90-day Intervals Research Articles

HEAT TOLERANCE INDEX IN DAIRY GOATS: CLASS REPORT

To evaluate the influence of the environment on the behavioral and physiological parameters of Saanen and alpine brown goats, disciplinary work was carried out in which a field experiment was conducted, in the municipality of Lajes do Cabugi, Rio Grande do Norte, on the Três property. Brothers, which is a dairy goat production farm. The adaptation of animals to the breeding environment is an important factor for them to have good health and achieve greater productivity, which is one of the objectives of the action of veterinarians, acting preventively (SOUZA et al., 2010; LOPES et al., 2012). When academics participate in pedagogical activities, they develop and prepare more completely for professional life. During the pedagogy, two specimens of each breed were used and observed over a 90-day interval. The following sequence of observations was adopted: 1st observation carried out at 9 am and the 2nd observation was carried out at 3 pm. All animals were female and carried out their normal grazing activities. The animals had access to pasture under identical conditions, as well as access to nutritional supplementation when they returned to the pen at night. The rectal and environmental temperature variables were recorded at 9:00 am and 3:00 pm, and these were used by applying them in the ITC formula (1.0 ta – 20 d +60) (FERREIRA, 2011). The average results obtained were 32.67ºC for room temperature; rectal temperature of the Saanen and alpine brown in the morning and afternoon, respectively, were 40.18ºC and 39.95ºC in the morning; 39.8ºC and 39.75ºC in the afternoon. It was concluded, with the results obtained during the field classes, that the Saanen presented better results compared to the alpine brown for the edaphoclimatic conditions of the property where the research work was carried out. Pedagogically, this activity carried out in the field increases the learning efficiency of veterinary medicine students and favors their better training, reflecting the community's desires and everyone's well-being.

Physicochemical, techno-functional, and proteolytic effects of various hydrocolloids as fat replacers in low-fat cheddar cheese

This study aimed to investigate the physiochemical properties, techno-functional attributes, and proteolytic impacts of incorporating different hydrocolloids as fat substitutes in low-fat cheddar cheese. The effects of hydrocolloids (gums) and dietary fiber, both individually and in combination, were studied for the production of low-fat cheddar cheese with the same textural and functional attributes as full-fat cheese. Physicochemical, techno-functional attributes, organic acid, and proteolysis analyses were performed at 0 and 90-day storage intervals. The results of different combinations were compared with positive (4% fat) and negative (2% fat) controls, and it was observed that using fat replacers improved the textural and functional properties of low-fat cheddar cheese. A significant difference was observed in the meltability and flowability of low-fat cheese samples with different analytes. The proteolysis pattern in low-fat cheese also differed from that of its full-fat counterpart. Three treatments were considered the best: T2 (guar gum at 0.45%), T6 (guar gum, inulin, and resistant starch at 33%), and T7 (all analytes at equal concentrations). The findings revealed that hydrocolloids notably improved the texture, meltability, and sensory characteristics of low-fat cheddar cheese. Additionally, SEM images revealed that the microstructure variations can be attributed to changes in the hydrocolloids water retention and fat content. The Pearson correlation coefficient revealed relationships between different functional properties, contributing to understanding how hydrocolloids as fat replacers impact the overall quality of low-fat cheddar cheese. This study offers useful information for the dairy sector to manufacture low-fat cheeses that have enhanced customer acceptance and provide nutritional advantages.

Efficacy and safety of venlafaxine versus nortriptyline for the preventive treatment of migraine: A double-blind randomized clinical trial

ObjectiveMigraine, as a primary headache disorder, stands as one of the primary causes of disability worldwide. Consequently, prophylactic treatments are highly recommended for individuals experiencing recurrent migraine episodes. Our study aimed to compare the efficacy and safety profiles of venlafaxine and nortriptyline in the prophylactic management of migraine. MethodsIn this single-center, randomized, double-blind clinical trial, 210 migraine patients were allocated into two groups in a 1:1 ratio. One group received venlafaxine (37.5 mg, orally twice daily), while the other group administered nortriptyline (25 mg, orally once daily). A neurologist documented (1) headache intensity using the Visual Analog Scale (VAS) and 6-point Behavioral Rating Scale (BRS-6), (2) headache frequency (per month), and (3) headache duration (in hours) of participants on days 0, 45, and 90 of the intervention. ResultsFollowing the 90-day intervention, a significant decrease was observed in VAS, BRS-6, frequency, and duration of headaches within both groups (all with p-values <0.001). No difference in VAS, BRS-6, or headache durations was observed between the two groups after 45 and 90 days of treatment (all p-values > 0.05). Although the headache frequency exhibited no difference between the groups after 45 days (p-value = 0.097), a significantly lower frequency in the venlafaxine group was observed at day 90 of the intervention (p-value = 0.011). The reductions in attack parameters in the 0–45- and 0–90-day intervals did not meet statistical significance between the two groups (p-values > 0.05). 77.0 % of the participants in the venlafaxine group and 79.2 % in the nortriptyline group experienced a minimum of 50 % improvement in all attack parameters. Venlafaxine demonstrated a statistically significant lower incidence of adverse reactions in comparison to nortriptyline (p-value = 0.005). A total of 33 adverse drug reactions were documented in the venlafaxine group and 53 in the nortriptyline group, with insomnia observed in the former and xerostomia in the latter as the most prevalent side effects. ConclusionsVenlafaxine and nortriptyline demonstrate clinically significant and comparable therapeutic efficacy for migraine patients in reducing the intensity, frequency, and duration of headache attacks. Venlafaxine may be preferred to nortriptyline in the context of migraine preventive treatment under comparable conditions due to its lower incidence of adverse effects.

Protection from prior natural infection vs. vaccination against SARS-CoV-2-a statistical note to avoid biased interpretation.

The fight against SARS-CoV-2 has been a major task worldwide since it was first identified in December 2019. An imperative preventive measure is the availability of efficacious vaccines while there is also a significant interest in the protective effect of a previous SARS-CoV-2 infection on a subsequent infection (natural protection rate). In order to compare protection rates after infection and vaccination, researchers consider different effect measures such as 1 minus hazard ratio, 1 minus odds ratio, or 1 minus risk ratio. These measures differ in a setting with competing risks. Nevertheless, as there is no unique definition, these metrics are frequently used in studies examining protection rate. Comparison of protection rates via vaccination and natural infection poses several challenges. For instance many publications consider the epidemiological definition, that a reinfection after a SARS-CoV-2 infection is only possible after 90 days, whereas there is no such constraint after vaccination. Furthermore, death is more prominent as a competing event during the first 90 days after infection compared to vaccination. In this work we discuss the statistical issues that arise when investigating protection rates comparing vaccination with infection. We explore different aspects of effect measures and provide insights drawn from different analyses, distinguishing between the first and the second 90 days post-infection or vaccination. In this study, we have access to real-world data of almost two million people from Stockholm County, Sweden. For the main analysis, data of over 52.000 people is considered. The infected group is younger, includes more men, and is less morbid compared to the vaccinated group. After the first 90 days, these differences increased. Analysis of the second 90 days shows differences between analysis approaches and between age groups. There are age-related differences in mortality. Considering the outcome SARS-CoV-2 infection, the effect of vaccination versus infection varies by age, showing a disadvantage for the vaccinated in the younger population, while no significant difference was found in the elderly. To compare the effects of immunization through infection or vaccination, we emphasize consideration of several investigations. It is crucial to examine two observation periods: The first and second 90-day intervals following infection or vaccination. Additionally, methods to address imbalances are essential and need to be used. This approach supports fair comparisons, allows for more comprehensive conclusions and helps prevent biased interpretations.

Evaluating the Differences of Wound Related Complications in Robotically Assisted Radical Cystectomy vs Open Radical Cystectomy

ObjectiveTo determine whether robotic assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) compared to open radical cystectomy (ORC) or RARC with extracorporeal urinary diversion (ECUD) would result in a decreased rate of surgical site complications. RARC has been shown to be non-inferior to ORC. Both RARC and ORC are complicated by a high rate of perioperative morbidity, including wound related complications, which may be decreased by a robotic approach with intracorporeal diversion. MethodsA retrospective review of our bladder cancer database for patients undergoing radical cystectomy from 2013 to 2021. Patients were stratified by surgical technique as RARC with ICUD vs. ORC vs. RARC with ECUD. Surgical site complications were measured at both 30 and 90-day intervals. ResultsOf the 269 patients, 127 (47.2%) had RARC with ICUD, 118 (43.7%) had ORC, and 24 (8.9%) had RARC with ECUD (mean ages 71.0, 69.5, 67.5 respectively). A comparison of the three groups demonstrated statistical significance at both the 30-day (p<0.001) and 90-day (p<0.001) timeframes for total surgical site complications, with RARC with ICUD having the fewest amount of patients experience a surgical site complication (0.8%) followed by ORC (25.4%) and RARC with ECUD (29.2%). ConclusionOverall, we observed lower surgical site complication rates among patients undergoing RARC with ICUD compared to patients who underwent ORC or RARC with ECUD. This study suggests that decreased surgical site complications may be one benefit of the minimally invasive approach particularly in patients at high risk for surgical site complications after radical cystectomy.

Thromboembolic incidents in prostate cancer patients: A nationwide propensity-matched study.

e23082 Background: Venous thromboembolic events (VTE) are a major cause of morbidity and mortality in cancer patients. We aim to investigate the outcome and incidence of acute DVT and PE in prostate cancer compared to all other malignancies. Methods: The National Readmission Database (2016-2020) was utilized to identify all-cause admissions for patients with a history of prostate cancer. A Propensity Score Matching (PSM) model, matched such patients with subjects having any type of other malignancies. Pearson’s x2 test was applied to the PSM-2 matched cohorts to compare outcomes. Results: Among 3.2 million all-cause hospitalizations of prostate cancer patients, about 3.3% suffered a VTE. The majority had acute DVT (1.6%), followed by PE (1.1%) &amp; DVT with PE (0.6%). On a propensity-matched &amp; multivariate analysis, patients with prostate cancer have a lower incidence of acute PE (1.1% vs 1.9%, aOR: 0.57), DVT (1.9% vs 2.8%, aOR: 0.65) &amp; combined DVT with PE (0.6% vs 1%, aOR: 0.62) [p &lt; 0.001] as compared to other malignancies. Among different VTEs, the mortality was highest for Acute PE (aOR: 2.69), followed by DVT with PE (aOR: 1.68) &amp; DVT (aOR: 1.55) [p &lt; 0.001] in prostate cancer. Resource utilization is also higher in prostate cancer hospitalizations complicated by VTE, with patients suffering a DVT having the highest LOS (9 vs 3 days) &amp; total cost of hospitalization ($20,425 vs $14,452) [p &lt; 0.001] followed by DVT with PE and only PE [p &lt; 0.05]. Interestingly, patients with DVT have higher readmission rates as compared to PE at 30 days (16.6% vs 13.5%, p &lt; 0.001) and subsequently at 90-day intervals. Conclusions: The odds of venous thromboembolism were lower in prostate cancer when compared to all other patients with active cancer. The mortality was highest for PE in this cohort, while healthcare-related burden and readmission rates were higher for DVT. [Table: see text]

The relationship of preoperative frailty with short- and long-term surgical outcomes among octogenarians with hepatocellular carcinoma: A multicenter comprehensive analysis.

e16269 Background: Hepatocellular carcinoma (HCC) management in very elderly individuals, particularly those considering hepatectomy, demands a balanced evaluation of surgical safety and survival outcomes. This multicenter study aims to elucidate the influence of preoperative frailty, as determined by the Clinical Frailty Scale (CFS), on both short-term and long-term outcomes in octogenarians undergoing hepatectomy for HCC. Methods: We conducted a retrospective analysis of a cohort of octogenarians (≥ 80 years) who underwent hepatectomy for HCC from 2010 to 2022 across 16 hepatobiliary centers. Patients were categorized into frail and non-frail groups based on their preoperative CFS scores, with a CFS score of ≥ 5 indicating frailty. We primarily focused on overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Secondary endpoints included perioperative outcomes such as postoperative morbidity and mortality. Results: The study encompassed 240 octogenarians, with 105 (43.8%) classified as frail. Frail patients exhibited significantly higher postoperative 30-day morbidity (61.0% vs. 43.0%, P = 0.006) and mortality at both 30-day (5.8% vs. 0.7%, P = 0.045) and 90-day (6.7% vs. 1.5%, P = 0.044) intervals compared to their non-frail counterparts. Furthermore, 5-year OS, RFS, and CSS were markedly lower in frail patients (25.1%, 15.6%, and 43.7% respectively) as opposed to non-frail patients (51.4%, 36.2%, and 66.7%; all P &lt; 0.001). Both univariable and multivariable analyses identified preoperative frailty as an independent risk factor for postoperative 30-day morbidity (OR: 2.060, 95% CI: 1.215-3.494, P = 0.007), as well as for OS (HR: 2.384, 1.682-3.380, P &lt; 0.001), RFS (HR: 2.190, 1.588-3.019, P &lt; 0.001), and CSS (HR: 2.203, 1.397-3.472, P = 0.001). Conclusions: Preoperative frailty emerges as a significant independent predictor of both short-term and long-term outcomes in octogenarians undergoing hepatectomy for HCC. Integrating frailty assessment into preoperative evaluations could substantially enhance patient selection and optimize perioperative management strategies.

Case Study for Predicting Failures in Water Supply Networks Using Neural Networks

This study deals with the prediction of recurring failures in water supply networks, a complex and costly task, but essential for the effective maintenance of these vital infrastructures. Using historical failure data provided by Companhia de Água e Esgotos da Paraíba (CAGEPA), the research focuses on predicting the time until the next failure at specific points in the network. The authors divided the failures into two categories: Occurrences of New Faults (ONFs) and Recurrences of Faults (RFs). To perform the predictions, they used predictive models based on machine learning, more specifically on MLP (Multi-Layer Perceptron) neural networks. The investigation unveiled that through the analysis of historical failure data and the consideration of variables including altitude, number of failures on the same street, and days between failures, it is possible to achieve an accuracy greater than 80% in predicting failures within a 90-day interval. This demonstrates the feasibility of using fault history to predict future water supply outages with significant accuracy. These forecasts allow water utilities to plan and optimize their maintenance, minimizing inconvenience and losses. The article contributes significantly to the field of water infrastructure management by proposing the applicability of a data-driven approach in diverse urban settings and across various types of infrastructure networks, including those pertaining to energy or communication. These conclusions underscore the paramount importance of systematic data collection and analysis in both averting failures and optimizing the allocation of resources within water utilities.

Assessment of inter- and intraobserver agreement for META score in distinguishing osteoporotic from multiple myeloma vertebral fractures.

To conduct an independent assessment of inter- and intraobserver agreement for the META score as a tool for differentiating osteoporotic vertebral fractures and multiple myeloma vertebral fractures. This is a retrospective observational study. The magnetic resonance imaging analysis was made by two independent spinal surgeons. We designated a Subjective assessment, in which the surgeon should establish a diagnostic classification for each vertebral fracture based on personal experience: secondary to osteoporosis, categorized as a benign vertebral fracture (BVF), or attributed to multiple myeloma, categorized a malign vertebral fracture (MVF). After a 90-day interval, both surgeons repeated the evaluations. For the next step, the observers should establish a diagnosis between BVF and MVF according to the META score system, and both observers repeated the evaluations after a 90-day interval. The intra and interobserver reliability of the Subjective evaluation was studied using the kappa (κ) test. Then, the META evaluations were paralleled using the intraclass correlation coefficient (ICC). A total of 220 patients who had the potential to participate in the study were initially enrolled, but after applying the exclusion criteria, 44 patients were included. Thirty-three patients had BVF, and 12 patients presented MVF. Interobserver agreement for both Subjective evaluations moments (initial and 90-days interval) found a slight agreement for both moments (0.35 and 0.40 respectively). Kappa test for both META evaluations moments (initial and 90-days interval) found a moderate interobserver agreement for both moments (0.54 and 0.48 respectively). It was observed that the ICC calculated for the Initial evaluation using META score was 0.680 and that in the 90-days interval was 0.726, indicating regular to good agreement. Kappa test for intraobserver agreements for the Subjective evaluation presented moderate agreement for both Surgeons. On the other side, Kappa test for intraobserver agreements for the META evaluation presented substantial agreement for both Surgeons. The Intraclass Correlation Coefficient of the META score found presented an almost perfect agreement for both Surgeons. Intra and interobserver agreement for both surgeons were unsatisfactory. The lack of consistent reproducibility by the same observer discourages and disfavors the routine use of the META score in clinical decision making, when potentially cases of multiple myeloma may be present.

Thirty- and 90-Day Morbidity and Mortality by Clavien-Dindo after Surgery for Antireflux and Hiatal Hernia.

The historic morbidity and mortality rates of antireflux and hiatal hernia operation are reported as 3% to 21% and 0.2% to 0.5%, respectively. These data come from either large national and population level or small institutional studies, with the former focusing on broad 30-day outcomes while lacking granular data on complications and their severity. Institutional studies tend to focus on long-term and quality-of-life outcomes. Our objective is to describe and evaluate the incidence of 30- and 90-day morbidity and mortality in a large, single-institution dataset. We retrospectively reviewed 2,342 cases of antireflux and hiatal hernia operation from 2003 to 2020 for intraoperative complications causing postoperative sequelae, as well as morbidity and mortality within 90 days. All complications were graded using the Clavien-Dindo (CD) grading system. The highest grade of complication was used per patient during 30- and 31- to 90-day intervals. Of 2,342 patients, the overall 30-day morbidity and mortality rates were 18.2% (427 of 2,342) and 0.2% (4 of 2,342), respectively. Most of the complications were CD less than 3a at 13.1% (306 of 2,342). In the 31- to 90-day postoperative period, morbidity and mortality rates decreased to 3.1% (78 of 2,338) and 0.09% (2 of 2,338). CD less than 3a complications accounted for 1.9% (42 of 2,338). Antireflux and hiatal hernia operations are safe with rare mortality and modest rates of morbidity. However, the majority of complications patients experience are minor (CD less than 3a) and are easily managed. A minority of patients will experience major complications (CD 3a or greater) that require additional procedures and management to secure a safe outcome. These data are helpful to inform patients of the risks of operation and guide physicians for optimal consent.

Relationship between remnant cholesterol and short-term prognosis in acute ischemic stroke patients.

Several studies have illustrated that elevated RC levels are related to a heightened risk of acute ischemic stroke (AIS). Our research aimed to explore the correlation between RC levels and poor prognosis after a 90-day interval in AIS patients. A total of 287 individuals were enrolled in the study, the primary outcome was defined as poor prognosis. RC was derived by the exclusion of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) from total cholesterol (TC). Following the screening process, 253 AIS patients were included in the study, presenting a median age of 66[57, 75] years. Upon stratifying RC levels into quartiles, those in the top quartile faced a greater likelihood of diabetes diagnosis (42.86%, p=.014) and experienced a higher rate of unfavorable outcomes after 90 days (36.51%, p=.001). After accounting for confounding factors, the correlation between the fourth quartile of RC levels and the amplified likelihood of poor prognosis remained significant (odds ratio (OR) 8.471, 95% confidence interval (CI) (1.841, 38.985); p=.006). Analysis of subgroups unveiled a notable correlation between higher RC levels and poor 90-day prognosis, particularly in individuals with elevated NIHSS scores (p=.044). A progressively increasing 90-day risk of poor prognosis after an RC greater than 0.38mmol/L was visualized by restricted cubic spline plots (p-overall=.011). Including RC as a contributing element may refine the prediction of poor 90-day prognosis for AIS patients. Integrating RC with traditional risk factors can potentially enhance the predictive value for cerebrovascular disease.

Radiographic and histologic assessment of osseointegration for surface-treated titanium dental implants: An experimental study in dogs.

Modifying the dental implant's surface texture enhances its biological response to the bone and implant‒tissue interface, resulting in the successful support of forces. This study assessed the impact of sandblasting, sandblasting plus acid etching, Er,Cr:YSGG laser, and propolis implant surface treatments and occlusal load on the osseointegration of titanium dental implants in dogs. Seventy-two titanium dental implants with a diameter of 4 mm and a length of 10 mm were divided into four groups according to implant surface modifications (n=18 for each group): group A: sandblasting plus acid etching, group B: sandblasting with Al2 O3, group C: Er,Cr:YSGG laser, group D: propolis coating. Twenty-four local breed male dogs were used. Premolar teeth (P1, P2, and P3) were extracted on the left side of the mandible, and after 12 weeks of bone healing, implants were unilaterally installed. The osseointegration at three study times from implant installation (14, 90, and 180 days) was evaluated. The dog jaws were scanned using an intraoral scanner for the virtual design of screw-retained three-unit crowns after 90 days of osseointegration. Final radiographs were taken before the animals were sacrificed at 14, 90, and 180 days, and the histological analysis was performed. Radiographic analysis showed new bone formation (NBF) along and in contact with the implant surface of the treated groups. The histological analysis after 14 days in groups A and B revealed a uniform and ongoing pattern of bone growth and many osteoblasts with few osteocytes within lacunae in new bone trabeculae. Group C showed an increase in the number of osteoblasts lining thin bone trabeculae. Group D showed a generative power concerning bone. At 90 days, there was increased bone ingrowth, and the new bone matured in all the treated implant groups. At 180 days, dense mature bone apposition was in direct contact with delayed-loaded implant surfaces. A radiographic examination revealed that surface modification significantly impacted osseointegration, with a strong bond between the implant surface and the surrounding bone. The histological sections at the 14-day interval revealed obvious bone remodeling activity, especially in sandblasting plus acid etching and sandblasting-modified implant surface groups. At the 90-day interval, bone ingrowth had increased, and the new bone became mature, especially in sandblasting and propolis surface modification groups. After 180 days of the delayed-loaded implant osseointegration, differences were observed between different implant-treated groups with a remarkable remodeling of the bone, especially in the propolis coating group.

The impact of preoperative benzodiazepine use on postoperative opioid use in total shoulder arthroplasty

As the rate of total shoulder arthroplasty (TSA) and preoperative benzodiazepine use rise, there is an increased need to understand the impact of preoperative benzodiazepine use on postoperative opioid consumption following TSA, especially amid the current opioid epidemic. The relationship between preoperative benzodiazepine use and chronic opioid use postoperatively has been well described following other orthopedic procedures; however, the impact on patients undergoing TSA remains unclear. This study aims to identify the impact of preoperative benzodiazepine use on opioid use following TSA. A retrospective chart review of 4488 patients undergoing primary TSA (Current Procedural Terminology code 23472) at a single institution from 2014 to 2022 was performed. Patient demographics, surgical variables, comorbidities, Distressed Communities Index (DCI), and clinical outcomes, including readmission and revision, were collected. The Charlson Comorbidity Index (CCI) was used to assess preoperative health status. Opioid use in morphine milligram equivalents (MMEs) and benzodiazepine use were also recorded using the Prescription Drug Monitoring Program Database. Opioid use was collected at 30-, 60-, and 90-day intervals both before and after each patient's date of surgery. Statistical analysis included stepwise logistic regression to identify variables independently affecting benzodiazepine use pre- and postoperatively. Overall, 16% of patients used benzodiazepines within 90 days before their date of surgery. Of those patients, 46.4% were also using preoperative opioids, compared with just 30.0% of patients who were benzodiazepine-naïve (P<.001). Preoperative benzodiazepine use was also associated with increased pre- and postoperative total opioid use in MMEs and the number of opioid prescriptions across all time points when compared to benzodiazepine-naïve patients (P<.001). Furthermore, 37.4% of preoperative benzodiazepine users went on to prolonged opioid use (filled prescriptions >30 days after surgery) compared to 19.0% of those who were benzodiazepine-naïve (P<.001). This study demonstrates a significant association between preoperative benzodiazepine use and increased and prolonged opioid use following TSA. Further exploration of risk factors contributing to preoperative benzodiazepine use may help to reduce overall opioid use in patients undergoing TSA.

2. ARTIFICIAL INTELLIGENCE IN MEDICINE: A COMPARATIVE STUDY OF CHATGPT'S LEARNING CAPABILITY IN RESOLVING MEDICAL SPECIALIZATION QUESTIONS

Abstract Introduction ChatGPT is a Natural Language Processing (NLP) model trained via machine learning algorithms that has proven capable of passing multiple selective medical tests. The aim of this study is to evaluate its “self-learning” capacity over a 90-day interval in solving specialized medical questions. Methods A comparative descriptive analysis of the problem-solving ability of ChatGPT - 3.5 (10/02/2023 - 15/02/2023) versus ChatGPT - 4 (11/05/2023 - 13/05/2023) was conducted on the competitive exams for the position of Specialist in Thoracic Surgery, as announced by the Andalusian Health Service in 2022. This competitive exam was chosen because of its multiple-choice structure and its division into a theoretical questionnaire and a practical questionnaire. Results Success rate: ChatGPT - 3.5 58.90% (86/146): theoretical questionnaire 63.2% (62/98) and practical questionnaire 50% (24/48) / ChatGPT - 4 65.7% (96/146): theoretical questionnaire 71.43% (70/98) and practical questionnaire 54.16% (26/48). Inferential analysis showed no significant differences (p&amp;gt;0.05) with regard to the rate of correct answers between both versions globally, nor with respect to the theoretical or practical questionnaire. Conclusion Despite the constant “self-learning” of this Artificial Intelligence model, its performance in solving specialized medical questions, which require critical reasoning, remains an ongoing developmental challenge.

Outpatient Versus Inpatient Total Shoulder Arthroplasty: A Matched Cohort Analysis of Postoperative Complications, Surgical Outcomes, and Reimbursements.

There has been a trend toward performing arthroplasty in the ambulatory setting. The primary purpose of this study was to compare outpatient and inpatient total shoulder arthroplasties (TSAs) for postoperative medical complications, healthcare utilization outcomes, and surgical outcomes. Patients who underwent outpatient TSA or inpatient TSA with a minimum 5-year follow-up were identified in the PearlDiver database. These cohorts were propensity-matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index > 30). All outcomes were analyzed using chi square and Student t-tests where appropriate. Outpatient TSA patients had markedly lower rates of various 90-day medical complications. Outpatient TSA patients had lower risk of aseptic loosening at 2 years postoperation and lower risk of periprosthetic joint infection at 5 years postoperation relative to inpatient TSA patients. Outpatient TSA reimbursements were markedly lower than inpatient TSA reimbursements at the 30-day, 90-day, and 1-year postoperative intervals. This study found patients undergoing outpatient TSA to be at lowers odds for both postoperative medical and surgical complications compared with those undergoing inpatient TSA. Despite increased risk of postoperative healthcare utilization for readmissions and emergency department visits, outpatient TSA was markedly less expensive at every postoperative time point assessed.

Long-Term Medical Treatment and Adherence in Patients With Left Ventricular Assist Devices: A Danish Nationwide Cohort Study.

The use of a left ventricular assist device (LVAD) in treating advanced heart failure has increased. However, data regarding medical treatment and adherence following LVAD implantation is sparse, particularly whether socioeconomic factors (cohabitation status, educational level, employment status, and income) and multimorbidity influence these aspects, which are known to impact adherence in heart failure patients. We performed a nationwide cohort study of 119 patients with LVAD implanted between January 1, 2006, and December 31, 2018, who were discharged alive with LVAD therapy. We linked individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish medical and administrative registers. Medical treatment 90-day pre-LVAD and 720-day post-LVAD were assessed using descriptive statistics in 90-day intervals. Medication adherence (proportion of days covered ≥80%) was assessed 181- to 720-day post-LVAD. The proportions of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (88.7%), beta-blockers (67.0%), mineralocorticoid receptor antagonists (62.9%), warfarin (87.6%), and aspirin (55.7%) within 90-day post-LVAD were higher than pre-LVAD and were stable during follow-up. Medication adherence ranged from 86.7% (aspirin) to 97.8% (warfarin). Socioeconomic factors and multimorbidity did not influence medical medication use and adherence. Among LVAD patients, medical treatment and adherence are at high levels, regardless of socioeconomic background and multimorbidity.

Effect of Nano-sized Hydroxyapatite Filler on Remineralization Efficacy of an Adhesive Resin: an in vitro study

Aim The aim of this study was to evaluate the remineralization efficacy of an adhesive resin containing nano-sized hydroxyapatite filler. Methodology The study consisted of four groups: control (without filler), 2% hydroxyapatite (HA), 5% HA, and 7% HA. Nano-hydroxyapatite powder was mixed with Scotchbond Multi-Purpose®. The teeth were sectioned to expose the midcoronal dentine. Bonding agents and resin composite restorations were applied. Teeth were incubated in simulated body fluid for 24-h, 30-day, and 90-day intervals. After incubation, the teeth were sliced. Hardness and elasticity modules were obtained for the three different time periods (for a total of n = 360 samples). The detection and measurement of mineral deposition areas were obtained by confocal laser scanning microscopy (CLSM) (for 120 samples). Elemental analysis was performed with energy-dispersive X-ray spectroscopy (EDS) (n = 360 samples). The statistical analysis of each parameter was performed using two-way ANOVA and group comparisons by post hoc tests. Results Study groups and storage periods affected the hardness (p = 0.00) and elasticity scores (p = 0.00). The CLSM results showed that increasing the storage periods and amount of HA resulted in mineral deposition areas (p = 0.02). The calcium and phosphor ion values of dentine that were obtained using EDS were increased (p = 0.00). Conclusion Hydroxyapatite fillers positively affect the remineralization activity of adhesive resins. In terms of remineralization efficacy, the best results were obtained in the 7% HA group.

0915 Comparison of In-person Versus Telehealth Positive Airway Pressure Set Up for Rural Veterans

Abstract Introduction Traditionally, positive airway pressure (PAP) therapy is initiated in a face-to-face visit. This can be a barrier to accessing care for rural Veterans. The COVID-19 pandemic led to the implementation of telehealth PAP set-ups at two large VA sleep centers providing an opportunity to assess the effectiveness of telehealth versus face-to-face PAP initiation in rural Veterans. Methods We performed a retrospective cohort study of rural Veterans (defined by the Rural-Urban Commuting Areas system) to compare outcomes for those who initiated PAP with in-person visits prior to the COVID-19 pandemic to those who initiated PAP with telehealth during the COVID-19 pandemic. We assessed the days of PAP use, hours of PAP use and residual Apnea Hypopnea Index (AHI) at 30-day and 90-day intervals in these two groups. We excluded individuals who received a replacement device, and those who received PAP on or after June 14, 2021, due to a safety recall of PAP devices that may have affected use. Results PAP initiation data was available for 93 individuals, approximately half of whom were initiated on PAP in-person (n=46) and half by telehealth (n=47). There were no significant differences between the in-person and telehealth groups in terms of age, BMI, and AHI, which were 57.23±16 vs 60.67±14 (mean±SD), 31.81±5 vs 31.99±13, and 27.52±23/hr vs 28.85±22/hr respectively. The average number of days per month with PAP use at 30-day and 90-day intervals for in-person vs telehealth set-up was 17.59±11 vs 15.38±12 (p=0.36) and 15.54±13 vs 14.11±14 (p=0.60) respectively. The average number of hours of PAP use at 30-days and 90-days for in-person vs telehealth set-up was 3.25±3 vs 3.11±3 (p=0.82) and 3.15±3 vs 3.07±3 (p=0.90) respectively. The residual AHI at 30-days and 90-days for in-person vs telehealth set-up was 6.61±8/hr vs 5.25±6/hr (p=0.37) and 6.35±8/hr vs 7.68±11/hr (p=0.60) Conclusion In this cohort of rural Veterans, there were no significant differences in outcomes for those who initiated PAP therapy via telehealth when compared to in-person. This supports the feasibility of more widespread implementation of telehealth services for treatment of OSA in order to improve access without compromising patient outcomes. Support (if any) VA OCC FY21 RFA, VAGLAHS GRECC, K24HL143055

The “microbiome-gut-brain axis” in Alzheimer's disease and its role in neurocognitive decline

Alzheimer’s disease (AD) is a progressive neurocognitive disease characterized by amyloid beta plaques and neurofibrillary tangles in the brain along with inflammation both in the brain and systemically. This has led to the theory of microbial communities or infections as being causative in the development of neuroinflammation as well as immunosenescence and inflamm-aging seen in AD. Our own research has demonstrated a decreased abundance of anti-inflammatory taxa and an increased abundance of pro-inflammatory taxa in the gut microbiome of AD patients. However, it is unclear how the AD microbiome exerts effects on the central nervous system. To address this gap in knowledge we have performed gut microbiome profiling, analysis of immune cell populations in serum, blood cytokine profiling, and cognitive assessments of AD older adults at 90-day intervals. In our early data collected from this ongoing study we have observed changes in B-cell populations with an increased abundance of class-switched B-cells in older adults with greater levels of cognitive impairment. We have further demonstrated that colonization of mice with the microbiome of AD older adults promotes B-cell class-switching when compared with cognitively impaired older adults without AD. Additionally, we have discovered a loss of phytoestrogen-metabolizing bacteria such as Adlercreutzia equolifaciens among AD older adults with rapidly progressing dementia. Phytoestrogens have been previously identified in protecting the intestinal epithelium from oxidative stress and epithelial permeability. Our preliminary studies have suggested that that the phytoestrogen (s)-equol, produced by A. equolifaciens, confers resistance to epithelial damage in the setting of bacterial lipopolysaccharide. Thus, we hypothesize that Adlercreutzia equolifaciens and similar phytoestrogen-metabolizing bacteria maintain epithelial homeostasis in the setting of inflammation while a gain of pro-inflammatory taxa in AD leads to intestinal barrier disruption, increased antigen presentation, immune cell dysregulation, and ultimately cognitive decline. This continuing work aims to further establish the connection between AD related neurocognitive decline, the microbiome, and immune system. This research was funded by grant numbers R01DK125407, R01AG067483, and 5T32A1007349-31 from the National Institutes of Health This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Using Recovery Capital to Predict Retention and Change in Recovery Residences in Virginia, USA

ABSTRACT Interest in recovery capital has been growing and there have been increased attempts to quantify this concept. The current paper uses the REC-CAP, a standardized assessment of recovery capital, to predict retention across multiple recovery residence settings and quantify changes in recovery capital and barriers to recovery over the initial period of residence. The REC-CAP was administered by peer navigators at admission and at 90-day intervals thereafter in recovery residences in Virginia, US. Strong effects predicting retention, changes in barriers and recovery capital growth were reported based on risk-taking and addressing acute housing concerns. The strongest effects predicting retention in recovery residences were for people not using substances and not being Black or African American. Reducing barriers to recovery and to improving recovery capital focused on avoiding ongoing substance use, lack of support needs around accommodation, higher psychological wellbeing and measures associated with social support and quality of life. There is a need to develop a holistic, tailored package of support for people in recovery residents to address these core concerns.