Extra Cases Research Articles

Diverticular disease and risk of incident major adverse cardiovascular events: A nationwide matched cohort study.

An increased risk of cardiovascular disease (CVD) has been reported in patients with diverticular disease (DD). However, there are knowledge gaps about specific risks of each major adverse cardiovascular event (MACE) component. This nationwide cohort study included Swedish adults with DD (1987-2017, N=52,468) without previous CVD. DD was defined through ICD codes in the National Patient Register and colorectal histopathology reports from the ESPRESSO study. DD cases were matched by age, sex, calendar year and county of residence to ≤5 population reference individuals (N=194,525). Multivariable-adjusted hazard ratios (aHRs) for MACE up until December 2021 were calculated using stratified Cox proportional hazard models. Median age at DD diagnosis was 62 years and 61% were females. During a median follow-up of 8.6 years, 16,147 incident MACE occurred in individuals with DD, and 48,134 in reference individuals (incidence rates (IRs)=61.4 vs. 43.8/1,000 person-years) corresponding to an aHR of 1.24 (95%CI=1.22-1.27), equivalent to one extra case of MACE for every 6 DD patients followed for 10 years. The risk was increased for ischemic heart disease (IR=27.9 vs. 18.6; aHR=1.36, 95%CI=1.32-1.40), congestive heart failure (IR=23.2 vs. 15.8; aHR=1.26, 95%CI=1.22-1.31), and stroke (IR=18.0 vs. 13.7; aHR=1.15, 95%CI=1.11-1.19). DD was not associated with cardiovascular mortality (IR=18.9 vs. 15.3; aHR=1.01, 95%CI=0.98-1.05). Results remained robust in sibling-controlled analyses. Patients with DD had a 24% increased risk of MACE compared with reference individuals, but no increased cardiovascular mortality. Future research should confirm these data and examine underlying mechanisms and shared risk factors between DD and CVD.

Rifampicin resistance in pulmonary and extra pulmonary tuberculosis cases in of children

: The prevalence of Rifampicin-resistant MTB/EPTB in children in India is a growing concern. Globally a large proportion of childhood tuberculosis (TB) cases are diagnosed based only on clinical findings. This study was undertaken to measure MTB positivity and their rifampicin resistance rates in different clinical samples from children. : Different samples of clinically suspected tuberculosis in children were included. All the samples were tested for Tuberculosis positivity and Rifampicin (Rif) resistance by GeneXpert assay. A total of 1420 samples were received from presumptive TB patients of all age group from February 2023 to January 2024. Total 1420 samples were analyzed for this study, of which 30% were male and 70% were females. Respiratory samples and extra-pulmonary samples were 1261 (88.8%) and 159 (11.2%) respectively. Among 1420, 211(14.86%) samples were from children and among these 75 (35.55%) were found MTB positive and 7 (9.33%) were Rif resistant MTB. Of 75 MTB detected patients, 77.8% and 22.2% MTB detected in female and male children respectively. There are higher prevalence of Rif resistant MTB in children so it is important for healthcare providers in India to be vigilant in timely diagnosis, individualized treatment and enhance surveillance. It is essential to combat this growing threat and protect the health of children.

Psychiatric Disorders Among 5,800 Patients With Microscopic Colitis: A Nationwide Population-Based Matched Cohort Study.

Microscopic colitis (MC) is an inflammatory condition of the large intestine. Primarily diagnosed in middle-aged and older adults, the incidence of the disease has increased markedly during the past few decades. While MC is associated with a reduced quality of life, large-scale studies on the association with future psychiatric disorders are lacking. We conducted a nationwide matched cohort study in Sweden from 2006 to 2021. Through a nationwide histopathology database (the Epidemiology Strengthened by histoPathology Reports in Sweden study), we identified 5,816 patients with a colorectal biopsy consistent with MC. These patients were matched with 21,509 reference individuals from the general population all of whom with no previous record of psychiatric disorders. From 2006 to 2021, 519 patients with MC (median age 64.4 years [interquartile range = 49.5-73.3]) and 1,313 reference individuals were diagnosed with psychiatric disorders (9.9 vs 6.5 events per 1,000 person-years), corresponding to 1 extra case of psychiatric disorder in 29 patients with MC over 10 years. After adjustments, the hazard ratio for psychiatric disorders was 1.57 (95% confidence interval = 1.42-1.74). We found significantly elevated estimates up to 10 years after MC diagnosis and a trend toward higher risk with increasing age. Specifically, we observed increased risks for unipolar depression, anxiety disorders, stress-related disorders, substance abuse, and suicide attempts. In sibling-controlled analysis, the adjusted hazard ratio was 1.76 (95% confidence interval = 1.44-2.15). Patients with MC are at increased risk of incident psychiatric disorders compared with the general population.

Evaluation and validation of a PrintrLab-based LAMP assay to identify Trypanosoma cruzi in newborns in Bolivia: a proof-of-concept study

Vertical transmission of Trypanosoma cruzi represents approximately 20% of new Chagas disease cases. Early detection and treatment for women of childbearing age and newborns is a public health priority, but the lack of a simple and reliable diagnostic test remains a major barrier. We aimed to evaluate the performance of a point-of-care loop-mediated isothermal amplification (LAMP) assay for the detection of Tcruzi. In this proof-of-concept study, we coupled a low-cost 3D printer repurposed for sample preparation and amplification (PrintrLab) to the Eiken Tcruzi-LAMP prototype to detect vertically transmitted Tcruzi, which we compared with standardised PCR and with the gold-standard algorithm (microscopy at birth and 2months and serological study several months later). We screened pregnant women from two hospitals in the Bolivian Gran Chaco province, and those who were seropositive for Tcruzi were offered the opportunity for their newborns to be enrolled in the study. Newborns were tested by microscopy, LAMP, and PCR at birth and 2months, and by serology at 8months. Between April 23and Nov 17, 2018, 986mothers were screened, among whom 276were seropositive for Tcruzi (28·0% prevalence, 95% CI 25·6-31·2). In total, 224infants born to 221seropositive mothers completed 8months of follow-up. Congenital transmission was detected in nine of the 224newborns (4·0% prevalence, 1·9-7·5) by direct microscopy observation, and 14more cases were diagnosed serologically (6·3%, 3·6-10·3), accounting for an overall vertical transmission rate of 10·3% (6·6-15·0; 23of 224). All microscopy-positive newborns were positive by PrintrLab-LAMP and by PCR, while these techniques respectively detected four and five extra positive cases among the remaining 215 microscopy-negative newborns. The PrintrLab-LAMP yielded a higher sensitivity than microscopy-based analysis. Considering the simpler use and expected lower cost of LAMP compared with PCR, our findings encourage its evaluation in a larger study over a wider geographical area. Inter-American Development Bank.

Is There an Added Value of Quantitative DCE-MRI by Magnetic Resonance Dispersion Imaging for Prostate Cancer Diagnosis?

In this multicenter, retrospective study, we evaluated the added value of magnetic resonance dispersion imaging (MRDI) to standard multiparametric MRI (mpMRI) for PCa detection. The study included 76 patients, including 51 with clinically significant prostate cancer (csPCa), who underwent radical prostatectomy and had an mpMRI including dynamic contrast-enhanced MRI. Two radiologists performed three separate randomized scorings based on mpMRI, MRDI and mpMRI+MRDI. Radical prostatectomy histopathology was used as the reference standard. Imaging and histopathology were both scored according to the Prostate Imaging-Reporting and Data System V2.0 sector map. Sensitivity and specificity for PCa detection were evaluated for mpMRI, MRDI and mpMRI+MRDI. Inter- and intra-observer variability for both radiologists was evaluated using Cohen's Kappa. On a per-patient level, sensitivity for csPCa for radiologist 1 (R1) for mpMRI, MRDI and mpMRI+MRDI was 0.94, 0.82 and 0.94, respectively. For the second radiologist (R2), these were 0.78, 0.94 and 0.96. R1 detected 4% additional csPCa cases using MRDI compared to mpMRI, and R2 detected 20% extra csPCa cases using MRDI. Inter-observer agreement was significant only for MRDI (Cohen's Kappa = 0.4250, p = 0.004). The results of this study show the potential of MRDI to improve inter-observer variability and the detection of csPCa.

Evaluation of Efficacy of Serum Adenosine Deaminase Values for Detection of Pulmonary and Extra Pulmonary Tuberculosis

Background Tuberculosis is one of the leading cause of morbidity and mortality worldwide and in Nepal. Despite advances in its diagnosis, majority of the cases still go undetected. These account for sputum smear negative and extra pulmonary cases where demonstration of the microorganism is challenging. ADA an enzyme found in all mammalian species is found raised in various effusion body fluids of organs affected by the disease. Time tested studies have also shown that serum values of ADA are elevated in patients affected with the disease thus can aid as supportive evidence in doubtful cases.MethodsAn Analytical cross sectional Hospital Based study involving 110 with 75 cases and 35 healthy participants was conducted in College of Medical Sciences for 5 months from January to June 2024. Serum ADA levels were measured in all participants, diseased and healthy and collected data was analyzed for significance.ResultsThe mean Serum ADA level in TB patients was found to be 47.01 and that of healthy participants was 14.68. Significant difference in the mean serum ADA level between TB and non TB patients (p-value < 0.001) was found concluding that TB patients have high serum ADA level. Comparisons between mean serum ADA levels in Different types of TB found no significant difference among them with all p- values in each pair being more than 0.5 suggesting that serum ADA levels rise in all forms of TB.Conclusions Serum ADA values are raised in all forms of tuberculosis and can serve as a supportive evidence in patients with Smear negative and Extrpulonary TB where microorganisms is difficult to demonstrate. However further validation need to be done by more studies in the future.

Increased NGS testing and real-world clinical usage of targeted therapy: All dressed up, nowhere to go.

e13758 Background: National and International recommendations mandate panel- based biomarker testing for all advanced cases of NSCLC. However, analogous to uptake of many other state of the art cancer management strategies, the uptake of NGS based testing and subsequent targeted therapy varies greatly across socio-demographic groups, explained by awareness and economic restraints. This study investigates the potential differences in uptake of NGS based testing and precision medicine in advanced NSCLC patients from India. Methods: This is a single center non-interventional study where retrospective review of patient data of biomarker driven advanced NSCLC patients was carried out. The records were recovered from electronic health records of the hospital. Single gene testing for EGFR and ALK are performed using Roche Cobas V2 and D5F3 Ventana systems respectively. A machine learning algorithm: Classification and Regression Tree (CART) was employed. Results: A total of 5894 patients of advanced NSCLC were identified. Of these 33% received NGS based biomarker testing at diagnosis. The proportion of patients who received NGS tests increased over calendar time from 2014-2023, with an average increment of 15.8% every year, and peak increase in 2022 of 51%. NGS based testing yielded a positive result in 80% cases with a median turnaround time of 18.2+/-3 days. NGS detected 10.2% cases more in EGFR, 3.2% cases less in ALK, 3.1% more in ROS1. Overall NGS was able to detect 37.8% extra cases of biomarker driven cases. Among the biomarker driven, uptake of targeted therapy was 65% for MET, 83% for ROS1, 52% for RET, 17.6% for ERBB2, 63% for BRAF V600E, 75% for EGFR and 79% for ALK at any given point in the disease. None of the G12C KRAS received selective treatment owing to drug unavailability in the country. Applying the CART model, targeted therapy was received by patients younger than 68 years of age, male gender, with ECOG status 0-2, and absence of brain metastases at diagnosis. Patients with brain metastases at diagnosis, females and those >69 years of age were less likely to opt for TKI(p<0.02*). Conclusions: This is the largest cohort from India reporting real world uptake of NGS based biomarker testing and targeted therapy. There is a clear disparity in terms of gender and age group, possibly attributable to social stigmata and taboos prevailing in rural parts of the country. Despite increased detection rates, access to targeted therapy is still a concern owing to inaccessibility to drugs/ lack of global clinical trials in India as well as lack of patient support programs/groups.

Epidemio-clinical aspects and neuro-meningeal tuberculosis prognosis in Batna

Neuromeningeal tuberculosis is rare, affecting around 1-2% of all tuberculosis cases and 5% of extra pulmonary tuberculosis cases. Our aim is to describe the epidemio-clinical, prognostic and evolutionary aspects of neuromeningeal tuberculosis. Materials and methods: To determine the spectrum of etiological agents of HIV-negative encephalitis and meningoencephalitis in Batna, we conducted a prospective study using an expanded testing approach. Patients were recruited from three departments (intensive care unit, infectious diseases department, pediatrics) during the period from April 1, 2012, to August 31, 2015. Data were collected according to the FLIPS case definition with a standardized form. We sought to identify etiological pathogens following a standardized procedure and to describe the epidemiological, clinical and biological features and outcomes associated with different causes. Results: A total of 141 patients with infectious encephalitis and meningoencephalitis were included in the study. Bacterial etiology was determined in 65/141 (46.1%) of whom 30 cases (21.3%) were of tuberculous origin; 21 confirmed and/or probable cases 9 possible cases with high clinical, epidemiological and radiological probability. The median age was 30.5 (0-83), predominantly female 12/18, 23.3% comorbidity with a frequency of motor deficits (86.7%) and psychiatric disorders (26.8%), respiratory involvement was present in 60% of cases, pleocytosis was present in 22/25 (73.4%). hyperalbuminorachy in 66. 7%, and hypoglycorachia in (46.7%). Anti-tuberculosis treatment was instituted in 90% of cases,17.6% were initially admitted to an intensive care unit, and the median length of hospital stay was 38.5 (1-146). death was identified in 46.6%, with 10% having sequelae. Conclusion: In our study, in addition to viruses, bacteria (especially intracellular) can be responsible for encephalitis and meningoencephalitis, in varying proportions. The most frequent and leading form of bacterial meningoencephalitis in adults is tuberculosis, the prognosis of which depends on early treatment.

Risk of heart failure in inflammatory bowel disease: a Swedish population-based study.

Dysregulation of inflammatory and immune responses has been implicated in the pathogenesis of heart failure (HF). But even if inflammation is a prerequisite for inflammatory bowel disease (IBD), little is known about HF risk in IBD. In this Swedish nationwide cohort, patients with biopsy-confirmed IBD were identified between 1969 and 2017 [n = 81 749, Crohn's disease (CD, n = 24 303), ulcerative colitis (UC, n = 45 709), and IBD-unclassified (IBD-U, n = 11 737)]. Each patient was matched with up to five general population reference individuals (n = 382 190) and IBD-free full siblings (n = 95 239) and followed until 31 December 2019. Flexible parametric survival models estimated the adjusted hazard ratio (aHR) and standardized cumulative incidence for HF, with 95% confidence intervals (CI). There were 5582 incident HF identified in IBD patients (incidence rate [IR]: 50.3/10 000 person-years) and 20 343 in reference individuals (IR: 37.9) during a median follow-up of 12.4 years. IBD patients had a higher risk of HF than reference individuals (aHR 1.19, 95% CI 1.15-1.23). This increased risk remained significant ≥20 years after IBD diagnosis, leading to one extra HF case per 130 IBD patients until then. The increased risk was also observed across IBD subtypes: CD (IR: 46.9 vs. 34.4; aHR 1.28 [1.20-1.36]), UC (IR: 50.1 vs. 39.7; aHR 1.14 [1.09-1.19]), and IBD-U (IR: 60.9 vs. 39.0; aHR 1.28 [1.16-1.42]). Sibling-controlled analyses showed slightly attenuated association (IBD: aHR 1.10 [1.03-1.19]). Patients with IBD had a moderately higher risk of developing HF for ≥20 years after IBD diagnosis than the general population.

Beyond Relevance: Factor-level Causal Explanation for User Travel Decisions with Counterfactual Data Augmentation

Point-of-Interest (POI) recommendation, an important research hotspot in the field of urban computing, plays a crucial role in urban construction. While understanding the process of users’ travel decisions and exploring the causality of POI choosing is not easy due to the complex and diverse influencing factors in urban travel scenarios. Moreover, the spurious explanations caused by severe data sparsity, i.e., misrepresenting universal relevance as causality, may also hinder us from understanding users’ travel decisions. To this end, in this article, we propose a factor-level causal explanation generation framework based on counterfactual data augmentation for user travel decisions, named Factor-level Causal Explanation for User Travel Decisions (FCE-UTD), which can distinguish between true and false causal factors and generate true causal explanations. Specifically, we first assume that a user decision is composed of a set of several different factors. Then, by preserving the user decision structure with a joint counterfactual contrastive learning paradigm, we learn the representation of factors and detect the relevant factors. Next, we further identify true causal factors by constructing counterfactual decisions with a counterfactual representation generator, in particular, it can not only augment the dataset and mitigate the sparsity but also contribute to clarifying the causal factors from other false causal factors that may cause spurious explanations. Besides, a causal dependency learner is proposed to identify causal factors for each decision by learning causal dependency scores. Extensive experiments conducted on three real-world datasets demonstrate the superiority of our approach in terms of check-in rate, fidelity, and downstream tasks under different behavior scenarios. The extra case studies also demonstrate the ability of FCE-UTD to generate causal explanations in POI choosing.

Cross Sectional Study on the Prevalence of Tuberculosis among the District of Sudhnuti, Azad Jammu and Kashmir

Globally, tuberculosis (TB) is a major health risk that is mostly caused by Mycobacterium tuberculosis, a member of the Mycobacterium Tuberculosis Complex (MTC). Ten million cases of tuberculosis and 1.3 million deaths from the disease occur each year, making Mycobacterium tuberculosis one of the leading causes of death globally. Pakistan is ranked fifth among high-burden countries for tuberculosis (TB) and is expected to rank fourth for the prevalence of multi-drug resistant (MDR) TB. As a result, tuberculosis poses a serious threat to public health in Pakistan. Tuberculosis is a common occurrence in Azad Jammu and Kashmir. Aims: The current study aimed to find out the prevalence of tuberculosis in the defined population. Study Design: The study was conducted in the District and Tehsil Headquarters Hospitals of District Sudhnuti AJK. Place and Duration of Study: Samples were collected from all the District and Tehsil headquarters hospitals of Sudhnuti district from January 2019 to December 2019. Methodology: Samples of sputum from suspected cases were gathered from district Sudhnuti hospitals and TB centers from January 2019 to December 2019. All the suspected cases were examined by sputum smear microscopy and then bacteriologically positive cases were further confirmed by GeneXpert. All positive cases were examined for multi-drug resistance by using GeneXpert. Results: In the current study during the year 2019, 201 TB cases were reported from district Sudhnuti out of which 107 (53.23%) were males and 94 (46.76%) were females. The value of P=0.51 which is >0.05 is insignificant shows that Tuberculosis has no selective effect on a specific gender. Pulmonary cases were 131 in number with 81 bacteriologically positive and 50 clinically diagnosed negative cases. Extra Pulmonary cases were 70 in number with 1 bacteriologically positive and 69 clinically diagnosed negative cases. Only 2 (0.99%) MDR cases were diagnosed and the case notification rate during 2019 was 66. Conclusion: The current study shows that males are slightly more prone to TB in district Sudhnuti AJK as compared to females. Individuals with age >64 are more susceptible to TB when compared to individuals with age <15. The CNR during 2019 is 66 which is far away from the WHO set criteria. The CNR indicates that there is a need for improvement in the surveillance system.

Improving the ventilation of a classroom to achieve heating energy savings and better indoor air quality

Indoor air quality and heating energy consumption are closely linked, especially in densely occupied spaces, as classrooms. In a classroom of Rennes University, a transient thermal simulation highlights the impact of ventilation on heating consumptions for different cases: (1) without controlled mechanical ventilation (CMV), (2) with a single flow CMV (SF CMV) of a regulatory flow of 18 m3.h−1. person−1 during periods of occupancy, and (3) a double flow CMV (DF CMV) whose flow is during periods of occupancy either equal to 18 m3.h−1. person−1 or (4) to 35 m3.h−1.person−1. The infiltration flowrate was evaluated experimentally using CO2 concentration measurements in the first case, which corresponds to the actual situation. In the normal use of the classroom with 30 persons inside, CO2 concentration exceeds 5000 ppm and the heating energy consumption is equal to 52 kWh.m−2.year−1. In case (2) and (3), CO2 concentration has a maximum level of 1350 ppm and the energy consumption is equal to 65 and 53 kWh.m−2.year−1, respectively. In case (4), the maximum CO2 concentration stays in the range 800-900 ppm without excessive heating consumption (58 kWh.m−2.year−1). Finally, by limiting the fresh air flowrate to 18 m3.h−1.person−1 in DF CMV and coupling it to a façade insulation (extra Case 5), the heating consumption is reduced to 32 kWh.m−2.year−1. These results are valuable within the context of the upcoming energy renovation strategy of the campus. Practical application In most schools, in France and elsewhere, insufficient ventilation flowrates are often observed compared to regulatory requirements. If compliance with ventilation standards and the subsequent revision of CMV installations are necessary to ensure the health of users, it is important to evaluate the energy cost of these renovations, and to identify the best choice to reduce heating consumptions. Our contribution is to compare different renovation choices in terms of two indicators: energy consumption and indoor air quality evaluated using CO2 concentration.

Microscopic Colitis and Risk of Incident Psoriasis: A Nationwide Population-Based Matched Cohort Study.

Microscopic colitis (MC) has been associated with several immune-mediated diseases including psoriasis, but earlier research has been limited to psoriasis occurring before MC. Data from large-scale cohort studies investigating MC and risk of future psoriasis are lacking. To examine the association between MC and psoriasis. In a nationwide, population-based, matched cohort study in Sweden from 2007 to 2021, we identified 8404 patients with biopsy-verified MC (diagnosed in 2007-2017), 37,033 matched reference individuals, and 8381 siblings without MC. Information on MC was obtained through the ESPRESSO cohort (a Swedish histopathology database with nationwide coverage). Using Cox regression, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for psoriasis up until 2021. During a median follow-up of 9.2 years (interquartile range = 6.7-11.7), 179 MC patients and 440 reference individuals were diagnosed with psoriasis (241.1 vs 131.8 events per 100,000 person-years), corresponding to one extra case of psoriasis in 91 patients with MC over 10 years. After adjustment for the matching variables (birth year, sex, county of residence, and calendar period) and level of education, we computed an adjusted hazard ratio (aHR) of 1.82 (95% CI = 1.53-2.17). Stratified by sex, estimates were similar and when examining the aHR across different lengths of follow-up, we found significantly elevated estimates up to 10 years after MC diagnosis. Compared to MC-free siblings, the aHR was 1.85 (95% CI = 1.36-2.51). Patients with MC are at an almost doubled risk of psoriasis compared to the general population. Clinicians need to consider psoriasis in MC patients with skin lesions.

Impact of inflammatory bowel disease on the risk of acute coronary syndrome: A Swedish Nationwide Cohort Study.

There are conflicting data on the risk of acute coronary syndrome (ACS) in patients with inflammatory bowel disease (IBD). Only a few previous reports include patients diagnosed during the last decade. To assess and compare the risk of ACS between patients with IBD and the general population. In this cohort study, we used nationwide registers to identify patients diagnosed with IBD in Sweden 2003-2021. Every patient was matched by birth year, sex, calendar year and area of residence with up to 10 general population comparators. The primary outcome was incident ACS. We used semi-parametric Cox proportional hazard models to estimate hazard ratios (HRs). We identified 76,517 patients with IBD (Crohn's disease [CD], N = 22,732; ulcerative colitis [UC], N = 42,194 and IBD-unclassified, N = 11,591) and 757,141 comparators. During a median follow-up of 8 years, 2546 patients with IBD (37.5/10,000 person-years) were diagnosed with ACS compared with 19,598 (28.0/10,000 person-years) among comparators (HR 1.30; 95% confidence interval 1.24-1.35) after adjustments for confounding factors, and approximately one extra case of ACS in 100 IBD patients followed for 10 years. The highest HRs for ACS were in patients with elderly onset IBD (≥60 years) and among patients with CD or UC with extra-intestinal manifestations. No increased HRs were observed in patients diagnosed with IBD before the age of 40. In this contemporary cohort of patients with IBD, exposed to modern IBD care, there was an increased risk for ACS compared with individuals from the general population.

Long-term risk of myocarditis in patients with inflammatory bowel disease: a nationwide cohort study in Sweden.

Despite a suggested link between inflammatory bowel disease (IBD) and myocarditis, the association has not been well-established. This study aimed to investigate the long-term risk of myocarditis in patients with IBD. This nationwide cohort involved all patients with biopsy-confirmed IBD in Sweden (1969-2017) (n=83,264, Crohn's disease [CD, n=24,738], ulcerative colitis [UC, n=46,409], and IBD-unclassified [IBD-U, n=12,117]), general population reference individuals (n=391,344), and IBD-free full siblings (n=96,149), and followed until 2019. Primary outcome was incident myocarditis and secondary outcome was severe myocarditis (complicated with heart failure, death, or readmission). Flexible parametric survival models were used to estimate adjusted hazard ratios (aHR) and cumulative incidence of outcomes, along with 95% confidence intervals (CIs). During a median follow-up of 12 years, there were 256 myocarditis cases in IBD patients (incidence rate [IR]=22.6/100,000 person-years) and 710 in reference individuals (IR=12.9), with an aHR of 1.55 (95%CI: 1.33 to 1.81). The increased risk persisted through 20 years after IBD diagnosis, corresponding to one extra myocarditis case in 735 IBD patients until then. This increased risk was observed in CD (aHR=1.48 [1.11 to 1.97]) and UC (aHR=1.58 [1.30 to 1.93]). IBD was also associated with severe myocarditis (IR: 10.1 vs. 3.5; aHR=2.44 [1.89 to 3.15]), irrespective of IBD subtypes (CD: aHR=2.39 [1.43 to 4.01], UC: aHR=2.82 [1.99 to 4.00], and IBD-U: aHR=3.14 [1.55 to 6.33]). Sibling comparison analyses yielded similar results. Patients with IBD had an increased risk of myocarditis, especially severe myocarditis, for ≥20 years after diagnosis, but absolute risks were low.

A critical analysis of physical activity's promising function in the management of Type 2 Diabetes Mellitus

Physical activity (PA) has been demonstrated to have negative correlations with type 2 diabetes mellitus. Considering provided the establishment of the dose‒response interactions still additionally undiscovered. For investigating the association involving extra cases of type 2-diabetes and PA, the study utilizes model nonlinearity. Implementing together study findings from multidemographic long-term studies. A metric that exclusively considers energy employed above resting metabolic rate was used to translate PA exposures through reduced metabolic equivalent of task (MET) and the physiological equivalent of task hours per the previous week. The association involving radiation and illness was modeled utilizing restricted quadratic splices. The results point to a general nonlinear association; utilizing the rectangular spline model, we discovered a probability decrease for type 2 diabetes of twenty-six percent among people who attained eleven twenty-five MET hours per month. A risk decrease of 36% was shown when this quantity of PA was doubled, and more significant reductions were seen at higher dosages. For moderate-intensity PA the power source marginal MET week dose‒response curve's findings revealed comparable. However, the advantages of higher-intensity PA were more significant, and those of lower-intensity activity substantially decreased. Among the overall population, higher levels of has been connected to a significantly decreased risk of type 2 diabetes. The relationships between type’s two diabetics with LTPA were curved. At quantities far higher than those recommended by the health department standards, however, further benefits may be possible. The most significant insufficient quantities of exercise result in relative improvements.

Color fundus photography versus fundoscopy in diabetic retinopathy patients: A pilot study

Aims/Purpose: To compare fundoscopy with Color fundus photography (CFP) in identifying diabetic retinopathy (DR) abnormalities.Methods: This is a pilot cross‐sectional study of diabetic patients attending the medical retina clinic for routine examination. All patients underwent dilated indirect ophthalmoscopy and CFP, both performed by the same doctor. The following retinal features were identified in 5 segments during both procedures (CA‐central area, UT‐upper temporal, LT‐lower temporal, UN‐upper nasal, LN‐lower nasal): pre‐retinal/retinal (RH)/vitreous haemorrhages, exudates (EX), intraretinal microvascular abnormalities (IRMA), venous beading (VB), vein loops (VL), cotton wool spots (CWS), retinal neovascularization (NVD/NVE) and ghost vessels (GV).Results: Thirty‐six eyes of 18 patients were included in the study. Overall, CFP recorded more retinal features in comparison with fundoscopy in most segments. In particular, in CFP: RH and VB were identified in 1 extra case but CWS was missed in 2 cases in CA. Imaging in UT segment revealed RH and CWS in 3 and 1 additional cases, respectively. RH, VB, CWS were recorded in 3, 1 and 1 extra cases in LT. RH and EX were documented in 4 and 1 additional cases respectively while CWS and GV were missed in 1 case in UN. In LN, RH and GV were identified in 2 extra cases, but NVD/NVE was missed in 1 case. The main differences were observed in the documentation of RH in all but one segment (apart from CA) as in >3 cases in each segment, RH was missed in fundoscopy. Moreover, in CA, retinal features were similarly identified in both examination techniques.Conclusions: Fundoscopy is part of routine ophthalmic assessment but requires experience and adequate patient cooperation. CFP is a reliable imaging tool that can objectively document diabetic retinopathy lesions. New advances in retina imaging make CFP a promising device for DR assessment patients.

Separate rooms for patient induction, case set-up and breakdown: Innovative operating room turnover through quality management

Turnover time (TT) is the time it takes to prepare an operating room (OR) between consecutive surgeries. Short TT improves OR efficiency, while maintaining patient and staff safety and satisfaction. Yet the multitude of staff involved and steps required creates process complexity that can hinder this goal. Leveraging a unique case study setting, this study deploys a collection of quality management tools to investigate how the use of separate support rooms for patient induction (the administration of anesthesia), case set-up, and case breakdown can reduce OR TT while maintaining safety and satisfaction. Key results show that separate rooms for patient induction and case breakdown can enable parallel processing, improve patient and staff safety, and patient experience. We use post implementation observations to measure TT reduction when using an induction room, which allows time for an extra case per day. We develop decision-support models practitioners can use to identify the potential benefits of separate support rooms during the OR turnover, based on operating conditions and surgical characteristics. We provide considerations from buffer theory and coordination theory for the separation of physical space, proposing a novel view of the OR turnover process as a set of service modules and interfaces.

Detecting and recovering critical mineral resource systems using broadband total-field airborne natural source audio frequency magnetotellurics measurements

Airborne geophysical methods offer a substantial advantage compared to ground-based techniques in exploring territories of different sizes, ranging from entire metallogenic provinces to the deposit scale, including those hosting critical minerals. An airborne method with measurements of natural magnetic field variations, known as audio frequency magnetotellurics (a passive field method), significantly increases the depth of investigation and expands the resistivity detection range compared with some controlled-source primary-field methods. We describe the technical solutions used in an airborne electromagnetic passive system with a mobile sensor of the total magnetic field variations and the stationary sensor of electric field variations, and its applications to recovering the complex geology of hydrothermal-magmatic systems often associated with critical minerals. The system’s ability to explore depths, typically beginning from the near-surface and down to 1–2 km, by recording responses in three orthogonal inductive coils over a broad bandwidth from 22 Hz to 21,000 Hz allows for mapping resistivities across a broad range. This capability is crucial for obtaining more comprehensive exploration models. Field case studies of the natural field system include application in exploring for unconformity uranium mineralization, along with other associated minerals, epithermal gold and polymetallic-bearing structures, and ferromanganese and polymetallic deposits formed in a continental rift valley. An extra case study involving kimberlites was incorporated as a proven example of the natural field system’s capability in conducting near-surface and deep investigations. The case histories illustrate the airborne natural electromagnetic field technology capabilities in recovering geoelectric models and their specific patterns.

Semi-Federated Learning: Convergence Analysis and Optimization of a Hybrid Learning Framework

Under the organization of the base station (BS), wireless federated learning (FL) enables collaborative model training among multiple devices. However, the BS is merely responsible for aggregating local updates during the training process, which incurs a waste of the computational resource at the BS. To tackle this issue, we propose a semi-federated learning (SemiFL) paradigm to leverage the computing capabilities of both the BS and devices for a hybrid implementation of centralized learning (CL) and FL. Specifically, each device sends both local gradients and data samples to the BS for training a shared global model. To improve communication efficiency over the same time-frequency resources, we integrate over-the-air computation for aggregation and non-orthogonal multiple access for transmission by designing a novel transceiver structure. To gain deep insights, we conduct convergence analysis by deriving a closed-form optimality gap for SemiFL and extend the result to two extra cases. In the first case, the BS uses all accumulated data samples to calculate the CL gradient, while a decreasing learning rate is adopted in the second case. Our analytical results capture the destructive effect of wireless communication and show that both FL and CL are special cases of SemiFL. Then, we formulate a non-convex problem to reduce the optimality gap by jointly optimizing the transmit power and receive beamformers. Accordingly, we propose a two-stage algorithm to solve this intractable problem, in which we provide the closed-form solutions to the beamformers. Extensive simulation results on two real-world datasets corroborate our theoretical analysis, and show that the proposed SemiFL outperforms conventional FL and achieves 3.2% accuracy gain on the MNIST dataset compared to state-of-the-art benchmarks.