bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis
Authors: Furnaz Shumaila , Shaikh Abdul Sattar , Qureshi Rayyan , Fatima Subhani , Bangash Sohail Khan , Karim Musa , Amanullah Muneer
Published: December 2023

Objective

This study aimed to assess the International Quality Improvement Collaborative single-site data from a developing country to identify trends in outcomes and factors associated with poor outcomes.

Design

Retrospective descriptive study.

Setting

The National Institute of Cardiovascular Diseases, Karachi, Pakistan.

Participants

Patients undergoing surgery for congenital heart disease (CHD).

Outcome measure

Key factors were examined, including preoperative, procedural and demographic data, as well as surgical complications and outcomes. We identified risk factors for mortality, bacterial sepsis and 30-day mortality using multivariable logistic regression.

Results

A total of 3367 CHD surgical cases were evaluated; of these, 59.4% (2001) were male and 82.8% (2787) were between the ages of 1 and 17 years. Only 0.2% (n=6) were infants (≤30 days) and 2.3% (n=77) were adults (≥18 years). The in-hospital mortality rate was 6.7% (n=224), and 4.4% (n=147) and 0.8% (n=27) had bacterial sepsis and surgical site infections, respectively. The 30-day status was known for 90.8% (n=3058) of the patients, of whom 91.6% (n=2800) were alive. On multivariable analysis, the adjusted OR for in-hospital mortality was 0.40 (0.29–0.56) for teenagers compared with infancy/childhood and 1.95 (1.45–2.61) for patients with oxygen saturation <85%. Compared with Risk Adjustment for Congenital Heart Surgery (RACHS-1) risk category 1, the adjusted OR for in-hospital mortality was 1.78 (1.1–2.87) for RACHS-1 risk category 3 and 2.92 (1.03–8.31) for categories 4–6. The adjusted OR for 30-day mortality was 0.40 (0.30–0.55) for teenagers and 1.52 (1.16–1.98) for patients with oxygen saturation <85%. The 30-day mortality rate was significantly higher in RACHS-1 risk category 3 compared with category 1, with an adjusted OR of 1.64 (1.06–2.55).

Conclusions

We observed a high prevalence of postoperative infections and mortality, especially for high-risk procedures, according to RACHS-1 risk category, in infancy/childhood, in children with genetic syndrome or those with low oxygen saturation (<85%).
Predictive factors of poor outcome and mortality among anterior ischaemic stroke patients despite successful recanalisation in China: a secondary analysis of the CAPTURE trial
Authors: Li Guangwen , Sun Yujie , Liu Tonghui , Yang Pengfei , Peng Ya , Chen Wenhuo , Zhang Liyong , Chu Jianfeng , Kuai Dong , Wang Zibo , Wu Wei , Xu Yun , Zhou Bin , Geng Yu , Yin Congguo , Li Jiang , Wang Ming , Peng Xiaoxiang , Xiao Yaping , Li Minghua , Zhang Xianjun , Liu Peng , Wang Naidong , Zhang Yong
Published: December 2023

Objectives

This work aimed to analyse the risk factors for poor outcomes and mortality among patients with anterior large vessel occlusion (LVO) ischaemic stroke, despite successful recanalisation.

Setting and participants

This study conducted a secondary analysis among patients who underwent successful recanalisation in the CAPTURE trial. The trial took place between March 2018 and September 2020 at 21 sites in China. The CAPTURE trial enrolled patients who had an acute ischaemic stroke aged 18–80 years with LVO in anterior circulation.

Interventions

Thrombectomy was immediately performed using Neurohawk or the Solitaire FR after randomisation in CAPTURE trial. Rescue treatment was available for patients with severe residual stenosis caused by atherosclerosis.

Primary and secondary outcome measures

The primary goal was to predict poor 90-day survival or mortality within 90 days post-thrombectomy. Univariate analysis, using the χ2test or Fisher’s exact test, was conducted for each selected factor. Subsequently, a multivariable analysis was performed on significant factors (p≤0.10) identified through univariate analysis using the backward selection logistic regression approach.

Results

Among the 207 recruited patients, 79 (38.2%) exhibited poor clinical outcomes, and 26 (12.6%) died within 90 days post-thrombectomy. Multivariate analysis revealed that the following factors were significantly associated with poor 90-day survival: age ≥67 years, internal carotid artery (ICA) occlusion (compared with middle cerebral artery (MCA) occlusion), initial National Institutes of Health Stroke Scale (NIHSS) score ≥17 and final modified Thrombolysis in Cerebral Infarction (mTICI) score 2b (compared with mTICI 3). Additionally, the following factors were significantly associated with mortality 90 days post-thrombectomy: initial NIHSS score ≥17, ICA occlusion (compared with MCA occlusion) and recanalisation with more than one pass.

Conclusions

Age, NIHSS score, occlusion site, mTICI score and the number of passes can be independently used to predict poor 90-day survival or mortality within 90 days post-thrombectomy.

Trial registration number

NCT04995757.
Exploring the patient experience of remote hypertension management in Scotland during COVID-19: a qualitative study
Authors: Mchale Sheona , Paterson Mary , Pearsons Alice , Neubeck Lis , Atherton Iain , Guthrie Bruce , McKinstry Brian , Hanley Janet
Published: December 2023

Objectives

The aim of this study was to understand how patients experienced hypertension management, with or without blood pressure (BP) telemonitoring, during the COVID-19 pandemic.

Design, methods, participants and setting

This qualitative study conducted between April and November 2022 consisted of 43 semistructured telephone interviews (23 men and 20 women) from 6 primary care practices in one area of Scotland.

Results

From the views of 25 participants with experience of using the Connect Me telemonitoring service and 18 participants without such experience, 5 themes were developed. These were: (1) navigating access to services. There were challenges to gaining timely and/or in-person access to services and a reluctance to attend clinical settings because participants were aware of their increased risk of contracting the COVID-19 virus. (2) Adapting National Health Service services. All six practices had adapted care provision in response to potential COVID-19 transmission; however, these adaptations disrupted routine management of in-person primary care hypertension, diabetes and/or asthma checks. (3) Telemonitoring feedback. Telemonitoring reduced the need to attend in-person primary care practices and supported access to remote healthcare monitoring and feedback. (4) Self-management. Many non-telemonitoring participants were motivated to use self-management strategies to track their BP using home monitoring equipment. Also, participants were empowered to self-manage lifestyle and hypertension medication. (5) Experience of having COVID-19. Some participants contracting the COVID-19 virus experienced an immediate increase in their BP while a few experienced ongoing increased BP readings.

Conclusions

The COVID-19 pandemic disrupted routine in-person care for patients with hypertension. Both telemonitoring and some non-telemonitoring patients were motivated to self-manage hypertension, including self-adjusting medication; however, only those with access to telemonitoring had increased access to hypertension monitoring and feedback. BP telemonitoring permitted routine care to continue for participants in this study and may offer a service useful in pandemic proofing hypertension healthcare in the future.
Prevalence and related factors of children myopia in Pudong New Area, Shanghai: a cross-sectional study
Authors: Cheng Peng , Zhang Xiaohua , Zhou Wei , Xu Jiawei , Chen Fangrong , Qian Dan , Cao Bin
Published: December 2023

Objectives

This study aimed to assess the prevalence and related factors of myopia among school-aged children after COVID-19 pandemic.

Design

Cross-sectional study.

Setting

Pudong New Area, Shanghai.

Participants

1722 children aged 7–9 randomly selected from 8 primary schools were screened from 1 February 2023 to 30 April 2023.

Main outcome measures

Children’s height, weight and eye parameters were examined. Myopia was defined as a cycloplegic spherical equivalent ≤−0.50 dioptres in either eye. A vision-related behaviour questionnaire was applied to investigate the associations between myopia and its risk factors.

Results

Of the 1722 individuals enrolled, 25.6% (456) had myopia. After adjusting other characteristics, the following factors were associated with an increased rate of myopia: age (9 years vs 7 years, adjusted OR (AOR) 1.84, 95% CI 1.18 to 2.85, p=0.007), parental myopia status (both myopia vs none, AOR 5.66, 95% CI 3.71 to 8.63, p<0.001; one myopia vs none, AOR 2.92, 95% CI 1.93 to 4.42, p<0.001), reading books too close (yes vs no, AOR 1.58, 95% CI 1.20 to 2.08, p=0.001), writing with a tilted head (yes vs no, AOR 1.37, 95% CI 1.05 to 1.77, p=0.019), sleep patterns (early to bed late to rise vs early to bed early to rise, AOR 1.52, 95% CI 1.02 to 2.26, p=0.039). By contrast, a higher monthly household income and the habit of reading while lying down were associated with lower risk of myopia.

Conclusions

The prevalence of myopia is of concern among young school-aged children after COVID-19. Correcting eye use behaviour and improving sleep habits may reduce myopia. Also, gender differences should be considered in prevention strategies for children’s myopia.
Risk prediction and treatment assessment in glioma patients using SEER database: a prospective observational study
Authors: Li XinRong , Shao Yan , Wang ZeMing , Zhu JunQuan
Published: December 2023

Objectives

To use a nomogram to predict the risk of mortality and estimate the impact of current treatment on the prognosis of glioma patients.

Methods

A total of 3798 cases were obtained from the Surveillance Epidemiology and End Results database according to the selection criteria. A nomogram was built on the independent clinical factors screened by the variance inflation factor, univariate analyses and a multivariate Cox regression model. Then, categorising the overall population into high-risk, medium-risk and low-risk groups using nomogram-derived risk scores, to study the impact of treatment on different subgroups’ survival outcomes. Furthermore, based on the postmatch cohorts, the influences of treatment on survival outcomes were assessed by the log-rank test.

Result

Age, race, stage of disease, histological type, histological grade, surgery, radiotherapy and chemotherapy were identified as the independent prognostic factors. A nomogram with good discrimination and consistency was built. Generally, the patients who underwent surgery, radiotherapy and chemotherapy were more likely to achieve better prognosis than those who did not, except for those who received radiotherapy in the low-risk cohort and those who underwent surgery in the high-risk cohort. Furthermore, the isocitrate dehydrogenase 1/2 (IDH1/2) wild-type patients with surgery, radiotherapy or chemotherapy tended to have higher survival probabilities, while some inconsistent results were observed in the IDH mutant-type cohort.

Conclusion

Surgery, radiotherapy and chemotherapy improved the prognosis, while appropriate selection of topical treatment for the low-risk or high-risk patients deserves further consideration. IDH status gene might be a reliable indicator of therapeutic effectiveness.
Frailty Assessment in Vascular OUtpatients Review (FAVOUR) protocol: single-centre prospective cohort study comparing feasibility and prognostic value of commonly used frailty assessment tools
Authors: Welsh Silje Alvsaaker , Hussey Keith , Brittenden Julie , Orr Douglas J , Quinn Terry
Published: December 2023

Introduction

Frailty has consistently demonstrated associations with poorer healthcare outcomes. Vascular guidelines have recognised the importance of frailty assessment. However, an abundance of frailty tools and a lack of prospective studies confirming suitability of routine frailty assessment in clinical practice has delayed the uptake of these guidelines. The Frailty Assessment in Vascular OUtpatients Review study speaks to this evidence gap. The primary aim is to assess feasibility of implementing routine frailty assessment in a reproducible outpatient setting. Secondary objectives include comparing prognostic values and interuser agreement across five frailty assessment tools.

Methods and analysis

This single-centre prospective cohort study of feasibility is conducted in a rapid-referral vascular surgery clinic, serving a population of 2 million. Adults with capacity (>18 years), attending a clinic for any reason, are eligible for inclusion. Five assessments are completed by patient (Rockwood Clinical Frailty Scale (CFS) and Frail NonDisabled Questionnaire), clinician (CFS, Healthcare Improvement Scotland FRAIL tool and ‘Initial Clinical Evaluation’) and researcher (11-item modified Frailty Index). Consistent with feasibility objectives, outcome measures include recruitment rates, frailty assessment completion rates, time-to-complete assessments and interuser variability. Electronic follow-up at 30 days and 1 year will assess home-time and mortality as prognostic indicators. Patients treated surgically/endovascularly will undergo additional 30-day and 1-year postoperative follow-up, outcome measures include: surgical procedure, mortality, complications (according to Clavien-Dindo Classification), length of stay, readmission rates, non-home discharge, home-time, higher social care requirements on discharge and amputation-free survival. Prognostic value will be compared by area under receiver operating characteristic curves. Continuous outcome variables will be analysed using Spearman’s rank correlation coefficient. Interuser agreement will be compared by percentage agreement in Cohen’s kappa coefficient. 

Ethics and dissemination

The study is sponsored by National Health Service Greater Glasgow and Clyde (R&IUGN23CE014). London-Riverside REC (23/PR/0062) granted ethical approval. Results will be disseminated through publication in peer-reviewed vascular surgery and geriatric medicine themed journals and presentation at similar scientific conferences.

Trials registration number

NCT06040658. Stage of study: pre-results.
Metformin for knee osteoarthritis with obesity: study protocol for a randomised, double-blind, placebo-controlled trial
Authors: Lim Yuan Z , Wang Yuanyuan , Urquhart Donna M. , Estee Mahnuma Mahfuz , Wluka Anita E , Heritier Stephane , Cicuttini Flavia M
Published: December 2023

Introduction

Over half of the populations with knee osteoarthritis (OA) have obesity. These individuals have many other shared metabolic risk factors. Metformin is a safe, inexpensive, well-tolerated drug that has pleiotropic effects, including structural protection, anti-inflammatory and analgesic effects in OA, specifically the knee. The aim of this randomised, double-blind, placebo-controlled trial is to determine whether metformin reduces knee pain over 6 months in individuals with symptomatic knee OA who are overweight or obese.

Methods and analysis

One hundred and two participants with symptomatic knee OA and overweight or obesity will be recruited from the community in Melbourne, Australia, and randomly allocated in a 1:1 ratio to receive either metformin 2 g or identical placebo daily for 6 months. The primary outcome is reduction of knee pain [assessed by 100 mm Visual Analogue Scale (VAS)] at 6 months. The secondary outcomes are OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) responder criteria [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, function and participant’s global assessment (VAS)] at 6 months; change in knee pain, stiffness, function using WOMAC at 6 months and quality of life at 6 months. Adverse events will be recorded. The primary analysis will be by intention to treat, including all participants in their randomised groups.

Ethics and dissemination

Ethics approval has been obtained from the Alfred Hospital Ethics Committee (708/20) and Monash University Human Research Ethics Committee (28498). Written informed consent will be obtained from all the participants. The findings will be disseminated through peer-review publications and conference presentations.

Trial registration number

ACTRN12621000710820 .
Methodology and application of three-dimensional technology for brace design and production for treatment in patients with adolescent idiopathic scoliosis: a scoping review protocol
Authors: Hoelen Thomáy-Claire Ayala , de Bie Rob A , Arts Jacobus JC , Willems Paul C
Published: December 2023

Introduction

Conservative treatment for adolescent idiopathic scoliosis (AIS) using bracing has proven to be effective at reducing curve progression. However, variation in brace design and lack of brace specificity hamper clinical treatment outcomes as well as the predictability and comparison hereof. To overcome this, recent technological developments aim to generate transparent and objective criteria for brace manufacturing by applying computer-aided design software and additive manufacturing to produce braces for scoliosis treatment. Yet, the extent of its applicability and clinical implementation are to be determined. This study will identify and map the available evidence for the methodology and application of three-dimensional technology for the design and production of clinical braces used for treatment in patients with AIS.

Methods and analysis

This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. This scoping review will consider studies on methodology of three-dimensional technological methodology and applications that have been or are currently being applied in brace treatment of AIS. The following databases will be searched: MEDLINE, Web of Science, Cochrane Database of Systematic Reviews and Embase (OVID). Search limits will be applied; for example, only articles written in the English language published after 2000 will be included. The retrieved articles will be screened independently by two researchers. A third researcher will be consulted in case of disagreement. Data from relevant articles will be independently extracted by two researchers and presented in a tabular manner accompanied by a descriptive narration.

Ethics and dissemination

Considering the nature of the study, no ethical approval needed to be requested. The study result will be submitted to a peer-reviewed journal.
Qualitative study of the consequences of vaccine-induced immune thrombocytopenia and thrombosis: the experiences of family members
Authors: Bennett Paul , Celik Filiz , Winstanley Jenna , Hunt Beverley J , Pavord Sue
Published: December 2023

Objectives

To explore the experiences of family members of patients who died or survived following a diagnosis of vaccine-induced immune thrombocytopenia and thrombosis (VITT).

Design

A semistructured qualitative study, conducted via Zoom.

Setting

Participants discussed their experiences during hospitalisation and following discharge.

Participants

Sixteen family members of patients with VITT (survivors=11; bereaved=5), recruited via a Facebook support group and advertising on Twitter.

Results

Analysis identified two themes common to both groups of participants: the stress of hospitalisation and the experience of multiple losses. A third theme, living with VITT, was unique to the survivor group and a fourth, battling against the system, was predominantly reported by bereaved participants.

Conclusions

This is a significantly challenged group of people, with multiple emotional, financial, social and psychological losses. These losses have been compounded by experiences of limited governmental and societal recognition of the problems they face.
Equitable and accessible informed healthcare consent process for people with intellectual disability: a systematic literature review
Authors: Dunn Manjekah , Strnadová Iva , Scully Jackie Leach , Hansen Jennifer , Loblinzk Julie , Sarfaraz Skie , Molnar Chloe , Palmer Elizabeth Emma
Published: December 2023

Objective

To identify factors acting as barriers or enablers to the process of healthcare consent for people with intellectual disability and to understand how to make this process equitable and accessible.

Data sources

Databases: Embase, MEDLINE, PsychINFO, PubMed, SCOPUS, Web of Science and CINAHL. Additional articles were obtained from an ancestral search and hand-searching three journals.

Eligibility criteria

Peer-reviewed original research about the consent process for healthcare interventions, published after 1990, involving adult participants with intellectual disability.

Synthesis of results

Inductive thematic analysis was used to identify factors affecting informed consent. The findings were reviewed by co-researchers with intellectual disability to ensure they reflected lived experiences, and an easy read summary was created.

Results

Twenty-three studies were included (1999 to 2020), with a mix of qualitative (n=14), quantitative (n=6) and mixed-methods (n=3) studies. Participant numbers ranged from 9 to 604 people (median 21) and included people with intellectual disability, health professionals, carers and support people, and others working with people with intellectual disability. Six themes were identified: (1) health professionals’ attitudes and lack of education, (2) inadequate accessible health information, (3) involvement of support people, (4) systemic constraints, (5) person-centred informed consent and (6) effective communication between health professionals and patients. Themes were barriers (themes 1, 2 and 4), enablers (themes 5 and 6) or both (theme 3).

Conclusions

Multiple reasons contribute to poor consent practices for people with intellectual disability in current health systems. Recommendations include addressing health professionals’ attitudes and lack of education in informed consent with clinician training, the co-production of accessible information resources and further inclusive research into informed consent for people with intellectual disability.

PROSPERO registration

CRD42021290548.
Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose?
Authors: Bashir Khalid , Beintaris Iosif , Sharp Linda , Newton Julia , Elliott Katherine , Rees Jon , Rogers Peter , Rutter Matt
Published: December 2023

Introduction

Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate identification of target populations for colonoscopy; then to use CDR to assess the impact of implementing an FIT-based referral pathway locally.

Methods

NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames.

Results

1, 123, 624 NED diagnostic colonoscopies were analysed. Locally, there was a significant increase in CDR between 2019 and 2021, from 3.01% (2.45%–3.47%) to 4.32% (3.69%–4.95%), p=0.003. The CDR increase was due to both a 10% increase in the number of CRCs detected and a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a smaller, but significant, increase in CDR from 2.02% (1.99%–2.07%) to 2.33% (2.29%–2.37%), p<0.001. The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared with nationally.

Conclusion

Our study indicates that the introduction of a robustly vetted FIT-based algorithm to determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically calculated through NED, enabling monitoring of the quality of referral and vetting pathways.
Outcome study of the Pipeline Vantage Embolization Device (second version) in unruptured (and ruptured) aneurysms (PEDVU(R) study)
Authors: Booth Thomas C , Bassiouny Ahmed , Lynch Jeremy , Sonwalkar Hemant , Bleakley Aaron , Iqbal Ahmed , Minett Thais , Buwanabala Jonathon , Narata Ana Paula , Patankar Tufail , Islim Fathallah Ismail , Kandasamy Naga , Balasundaram Parthiban , Sciacca Sara , Siddiqui Juveria , Walsh Daniel , Tolias Christos , Kailaya-Vasan Ahilan , Sultan Amina A , Abd El-Latif Mahmoud , Mortimer Alex , Sastry Anand
Published: December 2023

Background

The Pipeline Vantage Embolization Device (PEDV) is the fourth-generation pipeline flow diverter for intracranial aneurysm treatment. There are no outcome studies for the second PEDV version. We aimed to evaluate safety and efficacy outcomes. Primary and secondary objectives were to determine outcomes for unruptured and ruptured cohorts, respectively.

Methods

In this multicenter retrospective and prospective study, we analyzed outcome data from eight centers using core laboratory assessments. We determined 30-day and ≥3-month mortality and morbidity rates, and 6- and 18-month radiographic aneurysm occlusion rates for procedures performed during the period July 2021–March 2023.

Results

We included 121 consecutive patients with 131 aneurysms. The adequate occlusion rate for the unruptured cohort at short-term and medium-term follow up, and also for the ruptured cohort at short-term follow up, was >90%. Two aneurysms (1.5%) underwent retreatment. When mortality attributed to a palliative case in the unruptured cohort, or subarachnoid hemorrhage in the ruptured cohort, was excluded then the overall major adverse event rate in respective cohorts was 7.5% and 23.5%, with 0% mortality rates for each. When all event causes were included on an intention-to-treat basis, the major adverse event rates in respective cohorts were 8.3% and 40.9%, with 0.9% and 22.7% mortality rates.

Conclusions

For unruptured aneurysm treatment, the second PEDV version appears to have a superior efficacy and similar safety profile to previous-generation PEDs. These are acceptable outcomes in this pragmatic and non-industry-sponsored study. Analysis of ruptured aneurysm outcomes is limited by cohort size. Further prospective studies, particularly for ruptured aneurysms, are needed.
Resource utilisation and outcomes of people with heart failure in England: a descriptive analysis of linked primary and secondary care data – the PULSE study
Authors: Linden Stephan , Gollop Nicholas D , Farmer Ruth
Published: December 2023

Background

Heart failure (HF) is associated with high levels of resource use and mortality, but prior UK studies have not compared outcomes by HF subtype (HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)) in large patient populations. This study investigated healthcare resource utilisation and mortality in patients with HF in England, overall and by HF subtype.

Methods

This non-interventional cohort study linked data from the Clinical Practice Research Datalink database to Hospital Episode Statistics inpatient and UK Office for National Statistics mortality data. Patients with a recorded HF diagnosis (new (incident) or existing (prevalent)) based on clinical codes or measures of ejection fraction between 2015 and 2019 were included.

Results

Of 383 896 patients identified with HF, 100 224 patients (26%) had a recorded subtype: 68 780 patients with HFrEF (69%) and 31 444 patients (31%) with HFpEF. In total, 918 553 person-years (PY) were included (median follow-up: 2.1 years): 625 619 PY (68%) for unknown HF subtype, 204 862 PY (22%) for HFrEF and 88 017 PY (10%) for HFpEF. Overall, 11% of patients experienced ≥1 HF hospitalisation. After age and sex adjustment, hospitalisations for HF (HHF; including recurrent hospitalisations) and HF-related general practitioner consultations occurred at rates of approximately 80/1000 and 124/1000 PY, respectively, and were highest for patients with HFrEF and unknown subtype. Overall, all-cause and cardiovascular mortality rates were 132/1000 and 49/1000 PY, respectively. Patients with unknown subtype had the highest 1-year and 5-year mortality (20% and 48%), followed by HFrEF (8% and 35%) and HFpEF (6% and 25%).

Conclusions

HF is associated with high levels of healthcare resource use, mortality, HHF and comorbidities. Ensuring that patients receive early and appropriate guideline-directed therapies to manage HF and associated comorbidities is likely to improve patient care and reduce the burden of HF on the English healthcare system.
Palliative care for infants with life-limiting conditions: integrative review
Authors: Iten Rebecca , O'Connor Moira , Gill Fenella J
Published: December 2023

Background

Infants with life-limiting conditions are a heterogeneous population. Palliative care for infants is delivered in a diverse range of healthcare settings and by interdisciplinary primary healthcare teams, which may not involve specialist palliative care service consultation.

Objective

To synthesise the literature for how palliative care is delivered for infants aged less than 12 months with life-limiting conditions.

Methods

An integrative review design. MEDLINE, CINAHL, ProQuest, Cochrane, Joanna Briggs Institute and EMBASE were searched for research published in English language, from 2010 to 2022, and peer reviewed. Critical appraisal was completed for 26 patient case series, 9 qualitative, 5 cross-sectional and 1 quality improvement study. Data analysis involved deductive content analysis and narrative approach to summarise the synthesised results.

Results

37 articles met the eligibility for inclusion. Two models of palliative care delivery were examined, demonstrating differences in care received and experiences of families and health professionals. Health professionals reported lack of palliative care education, challenges for delivering palliative care in intensive care settings and barriers to advance care planning including prognostic uncertainty and transitioning to end-of-life care. Families reported positive experiences with specialist palliative care services and challenges engaging in advance care planning discussions.

Conclusion

There are complex issues surrounding the provision of palliative care for infants. Optimal palliative care should encompass a collaborative and coordinated approach between the primary healthcare teams and specialist palliative care services and prioritisation of palliative care education for nurses and physicians involved in providing palliative care to infants.
Salvianolic acid B attenuates diabetic nephropathy through alleviating ADORA2B, NALP3 in flammasome, and NFκB activity
Authors: Wang Ying , Chang Jiang , Qiao Shubin , Yang Ying , Yun Chuan , Li Yongyan , Wang Fa
Published: December 2023

Diabetic nephropathy is one of the microvascular complications of diabetes. This study is aimed at investigating the role and mechanisms of salvianolic acid B (Sal B) in diabetic nephropathy. High glucose (HG)-induced human renal tubular epithelial HK-2 cells were treated with Sal B, BAY-60-6583 (agonist of adenosine 2B receptor), or PSB-603 (antagonist of adenosine 2B receptor) for 24 h. Adenosine A2b receptor (ADORA2B), NACHT, leucine-rich repeat (LRR), and pyrin (PYD) domains-containing protein 3 (NALP3), and nuclear factor Kappa B (NFκB) expressions, mitochondrial membrane potential (MMP), and reactive oxygen species (ROS) levels were examined. Following 6 weeks of Sal B treatment, db/db mice blood and kidney tissue were harvested for biochemical detection with hematoxylin–eosin (H&E), Masson’s, periodic acid schiff (PAS), and Sirius red staining and detection of ADORA2B, NALP3, NFκB, interleukin 1β (IL-1β), and toll-like receptor 4 (TLR4) activity. NFκB, NALP3, and ADORA2B were found to be downregulated in Sal B treated HK-2 cells exposed to high glucose (HG), accompanied by elevated levels of MMPs and reduced intracellular ROS production. Sal B-treated diabetic mice had the improvement in body weight, water intake, hyperglycemia, hyperlipidemia, and liver and kidney function. Altogether, Sal B attenuates HG-induced kidney tubule cell injury and diabetic nephropathy in diabetic mice, providing clues to other novel mechanisms by which Sal B is beneficial in diabetic nephropathy.
Measurement of the double-$$\varvec{\beta }$$ decay of $$\varvec{^{150}}$$Nd to the 0$$\varvec{^+_1}$$ excited state of $$\varvec{^{150}}$$Sm in NEMO-3
Authors: Aguerre X. , Arnold R. , Augier C. , Barabash A. S. , Basharina-Freshville A. , Blondel S. , Blot S. , Bongrand M. , Breier R. , Brudanin V. , Busto J. , Bystryakov A. , Caffrey A. J. , Cerna C. , Cesar J. P. , Ceschia M. , Chauveau E. , Chopra A. , Dawson L. , Duchesneau D. , Durand D. , Evans J. J. , Flack R. , Franchini P. , Garrido X. , Girard-Carillo C. , Guillon B. , Guzowski P. , Hoballah M. , Hodák R. , Hubert P. , Hussain M. H. , Jullian S. , Klimenko A. , Kochetov O. , Konovalov S. I. , Koňařík F. , Křižák T. , Lalanne D. , Lang K. , Lemière Y. , Li P. , Loaiza P. , Lutter G. , Macko M. , Mamedov F. , Marquet C. , Mauger F. , Minotti A. , Morgan B. , Nemchenok I. , Nomachi M. , Nowacki F. , Ohsumi H. , Oliviéro G. , Palušová V. , Patrick C. , Perrot F. , Petro M. , Pin A. , Piquemal F. , Povinec P. , Pratt S. , Přidal P. , Quinn W. S. , Ramachers Y. A. , Remoto A. , Reyss J. L. , Riddle C. L. , Rukhadze E. , Saakyan R. , Salamatin A. , Salazar R. , Sarazin X. , Sedgbeer J. , Shitov Yu. , Simard L. , Šimkovic F. , Smetana A. , Smolnikov A. , Söldner-Rembold S. , Štekl I. , Suhonen J. , Szklarz G. , Tedjditi H. , Thomas J. , Timkin V. , Tretyak V. I. , Tretyak V. I. , Umatov V. I. , Vanushin I. , Vereshchaka Y. , Vorobel V. , Waters D. , Xie F.
Published: December 2023

The NEMO-3 results for the double-$$\beta $$
β
decay of $$^{150}$$

150

Nd to the 0$$^+_1$$

1
+

and 2$$^+_1$$

1
+

excited states of $$^{150}$$

150

Sm are reported. The data recorded during 5.25 year with 36.6 g of the isotope $$^{150}$$

150

Nd are used in the analysis. The signal of the $$2\nu \beta \beta $$

2
ν
β
β

transition to the 0$$^+_1$$

1
+

excited state is detected with a statistical significance exceeding 5$$\sigma $$
σ
. The half-life is measured to be $$T_{1/2}^{2\nu \beta \beta }(0^+_1) = \left[ 1.11 ^{+0.19}_{-0.14} \,\left( \hbox {stat}\right) ^{+0.17}_{-0.15}\,\left( \hbox {syst}\right) \right] \times 10^{20}$$

T

1
/
2

2
ν
β
β

(

0
1
+

)

=

1
.

11

-
0.14

+
0.19

stat

-
0.15

+
0.17

syst

×

10
20

 year, which is the most precise value that has been measured to date. 90% confidence-level limits are set for the other decay modes. For the $$2\nu \beta \beta $$

2
ν
β
β

decay to the 2$$^+_1$$

1
+

level the limit is $$T^{2\nu \beta \beta }_{1/2}(2^+_1) > 2.42 \times 10^{20}~\hbox {year}$$

T

1
/
2

2
ν
β
β

(

2
1
+

)

>
2.42
×

10
20

year

. The limits on the $$0\nu \beta \beta $$

0
ν
β
β

decay to the 0$$^+_1$$

1
+

and 2$$^+_1$$

1
+

levels of $$^{150}$$

150

Sm are significantly improved to $$T_{1/2}^{0\nu \beta \beta }(0^+_1) > 1.36 \times 10^{22}~\hbox {year}$$

T

1
/
2

0
ν
β
β

(

0
1
+

)

>
1.36
×

10
22

year

and $$T_{1/2}^{0\nu \beta \beta }(2^+_1) > 1.26 \times 10^{22}~\hbox {year}$$

T

1
/
2

0
ν
β
β

(

2
1
+

)

>
1.26
×

10
22

year

.
Influence of complete slip conditions on peristaltic transport of third-grade fluid with suction and injection
Authors: Lakshmi R. , Kavitha A.
Published: December 2023

This study is important for the fields of pharmaceutical nano-drug suspension, biomedical engineering, pressure surges and food processing systems. The slip condition is necessary for polishing internal cavities and artificial heart valves in a variety of manufactured objects, micro- or nano-channels, and applications. Low Reynolds number (Re[Formula: see text] and long wavelength ([Formula: see text]) considerations are used in the formulation of the mathematical model at low non-Newtonian parameter values, nonlinear boundary conditions and the governing nonlinear equation are analytically solved using the perturbation method. The graphs of frictional force, pressure rise, velocity, pressure gradient, and streamline graphs are done using Wolfram MATHEMATICA software. In this paper, we compared the results of the total slip condition with those of the first-order slip condition and the absence of any slip effects. It has been noticed that increasing the suction and injection parameters leads to a decrease the pressure rate with complete slip effects, partial slip effects and no slip effects. We show that an increase in the third grade fluid parameter [Formula: see text] increases the magnitude of axial velocity. From a physical perspective, it shows the shear thinning characteristic, which causes a decrease in viscosity and an increase in fluid velocity. Frictional force behaves differently when compared to pressure rate. In other words, the pressure gradient acts as an obstacle to the peristalsis-driven flow. The objective of the study is to find the impact of the peristaltic flow phenomena and the impact of peristaltic on third-grade non-Newtonian fluid where the suction and injection are prevailing which is similar to the thing in biomechanical devices, like blood vessels, etc. there is a change of oxygen and carbon dioxide from the tissue layer to the fluid within the blood vessel.
4FSK signal processing based on adaptive tristable stochastic resonance under levy noise
Authors: Zhang Yalin , Wang Fuzhong
Published: December 2023

Aiming at the problem of low quality of coherent demodulation transmission signal of digital signal in the background of Levy noise, this paper proposes a new method of 4FSK signal reception based on adaptive tristable stochastic resonance (SR) system. The bit error rate (BER) of output signals of adaptive tristable SR system model and the traditional modulation model are compared by simulation. The numerical simulation results show that compared with the traditional model, the output BER of the 4FSK signal after demodulation of the adaptive tristable SR system model is reduced by 4% compared with the traditional model. The time domain image of 4FSK signal is clearer, the burrs are significantly reduced and the spectral amplitude of 4FSK signal is greatly improved. The success of this experiment suggests a strong promise of SR systems for digital signal detection in impact noise.
Causes of Iatrogenic Median Nerve Injury after Endoscopic Carpal Tunnel Release
Authors: MURAMATSU Keiichi , TANI Yasuhiro , YAMASHITA Yosuke , CORPUS-ZUÑIGA Fidelis Marie , SUGIMOTO Hideaki , TEC Lou Mervyn
Published: December 2023

Background: Endoscopic carpal tunnel release (ECTR) is a less invasive procedure but has a higher risk of complications. We analysed ECTR cases dividing them into three periods according to a single surgeon’s experience when the ECTR was performed: the initial, midterm and late period. Cases of iatrogenically induced median nerve injuries that occurred after ECTR were then noted and evaluated.

Methods: We reviewed 195 ECTRs done with the 2-portal technique and divided the patients into three groups according to periods of when ECTR was done. The indications for ECTR surgery were limited to severe CTS cases. These groups of patients were similar in terms of age, duration of disease, electrophysiological study results and severity of the disease. The patients were evaluated for median neuropathy pre- and postoperatively using Semmes–Weinstein monofilament test (SWT), Disabilities of the arm, shoulder and hand (DASH) Score, Coin-flip test (CFT), postoperative paraesthesias and complications, such as pillar pain, and so on. Electrophysiological evaluation was performed only preoperatively.

Results: Postoperative median nerve recovery was overall good. Normal recovery was noted in 181 cases (93%). SWT, DASH and CFT were all significantly improved upon follow-up in all three groups. In terms of iatrogenic neuropathy, median nerve palsy worsened (including those transiently worsened) after ECTR in 11 cases (5.6%), even in the later period. The sensory disturbance was equally worsening from the radial to the ulnar side.

Conclusions: The fact that there were neurologically worsened cases even in the later period, when the operator is higher skilled in the technique, suggests that the surgical technique itself may be the one posing higher risk than the level of surgical skill. The most likely causes of aggravated nerve palsy were a direct injury by cannula insertion at the proximal portal, or additional median nerve compression during cannula insertion into the carpal tunnel.

Level of Evidence: Level IV (Therapeutic)
Coverage of Palmar Mini Plates with Flexor Pulleys in the Treatment of Dorsal Fracture-Subluxation of the Proximal Interphalangeal Joint
Authors: MANIGLIO Mauro , ZAIDENBERG Ezequiel E. , BORETTO Jorge G. , DE CARLI Pablo
Published: December 2023

Introduction: Dorsal fracture dislocations (DFD) of the proximal interphalangeal joint (PIPJ) are challenging fractures. A palmar surgical approach and plate fixation has a high complication rate, including flexor contractions, reduction of range of motion (ROM) and secondary need for plate removal.

Methods: We use the flexor tendon pulleys to cover the mini plate with the assumption that it may reduce the adhesion between the mini plates and the tendons and reduce postoperative complications. We present the outcomes of using this technique in eight patients.

Results: All patients had an excellent outcome at a mean follow-up of 17 months, and none required removal of the implants.

Conclusions: This study presents a surgical technique that may potentially reduce the high complication rate found after ORIF for treatment of DFD of the PIPJ. Therefore, improving the clinical outcomes after this type of surgery.

Level of Evidence: Level IV (Therapeutic)
Thoracic Outlet Syndrome Caused by a Primary Tumour in the Brachial Plexus
Authors: KAWANO Kenichi , HARA Yukinori , HOSHIKAWA Shinya , TAJIRI Yasuhito
Published: December 2023

Thoracic outlet syndrome (TOS) caused by a primary brachial plexus tumour is very rare. A male politician in his 40s presented with numbness, left limb pain and positive Wright and Roos test results. Magnetic resonance imaging (MRI) revealed a tumour located just below the clavicle, compressing the subclavian artery during left arm elevation. Despite concerns regarding postoperative nerve deficits, surgery was performed because of worsening symptoms during the election campaigns. The pathology report revealed a schwannoma. Few reports have described TOS caused by primary tumours of the brachial plexus. While the decision to perform surgery for primary tumours of the brachial plexus requires careful consideration, surgery may be indicated in cases where the tumour location causes such symptoms.

Level of Evidence: Level V (Therapeutic)
Industrial Internet of Things Ecosystems Security and Digital Forensics: Achievements, Open Challenges, and Future Directions
Authors: Kebande Victor R. , Awad Ali Ismail
Published: December 2023

The Industrial Internet of Things (IIoT) has been positioned as a key pillar of the Industry 4.0 revolution, which is projected to continue accelerating and realizing digital transformations. The IIoT is becoming indispensable, providing the means through which modern communication is conducted across industries and offering improved efficiency, scalability, and robustness. However, the structural and dynamic complexity introduced by the continuous integration of the IIoT has widened the scope for cyber-threats, as the processes and data generated by this integration are susceptible and vulnerable to attacks. This article presents an in-depth analysis of the state-of-the-art in the IIoT ecosystem from security and digital forensics perspectives. The dimensions of this study are twofold: first, we present an overview of the cutting-edge security of IIoT ecosystems, and second, we survey the literature on digital forensics. The key achievements, open challenges, and future directions are identified in each case. The challenges and directions for future studies that we identify will provide important guidance for cybersecurity researchers and practitioners.
Arbitrary Virtual Try-on Network: Characteristics Preservation and Tradeoff between Body and Clothing
Authors: Liu Yu , Zhao Mingbo , Zhang Zhao , Liu Yuping , Yan Shuicheng
Published: December 2023

Deep learning based virtual try-on system has achieved some encouraging progress recently, but there still remain several big challenges that need to be solved, such as trying on arbitrary clothes of all types, trying on the clothes from one category to another and generating image-realistic results with few artifacts. To handle this issue, we in this article first collect a new dataset with all types of clothes, i.e., tops, bottoms, and whole clothes, each one has multiple categories with rich information of clothing characteristics such as patterns, logos, and other details. Based on this dataset, we then propose the Arbitrary Virtual Try-On Network (AVTON) that is utilized for all-type clothes, which can synthesize realistic try-on images by preserving and trading off characteristics of the target clothes and the reference person. Our approach includes three modules: (1) Limbs Prediction Module, which is utilized for predicting the human body parts by preserving the characteristics of the reference person. This is especially good for handling cross-category try-on task (e.g., long sleeves ↔ short sleeves or long pants ↔ skirts), where the exposed arms or legs with the skin colors and details can be reasonably predicted; (2) Improved Geometric Matching Module, which is designed to warp clothes according to the geometry of the target person. We improve the TPS based warping method with a compactly supported radial function (Wendland’s Ψ-function); (3) Trade-Off Fusion Module, which is to tradeoff the characteristics of the warped clothes and the reference person. This module is to make the generated try-on images look more natural and realistic based on a fine-tune symmetry of the network structure. Extensive simulations are conducted and our approach can achieve better performance compared with the state-of-the-art virtual try-on methods.
TCN-SA: A Social Attention Network Based on Temporal Convolutional Network for Vehicle Trajectory Prediction
Authors: Li Qin , Ou Bingguang , Liang Yifa , Wang Yong , Yang Xuan , Li Linchao
Published: December 2023

Vehicle trajectory prediction can provide important support for intelligent transportation systems in areas such as autonomous driving, traffic control, and traffic flow optimization. Predicting vehicle trajectories is an extremely challenging task that not only depends on the vehicle’s historical trajectory but also on the dynamic and complex social-temporal relationships of the surrounding traffic network. The trajectory of the target vehicle is influenced by surrounding vehicles. However, existing methods have shortcomings in considering both time dependency and interactive dependency between vehicles or insufficient consideration of the impact of surrounding vehicles. To address this issue, we propose a hybrid deep learning model based on a temporal convolutional network (TCN) that considers local and global interactions between vehicles. Specifically, we use a social convolutional pooling layer to capture local interaction features between vehicles and a multihead self-attention layer to capture global interaction features between vehicles. Finally, we combine these two features using an encoder-decoder structure to predict vehicle trajectories. Through experiments on the Next-Generation Simulation (NGSIM) public dataset and ablation experiments, we validate the effectiveness of our model.