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Delayed Two-Stage Bentall Procedure:A Safe Technique of Redo Supra-Prosthetic Aortic Root Replacement
No full textBackground: Patients presented for complicated redo surgery after previous aortic valve replacement with the indication for aortic root repair due to dilatation or aneurysm. In those cases where the prosthetic aortic valve is in good condition, a valve-sparing procedure might simplify the complicated surgery. The aim of this case series paper is to describe a technique and to show the results of repairing the aortic root without compromising the previously inserted, well-functioning mechanical aortic valve. Methods: Between March 2017 and May 2017, 11 patients underwent re-sternotomy with placement on cardiopulmonary bypass with cardiac arrest and exposure of the aortic root. After the aortotomy, the aortic valve was inspected. Subsequently, the aortic sinuses were resected, sparing the coronary ostia buttons. A prosthetic tube was implanted above the preexisting valve. Finally, the coronary ostia were reattached to the tube, turning this procedure into a complete Bentall. Results: Echocardiography demonstrated fully functional valves and well-implanted aortic prosthesis. All patients were discharged within ten days post-surgery without any adverse events. Conclusions: The delayed two-stage Bentall procedure is a feasible and safe technique that preserves pre-implanted valves and does not cause any distortion of the aortic annulus
The affective registers of migration information campaigns:emotional violence and responses from Senegalese youth
No full textEuropean states fund Migration Information Campaigns (MICs) to curb irregular migration from West Africa. MICs mobilise emotions to influence decision-making and govern people's mobility. This research aims to deepen our understanding of MICs as affective spaces. Rather than merely examining the affective discourses they employ, which are the focus of existing literature on MICs, I also explore the emotional reactions exhibited by their recipients. The article is based on 15 months of ethnographic fieldwork in Senegal with young people who participated in MICs. It discusses how the campaigns impose emotional violence upon them and construct potential migrants as the "unwanted Other", and it explores how, through emotive communication, Senegalese young people articulate protest and perceptions of social justice. The youth targeted by these campaigns convey emotionally charged messages that underscore the inadequacies of campaign initiatives and advocate for the need to address the structural conditions constraining their lives in Senegal
Structural Connectivity of the Basal Ganglia from Patient-Individual Tractography Is Key for Understanding the Effects of Deep Brain Stimulation in Parkinson's Disease
No full textIntroduction: In Parkinson's disease (PD) patients, modulation of the fibre tracts of the cortico-basal ganglia-thalamo-cortical loop is the presumed mechanism of action of deep brain stimulation (DBS) of the subthalamic nucleus (STN). Therefore, we explored patient-individual cortical structural connectivity of the volume of tissue activated (VTA), as well as DBS-induced modulation of fibre tracts connecting the STN with cortical and subcortical nodes, and their correlation with therapeutic effects. Methods: A retrospective cohort of n = 69 PD patients treated with bilateral DBS of the STN was analysed. Clinical response was assessed from the DBS-induced change in the UPDRS-III motor scores (total and symptom-specific sub-scores) under regular medication after a median follow-up of 9.0 (range 2.6-20.2) months. Tractography based on patient-individual diffusion-weighted MRI was employed in two ways. Whole-brain tractography was used to identify the cortical connections of fibres passing the VTAs, and reconstruction of specific white matter pathways of the motor loop connecting the STN with the basal ganglia and cortex was used to identify the proportion of fibres within these pathways which was modulated by STN-DBS. This proportion of pathway modulation was used in a correlative analysis with clinical outcomes. Results: Fibres traversing the VTAs were primarily connected to the supplementary motor area (SMA) and to a lesser degree to the premotor cortex. Within the pathways connecting the STN with the cortical and subcortical nodes, on average 30-40% (range 10-80%) of the fibres were modulated by STN-DBS. This proportion correlated significantly with the percentage change in UPDRS motor score for fibres connecting the STN with the SMA (ρ = 0.28), pre-SMA (ρ = 0.26), ventral and dorsal premotor cortices (ρ = 0.26 and ρ = 0.29, respectively), and the globus pallidus externus (ρ = 0.26) and internus (ρ = 0.29). Also, good clinical responses for both tremor and rigidity were associated with a significantly (p < 0.05) higher proportion of modulated fibres for the same cortico- and sub-cortico-STN connections. Conclusion: Patient-individual tractography reveals that, in PD, most of the cortical fibres traversing the VTA are connected to the SMA. In addition, clinical efficacy is related to the proportion of DBS-affected fibres connecting the STN with nodes of both the hyperdirect (cortex-STN) and the indirect pathways (STN-basal ganglia). As such, patient-specific tractography, in particular in the basal ganglia, could be used in a clinical context as a tool to guide therapy.</p
The Roles of Civil Society Associations in Organising the Informal Circular Economy
No full textA circular economy (CE) transition requires more than technological innovation and market-based solutions. It demands a circular society that values informal repair, reuse and sharing practices. This study investigates how civil society associations (CSAs) support such practices in an industrialised setting. We apply a mixed-methods approach, combining survey data from 820 households in Flanders (Belgium) with 24 interviews involving CSA representatives at local, regional and European levels. Findings indicate that CSA membership increases participation in informal CE activities by strengthening trust, skills and accessibility, enabling activities that are less viable through market mechanisms alone. Respondents identify barriers to distributive, procedural and recognitional justice, which can be reduced by CSAs. We draw lessons for policymakers: providing structural support, reducing regulatory barriers and integrating informal CE practices into policies at municipal, regional, and European levels. These measures can help communities scale citizen-driven CE practices, enhancing resilience and supporting vulnerable groups throughout the CE transition
Recommendations for (Pharmaco)Genetic Sampling in Patients Following Allogeneic Hematopoietic Stem Cell Transplantation
No full textIn patients receiving allogenic hematopoietic stem cell transplantation (aHSCT) complete chimerism is desired. However, this brings a challenge when non-invasive assessment of recipient germline DNA is required for genetic testing. Here, we aim to create awareness for (pharmaco)genetic sampling in patients following aHSCT based on a case report of a patient following aHSCT in which pharmacogenetic analysis was performed. Six pharmacogenetic genes were analyzed in DNA extracted from peripheral blood (pre- and post-transplant), buccal swab, and hair follicles. To investigate the presence of donor DNA in post-transplant samples, short tandem repeat and digital droplet PCR analysis were performed. DNA from post-transplantation peripheral blood and the buccal swab showed identical genotypes: CYP2C9*1/*1, CYP2C19*1/*2, CYP2D6*2/*9, CYP3A4*1/*1, VKORC1-1639TT, SLCO1B1*1/*5. Pre-transplant DNA showed different genotypes for CYP2D6 (*1/*2) and SLCO1B1 (*1/*1). Due to the low DNA amount extracted from hair follicles, only CYP2D6 and SLCO1B1 were examined, showing identical genotypes to pre-transplantation DNA. Short tandem repeat analysis showed that the buccal swab contained DNA from both donor and recipient. It was estimated that the buccal swab contained similar to 63% donor DNA, while DNA from hair follicles showed 0% donor DNA. In conclusion, pharmacogenetic profiling after allogenic HSCT should be done with consideration. Analysis of pre-transplant peripheral blood is preferred over buccal swab due to the presence of donor DNA contamination. DNA extracted from hair is also a reliable source; however, application might be restricted due to limited DNA yield
A Brave New World:The Impact of Technology on Innovation Management
No full textThis special issue-focused on the transformative impact of emerging technologies (e.g., artificial intelligence, Internet of Things, service robots, blockchain) on innovation management-identifies the ways that firms are rethinking how they generate ideas, develop products, and engage with stakeholders across organizational and societal levels. The articles in this special issue span multiple domains, including ride-sharing, smart homes, health care, and digital communication. In addition, they demonstrate how new methods are reshaping new product development (NPD) processes. These contributions highlight how emerging technologies enable novel ideation through tools like large language models and topic modeling, as well as how they support agile, data-informed NPD and dynamic commercialization strategies. Leveraging these insights, this editorial proposes a conceptual framework that encompasses a simplified, three-step NPD process (ideation, development, and commercialization), along with key drivers of innovation and their implications for individuals, firms, society, and academia
Musculoskeletal pain in an ageing population:a cross-sectional analysis of the Maastricht study
No full textTo estimate the prevalence of musculoskeletal pain (MSP) across age groups in a Dutch population sample of middle-aged and older adults. Cross-sectional data of 8618 participants aged 40-75 years from The Maastricht Study was used. Participants reported any (>= 1 day in the past month) and chronic (>= 3 months) MSP. Additionally, the latter group reported pain locations (grouped in six pain regions) and intensity (visual analogue scale 1-10). Prevalence of any and (patterns of) chronic MSP were described across seven age groups. Logistic and multinominal regression analyses assessed associations of age groups with MSP, adjusted for sex or type 2 diabetes mellitus (T2DM). Interactions between age and sex or T2DM were tested. Prevalence of any and chronic MSP was 53% and 29%, respectively. Any MSP was less common in participants aged 70-75 years compared to those aged 40-44 years (OR = 0.80, 95% CI: 0.65-0.99). Chronic MSP plateaued after age 60 (range ORs 55-69 years 1.27-1.38). Neck/chest/shoulder (65%) and lower back (55%) were the most common chronic pain regions. Pain in four or more locations was reported by 43%, with no age-group differences. Sex and T2DM did not modify the relation between age group and chronic MSP. Mean pain intensity in those with chronic MSP (5.6, SD 1.7) was stable across age groups. The prevalence of chronic MSP seems not to increase further after the age of 60, possibly reflecting decreased work demands, altered pain perception, effective pain management, or selection bias of healthier older individuals
History and Application of Mechanical Assist Devices as a Bridge to Heart Transplant:A Review and Perspectives in Brazil
No full textINTRODUCTION: Mechanical circulatory support (MCS) devices have evolved significantly over the past decades and play a vital role in managing end-stage heart failure, especially as a bridge to heart transplantation. From the pioneering heart-lung machines to third-generation ventricular assist devices (VADs), MCS technology has advanced to provide more durable, efficient, and safer options for both short- and long-term support. This review outlines the historical development of mechanical assist devices, the types of available supports - ranging from intra-aortic balloon pumps and extracorporeal membrane oxygenation to implantable devices like HeartMate 3 - and their clinical indications and complications. Special attention is given to right ventricular dysfunction, thromboembolic and hemorrhagic complications, and infections, which remain major challenges in the management of patients with MCS devices. In Brazil, despite the growing evidence supporting MCS in critically ill patients, access remains limited due to financial and systemic constraints. The review explores the current landscape of device availability in the country, national guidelines, cost-effectiveness data, and the impact of recent changes in transplant allocation criteria that prioritize patients receiving mechanical support. Notably, the approval of long-term VADs for destination therapy in the public health system in 2024 marks a significant milestone. This review offers a comprehensive perspective on MCS utilization, highlighting both global advances and Brazil-specific challenges. By identifying gaps in access and proposing future directions, it advocates for expanded use of these life-saving technologies to improve survival and quality of life in advanced heart failure patients