bluuebunny/crossref_metadata_2025 huggingface dataset:
Local Anesthesia for above Knee Femoropopliteal Bypass: An Alternative Technique to Endoluminal Bypass Grafting
Authors: Lumsden A. B. , Weiss V. , Pitts M. , MacDonald M. J. , Surowiec S. M. , Ofenloch J. C.
Published: September 2024

Background:

The majority of patients with peripheral vascular disease have associated medical illnesses that contribute to a substantial incidence of perioperative complications. Some of the these complications may be related to the choice of anesthetic used. An ideal anesthetic would provide good analgesia, have few complications associated with its use, including minimizing hemodynamic instability, and provide an adequate surgical environment. Materials and

Methods:

Ten patients with an occluded superficial femoral artery and claudication or rest pain were selected. Eligibility criteria were a non-obese thigh and an above knee popliteal segment of at least 10 cm. Lidocaine local anesthesia with systemic sedation was employed. Above knee femoropopliteal bypasses were performed in all patients. Intraoperative fluid volume, anesthetic dose and perioperative morbidity were recorded.

Results:

All patients tolerated the procedure well. The operating environment was excellent. Intraoperative fluid requirements were less for patients receiving local anesthesia as compared with a similar group of patients undergoing above knee femoropopliteal bypass receiving regional anesthesia (mean 1750 ml versus 3386 ml). The mean dosage of lidocaine (0.5%) was 367 mg over a mean of 116 min operating time. All patients ambulated within 8 hours. There was no perioperative morbidity, mortality or graft occlusion.

Conclusion:

This technique is easy to perform and further reduces the systemic magnitude of anesthesia, while providing excellent perioperative analgesia and a satisfactory surgical environment. It may be ideal for the high risk patient, as intraoperative fluid volume requirements are reduced. In an era where endoluminal bypass grafting is being increasingly advocated, this technique retains the benefits of bypass grafting while possibly reducing the physiological insult.
The Value and Limitations of Magnetic Resonance Angiography of the Circle of Willis in Patients Undergoing Carotid Endarterectomy
Authors: DePippo P. S. , Ascher E. , Scheinman M. , Yorkovich W. , Hingorani A.
Published: September 2024

Magnetic resonance angiography is a useful technique to determine the patency of the circle of Willis when compared with conventional four-vessel angiography. The purpose of this study is to determine whether the integrity of the circle of Willis, assessed by magnetic resonance angiography, provides adequate collateral cerebral circulation during carotid endarterectomy and correlates with internal carotid artery back pressure. Over a recent 20-month period, 35 patients were studied preoperatively with magnetic resonance angiography of the carotid bifurcations of the circle of Willis and the vertebrobasilar system. All patients underwent standard carotid endarterectomy with intraoperative measurement of internal carotid artery back pressure. Patients with an internal carotid artery back pressure < 50 mmHg had an intraluminal shunt placed. Deficiencies in branches of the circle of Willis, the carotid bifurcation and the vertebrobasilar system determined by magnetic resonance angiography were correlated with internal carotid artery back pressure using Fisher's exact test. Only one patient had a completely intact circle of Willis. Eleven of 16 patients (69%) who had an internal carotid artery back pressure < 50 mmHg had an occluded A1 segment of the anterior cerebral artery combined with an occluded posterior communicating artery, whereas only five of 19 patients (26%) who had an internal carotid artery back pressure > 50 mmHg had similar findings ( P < 0.03). Severity of occlusive disease of the contralateral internal carotid artery and the basilar artery did not independently predict internal carotid artery back pressure. An occluded anterior branch of the circle of Willis in combination with an occluded posterior branch of the circle of Willis is associated with an internal carotid artery back pressure < 50 mmHg. Although magnetic resonance angiography of the circle of Willis may provide valuable anatomic information, it is not sufficiently accurate to predict the need for carotid shunting and therefore its use cannot be justified on a routine basis.
Myocardial Revascularization in Patients ≤ 45 Years Old: Evaluation of Cardial and Functional Capacity, and Return to Work
Authors: Noyez L. , Onundu J. W. , Janssen D. P. B. , Stotnicki S. H. , Lacquet L. K.
Published: September 2024

Objective:

To investigate whether patients ≤ 45 years old benefit from myocardial revascularization, measured by New York Heart classification, functional status and return to work.

Methods:

The data of 188 consecutive patients 45 years old and younger, and who were undergoing primary isolated aortocoronary bypass operation, were studied. Follow-up information was obtained from our follow-up databank. A cross-sectional follow-up was conducted and an additional functional evaluation by the Duke Activity Status Index and the work situation.

Results:

The follow-up, was complete for 98.2% of patients and showed a survival rate of 99% at 12 and 86.1% at 120 months. Eight patients died during follow-up. There was a significant improvement of NYHA classification. The Dukes Activity Status Index showed a good correlation with the NYHA class; however, only 47% of the patients returned to work.
The Blood Supply of the Hypoglossal Nerve and its Relevance to Carotid Endarterectomy
Authors: Fernando D. A. , Lord R. S. A. , Ozmen J.
Published: September 2024

Since the hypoglossal nerve is liable to injury during carotid endarterectomy and similar procedures, its blood supply was examined in microinjection studies of human cadavers. The nerve is supplied by arteries that arise from the ascending pharyngeal artery as it exits from the hypoglossal canal, the occipital artery as the nerve passes under its branch to the sternomastoid muscle, direct branches from the external carotid artery, and branches from the ascending pharyngeal artery just near the bifurcation of the common carotid artery. Within and close to the tongue, the nerve is supplied by branches from the lingual artery. Damage to the vessels supplying the nerve may account for some cases of hypoglossal palsy after carotid endarterectomy. Possible mechanisms are ischaemia, thermal or electrical injury from diathermy current conducted to the nerve, or intraneural haematoma from rupturing one or more of these fine vessels.
The Effect of Increasing Clamping Forces on Endothelial and Arterial Wall Damage: An Experimental Study in the Sheep
Authors: Margovsky A. I. , Chambers A. J. , Lord R. S. A.
Published: September 2024

Purpose:

This study aimed to relate the level of physical force applied to the arterial wall by atraumatic clamps to the degree of endothelial and wall damage.

Methods:

Sixteen sheep carotid and femoral arteries were each demarcated into four segments 1 cm apart (total 64 segments). Each segment was clamped for 15 min with a standard angled DeBakey vascular clamp. Four levels of force were generated by closing the clamp at three, four, five and six notches of closure. The extent of endothelial injury was assessed by using a dedicated computer assisted image acquisition program to measure the area stained by Evan's blue dye. The extent of damage to the layers of the arterial wall was analyzed and compared by scanning electron microscopy and light microscopy.

Results:

For femoral arteries, the area of endothelial injury was considerably less for three notch (3.76 ± 0.28 newtons) and four notch (5.68 ± 0.29 newtons) closure compared with that for five notch (6.19 ± 0.31 newtons) and six notch (6.61 ± 0.16 Newtons) closure ( P = 0.01). For carotid arteries, three notch (5.68 ± 0.28 newtons) closure caused less damage than did four notch (7.98 ± 0.29 newtons). five notch (9.17 ± 0.40 newtons) and six notch (9.57 ± 0.64 newtons) closure ( P = 0.02). Scanning electron microscopy confirmed the extent and depth of arterial injury corresponded directly to the forces generated by the vascular clamps.

Conclusions:

The closing forces generated by arterial clamps correlated positively with the extent of artery wall injury. Vascular clamps should be applied at the minimum level of force that will arrest blood flow.
Reoperative Aortic Surgery
Authors: Matsumura J. S. , Pearce W. H. , Cabellon A. , McCarthy W. J. , Yao J. S. T.
Published: September 2024

The presentation of long-term complications after conventional aortic surgery and the treatment of patients that have had reoperative aortic operations are reviewed. Ninety-seven consecutive patients that had 102 subsequent aortic operations at a tertiary referral center were studied. Presenting symptoms, demographics, risk factors, indications for initial and second procedures, operative techniques and outcomes were recorded in a computerized database. There were 70 men and 27 women studied, with an average age of 64 years. First operations were performed primarily for aneurysm (56%) and occlusive disease (44%). The interval between procedures ranged up to 23 years, with a mean of 6 years. Indications for reoperation were subsequent aneurysm (65), graft occlusions (25) and/or infections (24). Seventy-three percent of the subsequent aneurysms were true metachronous aneurysms; the others were associated with the graft or an anastomosis. Para-anastomotic aneurysms may be more common with a primary end-to-side graft configuration. One-third of subsequent aneurysms were not palpable and asymptomatic. Graft occlusion can be treated safely with elective repeat bypass (mortality 0%). Graft infections that require total graft removal remain a challenging problem (mortality 17%). Although surgical approach for reoperations utilized more extensive exposure and proximal clamping, 59 elective aneurysm cases had a 5.1% mortality rate; eight emergent procedures for ruptured aneurysms resulted in 88% mortality. Reoperation for graft occlusion or infection showed a similar high mortality rate with emergent cases. In this referral practice, graft occlusion and infection are relatively less frequent, whereas metachronous aneurysm formation is now the most common indication for reoperation. These aneurysms often remain undetected until symptoms occur; frank rupture is usually lethal. As elective repair with modern reoperative techniques can be safely performed, routine computed tomographic examination is advisable at least every 5 years after aortic operations.
Moral courage of nursing: Bibliometric analysis
Authors: Huang Mingtao , Wei Sihua , Xia Jiansen
Published: September 2024

Background

Moral courage is a recognized virtue. Researchers have focused on various aspects of nursing moral courage, such as its conceptualization and influencing factors. Within these studies, various literature reviews have been conducted, but to our knowledge, bibliometric mapping has not been utilized.

Aim

This article aims to analyze the production of literature within nursing moral courage research.

Research Design

To investigate publication patterns, we employed VOSviewer and CiteSpace software, focusing on publication dynamics, prolific research entities, and most cited articles. Additionally, we forecasted future research trends.

Ethical considerations

In our study, ethical review was not required.

Results

A total of 105 information sources were identified in the WoS database. Overall, there has been a significant increase in research volume after 2020. The most prolific countries are the United States, Finland, and China, while the most prolific source title is “Nursing Ethics.” Keywords are also related to moral dilemmas and ethics. However, there are further improvements needed in international cooperation.

Conclusions

The results proposed in this paper can serve as a starting point for comprehensive or systematic literature reviews and seek more detailed data, information, and knowledge in the field of nursing moral courage. It can enable outsiders to quickly understand research on nursing moral courage, whether for in-depth exploration or simply to facilitate more effective collaboration with nursing ethics experts.
Conceptualizing Patient as an Organization With the Adoption of Digital Health
Authors: Das Gupta Atantra
Published: September 2024

The concept of viewing a patient as an organization within the context of digital healthcare is an innovative and evolving concept. Traditionally, the patient-doctor relationship has been centered around the individual patient and their interactions with healthcare providers. However, with the advent of technology and digital healthcare solutions, the dynamics of this relationship are changing. Digital healthcare platforms and technologies enable patients to have more control and active participation in managing their health and healthcare processes. This shift empowers patients to take on a more proactive role, similar to how an organization functions with various stakeholders, goals, and strategies. The prevalence of mobile phones and wearables is regarded as an important factor in the acceptance of digital health.

Objective:

This study aimed to identify the factors affecting adoption intention using the TAM (Technology Acceptance Model), HB (Health Belief model), and the UTAUT (Unified Theory of Acceptance and Use of Technology). The argument is made that the adoption of the technology enables patients to create resources (ie, data), transforming patients from mere consumers to producers as well.

Results:

PLS analysis showed that health beliefs and perceived ease of use had positive effects on the perceived usefulness of digital healthcare, and system capabilities positively impacted perceived ease of use. Furthermore, perceived service, the customer’s willingness to change and reference group influence significantly impacted adoption intention ( b > 0.1, t > 1.96, P < .05). However, privacy protection and data security, online healthcare resources, and user guidance were not positively associated with perceived usefulness.

Conclusions:

Perceived usefulness, the customer’s willingness to change, and the influence of the reference group are decisive variables affecting adoption intention among the general population, whereas privacy protection and data security are indecisive variables. Online resources and user guides do not support adoption intentions.
Non-cosmetic use of botulinum toxin in surgical conditions
Authors: Marker Line , Toquer Peter , Helgstrand John Thomas , Helgstrand Frederik
Published: September 2024

Botulinum toxin (BTX) is a neurotoxin that has an ability to create a fully reversible relaxation of muscles through decreased release of acethylcholin. It also has an effect on the cholinergic autoimmune nervous system, and it can reduce pain sensitization. BTX is widely used in cosmetic treatments. In recent years, BTX has increasingly been used to treat several medical and surgical conditions. In many cases, this is despite weak evidence and without approval from the European Medicine Agency (EMA). This narrative review describes how BTX is used in the different surgical specialties and provides a brief overview of the use of BTX for non-cosmetic surgical conditions.
The managerial and future-oriented role of audience data in data-informed news organisations
Authors: Ahva Laura , Salonen Margareta , Ovaska Liisa , Talvitie-Lamberg Karoliina
Published: September 2024

One sign of datafication in journalism is that newsrooms utilise insights from audience data and related metrics in their decision-making. In professional discourse, this often alludes to the notion of ‘data-informed newsrooms’ in which organisations are managed with the help of data. This article focuses on the managerial role of audience data in such organisations: What types of audience data inform newsrooms, which domains of newsroom management are being informed by data, and what kinds of visions motivate the future of data use in news organisations? These questions are answered based on empirical material from three different research projects (2020–2022) in Finland, including both qualitative interviews and survey results featuring the views of varied journalism professionals on data use. The theoretical framework draws from conceptualisations of anticipatory governance. Professionals’ interpretations of audience data reveal the basic elements of data sources, types, systems and storages that inform the organisations. Such audience data are used for four main management purposes–leading individuals, work processes, the news product, and the audience. The role of audience data in the future preferably includes elements of predictability, fairness, usability, and depth. However, there are discrepancies between the visions themselves as well as the views of the managers and journalists, which results in an ongoing negotiation about the suitable role of audience data in news organisations.
Neurologically Motivated Simulation of Ensemble Performance
Authors: Darabi Nima , Svensson U. Peter , E. C. Mertens Paul
Published: September 2024

A “rhythmic agent” is simulated based on the foundation of a previously published behavioral sensorimotor synchronization (SMS) model. The model is adjustable to control the auditory and tactile modalities of the tap's feedback. In addition to the conventional mechanisms of phase and period error correction, as well as their activation conditions, the period is estimated by modeling a central timekeeper impacted by a novel short-term memory. Inspired by The ADaptation and Anticipation Model (ADAM), a mechanism for linearly extrapolating anticipation is also tested. To better match the perceptual and motor cognitive functions, the model's parameters have been tuned to observations from experimental neurosensory literature with an emphasis on transduction delays. The agent is programmed to synchronize with various external rhythmic input signals while accounting for both adaptive and predictive mechanisms. The definition of the agent is based on a minimal set of rules yet has successfully replicated results of real-world observations: against a metronome; it produces the well-known negative mean asynchrony. In a rhythmic joint action, the simulation of joint delayed coordination shows a behavior previously observed in human subjects: in a rhythmic collaboration, a moderate amount of delay is necessary to keep the tempo steady, and below that threshold, the rhythm tends to speed up. It is also shown that giving more weight to the tactile afferent feedback than the auditory intensifies this effect. Moreover, it is observed that including anticipation in addition to the reactive mechanism will decrease the effect. The proposed model as a rhythmic engine, combined with other standard modules such as a beat detection algorithm, can be used to implement musical co-performers that could improvise with a human rhythmically or perform a given score in a way that feels human-like.
Anti-Tubular Basement Membrane Antibody Nephritis Manifesting in a Patient With Chronic Lymphocytic Leukemia: A Very Rare Case Report
Authors: Ebrahimi Niloufar , Najafian Behzad , Chen Wongworawat Yan , Norouzi Sayna , Abdipour Amir
Published: September 2024

Anti-tubular basement membrane (anti-TBM) antibody nephritis is a rare type of tubulointerstitial nephritis associated with progressive decline in kidney function. It is characterized histopathologically by tubular atrophy and dilation, interstitial fibrosis, lymphocyte and macrophage-predominant cellular infiltration, and linear deposition of IgG and complement along the tubular basement membrane. We herein present a case of a 69-year-old male who was recently diagnosed with chronic lymphocytic leukemia (CLL) and was referred for evaluation of kidney failure, ultimately diagnosed as anti-TBM antibody nephritis progressing into end-stage kidney disease (ESKD). This case report highlights the management challenges of anti-TBM antibody nephritis as a rare kidney disorder.
Effects of the 5E Instructional Model: A Systematic Review and Meta-Analysis
Authors: Polanin Joshua R. , Austin Megan , Taylor Joseph A. , Steingut Rebecca Rose , Rodgers Melissa A. , Williams Ryan
Published: September 2024

We conducted a comprehensive, systematic review and meta-analysis on the effects of the BSCS 5E Instructional Model—and its related variants—on science, math, and motivation outcomes. The 5E Instructional Model is a framework for delivering STEM instruction that is based on constructivist learning theory; it has been used throughout the U.S. and other countries, particularly in Turkey. Despite its wide usage, no comprehensive systematic review and meta-analysis on the effects of 5E and related models has yet been conducted. Our search and screening procedures yielded 61 randomized controlled trial studies, estimating 156 effect sizes; 70% of studies met WWC standards with or without reservations. We found that the 5E instructional model resulted in improved science outcomes ( g = 0.82, 95% CI [0.67, 0.97]), but a large amount of heterogeneity requires some caution ( t = 0.56). We explored numerous explanations for the effect heterogeneity and provided practical recommendations.
The present and future for CAR-T cell therapy in adult B-cell ALL
Authors: Roddie Claire , Rampotas Alexandros
Published: September 2024

Chimeric Antigen Receptor T-cell therapy (CAR-T) targeting CD19 has transformed the management of relapsed/refractory (r/r) B-Acute Lymphoblastic Leukemia (B-ALL), with FDA approval of tisagenlecleucel (tisa-cel) for pediatric/young adult patients and brexucabtagene autoleucel (brexu-cel) for adults. Efficacy is contingent upon several factors including disease burden. Emerging data suggests that bridging therapy, lymphodepletion and for some patients, consolidation therapy have an important role in the success of treatment. Further, strategies to define and manage immunotoxic side effects including hematotoxicity is critical to safe delivery. Advancements in CAR-T design beyond CD19 represent an ongoing therapeutic evolution. Overall, CAR-T therapy signifies a paradigm shift in B-ALL management, with the potential for improved remission and survival in a historically challenging patient population.
How I Treat patients with AML using azacitidine and venetoclax
Authors: Wei Andrew H. , Loo Sun , Daver Naval G
Published: September 2024

Venetoclax received full approval in October 2020 for use in older, unfit patients with acute myeloid leukemia (AML) combined with either hypomethylating agents or low-dose cytarabine. This ended a semi-centennial of stalled clinical progress and initiated a new treatment option with proven capacity to enhance response and prolong survival in older patients with AML. Despite widespread use of azacitidine-venetoclax (AZA-VEN), there is increasing appreciation that this regimen is myelosuppressive and associated with a higher risk of infectious complications than AZA alone. Key principles of initial management include prevention of tumor lysis syndrome in patients at high risk and minimizing infectious complications during induction. In the post-remission phase, limiting cumulative marrow suppression by allowing sufficient time between cycles for optimal marrow recovery and truncating the duration of venetoclax exposure for those with delayed blood count recovery have emerged as important axioms of effective care. This new addition to the How I Treat series casts a clinical spotlight on important challenges and dilemmas encountered in practice. We also outline a structured framework to assist in the safe management of AZA-VEN in the clinic.
Recurrent CLTC::SYK fusions and CSF1R mutations in juvenile xanthogranuloma of soft tissue
Authors: Kemps Paul G. , Baelde Hans J. , Vorderman Ruben H. P. , Stelloo Ellen , Swennenhuis Joost F. , Szuhai Karoly , Lamers Meindert H. , Kenkhuis Boyd , Al-Hussaini Maysa , Briaire-de Bruijn Inge H. , Lam Suk Wai , Bovée Judith V. M. G. , Cleven Arjen H. G. , Verdijk Robert M. , van Noesel Carel J. M. , van Dijk Marijke R. , Scheijde-Vermeulen Marijn A. , Bruggink Annette H. , van Laar Jan A. M. , de Vries Andrica C. H. , Tissing Wim J. E. , van den Bos Cor , von Deimling Andreas , van Wezel Tom , van Halteren Astrid G. S. , Hogendoorn Pancras C. W.
Published: September 2024

Juvenile xanthogranuloma (JXG) is a histiocytic neoplasm that usually presents in the skin. Rarely, extracutaneous localizations occur; the genetic drivers of this clinical variant of JXG remain incompletely characterized. We present detailed clinicopathologic and molecular data of 16 children with extracutaneous JXG and 5 adults with xanthogranulomas confined to the central nervous system (CNS) or soft tissue. Tissue samples were obtained through the Dutch Nationwide Pathology Databank and analyzed with an innovative sequencing technique capable of detecting both small genomic variants and gene rearrangements. Targetable kinase alterations were detected in 16 of 16 children and 1 of 5 adults. Alterations included CLTC::SYK fusions in 6 children and CSF1R mutations in 7 others; all below 2 years of age with soft tissue tumors. One child had a CSF1R mutation and MRC1::PDGFRB fusion. Most were treated surgically, although spontaneous regression occurred in 1 of 6 with CLTC::SYK and 2 of 7 with CSF1R mutations, underscoring that treatment is not always necessary. Tumors with CLTC::SYK fusions generally lacked Touton giant cells but exhibited many other histologic features of JXG and concordant methylation profiles. Using multispectral immunofluorescence, phosphorylated–spleen tyrosine kinase expression was localized to CD163+ histiocytes; tumors with CLTC::SYK fusions also demonstrated mTOR activation, cyclin D1 expression, and variable phosphorylated–extracellular signal-regulated kinase expression. BRAFV600E was detected in 1 child and 1 adult with CNS-xanthogranulomas; both responded to BRAF inhibition. Finally, a TPM3::NTRK1 fusion or MAP2K1 deletion was detected in 2 children with systemic JXG who experienced spontaneous disease regression. This study advances the molecular understanding of histiocytic neoplasms and may guide diagnostics and clinical management.
CircMAPK1 induces cell pyroptosis in sepsis-induced lung injury by mediating KDM2B mRNA decay to epigenetically regulate WNK1
Authors: Li Min , Lu Hanjing , Ruan Chujun , Ke Qiao , Hu Longhui , Li Zhao , Liu Xiaoran
Published: September 2024

Background

Macrophage pyroptosis is a pivotal inflammatory mechanism in sepsis-induced lung injury, however, the underlying mechanisms remain inadequately elucidated.

Methods

Lipopolysaccharides (LPS)/adenosine triphosphate (ATP)-stimulated macrophages and cecal ligation and puncture (CLP)-induced mouse model for sepsis were established. The levels of key molecules were examined by qRT-PCR, Western blotting, immunohistochemistry (IHC) and ELISA assay. The subcellular localization of circMAPK1 was detected by RNA fluorescence in situ hybridization (FISH). Cell viability, LDH release and caspase-1 activity were monitored by CCK-8, LDH assays, and flow cytometry. The bindings between KDM2B/H3K36me2 and WNK1 promoter was detected by chromatin immunoprecipitation (ChIP) assay and luciferase assay, and associations among circMAPK1, UPF1 and KDM2B mRNA were assessed by RNA pull-down or RNA immunoprecipitation (RIP) assays. The pathological injury of lung tissues was evaluated by lung wet/dry weight ratio and hematoxylin and eosin (H&E) staining.

Results

CircMAPK1 was elevated in patients with septic lung injury. Knockdown of circMAPK1 protected against LPS/ATP-impaired cell viability and macrophage pyroptosis via WNK1/NLRP3 axis. Mechanistically, loss of circMAPK1 enhanced the association between KDM2B and WNK1 promoter to promote the demethylation of WNK1 and increase its expression. CircMAPK1 facilitated KDM2B mRNA decay by recruiting UPF1. Functional experiments showed that silencing of KDM2B or WNK1 counteracted circMAPK1 knockdown-suppressed macrophage pyroptosis. In addition, silencing of circMAPK1 alleviated CLP-induced lung injury in mice via KDM2B/WNK1/NLRP3 axis.

Conclusion

CircMAPK1 exacerbates sepsis-induced lung injury by destabilizing KDM2B mRNA to suppress WNK1 expression, thus facilitating NLRP3-driven macrophage pyroptosis.
Active Disturbance Rejection Control of Hydraulic Quadruped Robots Rotary Joints for Improved Impact Resistance
Authors: Zong Huaizhi , Yang Zhixian , Yu Xiu , Zhang Junhui , Ai Jikun , Zhu Qixin , Wang Feng , Su Qi , Xu Bing
Published: September 2024

Hydraulic actuated quadruped robots have bright application prospects and significant research values in unmanned area investigation, disaster rescue and other scenarios, due to the advantages of high payload and high power to weight ratio. Among these fields, inevitable collision of robots may occur when contact with unknown objects, step on empty objects, or collapse, all of which have an impact on the working hydraulic system. To overcome the unknown external disturbances, this paper proposes an active disturbance rejection control (ADRC) strategy of double vane hydraulic rotary actuators for the hip joints of the quadruped robots. Considering the order of the valve-controlled actuator model, a three-stage tracking differentiator, a four-stage extended state observer, and a state error feedback controller are designed relatively, and the extended state observer is adopted to observe and compensate the uncertainty of external load torque of the system. The effectiveness of the ADRC method is verified in simulation environment and a single joint experimental platform. Moreover, the impact experiments of the limb leg unit are carried out after introducing the proposed ADRC strategy into hip joint, the limb leg unit of quadruped robots presents better impact resistance ability.
Role of tenofovir dipivoxil in gut microbiota recovery from HBV-infection induced dysbiosis
Authors: Long Jianfei , Saw Maximilian , Zhang Pan , Wang Li , Li Ling , Ren Hongyan , Liu Chao , Ma Zhenxuan , Zhang Jiming , Wang Bin
Published: September 2024

Background

Studies have found dysbiosis of the gut microbiota in individuals infected with the hepatitis B virus (HBV). Tenofovir dipivoxil (TDF) is one of the preferred oral antiviral drugs used for the treatment of chronic hepatitis B (CHB), but the extent to which TDF is able to affect the gut microbiota and inflammatory factors of a patient remains largely unexplored. In this study, we collected stool samples from HBV patients prior to medication and from CHB patients treated with TDF.

Results

The gut microbiota and inflammatory factors were assessed in 42 healthy subjects (HC group), 109 HBV-infected subjects, including 48 CHB patients who were not medicated with nucleoside analogue drugs (No-NAs group), and 61 CHB patients who were medicated with TDF (TDF group). 16 S rRNA sequencing revealed that TDF treatment caused significant changes in the gut microbiota of HBV-infected individuals; however, the gut microbiota of HBV-infected individuals did not fully recover to a pre-dysbiosis state. The relative abundance of Bacteroidota gradually decreased from the HC group to the No-NAs and TDF groups. The relative abundance of Fusobacteriota was significantly higher in the No-NAs group than in the HC group. At the genus level, Dialister, Eubacterium_hallii_group, Halomonas, Collinsella, Sphingomonas, Xanthomonadaceae_unclassified, and Rhizobiaceae_unclassified were overrepresented; while the abundance of Bacteroides and Fusobacterium decreased significantly in the No-NAs and TDF groups.

Conclusions

This study showed that TDF treatment significantly improved the regulation of the gut microbiota and aided in dysbiosis recovery. We did not observe significant improvement in serum inflammatory factor concentrations, which may be related to the relatively short duration of TDF administration in this study.
Dementia Friendly communities (DFCs) to improve quality of life for people with dementia: a realist review
Authors: Craig Stephanie , Halloran Peter O’ , Mitchell Gary , Stark Patrick , Wilson Christine Brown
Published: September 2024

Background

Currently, there are more than 55 million people living with dementia worldwide. Supporting people with dementia to live as independently as possible in their communities is a global public health objective. There is limited research exploring the implementation of such interventions in the community context. The aim of the review was to create and refine programme theory – in the form of context mechanism-outcome configurations – on how the characteristics of dementia-friendly communities (DFCs) as geographical locations interact with their social and organisational contexts to understand what works for whom and why.

Methods

This realist review sourced literature from 5 electronic databases: Cochrane Library, CINAHL, Medline, Scopus, PsychINFO and Google Scholar, as well as relevant websites such as Alzheimer’s Society to identify grey literature. Methodological rigour was assessed using the Joanna Briggs Institute critical appraisal tool.

Results

Seven papers were included in this realist review that focused on DFCs in a geographical context The implementation of DFC interventions emerged as a process characterised by two pivotal implementation phases, intricately linked with sub-interventions. The first intervention, termed Hierarchy Commitment (I1a/b), involves the formalisation of agreements by businesses and organizations, along with the implementation of dementia-friendly action plans. Additionally, Educational Resources (I1c) play a significant role in this phase, engaging individuals with dementia and their caregivers in educational initiatives. The second phase, Geographical/Environmental Requirements (I2), encompasses the establishment of effective dementia-friendly signage, accessible meeting places, and community support.

Conclusions

This realist review highlighted a theoretical framework that might guide the development of dementia-friendly communities to enhance the experiences of individuals with dementia and their caregivers within DFCs. Emphasising the need for a theoretical framework in developing geographical DFCs, the review outlines contextual elements, mechanisms, and outcomes, providing a foundation for future studies. The ultimate goal is to establish a robust body of evidence for the sustainable implementation of dementia-friendly communities, thereby improving the quality of life for those with dementia.

Study registration

This study is registered as PROSPERO 2022 CRD42022317784.
Patients’ and stakeholders’ experiences of a personalized self-management SUPport program (P-SUP) for patients with type 2 diabetes mellitus and/or coronary heart disease: a qualitative process evaluation
Authors: Scholl Maximilian , Amerkamp Jessica , Chermette Chloé , Frank Friederike , Funke Christian , Giesen Lisa , Haas Viviana , Heßbrügge Martina , Küppers Lucas , Pilic Larisa , Vitinius Frank , Biallas Bianca
Published: September 2024

Background

Chronic diseases such as type 2 diabetes mellitus and coronary heart disease cause medical, social, and economic burdens worldwide. Disease management programs in Germany mostly lack components to improve patients’ self-management and health-promoting lifestyles despite clear guideline recommendations. Therefore, a Personalized Self-Management Support Program (P-SUP) was developed, which includes: (1) peer support groups; (2) telephone coaching; (3) feedback reports and, (4) a web portal. This study aims to explore patients’ and implementing stakeholders’ experiences in the implementation of P-SUP to identify barriers and facilitators to the implementation of the intervention.

Methods

A qualitative study was conducted using face-to-face focus group interviews with participating patients and telephone-based one-to-one expert interviews with implementing stakeholders, involved in the delivery of the intervention. The transcribed interview reports were analyzed using qualitative content analysis, and the contents were categorized according to Donabedian’s Structure-Process-Outcome framework.

Results

A total of six themes among patients (N = 35) and five themes among implementing stakeholders (N = 32) represent the experiences. The patient themes were: (1) technical conditions, (2) indoor facilities, (3) group composition, (4) acceptance of digital components, (5) supervision and feedback and (6) impact on lifestyle behavior. The themes among the implementing stakeholders were: (1) multiprofessional approach, (2) human resources, (3) patient acceptance, (4) supervision and feedback and (5) impact on lifestyle behavior.

Conclusions

Multiprofessional interventions such as P-SUP appear to be valuable for patients and implementing stakeholders. Although infrastructural barriers made the implementation of peer support and digital patient education difficult, patients rated the exchange with peers and experts on health-related topics positively. The lack of supervision and feedback during the course of the intervention might be compensated by regular telephone coaching. The findings from this study can be used in future studies to guide researchers and implementing stakeholders and to improve the feasibility and effectiveness of complex interventions in different contexts.

Trial registration

The P-SUP study was registered in the German Clinical Trials Register (DRKS) on 16/07/2020 under the registration number DRKS00020592.
Low intestinal parasite prevalence in Finnish pet dogs and cats
Authors: Rapp Pia , Williamson Eeva-Maria , Uski Riina , Savikoski Inka , Pynnönen Annika , Gindonis Veera , Sukura Antti , Näreaho Anu
Published: September 2024

Background

This study updates the knowledge of current canine and feline endoparasitic prevalence in Finland. The previous studies reported intestinal worm prevalence of 5.9% in dogs and 7.1% in cats. We also determined the anthelmintic regime and background data of dogs and cats concerning Toxocara spp. infection. Altogether 664 canine and 379 feline (including 46 shelter cats’) fecal samples from over six-month-old animals were examined with quantitative Mini-FLOTAC method using zinc sulfate with a specific gravity of 1.35. Of these samples, 396 canine and 89 feline samples were analyzed using the Baermann method for nematode larvae. A fenbendazole efficacy study was conducted with 12 animals positive for Toxocara spp.

Results

Endoparasites were found in the feces of 3.5% of dogs, 3.6% of pet cats, and 41.3% of shelter cats. The most common findings in dogs were strongylid (1.7%) and Toxocara canis (0.9%) eggs. Trematode (0.4%), Eucoleus spp. (0.3%), taeniid (0.2%), and Trichuris vulpis (0.2%) eggs, and Cystoisospora spp. oocysts (0.2%) were also detected. One dog (0.2%) was positive for Crenosoma vulpis based on the Baermann method. Toxocara cati (3.3%), taeniid (0.6%), and trematode (0.3%) eggs were found in pet cats’ samples. The findings in shelter cat samples were T. cati (34.8%), Eucoleus spp. (13.0%), Cystoisospora spp. oocysts (10.9%), taeniids (8.7%), and Toxoplasma gondii/Hammondia hammondii oocysts (2.2%). Fenbendazole efficacy was adequate in all treated animals, except one cat. The background data revealed 31.2% of dogs being dewormed less than once a year or never. Under twelve-month-old dogs and dogs that were dewormed twice a year were most likely to be T. canis- infected. Shelter cats, male cats, mixed-breed cats, cats that were dewormed two to four times a year, and cats with a history of parasitic infections were most likely to be T. cati infected.

Conclusions

The prevalence of pet canine and feline intestinal parasites in Finland is low, particularly the Toxocara spp. prevalence. In free-roaming cats Eucoleus spp. is surprisingly prevalent. The parasite control strategies reported do not follow the ESCCAP guidelines. Typically, owners deworm their pets only once a year or less frequently.
Initial signs in patients with ruptured abdominal aortic aneurysms: time for an expanded triad?
Authors: Bergmark Peter , Sadeghi Mitra , Talvitie Mareia , Hultgren Rebecka
Published: September 2024

Background and objective

Misdiagnosis of ruptured abdominal aortic aneurysms (rAAA) contributes to delayed treatment and potentially higher mortality. The symptomatology in patients with rAAA is complex and challenging, 25–50% presumably fulfill the criteria of the standard triad of signs (STS). The objective was to determine the initial signs registered for patients with verified rAAAs, and to investigate if an expanded diagnostic triad could increase the diagnostic accuracy.

Methods

A population-based study was conducted among all patients presenting with verified rAAAs in Stockholm County, Sweden, from January 2010 to October 2021. Patients were identified with ICD code 171.3 (rAAA). The STS was defined as (1) abdominal pain, (2) syncope and (3) the finding of a pulsatile abdominal mass, the prevalence of STS was investigated. An expanded triad included similar and related signs commonly registered for patients with rAAA, and was referred to as the modified abdominal aortic aneurysm rupture signs (MARS). The MARS-signs encompassed (1) the registered pain-associated symptoms or signs, (2) all hypovolemic associated signs, and (3) pulsatile abdominal mass and/or ultrasound finding, and the prevalence was similarly investigated. Finally, the STS and MARS were compared to evaluate the usefulness and performance of the MARS-score.

Results

A total of 216 patients were identified. The majority were men (77%) with a median age of 78 years. The dominating symptom was abdominal pain (84%), followed by dizziness (50%). Few patients presented with three STS (13%), two STS were found in 37% and one STS in almost half of the patients (41%). By contrast, when applying MARS 35% presented with the complete expanded triad, 47% with two and 17% with one. Comparison of accuracy favored MARS (13 vs. 35% with 3 signs, P < 0.001 for STS vs. MARS) (2 or 3 signs, 48 vs. 82% STS vs. MARS, P < 0.001).

Conclusions

The expanded MARS-signs could aid in easier and faster identification of rAAA patients, thus facilitating the first step with accurate diagnosis into the lifesaving rAAA care chain. Supportive diagnostic mnemonics and tools are especially important when targeting fatal diagnoses such as rAAA. Further studies are needed to investigate the implementation of the MARS-signs in various clinical settings.
Naivety dies with the calf: calf loss to human hunters imposes behavioral change in a long-lived but heavily harvested ungulate
Authors: Graf Lukas , Thurfjell Henrik , Ericsson Göran , Neumann Wiebke
Published: September 2024

Background

In prey, patterns of individual habitat selection and movement can be a consequence of an individuals’ anti-predator behavior. Adjustments of anti-predator behavior are important for prey to increase their survival. Hunters may alter the anti-predator behavior of prey. In long-lived animals, experience may cause behavioral changes during individuals’ lifetime, which may result in altered habitat selection and movement. Our knowledge of which specific events related to hunting activity induce behavioral changes in solitary living species is still limited.

Methods

We used offspring loss in a solitary and long-lived ungulate species, moose (Alces alces), as our model system. We investigated whether offspring loss to hunters induces behavioral changes in a species subjected to heavy human harvest but free from natural predation. To test for behavioral change in relation to two proxies for experience (calf fate and age), we combined movement data from 51 adult female moose with data on their offspring survival and female age. We tested for adjustments in females’ habitat selection and movement following calf harvest using Hidden Markov Models and integrated Step Selection Analysis to obtain behavioral state specific habitat selection coefficients.

Results

We found that females with a harvested calf modified habitat selection and movement during the following hunting season. Female moose selected for shorter distance to roads during the night, selected for shorter distance to forests and greater distance to human settlements following calf harvest than females who had not lost a calf. The survival of twins in a given hunting season was related to female age. Older females we more likely to have twins survive the hunting season.

Conclusions

Our findings suggest that losing offspring to human harvest imposes behavioral changes in a long-lived ungulate species, leading to adjustments in females' habitat selection and movement behavior, which may lower the risk of encountering hunters. In our study, female moose that experienced calf loss selected for lower distance to forest and selected for greater distance to human settlements during periods of high hunting pressure compared to females without the experience of calf loss during the previous hunting season. We interpret this as potential learning effects.
Association between red blood cell distribution width and 30-day mortality in critically ill septic patients: a propensity score-matched study
Authors: Wu Yu-Cheng , Chen Hsin-Hua , Chao Wen-Cheng
Published: September 2024

Background

Sepsis is the leading cause of death worldwide, and a number of biomarkers have been developed for early mortality risk stratification. Red blood cell distribution width (RDW) is a routinely available hematological data and has been found to be associated with mortality in a number of diseases; therefore, we aim to address the association between RDW and mortality in critically ill patients with sepsis.

Methods

We analyzed data of critically ill adult patients with sepsis on the TriNetX platform, excluding those with hematologic malignancies, thalassemia, and iron deficiency anemia. Propensity score-matching (PSM) (1:1) was used to mitigate confounding effects, and hazard ratio (HR) with 95% confidence (CI) was calculated to determine the association between RDW and 30-day mortality. We further conducted sensitivity analyses through using distinct cut-points of RDW and severities of sepsis.

Results

A total of 256,387 critically ill septic patients were included in the analysis, and 40.0% of them had RDW equal to or higher than 16%. After PSM, we found that high RDW was associated with an increased 30-day mortality rate (HR: 1.887, 95% CI 1.847–1.928). The associations were consistent using distinct cut-points of RDW, with the strength of association using cut-points of 12%, 14%, 16%, 18% and 20% were 2.098, 2.204, 1.887, 1.809 and 1.932, respectively. Furthermore, we found consistent associations among critically ill septic patients with distinct severities, with the association among those with shock, receiving mechanical ventilation, bacteremia and requirement of hemodialysis being 1.731, 1.735, 2.380 and 1.979, respectively.

Conclusion

We found that RDW was associated with 30-day mortality in critically ill septic patients, underscoring the potential as a prognostic marker in sepsis. More studies are needed to explore the underlying mechanisms.