bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome of different endovascular modalities to treat common iliac artery aneurysms, single center study
Authors: Morshed Ahmed M. , Farag Mohammed , Mowafy Khalid A. , Elkiran Yasser M. , Mastracci Tara M.
Published: July 2023

Introduction

Iliac aneurysms occur in 10% of patients with abdominal aortic aneurysms (AAA). There are three different endovascular approaches to their treatment in the context of infrarenal Endovascular Aortic Aneurysm Repair (EVAR): occlusion by coiling the internal iliac, incorporation using an iliac branch device, and delaying repair using a bell bottom limb. We sought to determine outcomes associated with these three strategies in our practice.

Methodology

The study was a combined prospective cohort study with a retrospective arm: prospective patient recruitment was done for 1 year from September 2019 and ended by September 2020, and retrospective data was collected from 2017 to 2019. Demographic, procedural, and imaging data was collected. SPSS was used to analyze data as patients were classified by limbs in four groups: iliac branched, bell bottom, coil and cover technique, and standard treated limbs.

Results

There were 65 male and 4 female patients included in this study incorporating 137 limbs with a mean age of 78 years (SD ± 8 years). Two patients died after discharge (at 3 and 21 months postoperatively, without hospital admission) and five patients were lost to long-term follow-up. Three patients had operations that deviated from the plan: one was an IBD converted to bell bottom, one was an IBD that was converted to coil and cover, and one was a bell bottom that did not seal. Follow-up revealed late type IB endoleak in three bell bottom limbs and one limb treated with coil and cover. Common iliac occlusion occurred in one IBD, three bell bottom limbs, and two limbs treated with coil/cover technique. There were four additional ischemic events (buttock claudication in three and intestinal ischemia in one): all ischemic events occurred in the coil and cover group ( p = .001).

Conclusions

Given the small population size examined in this study, there is no statistical difference between treatment groups; however, there was a trend toward bell bottom technique being associated with higher incidence of type IB endoleak. Coil and cover technique was associated with decreased IB endoleak; however, Buttock claudication and intestinal ischemia occurred more significantly in this group. Using IBD may be the best strategy to improve short- and long-term outcomes in patients with iliac aneurysms.
Herpes zoster and human papillomavirus vaccination opportunities identified using electronic prompts at the time of scheduling influenza or COVID-19 vaccines
Authors: Houle Sherilyn K.D. , Alsabbagh Mhd. Wasem , Waite Nancy M.
Published: July 2023

Background:

Due to workload and competing priorities, vaccination-related interactions in community pharmacies tend to be more reactive than proactive. The aim of this study is to determine the proportion of users of a web-based scheduling system for influenza and COVID-19 vaccines who may be eligible for herpes zoster or human papillomavirus (HPV) vaccination and interested in discussing these vaccines with a pharmacist.

Methods:

Individuals scheduling an influenza or COVID-19 vaccine at a pharmacy using the MedEssist platform between October 2021 and March 2022 were asked about their vaccination status against HPV (if aged 9-45) or herpes zoster (if aged ≥50). Those who were unvaccinated or unsure were asked to indicate their willingness to discuss this with a pharmacist. Logistic regression was performed to identify patient characteristics associated with responses to these screening questions.

Results:

Among 36,659 bookings by those aged 9 to 45 and 55,728 by those aged ≥50 that included responses to screening questions, 70.1% and 55.5% were potentially unvaccinated against HPV and herpes zoster, respectively, with approximately 1 in 5 also indicating willingness to have a discussion with the pharmacist. Those scheduling appointments for COVID-19 vaccines were significantly less likely to be vaccinated against HPV or herpes zoster and less willing to discuss this with a pharmacist than those seeking influenza vaccination.

Discussion:

Automated prompts while booking influenza or COVID-19 vaccinations have the potential to identify vaccine-willing individuals who may benefit from further discussion on their vaccination needs.

Conclusion:

Community pharmacies can leverage available technology to support the efficient and effective identification of individuals eligible for vaccination.
Ni(II) and Pd(II) complexes bearing novel chiral bis(β-ketoamino) ligand and their catalytic activity toward copolymerization of norbornene and polar norbornene derivatives
Authors: Liu Wanyun , Huo Ping , Yuan Lin , Zhao Bowen , Ge Junying
Published: July 2023

A series of novel Ni(II) and Pd(II) complexes bearing chiral bis(β-ketoamino) ligand were synthesized and characterized. The Ni(II) and Pd(II) complexes exhibited high activities for norbornene homopolymerization with only B(C6F5)3 as cocatalyst, for Ni(II) complex even up to 1.38 ×106 gpolymer/molNi·h. All the complexes had good thermal stability. Most importantly, the complexes also displayed high activities of 105 gpolymer/molmetal·h toward the copolymerization of norbornene and 5-norbornene-2-yl acetate with high molecular weights and tunable norbornene and 5-norbornene-2-yl acetate content. The copolymerization activity, molecular weight, and norbornene and 5-norbornene-2-yl acetate feed ratio of the Ni complex were higher than those of the Pd complex.
The progression of hepatorenal syndrome–acute kidney injury in acute alcohol-associated hepatitis: renal outcomes after liver transplant
Authors: Colletta Alessandro , Cooper Katherine M. , Devuni Deepika
Published: July 2023

Background:

Hepatorenal syndrome–acute kidney injury (HRS-AKI) is a complication of advanced liver disease in patients with ascites and circulatory dysfunction. Little data remain on the relationship between HRS-AKI outcomes and different etiologies of liver disease post-liver transplant (LT).

Objectives:

The primary aim was to evaluate the effect of HRS-AKI on renal outcomes in patients with acute alcohol-associated hepatitis (AAH) compared to chronic liver disease (CLD) after LT. The secondary aim was to evaluate the impact of acuity and chronicity of alcohol-associated liver disease in patients with HRS-AKI post-LT renal outcomes.

Design:

A retrospective observational study of patients undergoing urgent inpatient liver transplant evaluation (LTE) for cirrhosis and AAH at single academic LT center between October 2017 and July 2021 was conducted.

Methods:

Patients with HRS-AKI were selected based on indication for LTE: acute AAHHRS or CLDHRS. CLDHRS was categorized by disease etiology: cirrhosis due to alcohol (A-CLDHRS) versus cirrhosis from other causes (O-CLDHRS). CLD patients without HRS-AKI were labeled CLDno HRS.

Results:

A total of 210 subjects underwent LTE; 25% were evaluated for AAH and 75% were evaluated for CLD. Hepatorenal syndrome was more common in subjects evaluated for AAH (37/47) than CLD (104/163) (78.7 versus 63.8%, p = 0.04). For the primary outcome, AAHHRS subjects required ⩾30 days post-LT renal replacement therapy (RRT) more often than subjects with CLDHRS ( p = 0.02) and CLDno HRS ( p < 0.01). There was no significant difference in other forms of long-term renal outcomes including kidney transplant referral and kidney transplant among cohorts. In subgroup analysis, 30-days post-LT RRT was more common in AAHHRS than in A-CLDHRS ( p = 0.08). Logistic regression showed that AAHHRS conferred a 20× and 3.3× odds of requiring ⩾30 days post-LT RRT compared to CLDno HRS and CLDHRS, respectively. Postoperative complications were similar across cohorts, but had a significant effect on 30-day renal outcome post-LT.

Conclusions:

Patients with AAH were more likely to develop HRS and require RRT pre- and post-LT at our center. The etiology of hepatic decompensation and postoperative complications affect renal recovery post-LT. The systemic inflammation of AAH in addition to conditions favoring renal hypoperfusion may contribute to the unfavorable outcomes of HRS-AKI after LT in this patient population.
Situating and expanding the scope of dispositions towards automation
Authors: Lin Weiqiang , Adey Peter , Harris Tina
Published: July 2023

The four generous commentaries to our article, ‘Dispositions towards automation’, have truly enriched and extended our thinking on ‘dispositions’ as a way of challenging binary readings of automation (i.e. either towards capitulation or adaptation). Two of our interlocutors have encouraged us to think more situationally about the way dispositions develop through user experience and encounter, while the other two welcome a further expansion of our ideas to include infrastructural and other non-human or environmental agencies. In this response, we clarify our original curiosities about capital's affective projects with respect to automation, as well as its attempts at steering dispositions in order to mitigate, precisely, the indeterminacy of labour and user ‘reactions’. At the same time, we discuss how the four provocations have inspired us to re-assemble these tendencies and sentiments more plurally, to incorporate a series of overlapping affects, capitalist plots, shifting design values, detours, exigencies, digital glitches, and material interjections. We are impressed by the holism of perspectives presented in this dialogue, and how the discussion has only reinforced ideas about the fragility of automation's relations.
Severe multiple organ failure as a consequence of diabetic ketoacidosis in an adolescent with new-onset type 1 diabetes: A case report
Authors: Modarelli Rachel , Brown Lauren , Boyd Jenny , Podd Bradley , Willis Zachary , Levenson Amy
Published: July 2023

The initial presentation of pediatric diabetes is variable, making prompt diagnosis and treatment challenging. The overlap between type 1 and type 2 diabetes and presence of developmental delays can complicate diagnosis, resulting in delays and severe illness at presentation. Here we describe a case of a 13-year-old male with autism and attention deficit hyperactivity disorder who presented with severe diabetic ketoacidosis, multiple organ failure, and shock. Within 2 weeks of this initial presentation, he had further clinical decompensation due to an intestinal perforation. Cultures from resected gastrointestinal tissue grew mucormycosis, protracting his hospital stay and recovery. He was able to go home several months later with remarkable improvement. This case highlights the necessity of careful history taking and early testing, and how investigation for rare complications of diabetes is vital when patients do not improve as expected.
A case of giant prolactinoma and pituitary hemorrhage with the late recovery of pituitary function: A case report
Authors: Menon Lakshmi P , Edem Dinesh
Published: July 2023

Hypogonadotropic hypogonadism is a common finding in patients who are diagnosed with a prolactinoma. It can be accompanied by the presence of other pituitary hormone deficits, including secondary adrenal insufficiency and central hypothyroidism. While the proportion of improvement in endocrine deficits over the short term is well characterized, there is not enough literature about the recovery of pituitary function over the longer term. We present the case of a 23-year-old man with a giant prolactinoma who initially presented with pituitary hemorrhage and panhypopituitarism. He underwent decompression of the pituitary tumor followed by treatment with cabergoline. Over a 9-year follow-up period, we noted that the hypogonadotropic hypogonadism resolved after 4 years and the secondary adrenal insufficiency resolved after 8 years. This case suggests that partial or complete recovery of the pituitary function is possible over the long-term even in patients with a giant prolactinoma.
Using fsQCA to Illuminate Person Attributes of Music Engagement in Alzheimer's Disease
Authors: Vanstone Ashley D. , Cui Anja-Xiaoxing , Cuddy Lola L.
Published: July 2023

Preserved engagement with music in Alzheimer's disease (AD) is noteworthy given that such persons lack interest and engagement in the activities of daily life. Because music engagement is associated with increased well-being, illuminating personal attributes that facilitate music engagement is an important step towards utilizing music as a therapeutic tool. Here, we use Fuzzy Set Qualitative Comparative Analysis, a systematic approach to case study series analysis, to explore the role of personal attributes such as musical semantic memories, music perceptual abilities, and overall cognitive status in facilitating music engagement in 15 individuals with a diagnosis of probable AD. Nine different solution terms revealed many different pathways to preserved music engagement in AD. Solutions demonstrated the equifinality of music engagement and the usefulness of the qualitative comparative analysis approach. This article is meant to provide both concrete evidence for the role of different person attributes in music engagement in AD and an illustration of the application of qualitative comparative analysis. We discuss our results using the Comprehensive Process Model as a framework and provide suggestions on how to incorporate qualitative comparative analysis in the research workflow.
Availability of Evidence-Based Diabetes Programs in U.S. Children’s Hospitals
Authors: Hughes Allyson S. , Gutierrez Angela , Flint Julia , Franz Berkeley
Published: July 2023

Diabetes affects Americans across the lifespan requiring individual and community-level interventions for prevention and management. Nonprofit hospitals are required to address community health needs under current tax law. The study objective was to assess what strategies children’s hospitals implemented in prevention and care of diabetes and determine how many hospitals used evidence-based strategies. We identified the most recent Children’s Hospital Needs Assessments and implementation strategies for each hospital. Data were thematically coded. Twenty-nine of the 233 U.S. children’s hospitals addressed diabetes in their community benefit investments. Of the 130 hospital programs, 48 (37%) aligned with the DSMES framework. Programs focused on prevention (32%), healthy eating (18%), education (15%), physical activity (12%), quality improvement (11%), and self-management (5%). Most children’s hospital interventions (85%) did not state a focus on reducing health disparities and none addressed problem solving or diabetes technology. Minimal hospitals are using evidence-based programming for diabetes management and are not targeting health disparities which undercuts their efforts. Hospitals are not adopting structural evidence-based approaches, missing key opportunities to implement strategies shown to reduce diabetes prevalence and lower A1c. This study suggests that children’s hospitals need improvement in their diabetes programming to better serve their communities.
Providers’ Perspectives Related to Parents’ Choice of Pediatric Provider of Record and Newborn Screening: A Qualitative Study
Authors: Lowe Tracy , Boyd Jessica , Shu Lina , DeLuca Jane M.
Published: July 2023

The pediatric provider of record has a significant role in newborn screening and maintaining infant health after birth. Procedural errors and delays in communication can hinder the identification of infants with critical illnesses or follow up of unsatisfactory NBS samples. For this study, key stakeholders, including nurses, physicians, and midwives were interviewed to understand how the pediatric provider of record is selected by parents and examine factors affecting the newborn screening education and processes in the perinatal period. Provider responsibilities, timing of parent education, and social determinants of health played a role in parents’ choices of the pediatric provider. Investment in future intervention programs is needed for reducing the number of infants without a designated pediatric provider of record. Research is needed to understand social complexities and healthcare systems which affect parents’ choices of pediatric providers and newborn screening processes to optimize clinical outcomes for infants.
The Effect of Diversification Strategy on Corporate Tax Aggressiveness With Board Effectiveness as the Moderating Variable
Authors: Pramudito Rilo , Nuryanah Siti
Published: July 2023

This research examines the effect of diversification strategy on corporate tax aggressiveness activities with board effectiveness as the moderating variable. This study brings a context of the ASEAN Economic Community (AEC), which is argued inducing diversification strategies taken by companies in ASEAN countries. A sample from a developing country, that is, Indonesia, is collected due to this country’s specific characteristics related to tax regimes. Therefore, 246 observations from non-financial listed companies from 2014 to 2016 are used. The findings show that the firms with an international diversification strategy positively associate with corporate tax aggressiveness. On the other hand, companies conducting industrial diversification strategies were found to have ineffective tax management. The study also found an ineffective board of commissioners in the condition of corporate tax aggressiveness and ineffective tax management. This study brings some practical implications that the government needs to evaluate its tax policy while business practitioners must choose a business strategy congruent with tax management.
Predictors of Postoperative Segmental and Overall Lumbar Lordosis in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Consecutive Case Series
Authors: Zhang Justin K. , Greenberg Jacob K. , Javeed Saad , Benedict Braeden , Botterbush Kathleen S. , Dibble Christopher F. , Khalifeh Jawad M. , Brehm Samuel , Jain Deeptee , Dorward Ian , Santiago Paul , Molina Camilo , Pennicooke Brenton H. , Ray Wilson Z.
Published: July 2023

Study Design

Retrospective Case-Series.

Objectives

Due to heterogeneity in previous studies, the effect of MI-TLIF on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Therefore, we aim to identify radiographic factors associated with lordosis after surgery in a homogenous series of MI-TLIF patients.

Methods

A single-center retrospective review identified consecutive patients who underwent single-level MI-TLIF for grade 1 degenerative spondylolisthesis from 2015-2020. All surgeries underwent unilateral facetectomies and a contralateral facet release with expandable interbody cages. PROs included the ODI and NRS-BP for low-back pain. Radiographic measures included SL, disc height, percent spondylolisthesis, cage positioning, LL, PI-LL mismatch, sacral-slope, and pelvic-tilt. Surgeries were considered “lordosing” if the change in postoperative SL was ≥ +4° and “kyphosing” if ≤ -4°. Predictors of change in SL/LL were evaluated using Pearson’s correlation and multivariable regression.

Results

A total of 73 patients with an average follow-up of 22.5 (range 12-61) months were included. Patients experienced significant improvements in ODI (29% ± 22% improvement, P < .001) and NRS-BP (3.3 ± 3 point improvement, P < .001). There was a significant increase in mean SL (Δ3.43° ± 4.37°, P < .001) while LL (Δ0.17° ± 6.98°, P > .05) remained stable. Thirty-eight (52%) patients experienced lordosing MI-TLIFs, compared to 4 (5%) kyphosing and 31 (43%) neutral MI-TLIFs. A lower preoperative SL and more anterior cage placement were associated with the greatest improvement in SL (β = -.45° P = .001, β = 15.06° P < .001, respectively).

Conclusions

In our series, the majority of patients experienced lordosing or neutral MI-TLIFs (n = 69, 95%). Preoperative radiographic alignment and anterior cage placement were significantly associated with target SL following MI-TLIF.
Differences in the Severity and Location of Patellofemoral Cartilage Damage Between Instability Patients With and Without Patella Alta
Authors: Johnson Emma E. , Campbell Michael P. , Reddy Manoj , Paul Ryan W. , Erickson Brandon J. , Tjoumakaris Fotios P. , Freedman Kevin B. , Bishop Meghan E.
Published: July 2023

Background:

Patella alta is a risk factor for recurrent patellar instability. Differences in chondral injury in patients with patellar instability between patella alta and patella norma have not been evaluated.

Purpose:

To analyze whether preoperative cartilage damage differs in severity and location between patellar instability patients with and without patella alta.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients with patellar instability who underwent patellar realignment surgery at a single institution with preoperative magnetic resonance imaging (MRI) scans were included. After measurement of Caton-Deschamps index (CDI) on MRI, patients were divided into patella alta (CDI ≥1.3) and patella norma groups. The area measurement and depth and underlying structures (AMADEUS) score was used to quantify cartilage defect severity on MRI.

Results:

A total of 121 patients were divided into patella alta (n = 50) and patella norma (n = 71) groups. The groups did not differ significantly in sex ratio, age at MRI, body mass index, mean reported number of previous dislocations, or mean interval between first reported dislocation and date of MRI. A total of 34 (68%) of the patella alta group and 44 (62%) of the patella norma group had chondral defects ( P = .625) with no significant between-group differences in defect size ( P = .419). In both groups, chondral injuries most affected the medial patellar facet (55% in patella alta vs 52% in patella norma), followed by the lateral facet (25% vs 18%), and lateral femoral condyle (10% vs 14%). A smaller proportion of patients had full-thickness defects in the patella alta compared with the patella norma group (60% vs 82%; P = .030). The overall AMADEUS score was higher for the patella alta versus the patella norma group (68.9 vs 62.1; P = .023), indicating superior articular cartilage status.

Conclusion:

Patients with patella alta had less severe cartilage injury after patellar instability, including a lower proportion with full-thickness defects and better overall cartilage grade. The location of injury when present was similar between alta and norma, with most defects affecting the medial facet, lateral facet, and lateral femoral condyle in descending frequency.
Characteristics and Factors Associated With Age and Gender Among Peruvian Children and Adolescents Who Are Victims of Sexual Violence
Authors: Roman-Lazarte Victor , Roman Luz Angela , Galeas-Torre Maryorie Katteryne
Published: July 2023

Objectives. To identify the characteristics and factors associated with the gender and age of victims and aggressors. Methodology. A cross-sectional study was conducted using data from the Ministry of Women and Vulnerable Populations. Linear regression and Poisson regression were used to determine β coefficients and prevalence ratios (PR) between general characteristics and victim gender and age. Results. A total of 6929 records were analyzed. Factors associated with victim gender included urban area of residence ( P < .001), alcohol consumption ( P < .001). Factors associated with older victim age were being female (β = 3.08) and not being related to the aggressor (β = 1.73). Aggressors were older if they were the father (β = 7.58) or stepfather (β = 5.08), and if the rape had occurred previously (β = 6.11). Conclusions. There are factors directly associated with the gender and age of the victim. Strategies to prevent sexual assaults, especially within the family context, should be strengthened.
Winning a Battle while Losing the War: An Assessment of Afghan-led, US-Supported Counterinsurgency in Nangarhar Province, Afghanistan, 2019–2020
Authors: Miakhel Shahmahmood
Published: July 2023

There is an extensive literature on counterinsurgency strategy, its various campaigns as they were pursued in Afghanistan and the global war on terror that anchored the rationale behind them. But nearly all of this discourse has been steered by international experts and practitioners. The field lacks firsthand accounts and analysis from senior Afghan officials and military professionals. This account, which explores the Afghan government-led counterinsurgency campaign in Nangarhar province from February 2019 to July 2020, seeks to narrow that literature gap and to shed light on broader challenges and shortcomings facing the wider counterinsurgency campaign of United States intervention across Afghanistan for 20 years, which eventually ended up with recapturing of power by the Taliban in August 2021.
Unconventional treatment of inoperable biliary IPMN with an oesophageal stent in the common bile duct: case report
Authors: Siiki Antti , Antila Anne , Vaalavuo Yrjö , Ronkainen Johanna , Rinta-Kiikka Irina , Laukkarinen Johanna
Published: July 2023

Biliary intraductal papillary mucinous neoplasm (IPMN) is a rare biliary neoplasia preferably treated with oncologic resection. Endoscopic radio frequency (RF) ablation may be used as a palliative measure. We present a rare case, where heavy co-morbidities prevented surgery. Continuous mucus production caused recurrent episodes of severe cholangitis. Several ERCPs (endoscopic retrograde cholangio pancretography) were necessary due to recurrent biliary obstruction. RF ablation was not effective in the dilated common bile duct without a stricture. Standard biliary stents failed due to either migration or occlusion. When other options failed, an exceptional decision was made: a covered large diameter oesophageal stent was inserted in ERCP into the bile duct to secure bile flow and stop mucus production. Digital cholangioscopy was crucial adjunct to standard ERCP in endoscopic management. The palliative treatment method was successful: there were no stent-related adverse events or readmissions for cholangitis. The follow-up in the palliative care lasted until patient’s last 10 months of lifetime.
New ways to impact primary palliative care practices using online continuing education
Authors: Berke Charlene , Mollman Sarah , Skoglund Amy , Pravecek Brandi , Perrenoud Mari , Stewart Carol
Published: July 2023

Background:

Healthcare professionals trained in palliative care (PC) improve satisfaction and decrease healthcare overutilization for patients with serious illness and their families. A continuing education (CE) series on primary PC aligned to the National Clinical Practice Guidelines for Quality PC was developed by local, interdisciplinary experts for a target audience of rural, primary care healthcare professionals. The modules were accessed on an online learning management system platform.

Objective:

The study objectives were to assess differences in participants’ knowledge, competence, performance, and ability to improve patient care as well as commitment to change practice after taking each of the CE modules.

Design and Methods:

To achieve these objectives, a descriptive design was used with a convenience sample of healthcare professionals who registered for the CE series and completed at least one module. Participants completed demographic questions and an evaluation survey after completing each module.

Results:

So far, 158 healthcare professionals have registered for the series with the majority being nurses and social workers. Although the professionals reported having extensive healthcare experience, they did not report having the same level of PC experience. The professionals represent nine different states. All the CE modules increased teamwork skills for most participants. The CE modules on cultural aspects and self-care had the biggest influence on participants’ ability to improve patient outcomes. Cultural aspects, care of the actively dying, and advance care planning had the greatest impact on participants’ knowledge, competence, and performance.

Conclusion:

The primary PC education series improved self-reported skills in teamwork, practice habits, and meeting goals of healthcare professionals from a variety of disciplines and settings. These enhanced primary PC skills will improve the incorporation of PC into a variety of practice settings, by multiple disciplines to enhance access to PC outside of, and potentially referrals to, specialty PC programs. Palliative care (PC) is an emerging field of healthcare aimed at positively affecting patients living with serious illness and their families. An important factor that influences a health professional’s successful delivery of PC may be their knowledge, experiences, and confidence. PC training provided to healthcare professionals improves patients’ and healthcare professionals’ satisfaction and reduces healthcare expenditures through cost savings and cost avoidance.1,2
Discrete Optimization on Unsteady Pressure Fluctuation of a Centrifugal Pump Using ANN and Modified GA
Authors: Wang Wenjie , Deng Qifan , Pei Ji , Chen Jinwei , Gan Xingcheng
Published: July 2023

Pressure fluctuation due to rotor-stator interaction in turbomachinery is unavoidable, inducing strong vibration in the equipment and shortening its lifecycle. The investigation of optimization methods for an industrial centrifugal pump was carried out to reduce the intensity of pressure fluctuation to extend the lifecycle of these devices. Considering the time-consuming transient simulation of unsteady pressure, a novel optimization strategy was proposed by discretizing design variables and genetic algorithm. Four highly related design parameters were chosen, and 40 transient sample cases were generated and simulated using an automatic program. 70% of them were used for training the surrogate model, and the others were for verifying the accuracy of the surrogate model. Furthermore, a modified discrete genetic algorithm (MDGA) was proposed to reduce the optimization cost owing to transient numerical simulation. For the benchmark test, the proposed MDGA showed a great advantage over the original genetic algorithm regarding searching speed and effectively dealt with the discrete variables by dramatically increasing the convergence rate. After optimization, the performance and stability of the inline pump were improved. The efficiency increased by more than 2.2%, and the pressure fluctuation intensity decreased by more than 20% under design condition. This research proposed an optimization method for reducing discrete transient characteristics in centrifugal pumps.
A higher probability of subsequent stroke and ischemic heart disease in migraine patients: a longitudinal follow-up study in Korea
Authors: Kwon Mi Jung , Choi Hyo Geun , Kim Yoo Hwan , Kim Joo-Hee , Rim Hyun Taek , Lee Heui Seung , Oh Jae Keun , Chang In Bok , Song Joon Ho , Kim Ji Hee
Published: July 2023

Background

Whether migraine is related to the risk of cardiovascular diseases (CVDs) remains unclear. Therefore, we conducted a longitudinal follow-up study to address the association between migraine and the development of CVDs in Korea.

Methods

Using data from the national health screening cohort, we included 45,246 patients diagnosed with migraine between 2002 and 2019 and age-, sex-, income-, and residential region-matched nonmigraine participants at a ratio of 1:4. Participants with previous CVDs were excluded. Cox proportional hazards regression models were used to estimate the hazard ratios of three CVDs, stroke, ischemic heart disease, and heart failure, in patients with migraine after adjusting for potential cardiovascular risk factors.

Results

The incidence rate differences of stroke, ischemic heart disease, and heart failure among patients with migraine were 2.61, 1.69, and 0.11, respectively. The probability of developing stroke and ischemic heart disease in patients with migraine was significantly higher than that in controls after controlling for multiple confounders (adjusted hazard ratio [HR] = 1.35, 95% confidence interval [CI] = 1.31–1.39 and adjusted HR = 1.31, 95% CI = 1.26–1.35, respectively). However, when compared with the patients without migraine, patients with migraine did not have an increased HR of developing heart failure (adjusted HR = 1.01, 95% CI = 0.95–1.08). The overall migraine group, as well as groups stratified by migraine subtypes with and without aura, each showed a significantly higher probability of subsequent stroke and ischemic heart disease than the control group.

Conclusions

Our longitudinal follow-up study demonstrated a significant association between the presence of migraine and the development of stroke and ischemic heart disease in Korea, even after adjusting for cardiovascular risk factors.
Anesthesia quality indicators to measure and improve your practice: a modified delphi study
Authors: Yee May-Sann , Tarshis Jordan
Published: July 2023

Background

Implementation of the new competency-based post-graduate medical education curriculum has renewed the push by medical regulatory bodies in Canada to strongly advocate and/or mandate continuous quality improvement (cQI) for all physicians. Electronic anesthesia information management systems contain vast amounts of information yet it is unclear how this information could be used to promote cQI for practicing anesthesiologists. The aim of this study was to create a refined list of meaningful anesthesia quality indicators to assist anesthesiologists in the process of continuous self-assessment and feedback of their practice.

Methods

An initial list of quality indicators was created though a literature search. A modified-Delphi (mDelphi) method was used to rank these indicators and achieve consensus on those indicators considered to be most relevant. Fourteen anesthesiologists representing different regions across Canada participated in the panel.

Results

The initial list contained 132 items and through 3 rounds of mDelphi the panelists selected 56 items from the list that they believed to be top priority. In the fourth round, a subset of 20 of these indicators were ranked as highest priority. The list included items related to process, structure and outcome.

Conclusion

This ranked list of anesthesia quality indicators from this modified Delphi study could aid clinicians in their individual practice assessments for continuous quality improvement mandated by Canadian medical regulatory bodies. Feasibility and usability of these quality indicators, and the significance of process versus outcome measures in assessment, are areas of future research.
Comparison of outcomes of self-expanding versus balloon-expandable valves for transcatheter aortic valve replacement: a meta-analysis of randomized and propensity-matched studies
Authors: Wang Baiqiang , Mei Zeyuan , Ge Xiao , Li Yunyi , Zhou Quan , Meng Xiao , An Guipeng
Published: July 2023

Background

The postoperative outcomes of transcatheter aortic valve replacement (TAVR) with the new generation of self-expanding valves (SEV) and balloon-expandable valves (BEV) remain uncertain.

Methods

We conducted a meta-analysis based on randomized controlled trials (RCTs) and propensity score-matched (PSM) studies to evaluate the performance of the new generation TAVR devices, with a focus on Edwards SAPIEN 3/Ultra BEV, Medtronic Evolut R/PRO SEV, and Boston ACURATE neo SEV. Our primary endpoints were mortality and complications at both 30 days and one year post-operation.

Results

A total of 4 RCTs and 14 PSM studies were included. Our findings showed no significant difference between SEV and BEV regarding 30-day and 1-year mortality rates. ACURATE SEV required less permanent pacemaker implantation (PPI) at 30-day as compared to SAPIEN BEV, while Evolut SEV required a higher rate of PPI than SAPIEN BEV. The incidence of stroke, major or life-threatening bleeding (MLTB), major vascular complications (MVC), coronary artery obstruction (CAO) and acute kidney injury (AKI) did not differ significantly between the two groups. SEV had a larger effective orifice area (EOA) and lower mean transvalvular gradients (MPG) compared to BEV. However, there was an increased risk of paravalvular leakage (PVL) associated with SEV.

Conclusions

In terms of 30-day mortality, stroke, bleeding, MVC, AKI, CAO, and one-year mortality, there was comparability between the two valve types following TAVR. SEV was associated with better hemodynamic outcomes, except for a higher incidence of PVL. Compared to SAPIEN BEV, ACURATE SEV had a lower risk of PPI at 30 days, while Evolut SEV was associated with a higher risk of PPI. These findings underscore the importance of personalized valve selection.
Parallel administration of nanoliposomal irinotecan and levo-leucovorin for pancreatic cancer
Authors: Takada Ryoji , Ikezawa Kenji , Yamai Takuo , Watsuji Ko , Seiki Yusuke , Kawamoto Yasuharu , Hirao Takeru , Higashi Sena , Urabe Makiko , Kai Yugo , Nakabori Tasuku , Uehara Hiroyuki , Kotani Michiyo , Yagi Toshinari , Kimura Miho , Nozaki Keisuke , Takagi Mari , Ohkawa Kazuyoshi
Published: July 2023

Background

Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil (5-FU)/levo-leucovorin (Levo-LV) was approved for unresectable pancreatic cancer (UR-PC) in March 2020 in Japan. Levo-LV is administered by intravenous infusion over 120 min following 90 min intravenous infusion of nal-IRI (conventional method), causing a significant burden on both patients and the outpatient chemotherapy room owing to the prolonged administration time. Thus, from July 2021, we introduced the simultaneous intravenous administration of nal-IRI and Levo-LV (parallel method) with the approval of the institutional regimen committee.

Methods

We retrospectively reviewed the data of 69 patients with UR-PC who received nal-IRI plus 5-FU/Levo-LV at our hospital between June 2020 and October 2021. We examined the safety of the parallel method and compared the treatment outcomes and administration times between the two methods.

Results

The median age was 66 years (54%, male). Disease statuses were locally advanced, metastatic, and postoperative recurrence after pancreatectomy in 7, 50, and 12 patients, respectively. Nal-IRI plus 5-FU/Levo-LV treatment was second and third-line or later in 35 and 34 patients, respectively. No intravenous line problems were observed during the parallel administration of nal-IRI and Levo-LV. Although there were no significant differences in response rates and adverse events between the two methods, the administration time was significantly shorter in the parallel method than in the conventional method.

Conclusion

The parallel administration of nal-IRI and Levo-LV is clinically safe and not inferior in efficacy. Moreover, parallel administration may offer convenience to patients and healthcare workers by reducing administration time.
Predictors of Pediatric COVID-19 vaccination: a case-control study in Tabriz, Iran
Authors: Sarbakhsh Parvin , Jafari Nasrin , Salemi Saman , Akbarnejad Reza
Published: July 2023

Introduction

COVID-19 vaccination of children can help reduce the severity of the infection and the death rate caused by it and also helps achieve herd immunity. The level of acceptance and high vaccination coverage is the main elements in the success of immunization programs. Children’s vaccination is dependent on their parent’s decision. This study aims to identify predictors of the children’s COVID-19 vaccination accomplishment by their parents.

Method

In this case-control study, 577 vaccinated children as cases and 366 un-vaccinated children as controls were randomly selected from the general population of Tabriz, Iran 2022, and their data were collected by telephone calls and interviews with the children’s parents. Cases and controls were compared in terms of clinical and demographic factors of the child as well as the socioeconomic status (SES) of their parents by using a multivariable mixed-effect logistic regression model.

Results

According to the results of the multivariable logistic regression, the age of the child (OR = 1.26 95% CI (1.14, 1.40), p-value < 0.001), previous COVID-19 infection of the child (OR = 1.92, 95% CI (1.21, 3.04), p-value < 0.001), having no underlying disease in the child (OR = 1.76, 95% CI (1.02, 3.02), p-value = 0.04), the dwelling place of the household (the high-level dwelling in compared to a low level (OR = 3.34, 95% CI (1.6, 6.64), p-value = 0.001), the middle level of dwelling compared with low level (OR = 4.87, 95% CI (2.46, 9.51), p-value < 0.001)), and Father’s job (Employee and technician Fathers compared to worker fathers (OR = 2.99, 95% CI (1.55, 5.77), p-value = 0.001)) were significant independent predictors of children COVID-19 vaccination.

Conclusion

Several demographic and socioeconomic factors were associated with children’s vaccination. Older children, children without any underlying disease, children with a history of COVID-19 infection, and children of parents with higher levels of SES were more likely to receive the COVID-19 vaccine. This finding can be considered in children’s vaccination policymaking.
Changes in dietary and lifestyle behaviors and mental stress among medical students upon Ramadan diurnal intermittent fasting: a prospective cohort study from Taif/Saudi Arabia
Authors: Alotaibi Mohammed I. , Elsamad Ghadir , Aljardahi Abdulaziz N. , Alghamdi Ahmed N. , Alotaibi Abdulrahman I. , Alorabi Hibah M. , Alzahrani Khalid M. , Abdel-Moneim Ahmed S.
Published: July 2023

Background

Intermittent fasting (IF) is a popular dietary plan for weight loss. In fact, fasting is a common practice in different religions such as Buddhism, Hinduism, Judaism, Christianity, and Islam. During the month of Ramadan, more than 1.5 billion Muslims worldwide fast from dawn to sunset. Ramadan diurnal intermittent fasting (RDIF) has health benefits, including a reduction in cardiovascular disease (CVD) risk and an improvement in mood. However, little is known about the effects of RDIF on lifestyle behaviors, such as regular exercise, consuming healthy diet, and avoiding harmful substances, as well as mental stress, and academic performance in high school and university students.

Methods

In this prospective cohort study, two self-reported questionnaires were sent one week before and during the last week of Ramadan (April 2022; Ramadan 1443 in Hijri Islamic Calendar) to assess changes in lifestyle, perceived stress, and academic achievement of medical students at Taif University in Taif city, Saudi Arabia. Healthy lifestyle components data were collected to calculate healthy lifestyle scores, including body mass index, physical activity, adherence to a Mediterranean diet, smoking status, and sleep duration.

Results

RDIF was associated with a healthier lifestyle in both female and male participants (pre-RDIF mean score: 2.42 vs post-RDIF mean score: 2.74; statistical power = 0.99; P-value < 0.05). They were more active and adherent to the Mediterranean diet during RDIF. Additionally, the post-RDIF smoking rate declined by 53.4%. Male participants showed higher perceived stress scores during RDIF (pre-RDIF mean score: 19.52 vs post-RDIF mean score: 22.05; P-value < 0.01). No changes in academic performance were observed upon RDIF.

Conclusion

Medical students show healthier dietary and lifestyle behaviors and their academic performance is not affected during RDIF. However, perceived stress is higher among male students.
Are flat feet a disadvantage in performing unilateral and bilateral explosive power and dynamic balance tests in boys? A school-based study
Authors: Sagat Peter , Bartik Peter , Štefan Lovro , Chatzilelekas Vangelis
Published: July 2023

Background

Little evidence has been provided regarding physical performance and flat-footedness in school-age children. Although flat feet may decrease the level of motor performance, findings remain inconsistent. Therefore, the main purpose of the study was to determine whether children with flat feet had poorer physical task performance, compared to normal-footed children.

Methods

A total of 208 primary school boys were included in the study (107 normal-footed and 101 flatfooted boys). Flat footedness (< 42°) was determined using Clark’s method. The children were tested by a set of unilateral and bilateral tests selected from the area of ​​explosive power and dynamic balance which included: (i) countermovement jump, (ii) standing broad jump, (iii) the triple crossover hop for distance test, (iv) maximal sprinting speed over 10, 20 and 40 m and (v) the Star Excursion Balance Test. Differences were adjusted for age, body mass index, peak height velocity and physical activity.

Results

Flat footed children exhibited significantly poorer results in bilateral standing broad jump (effect size [ES] = 0.34), unilateral standing broad jump for dominant (ES = 0.31) and non-dominant leg (ES = 0.20), the triple crossover hop for distance test for dominant (ES = 0.24) and non-dominant leg (ES = 0.23) and the Star Excursion Balance Test (ES = 0.23–0.43) and were slower in maximal sprinting speed test over 20 m (ES = 0.25) and 40 m (ES = 0.30).

Conclusions

This study shows that children with flat feet performed poorer in some physical performance tasks, compared to the normal feet counterparts.
Potentilla reptans L. preconditioning regulates H19 and MIAT long noncoding RNAs in H9C2 myoblasts Ischemia/Reperfusion model
Authors: Mirzaei Hassan , Salehi Aref , Javan Bita , Enayati Ayesheh , nabi Morteza Olad , Zahedi Mehdi , Zengin Gokhan
Published: July 2023

The present study aimed to evaluate the effect of the ethyl acetate fraction of P. reptans root (PEF) preconditioning on expressions of lncRNAs H19 and MIAT in H9C2 myoblasts I/R injury.

H9C2 cells were treated with different concentrations ranging from (10–400 µg/ml) of PEF for 24 h, followed by simulation of I/R condition. For I/R experiments, H9C2 cells were subjected with the oxygen and glucose deprivation for 2 h.

H9C2 cell viability was significantly enhanced by PEF preconditioning under I/R condition in a concentration-dependent manner up to 200 µg/ml as a EC50. The PEF significantly diminished the expression of lncRNA MIAT and rate of apoptosis against the I/R group. In addition, PEF pretreated before stimulation I/R condition increased H19 expression compared to the normal PEF group with no statistically significant differences between groups. Hence, the results suggest that PEF can protect cardiomyocytes during hypoxia-induced myocardial cell injury by targeting specific involved genes.