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Role of artificial intelligence in enhancing insulin recommendations and therapy outcomes
No full textThe growing worldwide incidence of diabetes requires more effective approaches for managing blood glucose levels. Insulin delivery systems have advanced significantly, with artificial intelligence (AI) playing a key role in improving their precision and adaptability. AI algorithms, particularly those based on reinforcement learning, allow for personalised insulin dosing by continuously adapting to an individual’s responses. Despite these advancements, challenges such as data privacy, algorithm transparency, and accessibility still need to be addressed. Continued progress and validation in AI-driven insulin delivery systems promise to improve therapy outcomes further, offering people more effective and individualised management of their diabetes. This paper presents an overview of current strategies, key challenges, and future directions.</p
Metabolic and Immune Crosstalk in Cardiovascular Disease
No full textCardiovascular diseases including atherosclerosis and heart failure, arise from the intricate interplay of metabolic, immune, and neural dysregulation within vascular and cardiac tissues: This review focuses on integrating recent advances in metabolic and immune crosstalk of the cardiac vasculature that affects cardiometabolic health and disease progression. Coronary and lymphatic endothelial cells regulate cardiac metabolism, and their dysfunction is linked to cardiovascular diseases. Lymphatics maintain tissue homeostasis, including clearing metabolic waste, lipids, and immune cells, and their maladaptation in metabolic diseases worsens outcomes. Altered vascular endothelial metabolism in heart failure drives immune-mediated inflammation, fibrosis, and adverse cardiac remodeling. Concurrently, artery tertiary lymphoid organs formed in the adventitia of advanced atherosclerotic arteries, serve as pivotal neuroimmune hubs, coordinating local immunity through T and B cell activation and neurovascular signaling via artery-brain circuits. T cells within plaques and artery tertiary lymphoid organs undergo clonal expansion as a result of peripheral tolerance breakdown, with proinflammatory CD4+ and CD8+ subsets amplifying atherosclerosis, effects further shaped by systemic immune activation. Therapeutic strategies targeting endothelial cell metabolism, lymphatic dysfunction, neuroimmune crosstalk, and T cell plasticity hold promise for integrated cardiovascular disease management
13. Trigeminal Neuralgia
No full textIntroduction: Trigeminal neuralgia (TN) is a disorder characterized by recurrent, unilateral brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more branches of the trigeminal nerve, and triggered by innocuous stimuli. Methods: The literature on the diagnosis and treatment of TN was retrieved and summarized. Results: The diagnosis is made almost entirely based on the patient's history. In classical TN, the neurological examination is typically normal, whereas the exam in secondary TN is focused on surveilling for signs of multiple sclerosis (MS) or a cerebellopontine tumor. The appropriate imaging technique is magnetic resonance imaging (MRI) with contrast of the trigeminal ganglion, which is recommended prior to interventional procedures. The treatment of a patient with TN is a team effort and should always be multidisciplinary, addressing all dimensions of pain. Carbamazepine or oxcarbazepine are first-line medical treatments. Microvascular decompression (MVD) is the technique of choice for patients without or with minor comorbidities. Percutaneous procedures for TN are mainly radiofrequency thermocoagulation of the branches of the trigeminal nerve introduced by Sweet and Wepsic in 1965, retrogasserian glycerol injection introduced by Hakanson in 1981, and balloon compression introduced by Mullan and Lichtor in 1983. Radiofrequency treatment is recommended in elderly patients or those with major comorbidities. Other techniques such as stereotactic radiosurgery and pulsed radiofrequency treatment are also discussed. Conclusions: Recommendations are based on very low-quality evidence. MVD and radiofrequency are the preferred invasive treatments, although higher-quality evidence is necessary to better assess the risk–benefit ratios
Coronary CT angiography-derived pericoronary fat attenuation index:Post-mortem histopathological correlation in fatal plaques
No full textObjectives: The fat attenuation index (FAI) is a biomarker that has recently gained attention for reflecting perivascular inflammation in coronary arteries. We investigated the utility of the FAI in identifying high-risk coronary plaques responsible for sudden cardiac death (SCD). Methods: Using multiphase post-mortem CT angiography (MPMCTA), we analyzed culprit plaques from 35 individuals who died from acute coronary syndrome, comparing these to control vessels from within-subject unaffected coronary arteries, with FAI measurement. Histopathological examination of culprit plaques assessed intraplaque inflammation, adventitial inflammation, and vasa vasorum density. Results: Perivascular FAI values were significantly higher in culprit lesions than control lesions, -62.5 ± 10.4 vs. -68.5 ± 7.2 HU, respectively (p = 0.003). However, no significant differences in FAI were found between culprit lesions with and without local histopathological inflammation (p = 0.378). Additionally, FAI values = -70.1 HU were more common in culprit than control lesions, though this threshold did not reach statistical significance (p = 0.081). Other imaging biomarkers, including the napkin-ring sign (p = 0.049) and plaque enhancement (p = 0.024), were more closely associated with histopathological inflammation. Conclusion: Our findings support FAI as a surrogate marker of high-risk coronary artery disease, although more extensive studies are needed to confirm its predictive accuracy for SCD. Integrating FAI with routine coronary CT angiography features could improve risk stratification in clinical settings
Burnout in mental health professionals and its relation with their attitudes towards mental illness
No full textBackground and objectives: Staff burnout is a concern in the mental health field, in terms of its prevalence and its association with a range of undesirable outcomes. Recent research suggests there is a relationship between mental health professionals' (MHPs) burnout and stigmatizing attitudes towards their patients, probably leading to deleterious effects on the quality of their care. We measured burnout in a sample of professionals working in a wide range of mental health facilities in Spain, Portugal and Italy, and analyzed (1) its relationship with a set of relevant sociodemographic variables and (2) its influence on their stigmatizing attitudes. Methods: We administered a survey including the Maslach Burnout Inventory (MBI) and two questionnaires related to stigmatizing attitudes: The Community Attitudes towards the Mentally Ill (CAMI) and the Attribution Questionnaire (AQ-27). Sociodemographics including information on profession, work setting and country were also registered. Results: 1525 professionals of the surveyed population (34.06 %) completed the survey. Burnout scores were significantly related to many of the sociodemographic variables. Profession and country were the strongest and most consistently associated to the three dimensions of burnout (i.e., Emotional Exhaustion (EE), Depersonalization (Dp) and Personal Achievement (PA)) always with a p < 0.001. Fittings of linear models predicting stigmatizing attitudes from burnout pointed to PA as the most influential variable, being statistically significant for 11 of the 13 stigma variables, followed by both EE and Dp which were significant for 6 of the variables. Finally, higher adjusted R2 from the fitted models showed that burnout was more influential than profession, work setting or country in many of the stigma variables including Anger, Dangerousness, Fear, Help, Restrictiveness and Ideology. Conclusion: Results from this study indicate that burnout of MHPs is related to a wide range of sociodemographic factors, with profession and country being remarkably significant. MHPs reporting higher burnout (especially lower personal achievement at work) have more negative attitudes towards their patients and support more coercive and restrictive approaches in their care. Staff burnout seems to explain most of their stigmatizing attitudes more than personal and professional variables. Thus, interventions to diminish burnout might have a positive influence on mental health care. Future studies should include organizational variables, more specific scales for stigma in MHPs, and have a follow-up design
Lex Specialis as a Reason-Giving Norm:Balancing Norm Specificity and Individual Rights in Times of Crisis
No full textLex specialis is a fundamental tenet of law. It is particularly important in resolving conflicts between international humanitarian law (IHL) and human rights law (HRL). Nonetheless, in recent years, there has been growing interest in developing an alternative approach that harmonises IHL and HRL. This approach emphasises the mutual reinforcement of these two branches of law, rather than their opposition. However, the interaction between the harmonising approach and lex specialis remains poorly understood. This article proposes a reasoning framework for understanding lex specialis, including how it can be defeated. It explains that lex specialis can be seen as a second-order norm that prioritises certain norms over others by providing reasons that work in favour of the first group and against the second group. Nevertheless, the reasons given by lex specialis can be defeated by other reasons, thus reversing the primacy of specific norms over general ones
Long-Term Participation after Mild Traumatic Brain Injury in Comparison to Orthopedic Trauma Controls:Results from a Longitudinal Multicenter Observational Cohort Study
No full textA subgroup of patients shows incomplete recovery after mild traumatic brain injury (mTBI). Outcomes are commonly measured on the level of symptoms or functional recovery. An alternative way to study outcome after mTBI is to measure the level of participation. The objectives of this study were to examine (1) the level of participation in patients with mTBI at 12 months post-injury in comparison to a non-head injury orthopedic trauma control group; (2) the relationship between the outcome domains participation, functional outcome, and post-concussion symptoms. A prospective, longitudinal, multicenter cohort study was conducted. Participants were 140 adults with mTBI and 144 adults with minor (non-head) orthopedic injury. The following outcomes were measured: participation (Utrecht Scale for Evaluation and Rehabilitation-Participation: USER-P), functional outcome (Glasgow Outcome Scale Extended: (GOS-E), and post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire: RPQ). Adults with mTBI have a significantly lower objective participation level (USER-P Frequency scale) than controls. No differences were found between the groups on subjective participation (USER-P Restrictions and Satisfaction scales) nor on functional outcome (GOS-E). Fifty-three people with mTBI (38%) had a score of >= 2 on >= 3 items, while 26 (19%) had an unfavorable USER-P outcome (>= 2 restrictions) and only 9 (6.5%) had an unfavorable GOS-E score (<7). In both groups, the presence of persistent symptoms led to a significantly unfavorable outcome on both the USER-P and GOS-E. Participation frequency is lower in mTBI than in orthopedic controls, mainly determined by a significantly lower number of hours of (un)paid work, education, and/or household activities. People with mTBI more often report post-concussion symptoms, but functional recovery is not different between the groups. Participation seems to better represent incomplete recovery than functional outcome, but future research should confirm these findings
Identifying risk factors for one-year mortality after surgical treatment of periprosthetic femoral fractures around hip arthroplasty
No full textBackground: The increasing number of hip arthroplasties (HA) worldwide, including hemi- and total hip arthroplasties, has led to a rise in periprosthetic femoral fractures (PPFF). These fractures are technically complex, linked to high morbidity and mortality, and impose a burden on healthcare systems. However, clinical guidelines for managing PPFF are lacking, and data on factors affecting postoperative outcomes remain limited. This study aimed to identify risk factors for one-year mortality in surgically treated PPFF patients. Methods: A retrospective single-center cohort study was conducted on patients with surgically treated PPFF. Data on patient-, implant-, fracture-, surgical- and perioperative characteristics were collected. Univariate and multivariable logistic regression analyses were used to identify independent predictors of one-year mortality. Results: Among 157 patients (median age was 83 years, 59.2 % ASA III), the one-year overall mortality rate was 16.6 %. Multivariable analyses suggested that residency in a nursing home [OR 4.1 (95 %CI 1.20–14.25) p = 0.025], use of a walking aid [OR 3.6 (95 %CI 1.07–12.36) p = 0.039], initial uncemented stem fixation [OR 4.08 (95 %CI 1.25–13.35) p = 0.020], preoperative urinary bladder catheter (UBC) [OR 4.5 (95 %CI 1.33–15.25) p = 0.016] and lower Body Mass Index (BMI) (Kg/m2) [OR 0.87 (95 %CI 0.75–1.00) p = 0.049) were independently associated with one-year mortality. Conclusion: PPFF patients are frail and highly comorbid. Risk factors such as low BMI, nursing home residency, walking aid use, uncemented stem fixation, and preoperative UBC highlight the need for targeted strategies to improve outcomes
Experience with a Large-Bore Vascular Closure Device in Patients Undergoing a Percutaneous Endovascular Aneurysm Repair (EVAR):A Multicentre Study
No full textPurpose: Endovascular aneurysm repair (EVAR) is the preferred treatment for infrarenal aortic aneurysms, offering lower perioperative morbidity and mortality compared to open surgery. Common femoral artery (CFA) access can be achieved percutaneously or through surgical cutdown, with a percutaneous approach gaining more and more popularity. The MANTA vascular closure device (VCD), a collagen plug-based device, has shown promising results in transcatheter aortic valve replacement, but data on its use in percutaneous EVAR (pEVAR), particularly in obese patients, remain limited. Material and Methods: This retrospective study included all patients who underwent pEVAR from October 2018 to December 2022 across three Dutch hospitals and in whom the MANTA VCD has been applied. Patient demographics, perioperative characteristics, and clinical outcomes were recorded. Subgroup analysis was performed based on body mass index (BMI), comparing outcomes in obese (BMI ≥ 30) and non-obese (BMI < 30) patients. Technical success and access site complications were primary and secondary outcomes, respectively. Results: A total of 549 patients (mean age 75.16 ± 7.09 years, 88.9% male) were included, with 140 classified as obese. The MANTA VCD was used in 1024 CFAs. Overall technical success, defined as vascular closure with patent CFA, without requiring immediate surgery, was 98%, with a 3.1% complication rate, primarily due to closure failure. In obese patients, technical success was 98.9%, with a 1.5% complication rate, showing comparable outcomes to non-obese patients. Conclusion: The MANTA VCD is effective and safe for CFA closure in pEVAR, including in obese patients. Given rising obesity rates, the favorable outcomes in this population are encouraging and suggesting a broader applicability in large-bore percutaneous procedures.</p
The cohort effect in solar energy and nuclear power:unveiling collective agency in energy transitions
No full textHow does the collective agency of multiple individual actors shape energy transitions? This paper engages with the many, varying careers of petroleum chemists, engineers and (geo)physicists who got involved in the development of alternative energy sources during the second half of the Twentieth century. In this period alternatives to oil, such as nuclear and solar power, were developed, often with the aid of many actors with roots in the already established oil regime. To preserve the agency of these many individual actors within the broader framework of energy transitions offered by the Multi-Level Perspective (MLP), this paper argues for the inclusion of (generational) cohort theory from the social sciences. Using cohort theory helps us better understand the agency the multi-facetted careers of the studied (oil) actors, often leading them through the revolving door between the political landscape, the existing oil regime, and the new technological niches of solar and nuclear energy