Miracle-dz/UniFAR-FTUs huggingface dataset:
Diagnosis and treatment of the invasive extension of bacteria (cellulitis) from chronic wounds utilising point‐of‐care fluorescence imaging

Early diagnosis of wound‐related cellulitis is challenging as many classical signs and symptoms of infection (erythema, pain, tenderness, or fever) may be absent. In addition, other conditions (ie, chronic stasis dermatitis) may present with similar clinical findings. Point‐of‐care fluorescence imaging detects elevated bacterial burden in and around wounds with high sensitivity. This prospective observational study examined the impact of incorporating fluorescence imaging into standard care for diagnosis and management of wound‐related cellulitis. Two hundred thirty‐six patients visiting an outpatient wound care centre between January 2020 and April 2021 were included in this study. Patients underwent routine fluorescence scans for bacteria (range: 1‐48 scans/patient). Wound‐related cellulitis was diagnosed in 6.4% (15/236) of patients. In these patients, fluorescence scans showed an irregular pattern of red (bacterial) fluorescence extending beyond the wound bed and periwound that could not be removed through cleansing or debridement, indicating the invasive extension of bacteria (wound‐related cellulitis). Point‐of‐care identification facilitated rapid initiation of treatments (source control and antibiotics, when warranted) that resolved the fluorescence. No patients had worsening of cellulitis requiring intravenous antibiotics and/or hospitalisation. These findings demonstrate the utility of point‐of‐care fluorescence imaging for efficient detection and proactive, targeted management of wound‐related cellulitis.
Use of a passive lumbar back exoskeleton during a repetitive lifting task: effects on physiologic parameters and intersubject variability

Objectives. This study evaluated the effects of wearing the Laevo v2.56 exoskeleton (Laevo, The Netherlands) on physiological parameters related to working load and metabolic cost (MC) during a lifting task, explored the variability in exoskeleton performance among users and determined whether perceived discomfort negatively correlates with a reduction in MC. Methods. Twenty participants completed a 4-min repetitive lifting task with/without the exoskeleton. Respiratory gases, heart rate, blood lactate and ratings of perceived exertion and experienced discomfort were collected, and MC was calculated. Results. Wearing the exoskeleton significantly reduced MC and oxygen uptake during the lifting task by 4.8 and 3.8%, respectively. Workload reduction occurred in 65% of the participants. Conclusion. The Laevo v2.56 exoskeleton reduced MC and workload in a repetitive lifting task in a subject-dependent manner. Future studies should focus on identifying factors that could cause performance variability such as user–robot interaction forces.
Bioremediation of a polymetallic, arsenic‐dominated reverse osmosis reject stream

The treatment of metal‐laden industrial effluents by reverse osmosis is gaining in popularity worldwide due to its high performance. However, this process generates a polymetallic concentrate (retentate) stream in need of efficient post‐treatment prior to environmental discharge. This paper presents results on the bioremediation (in batch mode) of a metal‐laden, arsenic‐dominated retentate using Shewanella sp. O23S as inoculum. The incubation of the retentate for 14 days under anoxic conditions resulted in the following removal yields: As (8%), Co (11%), Mo (3%), Se (62%), Sb (30%) and Zn (40%). The addition of 1 mmol l−1 cysteine increased the removal rate as follows: As (27%), Co (80%), Mo (78%), Se (88%), Sb (83%) and Zn (90%). The contribution of cysteine as a source of H2S to enhancing the removal yield was confirmed by its addition after 7 days of incubations initially lacking it. Additionally, the cysteine‐sourced H2S was confirmed by its capture onto headspace‐mounted Pb‐acetate test strips that were analysed by X‐ray diffraction. We show that real metal‐laden industrial effluents can be treated to medium‐to‐high efficiency using a biological system (naturally sourced inocula) and inexpensive reagents (yeast extract, lactate and cysteine).
Lynch syndrome in urological practice: diagnosis, therapeutic strategies, and screening for upper tract urothelial carcinoma

Purpose of review To provide a comprehensive overview of diagnosis, treatment, and screening for upper tract urothelial carcinoma (UTUC) among Lynch syndrome patients. Recent findings Lynch syndrome is an autosomal dominant disorder resulting from the germline mutation in the mismatch repair (MMR) system. The Lynch syndrome predisposes to early onset of a broad spectrum of tumours, among which UTUC represents the third most frequent malignancy. Since up to 10% of UTUC can be attributed to Lynch syndrome, a correct recognition of this disease provides the opportunity for patients and their relatives to be properly treated for UTUC and to be followed up for other Lynch syndrome-related malignancies. Summary UTUC patients less than 65 years, or UTUC patients with personal history of Lynch syndrome-related cancer, or with one first-degree relative (FDR) less than 50 years with Lynch syndrome-related cancer, or two FDRs with Lynch syndrome-related cancer regardless of age should be referred to molecular testing and subsequent DNA sequencing to confirm Lynch syndrome diagnosis. Considering the increased risk of metachronous recurrence, treatments other than radical nephroureterectomy, such as ureteroscopic laser ablation may represent valuable therapeutic strategies. As Lynch syndrome patients exhibit an approximate 14-fold increased risk of developing UTUC compared with general population, expert recommendations are urgently required in order to point out appropriate screening protocols.
Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults

BACKGROUND There are 2 approaches to intensifying antihypertensive treatment when target blood pressure is not reached, adding a new medication and maximizing dose. Which strategy is better is unknown. OBJECTIVE To assess the frequency of intensification by adding a new medication versus maximizing dose, as well as the association of each method with intensification sustainability and follow-up systolic blood pressure (SBP). DESIGN Large-scale, population-based, retrospective cohort study. Observational data were used to emulate a target trial with 2 groups, new medication and maximizing dose, who underwent intensification of their drug regimen. SETTING Veterans Health Administration (2011 to 2013). PATIENTS Veterans aged 65 years or older with hypertension, an SBP of 130 mm Hg or higher, and at least 1 antihypertensive medication at less than the maximum dose. MEASUREMENTS The following 2 intensification approaches were emulated: adding a new medication, defined as a total dose increase with new medication, and maximizing dose, defined as a total dose increase without new medication. Inverse probability weighting was used to assess the observational effectiveness of the intensification approach on sustainability of intensified treatment and follow-up SBP at 3 and 12 months. RESULTS Among 178 562 patients, 45 575 (25.5%) had intensification by adding a new medication and 132 987 (74.5%) by maximizing dose. Compared with maximizing dose, adding a new medication was associated with less intensification sustainability (average treatment effect, -15.2% [95% CI, -15.7% to -14.6%] at 3 months and -15.1% [CI, -15.6% to -14.5%] at 12 months) but a slightly larger reduction in mean SBP (-0.8 mm Hg [CI, -1.2 to -0.4 mm Hg] at 3 months and -1.1 mm Hg [CI, -1.6 to -0.6 mm Hg] at 12 months). LIMITATION Observational data; largely male population. CONCLUSION Adding a new antihypertensive medication was less frequent and was associated with less intensification sustainability but slightly larger reductions in SBP. Trials would provide the most definitive support for our findings. PRIMARY FUNDING SOURCE National Institute on Aging and Veterans Health Administration.
Early decrease in lean mass and bone mass in postmenopausal women: a cross-sectional study

Abstract Objective The effect of menopause transition in body composition was evaluated in a cross-sectional study. Method The study was carried out in an outpatient clinic of Brazil enrolling premenopausal (n = 64) and postmenopausal (n = 42) women aged between 44 and 52 years, with weight stability (±2 kg) for at least 6 months before evaluation. Participants answered a sociodemographic semi-structured questionnaire, the Menopause Rating Scale, the International Physical Activity Questionnaire, 24-h dietary recall and a visual analogue scale of appetite. Blood biochemical, anthropometry and densitometry measurements were used for body composition estimation. Results Most participants were overweight (31.4%) or obese (45.7%) and categorized as ‘high active’ in physical activity (65.7%). Lean mass and bone mass decreased in the first few years of menopause. A metabolic turn to an increase of lipids was observed, represented by greater total cholesterol and high-density lipoprotein cholesterol levels. Menopause transition did not alter body fat distribution. Total body fat, android fat and gynoid fat were positively related to smoking habit, and android fat was also positively related to waist circumference. Conclusion Taken together, early postmenopause can be considered a time window of opportunity for preventing ailments such as atherogenic profile, obesity, increased cardiovascular risk and osteoporosis.
Low-molecular-weight heparin use in coronavirus disease 2019 is associated with curtailed viral persistence: a retrospective multicentre observational study

Abstract Aims Anticoagulation was associated with improved survival of hospitalized coronavirus disease 2019 (COVID-19) patients in large-scale studies. Yet, the development of COVID-19-associated coagulopathy (CAC) and the mechanism responsible for improved survival of anticoagulated patients with COVID-19 remain largely elusive. This investigation aimed to explore the effects of anticoagulation and low-molecular-weight heparin (LMWH) in particular on patient outcome, CAC development, thromboinflammation, cell death, and viral persistence. Methods and results Data of 586 hospitalized COVID-19 patients from three different regions of Austria were evaluated retrospectively. Of these, 419 (71.5%) patients received LMWH and 62 (10.5%) received non-vitamin-K oral anticoagulants (NOACs) during hospitalization. Plasma was collected at different time points in a subset of 106 patients in order to evaluate markers of thromboinflammation (H3Cit-DNA) and the cell death marker cell-free DNA (cfDNA). Use of LMWH was associated with improved survival upon multivariable Cox regression (hazard ratio = 0.561, 95% confidence interval: 0.348–0.906). Interestingly, neither LMWH nor NOAC was associated with attenuation of D-dimer increase over time, or thromboinflammation. In contrast, anticoagulation was associated with a decrease in cfDNA during hospitalization, and curtailed viral persistence was observed in patients using LMWH leading to a 4-day reduction of virus positivity upon quantitative polymerase chain reaction [13 (interquartile range: 6–24) vs. 9 (interquartile range: 5–16) days, P = 0.009]. Conclusion Time courses of haemostatic and thromboinflammatory biomarkers were similar in patients with and without LMWH, indicating either no effects of LMWH on haemostasis or that LMWH reduced hypercoagulability to levels of patients without LMWH. Nonetheless, anticoagulation with LMWH was associated with reduced mortality, improved markers of cell death, and curtailed viral persistence, indicating potential beneficial effects of LMWH beyond haemostasis, which encourages use of LMWH in COVID-19 patients without contraindications.
Functional imaging improves patient selection for mandibular advancement device treatment outcome in sleep-disordered breathing: a prospective study.

STUDY OBJECTIVES Mandibular advancement devices (MAD) are a non-invasive treatment option for patients with obstructive sleep apnea (OSA) and act by increasing the upper airway volume. However, the exact therapeutic mechanism of action remains unclear. The aim of this study was to assess MAD mechanisms using functional imaging, that combines imaging techniques and computational fluid dynamics (CFD) and assess associations with treatment outcome. METHODS One hundred OSA patients were prospectively included and treated with a custom-made MAD at a fixed 75% protrusion. A low-dose CT scan was made with and without MAD for CFD analysis. Patients underwent a baseline and 3-month follow-up polysomnography to evaluate treatment efficacy. A reduction in apnea-hypopnea index (AHI) ≥50% defined treatment response. RESULTS Overall, 71 patients completed both 3-month follow-up polysomnography and low-dose CT scan with CFD analysis. MAD treatment significantly reduced the AHI (16.5 (10.4-23.6) events/h to 9.1 (3.9-16.4) events/h, P<0.001, median (Q1-Q3)) and significantly increased the total upper airway volume (8.6 (5.4-12.8) cm3 vs. 10.7 (6.4-15.4) cm3; P=0.003), especially the velopharyngeal volume (2.1 (0.5-4.1) cm3 vs. 3.3 (1.8-6.0) cm3; P<0.001). However, subanalyses in responders and non-responders only showed a significant increase in the total upper airway volume in responders, not in non-responders. CONCLUSIONS MAD acts by increasing the total upper airway volume, predominantly due to an increase in the velopharyngeal volume. Responders showed a significant increase in the total upper airway volume with MAD treatment, while there was no significant increase in non-responders. Findings add evidence to implement functional imaging using CFD in routine MAD outcome prediction.
Price elasticity of demand for cigarettes among youths in high-income countries: a systematic review

Aims: Smoking in youth remains a major public health issue. As increasing tobacco prices is considered one of the most effective prevention strategies, examining youth’s responsiveness to price changes on cigarettes will provide crucial knowledge. This study aims systematically to review research examining the price elasticity of demand for cigarettes among youths (<30 years of age) in high-income countries. Methods: Searches were conducted in three databases (Web of Science, Pubmed and Scopus). Inclusion criteria were publications within the past 10 years (2011–2021) written in English and with a population of youths below 30 years of age, concerning price elasticity of demand for cigarettes and from high-income countries. Searches were screened by two independent reviewers and the quality of studies was assessed using a quality assessment tool. Results: Four outcomes related to price elasticity of demand for cigarettes were examined in six studies included in this review; that is, cigarette initiation, consumption, prevalence and cessation. Overall, findings indicate that increasing tobacco prices affect youth tobacco use. The effect was associated with gender and age; young women were more price sensitive concerning smoking initiation, whereas young men were more price sensitive concerning cigarette prevalence and consumption. Moreover, younger age was associated with higher price elasticity. Conclusions: Estimates for price elasticity varied across the included studies. This may be caused by differences in data sources, collection methods used and country of origin. Most included studies were of older date. Therefore, to make reliable predictions of the expected effects of increased tobacco prices, further examinations of up-to-date and locally embedded measures are required.
Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

Background Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere. Aim To analyse the association between longitudinal continuity with a named regular general practitioner (RGP) and use of out-of-hours (OOH) services, acute hospital admission, and mortality. Design and setting Registry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs. Method Duration of RGP–patient relationship was used as explanatory variable for the use of OOH services, acute hospital admission, and mortality in 2018. Several patient-related and RGP-related covariates were included in the analyses by individual linking to high-quality national registries. Duration of RGP–patient relationship was categorised as 1, 2–3, 4–5, 6–10, 11–15, or >15 years. Results are given as adjusted odds ratio (OR) with 95% confidence intervals (CI) resulting from multilevel logistic regression analyses. Results Compared with a 1-year RGP–patient relationship, the OR for use of OOH services decreased gradually from 0.87 (95% CI = 0.86 to 0.88) after 2–3 years’ duration to 0.70 (95% CI = 0.69 to 0.71) after >15 years. OR for acute hospital admission decreased gradually from 0.88 (95% CI = 0.86 to 0.90) after 2–3 years’ duration to 0.72 (95% CI = 0.70 to 0.73) after >15 years. OR for dying decreased gradually from 0.92 (95% CI = 0.86 to 0.98) after 2–3 years’ duration, to 0.75 (95% CI = 0.70 to 0.80) after an RGP–patient relationship of >15 years. Conclusion Length of RGP–patient relationship is significantly associated with lower use of OOH services, fewer acute hospital admissions, and lower mortality. The presence of a dose–response relationship between continuity and these outcomes indicates that the associations are causal.
Transient Noise Reduction Using a Deep Recurrent Neural Network: Effects on Subjective Speech Intelligibility and Listening Comfort

A deep recurrent neural network (RNN) for reducing transient sounds was developed and its effects on subjective speech intelligibility and listening comfort were investigated. The RNN was trained using sentences spoken with different accents and corrupted by transient sounds, using the clean speech as the target. It was tested using sentences spoken by unseen talkers and corrupted by unseen transient sounds. A paired-comparison procedure was used to compare all possible combinations of three conditions for subjective speech intelligibility and listening comfort for two relative levels of the transients. The conditions were: no processing (NP); processing using the RNN; and processing using a multi-channel transient reduction method (MCTR). Ten participants with normal hearing and ten with mild-to-moderate hearing loss participated. For the latter, frequency-dependent linear amplification was applied to all stimuli to compensate for individual audibility losses. For the normal-hearing participants, processing using the RNN was significantly preferred over that for NP for subjective intelligibility and comfort, processing using the RNN was significantly preferred over that for MCTR for subjective intelligibility, and processing using the MCTR was significantly preferred over that for NP for comfort for the higher transient level only. For the hearing-impaired participants, processing using the RNN was significantly preferred over that for NP for both subjective intelligibility and comfort, processing using the RNN was significantly preferred over that for MCTR for comfort, and processing using the MCTR was significantly preferred over that for NP for comfort.
Reliability and Validity of an Ultrasonic Device for Measuring Height in Adults

Background The ultrasonic stadiometer was originally developed as a device to measure and monitor children’s height. However, an ultrasonic stadiometer (InLab S50; InBody Co., Seoul, Korea) was used to measure adults’ height in the 2018 Korea Community Health Survey (KCHS). This study was conducted to assess the reliability and validity of the InLab S50 in adults. Methods The study subjects were 120 adults (reliability test, n=20; validity test, n=100) who had visited a health screening center. The intra- and inter-rater reliabilities of InLab S50 were assessed using the intraclass correlation coefficient (ICC). The agreement between InLab S50 and an automatic stadiometer (HM-201; Fanics, Busan, Korea) was assessed using Pearson’s correlation coefficient and Bland-Altman analysis. Results The intra- and inter-rater reliabilities of the InLab S50 were excellent (ICC=0.9999 and 0.9998, respectively). The correlation coefficient of the height measured by the two measurement devices was very high (r=0.996). The difference (Δheight [HM-201-InLab S50]) was -0.15±0.78 cm (95% limit of agreement [LOA], -1.69 to 1.38). After excluding the values outside 95% LOA, the difference was further reduced to -0.05±0.59 cm (95% LOA, -1.20 to 1.10). Conclusion This study showed that the InLab S50 is a reliable and valid device for the measurement of adults’ height. Therefore, we think that InLab S50 could be used to measure adults’ height in household health surveys such as the KCHS.
High-temperature high-sensitivity AlN-on-SOI Lamb wave resonant strain sensor

A piezoelectric AlN-on-SOI structured MEMS Lamb wave resonator (LWR) is presented for high-temperature strain measurement. The LWR has a composite membrane of a 1 μm thick AlN film and a 30 μm thick device silicon layer. The excited acoustic waves include Rayleigh wave and Lamb waves. A tensile strain sensor has been prepared with one LWR mounted on a uniaxial tensile plate, and its temperature characteristics from 15.4°C to 250°C and tensile strain behaviors from 0 μe to 400 μe of Rayleigh wave and S4 mode Lamb wave were tested. The temperature test verifies the adaptability of the tensile strain sensor to temperature up to 250°C, and S4 mode Lamb wave and Rayleigh wave represent almost the same temperature characteristics. The strain test demonstrates that S4 mode Lamb wave shows much higher strain sensitivity (-0.48 ppm/μe) than Rayleigh wave (0.05 ppm/μe) and confirms its advantage of strain sensitivity. Finally, for this one-LWR strain sensor, a method of beat frequency between S4 mode Lamb wave and Rayleigh wave is proposed for temperature compensation and high-sensitivity strain readout.A piezoelectric AlN-on-SOI structured MEMS Lamb wave resonator (LWR) is presented for high-temperature strain measurement. The LWR has a composite membrane of a 1 μm thick AlN film and a 30 μm thick device silicon layer. The excited acoustic waves include Rayleigh wave and Lamb waves. A tensile strain sensor has been prepared with one LWR mounted on a uniaxial tensile plate, and its temperature characteristics from 15.4°C to 250°C and tensile strain behaviors from 0 μe to 400 μe of Rayleigh wave and S4 mode Lamb wave were tested. The temperature test verifies the adaptability of the tensile strain sensor to temperature up to 250°C, and S4 mode Lamb wave and Rayleigh wave represent almost the same temperature characteristics. The strain test demonstrates that S4 mode Lamb wave shows much higher strain sensitivity (-0.48 ppm/μe) than Rayleigh wave (0.05 ppm/μe) and confirms its advantage of strain sensitivity. Finally, for this one-LWR strain sensor, a method of beat frequency between S4 mode Lamb wave and .