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Other than location of the primary colorectal cancer (CRC), a few factors are known to influence the intrahepatic distribution of colorectal cancer liver metastases (CRLM). We aimed to assess whether the anatomy of the portal vein (PV) could influence the intrahepatic distribution of CRLM.

Abstract Background Cardiac arrest remains a global health issue with limited data on long-term outcomes, particularly regarding recurrent cardiovascular events in patients surviving out-of-hospital cardiac arrest. (OHCA). We aimed to describe the long-term occurrence of major cardiac event defined by hospital admission for cardiovascular events or death in OHCA hospital survivors, whichever came first. Our secondary objective were to assess separately occurrence of hospital admission and death, and to identify the factors associated with major event occurrence. We hypothesized that patients surviving an OHCA has a protracted increased risk of cardiovascular events, due to both presence of the baseline conditions that lead to OHCA, and to the cardiovascular consequences of OHCA induced acute ischemia-reperfusion. Methods Consecutive OHCA patients from three hospitals of Sudden Death Expertise Center (SDEC) Registry, discharged alive from 2011 to 2015 were included. Long-term follow-up data were obtained using national inter-regime health insurance information system (SNIIRAM) database and the national French death registry. The primary endpoint was occurrence of a major event defined by hospital admission for cardiovascular events and death, whichever came first during the follow-up. The starting point of the time-to-event analysis was the date of hospital discharge. The follow-up was censored on the date of the first event. For patients without event, follow-up was censored on the date of December, 29th, 2016. Results A total of 306 patients (mean age 57; 77% male) were analyzed and followed over a median follow-up of 3 years for hospital admission for cardiovascular event and 6 years for survival. During this period, 38% patients presented a major event. Hospital admission for cardiovascular events mostly occurred during the first year after the OHCA whereas death occurred more linearly during the all period. A previous history of chronic heart failure and coronary artery disease were independently associated with the occurrence of major event (HR 1.75, 95%CI[1.06-2.88] and HR 1.70, 95%CI[1.11-2.61], respectively), whereas post-resuscitation myocardial dysfunction, cardiogenic shock and cardiologic cause of cardiac arrest did not. Conclusion Survivors from OHCA must to be considered at high risk of cardiovascular event occurrence whatever the etiology, mainly during the first year following the cardiac arrest and should require closed monitoring.

Introduction: Blood lactate is a marker of tissue hypoxia while capillary refill time (CRT) is a surrogate of tissue perfusion. Measuring these parameters is recommended for assessing circulatory status and guiding resuscitation. However, blood lactate is not widely available in African emergency departments. Additionally, CRT assessment faces challenges related to its precision and reproducibility. This study aims to evaluate the accuracy of visual CRT(V-CRT) compared to plethysmographic CRT (P-CRT) in predicting lactate levels among septic patients. Methods: This prospective observational study enrolled consecutive patients with sepsis or septic shock over a 6-month period from a tertiary hospital in Marrakech, Morroco. V-CRT and P-CRT were evaluated upon admission, and simultaneous measurements of arterial lactate levels were obtained. The precision of V-CRT and P-CRT in predicting arterial lactate was assessed using ROC curve analysis. Results: Forty-three patients aged of 64±15 years, of whom 70 % were male, were included in the study. Of these, 23 patients (53 %) had sepsis, and 20 patients (47 %) experienced septic shock. Both V-CRT and P-CRT demonstrated statistically significant correlations with arterial lactate, with correlation coefficients of 0.529 (p < 0.0001) and 0.517 (p = 0.001), respectively. ROC curve analysis revealed that V-CRT exhibited satisfactory accuracy in predicting arterial lactate levels >2 mmol/l, with an area under the curve (AUC) of 0.8 (95 % CI=0.65 – 0.93; p < 0.0001). The prediction ability of P-CRT was lower than V-CRT with an AUC of 0.73 (95 % CI: 0.57–0.89; p = 0.043). The optimal thresholds were determined as 3.4 s for V-CRT (sensitivity = 90 %, specificity = 58 %) and 4.1 s for P-CRT (sensitivity = 85 %, specificity = 62 %). Conclusion: These findings suggest that the plethysmographic evaluation did not improve the accuracy of CRT for predicting lactate level. However, V-CRT may still serve as a viable surrogate for lactate in septic patients in low-income settings.

Abstract Thoracic manifestations of inflammatory bowel disease (IBD) are rare, occurring in less than 1% of patients. Unlike most other extra-intestinal manifestations, they predominate in patients with ulcerative colitis rather than in Crohn’s disease. In most patients, thoracic involvement follows the onset of IBD by several years. However, thoracic involvement may also occur synchronously or even precede the onset of digestive symptoms. The thoracic manifestations of IBD include airway involvement and parenchymal lung abnormalities. Airways are the most frequent anatomical site for thoracic involvement in IBD. Airway manifestations usually develop several years after the onset of intestinal manifestations, preferentially when the latter are stable or in remission. Airway manifestations include bronchial wall thickening, bronchiectasis, small airway disease, and tracheal wall thickening. Parenchymal lung abnormalities are less prevalent in IBD and include organizing pneumonia, necrobiotic nodules, noncaseating granulomatous nodules, drug-induced pneumonia, and rarely interstitial lung diseases. The differential diagnosis between organizing pneumonia, necrobiotic nodules, and noncaseating granulomatous nodules is difficult and usually requires histopathological analysis for a definite diagnosis. Radiologists play a key role in the detection of thoracic manifestations of Crohn’s disease and ulcerative colitis and, therefore, need to be familiar with their imaging findings. This article aims to offer an overview of the imaging findings of thoracic manifestations in patients with Crohn’s disease or ulcerative colitis. Critical relevance statement Thoracic manifestations of Crohn’s disease and ulcerative colitis include tracheal involvement, bronchiectasis, small airway disease, and parenchymal lung abnormalities such as organizing pneumonia and necrobiotic nodules. These rare manifestations (

Abstract This study aimed to assess the significance of serum albumin levels within 24 h of patient admission in correlation with the incidence of outcomes and mortality in patients diagnosed with acute pancreatitis. A retrospective study was conducted over a 5-year period, from January 2018 to December 2023, at the Mohammed VI University Hospital in Oujda, Morocco. The study included 371 patients diagnosed with acute pancreatitis. Hypoalbuminemia (≤ 30 g/L) was observed in 124 patients (33.4% of cases), and these patients had a higher mean age compared to those with normal albumin levels (P = 0.003). Hypoalbuminemia was significantly associated with persistent Systemic Inflammatory Response Syndrome (SIRS) (70.8% vs. 29.2%, P = 0.000), a higher BISAP score (66.7% vs. 33.3%, P = 0.000), and a higher CTSI score (51.7% vs. 48.3%, P = 0.000). Hypoalbuminemia was also associated with the presence of pleural effusion (P = 0.000). The mortality in the sample was 4.6%, and it was significantly associated with hypoalbuminemia (76.5%, P = 0.000). In conclusion, serum albumin levels within 24 h of patient admission appear to be a significant prognostic biomarker in acute pancreatitis, particularly in anticipating persistent organ failure and mortality.

Abstract Background The use of psychoactive substances, including tobacco, alcohol, and others, remains a major public health problem. However, few studies have been conducted on Moroccan university students. This study aimed to assess the prevalence and associated factors of substance use among students at Mohammed First University, Oujda, Morocco. Methods We conducted this cross-sectional study with students enrolled at one of the Mohammed First University of Oujda’s institutes as part of the 2021–202 academic year. We used a self-administered survey to collect data anonymously. We cleaned the data and then entered it into IBM SPSS Statistics 21 for analysis. Data analysis involved descriptive statistics as well as univariate and multivariate analysis. We considered a P value 20 years, self-financing, school failure (one year repeated or more), the practice of a leisure activity, the presence of a personal medical or psychiatric history, and the presence of a family medical history were all significantly associated with the use of psychoactive substances. Conclusion Our study revealed a significant prevalence of psychoactive substance use among university students in Oujda, highlighting the need for interventions at various levels. Further analytical studies are necessary to better understand the initiation and maintenance of psychoactive substance use and to identify all associated factors to enhance prevention strategies against substance use disorders.

Background: Buttermilk, a significant by-product of the dairy industry, is acknowledged as a beneficial food due to its content of water-soluble vitamins, polar lipids, and milk fat globule membranes. This research is focused on investigating the potential of buttermilk as a substitute in the production of a novel soft cheese type ‘‘camembert’’. Methods: A total of 12 cheese samples of camembert cheese, both with and without buttermilk, were prepared and subjected to a series of physico-chemical analyses in October 2023 to measure protein, fat, total solids, pH, and production yield. Texture Profile Analysis was applied to evaluate textural characteristics, and the microstructure was examined using Scanning Electron Microscopy. A hedonic scale was employed in sensory evaluation to measure taste intensity. Results: The sample containing 90% cow's milk and 10% buttermilk exhibited the most significant (p≤0.05) physico-chemical characteristics as production yield of 45.33%±0.710, protein content of 28.9%±0.58, fat content of 24.88%±0.026, total solids of 54.62±0.23, and a pH of 6.42±0.58. Sensory evaluations demonstrated that camembert samples containing buttermilk were distinguished by high sensory quality and satisfactory taste profiles. In addition, a dense and tightly fused protein matrix was observed in the microstructure of the buttermilk fortified cheese. The results also emphasized that the acidic nature of buttermilk significantly affected the production yield, total solids content, and textural characteristics, evidenced by a hardness of 3.36 N and fracturability of 1.75 N. Conclusion: The results validate the use of buttermilk as an effective alternative in the production of a new type of soft cheese, manifesting improved sensory, structural, and physico-chemical characteristics. This investigation supports the innovative utilization of buttermilk in cheese production, potentially offering a valuable avenue for dairy industry by-products. DOI: 10.18502/jfqhc.11.2.15647

Abstract Background The COVID-19 pandemic has highlighted the importance of intensive care units (ICUs) and their organization in healthcare systems. However, ICU capacity and availability are ongoing concerns beyond the pandemic, particularly due to an aging population and increasing complexity of care. This study aimed to assess the current and future shortage of ICU physicians in France, ten years after a previous evaluation. A national e-survey was conducted among French ICUs in January 2022 to collect data on ICU characteristics, medical staffing, individual physician characteristics, and education and training capacities. Results Among 290 ICUs contacted, 242 responded (response rate: 83%), representing 4943 ICU beds. The survey revealed an overall of 300 full time equivalent (FTE) ICU physician vacancies in the country. Nearly two-thirds of the participating ICUs reported at least one physician vacancy and 35% relied on traveling physicians to cover shifts. The ICUs most affected by physician vacancies were the ICUs of non-university affiliated public hospitals. The retirements expected in the next five years represented around 10% of the workforce. The median number of physicians per ICU was 7.0, corresponding to a ratio of 0.36 physician (FTE) per ICU bed. In addition, 27% of ICUs were at risk of critical dysfunction or closure due to vacancies and impending retirements. Conclusion The findings highlight the urgent need to address the shortage of ICU physicians in France. Compared to a similar study conducted in 2012, the inadequacy between ICU physician supply and demand has increased, resulting in a higher number of vacancies. Our study suggests that, among others, increasing the number of ICM residents trained each year could be a crucial step in addressing this issue. Failure to take appropriate measures may lead to further closures of ICUs and increased risks to patients in this healthcare system.

Ticks play the main role, in veterinary terms, in transmitting important pathogens. Rhipicephalus sanguineus is a widespread tick known for its ability to thrive in indoor environments and could be the main reservoir host for many TBDs. In this study, the acaricidal and larvicidal potential of Rosmarinus officinalis essential oil was evaluated against R. sanguineus. The aerial part of this plant was extracted by hydrodistillation and then analyzed by gas chromatography coupled with mass spectrometry (GC/MS). The yield obtained from this oil was 0.38%, its major chemical compounds were found to be Camphor (43.52%), Eucalyptol (13.66%), and Camphene (13.2%). The adult immersion test (AIT) using four concentrations (1µl/ml,2µl/ml,10µl/ml, 30µl/ml) revealed that this oil presented oviposition reduction percentages of 5.75%, 20.68%, 33.27%, and 46.84%, hatching reductions percentages of 5%, 15%, 35%, and 60%, and efficacy extract percentages of 10.46%, 32.58%, 56.63%, and 78.74% Further, the larval immersion test (LIT) using five concentrations (0.5µl/ml,1µl/ml, 2µl/ml, 3µl/ml, and 5µl/ml) revealed considerable larvicidal activities with LC50 and LC90 values of 2.286 µl/ml and 5.380 µl/ml, respectively. These results are encouraging and open interesting and promising horizons for its application as a bio-acaricide.

In immersive VR, a self-avatar that replicates the user’s movements and is viewed from a first-person perspective can substitute the real body. If the avatar’s movements are sufficiently synchronized with the user’s actual movements, the user can experience a sense of embodiment over the avatar. Recent studies have shown that discrepancies between the movements of the avatar and those of the user can be well tolerated while maintaining high levels of embodiment. The point at which a distortion is perceived (detection threshold) and its impact on the level of embodiment has not been studied in lower limb tasks such as gait. This study aimed to identify a detection threshold of gait asymmetry by unilaterally manipulating the step length of a self-avatar, and the effect of this detection on perceived embodiment. A real-time step length distortion model was developed, and a detection threshold between actual and avatar’s gait movement was assessed on thirty healthy participants. The step length was manipulated to introduce gait asymmetry (ascending condition) or start from a large asymmetry that was gradually decreased (descending). The results showed that, on average, the avatar’s step length could be increased by up to 12% before the participants detected the distortion. Furthermore, in the descending condition, they detected increases that were above 9%. The point of detection had no effect on the sense of embodiment as participants still reported being embodied in their avatars, even when they consciously detected the step length distortion. The sense of embodiment was closely correlated with the level of distortion; as distortion increased, embodiment decreased, and vice versa. For a given distortion level, embodiment was similar whether in the ascending or descending condition. This suggests that embodiment can be achieved even when the avatar’s spatial alignment initially differs from the participants’, provided that alignment is gradually restored. These results provide valuable insights into participants’ ability to tolerate movement discrepancies in embodied avatar experiences during gait in virtual environments, with potential applications in motor training and gait rehabilitation.

IntroductionThe development of machine learning models for symptom-based health checkers is a rapidly evolving area with significant implications for healthcare. Accurate and efficient diagnostic tools can enhance patient outcomes and optimize healthcare resources. This study focuses on evaluating and optimizing machine learning models using a dataset of 10 diseases and 9,572 samples.MethodsThe dataset was divided into training and testing sets to facilitate model training and evaluation. The following models were selected and optimized: Decision Tree, Random Forest, Naive Bayes, Logistic Regression and K-Nearest Neighbors. Evaluation metrics included accuracy, F1 scores, and 10-fold cross-validation. ROC-AUC and precision-recall curves were also utilized to assess model performance, particularly in scenarios with imbalanced datasets. Clinical vignettes were employed to gauge the real-world applicability of the models.ResultsThe performance of the models was evaluated using accuracy, F1 scores, and 10-fold cross-validation. The use of ROC-AUC curves revealed that model performance improved with increasing complexity. Precision-recall curves were particularly useful in evaluating model sensitivity in imbalanced dataset scenarios. Clinical vignettes demonstrated the robustness of the models in providing accurate diagnoses.DiscussionThe study underscores the importance of comprehensive model evaluation techniques. The use of clinical vignette testing and analysis of ROC-AUC and precision-recall curves are crucial in ensuring the reliability and sensitivity of symptom-based health checkers. These techniques provide a more nuanced understanding of model performance and highlight areas for further improvement.ConclusionThis study highlights the significance of employing diverse evaluation metrics and methods to ensure the robustness and accuracy of machine learning models in symptom-based health checkers. The integration of clinical vignettes and the analysis of ROC-AUC and precision-recall curves are essential steps in developing reliable and sensitive diagnostic tools.

We have investigated a weakly q-deformed algebra, which leads to non-Hermitian operators. It has been explicitly shown that the harmonic oscillator Hamiltonian is quasi-Hermitian, and that the corresponding physical Hilbert-space metric Θ differs from that obtained in Ref. [1], by hermitizing the position operator. The reality of the Hamiltonian eigenvalues has been illustrated by analytically computing the first order correction to the energy spectrum of the harmonic oscillator (HO). Furthermore, we have shown that this q-deformation leads to a GUP with minimal uncertainties in both position and momentum measurements. Moreover, the physical implications of this q-deformation, have been investigated by studying the thermostatistics of a system of HOs and an ideal gas. For both systems, we computed the partition function, and then we derived some thermodynamic functions. In addition, for the ideal gas, a modified equation of state and a generalized Mayer's equation, consistent with the real behavior of gases, have been established. The obtained results show that the impact of this model would be significant at high temperatures. However, unlike earlier research, we observe that this q-deformation induced the similar corrections regardless of the system under study.

Background: Despite advances in asthma treatments, severe asthma exacerbation (SAE) remains a life-threatening condition in adults, and there is a lack of data derived from adult patients admitted to intensive care units (ICUs) for SAE. The current study investigated changes in adult patient characteristics, management, and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area. Methods: In this retrospective observational study, admissions to 40 ICUs in the greater Paris area for SAE from January 1, 1997, to December 31, 2016 were analyzed. The primary outcome was the proportion of ICU admissions for SAE during 5-year periods. Secondary outcomes were ICU and hospital mortality, and the use of mechanical ventilation and catecholamine. Multivariate analysis was performed to assess factors associated with ICU mortality. Results: A total of 7049 admissions for SAE were recorded. For each 5-year period, the proportion decreased over time, with SAE accounting for 2.84% of total ICU admissions (n=2841) between 1997 and 2001, 1.76% (n=1717) between 2002 and 2006, 1.05% (n=965) between 2007 and 2011, and 1.05% (n=1526) between 2012 and 2016. The median age was 46 years (interquartile range [IQR]: 32–59 years), 55.41% were female, the median Simplified Acute Physiology Score II was 20 (IQR: 13–28), and 19.76% had mechanical ventilation. The use of mechanical ventilation remained infrequent throughout the 20-year period, whereas the use of catecholamine decreased. ICU and hospital mortality rates decreased. Factors associated with ICU mortality were renal replacement therapy, catecholamine, cardiac arrest, pneumothorax, acute respiratory distress syndrome, sepsis, and invasive mechanical ventilation (IMV). Non-survivors were older, had more severe symptoms, and were more likely to have received IMV. Conclusion: ICU admission for SAE remains uncommon, and the proportion of cases decreased over time. Despite a slight increase in symptom severity during a 20-year period, ICU and hospital mortality decreased. Patients requiring IMV had a higher mortality rate.

Abstract Cardiogenic shock (CS) is characterized by low cardiac output and sustained tissue hypoperfusion that may result in end-organ dysfunction and death. CS is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. Timely diagnosis and multidisciplinary team-based management have demonstrated favourable effects on outcomes. We aimed to review evidence-based practices for managing patients with ischemic and non-ischemic CS, detailing the multi-organ supports needed in this critically ill patient population.

Wheeled mobile robots (WMR) are common autonomous systems requiring efficient control methods. This work investigates fixed-time adaptive sliding mode control (FxT-ASMC) for the trajectory tracking task of a WMR subject to disturbances/uncertainties. The developed control strategy seeks to avoid the chattering problem, cope with disturbances when the upper limit is undefined, and enhance the convergence of the system states. Indeed, a new adaptive technique has been developed to effectively handle disturbances, even in the absence of prior knowledge regarding their upper bound. This technique consists in estimating the switching gain for each channel separately. On the other hand, an appropriate design of the reaching law ensures the fixed-time convergence of the sliding variables to zero. Additionally, sliding variables are designed in a way that guarantees the tracking errors will stabilize within a set amount of time. This kind of convergence was demonstrated using Lyapunov stability theory. In order to realize the trajectory tracking control structure, the FxT-ASMC system is incorporated with a classical kinematic controller. The efficiency of the suggested control methodology is proven via simulations and practical implementation.

Adherence of Bacillus cereus spores to dairy industry equipment is a serious problem, causing food spoilage and, occasionally, outbreaks of foodborne diseases. Antimicrobial essential oils (EOs) have been proposed as an alternative to synthetic disinfectants due to their environmentally friendly properties. The aim of this study was to assess the effect of Cymbopogon winterianus and Juniperus phoenicea EOs on planktonic and adherent B. cereus spores to stainless steel surfaces. Eleven strains of B. cereus were used in this study. The chemical composition of the C. winterianus and J. phoenicea oils was analyzed by gas chromatography (GC)/mass spectrometry (MS). Ninety components were identified for C. winterianus, being geranial (37 %), neral (29 %), beta-myrcene (16 %) and geraniol (4 %) the most abundant constituents. Twelve components were identified for J. phoenicea, being alpha-pinene (65 %) the most abundant constituent. The results of the minimal inhibitory concentration and minimal bactericidal concentration revealed that C. winterianus was the most effective EO (p