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Harald Rittger,1,* Christoph Stadelmaier,1,* Thomas Kieschnick,1 Duygu Büber,1 Kristina Rank,1 Laura Vitali-Serdoz,1 Dirk Bastian,1 Matthias Waliszewski2,3 1Medizinische Klinik 1, Klinikum Fürth, Fürth, Germany; 2Medical Scientific Affairs, B. Braun Melsungen AG, Berlin, Germany; 3Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany*These authors contributed equally to this workCorrespondence: Harald RittgerKlinikum Fuerth, Medizinische Klinik 1, Jakob-Henle-Strasse 1, Fuerth 90766, GermanyTel +49-911-7580-1101Fax +49-911-7580-1104Email h.rittger@yahoo.comIntroduction: The clinical benefit of invasive therapy in elderly patients with acute coronary syndrome (ACS) remains unclear. Furthermore, the decision-making process to treat this growing patient group is also debatable. The purpose of this study was to assess the association between elderly ACS patients, the treatment choice and their in-hospital outcomes after non-ST-elevation (NSTE)-ACS in a consecutive series of patients > 75 years of age.Methods and Results: Consecutive patients > 75 years presenting with NSTE-ACS in our hospital between July 2017 and July 2018 were included during the first 2 days of hospital admission. Demographic data, prior medical history and present medical condition were documented. During day 0 and day 2, geriatric assessments (Clinical Frailty Scale [CFS], Barthel index, Charlson comorbidity index, “timed up and go” test [TUG], Mini-Mental Status Test [MMS], Geriatric Depression Scale [GDS], SF-36 for quality of life, instrumental activities of daily living [IADL], Killip-score, Grace-score and Euro-score) were conducted. After 6 months, patients were re-evaluated. In 106 patients (mean age 81.9± 5.3 years, 57% male gender), 68 patients (64%) were treated interventionally, and 38 patients had conservative treatment (36%). Patients treated with intervention were significantly younger (80.9± 4.7 years vs 83.5± 6.0 years, p=0.015), had a lower rate of prior cerebral events (17.6% vs 26.3%; p=ns) and suffered more often from chronic obstructive pulmonary disease (17.6% vs 34.2%; p=0.050). All other demographic variables were comparable between both groups. The composite clinical endpoint (death, re-infarction, bleeding) was reached in 7 patients (10.3%) of the invasive and in 2 patients (5.3%) of the conservative group. They were not significantly different between both groups. A frailty index, consisting of commonly used parameters of functional impairment in elderly patients, namely, MMS ≤ 2 at baseline, IADL ≤ 7, CFS ≥ 7 and age ≥ 85 years, significantly predicted conservative treatment.Conclusion: Effective revascularization techniques are still underused in patients of older age in the case of ACS. For decision-making, geriatric tests alone may not predict treatment in those patients, but the combination of different tests may better predict treatment and perhaps the clinical outcomes in those patients. Furthermore, frail patients are at higher risk for not receiving guideline recommended therapy.Keywords: acute coronary syndromes, elderly patients, frailty, interventional treatment

Pendahuluan: Infeksi kecacingan yang tersebar luas di daerah tropis dan subtropis. Khususnya Indonesia, salah satu negara yang mempunyai kasus kecacingan cukup tinggi, kasus ini biasaya ditemukan di daerah dengan kelembaban yang tinggi, dan kurangnya kebersihan diri, serta keadaan lingkungan yang kurang baik. Salah satu pemeriksaan laboratorium yang bisa dilakukan untuk mendiagnosis penyakit kecacingan adalah pemeriksaan mikroskopis. Pemeriksaan mikroskopis menggunakan sampel feses memerlukan pewarnaan yang tentunya mengandung zat pewarna yang baik sebagai penunjang. Zat pewarna ini ditemukan pada limbah gambir (Uncaria gambir) berupa zat katekin yang mampu memberikan warna merah kuning. Sehingga, limbah gambir (Uncaria gambir) dapat dijadikan pewarnaan alternatif pemeriksaan telur cacing STH. Tujuan penelitian : untuk memanfaatkan zat katekin pada limbah gambir (Uncaria gambir) sebagai pewarnaan pemeriksaan telur cacing STH. Penelitian ini meliputi pengumpulan, sampel feses, pengumpulan limbah gambir, pengolahan limbah gambir, pembuatan preparat menggunakan pewarnaan eosin dan pewarnaan limbah gambir, pengamatan telur cacing STH yang dilakukan secara mikroskopis. Metode penelitian : Eksperimen laboratorium, yang dilakukan di Laboratorium Parasitologi Fakultas Sains dan Teknologi Institut Ilmu Kesehatan dan Teknologi Muhammadiyah Palembang. Sampel berupa feses. Hasil penelitian : menunjukkan bahwa telur cacing STH dapat terwarnai pada kedua pewarnaan, yaitu Pewarnaan Limbah Gambir dan Pewarnaan Eosin. Kesimpulan penelitian : pewarnaan limbah gambir dapat dimanfaatkan sebagai pewarnaan telur cacing STH. Pewarnaan limbah gambir dapat dijadikan pewarnaan alternatif pengganti pewarna eosin untuk pewarnaan telur cacing STH.

IntroductionDeficits in social functioning and decision-making are well-documented in schizophrenia, but their relationship with positive symptoms and social conflicts is poorly understood. We created a new paradigm based on the Dictator Game (DG) to explore differences in social decision-making between individuals experiencing high levels of psychotic-like experiences (PLEs), particularly hallucinations and delusions, and controls with less PLEs.MethodsA large community sample (N = 1,161) completed a DG in an online study whereby extreme groups were built based on the positive subscale of the CAPE.ResultsOverall, participants experiencing PLEs did not act less prosocial than controls but showed a somewhat aberrant decision-making behavior, particularly a pattern of behaving more prosocial in fair situations and generally favoring punishment over compensation relative to controls. Mediation analyses suggest that measures of empathy and Machiavellism have predictive power for prosocial behavior beyond group status.DiscussionThe present study raises the possibility that individuals with high levels of PLEs may be less able to adapt their behavior to the situation at hand than controls. These irregularities might be due to deficits in social cognition which may elicit conflict, thus compromising social functioning and possibly contributing to the formation of positive symptoms.

The idea of sensorizing a strain wave gear to measure the transmitted torque has been reported since the 1980s. The strain in the elastic flex spline is typically measured by strain gages attached to it. The resulting voltages relate to the transmitted torque in the gear. However, periodic inaccuracies in the measured torque signal (sensing ripple), resulting from positioning inaccuracies of strain gages on the flex spline, prevented this technology from being used outside a lab environment. Regardless of these difficulties, measuring the torque directly in the strain wave gear would bring many advantages, especially in robotic applications, where design space is highly limited. Traditionally, robotic joints are equipped with link-sided torque sensors, which reduce the available design volume, lower the joint stiffness, and require complex cable routing. This paper presents an experimental study of a novel sensorized strain wave gear named RT1-T, which was developed by Schaeffler Technologies. The study was implemented on a joint testbed, including a high-resolution reference torque sensor at the link side. In addition to the measurement accuracy and linearity, a torque ripple analysis is performed. The joint torque control capabilities are determined along dynamic trajectories and compared to the performance achieved with a link-sided reference sensor. The sensor employed in the testbed has a static torque error of 0.42 Nm and an average closed-loop torque control error of 0.65 Nm above the reference sensor.

Transfection of mammalian and human cell lines in medical research both are key technologies in molecular biology and genetic engineering. A vast variety of techniques to facilitate transfection exists including different chemical and nanoparticle-based agents as mediators of nucleic acid uptake, with nanoparticles composed of the lipids DOSPA/DOPE belonging to the established type of agents. We show that inverse-nanoemulsion-derived protein nanohydrogels (NanoTrans-gels), prepared by a simple synthesis protocol, are suited to transfect two model cancer cell lines (MCF7 and A549) with high efficiency. The transfection efficiency was analyzed in comparison to the DOSPA/DOPE-dependent protocols as a reference method. Since nanogel-based transfection outperformed the Lipofectamine-dependent technique in our experiments, we believe that the NanoTrans-gels loaded with plasmid DNA may open new avenues for simple and efficient transfection for humans and probably also other mammalian cell lines and may develop into a general tool for standard transfection procedures in cell biology laboratories.

Continuum joints use structural elastic deformations to enable joint motion, and their intrinsic compliance and inherent mechanical robustness are envisioned for applications in which the robot, the human, and the environment need to be safe during interaction. In particular, the intrinsic compliance makes continuum joints a competitor to soft articulated joints, which require additional integrated spring elements. For soft articulated joints incorporating rigid and soft parts, natural motions have been investigated in robotics research to exploit this energy-efficient motion property for cyclic motions, e.g., locomotion. To the best of the author’s knowledge, there is no robotic system to date that utilizes the natural motion of a continuum joint under periodic excitation. In this paper, the resonant behavior of a tendon-driven continuum joint under periodic excitation of the torsional axis is experimentally investigated in a functional sense. In the experiments, periodic inputs are introduced on the joint side of a tendon driven continuum joint with four tendons. By modulating the pretension of the tendons, both the resonant frequency and the gain can be shifted, from 3 to 4.3 Hz and 2.8 to 1.4, respectively, in the present experimental setup. An application would be the rotation of a humanoid torso, where gait frequencies are synchronized with the resonant frequency of the continuum joint.

Introduction: The incidence of Rheumatoid Arthritis (RA) in Indonesia has a case prevalence ranging from 0.1% to 0.3%. Limitations in the supply of Glyceline saline buffer in laboratory examinations, especially in the laboratory for examination of Rheumatoid Factor (RF), is one of the reasons for the need for alternative materials with the same effectiveness to be used in examinations. An alternative in carrying out inspections if commercial reagents are not available so that ready-to-use 0.9% NaCl reagent can be an alternative reagent. The purpose of this study was to determine whether there were differences in the titers of rheumatoid factor levels using glycine saline buffer reagents and ready-touse 0.9% NaCl. Method: The study was conducted at the IKesT MP Clinical Pathology Laboratory. The research design used a posttest only control group design. The population is 43 elderly people at the Harapan Kita Nursing Home. a sample of 30 elderly people with purposive sampling technique. Data were analyzed by Wilcoxon test. Results: The results obtained were p = 0.000 for titer examination of RF levels using Glycine Saline Buffer reagent and ready-to-use 0.9% NaCl reagent. Discussion: There are differences in the titers of rheumatoid factor levels using glycerin saline buffer and ready-to-use NaCl. 0,9%.

Abstract Objective This study aimed to determine whether ultra-low tidal volume ventilation (ULTVV) applied during cardiopulmonary resuscitation (CPR) compared with standard ventilation (intermittent positive pressure ventilation, IPPV) can reduce pulmonary end-organ damage in the post-resuscitation period. Methods A prospective, randomized trial was conducted using a porcine model (n = 45). The animals were divided into three groups: IPPV, ULTVV, and a sham control group. Juvenile male pigs underwent CPR after inducing ventricular fibrillation and received the designated ventilation intervention [IPPV: tidal volume 6–8 ml per kilogram body weight (ml/kg BW), respiratory rate 10/min, FiO2 1.0; ULTVV: tidal volume 2–3 ml/kg BW, respiratory rate 50/min, FiO2 1.0]. A 20-h observation period followed if return of spontaneous circulation was achieved. Histopathological examination using the diffuse alveolar damage scoring system was performed on postmortem lung tissue samples. Arterial and venous blood gas analyses and ventilation/perfusion measurements via multiple inert gas elimination technique (MIGET) were repeatedly recorded during the experiment. Results Out of the 45 experiments conducted, 28 animals were excluded based on predefined criteria. Histopathological analysis showed no significant differences in lung damage between the ULTVV and IPPV groups. ULTVV demonstrated adequate oxygenation and decarboxylation. MIGET measurements during and after resuscitation revealed no significant differences between the intervention groups. Conclusion In the short-term follow-up phase, ULTVV demonstrated similar histopathological changes and functional pulmonary parameters compared to standard ventilation. Further research is needed to investigate the long-term effects and clinical implications of ULTVV in resuscitation settings.

Abstract Automated detection of lesions using artificial intelligence creates new standards in medical imaging. For people with epilepsy, automated detection of focal cortical dysplasias (FCDs) is widely used because subtle FCDs often escape conventional neuroradiological diagnosis. Accurate recognition of FCDs, however, is of outstanding importance for affected people, as surgical resection of the dysplastic cortex is associated with a high chance of postsurgical seizure freedom. Here, we make publicly available a dataset of 85 people affected by epilepsy due to FCD type II and 85 healthy control persons. We publish 3D-T1 and 3D-FLAIR, manually labeled regions of interest, and carefully selected clinical features. The open presurgery MRI dataset may be used to validate existing automated algorithms of FCD detection as well as to create new approaches. Most importantly, it will enable comparability of already existing approaches and support a more widespread use of automated lesion detection tools.

We propose a Majoron-like extension of the Standard Model with an extra global U(1)X-symmetry where neutrino masses are generated through an inverse seesaw mechanism at the 1-loop level. In contrast to the tree-level inverse seesaw, our framework contains dark matter (DM) candidates stabilized by a residual Z2-symmetry surviving spontaneous breaking of the U(1)X-group. We explore the case in which the DM is a Majorana fermion. Furthermore, we provide parameter space regions allowed by current experimental constraints coming from the dark matter relic abundance, (in)direct detection, and charged lepton flavor violation.

C-Reactive Protein (CRP) ialah protein fase akut dengan struktur homopentamer dan memiliki tempat ikatan kalsium yang spesifik terhadap phosphocholine. Peningkatan kadar C-Reactive Protein (CRP) dikarnakan adanya trauma, infek bakteri dan inflamasi (peradangan dan kerusakan jaringan). Pemeriksaan laboratorium C-Reactive Protein (CRP) dapat dilakukan dengan metode, aglutinasi, ELISA, dan immunoturbidimetri. Konsentrasi dari CRP ditentukan secara kuantitatif dengan pengukuran immunoturbidimetri, dalam pemeriksaan CRP lebih banyak menggunakan sampel serum tetapi penggunaan serum dalam pemeriksaan laboratorium sering terjadinya hemolisis sehingga pada proses pengambilan sampelnya membutuhkan waktu yang lebih lama dan membuat proses pemeriksaan kurang efisien, sehingga diperlukan penggunaan plasma lithium heparin dari pada serum karena plasma lithium heparin leebih baik dalam menggambarkan situasi patologis pasien. Penelitian ini bertujuan untuk mengetahui Pebandingan Kadar C-Reactive Protein (CRP) Pada Sampel Serum dan Plasma Lithium Heparin. Metode Penelitian: Penelitian ini dilakukan dilaboratorium Patologi Klinik Intitut Ilmu Kesehatan dan Teknologi Muhammadiyah Palembang pada bulan Januari 2022. Jenis penelitian yang digunakan pada penelitian ini yaitu Crosssection. Data dianalisis dengan uji Wilcoxon, Hasil: Didapatkan Hasil p= 0,000 dengan adanya perbedaan selisih kadar CRP menggunakan serum dan plasma lithium heparin mengalami peningkatan sebesar 15%.. Diskusi: terdapat perbedaan yang signitifikan pada pemeriksaan kadar CRP menggunakan sampel serum dan plasma lithium heparin.

In this research we consider a U(1)X gauge boson acting as a dark matter candidate. The vector dark matter (DM) gets mass when a complex singlet scalar breaks the gauge symmetry spontaneously, adding a second Higgs boson to the spectra. The dark matter candidates communicate with the SM particles via a scalar-Higgs portal. In this work, we concentrate on the masses of the vector dark matter and the scalar mediator below 10 GeV, aka light dark matter. Although we assume thermal freeze-out for the vector DM using the zero-moment of the full Boltzmann equation to calculate the relic abundance, we explore the effects of the second-moment when the vector DM annihilates resonantly. As typically light DM is highly sensitive to CMB bounds, we focus on two thermal mechanisms which alleviate this bound: dark matter annihilation via forbidden channels and near a pole. Other bounds from colliders, thermalization conditions, beam-dump experiments, and astrophysical observations are imposed. Taking into account all the bounds including the direct detection upper limits, the viable space is achieved.

Abstract Energy optimization of factory operations has gained increasing importance over recent years since it is understood as one way to counteract climate change. At the same time, the number of research teams working on energy-optimized factory operations has also increased. While many tools are useful in this area, our team has recognized the importance of a comprehensive framework to combine functionality for optimization, simulation, and communication with devices in the factory. Therefore, we developed a framework that provides a standardized interface to research energy-optimized factory operations with a rolling horizon approach. The optimization part of the framework is based on the OpenAI gym environment. The framework also provides connectors for multiple communication protocols including Open Platform Communication Unified Architecture and Modbus via Transmission Control Protocol. These facilities can be utilized to implement rolling horizon optimizations for factory systems easily and directly control devices in the factory with the optimization results. In this article, we present the framework and show some examples to prove the effectiveness of our approach.

Artificial Intelligence can support diagnostic workflows in oncology, but they are vulnerable to adversarial attacks. Here, the authors show that convolutional neural networks are highly susceptible to white- and black-box adversarial attacks in clinically relevant classification tasks.

BackgroundArtificial intelligence (AI) and machine learning (ML) models continue to evolve the clinical decision support systems (CDSS). However, challenges arise when it comes to the integration of AI/ML into clinical scenarios. In this systematic review, we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), the population, intervention, comparator, outcome, and study design (PICOS), and the medical AI life cycle guidelines to investigate studies and tools which address AI/ML-based approaches towards clinical decision support (CDS) for monitoring cardiovascular patients in intensive care units (ICUs). We further discuss recent advances, pitfalls, and future perspectives towards effective integration of AI into routine practices as were identified and elaborated over an extensive selection process for state-of-the-art manuscripts.MethodsStudies with available English full text from PubMed and Google Scholar in the period from January 2018 to August 2022 were considered. The manuscripts were fetched through a combination of the search keywords including AI, ML, reinforcement learning (RL), deep learning, clinical decision support, and cardiovascular critical care and patients monitoring. The manuscripts were analyzed and filtered based on qualitative and quantitative criteria such as target population, proper study design, cross-validation, and risk of bias.ResultsMore than 100 queries over two medical search engines and subjective literature research were developed which identified 89 studies. After extensive assessments of the studies both technically and medically, 21 studies were selected for the final qualitative assessment.DiscussionClinical time series and electronic health records (EHR) data were the most common input modalities, while methods such as gradient boosting, recurrent neural networks (RNNs) and RL were mostly used for the analysis. Seventy-five percent of the selected papers lacked validation against external datasets highlighting the generalizability issue. Also, interpretability of the AI decisions was identified as a central issue towards effective integration of AI in healthcare.