Search Results (58)

Background: Kidney transplantation (KTx) is a safe procedure that improves the life expectancy and quality of life of patients requiring it. However, despite the known benefits for patients who receive a kidney transplant, non-adherence to immunosuppressive medication is an unsolved problem, reflected mainly by graft rejection. Objective: The aim of this study is to systematically review the existing literature on adherence factors to medication after renal transplantation. Methods: A systematic literature review of studies published since 2010 was conducted in three databases. Records for the search were limited to publications from 2010 to 2024, available in full-text. The search was carried out in July 2024. In total, 2632 abstracts were downloaded from the different databases. Inclusion criteria were papers of any type (quantitative or qualitative) whose objective was the identification of predictors of adherence for patients who were prescribed immunosuppressive medication after kidney transplantation. Results: The predictors of adherence to treatment found in the systematic review were grouped into the following categories of the World Health Organization classification: socio-economic factors, factors related to the treatment/therapy, patient-related factors, disease-related factors, and health care system factors. Most of the studies were excluded, and in the end, 30 were included in the final analysis. According to these studies, a set of strong predictors was identified, but discrepancies among the variables of gender in young patients, pre-emptive transplantation, and the time of the transplantation were detected. Conclusions: In this study, we identified specific predictors and directions for the association of those predictors with adherence to immunosuppressive medication for patients after KTx. Further research should consider conducting reviews for different patient sub-groups on medication adherence and the development and validation of a screening instrument for adherence/non-adherence factors that clinicians could use as a detection tool for subjects at risk of low adherence. Full article

Manufacturing areas typically conduct machine maintenance to prevent early failures and to ensure a safe working environment and efficient production. In this study, the green unrelated parallel machine scheduling problem (GUPMSP) is studied. Besides preventive maintenance, machine availability and non-preemption are considered. A globally optimal solution (mathematical model) and local optimal solution (a modified Moore heuristic algorithm) are used to optimize the number of products returned early in the GUPMSP. Three datasets, namely, a most favorable case, an average case, and a least favorable case, are created to test the performance of the two solutions’ approaches. The results demonstrate the ability of the mathematical model to dominate the results of the modified Moore’s algorithm in the tested datasets. However, optimizing the number of products returned early in the UPMSP with preventive maintenance reduces costs as a step to support the concept of sustainability and enhance efficiency. Full article

The self-administration of meloxicam via medicated feed is a novel concept that could enable non-invasive, pre-emptive and long-term analgesia. Forty Bos taurus male calves were randomly allocated to four treatment groups: no castration (PC), surgical castration (NC), surgical castration with subcutaneous meloxicam (M), and surgical castration with medicated lick blocks (ML). Data collection occurred at various timepoints over 13 days following treatment. Plasma concentration of meloxicam was greater in ML compared to M calves at all timepoints except day 1 (p < 0.001); however, variation between ML individuals was high (standard deviation = 1.68). There was no effect of treatment on scrotal diameter or scrotal temperature. Wound morphology scores were improved in ML compared to NC calves. Eating observations were greater in ML calves immediately post-castration, followed by M calves at 3 h post-castration (p < 0.001). ML calves were observed locomoting more (p = 0.0032) and lying less (p < 0.001) than PC calves. These findings indicate that meloxicam-medicated lick blocks may provide a practical option for a longer duration of pain mitigation for surgically castrated calves. Conclusions are limited by the complexities of assessing pain in cattle, and further research into the toxicity effects of continued administration of meloxicam is recommended. Full article

In this paper, we develop an exact schedulability test and sufficient infeasibility test for fixed-priority scheduling on multiprocessor platforms. We base our tests on presenting real-time systems as a Kripke model for dynamic real-time systems with sporadic non-preemptible tasks running on a multiprocessor platform and an online scheduler using global fixed priorities. This model includes states and transitions between these states, allows us to formally justify a polynomial-time algorithm for an exact schedulability test using the idea of backward reachability. Using this algorithm, we perform the exact schedulability test for the above real-time systems, in which there is one more task than the processors. The main advantage of this algorithm is its polynomial complexity, while, in general, the problem of the exact schedulability testing of real-time systems on multiprocessor platforms is NP-hard. The infeasibility test uses the same algorithm for an arbitrary task-to-processor ratio, providing a sufficient infeasibility condition: if the real-time system under test is not schedulable in some cases, the algorithm detects this. We conduct an experimental study of our algorithms on the datasets generated with different utilization values and compare them to several state-of-the-art schedulability tests. The experiments show that the performance of our algorithm exceeds the performance of its analogues while its accuracy is similar. Full article

Objective: Transperineal prostate (TP) biopsy is the key diagnostic tool for evaluating prostate cancer and is feasible under local anaesthetic (LA) alone. However, concerns about its tolerability encourage use of a multimodal analgesia approach. Pre-emptive over-the-counter analgesia with LA may provide a simple and low-risk option. The objective of this study was to investigate the effects of over-the-counter analgesia on TP biopsies conducted under LA. Methods: This interventional single-centre study investigated 160 participants who undertook a TP biopsy under LA, with and without pre-emptive analgesia (1 g of paracetamol and 400 mg of ibuprofen). Pain tolerability was measured using a visual analogue scale (VAS) at three procedural points (probe insertion, LA infiltration, and biopsy); an overall average VAS score was subsequently calculated. The abstracted secondary variables include patient details (age, prostate size, and PSA level), biopsy details (number of cores and volume of LA used), and preferability for LA use in future TP biopsies. An inferential statistical analysis was performed using Wilcoxon’s Rank Sum non-parametric test, Pearson’s test of correlation, and Pearson’s Chi-squared test. Results: The groups were comparable in age, prostate size, and PSA level. Median VAS scores were consistently lower in the intervention cohort, but without statistical significance. A higher volume of LA was associated with lower overall VAS (p = 0.03). LA was strongly preferred over GA for hypothetical future TP biopsies in both cohorts. Conclusions: Pre-emptive analgesia does not significantly improve tolerability of TP biopsy under LA. Our study substantiates evidence that TP biopsy is generally well tolerated under LA and preferred over GA. Full article

(1) Background: In 2022, the World Stroke Organization said there were more than 12.2 million new cases of stroke each year, between all ages and sexes. Six and a half million people die each year from stroke. Ischemic stroke accounts for 7.6 million (62%) cases, with 3.3 million (51%) deaths. Stroke is mainly linked to the atherosclerosis of a large artery. (2) Objective: Since the carotid artery directly supplies the brain, we used age-dependent mechanical mapping on the healthy common carotid artery (CCA) with the aim of being able to predict and thus potentially prevent ischemic stroke. (3) Methods: We assessed the CCA stiffness of 95 healthy control (CTL) females (2.23–39.46 years) and 107 healthy CTL males (2.85–40 years). Cine-loops of B-mode CCA data were digitally recorded with conventional medical ultrasound devices. Arterial wall elastic moduli were estimated offline using a proprietary non-invasive imaging-based biomarker algorithm (ImBioMark). Statistical analyzes were carried out with Excel software. (4) Results: Females showed a linear regression profile of CCA elastic moduli ranging from 41 ± 2 kPa to 54 ± 17 kPa (R² = 0.88), while males showed one ranging from 38 ± 5 kPa to 63 ± 22 kPa (R² = 0.83). For qualitative and quantitative illustrations, the elastic modulus data of CTLs were compared with those of subjects with Kawasaki disease and subjects born prematurely, respectively. (5) Conclusions: This study introduced some fundamental features of the mechanical evolution of the CCA as a function of age (2–40 years). Since atherosclerotic arteriopathy starts early in life, this gives the ability to predict risks of stroke and other cardiovascular diseases with the possibility of applying a more comprehensive range of potential preventive measures early in life. This is consistent with preventive medicine objectives which aim to be more predictive to implement pre-emptive measures as opposed to diagnostic and curative approaches. Full article

Reproductive activity is costly in terms of future reproduction and survival. Oxidative stress has been identified as a likely mechanism underlying this cost of reproduction. However, empirical studies have yielded the paradoxical observation that breeders often sustain lower levels of oxidative damage than non-breeders. The oxidative shielding hypothesis attempts to explain such data, and posits that breeders pre-emptively reduce levels of oxidative damage in order to protect their germ cells, and any resultant offspring, from harm caused by exposure to oxidative damage. While there is some empirical evidence of oxidative shielding in females, there have been no explicit tests of this hypothesis in males, despite evidence of the oxidative costs to the male reproductive effort and the vulnerability of sperm cells to oxidative damage. In this study, we assess lipid oxidative damage (malondialdehyde, MDA) in the ejaculates of reproducing and non-reproducing wild banded mongooses. We found that, among breeding males, ejaculate MDA levels were lower during mate competition compared to 2 months later, when individuals were not mating, which is consistent with the oxidative shielding hypothesis, and similar to findings in females. However, ejaculate MDA levels did not differ significantly between breeding and non-breeding individuals at the time of mating, contrary to expectation. The finding that ejaculate MDA was not higher in non-breeders may reflect individual differences in quality and hence oxidative stress. In particular, breeders were significantly older than non-breeders, which may obscure differences in oxidative damage due to reproductive investment. Further research is needed to establish the causal relationship between reproductive investment and oxidative damage in ejaculates, and the consequences for offspring development in banded mongooses and other species. Full article

Background: Managing patients with obstructing rectal cancer is challenging due to the risks of gastrointestinal obstruction and perforation. This study evaluates the outcomes of pre-emptive laparoscopic colostomy creation in patients with locally advanced rectal and anal cancer to prevent symptoms and facilitate therapy initiation. Methods: This retrospective cohort study includes patients with locally advanced rectal or anal cancer assessed by our Colorectal Multidisciplinary Team from January 2017 to February 2024. Patients who underwent pre-emptive laparoscopic colostomy were compared to a control group of non-obstructing rectal cancer patients who started direct oncological treatment. The primary endpoint was the time from diagnosis to the initiation of oncological treatments. The secondary endpoints were the rate and timing of subsequent radical resection, surgical morbidity and hospital stay. A Weibull regression was used to evaluate the time differences between the groups. Results: There were 37 patients who received pre-emptive laparoscopic colostomy, compared to 207 control patients. The mean time from diagnosis to the start of neoadjuvant therapy was 38.3 ± 2.3 days. Despite higher rates of malnutrition and more advanced stages in the colostomy group, no significant differences were observed in the time to start therapy (p = 0.083) or time to radical resection (p = 0.187) between the groups. The laparoscopic procedure showed low rates of postoperative complications and acceptable lengths of stay. Discussion and Conclusions: Pre-emptive laparoscopic colostomy is a feasible approach for managing obstructing rectal or anal cancer. Treatment timelines were not extended compared to timelines for non-obstructing cases, despite differences in nutritional status and staging. Further prospective studies with larger cohorts are needed to validate these findings and refine treatment protocols for obstructing gastrointestinal malignancies. Full article

In this work, we consider a problem from the field of power-aware scheduling in which a fleet of electric vehicles have to be charged in a minimum time. Each vehicle is equipped with a lithium-ion battery of a given capacity. The initial power used for charging each battery is known, whereas it is assumed that the power drops to zero at the moment when the battery gets fully loaded. The power usage function is linear and decreasing. The charging jobs are nonpreemptable and independent, whereas the total available amount of power is limited. The objective is to minimize the schedule length. In this paper, we analyze the case of a problem with identical jobs that already cover a wide variety of practical situations. By employing inverses of natural numbers, similar to harmonic series, we prove two properties of this case, and we also discuss the phenomenon of the stabilization of the difference between the start times of two successive jobs in a schedule. We also take under examination a few special cases of the problem. Some conclusions and directions for future research are given. Full article

Objective: implementing appropriate pharmacological and non-pharmacological interventions to alleviate pain related to routine dental procedures in paediatric patients could enhance children’s ability to manage dental care. The aim of this review was to investigate the effectiveness of and provide recommendations for interventions that can be used to reduce intra-operative and post-operative pain associated with routine paediatric dental procedures. Methods: A systematic review of randomised controlled clinical trials (RCT) was conducted. Multiple electronic databases were systematically searched. The Cochrane risk-of-bias tool for RCTs was used to evaluate the quality of the included studies. A meta-analysis was performed to determine the effectiveness of the interventions using the Cohen’s d standardised mean differences (SMD) and 95% confidence intervals (CIs) for continuous outcomes. The GRADE tool was used to assess the certainty of evidence to make recommendations. Results: The review included forty-five RCTs comprising 3093 children. Thirty-seven RCTs were included in the meta-analysis, which showed the effectiveness of behavioural interventions (SMD = −0.50, 95% CI −0.83 to −0.18), mechanoreceptor and thermal receptor stimulation (SMD = −1.38, 95% CI −2.02 to −0.73) for intra-operative pain, and pre-emptive oral analgesics (SMD = −0.77, 95% CI −1.21 to −0.33) for reducing post-operative pain in children receiving routine dental care. Conclusion: The GRADE results for these interventions were strong recommendation (IB) for their use, based on moderate evidence and their benefits far outweighing the harm, and they can be delivered readily with minimal training to reduce the pain experience of paediatric patients. Full article

Background: The number of kidney transplant recipients over 70 years of age is increasing but detailed data on patient and graft survival in the modern era of immune suppression are few. Methods: A single-center cohort of patients of 70 years and older (n = 349) at time of kidney transplantation from 2010–2020 were followed until January 2023. Results: The median age was 73 years with a median follow-up of 4.3 years. Fifty percent of recipients of a living donor kidney (LDK, n = 143) received their graft pre-emptively. Cumulative death-censored graft survival was excellent in the LDK group and reached 98% at 5 years vs. 85% in the deceased donor kidney (DDK) group. Primary non-function (38%) and rejection (43%) were the major causes of graft loss in the first year after DDK transplantation. Rejection-related graft loss was 4.6% during follow-up. Median recipient survival was superior in the subgroup of pre-emptively transplanted LDK patients compared to non-pre-emptively LDK transplanted patients (11.1 versus 6.2 years). Non-pre-emptively transplanted patients had a significantly increased incidence of infection (HR 3.81, 1.46–9.96) and cardiovascular-related causes of death (HR 3.35, 1.16–9.71). Pre-emptive transplantation was also associated with a significantly improved graft survival in the DDK recipients but this result was confounded by significantly better HLA matching and younger donor age in this group. Conclusions: Pre-emptive LDK transplantation in patients of 70 years or older confers superior graft and recipient survival. Full article

Background: Anastomotic leakage, which is defined as a defect in the integrity of a surgical join between two hollow viscera leading to communication between the intraluminal and extraluminal compartments, continues to be of high incidence and one of the most feared complications following gastrointestinal surgery, with a significant potential for a fatal outcome. Surgical options for management are limited and carry a high risk of morbidity and mortality; thus, surgeons are urged to look for alternative options which are minimally invasive, repeatable, non-operative, and do not require general anesthesia. Methods: A narrative review of the international literature took place, including PubMed, Scopus, and Google Scholar, utilizing specific search terms such as “Digestive Surgery AND Anastomotic Leakage OR leak OR dehiscence”. Results: In the present review, we try to describe and analyze the pros and cons of the various endoscopic techniques: from the very first (and still available), fibrin gluing, to endoclip and over-the-scope clip positioning, stent insertion, and the latest suturing and endoluminal vacuum devices. Finally, alongside efforts to improve the existing techniques, we consider stem cell application as well as non-endoscopic, and even endoscopic, attempts at intraluminal microbiome modification, which should ultimately intervene pre-emptively, rather than therapeutically, to prevent leaks. Conclusions: In the last three decades, this search for an ideal device for closure, which must be safe, easy to deploy, inexpensive, robust, effect rapid and stable closure of even large defects, and have a low complication rate, has led to the proposal and application of a number of different endoscopic devices and techniques. However, to date, there is no consensus as to the best. The literature contains reports of only small studies and no randomized trials, failing to take into account both the heterogeneity of leaks and their different anatomical sites. Full article

Patients with non-obstructive lipid-rich plaques (LRPs) on combined intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) are at high risk for future events. Local pre-emptive percutaneous treatment of LRPs with a paclitaxel-eluting drug-coated balloon (PE-DCB) may be a novel therapeutic strategy to prevent future adverse coronary events without leaving behind permanent coronary implants. In this pilot study, we aim to investigate the safety and feasibility of pre-emptive treatment with a PE-DCB of non-culprit non-obstructive LRPs by evaluating the change in maximum lipid core burden in a 4 mm segment (maxLCBImm4) after 9 months of follow up. Therefore, patients with non-ST-segment elevation acute coronary syndrome underwent 3-vessel IVUS-NIRS after treatment of the culprit lesion to identify additional non-obstructive non-culprit LRPs, which were subsequently treated with PE-DCB sized 1:1 to the lumen. We enrolled 45 patients of whom 20 patients (44%) with a non-culprit LRP were treated with PE-DCB. After 9 months, repeat coronary angiography with IVUS-NIRS will be performed. The primary endpoint at 9 months is the change in maxLCBImm4 in PE-DCB-treated LRPs. Secondary endpoints include clinical adverse events and IVUS-derived parameters such as plaque burden and luminal area. Clinical follow-up will continue until 1 year after enrollment. In conclusion, this first-in-human study will investigate the safety and feasibility of targeted pre-emptive PE-DCB treatment of LRPs to promote stabilization of vulnerable coronary plaque at risk for developing future adverse events. Full article

Currently, autonomous vehicles, non-autonomous vehicles, and VIP (emergency) autonomous cars are using intelligent road management techniques to interact with one another and enhance the effectiveness of the traffic system. All sorts of vehicles are managed and under control using the intersection management unit approach. This study focuses on transportation networks where VIP cars are a major disruption, accounting for 40% of accidents and 80% of delays. Intelligent Mobility (IM) is a strategy promoted in this study that proposes setting up intelligent channels for all vehicle communication. As part of its function, the IM unit keeps tabs on how often each junction is used so that it may notify drivers on traffic conditions and ease their workload. The suggested layout may drastically cut average wait times at crossings, as shown in SUMO simulations. The entrance of a VIP car should disrupt all traffic, but the IM (intersection management) unit effectively manages all traffic by employing preemptive scheduling and non-preemptive scheduling techniques for all types of vehicles. We are employing Nishtar roads, the M4 motorway, Mexico, and Washington roads in our scenario. In comparison to all other routes, the simulation results demonstrate that the Washington road route is better able to manage all vehicle kinds. Washington’s traffic delays for 50 cars of all sorts are 4.02 s for autonomous vehicles, 3.62 s for VIP autonomous vehicles, and 4.33 s for non-autonomous vehicles. Full article

Achieving local anaesthesia for various clinical dental applications is a challenge that we encounter in our daily practice. Pre-emptive pulpal laser analgesia (PPLA) treatment strategy could be a promising non-pharmacological modality. Hence, our ex vivo laboratory study is aimed at evaluating the changes in enamel surface morphology when irradiated with various published PPLA protocols using scanning electron microscopy (SEM). To do so, 24 extracted healthy human permanent premolar teeth were collected, and each tooth was divided into equal halves randomised into six groups. The following laser parameter protocols based on published protocols of clinical Er:YAG laser-induced PPLA were randomly assigned for each group: 0.2 W/10 Hz/3 J/cm² (Group A—100% water spray; Group B—no water); 0.6 W/15 Hz/10 J/cm² (Group C—100% water spray; Group D—no water); 0.75 W/15 Hz/12 J/cm² (Group E—100% water spray; Group F—no water); 1 W/20 Hz/17 J/cm² (Group G—100% water spray; Group H—no water). Each sample was irradiated at an angle of 90° to the dental pulp, with a sweeping speed of 2 mm/s for a 30 s exposure time. Our results have shown, for the first time, no alteration to the mineralised tooth structure when irradiated with the following protocols: 0.2 W/10 Hz/3 J/cm² with 100% water spray or without water spray with an irradiated area fixed at a 10 mm tip-to-tissue distance, sweeping motion with 2 mm/s speed of movement; average power output of 0.6 W/15 Hz/10 J/cm², maximum water cooling of 100%, tip-to-tooth distance fixed at 10 mm, 30 s exposure time, sweeping motion with 2 mm/s speed of movement. The authors concluded that the current available proposed PPLA protocols in the literature might cause an alteration to the enamel surface. Hence, future clinical studies are warranted to validate our study’s PPLA protocols. Full article