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Post-operative delirium (POD) is common yet often underdiagnosed following vascular surgery. Elderly patients with advanced peripheral artery disease may be at particular risk for POD yet understanding of the clinical predictors and impact of POD is incomplete. We sought to identify POD predictors and associated resource utilization after infrainguinal lower extremity bypass.This single center retrospective analysis included all infrainguinal bypass cases performed for peripheral arterial disease from 2012-2020. The primary outcome was inpatient POD. Delirium sequelae were also evaluated. Key secondary outcomes were length of stay, nonhome discharge, readmission, 30-day amputation, post-operative myocardial infarction, mortality, and 2-year survival. Regression analysis was used to evaluate risk factors for delirium in addition to association with 2-year survival and amputation free survival.Among 420 subjects undergoing infrainguinal lower extremity bypass, 105 (25%) developed POD. Individuals with POD were older and more likely to have non-elective surgery (P 0.05). On multivariable analysis, independent predictors of POD were age 60-89 years old, chronic limb threatening ischemia, female sex, and nonelective procedure. Consultations for POD took place for 25 cases (24%); 13 (52%) were with pharmacists, and only 4 (16%) resulted in recommendations. The average length of stay for those with POD was higher (17 days vs. 9 days; P 0.001). POD was associated with increased non-home discharge (61.8% vs. 22.1%; P 0.001), 30-day major amputation (6.7% vs. 1.6%; P 0.01), 30-day postoperative myocardial infarction (11.4% vs. 4.1%; P 0.01), and 90-day mortality (7.6% vs. 2.9%; P = 0.03). Survival at 2 years was lower in those with delirium (89% vs. 75%; P 0.001). In a Cox proportional hazards model, delirium was independently associated with decreased survival (HR = 2.0; 95% CI = 1.15-3.38; P = 0.014) and decreased major-amputation free survival (HR = 1.9; 95% CI = 1.18-2.96; P = 0.007).POD is common following infrainguinal lower extremity bypass and is associated with other adverse post-operative outcomes and increased resource utilization, including increased hospital length of stay, nonhome discharge, and worse 2-year survival. Future studies should evaluate the role of routine multidisciplinary care for high-risk patients to improve perioperative outcomes for vulnerable older adults undergoing infrainguinal lower extremity bypass.

Bone Marrow Transplant, a gradational rescue for a wide range of disorders emanating from the bone marrow, is an efficacious surgical treatment. Several risk factors, such as post-transplant illnesses, new malignancies, and even organ damage, can impair long-term survival. Therefore, technologies like Machine Learning are deployed for investigating the survival prediction of BMT receivers along with the influences that limit their resilience. In this study, an efficient survival classification model is presented in a comprehensive manner, incorporating the Chi-squared feature selection method to address the dimensionality problem and Hyper Parameter Optimization (HPO) to increase accuracy. A synthetic dataset is generated by imputing the missing values, transforming the data using dummy variable encoding, and compressing the dataset from 59 features to the 11 most correlated features using Chi-squared feature selection. The dataset was split into train and test sets at a ratio of 80:20, and the hyperparameters were optimized using Grid Search Cross-Validation. Several supervised ML methods were trained in this regard, like Decision Tree, Random Forest, Logistic Regression, K-Nearest Neighbors, Gradient Boosting Classifier, Ada Boost, and XG Boost. The simulations have been performed for both the default and optimized hyperparameters by using the original and reduced synthetic dataset. After ranking the features using the Chi-squared test, it was observed that the top 11 features with HPO, resulted in the same accuracy of prediction (94.73%) as the entire dataset with default parameters. Moreover, this approach requires less time and resources for predicting the survivability of children undergoing BMT. Hence, the proposed approach may aid in the development of a computer-aided diagnostic system with satisfactory accuracy and minimal computation time by utilizing medical data records., Comment: 25 pages, 14 figures, 38 tables

This study assesses the effectiveness of policies to expand access to higher education in reducing inequities in the profile of graduates from medical courses in Brazil. This work consists of a cross-sectional study using data from the 2018 Higher Education Census. Analyses were carried out to identify the association between being a beneficiary of the Quota Law, the University for All Program, or the Student Financing Fund and three markers: born in a small-sized municipality, being non-white, or having attended high school in a public school. Analyses were performed using Pearson's chi-square test, and multivariate analysis was conducted using Poisson regression. A significant association was found between being a beneficiary of these policies and being a non-white graduate, who was born in a small town and who had studied in a public high school. All policies presented adjusted Prevalence Ratio (PR), which demonstrated an association with statistical significance. The Quota Law was the most effective policy, with RP=1.92 for non-white graduates, RP=6.66 for having studied in a public high school, and RP=1.08 for being born in a small town. Despite these results, these groups remain underrepresented in medical courses and in the workforce.Este estudo avalia o impacto de políticas de ampliação do acesso ao ensino superior na redução de iniquidades no perfil dos egressos de cursos médicos no Brasil. Estudo transversal que utiliza dados do Censo da Educação Superior de 2018. Foram realizadas análises para identificar associação entre ser beneficiário da Lei de Cotas, do Programa Universidade para Todos ou do Fundo de Financiamento Estudantil e três marcadores: nascimento em município de pequeno porte, ser não-branco ou ter cursado ensino médio em escola pública. Realizamos análises utilizando teste de qui-quadrado de Pearson e análise multivariada através de regressão de Poisson. Houve associação significativa entre ser beneficiário destas políticas e ser egresso não branco, ter nascido em município de pequeno porte e ser egresso de escola pública no ensino médio. Todas as políticas apresentaram resultados de Razões de Prevalências (RP) ajustadas superiores a um e com significância estatística. A Lei de Cotas foi a política mais efetiva com RP=1,92 para ser egresso não-branco, RP=6,66 para ter estudado ensino médio em escola pública e RP=1,08 para ter nascido em município de pequeno porte. Apesar destes resultados, estes grupos continuam sub-representados nos cursos médicos e na composição da força de trabalho.

Background. This is the first meta-analysis that assessed the association between maternal smoking and the risk of placenta accreta spectrum (PAS), so this study was aimed at investigating the association between maternal smoking and PAS based on observational studies. PAS is defined as a severe obstetric complication due to the abnormal invasion of the chorionic villi into the myometrium and uterine serosa. Methods. We searched electronic bibliographic databases including PubMed, Web of Science, Scopus, Science Direct, and Google Scholar until January 2022. The results were reported using a random effect model. The chi-square test and the I 2 statistic were used to assess heterogeneity. Egger’s and Begg’s tests were used to examine the probability of publication bias. All statistical analyses were performed at a significance level of 0.05 using Stata software, version 11. Results. Based on the random effect model, the estimated OR of the risk of PAS associated with smoking was 1.21 (95% CI: 1.02, 1.41; I 2 = 4.7 % ). Subgroup analysis was conducted based on study design, and the result showed that the association between smoking and PAS among cohort studies was significant 1.35 (95% CI: 1.15, 1.55; I 2 = 0.0 % ). Conclusion. Our results suggested that maternal smoking is a risk factor for the PAS. There was no heterogeneity among studies that reported an association between smoking and the PAS. The Newcastle-Ottawa Scale (NOS) was used to measure study quality.

Depending on the room type and various other assumptions, the damping distribution of a room will follow a specific “reference distribution,” i.e., any deviation from the distribution should indicate sound coloration. In this paper, sound coloration will be caused by the acoustic feedback when operating sound reinforcement systems at relatively high gain settings. A sound reinforcement system based on measured impulse responses as well as an “emulated” system are studied using two speech and two music samples with system gains ranging from low to just before instability. Using one microphone placed in the audience area, blind estimation of sound coloration is achieved by computing decay times of non-harmonic components in the time-frequency domain. The results show that the computed damping distributions agree well with the chi-square distributions at low system gains. As the system gain increases, the distributions are shifted toward lower damping constants, and their shapes deviate more and more from the reference distribution, thus, giving a clear indication of sound coloration. The suggested objective measures show that deviations from the reference damping distribution can be detected at substantially lower system gains compared to results of related listening tests where audible coloration is evaluated.

Background: Intraoperative findings during laparoscopic cholecystectomy (LC) are highly unpredictable and operative difficulty varies from straightforward to very challenging procedures. Several st...

Universal lipid screening (ULS) is recommended for all 9- to 11-year-old children. We investigated ULS outcomes and long-term pediatrician management of children with dyslipidemia using a retrospective chart review of well-child visits between 2014 and 2016. Descriptive statistics summarized demographics, ULS results, and follow-up visits/testing. Pearson χ2 test examined differences between those with and without an abnormal screen. A total of 1039 children aged 9 to 11 years were seen for a well-child visit; only 33.3% (343/1039) completed screening. Of children screened, 18.1% (62/343) had abnormal screen results and were more likely to have an elevated body mass index ( P < .001), though 30.1% (19/62) had no risk factors. A total of 10.2% (35/343) had dyslipidemia. A total of 77.1% of children with dyslipidemia received nutrition/exercise counseling and 57.1% received dietitian referrals; only 68.6% had a follow-up visit and 31.4% had repeat lipid testing. Pediatricians would benefit from more practical strategies for universal testing such as point-of-care testing and long-term management to ensure ULS is an effective screening tool.

Objective A decline in OHCA performance metrics during the pandemic has been reported in the literature but the cause is still not known. The Montgomery County Fire and Rescue Service (MCFRS) observed a decline in both the rate of return of spontaneous circulation (ROSC) and the proportion of resuscitations that resulted in cerebral performance category (CPC) 1 or 2 discharge of the patient beginning in March of 2020. This study examines whether the decline in these performance metrics persists when known COVID positive patients are excluded from the analysis. Methods Two samples of OHCA patients for similar time periods (one year apart) before and after the start of the COVID pandemic were developed. A database of known COVID positive patients among EMS encounters was used to identify and exclude COVID positive patients. OHCA outcomes in these two groups were then compared using a Chi-square test and Fisher's exact test for difference in proportions and Analysis of Variance (ANOVA) for difference in means. A two-stage multivariable logistic regression model was used to develop odds ratios for achieving ROSC and CPC 1 or 2 discharge in each period. Results After excluding known COVID patients, 32.5% of the patients in the pre-COVID period achieved ROSC compared to 25.1% in the COVID period (p = 0.007). 6% of patients in the pre-COVID period were discharged with CPC 1 or 2 compared to 3.2% from the COVID era (p = 0.026). Controlling for all available patient characteristics, patients undergoing OHCA resuscitation prior to be beginning of the pandemic were 1.2 times more likely to achieve ROSC and 1.6 times more likely to be discharged with CPC 1 or 2 than non-COVID patients in the pandemic era sample. Conclusions When known COVID patients are excluded, pre-pandemic OHCA resuscitation patients were more likely to achieve ROSC and CPC 1 or 2 discharge. The prevalence of known COVID positive patients among all OHCA resuscitations during the pandemic was not sufficient to fully account for the marked decrease in both ROSC and CPC 1 or 2 discharges. Other causative factors must be sought.

OBJECTIVE 1) Describe the progression of diabetes mellitus over time in an observational study of Wolfram syndrome, a rare, genetic, neurodegenerative disorder which often includes diabetes mellitus and is typically diagnosed during childhood or adolescence. 2) Determine whether C-peptide could be used as a marker of diabetes progression in interventional trials for Wolfram syndrome. METHODS N=44 (25F/19M) participants with genetically-confirmed Wolfram syndrome attended the Washington University Wolfram Research Clinic annually from 2010-2019. Medical history, physical examinations, blood sampling, and questionnaires were used to collect data about diabetes mellitus and other components of Wolfram syndrome. Beta-cell function was assessed by determination of C-peptide during a mixed meal tolerance test. Random coefficients models evaluated the rate of progression of C-peptide over time, and power analyses were used to estimate the number of subjects needed to detect a change in C-peptide decline during an intervention trial. RESULTS 93.2% of patients had diabetes mellitus. Mean HbA1c across all study visits was 7.9%. C-peptide significantly decreased with increasing duration of diabetes mellitus (p

Background Malnutrition and systemic inflammatory response have been confirmed to be important risk factors for various cancers. Objective To compare pretreatment prognostic nutrition index (PNI) among patients with laryngeal squamous cell carcinoma (LSCC), laryngeal precancerous lesion (LPL) and laryngeal benign lesion (LBL). Methods A total of 253 male patients with laryngeal lesions were divided into LBL, LPL with low risk (LPL (l)), LPL with high risk (LPL(h)), LSCC (i), LSCC (ii) and LSCC (iii) groups according to their histopathological findings and the TNM staging system. PNI and other clinical parameters were calculated. Kruskal-Wallis, Mann-Whitney U or Chi-square or Fisher's exact test were used for comparison of different parameters among groups. Logistic regression was performed to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI). Results The PNI in the LSCC group was significantly lower than those of the LBL and LPL groups (p = .013 and p = .004, respectively), and decreased from LPL(l) to LSCC (iii) (from 53.97 ± 3.69 to 50.02 ± 4.75). LPL patients with lower PNI values had a higher risk of LSCC, the OR was 0.91 (95% CI: 0.84, 0.97) for a one-unit decrease. Conclusions PNI could be a simple and reproducible marker for predicting the severity of laryngeal diseases.

Inadequate initial antibiotic treatment of ESBL urinary tract infections (UTI) can lead to increase in the number of antibiotics used, return visits, longer hospitalizations, increased morbidity and mortality and increased costs. Given the important health implications on patients, this study aimed to examine the prevalence and predictors of ESBL UTIs among Emergency Department (ED) patients of a tertiary care center in Beirut, Lebanon.Single-center retrospective observational study involving all adult UTI patients who presented to the ED of the American University of Beirut Medical Center, a tertiary care center between August 2019 and August 2020.Out of the 886 patients that were included, 24.9% had an ESBL organism identified by urine culture. They had higher bladder catheter use within the previous 90 days, antibiotic use within last 90 days, and were more likely to have a history of an ESBL producing isolate from any body site in the last year. Antibiotic use in the last 90 days and a history of ESBL producing isolate at any site in the previous year were significantly associated with developing an ESBL UTI (OR = 1.66, p = 0.001 and OR = 2.53, p0.001 respectively). Patients diagnosed with cystitis were less likely to have an ESBL organism (OR = 0.4 95%CI [0.20-0.81], p = 0.01) CONCLUSION: The prevalence of ESBL organisms was found to be 24.9% in urinary tract infections. The predictors of an ESBL UTI infection were antibiotic use in the last 90 days, a history of ESBL producing isolate at any site in the previous year. Based on the findings of our study, we can consider modifying initial empiric antibiotic treatment for patients presenting with a UTI with the above stated risk factors.

INTRODUCTION: Cannabinoid hyperemesis syndrome (CHS) is a clinical diagnosis characterized by symptoms of recurrent nausea, vomiting, and severe abdominal pain in the setting of chronic cannabis use. Symptoms of CHS are frequently unresponsive to standard antiemetic therapy. Topical capsaicin applied to the abdomen has been cited as a potential effective agent for CHS however robust evidence is lacking. METHODS: This was a single-center retrospective cohort study to evaluate the efficacy of topical capsaicin in pediatric and adult patients presenting to the emergency department (ED) with suspected or confirmed CHS. The primary outcome assessed was if utilization of capsaicin for CHS resulted in more patients achieving an “efficacious” result, defined as only requiring ≤1 rescue medication for symptom relief after receiving capsaicin or after administration of the first agent in patients who did not receive capsaicin during their ED course. Secondary outcomes included total ED length of stay, time to discharge after administration of the reference agent (RA), proportion of patients requiring admission, total number of medication doses given for symptom relief, change in pain score and episodes of emesis, and proportion of patients returning to the ED within 24 h for the same complaint. Additional analyses were also performed to explore patient characteristics that may be predictive of capsaicin efficacy. RESULTS: 201 patients were included in the final analysis of which 25 were

Background Research into new markers has been intensified for early diagnosis, prognosis, and differentiation of SIRS, sepsis, and septic shock in recent years. This study aimed to investigate the role of soluble triggering receptor expressed in myeloid cells-1 (sTREM-1) and interleukin (IL)-6 in distinguishing between systemic inflammatory response syndrome (SIRS), sepsis, and septic shock in pediatric intensive care unit (PICU) patients. Methods Between June 2014 and July 2015, 90 consecutive patients who were treated in the PICU were included in this prospective observational study. Patients were divided into four groups: control (n = 23), SIRS (n = 22), sepsis (n = 23), and septic shock (n = 22). All patients were evaluated for white blood cell (WBC), serum C-reactive protein (CRP), procalcitonin (PCT), IL-6, and sTREM-1 levels at 0, 24, and 72 h of admission. The prognostic evaluations were made using the Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores. Patients were evaluated in terms of age, gender, prognosis, pathogen growth in culture, PRISM III and PELOD score, WBC, CRP, PCT, IL-6, and sTREM-1 levels and a comparison was made between groups. Results There was no significant difference between all groups in terms of the 0-, 24-, and 72-h sTREM-1 values (p = 0.761, p = 0.360, and p = 0.822, respectively). CRP and PCT values did not differ between the septic shock, sepsis, and SIRS groups at 0, 24, and 72 h. In the septic shock group, the 0-h IL-6 value was significantly higher than that of the SIRS group (p = 0.025). The 24-h IL-6 value in the septic shock group was significantly higher than the values of the sepsis and SIRS groups (p = 0.048 and p = 0.043, respectively). No significant difference was detected between the septic shock, sepsis, and SIRS groups in terms of IL-6 values at 72 h. Conclusion sTREM-1 is not useful for the diagnosis of infection and for distinguishing between sepsis, septic shock, and SIRS since it does not offer a clear diagnostic value for PICU patients, unlike other reliable markers such as WBC, CRP, and PCT. Elevated IL-6 levels may indicate septic shock in PICU patients. More research on sTREM-1 is needed in this setting.

This study aimed to assess the zygomaticosphenoidal (ZS) angle in patients with reducted unilateral zygomatico-maxillary complex (ZMC) fracture and compare it with the normal control group. This study was performed on CT images of 60 cases and 60 controls with a mean age of 35.1 ± 14.6. The ZS angle was measured on axial images containing the equator of the eyeball. Moreover, the mean absolute difference value and asymmetry index were calculated. Chi-square test, independent-sample t test, 1-way ANOVA, paired-sample t test, and ROC curve analysis were applied. The mean ZS angle in the control group was 46.6° ± 3.5°. Considering laterality, the mean of ZS was not significant in the control group. However, after reduction of unilateral ZMC fracture, there was a significant difference between the mean ZS angle in right and left sides. The mean absolute difference between right and left ZS angles was significantly higher in the case group. A threshold number of 0.9° is established in the mean absolute difference value which is the difference between the right and left ZS angles in an individual for detecting asymmetry. The ZS angle can be a useful anatomical aid to guide surgeons in achieving facial symmetry in ZMC fractures.

INTRODUCTION: The outbreak of COVID-19 disrupted lives across the United States. Evidence shows that such a climate is deleterious to mental health and may increase demand for mental health services in emergency departments. The purpose of this study was to determine the difference in emergency department utilization for mental health diagnoses before and after the COVID-19 surge. METHODS: We conducted a cross-sectional study between January-August 2019 and January-August 2020 with emergency department encounter as the sampling unit. The primary outcome was the proportion of all emergency department encounters attributed to mental health. We performed chi-square analyses to evaluate the differences between 2019 and 2020. RESULTS: We found that overall emergency department volume declined between 2019 and 2020, while the proportion attributable to mental health conditions increased (p < 0.01). Substance abuse, anxiety, and mood disorders accounted for nearly 90% of mental health diagnoses during both periods. When stratified by sex, substance abuse was the leading mental health diagnosis for males and anxiety and substance abuse disorders combined accounted for the largest proportion for females. DISCUSSION: The emergency department is an important community resource for the identification and triage of mental health emergencies. This role is even more important during disasters and extended crises, making it imperative that emergency departments employ experienced mental health staff. This study provides a comparison of emergency department utilization for mental health diagnoses before the pandemic and during the spring 2020 surge and may serve as a useful guide for hospitals, health systems and communities in future planning.

Background Magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) in temporomandibular disorder (TMD) patients of different ages are still unclear. The aim of this study was to analyze and compare the characteristics of MRI features of TMJs in different age groups. Methods A total of 1760 TMJs from 880 patients were included in the study and divided into three groups: ≤ 18Y (n = 195, 14.89 ± 2.35Y); 19-30Y (n = 475, 24.09 ± 3.23Y); and > 30Y (n = 210, 41.73 ± 10.45Y). T2-weighted image (T2WI) of MRI was obtained to evaluate the relationship between age and disc morphology, the degree of disc displacement, joint effusion, joint movement and changes of condylar bone morphology. Data were analyzed by Pearson Chi square test and Spearman correlation coefficient. Results There was no statistical difference between left and right sides in all age groups. Except condylar morphology (χ2 = 0.943, P = 0.624), there were significant differences in the distribution of disc morphology, disc position, joint effusion and joint motion among different age groups (χ2 = 24.450, χ2 = 24.829, χ2 = 19.855, χ2 = 39.259, respectively). There were significant differences in the distribution of the degree of anterior disc displacement, condyle morphology and joint effusion in different types of disc morphology among the different age groups (except for joint effusion in > 30Y), among which the first two were significantly correlated with the disc morphology. Conclusions The morphology and position of the articular disc changed significantly with age, but the proportion of abnormal condylar bone remained about 50%. The greater the degree of disc folding, the more prone to bone abnormalities. Trial registration This study was retrospectively registered on 28/03/2022 and endorsed by the Ethics committee (LCYJ2022014).

nbsp;Children undergoing a hematopoietic stem cell transplantation (HSCT) are at a higher risk for malnutrition, which could be reduced by enteral nutrition (EN) support.nbsp;This study evaluated the safety and feasibility of implementing an EN pathway for children undergoing HSCT.nbsp;An evidence-based, standardized EN pathway was implemented for children undergoing HSCT. Parenteral nutrition and EN rates were compared among patients pre- and postimplementation, and t tests and chi-square tests were performed.nbsp;A larger proportion of patients received EN and had an increased number of EN days (8.3 versus 5.3 days) postimplementation, which was clinically significant but not statistically significant. Postimplementation, 15 patients required EN and parenteral nutrition. The EN pathway was safe, but had limited feasibility because of the difficulty of placing and maintaining the nasojejunal tube.

COVID-19 presented a unique scenario among children, specifically all over the world. The children had decrease outdoors activities and learning times, increased use of electronic gadgets and changes in sleep patterns. These altered behavior patterns of children directly influenced their behavior in the dental operatory. This coupled with the stringent protocols of COVID-19, made the behavior management of children a tedious task. However, as they say that necessity is the mother of all inventions, the pediatric dentist took this time to evaluate newer methods of behavior management and modified old strategies with newer modifications.The main aim of this study was to observe the modifications in behavior management strategies among pediatric dentists in the post-COVID-19 era while managing the child in dental operatory.Four hundred pediatric dentists were mailed a questionnaire consisting of 24 open and closed-ended questions consisting of personal data, professional information, and questions regarding various behavior management techniques used by them in pre- and post-COVID-19 era. Data obtained were subjected to statistical analysis using SPSS version 26.0, IBM, and a comparison of frequencies of categories of variables with groups was made using Chi-Square test and McNemar test.The results showed that there were statistically highly significant changes in behavior management strategies pre- and post-COVID-19 scenario with P0.01.Conventional techniques like Tell-Show-Do were popular in both pre- and post-COVID-19 times with minor modifications in approach, but conscious sedation and distraction techniques were evaluated to have gained more popularity in the post-COVID-19 times along with exploration of new novel techniques.

The objective of this study is to assess the prevalence of gingival recession (GR) and associated etiological factors among school children.The study sample consisted of 2095 children from the Nellore region divided into three groups of age ranges from primary dentition (7 years), mixed dentition (7-12 years), and permanent dentition (12 years) respectively, attending the department of pediatric and preventive dentistry and the school dental health programs organized by the department. The clinical examination involved measuring GR using William's periodontal probe and evaluating associated etiological factors. Data were statistically analyzed using the Chi-square test.The GR among the study population was 7.9% (n = 165). Among them, males were 46% and females were 54% (P0.05). The GR was more in children in the 7-12 years age group (75%), followed by7 years (21%) and12 years (4%) age groups. The associated factors include malocclusion (69%), deleterious habits (5%), and anomalies (26%). Anomalies showed an association with GR (P0.05) compared to malocclusion and deleteriousness habits (P0.05).The prevalence of GR is 7.9%, and GR is more prevalent in males and the 7-12 years age group. GR is associated with transient malocclusion, deleterious habits, and anomalies.

Cigarette smoking, alcohol consumption, and Lugol-voiding lesions (LVLs) are the major causative risk factors of esophageal squamous cell carcinoma (ESCC); however, reports on ESCC cases unrelated to these risk factors are very limited. Here, we investigated the clinicopathological features and etiology of such cases. We retrospectively analyzed 704 consecutive superficial ESCC tumors of 512 patients who were treated with endoscopic submucosal dissection. The enrolled patients were divided into two groups—the very low-risk (VLR)-group and risk (R)-group—based on the presence of the abovementioned risks. Clinical, endoscopic, and pathological characteristics and genetic findings were assessed in both groups. The VLR-group consisted of 21 (4.1%) patients, who were characteristically female. Patients in the VLR-group presented gastroesophageal reflux disease (GERD), hiatal hernia, and non-open-type atrophic gastritis, and were negative for Helicobacter pylori. We found unique endoscopic features—frequently observed in the posterior wall of the middle thoracic esophagus—with a linear shape that closely resembled the erosion-like form of GERD. Additionally, histopathological examination showed that these tumors presented atypical nuclei limited to the basal and parabasal layer, sequential to the surrounding changes that presented pathological chronic inflammation of esophagitis. Evaluation of somatic mutations in cancer-related genes using next-generation sequencing revealed that the positive carcinogenic potential (TP53 mutation) of the tumors was relatively frequent in the VLR-group. Our study suggests that ESCC without major causative factors is related to GERD, with no remarkable oncogenic difference.

OBJECTIVE To identify racial disparities in cell-free fetal DNA (cffDNA) first-line aneuploidy screening use among advanced maternal age women at a safety net hospital. STUDY DESIGN This retrospective cohort study of women 35 and older who delivered at Boston Medical Center from 2012 to 2015 compared to women who used cffDNA for first-line aneuploidy screening to those who did not. Maternal conventional demographics and social determinants of health were collected. We investigated the relationship between race and odds of cffDNA use, adjusting for covariates by stepwise logistic regression. RESULTS We identified 1223 women. Seventy-two percent were publicly insured. Upon adjusting for parity, prenatal care site, year of delivery, and insurance status, odds of cffNDA use remained lower for Black and Hispanic women (adjusted odds ratio [aOR] 0.47, 95% confidence interval [CI] 0.30, 0.71 and aOR 0.34 [0.21, 0.55]) compared to White women. Language proved to be an effect modifier among Hispanic women that attenuated but did not resolve the disparity in use among Hispanic compared to White women. Racial differences in cffDNA use persisted across the study period. CONCLUSION Disparity in cffDNA screening uptake exists by race in this diverse urban population. The gap in utilization between Hispanic and White women may be related to primary preferred language.

Background Ovarian cancer is the seventh most common cancer in women worldwide and the eighth most common cause of cancer death. Due to the lack of effective early detection strategies and the unspecific onset of symptoms, it is diagnosed at an advanced stage in 75% of cases. The cancer antigen (CA) 125 is used as a prognostic marker and its level is elevated in more than 85% of women with advanced stages of epithelial ovarian cancer (EOC). The standard treatment is primary debulking surgery (PDS) followed by adjuvant chemotherapy (ACT), but the later approach is neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Several studies have been conducted to find out whether preoperative CA-125 serum levels influence treatment choice, surgical resection and survival outcome. The aim of our study was to analyse experience of single institution as Cancer comprehensive center with preoperative usefulness of CA-125. Patients and methods At the Institute of Oncology Ljubljana a retrospective analysis of 253 women with stage FIGO IIIC and IV ovarian cancer was conducted. Women were divided into two groups based on their primary treatment. The first group was the NACT group (215 women) and the second the PDS group (38 women). The differences in patient characteristics were compared using the Chi-square test and ANOVA and the Kaplan-Meier method was used for calculating progression-free survival (PFS) and overall survival (OS). Results The median serum CA-125 level was higher in the NACT group than in the PDS group, 972 IU/ml and 499 IU/ ml, respectively. The PFS in the NACT group was 8 months (95% CI 6.4–9.5) and 18 months (95% CI 12.5–23.4) in the PDS group. The median OS was lower in the NACT group than in the PDS group, 25 months (95% CI 20.6–29.5) and 46 months (95% CI 32.9–62.1), respectively. Conclusions Preoperative CA-125 cut off value of 500 IU/ml is a promising threshold to predict a successful PDS.

Purpose To evaluate the relationship between clinical severity and functionality, sleep quality, depression, and quality of life (QoL) in patients with CVI with or without leg ulcers. Methods A total of sixty patients with CVI were enrolled in the study. The patients were C2-6 according to the CEAP classification. All the patients were assessed with Venous Clinical Severity Score (VCSS) for clinical severity, Visual Analog Scale (VAS) for pain, right and left lower limb (RLL and LLL) circumference measurements for edema, 6-min-walk test (6-MWT) for functional capacity, Lower Extremity Functional Scale (LEFS) for functionality, Pittsburg Sleep Quality Index (PSQI) for sleep quality, Beck Depression Inventory version I (BDI-I) for depression, and The Quality of Life Questionnaire for Chronic Venous Diseases-20 (CIVIQ-20) for QoL. Results The mean age of the patients was 45.83 ± 13.25 years, and the mean duration of disease was 8.30 ± 7.42 years. There was a significant association between VCSS and VAS-rest/activity, edema-RLL/LLL, PSQI, BDI-I, LEFS, and CIVIQ-20 in patients without leg ulcers. In addition, a significant association was found between VCSS and VAS-rest/activity and CIVIQ-20 in patients with leg ulcers. Conclusion The current study showed that an association has been found between clinical severity and pain at rest and during activity, edema, sleep quality, depression, lower extremity function, and QoL in patients without ulcers. However, clinical severity has been correlated with only pain at rest and during activity, and QoL in patients with leg ulcers.

Introduction Health care for children with complex chronic conditions (CCC) constitutes an evolving and a challenging part of practices in pediatrics. These children need end-of-life services such as palliative care. The aim of this study was to identify the frequency of patients with CCC among all hospitalized children at our general pediatrics services and to describe the demographics, diagnosis, clinical spectrum, long-term care needs, and mortality data of patients with CCC. Patients and Methods All hospitalizations in 2018 at the general pediatric services were screened retrospectively. Patients’ hospitalization diagnoses, gender, age, comorbid conditions, number of emergency admissions in 2018, intensive care unit needs, mortality rates, and the number of hospitalizations in 2018 were investigated. Results A total of 1591 patients were hospitalized for 2083 times in 2018. Overall, 145 of 1591 patients (9%) had CCC. Patients with CCC were hospitalized for 472 times (23% of all hospitalizations). The number of emergency admissions, the number of hospitalizations in 2018 and the need for intensive care, and the mortality rate during hospitalization for patients with CCC were significantly higher than those for patients without CCC. The median length of hospitalization in patients with CCC was significantly longer. Conclusion Patients with CCC were hospitalized frequently and longer, had increased emergency and PICU admissions, and special long-term care needs. Pediatricians who pioneer care for children with CCC need education, training, and coordinated support to ensure qualified long-term care for these patients.

Objective To compare pressure injury (PI) incidence based on repositioning intervals and support surfaces in acute care settings. Methods This pragmatic, quasi-experimental trial recruited a total of 251 critically ill patients who were at low or moderate risk for PI development. Participants were assigned to three interventions: a 2-hour repositioning interval using an air mattress, a 2-hour repositioning interval using a foam mattress, or a 3-hour repositioning interval using a foam mattress. Data were collected by nurses every shift over the course of 14 days. Pressure injury incidence was analyzed using a χ2 test. Results There were no statistically significant differences in PI incidence between the groups with a 2-hour repositioning interval. However, the PI incidence in the group using a foam mattress with a 3-hour repositioning interval was significantly lower than in the group using an air mattress with a 2-hour repositioning interval (odds ratio, 0.481; 95% confidence interval, 0.410-0.565). Conclusions The findings showed that PIs decreased when the repositioning interval was extended from every 2 hours to every 3 hours while using foam mattresses. This study suggests that a 3-hour repositioning interval using a foam mattress could be applied to reduce the risk of PI development for patients at low or moderate risk.

Objective To report the impact of the COVID-19 pandemic on the activity of nurses working on an inflammatory bowel disease (IBD) unit and to identify reasons for telehealth care and its relationship to certain characteristics. Background The COVID-19 pandemic had led to an increase in demand for remote care in patients with inflammatory bowel disease who require monitoring and frequent access to health services. Design – methods A retrospective study of all activity (in person and by phone call or email) done on the unit during the acute phase of the pandemic at a reference hospital in Spain. Numbers of activities done by nurses, reasons for telehealth care and sociodemographic and clinical data were collected. Statistical analysis was performed using frequency, chi-squared and analysis of variance tests. Results A total of 1095 activities for 561 patients who received care were reported. Among them, 1042 (95.2%) were telemedicine activities, amounting to a 47.3% increase over the prior year. COVID-19-related activities numbered 588 (59.5%). Consultations due to disease flare-up numbered 134 (13.7%), representing a 145% increase compared to 2019. Significant differences were found between reasons for using telemedicine and diagnosis, occupational status, contact week and treatment. Conclusion The acute phase of the pandemic has changed the activity managed by the nursing staff on the unit. Identifying and analysing these changes has yielded valuable information to achieve more efficient management and better care quality for patients in special situations.

Melioidosis is a tropical infectious disease with diverse clinical presentations. We aimed to investigate the characteristics and mortality risk factors of patients diagnosed with melioidosis in the past 10 years. This was a retrospective cohort study conducted at a quaternary care centre in South India. Clinical, demographic, and biochemical data in patients diagnosed with melioidosis with cultures were collected between January 2011 and December 2020 from medical records. Logistic regression analysis was performed to screen mortality risk factors of melioidosis in addition to descriptive statistics and chi-square analysis. Seventy-three melioidosis patients’ records were analysed, and the most common comorbidity was type 2 diabetes mellitus (n = 53, 72.6%). The patients showed diverse presentations: pulmonary involvement, 30 (41.1%); splenomegaly, 29 (39.7%); abscesses and cutaneous involvement, 18 (24.7%); lymph node, 10 (13.7%); arthritis and osteomyelitis, 9 (12.3%); and genitourinary infection, 4 (5.4%). The mortality was noted to be 15 (20.5%). Logistic regression analysis indicated that chronic kidney disease (OR = 14.0), CRP >100 IU/L (OR = 6.964), and S. albumin

Objectives Cardiac surgery-associated acute kidney injury occurs commonly following congenital heart surgery and is associated with adverse outcomes. This study represents the first multicenter study of neonatal cardiac surgery-associated acute kidney injury. We aimed to describe the epidemiology, including perioperative predictors and associated outcomes of this important complication. Design This Neonatal and Pediatric Heart and Renal Outcomes Network study is a multicenter, retrospective cohort study of consecutive neonates less than 30 days. Neonatal modification of The Kidney Disease Improving Global Outcomes criteria was used. Associations between cardiac surgery-associated acute kidney injury stage and outcomes (mortality, length of stay, and duration of mechanical ventilation) were assessed through multivariable regression. Setting Twenty-two hospitals participating in Pediatric Cardiac Critical Care Consortium. Patients Twenty-two-thousand forty neonates who underwent major cardiac surgery from September 2015 to January 2018. Interventions None. Measurements and main results Cardiac surgery-associated acute kidney injury occurred in 1,207 patients (53.8%); 983 of 1,657 in cardiopulmonary bypass patients (59.3%) and 224 of 583 in noncardiopulmonary bypass patients (38.4%). Seven-hundred two (31.3%) had maximum stage 1, 302 (13.5%) stage 2, 203 (9.1%) stage 3; prevalence of cardiac surgery-associated acute kidney injury peaked on postoperative day 1. Cardiac surgery-associated acute kidney injury rates varied greatly (27-86%) across institutions. Preoperative enteral feeding (odds ratio = 0.68; 0.52-0.9) and open sternum (odds ratio = 0.76; 0.61-0.96) were associated with less cardiac surgery-associated acute kidney injury; cardiopulmonary bypass was associated with increased cardiac surgery-associated acute kidney injury (odds ratio = 1.53; 1.01-2.32). Duration of cardiopulmonary bypass was not associated with cardiac surgery-associated acute kidney injury in the cardiopulmonary bypass cohort. Stage 3 cardiac surgery-associated acute kidney injury was independently associated with hospital mortality (odds ratio = 2.44; 1.3-4.61). No cardiac surgery-associated acute kidney injury stage was associated with duration of mechanical ventilation or length of stay. Conclusions Cardiac surgery-associated acute kidney injury occurs frequently after neonatal cardiac surgery in both cardiopulmonary bypass and noncardiopulmonary bypass patients. Rates vary significantly across hospitals. Only stage 3 cardiac surgery-associated acute kidney injury is associated with mortality. Cardiac surgery-associated acute kidney injury was not associated with any other outcomes. Kidney Disease Improving Global Outcomes criteria may not precisely define a clinically meaningful renal injury phenotype in this population.

Background Despite recent improvements in treatment technologies, such as surgical resection and chemoradiotherapy, the prognosis of patients with esophagogastric junction adenocarcinoma (EJA) remains poor due to early lymph node metastasis. Since few studies have investigated genes associated with lymph node metastasis in EJA, we aimed to screen lymph node metastasis‐associated genes and clarify their expression status and prognostic significance in EJA. Methods The differential frequency of mutations between carcinoma and para‐carcinoma tissues from 199 cases with EJA was detected using targeted next‐generation sequencing (tNGS). Following a stratified analysis to determine that gender has no effect on the frequency of gene mutations, lymph node metastasis‐related genes, including CDK6, MET, NOTCH1, and LRP1B, were screened, and CDK6 and LRP1B were selected for further study as they displayed significant differences in mutation rates. Differences in their expression status were verified using immunohistochemical (IHC) staining in 18 CDK6‐ and 17 LRP1B‐mutated samples and a randomly matched control group. Results tNGS revealed that CDK6 and LRP1B mutation frequencies were significantly different between EJA cases with (N ≥ 1) or without (N = 0) lymph node metastasis. In particular, CDK6 mutation frequency was expected less, whereas that of LRP1B was remarkably higher in cases with stage N0 than in those with stage N ≥ 1. IHC staining confirmed significant differences in CDK6 and LRP1B expression status between the study and control cohorts. Chi‐square tests revealed that a high CDK6 expression status correlated significantly with smoking history (p = 0.044), T stage (p = 0.035), N stage (p = 0.000), and advanced TNM stage (p = 0.001) in EJA, whereas a high LRP1B expression status only correlated with BMI (p = 0.013) and N stage (p = 0.000). Furthermore, as confirmed by survival status investigation, a high LRP1B expression status predicted good prognosis, and a high CDK6 expression status was an independent predictor of poor prognosis in patients with EJA. Conclusions Taken together, the findings of this study demonstrate that a high CDK6 and LRP1B expression status promotes and inhibits lymph node metastasis in patients with EJA, respectively, suggesting that both CDK6 and LRP1B are significantly potential predictors of lymph node metastasis and prognosis in EJA., Screening of lymph node metastasis‐related genes by targeted next‐generation sequencing in of esophagogastric junction adenocarcinoma. CDK6 and LRP1B were selected for further study to clarify their expression and prognostic significance in AEG.

Glioblastoma (GBM) is the most common and deadly brain tumor. We aimed to reveal potential prognostic GBM marker genes, elaborate their functions, and build an effective a prognostic model for GBM patients. Through data mining of The Cancer Genome Atlas (TCGA) and the Chinese Glioma Genome Atlas (CGGA), we screened for significantly differentially expressed genes (DEGs) to calculate risk scores for individual patients. Published data of somatic mutation and copy number variation profiles were analyzed for distinct genomic alterations associated with risk scores. In addition, single-cell sequencing was used to explore the biological functions of the identified prognostic marker genes. By combining risk scores and other clinical features, we built a comprehensive prognostic GBM model. Seven DEGs (CLEC5A, HOXC6, HOXA5, CCL2, GPRASP1, BSCL2 and PTX3) were identified as being prognostic for GBM. Expression of these genes was confirmed in different GBM cell lines using real-time PCR. Risk scores calculated from the seven DEGs revealed prognostic value irrespective of other clinical factors, including IDH mutation status, and were negatively correlated with TP53 expression. The prognostic genes were found to be associated with tumor proliferation and progression based on pseudo-time analysis in neoplastic cells. A final prognostic model was developed and validated with a good performance, especially in geriatric GBM patients. Using genetic profiles, age, IDH mutation status, and chemotherapy and radiotherapy, we constructed a comprehensive prognostic model for GBM patients. The model has a good performance, especially in geriatric GBM patients.

Several mechanisms play a role in the development of pneumonia after inhalation injury. Our aim was to analyze whether higher concentrations of inflammatory markers or of biomarkers of epithelial injury are associated with a higher incidence of pneumonia in patients with inhalation injury.Secondary analysis of a single-center prospective observational cohort pilot study, performed over a two-year period (2015-2017) at the Burns Unit of the Plastic and Reconstructive Surgery Department of Vall d'Hebron University Hospital. All patients aged 18 with suspected inhalation injury undergoing admission to the Burns Unit were included. Plasma biomarkers of the lung epithelium (RAGE and SP-D), inflammation markers (IL6, IL8), and IL33, as well as soluble suppression of tumorigenicity-2 (sST2) levels, were measured within the first 24 h of admission.Twenty-four patients with inhalation injury were included. Eight (33.3%) developed pneumonia after a median of 7 (4-8) days of hospital stay. Patients with pneumonia presented higher plasma concentrations of sST2 (2853 [2356-3351] ng/mL vs 1352 [865-1839] ng/mL; p0.001), IL33 (1.95 [1.31-2.59] pg/mL vs 1.26 [1.07-1.45] pg/mL; p = 0.002) and IL8 (325.7 [221.6-430.0] pg/mL vs 174.1 [95.2-253.0] pg/mL; p = 0.017) on day 1 of inclusion. Plasma sST2 concentration in the first 24 h demonstrated excellent diagnostic accuracy for predicting the occurrence of pneumonia in patients with smoke inhalation (AUROC 0.929 [95%CI 0.818-1.000]). A cutoff point of ≥2825 ng/mL for sST2 had a sensitivity of 75% and a specificity of 100%. The risk ratio of pneumonia in patients with sST2 ≥ 2825 ng/mL was 7.14 ([95% CI 1.56-32.61]; p = 0.016).Plasma sST2 in the first 24 h of admission predicts the occurrence of pneumonia in patients with inhalation injury.

Introduction A need exists to improve the efficiency of clinical trials in burn care. The objective of this study was to validate “Persistent Organ Dysfunction” plus death as endpoint in burn patients and to demonstrate its statistical efficiency. Methods This secondary outcome analysis of a dataset from a prospective international multicenter RCT (RE-ENERGIZE) included patients with burned total body surface area >20% and a 6-month follow-up. Persistent organ dysfunction was defined as persistence of organ dysfunction with life-supportiing technologies and ICU care. Results In the 539 included patients, the prevalence of 0p p+ pdeath was 40% at day 14 and of 27% at day 28. At both timepoints, survivors with POD (vs. survivors without POD) had a higher mortality rate, longer ICU- and hospital-stays, and a reduced quality of life. POD + death as an endpoint could result in reduced sample size requirements for clinical trials. Detecting a 25% relative risk reduction in 28-day mortality would require a sample size of 4492 patients, whereas 1236 patients would be required were 28-day POD + death used. Conclusions POD + death represents a promising composite outcome measure that may reduce the sample size requirements of clinical trials in severe burns patients. Further validation in larger clinical trials is warranted. Study type Prospective cohort study, level of evidence: II

Background Enhancing timely breastfeeding initiation within the first hour postpartum is a goal the WHO’s Early Essential Newborn Care (EENC) and Baby-friendly Hospital Initiative (BFHI) aim to achieve globally. However, many health professionals and facilities have yet to adopt these guidelines in Cambodia, impeding timely initiation progress and maternal-infant health goals. Methods This secondary data analysis used the 2014 Cambodia Demographic and Health Survey (CDHS) data of 2,729 women who gave birth in the two years preceding the survey to examine the association between place of birth and timely breastfeeding initiation. Descriptive statistics, chi-square test and multivariable logistic regression were performed. Pairwise interaction terms between place of birth and each covariate were included in the regression model to examine the presence of multiplicative effect modification. Results The prevalence of timely breastfeeding initiation was 62.9 percent. Most women gave birth in public health facilities (72.8%) followed by private health facilities (15.9%) and at home (11.2%). The proportions of timely breastfeeding initiation differ by place of birth (p Conclusions Wealth index and residence moderated the association between place of birth and timely breastfeeding initiation in Cambodia. To improve breastfeeding outcomes and eliminate practices impeding timely initiation, breastfeeding advocacy programs need greater integration and follow-up in Cambodia’s health systems, including among home birth attendants and private health facilities.

Studies on clinical features of systemic lupus erythematosus among different age-onset patients are lacking in China. This multicentre study aimed to systemically compare clinical manifestations, comorbidities, organ involvement, and laboratory findings among 797 Chinese juvenile-onset, adult-onset, and late-onset SLE (JSLE, ASLE, and LSLE) patients. They were classified into JSLE, ASLE, and LSLE groups if first diagnosed at < 18, 18–50, and > 50 years old, respectively. Chi-square test and analysis of variance were employed for categorical and continuous variables respectively. In younger-onset patients, the SLE Disease Activity Index 2000 score was significantly higher (JSLE vs. ASLE vs. LSLE = 17.43 ± 9.139 vs. 16.34 ± 8.163 vs. 14.08 ± 6.474, p = 0.031). Mucocutaneous symptoms (79.5% vs. 73.4% vs. 62.0%, p = 0.042), especially malar rash (76.1% vs. 66.1% vs. 53.5%, p = 0.011) occurred more frequently, and proteinuria rate was higher (54.5% vs. 56.3% vs. 36.6%, p = 0.007). In later-onset patients, cardiopulmonary involvement increased (11.4% vs. 24.3% vs. 29.6%, p = 0.012). In ASLE, hypoalbuminemia rate elevated (46.6% vs. 59.9% vs. 47.9%, p = 0.015). Our study demonstrated in a Chinese population that JSLE may be more active and suffer mucocutaneous disorders, while LSLE tended to suffer cardiopulmonary involvement at-onset. These findings may help identify treatment priorities when facing different age-onset SLE patients.

OBJECTIVES Inadequate bowel preparation (IBP) for colonoscopy leads to missed diagnosis, longer anesthesia time, higher chance of complications and increased costs. Adult studies have demonstrated that patient characteristics such as male gender and obesity are associated with IBP. Little is known about factors affecting bowel preparation in children. Our aim was to determine factors associated with IBP in children. METHODS We prospectively enrolled children undergoing outpatient colonoscopy. Quality of bowel preparation was assessed using Boston Bowel Preparation Scale (BBPS) score (range 0-9). Data collected included patient demographics, indication, and type of insurance. Patients were divided into two groups based on BBPS score-adequate (BBPS score > 5) and inadequate (BBPS score < 5) and groups were compared using Student t-test and chi-square test. Possible predictors were analyzed using multivariate logistic regression models. RESULTS A total of 334 children were prospectively enrolled of whom 321 were studied further (age range 2-18 years; mean age 12.4 years; 60.4% female; 85.9% Caucasian). The mean BBPS score was 6.8 (standard deviation of ±2). IBP was reported in 12.8% (41/321). Multivariable logistic regression analysis did not show statistical differences between the groups in studied patient factors including age, gender, obesity, race, insurance type, and indication for colonoscopy. CONCLUSION Contrary to several adult studies, the results of our prospective study did not show any relationship between examined patient factors and IBP in children. Interestingly, IBP was less prevalent in our pediatric study compared to published adult data (12.8% vs 20-40%).

Le confinement dans le cadre de la CoVid 19 a nécessité des organisations en centre de lutte contre le cancer avec notamment le report de certains soins. Nous avons interrogé 6 080 patients qui avaient un rendez-vous programmé durant cette période. Deux mille quatre cent soixante-dix-huit patients ont donné leur avis concernant l’accès et l’organisation des soins, la téléconsultation, leurs préoccupations et leurs motifs de satisfaction. S’ils se disent pour 83 % d’entre eux, satisfaits de l’organisation des soins, 25 % des répondants déclarent un renoncement à des soins qu’ils qualifient d’indispensables dans un tiers des cas. La préoccupation en lien avec le suivi de la maladie cancéreuse passe avant celle d’attraper le virus Sars-cov-2, contrairement à la population générale, et les relations avec leurs proches sont spontanément citées comme motif de satisfaction. Cette méthode permet de saisir l’expérience des patients, malgré certaines limites. Une telle approche pourrait servir à la mise en place en période normale d’un dispositif spécifique.

Statement of problem As a measure of the leadership diversity in prosthodontics, the number and percentage of women and nonwhite Presidents of prosthodontics organizations is unknown. Purpose The purpose of this observational study was to calculate and compare the number and percentage of women and nonwhite Presidents of 10 selected prosthodontic organizations over the past 20 years and to determine whether the number of women and nonwhite Presidents has changed over the time frame of 2000-2019 in comparison to male and white Presidents. Material and methods The number of women and nonwhite Presidents of the Academy of Prosthodontics (AP), American Academy of Fixed Prosthodontics (AAFP), American Academy of Maxillofacial Prosthetics (AAMP), American College of Prosthodontists (ACP), American Prosthodontic Society (APS), European Prosthodontic Association (EPA), International Association of Dental Research - Prosthodontics group (IADR-P), International College of Prosthodontists (ICP), Greater New York Academy of Prosthodontics (GNYAP), and Pacific Coast Society for Prosthodontics (PCSP) was recorded. The chi-square test was used to determine differences in the percentage of women and nonwhite Presidents over time and between organizations. Results The range of women Presidents in the selected years was 20% (EPA) to 0% (APS) with a mean of 10%. No statistically significant differences over time and between organizations were observed. The range of nonwhite Presidents in the selected years was 25% (ICP) to 0% (AAFP, AAMP, ACP, and GNYAP) with a mean of 7.5%. No statistically significant difference over time was observed while a statistically significant difference between organizations was observed (P=.015). Multiple comparisons revealed the ICP had significantly more nonwhite Presidents in the selected years. Conclusions The relatively low numbers of women and nonwhite Presidents in the organizations studied is compelling evidence that there are an insufficient number of women and nonwhite role models in prosthodontics and that important voices representing the diversity of members of the prosthodontic community remain unheard. Clinical Implications

This systematic review and meta-analysis examined the effects of creatine supplementation on recovery from exercise-induced muscle damage, and is reported according to the PRISMA guidelines. MEDLINE and SPORTDiscus were searched for articles from inception until April 2020. Inclusion criteria were adult participants (≥18 years); creatine provided before and/or after exercise versus a noncreatine comparator; measurement of muscle function recovery, muscle soreness, inflammation, myocellular protein efflux, oxidative stress; range of motion; randomized controlled trials in humans. Thirteen studies (totaling 278 participants; 235 males and 43 females; age range 20–60 years) were deemed eligible for analysis. Data extraction was performed independently by both authors. The Cochrane Collaboration Risk of Bias Tool was used to critically appraise the studies; forest plots were generated with random-effects model and standardized mean differences. Creatine supplementation did not alter muscle strength, muscle soreness, range of motion, or inflammation at each of the five follow-up times after exercise (p > .05). Creatine attenuated creatine kinase activity at 48-hr postexercise (standardized mean difference: −1.06; 95% confidence interval [−1.97, −0.14]; p = .02) but at no other time points. High (I2; >75%) and significant (Chi2; p

Coffee drinking has been associated with decreased risk of some autoimmune diseases as well liver disease and outcomes. Environmental factors, such as coffee consumption, are yet to be assessed among patients with autoimmune hepatitis (AIH). We sought to investigate the relationship between coffee consumption and risk of AIH utilizing the Genetic Repository of Autoimmune Liver Disease and Contributing Exposures (GRACE) database. Lifetime coffee drinking was collected from 358 AIH patients (cases) and 564 volunteers (controls) from primary care visits. Groups were compared utilizing the Wilcoxon rank sum test for continuous variables and the Chi-square test for discrete variables. Logistic regression was used to analyze the effects of different coffee parameters (time, frequency, and cups) after adjusting for age, sex, education, smoking status, BMI, and daily activity. 24.6% of AIH patients never drank coffee compared to 15.7% of controls (p

Among patients with severe aortic stenosis (AS), there are limited data on aortic valve replacement (AVR), reasons for nonreceipt and mortality by race.Utilizing the Duke Echocardiography Laboratory Database, we analyzed data from 110,711 patients who underwent echocardiography at Duke University Medical Center between 1999 and 2013. We identified 1,111 patients with severe AS who met ≥1 of 3 criteria for AVR: ejection fraction ≤50%, diagnosis of heart failure, or need for coronary artery bypass surgery. Logistic regression models were used to assess the association between race, AVR and 1-year mortality. χ2 testing was used to assess potential racial differences in reasons for AVR nonreceipt.Among the 1,111 patients (143 AA and 968 CA) eligible for AVR, AA were more often women, had more diabetes, renal insufficiency, aortic regurgitation and left ventricular hypertrophy. CA were more often smokers, had more ischemic heart disease, hyperlipidemia and higher median income levels. There were no racial differences in surgical risk utilizing logistic euroSCORES. Relative to CA, AA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P.001) yet similar 1-year mortality (aHR 0.81, 95% CI 0.57-1.17, P = .262). There were no significant differences in reasons for AVR nonreceipt.We identified 143 African Americans (AA) and 968 Caucasian Americans(CA) with severe AS who met prespecified criteria for AVR.. AA relative to CA were more often women, had more diabetes, renal insufficiency, and left ventricular hypertrophy, however had less tobacco use, ischemic heart disease, hyperlipidemia and lower median income levels. Among patients with severe AS, AA relative to CA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P.001) without significant differences in reasons for AVR nonreceipt and similar 1-year mortality.

This study was carried out to evaluate the effect of acupressure applied to hemodialysis patients on the level of daytime sleepiness and sleep quality. The data were collected using the Descriptive Information Form, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. In the study, a total of 12 sessions of acupressure were applied to the Shenmen (HT7), Sanyingjao (Sp6), and Yungquan (KI1) points in the experimental group for 4 weeks. No intervention was applied to the control group. After the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group and that daytime sleepiness was less compared with the control group. After the acupressure, it was determined that the sleep latency of the experimental group was statistically significantly less and their total sleep duration was higher compared with the control group (P < .05). Although there was a decrease in the sleep quality of the experimental group 1 month after the cessation of the acupressure, it was determined that the sleep quality of the experimental group was better than that of the control group (P < .05). It was concluded that acupressure was an effective nursing intervention in increasing sleep quality and decreasing daytime sleepiness of hemodialysis patients.

Introduction: Quasi-induced exposure (QIE) technique has been popularly applied in the field of traffic safety research for decades. One of the basic assumptions of QIE theory is that the not-at-fault driving parties (D2s) involved in the crashes are the random selection of overall driving population at the event of crash occurrence. Very few literatures, however, can be identified to validate the assumption for crashes with specific injury severities that may not be satisfied in reality. Method: The study aims to check the validity of the assumption categorized by crash injury severity with the use of Michigan crash data. Latent class analysis is employed to generate several latent classes for the crashes with specific injury outcomes. Chi-square test is adopted to identify the significance of the similarity of D2 distributions among the latent classes. Results: The results indicate that: (a) for fatal crashes the statistical tests do not identify the significant discrepancies for D2 distributions of driver gender, age, and vehicle type between latent classes; (b) for injury crashes, both D2 driver gender and age have the similar distributions between/among various classes, while the D2 vehicle types show the inconsistent distributions; and (c) with respect to property damage only crashes, the distributions of three vehicle-driver characteristics are significantly different among the latent classes. It implies that the underlying assumption may not entirely hold true for all the injury severities and driver-vehicle characteristics. Practical Applications: The findings pinpoint the applicability of the QIE technique under specific scenarios and highlight the importance of validating the underlying assumption of QIE prior to its application.

Introduction: In this study we explore the added value of bicycle crash descriptions from open text fields in hospital records from the Aarhus municipality in Denmark. We also explore how bicycle crash data from the hospital complements crash data registered by the police in the same area and time period. Method: The study includes 5,313 Danish bicycle crashes, of which 4,205 were registered at the hospital and 1,078 by the police. All crashes occurred from 2010 to 2015. We performed an in-depth analysis of the open text fields on hospital records to identify factors associated with each crash using four categories: bicyclist, road, bicycle, and the other party. We employed the chi-squared test to compare the distribution of variables between crashes registered at the hospital and by the police. A binary logit model was used to estimate the probability that a crash factor is identified, and that each crash factor is associated with a single-bicycle crash. Results: The open-ended text fields in hospital records provide detailed information about crash factors not available in police records, including riding speed, inattention, clothing, specific road conditions, and bicycle defects. The factors alcohol and curb had the highest odds of being identified in relation to a single-bicycle crash. Crash data registered at the hospital included a larger number of bicycle crashes, particularly single-bicycle crashes and crashes with slight injuries only. Conclusion: Crash information registered at the hospital in Aarhus Municipality contributes to a better understanding of bicycle crashes due to detailed information about crash-associated factors as well as information about a larger number of bicycle crashes, particularly single-bicycle crashes. Practical implication: Efforts to improve access to detailed information about bicycle crashes are needed to provide a better basis for bicycle crash prevention.

Vasopressors may be required during acute burn resuscitation to support mean arterial blood pressure, but their use is not well-described in the burn literature. The purpose of this study was to examine vasopressor use during acute fluid resuscitation.Retrospective review of adults with burns ≥ 20% TBSA admitted to an ABA-verified regional burn center. Patients administered an infusion of a vasopressor for at least 30 min during the 1 st 48 h post-burn formed the PRESSOR group while patients who did not receive vasopressors formed the NoPRESSOR group.We studied 52 burned adults, 85% of which had flame burns. Vasopressors were administered during resuscitation to 31% of patients. Vasopressor infusions began at 20.9 ± 10.9 h post burn and were continued for 16.8 ± 10.8 h. PRESSOR patients (N = 16) had significantly greater total (p = 0.001) and full thickness burn size (p 0.001), and need for mechanical ventilation (p = 0.005) than NoPRESSOR patients (N = 36). PRESSOR and NoPRESSOR patients did not differ significantly in per cent predicted fluid volume received in the first 24 h (143 ± 58 Vs. 125 ± 46 respectively). PRESSOR patients compared to NoPRESSOR patients tended to have been administered 5% albumin (Alb) less often (38% Vs 47%) and high dose vitamin C (HDVC) more often during resuscitation (69% vs 17%). Multivariate regression analysis found that patient age (OR 1.189, 95% CI: 1.047, 1.351) and HDVC (OR 24.701, 95% CI: 1.558, 391.551) were independently associated with greater use of vasopressors. An inverse probability weighted propensity analysis also identified a significant association between HDVC and increased use of vasopressors (OR 6.902, 95 % CI: 2.503, 19.026), and significantly decreased vasopressor administration following Alb administration (OR 0.310, 95% CI: 0.130, 0.739).Advanced age appears to be the most important determinant of vasopressor use during resuscitation. While vasopressor requirements appear to have been increased by HDVC and decreased by Alb, this needs to be formally evaluated in a large randomized study.

Background One of the most important problems in burn patients was pain, especially in dressing changes. This pain can lead to anxiety in the patient. The aim of this study was to determine the effect of foot reflexology on pain and anxiety severity in burn patients. Methods This study was a randomized controlled trial, in which 66 patients with burn injuries referred to Vali-e-asr Hospital, Arak, Iran participated. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into intervention (n = 33) and control (n = 33) groups using simple random allocation. In the intervention group, in addition to standard care, reflexology was performed for one week on Saturday, Monday and Wednesday (three times in a week). The intervention was done one hour before dressing change in a separate room for 30 min. The control group received only standard care during this time (both intervention and control groups were the same in the type of received treatment, and reflexology was considered as an extra care in the intervention group). Severity of pain and anxiety in both groups was measured using visual analog scale twice a day (5−10 min before dressing change and 5−10 min after dressing change) for six days. SPSS software ver. 15 was used for statistical analysis. Mean and standard deviation were used for quantitative variables and qualitative variables were reported as frequency and percentage. Data were analyzed using Chi‑square, Mann–Whitney, Fisher’s exact tests, and paired t-test. The Kolmogorov–Smirnov test was used to check the normality of data. Results The results showed that there was no significant difference in severity of pain (p = 0.25) and anxiety (p = 0.37) between the two groups on the first day, before the intervention. In the following, the results showed that there was no significant difference between the two groups in the second and third days after intervention too. But, the mean scores of pain showed that there was significant difference between the two groups in the forth (p = 0.005), fifth (p = 0.001), and sixth (p = 0.001) days after intervention. Anxiety scores also showed there was significant difference between the two groups on the fourth (p = 0.01), fifth (p = 0.001), and sixth (p = 0.001) days. Conclusions our results showed foot reflexology is an appropriate and safe intervention for management of pain and anxiety of burn patients. Therefore, it can be used as a complementary method alongside other methods.

Resistance training immediately after a burn injury has not been investigated previously. This randomised, controlled trial assessed the impact of resistance training on quality of life plus a number of physical, functional and safety outcomes in adults with a burn injury. Patients were randomly assigned to receive, in addition to standard physiotherapy, four weeks of high intensity resistance training (RTG) or sham resistance training (CG) three days per week, commenced within 72h of the burn injury. Outcome data was collected at six weeks, three and six months after burn injury. Quality of life at 6 months was the primary endpoint. Data analysis was an available cases analysis with no data imputed. Regression analyses were used for all longitudinal outcome data and between-group comparisons were used for descriptive analyses. Forty-eight patients were randomised resistance training (RTG) (n=23) or control group (CG) (n=25). The RTG demonstrated improved outcomes for the functional domain of the Burn Specific Health Scale-Brief (p=0.017) and the Quick Disability of Arm Shoulder and Hand (p0.001). Between group differences were seen for C-reactive protein and retinol binding protein (p=0.001). Total quality of life scores, lower limb disability, muscle strength and volume were not seen to be different between groups (p0.05). Resistance training in addition to usual rehabilitation therapy showed evidence of improving functional outcomes, particularly in upper limb burn injuries. Additionally, resistance training commenced acutely after a burn injury was not seen to be harmful to patients.

Hepatitis B virus (HBV) infection is a major public health problem worldwide. The study aimed to evaluate the efficacy of pegylated interferon (Peg-IFN) alfa-2a treatment for seroclearance of HBs antigen (HBsAg) in HBe antigen (HBeAg)-negative chronic hepatitis B (CHB) patients. This retrospective study investigated 16 HBeAg-negative CHB patients who received Peg-IFN alfa-2a weekly for 48 weeks. Thereafter, the patients were followed-up for 48 weeks after the end of therapy. The following criteria were also used for inclusion: HBV-DNA

The study intends to ascertain whether higher patient mortality occurs during weekends or nighttime or during a specific time of day. Time of death of all deceased in ICUs of a teaching hospital during study period (n = 844) was noted and analyzed. It was found that compared to daytime working hours, significantly higher mortality is not observed during Off Duty Hours (i.e. Evening/Night/Weekends/Holidays) and has no relationship with any particular time of the day. Patient deaths over time were found to conform to Poisson distribution. ICU deaths occur randomly and independently with no effect of nighttime/weekend or particular time of day.

In the inferential process of Principal Component Analysis (PCA), one of the main challenges for researchers is establishing the correct number of components to represent the sample. For that purpose, heuristic and statistical strategies have been proposed. One statistical approach consists in testing the hypothesis of the equality of the smallest eigenvalues in the covariance or correlation matrix using a Likelihood-Ratio Test (LRT) that follows a x2 limit distribution. Different correction factors have been proposed to improve the approximation of the sampling distribution of the statistic. We use simulation to study the significance level and power of the test under the use of these different factors and analyze the sample size required for an adequate approximation. The results indicate that for covariance matrix, the factor proposed by Bartlett offers the best balance between the objectives of low probability of Type I Error and high Power. If the correlation matrix is used, the factors W * B and cχ 2 D are the most recommended. Empirically, we can observe that most factors require sample sizes 10 or 20 times the number of variables if covariance or correlation matrices, respectively, are implemented. Resumen Dentro del proceso inferencial del Análisis de Componentes Principales (PCA) uno de los interrogantes principales de los investigadores es sobre el número correcto de componentes para representar la muestra. Para este fin se han propuesto estrategias heurísticas y estadísticas. Un enfoque estadístico consiste en probar la hipótesis sobre la igualdad de los valores propios más pequeños de la matriz de covarianza o correlación a través de una prueba de razón de verosimilitud (LRT) que sigue una distribución límite x2. Diferentes factores de corrección han sido propuestos para mejorar la aproximación de la distribución muestral del estadístico. En este trabajo utilizamos simulación para estudiar el nivel de significancia y la potencia de la prueba bajo el uso de estos diferentes factores, así como una revisión del tamaño de muestra requerido para una adecuada aproximación. Los resultados para la matriz de covarianza indican que el factor propuesto por Bartlett ofrece el mejor equilibrio entre los objetivos de baja probabilidad de Error Tipo I y alta potencia. En caso de la matriz de correlación, los factores W * B y cχ 2 D son los más recomendados. Empíricamente se observa que la mayoría de los factores requieren tamaños de muestra 10 y 20 veces mayores al número de variables en caso de la matriz de covarianza o de correlación respectivamente.

Resume Introduction Durant la pandemie de COVID-19, les mesures de confinement et les recommandations des societes savantes de cancerologie ont pu impacter le recours aux soins des patients. Methodes Cette etude retrospective unicentrique comparait le nombre et les caracteristiques des patientes recues pour une premiere consultation pour une tumeur du sein ou gynecologique entre la periode du confinement et une periode controle, ainsi que les delais de prise en charge et les traitements proposes. Resultats Durant le confinement, 91 patientes ont ete vues pour une demande de prise en charge, contre 159 durant la periode controle, soit une baisse de 43,5 %. Les patientes etaient plus âgees (62,9 contre 60,9 ans), sans que cette difference soit significative (p = 0,339). Le stade tumoral n’etait pas modifie. En senologie, le delai entre la biopsie et la premiere consultation a ete allonge de 5,5 jours (difference non significative). Parmi les 51 patientes ayant une indication operatoire durant le confinement, 16 (31,4 %) ont ete reportees apres la levee du confinement. Malgre tout, le delai entre la consultation et le debut des traitements n’a pas ete impacte. Nous n’avons pas non plus mis en evidence de modification statistiquement significative des pratiques. Discussion Au plus fort de la pandemie, les benefices et les risques du traitement du cancer ont du etre evalues en permanence, face au risque d’exposition au SARS-CoV-2. L’evaluation des pratiques en oncologie est essentielle pour comprendre le reel impact de cette pandemie, et se preparer a d’eventuelles crises futures.