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Left atrial appendage occlusion (LAAO) provides mechanical cardioembolic protection for atrial fibrillation (AF) patients who cannot use oral anticoagulation therapy (OAT). Patients with a thrombotic event despite OAT are at high risk for recurrence and may also benefit from LAAO. This study sought to investigate the efficacy of LAAO in AF patients with a thrombotic event on OAT compared to: 1) LAAO in AF patients with a contraindication for OAT; and 2) historical data. The international LAAO after stroke despite oral anticoagulation (STR-OAC LAAO) collaboration included patients who underwent LAAO because of thrombotic events on OAT. This cohort underwent propensity score matching and was compared to the EWOLUTION (Evaluating Real-Life Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN Left Atrial Appendage Closure Technology) registry, which represents patients who underwent LAAO because of OAT contraindications. The primary outcome was ischemic stroke. Event rates were compared between cohorts and with historical data without OAT, yielding relative risk reductions based on risk scores. Analysis of 438 matched pairs revealed no significant difference in the ischemic stroke rate between the STR-OAC LAAO and EWOLUTION cohorts (2.5% vs 1.9%; HR: 1.37; 95% CI: 0.72-2.61). STR-OAC LAAO patients exhibited a higher thromboembolic risk (HR: 1.71; 95% CI: 1.04-2.83) but lower bleeding risk (HR: 0.39; 95% CI: 0.18-0.88) compared to EWOLUTION patients. The mortality rate was slightly higher in EWOLUTION (4.3% vs 6.9%; log-rank P = 0.028). Relative risk reductions for ischemic stroke were 70% and 78% in STR-OAC LAAO and EWOLUTION, respectively, compared to historical data without OAT. LAAO in patients with a thrombotic event on OAT demonstrated comparable stroke rates to the OAT contraindicated population in EWOLUTION. The thromboembolic event rate was higher and the bleeding rate lower, reflecting the intrinsically different risk profile of both populations. Until randomized trials are available, LAAO may be considered in patients with an ischemic event on OAT. [Display omitted] [ABSTRACT FROM AUTHOR]

Despite the importance of marketing for community pharmacies, evidence on its effectiveness in influencing consumer behavior and the added value for pharmacies remains limited. This study explores the representation of pharmacists in consumer-facing print media used for consumer marketing. The aim of this study is to analyze professional representation, especially of community pharmacists alongside other health professionals, in health-related public-facing print media, and to explore and further develop the use of novel, consumer facing data sources in a healthcare research context. An exploratory qualitative content analysis of a sample of issues from a leading consumer-facing healthcare print magazine was conducted. Of 565 extracted text passages, 328 were retained for analysis and coded using a coding scheme focused on described professional role, type of content, depth of voice, and demographics. Physicians (42 %) and researchers (19 %) were the largest professional groups to be directly cited in print media texts while pharmacists provided 14 % of all direct quotations. Nurses were identified as sources in 1 % of texts. Male professionals were quoted almost twice as frequently as their female counterparts. Images accompanying texts were more gender balanced but did not reflect workforce demographics. The comparative lack of pharmacist representation in marketing print magazines suggests a missed opportunity both as a marketing tool and for educating the public about community pharmacist expertise. There is a need to harness the potential of print media, especially those financed by and distributed in community pharmacies, to improve public perception and visibility of pharmacists, and to inform the public about the evolving roles of pharmacists in the healthcare ecosystem. Further research should explore pharmacist representations in different types of news media to better understand the impacts on public perception of pharmacists internationally. [ABSTRACT FROM AUTHOR]

Modulation of the gut microbiome composition with probiotics may have beneficial metabolic effects in pregnant women with obesity. The aim was to investigate the effect of probiotic supplementation during pregnancy on metabolic and inflammatory markers and the body composition of the offspring. A randomized double-blind trial in 50 pregnant women (pre-pregnancy BMI ≥30 and < 35 kg/m2) comparing multi-strain probiotics (Vivomixx®; 450 billion CFU/d) versus placebo from 14 to 20 weeks of gestation until delivery was carried out. Participants were followed with two predelivery visits at gestational week 27–30 and 36–37 and with one postdelivery visit. All visits included fasting blood samples (C -reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), insulin, C -peptide, glucose, glucagon, and glucagon-like peptide-1 (GLP-1)). At delivery, umbilical cord blood samples were collected (GLP-1 and glucagon). At the postdelivery visit, a dual-energy X-ray absorptiometry (DXA) scan of the newborn was performed. Forty-nine of 50 participants completed the study until delivery, and 36 mother-offspring dyads underwent postdelivery examinations including a DXA scan. There were no significant differences in changes in measured biomarkers between the probiotic versus the placebo group. No differences were found in newborn body composition or GLP-1 and glucagon. GLP-1 measured in umbilical blood samples was positively correlated to fat percent in offspring from the probiotic group. In this study of pregnant women with obesity and their newborns, there was no effect of probiotic supplementation in mothers or babies on metabolic or inflammatory biomarkers or on body composition of offspring. This study was registered at clinicaltrials.gov as NCT02508844. • No effect of multi-strain probiotics was found on metabolic and inflammatory markers in pregnant women with obesity. • No effect of multi-strain probiotics was found in offspring body composition. • GLP-1 measured in umbilical blood was correlated to DXA determined fat percent in offspring in the probiotic group. [ABSTRACT FROM AUTHOR]

Evidence on the effectiveness of vaccination-induced immunity compared to SARS-CoV-2 natural immunity is warranted to inform vaccination recommendations. In this study, we aimed to conduct a comparative assessment of antibody responses between vaccinated naïve (VN) and unvaccinated naturally infected individuals (NI) over 10 Months. The study comprised fully-vaccinated naïve individuals (VN; n = 596) who had no history of SARS-CoV-2 infection, and received two doses of either BNT162b2 or mRNA-1273, and naturally infected individuals who had a documented history of SARS-CoV-2 infection and no vaccination record (NI cohort; n = 218). We measured the levels of neutralizing total antibodies (NtAbs), anti-S-RBD IgG, and anti-S1 IgA titers among VN and NI up to ∼10 months from administration of the first dose, and up to ∼7 months from SARS-CoV-2 infection, respectively. To explore the relationship between the antibody responses and time, Spearman's correlation coefficient was computed. Furthermore, correlations between the levels of NtAbs/anti-S-RBD IgG and NtAbs/anti-S1 IgA were examined through pairwise correlation analysis. Up to six months, VN individuals had a significantly higher NtAb and anti-S-RBD IgG antibody responses compared to NI individuals. At the 7th month, there was a significant decline in antibody responses among VN individuals, but not NI individuals, with a minimum decrease of 3.7-fold (p < 0.001). Among VN individuals, anti-S1 IgA levels began to decrease significantly (1.4-fold; p = 0.007) after two months, and both NtAb and S-RBD IgG levels began to decline significantly (NtAb: 2.0-fold; p = 0.042, S-RBD IgG: 2.4-fold; p = 0.035) after three months. After 10 months, the most significant decline among VN individuals was observed for S-RBD-IgG (30.0-fold; P < 0.001), followed by NtAb (15.7-fold; P < 0.001) and S-IgA (3.7-fold; P < 0.001) (most stable). Moreover, after 5 months, there was no significant difference in the IgA response between the two groups. These findings have important implications for policymakers in the development of vaccination strategies, particularly in the consideration of booster doses to sustain long-lasting protection against COVID-19. [ABSTRACT FROM AUTHOR]

To explore nurses' and physicians' experiences of the six dimensions of interprofessional (IP) collaboration when using Goal-Directed Therapy (GDT), and to examine how existing protocols on GDT facilitate the six dimensions of IP collaboration. A qualitative design using individual semi-structured interviews and participant observations. A secondary analysis of data from participant observation and semi-structured interviews with nurses (n= 23) and physicians (n=12) in three departments of anesthesiology. Observations and interviews were carried out from December 2016 to June 2017. A deductive, qualitative content analysis using the Inter-Professional Activity Classification as a categorization matrix was used to explore interprofessional collaboration as a barrier to implementation. This analysis was supplemented by a text analysis of two protocols. Four dimensions were identified to influence IP collaboration: commitment, roles and responsibilities, interdependence, and integration of work practices. Negative factors included hierarchical boundaries, traditional nurse-physician relationship, unclear responsibility, and lack of shared knowledge. Positive factors included physician involvement of nurses in decisions and bedside education. The text-analysis showed a lack of clear directions of specific action and responsibility. Commitment and roles and responsibilities were dominant aspects of interprofessional collaboration in this context, causing problems for enhanced collaboration. Lack of clear guidance in the protocols might detract nurses' feelings of responsibility. [ABSTRACT FROM AUTHOR]

For the first time, large-eddy simulations are conducted for a 40 kW th self-sustained pulverized torrefied biomass furnace in air and oxy-fuel atmospheres using an extended flamelet model. A recently developed chemical reaction mechanism specifically for oxy-fuel combustion (117 species and 840 elementary reactions) is employed. The simulation results are compared to the experimental data, including the axial and tangential velocities and selected species mass fractions. In addition to this, certain characteristics are investigated: the flame structure, thermo-chemical variable distributions and the NO x emissions in different atmospheres. The flame in the oxy-fuel atmosphere is predicted to be longer and broader than that in the air atmosphere. The main reason for this is the significantly different flow dynamics in different atmospheres that are specifically designed to achieve the same oxidizer-to-fuel ratio near the burner. Two external recirculation zones (ERZs) and a central internal recirculation zone (IRZ) exist in the air atmosphere due to the designed boundary condition with a strongly swirled flow. In contrast, only a single ERZ and a weak IRZ can be observed in the oxy-fuel atmosphere. These different flow dynamics significantly influence the torrefied biomass combustion characteristics for the two atmospheres. Overall, the combustion characteristics in the air atmosphere exhibit features which are expected for a strongly swirling flow, while the thermo-chemical variable distributions in the oxy-fuel atmosphere are similar to those of a jet flame. It is also found that the atmospheres have significant effects on the NO x emissions, particularly for the furnace studied, which features staged oxidizer combustion. [ABSTRACT FROM AUTHOR]

In this work, large-eddy simulation (LES) is conducted for a turbulent pulverized coal flame with a detailed phenomenological model to characterize the soot evolution and a flamelet model to describe the detailed gas phase kinetics. In particular, a quadrature-based moment method (QBMM) is adopted to describe the soot statistics with the physicochemical processes of soot particle nucleation, condensation, coagulation, chemical surface growth and oxidization being considered. The simulation results are compared to the experimental data, including the direct photograph images, particle velocities, laser induced fluorescence (LIF) for polycyclic aromatic hydrocarbons (PAHs), laser induced incandescence (LII) for soot, scanning electron microscope (SEM) with the thermophoretic sampling (TS), and the time-resolved LII (TiRe-LII) for spatial soot particle size distribution. The comparisons show that the ignition position and the mean velocity of the coal particles can be accurately predicted with the proposed flamelet/QBMM/LES method, and an overall good agreement is also obtained when comparing against the PAHs-LIF, soot-LII and SEM images. The importance of the contributions of the different physicochemical processes to the soot particle volume growth is quantified by analyzing the corresponding moment source terms. It is found that for the pulverized coal flame studied, the chemical surface growth is the most important contribution to the soot volume growth at different locations along the streamwise direction. Although the nucleation does not make a significant contribution to soot volume growth, it determines the number density of the primary soot particles formed in the main flow region. [ABSTRACT FROM AUTHOR]

In this work, carrier-phase direct numerical simulation (CP-DNS) is conducted for a pulverized coal flame in a temporally evolving turbulent jet with flue gas recirculation (FGR). Detailed gas phase kinetics are considered and heavy hydrocarbon molecules up to C 20 are included to accurately represent tars in the volatile matter. The structure of the pulverized coal flame is analyzed with different flamelet models considering two mixing scenarios, namely the mixing of recirculated flue gases with the other fuel or oxidizer streams. In the first model approach, the mixing of recirculated flue gases with the gaseous fuels released from the coal particle is characterized with a fuel-split-based flamelet (FLT-FS) model. In the second approach, the mixing of flue gases with the transport air is described with an oxidizer-split-based flamelet (FLT-OS) model. In total, five trajectory variables are introduced in the flamelet table to represent the pulverized coal combustion states with FGR. The suitability of the flamelet models is evaluated through an a priori analysis for both the fully ignited state, as well as (more challenging) the igniting states. Comparisons show that both the FLT-FS model and the FLT-OS model perform well in predicting the thermo-chemical quantities for the fully ignited state. The FLT-OS model performs slightly better than the FLT-FS model in predicting the gas temperature and specific species mass fractions. This is due to the fact that the partial oxidization of the gaseous fuels by the hot flue gases outside the mixing layers cannot be reproduced by the FLT-FS model. While the state at the beginning of ignition can still be accurately predicted by the FLT-OS model, discrepancies can be observed for the tar species C 20 H 10 and the intermediate species CO at a later stage when many particles ignite and the reason for this is explained. Further analysis in the flamelet solution spaces shows that the gaseous fuels are ignited on the fuel-lean side. The time evolution of the gas temperature from the beginning of ignition to the fully ignited state can be overall characterized by both flamelet models. [ABSTRACT FROM AUTHOR]

A multiphase flamelet/progress variable (FPV) model for the large eddy simulation (LES) of gas-assisted pulverised coal combustion (PCC) is developed. The target of the simulation is the Darmstadt turbulent gas-assisted swirling solid fuel combustion chamber. The coal particles are treated as Lagrangian point particles, the position, momentum and energy of which are tracked. The gas phase is described by the low-Mach Navier-Stokes equations alongside the Eulerian transport equations of the governing variables for the FPV model. The set of chemical states of the PCC flame is pre-tabulated in a six-dimensional flamelet table and determined by the mixing of the primary fuel stream, volatiles and char off-gases with the oxidising air, the progress of chemical reactions, the interphase heat transfer, as well as sub-grid scale variations. A presumed β -PDF approach for the total mixture fraction is applied to capture sub-grid scale effects. The discrete ordinate method (DOM) with the weighted sum of grey gases model (WSGGM) is employed to model radiation. The FPV-LES results are validated against the experimental evidence and a good agreement of the predicted mean and RMS velocities, as well as the mean gas temperature between experiments and simulations is obtained. The contributions of the pilot, volatile and char off-gas fuel streams to the coal flame are analysed. It is found that most regions of the furnace are dominated by either pilot or volatile combustion, while char conversion only occurs in the far downstream and outer furnace regions. The pilot gas dominates the near-wall region inside the quarl, whereas the volatile gas mainly released from small particles dominates a first volatile combustion zone in the interior of the internal recirculation zone. Larger particles heat up more slowly and release their volatile content further downstream, leading to a secondary volatile combustion zone. [ABSTRACT FROM AUTHOR]

This investigation provided independent external validation of an existing preoperative risk prediction model. A prospective observational cohort study of patients undergoing cardiac surgery covering the period between April 16, 2018 and January 18, 2022. Two academic hospitals in Switzerland. Adult patients (≥60 years of age) who underwent elective cardiac surgery, including coronary artery bypass graft, mitral or aortic valve replacement or repair, and combined procedures. None. The primary outcome measure was the incidence of postoperative delirium (POD) in the intensive or intermediate care unit, diagnosed using the Intensive Care Delirium Screening Checklist. The prediction model contained 4 preoperative risk factors to which the following points were assigned: Mini-Mental State Examination (MMSE) score ≤23 received 2 points; MMSE 24-27, Geriatric Depression Scale (GDS) >4, prior stroke and/or transient ischemic attack (TIA), and abnormal serum albumin (≤3.5 or ≥4.5 g/dL) received 1 point each. The missing data were handled using multiple imputation. In total, 348 patients were included in the study. Sixty patients (17.4%) developed POD. For point levels in the prediction model of 0, 1, 2, and ≥3, the cumulative incidence of POD was 12.6%, 22.8%, 25.8%, and 35%, respectively. The validation resulted in a pooled area under the receiver operating characteristics curve of 0.60 (median CI, 0.525-0.679). The evaluated predictive model for delirium after cardiac surgery in this patient cohort showed only poor discriminative capacity but fair calibration. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected various urban population groups in different ways. Earlier studies have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disproportionally impacts nursing home residents by increasing morbidity and mortality following viral exposure. However, little is known about the epidemiology of this disease in detail. Therefore, the objective of this study is to analyze the development of the COVID-19 pandemic in 14 nursing homes across Berlin-Neukölln, Germany, during pandemic waves 1 to 5 (Feb 2020 - May 2022). Reporting data to the Neukölln Department of Public Health on COVID-19 cases in connection with nursing homes were extracted from the SORMAS database. The case fatality rates (CFRs) and odds ratios (ORs) of demographic parameters, prevalent variants of concern (VOCs) and vaccine availability were calculated. In addition, the temporal course in waves 1–5 in Neukölln and the relevant government measures were examined. Data collected from nursing homes providing age-dependent physical care revealed that 1.9 % of the total 108,600 cases registered in Berlin-Neukölln during the study period were related one of the 14 facilities. Compared to the general population in Neukölln, nursing homes exhibited a 20-fold increase in the CFR. Notably, nursing homes with higher bed capacities displayed a greater CFR than did smaller nursing homes. Similarly, elderly residents living in nursing homes faced a much greater mortality rate than did their counterparts living outside of medical settings (OR = 3.5). The original wild-type SARS-CoV-2 strain had the most severe direct impact, with a CFR of 16.7 %, compared to the alpha (CFR = 6.9 %), delta (CFR = 10.2 %) and omicron (CFR = 2.8 %) variants in nursing homes. Interestingly, the number of infections increased following vaccination campaigns, but this trend was accompanied by a decrease in the number of deaths from 2.6 to 1.1 per week. As a result, the CFR significantly decreased from 18.4 to 5.5, while still exceeding the mean CFR compared to that of the general population of Neukölln. Our findings reveal the changing patterns of outbreak frequency and severity across the five pandemic waves. They highlight the crucial role of rapid vaccination programs for residents, staff, visitors, and third-party services in safeguarding nursing homes. Additionally, improvements in containment and cluster strategies are essential in prevaccination scenarios to prevent future infection traps for elderly individuals in long-term care facilities. The presented data highlight the importance of tailored protection measures for one of the most vulnerable populations in our society. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess patient satisfaction relating to inpatient stays. In this prospective observational study, adult patients with oncological (oral cancer, medication-related osteonecrosis of the jaw) and non-oncological (mandibular fracture) diagnoses, and who had undergone surgery, were contacted 4 weeks after discharge. Two validated questionnaires were used: EORTC QLQ-C30 for quality of life and IN-PATSAT32 for patient satisfaction. For quality of life, the mandibular fracture group had a lower impairment of physical functioning (M = 83.59, SD = 24.44; p = 0.029) in comparison with both other groups (M = 68.84, SD = 26.24; M = 59.33, SD = 24.43, for oral cancer and osteonecrosis, respectively). Regarding patient satisfaction, patients with oral cancer were slightly more satisfied with doctors' availability (M = 48.91, SD = 24.11; p = 0.583) compared with the other groups (M = 36.54, SD = 19.11; M = 46.67, SD = 20.86, for mandibular fracture and ostenecrosis, respectively). Patients with an unplanned inpatient stay following an acute event tended to be less satisfied than patients with a planned inpatient stay. Within the limitations of the study it seems that knowledge of these influencing external factors and their effects can support physicians and nursing staff in providing improved patient care. [ABSTRACT FROM AUTHOR]

As one of the flagship amendments to the Plastic Waste Management (PWM) Rules, 2021, the pan-Indian ban on a group of single-use plastic products (SUPPs) introduced in mid-2022 provided a departure point towards more progressive plastic waste legislation. The amendments have mostly been welcomed, yet challenges persist to facilitate its implementation, assess potential environmental impacts of alternative materials, and socio-economic concerns raised by various stakeholders. Considering the recent amendments to the PWM Rules, we critically engage with and highlight key considerations and prevailing challenges with regards to phasing out SUPPs. We argue that to shape sustainable solutions that reduce plastic pollution, uncertainties related to the environmental fate of SUPP alternatives need to be better understood, whilst recognising and accounting for broader socio-economic impacts of SUPP bans, including industry concerns, impacts on socio-economically disadvantaged communities, and the informal recycling sector. A stronger knowledge base on these aspects can mitigate negative social and environmental externalities, including potentially harmful consequences of ambitious plastic pollution reduction measures. • Bans on single-use plastic products may have adverse socio-economic and environmental impacts. • Contextual considerations are key when promoting alternatives to single-use plastic products. • India is phasing out single-use plastic products by 2022 but implementation varies across states. • Alternatives to single-use plastic products may have unforeseen environmental impacts. • Identifying socio-economic aspects of plastic pollution can promote just and sustainable development. [ABSTRACT FROM AUTHOR]

To support laparoscopic post-chemotherapy retroperitoneal lymph-node dissection (L-PC-RPLND) as a potential new standard, we report on a large dataset of patients systematically undergoing L-PC-RPLND. Patients with unilateral residual mass (≥1 cm), normalized markers, limited encasement (<30%) of gross retroperitoneal vessels underwent unilateral L-PC-RPLND with no adjuvant chemotherapy. Surgical performances, histology, hospital stay, complications within 30 days and follow-up visits were recorded. Multivariable linear and logistic regression models were used. Between February 2011 and January 2021, 151 consecutive patients underwent L-PC-RPLND. Median size of the residual mass was 25 mm (interquartile range [IQR] 20–35 mm). Overall median operative time was 208 min (IQR 177–241) and was 51 min longer (p-value <0.001) for right L-PC-RPLNDs. Eleven procedures were converted to open surgery. Median number of removed and positive nodes was 11 (IQR 8–16) and 1 (IQR 1–2), respectively. Mean hospital stay was 2 days (IQR 2–3). Nine complications (6%) occurred: two were Clavien-Dindo grade III. Definitive pathology revealed post-pubertal teratoma in 65.6%, fibro-necrotic tissue in 23.8%, teratoma with malignant somatic component in 6.6% and viable tumour in 4.0% patients. In multivariable linear regression models, fibro-necrotic tissue (32 min, CI 8.5–55.5; p < 0.01) and residual volume (1.05 min, CI 0.24–1.85; p < 0.01) achieved independent predictor status for longer operative time. All patients, but one, are alive and disease-free after a median follow-up of 22 months (IQR 10, 48). L-PC-RPLND, when adequately planned, is safe and effective for most patients with low to medium volume residual masses. [ABSTRACT FROM AUTHOR]

To study normative values of range of motion (ROM), strength, and functional performance and investigate changes over 1 year in adolescent female football players. Cross-sectional. 418 adolescent female football players aged 12–17 years. The physical characteristic assessments included (1) ROM assessment of the trunk, hips, and ankles; (2) strength measures (maximal isometric and eccentric strength for the trunk, hips, and knees, and strength endurance for the neck, back, trunk and calves), and (3) functional performance (the one-leg long box jump test and the square hop test). Older players were stronger, but not when normalized to body weight. Only small differences in ROM regarding age were found. ROM increased over 1 year in most measurements with the largest change in hip external rotation, which increased by 6–7° (Cohen's d = 0.83–0.87). Hip (d = 0.28–1.07) and knee (d = 0.38–0.53) muscle strength and the square hop test (d = 0.71–0.99) improved over 1 year. Normative values for ROM and strength assessments of neck, back, trunk, hips, knees, calves and ankles are presented for adolescent female football players. Generally, fluctuations in ROM were small with little clinical meaning, whereas strength improved over 1 year. • Normative values for clinical and functional tests in adolescent female football players. • Range of motion did not change over 1 year. • Older players were stronger, but not when normalized to body weight. • Female adolescent players improved in hip abduction strength and square hop test over 1 year. [ABSTRACT FROM AUTHOR]

The incidence of facial skin cancer increases worldwide, resulting in more surgical resections and reconstructions. Reconstructive surgery aims to approach a normal facial anatomy to optimize the quality of life. Objective automated assessment of the esthetic outcome of facial reconstructions could provide feedback for the improvement of surgical techniques and preoperative patient expectation management. This systematic literature review aimed to assess whether modern technologies can create automated objective measurements of surgical and non-surgical facial interventions outcomes using 3D surface imaging technology. A systematic literature search was conducted in Embase, Medline (Ovid), Web of Science, and Cochrane on May 19, 2021. All English literature was collected on surgical and non-surgical invasive facial interventions in which 3D surface imaging technology was used for objective automated assessment of outcomes. Fourteen articles were included in the systematic review. 3D surface imaging technology and automated assessment techniques were found for skin malignancy, cleft lip repair, rhinoplasty, orthognathic surgery, and injectables. Ten 3D surface imaging technology hardware systems and 12 software systems were described. Four studies compared 3D surface imaging techniques to conventional methods. Ten studies used 3D surface imaging techniques for the evaluation of the surgical outcome, without comparison to 2D photography, validated scores, or a panel. Two studies validated the hardware system. This systematic literature review shows that 3D surface imaging technology has the potential for automated objective assessment of facial intervention outcomes. Future studies are necessary to study and validate these tools for standard clinical use in patients with facial interventions. [ABSTRACT FROM AUTHOR]

Background: Data concerning the long-term risk of heart failure (HF) in patients with takotsubo syndrome (TTS) are sparse. We compared the rates of death and hospitalization due to HF with matched individuals from the background population and patients with ST-segment elevation myocardial infarction (STEMI).Methods: In this nationwide observational cohort study, all patients with first-time TTS (2011-2018) who were alive at discharge were identified by using data from Danish nationwide registries. These were matched for age and sex with individuals from the background population (1:4 matching) and with patients with STEMI who were alive at discharge (1:3 matching).Results: A total of 881 patients with TTS who were alive at discharge were identified (median age 70 years; 89.4% men). During a mean follow-up of 2.9 years, the incidence rates of death, HF hospitalization, and TTS recurrence in survivors of TTS were 6.9, 0.9 and 1.1 events per 100 person-years. The corresponding absolute 3-year risks were 9.3%, 1.8% and 2.5%, respectively. Survivors of TTS had higher associated rates of death compared with the background population (hazard ratio [HR] 2.05 [95% CI, 1.62-2.60]) and survivors of STEMI (HR 1.69 [1.34-2.13]). Similarly, survivors of TTS had higher associated rates of hospitalization due to HF compared with the background population (HR 4.24 [1.88-9.53]), but lower rates compared with survivors of STEMI (HR 0.34 [0.20-0.56]). Propensity-score matched analyses yielded similar results.Conclusions: Survivors of TTS had significantly higher associated mortality rates than the background population and survivors of STEMI. Survivors of TTS had lower HF hospitalization rates than survivors of STEMI, but the rates were higher than those of the background population. [ABSTRACT FROM AUTHOR]

A number of studies have suggested that pancreatic α cells produce intact GLP-1, thereby constituting a gut-independent paracrine incretin system. However, the debate on whether human α cells contain intact GLP-1 and whether this relates to the presence of diabetes is still ongoing. This study aimed to determine the presence of proglucagon-derived peptides, including GLP-1 isoforms, in pancreas biopsies obtained during partial pancreatectomy from metabolically profiled human donors, stratified according to pre-surgery glucose tolerance. We enrolled 61 individuals with no known history of type 2 diabetes (31F/30M, age 64.6 ± 10.6 yrs., BMI 24.2 ± 3.68 kg/m2) scheduled for partial pancreatectomy for periampullary neoplasm. Differences in glucose tolerance and insulin secretion/sensitivity were assessed using preoperative 2 h OGTT, 4 h-Mixed Meal Test and Hyperinsulinemic Euglycemic Clamp. Subjects were subsequently classified as normal glucose tolerant (NGT, n = 19), impaired glucose tolerant (IGT, n = 20) or newly diagnosed diabetes (DM) (n = 22). We measured total GLP-1, intact GLP-1, glucagon, insulin, and C-peptide in pancreas biopsies and plasma from these subjects and correlated the results with their secretory and metabolic parameters. Extractable levels of total GLP-1 were 23.9 ± 2.66 pmol/g, while intact GLP-1 levels were 1.15 ± 0.18 pmol/g. When we examined proglucagon derived peptides (adjusted for glucagon levels), in subjects classified according to glucose tolerance, we observed similar levels of total GLP-1, however, intact GLP-1 was significantly increased in IGT and DM groups and inversely associated with beta cell glucose sensitivity and insulin secretion in vivo. Our data show that development of glucose intolerance and beta cell dysfunction are significantly associated with increased levels of intra-islet intact GLP-1, a potentially beneficial adaptation of the paracrine regulation of insulin secretion in type 2 diabetes. • Intra-islet intact GLP-1 rises in prediabetes and early diabetes, suggesting a compensatory role in glucose control. • Inverse link between intra-islet GLP-1 and beta cell function impacts type 2 diabetes progression. • Pancreatic GLP-1, independent of gut sources, plays a novel role in regulating insulin secretion. [ABSTRACT FROM AUTHOR]

Guidelines for surgical correction of patients with ascending thoracic aortic aneurysm (ATAA) with a bicuspid aortic valve (BAV) have oscillated over the years. In this study, we outline the natural history of the ascending aorta in patients with BAV and trileaflet aortic valve (TAV) ATAA followed over time, to ascertain if their behavior differs and to determine if a different threshold for intervention is required. Aortic diameters and long-term complications (ie, adverse aortic events) of 2428 patients (554 BAV and 1874 TAV) with ATAA before operative repair were reviewed. Growth rates, yearly complication rates, event-free survival, and risk of complications as a function of aortic size were calculated. Long-term follow-up and precise cause of death granularity was achieved via a comprehensive 6-pronged approach. Aortic growth rate in patients with BAV vs TAV ATAA was 0.20 and 0.17 cm/year, respectively (P =.009), with the rate increasing with increasing aortic size. Yearly adverse aortic events rates increased with ATAA size and were lower for patients with BAV. The relative risk of adverse aortic events exhibited an exponential increase with aortic diameter. Patients with BAV had a lower all-cause and ascending aorta-specific adverse aortic events hazard. Age-adjusted 10-year event-free survival was significantly better for patients with BAV, and BAV emerged as a protective factor against type A dissection, rupture, and ascending aortic death. The threshold for surgical repair of ascending aneurysm with BAV should not differ from that of TAV. Prophylactic surgery should be considered at 5.0 cm for patients with TAV (and BAV) at expert centers. [Display omitted] [ABSTRACT FROM AUTHOR]

The phase 2 RAMONA study demonstrated that second-line nivolumab ± ipilimumab immunotherapy was feasible and effective in older patients with advanced esophageal squamous cell cancer (ESCC). Here, we presented results from functional status (FS) and quality-of-life (QoL) analyses. Patients aged ≥65 years with advanced ESCC and disease progression following first-line therapy were enrolled for study treatment with nivolumab ± ipilimumab. Geriatric assessments (GA) consisting of G8 and GoGo/SlowGo evaluation, and quality of life (QoL) assessments with EORTC QLQ-C30 questionnaires were conducted at baseline and during the treatment. A post hoc analysis was performed to compare therapy efficacy, toxicity, and QoL between age groups (≥70 years vs. <70 years) and functionality groups (G8 > 14 vs. ≤14 and GoGo vs. SlowGo). In 66 treated patients with a median age of 70.5 years, older patients had non-inferior overall survival and tumor response compared to younger patients, with no increased treatment-related adverse events. Fitter patients (G8 > 14, GoGo) had a clinically, yet not statistically significant, survival advantage than less fit patients (G8 ≤ 14, SlowGo) patients. Moreover, FS by G8 and GoGo/SlowGo significantly correlated with QoL. Overall, QoL was impaired at baseline but remained stable in all scales over the course of immunotherapy. The administration of nivolumab ± ipilimumab second-line immunotherapy in older patients with ESCC did not show age-dependent effects and maintained QoL. GA could identify functional deficits and limitations of QoL and should be implemented in the context of immunotherapy. ClinicalTrials.gov : NCT03416244. [ABSTRACT FROM AUTHOR]

Periprosthetic joint infection (PJI) is a devastating complication in hip and knee joint arthroplasty. The "Joint-Specific Bone Involvement, Antimicrobial Options, Coverage of the Soft Tissues, and Host Status (JS-BACH)" classification system was developed in 2021 to stratify the complexity of PJI, and more importantly, to act as a tool to guide referrals to specialist centers. The "JS-BACH" classification has not been validated in an external cohort. This study aimed to do so using a large prospective cohort from Australia and New Zealand. We applied the JS-BACH classification to the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort. This prospective study of newly diagnosed PJI collected 2-year outcome data from 653 participants enrolled in 27 hospitals. The definition of PJI treatment failure at 24 months was any of the following: death, clinical or microbiological signs of infection, destination prosthesis removed, or ongoing antibiotic use. Individual cases were classified as per JS-BACH into "1: uncomplicated" (n = 268), "2: complex" (n = 330), and "3: limited options" (n = 55). This cohort was similar to the original JS-BACH population in terms of baseline characteristics. However, there was a difference in complexity, with more debridement, antibiotics, and implant retention procedures, fewer revision procedures, and a higher proportion of uncomplicated patients in the PIANO cohort. The risk of treatment failure correlated strongly with the JS-BACH category, with odds ratios (95% confidence interval) for category 2 versus 1 of 1.75 (1.24 to 2.47) and for category 3 versus 1 of 7.12 (3.42 to 16.02). Despite the PIANO study population being less complicated than the original derivation cohort, the JS-BACH classification showed a clear association with treatment failure in this large external cohort. [ABSTRACT FROM AUTHOR]

Background: A few limited case series have shown that the subcutaneous implantable cardioverter-defibrillator (S-ICD) system is safe for teenagers and young adults, but a large-scale analysis currently is lacking.Objectives: The purpose of this study was to compare mid-term device-associated outcomes in a large real-world cohort of S-ICD patients, stratified by age at implantation.Methods: Two propensity-matched cohorts of teenagers + young adults (≤30 years old) and adults (>30 years old) were retrieved from the ELISIR Registry. The primary outcome was the comparison of inappropriate shock rate. Complications, freedom from sustained ventricular arrhythmias, and overall and cardiovascular mortality were deemed secondary outcomes.Results: Teenagers + young adults represented 11.0% of the entire cohort. Two propensity-matched groups of 161 patients each were used for the analysis. Median follow-up was 23.1 (13.2-40.5) months. In total, 15.2% patients experienced inappropriate shocks, and 9.3% device-related complications were observed, with no age-related differences in inappropriate shocks (16.1% vs 14.3%; P = .642) and complication rates (9.9% vs 8.7%; P = .701). At univariate analysis, young age was not associated with increased rates of inappropriate shocks (hazard ratio [HR] 1.204 [0.675-2.148]: P = .529). At multivariate analysis, use of the SMART Pass algorithm was associated with a strong reduction in inappropriate shocks (adjusted HR 0.292 [0.161-0.525]; P <.001), whereas arrhythmogenic right ventricular cardiomyopathy (ARVC) was associated with higher rates of inappropriate shocks (adjusted HR 2.380 [1.205-4.697]; P = .012).Conclusion: In a large multicenter registry of propensity-matched patients, use of the S-ICD in teenagers/young adults was safe and effective. The rates of inappropriate shocks and complications between cohorts were not significantly different. The only predictor of increased inappropriate shocks was a diagnosis of ARVC. [ABSTRACT FROM AUTHOR]

Older patients with metastatic pancreatic cancer may suffer increased toxicity from intensive chemotherapy. Treatment individualization by geriatric assessment (GA) might improve functional outcome. We performed a multicenter, phase IV, open label trial in patients ≥70 years with metastatic pancreatic adenocarcinoma. Patients underwent GA and were assigned to one of three categories based on their scores: Go-Go, Slow-Go, or Frail. These categories were intended to guide physician's treatment decisions when choosing to treat patients with nab-paclitaxel/gemcitabine (arm A), gemcitabine (arm B), or best supportive care (arm C). Primary objective was a stable (loss of five points or less) Barthel's Activities of Daily Living (ADL) score during chemotherapy; secondary endpoints included GA scores during therapy, safety, quality of life, response and survival rates. Thirty-two patients were enrolled in the trial in six centers in Germany (out of 135 planned), resulting in termination due to low recruitment. Fifteen patients were allocated to nab-paclitaxel/gemcitabine, fifteen to gemcitabine, and two to best supportive care by their physicians, although according to their GA scores 29 patients (91%) were categorized as Slow-Go and three (9%) as Go-Go. Thus, fifteen of 32 (47%) patients were misclassified and given a course of treatment inconsistent with their GA scores. Median progression-free survival (PFS) were 3.3 months and 9.1 months and median time to quality-of-life deterioration 13 days and 29 days in the nab-paclitaxel/gemcitabine and gemcitabine monotherapy arms, respectively. Serious adverse events were reported in 11 (78.6%) patients in the nab-paclitaxel/gemcitabine and 8 (53.3%) patients in the gemcitabine arm. Clinical evaluations by investigators differed markedly from geriatric assessments, leading to potential overtreatment. In our modest sample size study, those patients undergoing more intensive therapy had a less favorable course. [ABSTRACT FROM AUTHOR]

The adequacy of the surgical resection is the main controllable variable that is in the hands of the surgical team. There exists an unmet need to increase the rate of negative margins, particularly in cancers invading the craniofacial area. The study aimed 1) at developing a gross tumor model to be utilized for research, educational, and training purposes and 2) establishing the 3-dimensional relationship between the outer surface of the surgical specimen and tumor surface and test the effect of guiding ablations on cadavers with surgical navigation (SN). Seven cadaver heads were employed to create 24 craniofacial tumor models. Simulation of tumor resections was performed by 8 surgeons. Fourteen and 10 resections were performed with and without SN-guidance, respectively. Gross specimens underwent computed tomography and 3-dimensional analysis through dedicated software. Task load was assessed through a validated questionnaire. Tumor model reliability was studied based on visual analogue scale rate by surgeons and radiologists. SN reduced the rate of margin involvement, particularly by decreasing the percentage of the gross specimen outer surface involvement in areas uncovered by normal bony structures. The workload of SN-aided ablations was found to be medium-to-somewhat-high. Tumor model reliability was deemed satisfactory except for the extension to bony structures. A gross tumor model for head and neck cancers involving the craniofacial area was developed and resulted satisfactorily reliable from both a surgical and radiologic standpoint. SN reduced the rate of margin involvement, particularly by improving delineation of bone-uncovered areas. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Adnexal masses detected incidentally at transvaginal ultrasound (TVUS) are a common and still challenging diagnostic problem. The primary goal of further imaging is an accurate tissue characterization so an optimal treatment plan can be devised including surgery only for lesions that are indeterminate or malignant. The aim of this prospective study was to evaluate the diagnostic utility of complementary multiparametric magnetic resonance imaging (mMRI) for treatment planning in patients with adnexal masses, and to assess how it ultimately correlates with subsequent histopathologic findings.Material and Methods: A total of 126 women (mean age: 54.6 years) with indeterminate adnexal masses underwent mMRI at 3T in addition to TVUS and testing to determine their CA-125 levels. The mMRI protocol consisted of a high-resolution T2-TSE in three planes, diffusion weighted images and dynamic contrast enhanced. First the character of the adnexal mass and the associated management decision (follow-up, laparoscopy or laparotomy) were assessed independently for each diagnostic method (TVUS + CA-125 and mMRI). All methods were then assessed in synopsis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each diagnostic method alone and in combination were calculated. The standard of reference was either final histology in women who underwent surgery or follow-up of at least 24 months in women who underwent follow-up.Results: In 67.5% (85/126) of all patients, the adnexal mass was benign; a malignant tumor was diagnosed in 28.6% (36/126) and a borderline tumor in the remaining 4% (5/126) of patients. The diagnostic indices were as follows for TVUS + CA 125 alone, mMRI alone and all three methods combined: sensitivity 86% (31/36), 97% (35/36), and 100% (36/36); specificity 32% (29/90), 83% (75/90), and 80% (68/90); PPV 34% (31/91), 70% (35/50), and 74% (40/54); and NPV 65% (29/44), 98% (75/76), and 100% (72/72). Complementary use of mMRI changed the therapeutic management decision in 34% (41/126) of all patients. In 40.7% (37/91) of patients for whom surgery had been recommended based on TVUS + CA-125, MRI revealed a typical benign finding such that those patients underwent follow-up instead of surgery. None of the examined masses exhibited (tumor) progression or malignancy during the follow-up period. A laparotomy was performed instead of a laparoscopy in 8.7% (11/126) based on the mMRI result.Conclusion: MRI helps significantly improve sensitivity and specificity of diagnosis in patients with indeterminate adnexal masses detected at TVUS. Its diagnostic information revised the planned treatment in more than one-third of women. [ABSTRACT FROM AUTHOR]

• 2D-LV GLS did not differ significantly in awake versus anesthetized patients. • 2D-LV GLS did not decline after sternotomy. • 2D-LV GLS deteriorated after uneventful, complication-free on-pump CABG. • Whereas LV EF and LV S´ remained unchanged. There are limited data on perioperative left ventricular strain. The authors aimed to describe the entire perioperative course of two-dimensional left ventricular global longitudinal strain in patients undergoing coronary artery bypass graft (CABG) surgery and compare to common parameters of LV function assessment. Prospective observational study. Single university hospital. Forty patients scheduled for isolated on-pump CABG surgery with preserved left and right ventricular function with an unremarkable, complication-free perioperative course. Two-dimensional strain analysis and standard echocardiographic assessment of left ventricular function were performed pre- (T1) and postoperatively (T4) by transthoracic echocardiography (TTE) and intraoperatively pre- (T2) and poststernotomy (T3) by transesophageal echocardiography (TEE). Echocardiography was performed under stable hemodynamics and predefined fluid management, in sinus rhythm without any vasoactive support. Analysis of two-dimensional LV global longitudinal strain (2D-LV GLS) was performed using Tomtec 2D Cardiac Performance Analysis software. Philips QLAB 10.8 was used to analyze left ventricular ejection fraction (LV EF) and tissue velocity of the lateral mitral annulus (LV S ́). There were no significant differences (median with interquartile range [IQR]) after induction of anesthesia in values of LV EF and 2D-LV GLS (T1 v T2; 59% [IQR, 52 to 64] v 56% [IQR, 51.75 to 63] and -15.2 [IQR, –18.05 to –13.08] v –15.6 [IQR, –17.65 to –13.88]; both not significant [ns]), while LV S´ declined (T1 v T2, 7 cm/s [IQR, 5.25 to 8] v 5.25 cm/s [IQR, 4.6 to 6.83]; p < 0.001). Bland-Altman analysis for this comparison of 2D-LV GLS (T1 v T2) showed that bias was not significant between both techniques; however, there were limits of agreement. After sternotomy (T2 v T3) neither LV EF nor 2D-LV GLS or LV S´ declined. 2D-LV GLS deteriorated significantly after CABG (T1 v T4; –15.2 [IQR, –18.05 to –13.08] v –11.3 [IQR, –15.8 to –9.78]; p < 0.001). In contrast, LV EF and LV S´ did not change significantly in the perioperative interval (T1 v T4; 59% [IQR, 52 to 64] v 56% [IQR, 51.5 to 64.25] and 7 cm/s [IQR, 5.25 to 8] v 7 cm/s [IQR, 6 to 8]; both ns). Values of 2D-LV GLS did not differ in awake, spontaneously breathing patients assessed by TTE and in anesthetized and ventilated patients with stable hemodynamics measured by TEE. 2D-LV GLS did not change after sternotomy; however, it declined significantly after on-pump CABG, while LV EF and LV S´ remained unchanged. [ABSTRACT FROM AUTHOR]

The purpose of this study was to report our institutional experience with patients with COVID-19 who developed acute limb ischemia during hospitalization and to determine the characteristics and clinical outcomes. Between March 2020 and January 2021, we treated 3 patients who were COVID-19–positive and developed acute limb ischemia after they received thromboprophylaxis. We performed an embolectomy by exposing the popliteal artery below the knee to treat an occlusion of the popliteal and tibial arteries. An infusion of unfractionated heparin was initiated immediately after surgery, maintaining a partial thromboplastin time ratio > 2.5 times the normal value and transferred the patients to the intensive care unit. However, after these patients developed recurrent acute limb ischemia in the same leg, we decided to perform an embolectomy of popliteal and tibial arteries at the ankle and created an arteriovenous fistula (AVF) with tibial veins using polypropylene 7-0. The first patient died from pneumonia after 3 weeks in the intensive care unit; at that time, the foot was viable with triphasic flow in the distal posterior tibial artery and the AVF was patent. The second and third patients are doing well, they can walk without any problems, and the tibial arteries and AFV were patent on duplex ultrasound after 6 months. The AVF allowed part of the flow of tibial arteries to divert into the small veins of the foot that have a low resistance to maintain patency of tibial vessels, despite a hypercoagulable state and extensive thrombotic microangiopathy in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Increased attenuation of pericoronary adipose tissue (PCAT) around the right coronary artery (RCA) derived from coronary CTA might detect coronary inflammation. We investigated a potential association between RCA PCAT attenuation and serum levels of atherosclerosis-relevant cytokines and MACE (coronary revascularization, myocardial infarction and/or cardiac death). Blood samples of 293 clinically stable individuals (59.0 ​± ​9.8 years, 69% males) were analyzed for atherosclerosis-relevant cytokines including interleukin (IL)-2, IL- 4, IL-6, IL-7, IL-8, IL-10, IL-13, IL-15, IL-17, TNF-a, IP-10, CRP, MCP-1, MIP-1a, Eotaxin and GM-CSF. Subjects also underwent coronary calcium scoring (CCS) followed by CTA. PCAT CT attenuation was measured around the RCA using semi-automated software. Increased RCA PCAT attenuation was defined as PCAT attenuation above the 75th percentile (>−73.5 HU). To assess MACE, 232 individuals were followed for a mean duration of 9.6 ​± ​2.1 years. In patients with increased RCA PCAT attenuation the serum levels of MCP-1 were increased (p ​< ​0.01), whereas levels of anti-inflammatory mediators IL-4 and -13 were significantly reduced (each p ​< ​0.05). Adipocytokine MCP-1 (r ​= ​0.23, p ​< ​0.01) and pro-inflammatory mediator IL-7 (r ​= ​0.12, p ​= ​0.04) showed a mild positive correlation with RCA PCAT attenuation, whereas anti-inflammatory mediators Il-4, -10 and -13 correlated inversely (each r < −0.12, each p ​< ​0.05). 40/232 patients experienced MACE during follow-up. In multivariable Cox regression analysis increased RCA PCAT attenuation was shown to be an independent predictor of MACE (HR 2.01, p ​= ​0.044). Increased RCA PCAT CT attenuation shows a weak association with serum levels of selected atherosclerosis-relevant inflammatory biomarkers. Increased RCA PCAT attenuation is an independent predictor of MACE and may potentially guide future prevention strategies in stable patients. [ABSTRACT FROM AUTHOR]

Glucagon receptor agonism is currently explored for the treatment of obesity and metabolic dysfunction-associated steatotic liver disease (MASLD). The metabolic effects of glucagon receptor agonism may in part be mediated by increases in circulating levels of Fibroblast Growth Factor 21 (FGF21) and Growth Differentiation Factor 15 (GDF15). The effect of glucagon agonism on FGF21 and GDF15 levels remains uncertain, especially in the context of elevated insulin levels commonly observed in metabolic diseases. We investigated the effect of a single bolus of glucagon and a continuous infusion of glucagon on plasma concentrations of FGF21 and GDF15 in conditions of endogenous low or high insulin levels. The studies included individuals with overweight with and without MASLD, healthy controls (CON) and individuals with type 1 diabetes (T1D). The direct effect of glucagon on FGF21 and GDF15 was evaluated using our in-house developed isolated perfused mouse liver model. FGF21 and GDF15 correlated with plasma levels of insulin, but not glucagon, and their secretion was highly increased in MASLD compared with CON and T1D. Furthermore, FGF21 levels in individuals with overweight with or without MASLD did not increase after glucagon stimulation when insulin levels were kept constant. FGF21 and GDF15 levels were unaffected by direct stimulation with glucagon in the isolated perfused mouse liver. The glucagon-induced secretion of FGF21 and GDF15 is augmented in MASLD and may depend on insulin. Thus, glucagon receptor agonism may augment its metabolic benefits in patients with MASLD through enhanced secretion of FGF21 and GDF15. [Display omitted] • FGF21 and GDF15 were highly increased in MASLD following glucagon stimulation. • Plasma FGF21 and GDF15 levels correlated with insulin, but not glucagon. • FGF21 was unaffected by glucagon stimulation when insulin levels were constant. • No direct effect of glucagon on FGF21 and GDF15 secretion • The increase of FGF21 and GDF15 by glucagon in MASLD may depend on insulin. [ABSTRACT FROM AUTHOR]

• COVID-19 risk patterns and influencing factors change across different pandemic periods. • Sociodemographic factors exert a stronger influence over built-environmental features. • Elderly population is inversely associated with COVID-19 risk. • Migrant communities face higher COVID-19 risk, highlighting ethnic health inequalities. • A hierarchical Bayesian modelling approach was developed. Numerous studies have explored influencing factors in COVID-19, yet empirical evidence on spatiotemporal dynamics of COVID-19 inequalities concerning both socioeconomic and environmental factors at an intra-urban scale is lacking. This study, therefore, focuses on neighborhood-level spatial inequalities of the COVID-19 incidences in relation to socioeconomic and environmental factors for Berlin-Neukölln, Germany, covering six pandemic periods (March 2020 to December 2021). Spatial Bayesian negative binomial mixed-effect models were employed to identify influencing factors and risk patterns for different periods. We identified that (1) influencing factors and relative risks varied across time and space, with sociodemographic factors exerting a stronger influence over environmental features; (2) as the most identified predictors, the population with migrant backgrounds was positively associated, and the population over 65 was negatively associated with COVID-19 incidence; (3) certain neighborhoods consistently faced elevated risks of COVID-19 incidence. This study highlights potential structural health inequalities within migrant communities, associated with lower socioeconomic status and a higher risk of COVID-19 incidence across diverse pandemic periods. Our findings indicate that locally tailored interventions for diverse citizens are essential to address health inequalities and foster a more sustainable urban environment. [ABSTRACT FROM AUTHOR]

• 3D-RV FWS did not differ significantly in awake v anesthetized patients • 3D-RV FWS did not change significantly after sternotomy • 3D-RV FWS deteriorated after on-pump coronary artery bypass surgery • This was in line with changes of other measures of longitudinal RV contraction • 3D-RV EF changed according to 3D RV-FWS, while RV FAC remained unchanged Few data exist on perioperative three-dimensional–derived right ventricular strain. The authors aimed to describe the perioperative course of three-dimensional–derived right ventricular strain in coronary artery bypass graft (CABG) surgery patients. Prospective, observational, pilot trial. Single university hospital. Participants: The study comprised 40 patients with preserved left ventricular and right ventricular (RV) function undergoing isolated on-pump CABG surgery. Interventions: Three-dimensional strain analysis and standard echocardiographic evaluation of RV function were performed preoperatively (T1) and postoperatively (T4) with transthoracic echocardiography (TTE) and intraoperatively before sternotomy (T2) and after sternotomy (T3) with transesophageal echocardiography (TEE). All echocardiographic measurements were performed under stable hemodynamic conditions and predefined fluid management without any vasoactive support. The measurements of three-dimensional–derived RV free-wall strain (3D-RV FWS) and RV ejection fraction were performed using TomTec 4D RV-Function 2.0 software. Philips QLAB 10.8 was used to analyze tissue velocity of the tricuspid annulus, tricuspid annular systolic excursion, and RV fractional area change. There were no significant differences (median [interquartile range {IQR}]) between preoperative TTE and intraoperative TEE measurements for 3D-RV FWS (T1 v T2: –22.35 [IQR –17.70 to –27.22] v –24.35 [IQR –20.63 to –29.88]; not significant). 3D-RV FWS remained unchanged after sternotomy (T2 v T3: –24.35 [IQR –20.63 to –29.88] v –23.75 [IQR –20.25 to –29.28]; not significant) but deteriorated significantly after CABG (T1 v T4: –22.35 [IQR –17.70 to –27.22] v –18.5 [IQR –16.90 to –21.65]; p = 0.004). In patients undergoing on-pump CABG, 3D-RV FWS values for awake, spontaneously breathing patients measured with TTE and values assessed in patients under general anesthesia with TEE did not significantly differ. Three-dimensional RV FWS did not change after sternotomy but deteriorated after on-pump CABG. [ABSTRACT FROM AUTHOR]

This paper provides some of the conceptual and methodological underpinnings being developed in the ongoing TAPESTRY project which is part of the Transformations to Sustainability (T2S) Programme. We debate how the notion of transformation may be conceptualized from 'below' in marginal environments that are especially marked by high levels of climate-related uncertainties. We propose the notion of transformation as praxis — where the focus is on bottom-up change, identities, wellbeing and the recovery of agency by marginalized people and explore how 'patches' and the 'marginal' offer critical conceptual templates to examine whether and how systemic transformative changes are being assembled and effected on the ground by hybrid and transformative alliances. The article concludes by discussing potential challenges of such engagements, alongside pursuing a normative and political approach to T2S. [ABSTRACT FROM AUTHOR]

Due to its resistance to high temperatures and corrosion, Inconel 718 has a wide range of applications, particularly in the chemical and aerospace industry. The aim of this study is to investigate the potential of turning Inconel 718 with regard to tool life, depending on various cooling lubricant strategies and cutting materials. The reference process is flood cooling with carbide tools. Based on this, the process with carbide and CBN tools under dry machining, cryogenic cooling and cryogenic minimum quantity lubrication will further be investigated. Cutting forces, tool wear, roughness and chips are analyzed. Cutting length, surface quality and sustainability can be improved by using CBN and cryogenic minimum quantity lubrication (CMQL). [ABSTRACT FROM AUTHOR]

Severe immunopathology may drive the deleterious manifestations that are observed in the advanced stages of coronavirus disease 2019 (COVID-19) but are poorly understood. Our aim was to phenotype leukocyte subpopulations and the cytokine milieu in the lungs and blood of critically ill patients with COVID-19 acute respiratory distress syndrome (ARDS). We consecutively included patients less than 72 hours after intubation following informed consent from their next of kin. Bronchoalveolar lavage fluid was evaluated by microscopy; bronchoalveolar lavage fluid and blood were assessed by 10-color flow cytometry and a multiplex cytokine panel. Four mechanically ventilated patients (aged 40-75 years) with moderate-to-severe COVID-19 ARDS were included. Immature neutrophils dominated in both blood and lungs, whereas CD4 and CD8 T-cell lymphopenia was observed in the 2 compartments. However, regulatory T cells and T H 17 cells were found in higher fractions in the lung. Lung CD4 and CD8 T cells and macrophages expressed an even higher upregulation of activation markers than in blood. A wide range of cytokines were expressed at high levels both in the blood and in the lungs, most notably, IL-1RA, IL-6, IL-8, IP-10, and monocyte chemoattactant protein-1, consistent with hyperinflammation. COVID-19 ARDS exhibits a distinct immunologic profile in the lungs, with a depleted and exhausted CD4 and CD8 T-cell population that resides within a heavily hyperinflammatory milieu. [ABSTRACT FROM AUTHOR]

Islet-based recellularization of decellularized, repurposed rat livers may form a transplantable Neo-Pancreas. The aim of this study is the establishment of the necessary protocols, the evaluation of the organ structure and the analysis of the islet functionality ex vivo. After perfusion-based decellularization of rat livers, matrices were repopulated with endothelial cells and mesenchymal stromal cells, incubated for 8 days in a perfusion chamber, and finally repopulated on day 9 with intact rodent islets. Integrity and quality of re-endothelialization was assessed by histology and FITC-dextran perfusion assay. Functionality of the islets of Langerhans was determined on day 10 and day 12 via glucose stimulated insulin secretion. Blood gas analysis variables confirmed the stability of the perfusion cultivation. Histological staining showed that cells formed a monolayer inside the intact vascular structure. These findings were confirmed by electron microscopy. Islets infused via the bile duct could histologically be found in the parenchymal space. Adequate insulin secretion after glucose stimulation after 1-day and 3-day cultivation verified islet viability and functionality after the repopulation process. We provide the first proof-of-concept for the functionality of islets of Langerhans engrafted in a decellularized rat liver. Furthermore, a re-endothelialization step was implemented to provide implantability. This technique can serve as a bioengineered platform to generate implantable and functional endocrine Neo-Pancreases. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Vagus nerve stimulation (VNS) is an FDA-approved neuromodulatory treatment used in the clinic today for epilepsy, depression, and cluster headaches. Moreover, evidence in the literature has led to a growing list of possible clinical indications, with several small clinical trials applying VNS to treat conditions ranging from neurodegenerative diseases to arthritis, anxiety disorders, and obesity. Despite the growing list of therapeutic applications, the fundamental mechanisms by which VNS achieves its beneficial effects are poorly understood. In parallel, the glymphatic and meningeal lymphatic systems have recently been described as methods by which the brain maintains a healthy homeostasis and removes waste without a traditionally defined lymphatic system. In particular, the glymphatic system relates to the interchange of cerebrospinal fluid (CSF) and interstitial fluid (ISF) whose net effect is to wash through the brain parenchyma removing metabolic waste products and misfolded proteins. As VNS has well-documented effects on many of the pathways recently linked to the clearance systems of the brain, we hypothesized that VNS could increase CSF penetrance in the brain. We injected a low molecular weight lysine-fixable fluorescent tracer (TxRed-3kD) into the CSF system of mice with a cervical vagus nerve cuff implant and measured the amount of CSF penetrance following an application of a clinically-derived VNS paradigm (30 Hz, 10% duty cycle). We found that the clinical VNS group showed a significant increase in CSF tracer penetrance as compared to the naïve control and sham groups. (s) : This study demonstrates that VNS therapeutic strategies already being applied in the clinic today may induce intended effects and/or unwanted side effects by altering CSF/ISF exchange in the brain. This may have broad ranging implications in the treatment of various CNS pathologies. • The waste clearance systems of the brain are important for healthy brain homeostasis. • Clinically patterned vagus nerve stimulation enhanced cerebrospinal fluid penetrance. • These findings represent a new potential therapeutic mechanism of vagus stimulation. [ABSTRACT FROM AUTHOR]

A large-eddy simulation of a swirl-stabilized multi-stream laboratory-scale pulverized coal burner designed specifically for oxy-fuel investigation is conducted using a three-mixture-fraction flamelet model, in which both NO x and SO x emissions are considered. The simulation results are compared to those in an air atmosphere and the available experimental data. The flame structures and pollutant formation mechanisms are analyzed in detail. The results show that the oxy-coal flame is narrower in the radial direction compared to the air-coal flame. Further, the particle clustering phenomenon can be observed in the oxy-fuel atmosphere. The distributions of the thermo-chemical quantities in different conditions are significantly different. For pollutant formation, the results show that NO is mainly formed around the quarl zone in an oxy-fuel atmosphere, while a large amount of NO is formed in the far downstream region in an air atmosphere. Although the instantaneous distributions of SO x are qualitatively similar in different conditions, they are quantitatively different due to the different oxygen partial pressure in the air and oxy-fuel atmospheres. [ABSTRACT FROM AUTHOR]

The ignition and combustion of coal particle groups are investigated numerically in a laminar flow reactor. The Flamelet Generated Manifold method is extended to account for the complex mixture of gases being released during devolatilization, which is calculated with a competing two-step model. A second mixture fraction is introduced to include the mixing with the second methane fuel stream. The interactions of the gas phase with particles are modeled within a fully coupled Euler-Lagrange framework. To investigate the influence of particle groups on ignition and combustion, successively increasing densities of particle streams have been analyzed. The ignition delay time is increased significantly by higher particle densities. This delay is validated successfully with the available measurements. Moreover, the shape of the volatile flame was found to be strongly influenced by the particle number density inside the flame. A transition from spherical flames around single particles to a conical flame around the particle cloud could be found in numerical results as well as in experiments. As the primary mechanism for the substantial ignition delay and the formation of the flame, the increased heat transfer from the gas-phase to the particle group, resulting in lower gas-phase temperatures, was identified. [ABSTRACT FROM AUTHOR]

Objectives: Global health guidelines suggest that youth should accumulate at least 60min of daily, moderate-to-vigorous-intensity physical activity (MVPA). The relationship between meeting physical activity (PA) guidelines and motor competence (MC) in youth is relatively unknown. This study assessed levels of MVPA and MC among socially vulnerable youth and determined if meeting the PA guidelines was associated with MC.Design: Cross-sectional.Methods: A total of 1017 youths aged 3-14 years from three schools participated in the study. Participants wore accelerometers for seven consecutive days to assess PA. Motor competence was assessed using the Test of Gross Motor Development, 2nd Edition and the Körperkoordinationstest für Kinder. MVPA and MC were compared by sex and school levels (preschool, elementary school and middle school). Binary logistic regression models examined the predictive power of meeting PA guidelines and age on MC.Results: The prevalence of meeting PA guidelines declined across school levels among both girls (72% in preschool to 21% in middle school, p<0.001) and boys (84% in preschool to 57% in middle school, p<0.001). MC levels were low and also declined across age in both sexes (p<0.001). During preschool, age (older) was a consistent predictor of low MC, independently of meeting PA guidelines.Conclusions: Except for adolescent boys, meeting PA guidelines was not associated with higher MC. Public health policies should focus on the quantity and quality of MVPA within schools and on alleviating the decline in PA and MC across childhood and adolescence, with special attention to girls and disadvantaged families. [ABSTRACT FROM AUTHOR]

To compare the most important techniques usually used in these patients. A multicentric retrospective evaluation on patients treated for cT1/2 N0 OTFOM SCC was conducted; patients in group A were treated by transoral approach and miomucosal local flap while those in group B were treated by pull-through and free flap reconstruction. Oncologic, functional and quality of life evaluation was assessed. 55 patients were enrolled. Group A consisted of 35 patients and group B 20. At the 3-year follow-up 30 and 17 patients in group A and B were alive without disease. Tongue mobility index score was 23.3 in group A and 13.89 in group B (p <.001); Sydney swallowing mean score was 118.5 and 543.22 in group A and B (p <.001). EORTC QLC-C30 was of 33.57 in group A and 38.89 in group B (p = 0.057). T1/T2 cancers of the tongue and floor of the mouth can be equally treated with both techniques. Because of the fact that transoral resection with buccinators reconstruction provides better functional outcome, this technique should be preferred whenever appropriate. [ABSTRACT FROM AUTHOR]

To explore nurse and physician perceptions of working with and collaborating about arterial wave analysis for goal-directed therapy to identify barriers and facilitators for use in anesthesia departments, postanesthesia care units, and intensive care units. A qualitative study drawing on ethnographic principles in a field study using the technique of nonparticipating observation and semistructured interviews. Data collection occurred using semistructured interviews with nurses (n = 23) and physicians (n = 12) and field observations in three anesthetic departments. An inductive approach for content analysis was used. The results showed one overarching theme Interprofessional collaboration encourage and impede based on three categories: (1) interprofessional and professional challenges; (2) obtaining competencies; and (3) understanding optimal fluid treatment. Several barriers identified related to interprofessional collaboration. Nurses and physicians were dependent on each other's skills and capabilities to use arterial wave analysis. Education of nurses and physicians is important to secure optimal use of goal-directed therapy. [ABSTRACT FROM AUTHOR]

In the past years, the travel demand model mobiTopp has undergone substantial developments towards a full agent-based travel demand model. Until now, mobiTopp covers the generation of a synthetic population with synthetically generated activity plans, different models for ownership of cars or transit passes, destination choice models for long- and short-term destinations, and various mode choice models. However, it still does not contain a dynamic traffic assignment procedure for motorized traffic. On the other side, MATSim's origin is a traffic flow simulation used for a dynamic traffic assignment, and in the past years, extensions for destination and mode choice have been developed on a fundamental or experimental basis. As the strengths of both models are in different parts of a travel demand model, it suggests itself to combine both instead of redeveloping the missing parts in both models. Therefore, this paper presents our approach of integrating mobiTopp and MATSim to build a full travel demand model. [ABSTRACT FROM AUTHOR]

Displacement of the remaining mandibular segments may occur after alloplastic bridging of mandibular segmental defects using patient-specific reconstruction plates. Consequently, additional surgical devices are required for correct plate positioning. Patient-specific reconstruction plates with a conventional one beam-like design (cPSRP) have been modified by adding two flanges and giving a Y-shape to the distal ascending implant part to allow for segment positioning without using additional devices. We aimed to evaluate reconstruction results after using these modified patient-specific reconstruction plates (mPSRP). We compared the reconstruction results for mPSRP and cPSRP and evaluated mandibular segment dislocations after reconstruction using digital image analysis of the pre- and postoperative radiological data sets. Analysis showed better reconstruction results with mPSRP than with cPSRP; mean dislocation values concerning shifts and rotations of mandibular segments were lower for mPSRP (x -axis: 2.9 mm vs 1.1 mm, 4.2° vs 3.6°; y -axis: 6.0 mm vs 2.0 mm, 3.5° vs 2.8°; z -axis: 3.9 mm vs 3.3 mm, 4.2° vs 1.2°). Significant differences were found for shifts along the y -axis (p = 0.039) and rotations around the z -axis (p = 0.041). Therefore, implant design modifications with additional positioning elements could help simplify surgical reconstruction procedures and improve reconstruction in head and neck surgery. [ABSTRACT FROM AUTHOR]

A new approach to gait rehabilitation task of a 12 DOF lower limb exoskeleton is proposed combining time-delay estimation (TDE) based computed torque control (CTC) and robust adaptive RBF neural networks. In addition to the conventional advantages of the CTC, TDE technique is integrated to estimate unmodeled dynamics and external disturbance. To realize more accurate tracking, a robust adaptive RBF neural networks compensator is designed to approximate and compensate TDE error. The final asymptotic stability is guaranteed with Lyapunov criteria. To validate the proposed approach, co-simulation experiments are realized using SolidWorks, SimMechanics and MATLAB/Robotics Toolbox. Compared to CTC, sliding mode based CTC and TDE based CTC, the higher performances of the proposed controller are demonstrated by co-simulation. • A TDE based CTC method is proposed with a robust adaptive RBF neural networks. • To enhance CTC method, TDE is used to compensate unknown dynamics and disturbance. • To reduce TDE error, a robust adaptive RBF neural networks compensator is designed. • The asymptotic stability of exoskeleton control is guaranteed with Lyapunov theory. • Compared to CTC, SMC/TDE-CTC, high performances of the proposed method are validated. [ABSTRACT FROM AUTHOR]