Search

This retrospective cohort study aimed to confirm the previously reported inverse association between diabetes mellitus (DM) and abdominal aortic aneurysm (AAA) using large population based data. It also investigated the associations between AAA and impaired fasting glucose (IFG) and new onset DM (not yet treated). A representative dataset was obtained from the Korean National Health Insurance Service. Participants who were aged ≥ 50 years and received a national health examination in 2009 were included and followed until 31 December 2019. Glycaemic status was defined based on fasting plasma glucose level and the relevant diagnostic codes. AAA was ascertained using medical facility use records with relevant diagnostic codes or aneurysm repair surgery. A Cox proportional hazards model was used to examine the association between glycaemic status and AAA, with adjustment for confounders. Additionally, the interactions between glycaemic status and subgroups based on baseline characteristics were examined. The study population comprised 4 162 640 participants. Participants with IFG or DM were significantly more likely to be male, older, and have comorbidities compared with normoglycaemic participants at baseline. The incidence of AAA was lower in participants with IFG or DM compared with normoglycaemic participants. The AAA risk was lower in patients with DM than in patients with IFG, and decreased linearly according to glycaemic status: the adjusted hazard ratio was 0.88 (95% confidence interval [CI] 0.85 − 0.91) for IFG, 0.72 (95% CI 0.67 − 0.78) for newly diagnosed DM, 0.65 (95% CI 0.61 − 0.69) for DM duration < 5 years, and 0.47 (95% CI 0.44 − 0.51) for DM duration ≥ 5 years compared with the normoglycaemia group. Both IFG and DM were related to reduced AAA risk in all subgroups, suggesting an independent association. Both IFG and DM, even when not treated with antihyperglycaemic medication, were associated with a lower incidence of AAA. The AAA risk decreased linearly according to DM duration. [ABSTRACT FROM AUTHOR]

The incidence of gastric and duodenal neuroendocrine tumors (GNET and DNET, respectively) is increasing, however associated factors of these diseases are not well known. Here, we investigated the factors associated with GNET and DNET. Patients with GNET and DNET presenting at eight tertiary referral centers between 2001 and 2020 were included and compared with healthy controls who underwent upper endoscopic screening. Clinical factors and laboratory data were analyzed to determine associated factors of GNET and DNET. Overall, 396 patients with GNET and 193 patients with DNET were included and compared with 1725 healthy controls. Multivariate analysis showed that age (odds ratio [OR] 0.98), diabetes (OR 1.72), hypertension (OR 1.97), low serum high-density lipoprotein cholesterol (HDL-C) levels (OR 2.54), and past/present H. pylori infection (OR 1.46) were significantly associated with GNET. In contrast, DNET was significantly associated with diabetes (OR 1.80), hypertension (OR 1.68), low serum HDL-C levels (OR 2.29), and past/present H. pylori infection (OR 5.42). In the sex-based subgroup analysis in GNET, current smoking was strongly associated in women (OR 9.85), but not in men. This study identified several common metabolic factors associated with GNET and DNET. Additionally, some factors had sex-specific associations. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI)–enabled sinus rhythm (SR) electrocardiogram (ECG) interpretation can aid in identifying undiagnosed paroxysmal atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS). The purpose of this study was to assess the efficacy of an AI model in identifying AF based on SR ECGs in patients with ESUS. A transformer-based vision AI model was developed using 737,815 SR ECGs from patients with and without AF to detect current paroxysmal AF or predict the future development of AF within a 2-year period. Probability of AF was calculated from baseline SR ECGs using this algorithm. Its diagnostic performance was further tested in a cohort of 352 ESUS patients from 4 tertiary hospitals, all of whom were monitored using an insertable cardiac monitor (ICM) for AF surveillance. Over 25.1-month follow-up, AF episodes lasting ≥1 hour were identified in 58 patients (14.4%) using ICMs. In the receiver operating curve (ROC) analysis, the area under the curve for the AI algorithm to identify AF ≥1 hour was 0.806, which improved to 0.880 after integrating the clinical parameters into the model. The AI algorithm exhibited greater accuracy in identifying longer AF episodes (ROC for AF ≥12 hours: 0.837, for AF ≥24 hours: 0.879) and a temporal trend indicating that the AI-based AF risk score increased as the ECG recording approached the AF onset (P for trend <.0001). Our AI model demonstrated excellent diagnostic performance in predicting AF in patients with ESUS, potentially enhancing patient prognosis through timely intervention and secondary prevention of ischemic stroke in ESUS cohorts. [Display omitted] [ABSTRACT FROM AUTHOR]

Current guidelines recommend complete revascularization (CR) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD). With regard to the timing of percutaneous coronary intervention (PCI) for non-infarct-related artery (non-IRA), recent randomized clinical trials have revealed that immediate CR was non-inferior to staged CR. However, the optimal timing of CR remains uncertain. The OPTION-STEMI trial compared immediate CR and in-hospital staged CR guided by fractional flow reserve (FFR) for intermediate stenosis of the non-IRA. The OPTION-STEMI is a multicenter, investigator-initiated, prospective, open-label, non-inferiority randomized clinical trial. The study included patients with at least 1 non-IRA lesion with ≥50% stenosis by visual estimation. Patients fulfilling the inclusion criteria were randomized into 2 groups at a 1:1 ratio: immediate CR (i.e., PCI for the non-IRA performed during primary angioplasty) or in-hospital staged CR. In the in-hospital staged CR group, PCI for non-IRA lesions was performed on another day during the index hospitalization. Non-IRA lesions with 50%−69% stenosis by visual estimation were evaluated by FFR, whereas those with ≥70% stenosis was revascularized without FFR. The primary endpoint was the composite of all-cause death, non-fatal myocardial infarction, and all unplanned revascularization at 1 year after randomization. Enrolment began in December 2019 and was completed in January 2024. The follow-up for the primary endpoint will be completed in January 2025, and primary results will be available in the middle of 2025. The OPTION-STEMI is a multicenter, non-inferiority, randomized trial that evaluated the timing of in-hospital CR with the aid of FFR in patients with STEMI and MVD. URL: https://www.clinicaltrials.gov. Unique identifier: NCT04626882; and URL: https://cris.nih.go.kr. Unique identifier: KCT0004457. [ABSTRACT FROM AUTHOR]

[Display omitted] Asthma is often accompanied by type 2 immunity rich in IL-4, IL-5, and IL-13 cytokines produced by T H 2 lymphocytes or type 2 innate lymphoid cells (ILC2s). IL-2 family cytokines play a key role in the differentiation, homeostasis, and effector function of innate and adaptive lymphocytes. IL-9 and IL-21 boost activation and proliferation of T H 2 and ILC2s, but the relative importance and potential synergism between these γ common chain cytokines are currently unknown. Using newly generated antibodies, we inhibited IL-9 and IL-21 alone or in combination in various murine models of asthma. In a translational approach using segmental allergen challenge, we recently described elevated IL-9 levels in human subjects with allergic asthma compared with nonasthmatic controls. Here, we also measured IL-21 in both groups. IL-9 played a central role in controlling innate IL-33–induced lung inflammation by promoting proliferation and activation of ILC2s in an IL-21–independent manner. Conversely, chronic house dust mite–induced airway inflammation, mainly driven by adaptive immunity, was solely dependent on IL-21, which controlled T H 2 activation, eosinophilia, total serum IgE, and formation of tertiary lymphoid structures. In a model of innate on adaptive immunity driven by papain allergen, a clear synergy was found between both pathways, as combined anti-IL-9 or anti-IL-21 blockade was superior in reducing key asthma features. In human bronchoalveolar lavage samples we measured elevated IL-21 protein within the allergic asthmatic group compared with the allergic control group. We also found increased IL21R transcripts and predicted IL-21 ligand activity in various disease-associated cell subsets. IL-9 and IL-21 play important and nonredundant roles in allergic asthma by boosting ILC2s and T H 2 cells, revealing a dual IL-9 and IL-21 targeting strategy as a new and testable approach. [ABSTRACT FROM AUTHOR]

Treating opioid use disorder has reached a new level of challenge. Synthetic opioids and xylazine have joined the non-medical opioid supply, multiplying the complexities of caring for individuals in emergency departments (ED). This combination, known as 'tranq dope,' is poorly described in literature. Inadequate withdrawal treatment results in a disproportionately high rate of patient-directed discharges (also known as against medical advice dispositions, or AMA). This study aimed to describe a cohort of individuals who received a novel order set for suspected fentanyl and xylazine withdrawal in the ED. This is a descriptive study evaluating a cohort of ED patients who received withdrawal medications from a novel protocol and electronic health record order set. Individuals being assessed in the ED while suffering from withdrawal were eligible. Individuals under age 18, on stable outpatient MOUD or who were pregnant were excluded. Treatment strategies included micro-induction buprenorphine, short acting opioids, non-opioid analgesics, and other adjunctive medications. Data collected included: demographics including zip code, urine toxicology screening, order set utilization and disposition data. Clinical Opiate Withdrawal Scale (COWS) scores were recorded, where available, before and following exposure to the medications. There were 270 patient encounters that occurred between September 14, 2022, and March 9, 2023 included in the total study cohort. Of those, 66 % were male, mean age 37 with 71 % residing within Philadelphia zip codes. 100 % of urine toxicology screenings were positive for fentanyl. Of the 177 patients with both pre- and post-exposure COWS scores documented, constituting the final cohort, patients receiving medications had their COWS score decrease from a median of 12 to a median of 4 (p < 0.001). The AMA rate for this cohort was 3.9 %, whereas the baseline for the population with OUD was 10.7 %. Recorded adverse effects were few and resolved without complication. Fentanyl and xylazine withdrawal are challenging for patients and providers. A novel tranq dope withdrawal order set may reduce both COWS scores and rate of patient-directed discharge in this cohort of patients, though further investigation is needed to confirm findings. • Fentanyl and Xylazine are contaminating an ever-growing portion of non-medical opioid supply in the United States • The withdrawal syndromes faced by those using fentanyl and xylazine are unprecedented in their severity and complexity • Use of a multi-modal strategy to address pain, sympathetic activation and other features of the withdrawal may be important. • Potential options include micro-induction dosed buprenorphine, short acting conventional opioids and adjunctive medications. • Use of treatments may reduce withdrawal severity and risk of patient-directed discharge (against medical advice disposition). [ABSTRACT FROM AUTHOR]

This paper introduces a novel Multi-Level Inverter (MLI) design which utilizes a single input and leverages capacitor voltages source to generate a four-fold increase in output voltage as the main problem that stays with the inverters is their low boost ability and efficiency while maintaining power quality at the same time. One capacitor is charged to match the input voltage magnitude, while the other two capacitors store twice this magnitude. Through a series-parallel combination with switching operations, all capacitors are effectively charged and discharged within each cycle, ensuring natural voltage balance. A comprehensive comparative analysis is conducted to highlight the advantages of this innovative approach, particularly in terms of component reduction and mitigation of voltage stress. Detailed assessment of power losses within the proposed circuit is undertaken, simulation studies are first carried out while extensive experimentation verifies its operational efficiency under diverse conditions such as varying modulation indices, loads, and supply-side fluctuations with an impressive maximum efficiency of 96.9 % at a 200 W power rating, our research contributes to advancing compact power converters, addressing crucial challenges in modern power electronics applications, and paving the way for enhanced performance and reliability in such systems. [ABSTRACT FROM AUTHOR]

· Differences in the clinical course of intensive care unit (ICU) admitted male and female patients with serve coronavirus disease 2019 (COVID-19) has not been investigated. · We aimed to investigate, in a large global population of ICU admitted COVID-19 patients, the impact of sex on ICU mortality and complications. · Males experienced critical illness that was protracted and required intervention more often than females. · Males had higher odds of developing cardiac arrest and pulmonary embolism, as a complication of COVID-19. · Future investigators ought to evaluate sex-differences in the long-term recovery of patients admitted to ICU with COVID-19. Sex differences in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) susceptibility, illness severity, and hospital course are widely acknowledged. The effects of sex on outcomes experienced by patients with severe Coronavirus Disease 2019 (COVID-19) admitted to the intensive care unit (ICU) remains unknown. To determine the effects of sex on ICU mortality in patients with COVID-19 This retrospective analysis of an international multi-center prospective observational database included adults admitted to ICU for treatment of acute COVID-19 between 1st January 2020 and 30th June 2022. The primary outcome was ICU mortality. Multivariable Cox regression was used to ascertain the hazard of death (Hazard Ratio=HR) adjusted for pre-selected covariates. The secondary outcome was sex differences in complications of COVID-19 during hospital stay. Overall, 10,259 patients (3,314 females, 6,945 males) were included with a median age of 60 (interquartile range [IQR]=49–68) and 59 (IQR=49–67) years, respectively. Baseline characteristics were similar between sexes. More females were non-smokers (65% vs. 44 %, p < 0.01) and obese (39% vs. 30 %, p < 0.01), compared to males. Also, males received greater ICU intervention (mechanical ventilation, prone ventilation, vasopressors, and tracheostomy) than females. Males had a greater hazard of death (compared to females, HR=1.14; 95 % CI=1.02–1.26). Adjustment for complications during hospital stay did not alter the hazard of death (HR=1.16; 95 % CI=1.05–1.28). Males had a significantly elevated hazard of death among patients who received ECMO (HR=1.24; 95 % CI=1.01–1.53). Male sex was associated with cardiac arrest (adjusted OR [aOR]=1.37; 95 % CI=1.16–1.62) and PE (aOR=1.28; 95 % CI=1.06–1.55). Among patients admitted to ICU for severe COVID-19, males experienced higher severity of illness and more frequent intervention than females. Ultimately, the hazard of death was moderately elevated in males compared to females despite greater PE and cardiac arrest. [ABSTRACT FROM AUTHOR]

• Global income inequality and disparities of healthcare resources have been exacerbated by the pandemic. • Coronavirus disease-2019 (COVID-19) causes severe respiratory distress as well as a slew of additional systemic consequences that affect several organ systems, including neurological complications. Ischemic stroke represents the most common neurological complication of respiratory failure due to COVID-19. • Stroke incidence per admitted days in patients with respiratory failure due to COVID-19 was low in high income countries (HICs) and low-middle income countries (LMICs) although the stroke risk was higher in LMICs. • Both LMIC status and stroke increased the risk of death in patients with respiratory failure due to COVID-19. We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4–44.9) LMICs and 17.6 (95 %CI = 15.8–19.7) HICs; ischemic 9.47 (95 %CI = 6.57–13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73–10.9) LMICs, and 2.52 (95 %CI = 2.00–3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75–17.3) LMICs, 8.99 (95 %CI = 7.70–10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31–2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29–2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), p < 0.001)]. Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. ACTRN12620000421932 registered on 30/03/2020. [ABSTRACT FROM AUTHOR]

• Identification of protein biomarkers for predicting Tocilizumab response in Rheumatoid arthritis. • High-precision proteomics approach using Data-independent acquisition mass spectrometry in RA patient serum. • Developed a robust multi-biomarker panel with 86 % discriminative power and 0.84 AUC. • Potential diagnostic tool for TCZ non-responder prediction in RA patients. Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by inflammation in the synovial lining of the joints. Key inflammatory cytokines such as interleukin-6 (IL-6), TNF-α, and others play a critical role in the activation of local synovial leukocytes and the induction of chronic inflammation. Tocilizumab (TCZ), a humanized anti-IL-6 receptor monoclonal antibody, has demonstrated significant clinical efficacy in treating RA patients. However, similar to other inflammatory cytokine blockers, such as TNF-alpha inhibitors, Interleukin-1 inhibitors, or CD20 inhibitors, some patients do not respond to treatment. To address this challenge, our study employed a high-precision proteomics approach to identify protein biomarkers capable of predicting clinical responses to Tocilizumab in RA patients. Through the use of data-independent acquisition (DIA) mass spectrometry, we analyzed serum samples from both TCZ responders and non-responders to discover potential biomarker candidates. These candidates were subsequently validated using individual serum samples from two independent cohorts: a training set (N = 70) and a test set (N = 18), allowing for the development of a robust multi-biomarker panel. The constructed multi-biomarker panel demonstrated an average discriminative power of 86 % between response and non-response groups, with a high area under the curve (AUC) value of 0.84. Additionally, the panel exhibited 100 % sensitivity and 60 % specificity. Collectively, our multi-biomarker panel holds promise as a diagnostic tool to predict non-responders to TCZ treatment in RA patients. [ABSTRACT FROM AUTHOR]

• Nursing students should receive training in multidisciplinary collaboration to meet the increasing demand for community nurses. However, existing educational strategies could not adequately frame a learning environment for nursing students to fully experience collaboration in a multidisciplinary team. • Challenge-Based Learning (CBL) may be a promising educational approach to complement the limitations of current education strategies in nursing education because it allows nursing students to fully experience multidisciplinary collaboration through conducting community projects in a multidisciplinary context. • The preliminary findings suggest the potential positive effect of CBL in strengthening nursing students' multidisciplinary collaboration. It serves as a reference for nurse educators to integrate CBL into nursing curricula. It also provides direction for future studies to evaluate the effect of CBL on multidisciplinary collaboration in nurse training. Competence in multidisciplinary collaboration is an essential attribute of nurses working in community health settings. Nursing students should be equipped with this attribute during undergraduate training. To examine the effect of Challenge-Based Learning (CBL) on multidisciplinary collaboration among nursing students. A one-group pretest-posttest study. Nursing students worked in multidisciplinary groups to conduct community projects framed with CBL. The students designed, planned, and implemented health promotion activities for the selected health topics over a 14-week semester. Multidisciplinary collaboration was measured by Collaboration Scale at baseline and after the projects were completed. Wilcoxon signed-rank test was used to compare the total and subdomain collaboration scores within-group. p-value <0.05 was statistical significance. The total and subdomain collaboration scores were significantly greater than those of the pretest ones (p<0.001), with the effect sizes (r) ranging from 0.48 to 0.71. The present findings shed light on the potential positive effect of CBL on strengthening nursing students' competence in multidisciplinary collaboration. Future studies with a more rigorous approach are needed to verify the findings. [ABSTRACT FROM AUTHOR]

Few studies have investigated both the positive and negative impacts of perceived changes related to the COVID-19 pandemic on adolescents' wellbeing. This study aimed to comprehensively identify the factors associated with the overall wellbeing of the youth population. A cross-sectional study design was employed using data from the 2020 Korean Survey of Children and Youth. Data were collected from N = 7,170 adolescents (aged 9–24 years) during the implementation of social distancing measures in response to the COVID-19 pandemic. Participants provided self-reported data about their COVID-19–induced perceived changes, wellbeing, parental support, and self-esteem between November 2020 and February 2021. The effect of COVID-19–induced perceived changes on adolescents' wellbeing during the pandemic was assessed by evaluating the mediating roles of parental support and self-esteem. The findings highlighted a serial mediating effect of parental support and self-esteem on the relationship between adolescents' COVID-19–related perceived changes and wellbeing. This study deepens the understanding of the intricate interplay between pandemic-related perceived changes, mediating factors, and wellbeing among adolescents. The findings imply that a comprehensive approach combining interventions aimed at enhancing self-esteem at the individual level with parental support may be most effective in improving adolescents' wellbeing. [ABSTRACT FROM AUTHOR]

Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but devastating condition caused by bisphosphonates, receptor activator of nuclear factor kappa-B ligand inhibitors, anti-angiogenic medications, and disease-modifying antirheumatic drugs. While the clinical spectrum of MRONJ has a wide range, there is a subgroup of patients that do not improve with antibiotics and conservative surgical debridement resulting in pathologic fractures, draining fistulas, and/or osteomyelitis. For the severely affected individuals, the only cure is surgical resection with micro-vascular free flap reconstruction. The etiology of MRONJ is unknown because of the lack of understanding of the biological underpinnings of the disorder connected to the mechanisms of action of the various medications. This limited knowledge has resulted in the classification of patients by clinical presentation rather than underlying pathology. Therefore, the aim of this article is to present a mechanistic framework of MRONJ through the mevalonate pathway in the context of the medications that are known to induce it and explore potential novel therapeutics. [ABSTRACT FROM AUTHOR]

• We examined depressive symptom trajectories following transition to living alone • Three classes (low, moderate, and high stabilities) were detected • We identified baseline characteristics linked to the classes This study identified the trajectory classes of depressive symptoms after transitioning to living alone and the factors affecting these trajectories. Data from the initial to the seventh waves of the Korean Longitudinal Study of Aging were analyzed, focusing on four consecutive waves. We selected 369 participants aged ≥45 who transitioned to living alone between consecutive waves (T1 and T2). They were followed up for six years (T1 to T4) while living alone from T2 to T4. Using latent class growth modeling, three trajectories emerged: low-lessening, moderate-lessening, and high-stable. The highly stable class was associated with older age, more chronic diseases, lower satisfaction with health and financial status, and less frequent social interactions at T1 than the low-lessening class. These findings underscore the importance of community-based interventions for middle-aged and older adults with risk factors as they face an increased risk of depression over time after transitioning to living alone. [ABSTRACT FROM AUTHOR]

• Promoting healthcare professionals' (HCPs) retention at the workplace is essential to ensure high-quality care, particularly during global healthcare crises and in high-risk settings, such as long-term care facilities for older people. • Approximately 4 out of every 10 long-term care facilities' HCPs encountered at least one instance of social discrimination during the COVID-19 pandemic. • HCPs who experienced social discrimination were less likely to intend to stay in their current workplace. • Psychological support could avert the negative impact of discrimination on the intention to stay, underscoring the importance of psychological support as an effective strategy to retain and support HCPs during times of crisis. This international cross-sectional survey examined the potential role of organizational psychological support in mitigating the association between experiencing social discrimination against long-term care (LTC) facilities' healthcare professionals (HCPs) and their intention to stay in the current workplace during the COVID-19 pandemic. Participants included a convenience sample of 2,143 HCPs (nurses [21.5 %], nurse aids or residential care workers [40.1 %], social workers [12.1 %], and others [26.4 %]) working at 223 LTC facilities in 13 countries/regions. About 37.5 % of the participants reported experiencing social discrimination, and the percentage ranged from 15.3 % to 77.9 % across countries/regions. Controlling for socio-demographic and work-related variables, experiencing social discrimination was significantly associated with a lower intention to stay, whereas receiving psychological support showed a statistically significant positive association (p-value=0.015 and <0.001, respectively). The interaction term between social discrimination and psychological support showed a statistically significant positive association with the intention to stay, indicating a moderating role of the psychological support. [ABSTRACT FROM AUTHOR]

The aim of the study was to elucidate the long-term outcomes of atrial fibrillation surgery in patients with atrial fibrillation and mitral valve disease by comparing the patients who underwent mitral valve surgery with and without atrial fibrillation surgery. Between 2005 and 2017, 2680 patients with atrial fibrillation who underwent mitral valve surgery (mitral valve surgery with atrial fibrillation surgery, n = 1841; mitral valve surgery without atrial fibrillation surgery, n = 839) at 5 centers were included. After propensity score matching, 1442 patients were extracted (atrial fibrillation surgery group, n = 721; non–atrial fibrillation surgery group, n = 721). All-cause mortality, cardiac mortality, major adverse cardiac and cerebrovascular events, stroke or transient ischemic attack, and permanent pacemaker implantation were compared between the atrial fibrillation surgery and non–atrial fibrillation surgery groups. Overall survivals at 5 and 10 years postoperatively were 91.0% and 80.7% in the atrial fibrillation surgery group and 86.5% and 75.9% in the non–atrial fibrillation surgery group, respectively (P =.013). Cardiac mortality-free survivals at 5 and 10 years postoperatively were 96.9% and 91.7% in the atrial fibrillation surgery group and 90.9% and 83.7% in the non–atrial fibrillation surgery group, respectively (P <.001). Cumulative incidence of reoperation, major adverse cardiac and cerebrovascular events, and stroke or transient ischemic attack was lower in the matched atrial fibrillation surgery group compared with the matched non–atrial fibrillation surgery group up to 15 years postoperatively (P =.010, P <.001, and P =.012, respectively). Cumulative incidence of permanent pacemaker implantation was higher in the matched atrial fibrillation surgery group compared with the matched non–atrial fibrillation surgery group (P <.001). In patients with atrial fibrillation and mitral valve disease, mitral valve surgery concomitant with atrial fibrillation surgery was associated with lower mortality, cardiac mortality, major adverse cardiac and cerebrovascular events, and stroke or transient ischemic attack up to 15 years after surgery when compared with mitral valve surgery without atrial fibrillation surgery. In patients with AF with MV disease, MV surgery concomitant with AF surgery significantly lowered mortality, cardiac mortality, MACCE, and stroke or TIA up to 15 years after surgery when compared with MV surgery without AF surgery. [Display omitted] [ABSTRACT FROM AUTHOR]

This study aims to explore obesity-related behaviors (ORB) and health-related quality of life (HRQoL) in socioeconomically vulnerable children, while also examining potential associations between these variables. A total of 721 children enrolled in after-school care programs for socioeconomically vulnerable children participated in this study. Height (in cm) and weight (in kg) were measured directly by trained research assistants. ORB, including eating behaviors and physical activity, was assessed utilizing the Nutrition Quotient Questionnaire. HRQoL was measured utilizing the PedsQL™ 4.0. Data were analyzed using logistic regression. The findings revealed that participants exhibited lower levels of ORB and reduced HRQoL, particularly in the physical health dimension of HRQoL. Inadequate physical activity and poor dietary habits were strongly associated with a 2.625-fold (OR = 2.625, 95% CI = 1.867–3.691) and a 4.251-fold (OR = 4.251, 95% CI = 2.466–7.328) increase, respectively, in the likelihood of having low HRQoL. Surprisingly, the study did not find a significant link between ORB levels and obesity, and obesity status did not predict a higher probability of low HRQoL. This study underscores the need for tailored interventions designed specifically for children from socioeconomically vulnerable families to address their unique challenges. This research provides valuable insights for pediatric nurses and healthcare providers, highlighting the crucial role of promoting healthy ORB in socioeconomically vulnerable children to address disparities in childhood obesity and HRQoL. • Children from vulnerable families have worse obesity-related behaviors compared to general population. • Also, Health-related Quality of Life (HRQoL) is lower in those children. • A low level of physical activity and poor diet increased the likelihood of low HRQoL. • Obesity-related behaviors had no significant effect on obesity. • Obesity status did not increase the likelihood of low HRQoL in vulnerable children. [ABSTRACT FROM AUTHOR]

Faced with high unemployment and labor mismatches, many countries have mainly focused on stimulating labor demand through job creation policies. However, empirical evidence regarding their effectiveness is mixed, while the impact of labor supply-side policies remains underexplored. This study fills the gap by assessing the effectiveness of a labor supply-side policy—the Job Creation Income Tax Credit in Korea—which provides tax incentives for workers under 35 employed in small and medium-sized enterprises (SMEs). Using event-study and difference-in-differences models with national survey data from 2016 to 2019, we find insignificant effects on overall SME employment among individuals aged 32–34. While no significant effects are observed on regular workers, only low-educated male SME workers ineligible for the credit transition to eligible temporary SME jobs. These findings highlight that modest tax credits are ineffective in promoting employment for highly educated young individuals due to their high reservation wages and inelastic labor supply. [ABSTRACT FROM AUTHOR]

• The individualized hyperglycemic threshold was a better predictor of postcardiac surgery acute kidney injury than the conventional hyperglycemic threshold. • Intraoperative hyperglycemia was associated with the risk of acute kidney injury only for the individualized hyperglycemic threshold. • Blood glucose control during cardiac surgery may need to be individualized. This study was designed to compare individualized and conventional hyperglycemic thresholds for the risk of acute kidney injury (AKI) after cardiac surgery. This was an observational study. The study took place in a single-center tertiary teaching hospital. Adult patients who underwent cardiac surgery between January 2012 and November 2021 were enrolled. Two blood glucose thresholds were used to define intraoperative hyperglycemia. While the conventional hyperglycemic threshold (CHT) was 180 mg/dL in all patients, the individualized hyperglycemic threshold (IHT) was calculated based on the preoperative hemoglobin A1c level. Various metrics of intraoperative hyperglycemia were calculated using both thresholds: any hyperglycemic episode, duration of hyperglycemia, and area above the thresholds. Postoperative AKI associations were compared using receiver operating characteristic curves and logistic regression analysis. Among the 2,427 patients analyzed, 823 (33.9%) developed AKI. The C-statistics of IHT-defined metrics (0.58-0.59) were significantly higher than those of the CHT-defined metrics (all C-statistics, 0.54; all p < 0.001). The duration of hyperglycemia (adjusted odds ratio, 1.09; 95% confidence interval, 1.02-1.16) and area above the IHT (1.003; 1.001-1.004) were significantly associated with the risk of AKI, except for the presence of any hyperglycemic episode. None of the CHT-defined metrics were significantly associated with the risk of AKI. Individually defined intraoperative hyperglycemia better predicted postcardiac surgery AKI than universally defined hyperglycemia. Intraoperative hyperglycemia was significantly associated with the risk of AKI only for the IHT. Target blood glucose levels in cardiac surgical patients may need to be individualized based on preoperative glycemic status. [ABSTRACT FROM AUTHOR]

This meta-analysis aims to evaluate the effectiveness of adaptive support ventilation (ASV) in facilitating postoperative weaning from mechanical ventilation in cardiac surgery patients. A systematic review and meta-analysis to assess ASV in weaning postoperative cardiac surgery patients. Outcomes included early extubation, reintubation rates, time to extubation, and lengths of intensive care units and hospital stays. We searched electronic databases from inception to March 2023 and included randomized controlled trials that compared ASV with conventional ventilation methods in this population. Postoperative cardiac surgery patients. A random effects model was used for meta-analysis, and trial sequential analysis (TSA) was conducted to assess result robustness. The meta-analysis included 11 randomized controlled trials with a total of 1027 randomized patients. ASV was associated with a shorter time to extubation compared to conventional ventilation (random effects, mean difference –68.30 hours; 95% confidence interval, –115.50 to –21.09) with TSA providing a conclusive finding. While ASV indicated improved early extubation rates, no significant differences were found in reintubation rates or lengths of intensive care unit and hospital stays, with these TSA results being inclusive. ASV appears to facilitate a shorter time to extubation in postoperative cardiac surgery patients compared to conventional ventilation, suggesting benefits in accelerating the weaning process and reducing mechanical ventilation duration. [Display omitted] [ABSTRACT FROM AUTHOR]

We aimed to develop and investigate positional reproducibility using a fixation device (Unity Brain tumor Immobilization Device [UBID]) in patients with brain tumor undergoing magnetic resonance (MR)-guided radiation therapy (RT) with a 1.5 Tesla (T) MR-linear accelerator (MR-LINAC) to evaluate its feasibility in clinical practice and report representative cases of patients with central nervous system (CNS) tumor. Quantitative analysis was performed by comparing images obtained by placing only the MR phantom on the couch with those obtained by placing UBID next to the MR phantom. Twenty patients who underwent RT for CNS tumors using 1.5T MR-LINAC between June and October 2022 were retrospectively analyzed. Among them, 5 did not use UBID, whereas 15 used UBID. The positional reproducibility of UBID was evaluated using the median interfractional and intrafractional errors in the first 10 fractions. Each MR quality factor of the MR phantom with UBID satisfied the criteria presented by Elekta. Median values of median shifts in the mediolateral, anteroposterior, and craniocaudal axes for interfractional errors were 2.98, 2.35, and 1.40 mm, respectively. For intrafractional errors, the median values were 0.05, 0.03, and 0.06 mm, respectively. The median values of the median rotations in pitch, roll, and yaw for both interfractional and intrafractional rotations were 0.00°. One patient diagnosed with an optic nerve sheath meningioma received RT with motion monitoring during irradiation. In 2 patients, changes in the tumor cavity and residual lesions were observed in the MRI obtained using 1.5T MR-LINAC on the day of the first treatment and immediately before the 21st fraction, respectively; therefore, offline/online adaptation was performed. The reproducible and immobile UBID is clinically feasible in patients with CNS tumors receiving RT with 1.5T MR-LINAC. Based on our initial experience, we developed a workflow for 1.5T MR-LINAC treatment of CNS tumors. [ABSTRACT FROM AUTHOR]

Given the nonelective nature of most trauma admissions, patients who experience trauma are at a particular risk of discharge against medical advice. Despite the risk of unplanned readmission and financial burden on the health care system, discharge against medical advice among hospitalized patients continues to rise. The present study aimed to assess evolving trends and outcomes associated in patients with discharge against medical advice among patients hospitalized for traumatic injury. The 2016–2020 Nationwide Readmissions Database was queried to identify all hospitalizations for traumatic injuries. The patient cohort was stratified into those who had discharge against medical advice and those who did not. Temporal trends of discharge against medical advice and associated costs over time were evaluated using nonparametric tests. Multivariable regression models were developed to assess factors associated with discharge against medical advice. Associations of discharge against medical advice with length of stay, hospitalization costs, and unplanned 30-day readmission were subsequently evaluated. Of an estimated 4,969,717 patients, 65,354 (1.3%) had discharge against medical advice after hospitalization for traumatic injury. Over the study period, the incidence of discharge against medical advice increased (nptrend <0.001). After risk adjustment, older age (adjusted odds ratio, 0.98/per year; 95% confidence interval, 0.97–0.98), female sex (adjusted odds ratio, 0.65; 95% confidence interval, 0.64–0.67), and management at high-volume trauma center (adjusted odds ratio, 0.71; 95% confidence interval, 0.69–0.74) were associated with lower odds of discharge against medical advice. Compared with others, discharge against medical advice was associated with decrements in length of stay by 1.3 days (95% confidence interval, 1.1–1.5 days) and index hospitalization costs by $2,200 (5% confidence interval, $1,600–2,900), while having a greater risk of unplanned 30-day readmission (adjusted odds ratio, 2.21; 95% confidence interval, 2.06–2.36). The incidence of discharge against medical advice and its associated cost burden have increased in recent years. Community-level interventions and institutional efforts to mitigate discharge against medical advice may improve the quality of care and resource allocation for patients with traumatic injuries. [ABSTRACT FROM AUTHOR]

Pancreaticoduodenectomy is a highly morbid operation with significant resource utilization. Using a national cohort, we examined the interhospital variation in pancreaticoduodenectomy hospitalization cost in the United States. Adults undergoing elective pancreaticoduodenectomy in the setting of pancreatic cancer were tabulated from the 2016–2020 Nationwide Readmissions Database. A 2-level mixed-effects model was developed to evaluate the interhospital variation in pancreaticoduodenectomy hospitalization costs. Institutions within the top decile of risk-adjusted expenditures were defined as high-cost hospitals. Multivariable regression models were fitted to examine the association between high-cost hospital status and outcomes of interest. To account for the effects of complications on expenditures, a subgroup analysis comprising of patients with no adverse events was conducted. The study included an estimated 24,779 patients with a median hospitalization cost of $38,800. After mixed-effects modeling, 40.9% of the cost variation was attributable to hospital, rather than patient, factors. Multivariable regression models revealed an association between high-cost hospital status and greater odds of complications and longer length of stay. Among patients without an adverse event, interhospital cost variation remained significant at 61.0%, and treatment at high-cost hospitals was similarly linked to longer length of stay. Our study identified significant interhospital variation in pancreaticoduodenectomy hospitalization costs in the United States. Although high-cost hospital status was associated with increased odds of complications, variation remained significant even among patients without an adverse event. These results suggest the important role of hospital practices as contributors to expenditures. Further efforts to identify drivers of costs and standardize pancreatic surgical care are warranted. [ABSTRACT FROM AUTHOR]

With the aging population in the United States, the incidence of abdominal aortic aneurysms is shifting to older ages. Given changing demographic characteristics and increasing health care expenditures, the present study evaluated the degree of center-level variation in the cost of elective abdominal aortic aneurysm repair. We identified all adult (≥18 years) hospitalizations for elective repair of nonruptured abdominal aortic aneurysms in the 2017 to 2020 Nationwide Readmissions Database. Hierarchical mixed-effects models were used to rank hospitals based on risk-adjusted costs. The interclass coefficient was used to calculate the amount of variation attributable to hospital-level characteristics. High-cost hospitals were classified as centers in the top decile of costs. The association of high-cost hospitals status with outcomes of interest was examined. An estimated 62,626 patients underwent abdominal aortic aneurysm repair, and 5,011 (8.0%) were managed at high-cost hospitals. Compared with non–high-cost hospitals, high-cost hospitals were more commonly large (52.6% vs 48.3%) metropolitan (78.3% vs 66.9%) teaching centers (all P <.001). The interclass coefficient found that 28% of the observed variation in cost is attributable to hospital factors. After adjustment, high-cost hospitals were associated with increased odds of gastrointestinal (adjusted odds ratio = 1.42; 95% CI, 1.05–1.90) and infectious (adjusted odds ratio = 1.35; 95% CI, 1.14–1.59) complications. Finally, the Elixhauser index (β = +$2,700/unit; 95% CI, $2,500–$3,000) and open repair (β = +$4,100; 95% CI, $3,100–$5,200) were associated with increased costs. We observed significant variation in cost attributable to center-level differences. Our findings have implications for reimbursement paradigms and the establishment of quality and cost benchmarks in the elective repair of abdominal aortic aneurysm. [ABSTRACT FROM AUTHOR]

Robot-assisted surgery has seen exponential adoption over the last decade. Although the safety and efficacy of robotic surgery in the elective setting have been demonstrated, data regarding robotic emergency general surgery remains sparse. All adults undergoing non-elective appendectomy, cholecystectomy, small or large bowel resection, perforated ulcer repair, or lysis of adhesions were identified in the 2008 to 2020 National Inpatient Sample. Temporal trends were analyzed using a rank-based, non-parametric test developed by Cuzick (nptrend). Using laparoscopy as a reference, multivariable regressions were used to evaluate the association between robotic techniques and in-hospital mortality, major complications, and resource use for each emergency general surgery operation. Of an estimated 4,040,555 patients undergoing emergency general surgery, 65,853 (1.6%) were performed using robotic techniques. The robotic proportion of minimally invasive emergency general surgery increased significantly overall, with the largest growth seen in robot-assisted large bowel resections and perforated ulcer repairs. After adjustment for various patient and hospital-level factors, robot-assisted large bowel resection (adjusted odds ratio 0.73, 95% confidence interval 0.58–0.91) and cholecystectomy (adjusted odds ratio 0.66, 95% confidence interval 0.55–0.81) were associated with significantly reduced odds of perioperative blood transfusion compared to traditional laparoscopy. Although robotic techniques were associated with modest reductions in postoperative length of stay, costs were uniformly higher by increments of up to $4,900. Robotic surgery appears to be a safe and effective adjunct to laparoscopy in minimally invasive emergency general surgery, although comparable cost-effectiveness has yet to be realized. Increasing use of robotic techniques in emergency general surgery may be attributable in part to reduced complications, including blood loss, in certain operative contexts. [ABSTRACT FROM AUTHOR]

Congestive heart failure (CHF) as a risk of stroke in patients with atrial fibrillation (AF) mainly referred to patients with left ventricular systolic dysfunction. Whether this should include patients with preserved ejection fraction is debatable. The study aimed to investigate the variation in stroke risk of AF patients with heart failure with preserved ejection fraction (HFpEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF) for enhancing risk assessment and subsequent management strategies. In a longitudinal study using the National Taiwan University Hospital integrated Medical Database, 8358 patients with AF were observed for 10 years (mean follow-up, 3.76 years). The study evaluated the risk of ischemic stroke in patients with differing ejection fractions and CHA 2 DS 2 -VASc score, further using Cox models adjusted for risk factors of AF-related stroke. Patients with HFpEF and HFmrEF had a higher mean CHA 2 DS 2 -VASc score compared with patients with HFrEF (4.30 ± 1.729 vs 4.15 ± 1.736 vs 3.73 ± 1.712; P <.001) and higher risk of stroke during follow-up (hazard ratio [HR], 1.40 [1.161–1.688; P <.001] for HFmrEF; HR, 1.184 [1.075–1.303; P =.001] for HFpEF vs no CHF) after multivariate adjustment). In patients with lower CHA 2 DS 2 -VASc score (0–4), presence of any type of CHF increased ischemic stroke risk (HFrEF HR, 1.568 [1.189–2.068; P =.001]; HFmrEF HR, 1.890 [1.372–2.603; P <.001]; HFpEF HR, 1.800 [1.526–2.123; P <.001] vs no CHF). After multivariate adjustment, HFpEF and HFmrEF showed a similar risk of stroke in AF patients. Therefore, it is important to extend the criteria for C in the CHA 2 DS 2 -VASc score to include patients with HFpEF and HFmrEF. In patients with fewer concomitant stroke risk factors, the presence of any subtype of CHF increases risk for ischemic stroke. [Display omitted] [ABSTRACT FROM AUTHOR]

Lifestyle changes, such as those related to the COVID-19 pandemic, including alterations in physical activity and dietary habits, are known to affect pregnancy outcomes. In particular, suboptimal intrauterine conditions during pregnancy are known to influence not only fetal growth but also growth during infancy. However, research on the impact of the environmental changes caused by the COVID-19 pandemic on the growth of infants and children during their early years is lacking. To address this issue, this study evaluated the effect of the COVID-19 pandemic on obesity in infants. This retrospective cohort study used the data collected from the Korea National Health Insurance (KNHI) claims database. The data of 1985,678 women who delivered infants between 2015 and 2021 were collected. Women who delivered during the pandemic and those who delivered during the pre-pandemic period were matched in a 1:1 frequency-matched pair procedure for factors such as age, hypertension, diabetes mellitus, preeclampsia, gestational diabetes mellitus, mode of delivery, gestational age at delivery, offspring sex, and birth weight. Finally, 197,580 women were enrolled. The weight and head circumference of infants (4–6 months of age) of the COVID-19 pandemic group were compared with those of the pre-pandemic group. The COVID-19 pandemic group infants exhibited significantly higher weight and prevalence of obesity at 4–6 months of age compared to infants in the pre-pandemic group. After adjustment for covariates, pandemic group infants had a higher risk of obesity (odds ratio: 1.54, 95% confidence interval: 1.51–1.57) compared to the pre-pandemic group infants. The COVID-19 pandemic has had a notable impact on the weight of infants aged 4–6 months. This suggests that pandemic conditions may influence the growth of newborns, underscoring the importance of monitoring and assessing trends in the growth of infants born during such crises. [Display omitted] [ABSTRACT FROM AUTHOR]

Conventional surgical site infection (SSI) surveillance is labour-intensive. We aimed to develop machine learning (ML) models for the surveillance of SSIs for colon surgery and to assess whether the ML could improve surveillance process efficiency. This study included cases who underwent colon surgery at a tertiary center between 2013 and 2014. Logistic regression and four ML algorithms including random forest (RF), gradient boosting (GB), and neural networks (NNs) with or without recursive feature elimination (RFE) were first trained on the entire cohort, and then re-trained on cases selected based on a previous rule-based algorithm. We assessed model performance based on the area under the curve (AUC), sensitivity, and positive predictive value (PPV). The estimated proportion of reduction in workload for chart review based on the ML models was evaluated and compared with the conventional method. At a sensitivity of 95%, the NN with RFE using 29 variables had the best performance with an AUC of 0.963 and PPV of 21.1%. When combining both the rule-based algorithm and ML algorithms, the NN with RFE using 19 variables had a higher PPV (28.9%) than with the ML algorithm alone, which could decrease the number of cases requiring chart review by 83.9% compared with the conventional method. We demonstrated that ML can improve the efficiency of SSI surveillance for colon surgery by decreasing the burden of chart review while providing high sensitivity. In particular, the hybrid approach of ML with a rule-based algorithm showed the best performance in terms of PPV. [ABSTRACT FROM AUTHOR]

[Display omitted] • Growth factors play important roles in stem cell proliferation and differentiation. • Immobilization of FP2 peptide, 44-ERGVVSIKGV-53 is performed via EDC/NHS chemistry. • FP2 peptide-cultured hWJ-MSCs show enhanced in vitro proliferation and differentiation. • FP2 phosphorylates FRS2α and FGFR1 signaling pathways. • Transplantation of FP2 peptide-cultured cells ameliorates arthritis symptoms in an osteoarthritis mouse model. The stem cell microenvironment has been evidenced to robustly affect its biological functions and clinical grade. Natural or synthetic growth factors, especially, are essential for modulating stem cell proliferation, metabolism, and differentiation via the interaction with specific extracellular receptors. Fibroblast growth factor-2 (FGF-2) possesses pleiotropic functions in various tissues and organs. It interacts with the FGF receptor (FGFR) and activates FGFR signaling pathways, which involve numerous biological functions, such as angiogenesis, wound healing, cell proliferation, and differentiation. Here, we aim to explore the molecular functions, mode of action, and therapeutic activity of yet undetermined function, FGF-2-derived peptide, FP2 (44-ERGVVSIKGV-53) in promoting the proliferation, differentiation, and therapeutic application of human Wharton's jelly mesenchymal stem cells (hWJ-MSCs) in comparison to other test peptides, canofin1 (FP1), hexafin2 (FP3), and canofin3 (FP4) with known functions. The immobilization of test peptides that are fused with mussel adhesive proteins (MAP) on the culture plate was carried out via EDC/NHS chemistry. Cell Proliferation assay, colony-forming unit, western blotting analysis, gene expression analysis, RNA-Seq. analysis, osteogenic, and chondrogenic differentiation capacity were applied to test the activity of the test peptides. We additionally utilized three-dimensional (3D) structural analysis and artificial intelligence (AI)-based AlphaFold2 and CABS-dock programs for receptor interaction prediction of the peptide receptor. We also verified the in vivo therapeutic capacity of FP2-cultured hWJ-MSCs using an osteoarthritis mice model. Culture of hWJ-MSC onto an FP2-immobilized culture plate showed a significant increase in cell proliferation (n = 3; * p < 0.05, ** p < 0.01) and the colony-forming unit (n = 3; * p < 0.05, ** p < 0.01) compared with the test peptides. FP2 showed a significantly upregulated phosphorylation of FRS2α and FGFR1 and activated the AKT and ERK signaling pathways (n = 3; * p < 0.05, ** p < 0.01, *** p < 0.001). Interestingly, we detected efficient FP2 receptor binding that was predicted using AI-based tools. Treatment with an AKT inhibitor significantly abrogated the FP2-mediated enhancement of cell differentiation (n = 3; * p < 0.05, ** p < 0.01, *** p < 0.001). Intra-articular injection of FP2-cultured MSCs significantly mitigated arthritis symptoms in an osteoarthritis mouse model, as shown through the functional tests (n = 10; * p < 0.05, ** p < 0.01, *** p < 0.001, **** p < 0.0001), modulation of the expression level of the pro-inflammatory and anti-inflammatory genes, and improved osteochondral regeneration as demonstrated by tissue sections. Our study identified the FGF-2-derived peptide FP2 as a promising candidate peptide to improve the therapeutic potential of hWJ-MSCs, especially in bone and cartilage regeneration. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The utilization of short humeral stems in reverse total shoulder arthroplasty has gained attention in recent times. However, concerns regarding the risk of misalignment during implant insertion are associated with their use. Eight fresh-frozen cadaveric shoulders were prepared for dissection and biomechanical testing. A bespoke humeral implant was fabricated to facilitate assessment of neutral, varus, and valgus alignments using a single stem, and 10° was established as the maximum permissible angle for misalignments. Shift in humerus position and changes in deltoid length attributable to misalignments relative to the neutral position were evaluated using a Microscribe 3DLx system. The impingement-free range of motion, encompassing abduction, adduction, internal rotation, and external rotation (ER), was gauged using a digital goniometer. The capacity for abduction was evaluated at maximal abduction angles under successive loading on the middle deltoid. A specialized traction system coupled with a force transducer was employed to measure anterior dislocation forces. Relative to the neutral alignment, valgus alignment resulted in a more distal (10.5 ± 2.4 mm) and medial (8.3 ± 2.2 mm) translation of the humeral component, whereas the varus alignment resulted in the humerus shifting more superiorly (11.2 ± 1.3 mm) and laterally (9.9 ± 0.9 mm) at 0° abduction. The valgus alignment exhibited the highest abduction angle than neutral alignment (86.2°, P <.001). Conversely, the varus alignment demonstrated significantly higher adduction (18.4 ± 7.4°, P <.001), internal rotation (68.9 ± 15.0 °, P =.014), and ER (45.2 ± 10.5 °, P =.002) at 0° abduction compared to the neutral alignments. Anterior dislocation forces were considerably lower (23.8 N) in the varus group compared to the neutral group at 0°ER (P =.047). Additionally, abduction capability was markedly higher in varus alignment at low deltoid loads than the neutral alignment (5N, P =.009; 7.5 N, P =.007). The varus position enhances rotational range of motion (ROM) but increases instability, while the valgus position does not significantly impact ROM or instability compared to the neutral position. [ABSTRACT FROM AUTHOR]

Fat embolism is a life-threatening complication often occurring in patients with traumatic injuries. However, temporal trends and perioperative outcomes of fat embolism remain understudied. Using a nationally representative cohort, we aimed to characterize temporal trends of fat embolism and its associated resource utilization in operatively managed trauma patients. All patients (≥18 years) undergoing any major operations after traumatic injuries were tabulated using the 2005 to 2020 National Inpatient Sample. Patients were stratified into those with fat embolism and those without. Multivariable logistic and linear regressions were developed to assess the association between fat embolism and outcomes of interest. Of an estimated 10,600,000 hospitalizations, 7,479 (0.07%) patients had fat embolism. Compared to the non-fat embolism cohort, the fat embolism cohort was younger (55 [26–79] vs 69 [49–82] years, standard mean difference = 0.46) and more likely to receive treatment at a high-volume trauma center (42.9 vs 33.7%, standard mean difference = 0.19). Over the study period, there was an increase in annual mortality and hospitalization costs among the fat embolism group (nptrend <0.001). After risk adjustment, fat embolism was associated with greater odds of mortality (adjusted odds ratio: 2.65, 95% confidence interval: 2.24–3.14) compared to others. Additionally, fat embolism was associated with increased odds of cerebrovascular, infectious, and renal complications. Among all operatively managed trauma patients, those who developed fat embolism had increased mortality, rates of complications, length of stay, and costs. Optimization of early and accurate identification of fat embolism is warranted to mitigate complications and improve resource allocation among trauma patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Pediatric traumatic injury is associated with long-term morbidity as well as substantial economic burden. Prior work has labeled the catastrophic out-of-pocket medical expenses borne by patients as financial toxicity. We hypothesized uninsured rural patients to be vulnerable to exorbitant costs and thus at greatest risk of financial toxicity. Pediatric patients (<18 years) experiencing traumatic injury were identified in the 2016–2019 National Inpatient Sample. Patients were considered to be at risk of financial toxicity if their hospitalization cost exceeded 40% of post-subsistence income. Individual family income was computed using a gamma distribution probability density function with parameters derived from publicly available US Census Bureau data, in accordance with prior work. A multivariable logistic regression was developed to assess factors associated with risk of financial toxicity. Of an estimated 225,265 children identified for study, 34,395 (15.3%) were Rural. Rural patients were more likely to experience risk of financial toxicity (29.1 vs 22.2%, P <.001) compared to Urban patients. After adjustment, rurality (reference: urban status; adjusted odds ratio 1.45, 95% confidence interval 1.36–1.55) and uninsured status (reference: private; adjusted odds ratio 1.85, 95% confidence interval 1.67–2.05) remained linked to increased odds of risk of financial toxicity. Specifically among those with private insurance, Rural patients experienced markedly higher predicted risk of financial toxicity, relative to Urban. Our findings suggest a complex interplay between rural status and insurance type in the prediction of risk of financial toxicity after pediatric trauma. To target policy interventions, future studies should characterize the patients and communities at greatest risk of financial devastation among rural pediatric trauma patients. [ABSTRACT FROM AUTHOR]

Laparoscopic pancreatic resection is comparable to open pancreatic resection; however, cost-effectiveness analyses of laparoscopic pancreatic resection are scarce. The authors performed a population-based study investigating the cost-effectiveness of laparoscopic pancreatic resection versus open pancreatic resection. Data from 9,256 patients who received pancreaticoduodenectomy (66.8%) and distal pancreatectomy (33.2%) from 2016 to 2018 were retrieved from the Korean National Health Insurance Service. Events after pancreatectomy were categorized as no complication, complication, and death. Probabilities of each event and average cost during index admission and 1 year were utilized to calculate incremental cost-effectiveness ratio, the cost difference between two interventions divided by quality-adjusted life year. Quality-adjusted life year, a function of length and quality of life, was measured with utility values determined by researching literature. Laparoscopic pancreatic resection was performed in 12.4% of pancreaticoduodenectomies and 53.4% of distal pancreatectomies. For pancreaticoduodenectomy, laparoscopic pancreatic resection was associated with an increase of 0.0022 quality-adjusted life years for index admission and 0.0023 quality-adjusted life years for 1 year compared with open pancreatic resection. The incremental cost was $321 for index admission and −$1,414 for 1 year, leading to an incremental cost-effectiveness ratio of $147,429 per quality-adjusted life year gained for index admission and −$614,965 per quality-adjusted life year gained for 1 year. For distal pancreatectomy, laparoscopic pancreatic resection improved 0.0131 quality-adjusted life years for index admission and 0.0285 quality-adjusted life years for index admission. The incremental cost was −$1,240 for index admission and −$5,875 for 1 year, leading to an incremental cost-effectiveness ratio of −$94,519 per quality-adjusted life year gained for index admission and −$206,351 for 1 year. laparoscopic pancreatic resection was a cost-effective alternative to open pancreatic resection for pancreaticoduodenectomy and distal pancreatectomy, except for the higher cost of index admission for pancreaticoduodenectomy. [ABSTRACT FROM AUTHOR]

Recent studies have demonstrated a positive volume-outcome relationship in emergency general surgery. Some have advocated for the sub-specialization of emergency general surgery independent from trauma. We hypothesized inferior clinical outcomes of emergency general surgery with increasing center-level operative trauma volume, potentially attributable to overall hospital quality. Adults (≥18 years) undergoing complex emergency general surgery operations (large and small bowel resection, repair of perforated peptic ulcer, lysis of adhesions, laparotomy) were identified in the 2016 to 2020 Nationwide Readmissions Database. Multivariable risk-adjusted models were developed to evaluate the association of treatment at a high-volume trauma center (reference: low-volume trauma center) with clinical and financial outcomes after emergency general surgery. To evaluate hospital quality, mortality among adult hospitalizations for acute myocardial infarction was assessed by hospital trauma volume. Of an estimated 785,793 patients undergoing a complex emergency general surgery operation, 223,116 (28.4%) were treated at a high-volume trauma center. Treatment at a high-volume trauma center was linked to 1.19 odds of in-hospital mortality (95% confidence interval 1.12–1.27). Although emergency general surgery volume was associated with decreasing predicted risk of mortality, increasing trauma volume was linked to an incremental rise in the odds of mortality after emergency general surgery. Secondary analysis revealed increased mortality for admissions for acute myocardial infarction with greater trauma volume. We note increased mortality for emergency general surgery and acute myocardial infarction in patients receiving treatment at high-volume trauma centers, signifying underlying structural factors to broadly affect quality. Thus, decoupling trauma and emergency general surgery services may not meaningfully improve outcomes for emergency general surgery patients. Our findings have implications for the evolving specialty of emergency general surgery, especially for the safety and continued growth of the acute care surgery model. [ABSTRACT FROM AUTHOR]

Microbiota associated with primary endodontic infection (PEI) and secondary/persistent endodontic infection (SPEI) must be characterized to elucidate pathogenesis in apical periodontitis and bacterial biomarkers identified for diagnostic and therapeutic applications. This study analyzed the microbial community profiles of root canals and gingival sulci (sulcus-E) for teeth with PEI (n = 10) or SPEI (n = 10), using the Illumina MiSeq platform. Bacterial samples from gingival sulci (sulcus-C) of healthy contralateral teeth served as controls. There were 15 phyla, 177 genera, and 340 species identified. The number and diversity of bacteria in root canals did not differ significantly between PEI and SPEI. Proteobacteria, Firmicutes, Fusobacteria, Bacteroidetes, and Actinobacteria were the dominant phyla in both groups. At the genus level, Lancefieldella , Bifidobacterium , Stomatobaculum , and Schaalia were enriched in root canals with SPEI. Of significance, Lancefieldella was observed in both root canals and sulcus-E of teeth with SPEI. At the species level, Neisseria macacae, Streptococcus gordonii, Bifidobacterium dentium, Stomatobaculum longum , and Schaalia odontolytica were increased significantly in root canals with SPEI compared to PEI. Oribacterium species , Streptococcus salivarius, Lancefieldella parvula, Prevotella denticola , and Oribacterium asaccharolyticum were more abundant in sulcus-E of teeth with SPEI compared to PEI. There were distinctive and differing predominant bacterial species associated with the root canals and gingival sulci between teeth with PEI and SPEI. Specific bacteria identified in sulcus-E and root canals of teeth with SPEI could serve as noninvasive diagnostic biomarkers for detecting SPEI. [ABSTRACT FROM AUTHOR]

We sought to characterize the association between venovenous extracorporeal membrane oxygenation (VV-ECMO) bridging duration and outcomes in patients listed for lung transplantation. A retrospective observational study was conducted using the Organ Procurement and Transplantation Network (OPTN) database to identify adults (aged ≥18 years) who were listed for lung transplantation between 2016 and 2020 and were bridged with VV-ECMO. Patients were then stratified into groups, determined by risk inflection points, depending on the amount of time spent on pretransplant ECMO: group 1 (≤5 days), group 2 (6-10 days), group 3 (11-20 days), and group 4 (>20 days). Waiting list survival between groups was analyzed using Fine-Gray competing risk models. Posttransplant survival was compared using Cox regression. Of 566 eligible VV-ECMO bridge-to-lung-transplant patients (median age, 54 years, 49% men), 174 (31%), 124 (22%), 130 (23%), and 138 (24%) were categorized as groups 1, 2, 3, and 4, respectively. Overall, median duration of VV-ECMO was 10 days (interquartile range, 1-211 days), and 178 patients (31%) died on the waiting list. In the Fine-Gray model, compared with group 1, patients bridged with longer ECMO durations in group 2 (subdistribution hazard ratio [SHR], 2.95; 95% CI, 1.63-5.35), group 3 (SHR, 3.96; 95% CI, 2.36-6.63), and group 4 (SHR, 4.33; 95% CI, 2.59-7.22, all P <.001) were more likely to die on the waiting list. Of 388 patients receiving a transplant, pretransplant ECMO duration was not associated with 1-year survival in Cox regression. Prolonged duration of ECMO bridging was associated with worse waiting list mortality but did not impact survival after lung transplant. Prioritization of very early transplantation may improve waiting list outcomes in this population. [ABSTRACT FROM AUTHOR]

Single Point Insulin Sensitivity Estimator (SPISE) index was recently introduced as a reliable indirect indicator of insulin resistance, applicable to large population-based research. Here, we aimed to 1) examine racial/ethnic differences in SPISE index among US adults, 2) compare predictive power of SPISE index for metabolic syndrome (MetSyn) by race/ethnicity, and 3) evaluate its predictive power for MetSyn against other well-known IR indices including Triglyceride/HDL-C, Triglyceride-glucose index, homeostatic model assessment for insulin resistance, and inverse fasting insulin. A total of 2168 adults (814 white, 690 black, and 664 Hispanic) from NHANES 2017-March 2020 Pre-Pandemic Data was analyzed in this study. MetSyn was defined by the AHA/NHLBI criteria. SPISE index and insulin resistance indices were calculated by using physical and cardiometabolic parameters. SPISE index was lowest in Hispanic, followed by black and white, with no difference between white vs. black. The area under the curve of receiver operating characteristics of SPISE index for predicting MetSyn was highest in white (88 %), followed by Hispanic (86 %) and black (82 %) (P < 0.05 vs. black), with optimal cutoffs of 5.03, 4.84, and 4.89, respectively. In the total cohort, the predictive power of the SPISE index for MetSyn was 85 %, higher than the other insulin resistance indices (all P < 0.05). SPISE index outperforms various insulin resistance indices for predicting MetSyn in US adults, signifying its potential in large-scale observational studies. Race/ethnicity should be stratified when using the SPISE index as its predictive power and cutoffs for predicting MetSyn vary by race/ethnicity. [ABSTRACT FROM AUTHOR]

• The optimized full liquid phase sintering is investigated for binder jetting printed Mg alloy. • The Y and Nd in WE43 powder film contributes to keeping the shape during sintering. • The full liquid phase sintering exhibits a significantly reduced sintering time and low porosity. • The final sintered WE43 alloy products display superior corrosion resistance and mechanical properties. This study investigates full liquid phase sintering as a process of fabrication parts from WE43 (Mg-4wt.%Y-3wt.%RE-0.7wt.%Zr) alloy using binder jetting additive manufacturing (BJAM). This fabrication process is being developed for use in producing structural or biomedical devices. Specifically, this study focused on achieving a near-dense microstructure with WE43 Mg alloy while substantially reducing the duration of sintering post-processing after BJAM part rendering. The optimal process resulted in microstructure with 2.5% porosity and significantly reduced sintering time. The improved sintering can be explained by the presence of Y 2 O 3 and Nd 2 O 3 oxide layers, which form spontaneously on the surface of WE43 powder used in BJAM. These layers appear to be crucial in preventing shape distortion of the resulting samples and in enabling the development of sintering necks, particularly under sintering conditions exceeding the liquidus temperature of WE43 alloy. Sintered WE43 specimens rendered by BJAM achieved significant improvement in both corrosion resistance and mechanical properties through reduced porosity levels related to the sintering time. [Display omitted] [ABSTRACT FROM AUTHOR]

Although routine changing of central venous catheters (CVCs) is commonly performed in patients with severe burns, information on pathogen colonization of the CVC tip and associated bloodstream infections (BSIs) is limited in those patients. The medical records of 214 patients with severe burns who underwent routine CVC changing at 7-day intervals and their results of 686 pairs of CVC tips and concurrent blood cultures were retrospectively reviewed to evaluate the CVC colonization rate and associated BSI pathogens. Of the 686 CVCs, 137 (20.0%) were colonized by pathogens, and 81 (59.1%) of them had BSIs caused by the same pathogen. Nonflame burn (P =.002), total body surface area burn ≥30% (P =.004), femoral catheterization (P =.001), CVC changing during pre-existing BSI (P <.001), and renal replacement therapy (P =.017) were associated with catheter-related BSI in the multivariate analysis. Most BSIs were caused by Gram-negative bacteria (most commonly Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa). The CVC colonization rate in patients with severe burns and routine CVC changing was not high. Lengthening the CVC duration might be attempted in patients at a lower risk of catheter-related BSI although further prospective studies are necessary. • Routine central venous catheter changing was performed in severe burn patients. • Each catheter was maintained for a median of 8 days. • The tip colonization rate was 20.0%. • Concurrent bloodstream infection was accompanied by 59.1% of the colonized tips. • A baumannii, K pneumoniae, and P aeruginosa were most commonly identified. [ABSTRACT FROM AUTHOR]

• After adjusting for age, sex, ASPECTS, tPA, premorbid mRS, admission NIH stroke scale, prior history of TIA, stroke, atrial fibrillation, diabetes mellitus, hyperlipidemia, heart disease and hypertension, admission LAMS was found to be independently associated with CBV Index (adjusted OR:0.82, p < 0.01). • After adjusting for age, sex, ASPECTS, tPA, premorbid mRS, admission NIH stroke scale, prior history of TIA, stroke, atrial fibrillation, diabetes mellitus, hyperlipidemia, heart disease and hypertension, admission LAMS was found to be independently associated with and HIR (adjusted OR:1.70, p < 0.05). • Admission LAMS is independently associated with CTP CS markers, CBV index and HIR. This finding suggests that LAMS may also provide an indirect estimate of CS, among other factors. The Los Angeles Motor Scale (LAMS) is an objective tool that has been used to rapidly assess and predict the presence of large vessel occlusion (LVO) in the pre-hospital setting successfully in several studies. However, studies assessing the relationship between LAMS score and CT perfusion collateral status (CS) markers such as cerebral blood volume (CBV) index, and hypoperfusion intensity ratio (HIR) are sparse. Our study therefore aims to assess the association of admission LAMS score with established CTP CS markers CBV Index and HIR in AIS-LVO cases. In this prospectively collected, retrospectively reviewed analysis, inclusion criteria were as follows: a) CT angiography (CTA) confirmed anterior circulation LVO from 9/1/2017 to 10/01/2023, and b) diagnostic CT perfusion (CTP). Logistic regression analysis was performed to assess the relationship between admission LAMS with CTP CS markers HIR and CBV Index. p ≤ 0.05 was considered significant. In total, 285 consecutive patients (median age = 69 years; 56 % female) met our inclusion criteria. Multivariable logistic regression analysis adjusting for sex, age, ASPECTS, tPA, premorbid mRS, admission NIH stroke scale, prior history of TIA, stroke, atrial fibrillation, diabetes mellitus, hyperlipidemia, coronary artery disease and hypertension, admission LAMS was found to be independently associated with CBV Index (adjusted OR:0.82, p < 0.01), and HIR (adjusted OR:0.59, p < 0.05). LAMS is independently associated with CTP CS markers, CBV index and HIR. This finding suggests that LAMS may also provide an indirect estimate of CS. [ABSTRACT FROM AUTHOR]