Search

Importance Depression is the leading cause of mental health–related disease burden and may be reduced by physical activity, but the dose-response relationship between activity and depression is uncertain.Objective To systematically review and meta-analyze the dose-response association between physical activity and incident depression from published prospective studies of adults.Data Sources PubMed, SCOPUS, Web of Science, PsycINFO, and the reference lists of systematic reviews retrieved by a systematic search up to December 11, 2020, with no language limits. The date of the search was November 12, 2020.Study Selection We included prospective cohort studies reporting physical activity at 3 or more exposure levels and risk estimates for depression with 3000 or more adults and 3 years or longer of follow-up.Data Extraction and Synthesis Data extraction was completed independently by 2 extractors and cross-checked for errors. A 2-stage random-effects dose-response meta-analysis was used to synthesize data. Study-specific associations were estimated using generalized least-squares regression and the pooled association was estimated by combining the study-specific coefficients using restricted maximum likelihood.Main Outcomes and Measures The outcome of interest was depression, including (1) presence of major depressive disorder indicated by self-report of physician diagnosis, registry data, or diagnostic interviews and (2) elevated depressive symptoms established using validated cutoffs for a depressive screening instrument.Results Fifteen studies comprising 191 130 participants and 2 110 588 person-years were included. An inverse curvilinear dose-response association between physical activity and depression was observed, with steeper association gradients at lower activity volumes; heterogeneity was large and significant (I2 = 74%; P Conclusions and Relevance This systematic review and meta-analysis of associations between physical activity and depression suggests significant mental health benefits from being physically active, even at levels below the public health recommendations. Health practitioners should therefore encourage any increase in physical activity to improve mental health.

The Improved Inter Integrated Circuit (I3C) interface is a scalable, medium-speed, utility and control bus interface designed for connecting peripherals to an application processor. It is a backward-compatible successor to the I2C interface with increased speed, additional functionalities and improved energy efficiency. The Sensor Fusion project supports the early adoption of the I3C interface at the industry level by establishing a validation methodology of the timing parameters of the I3C interface and by setting up appropriate digital design workflows used in implementing I3C interface in Systems-on-Chip (SoC). The timing validation methodology is based on a Hardware- inLoop (HIL) topology, while the design workflows are represented by two I3C-based SoC examples: the autonomous I3C target and the temperature sensor integrated in Arm Cortex-M0 periphery with I3C Target interface.

This paper will explain what an artificial neural network is and how it works in theory. To make it easier to explain how an artificial neural network works, the first part will explain the terminology, the idea behind neural networks and their role in machine learning. In the continuation of the paper, the development of neural networks will be presented, as well as the principle of operation of the most important models that will be used through examples, and special attention will have focus to explain the concepts of neural networks. Through various applications in the examples, we will analyze the architecture of neural networks on image recognition using web applications and explain the concepts of convolutional neural networks.

ObjectiveTo estimate dose-response associations between non-occupational physical activity and multiple chronic disease outcomes in the general adult population.Eligibility criteriaProspective cohort studies with (a) general population samples >10,000 adults, (b) ≥3 exposure categories, and (c) risk measures and confidence intervals for all-cause mortality, total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer, and site-specific cancers (head and neck, myeloid leukemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, esophagus, prostate, kidney).Information sourcesPubMed, Scopus, Web of Science, and reference lists of published studies, searched in February 2019.Data extraction and synthesisIndependent extraction and double-checking of study characteristics, exposure, and outcome assessment by two reviewers for each paper. Primary exposure was non-occupational physical activity volume, harmonized to physical activity energy expenditure in marginal MET-hours per week (mMET-h/week). The current minimum recommendations for physical activity (150 min/week of moderate-to-vigorous physical activity) equate to 8.75 mMET-h/week. Outcomes were risks of mortality, cardiovascular diseases, and cancers. We used restricted cubic splines in random-effects meta-analyses. Potential population impact was quantified using impact fractions.Results196 articles were included, covering 94 cohorts. The evidence base was largest for all-cause mortality (50 independent results; 163,415,543 person-years; 811,616 events), and incidence of cardiovascular disease (37 independent results; 28,884,209 person-years; 74,757 events) and cancer (31 independent results; 35,500,867 person-years; 185,870 events). In general, inverse non-linear associations were observed, steeper between 0 and 8.75 mMET-h/week, with smaller marginal reductions in risk above this level to 17.5 mMET-h/week, beyond which additional reductions were small and uncertain. Associations were stronger for all-cause and cardiovascular disease mortality than for cancer mortality. If all insufficiently active individuals had met the recommended physical activity level, 15.7% (95%CI: 13.1 to 18.2%) of all premature deaths would have been averted.ConclusionsInverse non-linear dose-response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults.Review registrationPROSPERO CRD42018095481.

Diabetes and hyperglycaemia are associated with increased morbidity and large healthcare and economic costs.1 Glucocorticoid-induced diabetes and hyperglycaemia are common. Glucocorticoids are used widely to treat people with inflammatory and autoimmune conditions,2 malignancies3 and in hospitalised patients with COVID-19.4 In the United Kingdom (UK), among hospitalised patients, the prevalence of glucocorticoid use is 10% in all patients5 and 25–40% in those with diabetes.6 This is associated with adverse metabolic outcomes including impaired glycaemic control7 and can manifest as a new-onset diabetes (glucocorticoid-induced diabetes) or worsening hyperglycaemia in people with diabetes (glucocorticoid-induced hyperglycaemia). The hypothesised mechanism for glucocorticoid-induced diabetes and hyperglycaemia is reduced insulin sensitivity and increased gluconeogenesis. Approximately 2% of all newly diagnosed diabetes cases in the United Kingdom are related to glucocorticoid use over a mean duration of 8.9 (±1.7) years.8 A meta-analysis by Liu et al.9 demonstrated that the incidence of glucocorticoid-induced diabetes and hyperglycaemia is 18.6% and 32.3%, respectively, over the period of 1–12 months. Patients from the included studies were adults in outpatient and inpatient settings treated with systemic glucocorticoids for a variety of indications including haematological malignancies, rheumatoid arthritis, pemphigus, pemphigoid, systemic lupus erythematosus, respiratory and neurological conditions.9\ud \ud

The latest progress in therapies indicated for the treatment of childhood cancers has enabled the improvement of survival rates in affected patients. However, the treatment can have gonadotoxic effects and sometimes results in infertility. Therefore, strategies for fertility preservation are developed for storage of intact reproductive tissue and possible future fertility restoration when the patient is cured of the initial disease. Currently, only the cryopreservation of immature reproductive tissue is well established. In contrast, the approach to restoring fertility using the stored tissue is, for now, in most cases, only theoretical, especially concerning pre-pubertal boys. On the other hand, fertility restoration in pre-pubertal girls is much more advanced, but further studies are needed to ensure safety regarding malignancies with a high risk of metastases. In order to overcome the risk of malignant contamination, when the cryopreserved reproductive tissue is intended to be applied (whether it is immature testicular or ovarian tissue), a suitable alternative to reproductive tissue autotransplantation is in vitro culture and development of mature gametes. For now, these methods are still in their onset and far from clinical application. Still, their advancement can be expected in the near future, given the rapid development of scientific techniques.

Aim/Introduction: Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterised by one or more hyperfunctioning parathyroid glands with parathyroid surgery still representing the only definitive treatment. Maximising the accuracy of imaging localisation of hyperfunctional parathyroid glands is crucial for focused and minimally invasive surgical approach. The aim of the study is to assess the value of 18F- fluorocholine positron emission tomography (PET/CT) in preoperative localization of hyperfunctioning parathyroid glands, in patients with biochemically confirmed PHPT and negative or inconclusive neck ultrasound and MIBI scintigraphy. Materials and Methods: In 136 patients (17 male, 119 female ; mean age 58 years) with PHPT (median serum calcium 2, 7 mmol/L ; median PTH 14, 6 pmol/L) PET/CT scan was performed with 100-150 MBq of 18F-fluorocholine in a period of 40 months. Low-dose PET/CT acquisition of the neck and thorax was done, 15-30 minutes post injection, 3 min per bed position. Results: In 132 patients (97%) 143 foci of increased tracer uptake suggestive of hyperactive parathyroid glands were found (single focus in 121 patients, two in 8 patients, three in 2 patients). 4 patients were PET/ CT negative, and two were judged as false positive finding after surgery. Most common localisation of the hyperactive parathyroid gland in the neck region was the level of the lower poles of thyroid lobes (40 on the right side, 44 on the left). Lesions were also found in the level of the upper poles of thyroid lobes (13 right, 17 left). In 17 patients (13%) parathyroid gland was localized prevertebraly in the neck, and in 14 patients (10%) ectopic parathyroid glands were found in the mediastinum. The average maximum diameter of the lesion was 8 mm (range 3-30 mm), and median SUV value was 5, 8 (range 1, 9-16). 66 out of 136 (48%) patients underwent surgery, and 65 parathyroid glands were removed. Histopathology confirmed parathyroid hyperplasia in 21 and adenoma in 43 removed glands. The mean PTH and Ca serum levels postoperatively dropped significantly (PTH from 14, 6 to 5, 2 pmol/L ; Ca from 2, 7 to 2, 3 mmol/L) and normalized in 54 (81%) patients. Conclusion: 18F-fluorocholine PET/CT is a fast and sensitive method for localisation of hyperactive parathyroid glands in patients with long history of PHPT, representing a substrate for minimal invasive surgery after negative or inconclusive neck ultrasound and MIBI scintigraphy and showing excellent diagnostic performance. The data about specificity will be more detailed when surgery will be completed in majority of our patients.

Background: Patients with hematological diseases are polytransfused and often immunocompromised, therefore susceptible to transfusion reactions (TR). This study aims to document the incidence of TRs in adult hematological patients and assess the effect of changes in the production of blood components and transfusion practice on their occurrence. Study design and methods: Retrospective observational analysis of TRs reported from 1993 to 2019 was performed. For the analysis of the effect of changes on the incidence of TRs, the evaluated time was divided into two periods: the 1st period before the introduction of changes in production, when leukoreduced blood components were used only selectively, and the 2nd period, when semi-automated method of production and universal leukoreduction was introduced. Results: The decrease in the incidence of TRs was observed for both red blood cell (RBC) and platelet concentrate (PC) transfusions in the 2nd period. Since platelet additive solution has been used, a further decrease in the incidence was reported. The decrease in incidence was also observed for delayed hemolytic/serological transfusion reactions and for transfusion- transmitted bacterial infections. Four cases of incorrect blood transfusions were uniquely related to the hematological patients, caused by antigen loss and transfusion ordering after ABO- incompatible hematopoietic stem cell transplantation. Discussion: Our results provided evidence that the introduction of tools offered by modern transfusion medicine: universal leukodepletion, plasma replacement with additive solutions, sensitive laboratory techniques, prophylactic antigen matching policy, informatization, and automatization, decreased the incidence of TRs and improved transfusion safety.

Aim/Introduction: The aim of our study was to evaluate the diagnostic performance of 68Ga-PSMA PET-CT in patients with biochemical recurrence (BCR) of prostate cancer and to compare the results with PSA levels, PSAdt (doubling time), elapsed time from radical prostatectomy and Gleason score (GS). Materials and Methods: The study included 78 patients (median age 69y, range 49-84y ; median PSA value 0.47 ng/ml, PSA range 0.2-17, 4 ng/ml) who underwent 68Ga-PSMA PET-CT between April 2021 and March 2022. Results: 45 patients out of 78 (57.69%) were positive for active disease. In patients with PSA value of ≤0.5 ng/mL positivity rate (PR) was 53.49% (23/43), whereas patients with PSA > 0.5 ng/ml exhibited a PR of 65.71% (23/35). PSMA- PET/CT positivity in patients with a GS 7 was 50% (23/46), with GS 8 - 61.54% (8/13), and with GS 9 - 70% (7/10). Regarding PSAdt, out of 40 patients, PSMA-PET/CT PR was 66.67% (16/24) for PSAdt ≤6 months group, 64.29% (9/14) for PSAdt >6≤12 months, whereas in patients with PSAdt of >12 months only three patients were positive 25% (3/12). Out of all patients, androgen deprivation therapy (ADT) was reported in 25.64% (20/78) of the patients. 75% (15/20) of patients, that were ADT-treated, showed a positive Ga-PSMA PET-CT. In patients who were treated with only radical prostatectomy, positivity was correlated with shorter elapsed time from surgery. If a BCR of prostate cancer and PET/CT scan occurred within a year from surgery positivity was 92% (12/13). In the groups where PET-CT was performed more than a year after surgery positivity was significantly lower, only 35.3% (6/17). Local recurrence was found in 15.56%, lymph node metastases in 75.56%, and bone metastases in 28.89% of PSMA-PET/CT positive studies. Conclusion: 68Ga-PSMA PET/CT is a sensitive method for detection of lesions in early prostate cancer recurrence even in patients with very low PSA. Patients who were treated with radical prostatectomy only and had BCR and Ga-PSMA PET/CT scan within a year from surgery were almost all positive (92%), while the longer elapsed time from surgery was linked with a lower positivity rate (35.3%). We have shown that PSAdt may be considered the main positivity predictor of disease recurrence. Shorter PSAdt, even with low PSA was associated with a higher positivity rate, while longer PSAdt was most often linked with negative scans.

A postage stamp is a security that goes down in history. The stamp we are presenting was designed and issued in Croatia, EU, on 24 September 2021, on the occasion of the 100th anniversary of the Otorhinolaryngology Clinic in Croatia. This stamp contains new values through IRD, and that is exactly what we show and offer to philatelists. The stamp "100 years of otorhinolaryngology" has artistic beauty and scientific innovation in the development of twin colorants. In the visual solution of the stamp are embedded hidden graphics that expand the information about the anniversary. Two images are demonstrated in the same space of the stamp, which gives an advantage because it increases the space for communication of a small graphic art product that is printed and multiplied with the IRD procedure. It is a novelty in messaging that is essential in stamp design, with an emphasis on its security features. The stamp has two levels of viewing, for two light areas. The level that is not visible to our naked eye contains data that hides the author�s mark, the printer�s mark, and the institution that bears copyright. The discovery and development of the new INFRAREDESIGN� method offered new experiences in design documents and securities. IRD is an extension of the technology of making and protecting the stamp from counterfeiting because the visible image of the stamp is closely connected to the infrared image. Two images are printed in the same place: a visible image for the naked eye and another image that is recognizable by an infrared detector. The two graphics are inseparable and are widely used in the areas of proving the authenticity of a work of art.

Cardiovascular disease (CVD) is the most common non-communicable disease occurring globally. Although previous literature has provided useful insights into the important role that diet plays in CVD prevention and treatment, understanding the causal role of diets is a difficult task considering inherent and introduced weaknesses of observational (e.g. not properly addressing confounders and mediators) and experimental research designs (e.g. not appropriate or well designed). In this narrative review, we organised current evidence linking diet, as well as conventional and emerging physiological risk factors, with CVD risk, incidence and mortality in a series of diagrams. The diagrams presented can aid causal inference studies as they provide a visual representation of the types of studies underlying the associations between potential risk markers/factors for CVD. This may facilitate the selection of variables to be considered and the creation of analytical models. Evidence depicted in the diagrams was systematically collected from studies included in the British Nutrition Task Force report on diet and CVD and database searches, including Medline and Embase. Although several markers and disorders linked to conventional and emerging risk factors for CVD were identified, the causal link between many remains unknown. There is a need to address the multifactorial nature of CVD and the complex interplay between conventional and emerging risk factors with natural and built environments, while bringing the life course into the spotlight.

The Croatian Cardiovascular Tissue Bank (CTB) was established in June 2011. Activities managed by CTB are processing of heart valves and blood vessels, as well as quality control, storage, medical release and distribution of allografts. The aim of this report is to present CTB's vascular tissue activities and retrospectively evaluate the outcomes of their use in the University Hospital Centre Zagreb. Between June 2011 and July 2021, 90 vascular allografts (VAs) from 55 donors after brain death were referred to CTB. Only 54% of VAs met the tissue quality requirements while 46% of tissues were discarded. The most frequent reasons for discard were unacceptable morphology and initial microbiological contamination. Altogether 42 VAs were released for transplantation and 37 of them were used in 27 surgical procedures. The most common indication for surgery was prosthetic graft or stent infection. According to the anatomic position of vascular reconstruction, patients were divided in the aortic and peripheral reconstruction group. A total of 23 patients were treated. In the aortic reconstruction group 58% of patients did not experience any graft-related complications. In the group of patients who underwent peripheral reconstruction significant incidence of reinfection was observed highlighting it as a major graft-related complication. Despite the small patient groups and limited duration of follow-up, presented clinical outcomes provide valuable information on the efficacy of vascular allografts. Additional clinical results collected on a larger patient groups and comparison to other reconstructive treatment options are necessary.

Objective To evaluate the effectiveness of a multidisciplinary, nonpharmacological, integrative approach that uses shared medical appointments to improve health-related quality of life and reduce opioid medication use in patients with chronic pain. Design This is a retrospective, pre–post review of “Living Well with Chronic Pain” shared medical appointments (August 2016 through May 2018). Setting The appointments included eight 3-hour-long visits held once per week at an outpatient wellness facility. Subjects Patients with chronic, non–cancer-related pain. Methods Patients received evaluation and evidence-based therapies from a team of integrative and lifestyle medicine professionals, as well as education about nonpharmacological therapeutic approaches, the etiology of pain, and the relationship of pain to lifestyle factors. Experiential elements focused on the relaxation techniques of meditation, yoga, breathing, and hypnotherapy, while patients also received acupuncture, acupressure, massage, cognitive behavioral therapy, and chiropractic education. Patients self-reported data via the Patient-Reported Outcomes Measurement Information System (PROMIS-57) standardized questionnaire. Use of opioid medications was evaluated in morphine milligram equivalents. Results A total of 178 participants completed the PROMIS-57 questionnaire at the first and the last visits. Statistically significant improvements in all domains (Physical Functioning, Anxiety, Depression, Fatigue, Social Roles, Pain Interference, and Sleep Disturbance) were observed (P