Individual Approach Research Articles

Laparoscopic parastomal hernia repair: keyhole, Sugarbaker, sandwich, or hybrid technique with 3D mesh? An updated systematic review and meta-analysis

PurposeParastomal hernia is the most common complication after stoma formation with an incidence that approaches 50% at 2 years postoperatively. In the last decade, different approaches of minimally invasive procedures have been proposed for the treatment of parastomal hernia. Nevertheless, the superiority of one technique over the others remains still unclear. Our objective was to update and systematically analyze current state of research concerning the postoperative outcomes of the four most prevalent minimally invasive techniques.MethodsA systematic literature search of three databases (Medline, Scopus, Google Scholar) was undertaken for articles published from January 2015 to November 2022. Fifteen studies from a previous meta-analysis on the topic were included.ResultsThirty-three studies incorporating 1289 total patients were deemed eligible for inclusion in the final analysis. The keyhole technique was associated with the highest incidence of postoperative complications and recurrences (31.3% and 24.1%, respectively), followed by the Sugarbaker technique (27.6% and 9%, respectively). Operative time was among the lowest in patients operated with the 3D mesh technique, while patients undergoing the keyhole technique experienced the shortest cumulative length of hospital stay (6 days).ConclusionEach technique demonstrates a unique profile of effectiveness offset by the propensity towards developing postoperative complications. While no conclusive evidence on the optimal technique exist to date, newer minimally invasive techniques show promising results, albeit based on limited data. The future of parastomal hernia repair seems to rely on a highly individualized approach, tailored to the distinctive characteristics of both the hernia and the patient.

The Principles and Techniques of Artur Schnabel’s Performance of the Piano Sonatas by Ludwig van Beethoven

The piano sonatas by Ludwig van Beethoven (1770–1827) represent the highest achievement of the First Viennese School in modern piano performance. The complexity and depth of the stage interpretation requires the study of the composer’s music based on its performance specifics. The study of the features of the piano sonata works by Beethoven on the example of performances by Artur Schnabel, one of the most prominent pianists of the twentieth century, will enrich modern knowledge about the style of Beethoven’s piano works. The objectives of the paper are to characterize the genre and stylistic features of Beethoven’s sonata works and to study the performing features of the German composer’s sonatas in Schnabel’s interpretation. Rationalistic approach is not typical for Schnabel’s interpretation of Beethoven’s sonatas. On the contrary, his performance has romantic features in terms of strength and depth of feeling but is classical in terms of the proportionality of expressive means. His performance impresses with its philosophical orientation and epic spirit. What is especially important to him in the musical composition is an individual approach to the intonation of recitatives, cadences, syncopation, and those stylistic components of playing that form an original interpretation of Beethoven’s music. Schnabel embodies Beethoven’s concepts on the basis of integrity, starting from the epic characteristics of Beethoven’s work

Using individual approach to examine the association between urban heat island and preterm birth: A nationwide cohort study in China

BackgroundEvidence suggests that maternal exposure to heat might increase the risk of preterm birth (PTB), but no study has investigated the effect from urban heat island (UHI) at individual level. AimsOur study aimed to investigate the association between individual UHI exposure and PTB. MethodsWe utilized data from the ongoing China Birth Cohort Study (CBCS), encompassing 103,040 birth records up to December 2020. UHI exposure was estimated for each participant using a novel individual assessment method based on temperature data and satellite-derived land cover data. We used generalized linear mixed-effects models to estimate the association between UHI exposure and PTB, adjusting for potential confounders including maternal characteristics and environmental factors. ResultsConsistent and statistically significant associations between UHI exposure and PTB were observed up to 21 days before birth. A 5 °C increment in UHI exposure was associated with 27 % higher risk (OR = 1.27, 95 % confident interval: 1.20, 1.34) of preterm birth in lagged day 1. Stratified analysis indicated that the associations were more pronounced in participants who were older, had higher pre-pregnancy body mass index level, of higher socioeconomic status and living in greener areas. ConclusionMaternal exposure to UHI was associated with increased risk of PTB. These findings have implications for developing targeted interventions for susceptible subgroups of pregnant women. More research is needed to validate our findings of increased risk of preterm birth due to UHI exposure among pregnant women.

Potential of hydrogel treatment in forest regeneration: impact on growth and vitality of Central European tree species

IntroductionDrought negatively affects the growth and yield of plants. Several measures have been employed to improve the drought tolerance of plants, including the application of superabsorbent hydrogel (SAH) to soil. However, studies on the effect of SAH on trees in Central Europe, which has a temperate climate, are scarce.MethodsHere, the effects of SAH treatment on the cultivation of four key tree species in Central European forest ecosystems—European beech, sessile oak, Scots pine, and Norway spruce—were evaluated. Field and greenhouse experiments were conducted; the greenhouse conditions served as the reference for the absence of water stress.Results and DiscussionSAH treatment reduced seedling mortality by 1%–9% in the field experiment. The morphological parameters of the control and SAH-treated seedlings did not significantly differ. Among the tree species, oak seedlings exhibited a positive response to SAH treatment. Spruce, pine, and beech did not respond to SAH treatment; the proline content of SAH-treated conifer leaves was three times higher than that of oak leaves but still very low, revealing no drought stress. The results highlight the significance of employing an individual approach in the application of SAH in forestry, rather than relying on generic measures.

Learning Model to Overcome Aggressive Behavior Early Childhood

This research aims to determine the characteristics of early childhood behaviour, the factors that influence aggressive behaviour in early childhood, and the learning models used by educators to overcome aggressive behaviour. This research uses qualitative research methods with case studies. The subject selection method used purposive sampling included educators, parents of educational participants, and the head of the PAUD program. The research results show that a differentiated learning model using loose parts media can change children's aggressive behaviour. Before implementing the educator model, educators take an individual approach to children. The characteristics of children who have aggressive behaviour in PAUD are shown verbally, such as mocking, speaking harshly, shouting, getting angry, and spreading things when their desires are not fulfilled, while aggressive actions through non-verbal actions in early childhood, such as hitting, pushing, and grabbing. Toy friends. Factors that influence aggressive behaviour in this research are biological or innate, environmental factors and parenting patterns that spoil children too much. Keywords: Learning Model, Behavior Childhood Aggression, Early Childhood

Making leisure time meaningful for adolescents: an interview study from Sweden

ABSTRACT Adolescents’ school performance is influenced by several factors and meaningful leisure time, especially organized activities, has great potential to impact academic results. Therefore, this study aimed to gain a greater understanding of how community actors perceive meaningful leisure time and how they work to create meaningful leisure time with the intention of increasing the chances for more adolescents completing upper secondary school. Semi-structured interviews with 14 informants, representing nine different community actors in a middle-sized city in Sweden, were conducted and analysed using content analysis. Results suggest that meaningful leisure time positively impacts adolescents’ mental health through social relations, support, and guidance. Leisure is believed to have spillover effects on reducing stress, manage school demands and performance. Nevertheless, leisure time activities and school performance must be balanced with time and effort. Community actors work proactively with availability, individual approaches, and offering activities to create meaning. From a societal perspective, places to hang out with supportive adults, in particular structured activities, should be regarded as a social investment in adolescents’ health and prospects, especially in deprived areas where fewer activities are available. Finally, ensuring meaningful leisure time is in line with the Convention on the Rights of the Child.

864. Can Population Risk Factors be Directly Applied to Guide Individual Patient’s Diagnosis and Treatment in Clinical Practice? – the Need to Re-Direct Epidemiology Research for Clinical Application in the Future

Abstract Background The implementation of population risk factor-guided diagnostic approach and treatment regimen has been widely considered in clinical practice to treat individual patient. However, the meaning of these risk factors, which are primarily developed from population-based epidemiology studies and thus presented probability and risk/odds ratio, are hard to interpret in clinical settings for individual patient. In this study, we provided an example of risk analysis for COVID-19 early intervention, in which the diagnostic accuracy of a population risk factor-based treatment regimen and an individual risk factor-based treatment regimen were compared, and the associated benefits and costs were evaluated. Methods The treatment regimen guided by the population risk factors was defined as such, that every COVID-19 patient aged ≥65 years old, and/or with at least one of the pre-selected chronic co-morbid conditions will be given a 500 mg/8 mL dose of the monoclonal antibody therapy, Sotrovimab intravenous, to prevent fatal outcome. The individual risk factor-based treatment regimen was determined using logistic regression model. We set the cost of Sotrovimab as $315.00 per patient, and the total cost including medication, hospital and infusion center administration charges, and charges for medical staffs as $2,000.00 per patient. Results Our study showed that the treatment regimen guided by population risk factors had resulted in a large amount of patient misclassification, with only 51.9% overall diagnostic accuracy, which is close to a random chance. However, by using the precision approach we developed for individual patient, the diagnostic accuracy was improved to 75%. Population risk factor-based treatment regimen prevented 1,570 more patients from a fatal outcome, however, it added 8 million dollars of cost for Sotrovimab and overall additional 54 million dollars of total cost. Conclusion Population level risk analysis provided inadequate information for individual patient’s diagnosis and treatment in clinical practice. Future research needs to focus on developing personalized diagnostic and treatment approach. We anticipate the improved clinical prediction by adding additional laboratory biomarkers to the individual precision diagnostic approach we developed. Disclosures All Authors: No reported disclosures

Evolution of blood glucose self-monitoring technology

In 1838 G. Rees, a doctor from London (Guy's Hospital), for the first time isolated excess sugar from the blood serum of a patient with diabetes mellitus. Diagnosis of diabetes mellitus gradually developed. The next step was the understanding that regular monitoring of glucose levels by the patient himself is an integral part of diabetes mellitus therapy. The starting point of the technology for self-monitoring of diabetes mellitus was the determination of the sugar content in urine using chemical reactions. The method had no great clinical significance, it only indicated a progressive disease. The first Dextrostix blood glucose test strip (Ames-Mile's laboratories) was introduced in 1964. In 1970, the first automated blood glucose analysis system, the Ames Reflectance Meter (ARM), was created. Over time, the technology has been improved, accuracy, visibility, comfort, and an individual approach to glucometry have been formed. A new chapter was the development of remote technologies and the possibility of remote monitoring. More advanced data processing is now available in tabular and graphical form, with the calculation of 7-, 14-, 30-, and 90-day average glycemic values. A promising direction is the introduction of artificial intelligence in the management of diabetes mellitus.

The Shifting Faces of Epic Heroes: Unity and Diversity in Seventeenth-Century English Literary Criticism

Seventeenth-century England, renowned for its epic poems, stands as one of the most fruitful periods in the history of English literary criticism in terms of epic theory. One of the most significant topics of literary criticism during this era is the evolution of epic heroes. The critics at the time had comprehensive knowledge of the existing pagan and Christian traditions of epic heroes which were varied and interwoven. Moreover, the critics of the period were well acquainted with the literary criticisms of late Renaissance Italy and seventeenth-century France. However, they did not simply absorb influences from Greek, Roman, French, and Italian sources. Instead, English critics engaged in an active dialogue with these traditions, interpreting and adapting their ideas in light of their own cultural, historical, and theological context. This enabled critics to create individual approaches towards epic heroes, thereby making English literary criticism diverse but also too fragmented to form a cohesive group. This aspect of the period makes drawing the contours of the epic heroes immensely challenging. However, despite the overriding eclecticism inherent in the literary criticism of the period, this article indicates that there is a surprising degree of consensus on certain characteristics of epic heroes. Accordingly, this article examines the concept of epic heroes in seventeenth-century English literary criticism, focusing on four key aspects: the didactic role of epic heroes, their depiction as paragons of virtue, the significance of their lineage, and the intricate process of Christianising them.

Genomic Approaches for Monogenic Kidney Diseases: A Comparative Review of Diagnostic Methods and Precision Medicine Implications

Chronic kidney disease is a long-term condition with significant implications for quality of life and health care costs. To uncover the etiology in selected cases suspected of monogenicity, a genomic approach can be employed. There are multiple technologies available, but there is currently no consensus on the most effective diagnostic approach. This review provides a comparison of currently available diagnostic methods in terms of diagnostic yield. However, the heterogeneity of patient cohort inclusion criteria limits direct comparisons. Our review identified three studies which compared a targeted gene panel and whole-exome sequencing for the same patient population. However, the results are inconclusive due to the different sizes and specificity of the targeted panels employed. The contribution of a whole-genome sequencing approach is highly debated. It is noteworthy that a large number of data are generated by these sequencing technologies. This allows for rapid analysis of coding and non-coding regions. However, the interpretation of variants is a significant burden, and the reporting of incidental findings is still challenging. Therefore, the identification of the most efficient technology is pivotal but still controversial. To conclude, an objective comparison of the three methods for the same population could overcome the limits of these studies’ heterogeneity and highlight the weaknesses and the strengths of individual approaches.

Authority as a Challenge

The early Christian world was diverse. Various groups of Christians held opposite views on crucial theological and social elements while claiming to be the true followers of Jesus Christ. In this diversity, two streams of Christianity were particularly popular: proto-orthodox Christians and Valentinian Gnostics. These groups were included in the sharp polemical discussions and battles, as they tried to gain a monopoly in the early Christian world. In the end, proto-orthodoxy won thus marginalizing Valentinian Gnostics. In that process, Church authors, such as Irenaeus and Justin Martyr reclaimed the history of Christianity by defining themselves as the guardians of orthodoxy. Furthermore, they put the label of “heresy” on Valentinians claiming that they are not real Christians, but a subversive group that had corrupted the original message of Jesus and his disciples. In this paper, I have tried to demonstrate that one of the crucial reasons for the triumph of the Great Church was related to the concepts of authority and organization. To show that, I have analysed what kind of attitude Valentinian Gnostics had toward authority and organization. As sources reflect, Valentinian Gnosticism was an anti-structural movement that emphasized an individual approach to the divine through esoteric knowledge. Furthermore, their belief in the threefold division of humanity affected their attitude toward bishops and apostolic succession. Consequently, they rejected the authority of bishops and presbyters and put the emphasis on the small philosophical circle of students that would gather around influential teachers. Eventually, such a spiritual and religious perspective made it impossible to create a network of connected communities whose sense of universal identity would transgress local and regional borders. In the end, Valentinian Gnosticism was a conglomerate of independent communities scattered across the Mediterranean. In other words, Valentinian’s theological beliefs that modelled their attitude toward authority and social structure were a crucial factor in their marginalization within the early Christian world.

Didactic aspects of the transformation of clip thinking in the context of teaching of construction mechanics

The relevance of the problem of transforming the clip-based thinking of higher education students in the conditions of teaching construction mechanics and its solution taking into account the didactic capabilities of educational and digital technologies is undeniable in view of the dynamics of the growth of the volume of educational information, which requires the subjects of the educational process to flexibly adapt scientific approaches, teaching technologies , ways of thinking to modern educational needs. It was determined that clip thinking, which is characterized by speed and superficial consideration of information, lack of attention and its concentration, fragmentation and mosaicism of the world picture, loss of desire for knowledge, reduced need and ability for productive activity, can be both an advantage and a disadvantage in the conditions of digital era, modern system requirements for the training of professionals with a formed system of value orientations, innovative thinking, a culture of cognitive activity. It was established that the essence of the transformation of clip thinking of higher education students in the context of teaching construction mechanics is the integration of educational innovations with the aim of improving the quality of learning and teaching, developing students' critical thinking, and changes in the ways of perceiving and processing information. It was found that didactic mechanisms for the transformation of clip thinking - effective use of data analytics, interactive educational platforms, data visualization, joint platforms and exchange of opinions, automation of processes for data collection and processing, stimulation of critical thinking - contribute to the balanced use of educational tools to improve the perception of information , the development of cognitive competence and contribute to the creation of an educational environment that meets the needs of today. It was concluded that the properties of "clip thinking" can be transformed under the condition of the appropriate construction of the organization of the study of construction mechanics in the direction of the logical presentation of educational material; compliance of training with practical goals; implementation of learning technologies aimed at educational interaction; ensuring an individual approach to the organization of students' educational and cognitive activities.

Quality criteria for educational and methodological provision at the department of therapeutic dentistry of the faculty of dentistry in preparing future practitioners

The article deals with the methodological provision of the educational process, namely the creation of a complex of educational and methodological materials and dental equipment for students and interns when conducting practical manipulations in the specialty "Dentistry" according to the latest training systems during martial law.Aim. The main task of the faculty of dentistry is to train highly qualified specialists who possess high fundamental, general medical, and professional preparation in theoretical and practical skills.Material and methods. Therefore, higher education teachers face a number of essential tasks such as methodology for educational program development, designing a set of teaching and learning materials in the discipline, and implementing individual psychological approaches to each student.Results. Educational and methodological provision is a set of materials in printed and electronic form. In turn, teaching materials can be information (multimedia presentations, training videos, computer training programs, etc.), which is systematized by the purpose of the discipline or standard education program, presented in a form convenient for use in the educational process [3,4]. For successful mastery of the discipline by students in the specialty “Dentistry” and optimization of the educational process, a set of academic and methodological materials have been developed, which included the following stages:I. Development of a syllabus on the discipline "Therapeutic Dentistry" from 2020, which is included in the curriculum for training the relevant specialty, based on the standard educational program.II. Preparation of theoretical material on the discipline in accordance with the requirements of educational qualification characteristics and educational and professional programs for training specialists, methods of conducting practical classes, didactic and control materials:- sets of theoretical questions, tests and case studies on the discipline by the topic;- structural and logical schemes of the content arranged by topics, sections, and structural modules;- sets of tables on topics;- database of instructional and regulatory documents;- multimedia presentations of lectures;- a set of examination cards;- criteria for assessing students' knowledge and skills on the discipline;- a list of the availability of literature for the discipline, a list of scientific literature sources, and information resources from the Internet;- database of teaching and learning materials on the department's website.III. Systematization, structuring and design of educational materials.IV. Approbation and correction of materials.V. Replication of materials in printed or electronic form:- requirements for students in the specialty "Dentistry" according to the syllabus;- methodological guidelines of the lecture course for teachers;- a course of lectures on "Therapeutic Dentistry" for students;- methodological guidelines of practical classes for teachers;- methodical instructions of practical classes for students;- protocols for practical classes;- a collection of test tasks on the discipline developed for knowledge control in practical classes;- methodological guidelines for self-study work of students;- a collection of test tasks for self-study work.Conclusion. The complex of educational and methodological materials and their structuring, from the standpoint of the logic of cognitive activity of future specialists, will help acquire knowledge in this discipline and contribute to their qualified application by the future doctor in practical activities.

Peculiarities of psychological preparation before surgery in the practice of paediatric orthopaedic traumatologist and surgeon

Relevance. Psychological contact is defined as the patient's perception of previous communication with medical staff and the circumstances of their stay in the hospital. Interaction with a doctor and medical staff can significantly affect the patient's mental state before surgery, as well as the results of the operation itself, and has promising potential in improving medical practice and ensuring a high quality of medical services.The aim of the study is to investigate the methods of psychological contact in the process of preoperative preparation of children with exceptional traumas, which is necessary for the provision of adequate surgical care and positive results after surgery. Material and methods. The peculiarities of preoperative preparation of children of different ages were studied. Psychological contact with children was established according to the recommendations of psychologists and consisted of five stages. The main stages of psychological contact were overcoming a psychological barrier, finding common preferences, determining communication tactics, searching for obstacles to communication, and stabilizing the dialogue. The example of three clinical cases with exclusive traumas shows some features of establishing psychological contact before surgery. Clinical cases from practice, their course and treatment are described.The results of the study and their discussion. The main stages of psychological contact before surgery are highlighted and the main mistakes that can affect children's attitude before surgery are identified. Psychological preparation before surgery is mandatory, reducing the negative impact of stress and contributing to positive outcomes of surgeries. The study emphasises the importance of an individual approach to establishing psychological contact with children.Conclusions. For many children, going to the doctor is very stressful. Surgery is always unpleasant and causes anxiety and fear. Fear can be reinforced, nurtured to great lengths, or learned to be controlled. Psychological preparation before surgery is mandatory, it reduces the negative impact of stress and increases the positive results of the operation.

PredictONCO: a web tool supporting decision-making in precision oncology by extending the bioinformatics predictions with advanced computing and machine learning.

PredictONCO 1.0 is a unique web server that analyzes effects of mutations on proteins frequently altered in various cancer types. The server can assess the impact of mutations on the protein sequential and structural properties and apply a virtual screening to identify potential inhibitors that could be used as a highly individualized therapeutic approach, possibly based on the drug repurposing. PredictONCO integrates predictive algorithms and state-of-the-art computational tools combined with information from established databases. The user interface was carefully designed for the target specialists in precision oncology, molecular pathology, clinical genetics and clinical sciences. The tool summarizes the effect of the mutation on protein stability and function and currently covers 44 common oncological targets. The binding affinities of Food and Drug Administration/ European Medicines Agency -approved drugs with the wild-type and mutant proteins are calculated to facilitate treatment decisions. The reliability of predictions was confirmed against 108 clinically validated mutations. The server provides a fast and compact output, ideal for the often time-sensitive decision-making process in oncology. Three use cases of missense mutations, (i) K22A in cyclin-dependent kinase 4 identified in melanoma, (ii) E1197K mutation in anaplastic lymphoma kinase 4 identified in lung carcinoma and (iii) V765A mutation in epidermal growth factor receptor in a patient with congenital mismatch repair deficiency highlight how the tool can increase levels of confidence regarding the pathogenicity of the variants and identify the most effective inhibitors. The server is available at https://loschmidt.chemi.muni.cz/predictonco.

From diagnosis to treatment in genetic epilepsies: Implementation of precision medicine in real-world clinical practice

The implementation of whole exome sequencing (WES) has had a major impact on the diagnostic yield of genetic testing in individuals with epilepsy. The identification of a genetic etiology paves the way to precision medicine: an individualized treatment approach, based on the disease pathophysiology. The aim of this retrospective cohort study was to: (1) determine the diagnostic yield of WES in a heterogeneous cohort of individuals with epilepsy referred for genetic testing in a real-world clinical setting, (2) investigate the influence of epilepsy characteristics on the diagnostic yield, (3) determine the theoretical yield of treatment changes based on genetic diagnosis and (4) explore the barriers to implementation of precision medicine. WES was performed in 247 individuals with epilepsy, aged between 7 months and 68 years. In 34/247 (14 %) a (likely) pathogenic variant was identified. In 7/34 (21 %) of these individuals the variant was found using a HPO-based filtering. Diagnostic yield was highest for individuals with an early onset of epilepsy (39 %) or in those with a developmental and epileptic encephalopathy (34 %). Precision medicine was a theoretical possibility in 20/34 (59 %) of the individuals with a (likely) pathogenic variant but implemented in only 11/34 (32 %). The major barrier to implementation of precision treatment was the limited availability or reimbursement of a given drug. These results confirm the potential impact of genetic analysis on treatment choices, but also highlight the hurdles to the implementation of precision medicine. To optimize precision medicine in real-world practice, additional endeavors are needed: unifying definitions of precision medicine, establishment of publicly accessible databases that include data on the functional effect of gene variants, increasing availability and reimbursement of precision therapeutics, and broadening access to innovative clinical trials.

Composing Diverse Ensembles of Convolutional Neural Networks by Penalization

Ensemble-based systems are well known to have the capacity to outperform individual approaches if the ensemble members are sufficiently accurate and diverse. This paper investigates how an efficient ensemble of deep convolutional neural networks (CNNs) can be created by forcing them to adjust their parameters during the training process to increase diversity in their decisions. As a new theoretical approach to reach this aim, we join the member neural architectures via a fully connected layer and insert a new correlation penalty term in the loss function to obstruct their similar operation. With this complementary term, we implement the standard guideline of ensemble creation to increase the members’ diversity for CNNs in a more detailed and flexible way than similar existing techniques. As for applicability, we show that our approach can be efficiently used in various classification tasks. More specifically, we demonstrate its performance in challenging medical image analysis and natural image classification problems. Besides the theoretical considerations and foundations, our experimental findings suggest that the proposed technique is competitive. Namely, on the one hand, the classification rate of the ensemble trained in this way outperformed all the individual accuracies of the state-of-the-art member CNNs according to the standard error functions of these application domains. On the other hand, it is also validated that the ensemble members get more diverse and their accuracies are raised by adding the penalization term. Moreover, we performed a full comparative analysis, including other state-of-the-art ensemble-based approaches recommended for the same classification tasks. This comparative study also confirmed the superiority of our method, as it overcame the current solutions.

Associations of low levels of air pollution with cardiometabolic outcomes and the role of diet quality in individuals with obesity

BackgroundExposure to air pollution is associated with adverse cardiometabolic health effects and increased mortality, even at low concentrations. Some of the biological mechanisms through which air pollution can affect cardiometabolic health overlap with health outcomes associated with diet quality and changes in diet. ObjectiveThe objective of this study is to investigate associations of air pollutants at average concentrations below the World Health Organization, 2021 air quality guidelines with cardiometabolic outcomes. Furthermore, potential interaction between air pollutants and diet quality will be assessed. Methods82 individuals with obesity participated in a combined weight loss and weight loss maintenance study for a total of 33 weeks. A secondary analysis was conducted incorporating air pollution measurements. Data were analysed with linear mixed-effects models. ResultsA total of 17 significant associations were observed for single pollutants with 10 cardiometabolic outcomes, predominantly related to blood lipids, hormones, and glucose regulation. Diet quality, as measured by the Baltic Sea Diet score, did not appear to mediate the association of air pollution with cardiometabolic outcomes, however, diet quality was observed to significantly modify the association of PM2.5 with total cholesterol, and the associations of NO and O3 with ghrelin. DiscussionThese findings suggest that exposure to ambient air pollutants, especially particulate matter, at levels below World Health Organization, 2021 air quality guidelines, were associated with changes in cardiometabolic risk factors. Diet may be a personal-level approach for individuals to modify the impact of exposure to air pollution on cardiometabolic health.

Advance Care Planning: A Story of Trust Within the Family.

As the family usually plays a central role at the end of life, the quality of family relationships may influence how individuals approach advance care planning (ACP). Our study investigates the associations of trust in relatives with regard to end-of-life (EOL) issues-used as a proxy measure of family relationship quality-with individuals' engagement in EOL discussions, advance directive (AD) awareness, approval and completion, and designation of a healthcare proxy. Using nationally representative data of adults aged 55years and over from wave 6 (2015) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) in Switzerland (n = 1911), we show that complete trust in relatives is related to higher engagement in ACP. Subject to patient consent, the family should, therefore, be included in the ACP process, as such practice could enhance patient-centered EOL care and quality of life at the end of life.

Advances in Neuropathic Pain Research: Selected Intracellular Factors as Potential Targets for Multidirectional Analgesics.

Neuropathic pain is a complex and debilitating condition that affects millions of people worldwide. Unlike acute pain, which is short-term and starts suddenly in response to an injury, neuropathic pain arises from somatosensory nervous system damage or disease, is usually chronic, and makes every day functioning difficult, substantially reducing quality of life. The main reason for the lack of effective pharmacotherapies for neuropathic pain is its diverse etiology and the complex, still poorly understood, pathophysiological mechanism of its progression. Numerous experimental studies, including ours, conducted over the last several decades have shown that the development of neuropathic pain is based on disturbances in cell activity, imbalances in the production of pronociceptive factors, and changes in signaling pathways such as p38MAPK, ERK, JNK, NF-κB, PI3K, and NRF2, which could become important targets for pharmacotherapy in the future. Despite the availability of many different analgesics, relieving neuropathic pain is still extremely difficult and requires a multidirectional, individual approach. We would like to point out that an increasing amount of data indicates that nonselective compounds directed at more than one molecular target exert promising analgesic effects. In our review, we characterize four substances (minocycline, astaxanthin, fisetin, and peimine) with analgesic properties that result from a wide spectrum of actions, including the modulation of MAPKs and other factors. We would like to draw attention to these selected substances since, in preclinical studies, they show suitable analgesic properties in models of neuropathy of various etiologies, and, importantly, some are already used as dietary supplements; for example, astaxanthin and fisetin protect against oxidative stress and have anti-inflammatory properties. It is worth emphasizing that the results of behavioral tests also indicate their usefulness when combined with opioids, the effectiveness of which decreases when neuropathy develops. Moreover, these substances appear to have additional, beneficial properties for the treatment of diseases that frequently co-occur with neuropathic pain. Therefore, these substances provide hope for the development of modern pharmacological tools to not only treat symptoms but also restore the proper functioning of the human body.