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Bionic devices for reestablishing or augmenting users' capabilities (e.g., bionic prostheses or exoskeletons) are becoming increasingly common. While prior research examined how such devices affect others' perceptions of their users, little is known about how these devices affect users' self-image and -perception, and the corresponding theory is scarce. To account for this gap, we conducted semi-structured interviews with users of bionic upper limb prostheses to obtain insights into their self- and meta-perceptions. Results of our qualitative analysis indicate that using bionic prostheses influences the social (self-) perception of bionics users in multiple ways, such that users describe themselves as being seen as more competent by others and treated differently after receiving the bionic prosthesis in comparison to simpler models. Results imply a somewhat complex dual identity among users in the sense that the bionic device instills competence, but disability-related feelings of stigma are present simultaneously. Despite being exploratory, our findings thus indicate that using bionic devices affects users' self-perception, stereotypes, and interpersonal perceptions. The ongoing proliferation of restoring devices and the introduction of augmenting technologies in future work contexts, for example, might thus have unintended social consequences that need to be accounted for., Competing Interests: Declaration of competing interest No conflict of interest exists., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

In this review, we describe the application of shaped pulses for EPR spectroscopy. Pulses generated by fast arbitrary waveform generators are mostly used in the field of EPR spectroscopy for broadband (200 MHz-1 GHz) excitation of paramagnetic species. The implementation and optimization of such broadband pulses in existing EPR spectrometers, often designed and optimized for short rectangular microwave pulses, is demanding. Therefore, a major part of this review will describe in detail the implementation, testing and optimization of shaped pulses in existing EPR spectrometers. Additionally, we review applications using such pulses for broadband inversion of longitudinal magnetization as well as for the creation and manipulation of transverse magnetization in the field of dipolar and hyperfine EPR spectroscopy. They demonstrate the great potential of shaped pulses to improve the performance of pulsed EPR experiments. We give a brief theoretical description of shaped pulses and their limitations, especially for adiabatic pulses, most often used in EPR. We believe that this review can on the one hand be of practical use to EPR groups starting to work with such pulses, and on the other hand give readers an overview of the state of the art of shaped pulse applications in EPR spectroscopy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Background: In the treatment of diabetes mellitus, the challenge is to integrate adequate self-management into clinical care. Customization including goal setting, monitoring, and feedback could be achieved through digitization. Digital linking between different devices could simplify and promote self-management. The aim of this study is to evaluate the outcome of diabetes treatment assisted by a digital health application compared with standard diabetes therapy., Methods: The DAVOS study is a 6-month-period prospective, multicentric, randomized controlled trial. In total, 154 diabetes patients (age ≥18; treated with insulin) will be recruited and randomized into control group or intervention group. Both groups will receive standard diabetes care. The intervention group will additionally use a diabetes app. HbA1c value will be monitored on three separate defined visits. Primary endpoint is the overall reduction of HbA1c value. Secondary endpoints (eg, usability of the app) will be determined through patient-reported outcome questionnaires., Discussion: Through enhanced interaction of health care professionals, providers of the app, and patients, the study aims to demonstrate improvement in the self-management of diabetes. As part of the closure management, all patients will be invited to use the examined application after completion of the study. The DAVOS study will be conducted in accordance with the valid version of the present study protocol and the internationally recognized International Conference on Harmonization-Good Clinical Practice (ICH-GCP) Guidelines. Special attention will be paid to European, national, and regional requirements for the approval, provision, and use of medical devices. The study was registered in the German Register of Clinical Trials (DRKS) with number DRKS00025996.

New bionic technologies and robots are becoming increasingly common in workspaces and private spheres. It is thus crucial to understand concerns regarding their use in social and legal terms and the qualities they should possess to be accepted as 'co-workers'. Previous research in these areas used the Stereotype Content Model to investigate, for example, attributions of Warmth and Competence towards people who use bionic prostheses, cyborgs, and robots. In the present study, we propose to differentiate the Warmth dimension into the dimensions of Sociability and Morality to gain deeper insight into how people with or without bionic prostheses are perceived. In addition, we extend our research to the perception of robots. Since legal aspects need to be considered if robots are expected to be 'co-workers', for the first time, we also evaluated current perceptions of robots in terms of legal aspects. We conducted two studies: In Study 1, participants rated visual stimuli of individuals with or without disabilities and low- or high-tech prostheses, and robots of different levels of Anthropomorphism in terms of perceived Competence, Sociability, and Morality. In Study 2, participants rated robots of different levels of Anthropomorphism in terms of perceived Competence, Sociability, and Morality, and additionally, Legal Personality, and Decision-Making Authority. We also controlled for participants' personality. Results showed that attributions of Competence and Morality varied as a function of the technical sophistication of the prostheses. For robots, Competence attributions were negatively related to Anthropomorphism. Perception of Sociability, Morality, Legal Personality, and Decision-Making Authority varied as functions of Anthropomorphism. Overall, this study contributes to technological design, which aims to ensure high acceptance and minimal undesirable side effects, both with regard to the application of bionic instruments and robotics. Additionally, first insights into whether more anthropomorphized robots will need to be considered differently in terms of legal practice are given., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mandl, Bretschneider, Meyer, Gesmann-Nuissl, Asbrock, Meyer and Strobel.)

Purpose: Spinal diseases requiring urgent surgical treatment are rare during pregnancy. Evidence is sparse and data are only available in the form of case reports. Our aim is to provide a comprehensive guide for spinal surgery on pregnant patients and highlight diagnostic and therapeutic aspects., Methods: The study included a cohort of consecutive pregnant patients who underwent spinal surgery at five high-volume neurosurgical centers between 2010 and 2017. Perioperative and perinatal clinical data were derived from medical records., Results: Twenty-four pregnant patients were included. Three underwent a preoperative cesarean section. Twenty-one patients underwent surgery during pregnancy. Median maternal age was 33 years, and median gestational age was 13 completed weeks. Indications were: lumbar disk prolapse (n = 14; including cauda equina, severe motor deficits or acute pain), unstable spine injuries (n = 4); intramedullary tumor with paraparesis (n = 1), infection (n = 1) and Schwann cell nerve root tumor presenting with high-grade paresis (n = 1). Two patients suffered transient gestational diabetes and 1 patient presented with vaginal bleeding without any signs of fetal complications. No miscarriages, stillbirths, or severe obstetric complications occurred until delivery. All patients improved neurologically after the surgery., Conclusion: Spinal surgical procedures during pregnancy seem to be safe. The indication for surgery has to be very strict and surgical procedures during pregnancy should be reserved for emergency cases. For pregnant patients, the surgical strategy should be individually tailored to the mother and the fetus.

We demonstrate a series of multitrityl radical compounds where accurate spin-counting by pulsed electron paramagnetic resonance (EPR) can be achieved at X-band (9 GHz) frequencies, even for molecules with very short and flexible linkers. Multiquantum filter experiments, well-known from NMR, were used to count the number of coupled electron spins in these compounds. The six pulse double quantum filter sequence used in EPR for distance determinations in biradicals was used. Precise phase settings to separate higher quantum coherences were achieved by an arbitrary waveform generator. The trityl radicals have narrow spectral width so that homogeneous excitation of all spins by the pulses is possible. The transversal relaxation times of higher quantum coherences of trityl radicals are sufficiently long to allow their detection. Our results on model compounds show the potential of this approach to determine oligomeric states in protein complexes in their native environment using functionalized trityl spin labels.

Perioperative infarction in brain tumor surgery occurs in about 30-80% of cases and is strongly associated with poor patient outcomes and longer hospital stays. Risk factors contributing to postoperative brain infarction should be assessed. We retrospectively included all patients who underwent surgery for brain metastases between January 2015 and December 2017. Hemodynamic parameters were analyzed and then correlated to postoperative infarct volume and overall survival. Of 249 patients who underwent biopsy or resection of brain metastases during that time, we included 234 consecutive patients in this study. In total, 172/249 patients showed ischemic changes in postoperative magnet resonance imaging (MRI) (73%). Independent risk factors for postoperative brain infarction were perioperative blood loss (rho 0.189, p = 0.00587), blood glucose concentration (rho 0.206, p = 0.00358), blood lactate concentration (rho 0.176; p = 0.0136) and cumulative time of reduced PaCO 2 (rho -0.142; p = 0.0445). Predictors for reduced overall survival were blood lactate ( p = 0.007) and blood glucose levels ( p = 0.032). Other hemodynamic parameters influenced neither infarct volume, nor overall survival. Intraoperative elevated lactate and glucose levels are independently associated with postoperative brain infarction in surgery of brain metastases. Furthermore, they might predict reduced overall survival after surgery. Blood loss during surgery also leads to more cerebral ischemic changes. Close perioperative monitoring of metabolism might reduce those complications.

Awake craniotomies represent an essential opportunity in the case of lesions in eloquent areas. Thus, optimal surveillance of the patient during different stages of sedation, as well as the detection of seizure activity during brain surgery, remains difficult, as skin electrodes for electroencephalographic (EEG) analysis are not applicable in most cases. We assessed the applicability of ECoG to monitor different stages of sedation, as well as the influence of different patient characteristics, such as tumour volume, size, entity, and age or gender on permutation entropy (PeEn). We conducted retrospective analysis of the ECoG data of 16 patients, who underwent awake craniotomies because of left-sided brain tumours at our centre between 2014 and 2016. PeEn could be easily calculated and compared using frontal and parietal cortical electrodes. A comparison of PeEn scores showed significantly higher values in awake patients than in patients under anaesthesia (p ≤ 0.004) and significantly higher ones in the state of transition than under general anaesthesia (p = 0.023). PeEn scores in frontal and parietal leads did not differ significantly, making them both applicable for continuous surveillance during brain surgery. None of the following clinical characteristics showed significant correlation with PeEn scores: tumour volume, WHO grade, first or recurrent tumour, gender, and sex. Being 50 years or older led to significantly lower values in parietal leads but not in frontal leads. ECoG and a consecutive analysis of PeEn are feasible and suitable for the continuous surveillance of patients during awake craniotomies. Hence, the analysis is not influenced by patients' clinical characteristics.

Background: Postoperative ischemia is a frequent phenomenon in patients with brain tumors and is associated with postoperative neurological deficits and impaired overall survival. Particularly in the field of cardiac and vascular surgery, the application of a brief ischemic stimulus not only in the target organ but also in remote tissues can prevent subsequent ischemic damage. We hypothesized that remote ischemic preconditioning (rIPC) in patients with brain tumors undergoing elective surgical resection reduces the incidence of postoperative ischemic tissue damage and its consequences., Methods: Sixty patients were randomly assigned to two groups, with 1:1 allocation, stratified by tumor type (glioma or metastasis) and previous treatment with radiotherapy. rIPC was induced by inflating a blood pressure cuff placed on the upper arm three times for 5 min at 200 mmHg in the treatment group after induction of anesthesia. Between the cycles, the blood pressure cuff was released to allow reperfusion. In the control group no preconditioning was performed. Early postoperative magnetic resonance images (within 72 h after surgery) were evaluated by a neuroradiologist blinded to randomization for the presence of ischemia and its volume., Results: Fifty-eight of the 60 patients were assessed for occurrence of postoperative ischemia. Of these 58 patients, 44 had new postoperative ischemic lesions. The incidence of new postoperative ischemic lesions was significantly higher in the control group (27/31) than in the rIPC group (17/27) (p = 0.03). The median infarct volume was 0.36 cm 3 (interquartile range (IR): 0.0-2.35) in the rIPC group compared with 1.30 cm 3 (IR: 0.29-3.66) in the control group (p = 0.09)., Conclusions: Application of rIPC was associated with reduced incidence of postoperative ischemic tissue damage in patients undergoing elective brain tumor surgery. This is the first study indicating a benefit of rIPC in brain tumor surgery., Trial Registration: German Clinical Trials Register, DRKS00010409 . Retrospectively registered on 13 October 2016.

Aim of this study was to determine if perioperative hemodynamics have an impact on perioperative infarct volume and patients' prognosis. 201 cases with surgery for a newly diagnosed or recurrent glioblastoma were retrospectively analyzed. Clinical data and perioperative hemodynamic parameters, blood tests and time of surgery were recorded. Postoperative infarct volume was quantitatively assessed by semiautomatic segmentation. Mean diastolic blood pressure (dBP) during surgery (rho -0.239, 95% CI -0.11 - -0.367, p = 0.017), liquid balance (rho 0.236, 95% CI 0.1-0.373, p = 0.017) and mean arterial pressure (MAP) during surgery (rho -0.206, 95% CI -0.07 - -0.34, p = 0.041) showed significant correlation to infarct volume. A rank regression model including also age and recurrent surgery as possible confounders revealed mean intraoperative dBP, liquid balance and length of surgery as independent factors for infarct volume. Univariate survival analysis showed mean intraoperative dBP and MAP as significant prognostic factors, length of surgery also remained as significant prognostic factor in a multivariate model. Perioperative close anesthesiologic monitoring of blood pressure and liquid balance is of high significance during brain tumor surgery and should be performed to prevent or minimize perioperative infarctions and to prolong survival.

Inappropriately activated mineralocorticoid receptor (MR) is a risk factor for vascular remodeling with unclear molecular mechanism. Recent findings suggest that post-transcriptional regulation by micro-RNAs (miRs) may be involved. Our aim was to search for MR-dependent miRs in vascular smooth muscle cells (VSMCs) and to explore the underlying molecular mechanism and the pathologic relevance. We detected that aldosteroneviathe MR reduces miR-29bin vivoin murine aorta and in human primary and cultured VSMCs (ED50= 0.07 nM) but not in endothelial cells [quantitative PCR (qPCR), luciferase assays]. This effect was mediated by an increased decay of miR-29b in the cytoplasm with unchanged miR-29 family member or primary-miR levels. Decreased miR-29b led to an increase in extracellular matrix measured by ELISA and qPCR and enhanced VSMC migration in single cell-tracking experiments. Additionally, cell proliferation and the apoptosis/necrosis ratio (caspase/lactate dehydrogenase assay) was modulated by miR-29b. Enhanced VSMC migration by aldosterone required miR-29b regulation. Control experiments were performed with scrambled RNA and empty plasmids, by comparing aldosterone-stimulated with vehicle-incubated cells. Overall, our findings provide novel insights into the molecular mechanism of aldosterone-mediated vascular pathogenesis by identifying miR-29b as a pathophysiologic relevant target of activated MR in VSMCs and by highlighting the importance of miR processing for miR regulation.-Bretschneider, M., Busch, B., Mueller, D., Nolze, A., Schreier, B., Gekle, M., Grossmann, C. Activated mineralocorticoid receptor regulates micro-RNA-29b in vascular smooth muscle cells., (© FASEB.)

A new wavelength - dispersive X-ray spectrometer for scanning electron microscopy (SEM) has been developed. This spectrometer can cover an energy range from 50 eV to 1120 eV by using an array made of seventeen reflection zone plates. Soft X-ray emission spectra of simple elements of Li, Be, B, C, N, Ti, V, O, Cr, Mn, Fe, Co, Ni, Cu, Zn and Ga were measured. The overall energy resolving power on the order of E/ΔE ~80 to 160 has been demonstrated. Spectrometer with 200 reflection zone plates has been used as a multi-channel analyser in the energy range of 100 - 1000 eV for quasi - continuous spectra measurements. The predicted energy-resolving power on the order of E/ΔE = 50 has been achieved in the entire energy range.

The epidermal growth factor receptor (EGFR), a receptor tyrosine kinase, contributes to parainflammatory dysregulation, possibly causing cardiovascular dysfunction and remodeling. The physiological role of cardiovascular EGFR is not completely understood. To investigate the physiological importance of EGFR in vascular smooth muscle cells and cardiomyocytes, we generated a mouse model with targeted deletion of the EGFR using the SM22 (smooth muscle-specific protein 22) promoter. While the reproduction of knockout animals was not impaired, life span was significantly reduced. Systolic blood pressure was not different between the 2 genotypes-neither in tail cuff nor in intravascular measurements-whereas total peripheral vascular resistance, diastolic blood pressure, and mean blood pressure were reduced. Loss of vascular smooth muscle cell-EGFR results in a dilated vascular phenotype with minor signs of fibrosis and inflammation. Echocardiography, necropsy, and histology revealed a dramatic eccentric cardiac hypertrophy in knockout mice (2.5-fold increase in heart weight), with increased stroke volume and cardiac output as well as left ventricular wall thickness and lumen. Cardiac hypertrophy is accompanied by an increase in cardiomyocyte volume, a strong tendency to cardiac fibrosis and inflammation, as well as enhanced NADPH-oxidase 4 and hypertrophy marker expression. Thus, in cardiomyocytes, EGFR prevents excessive hypertrophic growth through its impact on reactive oxygen species balance, whereas in vascular smooth muscle cells EGFR contributes to the appropriate vascular wall architecture and vessel reactivity, thereby supporting a physiological vascular tone.

We demonstrate femtosecond operation of a Nd-doped mi-crostructure fiber laser. The fiber provides gain and anomalous dispersion at the lasing wavelength of 1.06 microm and enables the construction of short and simple cavity designs. The laser is passively mode-locked by the combined action of a saturable absorber mirror, fiber nonlinearity, and dispersion and produces transform limited sub-400-fs pulses with a pulse energy as high as 100 pJ.

An outbreak due to a methicillin-resistant S. aureus (MRSA) strain in an orthopaedic septic care unit was observed. 17 patients developed wound infections. Stronger regime of hygiene and chemotherapy and new technics of operations controlled the outbreak within 5 months. Studies of colonisation were performed at the care unit in march, june and august 1992. 618 isolates were investigated from patients, personnel and their environment. The frequencies of detected MRSA diminished from 30% in march only to 22% in august 1992. The long time persistence of endemic MRSA in a care facility was evident from the presence of MRSA even 5 months after the last infection.