Int J Gynaecol Obstet. 2024 May 9. doi: 10.1002/ijgo.15591. Online ahead of print.
NO ABSTRACT
PMID:38721632 | DOI:10.1002/ijgo.15591
Category: Nevin Manimala
J Neuroendovasc Ther. 2024;18(4):103-109. doi: 10.5797/jnet.oa.2023-0097. Epub 2024 Feb 20.
ABSTRACT
OBJECTIVE: Early intervention with mechanical thrombectomy (MT) is expected to improve the functional outcome in patients with large vessel occlusion (LVO); however, a method for the effective detection of these patients in a prehospital setting and early transport to MT-capable hospitals has not been established. This study aimed to analyze the clinical impact and diagnostic performance of the emergent large vessel occlusion (ELVO) screen and its influence on the transportation time.
METHODS: The emergency medical services (EMS) in one of the secondary medical areas in Akita, Japan, introduced a prehospital triage system employing an ELVO screen and a rotation system of three MT-capable hospitals on December 1, 2021. Patients who were transferred to each of the three hospitals involved in the rotation system according to a predefined priority list from December 2021 to November 2022 were included in the triage group. Patients who underwent MT in the three hospitals before the introduction of the triage system were assigned to the pre-triage group. We compared the transportation time parameters between the two groups and analyzed the performance of the ELVO screen for the diagnosis of LVOs. This study was approved by the institutional review boards of all three hospitals.
RESULTS: Time parameters were compared between the 37 and 42 patients who underwent MT and had detailed data in the triage (n = 351) and pre-triage (n = 43) groups, respectively. The time from door to puncture tended to decrease in the triage group in all hospitals, with one hospital showing a statistically significant shortening of 14 min (p = 0.018). In the triage group, 209 ELVO screen-positive patients were present, with 60 (28.7%) of these having LVO. The sensitivity, specificity, positive and negative predictive values, and area under the curve of the ELVO screen to detect LVO under the present triage system were 87.0%, 47.2%, 28.7%, 93.7%, and 0.671, respectively.
CONCLUSION: The present study demonstrated that the introduction of a triage system may have shortened the time required for MT. ELVO screen may be considered a useful marker for screening LVO in prehospital settings in terms of the sensitivity and negative predictive value; however, further improvement may be necessary to reduce the rate of false positive results.
PMID:38721618 | PMC:PMC11076143 | DOI:10.5797/jnet.oa.2023-0097
Perfusion. 2024 May 8:2676591241253461. doi: 10.1177/02676591241253461. Online ahead of print.
ABSTRACT
INTRODUCTION: Diabetes mellitus (DM) is associated with concomitant comorbidities, such as atherosclerosis and cardiovascular disease. Coronary artery bypass grafting (CABG) surgery is the optimal therapy in diabetic patients with triple vessel disease. DM is also known to be a relevant risk factor for higher morbidity and mortality in patients who underwent elective CABG procedures. Data regarding outcomes in diabetic patients in acute coronary syndrome (ACS) is heterogeneous. This study aimed to investigate the impact of DM on short-term outcomes in patients who underwent CABG surgery in ACS.
METHODS: A retrospective propensity score matched (PSM) analysis of 1370 patients who underwent bypass surgery for ACS between June 2011 and October 2019 was conducted. All patients were divided into two groups: non-diabetic group (n = 905) and diabetic group (n = 465). In-hospital mortality was the primary outcome. Secondary outcomes were perioperative myocardial infarction, new onset dialysis, reopening for bleeding and duration of intensive care unit (ICU) stay. A subgroup analysis of patients with insulin-dependent and non-insulin dependent DM was also performed.
RESULTS: After performing PSM analysis, baseline characteristics and the preoperative risk profile were comparable between both groups. The proportion of patients who underwent total arterial revascularization (p = .048) with the use of both internal thoracic arteries (p < .001) was significantly higher in the non-diabetic group. The incidence of perioperative myocardial infarction (p = .048) and new onset dialysis (p = .008) was significantly higher in the diabetic group. In-hospital mortality was statistically (p = .907) comparable between the two groups.
CONCLUSION: DM was associated with a higher incidence of adverse outcomes, however with comparable in-hospital mortality in patients who underwent CABG procedure for ACS.
PMID:38720184 | DOI:10.1177/02676591241253461
Physiol Rep. 2024 May;12(9):e16032. doi: 10.14814/phy2.16032.
ABSTRACT
INPP4A has been shown to be involved in the regulation of cell proliferation and apoptosis of multiple cell types including fibroblasts. Previous reports from our group have demonstrated the role of inositol polyphosphate 4-phosphatase Type I A (INPP4A) in these functions. Though existing evidences suggest a critical role for INPP4A in the maintenance of lung homeostasis, its role in chronic lung diseases is relatively under explored. In the current study, we made an attempt to understand the regulation of INPP4A in idiopathic pulmonary fibrosis (IPF). Through integration of relevant INPP4A gene expression data from public repositories with our results from in vitro experiments and mouse models, we show that INPP4A is altered in IPF. Interestingly, the direction of the change is dependent both on the disease stage and the region of the lung used. INPP4A was found to be upregulated when analyzed in lung sample representative of the whole lung, but was downregulated in the fibrotic regions of the lung. Similarly, INPP4A was found to be high, compared to controls, only in the early stage of the disease. Though the observed increase in INPP4A was found to be negatively correlated to physiological indices, FVC, and DLCO, of lung function, treatment with anti-INPP4A antibody worsened the condition in bleomycin treated mice. These contrasting results taken together are suggestive of a nuanced regulation of INPP4A in IPF which is dependent on the disease stage, cellular state and extent of fibrosis in the lung region being analyzed.
PMID:38720166 | DOI:10.14814/phy2.16032
Int J Comput Assist Radiol Surg. 2024 May 8. doi: 10.1007/s11548-024-03139-6. Online ahead of print.
ABSTRACT
PURPOSE: This paper considers a new problem setting for multi-organ segmentation based on the following observations. In reality, (1) collecting a large-scale dataset from various institutes is usually impeded due to privacy issues; (2) many images are not labeled since the slice-by-slice annotation is costly; and (3) datasets may exhibit inconsistent, partial annotations across different institutes. Learning a federated model from these distributed, partially labeled, and unlabeled samples is an unexplored problem.
METHODS: To simulate this multi-organ segmentation problem, several distributed clients and a central server are maintained. The central server coordinates with clients to learn a global model using distributed private datasets, which comprise a small part of partially labeled images and a large part of unlabeled images. To address this problem, a practical framework that unifies partially supervised learning (PSL), semi-supervised learning (SSL), and federated learning (FL) paradigms with PSL, SSL, and FL modules is proposed. The PSL module manages to learn from partially labeled samples. The SSL module extracts valuable information from unlabeled data. Besides, the FL module aggregates local information from distributed clients to generate a global statistical model. With the collaboration of three modules, the presented scheme could take advantage of these distributed imperfect datasets to train a generalizable model.
RESULTS: The proposed method was extensively evaluated with multiple abdominal CT datasets, achieving an average result of 84.83% in Dice and 41.62 mm in 95HD for multi-organ (liver, spleen, and stomach) segmentation. Moreover, its efficacy in transfer learning further demonstrated its good generalization ability for downstream segmentation tasks.
CONCLUSION: This study considers a novel problem of multi-organ segmentation, which aims to develop a generalizable model using distributed, partially labeled, and unlabeled CT images. A practical framework is presented, which, through extensive validation, has proved to be an effective solution, demonstrating strong potential in addressing this challenging problem.
PMID:38720159 | DOI:10.1007/s11548-024-03139-6
Environ Monit Assess. 2024 May 9;196(6):525. doi: 10.1007/s10661-024-12649-4.
ABSTRACT
Adıyaman, a city recently affected by an earthquake, is facing significant air pollution challenges due to both anthropogenic activities and natural events. The sources of air pollution have been investigated using meteorological variables. Elevated southerly winds, especially prominent in spring and autumn, significantly contribute to dust transport, leading to a decline in local air quality as detected by the HYSPLIT model. Furthermore, using Suomi-NPP Thermal Anomaly satellite product, it is detected and analyzed for crop burning activities. Agricultural practices, including stubble burning, contribute to the exacerbation of PM10 pollution during the summer months, particularly when coupled with winds from all directions except the north. In fall and winter months, heating is identified as the primary cause of pollution. The city center located north of the station is the dominant source of pollution throughout all seasons. The study established the connection between air pollutants and meteorological variables. Furthermore, the Spearman correlation coefficients reveal associations between PM10 and SO2, indicating moderate positive correlations under pressure conditions (r = 0.35, 0.52). Conversely, a negative correlation is observed with windspeed (r = -0.35, -0.50), and temperature also exhibits a negative correlation (r = -0.39, -0.54). During atmospheric conditions with high pressure, PM10 and SO2 concentrations are respectively 41.2% and 117.2% higher. Furthermore, pollutant concentration levels are 29.2% and 53.3% higher on days with low winds. Last, practical strategies for mitigating air pollution have been thoroughly discussed and proposed. It is imperative that decision-makers engaged in city planning and renovation give careful consideration to the profound impact of air pollution on both public health and the environment, particularly in the aftermath of a recent major earthquake.
PMID:38720137 | DOI:10.1007/s10661-024-12649-4
Environ Sci Pollut Res Int. 2024 May 9. doi: 10.1007/s11356-024-33574-6. Online ahead of print.
ABSTRACT
As a powerful engine for economic reform and curbing carbon emissions, digital inclusive finance provides solid support for achieving the goal of digital carbon neutrality. This study reveals the positive effect of digital inclusive finance on carbon emission reduction and the deeper reasons behind it by digging deeper into the panel data of 213 cities in China. The study adopts advanced empirical analysis methods to rigorously test the association between digital inclusive finance and carbon emissions. The results show that there is a strong positive correlation between the booming development of digital inclusive finance and the significant decline in carbon emissions. This finding remains solid after several rounds of robustness tests, which fully proves the reliability of the research results. Further mechanism analysis reveals the multiple paths of digital financial inclusion on carbon emission reduction. First, it promotes the optimization and upgrading of industrial structure by optimizing the allocation of financial resources, thus reducing the proportion of high-carbon emission industries. Second, digital inclusive finance attracts more foreign capital inflows and introduces advanced low-carbon technologies and management experience, further promoting the development of low-carbon economy. In addition, the study also found that the differences between different cities in terms of geographic location and city size have a significant impact on the carbon emission reduction effect of digital inclusive finance. In particular, the carbon emission reduction effect of digital inclusive finance is particularly significant in western regions, central cities, and first-tier cities. In response to these findings, this paper proposes a series of targeted policy recommendations. First, the financial service system should be further optimized to increase the coverage and penetration of digital inclusive finance, especially in less developed regions and small- and medium-sized cities. Second, regional policy synergies should be strengthened to form a strong synergy to promote the development of a low-carbon economy. In addition, it should guide capital flows to low-carbon industries and encourage enterprises to increase green technology research and development and application, while actively promoting low-carbon consumption concepts and guiding consumers to form green consumption habits. Through the implementation of these measures, it is expected that the potential of digital inclusive finance in the development of a low-carbon economy will be further stimulated, making a greater contribution to the realization of the goals of carbon peaking and carbon neutrality.
PMID:38720127 | DOI:10.1007/s11356-024-33574-6
Environ Sci Pollut Res Int. 2024 May 8. doi: 10.1007/s11356-024-33560-y. Online ahead of print.
ABSTRACT
The impact of climate change has malformed the world’s ecosystem, thus making humans call for environmental protection. Climate change, the biggest trauma of the twenty-first century, has made humans switch towards natural consumption. In this regard, the growing phenomenon of industrialization has spurred consumers to invest more in ecological products. Consuming eco-friendly products has several benefits; however, countries are still unable to satisfy the consumer’s concern for the environment. The current study presents literature on environmental concerns, psychological well-being, willingness to pay for pro-environmental products, pro-environmental self-identity, and pro-environmental consumer behavior, which are required to ensure the consumer’s organic behavior. The research used a questionnaire-driven methodology to gather data from 379 participants. Data analysis was conducted using statistical software packages, specifically SPSS (Version: 4.1.0.0). The suitability of the measurement model was evaluated through structural equation modeling (SEM), which was performed utilizing the SmartPLS. According to the research findings, there is a positive relationship between variables in the study, and individuals with greater levels of psychological well-being are more likely to engage in behaviors that promote sustainable consumption. In order to foster more sustainable consumption patterns in society, policymakers, marketers, and educators may find these findings to be valuable insights. As a result of its empirical exploration of these relationships, the study contributes to the growing body of literature on environmental psychology and sustainable marketing, emphasizing the important role psychological factors play in promoting a greener environment.
PMID:38720125 | DOI:10.1007/s11356-024-33560-y
Aesthetic Plast Surg. 2024 May 8. doi: 10.1007/s00266-024-04048-4. Online ahead of print.
ABSTRACT
BACKGROUND: Macromastia is a physically and psychologically distressing condition for adolescents. While reduction mammaplasty is often the best treatment, risk factors for adolescent wound complications remain unclear. This study aims to investigate the impact of obesity and other predictors of postoperative wound complications following adolescent reduction mammaplasty using a national database.
METHODS: The 2012-2019 National Surgical Quality Improvement Program Pediatric (NSQIP-P) databases were reviewed to identify primary reduction mammaplasty encounters. World Health Organization Body Mass Index (BMI), alongside patient and case characteristics, were assessed for association for 30-day wound disruption or surgical site complications. Statistical analyses were performed to identify independent predictors for complications and determine a potential BMI cutoff for risk stratification.
RESULTS: There were 1215 patients with an average age of 16.6 years. The average BMI was 30.7 kg/m2, and 593 (48.8%) patients were nonobese while 622 (51.2%) were obese. The incidence of complications was 5.27%. Independent predictors of complications included a BMI 35-39.9, BMI > 40, and an American Society of Anesthesiologists (ASA) Classification > 3. A receiver operating characteristic curve determined that a BMI of 34.6 can be a potential cutoff for increased complication risk.
CONCLUSIONS: Higher obesity increases risk of wound complications; however, complication rates remain low. A BMI of 34.6 is a potential screening metric for counseling and monitoring patients. Reduction mammaplasty should remain a viable option as it can significantly improve quality of life.
LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PMID:38720101 | DOI:10.1007/s00266-024-04048-4
Neuroradiology. 2024 May 8. doi: 10.1007/s00234-024-03373-4. Online ahead of print.
ABSTRACT
PURPOSE: To describe fetal brain Magnetic Resonance Imaging (MRI) findings in a large series of monochorionic (MC) pregnancies complicated by Twin Anemia-Polycythemia Sequence (TAPS) prenatally diagnosed, so to characterize the potential intracranial complications associated with this condition, their frequency and potential treatment options.
METHODS: This is a retrospective study of MC twin pregnancies complicated by TAPS and undergone fetal MRI in a single institution from 2006 to 2023. MRI control was performed and post-natal ultrasound (US) or MRI were available.
RESULTS: 1250 MC pregnancies were evaluated in our institution. 50 pregnancies (4%) were diagnosed with TAPS, 29 underwent a fetal brain MRI. 13/29 pregnancies (44.8%) demonstrated brain findings at MRI in at least a twin. Neuroradiological findings were detected in 14/57 twins (24.6%). We detected four main categories of findings: hemorrhagic lesions, T2-weighted white-matter hyperintensities (WMH), brain edema-swelling and venous congestion. Nineteen findings were present in the anemic and three in the polycythemic twins, with a statistically significant ratio between the two groups (p-value = 0.01). Intrauterine MRI follow-up demonstrated the sequalae of hemorrhagic lesions. A complete regression of brain swelling, veins prominence and T2-WMHs was demonstrated after treatment. Postnatal imaging confirmed prenatal features.
CONCLUSIONS: Our work demonstrates that TAPS-related MRI anomalies consisted in edematous/hemorrhagic lesions that occur mostly in anemic rather than in polycythemic twins. Fetoscopic laser surgery could have a potential decongestant role. Therefore, prenatal MRI may help in counselling and management in TAPS pregnancies, especially for the planning of therapy and the monitoring of its efficacy.
PMID:38720066 | DOI:10.1007/s00234-024-03373-4