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Abstract The British Standards Institution's Publicly Available Specification 440 (PAS 440) provides a Responsible Innovation Framework (RIF) that companies can use to continuously monitor the societal, environmental and health benefits and risks of their innovations, as well as relevant changes to the supply chain and regulations. PAS 440 is intended to help companies achieve the benefits of innovation in a timely manner and avoid any potential harm or unintended misuse of a new product, process or service. Here, the authors have applied the PAS 440 RIF to a novel single‐cell protein (SCP) animal feed ingredient taking into consideration the perspectives of the value chain partners (VCPs), companies and laboratories involved in an Innovate UK research project. The authors’ findings show how VCPs can use PAS440 to demonstrate that they are innovating responsibly. Using this approach to responsible innovation along the value chain—from manufacturing scale‐up, through regulatory approval, to incorporation in animal feed and from there to food on supermarket shelves—can support the development of innovations that contribute to the economic and environmental sustainability of the animal feed sector. The authors conclude that the PAS 440 Guide can facilitate the progress of a new product throughout a value chain and contribute to coordinating responsible behaviour among companies involved in the value chain.

Capacitor banks (CBs) play a crucial role in energy storage and frequency control within autonomous microgrids. However, the impact of internal capacitor configurations, varying in terms of equivalent series resistance (ESR), capacitance, and rated voltage, on CB degradation, reliability, and peak current remains an understudied aspect. Moreover, the absence of a capacitance degradation coefficient in the standard MIL-HDBK-217 equations for predicting the reliability of electrolytic capacitors poses a significant challenge. To address these issues, this study examines a microgrid composed of diverse renewable energy systems, featuring nine distinct CB arrangements. The design of CBs considers both capacitance and peak output current individually. An evaluation is conducted to compare construction costs, lifetimes, and peak output currents across all layouts. Additionally, a novel formula is introduced to estimate the reliability and lifetime of CBs, while an existing formula for calculating CB peak output current is enhanced. The research explores the impact of ambient temperature and capacitor voltage on the reliability of various capacitor designs, proposing a novel framework for assessing CB reliability based on MIL-HDBK-338B, which accounts for both short-circuit and open-circuit faults. The practicality of these findings is confirmed through a comparison of experimental and simulation results. The inverter operation video, simulation, and all production data including PCB and processor codes are also attached.

Summary: Neuroblastoma is the most common extracranial solid tumor of childhood. While MYCN and mutant anaplastic lymphoma kinase (ALKF1174L) cooperate in tumorigenesis, how ALK contributes to tumor formation remains unclear. Here, we used a human stem cell-based model of neuroblastoma. Mis-expression of ALKF1174L and MYCN resulted in shorter latency compared to MYCN alone. MYCN tumors resembled adrenergic, while ALK/MYCN tumors resembled mesenchymal, neuroblastoma. Transcriptomic analysis revealed enrichment in focal adhesion signaling, particularly the extracellular matrix genes POSTN and FN1 in ALK/MYCN tumors. Patients with ALK-mutant tumors similarly demonstrated elevated levels of POSTN and FN1. Knockdown of POSTN, but not FN1, delayed adhesion and suppressed proliferation of ALK/MYCN tumors. Furthermore, loss of POSTN reduced ALK-dependent activation of WNT signaling. Reciprocally, inhibition of the WNT pathway reduced expression of POSTN and growth of ALK/MYCN tumor cells. Thus, ALK drives neuroblastoma in part through a feedforward loop between POSTN and WNT signaling.

Abstract C–C motif chemokine ligand 2 (CCL2) is a monocyte chemoattractant that promotes metastatic disease and portends a poor prognosis in many cancers. To determine the potential of anti-CCL2 inhibition as a therapy for recurrent metastatic disease in neuroblastoma, a mouse model of minimal residual disease was utilized in which residual disease was treated with anti-CCL2 monoclonal antibody with etoposide. The effect of anti-CCL2 antibody on neuroblastoma cells was determined in vitro with cell proliferation, transwell migration, and 2-dimensional chemotaxis migration assays. The in vivo efficacy of anti-CCL2 antibody and etoposide against neuroblastoma was assessed following resection of primary tumors formed by two cell lines or a patient-derived xenograft (PDX) in immunodeficient NOD-scid gamma mice. In vitro, anti-CCL2 antibody did not affect cell proliferation but significantly inhibited neuroblastoma cell and monocyte migration towards an increasing CCL2 concentration gradient. Treatment of mice with anti-CCL2 antibody combined with etoposide significantly increased survival of mice after resection of primary tumors, compared to untreated mice.

The present paper aims to describe the structure, function, and goals of two of the oldest Mobile Mental Health Units in Greece, namely, the Mobile Mental Health Unit in Fokida (MMHU-F) and the Mobile Mental Health Unit in Thrace (Alexandroupolis, MMHU-T). Information about their historical background, catchment areas, and current staffing, as well as the services provided by each MMHU is discussed. The focus of the paper is slightly biased towards the MMHU-F because it is the only available mental health service in the whole Fokida prefecture. The major goals of the MMHUs are the diagnosis, treatment, and prevention of relapse of severe mental illness within the community. Other important goals of the MMHUs are psychoeducation, psychological support for the family/caregivers, as well as vocational training and support for patients with severe mental illness. Statistical data depicting the demographic characteristics and diagnostic profiles of patients in each MMHU is also provided, and the differences between the two MMHUs are briefly discussed.

We report a rare case of recurrent isolated internal ophthalmoplegia attributed to oculomotor nerve (CN III) compression by the posterior cerebral artery (PCA). A 30-year-old female patient presented with recurrent right-sided headaches, right periorbital pain, and slight anisocoria. Slit-lamp examination revealed normal anterior and posterior segments except for vermiform movements of the right pupil with a temporal hyporeactive flat area. Tonic pupils were ruled out with pilocarpine 0.1% testing. Suspecting an internal ophthalmoplegia, magnetic resonance imaging was ordered which demonstrated the right CN III indented by the PCA, fulfilling the criteria of a neurovascular conflict. The evaluation of unilateral mydriasis from internal ophthalmoplegia should prompt neuroimaging with exclusion of aneurysmal or compressive lesions. CN III palsy can rarely be caused by vascular anatomical variants because of the proximity of the posterior intracranial circulation and CN III. Newer, more precise imaging techniques will better help characterize neurovascular conflicts presenting as cranial nerve palsies.

In the modern technological era of sophisticated applications and high-quality communications, a platform of clever strategy and quickly updated systems is needed. It should be capable of withstanding the fastest emerging problems like signal attenuation and hostile actions intended to harm the whole network. The main contributions of this work are the production of an OFDM system (with low cost) that can sustain high-speed communications and be easily adjusted with new integrated code while exhibiting the feasibility of implementing a transmitter–receiver system in the same DSP and demonstrating the holistic approach with the qualitative integration of such an architecture in a warfare scenario. Specifically, in this research, the point of view is toward three facts. The first is to show a method of quick self-checking the operational status of a digital signal processor (DSP) platform and then the pedagogical issues of how to fast check and implement an updated code inside DSPs through simple schematics. The second point is to present the prototype system that can easily be programmed using a graphical user interface (GUI) and can change its properties (such as the transmitted modulated sinusoids—orthogonal frequency division multiplexing subcarriers). Alongside the presentation, the measurements are presented and discussed. These were acquired with the use of an oscilloscope and spectrum analyzer. The third point is to qualitatively show the application of such a system inside a modern warfare environment and to recommend various potential system responses according to the development of such a platform of reconfigurable implemented OFDM systems. The implementation was performed for two types of systems: (1) transmitter and (2) transmitter–receiver system. Notably, the system acts quickly with a delay of about 1 msec in the case of transmitting and receiving in the same DSP, suggesting excellent future results under real conditions.

We analyzed a large number (77) of low-to-medium-magnitude earthquakes (M3.5–M6.5) that occurred within a period of three years (2020–2022) in the Southern half of Greece in relation to the ELF activity in that region and time period. In most cases, characteristic ELF signals appear up to 20 days before the earthquakes. This observation may add an important new element to the Lithospheric–Atmospheric–Ionospheric scenario, thus contributing to a better prediction of incoming earthquakes. We discuss the role of ELF observations in reliable seismic forecasting. We conclude that the magnitude of an earthquake larger than M4.0 and the distance of the epicenter shorter than 300 km from the recording site is needed for typical pre-seismic signals to be observed. Finally, we remark that a reliable prediction of earthquakes could result from an integrated project of multi-instrumental observations, where all the known variety of precursors would be included, and the whole data set would be analyzed by advanced machine learning methods.

Assessing and controlling cyber risk is the cornerstone of information security management, but also a formidable challenge for organisations due to the uncertainties associated with attacks, the resulting risk exposure, and the availability of scarce resources for investment in mitigation measures. In this paper, we propose a cybersecurity decision-support framework, called CENSOR, for optimal cyber security investment. CENSOR accounts for the serial nature of a cyber attack, the uncertainty in the time required to exploit a vulnerability, and the optimisation of mitigation measures in the presence of a limited budget. First, we evaluate the cost that an organisation incurs due to a cyber security breach that progresses in stages and derive an analytical expression for the distribution of the present value of the cost. Second, we adopt a Set Covering and a Knapsack formulation to derive and compare optimal strategies for investment in mitigation measures. Third, we validate CENSOR via a case study of a small business (SB) based on: (i) the 2020 Common Weakness Enumeration (CWE) top 25 most dangerous software weaknesses; and (ii) the Center for Internet Security (CIS) Controls. Specifically, we demonstrate how the Knapsack formulation provides solutions that are both more affordable and entail lower risk compared to those of the Set Covering formulation. Interestingly, our results confirm that investing more in cybersecurity does not necessarily lead to an analogous cyber risk reduction, which indicates that the latter decelerates beyond a certain point of security investment intensity.

Purpose: We investigated intraoperative OCT (iOCT)—guided epiretinal membrane (ERM) and internal limiting membrane (ILM) removal using a novel forceps with a laser-ablated tip surface; it was designed to help prevent indentation force, shear stress, or tractional trauma when grasping very fine membranes. Patients and Methods: This retrospective study included patients who underwent 23- and 25-gauge pars plana vitrectomy (PPV) for vitreoretinal interface disorders. ERM and ILM peeling was performed under guidance with microscope-integrated iOCT using novel ILM forceps with laser-ablated tip surfaces. These forceps were engineered to enhance friction when grasping tissue. Evaluation of ERM/ILM manipulation included postoperative slow-motion video analysis of the number of grasping attempts, initial ILM mobilization, and observed damage to retinal tissue. Results: ERM/ILM removal was successfully performed in all patients, with an average of four grasp actions to initial membrane mobilization (91%). Additional use of a diamond-dusted membrane scraper was used in two cases (9%). Mean best-recorded visual acuity (BRVA) logMAR improved from 0.5 ± 0.34 to 0.33 ± 0.36 (p = 0.05) and mean central retinal thickness (CRT) improved from 462 ± 146 µm to 359 ± 78 µm (p = 0.002). Postoperative iOCT video analysis demonstrated hyper-reflectivity of the inner retinal layers associated with retinal hemorrhage in five eyes (22%), but no grasping-related retinal breaks. Conclusions: The texturized surface on the tips of the ILM forceps were found to be helpful for mobilizing ILM edges from the retinal surface. iOCT-guided ERM surgery also allowed for improved intraoperative tissue visualization. We believe that these two technologies helped reduce both unnecessary surgical maneuvers and retinal damage.

Abstract Since the turn of the century, metamaterials have gained a large amount of attention due to their potential for possessing highly nontrivial and exotic properties—such as cloaking or perfect lensing. There has been a great push to create reliable mathematical models that accurately describe the required material composition. Here, we consider a quantum graph approach to metamaterial design. An infinite square periodic quantum graph, constructed from vertices and edges, acts as a paradigm for a 2D metamaterial. Wave transport occurs along the edges with vertices acting as scatterers modelling sub-wavelength resonant elements. These resonant elements are constructed with the help of finite quantum graphs attached to each vertex of the lattice with customisable properties controlled by a unitary scattering matrix. The metamaterial properties are understood and engineered by manipulating the band diagram of the periodic structure. The engineered properties are then demonstrated in terms of the reflection and transmission behaviour of Gaussian beam solutions at an interface between two different metamaterials. We extend this treatment to N layered metamaterials using the Transfer Matrix Method. We demonstrate both positive and negative refraction and beam steering. Our proposed quantum graph modelling technique is very flexible and can be easily adjusted making it an ideal design tool for creating metamaterials with exotic band diagram properties or testing promising multi-layer set ups and wave steering effects.

Abstract Background Pacemaker implantation involves intraoperative testing of ventricular sensing using a device called a pacing system analyzer (PSA). The value obtained is expected to correspond to those taken by the pacemaker after its implantation. This study determined the latency period for sensing intracardiac electrogram (EGM) by the right ventricular (RV) lead. Methods Patients without significant heart disease and underlying intrinsic atrioventricular (AV) conduction underwent Medtronic or Abbott dual‐chamber pacemaker implantation with the RV lead positioned on the mid‐septum. Real‐time sensing data were obtained through PSA and after pacemaker implantation to evaluate latency as the time interval Q‐VS between the onset of QRS on surface electrocardiogram and the sensed EGM by the RV lead. Results Of 157 patients, 105 had narrow QRS (

Key Clinical Message CRAO is an ophthalmic and medical emergency. This case is a reminder that diagnosis and management of CRAO begins with ophthalmologists but immediately thereafter care involves emergency cardiovascular and neurological similar to cerebral stroke.

Abstract Background Osteoarthritis (ΟΑ) is characterized by cartilage breakdown and subchondral sclerosis. Micro‐fractures of the calcified tissues have been, also, detected, but their exact role has not been elucidated yet. This study was to examine the frequency of cracks during OA progression and to correlate them with the underlying cellular modifications and matrix metalloproteinase‐2 (MMP‐2) expression using histological/immunohistological methods. Methods Overall, 20 patients and 3 controls (9 specimens per patient), aged 60–89 years, diagnosed with hip/knee OA were included. The development of cracks was examined in 138 sections, whereas the expression of MMP‐2 was examined in 69 additional sections. Results Based on Mankin score, three groups of OA severity were analyzed: Group I (mild) was constituted of sections with score 1–5 while Groups II (moderate) and III (severe) with score 6–7 and greater or equal to 8, respectively. Demographic characteristics did not reveal any association between the number of microdefects and age or body mass index (BMI). Cartilage micro‐cracks were increased during moderate and severe OA, while bone cracks were increased during mild and severe OA. In knee OA, cartilage cracks were not correlated with Mankin score, whereas in hip OA they appeared association with severity score. Bone cracks were positively correlated with matrix apoptotic osteocytes and osteoblastic cells, but not with osteoclasts. MMP‐2 immunostaining was increasing by OA severity in the osteochondral unit. Similarly, MMP‐2 was expressed on the microcracks’ wall mainly in Group III. Conclusion Our data displayed that bone cracks during primary OA stages, represent an early adaptative mechanism aiming to maintain cartilage integrity. Accumulation of bone defects and concomitant increase of apoptotic osteocytes activated an abnormal remodeling due to osteoblastic activity, in which MMP‐2 played a pivotal role, leading to subchondral sclerosis promoting further osteochondral deformities.

This paper presents a compact multifrequency reconfigurable patch antenna in terms of design and fabrication for operating in the S and C bands of the RF spectrum, which are overwhelmed by wireless applications. Reconfiguration is achieved by using a single PIN diode on the ground plane. By varying the voltage applied to the diode, three modes can emerge, exhibiting main resonant frequencies at 2.07, 4.63, and 6.22 GHz. Resonance switching requires a voltage of less than 0.9 V. The antenna fabricated on an FR-4 substrate, with a volume of 70 × 60 × 1.5 mm3, has a radiating patch element of a rectangular ring shape. The proposed low-cost antenna is easily implemented in a typical university lab-based environment. The total bandwidth for the three modes is close to 1 GHz, while the voltage standing wave ratio (VSWR) of the fabricated version of the antenna does not exceed 1.02, and the return loss is well below −40 dB for the three primary resonant frequencies.

Abstract We present a numerical method for computing reflection and transmission coefficients at joints connecting composite laminated plates. The method is based on modelling joints with finite elements with boundary conditions given by the solutions of the wave finite element method for the plates in the infinite half-spaces connected to the joint. There are no restrictions on the number of plates, inter-plate angles, and material parameters of individual layers forming the composite. An L-shaped laminated plate junction is discussed in more detail. Comparisons of numerically predicted scattering coefficients with semi-analytical solutions for the selected structures are presented. The results obtained are essential for statistical energy analysis and dynamical energy analysis based calculations of the wave energy distribution in full built-up structure.

Abstract Objective The aim of this prospective pilot study is to establish an initial database to register patients diagnosed with different types of childhood glaucoma and the set-up of a national registry for childhood glaucoma (ReCG) in Germany. 28 children with different types of diagnosed childhood glaucoma, who were admitted and treated at the Childhood Glaucoma Center of the University Medical Center Mainz, Germany were included. Main outcome measures were the type of childhood glaucoma, mean intraocular pressure (IOP) and genetic data of the patients. Results The documents and questionnaires for each individual included: informed consent form of the parents, medical history form of the child, patient’s gestational history questionnaire and general anesthesia examination form. Primary congenital and secondary childhood glaucoma were revealed in 11 (39%) and 17 (61%) patients, respectively. The mean IOP measured with Perkins tonometer in all patients under general anesthesia at the time of inclusion was 17.5 ± 11.8 mmHg in the right and 17 ± 8.9 mmHg in the left eyes. In 33% of children with glaucoma mutations in the CYP1B1, FOXC1, LTBP2 and TEK genes were found. The development of specific questionnaires for childhood glaucoma provides detailed baseline data to establish a ReCG in Germany for the first time.

Cloud computing is an attractive model that provides users with a variety of services. Thus, the number of cloud services on the market is growing rapidly. Therefore, choosing the proper cloud service is an important challenge. Another major challenge is the availability of diverse cloud services with similar performance, which makes it difficult for users to choose the cloud service that suits their needs. Therefore, the existing service selection approaches is not able to solve the problem, and cloud service recommendation has become an essential and important need. In this paper, we present a new way for context-aware cloud service recommendation. Our proposed method seeks to solve the weakness in user clustering, which itself is due to reasons such as 1) lack of full use of contextual information such as cloud service placement, and 2) inaccurate method of determining the similarity of two vectors. The evaluation conducted by the WSDream dataset indicates a reduction in the cloud service recommendation process error rate. The volume of data used in the evaluation of this paper is 5 times that of the basic method. Also, according to the T-test, the service recommendation performance in the proposed method is significant.

The manuscript represents a comeprehensive and systematic literature review on the machine learning methods in the emerging applications of the smart cities. Application domains include the essential aspects of the smart cities including the energy, healthcare, transportation, security, and pollution. The research methodology presents a state-of-the-art taxonomy, evaluation and model performance where the ML algorithms are classified into one of the following four categories: decision trees, support vector machines, artificial neural networks, and advanced machine learning methods, i.e., hybrid methods, ensembles, and Deep Learning. The study found that the hybrid models and ensembles have better performance since they exhibit both a high accuracy and low overall cost. On the other hand, the deep learning (DL) techniques had a higher accuracy than the hybrid models and ensembles, but they demanded relatively higher computation power. Moreover, all these advanced ML methods had a slower processing speed than the single methods. Likewise, the support vector machine (SVM) and decision tree (DT) generally outperformed the artificial neural network (ANN) for accuracy and other metrics. However, since the difference was negligible, it can be concluded that using either of them is appropriate.

Abstract Frosted branch angiitis (FBA) is an uncommon form of severe retinal perivasculitis associated with systemic inflammatory/infectious diseases. In this report, we describe a case of FBA and macular edema as a result of immune recovery response in a patient newly diagnosed with HIV infection and cytomegalovirus viremia.

This paper investigates the applications of explainable AI (XAI) in healthcare, which aims to provide transparency, fairness, accuracy, generality, and comprehensibility to the results obtained from AI and ML algorithms in decision-making systems. The black box nature of AI and ML systems has remained a challenge in healthcare, and interpretable AI and ML techniques can potentially address this issue. Here we critically review previous studies related to the interpretability of ML and AI methods in medical systems. Descriptions of various types of XAI methods such as layer-wise relevance propagation (LRP), Uniform Manifold Approximation and Projection (UMAP), Local Interpretable Model-agnostic Explanations (LIME), SHapley Additive exPlanations (SHAP), ANCHOR, contextual importance and utility (CIU), Training calibration-based explainers (TraCE), Gradient-weighted Class Activation Mapping (Grad-CAM), t-distributed Stochastic Neighbor Embedding (t-SNE), NeuroXAI, Explainable Cumulative Fuzzy Class Membership Criterion (X-CFCMC) along with the diseases which can be explained through these methods are provided throughout the paper. The paper also discusses how AI and ML technologies can transform healthcare services. The usability and reliability of the presented methods are summarized, including studies on the usability and reliability of XGBoost for mediastinal cysts and tumors, a 3D brain tumor segmentation network, and the TraCE method for medical image analysis. Overall, this paper aims to contribute to the growing field of XAI in healthcare and provide insights for researchers, practitioners, and decision-makers in the healthcare industry. Finally, we discuss the performance of XAI methods applied in medical health care systems. It is also needed to mention that a brief implemented method is provided in the methodology section.

Nematic liquid crystal elastomers (LCE). exhibit unique mechanical properties such as large loss behaviour, which makes these materials interesting for damping applications. Here, the authors investigate the effect of anomalous damping in LCEs by comparing impact dissipation in shaped samples with elastic wave transmission and resonance.

Purpose: Bilateral fatigue femoral fractures (BFFF) represent an extremely rare clinical entity. The present study introduces a novel classification, in order to categorize the BFFFs and provide a thorough review of all these, so far in the literature, reported cases. Methods: The BFFF were classified taking into account the anatomical region of the femoral fracture; (fh): femoral head, (sc): sub-capital, (pt): peri-trochanteric, (st): sub-trochanteric, (s): shaft, (d): distal femur and the fracture type (complete or incomplete); type I: bilateral incomplete fractures, type II: unilateral incomplete fracture, and type III: bilateral complete fractures. Type III was further subdivided into type IIIA: bilateral non-displaced fractures, type IIIB: unilateral displaced fracture, and type IIIC: bilateral displaced fractures. Furthermore, a meticulous review of the PubMed and MEDLINE databases was conducted to locate all articles reporting these injuries. Results: A total of 38 patients (86.8% males), with a mean age of 25.3 years, suffering BFFFs were identified from the literature search. The mean time interval from symptoms’ onset to diagnosis was 54 days. According to the proposed classification, 2.6% of the fractures were categorized as type I (h), 36.8% as type I (sc), 2.6% as type I(st/s), 7.9% as type I (s), 2.6% as type I (d), 5.4% as type II (fh), 26.3% as type II (sc), 2.6% as type IIIA (st), 2.6% as type IIIA (d), 5.4% as type IIIB (sc), 2.6% as type IIIB (d) and 2.6% as type IIIC (sc). Surgery was performed in 52.6%, while non-operative treatment was followed in 47.4% of the population. Regarding the fracture type, 75% of type I fractures were conservatively treated, while 91.7% and 66.6% of type II and III fractures were surgically treated. For patients treated conservatively, the mean time from diagnosis to return to previous status was 260 days, while for patients treated surgically, 343 days. Conclusions: BFFFs, although rare, may pose a diagnostic and therapeutic challenge. The present classification offers valuable information and may act as a guide for the management of these patients.

Low physical function is associated with poor outcomes in the elderly population suffering from hip fractures. The present study aims to evaluate the prognostic tools for predicting patient recovery after hip fractures and investigate the correlation between the pre-fracture motor and functional statuses. A prospective study was performed, including 80 patients suffering from hip fractures. Patient history, previous falls, the type of fracture and overall survival were evaluated. Patient-reported outcome measures (SF-36, EQ-5D/VAS, Charlson Comorbidity Index (CCI), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and Harris Hip Score (HHS)) were monitored before hospital discharge at 6 weeks, and 3, 6 and 12 months postoperatively. Overall, 55% of patients experienced at least one fall, and 46% of them used crutches before the fracture. The average CCI score was 6.9. The SPPB score improved from 1.4 ± 1.3 (1 week) to 4.4 ± 2.1 (48 weeks). A one-year age increase, female sex, and prior history of falls lead to 0.1-, 0.92-, 0.56-fold lower SPPB scores, respectively, at 12 months. The HHS recorded the greatest improvement between 6 and 12 weeks (52.1 ± 14.6), whereas the TUG score continued to improve significantly from 139.1 ± 52.6 s (6 weeks) to 66.4 ± 54 s (48 weeks). The SPPB and performance test can be routinely used as a prognostic tool.

Since December 2019, the COVID-19 pandemic has had a significant impact on healthcare systems worldwide, prompting policymakers to implement measures of isolation and eventually adopt strict national lockdowns, which affected mobility, healthcare-seeking behavior, and services, in an unprecedented manner. This study aimed to analyze the effects of these lockdowns on hip-fracture epidemiology and care services, compared to nonpandemic periods in previous years. We retrospectively collected data from electronic patient records of two major hospitals in Western Greece and included patients who suffered a fragility hip fracture and were admitted during the two 5-week lockdown periods in 2020, compared to time-matched patients from 2017–2019. The results showed a drop in hip-fracture incidence, which varied among hospitals and lockdown periods, and conflicting impacts on time to surgery, time to discharge after surgery, and total hospitalization time. The study also found that differences between the two differently organized units were exaggerated during the COVID-19 lockdown periods, highlighting the impact of compliance with social-distancing measures and the reallocation of resources on the quality of healthcare services. Further research is needed to fully understand the specific variations and patterns of geriatric hip-fracture care during emergency health crises characterized by limited resources and behavioral changes.

Abstract In this work, we present a single low-profile metamaterial that provides bandgaps of acoustic and elastic waves at the same time. This was done by ensuring impedance mismatch in two different domains, the fluid domain where the acoustic waves propagate and the solid domain where the elastic waves propagate. Through creatively designing the metamaterial, waves of certain nature and frequencies of interest were completely blocked in the solid and fluid domains simultaneously. The simulation results showed bandgaps with acoustic waves attenuation below 5 kHz and elastic waves attenuation below 10 kHz. The acoustic and elastic dispersion curves of the metamaterials were calculated for various designs with various diameters and neck lengths, and the bandgaps were calculated. These parameters can be used as means for tuning both the acoustic and elastic bandgaps. A representative design of the metamaterial was manufactured on a laser powder bed fusion system and the dynamic performance was measured at various points. The measurements were carried out using a dynamic shaker setup and the dynamic performance was in good agreement with the numerical modelling results. Such metamaterials can be used for simultaneous acoustic and elastic attenuation, as well as saving in space and material consumption, in various fields including building construction, automobile, aerospace and rocket design.

Objective Osteoradionecrosis of the jaw (ORNJ) is one of the most severe head and neck complications in patients treated with radiotherapy. The goal of treatment is to suppress ORNJ progression. Currently, surgical removal of necrotic bone is an effective management approach for advanced stages. In this study, we present our experience in managing ORNJ using fluorescence-guided surgery. Methods Nineteen ORNJ lesions in 15 hospitalized patients were treated with fluorescence-guided surgery. We retrospectively reviewed patients’ demographic data, comorbidities, local preceding event, location, ORNJ stage, and treatment outcomes with a median follow-up of 12 months. Results Twelve lesions (63%) were treated surgically under tetracycline fluorescence, and seven lesions (37%) were surgically treated under auto-fluorescence. Overall, four lesions (21%) achieved complete mucosal healing, eight lesions (42%) showed partial mucosal healing with bone exposure and no signs or symptoms of inflammation, and seven lesions (37%) were progressive. The results showed that either healing or ORNJ stabilization was achieved in 63% of lesions (n = 12). Conclusion Fluorescence-guided surgery can be beneficial in curing or stabilizing ORNJ. However, randomized clinical trials are needed to confirm these findings.

Ιn a 76-year old man with a dual-chamber ICD implanted five years ago, dizzy spells and significant bradycardia on Holter were not initially recognized as inhibition of bradycardia pacing, due to oversensing. Hospital admission was deemed necessary only after repetitive ICD shocks attributed to right ventricular pace-sense lead fracture. The need to ensure adequate ICD antibradycardia backup pacing in pacing-dependent patients when deleterious sensing errors occur, cannot be overemphasized.

Atrial fibrillation (AF) is a very common arrhythmia that mainly affects older individuals. The mechanism of atrial fibrillation is complex and is related to the pathogenesis of trigger activation and the perpetuation of arrhythmia. The pulmonary veins in the left atrium arei confirm that onfirm the most common triggers due to their distinct anatomical and electrophysiological properties. As a result, their electrical isolation by ablation is the cornerstone of invasive AF treatment. Multiple factors and comorbidities affect the atrial tissue and lead to myocardial stretch. Several neurohormonal and structural changes occur, leading to inflammation and oxidative stress and, consequently, a fibrotic substrate created by myofibroblasts, which encourages AF perpetuation. Several mechanisms are implemented into daily clinical practice in both interventions in and the medical treatment of atrial fibrillation.

Ischemia-reperfusion (I/R) events are involved in the development of various ocular pathologies, e.g., retinal artery or vein occlusion. We tested the hypothesis that resveratrol is protective against I/R injury in the murine retina. Intraocular pressure (IOP) was elevated in anaesthetized mice to 110 mm Hg for 45 min via a micropipette placed in the anterior chamber to induce ocular ischemia. In the fellow eye, which served as control, IOP was kept at a physiological level. One group received resveratrol (30 mg/kg/day p.o. once daily) starting one day before the I/R event, whereas the other group of mice received vehicle solution only. On day eight after the I/R event, mice were sacrificed and retinal wholemounts were prepared and immuno-stained using a Brn3a antibody to quantify retinal ganglion cells. Reactivity of retinal arterioles was measured in retinal vascular preparations using video microscopy. Reactive oxygen species (ROS) and nitrogen species (RNS) were quantified in ocular cryosections by dihydroethidium and anti-3-nitrotyrosine staining, respectively. Moreover, hypoxic, redox and nitric oxide synthase gene expression was quantified in retinal explants by PCR. I/R significantly diminished retinal ganglion cell number in vehicle-treated mice. Conversely, only a negligible reduction in retinal ganglion cell number was observed in resveratrol-treated mice following I/R. Endothelial function and autoregulation were markedly reduced, which was accompanied by increased ROS and RNS in retinal blood vessels of vehicle-exposed mice following I/R, whereas resveratrol preserved vascular endothelial function and autoregulation and blunted ROS and RNS formation. Moreover, resveratrol reduced I/R-induced mRNA expression for the prooxidant enzyme, nicotinamide adenine dinucleotide phosphate oxidase 2 (NOX2). Our data provide evidence that resveratrol protects from I/R-induced retinal ganglion cell loss and endothelial dysfunction in the murine retina by reducing nitro-oxidative stress possibly via suppression of NOX2 upregulation.

In this paper, defect detection and identification in aluminium joints is investigated based on guided wave monitoring. Guided wave testing is first performed on the selected damage feature from experiments, namely, the scattering coefficient, to prove the feasibility of damage identification. A Bayesian framework based on the selected damage feature for damage identification of three-dimensional joints of arbitrary shape and finite size is then presented. This framework accounts for both modelling and experimental uncertainties. A hybrid wave and finite element approach (WFE) is adopted to predict the scattering coefficients numerically corresponding to different size defects in joints. Moreover, the proposed approach leverages a kriging surrogate model in combination with WFE to formulate a prediction equation that links scattering coefficients to defect size. This equation replaces WFE as the forward model in probabilistic inference, resulting in a significant enhancement in computational efficiency. Finally, numerical and experimental case studies are used to validate the damage identification scheme. An investigation into how the location of sensors can impact the identified results is provided as well.

Abstract Background Severe congenital ophthalmological malformations and glaucoma might be an important occasional feature in patients with Coffin-Siris syndrome (CSS), especially Coffin-Siris syndrome 9 (CSS9, OMIM #615866) caused by SOX11 mutation. Recently, primary (open-angle) glaucoma was described in two children with the most common form of Coffin-Siris syndrome, CSS1 (OMIM #135900) by ARID1B (AT-rich interaction domain-containing protein 1B) gene mutation. In this article, we present the first report of glaucoma with Coffin-Siris syndrome 9 as well as the first report of secondary glaucoma with any form of Coffin-Siris syndrome. These findings indicate that secondary glaucoma is an occasional finding in patients with Coffin-Siris syndrome. Case presentation A child with secondary childhood glaucoma and additional ocular manifestations was evaluated and treated at the childhood glaucoma centre in Mainz, Germany. Examination under general anaesthesia revealed ocular anterior segment dysgenesis (ASD) (Peters type iridocorneal dysgenesis) in combination with congenital limbal stem cell deficiency (LSCD), aniridia, and cataract. The patient also had multiple other congenital anomalies and severe developmental delay. To explain his combination of anomalies, molecular genetic analysis from peripheral blood was performed in late 2018 and early 2019. Following normal findings with a panel diagnostic of 18 genes associated with congenital glaucoma, whole exome sequencing was performed and revealed a novel likely pathogenic heterozygous variant c.251G>T, p.(Gly84Val) in the SOX11 gene (SRY-related HMG-box gene 11). The variant had occurred de novo. Thus, the multiple congenital anomalies and developmental delay of the patient represented Coffin-Siris syndrome 9 (CSS9, OMIM #615866). Conclusions When eye diseases occur in combination with other systemic features, genetic analysis can be seminal. Results indicate that glaucoma is an occasional feature of patients with Coffin-Siris syndrome. As early treatment may improve the visual outcome of patients with glaucoma, we suggest that patients with Coffin-Siris syndrome should receive specific ophthalmological screening.