but little is known about trends and practice pattern variation in CCT utilization for this population among centers. A 21-item survey was created to assess CCT utilization in the pediatric/CHD population in calendar years 2011 and 2021. The survey was sent to all non-invasive cardiac imaging directors of pediatric cardiology centers in North America in September 2022. Forty-one centers completed the survey. In 2021, 98% of centers performed CCT in pediatric and CHD patients (vs. 73% in 2011), and 61% of centers performed >100 CCTs annually (vs. 5% in 2011). While 62% of centers in 2021 utilized dual-source technology for high-pitch helical acquisition, 15% of centers reported primarily performing CCT on a 64-slice scanner. Anesthesia utilization, use of medications for heart rate control, and type of subspecialty training for physicians interpreting CCT varied widely among centers. 50% of centers reported barriers to CCT performance, with the most commonly cited concerns being radiation exposure, the need for anesthesia, and limited CT scan staffing or machine access. 37% (11/30) of centers with a pediatric cardiology fellowship program offer no clinical or didactic CCT training for categorical fellows. While CCT usage in the CHD/pediatric population has risen significantly in the past decade, there is broad center variability in CCT acquisition techniques, staffing, workflow, and utilization. Potential areas for improvement include expanding CT scanner access and staffing, formal CCT education for pediatric cardiology fellows, and increasing utilization of existing technological advances. [ABSTRACT FROM AUTHOR]

Vascular trauma arises from a variety of causes: penetrating and blast injury in conflict zones, and recently terrorist attacks on civilians; blunt injury from road traffic accidents and falls from height; and iatrogenic injury from modern invasive medicine. Massive haemorrhage is the pre-eminent cause of preventable death. Trauma teams now understand the necessity to control bleeding rapidly with targeted damage-control surgery, and goal-directed resuscitation, before the lethal triad of shock, hypothermia and coagulopathy make attempted salvage futile. Vascular trauma in the extremities may be identified clinically with hard signs of injury alone. Trauma CT scanning rapidly identifies sites of bleeding in chest, abdomen or pelvis. Vascular surgeons are key members of the trauma team, offering control of bleeding and vascular reconstruction, using aspects of open surgical and endovascular techniques. Once haemodynamic stability has been established, definitive surgical care can restore function and allow successful rehabilitation. [ABSTRACT FROM AUTHOR]

Due to the growing demand for medical treatment resulting from an ageing population and advancements in medical devices and technology, the waste produced by the healthcare industry is rapidly increasing. While in many sectors, the shift to a circular economy has become more prevalent, in the healthcare sector, the linear cradle-to-grave model seems to still be a common approach despite growing concerns over the environmental burdens. Many devices are designed for single-use, often due to contamination concerns, limiting their potential for reuse. This paper considers the challenges associated with establishing a circular economy for medical devices, focusing on syringes as a representative single-use product. Through a series of material decontamination experiments, the potential for recycling of syringes has been assessed. These experiments have highlighted possible design improvements that would allow for a more streamlined end-of-life management. The findings from this research highlight the significant potential for both environmental preservation and healthcare efficiency through the circular use of medical devices. [ABSTRACT FROM AUTHOR]

The megatrend sustainability is changing the way industrial companies view their products and services and how they interact with the environment. In combination with digitalization, the way their systems (products and services) evolve is undergoing a significant shift, offering huge potential for optimization in favor of sustainability. Large volumes of data from the systems-in-use, software tools, and databases reshape how the system life cycle unfolds. This results into complex interrelationships between the life cycle phases and the created and used artifacts (i.e. models or production reports). The challenge for industrial companies is to get a structured overview of data sources, and data flows along the system life cycle. To address these challenges, a system life cycle data map has been developed utilizing design science. The data map illustrates the system life cycle phases, the related data sources and associated artifacts, and their interrelationships, i.e., the data flows between different artifacts. Applying the data map for a given system enhances data clarity and opens new opportunities for improving the system life cycle, its design, and potential for data-driven applications. [ABSTRACT FROM AUTHOR]

COVID-19 has had enormous impact on health and social systems, with stringent public health measures enacted across Australia. The virus itself disproportionately affects immunocompromised individuals including people without functioning spleens. We thus sought to characterise the psychological and physical impact of COVID-19 and such measures upon this oft-neglected patient group. Adults ≥ 18 years old identified from the Spleen Australia (SA) database were invited to participate in an online survey in November to December 2021 to assess the impact of the COVID-19 pandemic. Stata (v17, StataCorps, Texas, USA) was used to conduct descriptive and frequency analyses. 2864 respondents were surveyed. The majority were female (1473/2838, 51.9%), Australian-born (2257/2835, 79.6%), and living in Victoria (1755/2822, 62.2%). The largest age group was 61–70 years-old (841/2858, 29.4%). Trauma was the commonest reason for asplenia (826/2724, 30.3%). Respondents reported the pandemic reduced their ability to visit a GP (753/2864, 26.3%), access food (153/2864, 5.3%), medications (179/2864, 6.3%) or spleen-specific vaccines (120/2864, 4.2%), maintain relationships (503/2864, 17.6%), or care for children (127/2864, 4.4%). 84.8% of participants reported at least one impact of COVID, including negative physical health (1463/2864, 51.1%), mental health (733/2864, 25.6%) and financial repercussions (509/2864, 17.8%). 96.9% (2743/2831) had received at least one dose of COVID-19 vaccines. Overall, we found detailed evidence of the negative psychological and physical impacts of the pandemic upon this cohort. We recommend that providers consider people without functioning spleens as requiring extra social and psychological support in circumstances such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Digital transformation strategies are of elementary importance for organizations competing in the digital age. Challenges such as faster changing customer needs, new value creation structures in digital eco-systems, or the use of collective intelligence to innovate business models require leveraging digital technologies. To achieve this and remain competitive, appropriate digital transformation strategies need to be in place. Yet, studies show that organizations struggle with strategy formulation and implementation. Based on workshops with practitioners the authors obtained concrete needs, pains, and gains as requirements for the development of an own, new intelligent and platform-based assessment tool. The proposed tool collects, calculates, and visualizes in a self-service manner, relevant company data to support decision-makers and organizations in digital transformation strategy development and implementation. [ABSTRACT FROM AUTHOR]

• Vitamin D supplementation has no beneficial effect on self-reported SAMS intensity. • Vitamin D supplementation has no beneficial effect on self-reported HRQoL. • Vitamin D supplementation has no beneficial effect on objective muscle performance. Statins are the leading lipid-lowering drugs, reducing blood cholesterol by controlling its synthesis. Side effects are linked to the use of statins, in particular statin-associated muscle symptoms (SAMS). Some data suggest that vitamin D supplementation could reduce SAMS. The purpose of this study was to evaluate the potential benefits of vitamin D supplementation in a randomized controlled trial. Men (n = 23) and women (n = 15) (50.5 ± 7.7 years [mean ± SD]) in primary cardiovascular prevention, self-reporting or not SAMS, were recruited. Following 2 months of statin withdrawal, patients were randomized to supplementation (vitamin D or placebo). After 1 month of supplementation, statins were reintroduced. Before and 2 months after drug reintroduction, muscle damage (creatine kinase and myoglobin) was measured. Force (F), endurance (E) and power (P) of the leg extensors (ext) and flexors (fle) and handgrip strength (FHG) were also measured with isokinetic and handheld dynamometers, respectively. The Short Form 36 Health Survey (SF-36) questionnaire and a visual analog scale (VAS) were administrated to assess participants' self-reported health-related quality of life and SAMS intensity, respectively. Repeated-measures analysis was used to investigate the effects of time, supplementation, and their interaction, according to the presence of SAMS. Despite no change for objective measures, subjective measures worsened after reintroduction of statins, independent of supplementation (VAS, SF-36 mental component score, all p < 0.05). However, no interaction between time and supplementation according to the presence of SAMS was observed for any variables. Vitamin D supplementation does not appear to mitigate SAMS. [ABSTRACT FROM AUTHOR]

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Proliferation and invasion are two key drivers of tumor growth that are traditionally considered independent multicellular processes. However, these processes are intrinsically coupled through a maximum carrying capacity, i.e., the maximum spatial cell concentration supported by the tumor volume, total cell count, nutrient access, and mechanical properties of the tissue stroma. We explored this coupling of proliferation and invasion through in vitro and in silico methods where we modulated the mechanical properties of the tumor and the surrounding extracellular matrix. E-cadherin expression and stromal collagen concentration were manipulated in a tunable breast cancer spheroid to determine the overall impacts of these tumor variables on net tumor proliferation and continuum invasion. We integrated these results into a mixed-constitutive formulation to computationally delineate the influences of cellular and extracellular adhesion, stiffness, and mechanical properties of the extracellular matrix on net proliferation and continuum invasion. This framework integrates biological in vitro data into concise computational models of invasion and proliferation to provide more detailed physical insights into the coupling of these key tumor processes and tumor growth. Tumor growth involves expansion into the collagen-rich stroma through intrinsic coupling of proliferation and invasion within the tumor continuum. These processes are regulated by a maximum carrying capacity that is determined by the total cell count, tumor volume, nutrient access, and mechanical properties of the surrounding stroma. The influences of biomechanical parameters (i.e., stiffness, cell elongation, net proliferation rate and cell-ECM friction) on tumor proliferation or invasion cannot be unraveled using experimental methods alone. By pairing a tunable spheroid system with computational modeling, we delineated the interdependencies of each system parameter on tumor proliferation and continuum invasion, and established a concise computational framework for studying tumor mechanobiology. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] • APE management guidelines are mostly based on low levels of evidence. • No major advances in APE therapeutics in the last two decades. • APE is at the crossroads of different specialties. • These specialties are cardiology, emergency medicine and intensive care medicine. • Multidisciplinary expertise and management of APE may be a strength. • It may also be a source of confusion and heterogeneity in patient care. • Four clinical cases have been designed to represent different APE phenotypes. • Physicians to be surveyed on the proposed management of these APE phenotypes. • The physicians are from the different specialties involved in APE management. • Proposed management of APE to be compared according to medical specialty. Because of their high morbidity and mortality, patients with acute pulmonary oedema (APE) require early recognition of symptoms, identification of precipitating factors and admission to specialized care units (cardiac critical care or intensive care). APE is at the crossroads of different specialties (cardiology, emergency medicine and intensive care medicine). Although multidisciplinary expertise and management may be a strength, it can also be a source of confusion, with unexpected heterogeneity in patient care. We hypothesized that the management of severe APE may be heterogeneous between specialties and, in some situations, may differ from international recommendations. We designed a survey to compare management of different APE phenotypes according to the physicians' medical specialty, and to compare the results with what experts would do and European guidelines. Four clinical cases of typical APE with questions pertaining to the latest guidelines were designed by a Scientific Committee designated by the French Scientific Societies for Cardiology, Emergency Medicine and Intensive Care Medicine. We focused on oxygenation and ventilation strategies, management of precipitating factors, including timing of coronary revascularization, use of diuretics and management of diuretic resistance, and discharge coverage. From 20 June 2022 until 09 September 2022, the four cases of APE (two during hypertensive crises, two during acute coronary syndromes) were proposed to French physicians involved in APE care, and to experts, using an open online survey. To avoid any diagnostic ambiguity, the diagnosis of APE was given at the beginning of each clinical case. The intention is to present the results at national and international conferences and publish them in a peer-reviewed journal. The results of this survey are intended to pave the way for the generation of novel hypotheses for future clinical trials in case of equipoise between subsets of therapeutic procedures in APE. [ABSTRACT FROM AUTHOR]

[Display omitted] • 149 consecutive patients with long-standing AF or peri-mitral flutter ablation. • EIVOM was feasible in 82% of cases. • Systematic EIVOM achieved complete MIB in 94% of feasible cases. • Systematic EIVOM achieved complete MIB in 77% of the total population. • No major complications during the procedure or postprocedural monitoring. • Failure to obtain MIB linked with increased MI length and high left atrial volume. Achieving bidirectional mitral isthmus block is still challenging. Conventional ablation methods involve radiofrequency applications on the endocardial aspect of the lateral mitral isthmus, and often epicardial applications inside the coronary sinus. To evaluate the impact of the systematic use of ethanol infusion in the vein of Marshall on the achievement of acute mitral isthmus block of additional epicardial component lesion. We evaluated patients referred to two centres for long-standing persistent atrial fibrillation ablation or recurrent peri-mitral flutter. All patients had pulmonary vein isolation and mitral isthmus line using ethanol infusion in the vein of Marshall for the first procedure and additional radiofrequency ablation lesion if necessary. For redo procedures, additional ablations (atrial lines and complex fractionated atrial electrogram ablations, if needed) were also performed. We included 149 patients, and ethanol infusion in the vein of Marshall was not performed in 27 patients (18%). Among 122 patients, 115 had long-standing persistent atrial fibrillation (94.2%) and seven had peri-mitral flutter (5.8%). The mean duration of continuous atrial fibrillation was 53 months before ablation. Acute bidirectional mitral isthmus block was obtained in 115 (94.2%) of the 122 patients who received ethanol infusion in the vein of Marshall (77% when considering the total population). The mean radiofrequency delivery time to obtain mitral isthmus block was 2.6 minutes for the endocardial mitral isthmus radiofrequency ablation and 2.6 minutes for the epicardial mitral isthmus radiofrequency ablation. Failure to obtain mitral isthmus block was associated with increased mitral isthmus length and left atrial dilation. No major complications related to ethanol infusion in the vein of Marshall were observed. Ethanol infusion in the vein of Marshall, when feasible (82%), was a safe approach to obtaining a high success rate (94%) of acute bidirectional endocardial and epicardial mitral isthmus block. [ABSTRACT FROM AUTHOR]

Aesthetic quality control (AQC) is an essential step in smart factories to ensure that product quality meets the desired standards. This operation includes assessing factors such as color, texture, and shape. In the context of AQC, bias can arise when the criteria used to evaluate the aesthetics of a product are subjective and influenced by personal preferences. Bias can also occur due to the background or other objective factors like the geometry of the material. This work will focus on applying an adversarial learning strategy to a pre-trained DL architecture for improving the generalization performance of a predictive model tailored explicitly for solving AQC task classification. Experimental results on a benchmark AQC dataset highlighted the robustness of the proposed methodology for learning only relevant components related to quality classes rather than other confusing traits, enabling the mitigation of the identified bias. [ABSTRACT FROM AUTHOR]

The rapid advancement of artificial intelligence (AI) systems has had a profound impact on various aspects of business and technology. One area greatly influenced by AI is innovation project management, which plays a critical role in driving organizational growth and success. The purpose of the paper examines the erosion of competencies in innovation project management as a consequence of the increasing reliance on AI systems. The object is innovation project management relying on the expertise, experience, and decision-making capabilities of human managers. However, the introduction of AI systems in project management processes has brought about significant changes. AI-powered tools and algorithms can automate tasks, analyse vast amounts of data, and provide valuable insights and recommendations. While this presents numerous benefits, it also raises concerns about the diminishing role of human competencies in managing innovation projects. AI systems require vast amounts of training data to operate effectively. In the process, they might overlook or undervalue the tacit knowledge and domain expertise possessed by human project managers. The results emphasize the need for project managers to develop new competencies, such as understanding AI capabilities, interpreting AI-generated insights, and effectively integrating AI systems into project workflows. To mitigate the erosion of competencies, organizations should invest in training programs that equip project managers with the necessary skills to work alongside AI systems. Recognizing these challenges and proactively addressing them through training, collaboration, and a balanced approach to human-AI interaction is crucial for organizations seeking to leverage AI while maintaining a high level of project management expertise. [ABSTRACT FROM AUTHOR]

Cette mise au point sur les tumeurs épithéliales coliques permet d'aborder la prise en charge de ces lésions par les pathologistes, les caractéristiques anatomopathologiques des adénomes conventionnels, des lésions festonnées, des polypes hamartomateux, des polyposes, et des adénocarcinomes du côlon. Elle détaille également les examens complémentaires immunohistochimiques et moléculaires à réaliser par les pathologistes sur les biopsies d'adénocarcinomes coliques. This review about colonic epithelial tumors deals with the management of these lesions by the pathologists, and the pathological features of conventional adenomas, serrated polyps, hamartomatous polyps, polyposis, and adenocarcinomas of the colon. It also details the ancillary immunohistochemical and molecular techniques to be carried out by the pathologists on colonic adenocarcinoma biopsies. [ABSTRACT FROM AUTHOR]

[Display omitted] • The performance ratio (PR) quantifies the losses induced by solar installations. • Microinverters have the same PR as inverters. • The size of an installation has no influence on the PR. • An installation with a strong irradiance will decrease the PR. The efficiency of a photovoltaic installation is determined by its performance ratio (PR). This ratio depends on many parameters including orientation, inclination, shading, losses in cables, and number and performance of panels. The topology of the installation is also of great importance. Indeed, the number and location of the converter(s) can also have a significant impact on the PR. This is why choices between a central inverter, string inverters or micro-inverters must be made so as not to degrade the PR. In the scientific literature, it is stated that a photovoltaic installation equipped with a central inverter has a PR of 70–80%. For micro-inverters in theory, it should be higher. The objective of this publication is to compare the PR of installations equipped with a central inverter and string inverters with the PR of those using micro-inverters, based on a statistical study grouping together 200 private installations spread throughout metropolitan France. For a better comparison, 100 installations will use a central inverter or string inverters and 100 other installations will use micro-inverters. For each installation, the data will be averaged over the longest possible periods. [ABSTRACT FROM AUTHOR]

In recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. However, only a few studies have focused on the impact of overweight and obesity on IBD-related disability. To identify the factors associated with obese and overweight patients with IBD, including IBD-related disability. In this cross-sectional study, we included 1704 consecutive patients with IBD in 42 centres affiliated with the Groupe d'Etude Therapeutique des Affections Inflammatoires du tube Digestif (GETAID) using a 4-page questionnaire. Factors associated with obesity and overweight were assessed using univariate and multivariate analyses (odds ratios (ORs) are provided with 95% confidence intervals). The prevalence rates of overweight and obesity were 24.1% and 12.2%, respectively. Multivariable analyses were stratified by age, sex, type of IBD, clinical remission and age at diagnosis of IBD. Overweight was significantly associated with male sex (OR = 0.52, 95% CI [0.39–0.68], p < 0.001), age (OR = 1.02, 95% CI [1.01–1.03], p < 0.001) and body image subscore (OR = 1.15, 95% CI [1.10–1.20], p < 0.001) (Table 2). Obesity was significantly associated with age (OR = 1.03, 95% CI [1.02–1.04], p < 0.001), joint pain subscore (OR = 1.08, 95% CI [1.02–1.14], p < 0.001) and body image subscore (OR = 1.25, 95% CI [1.19–1.32], p < 0.001) (Table 3). The increasing prevalence of overweight and obesity in patients with IBD is associated with age and poorer body image. A holistic approach to IBD patient care should be encouraged to improve IBD-related disability and to prevent rheumatological and cardiovascular complications. [ABSTRACT FROM AUTHOR]

There is debate over the impact of residual microscopic disease after ileocecal resection in Crohn's disease (CD) to predict recurrence. We conducted a meta-analysis to evaluate the impact of positive histological margins and plexitis after ileocecal resection on the risk of postoperative recurrence. Using a systematic search, we identified. 30 studies evaluating the impact of inflammatory margins on CD recurrence. The primary outcome was the postoperative clinical recurrence and secondary outcomes were surgical, and endoscopic recurrence. We performed random-effects meta-analysis and estimated odds ratio (OR) and 95% CIs. Thirty studies were analyzed, seven focused on myenteric plexitis, six on submucosal plexitis and twenty-three on positive margins. Inflammatory margins were associated with a higher rate of clinical and surgical recurrences: respectively 14 studies - OR 2.38; 95% CI, 1.54 - 3.68- I2 = 68.2%, Q test- p = 0.0003 and 8 studies - OR, 1.52; 95% CI, 1.07–2.16 - I2 =0%; Q test- p = 0.43. The presence of myenteric plexitis was associated with a higher rate of clinical recurrence (4 studies- OR, 1.60; 95%CI, 1.12–2.29; I2= 0%, Q-test- p = 0.61), and of endoscopic recurrence (4 studies - OR, 4.25; 95%CI; 2.06–8.76; I2= 0%, Q test- p = 0.97). Submucosal plexitis was not associated with an increased risk of endoscopic recurrence (4 studies - OR, 0.94; 95%CI; 0.58–1.52; I2= 0%, Q test- p = 0.79). Inflammatory margins and/or plexitis were associated with postoperative recurrence after ileocecal resection for CD. These elements should be taken into account in future algorithm for prevention of postoperative recurrence. [ABSTRACT FROM AUTHOR]

As additive manufacturing (AM) is currently used for fabrication of end-use products, different methods have been developed to decrease surface roughness of three-dimensional (3D)-printed parts. In this study, a series of experimental tests was performed to investigate influence of post-processing on the fracture behavior of 3D-printed polymer components. To this aim, acrylonitrile butadiene styrene (ABS) material was used to print dog-bone shaped and semi circular bending (SCB) specimens based on fused deposition modeling process. The surface treatment of 3D-printed ABS parts was conducted by immersing the test coupons into acetone solution. The dog-bone shaped specimens printed with different raster directions were examined to determine basic mechanical properties before and after surface treatment. A series of three-point bending tests was carried out on untreated and treated SCB specimens to investigate their structural performance and fracture behavior. Moreover, digital image correlation technique was used to track the fracture process and study the strain fields of the SCB specimens. The fracture toughness of untreated and treated specimens under mode I are determined. Although dipping 3D-printed parts into acetone solution improve the surface finish of the parts, the fracture toughness was reduced from 2.62 MPa m to 2.49 MPa m. Additionally, three-point bending tests on SCB specimens proved that the performed surface treatment changed the fracture growth path in 3D-printed ABS parts. [ABSTRACT FROM AUTHOR]

Infantile abdominoscrotal hydrocele is generally managed with early surgery. However, whether these patients actually benefit from an initial watchful waiting strategy is yet to be determined. This single-center, comparative observational analysis included 36 consecutive patients (9 bilateral cases) diagnosed between January 1998 and December 2019. Initial 16 patients (21 lesions) underwent surgical repair shortly after diagnosis (Group A) at a mean (SD) age of 8 (4) months. Remaining 20 patients (24 lesions) underwent initial nonoperative management (Group B). Overall follow-up was 82.74 (63.84) months. Six lesions of Group B spontaneously regressed at a mean age of 23.8 (7.8) months. Remaining 18 hydroceles underwent surgical management at a mean age of 18.7 (12.6) months. Early postoperative morbidity was high (43%) in both groups (Clavien-Dindo grade I-II). During follow-up, there were 1 recurrent hydrocele and 1 testicular atrophy, both events occurring in Group A patients. Group B patients required a higher need for concomitant ipsilateral orchidopexy (61% versus 14%; p = 0.001), and developed a higher rate of ipsilateral inguinal hernia (39% versus 5%; p = 0.01), occurring within 8.3 (3.53) months of surgery. On multivariable analysis, nonoperative management was associated with unplanned second surgery (odds ratio 5.5, 95% CI 1.25–24.17, p = 0.02), regardless of the type of hydrocelectomy performed. Nonoperative management provides effective spontaneous resolution in about 25% of infantile abdominoscrotal hydrocele. Clinicians must balance the potential benefits of such strategy against the impact of pressure induced detrimental effects on the success of future surgery when dealing with longstanding lesions. III. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is associated with important mortality but the usual clinical risk factor based scores only modestly predict mortality. This study aimed to develop machine learning models for the prediction of death occurrence within the year following atrial fibrillation diagnosis and compare predictive ability against usual clinical risk scores. We used a nationwide cohort of 2,435,541 newly diagnosed atrial fibrillation patients seen in French hospitals from 2011 to 2019. Three machine learning models were trained to predict mortality within the first year using a training set (70% of the cohort). The best model was selected to be evaluated and compared with previously published scores on the validation set (30% of the cohort). Discrimination of the best model was evaluated using the C index. Within the first year following atrial fibrillation diagnosis, 342,005 patients (14.4%) died after a period of 83 (SD 98) days (median 37 [10-129]). The best machine learning model selected was a deep neural network with a C index of 0.785 (95% CI, 0.781-0.789) on the validation set. Compared to clinical risk scores, the selected model was superior to the CHA 2 DS 2 -VASc and HAS-BLED risk scores and superior to dedicated scores such as Charlson Comorbidity Index and Hospital Frailty Risk Score to predict death within the year following atrial fibrillation diagnosis (C indexes: 0.597; 0.562; 0.643; 0.626 respectively. P <.0001). Machine learning algorithms predict early death after atrial fibrillation diagnosis and may help clinicians to better risk stratify atrial fibrillation patients at high risk of mortality. [Display omitted] CCI, Charlson Comorbidity Index; DNN, deep neural network; HFRS, Hospital Frailty Risk Score. [ABSTRACT FROM AUTHOR]

The objectives of this study were to assess Candida spp. distribution and antifungal resistance of candidaemia across Europe. Isolates were collected as part of the third ECMM Candida European multicentre observational study, conducted from 01 to 07-07-2018 to 31-03-2022. Each centre (maximum number/country determined by population size) included ∼10 consecutive cases. Isolates were referred to central laboratories and identified by morphology and MALDI-TOF, supplemented by ITS-sequencing when needed. EUCAST MICs were determined for five antifungals. fks sequencing was performed for echinocandin resistant isolates. The 399 isolates from 41 centres in 17 countries included C. albicans (47.1%), C. glabrata (22.3%), C. parapsilosis (15.0%), C. tropicalis (6.3%), C. dubliniensis and C. krusei (2.3% each) and other species (4.8%). Austria had the highest C. albicans proportion (77%), Czech Republic, France and UK the highest C. glabrata proportions (25–33%) while Italy and Turkey had the highest C. parapsilosis proportions (24–26%). All isolates were amphotericin B susceptible. Fluconazole resistance was found in 4% C. tropicalis , 12% C. glabrata (from six countries across Europe), 17% C. parapsilosis (from Greece, Italy, and Turkey) and 20% other Candida spp. Four isolates were anidulafungin and micafungin resistant/non-wild-type and five resistant to micafungin only. Three/3 and 2/5 of these were sequenced and harboured fks -alterations including a novel L657W in C. parapsilosis. The epidemiology varied among centres and countries. Acquired echinocandin resistance was rare but included differential susceptibility to anidulafungin and micafungin, and resistant C. parapsilosis. Fluconazole and voriconazole cross-resistance was common in C. glabrata and C. parapsilosis but with different geographical prevalence. • Candidaemia epidemiology differs notably across 41 centres in 17 countries. • C. albicans proportions varied from 77% in Austria to 36% in Turkey. • Acquired fluconazole resistance emerges in C. parapsilosis in southern Europe. • A novel echinocandin resistance mutation and MDR was demonstrated in C. parapsilosis. • Antifungal stewardship and infection control is of utmost importance. [ABSTRACT FROM AUTHOR]

To determine the monetary costs identified in economic evaluations of treatment with compression bandages among adults with venous leg ulcers (VLU). A scoping review of existing publications was conducted in February 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Ten studies met the inclusion criteria. To place the costs of treatment into context, these are reported in conjunction with the healing rates. Three comparisons were made: 1. 4 layer compression versus no compression (3 studies). One study reported that 4 layer compression was more expensive than usual care (£804.03 vs £681.04, respectively), while the 2 other studies reported the converse (£145 vs £162, respectively) and all costs (£116.87 vs £240.28 respectively). Within the three studies, the odds of healing were statistically significantly greater with 4 layer bandaging (OR: 2.20; 95% CI: 1.54–3.15; p = 0.001).; 2. 4 layer compression versus other compression (6 studies). For the three studies reporting the mean costs per patient associated with treatment (bandages alone), over the treatment period, analysis identified a mean difference (MD) in costs for 4 layer vs comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) of −41.60 (95% CI: 91.40 to 8.20; p = 0.10). The OR of healing for 4 layer compression vs comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) is: 0.70 (95% CI: 0.57–0.85; p = 0.004). For 4 layer vs comparator 2 (2 layer compression) the MD is: 14.00 (95% CI: 53.66 to −25.66; p < 0.49). The OR of healing for 4 layer compression vs comparator 2 (2 layer compression) is: 3.26 (95% CI: 2.54–4.18; p < 0.00001). For comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) vs comparator 2 (2 layer compression) the MD in costs is: 55.60 (95% CI: 95.26 to −15.94; p = 0.006). The OR of healing with Comparator 1 (2 layer compression, short-stretch compression, 2 layer compression hosiery, 2 layer cohesive compression, 2 layer compression) is: 5.03 (95% CI:4.10–6.17; p < 0.00001). Three studies presented the mean annual costs per patient associated with treatment (all costs). The MD is 172 (150–194; p = 0.401), indicating no statistically significant difference in costs between the groups. All studies showed faster healing rates in the 4 layer study groups. 3. Compression wrap versus inelastic bandage (one study). Compression wrap was less expensive than inelastic bandage (£201 vs £335, respectively) with more wounds healing in the compression wrap group (78.8%, n = 26/33; 69.7%, n = 23/33). The results for the analysis of costs varied across the included studies. As with the primary outcome, the results indicated that the costs of compression therapy are inconsistent. Given the methodological heterogeneity among studies, future studies in this area are needed and these should use specific methodological guidelines to generate high-quality health economic studies. • Venous Leg Ulcers (VLU) impact health, quality of life significantly. • Compression therapy is best for treating VLUs effectively. • Scoping review assessed costs of compression bandages in VLU treatment. • Analysis of cost varied across studies, indicating uncertainty in economic evaluations of VLU treatment. • Larger prospective study needed for accurate cost analysis in VLU care, following methodological guidelines. [ABSTRACT FROM AUTHOR]

State-of-the-art therapy improves the five-year survival rate of patients under the age of 20 with cranial and craniospinal tumors up to 74 %. We aimed to assess echocardiographic parameters and exercise performance in subjects following complex treatment for cranial and craniospinal tumors in childhood. 48 subjects who underwent cranial and craniospinal irradiation for CNS tumors in childhood were compared to 20 healthy controls. Examination included cardiopulmonary exercise testing (CPET), hormone studies and echocardiography. According to CPET parameters cancer survivors showed significantly impaired exercise tolerance compared to healthy volunteers resulting in lower peak VO 2 (19.8 vs 30.3 ml*min/kg; p<0.001), lower percent from predicted peak VO 2 (58.6% vs 85.8%; p<0.001) and lower ventilatory efficacy (VE/VCO 2 29.9 vs 23.6; p=0.044; peak PetCO 2 36.3 vs 40.6 mm Hg; p=0.009). Poor exercise tolerance was associated with a younger age at the time of treatment initiation. 5 patients from the main group (10.4%) demonstrated abnormal echocardiographic parameters including thickening and calcification of the aortic valve leaflets and diffuse reduction in the systolic LV and RV function. Hormonal derangements like somatotropin insufficiency, hypocorticism, hypothyroidism, hypogonadism in cancer survivors correlated both with exercise intolerance and echocardiographic abnormalities. Exercise intolerance and cardiac dysfunction coupled with hormonal deficits are not uncommon among patients following treatment for intracranial and craniospinal tumors at a young age. Obtained data confirms the importance of regular cardiovascular risk assessment in childhood cancer survivors. [ABSTRACT FROM AUTHOR]

To investigate how left and right ventricular strain measured by two different vendors compare to each other and how they compare in terms of interrater and intrarater reliability. In this secondary analysis, we examined transesophageal images acquired after induction of patients undergoing cardiac surgery during a period of hemodynamic stability. The same images were analyzed using Philps aCMQ and Tomtec analysis programs by two assessors. Specifically, global and segmental strain of the left ventricular (LV) was measured by two assessors in the midesophageal 4 chamber view (ME4C), the midesophageal 3 chamber view (ME4C), and midesophageal 2 chamber view (ME4C). Additionally, strain of the free wall (FW), septum (S), and segments were measured in the right ventricle (RV) in an RV focused ME4C. Correlation and agreement were examined between vendors in addition to interrater and intrarater reliability for each software. In a convenience sample of 50 patients, strain in a total of 181 views was examined. Median [interquartile range] strain values for aCMQ and TomTec for the ME4C, ME2C, ME3C, RVFW, and RVS were ME4C: -15.9% [-8.9% to -18.4%] vs -15.1% [-11.3% to -17.8%] p=0.83, ME2C: -14.0% [-11.9% to -17.0%] vs -16.7% [-12.2% to -18.6%] p=0.13, ME3C: -15.1% [-11.2% to -15.7%] vs -14.9% [-12.2% to -18.1%] p=0.39, RVFW: -18.3% [-14.1% to -21.2%] vs -24.9% [-21.5% to -29.3%] p<0.01, -17.1% [-11.7% to -19.8%] vs -19.8% [-16.2% to -22.8%] p=0.03, respectively. Correlation (Pearsons r = 0.79, 0.72, 0.91) and agreement (mean differences of -1%, -1%, -2%) were similar for LV views, while significant differences were found for the RV with correlation (Pearsons r = 0.62 and 0.73) and agreement (mean differences of -6% and -3%). On a segmental level, correlation was poorer for the basal, mid, and apical segments of the LV (Pearsons r = 0.37, 0.67, and 0.72). Interrater reliability (Pearsons r) for the ME4C, ME2C, ME3C, RVFW, and RVS were 0.91, 0.86, 0.81, 0.77, and 0.83 as well as 0.85, 0.89, 0.77, 0.88, and 0.89, for TomTec and Philips aCMQ respectively. Relevant differences in strain were found between the Philips aCMQ and TomTec Software tools for the RV, but not the LV. Segmental correlation between the two softwares was poorest in the basal segments. Similarly interrater reliability was observed. Clinicians should exercise caution in comparing strain measurements for the RV and on a segmental level; vendor-based systematic variation may exist. [ABSTRACT FROM AUTHOR]

To investigate whether estimates of peak global systolic (S') and diastolic (E') left ventricular (LV) flow rates based on 3D echocardiographic volumes are feasible and match expected physiology. In this retrospective feasibility study, we included Patients undergoing major cardiac surgery. S' and E' were derived from 190 patients by taking the first derivative of the volume-time relationship of 3D ecg-gated transesophageal echocardiography (TEE) intraoperative images which generated the ventricular output flow (Figure 1). To examine the quality of images upon which the estimates of flow were based we correlated intraoperative 3D TEE and preoperative 2D transthoracic echocardiography (TTE) volumes. As a proof-of-concept, we then correlated S' flow with stroke volume and S' and E' were compared by valve pathology. In each of the 190 images, S' and E' could be derived. There was good correlation between 1) the ejection fraction (EF) of 3D LV images obtained intraoperatively by TEE and preoperatively by TTE (Pearson's r=0.65) and also 2) S' and stroke volume (Pearson's r=0.73). Patients with aortic or mitral regurgitation showed higher S' than patients without valve pathologies (-315ml/s[95%CI -388ml/s to -264ml/s]p=0.001, -319 ml/s[95%CI -397ml/s to -246ml/s]p=0.001 vs. -242 ml/s[95%CI -300ml/s to -196ml/s]). These patients also showed higher E' than patients without valve pathologies (302ml/s[95%CI 237ml/s to 384ml/s]p=0.006, 341ml/s[95%CI 227ml/s to 442ml/s]p=0.001 vs. 240ml/s[95%CI 185ml/s to 315ml/s]). Patients with aortic stenosis showed no difference in S' or E' (-263ml/s[95%CI -300ml/s to -212ml/s]p=0.793, 255ml/s[95%CI 188ml/s to 344ml/s]p=0.400). We found that 3D images can be used to derive global flow into and out of the ventricle. These measurements are not only feasible and reliable, but they also match expected valve pathology. As a proof-of-concept study describing a novel measurement, clinical utility remains to be determined. However, a few points merit comment. First, the fact that flows match those expected from valve pathologies suggests a high level of quality in tracking and an acceptable volume rate of image acquisition. Second, in addition to systolic information, diastolic information may be obtained, resulting in a global filling rate. This may enable conclusions regarding not only valve pathology (AR, retrograde filling; MR, higher transmitral gradient), but potentially also diastolic function. For example, measuring lateral, basal E' by tissue Doppler in patients with coronary artery disease may be difficult as this is a regional marker with possible regional wall motion abnormalities; a global marker may be better suited. Third, as images were acquired in the midesophageal 4 chamber view, some flow quantification may be possible in patients in which transgastric views with proper alignment for Doppler measurements are not attainable or desirable. Fourth, it seems probable that analogous measurements may be possible for assessing right ventricular systolic and diastolic function. In conclusion, estimates of global peak systolic and diastolic LV flow based on 3D TEE are feasible, promising, and match valve pathologies. [ABSTRACT FROM AUTHOR]

Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with higher morbidity and mortality. The presence of an aberrant p-terminal force vector in lead V1 (PTFV1) has been identified as a significant predictor of atrial fibrillation in the non-surgical population. It is uncertain whether an association exists between PTFV1 and new-onset POAF in patients after cardiac surgery. In this secondary analysis, adult patients undergoing on-pump cardiac surgery for aortocoronary bypasses, valve surgery, combined bypass, and valve surgery were analyzed from 12/2018 to 08/2020. Patients who had a previous occurrence of atrial fibrillation or atrial flutter, patients with pacemakers and/or implantable cardioverter-defibrillators (ICDs), and those who did not have an electrocardiogram (ECG) performed within the 3 months before surgery were excluded. In addition, ECGs that were considered to be of low quality were also removed. Preoperative 12-lead ECGs were examined and the PTFV1 measured. Secondarily, we examined the P-wave length in lead II, the area under the P-wave in lead II, PR-interval, and QRS duration in lead V1 and II. The occurrence of POAF was extracted from the hospital record. Out of a total of 252 patients, 62 patients (24.6%) developed new onset POAF during their hospital stay. POAF occurred primarily in older patients, those with poor renal function, and those with a larger left atrium. Analysis of (odds ratios) ORs revealed that age, creatinine clearance, valve surgery, and left atrial volume index (LAVI) were associated with POAF. In the multivariable analysis, only age presented a significant correlation with postoperative atrial fibrillation (POAF). There was no observed relationship between any of the parameters based on ECG and the occurrence of POAF. No association was found between PTFV1 or other ECG based measurements and new onset POAF in cardiac surgery patients. Age was the only independent predictor of POAF. [ABSTRACT FROM AUTHOR]

The use of perioperative ECMO in lung transplantation helps overcome the unforeseen hemodynamic and respiratory instabilities that may occur during this type of surgery. However, no clear criteria are defined to predict the necessity of its application. Being able to anticipate the necessity for perioperative ECMO could enhance patient management, by preemptively avoiding unplanned ECMO and its associated complications. Therefore, we aim to assess whether criteria derived from preoperative echocardiography and right heart catheterization can effectively predict the necessity for ECMO support during lung transplantation. A total of 102 lung transplantations (27% for Pulmonary Fibrosis, 50% for Chronic Obstructive Pulmonary Disease, 10% for Pulmonary arterial hypertension and 13% for Cystic Fibrosis), performed at our center between January 2016 and December 2022, were retrospectively analyzed. Preoperative echocardiographies were reviewed, and qualitative and quantitative criteria were collected, alongside data from pre/perioperative right heart catheterization. Out of the total, 21 lung transplantations were performed under ECMO at our center. Our findings reveal that qualitative criteria derived from echocardiography, such as the presence of Right Ventricular Dysfunction (RVD) or moderate Tricuspid Regurgitation (mTR) are highly associated with the need for perioperative ECMO. In addition, various echocardiographic parameters, including Right Ventricle End-Diastolic Diameter (RVEDD), Tricuspid Annular Plane Systolic Excursion (TAPSE), Pulmonary Velocity Acceleration Time (PVAT), as well as values from perioperative right heart catheterization, such as systolic pulmonary arterial pressure (PAPs) and mean pulmonary arterial pressure (PAPm), were observed to be significantly correlated with the requirement for perioperative ECMO. Using Youden index and logistic regression, we established optimal cut-off values for each of these variables, as well as odds ratios, as indicated in the following table. Our study showed that we could identify patients at risk for unplanned ECMO during lung transplantation using criteria derived from preoperative echocardiography and perioperative right heart catheterization. These at-risk patients could gain from a preventive approach which could involve, for example, a preemptive introduction of ECMO cannula guides. [ABSTRACT FROM AUTHOR]

Cardiac surgery influences respiratory morbidity through multiple mechanisms. In our institution, the anesthesia team uses classic ventilation strategies: reduction of FiO2 and tidal volume, with PEEP and recruitment maneuvers. Their effectiveness is evaluated by continuous measurement of arterial oxygen saturation. But Peep is usually kept between 5 and 8 due to cardiac condition. Optimization of ventilation could still be possible. We postulate that this recruitment potential could be evaluated with the measurement of compliance and calculation of the R/I ratio (described the first time in 2020 by L.Chen & L.Brochard). ARDS Patients with a ratio >0.5 are candidates for optimization of ventilation parameters and new recruitment maneuvers. The primary endpoint is to evaluate the potential for alveolar recruitment, in patients undergoing cardiac surgery, at 2 times of the intervention (after intubation, and after cardiopulmonary bypass (CPB), by collecting the values of pulmonary compliance and the R/I ratio. The secondary endpoint is to determine if there are statistically significant differences, in terms of respiratory and hemodynamic parameters during and after recruitment. This is a prospective and observational study with agreement of our ethics committee. The 25 patients studied (Left ventricular ejection fraction above 40 %) are undergoing simple cardiac surgery (valve replacement, valve plasty or coronary artery bypass grafting). Patients' perioperative data were recorded, to evaluate the recruitment potential (Post-intubation, and post-CPB). The R/I ratio is measured with the single breath method describe by L. Chen: Peep is set at 12 mmHg during 3 min (= recruitment maneuver). "Abruptly releasing PEEP (from 12 to 5 cm H2O) increases expired volume: the difference between this volume and the volume predicted by compliance at low PEEP estimated the recruited volume by PEEP. This recruited volume divided by the effective pressure change gave the compliance of the recruited lung; the ratio of this compliance to the compliance at low PEEP gave the recruitment-to-inflation ratio". A low ratio indicate surdistension. Preliminary results show significant differences with improvement of compliance 10 min after recruitment. The median R/I was 1.58 ± 0.67 before CPB and, 1.15 ± 0.64 after CPB indicating a potential for recruitment. P/F values did not show a statistically significant increase, which could reflect good pulmonary vasoconstriction in pulmonary atelectasis. Pulmonary atelectasis aren't detectable with the ratio pO2/FiO2. Recruitment maneuvers, with moderate PEEP, are well tolerated in our patients, with a normal left ventricle (LV) ejection fraction. In conclusion R/I ratio highlights a potential for recruitment in our cardiac surgery patients. This test is hemodynamically well tolerated and could differentiate patients who are candidates for an increase in PEEP. A larger study is needed to confirm these results. [ABSTRACT FROM AUTHOR]

New-onset atrial fibrillation after cardiac surgery (NOAF) is a frequent complication and is associated with postoperative stroke, increased mortality, prolonged hospital length of stay, and higher treatment costs. The structures maintaining NOAF are mainly unknown. Thus, the present study aims to describe electrophysiological patterns of NOAF that might be future therapeutic targets. We present preliminary data from an ongoing prospective single-center cohort study of patients developing NOAF. We have included consecutive patients undergoing cardiac surgery and monitored them for the first seven postoperative days for the development of NOAF. Patients presenting with NOAF underwent non-invasive electrophysiological mapping using a 252-electrocardiogram vest to identify focal and rotational potential drivers (PDs) of NOAF. After mapping, a computed tomography scan of the chest was performed to generate a 3-dimensional model of the atria, where the PDs were projected, thus allowing a visual identification of NOAF maintaining structures. The primary outcome was the electrophysiological description of PDs of NOAF and NOAF-maintaining structures within the atria. Of 205 enrolled patients, 62 (30%) developed NOAF. Electrophysiological mapping was performed in 23 NOAF patients (37%). A median of 29 (21-48[IQR]) rotational PDs and a median of 26 (20-35[IQR]) focal PDs were identified per patient. The most frequent localizations of rotational drivers were the upper half of the right atrium (23 patients, 100%), the inferior/posterior left atrium (22 patients, 96%), and the left pulmonary veins (22 patients, 96%). The most frequent localizations of focal drivers were the upper half of the right atrium (22 patients, 96%), the left (22 patients, 96%), and right pulmonary veins (20 patients, 87%). Based on these preliminary results, structures such as the upper right atrium might play a role in maintaining NOAF and thus be targets for future preventive or therapeutic strategies. As the study is ongoing with the opening of a second study center in 2024, more precise results allowing identification of risk factors for specific PD locations and associations with outcomes are expected. [ABSTRACT FROM AUTHOR]