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Critical Care (London, England) Oct 2023Although the defining elements of "acute respiratory distress syndrome" (ARDS) have been known for over a century, the syndrome was first described in 1967. Since then,... (Review)
Review
Although the defining elements of "acute respiratory distress syndrome" (ARDS) have been known for over a century, the syndrome was first described in 1967. Since then, despite several revisions of its conceptual definition, it remains a matter of debate whether ARDS is a discrete nosological entity. After almost 60 years, it is appropriate to examine how critical care has modeled this fascinating syndrome and affected patient's outcome. Given that the diagnostic criteria of ARDS (e.g., increased pulmonary vascular permeability and diffuse alveolar damage) are difficult to ascertain in clinical practice, we believe that a step forward would be to standardize the assessment of pulmonary and extrapulmonary involvement in ARDS to ensure that each patient can receive the most appropriate and effective treatment. The selection of treatments based on arbitrary ranges of PaO/FiO lacks sufficient sensitivity to individualize patient care.
Topics: Humans; Respiratory Distress Syndrome; Lung; Treatment Outcome; Critical Care
PubMed: 37907946
DOI: 10.1186/s13054-023-04699-w -
Advanced Materials (Deerfield Beach,... Dec 2023Due to their superior mechanical properties, 2D materials have gained interest as active layers in flexible devices co-integrating electronic, photonic, and...
Due to their superior mechanical properties, 2D materials have gained interest as active layers in flexible devices co-integrating electronic, photonic, and straintronic functions altogether. To this end, 2D bendable membranes compatible with the technological process standards and endowed with large-scale uniformity are highly desired. Here, it is reported on the realization of bendable membranes based on silicene layers (the 2D form of silicon) by means of a process in which the layers are fully detached from the native substrate and transferred onto arbitrary flexible substrates. The application of macroscopic mechanical deformations induces a strain-responsive behavior in the Raman spectrum of silicene. It is also shown that the membranes under elastic tension relaxation are prone to form microscale wrinkles displaying a local generation of strain in the silicene layer consistent with that observed under macroscopic mechanical deformation. Optothermal Raman spectroscopy measurements reveal a curvature-dependent heat dispersion in silicene wrinkles. Finally, as compelling evidence of the technological potential of the silicene membranes, it is demonstrated that they can be readily introduced into a lithographic process flow resulting in the definition of flexible device-ready architectures, a piezoresistor, and thus paving the way to a viable advance in a fully silicon-compatible technology framework.
PubMed: 37148127
DOI: 10.1002/adma.202211419 -
Journal of Clinical Medicine Oct 2023Insulin resistance (IR) is a rather common condition that is often diagnosed on the basis of an arbitrary "increased insulin value" or the presence of symptoms...
Insulin resistance (IR) is a rather common condition that is often diagnosed on the basis of an arbitrary "increased insulin value" or the presence of symptoms indicative of the Metabolic Syndrome [...].
PubMed: 37835038
DOI: 10.3390/jcm12196394 -
Maturitas Dec 2023Late-onset hypogonadism is the clinical entity characterised by low testosterone concentrations associated with clinical symptoms in the absence of organic disease in...
INTRODUCTION
Late-onset hypogonadism is the clinical entity characterised by low testosterone concentrations associated with clinical symptoms in the absence of organic disease in ageing men. It has been associated with metabolic syndrome, reduced bone mineral density, and increased cardiovascular morbidity and mortality risk. Although testosterone replacement therapy (TRT) reverses most of these conditions in young hypogonadal men, the risk/benefit ratio of TRT in older men is debatable.
AIM
To update the 2015 EMAS statement on TRT in older men with new research on late-onset hypogonadism and TRT.
MATERIALS AND METHODS
Literature review and consensus of expert opinion.
SUMMARY RECOMMENDATIONS
TRT should be offered only to symptomatic older men with confirmed low testosterone concentrations after explaining the uncertainties regarding the long-term safety of this treatment. TRT may be offered to men with severe hypogonadism and erectile dysfunction to improve sexual desire, erectile, and orgasmic function. It should also be considered in hypogonadal men with severe insulin resistance or pre-diabetes mellitus. TRT may also be considered, in combination with proven treatment strategies, for osteoporosis, or for selected patients with persistent mild depressive symptoms and/or low self-perceived quality of life, combined with standard medical care for each condition. TRT is contraindicated in hypogonadal men actively seeking fertility treatment. Due to a lack of data, TRT should not be routinely used in older men to improve exercise capacity/physical function, improve cognitive function, or prevent cognitive decline. TRT must be avoided in older, frail men with known breast cancer or untreated prostate cancer and all men who have had myocardial infarction or stroke within the last four months, and those with severe or decompensated heart failure. The quality of evidence regarding patients with previous prostate cancer or cardiovascular disease is too low to draw definitive conclusions. Any limits on duration of use are arbitrary, and treatment should continue for as long as the man feels the benefits outweigh the risks for him, and decisions must be made on an individual basis. Withdrawal should be considered when hypogonadism is reversed after the resolution of underlying disorder. Short-acting transdermal preparations should be preferred for TRT initiation in older men, but injectable forms may be considered subsequently. Older men on TRT should be monitored at 3, 6, and 12 months after initiation and at least yearly thereafter, or earlier and more frequently if indicated. Evaluation should include assessment of the clinical response, and measurement of total testosterone, haematocrit, and prostate-specific antigen (PSA) concentrations. Bone density and/or quality should also be assessed. Obese and overweight patients should be encouraged to undergo lifestyle modifications, including exercise and weight loss, to increase endogenous testosterone.
Topics: Male; Humans; Aged; Quality of Life; Testosterone; Hypogonadism; Erectile Dysfunction; Prostatic Neoplasms; Hormone Replacement Therapy
PubMed: 37845136
DOI: 10.1016/j.maturitas.2023.107854 -
Trials Oct 2023In this commentary, we discuss a recent article in Trials that raised concerns about the number of poorly performed randomised trials in the medical literature and...
In this commentary, we discuss a recent article in Trials that raised concerns about the number of poorly performed randomised trials in the medical literature and discuss the trials literature more widely. Although we all aim for higher methodological standards in trials, we argue that (i) the idea that 'most randomised trials are bad', which the recent article concludes is an overly simplistic representation of the situation, and (ii) the suggestion that an increased focus on methodological review during trial development (e.g. ethical boards performing some assessment of the methodologists on a trial), while well meaning, may have negative unintended consequences. We therefore propose that (a) trials should be assessed on their merits and weaknesses, including an assessment of risk of bias but placing that in a wider context; (b) we should recognise that although the methodological conduct of trials is of utmost importance, interventions that aim to improve this could have unintended consequences-such as bureaucracy-that have an overall negative effect; and (c) we should therefore generate an evidence base for policy interventions to improve conduct of trials rather than applying arbitrary rules.
Topics: Humans; Bias; Randomized Controlled Trials as Topic; Research Design
PubMed: 37864198
DOI: 10.1186/s13063-023-07706-1 -
Optics Express Sep 2023A group-delay-unit-based integrated silicon photonic integrated circuit (PIC) is employed as a reconfigurable analog radio frequency decoder, which provides a real-time...
A group-delay-unit-based integrated silicon photonic integrated circuit (PIC) is employed as a reconfigurable analog radio frequency decoder, which provides a real-time temporal and spectral analysis of any arbitrary multi-tone signal in the micro- and mm-wave range. The circuit is based on cascaded Mach-Zehnder interferometer embedded silicon microring resonators as variable delay units. The temporal decoding of the multi-tone input signal is demonstrated by tuning the signal with respect to the ring resonator delay and resonance. A one-to-one conformal time-to-frequency mapping provides real-time spectral decoding of the signal under test without additional digital signal processing. The idea is validated by several experimental results with single-tone and two-tone input signals in a compact, low-power, silicon PIC. The proposed real-time temporal analog frequency decoder may be very intriguing for high-speed, low-latency wireless applications, such as autonomous driving and 6G.
PubMed: 37710564
DOI: 10.1364/OE.494674 -
AACN Advanced Critical Care Dec 2023Measuring hemodynamic parameters has become safer and more precise than in the past. Accurately monitoring and evaluating the effectiveness of fluid, inotrope, and...
Measuring hemodynamic parameters has become safer and more precise than in the past. Accurately monitoring and evaluating the effectiveness of fluid, inotrope, and vasoactive medication administration can improve patient outcomes. Arbitrary fluid administration without stroke volume measurement can be detrimental to patient outcomes. Early detection and prompt treatment of shock states is essential to combat deleterious effects on critically ill patients. In addition to measuring traditional hemodynamic variables, the use of advanced variables such as hypotension prediction index, dynamic arterial elastance, and systolic slope can improve the precision of treat ment for critically ill patients. Using predictive analytics can help the bedside critical care nurse provide patient care that is proactive rather than reactive.
Topics: Humans; Hemodynamic Monitoring; Critical Illness; Hemodynamics; Shock; Critical Care; Monitoring, Physiologic
PubMed: 38033220
DOI: 10.4037/aacnacc2023903 -
Nature Communications Oct 2023Dispersion decomposes compound light into its monochromatic components, which is detrimental to broadband imaging but advantageous for spectroscopic applications....
Dispersion decomposes compound light into its monochromatic components, which is detrimental to broadband imaging but advantageous for spectroscopic applications. Metasurfaces provide a unique path to modulate the dispersion by adjusting structural parameters on a two-dimensional plane. However, conventional linear phase compensation does not adequately match the meta-unit's dispersion characteristics with required complex dispersion, hindering at-will dispersion engineering over a very wide bandwidth particularly. Here, we propose an asymptotic phase compensation strategy for ultra-broadband dispersion-controlled metalenses. Metasurfaces with extraordinarily high aspect ratio nanostructures have been fabricated for arbitrary dispersion control in ultra-broad bandwidth, and we experimentally demonstrate the single-layer achromatic metalenses in the visible to infrared spectrum (400 nm~1000 nm, NA = 0.164). Our proposed scheme provides a comprehensive theoretical framework for single-layer meta-optics, allowing for arbitrary dispersion manipulation without bandwidth restrictions. This development is expected to have significant applications in ultra-broadband imaging and chromatography detection, among others.
PubMed: 37863896
DOI: 10.1038/s41467-023-42268-5 -
Nature Human Behaviour Jun 2024A long-standing engineering ambition has been to design anthropomorphic bionic limbs: devices that look like and are controlled in the same way as the biological body...
A long-standing engineering ambition has been to design anthropomorphic bionic limbs: devices that look like and are controlled in the same way as the biological body (biomimetic). The untested assumption is that biomimetic motor control enhances device embodiment, learning, generalization and automaticity. To test this, we compared biomimetic and non-biomimetic control strategies for non-disabled participants when learning to control a wearable myoelectric bionic hand operated by an eight-channel electromyography pattern-recognition system. We compared motor learning across days and behavioural tasks for two training groups: biomimetic (mimicking the desired bionic hand gesture with biological hand) and arbitrary control (mapping an unrelated biological hand gesture with the desired bionic gesture). For both trained groups, training improved bionic limb control, reduced cognitive reliance and increased embodiment over the bionic hand. Biomimetic users had more intuitive and faster control early in training. Arbitrary users matched biomimetic performance later in training. Furthermore, arbitrary users showed increased generalization to a new control strategy. Collectively, our findings suggest that biomimetic and arbitrary control strategies provide different benefits. The optimal strategy is probably not strictly biomimetic, but rather a flexible strategy within the biomimetic-to-arbitrary spectrum, depending on the user, available training opportunities and user requirements.
Topics: Humans; Hand; Biomimetics; Bionics; Adult; Learning; Male; Female; Motor Skills; Young Adult; Electromyography
PubMed: 38499772
DOI: 10.1038/s41562-023-01811-6