340880 research outputs found
Sort by
Association of anesthesia strategies with outcomes in endovascular treatment for distal and medium vessel occlusions:A propensity score-matched analysis of the MR CLEAN registry and meta-analysis
No full textBackground: Recent trials did not demonstrate the benefit of endovascular therapy (EVT) for distal or medium vessel occlusions (DMVOs), raising questions about factors influencing outcomes. Anesthesia choice may play a role, yet its impact remains unclear. This study assessed general anesthesia (GA) versus non-GA in EVT for DMVOs, evaluating procedural, functional, and safety outcomes. Patients and methods: Patients undergoing EVT for AIS due to anterior DMVOs in the middle cerebral artery (MCA-M2, M3, M4) and anterior cerebral artery (ACA-A1, A2, A3) from the MR CLEAN registry between March 2014 and December 2018 were included. They were stratified into GA and non-GA groups, with propensity score matching employed to adjust for differences in baseline risk. Primary outcomes included functional outcomes at 90 days, assessed by ordinal regression analysis of modified Rankin Scale (mRS) scores at 90 days, and recanalization rates measured by Thrombolysis in Cerebral Infarction (TICI) scores. Secondary outcomes included dichotomized mRS scores, death at 90 days, and symptomatic intracranial hemorrhage (sICH). A systematic review and meta-analysis of relevant DMVO studies with a random effects model was performed. This study was registered with PROSPERO (CRD42024607294). Results: Among 5193 patients in the registry, 657 were eligible for our study, with 506 in the non-GA group, and 151 in the GA group. The median age was 73 years (IQR 64–81) in the non-GA group and 73 years (IQR 61–80) in the GA group (p = 0.35). The proportion of male patients was 50.2% in the non-GA group and 57.0% in the GA group (p = 0.15). In the matched cohort (n = 170), recanalization rates were higher in the GA group compared to the non-GA group (excellent recanalization rates (TICI2c/3): 61.0% vs 32.1%; OR 3.31, 95% CI (1.74–6.29), p < 0.001). There were no significant differences in the overall distribution of functional outcomes at 90 days (common OR 0.93, 95% CI (0.54–1.56), p = 0.77). Mortality was comparable between groups (34.1% vs 31.8%; OR 1.11, 95% CI (0.59–2.11), p = 0.74), and there was no significant difference in sICH (12.9% vs 5.9%; OR 0.42, 95% CI (0.14–1.27), p = 0.12). The systematic review and meta-analysis included six studies with a total of 3521 patients. The pooled analysis indicated that GA was associated with significantly lower rates of excellent functional outcomes (mRS 0–1: OR 0.74, 95% CI (0.58–0.94), p = 0.01) and higher mortality (OR 1.36, 95% CI (1.07–1.74), p = 0.01) compared to the non-GA at 90 days. Discussion and conclusion: In the MR CLEAN Registry, GA was associated with higher recanalization rates during EVT, but this technical advantage did not translate into improved 90-day functional outcomes. Our meta-analysis further indicated that non-GA strategies were associated with better functional recovery and lower mortality. These associations, however, warrant cautious interpretation given potential unmeasured confounders, including blood pressure management and conversion from non-GA to GA. Broad categorization of anesthesia as GA versus non-GA overlooks critical factors such as agent selection, physiological targets, and intraoperative monitoring, which may substantially impact cerebral perfusion and outcomes. Further prospective randomized studies with detailed anesthetic data and expert input are needed to refine these findings and guide clinical practice.</p
To NER or Not to NER? A Case Study of Low-Resource Deontic Modalities in EU Legislation
No full textDeontic modality (obligation, permission, prohibition) in legal documents can convey critical information, and identification of deontic modalities is often performed using Natural Language Processing (NLP) techniques as a 'Deontic Modality Classification' (DMC) text classification task. As deontic modalities in legal text are not mutually exclusive, a key challenge with DMC is that it classifies the provided text into a single modality while in reality it might have multiple deontic modalities. To address this, this study analyzes the feasibility of performing deontic modality identification as a Named Entity Recognition (NER) task over DMC task approaches in a low-resource data setting with EU legislation. Low-resource NLP approaches can offer solutions to tackle the problem of scarce data. In this paper, we use a rule-based approach with modal verbs and a Decision Tree classifier for DMC task. For NER, we utilize Conditional Random Fields (CRFs) in a low-resource setting and report on the reliability and precision for identification of deontic modality. Our experiments reveal that simpler models, like decision trees, out perform larger models in the low-resource setting of DMC obtaining macro-F1 score of 0.83. For the NER task, the CRF models show consistent performance for 'obligation' labels with an F1-score of 0.51 but have wavering results for other classes with a max F1-score of 0.26 for 'permission', and 0.08 for 'prohibition'
Representativeness of surgical controls in aortic valve replacement trials:comparison with routine surgical cohorts
No full textBACKGROUND: Randomised controlled trials (RCTs) comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) have significantly influenced treatment guidelines for aortic stenosis, expanding the use of TAVI into lower risk populations. However, the patients enrolled in the SAVR arms of these trials may differ from those typically undergoing SAVR in routine clinical practice. This study aims to critically assess the representativeness of SAVR patients in these RCTs by comparing their characteristics and outcomes to those of patients undergoing SAVR in routine clinical practice. METHODS: A systematic literature review was conducted across PubMed, Embase, Web of Science, Emcare and the Cochrane Library, focusing on RCTs and large prospective studies (n=500 SAVR patients), enrolling low-risk or intermediate-risk patients since 2010. Patient characteristics, early outcomes and 5-year survival were compared between RCT SAVR cohorts and those treated in routine clinical practice settings. Meta-analyses of pooled data and reconstructed Kaplan-Meier survival analyses were performed, with stratification by risk category. RESULTS: Nineteen studies (9 RCTs and 10 studies describing routine clinical practice), encompassing 74 797 SAVR patients, were included. SAVR patients in routine clinical practice demonstrated comparable early mortality to SAVR patients in RCTs but experienced fewer periprocedural complications, including lower rates of stroke, pacemaker implantation and myocardial infarction. At 5 years, overall survival was notably higher in patients treated in routine clinical practice compared to those in the SAVR arms of RCTs, both for low-risk (HR 0.64, 95% CI 0.55 to 0.75) and intermediate-risk patients (HR 0.55, 95% CI 0.470.64). CONCLUSIONS: Compared with typical SAVR patients treated in routine practice, RCT SAVR patients experienced higher complication rates and worse long-term survival, despite similar or lower surgical risk scores. These findings question the external validity of SAVR versus TAVI trials
Proteomic Profiling of Urinary Large Extracellular Vesicles for the Diagnosis of Prostate Cancer
No full textDistinguishing between prostate cancer (PCa) and prostatitis poses a challenge in clinical settings, often resulting in overdiagnosis and treatment. Large extracellular vesicles (lEVs) extracted from urine samples of patients may contain information about prostate pathology and are, therefore, potential biopsies for early PCa detection. This research endeavors to create a urinary lEV-centric proteomic approach for early PCa identification. An integrated workflow utilizing functionalized magnetic beads, centrifugation, and filter membranes optimizes and expedites the analysis of urinary lEVs. To validate the stability and significance of lEV proteomic markers, the study employed multiple reaction monitoring (MRM) to assess the identified differentially expressed proteins in lEVs (lEV-DEPs) within a validation group for precise quantification. Furthermore, cell-line experiments were conducted to compare the proteomic profiles of lEVs, small EVs (sEVs), and cell membranes (CM). In total, 3549 urinary lEV proteins were captured, revealing 17 lEV-DEPs, with 12 confirmed through MRM. Notably, this isolation method reduced contaminants compared to centrifugation, facilitating the extraction of relatively large EVs. Pathway enrichment analysis of lEV-DEPs underscored their role in transitioning from inflammation to cancer, with specific post-translational modifications (PTMs) influencing PCa progression. A panel integrating four potential lEV-DEPs and prostate-specific antigen (PSA) exhibited a distinguished accuracy of 0.875, emphasizing the importance of lEV-DEPs over PSA in distinguishing PCa from prostatitis. Additionally, lEVs demonstrated significant protein content and pathway similarity with CM compared to sEVs. In conclusion, this investigation establishes a comprehensive protocol for isolating and characterizing urinary lEV proteomics, showcasing its efficacy in discriminating PCa from prostatitis. These results enhance diagnostic precision and offer fresh insights into the biological mechanisms underlying PCa, paving the way for improved diagnostic and therapeutic approaches
Measurement instruments of pain-related avoidance in chronic pain:a systematic review of psychometric properties
No full textAvoiding harmful events is adaptive in the short term but eventually may compromise functioning in daily life. Therefore, assessing pain-related avoidance is important in both pain research and treatment. Despite a variety of available measurement instruments, a systematic analysis of their quality and limitations is lacking. We evaluated the measurement properties of instruments used to assess pain-related avoidance in individuals with chronic pain. A systematic review following COSMIN guidelines was conducted (PROSPERO registration: CRD42020181461), including an electronic search of Cochrane, PsycArticles, PubMed, PubPsych, Scopus, and Web of Science as well as grey literature from inception to January 2024. Eligible studies were English, German, or French publications that explicitly claimed to evaluate one or more psychometric properties of measurement instruments assessing pain-related avoidance in adults with chronic pain. Of 703 screened records, 140 original articles were included, covering 20 self-reported questionnaires, one therapist-reported outcome measure, and one performance-based measure. Based on the current evidence, only the Brazilian Portuguese language version of the Chronic Pain Coping Inventory and the Italian version of the Chronic Pain Coping Inventory-42 fulfilled criteria to be recommended for use. Although the commonly used Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia were the most extensively studied, the study quality was mixed. The review further highlights extensive research on internal consistency, reliability, and construct validity but reveals a lack of high-quality evidence on measurement error and criterion validity. This work was supported by funding from the Flemish Government (METH/15/011)
Autonomous Construction Crack Vision-Based Repair Using an Aerial Platform and a Delta Manipulator
No full textAutonomous inspections of civil and critical infrastructure and the ability to perform basic repair operations with drones may lead to increased safety. However, the development of autonomous solutions faces many challenges. To address some of the underlying challenges of autonomous construction repair we developed and present a custom-made aerial robotic platform. Equipped with computer vision for autonomous detection and localization of cracks, a delta manipulator, and a syringe-based cement extruder the presented solution is capable of finding, landing on top, and filling cracks in constructions under lab conditions
Inadequate Oxygen Delivery During Cardiopulmonary Bypass Drives Inflammatory Reaction after Cardiac Surgery
No full textObjectives Systemic inflammatory response syndrome (SIRS) is a common complication following cardiopulmonary bypass (CPB), associated with increased mortality. We assessed the relationship between indexed oxygen delivery (DO(2)i) during CPB and SIRS. Methods We conducted a prospective observational study at 2 institutions. The primary end-point was clinically-defined SIRS 12 hours after surgery. The secondary end-point was a composite outcome comprising death, TIA/stroke, renal replacement therapy, bleeding, mechanical circulatory support, or intensive care unit (ICU) stay >96 hours. The primary analysis modelled DO(2)i in multivariable logistic regression. Linearity was assessed with restricted cubic splines, knot-sensitivity, quintiles, and piecewise fits. The optimal ROC-derived threshold was explored. Patients above and below the threshold were matched 1:1 by propensity score. Structural equation modelling (SEM) assessed mediation between DO(2)i, SIRS, and outcomes. Results Of 1154 patients screened, 908 were analysed; 221 (24.3%) developed SIRS. Median DO(2)i was lower in the SIRS group (274 vs 302 mL/min/m(2), P < .001). DO(2)i was inversely associated with SIRS (aOR 0.798; 95% CI 0.750-0.850, P < .001, per +10 mL/min/m(2)). In the secondary analysis, DO(2)i <= 293 mL/min/m(2) was identified as threshold (sensitivity 62%, specificity 74%). Propensity score matched 390 patient pairs, with higher SIRS incidence in the low-DO(2)i group (33.3% vs 14.4%; P < .001). The composite outcome occurred more frequently in the low-DO(2)i cohort (17.7% vs 8.2%; P < .001). SEM showed mediation by SIRS, accounting for 46.2% of the DO(2)i effect on outcomes (OR 1.052; 95% CI 1.036-1.067; P < .001). Conclusions Low DO(2)i during CPB predicts SIRS and adverse outcomes. Goal-directed perfusion to reduce inflammation warrants evaluation in randomized trials
Smart dendrimer nanogels boost mRNA-based cancer therapy via synergistic glycolysis inhibition and immune activation
No full textCancer mRNA vaccine has emerged as a promising immunotherapy approach. However, development of functional vehicles for safe and efficient mRNA delivery into immune cells (e.g., dendritic cells, DCs) remains to be challenging, and most of the mRNA-based vaccines just act on immune cells for improved anticancer immunity without additional input to tackle cancer cells, ultimately limiting the anticancer efficacy. Herein, we report the development of pH-responsive dual-action dendrimer nanogels (DNGs) to deliver gp100 mRNA as a potential nanovaccine. Mannose-conjugated generation 3 poly(amidoamine) dendrimers were crosslinked through dual functional polyethylene glycol with both ends of aldehyde groups to form pH-responsive DNGs. The DNGs with a size of 45.7 nm show excellent colloidal stability and cytocompatibility and allow dual-actions for DC-targeted mRNA delivery and cancer cell glycolysis inhibition. In a subcutaneous mouse melanoma model, the DNG/mRNA vaccine exerted glycolytic inhibition effect and triggered robust antitumor immune responses to suppress the tumor growth, especially in combination with anti-PD-L1 antibody-mediated immune checkpoint blockade. Meanwhile, the local vaccination of the vaccine enabled effective tumor occurrence prevention. Such a DNGbased mRNA vaccine with dual actions on both DCs and cancer cells may be applied for improved immunotherapy of other cancer types
Inclusive Language and Privacy Policies:A Rights-based Approach
No full textThis article explores the role of inclusive language in privacy policies, emphasizing its legal significance and impact on user trust and regulatory compliance. By analysing privacy policies from Amazon, Uber, and Meta, the study highlights the prevalent use of masculine as a default linguistic form, reinforcing gender biases and excluding diverse identities. The research argues that the right to personal data protection should inherently include non-discriminatory language as part of the principle of transparency under EU data protection law. The study further underscores how privacy policies, as fundamental tools for informing users about their rights, should reflect corporate commitment to gender equity and non-discrimination. It proposes that supervisory authorities should consider language inclusivity when interpreting GDPR requirements and suggests AI-driven solutions to assist companies in implementing inclusive language in legal texts. Ultimately, the findings call for a shift toward gender-fair language in privacy policies as a necessary step toward fostering a more equitable digital environment aligned with EU fundamental rights