Impact of Loop Diuretic on Outcomes in Patients with Heart Failure and Reduced Ejection Fraction.

PURPOSE OF REVIEW: Loop diuretics are the cornerstone of the treatment of congestion in heart failure patients. The manuscript aims to summarize the most updated information regarding the use of loop diuretics in heart failure. RECENT FINDINGS: Diuretic response can be highly variable between patients and needs to be carefully evaluated during and after the hospitalization. Diuretic resistance can lead to residual congestion which affects prognosis and can be difficult to detect. The effect of loop diuretics on long-term prognosis remains uncertain but patients with advanced heart failure typically have renal dysfunction and are more inclined to develop loop diuretic resistance, which may lead to an incomplete decongestion and thus to a worse prognosis. Loop diuretics are the most potent diuretics available and their use is recommended in order to alleviate symptoms, improve exercise capacity, and reduce hospitalizations in patients with heart failure. Their use should be limited to the lowest dose necessary to maintain euvolemia because a low dose does not increase the risk of decompensation but reduce the risk of adverse effects and allow the up-titration of disease-modifying drugs.

An epidemiological qualitative/quantitative SWOT-AHP analysis in order to highlight the positive or critical aspects of dental implants: A pilot study.

OBJECTIVES: In recent years, dental implants are increasing in popularity due to their high success rate, demonstrated functionality, and aesthetic treatment results. Scientific research is very active in proposing improvements in the quality and survival of implants, taking into consideration various aspects. The objective of this study was to provide a holistic epidemiologic view of the state of dental implants, using a systematic approach based on a multimethod SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis and AHP (analytical hierarchical process) qualitative-quantitative analysis to identify the characteristics that can determine their success or failure. MATERIALS AND METHODS: The study used the hybrid method of SWOT-AHP. RESULTS: Analysis of the results showed that among strengths, the skill of the dentist was considered the most important factor, followed by the success of dental implants in the old people; among weaknesses, bruxism and chronic diseases were highlighted; for opportunities, biomechanical behavior, in terms of good mechanical strength and good tribological resistance to chemical and physical agents in the oral cavity, were considered the most important factors; finally, among threats, medical liability and biomechanical problems had equal weight. CONCLUSIONS: This study applied a multimethod SWOT-AHP approach to bring out favorable or critical evidence on the topic of dental implants. In accordance with the result of the strategic vector identified in the Twisting zone Adjustment type section, showed that implant surgery is a widespread technique but always needs improvement to increase the likelihood of success and reduce the complications that can lead to implant failure.

Tribocorrosion of 3D printed dental implants: An overview.

With the advancements in dental science and the growing need for improved dental health, it has become imperative to develop new implant materials which possess better geometrical, mechanical, and physical properties. The oral environment is a corrosive environment and the relative motion between the teeth also makes the environment more hostile. Therefore, the combined corrosion and tribology commonly known as tribocorrosion of implants needs to be studied. The complex shapes of the dental implants and the high-performance requirements of these implants make manufacturing difficult by conventional manufacturing processes. With the advent of additive manufacturing or 3D-printing, the development of implants has become easy. However, the various requirements such as surface roughness, mechanical strength, and corrosion resistance further make the manufacturing of implants difficult. The current paper reviews the various studies related to3D-printed implants. Also, the paper tries to highlight the role of 3D-Printing can play in the area of dental implants. Further studies both experimental and numerical are needed to devise optimized conditions for 3D-printing implants to develop implants with improved mechanical, corrosion, and biological properties.

2D materials for Tribo-corrosion and -oxidation protection: A review.

The recent rise of 2D materials has extended the opportunities of tuning a variety of properties. Tribo-corrosion, the complex synergy between mechanical wear and chemical corrosion, poses significant challenges across numerous industries where materials are subjected to both tribological stressing and corrosive environments. This intricate interplay often leads to accelerated material degradation and failure. This review critically assesses the current state of utilizing 2D nanomaterials to enhance tribo-corrosion and -oxidation behavior. The paper summarizes the fundamental knowledge about tribo-corrosion and -oxidation mechanisms before assessing the key contributions of 2D materials, including graphene, transition metal chalcogenides, hexagonal boron nitride, MXenes, and black phosphorous, regarding the resulting friction and wear behavior. The protective roles of these nanomaterials against corrosion and oxidation are investigated, highlighting their potential in mitigating material degradation. Furthermore, we delve into the nuanced interplay between mechanical and corrosive factors in the specific application of 2D materials for tribo-corrosion and -oxidation protection. The synthesis of key findings underscores the advancements achieved through integrating 2D nanomaterials. An outlook for future research directions is provided, identifying unexplored avenues, and proposing strategies to propel the field forward. This analysis aims at guiding future investigations and developments at the dynamic intersection of 2D nanomaterials, tribo-corrosion, and -oxidation protection.

Stress-strain and fatigue life numerical evaluation of two different dental implants considering isotropic and anisotropic human jaw.

Dental prostheses are currently a valid solution for replacing potential missing tooth or edentulism clinical condition. Nevertheless, the oral cavity is a dynamic and complex system: occlusal loads, external agents, or other unpleasant events can impact on implants functionality and stability causing a future revision surgery. One of the failure origins is certainly the dynamic loading originated from daily oral activities like eating, chewing, and so on. The aim of this paper was to evaluate, by a numerical analysis based on Finite Elements Method (FEM), and to discuss in a comparative way, firstly, the stress-strain of two different adopted dental implants and, subsequently, their fatigue life according to common standard of calculations. For this investigation, the jawbone was modeled accounting for either isotropic or anisotropic behavior. It was composed of cortical and cancellous regions, considering it completely osseointegrated with the implants. The impact of implants' fixture design, loading conditions, and their effect on the mandible bone was finally investigated, on the basis of the achieved numerical results. Lastly, the life cycle of the investigated implants was estimated according to the well-established theories of Goodman, Soderberg, and Gerber by exploiting the outcomes obtained by the numerical simulations, providing interesting conclusions useful in the dental practice.

A body-shaped lumbar-sacral support for improving car-seat comfort.

BACKGROUND: Nowadays, the ergonomic study of the driving position is a critical aspect of automotive design. Indeed, due to the rising needs on the market, one focus for car industries is to improve the perceived comfort related to the cars' interior. Driving a car for a prolonged time could cause complaints in some body-regions, especially in the lumbar-sacral area. Thus, special lumbar-sacral supports for driver seat has been proposed for reducing this kind of complaints. OBJECTIVE: Development of two virtual and physical models of lumbar-sacral support for improving both the lumbar/sacral and overall perceived comfort while driving. METHODS: Two prototypes of lumbar/sacral support have been realized: the first one was integrated into the seat, and the second one was shaped as a removable pillow (removable support). Fifty participants were asked to rate the perceived comfort in lab tests performed on a seating-buck by comparing three configurations (5 min each): a standard seat, seat with the removable support, seat with integrated support. Subjective data (by questionnaires) and objective data (interface pressure between backrest and driver) have been acquired and statistically processed. In addition, real driving tests have been performed to test the actual performance of the removable support in term of perceived comfort comparing it with the standard seat. RESULTS: Statistical correlations between subjective and objective data showed interesting results in comfort improvement through the adopted solutions. Real driving tests showed an improvement in comfort perception with the lumbar-sacral support towards the standard seat. CONCLUSIONS: Thanks to the virtual prototyping and the application of previous knowledge, coming from literature and experience, a solution for improving the overall comfort and reduce the lumbar/sacral pain while driving has been developed, tested, and assessed.

Design and Operational Elements of the Robotic Subsystem for the e.deorbit Debris Removal Mission.

This paper presents a robotic capture concept that was developed as part of the e.deorbit study by ESA. The defective and tumbling satellite ENVISAT was chosen as a potential target to be captured, stabilized, and subsequently de-orbited in a controlled manner. A robotic capture concept was developed that is based on a chaser satellite equipped with a seven degrees-of-freedom dexterous robotic manipulator, holding a dedicated linear two-bracket gripper. The satellite is also equipped with a clamping mechanism for achieving a stiff fixation with the grasped target, following their combined satellite-stack de-tumbling and prior to the execution of the de-orbit maneuver. Driving elements of the robotic design, operations and control are described and analyzed. These include pre and post-capture operations, the task-specific kinematics of the manipulator, the intrinsic mechanical arm flexibility and its effect on the arm's positioning accuracy, visual tracking, as well as the interaction between the manipulator controller and that of the chaser satellite. The kinematics analysis yielded robust reachability of the grasp point. The effects of intrinsic arm flexibility turned out to be noticeable but also effectively scalable through robot joint speed adaption throughout the maneuvers. During most of the critical robot arm operations, the internal robot joint torques are shown to be within the design limits. These limits are only reached for a limiting scenario of tumbling motion of ENVISAT, consisting of an initial pure spin of 5 deg/s about its unstable intermediate axis of inertia. The computer vision performance was found to be satisfactory with respect to positioning accuracy requirements. Further developments are necessary and are being pursued to meet the stringent mission-related robustness requirements. Overall, the analyses conducted in this study showed that the capture and de-orbiting of ENVISAT using the proposed robotic concept is feasible with respect to relevant mission requirements and for most of the operational scenarios considered. Future work aims at developing a combined chaser-robot system controller. This will include a visual servo to minimize the positioning errors during the contact phases of the mission (grasping and clamping). Further validation of the visual tracking in orbital lighting conditions will be pursued.