Long-term Issues Research Articles

Acute Implantation of a Bioresorbable Polymer Scaffold in Patients With Complete Thoracic Spinal Cord Injury: 24-Month Follow-up From the INSPIRE Study.

BACKGROUND:Based on 6-month data from the InVivo Study of Probable Benefit of the Neuro-Spinal Scaffold for Safety and Neurological Recovery in Patients with Complete Thoracic Spinal Cord Injury (INSPIRE) study (NCT02138110), acute implantation of an investigational bioresorbable polymer device (Neuro-Spinal Scaffold [NSS]) appeared to be safe in patients with complete thoracic spinal cord injury (SCI) and was associated with an ASIA Impairment Scale (AIS) conversion rate that exceeded historical controls.OBJECTIVE:To evaluate outcomes through 24 months postimplantation.METHODS:INSPIRE was a prospective, open-label, multicenter, single-arm study. Eligible patients had traumatic nonpenetrating SCI with a visible contusion on MRI, AIS A classification, neurological level of injury at T2-T12, and requirement for open spine surgery ≤96 hours postinjury.RESULTS:Nineteen patients underwent NSS implantation. Three patients had early death determined by investigators to be unrelated to the NSS or its implantation procedure. Seven of 16 evaluable patients (44%) had improvement of ≥1 AIS grade at 6 months (primary end point) to AIS B (n = 5) or AIS C (n = 2). Three patients with AIS B at 6 months had further neurological improvement to AIS C by 12 (n = 2) and 24 (n = 1) months, respectively; none have deteriorated per latest available follow-up. No unanticipated or serious adverse device effects were reported.CONCLUSIONIn this small group of patients with complete thoracic SCI, acute NSS implantation within the spinal cord appeared to be safe with no long-term neurological issues identified during the 24-month follow-up. Patients remain stable, with additional AIS conversions observed in some patients at 12 months and beyond. These data further support the safety and probable benefit of NSS implantation in this patient population.

Safeguarding Athletes Against Head Injuries Through Advances in Technology: A Scoping Review of the Uses of Machine Learning in the Management of Sports-Related Concussion.

Sports injury prevention is an important part of the athlete welfare and safeguarding research field. In sports injury prevention, sport-related concussion (SRC) has proved to be one of the most difficult and complex injuries to manage in terms of prevention, diagnosis, classification, treatment and rehabilitation. SRC can cause long-term health issues and is a commonly reported injury in both adult and youth athletes around the world. Despite increased knowledge of the prevalence of SRC, very few tools are available for diagnosing SRC in athletic settings. Recent technological innovations have resulted in different machine learning and deep learning methodologies being tested to improve the management of this complex sports injury. The purpose of this article is to summarize and map the existing research literature on the use of machine learning in the management of SRC, ascertain where there are gaps in the existing research and identify recommendations for future research. This is explored through a scoping review. A systematic search in the three electronic databases SPORTDiscus, PubMed and Scopus identified an initial 522 studies, of which 24 were included in the final review, the majority of which focused on machine learning for the prediction and prevention of SRC (N = 10), or machine learning for the diagnosis and classification of SRC (N = 11). Only 3 studies explored machine learning approaches for the treatment and rehabilitation of SRC. A main finding is that current research highlights promising practical uses (e.g., more accurate and rapid injury assessment or return-to-sport participation criteria) of machine learning in the management of SRC. The review also revealed a narrow research focus in the existing literature. As current research is primarily conducted on male adolescents or adults from team sports in North America there is an urgent need to include wider demographics in more diverse samples and sports contexts in the machine learning algorithms. If research datasets continue to be based on narrow samples of athletes, the development of any new diagnostic and predictive tools for SRC emerging from this research will be at risk. Today, these risks appear to mainly affect the health and safety of female athletes.

Effectiveness of five interventions used for prevention of gestational diabetes: A network meta-analysis.

Background:Gestational diabetes mellitus (GDM) is associated with short- and long-term health issues for mother and child; preventing these complications is crucially important. This study aimed to perform a systematic review and network meta-analysis of the relationships among 5 interventions used to prevent GDM.Materials and methods:A comprehensive literature search was performed to pool evidence from inception to June 30, 2020. The type of studies was confined to randomized control trials and quasi-randomized control trials published in English investigating the interventions for preventing GDM, including physical activity, dietary intervention, probiotic intervention, mixed intervention, and inositol supplementation. The data were pooled together to report the odds ratio (OR) of GDM with a corresponding 95% credible interval (CrI) and generate a network plot, the surface under the cumulative ranking curve plot, and contribution plot. In addition, loop inconsistency was examined, and a funnel plot combined with Egger test was used to measure heterogeneity.Results:The network meta-analysis included 46 randomized control trials involving 16,545 patients. Compared with placebo, physical activity (OR: 0.64, 95% CrI: 0.46–0.88) and probiotic intervention (OR: 0.57, 95% CrI: 0.34–0.96) reduced the incidence of GDM significantly. However, dietary intervention, a combination of physical activity and diet intervention, and inositol supplementation did not significantly alter GDM risk.Conclusions:Physical activity and probiotic intervention are more effective than placebo in reducing the risk of developing GDM. Future work should focus on the type, duration, frequency, and timing of physical activity and probiotic intervention.

Development of Employee Retention Strategies for the New Zealand Construction Industry

The construction industry is one of the major employers in New Zealand and a significant contributor to economic growth. One of the main problems surrounding the construction sector is employee turnover. Voluntary employee turnover is costly and adversely impacts construction organizations. The long-term skill shortage issue within the industry and voluntary turnover, necessitate the retention of a qualified workforce. The development of effective employee retention strategies requires an understanding of turnover. Although the employee turnover phenomenon has been studied in different occupational groups and sectors, construction employee turnover has yet to be extensively investigated. Given the importance of the construction sector in New Zealand and the long-term difficulty of filling vacancies in professional roles, this research aims to develop retention strategies for professionals in the New Zealand construction industry. A mixed-methods approach will be applied. The qualitative stage using semi-structured interviews will identify the impact of employee turnover on construction organizations. It will provide practical implications about the importance of addressing turnover issues within construction organizations. During the next stage, a conceptual framework will be developed and tested using quantitative data from professionals in the New Zealand construction sector. This research will indicate the interaction effect of various factors on professionals’ turnover intention and further provide strategy implications for the retention of professionals within construction organizations. It makes practical and theoretical contributions to construction practices and literature. In practice, generated knowledge will ascertain the relative importance of different constructs on employees’ quitting decisions. It will help organizations to understand the underlying constructs of intention to quit and implement effective retention strategies. Theoretically, this research examines the possible mechanisms in which the integration of various factors leads to turnover intention. Further, it expands previous research to address repeated calls on studying employee turnover in different contexts.

Five-Year Cumulative Incidence of Axillary Web Syndrome and Comparison in Upper Extremity Movement, Function, Pain, and Lymphedema in Survivors of Breast Cancer With and Without Axillary Web Syndrome

ObjectiveTo determine the cumulative incidence and natural history of axillary web syndrome (AWS) and its related postoperative risk for physical impairments in a cohort of women followed for 5 years post breast cancer surgery. DesignProspective, longitudinal study. SettingAcademic health center. ParticipantsWomen (N=36) with and without AWS after breast cancer surgery with sentinel node biopsy or axillary lymph node dissection. InterventionsNot applicable. Main Outcome MeasuresParticipants were assessed for AWS, shoulder goniometric flexion and abduction range of motion, function (Disability of the Arm, Shoulder, and Hand), lymphedema (bioimpedance spectroscopy, girth measures, tissue dielectric constant), and pain (visual analog scale) at 2, 4, 12, and 78 weeks and 5 years after breast cancer surgery. Analysis of variance compared range of motion, function, lymphedema, and pain in women identified with AWS with those without AWS across visits. Univariate logistic regression assessed if AWS was a risk factor for physical impairment at 5 years. ResultsThe cumulative incidence of AWS was 57%. Fifty percent (14/28) of the women who completed all study visits had signs of AWS at 5 years. Abduction active range of motion was significantly lower in women with AWS at 2 and 4 weeks post surgery. AWS was identified as a risk factor for reduced shoulder motion at 5 years. Regardless of AWS, 75% of the women experienced 1 or more upper extremity physical impairments at 5 years, which is an increase from 66% at 78 weeks in the same cohort. ConclusionsAWS is associated with reduced shoulder range of motion in the early postoperative time period, can persist for 5 years after breast cancer surgery, and increases the risk of long-term reduced shoulder range of motion. Long-term physical issues are apparent after breast cancer surgery regardless of AWS.

Performance-based design of asphalt pavements concerning the reliability analysis

Fatigue is one of the most common types of distress in asphalt pavement due to traffic loading. Pavements are steadily deteriorating from a long-term issue of cracking resulting in reduced durability and increased maintenance cost. While limit states design methods have been adopted to enhance the service life of pavements, literature demands development in performance-based design models for these infrastructures. Hence, this study proposed a new performance-based design procedure for fatigue characterization of asphalt pavements at various performance levels. To do so, a performance-based limit state function was utilized to measure the reliability level of the pavements concerning accumulative fatigue failure. Then, the severity levels of the loading scenarios were defined based on the statistical analysis of the random variable WIM (weigh-in-motion) data and the pavement resistance formulated using the rational performance levels. Accordingly, the structural reliability analysis was conducted to determine the reliability level of the existing pavement condition. Eventually, the observed reliability indices were recommended to assure the reliability concern under the given performance level subjected to considered loading scenarios.

Application of Thomson scattering system toward direct measurement of extraction surface of the negative ion beam

As a challenge to measure the extraction surface of the negative ion beam, a laser Thomson scattering system with high spatial resolution was applied to a weakly ionized plasma in a negative ion source for the first time. The first target was to measure electron density around extraction region because shape of the extraction surface can be estimated by electron spatial profile. However, stray light by injected laser, filament and plasma was too intense compared to signal from the low density region. To solve this, a triple grating spectroscopy and a multilayer black screen were introduced, and the laser spot size was minimized to reduce slit sizes of the spectroscopy. As a result, electron density was successfully measured accurately in low density region. From an error estimation, measurement of electron density 3 × 1016 m-3 with spatial resolution of 0.5 mm at extraction region can be realized with accumulation of signals from multiple laser shots. This system can contribute to the understanding of the mechanism of formation of the extraction surface, which is a long-term issue in the negative ion source.

Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial

Renal denervation has been shown to lower blood pressure in the presence of antihypertensive medications; however, long-term safety and efficacy data from randomised trials of renal denervation are lacking. In this pre-specified analysis of the SPYRAL HTN-ON MED study, we compared changes in blood pressure, antihypertensive drug use, and safety up to 36 months in renal denervation versus a sham control group. This randomised, single-blind, sham-controlled trial enrolled patients from 25 clinical centres in the USA, Germany, Japan, the UK, Australia, Austria, and Greece, with uncontrolled hypertension and office systolic blood pressure between 150 mm Hg and 180 mm Hg and diastolic blood pressure of 90 mm Hg or higher. Eligible patients had to have 24-h ambulatory systolic blood pressure between 140 mm Hg and less than 170 mm Hg, while taking one to three antihypertensive drugs with stable doses for at least 6 weeks. Patients underwent renal angiography and were randomly assigned (1:1) to radiofrequency renal denervation or a sham control procedure. Patients and physicians were unmasked after 12-month follow-up and sham control patients could cross over after 12-month follow-up completion. The primary endpoint was the treatment difference in mean 24-h systolic blood pressure at 6 months between the renal denervation group and the sham control group. Statistical analyses were done on the intention-to-treat population. Long-term efficacy was assessed using ambulatory and office blood pressure measurements up to 36 months. Drug surveillance was used to assess medication use. Safety events were assessed up to 36 months. This trial is registered with ClinicalTrials.gov, NCT02439775; prospectively, an additional 260 patients are currently being randomly assigned as part of the SPYRAL HTN-ON MED Expansion trial. Between July 22, 2015, and June 14, 2017, among 467 enrolled patients, 80 patients fulfilled the qualifying criteria and were randomly assigned to undergo renal denervation (n=38) or a sham control procedure (n=42). Mean ambulatory systolic and diastolic blood pressure were significantly reduced from baseline in the renal denervation group, and were significantly lower than the sham control group at 24 and 36 months, despite a similar treatment intensity of antihypertensive drugs. The medication burden at 36 months was 2·13 medications (SD 1·15) in the renal denervation group and 2·55 medications (2·19) in the sham control group (p=0·26). 24 (77%) of 31 patients in the renal denervation group and 25 (93%) of 27 patients in the sham control group adhered to medication at 36 months. At 36 months, the ambulatory systolic blood pressure reduction was -18·7 mm Hg (SD 12·4) for the renal denervation group (n=30) and -8·6 mm Hg (14·6) for the sham control group (n=32; adjusted treatment difference -10·0 mm Hg, 95% CI -16·6 to -3·3; p=0·0039). Treatment differences between the renal denervation group and sham control group at 36 months were -5·9 mm Hg (95% CI -10·1 to -1·8; p=0·0055) for mean ambulatory diastolic blood pressure, -11·0 mm Hg (-19·8 to -2·1; p=0·016) for morning systolic blood pressure, and -11·8 mm Hg (-19·0 to -4·7; p=0·0017) for night-time systolic blood pressure. There were no short-term or long-term safety issues associated with renal denervation. Radiofrequency renal denervation compared with sham control produced a clinically meaningful and lasting blood pressure reduction up to 36 months of follow-up, independent of concomitant antihypertensive medications and without major safety events. Renal denervation could provide an adjunctive treatment modality in the management of patients with hypertension. Medtronic.

Reverse trajectory analysis of the hydrogen negative ion beam in a prototype accelerator for ITER

Reverse calculation of negative ion trajectory based on the measured beam emittance has been performed for the first time in multi-stage accelerator in order to reconstruct negative ion profile near meniscus, which has been a long-term issue for negative ion sources. According to reverse calculation, negative ions are mainly extracted from the periphery of extraction area, and the particles extracted from the aperture edge is lost on acceleration grids. By taking into account the lost component with reconstructed negative ion profile, the negative ion trajectory became consistent with observed beam traces on the acceleration grids. This result can be applied directly to the design of ITER accelerator as well as the other Cs-seeded negative ion sources.

Transitional and Long-Term Rehabilitation Care System After Stroke in Korea.

Stroke is one of the leading causes of mortality and disability in Korea. Patients who experience stroke require adequate management throughout the acute to subacute and chronic stages. Many patients with long-term functional issues require rehabilitative management even in the chronic stage. A comprehensive rehabilitation and care model for patients who experience stroke is necessary to effectively manage their needs during rehabilitation and allocate medical resources throughout the stages, thus ensuring reduced unmet needs and improved post-stroke quality of life. In Korea, the government and medical specialists are working on re-organizing the rehabilitation care model, including standardized triage and discharge planning after acute stroke treatment, and establishing systematic transitional and long-term rehabilitation care plans. This review briefly introduces the general rehabilitation triage after acute stroke and describes the current transitional and continuous care systems available for these patients in Korea. We also present the issues faced in transitional and long-term care plans of the current system and the efforts invested in resolving them and promoting long-term care in stroke cases.

Assessment Health Status of Healthcare Providers who work in Radiation Departments

Background: Exposure to radiation is becoming a long-term public health issue. Ionizing radiation is a pervasive threat to the lives of everyone on Earth. It's important to keep radiation doses as low as possible, even though the risk of long-term effects is extremely low. AIMS: Assess health status of healthcare providers who work in radiation departments., and to find out the differences between radiation exposure and health status of health care providers . Methodology: The cross-sectional study is conducted throughout the period of (May 10th to August 25th,2021,) in order to assess health status of healthcare providers who work in radiation departments. Purposive sample of (120) healthcare providers were selected from five hospitals in medical city complex. The sample was collected by uses the instruments which consist of two parts: Th Part 1: Healthcare providers’ general information, part2: Assessment of health status of healthcare providers : questionnaire validity the instrument was presented to 16 experts in different fields of Nursing to make it more valid. The internal consist reliability determine by crohnpach Alpha correlation which was r=0.82 for health status. Data are analyzed through the application of descriptive statistical data analysis approach that includes, frequencies, percentages, mean of scores, and inferential statistics include which include ANOVA. Results: healthcare providers are showing poor level of physical health as seen among 59.2% of them and 40.8% are showing fair level of physical health, and there are high significant differences in acute exposure to radiation with regard to physical health, psychological health, and emotional health at p-value= 0.002, 0.001, and 0.001. conclusion: The study concluded that more than half of health care provider have poor physical health ,more than half of health care provider have fair level of social role as part of their health status, more than half of health care providers have the poor psychological status Keywords-Assessment, Radiation exposure, Health care providers

Стратегические возможности развития газовой отрасли Дальнего Востока: газификация, газопереработка и газохимия

Introduction. The socio-economic development of the Far East is a complex and long-term issue. It requires new priorities and prospective areas. The local gas industry can become such a development driver. It can trigger a breakthrough in the socio-economic development of the macroregion, but it needs large-scale strategic priorities and projects. The export of pipeline and compressed natural gas is one of such strategic directions. However, the region has to look for other prospective directions. The research objective was to define and substantiate such strategic opportunities for the development of the Far Eastern gas industry. Study objects and methods. The theoretical and methodological basis of the study relied on certain methodological provisions of industrial strategizing, e.g. OTSW analysis, which proved to be an effective tool for monitoring and justifying strategic opportunities. Results and discussion. The author identified strategic opportunities for the development of the Far East gas industry and came up with two strategic directions: 1) gasification of the Far East regions and 2) development of gas processing and gas chemistry production in the Far East. Conclusion. Further formation and implementation of strategic priorities in these areas will improve the gas industry in the Far East in the long run, while providing a multiplicative impulse of socio-economic development of the entire macroregion.

Afterコロナの国土政策

Since the present National Spatial Strategies were established in August 2015, we have seen rapid changes in various aspects, which even may jeopardize the sustainability of our country. Given these changes, the Ministry of Land, Infrastructure, Transport and Tourism （MLIT） of Japan estalished the “Long-Term Spatial Vision Expert Committee” in October 2019 in order to analyze the current situation and changes surrounding our spatial land and to illustrate a future image of it in 2050, as well as to discuss the long-term issues and solutions in this field. The discussions in the Committee are summarized in the final report published in June 2021. Among the three view points presented in the final report, namely 1.Local, 2.Global and 3.Network, this article mainly introduces the Local viewpoint ─ a perspective that is essential in order to create a vast number of sustianable local communities by linking the physical world and the digital world.

Repeated exposure to chlorpyrifos is associated with a dose-dependent chronic neurobehavioral deficit in adult rats

Organophosphate (OP) chemicals include commonly used pesticides and chemical warfare agents, and mechanistically they are potent inhibitors of the cholinesterase (ChE) enzyme. Epidemiological studies report long-term neuropsychiatric issues, including depression and cognitive impairments in OP-exposed individuals. Chlorpyrifos (CPF) is one of the most widely used pesticides worldwide. Multiple laboratory studies have reported on either the long-term behavioral effect of an acute high-dose CPF (30–250 mg/kg) or studied sub-chronic behavioral effects, particularly the motor and cognitive effects of repeated low-dose CPF. However, studies are lacking on chronic mood and depression-related morbidities following repeated CPF doses that would mimic occupationally relevant OP exposures during adulthood. In this study, adult male rats were injected with CPF (1, 3, 5, or 10 mg/kg/d, s.c.) for 21 consecutive days. Dependent on the CPF dose, ChE activity was inhibited approximately 60–80% in the blood and about 20–50% in the hippocampus at 2-days after the end of CPF exposures. Following a 12-week washout period, a complete recovery of ChE activity was noted. However, CPF-treated rats exhibited a dose-dependent increase in signs related to anhedonia (sucrose preference test), anxiety (open-field and elevated plus-maze), and despair (forced swim test) at this stage. To the best of our knowledge, this could be the first laboratory study that demonstrates a cause-effect relationship between occupational-like CPF exposures in adult rats and the development of long-term depression-related outcomes and could provide an experimental system to study molecular mechanisms underlying environmental OP exposures and the elevated risk for chronic behavioral deficits.

Multifunctional nanostructured host-guest POM@MOF with lead sequestration capability induced stable and efficient perovskite solar cells

Long term stability and the toxicity of leaked lead ions represent the main barriers for commercialization of perovskite solar cells (PSCs). Here we report a novel chemical doping strategy with a series of polyoxometalates-metal organic frameworks (P@Ms) host-guest nanostructured dopants, shattering those barriers while maintaining a high-power conversion efficiency (PCE). The controllably oxidation of Spiro-OMeTAD was achieved under an inert environment through regulating the mass loading of H3PMo12O40 in a porphyrin-based MOF-545. Furthermore, the doped devices show a high PCE (21.5%) with remarkable long-term air stability, retaining approximately 85% of the initial PCE value for over 1000 h in ambient conditions. Significantly, the functionalized P@M with active sites as an encapsulation layer effectively restrict the migration and leakage of Pb2+ from the degraded PSCs, preventing the possible heavy metal pollution. This efficient strategy addresses the main troublesome long-term stability and lead ions leakage issues simultaneously, yielding stable and environmental-friendly sustainable PSCs.

The prevalence of inverse health consequences of COVID-19 vaccines: A post-vaccination study

BackgroundCOVID-19 vaccinations are intended to help produce neutralizing antibodies which target surface spike protein to combat the SARS-Cov-2 virus. Similarly, COVID-19 recovered patients exhibit high levels of SARS-CoV-2 neutralizing antibodies, which predominantly target the surface spike protein and are associated with the occurrence of health consequences in survivors. ObjectiveThe aim of the study is to explore the long-term health consequences of the COVID-19 vaccines. MethodologyA prospective, exploratory observational study conducted both online and offline using various questionnaires with all immunized individuals who had been inoculated for at least a month following their last COVID-19 vaccine either AZD1222® or BBV152® vaccines. ResultsWe evaluated 258 individuals who had taken the COVID vaccine and found that females made up the majority (54.3%) and that the mean age was 24 years. Post-vaccination long-term health issues were reported by 36.05% (93) of the participants, with 37.86% (53) of females and 33.9% (40) of males (p = 0.292). Myalgia was reported by 20.15% (52), fatigue was 13.95% (36), paresthesia was 1.16% (3), ageusia was 0.77% (2), sadness/irritability was 2.31% (6), and lack of concentration/excessive worry was 3.1% (8). ConclusionsMyalgia, fatigue, paresthesia, ageusia, coughs and colds, dyspnea, sadness/irritability, and lack of concentration/excessive worry are health consequences related to the COVID-19 vaccination which follow a similar pattern of post-COVID syndrome.

Long-Term Follow-Up of Pediatric CNS Tumor Survivors-A Selection of Relevant Long-Term Issues.

Introduction: Survivors of pediatric central nervous system (CNS) tumors are at high risk for late effects and long-term morbidity. The quality of survival became increasingly important, as advances in diagnostics, multimodal treatment strategies, and supportive care have led to significant increases in long-term survival. Aim: This review aims to provide a global overview of the potential late effects and long-term follow-up care of CNS tumor survivors, directed to trainees and practitioners with less targeted training in pediatric oncology. Late effects in CNS tumor survivors: A specific focus on CNS tumor survivors relies on cognitive and psychosocial late effects, as they may have an impact on education, professional career, independent living, and quality of life. Further important late effects in CNS tumor survivors include endocrine, metabolic, cardiovascular, and cerebrovascular diseases. Conclusions: Comprehensive long-term follow-up care is essential for pediatric CNS tumor survivors to improve their quality of survival and quality of life. An individualized approach, taking all potential late effects into account, and carried out by an interdisciplinary team, is recommended, and should continue into adulthood. Existing recommendations and guidelines on long-term follow-up care guide the multidisciplinary teams.

SUSTAINABILITY OF AGROHOLDINGS IN EUROPE IN THE CONDITIONS OF DECENTRALIZATION OF THE ECONOMY

The article examines the stability of agricultural holdings in Europe in the conditions of decentralization of the economy. It is established that the economic stability of agricultural holdings is a sphere of sustainable agriculture. Agricultural holdings must receive such income that they can cover all their expenses. The Common Agricultural Policy currently addresses many long-term issues, but it also has to deal with new challenges. It can simply be said that from a long-term perspective, the CAP (Common Agricultural Policy) in the EU aims to support farm incomes to achieve a balanced, productive agriculture. The relatively new focus of Green Europe is aimed at the mutual reciprocity of many different aspects with an emphasis on the environment. However, the economic stability of agricultural enterprises cannot be neglected in the picture of new policy goals. The study focuses on the issue of the double structure of farms, which is characterized by the different nature of two groups of agricultural enterprises and is found especially in countries that have undergone agricultural transformation. The dual structure of farms in agriculture is relatively unusual among EU states, for which a generally accepted EU methodology is insufficient. From the presented data, significant differences are noticeable both between the type of farm and between farms with different economic sizes within individual specializations. Farms of mixed production and milk production have the greatest load. Usually, large and very large farms employ paid workers, while small and medium-sized farms use their own labor. Larger holdings have more available external capital, which accounts for almost 40% of the total assets of livestock holdings. As the farm size increases, the share of land owned and the share of permanent pastures decreases. The largest share of sustainable farms was found in farms that focus on milk production. In terms of size, small farms are most at risk, which is confirmed for all production areas. On the contrary, larger and very large holdings were included in the group of viable holdings. This finding confirms the need to support the viability and sustainability of small extensive farms. These are farms focused on grazing livestock. These farms are located in remote areas that require sustainable maintenance. Agriculture is important to maintain employment and social interaction so that the countryside does not remain abandoned. An actual type of such support is redistribution. This methodology was applied as one of the impact assessment factors to determine it.

Renal-clearable and biodegradable black phosphorus quantum dots for photoacoustic imaging of kidney dysfunction

The kidney is a vital organ and susceptible to various diseases. Photoacoustic (PA) imaging provides a powerful technique for studying kidney dysfunction, for which many smart photoacoustic imaging agents have been developed. But the complete clearance of the introduced contrast agents after imaging remains to be challenging, leading to long-term toxicity concerns. In this study, we synthesized black phosphorous quantum dots (BPQDs) with ultra-small size (1.74 ± 0.23 nm after surface modification) and strong PA signal for imaging kidney dysfunction. Importantly, the renal-clearance property and biodegradability of the developed BPQDs help circumvent the long-term toxicity issue for in vivo studies. Based on these BPQDs, both acute kidney injury and chronic kidney disease were successfully detected in the living mice by PA imaging, with higher detection sensitivity than the clinical serum indices examination method. This BPQDs-based PA imaging method should have a promising potential for the early diagnosis of kidney dysfunction in clinic.

Recurrent Liver Allograft Injury in Patients With Donor-Derived Malignancy Treated With Immunosuppression Cessation and Retransplantation.

Donor-derived malignancy of the liver allograft is a rare but serious condition in the setting of necessary immunosuppression. Retransplantation after abrupt immunosuppression cessation has been performed with durable cancer-free survival. We present 2 cases of patients with donor-derived malignancy who were treated with complete immunosuppression cessation, which induced rapidly progressive liver allograft rejection and failure, with a need for subsequent retransplantation. We reviewed all serial liver biopsies and explants from both patients and performed C4d immunostaining. Initial explants of both patients showed severe allograft rejection, with unusual features of sinusoidal obstruction syndrome and C4d positivity. Malignant tumors in the explants were necrotic, related to rejection of donor-derived cancer cells and tissue. Follow-up of both patients has shown long-term cancer-free survival but issues with recurrent allograft failure requiring a third transplant. The reasons for retransplantation in both cases were related to allograft failure from antibody-mediated rejection. Clinicians should be aware of a potentially increased risk of rejection and recurrent allograft failure when strategizing treatment of donor-derived malignancy with immunosuppression cessation and retransplantation.