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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]

Apert (AS), Crouzon (CS), Muenke (MS), Pfeiffer (PS), and Saethre Chotzen (SCS) are among the most frequently diagnosed syndromic craniosynostoses. The aims of this study were (1) to train an innovative model using artificial intelligence (AI)–based methods on two-dimensional facial frontal, lateral, and external ear photographs to assist diagnosis for syndromic craniosynostoses vs controls, and (2) to screen for genotype/phenotype correlations in AS, CS, and PS. We included retrospectively and prospectively, from 1979 to 2023, all frontal and lateral pictures of patients genetically diagnosed with AS, CS, MS, PS and SCS syndromes. After a deep learning–based preprocessing, we extracted geometric and textural features and used XGboost (eXtreme Gradient Boosting) to classify patients. The model was tested on an independent international validation set of genetically confirmed patients and non-syndromic controls. Between 1979 and 2023, we included 2228 frontal and lateral facial photographs corresponding to 541 patients. In all, 70.2% [0.593–0.797] (p < 0.001) of patients in the validation set were correctly diagnosed. Genotypes linked to a splice donor site of FGFR2 in Crouzon-Pfeiffer syndrome (CPS) caused a milder phenotype in CPS. Here we report a new method for the automatic detection of syndromic craniosynostoses using AI. [ABSTRACT FROM AUTHOR]

[Display omitted] Growing evidence demonstrates the importance of high- and low-density lipoprotein cholesterol in certain immune and allergy-mediated diseases. This study aimed to evaluate levels of high- and low-density lipoprotein cholesterol and apolipoproteins A1 and B in sera from a cohort of patients presenting with hypersensitivity reactions. We further assessed the function of high-density lipoprotein particles as well as their involvement in the molecular mechanisms of anaphylaxis. Lipid profile determination was performed in paired (acute and baseline) serum samples from 153 patients. Thirty-eight experienced a non-anaphylactic reaction and 115 had an anaphylactic reaction (88 moderate and 27 severe). Lecithin cholesterol acyl transferase activity was assessed in patient sera, and we also evaluated macrophage cholesterol efflux in response to the serum samples. Last, the effect of anaphylactic-derived high-density lipoprotein (HDL) particles on the endothelial barrier was studied. Detailed methods are provided in the Methods section in this article's Online Repository available at www.jacionline.org. Serum samples from severe anaphylactic reactions show statistically significant low levels of HDL cholesterol, low-density lipoprotein cholesterol, and apolipoproteins A1 and B, which points to their possible role as biomarkers. Specifically, HDL particles play a protective role in cardiovascular diseases. Using functional human serum cell assays, we observed impaired capacity of apolipoprotein B–depleted serum to induce macrophage cholesterol efflux in severe anaphylactic reactions. In addition, purified HDL particles from human anaphylactic sera failed to stabilize and maintain the endothelial barrier. These results encourage further research on HDL functions in severe anaphylaxis, which may lead to new diagnostic and therapeutic strategies. [ABSTRACT FROM AUTHOR]

With the increase of interest in Facial Expression Recognition (FER) in the past few decades. Several challenges surfaced with the invention of many different FER models which are often based on Convolution Neural Network (CNN) architectures. Recently, an attention-based transformer model has been presented to address FER. One of the major issues with Transformers is the need for a large data quantity for training. Therefore, in this paper, we propose to learn how to fine-tune a vision transformer-based (ViT) model using a limited dataset. We will be using the JAFFE Dataset, which consists of only 213 images containing seven different emotions. The proposed method is evaluated using several fine-tuning methods, such as adding dropout, data augmentation, and layer freezing. We compared the models implemented with 5% dropout regularization, augmented dataset (up to 5000 images), and freezing the initial model's layers, fine-tuning around a fourth of the last layers. The best model was achieved by fine-tuning ViT L-16 with 96.06% accuracy, trained with 5% dropout in the augmented dataset, and freezing the initial 21st layers. We also compared our model to the other previous work model and the results showed that our model reached the state-of-the art for the JAFFE dataset. [ABSTRACT FROM AUTHOR]

Emotion recognition within online product reviews is pivotal for enhancing business strategies and customer insights. Recognizing emotions in Indonesian, a language rich in nuances and expressions presents significant challenges due to its complex linguistic structure and the scarcity of tailored datasets. This study aims to bridge this gap by evaluating the effectiveness of Bidirectional Long Short-Term Memory (BiLSTM), Bidirectional Encoder Representations from Transformers (BERT), and ensemble methods in analyzing emotions from Indonesian product reviews using the PRDECT-ID dataset. Extensive fine-tuning across 23 BERT con- figurations and multiple BiLSTM preprocessing combinations was conducted to adapt these models to the Indonesian linguistic context. Each model was assessed based on the F1 score. The BiLSTM model was particularly effective in configurations with complex preprocessing, achieving an optimal F1 score of 61% through advanced noise removal, stemming, and a modified stop- words list. Conversely, the minimally preprocessed fine-tuned 'base-p2' and 'large-p1' BERT variants achieved F1 scores of 72% and 73%, respectively, both surpassing the previous best result of 71%. This research also explored 4 ensemble methods, combin- ing the strengths of the best-performing BiLSTM and BERT models using both soft-voting and stacked generalization techniques. The unweighted stacked generalization achieved a 74% F1 score, while the weighted method excelled with the highest F1 score of 75%, surpassing other models and highlighting the advantages of strategic model integration. This research significantly advances the development of NLP models for Indonesian text, demonstrating how tailored deep-learning approaches can effectively enhance emotion recognition accuracy. [ABSTRACT FROM AUTHOR]

• The Orchard Sports Injury and Illness Classification System (OSIICS) is 1 of 2 sports injury classification systems recognized by the International Olympic Committee and needs regular update. • It was previously focused on injuries rather than common illness/medical condition presentations in athletes, so the most recent updates have extended medical presentation diagnoses. • Version 15 includes expansion of available diagnoses in the fields of mental health, sports concussion, sports cardiology, sports dermatology, sports ophthalmology, and infectious diseases. • The OSIICS has been previously translated into Italian, Spanish, and Catalan, and further translation into multiple other languages is planned. Sports medicine (injury and illnesses) requires distinct coding systems because the International Classification of Diseases is insufficient for sports medicine coding. The Orchard Sports Injury and Illness Classification System (OSIICS) is one of two sports medicine coding systems recommended by the International Olympic Committee. Regular updates of coding systems are required. For Version 15, updates for mental health conditions in athletes, sports cardiology, concussion sub-types, infectious diseases, and skin and eye conditions were considered particularly important. Recommended codes were added from a recent International Olympic Committee consensus statement on mental health conditions in athletes. Two landmark sports cardiology papers were used to update a more comprehensive list of sports cardiology codes. Rugby union protocols on head injury assessment were used to create additional concussion codes. It is planned that OSIICS Version 15 will be translated into multiple new languages in a timely fashion to facilitate international accessibility. The large number of recently published sport-specific and discipline-specific consensus statements on athlete surveillance warrant regular updating of OSIICS. [Display omitted] [ABSTRACT FROM AUTHOR]

Determine the capacity of individual items on the Tendinopathy Severity Assessment – Achilles (TENDINS-A), Foot and Ankle Outcome Score (FAOS), and Victorian Institute of Sports Assessment – Achilles (VISA-A) to differentiate patients with mild and severe tendon-related disability in order to provide clinicians the best questions when they are consulting patients with Achilles tendinopathy. Cross-sectional. Seventy participants with Achilles tendinopathy (61.4% mid-portion only, 31.4% insertional only, 7.2% both). The discrimination index was determined for each TENDINS-A, FAOS, and VISA-A item to determine if items could discriminate between mild and severe disability. A Guttman analysis for polytomous items was conducted. All 62 tems from the TENDINS-A, FAOS, and VISA-A were ranked with the best items relating to pain with physical tendon loading, time for pain to settle following aggravating activities and time for the tendon to 'warm-up' following inactivity. Pain with loading the Achilles tendon, time for pain to settle following aggravating activity, as well as time taken for the tendon symptoms to subside after prolonged sitting or sleeping are the best questions indicative of the severity of disability in patients with Achilles tendinopathy. These questions can assist clinicians with assessing baseline severity and monitoring treatment response. • Clinicians should ask about Achilles pain with physical tendon loading. • Clinicians should ask about time for Achilles pain to settle after aggravation. • Clinicians should ask about time for the tendon to 'warm-up' following inactivity. [ABSTRACT FROM AUTHOR]

Power Electronics (PE) endorse a critical role for ensuring energy transitions targeting carbon neutrality in 2050. Design strategies based on Life Cycle Assessment (LCA) have recently been introduced into the PE field to ecodesign Power Electronics Converters (PEC). LCA is a multi-criteria approach aimed at assessing environmental impacts at various stages of the product lifecycle, and its use is widely spread among scientific and ecodesign communities. Nevertheless, interpreting LCA results for PECs is challenging because of the complexity of PE (as systems with multiple subsystems and components) and multicriteria aspects of LCA. Previous research suggests a functional-analysis-based perspective to simplify the lifecycle modeling of electronics and integrate comprehensively LCA outcomes with the Product Development Process (PDP) and ecodesign. Inspired by this original proposition, this study derives a novel framework that dissects and guides the interpretation of LCA results of PECs in order to identify environmental hot spots and establish operational ecodesign strategies. The proposed framework helps to reveal the cause-and-effect relationships between the technical characteristics of hardware solutions and the prospective environmental consequences that may arise to PE designers. A case study of a DC-DC buck converter is presented to debate the effectiveness of this proposed framework in PEC with designers. [ABSTRACT FROM AUTHOR]

The upscaling of technology encompasses many facets a designer concerned with reducing environmental impacts must manage. Therefore, previous research proposed an environmental assessment for upscaling (EAU) methodology. This method hinges on Life Cycle Assessment (LCA) approaches (e.g., prospective, absolute) and coordinates the environmental modelling from an ecodesign perspective. The originality of this paper is to present an illustrative application on photovoltaic systems. The focus is on the modelling practices (step 3 of the method) using upscaling design levers and generating parametrized scenarios meant to be interpretable for a design team. Examples of data collection and upscaling modelling are provided for the upscaling of silicon-based photovoltaic technology in France from 2021 to 2050. This case study shows that integrating upscaling parameters, such as industrial process evolutions, the technology deployment strategy, and the socio-technical context associated with the technology upscaling phenomenon influence LCA results significantly. The paper, therefore, discusses recommendations for design teams to support them in assessing the environmental implications of their technology choices. [ABSTRACT FROM AUTHOR]

Stereolithographic (SLA) three-dimensional (3D) printing is considered a reliable manufacturing method for immediate complete dentures. However, studies on the implementation of computer-generated surface patterns to promote the union between printed denture base polymers and dental materials with different chemistries such as plasticized acrylic-resin resilient liners are lacking. The purpose of this in vitro study was to assess the effect of 3D printed surface patterns on the peak tensile load of a short-term plasticized acrylic-resin resilient liner. A total of 30 denture base specimens (Denture Base LP; FormLabs) were fabricated with 3 adhesive surface designs by using an SLA 3D printer (Forms2; FormLabs). Twenty specimens were designed with surface patterns in the adhesive areas (grid and spheres); 10 specimens comprised each surface pattern group. The remaining specimens were roughened with 220-grit silicon carbide paper and served as a control. A commonly used short-term resilient liner (CoeSoft; GC-America) was applied to the adhesive surface of all the specimens. Subsequently, the specimens were kept in distilled water at 37 °C for 48 hours. The specimens were tested in a universal testing machine, and the resulting peak tensile load data were analyzed by using a 1-way analysis of variance (ANOVA) and a post hoc Tukey test (α=.05). The groups with surface patterns on the adhesive surface displayed higher peak tensile load values than the control group. The mean peak tensile load of the grid group was 6.73 ±0.43 N, and that for the spheres group was 6.58 ±0.33 N. The control group displayed the lowest mean peak tensile load (2.71 ±0.51 N). Statistically significant differences were detected between the mean peak tensile loads of the surface pattern groups and the control group (P <.001) No statistically significant difference was found between the mean peak tensile loads of the grid and spheres groups (P =.893). Incorporating surface patterns on the intaglio surface of denture bases made with Denture Base LP via SLA 3D printing can enhance their union to a plasticized acrylic-resin resilient liner. Surface patterns generated higher peak tensile load values than slightly roughening the surface of a 3D printed denture with a 220-grit silicon carbide paper. No significant differences in the mean peak tensile loads were observed between the 2 types of surface patterns. [ABSTRACT FROM AUTHOR]

Computer-aided design and computer-aided manufacturing (CAD-CAM) technologies have become popular for manufacturing complete dentures. However, the adhesive strength of resilient liners to the polymers used to fabricate CAD-CAM complete dentures is unclear. The purpose of this in vitro study was to determine the adhesive strength of 3 long-term resilient liners to CAD-CAM denture base polymers and heat-polymerized PMMA with thermocycling. A total of 90 specimens were fabricated, 30 per group of denture base material (Lucitone 199, Ivo Base CAD, Denture Base LP). For each denture base polymer, 10 specimens were relined with 1 of 3 resilient liners (Permasoft, Mucopren Soft, Molloplast-B). Five specimens of each group were thermocycled, and the other 5 specimens were stored in distilled water. Subsequently, the adhesive strength of the specimens was assessed by tensile testing. The resulting data were analyzed by using a 3-way analysis of variance (ANOVA) (α=.05). After thermocycling, the adhesive strengths of all the resilient liners were found to be statistically different from each other for the same denture base polymer (P ≤.012). Mucopren Soft displayed a high mean ±standard deviation adhesive strength to Lucitone 199 (1.78 ±0.32 MPa), followed by Molloplast-B (1.27 ±0.21 MPa) and Permasoft (0.66 ±0.06 MPa). For Ivo Base CAD, Molloplast-B exhibited a high mean ±standard deviation adhesive strength (1.70 ±0.36 MPa), followed by Mucopren Soft (1.11 ±0.16 MPa) and Permasoft (0.53 ±0.04 MPa). Molloplast-B displayed high mean ±standard deviation adhesive strength to Denture Base LP (1.37 ±0.08 MPa), followed by Mucopren Soft (0.68 ±0.20 MPa) and Permasoft (0.32 ±0.04 MPa). The adhesive strength of the majority of resilient liners not exposed to thermocycling was statistically different from each other for the same type of denture base polymer (P <.001). The only exception was the difference between the adhesive strength of Molloplast-B and Mucopren Soft to Lucitone 199 with mean ±standard deviation values of 1.42 ±0.18 and 1.66 ±0.40 MPa, respectively, (P =.067). Without thermocycling, the mean ±standard deviation adhesive strength to Lucitone 199 of Permasoft (0.57 ±0.02 MPa) was statistically different from that of Molloplast-B and Mucopren Soft (P <.001). Molloplast-B displayed a high mean ±standard deviation adhesive strength to Ivo Base CAD (1.83 ±0.25 MPa), followed by Mucopren Soft (1.26 ±0.19 MPa) and Permasoft (0.58 ±0.08 MPa). Molloplast-B displayed a high mean ±standard deviation adhesion to Denture Base LP (1.76 ±0.23 MPa), followed by Mucopren Soft (0.88 ±0.14 MPa) and Permasoft (0.25 ±0.06 MPa). Only Molloplast-B was significantly adversely affected by thermocycling (P=.009). Molloplast-B displayed high adhesive strength to both CAD-CAM denture base polymers regardless of the storage conditions. Mucopren Soft displayed high adhesion to Lucitone 199. Permasoft presented moderate adhesion to PMMA-based denture bases and low adhesion to DBLP. Combining Permasoft with Denture Base LP should be considered carefully and limited to short-term use. Thermocycling had a detrimental effect on the adhesive strength of Molloplast-B. [ABSTRACT FROM AUTHOR]

Mental fatigue is known to influence endurance, skill, and tactical performance in sport. Research investigating the impact of mental fatigue on tasks that combine physical, cognitive, and aesthetic performance such as professional ballet does not exist. Objective: To understand the perceptions and experiences of mental fatigue in professional ballet. Design: Qualitative, focus groups and semi-structured interviews. Setting: The Australian Ballet. Participants: Thirty-nine professional ballet dancers (53% of the company) and six dance staff members aged 18 years or above (53% female). Main outcome measures: N/a. Results: The average focus group and interview length was 48 ± 7 min and 41 ± 8 min. Key categories were; (1) Dancers and dance staff perceive that new learning contributes to mental fatigue, (2) Dancers perceive changes to their mood and perception of effort when they are mentally fatigued, and (3) Dancers and dance staff perceive that mental fatigue negatively affects their physical and cognitive performance and, increases their risk of injury. Conclusion: This is the first study where participants associated mental fatigue with injury risk and provides a springboard to measure the impact of mental fatigue on learning, injury, and performance in professional ballet. • Learning new skills and choreography were identified as causes of mental fatigue. • Difficulty regulating emotion was identified as a common symptom of mental fatigue. • Dancers perceive that mental fatigue increases their risk of acute and over-use injury. • Psychological and environmental strategies are used by dancers to reduce mental fatigue. • Future Research must focus on the measurement of mental fatigue in professional ballet. [ABSTRACT FROM AUTHOR]

Although the prevalence of drug overdose has gradually increased worldwide, the risk factors associated with the recurrence of suicide attempts via drug overdose have not been well elucidated. In this study, we investigated the clinical course of patients with drug overdose and whether or not patients reattempted suicide via overdose, using telephone interviews, to evaluate the risk factors associated with overdose recurrence. This prospective observational study enrolled patients who attempted suicide by drug overdose and were transferred to a tertiary emergency hospital in Japan between January 1, 2015 and July 30, 2021. Recurrence of overdose within 1 year of admission for overdose was designated as the primary outcome. Multivariable logistic regression analysis was performed to assess the independent risk factors for the recurrence of overdose. Furthermore, we compared the difference in the recurrence interval between patients with and without cohabitants using the log-rank test. A total of 94 patients were identified, and recurrence of overdose was observed in 28 patients (29.8%). The median recurrence interval was 6.0 months [IQR (interquartile range), 4.0–7.0 months]. The recurrence rate was significantly higher in patients with a history of schizophrenia than that in patients without a history of schizophrenia (58.3% vs 25.6%, p = 0.048), and significantly lower in patients with cohabitants than that in patients without cohabitants (22.6% vs 43.8%, p = 0.015). The presence of a cohabitant was significantly associated with a longer recurrence interval (p = 0.049). The effect of psychiatric intervention during hospitalization and psychiatric visits after discharge could not be found in this study. A history of schizophrenia was an independent risk factor for the recurrence of overdose, and the presence of a cohabitant was significantly associated with a lower risk of recurrence. Large-scale, long-term studies are required to confirm the results of this study. • Suicide attempts via recurrent overdose were significantly related to schizophrenia. • The recurrent overdose interval was longer in patients with cohabitants. • The association between psychiatric intervention and overdose relapse rate/interval could not be found in this study. [ABSTRACT FROM AUTHOR]

Mitochondrial transplantation has been shown to preserve myocardial function and viability in adult porcine hearts donated after circulatory death (DCD). Herein, we investigate the efficacy of mitochondrial transplantation for the preservation of myocardial function and viability in neonatal and pediatric porcine DCD heart donation. Circulatory death was induced in neonatal and pediatric Yorkshire pigs by cessation of mechanical ventilation. Hearts underwent 20 or 36 minutes of warm ischemia time (WIT), 10 minutes of cold cardioplegic arrest, and then were harvested for ex situ heart perfusion (ESHP). Following 15 minutes of ESHP, hearts received either vehicle (VEH) or vehicle containing isolated autologous mitochondria (MITO). A sham nonischemic group (SHAM) did not undergo WIT, mimicking donation after brain death heart procurement. Hearts underwent 2 hours each of unloaded and loaded ESHP perfusion. Following 4 hours of ESHP perfusion, left ventricle developed pressure, dP/dt max, and fractional shortening were significantly decreased (P <.001) in DCD hearts receiving VEH compared with SHAM hearts. In contrast, DCD hearts receiving MITO exhibited significantly preserved left ventricle developed pressure, dP/dt max, and fractional shortening (P <.001 each vs VEH, not significant vs SHAM). Infarct size was significantly decreased in DCD hearts receiving MITO as compared with VEH (P <.001). Pediatric DCD hearts subjected to extended WIT demonstrated significantly preserved fractional shortening and significantly decreased infarct size with MITO (P <.01 each vs VEH). Mitochondrial transplantation in neonatal and pediatric pig DCD heart donation significantly enhances the preservation of myocardial function and viability and mitigates against damage secondary to extended WIT. [Display omitted] [ABSTRACT FROM AUTHOR]

Standard-diameter dental implants are not always applicable because of anatomic limitations of the residual ridge. Thus, mini-implants have been increasingly used and offer an alternative. However, data regarding prosthetic complications, maintenance factors, and clinical outcomes are limited. The purpose of this systematic review and meta-analysis was to compare prosthetic complications and maintenance events and clinical outcomes in residual ridges rehabilitated with mandibular implant overdentures (IODs) by using standard implants or mini-implants. Nine electronic databases were searched. Quantitative analyses to measure the risk ratio (RR) and standardized mean difference (SMD) were applied. Those methods were used to assess prosthetic complications and maintenance events (abutment adjustments, replacement of retentive element, occlusal adjustment, and overdenture fracture) and clinical outcomes related to postoperative pain, probing depth (PD), plaque index (PI), marginal bone loss (MBL), and implant survival rate. Altogether, 7 publications were selected. Mini-implants presented reduced abutment adjustments (RR 0.23 [0.07, 0.73], P =.01), replacement of retentive element (RR 0.41 [0.31, 0.54], P <.001), occlusal adjustment (RR 0.53 [0.31, 0.91], P =.02), and overdenture fracture (RR 0.46 [0.23, 0.94], P =.03) compared with standard implants. Additionally, mini-implants presented lower values for PI at 6 months (SMD -0.27 [-0.47, -0.08], P =.006) and 12 months (SMD -0.25 [-0.46, -0.05], P =.01). No additional tangible differences were noted. Mini-implants might be an alternative choice based on the number of prosthetic complications and maintenance events. This was also confirmed by the comparable clinical data between standard implants and mini-implants. [ABSTRACT FROM AUTHOR]

Following ACL reconstruction (ACLR), deficits in hip muscle strength and relationships to future outcomes are unknown. 111 participants one year after ACLR, completed hip external rotation (ER) and internal rotation (IR) strength assessment. At 1 (n = 111) and 5 (n = 74) years post-ACLR, participants completed a battery of functional, symptomatic (Knee Osteoarthritis Outcome Score (KOOS)) and structural assessments (radiography, magnetic resonance imaging (MRI)). Cartilage health of the patellofemoral and tibiofemoral compartments was assessed with the semiquantitative MRI Osteoarthritis Knee Score. Hip rotation strength was compared between-limbs, and relationships between hip strength at 1 year and functional, symptomatic and cartilage outcomes at 1 and 5 years were investigated with regression models. The index (ACLR) limb had weaker hip ER (but not IR) strength compared to the contralateral side (standardised mean difference ER = −0.33 (95%CI -0.60, −0.07; IR = −0.11 (95%CI -0.37, 0.15). Greater hip ER and IR strength was associated with superior function at 1 and 5 years, and better KOOS-Patellofemoral symptoms at 5 years. Greater hip ER strength was associated with lower odds of worsening tibiofemoral cartilage lesions at 5 years (odds ratio 0.01, 95%CI 0.00, 0.41). Hip rotation strength may play a role in worsening function, symptoms and cartilage health after ACLR. [ABSTRACT FROM AUTHOR]

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Determine if improvements in pain and disability in patients with mid-portion Achilles tendinopathy relate to changes in muscle structure and function whilst completing exercise rehabilitation. A systematic review exploring the relationship between changes in pain/disability and muscle structure/function over time, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six online databases and the grey literature were searched from database inception to 16th December 2022 whereas clinical trial registries were searched from database inception to 11th February 2020. We included clinical studies where participants received exercise rehabilitation (± placebo interventions) for mid-portion Achilles tendinopathy if pain/disability and Triceps Surae structure/function were measured. We calculated Cohen's d (95 % confidence intervals) for changes in muscle structure/function over time for individual studies. Data were not pooled due to heterogeneity. Study quality was assessed using a modified Newcastle–Ottawa Scale. Seventeen studies were included for synthesis. No studies reported the relationship between muscle structure/function and pain/disability changes. Twelve studies reported muscle structure/function outcome measures at baseline and at least one follow-up time-point. Three studies reported improvements in force output after treatment; eight studies demonstrated no change in structure or function; one study did not provide a variation measure, precluding within group change over time calculation. All studies were low quality. No studies explored the relationship between changes in tendon pain and disability and changes in muscle structure and function. It is unclear whether current exercise-based rehabilitation protocols for mid-portion Achilles tendinopathy improve muscle structure or function. PROSPERO (registration number: CRD42020149970). [ABSTRACT FROM AUTHOR]

Existing efforts to promote cleaner fuels have not achieved exclusive use. We investigated whether receiving 12 months of free liquefied petroleum gas (LPG) and behavioral support could motivate continued purchase and use. The Cardiopulmonary outcomes and Household Air Pollution (CHAP) trial enrolled 180 women. Half were randomly assigned to an intervention group, which included free LPG delivered in months 1–12 followed by a post-intervention period in which they no longer received free fuel (months 13–24). For the purposes of comparison, we also include months 1–12 of data from control participants. We tracked stove use with temperature monitors, surveys, and observations, and conducted in-depth interviews with 19 participants from the intervention group at the end of their post-intervention period. Participants from the intervention group used their LPG stove for 85.4 % of monitored days and 63.2 % of cooking minutes during the post-intervention months (13–24) when they were not receiving free fuel from the trial. They used a traditional stove (fogón) on 45.1 % of days post-intervention, which is significantly lower than fogón use by control participants during the intervention period (72.2 % of days). In months 13–24 post-intervention, participants from the intervention group purchased on average 12.3 kg and spent 34.1 soles (10.3 USD) per month on LPG. Continued LPG use was higher among participants who said they could afford two tanks of LPG per month, did not cook for animals, and removed their traditional stove. Women described that becoming accustomed to LPG, support and training from the project, consistent LPG supply, choice between LPG providers, and access to delivery services facilitated sustained LPG use. However, high cost was a major barrier to exclusive use. A 12-month period of intensive LPG support achieved a high level of sustained LPG use post-intervention, but other strategies are needed to sustain exclusive use. • Exclusive clean fuel use is necessary for realizing full health and other benefits. • Mixed methods investigation to inform achievement of sustained LPG use in Peru • One year of free fuel motivated sustained (but not exclusive) LPG use post-trial. • Sustained use motivated by becoming accustomed to LPG and training during trial • Consistent LPG supply, multiple distributors, and delivery services were also key. [ABSTRACT FROM AUTHOR]

Patients with cancers have been severely affected by the COVID-19 pandemic. This is highlighted by the adverse outcomes in cancer patients with COVID-19 as well as by the impact of the COVID-19 pandemic on cancer care. Patients with cancer constitute a heterogeneous population that exhibits distinct mechanisms of immune dysfunction, associated with distinct systemic features of hot (T-cell-inflamed/infiltrated) and cold (Non-T-cell-inflamed and/or infiltrated) tumors. The former show hyper immune activated cells and a highly inflammatory environment while, contrastingly, the latter show the profile of a senescent and/or quiescent immune system. Thus, the evolution of SARS-CoV-2 infection in different types of cancers can show distinct trajectories which could lead to a variety of clinical and pathophysiological outcomes. The altered immunological environment including cytokines that characterizes hot and cold tumors will lead to different mechanisms of immune dysfunction, which will result in downstream effects on the course of SARS-CoV-2 infection. This review will focus on defining the known contributions of soluble pro- and anti-inflammatory mediators on immune function including altered T-cells and B-cells responses and as well on how these factors modulate the expression of SARS-CoV-2 receptor ACE2, TMPRSS2 expression, and lymph node fibrosis in cancer patients. We will propose immune mechanisms that underlie the distinct courses of SARS-CoV-2 infection in cancer patients and impact on the success of immune based therapies that have significantly improved cancer outcomes. Better understanding of the immune mechanisms prevalent in cancer patients that are associated to the outcomes of SARS-CoV-2 infection will help to identify the high-risk cancer patients and develop immune-based approaches to prevent significant adverse outcomes by targeting these pathways. [ABSTRACT FROM AUTHOR]

Eco-innovations are considered key in the transition towards a more sustainable economy. However, since there are several barriers to the adoption of eco-innovations, different instruments have been proposed to encourage their uptake, leading to instrument mixes. Analysis of these mixes has been scarce in the eco-innovation literature and mostly focused on static rather than dynamic combinations of instruments. This paper tries to cover this gap by assessing the sequencing of instruments to promote eco-innovation. To that aim we use a panel database of investments in green technologies by Spanish firms between 2010–2020. Our results show that the order in which the instruments are introduced (sequencing) affects the adoption of eco-innovation, although the effective sequencing effect slightly differs for different environmental technological innovation types (cleaner production vs. end-of-pipe). In both cases, using subsidies ("carrots") first and then using environmental taxes ("sticks") positively and significantly influence the adoption of environmental technologies. Results from heterogeneous analysis confirms that this is especially true for small and medium firms. Within carrots, it seems tax credits and subsidies are substitutes, whatever the sequence of their introduction is. These results have clear policy implications which cannot be derived from analyses of static policy mixes. They suggest that, if the aim is to promote the adoption of eco-innovations, carrots should be used first, and then sticks should be adopted. In addition, it warns against using tax credits and subsidies together, given their redundancy in promoting eco-innovation. If subsidies are introduced after tax credits have already been applied (or the other way around), substantial inefficiencies can be expected, increasing the costs of eco-innovation promotion without any added value in terms of effectiveness. • The order/sequence of environmental policy instruments matters for adoption of green technologies. • Using subsidies ("carrots") first and then using environmental taxes ("sticks") positively and significantly influence the adoption of environmental technologies. • Within carrots, tax credits and subsidies are substitutes, whatever the sequence. [ABSTRACT FROM AUTHOR]

A female juvenile green turtle (Chelonia mydas), found alive in Guanabara Bay, Rio de Janeiro, Brazil, was weak, dehydrated and cachectic, with a healed fracture in the caudal portion of the carapace. Despite supportive treatment, the animal died after 9 days. At necropsy the main lesions were pallor of visceral organs, arthritis and deposits of whitish granular material in the wall of large arteries and the trachea. Histopathological analysis revealed mild to severe deposition of crystals, consistent with calcium oxalate, in both kidneys and the spleen, heart, small intestine, pancreas, thymus and salt gland, as well as bacterial meningitis, septic arthritis, spirorchidiasis and a fibropapilloma on the nictitating membrane. The main pathological findings were suggestive of septic shock, mainly due to the bacterial meningitis and septic arthritis, with systemic oxalosis and spirorchidiasis as contributing lesions. Although renal oxalosis has been described in green turtles as an incidental finding, presumably due to ingestion of oxalate-containing plants, this turtle had an unusual systemic deposition of oxalate crystals. [Display omitted] [ABSTRACT FROM AUTHOR]

The upscaling of a technology has different facets that should be considered with anticipatory environmental assessment to deem its sustainability before industrialization. The Life Cycle Assessment (LCA) methodology is widely used to assess a product sustainability based on technologies. LCA is however usually applied after technology deployment, as a comparative approach validating the efficiency of the previous technology usage. Anticipatory LCA developments are therefore needed to help designers and engineers to investigate the sustainability of future technology implementations. This article paves the way to enhance ex-ante (or prospective) studies with an absolute sustainability framework, thus demonstrating the incompleteness of current developments on the upscaling from the designer's perspective. This is achieved through a case study applied on two photovoltaic technologies, silicon mono-crystalline and silicon/perovskite tandem in France, and in the current and the 2050 perspectives. Results show that assigning absolute sustainability targets at the technology level provides a new design framework, resulting in a go/no-go strategy. The minimal environmental performance requirements associated to technology deployment conditions through scenarios are identified. During this process, however, questioning the temporal and spatial scope of the study remains crucial to design a sustainable technology and the corresponding service it provides. [ABSTRACT FROM AUTHOR]

Integrating eco-design methods for circular Power Electronics Converters (PECs) based products in industry is crucial to endorse Sustainable Development Goals within planetary limits. However, eco-designing Power Electronics (PE) remains today on optimising the energy efficiency and the power density of the usage phase of the electronic designed. PE engineers design the PECs by developing electrical equations and topologies, with a weak consideration of the physical connections and kinematic relations between components. Therefore, there is a lack of engineering research focusing on PECs architectures to eco-design for sustainable life cycles, integrating well-known mechatronics methods for repair, reuse, and remanufacturing. This paper investigates two major eco-design challenges: first, the existing circularity design criteria are not yet adapted to PECs physical subsystems. Second, the conversion topology design process needs to integrate this new "potential circular" physical structure. This paper therefore suggests requirements to allow PE designers to overcome these two issues from the early design phases. [ABSTRACT FROM AUTHOR]

The goal of this research is to produce a game that uses speech recognition technology that can be used to learn basic Japanese and to find out whether there is an increase in basic Japanese skills for beginner students who use game media for learning. The research method includes the pre-test and the final test in the form of a quiz, with questions addressed to players to determine the improvement achieved after playing the game "Miryoku" for five days. The Android-based SpeechRecognizer API will be implemented as the core of the algorithm. Data collection was carried out using the distribution of a survey form to 31 participants with minimal skills in Japanese and or who wish to learn Japanese. The result was an increase in the average score obtained by the participants from 64.77 out of 100 on the initial test to a score of 87.77 out of 100 on the final test. It can be concluded that game media is in demand and effective for learning Japanese as seen from the improvement. [ABSTRACT FROM AUTHOR]

Nowadays, there has been much attention on computer vision regarding human-computer interaction, especially facial expression recognition (FER). Many researchers have explored and suggested systems for this field. In this paper, we propose the Deep Learning architecture to improve the performance of models from the previous work. Additionally, we propose the BiLSTM-CNN model, which combines our proposed CNN and BiLSTM model. Besides that, we also compare the model to our CNN and LSTM-CNN models. We conduct the experiments on the CK+ dataset and evaluate the accuracy rate of the built models. Data augmentation is used in the dataset to improve the model's performance and prevent overfitting. The results demonstrate that the BiLSTM-CNN method achieves a state-of-the-art accuracy rate compared to other methods from previous work. The highest accuracy of 99.43% is reached by the BiLSTM-CNN model with data augmentation. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effects of 15 min of high intensity treadmill running on concussion testing assessed by the King-Devick test.Design: Prospective Cohort Study.Methods: Participants self-selected to either a running or a control group. At baseline both groups were assessed using the King-Devick concussion test. The running group then completed 15-minutes of treadmill running at rating of perceived exertion of 7-9/10 while the control group sat quietly. Both groups repeated the King-Devick test following that 15-minute period.Results: Participants (n = 84 men, 53 women) were divided in two groups; running or control. Both groups, on average, had significant improvement after 15 min (suggesting a learning effect). Comparisons between the baseline and re-assessment scores indicated impaired performance was more common following high intensity treadmill running (n = 23 participants, 34.3%) compared to the control group (n = 10 participants, 14.3%, p = 0.006, OR = 3.44 [95%CI 1.40-8.50]). Four participants in the running group worsened their score at reassessment by more than 3 s compared to no participants in the control group.Conclusions: After 15 min of high intensity treadmill running, 1 in 3 participants scored a slower time at follow-up or committed a mistake compared to baseline. Implications for clinical practise include: the recommendation that baseline tests be conducted at rest and after high intensity exercise to provide accurate comparisons to assist in clinical decision making; and a cut-off of >3 s may be a clinically useful difference between resting baseline and re-assessment using the King-Devick test. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the number of days following hamstring strain injury (HSI) taken to introduce high-intensity eccentric loading (HIEL) into rehabilitation based on exercise-specific progression criteria, and whether pain resolution during isometric knee flexion strength testing occurred before or after this milestone.Design: Cohort study.Methods: We included 42 men (mean ± sd; age = 26 ± 5 years; height = 181 ± 8 cm; mass = 86 ± 12 kg) with HSIs, who performed fully supervised rehabilitation twice per week until they met return to play clearance criteria. Isometric knee flexion strength testing was completed before every rehabilitation session and HIEL was introduced via the Nordic hamstring exercise and unilateral slider once participants could perform a bilateral slider through full eccentric knee flexion range of motion. We reported the median (IQR) number of days following HSI taken to introduce HIEL, along with participant's pain rating during isometric knee flexion strength testing before that rehabilitation session. We also reported the median (IQR) number of days following HSI taken for participants to achieve pain resolution during isometric knee flexion.Results: HIEL was introduced 5 (2-8) days following HSI, despite 35/42 participants reporting pain during isometric knee flexion strength testing immediately prior to that rehabilitation session, which was rated as 3.5 (3-5) on a 0-10 numeric rating scale. Pain resolution during isometric knee flexion strength testing was achieved 11 (9-13) days following HSI.Conclusion: HIEL can be safely introduced into early HSI rehabilitation based on exercise-specific progression criteria, without needing to wait for pain resolution during isometric knee flexion strength testing before doing so. [ABSTRACT FROM AUTHOR]

Shade selection is a challenge in restorative dentistry. While single-shade composite resins may simplify this process, whether the color mismatch between this composite resin and the substrate is within acceptable levels to ensure successful outcomes is unclear. The purpose of this in vitro study was to assess the influence of background and surrounding shade, thickness, and proximity to the surrounding on color mismatch when shaded and single-shade composite resins are used in the center of an enamel layer. Two-layer specimens mimicking dentin (the background) and enamel (the surrounding and center) were prepared. Two shades were used for the background and the surrounding layer (OA1/A1 and OA3/A3). At the Ø3-mm center, 2 single-shade composite resins were placed, Omnichroma (OM) and Admira Fusion x-tra (FU), and also shaded composite resins A1, WE, A3, and C2. For the OA1/A1 background and surrounding, shades A1 and WE served as positive controls, while the A3 and C2 were negative controls. For OA3/A3, these controls were reversed. Two enamel layer thicknesses were evaluated (0.5- and 1.0-mm). Reflectance measurements were made at 0.0, 1.0, 2.0, and 2.5 mm from the center. Color differences were calculated between those at 2.5 mm and at other distances (ΔE 0, ΔE 1, and ΔE 2). Data analysis employed a 4-way repeated measure ANOVA with Bonferroni corrections for the pair-wise comparisons (α=.05). Background and surrounding shade, central shade, distance, and thickness affected color mismatch (P <.05). For the OA1/A1 specimens, single-shade color mismatch values were found between both the positive and negative controls (P <.05). For the OA3/A3 specimens, the color mismatch did not differ significantly from that of negative controls (P >.05). No difference was found between ΔE 0 and ΔE 1 , but each was distinct from ΔE 2. Thickness did not affect the color mismatch of the single-shade composite resins (P <.05). Single-shade composite resins for enamel replacement showed higher color mismatches compared with positive controls. [ABSTRACT FROM AUTHOR]

The Jakarta Metropolitan Area is one of the cities heavily affected by floods in Asia. Effective disaster risk reduction strategies require deep understanding of what motivates its citizens towards preparedness and mitigation actions. This study aimed to discern these motivating factors among Jakarta's residents through the Protection Motivation Theory (PMT) approach. Through an online survey, 304 participants provided insights into how the extended PMT factors shape their Protection Motivation (PM) towards flood preparedness. A total of nine (9) variables and 41 constructs were considered in this study. PMT factors were comprised of PM, Perceived Severity (PS), Perceived Vulnerability (PV), Response Efficacy (RE), and Perceived Self-Efficacy (SE) along with additional factors such as Media (M), Government Preventive Actions (GA), Flood Experience (FE), and Geographical Perspectives (GP). Partial Least Square Structural Equation Modeling (PLS-SEM) revealed that SE had the most substantial impact on influencing PM (β = 0.522) followed by PV, PS, and RE. The results also showed the significance of M and GA to both SE and RE. Meanwhile, FE illustrates positive impact to both PV and PS. Interestingly, GP was found to be only significant to PV and not to PS. External factors M and GA demonstrated a significant indirect effect on PM through SE, whereas GP exhibited a significant indirect effect on PM through PV. These findings provide actionable insights for policymakers and disaster management practitioners, emphasizing the power of media and the need for comprehensive strategies that address both the psychological and practical aspects of flood disaster readiness in Jakarta and potentially other flood-prone regions. [ABSTRACT FROM AUTHOR]

Large language models including Chat Generative Pretrained Transformers version 4 (ChatGPT4) improve access to artificial intelligence, but their impact on the clinical practice of gastroenterology is undefined. This study compared the accuracy, concordance, and reliability of ChatGPT4 colonoscopy recommendations for colorectal cancer rescreening and surveillance with contemporary guidelines and real-world gastroenterology practice. History of present illness, colonoscopy data, and pathology reports from patients undergoing procedures at 2 large academic centers were entered into ChatGPT4 and it was queried for the next recommended colonoscopy follow-up interval. Using the McNemar test and inter-rater reliability, we compared the recommendations made by ChatGPT4 with the actual surveillance interval provided in the endoscopist's procedure report (gastroenterology practice) and the appropriate US Multisociety Task Force (USMSTF) guidance. The latter was generated for each case by an expert panel using the clinical information and guideline documents as reference. Text input of de-identified data into ChatGPT4 from 505 consecutive patients undergoing colonoscopy between January 1 and April 30, 2023, elicited a successful follow-up recommendation in 99.2% of the queries. ChatGPT4 recommendations were in closer agreement with the USMSTF Panel (85.7%) than gastroenterology practice recommendations with the USMSTF Panel (75.4%) (P <.001). Of the 14.3% discordant recommendations between ChatGPT4 and the USMSTF Panel, recommendations were for later screening in 26 (5.1%) and for earlier screening in 44 (8.7%) cases. The inter-rater reliability was good for ChatGPT4 vs USMSTF Panel (Fleiss κ, 0.786; 95% CI, 0.734–0.838; P <.001). Initial real-world results suggest that ChatGPT4 can define routine colonoscopy screening intervals accurately based on verbatim input of clinical data. Large language models have potential for clinical applications, but further training is needed for broad use. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: To investigate relationships between load tolerance of single leg isometric knee extension and athlete reported knee pain location and severity during the single leg decline squat.Design: Cross-sectional study.Methods: 175 college basketball athletes (99 women, 76 men) in Alberta, Canada participated at the start of the 2018-19 season. Knee pain location (dichotomized into focal/diffuse pain), and severity (numerical rating scale 0-10) were collected during the single leg decline squat. Athletes completed a standardized single leg isometric knee extension to determine load tolerance (defined by pain or reduced form). A quantile regression model was used to examine the association between load tolerance and pain location adjusting for sex, years played, body mass index and team.Results: Athletes with diffuse pain had a significantly lower median load tolerance (-0.89 kg) than athletes without pain (95% confidence interval [-1.49, -0.29]; p = 0.003). Athletes with focal pain tolerated similar median loads (-0.42 kg) to those without pain (95% confidence interval [-1.17, 0.33]; p = 0.26). Higher knee pain severity was associated with a non-linear but consistent reduction in load tolerance (p < 0.001).Conclusions: Athlete-reported knee pain location during the single leg decline squat influenced load tolerance to isometric knee extension. Athletes with focal pain tolerated similar isometric loads to their pain free teammates. Clinicians should consider load selection of isometric knee extension for athletes with diffuse pain given their lower load tolerance. Future research should consider reporting pain location in addition to pain severity to differentiate clinical presentations and response to exercise. [ABSTRACT FROM AUTHOR]

Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a new disease entity that is characterised by hard severely limited mouth opening without pain. Additionally, MMTAH may be frequently misdiagnosed as bilateral fibrous ankylosis of the temporomandibular joint (TMJ) by clinicians. This study aimed to identify the characteristics and treatment of MMTAH. We selected 22 patients who presented with limited mouth opening and underwent bilateral aponeurectomy and coronoidectomy and 10 healthy participants without limitations in mouth opening. All participants underwent mouth opening training following surgery, and follow-up assessments were performed every 3 months. Mandibular movements were recorded during maximal opening and excursion. Moreover, we conducted surface electromyography (EMG) of the masseter and anterior temporalis muscles during maximum voluntary teeth clenching and used a pressure-sensitive film to assess the occlusal load in the intercuspal position. There were no significant differences in the lateral and protrusive movements of the mandible between patients with MMTAH and their healthy counterparts. Both occlusal force and EMG activity were considerably higher in patients with MMTAH than in healthy participants. In addition, the EMG activity of the anterior temporalis muscle was significantly higher than that of the masseter muscle in these patients. Furthermore, the maximal opening increased markedly and the occlusal force decreased significantly after surgery. MMTAH is characterised by the large occlusal force and EMG activity of the masseter muscles and anterior temporalis, and surgery is a useful treatment for this disorder. [ABSTRACT FROM AUTHOR]

Introduction of postoperative oral rehabilitation has been expected to improve the oral function after orthognathic surgery for mandibular prognathism, but remains uncertain on its efficacy. This study was to clarify what kind of improvement in oral function is associated with postoperative oral rehabilitation. 51 patients of mandibular prognathism underwent orthognathic surgery. Gum chewing exercise was introduced in all patients from the third month after surgery. At the fourth month only 12 patients (EG) performed training perfectly and continued till the sixth month, however another group of 12 patients (NEG) quitted training then. The occlusal contact area(OCA), the maximum bite force(MBF), and the chewing ability(CA) were measured at the day before surgery, the first, the third, and the sixth month compared with a control group comprised of 20 normal subjects. The chewing pathway area of EG and NEG were measured using a mandibular movement measurement device. Each measured value was compared by Shapiro-Wilk normality test. Analysis of variance was performed by ANOVA, and multiple comparison test (p Value＜0.05). OCA and MBF were low significantly at the sixth month after surgery compared to the control group. There was no difference in OCA and MBF at the third month between in EG and in NEG, but CA was improved and the chewing pathway area was higher at the sixth month in EG. Gum chewing exercise as postoperative oral rehabilitation may restore chewing ability even in a short period of months after orthognathic surgery for mandibular prognathism. [ABSTRACT FROM AUTHOR]

Mechanical Design is a subject usually included in Chemical Engineering Degrees. In this work, we present the application of a project-based learning to the lab in two different engineering degrees, in of one the most time-consuming and difficult subjects of their programs. These two degrees, Mechanical and Chemical engineering degrees, were selected in order to compare the learning outcomes and satisfaction with the activity in the degree more related to mechanical concepts and the Chemical engineering degree. Moreover, to enhance students' enthusiasm and motivation, these sessions included an innovative manufacturing technology, 3D printing, and digital image correlation (DIC). Before each practical session, the students are encouraged to watch an online video with the fundamental aspects. In order to assess the success of this methodology, after finishing the lab sessions, the students answered a non-formal quantitative survey. The results showed that the proposed project-based learning had the ability to help integrating the knowledge and improve the skills included in the main competences. Although these results are encouraging, there are still parts of the lab activity that should be improve in order to make the activity less time consuming and the most difficult part being easier for the students. • A mechanical laboratory approach for chemical engineers was successfully applied. • The design and assessment of a project-based learning lab is discussed in detail. • Project-based learning, flipped classroom and collaborative learning was combined. • The employment of this new laboratory achieves high student satisfaction. [ABSTRACT FROM AUTHOR]

Candy cane syndrome (CCS) is an adverse event (AE) from gastrectomy or gastric bypass and end-to-side anastomosis to a jejunal loop. Preferential passage of food to the blind loop induces early satiety, pain, and regurgitation. An endoscopic device that combines 2 magnets and a self-retractable wire was designed to perform progressive septotomy with marsupialization. We evaluated the clinical safety and efficacy of this treatment in CCS. Consecutive patients presenting with symptoms associated with CCS after gastrectomy or Roux-en-Y gastric bypass were treated with the MAGUS (Magnetic Gastrointestinal Universal Septotome) system. Weight, dysphagia, pain scores, 12-item Short Form Survey quality of life physical and mental scores, GERD Health-Related Quality of Life, and Eckardt score were measured at baseline and 1 and 3 months postprocedure. Satisfaction with therapy and AEs were monitored during follow-up. Fourteen consecutive patients with CCS were enrolled in the study. Thirteen MAGUS systems migrated within 28 days after achieving uneventful complete septotomy. In 1 patient the magnet had to be collected from the right-sided colon after 1 month. Treatment was completed in a single endoscopy session. Dysphagia score (2 [1-3] vs 1 [1-1], P =.02), pain score (7 [6-8] vs 1 [0-1], P =.002), Eckardt score (5 [3-8] vs 1 [0-2], P =.002), GERD Health-Related Quality of Life score (37 [29-45] vs 8 [6-23], P =.002), and quality of life physical and mental scores were all significantly improved at 3 months. No device or procedure-related serious AEs were observed. One patient died during follow-up from evolution of oncologic disease. Endoluminal septotomy using a retractable wire and magnet system in CCS is feasible and safe, with rapid improvement of symptoms. (Clinical trial registration number: NCT04480216.) [ABSTRACT FROM AUTHOR]