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Frontiers in Immunology 2024Despite advances in surgical and therapeutic approaches, high-grade serous ovarian carcinoma (HGSOC) prognosis remains poor. Surgery is an indispensable component of...
Despite advances in surgical and therapeutic approaches, high-grade serous ovarian carcinoma (HGSOC) prognosis remains poor. Surgery is an indispensable component of therapeutic protocols, as removal of all visible tumor lesions (cytoreduction) profoundly improves the overall survival. Enhanced predictive tools for assessing cytoreduction are essential to optimize therapeutic precision. Patients' immune status broadly reflects the tumor cell biological behavior and the patient responses to disease and treatment. Serum cytokine profiling is a sensitive measure of immune adaption and deviation, yet its integration into treatment paradigms is underexplored. This study is part of the IMPACT trial (NCT03378297) and aimed to characterize immune responses before and during primary treatment for HGSOC to identify biomarkers for treatment selection and prognosis. Longitudinal serum samples from 22 patients were collected from diagnosis until response evaluation. Patients underwent primary cytoreductive surgery or neoadjuvant chemotherapy (NACT) based on laparoscopy scoring. Twenty-seven serum cytokines analyzed by Bio-Plex 200, revealed two immune phenotypes at diagnosis: Immune High with marked higher serum cytokine levels than Immune Low. The immune phenotypes reflected the laparoscopy scoring and allocation to surgical treatment. The five Immune High patients undergoing primary cytoreductive surgery exhibited immune mobilization and extended progression-free survival, compared to the Immune Low patients undergoing the same treatment. Both laparoscopy and cytoreductive surgery induced substantial and transient changes in serum cytokines, with upregulation of the inflammatory cytokine IL-6 and downregulation of the multifunctional cytokines IP-10, Eotaxin, IL-4, and IL-7. Over the study period, cytokine levels uniformly decreased in all patients, leading to the elimination of the initial immune phenotypes regardless of treatment choice. This study reveals distinct pre-treatment immune phenotypes in HGSOC patients that might be informative for treatment stratification and prognosis. This potential novel biomarker holds promise as a foundation for improved assessment of treatment responses in patients with HGSOC. ClinicalTrials.gov Identifier: NCT03378297.
Topics: Humans; Female; Ovarian Neoplasms; Cystadenocarcinoma, Serous; Cytokines; Middle Aged; Aged; Neoadjuvant Therapy; Phenotype; Cytoreduction Surgical Procedures; Biomarkers, Tumor; Neoplasm Grading; Prognosis; Treatment Outcome; Adult
PubMed: 38947323
DOI: 10.3389/fimmu.2024.1394497 -
Frontiers in Psychiatry 2024Forensic psychiatric patients receive treatment to address their violent and aggressive behavior with the aim of facilitating their safe reintegration into society. On...
INTRODUCTION
Forensic psychiatric patients receive treatment to address their violent and aggressive behavior with the aim of facilitating their safe reintegration into society. On average, these treatments are effective, but the magnitude of effect sizes tends to be small, even when considering more recent advancements in digital mental health innovations. Recent research indicates that wearable technology has positive effects on the physical and mental health of the general population, and may thus also be of use in forensic psychiatry, both for patients and staff members. Several applications and use cases of wearable technology hold promise, particularly for patients with mild intellectual disability or borderline intellectual functioning, as these devices are thought to be user-friendly and provide continuous daily feedback.
METHOD
In the current randomized crossover trial, we addressed several limitations from previous research and compared the (continuous) usability and acceptance of four selected wearable devices. Each device was worn for one week by staff members and patients, amounting to a total of four weeks. Two of the devices were general purpose fitness trackers, while the other two devices used custom made applications designed for bio-cueing and for providing insights into physiological reactivity to daily stressors and events.
RESULTS
Our findings indicated significant differences in usability, acceptance and continuous use between devices. The highest usability scores were obtained for the two fitness trackers (Fitbit and Garmin) compared to the two devices employing custom made applications (Sense-IT and E4 dashboard). The results showed similar outcomes for patients and staff members.
DISCUSSION
None of the devices obtained usability scores that would justify recommendation for future use considering international standards; a finding that raises concerns about the adaptation and uptake of wearable technology in the context of forensic psychiatry. We suggest that improvements in gamification and motivational aspects of wearable technology might be helpful to tackle several challenges related to wearable technology.
PubMed: 38947186
DOI: 10.3389/fpsyt.2024.1330993 -
Research Square Jun 2024Background Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in...
Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac...
Background Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the United States. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established. Methods This study is a multi-center randomized, response-adaptive, duration (dose) finding, comparative effectiveness clinical trial with blinded outcome assessment. We investigate two populations of adult comatose survivors of cardiac arrest to ascertain the shortest duration of cooling that provides the maximum treatment effect. The design is based on a statistical model of response as defined by the primary endpoint, a weighted 90-day mRS (modified Rankin Scale, a measure of neurologic disability), across the treatment arms. Subjects will initially be equally randomized between 12, 24, and 48 hours of therapeutic cooling. After the first 200 subjects have been randomized, additional treatment arms between 12 and 48 hours will be opened and patients will be allocated, within each initial cardiac rhythm type (shockable or non-shockable), by response adaptive randomization. As the trial continues, shorter and longer duration arms may be opened. A maximum sample size of 1800 subjects is proposed. Secondary objectives are to characterize: the overall safety and adverse events associated with duration of cooling, the effect on neuropsychological outcomes, and the effect on patient reported quality of life measures. Discussion In-vitro and in-vivo studies have shown the neuroprotective effects of therapeutic hypothermia for cardiac arrest. We hypothesize that longer durations of cooling may improve either the proportion of patients that attain a good neurological recovery or may result in better recovery among the proportion already categorized as having a good outcome. If the treatment effect of cooling is increasing across duration, for at least some set of durations, then this provides evidence of the efficacy of cooling itself versus normothermia, even in the absence of a normothermia control arm, confirming previous RCTs for OHCA survivors of shockable rhythms and provides the first prospective controlled evidence of efficacy in those without initial shockable rhythms. Trial registration ClinicalTrials.gov (NCT04217551, 2019-12-30).
PubMed: 38947064
DOI: 10.21203/rs.3.rs-4033108/v1 -
Research Square Jun 2024Here, we evaluated whether a synthetic lipoxin mimetic, designated AT-01-KG, would improve the course of influenza A infection in a murine model.
OBJECTIVE AND DESIGN
Here, we evaluated whether a synthetic lipoxin mimetic, designated AT-01-KG, would improve the course of influenza A infection in a murine model.
TREATMENT
Mice were infected with influenza A/H1N1 and treated with AT-01-KG (1.7 mg/kg/day, i.p.) at day 3 post-infection. Methods Mortality rate was assessed up to day 21 and inflammatory parameters were assessed at days 5 and 7. Results AT-01-KG attenuated mortality, reducing leukocyte infiltration and lung damage at day 5 and day 7 post-infection. AT-01-KG is a Formyl Peptide Receptor 2 (designated FPR2/3 in mice) agonist, and the protective responses were not observed in FPR2/3 animals. In mice treated with LXA (50mg/kg/day, i.p., days 3-6 post-infection), at day 7, macrophage reprogramming was observed, as seen by a decrease in classically activated macrophages and an increase in alternatively activated macrophages in the lungs. Furthermore, the number of apoptotic cells and cells undergoing efferocytosis was increased in the lavage of treated mice. Treatment also modulated the adaptive immune response, increasing the number of anti-inflammatory T cells (Th2) and regulatory T (Tregs) cells in the lungs of the treated mice. Conclusions Therefore, treatment with a lipoxin A analog was beneficial in a model of influenza A infection in mice. The drug decreased inflammation and promoted resolution and beneficial immune responses, suggesting it may be useful in patients with severe influenza.
PubMed: 38947034
DOI: 10.21203/rs.3.rs-4491036/v1 -
The Medical Journal of Australia Jul 2024To assess the effectiveness of the Cultural, Social and Emotional Wellbeing Program for reducing psychological distress and enhancing the social and emotional wellbeing...
OBJECTIVE
To assess the effectiveness of the Cultural, Social and Emotional Wellbeing Program for reducing psychological distress and enhancing the social and emotional wellbeing of Aboriginal women preparing for release from prison.
STUDY DESIGN
Mixed methods; qualitative study (adapted reflexive thematic analysis of stories of most significant change) and assessment of psychological distress.
SETTING, PARTICIPANTS
Aboriginal and Torres Strait Islander women at the Boronia Pre-release Centre for Women, Perth, Western Australia, May and July 2021.
INTERVENTION
Cultural, Social and Emotional Wellbeing Program (two days per week for six weeks). The Program involves presentations, workshops, activities, group discussions, and self-reflections designed to enhance social and emotional wellbeing.
MAIN OUTCOME MEASURES
Themes and subthemes identified from reflexive thematic analysis of participants' stories of most significant change; change in mean psychological distress, as assessed with the 5-item Kessler Scale (K-5) before and after the Program.
RESULTS
Fourteen of 16 invited women completed the Program; ten participated in its evaluation. They reported improved social and emotional wellbeing, reflected as enhanced connections to culture, family, and community. Mean psychological distress was lower after the Program (mean K-5 score, 11.3; 95% confidence interval [CI], 9.0-13.6) than before the Program (9.0; 95% CI, 6.5-11.5; P = 0.047).
CONCLUSION
The women who participated in the Program reported personal growth, including acceptance of self and acceptance and pride in culture, reflecting enhanced social and emotional wellbeing through connections to culture and kinship. Our preliminary findings suggest that the Program could improve the resilience of Aboriginal and Torres Strait Islander in contact with the justice system.
Topics: Humans; Female; Native Hawaiian or Other Pacific Islander; Adult; Mental Health; Western Australia; Program Evaluation; Psychological Distress; Qualitative Research; Middle Aged; Emotions; Prisoners; Stress, Psychological; Young Adult
PubMed: 38946642
DOI: 10.5694/mja2.52354 -
Journal of Indian Prosthodontic Society Jul 2024The aim of this study was to compare the marginal fit of prefabricated occlusal veneers with computer-aided design/computer-aided manufacturing (CAD-CAM)-milled zirconia... (Comparative Study)
Comparative Study
A comparative evaluation of marginal fit and microleakage of computer-aided design/computer-aided manufacturing-milled zirconia and prefabricated posterior occlusal veneers: An in vitrostudy.
AIMS
The aim of this study was to compare the marginal fit of prefabricated occlusal veneers with computer-aided design/computer-aided manufacturing (CAD-CAM)-milled zirconia occlusal veneers in the posterior teeth.
SETTINGS AND DESIGN
Forty extracted human maxillary premolars were divided into two groups of 20 each. Group 1 was prepared to receive prefabricated occlusal veneers, and Group 2 was prepared to receive CAD-CAM-milled zirconia occlusal veneers.
MATERIALS AND METHODS
Prefabricated samples (Edelweiss) were selected for Group 1, whereas for Group 2, the tooth preparations were scanned, and occlusal veneers were fabricated using Exocad designing software and milling machine. After luting, both the groups were submerged in dye, sectioned, and evaluated for marginal fit and microleakage under a stereomicroscope using the microscope imaging software and its measurement tool.
STATISTICAL ANALYSIS USED
Data collected were subjected to statistical analysis using SPSS 27.0. Intragroup and intergroup comparison was done using the Mann-Whitney U test. The Chi-square test was applied to check the depth of penetration of dye based on percentages.
RESULTS
The marginal gap of zirconia occlusal veneers fabricated with CAD-CAM is higher compared to that of prefabricated occlusal veneers. Similarly, the depth of penetration of dye is higher in CAD-CAM-milled zirconia occlusal veneers than prefabricated occlusal veneers.
CONCLUSION
The marginal fit of prefabricated occlusal veneer is better than the marginal fit of zirconia occlusal veneers fabricated with CAD-CAM. Similarly, it can also be concluded that the microleakage of prefabricated occlusal veneer is less compared to the CAD-CAM-milled zirconia occlusal veneers.
Topics: Dental Veneers; Zirconium; Computer-Aided Design; Humans; Dental Marginal Adaptation; Dental Leakage; Dental Prosthesis Design; In Vitro Techniques; Bicuspid
PubMed: 38946505
DOI: 10.4103/jips.jips_346_23 -
American Journal of Critical Care : An... Jul 2024Pain is a significant burden for children with neurodevelopmental disabilities but is difficult for clinicians to identify. No pain assessment tools for children with... (Observational Study)
Observational Study
BACKGROUND
Pain is a significant burden for children with neurodevelopmental disabilities but is difficult for clinicians to identify. No pain assessment tools for children with neurodevelopmental disabilities have been validated for use in pediatric intensive care units. The Individualized Numeric Rating Scale (INRS) is an adapted 0-to-10 rating that includes parents' input on their child's pain indicators.
OBJECTIVES
To evaluate the reliability, validity, and feasibility and acceptability of use of the INRS for assessing pain in critically ill children with neurodevelopmental disabilities.
METHODS
This observational study enrolled critically ill patients with neurodevelopmental disabilities aged 3 to 17 years in 2 pediatric intensive care units at a children's hospital using a prospective repeated-measures cohort design. Structured parent interviews were used to populate each patient's INRS. Bedside nurses assessed pain using the INRS throughout the study. The research team completed independent INRS ratings using video clips. Participating parents and nurses completed feasibility and acceptability surveys. Psychometric properties of the INRS and survey responses were evaluated with appropriate statistical methods.
RESULTS
For 481 paired INRS pain ratings in 34 patients, interrater reliability between nurse and research team ratings was moderate (weighted κ = 0.56). Parents said that creating the INRS was easy, made them feel more involved in care, and helped them communicate with nurses.
CONCLUSIONS
The INRS has adequate measurement properties for assessing pain in critically ill children with neurodevelopmental disabilities. It furthers goals of patient- and family-centered care but may have implementation barriers.
Topics: Humans; Child; Child, Preschool; Female; Adolescent; Male; Critical Illness; Pain Measurement; Reproducibility of Results; Prospective Studies; Psychometrics; Intensive Care Units, Pediatric; Neurodevelopmental Disorders; Parents; Feasibility Studies
PubMed: 38945815
DOI: 10.4037/ajcc2024343 -
ISA Transactions Jun 2024This paper presents an adaptive probabilistic recurrent Takagi-Sugeno-Kang fuzzy neural PID controller for handling the problems of uncertainties in nonlinear systems....
This paper presents an adaptive probabilistic recurrent Takagi-Sugeno-Kang fuzzy neural PID controller for handling the problems of uncertainties in nonlinear systems. The proposed controller combines probabilistic processing with a Takagi-Sugeno-Kang fuzzy neural system to proficiently address stochastic uncertainties in controlled systems. The stability of the controlled system is ensured through the utilization of Lyapunov function to adjust the controller parameters. By tuning the probability parameters of the controller design, an additional level of control is achieved, leading to enhance the controller performance. Furthermore, it can operate without relying on the system's mathematical model. The proposed control approach is employed in nonlinear dynamical plants and compared to other existing controllers to validate its applicability in engineering domains. Simulation and experimental investigations demonstrate that the proposed controller surpasses alternative controllers in effectively managing external disturbances, random noise, and a broad spectrum of system uncertainties.
PubMed: 38945764
DOI: 10.1016/j.isatra.2024.06.020 -
ISA Transactions Jun 2024This paper proposes a novel adaptive variable power sliding mode observer-based model predictive control (AVPSMO-MPC) method for the trajectory tracking of a...
This paper proposes a novel adaptive variable power sliding mode observer-based model predictive control (AVPSMO-MPC) method for the trajectory tracking of a Mecanum-wheeled mobile robot (MWMR) with external disturbances and model uncertainties. First, in the absence of disturbances and uncertainties, a model predictive controller that considers various physical constraints is designed based on the nominal dynamics model of the MWMR, which can transform the tracking problem into a constrained quadratic programming (QP) problem to solve the optimal control inputs online. Subsequently, to improve the anti-jamming ability of the MWMR, an AVPSMO is designed as a feedforward compensation controller to suppress the effects of external disturbances and model uncertainties during the actual motion of the MWMR, and the stability of the AVPSMO is proved via Lyapunov theory. The proposed AVPSMO-MPC method can achieve precise tracking control while ensuring that the constraints of MWMR are not violated in the presence of disturbances and uncertainties. Finally, comparative simulation cases are presented to demonstrate the effectiveness and robustness of the proposed method.
PubMed: 38945763
DOI: 10.1016/j.isatra.2024.05.050 -
Nurse Education Today Jun 2024The rapid and accurate assessment of neonatal asphyxia is critical to preventing potentially fatal outcomes. Therefore, nursing students must acquire the skills to...
BACKGROUND
The rapid and accurate assessment of neonatal asphyxia is critical to preventing potentially fatal outcomes. Therefore, nursing students must acquire the skills to assess newborn conditions immediately after birth and implement appropriate interventions. Virtual reality (VR) simulation education has emerged as a promising tool for nursing education, offering repetitive and customizable clinical training while ensuring patient safety and overcoming spatiotemporal limitations.
AIM
This study investigated the effects of a contactless hand-tracking-based immersive VR neonatal Apgar scoring program, adapted from experiential learning theory.
DESIGN
A non-randomized controlled trial with a pre-post-test, quasi-experimental design was conducted.
SETTINGS
The study was conducted at two nursing schools from July to October 2023.
PARTICIPANTS
Participants comprised nursing students holding bachelor's degrees in nursing, with three or four years of experience and successful completion of a neonatal nursing theory course. Additionally, individuals with at least six months of experience working in a neonatal ward or delivery room before enrolling in nursing school were eligible.
METHODS
The participants were divided into three groups: the VR group (n = 27) received contactless hand-tracking-based immersive VR neonatal Apgar scoring training; the simulation group (n = 28) received face-to-face Apgar scoring simulation training; and the control group (n = 26) received instruction on the Apgar scoring criteria. Changes in scores among the VR, simulation, and control groups were statistically compared using ANOVA with SPSS-WIN 27.0.
RESULTS
The VR group exhibited significant improvements in knowledge, learning satisfaction, self-confidence, immersion, and motivation compared to the simulation and control groups. Moreover, satisfaction was significantly higher in the VR group than in the simulation group.
CONCLUSIONS
The hand-tracking-based immersive VR neonatal Apgar scoring program represents an innovative and effective educational tool, prioritizing the privacy and rights of mothers and infants. It can potentially replace traditional delivery-room clinical training, which is observation-based and limited.
PubMed: 38944937
DOI: 10.1016/j.nedt.2024.106294