Volunteering has many social, emotional and health benefits and could be an option for people with younger/early onset dementia to engage in stage/age-appropriate, personally meaningful activity within their local community. Audio data of people with young onset dementia discussing their volunteering experiences were taken from the Dementia Diaries and co-analysed. This study explored how people with dementia volunteer in the UK, the benefits and barriers, and how we can improve access to volunteering opportunities. The findings suggest that stigma is the overarching concept (or net) which influences people’s experiences of volunteering with dementia. Within the stigma net, three themes were developed that employed a lifespan approach to challenging said stigma: 1) Valuing the past, 2) Valuing the present and 3) Valuing the future, each with additional subthemes. This research contributes to the limited pool of literature that highlights the clear benefits of volunteering for people with young onset dementia, while also considering how dementia stigma can create practical and institutional barriers to accessing volunteering. Guidance is provided for how to deliver meaningful and accessible volunteering opportunities.

Percutaneous aortic valve replacement (TAVI) has become the treatment of choice for elderly patients with severe aortic valve stenosis because of its less invasiveness compared to surgery. However, it introduces new complications, such as vascular lesions, access site problems, paravalvular leaks, and aortic dissection. Aortic dissection after TAVI is rare but serious, occurring in 0.2% to 0.3% of cases, with both intraprocedural and late cases reported. This case study concerns a 68-year-old woman who developed Stanford B aortic dissection, external iliac artery dissection, and right common femoral artery occlusion after TAVI. Treatment included stenting of the iliac and common femoral arteries, followed by a staged procedure: debranching, thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR), with satisfactory results. This case, underscores the importance of vigilance in the management of TAVI-related complications to optimize patient care and outcomes.

Objectives: Robotic bilateral axillary breast approach (BABA) thyroid surgery began in 2008 and is now one of the most widely used remote-access thyroid surgeries worldwide. This study aimed to analyze the results of 500 robotic BABA thyroid surgeries performed in a single institution in Korea compared with open thyroid surgery. Methods: From December 2018 to March 2020, 502 robotic BABA thyroidectomies (RTs) and 531 conventional open thyroidectomies (OTs) were performed in our institution by a single endocrine surgeon. We retrospectively reviewed patient medical records and performed a comparative analysis of OT and RT. Results: The RT group was younger (43.41±11.41 versus 54.28±13.41 years, p<0.001) and had a higher proportion of females (84.3% versus 69.3%, p<0.001), a lower BMI (24.66±3.97 versus 25.83±4.07 kg/m2), a higher proportion of lobectomies (52.6% versus 45.2%) and a lower proportion of lateral neck dissections (3.4% versus 10.0%, p<0.001). The RT group had a lnger operation time (145.33±40.80 versus 93.39±43.55 minutes, p<0.001) and higher surgical cost. Although the OT group had a larger tumor size and higher proportion of extrathyroidal extension, the numbers of retrieved lymph nodes were not significantly different between the two groups. Additionally, there was no difference in the stimulated thyroglobulin level before radioactive iodine therapy (7.01±35.73 versus 8.39±58.77, p=0.782). The rates of transient vocal cord palsy and transient hypoparathyroidism were significantly lower in the RT group, and those of scar-related complications were higher in the OT group. Conclusion: Robotic BABA thyroid surgery has advantages not only in better cosmetic outcomes but also in lower rates of vocal cord palsy and hypoparathyroidism, with comparable lymph node retrieval and serum thyroglobulin levels.

The accurate classification of landfill waste diversion plays a critical role in efficient waste management practices. Traditional approaches, such as visual inspection, weighing and volume measurement, and manual sorting, have been widely used but suffer from subjectivity, scalability, and labour requirements. In contrast, machine learning approaches, particularly Convolutional Neural Networks (CNN), have emerged as powerful deep learning models for waste detection and classification. This paper analyses VGG-16, InceptionResNetV2, DenseNet121, Inception V3, and MobileNetV2 models to classify real-life waste when trained on pristine and unadulterated materials, versus samples collected at a landfill site. When training on DiversionNet, the unadulterated material dataset with labels required for landfill modelling, classification accuracy was limited to 49.69% in the real environment. Using real-world samples in the newly formed RealWaste dataset showed that practical applications for deep learning in waste classification is possible, with Inception V3 reaching 89.19% classification accuracy on the full spectrum of labels required for accurate modelling.

Background/Objectives: Peritoneal dialysis as a form of renal function sub-stitution is not as widespread as hemodialysis. However, it has recognized advantages such as preservation of the residual renal func-tion, no need for vascular access , can be performed at home, but requires a proper in-sertion of a peritoneal dialysis (PD) catheter and maintaining its patency. Methods: We presented a 10-year retrospective study on a group of 133 patients hos-pitalized for peritoneal dialysis catheter insertion/replacement. We routinely implant the catheter laparoscopically, but there were cases in which the insertion was performed open route. We analyzed the patient group by age and gender criteria, number of complications and time when they appeared, duration of surgical intervention and the surgical technique used (126 were performed laparoscopically and 7 were inserted via open route). The open technique was performed mainly in patients with contraindications of general anesthesia. Results: We encountered a number of 23 complications in 18 patients, in only 1 case the patient was switched to permanent hemodialysis (at his own wish). We highlighted in the study the indisputable advantages of laparoscopy, supported by the results obtained: correct placement of the catheter, the possibility of adhesiolysis, preservation of the peritoneal surface through minor op-erative trauma, low number of complications(bleeding, migration, hernia 0,8%, leakage 4%, lower than those found in the literature). Even if infection was the most frequent complication (peritonitis 35%, catheter exit site infection 30.4%), only 1 case appered in the pretraining period. All complications were managed by medical treatment or by temporary cessation of peritoneal lavage, except of two cases that required reimplantation of the catheter. Conclusions: Laparoscopic catheter insertion for PD is a safe method, with reduced post-procedural complications, thus ensuring a long duration of the functionality of the catheter.

Background: The validation of laser usage during laparoscopic procedures, notably by Camran Nezhat in the late 1980s, has been significant. Lasers offer precision and depth control in tissue vaporization without bleeding. Surgical intervention remains central in managing endometrio-sis-associated pain and infertility, especially for patients unresponsive to hormonal therapy. Methods: This retrospective cohort study included 200 patients with SPE who underwent laparo-scopic laser vaporization. Surgery was performed using a CO2 laser, and histological confirma-tion of endometriosis was obtained for all cases. Pain scores and SF-36 questionnaire domains were assessed preoperatively and postoperatively. Fertility outcomes were evaluated among pa-tients desiring pregnancy. Results: Significant improvements in pain score and SF-36 questionnaire domains were ob-served postoperatively (p-value

We previously reported our initial experience of subxiphoid single-port robotic-assisted thoracic surgery (SRATS) thymectomy using the single-port robotic surgical system (SPS). However, the potential benefits of this technique remain unknown. Thus, this study examined the multi-institutional experience of SRATS thymectomy and compared perioperative outcomes of this technique with those of subxiphoid single-port video-assisted thoracic surgery (SVATS) thymectomy. Data of patients who underwent subxiphoid SRATS and SVATS thymectomy performed by three thoracic surgeons at three institutions between September 2018 and May 2024 were retrospectively collected. In total, 110 patients were included, with 85 and 25 undergoing SRATS and SVATS thymectomy, respectively. No significant differences were noted in the total operative time (154.46±74.06 vs. 146.76±67.07 min, P=0.674) and conversion rate to median sternotomy (0% vs. 4 %, P=0.227) between the two groups. The SRATS group was associated with a lower conversion rate to multi-port surgery (2% vs. 20%, P=0.006), shorter chest tube drainage duration (1.40±0.94 vs. 2.00±1.29 days, P=0.001), and shorter postoperative hospital stay (2.87±1.26 vs. 5.08±5.20 days, P=0.007). Subxiphoid SRATS thymectomy using the SPS is feasible and can be a good alternative to conventional minimally invasive thymectomy. Further large-scale randomized controlled studies are needed to confirm its benefits.

Background: Infantile hemangiomas (IHs) are the most common benign vascular tumors of infancy. Methods: We report our experience of 248 patients with head and neck IHs. Results: The median age on admission was 4 months, and female/male ratio was 2.17. Among the cases, 45% were followed without treatment. No local complications were observed in any of these patients. Propranolol was given to all patients who received medical treatment. The median duration of treatment was 12 months (1-30 months), and the median follow-up period of all patients was 14 months (0-118 months). The treatment response was 98%. Complication rate was 17% and children aged between 3 and 9 months accounted for 60% of patients who developed complications. Most of the complications were local complications such as bleeding, ulcer, and infection. Conclusion: Although most of them regress spontaneously, complications may occur. Propranolol alone is an effective treatment option, and early treatment initiation increases success rates.

Abdominal injuries in children caused by guns are a rare clinical entity globally. But, in countries with undefined legal regulations and in the war zones urban violence is a great social problem among older children and adolescents. This manuscript provides details regarding two cases of severe gunshot injuries in young children. The injuries were very complicated and included damage to the parenchymatous and hollow organs as well as major blood vessels. The clinical presentation on admission was very serious and dramatic, but the patients survived. However, one patient developed numerous complications that required repeated surgical interventions and long treatment. The article provides a detailed description of injuries and how to treat them. Patient care requires a multidisciplinary approach, and the initial decision on further treatment depends on the patient's hemodynamic stability.

Evaluation of biliary strictures remains a challenge due to the low sensitivity of standard diagnostic work up, but the introduction of direct single-operator cholangioscopy (DSOC) changed this paradigm. Aim of our study was to evaluate diagnostic performance of DSOC and DSOC-targeted biopsies, intraductal ultrasound (IDUS) and brush cytology in patients with indeterminate biliary stricture (IBS). We evaluated patients who underwent advanced diagnostic work up for IBS in our endoscopy unit from ‘01/2018 to ‘12/2022; all patients had at least one previous attempt to characterize the biliary stricture. Final diagnosis was based on surgical pathology and/or clinical and radiological follow-up of at least 12 months. A total of 57 patients with a mean age of 67.2 ± 10.0 years were included, with a mean follow up of 18.2 ± 18.1 months. IBS were mostly located in the distal common bile duct (45.6%) and final diagnosis was consistent with malignancy in 35 patients (61.4%). DSOC and IDUS showed a significantly higher accuracy (89.5% and 82.7% respectively) compared to standard cytology (61.5%, p <0.05). In our experience, DSOC visualization and IDUS both demonstrated an optimal diagnostic yield in the differentiation of IBS, with an acceptable safety profile both quantitatively and qualitatively.

Background DaVinci Single-Port (SP) robotic surgery offers several benefits compared to traditional multiport laparoscopic or robotic surgeries. One of the main advantages is that it allows for a minimally invasive approach, resulting in a single, smaller incision and reduced trauma to the patient’s body leading to less postoperative pain, faster recovery, and reduced risk of complications. The cosmesis of a single port with minimal visible scarring is also an attractive aspect to the patients; however, many surgeons use an additional port for energy device, stapler use, and drain insertion. Pure single port surgery with one incision is still rare. Here we share our experience of first 10 cases using SP robotic platform in colorectal surgery. Methods From May 2023 to December 2023, colorectal patients who underwent SP-robotic surgery were analyzed. Placement of the incision was umbilicus for 8 patients, and right lower quadrant for 2 patients through which ileostomy maturation was performed. Data including perioperative parameters and postoperative outcomes were analyzed with a median follow-up of 4.6months (range 0.6-7.4months). Results A total number of 10 colorectal patients underwent DaVinci Single-Port robotic colorectal surgery at our institution during this period. Demographics of the patients showed 4 males (40%) and 6 females (60%) with a median age of 63.5years (range 50-75years). Median body mass index (BMI) was 22.89kg/m2 (range 19.92-26.84kg/m2), and 9 patients were diagnosed with colorectal cancer and 1 patient was diagnosed with rectal gastrointestinal tumor. One patient underwent anterior resection and cholecystectomy simultaneously. Mean operation time was 222min (range 142-316min), and mean wound size was 3.25cm (range 2.5-4.5cm). Nine patients underwent surgery with single incision through which single port trocar was inserted, and one patient had one additional port for drain insertion. Mean hospital stay was 6 days (range 4-8 days) with 1 postoperative complication of bleeding requiring transfusion, but there was no re-admission within 30 days. Conclusion Overall, our experience with single-port robotic colorectal surgery has been promising. With only one patient with additional port for drain insertion, all nine patients underwent SP-robotic surgery with single incision for colon as well as rectal surgeries. Compared to an average postoperative length of stay of 6.5-8 days in laparoscopic colorectal surgeries reported in literature, SP-robotic surgery showed faster recovery of 6 days highlighting its benefits in patient recovery and satisfaction.

Background: Infective endocarditis (IE) remains a difficult disease to diagnose and treat, with a persistently high mortality rate. There is a lack of recent data on IE in Bulgaria over the last decades. Methods: The study is retrospective, single centered, includes 270 patients diagnosed with IE, for the period 2005 - 2021. We compared the two periods 2005-2015 (n=119) and 2016-2021 (n=151) to find the characteristics changes. Results: The median age was 65 (23) years and 65.5% (177) were male. In the second period, there is a significant increase in age from 62 (29) to 67 (22), (p=0.023); Charlson comorbidities index (CCI) from 3 (3) to 4 (4), (p=0.000); cases with chronic kidney diseases (CKD) from 12.6% (15) to 36.9% (55), (p=0.001); coronary arterial diseases (CAD) from16.85% (20) to 29.1% (44), (p=0.018); atrial fibrillation (AF) from 10.9% (13) to 23.8% (36), (p=0.006). Injection fraction decreased significantly in the second period from 63 (14) to 59 (15), (p=0.000). Almost half of the patients 45.6% (123) had no known predisposing cardiac condition and 46.3 (125) had an unknown port of entry. IE was community-acquired in 173 (64.1%), healthcare-associated in 26.7% (72), and injection drug use related IE in 9.3% (25).The study population included 67.8% (183) native valve IE, 31.5% (85) prosthetic IE, and 0.74% (2) intracardiac device­related IE. The hemoculture were positive in 59.6%, and the most frequent pathogenic agent was Staphylococcus - 33.3 % ( aureus – 16.5 % and coagulase negative - 16.8 %). Only 20% of patients underwent early surgery. The all­cause 30 days mortality rate was 24.8%. There is no significant difference between the two periods in terms of the characteristics listed above. Conclusion: The profile of IE in Bulgaria has changed with increasing age and comorbidity, changing predisposing cardiac conditions and entry door. The most common pathogen was the Staphylococcus group. The 30 day mortality rate remains high.

In the digital age, Artificial Intelligence (AI) is emerging as a transformative force in various sectors, in-cluding medicine. This article explores the potential of AI, akin to the magical genie of Aladdin's lamp, particularly within thoracic surgery and lung cancer management. It examines AI applications like ma-chine learning and deep learning in achieving more precise diagnoses, preoperative risk assessment, and improved surgical outcomes. The challenges and advancements in AI integration, especially in computer vision and multi-modal models, are discussed alongside their impact on robotic surgery and operating room management. Despite its transformative potential, implementing AI in medicine faces challenges regarding data scarcity, interpretability issues, and ethical concerns. Collaboration between AI and medi-cal communities is essential to address these challenges and unlock the full potential of AI in revolution-izing clinical practice. This article underscores the importance of further research and interdisciplinary collaboration to ensure the safe and effective deployment of AI in real-world clinical settings.

Aim: To analyze a single center's experience with Short Bowel Syndrome/ Chronic Intestinal Failure (SBS/CIF) in adult patients treated with Home Parenteral Nutrition (HPN). Materials and methods: In the last thirty years, 13 patients with SBS/CIF were included in an HPN program. Results: Between 1992 and 2023, 13 patients were included in an HPN program. The primary underlying pathology was acute mesenteric ischemia. The median age of the starting HPN was 44 years old. Most are submitted to several surgeries of extensive intestinal resection with posterior intestinal reconstruction. Five of the 13 patients have died while on HPN for a median of 42 months. The causes of death HPN-related were catheter sepsis, endocarditis with cardiac failure, or hepatic failure. One patient died due to underlying pathology: pelvic abscesses and bleeding related to radiotherapy. Eight patients remain alive with a median time of HPN of 173 months. During the HPN support, the most frequent complications were venous catheter infection and venous territory thrombosis. None of the eight patients alive have hepatic failure. Two patients recently started teduglutide, with good tolerance, and need reduction of HPN support. All these eight patients have a satisfactory quality of life (parenteral support needs range between five to two nutrition bags per week). Conclusion: HPN remains the gold standard of SBS/CIF treatment, although Teduglutide may reduce HPN needs and HPN complications and provide a better quality of life. An HPN multidisciplinary healthcare group support is essential to ensure these patients' survival and quality of life. Keywords Short bowel Syndrome, Chronic Intestinal failure, Home Parenteral Nutrition, Teduglutide, Complications of Parenteral Support.

Purpose: To meet the challenges of the precision medicine era, quality assessment of shared sarcoma care becomes pivotal. The MDT approach is the most important parameter for succesfull outcome. Because of all MDTs disciplines surgery is the key step to render sarcoma patients disease free, defining the spectrum of a sarcoma surgeon is critical. To the best of the authors knowledge, a comprehensive interoperable digital platform to assess the scope of sarcoma surgery and the experience of a sarcoma surgeon in its full complexity is lacking. Methods: A web-based real-world data (RWD) registry on sarcoma surgery has been created to assess the clinical exposure, tumor characteristics, and surgical settings and techniques applied for both resections and reconstructions of sarcomas and thereby the surgical exposure of an individual surgeon over time. Results: During 10 years, there were 723 sarcoma board/MDT meetings discussing 3130 patients. A total of 1094 patients underwent 1250 surgical interventions on mesenchymal tumors by one single sarcoma surgeon. These included 615 deep soft tissue tumors (197 benign, 102 intermediate, 281 malignant, 27 simulator, 7 metastasis, 1 blood), 116 superficial soft tissue tumors (45 benign, 12 intermediate, 40 malignant, 18 simulator, 1 blood) and 519 bone tumors (129 benign, 112 intermediate, 182 malignant, 18 simulator, 46 metastasis, 14 blood and 18 sequelae of 1st treatment). Detailed types of resections and reconstructions were analyzed. Conclusion: A web-based RWD sarcoma surgeon registry with transparent real-time descriptive analytics is feasible and enables large scale definition of the surgical complexity and ultimately quality of sarcoma care.

Background: The incidence of spinal metastatic disease has risen with improved cancer survivorship. Separation surgery, the current standard surgical treatment, does not fully address spinal deformity. Advances in operative management warrant reevaluating maximal tumor resection and anterior column reconstruction with corpectomy. Methods: An IRB-approved retrospective single-center review of 63 patients was performed. Demographics, tumor characteristics, clinical and radiographic data, treatments, and neurological and survival outcomes were analyzed. Results: The mean age at presentation was 63.5 ± 9.6 years (range, 37-84 years) and 28 patients (44.4%) were female. Functional outcomes, measured by KPS, RAND-36 survey scores and Oswestry Disability Index all improved postoperatively (pre- vs postop: 70 to 80 (p=0.0056), 26.5 to 46.4 (p=0.0081), and 28.9 to 16.9 (p=0.0613), respectively). Spinal alignment also improved, with Cobb angle measurements showing a reduction in spinal kyphosis from -5 to 0 (p=0.021). Nine patients (14.5%) had non-fatal postoperative complications. The median OS for this cohort was 14.4 months (range, 0.6-145.0 months) with median follow-up time of 15.5 months. Conclusion: In oligometastatic spinal disease patients with good functional status, corpectomy for decompression of neural elements, deformity correction, and spinal stabilization is associated with improvements in pain and functional outcomes without overwhelming morbidity.

Bowel intussusception is a rare cause of acute or subacute abdomen in adults. The frequency, etiology, symptoms, diagnosis and treatment of the disease differ significantly in comparison to the pediatric population. In adult patients, the cause of the intussusception in the majority of the cases is an underlying intestinal tumor (benign or malign), leading in a complete or incomplete mechanical ileus with corresponding symptoms. Diagnosis via imaging modalities may be challenging and is sometimes set only after exploratory laparotomy. Surgical treatment in adult patients is most of the times mandatory, because it aims not only to reverse the intussusception but also to treat the underlying cause of the disease. We present 4 cases of adult intussusception that were treated surgically and discuss the crucial points in the management of this disease through a review of the literature.

Rhabdomyolysis is a serious clinical condition, which if left untreated can lead to kidney failure and in extreme cases, to death. It has also been reported in association with SARS COV2 infection and can be its initial presentation. COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), which has many variants that change the characteristics of the disease affecting, among other things, the method of transmission or treatment. Some investigators have implicated excessive immune response in the causes of muscle damage during SARS-CoV-2 infection. Others point to direct damage caused by the virus or involving immune factors. In this study we described cases of COVID-19 infection from 1 June 2022 to 15 July 2022 with elevated muscle enzymes in the blood and hospitalized to the first division of Cotugno hospital in Campania. Of 39 patients with SARS-CoV-2 infection, 15 patients presented also rhabdomyolysis. The most common symptoms were: asthenia, fever, arthomyalgia, lipothymia and syncope. No patient had myocardial infarction and 2 patients had atrial fibrillation. All patients were affected by omicron SARS-CoV-2 variants. Of these patients: 4 patients died (2 due to rhabdomyolysis and 2 due to sepsis) and only one patient presented acute kidney injury.

Purpose The COVID-19 pandemic, triggered by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in over 160 million infections and 3.5 million fatalities worldwide. Evidence of SARS-CoV-2 presence in the highly vascularized penile tissue and the established correlation between COVID-19 and subsequent erectile dysfunction (ED) has emerged. Robot-assisted radical prostatectomy (RARP) is a popular procedure for prostate cancer because of its reliability and swift recovery rate. However, the ED prevalence post-surgery is believed to be comparable to open surgery, and postoperative ED significantly affects the patient's quality of life. Our study aimed to explore the effect of COVID-19 on ED recovery in patients undergoing bilateral nerve preservation during RARP. Materials and Methods We conducted a retrospective study on 85 patients who underwent bilateral nerve-sparing RARP (nsRARP) at our institution between December 2017 and May 2021. Chart reviews and the International Index of Erectile Function-5 (IIEF-5) questionnaire facilitated the analysis. Our objective was to contrast ED recovery after surgery between SARS-CoV-2–infected and non-infected patients using preoperative IIEF-5 scores and scores at 6, 12, and 24 months post-surgery. We defined successful ED recovery as an IIEF-5 score of 17 or higher and successful sexual intercourse. We also compared ED recovery rates between the two groups, regardless of the timing of COVID-19 diagnosis. IBM's SPSS version 18.0 assisted in the statistical analysis, with Fisher's exact test and chi-square test used for comparing categorical variables. Independent t-tests determined mean differences between baseline and postoperative IIEF-5 scores. A p-value less than 0.05 was considered statistically significant. Results From December 2017 to May 2021, our institution executed 213 RARP cases, with 185 of these involving nerve preservation. Among these patients, 133 had an IIEF-5 score of 17 or higher during preoperative EF assessment. We included 85 patients with consistent IIEF-5 records before surgery and at 6, 12, and 24 months post-surgery in this study. Of these, 44 and 41 patients comprised the COVID-19–positive and COVID-19–negative groups, respectively. The COVID-19–positive group had a higher proportion of diabetes mellitus (DM) patients (24 (54.55%) vs. 7 (17.07%), p<0.001). There was no significant difference in preoperative IIEF-5 scores or scores up to 6 months after surgery between the two groups. However, the IIEF-5 scores of the COVID-19–positive group were statistically lower after 12 and 24 months post-surgery. Additionally, the COVID-19–negative group showed a more considerable score increase between 6 and 12 months post-surgery, and the EF recovery rate was lower in the COVID-19–positive group starting from the 12th month after surgery. Within the COVID-19–positive group, no statistically significant difference in IIEF-5 scores was found between single infection and multiple reinfection groups. Conclusions Principal component analysis revealed the impact of COVID-19 on ED recovery in patients who underwent nsRARP. The most substantial changes in IIEF-5 scores occurred between 6 and 12 months. From 12 months onwards, the COVID-19–positive group had significantly lower scores, and fewer patients had IIEF-5 scores above 17. However, the number of COVID-19 diagnoses did not significantly affect the IIEF-5 scores.

(1) Background: Usually, the majority of patients suffering from vertigo and dizziness can be identified in four major categories: acute spontaneous vertigo, episodic (recurrent) vertigo, recurrent positional vertigo, chronic imbalance. Our purpose is to retrospectively evaluate the main causes of episodic vertigo and to find indications for a reliable clinical suspicion useful for a definitive diagnosis, comparing patients affected by different presenting symptomatology (acute vertigo, recurrent episodic vertigo, and imbalance) (2) Methods: we retrospectively evaluated the clinical records in a population of 249 consecutive patients observed for vertigo in our tertiary referral center in the period 1 January 2019 – 31 January 2020. On the basis of the reported clinical history, patients were divided into three groups: patients with first ever attack of vertigo, patients with recurrent vertigo and dizziness; patients with chronic imbalance. (3) Results: On the basis of the results of the instrumental examination, we arbitrary divided (for each type of symptoms) the patients in a group with a normal vestibular instrumental examination and a group of patients in which the clinical-instrumental evaluation showed some pathological results; a highly significant difference (p: 0.157) was found between recurrent and acute vertigo and between recurrent vertigo and imbalance. (4) Conclusions: patients with recurrent vertigo more frequently exhibit a negative otoneurological examination since they are often examined in the intercritical phase. A precise and in-depth research of the patient's clinical history is the key to suspect or make a diagnosis together with the search for some instrumental or clinical hallmark, especially in cases where the clinical picture does not fully meet the international diagnostic criteria.

Background and Aims: Of all primary liver tumors, primary hepatic angiosarcoma (PHA) is a rare and aggressive malignant vascular tumor. The standard therapeutic care for hepatic angiosarcoma remains unclear. This study compared the survival outcomes of aggressive treatment (resection and liver transplant) and nonaggressive treatment (chemotherapy, transarterial chemoembolization [TACE], and conservative treatments) for patients with PHA and analyzed the prognostic factors influencing survival. Materials and Methods: Data of patients diagnosed as having PHA at our facility were retrospectively reviewed. The primary outcome was survival time. The secondary outcome was calculated baseline characteristics. Results: We included a total of 19 patients, who were divided into 2 treatment groups: aggressive (8 patients had undergone resection or transplants) and nonaggressive (11 patients had undergone TACE, chemotherapy, or conservative treatment). The mean survival time was 233.1 ± 189.7 days in the aggressive treatment group and 146.5 ± 115.8 days in the nonaggressive treatment group. A Kaplan-Meier plot revealed no significant difference in survival time between the 2 treatment groups (P = .3256). Conclusions: The survival time of patients receiving aggressive treatment was longer than that of those receiving nonaggressive treatment. The long term survival time in some selective cases of aggressive treatment will be achieved. Thought a difference was not significant between the groups. Because the number of patients was limited, more cases are required to confirm these findings.

Single-Anastomosis Duodeno-Ileal bypass with Sleeve Gastrectomy (SADI-S) is a modification of the duodenal switch in which only one anastomosis is performed, with a longer common limb and an expected less malabsorptive effect. The present study analyzes presentation and treatment of malnutrition after SADI-S. 258 consecutive patients undergoing SADI-S between May 2007 and September 2017 were included. The common limb length was 200 cm in 50 cases, 250 cm in 156 and 300 in 52. 30 patients were admitted for severe hypoalbuminemia and 16 patients were submitted to revisional surgery and constitute the series of our study. Mean weight before reoperation was 57 kg and mean body mass index (BMI) was 21 kg/m2. Mean number of daily bowel movements was 5,6. Mean time to reoperation was 56 months. Revisional surgery consisted mainly in elongation of the common limb. Mean weight regain was 14 kg and mean final BMI was 26 kg/m2. Daily bowel movements were decreased to 1,3. Factors related to hypoalbuminemia were hypertension, poor controlled diabetes, age over 55 years and a shorter common limb. Although SADI-S is expected to be less malabsorptive than previous biliopancreatic diversions, caution has to be taken with selected patients to avoid postoperative malnutrition.

Background: To analyze long-term outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). Methods: All consecutive 97 patients undergoing TEVAR between September 2014 and September 2022 were included in the study. Primary outcome was long-term incidence of overall death and major adverse cardiovascular and cerebrovascular events (MACCE). Results: Mean age was 70.4 years, and 22(23.2%) had cerebrovascular disease (CBVD). A total of 49(51.6%) of patients had prior cardiac surgery intervention and 8(8.5%) had prior aortic valve replacement. Twenty-eight patients(28.8%) presented with aortic dissection, 60(61.8%) had aortic aneurysm, 4(4.1%) had intramural hematoma, and 5(5.1%) had other presentations. An emergent procedure was performed in 6(6.2%) patients, an urgent procedure in 37(38.1%) patients and 54(55.7%) patients had an elective procedure. Intraoperatively, 78.3% had percutaneous TEVAR, 5.1% had ministernotomy TEVAR, while 10.3% had concomitant full sternotomy TEVAR repair. Hospital mortality was 7 patients(7.2%). At 8-years follow-up, 76% were alive, 25.8% had MACCE, 21.6% were diagnosed with endoleaks(13 patients type II and 2 patients type 1) while 10.3% un-derwent repeat intervention. Conclusions: This single center experience in patients undergoing TEVAR evidenced good short and long-term survival and MACCE. Nonetheless, almost half of the patients underwent an ur-gent/emergent procedure, clinical results were favourable for TEVAR.

Objectives: Chylothorax is a relatively rare condition of lymphatic fluid accumulation in the thoracic cavity due to a leakage from the thoracic duct or its tributaries. Patients present with dyspnea, malnutrition, and immunosuppression. Treatment can be conservative or surgical, depending on etiology and clinical course. The optimal management algorithm for chylothorax is still controversial. Methods: This is a retrospective study of all patients with chylothorax treated at our Department of Thoracic Surgery during the 10-year period. Results: A total of 14 patients were identified for the study. Nine patients had chylothorax after lung or esophageal cancer surgery. Four patients had chylothorax in advanced lymphoma. One patient had chylothorax after blunt chest trauma. A conservative approach was initiated in most patients (92%), including pleural drainage, nil per mouth, total parenteral nutrition, and somatostatin 0.1 mg bid subcutaneously. Surgical treatment was indicated in patients with thoracic drain production >800 mL per day beyond the fifth day of treatment and those with blunt thoracic trauma. Two patients had thoracic duct ligation via right-sided thoracotomy, and five patients had video-assisted thoracoscopic thoracic duct ligation with the immediate arrest of chylous leakage. Conclusion: Chylothorax should be treated conservatively initially. Surgical treatment should not be delayed in case of failure beyond the fifth day. In our series of patients, a video-assisted thoracoscopic approach for thoracic duct ligation proved to be minimally invasive, highly efficient, and well tolerated by patients and, therefore, should be the preferable route of surgical treatment.

The COVID-19 global pandemic is now a public health emergency in Morocco. Reports on factors associated with prolonged viral shedding are not consistent. In this retrospective laboratory based study, time to RNA negative conversion is reported in a series of 129 patients monitored in a single laboratory in Casablanca. Risk factors associated with delayed negative conversion have been evaluated, by chi-squared test. Median delay of negative conversion was 22.5 days (IQR 17.75-29.0) from illness onset. Neither gender nor age were particularly associated with delayed viral clearance. Delayed time to hospital admission and disease severity were associated with prolonged viral shedding in this series. We recommend early diagnosis and treatment onset to reduce time to viral clearance and transmissibility of SARS-CoV-2 virus.

Flow experience, characterized by deep immersion and complete engagement in a task, is highly recognized for its positive psychological impacts. However, previous studies have been restricted to use a single type of task, and the exploration on its neural correlates has been limited. This study aimed to explore the neural correlates of flow experience with the employment of multifac-eted flow-induction tasks. Six tasks spanning mindfulness, artistic tasks, free recall, and varying levels of Tetris complexity (easy, flow, and hard conditions) were employed to have a relatively complete coverage of the known flow-induction tasks for a better induction of individualized flow experience. Twenty-eight participants were recruited to perform these six tasks, with a sin-gle-channel prefrontal electroencephalography (EEG) recording. Significant positive correlations were observed between the subjective flow scores of individual’s best-flow-experience task and the EEG activities at delta, gamma, and theta bands, peaking at latencies around 2 minutes after task onset. The outcomes of our multiple regression analysis yield a maximum coefficient of de-termination (R²) of 0.279. Our findings report the EEG correlates of flow experience in naturalistic settings and highlight the potential of portable and unobtrusive EEG technology for an objective measurement of flow experience.

Purpose: Data on Eosinophilic esophagitis in Israel is sparse. We appraised the clinical, endoscopic, and histological characteristics of 50 Israeli adults with EoE. Methods: Medical records of 50 adult patients with established diagnoses of EoE who were referred to our center from 2020 until 2023 at Bnai Zion Medical Center, Haifa, Israel, were reviewed. Results: Fifty patients with EoE were included, the mean age at diagnosis was 34±9.5 years. The sex ratio of males to females was approximately 2:1 with 34 males (68%) and 16 females (32%). Twenty-two of the 50 patients had a history of allergic diseases, Symptoms at diagnosis were as follows: Dysphagia was the primary presenting symptom observed (n=25, 50%), followed by food impaction (n=17, 34%) and GERD-like symptoms (n=14, 28%). Less frequent symptoms included vomiting, nausea, and chest pain. The most common endoscopic findings were normal mucosa (n=21, 42%) followed by Trachealization (n=17, 34%), esophagitis (n=7, 14%), and exudates (n=5, 10%). 66% of the subjects were initially treated with proton-pump inhibitors (PPIs). Nine patients (18%) were asymptomatic without any treatment. The remaining eight patients (16%) were given topical steroids. Clinical and histological resolution was detected in 50% of the patients who underwent a second EGD after 6–8 weeks of PPI. Conclusion: Our current study depicts the clinical features of adult patients with EoE in north Israel. This is the first demographic study in Israel that defines the clinical, endoscopic, and histological manifestations of EoE in the adult population.

Background: Eid al-Adha is celebrated every year in Muslim countries; however, it is a time when patients present to the emergency department with serious injuries. In our study, we examined current injuries at the time of Eid al-Adha in the largest patient population in one of the largest hospitals in Turkiye, including tendon injury map and maxillofacial injuries for the first time in the literature. Methods: Between 2019 and 2023, patients admitted to Ankara City Hospital during Eid al-Adha were examined. The demographic characteristics, injury patterns, and injury sites of the patients were evaluated by analyzing the patients admitted on the four days of Eid al-Adha. Statistical analysis were performed using IBM SPSS Statistics for Windows. Results: Six hundred and ten patients, including 101 female and 509 male patients, were included in this study. There was a statistically significant increase (p

To examine the association of clinical, treatment, and dose parameters with late urinary toxicity after low-dose-rate brachytherapy (LDR-BT) for prostate cancer, we retrospectively studied patients with prostate cancer who underwent LDR-BT from January 2007 through December 2016. Urinary toxicity was assessed using the International Prostate Symptom Score (IPSS) and Overactive Bladder (OAB) Symptom Score (OABSS). Severe and moderate lower urinary tract symptoms (LUTS) were defined as IPSS ≥ 20 and ≥ 8, respectively; OAB was defined as a nocturnal frequency of ≥ 2 and a total OABSS of ≥ 3. In total, 203 patients (median age, 66 years) were included, with a mean follow-up of 8.4 years after treatment. The IPSS and OABSS worsened after 3 months of treatment; these scores improved to pretreatment levels after 18–36 months in most patients. Patients with a higher baseline IPSS and OABSS had a lower frequency of moderate and severe LUTS and OAB at 24 and 60 months, respectively. LUTS and OAB at 24 and 60 months were not correlated with the dosimetric factors of LDR-BT. Although the rate of long-term urinary toxicities assessed using IPSS and OABSS was low, the baseline scores were related to long-term function. Refining patient selection may further reduce long-term urinary toxicity.

The question of what generates conscious experience has mesmerized thinkers since the dawn of humanity, yet its origins remain a mystery. The topic of consciousness has gained traction in recent years, thanks to the development of large language models that now arguably pass the Turing test, an operational test for intelligence. However, intelligence and consciousness are not related in obvious ways, as anyone who suffers from a bad toothache can attest - pain generates intense feelings and absorbs all our conscious awareness yet nothing particularly intelligent is going on. Still, in the hard sciences, this topic is frequently met with skepticism because to date no protocol to measure the content or intensity of conscious experiences in an observer-independent manner has been agreed upon. Here we present a novel proposal: Conscious experience arises whenever a quantum mechanical superposition forms. Our proposal has several implications: First, it suggests that the structure of the superposition determines the qualia of the experience. Second, quantum entanglement naturally solves the binding problem, ensuring the unity of phenomenal experience. Finally, a moment of agency may coincide with the formation of a superposition state. We outline a research program to experimentally test our conjecture via a sequence of quantum biology experiments. Applying these ideas opens up the possibility of expanding human experience through brain-quantum computer interfaces.

Vancomycin is one of the ‘last-line’ classes of antibiotics used in the treatment of life-threatening infections caused by Gram-positive bacteria. Even though vancomycin was discovered in 1950s it was widely used after 1980s for the treatment of infections caused by methicillin-resistant Staphylococci as prevalence of such strains were increased. However, currently it is evident that vancomycin resistant Staphylococcusaureusandvancomycin-resistant Enterococci have been developed as a result of various reasons including use of avaparcin, which is an analog of vancomycin, as feed additive in livestock. In present day context, more attention should be paid on prevention of emergence of resistance for the antibiotics in order to keep antibiotics effective. In order to prevent emergence of resistance, proper guidance for the responsible use of antimicrobials is indispensable. Therefore, almost all stakeholders who use antibiotics should have in depth understanding on the antibiotic they use. As such, it is imperative to be aware of the important aspects of vancomycin. In the present review, efforts have been made to discussthe pharmacokinetics and pharmacodynamics, indications, emergence of resistance, control of resistance, adverse effects and alternative therapy for vancomycin.

This communication is to summarize our single center experience on applications of anti-IL-1 biologic response modifiers on autoimmune and autoinflammatory conditions in children. We present our rationale for off-label utilization of Anakinra and discuss evolving treatment paradigms that warrants further research and validation. Based on our observations and successful treatment outcomes, we advocate future multilateral efforts to liberate access to anti-IL-1 medications to control inordinate and detrimental inflammation in children.

(1) Background: adnexal masses during pregnancy detection are increased due to the use of first trimester screening and to advanced maternal age. Although the low risk of malignancy, other risks are associated: torsion, rupture or labour obstruction. Correct diagnosis and management are fundamental to guarantee both maternal and fetal safety. Adnexal masses may be troublesome to classify during pregnancy due to the increase in the uterus volume and to pregnancy-related hormonal changes. Management should be based on ultrasound examination to provide the best treatment. (2) Methods: the aim was to describe the ultrasound features of ovarian masses detected during pregnancy. We evaluated patient’s management, perinatal outcomes and follow-up. (3) Results: our study demonstrated that the management should be guided by an accurate ultrasound examination performed by an expert operator according to standardized techniques. Secondly, our results confirm the data present in the literature: the masses are most frequently benign, ultrasound follow-up is the best management strategy and obstetric outcome is not considerably affected. (4) Conclusions: the management of patients with ovarian masses detected during pregnancy should be based on ultrasound examination and a centralization in referral centers for ovarian masses should be considered.

Ovarian cancer (OC) represents the most common and lethal gynecologic malignancy, due to its increased incidence and mortality rate. It is usually diagnosed in advanced stages and, even though surgery and platinum-based treatment are initially efficient, recurrences emerge in over 70% of cases. Although there are multiple options of chemotherapy drugs from which to choose, little is known regarding the best strategy for prolonged survival. Thus, the aim of this study was to assess the effect that most frequently used chemotherapeutic regimens have upon time-to-treatment-failure (TTF) from the first line and beyond, considering clinical and biological factors which influence the treatment outcome of platinum-resistant recurrent OC. We retrospectively analyzed data from 78 patients diagnosed with platinum-resistant OC, who underwent chemotherapy-based treatment with or without anti-angiogenic therapy at OncoHelp Oncology Center, Romania (January 2016 - February 2021). Our study identified positive predictive factors for TTF related to anthropometry (age over 60 for patients treated with topotecan with or without bevacizumab), renal function (creatinine levels between 0.65 and 1 mg/dl for patients treated with regimens containing bevacizumab and pegylated liposomal doxorubicin) and treatment choice (bevacizumab in combination with pegylated liposomal doxorubicin or topotecan used from the first line and beyond).

Background: Positive person-centered attributes of inpatient rehabilitation need to be identified from the patient perspective to be further developed and sustained. Purpose: To identify which attributes patients openly evoke as being great care experiences, using an open appreciative inquiry during the inpatient rehabilitation stay. Methods: Qualitative secondary analysis of appreciative patient comments during a bedside patient experience rounding, facilitated by a neutral party. Two independent analysts employed an inductive, summative form of content analysis. Results: Among 150 patients rounded, 122 provided categorizable appreciative accounts. Over two thirds of the patients (67.2%) focused on “staff attributes” in their great-experience accounts. Those attributes were mostly interpersonal such as being “attentive & caring - beyond clinical duty” and being “encouraging (but not too hard) & reassuring”. These interpersonal staff attributes were reported with words showing deep levels of personal significance or patient appreciation. Beyond staff attributes, the perceived quality of the “patient care” (31.1%) and opportunities for “leisure and social activities” (9.0%) were also frequently evoked. Amenities like food or costumer service were the least evoked, rarely so as an exclusive attribute (0.8% for each). Conclusions: The human(e) factor, especially the interpersonal qualities of staff, emerged as greatly appreciated from the patient experience perspective during inpatient rehabilitation. These experiences help identify which person-centered attributes of care might be further developed and sustained.

Starting from the model of a slow-rolling missile with six degrees of freedom (6 DOF) in the body frame, a 6 DOF model in the Resal frame is obtained, which is used to linearize the coupled commanded motion. Based on the linearized model, we obtain the structural scheme of the commanded object and define the quality parameters. The obtained parameters have a complex representation (with real and imaginary parts) due to the coupling between longitudinal channels. Then, the kinematic guidance equations, the seeker equations and the actuator specific to the slow-rolling single-channel missile are defined using a switching function. The guidance kinematic equations, the seeker equations and the actuator model are linearized in the Resal frame, and the structural diagram of the homing missile is constructed. Starting from this, the characteristic polynomial having complex coefficients is determined and then analyzed with the Frank-Wall stability criterion. Based on the analysis, a stability range is determined for the navigation constant and a minimum and possibly a maximum limit for the time to hit the target is obtained. The stability range defined for the navigation constant on the linear model is finally validated on the nonlinear model in the body frame.

(1) Background: This retrospective study aimed to compare the efficacy and safety of one-stage computed tomography (OSCT)- to that of two-stage computed tomography (TSCT)-guided localization for the surgical removal of small lung nodules. (2) Methods: We collected data from patients with ipsilateral pulmonary nodules who underwent localization before surgical removal at Veteran General Hospital Kaohsiung between October 2017 and January 2022. The patients were divided into the OSCT and TSCT groups. (3) Results: We found that OSCT significantly reduced the localization time and risky time compared to TSCT, and the success rate of localization and incidence of pneumothorax were similar in both groups. However, the time spent under general anesthesia was longer in the OSCT group than in the TSCT group. (4) Conclusions: The OSCT-guided approach to localize pulmonary nodules in hybrid operation room is a safe and effective technique for the surgical removal of small lung nodules.

Background. The type-2 sodium-glucose cotransporters inhibitors (SGLT2i) are a new relevant therapeutic option for patients affected by chronic heart failure with reduced ejection fraction (HFrEF). The aim of this study was to evaluate, in a real-world population from a single center, the feasibility of introducing SGLT2i and their interaction with other recommended drug classes. Methods. We evaluated the consecutive patients affected by chronic heart failure (CHF) since January 2022. At baseline clinical visit the therapy taken by the patients as well as that prescribed were accurately collected. During a 6-12 month follow-up the the changes in concomitant therapy were analyzed. Results. At baseline, among 350 patients evaluated, only 17 (5%) were already taking SGLT2i, 13 with HFrEF, 2 with CHF with mild reduced (HFmrEF) and 2 with preserved ejection fraction (HFpEF). After baseline evaluation, SGLT2i were prescribed to 220 (63%) of all the patients enrolled, among whom 178 (84%) of HFrEF patients, 25 (42%) of HFmrEF and 17 (22%) of HFpEF. After follow-up, SGLT2i therapy was highly tolerated and it was associated with a significant increased prescription of sacubitril/valsartan and a reduced use of diuretics. Finally, a significant improvement in functional status and left ventricular systolic function after SGLT2i therapy was observed. Conclusions. In this single center “real world” study, SGLT2i were prescribed in HFrEF patients most of all already in therapy with the other classes of drugs currently recommended for their treatment. Moreover, a further optimization in prescribed ther-apy was observed during a short term follow-up. These data further support the use of this thera-peutic approach in routine clinical practice.

The treatment of patients with metastatic colorectal cancer (mCRC) is complex and impacted by the location of the primary tumor (LPT). Our study aims to emphasize the importance of LPT as a prognostic and predictive marker, as well as to examine the significance of HER2 overexpression in patients with mCRC, particularly in relation to response to anti-EGFR therapy. In this study, 181 patients with KRAS wild-type mCRC who received anti-EGFR therapy were included. Among them, 101 had left colon cancer (LCC) and 80 had right colon cancer (RCC). Results demonstrated that patients with KRAS wild-type LCC had better median overall survival (OS) (43 vs. 33 months, p = 0.005) and progression-free survival (PFS) (6 vs. 3 months, p &lt; 0.001) compared to those with RCC. Multivariate analysis identified mucinous adenocarcinoma (p &lt; 0.001), RCC location (p = 0.022), perineural invasions (p = 0.034), and tumors at the resection margin (p = 0.001) as independent predictors of OS, while mucinous adenocarcinoma (p = 0.001) and RCC location (p = 0.004) independently correlated with significantly shorter PFS. In addition, HER2 positive expression was significantly associated with worse PFS compared to HER2 negative results (p &lt; 0.001). In conclusion, LPT is an important marker for predicting outcomes in the treatment of wild-type mCRC using anti-EGFR therapy, since patients with RCC have a statistically significantly shorter PFS and OS. Further investigation is needed to understand the role of HER2 overexpression in wild-type mCRC, as these patients also exhibit shorter survival.

Non-Small Cell Lung Cancer (NSCLC) is the most common pulmonary malignancy, most frequently diagnosed at an advanced stage (III/IV). Patients in the Locally-Advanced Stage Subgroup (IIIA) are relatively few, yet compose of heterogenic phenotypes posing a diagnostic and treating challenge, leading to lack of clinical guidelines regarding the optimal standard of care. Several approaches exist, with a general agreement that a combined oncological and surgical modality approach is required. In this current retrospective descriptive study, operable Stage IIIA NSCLC patients who underwent surgery between 2013-2020 were evaluated on several aspects, including initial diagnosis, neoadjuvant regimens, outcomes of surgical intervention, overall survival at 2-years and 5-years following treatment. A total of 35 patients had neoadjuvant oncological treatment (mostly chemoradiation therapy) prior to surgery, out of which 28 patients were diagnosed with Stage IIIA NSCLC. In post-operative assessment of pathological staging, downstaging was reported in 20 patients, of which 7 (25%) cases were defined as complete pathological response. The 2-years overall survival rate was 65% and the 5-years overall survival rate was 60%. The main pattern of disease recurrence was distant metastasis.

The aim is to evaluate a program for direct oral anticoagulants (DOACs) management in nonvalvular atrial fibrillation (NVAF) patients, according to patient profiles, appropriateness of dosing, patterns of crossover, effectiveness and safety. This is an observational and longitudinal retrospective study in a cohort of patients attended in daily clinical practice in a single regional hospital in Spain with a systematic follow-up plan for up to 3 years for patients initiating dabigatran, rivaroxaban or apixaban between JAN/2012-DEC/2016. We analyzed 490 episodes of treatment (apixaban 2.5 mg: 9.4%, apixaban 5 mg: 21.4%, dabigatran 75 mg: 0.6%, dabigatran 110 mg: 12,4%, dabigatran 150 mg: 19.8%, rivaroxaban 15 mg: 17.8% and rivaroxaban 20 mg: 18.6%) in 445 patients. 13.6% of patients on dabigatran, 9.7% on rivaroxaban, and 3.9% on apixaban, switched to other DOACs or changed dosing. Apixaban was the most frequent DOAC switched to. The most frequent reasons for switching were toxicity (23.8%), bleeding (21.4%) and renal deterioration (16.7%). Inappropriateness of dose was found in 23.8% of episodes. Patients taking apixaban 2.5 mg were older, had higher CHA2DS2VASc score and lower creatinine clearance. Patients taking dabigatran 150 mg and rivaroxaban 20 mg were younger, had lower CHA2DS2VASc and higher creatinine clearance. Rates of stroke/transient ischemic attack (TIA) were 1.64/0.54 events/100 patients-years, while rates of major, clinically relevant non-major (CRNM) bleeding and intracranial bleeding where 2.4, 5, and 0.5 events/100 patients-years. Gastrointestinal and genitourinary bleeding were the most common type of bleeding events (BE). On multivariable analysis, prior stroke (RR: 4.2; CI: 1.5-11.8; p=0.006) and age (RR: 1.2; CI: 1.1-1.4; p=0.006) were independent predictors of stroke/TIA. Concurrent platelet inhibitors (RR: 7.1; CI: 2.3-21.8; p=0.001), male gender (RR: 2.1; CI: 1.2-3.7; p=0.0012) and age (RR: 1.1; CI: 1.02-1.13; p=0.005) were independent predictors of BE. This study complements the scant data available on the use of DOACs in NVAF patients in Spain, confirming a good safety and effectiveness profile

Background:Caregiving for individuals with neurological disease involves providing physical, emotional, and social support, which can be a challenging and stressful experience. This study aims to compare the caregivers' burden, including the impact on mental and physical health, social support, and quality of life, in different neurodegenerative disorders. Methods:Fifty-five primary caregivers (F=41;mean age=53.07±12.29) of patients with Parkinson's Disease (PD=26), Multiple System Atrophy (MSA=16), and Amyotrophic Lateral Sclerosis (ALS=13), took part in the study. Standardized screening scales for the quality of life (EQ-5D/EQ-VAS and PQoL), levels of the caregiving burden (CBI and FSQ), and the assessment of the anxiety-depressive axis (HADS) were administered. Results: The mean CBI score was higher for caregivers of MSA patients (28.81±21.90) and ALS (25.15±16.23) than for caregivers of PD patients (16.08±10.34; p=0.036). Critical burden (cut-off>36) was present in the caregivers of MSA (31.3%), ALS (23.1%), and PD (19.2%) patients. Caregivers of patients with ALS had a worse perception of quality of life (EQ-5D total score) than caregivers of patients with MSA and PD (p

Photocatalytic ammonia decomposition to produce N2 and H2 was achieved using single-walled carbon nanotube (SWCNT) nanohybrids. Physical modification of ferrocene-dye-encapsulated CNTs by amphiphilic C60-dendron yielded nanohybrids with a dye/CNT/C60 coaxial heterojunction. Upon visible light irradiation, an aqueous solution of NH3 and dye@CNT/C60-dendron nanohybrids produced both N2 and H2 in a stoichiometric ratio of 1:3. Action spectra of this reaction clearly demonstrated that the encapsulated dye acted as the photosensitizer, with an apparent quantum yield (AQY) of 0.22% at 510 nm (the λmax of the dye). This study presents the first example of dye-sensitized ammonia decomposition and offers a new avenue for developing efficient and sustainable photocatalytic hydrogen production systems.

Monkeypox (mpox) caused by the monkeypox virus (MPXV) is currently the most common orthopoxvirus (OPXV) zoonotic disease. Since 2022, a multi-country outbreak of mpox has been reported with atypically rapid human-to-human transmission. The present work aimed to investigate the frequency of MPXV and OPXV DNA detection in different clinical materials taken at acute and convalescent phases of the infection in Bulgarian patients. A total of 181 clinical samples from 42 Bulgarian patients with possible mpox infections were tested. Screening for MPXV DNA (F3L gene) and OPXV DNA (rpo18 gene) were performed by real-time PCR assays. Of all tested patients six (14%) were confirmed with mpox infection. MPXV DNA was detected in 23/181 (12,71%) and OPXV DNA in 20/181 (11,05%) clinical samples. All confirmed patients were men who have sex with men, aged 23 to 44 (at an average age of 35,17±7,91 years) and two of them were HIV positive. The commonest clinical features of patients were fever (5/6), vesicular-pustular rash: perianal (6/6), penile (4/6), and limbs (4/6). MPXV DNA was found with the greatest frequency in specimens of vesicle contents and nasal/oropharyngeal swabs in 6/6 and 5/6. OPXV DNA mainly was detected in vesicle contents (6/6), nasal/oropharyngeal swabs (4/6), and urine (4/6). In the collected follow-up samples, MPXV DNA was detected in the highest percentage in the specimen's vesicle contents (6/6) and urine (6/6) and not demonstrated in samples of feces and saliva. The laboratory surveillance of MPXV is critical to contain the outbreak and to elucidate the new fast transmission of the virus.

The life cycle of a microgrid covers all the stages from idea to implementation, exploitation until its end of life, but with a lifespan of around 25 years. Covering them usually requires several software tools, which can make integration of results from different stages very difficult and may imply costs hard to estimate from the beginning of a project. This paper proposes a single platform of four modules developed in Matlab to assist all the processes a microgrid passes during its lifetime. The authors detail the architecture, functions and the development of the platform, either by using existing tools available in Matlab, or by developing new ones and designing new user interfaces linked with scripts based on its complex mathematical libraries. A proof-of-concept for this platform was presented by applying the life-cycle assessment process on a real-case study, a microgrid consisting in a photovoltaic plant, an office building as consumer and energy storage units.

The oncologic merits of laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by only one surgeon in a medical institution were randomized to either laparoscopic or open treatment. During this period, total 188 patients received laparoscopic surgery and other 163 patients to open approach. The primary endpoint was cancer-free 5-year survival after operative treatment and secondary endpoint was the tumor recurrence incidence. We found there was no statistically significant difference between open and laparoscopic groups regarding average number of lymph nodes dissected, overall mortality rate, cancer recurrence rate or cancer-free 5-year survival. Nevertheless, laparoscopic approach was more effective for colorectal cancer treatment with shorter hospital stay and less blood loss despite operation time was significantly longer. Meanwhile fewer patients receiving laparoscopic approach developed postoperative urinary tract infection, wound infection, pneumonia or anastomosis leakage, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes whether in total complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free 5-year survival and tumor recurrence, we favor patients receiving laparoscopic surgery if not contraindicated.

The COVID-19 pandemic struck unexpectedly, emergency services and chronic care institutions, including dialysis centers, were overloaded. An important problem was the care of positive COVID patients, but also the care of chronically dialyzed patients who presented emergencies. In our Hospital, which has become a COVID support for dialysis patients with severe forms of the disease, we had to care for PD patients with dialysis-related emergencies. We presented 2 cases of patients managed on an outpatient basis or 1 day hospitalization, treated successfully and without compromising the quality of the care provided. We used remote monitoring, we worked in a multidiscipli-nary team, we shortened the hospitalization of patients (and implicitly the risk of contact). In pandemic conditions, the advantage of PD was represented by the possibility of patient isolation, so that in the first 6 months of the pandemic, we recorded no deaths in this category of patients. In case of hemodialysis patients, in-fection and mortality rates were high. Although we expected an increase in the number of peritoneal dialysis patients in the post-pandemic period, this did not happen. We continue to plead for the popularization of the PD method among patients and doctors, which has proven its advantages under the conditions of the pandemic.

This article explores the specific impact of artificial intelligence (AI) -driven data visualisation technologies in the user experience of the Internet industry. Through the introduction of machine learning and data mining technologies, AI has significantly improved the intelligence and automation of data visualization tools, promoting innovation in visualization methods and improving the quality and efficiency of data cleaning, processing, and analysis. In addition, AI has also promoted the development of personalised data visualization, providing users with a richer and more intuitive way to present data. This paper analyses the applications of AI-driven data visualization in machine learning, natural language processing, and computer vision. It demonstrates the positive effects of AI data visualization on user understanding and optimisation of models through practical feedback from Yellowbrick tools.

Thalassemia syndromes are common monogenic disorders that represent a significant global health issue. No systematic epidemiological and molecular investigations on thalassemias in Croatian population have been reported to date. This prospective study included 70 children with a presumptive diagnosis of thalassemia, and their 42 first-degree relatives. Molecular characterization was performed using direct sequencing and gap-PCR methods. We identified 46 (30 children and 16 first-degree relatives) β-thalassemia heterozygous carriers from 24 unrelated families, carrying eight different mutations and one hemoglobin variant. Five variants account for approximately 85% of all affected β-globin alleles: Hb Lepore-Boston-Washington (32,6%), HBB: c.93-21G&gt;A (19,6%), HBB:c.315+1G&gt;A (13,1%), HBB:c.92+1G&gt;A (10,9%), and HBB:c.92+6T&gt;C variant (8,7%). A need for more detailed genetic profiling of β-thalassemia carriers is emphasized since genetic modifiers can significantly impact their phenotype. Our study provides important new insights into the relevance of β-thalassemia heterozygosity in the pediatric clinical practice.

The objective of image super-resolution is to reconstruct a high-resolution (HR) image with the prior knowledge from one or several low-resolution (LR) images. However, in the real world, due to the limited complementary information, the performance of both single-frame and multi-frame super-resolution reconstruction degrades rapidly as the magnification increases. In this paper, we propose a novel two-step image super resolution method concatenating multi-frame super-resolution (MFSR) with single-frame super-resolution (SFSR), to progressively upsample images to the desired resolution. The proposed method consisting of an L0-norm constrained reconstruction scheme and an enhanced residual back-projection network, integrating the flexibility of the variational model-based method and the feature learning capacity of the deep learning-based method. To verify the effectiveness of the proposed algorithm, extensive experiments with both simulated and real world sequences were implemented. The experimental results show that the proposed method yields superior performance in both objective and perceptual quality measurements, compared to the baseline super-resolution algorithms in the cascade model. In addition, the experiment indicates that this cascade model can be robustly applied to different SFSR and MFSR methods.

This study explores the Experience Economy dimensions within fishing tourism, adopting a data science perspective by employing web crawling for extensive data gathering on reviewer profiles from TripAdvisor. Utilizing Natural Language Processing (NLP) techniques, it scrutinizes the relationship between Experience Economy dimensions and user profiling aspects. Findings reveal "Entertainment" as the predominant dimension in tourist reviews, followed by "Aesthetic," "Educational," and "Escapist." Particularly notable are the frequent co-occurrences of "Entertainment"-"Aesthetic" and "Educational"-"Entertainment" pairs. The practical implications underscore the potential socioeconomic benefits of fishing tourism for local communities and fishermen, emphasizing the necessity for governmental support in terms of infrastructure, leadership, legislation, and financial backing to foster sustainable development in this sector. Notably, this research stands as a pioneering effort in its focus on Experience Economy dimensions and user profiling within the context of fishing tourism, drawing data from business pages and user profiles.

Introduction- Chiari malformation type 1 (CM-1) is defined by the caudal displacement of cerebellar tonsils through the foramen magnum (cut off of 5 mm from McRae line.) In Chiari malformation type 1.5 (CM-1.5) both cerebellar tonsils and brainstem result herniated. Patient with CM may exhibit a variety of symptoms: the most common are headache and cervical pain. Associated anomalies such as syringomyelia (67-80%), hydrocephalus (10 %), craniosynostosis or tethered spinal cord may be present. Surgical treatment is not performed in asymptomatic patients, while the presence of syringomyelia represents an indication for surgical decompression. In this paper we report our experience with the use of intra-operative ultrasonography in orienting surgical decompression with or without dural opening. Methods- We retrospectively examined and selected pediatric patients with CM-1/ CM-1.5 who were managed between 2006-2020 at Giannina Gaslini Hospital. Exclusion criteria were the association with achondroplasia and with spina bifida. Results- A total of 211 pediatric patients were identified for evaluation: CM-1 accounted for 83.9% of patients and CM-1.5 for 16.1%. Syringomyelia was associated in 28.4% of cases and hydrocephalus in 8%. According to findings at the intra-operative ultrasonography, a bony and ligamentous decompression alone was sufficient in 59.8% patients, a simple opening of dura mater was performed in 3% and a duraplasty in 27.1%. Seven patients experience post-operative complications, and 3 patients needed a second surgical operation for insufficient decompression, found at follow-up. Discussion and conclusion- The standard surgical treatment of CM-1/ CM-1.5 consists in decompression of posterior cranial fossa. Whether to perform a simple bony decompression or to associate the opening of the dura mater with duraplasty has always been controversial in pediatric population. Our case series, where good radiological findings were achieved with a limited number of reoperations, shows how intra-operative ultrasound may be a real-time helpful tool in orienting the surgical strategy, if we consider as surgical endpoint the restoration of cerebrospinal fluid (CSF) flux. However, there is the need to standardize this method, using quantitative variables.

Background Successful treatment for patients with metastatic colorectal cancer who failed to response to first-line treatment has been a challenge due to their low response rate for later-line treatment and poor progression free survival and overall survival. The application of dendritic cell-cytokine-induced killer cells (DC-CIK) immunotherapy combined with conventional treat-ment, either surgical resection or chemotherapy, showed improvement in survivals in first-line treatment for metastatic colorectal cancer. In this retrospective study, we aimed to evaluate the benefit of dendritic cell-cytokine-induced killer cells (DC-CIK) immunotherapy for patient with refractory metastatic colorectal cancer. Methods A total of 20 patients with refractory metastatic colorectal cancer receiving cell-cytokine-induced killer cells (DC-CIK) immunotherapy were enrolled to this study. Among these patients, 11 patients responded to the treatment and the remaining 9 patients did not. All patients were followed for at least one years and the determination of treatment response was mainly based on image study at 6 months after the completion of treatment. Data were analyzed with Kaplan-Meier method and log-rank test. Results The treatment response rate of the study group is 55% (11/20). The median progression free sur-vival (PFS) and median overall survival (OS) of responsive patients was 7 months and 12 months, respectively. The median overall survival of irresponsive patients was 9.5 months. Four responsive patients received subsequent metastectomy or cytoreduction plus hyperthermic in-traperitoneal chemotherapy surgery (CRS + HIPEC). Conclusion DC-CIK cell-based immunotherapy may provide benefits for patients with refractory mCRC with improved response rate and progression free survival.

Introduction: COVID-19's emergence caused devastating consequences worldwide, with high morbidity and mortality rates. Critically ill patients face challenges like acute respiratory failure requiring intensive measures, including mechanical ventilation. Mortality rates in ARDS are influenced by various factors. This paper focuses on describing characteristics, management, and survival factors of mechanically ventilated ICU patients in Saudi Arabia. Methods: a retrospective, noninterventional approach, we reviewed charts and data of all COVID-19-infected patients who were admitted to the ICU, particularly those requiring ventilation support at Aseer Central Hospital (ACH) in the southern region of Saudi Arabia. Results: The study enrolled 594 COVID patients, mean age 60.5 ± 17.3 years, with 67% males. Approximately half had O negative blood group. Common chronic health issues: diabetes mellitus (35.5%). Positive culture findings in almost 340 (57.2%), with Klebsiella pneumoniae being the most isolated microorganism (45.5%). Significant correlations found with mortality: age, blood culture, Rh positive group (P<0.05). Conclusion: this study provides critical insights into the clinical and epidemiological aspects of COVID-19 patients admitted to the ICU in a Saudi Arabian hospital. The research underscores the impact of age, comorbidities, laboratory markers, and treatment interventions on patient out-comes, emphasizing the significance of tailored management strategies in this context.

This paper proposes to study mystical experience by contrasting it with “ordinary” experience, i.e., with standard consciousness. It emphasises the construed nature of standard consciousness and the role that the mutual connectedness of mental contents plays in its construction. It then shows that removal of the factors that are responsible for the “making” of standard consciousness accounts for the principal features of mystical experience; these features are therefore mainly negative. The understanding of mystical experience as the suppression of factors that contribute to the construction of standard consciousness, along with a discussion of the mechanism that makes this possible, permits answers to some frequently asked questions, such as: why is mystical experience ineffable? what is its epistemic status? does it have implications for our understanding of mind, consciousness, and self?

(1) Background: Second Victims are health care workers negatively affected by adverse events and are prone to developing dysfunctional coping strategies compromising not only their own, but also patient safety. An effective way to address this issue is the implementation of peer support programs. This paper reports on the effectiveness of a peer support program at the Austrian Hietzing Clinic (KHI). (2) Methods: Telephone interviews were carried out after peer support sessions using a questionnaire. Descriptive analysis was carried out reporting frequencies and proportions for nominal variables, means with standard deviations for ordinal and interval-scaled variables. (3) Results: So far, 45 peer supporters have completed telephone interviews after a peer support session. The main reasons for the session were bad news from the private sphere and death of a patient. The peer supporters rated the helpfulness of the sessions for their colleagues as very high while not feeling very burdened themselves afterwards. (4) Conclusions: Underutilization of the program is probable. However, the high rating of helpfulness of the carried-out sessions by the peer supporters in combination with them not feeling very burdened, shows that the program is safe for the peer supporters and an upscaling is warranted.

The teaching of mathematics at the Faculty of Military Technology of the University of Defense in the first two years of the five-year Military master’s degree is divided into the teaching of students in four specializations: Military Technologies – Mechanical, Military Technologies – Electrical, Military Geography and Cartography, and Cybersecurity. The article discusses the previous five-year experience in teaching the subjects Mathematics I, Mathematics II, Mathematics III, and Graph theory for the specialization in Cybersecurity, that the author of the paper gained while teaching, as a guarantor of these four subjects. The article provides an overview of the topics that are covered, typical exam assignments, and an evaluation of the results of the semester exams in the five years since the accreditation of the Cybersecurity specialization was granted.

Background: C-reactive protein (CRP) is a predictive biomarker of colorectal surgery (CRS) complications but has not been evaluated by comparing patients undergoing CRS with intracorporeal anastomosis (IA) or extracorporeal anastomosis (EA). Therefore, we aimed to describe postoperative CRP values between two groups of patients who underwent laparoscopic right hemicolectomy for right-side colon cancer with IA or EA. Methods: We retrospectively reviewed the data of patients affected by right-side colon cancers who underwent laparoscopic right-hemicolectomy with ileo-colic IA or EA between January 2016 and December 2022. Results: A total of 340 patients underwent laparoscopic right hemicolectomy. EA was performed in 238 (70%) and IA in 102 (30%) cases. Patients with IA showed significantly higher values of CRP in the second, third and fourth postoperative days (15.2 mg/dL vs 9.5 mg/dL p=

Receptor–ligand interactions at cell interfaces initiate signaling cascades essential for cellular communication and effector functions. Specifically, T cell receptor (TCR) interactions with pathogen-derived peptides presented by the major histocompatibility complex (pMHC) molecules on antigen-presenting cells are crucial for T cell activation. The binding duration, or dwell time, of TCR–pMHC interactions correlates with downstream signaling efficacy, with strong agonists exhibiting longer lifetimes compared to weak agonists. Traditional surface plasmon resonance (SPR) methods quantify 3D affinity but lack cellular context and fail to account for factors like membrane fluctuations. In the recent years, single-molecule Förster resonance energy transfer (smFRET) has been applied to measure 2D binding kinetics of TCR–pMHC interactions in a cellular context. Here, we introduce a rigorous mathematical model based on survival analysis to determine exponentially distributed receptor–ligand interaction lifetimes, verified through simulated data. Additionally, we developed a comprehensive analysis pipeline to extract interaction lifetimes from raw microscopy images, demonstrating the model’s accuracy and robustness across multiple TCR–pMHC pairs. Our new software suite automates data processing to enhance throughput and reduce bias. This methodology provides a refined tool for investigating T cell activation mechanisms, offering insights into immune response modulation.

β-Ga2O3 is a well-known semiconductor material for power devices and other applications. Recently, β-Ga2O3 has also been reported as a scintillator material with a light yield of approximately 8400 ph./MeV, scintillation decay time of &lt;1 μs, and density of 6.44 g/cm3. In this study, 2-inch diameter β-Ga2O3 single crystals were prepared by oxide crystal growth using the cold crucible (OCCC) method under various oxygen partial pressures. In the OCCC method, as in the cold crucible method, a high frequency is applied directly to the oxide materials, which are heated and melted, and the melt is held by the outermost solid material itself that is cooled by water using a copper hearth. In the OCCC method, crystal growth is performed while rotating the seed crystal, as in the Czochralski method, to increase the crystal diameter. The optical properties and radiation responses of the crystals grown under various oxygen partial pressures were evaluated.

This paper introduces a novel method for accurately calculating the upper biomass of single trees using Light Detection And Ranging (LiDAR) point cloud data. The proposed algorithm involves classifying the tree point cloud into two distinct ones: the trunk point cloud and the crown point cloud. Each part is then processed using specific techniques to create a 3D model and determine its volume. The trunk point cloud is segmented based on individual stems, with each stem further divided into slices that are modeled as cylinders. On the other hand, the crown point cloud is analyzed by calculating its footprint and gravity center. The footprint is further divided into angular sectors, with each being used to create a rotating surface around the vertical line passing through the gravity center. All models are represented in a matrix format, simplifying the process of minimizing and calculating the tree’s upper biomass, consisting of crown biomass and trunk biomass. To validate the proposed approach, both terrestrial and airborne datasets are utilized. A comparison with existing algorithms in the literature confirms the effectiveness of the new method. The study shows that the proposed algorithm achieves an average fit between 0.01 m and 0.49 m for individual trees.

Head and neck squamous cell carcinoma (HNSCC) is a highly heterogeneous and the most common form of head and neck cancer, posing significant challenges for disease management. Single-cell RNA sequencing (sc-RNAseq) has emerged as a valuable tool for addressing these challenges by enabling detailed characterization of the tumor microenvironment (TME) at the cellular level. This review assesses the utility of sc-RNAseq in HNSCC research, compiling current strategies employing single-cell technologies. For HNSCC etiology, sc-RNAseq allows for the construction of cellular atlases, characterization of different cell types, and investigation of key genes and processes involved in cancer initiation, development, and progression within the TME. In terms of HNSCC diagnosis and prognosis, the high resolution offered by sc-RNAseq enables the identification of cell type-specific signatures, enhancing prognostic models and disease stratifiers for more accurate patient outcome assessments. Regarding HNSCC treatment, sc-RNAseq provides insights into cellular responses to various treatments, including radiotherapy, chemotherapy, and immunotherapy, contributing to improved patient stratification and personalized treatment strategies. This review highlights the unique contributions of sc-RNAseq to HNSCC research, addressing its cellular and biological complexity, and emphasizes its potential for advancing research and clinical practice in other cancer types.

Congenital heart disease (CHD) is the most commonly detected congenital anomaly and affects up to 1 % of all live-born neonates. Current guidelines support the use of Chromosomal Microarray Analysis (CMA) and Next Generation Sequencing (NGS) as diagnostic approaches to identify genetic causes. The aim of our study was to evaluate the diagnostic yield of CMA and NGS in a cohort of neonates with both isolated and syndromic CHD. The present study included 188 infants under 28 days of age with abnormal echocardiography findings hospitalized at the Department of Neonatology, UMC Ljubljana, between January 2014 and December 2023. Phenotypic data were obtained for each infant by retrospective medical chart review. We established the genetic diagnosis of 22 distinct syndromes in 17% of neonates. The most common genetic diagnoses were 22q11.2 microdeletion (22.7%) and CHARGE syndromes (22.7%), Noonan syndrome (9.1%), and Williams syndrome (9.1%). In addition, we detected variants of uncertain significance in 4.8% of neonates. Timely genetic diagnosis is important for the detection of syndrome-related comorbidities, prognosis, reproductive genetic risks and, when appropriate, genetic testing of other family members.

Background: In most cases, intra-labyrinthine schwannoma (ILS) occurs in patients with unilateral hearing deterioration or neurofibromatosis type II (NF II). The pattern of localization of these tumors is various but affects mostly the cochlea. Extirpation of the ILS, if hidden by the cochlea modiolus, is difficult under the aspect of complete removal. Therefore, a tissue removal device (TRD) was designed and tested in temporal bones. The principle of handling the new device is a pushing and pipe cleaner handling inside the cochlea. This present study aimed to describe the first in vivo experience with the newly developed TRD for removing cochlear intra-labyrinthine schwannoma. Methods: In three patients, the TRD was used for the tumor removal of ILS. In two patients with a cochlear schwannoma in combination with a cochlea implantation and one patient suffering from NF II, a cochlear schwannoma was removed with the TRD. The access was performed with a posterior tympanotomy, an enlarged round window approach, and an additional second-turn access. The device was inserted and extracted gradually from the second turn access until the rings were visible in the second turn access. By pushing and pipe cleaner handling, the tumors were removed. An MRI control was performed on the day postoperatively with a T1 GAD sequence. Results: Tumor removal with the TRD was performed in a 15-minute procedure. MRI control confirmed a complete removal on the postoperative day in both cases. Conclusion: In vivo handling of the device confirmed a straightforward handling for tumor removal. MRI scanning showed a complete removal of the tumor by the TRD.

Coagulase negative Staphylococci (CoNS) are reported to be responsible for 50-60% of bloodstream infections in very preterm (&lt;1500 g) infants in Neonatal Intensive Care Units (NICU). Staphylococcus capitis is an increasingly prevalent pathogen in neonatal setting, frequently causing central-line associated bloodstream infections (CLABSI) that can be difficult to eradicate. CVC removal versus in situ treatment of CoNS CLABSIs is a matter of debate, with no clear consensus emerging in the existing literature. We revised all S. capitis CLABSIs in our NICU between 2019 and 2022, focusing on the role of catheter removal for eradication. Among 25 cases, 17 CVCs were removed after diagnosis, leading to a 76.5% eradication rate in this group. 3 infants had a persistently positive blood culture after CVC substitution. A new catheter was than inserted after a 48-hours washout period, resulting in resolution of the infection. Only 2 of 8 patients (25%) who retained the catheter after diagnosis, underwent infection eradication with antibiotic therapy alone. Catheter removal, when feasible, seems to be the most effective strategy to eradicate S. capitis CLABSIs, sometimes even requiring a 48-hours washout period before reinsertion. Further studies on this subject are needed to better standardize the management of this kind of infections.

Background: PFO (Patent foramen ovale) is a common defect that affects about 25% of the population. Although its presence is asymptomatic in the majority of the cases, the remaining part becomes overt with different symptoms, including cryptogenic stroke. The PFO closure procedure is widely available to date with the most used Amplatzer PFO Occluder, also in complex anatomy, but the performance of another device, the GORE Septal Occluder (GSO), has not been completely explored with regard to different septal anatomies. Methods: From March 2012 to June 2020, 118 consecutive patients with an indication for PFO closure were treated using the GSO system and included in a prospective analysis and followed. After 12 months, every patient underwent transcranial Doppler to evaluate the effectiveness of treatment. Results: of 111 patients evaluated, 107 showed effective PFO closure (96,4%) and 4 showed a residual shunt (3,6%). To better evaluate the device performance, the overall population was sorted into 2 clusters based on the echocardiographic characteristics. The main difference between groups was for PFO width (4,85 ± 1,8 vs 2,9 ± 1 mm, p <0,001) and PFO tunnel length (12,6 ± 3,8 vs 7,2 ± 2 respectively, p <0,001), allowing identification of complex anatomy and simple anatomy, respectively. Regardless of the aforementioned cluster, the GSO performance to reach an effective closure was independent of anatomy type and the chosen device size. Conclusion: GSO device showed efficacy and safety at 1-year follow-up in patients with at least 1 anatomical factor of complexity of PFO, irrespectively from the level of complexity itself.

The case of a patient with autoimmune haemolytic anaemia and an anastomosing haemangioma, is presented. The main dilemma was whether the haemangioma was the cause or the consequence of the autoimmune haemolytic anaemia and how both processes should be management. The diagnostic methods used are analytical and imaging techniques, which have not been conclusive in the diagnosis of anastomosing haemangiomas. Preoperative corticosteroid treatment does not prevent the recurrence of autoimmune haemolytic anaemia in the postoperative period. Surgical indication is established by the progression of proliferative activity, tumor enlargement and compression of the vena cava over time. Surgical resection of the tumor is the procedure used. The indication for surgical treatment of the anastomosing haemangioma and the decrease in alpha- fetoprotein after tumor resection are the most relevant results, although it increases again after a few weeks. The development of an anastomotic haemangioma may be secondary to autoimmune haemolytic anaemia. Angiogenesis resulting from the formation of erythroblastic islands at the periphery of the tumor and clonal expansions may be a mechanism to compensate for the haemolysis caused by autoimmune haemolytic anaemia

Objective: The aim of our study was to perform a retrospective analysis of the volume of cervical screening tests, the number of patients treated with an excision method, and the incidence of invasive and non-invasive cervical during a pandemic and pre-pandemic period of 24 months. Results: There was a statistically significant age difference between the two study periods, both by the average age of patients and by age group. The mean difference was 32 years before the pan-demic and 35 years during the pandemic (p-value >0.05). The majority of patients presenting for investigations before and during the pandemic were in the 30-39-year-old age group (31.95%, respectively; 34.2% (p-value = 0.003). The biggest patient loss ratio identified by age group was in the 50–59 years: 14,53% in the pre-pandemic period and 9,1% in the pandemic period. In the pan-demic period, patients from rural areas presented in the clinical trial with a lower rate of 39.52% (83 patients) vs. 60.47% (127 patients) in urban areas. A higher percentage of patients experiencing cervicorrhagia as a clinical manifestation in the pandemic period vs. the prepandemic period, with an increase in more severe lesions in the pandemic period, has a statistical significance of 8% more newly diagnosed compared to the pre-pandemic period. Conclusion: The addressability of the patients during the COVID period was not affected in a drastic way in our study. We encountered a decrease in appointments in the age group 50–59 years and a decrease in patients with rural residence. In our study, we found an increase in cervicorrhagia as a reason for consultation in the pandemic period with a higher lesion degree, both on a pap smear and on a cervical biopsy.

Introduction After the first use of infliximab in Crohn’s disease in 1995, the wide scale introduction of anti-tumour necrosis factor alfa (anti-TNF alfa) medications revolutionized the treatment of inflammatory bowel diseases (IBD’s). During the last two decades an increased number of molecules with multiple mechanisms of action were approved for the treatment of IBD with substantial increase of the costs of related to therapy. The increasing costs and access to therapy became a concern of payers and regulators but also for healthcare professionals. Biosimilars are biologic medical products that are highly structurally identical to their reference products and without any clinically meaningful differences in immunogenicity, safety or effectiveness. The introduction of biosimilars was seen as a way to provide a lower-cost alternative to the originator anti-TNF molecules and hence to increase treatment access and availability for patients. Material and methods This an observational, prospective study conducted in two IBD centers in Bucharest. The study included 53 patients, 27 male(M) and 26 female(F), diagnosed with UC or BC according to standard clinical,endoscopic, radiological, histological criteria that were non medically switched to a biosimilar. All patients completed at least the induction treatment with the originator adalimumab and they were clinically stable. After switch they received one of the market available biosimilars of Adalimumab(Hukyndra, Imraldi or Hyrimoz). For each patient, the following data were collected: age, sex, BC or UC diagnosis, previous and current therapy, clinical evolution, endoscopic scores as well as several biological markers. Aim The primary objective was the maintenance of clinical remission at twelve months after switching the original Adalimumab treatment to the biosimilar Adalimumab. The secondary objectives were to evaluate the presence of adverse effects and the treatment persistence at one year. Results In our population, there were 42 patients with Crohn's disease and 11 with ulcerative colitis who switched from the originator adalimumab to a biosimilar Adalimumab. The average age was 44,07 years old for patients with BC and 51,72 years old for patients with UC. No significant differences were found in terms of CF and CRP levels at 6 and 12 months after changing the originator biologic treatment to a biosimilar. Only one patient required changing the biological treatment, following the clinical and biological loss of response. The main adverse effect reported by patients was pain at the injection site. Of the 53 patients, only 2 patients reported pain at the injection site, but this was considered not significant because the patients had a BMI below 20 and they also reported the same symptom when administering the originator. One patient reported experiencing abdominal pain and rectal bleeding immediately after switch, but no recurrence was observed clinically and endoscopically. Conclusion: This observational study is the first carried out in Romania that shows that the after the non-medical switch, biosimilars of Adalimumab were as efficient as the originator Adalimumab in the clinical practice of patients with IBD. These results support that conclusion that the large-scale use of biosimilars does not significantly affect the effectiveness of the therapy and the safety of the patient.

In the recent years, tubular nanostructures have been related with immense advances in various fields of science and technology. Considerable research efforts have been centered on the theoretical prediction and manufacturing of non-carbon nanotubes (NTs), which meet modern requirements for the developing of novel devices and systems. In this context, diatomic inorganic nanotubes formed by atoms of elements from the 13th group of the periodic table (B, Al, Ga, In, Tl) and nitrogen (N), have received much research attention. In the present work, the elastic properties of single-walled boron nitride, aluminium nitride, gallium nitride, indium nitride and thallium nitride nanotubes were numerically evaluated using the nanoscale continuum modelling approach (also called molecular structural mechanics). The elastic properties (rigidities, surface Young´s and shear moduli, and Poisson´s ratio) of nitride nanotubes are discussed with respect to the bond length of the corresponding diatomic hexagonal lattice. The results obtained contribute to a better understanding of the mechanical response of nitride compound-based nanotubes, covering a broad range from the well-studied boron nitride NTs to the hypothetical thallium nitride NTs.

Design plays a critical role and creates a positive user experience, establishing a solid brand identity and staying competitive in the digital world. This research investigates the impact of user data collecting and analysis in improving user experience. The Data-driven User interface design can create an optimized and relevant UI with individual preferences, which leads to increasing user engagement and usability. The proposal explores methodologies to implement data collection and user research for tailoring digital products.

The speed-density or flow-density relationship is a fundamental aspect of traffic flow theory. Single-regime models often face challenges in consistently fitting empirical data under diverse traffic conditions. This paper addresses the inaccuracies of single-regime models, attributing them not only to their functional forms but also to data dispersion and sample selection bias. To mitigate these issues, the data is segmented into day and night periods, leading to the creation of separate models for each. Calibration results, conducted on data from two freeways, Tehran-Karaj and Tehran-Qom, reveal distinct challenges, with the former exhibiting high dispersion and the latter showing low dispersion. Surprisingly, single-regime models demonstrate notable effectiveness when applied to distinct day and night data. Further analysis, categorizing data into day and night, results in reduced errors (20-60% improvement in R-Square), emphasizing the potential for enhanced accuracy by considering distinct regimes. Overall, the study underscores the significance of regime-specific considerations for accurate traffic flow modeling. Upon thorough evaluation, the study highlights the superiority of the neural network Multi-layer Perceptron (MLP) over traditional models. The research discusses the implications of incorporating day and night parameters into the models, emphasizing their potential for accuracy enhancement.

Background: A Morel–Lavallée lesion (MLL) is a traumatic, internal closed degloving injury that results from shearing of subcutaneous tissue away from underlying fascia, usually associated with high-velocity trauma. Case presentation: A 52-year-old man was transported to hospital for further follow-up of a superficial femoral artery injury. Examination on admission showed bruising seen around the left thigh. Contrast-enhanced computed tomography of the left thigh revealed hematoma with extravasation from a branch of the left superficial femoral artery, but no apparent aneurysms or femoral fractures. The patient was treated with compression bandages and discharged on hospital day 6. He left hospital able to walk unaided. He subsequently complained of left thigh pain with swelling and visited the hospital several times. He was treated at another outpatient clinic and was diagnosed with MLL. Single-use disposable portable negative pressure wound therapy (NPWT) was applied for about 2 months, achieving a stable wound site. Conclusion: We encountered a case of MLL successfully treated with single-use portable NPWT. This report presents the case of a patient with isolated MLL without fracture in the left thigh, in which the diagnosis was missed on initial admission. Finally, the patient received minor interventions including drainage along with tissue debridement and portable NPWT. We reviewed the relevant literature and summarize the pathogenesis, clinical manifestations, and treatment strategies for MLL. Emergency physicians require an increased understanding of MLL to avoid misdiagnosis and missed diagnosis.

Pre-exposure prophylaxis for COVID-19 with Tixagevimab/Cilgavimab in immunocompromised patients has reduced the risk of breakthrough infection, disease, hospitalization, and COVID-19 related mortality. However, the advent of the Kraken variant (XBB.1.5) has limited the use of this monoclonal antibody, based on poor efficacy in in vitro studies The objective of the study was to evaluate the risk of breakthrough infection, symptomatic disease, hospitalization, intensive care admission and COVID-19 related death in kidney transplanted recipients receiving pre-exposure prophylaxis with Tixagevimab/Cilgavimab for COVID-19 in the era of the Kraken variant (XBB.1.5). In a prospective, observational study, we enrolled kidney transplant patients undergoing pre-exposure prophylaxis for COVID-19 with Tixagevimab/Cilgavimab at the Division of Infectious Diseases of Federico II University of Naples between February 2023 and August 2023. Each patient subsequently underwent a six-month follow-up with symptom monitoring and surveillance nasopharyngeal swab for SARS-CoV-2 RNA detection every 30 days, regardless of symptoms. Thirty-four kidney transplant patients were enrolled and in the follow-up period, only one tested positive for the nasopharyngeal swab for SARS-CoV-2 research with asymptomatic infection and virological recovery on the eighth day from the diagnosis of infection. Therefore, no patient developed disease and no patient needed hospitalization and no death occurred. No adverse drug reaction to Tixagevimab/Cilgavimab occurred. Our data, although derived from a limited and uncontrolled sample, show the potential of Tixagevimab/Cilgavimab as a valid and viable therapeutic strategy in pre-exposure prophylaxis for immunocompromised patients. These findings highlight the importance of conducting clinical studies on this topic.

To elucidate mesenchymal stromal cells (MSC)-tumor intricate and ambiguous interactions, the reliable cell labeling and tracking techniques are imperative. Traditional methods of cell labelling have limitations mostly relevant to need for genetic modification what demands the exploration for alternative strategies. Here, we propose using fluorescent photoconvertible microcapsules containing Rhodamine B (RhB) to study mMSC migration in brain tumors. These 3 μm sized microcapsules are readily internalised by cells and undergo photoconversion under 561 nm laser exposure with fluorescence blue shift on demand. Optimal photoconversion was achieved with a laser irradiation duration of 0.4 ms, which provide a maximal brightness of photoconverted label without an excessive laser exposure on cells. Capsules modified with polyallylamine hydrochloride demonstrated the best potential for intracellular uptake without significantly affecting cell viability, motility, or proliferation. The optimal ratio of 20 capsules per mMSC was determined for labeling. Moreover, migration of individual mMSCs within 2D and 3D glioblastoma cell (EPNT-5) colonies over 2 days and in vivo tumor settings over 7 days was tracked. Our study unveils a robust platform for investigating MSC-tumor dynamics, offering insights into therapeutic strategies. Photoconvertible microcapsules could also become an indispensable tool for studying complex fundamental processes of cell-cell interactions for a wide range of problems in biology and medicine.

Objectives: Describe the epidemiology of burns in the pediatric population. Analyze and compare the results obtained from the treatment of burn wounds by using the bio-preserved human epidermis allograft (BHEA) and other types of dressings and determine the need for further need of a skin graft. Methods: A retrospective cross-sectional study of pediatric population with burn injuries was conducted, grouped into categories based on their age group, and the mechanisms of injury into 6 categories: scald, flame, contact, electrical, chemical and friction. Describing the extension and depth of the burn injury. The results of treatment of two groups; the patients who used (BHEA) and the group with “other dressings” were analyzed by inferential statistics to establish the relationship between the use of BHEA and the need for skin grafts compared to the other group. Results: A total of 65 patients were obtained. The average age was 4.5 years (±3.8). Preschoolers (1-5 years old) were the most frequent age group 64% (n=42). Male patients represented 61% (n=40) of cases. Scald was the most reported mechanism 64% (n=42). The average total body surface area burned (TBSAB) was 10.8% (± 9.2). Mixed partial thickness burn (superficial and deep) was the most common with a 55%. The head was the most affected anatomical site; 30%. The face was the most reported “special anatomical site” with a 40% (n=30). 32.2 % of the population (n=21) was treated with BHEA. The average time of epithelialization of the BHEA group was 8 days (±7.2), and their average hospital stay time was 7 days (±5.7). In the “other dressing” group, the average epithelialization time was 18 days (±13.6), and the average hospital stay time was 11 days (±12.6). Fifty percent (n=22) of the “other dressing” group required skin grafts. In the BHEA group only 19% (n=4) required skin grafts. An OR of 0.23 and CI of 95% (0.06 – 0.81) with a p value of (0.017) for the need of skin grafts after de use of BHEA was obtained. Conclusion: The epidemiological results reported are similar to those described in the literature. The use of (BHEA) proved to be a good option for the management of partial thickness burns and burns in transition, promoting timely epithelilization and avoiding deepening of the burns while reducing morbidity, hospital stay and care costs.

The Imbalance Cost Pass-Through (ICPT) is a flexible component of the Incentive Regulation (IBR) that empowers power producers to adjust tariffs in response to variable fuel prices, thereby enhancing the economic resilience of electricity generation. However, the cost of electricity generation is significantly influenced by the volatility of commodity prices, including coal, gas and LNG. In Malaysia, the Energy Commission has conducted biannual reviews of fuel and other generation costs. Any cost savings or increases identified during these reviews will be passed on to customers in the form of rebates or surcharges. Due to that reason, this study proposes ICPT price forecasting for the electricity market in Peninsular Malaysia. The study aims to construct an ICPT-related baseline model for the peninsular generation data by employing three forecasting methods. The forecasting performance is analysed by a Mean Absolute Percentage Error (MAPE). In findings, the ARIMA method is one of the most accurate forecasting methods for fuel prices compared to the Moving Average (MA) and LSSVM methods. The observed price differences between the ARIMA and LSSVM models for ICPT are minimal. The ICPT price for July-December 2022 and January-June 2023 is MYR 0.21/ kWh for ARIMA and MYR 0.18/kWh for LSSVM, which are close to the actual TNB’s ICPT tariff. As for the forecasting, the ICPT price is expected to drop for the next announcement. The findings of this study may contribute to a positive impact on the sustainability of the energy sector in Malaysia.

Fostering fruitful collaboration between chemistry and physics scholars, the analysis of the differences in the practical approach to single atoms in chemistry and in physics affords a number of conceptual outcomes pointing to a more balanced relationship between chemistry and physics.

The observation that certain therapeutic strategies for targeting inflammation benefit patients with distinct immune-mediated inflammatory diseases (IMIDs) is exemplified by the success of TNF blockade in conditions including rheumatoid arthritis, ulcerative colitis and skin psoriasis, albeit only for subsets of individuals with each condition. This suggests intersecting "nodes" in inflammatory networks at a molecular and cellular level may drive and/or maintain IMIDs, being “shared” between traditionally distinct diagnoses without mapping neatly to a single clinical phenotype. In line with this proposition, integrative tumour tissue analyses in oncology have highlighted novel cell states acting across diverse cancers, with important implications for precision medicine. Drawing upon advances in the oncology field, this narrative review will first summarise learnings from the Human Cell Atlas in health as a platform for interrogating IMID tissues. It will then review cross-disease studies to date that inform this endeavour, before considering future directions in the field.

Keywords: Rhinoplasty - Augmentation rhinoplasty - Open rhinoplasty - Facial rejuvenation – Centrofacial lipofilling.

In considering the question of machine as artist, the art object can be analytically separated from its making, and its making can be dualistically conceptualized as process on one hand and experience on the other. One of the reasons we value art is that there was an experience of its making. To better understand what is meant by the experience of art-making, this paper presents results from a qualitative, phenomenological study of a group of artists. These results appear in three groups: feeling, intention and lifeworld. Machines cannot experience art-making, at least not in the same way as humans, and thus they cannot create art but only art-like objects. Even so, in the present century, we should not be asking whether machines can be artists, but rather how machines can help more people experience art-making for themselves.

This study introduces a novel algorithm tailored for the precise detection of lower outliers in univariate datasets, particularly suited for scenarios with a single cluster. The approach leverages a combination of transformative techniques and advanced filtration methods to efficiently segregate anomalies from normal values. Notably, the algorithm emphasizes high precision, ensuring minimal false positives, and requires only a few parameters for configuration. Its unsupervised nature enables robust anomaly filtering without the need for extensive manual intervention. To validate its efficacy, the algorithm is rigorously tested using real-world data obtained from photovoltaic (PV) module strings with similar DC capacities, containing various anomalies. Results demonstrate the algorithm's capability to accurately identify lower outliers while maintaining computational efficiency and reliability in practical applications.

Background: The effect of velamentous cord insertion (VCI) on perinatal outcomes in twin pregnancies is unclear due to conflicting findings. This retrospective study aimed to examine VCI prevalence and related risk factors in twin pregnancies and its association with adverse perinatal outcomes. Methods: Women with twin pregnancies who delivered between January 2012 and December 2021 in a single tertiary hospital were included. The participants were divided into dichorionic (DC) and monochorionic diamniotic (MCDA) groups, and their maternal and fetal characteristics and VCI rates were compared. Logistic regression models were used to identify risk factors for VCI and VCI-related perinatal outcomes. Results: Among the 694 twin pregnancies included in this study, the VCI rate was significantly higher in MCDA than in DC twins. Body mass index and MCDA twins were significant risk factors for VCI, whereas assisted reproductive technology pregnancy was a significant protective factor against VCI. In DC twins, VCI did not affect perinatal outcomes. Conclusion: In MCDA twins, VCI was a significant risk factor for fetal growth restriction, twin-to-twin transfusion syndrome, and preterm birth at

Single-cell RNA sequencing (scRNA-seq) technique has enabled detailed analysis of gene expression at the single cell level, enhancing the understanding of subtle mechanisms that underly pathologies and drug resistance. To derive such biological meaning from sequencing data in oncology, some critical processing must be performed, including identification of the tumor cells by markers and algorithms that infer copy number variations (CNVs). We compared the performance of sciCNV, InferCNV, CopyKAT and SCEVAN tools that identify tumour cells by inferring CNVs from scRNA-seq data. Sequencing data from Pancreatic Ductal Adenocarcinoma (PDAC) patients, adjacent and healthy tissues were analysed, and the predicted tumor cells were compared to those identified by well-assessed PDAC markers. Results from InferCNV, CopyKAT and SCEVAN overlapped by less than 30% with InferCNV showing the highest sensitivity (0.72) and SCEVAN the highest specificity (0.75). We show that the predictions are highly dependent on the sample and the software used, and that they return so many false positives hence are of little use in verifying or filtering predictions made via tumor biomarkers. We highlight how critical this processing can be, warn against the blind use of these software and point out the great need for more reliable algorithms.

Objective: This study aimed to demonstrate the availability of portable devices for nasal FeNO measurement, which could replace exhaled NO measurement based on the continuous aspiration of multiple flow measurement systems. Methods: A descriptive cross-sectional study. The healthy subjects without rhinosinusis disorders (control group) and those with diagnosed allergic rhinitis (AR group) were enrolled in the study. They underwent nasal and bronchial FeNO measurements by both fixed flow NObreath® connected to nasal mask and multiple flows HypAir FeNO®. Results: A total of 153 people were recruited including 63 healthy subjects and 90 subjects with AR. There were no statistically significant differences in anthropometric characteristics between the two groups (P > 0.05). There were a significant increase in FeNO values in the AR group compared to the control group; concentrations of nasal and bronchial FeNO mearsured by NObreath® were 76.0 ± 50.7 ppb (vs 36.0 ± 28.1 ppb, P < 0.01) and 32.3 ± 15.4 ppb (vs 9.2 ± 5.6 ppb, P < 0.001), and those mearsured by NObreath® Hypair FeNO® were 1796.9 ± 523.3 ppb (vs 400.2 ± 123.1 ppb, P < 0.001) and 37.3 ± 23.0 ppb (vs 17.4 ± 18.3 ppb, P < 0.01). A weak correlation between the values measured by NObreath® and Hypair FeNO® devices was observed (r = 0.023 and r = 0.089, respectively; p < 0.05). Conclusions: The handheld NObreath® device is effective in measuring FeNO concentrations in both normal subjects and AR patients. The advantages in price and size, creating a compact, low-cost device that is convenient for use and research.

This study examines the feasibility of using event-related potentials (ERPs) obtained from electroencephalographic (EEG) recordings as biomarkers for long-term memory item classification. Previous studies have identified old/new effects in memory paradigms associated with explicit long-term memory and familiarity. Recent advancements in convolutional neural networks (CNNs) have enabled the classification of ERP trials under different conditions and identification of features related to neural processes at the single-trial level. We employed this approach to compare three CNN models with distinct architectures using experimental data. Participants (N = 25) performed an association memory task while recording ERPs that were used for training and validation of the CNN models. The EEGNET-based model achieved the most reliable performance in terms of precision, recall, and specificity compared with the shallow and deep convolutional approaches. The classification accuracy of this model reached 70% for known items and 62% for unknown items. Good overall accuracy requires a trade-off between recall and specificity and depends on the architecture of the model and the dataset size. These results suggest the possibility of integrating ERP and CNN into online learning tools and identifying the underlying processes related to long-term memorization.

Background: In recent years, the integration of robotic systems into various aspects of daily life has become increasingly common. As these technologies continue to advance, ensuring user-friendly interfaces and seamless interactions becomes more essential. For social robots to genuinely provide lasting value to humans, a favourable user experience (UX) emerges as an essential prerequisite. Aim: This article aimed to evaluate the usability of the MINI robot, highlighting its strengths and areas for improvement based on user feedback and performance. Method: In a controlled lab setting, a mixed-method qualitative study was conducted with ten individuals aged 65 and above diagnosed with mild dementia (MD) and mild cognitive impairment (MCI). Participants engaged in individual MINI robot interaction sessions, completing cognitive tasks as per written instructions. Video and audio recordings documented interactions, while post-session System Usability Scale (SUS) questionnaires quantified usability perception. Ethical guidelines were followed, ensuring informed consent, and the data underwent qualitative and quantitative analyses, contributing insights into the MINI robot's usability for this demographic. Results: The study addresses the ongoing challenges that tasks present, especially for MD individuals, emphasizing the importance of user support. Most tasks require both verbal and physical interactions, indicating that MD individuals face challenges when switching response methods within subtasks. These complexities originate from the selection and use of response methods, including difficulties with voice recognition, tablet touch, and tactile sensors. These challenges persist across tasks, with individuals with MD struggling to comprehend task instructions and provide correct answers and individuals with MCI struggling to use response devices, often due to the limitations of the robot's speech recognition. Technical shortcomings have been identified. The results of the System Usability Scale (SUS) indicate positive perceptions, although there are lower ratings for instructor assistance and pre-use learning. The average SUS score of 68.3 places device usability in the "good" category. Conclusion: Our study examines the usability of the MINI robot, revealing strengths in quick learning, simple system and operation, and integration of features while also highlighting areas for improvement. Careful design and modifications are essential for meaningful engagement with people with dementia. The robot could better benefit people with MD and MCI if clear, detailed instructions and instructor assistance are available.

One of the main challenges of cultured meat is reducing the costs of production, often described as scaling. The main components of the cultivation process include: cells, media, scaffolds and bioreactors. This work presents an alternative to current stainless steel or glass bioreactors and uses food-grade plant-based scaffolds. Bioreactors must be sterile and leak-free to maintain a proper environment for cell growth. Thermoplastic films are a popular material for constructing these fluidic systems, but traditional methods of welding these film are expensive and do not allow rapid prototyping resulting in high research and development costs for companies. In this study, a laser welding method was developed to join thermoplastic films in a way that prevents contamination and leaks, affording effective macro-fluidics fabrication. This technique was tested using polyethylene (PET) films and a laser cutter operating with settings calibrated for the material to be welded or cut. The laser welding method was found to produce strong, leak-free seals in PET films with minimal heat-induced damage to the films. The ability to design fluidics, chambers and ports of various size. Using this method afforded the incorporation of plant-based scaffolds from food-grade plants (Rice). The laser welding method developed in this study provides a reliable, contamination-free method for the rapid fabrication of fluidic systems for cell cultivation. This technique has the potential to be compatible with a vast range of cell types and scaffolds and to be widely adopted in tissue engineering for regenerative medicine and food applications such as cultured meat.

Introduction. Anesthesia is widely used in various fields of dentistry to reduce patient discomfort when the treatment would be painful. The dentist may need to infiltrate the anesthetic into multiple locations and this is usually done with the same needle which passes through the soft tissues several times to distribute the anesthetic solution over a larger area. The present study aims to evaluate, through a morphological analysis under a scanning electron microscope (SEM), how the beveled tip of a 30G needle, used to inject anesthetic several times into different areas of the vestibular mucosa, changes. Materials and methods. 30G needles with two different brands were tested, in vivo used for a variable number of sequential injections from 1 to 6 on 192 patients. The specimens were analyzed under SEM observation to evaluate any deformations induced by contact with the vestibular soft tissues. Results. The amount of deformation, measured along the axis parallel to the needle, was proportional to the number of injections. The protrusion of deformations, measured on an axis perpendicular to the needle, were maximum on the needles used 3 times. For the needles used 4,5 and 6 injections, no further increase in deformations was noted. Conclusion. From the data it seems that the tested needles are not produced to withstand multiple injections consequently after the first injection on soft tissues, they undergo a deformation which could increase the risk of injury to the mucosa itself or to nerves and vessels with which they come into contact. It would be advisable to use the single needle for a reduced number of injections.

Background and Objectives: The complications seen after lower impacted third molar surgery affect the quality of life of the patients. The aim of the study was to investigate the efficacy of a single preoperative dose of deflazacort on pain, swelling and trismus following impacted lower third molar surgery. Materials and Methods: This randomised, prospective, double-blind, split-mouth clinical study included 30 healthy individuals with bilaterally impacted lower third molars that was removed for orthodontic purposes between September 2017 and September 2018. Group 1 was given a placebo (single dose vitamin C tablet) and group 2 was given a single 30 mg dose of deflazacort 1 hour prior to the surgery. Pain was evaluated using the visual analog scale for 1 week postoperatively. Edema (in mm) and trismus (in mm) were evaluated preoperatively and on postoperative days 2 and 7. The Mann-Whitney U test was applied for group analysis. p values < 0.05 were considered statistically significant. Results: When postoperative pain scores were evaluated, a significant difference was found between the groups only at the 6th and 12th hours (p0.05). Even high trismus values were recorded on the 2nd day, it was observed that the trismus resolved on the 7th day. There were no significant differences in trismus between the groups at any time point (p>0.05). Evaluation of swelling showed that there was no statistically significant difference between the study and control groups at any time point (p>0.05). No side effect was detected in both the study and the control groups. Conclusions: This was the first split-mouth study evaluating the anti-inflammatory effect of deflazacort after lower impacted third molar surgery. A single dose of 30 mg deflazacort was shown to be effective in reducing pain at 6 and 12 hours postoperatively.

The results of the investigation showed that second-order kinetics govern the adsorption process, and the corresponding rate constants were found. To evaluate the parameters related to the adsorption process, the adsorption equilibrium was examined using a variety of mathematical models, such as the Langmuir, Freundlich, Temkin, and Dubinin-Radushkevich isotherm models. The Langmuir isotherm was found to be the best appropriate among all models for describing the adsorption of Cu2+ and Ni2+ ions using bio-nanocomposite beads. The positive values of ΔH° indicate that the adsorption is physical and endothermic, in agreement with experimental results. The negative value of ∆G° shows that the adsorption process is spontaneous. Positive ΔS° values indicate increased randomness at the solid/liquid interface, during adsorption of Cu2+ and Ni2+ cations onto the engineered bio-nanocomposite. The maximum adsorbed amounts of metal ions by the bio-nanocomposite used were 370.37 mg/g for Ni2+ and 454.54 mg/g for Cu2+ from single system. For the binary system, according to the Langmuir isotherm, the maximum adsorbed amounts of Ni2+ and Cu2+ were 357.14 mg/g and 370,37 mg/g, respectively. There is proof that Alginate-Moroccan clay bio-nanocomposites can serve as a different, less expensive source of sorbents for the removal of metal ions from single and binary systems.

A useful perioperative nutritional therapy for highly invasive esophageal cancer surgical cases needs to be developed. We clarified the usefulness of amino acid-enriched nutritional therapy using glutamine (Gln)/arginine (Arg)/calcium β-hydroxy-β-methylbutyrate (HMB) products on the short-term postoperative outcomes of minimally invasive esophagectomy for esophageal cancer. Altogether, 114 patients (Gln/Arg/HMB group) received perioperative nutritional therapy with Gln/Arg/HMB products, and we retrospectively investigated the change in nutritional parameters including skeletal muscle mass, occurrence of postoperative complications, and short-term postoperative outcomes in this group. The results were compared between the Gln/Arg/HMB and control groups (79 patients not receiving the Gln/Arg/HMB products). The incidence of all postoperative complications, sputum expectoration disorder, and pleural effusion of grade ≥III was significantly lower in the Gln/Arg/HMB group (62.0% vs. 38.6%, p = 0.001; 44.3% vs. 28.1%, p = 0.020; 27.8% vs. 13.2%, p = 0.011, respectively). The psoas muscle area and postoperative body weight was significantly higher at 1 month and 1 year after surgery in the Gln/Arg/HMB group than in the control group (93.5% vs. 99.9%, p &lt; 0.001; 92.0% vs. 95.4%, p = 0.006). Perioperative amino acid-enriched nutritional therapy may improve the short-term postoperative outcomes, nutritional status, and skeletal muscle mass of esophageal cancer surgical patients.

Since its introduction almost 50 years ago, the concept of ‘flow’ has been descriptive of optimal experiences, also in relation to play. However, the explorative nature of play leads to some discrepancies between flow and the optimal experience of play. In this paper the differences between flow and play are explored, leading to proposing the state of ‘wonder’ (directed at exploration) as an alternative to ‘flow’. From this perspective, the study further explores how we may design toys that enable meaningful experiences of play, identifying opportunities in designing for toys as the enablers of immersed experiences of wonder.

Spectacular shifts have been led to by The COVID-19 crisis in consumer behavior. Retailers will have to work hard to meet ever-evolving customer service experience with respect to the ways in which it may be differently affected by offline or online transactions in order to win and stay relevant. We suggest an integrative framework and construct customer service experience hypotheses, based on its antecedents and consequences that will contribute to academic study as well as managerial implications. The hypotheses are tested by a simultaneous equation model employing two data sets of the retail industry's offline and online customers. In this study, 571 samples of these businesses, 319 and 252 respondents from offline and online retail channels, respectively, were collected by means of an online web survey of consumers. The results show that the impact of consequences and antecedents of CSX differs based on the media utilized. The integrative framework of CSX in its online medium is far more effective than its explanatory power offline. The outcomes are reasonably counterintuitive in so far as they demonstrate that while most elements of CSX where a service is selected offline is the same in terms of customer loyalty and value equity, the emotional element related to the service provider is higher when the service is selected offline rather than online. These outcomes indicate that, contrary to popular fears, the online medium enables firms to develop a loyal customer foundation. These findings offer perceptivity into how an online channel could be used to better complement the offline channel, contributing towards new knowledge and understanding on CSX and how it may be utilized for managerial decision-making.

Mate crime is a specific subset of hate crime in which the perpetrator is known to the victim. To date, there is very little research into the perception and experience of mate crime in autism. The aim of the current study was to examine perceptions of friendship and mate crime in autistic adults, using semi-structured interviews. Five adults were interviewed about their experiences of social interactions, friendships and mate crime. Participants described distancing themselves from the ‘disability’ label whilst growing up to avoid condescension and being perceived as vulnerable, whilst learning to camouflage their social difficulties. Feelings of anxiety were associated with socialising, and participants valued relationships that did not place too many overwhelming demands on their time or energy. Finally, all participants had prior experiences of bullying. They understood the concept of mate crime but were unsure as to whether they would be able to identify it in their own lives if it occurred. However they could identify potential support networks in close friends and family. Results highlight the importance of further research into positive and negative aspects of social relationships in autistic adults, and the need to provide support to those who are socially vulnerable.

The power of movement in plants” by Charles Darwin details many examples of oscillatory growth exemplified more recently at the single cell level by pollen tube tip oscillations and associated ion fluxes, particularly Ca²⁺and H⁺. That implies an underlying growth oscillator based on the recent discovery that classical AGPs bind Ca²⁺ at the cell surface. The juxtaposition of AGPs with three other components embedded in the plasma membrane is evidence of a Ca²⁺ cycle that generates cytosolic Ca²⁺. It involves Ca²⁺ channels, auxin efflux “PIN” proteins and an auxin-activated proton pump that dissociates AGP-Ca²⁺ on demand. While the apparent simplicity of this system satisfies Occam’s Razor its hypothetical role as a global growth oscillator demands rigorous experimental appraisal. The wide ramifications extend from pollen tubes to stomatal guard cells. Stomata act as crucial components of a water hypercycle that contributes to homeostasis of a warming planet by regulating evaporative cooling, reflective cloud cover generated by vast forests and the high albedo of snow-capped mountains including polar ice-caps . The Gaia hypothesis of James Lovelock and Lynn Margulis is a brilliant metaphor.

Objectives: To assess the short-term impact of a single global stretching session on plantar pressures and lumbar range of motion (RoM) over one week in sedentary university students. Design: A randomised controlled trial with two parallel groups. Participants: Sixty-four university students were randomly assigned to a stretching group or control group. The stretching group received a single session of global stretching and the control group remained seated for the same length of time as the stretching session. Main outcome measures: Lumbar RoM and plantar pressures were assessed before, immediately after, 48 hours after, and 7 days after intervention. Results: Group-by-time interaction was significant for lumbar lateral flexion (p = 0.044), right maximal pressure (p = 0.003), left maximal pressure (p = 0.008), right mean pressure (p = 0.025), left mean pressure (p = 0.002), and maximal pressure minus mean pressure in right foot (p = 0.007). The model with plantar pressures showed a significant difference for group-by-time interaction (p = 0.010).Conclusion: Global stretching seems to counteract the ill-effects of prolonged sitting up to seven days with respect to plantar pressure in standing without improving lumbar ROM

This retrospective study aimed to evaluate the performance of the hormone treatment protocols, determine the factors associated with pregnancy success after hormone treatment, and compare the cost-efficiencies of two types of hormone treatment among cyclic and noncyclic anestrous dairy cows. The clinical records of 279 anestrous cows who received hormone treatment for artificial insemination (AI) from 64 herds in the western region of Thailand were obtained from Kasetsart University Veterinary Teaching Hospital from January to August 2017. The performance of the hormone treatment protocols, fixed-time AI (TAI) and estrus detection before AI (EAI), showed that the pregnancy risk for the TAI protocol was higher than for the EAI protocol, but pregnancy per AI did not differ significantly between the two protocols in cyclic and noncyclic cows. Multivariate logistic regression analysis showed that cows receiving the TAI protocol were more likely to be pregnant compared to those treated with the EAI protocol. Cows with a 3.00 body condition score (BCS) &lt;3.75 after treatment and loose-housing cows were more likely to become pregnant. Treatment during winter showed higher pregnancy success than in the summer and rainy seasons. The cost-efficiency analysis showed that the TAI protocol was the most cost-efficient option for noncyclic cows, whereas the EAI protocol was the most cost-efficient option for cyclic cows.

The aim of this study was to evaluate the usefulness of cystoscopic injection of Botulinum-A toxin (BTX) in the detrusor wall in the treatment of children with decreased bladder capacity due to neurogenic bladder. The prospective, randomized non placebo controlled trial is conducted in our institution since year 2006 with the approval of the local Ethics Committee. 556 cystoscopic injections of BTX were performed in 141 children with neurogenic bladder in age 1 to 18 years. In all cases decreased bladder capacity and bladder overactivity with urine incontinence were estimated. The pre-and post-treatment evaluations included determination of urinary continence status, bladder function in frequency/volume chart of catheterized urine and in urodynamic studies. Parameters measured in urodynamic investigations included maximal cystometric capacity, detrusor reflex volume, maximal detrusor pressure. Parameters were analyzed before the cystoscopy and during the follow-up examinations in 5 age groups. Values of all measured parameters improved significantly and equally after therapy in every from 5 age groups. The results obtained from the study confirmed that endoscopic administration of BTX improves function of urinary bladder in children with neurogenic bladder, and the method represents an alternative approach to conservative treatment and surgical augmentation.

Hydrogen evolution reaction (HER) is one of the most important reaction in electrochemistry. This is not only because it is the simplest way to produce high purity hydrogen and the fact that it is the side reaction in many other technologies. HER actually shaped current electrochemistry because it was in focus of active research for so many years (and it still is). The number of catalysts investigated for HER is immense, and it is impossible to overview them all. In fact, it seems that the complexity of the field overcomes the complexity of HER. The aim of this review is to point out some of the latest developments in HER catalysis, current directions and some of the missing links between a single crystal, nanosized supported catalysts and, recently emerging, single atom catalysts for HER