The effects of a Virtual Fracture Care review protocol on secondary healthcare utilization in trauma patients requiring semi-acute surgery: a retrospective cohort study.

Purpose: The demand for trauma care in the Netherlands is increasing due to a rising incidence of injuries. To provide adequate trauma care amidst this increasing pressure, a Virtual Fracture Care (VFC) review protocol was introduced for treatment of musculoskeletal injuries to the extremities (MIE). This study aimed to assess the influence of the Dutch VFC review protocol on secondary healthcare utilization (i.e., follow-up appointments and imaging) in adult trauma patients (aged ≥18 years) who underwent semi-acute surgery (2-14 days after initial presentation) for MIE, compared to traditional workflows. We hypothesized utilization of VFC review would lead to reduced secondary healthcare utilization. Methods: This retrospective cohort study assessed the influence of VFC review on secondary healthcare utilization in adult trauma patients (aged ≥18 years) who underwent semi-acute surgery for a MIE. Patients treated before VFC review and the COVID-19 pandemic, from 1st of July 2018 to 31st of December 2019, formed a pre-VFC group. Patients treated after VFC review implementation from January 1st 2021 to June 30th 2022, partially during and after the COVID-19 pandemic (including distancing measures), formed a VFC group. Outcomes were follow-up appointments, radiographic imaging, time to surgery, emergency department reattendances, and complications. The study was approved by the local ethical research committee approved this study (WO 23.073). Results: In total, 2,682 patients were included, consisting of 1,277 pre-VFC patients, and 1,405 VFC patients. Following VFC review, the total number of follow-up appointments reduced by 21% and a shift from face-to-face towards telephone consultations occurred with 19% of follow-up appointments performed by telephone in the VFC group vs. 4% in the pre-VFC group. Additionally, VFC review resulted in a 7% reduction of radiographs, improved time scheduling of surgery, and a 56% reduction of emergency department reattendances. Registered complication rates remained similar. Conclusion: The utilization of VFC review for management of adult patients with a MIE requiring semi-acute surgery improves efficiency compared to traditional workflows. It results in a 21% follow-up appointment reduction, a shift from face-to-face to remote delivery of care, fewer radiographs, improved time scheduling of surgery, and reduces emergency department reattendances by 56%.

[Clinical characteristics analysis of 4 cases with acute flaccid myelitis in children].

Objective: To summarize the clinical manifestations, diagnosis, treatment and prognosis of acute flaccid myelitis (AFM) in children. Methods: Clinical characteristics of 4 AFM cases from Department of Neurology, Children's Hospital Affiliated to Capital Institute of Pediatrics, from September 2018 to November 2022, were analyzed retrospectively. Results: The age of 4 children with AFM was 7 years, 4 years and 3 months, 7 years and 1 month, 6 years and 5 months, respectively. There were 2 boys and 2 girls. Prodromal infection status showed 3 children of respiratory tract infection and 1 child of digestive tract infection. The main manifestation was asymmetrical limb weakness after infection, and the affected limb range was from monoplegia to quadriplegia. Cranial nerve injury was involved in 1 child, no encephalopathy. Magnetic resonance imaging in the spinal cord of all 4 children showed long T1 and T2 signals, mainly involving gray matter. Cerebrospinal fluid cell-protein separation was observed in 2 children. Pathogen detected in 1 child pharyngeal swab was enterovirus D68. Antibody IgM to adenovirus was positive in the blood of 1 child. Antibody IgG against Echo and Coxsackie B virus were positive in the blood of another child. After glucocorticoid, human immunoglobulin or simple symptomatic treatment and at the same time under later rehabilitation training, muscle strength recovered to different degrees, but there were disabilities left in 3 children. Conclusions: AFM should be considered in children with acute and asymmetrical flaccid paralysis accompanied by abnormal magnetic resonance imaging signal in the central region of spinal cord, especially post-infection. The effective treatment is limited and the prognosis is poor.

3D Printed Interdigitated Electrodes for Cardiac Biomarker Detection.

The identification of biomarkers has significant benefits for early disease diagnosis and treatment. Hence, there is an increasing demand for low-cost, disposable point-of-care diagnostic devices for rapid and specific biomarker detection, with good sensitivity and range. Interdigitated electrodes (IDEs) are among the most widely used transducers, especially in chemical and biological sensors, because of their high sensitivity, low cost, and straightforward manufacturing procedure. In this work, a simple 3D printed IDE structure has been developed for cardiac troponin I detection to indicate the risk of acute myocardial infarction (AMI). IDEs have been fabricated using 3D printing technique and the electrically conductive composite polylactic acid (PLA) filament being utilized for the fabrication of electrodes. The demonstrated cardiac troponin I sensor has a calculated quantification limit and detection limit of 0.233 ng ml-1 and 76.97 pg ml-1, respectively which are clinically significant ranges for AMI identification. Electrochemical analytical techniques, such as electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV), were carried out for the detection of analyte concentration. Furthermore, using this fabrication methodology IDEs can be fabricated for under US$ 0.4 which can be utilized to detect several other biomarkers.

[To assess the effectiveness of treatment methods for patients of different age groups with basal cell cancer of the skin of the nose and ears].

The relevance of the problems of diagnosis and treatment of skin cancer is currently determined not only by the high incidence rate, but by the existing difficulties in differential diagnosis and treatment with traditional methods. For localizations of basal cell skin cancer (BCSC) that are "inconvenient" for treatment, such as the external auditory canal, auricle, and wing of the nose, treatment is associated with certain difficulties and the possible appearance of a cosmetic defect, therefore, when choosing a treatment method, the anatomical features of these organs are taken into account. It has been determined that the effectiveness of treatment for primary BCSC of the nose and auricles is higher than recurrent one, and among the various treatment methods, the most effective and radical is the surgical method. The immediate results of treatment of BCSC in the form of PR by surgical method were 86.7%, which is statistically significant compared with other types of treatment (p < 0.05). Long-term treatment results with the surgical method are also higher (77%) compared to other methods, which is also statistically significant (p < 0.05).

[A healthy lifestyle of students is a resource for preserving the health of the working-age population in the near future].

The issues of acceptance and support of a healthy lifestyle by various social and age groups of the population, especially among the younger generation and youth, through the pursuit of physical, mental and social well-being remain relevant. Educational organizations, including universities, are important actors in this direction, since their students will soon become leaders in society, decision makers, as well as parents of tomorrow. According to scientists, a weak attitude towards sports, lack of time for physical education lead to a vicious circle of focusing on intellectual education, high knowledge scores, low physical abilities and physical fitness. It is emphasized that universities should have organizational systems for managing educational materials, teaching staff, as well as technologies to improve learning processes through a technology platform. Universities are strategic places to launch a wellness campaign and «have conversations¼ about healthy lifestyles and sustainable development.

The Value of Routine Radiography in the Non-operative Treatment of Metatarsal Fractures: a Retrospective Cohort Study.

Although widely used in follow-up treatment protocols, the added value of routine radiographs to clinical decision-making in non-operative treatment of patients with metatarsal fractures is unclear. This retrospective cohort study aimed to determine whether routine follow-up radiographs contributed to changes in treatment strategies in non-operative treatment of patients with a metatarsal fracture. Adult (aged≥18 years) patients who received non-operative follow-up treatment for a metatarsal fracture between May 1st, 2020 and May 2nd, 2022 were included. All relevant data were extracted from patient records. Radiographs without a documented clinical indication were classified as routine. Outcomes included changes in treatment strategies based on routine radiographs during follow-up treatment and secondarily, changes in treatment strategy based on clinically indicated radiographs. A total of 168 patients were included, with 135 single and 33 multiple metatarsal fractures. During follow-up, 223 radiographs were performed, of which 154 (69%) were routine and 69 (31%) were on clinical indication. Of routine radiographs, nine (6%) led to a change in treatment which only included additional imaging. No switch to operative treatment or prolonging of immobilization was observed based on routine radiographs. Of clinically indicated radiographs, 16 (23%) led to a change of treatment, including prolonged immobilization (n=2), additional follow-up appointments (n=1) and additional imaging (n=12). Our results show routinely performed radiographs seldom affect treatment strategies in non-operative treatment of metatarsal fractures, indicating minimal added value to clinical decision-making. Omitting routine radiographs from treatment protocols may contribute to the reduction of unnecessary healthcare resource utilization in clinical practice. Level of Clinical Evidence: 3.

Controlling Drug Partitioning in Individual Protein Condensates through Laser-Induced Microscale Phase Transitions.

Gelation of protein condensates formed by liquid-liquid phase separation occurs in a wide range of biological contexts, from the assembly of biomaterials to the formation of fibrillar aggregates, and is therefore of interest for biomedical applications. Soluble-to-gel (sol-gel) transitions are controlled through macroscopic processes such as changes in temperature or buffer composition, resulting in bulk conversion of liquid droplets into microgels within minutes to hours. Using microscopy and mass spectrometry, we show that condensates of an engineered mini-spidroin (NT2repCTYF) undergo a spontaneous sol-gel transition resulting in the loss of exchange of proteins between the soluble and the condensed phase. This feature enables us to specifically trap a silk-domain-tagged target protein in the spidroin microgels. Surprisingly, laser pulses trigger near-instant gelation. By loading the condensates with fluorescent dyes or drugs, we can control the wavelength at which gelation is triggered. Fluorescence microscopy reveals that laser-induced gelation significantly further increases the partitioning of the fluorescent molecules into the condensates. In summary, our findings demonstrate direct control of phase transitions in individual condensates, opening new avenues for functional and structural characterization.

Uterine cancer restaging according to the updated 2023 FIGO Guidelines does not uniformly affect prognosis: An institutional retrospective cohort study.

OBJECTIVE: Efforts have been made to better risk stratify patients given the rise in incidence of endometrial cancer (EC). The 2023 FIGO staging now incorporates histologic subtype and molecular classification into determination of EC stage. We sought to elucidate if the new staging system demonstrated prognostic differences compared to the 2009 staging system. METHODS: A retrospective chart review was performed on women treated for EC at our institution from September 2013 to May 2023 and combined with the publicly available TCGA Nature 2013 dataset. Detailed clinical information was captured. Patients were restaged according to the 2023 guidelines. Survival estimates were obtained using Kaplan-Meier method, and the log-rank test was used to compare survival curves for progression-free survival (PFS). RESULTS: 919 patients were included in our analysis. The datasets were comparable regarding histologic grade, stage, and age at diagnosis. 175 (31.5%) of patients in the institution dataset and 115 (31.6%) patients in the TCGA dataset experienced a stage change. Most patients whose stage changed were upstaged (275/290; 94.8%). 3-year PFS estimates for stage IA patients with no stage change versus those upstaged were 92.3% (95% CI: 87.2, 95.4) v. 72.0% (95% CI: 68.4, 84.9), p = 0.002. No significant differences in survival difference were seen in other stage subsets. CONCLUSION: Modest survival differences exist in patients with EC originally staged as IA who underwent upstaging. No significant survival difference is observed in patients who are restaged to stage II or III subsets. Improved risk stratification is needed in assessing prognosis and adjuvant therapy for patients with endometrial cancer.

[The Eurasian strategy of production of organic foodstuffs from position of economic sustainability and population health support: The publications review].

The article presents information reflecting current consideration of strategy of food production from position of of economic sustainability, ensuring population health through compliance of principles of food safety, accessibility and quality improvement. The organic food industry with systems of production, processing, distribution and retailing develops since the 1940s and has huge impact on strategies of food consumption by population, especially in high-income countries. The priorities, goals and objectives of development of organic production in the Russian Federation are targeted to ensure favorable state of environment and preservation of human health.

Bringing online adaptive radiotherapy to a standard C-arm linac.

Current online adaptive radiotherapy (oART) workflows require dedicated equipment. Our aim was to develop and implement an oART workflow for a C-arm linac which can be performed using standard clinically available tools. A workflow was successfully developed and implemented. Three patients receiving palliative radiotherapy for bladder cancer were treated, with 33 of 35 total fractions being delivered with the cone-beam computed tomography (CBCT)-guided oART workflow. Average oART fraction duration was 24 min from start of CBCT acquisition to end of beam on. This work shows how oART could be performed without dedicated equipment, broadening oART availability for application at existing treatment machines.

Microglia mediate the early-life programming of adult glucose control.

Mammalian glucose homeostasis is, in part, nutritionally programmed during early neonatal life, a critical window for the formation of synapses between hypothalamic glucoregulatory centers. Although microglia are known to prune synapses throughout the brain, their specific role in refining hypothalamic glucoregulatory circuits remains unknown. Here, we show that microglia in the mediobasal hypothalamus (MBH) of mice actively engage in synaptic pruning during early life. Microglial phagocytic activity is induced following birth, regresses upon weaning from maternal milk, and is exacerbated by feeding dams a high-fat diet while lactating. In particular, we show that microglia refine perineuronal nets (PNNs) within the neonatal MBH. Indeed, transiently depleting microglia before weaning (P6-16), but not afterward (P21-31), remarkably increased PNN abundance in the MBH. Furthermore, mice lacking microglia only from P6-16 had glucose intolerance due to impaired glucose-responsive pancreatic insulin secretion in adulthood, a phenotype not seen if microglial depletion occurred after weaning. Viral retrograde tracing revealed that this impairment is linked to a reduction in the number of neurons in specific hypothalamic glucoregulatory centers that synaptically connect to the pancreatic ß-cell compartment. These findings show that microglia facilitate synaptic plasticity in the MBH during early life through a process that includes PNN refinement, to establish hypothalamic circuits that regulate adult glucose homeostasis.

Diabetes mellitus, hearing loss, and therapeutic interventions: A systematic review of insights from preclinical animal models.

OBJECTIVES: The aim of this systematic review article is to evaluate the relationship between diabetes mellitus (DM) and sensorineural hearing loss (SNHL) utilizing preclinical animal models. The review focused on studies assessing SNHL in diabetic animal models, elucidating the mechanisms of DM-associated SNHL, and exploring the response of diabetic animal models to noise overexposure. We also discussed studies investigating the efficacy of potential therapeutic strategies for amelioration of DM-associated SNHL in the animal models. METHODS: A protocol of this systematic review was designed a priori and was registered in the PROSPERO database (registration number: CRD42023439961). We conducted a comprehensive search on PubMed, Science Direct, Web of Science, Scopus, and EMBASE databases. A minimum of three reviewers independently screened, selected, and extracted data. The risk of bias assessment of eligible studies was conducted using the Systematic Review Center for Laboratory Animal Experimentation (SYRCLE) tool. RESULTS: Following the screening of 238 studies, twelve original articles were included in this systematic review. The studies revealed that hyperglycemia significantly affects auditory function, with various pathological mechanisms contributing to DM-induced hearing impairment, including cochlear synaptopathy, microangiopathy, neuropathy, oxidative stress, mitochondrial abnormalities, and apoptosis-mediated cell death. Emerging interventions, such as Asiaticoside, Trigonelline, Chlorogenic acid, and Huotanquyu granules, demonstrated efficacy in providing otoprotection for preserving cochlear hair cells and hearing function. CONCLUSIONS: Our systematic review delves into the intricate relationship between DM and hearing impairment in animal models. Future research should focus on targeted therapies to enhance cochlear mitochondrial function, alleviate oxidative stress, and regulate apoptosis. The association between SNHL and social isolation as well as cognitive decline underscores the necessity for innovative therapeutic modalities addressing yet undiscovered mechanisms. Translating findings from animal models to human studies will validate these findings, offering a synergistic approach to effectively manage DM-associated co-morbidities such as hearing impairment.

A review of the role of testosterone in the care of the critically ill patient.

Background: Testosterone is an anabolic and androgenic steroid hormone therapeutically used to produce male sex characteristics. It has also been shown to have a modulating effect on proinflammatory biomarkers. Critical illness is characterised by a proinflammatory and catabolic state and is accompanied by altered testosterone production, which may persist into the recovery phase. Testosterone may, therefore be a potential therapeutic option in critical illness. This paper reviews normal testosterone physiology, and the changes seen during critical illness and systematically reviews testosterone therapy during both the acute and chronic phases of critical illness. Contribution of the study: This article explains the pathophysiology of testosterone during critical illness and explores the therapeutic value of testosterone in the management of critically ill patients.

Balancing Expectations: Navigating Medically Necessary Torso Procedures with Cosmetic Components in the Military Healthcare System.

Background: Surgeons performing federal insurance-financed procedures involving medically necessary and cosmetic components must navigate patient expectations to avoid postoperative disappointment. This challenge is amplified in military healthcare, where different surgical specialties concurrently address the same diagnosis, while the Department of Defense policy on cosmetic fees and TRICARE's definition of excluded services adds further complexity. With the increasing prevalence of elevated body mass index, focus is directed toward diagnoses involving the torso, specifically gynecomastia in male individuals, and diastasis of the rectus abdominis muscles (DRAM) in female individuals. Methods: The study involves a team of experienced board-certified surgeons conducting a narrative review of surgical procedures addressing gynecomastia and DRAM. Relevant literature from 2000 to 2023 is reviewed, focusing on patient satisfaction regarding outcome of medically necessary and cosmetic aspects. Results: For gynecomastia, distinguishing between true and pseudogynecomastia is critical. A protocol is presented based on the Simon classification, offering evidence-based guidelines for surgical interventions. Similarly, for DRAM, a minimally invasive approach balances deployment readiness and surgical recovery. The presence of a symptomatic panniculus, however, requires more invasive intervention. The downstream ramification of limited Current Procedural Terminology codes for these interventions is discussed. Conclusions: In medically necessary procedures funded through federal health plans such as TRICARE, the primary goal is functional improvement, not the final torso contour. Clear communication and preoperative counseling are crucial to managing patient expectations. Providers in military healthcare must navigate the complex landscape of patient expectations, policy guidelines, and duty readiness while maintaining the standard of care.

A dual-track feature fusion model utilizing Group Shuffle Residual DeformNet and swin transformer for the classification of grape leaf diseases.

Grape cultivation is important globally, contributing to the agricultural economy and providing diverse grape-based products. However, the susceptibility of grapes to disease poses a significant threat to yield and quality. Traditional disease identification methods demand expert knowledge, which limits scalability and efficiency. To address these limitations our research aims to design an automated deep learning approach for grape leaf disease detection. This research introduces a novel dual-track network for classifying grape leaf diseases, employing a combination of the Swin Transformer and Group Shuffle Residual DeformNet (GSRDN) tracks. The Swin Transformer track exploits shifted window techniques to construct hierarchical feature maps, enhancing global feature extraction. Simultaneously, the GSRDN track combines Group Shuffle Depthwise Residual block and Deformable Convolution block to extract local features with reduced computational complexity. The features from both tracks are concatenated and processed through Triplet Attention for cross-dimensional interaction. The proposed model achieved an accuracy of 98.6%, the precision, recall, and F1-score are recorded as 98.7%, 98.59%, and 98.64%, respectively as validated on a dataset containing grape leaf disease information from the PlantVillage dataset, demonstrating its potential for efficient grape disease classification.

Control of proton transport and hydrogenation in double-gated graphene.

The basal plane of graphene can function as a selective barrier that is permeable to protons1,2 but impermeable to all ions3,4 and gases5,6, stimulating its use in applications such as membranes1,2,7,8, catalysis9,10 and isotope separation11,12. Protons can chemically adsorb on graphene and hydrogenate it13,14, inducing a conductor-insulator transition that has been explored intensively in graphene electronic devices13-17. However, both processes face energy barriers1,12,18 and various strategies have been proposed to accelerate proton transport, for example by introducing vacancies4,7,8, incorporating catalytic metals1,19 or chemically functionalizing the lattice18,20. But these techniques can compromise other properties, such as ion selectivity21,22 or mechanical stability23. Here we show that independent control of the electric field, E, at around 1 V nm-1, and charge-carrier density, n, at around 1 × 1014 cm-2, in double-gated graphene allows the decoupling of proton transport from lattice hydrogenation and can thereby accelerate proton transport such that it approaches the limiting electrolyte current for our devices. Proton transport and hydrogenation can be driven selectively with precision and robustness, enabling proton-based logic and memory graphene devices that have on-off ratios spanning orders of magnitude. Our results show that field effects can accelerate and decouple electrochemical processes in double-gated 2D crystals and demonstrate the possibility of mapping such processes as a function of E and n, which is a new technique for the study of 2D electrode-electrolyte interfaces.

An EEG study on artistic and engineering mindsets in students in creative processes.

This study aims to take higher-education students as examples to understand and compare artistic and engineering mindsets in creative processes using EEG. Fifteen Master of Fine Arts (MFA) visual arts and fifteen Master of Engineering (MEng) design engineering students were recruited and asked to complete alternative uses tasks wearing an EEG headset. The results revealed that (1) the engineering-mindset students responded to creative ideas faster than artistic-mindset students. (2) Although in creative processes both artistic- and engineering-mindset students showed Theta, Alpha, and Beta wave activity, the active brain areas are slightly different. The active brain areas of artistic-mindset students in creative processes are mainly in the frontal and occipital lobes; while the whole brain (frontal, oriental, temporal, and occipital lobes) was active in creative processes of engineering-mindset students. (3) During the whole creative process, the brain active level of artistic-mindset students was higher than that of engineering-mindset students. The results of this study fills gaps in existing research where only active brain areas and band waves were compared between artistic- and engineering-mindset students in creative processes. For quick thinking in terms of fluency of generating creative ideas, engineering students have an advantage in comparison to those from the visual arts. Also, the study provided more evidence that mindset can affect the active levels of the brain areas. Finally, this study provides educators with more insights on how to stimulate students' creative ability.

Spatial Multi-omics Reveals the Role of the Wnt Modulator, Dkk2, in Palatogenesis'.

Multiple genetic and environmental etiologies contribute to the pathogenesis of cleft palate, which is the most common of the inherited disorders of the craniofacial complex. Insights into the molecular mechanisms regulating osteogenic differentiation and patterning in the palate during embryogenesis are limited and needed for the development of innovative diagnostics and cures. This study used the Pax9-/- mouse model with a consistent phenotype of cleft secondary palate to investigate the role of Pax9 in the process of palatal osteogenesis. Although prior research has identified the upregulation of Wnt pathway modulators Dkk1 and Dkk2 in Pax9-/- palate mesenchyme, limitations of spatial resolution and technology restricted a more robust analysis. Here, data from single-nucleus transcriptomics and chromatin accessibility assays validated by in situ highly multiplex targeted single-cell spatial profiling technology suggest a distinct relationship between Pax9+ and osteogenic populations. Loss of Pax9 results in spatially restricted osteogenic domains bounded by Dkk2, which normally interfaces with Pax9 in the mesenchyme. Moreover, the loss of Pax9 leads to a disruption in the normal osteodifferentiaion of palatal osteogenic mesenchymal cells. These results suggest that Pax9-dependent Wnt signaling modulators influence osteogenic programming during palate formation, potentially contributing to the observed cleft palate phenotype.