Smart Anklet Use to Measure Vascular Health Benefits of Preventive Intervention in a Nature-Based Environment-A Pilot Study.

The present study aimed to investigate the associations between nature-based intervention and peripheral pulse characteristics of patients with PAOD using new smart technology specifically designed for this purpose. A longitudinal panel study performed between 1 January 2022 and 31 December 2022 included 32 patients diagnosed with peripheral arterial occlusive disease (PAOD) who were treated in the vascular surgeons' hospital "Dobb" in Valjevo. These patients were exposed for six months to moderate-intensity physical activity (MPA) in a nature-based environment. They practiced 150 to 300 min of walking 6 km/h and cycling activities (16-20 km/h) weekly as recommended for patients with chronic conditions and those living with disability. Univariate logistic regression analysis was used to identify factors associated with major improvements in peripheral pulse characteristics of patients with PAOD. After six months of MPA, half of the patients (50%, 16/32) achieved minor, and half of them major improvements in peripheral pulse characteristics. The major improvements were associated with current smoking (OR = 9.53; 95%CI = 1.85-49.20), diabetes (OR = 4.84; 95%CI = 1.09-21.58) and cardiac failure, and concurrent pulmonary disease and diabetes (OR = 2.03; 95%CI = 1.01-4.11). Our pilot study showed that patients with PAOD along with other chronic conditions and risk factors benefited more from continuous physical activity in a nature-based environment.

Nanocarriers in topical photodynamic therapy.

INTRODUCTION: Photodynamic therapy (PDT) has gained significant attention due to its superiority over conventional treatments. In the context of skin cancers and nonmalignant skin diseases, topical application of photosensitizer formulations onto affected skin, followed by illumination, offers distinct advantages. Topical PDT simplifies therapy by providing easy access to the skin, increasing drug concentration within the target area, and confining residual photosensitivity to the treated skin. However, the effectiveness of topical PDT is often hindered by challenges such as limited skin penetration or photosensitizer instability. Additionally, the hypoxic tumor environment poses further limitations. Nanocarriers present a promising solution to address these challenges. AREAS COVERED: The objective of this review is to comprehensively explore and highlight the role of various nanocarriers in advancing topical PDT for the treatment of skin diseases. The primary focus is to address the challenges associated with conventional topical PDT approaches and demonstrate how nanotechnology-based strategies can overcome these challenges, thereby improving the overall efficiency and efficacy of PDT. EXPERT OPINION: Nanotechnology has revolutionized the field of PDT, offering innovative tools to combat the unfavorable features of photosensitizers and hurdles in PDT. Nanocarriers enhance skin penetration and stability of photosensitizers, provide controlled drug release, reduce needed dose, increase production of reactive oxygen species, while reducing side effects, thereby improving PDT effectiveness.

Image-plane self-calibration in interferometry.

We develop a process of image-plane self-calibration for interferometric imaging data. The process is based on shape-orientation-size (SOS) conservation for the principal triangle in an image generated from the three fringes made from a triad of receiving elements, in situations where interferometric phase errors can be factorized into element-based terms. The basis of the SOS conservation principle is that, for a three-element array, the only possible image corruption due to an element-based phase screen is a tilt of the aperture plane, leading to a shift in the image plane. Thus, an image made from any three-element interferometer represents a true image of the source brightness, modulo an unknown translation. Image-plane self-calibration entails deriving the unknown translations for each triad image via cross-correlation of the observed triad image with a model image of the source brightness. After correcting for these independent shifts, and summing the aligned triad images, a good image of the source brightness is generated from the full array, recovering source structure at diffraction-limited resolution. The process is iterative, using improved source models based on previous iterations. We demonstrate the technique in a high signal-to-noise context, and include a configuration based on radio astronomical facilities, and simple models of double sources. We show that the process converges for the simple models considered, although convergence is slower than for aperture-plane self-calibration for large-N arrays. As currently implemented, the process is most relevant for arrays with a small number of elements. More generally, the technique provides geometric insight into closure phase and the self-calibration process. The technique is generalizable to non-astronomical interferometric imaging applications across the electromagnetic spectrum.

Biodistribution of the photosensitizer temoporfin after in vivo topical application of temoporfin-loaded invasomes in mice bearing subcutaneously implanted HT29 tumor.

Temoporfin (mTHPC) has a great potential for the topical photodynamic therapy. However, it presents a highly hydrophobic second generation photosensitizer with low percutaneous penetration. In order to use mTHPC for dermal/transdermal delivery it is necessary to employ some of the penetration enhancement methods. In this study invasomes were used as a highly effective drug nanocarrier system to enhance its skin penetration, being composed of non-hydrogenated soybean lecithin (10% w/v), ethanol (3.3%w/v), a mixture of terpenes (1% w/v of the mixture cineole:citral:d-limonene = 45:45:10 v/v) and phosphate buffer saline up to 100% w/v. A pharmacokinetic/biodistribution study was performed in mice bearing s.c. implanted human colorectal tumor HT29 upon the application of mTHPC-loaded invasomes onto the skin above the underlying tumor. The aim was to obtain the biodistribution profile of mTHPC i.e. to gain data on mTHPC-distribution in the body (tumor, treated skin, muscle, blood, liver and untreated skin) of mice after the topical application of mTHPC-loaded invasomes. The results revealed that a significant mTHPC-amount was found in treated skin already after 2 h of incubation time. As to the tumor, significant amounts were found after 12 h, while the highest mTHPC-amount was found after 24 h. This study showed that invasomes applied onto the skin may deliver mTHPC to the tumor being necessary for PDT. Since mTHPC was also found in blood and liver, transdermal mTHPC delivery was confirmed. In conclusion, mTHPC-invasomes could be used for topical PDT of cutaneous and subcutaneous lesions, however with general photoxicity induced by systemic apsorption of mTHPC lasting only for 2 weeks. Additionally, due to systemic absorption of mTHPC after invasomes application onto the skin, they could be used transdermally for the PDT treatment of diseases, which need systemic drug absorption. However, it should be emphasized that mice were used in the study, differing in the skin properties compared to human skin. Thus, additional studies should be conducted.

Dynamic monitoring of carcinoembryonic antigen, CA19-9 and inflammation-based indices in patients with advanced colorectal cancer undergoing chemotherapy.

BACKGROUND: The roles of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) in monitoring the patient response to chemotherapy for metastatic colorectal cancer (mCRC) are not clearly defined, and inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII), have been sparsely investigated for this purpose. AIM: To aim of this study was to evaluate the relationship between the kinetics of CEA, CA19-9, NLR, LMR, PLR and SII in serum and patient response to chemotherapy estimated by computed tomography (CT) in patients with unresectable mCRC. METHODS: Patients with mCRC treated with a 1st-line and 2nd-line chemotherapy underwent at least 3 whole-body spiral CT scans during response monitoring according to the Response Evaluation Criteria in Solid Tumour 1.1 (RECIST 1.1), and simultaneous determination of CEA, CA19-9, neutrophil, lymphocyte, platelet and monocyte levels was performed. The kinetics of changes in the tumour markers and inflammatory indices were calculated as the percentage change from baseline or nadir, while receiver operating characteristic curves were drawn to select the thresholds to define patients with progressive or responsive disease with the highest sensitivity (Se) and specificity (Sp). The correlation of tumour marker kinetics with inflammatory index changes and RECIST response was determined by univariate and multivariate logistic regression analysis and the clinical utility index (CUI). RESULTS: A total of 102 patients with mCRC treated with chemotherapy were included. Progressive disease (PD), defined as a CEA increase of 25.52%, resulted in an Se of 80.3%, an Sp of 84%, a good CUI negative [CUI (Ve-)] value of 0.75 and a good fraction correct (FC) value of 81.2; at a CEA cut-off of -60.85% with an Se of 100% and an Sp of 35.7% for PD, CT could be avoided in 25.49% of patients. The 21.49% CA19-9 cut-off for PD had an Se of 66.5%, an Sp of 87.4%, an acceptable CUI (Ve-) value of 0.65 and an acceptable FC value of 75. An NLR increase of 11.5% for PD had an Se of 67% and an Sp of 66%; a PLR increase of 5.9% had an Se of 53% and an Sp of 69%; an SII increase above -6.04% had an Se of 72% and an Sp of 63%; and all had acceptable CUI (Ve-) values at 0.55. In the univariate logistic regression analysis, CEA (P < 0.001), CA19-9 (P < 0.05), NLR (P < 0.05), PLR (P < 0.05) and SII (P < 0.05) were important predictors of tumour progression, but in the multivariate logistic regression analysis, CEA was the only independent predictor of PD (P < 0.05). CONCLUSION: CEA is a useful marker for monitoring the chemotherapy response of patients with unresectable mCRC and could replace a quarter of CT examinations. CA19-9 has poorer diagnostic characteristics than CEA but could be useful in some clinical circumstances, particularly when CEA is not increased. Dynamic changes in the inflammatory indices NLR, PLR and SII could be promising for further investigation as markers of the chemotherapy response.

Detecting Cosmic Reionization Using the Bispectrum Phase.

Detecting neutral hydrogen (H i) via the 21 cm line emission from the intergalactic medium at z≳6 has been identified as one of the most promising probes of the epoch of cosmic reionization-a major phase transition of the Universe. However, these studies face severe challenges imposed by the bright foreground emission from cosmic objects. Current techniques require precise instrumental calibration to separate the weak H i line signal from the foreground continuum emission. We propose to mitigate this calibration requirement by using measurements of the interferometric bispectrum phase. The bispectrum phase is unaffected by antenna-based direction-independent calibration errors and hence for a compact array it depends on the sky brightness distribution only (subject to the usual thermal-like noise). We show that the bispectrum phase of the foreground synchrotron continuum has a characteristically smooth spectrum relative to the cosmological line signal. The two can be separated effectively by exploiting this spectral difference using Fourier techniques, while eliminating the need for precise antenna-based calibration of phases introduced by the instrument, and the ionosphere, inherent in existing approaches. Using fiducial models for continuum foregrounds, and for the cosmological H i signal, we show the latter should be detectable in bispectrum phase spectra, with reasonable significance at |k_{∥}|≳0.5h Mpc^{-1}, using existing instruments. Our approach will also benefit other H i intensity mapping experiments that face similar challenges, such as those measuring baryon acoustic oscillations (BAO).

Can we identify risk factors for postoperative delirium in cardiac coronary patients? Our experience.

INTRODUCTION: Delirium is a temporary mental disorder that frequently occurs among elderly hospitalized patients. Patients who undergo cardiac operations have an increased risk of postoperative delirium, which is associated with higher mortality and morbidity rates, a prolonged hospital stay, and reduced cognitive and functional recovery. PATIENTS AND METHODS: In our prospective study, we included 370 consecutive adult patients who underwent on-pump coronary artery surgery between January 1, 2011, and July 1, 2011. We selected 21 potential risk factors and divided them into preoperative, intraoperative, and postoperative groups. Delirium was diagnosed with the Confusion Assessment Method. RESULTS: Postoperative delirium was diagnosed in 74 patients (20%). Four predictive factors were associated with postoperative delirium: diabetes mellitus, cerebrovascular disease, peripheral vascular disease, and prolonged intubation (P < .05). CONCLUSION: Three of the four predictive factors significantly associated with delirium are preoperative. They are relatively easy to measure and can be used to identify patients at higher risk. Fast extubation of these patients and preventive interventions can be taken to prevent negative consequences of this postoperative complication.

[Surgical revascularization on the beating heart in patients with low ejection fraction].

INTRODUCTION: The subset of patients most likely to benefit from off-pump coronary artery bypass grafting (OPCABG) remains a controversial issue, but the technique has been proposed to decrease postoperative mortality and morbidity. Coronary artery bypass grafting (CABG) with a cardiopulmonary bypass carries a significant risk for patients with severe left ventricular (LV) dysfunction. OBJECTIVE: The objective of this study was to compare off-pump to on-pump CABG in patients with ejection fraction (EF) lower than 30%. METHODS: Prospective randomized study was carried out between June 2004 and March 2006 at the Institute for Cardiovascular Diseases of the Clinical Centre of Serbia. Sixty prospectively randomized high-risk patients divided into two groups to undergo off-pump or on-pump CABG. All recruited patients had left ventricular ejection fraction lower than 30%. RESULTS: Thirty patients averaging 59.2 years of age underwent 2.30 grafts on pump, and another 30 averaging 59.6 years of age underwent 2.03 grafts off pump. OPCABG patients exhibited a significantly less release of TnI (average 0.71 micro/L) than on-pump patients (3.00 micro/L). Inotropic requirements were less in the off-pump group. The patients undergoing OPCABG received fewer units of blood and had shorter postoperative length of stay in intensive care unit and hospital stay. There was no significant difference in hospital mortality and complication rate. CONCLUSION: The present study suggests that off-pump CABG in patients with poor LV function when compared with conventional CABG achieved similar number of grafts per patient, similar in-hospital outcomes, shorter length of stay, reduced transfusion requirement, and less myocardial injury.

Aortic dissection in the second trimester of pregnancy: is it possible to save both lives?

Aortic dissection during pregnancy is a potentially catastrophic clinical condition and can be lethal to both mother and fetus. The treatment of aortic dissection in pregnancy is based on location, severity, and gestational age. We report a case of acute aortic dissection in a 30-year-old female patient in her 26th week of gestation. Ascending aorta resection and interposition of a 26-mm Dacron graft was carried out without circulatory arrest by means of a double-felt "sandwich" technique on both anastomoses. The patient was discharged from the hospital 10 days after her initial admission. At the 34th week of gestation, the patient delivered a healthy baby by cesarean section. Because our patient was hemodynamically unstable, our aim at the 26th week of gestation was to perform a simplified surgical procedure, to avoid circulatory arrest, and to maintain a high perfusion pressure, in order to save the patient's life and to decrease the potential risk of damage to the fetus.

[Accessory bones of the feet--radiological analysis of frequency].

BACKGROUND/AIM: Accessory bones are most commonly found on the feet and they represent an anatomic variant. They occur when there is a failure in the formation of a unique bone from separated centre of ossification. The aim of this study was to establish their frequency and medical significance. METHODS: Anteroposterior and lateral foot radiography was performed in 270 patients aged of 20-80 years with a history of trauma (180) and rheumatology disease (90). The presence and distribution of accessory bones was analysed in relation to the total number of patients and their gender. The results are expressed in numeric values and in terms of percentage. RESULTS: Accessory bones were identified in 62 (22.96%) patients: 29 (10.74%) of them were found in female patients and 33 (12.22%) in males. The most common accessory bones were as follows: os tibiale externum 50%, os pemroneum 29.03%, os trigonum 11.29%, os vaselianum 9.68%. CONCLUSION: Accessory bones found in 23% of patients with trauma and some of rheumatological diseases. Their significance is demonstrated in the differential diagnosis among degenerative diseases, avulsion fractures, muscle and tendon trauma and other types of injuries which can cause painful affection of the foot, as well as in forensic practice.