Miracle-dz/UniFAR-FTUs huggingface dataset:
Selective Angioembolisation of Iatrogenic Renal Artery Pseudoaneurysms Following Minimally Invasive Urological Procedures: A Single Centre Case Series

Introduction The purpose of this study was to report our centre’s experience using selective angioembolisation in the treatment of iatrogenic renal artery pseudoaneurysms (RAP) following minimally invasive urological procedures. Methods Our retrospective analysis included four consecutive patients treated with angioembolisation for iatrogenic RAP between October 2016 and October 2021. Data on demographics, minimally invasive urological intervention, clinical features, imaging findings, embolization procedure and perioperative details were collected. Rates of technical and clinical success, defined as 1. total occlusion of the extravasation site on completion digital subtraction angiography (DSA), and 2. resolution of symptoms, signs, and serum hemoglobin (Hb) derangements secondary to RAP, were analysed. Renal function, measured by serum creatinine (Cr) and estimated glomerular filtration rate (eGFR), was recorded prior to and post - angioembolisation procedure and compared. Results Mean time between urological intervention and angioembolisation was 9 days (range, 2–17 days). Rates of technical and clinical success were 100% and 100% respectively. No additional angioembolisation procedures were required, and there were no peri or post-operative complications identified during mean follow-up of 662 days (range, 30–1845 days). Mean serum Cr prior to and post angioembolisation was 83 mmol/L and 79.5 mmol/L. Mean eGFR prior to and post angioembolisation was 73.8 and 77.8 mL/min/1.73 m2. In all patients, no significant difference was observed in serum Cr and eGFR prior to and post angioembolisation. Conclusion Iatrogenic renal artery pseudoaneurysms can occur following a range of minimally invasive urological procedures. This retrospective review highlights the utility of angioembolisation as a safe and effective treatment with high clinical and technical success rates. Further studies involving larger populations are required to validate its broader application.
Glomerular hyperfiltration in morbid obesity: Role of the inflammasome signalling

Obesity is associated with glomerular hyperfiltration which may precede the development of overt renal damage. Few studies evaluated the link between inflammasome signalling and hyperfiltration. The aim is to evaluate the relationship between IL1‐β/Caspase‐1, insulin sensitivity and hyperfiltration in subjects with severe obesity, before and after weight loss.
Dynamic blood oxygen indices in mechanically ventilated COVID-19 patients with acute hypoxic respiratory failure: A cohort study

Background Acute hypoxic respiratory failure (AHRF) is a hallmark of severe COVID-19 pneumonia and often requires supplementary oxygen therapy. Critically ill COVID-19 patients may require invasive mechanical ventilation, which carries significant morbidity and mortality. Understanding of the relationship between dynamic changes in blood oxygen indices and clinical variables is lacking. We evaluated the changes in blood oxygen indices–PaO2, PaO2/FiO2 ratio, oxygen content (CaO2) and oxygen extraction ratio (O2ER) in COVID-19 patients through the first 30-days of intensive care unit admission and explored relationships with clinical outcomes. Methods and findings We performed a retrospective observational cohort study of all adult COVID-19 patients in a single institution requiring invasive mechanical ventilation between March 2020 and March 2021. We collected baseline characteristics, clinical outcomes and blood oxygen indices. 36,383 blood gas data points were analysed from 184 patients over 30-days. Median participant age was 59.5 (IQR 51.0, 67.0), BMI 30.0 (IQR 25.2, 35.5) and the majority were men (62.5%) of white ethnicity (70.1%). Median duration of mechanical ventilation was 15-days (IQR 8, 25). Hospital survival at 30-days was 72.3%. Non-survivors exhibited significantly lower PaO2 throughout intensive care unit admission: day one to day 30 averaged mean difference -0.52 kPa (95% CI: -0.59 to -0.46, p<0.01). Non-survivors exhibited a significantly lower PaO2/FiO2 ratio with an increased separation over time: day one to day 30 averaged mean difference -5.64 (95% CI: -5.85 to -5.43, p<0.01). While all patients had sub-physiological CaO2, non-survivors exhibited significantly higher values. Non-survivors also exhibited significantly lower oxygen extraction ratio with an averaged mean difference of -0.08 (95% CI: -0.09 to -0.07, p<0.01) across day one to day 30. Conclusions As a novel cause of acute hypoxic respiratory failure, COVID-19 offers a unique opportunity to study a homogenous cohort of patients with hypoxaemia. In mechanically ventilated adult COVID-19 patients, blood oxygen indices are abnormal with substantial divergence in PaO2/FiO2 ratio and oxygen extraction ratio between survivors and non-survivors. Despite having higher CaO2 values, non-survivors appear to extract less oxygen implying impaired oxygen utilisation. Further exploratory studies are warranted to evaluate and improve oxygen extraction which may help to improve outcomes in severe hypoxaemic mechanically ventilated COVID-19 patients.
Effects of different stent wire mesh densities on hemodynamics in aneurysms of different sizes

Background Intracranial stents are used to treat aneurysms by diverting the blood flow from entering into the aneurysmal dome. Although delayed rupture is rare, clinical outcomes are extremely poor in such cases. Hemodynamics after stent deployment may be related to delayed rupture and a better understanding of the basic characteristics of pressure changes resulting from stent deployment is needed; therefore, this study investigated the relationships between hemodynamics in aneurysms of different sizes treated using stents of different wire mesh densities. Methods Using computational fluid dynamics analysis, parameters related to velocity, volume flow rate, pressure, and residual volume inside the aneurysm were evaluated in digital models of 5 basic aneurysms of differing sizes (Small, Medium, Medium-Large, Large, and Giant) and using 6 different types of stent (varying number of wires, stent pitch and wire mesh density) for each aneurysm. Results Regardless of the aneurysm size, the velocity inside the aneurysm and the volume flow rate into the aneurysm were observed to continuously decrease up to 89.2% and 78.1%, respectively, with increasing stent mesh density. In terms of pressure, for giant aneurysms, the pressure on the aneurysmal surface elevated to 10.3%, then decreased to 5.1% with increasing stent mesh density. However, in smaller aneurysms, this pressure continuously decreased with increasing stent mesh density. The flow-diverting effect of the stents was limited when a stent with low mesh density (under 20%) was used with a giant aneurysm. Conclusions The present results indicate that the selection of appropriate stents according to aneurysm size may contribute to reduced risks of hemodynamic alternations related to stent deployment, which could reduce the incidence of delayed rupture.
Systematic reviews of randomized controlled trials of cannabinoid products in chronic pain conditions and for symptoms associated with multiple sclerosis: what do they tell us?

ABSTRACT Introduction To investigate whether published systematic reviews of randomized controlled trials provide sufficient clarity to inform prescribing of medicinal cannabinoid products, we examined their features and findings in two well-researched areas: chronic cancer/noncancer pain and multiple sclerosis (MS)-related symptoms. Areas covered Structured searches from January 2011 to 2 February 2021 identified 31 systematic reviews (with/without meta-analyses) that met the inclusion criteria. Support for the efficacy of cannabinoids was minimal in cancer pain, and somewhat stronger in noncancer (especially neuropathic) pain and MS spasticity. All systematic reviews and most meta-analyses grouped cannabinoid products together without appropriate consideration of their differential attributes (active constituent(s), concentration/strength, dosage forms, administration route), dosing regimens or treatment durations. Patient populations and efficacy outcome measures were inhomogeneous, particularly for studies in noncancer pain and MS. Separate results for specific cannabinoid formulations were rarely provided. Expert opinion The therapeutic effect of cannabinoids, as already demonstrated for some products, is not reflected clearly in the current range of systematic reviews and meta-analyses in chronic pain and MS. To truly inform evidence-based practice, future publications should aim to present results by individual product from well-conducted clinical trials using appropriate and homogeneous outcome measures in well-defined patient populations.
Encountering uncertainty and complexity in decision-making: an observational study of clinical reasoning among medical and interprofessional groups of health care students

ABSTRACT Poor teamwork and clinical decisions have a major impact on patient outcomes and safety. Clinical decision-making rarely occurs under ideal conditions, but complex health care environments make this particularly challenging for new graduate health professionals as beginner practitioners. Recent evidence indicates that effective collaboration also enhances quality of clinical decisions for patients with complex needs. However, collaborative decision-making is not standard in educational curricula, where clinical decision-making is usually taught in profession-specific courses emphasizing individual rationality and cognition. The aim of this study was to gain detailed insights into the practice of clinical decision-making by small groups of medical and other health care students. A qualitative observational study design was used. Students (n = 45) took part in a short role-play of a hospital clinical ethics committee meeting discussing three complex patient cases, considering clinical and ethical aspects of care, and made a group decision about priorities for treatment. Audio-recorded data were transcribed verbatim and inductively analyzed based on Strauss’s “Theoretical Coding” approach. Coding and interpretation of transcripts resulted in three key themes: a) values/beliefs as a basis for negotiation; b) encountering obstacles; c) overcoming obstacles. All groups benefited from shared knowledge, assisting each other in dealing with uncertainty and perceived emotional burden. In small groups, they were able to overcome challenges and fulfil a goal potentially beyond many of them as individuals. Provision of learning opportunities where students learn to share expertise and decision-making responsibilities has the potential to optimize their learning in preparation for challenges in future practice.
Secretory Cells are the Primary Source of pIgR in Small Airways.

Loss of secretory immunoglobulin A (SIgA) is common in COPD small airways and likely contributes to disease progression. We hypothesized loss of SIgA results from reduced expression of pIgR, a chaperone protein needed for SIgA transcytosis, in the COPD small airway epithelium. pIgR-expressing cells were defined and quantified at single-cell resolution in human airways using RNA in-situ hybridization, immunostaining, and single-cell RNA sequencing. Complementary studies in mice utilized immunostaining, primary murine tracheal epithelial cell (MTEC) culture, and transgenic mice with secretory or ciliated cell-specific knockout of pIgR. SIgA degradation by human neutrophil elastase or secreted bacterial proteases from non-typeable Haemophilus influenzae (NTHi) was evaluated in vitro. We found that secretory cells are the predominant cell type responsible for pIgR expression in human and murine airways. Loss of SIgA in small airways was not associated with a reduction in secretory cells but rather a reduction in pIgR protein expression despite intact PIGR mRNA expression. Neutrophil elastase and NTHi-secreted proteases are both capable of degrading SIgA in vitro and may also contribute to a deficient SIgA immunobarrier in COPD. Loss of the SIgA immunobarrier in small airways of patients with severe COPD is complex and likely results from both pIgR-dependent defects in IgA transcytosis and SIgA degradation.
Pain and fatigue in adults with Loeys–Dietz syndrome and vascular Ehlers–Danlos syndrome, a questionnaire‐based study

The purpose was to study self‐reported chronic pain and fatigue symptoms among adults with molecularly verified Loeys–Dietz and vascular Ehlers–Danlos syndrome using a cross‐sectional questionnaire design. Seventy adults were invited through a National Resource Centre for Rare Disorders. A study specific questionnaire including Brief Pain Inventory, Standardized Nordic Questionnaire, Fatigue Severity Scale, Hospital Anxiety & Depression Scale, questions on physical activity, and disease burden was used. Fifty‐two persons participated, n = 34 with Loeys–Dietz and n = 18 with vascular Ehlers–Danlos syndrome, aged 18–68 years, 58% women. Chronic pain (79%) and fatigue (58%) symptoms were common. Half developed pain during childhood/adolescence. Sleep problems and high multi‐organ burden were significantly associated with chronic pain (p = 0.004, p = 0.014) and high fatigue (p < 0.001, p < 0.001). Chronic pain was associated with higher scores of fatigue (p = 0.002). Higher scores of fatigue were associated with lower level of physical activity (p = 0.014), higher cardiovascular burden (p = 0.025), and higher symptoms of anxiety (p = 0.001). In this study, symptoms of chronic pain, fatigue, sleep problems, and disease burden seemed to mutually reinforce each other. Initiatives should consider interventions aimed at postponing the onset and reducing symptoms of pain, fatigue, and sleep problems and thus reduce the total disease burden at an early stage in patients with these complex conditions.
Psychosocial resources moderate the association between stress and insomnia among patients with digestive system cancers

ABSTRACT This study explored the profiles of psychosocial resources combined with resilience and family care, and analyzed their moderating effects on the relationship between stress and insomnia in patients with digestive system cancers. A total of 366 patients were recruited to participate in this study from two tertiary hospitals in China. They were assessed using the Perceived Stress Scale – 4 items, Insomnia Severity Index, Family Concern Index Questionnaire, and 10-item Connor–Davidson Resilience Scale. Latent profile analysis and the BCH (Bolck, Croon & Hagenaars) method were used to identify the subtypes and estimate the moderating role of psychosocial coping resources. About 62.3% of participants had insomnia symptoms. Insomnia was positively correlated to the stress (r = 0.25, P < 0.001). The latent classes were the low resources class (32.8%), the medium resources class (46.1%), and high resources class (21.1%). Among these, in low (estimate value = 0.563, P = 0.003) and medium (estimate value = 0.301, P = 0.029) resources class, stress had an effect on insomnia. There was no association between stress and insomnia in high resources class (estimate value = 0.165, P = 0.637). Stress might be associated with to insomnia problems, whereas patients with high psychosocial resources are more not vulnerable. Interventions to improve family function and resilience could contribute to easing the insomnia of patients with digestive system cancers.
Process standardization in requirements engineering at Movares

The department of System Integration (SI) at the engineering and consultancy organization Movares in Utrecht is particularly concerned with finding and managing interfaces between different disciplines within infrastructure projects and directing processes that lead up to delivering specific documents. From interviews with employees at the SI department, several needs rose to the surface. One such need is that SI employees are often asked to make complete SRS documents, including the elicitation of the requirements themselves. SRSs are system requirements specifications, which are documents specifying the technical requirements imposed on the designs of a particular infrastructure project. Making these documents is part of the requirements engineering (RE) process. Eliciting the technical requirements in this process requires specialized technical knowledge, which SI employees often do not possess. Thus, the technical tasks need be delegated more to the technical disciplines, who often do not know how to correctly elicit requirements. Another issue is that work processes are often not documented and employees then usually work from own experiences, which leads to employees having to reinvent the wheel and are thus working inefficiently. Additionally, and relatable to the previously mentioned issue, employees experience the quality of some of the documents as below standard and inconsistent. The core problem that these issues have in common, is that the processes are not documented and standardized. This leads up to the main research question, which is: How can a standardized system requirements engineering process be realized at Movares, in order to move towards a more economical way of working and allow SI employees to employ a more organizational role in projects?
Designing Equitable Health Care Outreach Programs From Machine Learning Patient Risk Scores

There is growing interest in ensuring equity and guarding against bias in the use of risk scores produced by machine learning and artificial intelligence models. Risk scores are used to select patients who will receive outreach and support. Inappropriate use of risk scores, however, can perpetuate disparities. Commonly advocated solutions to improve equity are nontrivial to implement and may not pass legal scrutiny. In this article, we introduce pragmatic tools that support better use of risk scores for more equitable outreach programs. Our model output charts allow modeling and care management teams to see the equity consequences of different threshold choices and to select the optimal risk thresholds to trigger outreach. For best results, as with any health equity tool, we recommend that these charts be used by a diverse team and shared with relevant stakeholders.
Histone deacetylase 4 reverses cellular senescence via DDIT4 in dermal fibroblasts

Histone deacetylases (HDACs) remove acetyl groups from lysine chains on histones and other proteins and play a crucial role in epigenetic regulation and aging. Previously, we demonstrated that HDAC4 is consistently downregulated in aged and ultraviolet (UV)-irradiated human skin in vivo. Cellular senescence is a permanent cell cycle arrest induced by various stressors. To elucidate the potential role of HDAC4 in the regulation of cellular senescence and skin aging, we established oxidative stress- and UV-induced cellular senescence models using primary human dermal fibroblasts (HDFs). RNA sequencing after overexpression or knockdown of HDAC4 in primary HDFs identified candidate molecular targets of HDAC4. Integrative analyses of our current and public mRNA expression profiles identified DNA damage-inducible transcript 4 (DDIT4) as a critical senescence-associated factor regulated by HDAC4. Indeed, DDIT4 and HDAC4 expressions were downregulated during oxidative stress- and UV-induced senescence. HDAC4 overexpression rescued the senescence-induced decrease in DDIT4 and senescence phenotype, which were prevented by DDIT4 knockdown. In addition, DDIT4 overexpression reversed changes in senescence-associated secretory phenotypes and aging-related genes, suggesting that DDIT4 mediates the reversal of cellular senescence via HDAC4. Collectively, our results identify DDIT4 as a promising target regulated by HDAC4 associated with cellular senescence and epigenetic skin aging.
ICT to improved Teaching And Learning Process in Omoku, Nigeria using VBSE

—Teaching and learning has been and will live as one of the oldest industries world over. The academia during the industrial revolution contributed immensely to its development. Principles, theory, norms, ethnics and manpower were developed through the help of the academia. The industrial sectors are firmly rooted and established, it is a payback time through it established successes to the academia. Hence, a modification and hybrid of some widely used and acceptable model in the industrial sector is proposed for adoption and used in the academia due to it hug successes in the industries. This work improves and cross bird TAM, TOE and UTAUT in improving teaching and learning. This paper is a study about the different ICT techniques that can be adopted to improve teaching and learning process in Omoku, Nigeria. We also proposed a hybrid model which gives a productive usage of technical tools and increase its impact
Enhanced systemic antilymphoma immune response by photothermal therapy with CpG deoxynucleotide–coated nanoparticles

Abstract In preclinical studies, we investigated a novel mechanism of in situ vaccination in lymphoma. Radiation therapy (RT) can induce abscopal responses in lymphoma models, but this has not translated into clinical efficacy. We hypothesized that immune stimulation with cytosine guanine dinucleotide (CpG) deoxynucleotides could enhance abscopal effects induced by RT or photothermal therapy (PTT), which has been shown to have an immune stimulatory effect in solid tumors but has not been studied in lymphoma. We designed a branched gold nanoparticle (NP) platform to carry CpG deoxynucleotides while maintaining PTT function and compared the immunologic profile of the tumor microenvironment after PTT or RT in a dual-flank lymphoma model. One flank was treated with CpG deoxynucleotides with RT or PTT, and the other tumor was left untreated. We found that the CpG deoxynucleotide/PTT group had significant reduction in growth in both treated (primary) and untreated (secondary) tumors, suggesting an improved abscopal response, with a concomitant increase in CD8/CD4 and cytotoxic T-cell/regulatory T-cell ratios in both primary and secondary tumors compared with CpG deoxynucleotides/RT. Dendritic cells in primary and secondary draining lymph nodes had increased maturation markers in the CpG deoxynucleotide/PTT group, and the effector memory T cells (both CD4 and CD8) in the secondary tumor and spleen were increased, suggesting a systemic vaccination effect. These data suggest that in a lymphoma model, PTT using a CpG deoxynucleotide NP platform resulted in enhanced in situ vaccination and abscopal response compared with RT.
Peritraumatic distress across the lifespan: Clinical implications of age differences during the COVID‐19 pandemic

Abstract The Peritraumatic Distress Inventory (PDI) is a well‐known self‐report questionnaire indexing the distress experienced during and shortly after a most stressful or traumatic event. Although sociodemographic factors contributing to peritraumatic distress have been previously investigated, no research has examined the nature and severity of peritraumatic distress reactions in a non‐clinical, community sample as a function of age. An international sample of 5621 adult participants were grouped according the World Health Organization's age stratification protocol. Mean scores and item endorsement on the PDI were compared across groups with respect to their worst experience of the COVID‐19 pandemic. A significant between‐group difference was found, F(55,615) = 30.74, p < 0.001, n 2 = 0.027 whereby participants aged 18–39 years old reported the highest levels of peritraumatic distress. This group also endorsed a higher proportion of items on the PDI's two main factors (emotional distress and physical reactions), and were more likely to endorse feelings of helplessness, than older participants. It appears that severity of peritraumatic distress during the pandemic has affected younger people the most. Results are discussed in light of clinical implications.