An individualized digital twin of a patient for transdermal fentanyl therapy for chronic pain management.

Fentanyl transdermal therapy is a suitable treatment for moderate-to-severe cancer-related pain. The inter-individual variability of the patients leads to different therapy responses. This study aims to determine the effect of physiological features on the achieved pain relief. Therefore, a set of virtual patients was developed by using Markov chain Monte Carlo (MCMC) based on actual patient data. The members of this virtual population differ by age, weight, gender, and height. Tailored digital twins were developed using these correlated, individualized parameters to propose a personalized therapy for each patient. It was shown that patients of different ages, weights, and gender have significantly different fentanyl blood uptake, plasma fentanyl concentration, pain relief, and ventilation rate. In the digital twins, we included the virtual patients' response to the treatment, namely, pain relief. Therefore, the digital twin was able to adjust the therapy in silico to have more efficient pain relief. By implementing digital-twin-assisted therapy, the average pain intensity decreased by 16% compared to conventional therapy. The median time without pain increased by 23 h over 72 h. Therefore, the digital twin can be successfully used in individual control of transdermal therapy to reach higher pain relief and maintain steady pain relief. (Created with BioRender.com)

Physiological complexity of EEG as a proxy for dementia risk prediction: a review and preliminary cross-section analysis

The aim of this work is to give the readers a review (perspective) of prior work on this kind of complexity-based detection from resting-state EEG and present our preliminary cross-section analysis results on how EEG complexity of supposedly healthy senior persons can serve as an early warning to clinicians. Together with the use of wearables for health, this approach to early detection can be done out of clinical setting improving the chances of increasing the quality of life in seniors.Comment: 19 pages, 1 figure, 1 tabl

Conception d'un doigt artificiel à fibre optique polymérique pour application du toucher de surfaces textiles

L'objectif de ce travail est de mettre au point un capteur mécanique capable de retranscrire le toucher en utilisant une fibre optique polymérique comme élément senseur. Le développement d'un doigt artificiel permet de raccourcir le temps de développement de nouvelles surfaces en évitant l'utilisation d'un panel humain. L'avantage essentiel de ce type de technologie est de ne pas être sensible à l'humidité. Le capteur étudié est composé d'une structure aluminium, d'un corps mou en PDMS (Sylgard®184) dans lequel est noyée une fibre polymérique développée à l'EMPA et de longueur 20 mm. Le contact entre la surface frottée et le capteur se fait par un téton de PDMS (Sylgard®184) de dureté plus importante. La surface considérée est un textile. Le coefficient de frottement observable entre le textile et le téton est comparable à celui que l'on peut trouver lors d'un frottement entre le doigt et le même textile. Le téton est moulé avec une texture concentrique aux dimensions des dermatoglyphes (100 µm de profondeur et 500 µm de période). Le montage d'étude permettant de caractériser la réponse du capteur en fonction des stimuli mécaniques est composé d'une source lumineuse Avalight Hal mini (lampe halogène 10W), de deux fibres optiques de verre large bande 250-2500 nm et d'un spectromètre Avantes AvaspecULS2048CL-Evo. Le capteur à fibre optique fonctionne selon le principe suivant : le spectromètre en fin de montage nous permet de mesurer l'intensité lumineuse transmise au travers de la fibre optique du capteur. La fibre est non couverte, ce qui implique que le saut d'indice de réfraction entre la fibre et le PDMS ne convient pas pour une transmission précise du flux lumineux, nous avons des fuites de lumière tout au long de cette fibre. De plus, la fibre éjecte plus de lumière à chaque courbure, sa déformation lors d'un stimulus mécanique est détectable par l'intensité transmise. La fibre est positionnée dans le capteur avec un angle imposé de 45° par rapport au plan horizontal à chaque extrémité. Deux méthodes de de caractérisation du capteur à fibre optique sont utilisées par mesure du comportement à l'indentation et au frottement. Un capteur de force, d'amplitude maximale 5N, est couplé à une platine de translation permettant une pénétration du matériau. Ce dispositif nous permet d'étudier le comportement du capteur à fibre optique en termes d'enfoncement en fonction de la force normale appliquée à la charge et à la décharge. Pour l'étude du comportement au frottement du doigt artificiel, celui-ci est monté à la place du frotteur d'un tribomètre. Il permet de mesurer les forces tangentielle et normale lors d'un frottement linéaire alternatif sur une platine mobile pour un déplacement choisi ici de 50mm, à 20mm/s avec une accélération de 50 mm/s². La force normale peut être : i) constante, elle est alors appliquée par une masse morte, le déplacement vertical du doigt artificiel est alors mesuré ou ii) mesurée à l'aide d'un capteur de force et alors le doigt artificiel est fixé à une altitude donnée. Les informations provenant de la fibre optique et de l'indenteur ou du tribomètre sont alors comparées. Il est montré que le capteur, bien qu'avec une seule fibre, permet de percevoir des influences mécaniques et ceci quelle que soit la direction de l'effort dans le cas d'une sollicitation en frottement. Différentes surfaces textiles, présentant ou non une anisotropie de surface, sont testées et montrent l'intérêt que peut présenter un tel capteur à fibre optique pour la caractérisation du toucher des surfaces textiles

Use of a novel pressure distribution system for severely ill neonates: a clinical pilot study carried out by the PREPICare consortium

Background: Pressure Injuries are not exclusively an adult phenomenon; various risk factors contribute to a high prevalence rate of 43% in the neonatal and pediatric intensive care population. Effective preventive measures in this population are limited. Methods: We performed a pilot study to analyze the distribution and localization of support surface interface pressures in neonates in a pediatric intensive care unit (PICU). The hypothesis was that pressure redistribution by a novel air mattress would reduce pressure peaks in critical neonates. The measurements were conducted in a 27-bed level III PICU between November and December 2020. This included measuring pressure distribution and pressure peaks for five neonates positioned on either a state-of-the-art foam mattress or a new prototype air mattress. Results: We confirmed that the pressure peaks were significantly reduced using the prototype air mattress, compared with the state-of-the-art foam mattress. The reduction of mean pressure values was 9-29%, while the reduction of the highest 10% of pressure values was 23-41%. Conclusions: The journey to an effective, optimal, and approved product for severely ill neonates to reduce Pressure Injuries is challenging. However, a crucial step was completed by this pilot study with the first pressure measurements in a real-world setting and the successful realization of a decrease in pressure peaks obtained using a prototype air mattress

E-Knitted Textile with Polymer Optical Fibers for Friction and Pressure Monitoring in Socks

The objective of this paper is to study the ability of polymer optical fiber (POF) to be inserted in a knitted fabric and to measure both pressure and friction when walking. Firstly, POF, marketed and in development, have been compared in terms of the required mechanical properties for the insertion of the fiber directly into a knitted fabric on an industrial scale, i.e. elongation, bending rigidity, and minimum bending radius before plastic deformation. Secondly, the chosen optical fiber was inserted inside several types of knitted fabric and was shown to be sensitive to friction and compression. The knitted structure with the highest sensitivity has been chosen for sock prototype manufacturing. Finally, a feasibility study with an instrumented sock showed that it is possible to detect the different phases of walking in terms of compression and friction

Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

BACKGROUND Trials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy. METHODS In a multicenter, randomized, open-label trial, we assigned, in a 1:1:1 ratio, patients 16 to 60 years of age who had had a recent stroke attributed to PFO, with an associated atrial septal aneurysm or large interatrial shunt, to transcatheter PFO closure plus long-term antiplatelet therapy (PFO closure group), antiplatelet therapy alone (antiplatelet-only group), or oral anticoagulation (anticoagulation group) (randomization group 1). Patients with contraindications to anticoagulants or to PFO closure were randomly assigned to the alternative noncontraindicated treatment or to antiplatelet therapy (randomization groups 2 and 3). The primary outcome was occurrence of stroke. The comparison of PFO closure plus antiplatelet therapy with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 2, and the comparison of oral anticoagulation with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 3. RESULTS A total of 663 patients underwent randomization and were followed for a mean (+/- SD) of 5.3 +/- 2.0 years. In the analysis of randomization groups 1 and 2, no stroke occurred among the 238 patients in the PFO closure group, whereas stroke occurred in 14 of the 235 patients in the antiplatelet-only group (hazard ratio, 0.03; 95% confidence interval, 0 to 0.26; P<0.001). Procedural complications from PFO closure occurred in 14 patients (5.9%). The rate of atrial fibrillation was higher in the PFO closure group than in the antiplatelet-only group (4.6% vs. 0.9%, P = 0.02). The number of serious adverse events did not differ significantly between the treatment groups (P = 0.56). In the analysis of randomization groups 1 and 3, stroke occurred in 3 of 187 patients assigned to oral anticoagulants and in 7 of 174 patients assigned to antiplatelet therapy alone. CONCLUSIONS Among patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone. PFO closure was associated with an increased risk of atrial fibrillation

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Measurement of the top quark forward-backward production asymmetry and the anomalous chromoelectric and chromomagnetic moments in pp collisions at √s = 13 TeV

Abstract The parton-level top quark (t) forward-backward asymmetry and the anomalous chromoelectric (d̂ t) and chromomagnetic (μ̂ t) moments have been measured using LHC pp collisions at a center-of-mass energy of 13 TeV, collected in the CMS detector in a data sample corresponding to an integrated luminosity of 35.9 fb−1. The linearized variable AFB(1) is used to approximate the asymmetry. Candidate t t ¯ events decaying to a muon or electron and jets in final states with low and high Lorentz boosts are selected and reconstructed using a fit of the kinematic distributions of the decay products to those expected for t t ¯ final states. The values found for the parameters are AFB(1)=0.048−0.087+0.095(stat)−0.029+0.020(syst),μ̂t=−0.024−0.009+0.013(stat)−0.011+0.016(syst), and a limit is placed on the magnitude of | d̂ t| < 0.03 at 95% confidence level. [Figure not available: see fulltext.

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe