Full Relief Research Articles

Enhanced thermomechanical fatigue resistance in W10Re alloys: Microstructural and surface engineering approaches

Thermomechanical fatigue of refractory metals is commonly observed in high-temperature environments like first walls and divertors for proposed fusion reactors or X-ray anodes for medical imaging. Typically, alloying with rhenium or optimized microstructures are employed to counteract or delay the detrimental effects of fatigue in tungsten. Additionally, a novel concept is the utilization of surface structures to compensate cyclic thermal stresses. This work aimed to investigate the combination of these approaches, by comparing two W10Re alloys with vastly different microstructures, as well as engineered surface conditions of varying scales. Samples were subjected to thermocyclic fatigue under pulsed electron beam exposure, mimicking the surface temperatures typically encountered in a rotating X-ray anode. Analysis of several in-situ data streams, post-mortem investigations by metallography, and finite element methods revealed the interplay between microstructure and surface modifications. The columnar microstructure exhibited higher resistance to severe surface damage compared to the globular one, linked to the deflection of cracks along grain boundaries and subsequent melting. Coarse structuring was found to partly relieve the surface stresses during thermal cycling, preventing most of the damage accumulation. A full damage relief and performance equivalence between columnar and globular microstructure was achieved by engineering fine-structured surfaces, which led to a ten-fold increase in fatigue resistance over the non-structured condition.

Comparative effectiveness of new pharmacotherapy regimens for mild COVID-19 based on symptom resolution dynamics

the treatment of COVID-19 remains a challenging issue worldwide due to the huge economic losses to society as a result of the disease's widespread prevalence, peculiarities of its course and complications of its development. The purpose of the work was comparative analysis of the effectiveness of new treatment regimens for outpatients with mild COVID-19. 64 medical charts of outpatient diseases with a mild course of COVID-19 were studied. Depending on the treatment regimen used, all patients were divided into two groups that received inhaled ACEs or antiviral therapy with the combination drug nortrelvir/ritonavir. The efficacy of each pharmacotherapeutic alternative would be determined on the basis of retrospective data for the timeframe of normalisation of clinical and laboratory parameters. A rule was established that the set of all clinical and laboratory parameters in the normal range is considered as a clinical endpoint. It was found that the use of ACC treats the disease until the rapid disappearance of clinical symptoms, especially in the first treatment, which works on its rapid therapeutic effect in the initial stages. Nirmatrelvir/ritonavir has also been shown to be effective in reducing symptoms, but its effect is incremental, reaching full relief slightly later than in ACC. Modeling of the dynamics of reaching the clinical point of elimination of all clinical symptoms indicates a pharmacoeconomic advantage of the use of ACC over nirmatrelvir/ritonavir, if the additional costs of treatment do not exceed the cost of three days of treatment.

Evaluating the Efficacy of a Digital Therapeutic (CT-152) as an Adjunct to Antidepressant Treatment in Adults With Major Depressive Disorder: Protocol for the MIRAI Remote Study.

Major depressive disorder (MDD) is common worldwide and can be highly disabling. People with MDD face many barriers to treatment and may not experience full symptom relief even when treated. Therefore, new treatment modalities are needed for MDD. Digital therapeutics (DTx) may provide people with MDD an additional treatment option. This study aimed to describe a phase 3 remote, multicenter, randomized, masked, sham-controlled trial evaluating the efficacy of a smartphone app-based DTx (CT-152) in adult participants diagnosed with MDD, used as an adjunct to antidepressant therapy (ADT). Participants aged 22-64 years with a current primary diagnosis of MDD and an inadequate response to ADT were included. Participants were randomized 1:1 to CT-152 or a sham DTx. CT-152 is a smartphone app-based DTx that delivers a cognitive-emotional and behavioral therapeutic intervention. The core components of CT-152 are the Emotional Faces Memory Task exercises, brief lessons to learn and apply key therapeutic skills, and SMS text messaging to reinforce lessons and encourage engagement with the app. The sham DTx is a digital working memory exercise with emotionally neutral stimuli designed to match CT-152 for time and attention. Participants took part in the trial for up to 13 weeks. The trial included a screening period of up to 3 weeks, a treatment period of 6 weeks, and an extension period of 4 weeks to assess the durability of the effect. Sites and participants had the option of an in-person or remote screening visit; the remaining trial visits were remote. Efficacy was evaluated using the Montgomery-Åsberg Depression Rating Scale, the Generalized Anxiety Disorder-7, Clinical Global Impression-Severity scale, the Patient Health Questionnaire-9, and the World Health Organization Disability Assessment Schedule 2.0. The durability of the effect was evaluated with the Montgomery-Åsberg Depression Rating Scale and Generalized Anxiety Disorder-7 scale. Adverse events were also assessed. Satisfaction, measured by the Participant and Healthcare Professional Satisfaction Scales, and health status, measured by the EQ-5D-5L, were summarized using descriptive statistics. This study was initiated in February 2021 and had a primary completion date in October 2022. This represents the methodological design for the first evaluation of CT-152 as an adjunct to ADT. This study protocol is methodologically robust and incorporates many aspects of conventional pivotal pharmaceutical phase 3 trial design, such as randomization and safety end points. Novel considerations included the use of a sham comparator, masking considerations for visible app content, and outcome measures relevant to DTx. The rigor of this methodology will provide a more comprehensive understanding of the effectiveness of CT-152. ClinicalTrials.gov NCT04770285; https://clinicaltrials.gov/study/NCT04770285. RR1-10.2196/56960.

An “Older Old” Woman with Large Squamous Cell Carcinoma of the Nasal Pyramid: Excellent Response to Ultra-Hypofractionated Radiation Therapy

A 98-year-old patient with cognitive impairment and a history of squamous cell carcinoma of the nasal pyramid was referred to the radiation oncology department of our institution’s hospital given that surgery was not recommended. The lesion was sized 6 × 6 cm, ulcerated, and bleeding; was significantly impairing the patient’s health-related quality of life, causing pain; and was not responsive to analgesics, including opioids. The patient experienced deterioration of her general conditions, with a Karnofsky performance status of 40. A single radiotherapy (RT) fraction was delivered on a weekly basis for 3 weeks, up to a total dose of 21 Gy, using a VMAT technique (7 Gy/fraction). The patient was given three fractions of radiotherapy, during which she received continuous assistance due to episodes of mental disorientation and an altered sense of consciousness. One month after the conclusion of the treatment, the patient exhibited a nearly complete clinical response, with full pain relief and an improved health-related quality of life. This favourable clinical outcome was maintained for a period of four months following the conclusion of RT. A brief review was performed on the role of hypofractionated radiation therapy in elderly patients with locally advanced skin cancer of the head and neck region.

A systematic review and meta-analysis of the dietary fiber menu provision and consumption for older adults living in residential care facilities

BackgroundOlder adults living in residential care facilities are commonly given laxatives to treat constipation; however, these may not always provide full relief, and side effects include diarrhea. Dietary fiber effectively prevents constipation, and international guidelines recommend 25 g/d for optimal laxation. Older adults in residential care rely on the facility menu to provide their nutritional requirements, including adequate dietary fiber. Little is known about how much dietary fiber is provided and consumed. ObjectivesWe aimed to determine the provision and consumption of dietary fiber for older adults living in residential care facilities. MethodsWe systematically searched available literature for studies reporting the analysis of residential care menus and meals consumed by residents aged over 65 y. A meta-analysis was performed on the studies that provided the mean amount of dietary fiber provided and consumed by residents. A random effect model was applied due to the heterogeneity of study methodologies. ResultsThe literature search yielded 4406 publications, but only 28 studies were eligible for our meta-analysis. The study sample comprised 4817 residents. The mean amount of fiber provided to residents was 21.4 g/d [standard error (SE): 1.2; 95% confidence interval: 18.8, 24.2 g/d], the mean amount of fiber consumed by residents was 15.8 g/d (SE: 0.6; 95% confidence interval: 14.7, 16.9 g/d). ConclusionsOlder adults living in care facilities are provided with dietary fiber below the recommended guidelines. Compounding this is that residents consume much less than what is provided and do not meet the recommendations for dietary fiber consumption. There is scope to improve dietary fiber provision, promote consumption to residents to aid laxation, and potentially reduce laxative use and the unwanted side effects of diarrhea.This trial was registered at PROSPERO as CRD42023427265.

Black spirituals for Irish evangelicals: the Fisk Jubilee Singers’ Irish tours, 1873–6

AbstractFrom 1873 to 1876, the Fisk Jubilee Singers, an African-American choral troupe from Nashville, Tennessee visited Ireland three times. This article details their experiences and impressions of the country, focusing especially on the relationship they forged with their Irish evangelical sponsors and audiences. While the Jubilee Singers’ story is typically told as an inspirational tale of triumph over adversity, this article argues that there is another way of framing the narrative that emphasises the centrality of evangelical Protestantism to the Jubilee Singers’ mission. The Irish tours brought this dimension into full relief, demonstrating how evangelicalism fostered a degree of mutual understanding between the singers and Irish Protestants while also serving to exclude Irish Catholics. This article also examines audience responses to the Jubilee Singers, particularly the racial and aesthetic concepts they used to describe them. For all that the singers were familiar on account of their faith, they were unfamiliar on account of their race; this tension structured not only Irish responses to the singers, but also the singers’ responses to Ireland.

Successful high-resolution three-dimensional electroanatomical mapping and radiofrequency catheter ablation of a posteroseptal accessory pathway in a dog using CARTO 3

A one-year-and-seven-month-old, 28 kg, male castrated crossbreed dog was presented for supraventricular tachycardia causing recurrent episodes of anorexia and lethargy. Sotalol (2.2 mg/kg q12 h) reduced the frequency of symptomatic episodes but did not provide full relief. Three-dimensional electroanatomical mapping was performed at the Ghent University Small Animal Teaching hospital using the CARTO 3. Right atrial activation mapping identified the earliest atrial activation right posteroseptal, near the tricuspid annulus. Fast retrograde ventriculoatrial conduction during tachycardia and extrastimulus testing confirmed the presence of a concealed right posteroseptal accessory pathway. Six radiofrequency catheter ablation applications were delivered, and tachycardia remained uninducible. The dog recovered well from the procedure. Sotalol was stopped three weeks later, and no more clinical signs were noted by the owner. Repeated 24-hour electrocardiography monitoring on day one and at one, three, and 12 months after the procedure showed no recurrence of tachycardia.

Evaluation of procedural pain for neonates in a neonatal intensive care unit: a single-centre study

BackgroundTo evaluate the procedural pain experienced by neonates in a neonatal intensive care unit (NICU) setting and determine the corresponding pain grades.MethodsTwo experienced nurses independently used the Neonatal Infant Pain...

Stereotactic Radiosurgery for Trigeminal Neuralgia: A Comparison of Proximal and Distal Isocenter Outcomes

Trigeminal neuralgia is a chronic pain condition of the trigeminal nerve affecting 12 per 100,000 people. Stereotactic radiosurgery (SRS) delivered by both a non-invasive stereotactic radiosurgery instrument and linear accelerators (LINAC) is a non-invasive alternative to surgical approaches. Although SRS in this setting is commonly performed, there lacks a consensus and comparative data on the optimal anatomical target with the two most common targets being the dorsal root entry zone (proximal) and retrogasserian zone (distal). This study aims to evaluate treatment outcomes in patients based on these two target locations. This multi-center, retrospective analysis included patients treated for trigeminal neuralgia between 2017 and 2021 with GK and LINAC-based SRS who were followed for at least 1 year. All patients received a dose of 85 Gy prescribed to the isocenter, set at the dorsal root entry zone (proximal) or the retrogasserian zone (distal). Isocenter location was based on the preference of the radiation oncologist and neurosurgeon. Patient reported clinical pain relief was recorded as full, partial, or no pain relief after SRS. Among patients with full and partial pain relief duration of pain relief was recorded. Ability to achieve full or partial medication de-escalation was also recorded. Outcomes of patients in the proximal and distal target cohort were compared using time based univariate analyses using log rank hazards model. We identified 86 eligible patients, of whom 54 patients (63%; median age 63, 72% female) were treated using a proximal target, and 32 (37%; median age 66, 71% female) were prescribed to a distal target. In the proximal and distal cohorts, patients experienced pain relief (either partial or full relief) at a rate of 74% and 90% and full pain relief at a rate of 46% and 31%, respectively (p = 0.011). The duration of pain relief was not significantly different amongst the two groups (p = 0.18). Partial medication de-escalation was more frequent in the distal target (75%) vs proximal (33%), while full medication de-escalation was more frequent with proximal (39%) vs distal (13%), p = 0.001. This study contributes to the limited data evaluating the differences in outcomes between proximal and distal targeting for treatment of trigeminal neuralgia with stereotactic radiosurgery. Overall, this study confirms that both approaches achieve a high rate of response in a difficult to control disease process. Our study suggests that a distal isocenter may be associated with higher rates of any type of pain improvement while a proximal isocenter may be associated with higher rates of complete pain relief. This data is hypothesis-generating and warrants further investigation into the effectiveness/toxicity differences of two approaches.

Risk factors for recurrence of post-dural puncture headache following an epidural blood patch: a retrospective cohort study

IntroductionPost-dural puncture headache (PDPH) occurs in 0.38–6.3% of neuraxial procedures in obstetrics. Epidural blood patch (EBP) is the standard treatment but fails to provide full symptom relief in 4–29% of cases. Knowledge of the risk factors for EBP failure is limited and controversial. This study aimed to identify these risk factors. MethodsWe performed a retrospective cohort study using electronic records of 47920 patients who underwent a neuraxial procedure between 2001 and 2018 in a large maternity hospital in Switzerland. The absence of full symptom relief and the need for further treatment was defined as an EBP failure. We performed univariate and multivariate analyses to compare patients with a successful or failed EBP. ResultsWe identified 212 patients requiring an EBP. Of these, 55 (25.9%) had a failed EBP. Signs and symptoms of PDPH did not differ between groups. While needle size and multiple pregnancies were risk factors in the univariate analysis, mostly those related to the performance of the EBP remained significant following adjustment. The risk of failure increased when the epidural space was deeper than 5.5 cm (OR 3.08, 95% CI 1.26 to 7.49) and decreased when the time interval between the initial dural puncture and the EBP was >48 h (OR 0.20, 95% CI 0.05 to 0.83). ConclusionPersistence of PDPH following a first EBP is not unusual. Close attention should be given to patients having their EBP performed <48 h following injury and having an epidural space located >5.5 cm depth, as these factors are associated with a failed EBP.

Anconeus epitrochlearis muscle (epitrochlearisanconeus muscle; Musculus epitrochleoanconeus) with cubital tunnel syndrome – a rare but relevant clinical entity

BackgroundCompression of the ulnar nerve at the elbow within the cubital tunnel is related to the anatomical structures and is generally believed to be caused by Osborne's ligament (also known as the cubital retinaculum). However, in rare cases an anatomical variation of the developmental peculiarity of a remaining anconeus epitrochlearis muscle may be responsible for the disease. MethodsWe present a series of five cases in which an anconeus epitrochlearis muscle was found as the cause of illness. ResultsAll patients presented with typical symptoms of numbness and tingling in the hand and ulnar fingers, and recurring pain as well as weakness of the ulnar innervated muscles. With neurophysiologically confirmed diminished nerve conduction velocity and unsuccessful conservative treatment, surgical decompression revealed an anconeus epitrochlearis muscle as the reason of compression. Full symptom relief was achieved immediately after the procedure in all cases. ConclusionsThis article strives to call attention to this entity when diagnosing ulnar nerve compression. Myectomy and medial epicondylectomy is the preferred treatment option in such cases.

MEDIUM-TERM OUTCOMES OF TRANSFEMORAL OSSEOINTEGRATION IN ASSOCIATION WITH TOTAL HIP ARTHROPLASTY

IntroductionTransfemoral osseointegration (TFOI) for amputees has substantial literature proving superior quality of life and mobility versus a socketed prosthesis. Some amputees have hip arthritis that would be relieved by a total hip replacement (THR). No other group has reported performing a THR in association with TFOI (THR+TFOI). We report the outcomes of eight patients who had THR+TFOI, followed for an average 5.2 years.Materials &amp; MethodsOur osseointegration registry was retrospectively reviewed to identify all patients who had TFOI and also had THR, performed at least two years prior. Six patients had TFOI then THR, one simultaneous, one THR then TFOI. All constructs were in continuity from hip to prosthetic limb. Outcomes were: complications prompting surgical intervention, and changes in subjective hip pain, K-level, daily prosthesis wear hours, Questionnaire for Persons with a Transfemoral Amputation (QTFA), and Short Form 36 (SF36). All patients had clinical follow-up, but one patient did not have complete mobility and quality of life survey data at both time periods.ResultsFour (50%) were male, average age 52.7±14.8 years. Three patients (38%) had amputation for trauma, three for osteosarcoma, one each (13%) infected total knee and persistent infection after deformity surgery. One patient died one year after THR+TOFA from subsequently diagnosed pancreatic cancer. One patient had superficial debridement for infection with implant retention after five years. No implants were removed, no fractures occurred. All patients reported severe hip pain preoperatively versus full relief of hip pain afterwards. K-level improved from 0/8=0% K&gt;2 (six were wheelchair-bound) to 5/8=63% (p=.026). At least 8 hours of prosthesis wear was reported by 2/7=29% before TOFA vs 5/7=71% after (p=.286). The QTFA improved in all categories, but not significantly: Global (40.0±21.6 vs 60.0±10.9, p=.136), Problem (50.2±33.2 vs 15.4±8.4, p=.079), and Mobility (35.9±26.8 vs 58.3±30.7, p=.150). The SF36 also improved minimally and not significantly: Mental (53.6±12.0 vs 54.7±4.6, p=.849) and Physical (32.5±10.9 vs 36.3±11.2, p=.634).ConclusionsTHR+TFOI is a successful reconstruction option for amputees who desire relief from severe pain related to hip joint degeneration, and also the opportunity for improved mobility and quality of life that TFOI typically confers. In our cohort, the procedure proved safe: no associated deaths, no removals, one soft tissue debridement. Mobility improved markedly. Quality of life improved, but not to significant thresholds as measured by the surveys. THR+TFOI appears safe and reasonable to offer to transfemoral amputees with painful hip joint degeneration.

Achieving high strength with low residual stress in WAAM SS316L using flow-forming and heat treatment

Preformed cylinder made of wire and arc additive manufacturing (WAAM) using 316 L stainless steel (SS316L) was used for a flow-forming operation to achieve a high-strength thin-walled cylinder. It was shown that the material can undergo large plastic deformation in the as-built condition without any heat treatment before the flow-forming operation. However, the flow-forming's high reduction in tube thickness and length increase generates large amounts of residual stresses that must be reduced or eliminated by appropriate heat treatment. In this work, different heat treatments on the final tube were investigated within the temperature range of 400–800 °C in air and in vacuum.The variation in the heat treatment temperatures was observed to directly influence the residual stress values from very high initially down to almost zero at the highest temperature. It was observed on the other hand, that up to ca. 20% strengthening could be gained by heat treatments up to 600 °C, while the residual stress decreased, in comparison to the post-deformation state, as in the case of anneal-hardening. It is only past this phase that the “classical” full stress relief, with corresponding strength reduction, was achieved at 800 °C.

Efficacy and safety of endoscopic septoplasty for treating nasal septal deviations compared with conventional septoplasty: A systematic review and meta-analysis.

We assessed the effects and safety of endoscopic septoplasty in patients with nasal septal deviations (NSD), compared with those of conventional septoplasty. Systematic review and meta-analysis. Patients who have undergone various endoscopic septoplasty procedure, such as hemitransfixion incision, incision at the deviated site and Killian incision, and conventional septoplasty. Six databases were searched up to April 2022. We analysed studies comparing improvements in NSD-related symptoms and post-operative complications between endoscopic septoplasty and control (conventional septoplasty) groups. A total of 38 articles with 2733 individuals were included. There were no significant differences in operative time (-0.4354, 95% confidence interval [CI: -1.1670; 0.2962]) or intra-operative bleeding (-1.3011 [-2.8003; 0.1981]) between the two groups. In the endoscopic septoplasty group, the change in nasal obstruction symptom evaluation score (9.5143 [5.4613; 13.5674] was statistically higher and the incidence of mucosal tearing (0.2766 [0.1889; 0.4049]) was lower. The incidences of full relief from symptoms such as headache (2.1996 [1.6896; 2.8634]), hyposmia (4.4468 [2.6806; 7.3767]), nasal obstruction (5.9871 [4.3292; 8.2800]), post-nasal drip (4.7241 [3.4086; 6.5472]) and snoring (2.9980 [1.2622; 7.1211]) were significantly higher in the endoscopic septoplasty group. In terms of post-operative endoscopic findings, epistaxis (0.3043 [0.1969; 0.4703]), hematoma (0.2022 [0.0785; 0.5213]), nasal obstruction 0.3373 [0.1334; 0.8527]), residual posterior septal deviation (0.1562 [0.0921; 0.2650]), septal perforation (0.2286 [0.1069; 0.4889]), residual spur (0.1294 [0.0602; 0.2780]) and synechia (0.2537 [0.1849; 0.3483]) were significantly less common in the endoscopic septoplasty group. Endoscopic septoplasty better relieved NSD-related symptoms and reduced surgery-related complications compared to conventional septoplasty.

Post COVID‐19 Cerebral Venous Thrombosis presenting as Acute Dementia

AbstractBackgroundCoronavirus disease (COVID‐19) is an infectious disease caused by SARS‐CoV‐2 virus which may lead to various neurological complications as reported in the literature. One important complication is CVT (Cerebral Venous Thrombosis) which classically presents as acute headache, seizures and focal neurological deficits. We report an interesting and rare case presentation of CVT here.MethodA 32 year old female presented to ER with history of progressive forgetfulness since 4 days. She had difficulty in remembering recent activities and names of close associates. This was followed by holocranial headache after 2 days. She had history of COVID‐19 infection 20 days before the symptom onset. With the suspicion of acute vascular event, she was subjected to brain imaging.ResultMRI brain with MR venogram showed left temporal venous infarct along with left transverse sinus and superior sagittal sinus thrombosis. She was treated with heparin and acenocoumarol subsequently along with supportive care with full relief in her symptoms.ConclusionCVT is now a known complication of COVID‐19 infection. It is generally an acute condition presenting with its classical features. However, it can also rarely present with other manifestations like acute cognitive decline or rapidly progressive dementia. Careful approach towards clinical presentation with appropriate diagnostic testing can quickly identify this condition for proper and timely treatment.

Mechanisms of Action in Exposure Therapy.

Exposure therapy is an effective treatment for anxiety-related disorders, but many individuals do not achieve full symptom relief, and return of fear is a common occurrence. Understanding how exposure therapy works enables further development of strategies to improve its effectiveness. Recent studies have examined mechanisms of exposure-based interventions across multiple levels of analysis, from cognitive and behavioral changes that occur during treatment to the neurobiological mechanisms underlying fear extinction. Belief change and reductions in safety behaviors and avoidance mediate symptom improvements during exposure therapy, suggesting plausible cognitive and behavioral mechanisms. On the neural level, increased activation of prefrontal regions during extinction learning is a likely mechanism of exposure. Improved understanding of the biological mechanisms of exposure have led to exciting developments in clinical research, including pharmacological augmentation, though clinical translation of basic research has produced mixed results. Though still in development, such translational research is a promising future direction for exposure-based interventions.

Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort

ObjectivePrior research on median arcuate ligament syndrome has been limited to institutional case series, making the optimal approach to median arcuate ligament release (MALR) and resulting outcomes unclear. In the present study, we compared the outcomes of different approaches to MALR and determined the predictors of long-term treatment failure. MethodsThe Vascular Low Frequency Disease Consortium is an international, multi-institutional research consortium. Data on open, laparoscopic, and robotic MALR performed from 2000 to 2020 were gathered. The primary outcome was treatment failure, defined as no improvement in median arcuate ligament syndrome symptoms after MALR or symptom recurrence between MALR and the last clinical follow-up. ResultsFor 516 patients treated at 24 institutions, open, laparoscopic, and robotic MALR had been performed in 227 (44.0%), 235 (45.5%), and 54 (10.5%) patients, respectively. Perioperative complications (ileus, cardiac, and wound complications; readmissions; unplanned procedures) occurred in 19.2% (open, 30.0%; laparoscopic, 8.9%; robotic, 18.5%; P < .001). The median follow-up was 1.59 years (interquartile range, 0.38-4.35 years). For the 488 patients with follow-up data available, 287 (58.8%) had had full relief, 119 (24.4%) had had partial relief, and 82 (16.8%) had derived no benefit from MALR. The 1- and 3-year freedom from treatment failure for the overall cohort was 63.8% (95% confidence interval [CI], 59.0%-68.3%) and 51.9% (95% CI, 46.1%-57.3%), respectively. The factors associated with an increased hazard of treatment failure on multivariable analysis included robotic MALR (hazard ratio [HR], 1.73; 95% CI, 1.16-2.59; P = .007), a history of gastroparesis (HR, 1.83; 95% CI, 1.09-3.09; P = .023), abdominal cancer (HR, 10.3; 95% CI, 3.06-34.6; P < .001), dysphagia and/or odynophagia (HR, 2.44; 95% CI, 1.27-4.69; P = .008), no relief from a celiac plexus block (HR, 2.18; 95% CI, 1.00-4.72; P = .049), and an increasing number of preoperative pain locations (HR, 1.12 per location; 95% CI, 1.00-1.25; P = .042). The factors associated with a lower hazard included increasing age (HR, 0.99 per increasing year; 95% CI, 0.98-1.0; P = .012) and an increasing number of preoperative diagnostic gastrointestinal studies (HR, 0.84 per study; 95% CI, 0.74-0.96; P = .012) Open and laparoscopic MALR resulted in similar long-term freedom from treatment failure. No radiographic parameters were associated with differences in treatment failure. ConclusionsNo difference was found in long-term failure after open vs laparoscopic MALR; however, open release was associated with higher perioperative morbidity. These results support the use of a preoperative celiac plexus block to aid in patient selection. Operative candidates for MALR should be counseled regarding the factors associated with treatment failure and the relatively high overall rate of treatment failure.

Racial equity in eligibility for a clean slate under automatic criminal record relief laws

AbstractStates have begun to pass legislation to provide automatic relief for eligible criminal records, potentially reducing the lifelong collateral consequences of criminal justice involvement. Yet numerous historical examples suggest that racially neutral policies can have profoundly disparate effects across racial groups. In the case of criminal record relief, racial equity in eligibility for a clean slate has not yet been examined. We find that in California, one in five people with convictions met criteria for full conviction relief under the state's automatic relief laws. Yet the share of Black Americans eligible for relief was lower than White Americans, reproducing racial disparities in criminal records. We identify two policy amendments that would reduce the share of Black men in California with convictions on their criminal records from 22% to 9%, thereby narrowing the difference compared to White men from 15 to seven percentage points. Put another way, an additional one in seven Black men currently has a conviction record, compared to their White counterparts. This would decline to an additional one in 14 if both hypothetical policy amendments were incorporated. We close with discussion of criminal history data quality limitations, which pose a second key challenge to equitable implementation of automatic criminal record relief reforms nationwide.

Full Diabetic Foot Ulcer Healing and Pain Relief Based on Platelet-Rich-Plasma gel Formulation Treatment and the Involved Pathways.

Diabetic foot ulcer is a severe Diabetic Mellitus-associated complication. It is induced by poor glycemic control, which leads to peripheral neuropathy and vascular diseases. Platelet-rich plasma could be beneficial for healing processes due to its active biomolecules that promotes immunomodulation, angiogenesis, cell proliferation and analgesia.

Endoskopická léčba refluxní nemoci jícnu pomocí radiofrekvenční energie (Stretta procedura) – ošetření prvních pacientů v České republice

Gastroesophageal reflux disease (GERD) is the most common disease of the gastrointestinal tract, affecting approximately a quarter of the European population with an increasing incidence. Some patients with GERD do not get full relief with conservative approach with proton pump inhibitors (PPI), while surgical solution is burdened with a significant percentage of complications and its effectiveness decreases over time. Endoscopic therapy of GERD currently includes five different methods, none of which have, to the knowledge of the authors, been more widely available and performed in the Czech Republic. The methods of electrical oesophageal stimulation, endoscopic fundoplication and Stretta have the potential to be used in practice. The latter method consists in the application of a low-frequency radiofrequency energy to the oesophagogastric junction (EGJ). According to the data published so far, it is probably a less effective alternative to laparoscopic fundoplication for patients with hiatal hernia ≤ 2 cm and failed conservative treatment, but its favourable safety profile, absence of EGJ anatomy alteration, repeatability and long-time effect in most patients are its undeniable advantages. On the other hand, the need to select suitable patients for the procedure and higher costs are among its disadvantages. Despite its limitations, Stretta offers an alternative option in the future for selected patients who would like to avoid the risks associated with long-term PPIs and are concerned about the risks of laparoscopic fundoplication. Keywords gastroesophageal reflux disease, endoscopic therapy, radiofrequency energy, Stretta