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القنفذ لاتيه وحجر الماء
سار القنفذ لآتيه في الغابة وقد كسا الحزن وجهه، يا له من تحول في أحوال الغابة خلال الآونة الأخيرة. قال القنفذ : أيتها الغابة المسكينة إلام سوف يؤول حالك إن لم تمطر قريبا ؟ سوف تموتين بكل تأكيد ؟. غابة القنفذ مظلمة ومعدومة المياه، حتى بحيرة الأسماك جفت. يروي الغراب أنه وجد حجر ماء غريب، سيعيد الماء إلى الغابة، فيمضي القنفذ باحثا عنه.
Book
Effects of losing public health insurance on preventative care, health, and emergency department use
This paper studies the effect of losing public health insurance eligibility on preventative care, self-reported health, and emergency department use. I exploit the 2005 TennCare disenrollment in which 190,000 residents–mainly non-elderly childless adults–lost public health insurance eligibility due to budget cuts. I use two surveys, the Behavioral Factor Surveillance System and the National Health Interview Survey, in a difference-in-difference methodology to study the effects of the reform. I find that the reform lead to a 4%–5% reduction in reporting having mammograms and breast exams. An increase of 20% in number of days with health incapacitation and no strong evidence of changes of emergency department visits (nor number of visits). I document margins of heterogeneity of the effects across demographic characteristics. Finally, I explore the margins of symmetry between gaining and losing public insurance by comparing estimates to those from the Affordable Care Act Medicaid Expansions.
Journal Article
Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients
The use of extracorporeal life support (ECLS) as part of cardio-circulatory support has increased rapidly in recent years. Severe hyperlactatemia is not uncommon in this group of patients. Lactate peak concentrations and lactate clearance have already been identified as independent marker for mortality in critical ill patients without mechanical device support. The aim of this study was to determine a supposed correlation between the variables lactate peak concentration and clearance in the blood and mortality in the ECLS context. Therefore, a total of 51 cardiac surgery ICU patients with ECLS therapy were included in this retrospective, clinical observational study (survivors n = 23; non-survivors n = 28). Lactate measurement was performed before, during and after ECLS therapy. Further, common ICU scores (SAPSII, SOFA, TISS28), the rates of transfusion and the different vasopressor therapies will be compared. Significant elevated peak lactate levels and poor lactate clearance were associated with higher mortality during ECLS therapy (p < 0.001). Deceased patients had higher SAPSII scores (p < 0.001), received more transfusions (p < 0.001) and presented with higher rates of epinephrine (p < 0.001). In conclusion, hyperlactatemia during ECLS therapy is a time sensitive emergency. Lactate cannot be cleared in all patients. Reversible causes should be explored and treated. In cases where the cause is irreversible, the prognosis of elevated lactate concentrations and reduced clearance is very poor.
Journal Article
Direct true lumen cannulation in type A acute aortic dissection: A review of an 11 years’ experience
Direct true lumen cannulation (DTLC) of the aorta is an alternative cardiopulmonary bypass cannulation technique in the context of type A acute aortic dissection (A-AAD). DTLC has been reported to be effective in restoring adequate perfusion to jeopardized organs. This study reports and compares operative outcomes with DTLC or alternative cannulation techniques in a large cohort of patients with A-AAD.
All patients who underwent surgery for A-AAD between January 2006 and January 2017 in Mainz university hospital were reviewed. The choice of cannulation technique was left to the operating surgeon, however DTLC was our preference in patients who were in state of shock or showed signs of tamponade or hypoperfusion, in cases of potential cerebral malperfusion, as well as in patients who were under resuscitation.
A total of 528 patients (63% males, mean age 64±13.8 years) underwent emergency surgery for A-AAD. The DTLC technique was used in 52.4% of patients. The DTLC group of patients had worse clinical status at the time of presentation with more shock, tamponade, true lumen collapse, cerebral and other malperfusion states. New neurologic events were diagnosed in around 8% of patients in each group following surgery, but there was a trend for quicker neurological recovery in the DTLC-group. Early mortality rates, short-term and long-term survival rates did not differ between the two groups.
DTLC is a safe cannulation technique that enables effective antegrade true lumen perfusion in complicated A-AAD scenarios, and is an advantageous addition to the aortic surgeons' armamentarium.
Journal Article
SPECULOOS Northern Observatory: Searching for Red Worlds in the Northern Skies
SPECULOOS is a ground-based transit survey consisting of six identical 1 m robotic telescopes. The immediate goal of the project is to detect temperate terrestrial planets transiting nearby ultracool dwarfs (late M-dwarf stars and brown dwarfs), which could be amenable for atmospheric research with the next generation of telescopes. Here, we report the developments of the northern counterpart of the project—SPECULOOS Northern Observatory, and present its performance during the first three years of operations from mid-2019 to mid-2022. Currently, the observatory consists of one telescope, which is named Artemis. The Artemis telescope demonstrates remarkable photometric precision, allowing it to be ready to detect new transiting terrestrial exoplanets around ultracool dwarfs. Over the period of the first three years after the installation, we observed 96 objects from the SPECULOOS target list for 6000 hr with a typical photometric precision of 0.5%, and reaching a precision of 0.2% for relatively bright non-variable targets with a typical exposure time of 25 s. Our weather downtime (clouds, high wind speed, high humidity, precipitation and/or high concentration of dust particles in the air) over the period of three years was 30% of overall night time. Our actual downtime is 40% because of additional time loss associated with technical problems.
Journal Article
Design of a Brain-Controlled Video Game based on a BCI System
The Computer Brain Interface (BCIs) is a new type of user interface designed to recognize real-time user-specific intentions based on user brain mapping. Gradual advancing technology behind the BCI interface has made it possible to develop gaming applications that use directly brain input instead of well-known traditional control methods. This paper presents the Mental Pool Game, a brain-controlled computer game powered by Unity3D, which uses a commercial BCI device based on a network of electroencephalography (EEG) sensors placed on the scalp capable of creating brain patterns only by capturing conscious thoughts from a user that can be easily reproduced as mental actions to control strength and speed on which the user can project on the white ball to hit any of the eight balls on the pool table. Mental PoolGame, powered by Unity3D, is a platform that provides all tools necessary for a developer to develop three-dimensional games that has been designed so that the end user no longer uses classical commands that depend on the use of well-known peripheral input devices present on any PC, such as a keyboard, mouse and more recently a joystick to control the movement of space in an object in a virtual environment.
Journal Article
Observational pilot study on the influence of an app-based self-management program on the quality of life of women with endometriosis
Purpose
Endometriosis can significantly impair the quality of life of those affected. Multimodal self-help measures are recommended but often difficult to access. Smartphone apps have been shown to improve the quality of life for other conditions with chronic pain. The aim of this study was to examine whether there is evidence of beneficial effects of the smartphone app “Endo-App
®
” and whether a multicenter randomized controlled trial should be planned to substantiate these effects.
Methods
In a sample of
N
= 106 women affected by endometriosis the present study determined the influence of the use of Endo-App
®
on their quality of life. Among others, the validated questionnaire
Endometriosis Health Profile
from Oxford University was used for this purpose.
Results
The use of Endo-App
®
lead to a highly significant improvement in quality of life already after 2 weeks. A statistically significant change was found for nine out of ten measured variables of quality of life. A series of further analyses validated that the measured positive effects were not due to other confounding factors.
Conclusion
In summary, the results indicate that the quality of life of women with endometriosis improved by the digital self-management tool Endo-App
®
. More studies are needed to further explore the influence of the app on quality of life and as confirmatory evidence of beneficial effects. For this purpose, a randomized controlled trial should be conducted over a longer period of time.
Trial registration
This trial is registered at clinicaltrials.gov under the registration number NCT05528601 on August 18, 2022. It was retrospectively registered.
Journal Article
Three-Dimensional-Evaluation of Aortic Changes after Frozen Elephant Trunk (FET) in Zone 0 vs. Zone 2 in Acute Type A Aortic Dissection
Introduction: The management of aortic dissection has evolved significantly over the decades, with the frozen elephant trunk (FET) procedure emerging as a key technique for treating complex aortic pathologies. Recent practices involve deploying the FET prosthesis more proximally in the aorta (Zone 0) to reduce complications, leading to questions about its impact on long-term aortic remodeling compared to traditional Zone 2 deployment. Methods: This retrospective analysis utilized 3D segmentation software to assess the volumetric changes in aortic remodeling after acute Type A aortic dissections, comparing FET stent graft deployment in Zone 0 and Zone 2. The study included 27 patients operated on between 2020 and 2022, with volumetric measurements taken from postoperative and 6-month follow-up CT scans. Statistical analyses were performed to evaluate the differences in the aortic true lumen (TL) and the perfused false lumen (PFL) between the two groups. Results: Both Zone 0 and Zone 2 deployments resulted in significant true lumen (TL) increases (Z0 p = 0.001, Z2 p < 0.001) and perfused false lumen (PFL) decreases (Z0 p = 0.02, Z2 p = 0.04), with no significant differences in volumetric changes between the groups (p = 0.7 post op and p = 0.9 after 6 months). The distal anastomosis in Zone 0 did not compromise the aortic remodeling outcomes and was associated with reduced distal ischemia and cerebral perfusion times (p = 0.041). The angle measurements in Zone 0 did not show any significant changes after the 6-month control (p = 0.2). However, in Zone 2, a significant change was detected. (p = 0.022). The part comparison analyses did not indicate significant differences in aortic deviation between the groups (p = 0.62), suggesting comparable effectiveness in aortic remodeling. Conclusions: Performing the distal anastomosis more proximally in Zone 0 offers technical advantages without compromising the effectiveness of aortic remodeling compared to the traditional Zone 2 deployment. This finding supports the continued recommendation of Zone 0 deployment in the management of acute Type A aortic dissections, with ongoing studies being needed to confirm the long-term outcomes and survival benefits.
Journal Article
Impact of Musashi-1 and Musashi-2 Double Knockdown on Notch Signaling and the Pathogenesis of Endometriosis
The stem cell marker and RNA-binding protein Musashi-1 is overexpressed in endometriosis. Musashi-1-siRNA knockdown in Ishikawa cells altered the expression of stem cell related genes, such as OCT-4. To investigate the role of both human Musashi homologues (MSI-1 and MSI-2) in the pathogenesis of endometriosis, immortalized endometriotic 12-Z cells and primary endometriotic stroma cells were treated with Musashi-1- and Musashi-2-siRNA. Subsequently, the impact on cell proliferation, cell apoptosis, cell necrosis, spheroid formation, stem cell phenotype and the Notch signaling pathway was studied in vitro. Using the ENDOMET Turku Endometriosis database, the gene expression of stem cell markers and Notch signaling pathway constituents were analyzed according to localization of the endometriosis lesions. The database analysis demonstrated that expression of Musashi and Notch pathway-related genes are dysregulated in patients with endometriosis. Musashi-1/2-double-knockdown increased apoptosis and necrosis and reduced stem cell gene expression, cell proliferation, and the formation of spheroids. Musashi silencing increased the expression of the anti-proliferation mediator p21. Our findings suggest the therapeutic potential of targeting the Musashi–Notch axis. We conclude that the Musashi genes have an impact on Notch signaling and the pathogenesis of endometriosis through the downregulation of proliferation, stemness characteristics and the upregulation of apoptosis, necrosis and of the cell cycle regulator p21.
Journal Article