Search Results (19,708)

Background: Frailty is a clinical syndrome prevalent among the elderly, characterised by a decline in physiological reserves and increased susceptibility to stressors, resulting in higher morbidity and mortality. Diabetes and hypertension are common in frail older individuals, often leading to polypharmacy. In this narrative review, we aimed to evaluate the relationship between frailty, diabetes, and hypertension and to identify effective management strategies and future research directions. Methods: This narrative review was conducted using the Scopus, Medline, PubMed, Cochrane Library, and Google Scholar databases. Results: Frailty significantly impacts the management and prognosis of diabetes and hypertension, which, in turn, affects the progression of frailty. Managing these conditions often involves multiple drugs to achieve strict glycaemic control and blood pressure targets, leading to polypharmacy and associated morbidities, including orthostatic hypotension, falls, fractures, hypoglycaemia, and reduced medication adherence. Identifying frailty and implementing strategies like deprescribing can mitigate the adverse effects of polypharmacy and improve outcomes and quality of life. Despite the availability of effective tools for identifying frailty, many frail individuals continue to be exposed to complex treatment regimens for diabetes and hypertension, leading to increased hospital admissions, morbidity, and mortality. Conclusions: Managing diabetes and hypertension in the frail ageing population requires a multidisciplinary approach involving hospital and community geriatricians and pharmacists. This is important due to the lack of sufficient clinical trials dedicated to diabetes and hypertension in the context of frailty. Future large population studies are needed to assess the best approaches for managing diabetes and hypertension in frail individuals. Full article

Nausea and vomiting during pregnancy (NVP), particularly its severe form, Hyperemesis gravidarum (HG), affects up to 70% of pregnancies and significantly impacts the quality of life for those with the condition as well as generates a great economic burden, with annual costs exceeding $1.7 billion in the United States. Despite the available treatments targeting neurotransmitters like serotonin and dopamine, many patients experience inadequate relief and suffer from severe side effects, including headaches and dizziness. Recent research has underscored the role of GDF15, a protein mainly produced by the placenta and linked to NVP symptoms. This protein, part of the TGF-β superfamily, has been implicated in appetite and weight regulation and is altered in those with HG due to specific genetic mutations. Addressing the challenges of delivering effective treatments, current innovations focus on targeting GDF15 to reduce symptoms while ensuring fetal safety. Promising therapeutic strategies include non-IgG immunotherapies, small peptide and molecule antagonists, and novel administration methods such as transdermal patches. These approaches aim to optimize dosage and reduce adverse effects. The effective development and testing of these treatments necessitate advanced animal models that closely resemble human pregnancy physiology, highlighting the need for further research and funding. This ongoing research holds significant potential to improve the clinical outcomes for HG patients and decrease the economic impact on healthcare systems, urging a dedicated response from the scientific and medical communities to advance these promising treatments. Full article

The speckle noise inherent in synthetic aperture radar (SAR) imaging has long posed a challenge for SAR data processing, significantly affecting image interpretation and recognition. Recently, deep learning-based SAR speckle removal algorithms have shown promising results. However, most existing algorithms rely on convolutional neural networks (CNN), which may struggle to effectively capture global image information and lead to texture loss. Besides, due to the different characteristics of optical images and synthetic aperture radar (SAR) images, the results of training with simulated SAR data may bring instability to the real-world SAR data denoising. To address these limitations, we propose an innovative approach that integrates swin transformer blocks into the prediction noise network of the denoising diffusion probabilistic model (DDPM). By harnessing DDPM’s robust generative capabilities and the Swin Transformer’s proficiency in extracting global features, our approach aims to suppress speckle while preserving image details and enhancing authenticity. Additionally, we employ a post-processing strategy known as pixel-shuffle down-sampling (PD) refinement to mitigate the adverse effects of training data and the training process, which rely on spatially uncorrelated noise, thereby improving its adaptability to real-world SAR image despeckling scenarios. We conducted experiments using both simulated SAR image datasets and real SAR image datasets, evaluating our algorithm from subjective and objective perspectives. The visual results demonstrate significant improvements in noise suppression and image detail restoration. The objective results demonstrate that our method obtains state-of-the-art performance, which outperforms the second-best method by an average peak signal-to-noise ratio (PSNR) of 0.93 dB and Structural Similarity Index (SSIM) of 0.03, affirming the effectiveness of our approach. Full article

Appropriate pharmacological management is a cornerstone of quality in palliative care (PC), focusing on comfort and quality of life. Therapeutic review is crucial in PC, aiming to optimize symptom relief, reduce adverse effects, and manage drug interactions. This study aims to delve into the real-world pharmacological prescription practices within a Community Palliative Care Support Team (CPCST) in the northern region of Portugal, comparing practices at admission and at the last consultation before death. It is an observational, cross-sectional, retrospective study without intervention involving patients admitted to a CPCST in 2021. Data were obtained from clinical records, and the statistical analysis included descriptive and inferential measures. Sixty-four patients were included, with an average age of 77.34 years, referred mainly by a specialized Hospital Palliative Care Support Team (65.63%). Polypharmacy was present, with a significant increase in opioids, antipsychotics, prokinetics, antiemetics, antispasmodics, and local corticosteroids, and a reduction in drugs for peptic ulcer and gastroesophageal reflux treatment, antithrombotics, hypolipidemics, antihypertensives, and antidiabetics, among others. The oral route was preferred, decreasing between the two analyzed moments (85.5% versus 49.1%). Pro re nata (PRN) medications increased significantly (p ≤ 0.001). The prescription profile reflects a focus on symptom relief. The deprescription of drugs for chronic comorbidities suggests adaptation to care goals. At the end of life, PRN medications increase significantly (1.34 versus 3.26, p ≤ 0.001), administered as needed to soothe fluctuating symptoms. The pharmacological classes that have significantly increased are relevant in alleviating common symptoms in PC. The use of alternative routes for medication administration increases as instability of the oral route occurs, leading to a reduction in orally administered medications. Among these alternatives, the subcutaneous route shows the largest increase. The findings underscore the importance of flexible and responsive medication strategies in end-of-life care. Full article

The present study focused on the roles of self-forgiveness and feeling divine forgiveness in mitigating the adverse effects of stress on substance use cravings in Trinidad and Tobago. We assessed 869 individuals (62 percent of whom were women) through self-report online questionnaires. A moderation analysis using the PROCESS macro and a bootstrapping strategy (N = 5000) revealed that greater levels of self-forgiveness weakened the positive relationship between stress and substance use cravings, though the relationship remained significant. This moderating effect was evident only when individuals reported high levels of feeling divine forgiveness. The findings suggest that both forms of forgiveness lessen the impact of stress on substance use cravings, highlighting their potential as protective factors and underscoring the importance of incorporating religious and spiritual dimensions into psychological education and intervention. However, the study’s cross-sectional nature makes it difficult to make causal inferences, indicating a need for longitudinal research. Full article

Background: Cervical cancer ranks third in frequency among female cancers globally and causes high mortality worldwide. Concurrent chemoradiotherapy improves the overall survival in cervical cancer patients by 6% but it can cause significant acute and late toxicities affecting patient quality of life. Whole pelvis radiotherapy doses of 10–20 Gy can lead to myelosuppression and to subsequent hematological toxicities since pelvic bones contain half of bone marrow tissue. Methods: A total of 69 patients with IB-IVB-staged cervical cancer have been included in this retrospective cohort study. We analyzed clinical adverse events and changes in blood cell counts (hemoglobin, neutrophils, leukocytes, and platelets) during radiation or chemoradiotherapy received at the Oncological Institute of Bucharest from 2018 to 2021. Results: Decreases in hemoglobin levels of over 2.30 g/dL during treatment were associated with BMI > 23.2 kg/m² (OR = 8.68, 95%CI = [1.01, 75.01]), age over 53 years (OR = 4.60 95%CI = [1.10, 19.22]), with conformational 3D irradiation (OR = 4.78, 95%CI = [1.31, 17.40]) and with total EQD2 of over 66.1 Gy (OR = 3.67, 95%CI = [1.02, 13.14]). The hemoglobin decrease rate of 0.07 g/dL/day was related to 95% isodose volume (OR = 18.00). Neutropenia is associated frequently with gastrointestinal side effects and with the bowel and rectal V45 isodoses (OR = 16.5 and OR = 18.0, respectively). Associations of total external and internal radiation dose with the time durations calculated from the initiation of treatment to the onset of hematological adverse reactions were also obtained. The maximum drop in leukocytes was observed before day 35 from the RT initiation in patients who underwent treatment with 3D conformal radiotherapy (OR = 4.44, 95%CI = [1.25, 15.82]). Neutrophil levels under 2.2 × 10³/μL and thrombocyte levels under 131 × 10³/μL during the follow-up period were associated with a total planned dose of 54 Gy to the pelvic region volume (OR = 6.82 and OR = 6.67, respectively). Conclusions: This study shows the existence of clinical and blood predictors of hematological adverse reactions in cervical cancer patients. Thus, patients who are in a precarious clinical situation, with low hematological values (but not yet abnormal), should be monitored during days 29–35 after the initiation of RT, especially if they are obese or over 53 years of age. Full article

Nutritional epigenomics is exceptionally important because it describes the complex interactions among food compounds and epigenome modifications. Phytonutrients or bioactive compounds, which are secondary metabolites of plants, can protect against osteoarthritis by suppressing the expression of inflammatory and catabolic mediators, modulating epigenetic changes in DNA methylation, and the histone or chromatin remodelling of key inflammatory genes and noncoding RNAs. The combination of natural epigenetic modulators is crucial because of their additive and synergistic effects, safety and therapeutic efficacy, and lower adverse effects than conventional pharmacology in the treatment of osteoarthritis. In this review, we have summarized the chondroprotective properties of bioactive compounds used for the management, treatment, or prevention of osteoarthritis in both human and animal studies. However, further research is needed into bioactive compounds used as epigenetic modulators in osteoarthritis, in order to determine their potential value for future clinical applications in osteoarthritic patients as well as their relation with the genomic and nutritional environment, in order to personalize food and nutrition together with disease prevention. Full article

Coaxial multirotors, characterized by overlapping rotors, represent a common solution to increasing payload capacity while maintaining a compact platform size. However, the overlap between motors generates airflow disturbances that, if not taken into account properly, may decrease the system’s overall performance. In this paper, aerodynamic interactions for coaxial multirotors are analyzed and characterized. Two rotor models are introduced, which account for the aerodynamic interaction between the upper and the lower rotor. Each model is accompanied by its corresponding mixer design and analyzed with respect to the state-of-the-art mixer solution for classical multirotor systems. The proposed approaches are tested through rotor stand experiments, simulations, and implementation on an actual coaxial platform. The results demonstrate the effectiveness of these models in mitigating the adverse aerodynamic effects, thereby improving the performance and efficiency of coaxial multirotor systems. Full article

Background and Objectives: Immune check inhibitor (ICI) colitis is one of most common and adverse side effects of ICI. However, there was no case report of ulcerative colitis (UC)-mimicking colitis after atezolizumab use in hepatocellular carcinoma (HCC) to our knowledge. Materials and Methods: We would like to introduce the case of a patient with Stage IV HCC who complained of abdominal pain, diarrhea and rectal bleeding after two cycles of atezolizumab/bevacizumab chemotherapy and was then diagnosed with UC-mimicking colitis. Results: Endoscopy revealed typical findings of UC, suggesting diagnosis of UC-mimicking colitis. The patient was treated with systemic steroids and oral mesalamine, which significantly improved his symptoms, which were also supported by endoscopic findings. The patient resumed chemotherapy with atezolizumab and bevacizumab without any interruption to the chemotherapy schedule. Conclusions: Early endoscopic evaluation is pivotal to diagnosing UC-mimicking colitis. If diagnosed, UC-based treatments such as steroids and mesalamine should be strongly considered. Given previous reports of inflammatory bowel disease (IBD) flare-ups after immunotherapy, routine lower endoscopy, performed together with upper endoscopy before atezolizumab/bevacizumab therapy, is promising to patients. Full article

Safety signal detection is an integral component of Pharmacovigilance (PhV), which is defined by the World Health Organization as “science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other possible drug related problems”. The purpose of safety signal detection is to identify new or known adverse events (AEs) resulting from the use of pharmacotherapeutic products. While post-marketing spontaneous reports from different sources are commonly utilized as a data source for detecting these signals, there are underlying challenges arising from data complexity. This paper investigates the implementation of the Apriori algorithm, a popular method in association rule mining, to identify frequently co-occurring drugs and AEs within safety data. We discuss previous applications of the Apriori algorithm for safety signal detection and conduct a detailed study of an improved method specifically tailored for this purpose. This enhanced approach refines the classical Apriori method to effectively reveal potential associations between drugs/vaccines and AEs from post-marketing safety monitoring datasets, especially when AEs are rare. Detailed comparative simulation studies across varied settings coupled with the application of the method to vaccine safety data from the Vaccine Adverse Event Reporting System (VAERS) demonstrate the efficacy of the improved approach. In conclusion, the improved Apriori algorithm is shown to be a useful screening tool for detecting rarely occurring potential safety signals from the use of drugs/vaccines using post-marketing safety data. Full article

Effective training programs are essential for safely integrating exoskeletons (EXOs) in industrial workplaces. Since the effects of wearable systems depend highly upon their proper use, lack of training of end-users may cause adverse effects on users. We reviewed articles that incorporated training and familiarization protocols to train novices on proper operation/use of EXOs. Findings showed variation in training methods that were implemented to train study participants in EXO evaluation studies. Studies also indicate that multiple (up to four) sessions may be needed for novice EXO wearers to match movement patterns of experts, and training can offer benefits in enhancing motor learning in novices. Biomechanical assessments and ergonomic evaluations can be helpful in developing EXO-specific training protocols by determining training parameters (duration/number of sessions and task difficulty). Future directions include development of personalized training approaches by assessing user behavior/performance through integration of emerging sensing technologies. Application of simulators and use of data-driven approaches for customizing training protocols to individuals, tasks, and EXO design are provided along with a comprehensive training framework. Discussed elements in this article can be helpful to exoskeleton researchers in familiarizing novice users to EXOs prior to evaluation, and to practitioners in developing protocols for training workforce. Full article

Existing literature thoroughly reviews the detrimental consequences that adverse childhood experiences (ACEs) have physically, emotionally, neurobiologically, and financially. It is imperative to develop effective treatments that offer a sense of hope to children who have been impacted. The established relationship between high ACE scores and physiological hyperarousal due to emotional dysregulation is clear in the literature. This relationship indicates that taking psychophysiological measures may be an effective method of gauging the effectiveness of trauma treatments. This study measured the heart rate of a child who had experienced multiple ACEs, during 16 child-centered play therapy (CCPT) sessions, using the Empatica (E4) wristband. Bayesian change point analysis was conducted and multiple changes in the heart rate mean were detected and identified within each session’s time series. Additionally, changes in heart rate variability during the 16 sessions were observed and points of interest, e.g., highest and lowest observed heart rates, were noted. Results suggested the number of breakpoints in the heart rate means within each session, as well as the location, i.e., the time of each breakpoint, so that each significantly detectable change in heart rate mean as well as sessions of noted differences in heart rate variability were discussed alongside what was occurring within the video recorded sessions. Full article

The study conducted in Morocco focused on addressing the challenges posed by canine parvovirus (CPV-2) through comprehensive research, vaccine development, and efficacy assessment. Through real-time PCR screening and genotyping, CPV-2 variants were identified circulating in the region. An inactivated vaccine, derived from a CPV-2 strain isolated from a symptomatic dog, was produced and evaluated for safety and efficacy. The vaccine, from the strain named “CaPV M/3-2022”, demonstrated safety in vaccinated puppies, with no adverse reactions observed during the trial period. Efficacy trials showed that vaccinated puppies remained healthy and exhibited lower viral excretion post-challenge compared to unvaccinated controls. These results indicate that the vaccine effectively protects against illness related to CPV-2 and reduces viral shedding. The study provides valuable insights into CPV-2 epidemiology in Morocco, offers a promising vaccine solution, and underscores the importance of vaccination in controlling CPV-2 outbreaks and protecting canine health. Full article

Background: Kratom is a substance that alters one’s mental state and is used for pain relief, mood enhancement, and opioid withdrawal, despite potential health risks. In this study, we aim to analyze the social media discourse about kratom to provide more insights about kratom’s benefits and adverse effects. Also, we aim to demonstrate how algorithmic machine learning approaches, qualitative methods, and data visualization techniques can complement each other to discern diverse reactions to kratom’s effects, thereby complementing traditional quantitative and qualitative methods. Methods: Social media data were analyzed using the latent Dirichlet allocation (LDA) algorithm, PyLDAVis, and t-distributed stochastic neighbor embedding (t-SNE) technique to identify kratom’s benefits and adverse effects. Results: The analysis showed that kratom aids in addiction recovery and managing opiate withdrawal, alleviates anxiety, depression, and chronic pain, enhances mood, energy, and overall mental well-being, and improves quality of life. Conversely, it may induce nausea, upset stomach, and constipation, elevate heart risks, affect respiratory function, and threaten liver health. Additional reported side effects include brain damage, weight loss, seizures, dry mouth, itchiness, and impacts on sexual function. Conclusion: This combined approach underscores its effectiveness in providing a comprehensive understanding of diverse reactions to kratom, complementing traditional research methodologies used to study kratom. Full article

Populus spp. is an economically valuable tree worldwide, known for its adaptability, fast growth, and versatile wood, often cultivated in short-rotation plantations. Effective propagation is crucial for rapid genetic improvement and global demand for forest products and biomass energy. This study focused on the rooting and growth of poplar cuttings, examining shoot collection timing and growth stimulant treatments across four hybrids: Populus deltoides × P. nigra (Agathe F), P. maximowiczii × P. trichocarpa (Arges), P. deltoides × P. trichocarpa (Donk), and an interspecific hybrid Populus × canadensis (F-448). The experiment used hybrid poplar cuttings collected in spring 2022 and 2023, planted in controlled climates with a randomized block design. Cuttings were soaked for 24 h in growth stimulants, namely indole-3-butyric acid, cinnamic acid, and indole-3-acetic acid. After 12 weeks, rooting percentage and seedling height were assessed. The study found that the optimal time for collecting poplar cuttings for best rooting is late winter to early spring, specifically from March to early April, with shoots collected after early April showing the lowest rooting potential. The growth stimulants significantly influenced the growth of poplar seedlings. There was a tendency for lower concentrations to increase root formation and seedling height, while higher concentrations had adverse effects. Despite variations in growth rates, a consistent growth pattern was observed across different shoot collection dates for all genomic groups. Full article