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Background: The Learning Ratio (LR) is a novel learning score that has shown improved utility over other learning metrics in detecting Alzheimer's disease (AD) across multiple memory tasks. However, its utility on the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Test (CERAD WLMT), a widely used list learning measure sensitive to decline in neurodegenerative disease, is unknown. The goal of the current study was to determine the utility of LR on the CERAD WLMT in differentiating between diagnostic (MiNCD vs MaNCD) and etiologic groups (VaD vs AD) in a veteran sample. Methods: Raw learning slope (RLS) and LR scores were examined in 168 veterans diagnosed with major neurocognitive disorder (MaNCD), mild neurocognitive disorder (MiNCD), or normal aging following neuropsychological evaluation. Patients with MaNCD were further classified by suspected etiology (i.e. microvascular disease vs AD). Results: Whereas RLS scores were not significantly different between MiNCD and MaNCD, LR scores were significantly different between all diagnostic groups (p's <.05). Those with AD had lower LR scores and RLS scores compared to those with VaD (p's <.05). LR classification accuracy was acceptable for MiNCD (AUC =.76), excellent for MaNCD (AUC =.86) and VaD (AUC =.81), and outstanding for AD (AUC =.91). Optimal cutoff scores for WLMT LR were derived from Youden's index. Conclusion: Results support the use of LR scores over RLS when interpreting the CERAD WLMT and highlight the clinical utility of LR in differentiating between diagnostic groups and identifying suspected etiology. [ABSTRACT FROM AUTHOR]

Background: Vascular dementia (VaD) is one of the most prevalent, burdensome, and costly forms of dementia. Pharmacological treatment is often the first-line choice for clinicians; however, there is a paucity of comparative information regarding the multiple available drug options. Methods and Analysis: A systematic review and network meta-analysis were conducted on randomized trials involving adult patients with VaD, sourced from PubMed, the Cochrane Library, EMBASE, Web of Science, OPENGREY, ClinicalTrials.gov, Wanfang Data, and CNKI. The primary outcomes included changes in Mini-Mental State Examination (MMSE) scores, activities of daily living (ADL) scores, and the incidence of adverse reactions. Efficacy and safety of intervention strategies were comprehensively analyzed using forest plots, cumulative ranking probability curves (SUCRA), and funnel plots, all generated with R software. Results: A total of 194 RCTs comparing 21 different anti-VaD drugs with placebos or no treatment were analysed. Regarding MMSE scores, the five most effective drugs were Butylphthalide, Huperzine A, Edaravone, Rivastigmine, and Memantine. For ADL scores, the top five drugs in efficacy were Huperzine A, Butylphthalide, Tianzhi granule, Nicergoline, and Idebenone. In terms of the incidence of adverse drug reactions, Co-dergocrine Mesylate, Tongxinluo capsule, Butylphthalide, Piracetam, and Oxiracetam demonstrated favourable safety profiles. Conclusion: This study enhances the understanding of the relative benefits and risks associated with various VaD treatments, providing a valuable reference for clinical decision-making. [ABSTRACT FROM AUTHOR]

Left ventricular assist devices (LVADs) are excellent therapies for advanced heart failure patients either bridged to transplant or for lifetime use. LVADs also allow for reverse remodeling of the failing heart that is often associated with functional improvement. Indeed, growing enthusiasm exists to better understand this population of patients, whereby the LVAD is used as an adjunct to mediate myocardial recovery. When patients achieve benchmarks suggesting that they no longer need LVAD support, questions related to the discontinuation of LVAD therapy become front and center. The purpose of this review is to provide a surgical perspective on the practical and technical issues surrounding LVAD deactivation. [ABSTRACT FROM AUTHOR]

The utilization of a minimally invasively placed catheter-mounted intravascular micro-axial flow blood pump (IMFBP) is increasing in the population with advanced heart failure. The current development of IMFBPs dates back around the 1990s, namely the Hemopump with a wire-drive system and the Valvopump with a direct-drive system. The wire-drive IMFBPs can use a brushless motor in an external console unit to transmit rotational force through the drive wire rotating the impeller inside the body. The direct-drive IMFBPs require an ultra-miniature and high-power brushless motor. Additionally, the direct-drive system necessitates a mechanism to protect against blood immersion into the motor. Therefore, the direct-drive IMFBPs can be categorized into two types of devices: those with seal mechanisms or those with sealless mechanisms using magnetically coupling. The IMFBPs can be classified into two groups depending on their purpose. One group is for cardiogenic shock following a heart attack or for use in high-risk percutaneous coronary intervention (PCI), and the other group serves the purpose of acute decompensated heart failure. Both direct-drive IMFBPs and wire-drive IMFBPs have their own advantages and disadvantages, and efforts are being made to develop and improve, and clinically implement them, leveraging their own strengths. In addition, there is a possibility that innovative new devices may be invented. For researchers in the field of artificial heart development, IMFBPs offer a new area of research and development, providing a novel treatment option for severe heart failure. [ABSTRACT FROM AUTHOR]

Abstract A blood turbine-pump system (iATVA), resembling a turbocharger was proposed as a mechanical right-heart assist device without external drive power. In this study, the iATVA system is investigated with particular emphasis on the blood turbine flow dynamics. A time-resolved 2D particle image velocimetry (PIV) set-up equipped with a beam splitter and two high speed cameras, allowed simultaneous recordings from both the turbine and pump impellers at 7 different phased-locked instances. The iATVA prototype is 3D printed using an optically clear resin following our earlier PIV protocols. Results showed that magnetically coupled impellers operated synchronously. As the turbine flow rate increased from 1.6 to 2.4 LPM, the rotational speed and relative inlet flow angle increase from 630 to 900 rpm, and 38 to 55% respectively. At the trailing edges, backflow region spanned 3/5 of the total passage outlet flow, and an extra leakage flow was observed at the leading edge. For this early turbine design, approximately, 75% of the turbine blade passage was not contributing to the impulse operation mode. The maximum non-wall shear rate was ~ 2288 s−1 near to the inlet exit, which is significantly lower than the commercial blood pumps, encouraging further research and blood experiments of this novel concept. Experimental results will improve the hydrodynamic design of the turbine impeller and volute regions and will be useful in computational fluid dynamics validation studies of similar passive devices.

To promote the adoption of the orange-fleshed sweet potato (OFSP) among the farmers, OFSP was introduced to the farmers through a program tagged "Jumpstarting Project" (JP), a West African project initiative of Harvestplus and its partners, which was implemented in Osun and Kwara States, in Nigeria. Using household-level data in Nigeria, this paper examined how the intervention of a farmer-led multiplication–dissemination Jumpstarting Project has sustained the adoption of OFSP after years of its implementation and the consequent impact of adoption on productivity and welfare of the farmers. Our main empirical findings are as follows. First, the implementation of the Jumpstarting Project in project communities of Osun and Kwara States shows that the adoption of OFSP has increased and has been sustained over the years. Furthermore, the result of the propensity score matching confirms possible spillover between project communities and control groups. Second, estimation from the endogenous treatment effect indicates that the estimated average treatment effects on the treated indicates a yield gain for the adopters of OFSP. Third, the result of the average treatment effects on the treated from the endogenous switching probit model shows that the probability of being poor in the households that adopted OFSP would be 5.3% more if these households did not adopt OFSP. Our results suggest that immediate replication and scaling up of the Jumpstarting Project in other states in Nigeria should be implemented. This study demonstrates that to ensure the diffusion and adoption of improved technologies such as OFSP, intervention projects that promote the adoption of these technologies have a greater role to play. [ABSTRACT FROM AUTHOR]

In 2016, the United Network for Organ Sharing revised its pediatric heart transplant (HT) allocation policy. This study sought to determine whether the 2016 revisions are associated with reduced waitlist mortality and capture patient-specific risks. Children listed for HT from 1999 to 2023 were identified using Organ Procurement and Transplantation Network data and grouped into 3 eras (era 1: 1999-2006; era 2: 2006-2016; era 3: 2016-2023) based on when the United Network for Organ Sharing implemented allocation changes. Fine-Gray competing risks modeling was used to identify factors associated with death or delisting for deterioration. Fixed-effects analysis was used to determine whether allocation changes were associated with mortality. Waitlist mortality declined 8 percentage points (PP) across eras (21%, 17%, and 13%, respectively; P < 0.01). At listing, era 3 children were less sick than era 1 children, with 6 PP less ECMO use (P < 0.01), 11 PP less ventilator use (P < 0.01), and 1 PP less dialysis use (P < 0.01). Ventricular assist device (VAD) use was 13 PP higher, and VAD mortality decreased 9 PP (P < 0.01). Non-White mortality declined 10 PP (P < 0.01). ABO-incompatible listings increased 27 PP, and blood group O infant mortality decreased 13 PP (P < 0.01). In multivariable analyses, the 2016 revisions were not associated with lower waitlist mortality, whereas VAD use (in era 3), ABO-incompatible transplant, improved patient selection, and narrowing racial disparities were. Match-run analyses demonstrated poor correlation between individual waitlist mortality risk and the match-run order. The 2016 allocation revisions were not independently associated with the decline in pediatric HT waitlist mortality. The 3-tier classification system fails to adequately capture patient-specific risks. A more flexible allocation system that accurately reflects patient-specific risks and considers transplant benefit is urgently needed. [ABSTRACT FROM AUTHOR]

Disturbance in bodily experience (BE) is a potential adverse consequence of ventricular assist device (VAD) implantation. The concept BE encompasses all cognitive and affective processes related to the subjective experience of one's own body. A cross-sectional, multicenter study was performed, involving 365 VAD patients (85% male; time postimplant: 3-36 months). Patients completed a BE questionnaire (BE-S, 5-point Likert scale), and the disturbance in BE was analyzed based on sex, time since implantation (in the first, second, or third years postimplant), and patient acuity (elective vs emergent implantation). Subsidiary, patients' gratitude was surveyed. Disturbance in BE was not particularly pronounced (mean = 2.69, standard deviation = 1.17). Eighty-five percent of patients expressed high levels of gratitude. Disturbance in BE decreased (p = 0.04), while gratitude increased (p = 0.02) with time since implantation. Female patients showed more disturbance in BE (p = 0.01) and less gratitude (p = 0.01) compared to male patients. Among patients who underwent emergency implantation, the decrease in disturbance occurred predominantly in the third year, exceeding the level observed in elective implanted patients (p = 0.03). Disturbance in BE following VAD implantation does generally not reach excessive levels and tends to decrease over time. Our data indicate more disturbance and less gratitude in female patients. In emergently implanted patients, disturbance in BE is prolonged. Screening for disturbance in BE is recommended during follow-up, especially for these at-risk groups, to ensure early and focused psychological support. [ABSTRACT FROM AUTHOR]

This paper deals with the problem of creating a keyword spotting (KWS) system with real-world audio data. The paper describes the different methods used to build KWS systems, deep learning models such as convolutional neural networks (CNN), transformers, etc. The paper also discusses the mainstream dataset for training and testing KWS models, Google Speech Commands. We conduct experiments on Google Speech Commands dataset and propose our method of creating a KWS dataset and that helps neural networks achieve better results in training on relatively small amounts of data. We also introduce an idea of a hybrid KWS inference system architecture that uses voice detection and light-weight speech recognition framework in attempt to boost its computational performance and accuracy. We conclude by noting that KWS is an important challenge in the field of speech recognition, and suggest that their method can be used to improve the performance of KWS systems in the circumstances of low amounts of training data. We also note that future research could focus on bettering the process of evaluating the models and improving the overall performance of KWS systems. [ABSTRACT FROM AUTHOR]

Background Objective Materials and methods Results Discussion and conclusions An animal model of the partial restoration of spermatogenesis may be useful in the field of reproductive biology and medicine. Vitamin A deficiency (VAD) induces the restorable arrest of spermatogenesis at the level of spermatogonia and is used as a mouse model of spermatogenesis disorder.We aimed to establish an animal model in which spermatogenesis is partially restored by switching a vitamin A deficiency diet to a normal vitamin A‐containing diet and conduct a comprehensive analysis to identify vulnerable sites in the seminiferous tubules that affect the efficient restoration of spermatogenesis in this model.Mice fed a vitamin A deficiency diet until 12 weeks old and then reared with a normal diet for 15 weeks served as the restoration model. We performed three‐dimensional reconstructions of the seminiferous tubules and analyzed the three‐dimensional distribution of restored spermatogenesis throughout the testis.Fifteen weeks after the switch to the normal diet, spermatogenesis was restored in 78% of the length of seminiferous tubules. The percentage of restored spermatogenesis was lower in longer seminiferous tubules. An analysis of the distribution of spermatogenesis throughout the testis in this model revealed that it was restored less in portions of seminiferous tubules near the rete testis and hairpin curves and also in those located in the caudal region of the testis. These sites tended to correspond to sites with fewer spermatogonia in the vitamin A deficiency testis.We established an animal model of the partial restoration of spermatogenesis and examined the three‐dimensional distribution of restored spermatogenesis in seminiferous tubules. The results obtained provide insights into the mechanisms underlying spermatogenesis disorders and may contribute to better clinical practices, such as the screening of drugs or therapeutic interventions for human male infertility and improvements in fertility preservation techniques for individuals undergoing chemotherapy. [ABSTRACT FROM AUTHOR]

Background/Objectives: Mental health and substance use disorders (MHDs and SUDs) affect cardiac allograft and VAD recipients and impact their quality of life and compliance. Limited research currently exists on MHDs and SUDs in this population. Methods: This study compares the incidence of MHDs and SUDs in the transplant list, VAD, and post-transplant patients with that in heart failure patients. Study cohorts were derived from the TriNetX database using ICD-10 codes. Differences in incidence were examined using the log-rank test. Adults with MHDs and SUDs before the window of time were excluded. All comparisons were made between propensity-matched cohorts. Statistical significance was set at p < 0.05. Results: Transplant waitlist patients showed a significant increase in the incidence of anxiety, depression, panic, adjustment, mood, alcohol use, and eating disorders. Post-transplant patients showed a significant increase in depression and opioid use. VAD patients showed a significant increase in depression and a decrease in panic disorder and anxiety. These results allow for further investigations on prevention and coping strategies. Conclusions: The deterioration of mental health can significantly impact medication compliance, survival, and quality of life. Opioid use for pain management in the early postoperative period should be further investigated to assess its impact on long-term substance use and addiction. [ABSTRACT FROM AUTHOR]

Voice activity detection (VAD) plays a crucial role in speech processing, serving as a fundamental component for various applications such as speech recognition and communication systems. Numerous approaches have been explored to address the VAD issue, but their effectiveness diminishes significantly in the presence of noise. In response to this challenge, we present a novel technique designed to enhance the robustness of VAD under noisy conditions. Our proposed system incorporates a background noise suppression module based on the minimum mean square error spectrum power estimator using zero crossing (MMSE-SPZC). This module is integrated before the semi-supervised Gaussian mixture model-based VAD (SSGMM-VAD). The effectiveness of the proposed VAD system is evaluated across four distinct types of noise and low signal-to-noise ratio (SNR) levels. Our experimental results reveal significant improvements in VAD accuracy, demonstrating the system's ability to maintain robust performance even in the presence of challenging background noise conditions. [ABSTRACT FROM AUTHOR]

The dementia epidemic, attributed to aging populations, represents a growing socio-economic burden. It is estimated that in 2019 about 55 million people worldwide were living with dementia. With many possible causes of dementia and the possibility of mixed dementia combining Alzheimer's disease (AD) and vascular dementia the question is whether diagnostic uncertainty exists or whether diagnostic constructs based on single etiologies are incorrect. Vascular Cognitive Impairment and Dementia (VCID) designates the extent of cognitive dysfunctions from the most benign state to that of dementia, of vascular origin. We reviewed epidemiological, pathophysiological and clinical data on VCID with a focus on VaD, as well as key data on the development of a new therapeutic solution, SaiLuoTong (MLC-SLT). From documentary research executed on different web sources (PubMed, Clintrials.gov, Z-library and Google), our initial selection for the short review of VCID and VaD was based on keywords contained in each paragraph subtitles of this article with exclusion of publications in a language other than English or published before 2010. For the review of SaiLuoTong development, there was just the language exclusion criterion. Sorted by relevance and publication date, 47 references were selected from 140 shortlisted for review. With new evidence-based classification systems, vascular cognitive impairment was proposed as umbrella term covering all forms of cognitive deficits related to vascular causes. The scope of application expanded with the VCID which includes VaD and mixed pathologies. No drugs are approved for the treatment of VaD by major Western regulatory agencies, while some traditional Chinese medicines are registered in China. VCID treatment should have a dual focus: managing the underlying cerebrovascular disease and dementia symptoms. This is the objective set for the development of the MLC-SLT, the essential data of which are reviewed in detail. To strengthen VCID and VaD research, consensus groups should attempt to consolidate scattered local research initiatives into coordinated international programs. In two VaD clinical trials, MLC-SLT improved cognitive symptoms and activities of daily living, with good safety and potential diseasemodifying effect. In a placebo-controlled study in 325 patients with mild to moderate VaD and randomized according to a delayed-start design, MLC-SLT demonstrated significant improvement in memory tests and performance in executive function tasks, expanding its place in the management of VCID. At week 26, changes in VADAS-cog scores (SD) from baseline were 23.25 (0.45) for MLCSLT 180 mg bid), 23.05 (0.45) for MLC-SLT 120 mg bid (both p < 0.0001), and 20.57 (0.45) for placebo (p = 0.15). At week 52, differences between both groups MLCSLT and placebo were 2.67 and 2.48, respectively (p < 0.0001), without significant difference between MLC-SLT groups. [ABSTRACT FROM AUTHOR]

Word embeddings have been successfully used in diverse tasks of Natural Language Processing, including sentiment analysis and emotion classification, even though these embeddings do not contain any emotional or sentimental information. This article proposes a method to refine pre-trained embeddings with emotional and sentimental content. To this end, a Multi-output Neural Network is proposed to learn emotions and sentiments simultaneously. The resulting embeddings are tested in emotion classification and sentiment analysis tasks, showing an improvement compared with the pre-trained vectors and other proposes in the state-of-the-art for fine-grained emotion classification. [ABSTRACT FROM AUTHOR]

Background: Patients with ventricular assist devices (VADs) represent a growing population presenting to Emergency Medical Services (EMS), but little is known about their prehospital care. This study aimed to characterize current EMS protocols in the United States for patients with VADs. Methods: States with state-wide EMS protocols were included. Protocols were obtained from the state EMS website. If not available, the office of the state medical director was contacted. For each state, protocols were analyzed for patient and VAD assessment and treatment variables. Results: Of 32 states with state-wide EMS protocols, 21 had VAD-specific protocols. With 17 (81%) states noting a pulse may not be palpable, protocols recommended assessing alternate measures of perfusion and mean arterial pressure (MAP; 15 [71%]). Assessment of VAD was advised through listening for pump hum (20 [95%]) and alarms (20 [95%]) and checking the power supply (15 [71%]). For treatment, EMS prehospital consultation was required to begin chest compression in three (14%) states, and mechanical (device) chest compressions were not permitted in two (10%) states. Contact information for VAD coordinator was listed in a minority of five (24%) states. Transport of VAD equipment/backup bag was advised in 18 (86%) states. Discussion: This national analysis of EMS protocols found VAD-specific EMS protocols are not universally adopted in the United States and are variable when implemented, highlighting a need for VAD teams to partner with EMS agencies to inform standardized protocols that optimize these patients' care. [ABSTRACT FROM AUTHOR]

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Background: Fulminant myocarditis (FM) constitutes a severe and life-threatening form of acute cardiac injury associated with cardiogenic shock. The condition is characterised by rapidly progressing myocardial inflammation, leading to significant impairment of cardiac function. Due to the acute and severe nature of the disease, affected patients require urgent medical attention to mitigate adverse outcomes. Besides symptom-oriented treatment in specialised intensive care units (ICUs), the necessity for temporary mechanical cardiac support (MCS) may arise. Numerous patients depend on these treatment methods as a bridge to recovery or heart transplantation, while, in certain situations, permanent MCS systems can also be utilised as a long-term treatment option. Methods: This review consolidates the existing evidence concerning the currently available MCS options. Notably, data on venoarterial extracorporeal membrane oxygenation (VA-ECMO), microaxial flow pump, and ventricular assist device (VAD) implantation are highlighted within the landscape of FM. Results: Indications for the use of MCS, strategies for ventricular unloading, and suggested weaning approaches are assessed and systematically reviewed. Conclusions: Besides general recommendations, emphasis is put on the differences in underlying pathomechanisms in FM. Focusing on specific aetiologies, such as lymphocytic-, giant cell-, eosinophilic-, and COVID-19-associated myocarditis, this review delineates the indications and efficacy of MCS strategies in this context. [ABSTRACT FROM AUTHOR]

Mechanical circulatory support is an increasingly important strategy for the treatment of a subset of patients with acute heart failure. Use of extracorporeal circuits with pumps and oxygenators to augment cardiac function can be immediately lifesaving, whereas implantable therapies can allow patients, with advanced heart disease, to resume near normal lives. Options for mechanical support are expanding, with long-term prognosis improving as devices become more sophisticated and complication rates fall. The perioperative management of such patients is reliant on complex specialist pathways and effective multidisciplinary decision-making. Critical care considerations for mechanical circulatory support are wide-ranging, and an understanding of the underlying physiology, device circuitry, anticoagulation, haemostasis, invasive monitoring and transoesophageal echocardiography is essential. [ABSTRACT FROM AUTHOR]

“El archivo trabaja siempre y a priori contra sí mismo”. Jacques Derrida Lo que no se archiva no existe. Esta extrema adaptación del clásico aforismo podría sintetizar las últimas décadas de creciente fascinación multidisciplinar por el archivo; fenómeno al que se ha otorgado carta de naturaleza mediante el tan manido tándem nominal del giro más su correspondiente epíteto. Siguiendo este “impulso archivístico”, distintas y diversas propuestas, tanto teóricas como metodológicas, han tratado de trascender el archivo como fuente para redefinirlo como un objeto de estudio en sí mismo. Sus retóricas nos susurran al unísono que ningún archivo es inocente, pues en su acervo confluyen igualmente la memoria y el olvido, ambos determinados por el poder selectivo de quien los construye, custodia y difunde. “No hay documento de cultura que no lo sea al tiempo de barbarie” advertía tempranamente Walter Benjamin. “Y como él mismo no está libre de barbarie, tampoco lo está el proceso de transmisión en el cual ha pasado desde el uno al otro”. Precisamente, el escepticismo epistémico posmoderno, inducido por la fuerza motriz del linguistic turn, llevó a ese ‘otro’ constitutivo a aceptar el desafío de abordar la lectura ‘a contrapelo’ de la historia; consecuentemente, también de los archivos, señalados por la arqueología del saber foucaultiana como origen y destino de aquella inaplazable expedición.

Abstract Background The research aims to observe the difference in the effect of preoperative doxorubicin curcumin co-loaded lipid nanoparticles (DOX+CUR LPNs) and doxorubicin (VAD) in the treatment of osteosarcoma. Methods 68 patients with osteosarcoma who visited the hospital from January 2020 to December 2022 are chosen. They are separated into VAD group and DOX+CUR LPNs group, with 34 cases in each group. VAD and DOX+CUR LPNs groups VAD chemotherapy, and DOX+CUR LPNs treatment, respectively. All patients receive tumor resection. Comparison is made between the two groups before chemotherapy, at the end of chemotherapy and 1 week after surgery on the changes of vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2), galectin-3 (Gal-3), renal function indicators cystatin-C (Cys-C), serum creatinine (Scr), blood urea nitrogen (BUN) in the peripheral blood. The clinical efficacy and adverse reactions are determined by observation and follow-up for 1 month. Results The VEGF, Ang-2, and Gal-3 in both groups were significantly lower at 1 week after chemotherapy and surgery compared to before chemotherapy (P

Many poor people worldwide cannot afford nutritious food and depend on rice for their daily food needs. In 2022, Asia was home to 55% (402 million) of the people in the world affected by hunger, while more than 38% (282 million) lived in Africa. India is the world's secondlargest producer of rice, wheat, vegetables, and fruit. Malnutrition is a major problem that causes many immediate and long-term health problems. Over 33 lakh children in India are malnourished, with Maharashtra, Bihar, and Gujarat having a major share. Vitamin A deficiency causes irreversible blindness in 500,000 children annually, which ultimately results in large-scale deaths. In Southeast Asia, due to VAD, every year, five million children develop symptoms that may lead to blindness. VAD is also a matter of concern in several areas of Africa, Latin America, and the Caribbean. It is estimated that vitamin A nutrition may prevent approximately 1 to 2 million deaths every year among children aged 1 to 4 and an additional 0.25 to 0.5 million during the higher age group of children. One of the major causes of vitamin A deficiency is that milled rice does not contain ß-carotene, which is the precursor of vitamin A synthesis. In this scenario, adopting Golden Rice which is genetically modified rice could benefit the population living in developing countries. This review article gives emphasis on the importance of overcoming vitamin A deficiency. [ABSTRACT FROM AUTHOR]

Background: The research aims to observe the difference in the effect of preoperative doxorubicin curcumin co-loaded lipid nanoparticles (DOX+CUR LPNs) and doxorubicin (VAD) in the treatment of osteosarcoma. Methods: 68 patients with osteosarcoma who visited the hospital from January 2020 to December 2022 are chosen. They are separated into VAD group and DOX+CUR LPNs group, with 34 cases in each group. VAD and DOX+CUR LPNs groups VAD chemotherapy, and DOX+CUR LPNs treatment, respectively. All patients receive tumor resection. Comparison is made between the two groups before chemotherapy, at the end of chemotherapy and 1 week after surgery on the changes of vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2), galectin-3 (Gal-3), renal function indicators cystatin-C (Cys-C), serum creatinine (Scr), blood urea nitrogen (BUN) in the peripheral blood. The clinical efficacy and adverse reactions are determined by observation and follow-up for 1 month. Results: The VEGF, Ang-2, and Gal-3 in both groups were significantly lower at 1 week after chemotherapy and surgery compared to before chemotherapy (P < 0.05). The VEGF and Gal-3 in the DOX+CUR LPNs group were lower than those in the VAD group in the same period, with P < 0.05. The Cys-C, Scr, and BUN in both groups of patients after chemotherapy and surgery increased compared to before chemotherapy, with P < 0.05. The Cys-C, Scr, and BUN in the DOX+CUR LPNs group were lower than those in the VAD group during the same period, with P < 0.05. Following up for 1 month, the ORR of the DOX+CUR LPNs group was 94.12% (32/34) higher than that of the VAD group, with P < 0.05. The incidence of adverse reactions in the DOX+CUR LPNs group was 47.05% lower than that in the VAD group, with P < 0.05. Conclusion: Preoperative application of DOX+CUR LPNs enables effective drug delivery to the tumor section by combining the antibacterial, antioxidant and anti-inflammatory effects of curcumin, which is co-wrapped in nanoparticles. It has the effect of promoting angiogenesis and damage repair, inhibiting inflammation-related factors, and protecting renal function, while adriamycin alone has drug resistance problems and toxic side effects, which can damage the patient's liver and kidney. Therefore, DOX+CUR LPNs are more effective than adriamycin alone, indicating that it can improve the therapeutic effect of the drug and reduce the side effects, which is of great significance for improving the survival rate and quality of life of patients. [ABSTRACT FROM AUTHOR]

Objectives: Limited data are available on renal dysfunction and neurologic complications in heart failure in children, when the heart failure is not related to congenital heart disease (CHD) or cardiac surgery. This study used a multi-center database to describe pediatric heart failure (pHF)-related renal dysfunction, neurological complications, and outcomes in non-CHD patients. Methods: The Pediatric Health Information System (PHIS) database between 2004 and 2020 was used to analyze the prevalence of renal dysfunction and neurologic complications associated with pHF hospitalizations and their impact on outcomes. Results: Of the 5515 hospitalizations included in the study, renal dysfunction was identified in 1239 (22.5%), and neurologic dysfunction was diagnosed in 539 (9.8%). The diagnosis of renal or neurologic complications was associated with significantly higher use of ICU therapies, including mechanical ventilation, parenteral nutrition, and mechanical circulatory support. Patients with significant renal dysfunction were likely to receive kidney transplants in 3.1% of the cases. Neurologic complications were higher in patients with pHF who underwent heart transplantation (21.3% vs. 7.8%, p < 0.001). Patients with renal dysfunction and neurologic complications had significantly higher mortality rates than those without renal dysfunction (11.7% vs. 4.3%, p < 0.001) and neurologic complications (18.4% vs. 4.6%, p < 0.001). Conclusions: Renal dysfunction and neurologic complications are common, resulting in significantly higher utilization of ICU therapies and mortality rates during non-CHD-related pHF hospitalization. Neurologic complications associated with hospitalization for pHF are associated with a significantly higher mortality, which has been underemphasized in the literature. This study assesses the burden of these morbidities and highlights the importance of monitoring and managing renal and neurologic complications in pHF to improve outcomes. [ABSTRACT FROM AUTHOR]

The demand for efficient and adaptable life support systems in the field of Extracorporeal Life Support (ECLS) is steadily increasing. To meet this growing need, there is a requirement for a versatile extracorporeal life support circuit that can be effectively applied in various medical scenarios, especially in tertiary hospitals where multiple ECLS services are utilized. These services include Extracorporeal Membrane Oxygenation (ECMO) for addressing respiratory or cardiac problems, Ventricular Assist Device (VAD) as a bridge to recovery or heart transplant, and Venovenous Bypass (VVB) for assisting liver transplantation. In light of this, we propose the creation of a multipurpose circuit that integrates multiple extracorporeal life support (ECLS) functions to cater to diverse medical needs. This innovative circuit not only offers cost-effectiveness and enhanced safety but also ensures optimal utilization, thereby revolutionizing the realm of life support technologies.

Objectives: Limited data are available on renal dysfunction and neurologic complications in heart failure in children, when the heart failure is not related to congenital heart disease (CHD) or cardiac surgery. This study used a multi-center database to describe pediatric heart failure (pHF)-related renal dysfunction, neurological complications, and outcomes in non-CHD patients. Methods: The Pediatric Health Information System (PHIS) database between 2004 and 2020 was used to analyze the prevalence of renal dysfunction and neurologic complications associated with pHF hospitalizations and their impact on outcomes. Results: Of the 5515 hospitalizations included in the study, renal dysfunction was identified in 1239 (22.5%), and neurologic dysfunction was diagnosed in 539 (9.8%). The diagnosis of renal or neurologic complications was associated with significantly higher use of ICU therapies, including mechanical ventilation, parenteral nutrition, and mechanical circulatory support. Patients with significant renal dysfunction were likely to receive kidney transplants in 3.1% of the cases. Neurologic complications were higher in patients with pHF who underwent heart transplantation (21.3% vs. 7.8%, p < 0.001). Patients with renal dysfunction and neurologic complications had significantly higher mortality rates than those without renal dysfunction (11.7% vs. 4.3%, p < 0.001) and neurologic complications (18.4% vs. 4.6%, p < 0.001). Conclusions: Renal dysfunction and neurologic complications are common, resulting in significantly higher utilization of ICU therapies and mortality rates during non-CHD-related pHF hospitalization. Neurologic complications associated with hospitalization for pHF are associated with a significantly higher mortality, which has been underemphasized in the literature. This study assesses the burden of these morbidities and highlights the importance of monitoring and managing renal and neurologic complications in pHF to improve outcomes.

Background: Ventricular assist device (VAD) implant represents a therapeutic option for pediatric patients with end-stage heart failure (HF). Heart unloading by VAD can modify several molecular pathways underlying cardiac function in HF. Among them, the potential role of microRNA (miRNAs) in response to VAD implant is emerging. This study was aimed at investigating in HF pediatric patients the effect of VAD-modified miRNAs on the adiponectin (ADPN) system, known to exert cardioprotective actions. Methods: ADPN was measured in plasma samples obtained from HF children, before and 1 month after VAD implant, and from healthy control children. miRNA profile and molecules belonging to ADPN system were determined in cardiac biopsies collected at the time of VAD implantation (pre-VAD) and at the moment of heart transplant (post-VAD). An in vitro study using HL-1 cell line was performed to verify the regulatory role of the VAD-modified miRNA on the ADPN system. Results: VAD implant did not affect circulating and cardiac levels of ADPN, but increased the cardiac mRNA expression of ADPN receptors, including AdipoR1, AdipoR2, and T-cad. AdipoR2 and T-cad were inversely related to the VAD-modified miRNA levels. The in vitro study confirmed the regulatory role of miR-1246 and miR-199b-5p on AdipoR2, and of miR-199b-5p on T-cad. Conclusions: These data suggest that VAD treatment could regulate the expression of the cardioprotective ADPN system by epigenetic mediators, suggesting that miRNAs have a potential role as therapeutic targets to improve cardiac function in HF pediatric patients.

Extracorporeal centrifugal pumps are widely used in various forms of mechanical circulatory support, including extracorporeal membrane oxygenation and ventricular assist device. A durable centrifugal pump was developed by implementing a new hydrodynamic bearing design that prevents the impeller from touching to the casing wall and provides sufficient washout through the pump to prevent thrombus formation in the pump. The hydrodynamic bearings of the pump are composed of dual annular paths located on both sides of the impeller. Computational fluid dynamics analyses were performed on the flow field inside the pump to estimate the leakage flow through the gap and its impact on the pump efficiency and biocompatibility. The calculations were performed for motor speeds from 3000 to 5000 rpm and flow rates from 1.0 to 9.0 L/min. The leakage flow increased linearly with increasing pressure head of the pump, and the total leakage flow ranged from 2.0 to 27.3% of the total flow. The average wall shear stresses in the casing bottom ranged from 10.6 to 40.9 Pa. The leakage flow of the centrifugal pump with the hydrodynamically levitated impeller had a measurable impact on hydraulic energy losses while enhancing the washout flow to achieve good anti-thrombogenicity. [ABSTRACT FROM AUTHOR]

Background: Data on the use and outcome of children on ventricular assist device (VAD) support provided with an implantable cardioverter‐defibrillator (ICD) remains poor. Methods: A retrospective analysis of the EUROMACS database on children supported with VAD < 19 years of age from January 1, 2009 to April 1, 2020. Patients with missing data on status of ICD, missing baseline and/or follow up information were excluded. The primary independent variable of interest was the concomitant presence or absence of an ICD at the time of VAD placement. Kaplan–Meier survival analysis was performed to evaluate survival differences between children on VAD with and without an ICD. Results: Out of 303 patients provided with a VAD, 7% (7♀, 15♂) had an ICD implanted and formed the study group. Median age was 14 years, median weight was 43.5 kg, and median BSA was 1.39. Median Intermacs stage was 2 (range: 1–7). Seventeen patients (77%) were transplanted, 4 (18%) died while on support, and 1 (5%) was weaned from device after myocardial recovery. Median time on support was 68 days compared to 361 days in the control group (p: 0.01). Three patients underwent device exchange due to thrombus formation in the pump. There was no difference in survival between groups (p = 0.342). Conclusion: The presence of ICD in pediatric patients supported with a VAD is low (7%). Children on VAD support provided with an ICD do not have a survival benefit compared to children without an ICD. [ABSTRACT FROM AUTHOR]

We reviewed outcomes in 82 consecutive children supported with the Berlin Heart pulsatile ventricular assist device (VAD), comparing those with functionally univentricular circulation (n = 34) to those with biventricular circulation (n = 48). The primary outcome was mortality. Kaplan-Meier (KM) methods and log-rank tests were used to assess group differences in long-term survival. T-tests using KM-estimated survival proportions and standard errors were used to compare groups at specific time points. 48 biventricular patients were supported (Age: median = 1.4 years, range = 17 days–17.7 years; Weight [kilograms]: median = 9.4, range = 3.1–112), including 43 BiVAD, 4 LVAD only, and 1 LVAD converted to BiVAD. In biventricular patients, duration of VAD support [days]: median = 97, range = 4–315. Of 48 biventricular patients, 35 underwent heart transplantation, 7 died on VAD, 5 weaned off VAD (1 of whom underwent heart transplantation 334 days after weaning), and 1 is still on VAD. 34 univentricular patients were supported with single VAD (sVAD) (Age: median = 38.5 days, range = 4 days–13.3 years; Weight [kilograms]: median = 3.98, range = 2.4–32.6). In univentricular patients, duration of VAD support [days]: median = 138, range = 4–554. Of 34 univentricular patients, 22 underwent transplantation, 11 died on VAD, and 1 is still on VAD. One-year survival after VAD insertion was 82.7% (95% CI = 72.4–94.4%) in biventricular patients and 59.7% (95% CI = 44.9–79.5%) in univentricular patients, p = 0.026. Five-year survival after VAD insertion was 79.7% (95% CI = 68.6–92.6%) in biventricular patients and 50.5% (95% CI = 35.0–73.0%) in univentricular patients, p = 0.010. Pulsatile VAD facilitates bridge to transplantation in neonates, infants, and children with functionally univentricular circulation; however, survival is worse than in patients with biventricular circulation. [ABSTRACT FROM AUTHOR]

Aims: We analyzed the impact of the revised pediatric heart allocation policy on types of ventricular assist device (VAD) utilization, and waitlist (WL) and post‐heart transplant (HT) survival outcomes in congenital heart disease (CHD) versus non‐CHD patients before (Era‐1) and after (Era‐2) pediatric heart allocation policy implementation. Methods: We retrospectively reviewed the UNOS database from December 16, 2011, through March 31, 2021, for patients < 18 years old and listed for primary HT. We compared the differences observed between Era‐1 and Era‐2. Results: 5551 patients were listed for HT, of whom 2447(44%) were in Era‐1 and 3104(56%) were in Era‐2. CHD patients were listed as status 1A unchanged, but the number of patients listed as status 1B decreased in Era‐2, whereas the number of non‐CHD patients listed as status 1A decreased, but status 1B increased. In Era‐2 compared to Era‐1, both temporary (1% to 4%, p <.001) and durable VAD (13.6% to 17.8%, p <.001) utilization increased, and the transplantation rate per 100‐patient years increased in both groups. The median WL period for CHD patients increased marginally from 70 to 71 days (p =.06), whereas for non‐CHD patients it decreased from 61 to 54 days (p <.001). Adjusted 90‐day WL survival increased from 84% to 88%, p =.016 in CHD, but there was no significant change in non‐CHD patients (p =.57). There was no significant difference in 1‐year post‐HT survival in CHD and non‐CHD patients between Era‐1 and Era‐2. Conclusions: In summary, after the revised heart allocation policy implementation, temporary and durable VAD support increased, HT rate increased, waitlist duration marginally increased in the CHD cohort and decreased in the non‐CHD cohort, and 90‐day WL survival probability improved in children with CHD without significant change in 1‐year post‐HT outcomes. Future studies are needed to identify changes to the policy that may further improve the listing criteria to improve WL duration and post‐HT survival. [ABSTRACT FROM AUTHOR]

Legislation supporting voluntary-assisted dying (VAD) is becoming more common globally, where it is used to promote an individual's autonomy in settings where they choose to alleviate their suffering by ending their life. This article examines and advocates for access to VAD in a new group - prisoners serving sentences of life imprisonment without parole. It addresses several morally important issues, and offers an ethical framework based on comparison to VAD in the setting of the terminally ill. [ABSTRACT FROM AUTHOR]

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Cardiac disease results in significant morbidity and mortality in patients with muscular dystrophy (MD). Single centers have reported their ventricular assist device (VAD) experience in specific MDs and in limited numbers. This study sought to describe the outcomes associated with VAD therapy in an unselected population across multiple centers. We examined outcomes of patients with MD and dilated cardiomyopathy implanted with a VAD at Advanced Cardiac Therapies Improving Outcomes Network (ACTION) centers from 9/2012 to 9/2020. A total of 19 VADs were implanted in 18 patients across 12 sites. The majority of patients had dystrophinopathy (66%) and the median age at implant was 17.2 years (range 11.7-29.5). Eleven patients were non-ambulatory (61%) and 6 (33%) were on respiratory support pre-VAD. Five (28%) patients were implanted as a bridge to transplant, 4 of whom survived to transplant. Of 13 patients implanted as bridge to decision or destination therapy, 77% were alive at 1 year and 69% at 2 years. The overall frequencies of positive outcome (transplanted or alive on device) at 1 year and 2 years were 84% and 78%, respectively. Two patients suffered a stroke, 2 developed sepsis, 1 required tracheostomy, and 1 experienced severe right heart failure requiring right-sided VAD. This study demonstrates the potential utility of VAD therapies in patients with muscular dystrophy. Further research is needed to further improve outcomes and better determine which patients may benefit most from VAD therapy in terms of survival and quality of life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Implantable devices such as ventricular assist devices provide appropriate treatment for patients with advanced heart failure. Unfortunately, these devices still have many problems, particularly related to blood damage. OBJECTIVE: The aim of this research is to examine two new ventricular assist devices in terms of induced shear stress, exposure time, and induced hemolysis. METHOD: Reverse engineering was used on multiple axial flow ventricular assist devices to collect all the details related to the designs (diameters, lengths, blade angles...), which were used to build two prototypes: Model A and Model B. RESULTS: The obtained results were close to a large extent, except for static pressure rise, where the difference was clear. CONCLUSION: Compared with what has been published in other studies, the overall performance of both models was excellent. [ABSTRACT FROM AUTHOR]