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Patients with type 2 diabetes (T2D) are more susceptible to severe respiratory viral infections, but the underlying mechanisms remain elusive. Here, we show that patients with T2D and coronavirus disease 2019 (COVID-19) infections, and influenza-infected T2D mice, exhibit defective T helper 1 (Th1) responses, which are an essential component of anti-viral immunity. This defect stems from intrinsic metabolic perturbations in CD4+ T cells driven by hyperglycemia. Mechanistically, hyperglycemia triggers mitochondrial dysfunction and excessive fatty acid synthesis, leading to elevated oxidative stress and aberrant lipid accumulation within CD4+ T cells. These abnormalities promote lipid peroxidation (LPO), which drives carbonylation of signal transducer and activator of transcription 4 (STAT4), a crucial Th1-lineage-determining factor. Carbonylated STAT4 undergoes rapid degradation, causing reduced T-bet induction and diminished Th1 differentiation. LPO scavenger ameliorates Th1 defects in patients with T2D who have poor glycemic control and restores viral control in T2D mice. Thus, this hyperglycemia-LPO-STAT4 axis underpins reduced Th1 activity in T2D hosts, with important implications for managing T2D-related viral complications. [Display omitted] • T2D hosts exhibit impaired anti-viral Th1 responses • Hyperglycemia impedes Th1 differentiation by triggering lipid peroxidation (LPO) • LPO induces protein carbonylation of STAT4 and accelerates its degradation • LPO scavenger mitigates Th1 defects and improves viral control in T2D hosts Patients with T2D are more susceptible to severe viral respiratory infections, yet the underlying mechanism remains elusive. Here, Gray et al. reveal that hyperglycemia triggers lipid peroxidation (LPO) in CD4+ T cells. LPO-derived reactive carbonyl species modify STAT4 and expedite its degradation, leading to diminished anti-viral Th1 responses. [ABSTRACT FROM AUTHOR]

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This study aims to organize an intergenerational program to provide unemployed young people with operational skills related to gerontechnology and the experience required to deliver digital outreach rehabilitation services to community-dwelling older people. A quasi-experimental research design was adopted. The young participants received a 12-session training program on the management of common chronic diseases, communication with older people, the functions and use of interactive games, and techniques to teach and match interactive games with older people. The perception of elderly outcomes (i.e., knowledge and attitude toward elderly care, willingness to care for the elderly), personal outcomes (i.e., life satisfaction, self-efficacy), and desired vocational outcomes (i.e., hours worked in the nongovernmental organization's center, hours spent with older people) were evaluated preprogram and postprogram. Fifty-one young people joined the program. A statistically significant improvement was seen from preprogram to postprogram in their willingness to care for the elderly (p =.016) and life satisfaction (p =.005), as well as in the number of hours that they spent in the community center volunteering or engaged in social services for older people. The findings proved that the program could improve the willingness of young people to care for older people, as well as improve their own life satisfaction. Using gerontechnology can serve to bridge the intergenerational gap and bring benefits to both young adults and older people. It may provide policy makers with a way to address the manpower shortage in elderly care services and help frail older people to age in place. [ABSTRACT FROM AUTHOR]

Peri-implantitis is a representative etiology that affects the long-term survival of dental implants. It is known that decontamination of the implant surface is essential for the successful outcome of regenerative therapy for peri-implantitis. In the present study, the stability of a novel separable dental implant (SDI) was evaluated and compared with a conventional non-separable dental implant (NDI) using biomechanical and histomorphometric analyses. In this animal study, 40 rabbits were implanted with two SDI fixtures in the left tibia and two NDI fixtures in the right tibia. The rabbits were sacrificed 3 and 6 weeks after implantation, and the implant samples were evaluated using resonance frequency analysis (RFA), micro-computed tomography (CT), removal torque testing, and histomorphometric analysis. SDI exhibited comparable or better osseointegration and implant stability to NDI. In particular, SDI showed significantly higher implant stability quotient (ISQ) values immediately and 6 weeks after implantation, while removal torque values were significantly higher at both 3 and 6 weeks. In addition, microgaps on the histomorphometric images were not observed and abnormal signs or inflammation did not occur at the connection between the top and bottom parts of the SDI. The novel SDI fixture demonstrated sufficient osseointegration and biomechanical stability compared with NDI in this animal study. In addition, the changeable top part of SDI indicates that it may be effective in easily treating peri-implantitis in clinical practice. Additional future studies on the stability and clinical application after loading to the fixture are necessary. [ABSTRACT FROM AUTHOR]

[Display omitted] • MO-2097 is a novel synthetic chiral-free HIF-1α inhibitor targeting hnRNPA2B1 which is elevated in cancer patients. • MO-2097 showed significant anticancer results on patient-derived cancer organoids. • MO-2097 is a novel chemotype and a promising potential anticancer therapeutic. Hypoxia-inducible factor 1 (HIF-1) is a transcriptional activator mediating adaptive responses to hypoxia. It is up-regulated in the tumor microenvironment and recognized as an effective anticancer drug target. Previously, we discovered that the natural compound moracin-O and its synthetic derivative MO-460 inhibited HIF-1α via hnRNPA2B1. This study aimed to develop novel HIF-1 inhibitors for cancer chemotherapy by harnessing the potential of the natural products moracins-O and P. In an ongoing search for novel HIF-1 inhibitors, a series of nature-inspired benzofurans with modifications on the chiral rings of moracins-O and P were synthesized. They showed improved chemical tractability and were evaluated for their inhibitory activity on HIF-1α accumulation under hypoxic conditions in HeLa CCL2 cells. The most potent derivative's chemical-based toxicities, binding affinities, and in vivo anti-tumorigenic effects were evaluated. Further, we examined whether our compound, MO-2097, exhibited anticancer effects in three-dimensional cultured organoids. Herein, we identified a novel synthetic chiral-free compound, MO-2097, with reduced structural complexity and increased efficiency. MO-2097 exhibited inhibitory effects on hypoxia-induced HIF-1α accumulation in HeLa CCL2 cells via inhibition of hnRNPA2B1 protein, whose binding affinities were confirmed by isothermal titration calorimetry analysis. In addition, MO-2097 demonstrated in vivo efficacy and biocompatibility in a BALB/c mice xenograft model. The immunohistochemistry staining of MO-2097-treated tissues showed decreased expression of HIF-1α and increased levels of apoptosis marker cleaved caspase 3, confirming in vivo efficacy. Furthermore, we confirmed that MO-2097 works effectively in cancer patient-based organoid models. MO-2097 represents a promising new generation of chemotherapeutic agents targeting HIF-1α inhibition via hnRNPA2B1, requiring further investigation. [ABSTRACT FROM AUTHOR]

[Display omitted] • Phytochrome B variant phyB[G515E] with a slow dark reversion was generated. • phyB[G515E] forms warm temperature-insensitive nuclear photobodies. • PHYB[G515E] expression inhibited the phytochrome interacting factor4-auxin pathway. • PHYB[G515E] transgenic Arabidopsis and rice showed warming-insensitive growth. • phyB[G515E] is a powerful tool for engineering warm temperature-insensitive crops. Ambient temperature-induced hypocotyl elongation in Arabidopsis seedlings is sensed by the epidermis-localized phytochrome B (phyB) and transduced into auxin biosynthesis via a basic helix-loop-helix transcription factor, phytochrome-interacting factor 4 (PIF4). Once synthesized, auxin travels down from the cotyledons to the hypocotyl, triggering hypocotyl cell elongation. Thus, the phyB–PIF4 module involved in thermosensing and signal transduction is a potential genetic target for engineering warm temperature-insensitive plants. This study aims to manipulate warm temperature-induced elongation of plants at the post-translational level using phyB variants with dark reversion, the expression of which is subjected to heat stress. The thermosensitive growth response of Arabidopsis was manipulated by expressing the single amino acid substitution variant of phyB (phyB[G515E]), which exhibited a lower dark reversion rate than wild-type phyB. Other variants with slow (phyB[G564E]) or rapid (phyB[S584F]) dark reversion or light insensitivity (phyB[G767R]) were also included in this study for comparison. Warming-induced transient expression of phyB variants was achieved using heat shock-inducible promoters. Arabidopsis PHYB[G515E] and PHYB[G564E] were also constitutively expressed in rice in an attempt to manipulate the heat sensitivity of a monocotyledonous plant species. At an elevated temperature, Arabidopsis seedlings transiently expressing PHYB[G515E] under the control of a heat shock-inducible promoter exhibited shorter hypocotyls than those expressing PHYB and other PHYB variant genes. This warm temperature-insensitive growth was related to the lowered PIF4 and auxin responses. In addition, transgenic rice seedlings expressing Arabidopsis PHYB[G515E] and PHYB[G564E] showed warm temperature-insensitive shoot growth. Transient expression of phyB variants with altered dark reversion rates could serve as an effective optogenetic technique for manipulating PIF4–auxin-mediated thermomorphogenic responses in plants. [ABSTRACT FROM AUTHOR]

Vitamin D is known to influence the risk of cardiovascular disease, which is a recognized risk factor for sudden cardiac arrest (SCA). However, the relationship between vitamin D and SCA is not well understood. Therefore, this study aims to investigate the association between vitamin D and SCA in out-of-hospital cardiac arrest (OHCA) patients compared to healthy controls. Using the Phase II Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES II) registry, a 1:1 propensity score-matched case-control study was conducted between 2017 and 2020. Serum 25-hydroxyvitamin D (vitamin D) levels in patients with OHCA (454 cases) and healthy controls (454 cases) were compared after matching for age, sex, cardiovascular risk factors, and lifestyle behaviors. The mean vitamin D levels were 14.5 ± 7.6 and 21.3 ± 8.3 ng/mL among SCA cases and controls, respectively. Logistic regression analysis was used adjusting for cardiovascular risk factors, lifestyle behaviors, corrected serum calcium levels, and estimated glomerular filtration rate (eGRF). The adjusted odds ratio (aOR) for vitamin D was 0.89 (95% confidence interval [CI] 0.87–0.91). The dose-response relationship demonstrated that vitamin D deficiency was associated with SCA incidence (severe deficiency, aOR 10.87, 95% CI 4.82–24.54; moderate deficiency, aOR 2.24, 95% CI 1.20–4.20). Vitamin D deficiency was independently and strongly associated with an increased risk of SCA, irrespective of cardiovascular and lifestyle factors, corrected calcium levels, and eGFR. • Vitamin D's potential for reducing the risk of SCA remains uncertain despite cardiovascular diseases being a leading cause of SCA. • In this study, lower vitamin D levels were associated with SCA, showing a dose-response relationship. • The association remained after adjusting for eGFR, calcium, cardiovascular and lifestyle risk factors. [ABSTRACT FROM AUTHOR]

Exercise intolerance is a common symptom associated with atrial fibrillation (AF). However, echocardiographic markers that can predict impaired exercise capacity are lacking. This study aimed to investigate the association between echocardiographic parameters and exercise capacity assessed by cardiopulmonary exercise testing in patients with AF. This single-center prospective study enrolled patients with AF who underwent echocardiography and cardiopulmonary exercise testing to evaluate exercise capacity at a tertiary center for AF management from 2020 to 2022. Patients with valvular heart disease, reduced left ventricular ejection fraction, or documented cardiomyopathy were excluded. Of the 188 patients, 134 (71.2%) exhibited impaired exercise capacity (peak oxygen consumption ≤85%), including 4 (2.1%) having poor exercise capacity (peak oxygen consumption <50%). Echocardiographic findings revealed that these patients had an enlarged left atrial end-systolic diameter (LA); smaller left ventricular end-diastolic diameter (LVEDD); and increased relative wall thickness, tricuspid regurgitation velocity, and LA/LVEDD and E/e′ ratios. In addition, they exhibited lower peak systolic velocity of the mitral annulus and LA reservoir strain. In the multivariate regression model, LA/LVEDD remained the only significant echocardiographic parameter after adjustment for age, sex, and body mass index (P =.020). This significance persisted even after incorporation of heart rate reserve, N-terminal pro-B-type natriuretic peptide level, and beta-blocker use into the model. In patients with AF, LA/LVEDD is strongly associated with exercise capacity. Further follow-up and validation are necessary to clarify its clinical implications in patient care. [Display omitted] [ABSTRACT FROM AUTHOR]

We evaluated the prevalence and outcomes of competitive flow in the terminal right coronary artery (RCA) graft after coronary artery bypass grafting (CABG) with left internal thoracic artery–based Y-composite grafting at 1 year after CABG. We enrolled 642 patients who underwent Y-composite graft–based off-pump CABG with in situ left internal thoracic artery between 2014 and 2022. All patients underwent early postoperative angiography, and 1-year postoperative angiography was performed in 81.2% (522/642) of patients. The early occlusion rate of distal anastomoses with Y-composite graft was 2.1%. Competitive flow was observed in 69 of 642 anastomoses (10.7%). Multivariate analysis showed that the maximal degree of target vessel stenosis (odds ratio [OR], 0.909; 95% CI, 0.886-0.931; P <.001), maximal degree of non–terminal target vessel in Y-arm grafts (OR, 1.103; 95% CI, 1.047-1.172; P <.001), and diabetes mellitus (OR, 0.535; 95% CI, 0.303-0.934; P =.029) were factors associated with competitive flow to the RCA territory. The optimal cutoff value for the degree of terminal target vessel stenosis predicting competitive flow to the RCA territory was 92.5%. The 1-year graft failure rate of anastomoses with competitive flow of the terminal anastomosis was 30.9% (17/55). The presence of competitive flow on early angiography was the only factor associated with graft occlusion of the terminal anastomosis at 1 year (OR, 2.339; 95% CI, 1.165-4.481; P =.013). For terminal anastomosis to the RCA territory in Y-composite graft–based CABG, the presence of competitive flow on early angiography was associated with graft occlusion of the terminal anastomosis at 1 year. Notably, 30.9% of these grafts demonstrated failure on 1-year follow-up angiography. [Display omitted] [ABSTRACT FROM AUTHOR]

To provide personalized recommendations for users, recommendation systems must predict their unknown preferences. Latent factor models consistently achieve high prediction accuracy for this task. During training, these models encode users and items as latent vectors. Aligning these vectors facilitates predicting the item preference of the user. The training process optimizes the objective function, aiming to minimize the disparity between latent vectors and the collected preferences. In this study, we aim to integrate item descriptions into the construction of the objective function due to the sparsity and inaccuracy of collected preferences. This process is accomplished using Bert for vectorizing item descriptions. We conducted experiments with the proposed approach on datasets Movielens 1M and Yahoo Webscope R4. Our approach demonstrates a reduction in RMSE compared to previous approaches within this research domain. [ABSTRACT FROM AUTHOR]

Late recurrence of hepatocellular carcinoma after curative resection significantly influences long-term patient survival outcomes, and yet it remains understudied. This study aims to explore the risk factors and patterns of late recurrence and predictors of subsequent outcome. This single-center retrospective study analyzed 1,701 consecutive patients who achieved a disease-free survival period exceeding 2 years after curative resection for hepatocellular carcinoma between 2001 and 2018. Univariate and multivariate analyses of factors associated with late recurrence and death after recurrence were conducted using Cox's models. The mean age of patients was 60.2 years, with 76.8% being male. During a median follow-up of 8.1 years, 653 patients (38.4%) experienced late recurrence, with median time to recurrence being 4.0 years (interquartile range, 2.7–6.0). Factors such as age >60, chronic hepatitis C, cirrhosis, high albumin-bilirubin grade, absence of family history, multiple tumors, satellite nodules, alpha-fetoprotein levels <400 ng/mL, and minor hepatic resection were identified as risk factors for late recurrence. Among patients with late recurrence, 131 (20.1%) underwent surgical treatment, 272 (41.7%) received radiofrequency ablation, and 27 (4.1%) exhibited extrahepatic lesions. A higher-high albumin-bilirubin grade, recurrent tumor >3 cm, and nonsurgical treatment emerged as predictors of death after late recurrence. Over one-third of patients who remain disease-free for more than 2 years postresection will experience late recurrence during subsequent follow-up. For 2-year disease-free survivors, risk factors for late recurrence differ from early recurrence. Treating underlying hepatitis is of paramount importance, given its association with both the risk of late recurrence and survival outcomes post-recurrence. [ABSTRACT FROM AUTHOR]

Current guidelines recommend complete revascularization (CR) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD). With regard to the timing of percutaneous coronary intervention (PCI) for non-infarct-related artery (non-IRA), recent randomized clinical trials have revealed that immediate CR was non-inferior to staged CR. However, the optimal timing of CR remains uncertain. The OPTION-STEMI trial compared immediate CR and in-hospital staged CR guided by fractional flow reserve (FFR) for intermediate stenosis of the non-IRA. The OPTION-STEMI is a multicenter, investigator-initiated, prospective, open-label, non-inferiority randomized clinical trial. The study included patients with at least 1 non-IRA lesion with ≥50% stenosis by visual estimation. Patients fulfilling the inclusion criteria were randomized into 2 groups at a 1:1 ratio: immediate CR (i.e., PCI for the non-IRA performed during primary angioplasty) or in-hospital staged CR. In the in-hospital staged CR group, PCI for non-IRA lesions was performed on another day during the index hospitalization. Non-IRA lesions with 50%−69% stenosis by visual estimation were evaluated by FFR, whereas those with ≥70% stenosis was revascularized without FFR. The primary endpoint was the composite of all-cause death, non-fatal myocardial infarction, and all unplanned revascularization at 1 year after randomization. Enrolment began in December 2019 and was completed in January 2024. The follow-up for the primary endpoint will be completed in January 2025, and primary results will be available in the middle of 2025. The OPTION-STEMI is a multicenter, non-inferiority, randomized trial that evaluated the timing of in-hospital CR with the aid of FFR in patients with STEMI and MVD. URL: https://www.clinicaltrials.gov. Unique identifier: NCT04626882; and URL: https://cris.nih.go.kr. Unique identifier: KCT0004457. [ABSTRACT FROM AUTHOR]

Dissociative symptoms, which are psychiatric phenomena recognized in both ICD-11 and DSM-5-TR, refer to failures in the process of integrating one's biopsychosocial experiences. While research shows that childhood trauma is associated with dissociative symptoms, little is known about whether childhood trauma could predict increases in dissociative symptoms even within a short period of time. Additionally, it remains unclear what moderators may influence this relationship. This study examined the effects of childhood trauma on subsequent dissociative symptoms and explored the potential moderating effects of mental health-related self-stigma. We analyzed longitudinal survey data from an international sample of young adults (N = 146). Participants completed validated standardized measures of childhood trauma, self-stigma, and dissociative symptoms at baseline, and they reported their dissociative symptoms again after approximately three months. Over 75 % of participants with pathological dissociation at baseline continued to exhibit pathological dissociation at follow-up. Baseline childhood trauma was associated with increases in dissociative symptoms even within a short period of time. Self-stigma significantly moderated the relationship between baseline childhood trauma and subsequent dissociative symptoms, after controlling for baseline dissociative symptoms. This study confirmed that childhood trauma is associated with increases in dissociative symptoms even within three months. We also found that self-stigma may exacerbate the effects of childhood trauma on subsequent dissociative symptoms. The results provide insights into the prevention and management of dissociative symptoms in childhood trauma survivors and inform the modification of the trauma model of dissociation. • Childhood trauma is associated with increases in dissociative symptoms even within 3 months. • Little is known about factors that affect this relationship. • Self-stigma might exacerbate the effects of childhood trauma. • Service providers can change the trajectory of dissociation in trauma survivors. [ABSTRACT FROM AUTHOR]

Asthma, characterized as a chronic heterogeneous airway disease, often presents with common comorbid conditions. The concept of "one airway, one disease" was coined more than 20 years ago, emphasizing the connection between asthma and upper airway comorbidities (UACs) such as allergic or nonallergic rhinitis, chronic rhinosinusitis with or without nasal polyps, and aspirin/nonsteroidal anti-inflammatory drug–exacerbated respiratory disease. Since then, numerous studies have demonstrated that UACs are closely related and affect asthma phenotypes. Recognizing these UACs and managing them are crucial aspects of comprehensive asthma care. Addressing these conditions as part of asthma treatment can lead to better control of symptoms, improved lung function, and better quality of life. Moreover, it is important to explore the field of respiratory biologics, which represents the latest advancements in medical treatment options for patients with asthma and UACs. [ABSTRACT FROM AUTHOR]

• Miniscrew-assisted intrusion in both maxillary and mandibular arches demonstrated significant improvements in facial profiles and long-term stability of treatment outcomes for patients with vertical maxillary excess and anterior open bite. • Customized treatment plans incorporating myofunctional therapy were essential in managing the complex anatomical variations associated with vertical maxillary excess, ensuring sustained correction well beyond the immediate post-treatment phase. • The study underscored the necessity of considering compensatory dental changes, such as the extrusion of mandibular molars, to optimize the efficacy of orthodontic interventions and prevent the negation of treatment benefits. This comprehensive review investigates the treatment of vertical maxillary excess (VME) with and without anterior open bite (AOB) in seven unique case studies. These cases illustrate the implementation of advanced orthodontic techniques, such as miniscrew-assisted intrusion of the maxillary and mandibular arches. The multifaceted nature of AOB must be considered, highlighting the need for clear diagnostic criteria and an understanding of the long-term impacts of treatment strategies. The main goal of treatment is to reduce the vertical dimension of the maxillomandibular complex. A single miniscrew in the midpalatal region for the maxillary arch and two miniscrews in the buccal areas of the mandibular arch can be applied for the effective intrusion of the posterior teeth. The review then delves into the specific challenges and treatment modalities for managing VME without AOB, stressing the critical role of individualized intervention plans. Each case study demonstrates a different aspect of the treatment approach: from differential intrusion of molars to address esthetic concerns and functional issues to comprehensive strategies involving the intrusion of entire dental arches to correct severe malocclusions. The outcomes emphasize the importance of controlled orthodontic mechanics in achieving and maintaining optimal posttreatment stability. This review underscores the effectiveness of these treatment strategies in significantly improving facial profiles and dental function while highlighting the adjunctive use of myofunctional therapy and other retention techniques to prevent relapse. Collectively, these cases provide valuable insights into the tailored treatment of complex orthodontic conditions, offering guidance on achieving long-term success in clinical practice. [ABSTRACT FROM AUTHOR]

• For anterior open bite (AOB) patients with severe incisor exposure, intrusion of the entire maxillary dentition is necessary. • An anteroposterior lingual retractor (APLR) is a useful lingual retractor for the retraction of the maxillary anterior teeth and the intrusion of the entire maxillary dentition. • When applying APLR, the length of the lever arm, the vertical position of the TADs, angulation of the posterior tube, posterior splint method, use of transpalatal arch (TPA), depth of the palatal vault, and compensatory extrusion of the mandibular molars must be taken into consideration. • Due to the total intrusion of the maxillary dentition, the mandible is rotated counterclockwise, improving AOB with severe incisor exposure. Anterior open bite (AOB) is considered one of the most difficult malocclusions to correct and achieve successful and stable results. Various treatment approaches have been proposed for the treatment of AOB in adults. Intrusion of the entire maxillary dentition is necessary for AOB patients with severe incisor exposure. In previous reports, a labial appliance with temporary anchorage devices (TADs) implanted in various positions has been used to achieve total intrusion of the maxillary dentition. This article describes the design and biomechanics of an anteroposterior lingual retractor (APLR) to attempt retraction of anterior teeth and total intrusion of maxillary dentition after premolar extraction in patients with both lip protrusion and AOB and the functions of each component of APLR is considered. When force is applied between the anterior lever arm of the APLR and a TAD in the midpalatal area, the anterior teeth are intruded and retracted with torque control. Because the direction of the APLR force and the guide bar are not parallel, intrusive force is generated in the posterior teeth. Due to this total intrusion of the maxillary dentition, the mandible is rotated counterclockwise, improving AOB with severe incisor exposure. Various cases are presented in which APLR was applied to AOB patients, and the clinical considerations behind the treatment are explained in detail. [ABSTRACT FROM AUTHOR]

To determine the association between preoperative covert brain infarction following coronary angiography (CAG) and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass grafting (CABG). A cohort study was conducted between January 2006 and December 2019, with the follow-up period concluding at either 5 years after surgery, the date of death, or April 27, 2023. A single tertiary center in Korea. Patients who underwent preoperative CAG and subsequent brain magnetic resonance imaging (MRI) before elective CABG. None. The primary outcome was the incidence of MACCEs within 30 days of CABG. MACCEs included operative death (all-cause death within 30 days of surgery or before discharge), myocardial infarction, mechanical circulatory support, circulatory arrest, and stroke. Secondary outcomes included each component of MACCEs and all-cause mortality at 5 years after surgery. Of the 2,476 study patients (median [interquartile range] age: 65 [58-71] years; 24.7% were female), 212 (8.6%) had covert cerebral infarction on brain MRI after CAG but before CABG, and 353 (14.3%) patients experienced MACCEs after CABG. After performing 1:4 propensity-score matching, 1,057 patients were included in the final outcome analysis (212 with covert brain infarction and 845 without). The incidence of MACCEs within 30 days was not significantly different between patients with covert brain infarction and those without (15.1% [32/212] v 15.6% [132/845]; risk difference: –0.5, 95% confidence interval: –5.6 to 4.4; risk ratio: 0.97, 95% confidence interval: 0.66 to 1.32, p = 0. 85). There were also no significant differences in each component of MACCEs within 30 days. There was no significant difference between the two groups regarding all-cause mortality at 5 years (18.7% v 17.0%, respectively, p for stratified log-rank test = 0.33). Among patients undergoing elective CABG, there was no significant association between covert brain infarction following CAG and the occurrence of MACCEs within 30 days or long-term mortality after CABG. [ABSTRACT FROM AUTHOR]

Post-acute COVID-19 syndrome (PACS) is associated with sleep disturbance, but treatment options are limited. The etiology of PACS may be secondary to alterations in the gut microbiome. Here, we report the efficacy of fecal microbiota transplantation (FMT) in alleviating post-COVID insomnia symptoms in a nonrandomized, open-label prospective interventional study. Between September 22, 2022, and May 22, 2023, we recruited 60 PACS patients with insomnia defined as Insomnia Severity Index (ISI) ≥8 and assigned them to the FMT group (FMT at weeks 0, 2, 4, and 8; n = 30) or the control group (n = 30). The primary outcome was clinical remission defined by an ISI of <8 at 12 weeks. Secondary outcomes included changes in the Pittsburgh Sleep Quality Index, Generalized Anxiety Disorder-7 scale, Epworth Sleepiness Scale, Multidimensional Fatigue Inventory, blood cortisol and melatonin, and gut microbiome analysis on metagenomic sequencing. At week 12, more patients in the FMT than the control group had insomnia remission (37.9% vs 10.0%; P =.018). The FMT group showed a decrease in ISI score (P <.0001), Pittsburgh Sleep Quality Index (P <.0001), Generalized Anxiety Disorder-7 scale (P =.0019), Epworth Sleepiness Scale (P =.0057), and blood cortisol concentration (P =.035) from baseline to week 12, but there was no significant change in the control group. There was enrichment of bacteria such as Gemmiger formicilis and depletion of microbial pathways producing menaquinol derivatives after FMT. The gut microbiome profile resembled that of the donor in FMT responders but not in nonresponders at week 12. There was no serious adverse event. This pilot study showed that FMT could be effective and safe in alleviating post-COVID insomnia, and further clinical trials are warranted. ClinicalTrials.gov , Number: NCT05556733. [Display omitted] [ABSTRACT FROM AUTHOR]

To examine the prevalence of preexisting articular bone pathology in patients with hip or knee pain due to osteoarthritis (OA) screened for fasinumab clinical trials. This post-hoc analysis included patients with OA screened for three phase 3 fasinumab studies (NCT02683239, NCT03161093, NCT03304379). During screening, participants who met other clinical inclusion/exclusion criteria underwent radiography of knees, hips, and shoulders. Those with Kellgren–Lawrence grade (KLG) ≥ 2 for index joint and without an exclusionary finding proceeded to magnetic resonance imaging (MRI) of index, contralateral, and KLG ≥ 3 joints. Exclusionary findings included bone fragmentation/collapse, bone loss/resorption, osteonecrosis, and fracture, by either X-ray or MRI. Participants with extensive subchondral cysts were also excluded. Prevalence of abnormalities on radiographs and MRIs are reported. Of 27,633 participants screened, 21,997 proceeded to imaging. Of these, 1203 (5.5%) were excluded due to the presence of ≥ 1 joint with severe articular bone pathology (X-ray or MRI): bone fragmentation/collapse (2.60%), subchondral insufficiency fracture (SIF; 1.67%), osteonecrosis (1.11%), and significant bone loss (0.32%). Additionally, 3.13% screen-failed due to extensive subchondral cysts. More than half of the exclusions due to bone fragmentation/collapse (386/572), osteonecrosis (141/245) and significant bone loss (59/71), and approximately one third of SIF (133/367) and extensive subchondral cysts (229/689) were evident on X-rays. Approximately one in 20 participants with OA who met the clinical screening criteria for fasinumab phase 3 trials were later excluded due to preexisting severe articular bone pathology findings by X-ray or MRI. [ABSTRACT FROM AUTHOR]

In this report, a tumor exhibited EWSR1 :: RORß gene fusion, to our knowledge, is the first such reported case. The Ewing sarcoma breakpoint region 1 gene (EWSR1) is known to be associated with several soft tissue tumors although its specific role remains unclear. Its fusion with a member of the ETS family, including FLI1 and ERG , results in Ewing sarcoma, and its fusion with other genes unrelated to the ETS family, including NFATC2 and PATZ1 , results in round cell sarcoma with EWSR1-non-ETS fusions, previously referred to as Ewing-like sarcoma. RORß encodes retinoic acid-related orphan receptor ß, a nuclear receptor (NR), and is involved in circadian rhythm modulation and cancer regulation. The specific role of ROR ß in tumorigenesis remains unclear; however, this case report suggests that it may form part of a new tumorigenic entity. [ABSTRACT FROM AUTHOR]

The popularity of arthroscopic Latarjet has increased significantly in recent years due to its perceived advantages. The latter include a smaller surgical incision, faster recovery, quicker return to sports, and ability to treat concomitant intra-articular pathology. Nevertheless, the arthroscopic technique is more technically challenging, has a more significant learning curve, longer operating time, and is less cost-effective. The study aimed to identify the various factors influencing patient decision-making between undergoing arthroscopic or open Latarjet using a stepwise questionnaire model. All patients with a primary, whether arthroscopic or open Latarjet procedure were subjected to a stepwise interviewing process and were asked to select between arthroscopic and open approaches at each step. Fifty patients with a mean age of 28.8 ± 8.8 year old participated in the study. Twenty (40%) consistently selected an arthroscopic approach after analysis of the incision's aspect, whereas 34 (68%) had a final decision different from their initial choice. In addition, out of the 15 patients who chose arthroscopy or were undetermined after presentation of the incisional aspect, 9 (60%) changed their decision to open surgery after presentation of the pros and cons of each approach. Twenty-three (46%) patients were unable to choose and left the choice to their surgeon. The faith in their surgeon and recovery were identified as the 2 most important factors influencing patients' final decisions. The minimally invasive nature of arthroscopic incisions was not considered to be more cosmetically appealing than that of a single open incision. The advantages of the arthroscopic procedure may not be as valued by patients as by surgeons. Patients were more interested in the equivalent short- and mid-term outcomes of both approaches and the shorter surgical duration of the open option. It is crucial to adequately inform patients during preoperative counseling to achieve the best consensus. [ABSTRACT FROM AUTHOR]

With increasing volume of cardiac implantable electronic devices in the last decade, the indications for device extraction have increased. Multidisciplinary collaboration between cardiothoracic surgeons, cardiac anesthesiologists, and cardiac electrophysiologists has been recognized as an essential pre-requisite in pre-procedural planning to limit complications from this inherently risky procedure. Fortunately, the tools and techniques have continued to evolve to make extraction safer and more effective. This article discusses traditional and non-traditional techniques for transvenous lead extraction in addition to retrieval of leadless pacemakers. [ABSTRACT FROM AUTHOR]

Implantable cardioverter-defibrillators (ICDs) reduce sudden cardiac death (SCD) and improve survival in patients with a history of life-threatening arrhythmia or sudden cardiac arrest, and in select populations at high risk of SCD due to ventricular arrhythmias. However, patients with ICDs may receive inappropriate or unnecessary shocks, which have been associated with pro-arrhythmia, psychological sequelae, poor quality of life, and increased mortality. The benefits and risks of ICD therapy are therefore directly impacted on by physician operative and programming decisions. This article aims to provide a detailed review of transvenous ICD programming as guided by clinical trials. [ABSTRACT FROM AUTHOR]

This study focused on enhancing the electrical conductivity of metal oxide nanosheet films by increasing the size of the nanosheets to promote the electron flow in the desired in-plane direction. We developed a method for increasing the size of RuO 2 metal oxide nanosheets, a 2D material, by controlling the heat-treatment process. The size of the RuO 2 nanosheets increased from 0.7 to 3.5 μm by modifying the heat-treatment conditions of K x RuO 2 , which was used as the precursor material. As a consequence, the electrical conductivity of the large-sized-RuO 2 nanosheet-coated films was eight times higher than that of their small-sized counterparts. This lower resistance was attributed to the minimal number of contacts required for electron flow; the contact resistance between the nanosheets being higher than the intrinsic resistance. The proposed approach for enhancing the conductivity of metal oxide 2D materials is very promising and is expected to significantly contribute to the development of advanced flexible electronic devices. [Display omitted] • Enlarged RuO 2 nanosheets boost electrical conductivity in flexible devices. • Controlled heat treatment of K x RuO 2 precursor material enhances nanosheet size. • Eightfold increase in electrical conductivity observed in larger nanosheets. • Reduced resistance due to minimized electron flow contacts in nanosheet films. • Promising method for improving electrical properties in flexible electronics. [ABSTRACT FROM AUTHOR]

This study examines a cooperative non-orthogonal multiple access (NOMA) network utilizing an energy-constrained unmanned aerial vehicle (UAV) relay (UAVR) to expand coverage and improve network throughput. In order to provide energy to the UAVR, we consider the hybrid simultaneous wireless information and power transmission (SWIPT) method, which allows the UAVR to harvest energy from the source (i.e., sink node) signal. Herein, a hybrid time switching (TS)-based and power splitting (PS)-based relaying scheme is applied to improve the UAVR's energy harvesting (EH) efficiency and the system performance. Given this context, we derive the closed-form expression of the outage probability (OP) for the sensors to evaluate the network performance. Based on the achieved analytical results, we apply the bat algorithm optimization (BAO) method to determine the optimal working point (as a fraction of received power and power allocation coefficients, and the 3-D positions of the UAVR) for the system such that the OP is minimized. The numerical analysis indicates that BAO is effective in both exploring and exploiting solutions, making it a suitable choice for similar non-convex optimization problems in continuous search spaces for cooperative NOMA IoT networks. [ABSTRACT FROM AUTHOR]

Laryngotracheal trauma is poorly studied and associated with serious morbidity and mortality. This study reports features associated with laryngotracheal fractures, and factors associated with laryngeal fracture repair. Retrospective database study American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP®) ACS-TQIP® 2014-2015 participant user data files were queried for laryngotracheal fractures using the International Classification of Diseases (ICD) 9th edition encodings. Demographic, diagnostic and procedure characteristics were analyzed with univariate chi-squared analysis and multivariate logistic regression. We extracted 635 cases of laryngotracheal injury, with a median Injury Severity Score of 16 (IQR: 10 – 25). Most were caused unintentionally (65.7%), followed by assault (28.8%). Blunt trauma (79.5%) was more common than penetrating trauma (20.0%). These trends were upheld in the subgroup of repaired fractures, which made up 12.6% (80/635) of cases. The median length of hospital stay was 6 days (IQR: 3 – 13) in all fractures and 10 days (IQR: 6 – 14) in the subgroup of repaired fractures, while the median length of ICU stay was 4 days (IQR: 2 – 9) in all fractures and 4.5 (IQR: 6 – 14.3) in the subgroup of repaired fractures. Cut/pierce injuries (OR: 4.7, P < 0.001) and ISS (OR: 0.97, p P = 0.026) significantly affected rate of laryngeal fracture repair. Laryngotracheal fractures are uncommon but serious injuries. Our results show that penetrating causes of injuries have the shortest time to repair, and that a higher ISS score is negatively associated with repair. [ABSTRACT FROM AUTHOR]

There are few data favoring the need for septotomy at the time of peroral endoscopic myotomy (POEM) or if POEM alone is sufficient. Our aim was to compare POEM outcomes with and without septotomy (POEM+S or POEM-S) in patients with symptomatic epiphrenic diverticula (ED) and an underlying motility disorder. This was an international, multicenter retrospective study involving 21 centers between January 2014 and January 2023. Patients with ED and an underlying motility disorder who underwent POEM were included. The primary outcome was clinical success (Eckardt score [ES] ≤3 or a 1-point drop in ES for patients with baseline ES <3) without the need for repeat surgical/endoscopic interventions during follow-up. A total of 85 patients (mean age, 64.29 ± 17.1 years; 32 [37.6%] female) with ED and underlying motility disorder underwent POEM+S (n = 47) or POEM–S (n = 38). Patients in the POEM+S group had a significantly higher mean pre-POEM ES (7.3 ± 2.1 vs 5.8 ± 2; P =.002). The most common indication for POEM was achalasia (51% in the POEM+S cohort and 51.8% in the POEM–S cohort; P =.7). A posterior approach was favored in the POEM+S group (76.6% vs 52.6%; P =.02). A similar rate of technical success was seen in both groups (97.9% vs 100%; P =.1). The rate of adverse events was similar between the 2 cohorts (4.2% vs 8.1%; P =.6). The median length of hospital stay after POEM–S was significantly longer compared with POEM+S (2 days [interquartile range (IQR), 1-4 days] vs 1 day [IQR, 1-2 days]; P =.005). Clinical success was equivalent between the 2 groups (83% vs 86.8%; P =.6) at a median follow-up duration of 8 months (IQR, 3-19 months). In patients with ED and an underlying motility disorder, both POEM+S and POEM–S are equally safe and effective, with similar procedure duration and a low recurrence rate at short-term follow-up. Future comparative prospective studies with long-term follow-up are required to validate these findings. [Display omitted] [ABSTRACT FROM AUTHOR]

To establish a quantitative CT threshold for radiological disease progression of progressive pulmonary fibrosis (PPF) and evaluate its feasibility in patients with connective tissue disease-related interstitial lung disease (CTD-ILD). Between April 2007 and October 2022, patients diagnosed with CTD-ILD retrospectively evaluated. CT quantification was conducted using a commercial software by summing the percentages of ground-glass opacity, consolidation, reticular opacity, and honeycombing. The quantitative threshold for radiological progression was determined based on the highest discrimination on overall survival (OS). Two thoracic radiologists independently evaluated visual radiological progression, and the senior radiologist's assessment was used as the final result. Cox regression was used to assess prognosis of PPF based on the visual assessment and quantitative threshold. 97 patients were included and followed up for a median of 30.3 months (range, 4.7–198.1 months). For defining radiological disease progression, the optimal quantitative CT threshold was 4%. Using this threshold, 12 patients were diagnosed with PPF, while 14 patients were diagnosed with PPF based on the visual assessment, with an agreement rate of 97.9% (95/97). Worsening respiratory symptoms (hazard ratio [HR], 12.73; P <.001), PPF based on the visual assessment (HR, 8.86; P =.002) and based on the quantitative threshold (HR, 6.72; P =.009) were independent risk factors for poor OS. The quantitative CT threshold for radiological disease progression (4%) was feasible in defining PPF in terms of its agreement with PPF grouping and prognostic performance when compared to visual assessment. [ABSTRACT FROM AUTHOR]

The British Association of Oral and Maxillofacial Surgeons (BAOMS) Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) reconstructive audit aims to provide surgical teams with risk adjusted comparative performance data. The goal is to enable surgeons to optimise surgical pathways. Risk adjustment requires that data on appropriate predictive variables are collected. This study looked at variables predicting major complications and flap failure in a single institution with the aim of determining whether the QOMS dataset adequately captures the appropriate data points. A prospective database of head and neck flap procedures and associated postoperative complications has been maintained in the maxillofacial surgery department since August 2009 up to August 2022 (n=1327). A total of 25 putative risk variables were extracted from the health records for each patient. The outcomes of interest were total flap failure and major complications. Independent predictors of flap failure were recipient site (sinonasal/anterior skull base), previous major surgery, previous major surgery and radiotherapy, and flap selection. For major complications ACE-27 comorbidity score, flap type, use of tracheostomy, elevated preoperative plasma C-reactive protein (CRP) and flap selection were independently predictive. Apart from preoperative activated innate immunity all relevant risk stratification variables identified in this study form part of the QOMS dataset. QOMS is therefore likely to adequately risk stratify patients based upon currently collected variables. [ABSTRACT FROM AUTHOR]

Both vestibular schwannoma (VS) and Meniere's disease (MD) patients underwent hydrops MRI to clarify the relationship between VS and endolymphatic hydrops (EH). Eighty patients with VS or MD underwent an inner ear test battery followed by hydrops MRI, and were then divided into 3 groups. Group A comprised 58 MD patients (62 ears) with positive EH but negative VS. Group B included 18 VS patients (18 ears) with negative EH, while Group C consisted of 4 patients (4 ears) who had VS concomitant with EH. Another 14 MD patients who tested negative for EH on hydrops MRI were initially excluded from this cohort, but were later included for comparison. The decreasing prevalence of EH at the cochlea, saccule and utricle in Group A was identified in 59 (95%), 42 (68%) and 40 (65%) ears, respectively, mimicking a declining sequence of abnormality rates running from audiometry (86%), cervical vestibular-evoked myogenic potential (cVEMP) test (55%) to the ocular (oVEMP) test (53%). However, such decreasing trend was not identified in Groups B and C. In Groups C and A combined, 4 (6%) of 62 EH patients had concomitant VS. Conversely, 4 (18%) of 22 VS patients in Groups C and B combined had concurrent EH. A very low (6%) rate of VS in EH patients indicates that VS in EH patients may be coincidental. In contrast, EH was identified in 18% prevalence of VS patients, mirroring the 22% prevalence of cochlear EH demonstrated in VS donors through histopathological studies. [ABSTRACT FROM AUTHOR]

Acute mountain sickness (AMS) is initiated in response to a hypoxic and hypobaric environment at a high altitude. The precise prevalence of AMS in Jade Mountain climbers remained largely unknown, particularly data obtained from real medical consultations. An overnight stay at the Pai-Yun Lodge (3402 m) is usually required before an ascent of the Jade Mountain. Since 2004, a Pai-Yun Clinic has been established in the Pai-Yun Lodge. The Pai-Yun Clinic provided regular and emergency medical service every weekend. We conducted a retrospective study by using medical records from the Pai-Yun Clinic between 2018 and 2019. A total of 1021 patients were enrolled, with 56.2 % males. Different age groups were 3.2 %, 54.5 %, 37.9 %, and 4.4 % in <20, 20−39, 40−59, and ≥60 years, respectively. There were 582 (57.0 %) patients diagnosed to have AMS (230 [39.5 %] were mild type and 352 [60.5 %] were severe type). The factors associated with AMS development included young age, absence of climbing history (>3000 m) within the last 3 months, first climbing (>3000 m) experience, taking preventive medication, low oxygen saturation, and a high Lake Louise AMS score (LLAMSS). The factors associated with AMS severity included absence of taking preventive medication, low oxygen saturation, and a high LLAMSS. Approximately 15 % of Jade Mountain climbers needed medical service, of which 60 % had AMS. 60 % of patients with AMS must require oxygen supply or medication prescription. Oxygen saturation measure and LLAMSS evaluation are reasonable tools to predict the occurrence and severity of AMS on Jade Mountain. [ABSTRACT FROM AUTHOR]

• AI TI-RADS provides a simplified risk stratification system for thyroid nodules, while maintaining performance similar to ACR TI-RADS. • Our study includes data from a new institution and different scanning machines to help validate AI TI-RADS performance. • Macrocalcifications may not confer as much risk of thyroid nodule malignancy as previously suggested. To validate the performance of a recently created risk stratification system (RSS) for thyroid nodules on ultrasound, the Artificial Intelligence Thyroid Imaging Reporting and Data System (AI TI-RADS). 378 thyroid nodules from 320 patients were included in this retrospective evaluation. All nodules had ultrasound images and had undergone fine needle aspiration (FNA). 147 nodules were Bethesda V or VI (suspicious or diagnostic for malignancy), and 231 were Bethesda II (benign). Three radiologists assigned features according to the AI TI-RADS lexicon (same categories and features as the American College of Radiology TI-RADS) to each nodule based on ultrasound images. FNA recommendations using AI TI-RADS and ACR TI-RADS were then compared and sensitivity and specificity for each RSS were calculated. Across three readers, mean sensitivity of AI TI-RADS was lower than ACR TI-RADS (0.69 vs 0.72, p < 0.02), while mean specificity was higher (0.40 vs 0.37, p < 0.02). Overall total number of points assigned by all three readers decreased slightly when using AI TI-RADS (5,998 for AI TI-RADS vs 6,015 for ACR TI-RADS), including more values of 0 to several features. AI TI-RADS performed similarly to ACR TI-RADS while eliminating point assignments for many features, allowing for simplification of future TI-RADS versions. [ABSTRACT FROM AUTHOR]

Preliminary analysis in the field of information security in commercial UAV shows significant lacklustre in the implementation of information security [ 1 , 2 ]. This subsequently has made UAV to be especially vulnerable to information attack such as a simple Denial-of-Service (DOS) attack as it is sufficient to severely cripple many of the core functions of commercial UAVs. This research paper aims to provide recommendations in securing UAV from DOS attack works within UAV and proposed solutions against DOS attack. Such as general security guidelines of using long password with mix of special characters; implementing intrusion detection system within the intermediary devices between the connection of the UAV and the pilot, along with proper up-to-date firmware with patches installed; Implementation of an algorithm of a watch dog timer for proper allocation of resources and priority between the processing of network connection attempt and navigational control; Usage of a Raspberry Pi as an intermediary to router for a secure network connection by implementing intrusion detection system to alert the pilot in the event of an attack, and implement the moving target defense technique to hinder the adversaries attempting DOS attack. [ABSTRACT FROM AUTHOR]

Thrombus aspiration (TA) is used to decrease large thrombus burden (LTB), but it can cause distal embolization. The aim of this study was to investigate the impact of TA failure on defective myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) and LTB. In total, 812 consecutive patients with STEMI and LTB (thrombus grade ≥3) were enrolled, who underwent manual TA during the primary percutaneous coronary intervention. TA failure was defined as the absence of thrombus retrieval, presence of prestenting thrombus residue, or distal embolization. The final TIMI flow grades and other myocardial perfusion parameters of the failed TA group were matched with those of the successful TA group. The proportion of final TIMI flow grade 3 was lower (74.6% vs 82.2%; P = 0.011) in the failed TA group (n = 279 [34.4%]) than in the successful TA group (n = 533 [65.6%]). The failed TA group also had lower myocardial blush grade, lower ST-segment resolution, and a higher incidence of microvascular obstruction than the successful TA group. TA failure was independently associated with low final TIMI flow grade (risk ratio: 1.525; 95% CI: 1.048-2.218; P = 0.027). Old age, Killip class ≥III, vessel tortuosity, calcification, and a culprit vessel other than the left anterior descending coronary artery were associated with TA failure. TA failure is associated with reduced myocardial perfusion in patients with STEMI and LTB. Advanced age, hemodynamic instability, hostile coronary anatomy such as tortuosity or calcification, and non–left anterior descending coronary artery status might attenuate TA performance. (Gangwon PCI Prospective Registry [GWPCI]; NCT02038127) [Display omitted] [ABSTRACT FROM AUTHOR]

• The study introduces a hybrid ML/E model combining machine learning with an energy-based physical model. • The model offers a unified prediction for the LCF life of anisotropic Mg alloys. • It enhances prediction accuracy utilizing several ML strategies: loop learning, ε t−1 feature, optimum ANN architecture, and modified morrow model. • It outperforms the conventional coffin-manson model in both predictability and generalizability. Mg alloys are extremely valuable in the automotive and aerospace industries because of their lightweight properties and excellent machinability. The applications in these industries necessitate the accurate prediction of fatigue life under cyclic loading. However, this is challenging for many wrought Mg alloys owing to their pronounced plastic anisotropy. Conventional predictive methods such as the Coffin-Manson equation require manual parameter adjustment for different conditions, thus limiting their applicability. Accordingly, a novel predictive model for low-cycle fatigue (LCF) life that combines machine learning (ML) with an energy-based physical model, referred to as the hybrid ML/E model, is proposed herein. The hybrid ML/E model leverages a substantial hysteresis-loop dataset generated from LCF tests on a rolled AZ31 Mg alloy to effectively predict fatigue life. The proposed approach addresses the inherent challenges of small fatigue datasets, hysteresis-loop perception, and algorithm selection. The hybrid ML/E model demonstrates superior predictive accuracy and robustness in various loading directions, based on validation against conventional methods. The integration of ML and physical principles offers a unified framework for the LCF life prediction of anisotropic materials and represents a significant advancement for industrial applications. [Display omitted] [ABSTRACT FROM AUTHOR]

To assess serial changes of preoperative bone marrow lesion (BML) following medial open-wedge high tibial osteotomy (MOWHTO) up to 2 years and evaluate whether postoperative change of BML affected patient-reported outcome measures (PROMs) at 2 years' follow-up. Factors related to the postoperative changes in BML also were evaluated. The current study retrospectively assessed prospectively collected data of consecutive patients between December 2016 and March 2018 who underwent MOWHTO for symptomatic knee osteoarthritis with varus malalignment (≥5°) and a minimum 2-year follow-up. Serial magnetic resonance imaging scans at preoperative and postoperative 3, 6, 18, and 24 months were performed, and the extent of BML was evaluated consecutively using 2 validated methods. Clinically, preoperative and postoperative PROMs and their achievement of minimal clinically important difference values were evaluated. The associations of the extent of BMLs with PROMs at each follow-up period over time were analyzed using a linear mixed model. Furthermore, factors related to the postoperative changes of BML were assessed. Of 26 patients, 21 (80.8%) had preoperative BML at medial femoral and tibial condyles. The postoperative decrease in BML was noted in 17 (81.0%) and 18 (85.7%) at medial femoral and tibial condyles. The BML decreased at postoperative 3 months and, thereafter, the extent of BML gradually reduced until postoperative 24 months. The proportion of patients achieved minimal clinically important difference was 84.6% for total Western Ontario and McMaster Universities Osteoarthritis Index scores and 80.8%, 76.9%, and 84.6% for KOOS symptom, pain, and activity of daily living subscales. Postoperative decrease in BML was significantly associated with better PROMs over postoperative 24 months. Furthermore, normo-correction (2°-5° valgus) was a significant factor for decreased BML following MOWHTO. Preoperative BML gradually decreased with time following MOWHTO, and the postoperative decrease in BML related with better PROMs over postoperative 24 months. Moreover, postoperative valgus alignment was a significant factor relating the postoperative decrease of BML. Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Invisible orthodontic treatments are becoming increasingly popular, and numerous brands of invisible aligners are now available. However, concerns remain about the safety of the materials used in these products. This study aimed to assess the cytotoxic effects of both original and thermoformed thermoplastic materials used in orthodontic aligners on human periodontal ligament (HPDL) cells in vitro. The experiment used six different brands, each containing three types of thermoplastic materials, Polyethylene terephthalateco-1, 4-cyclohexylenedimethylene terephthalate (PETG), thermoplastic polyurethane (TPU), and copolyester polyethylene terephthalate (PET). The original sheets and the thermoformed materials were soaked in a culture medium for seven and fourteen days, and then applied to cultured human periodontal ligament cells. Cells were harvested on the first, third, and fifth days after application, and their viability was analyzed using the MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] assay. The findings revealed that some thermoformed materials, notably PETG, exhibited lower survival rates compared to their non-thermoformed versions. However, other materials such as TP and PET maintained over 70% cell viability, indicating only minor cytotoxic effects. These findings highlight the need for further research into the long-term biocompatibility of these materials but generally affirm their safety for use in orthodontic aligners under the tested conditions. [ABSTRACT FROM AUTHOR]

In clinical settings, there may be a need for a guide device that is simple and enhances the positioning accuracy of prosthetics. This study aimed to compare the accuracy of implant positioning using two methods: implant placement with a simple guide device (SGD) and freehand surgery. A total of 103 patients were randomly assigned to the control or study group. In the control group, implant placement was performed using the freehand technique. In the study group, implant placement was conducted with an SGD. Implant positioning accuracy was assessed by measuring how much the central position, fixture angulation, and fixture position differed from the ideal implant position based on periapical radiographs and cone-beam computed tomography images. In patients with double implants, parallelism between the two fixtures was also measured. There were 124 subjects, with 84 having single implants (42 in the control group and 42 in the study group) and 40 having double implants (20 in the control group and 20 in the study group). Utilization of the SGD for both single and double implant placement improved the accuracy of the central position, fixture angulation, and fixture position (P < 0.05). Additionally, in double implantation cases, it significantly enhanced parallelism between the two fixtures (P < 0.001). These findings suggest that use of an SGD leads to more accurate implant placement compared with freehand surgery taking into account the final prosthetic restoration. [ABSTRACT FROM AUTHOR]

The rapid urease test (RUT) is widely used to detect Helicobacter pylori infection; however, it is not preferred as a monitoring strategy after eradication owing to its low sensitivity. In this study, we evaluated the diagnostic performance of RUT using the sweeping method, which overcomes the limitations of conventional tissue sampling methods after eradication. Patients who received H pylori eradication treatment were enrolled. Each of the sweeping and conventional methods was performed on the same patients to compare diagnostic performance. Urea breath test (UBT), histology, and polymerase chain reaction were performed to determine true infection. Logistic regression analysis was conducted to investigate reasons for discrepancies between the results of the 2 methods. In 216 patients, the eradication success rate was 68.1%, and the sensitivity and specificity of the sweeping method were 0.812 and 0.912, respectively, whereas those of the conventional method were 0.391 and 0.993, respectively (P <.05 for all). The area under the receiver operating characteristic curve for the sweeping method was higher than that for the conventional method (0.862 vs 0.692, P <.001). The mean time to H pylori detection for the sweeping method was 4.7 ± 4.4 minutes and 12.3 ± 16.1 minutes for the conventional method (P <.001). The risk for inconsistent results between the 2 methods was the highest for UBT values of 1.4‰ to 2.4‰ (odds ratio, 3.8; P =.016). The RUT with the sweeping method could potentially replace the tissue sampling method as a test to confirm H pylori eradication and be an alternative option to UBT for patients requiring endoscopy. [Display omitted] [ABSTRACT FROM AUTHOR]

• Patients in the cardiac intensive care unit have become increasingly complex and require multidisciplinary care. • There are limited and heterogeneous data on the role of multidisciplinary teams in acute cardiovascular care. • Further data on optimal leadership structure, training paradigms, staffing ratios, system-based logistics, and outcomes are needed. As cardiovascular care continues to advance and with an aging population with higher comorbidities, the epidemiology of the cardiac intensive care unit has undergone a paradigm shift. There has been increasing emphasis on the development of multidisciplinary teams (MDTs) for providing holistic care to complex critically ill patients, analogous to heart teams for chronic cardiovascular care. Outside of cardiovascular medicine, MDTs in critical care medicine focus on implementation of guideline-directed care, prevention of iatrogenic harm, communication with patients and families, point-of-care decision-making, and the development of care plans. MDTs in acute cardiovascular care include physicians from cardiovascular medicine, critical care medicine, interventional cardiology, cardiac surgery, and advanced heart failure, in addition to nonphysician team members. In this document, we seek to describe the changes in patients in the cardiac intensive care unit, health care delivery, composition, logistics, outcomes, training, and future directions for MDTs involved in acute cardiovascular care. As a part of the comprehensive review, we performed a scoping of concepts of MDTs, acute hospital care, and cardiovascular conditions and procedures. [ABSTRACT FROM AUTHOR]

To elucidate the prevalence of overt, occult and no demonstrated (ND) stress urinary incontinence (SUI) in women with advanced-stage cystoceles. Between November 2011 and January 2017, all women with ≥stage 2 cystoceles were retrospectively enrolled. Overt SUI was diagnosed before the prolapse reduction test, and occult SUI was diagnosed when urine leakage was noted after a reduction test with vaginal gauze. Otherwise, a diagnosis of ND-SUI was made. The prevalence, clinical and urodynamic findings of overt SUI, occult SUI, and ND-SUI. In 480 enrolled women, 62% had overt SUI, 17% had occult SUI, and 21% had ND-SUI. The occult SUI group had the most advanced prolapse. The pad weight results after prolapse reduction (37.3 ± 44.3 vs. 13.4 ± 21.9, p < 0.05), the bladder capacity (243 ± 54 vs. 273 ± 48, p < 0.001), and questionnaires regarding life quality were significantly different between the overt SUI and the occult SUI groups. Bladder oversensitivity (BO) was the most common urodynamic diagnosis (389/480, 81%), especially in overt SUI, while urodynamic stress incontinence (56/480, 12%) and detrusor overactivity (60/480, 13%) were uncommon. The cutoff value of stage 3 uterine prolapse was the strongest predictor for predicting occult SUI (sensitivity = 30.3%, specificity = 78.5%; area = 0.60, 95% CI: 0.52–0.68). SUI occurs in a ratio of 3:1:1 among cases with overt, occult, and no demonstrable symptoms. BO is the most common urodynamic diagnosis. Pad test with prolapse reduction remains an important tool, especially for coexistent stage 3 uterine prolapse. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] • Profound perturbation of metabolome preceding T2D onset was revealed in a prospective Chinese population-based cohort. • Insulin resistance rather than β-cell dysfunction was strongly associated with metabolic shifts before T2D. • The impact of metabolites on T2D risk could be mediated by insulin resistance. • Discovery of previously unknown independent associations between metabolites and incident T2D. • The inclusion of metabolites selected by machine learning improved the predictive power of traditional clinical models. Type 2 diabetes (T2D) is a heterogeneous metabolic disease with large variations in the relative contributions of insulin resistance and β-cell dysfunction across different glucose tolerance subgroups and ethnicities. A more precise yet feasible approach to categorize risk preceding T2D onset is urgently needed. This study aimed to identify potential metabolic biomarkers that could contribute to the development of T2D and investigate whether their impact on T2D is mediated through insulin resistance and β-cell dysfunction. A non-targeted metabolomic analysis was performed in plasma samples of 196 incident T2D cases and 196 age- and sex-matched non-T2D controls recruited from a long-term prospective Chinese community-based cohort with a follow-up period of ∼ 16 years. Metabolic profiles revealed profound perturbation of metabolomes before T2D onset. Overall metabolic shifts were strongly associated with insulin resistance rather than β-cell dysfunction. In addition, 188 out of the 578 annotated metabolites were associated with insulin resistance. Bi-directional mediation analysis revealed putative causal relationships among the metabolites, insulin resistance and T2D risk. We built a machine-learning based prediction model, integrating the conventional clinical risk factors (age, BMI, TyG index and 2hG) and 10 metabolites (acetyl-tryptophan, kynurenine, γ-glutamyl-phenylalanine, DG(18:2/22:6), DG(38:7), LPI(18:2), LPC(P-16:0), LPC(P-18:1), LPC(P-20:0) and LPE(P-20:0)) (AUROC = 0.894, 5.6% improvement comparing to the conventional clinical risk model), that successfully predicts the development of T2D. Our findings support the notion that the metabolic changes resulting from insulin resistance, rather than β-cell dysfunction, are the primary drivers of T2D in Chinese adults. Metabolomes as a valuable phenotype hold potential clinical utility in the prediction of T2D. [ABSTRACT FROM AUTHOR]

[Display omitted] • CORM-2 attenuates cisplatin-induced hearing loss in young adult mice. • CORM-2 co-treatment decreases platinum accumulation in the inner ear. • CORM-2 protects against cisplatin-induced toxic cellular responses including necroptosis, plasma membrane disruption, and apoptotic cell death. • CORM-2 co-treatment reverses the persistent inflammatory environment created by cisplatin. • CORM-2 co-treatment reduces cochlear capillary leakage (hyperpermeability) and maintains the integrity of blood-labyrinth barrier. Cisplatin is a life-saving anticancer compound used to treat multiple solid malignant tumors, while it causes permanent hearing loss. There is no known cure, and the FDA has not approved any preventative treatment for cisplatin-based ototoxicity. This study investigated whether the carbon monoxide (CO)-releasing tricarbonyldichlororuthenium (II) dimer, CORM-2, reverses cisplatin-induced hearing impairment and reduces cisplatin accumulation in the mouse inner ear. Male 6-week-old BALB/c mice were randomly assigned to one of the following groups: control (saline-treated, i.p.), CORM-2 only (30 mg/kg, i.p., four doses), cisplatin only (20 mg/kg, i.p., one dose), and CORM-2 + cisplatin, to determine whether cisplatin-based hearing impairment was alleviated by CORM-2 treatment. Our results revealed CORM-2 significantly attenuated cisplatin-induced hearing loss in young adult mice. CORM-2 co-treatment significantly decreased platinum accumulation in the inner ear and activated the plasma membrane repair system of the stria vascularis. Moreover, CORM-2 co-treatment significantly decreased cisplatin-induced inflammation, apoptosis, and cochlear necroptosis. Because the stria vascularis is the likely cochlear entry point of cisplatin, we next focused on the microvasculature. Cisplatin induced increased extravasation of a chromatic tracer (fluorescein isothiocyanate [FITC]-dextran, MW 75 kDa) around the cochlear microvessels at 4 days post-treatment; this extravasation was completely inhibited by CORM-2 co-therapy. CORM-2 co-treatment effectively maintained the integrity of stria vascularis components including endothelial cells, pericytes, and perivascular-resident macrophage-type melanocytes. CORM-2 co-therapy substantially protects against cisplatin-induced ototoxicity by reducing platinum accumulation and toxic cellular stress responses. These data indicate that CORM-2 co-treatment may be translated into clinical strategy to reduce cisplatin-induced hearing loss. [ABSTRACT FROM AUTHOR]

[Display omitted] Mesenchymal stem cells (MSCs) play important roles in therapeutic applications by regulating immune responses. We investigated the safety and efficacy of allogenic human bone marrow–derived clonal MSCs (hcMSCs) in subjects with moderate to severe atopic dermatitis (AD). The study included a phase 1 open-label trial followed by a phase 2 randomized, double-blind, placebo-controlled trial that involved 72 subjects with moderate to severe AD. In phase 1, intravenous administration of hcMSCs at 2 doses (1 × 106 and 5 × 105 cells/kg) was safe and well tolerated in 20 subjects. Because there was no difference between the 2 dosage groups (P =.9), it was decided to administer low-dose hcMSCs only for phase 2. In phase 2, subjects receiving 3 weekly intravenous infusions of hcMSCs at 5 × 105 cells/kg showed a higher proportion of an Eczema Area and Severity Index (EASI)-50 response at week 12 compared to the placebo group (P =.038). The differences between groups in the Dermatology Life Quality Index and pruritus numeric rating scale scores were not statistically significant. Most adverse events were mild or moderate and resolved by the end of the study period. The hcMSC treatment resulted in a significantly higher rate of EASI-50 at 12 weeks compared to the control group in subjects with moderate to severe AD. The safety profile of hcMSC treatment was acceptable. Further larger-scale studies are necessary to confirm these preliminary findings. [ABSTRACT FROM AUTHOR]

• We conducted a 6-month exercise randomized controlled trial on Parkinson disease. • The program consisted of balance exercise and brisk walking with 6-month follow-up. • This program alleviates nonmotor and motor symptoms posttraining. • It also improves motor symptoms, walking capacity, and functions at follow-up. To investigate the effects of balance exercise and brisk walking on nonmotor and motor symptoms, balance and gait functions, walking capacity, and balance confidence in Parkinson disease (PD) at posttraining and 6-month follow-up. Two-arm, assessor-blinded randomized controlled trial University research laboratory and the community Ninety-nine eligible individuals with mild-to-moderate PD Participants were randomized to balance and brisk walking group (B&B, n=49) or active control group (n=50). B&B received ten 90-minute sessions of balance exercises and brisk walking supervised by physical therapists for 6 months (week 1-6: weekly, week 7-26: monthly), whereas control practiced whole-body flexibility and upper limb strength exercise at same dosage (180 min/wk). Both groups performed unsupervised home exercises 2-3 times/wk during intervention and continued at follow-up. Primary outcomes were Movement Disorder Society Unified Parkinson Disease Rating Scale nonmotor (MDS-UPDRS-I) and motor (MDS-UPRDS-III) scores. Secondary outcomes were mini-Balance Evaluation Systems Test (mini-BEST) score, comfortable gait speed (CGS), 6-minute walk test (6MWT), dual-task timed-Up-and-Go (DTUG) time, and Activities-Specific Balance Confidence Scale score. Eighty-three individuals completed the 6-month intervention with no severe adverse effects. The mean between-group (95% CI) difference for the MDS-UPDRS nonmotor score was 1.50 (0.19-2.81) at 6 months and 1.09 (−0.66 to 2.85) at 12 months. The mean between-group (95% CI) difference for the MDS-UPDRS motor score was 3.75 (0.69-6.80) at 6 months and 4.57 (1.05-8.01) at 12 months. At 6 and 12 months, there were significant between-group improvements of the B&B group in mini-BEST score, CGS, 6MWT, and DTUG time. This combined balance and brisk walking exercise program alleviates nonmotor and motor symptoms and improves walking capacity, balance, and gait functions posttraining, with positive carryover effects for all except nonmotor outcomes, at 6-month follow-up in mild-to-moderate PD. [ABSTRACT FROM AUTHOR]

• Nursing students should receive training in multidisciplinary collaboration to meet the increasing demand for community nurses. However, existing educational strategies could not adequately frame a learning environment for nursing students to fully experience collaboration in a multidisciplinary team. • Challenge-Based Learning (CBL) may be a promising educational approach to complement the limitations of current education strategies in nursing education because it allows nursing students to fully experience multidisciplinary collaboration through conducting community projects in a multidisciplinary context. • The preliminary findings suggest the potential positive effect of CBL in strengthening nursing students' multidisciplinary collaboration. It serves as a reference for nurse educators to integrate CBL into nursing curricula. It also provides direction for future studies to evaluate the effect of CBL on multidisciplinary collaboration in nurse training. Competence in multidisciplinary collaboration is an essential attribute of nurses working in community health settings. Nursing students should be equipped with this attribute during undergraduate training. To examine the effect of Challenge-Based Learning (CBL) on multidisciplinary collaboration among nursing students. A one-group pretest-posttest study. Nursing students worked in multidisciplinary groups to conduct community projects framed with CBL. The students designed, planned, and implemented health promotion activities for the selected health topics over a 14-week semester. Multidisciplinary collaboration was measured by Collaboration Scale at baseline and after the projects were completed. Wilcoxon signed-rank test was used to compare the total and subdomain collaboration scores within-group. p-value <0.05 was statistical significance. The total and subdomain collaboration scores were significantly greater than those of the pretest ones (p<0.001), with the effect sizes (r) ranging from 0.48 to 0.71. The present findings shed light on the potential positive effect of CBL on strengthening nursing students' competence in multidisciplinary collaboration. Future studies with a more rigorous approach are needed to verify the findings. [ABSTRACT FROM AUTHOR]