Search

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

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

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

Jon Gitz Holler,1 Jens Ulrik Stæhr Jensen,2– 4 Frederik Neess Engsig,5 Morten H Bestle,3,6 Birgitte Lindegaard,1,3,7 Jens Henning Rasmussen,8 Henning Bundgaard,3,9 Finn Erland Nielsen,8 Kasper Karmark Iversen,3,10 Jesper Juul Larsen,11 Barbara Juliane Holzknecht,3,12 Jonas Boel,12,13 Pradeesh Sivapalan,2,3 Theis Skovsgaard Itenov3,14 1Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark; 2Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark; 3Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 4PERSIMUNE & CHIP: Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; 5Department of Emergency Medicine, Copenhagen University Hospital – Amager and Hvidovre, Copenhagen, Denmark; 6Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital – North Zealand, Hilleroed, Denmark; 7Centre for Physical Activity, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; 8Department of Emergency Medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark; 9Department of Cardiology, The Capital Region’s Unit of Inherited Cardiac Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; 10Department of Emergency Medicine, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark; 11Department of Emergency Medicine, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark; 12Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; 13Copenhagen University Hospital - Capital Region Pharmacy, Copenhagen, Denmark; 14Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, DenmarkCorrespondence: Jon Gitz Holler, Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark, Tel +45-48292578, Fax +45-48293935, Email Jon.Gitz.Holler@regionh.dkAbstract: Infectious diseases are major health care challenges globally and a prevalent cause of admission to emergency departments. Epidemiologic characteristics and outcomes based on population level data are limited. The Database of Community Acquired Infections in Eastern Denmark (DCAIED) 2018– 2021 was established with the aim to explore and estimate the population characteristics, and outcomes of patients suffering from community acquired infections at the emergency departments in the Capital Region and the Zealand Region of Denmark using data from electronic medical records. Adult patients (≥ 18 years) presenting to the emergency department with suspected or confirmed infection are included in the cohort. Presence of sepsis and organ failure are assessed using modified criteria from the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). During the inclusion period from January 2018 to January 2022, 2,241,652 adult emergency department visits have been registered. Of these, 451,825 were unique encounters of which 60,316 fulfilled criteria of suspected infection and 28,472 fulfilled sepsis criteria and 8,027 were defined as septic shock. The database covers the entire Capital and Zealand Region of Denmark with an uptake area of 2.6 million inhabitants and includes demographic, laboratory and outcome indicators, with complete follow-up. The database is well-suited for epidemiological research for future national and international collaborations.Keywords: emergency department, infectious diseases, sepsis, shock, database, epidemiology, community acquired

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

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

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

In machine learning study, classification analysis aims to minimize misclassification and also maximize the results of prediction accuracy. The main characteristic of this classification problem is that there is one class that significantly exceeds the number of samples of other classes. SMOTE minority class data is studied and extrapolated so that it can produce new synthetic samples. Random forest is a classification method consisting of a combination of mutually independent classification trees. K-Nearest Neighbors which is a classification method that labels the new sample based on the nearest neighbors of the new sample. SMOTE generates synthesis data in the minority class, namely class 1 (cervical cancer) to 585 observation respondents (samples) so that the total observation respondents are 1208 samples. SMOTE random forest resulted an accuracy of 96.28%, sensitivity 99.17%, specificity 93.44%, precision 93.70%, and AUC 96.30%. SMOTE K-Nearest Neighborss resulted an accuracy of 87.60%, sensitivity 77.50%, specificity 97.54%, precision 96.88%, and AUC 82.27%. SMOTE random forest produces a perfect classification model, SMOTE K-Nearest neighbors classification produces a good classification model, while the random forest and K-Nearest neighbors classification on imbalanced data results a failed classification model.

Charlotte Sandau,1 Ejvind Frausing Hansen,1 Thomas Jørgen Ringbæk,2 Thomas Kallemose,3 Dorthe Gaby Bove,4 Ingrid Poulsen,3,5 Vibeke Nørholm,3 Lars Pedersen,6 Jens Ulrik Stæhr Jensen,7,8 Charlotte Suppli Ulrik1,9 1Department of Respiratory Medicine and Endocrinology, Pulmonary Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; 2Allergy and Lung Clinic, Elsinore, Denmark; 3Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; 4University College Absalon, Centre for Nursing, Roskilde, Denmark; 5Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark; 6Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Bispebjerg Hospital, Copenhagen, Denmark; 7Respiratory Medicine Section, Department of Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark; 8Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, København, Denmark; 9Institute of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Charlotte Sandau, Email charlotte.sandau.bech.01@regionh.dkObjective: Devices for Automated Oxygen Administration (AOA) have been developed to optimize the therapeutic benefit of oxygen supplementation. We aimed to investigate the effect of AOA on multidimensional aspects of dyspnea and as-needed consumption of opioids and benzodiazepines, as opposed to conventional oxygen therapy, in hospitalized patients with Acute Exacerbation of COPD (AECOPD).Method and Patients: A multicenter randomized controlled trial across five respiratory wards in the Capital Region of Denmark. Patients admitted with AECOPD (n=157) were allocated 1:1 to either AOA (O2matic Ltd), a closed loop device automatically delivering oxygen according to the patient’s peripheral oxygen saturation (SpO2), or conventional nurse-administered oxygen therapy. Oxygen flows and SpO2 levels were measured by the O2matic device in both groups, while dyspnea, anxiety, depression, and COPD symptoms were accessed by Patient Reported Outcomes.Results: Of the 157 randomized patients, 127 had complete data for the intervention. The AOA reduced patients’ perception of overall unpleasantness significantly on the Multidimensional Dyspnea Profile (MDP) with a difference in medians of − 3 (p=0.003) between the intervention group (n=64) and the control group (n=63). The AOA also provided a significant between group difference in all single items within the sensory domain of the MDP (all p-values≤ 0.05) as well as in the Visual Analogue Scale – Dyspnea (VAS-D) within the past three days (p=0.013). All between group differences exceeded the Minimal Clinical Important Difference of the MDP and VAS-D, respectively. AOA did not seem to have an impact on the emotional response domain of the MDP, the COPD Assessment Test, the Hospital Anxiety and Depression Scale, or use of as-needed opioids and/or benzodiazepines (all p-values> 0.05).Conclusion: AOA reduces both breathing discomfort and physical perception of dyspnea in patients admitted with AECOPD but did not seem to impact the emotional status or other COPD symptoms.Keywords: dyspnea, oxygen, automated oxygen therapy, multidimensional dyspnea profile, COPD, hospital, admission, therapy

Christian Kjer Heerfordt,1 Josefin Eklöf,1 Pradeesh Sivapalan,1 Truls Sylvan Ingebrigtsen,1 Tor Biering-Sørensen,2– 4 Zitta Barrella Harboe,4,5 Jesper Koefod Petersen,6,7 Christian Østergaard Andersen,8 Jonas Bredtoft Boel,9 Anne Kathrine Bock,10 Alexander G Mathioudakis,11,12 John R Hurst,13 Shailesh Kolekar,7 Sofie Lock Johansson,14 Jette Marie Bangsborg,9 Jens Otto Jarløv,9 Ram Benny Dessau,15 Christian Borbjerg Laursen,14,16 Michael Perch,4,17 Jens-Ulrik Stæhr Jensen1,4,18 1Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark; 2Department of Cardiology, Herlev and Gentofte Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory, University of Copenhagen, Copenhagen, Denmark; 3Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark; 4Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 5Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Denmark; 6Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark; 7Department of Pulmonary Medicine, Zealand University Hospital, Roskilde, Denmark; 8Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark; 9Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark; 10Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; 11The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; 12Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; 13UCL Respiratory, University College London, London, UK; 14Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; 15Department of Clinical Microbiology, Zealand University Hospital, Slagelse Hospital, Slagelse, Denmark; 16Institute for Clinical Research, University of Southern Denmark, Odense, Denmark; 17Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, Copenhagen, Denmark; 18PERSIMUNE & CHIP: Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Christian Kjer Heerfordt, Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark, Tel +4523303431, Email christian.kjer.heerfordt@regionh.dkBackground: Inhaled corticosteroids (ICS) are associated with an increased risk of clinical pneumonia among patients with chronic obstructive pulmonary disease (COPD). It is unknown whether the risk of microbiologically verified pneumonia such as pneumococcal pneumonia is increased in ICS users.Methods: The study population consists of all COPD patients followed in outpatient clinics in eastern Denmark during 2010– 2017. ICS use was categorized into four categories based on accumulated use. A Cox proportional hazard regression model was used adjusting for age, body mass index, sex, airflow limitation, use of oral corticosteroids, smoking, and year of cohort entry. A propensity score matched analysis was performed for sensitivity analyses.Findings: A total of 21,438 patients were included. Five hundred and eighty-two (2.6%) patients acquired a positive lower airway tract sample with S. pneumoniae during follow-up. In the multivariable analysis ICS-use was associated with a dose-dependent risk of S. pneumoniae as follows: low ICS dose: HR 1.11, 95% CI 0.84 to 1.45, p = 0.5; moderate ICS dose: HR 1.47, 95% CI 1.13 to 1.90, p = 0.004; high ICS dose: HR 1.77, 95% CI 1.38 to 2.29, p < 0.0001, compared to no ICS use. Sensitivity analyses confirmed these results.Interpretation: Use of ICS in patients with severe COPD was associated with an increased and dose-dependent risk of acquiring S. pneumoniae, but only for moderate and high dose. Caution should be taken when administering high dose of ICS to patients with COPD. Low dose of ICS seemed not to carry this risk.Keywords: COPD, inhaled corticosteroids, Streptococcus pneumoniae, clinical epidemiology

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

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

Introdução/Objetivos: A neuropatia periférica (NP) é comum em pacientes com doenças associadas à deficiência de vitamina B12 (VitB12), como a gastrite atrófica, uso de medicamentos, toxinas como álcool e infecções virais, causando um processo de desmielinização que leva à deterioração da bainha de mielina. Os mecanismos podem envolver hipometilação, metabolismo fosfolipídico e efeitos neurotóxicos da homocisteína. Este estudo tem como objetivo realizar uma revisão sistemática com meta-análise, dos anos de 2018 a 2022, sobre a relação entre a deficiência de VitB12 e NP, a fim de avaliar essa associação. Material e métodos: Pesquisa bibliográfica, em março de 2023, realizada nas bases de dados PubMed, SciELO, e LILACS. Os descritores selecionados nos Descritores em Ciência da Saúde foram: (“Anemia, Megaloblastic” OR “Vitamin B12 Deficiency” OR “Cobalamin”) AND “Neuropathy”. A coleta de dados foi baseada no protocolo PRISMA. Os critérios de inclusão foram: artigos publicados de 2018 a 2022, com texto completo disponível, nos idiomas português, inglês e espanhol, e observacionais. Foram utilizados os programas Microsoft Excel para tabulação dos dados, e o RStudio para os cálculos estatísticos. Resultados: Foram encontrados 188 artigos, sendo excluído 1 repetido nas bases, 12 sem texto completo disponível, 8 em idiomas não selecionados, 159 estudos não observacionais, 3 por título ou resumo não correspondentes ao tema, restando 5 artigos para leitura na integra. A amostra final foi composta de 2.339 pacientes. O nível médio de corte considerado para deficiência de VitB12 foi de 214,43 ± 70,39 pg/mL. Os resultados da análise mostraram uma associação significativa entre a deficiência de VitB12 e a NP em comparação com o grupo sem deficiência (OR = 1,29, IC95% (1,04; 1,60), p < 0,01, I2 = 90%, τ2 = 0,7876. Discussão: Os estudos selecionados em sua maioria também demonstraram essa relação, como em pacientes com gastrite crônica atrófica, e diabetes mellitus tipo 2 (DM2) em uso de metformina. Em um estudo selecionado, foram comparados pacientes com gastrite crônica atrófica associada à deficiência de VitB12, concluindo que a deficiência é um fator de risco para NP, e está correlacionada com a gravidade da NP. Os outros quatro estudos incluíram pacientes com DM2, destes, dois concluíram que a insuficiência de vitamina B12 foi frequentemente encontrada nessa população, sendo maior a NP nos pacientes DM2 com a deficiência de VitB12, além de estar associada à neuropatia em indivíduos em uso de metformina. No entanto, dois estudos foram discordantes, citando que esses pacientes podem estar em uso de outras medicações que também alteram o nível de VitB12, e não encontraram associação com maior NP nos pacientes com deficiência de VitB12. Os sintomas da deficiência de VitB12 e da neuropatia diabética se sobrepõem, com sensação de vibração e propriocepção prejudicadas, e parestesia. As limitações deste estudo são os fatores de confundimento. Além disso, houveram variados graus de corte para deficiência de B12 e discordância entre os estudos sobre o efeito da metformina nos níveis de VitB12 e sua relação com a NP. Conclusão: Este estudo evidencia que a deficiência de VitB12 está associada à NP. No entanto, mais pesquisas são necessárias para esclarecer as divergências encontradas e avaliar melhor os fatores de confusão envolvidos nessa relação.

Introdução/Objetivos: A hemofilia é um distúrbio hemorrágico causado pela deficiência de fatores de coagulação, associado a morbidade e mortalidade significativas. Ela pode ser dos tipos A, B e C, relacionados à deficiência dos fatores VIII, IX e XI, respectivamente. A maioria dos casos é hereditária, mas até um terço pode ocorrer por mutações espontâneas. A forma adquirida é rara. O grau de acometimento e a apresentação clínica variam de acordo com a atividade residual dos fatores de coagulação. O tratamento teve grandes avanços, mas ainda não estão amplamente disponíveis. O objetivo deste trabalho é descrever os dados de internações hospitalares no Brasil para tratamento de hemofilias nos últimos 5 anos. Material e métodos: Trata-se de um estudo ecológico, utilizando dados públicos referentes as internações para o tratamento de hemofilias no Brasil, coletados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), entre janeiro de 2018 a dezembro de 2022. As variáveis selecionadas foram: ano de atendimento, internações, caráter de atendimento e óbitos. O programa Microsoft Excel foi utilizado para tabulação e cálculo das taxas dos dados. Resultados: Foram registradas 2.750 internações. Nos anos de 2018 e 2022 respectivamente: 578, 604, 493, 557 e 518. Sendo 83,9% de urgência (U), e 16,1% eletivas (E). A taxa de óbitos foi de 1,78%, desses 14,3% em internações E e 85.7% de U. Os anos de 2018 a 2022, registraram, respectivamente: 1,90% (18,2% E/81,2% U), 0,82% (40,0% E/60,0% U), 1,82% (11,1% E/88,9% U), 1,82% (8,3% E/91,7% U), e 2,15% (8,3% E/91,7% U). Discussão: O Brasil possui a quarta maior população de hemofílicos do mundo. Neste estudo o maior número de internações foram nos anos de 2019 e 2021, e 2020 teve o menor número, tendo como hipótese a influência direita ou indireta da pandemia de COVID-19. Segundo a World Federation of Hemophilia (WFH), em 2018 foram registradas em 21.1% internações no mundo, 8.8% em 2019, 14% em 2020, 9.4% em 2021, 8% em 2022, discordante da maioria dos nossos dados, exceto 2018. As taxas de óbitos encontradas neste estudo foram maiores em 2022 e 2018, e a menor em 2019, também tendo como hipótese a influência direta ou indireta da pandemia de COVID-19. Segundo a WFH, a taxa de óbitos mundial de 2018 a 2021 foi

Introdução/objetivos: O transplante de células-tronco hematopoéticas (TCTH) de Medula Óssea (MO) é utilizado no tratamento de várias doenças sanguíneas, malignas e não malignas, hereditárias ou adquiridas. No TCTH alogênico, as células-tronco vêm de um doador, idealmente um familiar com uma composição genética semelhante. Se o paciente não tem um doador aparentado compatível, as células-tronco de uma pessoa não aparentada cadastrada em um bancos de MO que tenha compatibilidade total ou parcial pode ser usada. O objetivo deste trabalho os dados de internações hospitalares no Brasil para TCTH de MO aparentado e não aparentado nos últimos 5 anos. Material e métodos: Trata-se de um estudo ecológico, utilizando dados públicos referentes as internações para TCTH de MO alogênico aparentado, comparando com o TCTH alogênico de MO não aparentado no Brasil. Os dados foram coletados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), entre 2018 a 2022. As variáveis selecionadas foram: internações, e óbitos. O programa Microsoft Excel foi utilizado para tabulação e cálculo das taxas dos dados. Resultados: Foram realizadas 1.823 internações para a realização TCTH alogênico de MO aparentado, e para não aparentado foram registradas 663 internações. A taxa de óbitos foi de 6,5% no TCTH alogênico de MO aparentado. No não aparentado a taxa de óbito foi de 6,8%. Discussão: Segundo a Sociedade Brasileira de Terapia Celular e Transplante de Medula Óssea (SBTMO), de 2018 a 2022 foram realizados no Brasil 2.531 TCTH alogênicos de MO, desses 76,1% de doador aparentado. Segundo os dados deste estudo, houve um número maior de internações para TCTH alogênicos aparentados comparando com o os não aparentados, corroborando com a literatura. Porém, nossos números de internações para realização do procedimento foram bem menores, isso se deve provavelmente aos casos registrados neste estudo serem somente os realizados pelo setor público. Quanto a taxa de óbitos, na literatura é descrito que os casos dos TCTH alogênicos, quando a medula utilizada é oriunda de um familiar ou do banco de medula óssea, o índice de mortalidade hospitalar é inferior aos 15%, corroborando com nossos dados. O sucesso do TCTH depende de fatores como idade, estado de saúde e doença de base do paciente. O ideal é um doador irmão com HLA (Human Leucocyte Antigen) idêntico. A disponibilidade de doadores familiares compatíveis é um fator limitante, e os não aparentados frequentemente são utilizados. Mas suas taxas de sobrevida a longo prazo podem ser inferiores. Apesar da pequena diferença, os transplantes aparentados neste estudo apresentaram uma mortalidade menor, como descrito na literatura. As limitações incluem o fato de o estudo se basear apenas em dados do sistema público de saúde, não fornecendo informações sobre a doença de base ou comorbidades associadas, e compatibilidade do HLA, sendos esses fatores que impactam na sobrevida do paciente. Conclusão: Observou-se neste estudo um maior número muito de internações para TCTH alogênico de MO aparentado. Quanto a taxa de óbitos, foi maior no não aparentado, mas similar ao aparentado. Este estudo ressalta a necessidade de aumentar a disponibilidade de doadores compatíveis e promover a conscientização sobre a importância da doação da MO para melhores resultados do TCTH.

Studies in a broad range of animal species have revealed phenotypes that are caused by ancestral life experiences, including stress and diet. Ancestral dietary macronutrient composition and quantity (over- and under-nutrition) have been shown to alter descendent growth, metabolism and behaviour. Molecules have been identified in gametes that are changed by ancestral diet and are required for transgenerational effects. However, there is less understanding of the developmental pathways altered by inherited molecules during the period between fertilization and adulthood. To investigate this non-genetic inheritance, we exposed great grand-parental and grand-parental generations to defined protein to carbohydrate (P:C) dietary ratios. Descendent developmental timing was consistently faster in the period between the embryonic and pupal stages when ancestors had a higher P:C ratio diet. Transcriptional analysis revealed extensive and long-lasting changes to the MAPK signalling pathway, which controls growth rate through the regulation of ribosomal RNA transcription. Pharmacological inhibition of both MAPK and rRNA pathways recapitulated the ancestral diet-induced developmental changes. This work provides insight into non-genetic inheritance between fertilization and adulthood.

In the original publication [...]

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

Heart failure remains a major global burden regarding patients’ morbidity and mortality and health system organization, logistics, and costs. Despite continual advances in pharmacological and resynchronization device therapy, it is currently well accepted that heart transplantation and mechanical circulatory support represent a cornerstone in the management of advanced forms of this disease, with the latter becoming an increasingly accepted treatment modality due to the ongoing shortage of available donor hearts in an ever-increasing pool of patients. Mechanical circulatory support strategies have seen tremendous advances in recent years, especially in terms of pump technology improvements, indication for use, surgical techniques for device implantation, exchange and explantation, and postoperative patient management, but not in the field of treatment of critically ill patients and those undergoing cardiac arrest. This contemporary review aims to summarize the collected knowledge of this topic with an emphasis on complications in patients with left ventricular assist devices, their treatment, and establishing a clear-cut algorithm and the latest recommendations regarding out-of-hospital or emergency department management of cardiac arrest in this patient population.

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

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

Aspergillus infectious endocarditis (IE) is a rare cause of culture-negative endocarditis. The main risk factors are severe immunosuppression and prosthetic heart valve. We describe a case of Aspergillus fumigatus IE on a native mitral valve in a patient with autoimmune hepatitis in remission while on low dose corticosteroids. The case is unique due to the patients’ low initial risk for invasive fungal disease, its clinical presentation and successful management with emergency surgery and antifungal therapy. After literature review we have not found a similar case report. The patient presented with right-sided eyesight deterioration due to endophthalmitis. Vitrectomy was performed and Aspergillus fumigatus grew on culture. IE on a native mitral valve was confirmed with echocardiography. The patient developed signs of acute heart failure soon after hospital admission and was diagnosed with several septic emboli (kidney, spleen, thumb, right common femoral artery). He was initially treated with surgical valve replacement, dual antifungal therapy with liposomal amphotericin B (LAmB) and voriconazole and vitrectomy, including intravitreal amphotericin B application. Long-term triazole therapy was not possible due to hepatotoxicity. The patient was maintained on intermittent LAmB for 12 months and is without signs of recurrence ten months after therapy was discontinued. Aspergillus can cause invasive infection in patients with autoimmune hepatitis on low dose corticosteroids. Early diagnosis followed by emergency surgical valve replacement and systemic antifungal therapy can improve prognosis. Additional studies are needed to evaluate alternative methods and duration of antimicrobial therapy following Aspergillus IE.

The presented work deals with the investigation of mechanical tribological properties on Inconel 625 superalloy, which is welded on a 16Mo3 steel pipe. The wall thickness of the basic steel pipe was 7 mm, while the average thickness of the welded layer was 3.5 mm. The coating was made by the cold metal transfer (CMT) method. A supercritical bending of 180° was performed on the material welded in this way while cold. The mechanical properties evaluated were hardness, wear resistance, coefficient of friction (COF) and change in surface roughness for both materials. The UMT Tribolab laboratory equipment was used to measure COF and wear resistance by the Ball-on-flat method, which used a G40 steel pressure ball. The entire process took place at an elevated temperature of 500 °C. The measured results show that the materials after bending are reinforced by plastic deformation, which leads to an increase in hardness and also resistance to wear. Superalloy Inconel 625 shows approximately seven times higher rate of wear compared to steel 16Mo3 due to the creation of local oxidation areas that support the formation of abrasive wear and do not create a solid lubricant, as in the case of steel 16Mo3. Strain hardening leads to a reduction of possible wear on Inconel 625 superalloy as well as on 16Mo3 steel. In the case of the friction process, the places of supercritical bending of the structure showed the greatest resistance to wear compared to the non-deformed structure.

Anne Orholm Nielsen,1 Ole Hilberg,2,3 Jens Ulrik Stæhr Jensen,4 Steffen Helmer Kristensen,5 Jannie Christina Frølund,2 Pernille Kølholt Langkilde,6 Anders Løkke2,3 1Department of Medicine, Zealand University Hospital, Roskilde, Denmark; 2Department of Medicine, Hospital Little Belt, Vejle, Denmark; 3Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 4Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Copenhagen, Denmark; 5Department of Pulmonary Medicine, Aalborg University Hospital, Aalborg, Denmark; 6Department of Medicine, Hospital Little Belt, Kolding, DenmarkCorrespondence: Anne Orholm NielsenDepartment of Medicine, Zealand University Hospital, Roskilde, DenmarkEmail anne_orholm@hotmail.comBackground: Inhaled corticosteroids (ICS) are widely used in the treatment of chronic obstructive pulmonary disease (COPD), but recent studies have raised doubts whether all COPD patients will benefit from ICS. This study evaluates in a real-life setting the effects of ICS withdrawal in patients with COPD.Methods: The study was a prospective intervention study following patients with COPD for 6 months after abrupt withdrawal of ICS. FEV1 (L), blood eosinophilic count (x10E9/L) and number of exacerbations were measured at baseline, 1, 3 and 6 months after ICS withdrawal.Results: Ninety-six patients (56 females (57.4%), mean age 70 years (51– 94 years)) with COPD were included in the study. Eleven patients were excluded during the study period (7 patients died, 4 patients withdrew their consent during the study period). During the 6 months, 51 patients (60%) had resumed treatment with ICS, of whom 34 patients (68%) experienced an exacerbation during follow-up. No significant decline in FEV1 was seen in this group between baseline and after 6 months (ΔFEV1 0.07 L, p = 0.09). In the remaining 34 patients (40%) without ICS after 6 months of follow-up, 15 patients (44.1%) experienced an exacerbation. No significant decline was seen in FEV1 at baseline and after 6 months (ΔFEV1 0.04 L, p = 0.28). There were no statistically significant differences between the two groups in age (70.5 vs 69.6 years, p = 0.53), nor between FEV1 at baseline (0.96 L vs 1.00 L, p = 0.63) or eosinophilic count (0.25 x10E9/L vs 0.17 x10E9/L, p = 0.07).Conclusion: Abrupt withdrawal of ICS was possible in some patients. However, more than half of the patients resumed ICS during follow-up. Based on results from our study we were not able to foresee – from neither history of exacerbations nor eosinophilic count – whom will be able to manage without ICS and who will resume treatment with ICS.Keywords: COPD, inhaled corticosteroids, withdrawal, real-life setting

Abstract Background Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections. Case presentation A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography—computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient’s severe pain symptoms and significantly enhancing her quality of life. Conclusions In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.

Equation discovery methods enable modelers to combine domain-specific knowledge and system identification to construct models most suitable for a selected modeling task. The method described and evaluated in this paper can be used as a nonlinear system identification method for gray-box modeling. It consists of two interlaced parts of modeling that are computer-aided. The first performs computer-aided identification of a model structure composed of elements selected from user-specified domain-specific modeling knowledge, while the second part performs parameter estimation. In this paper, recent developments of the equation discovery method called process-based modeling, suited for nonlinear system identification, are elaborated and illustrated in two continuous-time case studies. The first case study illustrates the use of the process-based modeling on synthetic data while the second case-study evaluates process-based modeling on measured data for a standard system-identification benchmark. The experimental results clearly demonstrate the ability of process-based modeling to reconstruct both model structure and parameters from measured data.