Acute pulmonary embolism (PE) management guidelines categorize normotensive patients with right ventricle dysfunction (RVD) and normal cardiac troponin (cTn) as intermediate low risk. This study explores the prevalence of cardiovascular comorbidities and their impact on risk stratification in this specific cohort. To investigate the characteristics of normotensive acute PE patients with RVD and normal cTn, emphasizing the role of pre-existing cardiovascular diseases in determining the intermediate-low risk status. A total of 1675 PE patients from a regional registry were screened, excluding high-risk and intermediate-high-risk cases. Among the remaining 400 normotensive patients with RVD, 353 with echocardiography and normal cTn were included. Patients were categorized into low or intermediate-low risk based on RVD presence. Cardiovascular comorbidities were assessed, and logistic regression analyzed their association with intermediate-low risk. Intermediate-low-risk patients (n=137) exhibited significantly higher rates of chronic heart failure, arterial hypertension, coronary artery disease, diabetes, and atrial fibrillation compared to low-risk patients (n=216). A substantial 77.4% of intermediate-low-risk patients had at least one cardiovascular comorbidity, significantly elevating the risk of RV dysfunction (adjusted OR 2.954, p<0.001). The all-cause hospital mortality was 5.1% in intermediate-low-risk and 1.4% in low-risk PE. Normotensive acute PE patients with RVD and normal cTn are predominantly burdened with chronic cardiovascular conditions. The majority of intermediate-low-risk patients have at least one cardiovascular comorbidity, indicating an increased risk of death during hospitalization compared to low-risk patients. This study underscores the necessity for nuanced risk stratification considering pre-existing cardiovascular diseases for tailored and effective management. These findings have important implications for optimizing treatment strategies and improving outcomes in this high-risk population.

Active malignant disease is associated with pulmonary embolism and the treatment of this condition is very challenging. The efficacy and safety of thrombolytic therapy for acute severe PE in patients with active malignant disease is unknown. This study aimed to investigate hospital mortality rate and the incidence of major bleeding at 7 days according to the International Society of Thrombosis and Hemostasis (ISTH) criteria in patients with active malignant disease who were treated with thrombolytic therapy due to severe acute PE. Patients with acute PE proven by computed tomography pulmonary angiography who were admitted to intensive care units have enrolled in the Regional PE Registry (REPER) since 2015, consisting of 10 hospitals from the 4 east Balkan countries. The decision to use thrombolytic therapy was at the discretion of the attending physicians, and it was used in high-risk, and intermediate-high-risk PE patients. Hospital mortality and the incidence of major bleeding at 7 days were compared between patients with active cancer and those without it who received thrombolytic therapy. Alteplase-based therapy was used. Among 2070 patients with acute PE enrolled in REPER, intermediate-high and high-risk PE had 795 patients without malignant disease and 135 had active malignant disease in the last 6 months. Patients with malignant disease had less chance to be treated with thrombolysis than patients without it (29.1% vs 44.7%, OR 0.508, 95%CI 0.341-0.756, p=0.001). For patients treated with thrombolysis, hospital mortality was non significantly higher in patients with the malignant disease compared to patients without it (25.6% vs 16,1%, OR 1.803, 95%CI 0.833-3.904, p=0.132), and the incidence of major bleeding at seven days was similar (15.4% vs 18.5%, OR 0.800, 95%CI 0.322-1.989, p=0.6131). There was no significant difference in age, sex, and PE risk distribution between patients with active malignant disease and those without it who were treated with thrombolysis. Thrombolytic therapy seems to be underutilized in patients with the active malignant disease compared to patients without it in severe acute PE. In the selected patients who were treated with thrombolysis for severe acute PE, the efficacy and safety are similar between patients with and without active malignant disease.

Background/Objectives: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a widely employed self-report tool for assessing upper extremity function. The aim of this study was to assess the psychometric properties of the Serbian version of the DASH by determining its criterion and construct validity, as well as internal consistency. Methods: This cross-sectional study was conducted among patients with hand and wrist disabilities at the Institute for Orthopedics “Banjica”, Serbia. The psychometric properties of the Serbian version of the DASH were analyzed through an examination of its factorial structure and internal consistency. The DASH consists of 30 items, 24 of which assess function, 21 of which focus on physical function and three on social/role function. The remaining six items evaluate symptoms related to pain, tingling/numbness, weakness, and stiffness. Results: A total of 297 patients were included in the study. The mean age was 47.4 ± 16.8 years, with 50.5% males. Three models were assessed to determine the reliability and validity of the questionnaire across different domains. Model 1 examined a single-factor structure. In Model 2, the items were divided into two domains: Physical Function and Psychosocial/Symptoms. In Model 3, items were subdivided into three domains: Physical Function, Symptoms, and Psychosocial. All models demonstrated an excellent internal consistency with a Cronbach’s alpha > 0.9 for most domains. The values for the fit indices Tucker–Lewis index (TLI) and Comparative-Fit Index (CFI) were above their cut-off criteria of 0.9, while the Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) were below the suggested value of 0.06, indicating an excellent level of models fit. Standardized factor loadings were statistically significant (p < 0.05). Conclusions: The present study provided the evidence for the appropriate metric properties of the Serbian version of the DASH. Results support both the unidimensional and multidimensional structures of the DASH.

This literature survey explores the domain of remote driving of road vehicles within autonomous vehicles, focusing on challenges and state-of-the-art solutions related to driving feedback, latency, support control, as well as remote driving platform and real applications. The advancement towards Level-5 autonomy faces challenges, including sensor reliability and diverse scenario feasibility. Currently, remote driving is identified as vital for commercialization, however, it comes with challenges like low situational awareness, latency, and a lack of comprehensive feedback mechanisms. Solutions proposed include enhancing visual feedback, developing haptic feedback, employing prediction techniques, and use control methods to support driver. This paper reviews the existing literature on remote driving in these fields, revealing research gaps and areas for future studies. Additionally, this paper reviews the industry applications of remote driving and shows the state-of-art use cases.

The main aim of the study was to determine the difference in the effects between the two applied protocols (Unilateral and Bilateral), on the ability of planned agility and acceleration. For this research, the sample were active soccer players (N=30; 14 years in average). Two equal groups were formed randomly, unilateral group (EG=15) and bilateral group (CG=15). The study included an 8-week intervention of unilateral and bilateral plyometric training, applied as an integral part of soccer training, with three training sessions in one week. Both applied protocols were equalized according to the total load volume, the number of foot contacts with the ground and the character of the jump performance. Variables included tests of planned agility (side step test, and 505 test, arrowhead test), and acceleration tests (5- and 20 meters sprint). T-test for independent samples, and combined analysis of variance (2x2 / time x group) were calculated. The results showed no differences between the treatment groups, but absolute effects were achieved in both groups. The sidestep test, 505 planned agility test, arrowhead test, and 5 and 20-meter sprint test improved equally in both groups (p<0.05). In conclusion, unilateral and bilateral plyometric training lasting eight weeks led to significant improvements (pre/post= p<0.05) in sprint-type explosive power (acceleration ability) and preplanned agility, but without statistically significant differences in the magnitude of the effects between training groups.

PurposeThe primary goal of this research is to evaluate the seismic performance of Asla Hocine Primary School, a heritage school building in Annaba, Algeria, to prevent additional damage during future earthquakes in the region. The study aims to guide decision-makers in strengthening weak parts or elements in the building, implementing preventive measures and ultimately reducing earthquake disaster risk by mitigating vulnerability.Design/methodology/approachThe research employs the 3Muri software to model the seismic behavior and structural failures of the school’s elements. An integrated multimodal pushover analysis is used to generate the non-linear capacity curve of the school to assess its seismic performance. The seismic demand is determined based on Algerian seismic regulations, with peak ground acceleration derived from a probabilistic seismic hazard analysis of Annaba city for return periods of 100, 200 and 500 years. The study develops three seismic scenarios to evaluate performance levels and expected damage probabilities.FindingsThe study reveals that the Asla Hocine Primary School faces a high risk of damage and potential collapse under the expected seismic hazard of the region. The analysis indicates variable resilience across different seismic return periods (100, 200 and 500 years), with the performance level degrading from life safety to collapse prevention and total collapse under increasing seismic intensity. This underscores the need for targeted structural analysis and potential retrofitting to enhance the building’s seismic robustness.Research limitations/implicationsThe paper encouraged to account for soil-structure interaction in similar studies, as it can significantly affect the overall seismic performance of buildings. Furthermore, conducting out-of-plane analysis when necessary can offer valuable insights into the structural behavior of specific components.Practical implicationsThe insights provided by this study contribute vital data toward conservation efforts and risk mitigation strategies for heritage structures in seismic zones. The findings are intended to guide decision-makers in implementing preventive measures and strengthening weak parts or elements in the studied school building, ultimately reducing earthquake disaster risk by mitigating vulnerability.Originality/valueThis research offers a comprehensive framework for assessing the seismic vulnerability of heritage schools using detailed modeling and analysis. It highlights the importance of considering return periods of seismic events in assessing a building’s seismic performance and provides a deeper understanding of the structural response to seismic stresses at both macrostructural and individual element levels. The study emphasizes the critical need for seismic risk assessment and targeted retrofitting to preserve cultural heritage assets and ensure their continued use.

Abstract Adrenocortical nodular hyperplasia and gastrointestinal stromal tumors are rare conditions, and their simultaneous occurrence in a single patient poses diagnostic and therapeutic challenges. Here, we present the case of a 39-year-old female patient who underwent surgical resection for concurrent adrenocortical nodular hyperplasia and GIST on the posterior part of the gastric fundus. The patient presented with symptoms of hyperaldosteronism and malignant hypertension, leading to the discovery of these two distinct tumors. Preoperative evaluation revealed normal laboratory findings and hormone levels, except for hyperaldosteronism and hypertension. The surgical intervention included left suprarenal gland removal and wedge resection of the gastric tumor. The patient experienced a successful outcome without intraoperative complications and remained normotensive during follow-up visits, with sustaining hormonal balance. This case underscores the importance of multidisciplinary collaboration and tailored surgical planning in managing complex neoplastic conditions.

ABSTRACT Takotsubo syndrome (TTS) still remains as an enigmatic phenomenon. In particular, long-term challenges (including clinical recurrence and persistent symptoms) and specific entities in the setting of TTS have been the evolving areas of interest. On the other hand, a significant gap still exists regarding the proper risk-stratification of this phenomenon in the short and long terms. The present paper, the second part (part-2) of the consensus report, aims to discuss less well-known aspects of TTS including specific entities, challenges after recovery and risk-stratification.

As surface wear is one of the major failure mechanisms in many applications that include polymer gears, lifetime prediction of polymer gears often requires time-consuming and expensive experimental testing. This study introduces a contact mechanics model for the surface wear prediction of polymer gears. The developed model, which is based on an iterative numerical procedure, employs a boundary element method (BEM) in conjunction with Archard’s wear equation to predict wear depth on contacting tooth surfaces. The wear coefficients, necessary for the model development, have been determined experimentally for Polyoxymethylene (POM) and Polyvinylidene fluoride (PVDF) polymer gear samples by employing an abrasive wear model by the VDI 2736 guidelines for polymer gear design. To fully describe the complex changes in contact topography as the gears wear, the prediction model employs Winkler’s surface formulation used for the computation of the contact pressure distribution and Weber’s model for the computation of wear-induced changes in stiffness components as well as the alterations in the load-sharing factors with corresponding effects on the normal load distribution. The developed contact mechanics model has been validated through experimental testing of steel/polymer engagements after an arbitrary number of load cycles. Based on the comparison of the simulated and experimental results, it can be concluded that the developed model can be used to predict the surface wear of polymer gears, therefore reducing the need to perform experimental testing. One of the major benefits of the developed model is the possibility of assessing and visualizing the numerous contact parameters that simultaneously affect the wear behavior, which can be used to determine the wear patterns of contacting tooth surfaces after a certain number of load cycles, i.e., different lifetime stages of polymer gears.