Categorical Data Research Articles

Effect of an artificial intelligence-assisted recognition system on colonoscopy quality

Objective: To explore the value of the artificial intelligence (AI)-assisted recognition system in the detection quality of colonoscopy. Methods: From January 2023, the data on 700 patients who underwent colonoscopy in the Digestive Endoscopy Center of the First Affiliated Hospital of Zhejiang Chinese Medical University were collected prospectively. Based on a computerized number method, patients were divided into the AI assistance group and control group. The detection rate of adenomas (ADR) and polyps, number and size of adenomas, Boston bowel preparation scale (BBPS), intubation time, withdrawal time, and cecal intubation rate were compared between groups. Normally distributed data were analyzed with the t-test for independent samples. Non-normally distributed data were analyzed with the Rank sum test. Categorical data were analyzed with the Chi-square test. Results: In total, 691 patients were included in the analysis. According to the intention to treat (ITT) analysis and per-protocol (PP) analysis, the withdrawal time of the AI group was higher than that of the control group (ITT:436 (305, 620) vs 368 (265, 510) s, Z=-4.24, P<0.001;PP:439 (306, 618) vs 364 (262, 500) s,t=-4.50, P<0.001); however, there were no significant differences in the ADR (ITT:123(35.5%) vs 111(32.2%), χ2=0.88, P=0.349;PP:108(34.2%) vs 99(31.1%), χ2=0.67, P=0.414), the number of adenomas (ITT:0(0, 1) vs 0(0, 1),Z=-1.08, P=0.282;PP:0(0, 1) vs 0(0, 1),Z=-0.87, P=0.387), the polyp detection rate (ITT:85(24.6%) vs 85(24.6%),χ2=0.001, P=0.983;PP:79(25.0%) vs 77(24.2%),χ2=0.05, P=0.818), BBPS (ITT:6.5±0.9 vs 6.5±0.7,t=-0.59, P=0.555;PP:6.7±0.6 vs 6.6±0.6,t=-1.83, P=0.068), and cecal intubation rate (ITT:346(100.0%) vs 343(99.4%), χ2=0.50, P=0.478) between these two groups. After excluding inadequate bowel preparation and failed cecal intubation cases, the AI-assisted system was found to significantly improve the detection rate of small adenomas (≤5 mm) (PP:27.8%(88/316)vs 21.1%(67/318), χ2=3.94, P=0.047). Conclusions: The application of an AI-assisted system in colonoscopy can increase the withdrawal time and improve the detection rate of small adenomas.

Effects of Ketamine 0.5 mg/kgBW administration as preemptive analgesia on analgesia duration and the need for Fentanyl following hysterectomy surgery: a randomized controlled trial

INTRODUCTION: Hysterectomy is a surgical procedure with a high number of moderate to severe postoperative pain complications. Preemptive analgesia prevents central sensitization before surgery, hampering postoperative hyperesthesia. Ketamine is one of several preemptive analgesia available. This study aims to study the effects of ketamine 0.5 mg/kgBW administration as preemptive analgesia on analgesia duration and the need for fentanyl following hysterectomy surgery. MATHERIALS AND METHODS: This study is a double-blind randomized controlled trial experiment on two groups: the treatment group (n = 20) was given ketamine 0.5 mg/kgBW and the control group (n = 20). The duration was measured starting from surgery completion up to the need for additional fentanyl 25 µg analgesia through Patient Controlled Analgesia (PCA) within 24-hour periods following surgery. Numerical data statistical analysis was done using unpaired T-test and Mann—Whitney for normally distributed data and non-normally distributed data respectively. Categorical data statistical analysis was done using the Exact Fisher test. RESULTS: The mean time recorded until additional analgesia was needed in the treatment group was 246.00 ± 33.150 minutes and in the control group was 121.50 ± 23.792 minutes. The mean total 24-hour post-surgery additional analgesia was 82.50 ± 11.75 µg and 118.75 ± 11.10 µg for the treatment group and control group respectively. There were statistically significant differences in the duration of analgesia and the need for additional analgesia between the two subject groups (p &lt; 0.05). CONCLUSIONS: Administration of ketamine preemptive analgesia at a dose of 0.5 mg/kgBW resulted in longer analgesia duration and reduced the need for fentanyl as an additional analgesic in postoperative patients compared with no preemptive analgesia and showed no significant side effects.

Evaluation of postoperative pain on Transversus Abdominis Plane block and Erector Spinae Plane block in patients undergoing gynecological surgery: a prospective, comparative study

INTRODUCTION: Moderate to severe pain after gynecological surgery has an impact on postoperative recovery and mobilization. Transversus Abdominis Plane (TAP) block and Erector Spinae Plane (ESP) block have been used as multimodal analgesia for abdominal surgery. OBJECTIVES: This study aims to compare postoperative pain in patients undergoing either ESP blocks or TAP blocks, and the need for postoperative morphine in patients undergoing gynecological surgery.MATERIALS AND METHODS: This was a single-center, prospective, double-arm, comparative study. Forty subjects were enrolled in this study, and classified into two groups. One group of 20 subjects underwent ESP block, and the remaining 20 subjects underwent TAP block following a gynecologic surgical procedure. Patients were then assessed using with the Numeric Rating Scale (NRS) pain score which will be observed at intervals of 0–1 hour, 1–6 hours, 6–12 hours, and 12–24 hours. Numerical data analysis was done using an unpaired T-test on normally distributed data and the Mann-Whitney test on non-normally distributed data. Categorical data analysis was done using Fisher's Exact Test. RESULTS: NRS score at rest was higher in the TAP block group at 1–6 hours and 6–12 hours (pain scale 3) than in the ESP block group (pain scale 1). Movement-evoked pain NRS score was higher in the TAP block groups significantly. CONCLUSION: ESP block results in a lower postoperative pain score NRS value and reduces the need for morphine in post-gynecological surgery patients with a median incision compared to the TAP block.

Diagnosis of Respiratory Sarcopenia for Stratifying Postoperative Risk in Non–Small Cell Lung Cancer

Physical biomarkers for stratifying patients with lung cancer into subtypes suggestive of outcomes are underexplored. To investigate the clinical utility of respiratory sarcopenia for optimizing postoperative risk stratification in patients with non-small cell lung cancer (NSCLC). This retrospective cohort study reviewed consecutive patients undergoing lobectomy and mediastinal lymph node dissection for NSCLC at 2 institutions in Tokyo, Japan, between 2009 and 2018. Eligible patients underwent electronic computed tomography image analysis. Follow-up began at the date of surgery and continued until death, the last contact, or March 2022. Data analysis was performed from April 2022 to March 2023. Respiratory sarcopenia was identified by poor respiratory strength (peak expiratory flow rate) and was confirmed by a low pectoralis muscle index (PMI; pectoralis muscle area/body mass index). Patients with poor peak expiratory flow rate but normal PMI received a diagnosis of pre-respiratory sarcopenia. Short-term and long-term postoperative outcomes were compared among patients with a normal status, pre-respiratory sarcopenia, and respiratory sarcopenia. Group differences were analyzed using the Kruskal-Wallis test and Pearson χ2 test for continuous and categorical data, respectively. Survival differences were compared using the log-rank test. Univariable and multivariable analyses were conducted using the Cox proportional hazards model. Of a total of 1016 patients, 806 (497 men [61.7%]; median [IQR] age, 69 [64-76] years) were eligible for electronic computed tomography image analysis. The median (IQR) duration of follow-up for survival was 5.2 (3.6-6.4) years. Respiratory strength was more closely correlated with PMI than pectoralis muscle radiodensity (Pearson r2, 0.58 vs 0.29). Respiratory strength and PMI declined with aging simultaneously (both P for trend < .001). Pre-respiratory sarcopenia was present in 177 patients (22.0%), and respiratory sarcopenia was present in 130 patients (16.1%). The risk of postoperative complications escalated from 82 patients (16.4%) with normal status to 39 patients (22.0%) with pre-respiratory sarcopenia to 39 patients (30.0%) with respiratory sarcopenia (P for trend < .001), as did the risk of delayed recovery after surgery (P for trend < .001). Compared with patients with normal status or pre-respiratory sarcopenia, patients with respiratory sarcopenia exhibited worse 5-year overall survival (438 patients [87.2%] vs 133 patients [72.9%] vs 85 patients [62.5%]; P for trend < .001). Multivariable analysis identified respiratory sarcopenia as a factor independently associated with increased risk of mortality (hazard ratio, 1.83; 95% CI, 1.15-2.89; P = .01) after adjustment for sex, age, smoking status, performance status, chronic heart disease, forced expiratory volume in 1 second, diffusing capacity for carbon monoxide, C-reactive protein, albumin, carcinoembryonic antigen, histology, and pathologic stage. This study identified individuals at higher risk of poor outcomes by screening and staging respiratory sarcopenia. The early diagnosis of respiratory sarcopenia could optimize management strategies and facilitate longitudinal care in patients with NSCLC.

A Randomized, Controlled Trial of Palonosetron Versus Ondansetron for Nausea, Vomiting, and Pruritus in Cesarean Delivery with Intrathecal Morphine.

Spinal anesthesia is the preferred anesthetic technique for cesarean deliveries. Postoperative nausea and vomiting (PONV) and pruritus occur in up to 80% and 83% of patients, respectively, after cesarean delivery with intrathecal opioids. Ondansetron is the recommended medication for PONV prophylaxis, but palonosetron, a second-generation 5-HT3 receptor antagonist, has a higher receptor affinity and a longer half-life. However, studies on palonosetron use in cesarean deliveries are limited. This study aimed to determine whether palonosetron was more effective than ondansetron in preventing intrathecal morphine-induced PONV and pruritus in cesarean deliveries. Parturients who underwent cesarean delivery under spinal anesthesia were randomized into 3 groups: P (palonosetron 0.075 mg), O (ondansetron 4 mg), and N (normal saline). The study drug was intravenously administered after the umbilical cord was clamped. The primary outcome measures were the 48-hour incidence of PONV and pruritus. The secondary outcome measures were the PONV and pruritus scores at the postanesthesia care unit (PACU) and ward, rescue medications, satisfaction scores, and adverse events. Ordinal data were analyzed using the Kruskal-Wallis test. Continuous and categorical data were analyzed using a 1-way analysis of variance, Kruskal-Wallis test, and Pearson's χ2 test, respectively. A value of P < .05 was considered significant. Post hoc analysis pairwise comparisons with Bonferroni correction were also performed. Overall, 300 parturients were enrolled, and 297 parturients completed the study. One patient in the P group and 2 in the O group were excluded because of conversion to general anesthesia after failed spinal anesthesia. The baseline patient characteristics were comparable between the groups. The PONV incidence rates in the P, O, and N groups were 26.3% (95% confidence interval [CI], 17.4-35.1), 34.7% (95% CI, 25.1-44.3), and 50.0% (95% CI, 40.0-59.9), respectively (P = .002). The incidence rates of pruritus in the P, O, and N groups were 69.7% (95% CI, 60.5-78.9), 76.5% (95% CI, 67.9-85.1), and 87.0% (95% CI, 80.3-93.7), respectively (P = .013). Pairwise comparisons revealed significantly lower incidences of PONV and pruritus in the P group than in the N group (P < .001 and P = .003, respectively). However, no significant differences were observed between the P and O groups or between the O and N groups. Additionally, the P group required significantly less nalbuphine rescue for pruritus than the N group (P = .004 and P = .005 for the PACU and ward, respectively). PONV rescue, satisfaction scores, and adverse events were not significantly different among the 3 groups. Palonosetron effectively prevents intrathecal morphine-induced PONV and pruritus during cesarean delivery. However, the efficacy of palonosetron is not significantly different from that of ondansetron.

Visualizing departures from marginal homogeneity for square contingency tables with ordered categories

Square contingency tables are a special case commonly used in various fields to analyze categorical data. Although several analysis methods have been developed to examine marginal homogeneity (MH) in these tables, existing measures are single-summary ones. To date, a visualization approach has yet to be proposed to intuitively depict the results of MH analysis. Current measures used to assess the degree of departure from MH are based on entropy such as the Kullback-Leibler divergence and do not satisfy distance postulates. Hence, the current measures are not conducive to visualization. Herein we present a measure utilizing the Matusita distance and introduce a visualization technique that employs sub-measures of categorical data. Through multiple examples, we demonstrate the meaningfulness of our analytical framework approach and validate its usefulness to provide insightful interpretations.

Invasive quantitative assessment of coronary microvascular dysfunction in patients with hypertrophic cardiomyopathy

Abstract Background Patients (P) with hypertrophic cardiomyopathy (HCM) commonly suffer from coronary microvascular dysfunction (CMD) - the affection of function/structure of the coronary microvasculature. Invasive assessment of CMD through thermodilution methods allows for the calculation of coronary flow reserve (CFR) and index of microvascular resistance (IMR). These methods, while extensively studied in the context of non-obstructive coronary artery disease and myocardial infarction, have not been thoroughly validated in HCM P. Objectives To invasively assess the presence of CMD in P with HCM and to determine clinical predictors of invasively assessed CMD. Methods In a prospective single-centre study, we opportunistically recruited consecutive adult P with an established diagnosis of HCM with or without LVOTO that had an indication to pursue elective coronarography – such as pre-procedural evaluation for alcoholic septal ablation (ASA) or exclusion of epicardial coronary artery disease. P characteristics and coronary hemodynamic invasive assessment data were extracted. CFR was calculated as the ratio between resting and hyperemia mean transit times (TmnRest;TmnHyper). IMR was calculated as the ratio between distal coronary pressure (Pd) and the inverse of TmnHyper (IMR=Pd/TmnHyper-1). A cutoff of ≤22.0 in IMR, an ≥d 2 in CFR was used. We excluded P with end-stage HCM (LV EF &amp;lt;50% and/or or left ventricular wall thinning), or with epicardial coronary artery disease. Continuous variables were reported as mean ± SD or median and IQR depending on data distribution pattern and categorical data as frequencies and percentages. A linear regression model was used to test predictors of IMR and CFR involvement. Results 25 HCM P with a mean age of 63±10 years were included, 14 (56%) were female. In 20 (80%) of the P the cause for coronary angiography was ASA. All P referred for ASA had LVOTO and were on beta-blocker therapy (Table 1.). Median CFR was 2.5 [1.5-3] and median IMR was 19 [14-22], both within normal range. A total of 13 (44%) P had a reduced CFR and 5 (20%) of P had an increased IMR. 14 P (56%) had an altered CFR or IMR value, with the presence of a functional CMD phenotype in 10 P (40%) (Table 2). Angina was associated with a higher IMR (5.3, 95% CI - 0.05-10, p=0.053) and for each +1 increase in CCS a larger increase in the likelihood of a higher IMR was observed (CCS 1, +7 (95%CI 0.68 – 14); CCS 2, +9 (95%CI 4 – 14); CCS 3, 10 (95%CI 2 – 18)). A similar but non significant trend was observed for higher CCS correlating with lower CFR (Table 3). Conclusion In a prospective cohort of HCM P submited to invasive angiographic evaluation 56% had at least one invasive measure compatible with CMD. Angina, and a higher degree of anginal symptoms correlated positively with the presence of higher IMR and therefore with a higher level of CMD. In the future, we intend to correlate these findings with multimodality imaging/clinical outcomes.Patient characteristics and LR results

The upfront lipid-lowering combination therapy of statins and ezetimibe vs statin monotherapy in the reduction of cardiovascular outcomes. A meta-analysis.

Abstract Background Despite some data in last few years, there is still some inconsistency concerning the effectiveness and safety of the upfront intensive lipid lowering combination therapy (LLT; of moderate to high intensity statin therapy and ezetimibe) in comparison to high intensity statin therapy and recommended by some guidelines stepwise therapy approach. Purpose We sought to evaluate the efficacy of combination LLT compared with statin monotherapy for cardiovascular outcomes, LDL-C reduction, and associated adverse events. Methods A systematic literature search was conducted using PubMed, Embase, and ClinicalTrial.gov to identify relevant articles published from inception until 29th December 2023. The outcomes were assessed using pooled odds ratio (OR) for categorical data and mean difference (MD) for continuous data, with corresponding 95% confidence intervals (95% CI). Results A total of 11 studies (8 randomized controlled trials and 3 cohort studies) with 106,358 were involved in the analysis. The mean age of the patients in the combination LLT and statin monotherapy group was 65.3 and 65.7 years, respectively. Pooled analysis shows that combination LLT significantly reduces the LDL-C level from the baseline (MD, -12.13 mg/dl [0.31 mmol/l] (95%CI: -18.26 to -5.99 mg/dl), p&amp;lt;0.001), all-cause mortality (ACM) (OR, 0.75, 95%CI: 0.62 to 0.92, p=0.01), cardiovascular mortality (CVM) (OR 0.75, 95%CI: 0.66 to 0.84, p&amp;lt;0.001), major adverse cardiovascular events (MACE) (OR, 0.72 95%CI: 0.63 to 0.82, p&amp;lt;0.001), non-significant reduction in the incidence of stroke (OR 0.82, 95%CI: 0.66 to 1.01, p=0.06) when compared with statin monotherapy alone. Similarly, the therapy discontinuation rate was comparable between combination LLT and statin monotherapy groups (OR, 0.87 (95%CI: 0.53 to 1.40), p=0.56). The risk of adverse events related to the gastrointestinal tract (OR, 1.12 (95%CI: 0.93 to 1.36), p=0.23) and musculoskeletal system (OR, 0.88 (95%CI: 0.52 to 1.50), p=0.65) was comparable between both the groups of patients. Conclusion Combination LLT was associated with an overall greater reduction in LDL-C, a lower risk of ACM, MACE, and CVM compared to statin monotherapy alone.Forest Plot of desired outcomes.Central illustration with key findings.

Trends in Takotsubo syndrome

Abstract Background Previously considered a rare and relatively benign cardiac condition, Takotsubo syndrome (TTS) has undergone a significant shift in perception over the last two decades. This shift was mainly driven by results indicating that TTS is associated with signicant mortality and morbidity. Consequently, also the criteria for diagnosing TTS have been updated to reflect its recognition as a complex, multifactorial disease. Purpose The aim of the present study was to investigate trends in clinical presentation, demographics, and outcomes of patients with TTS. Methods The study analyzed 3,675 patients diagnosed with TTS from 2004 to 2021. Participants were divided into groups based on diagnosis, using three-year intervals, to perform trend analyses on demographics, risk factors, clinical presentations, and outcomes. The Cochran-Mantel-Haenszel test was used for categorical data trends, while the Mann-Kendall test assessed numerical variables. Mortality rates were compared using the log-rank test. Findings: The study period saw a steady increase in male patients (from 10% to 15%, p = 0.003). While apical TTS continued to be the most common type, the occurrence of midventricular TTS increased (from 18% to 37%, p = 0.002). Emotional triggers remained constant, whereas the prevalence of physical triggers significantly rose (from 35% to 50%, p = 0.034). The incidence of cardiogenic shock increased (from 11% to 20%, p=0.030), leading to a rise in in-hospital mortality rates (from 2% to 9%, p&amp;lt;0.001). A landmark analysis showed a significant increase in 60-day mortality rates (p &amp;lt; 0.001), but no difference in one-year mortality over the years (p = 0.140, Figure 1). Summary: This study of temporal trends in TTS highlights a shift in patients demographic with agrowing prevalence among males, increasing recognition of midventricular TTS type, and increased rates of cardiogenic shock and mortality in recent years. This shift aligns with the rising prevalence of physical triggers, as an expression of increased recognition of TTS in association with acute comorbidities.

The CTOX-Score, a clinical risk prediction tool for cardiovascular toxicity secondary to cancer therapies

Abstract Introduction Cardiovascular toxicity (cardiotoxicity) is recognized as a major side-effect of cancer therapies. As early diagnosis and management is crucial in clinical practice1,2, knowledge about risk factors and risk scores is scarce3,4. Purpose The aim of this study is to develop a clinical prediction score to identify patients at high/very high risk of cardiotoxicity. Methods The CARDIOTOX registry5,6 included patients receiving cancer therapies related to moderate/high risk for cardiotoxicity (2012-2017). Clinical, laboratory and echo parameters were collected at baseline and at 3 weeks, 3 and 6 months, 1, 1.5 and 2 years after initiation of cancer therapy. Patients were classified according to current cardioncology guidelines2 and divided in two groups: no or mild cardiotoxicity vs moderate or high cardiotoxicity. Difference between groups were tested with t-student or U Mann-Withney for continuous variables and Fisher’s exact test for categorical data. Variables with p&amp;lt;0.05 were included in a multivariate binary logistic regression model to find independent predictors of cardiotoxicity and construct a clinical risk score, CTOX-Score. The calibration was evaluated by Hosmer-Lemeshow goodness-of-fit test and discrimination using ROC curves. Results From the 1324 individuals included in the registry we discarded all those with pre-existing symptomatic heart failure or LVEF&amp;lt;40% at baseline and those with incomplete baseline data. We considered 998 patients, aged 54.62±14.15 years, 176 men (17.6%), of which 53 (5.3%) developed moderate or severe cardiotoxicity. These patients had lower baseline LVEF (59.91±7.50% vs 64.20±5.88%), higher creatinine levels (0.90 (0.76, 1.10) mg/dl vs 0.74 (0.62, 0.90) mg/dl) and higher NT-ProBNP (177 (58, 476) pg/ml vs 66 (38, 133) pg/ml) compared with patients with no or mild cardiotoxicity (p&amp;lt;0.001). We found previous radiotherapy (OR=4.66, CI:1.24-17.52), acute myeloid leukemia (OR=6.85; CI:1.16-40.50), monoclonal antibodies (OR=3.27; CI:1.35-7.89), LVEF (OR=0.96; CI:0.84-0.98) and serum creatinine (OR=5.43; CI:1.63-18.14) as independent predictors of cardiotoxicity (p&amp;lt;0.05). A clinical risk score was developed based in beta coefficient of variables (Table 1). The model has good calibration according to Hosmer-Lemeshow goodness-of-fit (χ2=2.800, p=0.424) and good discrimination power (AUC:0.780, CI:0.69-0.87; p&amp;lt;0.001). The best cut-off value of CTOX-Score is ≥3 points (Sensitivity:70.00%, Specificity:72.25%, NPV:98.11%). Patients were classified in four risk categories: low (0-1 points); moderate (2); high (3-4); very high (≥5) (Figure 1). The model has good accuracy to identify very high-risk patients (Specificity 98.80%). Conclusion The CTOX-Score is a clinical risk prediction model to identify patients at high/very high-risk of cardiotoxicity and could allow for more personalized monitoring of patients. Additional studies are needed to externally validate the model prior to implementation in clinical practice.Multivariate binary logistic regressionCTOX-Score values among population

Left ventricular apical aneurysms and outcomes in hypertrophic cardiomyopathy

Abstract Background/Introduction The presence of left ventricular apical aneurysm (LVAA) has been shown to be associated with increased risk of adverse events in patients with hypertrophic cardiomyopathy (HCM). However, the between LVAA size and outcomes is uncertain. Purpose To explore associations between baseline LVAA diameter and progressive changes in LVAA size over time and poor outcomes in HCM patients. Methods Our HCM multimodality imaging database (transthoracic echocardiography (TTE) or cardiac magnetic resonance (CMR)) was retrospectively assessed for studies reporting LVAA, defined as one or more akinetic or dyskinetic apical segments. LVAA size (widest systolic diameter in millimetres in the transverse plane) was recorded at two time points: earliest identification and most recent imaging, with LVAA size progression (mm/year) calculated. Patients’ electronic records were reviewed for composite outcome including stroke, apical thrombus, death, and appropriate therapy from implantable cardioverter defibrillator (ICD). Continuous variables are presented as mean ± standard deviation (SD), categorical data numerically or as percentages. Comparisons between groups were made using Wilcoxon ranks sum and Fischer exact test for continuous and binary variables, respectively. Cox regression was used to assess independent associations with composite outcomes. A p value of &amp;lt;0.05 was considered statistically significant. Results A total of 106 patients were identified with LVAA and clinical follow-up (mean age 64.7±11.4 years, 70% male). Mean follow-up duration was 6.5±3.0 years. Baseline LVAA was confirmed by CMR and TTE in 70 and 30% of cases respectively. Mean LVAA size at baseline was 16.2±7.6 mm (range 6-56 mm). During multivariate Cox analysis, baseline LVAA size in mm was independently associated with the composite outcome (HR 1.04, 95% CIs 1.0 to 1.08, p=0.04). Mean duration between baseline and maximal LVAA size scan was 5.4±3.0 years. Median progression in LVAA size was 1.0 (IQR 0.6 to 1.8) mm per annum (range 0.0 to 8.1 mm). During multivariate analysis, LVAA progression rate in mm per year was independently associated with the composite outcome (HR 1.4 95% CIs 1.11 to 1.7, p=0.002). Conclusion(s) These data support the association between LVAA size and poor outcomes in HCM patients. We also demonstrate the progressive nature of LVAAs and indicate those more rapidly increasing in size are at highest risk of adverse events, with potential implications for management strategies.

Treatment Outcome of Surgery Followed By Corticosteroid Therapy For Idiopathic Granulomatous Mastitis

Introduction: Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic inflammatory breast condition that has been shown to have radiological and clinical similarities to breast cancer. In spite of the fact that the cause of IGM is unknown, various contributing variables have been identified, such as a reaction to chemical substances like OCP, viral disorders, autoimmune diseases, and an immunological response to milk leakage from the breast lobule. Although various methods have been used for IGM treatment (such as surgical excision, steroids, methotrexate, etc), no consensus currently exists regarding the ideal method of treatment. Due to its positive response to steroid treatment, it is hypothesized that IGM is an autoimmune disease and is well responds to corticosteroid therapy. The aim of this study is to observe the treatment outcomes of surgery and corticosteroid therapy in IGM. Materials and Methods: This quasi experimental study was conducted in Department of Surgery, Khulna Medical College Hospital from 8th August 2018 to 8th August 2019. Total 30 patients were enrolled and allocated in two groups a ratio of 1:1. In group-A there were 15 patients, received surgical treatment with corticosteroid therapy and group-B, 15 patients received only surgical treatment. A wide local excision (WLE) was done in surgical procedure to remove area of diseased unhealthy tissue with a margin of normal tissue. Corticosteroid therapy was given orally in the following regimen: 8 weeks of steroid therapy with prednisolone at 0.5mg/kg/day for 4 weeks and then tapered down slowly for 4 weeks. Then subsequent follow up conducted after 2 months and after 4 months of primary treatment to observe the treatment outcomes. Statistical analysis was carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). A descriptive analysis was performed for all data. The mean values were calculated for continuous variables. The quantitative observations were indicated by frequencies and percentages. Unpaired student t-test was used to compare continuous variables. Chi-square test used to compare categorical data. A “p” value of &lt;0.05 was considered as significant. Result was presented by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram &amp; charts etc. Result: Maximum numbers of patients (50.0%) were between 31-40 years age group, mean±SD age was 29.7±10.2 years. The left breast was affected in 16(53.3%) patients, right breast in 12(40.0%) patients and bilateral in 2(6.7%) patients. Included 30 patients were allocated in two groups. Among them in group-A there were 15 patients (Surgical treatment with corticosteroid therapy) and group-B, 15 patients (Surgical treatment alone). Wide local excision was performed in all patients. Concomitant corticosteroids therapy was used in selective group (group-A). Study shows that 22(73.3%) of the patients recovered completely (80.0% versus 66.7% in group-A and group-B respectively). There was a statistically significant difference (pd”0.05). Present study revealed that incidence of complications and recurrence rate was 8(26.7%) patients, among them 3(20.0%) were of group-A, while 5(33.3%) patients were group-B. Conclusions: Present study concluded that treatment outcomes of surgery, followed by corticosteroid therapy can be preferred at Idiopathic granulomatous mastitis (IGM) in the means of less early or late postoperative complication, resolution of symptoms with high accuracy rate to relief symptoms. J Dhaka Med Coll. 2023; 32(1) : 71-76

Enhanced Safety and Efficacy of O-Arm Navigation Over C-Arm Guidance in Percutaneous Kyphoplasty for Patients With Osteoporotic Vertebral Compression Fractures and Spinal Deformity: A Comparative Study.

Although percutaneous kyphoplasty (PKP) under C-arm guidance is an effective treatment for osteoporotic vertebral compression fractures (OVCF), obtaining high-definition images in patients with OVCF and spinal deformities can be challenging or insufficient using traditional C-arm guidance, prompting our institution to adopt the O-arm navigation system-which offers comprehensive 3D imaging and precise navigation-and this study compares its safety and efficacy with conventional C-arm-assisted PKP. This was a retrospective study. From February 2019 to February 2022, we enrolled 28 patients with OVCF (44 vertebrae) with spinal deformity treated with O-arm navigation-assisted PKP and 30 patients with OVCF (42 vertebrae) with spinal deformity treated with C-arm-guided PKP. We recorded puncture times, single-segment operation time, number of cases with bone cement leakage, and length of stay. The visual analog scales (VASs), Oswestry disability indexes (ODIs), recovery of Cobbs angle, and vertebral height were used to assess treatment effect before the operation, on the first day postoperation, the first month postoperation, and at the final follow-up. The chi-squared test was utilized for comparing discrete variables, an independent samples t-test was used for continuous variables, and Pearson's chi-squared test and Fisher's exact test were applied for categorical data. Demographic features were comparable between the groups. The O-arm navigation group showed a significant reduction in puncture adjustment per vertebrae, single-segment operation time, and the rate of trocar needle malposition compared to the C-arm guidance group. The rate of cement leakage was decreased in the O-arm-guided PKP group, and other complications did not differ between the two groups. Intragroup comparisons revealed significant improvements in VAS scores and ODI on the first day, first month, and final follow-up after the operation (p < 0.05). The VAS score was significantly lower in the O-arm navigation-assisted PKP group than in the C-arm-guided PKP group on the first day postoperatively (p = 0.049). However, no significant differences in VAS scores were observed between the groups at the first month postoperatively or at the final follow-up. In each follow-up period, there was no significant difference in ODI, Cobb angle, and the percent of anterior vertebral height (AVH %) between the groups. O-arm navigation-assisted PKP demonstrates better clinical safety and efficacy than C-arm-guided PKP, marking it as a minimally invasive, safe, and effective procedure for treating patients with OVCF with spinal deformity.

An analysis regarding the ultimate outcome of abstracts presented at the European Paediatric Surgeons' Association (EUPSA) Congresses.

The objective of this study is to analyze the conversion rate of abstracts presented at the European Paediatric Surgeons' Association (EUPSA) congress into full-text publications and to conduct a thorough analysis of the attributes and quality of the papers published. Abstract books including the years 2017 to 2022 were reviewed. Searches on PubMed and Google Scholar, utilizing keywords from the titles and the author names, were conducted to trace subsequent full-text publications. A categorical analysis detected variations and trends, with a significance threshold of P < 0.05. Quantitative data were presented as means ± standard deviations (SD), while categorical data were represented as counts (n) and percentages (%). A total of 2,139 abstracts were presented at the EUPSA annual meetings during five consecutive congresses. The average number of presented abstracts was 427.6 ± 20.4 per year from across 63 different countries. European countries contributed the majority (71%). The presentations included both oral (n=817, 38.2%) and poster presentations (n=1322, 61.8%). They predominantly focused on clinical topics (90.6%). Single-center retrospective studies were the most common study design (43.7%). Out of all abstracts presented, 1033 (48.3%) were published within an average time interval of 1.39 ± 1.19 years after presentation. Most journals had an impact factor (IF) between 1 and 5 (74.5%). There was no significant year-to-year variation in publication rates (p=1). Basic science studies were published in journals with significantly higher IF compared to clinical studies (p<0.001). The publication rate of abstracts presented at the EUPSA annual congress stands at 48.3%, aligning with the rates observed in other similar studies. This suggests that abstracts submitted to the EUPSA congresses were evaluated and scored rigorously, adhering to international selection criteria. Furthermore, the majority of these abstracts were published in journals with moderate to high impact factors, providing quantitative evidence of the scientific quality of research within the field of pediatric surgery.

Examining Retention Methods in Factor Analysis: A Comparison of Polychoric and Pearson Correlations for Categorical and Continuous Data.

In the last two decade, it has become clear that retention methods must utilize polychoric correlation instead of Pearson correlation to eliminate drawbacks such as underestimation of the magnitude of the relationship between latent variables that result in spurious findings (Bernstein &amp; Teng, 1989). In the present study, the literature review will be examined and compared using Monte Carlo simulation to determine the most parsimonious method of retention for categorical data. With continuous variables, the majority of researchers still implement Cattell’s scree test (Henson &amp; Roberts, 2006) and Kaiser-Guttman-1 rule (Velicer et al., 2000), because these procedures are the default in popular statistical packages, such as SPSS and SAS. The present study will examine two of the most accurate methods: MAP (Minimum Average Partial) and PA (Parallel Analysis) along with Very Simple Structure (VSS) with categorical variables.

Recommender Systems Applications: Data Sources, Features, and Challenges

In recent years, there has been growing interest in recommendation systems, which is matched by their widespread adoption across various sectors. This can be attributed to their effectiveness in reducing an avalanche of data into individualized information that is meaningful, relevant, and can easily be absorbed by a single person. Several studies have recently navigated the landscape of recommendation systems, attending to their approaches, challenges, and applications, as well as the evaluation metrics necessary for effective implementation. This systematic review investigates the understudied aspects of recommendation systems, including the data input into the systems and their features or outputs. The data in (input) and data out (features) are both diverse and vary significantly from not just one application domain to another, but also from one application use case to another, which is a distinction that has not been thoroughly addressed in the past. In addition, this study explores several application domains, providing a comprehensive breakdown of the categorical data consumed by these systems and the features, or outputs, of these systems. Without focusing on any particular journals or their rankings, this study collects and reviews articles on recommendation systems published from 2018 to April 2024, in four top-tier research repositories, including IEEE Xplore Digital Library, Springer Link, ACM Digital Library, and Google Scholar.

DASR-Net: Land Cover Classification Methods for Hybrid Multiattention Multispectral High Spectral Resolution Remote Sensing Imagery

The prompt acquisition of precise land cover categorization data is indispensable for the strategic development of contemporary farming practices, especially within the realm of forestry oversight and preservation. Forests are complex ecosystems that require precise monitoring to assess their health, biodiversity, and response to environmental changes. The existing methods for classifying remotely sensed imagery often encounter challenges due to the intricate spacing of feature classes, intraclass diversity, and interclass similarity, which can lead to weak perceptual ability, insufficient feature expression, and a lack of distinction when classifying forested areas at various scales. In this study, we introduce the DASR-Net algorithm, which integrates a dual attention network (DAN) in parallel with the Residual Network (ResNet) to enhance land cover classification, specifically focusing on improving the classification of forested regions. The dual attention mechanism within DASR-Net is designed to address the complexities inherent in forested landscapes by effectively capturing multiscale semantic information. This is achieved through multiscale null attention, which allows for the detailed examination of forest structures across different scales, and channel attention, which assigns weights to each channel to enhance feature expression using an improved BSE-ResNet bilinear approach. The two-channel parallel architecture of DASR-Net is particularly adept at resolving structural differences within forested areas, thereby avoiding information loss and the excessive fusion of features that can occur with traditional methods. This results in a more discriminative classification of remote sensing imagery, which is essential for accurate forest monitoring and management. To assess the efficacy of DASR-Net, we carried out tests with 10m Sentinel-2 multispectral remote sensing images over the Heshan District, which is renowned for its varied forestry. The findings reveal that the DASR-Net algorithm attains an accuracy rate of 96.36%, outperforming classical neural network models and the transformer (ViT) model. This demonstrates the scientific robustness and promise of the DASR-Net model in assisting with automatic object recognition for precise forest classification. Furthermore, we emphasize the relevance of our proposed model to hyperspectral datasets, which are frequently utilized in agricultural and forest classification tasks. DASR-Net’s enhanced feature extraction and classification capabilities are particularly advantageous for hyperspectral data, where the rich spectral information can be effectively harnessed to differentiate between various forest types and conditions. By doing so, DASR-Net contributes to advancing remote sensing applications in forest monitoring, supporting sustainable forestry practices and environmental conservation efforts. The findings of this study have significant practical implications for urban forestry management. The DASR-Net algorithm can enhance the accuracy of forest cover classification, aiding urban planners in better understanding and monitoring the status of urban forests. This, in turn, facilitates the development of effective forest conservation and restoration strategies, promoting the sustainable development of the urban ecological environment.

Prognostic Significance of Right Ventricular Free Wall Longitudinal Strain and Angiographic Correlation in Acute Inferior Wall ST-elevation MI

Background: In this study, we assessed the prognostic significance of right ventricular free wall longitudinal strain (RVfwLS) in patients with acute inferior wall MI and investigated its association with angiographic characteristics and adverse outcomes. Methods: A prospective observational study was conducted with 200 patients admitted with acute inferior wall MI who underwent primary angioplasty. 2D speckle tracking echocardiography was used to measure the RVfwLS at the time of admission. Angiographic characteristics were collected, and patients were followed up for adverse outcomes until discharge. Categorical data were compared using the χ2 test or Fisher’s exact test. Logistic regression analysis was used to identify adverse cardiovascular outcomes independently associated with RVfwLS. A p-value of &lt;0.05 was considered statistically significant for all analyses. Results: Compared with patients with normal strain (n=88, 44%), patients with diminished strain (n=116, 56%) had significantly lower blood pressure (56.52% versus 43.58%; p=0.03), reduced tissue velocities (93.3% versus 6.7%; p&lt;0.01), elevated jugular venous pressure (58.93% versus 41.07%; p=0.04), and higher right ventricular systolic pressure (52.04% versus 47.96%; p=0.04). Additionally, patients with diminished strain had a higher incidence of triple vessel disease (80% versus 20%; p=0.026) and arrhythmias necessitating inotropic support (66.67% versus 37.33%; p=0.02), as well as a longer hospital stay (78.7% versus 21.3%; p&lt;0.01) compared with patients with normal strain. In multivariate analysis, arrhythmias (p=0.046; OR 2.05; 95% CI [0.93–8.10]) and right heart failure (p=0.035; OR 3.64; 95% CI [1.35–11.53]) were independently associated with RVfwLS. The optimal RVfwLS cut-off value for predicting adverse outcomes was −14.8% (AUC=0.915; 95% CI [0.876–0.954]; p&lt;0.001), with a sensitivity of 81.3% and specificity of 86.8%. Conclusion: RVfwLS can be used to categorise the severity of infarction and predict adverse outcomes.

A Pilot Study Using Continuous Glucose Monitoring among Patients with a Low 1-Hour Glucose Challenge Test Result versus Controls to Detect Maternal Hypoglycemia.

A low 1-hour glucose challenge test (GCT) result (<10th percentile for population) has been associated with neonatal morbidity, including small-for-gestational-age birth weight, and it is hypothesized that underlying maternal hypoglycemia may contribute to this neonatal morbidity. We sought to assess whether eligible patients would undergo continuous glucose monitoring to allow comparison of maternal hypoglycemia between those with a low GCT result versus controls. This exploratory study enrolled patients who completed a GCT between 24 and 30 weeks' gestation from June to September 2022. English- or Spanish-speaking participants aged ≥18 years wore a blinded continuous glucose monitor (CGM) for 10 days. There were 10 participants each in the low GCT (<82 mg/dL) and normal GCT group. Proportions were calculated to determine recruitment rates and describe the low versus normal glycemic groups across clinical and sociodemographic characteristics. Maternal hypoglycemia, defined using various proposed thresholds, was analyzed as continuous data (time duration) with Student's t-tests and categorical data (number of episodes) with chi-square tests and bivariate analyses were performed comparing participants with a low versus normal GCT. Primary outcome measures were recruitment, enrollment, and adherence rates, and overall glycemic values for each group. Of 64 eligible patients, 58 (91%) were approached, and of them, 20 (35%) were enrolled. All 20 participants had CGM data to review with 100% adherence. Average glucose values were similar between participants in the low GCT and normal GCT groups (111.7 ± 18.0 vs. 111.6 ± 11.7 mg/dL, p = 0.99), and participants with a low GCT value did not demonstrate more hypoglycemia than those with a normal GCT value across five proposed thresholds on CGM analysis. In this pilot study, participants wore blinded CGMs to collect glycemic data, and those with a low GCT result did not experience more hypoglycemia than those with a normal GCT on CGM analysis. · Study participants wore continuous glucose monitors in blinded mode to gather glycemic data with 100% adherence.. · Participants with a low GCT result (<82 mg/dL) as compared with those with a normal GCT result were not more likely to demonstrate maternal hypoglycemia using several thresholds on CGM analysis.. · In our cohort, there were few participants in either glycemic group who reported food insecurity or lived in a food desert..

The association between triglyceride glucose index and gout: a cross-sectional analysis based on NHANES 2007–2018

BackgroundThe triglyceride glucose (TyG) index, defined as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2], provides insights into overall metabolic status. However, the association between the TyG index and gout has not been investigated. Therefore, this study explored the correlation between the TyG index and gout.MethodsUsing data from the National Health and Nutrition Examination Survey, which was conducted from 2007 to 2018, this study investigated the relationship between the TyG index and gout. Demographic data and potential risk factors were analyzed and compared using t tests for continuous data and chi-square tests for categorical data. Logistic regression and subgroup analysis were performed to examine the association between the TyG index and gout.ResultsA total of 14,924 participants were enrolled, among whom 726 (4.86%) were diagnosed with gout. Without controlling for any covariates, a significant positive correlation was observed between an elevated TyG index and increased risk of gout, with an odds ratio (OR) of 2.07 and a 95% confidence interval (CI) ranging from 1.76 to 2.43. After full adjustment, this association remained statistically significant, with an adjusted OR of 1.43 and a 95% CI from 1.14 to 1.80. Subgroup analyses revealed significant interactions, particularly for females (OR = 2.55; 95% CI: 2.00-3.26), individuals with no military service history (OR = 2.15; 95% CI: 1.66–2.43), and those without diabetes (OR = 2.00; 95% CI: 1.64–2.43).ConclusionA positive correlation was observed between the TyG index and gout. Consequently, further large-scale prospective studies are warranted for a comprehensive analysis of the role of the TyG index in gout.