Background: Patients with thromboembolic disease, prosthetic valves, or coagulation issues are commonly prescribed anticoagulants and antiplatelets. Although common professional oral hygiene might not represent a health concern for these patients, anticoagulant and antiplatelet medication might constitute a challenge for dentists and dental hygienists since possible prolonged bleeding might interfere with dental procedures. The aim of the present study was to investigate the bleeding time of different anticoagulants and antiplatelets during a professional hygiene session adapting the Ivy test to the oral environment; Methods: 93 consecutive patients undergoing professional oral hygiene were recruited. Debridement during oral hygiene was performed using ultrasonic mechanical instrumentation, and bleeding sites were assessed and treated with gentle pressure using sterile gauzes. The time for bleeding cessation was recorded. Patients were categorized into six groups based on their drug intake, Control: no anticoagulants or antiplatelets DTI: direct thrombin inhibitors (dabigatran) AntiXa: directa factor Xa inhibitors (endoxaban, apixaban, rivaroxaban) VKA: vitamin K antagonists (warfarin, acenocoumarol) SAPT: single anti-platelet therapy (acetylsalicylic acid or clopidogrel) DAPT: dual anti-platelet therapy (acetylsalicylic acid and clopidogrel). Bleeding time was measured in seconds and mean values were assessed among the different groups. Differences between groups were investigated with Kruskal-Wallis test followed by Dunn’s post-hoc correction for multiple comparisons or two-way ANOVA followed by Dunnett post-hoc; Results: Control patients presented the lowest bleeding time 50 sec, followed by AntiXa (98), SAPT (105), DTI (120), DAPT (190) and VKA (203). A statistically significant difference was present among control and DTI (p=0.004), VKA (p<0.001), DAPT (p<0.001). Conclusions: Based on the present outcomes, an increased risk of prolonged bleeding emerged in patients taking VKA and DAPT. However, bleeding did not interfere with the oral hygiene ses-sion The optimal period for dental treatment of these patients should be 2-3 hours before the next dose, without the need to temporarily suspend the medication.

Breast cancer (BC) is a prevalent malignancy with various subtypes, each presenting unique diagnostic and therapeutic challenges. Triple-negative breast cancer (TNBC), which comprises 12-17% of breast cancers, is particularly aggressive due to its lack of estrogen receptor (ER), progesterone receptor (PR), and HER2 expression. This case report details the management of a 64-year-old woman with TNBC. Initially presenting with a left breast nodule, she underwent a biopsy that confirmed triple-negative infiltrating ductal carcinoma. Despite negative BRCA genetic testing, her significant family history of cancer and a newly detected right breast lesion led to a bilateral mastectomy. Post-surgery imaging revealed multiple hypodense nodules and a spiculated pulmonary nodule, prompting further investigation. An endoscopic lung biopsy identified a primary pulmonary carcinoma with histological features similar to the breast cancer, indicating the lung as the primary source. This case underscores the complexity of TNBC, the importance of comprehensive diagnostic evaluations, and the need for considering extramammary origins in metastatic cases. The findings emphasize the role of multidisciplinary teams in managing such rare and challenging cases and highlight the necessity for thorough and repeated evaluations in atypical BC presentations.

Cervical fusion has been a standard procedure for treating the abnormalities associated with the cervical spine. However, the reliability of anterior cervical discectomy and fusion (ACDF) has become arguable due to its adverse effects on the biomechanics of adjacent segments. One of the drawbacks associated with ACDF is adjacent segment degeneration (ASD) which has served as the base for the development of dynamic stabilization systems (DSS) and total disc replacement (TDR) devices for cervical spine. However, the hybrid surgical technique has also gained popularity recently but their effect on the biomechanics of cervical spine is not well researched. Thus, the objective of this FE study was to draw the comparison among single, bi-level and hybrid surgery with DCI implant with traditional fusion. Reduction in range of motion (ROM) for all the implanted models was observed for all the motions except extension, compared to intact model. The maximum increase in ROM of 42% was observed at C5-C6 level in Hybrid-DCI model. The maximum increase in adjacent segment’s ROM of 8.7% was observed in multilevel fusion model. The maximum von Mises stress in the implant was highest for the multilevel DCI model. Our study also showed that the shape of DCI implant permits flexion/extension relatively more compared to lateral bending and axial rotation.

The increasing emergence of multidrug resistant (MDR) pathogens causes difficult-to-treat infections, with long-term hospitalizations and high incidence of death, thus representing a global public health problem. To manage MDR bacteria bugs, new antimicrobial strategies are necessary, and their introduction in practice is a daily challenge for scientists in the field. An extensively studied approach to treat MDR infections consists in inducing high levels of reactive oxygen species (ROS) by several methods. Although further clinical investigations are mandatory on the possible toxic effects of ROS to mammalian cells, clinical evaluations are extremely promising, and their topical use to treat infected wounds and ulcers, also in presence of biofilm, is already clinically approved. Biochar (BC) is a carbonaceous material obtained by pyrolysis of different vegetable and animal biomass feedstocks, at 200−1000 °C in limited presence of O2. Recently, it has been demonstrated that BC capability of removing organic and inorganic xenobiotics is mainly due to the presence of persistent free radicals (PFRs), which can activate oxygen, H2O2 or persulfate in the presence or not of transition metals by electron transfer thus generating ROS, which in turn degrade pollutants by advanced oxidation processes (AOPs). In this context, the antibacterial effects of BC containing PFRs have been demonstrated by some authors against Escherichia coli and Staphylococcus aureus, thus giving birth to our idea of the possible use of BC-derived PFRs as a novel method capable of inducing ROS generation for antimicrobial oxidative therapy. Here, the general aspects concerning ROS physiological and pathological production and regulation, and the mechanism by which they could exert antimicrobial effects have been reviewed. The methods currently adopted to induce ROS production for antimicrobial oxidative therapy have been discussed. Finally, for the first time, BC-related PFRs have been proposed as a new source of ROS for antimicrobial therapy via AOPs.

Background: A new access technique was developed to reduce postoperative adverse events after the extraction of impacted maxillary wisdom teeth. Hence, this study aimed to assess the occurrence of adverse events after extraction of maxillary impacted wisdom teeth using traditional or modified access. Methods: Two different surgical incision designs were used for bilateral wisdom tooth extractions in 30 patients. The traditional incision was performed distal to the second molar in the center of the tuberosity, followed by a buccal releasing incision. After tooth extraction the wound was secured by sutures. The new technique consists of an oblique incision from the distal palatal aspect of the tuberosity towards the buccal aspect of the second molar. After tooth extraction, cyanoacrylate glue was used on the wound. Results: Lower pain was reported by patients at the site treated with the new technique (p<0.01). Edema, postsurgical bleeding, and hematoma were similar in both groups. The surgical time was shorter for the new technique (p<0.01). Conclusions: The new technique applied for the extraction of impacted maxillary wisdom teeth reduced postsurgical pain and the duration of surgery.

The aim of the study was the comparison of conventional sintering versus additive manufacturing techniques for β-TCP bioceramics, focusing on mechanical properties and biocompatibility. A "critical" bone defect requires surgical intervention beyond simple stabilization. Autologous bone grafting is the gold standard treatment for such defects but it has its limitations. Alloplastic bone grafting using synthetic materials is becoming increasingly popular. The use of bone graft substitutes has increased significantly and current research was focused on optimizing these substitutes, whereas this study compares two existing manufacturing techniques and the thereby produced β-TCP implants. The 3D-printed β-TCP hybrid structure implant was fabricated using two components, a column structure and a freeze-foam, which were sintered together. The conventionally manufactured ceramics were made by pouring. Both scaffolds were characterized according to porosity, mechanical properties and biocompatibility. The hybrid structure had a total porosity of 74.4 ± 0.5%. Microporous β-TCP implants had a porosity of 43.5 ± 2.4%, while macroporous β-TCP implants had a porosity of 61.81%. Mechanical testing revealed that the hybrid structure had a compressive strength of 10.4 ± 6 MPa, significantly lower than the microporous β-TCP implant’s with 32.9 ± 8.7 MPa. Biocompatibility evaluations showed a steady increase in cell proliferation over time for all β-TCP implants, with minimal cytotoxicity. This study provides valuable insight into the potential of additive manufacturing for β-TCP bioceramics in the treatment of bone defects.

Glaucoma, a global leading cause of blindness, necessitates accurate segmentation of the optic disc (OD) and optic cup (OC) for effective screening. However, existing segmentation methods based on convolutional neural networks (CNNs) suffer from high computational complexity and long inference times. In this paper, we propose an end-to-end segmentation method for the OD and OC using a lightweight MobileNetv3 as the feature extraction network. Our approach incorporates boundary branches and an adversarial learning network to achieve multi-label segmentation of the OD and OC. We evaluate the proposed method on three publicly available datasets: Drishti-GS, RIM-ONE-r3, and REFUGE. The experimental results demonstrate segmentation accuracies of 0.974/0.900, 0.966/0.875, and 0.962/0.880 for the OD and OC on the respective datasets, while significantly reducing inference time.

The study of the tribological behavior of the braking system in auto vehicles requires knowing the characteristics of the material in contact and, in the work process, for the friction pair, brake disc-pads. Materials structural analysis is necessary because the wear process depends on the friction pair chemical composition, and brake disk-pads, respectively on the work process parameters (pressing force, rotational speed, traffic conditions, etc.). The material of the brake discs is generally the same gray cast iron, but the brake pads can be semi-metallic (particles of steel, copper, brass, and graphite, all united with a special resin), organic materials (particles of rubber, glass, and kevlar all joined with the help of a resin), composite materials that contain different constituents and ceramic materials (rarely have small copper particles). Therefore, the purpose of the paper is to know the crystalline structure and the mechanical properties of the brake pad materials, through specific studies and analyses, with important implications on the friction and wear behavior.

Renal replacement therapy (RRT), widely used in the treatment of renal injury in the course of sepsis, aims to eliminate the toxins and proinflammatory cytokines, involved in the pathomechanism underlying septic shock. Dialysis filters characterised by a high adsorption potential for cytokines in RRT when septic renal injury is the case. It is of key importance in the antibiotics treatment of sepsis to achieve desired values of PK/PD indices. Continuous renal replacement therapy (CRRT) may affect antimicrobial clearance, increasing their elimination in some cases. The aim of this study was to determine the degree of adsorption for linezolid, on three different types of filters used in CRRT. In our in vitro study a continuous veno-venous hemofiltration (CVVH) was conducted using 3 types of filters: polysulfone (PS), polyethyleneimine-treated polyacrylonitrile (PAN PEI) and non-PEI-treated polyacrylonitrile (PAN) filters. Each type of filter was used in 3 CVVH cycles, involving the use of 600 mg of linezolid dissolved in 700 ml of bovine blood or in 700 ml of 0.9% NaCl. In each case the total volume of the obtained solution was 1000 ml. Blood samples, at particular time points, were collected in order to measure drug concentration. The differences in mean drug/NaCl adsorption and drug/ blood adsorption were determined using one-way ANOVA with multiple comparisons by Tukey post-hoc test. A p-value of < 0.05 was considered to be significant. A significant adsorption of linezolid was found for PAN PEI filter, both in samples obtained from bovine blood and 0.9% NaCl solutions, at the endpoint. No significant adsorption was demonstrated on PAN or PS filters. There is a need for in vivo research to confirm the effect of filter type on linezolid concentration in patients undergoing CRRT.

Degenerative disc disease (DDD) is a pervasive condition that limits quality of life and burdens economies. Traditional pharmacological treatments aimed at slowing degeneration are ineffective in the long-term. Orthobiologics, regenerative agents derived from the patient’s own tissue, are a promising emerging therapy for degenerative disc disease. This review first outlines the pathophysiology of degenerative disc disease, highlighting the limitations of existing treatments and explores the orthobiologic tools for treating degenerative disc disease (platelet-rich plasma, mesenchymal stem cells). Their history in regenerative medicine is outlined, demonstrating how in vitro evidence informed preclinical animal studies on their efficacy in treating degenerative disc disease. Finally, clinical trials utilizing these treatment options are reviewed and directions for future research are outlined. Although the current clinical evidence available is limited to propagate their routine clinical usage the field holds immense potential in the management of DDD. There is room for these treatments to be optimized for effective consistent clinical outcomes in DDD.

Introduction:Lumbar radiculopathy, frequently triggered by disc herniation, affects around one in 50 young adults (30-55 ages), leading to significant impacts on quality of life. When conservative treatments fail to alleviate symptoms, surgical intervention such as discectomy is often pursued. Technological advancements have led to various minimally invasive techniques, promising improved outcomes. Our aim was to compare clinical outcomes of different techniques.Methods:We conducted a systematic search in PubMed using "lumbar disc hernia" and the meta-analysis filter. Inclusion criteria comprised meta-analyses focusing on lumbar disc herniation treatments, published in English. A rigorous selection process adhering to PRISMA guidelines ensured high-quality evidence extraction.Results:From 28,171 initial records, 31 meta-analyses involving 87,852 patients were included. Heterogeneity across the literature presented challenges, notably in study populations, surgical techniques, and research designs. Among the techniques evaluated, full-endoscopic lumbar discectomy (FELD) emerged as superior in various perioperative parameters, including Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), operation time, and complications. Conversely, automated percutaneous discectomy (AUTD) consistently exhibited poorer outcomes, suggesting limited effectiveness compared to other techniques. Conclusion:Despite advancements, the heterogeneity observed in the literature underscores the need for standardized approaches in minimally invasive spinal surgery research. FELD stands out as a preferred technique, offering favorable outcomes across multiple parameters. Conversely, techniques like AUTD raise concerns regarding efficacy. Future research should aim for uniformity in methodologies to facilitate accurate comparisons and guide clinical decision-making.

This paper deals with miniaturization technique based on frequency reduction using top loaded dielectric discs. In contrast to a simple monopole, the resonant frequency of monopole loaded with two dielectric discs changes from 1.98 to 1.29 GHz, resulting 34.84% reduction in resonant frequency keeping the antenna length (36.00 mm) unaltered. It is well-known fact that dielectric material can trap the energy to be delivered from source to antenna and as a result, it is unable to radiate efficiently. Then any approach to use the dielectric material for miniaturization process must, therefore, antenna coupled in such a way that it can radiate efficiently. The dielectric disc on top of monopole creates an inductive situation in a similar way to oppositely directed wire loop compensate the capacitive effect present at monopole causes the reduction in resonant frequency. This concept is implemented without sacrificing any desired features like bandwidth, radiation characteristics and efficiency (more than 98%) and analyzed with an equivalent circuit model. Experimental results illustrate good agreement with simulation results. This monopole antenna in car can be designed for GPS system, car to car communication, GSM or CDMA operation.

Aortic stenosis (AS) is a prevalent valvular disorder that often requires surgical aortic valve replacement (SAVR) to alleviate symptoms and improve survival. However, the selection of an appropriate prosthetic valve size is crucial to avoid patient-prosthesis mismatch (PPM), which can lead to suboptimal hemodynamic outcomes. Von Willebrand factor (VWF), a key component of hemostasis, has been shown to be altered in AS patients and may contribute to the hemostatic imbalance observed following valve replacement. This prospective study aimed to investigate the impact of PPM on postprocedural VWF levels in patients undergoing SAVR for severe AS. The study included 31 consecutive patients diagnosed with severe AS who underwent SAVR. By focusing on the relationship between PPM and VWF dynamics, this study sought to provide valuable insights into the potential role of VWF as a marker for hemostatic changes associated with PPM, ultimately informing strategies for optimal valve selection and perioperative management to minimize complications.

Let $(\{f_n\}_{n=1}^\infty, \{\tau_n\}_{n=1}^\infty)$ and $(\{g_n\}_{n=1}^\infty, \{\omega_n\}_{n=1}^\infty)$ be unbounded continuous p-Schauder frames ($0<p<1$) for a disc Banach space $\mathcal{X}$. Then for every $x \in ( \mathcal{D}(\theta_f) \cap\mathcal{D}(\theta_g))\setminus\{0\}$, we show that \begin{align}\label{UB} \|\theta_f x\|_0\|\theta_g x\|_0 \geq \frac{1}{\left(\displaystyle\sup_{n,m \in \mathbb{N} }|f_n(\omega_m)|\right)^p\left(\displaystyle\sup_{n, m \in \mathbb{N}}|g_m(\tau_n)|\right)^p}, \end{align} where \begin{align*} & \theta_f: \mathcal{D}(\theta_f) \ni x \mapsto \theta_fx \coloneqq \{f_n(x)\}_{n=1}^\infty\in \ell^p(\mathbb{N}), \quad \theta_g: \mathcal{D}(\theta_g) \ni x \mapsto \theta_gx \coloneqq \{g_n(x)\}_{n=1}^\infty\in \ell^p(\mathbb{N}). \end{align*} Inequality (1) is unexpectedly different from both bounded uncertainty principle \textit{[arXiv:2308.00312v1]} and unbounded uncertainty principle \textit{[arXiv:2312.00366v1]} for Banach spaces.

Liquorpheresis (CSF filtration) comprises a therapeutical approach that has been proposed to treat several neurological conditions where antibodies, inflammatory mediators or abnormal peptides are the cause or play an important role in the pathogenesis of the disease. CSF replacement may be an alternative approach not explored so far. Here, we review previous experiences in the use of liquorpheresis in autoimmune and degenerative neurological diseases. Then we describe previous developments and provide some new technical innovations in order to design bidirectional CSF shunting systems. These systems can be complemented either with a deposit of artificial CSF or with a CSF filter, allowing CSF replacement or liquorpheresis respectively. Both options would lead to mechanical dilution of the patient’s CSF.

This paper aimed to evaluate the growth, gas exchange and Chl a fluorescence in ipê-rosa seedlings, subjected to levels of 100, 75, 50 and 25% of water replacement (LWR), in a greenhouse. The morphometric variables of plant height, diameter at stem height, number of leaves and leaflets, root length and volume, plant dry mass and leaf area were evaluated. The potential evapotranspiration of seedlings (ETc) was obtained using direct weighing, considering as a reference the water replacement of 100% of the mass variation between subsequent days; the cultivation coefficients (kc) were obtained by the ratio between ETc and the reference evapotranspiration (ETo) obtained by the Penman-Montheit FAO-56 method. Biomass and evapotranspiration data were combined to determine water sensitivity. Diurnal fluxes of gas exchange (net photosynthesis rate, transpiration rate, stomatal conductance, internal and atmospheric carbon ratio, water use efficiency and leaf temperature) and Chl a fluorescence (Fv/Fm, ΦPSII, ETR, Fv’/Fm’, NPQ and qL) were evaluated. Water restriction caused reductions of 90.9 and 84.7% in the increase in height and diameter of seedlings subjected to 25% water replacement when compared to seedlings with 100% water replacement, while biomass accumulation reduced by 96.9%. The kc values increased throughout the seedling production cycle, ranging from 0.59 to 2.86. Maximum water sensitivity occurred at 50% water replacement, with Ky = 1.62. Maximum carbon assimilation rates occurred in the morning, ranging from 6.11 to 12.50 µmol m-2 s-1. Ipê-rosa seedlings regulate the physiology of growth, gas exchange, and Chl a fluorescence depending on the amount of water available, and only 25% of the water re-placement in the substrate allows the seedlings to survive.

The increasing emergence of multidrug resistant (MDR) pathogens, due to antibiotics misuse, translates in obstinate infections, with high morbidity and high-cost hospitalizations. To oppose these MDR superbugs, new antimicrobial options are necessary. Although both quaternary ammonium (QASs) and phosphonium salts (QPSs) possess antimicrobial effects, QPSs have been studied at lesser extent. Recently, we have successfully reported on the bacteriostatic and cytotoxic effects of a triphenyl phosphonium salt against MDR isolates of Enterococcus and Staphylococcus genus. Here, aiming at finding new antibacterial devices possibly bactericidal towards a broader spectrum of clinically relevant bacteria, responsible for severe human infections, we synthesized a water-soluble, sterically hindered quaternary phosphonium salt (BPPB). It encompasses two triphenyl phosphonium groups linked by a C12 alkyl chain, thus embodying the characteristics of molecules known as bola-amphiphiles. BPPB was characterized by ATR-FTIR, NMR and UV spectroscopy, FIA-MS (ESI), elemental analysis and potentiometric titrations. Optical and DLS analyses evidenced BPPB tendency to self-forming spherical vesicles in solution (45 nm by DLS), having a positive zeta potential (+18 mV). The antibacterial effects of BPPB were for the first time assessed against fifty clinical isolates of both Gram-positive and Gram-negative species. Excellent antibacterial effects were observed on all strains tested, involving all the most worrying species included in ESKAPE bacteria. The lowest MICs were 0.250 µg/mL, while the highest ones (32 µg/mL) were observed on MDR Gram-negative metallo-β-lactamase-producing bacteria and/or species resistant also to colistin, carbapenems, cefiderocol, so that intractable with current available antibiotics. Moreover, when administered to HepG2 human hepatic and Cos-7 monkey kidney cell lines, BPPB showed selectivity indices &gt; 10 for all Gram-positive isolated and for clinically relevant Gram-negative superbugs such as those of E. coli species, thus being very promising to be clinically developed.

Solar concentration is the ability to harness solar radiation to increase the temperature of a receiver. The receiver is the component into which a heat transfer fluid can be flowed for an ORC system and produce electricity, or it can be used for high-temperature thermal storage, or even to implement thermochemical cycles. The choice of material is critical to ensure optimal performance and long-lasting operation. It is also essential that such material can operate at high temperatures and high thermal gradients. In short, material identification involves high thermal stresses that result in structural deformation. Different metal alloys were used to verify that the yield strength limit was not exceeded due to thermal stress induced by concentrated solar radiation. The problem was implemented in Matlab starting from the general heat equation. The purpose is to test whether thermal stress exceeds the yield strength, which is the condition in which elastic bonds in the material are changed, causing deformation. The best material identified was Inconel 740H, which had a high yield strength value and the lowest temperature difference. Under extreme working conditions, it can withstand thermally induced shocks.

Chronic kidney disease (CKD) is actually considered a public health priority according to the increasing number of patients affected by this condition: this casuistry is not only related to specific glomerular, tubular or autoimmune diseases or a consequence of acute kidney injury (AKI) episodes leading to organ failure, but it is tied to the progression of life expectancy and the impact of comorbidities such as cardiovascular disease, diabetes and cancer. CKD and its comorbidities promote low grade inflammatory status with an impact on patients’ clinical conditions, reducing their possibility for kidney transplantation or graft survival and their survival when receiving renal replacement therapies such as hemodialysis (HD) or peritoneal dialysis (PD). CKD is often referred to as an ageing accelerator: innate immune system dysregulation, in the uraemic proinflammatory milieu, is involved in this accelerated senescence phenomena and pentraxins, particularly Pentraxin-3 (PTX-3), are of particular interest in the development of kidney disease. A complete understanding of the mechanism of CKD progression, innate immune system involvement and a proper definition of PTX-3 role in kidney disease, could redefine the approach for diagnosis and a more centered patients’ management to slow down CKD progression over time and reduce its clinical and social impact.

Geopolymers, made from aluminosilicate raw materials, offer significant environmental advantages over conventional concrete (CC) mixes. This study explores the compressive strength, setting time, and durability of geopolymer concrete (GPC) cylinders, some of which include an additional ordinary portland cement (OPC) mix. Consistent material composition and testing methods are emphasized to achieve reliable results. MATLAB was utilized to develop and assess a neural network model predicting the compressive strength of GPC based on key variables. The model was validated using 16 experimental samples and 1047 samples from various studies. The performance plot displayed the Mean Squared Error (MSE) over iterations, identifying the best training performance at epoch 658 with an MSE of 5.3408. The Error Histogram highlighted distribution errors between predicted and actual compressive strength values, with the highest range from -1.015 to 0.3587, meaning that the predicted values were mostly within a small margin of error from the actual values. This narrow error range indicates that the ANN model has high accuracy in its predictions, as most errors are small and clustered around zero, demonstrating reliable performance in estimating compressive strength. Regression analysis showed varying correlation coefficients (training set R=0.98373, test set R=0.88164, and whole set R=0.96982), indicating adequate predictive accuracy. The results demonstrate that properly trained neural networks can effectively predict the compressive strength of GPC, highlighting its potential as a sustainable construction material.

Solid waste management is a major environmental challenge, especially in developing countries, with increasing amounts of waste glass (WG) and waste plastics (WP) not being recycled. In Ethiopia, managing WG and WP requires innovative recycling techniques. This study examines concrete properties with WG and WP as partial replacements for fine aggregate. Tests were conducted on cement setting time, workability, compressive strength, splitting tensile strength, and flexural strength. Concrete grade C-25, with a compressive strength of 25 MPa, was prepared using an optimum ratio of 14% WG and 6% WP. Mechanical properties were tested at 7 and 28 days of curing. At 20% replacement, workability decreased at water-cement ratios of 0.5 and 0.6 but remained stable at 0.4. Thus, a 0.4 ratio was used. For 10% replacement, compressive strength increased by 12.55% and 6.44% on the 7th and 28th days, respectively. At 20% replacement, compressive strength decreased by 14.35% and 0.73% on the 7th and 28th days, respectively. On the 28th day, splitting tensile strength at optimum replacement was 4.3 MPa, an 8.5% reduction from the control mix. However, flexural strength increased by 19.7%, from 12.46 MPa to 15.52 MPa. Overall, WG and WP improved flexural strength but slightly reduced splitting tensile strength.

Purpose: The intervertebral disc is a leading avascular organ in the body that may gather nutrition through diffusion. It maintains homeostasis by the use of autophagy and apoptosis to survive in unfavorable conditions such as stress and mechanical force. Therefore, excessive force and stress beyond normal conditions may cause intervertebral disc degeneration. The purpose of this study was to examine which is the better method, either external fixator (EF) or saline injection (SI), for inducing autophagy and apoptosis-mediated nucleus pulposus (NP) cell death in the discs of rat tail’s. Methods: Sixteen, nine-weeks-old male Sprague–Dawley rat tails were treated with 0.9% saline and EF (two-cross Kirschner wires) for a period ofsix and twelve weeks. Treated discs were dissected to identify the participation of autophagy and apoptosis in intervertebral disc degeneration. For identification purposes, H&amp;E staining, Masson’s trichrome staining, and immunohistochemistry (IHC) for LC3, beclin-1, and P62 in addition to MMP-2, MMP-3, and TIMP-1 were performed. Furthermore, we performed real-time polymerase chain reaction (RT-PCR) to observe autophagy-related gene expression (beclin-1, LC3, and P62) and apoptosis-related gene expression (MMP-2, MMP-3, and TIMP-1). Results: TheEF group showed more insidious NP cell degeneration than the control (Ctrl) group. Degeneration was elevated with increasing compression duration of EF group, whereas the SI group could not distinguish the margin of annulus fibrosus (AF) and NP cells. LC3, beclin-1, and P62 showed the highest and lateral expression whilst MMP-2, MMP-3, and TIMP-1 showed up-regulated and central expression in both groups, although the SI group could not recognize the boundary between NP and AF cells. The EF group showed the highest autophagy-related gene expression whereas the SI group showed lower expression. In addition, the EF group showed more autophagy-accumulating materials than the SI group which elevated with increasing compression duration. Furthermore, the SI group induced the highest apoptotic gene expression, but the EF group showed the lowest expression. Conclusion: The EF method was better for studying autophagy and apoptosis because it enhanced intervertebral disc degeneration after compression, which is actively linked to autophagy and apoptosis. The degeneration process was elevated by increasing the compression duration, but SI could not distinguish AF and NP cell margins.

Adeno-associated viral (AAV) vectors can be used for gene delivery. AAV.CAP-Mac was recently developed; it can cross the blood-brain barrier and transduce cells throughout the CNS. However, some brain regions were not transduced in adult rhesus monkeys. Additionally, AAV vectors can only package 5 kb of DNA. Also, AAV vectors may be genotoxic and cytotoxic, especially at high doses. Finally, AAV vectors are very expensive to produce at sufficiently high titers for treatment. Off-the-shelf cell-based delivery systems wherein the cells can infiltrate the target tissue and be hyper-motile would be ideal. Also, mRNA-based gene editing would be a transient treatment, and thus be much safer.

This study presents an innovative approach for the utilization of industrial by-products and municipal waste in the production of sustainable and environmentally friendly cement mortar. We explored stabilized stainless-steel reduced slag (SSRS) and polyethylene (PE) plastic waste as partial replacements for aggregates. Various engineering properties of the resulting cement mortar specimens, including slump, slump flow, compressive strength, flexural strength, tensile strength, water absorption, and ultrasonic pulse velocity (UPV), were investigated through comprehensive experimental tests. The influence of different water-cement (w/c) ratios and substitution amounts on the engineering properties of the cement mortar samples was thoroughly examined. The findings revealed that an increase in PE substitution adversely affected the overall workability of the cement mortar mixtures, whereas an increase in SSRS amount contributed to enhanced workability. As for the hardened properties, a consistent trend was observed for both cases, with higher w/c ratios and substitution amounts leading to reduced mechanical properties. Water absorption and UPV test results validated the increased formation of porosity with higher w/c ratios and substitution amounts. This study proposes a promising method to effectively repurpose industrial by-products and municipal wastes, transforming them into sustainable construction and building materials. Additionally, a comparative analysis of transportation costs and carbon footprint emissions between SSRS-cement mortar and PE-cement mortar was conducted to assess their environmental impact and sustainability. Generally, higher w/c ratios and replacement levels corresponded to reduced carbon footprint. The geographical location of the source of SSRS and PE remains a challenge and studies to overcome this challenge must be further explored.

This study investigated the effect of partially replacing fish meal with krill and copepod meals in inert diets, co-fed with shrimp, on the growth and nutrient digestibility of long-snout seahorse (Hippocampus guttulatus). A control diet (Diet 1) using raw starch and four experimental diets with similar protein (≈44.8%) and energy (≈15.1 MJ/kg) levels were tested. Diet 2 used fish meal as the sole protein source, while in Diets 3-5, krill and copepod meals replaced 44% of the fish meal. Seahorses fed Shrimp + Diets 2-5 showed significantly higher growth rates (P &lt; 0.05) than those fed Shrimp + Diet 1, though there were no significant growth differences among Diets 2-5. Digestibility of dry matter (46.1% to 72.2%), lipids (73.3% to 85.5%), crude protein (89.8% to 95.8%), energy (82% to 92.2%), and phosphorus (28.7% to 64.4%) varied with diet, being consistently lower in seahorses fed Shrimp + Diet 1. As an agastric species, H. guttulatus did not exhibit impaired digestibility for any of the tested nutrients, minerals, or energy. This study suggests that crustacean meals can effectively substitute fish meal in inert diets for this species, contributing to the sustainability and optimization of captive seahorse husbandry practices.

Non-genuine medical products, including diagnostic devices, have become a lucrative business for fraudsters, causing significant damage to revenues and reputation of companies, as well as posing a significant risk to the health of people and societies. Along a “digital twin” representing centrifugal microfluidic flow control on exemplary “Lab-on-a-Disc” (LoaD) systems, a novel, two-pronged strategy to safeguard miniaturized point-of-care devices by means of secret features and manufacturing challenges is outlined; such “hardware encryption” is flexibly programmed for each chip during production, and deciphered from a secure, local or online database at the time of use. This way, unlicensed copying may be efficiently deterred by an unfavourable economy-of-scale, even in absence of legal prosecution.

While immutability is Blockchain's* much celebrated covenant, change is the rule of life. The paradox has seriously limited real-world deployability of Smart Contracts (SC), faltering its mainstream adoption and sustainability. Once implemented, SC remains unstoppable even if its execution makes losses, as evident in the recently exploded $50+B DeFi industry. How do we reconcile the two and make DeFI/Blockchain profitable and sustainable? A DISC (Dynamic Immutable Smart Contract) hypothesis was proposed to resolve the paradox. Using an existing decentralized IoT device framework we test the DISC hypothesis, by designing/implementing a DISC protocol that delivers an algorithmically controlled dynamic off-chain data feed into a self-executing SC. The experiment successfully introduced limited dynamism into SC without compromising its immutability or undermining user control over their SC terms. If consistently reproduced in diverse settings, the DISC protocol could earn an important milestone in the evolution of Blockchain's decentralized economy of the future.

There is limited data on pregnancy outcomes in Pompe Disease (PD) resulting from deficiency of the lysosomal enzyme acid alpha-glucosidase. Late-onset PD is characterized by progressive proximal muscle weakness and decline of respiratory function secondary to the involvement of the respiratory muscles. In a cohort of twenty-five females, the effects of both PD on the course of pregnancy and the effects of pregnancy on PD were investigated. Reproductive history, course of pregnancy, use of Enzyme replacement therapy (ERT), PD symptoms, and outcomes of each pregnancy were obtained through a questionnaire. Among 20 subjects that reported one or more pregnancies, one subject conceived while on ERT and continued therapy through two normal pregnancies with worsening of weakness during pregnancy and improvement postpartum. While fertility was not affected, pregnancy may worsen symptoms, or cause initial symptoms to arise. Complications with pregnancy or birth were not higher, except for an increase in the rate of stillbirths (3.8% compared to the national average of 0.2-0.7%). Given small sample size and possible bias of respondents being only women who have been pregnant, further data may be needed to better analyze the effects of pregnancy on PD, and the effects of ERT on pregnancy outcomes.

The main goal of this study was to evaluate sugarcane bagasse ash as a partial cement replacement material. Sugarcane bagasse ash is a by-product of fuel blending in the sugar industry. Yet all economic sugar is obtained after extraction from the cane. The disposal of the discharged waste in agriculture causes environmental problems in the sugar industry. The cement industry also creates environmental problems due to carbon dioxide emissions during cement manufacturing. Initially, bagasse ash samples were collected from the rubble of the Arjo Didessa sugar factory. The crude bagasse ash was sieved with a sieve size of 250µm. The strength of grade C-25 concrete was designed using five different concrete mixture proportions ranging from 5 to 20% cement by weight, including a water-cement ratio of 0.45. Impact strength tests were conducted at 7, 14, 21, and 28 days of age for each replacement ratio. For the experimental work, a total of 60 cubic concrete specimens were cast for compressive strength tests, and 15 cylindrical concrete specimens were cast for water absorption tests. Working compressive strength results indicated that bagasse ash could replace up to 5% of ordinary Portland cement concrete.

Testing in animals is mandatory in drug testing and the gold standard for evaluation of toxicity. This situation is expected to change in the future because the 3Rs principle, which stands for replacement, reduction and refinement of the use of animals in science, is reinforced by many countries. On the other hand, technologies for alternatives to animals experiments have increased. The necessity to develop and use of alternatives is influenced by the complexity of the research topic and also by the fact, to which extent the currently used animal models can mimic human physiology and/or exposure. Rodent lung morphology and physiology differs markedly for that of humans and inhalation exposure of the animals are challenging. In vitro and in silico methods can assess important aspects of the in vivo action, namely particle deposition, dissolution, action at and permeation across the respiratory barrier and pharmacokinetics. Out of the numerous homemade in vitro and in silico models some are available commercially or open access. This review discusses limitations of animal models and exposure systems and proposes a panel of in vitro and in silico techniques that, in the future, may replace animal experimentation in inhalation testing.

Total hip arthroplasty is a complex procedure. The achievements of implantology enabled the development of a faithful representation of hip joint physiology as well as the production of materials that can successfully replace damaged natural tissues. A very important issue is the correct selection of the geometry of the endoprosthesis adequate to the load of the joint. Materials used for endoprosthesis are a metal head and a polymer cup (e.g. PE-UHMW). The main interactions in the endoprosthesis are friction and surface pressure, which must be limited, exceeding them causes the destruction of the biomechanical system - plastic deformation of the polymer and the formation of too large and unacceptable radial clearances. Based on the author's developed calculation method of hip joint endoprosthesis contact parameters, the impact on maximum contact pressure and the angle of contact of the joint load was estimated depending on the diameter of the endoprosthesis and radial clearance. The correctness of changing the values of maximum contact pressure from the mentioned parameters was determined. Correspondingly: an increase in joint load causes a linear increase in the maximum contact pressure; increasing the diameter of the endoprosthesis head - their non-linear decrease, and increasing radial clearance - their increase

A proportion of osteoarthritis (OA) patients are unsatisfied with post-operative outcomes following total joint replacement surgery (TJR), with insufficient pain relief or poor functional improvement. Predicting those will have poor outcomes would be beneficial for patients and clinicians. The aim of this study was to determine the relationship between baseline anthropometric data and the concentration of pre-operative serum and peri-operative synovial fluid (SF) cytokines with 7-month post-operative outcomes in a cohort of knee and hip OA patients. 160 OA patients were recruited who were scheduled for TJR. The concentration of 24 cytokines were measured in blood and SF by multiplex assay. EQ5Dindex health status was assessed pre-operatively and at 7-months post-operatively. 13% of patients were identified as non-responders based on EQ5Dindex. Compared to responders, non-responders were of higher BMI, had greater waist and hip circumference and had higher levels of SF leptin but lower levels of SF Resistin (p&lt;0.05). Linear regression analysis found a significant relationship between pre-operative body weight and post-operative response (ΔEQ5Dindex; r=0.222, p=0.049). The combination of body weight with SF amphiregulin and SF IL-6 provided an improved predictive model of post-operative response (r=0.470, p=0.035).

Purpose: Intervertebral disc is a leading avascular organ in the body. Hence, it may utilize autophagy and apoptosis to alive in unfavorable condition like stress and mechanical force. But excessive force and stress is a key cause to intervertebral disc degeneration (IVDD). Purpose of this study is to identify, external fixator (EF) and saline injection (SI) may induce autopahgy and apoptosis mediated nucleus pulposus (NP) cells death in rat tail’s disc and which method is better for studying autophagy and apoptosis. Methods: Sixteen 9-week-old male Sprague–Dawley rat tails were treated with 0.9% saline and EF (two-cross kirschner wires) for 6 weeks and 12 weeks as well. Treated discs were dissected for checking out participation of autopahgy and apoptosis to intervertebral disc degradation (IVDD). For identifying them, we performed H&E staining, Masson’s trichrome staining, and Immunohistochemistry (IHC) for LC3, Beclin-1and P62 as well as MMP-2, MMP-3 and TIMP-1.Furthermore, we performed quantitative polymerase chain reaction (qPCR)to check out autophagy related gene expression (beclin-1, LC3 and P62) and apoptosis related gene expression (MMP-2, MMP-3 and TIMP-1) respectively. Results: More insidious nucleus pulposus (NP) cell degeneration was indentified in (EF) group than in (Ctrl) control group. And rate of degradation was elevated with increasing duration of compression, but SI group cannot distinguish the margin of AF and NP cells. Highest along with lateral expression was found for LC3, Beclin-1, and P62 of both groups. Up-regulated and central expression was observed for MMP-2, MMP-3 and TIMP-1 of both groups, although SI group cannot recognize the margin between NP and AF cells. Utmost autophagy related gene expression was identified in EF group than in SI group. Besides, maximum autophagy accumulating materials was found in EF group than in SI group. And it was amplified along with increasing the duration of compression. Highest, apoptotic gene expression was observed in SI group, whereas, EF group showed lowest expression. Conclusion: External fixator (EF) method was better to study autophagy and apoptosis because it enhanced IVDD after compression which is actively linked with autophagy and apoptosis. Degeneration process was conversely proportional along with duration of compression. On contrary, saline injection (SI) could not distinguish AF and NP cell border.

Osteoarthritis (OA) poses a growing challenge for the aging population, especially in hip and knee joints, contributing significantly to disability and societal costs. Conventional clinical evaluations, typically performed in controlled settings, face difficulties in capturing the dynamic characteristics of rehabilitation and functioning in real-life scenarios. The study assessed the use of automated unsupervised evaluations in the rehabilitation process for patients after hip and knee replacements. We analyzed data from 1144 individuals who used a digital application after surgery, activity data were collected using the Garmin Vivofit 4. Several parameters such as the Peak 6-Minute Consecutive Cadence (P6MC) and Peak 1-Minute Cadence (P1M) were computed and analyzed on a daily basis. The results indicated that cadence measurements, specifically, can effectively differ among individuals with hip and knee conditions as well as the recovery process. Moreover, these metrics demonstrated a high level of responsiveness in monitoring the progress of recovery, surpassing the effectiveness of simply measuring the total number of steps taken. The study highlighted the capacity of technology-driven, patient-centered rehabilitation to improve accuracy, tailor therapy to individual patients, and increased patient involvement. This research also highlighted the significance of automated, unsupervised assessments in enhancing rehabilitation results for OA patients following hip and knee replacement, as tele-rehabilitation becomes increasingly important.

Polyetheretherketone is a promising material for implants due to its good mechanical properties and excellent biocompatibility. Its accessibility to a wide range of applications is facilitated by the ability to process it with an easy-to-use manufacturing process such as Fused Filament Fabrication. The elimination of disadvantages associated with the manufacturing process, such as a poor surface quality, is a main challenge to deal with. As part of the mass finishing process, centrifugal disc finishing has demonstrated good results in surface optimization, making it a promising candidate for post-processing of additively manufactured parts. The objective of this study is to identify the key parameters of the centrifugal disc finishing process on the waviness of additively manufactured PEEK specimen, which has not been investigated yet. Waviness of the specimen was investigated by means of confocal laser scanning microscopy (CLSM), while weight loss was additionally tracked. Six parameters were investigated: type, amount and speed of media, use of compound, amount of water and time. Type of media, time and speed were found to significantly influence waviness reduction and weight loss. Surface electron microscopy images demonstrated the additional effects of deburring and corner rounding. Results on previous studies with specimens made of metal showed similar results. Further investigation is required to optimise waviness reduction and polish parts in a second post-processing step.

This study addresses the urgent need for sustainable protein sources in aquaculture due to the depletion of marine resources and rising costs. Animal protein sources, particularly poultry by-product meal (PBM) and insect exuviae meal, are investigated as viable alternatives to fishmeal (FM). Research confirms the successful replacement of FM with a combination of PBM and insect exuviae meal (up to 50%) in the diet of European seabass without compromising growth, feed conversion, gut health and liver fat content. In particular, growth performance was robust with both PBM formulations, with the 25% PBM diet showing better results. Histological examinations showed good gut and liver health, contradicting the concerns of previous studies. The study emphasizes the importance of holistic analyzes that go beyond growth parameters and include histomorphological investigations. The results show that PBM in combination with insect/exuviae meal is well tolerated by seabass, which is consistent with literature reports of mitigating negative effects on gut health. A detailed analysis of the microbiota revealed a decrease in the Firmicutes/Proteobacteria ratio due to an increase in potentially pathogenic bacteria. However, the formulation containing insect exuviae partially counteracted this effect by preserving the beneficial Lactobacillus and promoting the synthesis of short-chain fatty acids (SCFA), particularly butyrate. Chitin-rich components from insect exuviae were associated with improved gut health, which was supported by increased production of SCFA, which are known for their anti-inflammatory properties. The study concludes that a combination of PBM and insect/exuviae meal can replace up to 50% of FM in the diet of seabass, supporting sustainable aquaculture practices. Despite some changes in the microbiota, the negative effects are mitigated by the addition of insect exuviae, highlighting their potential as a prebiotic to increase fish productivity and contribute to a circular economy in aquaculture.

With the galaxy J101652.52 as a model galaxy, this paper studied on the temporal duration of optically observed spiral patterns in disc galaxies is based on the finite reservoir of hydrogen available without replenishment following the initial formation of these well-isolated galaxies. The galaxy J101652.52 exhibits a grand design spiral pattern of two wide open spiral arms with perfect central symmetry, has only rear side trail effect, which clearly indicates that there is no corotation circle, therefore, the Density wave theory proposed for the spiral arm formation may not be applicable in this galaxy. The results reveal a gradual decline in observable spiral arms regardless of any spiral arm formation mechanism. This reduction occurs after half-loop rotation (as defined in the paper) as hydrogen reserves deplete, hindering new star formation. Ultimately, spiral patterns may possibly become optically invisible at normal conditions after a full-loop rotation (as defined in the paper) with hydrogen depletion, even if the formation mechanism remains active. The spiral galaxies with spiral arms decoupled from galactic bars or having soft spiral structures shall have similar results as long as that the spiral pattern rotation speed is significant different from the galactic matter rotation speed. Most of observed spiral galaxies have soft spiral structures, their spiral patterns dynamically change constantly. The results of this study support the idea of short-lived spiral patterns compared to the lifespan of the spiral galaxies. The spiral arm formation may occur once like the onetime firework show in a galaxy’s life based on the limited availability of hydrogens. A concise, universally applicable mechanism for spiral arm formation across various galaxies should exist which provides a single mathematical formula to describe the broad range of morphologies of the spiral arms with few adjustable parameters. Some exceptions may be explained within this framework. Furthermore, the observed data on spiral pattern and galactic bar rotation speeds in the Milky Way require rigorous verification, particularly concerning the winding problem.

3.9 million individuals rely on kidney replacement therapy worldwide. They experience height-ened susceptibility to cardiovascular diseases and mortality, alongside an increased risk of in-fections and malignancies, with inflammation being key to explaining this intensified risk. This study utilized semi-targeted metabolomics to explore novel metabolic pathways related to in-flammation in this populations. We collected pre and post-session blood samples of patients who had already undergone one year of chronic hemodialysis. And used liquid chromatography and high resolution mass spectrometry to perform a metabolomic analysis. Afterwards, we employed both univariate (Mann-Whitney test) and multivariate (logistic regression with LASSO regulari-zation) to identify metabolites associated with inflammation. In the univariate analysis, in-dole-3-acetaldehyde, 2-ketobutyric acid, and urocanic acid showed statistically significant de-creases in median concentrations in the presence of inflammation. In the multivariate analysis, metabolites positively associated with inflammation include allantoin, taurodeoxycholic acid, norepinephrine, pyroglutamic acid, and L-hydroorotic acid. Conversely, metabolites showing negative associations with inflammation include benzoic acid, indole-3-acetaldehyde, methio-nine, citrulline, alphaketoglutarate, n-acetyl-ornithine and 3-4-dihydroxibenzeneacetic acid. Non inflamed patients exhibit preserved autophagy and reduced mitochondrial dysfunction. Under-standing inflammation in this group hinges on the metabolism of arginine and the urea cycle. Additionally, the microbiota, particularly uricase-producing bacteria and those metabolizing tryptophan, play critical roles.

The article focuses on the galvanic replacement synthesis of Ti-Ni and Zr-Ni metal systems with the "core-shell" structure which are potential precursors for intermetallics. The authors defined the effective synthesis parameters and the formation features of polymetallic systems character-ized by granulometric, phase and elemental composition. The X-ray fluorescence and X-ray phase analysis methods showed that the deposition of nickel on dispersed titanium and zirconium leads to the production of test samples with phase composition representing a mechanical mixture of Ni and Ti, Ni and Zr. The method of X-ray fluorescence analysis showed that the presence of hy-drofluoric acid with a 0.5-1.5 M concentration results in the formation of fixed quantitative ratios of elements in the precipitate, which allows the quantitative composition of dispersed systems "titanium - nickel", "zirconium - nickel" to be regulated within a relatively wide range. Scanning electron microscopy proved that all synthesized systems are characterized by a highly porous structure that follows the titanium and zirconium particle surface contour and the presence of spherical nanoscale subunits on the formed particle surface.

Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications including young patients. However, as for SAVR, TAVR is also associated with a risk of infectious complications, namely prosthetic valve endocarditis (PVE). As the number of performed TAVR procedure increases, and despite the low incidence of PVE post TAVR, clinicians should be familiar with the associated risk factors and the clinical presentation. Whereas the diagnosis of native valve endocarditis can be straightforward applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, lower sensitivity of the criteria, and low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as S. aureus, coagulase negative staphylococci, Enterococcus spp. and Streptococcus spp. (particularly the viridans group) and, less likely Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood.

Organ shortage is one of the most pressing issues with regard to human mortality. This issue is further complicated by the fact that HLA matching is required for patients, leading to restricted choices for transplant. If organs or tissues from non- or partially-HLA–matched donors could be edited such they evade cytotoxic T cells as well as natural killer cells, it would ameliorate the organ shortage problem.

The disc brake rotors are designed to withstand both, Maximum possible deceleration (emergency braking) and a series of frequent braking cycles. A effective rotor design and superior heat dissipating material provide better performance during the braking mechanism. In this experiment, modified ventilated disk brake rotors are developed with holes and slots and the stress, deformation, heat flux and temperature distribution has been analysed. Designing of the Finite element models of the rotor are created with SolidWorks and simulated using ANSYS. Structural and thermal characteristics are compared with a reference disk brake rotor of the motorcycle (TVS Apache RTR180). It is found that the modified rotors outperform the conventional one in terms of stress generation, temperature distribution and deformation. Furthermore, this Analysis helps us to find out the best suited material for one of the proposed designs. This experiment provides us an insight of the structural and thermal characteristics of the geometrically modified rotor that can be used to upgrade and outperform the current disc brake rotor used in the motorcycle (TVS Apache RTR180).

Breast Cancer Associated Susceptibility Proteins Type 1/2 (BRCA1/2) promote cellular functioning by modulating NRF2-mediated antioxidant signaling. Redox failure in women with BRCA1/2 insufficiency increases the risk for breast/ovarian/uterine cancers. Risk‐reducing salpingo‐oophorectomy (RRSO) is a prophylactic surgery of the reproductive organs, which is frequently conducted by the age of 40 to lower the occurrence of cancer in women with BRCA1/2 mutations. However, abrupt estrogen decline following RRSO causes ovarian failure, which implicates various cellular physiological processes, resulting in increased release of free radicals and subsequent severe onset of menopausal symptoms. Comfort measures (e.g., hormonal replacement therapy (HRT) and mindfulness-based stress reduction (MBSR)) may improve chronological menopause-related quality of life, but their specific effects are not clear in women with gene mutations. Aiming to fill the gap, this study used path analysis to examine the effects of HRT and MBSR on menopausal symptoms among RRSO patients (N = 199, mean age = 50.5 ± 6.7 years). HRT alleviated menopausal symptoms in BRCA2 carriers and women who were physically active, premenopausal at the time of RRSO, had a high BMI, and had no history of breast cancer. It increased the severity of urogenital symptoms in those with a history of cancer. MBSR, on the other hand, was associated with increased intensity of most menopausal symptoms. The results suggest that young women undergoing recent RRSO may benefit from HRT at an individual level while their need for extensive measures to optimize their psychological wellbeing is ongoing. Adverse effects of MBSR, which are captured in the present study imply that MBSR may interfere with redox sensitivity associated with estradiol fluctuations in BRCA1/2 carriers. Investigations are needed to test this hypothesis and elaborate on the underlying mechanisms in those women.

BackgroundIndex level disc herniation following lumbar spinal decompression is somewhat overlooked as postoperative complication, resulting in return of symptoms. It is proposed that the combination of local instability and degenerated disc is more likely to result in disc herniation. There is no literature comparing post-decompression disc herniation rates between different techniques. This study compares the postoperative disc herniation rates of the "mini-open" laminectomy versus the tubular system decompression.MethodsIn a retrospective comparative study, 563 patient files who underwent primary lumbar spinal decompression, were reviewed and divided into two groups, distinguished by surgical technique. Demographic, clinical, and postoperative data were collected and compared using independent two-tailed t-test and Fisher's exact test with significance set at p<0.05. Primary outcome: comparison of post-decompression surgery, index level, disc herniation occurrence between two surgical techniques.ResultsPostoperative index level disc herniation was significantly lower in the minimally invasive surgery group with 2 cases (0.8%) versus 19 cases (5.8%) in the "mini-open" group [p=0.002]. Disc herniation following single level and multi-level operations were also significantly lower in the minimally invasive group compared with the "mini-open" group (2 versus 11 and 0 versus 8 respectively; p<0.05).ConclusionPostoperative index level disc herniation following lumbar spinal decompression occurs in 3.7% of surgeries. Minimally invasive surgery is found to result in less herniations then "mini-open".

This paper aims to introduce the notions of various types of Qc-contractions for which we establish some fixed circle and fixed disc theorems in the setting of metric spaces. Some illustrative examples are also provided to support our results. Moreover, we present some fixed circle and fixed disc results of integral type contractive self-mappings.

The aim of this review was to provide an update on the potential of cell therapies to restore or replace damaged and/or lost cells in retinal degenerative and optic nerve diseases, describing the available cell sources and the challenges involved in such treatments when these techniques are applied in real clinical practice. Sources include human fetal retinal stem cells, allogenic cadaveric human cells, adult hippocampal neural stem cells, human CNS stem cells, ciliary pigmented epithelial cells, limbal stem cells, retinal progenitor cells (RPCs), human pluripotent stem cells (PSCs) (including both human embryonic stem cells (ESCs) and human induced pluripotent stem cells (iPSCs)) and mesenchymal stem cells (MSCs). Of these, RPCs, PSCs and MSCs have already entered early-stage clinical trials since they can all differentiate into RPE, photoreceptors or ganglion cells, and have demonstrated safety, while showing some indicators of efficacy. Stem/progenitor cell therapies for retinal diseases still have some drawbacks, such as the inhibition of proliferation and/or differentiation in vitro (with the exception of RPE) and the limited long-term survival and functioning of grafts in vivo. Some other issues remain to be solved concerning the clinical translation of cell-based therapy, including (1) the ability to enrich for specific retinal subtypes; (2) cell survival; (3) cell delivery, which may need to incorporate a scaffold to induce correct cell polarization, which increases the size of the retinotomy in surgery and, therefore, the chance of severe complications; (4) the need to induce retinal detachment to perform the subretinal placement of the transplanted cell; and (5) the evaluation of the risk of tumor formation caused by the undifferentiated stem cells and prolific progenitor cells. Despite these challenges, stem/progenitor cells represent the most promising strategy for retinal and optic nerve disease treatment in the near future, and therapeutics assisted by gene techniques, neuroprotective compounds and artificial devices can be applied to fulfil clinical needs.

A recently published article posited the use of polymer matrix composites (PMCs) as a replacement material for low-carbon steel (LCS) in large power transformer (LPT) tanks [1]. PMCs offer potential advantages such as weight reduction, corrosion prevention, and self-healing of the tank material which may not be achievable with traditional LCS. LCS can arrest ballistic projectiles at relatively low velocities, but at higher velocities, penetration can occur leading to a potential major transformer failure. Numerical simulations of steel projectile impacts upon LCS plates and glass and/or carbon fiber polymer composite laminates showed that with sufficient thickness both could prevent projectile penetration. This prevention was especially efficient when the plates were coated with a high strain rate sensitive material such as polyurea (PU). Our simulations show that the addition of a 3 mm coating of PU to a standard 10 mm thick LCS plate used in LPT tanks could prevent penetration of a 400 m/s steel projectile. For PMC plates, the simulations with the same projectile velocity showed three times faster deceleration with a 3 mm PU coating than without the coating. Thus, two realistic approaches to improving the ballistic protection of LPTs are presented. In addition to their other advantages, this research clearly shows that PMCs with the coating could provide significant ballistic protection for the next generation of LPT tanks.

Purpose: Hormone Replacement Therapy (HRT), an FDA-approved treatment for menopausal conditions was found to be associated with increased risk of endometrial cancer and reduced oestrogen. Studies showing benefits of HRT in preventing chronic diseases lead to development of clinical guidelines by American College of Physicians. This study aims to assess effectiveness of HRT treatments across cardiometabolic measures including Triglycerides (TG), Follicle-Stimulating Hormone, LDL cholesterol, HDL cholesterol, and Estradiol in menopausal women. It reports gaps in scientific knowledge and clinical practice to enhance current guidelines and policies.Methods: A systematic methodology designed and published in PROSPERO (CRD42022346057) to report network meta-epidemiology analysis was utilised. We used databases by PubMed, Web of Science, ScienceDirect, EMBASE and MEDLINE for studies published between 30th of April 1980-2022. Effects of HRT treatments were explored using a mixed treatment comparison (MTC) model. Fixed and random-effects models were used to address heterogeneity in published studies. Publication bias was assessed and corrected using funnel plots and Egger’s test.Results: Of 45 eligible studies, our findings indicate a significant statistical heterogeneity between HRTs and reduction of TG, SFH, LDL-C alongside increase of HDL-C and Estradiol among menopausal women. The analysis suggests a lack of direct evidence to support their efficacy in reducing TG, SFH and LDL-C levels or to substantiate HRT’s effectiveness in increasing HDL-C and Estradiol. The results showed no significant publication bias in the meta-analysis of included studies.Conclusion: Our findings demonstrate that use of HRT interventions among menopausal women may reduce TG, FSH and LDL-C levels and increase levels of HDL-C and estradiol via oral and oral + transdermal administration. Our study reaffirms efficacy of HRT in supporting favourable lipid profile in menopausal women whilst highlighting the need for robust and inclusive epidemiology studies and clinical trials to further develop clinical guidelines and policies.

Low back pain is a common problem in the active population, and the second reason for visiting a physician. In patients with lumbar disc protrusion, the nucleus pulposus bulges against the disc and the latter protrudes into the spinal column, but the annulus fibrosus remains intact. The purpose of this study was to prove that starting an early complex rehabilitation treatment results into pain and disability reduction, and increased muscle strength and mobility in patients with lumbar disc protrusions. We performed a prospective cohort study, enrolling 60 patients (25 men and 35 women) aged between 26 to 76 years, diagnosed with lumbar disc protrusion. Patients in the experimental group registered significant improvements in all studied variables (pain, mobility, muscle strength, disability) after 6 months of treatment. The results of our study suggest that, in the lumbar disc disease, a combined rehabilitation program may be more effective in terms of pain and disability reduction, if it starts early after diagnosis. The current study proves the importance of combining electrotherapy with hydrotherapy and physical therapy. Patients who received this treatment combination showed an extremely significant improvement in pain relief, and reduction of functional disability after 6 months of treatment.

Owing to their unique physicochemical properties, nanoparticles are used in a variety of ways in the field of cancer treatment, including imaging, drug delivery, and photothermal and photodynamic therapies. The fascinating properties of nanoparticles are determined by their size, morphology, and constituent elements, and various synthetic methods and post-synthetic techniques have been applied to control these factors. Herein, we present examples of shape and composition control through galvanic replacement, a technique that exploits redox potential differences between elements to induce spontaneous ion-exchange and highlight its specific contributions to cancer treatment applications. The present article identifies the recent advances in nanoparticle formation techniques and discusses the future outlook of the field.

Background: Low back pain (LBP) is a major cause of disability globally, and the diagnosis of LBP is challenging for clinicians. Objective: This study aimed to assess the accuracy level of arti-ficial intelligence as a Clinical Decision Support System (CDSS) called Therapa compared to MRI in predicting lumbar disc herniated patients. Methods: One hundred low back pain patients aged ≥18 years old were included in the study. The study was conducted in 3 stages, at first, a case se-ries was conducted by matching MRI and Therapha diagnosis for 10 patients. Subsequently, Delphi methodology was employed to establish a clinical consensus. Lastly, to determine the ac-curacy of the newly developed software, a cross-sectional study was undertaken, involving 100 patients. Results: The software showed a significant diagnostic accuracy with the area under the curve in the ROC analysis determined as 0.84 with a sensitivity of 88% and a specificity of 80%. Conclusion: The study’s findings revealed that CDSS using Therapha has a reasonable level of ef-ficacy, and this can be utilized clinically to acquire faster and more accurate screening of patients with lumbar disc herniation.

Background/Objectives: Transforaminal endoscopic lumbar discectomy (TELD) under local anesthesia is a promising minimally invasive surgical option for intractable lumbar disc herniation (LDH). However, our understanding of access pain prediction during foraminal pathological procedures is limited. To our knowledge, no predictive rules for access pain during TELD have been established for foraminal or extraforaminal LDH. This study, with its potential to predict access pain during TELD and to discuss strategies for pain prevention and management, could significantly impact the field of endoscopic spine surgery. Methods: This observational study included 73 consecutive patients who underwent TELD for foraminal or extraforaminal LDH between January 2017 and December 2022. Preoperative clinical and radiographic factors affecting significant access pain and the impact of access pain on clinical outcomes were evaluated. Results: The rate of significant access pain was 13.70% (10 of 73 patients). Extraforaminal LDH tended to cause more severe pain than foraminal LDH during TELD under local anesthesia (p &lt; 0.05). Although the degree of access pain was not related to global outcomes, increased pain was strongly associated with a prolonged operative time and length of hospital stay (p &lt; 0.05). Conclusions: TELD can be an effective surgical option for foraminal or extraforaminal LDH under local anesthesia. More access pain may develop during TELD for extraforaminal LDH. The extraforaminal component of LDH can narrow the safety working zone. Significant access pain may prolong the duration of surgery and hospitalization. Thus, a specialized technique is required for the clinical success of TELD.

In areas where conventional fundus cameras are logistically unaffordable, the smartphone-based approach is considered as a promising future of glaucoma screening due to their affordability and ease-of-use. Optic disc localization is a critical stage during glaucoma screenings. For fundus images captured with standard fundus cameras, the majority of the models available out there can locate the optic disc with satisfactory performance. However, for images that are captured with smartphone-based fundus cameras, the inherent noise and lower quality of the fundus image makes it difficult for models to detect the optic disc region. In this study, we have proposed to utilize YOLOv8n for optic disc localization due to the model’s cutting-edge performance in diverse tasks and its lightweight nature. We have used a public dataset which has 2000 low quality fundus images that are captured using a smartphone-based fundoscopy device. From these, 60% of the data was used for fine-tuning the model, and 25% for testing. By using a confidence of 50% set as threshold, the model was able to detect the optic disc successfully on over 97% of test images with intersection over union of above 0.85. These results highlight the potential of the lightweight YOLOv8n model for deployment on resource-constrained environments, offering a promising performance on accurately localizing the OD and enhancing the feasibility of affordable glaucoma screening on smartphones.

In the following work, the assessment of the strength properties of the critical area of the rotor stage of the turbine jet engine was undertaken. This is the place of fixing the blade in the rotor disc. An important aspect of this issue are characteristic geometrical dimensions and operating factors e.g., change in rotor speed. In this paper, the assessment of the strength properties of the existing trapezoidal blade-disc connection was undertaken using parametric analysis considering FSI. Virtual models of the compressor rotor stage were developed, including parametric blade-disc connections and discrete models for FEM and CFD analyses. In the parametric analysis of the blade-disc connection, one-way fluid-structure coupling was used. The parametric analysis was aimed at assessing selected geometric parameters in terms of their impact on the maximum reduced stresses in the blade root. It was examined how the adopted value of the friction coefficient influences the maximum reduced stresses in the rotor stage of the compressor.

The connection of two phenomena - non-conservative friction forces and dissipation-induced instability can lead to many interesting engineering problems. The paper studies general material-dependent damping influence on dynamical instability of disc brake systems leading to brake squeal. The effect of general damping is demonstrated on a minimal and complex model of a disc brake. A complex system including material-dependent damping is defined in the commercial finite element software. The finite element model validated by experimental data on the brake-disc test bench is used to compute the influence of a pad and a disc damping variations on system stability by complex eigenvalue analysis. Analyzes show a significant sensitivity of the experimentally verified unstable mode of the system to the ratio of the damping between the disc and the friction material components.

Background We aimed to compare the retinal, optic disc vascular density (ODVD) values, and acircularity index (AI) of patients with idiopathic macular telangiectasia type 2 (IMT) and healthy individuals using the optical coherence tomography angiography(OCTA) device. Methods The study included 39 patients with IMT and 37 healthy controls. The OCTA findings of the patients and controls were examined. Results The total, parafoveal and perifoveal vascular density of the superficial capillary plexus, choriocapillaris blood flow, inside-disc ODVD, retinal nerve fiber layer (RNFL), and retinal thicknesses were found to be statistically significantly lower and the foveal avascular zone value was statistically significantly higher in the IMT group compared to the control group (p=0.001, p=0.01, p=0.02, p=0.01, p=0.009, p=0.002, p=0.02, respectively).There was a statistically significant negative correlation between best-corrected visual acuity (BCVA) and AI (p=0.02), a statistically significant positive correlation between peripapillary vascular density and BCVA(p=0.04). Conclusion We consider that the lower retinal, choriocapillaris, and ODVD values, retinal and RNFL thicknesses in the patients with IMT compared to the controls were due to vascular damage, remodeling, fibrosis, proliferation, and Müller cell damage. Ellipsoid zone defect, AI, and peripapillary vascular density are important indicators in the evaluation of visual acuity in these patients.

Previous study demonstrated the reconstituted type I collagen matrix extracted from rabbit tendons enabled to regenerate the TMJ disc in the rabbit. The aim of this study was to investigate changes in the extracellular matrix (ECM) and mechanisms of regeneration in TMJ disc. In 36 New Zealand rabbits that underwent a partial discectomy, discs were replaced with reconstituted collagen templates for 3 months. A histological analysis showed that moderate to severe degeneration appeared in partially discectomized joints without implantation. In contrast, discs that received the reconstituted collagen template regenerated, and returned to normal to protect the joint. Cells in the regenerative tissue expressed ECM, and fibers became regular and compact due to tissue remodeling over time. Reparative cells differentiated into chondroblasts, and showed highly dense pericellular fibers. The morphology and collagen composition of the disc and condyle in the 3-month experimental group were similar to those of normal tissues. In conclusion, the reconstituted collagen template facilitated the regeneration of surgically discectomized discs. Type I and type II collagens play a crucial role in the regeneration of articular discs.

This study aims at the sustainable valorization of eggshells (ES) from different countries of origin in cement concrete as a cement replacement for Hong Kong. For this purpose, sixteen different eggs from different regions across the world were selected from the local market. Firstly, the extent of uniformity in the weight and mineral content of sampled eggshells were assessed by a specific gravity test and thermogravimetric analysis (TGA), respectively. It was found that specific gravity varies between 2.02 and 2.39, with an average value of 2.20 ± 0.01, whereas CaCO₃ varies between 94.65% and 97.23%, with an average value of 96.33%. These values were a bit lower than those of extra-pure limestone (LS) because of the organic part and the porous structure of eggshells. Secondly, three different eggshells were selected for cement replacement in cement concrete, both in the uncalcined and calcined states, based on having the highest, medium, and lowest CaCO₃ content, respectively. To get the calcined eggshells, the eggshells were calcined at 800^oC for three hours. It was found that the strength of eggshells varies with CaCO₃, but the variation was acceptable. The calcined eggshells showed comparatively more compressive strength and were close to the LS because of the free CaO and the absence of an organic part. In general, the variation in the basic properties of eggshells from different regions across the world is negligible and suitable to use as a cement replacement with acceptable variation in strength in Hong Kong.

To explore the characteristics of the concentric eyewall of a typhoon during its formation and replacement processes, with Super Typhoon Muifa in 2011 as the example case, the Weather Research and Forecast (WRF) mode was used to carry out a numerical simulation to reproduce the entire formation and replacement processes of the concentric eyewall. The physical quantities such as the tangential wind speed, radar echo, radial wind speed, vertical wind speed, and potential vortex were diagnosed and analyzed. The results of the analysis show that the outward expansion of the isovelocity in the lower troposphere was the early signal of the formation of the outer eyewall. After the outer eyewall formed, there was a center of second-highest tangential wind speed in the corresponding area. The second-highest wind speed increased as the strength of the outer eyewall increased, and the position of the second-highest wind speed center was retracted with the retraction of the outer eyewall. The tangential wind speed of the moat area was smaller than that corresponding to the concentric eyewall and this feature gradually disappeared with the increase of the height. The echo in the moat area was weak, and this characteristic was particularly evident when the moat area was relatively wide and the outer eyewall was relatively strong. With the formation and development of the outer eyewall, the intensity of the inflow in the boundary layer corresponding to the inner eyewall was reduced, the intensity of the outflow in the upper layers declined, and the intensities of the inflow and outflow corresponding to the outer eyewall were enhanced. After the second outer eyewall matured, there was a significant inflow in the upper layer of the moat area. Once the outer eyewall formed, a large amount of hydrometeors appeared in the corresponding area, and there was a strong ascending motion inside that area. The strength of the ascending motion and the content of hydrometeors increased as the outer eyewall increased. When the moat area was relatively wide, the divergent airflow generated by the developed outer eyewall in the upper layer would produce a significant descending motion in the moat area.

Low back pain (LBP) is a significant global health issue, contributing to considerable disability and socioeconomic burdens. The degeneration of the human intervertebral disc (IVD) is a critical factor in the pathogenesis of LBP. Recent studies have emphasized the significance of its specific set of genes and extracellular matrix (ECM) in IVD health. The Noggin gene has emerged as a critical factor due to its high expression levels in healthy nucleus pulposus cells (NPCs) observed in our previous research. In this study, we investigated the hypothesis that decreased Noggin expression in NPCs is associated with IVD degeneration, contributing to LBP development. A lentivirus-mediated RNAi was applied to knockdown Noggin expression in primary NPCs from six human donors. Cell viability analysis, XTT assay, and cell apoptosis were conducted to reveal the effect after transduction. After two weeks, colony formation unit (CFU) assay was used to examine the anchor-independent growth ability of transduced cells. Additionally, qPCR was performed to quantify cellular anabolism and catabolism makers at the transcript level. The results showed lentivirus-mediated downregulation of Noggin suppressed cell growth, cell viability, and colony formation, and induced apoptosis in human NPCs in vitro. Noteworthy, it hindered cellular anabolism and enhanced catabolism activity in human NPCs after transduction. Our findings indicated that the degeneration of human IVD is possibly related to decreased Noggin expression in NPCs. This research provides valuable insights into the role of Noggin in IVD homeostasis and its implications for LBP treatment.

Cancer is the second leading cause of death worldwide. Key to cancer initiation and progression is the crosstalk between cancer cells and their microenvironment. The extracellular matrix (ECM) is a major component of the tumour microenvironment and integrins, main cell-ECM adhesion receptors, are involved in every step of cancer progression. However, accumulating evidence has shown that integrins can act as tumour promoter but also as tumour suppressor factors, revealing that the biological roles of integrins in cancer are complex. This incites a better understating of integrin function in cancer progression. To achieve this goal, simple model organisms, such as Drosophila, offer a great potential to unravel underlying conceptual principles. Here, we find that in the Drosophila wing disc epithelium the PS integrins act as suppressors of tumours induced by a gain of function of the oncogenic form of Ras, RasV12. We show that PS integrin depletion enhances the growth, delamination and invasive behaviour of RasV12 tumour cells, as well as their ability to affect the tumour microenvironment. These results strongly suggest that integrin function as tumour suppressors might be evolutionary conserved. Drosophila can be used to understand the complex tumour modulating activities conferred by integrins, thus facilitating drug development.

Researchers achieved high torque volume ratios in magnetorheological (MR) fluid braking devices by introducing multiple layers and multiple poles concepts. The number of magnetic poles, pole geometry and placement have a significant effect on these multi-pole MR brake performances. This research work focused on the effect of the pole head geometry in a multi-pole dual-disc MR brake for the enhancement of braking torque. The magnetic field generated by the electromagnetic coil has to penetrate through pole heads and travel orthogonally through the rotor and MR fluid layers to achieve maximum brake torque. This flow depends on the profiles of the magnetic pole head area and corresponding core dimensions. This study considered pentagon, square, hexagon, trapezoid and ellipse pole head profiles in place of the conventional circular pole and the best possible core dimensions were used for each geometry. A three-dimensional electromagnetic analysis of the MR brake is conducted to simulate the brake performance. Results showed that the hexagonal and elliptical pole heads are having better magnetic field area, magnetic intensity distribution and higher magnetic flux lines piercing through the MR fluid perpendicularly than the circular and square pole heads. An increment of 3.88% for braking torque performance is obtained, and the braking torque is significantly enhanced.

Enhancing the degree of functional multiplexing while assuring operational reliability and manufacturability at competitive costs are crucial ingredients for enabling comprehensive sample-to-answer automation, e.g., for use in common, decentralized “Point-of-Care” or “Point-of-Use” scenarios. This paper demonstrates a model-based ‘digital twin’ approach which efficiently supports the algorithmic design optimization of exemplary centrifugo-pneumatic (CP) dissolvable-film (DF) siphon valves towards larger-scale integration (LSI) of well-established “Lab-on-a-Disc” (LoaD) systems. Obviously, the spatial footprint of the valves and their upstream laboratory unit operations (LUOs) have to fit, at a given radial position prescribed by its occurrence in the assay protocol, into the locally accessible disc space. At the same time, the retention rate of a rotationally actuated CP-DF siphon valve and, most challenging, its band width related to unavoidable tolerances of experimental input parameters, need to slot into a defined interval of the practically allowed frequency envelope. To accomplish particular design goals, a set of parametrized metrics is defined, which are to be met within their practical boundaries while (numerically) minimizing the band width in the frequency domain. While each LSI scenario needs to be addressed individually on the basis of the digital twin, a suite of qualitative design rules and instructive showcases structures are presented.

Background: Fiber-reinforced composites (FRCs) have been proposed as an alternative to traditional metal alloys for the realization of frameworks in full-arch implant supported prostheses. The aim of the present in vitro study was to evaluate the deflection under load of seven prostheses endowed with frameworks made of different materials, including different types of fiber reinforced composites (FRCs). Methods: A master cast with four implant analogues in correspondence of the two lateral incisors and the two first molars was used to create full-arch fixed prostheses with the same shape and different materials. Prostheses were made in different materials (framework+veneering material): gold alloy+resin (Au+R), titanium+resin (Ti+R), FRC with multi-directional carbon fibers+resin (ICFRC+R), FRC with unidirectional carbon fibers+composite (UCFRC+C), FRC with glass fibers+resin (GFRC+R), FRC with glass fibers+composite (GFRC+C), resin (R, full-acrylic prosthesis). Flexural tests were conducted using Zwick/Roell Z 0.5 machine and the deflection of the lower surface of the prosthesis was measured in order to obtain load/deflection graphs. Results: Greater rigidity and less deflection were recorded for UCFRC+C, GFRC+C, followed by Ti+R, and Au+R. The greatest deformations were observed for resin alone, ICFRC+R and GFRC+R. The results were slightly different in the incisal region probably due to the greater amount of veneering material in this area. Conclusions: When used to realize full-arch frameworks, Au and Ti allow a predictable mechanical behavior with gradual deformations with increasing load. UCFRC also demonstrated good outcomes and less deflection than ICFRCs when loaded. The GFRC full-arch framework may be a valid alternative, however showed greater deflections. Further studies are needed in order to evaluated how different prosthesis design and material thickness might affect the outcomes.

An 8-months old male American Staffordshire terrier was referred for a no weightbearing lameness of the right pelvic limb, hyperthermia, lethargy and inappetence caused by hematogenous osteomyelitis. Orthopedic, radiographic and tomographic examinations revealed a bone sequestrum of 4 x 1.4 cm and active periosteal reaction of the caudo-lateral cortical in the metaphysis and the distal third of the right femoral diaphysis, medullary osteolysis and interruption of the cranio-medial cortical profile, with involvement of the femoral trochlea leading to a secondary medial patella luxation. Once skeletally mature, after 4 months from surgical debridement and aggressive antibiotic therapy against Klebsiella oxytoca revealed by bacteriological exam, the patient underwent prosthetic surgery for the application of a custom-made patellar groove replacement (PGR) to fill the bone defect and restore the femoral trochlea surface. Despite the serious injury that afflicted the right pelvic limb, the surgery had satisfactory outcomes until the last 18-months postoperative follow up.

Aquaculture is growing rapidly as a food-producing sector and in recent years, fishmeal prices have climbed by more than twofold on a global scale. This review of previous studies was performed to contribute to the extant literature on the aquaculture sector to aid cost reduction of aquafeeds by identifying substitute protein that can replace fishmeal. The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) using the SCOPUS and WOS (Web of Science), DOAJ (Directory of Open Access Journals), Academia, and Pubmed Central databases with the following search terms: “fishmeal,” “alternative protein source” and “aquafeeds.” This resulted in 5,331 articles from the SCOPUS and WOS databases. Finally, the titles and abstracts of the articles were screened, giving a total of 162 articles that were used in the study; another 58 articles came from open databases. Results have shown that 100% replacement of fishmeal with blood meal did not affect the growth of fish as well as 75% to 100% combination of poultry-by-product (PBM), feather meal (FEM), and blood meal (BM). Moreover, a 10% replacement of fishmeal using seaweed (Gracilaria arcuata) has no adverse effect on feed efficiency and growth performance of tilapia, a 50% replacement of fishmeal using black soldier fly (Hermetia illucens), and 25% replacement using soybean (Glycine max) also showed better results for fish growth. With that, this review shows that alternative protein can be a great alternative to the aquaculture sector in reducing the cost of aquafeeds since alternative proteins are much cheaper than the usual fishmeal.

The main purpose of tissue engineering is to fabricate and exploit engineered constructs suitable for the effective replacement of damaged tissues and organs, and able to perfectly integrate with the host’s organism without eliciting any adverse reaction. Ideally, autologous materials represent the best option, but they are often limited due to the low availability of compatible healthy tissues. So far, one therapeutic approach relies on the exploitation of synthetic materials: they exhibit good features in terms of impermeability, deformability and flexibility, but present chronic risks of infections and inflammations. Alternatively, biological materials, including naturally derived ones and acellular tissue matrices of human or animal origin, can be used to induce cells growth and differentiation, which are needed for tissue regeneration: however, this kind of materials lacks satisfactory mechanical resistance and reproducibility, affecting their clinical application. In order to overcome the above-mentioned limitations, hybrid materials, which can be obtained by coupling synthetic polymers and biological materials, have been investigated with the aim to improve biological compatibility and mechanical features. Currently, the interest in these mate-rials is growing, but the ideal ones have not been found yet. The present review aims at exploring some applications of hybrid materials, with particular mention to urological and cardiovascular fields: in the first case, the efforts to find a construct that can guarantee impermeability, mechanical resistance and patency will be herein illustrated; in the second case, the search for impermeability, hemocompatibility and adequate compliance will be been disclosed.

Asphalt cement will not last for a long time as the world encounters a diminishment in the crude oil. For sustainable, flexible pavement development, new resources can provide a contribution to replace it partially or entirely. In this study, asphalt was partially and entirely replaced by guayule resin as a bioresource by-product, extracted during the guayule natural rubber production. Crumb rubber modifier (CRM) was used as an asphalt enhancer. The Superpave grading system was followed at high, intermediate, and low temperatures to evaluate such innovative binder for rutting, fatigue, and thermal cracking, respectively, in addition to viscosity. Therefore, the original, short-term aging and long-term aging were simulated using tank, rolling thin film oven, and pressure aging vessel materials. Additionally, component analysis using Fourier-transform infrared spectroscopy was provided to link the rheological properties with the chemical changes. Outcomes showed a relatively much lower viscosity of guayule in the same high-temperature asphalt grade indicating savings in plant energy consumption and reduced environmental emissions. CRM enhanced guayule, but not as much as asphalt, proven by polymeric component migration through liquid binder. This enhancement was reflected in the rheological performance besides other factors. As-received guayule seems to have high oxygen content proven by strong absorption peak intensities of oxidative bonds (e.g., Carbonyl and sulfoxide). Such pre-oxidation was negatively reflected in the intermediate- and low-temperature performance of guayule and guayule-based binders. However, the investigated guayule had potential to compensate for asphalt replacement in the presence of CRM by 23–42% by weight of blend.

Steel fibres provides ductility to concrete structures. This in turn gives possibility to replace or reduce conventional reinforcement in structural elements. In this study the focus is on structural walls and the fibres as potential replacement for horizontal reinforcement in areas where vertical re-bars are needed. An experimental study was conducted, in which prismatic specimens with longitudinal re-bars were subjected to centric loading. Ten samples with 12 specimens in each were tested. The parameters considered were: fibre content, concrete cover for the longitudinal bars, and presence of stirrups. Self-compacting concrete with 30 and 60 kg/m3 steel fibres was used. The influence of fibres on maximum load, stiffness, and ductility of the specimens is evaluated. The results show that fibres eliminated brittle collapse and spalling of concrete at failure. Samples with fibres tend to have reduced maximum force and stiffness but increased ductility. The specimens with fibre content of 60 kg/m3 showed more ductile behaviour than the ones with minimum amount of conventional stirrups. The study suggests that combination of steel fibres and conventional re-bars can lead to less qualitative compactness of the self-compacting concrete, which in turn may reduce load bearing capacity and stiffness of the structure.

Supplier selection/replacement strategies and optimized purchasing policies play a key role in efficient supply chain management in today’s dynamic market. Here we study supplier replacement in a one-level assembly system (OLAS) producing one type of finished product. To assemble the product, we need to provide multi-type components, but assembly will be interrupted if any single component is missing, and incoming units will get hoarded until the missing component arrives. The assembly process can be interrupted by various sources of uncertainty, including delays in component deliveries. There is consequently a non-negligible risk that the assembly process may get stopped any moment. This brings inventory-related costs, which should be minimized. Here we consider discrete lead-time distributions to mimic industry-world reality. We present a model that takes into account not only optimal assignment of component order release dates but also replacement of a critical supplier. For a given unit, we model several alternative suppliers with alternative pricing and lead-time uncertainties, and we evaluate the impact on the total assembly system. For a more general case where several suppliers may be replaced, we propose a genetic algorithm.

This study reports the likely real-world effects of fleet replacement with electric vehicles (EVs) and higher efficiency EURO6 vehicles on the exhaust emissions of NOx, PM, and CO2 in the seven boroughs of the West Midlands (WM) region, UK. National fleet composition data, local EURO distributions and traffic compositions were used to project vehicle fleet compositions for different roads in each borough. A large dataset of real-world emission factors including over 90,000 remote-sensing measurements, obtained from remote sensing campaigns in five UK cities, was used to parameterise the emission profiles of the studied scenarios. Results show that adoption of the fleet electrification approach would have the highest emission reduction potential on urban roads in WM boroughs. It would result in maximum reductions ranging from 35.0-37.9%, 44.3-48.3%, 46.9-50.3% for NOx, PM, and CO2, respectively. In comparison, the EURO6 replacement fleet scenario would lead to reductions ranging from 10.0-10.4%, 4.0-4.2%, and 6.0-6.4% for NOx, PM, and CO2, respectively. The studied mitigation scenarios have higher efficacies on motorways than on rural and urban roads because of the differences in traffic fleet composition. The findings presented will help policymakers choose climate and air quality mitigation strategies.

In this research, low-fat dried Chinese sausage was formulated with mango peel pectin (MPP) extracted by microwave assisted extraction (MAE) (0%, 5%, 10% and 15% (w/w). The extractable yield of pectin attained from peel of Nam Dok Mai variety was achieved at 13.85% using 700-watt power. The extracted MPP were of high equivalent weight (1,485.78 mg/mol), degree esterification (77.19%) and methoxyl content (19.33%) with the structure of more porosity as compared to that of the conventional method. Spectrum scans by Fourier transform infrared spectrophotometer (FT-IR) advised that the extracted MPP gave the similar wave number profiles as the commercial pectin. Quality attributes of the Chinese sausages were accessed and compared with the control formula (CTRL). At higher concentrations of MPP, the product had positively increased colour intensity. The texture profile of the sausage illustrated that only the hardness value was comparable with the CTRL, while springiness, cohesiveness, gumminess and chewiness were statistically lower (p < 0.05). Furthermore, the sensory evaluation by experienced panellists (n=12) indicated that 5% MPP similarly represented overall acceptability with the CTRL. Consequently, MPP can be effectively applied at low level as fat replacement in Chinese sausage allowing colour improvement and product of healthier option.

Background: This study aimed to investigate the association between the internal derangement of the temporomandibular joint (TMJ), in particular the severity of disc displacement (DD), and the presence of generalized joint hypermobility (GJH) in growing patients evaluated on magnetic resonance images (MRI). The study also investigated the relationship between the stages of DD severity and age. Methods: This cross-sectional study has been conducted on a pre-orthodontic population (8-16 years). The GJH was assessed with the Beighton test (cutoff ≥ 4) and the final sample of 56 patients was divided into two groups: a Study Group, 30 subjects with GJH, and a Control Group, 26 subjects without GJH. The disc position was evaluated on MRI and the severity of DD was classified in four stages. Pearson's χ2 Test was performed for the analysis of the statistical correlation. Results: A statistically significant relationship between GJH and disc position was found, in particular a disc displacement with reduction (DDwR) and DD severity. It also emerged a positive association between the severity of DD and age, that increased with increasing age. Conclusions: Growing patients with GJH have a higher risk of developing DD and with more severe stages. The risk of developing DD and the severity increases with increasing age.

Background: To date, FM using middle ear packing has rarely reported. In this study, we hypothesized that middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of TMP closure regardless of perforation size. Methods: Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at tertiary referral center were encountered and analyzed. The success rate and audiologic outcome was analyzed. Results: The mean successful TM closure rate was 88.0 %. The success rate by different age generation was not significant difference. The size of the perforation grade showed no significant difference. The perforation site by anterior or posterior was not significant. The preoperative mean threshold of AC, BC and ABG were 55.71, 12.98 and 42.73 dB respectively. The postoperative mean threshold of AC, BC and ABG were 23.67, 12.98 and 10.69 dB. The change of preoperative and postoperative hearing showed statistically significant. Conclusion: From our results, the simple trimming of the perforation edge and middle ear packing with external ear canal packing using fibrin glue induced the stable adhesion between the remnant TM and the fat graft.

Nowadays, the uses of laser and optics in the medical areas are extremely vivid, especially low-level laser therapy. The light with the wavelength of 633 nm to 1200 nm could penetrate and propagate deep in biological tissue. To develop the low-level laser therapy device, optimizing light delivery is critical to accurately stimulate the biological effects inside the biological tissue. Nevertheless, each form of the tissues at each zone on the body had various refractive optic, absorption, scattering, and anisotropy coefficients. This paper describes the simulation results of low-level laser propagation from skin surface at the lower spine, the knee, the femur and the prostate gland with four wavelengths (633 nm, 780 nm, 850 nm, and 940 nm) by the Monte Carlo method. These simulation results are the base for developing the low-level laser therapy device, that could be used in clinical for treating the fracture, knee osteoarthritis, spinal degeneration, and benign prostatic hypertrophy.

Since the 1990’s, studies and pilot tests have been conducted to reduce traffic, accidents, and pollution due to urban freight transport (UFT). These ended up in several policies, regulations, and restrictions for UFT, such as low emission zones, delivery time windows, and vehicle size and weight restrictions. However, issues in UFT under regulatory measures still persevere. This study introduces an optimization framework for deriving an optimal combination of various types of vehicles with different capacities for vehicle replacement in UFT. This framework allows an understanding of how an urban freight company with a limited budget efficiently satisfies its freight demand within an urban area in the presence of regulatory measures by urban administrators. The introduced formulation, which is a mixed-integer linear programming, will assist the operator in choosing the best investment strategy for introducing new vehicles of certain types and sizes, for operation in different zones, into its fleet while gaining economic benefits and having a positive impact on the liveability of the urban area. Furthermore, a sensitivity analysis is performed to consider the effects of specific uncertain parameters on the total cost. The numerical results show that the share of electric vehicles in the fleet increases, and they are more competitive than diesel vehicles.

Background: This study discerns surgeons’ attitudes and practices in the determination of heart valve replacement for patients with endocarditis due to intravenous drug use (IVDU-IE). We aimed to identify factors contributing to surgeons’ decision-making process for initial and recurrent surgical heart valves, and the availability of institutional guidance. Methods: An IRB approved, anonymous mixed-methods survey instrument was designed and validated with 24 questions. Cardiothoracic surgeons in the U.S. and globally were recruited with a total of 220 enrolling in the study with 176 completing every question on the survey. Results: A cluster analysis revealed that although surgeons can be divided into sub-groups based on their previous experience with valve replacements, these groups are not perfectly homogenous, and the number of identified clusters is dependent on technique used. ANOVA analysis revealed that the variables that most clearly divided the surgeons into subgroups were, in order of importance, years of practice, number of valve replacements, and geography. Conclusions: Our analysis showed heterogeneity among cardiothoracic surgeons regarding how they make clinical decisions regarding re-operative valve replacement related to IVDU-IE Therefore, an opportunity exists for an interprofessional team to develop guidelines to decrease variability in surgical decision-making regarding valve replacement associated with IVDU-IE

We show how some concentration inequalities for sampling without replacement can be used for bounding future samples. This process can be extended to bound the sum of future samples from multiple populations, and we analyse an illustrative sample allocation problem.

Introduction: These days, obesity is considered an important factor for many medical problems such as diabetes mellitus, cardiovascular diseases and joint degeneration. Obesity is one of the leading causes of osteoarthritis and the need for arthroplasty. We aim to study the effect of obesity and the duration of knee replacement surgery.Method: A cross-sectional study was conducted at the orthopedic department between February 2023 and July 2023. We had 68 patients who underwent total knee replacement surgery. Variables like age, gender, smoking history, ASA grade, BMI, and side of injury (unilateral or bilateral) were studied.Results: Out of 68 patients, we had 37 (54.4 %) of patients were female. The most common age group was 44- 54 years. 60.3 % of patients were non-smokers. We had 50 patients with unilateral injury and the rest were bilateral. ASA grade II (51 patients) were more than ASA grade I (17 patients). In this study, 41 patients were obese and the duration for total knee replacement was 90 - 120 minutes, in contrast to overweight patients (75 – 90 minutes) and normal patients (60-75 minutes).Conclusion:We found a significant correlation between BMI and the duration of total knee replacement surgery. The time could be doubled if the arthroplasty was bilateral.

Currently, aortic valve (AV) disease is the most common reason for heart valve surgery. The gold standard of care for people with aortic pathology is thought to be AV replacement. The issue of prosthesis selection has always been important. Although mechanical prosthesis are robust, lifelong anticoagulation medication is necessary due to the significant risk of thromboembolic consequences. Biological prostheses have a flow structure that is similar to the physiological one, and as malfunction gradually sets in, scheduled recurrent surgery can be carried out. The purpose of this study is to evaluate the short- and long-term effects of biological prosthetic aortic valve replacement (AVR) in elderly individuals. The study included 198 patients with AV pathology [85 men (42.9%)/113 women (57.1%)]. The median age was 70 [66–73] years. There were 175 (88.4%) patients with degenerative AV, 5 (2.5%) with infective endocarditis, and 30 patients (15.2%) had bicuspid AV. The median follow-up period was 26.3±1.4 months. Hospital mortality was 4.5%. No wound complications were detected. Thirty-one patients died in the long-term period. The causes of lethality were: cardiovascular disease (13 patients), malignant neoplasm (5 patients), gastrointestinal disease (2 patients), urinary system disease (1 patient), COVID-19 (1 patient), unknown cause (9 patients). Thus, the five-year postoperative survival rate was 63%, respectively. Throughout the observation period, two patients (2.9%) underwent reoperation on AV. 97.1% of patients were free of reoperation after five years. The five-year survival rate was 63% due to the history of severe concomitant pathology and mean age of the patients of 70 years.

Recent results have shown that the human malaria-resistant hemoglobin S mutation originates de novo more frequently in the gene and in the population where it is of adaptive significance, namely, in the hemoglobin subunit beta gene compared to the non-resistant but otherwise identical 20A>T mutation in the hemoglobin subunit delta gene, and in sub-Saharan Africans, who have been subject to intense malarial pressure for many generations, compared to Northern Europeans, who have not. This finding raises a fundamental challenge to the traditional notion of accidental mutation. Here we address this finding with the replacement hypothesis, according to which pre-existing genetic interactions can lead directly and mechanistically to mutations that simplify and replace them. Thus, a gradual evolutionary process under selection can hone in on interactions of importance for the currently evolving adaptations, from which large-effect mutations follow that are relevant to these adaptations. We exemplify this hypothesis using multiple types of mutation, including gene fusion mutations, gene duplication mutations, A>G mutations in RNA-edited sites and transcription-associated mutations, and place it in the broader context of a system-level view of mutation origination called Interaction-based Evolution. Potential consequences include that similarity of mutation pressures may contribute to parallel evolution in genetically related species, that the evolution of genome organization may be driven by mutational mechanisms, that transposable element movements may also be explained by replacement, and that long-term directional mutational responses to specific environmental pressures are possible. Such responses need to be further tested by future studies in natural and artificial settings.

Enzyme replacement therapy (ERT) improves the somatic manifestations in mucopolysaccharidoses (MPS))．However, because intravenously administered enzymes cannot cross the blood brain barrier (BBB), ERT is ineffective against the progressive neurodegeneration and resultant severe central nervous system (CNS) symptoms observed in patients with neuronopathic MPS. Attempts to surmount this problem have been made with intrathecal and intracerebroventricular ERT intend to achieve CNS effects, but the burdens on patients are inimical to long-term multiple administrations. However, after pabinafusp alfa, a human iduronate-2-sulfatase fused with a BBB-crossing anti-transferrin receptor antibody, showed both central and peripheral efficacy in mice model, subsequent clinical trials in a total of 62 patients with MPS-II (Hunter syndrome) in Japan and Brazil substantiated this dual efficacy and provided an acceptable safety profile. To date, pabinafusp alfa is the only approved intravenous ERT effective against both the somatic and CNS symptoms of patients with MPS-II. This article summarizes the hitherto obtained preclinical and clinical evidence associated with this drug, and discusses the preclinical, translational and clinical challenges of evaluating, ameliorating and preventing the neurodegeneration in patients with MPS-II.

The present article investigates the threshold analysis of yielding in a variable thickness rotating disk based on the Tresca criterion. The analysis is conducted on a Functionally Graded Material (FGM) constructed from tailored materials, following the theory of small deformations and for the case of plane stress. The elasticity modulus, density, and yield stress are assumed to be power functions of the radial coordinate. Poisson’s ratio is considered constant due to small variations in different materials. Additionally, the governing equation for the rotating disk is solved analytically. Besides the material type, another factor affecting the distribution of effective stress magnitudes is the cross-sectional shape (profile) of the disk. The thickness of the cross-sectional disk varies radially as a power function. In the current analysis, different conditions for the onset of yielding and the evolution of plastic flow are considered. For evaluation and validation, the obtained results are compared and validated against similar results for specific cases (homogeneous disk and constant thickness graded disk) available in previous references. The results indicate that considering variable thickness for the disk section significantly affects the stresses and the location of the initiation of yielding

Background: Transcatheter aortic valve replacement (TAVR) is a proven treatment for severe aortic stenosis (AS). Transfemoral access is the most prevalent method, achieved either surgically or percutaneously. This study compares in-hospital outcomes and length of stay between surgical cut-down and fully percutaneous approaches. Methods: This retrospective, propensity-matched study analyzed medical records of all patients who underwent transfemoral TAVR at our center from January 2019 to December 2023. Outcomes were assessed based on Valve Academic Research Consortium-2 (VARC-2) consensus criteria. Results: 251 TAVR patients (77 propensity score matching pairs) were included (55% female) with a median (IQR) age of 80 (11) years. Surgical cut-down showed fewer vascular complications, bleeding, and transfusions. No death, stroke, atrial fibrillation (AF), or need for pacemaker was reported in this group. Fewer mean hospitali-zation days were observed in the total cohort over the years (p< 0.001). This reduction was more pronounced after 2021 when the surgical approach was adopted. Mean hospitalization days were 6.40 ±6.46 for percutaneous and 4.34 ±1.61 for surgical groups (p< 0.001). Conclusions: Surgical cut-down for TAVR femoral access yields superior outcomes and shorter hospital stays compared to fully percutaneous methods.

Keywords: renal replacement therapy. Point-of-Care Ultrasound; intensive care; acute kidney injury; nephrologist.Point of care ultrasonography (POCUS) is gaining heightened significance in critical care settings as it allows for quick decision making at the bedside. While computerized to-mography is still considered the standard imaging modality for many diseases, the risks and delays associated with transferring a critically ill patient out of the Intensive Care Unit (ICU) have prompted physicians to explore alternative tools. Ultrasound guidance has increased safety of invasive procedures in the ICU, such as the placement of vascular catheters and drainage of collections. Ultrasonography is now seen as an extension of the clinical examination, providing quick answers for rapidly deteriorating patients in the ICU. The field of nephrology is increasingly acknowledging the value of diagnostic Point-of-Care Ultrasound (POCUS). By employing multi-organ POCUS, nephrologists can address specific queries arising during the diagnosis and treatment of patients with acute kidney injury. This approach aids in ruling out hydronephrosis and offering immediate information on hemodynamics, thereby consolidating patient data and facilitating the development of personalized treatment strategies.

Background Limited data are available from randomized trials comparing outcomes between transcatheter aortic valve replacement (TAVR) and surgery in patients with different risks and with follow-up >2 years. Objective In this large, population-based cohort study, long-term mortality and morbidity were investigated in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis using a surgically implanted bioprosthesis (sB-AVR) or TAVR. Methods Individual data from the Austrian Insurance funds from 2010 through 2020 were analysed. The primary outcome was all-cause mortality, assessed in the overall and propensity score–matched populations. Secondary outcomes included reoperation and cardiovascular events. Results From January 2010 through December 2020, a total of 18 882 patients underwent sB-AVR (n=11 749; 62.2%) or TAVR (n=7133; 37.8%); median follow-up was 4.0 (interquartile range 2.1–6.5) years (maximum 12.3 years). The risk of all-cause mortality was higher with TAVR compared with sB-AVR: hazard ratio (HR) 1.552, 95% confidence interval (CI) 1.469–1.640, p<0.001; propensity score–matched HR 1.510, 1.403–1.625, p<0.001. Estimated median survival was 8.8 years (95% CI 8.6–9.1) with sB-AVR vs 5 years (4.9–5.2) with TAVR. Estimated 5-year survival probability was 0.664 (0.664–0.686) with sB-AVR vs 0.409 (0.378–0.444) with TAVR overall, and 0.690 (0.674–0.707) and 0.560 (0.540–0.582), respectively, with propensity score matching. Other predictors of mortality were age, sex, previous heart failure, diabetes, and chronic kidney disease. Conclusions In >2-year follow-up, selection for TAVR was significantly associated with higher all-cause mortality compared with sB-AVR in patients ≥65 years with severe, symptomatic aortic stenosis.

We have previously demonstrated that the acute ingestion of essential amino acids may augment net protein balance in the elderly. Using a double blind, randomized controlled trial, our objective was to compare an experimental meal replacement enriched with essential amino acids (EMR) compared to a commercial meal replacement (Optifast®) provided once/day (q.d.) for four weeks on body composition and physical function in older, obese participants. Twenty-seven individuals (69±5 yrs; body mass index of 32±4 kg/m2) were randomly assigned to EMR (n=13) or Optifast® (n=15) supplementation. Measurements of body composition, skeletal muscle cross-sectional area (CSA), intrahepatic lipid and physical function were completed pre- and post-supplementation. Body mass, fat mass, and visceral fat mass were reduced with EMR but not altered with Optifast®. Thigh muscle CSA increased ( 4.1 ± 1.9 cm2, P = 0.03) with EMR but not Optifast®. There was a significant increase in the distance covered during the six-minute walk test with EMR ( 21±26 m) but no change in Optifast® ( 22±54 m). Improvements in body composition and physical function support the efficacious use of EMR-based meal replacements in the obese elderly.

Fluidic larger-scale integration (LSI) resides at the heart of comprehensive sample-to-answer automation and parallelization of assay panels for frequent and ubiquitous bioanalytical testing in decentralized the point-of-use / point-of-care settings. This paper develops a novel “digital twin” strategy with an emphasis on rotational, centrifugo-pneumatic flow control. The underlying model systematically connects retention rates of rotationally actuated valves as a key element of LSI to experimental input parameters; for the first time, the concept of band widths in frequency space as the decisive quantity characterizing operationally robustness is introduced, a set of quantitative performance metrics guiding algorithmic optimization of disc layouts is defined, and the engineering principles of advanced, logical flow control and timing are elucidated. Overall, the digital twin enables efficient design for automating multiplexed bioassay protocols on such “Lab-on-a-Disc” (LoaD) systems featuring high packing density, reliability, configurability, modularity and manufacturability to eventually minimize cost, time and risk of development and production.

Current, application-driven trends towards larger-scale integration (LSI) of microfluidic systems for comprehensive assay automation and multiplexing pose significant technological and economical challenges to developers. By virtue of their intrinsic capability for powerful sample preparation, centrifugal systems have attracted significant interest in academia and business since the early 1990s. This review models common, rotationally controlled valving schemes at the heart of such “Lab-on-a-Disc” (LoaD) platforms to predict critical spin rates and reliability of flow control mainly based on geometries, location and liquid volumes to be processed, and their experimental tolerances. In absence of larger-scale manufacturing facilities during product development, the method presented here facilitates the provision of efficient simulation tools for virtual prototyping and characterization to greatly expedite design optimization according to key performance metrics. This virtual in silico approach thus significantly accelerates, de-risks and lowers costs along the critical advancement from idea, fluidic testing, bioanalytical validation and scale-up to commercial mass manufacture.

The development of organ-on-chip and biological scaffolds is currently requiring simpler methods to microstructure biocompatible materials in three dimensions, fabricate structural and functional elements in biomaterials or modify the physicochemical properties of desired substrates. Aiming at addressing this need, a low-power CD-DVD-Blu-ray laser pickup head was mounted on a programmable three-axis micro-displacement system in order to modify the surface of polymeric materials in a local fashion. Thanks to a specially-designed method using a strongly absorbing additive coating the materials of interest, it has been possible to establish and precisely control processes useful in microtechnology for biomedical applications. The system was upgraded with blu-ray laser for additive manufacturing and ablation on a single platform. In this work, we present the application of these fabrication techniques to the development of biomimetic cellular culture platforms thanks to the simple integration of several features typically achieved with traditional, less cost-effective microtechnology methods in one step or through replica-molding. Our straightforward approach indeed enables great control of local laser microablation or polymerization for true on-demand biomimetic micropatterned designs in transparent polymers and hydrogels and is allowing integration of microfluidics, microelectronics, surface microstructuring and transfer of superficial protein micropatterns on a variety of biocompatible materials.

Identifying a panel of markers detecting kidney injury before the glomerular filtration rate (GFR) reduction is the challenge to improve the diagnosis and the management of acute kidney injury (AKI) in septic patients. This study evaluated the roles of tissue inhibitor metal proteinase, insulin growth factor binding protein (TIMP2*IGFBP7), and mid-regional pro-adrenomedullin (MR-proADM) in AKI patients. Patients and Methods: This study was prospectively conducted in the Intensive Care Unit (ICU) enrolling 230 patients who underwent cardiac surgery. Biomarkers were evaluated before and after 4 hours of the cardiac surgery. Results: Whereas urine and creatinine alterations appeared at 23.2 (12.7 – 36.5) hours, after cardiac surgery, urinary TIMP2*IGBP7 levels were higher at 4 hours in AKI patients (1.1±0.4 mg/l vs 0.08±0.02 mg/l; p < 0.001). Its concentration >2 mg/l increases the AKI risk within the following 24 hours, clearly identifying the population at high risk of renal replacement therapy (RRT). In patients with sepsis, MR-proADM levels were 2.3 nmol/l (0.7–7.8 nmol/l), with the highest values observed in septic shock [5.6 nmol/l (3.2–18 nmol/l)] and a better diagnostic profile than procalcitonin and C-reactive protein to identify septic patients. MR-proADM values >5.1 nmol/l and urine TIMP2*IGBP7 levels > 2 mg/l showed a significantly faster progression to RRT, with a mean follow-up time of 1.1 days. Conclusions: TIMP2*IGBP7 and MR-proADM precociously diagnose AKI in septic patients after cardiac surgery, giving prognostic information for RRT requirement.

Cement production requires a significant amount of energy and natural resources, severely impacting the environment due to harmful gas emissions. Coal Bottom Ash (CBA) and Coal Boiler Slag (CBS), byproducts of coal-fired power plants, have pozzolanic properties. CBA and CBS can be mechanically ground to obtain Ground Coal Bottom Ash (GCBA) or Ground Coal Bottom Slag (GCBS), which can potentially replace cement in concrete, reducing waste in landfills, benefit the economy, preserving natural resources, and reducing health hazards. This study was performed to determine the optimum amount of GCBA and GCBS that can replace cement in concrete. The fresh, mechanical, and durability properties of the concrete containing GCBA were compared to a control mix consisting of 100% Portland cement. The optimum amount of cement replaced with GCBA and GCBS was 10% and 5%, respectively, based on compressive strength. The GCBA-based concrete's tensile strength, modulus of elasticity, and durability properties were better than the control. The compressive strength of the GCBA and GCBS-based mortars increased with an increase in fineness. GCBA and GCBS fineness should be within the limit recommended in the ASTM C618 standard to enhance concrete or mortar properties.

Fabry disease is a lysosomal storage disorder caused by the deficiency of the α-galactosidase-A enzyme. Cardiac, renal, and neurological involvement significantly reduces life expectancy. Until a few years ago, treatment options for Fabry disease were limited to enzyme replacement therapy with agalsidase alfa or beta administered by intravenous infusion every 2 weeks. Migalastat (Galafold®) is an oral pharmacological chaperone that increases enzyme activity of “amenable” mutations. The safety and efficacy of migalastat were supported in the phase III FACETS and ATTRACT studies, compared to available enzyme replacement therapies; showing a reduction in left ventricular mass, and stabilization of kidney function and plasma Lyso-Gb3. Similar results were confirmed in subsequent extension publications, both in patients who started migalastat as their first treatment and in patients who were previously on enzyme replacement therapy and switched to migalastat. In this review we describe the safety and efficacy of switching from enzyme replacement therapy to migalastat in patients with Fabry disease and “amenable” mutations, referring to publications available to date.

Introduction: The effect of halogenated drugs as cardioprotectors in cardiac surgery has been evaluated in several studies. However, the possibility that there is a protective role at renal level, triggered by their use, is currently under study. Aortic valve replacement and coronary revascularization are the most frequent surgeries in cardiac surgery. Our research evaluates the effect of desflurane compared to propofol in aortic valve replacement surgery at renal level; including its administration during extracorporeal circulation. Method: Quasi-experimental prospective study performed on 60 patients, divided into 2 groups according to the drug used in intraoperative aortic valve replacement surgery. In group 1 propofol was used as a hypnotic during surgery, in group 2 desflurane was used. Differences in kidney damage measured through the urinary NGAL marker were evaluated. Other markers of renal function and myocardial damage and the need for inotropic support during the first 48 hours were also measured. Results: There were significant variations in the values ​​of urinary NGAL and creatinine regarding to basal values ​​in the propofol group, but not in the desflurane group, in which there were no differences in the hemodynamic parameters and myocardial damage. Conclusion: the use of desflurane during aortic valve replacement surgery produced better renal preservation than propofol.

All-polyamide composite coated fabric (APCCF) materials were developed and used as the material of construction of textile bioreactors as a replacement of traditional costly steel-/concreate-based bioreactors. Then, APCCF-bioreactor was used to cultivate filamentous fungus Neurospora intermedia to produce ethanol and fungal biomass. The results showed similar performance of the fungus cultivated in stain-less steel bioreactors. Techno-economical analysis for a 5000-m³ APCCF bioreactor for fermentation facility would lead to a reduction of the annual production cost of the facility by $128,000,000 compared to similar stainless-steel processes. The comparative analyses (including mechanical and morphological analyses, density measurements and techno-economical analysis) revealed that the APCCF is a better candidate for material of construction of the textile bioreactor. The APCCF is a 100% recyclable single polymer composite which was prepared from textile production line waste.

A single coronary artery is a very rare condition, commonly associated with other congenital anomalies. It could be generally classified as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches. By presenting the patient with an isolated single coronary artery, who underwent successful combined aortic valve replacement and coronary artery bypass grafting surgery, we intend to distinguish casual from causal in this extremely rare clinical and surgical scenario. This is the first-ever case published, combining such underlying pathology, clinical presentation, and surgical treatment.

Background: Chronic kidney disease and renal replacement therapy are associated with reduced physical activity, which may result in the presence of mineral-bone disorders and an increase in inflammation markers. The aim of the study was to assess the relationship between the performance of daily physical activity, expressed in the number of steps performed by patients undergoing hemodialysis and the concentration of selected biochemical parameters (SCL, IL-6). Materials and Methods: The study involved 33 patients aged 59.8 ± 9.8 years from the dialysis station at the Department of Nephrology, Transplantology and Internal Medicine PUM. Group C consisted of 30 people aged 54.9 (9.37), with GFR over 60 mL/min/1.73m. The study group was divided into S-N and N-S. Participants of the S-N group were assigned the task of performing the appropriate daily number of steps, and the N-S group was to perform spontaneous physical activity. The tasks were replaced after the third month of the research project. Physical activity was measured with pedometers. Anthropometric and biochemical parameters were assessed at baseline, after the third and sixth month of the study. Descriptive statistics, intergroup comparisons using Mann-Whitney U or Kruskal-Wallis tests and Spearman correlation analysis were performed. The level of significance was set at p≤0.005. Results: Patients from the S-N and N-S groups compared to group C performed significantly fewer steps in the 0-3 month and 4-6 month periods. In the S-N group, with an increase in steps performed in the period of 4-6 months, sclerostin levels dropped in the 6th month. In group C, the concentration of SCL and IL-6 decreased with the increase in the number of steps taken. Only in group C the waist circumference decreased with the increase of the number of steps performed. Conclusions: Patients receiving renal replacement therapy by hemodialysis showed significantly lower physical activity compared to people without kidney disease. Performing bigger number of steps can lower sclerostin levels in hemodialysis patients.

The Drosophila imaginal disc has been an excellent model for the study of developmental gene regulation. In particular, long non-coding RNAs (lncRNAs) have gained widespread attention in recent years due to their important role in gene regulation. Their specific spatiotemporal expressions further support their role in developmental processes and diseases. In this study, we explored the role of a novel lncRNA in Drosophila leg development by dissecting and dissociating w1118 third-instar larval third leg (L3) discs into single cells and single nuclei, and performing single-cell RNA-sequencing (scRNA-seq) and single-cell assays for transposase-accessible chromatin (scATAC-seq). Single-cell transcriptomics analysis of the L3 discs across three developmental timepoints revealed different cell types and identified lncRNA:CR33938 as a distal specific gene with high expression in late development. This was further validated by fluorescence in-situ hybridization (FISH). The scATAC-seq results reproduced the single-cell transcriptomics landscape and elucidated the distal cell functions at different timepoints. Furthermore, overexpression of lncRNA:CR33938 in the S2 cell line increased the expression of leg development genes, further confirming its important role in development.

Neuronal lesion or injury is a traditional approach to investigate neural circuit. Is any new neural pathway or new neurodegeneration related central nerve system injury? Spinal disc herniation can cause the spinal cord injury. However, the histological examination is still lack. It happened that a case of spinal disc herniation of a 10-year old dog was examined with NADPH diaphorase (N-d) histology. We did not find the N-d neurodegenerative aberrant in the tissue of the mid-rostral lumber segment besides the metamorphoses by the compression of the disc herniation. However, the severe neuropathological changes majorly occurred in the lumbosacral spinal cord. We found more diverse neurodegenerative alterations: the aging-related N-d body (ANB), megaloneurite and N-d homogeneous formazan globule in the lumbosacral spinal cord. We also found that a new circuit pathway (intermedial collateral pathway) showed by a megaloneurite between the lateral collateral pathway and the medial collateral pathway. The enormous notch caused by spinal disc herniation located at the mid-rostral lumber segments. The aging-related neurodegeneration occurred the specific lumbosacral segments. The homogeneous formazan globule was round or oval homogeneous N-d positivity which distributed in the gray matter and dorsal column. In the medulla oblongata, ANBs were revealed in the gracile nucleus, nucleus reticularis lateralis (ventrolateral spinal trigeminal nucleus) and middle of the spinal trigeminal nucleus.

Outcome of redo-mitral valve replacement in the small mitral annulus with the use of the chimney technology is not well documented. From 2019 to 2020, 77 consecutive patients underwent redo-mitral valve replacement with the use of the chimney technology because of a small mitral annulus. To evaluate heart structural integrity and clinical outcomes, postoperative clinical data and echocardiograms were examined. Mean age was 56.7 ± 15.98 years. All patients underwent mitral valve surgery of which 62 were mitral valve replacements, 7 mitral valve repairs, and 8 double valve replacements. Preoperative Mitral valve mean gradient was 18.07 ± 9.40 mmHg. Postoperative mitral prosthesis size 28.51 ± 1.22 mm. The median increment of mitral size enlargement was 4 (0, 6) valve sizes. Mean mitral gradient coming out of the operating room was 10.34 ± 2.12 mmHg and at follow-up echocardiogram performed at 3 years after the procedure was 10.36 ± 1.70 mmHg. One-year survival was 93.3%, while 4-year survival was 89.3% with no reoperation. Use of the chimney technology in small mitral valve re-mitral valve replacement results in larger valve sizes. Moreover, the mean gradients over the mitral valve are acceptable intraoperatively and over time.