Direct Access Research Articles

L-PRF como alternativa para tratamento de Comunicações Bucossinusais: uma revisão integrativa

Oroantral communication is defined as a direct access between the sinus cavity and the oral cavity. This condition is often accidentally caused during the dental extraction of a tooth whose roots are closely associated with the floor of the maxillary sinus, in addition to oral pathologies and even traumas. The technique of using the L-PRF membrane associated with flaps is widely used for extensive communications and has several advantages. The present study aims to analyze the efficacy of L-PRF in the treatment of existing oroantral communications in the most current literature. An integrative literature review was conducted to list and analyze the efficacy of L-PRF in tissue healing when obtaining the closure of oroantral communications. Scientific articles from 2014 to 2023, published in full in Portuguese and English, were selected and excluded were literature reviews and systematic reviews, articles in languages other than Portuguese and English, repeated articles in the databases, and articles that deviated from the theme proposed in the guiding question chosen. The data search was conducted in Google Scholar, LILACS, and PubMed, through the combination, using the Boolean operator “AND,” of the descriptors in English: “Oroantral Communication,” “L-PRF,” “Maxillary Sinus.” A total of 205 articles were found, but only 9 satisfactorily met the listed criteria. After a careful analysis, it was observed that the authors suggest that the use of the L-PRF membrane insertion technique for tissue healing involved in oroantral communication associated with sutures or flaps for its closure is feasible, effective, and widely spread in modern Dentistry.

Facilitators of and Barriers to the Use of a Digital Self-Management Service for Diagnostic Testing: Focus Group Study With Potential Users.

Health care lags in digital transformation, despite the potential of technology to improve the well-being of individuals. The COVID-19 pandemic has accelerated the uptake of technology in health care and increased individuals' willingness to perform self-management using technology. A web-based service, Directlab Online, provides consumers with direct digital access to diagnostic test packages, which can digitally support the self-management of health. This study aims to identify the facilitators, barriers, and needs of Directlab Online, a self-management service for web-based access to diagnostic testing. A qualitative method was used from a potential user's perspective. The needs and future needs for, facilitators of, and barriers to the use of Directlab Online were evaluated. Semistructured focus group meetings were conducted in 2022. Two focus groups were focused on sexually transmitted infection test packages and 2 were focused on prevention test packages. Data analysis was performed according to the principles of the Framework Method. The Consolidated Framework for Implementation Research was used to categorize the facilitators and barriers. In total, 19 participants, with a mean age of 34.32 (SD 14.70) years, participated in the focus groups. Important barriers were a lack of privacy information, too much and difficult information, and a commercial appearance. Important facilitators were the right amount of information, the right kind of tests, and the involvement of a health care professional. The need for a service such as Directlab Online was to ensure its availability for users' health and to maintain their health. According to the participants, facilitators and barriers were comprehension of the information, the goal of the website, and the overall appearance of the service. Although the service was developed in cocreation with health care professionals and users, the needs did not align. The users preferred understandable and adequate, but not excessive, information. In addition, they preferred other types of tests to be available on the service. For future research, it would be beneficial to focus on cocreation between the involved medical professionals and users to develop, improve, and implement a service such as Directlab Online.

Step height measurement of monoatomic silicon crystal lattice steps with a commercial atomic force microscope

Abstract Precise control of advanced materials relies on accurate dimensional metrology at the sub-nanometre scale. At this scale, the accuracy of scanning probe microscopy (SPM) has been limited by the lack of traceable transfer standard artefacts with calibration structures of suitable dimensions. With the adoption in 2019 of the silicon crystal lattice spacing as a secondary realization of the metre in the International System of Units (SI), SPM users have direct access to a realization of the SI metre at the sub-nanometre level by means of the step height of self-assembled monatomic lattice steps that can form on the surface of silicon crystals. A key challenge of successfully adopting this pathway is establishing the need for established protocols to minimize measurement errors and artifacts in routine laboratory use.
In this study, step height measurements of monoatomic lattice steps in an ordinal/staircase structure on a Si(111) crystal surface have been derived from images acquired with a commercially available, research-level atomic force microscope (AFM). Measurement results derived from AFM images using three different SPM image processing and analysis software packages are compared. Significant sources of measurement uncertainty are identified; principally the contribution from the dependence on scan direction. The calibration of the
AFM derived from this measurment was used to traceably measure the sub-nanometre lattice steps on a silicon carbide crystal surface to demonstrate the viability of this calibration pathway.

Study on the gelatinization and digestive characteristics of wheat starch and potato starch under low moisture conditions

This study explored the gelatinization and digestive characteristics of wheat and potato starches under low moisture conditions using identical processing parameters. The results revealed that potato starch exhibited greater resistance to digestion than wheat starch, with an enzyme hydrolysis rate 18 % to 30 % lower than wheat starch under the same conditions. The analysis of particle size, swelling power, and low-field NMR demonstrated that potato starch required almost 40 % more moisture for full gelatinization than wheat starch, indicating that low-moisture conditions could not meet the significant water demand of potato starch. Additionally, the DSC analysis showed that potato starch had superior thermal stability, with To of 62.13 °C and ΔH of 16.30 (J/g). Subsequently, the microscopy results showed that the partially gelatinized wheat starch had a rough, porous surface, allowing enzymes for direct access to hydrolysis. In contrast, the potato starch had smoother and less damaged particles without visible pores, enzymes had to degrade it progressively, layer by layer. Furthermore, potato starch still exhibited a lower enzyme hydrolysis rate than wheat starch under the same gelatinization levels. Overall, potato starch is more resistant to hydrolysis and gelatinization in low-moisture environments, making potato starch suitable for low-digestibility products like potato biscuits or chips.

Impact of the Lumbar Catheter on the Incidence of Postsurgical Meningitis in the Endoscopic Endonasal Approach

Abstract Objectives Endoscopic endonasal approach (EEA) procedures are inherently contaminated due to direct access through the nasopharyngeal mucosa. The reported rate of postoperative meningitis in EEA procedures is between 0.7 and 10%. Lumbar catheters are used in EEA surgeries to prevent cerebrospinal fluid (CSF) fistulae, but their use is associated with increased infection rates. This study investigated whether there is a difference in rates of postoperative meningitis based on lumbar catheter (LC) utilization. Methods We performed a retrospective review of consecutive patients who underwent EEA surgeries between January 2016 and March 2023 at a single institution (Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia). Main Outcome Incidence of meningitis following EEA surgery with lumbar catheter. Results Seventy-two patients were enrolled, median age was 44 years, and 53% were female. The most frequent surgery performed was craniopharyngioma 46% (26 patients). A LC was used in 28 patients. Meningitis was diagnosed in 11 of 72 patients (15.2%), being higher in the LC group (10 patients). The odds ratio for the development of meningitis in the presence of an LC was 23.38 (95% confidence interval, 2.77–123.78; p < 0.004). There was no statistical difference in the reported incidence of meningitis when CSF leak was present. Conclusions This study demonstrates an extremely high incidence of meningitis (36%) following EEA procedures when an LC is used. The incidence of meningitis was not significantly associated with CSF leak in our cohort.

Analysis of Properties and Macroscopic Defects of Metallic Bars, Pipes, and Strands through the Spectrum of Low-Frequency Excitations

It is demonstrated that the application of piezoelectric sensors to metallic bars and strands can enable determining the status of the integrity of these elements through the spectrum of their acoustic excitations. The voltage output of the piezo, secured to metal bars or strands, is fed to the input of a Fast Fourier Transform analyzer, which allows displaying the spectrum of the excitations from which information on the length, overall quality of the metal, and the presence of defects can be obtained. We show that the analysis, performed on several materials and strands of different lengths, could be useful for cases in which visible inspection and/or direct access to the entire body of the metallic elements is not possible. Applications of our study for testing metallic structures embedded in concrete foundations are reported for construction sites.

Silver-Catalyzed Carbofluorination of Olefins and α-Fluoroolefins with Carbamoyl Radicals.

The reactivity of carbamoyl radicals, generated in situ from sodium oxamate salts, has been investigated in the context of radical carbofluorination reactions of olefins and a-fluoroolefins, respectively. Both transformations are catalyzed by silver salts and required the presence of potassium persulfate (K2S2O8) and SelectfluorTM as a radicophilic fluorine source. The reported methods provide a direct access to beta-fluoroamides and beta,beta-difluoroamides.

Electron Spectroscopy and Microscopy: A Window into the Surface Electronic Properties of Polycrystalline Metal Halide Perovskites.

In the past years, an increasing number of experimental techniques have emerged to address the need to unveil the chemical, structural, and electronic properties of perovskite thin films with high vertical and lateral spatial resolutions. One of these is angle-resolved photoemission electron spectroscopy which can provide direct access to the electronic band structure of perovskites, with the aim of overcoming elusive and controversial information due to the complex data interpretation of purely optical spectroscopic techniques. This perspective looks at the information that can be gleaned from the direct measurement of the electronic band structure of single crystal perovskites and the challenges that remain to beovercame to extend this technique to heterogeneous polycrystalline metal halide perovskites.

Construction and Characteristics Analysis of the Xi’an Public Transport Network Considering Single-Mode and Multi-Mode Transferring

The connectivity of the urban public transport network and the convenience of transfers between modes of transit are important factors that affect whether passengers choose public transport. Identifying the key nodes that affect network connectivity, direct access, transfers, and clarifying the main factors that restrict the network efficiency play important roles in improving the efficiency of the public transport network and establishing a “green city”. On this premise, this paper constructs two single-layer networks and a composite network that can reflect the transfer relationship between ‘bus–bus’, ‘metro–metro’, and ‘metro–bus’ based on the method of Space-P. The composite network realizes the integration study of homogeneous and heterogeneous stops, lines, and transfer relationships in the public transport network. At the same time, five kinds of centrality indexes are applied to the transport transfer network, and the significance of these indexes in the network is explained. Through the comprehensive analysis of these five types of indexes, the key nodes affecting the network connectivity, direct access and transfer efficiency, can be identified more accurately. Taking the public transport network of Xi’an as an example, the structural characteristics of the networks, including scale-free and small-world characteristics, were empirically analyzed. The main stops that play important roles in networks were identified based on the integrated centrality, degrees, and weight degrees. The research results showed the following: (1) Xi’an’s metro network, bus network, and metro–bus composite network all have scale-free and small-world characteristics. (2) The influence of the key stops of the metro network is concentrated, while the influence of the key stops of the bus network is scattered. (3) The public transport network in the first ring road area of Xi’an has the highest degree of direct access, and the core areas of the south, west, and north of Xi’an also have high direct access. However, the direct access in the area east of Xi’an is slightly lower. (4) Xi’an’s bus transport network covers a large area, showing the characteristics of a dual-core “central + southern” network. (5) The metro–bus composite network demonstrates a closer connection between stops and a more balanced network. (6) Finally, the degree of direct access to stops in the bus transport network and metro transport network shows the characteristics of “the single core is dominant, and the circle diffusion weakens step by step”.

Development of the Mobile Application to Prevent Suicide (MAPS), a Personalized Smartphone App for Suicide Prevention: Feedback from Individual Interviews

The goal of this study was to explore preferences regarding the Mobile Application to Prevent Suicide (MAPS), an ecological momentary intervention smartphone app. We conducted individual interviews with 10 adults hospitalized for suicidal ideation or behavior. In these interviews, we asked about participants’ preferences associated with smartphone apps for suicide prevention in general and requested feedback on the specific features of the MAPS intervention. We used line-by-line inductive coding to create a codebook and identify where codes were most prominently displayed. Participants expressed interest in personalized, targeted approaches to suicide prevention, psychoeducation, access to coping strategies, and direct access to crisis services. Involving individuals with lived experience in the early stages is an essential step in the development of a smartphone app for suicide prevention.

An inexpensive, metal-free and one-pot approach towards N-sulfonyl amidines: Identification of a chorismate mutase inhibitor with activities against S. aureus

The simple yet innovative synthetic approaches for the direct access to the diversity based unique class of compounds of potential biological interest are of considerable interest as that can greatly facilitate the efforts in bioorganic / medicinal chemistry and drug discovery. In our efforts, we have developed a metal-free, inexpensive and one-pot method for the facile and direct synthesis of N-sulfonyl amidines that were designed as inhibitors of chorismate mutase. The methodology involved POCl3-SOCl2 promoted reaction of amide with sulphonamide to afford an array of new and unique class of compounds in good to acceptable yields. The methodology is free from the use of additional organic reaction media and amenable for scale-up. Based on in vitro and in silico studies, 3g has been identified as a first example of chorismate mutase inhibitor with selective and promising activities on a range of S. aureus strains. Indeed, the docking of 3g into AlphaFold predicted structure S. aureus CM I (UniProt ID: A0A380DU97) revealed good interactions with stabilization mostly via π-anion interactions in addition to a halogen (fluorine) bond. Compound 3g is of further pharmacological interest.

Prognostic Factors and Treatment Effect Modifiers for Physical Health, Opioid Prescription, and Health Care Utilization in Patients With Musculoskeletal Disorders in Primary Care: Exploratory Secondary Analysis of the STEMS Randomized Trial of Direct Access to Physical Therapist-Led Care.

The aims of the study were to identify prognostic factors associated with health care outcomes in patients with musculoskeletal conditions in primary care and to determine whether characteristics associated with choice of care modify treatment effects of a direct-access physical therapist-led pathway in addition to general practitioner (GP)-led care compared to GP-led care alone. A secondary analysis of a 2-parallel-arm, cluster randomized controlled trial involving general practices in the United Kingdom was conducted. Practices were randomized to continue offering GP-led care or to also offer a direct-access physical therapist-led pathway. Data from adults with musculoskeletal conditions who completed the 6-month follow-up questionnaire were analyzed. Outcomes included physical health, opioid prescription, and self-reported health care utilization over 6 months. Treatment effect modifiers were selected a priori from associations in observational studies. Multivariable regression models identified potential prognostic factors, and interaction analysis tested for potential treatment effect modifiers. Analysis of 767 participants indicated that baseline pain self-efficacy, pain severity, and having low back pain statistically predicted outcomes at 6 months. Higher pain self-efficacy scores at baseline were associated with improved physical health scores, reduced opioid prescription, and less health care utilization. Higher bodily pain at baseline and having low back pain were associated with worse physical health scores and increased opioid prescription. Main interaction analyses did not reveal that patients' age, level of education, duration of symptoms, or musculoskeletal presentation influenced response to treatment, but visual trends suggested those in the older age group proceeded to fewer opioid prescriptions and utilized less health care when offered direct access to physical therapy. Patients with musculoskeletal conditions with lower levels of pain self-efficacy, higher pain severity, and presenting with low back pain have less favorable clinical and health care outcomes in primary care. Prespecified characteristics did not modify the treatment effect of the offer of a direct-access physical therapist-led pathway compared to GP-led care. Patients with musculoskeletal conditions receiving primary care in the form of direct-access physical therapist-led or GP-led care who have lower levels of self-efficacy, higher pain severity, and low back pain are likely to have a less favorable prognosis. Age and duration of symptoms should be explored as potential patient characteristics that modify the treatment response to a direct-access physical therapist-led model of care.

Abstract PO4-10-02: Implementing Just ASK™ to achieve diverse participation and representation in a RCT of chemotherapy-induced peripheral neuropathy

Abstract Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting complication of cancer treatment which disproportionally affects Black patients, and can negatively impact survival and quality of life. Strategies to improve diverse participation and representation in clinical trials are necessary to reduce this health disparity. Methods: To ensure diverse representation in our RCT of CBD vs placebo in patients with grade 2-3 CIPN after treatment with taxane or platinum-based chemotherapy, key evidence-based strategies outlined in the ASCO-ACCC Just ASK™ Training Program were implemented. Eligibility criteria were as inclusive as possible, including CIPN duration up to 2 years and a range of diagnoses: nonmetastatic breast, colorectal, endometrial; and ovarian cancer. Few comorbidities were excluded. The diverse research team engaged every potentially eligible patient with the opportunity to make an informed decision to participate in the study. Using an assets-based approach, the team assessed and addressed social drivers of health (SDoH) and built trust by providing transparency, timely access to all team members, flexible study visits (including telemedicine), and study materials which were comprehensive, understandable, and accessible, within a culture of respect for patient autonomy and privacy. Results: Between 6/1/2020 and 8/8/2022, 230 patients were prescreened, 124 met eligibility, 54 consented and joined, and 46 completed ≥8 of the 12-week treatment phase and were included in the analysis. The study successfully enrolled a participant population that was 30% Black and 67% White (Table), reflecting community demographics of the enrolling facility. Attrition was lower than expected (15% vs 30% assumed in statistical plan) and only 5 of 425 planned study visits for the 46-patient cohort were missed. The most effective strategy to achieve diverse participation was prescreening the electronic medical record (EMR) with daily Epic® and OncoEMR® queries (DQ) by a research assistant. DQ allowed all potentially eligible patients to be approached to participate and yielded about half of enrollees. Also key to success were engaged study champions among medical oncology fellows, oncology nurses, nurse navigators, clinical research coordinators, and research-oriented attending physicians. Some physician referrals were facilitated by the ease of secured texts and EMR messages, and peer recognition; however, few referrals came from non-research-oriented physicians. Eleven of the 54 consented patients were identified to have essential needs and received facilitated social work assistance, including psychosocial support, financial assistance (for monetary grants for direct expenses or access to medical insurance and other benefits); and support for transportation, nutrition; child and eldercare. Of the 11 patients with essential needs, 4 were unable to complete the study due to either personal (3) or medical issues (1). Conclusions: The ASCO-ACCC Just ASK™ approach was successful for diverse clinical trial enrollment with strong protocol adherence and low attrition. Key steps included: study team diversity, a culture of respect and transparency, EMR prescreening, SDoH assessment and solutions, and engagement of research-oriented study champions. As achieving diverse participation in clinical trials is essential to reducing health disparities, the Just ASK™ approach should be considered an essential aspect of clinical trial design and implementation. Table. Baseline Characteristics Total n = 46 Age (Mean/SD) 59.6 (8.8) Gender Male 5 (10.9%) Female 41 (89.1%) Race White 31 (67.4%) Black 14 (30.4%) Other 1 (2.2%) Ethnicity Hispanic 2 (4.4%) Not Hispanic 44 (95.6%) Cancer Type Breast 29 (63.0%) Colo-rectal 9 (19.6%) Ovarian 7 (15.2%) Uterine 1 (2.2%) Citation Format: Marisa Weiss, Muath Giaddui, Stephanie Kjelstrom, Arezoo Ghaneie, Jennifer Hong, Jessica Burrell, Sarah Windawi, Ebuwa Erebor, Barry Mann, Shonalie Roberts, Gabrielle Bidas, Sam Meske, Lisa Saeed, Katherine Aliano Ruiz, Juliana Hibbs, John Marks, David Holtz, Zonera Ali, Aarthi Shevade, Robin Ciocca, Paul Gilman, Sharon Larson, Shoichi Shimamoto, Diana Martinez, Fumiko Chino, Nadine Barrett. Implementing Just ASK™ to achieve diverse participation and representation in a RCT of chemotherapy-induced peripheral neuropathy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-10-02.

Online training for hearing implant surgery : Anew approach to otological training.

Education in microsurgery of the ear includes staged training to allow for mastering of the complex microsurgical procedures, particularly in the context of middle ear reconstruction and cochlear implantation. Traditional surgical training includes temporal bone preparations by cadaver dissection and supervised operating room practice. As these on-site trainings are limited, there is aneed to broaden education facilities in an on-line format. Therefore, afirst basic on-line training for otosurgery was developed. The system consists of an artificial temporal bone model together with aset of basic surgical instruments and implant dummies. As an essential part of the training kit, ahigh-resolution camera set is included that allows for connection to avideo streaming platform and enables remote supervision of the trainees' surgical steps by experienced otological surgeons. In addition, apre-learning platform covering temporal bone anatomy and instrumentation and pre-recorded lectures and instructional videos has been developed to allow trainees to review and reinforce their understanding before hands-on practice. Over the three courses held to date, 28participants with varying levels of prior surgical experience took part in this otological surgical training program. The immediate feedback of the participants was evaluated by means of aquestionnaire. On this basis, the high value of the program became apparent and specific areas could by identified where further refinements could lead to an even more robust training experience. The presented program of an otosurgical online training allows for basal education in practical exercises on aremote system. In this way, trainees who have no direct access to on-site instruction facilities in ear surgery now have the chance to start their otosurgical training in an educational setting adapted to modern technologies.

[Evaluation of Pharmacy Students' Understanding of Clinical Trials and Research through Questionnaires Before and After the Hospital Practical Training].

A questionnaire survey was conducted to evaluate practical training and improve education on clinical trial and research. This survey was based on the results of questionnaire before and after the practical training undertaken by 240 pharmaceutical students (Kanto region; 1 university, Tokai region; 2 university, Kinki region; 9 university) at Mie University Hospital between 2011 and 2022. In the questionnaire before practical training, lectures in university (n=219, 91%) were the main source of information on clinical trials and research. Fifty-two students (22%) correctly answered the contents of phase 1-4 trials. As an occupation that can perform clinical research coordinator (CRC)'s work, only 7 students (3%) answered that "all medical and non-medical professionals" can perform the CRC's duties. Regarding the understanding of terms related to clinical trials and research, more than 90% of the students understood the meaning of "subjects," "informed consent," and "placebo" even before practical training. Otherwise, even after practical training, students' understanding of "reimbursement," "follow-up period," "audit," or "direct access" was less than 80%. Practical training improved the understanding of terms such as clinical trial (Wilcoxon signed-rank test, p<0.001), clinical research phase 1-4 trials (Wilcoxon signed-rank test, p<0.001), interest in clinical trials and research (McNemar-Bowker test, p<0.001), and understanding of CRC's work (McNemar-Bowker test, p<0.001). We will improve the content of practical training and bequeath the knowledge and importance of drug discovery and development to the next generation.

State of art of robotic prostatectomy: the way we do it in Catalonia, Spain

Introduction and objectiveRobotic-assisted laparoscopic prostatectomy (PLAR) seems to improve functional outcomes, however there is not a consensus of a standard procedure. The aim of this study was to identify the PLAR “state of art” in Catalonia, Spain. Material and methodsThis was a cross-sectional survey-based study conducted among urologists across Catalonia, Spain. The survey was distributed through online platforms and the professional urology society. All statistical analyses were performed using Stata software, v20. Results59 urologists completed the survey, revealing PLAR as the most commonly used technique (79.7%). Most urologist (70%) create the pneumoperitoneum using a controlled incision with direct access and 78.3% use the Airseal technology. The intraperitoneal approach is performed in >90% of cases. Endopelvic fascia preservation is not routinely performed. 34.5% of the survey not perform the dorsal vein complex suture. All preserves the bladder neck when oncologically safe. Nerve-vascular bundles bleeding control is performed using standard coagulation or suturing. 34% performed posterior reconstruction. Only use hemostatic devices when evident bleeding and 70% does not routinely left a drainage.Multivariable analysis showed that center volume had a significant independent association with dorsal venous complex suturing (OR 0.073, 95%CI 0.07−0.826), nerve-vascular bundles suturing hemostasis (OR 11.67, 95%CI 1.07−127.60) and endopelvic fascia preservation (OR 13.64, 95%CI 1.087–201.27), but there was no correlation with time the bladder catheter or days hospitalized. ConclusionsThe study provides an overview of the state of PLAR in Catalonia, Spain, showing significant variability and reflecting a commitment to advancing surgical technology and patient care.

Patient direct access to breast services in Ipswich, a pilot experiment

Patient direct access to breast services in Ipswich, a pilot experiment

Cetyltrimethylammonium-chloride assisted in situ metabolic incorporation of nano-sized ROS-generating cascade-reaction containers in Gram-positive and Gram-negative peptidoglycan layers for the control of bacterially-induced sepsis

Cascade-reaction containers generating reactive oxygen species (ROS) as an alternative for antibiotic-based strategies for bacterial infection control, require endogenous oxygen-sources and ROS-generation close to or preferably inside target bacteria. Here, this is achieved by cetyltrimethylammonium-chloride (CTAC) assisted in situ metabolic labeling and incorporation of mesoporous SiO2-nanoparticles, dual-loaded with glucose-oxidase and Fe3O4-nanoparticles as cascade-reaction containers, inside bacterial cell walls. First, azide-functionalized d-alanine (D-Ala-N3) was inserted in cell wall peptidoglycan layers of growing Gram-positive pathogens. In Gram-negatives, this could only be achieved after outer lipid-membrane permeabilization, using a low concentration of CTAC. Low concentrations of CTAC had no adverse effect on in vitro blood clotting or hemolysis nor on the health of mice when blood-injected. Next, dibenzocyclooctyne-polyethylene-glycol modified, SiO2-nanoparticles were in situ click-reacted with d-Ala-N3 in bacterial cell wall peptidoglycan layers. Herewith, a two-step cascade-reaction is facilitated inside bacteria, in which glucose-oxidase generates H2O2 at endogenously-available glucose concentrations, while subsequently Fe3O4-nanoparticles catalyze generation of •OH from the H2O2 generated. Generation of •OH inside bacterial cell walls by dual-loaded mesoporous SiO2-nanoparticles yielded more effective in vitro killing of both planktonic Gram-positive and Gram-negative bacteria suspended in 10 % plasma than SiO2-nanoparticles solely loaded with glucose-oxidase. Gram-positive or Gram-negative bacterially induced sepsis in mice could be effectively treated by in situ pre-treatment with tail-vein injected CTAC and d-Ala-N3, followed by injection of dual-loaded cascade-reaction containers without using antibiotics. This makes in situ metabolic incorporation of cascade-reaction containers as described attractive for further investigation with respect to the control of other types of infections comprising planktonic bacteria. Statement of SignificanceIn situ metabolic-incorporation of cascade-reaction-containers loaded with glucose-oxidase and Fe3O4 nanoparticles into bacterial cell-wall peptidoglycan is described, yielding ROS-generation from endogenous glucose, non-antibiotically killing bacteria before ROS inactivates. Hitherto, only Gram-positives could be metabolically-labeled, because Gram-negatives possess two lipid-membranes. The outer membrane impedes direct access to the peptidoglycan. This problem was solved by outer-membrane permeabilization using a quaternary-ammonium compound. Several studies on metabolic-labeling perform crucial labeling steps during bacterial-culturing that in real-life should be part of a treatment. In situ metabolic-incorporation as described, can be applied in well-plates during in vitro experiments or in the body as during in vivo animal experiments. Surprisingly, metabolic-incorporation proceeded unhampered in blood and a murine, bacterially-induced sepsis could be well treated.

Direct V3 Vertebral Artery Access for Embolization of Partially Thrombosed Fusiform Basilar Trunk Aneurysm: Technical Case Instruction.

Fusiform vertebrobasilar aneurysms carry significant morbidity. Endovascular strategies are preferred; however, unsafe or unfeasible access can call for innovative strategies. An octogenarian patient with an enlarging fusiform proximal basilar artery aneurysm causing a sixth nerve palsy was found to have multiple anatomic features that precluded a transradial or transfemoral endovascular approach. She was thus treated with direct microsurgical access of the V3 segment of the vertebral artery for subsequent coil embolization and flow diversion. This case introduces a novel combined microsurgical and endovascular strategy for treating a complex partially thrombosed fusiform basilar artery aneurysm. This approach should be reserved only for patients where conventional endovascular access is dangerous or unfeasible.

Exploring the Efficacy of Learning Techniques in Model Extraction Attacks on Image Classifiers: A Comparative Study

In the rapidly evolving landscape of cybersecurity, model extraction attacks pose a significant challenge, undermining the integrity of machine learning models by enabling adversaries to replicate proprietary algorithms without direct access. This paper presents a comprehensive study on model extraction attacks towards image classification models, focusing on the efficacy of various Deep Q-network (DQN) extensions for enhancing the performance of surrogate models. The goal is to identify the most efficient approaches for choosing images that optimize adversarial benefits. Additionally, we explore synthetic data generation techniques, including the Jacobian-based method, Linf-projected Gradient Descent (LinfPGD), and Fast Gradient Sign Method (FGSM) aiming to facilitate the training of adversary models with enhanced performance. Our investigation also extends to the realm of data-free model extraction attacks, examining their feasibility and performance under constrained query budgets. Our investigation extends to the comparison of these methods under constrained query budgets, where the Prioritized Experience Replay (PER) technique emerges as the most effective, outperforming other DQN extensions and synthetic data generation methods. Through rigorous experimentation, including multiple trials to ensure statistical significance, this work provides valuable insights into optimizing model extraction attacks.